The appearance can be the same as that seen with primary microcephaly: a markedly small head, but with normal proportions. However, pansynostosis can also appear as a Kleeblattschädel (cloverleaf skull), which presents with bulging of the different bones of the cranial vault.The condition is associated with syndromes caused by mutations in fibroblast growth factor receptor genes (FGFR), including thanatophoric dwarfism type 2 (FGFR3) and Pfeiffer syndrome type 2 (FGFR2). Other craniosynostosis types and their signs
Apert syndrome: an abnormal skull shape, small upper jaw, and fusion of the fingers and toes. Crouzon syndrome: Craniofacial abnormalities with bilateral coronal suture fusion; anterior and posterior of skull shortness, flat cheek bones and a flat nose are their features. Muenke syndrome: Coronal craniosynostosis (plagiocephaly and brachycephaly), short feet and palms, hearing impairment, hypertelorism, and proptosis
Pfeiffer syndrome: abnormalities of the skull, hands, and feet; wide-set, bulging eyes, an underdeveloped upper jaw, beaked nose. Saethre–Chotzen syndrome: short or broad head; the eyes may be spaced wide apart and have palpebral ptosis (droopy eyelids), and fingers maybe abnormally short and webbed. Complications
Not all cranial abnormalities seen in children with craniosynostosis are solely a consequence of the premature fusion of a cranial suture. This is especially true in the cases with syndromic craniosynostosis. Findings include elevation of the intracranial pressure; obstructive sleep apnea (OSA); abnormalities in the skull base and neurobehavioral impairment.
Physical examination
Fundoscopy should always be performed in children with craniosynostosis. It is used to find papilledema which is sometimes the only symptom of elevated intracranial pressure shown in these children.Other parts of the physical examination include the measurement of the head circumference, the assessment of the skull deformity and the search for deformities affecting other parts of the body. The head circumference and the growth curve of the head provide important clues into making a differentiation between craniosynostosis, primary microcephaly and hydrocephalus. This differentiation has an important influence on the further treatment of the child.In a recent article Cunningham et al. described several steps in which a pediatrician should observe the patient to assess skull deformity:

The first is looking with a birds eye view at the patient while the patient preferably faces the parent while sitting on the parents lap. The goal is to assess the shape of the forehead, the skull length, the width of the skull, position of the ears and the symmetry of the frontal bones and [occiput]. The second is looking at the patient from behind while preferably the child is in the same position as described above. It is important to look at the skull base (to determine whether it is level or not), the position of the ears and to the mastoid (to spot the possible presence of a bulge). The third point of view is the frontal view.