Premature skull suture closure can be classified in several ways. Single suture synostosis refers to a condition where only one suture is affected, all others are open and typically the babies are otherwise normal. Multiple synostosis can involve the closure of one, two, three or more sutures. If only the sutures are closed and no other problems can be found, then the classification of “non syndromic multisuture synostosis” is applied. If several sutures are closed and other well-known systemic problems are found, then the term “syndromic multisuture synostosis” is used. Common syndromes include: Crouzon, Apert, and Pfeiffer.

Single Suture Synostosis
Sagittal (SAJ-ut-ul)

The sagittal suture is located on the midline, on top of the head and extends from the soft spot towards the back of the head. When the head is palpated, a ridge can be felt along the suture. Because the skull does not grow properly from side to side, the brain grows forward towards the forehead and backwards (Sagittal Suture Craniosynostosis Case 1). As a result, the head has marked forehead protrusion and bulging (Sagittal Suture Craniosynostosis Case 2). It becomes long and narrow; the back of the head becomes prominent and pointed. Often times the top of the head arches into a point and the temples become “pinched in” and narrow (Sagittal Suture Craniosynostosis Case 3). The overall shape is known as scaphocephaly (SKAF-o-Sef-a-lee). This is the most common type of single suture synostosis and most commonly affects males. The majority of cases are "sporadic," meaning they do exhibit a specific pattern of inheritance.

View video animation of the treatment Sagittal Suture Synostosis

Coronal (co-RO-nul)

The coronal suture is located on the side of the head and extends from the soft spot to an area just in front of the ear. It allows the forehead and the frontal lobe to grow and expand forward. When the suture closes prematurely, the condition is known as anterior plagiocephaly (play-gee-o-sef-a-lee). On the side of involvement, the following deformities develop: the forehead is recessed and flattened; the eye socket is elevated and tilted (know as vertical dystopia [verti-i-kel dis-toe-pee-uh]); the eyeball and eyelids protrude (proptosis [prop•to•sis]); the nose deviates to the opposite side; there’s deviation of the top of the head in relation to the face and the baby tends to tilt the head to the side in order to prevent him/her from seeing double if untreated (Coronal Suture Craniosynostosis Case 4).

View video animation of the treatment Coronal Suture Synostosis

Metopic (mih-TOP-ick)

This midline suture is located in the middle of the forehead and extends from the soft spot to the root of the nose. It allows both frontal lobes to expand forward and sideways as well as the eye socket to move to either side. Premature closure leads to the condition know as trigonocephaly (try-GO-no-SEF-a-lee). The baby develops a midline ridge and the forehead slants sharply backwards giving the forehead the appearance of a triangle when viewed from above (Metopic Suture Craniosynostosis Case 6). The eyes are too close together, a condition known as hypotelorism (hi-po-tel-o-rizm). The eyes and eye lids bulge forward (proptosis [prop-toe-sees]) and the back of the head protrudes markedly as the brain grows in that direction.

View video animation of the treatment Metopic Suture Synostosis

Lambdoidal (lam-DOID-ul)

Premature closure of the lambdoid suture (lam-DOID) is the least common of all and has been frequently confused with positional molding of the head. Closure leads to posterior plagiocephalus (PLAY-gee-o-SEF-a-lee) with flattening of the back of the head on the affected side, protrusion of the mastoid bone and lowering of the affected ear. It may also cause the skull to tilt sideways.

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