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Occipital plagiocephaly: an epidemic of craniosynostosis?

BMJ 1997; 315 doi: (Published 20 September 1997) Cite this as: BMJ 1997;315:693

Craniosynostosis needs to be distinguished from more common postural asymmetry

  1. Barry M Jones, Consultant plastic and craniofacial surgeona,
  2. Richard Hayward, Consultant neurosurgeona,
  3. Robert Evans, Consultant orthodontista,
  4. Jonathan Brittoa, craniofacial fellow
  1. a Craniofacial Centre, Great Ormond Street Hospital, London WC1N 3JH

“A bizarre epidemic … 400% increase since 1992.” “Unkind cut: some physicians do unnecessary surgery on heads of infants.”1 These terms were used last year by the Wall Street Journal, in company with the British media, to report that the incidence of posterior skull asymmetry, or occipital plagiocephaly, and its surgical management, had increased to epidemic proportions. Such headlines have resulted in anxiety among parents, general practitioners, and paediatricians, and it is therefore important to be clear about the causes of the asymmetry.

One cause of plagiocephaly is craniosynostosis, which is premature fusion of the cranial sutures—the adaptive fibrous joints between the bones of the skull. The resulting abnormal skull shape is usually an isolated anomaly but it may be associated with a craniofacial syndrome such as that of Crouzon or Apert. The skull shape is predictable from the suture or sutures involved. Premature fusion of the lambdoid sutures, …

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