Coronal Synostosis vs. Complex Skull Deformity
Left picture: The diagnosis is a synostosis of the left coronal suture. Right picture: The pathology is a complex deformity of the skull without any suture synostosis. This differentiation is possible by means of a precise inspection and the presence or absence of direct and indirect clinical and radiological suture signs. In addition, a CT may serve to confirm the diagnosis, and shows a partial scoliosis (coronal synostosis), or a total scoliosis of the basal skull (complex skull deformity).
Looking from the top in the picture at the top and from the front in the picture at the bottom or in the middle, the left frontal region is flattened in both patients. Left picture: A very broad skull is visible. Right picture: Here, an elongated skull is present. Only the inspection exactly from the top in the picture at the bottom yields further information about the present pathology. Left picture: In the picture at the bottom the asymmetrical face is striking with a larger lid fissure on the left side, a lesser height of the left middle face, and a convex scoliosis of the vertical midline to the right side. Right picture: In this case the asymmetry is less remarkable; the left lid fissure is somewhat smaller, and the scoliosis of the vertical midline is convex to the left side in the middle picture. Right picture: On looking closely from the top in the picture at the bottom there is not only a crossed plagiocephaly, but also a scoliosis of the longitudinal axis of skull, concave to the left side.