Abstract
Retrospective studies have implicated fetal head constraint as one cause for sagittal, coronal and metopic craniostenosis, Early sutural patency is contingent on persistent dural growth stretch. We hypothesize that fetal head constraint in a particular plane is one mechanism through which one or more sutural regions may be relieved of growth stretch, enhancing the liability towards synostosis at that region. This hypothesis is supported by animal studies and we present sutural histology from 15 instances of sagittal craniostenosis for which gestational histories implicated fetal head constraint as the cause in 13 instances. We also present histology from 2 constraint-related cases of metopic craniostenosis. In each case there was ectocranial bone deposition, endocranial bone resorption and demonstrable sutural synostosis. A Sayers partial calvariectomy procedure was performed at or before 6 mos. in all instances. This dramatically restored head shape to normal with reformation of the calvarium and sutures. This sutural histology and restoration to normal form by surgery differed from that found in 6 instances of coronal craniostenosis which occured as part of a broader pattern of intrinsic malformation, such as Pfeiffer or Saethre-Chotzen syndromes. In these latter instances, the altered craniofacial form tended to persist despite early calvariectomy.
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Graham, J., Clarren, S., Koskinen-Moffett, L. et al. 1313 CRANIOSTENOSIS: CORRELATION OF ETIOLOGY WITH SUTURAL HISTOLOGY AND RESPONSE TO SURGERY. Pediatr Res 15 (Suppl 4), 662 (1981). https://doi.org/10.1203/00006450-198104001-01342
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DOI: https://doi.org/10.1203/00006450-198104001-01342