80 / 280
with single suture synostosis [16]. Fearon
et al.
[17]
showed that 66 out of 67 such patients at four
different centers were accurately diagnosed by
clinical exam prior to confirmation with a CT. Ultra-
sonography has also been used as a nonionizing
technique for the diagnosis of craniosynostosis in
patients up to 12 months of age, after which time
narrowing of the sutures and increased bony thick-
ness makes ultrasonography less reliable [16]. A
study by Regelsberger
et al.
[18] showed no missed
diagnoses of sutural synostosis with ultrasonogra-
phy in 26 patients.
OPERATIVE TREATMENT
There are disagreements among centers on the
optimal timing and best operative procedure.
Historically, craniosynostosis surgery began as a
simple suturectomy. Interestingly, it seems that
surgical treatment has come full circle from strip
craniectomies, to extensive cranial vault remodel-
ing, and back to the minimally invasive in the
form of endoscopic suturectomies and spring-
mediated cranioplasties. Lane and Lannelogue
independently described strip craniectomies for
craniosynostosis in the 1890s. Their techniques
were quickly adopted by others. The technique
was fraught with reossification of sutures and an
unacceptably high mortality rate of 15 out of 33
patients, as shown in one review by Jacobi [19].
Surgery evolved decades later to the extensive
cranial vault remodeling after Tessier’s work in
the 1960s [20]. His work involved direct removal
of the bone and contouring and offered
FIGURE 4.
6-month-old male with Apert syndrome and bicoronal synostosis.
Maxillofacial surgery
58