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. 2014 Aug;28(3):138-43.
doi: 10.1055/s-0034-1384809.

Craniosynostosis of the lambdoid suture

Jennifer L Rhodes  1 , Gary W Tye  2 , Jeffrey A Fearon  3
Affiliations

Craniosynostosis of the lambdoid suture

Jennifer L Rhodes et al. Semin Plast Surg. 2014 Aug.

Abstract

Craniosynostosis affecting the lambdoid suture is uncommon. The definition of lambdoid craniosynostosis solely applies to those cases demonstrating true suture obliteration, similar to other forms of craniosynostosis. In patients presenting with posterior plagiocephaly, true lambdoid craniosynostosis must be differentiated from the much more common positional molding. It can occur in a unilateral form, a bilateral form, or as part of a complex craniosynostosis. In children with craniofacial syndromes, synostosis of the lambdoid suture most often is seen within the context of a pansynostotic picture. Chiari malformations are commonly seen in multisutural and syndromic types of craniosynostosis that affect the lambdoid sutures. Posterior cranial vault remodeling is recommended to provide adequate intracranial volume to allow for brain growth and to normalize the skull shape. Although many techniques have been described for the correction of lambdoid synostosis, optimal outcomes may result from those techniques based on the concept of occipital advancement.

Keywords: Mercedes Benz pattern craniosynostosis; lambdoid craniosynostosis; posterior plagiocephaly.

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Figures

Fig. 1
Fig. 1
Magnetic resonance image revealing cerebellar tonsillar herniation in child with the Mercedes Benz pattern of craniosynostosis one year after surgical correction. (Reprinted with permission from Rhodes JL, Kolar JC, Fearon JA. Mercedes Benz pattern craniosynostosis. Plast Reconstr Surg 2010 Jan;125(1):302)
Fig. 2
Fig. 2
Posterior view. Infant with left lambdoid synostosis. Note right parietal bossing, left occipitomastoid bossing, left inferior tilt of skull base resulting in inferior displacement of left ear, and compensatory deformation of cervical spine.
Fig. 3
Fig. 3
Radiographic findings of the Mercedes Benz pattern of synostosis. A three-dimensional computed tomography scan revealing sagittal and bilateral lambdoid craniosynostosis. (Reprinted with permission from Rhodes JL, Kolar JC, Fearon JA. Mercedes Benz pattern craniosynostosis. Plast Reconstr Surg 2010 Jan;125(1):301)
Fig. 4
Fig. 4
Phenotypic findings of the Mercedes Benz pattern of synostosis include anterior tifficephaly (A) and a sublambda indentation (B). (Reprinted with permission from Rhodes JL, Kolar JC, Fearon JA. Mercedes Benz pattern craniosynostosis. Plast Reconstr Surg 2010 Jan;125(1):301.)
Fig. 5
Fig. 5
Three-dimensional computed tomography scans, posterior view. Patient with right lambdoid synostosis. Note external ridging and right inferior tilt of skull base.
Fig. 6
Fig. 6
Lambdoid synostosis is corrected by first cutting a neobandeau from the vertex of the skull. This new bandeau is then rotated 180 degrees so that the right side is switched to the left, and then rotated down 90 degrees in a “bucket handle” repair. Bone grafts are placed above and below the new bandeau, completing the reconstruction. (Reprinted with permission from Fearon JA. Rigid Fixaton of the calvaria in craniosynostosis without using “rigid” fixation. Plast Reconstr Surg 2003;11(1):30.)
Fig. 7
Fig. 7
Design template for harvest of posterior bandeau.
Fig. 8
Fig. 8
Design template for superior craniotomy.
Fig. 9
Fig. 9
Overcorrection of posterior flatness established by inset of bandeau.
Fig. 10
Fig. 10
Completed calvarial reconstruction.
See this image and copyright information in PMC

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