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Giuseppe Cinalli, Dominique Renier, Guy Sebag, Christian Sainte-Rose, Eric Arnaud and Alain Pierre-Kahn

roentgenograms to evaluate the sagittal suture, and both frontal and profile roentgenograms to evaluate the lambdoid suture. We did not use CT scans to evaluate the patency of the sutures because several patients were observed and treated before this procedure became easily available at our institution and because CT scans were not performed on as regular a basis as roentgenograms in the normal follow up. According to Christensen, et al. , 3 the criterion for the definition of synostosis was the lack of suture visibility on one of the above described studies, although it is

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Lambdoid synostosis

Part 2: Review of cases managed at The Hospital for Sick Children, 1972–1982

Kamel F. Muakkassa, Harold J. Hoffman, David R. Hinton, E. Bruce Hendrick, Robin P. Humphreys and Judith Ash

blastema would lead to both craniosynostosis and an abnormal cranial base. Recently, constraint of the fetal head has been proposed as an important etiological factor in craniosynostosis. 20, 21, 23 Isolated premature fusion of the lambdoid suture is not mentioned in the literature prior to 1960. 4, 29 The asymmetrical shape of unilateral lambdoid synostosis can mimic the plagiocephaly of unilateral coronal synostosis. Bilateral lambdoid synostosis can lead to brachycephaly as seen in bilateral coronal synostosis. Lambdoid synostosis is considered a rare form of

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Lambdoid synostosis

Part 1: The lambdoid suture: normal development and pathology of “synostosis”

David R. Hinton, Laurence E. Becker, Kamel F. Muakkassa and Harold J. Hoffman

suture pathology in isolated lambdoid synostosis is a brief description of one case by David, et al. , 3 in which a suture that appeared sclerotic on roentgenography showed unusually active bone growth with cartilage formation and endochondral ossification on histological study. Synostosis of the lambdoid suture as part of a syndrome or in association with other synostoses has been more widely reported, but in such cases the pathology is similar to that seen in other fused sutures. 9 Recognition and early surgery of lambdoid synostosis at our institution provided

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Christopher M. Bonfield, D. Douglas Cochrane, Ash Singhal and Paul Steinbok

lambdoid sutures ( Fig. 5 ). With the lambda localized, the posterior skin incision can be marked accurately. The patient can then be prepared and draped, and the operation can commence. A similar technique can also be used for the localization of the coronal suture, although it can usually be palpated, especially if an open anterior fontanelle is present. FIG. 2. Ultrasound image of a fused sagittal suture demonstrating hyperechoic bone and ridge (arrow). FIG. 3. Ultrasound image of the posterior sagittal suture showing a small area of the patient

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C. Corbett Wilkinson, Nicholas V. Stence, Cesar A. Serrano, Sarah J. Graber, Lígia Batista-Silverman, Emily Schmidt-Beuchat and Brooke M. French

reviewers reevaluated the suture jointly and assigned a consensus grade. When it was difficult to determine the extent of fusion of certain sutures and when it was suspected that sutures were fused early and/or atypically, we also evaluated the source images. Although we consider each normal cranium to have two coronal and two lambdoid sutures, left and right for each, for this study, we considered each cranium to have a single bilateral coronal and a single bilateral lambdoid suture. Individual sutures were excluded if they were obscured by artifact, incompletely imaged

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Jan Regelsberger, Günter Delling, Michael Tsokos, Knuth Helmke, Gertrude Kammler, Heidi Kränzlein and Manfred Westphal

immediately after the physical examination. A 7.5-MHz linear transducer was used with the following parameters: field of view 4 cm; depth of focus 5 mm, gain ± 20 dB; and gel used as contact medium. The ultrasound probe was held perpendicular to the plane of the long axis of the suture to obtain a precise coronal view of the suture and sufficient adjacent bone for assessment. Sonographic measurements of the lambdoid suture (suture width and thickness of adjacent bone) were obtained in the pupillary line by two independent investigators. The shortest distance between the

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Paul D. Sawin, Michael G. Muhonen and Arnold H. Menezes

N onsyndromic craniosynostosis is a relatively uncommon clinical entity, encountered in approximately one per 1000 live births. 3 Isolated unilateral involvement of the lambdoid suture comprises 1% to 15% of all cases of craniosynostosis in published series. 8, 9, 19, 22, 24, 27, 28 The incidence of infantile occipital calvarial flattening appears to have increased in recent years, a phenomenon that is coincident with the American Academy of Pediatrics' recommendation advocating the “non-prone” (that is, supine) position for healthy infants during sleep as a

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Samuel C. Ohaegbulam

. Tuberculin test and Wassermann reaction were negative. Hemoglobin was 12.3 gm%. The white blood cell count was 6900/cu mm with the differential count as follows: neutrophils 24%, eosinophils 40%, lymphocytes 30%, monocytes 6%. Sedimentation rate was 30 mm/hr. Genotype was AS. Serum calcium was 10 mg%, and serum alkaline phosphatase was 46 IU. A skull film revealed a 2 × 4-cm bone defect in the right occipital bone with smooth margins ( Fig. 2 ). Fig. 2. Lateral view of the skull film showing the oblong bone defect in the right occipital bone near the lambdoid suture

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R. Shane Tubbs, Marios Loukas, Mohammadali M. Shoja, Nihal Apaydin, Mohammad R. Ardalan and W. Jerry Oakes

the suture of the calvaria. High-speed drills were used to remove the calvaria, leaving intact the calvarial parts of the coronal, sagittal, and lambdoid sutures. Once these osseous parts were removed, the underlying lateral lacunae were identified and opened. The number of lacunae on each side and anterior and posterior to the lambdoid sutures was documented. The distance between the lateral extent of the lacunae and the sagittal suture, and between these lacunae and the coronal suture was measured ( Fig. 1 ). Occasional gross connections were found between