Craniofacial Surgery and Congenital Anomalies
Core concepts
Know craniosynostosis syndromes (Apert, Crouzon, Pfeiffer), the difference between suture fusion and positional molding, timing of cranial vault remodeling, and the principles of distraction osteogenesis. Understand fronto-orbital advancement and the role of intracranial pressure monitoring.
Traps in questions
- Confusing positional plagiocephaly (parallelogram head, no ridging) with lambdoid synostosis (trapezoid head, ridging, ear displacement).
- Assuming all synostosis requires urgent surgery; single-suture cases may be observed briefly while multisuture or syndromic cases need earlier intervention.
- Missing raised intracranial pressure signs in syndromic craniosynostosis.
- Overlooking airway concerns in Apert syndrome (midface hypoplasia).
Rule of thumb
Palpate and measure the head: ridging over a fused suture plus asymmetric ear position points to synostosis, not positioning.
Worked example
An infant has a trapezoid-shaped skull with a palpable lambdoid ridge and anterior displacement of the ipsilateral ear. The question asks the diagnosis. The rule: this is lambdoid synostosis, not deformational plagiocephaly (which gives a parallelogram shape without ridging). The distinction drives surgical versus positional management.