Patients in whom craniosynostosis is suggested should undergo a careful clinical examination, with the clinician looking for abnormalities of the skull and extremities.
Plain radiography quickly and simply identifies skull-shape abnormalities, which are seen in most patients with craniosynostosis.
Cranial sutures “may” be surveyed for patency.
***This step may be able to identify a synostosis but is also not a reliable tool in ruling out a synostosis.
The entire length of each suture is not always visible on plain radiographs, and some patients have only a small bony bar limiting growth at a particular suture.
***REMEMBER*** Diagnosing craniosynostosis can be challenging, even for experienced pediatricians.
Since craniosynostosis leads to predictable and characteristic patterns of abnormal skull growth, the diagnosis is best made after a physical exam by an experienced craniofacial surgeon.
On physical exam, your craniofacial surgeon will assess the overall shape of the skull, measure a head circumference and feel the soft spots (or fontanels) to see if they are open or closed. In addition, your surgeon will check to see if there is any visible or palpable ridging over the sutures of the skull. Ridging refers to raised areas of bone that follow the course of the sutures. As a suture begins to fuse, ridging that may be seen or felt is a common diagnostic sign of craniosynostosis. However, the lack of visible or palpable ridging does not rule-out craniosynostosis.
Although the vast majority of craniosynostosis diagnoses may be made by physical exam alone, X-ray studies may have a limited role in confirming a diagnosis where it is unclear whether a suture is fused.
In these rare instances, a CT scan of the skull is probably the best radiologic test for evaluating the cranial sutures. However, we encourage parents of all children suspected of having craniosynostosis to be seen by a craniofacial surgeon prior to any diagnostic imaging since these studies may be unnecessary.