The Diagnosis and Treatment of Single-Sutural Synostoses: Are Computed Tomographic Scans Necessary?
Abstract
BACKGROUND: Computed tomographic scan evaluation is the current standard of care for diagnosing craniosynostosis. Recent publications, and the National Cancer Institute, have raised concerns about ionizing radiation associated with computed tomographic scans in children (e.g., developmental delays, tumor induction). The authors sought to ascertain the diagnostic accuracy of the physical examination in evaluating single-sutural craniosynostosis and assess the need for computed tomographic scans in surgical correction. METHODS: This prospective, multicenter, outcome assessment included children clinically diagnosed with a single-sutural synostosis by craniofacial surgeons (with 1 to 18 years' experience) at four centers over a 1-year period. Clinical diagnoses were compared with computed tomographic scan evaluations. All surgeons scored the utility of computed tomographic scans during surgical repair. RESULTS: Sixty-seven patients were clinically diagnosed with single-sutural craniosynostosis (mean age, 7 months; range, 1 week to 48 months). Sixty-six of 67 patients were diagnosed with craniosynostosis by computed tomographic scan (sagittal, 40 percent; metopic, 31 percent; right unilateral coronal, 16 percent; left unilateral coronal, 6 percent; and right lambdoid, 6 percent), for a diagnostic accuracy exceeding 98 percent. One patient with suspected lambdoid synostosis was radiologically diagnosed with positional plagiocephaly. Three of four craniofacial surgeons scored computed tomographic scans as "unnecessary" for surgical correction; one scored scans as "sometimes helpful." CONCLUSIONS: Craniofacial surgeons with various experience levels were able to accurately diagnose single-sutural synostosis by physical examination alone. Considering potential side effects from ionizing radiation, risks of sedation, and costs, surgeons may wish to reserve computed tomographic scans only for infants with suspected single-sutural craniosynostosis in whom the physical examination is not clearly diagnostic.
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Fearon et al. (2007) concluded that CT imaging is unnecessary for isolated craniosynostosis due to clear clinical detectability and radiation risk, and should be reserved for cases not clearly diagnosed clinically.
“Fearon et al. in 2007 demonstrated that CT imaging is unnecessary due to the condition’s clear clinical detectability and the associated risk of radiation exposure.”
From Developments in diagnostic and surgical techniques in children with sagittal suture craniosynostosis: a systematic review spanning the last 30 years (2025) · cites this paper as [29]
Fearon et al. (2007) found that in 66 of 67 children with isolated craniosynostosis, clinical and radiological examinations were similar in description and associated diagnosis.
“In 66 of 67 children, the findings of the clinical and radiological examinations were similar in their description and associated diagnosis.”
From Developments in diagnostic and surgical techniques in children with sagittal suture craniosynostosis: a systematic review spanning the last 30 years (2025) · cites this paper as [29]
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Ulma, R. M., Ranganathan, K., Vercler, C. J., Garton, H. J. L., Maher, C. O., Muraszko, K. M., & Buchman, S. R. (2021) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0000000000007830 · Cited by 8 · see citing works
Computer-assisted shape descriptors for skull morphology in craniosynostosis
Shim, K., Lee, M. J., Lee, M., Park, E.-K., Kim, D. S., Hong, H., & Kim, Y. O. (2016) · Child s Nervous System · doi:10.1007/s00381-015-2995-9 · Cited by 7 · see citing works
Computed Tomography in Patients With Craniosynostosis
Makar, K. G., Garavaglia, H. E., Muraszko, K. M., Waljee, J. F., Vercler, C. J., & Buchman, S. R. (2021) · Annals of Plastic Surgery · doi:10.1097/sap.0000000000002751 · Cited by 7 · see citing works
Zimmerman, C. E., Khandelwal, P., Xie, L., Lee, H., Song, H. K., Yushkevich, P. A., Vossough, A., Bartlett, S. P. P., & Wehrli, F. W. (2021) · Academic Radiology · doi:10.1016/j.acra.2021.03.010 · Cited by 7 · see citing works
Early Complications and Associated Perioperative Factors in Nonsyndromic Craniosynostosis
Lu, Y., Bao, N., Ghanem, A., Cai, T., Yang, J., & Mu, X. (2017) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000003589 · Cited by 7 · see citing works
Isolierte, nichtsyndromale Kraniosynostosen
Freudlsperger, C., Castrillon‐Oberndorfer, G., Hoffmann, J., & Engel, M. (2013) · Der MKG-Chirurg · doi:10.1007/s12285-013-0364-9 · Cited by 7 · see citing works
A Longitudinal Analysis of Pre- and Post-Operative Dysmorphology in Metopic Craniosynostosis
Beiriger, J. W., Tao, W., Irgebay, Z., Smetona, J. T., Dvoracek, L. A., Kass, N. M., Dixon, A., Zhang, C., Mehta, M., Whitaker, R., et al. (2024) · The Cleft Palate-Craniofacial Journal · doi:10.1177/10556656241237605 · Cited by 6 · see citing works
Craniofacial Flash: Minimizing Radiation Dose in Pediatric Craniofacial Computed Tomography
Stewart, N. M., Hallac, R. R., Chou, P., Koral, K., Blackburn, T., Kane, A. A., & Seaward, J. R. (2018) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000004755 · Cited by 6 · see citing works
Cranial Suture Evaluation on Routine Pediatric MRI
Sreedher, G., Gillespie, C., Brown, M. F., & Ganapathy, S. S. (2020) · Current Problems in Diagnostic Radiology · doi:10.1067/j.cpradiol.2020.07.003 · Cited by 6 · see citing works
Diagnosis and Management of Suture-Related Concerns of the Infant Skull
Hersh, D. S., Bookland, M. J., & Hughes, C. D. (2021) · Pediatric Clinics of North America · doi:10.1016/j.pcl.2021.04.002 · Cited by 6 · see citing works
Şakar, M., Haidar, H., Sönmez, Ö., Erdoğan, O., Saçak, B., Bayri, Y., & Dağçınar, A. (2022) · Journal of Neurosurgery Pediatrics · doi:10.3171/2022.1.peds21553 · Cited by 6 · see citing works
Mićović, M., Živković, B., Vukašinović, I., Jelovac, D. B., Stojičić, M., & Baščarević, V. (2025) · Diagnostics · doi:10.3390/diagnostics15202632 · Cited by 5 · see citing works
Yuksel, S. S., Kearney, A. M., Taub, P. J., & Gosain, A. K. (2021) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000007592 · Cited by 5 · see citing works
The Top 100 Most-Cited Publications in Clinical Craniofacial Research
Braud, S. C., Treger, D., Lizardi, J. J., Boghosian, T., ElAbd, R., Arakelians, A. R. L., Jabori, S. K., & Thaller, S. R. (2024) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000010185 · Cited by 5 · see citing works
Management of Unicoronal and Metopic Synostoses
Hayek, G. M., Jimenez, D. F., & Yates, D. M. (2022) · Oral and Maxillofacial Surgery Clinics of North America · doi:10.1016/j.coms.2022.02.002 · Cited by 4 · see citing works
Planning and Osteotomy Designs in the Correction of Single-Suture Craniosynostosis
Bertrand, A. A., Hu, A. C., & Lee, J. C. (2021) · Annals of Plastic Surgery · doi:10.1097/sap.0000000000002385 · Cited by 4 · see citing works
Surgical Management in Isolated Squamosal Craniosynostosis
Fallahian, F., Meyer, A. M., Tadisina, K. K., & Lin, A. Y. (2023) · Annals of Plastic Surgery · doi:10.1097/sap.0000000000003642 · Cited by 3 · see citing works
Hermann, J., Raak, C. K., Ostermann, T., & Scharbrodt, W. (2025) · Orphanet Journal of Rare Diseases · doi:10.1186/s13023-025-03978-9 · Cited by 2 · see citing works
“For example, Cedzich and Farmand 2003 recommended a combination of conventional radiographs and CT imaging for diagnosis [26], while Fearon et al. 2007 advised against unnecessary CT images due to radiation risks and the good clinical accessibility especially of CI [29].”
Guida, L., Gardin, A., James, S., Arnaud, É., Toujouse, C., Roux, J., Barreau, E., Abdallah, M. B., Almes, M., Sartori, L., et al. (2025) · Neurosurgical FOCUS · doi:10.3171/2024.10.focus24588 · Cited by 2 · see citing works
Diagnostik und Therapie isolierter Kraniosynostosen
Freudlsperger, C., Hoffmann, J., & Engel, M. (2015) · Kinder- und Jugendmedizin · doi:10.1055/s-0038-1629263 · Cited by 2 · see citing works
Hall, J. J., & Lorenz, H. P. (2012) · Elsevier eBooks · doi:10.1016/b978-0-323-07255-7.00053-2 · Cited by 2 · see citing works
Clinical Features and the Use of Three-Dimensional Imaging for Unilateral Lambdoid Synostosis
Diab, J., Fowler, A., Gates, R., & Marucci, D. D. (2021) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000008190 · Cited by 2 · see citing works
Bielevelt, F., Chargi, N., van Aalst, J. E., Nienhuijs, M. E. L., Maal, T., Delye, H., & de Jong, G. (2025) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000011623 · Cited by 1 · see citing works
From head shape to diagnosis: Craniosynostosis for the pediatric neurologist
Quick, J. D., Provasek, V. E., Powell, L. E., Barta, R. J., & Dempsey, R. F. (2026) · Seminars in Pediatric Neurology · doi:10.1016/j.spen.2026.101327 · Cited by 1 · see citing works
Open approaches to craniosynostosis repair: indications, techniques, outcomes, and future directions
Jarvis, T. L., Staidl, N., & Samson, T. D. (2026) · Seminars in Pediatric Neurology · doi:10.1016/j.spen.2026.101332 · Cited by 1 · see citing works
Radiologic Examination of the Craniofacial Skeleton
Fearon, J. A. (2010) · Elsevier eBooks · doi:10.1016/b978-0-323-03470-8.00042-9 · Cited by 1 · see citing works
Self-citation
- Authors
- Fearon, J. A., Singh, D. J., Beals, S. P., & Yu, J. C.
- Affiliations
- Augusta University (US)
- Venue
- Plastic and Reconstructive Surgery
- Published
- 2007-10
- Volume
- 120
- Issue
- 5
- Pages
- 1327-1331
- ISSN
- 0032-1052 (ISSN-L)
- OpenAlex
- W2002200350
- Cited by
- 119
- References
- 11
- Citations by year
- 2026: 3 · 2025: 8 · 2024: 7 · 2023: 1 · 2022: 8 · 2021: 17 · 2020: 7 · 2019: 8 · 2018: 7 · 2017: 10 · 2016: 8 · 2015: 6 · 2014: 4 · 2013: 7 · 2012: 5
- FWCI
- 2.14
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Plastic & Reconstructive Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Craniofacial Disorders and Treatments
- Health Sciences › Medicine › Surgery › Pectus Deformity Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Reconstructive Facial Surgery Techniques
- Keywords
- physical examination, computed tomography, ionizing radiation risk, craniofacial surgery, surgical planning, positional plagiocephaly, lambdoid synostosis, coronal synostosis, metopic synostosis, sagittal synostosis, infants
- MeSH terms
- Child, Preschool, Craniosynostoses, Female, Humans, Infant, Infant, Newborn, Male, Physical Examination, Prospective Studies, Tomography, X-Ray Computed, Outcome Assessment, Health Care
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