Koronal sütür sinostozu

Özet

Koronal sinostoz, frontal ve parietal kemikler arasındaki sütürün tek ya da iki taraflı erken füzyonudur; ön-arka yönde büyümeyi kısıtlar. Tek taraflı füzyon ön plagiosefali, orbital asimetri ve karşı frontal bossing; iki taraflı füzyon ise kısa-geniş kafa ve bilateral orbital biçim değişikliği oluşturabilir. Kontrastsız ince kesit BT, kemik köprüsünü ve anterior kafa tabanı-orbita eşlikçilerini birlikte gösterir; koronal ve 3B rekonstrüksiyon taraf tayininde yardımcıdır. Füzyon tarafının veya karşı taraf telafi bulgularının belirtilmemesi, kafa ve orbita deformitesinin doğru paternle ilişkilendirilmesini güçleştirir.

Faz ve pencere

Kontrastsız tanısal

Koronal sütürlerde tırtıklı radyolüsent aralığın silinmesi, perisutural skleroz ve kemik köprüleşmesi kemik algoritmasında aranır; koronal ve 3B rekonstrüksiyon ipsilateral ön kafa çukuru sığlığı, karşı frontal bossing ve orbital çatı yükselmesini gösterir. Sütür füzyonunu değerlendirmede kemik gösterimi üstün olan BT temel görüntüleme yöntemidir.

Önerilen pencereler: Kemik (G 1800 / M 400).

BT bulguları

• Tek taraflı koronal füzyon — ilgili tarafta frontal-parietal sütür hattı kapanır ve kemik sırtı belirginleşebilir.
• İpsilateral anterior kraniyal fossa sığlığı — etkilenen frontal kemik ve ön kafa çukuru geride kalır.
• Karşı frontal bossing — karşı taraf frontal kemik dışa doğru kompansatuvar bombeleşir.
• Harlequin orbita — etkilenen tarafta orbital çatı ve lateral duvar yukarı yönelir, orbital kontur asimetrikleşir.
• Supraorbital kenar hipoplazisi — etkilenen tarafta kaş üstü kemik çıkıntısı yassı veya geride görünür.
• Ön plagiosefali ve yüz orta hat kayması — burun ucu ve çene karşı tarafa yönelmiş olabilir.
• Bilateral koronal füzyon — ön-arka kalvaryum kısalır, biparietal genişlik artar ve iki orbitada yükselmiş çatı görünümü oluşabilir.
• Kafa tabanı eşlikçisi — sfenoid kanatlar ve posterior fossa boyutu, özellikle sendromik çoklu füzyon şüphesinde incelenir.

Normalde

Normalde sağ ve sol koronal sütür, frontal kemik ile parietal kemiğin birleşiminde tırtıklı, radyolüsent ve devamlı bir çizgi oluşturur; ön kafa çukurları ve orbital çatılar karşılıklı benzer seviyededir. Tek taraflı şüphede iki koronal hattı, supraorbital kenarları ve anterior fossa derinliğini karşılaştırın; bilateral şüphede kalvaryumun ön-arka kısalığı ile enine genişliğini değerlendirin.

Ayırıcı tanı

Pozisyonel posterior plagiosefali

kafa asimetrisi görülebilir ancak sütürler açık kalır; kemik köprüsü ve orbital değişiklik beklenmez.

Bikoronal sinostoz

iki koronal sütür kapanır; tek taraflı ön plagiosefali yerine kısa-geniş kafa ve bilateral orbital şekil değişikliği gelişir.

Lambdoid sinostozda tek taraflı erken sütür füzyonu posterior plagiosefaliye yol açar.

Kraniyofasiyal sendrom

iki taraflı koronal füzyona orta yüz hipoplazisi veya başka sütürlerin tutulumu eşlik edebilir; yalnız tek koronal hatla sınırlı patern değildir.

Tuzaklar

• Taraf tayininde 3B BT’nin önden görünümünde füzyonlu koronal sütürü karşı taraftaki açık sütürle karşılaştırın; sütürün izlenmemesi ve kemik sırtı füzyonu destekler.
• Harlequin benzeri orbital konturu yalnız göz çukuru şekli olarak tarif etmeyin; koronal füzyon, yükselmiş orbital çatı ve sığ ön fossa ilişkisini kurun.
• Tek taraflı koronal füzyon saptandığında diğer koronal hattı ve sagittal-lambdoid sütürleri de izleyerek eşlik eden tutulumları arayın.

Kendini dene

1. Sağ koronal hatta kemik köprüsü, sağ orbital çatıda yükselme ve sol frontal bossing bulunuyor. En olası tanı nedir?

   • Sağ koronal sinostoz
   • Bikoronal sinostoz
   • Sagittal sinostoz
   • Lambdoid sinostoz
   Cevabı göster

   Sağ koronal sinostoz. Tek taraflı koronal füzyon ipsilateral orbital ve ön fossa değişikliği ile karşı frontal bossing oluşturur. Bikoronal tutulum iki taraflıdır; sagittal sinostoz uzun-dar kafa yapar, lambdoid sinostoz posterior kalvaryumu etkiler.

2. İki koronal sütür de kemik köprüsüyle kapanmış; kalvaryum kısa ve enine geniş. Bu patern nasıl adlandırılır?

   • Bikoronal sinostoz
   • Unikoronal sinostoz
   • Metopik sinostoz
   • Pozisyonel plagiosefali
   Cevabı göster

   Bikoronal sinostoz. Bikoronal sinostozda iki koronal sütür füzyondur; ön-arka boyut kısalması genellikle brakisefaliye (kısa kafaya) yol açar. Tek taraflı koronal sinostoz oblik ön kafa asimetrisi, metopik sinostoz üçgensi alın yapar; pozisyonel deformitede sütürler açık kalır.

İlgili konular

• Kraniyosinostoz ve sütür füzyonu
• Sagittal sütür sinostozu
• Metopik sütür sinostozu
• Lambdoid sütür sinostozu

Kaynaklar

Bu sayfadaki 37 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 5 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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