Posterior Closure

Occipital Knob

To correct the long and posteriorly narrow skull, a reverse n procedure may be employed (Fig. 25.6a). Similar to the anterior n technique but in the prone position, after the bi-parietal flaps are removed, the bone is rongeured across the posterior portion of the sagittal suture and across the lambdoids. The resultant craniotomy appears as a reversed n. Care must again be taken to release the dura along the remaining unfused portions of suture. Radial osteotomies in the occipital bone may be required to correct the knob. The results can be quite good and the normal contour can be re-established.

Golf Tee

To correct this more dramatic deformity, the skull must not only be shortened, but the occipital region must be widened as well (Fig. 25.6b). An occipital craniotomy is performed and a paramedian bi-parietal flap containing the sagittal suture is fashioned. A laterally oriented vaulted arch accomplishes the widening of the region and radial osteotomies allow the occipital bone to be refashioned.

Bathrocephaly

Surgical correction requires not only a shorter skull, but also one that has a normal contour (Fig. 25.6c). After bi-parietal flaps are established, the sagittal and lambdoid sutures are separated from the underlying dura. A parame-dian vault is created that normalizes the relationship between the posterior parietal and occipital bones. Radial cuts across the lambdoid sutures allow the occipital bone to be fractured outward and result in a wider occipital region.

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The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.

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