Deformations can almost always be diagnosed on the basis of a physical exam alone. Only in rare circumstances will a craniofacial surgeon, or pediatric neurosurgeon, order an x-ray. Children with deformations will have flattening on one side of the back of the skull (rarely, both sides are involved). One of the key physical signs that help us to rule out craniosynostosis is if the ear and ear canal, on the same side of the flatness, is further forward than the opposite side. If this is the case, then almost certainly the child has a deformation. However, if the ear is pulled back towards the flat side, then a CT scan is usually ordered to rule out lambdoid synostosis (go to the "Home page" and click on "Posterior Plagiocephaly - Lambdoid Synostosis"). Often the forehead on the affected side is further forward as well, and sometimes the cheekbone is also forward. When the back of the head is flat on one side, and on the same side the forehead is further forward, we refer to this as a parallelogram deformity. It is slightly more common for the right side to be affected than the left. This condition is also more common in twins. Occasionally the flatness is on both sides so that the entire back of the head is flat.