Shapes and how the head changes
The direction of the deformation indicates which seam has closed. With fusion of the sagittal suture, the head extends from front to back and becomes narrow - this is the most common form. Early closure of the metopic suture produces a triangular, keeled forehead and closely spaced orbits. Unilateral coronary synostosis squints the forehead and raises the brow on one side, often with nasal distortion. With lambdoid synostosis, the back of the head is flattened on one side. If several sutures are closed at once, the skull takes on a tower shape, and the risk of increased intracranial pressure is maximum.
- Sagittal synostosis - elongated narrow head (scaphocephaly)
- Metopic - triangular forehead (trigonocephaly)
- Unilateral coronary - sloping forehead (anterior plagiocephaly)
- Bilateral coronary – wide and short head (brachycephaly)
- Lambdoid - flattening of the back of the head on one side
- Multiple synostosis - tower skull
Causes and risk factors
In most cases, the cause remains unknown: fusion of one suture in an otherwise healthy child is called non-syndromic. In approximately some children, craniosynostosis is part of genetic syndromes in which the bones of the face and limbs are also affected. Additionally, the role of the close position of the fetus in the uterus, multiple pregnancies, certain medications, and maternal thyroid disease is discussed. Positional deformity, on the contrary, is formed after birth due to the constant position of the head and is in no way related to sutures.
- Nonsyndromic craniosynostosis is the most common situation
- Genetic syndromes with changes in the face and hands
- Close position of the fetus, multiple pregnancy
- Maternal thyroid disease
- Certain medications during pregnancy
How is it different from positional deformation?
Positional plagiocephaly is much more common and is associated with prolonged lying on one side. With it, the back of the head is flattened, and the ear and forehead on the same side are shifted forward, forming, as it were, a parallelogram. With lambdoid synostosis, on the contrary, the ear moves back, and a bone ridge can be felt behind the ear. Positional form improves when changing positions, laying on the stomach and active play on different sides, but true synostosis does not correct itself. Remember: a child should sleep on his back - this is protection against sudden infant death syndrome.
- Positional deformation is a consequence of position, not sutures
- Her head resembles a parallelogram
- In case of synostosis, a dense ridge along the seam is felt
- Positional form improves as you change poses
- Sleeping on your back remains mandatory
- More supervised tummy time
Diagnostics
The primary assessment is the job of a pediatrician: he measures the circumference of the head and plots it on centile graphs, examines and palpates the sutures and fontanelles, and evaluates the symmetry of the face and ears. Neurosonography through the fontanel shows the condition of the brain and ventricles. The main confirmation method is MSCT of the skull with three-dimensional reconstruction, where you can see exactly which sutures are closed; The study is prescribed by a specialist, weighing the benefits and radiation exposure. Fundus examination helps identify signs of increased intracranial pressure. When combined with anomalies of the face and hands, the child is referred to a geneticist.
- Measuring and graphing head circumference
- Inspection and palpation of sutures and fontanelles
- Neurosonography through the large fontanel
- MSCT of the skull with three-dimensional reconstruction
- X-ray of the skull in two projections as an indicative method
- Fundus examination by an ophthalmologist
- Genetic testing for syndromic forms
Treatment and observation
Helmets, massage and medications do not separate the fused suture - the only treatment is surgical. In the first months of life with a single synostosis, endoscopic surgery through small incisions is possible, followed by wearing a modeling helmet; it is shorter and easier to carry. In older children, an open reconstruction of the cranial vault is performed, in which the surgeon rearranges and fixes bone fragments, creating a reserve of volume for the growing brain. After the operation, the child is observed by a neurosurgeon, neurologist and ophthalmologist, monitoring head growth and development. The prognosis with timely treatment is usually good.
- Endoscopic correction in the first months of life
- Open calvarial reconstruction at an older age
- Modeling helmet after endoscopic surgery
- Regular monitoring of head circumference
- Observation by a neurologist and ophthalmologist
- Orthopedic helmet - only in case of positional deformity and as prescribed by a doctor