Craniosynostosis is a birth defect that causes the bones in the skull to grow together too early. This can affect the brain growth, and the shape of the skull as a child grows. The skull can become misshapen due to the brain still growing and there not being enough space in the area that is already closed.
When your baby is born they have a number of sutures, which are the space between the bones in the skull. These sutures allow spacing between the bones so that the brain can grow. Sutures don’t usually close until around age 2. When the sutures close too early it causes craniosynostosis. This condition’s cause is unknown, but is thought to be genetic in some ways. Craniosynostosis occurs in 1 in every 2500 births.
There are different types of craniosynostosis. Usually with craniosynostosis only one suture closes at a time. They are named for the suture that is affected.
The most common type is sagittal. This is when the sagittal suture which runs from front to back at the top of the skull closes too early. It can cause the head to grow long and narrow.
Another type is coronal. This is when the coronal suture which runs from ear to ear over the top of the skull closes too early. The forehead is usually flat on the affected side while the forehead tends to bulge on the unaffected side. The nose may turn and an eye socket may bulge as well. This type can occur where it affects both sides and is called bicoronal. It will cause the head to be short and wide with the forehead tilted forward.
Metopic is the suture that runs from the bridge of the nose through the middle of the forehead up to the soft spot and the sagittal suture. This suture closing early can cause the forehead to have a triangle appearance and the back of the head to widen.
The rarest form of craniosynostosis is lambdoid. The lambdoid suture runs along the back of the head. This type can cause one side of the head to be flat, or one ear to be higher than the other.
Signs & Symptoms
The first sign of craniosynostosis is there being a change to the shape of the head.
Other signs can be full or bulging fontanelle, which is the soft spot on the top of a baby’s head.
Sleepiness, increased irritability, poor feed, a high pitched cry, eye that won’t look up and projectile vomit may all be symptoms of craniosynostosis. There can be added pressure on the baby’s brain which can cause discomfort.
Noticeable scalp veins, increasing head circumference, and developmental delays are all also signs of craniosynostosis.
Diagnosis
Usually a diagnosis occurs shortly after birth. Sometimes it can be diagnosed later in life but not usually.
A doctor will usually be able to diagnose craniosynostosis with a physical exam. After feeling the baby’s skull with his hands, if the doctor suspects craniosynostosis they may want to run more tests. These may include a X-ray, CT, or CAT scan.
Things your doctor will be looking for in the physical exam is an abnormal shaped skull with no soft spot. A raised firm edge where the sutures closed early. A slowed growth or no growth of the baby’s head over time.
Treatment
Early detection and early treatment are key to get a successful outcome. Treatment of your child will be based on their age, extent of the condition, the type of craniosynostosis, tolerance to procedures, as well as the expectations of progression of the condition. Mild cases may not need treatment at all.
Some cases may just need helmet therapy. This is when a helmet is worn by the child for 23 hours every day usually until their first birthday. The molded helmet will help reshape the head and assist brain growth. The helmet does not push the head into how it should shape, but rather stop the head from growing in spots and guide it to grow where it won’t misshapen.
Surgery is usually the primary treatment for craniosynostosis. Minimally invasive surgery can be done. This is best when the child is younger than 6 months. A surgeon will make 1 to 2 small incisions in the head to remove the closed suture to allow there to be more room for brain growth. Since there is no reshaping done in surgery with this technique the use of a helmet or implanted springs are usually used after surgery to help reshape the head.
Another surgical option is open surgery. This surgery takes about 4 hours. It is done by a craniofacial plastic surgeon when the child is over the age of 6 months. During surgery your child may need a blood transfusion. Since the head is reshaped during this surgery no other reshaping treatment is necessary.
Outcomes
Depending on how severe the case of craniosynostosis is depends on if there will be long lasting treatment that your child needs.
Most children are healthy after treatment of craniosynostosis.
Some may experience some developmental delays.
Follow up visits will be a must to make sure that the facial, skull, jaw bones are all developing and aligning properly as the child grows.
Regular newborn checkups are critical. Craniosynostosis is a birth defect that causes the bones in the skull to grow together too early. #HealthSurgeon
Sources:
https://www.cdc.gov/ncbddd/birthdefects/craniosynostosis.html#:~:text=What%20is%20Craniosynostosis%3F-,Craniosynostosis%20is%20a%20birth%20defect%20in%20which%20the%20bones%20in,flexible%20material%20and%20called%20sutures.
https://www.mayoclinic.org/diseases-conditions/craniosynostosis/diagnosis-treatment/drc-20354517
https://www.hopkinsmedicine.org/health/conditions-and-diseases/craniosynostosis
https://www.nationwidechildrens.org/conditions/craniosynostosis
https://medlineplus.gov/ency/article/001590.htm
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