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Skull Deformities

Skull Deformities. Normal Infant Skull. Flexible enough to get through vagina Molding Expansile enough to accommodate rapid brain growth. Expansile. Flexible. Infant Skull Anatomy. Suture Growth. Sutures allow growth perpendicular to them Growth at suture lines related to brain growth.

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Skull Deformities

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  1. Skull Deformities

  2. Normal Infant Skull • Flexible enough to get through vagina • Molding • Expansile enough to accommodate rapid brain growth Expansile Flexible

  3. Infant Skull Anatomy

  4. Suture Growth • Sutures allow growth perpendicular to them • Growth at suture lines related to brain growth

  5. Ossification By Age 8 Bone Union By Age 20 Suture Closure

  6. Early Closure Causes Growth Parallel to the Suture

  7. Craniosynostosis: Early Fusion

  8. Sagittal Synostosis (Scaphocephaly)

  9. Coronal Synostosis Plagiocepahly

  10. Right Coronal Synostosis

  11. Metopic Synostosis “Triangle-Head” (Trigonocephaly)

  12. Metopic Synostosis

  13. Lamboid Synostosis MATTRESS “Slant-Head” (Occipital Plagiocephaly)

  14. Isolated Primary Craniosynostosis Sutures Involved

  15. Clinical Exam • OFC • Head shape (from above, side) • Ear and facial symmetry • Palpate suture lines & fontanelles • Look for ridging • Look for associated anomalies • Skull X-ray or CT

  16. Craniosynostosis Microcephaly Prematurity VP Shunting Positioning Secondary Primary Isolated Abnormal Suture Syndromic

  17. Prematurity • Deformational Scaphocephaly • Impaired mobility & prolonged positioning • Persists until adulthood • Prevention: • Donut-shaped head supports • waterbed mattresses • Does not warrant intervention

  18. Former Preemie’s Head

  19. VP Shunting • Scaphocephaly • Chronic hydrocephalus thickens the skull • Once decompression with shunt, the suture fuses • Surgery Indications: • OFC > 50 cm (4-5+ STDs) • When VPS performed during when VLBW

  20. Microcephaly • Surgical correction not indicated • Abnormal OFC • in primary craniosynostosis, OFC remains normal yet oddly shaped • Rare cases of multisutural craniosynostosis restricting head growth, but manifests with increased ICP

  21. PositionalDeformation • Most common cause • Usually forehead asymmetry • Sometimes associated with torticollis • Usually acts on coronal or lamboidal suture • 40% of newborns

  22. An Epidemic of Lamboidal Plagiocephaly • 1992: Back to Sleep • Campaign • 1996: Tertiary Care • Centers report rise in • lamboidal plagiocephaly • from 3% to 20%

  23. Sorting out the “Epidemic” • 102 Patients with occipital plagiocephaly over 4 year period • Only 4 (3%) had true lamboidal synostosis • The rest were deformational • Only 3 were progressive (required surgery) • Other responded to positioning or helmets

  24. Syndromic Craniosynostosis • 10-20 % of cases • Autosomal Dominant • Linked to Chromosome 10q • Multi-sutural, complex cases If a suture is fused, check hands, feet, big toe and thumb

  25. True Craniosynostosis & Surgery • Single Suture Synostosis: Confirm by exam and skull x-rays • Complex cases: CT or 3D CT • X-Ray: Fused sutures have a broad ridge of overgrowth of solid bone along a previous suture, or suture is completely obliterated • Ridge is especially characteristic of fused sagittal suture

  26. Conservative Therapy for Deformational Plagiocephaly • Re-positioning • If no improvement • by 6 months…. • Helmet Molding

  27. Custom Made for each head 24/7 wear for 4 months

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