Craniosynostosis is the premature closure or fusion of the open areas or sutures between the skull plates in an infant’s skull. When there is no other involvement besides the skull plates, the cause is usually unknown and the condition is called Non-Syndromic Craniosynostosis. When a suture closes prematurely, a predictable abnormality of head shape occurs due to compensatory expansion required by the growing brain. A skilled geneticist can determine if a child’s craniosynostosis is syndromic or non-syndromic.
The treatment of craniosynostosis is surgical. In a small percentage of cases surgery is mandated by an increase in intracranial pressure due to changes in head shape, configuration and volume. However most cases are treated because of the resulting aesthetic deformities, and the team efforts of a craniofacial plastic surgeon and neurosurgeon can optimize the cosmetic outcome. The FACES+ surgeons are well known for their ability to work with pediatric neurosurgeons in achieving the best appearance for each child.
Metopic Craniosynostosis is one of the more common forms of this disorder, accounting for approximately 40% of all single-suture synostosis. The metopic suture lies along the midline of the forehead and, when fused prematurely, leads to a ridge in the middle of the forehead and a triangular shape to the skull (trigonocephaly). A small fraction of these patients will have increased intracranial pressure and other neurologic abnormalities. Correction is usually recommended for improvement in the cosmetic appearance as well as to address any possible underlying neurologic concerns. Metopic craniosynostosis is usually corrected for cosmetic reasons and an experienced craniofacial plastic surgeon will assure a strong focus on this objective. Characteristics of metopic craniosynostosis include:
- Triangular shape of the anterior skull
- Triangular shape of the orbits
- Orbital hypotelorism
- Narrowing between the temples
Correction is generally carried out by a skilled pediatric craniofacial plastic surgeon and pediatric neurosurgeon team. The surgeons at FACES+ are among the most experienced craniofacial plastic surgeons in the world, ensuring a strong focus on the aesthetic outcome of corrective surgery. Our team at Children’s Hospital of San Diego is unparalleled in the management of these children and the utilization of the newest techniques and technologies.
Sagittal Craniosynostosis is one of the more common forms of this disorder, and like the metopic form, it accounts for approximately 40% of all single-suture synostosis. The sagittal suture lies along the midline of the skull. When this suture fuses prematurely, the head cannot grow in width, but must grow in length to accommodate the expanding brain. Sagittal Craniosynostosis can be corrected within the first year of life using new endoscopic techniques and biodegradable technologoy. Characteristics of sagittal craniosynostosis include:
- Elongated skull shape (front to back)
- Narrow skull shape (side to side)
- Midline bony ridge
- Occipital prominence
When caught early, children with sagittal synostosis are candidates for a new minimally invasive endoscopic approach. The surgeons at FACES+ have developed a brand new means of treating these children using a combination of endoscopy and immediate correction of the skull deformity with biodegradable plates and tacks, which are small rivets placed into the bone to stabilize the plates. This new approach reduces, and often completely eliminates, the need for the band or helmet molding of the skull that is utilized after traditional endoscopic approaches. When children with sagittal synostosis present at older ages, correction involves cranial vault reconstruction, which can be carried out safely and simply using a standard coronal incision from ear to ear that is hidden in the hair. Whether corrected early or late, it is best performed by a skilled pediatric craniofacial plastic surgeon and pediatric neurosurgeon team.
Coronal Craniosynostosis is a premature closure of the skull sutures that lie behind the forehead and run from side to side. Coronal craniosynostosis may be unilateral or bilateral. When both coronal sutures are involved, it is more likely that an underlying syndrome is present. The geneticists at Children’s Hospital of San Diego will determine if the condition is syndromic or non-syndromic. The correction of Coronal craniosynostosis using the new techniques possible with biodegradable technology permit a more precise achievement of the desired skull shape. Characteristics of coronal craniosynostosis include:
- Flattening of one or both sides of the forehead
- Increased forehead height
- Widening of the skull (side to side)
- Recessionof one or both brows
In children with bilateral coronal craniosynostosis the pediatric craniofacial plastic surgeon and neurosurgeon work together as a team to correct the skull deformities and reposition the bones in their normal location, holding them there with biodegradable fixation devices that will gradually disappear over time. When children have unicoronal synostosis, a similar approach is preferred. Both sides are addressed, even when only one side is involved, because of the compensatory changes present in the opposite side. The FACES+ craniofacial plastic surgeons have a vast experience with the correction of bilateral and unicoronal craniosynostosis.
Lambdoid Craniosynostosis is quite rare and occurs in only 2-4% of patients with craniosynostosis. The lambdoid suture is located along the back of the head and it may fuse prematurely on one side or on both sides. Typically, fusion will cause the skull to develop a trapezoid shape, indicating restricted growth at the fused suture and compensatory growth changes surrounding the suture. It is important to differentiate lambdoid craniosynostosis from positional head deformation in the first months of life.Characteristics of lambdoid craniosynostosis include:
- Ridging over the fused lambdoidal suture
- Contralateral frontal bossing
- Posterior displacement of the ipsilateral ear
- Ipslateral occipitomastoid bulge
A diagnosis can usually be made by physical examination, but occasionally a CT scan is necessary to verify true fusion of the lambdoid suture. More commonly a trapezoid shaped head is the result of a positional head deformity and the lambdoid suture is open. It is critical to differentiate the two disorders in the early months of life, as position related head deformities are then easily treated by molding with bands or helmets rather than surgical treatment. The FACES+ craniofacial plastic surgeons work with the geneticist and pediatric neurosurgeon to assure correct diagnosis and treatment.
DR. COHEN RESTORED MY CONFIDENCE AND HEALTH FROM AN EARLIER HORRENDOUS PLASTIC SURGERY EXPERIENCE PERFORMED BY ANOTHER DOCTOR. DR. COHEN GAVE ME BACK MY CONFIDENCE, TRUST, AND SATISFACTION WITH A NEW STANDARD OF PLASTIC SURGERY CARE.