Plastic and Craniofacial Surgery for Infants and Children; 9101 N Central Expy #595 Dallas, TX 75231 - (469) 375-3838;

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Craniofacial/Skull

At Plastic and Craniofacial Surgery for Infants and Children, treatment for craniofacial anomalies is one of our specialties. If you are the parent of a child with one of these challenging conditions, request a consultation online or call us at (469) 375-3838 to schedule a time to meet with our skilled team. You can also review our online resources about the following conditions:

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Distraction Osteogenesis

Children born with craniofacial disorders affecting the growth of the jaw may benefit from a technique called mandibular bone lengthening, or distraction osteogenesis. This technique was first used by Dr. Ilizarov of Russia to treat bone problems in the leg, and has now been used successfully to correct deformities of the jaw.

Some of the patients who may be able to benefit from this procedure are those with hemifacial microsomia, Treacher Collins Syndrome or other conditions affecting the jaw. Special x-rays are done to determine if a child will be a candidate for the device.

Craniosynostosis

Skull Suture DiagramCraniosynostosis is a term that refers to the early closing of one or more of the sutures of an infant's head. The skull is normally composed of bones which are separated by sutures. This diagram shows the different sutures which can be involved.

As an infant's brain grows, open sutures allow the skull to expand and develop a relatively normal head shape. If one or more of the sutures has closed early, it causes the skull to expand in the direction of the open sutures. This can result in an abnormal head shape. In severe cases, this condition can also cause increased pressure on the growing brain.

Types of Craniosynostosis

In sagittal synostosis (scaphocephaly), the sagittal suture is closed. As a result, the infant's head does not expand in width but grows long and narrow to accommodate the growing brain. The sagittal suture is the most common single suture involved in craniosynostosis. The incidence of sagittal synostosis in the population is approximately 1 in 4200 births. Males are affected about three times as often as females.

When the metopic suture is closed, this condition is called metopic synostosis. You may also hear the term trigonocephaly used to describe your child's head shape. The deformity can vary from mild to severe. There is usually a ridge down the forehead that can be seen or felt and the eyebrows may appear "pinched" on either side. The eyes may also appear close together.

The coronal suture goes from ear to ear on the top of the head. Early closure of one side, unilateral coronal synostosis (plagiocephaly) results in the forehead and orbital rim (eyebrow) having a flattened appearance on that side. This gives a "winking" effect. These features may also be more apparent when looking at the child in the mirror.

Both sides are fused in bicoronal synostosis (brachycephaly). In these cases, the child may have a very flat, recessed forehead. This suture fusion is most often found in Crouzon and Apert Syndromes.

How is Craniosynostosis diagnosed?

There are several clues that may have caused you or your doctor to suspect that your child has craniosynostosis. A misshapen head is usually the first clue. The anterior fontanelle, or soft spot, may or may not be open. The suspected diagnosis is confirmed by x-rays. A CT scan is also done to make sure there are no underlying abnormalities in the brain.

Crouzon and Apert Syndromes

Crouzon and Apert syndromes are the most common of the craniosynostosis syndromes. Craniosynostosis refers to the early closing of one or more of the sutures of an infant's head. The coronal suture goes from ear to ear on the top of the head and fusion of both sides (bicoronal synostosis or brachycephaly) results in a very flat, recessed forehead. This is the suture fusion found most often in Crouzon and Apert syndromes.

In addition to craniosynostosis these children also have fusion of the sutures or bones in the cranial base and midface, and shallow eye sockets. This gives the appearance of a flat midface and eyes which protrude. In addition, children with Apert syndrome have syndactaly (webbing) of the hands and feet.

Crouzon syndrome occurs in approximately 1 in 25,000 births. It may be transmitted as an autosomal dominant genetic condition or appear as a fresh mutation (no affected parents). The appearance of an infant with Crouzons can vary in severity from a mild presentation with subtle midface characteristics to severe forms with multiple cranial sutures fused and marked midface and eye problems.

The incidence of Apert syndrome is approximately 1 in 100,000 births and most cases are fresh mutations. The general features of a child with Apert syndrome are similar to those in Crouzon syndrome, however there is not as much variability between cases and the degree of presentation is more severe.

Deformational Plagiocephaly

(Positional plagiocephaly, molding plagiocephaly, flathead syndrome, occipital flattening, skull asymmetry)

What is deformational plagiocephaly?

Deformational plagiocephaly refers to a baby's head that is crooked or asymmetrically shaped due to repeated pressures on the same areas of the head. The bones are very soft in an infant's skull so the bones are easily misshapen if constant pressures are applied to the same spots of the skull. In Greek, "Plagio" means oblique and "cephaly" means head, thus "oblique head".

View an interview with Dr. Hobar and learn more about Deformational Plagiocephaly.

Typical Head Shapes

Deformationsal Plagiocephaly Deformationsal Brachycephaly Deformationsal Brachycephaly

Causes of Deformational Plagiocephaly

How is deformational plagiocephaly different from craniosynostosis?

In deformational plagiocephaly, the skull bones are all formed normally; there is no premature fusion of the skull bones. Craniosynostosis is when one or more of the skull bones have joined or fused together too soon. Skull x-rays or a CT scan of the head usually is performed to confirm the diagnosis. Treatment for deformational plagiocephaly is reviewed below. Possible surgical treatment for craniosynostosis is determined after careful evaluation by the Craniofacial Team.

  DEFORMATIONAL PLAGIOCEPHALY CRANIOSYNOSTOSIS
HEAD SHAPE: Crooked-Asymmetrical Crooked-Asymmetrical—Unusual Appearance
CAUSED BY: Baby's head flattened by repeated pressure to same area Skull bones grew together too soon
PREMATURE FUSION OF CRANIAL SUTURES? NO YES
DIAGNOSIS: Skull x-ray, exam Skull x-ray, CT Scan, exam
TREATMENT: Positioning, cranial remolding helmet or band Usually surgery, sometimes in association with cranial remolding helmet or band