Identifying & Managing Skull Deformities in Pediatrics: Plagiocephaly & Craniosynostosis, Slides of Pediatrics

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Skull Deformities

in Pediatrics

Case 1

 7wk female with parental concern over

head shape

 PMHx:

 35wk twin A; NICU x 6days (FEN, ID, bili)  Normal feeding/wets/stools  Progressive “flattening” of head since birth  No hx IVH; no neurological symptoms  No flattening in twin

What’s normal?

 Skull growth mainly secondary to brain growth  40% adult size at term  90% adult size by 1yo  95% adult size by 6yo  Suture closure  PF 3-6mo  AF 9-18mo  C,S,L sutures 40years

What’s most likely?

 Deformational Plagiocephaly:

 Asymmetric head  Up to 48% healthy infants  Most common referral to Peds NSGY

 Risk Factors:  Intrauterine crowding/positioning  Decreased mobility (dev.delay, MR, prematurity)  Posturing (torticollis, C-spine defect)  “Back to Sleep” campaign  Increased physician awareness

What’s a Pediatrician to do? The H&P, of course!

 Molding

 Pressure in AP dimension (labor)  Resolves in hours-weeks

 Deformation

 Pressure in local region (occipital)  No sutural ridging; bones mobile

 Synostosis

 Premature closure of sutures  Palpable ridges over suture; bones immobile

What’s normal?

Deformational Plagiocephaly Lambdoid Synostosis

PARALLELOGRAM TRAPEZOID

What’s not?

Sagittal Synostosis

Deformational Plagiocephaly

 AKA: Positional, Posterior, Occipital,

Plagiocephaly without synostosis

 Diagnosis:

 Usually clear based on H&P  Head shape (parallelogram)  Xray if unsure – sutures patent

When to refer?

 True craniosynostosis

 1/5-1/6 syndromic  Increased risk ICP, hydrocephalus, Chiari

 Multi-D Team:

 NSGY, Plastics, Ophtho, Neuro, ENT, Orthodontics, Psych, Genetics, Social Work

 Neurosurgery: 3-9 months old

Case 2

 Newborn female, term SVD

 No maternal hx; no family hx

 Physical Exam:

 Large, low AF  ?Fused coronal/lambdoid sutures?  Significant caput  Hypertelorism  Syndactyly on 3 extremities; clubfoot  Broad, flat hallux