Matthew 25:40

"And the King will answer and say to them, ‘Assuredly, I say to you, inasmuch as you did it to one of the least of these My brethren, you did it to Me.’ "

Thursday, July 2, 2009

Scaphocephaly with Craniofacial Surgery

Definition: Scaphocephaly (also know as, dolichocephaly) refers to the condition where the head is disproportionately long and narrow (see cranial index. Scaphocephaly can result from the premature fusion of the sagittal suture (see craniosynostosis) or from external deformation. Scaphocephaly is particularly common among infants who are born prematurely.

Diagnosis: The diagnosis begins with an examination by a pediatrician, pediatric neurosurgeon or craniofacial surgeon. A primary objective of the examination is to rule out craniosynostosis (a condition that requires surgical correction). The initial examination involves questions about gestation, birth, in utero and post-natal positioning (for example, sleeping position). The physical examination includes inspection of the infant's head and may involve palpation (carefully feeling) of the child's skull for suture ridges and soft spots (the fontanelles). The physician may also request x-rays or computerized tomography (a CAT scan, a series of photographic images of the skull). These images provide the most reliable method for diagnosing premature fusion of the sagittal suture (craniosynostosis). In addition, the physician may make (or order) a series of measurements from the child's face and head [more on cranial anthropometry]. These measurements will be used to assess severity and monitor treatment.

Treatment: The treatment of scaphocephaly depends upon the etiology (cause) of the condition: Scaphocephaly resulting from fusion of the sagittal suture (craniosynostosis) must be treated surgically. Parents should consult a pediatric neurosurgeon or a craniofacial surgeon to discuss treatment option. Depending upon severity, scaphocephaly resulting from external/positional deformation can be treated with repositioning and/or head banding. Parents should consult a pediatrician, a pediatric neurosurgeon or a craniofacial surgeon for information on repositioning and/or for referral and a prescription for head banding.

Support Groups:
Plagiocephaly Parents Support
Parents of Premature Babies Inc. (Preemie-L)

Craniofacial Surgery:
The craniofacial area includes the base of the skull, the facial skeleton and underlying soft tissues, the skull vaults and the scalp. Craniofacial surgery involves repairing damage caused by serious injuries as well as congenital deformities and abnormal growths such as tumors.

Congenital deformities include

  • clefts of the lip and palate: In these conditions, all of the parts of the lip and roof of the mouth are present, but they have failed to fuse in a normal fashion. Clefts can appear with varying severity: a cleft lip can be incomplete with a fractional notching of the lip, or complete, extending through the lip and into the nose. ear deformities: In these conditions, the outer ear may be underdeveloped, misshaped, or completely absent.
  • premature fusing of the bones of the head in young children: In the normal infant skull, cracks or “sutures” appear in between bones of the head to allow for brain growth. When one of these sutures closes prematurely, the brain continues to grow, but pushes out toward the area of the skull where the sutures are still open. The result is a malformation of the skull and/or face.
  • misshapen jaws: often caused by misalignment of the teeth and jaws referred to as malocclusion, or mild hypoplasia (inadequate tissue development) which can appear as a recessed upper jaw or other underdeveloped bony area of the face.
  • facial asymmetries: or hemifacial microsomia, a condition wherein one side of the face is smaller than the other, due to underdevelopment of bone and/or cartilage.

After appropriate assessment, surgical treatment may be recommended and this will vary considerably depending on what the particular problem is. Sometimes craniofacial surgery for deformity can be carried out without making visible scars on the face. Craniofacial surgeries carry varying degrees of risk, depending on the particular problem. Sometimes bone or cartilage grafts need to be harvested from other areas of the body such as the ribs.

***See pics below...note: none of these pictures are of any patients that I have cared for; they are all from the internet.