Everything you need to know about the fontanel. Age features of the skull. Baby skull. Skull sutures: anatomy Fusion of the bones of the skull in a child

10.01.2022

- This is a disease, the main symptom of which is the deformation of the cerebral part of the skull, which occurs as a result of premature overgrowth of bone sutures. The clinic includes skull deformities, symptoms of intracranial hypertension, pathology of the optic nerve, mental retardation. Rarely, the disease is accompanied by anomalies of the bones of the facial skull. Diagnosis consists in assessing the degree of overgrowing of cranial sutures and determining bone defects by physical examination, radiography, CT and MRI. The main treatment is early surgical correction of the shape of the skull bones.

General information

Craniosynostosis is a pathological condition in pediatrics that occurs against the background of early overgrowth of cranial sutures, characterized by deformation of the cranium and impaired development of brain tissues. On average, the prevalence of various forms of the disease in the CIS countries is 0.03-3.5% of all newborns. The male sex is more prone to the development of this pathology. The most common variant is monosynostosis. Most often, premature overgrowth of the sagittal suture (scaphocephaly) is observed - 50-65% of all craniosynostoses. The most rare and unfavorable prognostically is the syndromic form, in which there is a high risk of death in the first year of a child's life. With timely diagnosis and adequate treatment in the first 6-9 months of life, the further development of the patient passes without deviations.

Causes of craniosynostosis

The exact etiology of craniosynostosis has not been established. According to the theories put forward, this disease can develop as a result of intrauterine hormonal imbalance of the child, perinatal trauma and compression of the skull bones in the uterine cavity. Also, this pathology occurs with hereditary pathologies - Aper's syndrome, Cruson's syndrome and Pfeiffer's syndrome. One of the leading causes of the development of craniosynostosis is known for certain - an anomaly in the gene responsible for the formation of fibroblast growth factor receptors (FGFR types I, II and III).

Pathogenetically, craniosynostosis is caused by premature synostosis of one or several cranial sutures at once: coronal, sagittal, lambdoid or metopic. Against this background, according to Virchow's law, there is a compensatory growth of bone tissue in the perpendicular direction, due to which a deformity of the skull is formed. Polysynostosis (and often monosynostosis) is often accompanied by intracranial hypertension, which can manifest itself as neurological disorders due to compression of the cerebral cortex, venous congestion of the fundus, edema of the optic nerve head, and with a long course - complete atrophy of the optic nerve and loss of vision.

Classification of craniosynostosis

Craniosynostosis, according to etiological factors, is divided into two groups:

Syndromic. In this case, the pathology is combined with other congenital malformations. These include X-linked, monogenic, chromosomal, and other craniosynostoses. For example, a combination of synostosis with dysplasia of the bones of the facial skull, Smith-Lemli-Opitz syndrome or oro-finger-facial syndrome.
Non-syndromic. This is an isolated form that occurs independently and does not have concomitant diseases.

Depending on the number of overgrown cranial sutures, there are:

Monosynostosis. It is characterized by damage to only 1 suture. In the case of a coronal and lambdoid suture, overgrowth can be one- or two-sided. The most common form.
Polysynostosis. 2-3 sutures are drawn into the pathological process.
Pansynostosis. With this form, fusion of all bone sutures of the child's skull is observed. It is extremely rare.

Symptoms of craniosynostosis

Clinically, craniosynostosis manifests itself from the moment the child is born. All forms are characterized by plagiocephaly and early closure of the large fontanel (normally this occurs at 12-18 months). Only with polysynostosis or concomitant hydrocephalus, it can remain open until the age of 3 years. Also, with craniosynostoses, an increase in intracranial pressure is often observed, which can manifest itself as neurological disorders: anxiety, intense crying, nausea and vomiting, sleep disturbance, decreased appetite, positive symptom of Graefe, convulsions.

Each of the forms of the disease has characteristic clinical features. Craniosynostosis of the sagittal suture (scaphocephaly or navicular skull) is characterized by an increase in the anteroposterior size of the child's head with insufficient width. Visually, the elongation of the skull, the "indentation" of the temporal regions, the "hanging" of the forehead and the occipital part, the narrowing of the face and the acquisition of an oval shape are determined. Palpation above the passage of the sagittal suture reveals a bone ridge. At an early age, mental retardation is possible.

Overgrowth of the lambdoid suture is most often unilateral and manifests itself as a flattening of the occipital region. It is a difficult to diagnose form, since plagiocephaly is almost invisible under the hair, and neurological disorders are minimal. As the patient grows older, the dynamics of the disease is practically absent.

Coronary or coronal craniosynostosis can be either unilateral or bilateral. Overgrowth of only one half of the suture is accompanied by a typical deformity of the child's skull - flattening of the frontal bone and the upper part of the orbit on the affected side. At the same time, the opposite half “hangs” compensatory. Over time, the curvature of the nose in the opposite direction, flattening of the cheekbone, malocclusion and strabismus develop. Bilateral coronary craniosynostosis is manifested by a wide, flat and high forehead with flattened orbital edges of the frontal bone, rarely - a towering deformation of the skull (acrocephaly). Neurological disorders are nonspecific and similar to other forms.

Nontopic craniosynostosis or trigonocephaly is characterized by the development of a triangular forehead with a bony keel extending from the glabella to the large fontanel. Hypotelorism is also observed - a displacement of the orbits posteriorly with a decrease in the interorbital gap. Over time, there is some smoothing of the bone crest and normalization of the shape of the forehead. In half of the cases there are visual impairments and mental retardation.

Syndromic craniosynostosis is the rarest and most severe form. In addition to plagiocephaly, dysplasia of the bones of the facial part of the skull is noted, which causes respiratory failure, eating disorders and vision pathology. It is characterized by synostosis of the coronal suture and, as a result, by the brachycephalic shape of the child's head. Hypoplasia of the bones of the upper jaw, protrusion of the eyeballs from the orbits, hypertelorism also occur. Often there is a significant expansion of the fontanelle and the divergence of the swept suture. Without treatment, children develop a pronounced mental retardation, often they die during the first 12 months of life from SARS, complicated by pneumonia.

Diagnosis of craniosynostosis

Diagnosis of craniosynostosis is based on a physical examination and instrumental research methods. The anamnesis is often uninformative, but its data allow the pediatrician to trace the dynamics of clinical symptoms, if any. An important point is the visual examination of the child, which makes it possible to detect characteristic skull deformities, bone anomalies, etc. Laboratory tests do not reveal specific changes and can be used to determine genetic pathology or diagnose complications.

Mandatory are instrumental methods that allow visualizing bone deformities and assessing the degree of damage to brain tissues. These include neurosonography, radiography, computed tomography, and magnetic resonance imaging. Neurosonography is used to assess the state of brain tissue and the size of the ventricles, to identify intracranial hypertension. On the radiograph, it is possible to determine violations of the bone structure, ossification of the cranial sutures, and with increased intracranial pressure, increased digital impressions. CT and MRI are used to obtain more informative results. If a lesion of the visual system is suspected, ophthalmoscopy is performed to detect damage to the optic nerve head. Consultations of a neurosurgeon and an ophthalmologist are recommended.

Differential diagnosis of craniosynostosis is carried out with positional plagiocephaly, birth trauma of newborns (cephalohematoma, subaponeurotic hemorrhage, skull fracture), cerebral cysts, rickets and microcephaly.

Treatment of craniosynostosis

The main treatment for craniosynostosis is surgical correction of the bone deformity of the skull. The optimal time for surgical intervention is the first 6-9 months of a child's life. These terms are due to the fact that in this period the most intensive development of brain tissues is observed, which can be prevented by the deformation of the cranium. In addition, the bones of the skull at this age quickly restore their structure without the development of complications. The volume and technique of the operation depend on the form of craniosynostosis and associated pathologies. At 2-3 years of age, the correction is carried out solely with the aim of eliminating a cosmetic defect. In addition to surgical treatment, the child's diet is changed in accordance with age requirements. With the development of intercurrent diseases, drug therapy is indicated.

Forecast and prevention of craniosynostosis

The prognosis for children with craniosynostosis directly depends on the form of the disease, the timeliness of diagnosis and the effectiveness of surgical intervention. With the qualitative implementation of therapeutic measures, the outcome of the disease, as a rule, is favorable. The syndromic form of craniosynostosis is considered to be unfavorable prognostically.

There is no specific prophylaxis for this pathology. Non-specific measures include medical genetic counseling of the family and pregnancy planning, protecting the health of a woman during childbearing, rational nutrition, giving up bad habits and eliminating all potential etiological factors for the development of craniosynostosis.

Craniosynostosis is a pathology of overgrowing of the sutures of the cranium, which is the cause of the deformity of the normal shape of the head. Metopic synostosis (trigonocephaly) is the rarest type of craniosynostosis, occupying about 10-25% of such diseases.

Metopic synostosis in a child is mainly diagnosed in the maternity hospital. Mild forms can be detected when examined by a neonatologist or pediatrician (at a later age). Trigonocephaly is treated with surgery.

Metopic synostosis occurs as a result of premature fusion of the skull in the region of the metopic suture. The specified anatomical structure connects the parts of the frontal bone. Closure of the metopic suture is considered normal between 8-24 months. Untimely overgrowing of the suture causes deformation of the cranium, as well as the upper part of the face.

There are two types of metopic synostosis: trigonocephaly and asymptomatic craniosynostosis. The first type of deformation has the following features:

Closure of the suture usually occurs in utero or in early childhood (before 2 months);
The deformity is formed according to the type of hypotelorism or trigonocephaly;
Clinically, this is manifested by a decrease in the distance between the orbits;
The place of overgrowth can be determined by palpation in the form of a small hump;
Full overgrowing and smoothing ends up to 2 months.

Early closure of the metopic suture causes underdevelopment of the frontal bone. Visually, this is characterized as disproportionate, with a relatively small oval face.

The second type (asymptomatic
craniosynostosis) develops relatively later. Overgrowing of the mepotic suture is observed at the age of 3-4 months. A bone ridge forms on the joint, which can be detected by palpation. Asymptomatic craniosynostosis does not deform the frontal bone and oval of the face, so visual diagnosis becomes more difficult.

General characteristics of the disease

Metopic synostosis in a child is a relatively rare pathology of this group of diseases. In recent years, there has been a tendency towards an increase in the incidence of the disease in the population due to the increased influence of teratogenic factors during pregnancy (radiation, drugs, malnutrition). The trigger for the development of the disease can be a trauma to the skull when the child passes through the birth canal.

The clinic of metopic synostosis is characterized by:

Hypertension syndrome;
Violations of the mental sphere;
Pathology of the optic nerve.

Hypertension is caused by an increase in pressure inside the skull. Due to the pathological narrowing of the space, blood vessels do not have the opportunity to develop in the usual way. This can cause a violation of local blood circulation with subsequent ischemia.

The most active growth of the main brain and neurons occurs in the period up to two years. Premature closure of the metopic suture is the cause of the lack of space for the growth of gray matter, so trigonocephaly leads to mental disability. At an early age, the developmental pathology of this area is reversible. It is corrected with the help of surgery.

Reducing the distance between the orbits contributes to the compression of the optic nerve. Pulses passing through such beams are distorted, which leads to the occurrence of ophthalmic pathologies.

The diagnosis of metopic synostosis can be made by a pediatrician during a preventive examination of the child. In addition to the characteristic shape of the face, palpation of the area of the overgrown suture can reveal a crest of inert origin. It is difficult to determine the neurological symptoms of trigonocephaly, so the diagnosis is based on checking reflexes when examined by a neurologist.

Computed tomography is used for differential diagnosis. The method allows you to verify the presence of disproportion in the craniocerebral region, as well as to confirm the presence of compression of the frontal parts of the brain in the sagittal direction.

Treatment of metopic synostosis

Trigonocephaly is an indication for surgery.

Timely diagnosis and prompt treatment reduces the risk of complications to a minimum. The optimal period for surgical intervention is considered to be between 3 and 9 months of age. The bone structures during this period are relatively labile, due to which the operation is not complicated by the need for craniotomy.

The rapid growth of the brain during this period contributes to the speedy alignment of the deformity without consequences for the nervous system. Inert defects heal completely, leaving almost no scars, and the rehabilitation period is relatively better.

A feature of surgical intervention in metopic synostosis is an increase in the volume of the cranium along with a change in its shape. This eliminates the deformation of the facial region. The regenerative abilities of the nervous system depend on age.

The easier the patient's condition, the fewer complications after the operation. Surgery after 5 years is not very effective. Such an operation will not bring improvement in cognitive functions.

Trigonocephaly without surgery will progress over time. A deep deformation of the skull without the necessary plastic surgery can cause complete incapacity in relation to the mental sphere and visual impairment. After surgery during rehabilitation, the use of physiotherapy procedures is recommended.

Metopic synostosis is a severe form of deformity of the skull in the sagittal direction. This pathology can cause a number of complications. An important role is played by timely diagnosis of the disease.

After detecting suspicious symptoms, you must inform the pediatrician about this or contact a neurologist on your own. It must be remembered that the earlier surgery is performed, the less consequences there will be in the future.

Most often, manifestations of craniosynostosis begin as a deformity in the first months of life. In addition to a cosmetic defect, craniosynostosis can lead to an increase in intracranial pressure and has an adverse effect on the development of the child.

normal development of the skull

Scaphocephaly is premature fusion of the sagittal suture.
Plagiocephaly - premature fusion of the coronal suture.
Trigonocephaly - premature fusion of the metopic (frontal) suture.
The terms brachycephaly, oxycephaly, and turriccephaly are used to refer to various forms of synostosis in which different sutures of the skull are affected.

Cause of craniosynostosis

Manifestations of craniosynostosis

Diagnosis of craniosynostosis

Treatment of craniosynostosis

Free consultation on treatment in Moscow and abroad

Craniosynostosis, craniostenosis. Operations to change the shape of the skull in infants.

What is craniosynostosis?

Craniosynostosis, craniostenosis is a rare pathology, which is characterized by a violation of the structure of the skull and skeleton of the child. In children with this pathology, there is a violation of the structure of the facial and brain skull (for example, a narrow skull, narrow forehead). Also, the child may have pathologies of the skeletal structure, for example, fusion of several vertebrae, long and thin fingers and toes, some joints may develop incorrectly, which leads to limitation of movement.

The skull consists of bony plates, which are connected by sutures. Such stitches, as the child's brain grows, begin to increase, and eventually harden. With craniosynostosis, these sutures do not heal properly, and therefore the child's head has an unusual shape.

The severity of the disease depends on which part of the skull is damaged, and how many sutures have grown together incorrectly.

Most often, with this disease, only one suture is damaged and, as a rule, this sagittal suture that runs along the skull. In this case, the child's brain develops normally, however, the head acquires an irregular shape.

When fusion several seams the baby's brain can't grow properly. Moreover, pressure is gradually built up on the child's brain, which can cause blindness and convulsions, retardation in growth and development. If a child has several sutures of the skull that have grown together incorrectly, then he will have multiple pathologies of the face and skull.

Causes of craniosynostosis

Doctors still cannot say with complete certainty what exactly is the cause of the incorrect fusion of the bones of the skull. In 20% of cases, this disorder is hereditary, the child may have one pathological gene from the mother or father.

Most often, this pathology is transmitted genetically in an autosomal recessive manner. However, some scientists believe that this disorder can occur spontaneously, due to the mutation of certain genes, and can be transmitted in an autosomal dominant manner.

Some cases of this pathology can be attributed to the fact that the child during pregnancy lay incorrectly. Other reasons: smoking and drinking in large quantities by the mother during pregnancy.

Manifestations of craniosynostosis.

The most important manifestation of this pathology is the unusual shape of the head, which can be from birth or begin to change in the first months of a child's life, which may be the only sign of craniosynostosis.

In addition, there may be symptoms such as:

* the child does not play;

* sleep apnea at night.

In severe cases, there may be blindness, defects of various kinds, and developmental delays.

Diagnosis of craniosynostosis

Diagnosis is based on the fact that the shape of the child's skull is of an unusual shape; moreover, the child stops growing and developing. Parents and the doctor may notice that the child's skull shape is abnormal or shortened after birth. Even if a child has a pathological head shape, this does not mean at all that he has this disease. An unusual head shape can occur for a number of other reasons.

During the examination, the doctor will measure the diameter of the child's head. If the shape of the child's head does not change over time, then an X-ray examination or tomography is required, which will give the most accurate answer. Moreover, the specialist will study the child's medical history. It is possible that this disease is transmitted genetically.

In Israel, this procedure is carried out in Tipat Khalyav at each visit, the data is entered into a computer on site and checked against a schedule corresponding to the age of the child. Every month the baby is examined by a doctor in Tipat Freebie, even if his condition does not cause any alarms. If necessary, a referral for examination is issued.

Treatment of craniosynostosis

The usual treatment for an abnormally shaped head in infants is to perform skull surgery.

Remember! Only at the age of up to six months, an operation to change the shape of the skull makes sense - in the future, the changes are cosmetic in nature. In addition to the operation, you may be offered the option of wearing a helmet for 23 hours a day for a child, or courses of physiotherapy, lifestyle changes for the child.

In our clinic, operations of any degree of complexity are performed. When contacting our Top Ichilov clinic, you will receive an answer within two working days, so even with urgent requests you have the opportunity to arrive for treatment as soon as possible. We provide all the necessary documents for the visit.

Fusion of the bones of the skull in children

NEUROSURGERY - EuroMedicine.ru - 2007

Craniosynostosis is a pathology caused by premature overgrowing or congenital absence of one or more cranial sutures, leading to deformity.

With craniostenosis, compression of the brain occurs due to craniosynostosis.

Premature fusion of the bones of the skull can often occur even before the birth of the child, as a result of which the skull cannot expand in certain directions and take the normal shape necessary for the growing brain. Depending on which cranial sutures fuse first, the skull may be elongated from front to back, wide and short, pointed (acrocephaly (oxycephaly or turricephaly)) or asymmetrical.

normal development of the skull

In an adult, the skull normally consists of 28 bones. The flat bones that form the cranial vault are interconnected by sutures.

At birth, a baby's skull is made up of 45 individual bone elements. As they grow, many of these elements fuse into single bones (for example, the frontal bone, which at birth consists of two parts).

The bones of the cranial vault are initially divided into areas of dense connective tissue. At birth, these areas consist of fibrous tissue and are mobile, which is necessary for the newborn and further development. Over time, areas of connective tissue ossify.

There are two types of classification of craniosynostosis: according to clinical manifestations and, accordingly, the affected cranial suture.

Scaphocephaly is premature fusion of the sagittal suture.

Plagiocephaly - premature fusion of the coronal suture.

Trigonocephaly - premature fusion of the metopic (frontal) suture.

The terms brachycephaly, oxycephaly, and turriccephaly are used to refer to various forms of synostosis in which different sutures of the skull are affected.

The cause of craniosynostosis is still not completely known, but the genetic theory of the development of craniosynostosis is currently considered the main one. Similar genetic disorders of the development of the skull occur in three syndromes: Cruson, Apert and Pfeiffer.

In addition to the most visible deformation of the head and face, problems with the respiratory tract can be noted in craniosynostoses, especially in the syndromic form of craniosynostosis. Due to the underdevelopment of the upper jaw, such patients have difficulty in nasal breathing. At night, they may have periods of "apnea" - holding their breath. This affects not only their development, but also behavior and speech. With increased intracranial pressure in children, there is a chronic headache, mental disorders develop, visual impairment. As the child develops, the visible deformation of the skull negatively affects his social adaptation and self-esteem.

Special mention should be made of conditions similar to craniosynostosis. This is the so-called positional plagiocephaly. It is a flattening or deformation of certain areas of the skull. Although there may be some superficial similarity to craniosynostosis, it is important to distinguish these conditions. The fact is that positional plagiocephaly does not require surgical treatment. The treatment of this pathology is simple and consists in a certain laying of the child's head during sleep; in some cases, a special cranial "bandage" may be needed, put on the child's head in order to correct the shape of the skull.

Diagnosis of this disease is, first of all, in the examination by a doctor, as well as in the X-ray of the skull. In addition, methods such as computed tomography and magnetic resonance imaging are used.

Craniosynostosis is usually treated surgically. It consists in separating prematurely fused sutures and recreating the shape of the skull. Often, cosmetic problems require joint treatment with a dentist.

Surgical treatment consists of making a zigzag incision from one ear to the other through the top of the head. The use of this type of incision is due to the fact that the scar remaining after such an incision allows the hairline to look more natural. Leroy clamps are used to stop bleeding in this incision. After the incision, the skin flap (scalp) is folded back. There are holes in the skull. Through these holes, the bones of the skull are sawn, as it were, which makes it possible to divide it into several parts. After the surgeon has reconstructed the shape of the skull, the parts of the skull are put back (usually in a different configuration) and connected together with absorbable sutures, plates and screws. The plates and screws are made of special polymers that dissolve after a year to form water and carbon monoxide. Often, demineralized bone grafts are used to repair a bone defect after surgery. After removing the hemostatic clamps, the skin incision is sutured.

Currently, there are new methods for the treatment of craniosynostosis using endoscopic techniques. They are characterized by significantly less blood loss, swelling, pain, and hospital stay. However, this method of treatment is indicated only for children younger than 6 months. For older children, more intensive treatment is needed.

Craniosynostosis, causes, symptoms and treatment of pathology

Happiness is impossible without health

Especially when it comes to our long-awaited babies. All mothers carefully inspect their treasure during daily care, and any change in the appearance of the baby is of great concern. The greatest fear appears when we see the presence of problems associated with the development of the head and brain of our baby.

But know - any diagnosis made by doctors is not a sentence! When the baby is still very small, all violations can be corrected with the right approach. The more we know, the more effective our actions will be.

This terrible word craniosynostosis

In other words, the earlier fusion of the sutures of the skull. At birth, a child has 45 bone cranial elements. They are mobile and connected by a dense fibrous tissue. This instability allows the skull to expand as the brain grows and develops. As the baby grows older, the bone elements grow together.

But in some cases, overgrowing occurs ahead of time, and the head takes on an unusual shape. This is craniosynostosis (or craniostenosis). A fairly rare pathology (according to statistics, it occurs in 1 out of 2000 children). Most often, boys are affected by the disease.

When your baby's head becomes strangely shaped, frequent inexplicable vomiting appears, hearing goes down, eyes become inflamed. He ceases to please you with a good mood, cries for a long time and does not want to play - these may be symptoms of craniosynostosis.

What does he threaten

In addition to external changes, the disease can lead to big problems in the normal development of the little man and the appearance of many concomitant diseases:

Pathology of the structure of the entire skeleton (fusion of the vertebrae).
Improper development of the joints, which leads to disability.
Difficulty in nasal breathing (night sleep apnea, in which the baby temporarily stops breathing).
Hydrocephalus.
Lagging behind in physical and psychological development.
Strabismus, blindness, tremor.
Underdevelopment of the jaws and eye sockets.

Craniosynostosis leads to such severe complications in extreme forms, when several areas of the skull are fused. There are several degrees of the disease, which depend on the number and type of closed sutures.

Types of pathology

Scaphocephaly (sagittal craniosynostosis). Earlier closure of the sagittal or sagittal suture (it connects the left and right parietal region). The most common disease (40-60% of all cases). With scaphocephaly, the baby's head takes on a laterally flattened shape. The back of the head and forehead bulge.

Brachycephaly (coronary craniosynostosis). Fusion of the coronal suture (it is located across the entire head from ear to ear). The height of the crown increases, the occipital region protrudes, and the forehead is slanted. There is a type of pathology when the coronary and sagittal sutures are fused (oxycephaly or agrocephaly). The head in this case acquires a conical shape.

Trigonocephaly (metopic craniosynostosis). Closure of the metopic suture (frontal). A rare form of craniostenosis, it occurs in 10% of cases. The head of the baby becomes triangular, in the form of a drop, the distance between the eyes decreases.

Turriccephaly. Fusion of the coronal (the junction of the frontal and two parietal plates) and sagittal sutures. The skull is shaped like a clover leaf. The temporal bones bulge, the remaining parts narrow.

Diagnostics

Finally, such a diagnosis can be made only after the studies:

X-ray (contrary to popular belief about its harmfulness, the amount of radiation that the baby will receive is minimal and not dangerous to health).
Computed tomography of the brain (CT). Layered scan of the skull and brain. The procedure takes only a few minutes.
Magnetic resonance imaging (MRI). The most accurate research method. Images are obtained by applying electromagnetic waves. Longer in impact (about 20 minutes), so the baby can be anesthetized.

After conducting such studies, make sure that the baby receives the necessary vitamins and often walks in the fresh air. This will remove the possible consequences of the procedures.

Why does craniosynostosis occur?

In most cases, the fault lies with defective genes and hereditary pathologies (Cruzon, Pfeiffer and Apert syndromes). Also, various intrauterine diseases of the unborn child are also dangerous.

Treatment of craniosynostosis

Endoscopy. This method is used only if your baby is not yet 6 months old. This is a gentle method with the least tissue damage.
Operation. During the operation, the fused sutures are separated and the correct shape of the skull is recreated. In addition to skull surgery, consultation and treatment with a dentist is necessary. After the operation, the scar on the baby's head will be almost invisible and completely hidden under the hair.

After the operation, your little one will need to wear a special helmet every day and undergo physical therapy for a while.

And the most important. Don't panic! Our children are very sensitive and react to any change in the mental state of their mother. They should feel strength and protection from us, and not see tears and upset eyes. With timely treatment, your favorite miracle is waiting for a full recovery and the most wonderful life!

There are a number of conclusions about the dangers of washing cosmetics. Unfortunately, not all new mothers listen to them. 97% of shampoos use the hazardous substance Sodium Lauryl Sulfate (SLS) or its equivalents. Many articles have been written about the impact of this chemistry on the health of both children and adults. At the request of our readers, we tested the most popular brands.

The results were disappointing - the most advertised companies showed the presence of those very dangerous components in the composition. In order not to violate the legal rights of manufacturers, we cannot name specific brands. Mulsan Cosmetic, the only company that passed all the tests, successfully received 10 points out of 10 (read). Each product is made from natural ingredients, completely safe and hypoallergenic.

If you doubt the naturalness of your cosmetics, check the expiration date, it should not exceed 10 months. Approach carefully to the choice of cosmetics, it is important for you and your child.

Journal headings

Craniosynostosis is characterized by premature fusion of one or more cranial sutures, often resulting in an abnormal head shape. This may be the result of primary abnormal ossification (primary craniosynostosis) or, more commonly, a brain growth disorder (secondary craniosynostosis).

The disease often occurs in utero or at a very early age. It lends itself exclusively to surgical treatment, although a positive outcome is not possible in all cases.

Classification of craniosynostosis and the causes of its development

Normal ossification of the cranial vault begins in the central region of each cranial bone and extends outward to the cranial sutures. What shows the norm?

When the coronal suture separates the two frontal bones from the parietal bones.
The metopic suture separates the frontal bones.
The sagittal suture separates the two parietal bones.
The lambdoid suture separates the occipital bone from the two parietal bones.

The main factor that holds back the untimely fusion of the bones of the skull is the ongoing growth of the brain. It is worth emphasizing that the normal growth of each cranial bone occurs perpendicular to each suture.

Simple craniosynostosis is the term used in situations where only one suture is fused prematurely.
The term complex or junctional craniosynostosis is used to describe premature fusion of multiple sutures.
When children showing symptoms of craniosynostosis also suffer from other body deformities, this is called syndromic craniosynostosis.

Primary craniosynostosis

With premature fusion of one or more sutures, skull growth may be limited by perpendicular sutures. If several sutures are fused while the brain is still changing in size, intracranial pressure may increase. And this often ends with a series of complex symptoms, up to death.

Varieties of primary craniosynostosis (premature fusion)

Scaphocephaly - swept suture.
Anterior plagiocephaly - first coronal suture.
Brachycephaly - bilateral coronal suture.
Posterior plagiocephaly - early closure of one lambdoid suture.
Trigonocephaly - premature fusion of the metopic suture.

Secondary craniosynostosis

More often than in the primary type, this type of pathology can lead to early fusion of the sutures due to primary failure of brain growth. Since the growth of the brain controls the distance of the bone plates from each other, the disorder of its growth is the main cause of premature fusion of all sutures.

With this type of pathology, intracranial pressure is usually normal, and there is rarely a need for surgery. Typically, the lack of brain growth leads to microcephaly. Premature closure of the suture, which does not pose a threat to brain growth, also does not require surgical intervention.

Intrauterine space restrictions may play a role in premature fusion of the fetal skull sutures. This has been demonstrated in cases of coronal craniosynostosis. Other secondary causes include systemic disorders affecting bone metabolism such as rickets and hypercalcemia.

Causes and consequences of early craniosynostosis

Several theories have been proposed for the etiology of primary craniosynostosis. But the variant with the etiology of a primary defect in the mesenchymal layers of the skull bones has become the most widespread.

Secondary craniosynostosis usually develops along with systemic disorders

These are endocrine disorders (hyperthyroidism, hypophosphatemia, vitamin D deficiency, renal osteodystrophy, hypercalcemia and rickets).
Hematological diseases that cause bone marrow hyperplasia, such as sickle cell disease, thalassemia.
Low growth rates of the brain, including microcephaly and its underlying causes, such as hydrocephalus.

Causes of syndromic craniosynostosis are genetic mutations responsible for class 2 and class 3 fibroblast growth factor receptors.

Other important factors to consider when studying the etiology of the disease

Differentiation of plagiocephaly, which is often the result of positional fusion (which does not require surgery and is quite common) from fusion of the lambdoid suture, is an extremely important aspect.
The presence of multiple adhesions is suggestive of a craniofacial syndrome, which often requires diagnostic expertise in pediatric genetics.

Symptoms of craniosynostosis and diagnostic methods

Craniosynostosis in all cases is characterized by an irregular shape of the skull, which in a child is determined by the type of craniosynostosis.

Rigid bone ridge, well palpable along the pathological suture.
The soft spot (fontanelle) disappears, the child's head changes shape, the sensitivity in these areas is usually changed.
The baby's head does not grow in proportion to the rest of the body.
Increased intracranial pressure.

In some cases, craniosynostosis may not be noticeable until several months after birth.

Elevated intracranial pressure is a common feature of all types of craniosynostosis, with the exception of some secondary pathologies. When only one suture is fused prematurely, increased intracranial pressure occurs in less than 15% of children. However, in syndromic craniosynostosis, where multiple sutures are involved, an increase in pressure can be observed in 60% of cases.

If a child suffers from a mild form of craniosynostosis, the disease may not be noticed until patients begin to experience problems due to increased intracranial pressure. This usually occurs between the ages of four and eight.

Symptoms of increased intracranial pressure

They begin with persistent headaches, usually worsening in the morning and at night.
Vision problems - double vision, blurred vision, or impaired color vision.
An unexplained decrease in the child's mental abilities.

If a child complains of any of the above symptoms, a pediatrician should be contacted as soon as possible. In most cases, these symptoms will not be caused by increased intracranial pressure, but they should definitely be studied.

vomiting;
irritability;
lethargy and lack of reaction;
puffy eyes or difficulty seeing a moving object.
hearing impairment;
labored breathing.

A close examination of the skull makes it clear that its shape does not always confirm the diagnosis of craniosynostosis. In such cases, a number of visual examination methods are used, for example, an x-ray of the skull.

Radiography is performed in several projections - anterior, posterior, lateral and top. Prematurely fused sutures are easily identified by the absence of connected lines and the presence of bony ridges along the suture line. The sutures themselves are either not visible, or their localization shows evidence of sclerosis.

A cranial computed tomography with 3D projection is generally not required for most infants. The method is sometimes performed when surgery is being considered as the next step in treatment or if radiographic findings are inconclusive.

Pathology correction methods, possible complications and consequences

In the last 30 years, modern medicine has developed a deeper understanding of the pathophysiology and treatment of craniosynostosis. At present, surgery generally remains the main type of treatment for correcting skull deformities in children with fusion of 1-2 sutures resulting in an ugly head. Children with microcephaly, which is often seen in mild craniosynostosis, usually do not require surgery.

When drawing up a therapeutic regimen, specialists must take into account a number of points.

In patients with microcephaly, the cause of this disease should be studied.
At the first visit, the circumference of the head in the longitudinal direction is measured and further monitoring of changes is carried out. The physician should ensure normal brain growth in patients with primary craniosynostosis.
Regular monitoring for signs and symptoms of increased intracranial pressure should be made.
If there is a suspicion of increased intracranial pressure, then neurosurgical counseling is very appropriate.
Additional ophthalmological consultations should be performed in patients with elevated intracranial pressure to preserve visual function.

Surgical treatment is usually planned for increased intracranial pressure or to correct a deformity of the skull. The operation is usually performed in the first year of life.

Conditions for surgery

If the shape of the head does not change for the better at the age of two months, then the anomaly is unlikely to change with age. Early intervention is indicated if children may be candidates for minimally invasive surgery. It is worth noting that the deformity is more noticeable in the chest period, and it may become less obvious with age.
As the child grows, he has more hair, the visible manifestations of the anomaly may decrease.
Indications for surgical correction of craniosynostosis depend on the age, general condition of the child and the number of prematurely fused sutures.
Surgical treatment of a cranial or craniofacial deformity is performed in children aged 3-6 months, although the variety of approaches varies among surgeons.

Surgery in infants can result in relatively large blood volume losses. Accordingly, minimally invasive surgical techniques should be considered. One of the promising is the use of intraoperative tranexamic acid. Patients with indications for surgical correction of craniosynostosis were subjected to pretreatment with erythropoietin and tranexamic acid, which allowed them to maintain lower volumes of blood loss.

Other features of surgery

Surgery in infants over 8 months of age may be associated with reduced skull growth.
Infants diagnosed with syndromic craniosynostosis should be operated on as soon as possible.
The results of surgery are best when performed on infants under 6 months of age.
Patients with corresponding facial defects may need a stepwise approach - surgical treatment by the efforts of an entire team of multidisciplinary specialists.
In some cases, molding helmets may be required, which are used in especially severe cases.

The skull of a newborn child consists of six separate bones connected by thin elastic layers of fibrous tissue. In medical practice they are called cranial sutures or relatives.

Such areas are needed so that during the birth process the bones partially overlap. This nuance allows rule out brain injury newborn.

Fontanelles disappear in a child during the first year of life. Premature fusion of soft tissues is called craniosynostosis (craniostenosis) and is a serious disease.

Concept and characteristics

Craniostenosis in a child - photo:

Craniosynostosis is a disease in which there is an earlier closure or complete absence of cranial sutures in children. This condition leads to intracranial hypertension, significant deformation of the skull and limitation of its volume.

Pathology can be primary or secondary. In the first case, the disease develops against the background of abnormal formation of the bone skeleton and ossification of the skull, in the second, a violation of the process of brain growth plays an important role.

Features of the disease:

pathology begins to progress at the stage of intrauterine development of the fetus;
in rare cases, the disease manifests itself in newborns in the first months of life;
if at birth or in the first months of life the pathology was not detected, then at an older age the risk of its development is excluded.

Causes

The basis of the pathological process is a violation of the formation of the bone skeleton of the fetus.

Reasons for the development of this condition in medical practice not fully explored, but experts identify several factors that increase the risk of craniosynostosis in newborns.

In most cases, the pathology is combined with other malformations in the development of the child.

Causes of pathology are the following factors:

hereditary pathologies (for example, Crouzon's syndrome);
consequences of hormonal imbalance;
serious endocrine pathologies;
the position of the fetus, in which the uterus squeezes its skull;
premature synostosis of one or more cranial sutures;
abuse of bad habits during pregnancy;
uncontrolled intake of potent medications during the period of gestation;
incorrect position of the fetus during pregnancy;
slow growth of the brain;
perinatal trauma;
hematological diseases;
genetic abnormalities;
exposure to intrauterine infections.

What are the signs of Down syndrome in a newborn? find out right now.

Classification: types and forms

In medical practice, the classification of craniosynostosis is carried out in several directions. Pathology may be syndromic and non-syndromic. In the first case, the disease is accompanied by other defects, in the second case it develops independently.

Depending on the number of fused sutures, craniosynostosis is divided into pansynostosis(fusion of all sutures of the skull), monosynostosis(splicing one seam) and polysynostosis(splicing several seams).

Monosynostosis is divided into separate types:

lambdoid unilateral or bilateral craniosynostosis (premature fusion of the lambdoid suture);
isolatedmetopic craniosynostosis (overgrowth of the metopic suture);
coronary unilateral or bilateral craniosynostosis (fusion of the coronary suture);
isolated sagittal craniosynostosis (premature overgrowth of the sagittal suture).

Symptoms and signs

Symptoms of craniosynostosis directly depend on the stage of progression of the pathological process and the number of closed sutures. An important role is played by the period of fetal formation, during which this pathology manifested itself.

If the stitches began to close in the first months of pregnancy, then the symptoms will be more pronounced.

External signs of craniosynostosis appear immediately after the birth of the child and clearly visible visually.

Symptoms pathologies are the following factors:

Diagnostics

The diagnosis of craniosynostosis in a child begins with a visual examination. The doctor probes the fontanelles, abnormalities are detected and collects a complete history. The parameters of the baby's skull are measured using special tape.

Based on the collected data, the specialist is assigned additional tests, procedures and consultations with specialized doctors. The examination of the newborn should be carried out comprehensively and include identification of possible additional pathologies.

Diagnostics Craniosynostosis includes the following procedures:

MRI and CT of the brain;
angiography;
neurological examination;
physical examination;
Ultrasound of the vessels of the neck and head;
neurosonography;
consultation with an ophthalmologist;
ophthalmoscopy;
brain x-ray.

Treatment Methods

In the treatment of craniosynostosis in medical practice, two main methods are used - surgery and endoscopy.

Radical methods of correcting the disease are the most effective.

Endoscopy carried out only up to the age of six months of the child and in the presence of minimal complications of the pathological process. The decision to use a specific technique for the treatment of craniosynostosis is made by the doctor on the basis of a comprehensive examination of the baby.

Therapeutic regimen

Therapeutic treatment of craniosynostosis includes several stages. After examining the child, the doctor determines the degree of development of the disease and reveals the presence of complications of the pathological process.

There are certain contraindications for surgical intervention.

For example, a period of exacerbation of a viral disease, diseases associated with the composition of the blood, or the presence of a high temperature in a baby. After examination select a specific type of surgery.

The scheme of treatment of craniosynostosis:

Surgical

Surgical intervention is main and most effective way elimination of craniosynostosis.

The purpose of this procedure is to give the skull the correct shape by dissecting prematurely fused sutures.

In some cases, specialists use distraction devices for bone remodeling.

Features of the operation:

It is recommended to carry out the procedure up to seven months (in the first year of a child's life, active brain growth occurs).
Early surgical intervention can increase the regression of all existing pathological conditions in a child.
A timely operation significantly increases the likelihood of favorable prognosis for the baby.

For the treatment of hydrocephalus in a child, you will find on our website.

Forecasts

Craniosynostosis in children - before and after photos:

The prognosis for craniosynostosis depends on the form of the disease present. Almost completely eliminate the consequences disease can only be taken in a timely manner by treatment measures.

In some cases, complications lead to the death of the child in the first year of life.

Babies first become infected with SARS, and then pneumonia progresses against the background of a cold. Unfavorable prognosis observed only in the syndromic form of craniosynostosis.

Nuances prognosis for pathology:

The earlier the surgery is performed, the lower the risk of complications.
Endoscopy is accompanied by less blood loss for the child (the procedure has age restrictions).
If the operation is performed after the child reaches the age of three, then the risk of complications will be maximum.

Specific measures for the prevention of craniosynostosis in children does not exist.

Non-specific preventive actions include a woman's attentive attitude to her own health and the period of pregnancy, regular examinations by a gynecologist, as well as timely prevention of the risk of intrauterine infections.

If a child is diagnosed with craniosynostosis, then the treatment of the disease is necessary carry out as soon as possible.

You can learn about forecasts for craniosynostosis in children from the video:

We kindly ask you not to self-medicate. Sign up to see a doctor!

The skull undergoes great changes from the moment a child is born to the end of life. These rearrangements are associated with those features of the reaction of connective tissue, in particular bones, that are observed at different age periods of a person's life. We are primarily interested not in a change in the internal structure of the bones of the skull, but in the transformation of its external form, although it occurs under the influence of a restructuring of the architecture of the bone.

Changes in the skull can be conditionally divided into five age periods.

The first period covers the age from birth to 7 years. It is characterized by an active growth of the skull. In the first six months after birth, the volume of the brain skull increases by 2 times, the cranial fossae deepen. In this regard, the occipital region protrudes. The nasal cavity also increases in height up to 22 mm due to the growth of the upper jaw. In the first year of life, the cartilage in the occipital bone and the membranous tissue of the cranial vault disappear. The formation of seams is planned.

From 1 to 2 years, the volume of the brain skull triples, and up to 5 years it reaches 3/4 of the volume of the adult skull. There is a uniform growth of the brain and facial skull, the head becomes wider. The base of the skull reaches the same size as in an adult. The diameter of the large occipital foramen is finally formed. Due to the growth of teeth and alveolar processes, the height of the upper and lower jaws increases, which is reflected in the shape of the face, oral and nasal cavities. An important point is the formation of sutures, which not only hold together the individual bones of the skull, but also serve as a place for their growth in width.

According to the shape, the sutures of the skull are divided into: 1) jagged suture (sutura serrata): there are depressions on one bone, and protrusions filling these depressions on the side of the second bone; such a seam is the most durable; 2) scaly suture (sutura squamosa): the edges of two bones overlap each other; 3) flat seam (sutura plana): the contact surfaces of the bone are even or slightly wavy. All sutures are filled with fibrous connective tissue.

The following sutures are distinguished by location in the skull.

The sagittal suture (sutura sagittalis) in a child is longer than in adults, since it starts from the fronto-nasal suture and reaches the upper angle of the occipital bone. The anterior part of the suture connecting the halves of the frontal bone is called the metopic suture (sutura metopica) and closes by 5 years, while the posterior part of the sagittal suture remains. Metopic suture occurs in adults in 8% of cases (Fig. 84).

The coronal suture (sutura coronalis) runs from right to left in the frontal plane at the junction of the frontal and parietal bones.

Lambdoid suture (sutura lambdoidea) is located in the frontal plane at the junction of the occipital scales and parietal bones.

Early closure of these three sutures results in a conical head shape.

The scaly suture (sutura squamosa) is formed when the scales of the temporal and parietal bones are joined, when the edge of one bone overlaps the other.

The connection of the bones of the facial skull with each other and with the brain skull (with the exception of the connection of the lower jaw with the temporal bone) occurs due to a flat seam, where the edges of the adjacent bones are even or slightly wavy. The names of the sutures that have a flat shape are made up of the names of the bones that form them, for example: frontal-maxillary suture (sutura frontomaxillaris), temporo-zygomatic suture (sutura temporozygomatica), etc. The connection of the palatine processes of the upper jaw is called sutura palatina mediana, and the connection of the horizontal plates of the palatine bones with the palatine processes of the bones of the upper jaw - sutura palatina transversa.

The second period of changes in the skull occurs from 8 to 13-14 years and is characterized by a relative slowdown in the growth of the bones of the skull, although there is a significant increase in the nasal cavity, upper jaw and orbit.

The third period lasts from the beginning of puberty (14-16 years) to 20-25 years, when the growth of the skeleton ends. At this age, the development of the skull is completed completely. The facial skull grows more intensively relative to the brain (Fig. 76), especially in men. The base of the skull increases not only in the transverse, but also in the anteroposterior directions (Fig. 77). Air sinuses are formed (see individual bones of the skull), tubercles, protrusions, glabella and furrows.

76. Age-related changes in facial parameters in humans (according to Welcker). Age in years is indicated by numbers.
A - the height line (chin tubercle - the base of the nose) in a newborn is half the distance between the front surface of the zygomatic bones. The index of the face (the ratio of height to width x 100) is 62.8 for a newborn, 78.0 for a one-year-old, 89.6 for a six-year-old, and 90 for an adult.

77. Development of the skull in age terms.
1 - newborn; 2-1 year; 3-7 years; 4 - adult (according to Andronescu).

The fourth period (26-45 years) is the most stable, when there is no change in the size of the skull. Usually during this period, ossification of the sutures occurs. In men, the posterior part of the sagittal suture is first mellowed, in women, the coronal suture. Then the mastoid-occipital and lambdoid sutures are closed. The scaly seam disappears last. In dolichocephals, suture obliteration occurs earlier than in brachycephals. Rarely, seams persist throughout life, for example, the philosopher Kant - up to 80 years.

The fifth period lasts from the moment of fusion of sutures (45 years) to old age. It is characterized by a noticeable transformation of the facial skull, associated with loss of teeth. The absence of part or all of the teeth leads to atrophy of the bone substance of the alveolar processes of the upper and lower jaws. In this case, the shape of the face somewhat resembles the shape of the face of a newborn. Atrophy of the alveolar processes of the bones is reflected in the restructuring of the hard palate, lower and upper jaws, articular fossa and tubercle of the temporal bone, zygomatic process and zygomatic bone. In old people, the thickness of the compact plate and spongy bone decreases, the skull becomes light, in many bones (lacrimal, ethmoid, large wings of the sphenoid bone, tympanic part of the temporal bones) additional cavities are revealed due to bone resorption. On the contrary, the scales of the frontal bone against the background of atrophy of other bones of the skull are often preserved and thicker. The chemical composition of bone tissue in the elderly is significantly different in comparison with the young. With significant resorption of organic substances, restructuring of architectonics and an increase in the content of mineral salts in the bones, they become more brittle, break and crack with less effort compared to the bones of a young person.