142 lines
No EOL
58 KiB
XML
142 lines
No EOL
58 KiB
XML
<?xml version="1.0" encoding="utf-8"?>
|
||
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
|
||
<html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en">
|
||
|
||
<head><meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
|
||
<!-- AppResources meta begin -->
|
||
<meta name="paf-app-resources" content="" />
|
||
<script type="text/javascript">var ncbi_startTime = new Date();</script>
|
||
|
||
<!-- AppResources meta end -->
|
||
|
||
<!-- TemplateResources meta begin -->
|
||
<meta name="paf_template" content="" />
|
||
|
||
<!-- TemplateResources meta end -->
|
||
|
||
<!-- Logger begin -->
|
||
<meta name="ncbi_db" content="books" /><meta name="ncbi_pdid" content="book-part" /><meta name="ncbi_acc" content="NBK567709" /><meta name="ncbi_domain" content="statpearls" /><meta name="ncbi_report" content="printable" /><meta name="ncbi_type" content="fulltext" /><meta name="ncbi_objectid" content="" /><meta name="ncbi_pcid" content="/NBK567709/?report=printable" /><meta name="ncbi_app" content="bookshelf" />
|
||
<!-- Logger end -->
|
||
|
||
<title>Brachycephaly - StatPearls - NCBI Bookshelf</title>
|
||
|
||
<!-- AppResources external_resources begin -->
|
||
<link rel="stylesheet" href="/core/jig/1.15.2/css/jig.min.css" /><script type="text/javascript" src="/core/jig/1.15.2/js/jig.min.js"></script>
|
||
|
||
<!-- AppResources external_resources end -->
|
||
|
||
<!-- Page meta begin -->
|
||
<meta name="robots" content="INDEX,FOLLOW,NOARCHIVE" /><meta name="citation_inbook_title" content="StatPearls [Internet]" /><meta name="citation_title" content="Brachycephaly" /><meta name="citation_publisher" content="StatPearls Publishing" /><meta name="citation_date" content="2024/09/10" /><meta name="citation_author" content="Michael I. Ita" /><meta name="citation_author" content="Luke J. Weisbrod" /><meta name="citation_author" content="Munaza Batool Rizvi" /><meta name="citation_pmid" content="33620786" /><meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK567709/" /><link rel="schema.DC" href="http://purl.org/DC/elements/1.0/" /><meta name="DC.Title" content="Brachycephaly" /><meta name="DC.Type" content="Text" /><meta name="DC.Publisher" content="StatPearls Publishing" /><meta name="DC.Contributor" content="Michael I. Ita" /><meta name="DC.Contributor" content="Luke J. Weisbrod" /><meta name="DC.Contributor" content="Munaza Batool Rizvi" /><meta name="DC.Date" content="2024/09/10" /><meta name="DC.Identifier" content="https://www.ncbi.nlm.nih.gov/books/NBK567709/" /><meta name="description" content="The term "brachycephaly" is derived from the Greek words "brakhu" (short) and "cephalos" (head), which translates to "short head." Brachycephaly is an infant skull deformity characterized by a lower-than-normal ratio of the skull's length to its width.[1] Infants with this form of skull deformity have a flattening of the cranium's occipital aspect; there is an apparent shortening of the skull in the anteroposterior dimension (length).[2] Brachycephaly may be positional (non-synostotic) or synostotic. The incidence of infant positional skull deformities has increased since 1992.[3][4] The rising incidence appears to be related to the introduction of the measure of infant supine sleep positioning by the American Association of Pediatrics as a means to prevent sudden infant death syndrome (SIDS).[5][6] However, brachycephaly in infants can also occur due to craniosynostosis." /><meta name="og:title" content="Brachycephaly" /><meta name="og:type" content="book" /><meta name="og:description" content="The term "brachycephaly" is derived from the Greek words "brakhu" (short) and "cephalos" (head), which translates to "short head." Brachycephaly is an infant skull deformity characterized by a lower-than-normal ratio of the skull's length to its width.[1] Infants with this form of skull deformity have a flattening of the cranium's occipital aspect; there is an apparent shortening of the skull in the anteroposterior dimension (length).[2] Brachycephaly may be positional (non-synostotic) or synostotic. The incidence of infant positional skull deformities has increased since 1992.[3][4] The rising incidence appears to be related to the introduction of the measure of infant supine sleep positioning by the American Association of Pediatrics as a means to prevent sudden infant death syndrome (SIDS).[5][6] However, brachycephaly in infants can also occur due to craniosynostosis." /><meta name="og:url" content="https://www.ncbi.nlm.nih.gov/books/NBK567709/" /><meta name="og:site_name" content="NCBI Bookshelf" /><meta name="og:image" content="https://www.ncbi.nlm.nih.gov/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-statpearls-lrg.png" /><meta name="twitter:card" content="summary" /><meta name="twitter:site" content="@ncbibooks" /><meta name="bk-non-canon-loc" content="/books/n/statpearls/article-126812/" /><link rel="canonical" href="https://www.ncbi.nlm.nih.gov/books/NBK567709/" /><link rel="stylesheet" href="/corehtml/pmc/css/figpopup.css" type="text/css" media="screen" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books.min.css" type="text/css" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books_print.min.css" type="text/css" /><style type="text/css">p a.figpopup{display:inline !important} .bk_tt {font-family: monospace} .first-line-outdent .bk_ref {display: inline} </style><script type="text/javascript" src="/corehtml/pmc/js/jquery.hoverIntent.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/common.min.js?_=3.18"> </script><script type="text/javascript">window.name="mainwindow";</script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/book-toc.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/books.min.js"> </script>
|
||
|
||
<!-- Page meta end -->
|
||
<link rel="shortcut icon" href="//www.ncbi.nlm.nih.gov/favicon.ico" /><meta name="ncbi_phid" content="CE8E9D0C7D89CD1100000000000F000F.m_5" />
|
||
<meta name='referrer' content='origin-when-cross-origin'/><link type="text/css" rel="stylesheet" href="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/css/3852956/3985586/3808861/4121862/3974050/3917732/251717/4216701/14534/45193/4113719/3849091/3984811/3751656/4033350/3840896/3577051/3852958/3984801/12930/3964959.css" /><link type="text/css" rel="stylesheet" href="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/css/3411343/3882866.css" media="print" /></head>
|
||
<body class="book-part">
|
||
<div class="grid no_max_width">
|
||
<div class="col twelve_col nomargin shadow">
|
||
<!-- System messages like service outage or JS required; this is handled by the TemplateResources portlet -->
|
||
<div class="sysmessages">
|
||
<noscript>
|
||
<p class="nojs">
|
||
<strong>Warning:</strong>
|
||
The NCBI web site requires JavaScript to function.
|
||
<a href="/guide/browsers/#enablejs" title="Learn how to enable JavaScript" target="_blank">more...</a>
|
||
</p>
|
||
</noscript>
|
||
</div>
|
||
<!--/.sysmessage-->
|
||
<div class="wrap">
|
||
<div class="page">
|
||
<div class="top">
|
||
|
||
<div class="header">
|
||
|
||
|
||
</div>
|
||
|
||
|
||
|
||
<!--<component id="Page" label="headcontent"/>-->
|
||
|
||
</div>
|
||
<div class="content">
|
||
<!-- site messages -->
|
||
<div class="container content">
|
||
<div class="document">
|
||
<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. </p></div></div></div>
|
||
<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK567709_"><span class="title" itemprop="name">Brachycephaly</span></h1><p class="contrib-group"><h4>Authors</h4><span itemprop="author">Michael I. Ita</span><sup>1</sup>; <span itemprop="author">Luke J. Weisbrod</span><sup>2</sup>; <span itemprop="author">Munaza Batool Rizvi</span><sup>3</sup>.</p><h4>Affiliations</h4><div class="affiliation"><sup>1</sup> University College Cork</div><div class="affiliation"><sup>2</sup> UNMC</div><div class="affiliation"><sup>3</sup> Columbia Presbyterian, Morgan Stanley Children's Hospital</div><p class="small">Last Update: <span itemprop="dateModified">September 10, 2024</span>.</p></div><div class="body-content whole_rhythm" itemprop="text"><div id="article-126812.s1"><h2 id="_article-126812_s1_">Continuing Education Activity</h2><p>This activity discusses evaluating and managing brachycephaly, a pediatric skull deformity marked by a shortened anteroposterior length and widened biparietal diameter. This activity is essential for clinicians involved in pediatric care and emphasizes the distinction between positional and synostotic brachycephaly, highlighting the rising incidence of infant positional skull deformities since 1992. With positional brachycephaly and plagiocephaly affecting 20% to 50% of infants in the United States, accurate diagnosis becomes pivotal in determining appropriate treatment modalities.</p><p>The intricate anatomy of the infant skull is explored, emphasizing the role of cranial sutures in facilitating growth and protecting the developing brain. The occurrence of craniosynostosis is discussed, offering insights into its impact on cranial development. Attendees will gain a deeper understanding of the etiology of brachycephaly while considering both non-synostotic and synostotic variants. By examining the historical context of the increased incidence linked to supine sleep positioning recommendations, this activity equips healthcare professionals with knowledge essential for managing and treating brachycephalic conditions in infants.</p><p>
|
||
<b>Objectives:</b>
|
||
<ul><li class="half_rhythm"><div>Identify the etiology of positional brachycephaly.</div></li><li class="half_rhythm"><div>Differentiate the pathophysiology of synostotic brachycephaly from that of positional brachycephaly.</div></li><li class="half_rhythm"><div>Identify the indication for neck physiotherapy in infants with brachycephaly.</div></li><li class="half_rhythm"><div>Develop communication on the importance of interprofessional team coordination in managing patients with brachycephaly.</div></li></ul>
|
||
<a href="https://www.statpearls.com/account/trialuserreg/?articleid=126812&utm_source=pubmed&utm_campaign=reviews&utm_content=126812" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Access free multiple choice questions on this topic.</a>
|
||
</p></div><div id="article-126812.s2"><h2 id="_article-126812_s2_">Introduction</h2><p>The term "brachycephaly" is derived from the Greek words "brakhu" (short) and "cephalos" (head), which translates to "short head." Brachycephaly is an infant skull deformity characterized by a lower-than-normal ratio of the skull's length to its width.<a class="bk_pop" href="#article-126812.r1">[1]</a> Infants with this form of skull deformity have a flattening of the cranium's occipital aspect; there is an apparent shortening of the skull in the anteroposterior dimension (length).<a class="bk_pop" href="#article-126812.r2">[2]</a> Brachycephaly may be positional (non-synostotic) or synostotic. The incidence of infant positional skull deformities has increased since 1992.<a class="bk_pop" href="#article-126812.r3">[3]</a><a class="bk_pop" href="#article-126812.r4">[4]</a> The rising incidence appears to be related to the introduction of the measure of infant supine sleep positioning by the American Association of Pediatrics as a means to prevent sudden infant death syndrome (SIDS).<a class="bk_pop" href="#article-126812.r5">[5]</a><a class="bk_pop" href="#article-126812.r6">[6]</a> However, brachycephaly in infants can also occur due to craniosynostosis.</p><p>The infant skull has the dual function of protecting the brain and allowing for its volumetric growth and development. Infants' cranial vault or calvaria comprises several bones separated by fibrous joints or cranial sutures. There are 2 frontal bones separated by a metopic suture and 2 parietal bones separated from each other by a sagittal suture. A coronal suture separates the 2 parietal bones from the 2 frontal bones, which includes the anterior fontanelle (future bregma). Paired squamosal sutures separate paired temporal bones on either side of the calvaria from the 2 parietal bones, and a lambdoid suture, which includes the posterior fontanelle (future lambda), separates a single occipital bone from the 2 parietal bones. The anterior fontanelle typically closes by 3 years old, while the posterior fontanelle usually closes by 3 months old. Craniosynostosis refers to the premature mineralization and fusion of one or more of these fibrous joints, which occur between the bones of the calvaria before the completion of brain growth and development in infants.</p></div><div id="article-126812.s3"><h2 id="_article-126812_s3_">Etiology</h2><p>
|
||
<b>Positional (non-Synostotic)/Deformational Brachycephaly</b>
|
||
</p><p>The cranial sutures or fibrous joints that separate the cranium bones do not fuse or ossify at birth. This ensures the essential event of volumetric growth and development of the brain postnatally. As a result, a newborn skull retains its ability to mold in the initial months of life and is, therefore, susceptible to the deformational effects of external force. The frequent practice of placing an infant in a supine sleeping position can lead to a symmetrical flattening of the occipital bone, resulting in positional or deformational brachycephaly.<a class="bk_pop" href="#article-126812.r7">[7]</a> A unilateral flattening of the occipital bone in infants may result in deformational plagiocephaly, a related positional skull deformity. Positional brachycephaly may also be observed at the time of birth in some infants. This may be attributable to prolonged labor or intrauterine fetal head constraint due to factors such as abnormal intrauterine position, multiple gestations, oligohydramnios, and congenital or acquired structural anomalies of the uterus.<a class="bk_pop" href="#article-126812.r8">[8]</a></p><p>
|
||
<b>Brachycephaly Due to Craniosynostosis (Synostotic Brachycephaly)</b>
|
||
</p><p>The skull consists of the neurocranium and the viscerocranium (splanchnocranium). The neurocranium forms a protective shell surrounding the brain and the brainstem, while the facial bones form the viscerocranium (or facial skeleton).<a class="bk_pop" href="#article-126812.r9">[9]</a> The neurocranium consists of the cranial vault (calvaria) and the chondrocranium (skull base). The bones that constitute the chondrocranium mineralize by endochondral ossification, which is the replacement of cartilage by the bone matrix. The calvaria bones originate from intramembranous ossification, which involves direct mineralization of mesenchymal connective tissue without needing a transitional cartilaginous component.</p><p>Premature abnormal mineralization of the cranial sutures, which can occur between the calvaria bones, results in craniosynostosis. Bilateral premature mineralization of the coronal sutures leads to bi-coronal craniosynostosis, referred to as anterior brachycephaly.<a class="bk_pop" href="#article-126812.r10">[10]</a> Unilateral premature mineralization of the coronal suture in infants results in anterior plagiocephaly, a related skull deformity. Genetic abnormalities such as fibroblast growth factor receptor type-2 (<i>FGFR-2) </i>and type-3 (<i>FGFR-3)</i>, twist homolog-1 (<i>TWIST1)</i>, and ephrin-B1 (<i>EFNB1)</i> gene mutations may predispose an infant to craniosynostosis.<a class="bk_pop" href="#article-126812.r11">[11]</a> Fibroblast growth factor receptor type-2 plays an integral role in the abnormality, although the exact etiology remains unclear. Fibroblast growth factors (FGFs) participate in the differentiation, cell proliferation, migration, and regulation of normal bone morphogenesis.<a class="bk_pop" href="#article-126812.r12">[12]</a> These mutations may be clinically syndromic or non-syndromic.<a class="bk_pop" href="#article-126812.r10">[10]</a> Clinical syndromes with craniosynostosis include Crouzon syndrome, Apert syndrome, Pfeiffer syndrome, Saethre-Chotzen syndrome, Antley-Bixler syndrome, and Muenke syndrome.<a class="bk_pop" href="#article-126812.r13">[13]</a><a class="bk_pop" href="#article-126812.r14">[14]</a></p></div><div id="article-126812.s4"><h2 id="_article-126812_s4_">Epidemiology</h2><p>Positional brachycephaly or plagiocephaly is the most common head-shape abnormality, affecting between 20% and 50% of infants in the United States.<a class="bk_pop" href="#article-126812.r1">[1]</a><a class="bk_pop" href="#article-126812.r15">[15]</a><a class="bk_pop" href="#article-126812.r16">[16]</a> Approximately 20% of cases of positional plagiocephaly may be observed at the time of birth. In comparison, 80% of the cases present within the first 3 months of life as an acquired postnatal cranial deformation.<a class="bk_pop" href="#article-126812.r17">[17]</a> Positional plagiocephaly is more common in male children.<a class="bk_pop" href="#article-126812.r17">[17]</a> Up to 93% of infants with positional plagiocephaly will also have some degree of torticollis, which the average physician often underrates.<a class="bk_pop" href="#article-126812.r18">[18]</a> Synostotic brachycephaly, resulting from bicoronal synostosis, occurs in around 3% of non-syndromic synostoses and has a higher prevalence of around 0.5 per 10000 live births in syndromic synostosis.<a class="bk_pop" href="#article-126812.r19">[19]</a><a class="bk_pop" href="#article-126812.r20">[20]</a> Lambdoid craniosynostosis is relatively rare, with a reported incidence of 1% to 9% of cases of craniosynostosis.<a class="bk_pop" href="#article-126812.r21">[21]</a></p></div><div id="article-126812.s5"><h2 id="_article-126812_s5_">History and Physical</h2><p>It is essential to differentiate between non-synostotic (brachycephaly or plagiocephaly) and synostotic (bi-coronal or bi-lambdoid synostosis) infant head shape abnormalities by taking a detailed history in combination with an astute physical examination. Important questions include:</p><ul><li class="half_rhythm"><div>Family history of abnormal head shapes</div></li><li class="half_rhythm"><div>Prenatal exposure to teratogens</div></li><li class="half_rhythm"><div>When the abnormality was first observed</div></li><li class="half_rhythm"><div>History of intrauterine fetal head constraints</div></li><li class="half_rhythm"><div>Birth history</div></li></ul><p>Physical examination should include measuring the infant's head circumference, palpating the sutures for evidence of ridging, and examining the fontanelles to assess elevated intracranial pressure. The infant's head should be assessed from the anterior view, posterior view, lateral view, and, importantly, from the vertex (top of the head). Anthropometric measurements using cranial calipers provide vital information on head length, width, and occipitofrontal transcranial diameters. A complete neurological examination should also be performed. Indices such as the cephalic index (ie, the ratio of maximum width to the maximum length of the skull) and the cranial vault asymmetry index (ie, the percentage difference between the diagonal dimensions of the skull) may provide helpful information on the degree of severity of an infant's head shape abnormality.</p><p>Positional brachycephaly is characterized by bilateral/symmetrical flattening of the occiput, widening of the posterior skull, bilateral temporal bossing, and a round face. There is usually evidence of sutural ridging (bi-coronal or bi-lambdoid craniosynostosis) with synostotic brachycephaly. In lambdoid craniosynostosis, there may be an associated sutural trough rather than an expected ridge. Bicoronal synostosis is often associated with turricephaly; the forehead appears somewhat towered with seemingly shallow orbits and a shortened nasal bone. Some infants with bicoronal synostosis resulting in brachycephaly may have peri-orbital findings, including Harlequin eye signs and exophthalmos.<a class="bk_pop" href="#article-126812.r10">[10]</a> </p><p>The Harlequin eye sign is characterized by the affected side having a higher supra-orbital margin than the unaffected side. During the physical examination, it is essential to determine whether or not other craniofacial or systemic abnormalities are present, including mid-face hypoplasia, abnormal facies, or limb abnormalities, which may indicate the presence of an associated syndrome.<a class="bk_pop" href="#article-126812.r22">[22]</a> Patients with syndromic craniosynostosis may also present with elevated intracranial pressure (ICP), obstructive sleep apnea, hearing disabilities, visual impairment, dental malocclusion, ventricular dilatation, and Chiari malformations.<a class="bk_pop" href="#article-126812.r23">[23]</a> Determining whether urgent or elective treatment is required is also essential.<a class="bk_pop" href="#article-126812.r22">[22]</a></p><p>
|
||
<b>Positional Plagiocephaly</b>
|
||
</p><p>Positional plagiocephaly produces a parallelogram head-shape deformity. The affected side will have occipital flattening and associated bossing of the ipsilateral frontal region and contralateral occipital region. The ear position will be pushed forward, and the mastoid will have a normal appearance. </p><p>
|
||
<b>Posterior Plagiocephaly Secondary to Unilateral Lambdoid Craniosynostosis </b>
|
||
</p><p>Posterior plagiocephaly produces a trapezoid head-shape deformity. Similar to positional plagiocephaly, the affected side will have occipital flattening. In contrast to positional plagiocephaly, there will be associated bossing of both the contralateral frontal and contralateral parietal regions. The ear position will be backward, and the mastoid will be bulging and positioned downward. </p><p>
|
||
<b>Bilateral Lambdoid Craniosynostosis </b>
|
||
</p><p>The presentation of bilateral lambdoid suture craniosynostosis is that of brachycephaly, with both ears displaced inferiorly and anteriorly.<a class="bk_pop" href="#article-126812.r21">[21]</a></p><p>
|
||
<b>Bicoronal Craniosynostosis </b>
|
||
</p><p>The presentation of bi-coronal craniosynostosis is turricephaly, with a towered forehead, seemingly shallow orbits, and a shortened nasal bone. </p><p>
|
||
<b>Anterior Plagiocephaly</b>
|
||
</p><p>Anterior plagiocephaly is secondary to unilateral coronal suture craniosynostosis with contralateral forehead bossing. </p></div><div id="article-126812.s6"><h2 id="_article-126812_s6_">Evaluation</h2><p>The physical examination is the most crucial aspect of the diagnosis of craniosynostosis. Radiological imaging studies are usually not required to diagnose positional plagiocephaly but may be helpful in unclear cases. Conversely, synostotic infant head shape abnormalities require radiographic evaluation of the abnormal sutures either by skull x-ray or computed tomography (CT scan of the head). CT imaging with 3-dimensional image reconstruction is the imaging modality of choice. Other imaging modalities, such as ultrasonography before fontanelle closure or magnetic resonance imaging (MRI), may also be employed if there is a concern for intracranial abnormalities, such as hydrocephalus. In synostotic brachycephaly (bi-coronal synostosis), CT imaging studies usually demonstrate the thickening of the sutures implicated. Skull x-rays will show a sclerotic margin along the suture of interest. In some instances, these sutures may not be visible. Genetic tests may be performed if affected infants present with additional features suggesting the presence of an underlying genetic syndrome. </p></div><div id="article-126812.s7"><h2 id="_article-126812_s7_">Treatment / Management</h2><p>Positional (non-synostotic) brachycephaly or plagiocephaly are usually treated conservatively. The best management for positional plagiocephaly is prevention. Pediatrician counseling on tummy time beginning in infancy and early repositioning. If present, torticollis exercises should be utilized. Surgery is not indicated, given the absence of craniosynostosis. The parents of affected infants should be reassured, and attempts may be made to alternate the infant's head position for sleep (repositioning education). Other conservative treatment measures include massage therapy, physiotherapy (for torticollis), assistive devices, and helmet therapy. Helmets are expensive, require frequent visits to the orthotist every 2 weeks, and have their own complications, including pressure sores, subcutaneous abscess, and failure to correct the deformity.<a class="bk_pop" href="#article-126812.r24">[24]</a> Therefore, prevention and active repositioning should instead be the mainstay of therapeutic intervention in children. </p><p>Synostotic infant head shape abnormalities require surgical intervention, with the timing of surgery being crucial. Infants with signs or symptoms of raised intracranial pressure require urgent interventions. Surgical repair of uncomplicated bi-coronal synostosis is usually delayed until after the 6th month of life and is usually undertaken between 6 and 12 months old. Lambdoid synostosis should be repaired between the 2nd and 6th months of life. Established surgical management strategies include sub-total or complete cranial vault remodeling, cranioplasty (spring-assisted), and endoscopic suturectomy with postoperative helmet therapy. Early referral is advised as delayed referrals may result in more extensive surgical interventions with higher risks of complications. The best outcomes for endoscopic surgery are up to 6 months of age, while the bone is still the most malleable. The benefits of endoscopic surgery include less observed patient discomfort, less blood loss, and shorter hospital stays.<a class="bk_pop" href="#article-126812.r25">[25]</a> </p><p>Following endoscopic surgery, a helmet is often fitted 3 to 7 days following surgery and may be worn up to 1 year post-operatively.<a class="bk_pop" href="#article-126812.r26">[26]</a> Open surgical repair is usually employed between 4 to 12 months of age. All open cranial vault reconstructions begin with a bi-coronal skin incision. Lambdoid craniosynostosis requires bi-parietal craniotomies with barrel staving of the frontal and occipital bones. In cases of coronal craniosynostosis, anterior cranial vault remodeling with orbital rim advancement is used. This technique includes a bifrontal craniotomy, the creation of an orbital bandeau, and subsequent bifrontal advancement.<a class="bk_pop" href="#article-126812.r27">[27]</a></p></div><div id="article-126812.s8"><h2 id="_article-126812_s8_">Differential Diagnosis</h2><p>Synostotic (bi-coronal or bi-lambdoid synostosis) brachycephaly in infants may be associated with multiple syndromic conditions. Following a standardized pattern of physical examination is essential to avoid overlooking any vital etiological clues. Some of the common syndromes included in the differential diagnosis are as follows:</p><ul><li class="half_rhythm"><div>Crouzon syndrome: Bicoronal synostosis resulting in brachycephaly, proptosis, midface hypoplasia with a characteristic underbite (mal-occlusion), and an upturned nose.<a class="bk_pop" href="#article-126812.r28">[28]</a> Patients will usually have normal intelligence.</div></li><li class="half_rhythm"><div>Apert syndrome: Bicoronal synostosis with syndactyly of digits 2, 3, and 4.<a class="bk_pop" href="#article-126812.r29">[29]</a> Patients may have mental retardation and mid-face hypoplasia. </div></li><li class="half_rhythm"><div>Pfeiffer syndrome: Craniosynostosis, abnormally broad and medially deviated thumbs and great toes, varying degrees of protruding eyes, and conductive hearing loss.<a class="bk_pop" href="#article-126812.r30">[30]</a>
|
||
<ul><li class="half_rhythm"><div>Type 1: Turribrachycephaly, midface hypoplasia, high forehead, ocular hypertelorism, hypoplastic maxilla, and dental abnormalities. Intelligence is usually normal.</div></li><li class="half_rhythm"><div>Type 2: Cloverleaf skull (or Kleeblattschadel-type craniosynostosis), hydrocephalus, ocular proptosis, beak-shaped nose, and neurological problems due to severe involvement of the brain.</div></li><li class="half_rhythm"><div>Type 3: This is the same as type 2, except for the absence of a Cloverleaf skull. Additionally, natal teeth and an anterior cranial base are present.</div></li></ul>
|
||
</div></li><li class="half_rhythm"><div>Saethre-Chotzen syndrome: Also called "acrocephalosyndactyly," craniosynostosis and or syndactyly of certain digits and characterized by a low-set hairline and facial asymmetry.<a class="bk_pop" href="#article-126812.r31">[31]</a> </div></li><li class="half_rhythm"><div>Carpenter syndrome: Craniosynostosis, syndactyly of certain digits or polydactyly.<a class="bk_pop" href="#article-126812.r32">[32]</a> May have short stature and congenital heart defects. </div></li><li class="half_rhythm"><div>Antley-Bixler syndrome: Craniosynostosis, proptosis, low set ears, mid-face hypoplasia, radiohumeral or radioulnar synostosis, arachnodactyly, and joint contractures.</div></li><li class="half_rhythm"><div>Muenke syndrome: Coronal craniosynostosis, carpal synostosis, hearing loss, developmental delay, cone-shaped epiphysis, and high narrow palate.</div></li><li class="half_rhythm"><div>Beare-Stevenson cutis gyrata syndrome: Craniosynostosis, cutis gyrata (furrowed and wrinkled appearance of skin and acanthosis nigricans), choanal atresia, abnormality of the pancreas, and aplasia/hypoplasia of the earlobes.</div></li><li class="half_rhythm"><div>Jackson-Weiss syndrome: Craniosynostosis, midfacial hypoplasia, broad great toes, or malformation or fusion of certain bones within the feet.</div></li></ul></div><div id="article-126812.s9"><h2 id="_article-126812_s9_">Prognosis</h2><p>Positional (non-synostotic) brachycephaly or plagiocephaly are the most common infant head shape abnormalities encountered in the primary health care setting. Parental reassurance and management with conservative measures such as repositioning education are usually sufficient, with improvements evident in most infants as they attain their developmental milestones.<a class="bk_pop" href="#article-126812.r16">[16]</a> Refractory cases of positional brachycephaly should be referred for helmet therapy, and any instances of suspected craniosynostosis should be referred early for an opinion from an experienced craniofacial team. Early craniofacial referrals of synostotic brachycephaly may prevent the need for more extensive surgical interventions. Cosmetic outcomes following non-syndromic craniosynostosis repair are excellent for open and endoscopic approaches with low redo rates.<a class="bk_pop" href="#article-126812.r33">[33]</a></p></div><div id="article-126812.s10"><h2 id="_article-126812_s10_">Complications</h2><p>Positional brachycephaly primarily raises aesthetic concerns. Reliable evidence of its effect on the neurological development of affected infants is lacking. Conversely, untreated synostotic brachycephaly may impede volumetric brain growth and development, is associated with elevated intracranial pressure in infants, and has a high incidence of intracranial hypertension in older untreated patients.<a class="bk_pop" href="#article-126812.r34">[34]</a> Cognitive and behavioral difficulties in those affected have been previously suggested to be related to elevated ICP.<a class="bk_pop" href="#article-126812.r10">[10]</a> However, no correlation was identified between both variables in several other studies.<a class="bk_pop" href="#article-126812.r35">[35]</a><a class="bk_pop" href="#article-126812.r36">[36]</a><a class="bk_pop" href="#article-126812.r37">[37]</a> The effect of craniosynostosis surgical repair on neurodevelopment remains widely debated.</p></div><div id="article-126812.s11"><h2 id="_article-126812_s11_">Consultations</h2><p>A pediatrician usually detects and diagnoses the condition of brachycephaly in infants. Specialist consultation with a craniofacial team, traditionally led by a pediatric neurosurgeon in concert with a craniofacial plastic surgeon and occasionally a geneticist, is necessary in cases of synostotic brachycephaly.</p></div><div id="article-126812.s12"><h2 id="_article-126812_s12_">Deterrence and Patient Education</h2><p>Parents concerned about their infant's head shape should consult a pediatrician early. If there is suspicion of craniosynostosis, the pediatrician can arrange further specialist consultation with a craniofacial team. If the abnormal head shape is secondary to positional plagiocephaly, patient counseling can be provided. </p></div><div id="article-126812.s13"><h2 id="_article-126812_s13_">Enhancing Healthcare Team Outcomes </h2><p>Brachycephaly can be diagnosed by history and physical examination, which is essential to distinguish between non-synostotic and synostotic brachycephaly. Most cases of non-synostotic brachycephaly improve with conservative measures. Refractory cases should be referred for helmet therapy consideration. Cases of brachycephaly secondary to craniosynostosis should be referred early for craniofacial consultation and appropriate surgical management as part of an interprofessional team approach to care.</p></div><div id="article-126812.s14"><h2 id="_article-126812_s14_">Review Questions</h2><ul><li class="half_rhythm"><div>
|
||
<a href="https://www.statpearls.com/account/trialuserreg/?articleid=126812&utm_source=pubmed&utm_campaign=reviews&utm_content=126812" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Access free multiple choice questions on this topic.</a>
|
||
</div></li><li class="half_rhythm"><div>
|
||
<a href="https://mdsearchlight.com/child-health/brachycephaly/?utm_source=pubmedlink&utm_campaign=MDS&utm_content=126812" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Click here for a simplified version.</a>
|
||
</div></li><li class="half_rhythm"><div>
|
||
<a href="https://www.statpearls.com/articlelibrary/commentarticle/126812/?utm_source=pubmed&utm_campaign=comments&utm_content=126812" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Comment on this article.</a>
|
||
</div></li></ul></div><div id="article-126812.s15"><h2 id="_article-126812_s15_">References</h2><dl class="temp-labeled-list"><dt>1.</dt><dd><div class="bk_ref" id="article-126812.r1">Collett BR, Leroux BG, Wallace ER, Gallagher E, Shao J, Speltz ML. Head shape at age 36 months among children with and without a history of positional skull deformation. <span><span class="ref-journal">J Neurosurg Pediatr. </span>2018 Mar;<span class="ref-vol">21</span>(3):204-213.</span> [<a href="/pmc/articles/PMC5832631/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5832631</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/29303454" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29303454</span></a>]</div></dd><dt>2.</dt><dd><div class="bk_ref" id="article-126812.r2">Baird LC, Klimo P, Flannery AM, Bauer DF, Beier A, Durham S, Lin AY, McClung-Smith C, Mitchell L, Nikas D, Tamber MS, Tyagi R, Mazzola C. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline for the Management of Patients With Positional Plagiocephaly: The Role of Physical Therapy. <span><span class="ref-journal">Neurosurgery. </span>2016 Nov;<span class="ref-vol">79</span>(5):E630-E631.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/27776088" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27776088</span></a>]</div></dd><dt>3.</dt><dd><div class="bk_ref" id="article-126812.r3">van Cruchten C, Feijen MMW, van der Hulst RRWJ. Demographics of Positional Plagiocephaly and Brachycephaly; Risk Factors and Treatment. 2021 Nov-Dec 01<span><span class="ref-journal">J Craniofac Surg. </span><span class="ref-vol">32</span>(8):2736-2740.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/34231510" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34231510</span></a>]</div></dd><dt>4.</dt><dd><div class="bk_ref" id="article-126812.r4">Positional plagiocephaly and sleep positioning: An update to the joint statement on sudden infant death syndrome. <span><span class="ref-journal">Paediatr Child Health. </span>2001 Dec;<span class="ref-vol">6</span>(10):788-93.</span> [<a href="/pmc/articles/PMC2805995/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2805995</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/20084156" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20084156</span></a>]</div></dd><dt>5.</dt><dd><div class="bk_ref" id="article-126812.r5">Turk AE, McCarthy JG, Thorne CH, Wisoff JH. The "back to sleep campaign" and deformational plagiocephaly: is there cause for concern? <span><span class="ref-journal">J Craniofac Surg. </span>1996 Jan;<span class="ref-vol">7</span>(1):12-8.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/9086896" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9086896</span></a>]</div></dd><dt>6.</dt><dd><div class="bk_ref" id="article-126812.r6">Pelligra R, Doman G, Leisman G. A reassessment of the SIDS Back to Sleep Campaign. <span><span class="ref-journal">ScientificWorldJournal. </span>2005 Jul 21;<span class="ref-vol">5</span>:550-7.</span> [<a href="/pmc/articles/PMC5936520/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5936520</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/16075152" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16075152</span></a>]</div></dd><dt>7.</dt><dd><div class="bk_ref" id="article-126812.r7">Linz C, Kunz F, Böhm H, Schweitzer T. Positional Skull Deformities. <span><span class="ref-journal">Dtsch Arztebl Int. </span>2017 Aug 07;<span class="ref-vol">114</span>(31-32):535-542.</span> [<a href="/pmc/articles/PMC5624275/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5624275</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28835328" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28835328</span></a>]</div></dd><dt>8.</dt><dd><div class="bk_ref" id="article-126812.r8">Marshall JM, Shahzad F. Safe Sleep, Plagiocephaly, and Brachycephaly: Assessment, Risks, Treatment, and When to Refer. <span><span class="ref-journal">Pediatr Ann. </span>2020 Oct 01;<span class="ref-vol">49</span>(10):e440-e447.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/33034660" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33034660</span></a>]</div></dd><dt>9.</dt><dd><div class="bk_ref" id="article-126812.r9">Kuratani S. The neural crest and origin of the neurocranium in vertebrates. <span><span class="ref-journal">Genesis. </span>2018 Jun;<span class="ref-vol">56</span>(6-7):e23213.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/30134067" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30134067</span></a>]</div></dd><dt>10.</dt><dd><div class="bk_ref" id="article-126812.r10">Dias MS, Samson T, Rizk EB, Governale LS, Richtsmeier JT., SECTION ON NEUROLOGIC SURGERY, SECTION ON PLASTIC AND RECONSTRUCTIVE SURGERY. Identifying the Misshapen Head: Craniosynostosis and Related Disorders. <span><span class="ref-journal">Pediatrics. </span>2020 Sep;<span class="ref-vol">146</span>(3)</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/32868470" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32868470</span></a>]</div></dd><dt>11.</dt><dd><div class="bk_ref" id="article-126812.r11">Wilkie AOM, Johnson D, Wall SA. Clinical genetics of craniosynostosis. <span><span class="ref-journal">Curr Opin Pediatr. </span>2017 Dec;<span class="ref-vol">29</span>(6):622-628.</span> [<a href="/pmc/articles/PMC5681249/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5681249</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28914635" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28914635</span></a>]</div></dd><dt>12.</dt><dd><div class="bk_ref" id="article-126812.r12">Ornitz DM, Marie PJ. Fibroblast growth factors in skeletal development. <span><span class="ref-journal">Curr Top Dev Biol. </span>2019;<span class="ref-vol">133</span>:195-234.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/30902253" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30902253</span></a>]</div></dd><dt>13.</dt><dd><div class="bk_ref" id="article-126812.r13">Sawh-Martinez R, Steinbacher DM. Syndromic Craniosynostosis. <span><span class="ref-journal">Clin Plast Surg. </span>2019 Apr;<span class="ref-vol">46</span>(2):141-155.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/30851747" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30851747</span></a>]</div></dd><dt>14.</dt><dd><div class="bk_ref" id="article-126812.r14">Li H, Zhao A, Xie M, Chen L, Wu H, Shen Y, Wang H. Antley-Bixler syndrome arising from compound heterozygotes in the P450 oxidoreductase gene: a case report. <span><span class="ref-journal">Transl Pediatr. </span>2021 Dec;<span class="ref-vol">10</span>(12):3309-3318.</span> [<a href="/pmc/articles/PMC8753478/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8753478</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/35070845" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 35070845</span></a>]</div></dd><dt>15.</dt><dd><div class="bk_ref" id="article-126812.r15">Hutchison BL, Hutchison LA, Thompson JM, Mitchell EA. Plagiocephaly and brachycephaly in the first two years of life: a prospective cohort study. <span><span class="ref-journal">Pediatrics. </span>2004 Oct;<span class="ref-vol">114</span>(4):970-80.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/15466093" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15466093</span></a>]</div></dd><dt>16.</dt><dd><div class="bk_ref" id="article-126812.r16">Roby BB, Finkelstein M, Tibesar RJ, Sidman JD. Prevalence of positional plagiocephaly in teens born after the "Back to Sleep" campaign. <span><span class="ref-journal">Otolaryngol Head Neck Surg. </span>2012 May;<span class="ref-vol">146</span>(5):823-8.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/22241785" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22241785</span></a>]</div></dd><dt>17.</dt><dd><div class="bk_ref" id="article-126812.r17">Robinson S, Proctor M. Diagnosis and management of deformational plagiocephaly. <span><span class="ref-journal">J Neurosurg Pediatr. </span>2009 Apr;<span class="ref-vol">3</span>(4):284-95.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/19338406" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19338406</span></a>]</div></dd><dt>18.</dt><dd><div class="bk_ref" id="article-126812.r18">Rogers GF, Oh AK, Mulliken JB. The role of congenital muscular torticollis in the development of deformational plagiocephaly. <span><span class="ref-journal">Plast Reconstr Surg. </span>2009 Feb;<span class="ref-vol">123</span>(2):643-652.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/19182625" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19182625</span></a>]</div></dd><dt>19.</dt><dd><div class="bk_ref" id="article-126812.r19">Boulet SL, Rasmussen SA, Honein MA. A population-based study of craniosynostosis in metropolitan Atlanta, 1989-2003. <span><span class="ref-journal">Am J Med Genet A. </span>2008 Apr 15;<span class="ref-vol">146A</span>(8):984-91.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/18344207" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18344207</span></a>]</div></dd><dt>20.</dt><dd><div class="bk_ref" id="article-126812.r20">Cornelissen M, Ottelander Bd, Rizopoulos D, van der Hulst R, Mink van der Molen A, van der Horst C, Delye H, van Veelen ML, Bonsel G, Mathijssen I. Increase of prevalence of craniosynostosis. <span><span class="ref-journal">J Craniomaxillofac Surg. </span>2016 Sep;<span class="ref-vol">44</span>(9):1273-9.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/27499511" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27499511</span></a>]</div></dd><dt>21.</dt><dd><div class="bk_ref" id="article-126812.r21">Muakkassa KF, Hoffman HJ, Hinton DR, Hendrick EB, Humphreys RP, Ash J. Lambdoid synostosis. Part 2: Review of cases managed at The Hospital for Sick Children, 1972-1982. <span><span class="ref-journal">J Neurosurg. </span>1984 Aug;<span class="ref-vol">61</span>(2):340-7.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/6737059" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 6737059</span></a>]</div></dd><dt>22.</dt><dd><div class="bk_ref" id="article-126812.r22">Johnson D, Wilkie AO. Craniosynostosis. <span><span class="ref-journal">Eur J Hum Genet. </span>2011 Apr;<span class="ref-vol">19</span>(4):369-76.</span> [<a href="/pmc/articles/PMC3060331/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3060331</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/21248745" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21248745</span></a>]</div></dd><dt>23.</dt><dd><div class="bk_ref" id="article-126812.r23">Cohen MM. Craniosynostosis update 1987. <span><span class="ref-journal">Am J Med Genet Suppl. </span>1988;<span class="ref-vol">4</span>:99-148.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/3144990" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3144990</span></a>]</div></dd><dt>24.</dt><dd><div class="bk_ref" id="article-126812.r24">Wilbrand JF, Wilbrand M, Malik CY, Howaldt HP, Streckbein P, Schaaf H, Kerkmann H. Complications in helmet therapy. <span><span class="ref-journal">J Craniomaxillofac Surg. </span>2012 Jun;<span class="ref-vol">40</span>(4):341-6.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/21741852" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21741852</span></a>]</div></dd><dt>25.</dt><dd><div class="bk_ref" id="article-126812.r25">Vogel TW, Woo AS, Kane AA, Patel KB, Naidoo SD, Smyth MD. A comparison of costs associated with endoscope-assisted craniectomy versus open cranial vault repair for infants with sagittal synostosis. <span><span class="ref-journal">J Neurosurg Pediatr. </span>2014 Mar;<span class="ref-vol">13</span>(3):324-31.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/24410127" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24410127</span></a>]</div></dd><dt>26.</dt><dd><div class="bk_ref" id="article-126812.r26">Barone CM, Jimenez DF. Endoscopic approach to coronal craniosynostosis. <span><span class="ref-journal">Clin Plast Surg. </span>2004 Jul;<span class="ref-vol">31</span>(3):415-22, vi.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/15219748" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15219748</span></a>]</div></dd><dt>27.</dt><dd><div class="bk_ref" id="article-126812.r27">Nowinski D, Di Rocco F, Renier D, SainteRose C, Leikola J, Arnaud E. Posterior cranial vault expansion in the treatment of craniosynostosis. Comparison of current techniques. <span><span class="ref-journal">Childs Nerv Syst. </span>2012 Sep;<span class="ref-vol">28</span>(9):1537-44.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/22872270" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22872270</span></a>]</div></dd><dt>28.</dt><dd><div class="bk_ref" id="article-126812.r28">Conrady CD, Patel BC. <span class="ref-journal">StatPearls [Internet].</span> StatPearls Publishing; Treasure Island (FL): Aug 7, 2023. Crouzon Syndrome. [<a href="https://pubmed.ncbi.nlm.nih.gov/30085540" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30085540</span></a>]</div></dd><dt>29.</dt><dd><div class="bk_ref" id="article-126812.r29">Conrady CD, Patel BC, Sharma S. <span class="ref-journal">StatPearls [Internet].</span> StatPearls Publishing; Treasure Island (FL): Jun 1, 2023. Apert Syndrome. [<a href="https://pubmed.ncbi.nlm.nih.gov/30085535" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30085535</span></a>]</div></dd><dt>30.</dt><dd><div class="bk_ref" id="article-126812.r30">Das JM, Winters R. <span class="ref-journal">StatPearls [Internet].</span> StatPearls Publishing; Treasure Island (FL): Jul 4, 2023. Pfeiffer Syndrome. [<a href="https://pubmed.ncbi.nlm.nih.gov/30422477" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30422477</span></a>]</div></dd><dt>31.</dt><dd><div class="bk_ref" id="article-126812.r31">Abulezz TA, Allam KA, Wan DC, Lee JC, Kawamoto HK. Saethre-Chotzen Syndrome: A Report of 7 Patients and Review of the Literature. <span><span class="ref-journal">Ann Plast Surg. </span>2020 Sep;<span class="ref-vol">85</span>(3):251-255.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/32487807" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32487807</span></a>]</div></dd><dt>32.</dt><dd><div class="bk_ref" id="article-126812.r32">Bouaré F, Noureldine MHA, Hajhouji F, Ghannane H, Jallo GI, Ait Benali S. Complex craniosynostosis in the context of Carpenter's syndrome. <span><span class="ref-journal">Childs Nerv Syst. </span>2022 Apr;<span class="ref-vol">38</span>(4):831-835.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/34244844" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34244844</span></a>]</div></dd><dt>33.</dt><dd><div class="bk_ref" id="article-126812.r33">Simpson A, Wong AL, Bezuhly M. Surgical Correction of Nonsyndromic Sagittal Craniosynostosis: Concepts and Controversies. <span><span class="ref-journal">Ann Plast Surg. </span>2017 Jan;<span class="ref-vol">78</span>(1):103-110.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/26808733" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26808733</span></a>]</div></dd><dt>34.</dt><dd><div class="bk_ref" id="article-126812.r34">Judy BF, Swanson JW, Yang W, Storm PB, Bartlett SP, Taylor JA, Heuer GG, Lang SS. Intraoperative intracranial pressure monitoring in the pediatric craniosynostosis population. <span><span class="ref-journal">J Neurosurg Pediatr. </span>2018 Nov 01;<span class="ref-vol">22</span>(5):475-480.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/30074450" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30074450</span></a>]</div></dd><dt>35.</dt><dd><div class="bk_ref" id="article-126812.r35">Knight SJ, Anderson VA, Spencer-Smith MM, Da Costa AC. Neurodevelopmental outcomes in infants and children with single-suture craniosynostosis: a systematic review. <span><span class="ref-journal">Dev Neuropsychol. </span>2014;<span class="ref-vol">39</span>(3):159-86.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/24742309" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24742309</span></a>]</div></dd><dt>36.</dt><dd><div class="bk_ref" id="article-126812.r36">Arnaud E, Renier D, Marchac D. Prognosis for mental function in scaphocephaly. <span><span class="ref-journal">J Neurosurg. </span>1995 Sep;<span class="ref-vol">83</span>(3):476-9.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/7666225" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7666225</span></a>]</div></dd><dt>37.</dt><dd><div class="bk_ref" id="article-126812.r37">Gault DT, Renier D, Marchac D, Jones BM. Intracranial pressure and intracranial volume in children with craniosynostosis. <span><span class="ref-journal">Plast Reconstr Surg. </span>1992 Sep;<span class="ref-vol">90</span>(3):377-81.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/1513883" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1513883</span></a>]</div></dd></dl></div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_top_margin">
|
||
<b>Disclosure: </b>Michael Ita declares no relevant financial relationships with ineligible companies.</p></div></dd><dt></dt><dd><div><p class="no_top_margin">
|
||
<b>Disclosure: </b>Luke Weisbrod declares no relevant financial relationships with ineligible companies.</p></div></dd><dt></dt><dd><div><p class="no_top_margin">
|
||
<b>Disclosure: </b>Munaza Batool Rizvi declares no relevant financial relationships with ineligible companies.</p></div></dd></dl></div></div></div>
|
||
<div class="post-content"><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © 2025, StatPearls Publishing LLC.<p class="small">
|
||
This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)
|
||
(<a href="https://creativecommons.org/licenses/by-nc-nd/4.0/" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=uri">
|
||
http://creativecommons.org/licenses/by-nc-nd/4.0/
|
||
</a>), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.
|
||
</p></div><div class="small"><span class="label">Bookshelf ID: NBK567709</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/33620786" title="PubMed record of this page" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">33620786</a></span></div></div></div>
|
||
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="bottom">
|
||
|
||
<div id="NCBIFooter_dynamic">
|
||
<!--<component id="Breadcrumbs" label="breadcrumbs"/>
|
||
<component id="Breadcrumbs" label="helpdesk"/>-->
|
||
|
||
</div>
|
||
|
||
<script type="text/javascript" src="/portal/portal3rc.fcgi/rlib/js/InstrumentNCBIBaseJS/InstrumentPageStarterJS.js"> </script>
|
||
</div>
|
||
</div>
|
||
<!--/.page-->
|
||
</div>
|
||
<!--/.wrap-->
|
||
</div><!-- /.twelve_col -->
|
||
</div>
|
||
<!-- /.grid -->
|
||
|
||
<span class="PAFAppResources"></span>
|
||
|
||
<!-- BESelector tab -->
|
||
|
||
|
||
|
||
<noscript><img alt="statistics" src="/stat?jsdisabled=true&ncbi_db=books&ncbi_pdid=book-part&ncbi_acc=NBK567709&ncbi_domain=statpearls&ncbi_report=printable&ncbi_type=fulltext&ncbi_objectid=&ncbi_pcid=/NBK567709/?report=printable&ncbi_app=bookshelf" /></noscript>
|
||
|
||
|
||
<!-- usually for JS scripts at page bottom -->
|
||
<!--<component id="PageFixtures" label="styles"></component>-->
|
||
|
||
|
||
<!-- CE8B5AF87C7FFCB1_0191SID /projects/books/PBooks@9.11 portal107 v4.1.r689238 Tue, Oct 22 2024 16:10:51 -->
|
||
<span id="portal-csrf-token" style="display:none" data-token="CE8B5AF87C7FFCB1_0191SID"></span>
|
||
|
||
<script type="text/javascript" src="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/js/3879255/4121861/3501987/4008961/3893018/3821238/3400083/3426610.js" snapshot="books"></script></body>
|
||
</html> |