Further Outpatient Care
Following surgery, carefully monitor patients to ensure that the suture does not re-fuse. Continue head circumference measurements. Watch for signs of raised intracranial pressure in infants at risk.
Complications
In the immediate postoperative period, complications include hemorrhage.
Prognosis
Patients with primary craniosynostosis must be monitored after surgery. The vast majority of patients with primary, single suture synostosis have little or no morbidity following surgery. One systematic review of neurodevelopmental studies found some evidence that children with single suture synostosis are at increased risk for difficulties in cognitive, language, and motor domains during infancy (both pre- and post-surgery) and childhood. [17]
In secondary craniosynostosis, prognosis is dependent upon underlying etiology.
Patients with syndromic craniosynostosis can have a much more complicated clinical course due to the increased severity of the craniosynostosis and associated problems (e.g., hydrocephalus and airway obstruction). They are also at increased risk of intellectual disability, and social and attention problems. [18] A multidisciplinary approach is important in the management of the complex problems of these patients.
Patient Education
If a patient has a mild head shape deformity, inform parents that the deformity will become less prominent with the appearance of abundant hair and physiological molding.
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Diagram of a neonate's skull demonstrating the location of the sutures.
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Frontal view showing a fused and ridged metopic suture on 3-dimensional CT.
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CT image demonstrating features of secondary craniosynostosis with cerebral atrophy. Cerebral atrophy is not present in primary craniosynostosis.
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Positional molding. Note the anterior displacement of the right occiput and of the right frontal region on the same side, which differentiate positional molding from posterior plagiocephaly craniosynostosis.
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Posterior view of 3-dimensional cranial CT demonstrating early fusion of the lambdoid suture.
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Isolated fusion of the metopic suture. Note that the remaining sutures are open.
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Trigonocephaly. Note the triangular shape of the head.
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Infant with primary craniosynostosis. The specific deformity of the skull is Kleeblattschadel or cloverleaf skull.
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Skull deformities associated with single suture synostosis.
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Positional plagiocephaly. Note anterior position of the ear on the side with occipital flattening.
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Sagittal synostosis and the associated scaphocephaly seen on skull radiograph and 3-dimensional craniofacial CT scan.
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Sagittal synostosis before and after cranial vault surgery and the associate improvement of scaphocephaly.
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Unilateral coronal deformity with retrusion of the orbit and harlequin eye deformity. Note the ipsilateral deviation of the nasal radix and the contralateral deviation of the nasal tip.
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Fusion of coronal sutures bilaterally. Note the increase transverse dimension and retrusion of the orbital rim.
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Intraoperative view of bilateral coronal synostosis. Note the decreased anterior-posterior dimension, increased transverse width and retruded orbital rim.
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Pre- and postoperative photos of metopic synostosis. Note the prominent forehead keel corrected after surgical repair.
