What are the less severe conditions associated with skull defects?

From the Guidelines

Less severe conditions associated with skull defects include craniosynostosis, small cranial defects, non-displaced skull fractures, and benign skull lesions, which can be managed conservatively without immediate surgical intervention. These conditions may cause abnormal head shape, cosmetic concerns, or mild headaches, but typically do not affect brain development or function. According to a study published in Nature Reviews Nephrology 1, craniosynostosis can occur as early as 1 year of age and usually involves an abnormal fusion of the sagittal suture, leading to a dolichocephalic conformation of the head. Some key points to consider include:

• Craniosynostosis can be suspected in the presence of signs of intracranial hypertension, such as headache, neck pain, or papilledema 1
• Small cranial defects or dents that do not impact brain function may not require immediate surgical intervention
• Benign skull lesions like fibrous dysplasia or hemangiomas can be monitored through regular imaging and neurological examinations
• Cranial bone thinning from conditions like Paget's disease or osteoporosis can create areas of weakness without immediate danger The severity of these conditions often depends on the location, size, and whether the defect affects underlying brain tissue or cerebrospinal fluid containment. A study published in Pediatrics 1 recommends referral to a pediatric plastic surgeon for infants, children, and adolescents with congenital malformations of the skull, including craniosynostosis. Another study published in Pediatrics 1 discusses the importance of detecting and treating cranial dermal sinus tracts to prevent future complications.

From the Research

Less Severe Conditions Associated with Skull Defects

• Positional plagiocephaly: a deformation resulting from intrauterine constraint or postnatal positioning leading to asymmetrical cranial growth 2
• Positional skull deformities: manifesting as a uni- or bilateral flattening of the occiput, often giving rise to questions of differential diagnosis and potential treatment 3
• Craniosynostosis: the premature fusion of one or more of the cranial sutures, which can occur as a spontaneous isolated defect or as part of a familial or syndromic form 4

Characteristics and Treatment Options

• Positional plagiocephaly can be managed by stretching exercises and regular prone positioning in milder cases, while in more severe cases molding helmets may be needed 2
• Physical therapy treatment is considered as the first line of intervention in plagiocephaly with non-synostotic asymmetries, and manual therapy is the method that obtains the best results within this intervention 5
• Helmet therapy can be an effective second-line intervention in cases of moderate or severe plagiocephaly 5
• Parent education and counseling are essential for preventing positional skull deformities and promoting correct positioning habits 3, 2

Prevention and Early Intervention

• Early referral to a pediatric craniofacial center allows all treatment options to be explored for craniosynostosis 4
• Early treatment is essential for optimal therapeutic outcomes in positional plagiocephaly 5
• Comprehensive information and education should be provided to parents of children with positional skull deformities to promote correct positioning habits and prevent further deformation 3