Fusion of the frontal bones in a child. The importance of early diagnosis of congenital skull deformities in children. Craniosynostosis, craniostenosis. Surgery to reshape the skull in babies

Craniostenosis - (from the Greek. Kranion - skull and stenosis - narrowing) premature closure of cranial sutures or their congenital absence.

The baby's skull consists of 6 bones of the skull: the frontal bone, the occipital bone, two parietal bones, two temporal bones. Normally, all these bones of the skull are not fused, the anterior and posterior fontanelles are open. The bones listed above are held together by strong, elastic tissues called sutures. Without the flexibility of these seams, the baby's brain cannot grow properly. The brain grows and the baby's skull lid should expand as well. The stitches respond to brain growth by "stretching" and "producing" new bone, thereby allowing the skull to grow with the brain. Normal growth of the skull occurs perpendicular to each suture.

The posterior fontanelle closes by the end of the 2nd month, the anterior fontanelle closes during the 2nd year of life. By the end of the 6th month of life, the bones of the cranial vault are interconnected by a dense fibrous membrane. By the end of the 1st year of life, the size of the child's head is 90%, and by the age of 6 years it reaches 95% of the size of the head of an adult. Closing the sutures by connecting the jagged edges of the bones begins by the end of the 1st year of life and completely ends by the age of 12-14.

Premature and uneven overgrowing of fontanelles and cranial sutures in children - craniostenosis - interferes with the normal development of the brain and leads to the creation of conditions for liquorodynamic disorders. CSF disorders are usually called pathological conditions in which the secretion, resorption and circulation of cerebrospinal fluid are impaired. The incidence of craniostenosis is 1 per 1000 newborns. With craniostenosis, intracranial pressure is usually increased, in connection with this, hypertensive headache is characteristic, the development of congestive optic discs is possible, followed by their secondary atrophy and visual impairment, mental retardation.

Causes

Distinguish between primary (idiopathic) and secondary craniosynostosis. The development of secondary craniosynostosis can be due to various reasons. These include vitamin D-deficient rickets, hypophosphatemia, thyroid hormone overdose in cases of treatment of congenital hypothyroid oligophrenia (cretinism).

What's happening?

The overgrowth of the sutures of the skull is not only premature, but also uneven, usually leads to deformation of the skull. In the process of monitoring the development of the shape of the cerebral skull, the so-called cranial index (CI) is taken into account - the ratio of the transverse size of the skull to its longitudinal size, multiplied by 100. With a normal (average) ratio of the transverse and longitudinal dimensions of the head (with mesocephaly), the cranial index in men is 76-80.9, for women - 77-81.9.

With premature overgrowth of the sagittal suture (sagittal synostosis) develops dolichocephaly, in which the skull increases in the anteroposterior direction and is reduced in transverse size. In such cases, the head is narrow and elongated. The CHI is less than 75.

A variant of dolichocephaly caused by premature overgrowth of the sagittal suture, in which there is a restriction of the growth of the skull in the transverse direction and its growth in length turns out to be excessive, can be scaphocephaly(from the Greek skaphe - boat), cymbocephaly (scaphoid head, keel-headedness), in which a long narrow head with a protruding forehead and nape is formed, resembling a boat turned upside down by the keel. Saddle skull is a skull elongated in the longitudinal direction with an impression in the parietal region.

A variant of the skull deformity, in which the skull has an increased transverse size due to premature overgrowth of the coronary (coronal) sutures (coronary, or coronal, synostosis), is brachycephaly(from the Greek. brachis - short and kephale - head), while the head is wide and shortened, the cranial index is over 81. In brachycephaly due to bilateral coronary synostosis, the face is flattened, often exophthalmos is manifested - anterior displacement of one or both eyeballs.

With premature overgrowth of the coronary suture on one side, it develops plagiocephaly, or head-headedness (from the Greek plagios - oblique and kephale - head). In such cases, the skull is asymmetric, the frontal bone on the side of synostosis is flattened, on the same side exophthalmos and an increase in the middle and posterior cranial fossa are possible.

If there is a premature combined infection of the coronary and sagittal cranial sutures, the growth of the skull occurs mainly towards the anterior fontanelle and base, which leads to an increase in the height of the head while limiting its growth in the longitudinal and transverse directions. As a result, a tall, conical skull is formed, somewhat flattened in the anteroposterior direction (acroranium); it is often called a tower skull. A variant of the tower skull is oxycephaly, or a pointed head (from the Greek oxys - sharp, kephale - head), in which the early overgrowth of the cranial sutures leads to the formation of a high, tapering upward skull with a sloping forehead.

A variant of the skull deformity, characterized by a narrow frontal and wide occipital bones, is formed in connection with the premature overgrowth of the frontal suture. In this case, the frontal bones grow together at an angle (normally, overgrowth of the frontal suture occurs only by the end of the 2nd year of life) and a ridge is formed at the site of the frontal suture. If in such cases the posterior parts of the skull increase compensatory and its base deepens, trigonocranium or triangular skull occurs (from the Greek trigonon - triangle, kephale - head).

Isolated synostosis of the lambdoid suture is extremely rare and is accompanied by flattening of the occiput and compensatory expansion of the anterior part of the skull with an increase in the anterior fontanelle. It is often combined with premature closure of the sagittal suture.

At secondary craniostenosis at an early stage of its development, conservative treatment of the underlying disease can be effective. With primary craniostenosis, as well as with secondary craniostenosis, in the case of already developed significant intracranial hypertension, decompression surgery is indicated: the formation of craniectomy passages up to 1 cm wide along the suture ossification line. Timely surgical treatment for craniostenosis can ensure normal brain development in the future.

Treatment

The most active period of brain growth is considered to be the age of up to two years. Thus, from a functional point of view, craniostenosis can be prevented by early surgical treatment. The optimal age for surgery for craniosynostosis can be considered the period from 3 to 9 months. The advantages of treatment at this age can be considered: ease of manipulation with the thin and soft bones of the skull; facilitating the final remodeling of the skull shape by a rapidly growing brain; more complete and faster healing of residual bone defects.

If the treatment is performed after five years, it is doubtful that it will lead to a significant improvement in brain function. To a greater extent, the operation will be aimed at eliminating the deformation of the head. The main feature of modern surgical treatment is not only an increase in the volume of the skull, but also the correction of its shape and combined deformity of the face during one operation.

What parents should pay attention to

The unusual shape of the child's head
Early closure of the large fontanelle (up to a year)
Inconsistency of the growth rate of the head circumference of the child with the age norm (see the head circumference of boys and the circumference of the head of girls)
Poor sleep, anxiety in the child, aggravation of the child when the weather changes, regurgitation, retardation in psychomotor development (see psychomotor development of the child)

If you find the above symptoms in a child, you should contact a specialist:

Neurologist - assesses the presence of neurological symptoms, delayed development of the child
To an ophthalmologist - assesses the signs of intracranial hypertension according to the results of an examination of the fundus (in advanced cases - a decrease in visual acuity)
Pediatrician - assesses the presence of other anomalies in the development of organs and systems, somatic pathology
Genetics - reveals the presence of the genetic nature of the disease, the likelihood of anomalies of other organs and systems and the prognosis of the recurrence of a similar pathology in the next child

Please note that it is better to play it safe and refer a child with a skull deformity to a specialist than to skip the pathology.

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The main symptoms are:

Hand atrophy
Forearm atrophy
Elbow hypertrophy
Deformation of the skull
Short neck
Disorder of mental development
Inability to move the shoulder
Restricting brush movements
Restricted neck mobility
Mental retardation
Decreased performance

Synostosis is the process of fusion of some parts of a bone or two, located together, bones. There are many varieties of this condition. It is noteworthy that some of them do not have a pathological basis.

There are quite a few reasons for the occurrence of such a disorder, and they will all differ depending on the type of pathology. In some cases, the predisposing factors are completely harmless.

The disease has a characteristic external symptomatology, expressed in the fusion of several bones or other types of deformity. An experienced specialist will be able to identify the pathology already during the first examination, however, to determine the form of the ailment, several instrumental examinations and consultation of specialists from different fields of medicine will be required.

The therapy regimen will directly depend on the etiological factor and the form of the disease.

The International Classification of Diseases does not single out a single meaning for such a disorder. It follows from this that the ICD-10 code will differ depending on the type of pathology.

Etiology

Currently, clinicians do not know the mechanism of development and the causes of the congenital form of the disease in a child. However, doctors say that the hereditary factor plays the main role. This suggests that if one of the parents is diagnosed with a similar pathology, then the probability of having a sick child varies from 50 to 100%.

A large number of pathological cases of synostosis are associated with intrauterine skeletal anomalies. But in some cases, such a process can be secondary, that is, acquired.

Sources of such a disorder can be:

a wide range of injuries associated with a violation of the integrity of bone tissue, as well as cartilage or periosteum;
the presence in the medical history of such an ailment as;
the course of degenerative-dystrophic processes with localization in the spine;
ailments such as;
disruption of the functioning of the endocrine system.

It follows from this that synostosis can be both an independent disease and develop against the background of the lack of timely therapy for other ailments. In addition, some types of pathology can be combined with other anomalies.

In some cases, synostosis in children and adults may result from surgery. Sometimes the disease does not have a pathological basis, but is quite normal, for example, fusion of the pelvic bones.

It is extremely rare to find out the sources of the disease.

Classification

Depending on the main cause of the onset, synostosis is divided into:

congenital- is caused by intrauterine structural anomalies, namely, conditions such as hypoplasia or aplasia of connective tissue between spliced bones. In such cases, radioulnar synostosis is often diagnosed, less often the cranial sutures undergo fusion;
acquired- is often the result of diseases affecting the bones;
physiological- does not have a pathological basis and arises during the growing up of the body. Normally, synostosis is formed in adolescence, however, under the influence of some diseases, such a process can accelerate or, conversely, slow down. Such ailments include hypergonadism, eunuchoidism and Kashin-Beck syndrome;
pathological;
artificial- created during surgery. This is necessary to eliminate extensive structural bone defects, as well as to prevent the occurrence of false joints. Most often, this kind of synostosis is created between the tibia;
post-traumatic- based on the name, it is formed against the background of a violation of the integrity of the bone, which happened against the background of an injury. In the vast majority of situations, the bones of the lower leg, forearm and adjacent vertebrae are deformed.

At the site of localization, the fusion of bones has several types, for example:

Symptoms

The clinical signs of synostosis will differ depending on which variety the disease belongs to. For example, synostosis of the bones of the forearm or the radioulnar type of the disease is expressed in the following symptoms:

atrophy of the hand and forearm, which very rarely can be combined with a condition such as hypertrophy of the elbow joint;
the inability to perform shoulder movements, which is fraught with a decrease in performance and the presence of pronounced problems with self-care;
limiting the movement of the brush.

Coronary synostosis is expressed in:

Symptoms of vertebral lesion with synostosis:

shortened neck;
limited mobility of the upper areas of the spine;
deterioration of hair growth or their complete absence in the back of the head;
spina bifida;
decreased skin sensitivity;
increased location of the scapular zone;
the presence of pterygoid folds in the scapular region.

In addition, this type of disease is often accompanied by anomalies in the development of the reproductive system, fingers and toes, ribs and kidneys, the respiratory system and the face.

For any type of disease, a whining character is characteristic. The localization of pain will be the bone deformation zone.

Diagnostics

Despite the fact that synostoses have pronounced symptoms, hardware examinations will be required to establish the final diagnosis.

However, in any case, primary diagnostics should be carried out, which is aimed at the work of the clinician with the patient. Among such measures, it is worth highlighting:

study of the medical history and life history of the patient - to identify the nature of the pathology;
a thorough physical examination - aimed both at identifying the main defect and accompanying symptoms;
a detailed survey of the patient - its need is for the doctor to receive complete information about the nature of the course of the disease.

Diagnosis of synostosis does not imply the implementation of laboratory tests of the patient's blood, urine and feces, since such tests are not of diagnostic value.

Instrumental techniques for establishing the final diagnosis involve:

A similar diagnosis can be performed by an orthopedist or traumatologist, but in addition, you will need consultations from specialists from other fields of medicine, in particular, cardiology, endocrinology, neurology and surgery.

Treatment

The therapy regimen directly depends on the type of disease course.

Synostosis of the bones of the forearm and the radioulnar type of the disease are treated with:

corrective plaster casts;
therapeutic massage of the injured hand;
ensuring the supination position with the forearm;
surgical removal of synostosis, but only after ten months of conservative therapy.

Treatment of cranial synostosis involves only surgical intervention, which is performed in the first years of the patient's life.

Deformation of the vertebrae and coccyx is eliminated by using:

physiotherapy procedures;
therapeutic massage;
analgesics.

The question of the operation is decided on an individual basis for each patient.

In the treatment of rib synostosis, general strengthening techniques prevail, but with pronounced deformity, medical intervention is indicated. When metopic synostosis is diagnosed, the only treatment is a surgical procedure.

Prevention and prognosis

There are no specific preventive measures aimed at preventing synostosis. The general rules only include:

correct management of pregnancy;
early detection and treatment of pathologies that can lead to the development of the underlying ailment;
counseling with a geneticist before a couple decides to have a child
regular full medical examinations.

Despite the fact that the disease is difficult to treat, it has a favorable prognosis. After surgical intervention and with intensive physical therapy in the postoperative period, it is possible to achieve 100% restoration of the functioning of the affected area. However, untimely therapy can lead to patient disability.

In any case, the outcome depends on the degree of damage and deformation of the bones.

Is everything in the article correct from a medical point of view?

Only answer if you have proven medical knowledge

Most often, the manifestations of craniosynostosis begin as a deformity in the first months of life. In addition to a cosmetic defect, craniosynostosis can lead to increased intracranial pressure and adversely affect child development.

Normal development of the skull

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

Cause of craniosynostosis

Manifestations of craniosynostosis

Diagnosis of craniosynostosis

Craniosynostosis treatment

Free consultation on treatment in Moscow and abroad

Craniosynostosis, craniostenosis. Surgery to reshape the skull in babies.

What is craniosynostosis?

Craniosynostosis, craniostenosis is a rare pathology that is characterized by a violation of the structure of the child's skull and skeleton. In children with this pathology, there is a violation of the structure of the facial and cerebral skull (for example, a narrow skull, a narrow forehead). Also, the child may have pathologies in the structure of the skeleton, for example, fusion of several vertebrae, long and thin fingers and toes, some joints may not develop correctly, which leads to restriction of movement.

The skull is made up of bony plates that are connected by sutures. These sutures, as the child's brain grows, begin to grow, and over time they harden. With craniosynostosis, such sutures do not heal correctly, and therefore the child's head has unusual shape.

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

Most often, with this disease, only one seam 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 takes on an irregular shape.

When spliced multiple seams, the child's brain cannot grow properly. Moreover, pressure is gradually created on the child's brain, which can cause blindness and seizures, stunted growth and development... If a child has several sutures of the skull healed 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 abnormal fusion of the skull bones. 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 was lying incorrectly during pregnancy. Other reasons: smoking and drinking alcohol in large quantities by the mother during pregnancy.

Manifestations of craniosynostosis.

The most important manifestation of this pathology is an 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;

* night sleep apnea.

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 shape of the baby's skull is abnormal or that it is 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 baby's head. If the shape of the child's head does not change over time, then an x-ray 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 was transmitted genetically.

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

Craniosynostosis treatment

Typically, treatment for an irregular head in infants consists of surgery on the skull.

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

In our clinic, operations of any complexity are performed. When you contact our clinic Top Ichilov, you are provided with an answer within two working days, so even with urgent appeals, you have the opportunity to come for treatment as soon as possible. We provide everything Required documents for a visit.

Fusion of the bones of the skull in children

NEUROSURGERY - EuroMedicine.ru - 2007

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

In craniostenosis, the brain is compressed due to craniosynostosis.

Premature fusion of the skull bones can often occur even before the baby is born, as a result of which the skull cannot expand in certain directions and take on the normal shape necessary for a growing brain. Depending on which cranial sutures grow together earlier, the skull can be elongated from front to back, wide and short, pointed (acrocephaly (oxycephaly or turricephaly)) or asymmetric.

Normal development of the skull

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

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

The bones of the cranial vault are initially divided into areas of dense connective tissue. At birth, these areas are composed 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: clinical manifestations and, accordingly, the affected cranial suture.

Scaphocephaly is a premature fusion of the sagittal suture.

Plagiocephaly is a premature fusion of the coronal suture.

Trigonocephalus is a premature fusion of the metopic (frontal) suture.

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

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

In addition to the most visible deformity of the head and face, with craniosynostosis, there may be problems in relation to respiratory tract, especially with the syndromic form of craniosynostosis. Due to the underdevelopment of the upper jaw, such patients have difficulties in nasal breathing. At night, they may have periods of "apnea" - holding their breath. This affects not only their development, but also their behavior and speech. With increased intracranial pressure in children, chronic headache is observed, mental impairments develop, and 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. While there may be an outward resemblance to craniosynostosis, it is important to distinguish between these conditions. The fact is that with positional plagiocephaly, no surgical treatment is required. The treatment of this pathology is simple and it consists in a certain laying of the child's head during sleep; in some cases, you may need a special cranial "bandage" put on the child's head in order to correct the shape of the skull.

Diagnosis of this disease consists, 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 with surgery. It consists in separating prematurely fused sutures and recreating the shape of the skull. Cosmetic problems often 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 hair to look more natural. To stop bleeding with this incision, Leroy clamps are used. After the incision, the skin flap (scalp) is folded back. Holes are made in the skull. Through these holes, the bones of the skull are sawed, as it were, which allows it to be divided into several parts. After the surgeon has reconstructed the shape of the skull, the parts of the skull are laid back (usually in a different configuration) and joined together with absorbable sutures, plates and screws. The plates and screws are made of special polymers, which dissolve after a year with the formation of water and carbon monoxide. Demineralized bone grafts are often 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 treatment is only indicated for children under 6 months of age. 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 mums carefully examine their treasure during their 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 you should know - any diagnosis made by doctors is not a sentence! When the baby is still very small, all violations can be corrected with a competent approach. The more we know, the more effective our actions will be.

That scary word is craniosynostosis

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

But in some cases, overgrowth occurs prematurely, 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 face the disease.

When your baby's head becomes a strange shape, frequent unexplained vomiting appears, hearing decreases, eyes become inflamed. It ceases to please you 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).
Abnormal joint development, leading to disability.
Difficulty in nasal breathing (sleep apnea, in which the baby temporarily stops breathing).
Hydrocephalus.
Lagging in physical and psychological development.
Strabismus, blindness, tremors.
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 occiput and forehead bulge out.

Brachycephaly (coronary craniosynostosis). Fusion of the coronary 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 slopes. There is a type of pathology when the coronary and sagittal sutures are fused (oxycephaly or agrocephaly). The head in this case takes on 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 coronary (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 other parts narrow.

Diagnostics

Finally, such a diagnosis can be made only after the studies have been carried out:

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

After the similar 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 Craniosynostosis Occurs

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

Craniosynostosis treatment

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 disappear under the hair.

After the operation, your little one will have to wear a special helmet every day and undergo a course of physiotherapy for some time.

And the most important. Don't panic! Our kids are very sensitive and react to any change. mental state mom. 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 complete recovery and the most wonderful life!

There are a number of conclusions about the dangers of cleaning cosmetics. Unfortunately, not all newly minted moms listen to them. 97% of shampoos use the hazardous substance Sodium Lauryl Sulfate (SLS) or its analogues. Many articles have been written about the effects of this chemistry on the health of both children and adults. At the request of our readers, we have 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. Be careful with the choice of cosmetics, it is important for you and your child.

Journal headings

Craniosynostosis is characterized by premature adhesion of one or more cranial sutures, often resulting in an abnormal head shape. It may be the result of primary malformation of ossification (primary craniosynostosis) or, more commonly, abnormalities in brain growth (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 reasons for its development

Normal ossification of the cranial vault begins in the central region of each bone of the skull 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 inhibits the untimely fusion of the skull bones is considered to be the continued growth of the brain. It is worth emphasizing that normal growth of each cranial bone occurs perpendicular to each suture.

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

Primary craniosynostosis

If one or more of the sutures heal prematurely, the growth of the skull may be limited by perpendicular sutures. If several stitches are healed while the brain is still changing in size, intracranial pressure may increase. And this often ends with a number of complex symptoms, up to and including death.

Varieties of primary craniosynostosis (premature fusion)

Scaphocephaly is a sagittal suture.
Anterior plagiocephaly - the first coronary suture.
Brachycephaly is a bilateral coronary suture.
Posterior plagiocephaly - early closure of one lambdoid suture.
Trigonocephalus is a 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 lack of brain growth. Since the growth of the brain controls the distance of the bone plates from each other, the disturbance of its growth is the main reason for the 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 spatial restrictions may play a role in premature fusion of the fetal skull sutures. This has been demonstrated in observations of coronal craniosynostosis. Other secondary causes include systemic disorders that affect 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 most widespread was the variant with the etiology of the primary defect in the mesenchymal layers of the skull bones.

Secondary craniosynostosis, as a rule, develops along with systemic disorders

These are endocrine disorders (hyperthyroidism, hypophosphatemia, vitamin D deficiency, renal osteodystrophy, hypercalcemia and rickets).
Hematologic 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.

The causes of syndromic craniosynostosis are genetic mutations responsible for class II and III fibroblast growth factor receptors.

Other important factors that should be considered 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 lambdoid fusion, is an extremely important aspect.
The presence of multiple adhesions suggests craniofacial syndrome, which often requires diagnostic expertise in pediatric genetics.

Craniosynostosis symptoms and diagnostic methods

Craniosynostosis in all cases is characterized by an irregular skull shape, 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 baby's head changes shape, and 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.

Increased intracranial pressure is a common symptom of all types of craniosynostosis, with the exception of some secondary pathologies. When only one suture heals 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 is suffering 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 worse in the morning and at night.
Vision problems - double vision, blurred vision, or impaired color vision.
An unexplained decline in the child's mental capacity.

If a child complains of any of the above symptoms, you should contact your pediatrician as soon as possible. In most cases, these symptoms will not be caused by increased intracranial pressure, but they must be investigated.

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

On closer examination of the skull, it becomes 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 can be 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.

Cranial computed tomography with 3D projection is generally not required for most babies. The technique is sometimes performed when surgery is considered the next step in treatment, or when chest x-ray results are inconclusive.

Pathology correction techniques, possible complications and consequences

In the past 30 years, modern medicine has developed a deeper understanding of the pathophysiology and treatment of craniosynostosis. Currently, surgery, as a rule, remains the main type of treatment for correcting deformity of the skull in children with 1-2 suture adhesions, leading to an ugly head shape. For children with microcephaly, which is often seen with mild craniosynostosis, surgery is usually not required.

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

In patients with microcephaly, the cause of the disease must be investigated.
At the first visit, the circumference of the head in the longitudinal direction is measured and subsequently the changes are monitored. The physician should ensure that the brain is growing normally in patients with primary craniosynostosis.
Signs and symptoms of increased intracranial pressure should be monitored regularly.
If there is a suspicion of increased intracranial pressure, then neurosurgical counseling is very appropriate.
To preserve visual function in patients with increased intracranial pressure, additional ophthalmological consultations should be carried out.

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

Conditions for surgical intervention

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 are candidates for minimally invasive surgery. It is worth noting that the deformity is more noticeable in the breast and may become less obvious with age.
As the child grows, he has more hair, the visible manifestations of the abnormality 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 cranial or craniofacial deformities is performed in children aged 3–6 months, although a 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 most promising is the use of intraoperative tranexamic acid. Patients with indications for surgical correction of craniosynostosis were pretreated with erythropoietin and tranexamic acid to maintain lower blood loss volumes.

Other features of surgery

Surgical treatment 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 the surgery are better if it is performed on infants less than 6 months of age.
Patients with corresponding facial defects may need a phased approach - surgical treatment with the efforts of a whole team of multidisciplinary specialists.
In some cases, molding helmets may be required, which are used in particularly severe cases.

Trigonocephaly - premature closure (ossification) of the metopic cranial suture during the period of embryonic development of the child. The metopic suture runs along the center of the frontal bone, connecting its 2 parts. The main symptom of trigonocephaly is the vertical protrusion of the middle segment of the frontal bone parallel to the early overgrown suture. The lateral parts of the forehead are often depressed.

Content:

Why does the metopic suture protrude on the child's forehead?

The metopic suture remains open after birth during the first year of life. Overgrowing process goes on up to 8 years old. Premature synostosis leads to the formation of a characteristic ridge on the child's forehead which defines the triangular shape of the skull.

The protrusion on the frontal bone continues from the glabella (the point between the eyebrows, the bridge of the nose) to the large fontanelle, which is located at the intersection of the metopic and coronary sutures (the junction of the frontal bone perpendicular to the suture between the frontal and paired parietal bones of the skull). Skull volume decreased in the frontal and increased in the parietal lobes due to compensatory bone growth, which makes the deformity even more noticeable. The characteristic triangular shape of the baby's head is found immediately after birth.

Possible causes of trigonocephaly:

Gene defect responsible for the appearance of fibroblast growth factor receptors.
Chromosomal mutations lead to the occurrence of congenital syndromes, which include trigonocephaly. Examples: Jacobsen's syndrome, Opitz's trigonocephaly syndrome, in which there is not only deformation of the head in the form of a keel, but also other external deviations, pathologies internal organs, often mental retardation.
PPTSNS(damage to the nervous system of the fetus or newborn in the first days of life, usually due to cerebral hypoxia).
Prematurity statistically increases the risk of premature overgrowth of the metopic suture.

Trigonocephaly is from 20% all forms of craniosynostosis. It occurs in boys 3 times more often than in girls. Disease inherited in 2-8% cases.

Distinguish between trigonocephaly and permissible convexity of the metopic suture not due to true craniostenosis. A moderately pronounced scallop on the forehead is not a pathology, but an anatomical feature that can increase in proportion to the child's height. A small tubercle remains, which does not require correction and does not interfere with full development.

Symptoms

Early synostosis of the metopic suture defines a triangular shape of the skull with a bony keel on the forehead, which is well palpable and, unlike a bump, solid to the touch.

With prolonged growth restriction and severe deformation of the skull, when not only the frontal seam protrudes, but also the depressed areas near the temples are clearly visible, the child may experience ophthalmic problems. Visual impairment - the consequences of pinching the optic nerve or the auxiliary apparatus of the eye, which includes the eyelids and 6 pairs of eye muscles.

Early closure of the metopic suture on the forehead can lead to a number of problems associated with appearance and the functioning of the organs of vision:

hypothelorism (insufficient distance between the eye sockets due to abnormalities in the formation of the skull);
exophthalmos (bulging eyeballs, in rare cases accompanied by a displacement of the pupils to the sides);
strabismus.

To assess the patient's neurological health, the presence of complications of trigonocephaly a pediatric neurologist conducts examinations by several parameters:

the degree of restriction of the growth of cranial bones;
impact on the growing brain;
the functioning of the cranial nerves;
muscle tone, paresis, in severe cases, paralysis, including a history;
severe brain damage is determined by the general signs of organ dysfunction: weakness, apathy, restlessness, seizures, frequent regurgitation after eating.

Mental retardation observed in older children with untreated pathology. Trigonocephalus differs from other non-syndromic (not complicated by concomitant disorders) craniosynostosis by the largest percentage of cognitive defects. Intellect suffers approximately at 15-20% sick. Cognitive impairment may not appear until early school age.

Associated violations

About in 1 in 5 children with a diagnosis of trigonocephaly, concomitant neurological pathologies are observed:

increased intracranial pressure (the risk of increased intracranial pressure increases when combined with other forms of craniostenosis);
hydrocephalus;
stagnant optic disc;
congenital malformations of the organ of vision (rare);
difficulty in memorizing, slow mental development (the risk of mental retardation is predominantly in infants with increased ICP).

Up to 3% of children with trigonocephalus have a history of ventricuoloperitoneal shunting (performed to eliminate hydrocephalus).

Diagnostics

The degree and danger of trigonocephaly diagnosed in several stages. Mandatory are: taking anamnesis, assessing the physical and neurological condition of the child.

At the first visit, the doctor finds out the following data:

age child;
living conditions families (ecology);
place of work parents, including in the past (to identify risks of influence unfavorable factors on genetics);
Availability any shape craniosynostosis in the nearest relatives;
pathology during pregnancy, birth trauma;
condition baby after birth, dynamics and pathologies of development;
when the first signs of trigonocephaly are found, how the skull changed in the future (visual criteria);
survey results, carried out earlier, applied methods of treatment(if any), are there other pathologies associated with the formation of bone tissue and the general development of the child.

The location and degree of damage to the cranial sutures is revealed on examination by a pediatrician, pediatric neurologist or neurosurgeon. For instrumental diagnosis of metopic synostosis, the following are used:

CT 3D (three-dimensional CT reconstruction of the skull). The method is recognized as the most accurate for craniostenosis. Performed on a spiral tomograph. Sleeping pills are not used, the procedure is prescribed at the time of the alleged sleep or sleep state of the child.
MRI. Lets get Additional information on the presence of cognitive impairment associated with trigonocephaly.
Skull ultrasound (neurosonography).
X-ray (rarely used, ineffective).

During the initial diagnosis of trigonocephaly and during preparation for the operation, the distance between the parts of the face is assessed.

Calculate in centimeters to ensure accurate results.

To determine the appropriateness of their experiences and the appropriateness of an extraordinary visit to the hospital, parents can independently determine the interorbital distance using a conventional centimeter. Frontal angle and stenosis are measured only using the hardware capabilities of computed tomography.

The measured results are also important. when evaluating the results of the operation and in the process of monitoring the child during the period of correction of residual disorders. Doctors recommend that patients come to an appointment periodically during a year after surgery, in order to timely identify a relapse of the disease, if possible adjust minimal deviations, for example with the help of an orthopedic helmet.

If there are signs related violations additional examination methods are assigned:

Ultrasound of the digestive tract;
MRI of the chest, spine;
echocardiography;
electrocardiography;
ultrasound angiography of the vessels of the head and neck.

If the child has not only protrudes the frontal seam, but also found vision problems a consultation with a neuro-ophthalmologist is appointed. The fundus is examined using an ophthalmoscope, and a search for signs of optic nerve atrophy is performed.

Genetic consultation is required for children in whom trigonocephaly is combined with other developmental anomalies. A visit to a geneticist and additional examination will help to find out whether the craniostenosis is hereditary, what is the percentage of the likelihood of inheriting the disease.

Treatment

It is possible to completely remove the protrusion on the forehead of a baby only with the help of an operation. Hospitalization period in this case will be from 2 days to a week.

Reason for hospitalization children with a distorted skull like trigonocephaly is the result full examination with confirmation of the diagnosis by 3D CT, which shows signs of premature overgrowth of the metopic suture. Also, this study is performed one day after the operation, it is used once every 3-6 months with dynamic observation.

Postoperative control important for the modern correction of repeated violations and control over the general condition of the child. The observation of a small patient is carried out in the period of 2-3 years from the moment of discharge from the hospital. If the family lives far from medical center, in which the operation was carried out, the observation is carried out remotely using CT images, photographs or video meetings.

To achieve an excellent result of the operation, it is necessary to carry out subsequent orthotic therapy (wearing a corrective helmet).

Skull alignment without surgery: is it possible and how?

The orthopedic correction helmet is a dynamic system designed for non-invasive correction of the triangular shape of the head with trigonocephaly. Sometimes the orthopedic helmet is called the "second skull", as its design is formed taking into account the individual parameters of the child. The pressure is applied only to the deformed (convex) zones, leaving room for natural growth of the rest of the bones of the skull.

Modeling helmets are designed for correction of permanent deformities after operation. They are also used with success. with mild forms of trigonocephaly, when only cosmetic defects are diagnosed. Orthopedic helmets are completely safe and effective provided quality workmanship and correct use. The entire skull is corrected, including the facial section.

A helmet-orthosis is most effective in the first year of a baby's life if the bulge of the frontal bone is moderately pronounced. To cure trigonocephalus without surgery, you must wear an orthopedic helmet at least 20 hours a day.

If the helmet for correcting the shape of the head is made correctly, the only negative consequence wearing it can be skin irritation.

How is the operation performed?

Planned surgical intervention is performed 1-3 days after the child's admission to the clinic. Operations for trigonocephaly are prescribed after a complete examination, carried out in a planned manner.

Medical staff participating in the operation:

anesthesiologist;
an anesthetist (usually a nurse anesthetist);
surgeon;
assistant;
operating nurse.

The position of the child on the operating table: lying on his back, head straight, slightly tilted towards the chest. For proper laying and fixed position fixation, silicone elements are used: headrest, neck pad, roller, mat.

The operating field for trigonocephaly is on the child's head. The places in which the creation of incisions is planned are marked in advance, then the surgical underwear is put on. Area of influence: frontal bone, anterior fontanelle, coronary suture.

Expected operation results:

increasing the interorbital distance and interorbital-circumferential index to normal;
external decrease or disappearance of the ridge from the central part of the frontal bone;
complete overgrowth (disappearance) of bone tissue defects;
elimination of hypotelorism (if manifested).

Frequent effects surgical treatment of trigonocephaly:

nausea and vomiting;
pain, associated restlessness;
temperature rise to 37 ° -39 ° within 2-3 days;
swelling of the soft tissues of the head can occur a few days after the operation, it lasts about a week.

Dangerous complications are rare:

damage to the sagittal sinus;
infection of the subdural space;
large blood loss (permissible blood loss is 20-90 ml, if necessary, the volume is replenished by blood transfusion);
subcutaneous hematoma arising from the accumulation of blood (puncture is required to eliminate it);
convulsions;
air embolism (blockage of the movement of blood through the vessels by air bubbles).

Most of these complications are controlled by antibiotics and anti-inflammatory drugs.

Operation on the skull is difficult, always accompanied by blood loss. It is recommended to carry it out only if there are clear indications. Sometimes the child has a trigonocephalic head shape, but there is no premature synostosis of the cranial sutures. In this case, the operation should be abandoned if you are ready to put up with minimal cosmetic defects in adulthood.

Endoscopy for trigonocephaly

Minimally invasive operations are performed using a special endoscopic retractor. A screw or rack mount is also used. The endoscopic method allows the doctor to use both hands, which increases the usefulness of the intervention and minimizes the risk of negative consequences.

Another advantage of endoscopy is optical control at all stages of the operation. The image is transferred to endoscopic stand with video system.

The surgery is performed after the retractor holders are installed and the endoscope is adjusted. Not linear, but wavy cuts are made. The area of the incision is determined depending on where the metopic suture is more prominent. If the bulge is more pronounced in the middle of the forehead, the incision is made along the hairline or a little further to the back of the head. When the deformity is higher, the middle of the incision is at the anterior fontanelle. The length of the craniotomy (incision of the skull) during endoscopy is only 2-3 cm.

With the help of raspators, the incision and exfoliation of soft tissues and periosteum from the zone of the large fontanelle to the nasolabial angle is performed.

Trepanation hole usually applied only in the case of a closed large fontanelle. A high-speed drill is used with a bur that allows maximum protect the dura mater. In parallel with resection of the bone with nippers or a high-speed drill, the dura mater is separated from the bone - this is the most difficult and important stage of the operation. The resection margins are processed to stop bleeding.

After removing the retractor, internal sutures are applied using a fully absorbable material. Skin glue is often used in place of the outer seams.

Average duration of endoscopic surgery for trigonocephaly: 50-90 minutes. After graduation, the child is transferred to intensive care, Where is he located 2-3 hours.

In addition to endoscopy, to correct the protruding bone on the forehead, front-orbital advancement.

Even after successful treatment of trigonocephaly, reoperation may be required. Usually, the indications for it become apparent within the first year after discharge from the hospital.

Photos of children before and after surgery

In the first photo, a child with a cosmetic problem: the frontal suture protrudes. In the structure of the affected seam, connective tissue may be completely absent (or contained in an insufficient amount). There is an increase in bone density and hyperostosis (pathological proliferation) of the bone in the area of metopic synostosis. Such data are obtained on a histological examination performed after the operation.

The deformity zone covers not only the frontal bone, but also the orbits of the eyes, areas of the ethmoid and sphenoid bones.

With the correct choice of the method for correcting trigonocephaly, a positive clinical effect is achieved in the form of regression of cosmetic, neurological, ophthalmological signs of the disease.

Parents of a newborn, as a rule, know that the baby has a fontanelle on the head, or, as it is often called, a soft crown. Many of them are convinced that the fontanelle in babies is a weak and vulnerable spot that should not be touched once again. Is it really so? Do newborns have one fontanelle? What is it for? Let's figure it out.

FEATURES OF THE STRUCTURE OF THE SKULL OF THE FETAL AND THE NEWBORN

The fontanelles of a newborn, and there are several of them, can be safely called "adaptations" given by nature to facilitate the process of giving birth to a baby. During the passage of the fetus through the birth canal of the mother, its head can be deformed (in the good sense of the word) and take the form corresponding to the birth canal. This makes childbirth easier for both the baby and the mother.

Such anatomical "understanding" is possible due to the structural features of the fetal skull. It consists of the same bones as the skull of an adult. But the bones of the baby's cranial vault are highly elastic and are interconnected by peculiar shock absorbers - non-ossified connective tissue areas.

These are the seams and fontanelles:

frontal or metopic suture - between the frontal bones;
coronal or coronary suture - between the parietal and frontal bones;
sagittal or sagittal suture - between the parietal bones;
occipital or lambdoid suture - between the occipital and parietal bones;
left and right scaly sutures - between the parietal and temporal bones;

anterior or large fontanel - a rhomboid membranous plate, from the corners of which the frontal and sagittal sutures, the left and right parts of the coronal suture depart;
posterior or small fontanelle in children - a triangular depression at the intersection of the occipital and sagittal sutures;
left and right wedge-shaped fontanelles - at the junction of the coronal and scaly sutures;
left and right mastoid fontanelles - at the junction of the lambdoid and scaly sutures.

In a healthy full-term newborn, of all the listed membranous structures, the skulls remain open and only the large fontanelle (anterior) and, in rare cases, the posterior small fontanelle are determined. And all the seams and the rest of the fontanelles are closed. In premature newborns, some of the seams between the bones of the skull and the lateral fontanelles may remain partially open.

The connective tissue membrane that forms the fontanelle in children is similar in density to a tarp. Therefore, it is extremely difficult to violate its integrity. Calmly bathe your baby, if necessary, use a comb, play with your baby, give him a massage and do not be afraid to damage the fontanel.

The anterior fontanelle of the child resembles a rhombus in shape. The doctor measures the size of the fontanel not along the diagonals of the rhombus, but along the lines connecting the midpoints of its opposite sides.

The size of the large fontanelle in babies born on time varies from 2x2 cm to 3x3 cm. In premature babies, not only the fontanelle is larger, but also the areas of the skull sutures adjacent to it remain open.

Normally, the anterior fontanelle of the child is at the same level with the surrounding frontal and parietal bones or sinks quite a bit. Looking closely, you can see how the fontanel pulsates. With strong crying and anxiety, the baby may swell a little.

In the first year of a child's life, the brain grows rather quickly in size. Due to the elasticity and pliability of the fontanelle, the cranium does not interfere with the growth of the brain.

In addition, the fontanelle in the baby performs the function of thermoregulation. When the child's body temperature rises through the large fontanelle, excess heat is returned by the membranes of the brain, that is, they are cooled naturally. Therefore, never swaddle a feverish baby with his head and do not wrap his head in hats and scarves.

In a full-term baby, the size of the fontanel, located at the back, provided that it is not completely closed, is so small that the tip of a finger can hardly fit into the triangular depression.

In a healthy baby born at term, only the anterior large fontanelle remains unclosed. But as the bones of the skull grow, its size gradually decreases, and it closes.

For the age, upon reaching which the anterior children's fontanelle closes completely, the norms are not strictly defined. In most newborns, this occurs by 12, and sometimes by 18 months. But even if the fontanelle is overgrown, and the child is not one year old, you should not worry. In a healthy baby, this may be a variant of the norm, which the pediatrician will certainly tell you about.

The posterior fontanelle is usually not even detected at the time of delivery. If you manage to find it, do not worry. It usually happens like this: by the time the anterior fontanelle overgrows, not a trace remains of the posterior one for a long time. It closes by 1.5–2 months.

SPRING - SIGNAL BEACON

As a parent of a newborn baby, you should monitor the condition of the fontanelle and tell your local pediatrician about any changes. If you notice that your baby's fontanel is strongly pulsating, or it seems to you that he has a very small fontanel (you, for example, know the norms of its size), do not be silent, but share your observations with the doctor.

For neonatologists and pediatricians, the fontanelle in the baby is a kind of signal beacon. He is the first to react to any trouble in the head of a newborn. By too early or very late overgrowth of the fontanel, the pediatrician may suspect a serious illness.

If at birth the anterior fontanelle is very small or absent at all, first of all, doctors exclude microcephaly and craniostenosis. In the first case, the child has all parts of the body of normal size, and the head ( cerebral skull and the brain) are significantly lagging behind in development. Microcephaly is often a manifestation of severe chromosomal diseases such as Patau syndrome, Edwards syndrome, etc.

With craniostenosis, the seams between the bones of the skull overgrow early and the fontanelles close. Because of this, the head is deformed, the brain cannot grow normally, intracranial pressure rises with all the symptoms that follow from this.

The pressure inside the skull can be so high that the fused bones begin to separate again.

If a woman, while pregnant, ate a lot of foods containing calcium (cheese, milk, cottage cheese, etc.) and was fond of multivitamins, her child's fontanelle may close early. A lack of calcium in the body can cause late overgrowth of the fontanelle.

If a full-term baby has a very large anterior fontanelle and an open posterior fontanelle, it is examined for hydrocephalus (dropsy of the brain) and congenital hypothyroidism (thyroid insufficiency). Doctors exclude or confirm intrauterine hypoxia, birth trauma and intrauterine infections, in which the size of the fontanelle may also be above average.

The fontanelle in children reacts to an increase (ICP) with tension and bulging.

ICP in infants increases with the following diseases and conditions:

congenital diseases (hydrocephalus, etc.);
brain infections (purulent meningitis, etc.);
volumetric formations in the cranial cavity (hematomas, tumors, etc.);
perinatal encephalopathy;
thrombosis of the sinuses and veins of the brain in severe infections, blood diseases, etc.

Important:if the bulging fontanelle appears immediately after the child receives an injury (head and not only), immediately contact a medical institution or call ambulance on house.

Be sure to pay attention not only to the bulging, but also to the sunken fontanel, which serves as an indicator of the degree of dehydration of the body. With intestinal infections due to vomiting and diarrhea, with neuroinfections due to repeated vomiting, dehydration develops very quickly. A child in such a situation requires urgent medical attention.

Note: with meningitis, the fontanelle first swells due to an increase in ICP, and then, due to the loss of fluid by the baby's body, it sinks.

If a pediatrician or neurologist directs your baby to measure intracranial pressure, do not refuse this study. The procedure is absolutely safe and painless, but its results are quite informative. They will help the doctor make the correct diagnosis and promptly prescribe treatment for the baby, if required.

The fontanelle in babies is a kind of "window" through which you can "look" into the baby's skull and brain.

Therefore, infants with access through the fontanelle perform some diagnostic and therapeutic manipulations, such as:

subdural puncture under local anesthesia;
puncture of the ventricles of the brain to measure the pressure of the cerebrospinal fluid, study its composition and subsequent ventriculography;
non-functional measurement of ICP using special tonometers;
two-dimensional echoencephalography and sonography - ultrasound studies;

radioisotope scintigraphy.

Zaluzhanskaya Elena, pediatrician