It is known that when we are born, the bones of our head are not completely formed . Thanks to this, the baby’s head is able to pass through the birth canal, which would otherwise be too narrow. After birth, the bones of the skull gradually harden and weld together, slowly enough to allow the growth of the brain and the head of the child.

However, sometimes such suturing occurs at a very early stage of development, causing alterations that can have severe consequences. This early suturing is called craniosynostosis .

The skull: bones and sutures

The human skull, if we understand as such the bony coverage of the brain (not counting other facial bones such as those of the jaw) is made up of a set of eight bones: frontal, two temporal, two parietal, occipital, sphenoid and ethmoid.

This set of bones is not totally joined from birth, but is gradually welded together as we develop. The joints between these bones, initially formed by connective tissue although they become ossified throughout our lives, are called sutures and fontanelles. In the cranial vault, the points where several bones meet are called fontanelles , which are equally important.

Among the multiple sutures we have (a total of thirty-seven), the lamboid that joins the parietal and occipital, the metopic that joins the two parts of the frontal, the coronal that allows the frontal and parietal to overlap and the sagittal that allows the two parietals to meet.

As we have said, the bones of the skull are sutured and welded throughout our development , but sometimes this union occurs early.

Craniosynostosis

Craniosynostosis is a congenital defect or malformation in which some or all of the bones in the newborn’s skull are welded together earlier than normal . Although the sutures usually close around the age of three, in babies born with this malformation closure may occur in the first few months.

This early suturing of the skull bones can have serious effects on the child’s development. The skull does not develop as it should and malformations appear in its structure, also altering the normative development of the brain. In addition, this causes an increase in intracranial pressure as the brain tries to grow, which can have serious consequences. It is not uncommon for microcephaly to occur and for various brain structures not to develop properly. Hydrocephalus is also common.

The effects that this malformation causes can vary greatly, and can range from no obvious symptoms to the death of the child. It is common for patients with craniosynostosis to suffer from developmental delays, intellectual disability, continuous headaches, disorientation and lack of coordination, motor problems that can lead to seizures or sensory disabilities if they do not receive treatment. Nausea, lack of energy, dizziness and some typical symptoms of depression such as abulia are also common.

In addition, other facial structures and organs can also be compromised, such as the eyes, airways or the orophonatory system, due to morphological alterations. This can lead to blindness or deafness , in addition to difficulties in breathing, swallowing and communicating.

In short, it is a disorder that can cause severe problems for the child and its proper development. That is why it is recommended to look for an early treatment that avoids that the osseous alterations generate difficulties at brain level.

Types of craniosynostosis

Depending on the bones that are sutured prematurely, we can find different types of craniosynostosis. Some of the better-known and more common ones are as follows.

1. Scaphocephaly

The most common type of craniosynostosis. It occurs when the sagittal suture closes early.

2. Plagiocephaly

This type of craniosynostosis is the one that occurs when the coronal suture closes prematurely. It is the most frequent after scaphocephaly . It may appear that the forehead stops growing. It may appear bilaterally or only on one of the frontoparietal sutures.

3. Trigonocephaly

The metopic suture closes early. So the frontal bones close too early. It usually causes hypotelorism, or eyes together .

4. Brachycephaly

Coronal sutures are closed early.

5. Oxycephaly

It is considered the most complex and serious type of craniosynostosis . In this case all or almost all the sutures appear closed early, preventing the skull from expanding.

Possible causes

Craniosynostosis is a congenital disorder whose causes are mostly unclear. It usually occurs without precedent in the same family. It is suspected that there is a combination of genetic and environmental factors .

However, in many other cases this problem has been associated with different syndromes and disorders in which it does appear linked to genetic mutations that may or may not be inherited. An example of this is found in Crouzon syndrome.

Treatment

The treatment of craniosynostosis is done by surgery . The surgical procedure should be carried out before the subject reaches one year of age because the bones will subsequently harden and there will be more difficulties in correcting the malformations.

This is not a procedure that is carried out solely for aesthetic reasons, but because of the complications that can arise from early closure of the skull bones. If the brain were not operated on, it would have difficulties in developing normally , and during this development a level of intracranial pressure would be reached that could be dangerous. However, early intervention can make brain and bone development normative and not disruptive to the child’s life.

Bibliographic references:

  • Hoyos, M. (2014). Crouzon syndrome. Rev. Act. Act. Med.: 46. La Paz.
  • Kinsman, S.L.; Johnston, M.V. (2016). Craniosynostosis. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier.