Craniofacial Abnormalities and Craniosynostosis

Plagiocephaly, AKA positional molding, is the most common cause of a misshapen skull in infants. Babies with plagiocephaly have a flattened head on one side, and sometimes a bulging forehead and anteriorly displaced ear. Deformational plagiocephaly is not serious and usually resolves on its own without any treatment. It is not a form of craniosynostosis, which is a condition that needs surgical intervention. There is no association between plagiocephaly and developmental delay, hearing disorder, or facial asymmetry. It is cosmetic only.

Synostosis is the early fusion of one or more cranial sutures and requires surgical intervention to remove the pathological bone. Under the age of 4 months, this can be accomplished endoscopically. After 4 months, this is treated via open skull remodeling. Synostosis results in typical head shape depending on the closed suture and is often recognizable at or shortly after birth. There is a concern for cognitive impact if left untreated.

Patients should be assessed by a neurosurgeon or plastic surgeon when there is a concern that the head shape findings are not consistent with plagiocephaly, are worsening over time, or to help alleviate parental anxiety. Early referral is key to ensure that minimally invasive options are available for children with single suture synostosis.

Plagiocephaly is treated with behavioral modification: increased tummy time to advance the achievement of rolling and sitting up. Brain growth pushes the skull into a more rounded position from the inside out, achieving maximal correction by around 2 years of age. In children whose brain development will be delayed or who will not reach milestones at expected intervals due to other comorbid conditions, helmet therapy can present a good therapeutic option.