Diagnosis of infant synostotic and nonsynostotic cranial deformities: a review for pediatricians

Enrico Ghizoni,Rafael Denadai,Cesar Augusto Raposo-Amaral,Andrei Fernandes Joaquim,Helder Tedeschi,Cassio Eduardo Raposo-Amaral

doi:10.1016/j.rppede.2016.02.005

Abstract

ObjectiveTo review the current comprehensive care for nonsyndromic craniosynostosis and nonsynostotic cranial deformity and to offer an overall view of these craniofacial conditions. Data sourceThe review was conducted in the PubMed, SciELO, and LILACS databases without time or language restrictions. Relevant articles were selected for the review. Data synthesisWe included the anatomy and physiology of normal skull development of children, discussing nuances related to nomenclature, epidemiology, etiology, and treatment of the most common forms of nonsyndromic craniosynostosis. The clinical criteria for the differential diagnosis between positional deformities and nonsyndromic craniosynostosis were also discussed, giving to the pediatrician subsidies for a quick and safe clinical diagnosis. If positional deformity is accurately diagnosed, it can be treated successfully with behavior modification. Diagnostic doubts and craniosynostosis patients should be referred straightaway to a multidisciplinary craniofacial center. ConclusionsPediatricians are in the forefront of the diagnosis of patients with cranial deformities. Thus, it is of paramount importance that they recognize subtle cranial deformities as it may be related to premature fusion of cranial sutures.

Highlights

Cranial deformities are a common complaint in pediatric units, since 25% of infants of single pregnancies and 50% of multiple pregnancies have some degree of skull deformity at birth
Pediatricians must be aware of these issues and counsel the family for the importance to seek a craniofacial team
It is of fundamental importance that pediatrician be prepared at first consultation to make the differential diagnosis between a positional deformity and craniosynostosis, considering that children born with a positional deformity does not need to be exposed to the ionizing radiation of a computed tomography (CT), apart from the costs of the procedure and the sedation risks to achieve it.[2]

Summary

Introduction

Cranial deformities are a common complaint in pediatric units, since 25% of infants of single pregnancies and 50% of multiple pregnancies have some degree of skull deformity at birth. Parents usually recognize these changes in the first weeks or months of life.[1] in some scenarios the diagnosis may be overlooked by the family that tends to deny the problem. In these cases, pediatricians must be aware of these issues and counsel the family for the importance to seek a craniofacial team. It is of fundamental importance that pediatrician be prepared at first consultation to make the differential diagnosis between a positional deformity and craniosynostosis, considering that children born with a positional deformity does not need to be exposed to the ionizing radiation of a computed tomography (CT), apart from the costs of the procedure and the sedation risks to achieve it.[2]. The clinical criteria for the differential diagnosis between positional deformities and craniosynostosis are presented, allowing the pediatrician subsidies for a quick and safe clinical diagnosis

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