Cranial deformation in babies.
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A precise diagnosis is vital for every treatment. Differences are primarily made between congenital or position cranial deformities, along with possible combinations of the two and particularly treatment deemed necessary due to accidents. In the event of an early closure of the cranial sutures (synostosis) surgery may also be needed as growth in the relevant region would not be possible otherwise.

Causes of childhood skull deformations

They seldom stem from premature suture synostosis, however, these often need surgical correction. Such deformities are present from birth and then become ever more severe from then on. Positional deformities are generally postpartum, the cranial sutures are open, and the brain has enough space to grow. However, severe deformities can be created which are not completely misshapen in contrast to birth trauma deformities.

The differential diagnosis generally is best performed in hospitals.

Thus a synostosis of the coronary or lambda sutures can be seen in a trapezoid shaped cranial form, positional head deformities have a parallelogram shape with occipital flattening and contralateral frontal involvement. A shift in the ears is also noticeable, which indicates asymmetry in the cranial base. 

Such deformities stemming from positioning are much more common than the syntotic deformities and generally tend to result from the supine position to help avoid sudden infant death syndrome. A postpartum cranial deformation becomes apparent in the sixth to eighth week of life. Measures taken to shift positions are seldom successful due to the preference given to a single side. Supportive physical therapy - possibly even osteopathic treatment to correct the asymmetry - generally to improve mobility, which only has a limited impact on cranial form (only helps from the 4 / 5 month of life). 

Deformities from birth trauma are subject to self-correction through intra-cranial pressure and the growing brain, which should press the still soft cranial bones into an ideal round form. This is not possible for postpartum deformities stemming from positioning. As the child ages the cranial bones begin to mineralize, meaning that starting from the fourth or fifth month of life no changes in head shape are found. Size increase is only possible parallel to the percentile growth. Thus a relative improvement in the overall pressure is expected and hair growth also helps compensate for the deformity as well. Thus slight asymmetry and deformities do not need further attention and treatment.

Asymmetries of less than one centimetre (measurement of the diagonals) can be classified as aesthetic and are usually barely visible in advanced age and thus do not require treatment in infancy.

Asymmetries of more than two centimetres are generally visible in adulthood and thus form an absolute indication for treatment of the deformity. Due to the correlation between age, self-correction and severity level, the development of the cranial form in infants can be used and forms an important decision making aid regarding how to proceed and the possible need for treatment of the cranial deformity.

Positional plagiocephalus
Analogue measurement of the diagonals

Positional cranial deformity according to Blecher

Plagiocephaly (crooked head): asymmetrical cranial form involving cranial base
Brachycephaly (short head or "flat head"): a broad cranium stretched upward with flattened rear cranium.
"Crooked head" according to Blecher: significant deformation of the cranial base (special form of plagiocephaly