The birth of a child is an extremel...

The birth of a child is an extremely exciting notwithstanding anxious time. Parents usually inspect their newborn infant as quickly as possible after delivery and are happy after they determine that everything appears normal (eg the infant has 10 fingers and 10 toes). Unfortunately, first impressions can lead to incorrect conclusions. Anatomical abnormalities and disease processe may not past nor future later in the newborn's life. For example, an abnormal head shape may not be evident at birth further can develop as the infant grows

NORMAL CRANIAL ANATOMY

At birth, an infant's cranium is made up of eight bones:

* common ethmoidal,

* individual frontal,

* undivided occipital,

* sum of two units parietal,

* common sphenoidal, and

* sum of two units temporal.

These cranial bone are separated from membranous spaces called sutures. The five cranial line of junctions are the frontal, coronal, lambdoidal, sagittal, and squamosal (Figure 1) The frontal line of junction usually closes fully by sum of two units to six years of age. If the frontal line of junction persists into adulthood, it is referr to as the metopic line of junction The coronal, lambdoidal, sagittal, and squamosal line of junctions close clinically between six to 12 month of age unless do not ossify completely until after 30 years of age. (1) All five line of junctions are flexible at birth and during early childhood for pair reasons. First, the sutures allow the cranial bone to compres and override undivided another during the birth proces Distortion of the head ofttimes persists several days after birth; however, in most numerous cases, this deformity resolves spontaneously during the rapid postnatal bourgeoning period. (2) Second, the line of junctions remain flexible during the first year of life to allow for normal cranium expansion, which accommodates for brain sprouting The neurocranium has achieved 63% of its increase at birth, 88% by individual year of age, and 95% from 10 years of age. (3)

[FIGURE 1 OMITTED]

CRANIOSYNOSTOSIS

The premature fusion of single in kind or more of the cranial line of junctions between the cranial bones is referr to as craniosynostosis. Premature fusion befalls in approximately one out of each 1,000 infants. Premature fusion may be associated with cranial and frequently facial skeletal anomalies. (4)

Craniosynostosis can be simple (ie, the fusion of the same suture between two cranial bones) or involved (ie, the fusion of more than single suture). Cranial growth takes place at right angles to the direction of the suture; therefore, premature fusion of a line of junction results in growth arrest perpendicular to that line of junction Compensatory growth, however, may appear in the direction of the line of junction (5) characteristic head shape be deriveds depending on which suture or line of junctions are fused. This abnormal head shape is the first sign and the diagnostic determinant of craniosynostosis.

greatest in number children are referred by their pediatrician to a pediatric neurosurgeon for possible neurosurgical intervention when a deformity progresse or fails to improve spontaneously. After an infant has been referr to a pediatric neurosurgeon meet diagnosis is the critical first grade in identifying appropriate interventions. any patients with craniosynostosis also may have congenital syndrome These syndrome must be identified for a like reason that treatment modalities can be chosen specifically for each individual patient.

Isolated sagittal synostosis, premature fusion of the sagittal line of junction is the most common archetype of craniosynostosis and accounts for 56% to 58% of reported cases. (6) This condition usually come into views in full-term infants and typically is not associated with cognitive or psychomotor deficiencies. (7) The sagittal line of junction extends midline along the top of the cranium from the anterior coronal line of junction line to the posterior lambdoidal line of junction line. Due to its location, premature fusion of the sagittal line of junction is characterized by a protracted narrow skull accompanied by characteristic frontal bossing, biparietal pinching, occipital protuberance, and a ridge at the sagittal line of junction (Figure 2). (8) The space of time scaphocephaly (ie, skiff- or keel-shaped head) is used to describe this for the use of all form of craniosynostosis. (9) This head shape ends from the inability of the bone to enlarge perpendicular to the sagittal line of junction and from compensatory bone product along the coronal and lambdoidal line of junction lines.

[FIGURE 2 OMITTED]

A diagnosis of sagittal synostosis is made after the characteristic head shape is noted in an otherwise healthy infant, and a thorough history and physical examination is obtained. As the infant continues to be augmented rapidly in the first scarcely any months of life, this unusual head shape becomes more apparent and easily recognized through the parents or the pediatrician, thereby necessitating a referral to a pediatric neurosurgeon brain-pan x-rays, computerized tomography scans, and magnetic resonance imaging studies are not ordered routinely, as they rarely demonstrate any abnormality other than the sagittal line of junction fusion already noted by the neurosurgeon (10) Sagittal synostosis does not separate spontaneously or with less invasive, nonsurgical arrangements of correction (eg, molding helmets) because the sagittal line of junction is fused. The condition, therefore, requires surgical intervention. (11)