Craniosynostosis Before & After Photos

Craniosynostosis Before & After Case 1

Craniosynostosis Before and After Photo. Surgery performed in Dallas, TX at Law Plastic Surgery.

This young man has a history of craniosynostosis with cranial vault remodeling.

Over time, even a forehead which has been overcorrected may still be narrow compared to the rest of the skull at full skeletal maturity.

In this case, he was doing well without any need for expanding his intracranial volume.

This meant that we were able to avoid another extensive remodeling, and could perform a camouflage procedure with some calcium putty to fill in the depression.

Here you can see him several months after surgery, with the forehead and temple contour filled in. It is also a good time to improve on old scars as well.

Craniosynostosis Before & After Case 2

Craniosynostosis Before and After Photo. Surgery performed in Dallas, TX at Law Plastic Surgery.

Craniosynostosis is a condition where the sutures (or seams) of the skull close prematurely. The normal growth from the sutures is stopped.

The other growth plates work to keep up with the growth of the brain. But as more sutures are fused, the risk of excessive, harmful pressure increases.

This can affect development and lead to blindness.

This patient has bicoronal synostosis, where two sutures that go across the front of the scalp like a hair band are both fused.

This can lead to a characteristic short skull from front to back. As the other sutures work overtime, this can also lead to a much taller skull.

For this patient, posterior vault distraction was performed. This involves the release of the skull with our neurosurgeons. Immediately some decompression of the brain was seen.

After that, distractors were implanted and used. These provide gradual movement of the bone edges apart. The space in between fills in with bone, and the scalp is gradually stretched and adapted to the increased volume.

After the bone has some time to consolidate, or harden, the hardware is removed.

Craniosynostosis Before & After Case 3

Craniosynostosis Before and After Photo. Surgery performed in Dallas, TX at Law Plastic Surgery.

Craniosynostosis is a condition where the sutures (or seams) of the skull close prematurely. The normal growth from the sutures is stopped.

The other growth plates work to keep up with the growth of the brain. But as more sutures are fused, the risk of excessive, harmful pressure increases.

This can affect development and lead to blindness.

This patient has bicoronal synostosis, where two sutures that go across the front of the scalp like a hair band are both fused.

This can lead to a characteristic short skull from front to back. As the other sutures work overtime, this can also lead to a much taller skull.

For this patient, posterior vault distraction was performed. This involves the release of the skull with our neurosurgeons. Immediately some decompression of the brain was seen.

After the bone has some time to consolidate, or harden, the hardware is removed.

Craniosynostosis Before & After Case 4

Craniosynostosis Before and After Photo. Surgery performed in Dallas, TX at Law Plastic Surgery.

Craniosynostosis is a condition where the sutures (or seams) of the skull fuse too early. These growth centers for the skull respond to the growing brain, making sure there is enough space to avoid excessive pressure.

The more sutures that are fused, the higher the risk of excessive pressure on the brain and nerves. This may affect development, and can lead to pressure on the optic nerves and result in blindness.

Treatment for this condition depends on which sutures and how many are involved, the age of the patient, and any sign of excess pressure.

Here, the sagittal suture fused early. This results in a more narrow skull, as the top of the head is unable to widen. The skull also progressively lengthens as the other growth centers make up the difference.

A strip craniectomy was performed, meaning the affected suture was removed.

This allows the brain and skull to continue growing without restriction. A helmet afterwards helps to protect that soft spot, and to guide growth.

Craniosynostosis Before & After Case 5

Craniosynostosis Before and After Photo. Surgery performed in Dallas, TX at Law Plastic Surgery.

Craniosynostosis Before & After Case 6

Sagittal synostosis is when the growth plate along the midline of the top of the skull fuses prematurely.

As the brain continues to grow, but is restricted along this line, the back of the skull stays more narrow, as the front grows wider and more forward to compensate.

The back part of the skull also is shorter, and then can bulge at the back of the head with growth extending that direction as well.

The options for reconstruction include:
– strip craniectomy – removal of the affected suture – with helmet therapy afterwards
– cranial vault reconstruction – removal of either the front or back part of the cranium, splitting the bone, and rebuilding it with more space for the brain, in a more normal contour.

There are pros and cons to each option.

Before 4 months of age, generally speaking strip craniectomy is a good option to release the restriction on the brain’s growth, and let the skull’s volume and proportions expand more normally.

Craniosynostosis Before and After Photo. Surgery performed in Dallas, TX at Law Plastic Surgery.

Craniosynostosis Before & After Case 7

Sagittal craniosynostosis is when the sagittal suture (or growth center) running front-to-back over the center of the head closes too soon.

Here, you can see the visible and palpable sagittal ridge that can be a clue that the growth plate is affected.

The skull is then limited in its growth side-to-side outwards from the suture, and the head becomes long and skinny. This progressively worsens — especially over the first year — as the brain multiplies in size, and the skull grows to make space for it.

Here, we were able to perform a strip craniectomy with helmet therapy afterwards. The incisions are shorter than for a full cranial vault remodeling, avoiding the more visible incisions on the sides of the head. Also, the chance of needing blood transfusion is lower, and the hospital stay is shorter.

We usually do this surgery at 3-4 months of age. This child is seen 3 months after surgery and one round of helmet therapy.

Craniosynostosis Before and After Photo. Surgery performed in Dallas, TX at Law Plastic Surgery.

Craniosynostosis Before and After Photo. Surgery performed in Dallas, TX at Law Plastic Surgery.

Craniosynostosis Before and After Photo. Surgery performed in Dallas, TX at Law Plastic Surgery.

Craniosynostosis Before and After Photo. Surgery performed in Dallas, TX at Law Plastic Surgery.

Craniosynostosis Before & After Case 8

Sagittal craniosynostosis involves the growth plate running from the front soft spot to the back one.

If this closes too soon, the skull does not expand side-to-side at this spot, and must compensate by growing longer to the front and back.

Here, we performed a strip craniectomy at 3 months of age, meaning that growth plate was removed. This allowed the brain to immediately take on the shape that it would naturally want to be.

You can see this with the widening at the back part of the head, where it normally is a little wider than at the front.

He is seen here a few months after his surgery. The scars hide well inside the scalp, and recovery is 1-2 nights in the hospital.

A small percentage of patients may need another surgery for further expansion in the future, but most patients are able to avoid any further cranial reconstruction surgeries.

Craniosynostosis Before and After Photo. Surgery performed in Dallas, TX at Law Plastic Surgery.

Craniosynostosis Before & After Case 9

Many thanks to Dr. Jeff Fearon and Dr. David Sacco for their continual support and guidance as I constantly learn from their experience in caring for complex craniosynostosis patients at Medical City Dallas.

This patient had prior posterior cranial vault distraction, and was now ready for anterior cranial vault reconstruction for bicoronal craniosynostosis.

This procedure makes the skull bigger to give plenty of space for continued brain growth, better protection of the eyes, and reducing unwanted attention.

Even after posterior vault distraction, we were able to identify and use a smooth coronal section that worked well as a frontal bandeau. Split cranial bone grafts were used to fully reconstruct the donor site.

One small tip was to add a graft from the bandeau down to the nose, to smooth this transition that otherwise can be sharp.

Her hair is growing back and the swelling is coming down at the 2 week mark after surgery. Not a big surprise after seeing her up and about in the playroom less than 48 hours after surgery, and incredibly on home post-op day 2 like most patients after this surgery.

Craniosynostosis Before and After Photo. Surgery performed in Dallas, TX at Law Plastic Surgery.