Sagittal synostosis and ossified scalp hematoma: cause or consequence?

Area of Science:

• Craniofacial Surgery
• Pediatric Neurosurgery
• Developmental Biology

Background:

• Sagittal synostosis is a common premature fusion of the sagittal suture, leading to scaphocephaly.
• Cephalohematomas are common birth injuries, typically resolving without complication.
• The relationship between birth trauma, cephalohematomas, and sagittal synostosis remains incompletely understood.

Observation:

• Two cases of sagittal synostosis with scaphocephaly presented with ossified scalp hematomas straddling the sagittal suture.
• These ossified lesions were identified as originating from cephalohematomas.
• The obliteration of the sagittal suture by synostosis facilitated subgaleal blood collection across the midline.

Findings:

• The presence of ossified scalp hematomas in these cases was a consequence of sagittal synostosis, not its cause.
• Scaphocephaly likely contributed to difficult deliveries, leading to the scalp hemorrhages.
• The hypothesis that hematoma ossification causes synostosis was refuted based on anatomical and etiological review.

Implications:

• This study clarifies the pathophysiology of cephalohematomas in the context of sagittal synostosis.
• It emphasizes that sagittal synostosis is not a complication of birth trauma in these instances.
• Understanding this relationship is crucial for accurate diagnosis and management of craniosynostosis.