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Midface Hypoplasia and Cranial Base Morphology in Syndromic Craniosynostosis: A Comparative Analysis Study Using a Predictive Regression Model
Published on: November 4, 2025
The Natural History of Cranial Morphology in Sagittal Craniosynostosis
Sultan Al-Shaqsi1, Elizabeth Zellner2, Jessica Ching2
1Plastic and Reconstructive Surgery, University of Toronto, The Division of Plastic and Reconstructive Surgery.
Insights
The severity of craniosynostosis, a condition causing abnormal head shapes in children, does not change over time. This finding offers reassurance to parents considering surgical correction for their child.
Area of Science:
- Pediatric Plastic Surgery
- Craniofacial Surgery
- Pediatric Neurosurgery
Background:
- Craniosynostosis results in abnormal head shapes in children.
- Parents often inquire about the potential worsening of head deformities over time.
- Existing literature lacks data on the progression of untreated craniosynostosis.
Purpose of the Study:
- To evaluate the progression of cranial morphology in children with unoperated craniosynostosis.
- To provide data-driven insights for parental decision-making regarding surgical intervention.
Main Methods:
- Retrospective review of children with unoperated sagittal craniosynostosis.
- Analysis of serial 3D photographs from 14 patients (9 male, 5 female) aged 3 months to 5 years.
- Comparison of skull volume and cranial index over time against a normative skull database.
Main Results:
- Skull volume changes in unoperated craniosynostosis patients showed no significant difference compared to healthy infants.
- The cranial index remained stable over time in children with craniosynostosis.
- No worsening or improvement in deformity severity was observed.
Conclusions:
- The severity of craniosynostosis remains stable throughout a child's growth.
- Parents can be reassured that the skull deformity will not worsen if surgical correction is declined.
- This stability provides valuable information for families navigating treatment decisions.
Background:
Children with craniosynostosis have abnormal head shapes. Parents frequently ask whether the abnormal head shape will get worse with time. However, there is no information in the literature to indicate whether the deformity gets worse.
Objective:
To assess the progression of cranial morphology in children with unoperated craniosynostosis.
Methods:
A retrospective review of all children with unoperated sagittal craniosynostosis who were referred to the Craniofacial Clinic at the Hospital for Sick Children (SickKids) was conducted. Serial 3D photographs of patients with sagittal craniosynostosis who have not undergone surgical correction were included in the study. There were 14 cases included, with 9 males and 5 females. Ages at time of scans ranged from 3 months to 5 years of age (mean = 28.3 months, SD = 28.2 months). Nine patients had the first scan at age of <12 months. Multiple scans for each patient were sized for volume over time and compared with a normative skull database.
Results:
The results of measuring skull volume changes over time revealed no significant difference from infants without craniosynostosis. Furthermore, there cranial index was stable over time in patients with craniosynostosis.
Conclusion:
The severity of craniosynostosis does not worsen or improve with time. Parents having difficulty in deciding to proceed with surgical correction of craniosynostosis can be reassured that the skull deformity will remain stable with the growth of their child if they decide not to proceed with surgical correction.
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