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Spontaneous Closure of Congenital Cranial Defect: Is Early Surgical Intervention Warranted?
Michelle Y Seu1, Amir Aminzada1, Kelly A Harmon1
1Division of Plastic and Reconstruction Surgery, Rush University Medical Center.
Insights
Nonsyndromic congenital craniofacial anomalies present unique challenges. This case study suggests delaying pediatric cranioplasty may be beneficial, potentially avoiding newborn surgical risks.
Area of Science:
- Craniofacial surgery
- Pediatric plastic surgery
- Congenital anomalies
Background:
- Infantile cranial development is typically predictable, but less is understood in isolated, nonsyndromic congenital craniofacial anomalies.
- Pediatric cranioplasty timing is often based on adult data, posing management challenges for craniofacial surgeons.
- Nonsyndromic congenital craniofacial anomalies require tailored management strategies due to unique developmental patterns.
Observation:
- A case of a baby girl with right Tessier 3 cleft, cleft palate, anophthalmos, and severe left craniofacial microsomia (Pruzansky grade III) was analyzed.
- Three-dimensional chronological models revealed an abnormal fontanelle that enlarged until 22 weeks of age.
- The abnormal fontanelle subsequently closed spontaneously at a rate of 60.53 mm²/year.
Findings:
- The abnormal fontanelle's growth and spontaneous closure pattern in this infant with complex craniofacial anomalies.
- Analysis of 3D models provided insights into the unique cranial development in this specific case.
- The observed fontanelle behavior deviates from typical cranial development patterns.
Implications:
- Delaying surgical intervention, such as cranioplasty, until after two years of age may be a viable option for select patients.
- Postponing surgery could potentially mitigate surgical morbidity associated with early-life interventions in newborns.
- This case highlights the importance of individualized treatment timing for nonsyndromic congenital craniofacial anomalies.
Abstract:
Infantile cranial development typically occurs in a predictable sequence of events; however, less is known about how the development occurs in isolated, nonsyndromic congenital craniofacial anomalies. Furthermore, the timing of pediatric cranioplasty has been extrapolated from adult studies. Thus, the management of nonsyndromic congenital craniofacial anomalies presents with unique challenges to the craniofacial surgeon. The authors describe the case of a baby girl who was born with right Tessier 3 cleft, cleft palate, anophthalmos, and severe left craniofacial microsomia with Pruzansky grade III left mandibular anomaly. By analyzing 3-dimensional chronological models of the patient, the authors found that her abnormal fontanelle initially increased in size until 22 weeks of age, with subsequent spontaneous closure at a rate of 60.53 mm2/y. Although similar cranial anomalies are typically surgically corrected early in life, delaying treatment until after 2 years of age may be appropriate in some patients, obviating surgical morbidity in the newborn period.
