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Craniofacial AnomaliesThe Craniofacial Anomalies Program offers a team of specialists working together to ensure the physical health, growth and development of your child. Our team is composed of specialists from 22 different disciplines throughout the University of Michigan Medical Center. Experience has shown that it is not possible for a single physician to treat all the special medical, dental, educational, psychological and communication needs of children dealing with such conditions. Children will see many or all of these specialists during a clinic visit depending on their problem. At the end of the day, the team will meet to discuss each of the children seen. At that point, findings and recommendations will be shared with parents and professionals outside the hospital who are caring for the child. What is a Craniofacial Anomaly?
Children born with a craniofacial anomaly suffer from a deformity of the skull or face. There are many types of craniofacial anomalies and they can result from many different causes. A craniofacial anomaly can occur as a result of a birth defect (known as a congenital deformity) or it can be the result of something that happens after birth (known as an acquired deformity). Often a congenital craniofacial anomaly is apparent at birth, although sometimes the problem may appear later in infancy and childhood. Congenital Craniofacial Anomalies are thought to have many different causes and it is an active area of current research. What is Craniosynostosis?One form of craniofacial anomaly is called craniosynostosis. To understand this disorder it is important to understand the development of the skull. Development of the SkullThe skull plays an important role because it is the bony container that houses and protects the brain. The skull is not made up of one bone, rather it is made up of several pieces of bone that fit together along loose connections called "sutures" that connect the bones to each other. The sutures between the bones allow the baby's brain and skull to grow and enlarge together . The majority of the growth of the brain and skull occurs by the age of three. Although the brain continues to grow, after the age of three that it does so at a much slower rate. Once brain growth is complete the sutures close permanently, or "fuse". Craniosynostosis is the condition where the cranial sutures close too soon, while the baby's brain and skull are still growing. This premature fusion of the cranial sutures may lead to significant changes in the shape of the skull, face, orbits (eye sockets), and even the jaw. Craniosynostosis can potentially cause damage to the growing brain if there is not enough room for it to grow inside the skull. This can lead to increased pressure within the skull and possible brain damage, blindness, and/or developmental delay, The incidence of craniosynostosis is about 1 in 2,000 births. Types of CraniosynostosisSagittal SynostosisThere are several forms of craniosynostosis that may afflict a child. The most common type of suture synostosis is sagittal synostosis. In this type, the suture that runs from the front to the back fuses prematurely. This causes a condition which specialists refer to as "scaphocephaly" or "boat" shaped skull. The skull becomes long from front to back, and appears narrow when viewed from the front. There may be a prominent ridge along the top of the head extending from the "soft spot" to the back of the head. The forehead may seem too prominent or bossed and the temporal area of the skull may seem pinched. A sagittal synostectomy and cranial vault reshaping can be performed to surgically correct scaphycephaly resulting from sagittal craniosynostosis. In this operation, the neurosurgeon removes the sagittal suture and gives the craniofacial plastic surgeon access to the cranial vault. The craniofacial surgeon makes cuts in the bones of the skull and reshapes them in a way that restores the child to a more normal cosmetic appearance and allows for proper growth of the brain and skull in the future. The operation is preferably performed early in life, sometime after three months of age. Coronal SynostosisCoronal synostosis is the second most common type of suture synostosis. Bilateral (occurring on both sides of the head) coronal synostosis is common in many inherited craniofacial syndromes. In coronal synostosis, the coronal suture (the suture that is located across the the top of the head spanning from ear to ear ) heals prematurely leading to a condition known as plagiocephaly ("slanted head") when found on one side and brachycephaly ("short flat head") when found on both sides of the head. Unilateral Coronal SynostosisIn unilateral coronal synostosis, the coronal suture on one side of the head fuses prematurely. This leads to a condition which specialists refer to as plagiocephaly or slanted head. In this disorder, the forehead on the involved side appears flat, and the opposite side may bulge out. The bony rim above the eye on the involved side is also flatter and may look higher than the one on the uninvolved side and the nose points away from the fused suture. An operation is necessary to allow the brain room for growth, and to restore the normal shape to the forehead. If left untreated, this condition causes a skull deformity that will get worse over time. It also causes facial disfigurement, and could in rare cases cause brain damage. Babies with unilateral coronal synostosis should see a neurosurgeon and craniofacial surgeon to plan for surgery. The goal of surgery is to open the prematurely fused suture, restore the normal shape of both the forehead and rim above the affected eye, and allow for normal brain growth. In this operation, called a "frontal-orbital advancement", the surgeon accesses the bone of the skull through an incision that goes from ear to ear across the top of the head. The surgeon removes the bones of the forehead, reshapes and advances the bone with small plates and screws that are permanent. Bilateral Coronal SynostosisIn bilateral coronal synostosis, the entire forehead may appear flat, broad and too tall. An operation is necessary to correct Bilateral coronal synostosis to allow the brain room to grow, and to reshape the abnormal skull. Babies with coronal synostosis must see a neurosurgeon and craniofacial surgeon to plan for surgery. The goal of surgery is to open the prematurely fused sutures, reshape the entire forehead and allow for normal brain and skull growth. In this operation, called a "frontal-orbital advancement", the surgeon gains access to the bones of the skull through an incision that goes from ear to ear across the top of the head. The surgeons remove the bones of the forehead, reshapes the bones, and puts them back in place with small plates, and screws that are permanent. Metopic SynostosisMetopic synostosis is the premature fusion of the suture in the middle of the forehead. This causes a condition which specialists call "trigonocephaly," or triangle shaped head. In this case, the forehead is narrow, the temples appear pinched, and the eyes are too close together (hypotelorism). There may be a noticeable ridge in the middle of the forehead. A child with this condition may require surgery to correct the shape of the head, or to prevent it from getting worse. A child would also need surgery if there were too much pressure on the brain. Children with metopic synostosis should see a neurosurgeon and craniofacial surgeon to plan for surgery if needed. The goal of surgery is to open the prematurely fused sutures, to allow for normal brain growth, and to restore the normal shape of the forehead. In this operation, the surgeon accesses the bones of the skull through an incision that goes from ear to ear across the top of the head. The surgeon removes the bones of the skull and forehead, reshapes them, and puts them back in place with small plates and screws that are permanent. Preparing for Your Child's SurgeryYou will be given a pre-operative information packet that explains everything you should do and know before your child's surgery date. Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and taking or avoiding certain vitamins and medications. Your child may spend several days in the pediatric intensive care unit after surgery. Click here for a partial list of hotels and other lodging in Ann Arbor that offer discounts for patient's families. To reach the Patient & Visitor Hotel Accommodations Program, call (800) 544-8684 or (734) 936-0135. List of Physicians Who Perform Craniofacial Anomalies SurgeryFor details about education, experience, and specialty in this clinical area, please visit these physician profile pages: Mott Operating & Recovery RoomsYour child's surgery will take place at the University of Michigan's C.S. Mott Children's Hospital which provides state-of-the-art, "child friendly" surgical suites and recovery areas. Visit the Mott Children's Hospital OR & Recovery Room page for a "virtual tour" of the operating and recovery areas, before, during, and after surgery information, frequently asked questions and answers for parents and children, and much more. Types of AnesthesiaThe cleft palate repair is done in the operating room under general anesthesia so that your child will sleep throughout the entire procedure. Anesthesiologists and nurse anesthetists at Mott Children's Hospital are all trained and experienced in pediatric anesthesia and care for pediatric patients. Your child will remain comfortable throughout the entire procedure. After Your Child's SurgeryClick here for information about how to care for your child after the surgery and what to expect during the recovery period. It is very important that you follow your surgeon's instructions in order to promote healing and progress. Also, it is important that you attend all follow-up appointments scheduled so that your surgeon can assess your child's long-term results and answer any questions or concerns you may have. Resources for Families
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