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HEAD

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Head

  • Size & Shape

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  • Sutures & Fontanelle

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  • Scalp Defects

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  • Traumatic Lesions
    • Protuberances
    • Lacerations / Abrasions / Contusions

Always Remove The Cap

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Occipito-Frontal Circumference

  • Non stretchable tape.

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  • Just above the eyebrows and occipital prominence

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  • Largest of the 3 measurements

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  • 34.5 cm - 35 cm (33-37 cm = 10-90th centile)

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  • Beware of swelling and molding of skull.

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  • Plot on growth charts.

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Microcephaly & Macrocephaly

Microcephaly – OFC < 2SD

Macrocephaly – OFC > 2SD

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  • Junction of 2 flat bones

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  • Moulding

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  • Premature closure- craniosynostosis

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  • Wide suture

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Fontanelle

Junction of >2 flat bones

Anterior fontanelle

Junction of metopic, sagittal, and coronal sutures.

Diamond shaped - 1-4cm.

Posterior fontanelle

Junction of the sagittal and lambdoid sutures, <1 cm

Tense and bulging fontanelle

Raised intracranial pressure (ICP)

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Sutures

To Check

  • Should be checked in Sitting position, not crying
  • Should be soft and flat

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Wide Suture - > 1cm

Congenital Hypothyroidism

Down Syndrome

Achondroplasia

Increased Intracranial Pressure

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Moulding �Vs �Craniosynostosis

  • Mobility

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  • Ridge Formation

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  • Size of Fontanelle

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Craniosynostosis:�Premature fusion of sutures

One suture closes early & remaining continue growing, resulting in:

An Abnormally Shaped Skull

Lack Of Room For The Brain To Grow

Raised intra-cranial pressure.

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Primary or Secondary

Simple (one suture Involved) Or Compound (multiple sutures involved)

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  • Positional Plagiocephaly
  • Distortion Of The Head Shape without any Craniosynostosis.
  • Cause - Constantly Lying On One Side.
  • Self-corrects over time.

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Craniotabes

Soft area of skull bone, usually in the parietal region.

Seen in:

Preterm infants

Term infant whose head rested on the maternal pelvic brim

Maternal/fetal vitamin D deficiency

Syphilis

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Extra-cranial collections

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Features

Caput

Cephalhematoma

Subgaleal Hematoma

Location

Crosses suture lines

Distinct margins

Do not suture lines

Crosses suture lines “FOOTBALL helmet like “

Findings

Firm edema vaguely demarcated

Initially firm,

Fluctuant after 48 hours

Diffuse fluid like swelling, shifts to dependent areas ,

Timing

Noted at birth

Hour-days after birth

At birth or hours later

Volume of blood

None to very little

10-40ml

50-100ml

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Scalp defects

Encephalocele

Anencephaly

Cutis Aplasia

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Face

Symmetry

Dysmorphism)

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Symmetry of Face

Facial palsy

Asymmetric crying face

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Mouth��Ebstein Pearls Neonatal Tooth Cleft Palate

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Patau- Trisomy 13

Down- Trisomy 21

Edward- Trisomy 18

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Beckwith Wiedemann syndrome

Congenital Hypothyroidism

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Craniofacial Syndromes

Apert syndrome

prematurely fused facial deformities hypertelorism (wide eyes) and syndactyly

Crouzon syndrome

premature fusion sutures, deformities of mid-face, vision ,hearing ,cleft lip or palate ,no hand or foot deformity

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Compound Craniosynostosis

  • kleeblattschädel syndrome
  • Cloverleaf skull
  • Intrauterine premature closure of the sagittal, coronal  and lamboid suture

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Pfeiffer syndrome:

hypertelorism, hearing loss, dental abnormalities, brachydactyly (short fingers and toes) and syndactyly

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Carpenter Syndrome

malformations of hands and feet, cardiovascular deformities, skeletal abnormalities, obesity, vision problems, mental retardation

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