CCA posts a monthly blog series called, "Ask the Doctor." You can submit your questions to Annie Reeves (areeves@ccakids.com) and we will ask Dr. Earl Gage of Kids' Plastic Surgery in St. Louis to answer them. Thanks Dr. Gage for helping spread information and resources for our cranio families!
Ask The Doctor
Earl Gage, MD
Kids Plastic Surgery, Mercy
Children’s Hospital – St Louis, MO
Question: We had surgery
October 25 for saggital craniosynostosis. He had an 8x4 section removed along with relief cuts on the
side. At our six week check up I mentioned and the doctor
confirmed that his entire skull had regrown already. We are on our second
helmet to try and shape the head but it is 10mm longer (footballish) than
before surgery.
I love our craniofacial surgeon but wonder if a second
opinion is necessary? It seems awfully fast for the bone to regrow and I'm worried
we should be looking at, or preparing for, another surgery.
Answer: Thanks for your question. I presume that your
baby had endoscopic assisted suture removal where a limited section of bone was
removed through small incisions. Endoscopic assisted surgery is gaining
acceptance as a good technique for treating craniosynostosis because if offers
smaller scars, shorter surgery times, shorter hospital stays and less risk of
needing blood transfusion. In experienced hands, the outcomes in sagittal
synostosis are also quite good with normalization of skull shape in most cases.
In order for the surgery to work well in correcting the head shape, it is
important to remove a wide enough section of bone and release the fused suture
completely. It is also critical, in my opinion, that parents are compliant with
molding helmet therapy after the surgery and that teams use an experienced
orthotist to make the helmet and monitor for proper fit. While I am aware that
helmets are not used in some places in conjunction with endoscopic assisted
suture release, I believe the best results are achieved when a helmet is used
in conjunction with surgery. Parents should anticipate that their baby will
need the helmet until approximately 1 year of age. The helmet should be worn 23
hours a day.
The fact that your baby’s cranial bone seems to have
re-grown quickly is not surprising. In fact, this is normal. If the head shape
is not correcting or is worsening, this can be the result of not having had
enough bone removed, incomplete release of the suture or a molding helmet that
is not fitting properly or not being worn as instructed. These are things to
check and discuss with your team. Although it is rare to need a second surgery,
sometimes repeat surgery is recommended due to inadequate correction of the
head shape. When deemed necessary, any repeat surgery would likely be done as a
traditional, open surgery. It is never
wrong to seek a second opinion if you have concerns. Most surgeons will be OK
with this. It is always OK to be a strong advocate for your baby.
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