That new baby’s brain is about to start an incredible growth spurt. In nine months it will double in size and by 36 months it will be three times as big.
The ‘soft spot,’ also called the fontanel, is one of several gaps between the bones of the skull that, in addition to allowing the skull to expand, are constantly producing new bone to keep up with this growth.
The gaps are arranged along the skull in a functional pattern that allows the brain to grow symmetrically. In addition to the fontanel, there are other long narrow, hinge-like gaps called sutures.
The largest is the Sagittal suture (see the image at right) which runs along the top of the skull from front to back. It divides the two large Parietal bones.
The fontanel is located along the Sagittal suture between the Frontal and Parietal bones. In some rare cases, the sagittal suture fuses too early, causing sagittal synostosis – the most common form of Single-Suture craniosynostosis (SSC).
The brain still grows but because there is no longer a gap along the top of the head, the head can’t expand from side to side. This causes the brain to push out in front and in back, giving the baby a more elongated skull (This PICTORIAL guide shows the bone plates and sutures and explains how early fusion can cause skull deformity).
A small percentage of these children have developmental problems that can result from an increase in brain pressure. The most common problem however, and the reason most children have corrective surgery is skull and facial deformity.
In a recent paper published in the Journal of Neurosuregery: Pediatrics, authors* including Dr. Richard Anderson and Dr. Neil Feldstein from the Pediatric Neurosurgery Center say, ” Improvement of the cosmetic deformity associated with SSC not only eases parental anxiety but facilitates early parent-child bonding and will, in many cases, prevent damage to the growing child’s self image.”
There are a variety of tools that have been designed to objectively measure deformity but, the authors say that surgeons have not yet agreed upon which one to use routinely after surgery.
In their paper, they review a variety of these tools and urge that until a satisfactory method or group of methods is established it will be difficult to meaningfully compare the outcomes of the many types of surgery for SSC that are available today.
To learn more, you can read their paper Surgical treatment of single-suture craniosynostosis: an argument for quantitative methods to evaluate cosmetic outcomes in the Journal of Neurosurgery: Pediatrics (6:193–197, 2010).
In the meantime, be grateful you have to be careful of that precious ‘soft spot.’
*The authors of this study are: Todd Hankinson, M.d., M.B.A.; Elizabeth Fontana, M.D.;Richard Anderson, M.D.; and Neil Feldstein, M.D.
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