Head Flashcards
Physical Assessment of the Head
- Look for torticollis
- Examine the head from above and side
- Examine the entire head using fingertips
- Feel for ridge over sutures
- Face
- Forehead and upper orbit
- Orbitonasal zygomatic area
- Maxillomandibular area
- Posterior cranial vault
- Examine the extremities and back of child with deformation of head since congenital dislocation, scoliosis and deformed feet are most common
Torticollis
Inability to turn head in both directions
Sutures (5)
Location
Metopic – frontal
Squamosal – above eye
Coronal – side suture closer to front of head
Sagittal – middle suture
Lambdoidal – side suture closer to back of head
**C before L**
4 problems seen with Head
Abnormalities of size
Abnormalities of shape
Positional problems
Abnormality of the scap
Abnormalities of Size (3)
Microcephaly
Macrocephaly (megacephaly)
Normocephalic
Macrocephaly Assessment
- Serial head measures
- Measure parents head
- Developmental hx
- Transilluminate skull
- Look for skeletal dysplasia (short stature)
- Listen for bruit
- Look for sunset eyes
- Signs of neurocutaneous disorder
Sunsetting eyes
With severe hydrocephalus, there may be forced, conjugate downward deviation of the eyes so that the inferior half of the iris is hidden by the lower eyelid, producing the “sunsetting” sign
See sclera above iris*
Causes of Microcephaly (6)
- Genetic defect
- Karyotype, chromosomal microarray
- Intrauterine infections
- Antenatal radiation
- Exposure to drugs and chemicals (antiepileptics)
- Perinatal insult
- Has been found in some cases to cause Cerebral palsy
Abnormalities of Shape
Scaphocephaly
Plagiocephaly
- Scaphocephaly or dolichocephaly
- Positional problems in the premature infant
- Saggital Craniosynostosis
- 24-25 weeks = premie head; outgrow it
- Plagiocephaly (just positional)
- Common with back head sleep position
- Torticollis
What happens when the sagittal suture closes too early?
Head grows long ways –> long narrow head
Craniosynostosis
Two main categories
- Rare condition in which the skull sutures close and the bony plates of the skull become fused too early in life.
- Craniosynostosis develops while the fetus is still in the mother’s womb
- 1 in every 2,500 births
- Sagittal suture closes prematurely
- Craniosynostosis can occur as a part of a larger pattern of abnormalities
- Two main categories:
- Simple or isolated craniosynostosis
- Complex or syndromal craniosynostosis
- Not Genetic**
Craniosynostosis
Make sure to….
Palpate all sutures and feel for overriding bones
Causes long, narrow head, frontal bossing
Scaphocephaly
- No growth in perpendicular to sagittal suture
- Bitemporal narrowing
- Cranial elongation in anterior-posterior direction
What is characteristic of Scaphocephaly?
Frontal bossing and prominent occiput
Brachycephaly
- Bilateral coronal or lambdoidal (11%)
- Broad skull with a short base and a recessed lower forehead.
- Caused by premature closure of the coronal suture on both sides of the head
- Brachy-, turri- or acrocephaly
- Associated with:
- Apert syndrome
- Crouzon syndrome
- Pfeiffer syndrome
Brachycephaly Characteristics
- High hat appearance
- Long, underdeveloped philtrum
- Downward slanting eyes
- Prominent epicanthal folds
- Tongue out – low tone
- Low set ears
Crouzon’s Syndrome (4)
- Craniosynostosis most often of the coronal and lambdoid and occasionally sagittal sutures
- Underdeveloped midface with receded cheekbones or exophthalmos (bulging eyes)
- Ocular proptosis which is a prominence of the eyes due to very shallow orbits
- Esotropia (inward turning eyes) and/or wide set eyes
- Shallow eyes/orbit
Apert Syndrome (4)
- Very high brachycephalic head
- Severe syndactyly affecting all limbs.
- Syndactyly involves bony fusion.
- Apert is the second most common craniofacial syndrome after Crouzon.
Fushion of fingers and toes!
Patients with Aspert Syndrome
- Brachiocephaly
- Very low set ears (know by matching up canthus and occiput)
Metopic Craniosynostosis
- Trigoncephaly
- Narrow, triangular, ridged forehead
- METOPIC CLOSED*
- Head tilted back
- Ocular problems
- Not urgent and does not have affect on brain growth
- Pointed at forehead; frontal bossing
Oxycephaly
5 characteristics
- Closure of all sutures except squamosal
- Surgery is URGENT
- Brachiocephalic
- Long philtrum
- Low set ears
- Frontal bossing
- DYSMORPHIC FEATURES*
Positional Plagiocephaly
- Face will be pushed forward on the affected side
- Frontal Bossing due pressure on the occiput
- The ear on the affected side will be forward in comparison to the unaffected side
- A parallelogram will be formed.
Flattening on one side of head – sutures are okay; more about positioning!
Lambdoidal Craniosynostosis
- If there is lambbdoidal synostosis, the head cannot expand in the frontal region on the affected side of the head so the growth will be affected on the unaffected side.
- Since there is growth restriction on the affected side, there is overgrowth everywhere else
- A trapezoid results.
Affected side has NO OPEN SUTURE* One side of face jets out
What characterizes a child with Crouzon Syndrome?
Multiple craniosynostoses
Bulging or proptotic eyes