Craniosynostosis repair - discharge

Definition

Craniosynostosis repair is surgery to correct a problem that causes the bones of a child's skull to grow together (fuse) too early.

Alternative Names

Craniectomy - child - discharge; Synostectomy - discharge; Strip craniectomy - discharge; Endoscopy-assisted craniectomy - discharge; Sagittal craniectomy - discharge; Frontal-orbital advancement - discharge; FOA - discharge

When You're in the Hospital

Your baby was diagnosed with craniosynostosis. This is a condition that causes one or more of your baby's skull sutures to close too early. This can cause the shape of your baby's head to be different than normal. Sometimes, it can slow normal brain development.

During surgery:

• The surgeon made 2 to 3 small cuts (incisions) on your baby's scalp if an instrument called an endoscope was used.
• One or more larger incisions were made if open surgery was done.
• Pieces of abnormal bone were removed.
• The surgeon either reshaped these bone pieces and put them back in or left the pieces out.
• Metal plates and some small screws may have been put in place to help hold the bones in the right position.

What to Expect at Home

Swelling and bruising on your baby's head will get better after 7 days. But swelling around the eyes may come and go for up to 3 weeks.

Your baby's sleeping patterns may be different after getting home from the hospital. Your baby may be awake at night and sleep during the day. This should go away as your baby gets used to being at home.

Self-care

Your baby's surgeon may prescribe a special helmet to be worn, starting at some point after the surgery. This helmet has to be worn to help further correct the shape of your baby's head.

• The helmet needs to be worn every day, often for the first year after surgery.
• It has to be worn at least 23 hours a day. It can be removed during bathing.
• Even if your child is sleeping or playing, the helmet needs to be worn.

Your child should not go to school or daycare for at least 2 to 3 weeks after the surgery.

You'll be taught how to measure your child's head size. You should do this each week as instructed.

Your child will be able to return to normal activities and diet. Make sure your child doesn't bump or hurt the head in any way. If your child is crawling, you may want to keep coffee tables and furniture with sharp edges out of the way until your child recovers.

If your child is younger than 1, ask the surgeon if you should raise your child's head on a pillow during sleeping to prevent swelling around the face. Try to get your child to sleep on the back.

Swelling from the surgery should go away in about 3 weeks.

To help control your child's pain, use children's acetaminophen (Tylenol) as your child's doctor advises.

Wound Care

Keep your child's surgery wound clean and dry until the doctor says you can wash it. Do not use any lotions, gels, or cream to rinse your child's head until the skin has completely healed. Do not soak the wound in water until it heals.

When you clean the wound, make sure you:

• Wash your hands before you start.
• Use a clean, soft washcloth.
• Dampen the washcloth and use antibacterial soap.
• Clean in a gentle circular motion. Go from one end of the wound to the other.
• Rinse the washcloth well to remove the soap. Then repeat the cleaning motion to rinse the wound.
• Gently pat the wound dry with a clean, dry towel or a washcloth.
• Use a small amount of ointment on the wound as recommended by the child's doctor.
• Wash your hands when you finish.

When to Call the Doctor

Call your child's doctor if your child:

• Has a temperature of 101.5ºF (40.5ºC)
• Is vomiting and cannot keep food down
• Is more fussy or sleepy
• Seems confused
• Seems to have a headache
• Has a head injury

Also call if the surgery wound:

• Has pus, blood, or any other drainage coming from it
• Is red, swollen, warm, or more painful

References

Demke JC, Tatum SA. Craniofacial surgery for congenital and acquired deformities. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 187.

Fearon JA. Syndromic craniosynostosis. In: Rodriguez ED, Losee JE, Neligan PC, eds. Plastic Surgery: Volume 3: Craniofacial, Head and Neck Surgery and Pediatric Plastic Surgery. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 33.

Jimenez DF, Barone CM. Endoscopic treatment of craniosynostosis. In: Winn HR, ed. Youmans and Winn Neurological Surgery. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 195.