Cranial Asymmetry Basics

Babies have free floating plates of bone in their skull that are loosely connected with fibrous tissue known as sutures. When exposed to prolonged pressure, asymmetry or flat spots of the head can occur, this is known as plagiocephaly. Some factors of increased risk for plagiocephaly are: premature birth, Congenital Muscular Torticollis (CMT), multiple births or crowding in the womb, positional favoring of one or more spots on the head.

Plagiocephaly is defined in three common types of head shapes and are usually easiest to see looking from the top down.

Plagiocephaly

Plagiocephaly shows as an uneven or asymmetrical head shape. The back of one side will be flattened, sometimes pushing the forehead and ear on the same side forward. One ear or eye may show higher than the other.

Brachycephaly

Brachycephaly shows as an abnormally wide shape of the head as a result of a central flattening of the back of the head. Back of the head may increase in height and forehead may bulge when viewed from the side.

Scaphocephaly

Scaphocephaly shows as a long, narrow shape of the head looking down from the top. Forehead may bulge as well as the back when viewed from the side. This is more common in premature babies.

Craniosynostosis

Craniosynostosis is a rare condition where one or more of the fibrous tissues between the bony plates in an infant’s skull fuse or close prematurely and before the baby’s brain is fully formed. The brain continues to grow, giving the infant’s head an asymmetrical or misshapen shape or appearance. Sometimes a raised, hard ridge is felt along prematurely closed sutures.

Craniosynostosis typically involves the premature closing of one suture, but can have more, and results in Complex Craniosynostosis.

Treatment for craniosynostosis requires surgery to allow the sutures to close properly and allow the brain to grow normally. Early diagnosis and intervention are essential in allowing your baby’s brain to develop normally. The vast majority of plagiocephaly cases do not involve craniosynostosis.

Torticollis

Congenital Muscular Torticollis, also known as ‘wry neck’ is a condition where an infant has an abnormally shortened and tight neck muscle that causes the head to tilt to one side while rotating the chin to the opposite shoulder. Babies with torticollis have a limited range of motion in the neck and will usually hold their head in one position which can lead to plagiocephaly.

Torticollis is common in newborns and can be present at birth or take up to three months to develop. Some causes of torticollis include the baby’s position in the womb before birth, abnormal development of the sternocleidomastoid (SCM) muscle or trauma or damage related to birth.

Treatment usually involves a physical therapist and some neck re-positioning and stretching exercises to help stretch the SCM muscle.

Move on to Plagiocephaly Evaluation and Treatment