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Ask Dr. Yogindra Vasavada Your Own Question
Dr. Yogindra Vasavada
Dr. Yogindra Vasavada, Pediatrician
Category: Pediatrics
Satisfied Customers: 3116
Experience:  M.D.(ped) passed at first attempt, in practice continuously for last 37 years. Certi. in Comp
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In pictorial representations of brachycephaly the persons

Customer Question

In pictorial representations of brachycephaly the persons cheeks are shown as protruding forward. Why is this? My daughter has asymmetrical brachycephaly / plagiocephaly. As an infant her cephalic index was 91-93. Now at two years old her cephalic index
is 87. Her facial features appear symmetrical but she has parietal bossing and quite a flat head with asymmetry of 9mm. Could this cause her cheeks and maxilla to be more prominent and / or cause her to have a double chin? I just don't understand how all the
skull and facial bones articulate with each other, especially when you factor in head flattening.
Submitted: 1 year ago.
Category: Pediatrics
Expert:  Dr. Yogindra Vasavada replied 1 year ago.
Hello,
The flat skull bones are originating from membranes and kid's skull shape goes on changing with growth of brain. Final shape is only attained in teen years. Face and cheeks finalize only after full permanent dentition is over.
If nose bridge is depressed, as in your daughter, cheeks may appear protruding.
Customer: replied 1 year ago.
Is her depressed nose bridge normal? So just to be clear, her cheeks are not protruding because of the head flattening? I was told my family doctor that the overall shape my daughter's skull will not change as she gets older, is that correct?
Expert:  Dr. Yogindra Vasavada replied 1 year ago.
The joints of different skull bones do not fuse until late childhood and full adult skull diameter is attained. There is genetics involved in this final outcome, usually resembling either parent.
This allows growing brain to push skull bones appropriately. If there is any premature closure (fusion) of any suture line, this may grossly distort shape of skull and restrict brain growth producing symptoms like headache, vomiting, fits. etc. Plain X ray or MRI scan studies are required then.
Cheek bones are part of maxilla and this bone does not take part in shape of upper cranium.
Like other bones, nose saddle bone will also grow with age, to reshape nose to normal prominence.
Customer: replied 1 year ago.
Thanks. When a head is flattened at the back, and has parietal bossing as in the case of my daughter, what happens to the brain?From everything I have been told or read about plagiocephaly it sounds like I should not expect my daughter's head to spontaneously round out. You have mentioned that not all skull bone joints fuse until late childhood, how much change is realistic over time?You also mentioned that cheek bones are part of maxilla which doesn't take part in shape of upper cranium. Is the reverse true - do they upper cranium bones not take part in the shape / location of the maxilla?
Expert:  Dr. Yogindra Vasavada replied 1 year ago.
You are welcome.
As child matures and more and more time spent out of bed, the flattening of back of skull will reduce and rounding will take place. If required, suitable cushions may be used during sleep so that baby sleeps on either side rather than on back.
Yes, upper cranial vault shape does not affect shape of maxilla.
Customer: replied 1 year ago.
But if my daughter is two can I still expect the same results? I thought that repositioning and increasing time out of bed was only effective earlier on?
Expert:  Dr. Yogindra Vasavada replied 1 year ago.
If her soft spot is still there, it may help. Even otherwise, it is advisable to make her sleep on one or other side rather than on back.
Customer: replied 1 year ago.
Do you have any idea why the attached picture of someone with brachycephaly show the cheeks protruding?
Expert:  Dr. Yogindra Vasavada replied 1 year ago.
The cheeks may be normal, only the forehead may be receding giving prominence to cheeks as seen from above.
Customer: replied 1 year ago.
Can a flattened head lead to acquired chiari malformations?
Expert:  Dr. Yogindra Vasavada replied 1 year ago.
No,not in least unless there are prematurely fused joints of all skull bones.