Craniosynostosis and Medical Negligence in Chicago
Craniosynostosis occurs when one or more of the flexible seams between the bones of a baby’s skull close earlier than expected. These seams, called cranial sutures, normally allow the skull to expand as the brain grows during infancy and childhood.
When a suture closes prematurely, skull growth becomes restricted in that direction and continues in areas where the other sutures remain open. This can produce a characteristic head shape. When several sutures are involved, there may also be an increased risk of pressure developing inside the skull.
Most cases of craniosynostosis are not caused by medical malpractice. In many children, no single cause can be identified. Some cases involve a genetic change or occur as part of a syndrome, while others may reflect a combination of inherited and developmental influences.
A legal issue may arise in limited circumstances when a provider fails to investigate significant findings, delays an appropriate specialist referral, misinterprets diagnostic studies, or causes an additional preventable injury during treatment or surgery.
Free legal evaluation: If your concern involves a specific diagnostic or treatment error rather than the congenital condition alone, contact Sexner Injury Lawyers LLC or call (312) 243-9922.
How Craniosynostosis Affects Skull Growth
A baby’s skull is made up of several bones connected by flexible tissue. These connections permit growth and help the skull accommodate the rapidly developing brain.
Premature closure does not necessarily stop the brain from growing. Instead, the skull may expand unevenly through the remaining open sutures. The resulting shape depends largely on which suture or combination of sutures has closed.
Some children have an isolated condition involving only one suture. Others have multiple sutures involved or have craniosynostosis associated with a genetic syndrome such as Apert, Crouzon, Muenke, Pfeiffer, or Saethre-Chotzen syndrome.
General medical information is available from the Centers for Disease Control and Prevention.
Types of Craniosynostosis
- Sagittal synostosis: Premature closure of the suture running from the front to the back of the top of the skull. It commonly produces a long, narrow head shape called scaphocephaly.
- Unicoronal synostosis: Closure of one coronal suture, which may cause flattening of one side of the forehead and asymmetry around the eyes and face.
- Bicoronal synostosis: Closure of both coronal sutures, which can produce a shorter and wider skull shape known as brachycephaly.
- Metopic synostosis: Closure of the suture extending from the top of the head toward the nose. It can produce a triangular forehead called trigonocephaly.
- Lambdoid synostosis: A comparatively uncommon form involving a suture at the back of the skull. It may cause flattening and asymmetry in the back of the head.
- Multisuture craniosynostosis: More than one suture closes early, potentially creating a more complex skull abnormality and a greater concern about pressure inside the skull.
Craniosynostosis and Positional Plagiocephaly Are Different
A flattened or asymmetrical head does not always mean that a cranial suture has fused. Positional plagiocephaly can develop when repeated pressure is placed on one area of an infant’s head, particularly during the first months of life.
Positional flattening does not involve premature fusion of a skull suture and usually requires a different treatment approach. Because the two conditions can sometimes appear similar, an appropriate physical examination and specialist evaluation may be important.
Possible Signs and Findings
Findings that may lead a provider to investigate craniosynostosis include:
- A head shape that appears unusual at birth or becomes more noticeable during early infancy
- A hard or raised ridge along a cranial suture
- Facial or forehead asymmetry
- One eye socket or ear appearing higher than the other
- Head circumference that is not increasing as expected
- An unusually shaped or absent soft spot
- Symptoms that raise concern about increased pressure inside the skull
Not every child has all of these findings. A fontanel can remain open in some children with craniosynostosis, and an unusual head shape can have causes unrelated to fused sutures.
Diagnosis
Craniosynostosis is commonly recognized after birth through examination of the child’s head and face. The provider may evaluate skull shape, feel for ridging along the sutures, measure head circumference, and compare growth over time.
When the diagnosis is uncertain or treatment planning requires more detail, imaging may be ordered. Depending on the circumstances, this can include ultrasound of the sutures, specialized X-rays, or a CT scan that shows the skull’s bony anatomy.
A genetic evaluation may also be recommended when:
- More than one suture is affected
- The child has other physical or developmental findings
- A particular craniofacial syndrome is suspected
- There is a relevant family history
Treatment and Follow-Up
The treatment plan depends on the affected sutures, the severity of the skull changes, the child’s age, the presence of increased pressure, and whether the condition is syndromic.
Many children undergo an operation during infancy to reshape the skull and create space for continued growth. Treatment may involve a less invasive endoscopic procedure in selected younger infants or a more extensive open cranial-vault operation.
Helmet therapy may be used after certain endoscopic operations to guide skull growth. A helmet does not reopen a fused suture and should not be treated as a substitute for surgery when surgery is medically necessary.
Some very mild cases may be observed without an operation. Each child requires an individualized assessment by an appropriate craniofacial or pediatric neurosurgical team.
Ongoing follow-up may evaluate:
- Head and skull growth
- Vision and eye alignment
- Hearing
- Development and learning
- Signs of increased intracranial pressure
- Dental, facial, and airway development
- Emotional concerns associated with visible differences
Possible Complications
Many children with isolated single-suture craniosynostosis are otherwise healthy. The possible complications vary and are more concerning when multiple sutures are involved or when the condition is part of a syndrome.
Potential issues can include:
- Increased pressure within the skull
- Vision problems
- Headaches in older children
- Sleep or airway problems
- Developmental or learning difficulties
- Seizures in some circumstances
- Psychological or social concerns related to appearance
The existence of craniosynostosis does not mean that a child will develop all or any of these complications.
Medications and Pregnancy
The prior version of this page stated that some cases were linked to selective serotonin reuptake inhibitor medications. That generalized statement has been removed because craniosynostosis should not be presented as an established consequence of maternal SSRI use.
Researchers have studied possible associations involving certain medications used before or during early pregnancy. An observed association does not establish that a particular medication caused an individual child’s condition or that prescribing it constituted negligence.
A proper medication review would need to consider:
- The specific drug and dose
- Why it was prescribed
- The timing of use
- The risks of leaving the mother’s condition untreated
- Reasonably available alternatives
- The medical knowledge available at that time
- The counseling and monitoring provided
A pregnant patient should not stop a prescribed medication without first discussing the risks and alternatives with an appropriate healthcare provider.
When Could Medical Negligence Be Relevant?
The congenital condition itself ordinarily does not establish malpractice. A potential legal matter generally requires a separate medical error that caused additional harm.
Delayed or Incorrect Diagnosis
A legal review may be appropriate when there is evidence that a provider:
- Ignored a clearly abnormal skull shape or raised suture
- Failed to monitor abnormal head-growth measurements
- Incorrectly attributed concerning findings to positional flattening without appropriate evaluation
- Failed to order indicated imaging
- Misinterpreted imaging or another diagnostic study
- Unreasonably delayed referral to a craniofacial surgeon, pediatric neurosurgeon, geneticist, or other specialist
A delayed diagnosis does not automatically establish negligence. A viable diagnostic-error claim generally requires expert proof that the provider failed to meet the accepted standard of care and that earlier action probably would have prevented additional harm.
Negligent Treatment or Surgery
A child can experience a recognized complication even when the care was appropriate. A legal issue may exist, however, when preventable harm results from:
- Unreasonable delay of medically necessary treatment
- Inadequate preoperative evaluation or planning
- A preventable surgical error
- An anesthesia, medication, or monitoring error
- Failure to recognize bleeding, infection, swelling, vision changes, or neurological deterioration
- Inadequate postoperative follow-up
Records Used to Evaluate a Potential Case
A medical and legal review may require:
- Prenatal and delivery records
- Pediatric examinations and head-circumference measurements
- Primary-care and specialist referral records
- Photographs documenting head-shape changes
- Ultrasound, X-ray, CT, or MRI studies
- Genetic-testing and counseling records
- Craniofacial and neurosurgical evaluations
- Operative, anesthesia, and hospital records
- Postoperative and developmental follow-up records
Contact Sexner Injury Lawyers LLC
Most children diagnosed with craniosynostosis do not have a medical malpractice claim. A legal review may be appropriate when there is a specific concern involving delayed diagnosis, failure to refer, misinterpreted imaging, delayed treatment, or preventable injury during surgery or follow-up care.
Contact Sexner Injury Lawyers LLC or call (312) 243-9922 for a free and confidential evaluation. We will explain honestly whether the circumstances appear to justify further investigation.
