Craniosynostosis repair - discharge

Your child was diagnosed with craniosynostosis. This is a condition that causes one or more of your child's skull sutures (the junction of two skull bones) to close too early. This can cause the shape of your child'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 child'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.

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

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

Your child'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 child's head or to prevent unwanted recurrence or changes after surgery.

• 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 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.

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 their back.

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

To help control your child's pain, use children's acetaminophen (Tylenol) or other medicines by mouth or rectally as your child's surgeon or other health care provider advises.

Keep your child's surgery wound clean and dry until the surgeon 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 are told by your surgeon that you may 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. Do not scrub the wound.
• Use a small amount of ointment on the wound as recommended by the child's doctor.
• Wash your hands when you finish.

Contact your child's surgeon if your child:

• Has a temperature of 101.5ºF (38.6ºC)
• Is vomiting and cannot keep food down
• Is more fussy or sleepy
• Seems confused
• Seems to have a headache
• Has a head injury
• Develops unexpected bruising on the skull or scalp

Also contact the surgeon if the surgery wound:

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

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

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.

Forrest CR, Riesel JN. Craniosynostosis: introduction. In: Losee JE, Hopper RA, eds. Plastic Surgery: Volume 3: Craniofacial, Head and Neck Surgery and Pediatric Plastic Surgery. 5th ed. Philadelphia, PA: Elsevier; 2024:chap 25.1.

Jimenez DF, Barone CM. Endoscopic treatment of craniosynostosis. In: Winn HR, ed. Youmans and Winn Neurological Surgery. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 221.

Mortada H, AlKhashan R, Alhindi N, et al. The management of perioperative pain in craniosynostosis repair: a systematic literature review of the current practices and guidelines for the future. Maxillofac Plast Reconstr Surg. 2022;44(1):33. PMID: 36239849 pubmed.ncbi.nlm.nih.gov/36239849/.

Updated by: Luc Jasmin, MD, Ph.D., FRCS (C), FACS, Department of Neuroscience, Guam Regional Medical City, Guam; Department of Surgery, Johnson City Medical Center, TN; Department of Maxillofacial Surgery at UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.