Treatment General Considerations

The primary message emanating from these rules is that single-suture closure affects the entire skull. It follows that surgery cannot then focus only on the fused suture; it must address the compensatory changes primarily. Correction, regardless of the fused suture, should effect a normal contour.

The optimal time for surgical correction is prior to the fusion of the non-pathologic sutures. Early repair benefits from the pliability of infant skull - a quality that diminishes significantly near the end of the first year. The pliable skull may be re-contoured using either radial or barrel-stave osteotomies combined with controlled fractures and the Tessier rib bender. Early correction also takes advantage of the corrective influences of the growing brain. After surgery has restored normal contour, further brain growth tends to re-contour the skull appropriately. During the first 6 months, brain volume doubles, and triples by 2.5 years, at which time the brain has attained approximately 80% of its ultimate size. Early surgery also prevents the compensatory growth from being fully manifested. It is evident from our studies on the natural history of synostoses that, without correction, cranial deformity worsens with time [19]. Our previous recommendations were to perform surgery at 3 months. Currently, primarily to maximize fortitude and to benefit from pliability of the bone, surgery is delayed until 6 months of age.

After normal contour is restored, the expanding brain promotes persistent normal contour. This has been facilitated by the introduction of absorbable plates. These plates maintain the initial correction, but re-sorb prior to restricting the natural correction influenced by the expanding brain. When correction is performed late - after fusion of the sutures and after the majority of brain growth has occurred - the correction is designed to reflect the end result and may be rigidly fixed.

A constant consideration during these procedures is the location and status of the underlying venous sinuses. An unfused, non-pathologic suture remains adherent to the underlying dura. Prior to the craniotomy or bringing the bone

Cure Your Yeast Infection For Good

Cure Your Yeast Infection For Good

The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.

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