Management Of Calcified Cephalohematoma Of Infancy: The University Of Michigan 25-year Experience
Raquel M. Ulma, MD, DDS, Gina N. Sacks, MD, Kavitha L. Ranganathan, MD, Bridger Rodoni Rodoni, BS, Anthony Duncan, MD, Hugh J. Garton, MD, Cormack O. Maher, MD, Christian J. Vercler, MD, Steven J. Kasten, MD, Steven R. Buchman, MD, Karin M. Muraszko, MD.
University of Michigan, Ann Arbor, MI, USA.
Calcified cephalohematoma of infancy is a result of a subperiosteal blood collection, that usually forms during birth related trauma. In contrast to subgaleal cephalohematomas, blood in the subperiosteal location can lead to a permanent skull deformity that often requires surgical intervention. The resulting cranial asymmetry can be difficult to correct and although several reconstructive techniques have been proposed, there is currently no consensus on management. This is partly due to the paucity of literature exploring the long term results of calcified cephalohematoma reconstruction. In this study, we present a technique for the excision and reconstruction of calcified cephalohematoma in the infant calvarium in the context of long term follow-up and management of complications over the past 25 years. METHODS:
We performed a retrospective review to identify all patients diagnosed with calcified cephalohematoma within our institution between 1994 and 2019. All patients with a confirmatory diagnosis from either a pediatric plastic surgeon or pediatric neurosurgeon and at least 3 months of follow up were included in the study. Patients underwent observation or surgical intervention based on the recommendations of the surgical team. Chart review was preformed to obtain data including patient demographics, imaging findings, and complications. RESULTS:
We identified 160 infants with a diagnosis of cephalohematoma. Of those, 81 patients met inclusion criteria. Thirty-three patients with calcified cephalohematoma underwent surgical treatment. The mean age at diagnosis was 3.6 months, while the mean patient age at the time of surgery was 8.4 months. Of the infants who underwent surgery, 67% were male. Twenty-two patients, who underwent surgical resection had a cranial defect requiring inlay bone grafting (66.7%). Six patients had perioperative blood loss requiring transfusion (18.2%) and three patients had post-operative complications (9.1%). Complications included superficial wound infection in one patient and postsurgical subgaleal hematoma in two patients. Both patients who developed postoperative hematomas were treated successfully with bedside drainage. CONCLUSION:
Calcified cephalohematoma of infancy is rare entity that can cause significant deformity of the infant cranium. Over a 25-year period, our institution had 81 patients with calcified cephalohematomas, with less than half necessitating surgical intervention. In these cases, we found that the proposed technique was safe and effective in restoring normal cranial contours, while having a low complication profile.
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