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Hypertelorism is a congenital condition where there is an increased distance between the eyes. It is not a disease in itself, and there is a spectrum of what is considered an “acceptableâ€� distance between the eyes. 

There are many causes of hypertelorism, including cranio fronto nasal dysplasia (CFND), Apert syndrome, nasal dermoids and tumours of the naso orbital region.

Children with hypertelorism undergo a thorough physical examination in the clinic. Patients who are being considered for surgery will be assessed with CT scans. Surgical correction of hypertelorism is a significant operation involving neurosurgeons and plastic surgeons working together. 

The Craniofacial service receives many referrals for children with either large heads (macrocephaly), small heads (microcephaly) or where the soft spot at the front of the baby’s skull (fontanelle) appears to be closing early.

Macrocephaly

Macrocephaly refers to a condition where a child has a larger-than-average head size. While some children naturally have larger heads, macrocephaly may be a result of various underlying factors, including genetics, hydrocephalus (excess fluid around the brain), or certain metabolic disorders. It is rare that any special imaging is required. In the overwhelming majority of cases, surgery is not required.

Microcephaly

Microcephaly is characterised by a smaller-than-average head size. This condition may result from genetic factors, infections during pregnancy, or other developmental issues. As with macrocephaly, it is rare that any imaging is required and surgery is usually not indicated.

Premature closure of the fontanelles

Premature closure of the fontanelles is another condition that our team addresses. The fontanelles are soft spots on a baby's skull where sutures come together that allow for natural expansion during brain growth. The fontanelle can close anywhere between 12 â€� 24 months of age. 

Premature closure of the fontanelle on its own is of no concern if the baby’s head is otherwise growing normally. Early fontanelle closure can be associated with craniosynostosis, where the bones of the skull fuse early â€� but these babies usually have abnormal head shapes, indicating that there is something going on that requires investigation.