Ossified cephalhematoma: An unusual cause of calvarial mass in infancy

Abstract

Cephalhematomas occurring in newborn usually resolve within a month. Rarely, they tend to ossify and present as hard scalp swelling. Unless one is aware of this possibility, this condition may be misinterpreted as bony tumor and cause needless apprehension to parents as well as the treating physician. A suspicion that ossified cephalhematoma (OC) could present in such a manner supported by careful history taking and relevant imaging (X-ray/computed tomography) would help in appropriate evaluation of this benign condition. The management of OC is controversial. Occasionally, they undergo spontaneous remodeling. Those with secondary craniosynostosis and/or disfigurement are treated surgically. Simple ossified lesions with no significant cosmetic issues may be conservatively tackled. We report such a case in a 3-month-old child. The other management options are briefly discussed.

Management of Calcified Cephalohematoma of Infancy: The University of Michigan 25-Year Experience

“…Therefore, initial management consists of observation and massage to break down the organizing hematoma and any small amount of early calcification. 2,7–10,18 Although aspiration has been proposed, 10 it is not recommended, given the risk of infection 2,19 and difficulty with successful evacuation of the viscous contents. If the cephalohematoma persists beyond 4 weeks, a shell of calcification can develop just under the periosteum, forming a new outer bony lamella.…”

“…Therefore, initial management consists of observation and massage to break down the organizing hematoma and any small amount of early calcification. 2,[7][8][9][10]18 Although aspiration has been proposed, 10 it is not recommended, given the risk of infection Plastic and Reconstructive Surgery • August 2021…”

“…20 Therefore, various treatment approaches have been reported, ranging from close observation, 21,22 to orthotic helmets, 23 to surgical intervention. 10,18 Although observation is an option, we advocate for surgery in patients that desire aesthetic improvement. Helmet therapy has been used only for partially calcified cephalohematomas and is unlikely to be effective in cases of complete calcification.…”