A head dent, or an indentation on the skull or scalp, can be a source of concern for many individuals. While the human skull naturally possesses variations in its contours, a newly observed depression can prompt questions about its permanence and underlying cause. Understanding the various reasons why a head dent might appear is the initial step in addressing such a discovery.
Understanding Different Types of Head Dents
Head dents can arise from various factors, from common developmental patterns in infants to more serious conditions. Some indentations are within the soft tissues of the scalp, while others involve the bone itself. For instance, a “goose egg” hematoma, a collection of blood under the scalp, might initially feel like a bump but can later feel like a dent around its edges as the swelling recedes.
In infants, positional molding is a frequent cause of head shape irregularities, including dents. Conditions like plagiocephaly involve a flattening on one side of the head, making it asymmetrical, while brachycephaly results in a flattening across the back of the head, causing it to widen. These occur because a baby’s skull bones are soft and can change shape under constant external pressure, such as from prolonged time spent lying on their back or from pressure within the womb.
Head dents can also result from trauma. A depressed skull fracture, for example, occurs when a part of the skull is pushed inward towards the brain due to a direct impact. Congenital or developmental conditions can also lead to head dents. Craniosynostosis is a condition where one or more of the skull’s fibrous joints, called sutures, close prematurely. This early fusion restricts normal skull growth, leading to an abnormally shaped head. Another condition, benign external hydrocephalus, involves fluid accumulation around the brain, which can sometimes alter the skull’s shape.
Natural Resolution and Persistent Dents
Many types of head dents, particularly those related to positional molding in infants, often improve or resolve without specific intervention. For babies with plagiocephaly or brachycephaly, the head shape often corrects itself as the child grows, becomes more mobile, and spends less time in a single position. Hematomas on the scalp, which can initially present as a lump and then feel like a dent as they heal, typically resolve on their own.
However, some head dents may not fully resolve without intervention. If positional flattening is severe or not addressed, a slight indentation might remain. Dents caused by congenital conditions like craniosynostosis will not resolve on their own because they involve the premature fusion of skull bones, restricting normal skull growth.
When to Seek Professional Medical Advice
It is important to seek medical evaluation for a head dent, especially if it is new or causes concern. A sudden appearance of a dent after a significant head injury, such as from a fall or accident, warrants immediate medical attention. This is particularly true if the dent is accompanied by other symptoms like vomiting, lethargy, seizures, changes in behavior, or loss of consciousness.
Other warning signs include dents that are rapidly growing, changing in appearance, or are present from birth and are worsening or associated with developmental concerns. A dent that feels hard and bony, especially if it presents as a raised ridge along a skull suture, could suggest craniosynostosis. Consulting a healthcare professional is advisable if there is any doubt about the nature of a head dent or if it causes significant cosmetic concern.
Approaches for Persistent or Concerning Dents
When a head dent persists or is medically concerning, healthcare professionals may employ various diagnostic tools to determine the underlying cause. Imaging techniques such as X-rays, CT scans, or MRI scans can provide detailed views of the skull and brain structure. These tools help to identify skull fractures, assess suture fusion, or detect any fluid collections.
For infants with positional molding, management often begins with conservative strategies like repositioning techniques and increased “tummy time.” Repositioning involves regularly changing the baby’s head position during sleep and waking hours to relieve pressure on flattened areas. If these methods are not sufficient, helmet therapy may be recommended. Cranial orthosis helmets gently reshape the skull by applying consistent, gentle pressure to redirect growth into flatter areas as the infant’s head naturally expands.
Trauma-related dents, such as depressed skull fractures, may require different approaches. Minor depressed fractures might be observed for spontaneous improvement. However, more severe or open depressed fractures often necessitate surgical elevation to prevent complications like infection or increased pressure on the brain. Hematomas generally resolve on their own, but large or symptomatic ones might be monitored.
For congenital conditions like craniosynostosis, surgical intervention is typically required to correct the abnormal skull shape and allow the brain adequate space to grow. After surgery for craniosynostosis, some infants may still require helmet therapy to further refine the head shape. Benign external hydrocephalus is generally considered self-limiting and rarely requires surgical treatment unless there are signs of increased intracranial pressure. The approach for any persistent or concerning head dent is tailored to its specific cause and the individual’s needs.