Pediatric Cloverleaf Deformity

Cloverleaf deformity is an extremely rare skull deformity that happens when several joints (sutures) between a baby's skull bones begin to fuse too early. Also known as Kleeblattschädel syndrome, the cloverleaf deformity causes bulging at the front and sides of the skull, resembling a cloverleaf shape.

Babies with cloverleaf deformity often have related problems such as:

• Fluid collecting in the skull
• Pfeiffer syndrome: Disorder with other conditions including neurological and developmental problems in the fingers and toes
• Problems breathing because of facial deformities

Cloverleaf deformity is a genetic disorder that children inherit from parents. Mutated genes cause sutures to fuse together prematurely (craniosynostosis). The coronal (from ear to ear) and lambdoid (across the back of the head) sutures are most commonly involved.

Children with cloverleaf deformity may have one or more of these symptoms:

• Misshapen head: bulging at the front and sides and flat in the back
• Full or bulging "soft spot" (fontanel) on the newborn's skull
• Facial deformities including abnormally formed eye sockets, flat nasal bridge, small upper or lower jaw
• Prominent blood vessels in the scalp
• Crowded, crooked teeth

Cloverleaf deformity is usually noticeable at birth: your pediatrician can detect it by examining and measuring your baby's head. Because skull deformities appear in several similar syndromes, your pediatrician will use other testing methods to make an accurate diagnosis.

At Children's National Hospital, our pediatric team uses the following tools to help diagnose cloverleaf deformity and any related syndromes:

• X-rays to check for fused (missing) sutures on the sides or back of the head or ridges along these sutures
• Diagnostic imaging, especially CT scans, to check for fluid and pressure inside the skull, fused sutures or ridges along sutures
• Genetic tests to determine what syndromes may be involved for an accurate diagnosis and treatment

Treatment for cloverleaf deformity focuses on reducing pressure inside the skull, ensuring enough room for the brain to grow, and reshaping the skull. At Children's National, our treatment options include:

• Surgery on the skull as early as possible
  • Minimally invasive surgery for infants younger than 3 months to open skull sutures for normal skull and brain growth
  • Traditional surgery for infants 6 months or older to correct the skull’s shape
• Surgery to correct facial and jaw deformities
• Orthodontic surgery to correct dental problems
• Speech therapy to help with speech and language development