Medical Disclaimer This article is for educational purposes only and does not replace medical advice, diagnosis, or treatment. Bicoronal craniosynostosis evaluation and treatment depend on your child’s age, head shape, skull growth, eye findings, airway symptoms, genetic evaluation, imaging, and specialist assessment. Always talk with your child’s pediatrician, craniofacial team, pediatric neurosurgeon, craniofacial plastic surgeon, ophthalmologist, geneticist, or healthcare professional about your child’s individual situation.
When both sides of a baby’s forehead or upper skull seem affected, parents may hear the term bicoronal craniosynostosis.
That can feel overwhelming.
Parents may notice:
- “My baby’s head looks short from front to back.”
- “The head looks wide from side to side.”
- “The forehead looks flat.”
- “The forehead looks tall or steep.”
- “The back of the head looks flat too.”
- “The eyes or eye sockets look different.”
- “The doctor mentioned both coronal sutures.”
- “The craniofacial team wants genetics involved.”
Bicoronal craniosynostosis is different from one-sided coronal craniosynostosis. In unicoronal craniosynostosis, one coronal suture closes early and the baby often has forehead, brow, eye, or facial asymmetry. In bicoronal craniosynostosis, both coronal sutures close early, so the head-shape pattern is often more symmetric: short from front to back, wide from side to side, and sometimes taller than expected.
The short answer is:
Bicoronal craniosynostosis happens when both coronal sutures close too early. These sutures run from each ear area toward the top/front of the skull. When both close early, forward growth of the skull can be restricted, and the head may become broad, short, tall, or flat in the forehead area. This head shape is often called brachycephaly. Bicoronal craniosynostosis can be isolated, but it is also more likely than some other types to raise questions about genetic syndromes and the need for coordinated craniofacial care.
The CDC describes bicoronal synostosis as early closure of the coronal sutures on both sides of the baby’s head, causing the head to grow broad and short, a shape called brachycephaly. (CDC) Johns Hopkins similarly describes bicoronal craniosynostosis as early closure of both coronal sutures, producing a skull that is short front-to-back, wide, tall, and associated with a flat forehead and flat back of the head. (Hopkins Medicine)
This guide explains what bicoronal craniosynostosis means, how it differs from positional brachycephaly, why genetics may be discussed, and what families may hear about surgery, eye exams, pressure monitoring, and long-term follow-up.
Quick Answer: What Is Bicoronal Craniosynostosis?
Bicoronal craniosynostosis means both coronal sutures close too early.
The coronal sutures are the skull growth seams that run from each ear area toward the top/front of the skull. There is a right coronal suture and a left coronal suture.
When one coronal suture closes too early, the condition is called unicoronal craniosynostosis.
When both coronal sutures close too early, the condition is called bicoronal craniosynostosis or bilateral coronal craniosynostosis.
Because both front-side sutures are fused, the skull may not grow normally from front to back. Instead, the head may grow wider side to side and sometimes taller. Great Ormond Street Hospital describes the main symptoms of bicoronal craniosynostosis as a flatter forehead and eye sockets, with a head shape that is shorter front-to-back and taller than average. (GOSH Hospital site)
The parent-friendly takeaway:
Bicoronal craniosynostosis is the “both coronal sutures” type. It often causes a short, wide, sometimes tall head shape with forehead and upper eye-socket changes.
What Are the Coronal Sutures?
A baby’s skull is made of several bones connected by flexible seams called sutures. These sutures allow the skull to expand as the brain grows.
The coronal sutures are two seams near the front and sides of the skull. One is on the right, and one is on the left. They run from the ear area toward the top/front of the head.
Because the coronal sutures are near the forehead and upper eye sockets, early fusion can affect the front of the skull, forehead shape, brow area, and orbit, which is the bony eye-socket area.
Seattle Children’s explains that when skull sutures close too early, the shape of the baby’s skull changes, and the shape depends on which suture is closed. Seattle also notes that most children have one fused suture, but children with more than one fused suture may have craniosynostosis as part of a genetic condition. (Seattle Children's)
The practical message:
The coronal sutures help the front of the skull grow. When both close early, the whole forehead-front skull growth pattern can change.
Bicoronal vs Unicoronal Craniosynostosis
Parents often hear “coronal craniosynostosis” and are not sure whether it means one side or both sides.
Here is the simplest distinction:
- Type
- What closes early
- Common head or face pattern
- Unicoronal craniosynostosis
- One coronal suture
One-sided forehead flattening, brow difference, eye-socket asymmetry, nose deviation, facial asymmetry
Bicoronal craniosynostosis
Both coronal sutures
Short, wide, sometimes tall skull; flatter forehead and eye sockets; more symmetric forehead-front skull changes
Syndromic bicoronal craniosynostosis
Often both coronal sutures, sometimes additional sutures
Skull and face differences plus possible airway, eye, hearing, dental, limb, developmental, or genetic concerns
The CDC describes one-sided coronal synostosis as causing forehead flattening, raised eye socket, and nose pulling toward the affected side, while bicoronal synostosis causes a broad, short head shape. (CDC)
The parent-friendly takeaway:
Unicoronal usually looks asymmetric. Bicoronal often looks short, wide, tall, or flat in a more symmetric way.
What Does “Brachycephaly” Mean?
Parents may hear the word brachycephaly.
Brachycephaly means a head shape that is short from front to back compared with its width.
There are two very different reasons a baby may have a brachycephalic, or short-wide, head shape:
Positional brachycephaly This happens when the back of the head becomes flattened from external pressure while the sutures are open.
Synostotic brachycephaly This happens when sutures close too early. Bicoronal craniosynostosis can cause a synostotic form of brachycephaly.
HealthyChildren.org explains that deformational brachycephaly is when the head is symmetrically flat in the back and wide from side to side, often in babies who spend a lot of time on their backs and do not get enough tummy time. (HealthyChildren.org) By contrast, the CDC uses brachycephaly to describe the broad, short head shape that can occur when both coronal sutures close too early. (CDC)
The key point:
Brachycephaly describes the shape. It does not automatically tell you the cause. The cause may be positional molding or fused sutures.
Why Does Bicoronal Craniosynostosis Make the Head Short and Wide?
In normal skull growth, the coronal sutures help the front part of the skull grow forward as the brain grows.
When both coronal sutures close too early, forward growth can be restricted. The brain still grows, so the skull compensates by growing more in other directions, such as side-to-side and upward.
That can create a head shape that is:
- Short from front to back
- Wide from side to side
- Tall or tower-like in some children
- Flat across the forehead
- Flat at the back of the head
- Steep or high in the forehead
Johns Hopkins explains that early closure of the coronal sutures on both sides prevents the front of the skull from growing, resulting in a short, wide, tall skull with a flat forehead and flat back of the head. (Hopkins Medicine) Children’s Minnesota similarly describes bicoronal synostosis as limiting forward skull growth, causing the head to grow wider, with a short-wide appearance, flat back, and a taller or more steeply sloped forehead. (Children's Minnesota)
A simple explanation:
If the front growth seams close too early, the skull may not grow forward enough. Growth is redirected sideways and upward.
What Parents May Notice First
Parents may notice:
- A head that looks short from front to back
- A head that looks wide from side to side
- A forehead that looks flat
- A forehead that looks tall or steep
- A back of the head that looks flat
- The top of the head looking unusually high
- The head looking broad when viewed from the front
- The forehead and upper eye socket area looking flatter than expected
- The soft spot seeming unusual or harder to feel
- A raised ridge along both coronal sutures
- Family members commenting that the baby’s head looks “wide” or “tall”
- A pediatrician raising concern at a well-baby visit
Great Ormond Street Hospital lists flatter forehead and eye sockets, plus a head shape that is shorter front-to-back and taller than average, as the main symptoms of bicoronal craniosynostosis. (GOSH Hospital site) Cleveland Clinic lists misshapen skull, hard suture ridges, uneven facial features, and smaller-than-expected head circumference as possible craniosynostosis findings more generally. (Cleveland Clinic)
The patient-friendly takeaway:
The most classic parent description is “short and wide,” but some babies also look tall, flat in the forehead, or flat in the back.
Why Does the Forehead Look Flat, Tall, or Steep?
The forehead changes because the coronal sutures influence growth at the front of the skull.
If both coronal sutures close too early, the forehead may not project forward normally. The skull then compensates by growing upward or outward in other areas.
Parents may describe the forehead as:
- Flat
- High
- Tall
- Steep
- Sloped
- Broad
- Less rounded than expected
Great Ormond Street Hospital explains that premature fusion of the coronal sutures makes the forehead and eye sockets flatter as the rest of the skull compensates. (GOSH Hospital site) OHSU describes bilateral coronal synostosis as restricting forehead growth, causing the skull to grow upward and outward; the forehead may be high and flat, and the head may look tall. (OHSU)
The practical message:
In bicoronal craniosynostosis, the forehead may look flat because forward growth is restricted, and it may look tall because growth is redirected upward.
Can Bicoronal Craniosynostosis Affect the Eye Sockets?
Yes. Bicoronal craniosynostosis can affect the bones around the eyes because the coronal sutures sit near the forehead and upper orbit.
Parents may notice:
- Flatter upper eye socket area
- Eyes that appear more prominent
- Eyes that seem widely spaced
- Eyelids that do not close fully in more complex syndromic cases
- Eye irritation
- Strabismus, or crossed/misaligned eyes
- Need for ophthalmology follow-up
Great Ormond Street Hospital includes flatter eye sockets among the main symptoms of bicoronal craniosynostosis and notes that children may need regular eye examinations because raised pressure can initially occur without symptoms and may lead to visual or neurological problems if untreated. (GOSH Hospital site) Children’s Health explains that fronto-orbital advancement reshapes the forehead and upper eye socket, and in some cases can help protect the eyes by improving eyelid position. (Children's Health)
The patient-friendly takeaway:
The eye itself may be healthy, but the bones around the eye may need monitoring. Eye exams are often part of bicoronal craniosynostosis care.
Is Bicoronal Craniosynostosis the Same as Positional Brachycephaly?
No.
This is one of the most important distinctions for families.
Positional brachycephaly is caused by external pressure on a baby’s soft skull. The sutures are usually open.
Bicoronal craniosynostosis is caused by both coronal sutures closing too early.
They can both make the head look short and wide, but they are different conditions.
Feature
Positional brachycephaly
Bicoronal craniosynostosis
Cause
External pressure or positioning
Both coronal sutures close too early
Sutures
Usually open
Both coronal sutures fused
Head shape
Symmetric flatness at the back, wide side-to-side
Short, wide, often tall; forehead and eye sockets may be flatter
Forehead
May look broad, often from back flattening
May look flat, tall, steep, or restricted in front
Brain-growth concern
Usually not a brain-growth problem
Can restrict skull growth and may raise pressure concerns
Treatment
Repositioning, tummy time, PT for torticollis, helmet in selected cases
Craniofacial evaluation; surgery often discussed
Specialists
Pediatrician, PT, orthotist if needed
Craniofacial team, neurosurgery, plastic surgery, ophthalmology, genetics
HealthyChildren.org says common positional skull deformities do not require surgery and that pediatricians can help determine whether head shape is positional or a less common but more serious condition such as craniosynostosis. (HealthyChildren.org)
The practical message:
A short-wide head shape is not automatically bicoronal craniosynostosis. But if the forehead and eye-socket area look restricted, tall, flat, or unusual, a craniofacial evaluation is important.
Can Repositioning or Tummy Time Fix Bicoronal Craniosynostosis?
No.
Repositioning and tummy time can help positional brachycephaly because positional brachycephaly is caused by external pressure on a moldable skull.
But repositioning cannot reopen fused coronal sutures.
If both coronal sutures are fused, the issue is not simply pressure on the back of the head. It is a skull growth restriction involving both front-side sutures.
Mayo Clinic explains that craniosynostosis treatment is often surgery to reshape the head, lessen or prevent pressure on the brain, and create room for proper brain growth, although mild cases may not need surgery. (Mayo Clinic)
The patient-friendly takeaway:
Tummy time is healthy for development and can help positional flattening, but it does not treat fused coronal sutures.
Can a Helmet Fix Bicoronal Craniosynostosis?
A helmet alone generally does not fix bicoronal craniosynostosis.
Helmets are commonly used for some positional skull deformities and after certain minimally invasive craniosynostosis surgeries. But a helmet does not reopen fused sutures by itself.
For bicoronal craniosynostosis, treatment often involves surgical planning by a craniofacial team. Helmet therapy may or may not be part of care depending on the specific surgical approach, age, diagnosis, and center protocol.
Seattle Children’s explains that after endoscopic strip craniectomy, a baby wears a helmet for several months to mold the head, while open cranial vault reconstruction usually does not require a helmet afterward. (Seattle Children's)
The practical message:
For bicoronal craniosynostosis, ask the craniofacial team whether a helmet has any role in your child’s plan. Do not assume a helmet alone is enough.
Is Bicoronal Craniosynostosis Always Genetic?
Not always.
Bicoronal craniosynostosis can be nonsyndromic, meaning it is isolated and not part of a broader syndrome. But bicoronal craniosynostosis is also commonly associated with syndromic craniosynostosis, especially when other features are present.
Great Ormond Street Hospital states that bicoronal craniosynostosis may be syndromic or nonsyndromic, that the cause is not yet known, and that several associated genes have been identified. (GOSH Hospital site) Seattle Children’s notes that children with more than one fused suture may have craniosynostosis as part of a genetic condition such as Crouzon, Apert, Saethre-Chotzen, Muenke, or Pfeiffer syndrome. (Seattle Children's)
The patient-friendly takeaway:
Bicoronal craniosynostosis does not automatically mean your baby has a syndrome, but it is a strong reason to discuss genetics.
Why Genetic Testing May Be Discussed
Genetic testing may be recommended because bicoronal craniosynostosis is more often connected with genetic syndromes than some single-suture patterns.
A genetics evaluation may help answer:
- Is this isolated or syndromic?
- Is there a known gene change?
- Could other body systems be involved?
- Should hearing, eyes, airway, hands, feet, teeth, or development be monitored?
- What is the chance this could happen again in a future pregnancy?
- Should parents be tested?
- Could other family members carry the same variant?
Great Ormond Street Hospital states that genetic testing will most likely be undertaken to check whether there is a genetic reason for bicoronal craniosynostosis. (GOSH Hospital site) Seattle Children’s explains that its craniofacial genetics clinic can test for gene changes that may cause craniosynostosis and that diagnosing a specific syndrome helps guide care. (Seattle Children's)
The practical message:
Genetic testing is not about blame. It is about making sure the child gets the right monitoring and family counseling.
Syndromes Often Discussed With Bicoronal Craniosynostosis
Bicoronal craniosynostosis can be seen in several syndromic craniosynostosis conditions.
Families may hear about:
- Apert syndrome
- Crouzon syndrome
- Pfeiffer syndrome
- Muenke syndrome
- Saethre-Chotzen syndrome
- Other less common genetic causes
Children’s Hospital of Philadelphia lists Apert, Crouzon, Muenke, Pfeiffer, and Saethre-Chotzen among the common syndromic craniosynostosis diagnoses and emphasizes the need for coordinated multidisciplinary care because related health and developmental issues may be present. (Children's Hospital of Philadelphia) Johns Hopkins states that the most common suture-fusion pattern in syndromic craniosynostosis is fusion of the coronal sutures on both sides, called bicoronal craniosynostosis. (Hopkins Medicine)
The practical takeaway:
When both coronal sutures are fused, doctors often look beyond the skull shape to see whether a known craniofacial syndrome is present.
A Note About Muenke Syndrome
Muenke syndrome is especially important in bicoronal or coronal craniosynostosis discussions because it is strongly associated with coronal suture involvement.
GeneReviews states that Muenke syndrome can involve coronal synostosis, more often bilateral than unilateral, and that bilateral coronal synostosis typically results in brachycephaly. It also notes that features can include hearing loss, strabismus, developmental delay, and variability even within the same family. (Be-MD) MedlinePlus Genetics explains that many people with Muenke syndrome have premature fusion along the coronal suture and may have hearing loss or mild hand/foot differences, while many have normal intellect and some have developmental or learning concerns. (MedlinePlus)
The parent-friendly message:
If your child has bicoronal craniosynostosis, asking whether Muenke syndrome or another genetic condition should be evaluated is reasonable.
Did I Cause My Baby’s Bicoronal Craniosynostosis?
Usually, no.
Parents often worry that they caused the head shape through sleep position, car seats, baby carriers, birth position, missed tummy time, or something during pregnancy.
Bicoronal craniosynostosis is not caused by ordinary parenting choices.
Seattle Children’s states that doctors do not know exactly what causes craniosynostosis and that babies are often born with it. (Seattle Children's) Great Ormond Street Hospital notes that gene mutations associated with bicoronal craniosynostosis may be inherited in some families but often develop sporadically, meaning “out of the blue.” (GOSH Hospital site)
The patient-friendly takeaway:
Bicoronal craniosynostosis is not caused by how you held, fed, slept, or positioned your baby.
Can Bicoronal Craniosynostosis Affect Brain Growth or Pressure?
It can.
Because both coronal sutures are involved, there can be more concern about whether the skull has enough room for brain growth. The risk can be higher when bicoronal craniosynostosis is part of a syndrome or when additional sutures are involved.
Great Ormond Street Hospital states that children with bicoronal craniosynostosis may develop raised pressure in the head, sometimes without symptoms at first, and that untreated pressure may lead to visual or neurological problems. (GOSH Hospital site) Johns Hopkins notes that children with syndromic craniosynostosis and multiple fused sutures are more likely to develop increased skull pressure due to restricted head growth, which can contribute to headaches, developmental delays, seizures, and vision loss. (Hopkins Medicine)
The balanced message:
Bicoronal craniosynostosis should be taken seriously, but it does not automatically mean brain damage. The goal is timely evaluation, pressure monitoring, and treatment planning when needed.
Why Eye Exams Matter
Eye exams are often important in bicoronal craniosynostosis because pressure problems can sometimes show signs in the eyes before parents notice symptoms.
An ophthalmologist may check for:
- Papilledema, or swelling of the optic nerve
- Eye exposure or dryness
- Eye alignment problems
- Vision development
- Strabismus
- Astigmatism or focusing problems
- Eye protection if the orbits are shallow
Great Ormond Street Hospital specifically notes that regular eye examinations are often used to monitor children with bicoronal craniosynostosis because raised pressure can be symptom-free early but may lead to vision or neurological problems if untreated. (GOSH Hospital site) Johns Hopkins includes ophthalmologists as part of syndromic craniosynostosis care to evaluate vision and eye function. (Hopkins Medicine)
The practical message:
Even if your baby seems to see well, eye follow-up may be part of the safety plan.
What About Airway, Sleep, Hearing, and Development?
In isolated bicoronal craniosynostosis, the main concern may be skull shape, skull growth, and pressure monitoring.
In syndromic bicoronal craniosynostosis, the care plan may be broader.
Depending on the diagnosis, doctors may monitor:
Breathing and airway
Snoring or sleep apnea
Eye exposure
Vision
Hearing
Ear infections
Speech and language
Feeding
Teeth and bite
Midface growth
Hand and foot differences
Development and learning
Johns Hopkins explains that syndromic craniosynostosis can involve midface hypoplasia, eye irritation, airway obstruction, obstructive sleep apnea, dental anomalies, hearing/speech evaluation, ophthalmology, ENT, audiology, dentistry, orthodontics, and speech therapy. (Hopkins Medicine) CHOP similarly emphasizes coordinated multidisciplinary care for children with syndromic craniosynostosis because related health and developmental issues may be present. (Children's Hospital of Philadelphia)
The patient-friendly takeaway:
If bicoronal craniosynostosis is syndromic, the care team may watch more than head shape. That is not meant to scare families; it is meant to protect the child’s vision, breathing, hearing, feeding, and development.
How Is Bicoronal Craniosynostosis Diagnosed?
Diagnosis usually starts with a careful physical exam.
A pediatrician or craniofacial specialist may:
- Look at the head from the front, side, back, and top
- Assess whether the head is short and wide
- Assess whether the forehead is flat, tall, or steep
- Look at the upper eye sockets
- Feel for ridges along both coronal sutures
- Check the soft spot
- Measure head circumference
- Review the head growth curve
- Look for facial features that suggest a syndrome
- Look at hands and feet if syndromic craniosynostosis is possible
- Ask about breathing, feeding, sleep, hearing, vision, and development
- Ask about family history of craniosynostosis or craniofacial differences
Seattle Children’s explains that doctors often diagnose craniosynostosis in the first weeks of life by examining and measuring the child’s head; the head shape helps identify which cranial sutures have fused, and physical exam plus measurements may be enough in some cases. (Seattle Children's) Great Ormond Street Hospital notes that children with bicoronal craniosynostosis often have a characteristic appearance and that imaging may be suggested to monitor bone growth before, during, and after treatment. (GOSH Hospital site)
The practical message:
Bicoronal craniosynostosis is diagnosed by the pattern of skull shape, forehead growth, eye-socket shape, suture findings, head growth, and sometimes imaging and genetics.
Does My Baby Need Imaging?
Maybe.
Imaging can help confirm which sutures are fused, evaluate whether other sutures are involved, and help surgeons plan treatment.
Depending on the child and the center, imaging may include:
- CT scan
- 3D CT scan
- MRI
- Cranial ultrasound
- X-ray
- 3D surface photography or laser scanning
Seattle Children’s states that CT can confirm craniosynostosis and help plan treatment. (Seattle Children's) Mayo Clinic explains that CT, MRI, or cranial ultrasound can show whether sutures have fused, and that imaging, laser scans, and photographs may help make precise skull measurements and plan surgery. (Mayo Clinic)
The patient-friendly takeaway:
Ask what imaging is needed, why it is needed, and whether it will change the treatment plan.
Does Every Baby With Bicoronal Craniosynostosis Need Surgery?
Not every child’s plan is identical, but bicoronal craniosynostosis often leads to a surgery discussion because both coronal sutures are involved and the front of the skull may be restricted.
Surgery decisions depend on:
Age
Head shape severity
Whether the case is isolated or syndromic
Whether other sutures are fused
Whether pressure concerns are present
Eye socket shape and eye protection
Airway or sleep concerns
Developmental concerns
Genetic findings
The craniofacial team’s recommendation
Mayo Clinic states that mild craniosynostosis may not need surgery, but for most babies surgery is the main treatment; treatment aims to reshape the head, lessen or prevent pressure on the brain, and create room for brain growth. (Mayo Clinic) Great Ormond Street Hospital states that in many cases of bicoronal craniosynostosis, initial skull reshaping surgery takes place within the first few years of life, with surgical options depending on the child’s age at diagnosis. (GOSH Hospital site)
The practical message:
The question is not only “Are both coronal sutures fused?” The question is how the fusion affects skull growth, pressure risk, eyes, genetics, and long-term development.
What Is Surgery Trying to Correct?
Surgery for bicoronal craniosynostosis may aim to:
- Create more room for brain growth
- Reduce or prevent pressure inside the skull
- Improve forehead shape
- Improve the upper eye socket shape
- Improve eye protection if the orbits are shallow
- Improve the short-wide or tall head shape
- Support more balanced skull growth
- Address skull restriction from fused coronal sutures
- Plan for future facial growth if syndromic craniosynostosis is present
Children’s Health describes fronto-orbital advancement as a surgery used for craniosynostosis that expands space inside the skull and reshapes the forehead and upper eye socket; it can be used when craniosynostosis affects one or both coronal sutures. (Children's Health) Seattle Children’s explains that open cranial vault surgery gives the baby’s brain more room to grow and gives the skull a more typical shape. (Seattle Children's)
The parent-friendly explanation:
The surgery is usually on the skull bones around the brain, not on the brain tissue itself.
What Is Fronto-Orbital Advancement?
Fronto-orbital advancement , often shortened to FOA, is one of the major operations parents may hear about for coronal craniosynostosis.
“Fronto” refers to the forehead.“Orbital” refers to the eye sockets.“Advancement” means moving the bones forward or into a better position.
During FOA, surgeons reshape and reposition the forehead and upper eye socket area. This can improve forehead contour, increase space, and help protect the eyes in selected cases.
Children’s Health states that FOA is used for craniosynostosis involving the metopic suture or one or both coronal sutures, and that the goals are to expand skull space and reshape the forehead and upper orbit. (Children's Health) Seattle Children’s describes FOA as a procedure in which a plastic surgeon and neurosurgeon move and reshape the baby’s forehead and upper eye sockets, creating more space for the brain and more protection for the eyes. (Seattle Children's)
The patient-friendly takeaway:
FOA is the operation that addresses the forehead and upper eye-socket area — the region most affected by coronal suture fusion.
Will My Child Need More Than One Surgery?
Some children with isolated bicoronal craniosynostosis may need one major skull surgery. Others may need more than one procedure, especially if the condition is syndromic or if additional skull, face, eye, airway, or dental issues develop over time.
Great Ormond Street Hospital notes that as bones continue to grow during childhood and adolescence, further surgery may be needed to make minor corrections to skull shape and the forehead area. (GOSH Hospital site) Johns Hopkins states that children with syndromic craniosynostosis often need multiple surgeries to address craniosynostosis and other malformed bones in the face or other body areas. (Hopkins Medicine)
The practical message:
One surgery may be enough for some children, but syndromic bicoronal craniosynostosis often requires longer-term staged planning.
What Is Posterior Vault Expansion or Distraction?
Some children, especially those with syndromic craniosynostosis or pressure concerns, may need a procedure that expands the back of the skull. This may be called:
- Posterior cranial vault expansion
- Posterior vault remodeling
- Posterior cranial vault distraction
- Distraction osteogenesis
Instead of focusing first on the forehead and eye sockets, posterior vault expansion creates more room at the back of the skull. In some syndromic cases, this may be part of a staged plan before or after fronto-orbital surgery.
Johns Hopkins describes posterior cranial vault distraction osteogenesis as a procedure where part of the back skull bones are removed to create a gap, devices are placed, and the edges are gradually pulled apart to encourage new bone growth. It also lists fronto-orbital advancement as moving the forehead and upper eye-socket bones forward. (Hopkins Medicine) Children’s Health notes that in some patients, posterior cranial distraction may be performed first and FOA may be delayed when safe to improve long-term skull growth and appearance. (Children's Health)
The parent-friendly takeaway:
Some children need forehead-first surgery. Others need back-of-skull expansion first. The plan depends on pressure, age, syndrome, skull shape, eye protection, and the craniofacial team’s approach.
Is Endoscopic Surgery an Option for Bicoronal Craniosynostosis?
Endoscopic surgery is more commonly discussed for selected young babies with certain single-suture craniosynostosis patterns. Bicoronal craniosynostosis is often more complex, especially if syndromic or multisuture.
Some centers may consider minimally invasive approaches in selected very young babies, but families should ask carefully about whether this applies to bicoronal craniosynostosis, whether both sutures would be addressed, whether helmet therapy would be required, and whether later open surgery is likely.
Mayo Clinic states that endoscopic surgery may be considered for babies up to 6 months and is followed by helmet therapy, while open surgery is generally used later and usually does not require a helmet. (Mayo Clinic) Seattle Children’s notes that babies with multiple fused sutures or genetic syndromes usually need a series of operations, while endoscopic options are discussed in selected younger babies with particular single-suture patterns. (Seattle Children's)
The practical message:
Endoscopic surgery is not automatically the main option for bicoronal craniosynostosis. Ask the team what approach fits your child’s exact anatomy and diagnosis.
Will My Baby Need a Helmet After Surgery?
It depends on the operation.
After endoscopic surgery, helmet therapy is often used to guide skull growth. After open cranial vault remodeling or fronto-orbital advancement, helmet therapy is often not required because surgeons reshape the bones directly.
Seattle Children’s states that after open cranial vault reconstruction, the child does not need a helmet to shape the head, while after endoscopic surgery the baby wears a helmet for several months. (Seattle Children's) Mayo Clinic similarly states that helmet visits are used after minimally invasive surgery and that open surgery usually does not require a helmet afterward. (Mayo Clinic)
The parent-friendly takeaway:
Helmet use depends on the surgical plan. A helmet alone usually does not treat bicoronal craniosynostosis.
What If Bicoronal Craniosynostosis Is Diagnosed Late?
Late diagnosis does not mean nothing can be done.
It may change the treatment options. A child diagnosed later may be evaluated for:
Open cranial vault remodeling
Fronto-orbital advancement
Posterior vault expansion
Distraction osteogenesis
Eye exams for pressure signs
Genetic testing
Syndromic evaluation
Developmental assessment
Long-term craniofacial follow-up
Great Ormond Street Hospital notes that imaging may be used to monitor bone growth before, during, and after treatment, and that different types of surgery may be considered depending on the child’s age at diagnosis. (GOSH Hospital site)
The practical message:
Even if your child is older, a craniofacial team can still assess skull growth, pressure risk, eye findings, genetics, and treatment options.
What Parents Should Do After Hearing “Possible Bicoronal Craniosynostosis”
A calm next-step plan can help.
1. Ask what pattern the doctor sees
Ask:
- “Are both coronal sutures suspected?”
- “Does the head look short and wide?”
- “Does the forehead look flat or tall?”
- “Are the eye sockets affected?”
- “Could this be positional brachycephaly instead?”
2. Ask for craniofacial referral
Bicoronal craniosynostosis should be evaluated by a craniofacial team, often including pediatric neurosurgery and craniofacial plastic surgery.
3. Ask whether ophthalmology is needed
Because pressure and eye-socket issues may be part of care, ask whether an eye exam is recommended.
4. Ask whether genetics should be involved
Genetic testing is commonly discussed for bicoronal craniosynostosis, especially if there are other findings, family history, multisuture involvement, hearing concerns, hand/foot differences, or facial features suggesting a syndrome.
5. Track head shape and growth
Bring photos and ask whether head circumference is following the expected growth curve.
6. Write down questions
Bicoronal craniosynostosis appointments can include surgery, genetics, eyes, airway, sleep, development, imaging, and long-term follow-up. A written list helps.
You can ask:
- Does this look like positional brachycephaly or bicoronal craniosynostosis?
- Do both coronal sutures seem involved?
- Is my baby’s head short from front to back?
- Is the head wide from side to side?
- Does the forehead look flat, tall, or steep?
- Do you feel ridges along the coronal sutures?
- Is head circumference growing normally?
- Are the eyes or eye sockets concerning?
- Should we be referred to a craniofacial team?
- Should we see pediatric ophthalmology?
- Should genetics be involved?
- Should imaging wait until after specialist evaluation?
- Are there symptoms that should make us call urgently?
At the specialist visit, ask:
- Is this bicoronal craniosynostosis?
- Are both coronal sutures fully fused?
- Are any other sutures involved?
- Does this look isolated or syndromic?
- Do we need genetic testing?
- Which syndromes are you considering?
- Should parents be tested too?
- Do we need an eye exam?
- Do we need hearing testing?
- Do we need airway or sleep evaluation?
- Is there any sign of increased intracranial pressure?
- Do we need imaging?
- If imaging is needed, what kind and why?
- Is surgery recommended?
- What are the goals of surgery?
- Would fronto-orbital advancement be recommended?
- Would posterior vault expansion be considered?
- Would surgery be staged?
- Is endoscopic surgery realistic in this case?
- Would helmet therapy be needed?
- How does my baby’s age affect the options?
- How long is the hospital stay?
- Will blood transfusion be likely?
- Could another surgery be needed later?
- What follow-up is needed during childhood?
- How will development be monitored?
- What symptoms should make us call urgently?
Red Flags: When to Call a Doctor Promptly
Many babies with bicoronal craniosynostosis act like typical babies. Head shape may be the first or main sign.
Still, call your child’s healthcare professional promptly if your baby has:
Rapidly worsening head shape
Head circumference that is not growing as expected
A persistently bulging soft spot
Repeated or projectile vomiting
Poor feeding
Unusual sleepiness or decreased alertness
Extreme irritability
High-pitched cry
Very noticeable scalp veins
Developmental delay or loss of skills
Eye swelling, eye irritation, or inability to close the eyelids fully
New eye movement concerns
Breathing problems
Loud snoring or pauses in breathing during sleep
Seizure-like activity
Johns Hopkins lists increased pressure in the skull as a concern in syndromic craniosynostosis and notes that this can cause headaches, developmental delays, seizures, and vision loss. Johns Hopkins also lists airway obstruction, obstructive sleep apnea, eye irritation, dental anomalies, and hearing/speech evaluation as possible syndromic craniosynostosis care concerns. (Hopkins Medicine)
Seek urgent medical care if your baby is difficult to wake, has trouble breathing, has repeated vomiting, has seizure-like activity, has a bulging soft spot with illness or lethargy, or seems seriously unwell.
Common Parent Fears
“Does bicoronal craniosynostosis mean my baby has a syndrome?”
Not always. Bicoronal craniosynostosis can be isolated. But because both coronal sutures are involved, doctors often discuss genetic evaluation. Great Ormond Street Hospital states that bicoronal craniosynostosis may be syndromic or nonsyndromic and that genetic testing will likely be used to check for a genetic reason. (GOSH Hospital site)
“Did I cause this?”
Usually, no. Craniosynostosis is not caused by ordinary parenting choices. Seattle Children’s states that doctors do not know exactly what causes craniosynostosis and that babies are often born with it. (Seattle Children's)
“Will my baby need brain surgery?”
Craniosynostosis surgery is usually surgery on the skull bones around the brain, not surgery on the brain tissue itself. A pediatric neurosurgeon and craniofacial plastic surgeon often work together to create space and reshape the skull.
“Will my child need many surgeries?”
Some children need one main surgery. Children with syndromic craniosynostosis or multiple fused sutures may need staged surgery or later procedures as they grow. Johns Hopkins states that children with syndromic craniosynostosis often need multiple surgeries to address skull, face, jaw, teeth, or other differences. (Hopkins Medicine)
“Will my child have a normal life?”
Many children do well, but the outlook depends on whether the case is isolated or syndromic and whether other medical issues are present. Great Ormond Street Hospital states that the outlook for children with bicoronal craniosynostosis is generally good, with many growing up to lead normal lives, although the outlook varies depending on other medical conditions. (GOSH Hospital site)
How to Explain Bicoronal Craniosynostosis to Family
Here is a simple explanation:
“Bicoronal craniosynostosis means both of the skull growth seams near the front sides of the head closed too early. Because those seams help the front of the skull grow, the head can become short, wide, tall, or flatter in the forehead and eye-socket area. The craniofacial team will check whether this is isolated or part of a genetic syndrome, whether the eyes or pressure need monitoring, and what surgery plan is best.”
This explanation can help relatives understand why this is different from ordinary flat head syndrome.
- Bicoronal craniosynostosis means both coronal sutures close too early.
- The coronal sutures run from each ear area toward the top/front of the skull.
- Bicoronal craniosynostosis can cause a short, wide, sometimes tall head shape.
- The medical term brachycephaly may be used for the short-wide shape.
- Brachycephaly can be positional or caused by fused sutures, so the cause matters.
- Bicoronal craniosynostosis can make the forehead look flat, high, steep, or tall.
- The upper eye-socket area may also be affected.
It is different from unicoronal craniosynostosis, which usually causes one-sided forehead, brow, eye, and facial asymmetry.
It is different from positional brachycephaly, which is caused by external pressure while the sutures are open.
Repositioning and tummy time do not reopen fused coronal sutures.
A helmet alone usually does not fix bicoronal craniosynostosis.
Bicoronal craniosynostosis can be isolated, but it often raises genetic questions.
Genetic testing may help identify syndromes such as Muenke, Crouzon, Apert, Pfeiffer, or Saethre-Chotzen.
Eye exams are often important because pressure and eye-socket shape can affect vision monitoring.
Surgery may involve fronto-orbital advancement, cranial vault remodeling, posterior vault expansion, or staged procedures depending on the child.
Some children need one main surgery; others, especially syndromic cases, may need longer-term staged care.
The simplest parent-friendly summary is:
Bicoronal craniosynostosis is the “both coronal sutures” type. It often causes a short, wide, tall, or flat-front head shape and should be evaluated by a craniofacial team because genetics, eye monitoring, pressure risk, and surgery planning may all matter.
Frequently Asked Questions About Bicoronal Craniosynostosis
What is bicoronal craniosynostosis?
Bicoronal craniosynostosis means both coronal sutures close too early. These sutures run from each ear area toward the top/front of the skull. The CDC explains that bicoronal synostosis causes the baby’s head to grow broad and short, a shape called brachycephaly. (CDC)
What is bilateral coronal craniosynostosis?
Bilateral coronal craniosynostosis is another name for bicoronal craniosynostosis. “Bilateral” means both sides. It means both coronal sutures are fused.
What head shape does bicoronal craniosynostosis cause?
It often causes a head that is short from front to back, wide from side to side, and sometimes tall. Johns Hopkins describes bicoronal craniosynostosis as producing a short, wide, tall skull with a flat forehead and flat back of the head. (Hopkins Medicine)
What does brachycephaly mean?
Brachycephaly means a short-wide head shape. It can be positional, from external pressure, or synostotic, from fused sutures. In bicoronal craniosynostosis, brachycephaly happens because both coronal sutures close too early. (CDC)
Is bicoronal craniosynostosis the same as positional brachycephaly?
No. Positional brachycephaly is caused by pressure on a baby’s skull while the sutures are open. Bicoronal craniosynostosis is caused by both coronal sutures closing too early. HealthyChildren.org explains that deformational brachycephaly is symmetric back flattening and width from side to side, often related to time spent on the back. (HealthyChildren.org)
Can tummy time fix bicoronal craniosynostosis?
No. Tummy time can help positional head-shape changes, but it cannot reopen fused coronal sutures.
Can a helmet fix bicoronal craniosynostosis?
A helmet alone usually does not fix fused coronal sutures. Helmets may be used after certain minimally invasive craniosynostosis surgeries or for positional head-shape issues. Seattle Children’s explains that helmets are used after endoscopic strip craniectomy, while open surgery usually does not require a helmet. (Seattle Children's)
Is bicoronal craniosynostosis always syndromic?
No. It can be isolated or syndromic. Great Ormond Street Hospital states that bicoronal craniosynostosis may be part of a syndrome or nonsyndromic. (GOSH Hospital site)
Why is genetic testing often discussed?
Genetic testing is often discussed because bicoronal craniosynostosis can be associated with syndromic craniosynostosis. Great Ormond Street Hospital states that genetic testing will most likely be undertaken to check whether there is a genetic reason for bicoronal craniosynostosis. (GOSH Hospital site)
Which syndromes can involve bicoronal craniosynostosis?
Syndromes that may involve bicoronal craniosynostosis include Apert syndrome, Crouzon syndrome, Muenke syndrome, Pfeiffer syndrome, and Saethre-Chotzen syndrome. CHOP lists these among common syndromic craniosynostosis conditions. (Children's Hospital of Philadelphia)
What is Muenke syndrome?
Muenke syndrome is a genetic craniosynostosis condition often involving the coronal sutures. GeneReviews states that Muenke syndrome may include bilateral or unilateral coronal synostosis, hearing loss, strabismus, developmental delay, and other variable features. (Be-MD)
Did I cause my baby’s bicoronal craniosynostosis?
Usually, no. It is not caused by safe sleep, car seats, baby carriers, tummy time, or how you held your baby. Great Ormond Street Hospital notes that gene mutations may be inherited in some families but often develop sporadically. (GOSH Hospital site)
Can bicoronal craniosynostosis affect vision?
It can. Bicoronal craniosynostosis can affect the eye-socket area and can be associated with pressure monitoring. Great Ormond Street Hospital notes that regular eye exams are often used because raised pressure may initially occur without symptoms and can affect vision if untreated. (GOSH Hospital site)
Can bicoronal craniosynostosis affect breathing or sleep?
In syndromic craniosynostosis, airway obstruction and obstructive sleep apnea may be concerns, especially when midface growth is affected. Johns Hopkins lists airway obstruction and obstructive sleep apnea among possible complications in syndromic craniosynostosis. (Hopkins Medicine)
How is bicoronal craniosynostosis diagnosed?
Diagnosis usually involves physical exam, head measurements, assessment of forehead and eye-socket shape, and sometimes imaging. Seattle Children’s states that exam and measurements may be enough in some cases, while CT can confirm the diagnosis and help plan treatment. (Seattle Children's)
Does my baby need a CT scan?
Maybe. CT can confirm which sutures are fused and help with surgical planning, but imaging decisions vary by child and center. Ask your craniofacial team what imaging is needed and why.
What surgery is used for bicoronal craniosynostosis?
Surgery may include fronto-orbital advancement, cranial vault remodeling, posterior vault expansion, distraction osteogenesis, or staged procedures depending on age, severity, pressure, eye findings, and whether the case is syndromic. Children’s Health states that fronto-orbital advancement can be used for craniosynostosis affecting one or both coronal sutures. (Children's Health)
What is fronto-orbital advancement?
Fronto-orbital advancement is surgery that reshapes and moves the forehead and upper eye-socket bones. The goals are to expand skull space, reshape the forehead and orbit, and sometimes help protect the eyes. (Children's Health)
Will my child need more than one surgery?
Some children need one major surgery. Children with syndromic craniosynostosis or multiple fused sutures may need staged surgery or later procedures. Johns Hopkins states that syndromic craniosynostosis often requires multiple surgeries. (Hopkins Medicine)
When should I ask for a craniofacial referral?
Ask for referral if your baby’s head looks short and wide, the forehead looks flat or tall, both coronal sutures are suspected, the eye sockets look shallow or unusual, the diagnosis is unclear, or the pediatrician mentions bicoronal craniosynostosis.
What symptoms should I report urgently?
Report repeated vomiting, poor feeding, unusual sleepiness, a persistently bulging soft spot, developmental regression, seizure-like activity, breathing trouble, eye irritation or inability to close the eyelids, or rapidly worsening head shape.
Suggested External Sources for the Published Blog
Use these at the bottom of the published article as a “Sources” section:
CDC — Craniosynostosis Best for: basic definition, bicoronal synostosis description, broad and short head shape, brachycephaly, diagnosis signs, and treatment overview. (CDC)
Johns Hopkins Medicine — Craniosynostosis / Syndromic Craniosynostosis Best for: bicoronal head-shape pattern, short-wide-tall skull, flat forehead and back of head, syndromic craniosynostosis overview, increased pressure, airway, eye, dental, hearing, and multidisciplinary care. (Hopkins Medicine)
Great Ormond Street Hospital — Bicoronal Craniosynostosis Best for: bicoronal symptoms, flatter forehead and eye sockets, short front-to-back and tall head shape, genetic testing, multidisciplinary team care, eye exams, raised-pressure monitoring, surgery timing, and outlook. (GOSH Hospital site)
Seattle Children’s — Craniosynostosis Best for: diagnosis process, CT confirmation, genetic testing, team-based care, surgery planning by age and suture, open surgery, endoscopic surgery, helmet therapy, and craniofacial follow-up. (Seattle Children's)
Children’s Health — Pediatric Fronto-Orbital Advancement Best for: FOA explanation, forehead and upper eye-socket reshaping, use in metopic and coronal craniosynostosis, eye protection, and staged surgical planning in complex cases. (Children's Health)
Children’s Hospital of Philadelphia — Syndromic Craniosynostosis Best for: common syndromic craniosynostosis diagnoses, including Apert, Crouzon, Muenke, Pfeiffer, and Saethre-Chotzen, and the need for coordinated multidisciplinary care. (Children's Hospital of Philadelphia)
GeneReviews / MedlinePlus Genetics — Muenke Syndrome Best for: Muenke syndrome, coronal synostosis, bilateral coronal synostosis and brachycephaly, FGFR3-related craniosynostosis, hearing loss, strabismus, developmental variability, and family counseling. (Be-MD)