DEFORMITIES OF THE HEAD IN FACE PRESENTATIONS.
As in vertex cases, the distortions are of two kinds: first, those due to the caput succedaneum, and, second, those due to osseous deformities.
1. The Caput Succedaneum.
Since the face corresponds to the pelvic cavity, the caput forms upon it and the face becomes hideous. The child is born with the face almost black, the lips and cheeks swollen, the lids so oedematous that the child cannot open them, and, when the globe can be uncovered, we often find it covered with more or less extensive ecchymoses. The head re mains tipped backward for some days. Generally, the caput disappears in three or four days, but the sub-conjunctival ecchymoses sometimes last much longer. It is, therefore, always well to inform the family of the probable appearance which the child will present. Beginning near the mouth, at the angle which was in front, the caput extends to the cheek, the nose or even to the other side.
2. 08800118 Deformities.
According to Schroeder, the cranial deformity varies in face and brow cases. In face presentations, the cranial vertical diameter is compressed. As a result the vault of the cranium is flattened, while the occiput is re tracted and a little elongated toward the neck. The head's right diameter is thus elongated, but the vertical one is lessened. Schroeder admits, as does Hecker, an original dolicho-cephalic head in these cases. In brow presentations the caput succedaneum is on the brow, reaching from the root of the nose to the upper angle of the large. fontanelle. The cranium is very high in front, so that the distance separating the brow and the chin is very great, but, from the large fontanelle backward, the parietal bones grow lower, so that, near the neck, the vault of the occiput is very low. The cranium is compressed in the direction of a line passing from the chin to the region above the small fontanelle.
Budin holds that, in face presentations, the diameters O. M. and O. F. are increased, and the angle of the occipital bone bending abruptly for ward, its posterior surface becomes more and more convex. The con vexity of the frontal is exaggerated, but, as in vertex cases, the free end of the frontal, that which arrives at the level of the anterior fontanelle and of the fronto-parietal suture, allows itself to be depressed, and the diameter sub-occipito-bregmatic is lessened. The normal curve of the parietal bones, at the level of the sagittal suture, is obliterated, and the sagittal border forms an almost straight line between the fontanelles. The maximum diameter either approaches very close to the angle of the occipital, or else is confounded with the diameter, occipito-mental, or even descends below it. In this case, the maximum diameter is the sub-occipito mental diameter. Tarnier and Chantreuil borrow their description from both Schroeder and Budin.
According to Hecker, to whom wo owe the most important monograph on this subject, the crania of children delivered by the face is dolicho cephalic, i.e., the posterior part is more developed than the anterior.
This is true, but.Hecker is wrong in considering this distortion to be the cause of face presentation, whereas it is, usually, the result. We say usually, for certain observations by Hecker show that dolicho-cephalus cer tainly sometimes exists as a result of cranial developments, and not of dis tortion after labor. The subjoined table, borrowed from his work " Ueber die SchAdelformen bei Gesichtlagen," shows the differences in the crania of children born by vertex and by face presentations.