3. HEAD a. Deformities of the skull, face, or mandible (738.19, 744.9, 754.

0) of a degree that shall prevent the individual from the proper wearing of a protective mask or military headgear.
You will sometimes see an applicant with an abnormal head shape during your exam. Perhaps the applicant is unaware or sensitive (look for low self-esteem). Or, it may only be a subtle finding on your part. Most skull deformities are caused by positional deformities caused during pregnancy or while sleeping as an infant. 40% of newborns are affected, most will not persist. They are not disqualifying if they do not interfere with the proper wearing of a protective mask or military headgear. Some will be due to craniosynostosis or early closure of the cranial sutures. Craniosynostosis: The cause of this premature fusion is unknown. Often mothers note their childs face is a little screwed up. Over 80% of these are the sagittal synostosis (Scaphocephaly a long Boat-Head) or coronal synostosis (Plagiocephaly Bent-Head). You may see nothing but a slightly off-balanced face, low ears or uneven eyes. They may have a history of increased pressure on the brain (look for a history of hydrocephalus or presence of a VP shunt). A few will be due congenital craniofacial syndromes 10 to 20% of craniosynostosis are syndromic. Syndromic applicants: Congenital syndromes may have a variety of small physical findings spread throughout the body. You should develop your genetic eye early on. Particularly be on the lookout for abnormalities of the fingers and toes, particularly the thumbs and big toes in any bony head deformity. Hands may show a crooked (deviated) or broad thumb(s), and/or fused thumb and fingers. (Bony syndactyly is fused digits, and brachydactyly is shorter sometimes broad digits) You may find this during the ortho-neuro maneuvers in limited ROM of the wrist (carpal syndactyly), or with the ankles (tarsal syndactyly) you may see decreased ankle ROM, a limp or rigid pes planus (see Section 19 c. (6) Foot and Ankle). The combination of craniosynostosis and syndactyly/brachydactyly is seen in congenital syndromes such as Aperts Crouzons and Pfeiffers syndrome, to name a few see the Syndromal Worksheet at the end of this discussion.
A deformed head and funny fingers is a craniosynostosis syndrome until proven otherwise

b. Loss, or absence of the bony substance of the skull (756.0 or 738.19) not successfully corrected by reconstructive materials, or leaving any residual defect in excess of 1 square inch (6.45 square centimeters), or the size of a 25-cent piece.
Skull defects are usually from burr holes or linear skull defects as a result of neurosurgery procedures. Holes and other defects are repaired (cranioplasty) using various materials including bone chips, acrylic resins, ceramics, and titanium mesh or plates. The dura mater can be repaired with Gore-Tex. After repair, these fillings can shrink from resorption overtime, leaving various degrees of defects and a sunken cranioplasty with residual collections of fluid, or even form a chronic abscess. Palpation of the scalp during your examination will usually pick this up.