Cephalohematomas are subperiosteal hemorrhages that not cross the suture lines They should not be routinely incised or aspirated Subgaleal hemorrhage can lead to hypovolemic shock and can present days after birth Traumatic facial nerve palsy is unilateral and will usually recover spontaneously Neck masses in a neonate need evaluation for airway proximity and compression Cephalohematoma Cephalohematoma ( Fig 96.17 ) is a subperiosteal hemorrhage occurring commonly over a parietal bone, distinguished from a caput succedaneum by the fact that the swelling never crosses suture lines ( Fig 96.23 ) It occurs in 0.4% to 2.5% of live births due to rupture of blood vessels traversing the skull to the periosteum The overlying skin is intact with no petechiae or hemorrhage Cephalohematomas often feel fluctuant and may be bordered by elevated ridges of surrounding tissue, giving a false sensation of a skull depression They may be associated with intracranial hemorrhage and 5.4% are also associated with linear skull fractures Cephalohematomas often become prominent after the immediate newborn period when scalp edema subsides Most commonly, a cephalohematoma is unilateral, but it can be bilateral They resolve slowly over to weeks, possibly with calcification and the formation of a hard bump on the scalp that may be a source of great concern to parents Occasional complications resulting from the breakdown and resorption of large hematomas are hyperbilirubinemia or anemia No therapy is required for uncomplicated lesions Routine incision or aspiration of a cephalohematoma is contraindicated due to the high risk of introducing infection Rare complications of localized infection of cephalohematoma include osteomyelitis, meningitis, and venous sinus thrombosis Subgaleal Hemorrhage Subgaleal hemorrhage (SGH) refers to hemorrhage into the soft tissue space between the galea aponeurotica and the periosteum ( Fig 96.24 ) Rupture of emissary veins within this extensive space results in hemorrhage across the whole cranial vault from the orbital ridges to the nape of the neck This space can hold up to 260 mL of blood (which could exceed the entire blood volume of a fullterm baby) and thus bleeding here can result in hemorrhagic shock Newborns