ephalic index is the ratio between head width, the biparietal diameter, and head length, the anteroposterior diameter. Cephalic index can be obtained through the use of a manual caliper, skull radiography, computed tomography, or three-dimensional computed tomographic imaging. Cephalic index is a key measure that guides management of positional plagiocephaly, which is occipital flattening because of time spent on the back in infancy. The effect of supine sleeping on molding of the occipital skull is greatest at 2 to 4 months of life, and often starts to resolve as the infant gains head control and becomes more mobile. Additional risk factors for plagiocephaly include male sex, first-born child, difficult delivery, multiple births, prematurity, and torticollis. 1 The majority of plagiocephaly can be treated with behavioral interventions such as repositioning and stretching. 2 However, in severe cases, this treatment may be inadequate, and without further intervention there is a risk of retained facial asymmetry and
This retrospective review identifies patient and clinical factors that contributed to the number of surgeries and anesthesia events that children with a cleft underwent from birth to adulthood at a single children's hospital. We found that "heralding" events, such as palatal fistula and multiple nasal or lip revisions, can put children at risk for an increasing--and perhaps deleterious--number of surgery and anesthesia events.
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