Helmet Treatment of Infants With Deformational Brachycephaly

Abstract

Deformation of the cranium in infancy represents a spectrum of deformity, ranging from severe asymmetric yet proportional distortion of the skull in plagiocephaly, to nearly symmetric yet disproportional distortion in brachycephaly. As such, the condition is best described as deformational plagiocephaly-brachycephaly with isolated plagiocephaly and/or isolated brachycephaly being at either ends of the spectrum. Due to its symmetric appearance, deformational brachycephaly is often incorrectly dismissed as being less concerning, and it has sometimes erroneously been reported that brachycephaly cannot be treated successfully with a cranial orthosis. We prospectively report on 4205 infants with isolated deformational brachycephaly treated with a cranial orthosis from 2013 to 2017. These results demonstrate that the orthosis is successful in the treatment of deformational brachycephaly with an 81.4% improvement toward normal (95.0 to 89.4) in cephalic index. We furthermore demonstrate that entrance age influences treatment results, with younger infants demonstrating both improved outcomes and shorter treatment times.

Significant Factors in Cranial Remolding Orthotic Treatment of Asymmetrical Brachycephaly

“…Results from this study support the hypothesis that the effectiveness of CROs is related to both age at the initiation of treatment and severity of CI and CVAI at the start of treatment in asymmetrical brachycephaly. Age has been shown in previous studies of isolated plagiocephaly [32][33][34][35] and brachycephaly to significantly affect treatment [3,5]. This is intuitive as younger infants have more growth potential left which the CRO can harness to provide correction.…”

“…The cranial circumferential growth chart published by the CDC shows younger infants have faster growth [37]. Additionally, previous literature has supported the conclusion that a younger age at initiation of treatment correlates to higher likelihood of correction for plagiocephaly and brachycephaly respectively [3,5,24,32,33,38,39]. The initial severity of the head shape plays a crucial role in determining which subjects achieved full correction and how much correction they achieved.…”

“…Therefore, asymmetrical brachycephaly is characterized by a posterior flattening of the occiput as well as an asymmetry with compensatory posterior bossing contralaterally. These deformities are caused by external pressures on the baby's skull when the skull is in the same position for extended periods of time [1][2][3][4][5]. This relatively common occurrence is often attributed to the American Academy of Pediatrics "Back to Sleep" campaign, which recommended infants be placed supine to sleep.…”

“…If repositioning therapy is attempted and is not successful, or if the skull deformity is very severe to begin with, a CRO is then considered [6]. Severity has also been shown to play a role in the outcome of the final head shape in brachycephalic and plagiocephalic head shapes [3,8].…”

“…Some studies have shown relationships between children with plagiocephaly and brachycephaly having additional health issues, with asymmetrical brachycephaly having the highest risk of complications [2]. Some of the issues associated with skull deformations include: increased need for special services at school age [1], delays in psychomotor development [18], abnormal speech development [1], jaw asymmetry [3], temporomandibular joint dysfunction [3,4,[19][20][21][22][23], abnormal muscle tone [3], ear misalignment [24], and middle ear abnormalities [24]. Additionally, abnormal head and face shapes can be very noticeable on children and adults.…”