Importance of Early Recognition and Treatment of Deformational Plagiocephaly with Orthotic Cranioplasty

Abstract

Objectives Infants with positional plagiocephaly often exhibit complex multistructuraI asymmetries that affect the face and skull base as well as the cranial vault. Dynamic Orthotic Cranioplasty (DOC) was developed as a nonsurgical alternative for the treatment of positional plagiocephaly. The effectiveness of DOC has been discussed elsewhere. The purpose of this study was to assess the influence of factors such as entrance age, treatment time, and initial severity on the effectiveness of correction. Methods The study sample consisted of 258 children with cranial vault asymmetry (CVA) treated prior to 1 year of age. In addition, 246 patients (92%) exhibited concurrent skull base (SBA) and orbitotragial depth (OTDA) asymmetries. All patients had been diagnosed with nonsynostotic plagiocephaly, did not have other contributing medical conditions, were compliant with DOC protocol, and had complete anthropometric measurements at entrance and exit from treatment. Results Mean age at start of treatment was 6.5 (±1.9) months (range, 2.8 to 11.0 months), with an average treatment time of 4.1 (±2.2) months. The effects of the treatment variables were analyzed using three-way analysis of variance. As expected, initial severity was significantly associated with the amount of correction (p = .0001). However, treatment time was not significant (p > .05). Most importantly, the analysis revealed that, having accounted for initial severity, entrance age had a statistically significant effect [F[1,254) = 8.36, p = .0042] on the correction of CVA. Similar results were Identified for both the SBA [F[1,254) = 5.53, p = .0195] and the OTDA [F[1,254) = 5.22, p = .0231] asymmetries. Conclusions These findings support clinical observations that earlier intervention results in significantly improved treatment of plagiocephaly, independent of the severity of the presenting asymmetries.

Plagiocephaly and head binding

“…A range of clinical studies [15][16][17][18] have charted the change in anthropometric measurements with orthotic treatment. They show what would appear to be an impressive asymmetrical resolution with a mean change in asymmetry of about 5 mm.…”

Automatic 3D shape severity quantification and localization for deformational plagiocephaly

“…Early measurement techniques for plagiocephaly began by using anthropometric landmark measurements 5–7. These landmarks identify certain points on the head that are commonly found across all head shapes.…”

Management of positional plagiocephaly

“…The principle of dynamic devices is that they apply pressure on the areas of deformity, limiting further growth, and encourage the relieved adjacent flattened areas to expand. Kelly et al 8 have suggested that the greatest benefit from these devices is derived when they are used before 1 year of age and ideally when initiated before 6 months of age. They argue that this allows the propulsive rate of brain growth during this period to drive outward expansion and remodelling of the cranium.…”