Nonsynostotic Cranial Deformity: A Six-Month Matched-Pair Photogrammetric Comparison of Treated and Untreated Infants

Abstract

Objective : To photogrammetrically objectify changes in nonsynostotic craniofacial deformity in orthotically treated versus untreated infants. Design : A statistical retrospective pairwise comparison of two respective three-dimensional (3D) photo scans of 80 children performed in a 6-month time lag. Patients : Two comparable samples of children (40 treated, 40 untreated) with nonsynostotic cranial deformity. Interventions : Respective 3D photo scans were matched using Cranioform Analytics 4.0 software. Main Outcome Measures : Median change of 30° Cranial Vault Asymmetry Index (CVAI), modified CVAI (CVAImod), Cranial Index (CI), and posterior symmetry ratio (PSR). Results : We found an improvement in Δ30° CVAI by 3.3% (treated) and by 1.31% (untreated), respectively. CVAImod improved by 3.46% in the treated group and by 1.55% in the untreated group. CI improved by 4.41% in the treated group and by 3.68% in the untreated group, and PSR improved by 0.71 in the treated group and 0.49 in the untreated group. Although improvement of cranial asymmetry was higher in those children treated with an individual molding orthosis, we could not document a statistically significant difference between the two groups. Conclusions : Helmet therapy may be less appropriate for the correction of brachycephaly than for cranial asymmetry. Nonsynostotic cranial deformity shows some spontaneous correction. Photogrammetry presents an accurate method to objectify craniofacial changes in early infancy.

Normal Head Shape Parameters in the First 2 Years of Life and Effect of Helmet Therapy

“…Therefore, absolute measures are better suited to assess spontaneous normalization of cranial shape (►Table 1). 10,29,30 The results of our retrospective study relating the data of a large number of patients to normal values are also in contrast to the findings of van Wijk et al, who performed a prospective randomized trial including 80 children. 7 These authors could not show any beneficial effect of orthotic therapy, when assigning the examinees in a randomized way to either treatment with an individual molding helmet or to a control group.…”

“…We have studied the natural course of mild-to-moderate skull deformation comprehensively since 1998. 8 By using a classical standardized measurement protocol with tapeline and spreading calipers, 9 we did not find any significant spontaneous improvement of absolute cranial deformity over a period of 6 months, 10 5 years, 11 or longer. In contrast, we did find improvement in cranial deformation after helmet treatment when using these anthropometric standards in combination with more modern measurement methods, such as three-dimensional photogrammetry.…”

“…According to our experience, spontaneous normalization of asymmetric head deformities is not occurring regularly. 10,11 This notion is inconsistent with the opinion of other authors reporting that nonsynostotic head deformities have the tendency to improve by natural course 6 or by nonorthotic methods, such as physiotherapy 14 or osteopathy. 28 One explanation for this discrepancy could be that the latter studies used only indices describing cranial asymmetry (e.g., CVAI), whereas absolute measures of cranial asymmetry (e.g., CVA) were not taken into account.…”

“…The CVAI, for example, improves with increment of length of the utilized transcranial diagonals. 25 Similarly, the CI as a measure of ovality of the cranium declines early in healthy children, 5,10 while CVAI as a parameter of asymmetry shows a rather slow downward slope. 6,7 In contrast, the CVA as a measure of absolute cranial asymmetry remains largely unchanged during the first 2 years of life.…”

“…However, since the CI improved faster and in a significant manner in a substantial number of children orthotically treated for positional brachycephaly, we stick to recommend treatment of severe cases of central-occipital flattening with individual molding orthoses, although other authors might advise differently. 33 But caregivers should be informed that brachycephaly improves to some extent with 25,34 or without 10,16,35 molding devices, and that it might not be normalized fully by any nonsurgical means. Collectively, the findings of this study support the idea that positional cranial deformation once being classified as moderate or severe should be treated 36 in the crucial period of time.…”