The Effects of Helmet Therapy Relative to the Size of the Anterior Fontanelle in Nonsynostotic Plagiocephaly: A Retrospective Study

Abstract

Helmet therapy is an important nonsurgical approach for patients with nonsynostotic plagiocephaly, but its effectiveness may depend on certain anatomical features. We retrospectively examined the effects of helmet therapy according to the size of the anterior fontanelle. Two hundred patients with nonsynostotic plagiocephaly who underwent helmet therapy between 2016 and 2018 were included. Data regarding age at treatment onset and treatment duration were collected. Patients were divided into two groups depending on the age at treatment initiation: the 12–23 weeks group and the >23 weeks group. Patients were also divided based on the anterior fontanelle size to analyze the effects of helmet therapy according to the severity of plagiocephaly in each group as the change in the cranial vault asymmetry index (CVAI). Therapeutic effects were evaluated using the cranial vault asymmetry (CVA), CVAI, anterior symmetry ratio, posterior symmetry ratio (PSR), and overall symmetry ratio at baseline and treatment completion. Treatment initiation at age 12–23 weeks resulted in better effects than that after age 24 weeks. There were no sex-dependent differences in therapeutic effects. Greater changes in the CVA, CVAI, and PSR were associated with larger anterior fontanelles. Therefore, the anterior fontanelle size could be a prognostic factor for estimating helmet therapy outcomes.

Effectiveness of Helmet therapy for infants with moderate to severe positional plagiocephaly

“…During the first year of life, the infant’s skull grows rapidly; thus, early intervention is considered important for more successful treatment of skull deformation [ 8 , 21 ]. Since it was first introduced by Clarren et al, helmet therapy has been widely applied [ 22 , 23 ]. Many studies have examined the effectiveness of helmet therapy; however, no definite conclusions have been reported [ 9 , 15 , 24 , 25 ].…”

Consideraciones actuales en el abordaje de la plagiocefalia posicional

“…Actualmente hay acuerdo en que el reposicionamiento es efectivo para todas las deformaciones plásticas del existiendo evidencia respecto a que la kinesioterapia es superior al reposicionamiento y que el casco sería el tratamiento de elección en las PP severas que no responden a las terapias previas, y se debe instalar a partir de los 6-8 meses de edad 46,55 . Se debe tener en consideración que los cascos y órtesis craneanas no debiesen usarse si ya se estabilizó el crecimiento craneano (después del año de vida), en plagiocefalia leve a moderada, en presencia de hidrocefalia y según los últimos estudios, en aquellos lactantes de fontanela pequeña, pues sería un factor de menor respuesta [62][63][64] .…”

Cranial Shape Measurements Obtained Using a Caliper and Elastic Bands Are Useful for Brachycephaly and Deformational Plagiocephaly Screening

“…Traditionally, calipers, photographs, and drafting with landmarks have been used to determine cranial geometry without using 3DS [18][19][20][21]. However, with these methods, it can be difficult to accurately evaluate the left-to-right diagonal difference 30 • from the y-axis, as proposed by Loveday et al [2].…”