Treatment of Craniofacial Asymmetry With Dynamic Orthotic Cranioplasty

Determinants of Nonsynostotic Plagiocephaly: A Case-Control Study

“…As in other reports, 12,14,15,31 supine sleeping at 6 weeks was strongly related to development of plagiocephaly, both at the univariate and the multivariate levels. By the time of interview, however, only one third of case patients were sleeping supine, probably reflecting attempts at positioning changes to counter head shape asymmetry in the case patients.…”

Soft-helmet skull remodeling in canine models: intracranial volume unchanged by compensatory skull growth

“…25,28,40 Nevertheless, in children 2 to 4 years of age who have severely deformed cranial development, reconstructive surgery is often necessary. Given such an invasive procedure, the possible complications of surgery and anesthesia can preclude surgical intervention for positional plagiocephaly in many young patients; therefore, early diagnosis and treatment have been emphasized.…”

“…24 By taking advantage of these characteristics of the infant skull, it has been demonstrated that therapy with a molding helmet will subsequently lead to two different types of remodeling: compensatory growth and pressure on the protuberant portion. 42 The former is the classic molding helmet of Clarren, et al, 8 which passively prevents compression of the flat area of the skull, and the latter is the active or dynamic orthosis, or dynamic orthotic cranioplasty, 28,41 which not only prevents compression of the flat area but also constrains the frontal and occipital prominences.…”

“…This is because remodeling by passive molding helmets is usually most effective between 3 and 12 months after birth, whereas active molding helmets are effective for young children 20 months of age. 25,[28][29][30] The passive molding helmet also compresses the protuberant area to some degree, depending on its fit and weight, and thus factors that can make the dif-ference between passive and active helmets become less significant. 31,33 All molding helmets-especially those with active compression-exert some degree of pressure on the skull, a feature that results in poor compliance when they are worn by infants and young children.…”

“…5 Recently, the introduction of molding-helmet therapy has afforded a nonsurgical alternative that is safer and easier to perform. 25,28,41 Clarren, et al, 8 developed the first molding helmet that passively led to compensatory growth because of the flat area of the skull no longer was compressed. Ripley, et al, 41 revised the molding helmet not only to prevent compression of the flat area but also to compress the protuberant area.…”