Outcome Analysis of Cranial Molding Therapy in Nonsynostotic Plagiocephaly

Background It is known that nonsynostotic plagiocephaly does not spontaneously improve, and the craniofacial deformities that result from it. This study was conducted to analyze the effectiveness of helmet therapy for the nonsynostotic plagiocephaly patient, and to suggest a new treatment strategy based on this analysis.

Methods A total of 108 pediatric patients who had undergone helmet therapy after being diagnosed with nonsynostotic plagiocephaly were included in this study. The patients were classified according to the initiation age of the helmet therapy, severity, and helmet wearing time. The treatment effect was compared using cranial vault asymmetry (CVA) and the cranial vault asymmetry index (CVAI), which were obtained from diagonal measurements before and after therapy.

Results The discrepancy of CVA and CVAI of all the patients significantly decreased after helmet therapy. According to the initiation time of helmet therapy, the treatment effect was best at 5 months old or less. The helmet wearing time per day was proportional to the treatment effect up to 20 hours. In addition, the rate of the successful treatment (final CVA ≤5 mm) significantly decreased when the initiation age was 9.1 months or older and the treatment period was less than 7.83 months.

Conclusions This study showed the effectiveness of the helmet therapy for nonsynostotic plagiocephaly patients. Based on analysis of this study, helmet therapy should be started at the age of 9 months or younger for 7.83 months or more, and the helmet wearing time should be more than 20 hours a day.

Keywords

Head protective device - Plagicephaly, nonsynostotic - Treatment outcome

This article was presented at the 69th Congress of the Korean Society of Plastic and Reconstructive Surgeons on November 11-13 2011 in Seoul, Korea.

Publikationsverlauf

Eingereicht: 08. März 2012

Angenommen: 14. Mai 2012

Artikel online veröffentlicht:
01. Mai 2022

• REFERENCES

• 1 Kelly KM, Littlefield TR, Pomatto JK. et al. Cranial growth unrestricted during treatment of deformational plagiocephaly. Pediatr Neurosurg 1999; 30: 193-199
• 2 McGarry A, Dixon MT, Greig RJ. et al. Head shape measurement standards and cranial orthoses in the treatment of infants with deformational plagiocephaly. Dev Med Child Neurol 2008; 50: 568-576
• 3 American Academy of Pediatrics AAP Task Force on Infant Positioning and SIDS: positioning and SIDS. Pediatrics. 1992. 89. 1120-1126
• 4 Boere-Boonekamp MM, van der Linden-Kuiper LL. Positional preference: prevalence in infants and follow-up after two years. Pediatrics 2001; 107: 339-343
• 5 Danby PM. Plagiocephaly in some 10-year-old children. Arch Dis Child 1962; 37: 500-504
• 6 Kelly KM, Littlefield TR, Pomatto JK. et al. Importance of early recognition and treatment of deformational plagiocephaly with orthotic cranioplasty. Cleft Palate Craniofac J 1999; 36: 127-130
• 7 Shin JH, Persing J. Asymmetric skull shapes: diagnostic and therapeutic consideration. J Craniofac Surg 2003; 14: 696-699
• 8 Teichgraeber JF, Seymour-Dempsey K, Baumgartner JE. et al. Molding helmet therapy in the treatment of brachycephaly and plagiocephaly. J Craniofac Surg 2004; 15: 118-123
• 9 Teichgraeber JF, Ault JK, Baumgartner J. et al. Deformational posterior plagiocephaly: diagnosis and treatment. Cleft Palate Craniofac J 2002; 39: 582-586
• 10 Ripley CE, Pomatto J, Beals SP. et al. Treatment of positional plagiocephaly with dynamic orthotic cranioplasty. J Craniofac Surg 1994; 5: 150-159
• 11 O'Broin ES, Allcutt D, Earley MJ. Posterior plagiocephaly: proactive conservative management. Br J Plast Surg 1999; 52: 18-23
• 12 Rekate HL. Occipital plagiocephaly: a critical review of the literature. J Neurosurg 1998; 89: 24-30
• 13 Thompson JT, David LR, Wood B. et al. Outcome analysis of helmet therapy for positional plagiocephaly using a three-dimensional surface scanning laser. J Craniofac Surg 2009; 20: 362-365
• 14 Schaaf H, Malik CY, Streckbein P. et al. Three-dimensional photographic analysis of outcome after helmet treatment of a nonsynostotic cranial deformity. J Craniofac Surg 2010; 21: 1677-1682
• 15 Clarren SK. Plagiocephaly and torticollis: etiology, natural history, and helmet treatment. J Pediatr 1981; 98: 92-95
• 16 Lee RP, Teichgraeber JF, Baumgartner JE. et al. Long-term treatment effectiveness of molding helmet therapy in the correction of posterior deformational plagiocephaly: a five-year follow-up. Cleft Palate Craniofac J 2008; 45: 240-245
• 17 Xia JJ, Kennedy KA, Teichgraeber JF. et al. Nonsurgical treatment of deformational plagiocephaly: a systematic review. Arch Pediatr Adolesc Med 2008; 162: 719-727
• 18 Clarren SK, Smith DW, Hanson JW. Helmet treatment for plagiocephaly and congenital muscular torticollis. J Pediatr 1979; 94: 43-46
• 19 Loveday BP, de Chalain TB. Active counterpositioning or orthotic device to treat positional plagiocephaly?. J Craniofac Surg 2001; 12: 308-313
• 20 Littlefield TR. Food and Drug Administration regulation of orthotic cranioplasty. Cleft Palate Craniofac J 2001; 38: 337-340
• 21 Vles JS, Colla C, Weber JW. et al. Helmet versus nonhelmet treatment in nonsynostotic positional posterior plagiocephaly. J Craniofac Surg 2000; 11: 572-574
• 22 Mortenson PA, Steinbok P. Quantifying positional plagiocephaly: reliability and validity of anthropometric measurements. J Craniofac Surg 2006; 17: 413-419
• 23 Argenta L, David L, Thompson J. Clinical classification of positional plagiocephaly. J Craniofac Surg 2004; 15: 368-372
• 24 Kluba S, Kraut W, Reinert S. et al. What is the optimal time to start helmet therapy in positional plagiocephaly?. Plast Reconstr Surg 2011; 128: 492-498