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Watt A, Lee J, Toews M, Gilardino MS. Smartphone Integration of Artificial Intelligence for Automated Plagiocephaly Diagnosis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4985. [PMID: 37197011 PMCID: PMC10184988 DOI: 10.1097/gox.0000000000004985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/17/2023] [Indexed: 05/19/2023]
Abstract
Positional plagiocephaly is a pediatric condition with important cosmetic implications affecting ∼40% of infants under 12 months of age. Early diagnosis and treatment initiation is imperative in achieving satisfactory outcomes; improved diagnostic modalities are needed to support this goal. This study aimed to determine whether a smartphone-based artificial intelligence tool could diagnose positional plagiocephaly. Methods A prospective validation study was conducted at a large tertiary care center with two recruitment sites: (1) newborn nursery, (2) pediatric craniofacial surgery clinic. Eligible children were aged 0-12 months with no history of hydrocephalus, intracranial tumors, intracranial hemorrhage, intracranial hardware, or prior craniofacial surgery. Successful artificial intelligence diagnosis required identification of the presence and severity of positional plagiocephaly. Results A total of 89 infants were prospectively enrolled from the craniofacial surgery clinic (n = 25, 17 male infants [68%], eight female infants [32%], mean age 8.44 months) and newborn nursery (n = 64, 29 male infants [45%], 25 female infants [39%], mean age 0 months). The model obtained a diagnostic accuracy of 85.39% compared with a standard clinical examination with a disease prevalence of 48%. Sensitivity was 87.50% [95% CI, 75.94-98.42] with a specificity of 83.67% [95% CI, 72.35-94.99]. Precision was 81.40%, while likelihood ratios (positive and negative) were 5.36 and 0.15, respectively. The F1-score was 84.34%. Conclusions The smartphone-based artificial intelligence algorithm accurately diagnosed positional plagiocephaly in a clinical environment. This technology may provide value by helping guide specialist consultation and enabling longitudinal quantitative monitoring of cranial shape.
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Affiliation(s)
- Ayden Watt
- From the Department of Experimental Surgery, McGill University, Montreal, Canada
| | - James Lee
- Division of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal, Canada
| | - Matthew Toews
- École de Technologie Supérieure, Department of Systems Engineering, Montréal, Canada
| | - Mirko S. Gilardino
- Division of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal, Canada
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Junn A, Dinis J, Long A, Hauc S, Phillips S, Junn AH, Reategui A, Lopez J, Persing JA, Alperovich M. Disparities in Access to Cranial Remodeling Orthosis for Deformational Plagiocephaly. Cleft Palate Craniofac J 2023; 60:454-460. [PMID: 34967227 DOI: 10.1177/10556656211069816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Moderate to severe cases of deformational plagiocephaly (DP) may be treated with cranial remolding orthoses (CRO). This study investigated the socioeconomic disparities in access to care for CRO for DP correction. DESIGN This was a retrospective review of medical records from a single CRO company in Connecticut from 2014 to 2020. METHODS Demographic variables were collected from all patients. Univariable logistic regressions were used to identify differences for presenting age at consultation, whether CRO was pursued, and length of CRO treatment by insurance payor and household income quartile. RESULTS Of the 5620 patients identified, 4100 (73.0%) received CRO, with 674 (12.0%) receiving a second helmet. Of those receiving CRO, 1536 (37.5%) had Medicaid insurance while 2558 (62.4%) were commercially insured. Patients on Medicaid were 1.30 times more likely to have delayed presentation (P = .017), while patients from the lowest income quartile were 1.26 1.50 (P < .001) and 1.58 (P < .001) times more likely to have a delayed presentation relative to those in the highest and second-highest income quartiles, respectively. Patients in the highest and second-highest income quartiles were also 1.55 (P < .001) and 1.45 (P < .001) more likely, respectively, to receive CRO after consultation than those from the lowest income quartile. CONCLUSIONS Lower income and Medicaid-insured patients had delayed presentation for CRO consultation. Those from the lowest income quartile were more likely to never receive CRO than those from wealthier backgrounds. Low socioeconomic status and Medicaid insurance, which can have more restrictive coverage policies for CRO, may result in the delayed treatment of DP.
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Affiliation(s)
- Alexandra Junn
- Division of Plastic Surgery, Department of Surgery, Yale New Haven Hospital, New Haven, CT, USA
| | - Jacob Dinis
- Division of Plastic Surgery, Department of Surgery, Yale New Haven Hospital, New Haven, CT, USA
| | - Aaron Long
- Division of Plastic Surgery, Department of Surgery, Yale New Haven Hospital, New Haven, CT, USA
| | - Sacha Hauc
- Division of Plastic Surgery, Department of Surgery, Yale New Haven Hospital, New Haven, CT, USA
| | - Sarah Phillips
- Division of Plastic Surgery, Department of Surgery, Yale New Haven Hospital, New Haven, CT, USA
| | - Adam H Junn
- Division of Plastic Surgery, Department of Surgery, Yale New Haven Hospital, New Haven, CT, USA
| | - Alvaro Reategui
- Division of Plastic Surgery, Department of Surgery, Yale New Haven Hospital, New Haven, CT, USA
| | - Joseph Lopez
- Division of Plastic Surgery, Department of Surgery, Yale New Haven Hospital, New Haven, CT, USA
| | - John A Persing
- Division of Plastic Surgery, Department of Surgery, Yale New Haven Hospital, New Haven, CT, USA
| | - Michael Alperovich
- Division of Plastic Surgery, Department of Surgery, Yale New Haven Hospital, New Haven, CT, USA
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Aranke M, Lloyd N, Effendi M, Nair A, Demke J. Adult Preferences of Infant Head Shapes: A Survey of Computerized Morphometric Models and Overview of Clinical Implications. Facial Plast Surg Aesthet Med 2022. [PMID: 35325571 DOI: 10.1089/fpsam.2020.0521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mayank Aranke
- School of Medicine, Texas Tech University Health Science Center, Lubbock, Texas, USA
| | - Nathan Lloyd
- School of Medicine, Texas Tech University Health Science Center, Lubbock, Texas, USA
| | - Maleeh Effendi
- School of Medicine, Texas Tech University Health Science Center, Lubbock, Texas, USA
| | - Arya Nair
- School of Medicine, Texas Tech University Health Science Center, Lubbock, Texas, USA
| | - Joshua Demke
- School of Medicine, Texas Tech University Health Science Center, Lubbock, Texas, USA
- Department of Otolaryngology-Head and Neck Surgery, Texas Tech University Health Science Center, Lubbock, Texas, USA
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Demographics of Positional Plagiocephaly and Brachycephaly; Risk Factors and Treatment. J Craniofac Surg 2021; 32:2736-2740. [PMID: 34231510 DOI: 10.1097/scs.0000000000007811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT In the last 3 decades, the incidence of positional cranial deformations in infants, such as positional plagiocephaly and positional brachycephaly, has increased. The deviating shape often causes parental concern for the later psychosocial wellbeing of the child. Treatment options are nonoperative, varying from positional change to helmet therapy, of which the effect has often been debated. Multiple risk factors have been associated with an increased risk on the development of these deformations. The goal of this study was to assess the impact of known risk factors on the type and severity of resulting positional cranial deformation.Parents were asked to fill out a questionnaire regarding the presence of risk factors, such as gender, age, pregnancy duration, method of delivery and reasons for atypical deliveries, breech position, birth weight, developmental status, positional preference, family history, number of siblings, and torticollis presence. Treatment methods were documented and plagiocephalometry was used to measure the cranial proportions. All children were invited to participate in short-term follow-up. The significance of the risk factors and the effect of different kinds of therapy are discussed. Although no significant correlation was found between severity and risk factors, some risk factors could be correlated with the kind of positional cranial deformation. Of the different therapies, helmet therapy had a significant impact on the reduction of positional plagiocephaly.
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Ryall JJ, Xue Y, Turner KD, Nguyen PD, Greives MR. Assessing the quality of life in infants with deformational plagiocephaly. J Craniomaxillofac Surg 2020; 49:29-33. [PMID: 33239212 DOI: 10.1016/j.jcms.2020.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/25/2020] [Accepted: 11/12/2020] [Indexed: 10/23/2022] Open
Abstract
This was a parent-reported outcome study on the impact of helmet therapy on the quality of life of infants with deformational plagiocephaly and their caregivers. Using survey-based analysis, we compared the quality of life in infants with deformational plagiocephaly with a cohort of their healthy peers. In addition, we compared infant quality of life before and after helmet therapy to evaluate the impact of this mainstay therapy for deformational plagiocephaly. Our results demonstrated that infants with plagiocephaly and their caregivers had a significantly decreased quality of life compared with healthy controls. This reframes our understanding of deformational plagiocephaly and emphasizes the need for therapeutic intervention in these individuals. A common therapeutic option - helmet remolding therapy - was shown to have no negative impact on quality of life, underscoring this as an appropriate therapeutic option. These data will allow us to counsel our future parents more effectively regarding the impact of deformational plagiocephaly and helmet therapy.
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Affiliation(s)
- Jacob J Ryall
- McGovern Medical School, University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Division of Pediatric Plastic Surgery, Department of Pediatric Surgery, Houston, TX, USA
| | - Yunfeng Xue
- McGovern Medical School, University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Division of Pediatric Plastic Surgery, Department of Pediatric Surgery, Houston, TX, USA
| | - Kelly D Turner
- McGovern Medical School, University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Division of Pediatric Plastic Surgery, Department of Pediatric Surgery, Houston, TX, USA
| | - Phuong D Nguyen
- McGovern Medical School, University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Division of Pediatric Plastic Surgery, Department of Pediatric Surgery, Houston, TX, USA
| | - Matthew R Greives
- McGovern Medical School, University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Division of Pediatric Plastic Surgery, Department of Pediatric Surgery, Houston, TX, USA.
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Foster J, Ahluwalia R, Sherburn M, Kelly K, Sellyn GE, Kiely C, Wiseman AL, Gannon S, Shannon CN, Bonfield CM. Pediatric cranial deformations: demographic associations. J Neurosurg Pediatr 2020; 26:415-420. [PMID: 32470930 DOI: 10.3171/2020.3.peds2085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 03/31/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE No study has established a relationship between cranial deformations and demographic factors. While the connection between the Back to Sleep campaign and cranial deformation has been outlined, considerations toward cultural or anthropological differences should also be investigated. METHODS The authors conducted a retrospective review of 1499 patients (age range 2 months to less than 19 years) who presented for possible trauma in 2018 and had a negative CT scan. The cranial vault asymmetry index (CVAI) and cranial index (CI) were used to evaluate potential cranial deformations. The cohort was evaluated for differences between sex, race, and ethnicity among 1) all patients and 2) patients within the clinical treatment window (2-24 months of age). Patients categorized as "other" and those for whom data were missing were excluded from analysis. RESULTS In the CVAI cohort with available data (n = 1499, although data were missing for each variable), 800 (56.7%) of 1411 patients were male, 1024 (79%) of 1304 patients were Caucasian, 253 (19.4%) of 1304 patients were African American, and 127 (10.3%) of 1236 patients were of Hispanic/Latin American descent. The mean CVAI values were significantly different between sex (p < 0.001) and race (p < 0.001). However, only race was associated with differences in positional posterior plagiocephaly (PPP) diagnosis (p < 0.001). There was no significant difference in CVAI measurements for ethnicity (p = 0.968). Of the 520 patients in the treatment window cohort, 307 (59%) were male. Of the 421 patients with data for race, 334 were Caucasian and 80 were African American; 47 of the 483 patients with ethnicity data were of Hispanic/Latin American descent. There were no differences between mean CVAI values for sex (p = 0.404) or ethnicity (p = 0.600). There were significant differences between the mean CVAI values for Caucasian and African American patients (p < 0.001) and rate of PPP diagnosis (p = 0.02). In the CI cohort with available data (n = 1429, although data were missing for each variable), 849 (56.8%) of 1494 patients were male, 1007 (67.4%) of 1283 were Caucasian, 248 (16.6%) of 1283 were African American, and 138 patients with ethnicity data (n = 1320) of Hispanic/Latin American descent. Within the clinical treatment window cohort with available data, 373 (59.2%) of 630 patients were male, 403 were Caucasian (81.9%), 84 were African American (17.1%), and 55 (10.5%) of 528 patients were of Hispanic/Latin American descent. The mean CI values were not significantly different between sexes (p = 0.450) in either cohort. However, there were significant differences between CI measurements for Caucasian and African American patients (p < 0.001) as well as patients of Hispanic/Latin American descent (p < 0.001) in both cohorts. CONCLUSIONS The authors found no significant associations between cranial deformations and sex. However, significant differences exist between Caucasian and African American patients as well as patients with Hispanic/Latin American heritage. These findings suggest cultural or anthropological influences on defining skull deformations. Further investigation into the factors contributing to these differences should be undertaken.
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Affiliation(s)
- Jarrett Foster
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
- 2University of South Carolina School of Medicine, Columbia, South Carolina
| | - Ranbir Ahluwalia
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
- 3Florida State University College of Medicine, Tallahassee, Florida
| | - Madeleine Sherburn
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Katherine Kelly
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
- 6Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Georgina E Sellyn
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Chelsea Kiely
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
- 4Department of Neurobiology, Cornell University, Ithaca, New York
| | - Alyssa L Wiseman
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Stephen Gannon
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Chevis N Shannon
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
- 5Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; and
| | - Christopher M Bonfield
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
- 5Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; and
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7
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Feijen MMW, van Cruchten C, van der Hulst RRWJ. The Effect of Cranial Shape on Esthetic Self-Worth in Bald Men. J Craniofac Surg 2020; 32:233-237. [PMID: 32833829 DOI: 10.1097/scs.0000000000006916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT During the last 3 decades, the incidence of positional plagiocephaly and brachycephaly has increased. Treatment options are conservative and can include physiotherapy and molding helmet therapy. The decision to start therapy is based on patient history and subjective assessment of cranial shape by the physician and the parents. To determine the impact of these deformations on esthetic self-worth, as well as cranial shape, this study was conducted on a population of adult bald men.Participants were asked to fill in a questionnaire about the amount of comments received on cranial shape, as well as grade their general esthetic and grade craniofacial features using a visual analogue scale. The cranial proportions and symmetry were measured using plagiocephalometry.50 adult bald men were included in this study. The prevalence of nonsynostotic plagiocephaly was 12%; the prevalence of nonsynostotic brachycephaly was 0%. No significant correlation was found between plagiocephaly or brachycephaly, cranial circumference, width or length and amount of comments on cranial shape, cosmetic assessment of appearance or cosmetic assessment of cranial shape. On average, teeth and eyes were given the highest cosmetic value, eyebrows and chin were given the lowest scores.Cranial shape does not have a significant impact on the amount of comments received on cranial shape, nor the cosmetic assessment of either overall appearance or cranial shape in bald men. For bald men, eyes and teeth are more important craniofacial features in cosmetic assessment. There is no clear esthetic need to treat deviating cranial shape with helmet therapy in male patients.
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8
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Ahluwalia R, Foster J, Sherburn MM, Sellyn GE, Kelly KA, Abdul Ghani MO, Wiseman AL, Shannon CN, Bonfield CM. Deformational brachycephaly: the clinical utility of the cranial index. J Neurosurg Pediatr 2020; 26:122-126. [PMID: 32357338 DOI: 10.3171/2020.2.peds19767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 02/18/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The incidence of deformational brachycephaly has risen since the "Back to Sleep" movement in 1992 by the American Academy of Pediatrics. Brachycephaly prevalence and understanding the dynamic nature of the pediatric skull have not been explored in relation to the cranial index (CI). The objective of the study was to determine the prevalence of brachycephaly, via the CI, with respect to time. METHODS The authors conducted a retrospective review of 1499 patients ≤ 19 years of age who presented for trauma evaluation with a negative CT scan for trauma (absence of bleed) in 2018. The CI was calculated using CT at the lateral-most point of the parietal bone (cephalic width), and the distance from the glabella to the opisthocranion (cephalic length). Brachycephaly was defined as a CI ≥ 90%. RESULTS The mean CI was 82.6, with an average patient age of 6.8 years. The prevalence of deformational brachycephaly steadily decreased from 27% to 4% from birth to > 2 years of life. The mean CI was statistically different between ages < 12 months, 12-24 months, and > 24 months (F[2,1496] = 124.058, p < 0.0005). A simple linear regression was calculated to predict the CI based on age; the CI was found to decrease by 0.038 each month. A significant regression equation was found (F[1,1497] = 296.846, p < 0.0005), with an R2 of 0.140. CONCLUSIONS The incidence of deformational brachycephaly is common in infants but decreases as the child progresses through early childhood. Clinicians can expect a significant decrease in mean CI at 12 and 24 months. Additionally, these regression models show that clinicians can expect continued improvement throughout childhood.
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Affiliation(s)
- Ranbir Ahluwalia
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
- 2Florida State University College of Medicine, Tallahassee, Florida
| | - Jarrett Foster
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
- 3University of South Carolina School of Medicine, Columbia, South Carolina; and
| | - Madeleine M Sherburn
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Georgina E Sellyn
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Katherine A Kelly
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
- 4Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Muhammad Owais Abdul Ghani
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Alyssa L Wiseman
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Chevis N Shannon
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
- 4Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christopher M Bonfield
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
- 4Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Ahluwalia R, Kiely C, Foster J, Gannon S, Wiseman AL, Shannon CN, Bonfield CM. Positional posterior plagiocephaly: a single-center review. J Neurosurg Pediatr 2020; 25:514-518. [PMID: 32005011 DOI: 10.3171/2019.12.peds19651] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 12/05/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors sought to assess the prevalence and severity of positional posterior plagiocephaly (PPP) in the pediatric population at a tertiary care center. METHODS The authors conducted a retrospective review of 1429 consecutive patients aged 2 months to 18 years who presented with head trauma and a negative CT scan in 2018. The cohort was stratified by age. The cranial vault asymmetry index (CVAI) was calculated at the superior orbital rim. Asymmetry was categorized according to the following CVAI scores: mild (3.5%-7%), moderate (7%-12%), and severe (> 12%). Patients were grouped by age to assess PPP at different stages of head development: group 1, 2-5 months; group 2, 6-11 months; group 3, 12-23 months; group 4: 2-4 years; group 5, 5-8 years; group 6, 9-12 years; and group 7, 13-18 years. Patients with a history of shunted hydrocephalus, craniosynostosis, skull surgery, or radiographic evidence of intracranial trauma were excluded. RESULTS The overall cohort prevalence of PPP was 24.8% (354 patients). PPP prevalence was higher among younger patients from groups 1-3 (40.4%, 33.5%, and 0.8%, respectively). There was a continued decline in PPP by age in groups 4-7 (26.4%, 20%, 20%, and 10.8%, respectively). Mild cranial vault asymmetry was noted most often (78.0%, 276 patients), followed by moderate (19.5%, 69 patients) and severe (2.5%, 9 patients). There were no patients in group 6 or 7 with severe PPP. CONCLUSIONS PPP is prevalent in pediatric populations and most commonly presents as a case of mild asymmetry. Although there was an overall decline of PPP prevalence with increasing age, moderate asymmetry was seen in all age groups. No patients in the cohort had severe asymmetry that persisted into adolescence.
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Affiliation(s)
- Ranbir Ahluwalia
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
- 2Florida State University College of Medicine, Tallahassee, Florida
| | - Chelsea Kiely
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
- 3Cornell University Department of Neurobiology, Ithaca, New York
| | - Jarrett Foster
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
- 4University of South Carolina School of Medicine, Columbia, South Carolina; and
| | - Stephen Gannon
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Alyssa L Wiseman
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Chevis N Shannon
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
- 5Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christopher M Bonfield
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
- 5Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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González-Santos J, González-Bernal JJ, De-la-Fuente Anuncibay R, Soto-Cámara R, Cubo E, Aguilar-Parra JM, Trigueros R, López-Liria R. Infant Cranial Deformity: Cranial Helmet Therapy or Physiotherapy? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072612. [PMID: 32290217 PMCID: PMC7177616 DOI: 10.3390/ijerph17072612] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 11/16/2022]
Abstract
Objective: To compare cranial helmet therapy (CHT) and physiotherapy (PT) for the effective treatment of positional plagiocephaly in infants in terms of improving functional recovery. Methods: This was a prospective cohort study involving 48 infants between 5–10 months of age with cranial deformities. The Cranial Vault Asymmetry Index (CVAI) and the Brunet–Lezine scale were calculated at the initiation of the study and after 40 treatment sessions. Results: The infants’ first assessment showed a delay in overall development areas with a global developmental quotient (DQ) (posture, coordination, sociability, and language) of 80.15. Although developmental improvements were observed in both groups in the Brunet–Lezine scale after treatment, the MANCOVA test showed no significant differences (F(5) = 0.82, p = 0.506, eta2 = 0.09). The CVAI reduced to 4.07% during the final evaluation in the cranial helmet group and 5.85% in the physiotherapy group without any significant differences between the two therapies (p = 0.70). Conclusions: No statistically significant differences were found between CHT and PT. After treatment, improvements from baseline measurements were observed in each of the readings of cranial deformity.
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Affiliation(s)
- Josefa González-Santos
- Department of Health Sciences, Cavidito Research Team, Health Research Centre, University of Burgos, 09001 Burgos, Spain; (J.G.-S.); (J.J.G.-B.); (R.S.-C.); (E.C.)
| | - Jerónimo J. González-Bernal
- Department of Health Sciences, Cavidito Research Team, Health Research Centre, University of Burgos, 09001 Burgos, Spain; (J.G.-S.); (J.J.G.-B.); (R.S.-C.); (E.C.)
| | - Raquel De-la-Fuente Anuncibay
- Department of Educational Sciences, Discondu Research Team, Educational Research Centre, University of Burgos, 09001 Burgos, Spain;
| | - Raúl Soto-Cámara
- Department of Health Sciences, Cavidito Research Team, Health Research Centre, University of Burgos, 09001 Burgos, Spain; (J.G.-S.); (J.J.G.-B.); (R.S.-C.); (E.C.)
| | - Esther Cubo
- Department of Health Sciences, Cavidito Research Team, Health Research Centre, University of Burgos, 09001 Burgos, Spain; (J.G.-S.); (J.J.G.-B.); (R.S.-C.); (E.C.)
| | - José M. Aguilar-Parra
- Department of Psychology, Hum 878 Research Team, Health Research Centre, University of Almería, 04120 Almería, Spain
- Correspondence: (J.M.A.-P.); (R.T.)
| | - Rubén Trigueros
- Department of Language and Education, University of Antonio de Nebrija, 28015 Madrid, Spain
- Correspondence: (J.M.A.-P.); (R.T.)
| | - Remedios López-Liria
- Department of Nursing Science, Physiotherapy and Medicine, Hum 498 Research Team, Health Research Centre, University of Almería, 04120 Almería, Spain;
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Linz C, Kunz F, Böhm H, Schweitzer T. Positional Skull Deformities. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 114:535-542. [PMID: 28835328 PMCID: PMC5624275 DOI: 10.3238/arztebl.2017.0535] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 12/29/2016] [Accepted: 04/04/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Especially in the first 6 months of life, skull deformities manifesting as a uni- or bilateral flattening of the occiput often give rise to questions of differential diagnosis and potential treatment. In this review, the authors summarize the current understanding of risk factors for this condition, and the current state of the relevant diagnostic assessment and options for treatment. METHODS The recommendations given in this selective review of the literature are based on current studies and on existing guidelines on the prevention of sudden infant death, the recommendations of the German Society for Pediatric Neurology (Deutsche Gesellschaft für Neuropädiatrie), and the American guidelines on the treatment of positional plagiocephaly in infancy. RESULTS Pre-, peri-, and postnatal risk factors can contribute to the development of positional skull deformities. These deformities can be diagnosed and classified on the basis of their clinical features, supplemented in unclear cases by ultrasonography of the cranial sutures. The putative relationship between positional skull deformities and developmental delay is currently debated. The main preventive and therapeutic measure is parent education to foster correct positioning habits (turning of the infant to the less favored side; prone positioning on occasion when awake) and beneficial stimulation of the infant (to promote lying on the less favored side). If the range of motion of the head is limited, physiotherapy is an effective additional measure. In severe or refractory cases, a skull orthosis (splint) may be useful. CONCLUSION The parents of children with positional skull deformities should be comprehensively informed about the necessary preventive and therapeutic measures. Treatment should be initiated early and provided in graded fashion, according to the degree of severity of the problem. Parental concern about the deformity should not be allowed to lead to a rejection of the reasonable recommendation for a supine sleeping position.
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Affiliation(s)
- Christian Linz
- University Hospital of Würzburg, Center for Craniofacial Surgery, Department of Oral and Maxillofacial Plastic Surgery
| | - Felix Kunz
- University Hospital of Würzburg, Department of Orthodontics
| | - Hartmut Böhm
- University Hospital of Würzburg, Center for Craniofacial Surgery, Department of Oral and Maxillofacial Plastic Surgery
| | - Tilmann Schweitzer
- University Hospital of Würzburg, Department of Neurosurgery, Section of Pediatric Neurosurgery
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