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Cinalli G, Di Martino G, Russo C, Cristofano A, Picariello S, Cinalli MA, Mirone G, Mazio F, Quarantelli M, Spennato P, Covelli E. Jugular foramen stenosis in external hydrocephalus in infants. Childs Nerv Syst 2024:10.1007/s00381-024-06414-8. [PMID: 38642112 DOI: 10.1007/s00381-024-06414-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 04/14/2024] [Indexed: 04/22/2024]
Abstract
OBJECTIVE To measure the size of jugular foramina in infants affected by external hydrocephalus (EH) and in a control group, to support the hypothesis that a jugular foramen (JF) stenosis may determine dural venous sinus alterations and increased venous outflow resistance as main pathophysiological factor. METHODS Minimum, maximum, and mean values of JF areas were measured in a series of phase-contrast magnetic resonance venous angiography (angio MRV PCA3D) performed on 81 infants affected by EH. Results were compared with a group of 54 controls. RESULTS Smaller JF area was significantly smaller in patients versus controls (43.1 ± 14.6 vs. 52.7 ± 17.8; p < 0.001) resulting in a significantly smaller mean JF areas in patients vs. controls (51.6 ± 15.8 vs. 57.0 ± 18.3; p = 0.043). In patients, smaller JF areas were significantly associated with higher venous obstruction grading score (VOGS) both on the right (p = 0.018) and on the left side (p = 0.005). Positional plagiocephaly (cranial vault asymmetry index > 3.5%) was more frequent among EH patients than controls (38/17) but the difference was not significant (p = 0.07). In the 38 plagiocephalic patients, JF area was smaller on the flattened side than the contralateral in a significant number of cases both in right (21/7) and left (9/1) plagiocephaly (p < 0.0005) as well as the mean area (48.2 + 16.4 mm2 vs. 57.5 + 20.7 mm2, p = 0.002) and VOGS was significantly higher on the plagiocephalic side than on the contralateral side (1.6 ± 1.1 vs. 1.1 ± 0.9, p = 0.019). CONCLUSION In this series of infants affected by EH, the mean size of the ostium of both JF resulted significantly smaller than controls. JF stenosis was significantly associated with higher degrees of venous obstruction on both sides, suggesting a direct extrinsic effect of JF size on dural sinus lumen and possible consequent effect on venous outflow resistance. Positional plagiocephaly, when present, was associated with a decreased JF area and increased VOGS on the flattened side.
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Affiliation(s)
- Giuseppe Cinalli
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital (AORN), Naples, Italy.
| | - Giuliana Di Martino
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital (AORN), Naples, Italy
| | - Carmela Russo
- Pediatric Neuroradiology, Santobono-Pausilipon Children's Hospital (AORN), Naples, Italy
| | - Adriana Cristofano
- Pediatric Neuroradiology, Santobono-Pausilipon Children's Hospital (AORN), Naples, Italy
| | - Stefania Picariello
- Pediatric Neuro-Oncology, Santobono-Pausilipon Children's Hospital (AORN), Naples, Italy
| | | | - Giuseppe Mirone
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital (AORN), Naples, Italy
| | - Federica Mazio
- Pediatric Neuroradiology, Santobono-Pausilipon Children's Hospital (AORN), Naples, Italy
| | - Mario Quarantelli
- Biostructure and Bioimaging Institute, National Research Council, Naples, Italy
| | - Pietro Spennato
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital (AORN), Naples, Italy
| | - Eugenio Covelli
- Pediatric Neuroradiology, Santobono-Pausilipon Children's Hospital (AORN), Naples, Italy
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Watson AL, Winters R. Nonsyndromic Craniofacial Disorders. Facial Plast Surg Clin North Am 2024; 32:127-139. [PMID: 37981408 DOI: 10.1016/j.fsc.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
We describe the investigation and management of select pediatric craniofacial disorders their recent advances. Positional plagiocephaly: The incidence of positional plagiocephaly has increased since the institution of the "safe to sleep" campaign to reduce sudden infant death syndrome. Positional plagiocephaly may be associated with underlying developmental delay. Nonsyndromic craniosynostosis: Treatment of nonsyndromic craniosynostosis depends on the age of the patient and the suture involved. Pediatric skull lesions: Management of skull lesions depends on histologic diagnosis. Some benign skull lesions are managed conservatively, whereas erosive and malignant lesions may require surgical excision, radiotherapy, chemotherapy, or multimodality treatment.
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Affiliation(s)
- Antonia L Watson
- Department of Otolaryngology - Head & Neck Surgery, John Hunter Hospital, Lookout Road, New Lambton Heights, New South Wales 2035, Australia
| | - Ryan Winters
- Department of Otolaryngology - Head & Neck Surgery, John Hunter Hospital, Lookout Road, New Lambton Heights, New South Wales 2035, Australia; Department of Otolaryngology-Head & Neck Surgery, Tulane University, New Orleans, LA, USA; Division of Plastic & Reconstructive Surgery, Tulane University, New Orleans, LA, USA.
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Kim J, Kim J, Chae KY. Effectiveness of Helmet therapy for infants with moderate to severe positional plagiocephaly. Clin Exp Pediatr 2024; 67:46-53. [PMID: 38062714 PMCID: PMC10764669 DOI: 10.3345/cep.2023.00626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 10/12/2023] [Accepted: 10/21/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The use of helmet treatment for positional plagiocephaly has increased recently; however, its effect is unknown in Korea. PURPOSE This study aimed to investigate the effectiveness of helmet therapy and identify its influencing factors. METHODS Ninety pediatric patients diagnosed with moderate to severe positional plagiocephaly received helmet therapy. Severity of moderate to severe positional plagiocephaly was defined as cranial vault asymmetry (CVA) >10 mm or CVA index (CVAI) >6%. Patients were categorized by age, severity, and daily helmet wear. Multiple regression analysis controlled for factors like sex and prematurity. Treatment success was assessed by comparing pre/post-helmet theray CVA and CVAI, considering normalization or decrease to mild plagiocephaly (CVA ≤10 mm or CVAI ≤6%). RESULTS A total of 90 participants were enrolled (mean age, 5.6±1.6 months; male, 53 [58.9%]). The mean helmet therapy duration was 6.4±2.7 months, while the mean daily wear time was 18.4±2.7 hours. Among the 90 patients, 66 (73.3%) had moderate disease and 24 (26.7%) had severe disease. The mean CVA and CVAI decreased by 6.3±2.7 mm and 4.3%±1.8% after versus before treatment (P<0.001). Treatment was successful in 76 infants (84.4%). The most effective changes in CVA and CVAI were noted in those who began treatment before 9 months of age (6.2±2.5 mm and 5.0%±1.9%, P<0.001), had high compliance (6.2±2.4 mm and 4.9%±1.9%, P<0.001), and had high severity (8.0±2.3 mm and 6.6%±1.7%, P<0.001). CONCLUSION Starting helmet treatment before 9 months and wearing it over 15 hours daily yielded better outcomes.
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Affiliation(s)
- Jeongho Kim
- Department of Pediatrics, CHA Gumi Medical Center, CHA University School of Medicine, Gumi, Korea
| | - Jina Kim
- Center of ISARANGDOO, Daegu, Korea
| | - Kyu Young Chae
- CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
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Hasegawa S, Sasaki J, Nakao H, Tomimatsu M, Yamamoto S, Watanabe S, Miyabe S, Miyachi H, Goto M. Impact of the lateral skeletal stability following bilateral sagittal split ramus osteotomy for mandibular asymmetry. JPRAS Open 2023; 38:36-47. [PMID: 37675277 PMCID: PMC10477061 DOI: 10.1016/j.jpra.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/06/2023] [Indexed: 09/08/2023] Open
Abstract
This study evaluated the stability of bilateral sagittal split ramus osteotomy (BSSRO) associated with positional plagiocephaly and temporal and masseter muscles using posteroanterior cephalogram analysis and three-dimensional computed tomography (3D-CT). This retrospective cohort study included 31 patients who underwent BSSRO for mandibular asymmetry. The cranial vault asymmetry index (CVAI) and the cephalic index were used as indicators of positional plagiocephaly. The distance from the vertical reference line to the menton (Me) was measured on posteroanterior cephalograms immediately and 1 year after surgery, and postoperative stability was assessed. Temporal and masseter muscles were constructed from 3D-CT data and their volumes were measured. Simple regression analysis showed a significant correlation between postoperative changes in the vertical reference line to the Me and the CVAI (R = 0.56, p = 0.001), the amount of surgical movement in the vertical reference line to the Me (R = 0.41, p = 0.023), and the variable temporal muscle volume (R = 0.27, p = 0.028). There was no significant correlation between postoperative changes in the vertical reference line to the Me and the cephalic index (R = 0.093, p = 0.62) and variable masseter muscle volume (R = 0.16, p = 0.38). According to multivariate analysis, CVAI (p = 0.003) and amount of surgical movement in the vertical reference line to the Me (p = 0.014) were significant predictors of postoperative change in the vertical reference line to the Me. Positional plagiocephaly and amount of surgical movement influence lateral skeletal stability following BSSRO for mandibular asymmetry.
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Affiliation(s)
- S. Hasegawa
- Department of Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Aichi, Japan
| | - J. Sasaki
- Department of Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Aichi, Japan
| | - H. Nakao
- Department of Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Aichi, Japan
| | - M. Tomimatsu
- Department of Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Aichi, Japan
| | - S. Yamamoto
- Department of Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Aichi, Japan
| | - S. Watanabe
- Department of Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Aichi, Japan
| | - S. Miyabe
- Department of Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Aichi, Japan
| | - H. Miyachi
- Department of Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Aichi, Japan
| | - M. Goto
- Department of Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Aichi, Japan
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Pan WW, Liao JJ, Tong XM. [Follow-up and prognostic study of infants with positional plagiocephaly]. Zhongguo Dang Dai Er Ke Za Zhi 2023; 25:368-373. [PMID: 37073841 PMCID: PMC10120334 DOI: 10.7499/j.issn.1008-8830.2210031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
OBJECTIVES To study the effects of infantile positional plagiocephaly on the growth and neural development. METHODS A retrospective study was conducted on the medical data of 467 children who underwent craniographic examination and were followed up to 3 years of age in Peking University Third Hospital from June 2018 to May 2022. They were divided into four groups: mild positional plagiocephaly (n=108), moderate positional plagiocephaly (n=49), severe positional plagiocephaly (n=12), and normal cranial shape (n=298). The general information of the four groups and the weight, length, head circumference, visual acuity screening results, hearing test results, and the scores of Pediatric Neuropsychological Developmental Scales/Gesell Developmental Schedules of the four groups from 6 to 36 months old were compared. RESULTS The rates of adverse perinatal factors, congenital muscular torticollis, and supine fixed sleeping posture in the mild, moderate, and severe positional plagiocephaly groups were higher than the normal cranial group (P<0.05). There was no significant difference in weight, length, and head circumference among the four groups at 6, 12, 24 and 36 months of age (P>0.05). The incidence rate of abnormal vision in the severe positional plagiocephaly group was higher than that in the mild positional plagiocephaly, moderate positional plagiocephaly and normal cranial shape groups at 24 and 36 months of age (P<0.05). The scores of the Pediatric Neuropsychological Developmental Scales at 12 and 24 months of age and the scores of the Gesell Developmental Schedules at 36 months of age in the severe positional plagiocephaly group were lower than those in the mild positional plagiocephaly, moderate positional plagiocephaly and normal cranial shape groups, but the difference was not statistically significant (P>0.05). CONCLUSIONS Adverse perinatal factors, congenital muscular torticollis, and supine fixed sleeping position may be associated with infantile positional plagiocephaly. Mild or moderate positional plagiocephaly has no significant impact on the growth and neural development of children. Severe positional plagiocephaly have adverse effects on the visual acuity. However, it is not considered that severe positional plagiocephaly can affect the neurological development.
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Affiliation(s)
- Wei-Wei Pan
- Department of Pediatrics, Peking University Third Hospital, Beijing 100191, China
| | | | - Xiao-Mei Tong
- Department of Pediatrics, Peking University Third Hospital, Beijing 100191, China
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Verdier C, Marangelli G, Gebeile-Chauty S. [Does positional plagiocephaly affect the need for orthodontic treatment, and the mandibular and occlusal symmetry?]. Orthod Fr 2022; 93:169-186. [PMID: 35818283 DOI: 10.1684/orthodfr.2022.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Positional plagiocephaly (PP) is characterized by an asymmetrical flatness of the posterior part of the skull which may involve the frontal part of the skull and the face. The aim is to assess whether children and adolescents with PP have more occlusal and skeletal asymmetries and whether the need for orthodontic treatment is greater than in the healthy population. MATERIAL AND METHOD A comparative cross-sectional epidemiological study was carried out. One hundred children and adolescents were included: 50 in the PP group and 50 in the control group. The need for orthodontic treatment was assessed by the Index of Orthodontic Treatment Need (IOTN). The mandibular and dental asymmetries were measured on lateral cephalometry by two indexes: index of mandibular asymmetry (IMA) and index of dental asymmetry (IDA) respectively. Chi and Student independence tests were performed with a threshold of 5%. RESULTS The tests are significant for IMA (p = 0.02) and IOTN (p = 0.000012). IDA is insignificant. DISCUSSION Orthosurgical treatment of mandibular laterognathies by mandibular recentering sometimes creates mandibular asymmetry, while the shift is basal. We must be able to act early on the vault of the skull to hope to obtain a consecutive effect on the base and therefore on the position of the glenoid cavities. Management by manual therapy and early cranial orthosis could be estimated. CONCLUSION The need for orthodontic treatment is significantly greater in PP. Unlike mandibular asymmetry, dental asymmetry is not significantly greater than in the control group, testifying to the adaptive capacities of the organism.
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Maniglio P, Noventa M, Tartaglia S, Petracca M, Bonito M, Ricciardi E, Ambrosini G, Buzzaccarini G, Laganà AS. The Obstetrician Gynecologist's role in the screening of infants at risk of severe plagiocephaly: Prevalence and risk factors. Eur J Obstet Gynecol Reprod Biol 2022; 272:37-42. [PMID: 35279639 DOI: 10.1016/j.ejogrb.2022.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/26/2022] [Accepted: 03/03/2022] [Indexed: 11/27/2022]
Abstract
This study was conducted to determine the prevalence, maternal and/or neonatal risk factors for severe plagiocephaly in order to early detect and refer infants at risk. A prospective observational study was conducted, involving 4337 infants who visited the Perinatology Center at San Pietro Fatebenefratelli Hospital in Rome, evaluated following the Plagiocephaly Severity Scale of Atlanta. ©The plagiocephaly prevalence resulted 1.89%, considering moderate to severe forms. Maternal risk factors include primiparity, older age, gestational diabetes, and uterine fibromatosis. Neonatal risk factors are early term gestational age, low weight, twin pregnancy, and prolonged labor with an emergency cesarean section. Screening for severe plagiocephaly should begin antenatally. Although the low prevalence, identifying infants at risk can prevent potential permanent sequelae. We suggest a multidisciplinary approach for the management of plagiocephaly, involving the figure of the Obstetrician Gynecologist, who can highlight the risk factors ranging from obstetric and birth conditions.
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Affiliation(s)
- Paolo Maniglio
- AUSL Romagna Ospedale "G.B. Morgagni L. Pierantoni", Forlì, Italy
| | - Marco Noventa
- Gynaecologic and Obstetrics Clinic, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Silvio Tartaglia
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | | | - Marco Bonito
- Ospedale San Pietro Fatebenefratelli, Rome, Italy
| | | | - Guido Ambrosini
- Gynaecologic and Obstetrics Clinic, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Giovanni Buzzaccarini
- Gynaecologic and Obstetrics Clinic, Department of Women's and Children's Health, University of Padua, Padua, Italy.
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
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SOLANI B, TALEBIAN ARDESTANI M, BOROUMAND H, OSTADMOHAMMADI V, HALLAJNEJAD M, KASHANI ZADE M, LOGHMAN A, TALEBIAN ARDESTANI A. Risk factors associated with positional plagiocephaly in healthy Iranian infants: a case-control study. Iran J Child Neurol 2022; 16:85-92. [PMID: 35497110 PMCID: PMC9047834 DOI: 10.22037/ijcn.v16i1.28524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 12/12/2020] [Indexed: 12/03/2022]
Abstract
OBJECTIVES Deformation of the skull by external forces in the absence of synostosis has been defined as positional plagiocephaly (PP). The aim of this investigation was to determine the risk factors of PP in healthy Iranian infants. MATERIALS & METHODS This case-control study was performed on 300 healthy Iranian infants aged 8-12 weeks who were referred to the pediatric neurology clinic at Shahid Beheshti Hospital of Kashan. Plagiocephaly evaluations were done using Argenta's scale. RESULTS Based on multivariate logistic regression analysis, there was a significant association between PP and male gender (OR=2.26; P=0.002), head circumference (OR=1.22; P=0.006), multiple pregnancy (OR=2.55; P=0.03), abnormal presentation in uterine (OR=2.18; P=0.02), primiparity (OR=2.43; P=0.003), and supine sleep position (OR=2.97; P<0.001). However, type of delivery, firmness of headrest, oligohydramnios, and prolonged labor were not correlated with PP. CONCLUSIONS The current investigation supports the idea that head circumference, male gender, primiparity, multiple pregnancy, supine sleep position, and abnormal presentation in the uterine are correlated with a greater incidence of PP. Further investigations should be undertaken to understand PP and its related risk factors fully.
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Affiliation(s)
- Babak SOLANI
- Infectious Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran,Department of Pediatrics, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Motahare TALEBIAN ARDESTANI
- Infectious Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran,Department of Pediatrics, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Homa BOROUMAND
- Infectious Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | | | - Mohammad HALLAJNEJAD
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mansour KASHANI ZADE
- Department of Pathology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Amirhossein LOGHMAN
- Infectious Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Ahmad TALEBIAN ARDESTANI
- Infectious Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran,Department of Pediatrics, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
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Pastor-Pons I, Hidalgo-García C, Lucha-López MO, Barrau-Lalmolda M, Rodes-Pastor I, Rodríguez-Fernández ÁL, Tricás-Moreno JM. Effectiveness of pediatric integrative manual therapy in cervical movement limitation in infants with positional plagiocephaly: a randomized controlled trial. Ital J Pediatr 2021; 47:41. [PMID: 33632268 PMCID: PMC7908758 DOI: 10.1186/s13052-021-00995-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/16/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Positional plagiocephaly (PP) is a cranial deformation frequent amongst children and consisting in a flattened and asymmetrical head shape. PP is associated with excessive time in supine and with congenital muscular torticollis (CMT). Few studies have evaluated the efficiency of a manual therapy approach in PP. The purpose of this parallel randomized controlled trial is to compare the effectiveness of adding a manual therapy approach to a caregiver education program focusing on active rotation range of motion (AROM) and neuromotor development in a PP pediatric sample. METHODS Thirty-four children with PP and less than 28 week-old were randomly distributed into two groups. AROM and neuromotor development with Alberta Infant Motor Scale (AIMS) were measured. The evaluation was performed by an examiner, blinded to the randomization of the subjects. A pediatric integrative manual therapy (PIMT) group received 10-sessions involving manual therapy and a caregiver education program. Manual therapy was addressed to the upper cervical spine to mobilize the occiput, atlas and axis. The caregiver educational program consisted in exercises to reduce the positional preference and to stimulate motor development. The control group received the caregiver education program exclusively. To compare intervention effectiveness across the groups, improvement indexes of AROM and AIMS were calculated using the difference of the final measurement values minus the baseline measurement values. If the distribution was normal, the improvement indexes were compared using the Student t-test for independent samples; if not, the Mann-Whitney U test was used. The effect size of the interventions was calculated using Cohen's d. RESULTS All randomized subjects were analysed. After the intervention, the PIMT group showed a significantly higher increase in rotation (29.68 ± 18.41°) than the control group (6.13 ± 17.69°) (p = 0.001). Both groups improved the neuromotor development but no statistically significant differences were found. No harm was reported during the study. CONCLUSION The PIMT intervention program was more effective in increasing AROM than using only a caregiver education program. The study has been retrospectively registered at clinicaltrials.gov, with identification number NCT03659032 . Registration date: September 1, 2018.
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Affiliation(s)
- Iñaki Pastor-Pons
- Departamento de Fisiatría y Enfermería, Unidad de Investigación en Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Zaragoza, Domingo Miral, s/n, 50009, Zaragoza, Spain
- Instituto de Terapias Integrativas, San Miguel, 16, 50001, Zaragoza, Spain
| | - César Hidalgo-García
- Departamento de Fisiatría y Enfermería, Unidad de Investigación en Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Zaragoza, Domingo Miral, s/n, 50009, Zaragoza, Spain.
| | - María Orosia Lucha-López
- Departamento de Fisiatría y Enfermería, Unidad de Investigación en Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Zaragoza, Domingo Miral, s/n, 50009, Zaragoza, Spain
| | | | - Iñaki Rodes-Pastor
- Instituto de Terapias Integrativas, San Miguel, 16, 50001, Zaragoza, Spain
| | - Ángel Luis Rodríguez-Fernández
- Departamento de Fisioterapia, Facultad de Medicina, Universidad San Pablo CEU, Urbanización Montepríncipe, 28925, Alcorcón, Madrid, Spain
| | - José Miguel Tricás-Moreno
- Departamento de Fisiatría y Enfermería, Unidad de Investigación en Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Zaragoza, Domingo Miral, s/n, 50009, Zaragoza, Spain
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Cinalli G, di Martino G, Russo C, Mazio F, Nastro A, Mirone G, Ruggiero C, Aliberti F, Cascone D, Covelli E, Spennato P. Dural venous sinus anatomy in children with external hydrocephalus: analysis of a series of 97 patients. Childs Nerv Syst 2021; 37:3021-3032. [PMID: 34430999 PMCID: PMC8510989 DOI: 10.1007/s00381-021-05322-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 08/03/2021] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the anatomical variations of dural venous sinuses in children with external hydrocephalus, proposing a radiological grading of progressive anatomic restriction to venous outflow based on brain phase-contrast magnetic resonance venography (PC-MRV); to evaluate the correlation between positional plagiocephaly and dural sinuses patency; and to compare these findings with a control group to ascertain the role of anatomical restriction to venous outflow in the pathophysiology of external hydrocephalus. METHODS Brain MRI and PC MRV were performed in 97 children (76 males, 21 females) diagnosed with external hydrocephalus at an average age of 8.22 months. Reduction of patency of the dural sinuses was graded as 1 (stenosis), 2 (complete stop) and 3 (complete agenesis) for each transverse/sigmoid sinus and sagittal sinus. Anatomical restriction was graded for each patient from 0 (symmetric anatomy of patent dural sinuses) through 6 (bilateral agenesis of both transverse sinuses). Ventricular and subarachnoid spaces were measured above the intercommissural plane using segmentation software. Positional plagiocephaly (PP) and/or asymmetric tentorial insertion (ATI) was correlated with the presence and grading of venous sinus obstruction. These results were compared with a retrospective control group of 75 patients (35 males, 40 females). RESULTS Both the rate (84.53% vs 25.33%) and the grading (mean 2.59 vs mean 0.45) of anomalies of dural sinuses were significantly higher in case group than in control group. In the case group, sinus anomalies were asymmetric in 59 cases (right-left ratio 1/1) and symmetric in 22. A significant association was detected between the grading of venous drainage alterations and diagnosis of disease and between the severity of vascular anomalies and the widening of subarachnoid space (SAS). Postural plagiocephaly (39.1% vs 21.3%) and asymmetric tentorial insertion (35.4% vs 17.3%) were significantly more frequent in the case group than in the control group. When sinus anomalies occurred in plagiocephalic children, the obstruction grading was significantly higher on the flattened side (p ≤ 0.001). CONCLUSION Decreased patency of the dural sinuses and consequent increased venous outflow resistance may play a role in the pathophysiology of external hydrocephalus in the first 3 years of life. In plagiocephalic children, calvarial flattening may impact on the homolateral dural sinus patency, with a possible effect on the anatomy of dural sinuses and venous drainage in the first months of life.
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Affiliation(s)
- Giuseppe Cinalli
- Department of Pediatric Neurosciences, Pediatric Neurosurgery Unit, Santobono-Pausilipon Children's Hospital, Via Mario Fiore n. 6, 80129, Naples, Italy.
| | - Giuliana di Martino
- grid.415247.10000 0004 1756 8081Department of Pediatric Neurosciences, Pediatric Neurosurgery Unit, Santobono-Pausilipon Children’s Hospital, Via Mario Fiore n. 6, 80129 Naples, Italy
| | - Carmela Russo
- grid.415247.10000 0004 1756 8081Department of Pediatric Neurosciences, Pediatric Neuroradiology Unit, Santobono-Pausilipon Children’s Hospital, Via Mario Fiore n. 6, 80129 Naples, Italy
| | - Federica Mazio
- grid.415247.10000 0004 1756 8081Department of Pediatric Neurosciences, Pediatric Neuroradiology Unit, Santobono-Pausilipon Children’s Hospital, Via Mario Fiore n. 6, 80129 Naples, Italy
| | - Anna Nastro
- grid.415247.10000 0004 1756 8081Department of Pediatric Neurosciences, Pediatric Neuroradiology Unit, Santobono-Pausilipon Children’s Hospital, Via Mario Fiore n. 6, 80129 Naples, Italy
| | - Giuseppe Mirone
- grid.415247.10000 0004 1756 8081Department of Pediatric Neurosciences, Pediatric Neurosurgery Unit, Santobono-Pausilipon Children’s Hospital, Via Mario Fiore n. 6, 80129 Naples, Italy
| | - Claudio Ruggiero
- grid.415247.10000 0004 1756 8081Department of Pediatric Neurosciences, Pediatric Neurosurgery Unit, Santobono-Pausilipon Children’s Hospital, Via Mario Fiore n. 6, 80129 Naples, Italy
| | - Ferdinando Aliberti
- grid.415247.10000 0004 1756 8081Department of Pediatric Neurosciences, Pediatric Neurosurgery Unit, Santobono-Pausilipon Children’s Hospital, Via Mario Fiore n. 6, 80129 Naples, Italy
| | - Daniele Cascone
- grid.415247.10000 0004 1756 8081Department of Pediatric Neurosciences, Pediatric Neuroradiology Unit, Santobono-Pausilipon Children’s Hospital, Via Mario Fiore n. 6, 80129 Naples, Italy
| | - Eugenio Covelli
- grid.415247.10000 0004 1756 8081Department of Pediatric Neurosciences, Pediatric Neuroradiology Unit, Santobono-Pausilipon Children’s Hospital, Via Mario Fiore n. 6, 80129 Naples, Italy
| | - Pietro Spennato
- grid.415247.10000 0004 1756 8081Department of Pediatric Neurosciences, Pediatric Neurosurgery Unit, Santobono-Pausilipon Children’s Hospital, Via Mario Fiore n. 6, 80129 Naples, Italy
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Ellwood J, Draper-Rodi J, Carnes D. The effectiveness and safety of conservative interventions for positional plagiocephaly and congenital muscular torticollis: a synthesis of systematic reviews and guidance. Chiropr Man Therap 2020; 28:31. [PMID: 32522230 PMCID: PMC7288527 DOI: 10.1186/s12998-020-00321-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 05/12/2020] [Indexed: 12/24/2022] Open
Abstract
Aim To investigate for congenital muscular torticollis (CMT) and positional plagiocephaly (PP) the effectiveness and safety of manual therapy, repositioning and helmet therapy (PP only) using a systematic review of systematic reviews and national guidelines. Methods We searched four major relevant databases: PubMed, Embase, Cochrane and MANTIS for research studies published between the period 1999–2019. Inclusion criteria were systematic reviews that analysed results from multiple studies and guidelines that used evidence and expert opinion to recommend treatment and care approaches. Three reviewers independently selected articles by title, abstract and full paper review, and extracted data. Selected studies were described by two authors and assessed for quality. Where possible meta-analysed data for change in outcomes (range of movement and head shape) were extracted and qualitative conclusions were assessed. Results We found 10 systematic reviews for PP and 4 for CMT. One national guideline was found for each PP and CMT. For PP, manual therapy was found to be more effective than repositioning including tummy time (moderate to high evidence) but not better than helmet therapy (low evidence). Helmet therapy was better than usual care or repositioning (low evidence); and repositioning better than usual care (moderate to high evidence). The results for CMT showed that manual therapy in the form of practitioner-led stretching had moderate favourable evidence for increased range of movement. Advice, guidance and parental support was recommended in all the guidance to reassure parents of the favourable trajectory and nature of these conditions over time. Conclusions Distinguishing between superiority of treatments was difficult due to the lack of standardised measurement systems, the variety of outcomes and limited high quality studies. More well powered effectiveness and efficacy studies are needed. However overall, advice and guidance on repositioning (including tummy-time) and practitioner-led stretching were low risk, potentially helpful and inexpensive interventions for parents to consider. Systematic review registration number PROSPERO 2019 CRD42019139074.
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Affiliation(s)
- Julie Ellwood
- University College Osteopathy, 275 Borough High St, London, SE1 1JE, England
| | - Jerry Draper-Rodi
- University College Osteopathy, 275 Borough High St, London, SE1 1JE, England
| | - Dawn Carnes
- University College Osteopathy, 275 Borough High St, London, SE1 1JE, England. .,Faculty of Health, University Applied Sciences and the Arts Western Switzerland, Fribourg, Switzerland.
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12
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Lopes Alho EJ, Rondinoni C, Furokawa FO, Monaco BA. Computer-assisted craniometric evaluation for diagnosis and follow-up of craniofacial asymmetries: SymMetric v. 1.0. Childs Nerv Syst 2020; 36:1255-61. [PMID: 31820081 DOI: 10.1007/s00381-019-04451-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 11/26/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE The current assessment of patients with craniofacial asymmetries is accomplished by physical examination, anamnesis and radiological imaging. We propose a semi-automated, computer-assisted craniofacial evaluation (SymMetric v 1.0) based on orthogonal photography of the patient's head in 3 positions. The system is simple, low-cost, no-radiation or special resources needed. Although it does not substitute CT in cases of doubt between craniosynostosis and positional plagiocephaly, multiple numeric evaluations indicate regional deformities and severity of the asymmetry, which can help in the clinical decision of indicating or not the orthosis in positional deformities, determining treatment duration or evaluating surgical outcomes after correction. METHODS A Matlab-based tool was developed for digital processing of photographs taken in 3 positions (anterior, superior and lateral). The software guides the user to select visible and reproducible landmarks in each photograph acquisition and calculates multiple indexes and metrics, generating a set of comprehensive plots to offer the user an overview of head and facial symmetry across the orthogonal views. For purposes of demonstration, we evaluated 2 patients (one control and one with non-sinostotic deformity). RESULTS The results show a clear differentiation of the control and plagiocephalic patient metrics mainly in the superior view, showing potential for diagnosis of the condition, and also detected the clinical improvement during helmet treatment in the follow-up, 3 and 5 months after orthosis' use. CONCLUSION We presented a proof-of-concept for a low cost, no radiation evaluation system for craniofacial asymmetries, that can be useful in a clinical context for diagnosis and follow-up of patients.
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13
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Çevik S, Işık S, Özkılıç A. The role of age on helmet therapy in deformational plagiocephaly and asymmetric brachycephaly. Childs Nerv Syst 2020; 36:803-810. [PMID: 31482314 DOI: 10.1007/s00381-019-04354-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 08/13/2019] [Indexed: 01/05/2023]
Abstract
PURPOSE This study aimed to investigate the effect of age at helmet therapy onset on treatment efficacy in moderate-to-severe deformational plagiocephaly (DP) and combined DP and asymmetrical brachycephaly (AB) in infants. METHODS Ninety-eight infants who were referred to our institution and who underwent helmet therapy between 2014 and 2018 were retrospectively reviewed. Patients with DP [cranial vault asymmetry index (CVAI) > 7% and DD > 10 mm] and AB [CVAI > 7% and cephalic ratio (CR) ≥ 94] were included. Pre- and post-treatment calvarial asymmetries (difference among DD, CVAI, and CR) were measured using 3D screening systems (SmartSoc and Omega Scanner 3D). Infants were classified according to age at treatment onset: group 1 (age, < 6 months) and group 2 (age, ≥ 6 months). RESULTS CVAI was statistically different between treatment onset and end in subgroups. Moreover, the regression of CVAI between groups DP1 (- 7.5% ± 1.2%) versus DP2 (- 5.4% ± 1.5%; p = 0.001) and groups AB1 (- 6.6% ± 1.4%) versus AB2 (- 4.4 ± 2.5; p = 0.0013) was statistically significant. CVAI was < 3.5% and CR was ≤ 89 (assumed as normal cranial shape) after treatment in 48%, 40%, 32%, and 6% of infants in groups DP1, DP2, AB1, and AB2, respectively. CONCLUSION These findings emphasize the efficacy of helmet therapy for DP and AB. Helmet is an appropriate treatment option particularly for infants with severe DP and AB, and early onset of helmet therapy before the age of 6 months is advised.
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Affiliation(s)
- Serdar Çevik
- Department of Neurosurgery, Memorial Şişli Hospital, Istanbul, Turkey.
| | - Semra Işık
- Department of Neurosurgery, Başkent University Istanbul Hospital, İstanbul, Turkey
| | - Alper Özkılıç
- Department of Pediatrics, Biruni University, İstanbul, Turkey
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14
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Wendling-Keim DS, Macé Y, Lochbihler H, Dietz HG, Lehner M. A new parameter for the management of positional plagiocephaly: the size of the anterior fontanelle matters. Childs Nerv Syst 2020; 36:363-71. [PMID: 31209640 DOI: 10.1007/s00381-019-04215-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 05/20/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE The rate of positional plagiocephaly has increased since guidelines for the prevention of sudden infant death have led to the recommendation of positioning infants on their back during sleeping. Therapy includes repositioning, physiotherapy, and helmet therapy. To date, there is no consensus on the treatment of positional plagiocephaly. Therefore, it was the goal of this study to compare the results of physiotherapy and helmet therapy and to investigate if the size of the anterior fontanelle can be used as an additional parameter for the indication of the helmet therapy. METHODS We enrolled 98 infants with a diagonal difference of 7 mm or more and plagiocephaly classified as Argenta II or more. Patients were grouped into infants with a small anterior fontanelle (< 25mm2) and infants with a large anterior fontanelle (≥ 25mm2). The patients were observed for at least 18 months. Sixty-eight patients were treated with repositioning and physiotherapy, whereas 30 infants received helmet therapy. RESULTS The remolding rate was significantly higher with the helmet therapy than with physiotherapy. In patients with a small fontanelle, a lower spontaneous remolding rate was seen pointing to their lower correction potential. Especially in these patients, plagiocephaly was reduced significantly more quickly with the helmet treatment than with physiotherapy, so that they may benefit from the helmet due to their otherwise reduced spontaneous remolding capacity. CONCLUSION The helmet therapy led to a faster reduction of the asymmetry than physiotherapy in this study. In patients with a small anterior fontanelle and therefore lower remolding potential, the helmet treatment was more effective than physiotherapy.
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15
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Khormi Y, Chiu M, Goodluck Tyndall R, Mortenson P, Smith D, Steinbok P. Safety and efficacy of independent allied healthcare professionals in the assessment and management of plagiocephaly patients. Childs Nerv Syst 2020; 36:373-377. [PMID: 31728704 DOI: 10.1007/s00381-019-04400-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 09/27/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The incidence of positional plagiocephaly has increased significantly over the last two decades, which has caused a service delivery challenge for pediatric neurosurgeons. As a potential solution to the long waitlists for abnormal head shape, a plagiocephaly clinic was established at BC Children's Hospital (BCCH) in Vancouver, Canada. This clinic was supervised by an occupational therapist who had been trained by a neurosurgeon to independently assess and manage patients with a referring diagnosis of positional plagiocephaly. OBJECTIVES To determine the efficiency of the BCCH Plagiocephaly Clinic in the management of positional plagiocephaly patients and to investigate the clinic's ability to appropriately identify and refer patients with craniosynostosis to pediatric neurosurgeons for further assessment. METHODS A retrospective chart review was conducted to identify patients who were assessed and managed at the BCCH Plagiocephaly Clinic between 2008 and 2014. Data on patient demographics, head shape measurements, and treatment recommendations were collected, and the BC Children's neurosurgical database was cross-referenced to identify craniosynostosis cases missed by the Plagiocephaly Clinic. A descriptive analysis of the clinic's average wait times, severity of the patients' plagiocephaly, and recommended interventions was conducted. In addition, the sensitivity and specificity of the clinic's ability to appropriately refer craniosynostosis patients to pediatric neurosurgery were calculated. RESULTS Of 1752 patients seen in the BC Children's Plagiocephaly Clinic between 2008 and 2014, 66% of patients received counseling about repositioning, 34% were referred for head banding, 19% were referred to physiotherapy for torticollis, and 1.4% were referred to the BC Children's Pediatric Neurosurgery Clinic for suspicion of craniosynostosis. The mean time from referral to first assessment by the Plagiocephaly Clinic was 41 days, and time from referral by the plagiocephaly clinic to diagnosis of craniosynostosis by a pediatric neurosurgeon was 8 days. Pediatric neurosurgeons requested imaging for 6 of the referred patients (25% ). The sensitivity and specificity of the plagiocephaly clinic for referral of craniosynostosis patients to the Pediatric Neurosurgery Clinic were 100 and 99%, respectively. CONCLUSION The BC Children's Plagiocephaly Clinic is efficient and safe for the initial evaluation and treatment of patients with positional plagiocephaly. The clinic's model decreases wait times, appropriately manages patients with positional plagiocephaly, screens for craniosynostosis with high sensitivity and specificity, and takes pressure off outpatient neurosurgical clinics. This model for assessment of plagiocephaly could be considered in other medical centers.
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Affiliation(s)
- Yahya Khormi
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Jazan University, Gizan, Saudi Arabia.
| | - Michelle Chiu
- Division of Neurology, University of British Columbia, Vancouver, BC, Canada.,Department of Pediatrics, British Columbia Children's Hospital, Vancouver, Canada
| | - Ronette Goodluck Tyndall
- Division of Neurosurgery, Department of Surgery, University of West Indies and University Hospital of West Indies, Kingston, Jamaica
| | - Patricia Mortenson
- Department of Occupational Therapy, British Columbia Children's Hospital, Vancouver, BC, Canada.,Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada
| | - David Smith
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Paul Steinbok
- Division of Pediatric Neurosurgery, University of British Columbia, Vancouver, BC, Canada.,Department of Surgery, British Columbia Children's Hospital, Vancouver, BC, Canada
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16
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Picart T, Beuriat PA, Szathmari A, Di Rocco F, Mottolese C. Positional cranial deformation in children: A plea for the efficacy of the cranial helmet in children. Neurochirurgie 2020; 66:102-109. [PMID: 31958410 DOI: 10.1016/j.neuchi.2019.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/15/2019] [Accepted: 10/16/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cranial deformations have historically aroused the interest of people worldwide. One of the more debated points about positional plagiocephaly is the choice of the treatment. In this article, the senior author (CM) shares his experience on almost 30 years of use of the helmet molding therapy in children with deformation plagiocephaly. METHODS AND POPULATION We retrospectively and systematically reviewed the cases of 2188 patients (75% males and 25% females) presenting positional head deformity and treated between 1991 and 2013 with a cranial helmet. To assess the effectiveness of the helmet, we compared the cranial index in bilateral plagiocephaly and the Cranial Diagonals Difference (CDD) in unilateral plagiocephaly at the beginning and at the end of the treatment. RESULTS The cranial indexes ranged between 94.4% and 124.2% before the treatment and decreased significantly between 86.8% and 121.4% after the treatment (P<0.01). The CDD ranged between 0.3 cm and 4.5 cm with an average of 1.50±0.54 cm before the treatment and decreased significantly between 0.1 cm and 2.5 cm with an average of 0.72±0.37 cm after the treatment (P<0.01). For unilateral plagiocephaly, at the beginning of the treatment, 2.5% children presented a mild plagiocephaly, 19.6% a moderate plagiocephaly and 77.9% a severe plagiocephaly. At the end of the treatment, the deformation was classified as mild in 40.2% children, moderate in 44.3% children and severe in 15.5% children with significantly less children in the most severe subgroups (P<0.01) Facial symmetry pre-existed before the treatment in 13.7% of children. This rate was significantly increased at the end of the treatment to 66.7% (P<0.01). In only 8 cases (0.2%), the helmet therapy did not allow to obtain correct clinical results and a surgical posterior cranial remodeling was performed. CONCLUSIONS The results observed in this series confirms that cranial helmet is a simple and well tolerated alternative which bring satisfying results. Its success implies a good collaboration with parents and a management both by orthoptist, physiotherapist and doctor. Nevertheless, it remains many controversies in the literature concerning in particular long-term cosmetic and functional outcomes. A long-term multicentric prospective study could enable to remove doubts.
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Affiliation(s)
- T Picart
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 32, avenue du Doyen Jean-Lépine, 69677 Bron cedex, France; Claude-Bernard University Lyon 1, 8, avenue Rockefeller, 69003 Lyon; Reference center for Craniosynostosis, Hôpital Femme Mère Enfant, 32, avenue du Doyen Jean-Lépine, 69677 Bron cedex, France
| | - P A Beuriat
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 32, avenue du Doyen Jean-Lépine, 69677 Bron cedex, France; Claude-Bernard University Lyon 1, 8, avenue Rockefeller, 69003 Lyon; Reference center for Craniosynostosis, Hôpital Femme Mère Enfant, 32, avenue du Doyen Jean-Lépine, 69677 Bron cedex, France
| | - A Szathmari
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 32, avenue du Doyen Jean-Lépine, 69677 Bron cedex, France; Claude-Bernard University Lyon 1, 8, avenue Rockefeller, 69003 Lyon; Reference center for Craniosynostosis, Hôpital Femme Mère Enfant, 32, avenue du Doyen Jean-Lépine, 69677 Bron cedex, France
| | - F Di Rocco
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 32, avenue du Doyen Jean-Lépine, 69677 Bron cedex, France; Claude-Bernard University Lyon 1, 8, avenue Rockefeller, 69003 Lyon; Reference center for Craniosynostosis, Hôpital Femme Mère Enfant, 32, avenue du Doyen Jean-Lépine, 69677 Bron cedex, France
| | - C Mottolese
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 32, avenue du Doyen Jean-Lépine, 69677 Bron cedex, France; Claude-Bernard University Lyon 1, 8, avenue Rockefeller, 69003 Lyon; Reference center for Craniosynostosis, Hôpital Femme Mère Enfant, 32, avenue du Doyen Jean-Lépine, 69677 Bron cedex, France.
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17
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Ballardini E, Sisti M, Basaglia N, Benedetto M, Baldan A, Borgna-Pignatti C, Garani G. Prevalence and characteristics of positional plagiocephaly in healthy full-term infants at 8-12 weeks of life. Eur J Pediatr 2018; 177:1547-1554. [PMID: 30030600 DOI: 10.1007/s00431-018-3212-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 07/11/2018] [Accepted: 07/12/2018] [Indexed: 10/28/2022]
Abstract
UNLABELLED Positional plagiocephaly (PP) denotes flattening of the skull that occurs frequently in healthy infants. Aim of this study was to estimate the prevalence of positional plagiocephaly and to identify the risk factors in a cohort of healthy infants in order to help prevention of PP. In a prospective design, all healthy full-term infants, ranging from 8 to 12 weeks of age, who presented at the public immunization clinic in Ferrara, were eligible for the study. After obtaining informed consent, we interviewed the parents and examined the infants using the Argenta's assessment tool. Of 283 infants examined, 107 (37.8%) were found to have PP at 8-12 weeks of age. In 64.5%, PP was on the right side, 50.5% were male and 15% presented also with brachycephaly. Risk factors significantly associated were lower head circumference, advanced maternal age, Italian compared to African, and supine sleep position, in particular for infants born at 37 weeks, preference for one side of the head. In logistic regression, risk factors significantly associated were lower birth weight, advanced maternal age, and supine sleep position. CONCLUSIONS Positional plagiocephaly is a common issue faced by pediatricians; our results reinforce the need of improving prevention both of sudden infant death and positional plagiocephaly, through uniform messages provided prenatally and postnatally by different health professionals. "What is Known:" •The incidence of positional plagiocephaly varies due to population studied and measuring methods. •Different factors are considered in the literature as being associated to positional plagiocephaly (infant factors, obstetric factors, infant care practices, sociodemographic factors). "What is New:" •This is one of the few European studies quantifying positional plagiocephaly prevalence in a population of unselected healthy infants. •In this study, positional plagiocephaly is confirmed as a common issue, related to some factor (as supine sleep position and positional head prevalence) that should be addressed in pre and postnatal counseling. •The prone sleepers rate in our population highlight the need to improve parental awareness regarding SIDS prevention, in particular in borderline gestational age.
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Affiliation(s)
- Elisa Ballardini
- Department of Medical Sciences, Pediatric Section, Neonatal Intensive Care Unit, University of Ferrara, Via Aldo Moro, 8-44124 Cona, Ferrara, Italy.
| | - M Sisti
- Department of Neurosciences and Rehabilitation Medicine, University of Ferrara, Ferrara, Italy
| | - N Basaglia
- Department of Neurosciences and Rehabilitation Medicine, University of Ferrara, Ferrara, Italy
| | - M Benedetto
- Department of Medical Sciences, Pediatric Section, University of Ferrara, Ferrara, Italy
| | - A Baldan
- Department of Medical Sciences, Pediatric Section, University of Ferrara, Ferrara, Italy
- Department of Pediatrics, Texas Children's Hematology Center, Baylor College of Medicine, Houston, TX, USA
| | - C Borgna-Pignatti
- Department of Medical Sciences, Pediatric Section, University of Ferrara, Ferrara, Italy
| | - G Garani
- Department of Medical Sciences, Pediatric Section, Neonatal Intensive Care Unit, University of Ferrara, Via Aldo Moro, 8-44124 Cona, Ferrara, Italy
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18
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Kuusela L, Hukki A, Brandstack N, Autti T, Leikola J, Saarikko A. Use of black-bone MRI in the diagnosis of the patients with posterior plagiocephaly. Childs Nerv Syst 2018; 34:1383-1389. [PMID: 29594536 DOI: 10.1007/s00381-018-3783-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 03/16/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE Ionising radiation exposure is especially harmful to brain development. The purpose of this study was to evaluate whether black-bone (BB) magnetic resonance imaging (MRI), a non-ionising imaging method, offers an alternative to ionising imaging methods such as computed tomography (CT) in the examination of cranial deformities. METHODS From 2012 to 2014, a total of 408 children were referred to the Craniofacial Centre at the Helsinki University Hospital for further examination due to flatness of the posterior skull. Fifteen of these patients required further diagnostic imaging. To avoid ionising radiation, we used an MRI protocol that included sequences for evaluation of both brain anatomy and skull bone and sutures by BB-MRI. A semi-automatic skull segmentation algorithm was developed to facilitate the visualisation. Two patients with scaphocephaly were included in the study to confirm the ability to differentiate synostosis with BB-MRI. RESULTS We obtained informative 3D images using BB-MRI. Seven patients (7/15, 46.7%) had plagiocephaly on the right side and seven on the left side (7/15, 46.7%). One patient (1/15, 6.7%) had symmetric posterior flatness affecting both sides. Neither structural nor signal-intensity alterations of the brain were detected in visual analysis. CONCLUSION BB-MRI provides an alternative to CT when imaging craniofacial deformities. BB-MRI provides not only high-quality 3D-reconstructed imaging of the bony structures and sutures but also information on brain structure in one imaging session. With further development, this method could replace ionising radiation-based methods in analysing deformities of the skull.
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Affiliation(s)
- Linda Kuusela
- Helsinki Medical Imaging Center, Helsinki University Hospital, Helsinki, Finland.,Department of Physics, University of Helsinki, Helsinki, Finland
| | - Ada Hukki
- Cleft Palate and Craniofacial Centre, Department of Plastic Surgery, Helsinki University Central Hospital, Topeliuksenkatu 3-5, PO Box 266, 00029, Helsinki, Finland
| | - Nina Brandstack
- Helsinki Medical Imaging Center, Helsinki University Hospital, Helsinki, Finland
| | - Taina Autti
- Helsinki Medical Imaging Center, Helsinki University Hospital, Helsinki, Finland
| | - Junnu Leikola
- Cleft Palate and Craniofacial Centre, Department of Plastic Surgery, Helsinki University Central Hospital, Topeliuksenkatu 3-5, PO Box 266, 00029, Helsinki, Finland
| | - Anne Saarikko
- Cleft Palate and Craniofacial Centre, Department of Plastic Surgery, Helsinki University Central Hospital, Topeliuksenkatu 3-5, PO Box 266, 00029, Helsinki, Finland.
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19
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Aarnivala H, Vuollo V, Heikkinen T, Harila V, Holmström L, Pirttiniemi P, Valkama AM. Accuracy of measurements used to quantify cranial asymmetry in deformational plagiocephaly. J Craniomaxillofac Surg 2017; 45:1349-1356. [PMID: 28615136 DOI: 10.1016/j.jcms.2017.05.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 04/24/2017] [Accepted: 05/15/2017] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE Various measurements are used to quantify cranial asymmetry in deformational plagiocephaly (DP), but studies validating cut-off values and comparing the accuracy of such measurements are lacking. In this study, we compared the accuracy of four different measurements in classifying children with and without DP diagnosed by visual assessment, and sought to determine their optimal cut-off values. STUDY DESIGN Two experts rated 407 3D craniofacial images of children aged between 3 and 36 months old using the Argenta classification. We then measured the following asymmetry-related variables from the images: Oblique Cranial Length Ratio (OCLR), Diagonal Difference (DD), Posterior Cranial Asymmetry Index (PCAI), and weighted Asymmetry Score (wAS). We created receiver operating characteristic curves to evaluate the accuracy of these variables. RESULTS All variables performed well, but OCLR consistently provided the best discrimination in terms of area under the curve values. Subject's age had no clear effect on the cut-off values for OCLR, PCAI, and wAS; however, the cut-off for DD increased monotonically with age. When subjects with discrepant expert ratings were excluded, the optimal cut-off values for DP (Argenta class ≥ 1) across all age-groups were 104.0% for OCLR (83% sensitivity, 97% specificity), 10.5% for PCAI (90% sensitivity, 90% specificity), and 24.5 for wAS (88% sensitivity, 90% specificity). CONCLUSION We recommend using OCLR as the primary measurement, although PCAI and wAS may also be useful in monitoring cranial asymmetry. The threshold of relative asymmetry required for a deformation to appear clinically significant is not affected by the child's age, and DD has no additional utility in monitoring DP compared to using only OCLR.
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Affiliation(s)
- Henri Aarnivala
- Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland; Medical Research Center Oulu, University of Oulu, Oulu, Finland; PEDEGO Research Group, University of Oulu, Oulu, Finland.
| | - Ville Vuollo
- Medical Research Center Oulu, University of Oulu, Oulu, Finland; Department of Orthodontics, Oral Health Sciences, University of Oulu, Oulu, Finland; Department of Mathematical Sciences, University of Oulu, Oulu, Finland
| | - Tuomo Heikkinen
- Medical Research Center Oulu, University of Oulu, Oulu, Finland; Department of Orthodontics, Oral Health Sciences, University of Oulu, Oulu, Finland
| | - Virpi Harila
- Medical Research Center Oulu, University of Oulu, Oulu, Finland; Department of Orthodontics, Oral Health Sciences, University of Oulu, Oulu, Finland
| | - Lasse Holmström
- Medical Research Center Oulu, University of Oulu, Oulu, Finland; Department of Mathematical Sciences, University of Oulu, Oulu, Finland
| | - Pertti Pirttiniemi
- Medical Research Center Oulu, University of Oulu, Oulu, Finland; Department of Orthodontics, Oral Health Sciences, University of Oulu, Oulu, Finland
| | - A Marita Valkama
- Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland; Medical Research Center Oulu, University of Oulu, Oulu, Finland; PEDEGO Research Group, University of Oulu, Oulu, Finland
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Abstract
This article provides an overview of etiology, epidemiology, pathology, diagnosis, and treatment of nonsyndromic craniosynostosis, including sagittal, metopic, coronal, lambdoid, and complex synostosis. Detailed discussion is presented regarding indications for surgical intervention and management options, including frontoorbital advancement, cranial vault reconstruction, endoscopic strip craniectomy, spring-assisted strip craniectomy, and cranial vault distraction osteogenesis. Deformational plagiocephaly is also presented with treatment options including repositioning, physical therapy, and helmet therapy.
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Affiliation(s)
- Lisa M Morris
- Craniofacial Foundation of Utah, 5089 South 900 East, Suite 100, Salt Lake City, UT 84117, USA.
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21
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Leung A, Mandrusiak A, Watter P, Gavranich J, Johnston L. Positional plagiocephaly is associated with sternocleidomastoid muscle activation in healthy term infants. Childs Nerv Syst 2017; 33:617-24. [PMID: 28236068 DOI: 10.1007/s00381-017-3351-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 01/20/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE To explore the relationship between sternocleidomastoid activation and positional plagiocephaly in healthy full term infants. METHODS Participants were 82 infants from a regionally based-longitudinal study of infant development. Sternocleidomastoid (SCM) activation was assessed using active head-righting responses of body-on-head with and against gravity and head-on-body against gravity at 3, 6 and 9 weeks. Plagiocephaly was assessed using the Modified Cranial Vault Asymmetry Index (mCVAI) at 9 weeks. RESULTS More severe plagiocephaly was associated with more severe asymmetry in active head-righting responses at all ages (p < 0.001). Greater right-sided occipital flatness was related to stronger contralateral/left SCM activation at 3 and at 9 weeks (p = 0.008). Greater left-sided occipital flatness was related to stronger contralateral/right SCM activation at 3 weeks (p = 0.004). In infants with any right-sided occipital flatness, the mCVAI was greater in infants with asymmetrical gravity assisted body-on-head responses at 3 weeks (mCVAI = 4.31 (2.01)%, 95% CI 2.87-5.75) compared to those with symmetrical responses (mCVAI = 2.64 (1.66)%, 95% CI 2.06-3.22) (p = 0.011). CONCLUSIONS Sternocleidomastoid activation asymmetry is a significant contributor to plagiocephaly development by 9 weeks of age due to stronger contralateral SCM activation. Active head-righting responses are appropriate to assess sternocleidomastoid activation in infants under 2 months of age.
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Aarnivala H, Vuollo V, Harila V, Heikkinen T, Pirttiniemi P, Holmström L, Valkama AM. The course of positional cranial deformation from 3 to 12 months of age and associated risk factors: a follow-up with 3D imaging. Eur J Pediatr 2016; 175:1893-1903. [PMID: 27624627 DOI: 10.1007/s00431-016-2773-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 08/24/2016] [Accepted: 08/30/2016] [Indexed: 11/30/2022]
Abstract
Deformational plagiocephaly is reported in up to 46.6 % of healthy infants, with the highest point prevalence at around 3 months of age. Few prospective studies on the natural course of skull deformation have been conducted, and we know of no studies using 3D imaging starting from the highest point prevalence period. In this prospective, population-based cohort study, we describe the course of cranial asymmetry and shape in an unselected population using 3D stereophotogrammetry and investigate factors associated with late cranial deformation and failure to recover from previous deformation. We evaluated 99 infants at 3, 6, and 12 months of age. We acquired 3D craniofacial images and performed structured clinical examinations and parental interviews at each visit. Eight outcome variables, representing different aspects of cranial shape, were calculated from a total of 288 3D images. Scores of asymmetry-related variables improved throughout the observation period. However, the rate of correction for cranial asymmetry decreased as the infants grew older, also in relation to the rate of head growth, and a significant amount of asymmetry was still present at 12 months. Positional preference at 3 months predicted an unfavorable course of cranial asymmetry after 3 months, increasing the risk for DP persisting. What is known: • The prevalence of deformational plagiocephaly spontaneously decreases after the first months of life. • Limited neck range of motion and infant positional preference increase the risk of deformational plagiocephaly during the first months of life. What is new: • Positional preference at 3 months predicts an unfavorable spontaneous course of deformation also from three to 12 months of age, presenting a potential target for screening and treatment. • The spontaneous rate of correction for cranial asymmetry decreases after 6 months of age, also in relation to the rate of head growth.
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Affiliation(s)
- Henri Aarnivala
- Department of Children and Adolescence, Oulu University Hospital, Oulu, Finland. .,Medical Research Center Oulu, University of Oulu, Oulu, Finland. .,PEDEGO Research Group, University of Oulu, Oulu, Finland.
| | - Ville Vuollo
- Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Department of Orthodontics, Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland.,Department of Mathematical Sciences, University of Oulu, Oulu, Finland
| | - Virpi Harila
- Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Department of Orthodontics, Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Tuomo Heikkinen
- Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Department of Orthodontics, Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Pertti Pirttiniemi
- Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Department of Orthodontics, Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Lasse Holmström
- Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Department of Mathematical Sciences, University of Oulu, Oulu, Finland
| | - A Marita Valkama
- Department of Children and Adolescence, Oulu University Hospital, Oulu, Finland.,Medical Research Center Oulu, University of Oulu, Oulu, Finland.,PEDEGO Research Group, University of Oulu, Oulu, Finland
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23
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Dörhage KWW, Beck-Broichsitter BE, von Grabe V, Sonntag A, Becker ST, Wiltfang J. Therapy effects of head orthoses in positional plagiocephaly. J Craniomaxillofac Surg 2016; 44:1508-1514. [PMID: 27595189 DOI: 10.1016/j.jcms.2016.06.035] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 05/29/2016] [Accepted: 06/29/2016] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Head orthoses offer a valuable therapeutic option for infants with positional plagiocephaly. The aim of this retrospective study was to evaluate the influence of therapy start and duration due to improvement of cranial asymmetry. MATERIAL AND METHODS A total of 102 children during the years 2009-2014 were included. The patient cohort was divided according to age at the beginning of therapy (younger/older than 7.5 months) and duration (less/more than 150 days). To evaluate the therapy, ear shift (ES), Cranial Vault Asymmetry Index (CVAI), and Cranial Index (CI) were calculated pre- and post-therapy by using three-dimensional photogrammetry measurements. RESULTS Treatment with head orthoses led to a significant reduction of CVAI in groups with less and more than 150 days of therapy (p < 0.0001). A significant reduction in CVAI was observed (p = 0.0235) in children younger than 7.5 months in short-term therapy. At the end of therapy, no significant difference was found in the groups, whether treated with short- or long-term head orthoses (p = 0.0813), although CVAI was significantly different comparing the third time point of both groups for treatment duration (p = 0.017). The major positive effect of helmet therapy has been seen after 75 days of treatment. A treatment that was longer than 150 days did not show any significant improvement concerning the cranial asymmetry. CONCLUSIONS Helmet therapy is a reliable method in the treatment of positional plagiocephaly to improve cephalic asymmetries. This retrospective study indicates that an early beginning can lead to satisfying results after short-term therapy.
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Affiliation(s)
- Klaus W W Dörhage
- Private Practice for General Medicine, Hamburger Landstraße 26a, 24113 Molfsee, Germany.
| | - Benedicta E Beck-Broichsitter
- Medical University Center Hamburg-Eppendorf, Department of Oral and Maxillofacial Surgery, Martinistraße 52, Campus Forschung, 20246 Hamburg, Germany
| | - Vera von Grabe
- Department of Oral and Maxillofacial Surgery, Schleswig-Holstein University Hospital, Arnold-Heller-Straße 3, Haus 26, 24105 Kiel, Germany
| | - Annalena Sonntag
- Department of Oral and Maxillofacial Surgery, Schleswig-Holstein University Hospital, Arnold-Heller-Straße 3, Haus 26, 24105 Kiel, Germany
| | - Stephan T Becker
- Department of Oral and Maxillofacial Surgery, Schleswig-Holstein University Hospital, Arnold-Heller-Straße 3, Haus 26, 24105 Kiel, Germany
| | - Jörg Wiltfang
- Department of Oral and Maxillofacial Surgery, Schleswig-Holstein University Hospital, Arnold-Heller-Straße 3, Haus 26, 24105 Kiel, Germany
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24
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Leung AYF, Mandrusiak A, Watter P, Gavranich J, Johnston LM. Clinical assessment of head orientation profile development and its relationship with positional plagiocephaly in healthy term infants - A prospective study. Early Hum Dev 2016; 96:31-8. [PMID: 27031440 DOI: 10.1016/j.earlhumdev.2016.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 02/18/2016] [Accepted: 03/01/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Positional plagiocephaly refers to atypical development of an uneven head shape with asymmetrical head orientation as a post-natal risk factor. The development of the head orientation profile and its relationship with positional plagiocephaly are lacking. OBJECTIVES To explore the head orientation profile development and its relationship with positional plagiocephaly in healthy full term infants. METHODS A prospective observational study including 94 infants was conducted. Head orientation measures including head orientation duration, head orientation strength and latency to turn were conducted at three, six and nine weeks of age. Plagiocephaly outcome was measured by modified Cranial Vault Asymmetry Index at nine weeks. RESULTS Lateral head orientation duration predominated at three weeks, mean (standard deviation) (right=40 [21.7]%; left=41 [21.5]%; midline=19 [19.9]%). It decreased bilaterally in favour of midline positioning at nine weeks (right=30 [22.3]%; left=24 [22.0]%; midline=46 [27]%. Although head orientation strength was similar across the three ages after accounting for side, head orientation strength to left was decreased from three to nine weeks (p=0.031; 95% CI: 0.12-2.06). There was a reduction in left-consistent with increase in left-bias from 3weeks to 6weeks of age (p=0.011). Positional plagiocephaly at nine weeks was associated with head orientation duration-right (p<0.001; r(2)=0.20); head orientation duration-left (p<0.001; r(2)=0.17); head orientation strength at three and six weeks (p<0.001; r(2)=0.22), but not latency to turn. CONCLUSIONS Healthy infants show progressive change from symmetrical lateral head orientation to midline orientation from three to nine weeks. There is association of head orientation duration and strength with positional plagiocephaly.
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Kluba S, Roßkopf F, Kraut W, Peters JP, Calgeer B, Reinert S, Krimmel M. Malocclusion in the primary dentition in children with and without deformational plagiocephaly. Clin Oral Investig 2016; 20:2395-2401. [PMID: 26795625 DOI: 10.1007/s00784-016-1716-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 01/10/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Asymmetries of the jaw and orthodontic abnormalities are suspected as long-term consequences of positional cranial deformity. But only few data exist on this issue. As plagiocephaly is a common problem in infancy, potential functional impairments should be investigated to initiate appropriate measures if necessary. The aim of our study was to compare the orthodontic situation in primary dentition of children with positional plagiocephaly and children without cranial deformities. MATERIAL AND METHODS Fifty children treated by helmet therapy for plagiocephaly and 50 non-affected children (age 1.98-5.69 years) were examined in a cross-sectional study. Orthodontic parameters of all dimensions were assessed and analyzed. RESULTS Children of the plagiocephalic group showed more often orthodontic alterations compared to the others. Especially the frequencies of a class II malocclusion (36 vs. 14 %), an edge-to edge bite (28 vs. 12 %), and deviations of the midline (38 vs. 16 %) were conspicuous. However, none of the differences was significant (p > 0.003). Of all observed mandibular asymmetries, 69 % appeared as a shift to the contralateral side of the former flattened occipital region. CONCLUSION Positional head deformity might be associated in some cases with a higher prevalence of occlusal abnormalities in primary dentition. CLINICAL RELEVANCE Positional plagiocephaly interfaces medicine and dentistry. As it is a common disorder, this etiology has to be considered in the prevention and therapy of malocclusion.
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Affiliation(s)
- Susanne Kluba
- Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Osianderstr. 2-8, 72076, Tuebingen, Germany.
| | - Fabian Roßkopf
- Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Osianderstr. 2-8, 72076, Tuebingen, Germany
| | - Wiebke Kraut
- Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Osianderstr. 2-8, 72076, Tuebingen, Germany
| | - Jens Peter Peters
- Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Osianderstr. 2-8, 72076, Tuebingen, Germany
| | - Benjamin Calgeer
- Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Osianderstr. 2-8, 72076, Tuebingen, Germany
| | - Siegmar Reinert
- Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Osianderstr. 2-8, 72076, Tuebingen, Germany
| | - Michael Krimmel
- Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Osianderstr. 2-8, 72076, Tuebingen, Germany
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Mawji A, Vollman AR, Fung T, Hatfield J, McNeil DA, Sauvé R. Risk factors for positional plagiocephaly and appropriate time frames for prevention messaging. Paediatr Child Health 2014; 19:423-7. [PMID: 25382999 PMCID: PMC4220526 DOI: 10.1093/pch/19.8.423] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2014] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To determine potential risk factors for developing positional plagiocephaly in infants seven to 12 weeks of age in Calgary, Alberta. METHODS A prospective cohort design was used. Healthy term infants (n=440), seven to 12 weeks of age, from well-child clinics at four community health centres in Calgary, Alberta were assessed by the primary author and a registered nurse research assistant using Argenta's plagiocephaly assessment tool. Parents completed a questionnaire surveying risk factors. RESULTS The incidence of positional plagiocephaly was estimated to be 46.6%. The following risk factors were identified using multiple logistic regression: right-sided head positional preference (OR 4.66 [95% CI 2.85 to 7.58]; P<0.001), left-sided head positional preference (OR 4.21 [95% CI 2.45 to 7.25]; P<0.001), supine sleep position (OR 2.67 [95% CI 1.58 to 4.51]; P<0.001), vacuum/forceps assisted delivery (OR 1.88 [95% CI 1.02 to 3.49]; P=0.04) and male sex (OR 1.55 [95% CI 1.00 to 2.38]; P=0.05). CONCLUSION Advice to vary infants' head positions needs to be communicated to parents/guardians well before the two-month well-child clinic visit. This could occur in the prenatal period by prenatal care providers or educators, or during the neonatal period by postpartum and public health nurses. Prevention education may be emphasized for parents/guardians of male infants and infants who have had assisted deliveries.
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Affiliation(s)
- Aliyah Mawji
- School of Nursing, Faculty of Health and Community Studies, Mount Royal
University
| | | | - Tak Fung
- Information Technologies, University of Calgary
| | - Jennifer Hatfield
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary
| | - Deborah A McNeil
- Faculty of Nursing, University of Calgary
- Population and Public Health, Alberta Health Services
| | - Reginald Sauvé
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary
- Department of Paediatrics, Faculty of Medicine, University of Calgary, Calgary,
Alberta
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Kim HY, Chung YK, Kim YO. Effectiveness of Helmet Cranial Remodeling in Older Infants with Positional Plagiocephaly. Arch Craniofac Surg 2014; 15:47-52. [PMID: 28913190 PMCID: PMC5556813 DOI: 10.7181/acfs.2014.15.2.47] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 07/29/2014] [Accepted: 08/05/2014] [Indexed: 11/23/2022] Open
Abstract
Background Management of positional plagiocephaly by wearing a cranial molding helmet has become a matter of growing medical interest. Some research studies reported that starting helmet therapy early (age 5 to 6 months) is important and leads to a significantly better outcome in a shorter treatment time. The aim of the present study was to evaluate the effectiveness of cranial remodeling treatment with wearing helmet for older infants (≥18 months). Methods We conducted a retrospective study of 27 infants with positional plagiocephaly without synostosis, who were started from 2008 to 2012. Every child underwent a computerized tomography (CT) before starting helmet therapy to exclude synostosis of the cranial sutures and had CT performed once again after satisfactory completion of therapy. Anthropometric measurements were taken on using spreading calipers in every child. 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 cranial molding helmet treatment in older infants (≥18 months) 7.6 mm from 15.6 mm to 8 mm and 4.51% from 9.42% to 4.91%. Six patients had confirmed successful outcome, and all subjects were good compliance patients. The treatment lasted an average of 16.4 months, was well tolerated, and had no complication. Additionally, the rate of the successful treatment (final CVA ≤5 mm) significantly decreased when the wearing time per was shorter. Conclusion This study showed that treatment by cranial remodeling orthosis was effective if the patient could wear the helmet longer and treatment duration was somewhat longer than in younger patients, well tolerated in older infants and had no morbidity. This therapeutic option is available and indicated in these older infants before other cranial remodeling surgery.
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Affiliation(s)
- Hong Youl Kim
- Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Kyu Chung
- Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Oock Kim
- Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Korea
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Kluba S, Kraut W, Calgeer B, Reinert S, Krimmel M. Treatment of positional plagiocephaly--helmet or no helmet? J Craniomaxillofac Surg 2014; 42:683-8. [PMID: 24238984 DOI: 10.1016/j.jcms.2013.09.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 07/09/2013] [Accepted: 09/30/2013] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Positional plagiocephaly has attained widespread attention. There is a lot of data on helmet therapy available, but the natural course of the deformity has not been investigated in depth. The decision for or against helmet therapy can be controversial. This study examined the outcome of both options. METHODS 128 infants were enrolled in this prospective, non-randomized, longitudinal study. 62 were treated with and 66 without a helmet. The initial cranial vault asymmetry index (modified CVAI) was determined at 6.3 and 6.2 months of age (SD 1.44/2.14). Follow-up took place at the end of helmet therapy (age: 10.2 months, SD 1.77) or after 1 year (age: 18.5 months, SD 2.28) respectively. The outcome and the correlation of the changes to the initial asymmetry were compared. RESULTS All infants showed a significant reduction of their plagiocephaly. Although children with helmet had more severe asymmetry initially, they showed significantly better improvement (68% vs. 31%). Only a weak correlation was found between the initial asymmetry and the amount of improvement in both groups. CONCLUSION Despite concerns against helmet therapy (comfort, finances), it should be the treatment of choice for moderate to severe cases. Only mild cases (modified CVAI ≤ 6.5%) can be adequately treated by conservative, i.e. non-helmet, management.
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Schweitzer T, Böhm H, Linz C, Jager B, Gerstl L, Kunz F, Stellzig-Eisenhauer A, Ernestus RI, Krauß J, Meyer-Marcotty P. Three-dimensional analysis of positional plagiocephaly before and after molding helmet therapy in comparison to normal head growth. Childs Nerv Syst 2013; 29:1155-61. [PMID: 23371067 DOI: 10.1007/s00381-013-2030-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 01/09/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Stereophotogrammetry enables a simple and radiation free longitudinal analysis of skull asymmetries: in a three-dimensional coordinate system various distances (length, breadth, cephalic index, oblique diameters, ear shift, head circumference) can be analyzed. We also defined separate volume sections in order to further quantify the degree of asymmetry in the posterior and anterior components of both sides of the head. PATIENTS AND METHODS In 51 infants (mean age, 6 months; SD 0.97) with positional plagiocephaly, we determined these parameters at the beginning as well as at the end of molding helmet therapy (mean therapy time 4.9 months). Thirty-seven infants without positional deformity (mean age, 6.4 months; SD 0.3) served as control group and provided data about what appears to be normal and how these parameters change during growth over a comparable period of time. RESULTS Compared with the control group, the plagiocephalic heads were more brachycephalic, but closely approximated the normal shape under molding therapy. The striking volume difference between the left and right posterior sections in the plagiocephalic children (the mean volume of the flattened side being 21% smaller than the one on the contralateral side) improved as well (to a residual difference of mean 8%) and ended up with a value close to the control group (mean 6%). CONCLUSION There is a broad clinical application area for stereophotogrammetry analyzing skull morphology: In plagiocephalic infants we demonstrate impressive changes of head shape under molding therapy; in normal-looking infants we describe the extent of unperceived asymmetry.
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