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The treatment of the positional plagiocephaly with a new thermoplastic orthotic device
Ferdinando Aliberti1, Luigi Pittore, Claudio Ruggiero
1Division of Paediatric Neurosurgery, Department of Neurological Sciences, Santobono Children's Hospital, Via M. Fiore 332, 80122 Naples, Italy. alibrain@libero.it
Insights
A new thermoplastic orthotic device (TOD) simplifies treatment for infant positional plagiocephaly. This custom-molded device offers improved adaptability and adjustable corrective forces for better cranial symmetry outcomes.
Area of Science:
- Pediatric Neurosurgery
- Craniofacial Abnormalities
- Orthotics and Prosthetics
Background:
- Posterior cranial asymmetry in infants is common, often caused by external factors like intrauterine constraint or postnatal positioning.
- Most cases are nonsynostotic plagiocephaly, distinct from lambdoidal synostosis.
- Conservative management includes positional therapy and orthotic molding with helmets or bands.
Purpose of the Study:
- To introduce a novel thermoplastic orthotic device (TOD) for treating nonsynostotic plagiocephaly.
- To simplify the manufacturing process of cranial orthoses.
- To enhance the modulation of corrective forces for improved treatment outcomes.
Main Methods:
- Development of a new orthotic device using thermoplastic materials.
- Direct molding of the thermoplastic orthotic device onto the infant's head.
- Utilizing the device's flexibility for adjustable corrective forces.
Main Results:
- Eliminates the need for traditional cranial impressions.
- Allows for easy remodeling and continuous adaptation of the device to the infant's growing skull.
- Offers superior flexibility for precise modulation of corrective forces.
Conclusions:
- The thermoplastic orthotic device (TOD) provides a simplified and adaptable solution for treating positional plagiocephaly.
- The device's design facilitates ongoing adjustments, ensuring optimal fit throughout treatment.
- Enhanced flexibility allows for tailored corrective forces, improving treatment efficacy for cranial asymmetry.
Introduction:
An increasing number of infants presenting with posterior cranial asymmetry are referred to the paediatric neurosurgeon for clinical evaluation. Most of these cranial dysmorphisms cannot be due to lambdoidal sinostosis, since they originate from pre- (intrauterine constraint) or postnatal (prematurity, torticollis, sleeping position) predisposing factors that have deformed the cranial vault. In the literature there is broad consensus about the conservative management of this nonsynostotic plagiocephaly by means of "positional therapy" or "orthoplasty moulding" with cranial helmets or bands. Some reports can be found about the effectiveness of so-called dynamic orthotic cranioplasty (DOC) to improve the cranial asymmetry.
Technical Note:
In order to simplify the manufacturing procedure and improve the modulation of the corrective forces, we have designed a new orthotic device (thermoplastic orthotic device, TOD) using thermoplastic materials that can be moulded directly on the infant's head.
Conclusion:
With this technique it is no longer necessary to take any cranial impressions and the orthotic device can be easily remodelled, ensuring perfect adaptability of the device to the cranial vault throughout the entire treatment. Moreover, the superior flexibility of this orthosis allows modulation of the corrective forces.