Molding helmet therapy in the management of sagittal synostosis

The current surgical treatment of sagittal craniosynostosis often fails to produce a normal cephalic index; however, recent reports of early endoscopic suture release and postoperative helmet therapy promise improved cranial symmetry. The role of helmet therapy is critical in this approach, but there are few reports on the use of helmet therapy after craniosynostosis surgery. The authors present a retrospective review comparing the results of surgery alone versus surgery and postoperative banding in treating children diagnosed with sagittal synostosis. Cephalic index (CI) measurements and the divergence of the CI from the norm (DFN) were used to compare the banded and the non-banded groups. Included in the study were 21 children with sagittal craniosynostosis of whom 6 were treated with surgery alone and 15 were treated with surgery and postoperative banding. Preoperatively, both groups were significantly different from the norm (non-banded, P < 0.05; banded, P < 0.01), while postoperatively they were not significantly different from the norm. Statistically significant changes were present in the CIs of the banded group in the preoperative-follow-up interval (P < 0.01), while no significant changes occurred in the non-banded group during this same interval. Statistically significant changes in the DFN occurred in the preoperative-postoperative and preoperative-follow-up intervals of the banded group; however, these changes were not significant in the non-banded group during the same intervals. Correction toward a normal CI was seen in the banded group throughout the course of treatment, while this trend was not present in the non-banded group. Therefore, molding helmet therapy maintains the operative correction obtained and promotes more normal cranial growth patterns.