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Posterior positional plagiocephaly treated with cranial remodeling orthosis
S de Ribaupierre1, O Vernet, B Rilliet
1Service of Neurosurgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. s_derib@hotmail.com
Insights
Dynamic orthotic cranioplasty effectively treats posterior positional plagiocephaly in infants. This cranial remodelling helmet therapy is well-tolerated and recommended when physiotherapy is insufficient.
Area of Science:
- Pediatric orthopedics
- Craniofacial abnormalities
Background:
- Supine sleeping position recommendations have increased posterior positional plagiocephaly in infants.
- While often cosmetic, severe plagiocephaly can cause psychological distress.
- Physiotherapy is effective for mild to moderate cases, but severe cases require active intervention.
Purpose of the Study:
- To evaluate the efficacy and safety of dynamic orthotic cranioplasty for posterior positional plagiocephaly.
Main Methods:
- A prospective study of 260 infants treated with dynamic orthotic cranioplasty.
- Treatment was conducted in Lausanne between 1995 and 2001.
- Detailed description of cranial remodelling helmet construction.
Main Results:
- The average treatment duration was 3 months.
- The therapy demonstrated high effectiveness and good tolerability.
- Zero morbidity was reported, with an ideal treatment initiation period between 4 and 6 months of age.
Conclusions:
- Dynamic orthotic cranioplasty is a recommended treatment for infants with posterior positional plagiocephaly unresponsive to physiotherapy.
- Helmet therapy should be considered before surgical intervention for positional plagiocephaly in the first year of life.
Principles:
Since the recommendation that infants sleep in the supine position, there has been an increase in cases of posterior positional plagiocephaly. Even though this condition is a purely cosmetic problem, if it is severe it may affect the child psychologically. Positioning may help in mild or moderate cases, but more active treatment may be necessary in severe cases.
Methods:
A prospective study of 260 children treated by dynamic orthotic cranioplasty for posterior positional plagiocephaly was conducted in Lausanne from 1995 to 2001. Construction of these cranial remodelling helmets is decribed in detail.
Results:
The treatment lasted 3 months on average, was effective, well tolerated, and had zero morbidity. The ideal period for initiating this therapy is between the ages of 4 and 6 months.
Conclusion:
The remodelling helmet is a convincing option which can be recommended in infants with posterior positional plagiocephaly whose skull deformity is not satisfactorily corrected by physiotherapy. It should always be used before surgery is considered for patients with recognised positional plagiocephaly in the first year of life.
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