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[Positional plagiocephaly. Diagnosis and treatment]
J Esparza1, J Hinojosa, M J Muñoz
1Unidad de Cirugía Craneofacial (Servicios de Neurocirugía Pediátrica), Hospital Infantil 12 de Octubre, Madrid.
Insights
Positional plagiocephaly, a common condition, requires clear diagnosis and staged treatment. This protocol clarifies management for mild to severe cases, prioritizing conservative measures before surgical intervention.
Area of Science:
- Pediatric Neurosurgery
- Cranial Deformities
- Developmental Pediatrics
Context:
- Positional plagiocephaly is the most frequent consultation in pediatric neurosurgery in Western countries.
- Existing literature presents confusion regarding terminology, pathophysiology, and differential diagnosis with synostosis.
- A clear protocol is needed for consistent diagnosis and management.
Purpose:
- To clarify concepts surrounding positional plagiocephaly.
- To present a standardized protocol for diagnosis and treatment.
- To improve coordination between pediatricians and neurosurgeons.
Summary:
- A staged treatment protocol is proposed for positional plagiocephaly, classifying severity (mild, moderate, severe) via digital photography.
- Management involves a two-phase approach: a pediatric phase (up to 5 months) focusing on postural changes and physiotherapy, followed by a neurosurgical phase (from 5 months).
- Referral to neurosurgery is recommended only after conservative measures are exhausted by 5 months of age.
Impact:
- Provides a clear, staged treatment pathway for positional plagiocephaly.
- Enhances collaboration between pediatricians and neurosurgeons.
- Offers precise information for healthcare providers and parents, improving patient outcomes.
Introduction:
Positional plagiocephaly is nowadays the most frequent consultation at pediatric neurosurgical departments in Spain and western countries. Another important issue is the confusion existing in literature regarding terminology, physiopathology, differential diagnosis with true synostosis and, of course, proper recommendations for treatment.
Objectives:
To clarify all these concepts and present a protocol that was recently asked by the Health Administration of the Community of Madrid.
Protocol:
Pretends to achieve coordination among paediatricians and neurosurgeons, as much as to offer precise information about data concerning this entity for parents, paediatricians and neurosurgeons.
Material And Methods:
Previous consensus is reached about some data. Children are classified in three categories of deformation (mild; moderate; severe), according to measurements on digital photography. Diagnosis and treatment follows two phases: Paediatric phase (up to 5 months of age) and Neurosurgical phase (from 5 months on). Children would be referred to neurosurgical consultation only after being treated with postural changes and physiotherapy by the age of 5 months. Reasons are explained in the protocol that defines also functions and responsibilities for each speciality.
Conclusion:
Treatment proposed here is staged, starting with postural changes and physiotherapy, followed by orthotic cranial devices and finally surgical treatment.
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