Classification and pathogenic models of unintentional postural cranial deformities in infants: plagiocephalies and
Guillaume Captier1, David Dessauge, Marie-Christine Picot
1Service de Chirurgie Plastique Pédiatrique, Hôpital Lapeyronie, CHU Montpellier, France. captier@chu-montpellier.fr
Insights
Limited cervical mobility in infants may cause unintentional skull deformities. Early assessment and rehabilitation are crucial for preventing positional plagiocephaly and brachycephaly.
Area of Science:
- Pediatrics
- Neurology
- Developmental Biology
Background:
- Unintentional skull deformities in infants have seen a pseudoepidemic increase over the past 15 years.
- While supine positioning and prenatal factors contribute, postnatal cervical mobility deficits are increasingly recognized as key.
- Muscular factors limiting infant head and neck movement have been historically underestimated in causing skull deformities.
Purpose of the Study:
- To analyze the role of cervical mobility deficits in infant skull deformities.
- To propose a classification system for unintentional skull deformities based on pathogenic models.
- To emphasize early detection and intervention for improved infant outcomes.
Main Methods:
- Retrospective analysis of data from 181 infants diagnosed with unintentional skull deformities.
- Classification of deformities into three types based on clinical presentation and underlying cause.
- Review of potential muscular and neurological factors contributing to positional preferences.
Main Results:
- A classification system was proposed, categorizing deformities into: 1) Fronto-occipital plagiocephalies (myogenic hypertonia), 2) Occipital plagiocephalies (neurogenic hypertonia with muscle imbalance), and 3) Posterior brachycephalies (neurogenic hypertonia of suboccipital muscles due to occipitovertebral trauma).
- Evidence suggests a strong link between reduced cervical mobility and the development of these deformities.
- The study highlights the underestimation of muscular factors in the pathogenesis of positional skull deformities.
Conclusions:
- Cervical muscle hypertonia and restricted mobility are significant contributors to infant skull deformities.
- Early assessment of infant cervical mobility in the first week of life is vital for identifying potential issues.
- Prompt rehabilitation and appropriate postural management during supine sleep are recommended to prevent and manage these conditions.
Abstract:
Unintentional postural deformities of the skull have increased in a pseudoepidemic manner in the last 15 years. Although dorsal decubitus and prenatal risk factors can play a role in the genesis of such deformities, we think that a crucial determinant is a postnatal defect of cervical mobility responsible for the infant's posture (ie, positional preference) when supine. Indeed, muscular factors, which limit the range of head and neck movements, have been underestimated in the genesis of skull deformities. Here, we have retrospectively analyzed data from 181 infants with unintentional skull deformities and propose a classification of these deformities into 3 types based on their pathogenic model and clinical appearance: fronto-occipital plagiocephalies due to severe muscle hypertonia in which the myogenic component is the first implicated, occipital plagiocephalies with muscle imbalance due to neurogenic muscle hypertonia, and posterior brachycephalies with neurogenic muscle hypertonia of the suboccipital muscles due to trauma to the occipitovertebral junction. Future studies on the size and density of specific muscles or group of muscles should help us to better understand their involvement in the pathogenesis of postural deformities. Our findings also highlight the importance of carefully assessing cervical mobility during the first week of life to detect possible limitations and to prescribe (if needed) an adapted rehabilitation. Rehabilitation should be associated with postural measures put in place when infants sleep supine to prevent the appearance of skull deformations.
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