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Posterior plagiocephaly
1Department of Neurological Surgery, Division of Pediatric Neurosurgery, Primary Children's Medical Center, University of Utah, Salt Lake City, UT 84113, USA.
Insights
Posterior plagiocephaly, often deformational, has increased since the "Back to Sleep" campaign. Accurate diagnosis differentiating deformational from synostotic plagiocephaly is crucial for appropriate infant treatment.
Area of Science:
- Pediatric medicine
- Craniofacial anomalies
- Public health initiatives
Background:
- Infant cranial asymmetry, or plagiocephaly, stems from abnormal sutural development (synostotic) or external forces (deformational).
- The incidence of posterior plagiocephaly has significantly risen following the 'Back to Sleep' campaign for sudden infant death syndrome prevention.
Purpose of the Study:
- To differentiate between deformational and synostotic plagiocephaly.
- To highlight diagnostic methods and treatment implications for infant cranial asymmetry.
Main Methods:
- Clinical examination and radiological imaging, including computed tomography (CT), are essential for diagnosis.
- Review of clinical features and diagnostic modalities for posterior plagiocephaly.
Main Results:
- Deformational plagiocephaly constitutes the majority of recent posterior plagiocephaly cases.
- Accurate differentiation is critical as treatments differ significantly: conservative for deformational, surgical for synostotic.
Conclusions:
- While often benign, increased plagiocephaly cases warrant vigilance for potential developmental issues.
- Prompt and accurate diagnosis ensures appropriate management, distinguishing between positional molding and craniosynostosis.
Introduction:
Asymmetrical cranial vaults resulting from external forces on an infant's head can be caused by abnormal sutural development (synostotic plagiocephaly) or abnormal external forces acting on an intrinsically normal, developing cranium (deformational plagiocephaly).
Discussion:
The incidence of posterior plagiocephaly has increased dramatically since the initiation of the "Back to Sleep" campaign against sudden infant death syndrome. The majority of cases are due to deformational plagiocephaly, but rigorous diagnostic evaluation including physical examination and radiological imaging must be undertaken to rule out lambdoid synostosis in extreme or refractory cases.
Conclusion:
Unique clinical features and radiological examination using computed tomography technology are helpful in confirming the correct cause of posterior plagiocephaly. Plagiocephaly is considered a benign condition, but with the recent increase in cases, new studies have revealed developmental problems associated with cranial vault asymmetries. Treatment of positional/deformational plagiocephaly includes conservative measures, primarily behavior modification, and, in some cases, helmet therapy, whereas lambdoid synostotic plagiocephaly requires surgical intervention, making differentiation of the cause of the asymmetry critical.
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