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Cosmetic and cognitive outcomes of positional plagiocephaly treatment
Mohammed F Shamji1, Elana C Fric-Shamji, Praneal Merchant
1Divisaion of Neurosurgery, Children’s Hospital of Eastern Ontario, Ottawa, Canada.
Insights
Non-surgical management of positional plagiocephaly yields good cosmetic results. However, left-sided infant skull deformities are linked to language and academic challenges, requiring further investigation into causes and treatments.
Area of Science:
- Pediatric medicine
- Developmental pediatrics
- Craniofacial abnormalities
Background:
- Positional plagiocephaly is an acquired infant skull deformation caused by external forces.
- Non-surgical treatments include repositioning, supervised tummy time, and helmet orthotics.
- Long-term developmental impacts of positional plagiocephaly are not well-defined.
Purpose of the Study:
- To evaluate the cosmetic and cognitive outcomes of non-surgical positional plagiocephaly management.
- To assess the long-term effects on development, including school performance and language skills.
Main Methods:
- Surveys were administered to parents of children treated for positional plagiocephaly.
- Data collected included cosmetic outcome, school performance, language, cognitive development, and societal function.
- Pearson coefficient analysis examined outcome correlations with gender, age, and deformity side.
Main Results:
- Good cosmetic outcomes were observed in 75% of cases, with minimal residual asymmetry.
- Left-sided plagiocephaly was associated with poorer language development and academic performance.
- Patients with left-sided deformities showed increased expressive speech abnormalities and special education needs.
Conclusions:
- Non-surgical treatment for positional plagiocephaly generally results in favorable cosmetic outcomes.
- Left-sided infant skull deformities may predict difficulties in cognitive and scholastic areas.
- The study could not differentiate the roles of the condition versus treatment in developmental delays.
Purpose:
Positional plagiocephaly is an acquired deformation of an intrinsically normal infant skull by sustained or excessive extrinsic forces. Non-surgical techniques include counter-positioning, supervised prone time and orthotic molding for more refractory cases. Long-term effects of positional plagiocephaly on development remain undefined, and this study evaluated cosmetic and cognitive outcomes of plagiocephaly management.
Method:
Surveys were administered to parents of patients treated for positional plagiocephaly through the Children's Hospital of Eastern Ontario. Categorical responses interrogated cosmetic outcome, school performance, language skills, cognitive development and societal function. Pearson coefficient analysis tested outcomes dependency on gender, age, and plagiocephaly side at the 0.05 level of significance.
Results:
Eighty respondents (51 male, 29 female) were divided as 58 right- and 22 left-sided pathology. Positional therapy was uniformly applied, and a helmet orthosis was utilized in 36% of cases. Median follow-up age was nine years with normal head appearance in 75% of cases. Only 4% of parents and 9% of patients observed significant residual asymmetry. These results did not vary by gender, age or deformity side. Left-sided disease predicted poorer language development and academic performance. Expressive speech abnormality occurred in twice as many patients with left-sided disease (36% versus 16%, p=0.04) along with three-fold greater special education requirements (27% versus 10%, p=0.04).
Conclusions:
Non-surgical plagiocephaly management achieved good cosmetic outcome among patients in this study. Children with left-sided disease frequently encountered difficulties with cognitive and scholastic endeavors, although the roles of the underlying disease and the treatment measures in this delay cannot be differentiated.
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