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Treated Versus Untreated Positional Head Deformity
Jan-Falco Wilbrand1, Nikolai Lautenbacher, Jörn Pons-Kühnemann
1*Department of Cranio-Maxillofacial Surgery †Department of Biostatistics ‡Department of Neurosurgery, University Hospital Giessen, Giessen, Germany.
Insights
Helmet therapy significantly improved positional head deformity in children over five years, showing greater improvement than untreated cases. This study contrasts with recent findings suggesting no benefit from helmet use.
Area of Science:
- Craniofacial Surgery
- Pediatric Orthopedics
- Developmental Pediatrics
Background:
- Positional head deformity is common in infants, often considered benign and self-correcting.
- Helmet therapy is frequently recommended for moderate to severe cases of deformational plagiocephaly and brachycephaly.
- Recent studies have questioned the efficacy of helmet therapy for positional head deformities.
Purpose of the Study:
- To evaluate the long-term clinical course of positional cranial deformation.
- To compare anthropometric parameters between children treated with orthotic helmets and untreated children.
- To assess the effectiveness of individual molding helmets in correcting nonsynostotic head deformities.
Main Methods:
- A 5-year observational study comparing treated and untreated children with positional cranial deformation.
- Anthropometric measurements including cranial vault asymmetry (CVA), cranial vault asymmetry index (CVAI), and oblique cranial length ratio (OCLR) were recorded.
- Patients were matched at baseline, with initial differences in CVA and CVAI noted between groups.
Main Results:
- Children treated with molding helmets showed significant improvement in CVA (ΔCVA 1.35 cm) and CVAI over 5 years.
- Untreated children exhibited minimal improvement in CVA (ΔCVA 0.01 cm) and CVAI during the same period.
- Despite baseline differences, helmet therapy demonstrated a clear positive impact on cranial symmetry.
Conclusions:
- Individual molding helmet therapy leads to significant improvement in nonsynostotic head deformities.
- Untreated positional cranial deformities show limited improvement in absolute measurements over a 5-year period.
- Findings suggest that helmet therapy is an effective treatment for positional head deformity, contrary to some recent research.
Background:
Positional head deformity in early childhood is asserted to be a benign and in some cases spontaneously correcting entity encountered in craniofacial surgery. Although many authors have stated that helmet therapy is indicated in moderate and severe cases of deformational plagiocephaly and brachycephaly; others have reported resolution of these conditions within the first 2 to 3 years of life. A recent randomized controlled trial found that helmet therapy does not have beneficial effects for patients with positional head deformity.
Methods:
The authors evaluated the clinical course of positional cranial deformation during a period of 5 years and compared the anthropometric parameters of orthotically treated versus untreated children within this timeframe.
Results:
Although the patients were matched with respect to their cranial deformation at baseline, there were significant differences in the cranial vault asymmetry (CVA), cranial vault asymmetry index (CVAI), and oblique cranial length ratio (OCLR) between Groups 1 and 2 at the initial point (P < 0.05). The mean CVA was 0.95 cm in Group 1 (no helmet) and 1.74 cm in Group 2 (helmet). The mean CVAI at baseline was 7.25 for Group 1 and 13.77 for Group 2. Approximately 5 years after the first examination, the authors found clear improvement in the mean CVA in Group 2 (ΔCVA 1.35 cm) compared with Group 1 (ΔCVA 0.01 cm) and the mean CVAI.
Conclusions:
In contrast to recently published studies, the authors found clear improvement in nonsynostotic head deformity treated with an individual molding helmet and no clear evidence of improvement of absolute measurements in untreated cranial deformity within a 5-year follow-up period.
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