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[Postural deformities of the skull. Advantages of protocolization in its treatment]
A Y Molina Caballero1, A Pérez Martínez1, S Hernández Martín1
1Servicio de Cirugía Pediatría. Complejo Hospitalario de Navarra. Pamplona, Navarra.
Insights
A new protocol improved care for children with cranial deformities. Postural treatment and family support effectively reduced the need for cranial orthosis in many cases.
Area of Science:
- Pediatric medicine
- Craniofacial abnormalities
Background:
- Increasing demand for pediatric cranial deformity treatment.
- Limited professionals necessitated in-house management.
- Experience gained since 2007.
Purpose of the Study:
- To present experience in treating children with cranial deformities.
- To evaluate the impact of a standardized treatment protocol.
- To assess the efficacy of postural therapy versus orthosis.
Main Methods:
- Retrospective study of 261 pediatric patients (2010-2015).
- Data collected: age, skull measurements, cranial index, treatment type.
- Protocol implemented in 2012 for standardized care and follow-up.
Main Results:
- 151 patients with complete data analyzed.
- Postural treatment was primary; orthosis used for non-responders.
- 66.8% of orthosis patients and 64.4% of postural-only patients showed improvement to milder forms.
Conclusions:
- Protocol implementation unified patient care and follow-up.
- Need for improved precision and reproducibility in cranial measurement.
- Effective postural treatment and family support minimize orthosis use.
Introduction:
Since 2007, we have examined in our medical practice children with cranial deformities. The increasing demand and lack of professionals dedicated to it has forced us to assume the treatment of this disease. We present our experience.
Material And Methods:
Retrospective study of patients with cranial deformities treated from 2010 to 2015. We collected data as age at the first visit and at discharge, sequential measurements of the skull and cranial index, type of treatment prescribed (postural, orthosis or both) and consultation requested to other specialties. In the first stage (2010-2012), each surgeon prescribed the treatment he considered appropriate. Since November 2012 a protocol has been implemented, it includes guideline sheets for the surgeon and parents with information on postural therapy and graphs to record the measurements.
Results:
We have treated 261 patients. Two were diagnosed with craniosynostosis. From the rest, only 151 possessed complete quantitative data and were included in the study with 105 men and 46 women and a mean age of 5.8 months (± 1.9 months). There were 23 pure brachycephaly, 126 mixed forms and 2 pure plagiocephaly. A significant disparity between observers' measurements was noticed. All patients underwent a protocolized postural treatment. In 36 patients who did not improve with postural treatment, cranial orthosis was prescribed with good response: 66.8% became mild forms. Those who maintained only postural treatment also improved to milder forms in 64.4%.
Conclusions:
The implementation of a protocol has enabled us to unify the care and follow-up of these patients. Cranial measurement techniques should be more precise and reproducible. Good postural treatment and empathy with the family reduce the use of orthosis in carefully selected cases.
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