Adjunct Use of Orthotic Therapy in Patients With Craniosynostosis and Concurrent Plagiocephaly or Brachycephaly

Craniosynostosis (CS), the premature fusion of 1 or more cranial sutures, can present with coexisting deformation plagiocephaly or brachiocephaly. While surgical correction is the standard for CS, the management of cases with concurrent positional head shape deformities remains undefined. This study aims to describe clinical outcomes in this subset of patients and evaluate the role of adjunct orthotic therapy in their management. A retrospective chart review was conducted from February 2016 to February 2021, including patients diagnosed with CS and concurrent deformational plagiocephaly or brachycephaly who underwent orthotic therapy postsurgery. Exclusion criteria included cases without orthotic intervention. Patient demographics, suture involvement, head shape, surgical details, cephalic ratio (CR), and cranial vault asymmetry (CVA) pre- and posttreatment were analyzed. A paired 2-sample Student t test assessed treatment outcomes. Patients with plagiocephaly (n=7, CVA ≥5 mm) showed significant improvement, with mean CVA decreasing from 10.99 mm preoperatively to 2.73 mm posttreatment ( P =0.00023). Patients with brachycephaly (n=8, CR ≥0.9) demonstrated a reduction in CR from 0.9575 to 0.8999 ( P =0.0016) after orthotic therapy. The average duration of helmet therapy was 5.3 months, with an average follow-up period was 2.2 years. These findings suggest that adjunct orthotic therapy may support improved cranial symmetry in patients with CS and concurrent deformational asymmetry. This study highlights the need to recognize CS with concurrent deformational plagiocephaly or brachycephaly as a distinct clinical presentation. Recognizing and treating this dual-pathology subset may enhance surgical outcomes and warrants further study in prospective, controlled settings.