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Comparative Evaluation of Measurement Methods for Positional Skull Deformities in Infants: A Prospective Analysis.
Jan-Falco Wilbrand1, Richard Krüger2, Jörn Pons-Kuehnemann3
1Department of Cranio-Maxillofacial Surgery, Dr. Jan-Falco Wilbrand, Diakonie Klinikum, Siegen, Germany.
The Journal of Craniofacial Surgery
|November 14, 2025
Summary
Caliper measurements are a fast, cost-effective screening tool for infant positional skull deformities. 3D photogrammetry is recommended for treatment planning, while plagiocephalometry offers no significant daily practice advantages.
Area of Science:
- Pediatric orthopedics
- Infant health
- Cranial morphology
Background:
- Increased incidence of infant positional skull deformities following SIDS prevention campaigns.
- Discrepancies in measurement methods (anthropometry, 3D photogrammetry, plagiocephalometry) affect severity classification and treatment decisions.
- Need for harmonized assessment protocols for cranial asymmetries.
Purpose of the Study:
- To prospectively compare caliper-based anthropometry, 3D photogrammetry, and plagiocephalometry for evaluating infant cranial deformity.
- To assess the reproducibility of each measurement technique.
- To evaluate the impact of each method on clinical decision-making for treatment.
Main Methods:
- Prospective study of 51 infants (3-12 months) undergoing outpatient helmet consultation.
- Measurements using standardized direct anthropometry (caliper/tape), 3D photogrammetry (multicamera system, Cranioform Analytics 4.0), and plagiocephalometry (thermoplastic strip).
- Calculation of key indices: cephalic index (CI) and cranial vault asymmetry index (CVAI)/occipital depth difference index (ODDI). Variance component and Bland-Altman analyses were performed.
Main Results:
- Caliper measurement was the "gold standard" with a treatment threshold of CVA ≥ 1.0 cm.
- 3D photogrammetry showed excellent reproducibility with minimal bias (CI systematic error -0.77).
- Plagiocephalometry exhibited slightly higher CI bias (-1.35) and offered no significant advantages over other methods despite high reliability. Caliper screening identified more infants needing orthotic treatment.
Conclusions:
- Caliper measurement is a rapid, cost-effective screening tool for infant cranial deformities.
- 3D photogrammetry is recommended for detailed treatment planning.
- Standardization of measurement landmarks and index calculation is crucial for international harmonization of clinical decision-making.
