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Published on: November 20, 2015
Clinical presentation and management of 100 infants with occipital plagiocephaly
I K Pople1, R A Sanford, M S Muhlbauer
1Semmes-Murphey Clinic, Memphis, Tenn. 38103, USA.
Insights
Most infants with occipital plagiocephaly improve with non-surgical methods like physical therapy. Surgery is effective for a small subset with specific lambdoid suture issues, offering good cosmetic outcomes.
Area of Science:
- Neurosurgery
- Pediatric Orthopedics
- Developmental Pediatrics
Background:
- Occipital plagiocephaly is a common condition in infants.
- Management strategies range from conservative to surgical interventions.
- Identifying appropriate candidates for each approach is crucial.
Purpose of the Study:
- To evaluate the outcomes of surgical and nonsurgical management for occipital plagiocephaly.
- To identify predictors for successful treatment in infants.
Main Methods:
- Retrospective analysis of 100 consecutive infants with occipital plagiocephaly over 15 years.
- Categorization into surgical (n=18) and nonsurgical (n=82) groups based on deformity progression and suture fusion.
- Assessment of cosmetic outcomes and clinical improvement post-treatment.
Main Results:
- Nonsurgical management (physical therapy, sleep positioning) led to satisfaction in all parents, with 63% showing improvement and 27% stabilization.
- Surgical intervention for 18 infants (lambdoid suture resection) resulted in good cosmetic outcomes with no complications.
- True lambdoid synostosis or marked internal ridging was confirmed in 16 of the 18 surgical cases.
Conclusions:
- The majority of infants with occipital plagiocephaly can be successfully managed non-surgically.
- Surgical intervention is beneficial for a specific subgroup (18%) with radiological signs of fusion or significant suture ridging.
- Differentiating features between surgical and nonsurgical candidates are discussed for optimized treatment planning.
Abstract:
One hundred consecutive infants who presented with occipital plagiocephaly over 15 years were analyzed retrospectively to determine results of both surgical and nonsurgical management. Eighteen infants who showed obvious progression of their deformity or radiological signs of fusion of the lambdoid suture had surgical resection of one or both lambdoid sutures and the remaining 82 infants were treated nonsurgically with physical therapy and advice on sleeping position. Of the 18 surgical cases 9 were found at operation to have true lambdoid synostosis, 7 had marked internal ridging of the lambdoid suture and 2 had an open suture. After a mean follow-up period of 6 months all parents of the 82 children treated nonsurgically were satisfied with their child's cosmetic appearance: 63% showed improvement in their plagiocephaly and 27% stabilized. There were no surgical complications in the 18 operative cases, all of whom had a good cosmetic result. From these results we conclude that the majority of infants referred to neurosurgeons with occipital plagiocephaly can be successfully managed nonsurgically. A small proportion of cases (18% with radiological signs of fusion or pronounced ridging of the suture) appeared to benefit from surgery. The clinical, radiological and pathological differentiating features of the surgical and nonsurgical cases are discussed.
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