Helmet Treatment of Infants With Deformational Brachycephaly

Kevin M Kelly, Edward F Joganic, Stephen P Beals, Jeff A Riggs, Mary Kay McGuire, Timothy R Littlefield, Kevin M Kelly, Edward F Joganic, Stephen P Beals, Jeff A Riggs, Mary Kay McGuire, Timothy R Littlefield

Abstract

Deformation of the cranium in infancy represents a spectrum of deformity, ranging from severe asymmetric yet proportional distortion of the skull in plagiocephaly, to nearly symmetric yet disproportional distortion in brachycephaly. As such, the condition is best described as deformational plagiocephaly-brachycephaly with isolated plagiocephaly and/or isolated brachycephaly being at either ends of the spectrum. Due to its symmetric appearance, deformational brachycephaly is often incorrectly dismissed as being less concerning, and it has sometimes erroneously been reported that brachycephaly cannot be treated successfully with a cranial orthosis. We prospectively report on 4205 infants with isolated deformational brachycephaly treated with a cranial orthosis from 2013 to 2017. These results demonstrate that the orthosis is successful in the treatment of deformational brachycephaly with an 81.4% improvement toward normal (95.0 to 89.4) in cephalic index. We furthermore demonstrate that entrance age influences treatment results, with younger infants demonstrating both improved outcomes and shorter treatment times.

Keywords: cephalic index; cranial orthosis; deformational brachycephaly; flat head syndrome.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Mr Littlefield, Mr Riggs, and Ms McGuire are employees of Cranial Technologies, Inc. The remaining authors have no financial or commercial interest.

Figures

Figure 1.
Figure 1.
Digital Surface Imaging. Image shown in (a) photographic, (b) solid, and (c) wireframe.
Figure 2.
Figure 2.
Female infant starting treatment at 4 months of age; initial cephalic index: 98.5; exit cephalic index: 89.3; treatment time 2¾ months (grid units 20 mm).
Figure 3.
Figure 3.
Mean treatment time by group (with 1 standard deviation bars).
Figure 4.
Figure 4.
Mean change in cephalic index by group (with 1 standard deviation bars).
Figure 5.
Figure 5.
Male infant entering treatment at 3¾ months of age; initial cephalic index: 102.3; exit cephalic index: 90.5; treatment time 3.25 months.
Figure 6.
Figure 6.
Male infant entering treatment at 8 months of age; initial cephalic index: 102.9; exit cephalic index: 91.1; treatment time 9.5 months.

References

    1. Pomatto JK, Calcaterra J, Kelly KM, Beals SP, Manwaring KH, Littlefield TR. A study of family head shape: environment alters cranial shape. Clin Pediatr (Phila). 2006;45:55-63.
    1. Lee RP, Teichgraeber JF, Baumgartner JE, et al. Long-term treatment effectiveness of molding helmet therapy in the correction of posterior deformational plagiocephaly: a five-year follow-up. Cleft Palate Craniofac J. 2008;45:240-245.
    1. Kawamoto HK, Kim SS, Jarrahy R, Bradley JP. Differential diagnosis of the idiopathic laterally deviated mandible. Plast Reconstr Surg. 2009;124:1599-1609.
    1. Meyer-Marcotty PDP, Boehm H, Linz C, et al. Head orthesis therapy in infants with unilateral positional plagiocephaly: an interdisciplinary approach to broadening the range of orthodontic treatment. J Orofac Orthop. 2012;73:151-165.
    1. Kim SJ, Lee KJ, Lee SH, Baik HS. Morphologic relationship between the cranial base and the mandible in patients with facial asymmetry and mandibular prognathism. Am J Orthod Dentofacial Orthop. 2013;144:330-340.
    1. Kluba S, Roßkopf F, Kraut W, et al. Malocclusion in the primary dentition in children with and without deformational plagiocephaly. Clin Oral Investig. 2016;20:2395-2401.
    1. Kreutz M, Fitze B, Blecher C, et al. Facial asymmetry correction with moulded helmet therapy in infants with deformational skull base plagiocephaly. J Craniomaxillofac Surg. 2018;46:28-34.
    1. Enlow DH, McNamara JA., Jr. The neurocranial basis for facial form and pattern. Angle Orthod. 1973;43:256-270.
    1. Bhat M, Enlow DH. Facial variations related to headform type. Angle Orthod. 1985;55:269-280.
    1. Enlow DH, Kuroda T, Lewis AB. Intrinsic craniofacial compensations. Angle Orthod. 1971;41:271-285.
    1. Enlow DH, Hunter WS. The growth of the face in relation to the cranial base. Rep Congr Eur Orthod Soc. 1968;44:321-325.
    1. Enlow DH. Facial growth and development. Int J Oral Myol. 1979;5:7-10.
    1. Martone VD, Enlow DH, Hans MG, Broadbent BH, Jr, Oyen O. Class I and class III malocclusion sub-groupings related to head form type. Angle Orthod. 1992;62:35-44.
    1. Cakirer B, Hans MG, Graham G, Aylor J, Tishler PV, Redline S. The relationship between craniofacial morphology and obstructive sleep apnea in whites and African-Americans. Am J Respir Crit Care Med. 2001;163:947-950.
    1. Cheng MC, Enlow DH, Papsidero M, Broadbent BH, Jr, Oyen O, Sabat M. Developmental effects of impaired breathing in the face of the growing child. Angle Orthod. 1988;58:309-320.
    1. Hans MG, Nelson S, Pracharktam N, Baek SJ, Strohl K, Redline S. Subgrouping persons with snoring and/or apnea by using anthropometric and cephalometric measures. Sleep Breath. 2001;5:79-91.
    1. Pracharktam N, Nelson S, Hans MG, et al. Cephalometric assessment in obstructive sleep apnea. Am J Orthod Dentofacial Orthop. 1996;109:410-419.
    1. Pracharktam N, Hans MG, Stohl KP, Redline S. Upright and supine cephalometric evaluation of obstructive sleep apnea syndrome and snoring subjects. Angle Orthod. 1994;64:63-73.
    1. Alexander R, Boehme R, Cupps B. Normal Development of Functional Motor Skills: The First Year of Life. 1st ed. San Antonio, TX: Therapy Skill Builders; 1998.
    1. Karmel-Ross K. Congenital muscular tortocillis. In: Campbell SK, Palisano RJ, Orlin MN, eds. Physical Therapy for Children. 4th ed. St. Louis, MO: Elsevier Saunders; 2012:292-312.
    1. Cabrera-Martos I, Valenza MC, Valenza-Demet G, Benitez-Feliponi Á, Robles-Vizcaino C, Ruiz-Extremera Á. Repercussions of plagiocephaly on posture, muscle flexibility and balance in children aged 3-5 years old. J Paediatr Child Health. 2016;52:541-546.
    1. Leung A, Watter P, Gavranich J. Characteristics of infants with positional abnormal head shapes and their physiotherapy service at an Australian community health facility. Pediatric Health Med Ther. 2014;5:83-92.
    1. Murgia M, Venditto T, Paoloni M, et al. Assessing the cervical range of motion in infants with positional plagiocephaly. J Craniofac Surg. 2016;27:1060-1064.
    1. Collett BR, Aylward EH, Berg J, et al. Brain volume and shape in infants with deformational plagiocephaly. Childs Nerv Syst. 2012;28:1083-1090.
    1. Pathmanaban ON, Burke KA, Leach P, Thorne J, Kamaly-Asl ID. Nonsynostotic posterior brachycephaly with hindbrain herniation. World Neurosurg. 2017;97:755.e11-755.e15.
    1. Flannery AB, Looman WS, Kemper K. Evidence-based care of the child with deformational plagiocephaly, part II: management. J Pediatr Health Care. 2012;26:320-331.
    1. Teichgraeber JF, Seymour-Dempsey K, Baumgartner JE, Xia JJ, Waller AL, Gateno J. Molding helmet therapy in the treatment of brachycephaly and plagiocephaly. J Craniofac Surg. 2004;15:118-123.
    1. Graham JM, Jr, Kreutzman J, Earl D, Halber A, Samyoa C, Guo X. Deformational brachycephaly in supine-sleeping infants. J Pediatr. 2005;146:253-257.
    1. Littlefield TR, Kelly KM, Pomatto JK, Beals SP. Multiple-birth infants at higher risk for development of deformational plagiocephaly. Pediatrics. 1999;103:565-569.
    1. Littlefield TR, Kelly KM, Pomatto JK, Beals SP. Multiple-birth infants at higher risk for development of deformational plagiocephaly: II. Is one twin at greater risk? Pediatrics. 2002;109:19-25.
    1. Joganic JL, Lynch JM, Littlefield TR, Verrelli BC. Risk factors associated with deformational plagiocephaly. Pediatrics. 2009;124:e1126-e1133.
    1. Littlefield TR, Kelly KM, Cherney JC, Beals SP, Pomatto JK. Development of a new three-dimensional cranial imaging system. J Craniofac Surg. 2004;15:175-181.
    1. Littlefield TR, Cherney JC, Luisi JN, Beals SP, Kelly KM, Pomatto JK. Comparison of plaster casting with three-dimensional cranial imaging. Cleft Palate Craniofac J. 2005;42:157-164.
    1. VAM [computer software]. Fairfield, NJ: Canfield Scientific.
    1. Ripley CE, Pomatto JK, Beals SP, Joganic EF, Manwaring KH, Moss SD. Treatment of positional plagiocephaly with dynamic orthotic cranioplasty. J Craniofac Surg. 1994;5:150-160.
    1. Littlefield TR, Beals SP, Manwaring KH, et al. Treatment of craniofacial asymmetry with dynamic orthotic cranioplasty. J Craniofac Surg. 1998;9:11-19.
    1. Kelly KM, Littlefield TR, Pomatto JK, Ripley CE, Beals SP, Joganic EF. Importance of early recognition and treatment of deformational plagiocephaly. Cleft Palate Craniofac J. 1999;36:127-130.
    1. SAS Institute Inc. What’s New in SAS® 9.4. Cary, NC: SAS Institute Inc; 2013.
    1. Littlefield TR, Kelly KM, Reiff JL, Pomatto JK. Car seats, infant carriers, and swings: their role in deformational plagiocephaly. J Prosthet Orthot. 2003;15:102-106.
    1. Hrdlicka A. Physiological and Medical Observations Among the Indians of Southwestern United States and Northern Mexico. Bulletin 34. Washington, DC: Bureau of American Ethnology; 1908:79-81.
    1. Dingwall EJ. Artificial Cranial Deformation—A Contribution to the Study of Ethnic Mutilation. London, England: John Bale, Sons & Danielson, Ltd; 1931.
    1. Davis BE, Moon RY, Sachs HC, Ottolini MC. Effects of sleep position on infant motor development. Pediatrics. 1998;102:1135-1140.
    1. Persing J, James H, Swanson J, Kattwinkel J; American Academy of Pediatrics Committee on Practice and Ambulatory Medicine, Section on Plastic Surgery and Section on Neurological Surgery. Prevention and management of positional skull deformities in infants. American Academy of Pediatrics Committee on Practice and Ambulatory Medicine, Section on Plastic Surgery and Section on Neurological Surgery. Pediatrics. 2003;112(1 pt 1):199-202.
    1. Kluba S, Kraut W, Reinert S, Krimmel M. What is the optimal time to start helmet therapy in positional plagiocephaly? Plast Reconstr Surg. 2011;128:492-498.
    1. Mortenson P, Steinbok P, Smith D. Deformational plagiocephaly and orthotic treatment: indications and limitations. Childs Nerv Syst. 2012;28:1407-1412.
    1. Seruya M, Oh AK, Taylor JH, Sauerhammer TM, Rogers GF. Helmet treatment of deformational plagiocephaly: the relationship between age at initiation and rate of correction. Plast Reconstr Surg. 2013;131:55e-61e.
    1. Freudlsperger C, Steinmacher S, Saure D, et al. Impact of severity and therapy onset on helmet therapy in positional plagiocephaly. J Craniomaxillofac Surg. 2016;44:110-115.
    1. Steinberg JP, Rawlani R, Humpries LS, Rawlani V, Vicari FA. Effectiveness of conservative therapy and helmet therapy for positional cranial deformation. Plast Reconstr Surg. 2015;135:833-842.
    1. Matarazzo CG, Pinto FCG, Peccin MS, Schreen G. Orthotic treatment of cranial asymmetries: comparison between early and late interventions. J Prosthet Orthot. 2016;28:15-22.
    1. Han MH, Kang JY, Han HY, Cho YH, Jang DH. Relationship between starting age of cranial-remolding-orthosis therapy and effectiveness of treatment in children with deformational plagiocephaly. Childs Nerv Syst. 2017;33:1349-1356.
    1. Kunz F, Schweitzer T, Kunz J, et al. Head orthosis therapy in positional plagiocephaly: influence of age and severity of asymmetry on effect and duration of therapy. Plast Reconstr Surg. 2017;140:349-358.
    1. Lam S, Pan IW, Strickland BA, et al. Factors influencing outcomes of the treatment of positional plagiocephaly in infants: a 7-year experience. J Neurosurg Pediatr. 2017;19:273-281.
    1. Robinson S, Proctor M. Diagnosis and management of deformational plagiocephaly. J Neurosurg Pediatr. 2009;3:284-295.
    1. Rogers GF. Deformational plagiocephaly, brachycephaly, and scaphocephaly. Part II: prevention and treatment. J Craniofac Surg. 2011;22:17-23.
    1. Wilbrand JF, Wilbrand M, Pons-Kuehnemann J, et al. Value and reliability of anthropometric measurements of cranial deformity in early childhood. J Craniomaxillofac Surg. 2011;39:24-29.
    1. Lipira AB, Gordon S, Darvann TA, et al. Helmet versus active repositioning for plagiocephaly: a three-dimensional analysis. Pediatrics. 2010;126:e936-e945.
    1. Moghaddam MB, Brown TM, Clausen A, DaSilva T, Ho E, Forrest CR. Outcome analysis after helmet therapy using 3D photogrammetry in patients with deformational plagiocephaly: the role of root mean square. J Plast Reconstr Aesthet Surg. 2014;67:159-165.
    1. Rogers GF. Deformational plagiocephaly, brachycephaly, and scaphocephaly. Part I: terminology, diagnosis, and etiopathogenesis. J Craniofac Surg. 2011;22:9-16.
    1. Meyer-Marcotty P, Böhm H, Linz C, et al. Spectrum of positional deformities—is there a real difference between plagiocephaly and brachycephaly? J Craniomaxillofac Surg. 2014;42:1010-1016.

Source: PubMed

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