Comparison of helmet therapy and counter positioning for deformational plagiocephaly

Se Yon Kim, Moon-Sung Park, Jeong-In Yang, Shin-Young Yim, Se Yon Kim, Moon-Sung Park, Jeong-In Yang, Shin-Young Yim

Abstract

Objective: To compare effectiveness on correcting cranial and ear asymmetry between helmet therapy and counter positioning for deformational plagiocephaly (DP).

Methods: Retrospective data of children diagnosed with DP who visited our clinic from November 2010 to October 2012 were reviewed. Subjects ≤10 months of age who showed ≥10 mm of diagonal difference were included for analysis. For DP treatment, information on both helmet therapy and counter positioning was given and either of the two was chosen by each family. Head circumference, cranial asymmetry measurements including diagonal difference, cranial vault asymmetry index, radial symmetry index, and ear shift were obtained by 3-dimensional head-surface laser scan at the time of initiation and termination of therapy.

Results: Twenty-seven subjects were included: 21 had helmet therapy and 6 underwent counter positioning. There was no significant difference of baseline characteristics, head circumferences and cranial asymmetry measurements at the initiation of therapy. The mean duration of therapy was 4.30±1.27 months in the helmet therapy group and 4.08±0.95 months in the counter positioning group (p=0.770). While cranial asymmetry measurements improved in both groups, significantly more improvement was observed with helmet therapy. There was no significant difference of the head circumference growth between the two groups at the end of therapy.

Conclusion: Helmet therapy resulted in more favorable outcomes in correcting cranial and ear asymmetry than counter positioning on moderate to severe DP without compromising head growth.

Keywords: Cephalometry; Deformational plagiocephaly; Facial asymmetry; Nonsynostotic plagiocephaly; Patient positioning.

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
The head was to be positioned in a 45-degree turn, resting against a hard surface on the nonflattened side of occiput when the child was lying on its back.
Fig. 2
Fig. 2
Pictures showing anatomical landmarks (A) and the reference plane (B). Sellion is set at the most concave point in the soft tissue on the naso-frontal angle between the forehead slope and the proximal nasal bridge. Tragion is set at the upper margin of the tragus. After setting these landmarks the origin is set at the midpoint between the right and left tragia. Then the Y-axis is defined as a line through the sellion and the origin. The X-axis was defined as the line perpendicular to the Y-axis that crosses the origin. Level 0 is the reference cross-sectional plane including sellion and both tragia. The portion of the cranium superior to the reference plane was divided into 9 equally spaced cross-sectional planes, each parallel to the reference plane, where the level 10 is the plane through vertex. Anthropometric measurements on level 3 and 5 planes were used in this study.
Fig. 3
Fig. 3
(A) Diagonal difference (DD; mm)=longer diagonal (AB)-shorter diagonal (CD). Cranial vault asymmetry index (%)=DD/CD×100. (B) Radial symmetry index (mm)=|(A1+A2+...+A11)-(B1+B2+...+B11)|. (C) The ear shift (mm)=|a-b|.

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