Search Results (8)

Objectives: The objective of this study was to analyze the correlation between muscle tone distribution disorders and asymmetry, with specific postnatal positional cranial deformities in infants. The study focused on assessing the level of unilateral occipital flattening and the extent of symmetrical occipital flattening. Methods: The study involved 60 infants aged between 1 and 5 months. Each infant was neurologically diagnosed and assigned to one of three groups: asymmetry, reduced muscle tone, or increased muscle tone. Each group consisted of 20 infants (10 girls and 10 boys). A MIMOS craniometer was used to measure the infants’ head shapes, calculating the cranial vault asymmetry (mm) and cranial index (%). The data were analyzed and processed using Statistica software and appropriate statistical tests. Results: The results revealed a correlation between asymmetry and reduced muscle tone, increased muscle tone, and specific positional head deformities in infants up to the age of 5 months. Full article

Objectives: Positional deformity (PD), also known as deformational plagiocephaly or non-synostosis, is a primary cause of abnormal head shape and asymmetry in infants. The most common type, occipital plagiocephaly, leads to flattening of one side of the back of the head or the entire head (positional brachycephaly). PD results from external forces on the growing skull, often due to childbirth and improper positioning during sleep. The incidence is approximately 1 in 300 births, with prevalence peaking between the seventh week and four months of age. Our objective was to monitor craniofacial parameters in patients with positional deformity (PD), to evaluate cranial asymmetry and PD severity, and to determine the relationship between craniofacial asymmetry and PD severity. Methods: This study included patients from the Department of Pediatric Neurosurgery at the National Institute of Children’s Diseases and the Faculty of Medicine, Comenius University in Bratislava, Slovakia. Craniofacial parameters on the right and left sides of the face were examined. Results: Significant differences were found in the upper and middle thirds of the face, indicating a strong association between positional deformity and facial asymmetry. Conclusions: the findings contribute new insights into craniofacial anthropometry and neurosurgery, enhancing the diagnosis of positional deformity in Slovakian patients. Full article

Positional plagiocephaly is a deformational cranial flattening frequently treated in pediatric neurosurgical practice. Positional maneuvers and orthotic helmet therapy are preferred therapeutic options for moderate-to-severe forms. Treatment response seems to be age-dependent. Nevertheless, predictive data are vague, and cost-efficiency might be a limiting factor for treatment. The purpose of this study was to investigate the early predictive value of sonographic parameters on the efficacy of orthotic helmet therapy through the assessment of changes in skull shape and correlation of the parameters with caliper cephalometry values and with age. A consecutive cohort of 49 patients < 10 months of age, undergoing orthotic helmet therapy for positional plagiocephaly, was recruited prospectively. The authors routinely assessed the patency of the lambdoid sutures by ultrasound and the following additional skull parameters were measured: suture width, adjacent full bone thickness, adjacent cortical bone thickness and occipital angle. Caliper cephalometric values, as well as demographic and clinical data were collected. Retrospective data analysis showed an inverse relation between both cortical and full skull bone thickness and early treatment efficacy, defined by a reduction in the occipital angle. The improvement of sonographic parameters correlated with the development of cranial caliper cephalometry values. In conclusion, the sonographic assessment of skull bone thickness is a safe and cost-effective tool to predict the early efficacy of orthotic helmet therapy in positional plagiocephaly and might, therefore, help the clinician to foresee the potential evolution of the deformity. Full article

Tracheal hypoplasia is a major concern in brachycephalic dogs, but there is no consensus for the trachea in brachycephalic cats. We aimed to compare tracheal length and diameter between normo- and brachycephalic cats using computed tomography (CT) image measurements and evaluate their usefulness in tracheostomy planning. A total of 15 normocephalic and 14 brachycephalic cats were included in the study. Tracheas of normocephalic cats were significantly longer compared with brachycephalic cats. No difference was detected in tracheal diameter between normocephalic and brachycephalic cats. Both groups had a lateral diameter significantly larger than the dorsoventral diameter at the level of the cranial end of the manubrium sterni and at the level of the second rib. Normocephalic and brachycephalic cats’ tracheas have the same dorsoventral flattening at the level of the cranial end of the manubrium sterni and at the level of the second rib. The location between the 4th and 5th cervical vertebrae seems the best place to perform a tracheostomy in cats due to its round shape and easily accessible anatomical location. No sign of tracheal hypoplasia in brachycephalic cats was detected. Finally, 7 mm appears to be an adequate diameter for the tracheal tubes used to perform feline tracheostomies. Full article

Hip dysplasia is a disabling orthopedic disease in dogs. The aim of this retrospective study was to evaluate the morphological aspects and radiographic changes in the development of hip dysplasia in adult dogs, and to describe the frequency of each radiographic parameter according to each Fédération Cynologique Internationale (FCI) grade. Brass descriptive forms for the evaluation of hip dysplasia were obtained from the archive of the Italian Fondazione Salute Animale, and the radiographic evaluation of 642 hips were processed. Sixteen radiographic criteria were assessed, divided into six main parameters: acetabulum, femoral head and its position in the acetabulum, femoral neck, joint space, and Norberg angle. The initial mild alterations were shown in the craniolateral acetabular rim (31.8%), slightly divergent in the joint space in 58.6% of FCI-A. The spherical shape of the femoral head was mildly small/flattened in 56.9% of FCI-B, in addition to a slightly cylindrical-shaped femoral neck (60.5%) and slightly lost contours (55.0%). Changes in acetabular depth (45.0%), and in the cranial acetabular margin (56.7%) were found in FCI-C. The center of the femoral head was lateral to the dorsal acetabular rim in 70.0% of FCI-B; the Norberg angle appeared normal in 70.6% of FCI-B. Elaboration of the radiographic criteria from the Brass descriptive forms allowed for the extrapolation of accurate knowledge regarding morphologic changes in the development of dysplasia by providing detailed information for each individual. In particular, the present survey showed that the morphological alterations of the acetabulum prevailed over those of the femoral head only at the beginning of the development of canine hip dysplasia, and then worsened after the changes occurred in the femoral head and neck. Full article

This retrospective chart review focuses on determining the most effective time to begin cranial remolding orthosis (CRO) treatment for infants with asymmetrical brachycephaly. Subjects with asymmetrical brachycephaly started CRO treatment between 3 and 18 months of age. These infants had a cranial vault asymmetry index (CVAI) ≥ 3.5 and a cranial index (CI) ≥ 90. Subjects were excluded if they had any comorbidities affecting growth, dropped out of treatment, were lost to follow-up, or were noncompliant. Factors which were found to statistically influence treatment outcomes were subject initial age, initial CVAI, and initial CI. Overall, younger subjects were more likely to achieve a corrected head shape. The presence of prematurity or torticollis had statistically nonsignificant effects on the success of treatment. Initial CI was found to be a stronger predictor than initial CVAI as to which subjects achieved correction. The less severe the starting CI, the more likely the subject was to achieve full correction. The clinical understanding is that it requires more cranial growth to “round out” a full posterior skull flattening than an asymmetry. Based on the study results, infants with asymmetrical brachycephaly should be treated as early as possible to increase chances of achieving full correction of the deformity. Full article

Preterm infants are at higher risk for both symmetrical and asymmetrical head molding. This study involved 3D stereophotogrammetry to assess the cranial growth, molding, and incidence of deformational plagiocephaly (DP) in preterm children compared to term born children. Thirty-four preterm infants and 34 term born controls were enrolled in this study from Oulu University Hospital, Finland. Three-dimensional head images were obtained at the age of 2–4 months (T1), 5–7 months (T2), 11–13 months (T3), and 2.5–3 years (T4) from the term equivalent age (TEA). There was no statistically significant difference in oblique cranial length ratio (OCLR), cephalic index (CI), or weighted asymmetry score (wAS) between the two groups. Occipital flattening, defined by flatness score (FS) was statistically significantly greater in the preterm group than in the term group at T1–T4 (p < 0.05). In both groups, OCLR improved gradually over time. There were no instances, in either group, of severe DP and no moderate DP after T2. Results indicate that DP affects preterm and full-term children almost equally during the first three years of life, and cranial asymmetry resolves at a similar rate in both preterm and term groups after three months of corrected age. Preterm infants present with more occipital flattening than full-term children. Full article

The aim of this study is to review the effects of an infant’s presenting age and severity of deformation on cranial remolding orthotic (CRO) treatment outcomes for patients with deformational plagiocephaly. This study is a retrospective chart review of 499 infants with non-synostotic plagiocephaly who completed CRO treatment. Data collected included age at start of treatment, head shape measurements before and after treatment, total months of CRO treatment, and other factors such as presence/absence of prematurity. The infants were divided into subgroups according to age and severity at initiation of treatment and data for subgroups was analyzed to track the change in head shape over the course of treatment, review overall treatment duration, and discuss the rate of change of cranial deformation. Overall, treatment times tended to statistically increase with increasing initial severity and age. Posttreatment asymmetry measurements statistically trended to greater residual deformation in infants who began treatment in the older or more severe subcategories. This indicates that younger and less severe infants have shorter treatment durations and less residual cranial deformation after CRO treatment. Therefore, clinical consideration may need to be taken to treat infants at younger ages or prior to progression of the cranial deformity. Full article