Search Results (21)

Background: Helmet therapy is considered to be a treatment for infants with positional plagiocephaly. Although some studies suggest that anterior fontanelle (AF) size may also affect treatment outcomes, evidence and influence remain unclear. The aim of this study is to assess the impact of anterior fontanelle size on the effectiveness of helmet therapy, with the goal of determining the optimal timing and patient criteria for treatment. Methods: We conducted a retrospective study of 94 infants treated with helmet therapy for positional plagiocephaly at Kwangju Christian Hospital between January 2020 and December 2021. Patients were divided into two age groups (≤6 months and >6 months) and three SAF quartiles (≤25%, 25–75%, ≥75%). Parameters reflecting the degree of cranial asymmetry correction, including cranial vault asymmetry (CVA) and cranial vault asymmetry index (CVAI), were recorded at the start and end of treatment. Results: Infants aged ≤6 months showed significantly greater improvements in cranial vault asymmetry (CVA) and cranial vault asymmetry index (CVAI) compared to older infants (CVA: 4.57 ± 2.30 mm vs. 7.04 ± 3.85 mm, p = 0.003; CVAI: 3.10 ± 1.55% vs. 4.45 ± 2.44%, p = 0.011). When analyzed by anterior fontanelle (AF) size quartiles (≤25%, 25–75%, ≥75%), no significant differences in treatment outcomes were observed at the end of therapy for CVA (p = 0.88) or CVAI (p = 0.91). In infants ≤6 months, SAF quartile analysis also showed no significant differences in CVA (p = 0.97) or CVAI (p = 0.98) improvements. Conclusions: Our findings indicate that anterior fontanelle size is not a predictor of helmet therapy outcomes in positional plagiocephaly. Early initiation of helmet therapy (≤6 months) remains the most critical factor for achieving optimal results. Full article

Background/Objectives: Deformational plagiocephaly (DP) is defined as an asymmetrical flattening of infants’ occipital skull. Helmet therapy is one of the treatments reported that can reduce skull deformity by guiding the growing direction of the head. However, its effectiveness remains insufficiently validated in the literature due to variability in treatment protocols and regimes. This study aims to evaluate the clinical outcomes of helmet therapy in infants with deformational plagiocephaly. Methods: This single-center retrospective study was conducted at a tertiary university hospital and included 30 consecutive infants (mean age 7.83 ± 2.51 months) who attended a pediatric orthopedic outpatient clinic between 2022 and 2025. Infants without craniosynostosis and with cranial vault asymmetry index (CVAI) ≥ 5% were prescribed a course of helmet therapy (mean duration 3.77 ± 2.37 months). The primary outcome was the change in CVAI. Results: The mean CVAI (%) significantly decreased from 7.57 ± 2.45 to 6.10 ± 2.63 (p = 0.002). The effect of helmet therapy was dose-dependent, with greater improvement observed in infants wearing the helmet for at least 6 h per day. Poor compliance and predominantly daytime helmet use were associated with less improvement. Increased sweating and mild skin redness were the most common reported adverse effects, but the skin redness can be relieved by proper donning of the helmet. Conclusions: Helmet therapy is effective for infants with plagiocephaly when initiated early and with high compliance of helmet use. Greater improvements were observed in infants using the helmet during sleeping. Further multi-center studies with a larger sample size and longer follow-up are recommended. Full article

Positional plagiocephaly is a common condition in infants, characterized by asymmetrical posterior occipital flattening due to external mechanical pressure. The Argenta classification is an observational diagnostic tool that classifies plagiocephaly into five degrees of severity according to specific cranial asymmetry characteristics. The purpose was to examine the inter-rater and intra-rater reliability of the Argenta classification among developmental physiotherapists. Two raters examined 42 infants aged 6 weeks to 12 months that were separately enrolled in Clalit child development centers. A second observation was held within 7 days of the first observation. A strong agreement was reached among the raters (κ = 0.85, p < 0.0001) and within two observations of the same rater (κ = 0.90, p < 0.0001). The high degree of agreement indicates the high reliability of the Argenta classification. No significant relationships between severity and gender, age, flattened side, primaparity, number of pregnancies, type of birth, or the Alberta Infant Motor Scale score were found. In conclusion, the Argenta classification demonstrates high inter- and intra-rater reliability, particularly for milder severity levels. It is an easy, quick, and free method to use clinically without causing inconvenience to the assessed infant. While these results support clinical integration, particularly in resource-limited settings, the variable reliability across severity levels indicate that further validation studies are needed before universal adoption. Full article

Background/Objectives: Preventing head deformity in the early postnatal period could avert positional plagiocephaly (PP). Accordingly, we developed a novel prophylactic device to prevent head deformity and examined its impact on the incidence of PP and prevention of severe PP at 3 months of age. Methods: The newly developed prophylactic device was used immediately after birth or at the 1-month checkup, and cranial shape was measured before device application and at 3 months of age. The diagnostic threshold for PP was >5% for cranial vault asymmetry index (CVAI); cranial asymmetry (CA) of ≥13 mm was deemed severe. A database comprising cranial geometry of 3-month-old healthy Japanese infants (n = 110) served as the control. Results: This study included 42 infants who started using the novel prophylactic device immediately after birth or at the 1-month checkup. Measurements at 3 months of age revealed that the prophylactic device group had significantly lower CA and CVAI than the control group (CA [median]: 5.5 vs. 8.0, respectively, p = 0.007; CVAI: 4.3 vs. 5.8, respectively, p = 0.048). However, the PP prevalence did not differ significantly between the two groups (41% vs. 57%, respectively, p = 0.094). The number of infants with severe PP was significantly lower in the prophylactic device group than in the control group (0% vs. 14%, respectively; p = 0.012). At 3 months of age, no significant differences in CA or CVAI were observed between the immediate postnatal and 1-month groups. Conclusions: The novel prophylactic device against head deformity could prevent severe PP. 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

This multicenter study evaluated the efficacy and safety of a novel cranial remolding helmet (baby band2), which is completely custom-made based on the shape of an infant’s cranium. The study included 224 full-term infants from moderate to very severe positional plagiocephaly in Japan. Cranial geometry was assessed before and after helmet therapy using a three-dimensional scanner, and changes in the cranial vault asymmetry index (CVAI) were analyzed. The CVAI improved significantly in all patients, with the most significant improvement observed in the most severely affected group [very severe group: −9.1, severe group: −6.6, moderate group: −4.4 (mean values), p < 0.001]. The group that started therapy before the age of 7 months showed greater improvement compared to those who started therapy at the age of 7 months or older; however, both groups demonstrated significant improvement (<7 months group: −6.6, ≥7 months group: −4.4 (mean values), p < 0.001). No significant differences were observed in therapy efficacy between the centers (p = 0.402) and sex (p = 0.131). During the study period, helmet therapy did not lead to head circumference stunting, and the incidence of redness with baby band2 was five patients (2.2%). This study demonstrated that baby band2 is effective and safe for the therapy of positional plagiocephaly. 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

Positional cranial deformities are associated with prematurity evolving during the first 2 years of life due to the malleable characteristics of the skull, the first year being the main/primary therapeutic window for intervention. The objectives were (a) to describe health characteristics, peri- and postnatal pathologies, and positional cranial deformities in infants enrolled in an early intervention program and (b) to analyze the effects of a parent education-based intervention program on positional cranial deformity in premature infants. A quantitative, analytical, longitudinal study was conducted. It included 103 premature infants enrolled in an early intervention program (EIP) during the year 2017, all under 4 months of corrected age, to whom a parent education-based intervention program was applied. Cranial circumference, cranial width, diagonals, and anteroposterior diameter were measured, and the cranial asymmetry index (CAI) and cephalic index (CI) were calculated at baseline and during two subsequent evaluations separated by a 3-month period. The main results showed that 75.7% of the infants belonged to a very premature gestational age category, and 57.3% had an adequate weight for gestational age. The most frequent pathologies were premature jaundice, premature anemia, and hyaline membrane disease. The most frequent positional cranial deformity was plagiocephaly. The parent education-based intervention program resulted in (1) a significant decrease in the CAI and a significant increase in the IC, (2) plagiocephalies: an increase in the mild category and a decrease in the moderate + severe categories, (3) brachycephalies: a decrease in the absence category and an increase in the moderate + severe category, and (4) dolichocephalies: an increase in the absence category and a decrease in the mild category. In conclusion, the recommended first line of intervention was not enough for this population, and future studies should support the development of national clinical guidelines, where education is complemented with other therapeutic measures. Full article

Positional cranial deformities are a common finding in toddlers, yet differentiation from craniosynostosis can be challenging. The aim of this study was to train convolutional neural networks (CNNs) to classify craniofacial deformities based on 2D images generated using photogrammetry as a radiation-free imaging technique. A total of 487 patients with photogrammetry scans were included in this retrospective cohort study: children with craniosynostosis (n = 227), positional deformities (n = 206), and healthy children (n = 54). Three two-dimensional images were extracted from each photogrammetry scan. The datasets were divided into training, validation, and test sets. During the training, fine-tuned ResNet-152s were utilized. The performance was quantified using tenfold cross-validation. For the detection of craniosynostosis, sensitivity was at 0.94 with a specificity of 0.85. Regarding the differentiation of the five existing classes (trigonocephaly, scaphocephaly, positional plagiocephaly left, positional plagiocephaly right, and healthy), sensitivity ranged from 0.45 (positional plagiocephaly left) to 0.95 (scaphocephaly) and specificity ranged from 0.87 (positional plagiocephaly right) to 0.97 (scaphocephaly). We present a CNN-based approach to classify craniofacial deformities on two-dimensional images with promising results. A larger dataset would be required to identify rarer forms of craniosynostosis as well. The chosen 2D approach enables future applications for digital cameras or smartphones. Full article

Background: Omitting the early closure of the cranial sutures in newly born children is not an uncommon practice. We describe the natural history of several unrelated children and adults from two unrelated families. These children were born with variable clinical manifestations: craniofacial asymmetry, ocular proptosis, floppiness, and progressive deceleration in cognitive development. None of these children underwent a cranial sutures assessment. False diagnoses of positional plagiocephaly, neonatal thyrotoxicosis, congenital muscular atrophy, and hydrocephalus were given to the parents. This sort of malpractice was the reason behind a sequence of devastating pathological events that occurred in the lifetime of these children and adults. Material and Methods: This was a multigenerational study of two unrelated families. In total, we studied three children (aged 7–19 years) and three adults (aged 40–52 years) from two families. The children from the first family were referred to our departments because of pre-pubertal scoliosis, kyphoscoliosis, and early-onset osteoarthritis. Reading the clinical histories of these children signified apparent clinical misconceptions. For instance, craniofacial asymmetry was misinterpreted as positional plagiocephaly and treated by means of helmet molding therapy. Ocular proptosis was given the false diagnosis of neonatal thyrotoxicosis. Floppiness (hypotonia) was misdiagnosed as congenital muscular dystrophy. The index case from the second family showed progressive deceleration in his cognitive development, associated with signs of increased intracranial pressure. The only diagnosis was Dandy–Walker malformation. We documented every patient in accordance with the clinical and radiological phenotypic characterizations. The genotype characterization followed accordingly. Results: All patients in family (I) manifested a phenotype consistent to a certain extent with the clinical phenotype of Shprintzen–Goldberg syndrome (SGS), though the intensity of spine deformities was greater than has been described in the literature. The second family showed a constellation of Marfanoid habitus, craniosynostosis, increased intracranial pressure, hydrocephalus, Dandy–Walker malformation, seizures, and intellectual disability. The overall clinical phenotype was consistent but not fully diagnostic of craniosynostosis–Dandy–Walker-malformation hydrocephalus syndrome. The early closure of the sutures was totally different from one patient to another, including the premature closure of the metopic, coronal, squamosal, and sagittal sutures. One patient from family (II) underwent the implementation of a shunt system at the age of 3 years, unfortunately passing over the pre-existing craniosynostosis. In addition to skeletal deformities, a history of seizures and severe intellectual disability was recorded. The proband underwent chromosomal karyotyping, the FISH test, and whole-exome sequencing. Conclusion: The purpose of this study was fivefold. Firstly, to gain a meticulous understanding in order to differentiate between positional plagiocephaly, hypotonia, and congenital exophthalmos and their connections to abnormal craniofacial contours was and still is our first and foremost concern. Secondly, we aimed to characterize craniosynostosis, seizures, intellectual disabilities, and hydrocephalus associated with Marfanoid habitus, which were clearly demonstrated in our patients. Thirdly, we aimed to address the imperative for interpretations of clinical and radiological phenotypes and relate these tools to etiological understanding, which is an essential basis for diagnosis in the majority of long-term pediatric admissions. Fourthly, we aimed to assess the impacts of the missed early closure by the pediatricians and pediatric neurologists, which added a heavy pathological burden on these patients and their families. Fifthly, we aimed to identify whether early and diligent recognition can assist in cranial vault remodeling via surgical intervention to halt premature cranial suture fusions and can possibly alter the devastating course and the complications of the synostosed sutures. Full article

Objective: The objective of this study is to analyze conservative treatments implemented to manage positional plagiocephaly in infants. Methods: This is a systematic review conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, performed in the Medline (PubMed), Scopus, Web of Science, and Cochrane databases. Articles were selected according to the eligibility criteria, regarding the effectiveness of conservative treatments in positional plagiocephaly in infants, published in the last 10 years with a score ≥3 in the PEDro Scale. Results: A total of 318 articles were identified and 9 of them were finally selected. Conclusions: Physical therapy treatment is considered as the first line of intervention in plagiocephaly with non-synostotic asymmetries and manual therapy is the method that obtains the best results within this intervention. In cases of moderate or severe plagiocephaly, helmet therapy can be an effective second-line intervention; however, the best way to prevent this condition is through counseling of parents or caregivers, and early treatment is essential for optimal therapeutic outcomes. The review was registered in PROSPERO (CDR42022306466). Full article

This study compared manual and digital measurements of plagiocephaly and brachycephaly in infants and evaluated whether three-dimensional (3D) digital photography measurements can be used as a superior alternative in everyday clinical practice. A total of 111 infants (103 with plagiocephalus and 8 with brachycephalus) were included in this study. Head circumference, length and width, bilateral diagonal head length, and bilateral distance from the glabella to the tragus were assessed by manual assessment (tape measure and anthropometric head calipers) and 3D photographs. Subsequently, the cranial index (CI) and cranial vault asymmetry index (CVAI) were calculated. Measured cranial parameters and CVAI were significantly more precise using 3D digital photography. Manually acquired cranial vault symmetry parameters were at least 5 mm lower than digital measurements. Differences in CI between the two measuring methods did not reach significance, whereas the calculated CVAI showed a 0.74-fold decrease using 3D digital photography and was highly significant (p < 0.001). Using the manual method, CVAI calculations overestimated asymmetry, and cranial vault symmetry parameters were measured too low, contributing to a misrepresentation of the actual anatomical situation. Considering consequential errors in therapy choices, we suggest implementing 3D photography as the primary tool for diagnosing deformational plagiocephaly and positional head deformations. Full article

Positional plagiocephaly is an asymmetrical skull deformation caused by various factors. Although it is not responsible for abnormal brain development in infants and is not related to the onset of neurophysiological problems, it is critical to prevent skull deformity to avoid aesthetic and functional consequences. The purpose of the study is to investigate the relevance of preventive procedures to the onset of positional plagiocephaly, such as the use of passive mattresses, which is primarily correlated with the need for newborns and infants to sleep and rest in proper posture. PubMed, Web of Science, Google Scholar, Scopus, Cochrane Library, and Embase were searched for papers that matched our topic, dating from January 2012 to 22 October 2022, with an English language restriction, using the following Boolean keywords: (“positional plagiocephaly” AND “prevention”). A total of 11 papers were included as relevant papers matching the purpose of our investigation. According to the research results, inadequate vitamin D and folic acid intake during pregnancy may increase the risk of skull deformation. Furthermore, babies should sleep on their backs and spend at least 30 min in tummy time. Using a passive sleep curve mattress has several advantages such as low cost, easy handling, no compliance system, and a marked improvement in head shape, allowing harmonious skull growth guided by normal brain expansion. Full article

Background: A long list of syndromic entities can be diagnosed immediately through scrutinizing the clinical phenotype of the craniofacial features. The latter should be assisted via proper radiological interpretations. Patients and Methods: Different children aged from 1 month to 12 years were referred to our departments seeking orthopedic advice. Primarily, all received variable false diagnoses in other institutes. Two unrelated boys of one month and 12 months were falsely diagnosed as having positional plagiocephaly associated with contractures of idiopathic origin. Two unrelated boys of 14 months and 2 years were diagnosed with pseudo-hydrocephalus and non-specific syndrome, and were referred to explore their skeletal development. Two unrelated girls of 4 years old and 12 years old presented with multiple contractures were referred because of progressive scoliosis. A 4-year-old girl was referred with a false provisional diagnosis of facial diplegia. All children underwent detailed clinical, radiological and tomographic phenotypic characterizations and genetic testing, respectively. Results: Idaho syndrome (craniosynostosis associated with multiple dislocations) was the final diagnosis in the two unrelated boys with plagiocephaly and multiple contractures. Two children falsely diagnosed with pseudo-hydrocephalus and non-specific syndrome, were diagnosed with Silver–Russell syndrome (RSS). Contractural arachnodactyly Beals (CAB) was confirmed as the definitive diagnosis in the two unrelated girls with progressive scoliosis and multiple contractures. Parry–Romberg syndrome (PRS) associated with congenital lumbar kyphosis was the final diagnosis of the girl with the diagnosis of facial diplegia. Hypomethylation of ICR1 was confirmed in the RSS patients. Whole exome sequencing (WES) revealed a heterozygous mutation in the PRS patients. WES and array-CGH showed that no relevant variants or copy number variations (CNV) were identified in the CAB patients. Conclusions: On the one hand, newborn children can manifest diverse forms of abnormal craniofacial features, which are usually associated with either major or minor dysmorphic stigmata. A cleft lip/ palate is a major craniofacial malformation, and frontal bossing or a disproportionate craniofacial contour can be falsely considered as a transient plagiocephaly, which is spontaneously resolved by time. On the other hand, many physicians fall into the problem of deeming a countless number of diseases, such as contractures, as an idiopathic or non-specific syndrome. The latter stems from limited clinical experience. Therefore, failing to establish between the onset of the deformity and other inexplicit abnormal features that the patient or their immediate families or relatives carry is the final outcome. In this study, we used, for the first time, a reconstruction CT scan to further delineate the congenital disruption of the craniofacial anatomy and the other skeletal malformation complex. Full article

Positional plagiocephaly (PP) is a general term describing cranial distortion from pre- or postnatal forces on the infant head. Abnormal intrauterine forces, multiple births, primiparous mothers, obstetric interventions, prematurity, male sex, excessive time lying in the supine position, and mobility restrictions of the cervical spine have been considered as the main predisposing factors. The objective was to investigate the association between the severity of PP and the active cervical rotation and to analyze the influence of predisposing factors in babies with PP. An analytical cross-sectional study was performed on 74 babies with moderate PP. Clinical and demographic data, cranial vault asymmetry, and active cervical rotation range of motion (ROM) were measured. Associations were analyzed with generalized linear models. The mean age was 16.8 ± 5.0 weeks, and 56.8% were male. A restriction in the ROM of active cervical rotation, especially to the left side, was observed. Our models showed that cranial asymmetry was related with left active cervical rotation ROM (p = 0.034) and with being transported in a pushchair (p < 0.001). Conclusions: An increased severity of PP was related with being transported in a baby pushchair and with a reduced active cervical rotation ROM toward the most restricted side. Full article