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Tilmann Schweitzer - One of the best experts on this subject based on the ideXlab platform.
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occipital Plagiocephaly unilateral lambdoid synostosis versus positional Plagiocephaly
Archives of Disease in Childhood, 2015Co-Authors: Christian Linz, Hartmut Bohm, Philipp Meyermarcotty, H Collmann, Jurgen Kraus, Urs D A Mullerrichter, Ralfingo Ernestus, Johannes Wirbelauer, Alexander C Kubler, Tilmann SchweitzerAbstract:Objective We defined parameters that could differentiate between positional and synostotic Plagiocephaly and defined a diagnostic chart for decision making. Design Prospective study. Setting We examined 411 children with non-syndromic skull abnormalities between January 2011 and December 2012. Participants A total of 8 infants under 1 year of age with proven unilateral non-syndromic lambdoid synostosis (LS) and 261 children with positional deformity were examined to outline the specific clinical features of both diagnoses. After clinical examination, an ultrasound revealed either a closed suture suggestive of LS or a patent lambdoid suture suggestive of positional deformity. For patients with synostosis, plain radiographs, MR imaging and follow-up examinations were performed. In cases of open sutures, only follow-ups were completed. Main outcome measure Clinical, imaging, genesis and treatment differences between positional Plagiocephaly and LS. Results In all 8 cases of unilateral LS and 258 cases of positional Plagiocephaly, the diagnosis was established by clinical examination alone. In three cases of positional Plagiocephaly, diagnosis was determined after an additional ultrasonography. MR imaging revealed a unilateral tonsillar herniation in five of the eight children with LS and hydrocephalus in one child. Conclusions We have suggested a list of clinical features that specify the underlying cause of posterior Plagiocephaly. An additional ultrasound scanning confirmed the diagnosis without any risks of ionising radiation or sedation as in a CT scan.
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spectrum of positional deformities is there a real difference between Plagiocephaly and brachycephaly
Journal of Cranio-maxillofacial Surgery, 2014Co-Authors: Philipp Meyermarcotty, Hartmut Bohm, Christoph Blecher, Nina Keil, Angelika Stellzigeisenhauer, Janka Kochel, Christian Linz, Tilmann SchweitzerAbstract:Abstract Aim This study analyses pathomorphological and physiological head shapes and classifies the pathomorphology in positional Plagiocephaly and brachycephaly. Patients and methods 78 infants with a positional Plagiocephaly (5.99 months) and 32 infants with a positional brachycephaly (6.53 months) with a Cephalic index > 94% were investigated in this study and compared to a matched control group of 35 infants. The head shapes were analysed by stereophotogrammetry 3D data. Results The cephalic index, the total width, and coronal circumference were the highest values in patients with brachycephaly and the lowest values in the control group. The asymmetry of the head showed that the diagonal difference in brachycephalic patients more than doubled, and in patients with Plagiocephaly almost tripled compared to the controls. A significantly higher total volume and vertex height was found for the patients with Plagiocephaly and the patients with brachycephaly compared to the controls. Conclusion The cephalic index is a valuable and reliable parameter in order to differentiate positional deformities from unaffected skulls. Pathomorphology of a Plagiocephaly is associated with the most severe asymmetry of the head. Plagiocephaly and brachycephaly overlap in several criteria. Therefore it seems justified to speak of a continuum rather than to differentiate between Plagiocephaly and brachycephaly.
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Spectrum of positional deformities – Is there a real difference between Plagiocephaly and brachycephaly?
Journal of Cranio-maxillofacial Surgery, 2014Co-Authors: Philipp Meyer-marcotty, Hartmut Bohm, Christoph Blecher, Nina Keil, Janka Kochel, Christian Linz, Angelika Stellzig-eisenhauer, Tilmann SchweitzerAbstract:Abstract Aim This study analyses pathomorphological and physiological head shapes and classifies the pathomorphology in positional Plagiocephaly and brachycephaly. Patients and methods 78 infants with a positional Plagiocephaly (5.99 months) and 32 infants with a positional brachycephaly (6.53 months) with a Cephalic index > 94% were investigated in this study and compared to a matched control group of 35 infants. The head shapes were analysed by stereophotogrammetry 3D data. Results The cephalic index, the total width, and coronal circumference were the highest values in patients with brachycephaly and the lowest values in the control group. The asymmetry of the head showed that the diagonal difference in brachycephalic patients more than doubled, and in patients with Plagiocephaly almost tripled compared to the controls. A significantly higher total volume and vertex height was found for the patients with Plagiocephaly and the patients with brachycephaly compared to the controls. Conclusion The cephalic index is a valuable and reliable parameter in order to differentiate positional deformities from unaffected skulls. Pathomorphology of a Plagiocephaly is associated with the most severe asymmetry of the head. Plagiocephaly and brachycephaly overlap in several criteria. Therefore it seems justified to speak of a continuum rather than to differentiate between Plagiocephaly and brachycephaly.
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head orthesis therapy in infants with unilateral positional Plagiocephaly an interdisciplinary approach to broadening the range of orthodontic treatment
Journal of Orofacial Orthopedics-fortschritte Der Kieferorthopadie, 2012Co-Authors: Philipp Meyermarcotty, Hartmut Bohm, Angelika Stellzigeisenhauer, Christian Linz, Felix Kunz, N Keil, Tilmann SchweitzerAbstract:Objective Unilateral positional Plagiocephaly is the most common deformity of the head in infants. As part of a prospective controlled clinical study, the pathomorphology of the positional Plagiocephaly in early infancy was examined. The goal was to use noninvasive three-dimensional (3D) imaging to generate, for the first time ever, a standard database of infants without head deformities, to quantify the asymmetry of the positional Plagiocephaly, and to evaluate the effectiveness of functional growth control using head orthesis.
Michael L Cunningham - One of the best experts on this subject based on the ideXlab platform.
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a case control study of infant maternal and perinatal characteristics associated with deformational Plagiocephaly
Paediatric and Perinatal Epidemiology, 2009Co-Authors: Christy M Mckinney, Michael L Cunningham, Victoria L Holt, Brian G Leroux, Jacqueline R StarrAbstract:Summary Deformational Plagiocephaly, an abnormal asymmetric flattening of infants' heads, is diagnosed in approximately 10% of infants. The prevalence of Plagiocephaly has increased dramatically since 1992 when it was first recommended that infants be placed to sleep in a non-prone position to reduce the risk of sudden infant death syndrome. The authors conducted a case–control study to evaluate associations between Plagiocephaly and perinatal characteristics. The authors assessed whether risk factors for Plagiocephaly have changed since 1992. Cases were born 1987–2002 in Washington State and diagnosed with Plagiocephaly at the Craniofacial Center at Seattle Children's Hospital. Risk factor information was abstracted from birth certificate and hospital discharge data and unconditional logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI). Cases (n = 2764) were more likely than controls (n = 13 817) to have been injured at birth (OR 1.4; 95% CI 1.2, 1.7) or diagnosed with a congenital anomaly (OR 2.0; 95% CI 1.8, 2.3). Cases were more likely to have been male, a twin, or small-for-gestational-age. This first large-scale, case–control study of risk factors for Plagiocephaly in a U.S. population provides new evidence that birth injuries and congenital anomalies are associated with Plagiocephaly risk.
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characteristics of 2733 cases diagnosed with deformational Plagiocephaly and changes in risk factors over time
The Cleft Palate-Craniofacial Journal, 2008Co-Authors: Michael L Cunningham, Christy M Mckinney, Victoria L Holt, Brian G Leroux, Jacqueline R StarrAbstract:OBJECTIVES: To describe infant and maternal characteristics among infants with Plagiocephaly and to quantify time trends in potential risk factors for Plagiocephaly. DESIGN: Case-only study. We described the characteristics of individuals born between 1987 and 2002. We also compared characteristics of individuals born from 1987 through 1990, before the American Academy of Pediatrics 1992 sleep-position recommendations, with those of individuals born from 1991 to 2002. SETTING: Children's Craniofacial Center at Children's Hospital and Regional Medical Center in Seattle, Washington. PARTICIPANTS: Subjects included 2733 infants diagnosed with deformational Plagiocephaly or brachycephaly before 18 months of age who were born from 1987 to 2002. MAIN OUTCOME MEASURE: Descriptive statistics, odds ratios, and 95% confidence intervals. RESULTS: Among individuals born from 1991 to 2002, 91.6% had occipital-only flattening, 17.2% were brachycephalic, 67.7% were boys, and 9.9% were multiple birth infants. As compared with individuals born from 1987 through 1990, those born from 1991 to 2002 were more apt to be a multiple birth (odds ratio [OR] 3.4, 95% confidence interval [CI]: 0.8, 14.1) and to have a mother > or =35 years of age (OR, 3.2; 95% CI, 1.4 to 7.3); they were hospitalized less commonly at birth for 4 or more days (OR, 0.02; 95% CI, 0.01 to 0.06). CONCLUSIONS: Several risk factors for Plagiocephaly were more common among individuals born after the 1992 American Academy of Pediatrics sleep-position recommendations. These results are consistent with the explanation that supine sleeping modifies the association between such risk factors and Plagiocephaly. Further studies with a control group are needed to validate this conclusion.
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mdct diagnosis of the child with posterior Plagiocephaly
American Journal of Roentgenology, 2005Co-Authors: Richard A Hopper, Victor Ghioni, Joseph S Gruss, Richard G Ellenbogen, Darcy King, Anne V Hing, Michael L CunninghamAbstract:OBJECTIVE: In this article, we review the normal anatomy and development of the posterior skull base and describe distinguishing imaging features of the two most common causes of posterior Plagiocephaly: posterior deformational Plagiocephaly and unilateral lambdoid synostosis. We also describe three unusual cases of posterior Plagiocephaly, including asymmetric premature fusion of the anterior and posterior intraoccipital synchondroses, with diagnoses enabled by volume-reformatted MDCT. CONCLUSION: Three-dimensional reformatted MDCT enables accurate diagnosis of common and rare causes of posterior Plagiocephaly in children.
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the differential diagnosis of posterior Plagiocephaly true lambdoid synostosis versus positional molding
Plastic and Reconstructive Surgery, 1996Co-Authors: Martin H S Huang, Joseph S Gruss, Michael L Cunningham, Sterling K Clarren, Wendy E Mouradian, Theodore S Roberts, John D Loeser, Cathy J CornellAbstract:The diagnosis and treatment of posterior Plagiocephaly is one of the most controversial aspects of craniofacial surgery. The features of true lambdoid synostosis versus those of deformational Plagiocephaly secondary to positional molding are inadequately described in the literature and poorly understood. This has resulted in many infants in several craniofacial centers across the United States undergoing major intracranial procedures for nonsynostotic Plagiocephaly. The purpose of this study was to describe the detailed clinical, imaging, and operative features of true lambdoid synostosis and contrast them with the features of positional Plagiocephaly. During a 4-year period from 1991 to 1994, 102 patients with posterior Plagiocephaly were assessed in a large multidisciplinary craniofacial program. During the same period, 130 patients with craniosynostosis received surgical treatment. All patients were examined by a pediatric dysmorphologist, craniofacial surgeon, and pediatric neurosurgeon. Diagnostic imaging was performed where indicated. Patients diagnosed with lambdoid synostosis and severe and progressive positional molding underwent surgical correction using standard craniofacial techniques. Only 4 patients manifested the clinical, imaging, and operative features of unilambdoid synostosis, giving an incidence among all cases of craniosynostosis of 3.1 percent. Only 3 among the 98 patients with positional molding required surgical intervention. All the patients with unilambdoid synostosis had a thick ridge over the fused suture, identical to that found in other forms of craniosynostosis, with compensatory contralateral parietal and frontal bossing and an ipsilateral occipitomastoid bulge. The skull base had an ipsilateral inferior tilt, with a corresponding inferior and posterior displacement of the ipsilateral ear. These characteristics were completely opposite to the findings in the 98 patients who had positional molding with open lambdoid sutures and prove conclusively that true unilambdoid synostosis exists as a specific but rare entity. Awareness of the features of unilambdoid synostosis will allow more accurate diagnosis and appropriate treatment of posterior Plagiocephaly in general and in particular will avoid unnecessary surgical intervention in patients with positional molding.
Christian Linz - One of the best experts on this subject based on the ideXlab platform.
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occipital Plagiocephaly unilateral lambdoid synostosis versus positional Plagiocephaly
Archives of Disease in Childhood, 2015Co-Authors: Christian Linz, Hartmut Bohm, Philipp Meyermarcotty, H Collmann, Jurgen Kraus, Urs D A Mullerrichter, Ralfingo Ernestus, Johannes Wirbelauer, Alexander C Kubler, Tilmann SchweitzerAbstract:Objective We defined parameters that could differentiate between positional and synostotic Plagiocephaly and defined a diagnostic chart for decision making. Design Prospective study. Setting We examined 411 children with non-syndromic skull abnormalities between January 2011 and December 2012. Participants A total of 8 infants under 1 year of age with proven unilateral non-syndromic lambdoid synostosis (LS) and 261 children with positional deformity were examined to outline the specific clinical features of both diagnoses. After clinical examination, an ultrasound revealed either a closed suture suggestive of LS or a patent lambdoid suture suggestive of positional deformity. For patients with synostosis, plain radiographs, MR imaging and follow-up examinations were performed. In cases of open sutures, only follow-ups were completed. Main outcome measure Clinical, imaging, genesis and treatment differences between positional Plagiocephaly and LS. Results In all 8 cases of unilateral LS and 258 cases of positional Plagiocephaly, the diagnosis was established by clinical examination alone. In three cases of positional Plagiocephaly, diagnosis was determined after an additional ultrasonography. MR imaging revealed a unilateral tonsillar herniation in five of the eight children with LS and hydrocephalus in one child. Conclusions We have suggested a list of clinical features that specify the underlying cause of posterior Plagiocephaly. An additional ultrasound scanning confirmed the diagnosis without any risks of ionising radiation or sedation as in a CT scan.
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spectrum of positional deformities is there a real difference between Plagiocephaly and brachycephaly
Journal of Cranio-maxillofacial Surgery, 2014Co-Authors: Philipp Meyermarcotty, Hartmut Bohm, Christoph Blecher, Nina Keil, Angelika Stellzigeisenhauer, Janka Kochel, Christian Linz, Tilmann SchweitzerAbstract:Abstract Aim This study analyses pathomorphological and physiological head shapes and classifies the pathomorphology in positional Plagiocephaly and brachycephaly. Patients and methods 78 infants with a positional Plagiocephaly (5.99 months) and 32 infants with a positional brachycephaly (6.53 months) with a Cephalic index > 94% were investigated in this study and compared to a matched control group of 35 infants. The head shapes were analysed by stereophotogrammetry 3D data. Results The cephalic index, the total width, and coronal circumference were the highest values in patients with brachycephaly and the lowest values in the control group. The asymmetry of the head showed that the diagonal difference in brachycephalic patients more than doubled, and in patients with Plagiocephaly almost tripled compared to the controls. A significantly higher total volume and vertex height was found for the patients with Plagiocephaly and the patients with brachycephaly compared to the controls. Conclusion The cephalic index is a valuable and reliable parameter in order to differentiate positional deformities from unaffected skulls. Pathomorphology of a Plagiocephaly is associated with the most severe asymmetry of the head. Plagiocephaly and brachycephaly overlap in several criteria. Therefore it seems justified to speak of a continuum rather than to differentiate between Plagiocephaly and brachycephaly.
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Spectrum of positional deformities – Is there a real difference between Plagiocephaly and brachycephaly?
Journal of Cranio-maxillofacial Surgery, 2014Co-Authors: Philipp Meyer-marcotty, Hartmut Bohm, Christoph Blecher, Nina Keil, Janka Kochel, Christian Linz, Angelika Stellzig-eisenhauer, Tilmann SchweitzerAbstract:Abstract Aim This study analyses pathomorphological and physiological head shapes and classifies the pathomorphology in positional Plagiocephaly and brachycephaly. Patients and methods 78 infants with a positional Plagiocephaly (5.99 months) and 32 infants with a positional brachycephaly (6.53 months) with a Cephalic index > 94% were investigated in this study and compared to a matched control group of 35 infants. The head shapes were analysed by stereophotogrammetry 3D data. Results The cephalic index, the total width, and coronal circumference were the highest values in patients with brachycephaly and the lowest values in the control group. The asymmetry of the head showed that the diagonal difference in brachycephalic patients more than doubled, and in patients with Plagiocephaly almost tripled compared to the controls. A significantly higher total volume and vertex height was found for the patients with Plagiocephaly and the patients with brachycephaly compared to the controls. Conclusion The cephalic index is a valuable and reliable parameter in order to differentiate positional deformities from unaffected skulls. Pathomorphology of a Plagiocephaly is associated with the most severe asymmetry of the head. Plagiocephaly and brachycephaly overlap in several criteria. Therefore it seems justified to speak of a continuum rather than to differentiate between Plagiocephaly and brachycephaly.
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head orthesis therapy in infants with unilateral positional Plagiocephaly an interdisciplinary approach to broadening the range of orthodontic treatment
Journal of Orofacial Orthopedics-fortschritte Der Kieferorthopadie, 2012Co-Authors: Philipp Meyermarcotty, Hartmut Bohm, Angelika Stellzigeisenhauer, Christian Linz, Felix Kunz, N Keil, Tilmann SchweitzerAbstract:Objective Unilateral positional Plagiocephaly is the most common deformity of the head in infants. As part of a prospective controlled clinical study, the pathomorphology of the positional Plagiocephaly in early infancy was examined. The goal was to use noninvasive three-dimensional (3D) imaging to generate, for the first time ever, a standard database of infants without head deformities, to quantify the asymmetry of the positional Plagiocephaly, and to evaluate the effectiveness of functional growth control using head orthesis.
Scott P Bartlett - One of the best experts on this subject based on the ideXlab platform.
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Perceptions and Preferences of Laypersons in the Management of Positional Plagiocephaly.
Journal of Craniofacial Surgery, 2020Co-Authors: Giap H. Vu, Scott P Bartlett, Katherine Magoon, Carrie E. Zimmerman, Christopher L. Kalmar, Laura S. Humphries, Jordan W. Swanson, Jesse A. TaylorAbstract:BACKGROUND Uncertain clinical evidence for treating positional Plagiocephaly, especially with helmet therapy, creates difficulties in counseling parents of patients. This study investigates layperson perceptions and treatment preferences for positional Plagiocephaly to provide patient-oriented evidence for management. METHODS Adult laypersons were recruited through crowdsourcing to view digitally-modified images of normal, mildly, moderately, or severely plagiocephalic infant heads. Participants provided demographic information and rated the infant's head shape and potential related social difficulties, likelihood of consulting a physician for treatment options, and likelihood of seeking helmeting treatment for the infant. RESULTS Nine hundred forty-five individuals participated in the study. Perception of head shape, prediction of future embarrassment and social difficulties, likelihood of seeking physician evaluation, likelihood of choosing helmet therapy, and willingness-to-pay for helmet therapy were pairwise-different between 4 Plagiocephaly severities (corrected-P
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analysis of differences in the cranial base and facial skeleton of patients with lambdoid synostosis and deformational Plagiocephaly
Plastic and Reconstructive Surgery, 2011Co-Authors: James M Smartt, River M Elliott, Russell R Reid, Scott P BartlettAbstract:BACKGROUND: Earlier investigations suggest that the morphologic features of patients with lambdoid synostosis include ipsilateral occipital flattening, an ipsilateral mastoid prominence, downward cant of the posterior skull base to the affected side, and contralateral hemifacial deficiency. These features are absent in patients with deformational Plagiocephaly. The authors hypothesize that significant differences in craniofacial morphology exist between patients with lambdoid synostosis and those with deformational Plagiocephaly. METHODS: Craniometric measurements were performed on patients with unilateral lambdoid synostosis (n = 9) and deformational Plagiocephaly (n = 12). Measurements were performed on affected and unaffected sides and included posterior fossa deflection angle, petrous ridge angle, middle cranial fossa and anterior cranial fossa area, temporomandibular joint displacement, and maxillary and mandibular dimensions. Appropriate statistical tests were performed. RESULTS: Statistically significant differences in posterior fossa deflection angle, petrous ridge angle, and middle cranial fossa were found between groups. Lambdoid synostosis patients demonstrated a larger petrous ridge angle (p = 0.0001) and middle cranial fossa (p = 3.37 × 10(-6)) on the unaffected side. Deformational Plagiocephaly patients exhibited no discrepancies between sides. The mean posterior fossa deflection angle was 10.55 degrees for the lambdoid synostosis group and 3.59 degrees for the deformational Plagiocephaly group (p < 0.0001). All lambdoid synostosis patients had deviation of the posterior cranial fossa toward the affected side. Deformational Plagiocephaly patients had variable deflection. All lambdoid synostosis patients demonstrated marked posterior displacement of the contralateral temporomandibular joint. Deformational Plagiocephaly patients had either symmetric temporomandibular joint position (75 percent) or slight contralateral posterior displacement (25 percent). Mandibular size was not significantly different between groups. CONCLUSION: Patients with lambdoid synostosis and deformational Plagiocephaly manifest significant differences in cranial base morphology, contributing to the phenotypic differences seen in these two groups of patients.
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nonsynostotic occipital Plagiocephaly radiographic diagnosis of the sticky suture
Plastic and Reconstructive Surgery, 2005Co-Authors: Joseph E Losee, Evan M Feldman, Manoj Ketkar, Davinder J Singh, Richard E Kirschner, Perlennart Westesson, G M Cooper, Mark P Mooney, Scott P BartlettAbstract:BACKGROUND: While the clinical differences between nonsynostotic occipital Plagiocephaly and lambdoid craniosynostosis have been described, the radiographic differentiation between the two remains obscure. The aim of this study was to characterize morphological differences in the lambdoid suture between nonsynostotic occipital Plagiocephaly and lambdoid craniosynostosis. METHODS: Computed tomography scans of children clinically diagnosed with nonsynostotic occipital Plagiocephaly (n = 26) were compared with computed tomography scans from children diagnosed with lambdoid craniosynostosis (n = 7). Suture and cranial morphology, ear position, and endocranial base angles were qualitatively and quantitatively compared. RESULTS: Nonsynostotic occipital Plagiocephaly sutures demonstrated areas of focal fusion (25 percent), endocranial ridging (78 percent), narrowing (59 percent), sclerosis (19 percent), and changes from overlapping to end-to-end orientation (100 percent). No sutures demonstrated ectocranial ridging. All cases of nonsynostotic occipital Plagiocephaly presented with ipsilateral occipital flattening, 85 percent with ipsilateral frontal, and 95 percent with contralateral occipital bossing producing parallelogram morphology. In contrast, a greater frequency of sutures in lambdoid craniosynostosis patients demonstrated nearly complete obliteration (p < 0.001) with ectocranial ridging (p < 0.001); significantly more of these patients presented with ipsilateral occipital flattening with compensatory ipsilateral mastoid (p < 0.001) and contralateral parietal (p < 0.01) bossing, producing a trapezoid morphology. Sutures from nonsynostotic occipital Plagiocephaly patients showed endocranial ridging, focal fusions, and narrowing, previously reported as lambdoid craniosynostosis. CONCLUSIONS: In contradiction to previous reports, lambdoid craniosynostosis is not radiographically unique among suture fusions. This work establishes the radiographic diagnosis of nonsynostotic occipital Plagiocephaly.
Dimitrios C Nikas - One of the best experts on this subject based on the ideXlab platform.
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guidelines congress of neurological surgeons systematic review and evidence based guideline for the diagnosis of patients with positional Plagiocephaly the role of imaging
Neurosurgery, 2016Co-Authors: Catherine A Mazzola, David F. Bauer, Susan R. Durham, Paul Klimo, Lissa C Baird, Alexandra D Beier, Catherine Mcclungsmith, Laura Mitchell, Dimitrios C NikasAbstract:BACKGROUND: No evidence-based guidelines exist for the imaging of patients with positional Plagiocephaly. OBJECTIVE: The objective of this systematic review and evidence-based guideline is to answer the question, Is imaging necessary for infants with positional Plagiocephaly to make a diagnosis? METHODS: The National Library of Medicine Medline database and the Cochrane Library were queried with the use of MeSH headings and key words relevant to imaging as a means to diagnose Plagiocephaly. Abstracts were reviewed, and an evidentiary table was assembled summarizing the studies and the quality of evidence (Classes I-III). Based on the quality of the literature, a recommendation was rendered (Level I, II, or III). RESULTS: A total of 42 full-text articles were selected for review. Of these, 10 were eliminated; thus, 32 full-text were manuscripts selected. There was no Class I evidence, but 2 Class II and 30 Class III studies were included. Three-dimensional cranial topographical imaging, ultrasound, skull x-rays, computed tomography, and magnetic resonance imaging were investigated. CONCLUSION: Clinical examination is most often sufficient to diagnose Plagiocephaly (quality, Class III; strength, Level III). Within the limits of this systematic review, the evidence suggests that imaging is rarely necessary and should be reserved for cases in which the clinical examination is equivocal. Many of the imaging studies were not designed to address the diagnostic utility of the imaging modality, and authors were actually assessing the utility of the imaging in longitudinal follow-up, not initial diagnosis. For this reason, some of the studies reviewed were downgraded in Level of Evidence. When needed, 3-dimensional cranial topographical photo, skull x-rays, or ultrasound imaging is almost always sufficient for definitive diagnosis. Computed tomography scanning should not be used to diagnose Plagiocephaly, but it may be necessary to rule out craniosynostosis. The full guidelines document can be located at https://www.cns.org/guidelines/guidelines-management-patients-positional-Plagiocephaly/Chapter_2.
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guidelines congress of neurological surgeons systematic review and evidence based guideline on the role of cranial molding orthosis helmet therapy for patients with positional Plagiocephaly
Neurosurgery, 2016Co-Authors: Mandeep S Tamber, David F. Bauer, Susan R. Durham, Catherine A Mazzola, Paul Klimo, Lissa C Baird, Alexandra D Beier, Dimitrios C Nikas, Catherine McclungsmithAbstract:Background No evidence-based guidelines exist on the role of cranial-molding orthosis (helmet) therapy for patients with positional Plagiocephaly. Objective To address the clinical question: "Does helmet therapy provide effective treatment for positional Plagiocephaly?" and to make treatment recommendations based on the available evidence. Methods The US National Library of Medicine Medline database and the Cochrane Library were queried by using MeSH headings and key words relevant to the objective of this systematic review. Abstracts were reviewed, after which studies meeting the inclusion criteria were selected and graded according to their quality of evidence (Classes I-III). Evidentiary tables were constructed that summarized pertinent study results, and, based on the quality of the literature, recommendations were made (Levels I-III). Results Fifteen articles met criteria for inclusion into the evidence tables. There was 1 prospective randomized controlled trial (Class II), 5 prospective comparative studies (Class II), and 9 retrospective comparative studies (Class II). Conclusion There is a fairly substantive body of nonrandomized evidence that demonstrates more significant and faster improvement of cranial shape in infants with positional Plagiocephaly treated with a helmet in comparison with conservative therapy, especially if the deformity is severe, provided that helmet therapy is applied during the appropriate period of infancy. Specific criteria regarding the measurement and quantification of deformity and the most appropriate time window in infancy for treatment of positional Plagiocephaly with a helmet remains elusive. In general, infants with a more severe presenting deformity and infants who are helmeted early in infancy tend to have more significant correction (and even normalization) of head shape. The full guidelines document can be located at https://www.cns.org/guidelines/guidelines-management-patients-positional-Plagiocephaly/Chapter_5.
