The Role of Age on Effectiveness of Active Repositioning Therapy in Positional Skull Deformities

Purpose: Non-synostotic positional deformities are currently diagnosed in nearly half of the newborns, however not any evidence-based guidelines are available for management. The aim of this study is to assess the effect of active repositioning treatment at infants with positional skull deformities.Method: A retrospective data of 158 infants treated with active repositioning as a conservative treatment for at least 2 months were analyzed in this study. Anthropometric 3D scanner measurements of pre-and post-treatment diagonal difference, cranial vault asymmetry index, cranial ratio were evaluated for each patient. Infants were separated to 4 different groups according to their morphologic deformation types as plagiocephaly, brachycephaly, scaphocephaly and combined (brachycephaly+plagiocephaly), and 2 groups according to age at onset of treatment.Results: In combined group, pre-treatment mean diagonal difference and cranial vault asymmetry index values decreased from 9.38 mm and 6.9% to 6.94 mm and 4.9% respectively. In plagiocephaly group, mean pre-treatment results changed from 10.32 mm and 7.5% to 7.83 mm and 5.5% respectively after treatment. All these changes were statistically significant. Effectiveness of timing of repositioning treatment on different positional skull deformities was analyzed and outcome was found significantly improved when the active repositioning treatment was started before 4 months of age.Conclusion: Improvement rates of the asymmetry decrease with age due to decreasing skull enlargement rate. Early diagnosis, especially before 4 months of age, more parental education, and close follow-up are important for babies with this condition who may benefit just from repositioning treatment.

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1. Clarren SK. Plagiocephaly and torticollis: etiology, natural history, and helmet treatment. J Pediatr 1981;98:92–95. [CrossRef ]
2. Pollack IA, Losken HW, Fasick P. Diagnosis and management of posterior plagiocephaly. Pediatrics 1997;99:180–185. [CrossRef ]
3. Kelly KM, Littlefield TR, Pomatto JK, Ripley CE, Beals SP, Joganic EF. Importance of early recognition and treatment of deformational plagiocephaly with orthotic cranioplasty. Cleft Palate-Craniofac J 1999;36:127–130. [CrossRef ]
4. American Academy of Pediatrics, Task Force on Infant Positioning and SIDS. Positioning and sudden infant death syndrome. Pediatrics 1992;89:1120–1126.
5. American Academy of Pediatrics, Task Force on Infant Positioning and SIDS. Positioning and sudden infant death syndrome (SIDS): update. Pediatrics 1996;98:1216–1218.
6. Argenta LC, David LR, Wilson JA, Bell WO. An increase in infant cranial deformity with supine sleeping position. J Craniofac Surg 1996;7:5–11. [CrossRef ]
7. Turk AE, McCarthy JG, Thorne CH, Wissoff JH. The “back to sleep campaign” and deformational plagiocephaly: is there a cause for concern? J Craniofac Surg 1996;7:12–18. [CrossRef ]
8. Dörhage KWW, Beck-Broichsitter BE, von Grabe V, Sonntag A, Becker ST, Wiltfang J. Therapy efects of head orthoses in positional plagiocephaly. J Craniomaxillofac Surg 2016;44:1508–1514. [CrossRef ]
9. 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. [CrossRef ]
10. Rowland K, Das N PURLs: Helmets for positional skull deformities: A good idea, or not? J Fam Pract 2015;64:44–46. [CrossRef ]
11. Schulz M, Spors B, Haberl H, Thomale UW. Results of posterior cranial vault remodeling for plagiocephaly and brachycephaly by the meander technique. Childs Nerv Syst 2014;30:1517–1526. [CrossRef ]
12. Morterson P, Steinbok P, Smith D. Deformational plagiocephaly and orthotic treatment: indications and limitations. Childs Nerv Syst 2012;28:1407–1412. [CrossRef ]
13. Di Rocco C, Paternoster G, Caldarelli M, Massimi L, Tamburrini G. Anterior plagiocephaly: epidemiology, clinicalfindings, diagnosis, and classification. A review. Childs Nerv Syst 2012;28:1413–1422. [CrossRef ]
14. Siatkowski RM, Fortney AC, Nazir SA, et al. Visual field defects in deformational posterior plagiocephaly. JAAPOS 2005;9:274–278. https://doi.org/10.1016/j.jaapos.2005.01.01
15. Speltz ML, Collett BR, Stott-Miller M, et al. Case control study of neurodevelopment in deformational plagiocephaly. Pediatrics 2010;125:e537–e542. [CrossRef ]
26. 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. [CrossRef ]
17. Purzycki A, Thompson E, Argenta L, David L. Incidence of otitis media in children with deformational plagiocephaly. J Craniofac Surg 2009;20:1407–1411. [CrossRef ]
18. Kane AA, Lo L, Vannier MW, Marsh, JL. Mandibular dysmorphology in unicoronal synostosis and plagiocephaly without synostosis. Cleft Palate-Craniofac J 1996;33:418–423. [CrossRef ]
19. Hutchison BL, Hutchison LA, Thompson JM, Mitchell EA. Plagiocephaly and brachycephaly in the first two years of life: a prospective cohort study. Pediatrics 2004;114:970–980. [CrossRef ]
20. American Academy of Pediatrics 2008. Back to sleep, tummy to play. Retrieved August 11, 2012, from: http://www.healthychildcare.org/pdf/SIDStummytime.pdf
21. Shweikeh F, Nuno M, Danielpour M, Krieger MD, Drazin D. Positional plagiocephaly: an analysis of the literatüre on the effectiveness of current guidelines. Neurosurgical Focus 2013;35:E1. [CrossRef ]
22. Farkas LG. Accuracy of anthropometric measurements: past, present, and future. Cleft Palate Craniofac J 1996;33:10–18. [CrossRef ]
23. Mortenson PA, Steinbok P. Quantifying positional plagiocephaly: reliability and validity of anthropometric measurements. J Craniofac Surg 2006;17:413–419. [CrossRef ]
24. 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;112:199–202. [CrossRef ]
25. Plank L, Giavedoni B, Lombardo J, Geil M, Reisner A. Comparison of infant head shape changes in deformational plagiocephaly following treatment with a cranial remolding orthosis using a noninvasive laser shape digitizer. J Craniofac Surg 2006;17:1084–1091. [CrossRef ]
26. Kalra R, Walker ML. Posterior plagiocephaly. Childs Nerv Syst 2012;28:1389–1393. [CrossRef ]
27. Collett B, Breiger D, King D, Cunningham M, Speltz M. Neurodevelopmental implications of “deformational” plagiocephaly. J Dev Behav Pediatr 2005;26:379–389. [CrossRef ]
28. Binkiewicz-Glińska A, Mianowska A, Sokołów M, et al. Early Diagnosis and Treatment of Children with Skull Deformations. The Challenge of Modern Medicine. Dev Period Med 2016;20:289–295.
29. Miller RI, Clarren SK Long-term developmental outcomes in patients with deformational plagiocephaly. Pediatrics 2000;105:e26. [CrossRef ]
30. Steinbok P, Lam D, Singh S, Mortenson PA, Singhal A. Long-term outcome of infants with positional occipital plagiocephaly. Childs Nerv Syst 2007;23:1275–1283. [CrossRef ]