POSTNATAL PLACIOCEPIIALY: PATHOGENESIS AND THERAPY IN 40 CASES (1981–86)

Abstract

We report 40 cases of postnatal plagiocephaly seen over a 6 yr period (1981-86). Twenty cases had mild to moderate plagiocephaly (10 males, 10 females) due to muscular torticollis and responded to physical therapy and repositioning within the first few months of life. In 3 instances, a head positioning device was helpful; in 2 instances where no consistent therapy was attempted the cranial deformity persisted. An additional 9 cases had severe plagiocephaly due to persistent muscular torticollis (8 males, 1 female). When the above measures failed to correct cranial symmetry by 5 to 6 months, helmet therapy was instituted with excellent results. Another 5 cases (3 males, 2 females), had marked occipital flattening from prolonged use of an Infant Seat; 3 improved with repositioning alone, while 2 with associated muscular torticollis required either head positioning device or helmet. Four children with medical problems resulting in prolonged recumbency (CNS abnormalities, intestinal atresia, TE fistula) and associated mild torticollis, responded to simple repositioning. Two other children with unremitting torticollis due to Klippel-Feil anomaly required helmet therapy. Neck stretching exercises and repositioning were most effective in correcting plagiocephaly when instituted early in the first year of life. When torticollis was severe (more common in males) or due to underlying vertebral anomalies, helmet therapy was effective.