Abstract
Helmet therapy is an important nonsurgical approach for patients with nonsynostotic plagiocephaly, but its effectiveness may depend on certain anatomical features. We retrospectively examined the effects of helmet therapy according to the size of the anterior fontanelle. Two hundred patients with nonsynostotic plagiocephaly who underwent helmet therapy between 2016 and 2018 were included. Data regarding age at treatment onset and treatment duration were collected. Patients were divided into two groups depending on the age at treatment initiation: the 12–23 weeks group and the >23 weeks group. Patients were also divided based on the anterior fontanelle size to analyze the effects of helmet therapy according to the severity of plagiocephaly in each group as the change in the cranial vault asymmetry index (CVAI). Therapeutic effects were evaluated using the cranial vault asymmetry (CVA), CVAI, anterior symmetry ratio, posterior symmetry ratio (PSR), and overall symmetry ratio at baseline and treatment completion. Treatment initiation at age 12–23 weeks resulted in better effects than that after age 24 weeks. There were no sex-dependent differences in therapeutic effects. Greater changes in the CVA, CVAI, and PSR were associated with larger anterior fontanelles. Therefore, the anterior fontanelle size could be a prognostic factor for estimating helmet therapy outcomes.
Highlights
Refers to a skull with occipital flatness; the prevalence of nonsynostotic deformational or positional plagiocephaly, which occurs as a result of external factors such as molding, is higher than that of congenital plagiocephaly caused by internal factors such as craniosynostosis [1,2,3,4,5,6,7,8]
It is well known that the prevalence of positional plagiocephaly caused by sleeping position has substantially increased since the Back to Sleep campaign in the United States as an attempt to prevent sudden infant death syndrome (SIDS) [9]
This study found that helmet therapy produces better outcomes in infants with larger anterior fontanelles
Summary
Refers to a skull with occipital flatness; the prevalence of nonsynostotic deformational or positional plagiocephaly, which occurs as a result of external factors such as molding, is higher than that of congenital plagiocephaly caused by internal factors such as craniosynostosis [1,2,3,4,5,6,7,8]. Deformational plagiocephaly is known to have diverse causes, which can be broadly divided into prenatal and postnatal. It is well known that the prevalence of positional plagiocephaly caused by sleeping position has substantially increased since the Back to Sleep campaign in the United States as an attempt to prevent sudden infant death syndrome (SIDS) [9]. Continuously placing an infant in the supine position can induce positional plagiocephaly, thereby increasing its prevalence [11]. Unilateral occipital plagiocephaly can cause contralateral frontal flatness; if this situation progresses, it may cause an ear shift, which leads to skull base and facial asymmetry [12,13,14]. Many studies have examined measures to prevent the progression of unilateral occipital plagiocephaly
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