Abstract
ABSTRACTThe number of cranial deformities has increased considerably since international efforts of pediatricians to recommend parents putting their babies to sleep in the supine position as a strategy to reduce sudden death syndrome of the newborn. On the one hand, this program has demonstrated very efficient results at reducing deaths and, on the other hand, such recommendation has increased the incidence of cranial asymmetries. In addition, infants are kept too long in one position, much of this due to abusive use of strollers, baby carriers, car seats, swings and other devices. Among resulting asymmetries, the most frequently found are plagiocephaly (parallelogram shaped skull, with posterior unilateral flattening with the opposite frontal area also flattened) and brachycephaly (occipital bilateral flattening). The present study is a case report of a patient with brachycephaly associated with deformational plagiocephaly treated with cranial orthosis. The same physician clinically evaluated the patient before and after treatment using photographic recording and a laser scanning device, which allows the accurate measurement of variables determining asymmetries. It became clear during treatment that there was significant improvement in cranial symmetry documented by decrease in the cephalic index, diagonal difference and volume gain in the quadrant that was flattened. The authors conclude that orthotic therapy is a safe and effective therapeutic modality for position cranial asymmetries.
Highlights
The number of cranial deformities has grown since international efforts of pediatricians recommending parents to put their babies to sleep in the supine position as a strategy to reduce sudden death syndrome of the newborn
Deformational plagiocephaly is a skull asymmetry resulting from external forces applied to an infants malleable skull, and its most common presentation is the parallelogram, with occipital flattening, an anterior ipsilateral caput succedaneum, and contralateral occipital bulging
The values obtained before and after treatment were compared and the following variables were used: - cephalic index: percentage resulting from dividing skull width by skull length at level 3; - quadrant volume: measurement of the volume of each quadrant, from level 2 to level 8 of the cross section of the childs head, as shown in figure 1; - diagonal difference: difference, measured in mm, among 30° oblique diagonals; - cranial asymmetry index: difference between diagonals 1 and 2, at 30°, divided by the largest diagonal, expressed in percentage;
Summary
The number of cranial deformities has grown since international efforts of pediatricians recommending parents to put their babies to sleep in the supine position as a strategy to reduce sudden death syndrome of the newborn. After one month of treatment, photo registration and scan were repeated to monitor development, and upon discharge on July 29, 2011, in order to document results These periods were named T1 (initial assessment and scan), T2 (reassessment for follow-up, one month after initiating use of the orthesis) and T3 (last assessment made, totaling 3 months and 3 weeks from initial assessment). The values obtained before and after treatment were compared and the following variables were used: - cephalic index: percentage resulting from dividing skull width by skull length at level 3 (plane 3cm above the reference plane); - quadrant volume: measurement of the volume (in cm3) of each quadrant, from level 2 to level 8 of the cross section of the childs head, as shown in figure 1; - diagonal difference: difference, measured in mm, among 30° oblique diagonals; - cranial asymmetry index: difference between diagonals 1 and 2, at 30°, divided by the largest diagonal, expressed in percentage;. Comparative analysis of scans on T1 and T3 is shown in figure 4
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