Dynamic Orthotic Cranioplasty Research Articles

Long-Term Treatment Effectiveness of Molding Helmet Therapy in the Correction of Posterior Deformational Plagiocephaly: A Five-Year Follow-Up

To evaluate the long-term effectiveness of helmet therapy in the correction of deformational plagiocephaly and to assess the early occlusal abnormalities seen in these patients. A prospective study with blinded measurements. Twenty-eight patients with deformational plagiocephaly who were treated with molding helmet therapy with at least 5 years of follow-up. The average length of molding helmet treatment was 6.2 months. At the time of this follow-up evaluation, the mean interval since completing the molding helmet therapy was 5.6 years. Anthropometric measurements of cranial asymmetry included cranial vault asymmetry (CVA), orbitotragial depth asymmetry (OTDA), and cranial base asymmetry (CBA). A dental examination was also performed. At the completion of therapy, the most improvement was seen in the measurement of CBA, followed by CVA and OTDA. However, in evaluating the long-term stability of molding treatment, OTDA tended to continue improving after the initial treatment, while CBA and CVA appeared to regress, although none of the changes reached statistically significant levels. In dental measurements, all the dental midline and chin deviations were toward the unaffected side with respect to occipital deformation. This study demonstrated that helmet remodeling with the dynamic orthotic cranioplasty band is effective in the correction of cranial asymmetry, with some nonstatistically significant changes in long-term cranial vault symmetry. Dental observations indicated the possibility of occlusal abnormalities that may affect dental, especially orthodontic, diagnosis and treatment planning.

Posterior positional plagiocephaly treated with cranial remodeling orthosis.

Since the recommendation that infants sleep in the supine position, there has been an increase in cases of posterior positional plagiocephaly. Even though this condition is a purely cosmetic problem, if it is severe it may affect the child psychologically. Positioning may help in mild or moderate cases, but more active treatment may be necessary in severe cases. A prospective study of 260 children treated by dynamic orthotic cranioplasty for posterior positional plagiocephaly was conducted in Lausanne from 1995 to 2001. Construction of these cranial remodelling helmets is decribed in detail. The treatment lasted 3 months on average, was effective, well tolerated, and had zero morbidity. The ideal period for initiating this therapy is between the ages of 4 and 6 months. The remodelling helmet is a convincing option which can be recommended in infants with posterior positional plagiocephaly whose skull deformity is not satisfactorily corrected by physiotherapy. It should always be used before surgery is considered for patients with recognised positional plagiocephaly in the first year of life.

Posterior positional plagiocephaly treated with cranial remodeling orthosis.

Since the recommendation that infants sleep in the supine position, there has been an increase in cases of posterior positional plagiocephaly. Even though this condition is a purely cosmetic problem, if it is severe it may affect the child psychologically. Positioning may help in mild or moderate cases, but more active treatment may be necessary in severe cases. A prospective study of 260 children treated by dynamic orthotic cranioplasty for posterior positional plagiocephaly was conducted in Lausanne from 1995 to 2001. Construction of these cranial remodelling helmets is decribed in detail. The treatment lasted 3 months on average, was effective, well tolerated, and had zero morbidity. The ideal period for initiating this therapy is between the ages of 4 and 6 months. The remodelling helmet is a convincing option which can be recommended in infants with posterior positional plagiocephaly whose skull deformity is not satisfactorily corrected by physiotherapy. It should always be used before surgery is considered for patients with recognised positional plagiocephaly in the first year of life.

Diagnosis and Treatment Algorithm in Cases of Head Deformity

Purpose: To demonstrate the diagnostic and therapeutic approach to infants with head deformities since a variety of treatments including physiotherapy, dynamic orthotic cranioplasty (DOC), and surgical remodeling have to be clearly differentiated.

Diagnosis and Treatment Algorithm in Cases of Head Deformity

Purpose: To demonstrate the diagnostic and therapeutic approach to infants with head deformities since a variety of treatments including physiotherapy, dynamic orthotic cranioplasty (DOC), and surgical remodeling have to be clearly differentiated. Method: One hundred twenty-six nonsyndromal infants presenting with abnormal head shape were clinically evaluated. Signs leading to the clinical diagnosis of deformational plagiocephaly included ipsilateral occipital flattening, contralateral occipital or ispilateral frontal bossing, or ear displacement. Contrarily, a synostotic plagiocephaly was considered in cases of ipsilateral occipital flattening with compensatory ipsilateral mastoid and contralateral parietal bossing. In all cases sonography of the cranial sutures was performed as first-line imaging modality. Only patients with uncertain sonographic findings or signs of premature synostosis underwent x-ray or CT imaging. Treatment modalities were DOC and surgical remodeling. Results: Interosseous hypoechogenic tissues between hyperechogenic bony plates comparable to normal cranial sutures were found in nonsynostotic sutures. In synostotic sutures hyperechogenic bony bridging and osseous ridging with a thin layer of periosteum was seen. Synostotic and nonsynostotic sutures could reliably be distinguished sonographically. The correct diagnoses already confirmed by sonography led to DOC treatment in nonsynostotic plagiocephaly (N = 100) and to surgical correction in true craniosynostoses (n = 26). Conclusion: The sonographic findings led to a change of the diagnostic algorithm in infant head deformity in our clinic. X-ray or CT imaging is only performed in doubtful sonographic findings for further diagnostic security. Ultrasound examination consistently leads the way to treatment with DOC or to a surgical approach. Since ultrasound examinations turned out to be as effective as CT imaging in diagnosing suture fusion or nonsynostotic plagiocephaly, and CT imaging does not add any morphological information, it remains controversial whether CT reconstruction is necessary in planning surgery of solitary affected sutures. Due to radiation doses, CT imaging should be restricted to the infants with complex or multiple suture synostosis. Furthermore, since treatments vary from physiotherapy, DOC, to craniofacial remodeling, due to the lack of objective and noninvasive assessing methods treatment guidelines become highly necessary.

Torticollis and plagiocephaly in infancy: Therapeutic strategies

Asymmetry in infancy is a diagnosis with a large spectrum of features, expressing an abnormal shape of parts of the body or unequal postures and movements, which might be structural and/or functional, with localized or generalized expression. The purpose of the present study is to highlight different therapeutic aspects of the most occurring asymmetries in infancy: congenital muscular torticollis, positional torticollis and plagiocephaly, based on best evidence in current literature. A flow chart is presented showing different pathways in therapeutic strategies, such as physical therapy, orthotic devices (helmet treatment and Dynamic Orthotic Cranioplasty) and surgery. It is concluded that there are different views towards management on torticollis and plagiocephaly. A systematic therapeutic management to evaluate these asymmetries is indicated. The presented therapeutic flow chart might serve as a basis in order to achieve uniformity in therapeutic thinking and performance.

Dynamic orthotic cranioplasty: treatment of the older infant.

The Dynamic Orthotic Cranioplasty Band is a cranial orthotic device used to treat deformational plagiocephaly in infants. The device works by applying a mild holding pressure to the most anterior and posterior prominences, where growth is not desired, while encouraging growth in adjacent flattened regions. Although this technique has been successfully used to treat infants as young as 3 months of age, it is often assumed that decreasing cranial growth and increasing cranial rigidity prohibit treatment in infants older than 1 year of age. The authors' experience with older infants suggests the contrary. Through a series of case reports, they present evidence that this treatment remains viable during the 2nd year of life and that improvement has been observed in infants in whom treatment has been initiated as late as 18 months. These examples certainly suggest that additional prospective studies are warranted.

Sternocleidomastoid imbalance versus congenital muscular torticollis: their relationship to positional plagiocephaly.

The purpose of this study was to investigate the existence of sternocleidomastoid (SCM) imbalance in a plagiocephalic population and further clinically describe its difference, if any, from congenital muscular torticollis (CMT). If SCM imbalance is different from CMT, then the development of terminology and a differential diagnosis may allow early recognition and intervention and possible prevention of positional plagiocephaly in the first place. This was a retrospective, random review of 100 patients referred for orthotic correction of their positional plagiocephaly. The data was collected in a private orthotic clinic and was directed by a physical therapist. The patients were seen on a weekly or biweekly basis. Eighty-three patients diagnosed with positional plagiocephaly that were referred for Dynamic Orthotic Cranioplasty during 1996 were studied. Sixty-four percent of the sample was identified as having SCM imbalance and 12% was diagnosed with CMT. There were no statistically significant differences between the characteristics of these two groups in relation to the etiological factors of positional plagiocephaly. The only observed difference was related to symptoms of the neck itself. Seventy-six percent of the sample was found to have some degree of SCM dysfunction, whether it be SCM imbalance or CMT. The finding that over three quarters of our population suffers from some form of SCM dysfunction, either SCM imbalance or CMT, suggests that any degree of SCM dysfunction may act as a precursor to positional plagiocephaly and therefore should be recognized and treated at the earliest opportunity.

Cranial Growth Unrestricted during Treatment of Deformational Plagiocephaly

Objectives: The Dynamic Orthotic Cranioplasty (DOC) Band^TM is a cranial orthosis used to treat deformational plagiocephaly. The ability of this device to redirect growth and thus, improve craniofacial asymmetry has raised concerns regarding the potential restriction of cranial growth. The purpose of this study was to evaluate the growth of the head during correction of plagiocephaly. Methods: The study sample consisted of 190 children: 81 females (42.6%) and 109 males (57.4%) All patients had been diagnosed with nonsynostotic plagiocephaly, did not have other significant medical conditions, were compliant with DOC protocol, and had complete anthropometric measurements at entrance and exit from treatment. Growth of the head was evaluated using head circumference, maximum cranial width and maximum cranial length. Correction of plagiocephaly was evaluated by documenting the reduction of craniofacial asymmetry of the cranial vault, skull base and face. Paired t tests were used to assess the significance of changes in these anthropometric measurements. Differences were considered significant if p < 0.05. Results: Average entrance age was 6.5 months with a mean treatment time of 4.1 months. Statistical analysis demonstrated highly significant reductions in asymmetry in all three regions (p < 0.001). More importantly, these corrections were achieved with synchronous growth of the skull as demonstrated by highly significant increases (p < 0.001) in head circumference, maximum cranial width and maximum cranial length. Conclusions: These findings document statistically significant increases in cranial growth in association with concomitant reductions of the cranial asymmetries associated with deformational plagiocephaly.

Importance of early recognition and treatment of deformational plagiocephaly with orthotic cranioplasty.

Infants with positional plagiocephaly often exhibit complex multistructural asymmetries that affect the face and skull base as well as the cranial vault. Dynamic Orthotic Cranioplasty (DOC) was developed as a nonsurgical alternative for the treatment of positional plagiocephaly. The effectiveness of DOC has been discussed elsewhere. The purpose of this study was to assess the influence of factors such as entrance age, treatment time, and initial severity on the effectiveness of correction. The study sample consisted of 258 children with cranial vault asymmetry (CVA) treated prior to 1 year of age. In addition, 246 patients (92%) exhibited concurrent skull base (SBA) and orbitotragial depth (OTDA) asymmetries. All patients had been diagnosed with nonsynostotic plagiocephaly, did not have other contributing medical conditions, were compliant with DOC protocol, and had complete anthropometric measurements at entrance and exit from treatment. Mean age at start of treatment was 6.5 (+/-1.9) months (range, 2.8 to 11.0 months), with an average treatment time of 4.1 (+/-2.2) months. The effects of the treatment variables were analyzed using three-way analysis of variance. As expected, initial severity was significantly associated with the amount of correction (p = .0001). However, treatment time was not significant (p > .05). Most importantly, the analysis revealed that, having accounted for initial severity, entrance age had a statistically significant effect [F(1,254) = 8.36, p = .0042] on the correction of CVA. Similar results were identified for both the SBA [F(1,254) = 5.53, p = .0195] and the OTDA [F(1,254) = 5.22, p = .0231] asymmetries. These findings support clinical observations that earlier intervention results in significantly improved treatment of plagiocephaly, independent of the severity of the presenting asymmetries.

Treatment of craniofacial asymmetry with dynamic orthotic cranioplasty.

Dynamic Orthotic Cranioplasty (DOC) was developed to treat craniofacial deformities associated with positional plagiocephaly. This investigation describes the treatment of more than 750 patients with the DOC Band since 1988. All patients undergoing DOC treatment were fit with a custom fabricated orthosis made from a plaster impression taken from the infant's head. When the orthosis was applied, the corrective pressure was directed to hold growth at the calvarial prominences and redirect symmetrical growth. A detailed medical history was obtained and anthropometric measurements were taken at start, exit, 12, 18, and 24 months follow-up. This information was recorded in a database created in Microsoft Excel. Mean length of treatment was 4.3 months with an average entrance age of 6.9 months. Analysis of anthropometric data showed significant reduction in mean cranial vault, skull base, and facial asymmetries. Correction of the more difficult skull base was documented with computed tomography. Our anthropometric and clinical observations document complete or near complete correction of asymmetry for a wide variety of head shapes. Based on the results of this investigation, we are able to support the earlier claims of our pilot study, which concluded that DOC is effective in the treatment of positional plagiocephaly.

Special Commentary on Treatment of Craniofacial Asymmetry With Dynamic Orthotic Cranioplasty

Special Commentary on Treatment of Craniofacial Asymmetry With Dynamic Orthotic Cranioplasty

Etiology of positional plagiocephaly in triplets and treatment using a dynamic orthotic cranioplasty device

In 1994 a set of triplets presented to the authors for treatment of their positional plagiocephaly with Dynamic Orthotic Cranioplasty (DOC). The three 8-month-old infants were diagnosed with severe, moderate, and mild plagiocephaly. Only the severe and moderate cases were treated with the DOC band. The mild case was not treated with the DOC band because it was thought that the condition could be addressed through alteration in the child's sleeping position. The child with severe deformation required 8.5 months of treatment with two DOC bands and had significant residual asymmetries at the end of the treatment course. The child with moderate deformity required 2.5 months of treatment with only one DOC band and had excellent correction of the initial asymmetries. The results of their treatment provide a unique forum for discussing the etiology of positional plagiocephaly, as well as those factors that can influence the efficacy of DOC treatment.

Commentary on Article 2: Etiology of positional plagiocephaly in triplets and treatment using a dynamic orthotic cranioplasty device. Report of three cases

Commentary on Article 2: Etiology of positional plagiocephaly in triplets and treatment using a dynamic orthotic cranioplasty device. Report of three cases

Treatment of positional plagiocepli aly with dynamic orthotic cranioplasty

Treatment of positional plagiocepli aly with dynamic orthotic cranioplasty

Treatment of Positional Plagiocephaly with Dynamic Orthotic Cranioplasty

Dynamic orthotic cranioplasty (DOC) was developed to treat asymmetrical head shape of a nonsynostotic origin, which is defined by the term positional plagiocephaly. These positional deformations have been found to correlate with a number of environmental factors. Infants with positional plagiocephaly may exhibit complex multistructural asymmetry affecting the cranial vault, face, and skull base, or expression may be local in nature. Between 1988 and 1993, we performed DOC on 124 infants with positional plagiocephaly. Through clinical, anthropometric, radiographic, and statistical evaluation, we found that DOC corrects positional deformation of the cranial vault, skull base, and upper face, with no evident relapse following treatment. The design and the global approach to deformation address a wide spectrum of abnormal head shapes. The procedure is dynamic and customized, and it does not rely on passive growth alone for improvement.