El pediatra y los padres en la toma de decisiones de tratamiento en plagiocefalia posicional: una revisión narrativa / The pediatrician and parents in treatment decision-making in positional plagiocephaly: A narrative review

La plagiocefalia posicional (PP) es una de las causas más frecuentes de consulta en neurocirugía pediátrica. La incidencia de PP aumentó en los '90, a partir de la campaña Dormir de espaldas. Junto con el aumento de la demanda de atención, se verifica un debate acerca de la eficacia de los distintos tratamientos. La interacción padres ­ pediatra orientada a elegir la mejor terapéutica adquiere importancia, particularmente cuando se trata de decisiones sensibles a la preferencia. Es necesario saber más acerca de la naturaleza de la toma de decisiones de tratamiento de PP, para contribuir al desarrollo de procesos decisorios eficaces. Se realizó una revisión narrativa sobre investigaciones en toma de decisiones de tratamiento en PP. Se identificaron artículos en PubMed y Google Scholar (1990 ­ 2022) en una búsqueda con los descriptores "plagiocephaly", "decision making" y "parents". Se incluyeron artículos cuyo tema central fuera la toma de decisiones en PP, o que la desarrollaran como parte de otro tema. Se excluyeron trabajos en los que la toma de decisiones aparece de modo secundario o tangencial. Se encontraron 3 artículos con distintos diseños metodológicos, en los que la severidad de la presentación, los elementos socioculturales y emocionales, y los aspectos relacionados con el tratamiento son los factores más implicados en la toma de decisiones. Las relaciones entre la ansiedad parental, las expectativas de tratamiento y la percepción subjetiva de la PP, y el rol del pediatra como proveedor de información válida y confiable son temas que necesitan de ulterior investigación (AU)

Positional plagiocephaly (PP) is one of the main reasons for consultation in pediatric neurosurgery. The incidence of PP increased in the 1990s, after the "Back to Sleep" campaign. Concurrently, the growing demand for care has led to a debate regarding the effectiveness of the different treatments. The parent-pediatrician interaction is aimed at choosing the best therapeutic approach becomes important, particularly when it comes to preference-sensitive decisions. There is a need to better understand the nature of PP treatment decision-making in order to contribute to the development of effective decisionmaking processes. In this narrative review, we evaluated the research on treatment decision-making in PP. Articles were identified in PubMed and Google Scholar (1990 - 2022) using the search terms "plagiocephaly", "decision-making" and "parents". Articles were included if their central theme was decision-making in PP, or if they developed it as part of another subject. We excluded articles in which decision-making appeared in a secondary or tangential way. Three articles were identified with different methodological designs, in which the severity of the presentation, sociocultural and emotional aspects, and aspects related to treatment were the factors most implicated in decision making. The relationships between parental anxiety, treatment expectations, subjective perception of PP, and the role of the pediatrician as a provider of valuable and reliable information are topics that require further investigation (AU)

Follow-up and prognostic study of infants with positional plagiocephaly / 中国当代儿科杂志

OBJECTIVES@#To study the effects of infantile positional plagiocephaly on the growth and neural development.@*METHODS@#A retrospective study was conducted on the medical data of 467 children who underwent craniographic examination and were followed up to 3 years of age in Peking University Third Hospital from June 2018 to May 2022. They were divided into four groups: mild positional plagiocephaly (n=108), moderate positional plagiocephaly (n=49), severe positional plagiocephaly (n=12), and normal cranial shape (n=298). The general information of the four groups and the weight, length, head circumference, visual acuity screening results, hearing test results, and the scores of Pediatric Neuropsychological Developmental Scales/Gesell Developmental Schedules of the four groups from 6 to 36 months old were compared.@*RESULTS@#The rates of adverse perinatal factors, congenital muscular torticollis, and supine fixed sleeping posture in the mild, moderate, and severe positional plagiocephaly groups were higher than the normal cranial group (P<0.05). There was no significant difference in weight, length, and head circumference among the four groups at 6, 12, 24 and 36 months of age (P>0.05). The incidence rate of abnormal vision in the severe positional plagiocephaly group was higher than that in the mild positional plagiocephaly, moderate positional plagiocephaly and normal cranial shape groups at 24 and 36 months of age (P<0.05). The scores of the Pediatric Neuropsychological Developmental Scales at 12 and 24 months of age and the scores of the Gesell Developmental Schedules at 36 months of age in the severe positional plagiocephaly group were lower than those in the mild positional plagiocephaly, moderate positional plagiocephaly and normal cranial shape groups, but the difference was not statistically significant (P>0.05).@*CONCLUSIONS@#Adverse perinatal factors, congenital muscular torticollis, and supine fixed sleeping position may be associated with infantile positional plagiocephaly. Mild or moderate positional plagiocephaly has no significant impact on the growth and neural development of children. Severe positional plagiocephaly have adverse effects on the visual acuity. However, it is not considered that severe positional plagiocephaly can affect the neurological development.

Características, diagnóstico y tratamiento de la tortícolis muscular congénita / Characteristics, Diagnosis and Management of Congenial Muscular Torticollis

Introducción: La tortícolis muscular congénita es una entidad clínica que se hace evidente al nacimiento o poco después, presenta un amplio espectro de secuelas; algunas de estas, una vez establecidas, pueden requerir complejas y costosas correcciones quirúrgicas. we Objetivo: Caracterizar la tortícolis muscular congénita según elementos clínicos, diagnósticos y terapéuticos. Métodos: Se realizó una búsqueda de literatura relevante sobre el tema en el primer cuatrimestre de 2021. Se utilizaron como buscadores de información científica: Pubmed/Medline, SciELO, Scopus y ScienceDirect, así como fuentes oficiales como, China CDC, CDC y FDA. La estrategia de búsqueda incluyó los siguientes términos como palabras clave: tortícolis muscular congénita, complicaciones dentofaciales y psicológicas, plagiocefalia posicional. Se evaluaron artículos de revisión, de investigación y páginas web que, en general, tenían menos de 10 años de publicados, en idioma español e inglés, y que hicieran referencia específicamente al tema de estudio a través del título. Fueron excluidos los artículos que no cumplieron con estas condiciones. Esto permitió el estudio de 90 referencias bibliográficas, de las cuales 30 se citaron en el presente artículo. Conclusiones: La tortícolis muscular congénita es una enfermedad de observancia frecuente, su diagnóstico clínico y por exámenes complementarios debe hacerse en los primeros meses de vida. La detección y tratamiento rehabilitador precoz constituyen las armas fundamentales para evitar sus secuelas dentofaciales y psicológicas.

Introduction: Congenital muscular torticollis is a clinical entity that becomes evident at birth or shortly thereafter. It presents a wide spectrum of sequelae. Some of these, once established, may require complex and costly surgical corrections. Objective: To characterize congenital muscular torticollis according to clinical, diagnostic and therapeutic elements. Methods: A search for relevant literature on the subject was carried out in the first third of 2021. As information search engines Pubmed/Medline, SciELO, Scopus and ScienceDirect were used; as well as official sources, such as China CDC, CDC and FDA. The search strategy included the following keywords: tortícolis muscular congénita [congenital muscular torticollis], complicaciones dentofaciales y psicológicas [dentofacial and psychological complications], plagiocefalia posicional [positional plagiocephaly]. Review articles, research articles and web pages, in Spanish and in English, were assessed by considering that they had generally been published within less than ten years and that they referred, within their title, specifically to the topic of study. The articles that did not meet these conditions were excluded. This allowed the study of ninety bibliographic references, thirty of which were cited in the present article. Conclusions: Congenital muscular torticollis is a frequently observed disease, which should be diagnosed, clinically and by complementary tests, in the first months of life. Early identification and rehabilitation treatment are the fundamental weapons to avoid its dentofacial and psychological sequelae.

Incidence of Metopic Suture in Adult Human Crania in Uttar Pradesh

Introduction: Failure of ossification in the vertical direction between the two halves of the frontal bone is called a metopic suture; this suture is present in between the superciliary arch and tubers of the frontal bone so it is also called a median frontal suture. At birth, the frontal bone present is two half, in the 1st year they contact each other, and within the 7th to 8th year, they fused together. Sometimes, bones may not be fused completely and it becomes metopic fontanelle. MaterialsandMethods: The goal of the current study was to determine the prevalence of metopic suture in adult human skulls in Uttar Pradesh. One hundred and fifty macerated skulls of undetermined age and sex were used for this. The anatomical departments of Teerthankar Mahaveer Medical College and Research Center (Moradabad), King George Medical College (Lucknow), SRMS Institute of Medical Science (Bareilly), Govt. Medical College Kannauj, and Govt. Medical College Saharanpur provided these skulls. Results: This study has found the incidence of metopic sutures of about 12.90%. The two types of metopic sutures were found in this study, namely complete metopic suture 4.52% and incomplete metopic suture 8.38% in which found 0.64% “V” shape metopic suture. Conclusion: Themorphological study of metopic sutures on adult crania is useful for anatomists, experts in forensic medicine, and neurologists for performing surgical procedures in this area

Estudio retrospectivo. Influencia de la Terapia Kinesiológica Temprana en el uso de Casco Modelador Craneal / Retrospective study. Influence of early physical therapy on the need to wear a skull molding helmet

Introducción. La plagiocefalia no sinostósica es una condición de salud caracterizada por una asimetría de cráneo que tiene diversas consecuencias en el desarrollo. Los principales tratamientos son la kinesioterapia y el casco de moldeado craneal (CMC). Objetivo. Evidenciar la influencia de la kinesioterapia temprana en la necesidad de usar casco modelador craneal. Métodos. Se realizó un estudio cuantitativo, descriptivo y retrospectivo en lactantes mayores de tres meses ingresados al Centro de Rehabilitación Integral de Carabineros (CRICAR) con diagnóstico confirmado de plagiocefalia mediante la técnica de craneometría. Se recopilaron datos de 39 pacientes diagnosticados con plagiocefalia, evaluados y tratados entre 2017 y 2019. Se dividieron en dos grupos, ingreso temprano (bajo los 5,5 meses de edad cronológica) e ingreso tardío (sobre los 5,5 meses de edad cronológica). Resultados. Al realizar un análisis bivariado, se obtuvo que 9 de 20 pacientes tuvieron que usar CMC en el grupo de ingreso tardío, y solo 4 de 19 pacientes en el grupo de ingreso temprano. Al contrastar la razón de riesgo de usar CMC en el grupo expuesto versus el grupo no expuesto se obtiene que es 3 veces mayor, sin embargo, esta diferencia no es estadísticamente significativa (OR=3.06, IC95% 0.6-16.8) Conclusiones. El principal resultado de este estudio es la disminución en la diferencia de diagonales evaluadas con craneometría. Además, se ha observado que en nuestra muestra el uso de CMC es tres veces mayor cuando el ingreso a terapia kinesiológica es tardío.

Introduction. Non-synostotic plagiocephaly is health condition characterized by a skull asymmetry that has various developmental consequences. The main treatments are kinesiotherapy and cranial molding helmet (CMH). The purpose of this study is to evidence the influence of early kinesiotherapy on the need to use CMH. Methods. A quantitative, descriptive and retrospective study of infants older than three months, admitted to the Carabineros Comprehensive Rehabilitation Center (CRICAR) since January 2017 with a confirmed diagnosis of plagiocephaly by craniometry technique was performed. Data were collected from 39 patients diagnosed with plagiocephaly, evaluated and treated between 2017 and 2019. They were divided into two groups, early admission (under 5.5 months of chronological age) and late admission (over 5.5 months of chronological age). Results. When performing a bivariate analysis, we obtained that 9 out of 20 patients had to use CMC in the late admission group, and only 4 out of 19 patients had to use it in the opposite group. When contrasting the oods ratio of using CMC in the exposed group versus the non-exposed group we obtain that it is 3 times higher, however, this difference is not statistically significant (OR=3.06, IC95% 0.6-16.8). Conclusions. The main result of this study is the decrease in the difference in diagonals assessed with craniometry. In addition, it has been observed that in our sample the use of CMC is three times higher when admission to physical therapy is late.

Quirúrgico de plagiocefalia anterior: reporte de caso / Surgical management of anterior plagiocephaly: case report / Tratamento cirúrgico da plagiocefalia anterior: relato de caso

Craniosynostosis is the premature, abnormal, and non-physiological fusion of one or more cranial sutures. Its etiology can be multifactorial and genetic factors, bone abnormalities or environmental factors may be involved. Among the different types of craniosynostosis we can find anterior plagiocephaly, which generally corresponds to a non-syndromic craniosynostosis and which can affect the patient in a physiological and aesthetic way. Hemi-coronal sutures are affected in this condition. The treatment will depend on each case, although many times it is usually the surgical choice in order to prevent functional deterioration and improve the facial and cranial appearance... (AU)

La craneosinostosis es la fusión prematura, anormal y no fisiológica de una o más suturas craneales. Su etiología puede ser multifactorial y pueden estar involucrados factores genéticos, anormalidades propias del hueso o factores ambientales. Dentro de los diferentes tipos de craneosinostosis podemos encontrar a la plagiocefalia anterior, que corresponde generalmente a una craneosinostosis no sindrómica y que cual puede afectar de manera fisiológica y estética al paciente. Las suturas hemi-coronales se ven afectadas en dicha condición. El tratamiento dependerá de cada caso, aunque muchas de las veces suele ser de elección quirúrgica con el fin de prevenir el deterioro funcional y mejorar el aspecto facial y craneal... (AU)

Craniossinostose é a fusão prematura, anormal e não fisiológica de uma ou mais suturas cranianas. Sua etiologia pode ser multifatorial e fatores genéticos, anormalidades ósseas ou fatores ambientais podem estar envolvidos. Entre os diferentes tipos de craniossinostose podemos encontrar a plagiocefalia anterior, que geralmente corresponde a uma craniossinostose não sindrômica e que pode afetar o paciente de forma fisiológica e estética. Suturas hemicoronais são afetadas nessa condição. O tratamento dependerá de cada caso, embora muitas vezes seja a escolha cirúrgica para prevenir deterioração funcional e melhorar o aspecto facial e cranial... (AU)

The efficacy of an orthotic helmet in cranial remodeling of infants with deformational plagiocephaly / 中华物理医学与康复杂志

Objective:To observe the clinical effect of helmet therapy in cranial remodeling of infants with deformational plagiocephaly.Methods:A total of 114 infants with plagiocephaly received helmet therapy at the age of 4 to 12 months over the period from 2016 to 2018 and the results were analyzed retrospectively. Seventy-four were male and forty female. The average ages were (7.49±1.91) and (7.54±2.10) months, respectively. A Spectra scanner was used to quantify each head′s radial symmetry index (RSI), cranial vault asymmetry (CVA) and cranial vault asymmetry index (CVAI) before and after 100 days of treatment, and those data were related with age (4-6 months, 7-9 months and 10-12 months), gender and severity of deformity (levels III-V).Results:The average RSI, CVA and CVAI improved significantly for all of the infants studied. The average RSI, CVA and CVAI improved the most for those 4-6 months old. Those with level-IV deformity showed significantly better improvement than those with level III or V deformity.Conclusions:Helmet therapy is an effective way to improve deformities due to plagiocephaly among infants. The best age for treatment is 4-6 months. Patients with less malformation are more easily corrected.

Craneosinostosis, una perspectiva pediátrica / Craniosynostosis, a pediatric perspective

La craneosinostosis se define como el cierre prematuro de una o más suturas del cráneo, que se manifiesta por una forma anormal de la cabeza. Es una condición infrecuente, pero requiere ser reconocida y derivada oportunamente a Neurocirugía para prevenir complicaciones. El objetivo de esta revisión es describir las características clínicas y genéticas más frecuentes de esta patología, su clasificación de acuerdo a la forma del cráneo y los signos más característicos para lograr reconocerla oportunamente. Se realizó una búsqueda de artículos científicos en bases de datos Pubmed, Scielo y EMBASE con las palabras craneosinostosis, plagio, escafo y braquicefalia. Se seleccionaron artículos en español e inglés que describieran las características de la patología y su manejo, optando por revisiones sistemáticas o recomendaciones de sociedades científicas cuando estuvieran disponibles. La craneosinostosis puede presentarse en forma aislada o asociada a otras deformidades. Su clasifi cación depende de la(s) sutura(s) afectada(s), lo que lleva a la forma característica del cráneo y de la presencia de otras malformaciones. Suele diagnosticarse y derivarse de forma tardía, lo que se asocia a complicaciones como hipertensión endocraneana y alteración del desarrollo encefálico. La cirugía precoz tiene menor comorbilidad y mejores resultados estético. En conclusión, la forma anormal del cráneo debe hacer sospechar la presencia de craneosinostosis, aunque se presente en forma aislada. El manejo quirúrgico antes del año de vida se asocia a mejor pronóstico.

Craniosynostosis is defined as the premature fusion of one or more skull sutures, characterized by an abnormal shape of the head. It is a rare condition but should be recognized and timely referred to Neurosurgery in order to prevent complications. The objective of this review is to describe the most frequent clinical and genetic characteristics of this pathology, its classification according to the shape of the skull, and the most characteristic signs to achieve timely recognition. A search for scientific articles in Pubmed, Scielo, and EMBASE databases was performed using the terms craniosynostosis, plagiocephaly, scaphocephaly, and brachycephaly. We selected articles in Spanish and English that described the characteristics of the pathology and about its management, choosing systematic reviews or recommendations from scientific societies when available. Craniosynostosis may occur in isola tion or associated with other deformities. Its classification depends on the affected suture(s), leading to the characteristic shape of the skull and the presence of other malformations. This condition is usually diagnosed and referred late, which is associated with complications such as intracranial hy pertension and impaired brain development. Early surgery has less comorbidity and better esthetic results. In conclusion, the abnormal shape of the skull must raise the suspicion of craniosynostosis, even if it occurs in isolation. Surgical management before one year of life is associated with a better prognosis.

Cranial measurement analysis of 3 406 infants aged 0 to 6 months in Chongqing / 国际儿科学杂志

Objective@#The incidence and distribution of positional deformities(PD)were studied by measuring cranial types of infants aged 0-6 months of 3 hospitals in Chongqing, and the recommended values of local PD were discussed.@*Methods@#Data of 3 406 infants with 0-6 months head size measurements were collected from the Second Affiliated Hospital of Army Military Medical University, Yongchuan Maternal and Child Health Care Hospital and Wanzhou Maternal and Child Health Care Hospital from September 1, 2017 to August 31, 2018, cranial vault asymmetry(CVA)and cranial index(CI)were calculated.According to different age groups, observe the distribution of cranial types, and use the current international common diagnostic criteria to understand the incidence of cranial abnormalities, and analyze the distribution of percentile values of CVA and CI in infants in Chongqing.@*Results@#According to the current international standard diagnosis of PD, the incidence of simple brachycephaly was the highest(39.9%)in the overall cranial abnormalities of infants, followed by brachycephaly with plagiocephaly was the second(36.1%), simple plagiocephaly was the lowest(6.9%), and normal cranial type only accounted for 17.1%.The detection rates of plagiocephaly(36.9%)and brachycephaly(67.0%)were the lowest in the 0-2 months group, and the highest in the 3-4 months group(47.3%/83.3%), and then decreased in the 5-6 months group(46.6%/80.2%).@*Conclusion@#The basic values of cranial type measurement of full-term infants in chongqing were significantly different from international reports, mainly due to the large CI value.The general international diagnosis standard for positional deformities do not conform to Chinese infants.We suggest that the reference value for positional deformities in this region is as follows: CVA≥0.4 cm is abnormal, of which 0.4 cm≤CVA<0.6 cm for mild plagiocephaly, 0.6 cm≤CVA<1.0 cm for moderate plagiocephaly, CVA≥1.0 cm for severe plagiocephaly; 82%≤CI≤91% is abnormal, of which 91%≤CI<94% for mild brachycephaly; 94% ≤CI<99% for moderate brachycephaly; CI≥ 99% for severe brachycephaly.CI≤82% is scaphocephaly.

Cranial measurement analysis of 3406 infants aged 0 to 6 months in Chongqing / 国际儿科学杂志

Objective The incidence and distribution of positional deformities ( PD) were studied by measuring cranial types of infants aged 0-6 months of 3 hospitals in Chongqing, and the recommended values of local PD were discussed. Methods Data of 3406 infants with 0-6 months head size measurements were col-lected from the Second Affiliated Hospital of Army Military Medical University, Yongchuan Maternal and Child Health Care Hospital and Wanzhou Maternal and Child Health Care Hospital from September 1, 2017 to August 31, 2018, cranial vault asymmetry ( CVA) and cranial index ( CI) were calculated. According to different age groups, observe the distribution of cranial types, and use the current international common diagnostic crite-ria to understand the incidence of cranial abnormalities, and analyze the distribution of percentile values of CVA and CI in infants in Chongqing. Results According to the current international standard diagnosis of PD, the incidence of simple brachycephaly was the highest ( 39. 9％) in the overall cranial abnormalities of infants, followed by brachycephaly with plagiocephaly was the second (36. 1％), simple plagiocephaly was the lowest (6. 9％), and normal cranial type only accounted for 17. 1％. The detection rates of plagiocephaly (36. 9％)and brachycephaly ( 67. 0％) were the lowest in the 0-2 months group, and the highest in the 3-4 months group (47. 3％/83. 3％), and then decreased in the 5-6 months group (46. 6％/80. 2％). Conclusion The basic values of cranial type measurement of full-term infants in chongqing were significantly different from inter-national reports, mainly due to the large CI value. The general international diagnosis standard for positional deformities do not conform to Chinese infants. We suggest that the reference value for positional deformities in this region is as follows: CVA≥0. 4 cm is abnormal, of which 0. 4 cm≤CVA<0. 6 cm for mild plagiocepha-ly, 0. 6 cm≤CVA<1. 0 cm for moderate plagiocephaly, CVA≥1. 0 cm for severe plagiocephaly; 82％≤CI≤91％ is abnormal, of which 91％≤CI <94％ for mild brachycephaly; 94％ ≤CI <99％ for moderate brachycephaly; CI≥99％ for severe brachycephaly. CI≤82％ is scaphocephaly.

Deformidades craneales sinostósicas y no sinostósicas / Synostosic and non-synostosic cranial deformities

Las alteraciones de la forma del cráneo han aumentado en las últimas décadas a expensas de las plagiocefalias, como consecuencia de las recomendaciones de la Academia Americana de Pediatría de dormir al lactante en decúbito supino. El clínico debe diferenciar entre plagiocefalia posicional y craneosinostosis, ya que la conducta terapéutica será potencialmente neuroquirúrgica de comprobar una sinostosis craneal. Si bien la tomografía de cráneo tridimensional con ventana ósea es el estudio de mayor sensibilidad y especificidad diagnóstica, la mayoría de los casos pueden confirmarse por la clínica, reservando la radiografía simple o de preferencia la ecografía con enfoque de suturas para casos dudosos. Las craneosinostosis deben derivarse tempranamente a un equipo craneofacial para definir la indicación, oportunidad y técnica quirúrgica más adecuada para evitar futuras complicaciones neurocognitivos y psicosociales. Los niños con plagiocefalias posicionales, independientemente del tratamiento de la deformidad craneal, pueden tener más riesgo de retraso del desarrollo motor. Para su corrección se sugiere reposicionamiento y fisioterapia en formas leves a moderadas, reservando el uso de ortésis craneal en formas graves.

In the last decades alterations in the skull shape have increased at the expense of plagiocephaly, as consequence of the American Academy of Pediatrics recommendations to sleep the infant in the supine position. The clinician must differentiate between positional plagiocephaly and craniosynostosis, since if a cranial synostosis is proven, the therapeutic behavior will be potentially neurosurgical. Although three-dimensional skull tomography with bone window is the study of greater sensitivity and diagnostic specificity, the majority of cases can be confirmed by the clinic, reserving the radiography or ultrasound with a suture approach for doubtful cases. Craniosynostosis must be early referral to a craniofacial team to define the indication, opportunity and most appropriate surgical technique, in order to avoid future neurocognitive and psychosocial complications. Children with positional plagiocephaly regardless of the treatment of cranial deformity may have a higher risk of motor development delay. For correction, repositioning and physiotherapy are suggested in mild to moderate forms, reserving the use of cranial orthesis in severe forms.

Parents' Perspectives and Clinical Effectiveness of Cranial-Molding Orthoses in Infants With Plagiocephaly

OBJECTIVE: To investigate the clinical effectiveness of and parents’ perspectives on cranial-molding orthotic treatment. METHODS: Medical charts were reviewed for 82 infants treated for plagiocephaly with cranial-molding orthoses in our clinic from April 2012 to July 2016 retrospectively. Infants who were clinically diagnosed with positional plagiocephaly and had a Cranial Vault Asymmetry Index (CVAI) of more than 3.5% were included. Pre- and post-treatment CVAI was obtained by three-dimensional head-surface laser scan. Parents’ perceptions of good outcome (satisfaction) were evaluated with the Goal Attainment Scale (GAS). The GAS score assessed how much the parent felt that his or her initial goal for correcting the skull asymmetry was achieved after the treatment. RESULTS: The compliance with cranial-molding orthoses was 90.2% (74 of 82 infants). There were 53 infants (65% of the 82 infants) who had adverse events with the cranial-molding orthoses during the study. Heat rash was found in 29 cases (35.4%) and was the most common adverse event. The mean GAS T-score was 51.9±10.2. A GAS T-score of 0 or more was identified for 71.6% of parents. The GAS T-score was significantly related to the age (p < 0.001), the initial CVAI, and the difference of CVAI during the treatment (p < 0.001). CONCLUSION: Parents’ perception of good outcome was correlated with the anthropometric improvement in cranialmolding orthotic treatment in infants with plagiocephaly. A high percentage of parents felt that the treatment met their initial goals in spite of a high occurrence of adverse events.

Craneosinostosis y deformidades posicionales del cráneo: revisión crítica acerca del manejo / Craniosynostosis and cranial positional deformities: a critical review on its management

RESUMEN OBJETIVO: Revisar la fisiopatología de las craneosinostosis y las deformidades posicionales del cráneo y analizar los tipos de tratamiento, especialmente las ortesis de moldeamiento craneal. MÉTODOS: Revisión de la literatura de estudios observacionales, ensayos clínicos y de revisión en la base de datos PubMed desde 1980 a 2018 y manual de los artículos no referenciados. Se utilizaron las palabras clave: craniosynostosis, plagiocephaly, nonsynostotic, skull, cranial, asociadas a: surgical treatment, pathophysiology, cognition, orthotic devices, head protective devices. El título y el resumen fueron analizados antes de solicitar el artículo completo. En el caso de que fueran ambiguos, se analizaron los artículos en su totalidad para determinar su pertinencia. RESULTADOS: El tratamiento de las craneosinostosis es quirúrgico, mediante reconstrucción craneal, pero existe controversia respecto al manejo de deformidades posicionales: cambios de posición supervisados u ortesis de moldeamiento craneal. Aunque la corrección del defecto estético es recomendación principal de las ortesis, se discute la influencia que puede haber sobre el desarrollo cognitivo y motor, trastornos visuales, hipertensión endocraneana y defectos ortognáticos. No existen diferencias con el manejo de cambios de posición supervisada en la modificación del índice craneal. Algunos pacientes mejoran espontáneamente cuando adquieren el sostén cefálico y empiezan a incorporarse. Existen además complicaciones con las ortesis que pueden llegar a ser serias. CONCLUSIÓN: No se recomienda la utilización de medidas restrictivas como las ortesis de moldeamiento craneal para el tratamiento de estos pacientes con deformidades posicionales craneanas. La cirugía reconstructiva es el manejo de elección para las craneosinostosis.

SUMMARY OBJECTIVE: to review the pathophysiology of craniosynostosis and positional deformities of the skull, and analyze the types of treatment, especially cranial orthoses. METHODS: Review of the literature on observational studies, clinical trials and reviews in the PubMed database from 1980 to 2018 and manual search of non-referenced articles. The following keywords were used: craniosynostosis, plagiocephaly, nonsynostotic, skull, cranial, associated with: surgical treatment, pathophysio-logy, cognition, orthotic devices, head protective devices. We analyzed the title and abstract before requesting the full article. If they were ambiguous, we analyzed the whole article to determine its relevance. RESULTS: Treatment of craniosynostosis is surgical by cranial reconstruction. On the other hand, there is controversy over supervised position changes and use of cranial orthosis to manage positional deformities. Although correcting the esthetic defect is the main purpose of orthoses, their potential influence on cognitive and motor development, visual disorders, endocranial hypertension and orthognathic defects is discussed. There are no differences between conservative management with changes of supervised position and orthoses, in the modification of the cranial index. In addition, some patients improve spontaneously when they acquire cephalic support and begin to incorporate. On the other hand, there are complications with orthoses that can become serious. CONCLUSION: There is no recommendation for the use of restrictive measures such as cranial orthotics devices to treat patients with cranial positional deformities. reconstructive surgery is the treatment of choice for craniosynostosis.

Aesthetic Correction of Severe Facial Asymmetry in a Deformational Plagiocephaly Patient: A Case Report and Literature Review

Deformational plagiocephaly (DP) (also referred to as positional plagiocephaly) has long posed challenges for plastic surgeons because it is difficult to differentiate from several other diseases, such as unilateral coronal synostosis, hemifacial microsomia, and unilateral lambdoidal craniosynostosis. These diseases can actually masquerade as DP or vice versa. Only in recent years has the differential diagnosis among these diseases become possible through improved imaging modalities, such as computed tomography, and a greater understanding of their pathophysiology. Herein, we report a rather rare, yet severe, form of DP that can easily be confused with the aforementioned diseases.

Hip Screening in Infants Presenting with Asymmetricity of Lower Extremity / 대한정형외과학회잡지

PURPOSE: This study aimed to investigate the clinical features of congenital postural deformities and lower extremity asymmetry with respect to the presence of developmental dysplasia of the hip (DDH) in infants with a discrepancy of the limb length referred for suspected DDH. MATERIALS AND METHODS: We retrospectively reviewed the medical records and radiographs of 150 infants who visited Korea University Anam Hospital Orthopedic Clinic for suspected DDH between March 2013 and March 2015. RESULTS: There were greater numbers of infants with a shorter lower extremity on the left side (n=86, 57.3%) than the right. Plagiocephaly was present in 62 infants and trunk curvature in 124 infants (82.7%). Pelvic tilting—indirectly assessed by a skewed direction of the external genitalia in female infants—was present in 62 infants (63.3%). None of the 139 infants with normal physical examination of the hip were diagnosed with DDH. Of those 11 infants with abnormal findings from the hip physical examination, a total of 6 infants were diagnosed with DDH. CONCLUSION: Regardless of the associated findings of congenital postural deformation, all infants diagnosed with DDH had abnormal findings from the physical examination of the hip joint. Thus, we conclude that the hip examination is important as the primary clinical screening in aiding the diagnosis of DDH.

Study of characteristics and correlation of the head shape of infants with plagiocephaly / 中华实用儿科临床杂志

Objective To study the characteristics of the head shape and correlations among the shape parameters in infants at the plagiocephaly.Methods One hundred and four infants at the age of 4-12 months from Department of Rehabilitation,Guangzhou Women and Children's Medical Center with plagiocephaly or normal head shape from January to October 2016 were selected for head shape characteristic analysis.Seventy-four males and 30 females were included.Seventy-three infants (53 males and 20 females) with plagiocephaly were plagiocephaly group with age of (7.07 ±2.23) months.Thirty-one infants (21 males and 10 females) with normal head shape were control group with age for (8.29 ± 2.81) months.The Spectra scanner 2.0 was applied to acquire head shape parameters including cephalic ratio (CR),radial symmetry index (RSI),oblique diagonal difference (ODD),and cranial vault asymmetry index (CVAI).The correlation between the head shape characteristics and shape parameters of infants in different month ages and gender with plagiocephaly were analyzed through independent sample t-test and Pearson correlation analysis.Among all the enrolled infants,there were 46 infants in 4-7 months (36 cases with plagiocephaly and 10 cases with normal head shape),34 infants in ＞ 7-10 months (24 cases with plagiocephaly and 10 cases with normal head shape),and 24 infants in ＞ 10-12 months (13 cases with plagiocephaly and 11 cases with normal head shape).Results CR in 4-7 months group and ＞ 7-10 months of plagiocephaly group were all significantly higher than that in control group [(91.32 ± 5.60) ％ vs.(80.73 ± 2.68) ％,(90.31 ± 6.22) ％ vs.(84.14 ± 3.57) ％],and the differences were all statistically significant (t =-5.765,-2.924,all P ＜ 0.05).The difference was not significant of the CR in ＞ 10-12 months plagiocephaly group compared with that in control group (t =-1.917,P =0.060).RSI,ODD,and CVAI of plagiocephaly group in all ages were significantly higher than those in control group [(46.40 ± 13.59) mmvs.(16.13 ±4.18) mm,(11.84±3.58) mmvs.(3.44±1.59) mm,7.92±2.43 vs.2.34± 1.07],and the differences were all statistically significant (t =-17.210,-16.579,-16.304,all P ＜ 0.001).CR,RSI,ODD,and CVAI of males and females in plagiocephaly group were respectively higher than those of control group,and the differences were all statistically significant (all P ＜ 0.001).There was no statistical significance in CR,RSI,ODD,CVAI between males and females in plagiocephaly group or control group (all P ＞ 0.05).Pearson correlation analysis revealed that there was no correlation between CR and RSI,ODD,CVAI in any age of plagiocephaly group (all P ＞ 0.05).There was a positive correlation among RSI,ODD,and CVAI in the plagiocephaly group in any age (r =0.940,0.912,0.973,all P ＜ 0.001).Conclusions In the infants with plagiocephaly may exist asymmetric head shape and the shorter length of head at the same time.When one of the values of RSI,ODD and CVAI increases,the other two values increase too with more serious level of plagiocephaly.

Effect of Sleeping Positions Guidance on Deformational Plagiocephaly and/or Brachycephaly in Prematures / 中国康复理论与实践

Objective To investigate the effect of sleep position guidance on deformational plagiocephaly and/or brachycephaly (DPB) in the prematures. Methods 321 preterm infants in neonatal intensive care unit from October, 2012 to September, 2015 were divided into sleep positions guidance group (n=159) and control group (n=162). The sleep positions guidance group accepted sleeping positions guidance when they were in neonatal intensive care unit and followed up in child care clinic, and the control group accepted routine treatment and nursing. The incidences of DPB were compared. Results The incidences of mild (χ2=6.591, P=0.010), moderate (χ2=4.862, P=0.027) and se-vere (χ2=11.261, P=0.001) DPB were less in the sleep positions guidance group than in the control group. Conclusion Sleeping positions guidance may reduce the incidence of DPB in prematures.

Double blood supply of ulnar-sided thumb ladder progressive flap for repair of grade Ⅰ and Ⅱ thumb oblique wound / 中华创伤杂志

Objective To investigate the clinical application and effecacy of ulnar-sided thumb ladder progressive flap in repairing grade Ⅰ and Ⅱ thumb oblique wound.Methods Between October 2009 and October 2013,ulnar-sided thumb ladder progressive flap with double blood supply was transferred to cover the grade Ⅰ and Ⅱ thumb oblique wound in 24 patients (12 males and 12 females).Mean age was 30 years (range,10-40 years).Mechanism of injury was machine twist injury in 8 patients,machine cutting injury in 6,sharp weapon injury in 6 and injury by a heavy object in 4.Twelve patients had grade Ⅰ defect and twelve patients grade Ⅱ defect.Flap ranged in size from 1.0 cm ×3.0 cm to 1.5 cm × 3.5 cm.Flap advancement distance was 1.5-2.5 cm.Donor area was sutured directly.Wound healing and color,swelling and temperature of the flap were observed after operation.Finger function was assessed with the upper limb function evaluation standard set up by hand surgery branch of Chinese Medical Association.Results Postoperatively,the flap survived and the fingertip had protective sensation.The wound healed by first intention.Two patients developed distal interphalangeal joint stiffness,and restored to normal after rehabilitation.All patients were followed up for 1-36 months (mean,20 months).Finger color,temperature,texture and pulp were restored.Finger function recovered satisfactorily,with excellent results in 22 patients and good results in 2 patients.Conclusion The procedure is easy and reliable,has affirmative effect and achieves maximal preservation of finger length and function.

Diagnóstico y tratamiento de plagiocefalia: presentación de caso clínico y revisión de literatura / Diagnosis and treatment of plagiocephaly: clinical case presentation and clinical review

La plagiocefalia se define como el cierre prematuro de la sutura frontoparietal o coronal unilateral, la cual es causada por una sinostosis frontoparietal (unicoronal) y/o fusiones a lo largo de la sutura coronal, se caracteriza por asimetría facial en la región frontal, inclinación de la cabeza hacia el lado afectado y desviación del mentón hacia el lado no afectado. Se presenta el caso de un infante de género femenino de cinco meses de edad con plagiocefalia, asimetría facial de predominio derecho, el reborde supraorbitario y ceja están desplazados posterior y superior, tratado mediante avance frontoorbitario ipsilateral, llevado a cabo en el Hospital Regional <

Plagiocephaly can be defined as the premature closing of the frontal-parietal suture or unilateral coronal suture which is caused by a frontal-parietal (unicoronal) synostosis, and/or fusions along the coronal suture. Plagiocephaly is characterized by facial asymmetry in the frontal region, inclination of the head towards the affected side as well as deviation of the chin towards the non-affected side. We herein present the case of a five month old female infant with plagiocephaly, facial asymmetry with right side predominance, posterior and superior displacement of the eyebrow and supra-orbital ridge. The case was treated with ipsilateral frontal-orbital advancement, at the Regional Hospital <

Risk Factors for Plagiocephaly and Brachycephaly / 中国康复理论与实践

Objective To investigate the factors related with plagiocephaly and brachycephaly. Methods 239 infants with plagiocephaly and brachycephaly were investigated, and analyzed with univariate analyses and multivariate Logistic regression analysis. Results The fac-tors, such as gestational age birth (OR=0.636, P<0.001), birth weight (OR=0.095, P<0.001), time of hospitalization (OR=1.307, P<0.001), preterm birth (OR=2.649, P<0.001), stay in newborn intensive care unit (OR=4.456, P<0.001), change the position (OR=0.046, P<0.001), accepted early intervention guidance (OR=0.054, P<0.001), were significantly related with plagiocephaly and brachycephaly. Conclusion Preterm birth, low birth weight, and newborn complications are the risk factors for plagiocephaly and brachycephaly, while change the posi-tion and early intervention may prevent it.