Comparison of Helmet Therapy and Counter Positioning for Deformational Plagiocephaly

OBJECTIVE: To compare effectiveness on correcting cranial and ear asymmetry between helmet therapy and counter positioning for deformational plagiocephaly (DP). METHODS: Retrospective data of children diagnosed with DP who visited our clinic from November 2010 to October 2012 were reviewed. Subjects or =10 mm of diagonal difference were included for analysis. For DP treatment, information on both helmet therapy and counter positioning was given and either of the two was chosen by each family. Head circumference, cranial asymmetry measurements including diagonal difference, cranial vault asymmetry index, radial symmetry index, and ear shift were obtained by 3-dimensional head-surface laser scan at the time of initiation and termination of therapy. RESULTS: Twenty-seven subjects were included: 21 had helmet therapy and 6 underwent counter positioning. There was no significant difference of baseline characteristics, head circumferences and cranial asymmetry measurements at the initiation of therapy. The mean duration of therapy was 4.30+/-1.27 months in the helmet therapy group and 4.08+/-0.95 months in the counter positioning group (p=0.770). While cranial asymmetry measurements improved in both groups, significantly more improvement was observed with helmet therapy. There was no significant difference of the head circumference growth between the two groups at the end of therapy. CONCLUSION: Helmet therapy resulted in more favorable outcomes in correcting cranial and ear asymmetry than counter positioning on moderate to severe DP without compromising head growth.

Craniofacial malformation treatment: craniosynostosis and positional plagiocephaly

After the publication of the modern Virchow's suture fusion hypothesis regarding craniosynostosis, various types of linear craniotomy have been developed. However, after the Moss's functional matrix hypothesis became known, extensive cranial remodeling surgical procedures have emerged. However, a recent view that the cause of craniosynostosis may be due to gene mutation has led to a tendency toward treating craniosynostosis with minimally invasive surgery including endoscopic surgery and distraction procedures that utilize springs or distractors. As nonsyndromic craniosynostoses are accompanied by unilateral coronal or lambdoid craniosynostosis, and syndromic craniosynostoses are accompanied by facial anomalies, it is presumed that cranial anomalies are accompanied by facial anomalies. However, the "back to sleep" campaign that was initiated in the 1990's in order to prevent infantile death syndrome led to research in the dramatic increase in the incidence of craniofacial anomalies, which resulted in the establishment of the positional plagiocephaly concept, which has also been ascertained in animal experiments. Despite these advances, the basic problem of whether craniosynostosis is simply a cosmetic anomaly or whether it is a neurological disease that is accompanied by complications such as increased intracranial pressure has not been resolved. The consequent confusion has prevented establishment of the optimal timing for surgery and the type of surgical procedure. The authors of this study review the history of craniosynostosis treatment and attempt to clarify the situation pertaining to the surgical treatment concepts and limitations.