To photogrammetrically objectify changes in nonsynostotic craniofacial deformity in orthotically treated versus untreated infants.
Design
A statistical retrospective pairwise comparison of two respective three-dimensional (3D) photo scans of 80 children performed in a 6-month time lag.
Patients
Two comparable samples of children (40 treated, 40 untreated) with nonsynostotic cranial deformity.
Interventions
Respective 3D photo scans were matched using Cranioform Analytics 4.0 software.
Main Outcome Measures
Median change of 30° Cranial Vault Asymmetry Index (CVAI), modified CVAI (CVAImod), Cranial Index (CI), and posterior symmetry ratio (PSR).
Results
We found an improvement in Δ30° CVAI by 3.3% (treated) and by 1.31% (untreated), respectively. CVAImod improved by 3.46% in the treated group and by 1.55% in the untreated group. CI improved by 4.41% in the treated group and by 3.68% in the untreated group, and PSR improved by 0.71 in the treated group and 0.49 in the untreated group. Although improvement of cranial asymmetry was higher in those children treated with an individual molding orthosis, we could not document a statistically significant difference between the two groups.
Conclusions
Helmet therapy may be less appropriate for the correction of brachycephaly than for cranial asymmetry. Nonsynostotic cranial deformity shows some spontaneous correction. Photogrammetry presents an accurate method to objectify craniofacial changes in early infancy.
American Academy of Pediatrics.American Academy of Pediatrics AAP Task Force on Infant Positioning and SIDS: positioning and SIDS. Pediatrics.1992; 89(6 pt 1): 1120–1126.
ArgentaL.C., DavidL.R., WilsonJ.A., BellW.O.An increase in infant cranial deformity with supine sleeping position. J Craniofac Surg.1996; 7: 5–11.
4.
BialocerkowskiA.E., VladusicS.L., Wei NgC.Prevalence, risk factors, and natural history of positional plagiocephaly: a systematic review. Dev Med Child Neurol.2008; 50: 577–586.
5.
BiggsW.S.Diagnosis and management of positional head deformity. Am Fam Physician.2003; 67: 1953–1956.
6.
BlecherJ.C., HowaldtH.P.Treatment of non-synostotic, pediatric skull deformities with dynamic head orthosis [in German]. Mund Kiefer Gesichtschir. May 1998; 2(suppl 1): S81–S85.
7.
BrunerT.W., DavidL.R., GageH.D., ArgentaL.C.Objective outcome analysis of soft shell helmet therapy in the treatment of deformational plagiocephaly. J Craniofac Surg.2004; 15: 643–650.
8.
HutchisonB.L., HutchisonL.A., ThompsonJ.M., MitchellE.A.Plagiocephaly and brachycephaly in the first two years of life: a prospective cohort study. Pediatrics.2004; 114: 970–980.
9.
HutchisonB.L., HutchisonL.A., ThompsonJ.M., MitchellE.A.Quantification of plagiocephaly and brachycephaly in infants using a digital photographic technique. Cleft Palate Craniofac J.2005; 42: 539–547.
10.
KaneA.A., MitchellL.E., CravenK.P., MarshJ.L.Observations on a recent increase in plagiocephaly without synostosis. Pediatrics.1996; 97(6 pt 1): 877–885.
11.
KauC.H., RichmondS., IncraperaA., EnglishJ., XiaJ.J.Three-dimensional surface acquisition systems for the study of facial morphology and their application to maxillofacial surgery. Int J Med Robot.2007; 3: 97–110.
12.
KlubaS., KrautW., ReinertS., KrimmelM.What is the optimal time to start helmet therapy in positional plagiocephaly?Plast Reconstr Surg.2011; 128: 492–498.
13.
LessardS., GagnonI., TrottierN.Exploring the impact of osteopathic treatment on cranial asymmetries associated with nonsynostotic plagiocephaly in infants. Complement Ther Clin Pract.2011; 17: 193–198.
14.
LittlefieldT.R., BealsS.P., ManwaringK.H., PomattoJ.K., JoganicE.F., GoldenK.A., RipleyC.E.Treatment of craniofacial asymmetry with dynamic orthotic cranioplasty. J Craniofac Surg.1998; 9: 11–17.
15.
LovedayB.P., de ChalainT.B.Active counterpositioning or orthotic device to treat positional plagiocephaly?J Craniofac Surg.2001; 12: 308–313.
16.
McGarryA., DixonM.T., GreigR.J., HamiltonD.R., SextonS., SmartH.Head shape measurement standards and cranial orthoses in the treatment of infants with deformational plagiocephaly: a systematic review. Dev Med Child Neurol.2008; 50: 568–576.
17.
MossS.D.Nonsurgical, nonorthotic treatment of occipital plagiocephaly: what is the natural history of the misshapen neonatal head?J Neurosurg.1997; 87: 667–670.
18.
NajarianS.P.Infant cranial molding deformation and sleep position: implications for primary care. J Pediatr Health Care.1999; 13: 173–177.
19.
PollackI.F., LoskenH.W., FasickP.Diagnosis and management of posterior plagiocephaly. Pediatrics.1997; 99: 180–185.
20.
SchaafH., Pons-KühnemannJ., MalikC.Y., StreckbeinP., PreussM., HowaldtH.P., WilbrandJ.F.Accuracy of three-dimensional photogrammetric images in non-synostotic cranial deformities. Neuropediatrics.2010; 41: 24–29.
21.
SchaafH., WilbrandJ.F., BoedekerR.H., HowaldtH.P.Accuracy of photographic assessment compared with standard anthropometric measurements in nonsynostotic cranial deformities. Cleft Palate Craniofac J.2010; 47: 447–453.
TeichgraeberJ.F., Seymour-DempseyK., BaumgartnerJ.E., XiaJ.J., WallerA.L., GatenoJ.Molding helmet therapy in the treatment of brachycephaly and plagiocephaly. J Craniofac Surg.2004; 15: 118–123.
24.
TurkA.E., McCarthyJ.G., ThorneC.H., WisoffJ.H.The “back to sleep campaign” and deformational plagiocephaly: is there cause for concern?J Craniofac Surg.1996; 7: 12–18.
25.
van VlimmerenL.A., TakkenT., van AdrichemL.N., van der GraafY., HeldersP.J., EngelbertR.H.Plagiocephalometry: a non-invasive method to quantify asymmetry of the skull; a reliability study. Eur J Pediatr.2006; 165: 149–157.
26.
VlesJ.S., CollaC., WeberJ.W., BeulsE., WilminkJ., KingmaH.Helmet versus nonhelmet treatment in nonsynostotic positional posterior plagiocephaly. J Craniofac Surg.2000; 11: 572–574.
WilbrandJ.F., SzczukowskiA., BlecherJ.C., Pons-KühnemannJ., ChristophisP., HowaldtH.P., SchaafH.Objectification of cranial vault correction for craniosynostosis by three-dimensional photography. J Craniomaxillofac Surg.2012; 40: 726–730.
29.
WilbrandJ.F., WeberM., SchaafH., HowaldtH.O.092 Diagnosis and therapy in early childhood cranial deformity. J Craniomaxillofac Surg.2008; 36: S23–S24.
30.
WilbrandJ.F., WilbrandM., Pons-KühnemannJ., BlecherJ.C., ChristophisP., HowaldtH.P., SchaafH.Value and reliability of anthropometric measurements of cranial deformity in early childhood. J Craniomaxillofac Surg.2011; 39: 24–29.
31.
WongJ.Y., OhA.K., OhtaE., HuntA.T., RogersG.F., MullikenJ.B., DeutschC.K.Validity and reliability of craniofacial anthropometric measurement of 3D digital photogrammetric images. Cleft Palate Craniofac J.2008; 45: 232–239.
32.
XiaJ.J., KennedyK.A., TeichgraeberJ.F., WuK.Q., BaumgartnerJ.B., GatenoJ.Nonsurgical treatment of deformational plagiocephaly: a systematic review. Arch Pediatr Adolesc Med.2008; 162: 719–727.
