• Archives of Craniofacial Surgery
• /
• v.21 no.2
• /
• pp.80-86
• /
• 2020

Positional plagiocephaly is increasing in infants. Positional plagiocephaly is an asymmetric deformation of skull due to various reasons; first birth, assisted labor, multiple pregnancy, prematurity, congenital muscular torticollis and position of head. Positional plagiocephaly can mostly be diagnosed clinically and by physical examinations. The simplest way to assess the severity of plagiocephaly is to use a diagonal caliper during physical examination, which measures the difference between the diagonal lengths on each side of the head. Plagiocephaly can be treated surgically or conservatively. Positional plagiocephaly, which is not accompanied by craniosynostosis, is treated conservatively. Conservative treatments involve a variety of treatments, such as change of positions, physiotherapy, massage therapy, and helmet therapy. Systematic approaches to clinical examination, diagnosis and treatment of positional plagiocephaly can be necessary and the age-appropriate treatment is recommended for patients with positional plagiocephaly.

• Archives of Craniofacial Surgery
• /
• v.14 no.2
• /
• pp.73-80
• /
• 2013

It is important to distinguish deformational plagiocephaly from craniosynostosis, the two conditions are different with respect to clinical progression and treatment options. Deformational plagiocephaly is diagnosed based on the patient's medical history and physical examination. Until recently, there has been no standardized method of evaluation. Visual assessment, anthropometric assessment, digital scanning, and radiologic evaluation are mostly commonly used modalities for diagnosis and assessment. Treatment of deformational plagiocephaly requires an understanding of natural progression of the disease. Deformational plagiocephaly should be classified according to its severity before the proper method and time for treatment are determined. Treatment includes repositioning, physiotherapy and remodeling with the use of orthotic devices. In general, repositioning is preferred for patients younger than six months old while treatment with the use of orthotic devices such as helmet is preferred for patients over six months old. Moreover, treatment with the use of orthotic devices is also favored for severe plagiocephaly. There is continuing research on the relation between deformational plagiocephaly and developmental delay.

• Archives of Craniofacial Surgery
• /
• v.12 no.1
• /
• pp.28-32
• /
• 2011

Purpose: A cranioremodeling helmet for correcting plagiocephaly was recently developed. However, no discrete objective methods to evaluate how the deformity is being corrected have been developed. We have established an easy and cost-effective method that can be used not only to show the correction process, but can also be used by physicians to assess the degree of plagiocephaly two-dimensionally. Methods: For two-dimensional evaluation, a length of malleable memory wire (2 mm in diameter) resembling "Sun-Wukong's headband" was placed on the patient's head. The wire around the patient's head was positioned on a plane including points 1 cm above the eyebrow and 1 cm above the auricle. The wire was placed on a sheet of paper and the outline was marked using pens of various colors during each visit. The degree of plagiocephaly correction could then be shown to the patient's parents at every consultation. Results: The method established by the present study easily shows the horizontal cross-section transformation of the head, illustrates plagiocephaly correction by the helmet, and shows the degree of correction in a two-dimensional manner. Conclusion: A soft-shell helmet is widely used for correcting plagiocephaly. However, evaluating the effectiveness of the helmet has been determined in a subjective manner, and a more objective method is now in demanded. Our study found that a "Sun-Wukong's headband" wire can accurately measure two-dimensional changes. Future studies will be required to identify landmarks needed for assessing plagiocephaly correction.

• Fashion & Textile Research Journal
• /
• v.24 no.4
• /
• pp.443-450
• /
• 2022

This study developed a three-dimensional helmet mold design software that can design helmets for treating the infant plagiocephaly (flat head syndrome) using three-dimensional head scan data. For this, the three-dimensional head data of sixth SizeKorea body measurement project as well as the data produced by a head modeling software were used to prepare the head shape data of plagiocephaly patients. A total of 14 landmarks and 10 dimensions of heads required for helmet mold shape design and plagiocephaly diagnosis were automatically measured using an anthropometric analysis software. Using the software developed in this study, plagiocephaly can be diagnosed not only visually by three-dimensional head data visualization but also quantitatively by calculating the medically defined indices such as cranial index, which measures the proportions of the head, and the cranial vault asymmetry index, which measures the asymmetry of the head. The basic shape of the helmet mold was automatically generated based on the head scan data. Additionally, it is possible to fine tune the shape of the mold to reflect individual characteristics by using a free form deformation technique. Finally, the designed helmet mold was converted into the data that can be printed on a three-dimensional printer for generating the actual prototype.

• Archives of Craniofacial Surgery
• /
• v.23 no.2
• /
• pp.59-63
• /
• 2022

Background: Deformational plagiocephaly is usually managed conservatively, as it tends to improve over time and with the use of conservative measures. However, before the year 2017 we operated on patients with severe plagiocephaly and neurological symptoms at the Helsinki Cleft Palate and Craniofacial Center. Methods: Of the 20 infants with severe deformational plagiocephaly and neurological symptoms referred to us between 2014 and 2016, 10 underwent cranioplasty open reshaping of the posterior cranial vault. The parents of the last 10 patients were given information on the natural history of the condition and the patients were followed up with an outpatient protocol. The aim of this study was to gain information on the brain electrophysiology and recovery of patients after total cranial vault reconstruction by measuring the electroencephalogram (EEG) somatosensory evoked potentials (SEP; median nerve). Results: Of the 10 participants in the operation arm, six had abnormal SEP at least on the affected cerebral hemisphere and all SEPs were recorded as normal when controlled postoperatively. In the follow-up arm, eight out of 10 participants had abnormal SEP at the age of approximately 24 months, and all had normalized SEPs at control visits. Conclusion: Our data suggest that cranioplasty open reshaping of the posterior cranial vault did not affect abnormal SEP-EEG recordings. We have abandoned the operations in deformational plagiocephaly patients due to findings suggesting that expanding cranioplasty is not beneficial for brain function in this patient group.

• Archives of Plastic Surgery
• /
• v.51 no.2
• /
• pp.169-181
• /
• 2024

Background With the advent of cranial orthoses as therapeutic medical devices for the treatment of severe positional head deformities in Japan, an increasing number of patients are being treated with them. However, assessing the effectiveness of a treatment is often difficult due to the use of different metrics. This study aimed to evaluate the effectiveness of cranial orthoses for deformational plagiocephaly using two- (2D) and three-dimensional (3D) evaluation metrics. Methods We conducted a retrospective study of infant patients with deformational plagiocephaly who underwent cranial orthosis treatment. We evaluated the severity of deformational plagiocephaly using cranial asymmetry (CA) and the cranial vault asymmetry index (CVAI) as 2D metrics, and anterior and posterior symmetry ratios as 3D metrics. The patients were divided into 24 subgroups based on the initial severity of each outcome and their age at the start of treatment. We analyzed the changes in outcomes and correlations within improvements across the age and severity categories. Results Overall, 1,038 infants were included in this study. The mean CA, CVAI, and anterior and posterior symmetry ratios improved significantly after cranial orthosis treatment. The improvement in each score was greater in patients with more severe initial deformities and in those who underwent treatment at a younger age. Conclusion Cranial orthosis treatment was effective in correcting deformational plagiocephaly in infants, as demonstrated by improvements in both 2D and 3D metrics. Patients with more severe initial deformities and those who underwent treatment at a younger age showed greater improvement.

• Archives of Plastic Surgery
• /
• v.39 no.4
• /
• pp.338-344
• /
• 2012

Background It is known that nonsynostotic plagiocephaly does not spontaneously improve, and the craniofacial deformities that result from it. This study was conducted to analyze the effectiveness of helmet therapy for the nonsynostotic plagiocephaly patient, and to suggest a new treatment strategy based on this analysis. Methods A total of 108 pediatric patients who had undergone helmet therapy after being diagnosed with nonsynostotic plagiocephaly were included in this study. The patients were classified according to the initiation age of the helmet therapy, severity, and helmet wearing time. The treatment effect was compared using cranial vault asymmetry (CVA) and the cranial vault asymmetry index (CVAI), which were obtained from diagonal measurements before and after therapy. Results The discrepancy of CVA and CVAI of all the patients significantly decreased after helmet therapy. According to the initiation time of helmet therapy, the treatment effect was best at 5 months old or less. The helmet wearing time per day was proportional to the treatment effect up to 20 hours. In addition, the rate of the successful treatment (final CVA ${\leq}$ 5 mm) significantly decreased when the initiation age was 9.1 months or older and the treatment period was less than 7.83 months. Conclusions This study showed the effectiveness of the helmet therapy for nonsynostotic plagiocephaly patients. Based on analysis of this study, helmet therapy should be started at the age of 9 months or younger for 7.83 months or more, and the helmet wearing time should be more than 20 hours a day.

• Archives of Craniofacial Surgery
• /
• v.15 no.2
• /
• pp.47-52
• /
• 2014

Background: Management of positional plagiocephaly by wearing a cranial molding helmet has become a matter of growing medical interest. Some research studies reported that starting helmet therapy early (age 5 to 6 months) is important and leads to a significantly better outcome in a shorter treatment time. The aim of the present study was to evaluate the effectiveness of cranial remodeling treatment with wearing helmet for older infants (${\geq}18$ months). Methods: We conducted a retrospective study of 27 infants with positional plagiocephaly without synostosis, who were started from 2008 to 2012. Every child underwent a computerized tomography (CT) before starting helmet therapy to exclude synostosis of the cranial sutures and had CT performed once again after satisfactory completion of therapy. Anthropometric measurements were taken on using spreading calipers in every child. The treatment effect was compared using cranial vault asymmetry (CVA) and the cranial vault asymmetry index (CVAI), which were obtained from diagonal measurements before and after therapy. Results: The discrepancy of CVA and CVAI of all the patients significantly decreased after cranial molding helmet treatment in older infants (${\geq}18$ months) 7.6 mm from 15.6 mm to 8 mm and 4.51% from 9.42% to 4.91%. Six patients had confirmed successful outcome, and all subjects were good compliance patients. The treatment lasted an average of 16.4 months, was well tolerated, and had no complication. Additionally, the rate of the successful treatment (final CVA ${\leq}5mm$) significantly decreased when the wearing time per was shorter. Conclusion: This study showed that treatment by cranial remodeling orthosis was effective if the patient could wear the helmet longer and treatment duration was somewhat longer than in younger patients, well tolerated in older infants and had no morbidity. This therapeutic option is available and indicated in these older infants before other cranial remodeling surgery.

• Archives of Craniofacial Surgery
• /
• v.15 no.3
• /
• pp.109-116
• /
• 2014

Background: Infants with deformational plagiocephaly (DP) usually present with cranial vault deformities as well as facial asymmetry. The purpose of this study was to use three-dimensional anthropometric data to evaluate the influence of cranial deformities on facial asymmetry. Methods: We analyzed three-dimensional computed tomography data for infants with DP (n=48) and without DP (n=30, control). Using 16 landmarks and 3 reference planes, 22 distance parameters and 2 angular parameters were compared. This cephalometric assessment focused on asymmetry of the orbits, nose, ears, maxilla, and mandible. We then assessed the correlation between 23 of the measurements and cranial vault asymmetry (CVA) for statistical significance using relative differences and correlation analysis. Results: With the exception of few orbital asymmetry variables, most measurements indicated that the facial asymmetry was greater in infants with DP. Mandibular and nasal asymmetry was correlated highly with severity of CVA. Shortening of the ipsilateral mandibular body was particularly significant. There was no significant deformity in the maxilla or ear. Conclusion: This study demonstrated that the cranial vault deformity in DP is associated with facial asymmetry. Compared with the control group, the infants with DP were found to have prominent asymmetry of the nose and mandible.

• Journal of International Society for Simulation Surgery
• /
• v.1 no.2
• /
• pp.83-86
• /
• 2014

Purpose This paper was purposed to suggest the method to produce the supportive helmet (head correction) for the infants who are suffering from plagiocephaly and to evaluate the level of transformation through 3D model. Method Either of CT or X-ray restored images has been used in making the supportive helmet (Head correction) in general, but these methods of measuring have problems in cost and safety. 3D surface measurement technology was suggested to solve such matters. Results It was to design the transformed model of the head within 0.7cm in average by scanning the surface of head and performing 3D restoration with marching cube and the changing rate of the head was compared in numerical data with 3D model. Conclusion The suggested methods displayed the better performance than the conventional method in respect of the speed and cost.