Plagiocephaly

An increasing number of parents engage in extended daily chest-to-chest contact with their full-term healthy infants for several months after birth as an extension of skin-to-skin contact in the early postpartum period. This practice is commonly known as "babywearing" (BW) and employs various carrying devices. The purpose of this review is to acquaint pediatricians and primary care providers with the numerous studies of physical, behavioral and social effects of BW as well as the different types of infant carriers and safe practices. BW studies demonstrate improved attachment and breastfeeding outcomes and infant sleep organization, as well as reduced maternal postpartum depressive symptoms and infant crying. BW is likely to strengthen paternal caregiving engagement, associated with positive child outcomes. The spread squat position for the hips during BW offers an optimal position for hip development and may prevent some forms of developmental hip dysplasia. BW may reduce the risk of positional plagiocephaly, by decreasing the time infants spend in the supine position while also allowing for spontaneous head movements. BW enables some mothers with short maternity leave to bring their infants to the workplace with limited interference in their tasks. Numerous designs of infant carriers are described along with basic safety precautions. Pediatricians may be key influencers for parents in achieving the positive outcomes described in this review.

The deformities described in this study involved both the skull contour and the cranial base. The custom of deliberate ring deformation of a head was known in the Early Feudal population of the Armenia. The individual had a rhomboid cranial shape. The deformity appeared on the calvarium and cranial base in an early period of life. The calvarial and endocranial base morphology is similar to deformational plagiocephaly (i.e., nonsynostotic plagiocephaly) of patients with associated torticollis. This is the first documented case of torticollis in Armenia.

To determine the effectiveness of helmet therapy for positional skull deformation compared with the natural course of the condition in infants aged 5-6 months. Pragmatic, single blinded, randomised controlled trial (HEADS, HElmet therapy Assessment in Deformed Skulls) nested in a prospective cohort study. 29 paediatric physiotherapy practices; helmet therapy was administered at four specialised centres. 84 infants aged 5 to 6 months with moderate to severe skull deformation, who were born after 36 weeks of gestation and had no muscular torticollis, craniosynostosis, or dysmorphic features. Participants were randomly assigned to helmet therapy (n=42) or to natural course of the condition (n=42) according to a randomisation plan with blocks of eight. Six months of helmet therapy compared with the natural course of skull deformation. In both trial arms parents were asked to avoid any (additional) treatment for the skull deformation. The primary outcome was change in skull shape from ba...

Deformational Plagiocephaly (DP) is a common clinical presentation. There is no consensus as to the aetiology of DP, there is no risk factor that is uniformly considered as dominant. The consensus about the pathogenetic factors that are important in the onset of DP is more robust. Most cases are presented with no skull deformity at birth and most problems seem to appear at the age of two months. This implies that postnatal factors have an influence on the onset of DP. Prolonged back-laying position in combination with a restriction in motion of the upper neck area are generally considered as important factors in the onset of DP. The restriction in motion can be caused by muscular and neurological reasons. The purpose of this article is to present an aetiology model as to the neurological aspects that may be causing plagiocephaly and how osteopathy may potentially influence the amelioration of plagiocephaly. Sensitization of the upper neck and brainstem may be caused by intrauterine positioning, traumatic birth processes or prolonged pressure on specific areas of the skull. This sensitization will increase sensitivity of touch-, pressure-and pain-fibers, muscle tone, impair muscle function and enhance postural and birth survival reflexes. The postural reflexes, in combination with impaired muscle function and the prolonged supine positioning of the infant, play a crucial role in the progress of some types of Deformational Plagiocephaly (DP). These neurological considerations should be analyzed and treated by osteopaths and allied professions when faced with DP.

This study is about a human skeleton discovered in 2008 during the
archaeological excavations in the Baba Cave. This belongs to male who died at 35‐40 years
old. The deformation of the skull shows an occipital plagiocephaly caused by a lambdoidal
synostosis. Also, can be noticed an enamel hypoplasia due to a deprivation in childhood.
During the life he suffered violent injuries: blows to the head, broken nose, and the
fracture of a rib. The active life is suggested by osteoarthritis of articulations.

OBJECTIVE Cranioplasty is a reconstructive procedure used to restore skull anatomy and repair skull defects. Optimal skull reconstruction is a challenge for neurosurgeons, and the strategy used to achieve the best result remains a topic of debate, especially in pediatric patients for whom the continuing skull growth makes the choice of material more difficult. When the native bone flap, which is universally accepted as the preferred option in pediatric patients, is unavailable, the authors' choice of prosthetic material is a polymethylmethacrylate (PMMA) implant designed using a custom-made technique. In this paper the authors present the results of their clinical series of 12 custom-made PMMA implants in pediatric patients. METHODS A retrospective study of the patients who had undergone cranioplasty at Gaslini Children's Hospital between 2006 and 2013 was conducted. A total of 12 consecutive cranioplasties in 12 patients was reviewed, in which a patient-specific PMMA implan...

We present the first report of the development of characteristic radiologic appearances of long bones during the first year of life in an infant with type V osteogenesis imperfecta (OI). We show the evolution of metaphyseal abnormalities from a rickets-like appearance to the classically described dense metaphyseal bands. These abnormalities suggest that the underlying defect in type V OI may involve a molecule common to both bone and cartilage that is involved in the regulation of growth plate development and metadiaphyseal ossification. Our findings provide new insights into skeletal development in type V OI and potentially yield useful clues to the identity of the defect underpinning the condition.

OBJECTIVE: This study was designed to statistically evaluate the independent and interacting effects of biological and environmental risk factors that influence lateralization of deformational plagiocephaly (DP) in an attempt to provide future guidance for clinical treatment.

METHODS: A database of >20000 children treated for DP was examined by using 2- and 3-way factor analyses for categorical frequency data, representing the largest statistical analysis of DP to date. Data on parity, zygosity, intrauterine presentation, birth number and weight, sleep position, lateralization, and sex were collected from parents of children with DP who were treated at Cranial Technologies, Inc, from 1990 to 2007.

RESULTS: As with most DP studies, male patients were significantly overrepresented. Nonetheless, after statistically accounting for sex in our analyses, DP is significantly correlated with primiparity, fewer vertex but more breech and transverse intrauterine presentations, twinning (specifically, dizygosity), and, finally, right-sided lateralization. Additional analyses revealed that several factors correlated with DP, such as intrauterine presentation, sleep position, and lateralization, are not easily explained by an underlying biological factor. Instead, sleep position was the single greatest predictor of lateralization.

CONCLUSION: Although previous studies have argued for both environmental and underlying biological factors associated with DP, we found that lateralization in children with DP could be largely explained by environmental factors such as sleep position.

Anterior plagiocephaly usually occurs with premature synostosis of the ipsilateral half of the coronal suture. The forehead is flattened on the affected side, with a backward and upward displacement of the affected orbit. The bulging of the calvaria may occur in the contralateral parietal area. MATERIAL and

Deformational plagiocephaly, unilateral coronal craniosynostosis, and lambdoid craniosynostosis all cause oblique deformities of the skull. They are separate entities with different etiologies resulting in clear differences of physical examination, radiologic findings, and clinical course. Treatment for each condition is markedly different. Surgical intervention is recommended for unilateral coronal and lambdoid craniosynostosis using different techniques. Deformational plagiocephaly, on the other hand, is often satisfactorily managed with conservative treatment. We present 4 clinical reports on patients in whom unilateral coronal craniosynostosis and lambdoid craniosynostosis were originally misdiagnosed as occipital deformational plagiocephaly and highlight individual structural distinctions.

Correction of craniosynostosis is necessary in predominant cases. Surgical planning usually requires a preoperative CT to estimate the bony and intracerebral structures. A postoperative CT scan would involve a significant dose of radiation, which carries an elevated risk of malignant tumor development in later life. This study was performed to demonstrate the quality of three-dimensional (3D) photogrammetry when objectifying perioperative changes in craniofacial surgery. Twenty-eight patients with different premature craniosynostoses were analyzed photogrammetrically before and after surgical correction. 3D changes in cranial distances, symmetry and volumes were evaluated. A statistical covariance analysis excluded changes in cranial shape caused by physiological head growth. The Cephalic Index in Scaphocephaly changed from 75.1% to a median value of 77.4%. The anterior symmetry ratio for coronal synostoses improved from 0.943 to 0.949 (a value of 1.0 represents perfect symmetry). The posterior symmetry ratio improved from 0.733 to 0.808 postoperatively in one single lambdoidal synostosis. In trigonocephaly, the median anterior skull volume rose from 528 to 601 ml. 3D photogrammetry has great potential to track and objectify the clinical course of surgical correction of craniosynostoses. Craniofacial changes become highly reproducible and demonstrate clinical utility based on this technology.