Treatment Efficacy of Deformational Plagiocephaly and Brachiocephaly: Results of a Large, Prospective Clinical Trial

PURPOSE:Although various treatments (repositioning, physical therapy (PT), cranial orthotic molding) for deformational plagiocephaly (DP) and brachiocephaly (DB) have been well described, there is limited strong evidence evaluating the efficacy of these therapies.^1-2Previous studies are often limited by small cohorts, inadequate follow-up, lack of reliable objective outcomes measures, and influence of commercial interests.^2-3The purpose of this study was to analyze the efficacy of repositioning, PT and cranial molding in the treatment of DP and DB in a large, prospective cohort utilizing objective outcome measures.

METHODS:All patients undergoing treatment of DP or DB between 2004 and 2010 were followed until cure or 18 months of age. Patients underwent either regimented conservative treatment (repositioning and/or PT) and/or cranial orthotic molding. Outcomes where measured objectively using a 3D laser surface scanner; complete correction was defined as a cranial ratio (CR)<0.85 and diagonal difference (DD)<5mm. Independent risk factors for failure of treatment (severity of deformity, age, sex, torticollis, developmental delay, prematurity, compliance, and intrauterine factors) were identified for each group by multivariate analysis.

RESULTS:4,378 patients with DP or DB were included in the study. Treatment was initiated with conservative measures (repositioning and/or PT) in 3,381 infants and with cranial helmets in 997 infants. Of patients initially treated with conservative measures, 22.9% failed management (15.8% required cranial molding, 7.1% had incomplete correction). Independent risk factors for failure of conservative treatment included severity of deformity (RR 1.31-1.64), advanced age (RR 1.20-2.08), torticollis (RR 1.12-1.74), developmental delay (RR 1.44) and poor treatment compliance (RR 2.4). Prematurity and male gender were non-risk factors, while multiparity and vaginal delivery were protective. Ultimately, 1,531 patients underwent cranial orthotic molding (997 initially assigned to helmet therapy, and 534 failed conservative management). Complete correction was achieved in 95.0% of these patients. Independent risk factors for helmet therapy failure included advanced age (RR 1.13-3.08) and poor treatment compliance (RR 3.01).

CONCLUSIONS:Repositioning, PT, and cranial orthotic molding are effective treatments for DP and DB. Appropriate selection of a treatment modality requires evaluation of patient-specific risk factors. Cranial orthotic molding appears to isolate out intrinsic and environmental factors that increase the risk of conservative treatment failure.

REFERENCES:

1. Robinson,S & Proctor,M.Diagnosis and management of deformational plagiocephaly.JNeurosurgPediatri.2009;3:284—295.

2. Bialocerkowski,AE, Vladusic,SL, Howell,SM.Conservative interventions for positional plagiocephaly:a systematic review.DevMedChild.2005;47:563—570.

3. Rogers,GF.Deformational Plagiocephaly,Brachycephaly and Scaphocephaly.Part II:Prevention and Treatment.JCraniofacSurg.2011;22:17—23.