Effectiveness for Older Infants to Start Cranial Remodeling Treatment With Wearing Helmet in Positional Plagiocephaly

1) Purpose

Infants have malleable and fast-growing cranial bones, and are therefore at risk of developing skull deformation if their head often remains in the same position. There were several studies for optimal time to start cranial remodeling treatment with wearing helmet. Along some research studies, starting helmet therapy early (age 5 to 6months) is important and leads to a significantly better outcome in a shorter treatment time. However, there is insufficient literature for effectiveness of helmet therapy for older infants. Therefore, the aim of this present study is to evaluate effectiveness of cranial remodeling treatment with wearing helmet for older infants (>= 18months).

 2) Methods

The study was designed as a retrospective study of 30 infants with positional plagiocephaly without synostosis who were started from January 1, 2008 to August 1, 2011. All of the patient was aged over 18months when they were started cranial remodeling treatment with wearing helmet.  Every child underwent a computerized tomography before starting helmet therapy to exclude synostoses of the cranial sutures and performed CT once again after completion of therapy who have had satisfactory result. In every child anthropometric measurements were taken through CT scan and using spreading calipers. 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.

 3) Results

 The discrepancy of CVA and CVAI of all the patients significantly decreased after treatment with cranial molding helmet for older infants (>= 18months). The treatment lasted 14.5 months on average, was well tolerated and had no complication. In addition, the rate of the successful treatment (final CVA ≤5 mm) significantly decreased when the wearing time per day was less than twenty hours. 

4) Conclusion

 With the increasing incidence and rising awareness of parents, management of positional plagiocephaly by wearing cranial molding helmet has become a matter of growing medical interest. There are still a lot of different, inconsistent treatment regimens, and helmet therapy itself is controversial for older infants. This study shows that treatment by cranial remodeling orthosis is effective, well tolerated for older infants and has no morbidity. This therapeutic option should always be taken up for these older infants before other cranial remodeling surgery or abandonment for treatment.