Positional posterior plagiocephaly: a single-center review

View More View Less
  • 1 Surgical Outcomes Center for Kids, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee;
  • 2 Florida State University College of Medicine, Tallahassee, Florida;
  • 3 Cornell University Department of Neurobiology, Ithaca, New York;
  • 4 University of South Carolina School of Medicine, Columbia, South Carolina; and
  • 5 Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

OBJECTIVE

The authors sought to assess the prevalence and severity of positional posterior plagiocephaly (PPP) in the pediatric population at a tertiary care center.

METHODS

The authors conducted a retrospective review of 1429 consecutive patients aged 2 months to 18 years who presented with head trauma and a negative CT scan in 2018. The cohort was stratified by age. The cranial vault asymmetry index (CVAI) was calculated at the superior orbital rim. Asymmetry was categorized according to the following CVAI scores: mild (3.5%–7%), moderate (7%–12%), and severe (> 12%). Patients were grouped by age to assess PPP at different stages of head development: group 1, 2–5 months; group 2, 6–11 months; group 3, 12–23 months; group 4: 2–4 years; group 5, 5–8 years; group 6, 9–12 years; and group 7, 13–18 years. Patients with a history of shunted hydrocephalus, craniosynostosis, skull surgery, or radiographic evidence of intracranial trauma were excluded.

RESULTS

The overall cohort prevalence of PPP was 24.8% (354 patients). PPP prevalence was higher among younger patients from groups 1–3 (40.4%, 33.5%, and 0.8%, respectively). There was a continued decline in PPP by age in groups 4–7 (26.4%, 20%, 20%, and 10.8%, respectively). Mild cranial vault asymmetry was noted most often (78.0%, 276 patients), followed by moderate (19.5%, 69 patients) and severe (2.5%, 9 patients). There were no patients in group 6 or 7 with severe PPP.

CONCLUSIONS

PPP is prevalent in pediatric populations and most commonly presents as a case of mild asymmetry. Although there was an overall decline of PPP prevalence with increasing age, moderate asymmetry was seen in all age groups. No patients in the cohort had severe asymmetry that persisted into adolescence.

ABBREVIATIONS AAP = American Academy of Pediatrics; CVAI = cranial vault asymmetry index; MCJCHV = Monroe Carell Jr. Children’s Hospital at Vanderbilt; PPP = positional posterior plagiocephaly.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Correspondence Ranbir Ahluwalia: Florida State University College of Medicine, Tallahassee, FL. ra16@med.fsu.edu.

INCLUDE WHEN CITING Published online January 31, 2020; DOI: 10.3171/2019.12.PEDS19651.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Biggs WS: Diagnosis and management of positional head deformity. Am Fam Physician 67:19531956, 2003

  • 2

    Collett BR: Helmet therapy for positional plagiocephaly and brachycephaly. BMJ 348:g2906, 2014

  • 3

    Di Rocco F, Ble V, Beuriat PA, Szathmari A, Lohkamp LN, Mottolese C: Prevalence and severity of positional plagiocephaly in children and adolescents. Acta Neurochir (Wien) 161:10951098, 2019

    • Search Google Scholar
    • Export Citation
  • 4

    Feijen M, Franssen B, Vincken N, van der Hulst RR: Prevalence and consequences of positional plagiocephaly and brachycephaly. J Craniofac Surg 26:e770e773, 2015

    • Search Google Scholar
    • Export Citation
  • 5

    Graham T, Adams-Huet B, Gilbert N, Witthoff K, Gregory T, Walsh M: Effects of initial age and severity on cranial remolding orthotic treatment for infants with deformational plagiocephaly. J Clin Med 8:E1097, 2019

    • Search Google Scholar
    • Export Citation
  • 6

    Hinken L, Willenborg H, Dávila LA, Daentzer D: Outcome analysis of molding helmet therapy using a classification for differentiation between plagiocephaly, brachycephaly and combination of both. J Craniomaxillofac Surg 47:720725, 2019

    • Search Google Scholar
    • Export Citation
  • 7

    Holowka MA, Reisner A, Giavedoni B, Lombardo JR, Coulter C: Plagiocephaly severity scale to aid in clinical treatment recommendations. J Craniofac Surg 28:717722, 2017

    • Search Google Scholar
    • Export Citation
  • 8

    Hutchison BL, Hutchison LA, Thompson JM, Mitchell EA: Plagiocephaly and brachycephaly in the first two years of life: a prospective cohort study. Pediatrics 114:970980, 2004

    • Search Google Scholar
    • Export Citation
  • 9

    Korpilahti P, Saarinen P, Hukki J: Deficient language acquisition in children with single suture craniosynostosis and deformational posterior plagiocephaly. Childs Nerv Syst 28:419425, 2012

    • Search Google Scholar
    • Export Citation
  • 10

    Moon RY: SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleeping environment. Pediatrics 128:e1341e1367, 2011

    • Search Google Scholar
    • Export Citation
  • 11

    Panchal J, Amirsheybani H, Gurwitch R, Cook V, Francel P, Neas B, : Neurodevelopment in children with single-suture craniosynostosis and plagiocephaly without synostosis. Plast Reconstr Surg 108:14921500, 2001

    • Search Google Scholar
    • Export Citation
  • 12

    Roby BB, Finkelstein M, Tibesar RJ, Sidman JD: Prevalence of positional plagiocephaly in teens born after the “Back to Sleep” campaign. Otolaryngol Head Neck Surg 146:823828, 2012

    • Search Google Scholar
    • Export Citation
  • 13

    van Vlimmeren LA, Engelbert RH, Pelsma M, Groenewoud HM, Boere-Boonekamp MM, der Sanden MW: The course of skull deformation from birth to 5 years of age: a prospective cohort study. Eur J Pediatr 176:1121, 2017

    • Search Google Scholar
    • Export Citation
  • 14

    van Vlimmeren LA, van der Graaf Y, Boere-Boonekamp MM, L’Hoir MP, Helders PJ, Engelbert RH: Risk factors for deformational plagiocephaly at birth and at 7 weeks of age: a prospective cohort study. Pediatrics 119:e408e418, 2007

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 126 126 116
Full Text Views 23 23 22
PDF Downloads 32 32 32
EPUB Downloads 0 0 0