✓ Management of neonates with nonsynostotic occipital plagiocephaly has been controversial, and there has been a lack of uniformity concerning its treatment. Patients with nonsynostotic occipital plagiocephaly have been treated surgically or with cranial remodeling orthotic devices and have shown improvement in asymmetry. The cost of orthotic treatment has risen, and its validity has been contested by many third-party insurance payers. The effectiveness of orthotic treatment has not been adequately compared to the natural history of nonsynostotic occipital plagiocephaly. A nonsurgical, nonorthotic treatment study was initiated in June 1995 at Phoenix Children's Hospital. All new patients referred with a diagnosis of nonsynostotic occipital plagiocephaly were categorized into two groups: those with mild-to-moderate asymmetry and those with moderate-to-severe asymmetry. Categories were determined by cephalic measurements. The patients with moderate-to-severe asymmetry were offered orthotic treatment with a cranial remodeling band. Those patients with mild-to-moderate asymmetry were treated with physiotherapy, repositioning of the head, and repeated notation of cephalic measurements without orthotic devices or surgery. Seventy-two neonates, seen consecutively, with mild-to-moderate, nonsynostotic occipital plagiocephaly were evaluated by noting cephalic measurements. The parents of six of these patients elected treatment with a cranial remodeling band and results in these patients were excluded from our data. The remaining 66, treated without orthotic devices, showed improvement in average cranial vault asymmetry (CVA) from 9.2 to 4.7 mm over an average treatment period of 4.5 months that commenced when the average age of the patient was 6.4 months. A comparison of the present data with data published in 1994 for neonates treated with a headband indicates that neonates with mild-to-moderate asymmetry who are treated aggressively with physiotherapy and repositioning have similar improvement in CVA.
CarmelPWLukenMGIIIAscherlGFJr: Craniosynostosis: computed tomographic evaluation of the skull base and calvarial deformities and associated intracranial changes.Neurosurgery9:366–3721981Carmel PW Luken MG III Ascherl GF Jr: Craniosynostosis: computed tomographic evaluation of the skull base and calvarial deformities and associated intracranial changes. Neurosurgery 9:366–372 1981
ClarrenSK: Plagiocephaly and torticollis: etiology, natural history, and helmet treatment.J Pediatr98:92–951982Clarren SK: Plagiocephaly and torticollis: etiology natural history and helmet treatment. J Pediatr 98:92–95 1982
FuruyaYEdwardsMSBAlpersCEet al: Computerized tomography of cranial sutures. Part 1: Comparison of suture anatomy in children and adults.J Neurosurg61:53–581984Furuya Y Edwards MSB Alpers CE et al: Computerized tomography of cranial sutures. Part 1: Comparison of suture anatomy in children and adults. J Neurosurg 61:53–58 1984
HellbuschJLHellbuschLCBruneteauRJ: Active counter-positioning treatment of deformational occipital plagiocephaly.Nebraska Med J80:344–3491995Hellbusch JL Hellbusch LC Bruneteau RJ: Active counter-positioning treatment of deformational occipital plagiocephaly. Nebraska Med J 80:344–349 1995
HigginbottomMCJonesKLJamesHE: Intrauterine constraint and craniosynostosis.Neurosurgery6:39–441980Higginbottom MC Jones KL James HE: Intrauterine constraint and craniosynostosis. Neurosurgery 6:39–44 1980
KaneAAMitchellLECravenKPet al: Observations on a recent increase in plagiocephaly without synostosis.Pediatrics97:877–8851996Kane AA Mitchell LE Craven KP et al: Observations on a recent increase in plagiocephaly without synostosis. Pediatrics 97:877–885 1996
PattisapuJVWalkerMLMyersGGet al: Use of helmets in positional molding in MarlinAE (ed): Concepts of Pediatric Neurosurgery.Basel: Karger1989 Vol. 9 pp 178–184Pattisapu JV Walker ML Myers GG et al: Use of helmets in positional molding in Marlin AE (ed): Concepts of Pediatric Neurosurgery. Basel: Karger 1989 Vol. 9 pp 178–184