Nonsurgical, nonorthotic treatment of occipital plagiocephaly: what is the natural history of the misshapen neonatal head?

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✓ 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.

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Address reprint requests to: S. David Moss, M.D., Phoenix Children's Hospital, 909 East Brill Street, Phoenix, Arizona 85006.

© AANS, except where prohibited by US copyright law.

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    Illustration showing CVA due to gravitational forces. The image on the left represents a water-filled balloon placed on a flat surface. The bottom becomes flat, as does the top to a lesser degree, and the sides bulge outward. The image on the right shows the same effects on the cranium of a neonate, which results in asymmetry of the face and ear position. Note the parallelogram-like changes.

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    Upper: Illustration showing CVA (CVA = fz − eu cross-diagonal measurement [mm]). The amount of asymmetry is determined using the largest measurement that can be obtained by placing the calipers on the fz (frontozygomatic) point and moving the other arm of the calipers over the opposite eurion (eu) area. Lower: Illustration showing how anterior cranial asymmetry is obtained by measuring frontoorbital asymmetry (FOA) (FOA = fz − tragus cross-diagonal measurement [mm]).

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