No abstract available.
Plagiocephaly*

No abstract available.
Methylmethacrylate* ; Plagiocephaly*

PURPOSE: A cranioremodeling helmet for correcting plagiocephaly was recently developed. However, no discrete objective methods to evaluate how the deformity is being corrected have been developed. We have established an easy and cost-effective method that can be used not only to show the correction process, but can also be used by physicians to assess the degree of plagiocephaly two-dimensionally. METHODS: For two-dimensional evaluation, a length of malleable memory wire (2 mm in diameter) resembling "Sun-Wukong's headband" was placed on the patient's head. The wire around the patient's head was positioned on a plane including points 1 cm above the eyebrow and 1 cm above the auricle. The wire was placed on a sheet of paper and the outline was marked using pens of various colors during each visit. The degree of plagiocephaly correction could then be shown to the patient's parents at every consultation. RESULTS: The method established by the present study easily shows the horizontal cross-section transformation of the head, illustrates plagiocephaly correction by the helmet, and shows the degree of correction in a two-dimensional manner. CONCLUSION: A soft-shell helmet is widely used for correcting plagiocephaly. However, evaluating the effectiveness of the helmet has been determined in a subjective manner, and a more objective method is now in demanded. Our study found that a "Sun-Wukong's headband" wire can accurately measure two-dimensional changes. Future studies will be required to identify landmarks needed for assessing plagiocephaly correction.
Congenital Abnormalities ; Eyebrows ; Head ; Head Protective Devices ; Humans ; Memory ; Parents ; Plagiocephaly ; Plagiocephaly, Nonsynostotic

OBJECTIVE: To compare a new ultrasound measurement method with calliper cephalometry in infants with deformational plagiocephaly (DP) and to assess the differences of two methods according to the severity of DP. METHODS: Fifty-two infants with DP were divided into two groups according to the degree of cranial vault asymmetry (CVA); group 1 included 42 infants with CVA over 10 mm, and group 2 included 10 infants with CVA under 10 mm. Cranial vault asymmetry index (CVAI) and occipital angle ratio (OAR) were measured by using calliper and ultrasound measurements, respectively. The occipital angle was defined as the angle between the lines projected along the lambdoid sutures of the skull. RESULTS: The occipital angles of the affected sides were significantly greater than those of unaffected sides in both groups. The CVAI and OAR were significantly greater in group 1 than in group 2 (CVAI, 9.3%+/-2.3% vs. 4.6%+/-1.5%; OAR, 1.05+/-0.4 vs. 1.01+/-0.0; p<0.05). The OAR was positively correlated with the CVAI in all infants (r=0.789) and in group 1 (r=0.784; p<0.05). CONCLUSION: Our study revealed that OAR using the new ultrasound measurement was positively correlated with the CVAI in infants with DP. Therefore, the occipital angle measurement using ultrasound combined with cephalometry could provide better understanding about the characteristics of the overall cranial bone and lambdoid suture complex in infants with DP.
Cephalometry ; Craniofacial Abnormalities ; Head* ; Humans ; Infant* ; Plagiocephaly* ; Plagiocephaly, Nonsynostotic ; Skull ; Sutures ; Ultrasonography*

Deformational plagiocephaly (DP) (also referred to as positional plagiocephaly) has long posed challenges for plastic surgeons because it is difficult to differentiate from several other diseases, such as unilateral coronal synostosis, hemifacial microsomia, and unilateral lambdoidal craniosynostosis. These diseases can actually masquerade as DP or vice versa. Only in recent years has the differential diagnosis among these diseases become possible through improved imaging modalities, such as computed tomography, and a greater understanding of their pathophysiology. Herein, we report a rather rare, yet severe, form of DP that can easily be confused with the aforementioned diseases.
Blepharoplasty ; Craniosynostoses ; Diagnosis, Differential ; Facial Asymmetry* ; Goldenhar Syndrome ; Humans ; Plagiocephaly ; Plagiocephaly, Nonsynostotic* ; Plastics ; Surgeons

It is important to distinguish deformational plagiocephaly from craniosynostosis, the two conditions are different with respect to clinical progression and treatment options. Deformational plagiocephaly is diagnosed based on the patient's medical history and physical examination. Until recently, there has been no standardized method of evaluation. Visual assessment, anthropometric assessment, digital scanning, and radiologic evaluation are mostly commonly used modalities for diagnosis and assessment. Treatment of deformational plagiocephaly requires an understanding of natural progression of the disease. Deformational plagiocephaly should be classified according to its severity before the proper method and time for treatment are determined. Treatment includes repositioning, physiotherapy and remodeling with the use of orthotic devices. In general, repositioning is preferred for patients younger than six months old while treatment with the use of orthotic devices such as helmet is preferred for patients over six months old. Moreover, treatment with the use of orthotic devices is also favored for severe plagiocephaly. There is continuing research on the relation between deformational plagiocephaly and developmental delay.
Craniosynostoses ; Head Protective Devices ; Humans ; Orthotic Devices ; Physical Examination ; Plagiocephaly ; Plagiocephaly, Nonsynostotic*

Congenital muscular torticollis (CMT) and craniosynostosis are diseases that cause plagiocephaly and craniofacial asymmetry in children. In our literature review, we did not find any report of concurrent manifestation of CMT and craniosynostosis. A 41-month-old boy visited our hospital with left torticollis, right laterocollis, and craniofacial asymmetry as the main findings. During clinical examination, prominent right sternocleidomastoid muscle and limited range of motion of the neck were noted, and right CMT was confirmed by magnetic resonance imaging of the neck. Three-dimensional computed tomography of the skull, which was conducted due to the unusual appearance of the skull with a large head circumference, mild brachycephaly, as well as left plagiocephaly, revealed premature closure of the sagittal suture. Thus, we report the first case that showed concurrence of CMT and sagittal synostosis. We recommend that concurrently manifested craniosynostosis needs to be examined if the subject with CMT displays unusual craniofacial asymmetry to a greater extent than deformational plagiocephaly.
Child ; Child, Preschool ; Craniosynostoses* ; Head ; Humans ; Magnetic Resonance Imaging ; Male ; Neck ; Plagiocephaly ; Plagiocephaly, Nonsynostotic ; Range of Motion, Articular ; Skull ; Sutures ; Torticollis*

OBJECTIVE: To investigate the clinical effectiveness of and parents’ perspectives on cranial-molding orthotic treatment. METHODS: Medical charts were reviewed for 82 infants treated for plagiocephaly with cranial-molding orthoses in our clinic from April 2012 to July 2016 retrospectively. Infants who were clinically diagnosed with positional plagiocephaly and had a Cranial Vault Asymmetry Index (CVAI) of more than 3.5% were included. Pre- and post-treatment CVAI was obtained by three-dimensional head-surface laser scan. Parents’ perceptions of good outcome (satisfaction) were evaluated with the Goal Attainment Scale (GAS). The GAS score assessed how much the parent felt that his or her initial goal for correcting the skull asymmetry was achieved after the treatment. RESULTS: The compliance with cranial-molding orthoses was 90.2% (74 of 82 infants). There were 53 infants (65% of the 82 infants) who had adverse events with the cranial-molding orthoses during the study. Heat rash was found in 29 cases (35.4%) and was the most common adverse event. The mean GAS T-score was 51.9±10.2. A GAS T-score of 0 or more was identified for 71.6% of parents. The GAS T-score was significantly related to the age (p < 0.001), the initial CVAI, and the difference of CVAI during the treatment (p < 0.001). CONCLUSION: Parents’ perception of good outcome was correlated with the anthropometric improvement in cranialmolding orthotic treatment in infants with plagiocephaly. A high percentage of parents felt that the treatment met their initial goals in spite of a high occurrence of adverse events.
Compliance ; Exanthema ; Hot Temperature ; Humans ; Infant* ; Orthotic Devices* ; Parents ; Plagiocephaly* ; Plagiocephaly, Nonsynostotic ; Retrospective Studies ; Skull ; Treatment Outcome*

BACKGROUND: Infants with deformational plagiocephaly (DP) usually present with cranial vault deformities as well as facial asymmetry. The purpose of this study was to use three-dimensional anthropometric data to evaluate the influence of cranial deformities on facial asymmetry. METHODS: We analyzed three-dimensional computed tomography data for infants with DP (n=48) and without DP (n=30, control). Using 16 landmarks and 3 reference planes, 22 distance parameters and 2 angular parameters were compared. This cephalometric assessment focused on asymmetry of the orbits, nose, ears, maxilla, and mandible. We then assessed the correlation between 23 of the measurements and cranial vault asymmetry (CVA) for statistical significance using relative differences and correlation analysis. RESULTS: With the exception of few orbital asymmetry variables, most measurements indicated that the facial asymmetry was greater in infants with DP. Mandibular and nasal asymmetry was correlated highly with severity of CVA. Shortening of the ipsilateral mandibular body was particularly significant. There was no significant deformity in the maxilla or ear. CONCLUSION: This study demonstrated that the cranial vault deformity in DP is associated with facial asymmetry. Compared with the control group, the infants with DP were found to have prominent asymmetry of the nose and mandible.
Congenital Abnormalities ; Ear ; Facial Asymmetry* ; Humans ; Infant ; Mandible ; Maxilla ; Nose ; Orbit ; Plagiocephaly, Nonsynostotic*

PURPOSE:We performed this study in order to investigate the clinical features and the therapeutic outcome of infants with torticollis according to the classification; congenital muscular torticollis(CMT), postural torticollis(PT) and, ocular torticollis(OT). METHODS:This study was conducted on 80 infants with torticollis who had been treated from March 2000 to July 2004 in the outpatient clinic of the pediatrics and rehabilitation medicine department of NHIC Ilsan Hospital. All the patients were physically and neurologically examined and took cervical X-rays and ultrasonographies. Based on the results the patients were classified into the subtypes of torticollis. Except OT, the patients underwent conservative treatment programs with physical therapy and home treatment programs. RESULTS:Among the three groups, the time of the first visit to the hospital was the fastest in CMT and the latest in OT. The appearance of facial asymmetry and plagiocephaly didn't show any difference between CMT and PT. The presence of asymmetric neck righting reaction was noted similarly between the two groups. The duration of the treatment was longer in the CMT group than that of the PT group. The outcomes of the treatment in CMT were not different from those of PT. CONCLUSIONS:There are no significant differences of the clinical features and the treatment results between the CMT and the PT groups except the duration of treatment. The ophthalmologic assessment is strongly recommended, if the age of an infant with torticollis is older than one year.
Ambulatory Care Facilities ; Classification ; Facial Asymmetry ; Humans ; Infant ; Neck ; Pediatrics ; Plagiocephaly ; Rehabilitation ; Torticollis*