Plagiocephaly

Plagiocephaly

Physiologically and other kind of cranial deformities
Classification and external resources
Specialty medical genetics
ICD-10 Q67.3
ICD-9-CM 754.0
DiseasesDB 29858

Plagiocephaly, also known as flat head syndrome,[1][2] is a condition characterized by an asymmetrical distortion (flattening of one side) of the skull. It is characterized by a flat spot on the back or one side of the head caused by remaining in a supine position for too long.[3]

Plagiocephaly is the word that is used to describe a diagonal asymmetry across the head shape. This word particularly describes a flattening which is to one side at the back of the head and there is often some facial asymmetry. Plagiocephaly divides into two groups: synostotic plagiocephaly, with one or more fused cranial sutures, and nonsynostotic (deformational) plagiocephaly. Surgical treatment of these groups includes the deference method; however, the treatment of deformational plagiocephaly is controversial.[4] Brachycephaly describes a very wide head shape with a flattening across the whole back of the head.

Causes

Left posterior positional plagiocephaly in a baby

Slight Plagiocephaly is routinely diagnosed at birth and may be the result of a restrictive intrauterine environment giving a "diamond" shaped head when seen from above. If there is premature union of skull bones, this is more properly called craniosynostosis.

The incidence of plagiocephaly has increased dramatically since the advent of anti-Sudden Infant Death Syndrome recommendations for parents to keep their babies on their backs.[5] Treatments range from a simple repositioning of babies below the age of 5 months to more involved treatment with a helmet for children under the age of 18 months.[3]

Prognosis

Preliminary research indicates that some babies with plagiocephaly may comprise a high-risk group for developmental difficulties.[6][7][8]

Prevention

Following tools and therapy could serve as an effective and safe treatment modality on managing this development disorder such as:

  1. Tummy time.
  2. Carrying the infant
  3. Specialist baby mattress[9][10]
  4. Specially designed infant headwear with a support roll which ensures the head is positioned correctly and can be adjusted every few hours. This eliminates any potential flat spots and prevents them in the critical early growth stages of the child's life.[11]

Treatment

The condition will usually improve to some extent as the baby grows, but in some cases, treatment can improve the shape of a baby’s head.

Conservative

Initially, treatment usually takes the form of reducing the pressure on the affected area through repositioning of the baby onto their abdomen for extended periods of time throughout the day.[12]

This may include repositioning the child's head throughout the day so that the rounded side of the head is placed dependent against the mattress, repositioning cribs and other areas that infants spend time in so that they will have to look in a different direction to see their parents, or others in the room, repositioning mobiles and other toys for similar reasons, and avoiding extended time sleeping in car-seats (when not in a vehicle), bouncy seats, or other supine seating which is thought to exacerbate the problem. If the child appears to have discomfort or cries when they are repositioned, they may have a problem with the neck.[13]

Helmets

High quality evidence is lacking for cranial remolding orthosis (baby helmet) for the positional condition and use for this purpose is controversial.[14]

If conservative treatment is unsuccessful helmets may help to correct abnormal head shapes. These helmets are used to treat deformational plagiocephaly, brachycephaly, scaphocephaly and other head shape deformities in infants 3–18 months of age by gently allowing the head shape to grow back into a normal shape. This type of treatment has been used for severe deformations.[12]

Etymology

Greek plagios "oblique, slanting," from PIE plag- "flat, spread," from *plak,[15] and cephal Modern Latin "head, skull, brain,"[16] together means flat head.

References

  1. ↑ Kadom, Nadja; Sze, Raymond W. (2010). "Radiological Reasoning: A Child with Posterior Plagiocephaly". American Journal of Roentgenology 194 (3 Suppl): WS5–9. doi:10.2214/AJR.07.7121. PMID 20173180.
  2. ↑ "Doctor Finds Success In Treating Infants With Flat-Head Syndrome". CBS Los Angeles. April 30, 2013. Retrieved November 11, 2013.
  3. 1 2 Laughlin, J.; Luerssen, T. G.; Dias, M. S.; Committee On Practice Ambulatory Medicine (2011). "Prevention and Management of Positional Skull Deformities in Infants". Pediatrics 128 (6): 1236–41. doi:10.1542/peds.2011-2220. PMID 22123884.
  4. ↑ S J Bridges, T L Chambers1, K Popl,Controversy Plagiocephaly and head binding, Arch Dis Child 2002;86:144-145 doi:10.1136/adc.86.3.144. http://adc.bmj.com/content/86/3/144.full
  5. ↑ "Plagiocephaly and related cranial deformities". Pediatric Views. Children's Hospital Boston. April 2010. Archived from the original on June 22, 2011. Retrieved November 11, 2013.
  6. ↑ "Unraveling How Craniofacial Conditions Affect Development". Seattle Children's Hospital. September 29, 2014.
  7. ↑ Miller, RI; Clarren, SK (February 2000). "Long-term developmental outcomes in patients with deformational plagiocephaly". Pediatrics 105 (2): E26. doi:10.1542/peds.105.2.e26. PMID 10654986. Retrieved 2014-09-29.
  8. ↑ "Flat-headed babies may face learning problems". CBC News. September 29, 2014.
  9. ↑ "Positional plagiocephaly: experience with a passive orthotic mattress". The Journal of Craniofacial Surgery 25 (4): 1365–8. 2014. doi:10.1097/SCS.0000000000000835.
  10. ↑ "Flat Head Syndrome Prevention". SleepCurve and Alder Hey Children's Hospital. SleepCurve.
  11. ↑ "Early Interventions". Tortle Head Repositioning Systems. Tortle Midliner.
  12. 1 2 Robinson, S; Proctor, M (April 2009). "Diagnosis and management of deformational plagiocephaly". J Neurosurg Pediatr 3 (4): 284–95. doi:10.3171/2009.1.PEDS08330. PMID 19338406.
  13. ↑ Persing, J.; James, H.; Swanson, J.; Kattwinkel, J.; American Academy Of Pediatrics Committee On Practice Ambulatory Medicine (2003). "Prevention and Management of Positional Skull Deformities in Infants". Pediatrics 112 (1 Pt 1): 199–202. doi:10.1542/peds.112.1.199. PMID 12837890.
  14. ↑ Goh, JL; Bauer, DF; Durham, SR; Stotland, MA (October 2013). "Orthotic (helmet) therapy in the treatment of plagiocephaly.". Neurosurgical focus 35 (4): E2. PMID 24079781.
  15. ↑ http://www.etymonline.com/index.php?allowed_in_frame=0&search=Plagio+&searchmode=none
  16. ↑ http://www.etymonline.com/index.php?term=cephalo-&allowed_in_frame=0
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