Plagiocephaly and cranial molding
Tom Lunsford, CO
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Title:
Plagiocephaly and cranial molding
Creator:
Tom Lunsford, CO
Text:
Timothy,
Below are a few references re plagiocephaly which you may find interesting.
There is either no orthotic literature or at least a paucity of orthotic
literature on the orthotic management of plagiocephaly. This is unfortunate.
In the past 7 years we have made hundreds of helmet for infants with this
condition. We follow the concepts espoused by S. Clarren, MD, in Seattle.
The key concept is that growth can be restrained with the application of a
rigid helmet. Generally, the head of the patient with plagiocephaly, when
viewed in the transverse plane, exhibits asymmetry which can be described by
a major diagonal and a minor diagonal. The helmet is designed to encourage
growth of the head along the minor diagonal and to restrain growth along the
major diameter. Therefore, the helmet should fit snugly along the major
diagonal and there will be gaps along the minor diagonal. The helmet must be
symmetrical. Therefore, you begin by measuring the major and minor diagonals
and taking an impression of the infants head using large stockinette and a
supervising mother. Plaster bandage splints (6 inch) are draped over the
head until at least four layers are obtained. If a cutoff strip or tube is
used it should be placed along a non-critial area of symmetry. The ears are
covered with the plaster bandage. The ears should be marked as well as any
other significant landmarks. The impression is removed and filled with
plaster. After removing the impression, plaster is added to the cast
(positive model) to achieve symmetry. There are several techniques for doing
this and most are acceptable. The helmet is frame vacuum formed with
.188-.375 inch thick polypropylene over a .25 inch thick liner. The helmet
is trimmed like a football helmet with audio holes over the ear locations. A
chin strap with pad is added and many toon stickers are added to the outside
surface of the helmet. I realize this is a very terse description of the
process, but maybe someday I shall endeavor to publish our process.
We measure the is equator (circumference) of the helmet (e.g., 47 cm) and the
corresponding equator of the infant's head (e.g., 44 cm). You need to obtain
growth charts for the heads of infant boys and girls and based on their age
you can predict when the helmet needs to be replaced or at least reevaluated.
According to S. Clarren, MD, the optimum age range is 6 to 18 months.
Earlier than 6 months and they are growing too fast and after 18 months they
are growing too slowly.
I am not a fan of the helmet with a slit and velcro closure since this
would inexorably impact symmetry. Also, I am not a fan of the helmet with an
open top since I have seen varying degrees of window edema.
I hope this helps.
Tom Lunsford, CO
1. Skull Molding Caps: An Adjunct to Crainosynostosis Surgery, C. K. Ham and
S. W. Meyer, PLASTIC AND RECONSTRUCTIVE SURGERY, Nov., 1987, pp 737-742.
2. External Cranial Vault Molding after Craniofacial Surgery, J. A. Persing,
L.S. Nichter, J. A. Jane, and M. T. Edgerton, ANNALS OF PLASTIC SURGERY, Vol.
17, No. 4, October 1986, pp 274-283.
3. Plagiocephaly and Torticollis: Etiology, Natural History, and Helmet
Treatment, S. K. Clarren, THE JOURNAL OF PEDIATRICS, Vol. 98, No. 1, January
1981, pp92-95.
4. External Cranioplasty: Historical Perspectives, L. S. Nichter, et al,
PLASTIC AND RECONSTRUCTIVE SURGERY, Vol. 77, No. 2, Feb. 1986, pp325-332.
5. Skeletal Analysis of Craniofacial Asymmetries in Plagiocephaly
(Unilateral Coronal Synostosis), Sakurai, et al, SCANDINAVIAN JOURNAL OF
PLASTIC SURGERY, Vol. 32, No. 1, p81, 1998.
6. Helmet Treatment for Plagiocephaly and Congenital Muscular Torticollis,
S.K. Clarren, JOURNAL OF PEDIATRICS, 1979 Jan; 94 (1): 43-6.
7. Unilateral Coronal Synotosis (Anterior Plagiocephaly): Current Clinical
Perspectives, J.C. Posnick, ANNALS OF PLASTIC SURGERY, 1996, Apr; 36(4):
430-47.
8. Diagnosis and Management of Posterior Plagiocephaly, I. F. Pollack, et
al, PEDIATRICS, Vol. 99, No. 2, Feb 1997.
9. Nonsurgical, nonorthotic treatment of occipital plagiocephaly: What is
the natural history of the misshapen neonatal head?, S. D. Moss, JOURNAL OF
NEUROSURGERY, Vol. 87, Nov. 1997, pp 667-670.
10. Analysis of Posterior Plagiocephaly: Deformational versus Synostotic,
J. B. Mulliken, et al, PLASTIC AND RECONSTRUCTIVE SURGERY, Feb. 1999, Vol.
103, No. 2, pp371-380.
11. Clinical Presentation and Management of 100 Infants with Occipital
Plagiocephaly, I. K. Pople, et al, PEDIATRIC NEUROSURGERY, 1996, 25: 1-6,
Below are a few references re plagiocephaly which you may find interesting.
There is either no orthotic literature or at least a paucity of orthotic
literature on the orthotic management of plagiocephaly. This is unfortunate.
In the past 7 years we have made hundreds of helmet for infants with this
condition. We follow the concepts espoused by S. Clarren, MD, in Seattle.
The key concept is that growth can be restrained with the application of a
rigid helmet. Generally, the head of the patient with plagiocephaly, when
viewed in the transverse plane, exhibits asymmetry which can be described by
a major diagonal and a minor diagonal. The helmet is designed to encourage
growth of the head along the minor diagonal and to restrain growth along the
major diameter. Therefore, the helmet should fit snugly along the major
diagonal and there will be gaps along the minor diagonal. The helmet must be
symmetrical. Therefore, you begin by measuring the major and minor diagonals
and taking an impression of the infants head using large stockinette and a
supervising mother. Plaster bandage splints (6 inch) are draped over the
head until at least four layers are obtained. If a cutoff strip or tube is
used it should be placed along a non-critial area of symmetry. The ears are
covered with the plaster bandage. The ears should be marked as well as any
other significant landmarks. The impression is removed and filled with
plaster. After removing the impression, plaster is added to the cast
(positive model) to achieve symmetry. There are several techniques for doing
this and most are acceptable. The helmet is frame vacuum formed with
.188-.375 inch thick polypropylene over a .25 inch thick liner. The helmet
is trimmed like a football helmet with audio holes over the ear locations. A
chin strap with pad is added and many toon stickers are added to the outside
surface of the helmet. I realize this is a very terse description of the
process, but maybe someday I shall endeavor to publish our process.
We measure the is equator (circumference) of the helmet (e.g., 47 cm) and the
corresponding equator of the infant's head (e.g., 44 cm). You need to obtain
growth charts for the heads of infant boys and girls and based on their age
you can predict when the helmet needs to be replaced or at least reevaluated.
According to S. Clarren, MD, the optimum age range is 6 to 18 months.
Earlier than 6 months and they are growing too fast and after 18 months they
are growing too slowly.
I am not a fan of the helmet with a slit and velcro closure since this
would inexorably impact symmetry. Also, I am not a fan of the helmet with an
open top since I have seen varying degrees of window edema.
I hope this helps.
Tom Lunsford, CO
1. Skull Molding Caps: An Adjunct to Crainosynostosis Surgery, C. K. Ham and
S. W. Meyer, PLASTIC AND RECONSTRUCTIVE SURGERY, Nov., 1987, pp 737-742.
2. External Cranial Vault Molding after Craniofacial Surgery, J. A. Persing,
L.S. Nichter, J. A. Jane, and M. T. Edgerton, ANNALS OF PLASTIC SURGERY, Vol.
17, No. 4, October 1986, pp 274-283.
3. Plagiocephaly and Torticollis: Etiology, Natural History, and Helmet
Treatment, S. K. Clarren, THE JOURNAL OF PEDIATRICS, Vol. 98, No. 1, January
1981, pp92-95.
4. External Cranioplasty: Historical Perspectives, L. S. Nichter, et al,
PLASTIC AND RECONSTRUCTIVE SURGERY, Vol. 77, No. 2, Feb. 1986, pp325-332.
5. Skeletal Analysis of Craniofacial Asymmetries in Plagiocephaly
(Unilateral Coronal Synostosis), Sakurai, et al, SCANDINAVIAN JOURNAL OF
PLASTIC SURGERY, Vol. 32, No. 1, p81, 1998.
6. Helmet Treatment for Plagiocephaly and Congenital Muscular Torticollis,
S.K. Clarren, JOURNAL OF PEDIATRICS, 1979 Jan; 94 (1): 43-6.
7. Unilateral Coronal Synotosis (Anterior Plagiocephaly): Current Clinical
Perspectives, J.C. Posnick, ANNALS OF PLASTIC SURGERY, 1996, Apr; 36(4):
430-47.
8. Diagnosis and Management of Posterior Plagiocephaly, I. F. Pollack, et
al, PEDIATRICS, Vol. 99, No. 2, Feb 1997.
9. Nonsurgical, nonorthotic treatment of occipital plagiocephaly: What is
the natural history of the misshapen neonatal head?, S. D. Moss, JOURNAL OF
NEUROSURGERY, Vol. 87, Nov. 1997, pp 667-670.
10. Analysis of Posterior Plagiocephaly: Deformational versus Synostotic,
J. B. Mulliken, et al, PLASTIC AND RECONSTRUCTIVE SURGERY, Feb. 1999, Vol.
103, No. 2, pp371-380.
11. Clinical Presentation and Management of 100 Infants with Occipital
Plagiocephaly, I. K. Pople, et al, PEDIATRIC NEUROSURGERY, 1996, 25: 1-6,
Citation
Tom Lunsford, CO, “Plagiocephaly and cranial molding,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/212883.
