Nonsynostotic Occipital Plagiocephaly: Factors Impacting Onset, Treatment, and Outcomes

University of Pittsburgh, Pittsburgh, Pennsylvania, United States
Plastic and Reconstructive Surgery (Impact Factor: 2.99). 05/2007; 119(6):1866-73. DOI: 10.1097/
Source: PubMed


Nonsynostotic occipital plagiocephaly remains a diagnosis of concern in infancy. This study evaluates factors affecting the onset, treatment, and outcomes of nonsynostotic occipital plagiocephaly.
A retrospective chart review and telephone survey were performed. A posterior occipital deformation severity score was used. Factors such as demographics, behavioral and helmet therapy, feeding patterns, torticollis, multiple gestation pregnancies, prematurity, and congenital nonsynostotic occipital plagiocephaly were evaluated.
One hundred five infants were identified. Of these, 95 percent were Caucasian, 93 percent were from two-parent households, and 70 percent were from households earning more than $50,000. Repositioning was attempted in 95 percent, and 45 percent progressed to helmet therapy. When comparing change in posterior occipital deformation severity score with helmet therapy to repositioning, a difference was found (p < 0.05). Forty-nine percent of patients were breast-fed, and when compared with the general population, a difference was found (p < 0.05). Twenty percent of infants had torticollis, and when compared with population norms, a difference was found (p < 0.05). Twelve percent of patients were twins, and when compared with population norms, more twinning occurred (p < 0.05). Congenital nonsynostotic occipital plagiocephaly was found in 10 percent of patients and did not result in an increased risk of progression to helmet therapy.
This study demonstrates trends that may predict additional risks for developing nonsynostotic occipital plagiocephaly, including torticollis, plural births, and increased socioeconomic affluence. In addition, the nonsynostotic occipital plagiocephaly cohort was breast-fed less than the general population, demonstrating that breast-feeding may be preventative, as breast-fed infants are repositioned more frequently and sleep for shorter periods. As in other studies, cranial molding helmet therapy was more effective in correcting nonsynostotic occipital plagiocephaly than repositioning alone.

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    • "In other cases, 3-D evaluations are performed with the help of a surface scanner [22] [32]. Some authors [13] [23] [41] use non-validated subjective scales based on anthropomorphic – or only visual – evaluations to grade the plagiocephaly severity. They include four, nine, and eleven levels. "
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    ABSTRACT: Objective: Evaluate from the literature, the evidence of comparative efficiency of non-surgical treatments (orthotics or head repositioning therapy) in posterior positional plagiocephaly. Material and methods: Systematic review from scientific articles (original cohort studies and review of literature), published in French or in English, searched on five online literature data bases, comparing non-chirurgical treatments (repositioning and orthotics therapy) for deformational plagiocephaly. A standardized method guidelines (Critical Review Form-Quantitative Studies) has been used. Results: Only 11 cohort studies met the inclusion criteria and six reviews of literature were analyzed. Many biases have been identified, most of the time, favoring the repositioning groups (older infants and plagiocephaly more severe). Conclusions: Several different orthotics seem to correct head deformities better and faster than repositioning protocols. Evaluation methods, treatment indications and long-term efficacy should be clarified. Studies about treatment risks are warranted.
    Preview · Article · Jan 2013 · Annals of physical and rehabilitation medicine
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    • "Cranioplasty can improve neurological status in patients with skull bone defects. The mechanism of postoperative improvement in neurologic status might be increased cerebral blood flow velocity due to elimination of the effects of atmospheric pressure [1] [2]. Collaboration between medical doctors and engineers contributes to latest cranioplasty methods creation. "

    Full-text · Conference Paper · Jan 2010
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    • "Numerous studies have utilized subjective or two-dimensional measures to evaluate the outcomes of this therapy (Loveday and de Chalain, 2001; Elwood et al., 2005; Losee et al., 2007; Govaert et al., 2008). However, few studies have used three-dimensional measures to evaluate helmet molding therapy (Glat et al., 1996; Sze et al., 2005; Netherway et al., 2006; Plank et al., 2006; Thompson et al., 2009). "
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    ABSTRACT: To investigate facial asymmetry associated with both deformational and synostotic plagiocephaly and to identify variables based on skeletal landmarks that distinguish the conditions and quantify severity. Retrospective, cross sectional. Australian Craniofacial Unit, Adelaide. Proportional differences between bilateral distances and principal component (PC) analysis of the skeletal landmarks. The three-dimensional positions of 78 osseous landmarks were determined from computed tomography (CT) scans of 21 patients with deformational plagiocephaly (DP), 20 patients with unilateral coronal synostosis (UCS), and 2 patients with unilateral lambdoid synostosis (ULS). For both DP and UCS, significant asymmetry was found for the orbital depths, mandibular lengths, maxillary depths, zygomatic arch lengths, lateral base of the parietal bone, and the angle between the anterior and the posterior cranial base projected onto the axial plane. The small sample size for ULS precluded definitive statistical statements but allowed some useful comparisons with the other conditions. The first three PC scores were able to distinguish among the three conditions and which side was affected. The asymmetry of the cranial base and facial structures, arising from localized abnormality or deformational forces in either the frontal or the occipital regions, can be quantified by a plethora of bilateral features or summarized by PC analysis.
    Full-text · Article · Apr 2006 · The Cleft Palate-Craniofacial Journal
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