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Three-dimensional analysis of cranial and facial asymmetry after helmet therapy for positional plagiocephaly

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Abstract

Purpose

Helmet therapy is a non-surgical option for treating positional plagiocephaly, and its effectiveness has been validated by various researches. In addition to cranial flattening and asymmetry, ipsilateral prominence of the mid-face and relative anterior transposition of the ipsilateral ear is also common. Hence, we investigated the impact of helmet therapy on mid-facial asymmetry.

Methods

Ninety-nine patients diagnosed with positional plagiocephaly and treated by helmet therapy between September 2005 and July 2012 were enrolled. Therapy was initiated at various ages: group I, <6 months (n = 35); group II, 6 months to 1 year (n = 43); group III, >1 year (n = 21). A cranial vault asymmetry index was measured at the levels of the inferior orbital rim (CVAIIOR-MF) and superior orbital rim (CVAISOR-LC) and midway from the superior orbital rim to the vertex (CVAIMID-UC). Anterior transposition of the ipsilateral ear was verified by measuring the distance (D EAR) between the actual position of the ear and its expected position relative to the contralateral ear. All variables were compared before and after helmet therapy and were categorized by age at treatment initiation.

Results

CVAIIOR-MF and CVAISOR-LC were lower in all three age groups after helmet therapy, confirming therapeutic efficacy. CVAIMID-UC (upper level cranial asymmetry) and D EAR (mid-facial soft tissue asymmetry) also improved significantly in groups I and II which were younger than 1 year old.

Conclusion

In positional plagiocephaly, helmet therapy is effective in correcting both cranial and mid-facial asymmetries. Outcomes were optimal in patients <1 year of age, but older patients also showed some improvement.

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Author contributions

IS Yun performed all therapeutic procedures, analyzed the data, and wrote one draft of the paper. MC Lee analyzed the data, wrote the paper in part, and edited figures—all commensurate with the contributions of IS Yun. J Hwang analyzed the data and edited the manuscript. YO Kim discussed therapeutic procedures and formulated strategies. KW Shim and EK Park played roles in therapeutic managements. DH Lew supervised the progress of this report, which included extensive editing and overseeing related communications.

Conflict of interest

None of the authors have any conflicting or potentially influential interests with respect to this research.

Financial Disclosure

The authors have no proprietary or commercial interest in any materials discussed in this article.

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Authors and Affiliations

  1. Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Severance Hospital, Yonsei University Health System, 250 Seongsan-ro, Seodaemun-gu, Seoul, 120-752, Korea

    Myung Chul Lee, Jin Hwang, Yong Oock Kim, Dae Hyun Lew & In Sik Yun

  2. Department of Neurosurgery, Severance Hospital, Yonsei University Health System, 250 Seongsan-ro, Seodaemun-gu, Seoul, 120-752, Korea

    Kyu Won Shim & Eun Kyung Park

Authors
  1. Myung Chul Lee
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  2. Jin Hwang
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  3. Yong Oock Kim
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  4. Kyu Won Shim
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  5. Eun Kyung Park
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  6. Dae Hyun Lew
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  7. In Sik Yun
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Correspondence to In Sik Yun.

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Lee, M.C., Hwang, J., Kim, Y.O. et al. Three-dimensional analysis of cranial and facial asymmetry after helmet therapy for positional plagiocephaly. Childs Nerv Syst 31, 1113–1120 (2015). https://doi.org/10.1007/s00381-015-2677-7

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  • DOI: https://doi.org/10.1007/s00381-015-2677-7

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