The current management of plagiocephaly is the focus of the October issue of the journal Neurosurgical Focus. The featured article is a literature review on the use of remolding helmets in the treatment of deformational plagiocephaly. Other articles include a literature analysis on the effectiveness of guidelines for positional plagiocephaly, a review of studies that have explored complications associated with remolding helmets for positional plagiocephaly, and a retrospective study on the efficacy of passive helmet treatment for deformational plagiocephaly. A summary of each follows.
“Orthotic (Helmet) Therapy in the Treatment of Plagiocephaly”: Forty-two articles were examined for this literature review: There were no Class I studies, seven Class II studies, one Class III study, and 13 Class IV studies. The authors found that the articles indicate cranial orthoses have been shown to be effective in treating deformational plagiocephaly. However, they conclude there are controversies surrounding the use of cranial orthoses such as appropriate use, cost, use in older children, and long-term outcomes. “Hopefully, as new research studies address these issues, the clinical indications for helmet therapy in deformational plagiocephaly will be better defined,” the authors wrote.
“Positional Plagiocephaly: An Analysis of the Literature on the Effectiveness of Current Guidelines”: For this literature review, the authors’ goal was to assess the effectiveness of current recommendations to parents regarding positional plagiocephaly. The authors found that current guidelines and recommendations on prevention might not be easily followed by both parents and clinicians, and that better awareness and education are necessary for the population as a whole, but there is evidence that those with lower education levels and socioeconomic status as well as Southern populations should be given special attention. “Adjusting current recommendations, introducing initiatives, and offering elaborate educational campaigns would help deliver…[better awareness and education]. Educating parents on positional plagiocephaly as early as possible through clearer guidelines and close monitoring is central to preventing and managing this common condition,” the authors wrote.
“Complications Associated with Molding Helmet Therapy for Positional Plagiocephaly: A Review”: The authors reviewed multiple studies to examine potential complications associated with molding helmet therapy to treat positional plagiocephaly, which they said has an estimated complication rate of ≤1 percent. The authors concluded that the most reported complications are mild and self-limited, such as minor skin irritations. “Maintenance of good helmet hygiene appears to be the most effective strategy for reducing or eliminating complications,” they concluded.
“Efficacy of Passive Helmet Therapy for Deformational Plagiocephaly: Report of 1,050 Cases”: Researchers conducted an institutional review board-approved retrospective study that examined the charts of 1,050 patients, all of whom were treated for deformational plagiocephaly with a prefabricated passive helmet. The study had three objectives: determine the accuracy of the Argenta classification in defining a progressive degree of severity, identify an upper age limit when treatment is no longer effective, and examine the effectiveness of an off-the-shelf (OTS) prefabricated helmet in correcting deformational plagiocephaly. According to the authors, “the study supports the use of passive helmet therapy for improvement in deformational plagiocephaly in infants from birth to 18 months of age and verifies the Argenta classification as a useful stratification of degree of deformity.” The authors also stated that none of the patients in the study who used an OTS prefabricated helmet developed pressure problems or helmet-related complications. Successful treatment correlates with consistent wearing of the helmet, they said.
Editor’s note: This story was adapted from materials provided by the journal Neurosurgical Focus.
