OHSU

Deformational Plagiocephaly

Plagiocephaly

What is deformational plagiocephaly?

Deformational (or positional) plagiocephaly refers to a misshapen (asymmetric) shape of the head (cranium) from repeated pressure to the same area of the head. Plagiocephaly literally means "oblique head" (from the Greek words "plagio" for oblique and "cephale" for head).

How is deformational plagiocephaly different from craniosynostosis?

In deformational plagiocephaly, there is no fusion of the skull sutures (the spaces normally found in the infant skull between the bones that make up the skull). It is a clinical diagnosis made after a thorough medical history and physical examination.CT scans are rarely necessary for diagnosis. Treatment of deformational plagiocephaly generally includes positioning changes, neck stretching and/or helmeting.

Craniosynostosis is a premature fusion of one or more of the sutures of the skull. Synostosis may limit the size of the cranial vault (skull) and therefore impair brain growth. This can cause problems with development of the child and may increase the pressure inside the skull.Surgery is usually the recommended treatment for craniosynostosis.This diagnosis can also be made by physical exam, but a CT scan of the head is usually performed to confirm the diagnosis and help with surgical planning.

The major differences between craniosynostosis and deformational plagiocephaly are summarized in the chart below:


Craniosynostosis

Deformational plagiocephaly

Head shape

asymmetric head

asymmetric head

Results from

internal events

external molding

Fusion of cranial sutures

premature fusion of cranial suture(s)

normal cranial sutures

Diagnosis

Confirmed by CT scan

Clinical diagnosis, CT scan rarely required

Treatment

surgery

repositioning and/or helmeting

Causes

Probably a combination of genetic and environmental factors

may include back sleeping, restrictive intrauterine environment, muscular torticollis, prematurity

Outcome without treatment

Increased risk of developmental delay and increased pressure inside the skull without treatment

Difference in cosmetic appearance without treatment but does not cause developmental delay



What causes deformational plagiocephaly?

When an infant's head is in one position for long periods of time, the skull flattens because of external pressure. Occasionally, a baby is born with this flattening because of a tight intrauterine environment (i.e., in multiple births, small maternal pelvis, or with a breech position). Other factors which may increase the risk of deformational plagiocephaly include the following:

  • Muscular torticollis. One cause of deformational plagiocephaly is muscular torticollis. Muscular torticollis is a congenital (present at birth) finding in which one or more of the neck muscles is extremely tight, causing the head to tilt and/or turn in the same direction. Torticollis is often associated with the development of plagiocephaly since the infant holds his/her head against the mattress in the same position repeatedly.
  • Prematurity. Premature infants are at a higher risk for plagiocephaly since the cranial bones become stronger and harder in the last 10 weeks of pregnancy. Also, since many premature infants spend extended periods of time in the neonatal intensive care (NICU) unit on a respirator, their heads are maintained in a fixed position, increasing the risk for this condition.
  • Back sleeping. Infants who sleep on their backs or in car seats without alternating positions for extended periods of time are also at a higher risk for deformational plagiocephaly.

Treatment for deformational plagiocephaly

Specific treatment will be determined by your child's physician based on the severity of the deformational plagiocephaly. Frequent rotation of your child's head would be the first recommendation once your infant has been diagnosed with plagiocephaly. Alternating your infant's sleep position from the back to the sides, and not putting infants on their backs when they are awake may also help prevent and treat positional plagiocephaly. Some cases do not require any treatment and the condition may resolve spontaneously when the infant begins to sit.

If the deformity is moderate to severe and a trial of re-positioning has failed, your child's physician may recommend a cranial remodeling band or helmet.

How does helmeting correct deformational plagiocephaly?

Helmets are made of an outer hard shell with a foam lining. Gentle, persistent pressures are applied to capture the natural growth of an infant's head, while inhibiting growth in the prominent areas and allowing for growth in the flat regions. As the head grows, adjustments are made.The helmet provides a tight, round space for the head to grow into.

How long will my child wear a helmet?

The average treatment with a helmet is usually three to six months, depending on the age of the infant and the severity of the condition. Careful and frequent monitoring is required. Helmets must be prescribed by a licensed pediatric provider with craniofacial experience.