Postural plagiocephaly is the most common craniofacial anomaly and consists of a flattening of the occiput of the child with facial asymmetry. It does not affect the child’s intellectual development, but it is recommended to correct it because of the aesthetic problems it entails.
In most cases, a simple clinical examination and an analysis of the child’s history by the pediatrician will allow a reliable diagnosis to be made.
However, three groups of skull deformities can create doubts as to the diagnosis:
- early closure of a suture,
- the shape of the premature infant’s head, which can be mistaken for a malformation, and
- plagiocephaly of both the anterior (frontal) and posterior (occipital) parts of the head.
If there is any doubt about whether it is a postural plagiocephaly or a skull malformation, the tests to be performed are a cranial CT scan and a three-dimensional reconstruction.
We must determine with certainty whether we are dealing with a case of postural deformity. Therefore, with a minor problem that only requires conservative management and follow-up, or with true craniosynostosis, surgical treatment with major intracranial procedures will require surgical treatment.
The treatment of positional plagiocephaly consists of a series of measures that should be staggered in the opinion of many physicians: rehabilitation, cranial orthosis techniques, and surgical reconstruction as a last resort.
During the whole process, the information provided to the families by the pediatrician and the rehabilitation specialist should be as straightforward as possible, educating them especially on the measures aimed at achieving a proper positional rehabilitation of the child.
Thus, for example, changes in the lateral position of the head. At the same time, the child sleeps, with the help of the inclination of the mattress, taking advantage of the time when the child is awake to practice head movements and exercises on hard surfaces. Of course, the treatment of torticollis with appropriate neck movements are all fundamental measures with which children are cured in the vast majority of cases during the first months of life. The parents themselves should perform these exercises to the child, for which the pediatrician or rehabilitator should appropriately instruct them.
Although some authors have questioned the treatment with cranial orthosis, it seems appropriate to use it in some instances, especially in cases refractory to previous treatments, according to a generalized opinion that is in the majority. These procedures use the same methods used in some ancient civilizations to achieve cranial molding in infants to obtain a previously determined cranial morphology. In the same way, different types of “bands or helmets” are currently described, which aim to modify the morphology of the skull within a few months.
It seems that the most suitable response to this type of treatment can be obtained from 4 months of age and up to a limit of 12 months, after which the skull is no longer susceptible to external cranial molding. In any case, and given that this treatment generates evident costs, either for the families or in public funding for the administration, it is advisable to systematize its use as much as possible.
Finally, surgical treatment should be reserved for cases of craniosynostosis or for those rare patients in whom previous treatments have not had the desired effect.