Plagiocephaly
Plagiocephaly is a term used to describe asymmetrical head shape.
Deformational plagiocephaly (also known as positional or non-synostotic plagiocephaly) is used to describe asymmetrical head shape as a result of head preference to one side. This should be differentiated from craniosynostosis, a rare cause of head shape asymmetry, which is caused by early fusion of sutures.
Deformational Plagiocephaly is caused by an external force consistently to a specific region over a long period. This creates increased pressure to one side of the head. The area most often affected in the posterior occiput (back part of the head)There has been an increased incidence of since the introduction of the back to sleep program [1].
There are numerous possible causes of head preference. These include common conditions such as torticollis, conditions that must be considered with each patient (such as eye and neurological conditions), and rare conditions. In each person, the rare condition craniosynostosis (fused sutures) must be ruled out.
Plagiocephaly leads to characteristic head shape changes, with flattening on one side at the back of the head, shift in ear position, and changes to facial shape. Various measurement systems are used to assess and monitor shape.
Previously this problem was considered simply cosmetic, however, the neurological effects in deformational plagiocephaly are becoming more established in the literature, with effects related to head control [2, 4], cognitive, language, learning and attention [3, 5], motor development [6-8], auditory development [9], developmental delays [10], visual fields [11], and muscle tone [12].
(Copyright Adam Stewart, 2013)
References:
1. Bialocerkowski AE, Vladusic SL. Prevalence, risk factors, and natural history of positional plagiocephaly: a systematic review. Developmental Medicine & Child Neurology 2008, 50: 577–586
2. Pople IK, Sanford RA, Muhlbauer MS. Clinical presentation and management of 100 infants with occipital plagiocephaly. Pediatr Neurosurg 1996;25(1):1-6.
3. Steinbok P, Lam D, Singh S, Mortenson PA, Singhal A. Long-term outcome of infants with positional occipital plagiocephaly. Childs Nerv Syst 2007;23:1275-1283.
4. Kane AA, Mitchell LE, Gavin KP, Marsh JL. Observations on a recent increase in plagiocephaly without synostosis. Pediatrics 1996;97:877-885.
5. Miller RI, Clarren SK. Long-Term Developmental Outcomes in Patients With Deformational Plagiocephaly. Pediatrics 2000;105(2).
6. Panchal J, Amirsheybani H, Gurwitch R, Cook V, Francel P, Neas B, et al. Neurodevelopment in Children with single suture craniosynostosis and Plagiocephaly without synostosis. Plast Reconstr Surg 2001;108(6):1492-1498.
7. Kennedy E, Majnemer A, Farmer J, Barr RG, Platt RW. Motor Development of Infants with Positional Plagiocephaly. Physical & Occupational Therapy in Pediatrics 2009;29(3):222-235.
8. Collett BR, Starr JR, Kartin D, Heike CL, Berg J, Cunningham ML, et al. Development in Toddlers With and Without Deformational Plagiocephaly. Arch Pediatr Adolesc Med 2011;165(7):653-658.
9. Balan P, Kushnerenko E, Sahlin P, Huotilainen M, Näätänen R, Hukki J. Auditory ERPs Reveal Brain Dysfunction in Infants With Plagiocephaly. J Craniofac Surg 2002;13(4):520-525.
10. Collett B, Breiger D, King D, Cunningham M, Speltz M. Neurodevelopmental implications of “deformational” plagiocephaly. Dev Behav Pediatr 2005;26(5):379 -389.
11. Siatkowski RM, Fortney AC, Nazir SA, Cannon SL, Panchal J, Francel P, et al. Visual Field Defects in Deformational Posterior Plagiocephaly. J AAPOS 2005;9:274-278.
12. Fowler EA, Becker DB, Pilgram TK, Noetzel M, Epstein J, Kane AA. Neurologic Findings in Infants With Deformational Plagiocephaly. J Child Neurol 2008;23:742.
