Re: Helmet Versus Nonhelmet Treatment in Nonsynostotic Positional Posterior Plagiocephaly

Re: Helmet Versus Nonhelmet Treatment in Nonsynostotic Positional Posterior Plagiocephaly. Vles JSH, Colla C, Weber JW, Beuls E, Wilmink J, Kingma H. J Craniofac Surg 2000;25:572–574.

The authors have provided us with a study that prospectively evaluates the effectiveness of helmet therapy in the treatment of posterior deformational plagiocephaly. This study is an important one as the incidence of such cranial deformities has recently been increasing, while the use of open surgical reconstruction is now openly condemned with the exception of very severe occipital asymmetries with resultant frontal facial compensations. Of equal interest in this study is how effective this therapy is based upon the initial severity of the asymmetry, at what age helmet treatment was begun, and the amount of treatment time that the helmet was used.

For those who have a significant experience in the use of helmet therapy for cranial deformities, this study demonstrates in a more quantitative manner what is commonly observed. Helmet therapy is more effective than no treatment at all at improving occipital assymmetries. It should be started before 6 months of age, total treatment time is generally 4 to 5 months or until cranial growth exceeds the dimensions of the initial fabricated helmet, and the most dramatic improvements occur in the most severe deformities. In addition, occipital symmetry is only rarely achieved and cannot be expected in the more severe deformities. It should be noted that this study used a static helmet as opposed to a dynamic one and the corrective outcome with its use is most likely less. Despite this, the use of static helmets is far more common due to their easier fabrication, improved parental and patient compliance, and relative low cost.

This study emphasizes the importance and effectiveness of early helmet therapy in positional posterior plagiocephaly. Its significance should be emphasized to the pediatricians and general practitioners who see these infants early after birth and are usually responsible for the craniofacial referral. Too often, such infants are referred late because the deformity is thought to be self-correcting. At such a time, particularly after 9 months of age, the effectiveness of helmet therapy diminishes considerably. Barry L. Eppley, MD, DMDIndianapolis, Indiana