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The Incidence of Complications Associated With Molding Helmet Therapy: An Avoidable Risk in the Treatment of Positional Head Deformities?

Freudlsperger, Christian MD; Bodem, Jens P. MD; Kargus, Steffen MD; Castrillon-Oberndorfer, Gregor MD; Hoffman, Jürgen MD; Engel, Michael MD

Journal of Craniofacial Surgery: June 2015 - Volume 26 - Issue 4 - p e299–e302
doi: 10.1097/SCS.0000000000001649
Brief Clinical Studies

Molding helmet therapy using an individual head orthosis presents a widely accepted treatment option for children with positional head deformities; however, studies addressing the incidence of complications during helmet therapy are rare.

The current study evaluates the incidence of complications in 205 children with positional head deformity undergoing molding helmet therapy. Children were classified according to the severity of their deformity as presented by the Cranial Vault Asymmetry Index (CVAI) and the Cephalic Index (CI).

Fifty-nine (28.8%) of our patients presented a moderate and 146 (71.2%) a severe form of a positional head deformity. Of these children, 166 (81.0%) were diagnosed for plagiocephaly, 19 (9.3%) were brachycephalic, and 20 (9.7%) showed a combination of plagiocephaly and brachycephaly.

Overall, 54 children (26.3%) showed minor complications during their helmet molding including pressure sores (13.7%), ethanol erythema (2.9%), skin erosions/skin infections (4.3%), or deficient fitting (5.4%). Children with a combination of plagiocephaly and brachycephaly (n = 20) showed the highest risk for complications, which was significantly higher compared with children with plagiocephaly (50% vs 22.3%; P = 0.012). Irrespective of the type of positional head deformity, no statistical difference was revealed between the moderate and the severe form.

Minor complications are a relatively frequent event during helmet molding therapy. Especially children with a combination of plagiocephaly-brachycephaly are at high risk for complications. A reduction of this rate might be reached by a close follow-up for a short period between helmet manufacturing adjustments.

From the Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany.

Address correspondence and reprint requests to Michael Engel, MD, Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; E-mail:

Received 27 October, 2014

Accepted 26 January, 2015

The authors report no conflict of interest.

© 2015 by Mutaz B. Habal, MD.