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Diagnostic Yield of Cervical Radiographs in Infants with Deformational Plagiocephaly

Cho, Min-Jeong M.D.; Borchert, Loa L. R.N.; Rollins, Nancy M.D.; Kane, Alex A. M.D.

Plastic and Reconstructive Surgery: August 2015 - Volume 136 - Issue 2 - p 208e–213e
doi: 10.1097/PRS.0000000000001411
Pediatric/Craniofacial: Original Articles
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Background: When evaluating infants with deformational plagiocephaly, cervical spine radiographs are often acquired along with skull radiographs to exclude segmentation and fusion anomalies as the cause of associated torticollis. The diagnostic yield of cervical spine radiographs has not been evaluated in this clinical setting.

Methods: The authors retrospectively reviewed the charts of all patients who were referred to the University of Texas Southwestern School of Medicine, Children’s Medical Center (Dallas, Texas) with deformational plagiocephaly and torticollis and underwent cervical radiography (anteroposterior and lateral views) from 2010 to 2012. The authors reviewed the radiology reports, and a single experienced pediatric neuroradiologist again reviewed all radiographic studies in which the interpreting radiologist had suggested any bony or soft-tissue abnormality. Patient demographics, perinatal data, and physical examination findings were collected, and descriptive statistics were calculated.

Results: There were 730 patients with deformational plagiocephaly and torticollis; 49 of 730 reports (6.7 percent) described an abnormality. Of those with abnormal radiologic reports that were abnormal, 23 (47 percent) described osseous abnormalities, 20 (41 percent) described nonosseous deformities, and six (12 percent) described both. Follow-up studies (computed tomography, magnetic resonance imaging, and repeated radiography) of those with abnormalities showed three infants with true upper cervical spine anomalies that might lead to instability of the cervical spine.

Conclusions: There is a low diagnostic yield in ordering cervical radiographs in most patients with deformational plagiocephaly. Although the radiation exposure is low, cervical radiographs add additional cost and may not be warranted as a routine practice in this clinical setting.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, IV.

Dallas, Texas

From the Departments of Plastic Surgery and Radiology, University of Texas Southwestern Medical Center; and Children’s Medical Center.

Received for publication August 29, 2014; accepted February 12, 2015.

Presented at the 71st Annual Meeting and Preconference Symposia of the American Cleft Palate Craniofacial Association, in Indianapolis, Indiana, March 24 through 29, 2014.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Alex A. Kane, M.D., Department of Plastic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas 75390-9132, alex.kane@utsouthwestern.edu

©2015American Society of Plastic Surgeons