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Head Orthosis Therapy in Positional Plagiocephaly: Influence of Age and Severity of Asymmetry on Effect and Duration of Therapy

Kunz, Felix, D.M.D.; Schweitzer, Tilmann, M.D., Ph.D.; Kunz, Jessica, D.M.D.; Waßmuth, Nina, M.Sc. (Psych.); Stellzig-Eisenhauer, Angelika, D.M.D., Ph.D.; Böhm, Hartmut, M.D., D.M.D.; Meyer-Marcotty, Philipp, D.M.D., Ph.D.; Linz, Christian, M.D., D.M.D., Ph.D.

Plastic and Reconstructive Surgery: August 2017 - Volume 140 - Issue 2 - p 349-358
doi: 10.1097/PRS.0000000000003517
Pediatric/Craniofacial: Original Articles
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Discussion

Background: Only a few studies investigating the optimal time point at which to start orthotic treatment for deformational plagiocephaly take into account the severity of skull asymmetry. The present study performs a three-dimensional analysis of the effects of age and severity of asymmetry on the final outcome.

Methods: A total of 144 patients with deformational plagiocephaly treated by molding orthosis were examined and divided into three age groups (group I, <24 weeks; group II, ≥24 to <32 weeks; and group III, ≥32 weeks) and two severity levels (mild to moderate, 30-degree cranial vault asymmetry ≥3 mm to ≤12 mm; and moderate to severe, 30-degree cranial vault asymmetry >12 mm). The extent of the reduction of asymmetry was analyzed using three-dimensional stereophotogrammetry.

Results: Therapy with molding orthosis led to a significant reduction in asymmetry in all defined age groups. Efficacy of reduction decreased with increasing age. Successful treatment (cranial vault asymmetry index <3.5 percent) was achieved in 83, 69, and 40 percent of patients with mild to moderate asymmetry in groups I, II, and III, respectively; and in 50, 30, and 7 percent of patients with moderate to severe asymmetry in groups I, II, and III, respectively. The average duration of treatment increased from 18.6 weeks to 25.3 weeks (age groups I and III).

Conclusion: Age at the beginning of treatment and severity of asymmetry have a definite impact on the duration and effectiveness of molding orthosis therapy.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

Würzburg and Göttingen, Germany

From the Departments of Orthodontics, Neurosurgery, and Oral and Maxillofacial Surgery, University Hospital Würzburg; and the Department of Orthodontics, University Hospital Göttingen.

Received for publication November 24, 2016; accepted January 10, 2017.

Disclosure:The authors have no financial interest in any of the products or devices mentioned in this article.

Felix Kunz, D.M.D., Poliklinik für Kieferorthopädie, Pleicherwall 2, D- 97070 Würzburg, Germany, kunz_f@ukw.de

Copyright © 2017 by the American Society of Plastic Surgeons