PHS302 - Plagiocephaly - "Oblique Head"

Deformational Plagiocephaly
1. Non-synostotic
  1. pressure on outside causing bones to shift and no closure
  2. ipsilateral frontal bossing
  3. ipsilateral ear displaced anteriorly
  4. ipsilateral occipitoparietal flattening
  5. contralateral occipital bossing
  6. due to position
2. Synostotic
  1. contralateral frontal bossing
  2. contralateral parietal bossing
  3. ipsilateral occipitoparietal flattening
  4. ipsilateral ear displaced posteriorly
  5. not due to position
3. causes
  1. restrictive intrauterine environment
  2. premature birth
  3. assisted vaginal delivery
  4. prolonged labour - unusual birth
  5. multiple birth
  6. primiparity (first pregnancy)
4. plagiocephaly = misshapen
5. brachiocephaly = flat (occiput)
6. scaphocephaly = flat (side-side)
7. Assessment
  1. visual
    1. superior view
      1. posterior flattening
      2. ear misalignent
      3. forehead asymmetry
    2. frontal view
      1. neck involvement
      2. facial asymmetry
  2. assessment tools
    1. CT scans
    2. digital photographs
    3. flexi-curve
    4. thermoplastic band
    5. Cranial Vault Asymmetry Index (CVAI
      1. ratio of oblique diameters
      2. significant >= 5
8. CF = Torticollis
prolonged exposure to one posn => moulding of developing skull
most common headshape since intro of "Back to Sleep"
20% of infants affected in 1st 4/12 of life
CRANIOSYNOSTOSIS = premature closure of one or more of the cranial sutures - requires sx
Management
1. provide info to parents
2. early ID and rx for torticollis likely to reverse plagiocephaly
3. counter positioning
  1. active/consistent re-positioning
  2. posn in midline
4. if not resolving ? refer to plastics/orthotics re helmet
5. helmet
  1. consider at 4/12
  2. prevents head growing wider at contact points

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PHS302 - Plagiocephaly - "Oblique Head"

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	Created by Louise Weir about 8 years ago