Eff ffectivenes ectiveness s For r Ol Older r Infa fants nts To Star art Cra ranial nial Remodelin modeling g Tre reat atment ment Wi With Cra ranial nial Molding ding He Helme met In Positiona tional l Plag agiocephaly ocephaly Hong Youl Kim, M.D., Yong Oock Kim, M.D., PhD Department of Plastic and Reconstructive Surgery Institute for human tissue restoration Yonsei University College of Medicine, Korea
Positional Plagiocephaly Asymmetric condition of the head without craniosynostosis Deformational Plagiocephaly Plagiocephaly without synostosis
Incid idenc ence Since ce 19 1992 92, d dramatic tic rise of the inci ciden ence ce in the US → “Back to sleep” campaign (the American Academy of pediatrics) Up to 15% 15% of otherwise healthy infants Th The e most t co commonly monly rep eported ted inci ciden ence: ce: 1 in 300 births
Tre reatme tment nt Hel elmet met ther erapy; apy; 4 m 4 mos. ~ 1 ~ 18 8 mos. Promi omine nent nt area: passive retaining Flatte tene ned d area: growing to empty space Position Change; less than 4-6 months Surgery; rare
Patie Pa ients nts and Method od Positional Plagiocephaly without Synostosis by 3D CT scan Start age of Helmet therapy : over 18 month Completion of helmet therapy or regular follow-up over one year during therapy and complete documentation. Patie ient nt No.; 27 (M (M:F=15:1 :12) 2) Mean n Age ge; 29.7 months s (17~75 mos.) Duratio tion n of Helm lmet Tx Tx. ; 16 16.4 m mos.
Pa Patie ients nts and Method od Metho thod d : Spreading caliper Cranial nial va vault lt asymme mmetry y (CVA) ) = = diagonal A - diagonal B Cranial anial va vault lt asymme mmetry y index ex (CVAI) ) Di Diagonal B Diagonal A Di = (diagonal A - diagonal B) / diagonal A x 100 *** (diagonal A: fz A to eu A (longer one), diagonal B: fz B to eu B) Goal al of Treatm tmen ent : CVA ≤ 5 mm
Patie Pa ients nts and Method od Value Standard deviation ± 7mm Initial CVA 15.6mm ± 4.16% Initial CVAI 9.42% ± 2.6 Compliance 17.5 hours/day Helmeting ± 7.2 16.4 months Duration
Results Initial CVAI Final CVAI Initial CVA Final CVA (mean) (mean) (mean) (mean) 15.6 mm 8 mm 9.42 % 4.91 % 4.51% 7.6mm 50% Improvement in Average
Results Successful outcome : CVA ≤ 5 mm → 6 patients among 27 (22%)
Results of Successful Outcome Age of start Initial Final Initial Final Helmeting compliance No. helmet CVA CVA CVAI CVAI Duration (hour/day) therapy (mm) (mm) (%) (%) (months) 1 31.3 9 1 5.36 0.61 12.2 21.3 2 17.1 12 1 7.14 0.59 7.8 19.2 3 26.9 19.5 22 3 4.07 1.18 5.9 4 33.7 20 7 2 2.94 1.78 13.4 5 28.8 19 4 11.18 2.48 19.4 21 6 25.6 6 4 3.53 2.38 12.2 20.3 Mean 27.2 12.5 2.5 6.56 1.51 10.84 20.2 Over r 20 ho hours rs applic licatio ion of f Helm elmet per er day ca can ach chie ieve the the su succ ccessfu ful l outc tcome
Resul ults ts Age of start Initial Final Initial Final Helmeting Compliance helmet CVA CVA CVAI CVAI Duration (hours/day) therapy (mm) (mm) (%) (%) (months) (months) Good S compliance 26.7 7 2 6.25 1.45 10.5 21.1 (n=5) Poor S compliance 26.9 22 3 12.79 1.79 13.4 16.0 (n=1) Good F compliance 31.9 17.7 19 10 10.63 5.28 20.6 (n=15) Poor F compliance 28.3 15.4 14 11 9.23 6.27 20.6 (n=6)
Discussion Mean n Age; e; 29.7 9.4 9.42 4.9 4.91 month ths (17~75) ~75)
Conclusion Even in babies older than 1&1/2 year, Helmet Therapy can be effective, when wearing time is more than 18~20 hours/day and 11~20 months’ duration .
Thank you for your attention ! The authors have no conflict of interest to declare in relation to the content of this article Department of Plastic and Reconstructive Surgery Institute for human tissue restoration Yonsei University College of Medicine, Korea
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