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Orthopaedics and Fractures
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
A careful examination will exclude significant abnormalities; postural problems improve with time and/or some stretching exercises. Occasionally plagiocephaly is treated with a helmet (Fig. 21.15).
Head and neck
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
The usual skull changes are ipsilateral cranioorbital flattening with contralateral occipital flattening (i.e. positional plagiocephaly) that often resolves with conservative measures; cases that persist beyond 12–18 months will usually require surgery to treat the deformity.
Craniofacial Surgery
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
Benjamin Robertson, Sujata De, Astrid Webber, Ajay Sinha
The most common presentation of non-synostotic abnormalities of head shape is occipital plagiocephaly. This is usually due to deformational or positional plagiocephaly. The incidence of deformational plagiocephaly has significantly increased since 1992 when the National Institute of Child Health and Human Development at the US National Institutes of Health advocated and encouraged infants to sleep on their backs/supine to reduce the risk of sudden infant death syndrome (SIDS). This, combined with prematurity or potentially a delay in the ability to hold one’s own head, may predispose a child to either symmetrical or asymmetrical flattening of the occiput. Other causes include abnormal head posture due to torticollis, vertebral abnormalities or ocular squint.
Unilateral chronic subdural hematoma due to spontaneous intracranial hypotension: a report of four cases
Published in British Journal of Neurosurgery, 2020
Yoshinari Osada, Ichiyo Shibahara, Atsuhiro Nakagawa, Hiroyuki Sakata, Kuniyasu Niizuma, Ryuta Saito, Masayuki Kanamori, Miki Fujimura, Shinsuke Suzuki, Teiji Tominaga
The incidence of symmetrical cranium is reportedly 34.6%–47.0%, whereas that of asymmetrical cranium is 53.0%–65.4%.15,16,20 To differentiate between symmetrical and asymmetrical cranium, these studies had set the cutoffs at 2°. Cranial asymmetry in Case 3 was subtle; however, based on their criteria, the case was categorized as asymmetrical cranium. Radiological studies relating to plagiocephaly or craniofacial asymmetry have been performed. However, to date, studies on cranial convexity in the normal population have not been conducted. Therefore, the mechanism via which asymmetrical cranium affects the dura–arachnoid interface remains largely unknown. The possibility that the relationship of the most curved convexity to the development of CSDH due to SIH is merely coincidental cannot be excluded. Importantly, the four cases presented herein suggest that such an observation is feasible.
Medical devices and the pediatric population – a head-to-toe approach
Published in Expert Review of Medical Devices, 2019
Joy H. Samuels-Reid, Judith U. Cope
The head is large relative to the body in infants and young children. The skull is thinner and more flexible. This requires different types of considerations for the pediatric population and age-appropriate medical devices. Head circumference is a significant metric in assessing growth and development of the neonate and infant and is measured across the frontal-occipital prominence, the area of greatest diameter. While head circumference is an indicator for growth and development in the pediatric population, it is not in adults. It is tracked on growth charts during pediatric exams from birth through the first few years. Newborns have greater brain weights in proportion to body weight. The anterior and posterior fontanelles close at different times: the anterior fontanelle is the last to close between 1 to 3 years (the median time is about 13.8 months) and the posterior closes 2–3 months after birth. Depressed fontanelles may indicate dehydration, while bulging fontanelles may indicate swelling in the brain [6]. Early closure of fontanelles may lead to microcephaly, misshapen head and delay in closure may signal hydrocephalus. Cranial sutures close at different rates. It is important that use of devices take into consideration the status of cranial sutures and the stage of growth and development of the skull. If sutures close prematurely, they result in craniosynostosis [7]. Devices such as cranial helmets are often used to correct positional head deformity such as plagiocephaly.
Periocular Asymmetry in Infants with Deformational Posterior Plagiocephaly
Published in Journal of Binocular Vision and Ocular Motility, 2019
Anna Schweigert, Kimberly Merrill, Ali Mokhtarzadeh, Andrew Harrison
The term plagiocephaly refers to a diagonal asymmetry of the skull that is categorized into two types: synostotic plagiocephaly, due to premature closure of cranial sutures, and non-synostotic, also known as deformational plagiocephaly. Non-synostotic deformational posterior plagiocephaly (DPP), or positional plagiocephaly, is the most common form of cranial misshape in infants, presenting with occipital flatness, anterior displacement of the ear, and facial asymmetry.1,2 The occipital flatness in DPP is a result of continued external pressure to the same spot in the back of the head, most commonly acquired when babies lie with the back of their heads in the same position for prolonged periods of time.1 A significant increase in the incidence of DPP has been noted since 1992, when the American Academy of Pediatrics (AAP) recommended that infants sleep on their backs to reduce the risk of sudden infant death syndrome.3,4 The prevalence of DPP is not known for certain, with reports ranging from 5% to 48% of healthy infants.2