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Head orthesis therapy in infants with unilateral positional plagiocephaly: an interdisciplinary approach to broadening the range of orthodontic treatment

Kopforthesentherapie bei Säuglingen mit einseitigem Lagerungsplagiozephalus − Eine interdisziplinäre Aufgabe mit Ausweitung des kieferorthopädischen Behandlungsspektrums

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Abstract

Objective

Unilateral positional plagiocephaly is the most common deformity of the head in infants. As part of a prospective controlled clinical study, the pathomorphology of the positional plagiocephaly in early infancy was examined. The goal was to use noninvasive three-dimensional (3D) imaging to generate, for the first time ever, a standard database of infants without head deformities, to quantify the asymmetry of the positional plagiocephaly, and to evaluate the effectiveness of functional growth control using head orthesis.

Patients and methods

In the present study, 3D soft-tissue data of the entire head were collected from a total of 40 infants: 20 with positional plagiocephaly (6.0 ± 0.97 months) and 20 infants without a head deformity (6.4 ± 0.3 months). Functional growth was controlled using a custom-made head orthesis. To evaluate the therapy, pre- and posttherapeutic scans were evaluated in three dimensions.

Results

Compared with the control group, infants with positional plagiocephaly demonstrated a reduced maximum length of the head, an increased head height, a shift in the ear axis as well as asymmetric anterior and posterior volumes of the neurocranium in lateral comparisons. Therapy using head orthesis led to a significant improvement of the asymmetry, with a reduction of the diagonal difference and an adjustment of the posterior volumes.

Conclusion

Conservative growth control of extrinsically deformed infant skulls represents an interdisciplinary medical expansion of the orthodontic therapeutic spectrum. To prevent potential effects of positional plagiocephaly on the viscerocranium, head orthesis therapy is advisable in infancy.

Zusammenfassung

Ziel

Der einseitige lagerungsbedingte Plagiozephalus ist die häufigste Kopfdeformität im Säuglingsalter. Im Rahmen einer prospektiv kontrollierten klinischen Studie wurde die Pathomorphologie des Lagerungsplagiozephalus im Säuglingsalter untersucht. Ziel war es, durch Einsatz der nichtinvasiven dreidimensionalen Bildgebung erstmals eine Normdatenbank von Säuglingen ohne Kopfdeformitäten zu generieren, die Asymmetrie des Lagerungsplagiozephalus zu quantifizieren und die Effektivität der funktionellen Wachstumssteuerung mittels Kopforthese zu evaluieren.

Patienten und Methodik

Insgesamt wurden von 40 Säuglinge (20 Säuglinge mit Lagerungsplagiozephalus: 6,0 ± 0,97 Monate, 20 Säuglinge ohne Kopfdeformität: 6,4 ± 0,3 Monate) die 3D-Weichteildaten des gesamten Kopfes erhoben. Die funktionelle Wachstumssteuerung erfolgte mittels individuell angefertigter Kopforthese. Zur Evaluation der Therapie wurden die prä- und posttherapeutischen Scans dreidimensional ausgewertet.

Ergebnisse

Säuglinge mit Lagerungsplagiozephalus wiesen gegenüber der Kontrollgruppe eine reduzierte maximale Kopflänge, eine vergrößerte Kopfhöhe und eine Verschiebung der Ohrachse auf sowie im Seitenvergleich asymmetrische anteriore und posteriore Volumina des Neurokraniums. Die Therapie mittels Kopforthese führte zu einer signifikanten Verbesserung der Asymmetrie mit Reduktion der Diagonalendifferenz und Angleichung der posterioren Volumina.

Schlussfolgerung

Die konservative Wachstumssteuerung des extrinsisch deformierten Säuglingsschädels stellt eine interdisziplinäre medizinisch-relevante Ausweitung des kieferorthopädischen Spektrums dar. Um potenzielle Folgen des Lagerungsplagiozephalus auf das Viszerokranium zu verhindern ist eine Kopforthesentherapie im Säuglingsalter angezeigt.

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Acknowledgment

This investigation was supported by grants from the German Orthodontic Society (“Deutschen Gesellschaft für Kieferorthopädie”, DGKFO) and by the Interdisciplinary Center for Clinical Research (“Interdisziplinäre Zentrum für klinische Forschung”, IZKF) at the University Hospital Würzburg.

Danksagung

Die Arbeit wurde unterstützt durch Fördermittel der Deutschen Gesellschaft für Kieferorthopädie (DGKFO) sowie durch das Interdisziplinäre Zentrum für klinische Forschung (IZKF) des Universitätsklinikums Würzburg.

Conflict of interest

The corresponding author states that there are no conflicts of interest.

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

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Authors and Affiliations

  1. Department of Orthodontics, University Hospital Würzburg, Pleicherwall 2, 97070, Würzburg, Germany

    P. Meyer-Marcotty, F. Kunz, N. Keil & A. Stellzig-Eisenhauer

  2. Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital Würzburg, Würzburg, Germany

    H. Böhm & C. Linz

  3. Department of Neurosurgery, Section Pediatric Neurosurgery, University Hospital Würzburg, Würzburg, Germany

    T. Schweitzer

Authors
  1. P. Meyer-Marcotty
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  2. H. Böhm
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  3. C. Linz
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  4. F. Kunz
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  5. N. Keil
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  6. A. Stellzig-Eisenhauer
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  7. T. Schweitzer
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Corresponding author

Correspondence to P. Meyer-Marcotty.

Additional information

This paper was granted the Arnold Biber Research Award of the German Orthodontic Society for the year 2011.

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Meyer-Marcotty, P., Böhm, H., Linz, C. et al. Head orthesis therapy in infants with unilateral positional plagiocephaly: an interdisciplinary approach to broadening the range of orthodontic treatment. J Orofac Orthop 73, 151–165 (2012). https://doi.org/10.1007/s00056-011-0070-z

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