Assessing calvarial vault constriction associated with helmet therapy in deformational plagiocephaly

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Deformational plagiocephaly and/or brachycephaly (DPB) is a cranial flattening frequently treated in pediatric craniofacial centers. The standard of care for DPB involves patient positioning or helmet therapy. Orthotic therapy successfully reduces cranial asymmetry, but there is concern over whether the orthotics have the potential to restrict cranial growth. Previous research addressing helmet safety was limited by lack of volume measurements and serial data. The purpose of this study was to directly compare head growth data in patients with DPB between those who underwent helmet therapy and those who received repositioning therapy.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>This retrospective cohort study analyzed pre- and posttherapy 3D photographs of 57 patients with DPB who had helmet therapy and a control group of 57 patients with DPB who underwent repositioning therapy. The authors determined the change in cranial vault volume and cranial circumference between each patient’s photographs using 3D photogrammetry. They also computed a cubic volume calculated by multiplying anterior-posterior diameter, biparietal diameter, and height. Linear regressions were used to quantify effects of age and therapy type on these quantities.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>A comparison of the following variables between the two groups yielded nonsignificant results: age at the beginning (p = 0.861) and end (p = 0.539) of therapy, therapy duration (p <jats:italic>=</jats:italic> 0.161), and the ratio of males to females (p = 0.689). There was no significant difference between patients who underwent helmeting versus positioning therapy with respect to change in either volume calculation or head circumference z-score (p ≥ 0.545). Pretherapy photograph age was a significant predictor of cranial growth (p ≤ 0.001), but therapy type was not predictive of the change in the study measurements (p ≤ 0.210).</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>The authors found no evidence that helmet therapy was associated with cranial constriction in the study population of patients with DPB. These results strengthen previous research supporting helmet safety and should allow health care providers and families to choose the appropriate therapy without concern for potential negative effects on cranial growth.</jats:p></jats:sec>

Evaluating Cranial Growth in Japanese Infants Using a Three-dimensional Scanner: Relationship between Growth-related Parameters and Deformational Plagiocephaly

“…Peterson et al compared DP infants with and without helmet therapy and reported no significant differences in final CrV. 21 ) The lack of significant differences in CrV with and without DP and with and without helmet therapy could guide decision-making regarding the suitability of helmet therapy for children with DP. Previous report shows that DP exacerbates until 3 months of age before spontaneously improving throughout the first 6 months of life.…”

Photogrammetry Applied to Neurosurgery: A Literature Review

“…The most widely used systems among the studies are the 3dMD System (3dMD Inc., Atlanta, GA, USA) [ 24 , 25 , 30 , 42 ], and the Canfield VECTRA-360 nine-pod system (Canfield Scientific, Parsippany, NJ, USA) [ 27 , 47 , 49 , 51 ], which are developed specifically for the creation of 3D models from images. The systems come with proprietary software that deals with the integration of the images into one single model.…”

“…The systems come with proprietary software that deals with the integration of the images into one single model. For the refinement of the model third-party software is used, such as Blender [ 30 , 42 ] and MeshLab [ 27 , 47 ]. The alternative to using such technology is the use of standard cameras and third-party software both for the creation of the model and for its refinement, which was described in one paper [ 23 ].…”

Applications of 3D Photography in Craniofacial Surgery

“…Petersen et al [ 8 ] investigated the extent to which helmet therapy, used in the correction of deformational plagiocephaly, resulted in constriction of calvarial growth. Their method involved retrospective review of 3dMD photographs of helmet and positioning therapy patients that were landmarked according to traditional methods, and then the landmarks were used to estimate cranial volume.…”