the Infant Skull Cranial malformations are increasing in babies, but the prognosis for correction is excellent
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n various cultures, babies’ soft skulls have been shaped intentionally according to the customs and tastes of the times. Today, however, head shaping is done to correct deformities of the skull, primarily congenital. And unfortunately, these deformities are becoming more common. The incidence of plagiocephaly (asymmetry), brachycephaly (excessive width), and scaphocephaly (excessive length) is rising. Failure to treat these skull malformations can result in deformations of adjacent craniofacial structures, causing increased risk of ear infection, jaw misalignments, temporomandibular joint disorder (TMJ), and orbital asymmetries that cause vision and balance problems—to say nothing of the social stigma that can arise when a child has an unusual looking head and face. Fortunately, the outlook for correcting these skull malformations is excellent. Keys to a successful outcome are early detection and treatment and the family’s compliance with the treatment program.
Types of Malformation Plagiocephaly, brachycephaly, and scaphocephaly are congenital malformations of the skull that are distinguished by their characteristic shapes. Plagiocephaly presents
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O&P Almanac APRIL 2012
“with significant asymmetry between the right and left side,” says Deanna Fish, MS, CPO, director of orthotics at Hanger Prosthetics & Orthotics in Draper, Utah. As Nicole Steele, CO, of Wright & Filippis: Pediatric Center in Madison Heights, Michigan, explains, plagiocephaly “results in a parallelogram-shaped skull where you have two bossed, or enlarged, regions that are opposite each other (anterior and posterior), and two opposite regions that are flattened.” Plagiocephaly often occurs in combination with congenital muscular torticollis—also called wry neck— in which an infant’s head twists to one side while the chin tips up toward the other side. Torticollis often exacerbates plagiocephaly because the neck twisting causes the child to continue to place pressure on the same side of the skull, thus further flattening an already flattened area. Brachycephaly and scaphocephaly are less about asymmetry than about proportional deformations of the skull. “Brachycephaly is more about lack of volume, or void, than it is about asymmetry,” says Blake Norquist, CO, LO, and cranial products manager for Orthomerica in Orlando, Florida. “It presents as a flat posterior; a lot of volume is missing posteriorly. Infants with this condition usually have some bossing in the anterior. Scaphocephaly, in contrast, presents as a lack of volume in the width, in the mediolateral (ML) axis; so they have a long anteroposterior (AP) axis and a narrow ML.”