Current status of Molding helmet therapy in Tohoku

Abstract

Purpose: In recent years, helmet therapy for cranial deformities has become possible in Japan, and treatment often requires outpatient treatment. The most important thing is to differentiate between craniosynostosis: CS and physiological deformities such as positional head deformity: PHD, however in outpatient settings, a high proportion of the family’s concerns about future disadvantage of cranial deformity are addressed. There are concerns that patients may be transitioned to helmet therapy without proper diagnosis. In this study, we examined the patients who visited our department’s outpatient department with the chief complaint of cranial deformity.

Methods: We investigated the reasons for consultation and cranial morphology of patients who visited our outpatient department with cranial deformity as their chief complaint over a 2-year period starting January 2020. Cases referred for treatment of CS were excluded. Differentiation from CS was made based on physical findings, and head XP and CT were performed when necessary.

Results: There were 291 cases (190 males, 101 females, age at presentation: mean 5.7±5.3 months, median 5 months, mode 4 months), 37 cases were found to have deformities during infant check-up, and 254 cases were diagnosed by their parents. Four patients (1.4%) were diagnosed with CS (lambda synostosis 1, sagittal suture synostosis 2, and coronal suture synostosis 1). Three cases were diagnosed at infant check-up (at 2 months, 8 months, and 1.5 years old), and one case (at 3.5 years old) was diagnosed after being examined by a family member. Cases other than CS included 258 cases of positional head deformity: PHD, 11 cases of metopic ridge, 3 cases of ossifying cephalhematoma, and 16 other cases.

Discussions: As interest in PHD increases in pediatric neurosurgery outpatient clinics, it is thought that patients will become polarized into those seeking cosmetic improvements and those seeking to alleviate concerns about other disadvantages. For the former, we believe it is desirable to respond to the wishes of the patient’s family in order to meet the needs of aesthetic medicine. In the latter case, the response may vary depending on what is considered disadvantageous, so it is desirable to provide accurate information for PHD. In outpatient treatment of PHD, the first step is to differentiate it from pathological diseases such as CS, and before the stage of neck stabilization is reached, we should provide guidance on appropriate physical countermeasures. If helmet therapy is to be performed after neck stabilization, obtaining sufficient understanding from the patient’s family is considered to be essential.