title: Treated Versus Untreated Positional Head Deformity.
abstract: BACKGROUND
  Positional head deformity in early childhood is asserted to be a benign and in some cases spontaneously correcting entity encountered in craniofacial surgery. Although many authors have stated that helmet therapy is indicated in moderate and severe cases of deformational plagiocephaly and brachycephaly; others have reported resolution of these conditions within the first 2 to 3 years of life. A recent randomized controlled trial found that helmet therapy does not have beneficial effects for patients with positional head deformity.
  
  
  METHODS
  The authors evaluated the clinical course of positional cranial deformation during a period of 5 years and compared the anthropometric parameters of orthotically treated versus untreated children within this timeframe.
  
  
  RESULTS
  Although the patients were matched with respect to their cranial deformation at baseline, there were significant differences in the cranial vault asymmetry (CVA), cranial vault asymmetry index (CVAI), and oblique cranial length ratio (OCLR) between Groups 1 and 2 at the initial point (P < 0.05). The mean CVA was 0.95 cm in Group 1 (no helmet) and 1.74 cm in Group 2 (helmet). The mean CVAI at baseline was 7.25 for Group 1 and 13.77 for Group 2. Approximately 5 years after the first examination, the authors found clear improvement in the mean CVA in Group 2 (ΔCVA 1.35 cm) compared with Group 1 (ΔCVA 0.01 cm) and the mean CVAI.
  
  
  CONCLUSIONS
  In contrast to recently published studies, the authors found clear improvement in nonsynostotic head deformity treated with an individual molding helmet and no clear evidence of improvement of absolute measurements in untreated cranial deformity within a 5-year follow-up period.
authors.affiliation: *Department of Cranio-Maxillofacial Surgery †Department of Biostatistics ‡Department of Neurosurgery, University Hospital Giessen, Giessen, Germany.
authors.forename: Jan-Falco
authors.initials: JF
authors.lastname: Wilbrand
authors.forename: Nikolai
authors.initials: N
authors.lastname: Lautenbacher
authors.forename: Jörn
authors.initials: J
authors.lastname: Pons-Kühnemann
authors.forename: Philipp
authors.initials: P
authors.lastname: Streckbein
authors.forename: Christopher
authors.initials: C
authors.lastname: Kähling
authors.forename: Marcus H T
authors.initials: MH
authors.lastname: Reinges
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Howaldt
authors.forename: Martina
authors.initials: M
authors.lastname: Wilbrand
mesh_terms: D002508:Cephalometry / Q000379:methods; D015331:Cohort Studies; D003398:Craniosynostoses / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006260:Head Protective Devices; D006801:Humans; D007223:Infant; D008297:Male; D009989:Orthotic Devices; D010780:Photogrammetry / Q000379:methods; D049068:Plagiocephaly, Nonsynostotic / Q000628:therapy*; D012886:Skull / Q000473:pathology; D016896:Treatment Outcome