Neurodevelopmental implications of "deformational" plagiocephaly

Abstract

Over the past decade there has been a dramatic increase in referrals to specialty clinics, craniofacial centers, plastic surgeons, and neurosurgeons for assessment and treatment of deformational plagiocephaly (DP). Though considered a medically benign condition, preliminary reports suggest that DP may be associated with developmental problems. However, mechanisms to account for this association have not been hypothesized or empirically tested. Although treatment justifications often center on prevention of atypical appearance, little is known about the cosmetic outcomes of treated and untreated children. In this review we hypothesize different etiological pathways linking DP with neurodevelopment (e.g., environmental positioning limitations with and without underlying CNS pathology). We outline directions for research on incidence and prevalence, developmental outcomes, sex differences, determinants of treatment participation, and craniofacial appearance. Despite the paucity of existing research, preliminary findings suggest that children with this condition should be screened and monitored for developmental delays or deficits, as we await more conclusive information from future studies.

FIGURE 1

Top view of children’s skulls with various presentations of DP (from left to right: typical manifestation of DP, with flattening of the left occiput, ipsilateral bossing of the forehead, and contralateral occipital bulging; “dolichocephaly,” or bi-lateral skull flattening; and “brachycephaly,” or flattening of central occiput).

FIGURE 2

Proposed developmental pathways accounting for association between DP and developmental.