The role of age on helmet therapy in deformational plagiocephaly and asymmetric brachycephaly

Purpose This study aimed to investigate the effect of age at helmet therapy onset on treatment efficacy in moderate-to-severe deformational plagiocephaly (DP) and combined DP and asymmetrical brachycephaly (AB) in infants. Methods Ninety-eight infants who were referred to our institution and who underwent helmet therapy between 2014 and 2018 were retrospectively reviewed. Patients with DP [cranial vault asymmetry index (CVAI) > 7% and DD > 10 mm] and AB [CVAI > 7% and cephalic ratio (CR) ≥ 94] were included. Pre- and post-treatment calvarial asymmetries (difference among DD, CVAI, and CR) were measured using 3D screening systems (SmartSoc and Omega Scanner 3D). Infants were classified according to age at treatment onset: group 1 (age, < 6 months) and group 2 (age, ≥ 6 months). Results CVAI was statistically different between treatment onset and end in subgroups. Moreover, the regression of CVAI between groups DP1 (− 7.5% ± 1.2%) versus DP2 (− 5.4% ± 1.5%; p = 0.001) and groups AB1 (− 6.6% ± 1.4%) versus AB2 (− 4.4 ± 2.5; p = 0.0013) was statistically significant. CVAI was < 3.5% and CR was ≤ 89 (assumed as normal cranial shape) after treatment in 48%, 40%, 32%, and 6% of infants in groups DP1, DP2, AB1, and AB2, respectively. Conclusion These findings emphasize the efficacy of helmet therapy for DP and AB. Helmet is an appropriate treatment option particularly for infants with severe DP and AB, and early onset of helmet therapy before the age of 6 months is advised.