The Diagnosis of Plagiocephaly

The diagnosis of plagiocephaly should be made by a qualified Pediatrician, Neurosurgeon or Craniofacial surgeon. This is important to rule out craniosynostosis, which is a fusion of the sutures in the skull that results in deformity of the skull. If true craniosynostosis is present, surgery is required so that multiple complications including brain damage, visual impairment and intellectual compromise can be avoided.

Another condition that must be ruled out is Torticollis, which is a restriction in the sternocleidomastoid muscle of the neck. This tightening causes the infant to keep his/her head in an abnormal position with a tilt to the affected side. This results in the skull becoming deformed when the baby sleeps on it.

Central Plagiocephaly

About 10% of children affected with deformational plagiocephaly have a central depression in the back of the skull rather than the deformity being on one side. If the deformity is significant, the back of the skull begins to widen out or grow vertically to compensate for the growth of the underlying brain. This deformity occurs when the child tends to lie perfectly flat and places all of the pressure on the back of the skull to the central skull area. These children benefit significantly from helmet therapy as they tend to resist positioning. They should also be placed in physical therapy to encourage them to roll from side to side. Such central deformities take significantly longer to correct and often times are not completely corrected. The earlier such cranial deformities are treated the better the long term result.

X-Ray, CT Scans and Other Studies

A qualified physician can usually make the diagnosis of positional plagiocephaly without the help of X-rays or CT scans. These studies are helpful and may be necessary when the diagnosis is unclear and some possibility of craniosynostosis exists. CAT scans are the definitive diagnosis as to whether or not a suture is fused. They frequently require sedation or anesthesia in an infant.

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