Postoperative Orthotic Helmet Use Following Cranial Vault Remodeling for Craniosynostosis

摘要

Objective: To evaluate the effect of postoperative orthotic helmet molding following total cranial vault remodeling in non-syndromic craniosynostosis. Methods: Via chart review, 15 patients were assessed following total cranial vault remodeling and post-operative helmet molding therapy for craniosynostosis (2 metopic, 3 bicoronal, 1 lambdoid, 2 sagittal, 4 left coronal and 3 right coronal) from April 2003 to August 2006 at Texas Children's Hospital in Houston, Texas. Helmets consisted of 3/8" co-polymer thermoplastic with a foam interface of 1/2" closed cell pelite. Measurement sets, taken at the initiation and end of helmet therapy, included head circumference, cranial width, and cranial diameter. For each measurement set, a cephalic index (CI) was calculated for quantitative analysis. Results. At operation, patient age ranged from 4.25 to 15.5 months (average: 7.5 months). Helmets were custom-fitted and applied on day 21-28 (mean: 23.4 days). Helmet therapy lasted an average of 109 days (range: 50 days to 160 days). Overall, CI's increased by an average of 6.3 (range: 1.6 to 22.0), a statistically significant improvement (P< .01). All but one patient (93.33%) reached normocephalic appearance upon helmet therapy completion. Other than slight local tissue break down in 5 patients, no complications were related to surgical procedure or helmet use. Conclusions: Postoperative orthotic helmet use is critical in obtaining superior results following cranial remodeling for craniosynostosis. Not only does postoperative helmet therapy directly improve quantitative cephalic indices, but it facilitates significant normalization of clinical appearance.