Lets Talk About Cranial Flattening and Other Issues...

Parents,

I have spent my entire professional life as an academic surgeon, studying and managing patients with conditions in the field of pediatric plastic surgery. I was fortunate as a young surgeon to be influenced by some of the most influential surgeons of the last 50 years. My interest in plagiocephaly started as a craniofacial fellow at Boston Children’s Hospital. Each Friday there was an all-day interdisciplinary clinic in which the group would evaluate and discuss patients with a variety of complex craniofacial conditions. My mentor John B. Mulliken, perhaps the greatest living pediatric plastic surgeon, would assume center stage in the main conference room filled with over 100 faculty, residents, and students. Patients and their families come through one by one and, after much discussion with and among the group, a plan of surgical treatment was created and conveyed.

Patients with deformational flattening were never brought to the main conference as this condition was considered largely an aesthetic concern and the treatment was invariably nonoperative. Patients were seen in the hallway clinic rooms and by the fellow. To a group of surgeons interested in operative procedures, this diagnosis was viewed as one to be avoided if possible. As the fellow, it was your job to evaluated and recommend treatment for these patients and the line of families looking for answers was seemingly endless.

I was fortune to be asked to stay on as a faculty member at Boston Children’s Hospital following my fellowship training at BCH and the Massachusetts General Hospital (hand and microsurgery). I was asked to manage most of the patients with craniosynostosis and, by default, all of the patients with other cranial shape anomalies, including deformational plagiocephaly. It was not long before I was seeing upwards of 40-50 new patients with this diagnosis each clinic and really began to dive into the causes and nuances of the problem. As a plastic surgeon with orthopedic training, it was not long before I realized that virtually all of the patient I saw had a measurable cervical imbalance, or torticollis. While other authors had noted this association, it was largely under-reported because most clinicians failed to recognize the often subtle manifestations of torticollis in most patients with plagiocephaly.

I still have debates with very well trained clinicians who argue that a head rotation preference in a newborn or infant is largely behavioral and does not reflect a true muscle imbalance or torticollis. This idea is easy to dismiss by merely rotating the infants body to eliminate the role of environmental cues and measuring active head rotation as illustrated in the text and video segments (coming soon). Ability to recognize such a head rotation predisposition is the key to starting preventative measures and preventing the development of flattening. My advice to pediatricians: ask new parents if their infant has a favorite head position. If he or she does, they should receive appropriate intervention to avoid the development of deformational flattening.

I welcome you to read the papers and text include on the site and email me with questions or comments.