A Retrospective Evaluation of the Effectiveness of Cranial Remolding Orthoses for the Treatment of Deformational Brachycephaly

Introduction This retrospective chart review aims to analyze the effects of initial severity and age on cranial remolding orthosis (CRO) treatment of deformational brachycephaly. It is predicted that younger cases will show greater rates of correction and more severe cases will require longer treatment times. With the data collected, statistical analysis will aid in the development of a measurement scale for categorizing severity for brachycephaly. Methods Subjects were diagnosed with brachycephaly and started CRO treatment between 3 and 18 months of age. Subjects had a cranial vault asymmetry index lower than 3.5 and cranial index of 90% or higher. Subjects were excluded if they had comorbidities affecting growth, failed to complete treatment, or were noncompliant. In total, 2977 charts were retrospectively reviewed, and 253 subjects were included. Results Statistical analyses showed that age at treatment initiation is significantly correlated with final cranial index and treatment duration, and initiation at a younger age allows for more correction and shorter treatment durations. In addition, a receiver operating characteristic curve analysis showed a statistically significant, inverse relationship between initial severity and the likelihood of achieving correction (milder head shapes are more likely to achieve correction). Conclusion Together, these findings suggest that CRO treatment should be initiated as early as possible and the head shape deformation should not be allowed to progress without intervention. Clinical Relevance Clinical decisions and caregiver expectations during orthotic treatment should be guided by historical treatment outcomes. This study examines the influence of initial age and cephalic index severity on CRO treatment outcomes for deformational brachycephaly.