Head and Neck Deformities

Deformational plagiocephaly, which occurs in approximately one in every 50 newborns, is a condition where a baby’s head becomes flattened or misshaped, often due to pressure on one part of the skull. It can result from factors like spending too much time lying in one position or being born with a tight neck muscle (torticollis).

If diagnosed early, treatment usually involves positioning the child differently (not on the back) and using an orthotic remolding helmet (helmet therapy). In severe cases, a surgical procedure can be performed to reshape the head.

Plagiocephaly is commonly associated with a neck deformity called torticollis, which is a congenital tightening of a neck muscle (sternocleidomastoid). This condition causes an abnormal tilt or rotation of the head to one side or the other.

It is essential that torticollis is ruled out in any child who has plagiocephaly. If torticollis is not treated, then treatment for plagiocephaly will not be fully effective and the condition will continue. Torticollis is treated with physical therapy and an at-home stretching and exercise program.

Treatment options for torticollis at Pediatrix Plastic and Reconstructive Surgery Specialists include physical therapy, Botox®, TOT™ collar or surgery. Ninety percent of patients are treated non-surgically, but if surgery is needed, we offer both open and endoscopic repair for selected patients.

Brachycephaly is when a baby’s head shape appears wider or shorter than usual, often due to flattening at the back. It can occur if a baby spends a lot of time lying on his or her back or due to other conditions, such as torticollis (tight neck muscles).

Depending on the severity and underlying cause, we use several methods of treatment, such as:

• Repositioning techniques to change the baby’s head position during sleep
• Physical therapy to address tight neck muscles
• Helmet therapy to gently reshape the head over time
• Surgery in severe cases

Craniosynostosis is a condition where the sutures (the joints between the bones) in a baby’s skull close too early, before the brain has fully grown. This can lead to an abnormal head shape and sometimes increased pressure on the brain.

Treatment for craniosynostosis typically involves surgical intervention to correct the premature fusion of the skull bones. The surgical procedure, known as cranial vault remodeling or cranial vault reconstruction, involves reshaping the skull to allow for normal growth and development.

The specific surgical procedure depends on several factors, such as the type of craniosynostosis and the age of the child.

Types of craniosynostosis include:

• Sagittal synostosis, often referred to as scaphocephaly, occurs when the suture running from the front to the back of the skull, called the sagittal suture, closes too early. It can cause the head to become long and narrow.
• Coronal synostosis occurs when one or both of the sutures running from each ear to the top of the head, called the coronal sutures, close prematurely. It can lead to a flat forehead and sometimes one eye socket appearing higher than the other.
• Metopic synostosis involves the metopic suture, which runs down the middle of the forehead. When it closes too early, it can cause a triangular-shaped forehead, often called trigonocephaly.
• Lambdoid synostosis occurs when the lambdoid suture that runs across the back of the head closes prematurely. It can cause flattening on one side of the head and may affect the position of the ear on that side.
• Multiple sutures synostosis occurs when more than one suture closes too early, leading to a combination of symptoms from different types of craniosynostosis.

Early detection and prevention is essential. For children requiring surgical treatment, our team is here to help parents through the process of diagnosis, surgery and post-operative helmeting treatment for their babies. 

Helmets are used after surgery to help: 

• Protect the skull and cranium
• Recreate and stabilize normal cephalic measurements and skull proportion following surgery
• Provide total contact to areas where bone was removed to prevent the bone from repositioning improperly
• Limit or prevent the cranial shape from going back to its previous appearance after surgical correction

We use the STARband® cranial remolding helmet, the most prescribed cranial remolding orthosis in the world. There are numerous patterns available to help customize your child's helmet.

The helmet (cranial molding orthosis) creates a rounded surface so your baby won't prefer to lay on the flattened spot. Our team has successfully used helmet therapy to treat plagiocephaly that has not responded to positioning. The helmet must be adjusted by the provider every two weeks to accommodate the rapid growth of the baby's head.

The duration of helmet therapy typically depends on the age at which the child begins therapy. To be effective, the helmet must be worn 23 hours a day. More than one helmet may be needed to complete the therapy.

The most effective time to begin helmet therapy is when the head circumference is growing most rapidly, which, in most children, begins at approximately 4 and a half months. Cranial remodeling devices can be used effectively up to 18 months old, and beyond that, if necessary.

The helmets we use are designed to be easy to put on and remove. They are lightweight with enhanced ventilation, keeping your child's comfort in mind.

In addition, we use a STARscanner™ Laser Data Acquisition System, a U.S. Food and Drug Administration (FDA)-approved device that allows us to perform a 3D surface scan of your baby’s head quickly, safely and easily.

The scanner users an eye-safe laser and does not involve any radiation. The scan takes two seconds to complete. The data from this device allows us to analyze your child's head shape and plan for a customized molding helmet, should this be required.

For babies with craniosynostosis undergoing helmet or surgical therapies, we can use the data from the STARscanner to track their progress and evaluate the effectiveness of treatment.

Having this scanner in our office allows patients to see a surgical specialist, obtain their STAR imaging results and consult with the orthotist who will be involved in the customization and adjustment of the helmet, all in one place, in a single visit.

Some insurance plans cover the cost of the helmet; however, we will not know if your baby’s particular insurance will cover the cost of the helmet without contacting the company and providing the necessary paperwork.

It can take seven to 14 business days for the insurance company to let us know if your baby’s helmet is covered. This includes the time it takes to obtain any necessary medical history documentation from your pediatrician and referring physician, and for the insurance company to process the information.

Our insurance specialist will contact you via phone to inform you as soon as the helmet has been approved or denied. A letter will be sent by the insurance company to your home address with details of the approval or denial.

If approval for helmet therapy requires your primary care physician’s involvement, we may reach to them on behalf of your insurance company.

No. Insurance must approve or deny your baby’s helmet prior to moving forward with self-pay.

Yes. The cost of the helmet includes all adjustments and scan visits with the cranial remolding specialist. Any separate visits with the physicians are not included and are subject to your baby’s insurance policy. 

No. Each helmet is custom made and will need time for fabrication.

The helmet is designed using a 3D scan of your baby’s head from the STARscanner.

STARband is the brand name of a type of infant cranial helmet. The STARband helmets are manufactured by Orthomerica Products, Inc., and are FDA approved and have many fun patterns and colors. 

It takes about 10 days for the helmet to be made and shipped to our office.

No. The helmet is shipped to our office, and we schedule an appointment to fit it on your baby. 

Yes. During the fitting appointment, your cranial specialist will provide you with oral and written instructions that include a weaning schedule and basic wear and care.