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Chiropractic Journal of Australia : CJA December 2013
124 Chiropractic Journal of Australia Volume 43 Number 4 December 2013 INTRODUCTION There are two types of plagiocephaly; 1. Deformational plagiocephaly (also known as positional or non- synostotic plagiocephaly) and 2. Synostotic plagiocephaly (craniosynostosis). In Deformation Plagiocephaly (DP) there is a consistent pressure to one side of the infant's head due to various causes. There are short and long term effects on head/facial symmetry,1-3 neurological function and development. The neurological effects in deformational plagiocephaly are becoming more established in the literature, with effects related to head control,1,2 cognitive, language, learning and attention,3,4 motor development,5-7 auditory development,8 developmental delays,9 visual felds,10 and muscle tone.11 It is important that deformational plagiocephaly is differentiated from craniosynostosis. Craniosynostosis is the premature fusion of one or more cranial sutures. Deformational Plagiocephaly may be readily managed by the chiropractor, with improvements expected in head shape and neurological function. Craniosynostosis is a condition requiring co-management. Without medical intervention craniosynostosis is likely to lead to poor head shape and neurological outcomes. Chiropractic care is reasonable whilst waiting for medical evaluation, provided no contraindications exist. In this paper we discuss two infants presenting to a Paediatric (only) Chiropractic clinic for assessment regarding Plagiocephaly who were subsequently diagnosed with Lambdoid Craniosynostosis. We outline the clinical examination signs and the resulting management. This case report adds to the evidence base of optimal Chiropractic management for Plagiocephaly. Case One: PH, aged two weeks, presented with concerns regarding left head preference and head shape asymmetry. The shape asymmetry was frst detected by a paediatrician at the age of two days. There was reported "suture remodelling." The pregnancy history was unremarkable. There was a vaginal labour of approximately 24 hours, with a 4 hour second stage, and manual rupture of the membranes. Pethidene was required. There was no use of forceps and presentation was occiput anterior. The birth weight was 3.550 kg, length 52.0 cm, head circumference 34.5 cm and Apgar scores were 9 (one minute) and 9 (fve minutes). PH was breastfeeding well with no issues with attachment, fussiness, suck, swallow, feeding frequency/speed, vomiting, or maternal issues. Night and day sleeps were normal for age. There was good comfort being dressed/undressed, getting in/out of car seat, bathing and changing nappies. The systems review was unremarkable except for some mild upper respiratory congestion and mild "gunky" eyes (dacrostenosis). On examination there was palpable prominence of the left lambdoid suture, with palpable and obvious ridging. There was mild fattening of the whole left vault, and very mild prominence of the left frontal bone. Subluxation patterns were found at the right occipital-atlantal articulation (C0/1), left atlanto-axial (C1/2) articulation and right glenohumeral joint. There was right temperomandibular (TMJ) deviation and a cranial fault at the sphenobasilar junction. The scapulohumeral refex was positive on the left, indicating irritation of upper cervical nerve roots C1-3.12 The scapulohumeral refex is not normally present and if present indicates involvement of one or more of the upper three cervical nerve roots on the side of involvement, with bilateral positive tests associated with upper cervical cord compression syndrome. All other neurological examination, including observation, primitive The Recognition of Craniosynostosis when Managing Patients with Plagiocephaly: Two Case Reports of Lambdoid Craniosynostosis CARRIE O'NEIL and ADAM STEWART Carrie O'Neil, BSc (Chiro) BChiro Rosanna VIC 3084 Adam Stewart, B.App.Sci (chiro) B.App.Sci (clinical). Ringwood VIC 3134 Received: 23 August 2013, Accepted: 15 September 2013 The authors claim no confict of interest or external funding ABSTRACT: When assessing infants with plagiocephaly it is important to differentiate between deformational plagiocephaly and craniosynostosis. We report on two children presenting to a Paediatric (only) Chiropractic clinic for assessment regarding head shape asymmetry who were later diagnosed with lambdoid craniosynostosis. The expected clinical signs of Deformational Plagiocephaly and Craniosynostosis are discussed. In cases of suspected craniosynostosis referral for further imaging is recommended. This paper adds to the evidence base of optimal Paediatric Chiropractic management in infants with Plagiocephaly. Chiropr J Aust 2013;43: 124-30. Index terms: (MeSH): PLAGIOCEPHALY; CRANIOSYNOSTOSIS; PEDIATRICS; CHIROPRACTIC.
CJA September 2013