ONSIDERABLE debate exists regarding the ideal treatment for occipital, or positional, plagiocephaly. The management of this common and benign condition ranges from careful observation to orthotic helmet therapy to craniofacial remodeling. Treatment planning has often been guided by bias within the institution, rather than by impartial factors. The debate has been partially fueled by a paucity of objective methods with which to measure the severity of plagiocephaly, as well as the effects of various treatment modalities. The objective measurements that have been applied to date have been cumbersome to use or required radiographic imaging. We have developed an objective and convenient method of measuring the degree of plagiocephaly that requires only an elastic headband, a digital camera, and a personal computer. Clinical Material and Methods Sixteen infants who ranged in age between 2 and 10 months were included in this study. Eight children were referred for cranial dysmorphism consistent with plagiocephaly, whereas eight were referred for other reasons and served as controls. A white high-contrast elastic headband (Nike, Beaverton, OR) was placed around an infant's head in a similar manner and location as those used when routinely determining head circumference. The headband compressed the hair against the scalp, minimizing its effects on the overall head shape. Two small black spots, which were made by an indelible marker on opposite ends of the headband, denoted the location of the nasion and inion. These markings were manually adjusted when positioning the elastic headband and served to identify the midline.  Object. The prevalence of deformational, or positional, plagiocephaly has increased during the last decade. Treatments vary among centers, ranging from expectant management to orthotic helmet therapy to craniofacial remodeling. This management variability is partially due to a lack of objective methods with which to measure the severity of plagiocephaly, as well as procedures that are not cumbersome or require radiographic studies. A simple and objective method of determining the degree of cranial deformation has been developed. Methods. A headband placed around the head was marked with two adjustable points-one denoting the nasion and the other, the inion. A digital camera was used to image the head from a vertex view. The shape of the headband and the area of each hemisphere were then determined by analyzing the image on a personal computer in a semiautomated fashion. A cranial index of symmetry (CIS) was calculated and, by definition, equaled 100% for a perfectly symmetrical head. In this preliminary study, the authors studied eight children referred for evaluation of their plagiocephaly and eight infants referred for noncraniofacial entities. In the unaffected infants the mean CIS was 96.3 Ϯ 1.3% (Ϯ standard deviation). In children with clinical evidence of plagiocephaly, however, the CIS was 81.9 Ϯ 3.4% (p Ͻ 0.001). Although the CIS in healthy children was never less than 95%, that in all infants with plagiocephaly was below 90%. Conclusions. Although preliminary, this objective nonradiographic measurement of cranial symmetry appears to allow grading of the severity of positional plagiocephaly. The aforementioned methodology may potentially be used as an unbiased means of comparing different treatment modalities in longitudinal studies.  KEY WORDS
Zonenshayn et al. REF used a headband with two adjustable points and photographs of the headband shape to calculate a cranial index of symmetry.
Cranial index of symmetry: an objective semiautomated measure of plagiocephaly
Journal of neurosurgery
Journal of neurosurgery
Medicine