Hallac Rami R, Ajiwe Tochi, Effendi Maleeh, Seaward James R, Kane Alex A
Department of Plastic Surgery, UT Southwestern Medical Center.
Analytical Imaging and Modeling Center, Children's Medical Center, Dallas, TX.
J Craniofac Surg. 2019 Sep;30(6):1756-1759. doi: 10.1097/SCS.0000000000005611.
Molding helmet therapy is used for the treatment of infants with deformational brachycephaly (DB). There is a lack of rigorous outcome measures of helmet therapy in patients with DB using 3-dimensional (3D) imaging, with most reports rely on either subjective or 2-dimensional analyses. Furthermore, the longitudinal assessment of head shape improvement over the course of helmet therapy has not been documented. Our goal was to assess the outcome of molding helmet therapy using 3D surface imaging, and to document the pace of improvement during treatment.
The head shape of 18 infants with DB who underwent orthotic molding helmet therapy was assessed. The 3D scans were obtained before treatment, during treatment, and at the end of treatment. First, we applied shape analysis techniques based on template deformation to obtain average (composite) heads of the 18 patients at the 3 time points of treatment (pretreatment, during, and posttreatment). In addition, we used 3D curvature analysis to quantify the degree of flatness at the same time points.
Molding helmet therapy started at 6.7 ± 0.9 months of age and lasted for 4.3 ± 0.8 months. The overall difference in the occipital contour between pretreatment and end of treatment was 6.3 ± 1.7 mm. Curvature analysis revealed that 15% of the back of the head had prehelmet marked flatness (mean curvature <5/m), which decreased to 9% at 2.5 months into treatment and 7% at the end of treatment.
Over 65% of the head shape improvement occurred during the 2.5 months of molding helmet therapy.
塑形头盔疗法用于治疗婴儿变形性短头畸形（DB）。目前缺乏使用三维（3D）成像对DB患者头盔疗法进行严格的疗效评估，大多数报告依赖主观或二维分析。此外，尚未记录头盔治疗过程中头部形状改善的纵向评估情况。我们的目标是使用3D表面成像评估塑形头盔疗法的疗效，并记录治疗期间的改善速度。
评估了18例接受矫形塑形头盔治疗的DB婴儿的头部形状。在治疗前、治疗期间和治疗结束时进行3D扫描。首先，我们应用基于模板变形的形状分析技术，在治疗的3个时间点（治疗前、治疗期间和治疗后）获得18例患者的平均（复合）头部形状。此外，我们使用3D曲率分析来量化同一时间点的扁平程度。
塑形头盔治疗开始于6.7±0.9个月龄，持续4.3±0.8个月。治疗前与治疗结束时枕部轮廓的总体差异为6.3±1.7mm。曲率分析显示，15%的后脑勺在佩戴头盔前有明显扁平（平均曲率<5/m），在治疗2.5个月时降至9%，治疗结束时降至7%。
超过65%的头部形状改善发生在2.5个月的塑形头盔治疗期间。
