{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T03:05:23Z","timestamp":1784862323570,"version":"3.55.0"},"reference-count":48,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2024,7,1]],"date-time":"2024-07-01T00:00:00Z","timestamp":1719792000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Positional plagiocephaly is a deformational cranial flattening frequently treated in pediatric neurosurgical practice. Positional maneuvers and orthotic helmet therapy are preferred therapeutic options for moderate-to-severe forms. Treatment response seems to be age-dependent. Nevertheless, predictive data are vague, and cost-efficiency might be a limiting factor for treatment. The purpose of this study was to investigate the early predictive value of sonographic parameters on the efficacy of orthotic helmet therapy through the assessment of changes in skull shape and correlation of the parameters with caliper cephalometry values and with age. A consecutive cohort of 49 patients &lt; 10 months of age, undergoing orthotic helmet therapy for positional plagiocephaly, was recruited prospectively. The authors routinely assessed the patency of the lambdoid sutures by ultrasound and the following additional skull parameters were measured: suture width, adjacent full bone thickness, adjacent cortical bone thickness and occipital angle. Caliper cephalometric values, as well as demographic and clinical data were collected. Retrospective data analysis showed an inverse relation between both cortical and full skull bone thickness and early treatment efficacy, defined by a reduction in the occipital angle. The improvement of sonographic parameters correlated with the development of cranial caliper cephalometry values. In conclusion, the sonographic assessment of skull bone thickness is a safe and cost-effective tool to predict the early efficacy of orthotic helmet therapy in positional plagiocephaly and might, therefore, help the clinician to foresee the potential evolution of the deformity.<\/jats:p>","DOI":"10.3390\/diagnostics14131407","type":"journal-article","created":{"date-parts":[[2024,7,2]],"date-time":"2024-07-02T05:08:34Z","timestamp":1719896914000},"page":"1407","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Predictive Value of Sonographic Parameters on the Effects of Cranial Molding Helmet Therapy in Infants with Positional Plagiocephaly"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2625-4151","authenticated-orcid":false,"given":"Maria","family":"Licci","sequence":"first","affiliation":[{"name":"Department of Pediatric Neurosurgery, French Referral Center for Craniosynostosis, H\u00f4pital Femme M\u00e8re-Enfant, Hospices Civils de Lyon University of Lyon, INSERM 1033, 69500 Bron, Lyon, France"},{"name":"Department of Neurosurgery, Division of Pediatric Neurosurgery, University Hospital and University Children\u2019s Hospital of Basel, 4031 Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agnes","family":"Paasche","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurosurgery, French Referral Center for Craniosynostosis, H\u00f4pital Femme M\u00e8re-Enfant, Hospices Civils de Lyon University of Lyon, INSERM 1033, 69500 Bron, Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0364-6304","authenticated-orcid":false,"given":"Alexandru","family":"Szathmari","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurosurgery, French Referral Center for Craniosynostosis, H\u00f4pital Femme M\u00e8re-Enfant, Hospices Civils de Lyon University of Lyon, INSERM 1033, 69500 Bron, Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre-Aur\u00e9lien","family":"Beuriat","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurosurgery, French Referral Center for Craniosynostosis, H\u00f4pital Femme M\u00e8re-Enfant, Hospices Civils de Lyon University of Lyon, INSERM 1033, 69500 Bron, Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmine","family":"Mottolese","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurosurgery, French Referral Center for Craniosynostosis, H\u00f4pital Femme M\u00e8re-Enfant, Hospices Civils de Lyon University of Lyon, INSERM 1033, 69500 Bron, Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raphael","family":"Guzman","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Division of Pediatric Neurosurgery, University Hospital and University Children\u2019s Hospital of Basel, 4031 Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Di Rocco","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurosurgery, French Referral Center for Craniosynostosis, H\u00f4pital Femme M\u00e8re-Enfant, Hospices Civils de Lyon University of Lyon, INSERM 1033, 69500 Bron, Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,7,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1120","DOI":"10.1016\/j.jpeds.2012.05.023","article-title":"Clinical Classification of Infant Nonsynostotic Cranial Deformity","volume":"161","author":"Wilbrand","year":"2012","journal-title":"J. Pediatr."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"284","DOI":"10.3171\/2009.1.PEDS08330","article-title":"Diagnosis and Management of Deformational Plagiocephaly","volume":"3","author":"Robinson","year":"2009","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1097\/SCS.0000000000001511","article-title":"Argenta Clinical Classification of Deformational Plagiocephaly","volume":"26","author":"Branch","year":"2015","journal-title":"J. Craniofac. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1097\/00001665-199601000-00005","article-title":"An Increase in Infant Cranial Deformity with Supine Sleeping Position","volume":"7","author":"Argenta","year":"1996","journal-title":"J. Craniofac. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1111\/j.1469-8749.2008.03029.x","article-title":"Prevalence, Risk Factors, and Natural History of Positional Plagiocephaly: A Systematic Review","volume":"50","author":"Bialocerkowski","year":"2008","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1991","DOI":"10.1007\/s00381-020-05003-9","article-title":"Synostosis of the Lambdoid Suture: A Spectrum","volume":"37","author":"Vinchon","year":"2021","journal-title":"Childs Nerv. Syst. ChNS Off. J. Int. Soc. Pediatr. Neurosurg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1016\/j.fsc.2016.06.007","article-title":"Nonsyndromic Craniosynostosis and Deformational Head Shape Disorders","volume":"24","author":"Morris","year":"2016","journal-title":"Facial Plast. Surg. Clin. N. Am."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1097\/00006534-199902000-00003","article-title":"Analysis of Posterior Plagiocephaly: Deformational versus Synostotic","volume":"103","author":"Mulliken","year":"1999","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e72","DOI":"10.1542\/peds.110.6.e72","article-title":"Incidence of Cranial Asymmetry in Healthy Newborns","volume":"110","author":"Peitsch","year":"2002","journal-title":"Pediatrics"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1016\/j.neuchi.2019.09.019","article-title":"How Ultrasonography Can Contribute to Diagnosis of Craniosynostosis","volume":"65","author":"Proisy","year":"2019","journal-title":"Neurochirurgie"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1016\/j.ejrad.2017.03.006","article-title":"Ultrasonography for the Diagnosis of Craniosynostosis","volume":"90","author":"Proisy","year":"2017","journal-title":"Eur. J. Radiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1545","DOI":"10.1007\/s00381-017-3449-3","article-title":"Cranial Ultrasound Is a Reliable First Step Imaging in Children with Suspected Craniosynostosis","volume":"33","author":"Pogliani","year":"2017","journal-title":"Childs Nerv. Syst. ChNS Off. J. Int. Soc. Pediatr. Neurosurg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e20152230","DOI":"10.1542\/peds.2015-2230","article-title":"Cranial Ultrasound as a First-Line Imaging Examination for Craniosynostosis","volume":"137","author":"Rozovsky","year":"2016","journal-title":"Pediatrics"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1097\/00001665-200607000-00002","article-title":"Ultrasound in the Diagnosis of Craniosynostosis","volume":"17","author":"Regelsberger","year":"2006","journal-title":"J. Craniofac. Surg."},{"key":"ref_15","first-page":"413","article-title":"High-Frequency Ultrasound Confirmation of Positional Plagiocephaly","volume":"105","author":"Regelsberger","year":"2006","journal-title":"J. Neurosurg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1007\/s00431-016-2800-0","article-title":"The Course of Skull Deformation from Birth to 5 Years of Age: A Prospective Cohort Study","volume":"176","author":"Engelbert","year":"2017","journal-title":"Eur. J. Pediatr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1001\/archpedi.162.8.712","article-title":"Effect of Pediatric Physical Therapy on Deformational Plagiocephaly in Children with Positional Preference: A Randomized Controlled Trial","volume":"162","author":"Helders","year":"2008","journal-title":"Arch. Pediatr. Adolesc. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1389","DOI":"10.1007\/s00381-012-1784-y","article-title":"Posterior Plagiocephaly","volume":"28","author":"Kalra","year":"2012","journal-title":"Childs Nerv. Syst. ChNS Off. J. Int. Soc. Pediatr. Neurosurg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1136\/archdischild-2014-305944","article-title":"Occipital Plagiocephaly: Unilateral Lambdoid Synostosis versus Positional Plagiocephaly","volume":"100","author":"Linz","year":"2015","journal-title":"Arch. Dis. Child."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1111\/jpc.14717","article-title":"Effect of Helmet Therapy in the Treatment of Positional Head Deformity","volume":"56","author":"Wen","year":"2020","journal-title":"J. Paediatr. Child Health"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"E4","DOI":"10.3171\/2013.8.FOCUS13258","article-title":"Efficacy of Passive Helmet Therapy for Deformational Plagiocephaly: Report of 1050 Cases","volume":"35","author":"Couture","year":"2013","journal-title":"Neurosurg. Focus"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"g2741","DOI":"10.1136\/bmj.g2741","article-title":"Helmet Therapy in Infants with Positional Skull Deformation: Randomised Controlled Trial","volume":"348","author":"Ijzerman","year":"2014","journal-title":"BMJ"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"E2","DOI":"10.3171\/2013.7.FOCUS13260","article-title":"Orthotic (Helmet) Therapy in the Treatment of Plagiocephaly","volume":"35","author":"Goh","year":"2013","journal-title":"Neurosurg. Focus"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2008","DOI":"10.1097\/SCS.0000000000005665","article-title":"Treatment of Deformational Plagiocephaly With Physiotherapy","volume":"30","author":"Ramieri","year":"2019","journal-title":"J. Craniofac. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1097\/PRS.0b013e31821b62d6","article-title":"What Is the Optimal Time to Start Helmet Therapy in Positional Plagiocephaly?","volume":"128","author":"Kluba","year":"2011","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"55e","DOI":"10.1097\/PRS.0b013e3182729f11","article-title":"Helmet Treatment of Deformational Plagiocephaly: The Relationship between Age at Initiation and Rate of Correction","volume":"131","author":"Seruya","year":"2013","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1097\/SCS.0b013e3181992382","article-title":"Outcome Analysis of Helmet Therapy for Positional Plagiocephaly Using a Three-Dimensional Surface Scanning Laser","volume":"20","author":"Thompson","year":"2009","journal-title":"J. Craniofac. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e4328","DOI":"10.1097\/GOX.0000000000004328","article-title":"Practical Review of the Cost of Diagnosis and Management of Positional Plagiocephaly","volume":"10","author":"Watt","year":"2022","journal-title":"Plast. Reconstr. Surg. Glob. Open"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e2225","DOI":"10.1097\/GOX.0000000000002225","article-title":"Cranial Suture Measurement by 2-Point Method in Ultrasound Screening of Craniosynostosis","volume":"7","author":"Okamoto","year":"2019","journal-title":"Plast. Reconstr. Surg. Glob. Open"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"541","DOI":"10.5535\/arm.2014.38.4.541","article-title":"A New Ultrasound Method for Assessment of Head Shape Change in Infants with Plagiocephaly","volume":"38","author":"Kim","year":"2014","journal-title":"Ann. Rehabil. Med."},{"key":"ref_31","first-page":"e408-418","article-title":"Risk Factors for Deformational Plagiocephaly at Birth and at 7 Weeks of Age: A Prospective Cohort Study","volume":"119","author":"Helders","year":"2007","journal-title":"Pediatrics"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1578","DOI":"10.1016\/S0140-6736(07)61662-6","article-title":"Sudden Infant Death Syndrome","volume":"370","author":"Moon","year":"2007","journal-title":"Lancet Lond. Engl."},{"key":"ref_33","first-page":"535","article-title":"Positional Skull Deformities","volume":"114","author":"Linz","year":"2017","journal-title":"Dtsch. Arzteblatt Int."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1097\/00001665-200405000-00004","article-title":"Clinical Classification of Positional Plagiocephaly","volume":"15","author":"Argenta","year":"2004","journal-title":"J. Craniofac. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"557","DOI":"10.23736\/S2724-5276.19.05424-0","article-title":"Ultrasonography as First Line Imaging for the Diagnosis of Positional Plagiocephaly","volume":"75","author":"Sertorio","year":"2023","journal-title":"Minerva Pediatr."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1007\/s00247-003-1009-3","article-title":"Ultrasound Screening of the Lambdoid Suture in the Child with Posterior Plagiocephaly","volume":"33","author":"Sze","year":"2003","journal-title":"Pediatr. Radiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/S0379-0738(00)00447-3","article-title":"Cranial Thickness in Relation to Age, Sex and General Body Build in a Danish Forensic Sample","volume":"117","author":"Lynnerup","year":"2001","journal-title":"Forensic Sci. Int."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"687","DOI":"10.3171\/2015.4.PEDS1493","article-title":"Creating a Normative Database of Age-Specific 3D Geometrical Data, Bone Density, and Bone Thickness of the Developing Skull: A Pilot Study","volume":"16","author":"Delye","year":"2015","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1111\/clr.12829","article-title":"Assessment of Cortical Bone Thickness Using Ultrasound","volume":"28","author":"Degen","year":"2017","journal-title":"Clin. Oral Implants Res."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.1016\/j.bjps.2017.06.017","article-title":"Cranial Bone Structure in Children with Sagittal Craniosynostosis: Relationship with Surgical Outcomes","volume":"70","author":"Ibrahim","year":"2017","journal-title":"J. Plast. Reconstr. Aesthetic Surg. JPRAS"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1007\/s00381-016-3031-4","article-title":"Wire Fixation of Internal Distractor for Cranial Vault Remodeling","volume":"32","author":"Szathmari","year":"2016","journal-title":"Childs Nerv. Syst. ChNS Off. J. Int. Soc. Pediatr. Neurosurg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1097\/01241398-198607000-00008","article-title":"Skull Osteology as It Affects Halo Pin Placement in Children","volume":"6","author":"Garfin","year":"1986","journal-title":"J. Pediatr. Orthop."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.1097\/SCS.0000000000000762","article-title":"Calvarial Thickness and Diploic Space Development in Children with Sagittal Synostosis as Assessed by Computed Tomography","volume":"25","author":"Ghosh","year":"2014","journal-title":"J. Craniofac. Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1808","DOI":"10.1097\/SCS.0000000000001948","article-title":"Assessment of Head Shape by Craniofacial Teams: Structuring Practice Parameters to Optimize Efficiency","volume":"26","author":"Purnell","year":"2015","journal-title":"J. Craniofac. Surg."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Callejas Pastor, C.A., Jung, I.-Y., Seo, S., Kwon, S.B., Ku, Y., and Choi, J. (2020). Two-Dimensional Image-Based Screening Tool for Infants with Positional Cranial Deformities: A Machine Learning Approach. Diagnostics, 10.","DOI":"10.3390\/diagnostics10070495"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Launonen, A.M., Aarnivala, H., Kyteas, P., Vuollo, V., Heikkinen, T., Kau, C.H., Pirttiniemi, P., Harila, V., and Valkama, A.M. (2019). A 3D Follow-Up Study of Cranial Asymmetry from Early Infancy to Toddler Age after Preterm versus Term Birth. J. Clin. Med., 8.","DOI":"10.3390\/jcm8101665"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1842","DOI":"10.1097\/SCS.0000000000005618","article-title":"Head Shape Retention Following Helmet Therapy for Deformational Plagiocephaly","volume":"30","author":"Naidoo","year":"2019","journal-title":"J. Craniofac. Surg."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e20182373","DOI":"10.1542\/peds.2018-2373","article-title":"Cognitive Outcomes and Positional Plagiocephaly","volume":"143","author":"Collett","year":"2019","journal-title":"Pediatrics"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/13\/1407\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:08:52Z","timestamp":1760108932000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/13\/1407"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,1]]},"references-count":48,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2024,7]]}},"alternative-id":["diagnostics14131407"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics14131407","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,1]]}}}