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Master Thesis

Conduite à tenir devant une plagiocéphalie positionnelle : revue systématisée de la littérature

Abstract : Introduction: Positional plagiocephaly is a posterior skull deformity affecting one in four infants. Its management differs between centers and doctors. Previous studies have shown the lack of knowledge of primary care physicians about it. They are willing to have synthetic informations. There are many treatment options, but no guideline. Our objective was to assess each treatment, and propose a course of action with a decision flow chart to plagiocephaly in small infants. Materials and Methods: We did a systematic literature review on each of the treatment option. Results: In this literature review, we selected 52 articles, 7 literature reviews and 2 recommandations. This is the first literature review on the subject, which includes a recent randomized controlled trial class I. Parents reassurance is needed about the neurological prognosis for these infants. The consequences are only “aesthectics". Age and initial severity are predictors of lower recovery. The management is mainly based on positioning measures that parents should apply in everyday life, as soon as even a minimal asymmetry appears, or if the infant prefers cervical rotation to one side. When the distortion is associated with a stiff neck, it is essential to involve an early (before 3 months) re-education through multi weekly physiotherapy and until normalization of the cervical rotation. Parents can keep some home stretch exercises. When plagiocephaly is associated with a preferential side, it is important to use some additional measures. Rehabilitation can be discussed in case of failure in this caseor in case of severe deformity. Osteopathic manipulation did not show superiority to positioning measures. Treatment with cranial orthotic helmet showed no clinical significant superiority compared to positioning, or even to the natural long-term evolution (2 years). It is possible that helmet therapy accelerates the rhythm of the asymmetry correction, but not the final results. The cost is significant for the families. Cutaneous side effects are very commonly reported and overall tolerance is not always obvious. In our opinion, the benefit/risk balance is clearly to the detriment of the helmet therapy. However, some very rare indications in very severe cases should not be excluded, but the correction is slow, limited and the helmet tolerance is poor in older infants. For these very rare cases, a specialized Neurosurgery consultation is essential before talking about cranial orthotic to parents. The orthotic helmet is never a first option therapy. There is no significant difference in the improvement of the deformation weather the brace was introduced in first line or after failure of other conservative treatments. Surgery is not indicated because of the heaviness of the procedure and the associate.
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Master Thesis
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Submitted on : Monday, November 7, 2016 - 4:31:32 PM
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Marine Blanchard. Conduite à tenir devant une plagiocéphalie positionnelle : revue systématisée de la littérature. Médecine humaine et pathologie. 2015. ⟨dumas-01393536⟩

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