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A Systematic Review

James J. Xia, MD, PhD, MS; Kathleen A. Kennedy, MD; John F. Teichgraeber, MD; Kenneth Q. Wu, BS; James B. Baumgartner, MD; Jaime Gateno, DDS, MD

Arch Pediatr Adolesc Med. 2008;162(8):719-727.

Objective  To evaluate and summarize the evidence comparing nonsurgical therapies in the treatment of infants with deformational plagiocephaly.

Data Sources  Scientific articles and abstracts published in English between January 1978 and August 2007 were searched from 5 online literature databases, along with a manual search of conference proceedings.

Study Selection  Studies were selected and appraised for methodological quality by 2 reviewers independently using a Critical Appraisal Skills Programme form (cohort criteria).

Interventions  Molding helmet therapy vs head repositioning therapy.

Main Outcome Measure  Success rate of the treatment.

Results  A total of 3793 references were retrieved. There were no randomized controlled trials. Only 7 cohort studies met the inclusion criteria. Five of the 7 studies presented evidence that molding therapy is more effective than repositioning, even with the biases favoring the repositioning groups. In the molding groups, the asymmetry was more severe and the infants were older. The infants who failed to respond to repositioning therapy were also switched to molding therapy. The treatment outcomes from the other 2 studies were difficult to assess because of flaws in their study design. Finally, the relative improvement of using molding therapy was calculated from one study. It was about 1.3 times greater than with repositioning therapy.

Conclusion  The studies showed considerable evidence that molding therapy may reduce skull asymmetry more effectively than repositioning therapy. However, definitive conclusions on the relative effectiveness of these treatments were tempered by potential biases in these studies. Further research is warranted.

Author Affiliations: Department of Oral and Maxillofacial Surgery, The Methodist Hospital Research Institute (Drs Xia and Gateno), Houston, Texas; Department of Surgery (Oral and Maxillofacial Surgery), Weill Medicine College, Cornell University, New York, New York (Drs Xia and Gateno); and Division of Pediatric Plastic Surgery, Department of Pediatric Surgery (Drs Xia, Teichgraeber, Baumgartner, and Gateno), Department of Orthodontics (Dr Xia), and Division of Neonatal-Perinatal Medicine, Department of Pediatrics (Dr Kennedy), Medical School, The University of Texas Health Science Center at Houston, and Memorial Hermann Hospital (Dr Baumgartner), Houston, and Texas Tech University Health Science Center, Amarillo (Mr Wu).

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