Pectus Carinatum and Plagiocephaly (Unit 14)

pigeon chest

another name for pectus carinatum

overgrowth of cartilage between ribs and sternum

what causes pectus carinatum

no

does pectus carinatum affect the internal organs?

adolescent males

who is pectus carinatum most common in

4:1

ratio of males to females who have pectus carinatum

puberty

when does pectus carinatum become more noticeable?

skeletal maturity

when does pectus carinatum continue until?

pigeon chest

sternum projects forward and downward

impairs effectiveness of breathing by restricting ventilation volume

what does pigeon chest affect?

funnel chest

depression of sternum

respiration and may result in kyphosis

what does funnel chest affect?

barrel chest

sternum projects forward and upward so that antero-posterior diameter is increased

emphysema (chronic obstructive pulmonary disease)

when is barreal chest seen?

chest orthosis

how is pectus carinatum treater?

correct shape of chest wall by compressing or squeezing overgrown ribs or breastbone back to a normal position

how does pectus carinatum chest orthosis work?

satisfactory results achieved and chest wall stays in position

when is pectus carinatum chest orthosis worn until?

to shape of body

how are the adjustable side bars on the pectus carinatum chest orthosis contoured?

corrective

maintenance

two main phases of chest orthoses wear

first 3-6 months

23 hours a day

corrective phase of chest orthosis

chest overgrowth has flattened sufficiently

worn during night for 8 hours

monitor chest to make sure no relapse

3-6 months

maintenance phase of chest orthosis

parietal bone

frontal bone

lamboid suture

metopic suture

coronal suture

sagittal suture

temporal bone

occipital bone

nonsynostotic or synostotic

what factors can plagiocephaly be a result of?

craniosynostosis

type of plagiocephaly with premature closing of cranial sutures

more

is craniosynostosis more or less serious than deformational plagiocephaly?

congenital

what type of condition is craniosynostosis?

external environmental factors

cause of deformational plagiocephaly

rare

1:2000

occurrence rate of craniosynostosis

significant functional and cognitive issues

what can craniosynostosis be associated with?

nonsyndromic

syndromic

two types of craniosynostosis

nonsynostotic

is deformational plagiocephaly synostotic or nonsynostotic?

deformational plagiocephaly

condition in which infant's head is asymmetrically shaped, usually with flattened surface

top view

what view is deformational plagiocephaly easiest to identify?

deformational plagiocephaly

asymmetrical molding of the head caused by external factors

torticollis

what is deformational plagiocephaly often accompanied by

68% males

is deformational plagiocephaly higher in males or females?

77% right

is deformational plagiocephaly more common on left or right side?

89%

percentage of deformational plagiocephaly that reported being supine sleepers since birth

sleeping positions

premature births (NICU positioning)

congenital muscular torticollis

restrictive intrauterine positioning

cervical abnormalities

birth trauma

6 causes of deformational plagiocephaly

posterior plagiocephaly

what type of plagiocephaly may be related to or accompanied by muscular torticollis

muscular torticollis

a shortening and tightening of the sternocleidomastoid muscle on one side

congenital muscular torticollis (CMT)

what is most common form of muscular torticollis?

infants

who does CMT affect

within first 2 months of life

when is CMT generally observed

50%

what percent of kids who have plagiocephaly will also have torticollis?

PT

what is primary torticollis treatment regardless of age?

early treatment

what types of treatment produces best outcomes for torticollis?

permanent condition

if not treated, what happens to torticollis?

tubular orthosis for torticollis (T.O.T. collar)

CCO

two orthotic options for CMT

Tubular orthosis for torticollis

train and aid in positioning head correctly

what does T.O.T. collar do?

once a week

how often is torticollis therapy?

yes

for most kids who have torticollis, is once a week PT a successful form of treatment?

stretch muscle on affected side and strengthen muscles on opposite side

Develop plan of care

Teach parents at home exercises to help infants get better mobility

what do PT do for torticollis?

2-3 months

how long does PT for torticollis last?

rare cases when torticollis is persistent and unresponsive to therapy

when is surgery necessary for torticollis?

scaphocephaly

trigonocephaly

brachycephaly

anterior plagiocephaly

unilateral coronal synostosis

posterior plagiocephaly

lamboid synostosis

normocephaly

what is head without synostosis deformations called?

deformational posterior plagiocephaly

mild, non-surgical problem of cosmetic concern only

what type of problem is deformational posterior plagiocephaly?

plagiocephaly

brachycephaly

scaphocephaly

3 types of deformational plagiocephaly

symmetric occipital flattening and compensatory parietal widening

what is brachycephaly characterized by?

asymmetric occipital flattening

anterior shift of ipsilateral ear

ipsilateral frontal and contralateral occipital bossing

characterizations of plagiocephaly

no

does the skull shape of plagiocephaly affect brain function?

parallelogram

shape of plagiocephaly

deformational = displaced anteriorly

unilambdoid synostosis = displaced posteriorly

difference between deformational plagiocephaly and unilambdoid synostosis ear displacement

deformational = ipsilateral frontal bossing

unilambdoid synostosis = contralateral frontal bossing

difference between deformational plagiocephaly and unilambdoid synostosis frontal bossing

cranial orthosis (CRO, CFO, or molding helmet or headband)

treatment of deformational plagiocephaly

S code

what type of code is CRO billing code?

FDA clearance

what is required for cranial orthoses and is the only orthosis to require this?

cosmetic

what type of condition is deformational plagiocephaly?

inhibit growth in some areas of an infant skull and enable growth in others to improve cranial asymmetry and/or shape

goal of cranial orthotic treatment

prevent infant from lying on flattened side of skull to inhibit further asymmetric development

another benefit of cranial orthosis

head helmets

what is post-op treatment for congenital plagiocephaly?

cosmetic purposes

what is reasoning for head helmets in post-op treatment for congenital plagiocephaly?

3 days to 1 week post op

when is head helmet for post-op treatment for congenital plagiocephaly applied

up to 1 year (at least 9 months)

length of helmet therapy for post-op treatment for congenital plagiocephaly with head helmet

no lined

one layer lined

multi lined

lining options for helmet for deformational plagiocephaly

post op

which helmet is total contact - post op or deformational plagiocephaly helmet?

no lined, bivalve opening, no top opening

one layer lined, posterior opening, top opening

2 options for post op helmet

custom fabricated

prefab

soft shell

hard shell

4 options for head protection helmet

apply passive pressure to prominent or normal regions of skull while allowing space for growth in relief area for flattened regions

how does cranial orthosis work for deformational plagiocephaly?

shape of head changes

why must CRO be adjusted?

bossing diagonals

where is CRO hold for plagiocephaly?

front diagonals and sides

where is CRO hold for brachycephaly

front and back

where is CRO hold for scaphocephaly?

copolymer shell with pelite polyethylene inner foam liner

Top and side opening

characteristics of orthomericas STARband design

outer shell of low-density polyethylene

aliplast foam inner liner

characteristics of gillette craniocap design

3-5 months

average length of CRO/CFO treatment

8 weeks

minimum length of CRO/CFO treatment