From the Guidelines
The gold standard diagnosis for plagiocephaly is clinical assessment combined with anthropometric measurements, as it provides a non-invasive and cost-effective approach to diagnosing the condition. This approach typically involves a healthcare provider, such as a pediatrician or craniofacial specialist, examining the infant's head shape and taking specific measurements, including cranial vault asymmetry (CVA) and cranial vault asymmetry index (CVAI) 1.
Key Components of Diagnosis
- Clinical assessment to identify asymmetry and flattening of the infant's head
- Anthropometric measurements, such as CVA and CVAI, to quantify the diagonal difference of the skull
- Use of calipers or a flexicurve to take precise measurements
- Photography documentation to track changes over time While imaging studies, such as skull x-rays or CT scans, can be performed, they are not routinely necessary and are typically reserved for cases where craniosynostosis needs to be ruled out, as recommended by pediatric surgical specialists, including pediatric plastic surgeons 1.
Importance of Specialized Care
- Infants and children with congenital malformations, including deformational plagiocephaly, should be referred to a pediatric plastic surgeon or other pediatric surgical specialist with the appropriate education, training, and experience 1
- A pediatric plastic surgeon is optimally part of a multispecialty team in the management of conditions such as myelomeningocele or complex problems requiring tissue expansion or microsurgical procedures 1
From the Research
Diagnosis of Plagiocephaly
The diagnosis of plagiocephaly can be made through various methods, including:
- Clinical examination, which is often sufficient to diagnose plagiocephaly 2
- Physical examination, which can assess the severity of plagiocephaly using a diagonal caliper to measure the difference between the diagonal lengths on each side of the head 3
- Imaging studies, such as:
- Ultrasound, which can be used to evaluate skull shape deformities and identify synostotic sutures 4
- Three-dimensional cranial topographical imaging, which can provide detailed images of the skull shape 2
- Skull x-rays, which can be used to diagnose plagiocephaly, but are not always necessary 2
- Computed tomography (CT) scans, which can be used to rule out craniosynostosis, but are not recommended for initial diagnosis due to radiation exposure 2
- Endocranial three-dimensional CT osseous surface re-formations, which can help differentiate between unicoronal synostosis, unilambdoid synostosis, and plagiocephaly without synostosis 5
Gold Standard Diagnosis
The gold standard diagnosis for plagiocephaly is not explicitly stated in the provided evidence, but it can be inferred that a combination of clinical examination and imaging studies is the most accurate method for diagnosis. According to 2, clinical examination is most often sufficient to diagnose plagiocephaly, and imaging studies should be reserved for cases where the clinical examination is equivocal.
Key Findings
- Plagiocephaly can be diagnosed clinically and by physical examinations 3
- Imaging studies, such as ultrasound and three-dimensional cranial topographical imaging, can be useful in evaluating skull shape deformities and identifying synostotic sutures 4, 2
- Endocranial three-dimensional CT osseous surface re-formations can help differentiate between unicoronal synostosis, unilambdoid synostosis, and plagiocephaly without synostosis 5
- Computed tomography scans should not be used to diagnose plagiocephaly, but may be necessary to rule out craniosynostosis 2