RESUMO
In the last decades alterations in the skull shape have increased at the expense of plagiocephaly, as consequence of the American Academy of Pediatrics recommendations to sleep the infant in the supine position. The clinician must differentiate between positional plagiocephaly and craniosynostosis, since if a cranial synostosis is proven, the therapeutic behavior will be potentially neurosurgical. Although three-dimensional skull tomography with bone window is the study of greater sensitivity and diagnostic specificity, the majority of cases can be confirmed by the clinic, reserving the radiography or ultrasound with a suture approach for doubtful cases. Craniosynostosis must be early referral to a craniofacial team to define the indication, opportunity and most appropriate surgical technique, in order to avoid future neurocognitive and psychosocial complications. Children with positional plagiocephaly regardless of the treatment of cranial deformity may have a higher risk of motor development delay. For correction, repositioning and physiotherapy are suggested in mild to moderate forms, reserving the use of cranial orthesis in severe forms.
Assuntos
Craniossinostoses/diagnóstico por imagem , Plagiocefalia não Sinostótica/diagnóstico por imagem , Crânio/diagnóstico por imagem , Pré-Escolar , Craniossinostoses/cirurgia , Diagnóstico Diferencial , Humanos , Plagiocefalia não Sinostótica/cirurgia , Crânio/cirurgiaRESUMO
Las alteraciones de la forma del cráneo han aumentado en las últimas décadas a expensas de las plagiocefalias, como consecuencia de las recomendaciones de la Academia Americana de Pediatría de dormir al lactante en decúbito supino. El clínico debe diferenciar entre plagiocefalia posicional y craneosinostosis, ya que la conducta terapéutica será potencialmente neuroquirúrgica de comprobar una sinostosis craneal. Si bien la tomografía de cráneo tridimensional con ventana ósea es el estudio de mayor sensibilidad y especificidad diagnóstica, la mayoría de los casos pueden confirmarse por la clínica, reservando la radiografía simple o de preferencia la ecografía con enfoque de suturas para casos dudosos. Las craneosinostosis deben derivarse tempranamente a un equipo craneofacial para definir la indicación, oportunidad y técnica quirúrgica más adecuada para evitar futuras complicaciones neurocognitivos y psicosociales. Los niños con plagiocefalias posicionales, independientemente del tratamiento de la deformidad craneal, pueden tener más riesgo de retraso del desarrollo motor. Para su corrección se sugiere reposicionamiento y fisioterapia en formas leves a moderadas, reservando el uso de ortésis craneal en formas graves.
In the last decades alterations in the skull shape have increased at the expense of plagiocephaly, as consequence of the American Academy of Pediatrics recommendations to sleep the infant in the supine position. The clinician must differentiate between positional plagiocephaly and craniosynostosis, since if a cranial synostosis is proven, the therapeutic behavior will be potentially neurosurgical. Although three-dimensional skull tomography with bone window is the study of greater sensitivity and diagnostic specificity, the majority of cases can be confirmed by the clinic, reserving the radiography or ultrasound with a suture approach for doubtful cases. Craniosynostosis must be early referral to a craniofacial team to define the indication, opportunity and most appropriate surgical technique, in order to avoid future neurocognitive and psychosocial complications. Children with positional plagiocephaly regardless of the treatment of cranial deformity may have a higher risk of motor development delay. For correction, repositioning and physiotherapy are suggested in mild to moderate forms, reserving the use of cranial orthesis in severe forms.