Clinical Findings (Positional Plagiocephaly) and Tracings (Facial Asymmetry/Plagiocephaly)

scha_12a_n.jpg and scha_12b_n.jpg: Infant with a broad head, some inclination to the right, and an isolated left-sided posterior plagiocephaly which fits in with a uni- or bilateral (in which the left side is more involved) lambdoid synostosis, or - occurring more frequently - with a positional plagiocephaly not caused by congenital muscular torticollis. In lambdoid synostosis additional features occur which are not present in this case; $$kran_10??££see alterante figures§§. In isolated positional plagiocephaly, torticollis is not present, or if torticollis is present, there is a hypertonic, not a fibrotic sternocleidomastoid muscle, a restriction of rotation is not present in 2/3 of the cases, and is in 1/3 only of slight degree (up to 15 or a few degrees more). A differentiation from congenital muscular torticollis in the latter situation may be difficult, and only the course of the pathology finally allowsa differentiation; positional torticollis due to increased tonus has a favourable prognosis and needs no surgery. scha_9a_n.jpg and scha_9b_n.jpg: Tracings of the two axes of the face and of the contours of the head which allow a measurable and reproducible presentation of the asymmetry of the face and of the plagiocephaly during the course of the pathology. The tracings are derived from the already presented infant with positional pagiocephaly due to a hypertonic sternocleidomastoid muscle (Jones PJ. In: Welch KJ et al. Pediatric Surgery 4th ed Vol 1. Chicago: Year Book Medical Publishers, 1986).