Diagnostic Yield of Cervical Radiographs in Infants with Deformational Plagiocephaly

BACKGROUND: Deformational plagiocephaly is a common condition of infancy in which the child presents with craniofacial asymmetry thought to be due to prenatal/postnatal external molding forces on the cranium. Etiologies may include muscular torticollis, intrauterine constraint (i.e. small maternal pelvis, multiple gestation, or breech position), and supine sleep position. The current standard of care for deformational plagiocephaly is active repositioning or orthotic helmet, and these treatments rely on cranial malleability. Patients with deformational plagiocephaly are frequently referred for cervical radiographs in order to determine whether there is osseous abnormality associated with torticollis. Some clinicians believe that screening cervical radiographs are important to rule out bony abnormalities in this condition, while others believe this is unnecessary due to low prevalence of accompanying osseous deformity. OBJECTIVE: The purpose of this study was to determine the diagnostic yield of cervical radiographs in demonstrating cervical anomalies in a population of infants referred to a tertiary craniofacial center with deformational plagiocephaly (DP). METHODS: After obtaining IRB approval, all patients with diagnosis of DP who underwent cervical radiographs between the years of 2010 to 2012 were reviewed. Cervical radiographic findings as determined by radiologist report, perinatal data, and physical exam findings were recorded, and descriptive statistics were generated. RESULTS: Electronic medical records of 730 patients with diagnosis of DP were reviewed. Abnormal findings were recorded in 6.71% of cervical radiograph reports (n=49/730). Of those with abnormal findings, 59% (n=29/49) demonstrated osseous abnormalities including: clavicle abnormality (n=4), bony fusion (n=10), cervical ribs (n=4), joint instabilities (n=5), and vertebral abnormalities (n=11). Those with non-osseous abnormalities (n=26/49) included head tilt (n=4), abnormal curvature (n=16), and soft tissue prominence (n=6). The other 96% of the study population were without osseous abnormalities. CONCLUSION: There is a fairly low diagnostic yield in ordering cervical radiographs in patients with deformational plagiocephaly. Considering the radiation exposure and cost associated with the practice of ordering routine cervical radiographs in all patients presenting with this DP, an inspection of its inclusion as a necessary step in the diagnostic algorithm is warranted.