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An Osteopathic Approach to Plagiocephaly in the Absence of Pre-Post Sphenoid Fusion

Journal: The AAO Journal Date: 2023/06, 33(2):Pages: 13-14. doi: Subito , type of study: case report

Full text    (https://meridian.allenpress.com/aaoj/article/33/2/10/493538/LBORC-NUFA-Poster-Abstracts-2023-Residents)

Keywords:

case report [514]
cranial osteopathy [62]
Down syndrome [4]
OMT [2951]
osteopathic manipulative treatment [2973]
pediatrics [375]
plagiocephaly [41]
skull [41]
trisomy 21 [1]

Abstract:

Introduction/Background: The pre and post sphenoid fuse through the sphenoid sinus during the 8th month of gestation. This does not occur in the Trisomy 21 fetus. As a result, the sphenoid does not correctly transfer cranial motion from the sphenobasilar synchondrosis to the face. This contributes to both atypical plagiocephaly patterns and Down’s facies, since the extraocular muscles originate on the (now untethered) greater wing of the sphenoid. The sphenoid sits vertically, contributing to an atypical brachycephaly. Case: 7 month male presents with postural plagiocephaly apparent at 6 weeks. Born at 35.2 by cesarean section, Trisomy 21, Atrial and Ventricular Septal defects, GERD, hypotonia. Neonatal intensive care for 5 weeks upon birth for hypoglycemia, poor feeding (required nasogastric tube), and hypoxemia. Osteopathically: left lateral strain, brachycephaly, right tongue deviation, Atlas Rr, right SI joint restriction Results: OMT visits twice weekly (x4), then weekly (x4), then biweekly. Visit 11: reduced cranial asymmetry, reduced brachycephaly, reduced GERD, discontinued famotidine. Resolved: noisy breathing, torticollis, and difficulty suckling. Discussion: In the Trisomy 21 patient, altered cranial mechanics require an atypical plan of care. Standard cranial treatments assumed a fused sphenoid and did not retain improvement in this patient. The left lateral strain was held primarily by the right styloglossus muscle. Direct inhibition and myofascial release to this muscle permitted temporal motion. The occiput itself carried an intraosseous strain and improved with direct cranial approach. Treating atlas reflexively softened the stylopharyngeal muscles, as these developed from the same somite. Treating a patient with Down’s requires consideration of not just the innate cranial mechanism, but of muscular and embryologic influences on the altered development of the skull.


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