Cos’è la deformazione posizionale del cranio?

Cos’è la deformazione posizionale del cranio?

Cos’è la deformazione posizionale del cranio (DPC)?

La plagiocefalia è un’anomalia morfologica benigna di origine meccanica che si osserva a carico della volta cranica.
Nei gradi di deformazione più severi l’alterazione interessa anche le strutture ossee della base del cranio, della faccia e della mandibola.

deformazione posizionale del cranio

Cosa comporta?

Come effetto a lungo termine esita nella persistenza dell’anomalia morfologica del cranio e della faccia.
Le forme plagiocefaliche che si accompagnano ad una torsione della base del cranio e della faccia, con conseguente asimmetria dell’articolazione temporo-mandibolare e della masticazione, possono incrementare significativamente la probabilità che si sviluppino anomalie dell’occlusione dentale, morso incrociato o crossbite.

Ruolo determinante, nella DPC, dell’angolo di rotazione del capo sul piano di appoggio

La DPC si realizza quando l’espansione e l’accrescimento cranico sono stabilmente e costantemente contrastati da una forza esterna in una specifica area. Il cranio, infatti, si accresce passivamente in risposta alla minima pressione interna esercitata dal rapido accrescimento del cervello.
Questo processo è ovviamente più rapido nel corso dei primi mesi di vita e rallenta in maniera significativa dopo il primo anno; è proprio a causa di questo continuo e rapido accrescimento encefalico che le posizioni assunte dal neonato durante i periodi di decubito sono di fondamentale importanza per un armonico accrescimento del cranio.
Nell’eventualità che il bambino manifesti un «decubito preferenziale» la resistenza all’espansione sarà costantemente esercitata in una specifica ristretta regione del cranio,
generando un appiattimento regionale e un’alterazione progressiva della forma del cranio.
L’espansione cranica verrà altresì orientata verso le regioni adiacenti determinando così una deformazione compensativa associata.
come curare la plagiocefalia
Poiché il cranio non ha fisiologicamente la possibilità di espandersi in maniera differenziale, ovvero più velocemente dal lato appiattito e più lentamente dal lato iper-espanso, è opportuno screditare l’opinione diffusa che la deformazione sarà destinata a scomparire spontaneamente una volta che il bambino sarà in grado di appoggiare il capo in maniera pressappoco simmetrica su tutti i lati.
Questa attesa di miglioramento, a seguito di un recupero spontaneo della forma simmetrica si basa su presupposti illogici. Una volta che il bambino affetto da DPC sarà in grado di alternare autonomamente l’appoggio su tutte le regioni del cranio, queste persevereranno nel loro processo di espansione con la stessa velocità reciproca lasciando di fatto l’asimmetria cranica invariata.
Da qui l’importanza di intervenire tempestivamente mediante un adeguato trattamento ortesico, finalizzato alla ottimale distribuzione della crescita cranica residua e a riportare l’indice di asimmetria cranico nel range della normalità.

Fattori che possono favorire lo sviluppo di una deformazione posizionale del cranio.

Attualmente è possibile identificare fin dalle prime settimane di vita i gruppi di bambini che sono maggiormente esposti alla possibilità di sviluppare una DPC. Ciò consente di poterli sottoporre molto precocemente ai più efficaci protocolli di prevenzione.

Il Pediatra riveste un ruolo fondamentale per una identificazione precoce dei bambini esposti al rischio di una DPC

Una precoce identificazione dei bambini a rischio per lo sviluppo di DPC offre le migliori opportunità per l’applicazione di un efficiente protocollo di prevenzione.
I primi tratti distintivi da ricercare sono un’eventuale preferenza di lato durante il sonno o la veglia quieta, o un’asimmetria dell’arco di rotazione laterale del collo.
I bambini che manifestano questi segnali devono essere inseriti in un programma di prevenzione della DPC così come i neonati prematuri, i macrocranici e quanti presentino un’area asimmetrica nelle regioni posteriori del cranio o una qualsiasi condizione medica che possa rallentare lo sviluppo delle acquisizioni motorie.
➢ Il bambino dovrà essere precocemente indotto, per mezzo di semplici programmi domestici di abilitazione motoria, a dormire supino con il capo rivolto nella posizione ritenuta ottimale per arrestare la progressione della deformazione cranica (sul lato opposto a quello dell’appiattimento) sia durante le fasi di sonno sia durante le fasi di veglia.
➢ Attenzione però, non su un lato: numerosi organismi internazionali non approvano la posizione laterale (ritenuta di gran lunga meno efficace della posizione supina nel prevenire la morte improvvisa in culla), né ammettono l’utilizzo di cunei o cuscini che costringano il bambino in una posizione obbligata.

Plagiocefalia: cosa fare e come curalra? L’ortesi cranica (caschetto) è la soluzione!

Un approccio tempestivo, commisurato all’età del piccolo e all’entità della deformazione, è raccomandato ogni qual volta i programmi di abilitazione motoria domestica non siano risultati adeguati a garantire un controllo della deformazione da posizione.
plagiocefalia cosa fare
La deformazione si manifesta già dalle prime settimane di vita.
L’intervento pertanto dovrà essere tempestivo in quanto ogni ritardo attendista esiterà in una maggiore strutturazione della deformazione e renderà più lungo, complesso e meno efficace il trattamento; ciò indipendentemente dalla terapia attuata.
Nell’eventualità che la deformazione cranica si sia stabilizzata, è di estrema importanza associare, contestualmente al trattamento ortesico per la correzione della morfologia del cranio, un adeguato programma di fisioterapia.
Questa attenzione è sollecitata dalla consapevolezza del ruolo che gioca l’attività del complesso muscolare cervicale nella determinazione della morfologia del massiccio facciale e della mandibola, nonché della morfologia e della dinamica della colonna vertebrale (specialmente nel settore della giunzione cranio-cervicale).




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