plagiocefalia posizionale_7

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7. Kết quả Tặng Villani, Maria Vittoria Wonder, Emiliano Bruni Người ta tin rằng vị trí tốt nhất plagiocephaly một cách tự nhiên trong vòng 2-3 năm cuộc đời của một đứa trẻ, nhưng có thể dẫn đến vĩnh viễn không đối xứng của đầu, nếu không được điều trị.

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| Outcome 61 7. Outcome Donata Villani, Maria Vittoria Meraviglia, Emilio Brunati Si ritiene che la plagiocefalia posizione migliori spontaneamente entro i 2-3 anni di vita del bambino, ma che possa condurre ad asimmetrie permanenti del capo, se non trattata. Benché sia ritenuta una condizione benigna dal punto di vista medico, si ritiene tuttavia che possa essere associata a vari gradi di ritardo dello sviluppo. E’ stata trovata un’associazione con alcuni disturbi uditivi, con l’asimmetria mandibolare, anche se non è mai stato stabilito alcun nesso causale. Eventuali asimmetrie del volto, oltre che un problema di tipo estetico, possono costituire la causa di alcuni difetti visivi quali un astigmatismo bilaterale di difficile correzione. Studi recenti hanno dimostrato che la plagiocefalia posizionale non porta ad avere disturbi cognitivi in età scolare. Prognosi La diagnosi e il trattamento precoce correlano positivamente con l’outcome. La PPO può essere completamente risolta dal trattamento non chirurgico se riconosciuta e trattata precocemente (7/8 settimane di vita) e può andare incontro a notevoli miglioramenti se diagnosticata entro il primo anno d’età (Marchac 2011). Nella maggior parte dei casi, le misure preventive e/o il trattamento fisioterapico si dimostrano This is trial version www.adultpdf.com
| 62 La Plagiocefalia Posizionale sufficienti (Boere-Boonekamp 2001, Persing 2002, Hutchison 2003). Il “tummy time” sembra rivestire grande importanza per l’ottenimento di una buona prognosi: i bambini che giocano in posizione prona, più precocemente, più frequentemente e più a lungo, presentano gradi di PPO meno severa, verosimilmente perché ruotano il capo spontaneamente da entrambi i lati in modo più frequente di quanto sia loro possibile fare da supini (Van Vlimmeren 2007). In due terzi dei casi la PPO si risolve in età prescolare: a quest’età, infatti, le misurazioni antropometriche dimostrano un netto miglioramento della forma del cranio. Eventuali ritardi dello sviluppo motorio migliorano drasticamente a 3-4 anni d’età (Hutchison 2011). Complicanze Esistono, in letteratura, studi relativi al rischio di sviluppare delle asimmetrie cranio-facciali, ritardi dello sviluppo psicomotorio, difetti visivi ed uditivi. Nei pazienti con PPO l’articolazione temporo-mandibolare ipsilaterale è spinta anteriormente e la mandibola si sviluppa in modo asimmetrico (St John 2002): il riposizionamento attivo e/o l’uso del caschetto migliorano la forma del cranio ma non modificano la posizione dell’articolazione temporo-mandibolare o l’asimmetria della mandibola (Slate 1993, Baumler 2007). Alcuni studi segnalano la possibilità di successive anomalie dell’occlusione dentale che possono interferire con i trattamenti ortodontici (Lee 2008). Sono stati riferiti difetti uditivi dovuti a otiti ricorrenti per diminuito drenaggio dell’orecchio medio conseguente alla dislocazione delle tube di Eustachio (Balan 2002). La PPO può anche causare asimmetrie del volto e della fronte che possono portare ad un’asimmetria di posizione degli occhi e ad astigmatismo bilaterale per il quale è molto difficile trovare lenti correttive adatte. Sono stati anche riferiti disturbi del campo visivo. La PPO è ritenuta influire sullo sviluppo del campo visivo ma né la lateralità né la gravità della deformazione This is trial version www.adultpdf.com
| Outcome 63 cranica sembrano essere predittive dell’entità del disturbo (Siatkowski 2005). E’ tuttora controverso se si tratti di un restringimento del campo visivo piuttosto che di un suo ritardato sviluppo, in considerazione di una possibile normalizzazione in seguito all’acquisizione delle successive tappe di sviluppo neuromotorio. Non è stata invece confermata un’aumentata prevalenza di strabismo in concomitanza con la plagiocefalia posizionale (Gupta 2003, Jordi 2011). I soggetti con plagiocefalia posizionale non sembrano mostrare una maggior prevalenza di strabismo orizzontale rispetto alla popolazione generale. L’exotropia è invece di più frequente riscontro nei soggetti con plagiocefalia non sinostosica rispetto alla popolazione generale. Anche la prevalenza di astigmatismo nei pazienti plagiocefalici sembra essere superiore a quella della popolazione generale (Gupta 2003). Lo sviluppo psicomotorio e cognitivo sono spesso lievemente ritardati nei pazienti con PPO: non è noto se questo ritardo possa essere modificato con la terapia e non è neppure noto se questo ritardo sia la causa o l’effetto della PPO (Collett 2005). Controlli a distanza in pazienti con PPO hanno mostrato il persistere di questo ritardo di sviluppo (Miller 2000, Panchal 2001, Kordestani 2006). Questi studi sembrano indicare che, prima dell’inizio del trattamento, i bambini con PPO mostravano un ritardo di sviluppo sia dal punto di vista cognitivo che psicomotorio. Nessun bambino plagiocefalico mostrava inoltre una precocità nello sviluppo (Kordestani 2006). Altri studi dimostrano come la PPO sembri essere associata con un ritardo dello sviluppo neurologico, più evidente per quanto riguarda la funzione motoria. Questi dati non implicano però necessariamente che la PPO sia la causa del ritardo, ma indicano piuttosto che essa è un indice del rischio di un ritardo dello sviluppo più evidente sul versante motorio (Speltz 2010) e come tale merita un accurato follow-up da parte del pediatra (Pogliani 2011). Tutte questi studi sono però ancora controversi per mancanza di evidenze sufficienti alla loro validazione. This is trial version www.adultpdf.com
| 64 La Plagiocefalia Posizionale This is trial version www.adultpdf.com
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