THE ENIGMA OF LAMBDOID POSITIONAL MOLDING

One hundred and twenty-one consecutive patients presenting to the Chil dren's National Medical Center with lambdoid positional molding (LPM) were reviewed. Clinical features included unilateral occipital flatten ing and alopecia and forward displacement of the ipsilateral ear, fore head, and maxilla. Head tilt and tightness of the ipsilateral sternocl eidomastoid muscle were common. An unexplained preponderance of LPM wa s found in males (74%) and on the right side (72%), both findings stat istically significant (p < 0.001). Importantly, a variety of other abn ormalities were seen with LPM: torticollis (41%), large head circumfer ence (40), excess extra-axial cerebrospinal fluid (35), developmental delay (19), and other CNS abnormalities (20%). Systemic problems affec ting the mobility were also common. Only 3 patients had craniosynostos is, and only 2 with LPM required surgery for severe cosmetic deformiti es. An apparent increase in the incidence of LPM was attributed to cur rent recommendations to keep infants supine to decrease the risk of su dden infant death syndrome, overutilization of infant carriers similar to cradle-boards of earlier cultures, and neonatal medical problems r esulting in relative immobility. No evidence was found to support the concept that LPM causes compressive brain pathology; thus, surgical tr eatment is not required for such fears. Further, the sequelae of under lying CNS and systemic problems associated with LPM would not be corre cted by opening unfused sutures, but could even be misinterpreted as c omplications of surgery.