Helmet therapy does not impact facial asymmetry more than growth alone.
- grogers74
- Apr 3
- 2 min read
I am frequently asked by parents and clinicians alike about the role of helmet therapy to correct facial asymmetry. Conceptually, it makes no sense why a helmet placed on the cranium, with really no component directly bracing the face (for those wondering, the small side flanges in front of the ears are for support and are in the wrong orientation to alter the sagittal facial asymmetry), would affect facial growth. Moreover, the face grows very slowly in infancy so the change in form over the 3-4 months of helmet treatment should be nominal.
There are, however, a series of publications that appear to show that helmet therapy does improves fronto-facial asymmetry. These studies are heavily relied upon by some helmet companies and clinicians to support the use of helmets to improve facial and ear asymmetry in kids with plagiocephaly independent of the cranial shape. These are linked below:
Looks pretty convincing, right? Not really. The problem with all of these studies is they lack a control group. For those unfamiliar with what this is, to demonstrate that an intervention has CAUSED a change in outcome, we must compare it to the outcome without the intervention. As this applies to helmet therapy, we would need to compare what happens to the facial asymmetry naturally versus what happens when we use a helmet. This is important because there are, in fact, several studies that confirm that the facial asymmetry (and also the ear asymmetry) that occurs as a result of deformational plagiocephaly improves naturally with growth. These are linked below and the relevant conclusions summarized.
**Prospective cohort-based study looking at facial asymmetry in patients with deformational plagiocephaly who had no intervention. Measurements taken at one year and three years. Findings: upper and lower (jaw) facial asymmetry improved naturally. Conclusions: “The asymmetric effect of deformational plagiocephaly (DP) on the upper parts of the face tends to correct spontaneously during growth. Results indicate that previous DP does not seem to transfer to facial or occlusal asymmetry at the age of three years old.”
**Longitudinal cohort study following infants with deformational plagiocephaly in infancy to a mean of 4 years of age. No intervention. Findings (relative to face): “Facial and frontal asymmetry reduced to almost nil.”
So the question is- does the use of a helmet for plagiocephaly improve the facial asymmetry MORE THAN mere growth alone? The only truly randomized, controlled trial out there says NO. While I have my reservations about some aspect of this study, as it shows no benefit to helmet therapy on the cranial shape (an observation that defies what we see clinically and what other studies seem to refute), it does confirm that helmet therapy does not significantly accelerate or alter the natural improvement in facial or ear asymmetry.
Randomized, controlled trial comparing helmet therapy to no intervention. Secondary outcomes included ear position asymmetry and facial asymmetry. All outcomes measured at 24 months. Findings: there were no statistically significant differences between the helmet and non-helmeted patients in terms of ear position or facial asymmetry.
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