The use of orthotic modeling to achieve symmetry of the developing asymmetric or disproportionate skull has been highly criticized during the past few years. The resistance of some members of the medical community, including many insurance carriers, as to the efficacy of cranial remolding appears to be largely the result of misinformation and lack of education regarding this intervention. The practice of altering bone structure during periods of rapid bone growth is not a new concept and has been practiced for many years throughout the world by numerous cultures. Alterations and deformational changes along cranial structures were described as early as 1791 by Soommering. He hypothesized that skull growth occurs along suture lines and within fontanels. In 1851, Rudolph Virchow established the principle that growth of the cranium was restricted in a plane perpendicular to the fused suture and was enhanced in the corresponding parallel plane. Described in 1868, Wolfe's Law holds that every change in the form or function of a bone is followed by adaptive changes in its internal architecture and its external shape. Along with published research, far less developed cultures have inherently understood that externally applied forces during rapid bone growth elicit permanent changes in structure. A thorough understanding of how the developing cranium is modeled during orthotic management is necessary for the development of orthotic protocols regarding this matter.
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