Ocular manifestations of Apert and Crouzon syndromes: qualitative and quantitative findings

Complex craniosynostoses: a review of the prominent clinical features and the related management strategies

The protocols for clinical evaluation and management of children with complex craniosynostoses are significantly different from those used in single suture forms. The time at which the various anatomical and functional anomalies observed in the affected subjects become clinically relevant varies from patient to patient, consequently requiring a tailored approach. The clinical course is variable and influenced by multiple factors, acting at different steps of the children growth. Intracranial hypertension is a major concern already in the first months of life; active cerebrospinal fluid (CSF) dynamics disorders, venous hypertension, and progressive craniocerebral disproportion are considered the main pathogenetic factors. Cranial vault and skull base sutures synostoses account for the frequently observed increased venous pressure. Skull base abnormalities lead to upper airways obstruction, which, on one side, might create significant upper airways obstructive problems and, on the other, contribute to the increase in the intracranial pressure. Secondary Chiari malformation is common and considered as a progressive disorder, mainly due to progressive craniocerebral disproportion, venous hypertension, and CSF dynamics disorders. Optic nerve and orbit-related eye-globe diseases are also a major concern. Papilledema is mostly related to increased intracranial pressure. The skull base synostotic process is the base of significant abnormalities of the orbital space, ending in the common feature of significant proptosis with the consequent risk of corneal ulcers. Aims of this paper are to analyze the physiopathogenetic mechanisms at the base of the clinical manifestations presented by children with complex craniosynostoses, and the therapeutic options currently available.

The assessment of facial variation in 4747 British school children

The aim of this study is to identify key components contributing to facial variation in a large population-based sample of 15.5-year-old children (2514 females and 2233 males). The subjects were recruited from the Avon Longitudinal Study of Parents and Children. Three-dimensional facial images were obtained for each subject using two high-resolution Konica Minolta laser scanners. Twenty-one reproducible facial landmarks were identified and their coordinates were recorded. The facial images were registered using Procrustes analysis. Principal component analysis was then employed to identify independent groups of correlated coordinates. For the total data set, 14 principal components (PCs) were identified which explained 82 per cent of the total variance, with the first three components accounting for 46 per cent of the variance. Similar results were obtained for males and females separately with only subtle gender differences in some PCs. Facial features may be treated as a multidimensional statistical continuum with respect to the PCs. The first three PCs characterize the face in terms of height, width, and prominence of the nose. The derived PCs may be useful to identify and classify faces according to a scale of normality.

Management of exorbitism using midface distraction osteogenesis

INTRODUCTION

Management of patients with syndromal craniosynostosis is probably one of the greatest challenges. They usually present with variable deformities yet share common characteristics. Patients with Crouzon and Aperts syndrome present with exorbitism and midface hypoplasia. Exorbitism is a protrusion of the eyeball due to a decrease in the capacity of the orbital container, and it may lead to drastic consequences if left untreated.

MATERIAL AND METHODS

Four cases with exorbitism and midface hypoplasia. Three presented with Aperts syndrome and one with Crouzon syndrome. They all underwent an intraoral modified Le Fort III osteotomy followed by midface distraction osteogenesis.

CONCLUSION

Distraction osteogenesis of the midface is a safe and highly effective method in managing exorbitism associated with midface deficiency.