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Three-Dimensional Evaluation of Dental Arches in Individuals with Syndromic Craniosynostosis. Int J Dent 2023; 2023:1043369. [PMID: 36647423 PMCID: PMC9840551 DOI: 10.1155/2023/1043369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 12/13/2022] [Accepted: 12/22/2022] [Indexed: 01/09/2023] Open
Abstract
Objective Individuals with syndromic craniosynostosis present alterations in the dental arches due to anomalies caused by the early fusion of the craniomaxillary sutures. This study aimed to compare intradental and interdental dimensions between individuals with Apert and Crouzon syndromes and nonsyndromic controls. Materials and Methods Digital models were obtained from the archive of a public tertiary care hospital. The sample consisted of 34 patients (Apert n = 18, Crouzon n = 16) and 34 nonsyndromic controls matched for gender and age. Measurements of perimeter, length, intercanine and intermolar distances (upper and lower), overjet, and molar ratio were performed. Statistical comparisons were performed using ANOVA and Tukey tests (p < 0.05). Results Patients with Apert and Crouzon syndromes have severely reduced maxillary transverse dimensions, perimeter, and length of the upper arch compared to the control group (p < 0.001). The lower arch is less impacted. Patients with Apert syndrome had an anterior crossbite (p < 0.001), while patients with Crouzon syndrome had an edge-to-edge bite (p < 0.011). Patients with Apert and Crouzon syndromes do not have serious transverse proportion problems when comparing the upper and lower arches. Conclusions In this sample, both the Apert and Crouzon groups have severely compromised upper arches compared to the control group. Mild dentoalveolar expansion in the maxilla should be sufficient for the transverse adaptation of the dental arches before frontofacial advancement.
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Nevaste‐Boldt T, Saarikko A, Kaprio L, Leikola J, Kiukkonen A. Facial asymmetry in children with either unilateral lambdoid craniosynostosis or positional posterior plagiocephaly. Orthod Craniofac Res 2022; 26:216-223. [PMID: 36087308 DOI: 10.1111/ocr.12603] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/15/2022] [Accepted: 08/01/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND In unilateral lambdoid craniosynostosis (ULC), the posteriorly situated lambdoid suture of the cranial vault fuses prematurely. Positional posterior plagiocephaly (PPP) causes flattening of the posterior side of the head, either through external forces or through underlying differences in brain development. Both conditions cause occipital flattening of the head, but the aetiology is different. MATERIALS AND METHODS Eight ULC children were compared with 16 sex- and age-matched PPP children. 3D computer tomography scans of all 24 children were analysed with Dolphin imaging software. The location and symmetry of the temporomandibular joint (Co), and the symmetry of the maxillary anterior nasal spine (ANS) and the mandibular symphysis (Pgn) were analysed. Furthermore, the mandibular bone (Co-Pgn) length, corpus length, ramus height, positional changes in the external acoustic meatus (PoL) and the distance from the orbital margin to the articular fossa were measured. RESULTS In all eight ULC children, the Co was anteriorly displaced on the affected side compared with the unaffected side. In all ULC and PPP children, the ANS, which is considered the bony maxillary midpoint, was shifted towards the affected side. In all ULC children, the mandibular bone (Co-Pgn) was shorter on the affected side. The PoL was antero-inferiorly positioned in all ULC children on the affected side compared with the unaffected side. CONCLUSIONS Our results show that both types of posterior plagiocephaly are associated with an asymmetric position of the Co and asymmetry of the mandible and maxilla. Facial asymmetry was more frequently seen in ULC than PPP children.
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Affiliation(s)
- Tuuli Nevaste‐Boldt
- Department of Cleft Palate and Craniofacial Center University of Helsinki and Helsinki University Hospital Finland
- Orthodontics, Department of Oral and Maxillofacial Diseases, Clinicum, Faculty of Medicine University of Helsinki Finland
| | - Anne Saarikko
- Department of Cleft Palate and Craniofacial Center University of Helsinki and Helsinki University Hospital Finland
| | - Laura Kaprio
- Department of Oral and Maxillofacial Diseases, Head and Neck Center University of Helsinki and Helsinki University Hospital Finland
- Orthodontics, Department of Oral and Maxillofacial Diseases, Clinicum, Faculty of Medicine University of Helsinki Finland
| | - Junnu Leikola
- Department of Cleft Palate and Craniofacial Center University of Helsinki and Helsinki University Hospital Finland
| | - Anu Kiukkonen
- Department of Cleft Palate and Craniofacial Center University of Helsinki and Helsinki University Hospital Finland
- Department of Oral and Maxillofacial Diseases, Head and Neck Center University of Helsinki and Helsinki University Hospital Finland
- Orthodontics, Department of Oral and Maxillofacial Diseases, Clinicum, Faculty of Medicine University of Helsinki Finland
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Gallagher ER, Fulton GK, Susarla SM, Birgfeld CB. Multidisciplinary Care Considerations for Patients with Craniosynostosis. Oral Maxillofac Surg Clin North Am 2022; 34:353-365. [PMID: 35787826 DOI: 10.1016/j.coms.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Infants and children with craniosynostosis require multidisciplinary care, and this is best accomplished when care is provided on a craniofacial team. Most patients with craniosynostosis will have non-syndromic presentations; however, longitudinal care remains critical to ensure appropriate growth and development throughout childhood. In patients with syndromic craniosynostoses, coordinated longitudinal care becomes even more paramount because of the high level of complexity across many different specialties or disciplines. Care delivery that includes perspective and expertise from multiple disciplines is important to help patients reach their full potential and optimal outcomes.
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Affiliation(s)
- Emily R Gallagher
- Department of Pediatrics, Division of Craniofacial Medicine, University of Washington and Seattle Children's Hospital, 4800 Sand Point Way Northeast, M/S OB.9.520, PO Box 5371, Seattle, WA 98145-5005, USA; Craniofacial Center, Seattle Children's Hospital, University of Washington, Seattle, WA, USA; Louisiana State University School of Medicine, New Orleans, LA, USA.
| | - G Kyle Fulton
- Louisiana State University School of Medicine, New Orleans, LA, USA
| | - Srinivas M Susarla
- Craniofacial Center, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Craig B Birgfeld
- Craniofacial Center, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
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Alam MK, Alfawzan AA, Srivastava KC, Shrivastava D, Ganji KK, Manay SM. Craniofacial morphology in Apert syndrome: a systematic review and meta-analysis. Sci Rep 2022; 12:5708. [PMID: 35383244 PMCID: PMC8983770 DOI: 10.1038/s41598-022-09764-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/14/2022] [Indexed: 11/25/2022] Open
Abstract
This meta-analysis aims to compare Apert syndrome (AS) patients with non-AS populations (not clinically or genetically diagnosed) on craniofacial cephalometric characteristics (CCC) to combine publicly available scientific information while also improving the validity of primary study findings. A comprehensive search was performed in the following databases: PubMed, Google Scholar, Scopus, Medline, and Web of Science, an article published between 1st January 2000 to October 17th, 2021. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to carry out this systematic review. We used the PECO system to classify people with AS based on whether or not they had distinctive CCC compared to the non-AS population. Following are some examples of how PECO has been used: People with AS are labeled P; clinical or genetic diagnosis of AS is labeled E; individuals without AS are labeled C; CCC of AS are labeled O. Using the Newcastle–Ottawa Quality-Assessment-Scale, independent reviewers assessed the articles' methodological quality and extracted data. 13 studies were included in the systematic review. 8 out of 13 studies were score 7–8 in NOS scale, which indicated that most of the studies were medium to high qualities. Six case–control studies were analyzed for meta-analysis. Due to the wide range of variability in CCC, we were only able to include data from at least three previous studies. There was a statistically significant difference in N-S-PP (I2: 76.56%; P = 0.014; CI 1.27 to − 0.28) and Greater wing angle (I2: 79.07%; P = 0.008; CI 3.07–1.17) between AS and control subjects. Cleft palate, anterior open bite, crowding in the upper jaw, and hypodontia occurred more frequently among AS patients. Significant shortening of the mandibular width, height and length is the most reported feature in AS patients. CT scans can help patients with AS decide whether to pursue orthodontic treatment alone or to have their mouth surgically expanded. The role of well-informed orthodontic and maxillofacial practitioners is critical in preventing and rehabilitating oral health issues.
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Affiliation(s)
- Mohammad Khursheed Alam
- Orthodontics, Preventive Dentistry Department, College of Dentistry, Jouf University, Sakaka, Saudi Arabia.
| | - Ahmed Ali Alfawzan
- Department of Preventive Dentistry, College of Dentistry in Ar Rass, Qassim University, Ar Rass, Saudi Arabia
| | - Kumar Chandan Srivastava
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jouf University, Sakaka, Saudi Arabia
| | - Deepti Shrivastava
- Preventive Dentistry Department, College of Dentistry, Jouf University, Sakaka, Saudi Arabia
| | - Kiran Kumar Ganji
- Preventive Dentistry Department, College of Dentistry, Jouf University, Sakaka, Saudi Arabia
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Fowler P, Hallang S, Snape L. Apert syndrome: an informative long-term dentofacial outcome. BMJ Case Rep 2022; 15:e245224. [PMID: 35236672 PMCID: PMC8895904 DOI: 10.1136/bcr-2021-245224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 11/03/2022] Open
Abstract
The management of patients with Apert syndrome (AS) is complex and reflects the multisystem disease as a result of premature fusion of cranial vault, cranial base and midface sutures as well as extremity anomalies characterised by syndactyly. Early cranial sutural fusion results in craniocerebral disproportion which can lead to crisis surgical intervention due to raised intracranial pressure, ophthalmic and compromised airway concerns. Childhood inventions are often determined by psychosocial concerns and adult surgical interventions are often determined by cosmetic concerns. Treatments are provided by many different specialists within multidisciplinary teams (MDT). The treatment pathway extends from birth well into adulthood and is often associated with a heavy burden of care. Due to the extensive nature of the interaction with these patients MDT members have opportunities to provide enhanced patient-centred care and support.This case report provides an overview of the current knowledge of the aetiology of AS, illustrates the pathway of surgical and non-surgical management of AS and provides a long-term review of the dentofacial treatment outcomes.By having a better understanding of the impact of AS and treatment provided, MDT members can not only provide improved clinical treatment but also offer improved patient experiences for those with craniofacial anomalies, in particular, an increased awareness of the psychosocial challenges they endure.
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Affiliation(s)
- Peter Fowler
- Orthodontic Department, University of Bristol School of Oral and Dental Sciences, Bristol, UK
- Orthodontic Department, University of Bristol Dental Hospital, Bristol, UK
| | | | - Leslie Snape
- Canterbury Oral and Maxillofacial Surgery, Christchurch, Canterbury, New Zealand
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Giraldo–Barrero YP, Carrillo–Mendigaño N, Peña–Vega CP, Yezioro–Rubinsky S. Síndrome de Apert: alternativas de tratamiento ortodóntico - quirúrgico y tiempos de ejecución. Una revisión de la literatura. ACTA ODONTOLÓGICA COLOMBIANA 2022. [DOI: 10.15446/aoc.v12n1.97958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objetivo: realizar una revisión de la literatura acerca de los tratamientos ortodónticos y quirúrgicos del síndrome de Apert durante las diferentes etapas de crecimiento y desarrollo. Métodos: se llevó a cabo una búsqueda en las bases de datos MedLine (PubMed), Science Direct, Scopus y Wiley Online Library con la combinación de los siguientes términos: Syndromic craniosynostosis, Dental treatment, orthodontic treatment, Apert Syndrome, surgical treatment, dental care. Se incluyeron revisiones sistemáticas y de literatura, estudios retrospectivos, longitudinales y de cohorte, series y revisiones de caso publicados entre 1990 y 2020 en español o inglés; se excluyeron artículos relacionados con otros síndromes, así como estudios en animales. Los artículos fueron seleccionados según su pertinencia y disponibilidad de texto completo; hallazgos repetidos fueron eliminados; adicionalmente, se utilizó el sistema bola de nieve en los artículos seleccionados; la calidad de la evidencia fue evaluada mediante el sistema GRADE. Resultados: 34 artículos fueron incluidos (calidad alta: 2, moderada: 1, baja: 19 y muy baja: 12). Entre estos, se identificaron discusiones relacionadas con la etapa de crecimiento a la que se recomienda realizar los procedimientos quirúrgicos requeridos para minimizar sus impactos negativos. La mayoría de los artículos apoyan el manejo terapéutico ejecutado por equipos multidisciplinarios. Conclusiones: un plan de tratamiento combinado de ortodoncia y cirugía ortognática se presentó como la mejor opción para obtener los mejores resultados funcionales y estéticos para la población en cuestión. El momento adecuado durante el crecimiento y desarrollo de los individuos para implementar cada fase de tratamiento fue decidido por cada equipo multidisciplinario.
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Leinonen S, Rice D, Leikola J, Heliövaara A. Dental Age, Agenesis, and Morphology in Patients With Operated Single-Suture Craniosynostoses. Cleft Palate Craniofac J 2020; 58:290-298. [PMID: 32815397 DOI: 10.1177/1055665620950145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the dental age, agenesis, and morphology of children with surgically operated single-suture craniosynostoses from orthopantomographs. DESIGN A single-centered cross-sectional observational archival study. PATIENTS A sample of 196 Finnish patients with single-suture craniosynostosis without additional birth defects or syndromes (excluding Muenke syndrome) was included in this study. MAIN OUTCOME MEASURES Dental age was assessed using the method developed by Demirjian et al. and modified by Nyström et al. for the Finnish population. Methods described by Tulensalo et al. and Oehlers et al. were used to study taurodontism and dens invaginatus, respectively. RESULTS The study sample of 149 patients was divided into 3 groups: patients with sagittal synostosis (n = 103), coronal synostosis (n = 25), and metopic synostosis (n = 21). Orthopantomographs taken on average at ages 8.20 to 8.33 were used. The dental ages in different groups were on average 0.37, 0.60, and 0.66 years ahead of normative values, for sagittal, coronal, and metopic groups, respectively. Tooth agenesis, taurodontism, and invaginated teeth were found in all groups with invaginations having a high prevalence. Peg-shaped upper lateral incisors and one geminated lower lateral incisor were also found. CONCLUSIONS These descriptive data may help improve dental care in patients with single-suture craniosynostosis.
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Affiliation(s)
- Sami Leinonen
- Department of Plastic Surgery, Cleft Palate and Craniofacial Center, Helsinki University Hospital, Helsinki, Finland
| | - David Rice
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Junnu Leikola
- Department of Plastic Surgery, Cleft Palate and Craniofacial Center, Helsinki University Hospital, Helsinki, Finland
| | - Arja Heliövaara
- Department of Plastic Surgery, Cleft Palate and Craniofacial Center, Helsinki University Hospital, Helsinki, Finland
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Azoulay-Avinoam S, Bruun R, MacLaine J, Allareddy V, Resnick CM, Padwa BL. An Overview of Craniosynostosis Craniofacial Syndromes for Combined Orthodontic and Surgical Management. Oral Maxillofac Surg Clin North Am 2020; 32:233-247. [PMID: 32081578 DOI: 10.1016/j.coms.2020.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This article provides an overview of epidemiology, genetics, and common orofacial features of those with craniosynostosis. Patients with craniosynostosis require several surgical procedures along with continuum of care. The earliest surgical interventions are done during the first few years of life to relieve the fused sutures. Midface advancement, limited phase of orthodontic treatment, and combined orthodontics/orthognathic surgery treatment are usually required during later years. This article presents several examples of cases with outcomes associated with these procedures.
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Affiliation(s)
- Shayna Azoulay-Avinoam
- Department of Orthodontics, College of Dentistry, University of Illinois at Chicago, 801 South Paulina Street, 138AD (MC841), Chicago, IL 60612-7211, USA
| | - Richard Bruun
- Boston Children's Hospital Cleft Lip/Palate and Craniofacial Teams, Department of Dentistry, Boston Children's Hospital, Harvard School of Dental Medicine, 300 Longwood Avenue, Boston, MA 02115, USA
| | - James MacLaine
- Department of Developmental Biology, Boston Children's Hospital, Harvard School of Dental Medicine, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Veerasathpurush Allareddy
- Department of Orthodontics, College of Dentistry, University of Illinois at Chicago, 801 South Paulina Street, 138AD (MC841), Chicago, IL 60612-7211, USA.
| | - Cory M Resnick
- Oral & Maxillofacial Surgery Program, Department of Plastic & Oral Surgery, Harvard Medical School, 300 Longwood Avenue, Hunnewell, 1st Floor, Boston, MA 02115, USA
| | - Bonnie L Padwa
- Section of Oral and Maxillofacial Surgery, Department of Plastic & Oral Surgery, Harvard Medical School, 300 Longwood Avenue, Hunnewell, 1st Floor, Boston, MA 02115, USA
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Shin K, Moreno-Uribe LM, Allareddy V, Burton RG, Menezes AH, Fisher MD, Weber-Gasparoni K, Elangovan S. Multidisciplinary care for a patient with syndromic craniosynostosis: A case report with 20 years of special care. SPECIAL CARE IN DENTISTRY 2019; 40:127-133. [PMID: 31850547 DOI: 10.1111/scd.12437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 10/08/2019] [Accepted: 10/25/2019] [Indexed: 01/10/2023]
Abstract
AIM The functional and structural complexities accompanying syndromic craniosynostosis make dental care for these patients particularly challenging. We report a case of long-term care for a syndromic craniosynostosis patient. The objective of this report is to introduce special care guidance and clinical recommendation, so that oral health care providers, as key members of a multidisciplinary care team, can provide optimal diagnosis, treatment, and management for the patient with syndromic craniosynostosis. CASE REPORT The patient of this case report had a medical history of syndromic craniosynostosis involving multiple comorbidities. Over the past 20 years, a multidisciplinary care team has successfully treated the patient. Dental and medical procedures that the patient has received include cranial surgeries, prophylactic dental care, caries control, growth hormone therapy, comprehensive orthodontic treatment in conjunction with orthognathic surgeries, and plastic surgery. CONCLUSION Oral health care providers can play essential roles in multidisciplinary care for patients with craniosynostosis by understanding the patients' unique oral health conditions and dentofacial deformities. To provide optimal oral health care in a multidisciplinary team, clear communication between the members of the care team is crucial.
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Affiliation(s)
- Kyungsup Shin
- Department of Orthodontics, College of Dentistry & Dental Clinics, University of Iowa, Iowa City, Iowa
| | - Lina M Moreno-Uribe
- Department of Orthodontics, College of Dentistry & Dental Clinics, University of Iowa, Iowa City, Iowa
| | | | - Richard G Burton
- Department of Oral and Maxillofacial Surgery, College of Dentistry & Dental Clinics, University of Iowa, Iowa City, Iowa
| | - Arnold H Menezes
- Department of Neurosurgery, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Mark D Fisher
- Department of Surgery, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Karin Weber-Gasparoni
- Department of Pediatric Dentistry, College of Dentistry & Dental Clinics, University of Iowa, Iowa City, Iowa
| | - Satheesh Elangovan
- Department of Periodontics, College of Dentistry & Dental Clinics, University of Iowa, Iowa City, Iowa
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Harada A, Miyashita S, Nagai R, Makino S, Murotsuki J. Prenatal sonographic findings and prognosis of craniosynostosis diagnosed during the fetal and neonatal periods. Congenit Anom (Kyoto) 2019; 59:132-141. [PMID: 30132994 DOI: 10.1111/cga.12308] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 08/08/2018] [Accepted: 08/08/2018] [Indexed: 11/26/2022]
Abstract
The aim of the study was to explore the sonographic findings of fetuses with craniosynostosis and investigate their prognosis. We conducted a 5-year, multicenter retrospective study and collected data on patients with craniosynostosis diagnosed in the perinatal period. Of 41 cases, 30 cases (73%) were syndromic craniosynostosis, eight cases (20%) were non-syndromic craniosynostosis and the other three cases (7%) were secondary craniosynostosis of chromosomal deletion syndromes. The prenatal ultrasound detection rate was 61%. Half of the cases of syndromic craniosynostosis detected during the perinatal period were Pfeiffer syndrome; there were also six cases of Apert syndrome, three cases of Crouzon syndrome and other rare form of syndromic craniosynostosis (Beare-Stevenson syndrome, Saethre-Chotzen syndrome, cranioectodermal dysplasia, and thanatophoric dysplasia). Abnormal shape of the skull was the most common finding leading to prenatal diagnosis of craniosynostosis. Abnormal head biometry, which was the second most frequent finding, was closely correlated with deformation of the cranial shape. Three cases presented with ventriculomegaly and exophthalmos but normal cranial shape and size. The overall survival rate of infants with syndromic craniosynostosis was 79%, while all of the infants with non-syndromic craniosynostosis survived. In conclusion, prenatal diagnosis of craniosynostosis is difficult, especially when dysmorphic change of the fetal cranium is not evident. Abnormal head biometry and ventriculomegaly could potentially be additional markers of fetal craniosynostosis and consequently increase the prenatal detection rate.
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Affiliation(s)
- Aya Harada
- Department of Maternal and Fetal Medicine, Miyagi Children's Hospital, Sendai, Japan
| | - Susumu Miyashita
- Division of Maternal and Fetal Medicine, Dokkyo Medical University, Tochigi, Japan
| | - Ryuhei Nagai
- Department of Obstetrics and Gynecology, Kochi Health Sciences Centre, Kochi, Japan
| | - Shintaro Makino
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Jun Murotsuki
- Department of Maternal and Fetal Medicine, Miyagi Children's Hospital, Sendai, Japan.,Department of Advanced Fetal and Developmental Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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Sicard L, Hounkpevi M, Tomat C, James S, Paternoster G, Khonsari RH, Arnaud E. Dental consequences of pterygomaxillary dysjunction during fronto-facial monobloc advancement with internal distraction for Crouzon syndrome. J Craniomaxillofac Surg 2018; 46:1476-1479. [DOI: 10.1016/j.jcms.2018.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 05/04/2018] [Accepted: 06/01/2018] [Indexed: 10/14/2022] Open
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Abstract
Summary
Crouzon syndrome is a rare genetic disorder with autosomal dominant inheritance. The underlying pathological process is premature synostosis of the cranial sutures with subsequent phenotypic alterations of the affected person. A review of the literature has been conducted in order to resume the overall characteristics of Crouzon syndrome such as craniomaxillofacial malformations, clinical features, dentoalveolar characteristics, aesthetic impairments, and psychological background, as well as, the different therapeutic procedures, which combine surgical and orthodontic interventions. Facial and functional malformations in individuals with Crouzon syndrome could be significantly improved after a series of surgical and orthodontic procedures in almost all cases. A multidisciplinary treatment approach would provide the best outcomes in affected patients.
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Susami T, Fukawa T, Miyazaki H, Sakamoto T, Morishita T, Sato Y, Kinno Y, Kurata K, Watanabe K, Asahito T, Saito I. A Survey of Orthodontic Treatment in Team Care for Patients With Syndromic Craniosynostosis in Japan. Cleft Palate Craniofac J 2018; 55:479-486. [PMID: 29351022 DOI: 10.1177/1055665617747703] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To understand the actual condition of orthodontic treatment in team care for patients with syndromic craniosynostosis (SCS) in Japan. DESIGN A nationwide collaborative survey. SETTING Twenty-four orthodontic clinics in Japan. PATIENTS A total of 246 patients with SCS. MAIN OUTCOME MEASURE Treatment history was examined based on orthodontic records using common survey sheets. RESULTS Most patients first visited the orthodontic clinic in the deciduous or mixed dentition phase. Midface advancement was performed without visiting the orthodontic clinic in about a quarter of the patients, and more than a half of the patients underwent "surgery-first" midface advancement. First-phase orthodontic treatment was carried out in about a half of the patients, and maxillary expansion and protraction were performed. Tooth extraction was required in about two-thirds of patients, and the extraction of maxillary teeth was required in most patients. Tooth abnormalities were found in 37.8% of patients, and abnormalities of maxillary molars were frequently (58.3%) found in patients who had undergone midface surgery below the age of 6 years. CONCLUSIONS Many patients underwent "surgery-first" midface advancement, and visiting the orthodontic clinic at least before advancement was considered desirable. First-phase orthodontic treatment should be performed considering the burden of care. Midface advancement below the age of 6 years had a high risk of injury to the maxillary molars. This survey is considered useful for improving orthodontic treatment in team care of patients with SCS.
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Affiliation(s)
- Takafumi Susami
- 1 Department of Oral-Maxillofacial Surgery, Dentistry and Orthodontics, University of Tokyo Hospital, Tokyo, Japan
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14
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Rubio EI, Blask A, Bulas DI. Ultrasound and MR imaging findings in prenatal diagnosis of craniosynostosis syndromes. Pediatr Radiol 2016; 46:709-18. [PMID: 26914936 DOI: 10.1007/s00247-016-3550-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 12/20/2015] [Accepted: 01/17/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Craniosynostosis syndromes are uncommonly encountered in the prenatal period. Identification is challenging but important for family counseling and perinatal management. OBJECTIVE This series examines prenatal findings in craniosynostosis syndromes, comparing the complementary roles of US and MRI and emphasizing clues easily missed in the second trimester. MATERIALS AND METHODS Six prenatal cases evaluated from 2002 through 2011 were retrospectively reviewed. Referral history, gestational age, and sonographic and MRI findings were reviewed by three pediatric radiologists. Abnormalities of the calvarium, hands, feet, face, airway and central nervous system were compared between modalities. RESULTS The diagnosis was Apert syndrome in three, Pfeiffer syndrome in two and Carpenter syndrome in one. The gestational age at evaluation ranged from 21 to 33 weeks. All six were evaluated by MRI and US, with two undergoing repeat evaluation in the third trimester, yielding a total of eight MRIs and US exams. The referral history suggested cloverleaf skull in two cases but did not suggest craniosynostosis syndrome in any case. In four, the referral suggested central nervous system (CNS) findings that were not confirmed by MRI; additional CNS findings were discovered in the remaining two. In four cases, developing turricephaly resulted in a characteristic "lampshade" contour of the fetal head. Hypertelorism and proptosis were present in five, with proptosis better appreciated by MRI. Digit abnormalities were present in all, seen equally well by MRI and US. Lung abnormalities in the second trimester in one fetus resolved by the third trimester. CONCLUSION Prenatal diagnosis of craniosynostosis syndromes is difficult prior to the third trimester. MRI and US have complementary roles in evaluation of these patients.
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Affiliation(s)
- Eva I Rubio
- Department of Radiology, Children's National Health System, 111 Michigan Ave. NW, Washington, DC, 20010, USA.
| | - Anna Blask
- Department of Radiology, Children's National Health System, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Dorothy I Bulas
- Department of Radiology, Children's National Health System, 111 Michigan Ave. NW, Washington, DC, 20010, USA
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Cifuentes-Mendiola S, Pérez-Martínez I, Muñoz-Saavedra Á, Torres-Contreras J, García-Hernández A. Clinical applications of molecular basis for Craniosynostosis. A narrative review. JOURNAL OF ORAL RESEARCH 2016. [DOI: 10.17126/joralres.2016.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Lambdoid Synostosis Versus Positional Posterior Plagiocephaly, a Comparison of Skull Base and Shape of Calvarium Using Computed Tomography Imaging. J Craniofac Surg 2015; 26:1917-22. [DOI: 10.1097/scs.0000000000002098] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Heliövaara A, Vuola P, Hukki J. Craniofacial cephalometric morphology in 8-year-old children with operated sagittal synostosis. Orthod Craniofac Res 2014; 18:27-32. [PMID: 25264570 DOI: 10.1111/ocr.12056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate cephalometrically craniofacial morphology in children with operated sagittal synostosis and to compare the findings with age- and sex-matched controls. SETTING AND SAMPLE POPULATION Forty-two children (37 boys) with operated primary sagittal synostosis were compared retrospectively with age- and sex-matched controls from lateral cephalograms taken at a mean age of 8.1 (range 7.0-8.9) years. MATERIAL AND METHODS The operations had been performed between the ages of 2 months and 6.3 years at three Finnish hospitals. The surgical methods included strip craniectomy, pi-plasty and cranial vault expansion. A paired Student's t-test and Pearson's correlation analysis were used in the statistical analyses. RESULTS Children with operated sagittal synostosis had wide cranial base angles and their mandibles were retrognathic with labially inclined lower incisors relative to the controls. Age at craniosynostosis operation did not correlate with the cranial base angle. CONCLUSION This study suggests that children with operated sagittal synostosis have minor distinctive morphological features in the cranial base and mandible. Orthodontic evaluation of craniofacial growth is recommended.
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Affiliation(s)
- A Heliövaara
- Cleft Palate and Craniofacial Center, Department of Plastic Surgery, Helsinki University Central Hospital, Helsinki, Finland
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