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Bhattacharjee K, Rehman O, Venkatraman V, Kikkawa D, Bhattacharjee H, Gogoi R, Grewal AM, Bhattacharjee P. Crouzon syndrome and the eye: An overview. Indian J Ophthalmol 2022; 70:2346-2354. [PMID: 35791116 PMCID: PMC9426041 DOI: 10.4103/ijo.ijo_3207_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The current literature review aims to evaluate the ocular findings and associated ophthalmic features in Crouzon syndrome. Craniosynostoses are syndromes characterized by premature fusion of sutures of the skull and Crouzon syndrome is the most common of the craniosynostosis syndromes. Early fusion of sutures results in craniofacial anomalies, including abnormalities of the orbits. To prepare this review of the ophthalmic findings in this disorder, an organized search on online databases such as PubMed, Scopus, Cochrane Library, and Ovid was carried out. The key terms searched were "Crouzon", "craniosynostosis", "eye" and "ophthalmic", and 51 research items were found. A total of 17 articles were included after scrutiny of the databases and a further 25 articles were added after augmented search. A detailed review was performed from the final 42 articles. A comprehensive description of associated anomalies is given along with the author's own technique of surgical management in cases with Crouzon syndrome having bilateral luxation bulbi with exposure keratopathy. However, for optimum management of cranial and oculo-facial dysmorphisms, a multidisciplinary team of specialists is required.
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Affiliation(s)
- Kasturi Bhattacharjee
- Department of Orbit, Oculoplasty and Facial Aesthetics, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
| | - Obaidur Rehman
- Department of Orbit, Oculoplasty and Facial Aesthetics, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
| | - Vatsalya Venkatraman
- Department of Orbit, Oculoplasty and Facial Aesthetics, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
| | - Don Kikkawa
- Department of Oculofacial Plastic and Reconstructive Surgery, UCSD Shiley Eye Institute, La Jolla, CA 92093, United States
| | - Harsha Bhattacharjee
- Department of Comprehensive Ophthalmology, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
| | - Rahul Gogoi
- Department of Orbit, Oculoplasty and Facial Aesthetics, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
| | - Aditi Mehta Grewal
- Department of Orbit, Oculoplasty and Facial Aesthetics, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
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Correction of Midface Deficiency in Patient With Crouzon Syndrome by Orthognathic Surgery and Patient Specific Facial Implant: Case Report. J Craniofac Surg 2022; 33:e191-e194. [DOI: 10.1097/scs.0000000000008287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Effect of Early Spheno-Occipital Synchondrosis Fusion in Preadolescent Patients With Syndromic Craniosynostosis on Craniofacial Skeletal Patterns: A Preliminary Study Using Cephalometric Analysis. J Craniofac Surg 2021; 33:179-182. [PMID: 34560746 DOI: 10.1097/scs.0000000000008191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT The purpose of this study was to investigate the effects of early spheno-occipital synchondrosis (SOS) fusion in preadolescent patients with syndromic craniosynostosis (SC) on the craniofacial skeletal patterns. Twenty preadolescent SC patients were divided into the fused SOS (FS, n = 10; 8 Crouzon and 2 Apert) and not-fused SOS groups (NFS, n = 10; 9 Crouzon and 1 Apert). Lateral cephalograms (mean age: 9.60 years, cervical vertebral maturation index: stage I and II) were used to investigate the skeletal sagittal (ANB) and vertical patterns (SN-GoMe), upward inclination of the anterior cranial base (ACB; SN-FH), degree of midface hypoplasia (MH, SNA), retrusive position of orbitale (SNO), and forward position of the condyle in relation to sella (saddle angle). Using the ordinal values calculated by ethnic norm (criteria: moderate, over ±1 standard deviation, severe, over ±2 standard deviation), statistical analysis was performed. The FS group showed a higher percentage of severe MH than the NFS group (70% versus 10%, P < 0.05). Although the 2 groups did not differ in the distribution of ANB, SN-GoMe, saddle angle, and SN-FH (all P > 0.05), the FS group showed relatively higher percentages of severe Class III (100% versus 70%), severe hyper-divergent pattern (40% versus 10%), severely forward condyle position (30% versus 0%), and moderate and severe upward anterior cranial base inclination (90% versus 50%) than the NFS group. However, the 2 groups exhibited the same distribution of moderately and severely retrusive orbitale position ([50%, 20%], P > 0.05). Early SOS fusion in preadolescent SC patients might not be related to retrusive orbitale position, but to severe MH.
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Respective Roles of Craniosynostosis and Syndromic Influences on Cranial Fossa Development. Plast Reconstr Surg 2021; 148:145-156. [PMID: 34181610 DOI: 10.1097/prs.0000000000008101] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Little is known about the detailed growth of the cranial fossae, even though they provide an important structural connection between the cranial vault and the facial skeleton. This study details the morphologic development of isolated cranial vault synostosis and associated syndromes on cranial fossa development. METHODS A total of 125 computed tomographic scans were included (nonsyndromic bicoronal synostosis, n = 36; Apert syndrome associated with bicoronal synostosis, n = 24; Crouzon syndrome associated with bicoronal synostosis, n = 11; and controls, n = 54). Three-dimensional analyses were produced using Materialise software. RESULTS The regional anterior and middle cranial fossae volumes of nonsyndromic bicoronal synostosis are characterized by significant increases of 43 percent (p < 0.001) and 60 percent (p < 0.001), respectively, and normal posterior cranial fossa volume. The cranial fossae depths of nonsyndromic bicoronal synostosis were increased, by 37, 42, and 21 percent (all p < 0.001) for anterior, middle, and posterior cranial fossae, respectively, accompanying the shortened cranial fossae lengths. The volume and morphology of all cranial fossae in Apert syndrome nearly paralleled nonsyndromic bicoronal synostosis. However, Crouzon syndrome had reduced depths of cranial fossae, and more restricted fossa volumes than both Apert syndrome and nonsyndromic bicoronal synostosis. CONCLUSIONS Cranial vault suture synostosis is likely to be more influential on cranial fossae development than other associated influences (genetic, morphologic) in Apert and Crouzon syndromes. Isolated Apert syndrome pathogenesis is associated with an elongation of the anterior cranial fossa length in infants, whereas in Crouzon syndrome, there is a tendency to reduce cranial fossa depth, suggesting individual adaptability in cranial fossae development related to vault synostosis.
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Characteristics of the Sphenoid Bone in Crouzon Syndrome. J Craniofac Surg 2021; 32:2277-2281. [PMID: 33606434 DOI: 10.1097/scs.0000000000007560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The goal of this study is to analyze the safety of reconstructive surgeries for Crouzon syndrome, and to understand the deformities and complications related to the surgical procedure. METHODS Thirty-nine subjects underwent preoperative computed tomographic scans were included (Crouzon, n = 19; controls, n = 20) in this study. Craniofacial cephalometric measurements were analyzed by Materialise software. RESULTS The overall average distance from the pterygoid junction to the coronal plane in the patients with Crouzon syndrome was 21.34 mm (standard deviation [SD] 5.13), which was deeper than that in the controls by 35% (P = 0.000).The overall average distances between the left and right foramen ovale and pterion on the sphenoid bone in the subjects were 64.93 mm (SD 7.56) and 67.83 mm (SD 8.57), which were increased by 13% (P = 0.001) and 14% (P = 0.001) compared with those in the controls.The overall distances between the most inferior point of the left and right lateral pterygoid plate and the medial pterygoid plate in the subjects were 51.09 mm (SD 6.68) and 51.51 mm (SD 10.98), which was not statically different from the controls (P = 0.887, P = 0.991, respectively). CONCLUSIONS This study characterized the surgically relevant anatomy of the sphenoidal bone. The pterygomaxillary junction is located in the posterior of the skull. Though there are some anatomical differences due to age, it is well known that the cranial cavity of the sphenoid side is likely to be enlarged in Crouzon syndrome, which may contribute to the other complications of the disease.
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What Is the Difference in Cranial Base Morphology in Isolated and Syndromic Bicoronal Synostosis? Plast Reconstr Surg 2020; 146:599-610. [DOI: 10.1097/prs.0000000000007068] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lu X, Forte AJ, Park KE, Allam O, Mozaffari MA, Alperovich M, Steinbacher DM, Alonso N, Persing JA. Sphenoid Bone Structure and Its Influence on the Cranium in Syndromic Versus Nonsyndromic Craniosynostosis. J Craniofac Surg 2020; 32:67-72. [DOI: 10.1097/scs.0000000000006914] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Lu X, Forte AJ, Fan F, Zhang Z, Teng L, Yang B, Alperovich M, Steinbacher DM, Alonso N, Persing JA. Racial disparity of Crouzon syndrome in maxilla and mandible. Int J Oral Maxillofac Surg 2020; 49:1566-1575. [PMID: 32362538 DOI: 10.1016/j.ijom.2020.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 02/17/2020] [Accepted: 04/06/2020] [Indexed: 12/26/2022]
Abstract
The racial disparity of facial features in craniosynostosis patients is not fully understood. The aim of this study was to explore the difference in maxillary and mandibular morphology and spatial position in Asian and Caucasian Crouzon syndrome patients. Ninety-one computed tomography scans were included (12 Asian Crouzon syndrome patients, 22 Asian controls; 16 Caucasian Crouzon syndrome patients, 41 Caucasian controls) and measured using Materialise software. The maxillary and mandibular volumes of Asian patients were both reduced by 19% (P=0.102 and P=0.187), and those of Caucasian patients were reduced by 15% (P=0.142) and 14% (P=0.211) when compared to the respective race-specific controls. Maxilla length of Asian patients was reduced by 6.36mm (14%, P=0.003), while the reduction in Caucasian patients was 4.88mm (10%, P=0.038). ANS was retracted 11.99mm (P<0.001) in Asian patients and 11.54mm (P<0.001) in Caucasian patients. The ANB angle was narrowed by 13.17° (P<0.001) in Asian patients compared to Asian controls, and by 7.02° (P<0.001) in Caucasian patients compared to Caucasian controls. The retrusive midface profiles of Asian and Caucasian Crouzon syndrome look similar; both result from the combined effect of hypoplastic size and backward displacement. However, the insufficiency was found to be more a failure of the anteroposterior maxillary length in Asian patients, and more due to posterior maxillary positioning in Caucasian patients. Therefore, prognathism in Crouzon syndrome patients is more likely caused by displacement rather than elongation of mandibular length in both races. Crouzon syndrome results in the same extent of overall volume deficiency of the maxilla and mandible in these races.
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Affiliation(s)
- X Lu
- Chinese Academy of Medical Sciences, Peking Union Medical College, Plastic Surgery Hospital, Beijing, China; Division of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT, USA
| | - A J Forte
- Division of Plastic and Reconstructive Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | - F Fan
- Chinese Academy of Medical Sciences, Peking Union Medical College, Plastic Surgery Hospital, Beijing, China
| | - Z Zhang
- Chinese Academy of Medical Sciences, Peking Union Medical College, Plastic Surgery Hospital, Beijing, China
| | - L Teng
- Chinese Academy of Medical Sciences, Peking Union Medical College, Plastic Surgery Hospital, Beijing, China
| | - B Yang
- Chinese Academy of Medical Sciences, Peking Union Medical College, Plastic Surgery Hospital, Beijing, China
| | - M Alperovich
- Division of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT, USA
| | - D M Steinbacher
- Division of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT, USA
| | - N Alonso
- Department of Plastic Surgery, University of São Paulo, São Paulo, Brazil
| | - J A Persing
- Division of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT, USA.
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What Is the Skull Structure Influence of Squamosal Suture Synostosis in Nonsyndromic and Syndromic Crouzon Craniosynostosis? J Craniofac Surg 2019; 30:1671-1675. [DOI: 10.1097/scs.0000000000005396] [Citation(s) in RCA: 7] [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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