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Osborn AJ, Lange O, Roberts RM. Attention Deficit/Hyperactivity Disorder in Individuals with Non-Syndromic Craniosynostosis: A Systematic Review and Meta-Analysis. Dev Neuropsychol 2024; 49:191-206. [PMID: 38801083 DOI: 10.1080/87565641.2024.2357801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 05/15/2024] [Indexed: 05/29/2024]
Abstract
It is not yet understood whether, and to what extent, craniosynostosis impacts the development of Attention Deficit/Hyperactivity Disorder (ADHD). This PRISMA compliant and PROSPERO pre-registered (ID: CRD42023458640) systematic review and meta-analysis examines the association of single-suture, non-syndromic craniosynostosis with ADHD and inattention/hyperactivity symptoms. Data from 17 independent studies (Nparticipants = 2,389; Mage = 7.3 years) were analyzed, taking into consideration suture location, surgical status, age, and measures administered, where feasible. Few differences were found between cases and controls, but some studies reported high symptom levels. Additional research is required utilizing larger sample sizes and more comprehensive assessment of ADHD.
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Affiliation(s)
- Amanda J Osborn
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - Olivia Lange
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - Rachel M Roberts
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
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2
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Patino M, Jaimes C, Robson CD. Fetal Head and Neck Imaging. Magn Reson Imaging Clin N Am 2024; 32:413-430. [PMID: 38944431 DOI: 10.1016/j.mric.2024.03.003] [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] [Indexed: 07/01/2024]
Abstract
Prenatal MRI plays an essential role in the evaluation of the head and neck. This article overviews technical considerations and both isolated and syndromic anomalies of the fetal calvarium, globes and orbits, ears, maxilla, mandible, and neck.
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Affiliation(s)
- Manuel Patino
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA; Pediatric Imaging Research Center, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Camilo Jaimes
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA; Pediatric Imaging Research Center, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Caroline D Robson
- Neuroradiology Division, Department of Radiology, Boston Children's Hospital, Harvard Medical School, Main Building 2nd Floor, 300 Longwood Avenue, Boston, MA 02115, USA.
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Wongbanthit Y, Rojvachiranonda N, Chantarangsu S, Suwanwitid P, Kamolvisit W, Porntaveetus T. Craniosynostosis: orofacial and oral health perspectives with masticatory insights. BMC Oral Health 2024; 24:767. [PMID: 38978035 PMCID: PMC11229286 DOI: 10.1186/s12903-024-04540-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 06/27/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Craniosynostosis (CS), premature fusion of one or more cranial sutures, leads to abnormal skull development, impacting both facial esthetics and oral function. This study aimed to evaluate the specific orofacial and oral health characteristics, including masticatory performance, in Thai patients with CS. METHODS A comparative study was conducted with Thai CS patients aged 6-17 years and a control group of healthy individuals with similar age distribution. Assessments included craniofacial morphology, oral health status, and masticatory performance. Intergroup comparisons utilized appropriate statistical tests. RESULTS The study included 24 CS patients with a mean age of 10.11 ± 2.98 years and 30 controls. CS patients exhibited a significantly higher prevalence of various oral conditions compared to controls: cleft palate (20.8%), anterior open bite (41.7%), anterior crossbite (54.2%), posterior crossbite (50%), combined anterior-posterior crossbite (45.8%), dental crowding in both maxilla and mandible (50% and 45.8% respectively), congenitally missing teeth (50%), supernumerary teeth (12.5%), and eruption failure (54.2%). Furthermore, CS patients exhibited significantly higher caries prevalence and susceptibility, alongside poorer oral hygiene, compared to controls. Regarding jaw relationships, CS patients exhibited a significantly higher proportion of Angle's Class III malocclusion (50%) compared to the control group, where Class I malocclusion was predominant (50%). Masticatory performance, assessed using the two-color gum mixing ability test, showed significantly higher hue variance in CS patients (0.12 ± 0.07) compared to the control group, indicating reduced chewing performance. CONCLUSION This study underscores the significant orofacial and oral health challenges faced by children with CS, including a high prevalence of malocclusions, dental anomalies, elevated caries experience, and compromised masticatory function. These findings emphasize the importance of tailored interventions and comprehensive oral healthcare strategies to address the unique needs of this population and improve their overall quality of life.
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Affiliation(s)
- Yanisa Wongbanthit
- Center of Excellence in Genomics and Precision Dentistry, Department of Physiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, 10330, Thailand
- Clinical Research Center, Faculty of Dentistry, Graduate Program in Geriatric and Special Patients Care, Chulalongkorn University, Bangkok, Thailand
| | - Nond Rojvachiranonda
- Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Princess Sirindhorn Craniofacial Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Soranun Chantarangsu
- Department of Oral Pathology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Preeya Suwanwitid
- Department of Orthodontics, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Wuttichart Kamolvisit
- Center of Excellence for Medical Genomics, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Excellence Center for Genomics and Precision Medicine, King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand
| | - Thantrira Porntaveetus
- Center of Excellence in Genomics and Precision Dentistry, Department of Physiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, 10330, Thailand.
- Clinical Research Center, Faculty of Dentistry, Graduate Program in Geriatric and Special Patients Care, Chulalongkorn University, Bangkok, Thailand.
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Chang Y, Yu Y, Zhang W, Gao Y, Feng J, Li M, Han F. The effect of continuous positive airway pressure on obstructive sleep apnea in children with syndromic craniosynostosis. Sleep Breath 2024; 28:1439-1448. [PMID: 38180682 PMCID: PMC11196332 DOI: 10.1007/s11325-023-02981-3] [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] [Received: 09/28/2023] [Revised: 12/05/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is common in children with syndromic craniosynostosis (SC). However, objective data on the treatment of OSA in children with SC remain inadequate. This study aimed to explore the efficacy of continuous positive airway pressure (CPAP) in the management of OSA in children with SC. METHODS A retrospective study was performed in children with SC and OSA diagnosed by polysomnography (PSG), which was defined as an apnea hypopnea index (AHI) ≥ 1. Patients were included if they were treated with CPAP and had baseline PSG and follow-up sleep studies. Clinical and demographic data were collected from all enrolled subjects. RESULTS A total of 45 children with SC and OSA were identified, with an average age of 6.8 ± 4.7 years. Among them, 36 cases had moderate to severe OSA (22 with severe OSA) and received CPAP therapy followed by post-treatment sleep studies. Notably, there was a significant reduction in the AHI observed after CPAP treatment (3.0 [IQR: 1.7, 4.6] versus 38.6 [IQR: 18.2, 53.3] events/h; P < 0.001). CONCLUSIONS CPAP is effective and acceptable in treating severe OSA in children with SC.
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Affiliation(s)
- Yuan Chang
- Department of Sleep Medicine, Peking University Pepole's Hospital, 11 Xizhimennan Road, Beijing, 100044, China
| | - Yongbo Yu
- Sleep Center, Peking University International Hospital, Beijing, China
| | - Wei Zhang
- Sleep Center, Peking University International Hospital, Beijing, China
| | - Yinghui Gao
- Sleep Center, Peking University International Hospital, Beijing, China
| | - Junjun Feng
- Sleep Center, Peking University International Hospital, Beijing, China
| | - Mengjie Li
- Sleep Center, Peking University International Hospital, Beijing, China
| | - Fang Han
- Department of Sleep Medicine, Peking University Pepole's Hospital, 11 Xizhimennan Road, Beijing, 100044, China.
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Rufai SR, Panteli V, Henderson RH, Bunce C, Gottlob I, Thomas MG, Proudlock FA, Bowman R, Jeelani NUO. Improved feasibility of handheld optical coherence tomography in children with craniosynostosis. Eye (Lond) 2024:10.1038/s41433-024-03118-w. [PMID: 38789790 DOI: 10.1038/s41433-024-03118-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/12/2024] [Accepted: 05/01/2024] [Indexed: 05/26/2024] Open
Affiliation(s)
- Sohaib R Rufai
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Foundation Trust and UCL Great Ormond Street Institute of Child Health, London, UK
- The University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, UK
- Craniofacial Unit, Great Ormond Street Hospital for Children NHS Foundation Trust and UCL Great Ormond Street Institute of Child Health, London, UK
| | - Vasiliki Panteli
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Foundation Trust and UCL Great Ormond Street Institute of Child Health, London, UK
| | - Robert H Henderson
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Foundation Trust and UCL Great Ormond Street Institute of Child Health, London, UK
| | - Catey Bunce
- Clinical Trials Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Irene Gottlob
- The University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, UK
| | - Mervyn G Thomas
- The University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, UK
| | - Frank A Proudlock
- The University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, UK
| | - Richard Bowman
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Foundation Trust and UCL Great Ormond Street Institute of Child Health, London, UK
| | - Noor Ul Owase Jeelani
- Craniofacial Unit, Great Ormond Street Hospital for Children NHS Foundation Trust and UCL Great Ormond Street Institute of Child Health, London, UK.
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Kai LC, Khaliddin N, Hassan MK, Hariri F. Skeletal expansion via craniofacial distraction osteogenesis technique in syndromic craniosynostosis: impact on ophthalmic parameters. Int Ophthalmol 2024; 44:147. [PMID: 38499845 DOI: 10.1007/s10792-024-03084-y] [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] [Received: 07/31/2023] [Accepted: 02/23/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND This study aims to compare the changes in ophthalmic parameters among syndromic craniosynostosis patients who underwent craniofacial skeletal expansion procedures via distraction osteogenesis (DO). METHOD A retrospective study was conducted involving syndromic craniosynostosis patients who underwent surgical expansion via the DO technique from the year 2012 to March 2022. Changes in six parameters which consist of visual acuity, refractive error, optic disc health, intraocular pressure, degree of proptosis and orbital volume were measured objectively pre and post-surgery. For categorical parameters, the Chi-square cross-tab test was done. Paired sample T-test was used for normally distributed variables. Wilcoxon signed-rank test was used for non-normally distributed data. RESULTS Visual impairment was present in 21.4% of eyes before surgery and increased to 28.5% post-surgery. Three patients had changes of refractive error post-surgery with one developed hypermetropia, another developed anisometropia and the last had improvement to no refractive error. Two patients had optic disc swelling which was resolved post-surgery. Intraocular pressure changes were inconsistent post-surgery. All patients achieved a significant reduction in the degree of proptosis post-surgery. Orbital volume calculation using computed tomography (CT) scans shows a significant increase in volume post-surgery for all patients. CONCLUSION Our study shows a significant increase in orbital volume post-surgery with a reduction in the degree of proptosis. Optic disc and nerve health improved after the surgery. Changes in terms of visual acuity, refractive error and IOP were inconsistent after the surgical intervention.
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Affiliation(s)
- Lim Chin Kai
- Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Nurliza Khaliddin
- Department of Ophthalmology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Muhammad Kamil Hassan
- Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Firdaus Hariri
- Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
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De Luca F, Pasini A, Scianò F, Zedda N, Guarnieri C, Masotti S, Bramanti B, Gualdi-Russo E, Rinaldo N. "Heal the sick": Health status and caregiving during the 17th-18th century in Northern Italy (St. Biagio cemetery, Ravenna). AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2024; 183:125-140. [PMID: 37830270 DOI: 10.1002/ajpa.24861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/16/2023] [Accepted: 09/24/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE The study of health-related care provision in archeology gives important indications on the culture and community organization of past populations. This study aims to assess the health status of the skeletal assemblage recovered from the burial site of St. Biagio (Ravenna, 17th-18th Centuries); next, we identified likely instances of need for and receipt of caregiving in response to the condition, to examine evidence of community attitudes toward disease and disability. MATERIALS AND METHODS The skeletal assemblage is composed of 133 individuals in a generally good state of preservation. Sex and age-at-death were estimated through classical anthropological methods. Health status was inferred through the biological index of frailty (BIF) and paleopathological analysis was performed through macroscopic and radiographic investigations. The "bioarcheology of care" approach was applied to individuals who showed evidence of impairment and disability. RESULTS The skeletal assemblage of St. Biagio was equally represented by males and females (50% males), with a higher percentage of adults (83.4%) than subadults (10.5%), and this is reflected in the high life expectancy at birth (40.3 years). No significant differences in health status emerged between age groups and sexes, with a generally high percentage of joint diseases, antemortem trauma, and infectious diseases. Evidence of care and compassion was found in some individuals with a high degree of impairment or disability, as in the case of probable Angelman syndrome. DISCUSSION This study provided important insights into the biological and social aspects of an Early Modern population in Northern Italy, showing that people with functional and/or visible abnormalities were probably cared for in life and were presumably considered full members of the society.
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Affiliation(s)
- Federica De Luca
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Alba Pasini
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Filippo Scianò
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
- UOC Gastroenterologia, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Nicoletta Zedda
- Department of Environmental and Prevention Sciences, University of Ferrara, Ferrara, Italy
| | - Chiara Guarnieri
- Archaeological Heritage Office, Superintendence SABAP Bologna, Modena, Reggio Emilia, Ferrara, Bologna, Italy
| | - Sabrina Masotti
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Barbara Bramanti
- Department of Environmental and Prevention Sciences, University of Ferrara, Ferrara, Italy
| | - Emanuela Gualdi-Russo
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Natascia Rinaldo
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
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Deliège L, Ramdat Misier K, Silva D, James G, Ong J, Dunaway D, Jeelani NUO, Schievano S, Borghi A. Spring-assisted posterior vault expansion: a parametric study to improve the intracranial volume increase prediction. Sci Rep 2023; 13:21371. [PMID: 38049445 PMCID: PMC10695940 DOI: 10.1038/s41598-023-48143-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/22/2023] [Indexed: 12/06/2023] Open
Abstract
Spring-assisted posterior vault expansion has been adopted at the London Great Ormond Street Hospital for Children to treat raised intracranial pressure in patients affected by syndromic craniosynostosis, a congenital calvarial anomaly causing the premature fusion of skull sutures. This procedure involves elastic distractors used to dynamically reshape the skull and increase the intracranial volume (ICV). In this study, we developed and validated a patient-specific model able to predict the ICV increase and carried out a parametric study to investigate the effect of surgical parameters on that final volume. Pre- and post-operative computed tomography data relative to 18 patients were processed to extract simplified patient-specific skull shape, replicate surgical cuts, and simulate spring expansion. A parametric study was performed to quantify each parameter's impact on the surgical outcome: for each patient, the osteotomy location was varied in a pre-defined range; local sensitivity of the predicted ICV to each parameter was analysed and compared. Results showed that the finite element model performed well in terms of post-operative ICV prediction and allowed for parametric optimization of surgical cuts. The study indicates how to optimize the ICV increase according to the type of procedure and provides indication on the most robust surgical strategy.
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Affiliation(s)
| | | | | | | | - Juling Ong
- Great Ormond Street Hospital, London, UK
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Dibbs RP, Ferry AM, Davies L, Bauer DF, Buchanan EP, Beh HZ. Elevated Intracranial Pressure After Primary Surgical Correction of Sagittal Suture Craniosynostosis. Craniomaxillofac Trauma Reconstr 2023; 16:70-77. [PMID: 36824189 PMCID: PMC9941297 DOI: 10.1177/19433875211064680] [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: 11/16/2022] Open
Abstract
Study Design: A Case Report. Objective: Craniosynostosis is a craniofacial condition defined by premature fusion of at least one cranial suture. Resynostosis or secondary craniosynostosis of a previously patent adjacent suture following primary repair is a relatively common complication. While studies have assessed the rates of secondary craniosynostosis and subsequent reoperation, extremely limited data regarding reoperation techniques is available. Methods: We present a unique case of a pediatric patient with sagittal craniosynostosis who previously underwent a modified pi procedure and later developed resynostosis of the sagittal suture and secondary synostosis of the bicoronal sutures. We subsequently performed total cranial vault reconstruction with virtual surgical planning (VSP). Results: At his 31-month postoperative follow-up, he displayed normal head shape and denied any clinical signs of elevated intracranial pressures with a normal ophthalmological exam. Conclusions: The reoperation was successful with no significant postoperative complications noted. Performing geometric expansion with VSP to manage fusion of a previously open suture following primary treatment of sagittal synostosis should be considered within the armamentarium of operative options.
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Affiliation(s)
- Rami P. Dibbs
- Division of Plastic Surgery, Texas Children’s Hospital, Houston, TX, USA
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Andrew M. Ferry
- Division of Plastic Surgery, Texas Children’s Hospital, Houston, TX, USA
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Lesley Davies
- Division of Plastic Surgery, Texas Children’s Hospital, Houston, TX, USA
| | - David F. Bauer
- Department of Neurosurgery, Texas Children’s Hospital, Houston, TX, USA
| | - Edward P. Buchanan
- Division of Plastic Surgery, Texas Children’s Hospital, Houston, TX, USA
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Han Zhuang Beh
- Division of Plastic Surgery, Texas Children’s Hospital, Houston, TX, USA
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
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Evaluation of Complications and Outcomes in Craniosynostosis by Age of Operation: Analysis of the National Surgical Quality Improvement Program-Pediatric. J Craniofac Surg 2023; 34:29-33. [PMID: 35949013 DOI: 10.1097/scs.0000000000008872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/20/2022] [Indexed: 01/11/2023] Open
Abstract
Considerable controversy exists around the optimal age on which to operate for craniosynostosis. This study aims to use data from the American College of Surgeons National Surgical Quality Improvement Program-Pediatric to assess the impact of operative age on hospital stay and outcomes. After excluding patients who underwent endoscopic cranial vault remodeling, a total of 3292 patients met inclusion criteria in the National Surgical Quality Improvement Program-Pediatric between 2012 and 2019. Median age at surgery was 300 days (interquartile range: 204-494). Patients between 0 and 6 months underwent the highest proportion of complex cranial vault remodeling, Current Procedural Terminology 61,558 ( n =44, 7.7%) and Current Procedural Terminology 61,559 ( n =317, 55.1%). White blood cell counts peaked in the 12 to 18 months group, and were lowest in the 24± months group. Hematocrit was lowest in the 0 to 6 months group and rose steadily to the 24± months group; the inverse pattern was found in platelet concentration, which was highest in the youngest patients and lowest in the oldest. Prothrombin time, international normalized ratio, and partial thromboplastin time were relatively consistent across all age groups. Younger patients had significantly shorter operating room times, which increased with patient age ( P <0.001). Younger patients also had significantly shorter length of stay ( P =0.009), though length of stay peaked between 12 and 18 months. There was a significantly lower rate of surgical site infection in younger patients, which occurred in 0.7% of patients 0 to 12 months and 1.0 to 3.0% in patients over 12 to 24± months. There was no significant difference in the average number of transfusions required in any age group ( P =0.961).
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Perioperative Morbidity of Secondary Frontal Orbital Advancement After Initial Frontal Orbital Advancement. J Craniofac Surg 2023; 34:173-176. [PMID: 36084230 DOI: 10.1097/scs.0000000000009002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 08/08/2022] [Indexed: 01/11/2023] Open
Abstract
Frontal orbital advancement (FOA) is frequently performed for patients with syndromic and/or multisuture craniosynostosis. A small proportion of patients who undergo FOA have unfavorable growth and subsequently require a second FOA later in life; however, the perioperative risks associated with this second procedure are not well studied. We report results from a retrospective review of FOAs conducted from 2007 to 2022 at a single site with the same craniofacial surgeon. A total of 33 patients were included. Perioperative outcomes were compared between primary and secondary FOA procedures. The two groups were similar in regard to suture involvement and diagnosis, although the secondary FOA group was older at the time of their FOA (1.23 versus 7.07 y, P <0.001). There was no significant difference between groups in operating time, volume of blood transfusion by weight, or in the incidence of postoperative wound complications ( P >0.05). Primary FOA procedures had significantly higher weight-adjusted blood loss (28 versus 18 mL/kg, P =0.014), with a higher proportion of patients receiving a blood transfusion (95% versus 62%, P =0.025). There was no significant difference between groups in the incidence of intraoperative dural injury (50% versus 84%, P =0.067). Our findings suggest that secondary procedures appear to impose less of a surgical risk relative to primary FOA traditionally performed in infancy, likely because of the advanced age at the time of secondary FOA.
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Thumb and first webspace reconstruction in nonsyndromic congenital mitten hand with symbrachydactyly. J Plast Reconstr Aesthet Surg 2022; 75:1902-1906. [PMID: 34972652 DOI: 10.1016/j.bjps.2021.11.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 11/11/2021] [Accepted: 11/22/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Nonsyndromic congenital mitten hand with thumb and index finger syndactyly is rare. Reconstruction of this condition is challenging, requiring repositioning of the thumb and creation of a wide and deep first webspace. The aim of this paper is to describe the characteristics of patients with this condition and also to describe our surgical technique. METHODS We describe our technique in 16 consecutive children utilizing complete mobilization of the first metacarpal and thumb as an island flap on the neurovascular bundle, with a rotational osteotomy to reposition the thumb in pronation. In addition, a dorsal M flap was used to reconstruct the first webspace. Patients in this series also had varying degrees of symbrachydactyly with hypoplastic or aplastic phalanges of the central digits. RESULTS There were 9 male and 7 female patients, with a mean age of 24.4 ± 22.4 months at the time of surgery. Mean follow-up was 19.1 ± 18.3 months. All reconstructions healed well. The mean thumb web distance in the affected hands was 4.2 cm (range 3.5 to 5). All reconstructed thumbs had a good opposition. Two children initially had mild hypertrophic scarring, which resolved with pressure gloves. No other complications were observed. CONCLUSION One-stage reconstruction of the thumb and first webspace can be effectively achieved with our technique of complete mobilization of the thumb unit, rotational osteotomy, and a dorsal interdigitating M flap.
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Abstract
SUMMARY Facial sutures contribute significantly to postnatal facial development, but their potential role in craniofacial disease is understudied. Since interest in their development and physiology peaked in the mid-twentieth century, facial sutures have not garnered nearly the same clinical research interest as calvarial sutures or cranial base endochondral articulations. In addition to reinforcing the complex structure of the facial skeleton, facial sutures absorb mechanical stress and generally remain patent into and beyond adolescence, as they mediate growth and refine the shape of facial bones. However, premature closure of these sites of postnatal osteogenesis leads to disrupted growth vectors and consequent dysmorphologies. Although abnormality in individual sutures results in isolated facial deformities, we posit that generalized abnormality across multiple sutures may be involved in complex craniofacial conditions such as syndromic craniosynostosis. In this work, the authors comprehensively review 27 key facial sutures, including physiologic maturation and closure, contributions to postnatal facial development, and clinical consequences of premature closure.
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Examining the Role of Early Diagnostic Imaging for Craniosynostosis in the Era of Endoscopic Suturectomy: A Single Institution Experience. J Craniofac Surg 2022; 33:1363-1368. [PMID: 35132031 DOI: 10.1097/scs.0000000000008534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/15/2022] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Endoscopic suturectomy is a minimally invasive surgical treatment for single-suture craniosynostosis in children between 1 and 4 months of age. This study sought to characterize the role played by diagnostic imaging in facilitating early surgical management with endoscopic suturectomy. The authors also characterized the overall diagnostic utility of imaging in patients assessed for abnormal head shape at their institution, regardless of surgical status. A retrospective cohort of children diagnosed with single-suture synostosis undergoing either primary endoscopic suturectomy or open calvarial reconstruction at the authors' institution from 1998 to 2018 was first reviewed. Of 132 surgical patients, 53 underwent endoscopic suturectomy and 79 underwent open repair. There was no difference in the proportion of endoscopic and open surgery patients imaged preoperatively before (24.5% versus 35.4%; P = 0.24) or after (28.3% versus 25.3%; P = 0.84) craniofacial assessment. Stratifying by historical epoch (1998-2010 versus 2011-2018), there was also no difference found between preoperative imaging rates (63.6% versus 56.4%; P = 0.35). In another cohort of 175 patients assessed for abnormal head shape, 26.9% were imaged to rule out craniosynostosis. Positive diagnostic imaging rates were recorded for suspected unicoronal (100%), metopic (87.5%), lambdoidal (75.0%), sagittal (63.5%), multi-suture (50%), and bicoronal (0%) synostosis. The authors conclude that the use of diagnostic imaging at their institution has not increased despite higher utilization of endoscopic suturectomy and need for expedient identification of surgical candidates. However, their results suggest that imaging may play a greater diagnostic role for suspected bicoronal, sagittal, and multi-sutural synostosis among sutural subtypes of synostosis.
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Rufai SR, Jeelani NUO, Bowman R, Bunce C, Proudlock FA, Gottlob I. Recognition of intracranial hypertension using handheld optical coherence tomography in children (RIO Study): a diagnostic accuracy study protocol. BMJ Open 2022; 12:e048745. [PMID: 35017232 PMCID: PMC8753392 DOI: 10.1136/bmjopen-2021-048745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Paediatric intracranial hypertension (IH) is a rare but serious condition that can pose deleterious effects on the brain and vision. Estimating intracranial pressure (ICP) in children is difficult. Gold standard direct ICP measurement is invasive and carries risk. It is impractical to routinely perform direct ICP measurements over time for all children at risk of IH. This study proposes to assess the diagnostic accuracy of handheld optical coherence tomography (OCT), a non-invasive ocular imaging method, to detect IH in children. METHODS AND ANALYSIS This is a prospective study evaluating the diagnostic accuracy of handheld OCT for IH in at risk children. Inclusion criteria include clinical and/or genetic diagnosis of craniosynostosis, idiopathic intracranial hypertension, space occupying lesion or other conditions association with IH and age 0-18 years old. Exclusion criteria include patients older than 18 years of age and/or absence of condition placing the child at risk of IH. The primary outcome measures are handheld OCT and 48-hour ICP assessments, which will be used for diagnostic accuracy testing (sensitivity, specificity, positive predictive value, negative predictive value and accuracy). Main secondary outcome measures include visual acuity, fundoscopic examination, contrast sensitivity, visual field testing and visual evoked potentials, wherever possible. ETHICS AND DISSEMINATION Ethical approval was granted for this study by the East Midlands Nottingham 2 Research Ethics committee (UOL0348/IRAS 105137). Our findings will be disseminated through presentation at relevant meetings, peer-reviewed publication and via the popular media. TRIAL REGISTRATION NUMBER ISRCTN52858719.
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Affiliation(s)
- Sohaib R Rufai
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
- Ulverscroft Eye Unit, University of Leicester, Leicester, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Noor Ul Owase Jeelani
- UCL Great Ormond Street Institute of Child Health, London, UK
- Craniofacial Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Richard Bowman
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Catey Bunce
- Clinical Trials Unit, Royal Marsden Hospital NHS Trust, London, UK
| | | | - Irene Gottlob
- Ulverscroft Eye Unit, University of Leicester, Leicester, UK
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Magdum S, Ganau M, Syrmos N. Imaging in craniofacial disorders with special emphasis on gradient echo Black-Bone and Zero Time Echo MRI sequences. J Pediatr Neurosci 2022; 17:S14-S20. [PMID: 36388002 PMCID: PMC9648653 DOI: 10.4103/jpn.jpn_46_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/04/2022] [Indexed: 11/25/2022] Open
Abstract
Context: The well-known effects of ionizing radiation on brain cells have been a major driving force toward the use of non-ionizing methods of imaging in both elective and emergency settings. Pediatric neurosurgery has certainly leveraged on this shift in clinical practice, however patients with craniofacial disorders could not fully benefit from the adoption of magnetic resonance imaging (MRI) because computed tomography (CT) scans still retain superior imaging power on bone tissue. Aims: To explore the knowledge available on the use of MRI as surrogate for CT scan in the assessment of craniosynostosis. Settings and Design: A scoping review was designed to identify landmark studies and ongoing clinical trials exploring the accuracy of MRI-based bone imaging in the preoperative planning of pediatric patients with craniosynostosis. Materials and Methods: A total of 492 records were screened from Pubmed, Ovid Medline, Scopus, and Cochrane Library databases; while 55 records were retrieved from ClinicalTrials.gov register. Only clinical studies revolving around the use of Gradient Echo Black-Bone (BB) and Zero Time Echo (ZTE) MRI sequences for the preoperative planning of pediatric craniosynostosis were retained for inclusion. Results and Conclusions: This review identified only five clinical studies reporting a high accuracy of MRI-based 3D bone reconstruction in 47 pediatric candidates to surgical correction of craniosynostosis. Although promising, limited evidence (Level IV) exist that BB and ZTE MRI could help in the surgical planning for craniosynostosis management. The results of two ongoing randomized clinical trials, which are actively enrolling patients, will hopefully help answering this research question.
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Udayakumaran S, Krishnadas A, Subash P. Multisuture and syndromic craniosynostoses: Simplifying the complex. J Pediatr Neurosci 2022; 17:S29-S43. [PMID: 36388010 PMCID: PMC9648657 DOI: 10.4103/jpn.jpn_26_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 03/12/2022] [Indexed: 11/30/2022] Open
Abstract
Most complex craniosynostoses are managed the same way as syndromic craniosynostoses (SCs), as these patients often experience similar problems regarding cognition and increased intracranial pressure (ICP). The evaluation and treatment plan for craniosynostoses is complex, and this, additionally, is complicated by the age at presentation. In this article, the authors review the complexity of SCs in the presentation and management. An algorithm is necessary for such multifaceted and multidimensional pathology as craniosynostoses. In most algorithms, posterior calvarial distraction is a consistent early option for complex craniosynostoses presenting early with raised ICP. Addressing the airway early is critical when significant airway issues are there. All other surgical interventions are tailored on the basis of presentation and age.
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Richardson IJ, Wager LE, Recker MJ, Reynolds R, Ruiz R, Markiewicz MR. Morbidity Associated With Anterior Versus Posterior Cranial Vault Expansion for Early Treatment of Syndromic Craniosynostosis: A Systematic Review and Meta-Analysis. J Oral Maxillofac Surg 2021; 80:651-661. [PMID: 34863645 DOI: 10.1016/j.joms.2021.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/25/2021] [Accepted: 10/28/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this systematic review and meta-analysis was to estimate and compare rates of unplanned reoperation and complications after undergoing either fronto-orbital advancement (anterior cranial vault expansion) or posterior cranial vault expansion as an early surgery in the management of syndromic craniosynostosis. MATERIALS AND METHODS A literature search was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Relevant articles were identified in 2 electronic databases (PubMed and EMBASE) from the time of electronic publication to November 2020. Quality assessment and risk of bias were appraised using the Grading of Recommendations Assessment, Development and Evaluation system. A meta-analysis was performed comparing rates of reoperation and complications between participants who underwent anterior or posterior cranial vault expansion as an early surgery. RESULTS Of 1,373 screened records, 7 met inclusion criteria. Six were included in the meta-analysis. The studies that met inclusion criteria reported on 103 patients treated with anterior techniques and 72 patients treated with a posterior approach. Anterior cranial vault expansion was associated with significantly higher rates of reoperation (Peto odds ratio = 2.83; 95% confidence interval = 1.19, 6.74, P = .02) and complications (Peto odds ratio = 2.61; 95% confidence interval = 1.12, 6.12, P = .03) than posterior cranial vault expansion. CONCLUSIONS Both anterior and posterior approaches are suitable options in the treatment of syndromic craniosynostosis depending on patient-specific factors. Anterior cranial vault expansion was associated with higher rates of unplanned reoperation and complications than posterior techniques in this analysis. Because of the paucity of literature which met inclusion criteria, this study was not able to assess critical outcome variables such as distance distracted/volumetric expansion, estimated blood loss, and cost. Larger studies evaluating both techniques under multiple institutions with long-term follow-up are indicated.
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Affiliation(s)
- Ian J Richardson
- Resident, Department of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, Louisiana State University, New Orleans, LA; Former predoctoral student, School of Dental Medicine, State University of New York at Buffalo, Buffalo, NY
| | - Lauren E Wager
- Resident, Department of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, University of Florida, College of Medicine- Jacksonville, Jacksonville, FL; Former predoctoral student, School of Dental Medicine, State University of New York at Buffalo, Buffalo, NY
| | - Matthew J Recker
- Resident in training, Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY
| | - Renée Reynolds
- Assistant professor and Residency Program Director, Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY
| | - Ramon Ruiz
- Director, Pediatric Craniomaxillofacial Surgery, Arnold Palmer Hospital for Children, Orlando, FL
| | - Michael R Markiewicz
- Professor and Chair, Department of Oral and Maxillofacial Surgery, School of Dental Medicine, University at Buffalo, Clinical Professor, Department of Neurosurgery, Division of Pediatric Surgery, Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, Attending Surgeon, Roswell Park Comprehensive Cancer Center, Co-Director, Craniofacial Center of Western New York, John Oishei Children's Hospital, Buffalo, NY.
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Wang MM, Haveles CS, Zukotynski BK, Reid RR, Lee JC. Facial Suture Pathology in Syndromic Craniosynostosis: Human and Animal Studies. Ann Plast Surg 2021; 87:589-599. [PMID: 34699435 PMCID: PMC8667083 DOI: 10.1097/sap.0000000000002822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Facial deformities in syndromic craniosynostosis are not only functionally, psychosocially, and aesthetically impairing but also notoriously challenging to reconstruct. Whether facial suture synostosis plays a significant role in the pathogenesis of these deformities is inadequately studied in human patients. METHODS The MEDLINE database was queried using a methodologically generated search term inventory. Article inclusion was adjudicated by 2 authors after independent review. Articles provided insight into facial suture involvement in either syndromic craniosynostosis patients or animal models of disease. RESULTS Comprehensive review yielded 19 relevant articles meeting inclusion criteria. Mid-20th century craniofacial biologists characterized how patent facial sutures are essential for normal postnatal facial development. They also posited that premature ossification disrupts growth vectors, causing significant dysmorphologies. Recently, facial suture synostosis was found to cause midfacial deformities independent of cranial base pathology in mouse models of syndromic craniosynostosis. Few recent studies have begun exploring facial suture involvement in patients, and although they have paved the way for future research, they bear significant limitations. CONCLUSIONS The hypothesis that facial suture synostosis acts in conjunction with cranial base pathology to produce the prominent, multifocal facial deformities in syndromic craniosynostosis may fundamentally alter surgical management and warrants further investigation. Methodically evaluating the literature, this review synthesizes all basic science and human clinical research thus far on the role of facial sutures in syndromic craniosynostosis and elucidates important topics for future research. We ultimately identify the need for rigorous imaging studies that longitudinally evaluate facial osteology across patients with various craniosynostosis syndromes.
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Affiliation(s)
- Maxwell M. Wang
- Division of Plastic and Reconstructive Surgery; University of California, Los Angeles, California
| | - Christos S. Haveles
- Division of Plastic and Reconstructive Surgery; University of California, Los Angeles, California
| | - Brian K. Zukotynski
- Division of Plastic and Reconstructive Surgery; University of California, Los Angeles, California
| | - Russell R. Reid
- Section of Plastic and Reconstructive Surgery; University of Chicago, Chicago, Illinois
| | - Justine C. Lee
- Division of Plastic and Reconstructive Surgery; University of California, Los Angeles, California
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Eisová S, Naňka O, Velemínský P, Bruner E. Craniovascular traits and braincase morphology in craniosynostotic human skulls. J Anat 2021; 239:1050-1065. [PMID: 34240418 PMCID: PMC8546506 DOI: 10.1111/joa.13506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 06/16/2021] [Accepted: 06/18/2021] [Indexed: 11/28/2022] Open
Abstract
Middle meningeal vessels, dural venous sinuses, and emissary veins leave imprints and canals in the endocranium, and thus provide evidence of vascular patterns in osteological samples. This paper investigates whether craniovascular morphology undergoes changes in craniosynostotic human skulls, and if specific alterations may reflect structural and functional relationships in the cranium. The analyzed osteological sample consists of adult individuals with craniosynostoses generally associated with dolichocephalic or brachycephalic proportions, and a control sample of anatomically normal adult skulls. The pattern and dominance of the middle meningeal artery, the morphology of the confluence of the sinuses, and the size and number of the emissary foramina were evaluated. Craniovascular morphology was more diverse in craniosynostotic skulls than in anatomically normal skulls. The craniosynostotic skulls often displayed enlarged occipito-marginal sinuses and more numerous emissary foramina. The craniosynostotic skulls associated with more brachycephalic morphology often presented enlarged emissary foramina, while the craniosynostotic skulls associated with dolichocephalic effects frequently displayed more developed posterior branches of the middle meningeal artery. The course and morphology of the middle meningeal vessels, dural venous sinuses, and emissary veins in craniosynostotic skulls can be related to the redistribution of growth forces, higher intracranial pressure, venous hypertension, or thermal constraints. These functional and structural changes are of interest in both anthropology and medicine, involving epigenetic traits that concern the functional and ontogenetic balance between soft and hard tissues.
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Affiliation(s)
- Stanislava Eisová
- Katedra antropologie a genetiky člověkaPřírodovědecká fakultaUniverzita KarlovaPragueCzech Republic
- Antropologické odděleníPřírodovědecké muzeum, Národní muzeumPragueCzech Republic
| | - Ondřej Naňka
- Anatomický ústav1. lékařská fakultaUniverzita KarlovaPragueCzech Republic
| | - Petr Velemínský
- Antropologické odděleníPřírodovědecké muzeum, Národní muzeumPragueCzech Republic
| | - Emiliano Bruner
- Programa de PaleobiologíaCentro Nacional de Investigación sobre la Evolución HumanaBurgosSpain
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Rufai SR, Hisaund M, Jeelani NUO, McLean RJ. Detection of intracranial hypertension in children using optical coherence tomography: a systematic review. BMJ Open 2021; 11:e046935. [PMID: 34380720 PMCID: PMC8359522 DOI: 10.1136/bmjopen-2020-046935] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To evaluate the diagnostic capability of optical coherence tomography (OCT) in children aged under 18 years old with intracranial hypertension (IH). DESIGN Systematic review. METHODS We conducted a systematic review using the following platforms to search the keywords 'optical coherence tomography' and 'intracranial hypertension' from inception to 2 April 2020: Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, PubMed and Web of Science, without language restrictions. Our search returned 2729 records, screened by two independent screeners. Studies were graded according to the Oxford Centre for Evidence-Based Medicine and National Institutes of Health Quality Assessment Tool for observational studies. RESULTS Twenty-one studies were included. Conditions included craniosynostosis (n=354 patients), idiopathic IH (IIH; n=102), space-occupying lesion (SOL; n=42) and other pathology (n=29). OCT measures included optic nerve parameters, rim parameters (notably retinal nerve fibre layer thickness) and retinal parameters. Levels of evidence included 2b (n=13 studies), 3b (n=4) and 4 (n=4). Quality of 10 studies was fair and 11 poor. There was inconsistency in OCT parameters and reference measures studied, although OCT did demonstrate good diagnostic capability for IH in craniosynostosis, IIH and SOL. CONCLUSIONS This systematic review identified various studies involving OCT to assist diagnosis and management of IH in children with craniosynostosis, IIH, SOL and other pathology, in conjunction with established clinical measures of intracranial pressure. However, no level 1 evidence was identified. Validating prospective studies are, therefore, required to determine optimal OCT parameters in this role and to develop formal clinical guidelines. PROSPERO REGISTRATION NUMBER CRD42019154254.
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Affiliation(s)
- Sohaib R Rufai
- University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, UK
- UCL Great Ormond Street Institute of Child Health and Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children, London, UK
| | - Michael Hisaund
- University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, UK
| | - Noor Ul Owase Jeelani
- UCL Great Ormond Street Institute of Child Health and Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - Rebecca J McLean
- University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, UK
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Deliège L, Misier KR, Bozkurt S, Breakey W, James G, Ong J, Dunaway D, Jeelani NUO, Schievano S, Borghi A. Validation of an in-silico modelling platform for outcome prediction in spring assisted posterior vault expansion. Clin Biomech (Bristol, Avon) 2021; 88:105424. [PMID: 34303069 DOI: 10.1016/j.clinbiomech.2021.105424] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/05/2021] [Accepted: 07/07/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Spring-Assisted Posterior Vault Expansion has been adopted at Great Ormond Street Hospital for Children, London, UK to treat raised intracranial pressure in patients affected by syndromic craniosynostosis, a congenital calvarial anomaly which causes premature fusion of skull sutures. This procedure aims at normalising head shape and augmenting intracranial volume by means of metallic springs which expand the back portion of the skull. The aim of this study is to create and validate a 3D numerical model able to predict the outcome of spring cranioplasty in patients affected by syndromic craniosynostosis, suitable for clinical adoption for preoperative surgical planning. METHODS Retrospective spring expansion measurements retrieved from x-ray images of 50 patients were used to tune the skull viscoelastic properties for syndromic cases. Pre-operative computed tomography (CT) data relative to 14 patients were processed to extract patient-specific skull shape, replicate surgical cuts and simulate spring insertion. For each patient, the predicted finite element post-operative skull shape model was compared with the respective post-operative 3D CT data. FINDINGS The comparison of the sagittal and transverse cross-sections of the simulated end-of-expansion calvaria and the post-operative skull shapes extracted from CT images showed a good shape matching for the whole population. The finite element model compared well in terms of post-operative intracranial volume prediction (R2 = 0.92, p < 0.0001). INTERPRETATION These preliminary results show that Finite Element Modelling has great potential for outcome prediction of spring assisted posterior vault expansion. Further optimisation will make it suitable for clinical deployment.
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Affiliation(s)
- Lara Deliège
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.
| | - Karan Ramdat Misier
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Selim Bozkurt
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - William Breakey
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Greg James
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Juling Ong
- Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK
| | - David Dunaway
- Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK
| | - N U Owase Jeelani
- Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK
| | - Silvia Schievano
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Alessandro Borghi
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
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Dibbs RP, Beh HZ, Donoho DA, Davies LW, Ferry AM, Bauer DF, Buchanan EP. Late Presenting Multi-Suture Craniosynostosis. J Craniofac Surg 2021; 33:e34-e37. [PMID: 34292251 DOI: 10.1097/scs.0000000000007888] [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 authors provide the case of a 6-year-old male who presented late with multi-suture craniosynostosis and chronically elevated intracranial pressures (ICPs). He was surgically managed with frontal orbital advancement. This particular case illustrates the significant bleeding and unique bony pathology that can occur in patients with high ICP with concomitant venous collateralization. At 1-month follow-up, he demonstrated significant improvement with maintained expansion and no signs of elevated ICP despite delayed intervention. Frontal orbital advancement serves as an effective method for cranial vault expansion and correction of frontal deformities caused by craniosynostosis.
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Affiliation(s)
- Rami P Dibbs
- Division of Plastic Surgery, Texas Children's Hospital Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine Department of Neurosurgery, Texas Children's Hospital, Houston, TX
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Abstract
Importance Craniosynostosis is a fetal condition caused by premature closure of the cranial sutures. Through provider awareness, we can raise suspicion in high-risk individuals, increase prenatal detection, optimize genetic testing, perform appropriate antenatal surveillance and delivery planning, and allow for a comprehensive, multidisciplinary approach to treatment. Objective The aim of this study was to review what is currently known regarding the genetics, pathophysiology, diagnosis, and treatment of craniosynostosis for the obstetric care provider. Evidence Acquisition A comprehensive literature review was performed using the PubMed database with the search term "craniosynostosis." The search was limited to the English language. Results A total of 220 articles were identified, and a total of 53 were used in completion of this article. The results highlight the multiple factors involved with abnormal suture formation, including various genetic factors. Although rare at this time, prenatal detection can allow families to prepare and practitioners to provide appropriate clinical treatment. Both 3-dimensional sonography and magnetic resonance imaging have been identified as modalities to aid in detection for high-risk individuals. Early referral allows for less-invasive surgical outcomes with lower complication rates. Results Familiarity with craniosynostosis among obstetric providers can improve patient counseling, prenatal detection rates, and appropriate antepartum, intrapartum, and postpartum counseling.
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Rufai SR, Bowman R, Bunce C, Panteli V, McLean RJ, Teli S, Gottlob I, Thomas MG, Jeelani NUO, Proudlock FA. Feasibility and Repeatability of Handheld Optical Coherence Tomography in Children With Craniosynostosis. Transl Vis Sci Technol 2021; 10:24. [PMID: 34313724 PMCID: PMC8322722 DOI: 10.1167/tvst.10.8.24] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/11/2021] [Indexed: 12/13/2022] Open
Abstract
Purpose To determine whether handheld optical coherence tomography (OCT) is feasible and repeatable in children with craniosynostosis. Methods This was a prospective cross-sectional study. Children with syndromic and non-syndromic craniosynostosis 0 to 18 years of age were recruited between February 13, 2020, and October 1, 2020. Main outcome measures included feasibility (patient recruitment and handheld OCT success rates) and repeatability, which were assessed using intraclass correlation coefficients (ICCs) where repeated images of the optic nerve head (ONH) within the same visit were available. ONH parameters used for repeatability analysis included cup depth, width, and area; disc width; rim height; retinal thickness; retinal nerve fiber layer thickness; and Bruch's membrane opening minimum rim width. Results Fifty children were approached, and all 50 (100%) were successfully recruited. Median age was 51.1 months (range, 1.9-156.9; interquartile range, 37.0-74.2), and 33 of the children (66%) were male. At least one ONH image was obtained in 43 children (86%), and bilateral ONH imaging was successful in 38 children (76%). Factors boosting the likelihood of success included good understanding and cooperation of the child and parent/guardian and availability of an assistant. Repeatability analysis was performed in 20 children, demonstrating good repeatability (ICC range, 0.77-0.99; the majority exceeded 0.90). OCT correctly identified two cases of intracranial hypertension, one of which was undetected by prior fundoscopy. Conclusions Handheld OCT is feasible and repeatable in children with syndromic and non-syndromic forms of craniosynostosis. Translational Relevance Our handheld OCT approach could be used for the clinical surveillance of children with craniosynostosis.
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Affiliation(s)
- Sohaib R. Rufai
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
- The University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, UK
- Craniofacial Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Richard Bowman
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Catey Bunce
- Clinical Trials Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Vasiliki Panteli
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Rebecca J. McLean
- The University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, UK
| | - Seema Teli
- The University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, UK
| | - Irene Gottlob
- The University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, UK
| | - Mervyn G. Thomas
- The University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, UK
| | - Noor ul Owase Jeelani
- UCL Great Ormond Street Institute of Child Health, London, UK
- Craniofacial Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Frank A. Proudlock
- The University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, UK
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Tripathi T, Srivastava D, Bhutiani N, Rai P. Comprehensive management of Crouzon syndrome: A case report with three-year follow-up. J Orthod 2021; 49:71-78. [PMID: 34100307 DOI: 10.1177/14653125211019412] [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: 11/15/2022]
Abstract
Crouzon syndrome is one of the most common craniosynostosis facial syndromes caused by a mutation in the fibroblast growth factor receptor 2 (FGFR2) gene. Less commonly, there is a mutation of the FGFR3 gene which results in Crouzon syndrome syndrome with acanthosis nigricans. It involves the premature fusion of sutures of the cranial vault, base, orbital and maxillary region. The clinical presentation of this congenital deformity depends on the pattern and timing of sutural fusion. The present report describes the features and management of this syndrome in an 18-year-old woman. The patient presented with a hypoplastic maxilla, deficient midface, exorbitism due to shallow orbits, severe crowding and bilateral crossbite. A multidisciplinary approach involving orthodontics and surgical intervention with distraction osteogenesis brought about marked improvement in the facial profile, occlusion and upper airway. The aesthetics and function were greatly enhanced, and the results were found to be stable at the end of three years.
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Affiliation(s)
- Tulika Tripathi
- Department of Orthodontics and Dentofacial Orthopedics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Dhirendra Srivastava
- Oral and Maxillofacial Surgery, Esic Dental College and Hospital, New Delhi, India
| | - Neha Bhutiani
- Department of Orthodontics and Dentofacial Orthopedics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Priyank Rai
- Department of Orthodontics and Dentofacial Orthopedics, Maulana Azad Institute of Dental Sciences, New Delhi, India
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Kamel GN, Carbulido MK, McKee RM, Segal RM, Ewing E, Brandel MG, Lance SH, Gosman AA. Analysis of Actual Versus Predicated Intracranial Volume Changes for Distraction Osteogenesis Using Virtual Surgical Planning in Patients With Craniosynostosis. Ann Plast Surg 2021; 86:S374-S378. [PMID: 33625026 DOI: 10.1097/sap.0000000000002759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The primary outcome metric in patients with craniosynostosis are changes in intracranial volumes (ICVs). In patients who undergo distraction osteogenesis (DO) to treat craniosynostosis, changes are also dependent on the length of distraction. Virtual surgical planning (VSP) has been used to predict anticipated changes in ICV during cranial vault reconstruction. The purpose of this study is to analyze the actual versus predicted ICV changes using VSP in patients who undergo DO for craniosynostosis management. METHODS All patients with craniosynostosis treated with DO at a single institution, Rady Children's Hospital, between December 2013 and May 2019 were identified. Inclusion criteria are as follows: VSP planning with predicted postoperative ICV values and preoperative and postdistraction CT scans to quantify ICV. Postoperative ICV and VSP-estimated ICV were adjusted for age-related ICV growth. The primary outcome measure calculated was age-adjusted percent volume change per millimeter distraction (PVCPD), and results were analyzed using paired Wilcoxon signed rank tests. RESULTS Twenty-seven patients underwent DO for cranial vault remodeling. Nineteen patients were nonsyndromic, and 8 patients were syndromic. The median postoperative PVCPD was 0.30%/mm, and the median VSP-estimated PVCPD was 0.36% per millimeter (P < 0.001). A subanalysis of nonsyndromic patients showed a median postoperative PVCPD of 0.29%/mm in nonsyndromic patients that differed significantly from the VSP estimate of 0.34%/mm (P = 0.003). There was also a significant difference in syndromic patients' observed PVCPD of 0.41%/mm versus VSP estimate of 0.79%/mm (P = 0.012). CONCLUSIONS Virtual surgical planning overestimates the change in ICV attributable to DO in both syndromic and nonsyndromic patients.
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Nguyen TN, Hoang HD. Exome sequencing revealed the potential causal mutation in a Vietnamese patient with Apert syndrome. GENE REPORTS 2021. [DOI: 10.1016/j.genrep.2020.100995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ferry AM, Dibbs RP, Sarrami SM, Abu-Ghname A, Beh HZ, Maricevich RS, Buchanan EP. Pediatric Fronto-Orbital Skull Reconstruction. Facial Plast Surg 2021; 37:771-780. [PMID: 33525031 DOI: 10.1055/s-0041-1722920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Craniofacial surgery in children is a highly challenging discipline that requires extensive knowledge of craniofacial anatomy and pathology. Insults to the fronto-orbital skeleton have the potential to inflict significant morbidity and even mortality in patients due to its proximity to the central nervous system. In addition, significant aesthetic and ophthalmologic disturbances frequently accompany these insults. Craniosynostosis, facial trauma, and craniofacial tumors are all pathologies that frequently affect the fronto-orbital region of the craniofacial skeleton in children. While the mechanisms of these pathologies vary greatly, the underlying principles of reconstruction remain the same. Despite the limited data in certain areas of fronto-orbital reconstruction in children, significant innovations have greatly improved its safety and efficacy. It is imperative that further investigations of fronto-orbital reconstruction are undertaken so that craniofacial surgeons may provide optimal care for these patients.
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Affiliation(s)
- Andrew M Ferry
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Rami P Dibbs
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Shayan M Sarrami
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Amjed Abu-Ghname
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Han Zhuang Beh
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Renata S Maricevich
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Edward P Buchanan
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
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Rufai SR, Jeelani NUO, McLean RJ. Early Recognition of Raised Intracranial Pressure in Craniosynostosis Using Optical Coherence Tomography. J Craniofac Surg 2021; 32:201-205. [PMID: 33185414 PMCID: PMC7769183 DOI: 10.1097/scs.0000000000006771] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 05/14/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Craniosynostosis can be associated with raised intracranial pressure (ICP), which can pose deleterious effects on the brain and vision if untreated. Estimating ICP in children is challenging, whilst gold standard direct intracranial measurement of ICP is invasive and carries risk. This systematic review aims to evaluate the role of optical coherence tomography (OCT), a noninvasive imaging technique, for detecting raised ICP in children with craniosynostosis. METHODS The authors conducted a systematic review of the literature published from inception until 19 August, 2019 in the Cochrane Central Register of Controlled Trials, PubMed, MEDLINE, and EMBASE. Eligible studies evaluated the role of OCT in detecting raised ICP in children aged 0 to 16 years with craniosynostosis. Main outcome measures were sensitivity and specificity of OCT parameters for raised ICP. Quality assessment was performed using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-sectional Studies. RESULTS Out of 318 records identified, data meeting the inclusion criteria were obtained from 3 studies. The quality of 2 studies was poor whilst 1 was fair. Optical coherence tomography demonstrated higher sensitivity and specificity for detecting raised ICP compared to fundus examination, clinical history, radiological testing, and visual field testing. CONCLUSIONS This systematic review demonstrated a lack of quality evidence for OCT as a screening tool for children with craniosynostosis. Further research is required to clarify the strength of OCT in this role and to determine which OCT parameters are most appropriate.
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Affiliation(s)
- Sohaib R. Rufai
- University of Leicester Ulverscroft Eye Unit, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, Leicester
- Clinical and Academic Department of Ophthalmology
| | - Noor ul Owase Jeelani
- Department of Neurosurgery, Great Ormond Street Hospital for Children NHS Trust, London
- Developmental Biology & Cancer Department, UCL GOS Institute of Child Health, Faculty of Population Health Sciences, UCL, London, UK
| | - Rebecca J. McLean
- University of Leicester Ulverscroft Eye Unit, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, Leicester
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Abdelhamid K, Konci R, ElHawary H, Gorgy A, Smith L. Advanced parental age: Is it contributing to an increased incidence of non-syndromic craniosynostosis? A review of case-control studies. J Oral Biol Craniofac Res 2020; 11:78-83. [PMID: 33376670 DOI: 10.1016/j.jobcr.2020.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/17/2020] [Accepted: 11/24/2020] [Indexed: 11/30/2022] Open
Abstract
Background Craniosynostosis (CS) is a congenital birth defect characterized by the premature fusion of one or several calvarial suture(s). CS could lead to serious complications, such as intracranial hypertension and neurodevelopmental impairment. There is an increasing trend in the prevalence of CS - 75% of which are of non-syndromic type (NSCS). In parallel, there is a steady rise in the average maternal age. The goal of this paper was to review the literature to clearly identify any associations between parental age and NSCS. This review was performed and reported in compliance with PRISMA guidelines. Methods The PUBMED and EMBASE databases were systematically searched, and all studies that observed the relationship between maternal and/or paternal age on NSCS were included. The articles were then assessed for methodological quality using the Newcastle-Ottawa Scale (NOS). The effect of advanced maternal and/or paternal age on the incidence of NSCS was identified by the prevalence ratios reported at a confidence interval of 95%. Results Six retrospective case-control studies, reporting on a total of 3267 cases of NSCS were included in this review. While there were some inconsistencies in the findings of the different studies, the majority reported a positive correlation between advanced maternal and/or paternal age and an increased incidence of NSCS. Conclusion This review identified an association between advanced parental age and an increased incidence of NSCS.
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Affiliation(s)
- Kenzy Abdelhamid
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Rea Konci
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
| | - Hassan ElHawary
- Division of Plastic and Reconstructive Surgery, McGill University, Montreal, Quebec, Canada
| | - Andrew Gorgy
- Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
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Abstract
ABSTRACT Crouzon syndrome is a known craniosynostosis syndrome with a heterogenous presentation. Suture closure can rapidly develop postnatally and involve multiple sutures, requiring vigilant clinical monitoring to prevent delay in diagnosis and developing intracranial hypertension. The authors present the case of a male patient with Crouzon syndrome who developed postnatal pansynostosis at 18 months of age when several missed appointments led to diagnosis after complete closure of all sutures and signs of elevated intracranial pressure. Posterior cranial vault distraction was performed soon after, and the patient improved clinically. There is a need for improved monitoring and management of these patients to prevent delay in diagnosis and potential permanent sequelae as well as minimizing radiation exposure through watchful CT scanning.
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Gandhoke CS, Syal SK, Sharma A, Srivastava AK, Singh D. Craniosynostosis: To Study the Spectrum and Outcome of Surgical Intervention at a Tertiary Referral Institute in India. J Pediatr Neurosci 2020; 15:72-80. [PMID: 33042234 PMCID: PMC7519732 DOI: 10.4103/jpn.jpn_101_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/04/2019] [Accepted: 10/30/2019] [Indexed: 11/23/2022] Open
Abstract
Aims and Objectives: This study aimed to analyze the spectrum and surgical outcome of cases of craniosynostosis operated at a tertiary referral institute in India Design: This was a cross-sectional study. Materials and Methods: We retrospectively examined 60 cases of craniosynostosis operated at our institute from 2008 to 2014 (with a minimum follow-up of 2 years). Data was collected including name, age, gender, involved sutures, other medical conditions, whether syndromic craniosynostosis or not, whether symptoms and signs of intracranial hypertension were present or not, associated findings on magnetic resonance imaging of brain and cervico-medullary junction, type of surgery performed, age at which surgery was performed, perioperative complications (if any), and findings on follow-up. To be able to analyze the surgical results, we used the seven category classification system used by Sloan et al. Results: Craniosynostosis affected more men than women. The incidence of syndromic craniosynostosis was 11.67%. Mean age at first surgery was 3.85 years. Chiari malformation was present in 80% of the Crouzon’s syndrome cases, 62.5% of the oxycephaly cases, and 4.44% of the non-syndromic, non-oxycephaly cases. Intracranial hypertension was present in 80% of the Crouzon’s syndrome cases, 75% of the oxycephaly cases, and 6.67% of the non-syndromic, non-oxycephaly cases. Perioperative complications were present in 42.86% of the syndromic craniosynostosis cases, 50% of the oxycephaly cases, and 15.56% of the non-syndromic, non-oxycephaly cases. Compromised overall correction was present in 4 of 7 cases of syndromic craniosynostosis, 3 of 8 cases of oxycephaly, and 2 of 45 cases of non-syndromic, non-oxycephaly group. Conclusion: The study highlights the importance of educating the masses so that cases of craniosynostosis present early. The incidence of Chiari malformation, intracranial hypertension, and perioperative complications was significantly higher in the syndromic craniosynostosis and oxycephaly groups than in single-suture craniosynostosis. The best surgical outcome and the least perioperative complications were seen in the trigonocephaly group. Compromised overall correction and reoperations were more common in the syndromic and complex craniosynostosis groups than in single-suture craniosynostosis.
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Affiliation(s)
- Charandeep S Gandhoke
- Department of Neurosurgery, Maulana Azad Medical College, Lok Nayak Jai Prakash Narayan Hospital, Guru Nanak Eye Centre and Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Simran K Syal
- Department of Paediatrics, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India
| | - Ajay Sharma
- Department of Neurosurgery, Maulana Azad Medical College, Lok Nayak Jai Prakash Narayan Hospital, Guru Nanak Eye Centre and Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Arvind K Srivastava
- Department of Neurosurgery, Maulana Azad Medical College, Lok Nayak Jai Prakash Narayan Hospital, Guru Nanak Eye Centre and Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Daljit Singh
- Department of Neurosurgery, Maulana Azad Medical College, Lok Nayak Jai Prakash Narayan Hospital, Guru Nanak Eye Centre and Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
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Öwall L, Darvann TA, Hove HB, Heliövaara A, Dunø M, Kreiborg S, Hermann NV. Facial Asymmetry in Nonsyndromic and Muenke Syndrome-Associated Unicoronal Synostosis: A 3-Dimensional Study Based on Facial Surfaces Extracted From CT Scans. Cleft Palate Craniofac J 2020; 58:687-696. [PMID: 32969272 DOI: 10.1177/1055665620959983] [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: 11/15/2022] Open
Abstract
OBJECTIVE To quantify soft tissue facial asymmetry (FA) in children with nonsyndromic and Muenke syndrome-associated unicoronal synostosis (NS-UCS and MS-UCS), hypothesizing that MS-UCS presents with significantly larger FA than NS-UCS. DESIGN Retrospective cohort study. PATIENTS AND METHODS Twenty-one children (mean age: 0.6 years; range: 0.1-1.4 years) were included in the study (NS-UCS = 14; MS-UCS = 7). From presurgical computed tomography scans, facial surfaces were constructed for analysis. A landmark guided atlas was deformed to match each patient's surface, obtaining spatially detailed left-right point correspondence. Facial asymmetry was calculated in each surface point across the face, as the length (mm) of an asymmetry vector, with its Cartesian components providing 3 directions. Mean FA was calculated for the full face, and the forehead, eye, nose, cheek, mouth, and chin regions. RESULTS For the full face, a significant difference of 2.4 mm (P = .001) was calculated between the 2 groups, predominately in the transverse direction (1.5 mm; P < .001). The forehead and chin regions presented with the largest significant difference, 3.5 mm (P = .002) and 3.2 mm (P < .001), respectively; followed by the eye (2.4 mm; P = .004), cheek (2.2 mm; P = .004), nose (1.7 mm; P = .001), and mouth (1.4 mm; P = .009) regions. The transverse direction presented with the largest significant difference in the forehead, chin, mouth, and nose regions, the sagittal direction in the cheek region, and the vertical direction in the eye region. CONCLUSIONS Muenke syndrome-associated unicoronal synostosis presented with significantly larger FA in all regions compared to NS-UCS. The largest significant differences were found in the forehead and chin regions, predominantly in the transverse direction.
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Affiliation(s)
- Louise Öwall
- 3D Craniofacial Image Research Laboratory (School of Dentistry, University of Copenhagen, Center of Head and Orthopedics, Copenhagen University Hospital Rigshospitalet, and DTU Compute, Technical University of Denmark), Copenhagen, Denmark
| | - Tron A Darvann
- 3D Craniofacial Image Research Laboratory (School of Dentistry, University of Copenhagen, Center of Head and Orthopedics, Copenhagen University Hospital Rigshospitalet, and DTU Compute, Technical University of Denmark), Copenhagen, Denmark.,Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Hanne B Hove
- Center for Rare Diseases, Department of Pediatrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,The RAREDIS Database, Center for Rare Diseases, Department of Pediatrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Arja Heliövaara
- Cleft Palate and Craniofacial Center, Department of Plastic Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Morten Dunø
- Center for Rare Diseases, Department of Clinical Genetics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Sven Kreiborg
- 3D Craniofacial Image Research Laboratory (School of Dentistry, University of Copenhagen, Center of Head and Orthopedics, Copenhagen University Hospital Rigshospitalet, and DTU Compute, Technical University of Denmark), Copenhagen, Denmark.,Department of Pediatric Dentistry and Clinical Genetics, School of Dentistry, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Nuno V Hermann
- 3D Craniofacial Image Research Laboratory (School of Dentistry, University of Copenhagen, Center of Head and Orthopedics, Copenhagen University Hospital Rigshospitalet, and DTU Compute, Technical University of Denmark), Copenhagen, Denmark.,Department of Pediatric Dentistry and Clinical Genetics, School of Dentistry, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
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Rufai SR, Jeelani NUO, McLean RJ. Detection of intracranial hypertension in children using optical coherence tomography: a systematic review protocol. BMJ Open 2020; 10:e037833. [PMID: 32636287 PMCID: PMC7342863 DOI: 10.1136/bmjopen-2020-037833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Intracranial hypertension (ICH) in children can have deleterious effects on the brain and vision. It is notoriously difficult to estimate intracranial pressure (ICP) in children and existing methods deliver suboptimal diagnostic accuracy to be used as screening tools. Optical coherence tomography (OCT) may represent a valuable, non-invasive surrogate measure of ICP, as has been demonstrated in a number of associated conditions affecting adults. More recently, OCT has been employed within the paediatric age group. However, the role of OCT in detecting ICH in children has not been rigorously assessed in a systematic review for all relevant conditions. Here, we propose a systematic review protocol to examine the role of OCT in the detection of ICH in children. METHODS AND ANALYSIS Electronic searches in the Cochrane Central Register of Controlled Trials, Medline, Embase, Web of Science and PubMed will identify studies featuring OCT in detecting ICH in children. Two independent screeners will identify studies for inclusion using a screening questionnaire. The systematic search and screening will take place between 2 April 2020 and 1 June 2020, while we aim to complete data analysis by 1 September 2020. Quality assessment will be performed using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. The primary outcome measure is the sensitivity and specificity of OCT in detecting ICH in children. Secondary outcomes measures include conditions associated with ICH per study, direct ICP monitoring, sensitivity and specificity of other measures for ICP and OCT parameters used. ETHICS AND DISSEMINATION Ethical approval is not required for the proposed systematic review as no primary data will be collected. The findings will be disseminated through presentations at scientific meetings and peer-reviewed journal publication. PROSPERO REGISTRATION NUMBER CRD42019154254.
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Affiliation(s)
- Sohaib R Rufai
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children, London, United Kingdom
- University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Noor Ul Owase Jeelani
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, United Kingdom
- Developmental Biology & Cancer Dept, UCL GOS Institute of Child Health, London, United Kingdom
| | - Rebecca J McLean
- University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, United Kingdom
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Craniosynostosis in an Indian Scenario: A Long-term Follow-up. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2696. [PMID: 32537352 PMCID: PMC7253269 DOI: 10.1097/gox.0000000000002696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 01/17/2020] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is available in the text. Craniofacial surgery as a subspecialty has finally taken off in India. Young plastic surgeons in the early 1990s became fascinated by its enormous scope. The author was also among the lucky ones to be trained in this field with Dr. Ian Jackson at the Craniofacial Center at Southfield, Michigan, from 1993-1994. This facility for craniofacial surgery was established in the North Indian tertiary care hospital at the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, in 1995.
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Liu T, Liu G, Jiang S, Hu Y, Zhang M, Liu X. A novel therapeutic hypothesis for craniosynostosis syndromes: Clover to clever. Med Hypotheses 2020; 144:109837. [PMID: 32512489 DOI: 10.1016/j.mehy.2020.109837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 04/23/2020] [Accepted: 05/11/2020] [Indexed: 02/08/2023]
Abstract
Cloverleaf skull is a complex skull deformity named after its cloverleaf shape. The primary pathogenic factor is craniosynostosis. Craniosynostosis could result in limited development of skull, brain, maxillofacial and nervous system, thus arising a series of complex syndromes, including Crouzon, Apert, Pfeiffer, Saethre-Chotzen and Muenke syndromes. Craniosynostosis syndromes exhibit a group of similar symptoms because of the mutual cause, craniosynostosis, with Crouzon syndrome being the most common one. At present, the surgical approach for Craniosynostosis syndromes has been established and generally accepted, including a series of surgical interventions in stages according to patients' age, severity and function of skull malformation. It's a large, complex, long time span deformity correcting procedure with formidable limitations, including high risk, expensive cost, quantity shortage of qualified surgeons and unsatisfactory successful rate for complicated cases. Hence, a new nonsurgical therapy for patients with craniosynostosis syndromes is seriously needed. A concept of Dynamic Cranial Suture Management (DCSM) was introduced. It includes objective and evaluable monitoring tools and craniosynostosis patent modifying drugs or medications tools which consist of regulatory factors for osteoclasts, osteoblasts and mesenchymal stem cells. By using these tools alternatively in different skull developing stages, DCSM is designed to prevent craniosynostosis. A Crouzon syndrome case was also presented.
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Affiliation(s)
- Tiannan Liu
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Guo Liu
- Shenzhen Key Laboratory of Ophthalmology, Shenzhen Eye Hospital, School of Optometry, Shenzhen University, Shenzhen, China
| | - Shanming Jiang
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yue Hu
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Meixia Zhang
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu 610041, China.
| | - Xuyang Liu
- Shenzhen Key Laboratory of Ophthalmology, Shenzhen Eye Hospital, School of Optometry, Shenzhen University, Shenzhen, China; Xiamen Eye Center, Xiamen University, Xiamen, China.
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Orbito-facial dysmorphology in patients with different degrees of trigonocephaly severity: quantitative morpho-volumetric analysis in infants with non-syndromic metopic craniosynostosis. Childs Nerv Syst 2020; 36:1263-1273. [PMID: 31845029 DOI: 10.1007/s00381-019-04456-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 11/27/2019] [Indexed: 01/13/2023]
Abstract
PURPOSE Craniofacial dysmorphology varies significantly along a wide spectrum of severity in metopic cranial synostosis (MCS). This study aimed to quantify craniofacial changes, in MCS, to investigate their relationships with the severity of trigonocephaly. METHODS By combining the metopic ridge and interfrontal angles, we identified three groups of trigonocephaly severity (mild group n.14, moderate group n.19, severe group n.18). We perform a quantitative analysis using high-resolution CT images evaluating (1) cranial fossae dimensions; (2) vault indices and ratios: interparietal/ intercoronal (IPD/ICD), interparietal/intertemporal (IPD/ITD), cephalic index, vertico-longitudinal index; (3) orbito-facial distances (midfacial depth, maxillary height, upper facial index, orbital distances, globe protrusions), maxilla and orbital volumes; (4) supratentorial (ICV) and infratentorial (PCFV) cranial volumes and supratentorial (WBV) and infratentorial (PCFBV) brain volumes. RESULTS In all groups, middle skull base lengths and upper midface index were increased. In moderate and severe groups: anterior hemifossa lengths were reduced, IPD/ICD and vertico-longitudinal index were changed; midfacial depth, anterior, mild, and lateral interorbital distances were reduced; globe protrusions were increased. The comparison between moderate and severe groups showed an increase of both globe protrusions and IPD/ICD. Among all groups, ICV and WBV were reduced in the severe group. CONCLUSION This morpho-volumetric study provides new insights in understanding the craniofacial changes occurring in infants at different severity of trigonocephaly. The increase of globe protrusions and the reduction of supratentorial volumes found in the severe group reflect the severity of trigonocephaly; these findings might have a clinical and surgical relevance.
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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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Wu T, Reese P, Lee JC, Kerayechian N, Martz M, Solem RC. Orthodontic and surgical treatment of facial asymmetry in a patient with unicoronal craniosynostosis. Am J Orthod Dentofacial Orthop 2020; 157:259-268. [PMID: 32005478 DOI: 10.1016/j.ajodo.2018.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 08/01/2018] [Accepted: 10/01/2018] [Indexed: 11/28/2022]
Abstract
This case report presents the unique treatment of a patient with varying asymmetries at different levels within the face. The patient was a 17-year-old male with a diagnosis of right unilateral coronal synostosis. He had frontal and superior orbital retrusion on the fused side, and bossing of the contralateral side. The middle and lower portions of his face were rotated toward the nonfused side. This unique diagnosis presented particular challenges to surgical and orthodontic correction. The treatment approach, which included a combination of Le Fort I and II osteotomies, bilateral sagittal split osteotomy, and orthodontic treatment with 4 premolar extractions, enabled simultaneous correction of nasal, midfacial, lower facial, and dental asymmetries. The orthodontist and surgeon integrated their efforts to correct dentofacial asymmetry in all 3 planes of space. Facial esthetics and dental function were significantly improved with no appreciable relapse occurring over a 2-year retention period.
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Affiliation(s)
- Tingxi Wu
- Formerly, Department of Orthodontics, School of Dental Medicine, University at Buffalo, State University of New York, Buffalo, NY; Currently, The Forsyth Institute, Cambridge, Mass
| | - Patricia Reese
- Section of Orthodontics, School of Dentistry, University of California, Los Angeles, Los Angeles, Calif
| | - Justine C Lee
- Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, Calif
| | - Navid Kerayechian
- Section of Orthodontics, School of Dentistry, University of California, Los Angeles, Los Angeles, Calif
| | - Martin Martz
- Section of Orthodontics, School of Dentistry, University of California, Los Angeles, Los Angeles, Calif
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Aldersey JE, Sonstegard TS, Williams JL, Bottema CDK. Understanding the effects of the bovine POLLED variants. Anim Genet 2020; 51:166-176. [PMID: 31999853 DOI: 10.1111/age.12915] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2020] [Indexed: 12/31/2022]
Abstract
Horns are paired appendages on the head of bovine species, comprising an inner bony core and outer keratin sheath. The horn bud forms during early fetal development but ossification of the developing horn does not occur until approximately 1 month after birth. Little is known about the genetic pathways that lead to horn growth. Hornless, or polled, animals are found in all domestic bovids. Histological studies of bovine fetuses have shown that the horn bud does not form in polled individuals. There are currently four known genetic variants for polledness in cattle on BTA1. All of the variants are intergenic, but probably affect regulation of nearby genes or long non-coding RNAs. Transcriptomic studies suggest that the expression of two nearby long non-coding RNAs are affected by the Celtic POLLED variant, but further studies are required to confirm these data. Candidate genes located elsewhere in the genome are involved in regulating bone formation and epithelial-to-mesenchymal transition. Expression of one of these candidate genes, RXFP2, appears to be reduced in the fetal horn bud of polled animals carrying the Celtic variant compared with horned individuals. Investigating horn ontogenesis and the genetic pathway by which the POLLED variants prevent horn development has implications for cattle breeding. If the genetic basis of horn bud formation and polledness is better understood, then new targets may be identified for precision genome editing to create polled individuals.
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Affiliation(s)
- J E Aldersey
- Davies Research Centre, School of Animal and Veterinary Sciences, University of Adelaide, Roseworthy Campus, Adelaide, SA, 5371, Australia
| | | | - J L Williams
- Davies Research Centre, School of Animal and Veterinary Sciences, University of Adelaide, Roseworthy Campus, Adelaide, SA, 5371, Australia
| | - C D K Bottema
- Davies Research Centre, School of Animal and Veterinary Sciences, University of Adelaide, Roseworthy Campus, Adelaide, SA, 5371, Australia
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Couloigner V, Ayari Khalfallah S. Craniosynostosis and ENT. Neurochirurgie 2019; 65:318-321. [DOI: 10.1016/j.neuchi.2019.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 09/18/2019] [Accepted: 09/19/2019] [Indexed: 10/25/2022]
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Bariana M, Kaidonis JA, Losic D, Ranjitkar S, Anderson PJ. Titania nanotube-based protein delivery system to inhibit cranial bone regeneration in Crouzon model of craniosynostosis. Int J Nanomedicine 2019; 14:6313-6324. [PMID: 31496688 PMCID: PMC6690047 DOI: 10.2147/ijn.s202090] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 06/27/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Craniosynostosis is a developmental disorder characterized by the premature fusion of skull sutures, necessitating repetitive, high-risk neurosurgical interventions throughout infancy. This study used protein-releasing Titania nanotubular implant (TNT/Ti) loaded with glypican 3 (GPC3) in the cranial critical-sized defects (CSDs) in Crouzon murine model (Fgfr2c342y/+ knock-in mutation) to address a key challenge of delaying post-operative bone regeneration in craniosynostosis. MATERIALS AND METHODS A 3 mm wide circular CSD was created in two murine models of Crouzon syndrome: (i) surgical control (CSDs without TNT/Ti or any protein, n=6) and (ii) experimental groups with TNT/Ti loaded with GPC3, further subdivided into the presence or absence of chitosan coating (on nanotubes) (n=12 in each group). The bone volume percentage in CSDs was assessed 90 days post-implantation using micro-computed tomography (micro-CT) and histological analysis. RESULTS Nano-implants retrieved after 90 days post-operatively depicted well-adhered, hexagonally arranged, and densely packed nanotubes with average diameter of 120±10 nm. The nanotubular architecture was generally well-preserved. Compared with the control bone volume percentage data (without GPC3), GPC3-loaded TNT/Ti without chitosan coating displayed a significantly lower volume percent in cranial CSDs (P<0.001). Histological assessment showed relatively less bone regeneration (healing) in GPC3-loaded CSDs than control CSDs. CONCLUSION The finding of inhibition of cranial bone regeneration by GPC3-loaded TNT/Ti in vivo is an important advance in the novel field of minimally-invasive craniosynostosis therapy and holds the prospect of altering the whole paradigm of treatment for affected children. Future animal studies on a larger sample are indicated to refine the dosage and duration of drug delivery across different ages and both sexes with the view to undertake human clinical trials.
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Affiliation(s)
- Manpreet Bariana
- Adelaide Dental School, The University of Adelaide, Adelaide, SA5005, Australia
| | - John A Kaidonis
- Adelaide Dental School, The University of Adelaide, Adelaide, SA5005, Australia
| | - Dusan Losic
- School of Chemical Engineering, The University of Adelaide, Adelaide, SA5005, Australia
| | - Sarbin Ranjitkar
- Adelaide Dental School, The University of Adelaide, Adelaide, SA5005, Australia
| | - Peter J Anderson
- Adelaide Dental School, The University of Adelaide, Adelaide, SA5005, Australia
- Australian Craniofacial Unit
, Adelaide, SA5006, Australia
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Posterior Vault Distraction in Multisuture Synostosis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2274. [PMID: 31942329 PMCID: PMC6952159 DOI: 10.1097/gox.0000000000002274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 04/08/2019] [Indexed: 11/26/2022]
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Shin HR, Bae HS, Kim BS, Yoon HI, Cho YD, Kim WJ, Choi KY, Lee YS, Woo KM, Baek JH, Ryoo HM. PIN1 is a new therapeutic target of craniosynostosis. Hum Mol Genet 2019; 27:3827-3839. [PMID: 30007339 PMCID: PMC6216213 DOI: 10.1093/hmg/ddy252] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 07/05/2018] [Indexed: 01/14/2023] Open
Abstract
Gain-of-function mutations in fibroblast growth factor receptors (FGFRs) cause congenital skeletal anomalies, including craniosynostosis (CS), which is characterized by the premature closure of craniofacial sutures. Apert syndrome (AS) is one of the severest forms of CS, and the only treatment is surgical expansion of prematurely fused sutures in infants. Previously, we demonstrated that the prolyl isomerase peptidyl-prolyl cis-trans isomerase interacting 1 (PIN1) plays a critical role in mediating FGFR signaling and that Pin1+/- mice exhibit delayed closure of cranial sutures. In this study, using both genetic and pharmacological approaches, we tested whether PIN1 modulation could be used as a therapeutic regimen against AS. In the genetic approach, we crossbred Fgfr2S252W/+, a mouse model of AS, and Pin1+/- mice. Downregulation of Pin1 gene dosage attenuated premature cranial suture closure and other phenotypes of AS in Fgfr2S252W/+ mutant mice. In the pharmacological approach, we intraperitoneally administered juglone, a PIN1 enzyme inhibitor, to pregnant Fgfr2S252W/+ mutant mice and found that this treatment successfully interrupted fetal development of AS phenotypes. Primary cultured osteoblasts from Fgfr2S252W/+ mutant mice expressed high levels of FGFR2 downstream target genes, but this phenotype was attenuated by PIN1 inhibition. Post-translational stabilization and activation of Runt-related transcription factor 2 (RUNX2) in Fgfr2S252W/+ osteoblasts were also attenuated by PIN1 inhibition. Based on these observations, we conclude that PIN1 enzyme activity is important for FGFR2-induced RUNX2 activation and craniofacial suture morphogenesis. Moreover, these findings highlight that juglone or other PIN1 inhibitors represent viable alternatives to surgical intervention for treatment of CS and other hyperostotic diseases.
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Affiliation(s)
- H R Shin
- BK21 Program, Department of Molecular Genetics and Dental Pharmacology and Therapeutics, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - H S Bae
- BK21 Program, Department of Molecular Genetics and Dental Pharmacology and Therapeutics, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - B S Kim
- BK21 Program, Department of Molecular Genetics and Dental Pharmacology and Therapeutics, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - H I Yoon
- BK21 Program, Department of Molecular Genetics and Dental Pharmacology and Therapeutics, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Y D Cho
- BK21 Program, Department of Molecular Genetics and Dental Pharmacology and Therapeutics, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea.,Department of Periodontology, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - W J Kim
- BK21 Program, Department of Molecular Genetics and Dental Pharmacology and Therapeutics, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - K Y Choi
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Y S Lee
- BK21 Program, Department of Molecular Genetics and Dental Pharmacology and Therapeutics, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - K M Woo
- BK21 Program, Department of Molecular Genetics and Dental Pharmacology and Therapeutics, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - J H Baek
- BK21 Program, Department of Molecular Genetics and Dental Pharmacology and Therapeutics, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - H M Ryoo
- BK21 Program, Department of Molecular Genetics and Dental Pharmacology and Therapeutics, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea
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Abstract
Management strategies for syndromic craniosynostosis patients require multidisciplinary subspecialty teams to provide optimal care for complex reconstructive approaches. The most common craniosynostosis syndromes include Apert (FGFR2), Crouzon (FGFR2), Muenke (FGFR3), Pfeiffer (FGFR1 and FGFR2), and Saethre-Chotzen (TWIST). Bicoronal craniosynostosis (turribrachycephaly) is most commonly associated with syndromic craniosynostosis. Disease presentation varies from mild sutural involvement to severe pansynostoses, with a spectrum of extracraniofacial dysmorphic manifestations. Understanding the multifaceted syndromic presentations while appreciating the panoply of variable presentations is central to delivering necessary individualized care. Cranial vault remodeling aims to relieve restriction of cranial development and elevated intracranial pressure and restore normal morphology.
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Affiliation(s)
- Rajendra Sawh-Martinez
- Section of Plastic and Reconstructive Surgery, Department of Surgery, Yale University, 330 Cedar Street, Boardman Building, 3rd Floor, New Haven, CT 06511, USA
| | - Derek M Steinbacher
- Section of Plastic and Reconstructive Surgery, Oral and Maxillofacial Surgery, Department of Surgery, Yale-New Haven Hospital, Yale University, 330 Cedar Street, Boardman Building, 3rd Floor, New Haven, CT 06511, USA.
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Rymer K, Shiang R, Hsiung A, Pandya A, Bigdeli T, Webb BT, Rhodes J. Expanding the phenotype for the recurrent p.Ala391Glu variant in FGFR3: Beyond crouzon syndrome and acanthosis nigricans. Mol Genet Genomic Med 2019; 7:e656. [PMID: 31016899 PMCID: PMC6565579 DOI: 10.1002/mgg3.656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 02/28/2019] [Accepted: 03/01/2019] [Indexed: 01/22/2023] Open
Abstract
Background Craniosynostosis, or premature fusion of the skull sutures, is a group of disorders that can present in isolation (nonsyndromic) or be associated with other anomalies (syndromic). Delineation of syndromic craniosynostosis is confounded due to phenotypic overlap, variable expression as well as molecular heterogeneity. We report on an infant who presented at birth with multisuture synostosis, turribrachycephaly, midface hypoplasia, beaked nose, low set ears, a high palate and short squat appearing thumbs, and great toes without deviation. The additional MRI findings of choanal stenosis and a Chiari I malformation suggested a diagnosis of Pfeiffer syndrome. First tier molecular testing did not reveal a pathogenic variant. Methods Whole exome sequencing on DNA samples from the proband and her unaffected parents was utilized to delineate the variant causative for the Pfeiffer syndrome diagnosis. Results On whole exome sequencing, a de novo NM_000142.4:c.1428C>A missense variant causing a p.Ala391Glu amino acid change in FGFR3 has been identified. The p.Ala391Glu change has been predominantly identified in patients with Crouzon syndrome with acanthosis nigricans. Conclusions This finding illustrates the first reported case of a child with an overlap with Pfeiffer syndrome to have the p.Ala391Glu variant.
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Affiliation(s)
- Karen Rymer
- Department of Human and Molecular Genetics, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Rita Shiang
- Department of Human and Molecular Genetics, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Anting Hsiung
- Department of Human and Molecular Genetics, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Arti Pandya
- Department of Human and Molecular Genetics, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Tim Bigdeli
- Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, New York
| | - Bradley T Webb
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, Virginia.,Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Jennifer Rhodes
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
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A systematic approach in the diagnosis of paediatric skull lesions: what radiologists need to know. Pol J Radiol 2019; 84:e92-e111. [PMID: 31019602 PMCID: PMC6479152 DOI: 10.5114/pjr.2019.83101] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 12/03/2018] [Indexed: 12/14/2022] Open
Abstract
Paediatric skull lesions are commonly identified on imaging. They can be challenging to image, given their location and size, and often require several imaging modalities to narrow down the differential diagnosis. Accurate diagnosis of these lesions is paramount because the clinical therapy can vary tremendously. In this review, we provide a simple and systematic approach to clinical-radiological features of primary skull lesions. We highlight the imaging characteristics and differentiate pathologies based on imaging appearances. We also accentuate the role of cross-sectional imaging in lesion identification and management implications.
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Bianucci R, Perciaccante A, Lippi D, Charlier P, Appenzeller O. Did Blaise Pascal have autism spectrum disorder and a genetic predisposition for skull deformities? Med Hypotheses 2018; 122:180-183. [PMID: 30593407 DOI: 10.1016/j.mehy.2018.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 11/28/2018] [Accepted: 11/29/2018] [Indexed: 10/27/2022]
Abstract
Many world-renowned scientists and artists had autism spectrum disorder (ASD). We suggest that the French mathematician and physicist Blaise Pascal (1623-1662) also had ASD. As a boy, he demonstrated his mastery of language, mathematics and science. He showed single-mindedness and obsessive interests in the pursuit of science in his younger years and later he pursued with religion with the same determination. Pascal neglected social interactions; he was cold and aloof and had an obsessive revulsion to any expression of emotional attachment. As shown by his funerary mask and the autopsy report Pascal had craniosynostosis (primary nonsyndromic oxycephaly) with atrophy of the right half of the face. Congenital facial asymmetry due to craniosynostosis has a genetic basis. This suggests that Pascal's facial deformity may betray his propensity to suffer from genetically determined diseases including ASD. Despite the intrinsic limitations of a diagnosis based only on biographical information, we surmise that Pascal had the three key symptoms (obsessive interests, difficulty in social relationship and problems in communicating) that characterize ASD individuals.
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Affiliation(s)
- R Bianucci
- Legal Medicine Section, Laboratory of Physical Anthropology, Department of Public Health and Paediatric Sciences, University of Turin, Italy; Warwick Medical School, Microbiology and Infection Unit, University of Warwick, United Kingdom; UMR 7268, Laboratoire d'Anthropologie bio-culturelle, Droit, Etique & Santé (Adés), Faculté de Médecine de Marseille, France.
| | - A Perciaccante
- Department of Medicine, "San Giovanni di Dio" Hospital, Gorizia, Italy
| | - D Lippi
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - P Charlier
- Département de la Recherche et de l'Enseignement Musée du Quai Branly - Jacques Chirac, Paris, France; UVSQ/EA4498 Laboratoire DANTE, Montigny-le-Bretonneux, France
| | - O Appenzeller
- New Mexico Health Enhancement and Marathon Clinics Research Foundation, 361 Big Horn Ridge Dr. NE, Albuquerque, NM, USA; New Mexico Museum of Natural History and Science, 1801 Mountain Road NW, Albuquerque, NM, USA
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50
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Mathews F, Shaffer AD, Georg MW, Ford MD, Goldstein JA, Jabbour N, Simons JP. Airway anomalies in patients with craniosynostosis. Laryngoscope 2018; 129:2594-2602. [DOI: 10.1002/lary.27589] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2018] [Indexed: 01/14/2023]
Affiliation(s)
- Fasil Mathews
- Department of OtolaryngologyUniversity of Pittsburgh School of Medicine Pittsburgh Pennsylvania U.S.A
| | | | | | - Matthew D. Ford
- Department of Pediatric Plastic SurgeryChildren's Hospital of Pittsburgh of UPMC Pittsburgh Pennsylvania U.S.A
| | | | - Noel Jabbour
- Department of OtolaryngologyChildren's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine Pittsburgh Pennsylvania U.S.A
| | - Jeffrey P. Simons
- Department of OtolaryngologyChildren's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine Pittsburgh Pennsylvania U.S.A
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