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Thornton R, Mendelow MG, Hutchinson EF. Bone mineral density and geometric morphometrics: Indicators of growth in the immature pars basilaris. Forensic Sci Int 2024; 361:112111. [PMID: 38908071 DOI: 10.1016/j.forsciint.2024.112111] [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: 11/13/2023] [Revised: 05/27/2024] [Accepted: 06/12/2024] [Indexed: 06/24/2024]
Abstract
The pars basilaris forms a central component of the immature basicranium and owing to its resilience to post-mortem and taphonomic changes, holds significance across evolutionary, clinical, and forensic contexts. While size and shape parameters of the pars basilaris have been investigated, little is known about the influence of the underlying bone mineral density on the morphometry of this bone during growth. This study aimed to investigate the development and growth of the pars basilaris with specific reference to changes in bone density patterning and development of osteological features, during the prenatal and early postnatal periods of life. A total of 109 pars basilari were sourced from the Johannesburg Forensic Paediatric Collection, University of the Witwatersrand, South Africa. The study sample was subdivided into early prenatal (<30 gestational weeks), prenatal (30-40 gestational weeks) and postnatal (birth to 7.5 months) groups and micro-CT scanned to assess bone mineral density patterns across seven regions of interest. Size and shape changes were analysed using 11 digitized landmarks and geometric morphometrics. When comparing across age groups, the assessed dimensions increased with growth manifesting as a deepening at the anterior border of the foramen magnum, development of the lateral angles and widening of the bone at the lateral projections and spheno-occipital synchondrosis. However, no significant changes in the distribution of bone mineral density were observed. An appreciation of morphological changes and bone quality at specific growth sites in the pars basilaris is essential when analyzing remains of unknown provenance for the purposes of identification in disaster victim settings.
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Affiliation(s)
- Roxanne Thornton
- School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Mira G Mendelow
- School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Erin F Hutchinson
- School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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2
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Raoul-Duval J, Ganet A, Benichi S, Baixe P, Cornillon C, Eschapasse L, Geoffroy M, Paternoster G, James S, Laporte S, Blauwblomme T, Khonsari RH, Taverne M. Geometric growth of the normal human craniocervical junction from 0 to 18 years old. J Anat 2024. [PMID: 38783688 DOI: 10.1111/joa.14067] [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: 01/30/2024] [Revised: 04/09/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024] Open
Abstract
The craniocervical junction (CCJ) forms the bridge between the skull and the spine, a highly mobile group of joints that allows the mobility of the head in every direction. The CCJ plays a major role in protecting the inferior brainstem (bulb) and spinal cord, therefore also requiring some stability. Children are subjected to multiple constitutive or acquired diseases involving the CCJ: primary bone diseases such as in FGFR-related craniosynostoses or acquired conditions such as congenital torticollis, cervical spine luxation, and neurological disorders. To design efficient treatment plans, it is crucial to understand the relationship between abnormalities of the craniofacial region and abnormalities of the CCJ. This can be approached by the study of control and abnormal growth patterns. Here we report a model of normal skull base growth by compiling a collection of geometric models in control children. Focused analyses highlighted specific developmental patterns for each CCJ bone, emphasizing rapid growth during infancy, followed by varying rates of growth and maturation during childhood and adolescence until reaching stability by 18 years of age. The focus was on the closure patterns of synchondroses and sutures in the occipital bone, revealing distinct closure trajectories for the anterior intra-occipital synchondroses and the occipitomastoid suture. The findings, although based on a limited dataset, showcased specific age-related changes in width and closure percentages, providing valuable insights into growth dynamics within the first 2 years of life. Integration analyses revealed intricate relationships between skull and neck structures, emphasizing coordinated growth at different stages. Specific bone covariation patterns, as found between the first and second cervical vertebrae (C1 and C2), indicated synchronized morphological changes. Our results provide initial data for designing inclusive CCJ geometric models to predict normal and abnormal growth dynamics.
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Affiliation(s)
- Juliette Raoul-Duval
- Craniofacial Growth and Form, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Angèle Ganet
- Craniofacial Growth and Form, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Sandro Benichi
- Department of Paediatric Neurosurgery, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
- CRMR C-MAVEM, Filière NeuroSphinx, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Pauline Baixe
- Craniofacial Growth and Form, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Clara Cornillon
- Craniofacial Growth and Form, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Lou Eschapasse
- Craniofacial Growth and Form, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Maya Geoffroy
- Craniofacial Growth and Form, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
- Institut de Biomécanique Humaine Georges Charpak, Ecole Nationale Supérieure Des Arts et Métiers, Paris, France
| | - Giovanna Paternoster
- Department of Paediatric Neurosurgery, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
- CRMR C-MAVEM, Filière NeuroSphinx, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Syril James
- Department of Paediatric Neurosurgery, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
- CRMR C-MAVEM, Filière NeuroSphinx, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Sébastien Laporte
- Institut de Biomécanique Humaine Georges Charpak, Ecole Nationale Supérieure Des Arts et Métiers, Paris, France
| | - Thomas Blauwblomme
- Department of Paediatric Neurosurgery, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Roman H Khonsari
- Craniofacial Growth and Form, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
- Department of Paediatric Maxillofacial Surgery and Plastic Surgery, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
- Faculté de Médecine, Université Paris Cité, Paris, France
- CRMR CRANIOST, Filière TeteCou, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Maxime Taverne
- Craniofacial Growth and Form, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
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Thornton R, Mendelow MG, Hutchinson EF. Assessing the morphology and bone mineral density of the immature pars lateralis as an indicator of age. Int J Legal Med 2024; 138:467-486. [PMID: 37775592 PMCID: PMC10861619 DOI: 10.1007/s00414-023-03085-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: 07/19/2023] [Accepted: 09/09/2023] [Indexed: 10/01/2023]
Abstract
Age estimation is crucial when the state of personhood is a mitigating factor in the identification of immature human remains. The maturation sequence of immature bones is a valuable alternative to dental development and eruption standards. Bordering the foramen magnum and pars basilaris, the pars lateralis is somewhat understudied. The aim of this study was to comprehensively describe the morphology of the immature human pars lateralis bone. Human pars laterali were sourced from the crania of 103 immature individuals of unknown provenance from the Johannesburg Forensic Paediatric Collection (JFPC), University of the Witwatersrand (HREC-Medical: M210855). The study sample was subdivided into early prenatal (younger than 30 gestational weeks; n = 32), prenatal (30-40 gestational weeks, n = 41) and postnatal (birth to 7.5 months, n = 30) age groups. The morphology of the pars laterali was studied using a combination of bone mineral density pattern assessments, geometric morphometrics and stereomicroscopy. Bone mineral density in postnatal individuals was lower when compared with the prenatal individuals. No statistically significant differences between density points were noted. The overall shape of the pars lateralis changed from a triangular shape in the early prenatal individuals to a fan-like quadrilateral bone in postnatal individuals. The angulation of the medial border for the foramen magnum highlighted a change in shape between straight in the early prenatal cohort to V-shaped in the postnatal individuals. The various technical approaches used in the current study provided detailed descriptions of the pars lateralis which establishes a valuable foundation for diagnostic criteria employing morphological predictors for biological profiling.
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Affiliation(s)
- Roxanne Thornton
- School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Mira G Mendelow
- School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Erin F Hutchinson
- School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Cleft and Craniofacial Surgery. J Oral Maxillofac Surg 2023; 81:E120-E146. [PMID: 37833020 DOI: 10.1016/j.joms.2023.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
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Ohkura N, Nam HK, Liu F, Hatch N. Cranial Neural Crest Specific Deletion of Alpl (TNAP) via P0-Cre Causes Abnormal Chondrocyte Maturation and Deficient Cranial Base Growth. Int J Mol Sci 2023; 24:15401. [PMID: 37895082 PMCID: PMC10607232 DOI: 10.3390/ijms242015401] [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: 08/27/2023] [Revised: 10/08/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
Bone growth plate abnormalities and skull shape defects are seen in hypophosphatasia, a heritable disorder in humans that occurs due to the deficiency of tissue nonspecific alkaline phosphatase (TNAP, Alpl) enzyme activity. The abnormal development of the cranial base growth plates (synchondroses) and abnormal skull shapes have also been demonstrated in global Alpl-/- mice. To distinguish local vs. systemic effects of TNAP on skull development, we utilized P0-Cre to knockout Alpl only in cranial neural crest-derived tissues using Alpl flox mice. Here, we show that Alpl deficiency using P0-Cre in cranial neural crest leads to skull shape defects and the deficient growth of the intersphenoid synchondrosis (ISS). ISS chondrocyte abnormalities included increased proliferation in resting and proliferative zones with decreased apoptosis in hypertrophic zones. ColX expression was increased, which is indicative of premature differentiation in the absence of Alpl. Sox9 expression was increased in both the resting and prehypertrophic zones of mutant mice. The expression of Parathyroid hormone related protein (PTHrP) and Indian hedgehog homolog (IHH) were also increased. Finally, cranial base organ culture revealed that inorganic phosphate (Pi) and pyrophosphate (PPi) have specific effects on cell signaling and phenotype changes in the ISS. Together, these results demonstrate that the TNAP expression downstream of Alpl in growth plate chondrocytes is essential for normal development, and that the mechanism likely involves Sox9, PTHrP, IHH and PPi.
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Affiliation(s)
- Naoto Ohkura
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI 48109, USA; (N.O.); (H.K.N.)
- Division of Cariology, Operative Dentistry and Endodontics, Department of Oral Health Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
| | - Hwa Kyung Nam
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI 48109, USA; (N.O.); (H.K.N.)
| | - Fei Liu
- Department of Biomaterials Sciences and Prosthodontics, School of Dentistry, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Nan Hatch
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI 48109, USA; (N.O.); (H.K.N.)
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Jhamb T, AlSulaiman A, Parsi G, Will L, Motro M. Three-dimensional morphometric analysis of anterior cranial base in growing patients. Am J Orthod Dentofacial Orthop 2023; 164:530-536. [PMID: 37212768 DOI: 10.1016/j.ajodo.2023.02.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 02/01/2023] [Accepted: 02/01/2023] [Indexed: 05/23/2023]
Abstract
INTRODUCTION The growth of the sphenoethmoidal and sphenofrontal suture in the anterior cranial base (ACB) terminates around 7 years old; therefore, ACB is used as a reference structure for superimposing radiographs in 2-dimensions (2D) and 3-dimensions (3D). The data in the literature regarding the cessation of growth of ACB in 3D is insufficient. The study aimed to evaluate the volumetric changes of ACB in growing patients on cone-beam computed tomography (CBCT) data in 3D. METHODS The CBCT sample was obtained from a repository of scans of subjects (n = 30) aged 6-11 years with no craniofacial anomalies or growth-related disorders. CBCTs were taken at 2 time points (approximately 12 months apart). The mean age at the initial scan (T1) was 8.4 ± 0.89 years, and the follow-up scan (T2) was 9.6 ± 0.99 years. The bones of the ACB were segmented, and 3D models of the bones were generated using Mimics software. The volumetric measurement was performed on the 3D-rendered model. Linear measurements were performed on the slices. RESULTS The volumetric analysis of the ACB between T1 and T2 showed a significant change (P <0.0001). There were no significant differences in volumetric changes of the ACB between the male and female subjects. The linear measurements on the right side of the cranial base showed continued growth between T1 and T2. CONCLUSIONS In the studied sample, growth-related changes of ACB were observed through volumetric analysis after 7 years old.
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Affiliation(s)
- Tania Jhamb
- Department of Orthodontics and Dentofacial Orthopedics, Henry M. Goldman School of Dental Medicine, Boston University, Boston, Mass
| | - Ahmed AlSulaiman
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Goli Parsi
- Department of Orthodontics and Dentofacial Orthopedics, Henry M. Goldman School of Dental Medicine, Boston University, Boston, Mass
| | - Leslie Will
- Department of Orthodontics and Dentofacial Orthopedics, Henry M. Goldman School of Dental Medicine, Boston University, Boston, Mass
| | - Melih Motro
- Department of Orthodontics and Dentofacial Orthopedics, Henry M. Goldman School of Dental Medicine, Boston University, Boston, Mass.
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Chaisrisawadisuk S, Khampalikit I, Moore MH, Anderson PJ, Chaisrisawadisuk S. Proboscis Lateralis With Basal Encephalocele: A Report of Clinical Management and Reconstructive Approach. Cleft Palate Craniofac J 2023; 60:1331-1336. [PMID: 35473415 DOI: 10.1177/10556656221096323] [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: 11/15/2022] Open
Abstract
Proboscis lateralis is a rare craniofacial anomaly in which a rudimentary nasal appendage arises at the medial canthal area. The severity depends on organ involvement, including eyes, nose, cleft lip/palate, and/or concomitant intracranial anomalies. Here, we present a child with proboscis lateralis and associated trans-ethmoidal encephalocele. We suggest doing the preoperative CT and/or MRI to rule out associated intracranial anomalies and reliably preoperative planning tools. Moreover, we proposed an alternative nasal reconstructive technique using a composite graft from the proboscis mass at the same time as encephalocele repair with promising results.
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Affiliation(s)
- Sarut Chaisrisawadisuk
- Division of Plastic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Inthira Khampalikit
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Mark H Moore
- Cleft and Craniofacial South Australia, Women's and Children's Hospital, North Adelaide, Australia
| | - Peter J Anderson
- Cleft and Craniofacial South Australia, Women's and Children's Hospital, North Adelaide, Australia
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Hasani M, Mokhberi M, Karandish M, Boroumand R. Timing of Spheno-Occipital Synchondrosis Closure in Cleft Lip and Palate Patients in Iranian Population. Cleft Palate Craniofac J 2023; 60:1113-1117. [PMID: 35384777 DOI: 10.1177/10556656221091711] [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: 11/17/2022] Open
Abstract
This study aimed to evaluate the chronological age range associated with each stage of spheno-occipital synchondrosis (SOS) fusion in patients with cleft lip and palate compared to the noncleft group, using cone-beam computed tomography (CBCT) images. In this study, the degree of SOS fusion was assessed using a 4-stage scoring system on CBCT images of 190 individuals (92 patients with cleft lip and palate, 98 noncleft individuals). A χ2 test was performed to assess the correlation between age and fusion stage. The independent sample t tests were used to evaluate the differences in the mean values of the samples of each group and each sex, as well as the mean value of each stage (P < .05). The results showed that there was no significant difference in the timing of the SOS fusion stages between the patients with cleft palate and the noncleft group. Although the fusion process of SOS begins about one year earlier in females, the complete ossification occurs at the mean age of 18.5 for both sexes in the experimental group and the mean age of 19.0 in the noncleft group. The present study found no differences in the fusion stages of the spheno-occipital synchondrosis between patients with cleft lip and palate and healthy individuals.
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Affiliation(s)
- Mahvash Hasani
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Marzieh Mokhberi
- School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Karandish
- Department of Orthodontics, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Rabieh Boroumand
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
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Yoon A, Gozal D, Kushida C, Pelayo R, Liu S, Faldu J, Hong C. A roadmap of craniofacial growth modification for children with sleep-disordered breathing: a multidisciplinary proposal. Sleep 2023; 46:zsad095. [PMID: 37014012 PMCID: PMC10424160 DOI: 10.1093/sleep/zsad095] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/19/2023] [Indexed: 04/05/2023] Open
Abstract
Craniofacial modification by orthodontic techniques is increasingly incorporated into the multidisciplinary management of sleep-disordered breathing in children and adolescents. With increasing application of orthodontics to this clinical population it is important for healthcare providers, families, and patients to understand the wide range of available treatments. Orthodontists can guide craniofacial growth depending on age; therefore, it is important to work with other providers for a team-based approach to sleep-disordered breathing. From infancy to adulthood the dentition and craniofacial complex change with growth patterns that can be intercepted and targeted at critical time points. This article proposes a clinical guideline for application of multidisciplinary care with emphasis on dentofacial interventions that target variable growth patterns. We also highlight how these guidelines serve as a roadmap for the key questions that will influence future research directions. Ultimately the appropriate application of these orthodontic techniques will not only provide an important therapeutic option for children and adolescents with symptomatic sleep-disordered breathing but may help also mitigate or prevent its onset.
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Affiliation(s)
- Audrey Yoon
- Division of Sleep Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Department of Orthodontics, Arthur A. Dugoni School of Dentistry at the University of the Pacific, San Francisco, CA, USA
| | - David Gozal
- Department of Child Health, and Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO, USA
| | - Clete Kushida
- Division of Sleep Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Rafael Pelayo
- Division of Sleep Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Stanley Liu
- Division of Sleep Surgery, Department of Otolaryngology-Head & Neck Surgery, School of Medicine, Stanford University, Stanford, CA, USA
| | - Jasmine Faldu
- Division of Orthodontics, Department of Orofacial Science, School of Dentistry, the University of California San Francisco, San Francisco, CA, USA
| | - Christine Hong
- Division of Orthodontics, Department of Orofacial Science, School of Dentistry, the University of California San Francisco, San Francisco, CA, USA
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Qing G, Jia F, Liu J, Jiang X. Anatomical network modules of the human central nervous-craniofacial skeleton system. Front Neurol 2023; 14:1164283. [PMID: 37602256 PMCID: PMC10433180 DOI: 10.3389/fneur.2023.1164283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/14/2023] [Indexed: 08/22/2023] Open
Abstract
Anatomical network analysis (AnNA) is a systems biological framework based on network theory that enables anatomical structural analysis by incorporating modularity to model structural complexity. The human brain and facial structures exhibit close structural and functional relationships, suggestive of a co-evolved anatomical network. The present study aimed to analyze the human head as a modular entity that comprises the central nervous system, including the brain, spinal cord, and craniofacial skeleton. An AnNA model was built using 39 anatomical nodes from the brain, spinal cord, and craniofacial skeleton. The linkages were identified using peripheral nerve supply and direct contact between structures. The Spinglass algorithm in the igraph software was applied to construct a network and identify the modules of the central nervous system-craniofacial skeleton anatomical network. Two modules were identified. These comprised an anterior module, which included the forebrain, anterior cranial base, and upper-middle face, and a posterior module, which included the midbrain, hindbrain, mandible, and posterior cranium. These findings may reflect the genetic and signaling networks that drive the mosaic central nervous system and craniofacial development and offer important systems biology perspectives for developmental disorders of craniofacial structures.
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Affiliation(s)
- Gele Qing
- Affiliated Hospital of Chifeng University, Chifeng, China
| | - Fucang Jia
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Jianwei Liu
- Affiliated Hospital of Chifeng University, Chifeng, China
| | - Xiling Jiang
- Affiliated Hospital of Chifeng University, Chifeng, China
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Crasnean E, Ban A, Roman R, Dinu C, Băciuț M, Nechita VI, Bran S, Onișor F, Badiu T, Almășan O, Hedeșiu M. The Impact of Benign Jawbone Tumors on the Temporomandibular Joint and Occlusion in Children: A Ten-Year Follow-Up Study. Biomedicines 2023; 11:biomedicines11041210. [PMID: 37189828 DOI: 10.3390/biomedicines11041210] [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: 03/19/2023] [Revised: 04/05/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023] Open
Abstract
This study aimed to provide a complex analysis of the modifications in craniofacial skeleton development that may arise following the diagnosis of pediatric benign jaw tumors. A prospective study was undertaken involving 53 patients younger than 18 years of age, who presented for treatment at the Department of Maxillo-Facial Surgery, University of Medicine and Pharmacy, Cluj-Napoca, with a primary benign jaw lesion between 2012 and 2022. A total of 28 odontogenic cysts (OCs), 14 odontogenic tumors (OTs), and 11 non-OTs were identified. At follow-up, dental anomalies were identified in 26 patients, and overjet changes were found in 33 children; lateral crossbite, midline shift, and edge-to-edge bite were found in 49 cases; deep or open bite were found in 23 patients. Temporomandibular disorders (TMDs) were found in 51 children, with unilateral TMJ changes identified in 7 cases and bilateral modifications found in 44 patients. Degenerative changes in the TMJ were also diagnosed in 22 pediatric patients. Although benign lesions could be associated with dental malocclusions, a direct etiological factor could be not identified. The presence of jaw tumors or their surgical treatment could, however, be linked to a change of the occlusal relationships or the onset of a TMD.
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Affiliation(s)
- Emil Crasnean
- Department of Maxillofacial Surgery and Implantology, Iuliu Hațieganu University of Medicine and Pharmacy, 37 Iuliu Hossu Street, 400029 Cluj-Napoca, Romania
| | - Alina Ban
- Department of Maxillofacial Surgery and Implantology, Iuliu Hațieganu University of Medicine and Pharmacy, 37 Iuliu Hossu Street, 400029 Cluj-Napoca, Romania
| | - Raluca Roman
- Department of Maxillofacial Surgery and Implantology, Iuliu Hațieganu University of Medicine and Pharmacy, 37 Iuliu Hossu Street, 400029 Cluj-Napoca, Romania
| | - Cristian Dinu
- Department of Maxillofacial Surgery and Implantology, Iuliu Hațieganu University of Medicine and Pharmacy, 37 Iuliu Hossu Street, 400029 Cluj-Napoca, Romania
| | - Mihaela Băciuț
- Department of Maxillofacial Surgery and Implantology, Iuliu Hațieganu University of Medicine and Pharmacy, 37 Iuliu Hossu Street, 400029 Cluj-Napoca, Romania
| | - Vlad-Ionuț Nechita
- Department of Medical Informatics and Biostatistics, Iuliu Hațieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Simion Bran
- Department of Maxillofacial Surgery and Implantology, Iuliu Hațieganu University of Medicine and Pharmacy, 37 Iuliu Hossu Street, 400029 Cluj-Napoca, Romania
| | - Florin Onișor
- Department of Maxillofacial Surgery and Implantology, Iuliu Hațieganu University of Medicine and Pharmacy, 37 Iuliu Hossu Street, 400029 Cluj-Napoca, Romania
| | - Teodora Badiu
- Department of Maxillofacial Surgery and Implantology, Iuliu Hațieganu University of Medicine and Pharmacy, 37 Iuliu Hossu Street, 400029 Cluj-Napoca, Romania
| | - Oana Almășan
- Department of Prosthetic Dentistry and Dental Materials, Iuliu Hațieganu University of Medicine and Pharmacy, 32 Clinicilor Street, 400006 Cluj-Napoca, Romania
| | - Mihaela Hedeșiu
- Department of Maxillofacial Surgery and Implantology, Iuliu Hațieganu University of Medicine and Pharmacy, 37 Iuliu Hossu Street, 400029 Cluj-Napoca, Romania
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Occlusal characteristics and oral health-related quality of life in adults operated due to sagittal synostosis in childhood: a case-control study with 26 years of follow-up. Childs Nerv Syst 2023; 39:1277-1282. [PMID: 36752911 PMCID: PMC10167105 DOI: 10.1007/s00381-023-05871-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 01/28/2023] [Indexed: 02/09/2023]
Abstract
PURPOSE The aim of this case-control study was to investigate occlusal characteristics, received orthodontic treatment, oral health-related quality of life (OHRQoL), and satisfaction with dental esthetics in adults operated due to sagittal synostosis. METHODS The study group consisted of 40 adults (25 males, 15 females, mean age 27.4 years, range 18-41) who were operated due to isolated sagittal synostosis in childhood. The control group comprised 40 age and gender-matched adults. Occlusal characteristics were evaluated clinically during study visits. Information on the previous orthodontic treatment was collected from dental records. OHRQoL was measured using the 14-item Oral Health Impact Profile (OHIP-14), and satisfaction with dental esthetics was evaluated using a visual analogue scale. RESULTS No statistically significant differences were found between the patient group and the controls in malocclusion traits (overjet, overbite, molar relationships, crossbite, scissor bite), previous orthodontic treatment, pre-treatment malocclusion diagnoses, OHIP variables, or satisfaction with dental esthetics. However, there was a tendency toward increased overjet and overbite in scaphocephalic patients. CONCLUSION It seems that adults with scaphocephaly operated in childhood do not differ from the average population in terms of occlusion, received orthodontic treatment, or oral health-related well-being.
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Krishnan N, McMullan P, Yang Q, Buscarello AN, Germain-Lee EL. Prevalence of Chiari malformation type 1 is increased in pseudohypoparathyroidism type 1A and associated with aberrant bone development. PLoS One 2023; 18:e0280463. [PMID: 36662765 PMCID: PMC9858345 DOI: 10.1371/journal.pone.0280463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 12/29/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Albright hereditary osteodystrophy (AHO) is caused by heterozygous inactivating mutations in GNAS. Patients with maternally-inherited mutations develop pseudohypoparathyroidism type 1A (PHP1A) with multi-hormone resistance and aberrant craniofacial and skeletal development among other abnormalities. Chiari malformation type 1 (CM1), a condition in which brain tissue extends into the spinal canal when the skull is too small, has been reported in isolated cases of PHP1A. It has been hypothesized to be associated with growth hormone (GH) deficiency. Given the adverse clinical sequelae that can occur if CM1 goes unrecognized, we investigated the previously undetermined prevalence of CM1, as well as any potential correlations with GH status, given the known increased prevalence of GH deficiency in PHP1A. We also investigated these metrics for low lying cerebellar tonsils (LLCT), defined as tonsillar descent less than 5 mm below the foramen magnum. In addition, we investigated possible correlations of CM1/LLCT with advanced hand/wrist bone ages and craniofacial abnormalities known to occur in PHP1A to determine whether premature chondrocyte differentiation and/or aberrant craniofacial development could be potential etiologies of CM1/LLCT through both human studies and investigations of our AHO mouse model. METHODS We examined patients with PHP1A in our clinic and noticed CM1 more frequently than expected. Therefore, we set out to determine the true prevalence of CM1 and LLCT in a cohort of 54 mutation-confirmed PHP1A participants who had clinically-indicated brain imaging. We examined potential correlations with GH status, clinical features, biological sex, genotype, and hand/wrist bone age determinations. In addition, we investigated the craniofacial development in our mouse model of AHO (Gnas E1+/-m) by histologic analyses, dynamic histomorphometry, and micro-computerized tomographic imaging (MCT) in order to determine potential etiologies of CM1/LLCT in PHP1A. RESULTS In our cohort of PHP1A, the prevalence of CM1 is 10.8%, which is at least 10-fold higher than in the general population. If LLCT is included, the prevalence increases to 21.7%. We found no correlation with GH status, biological sex, genotype, or hand/wrist bone age. Through investigations of our Gnas E1+/-m mice, the correlate to PHP1A, we identified a smaller cranial vault and increased cranial dome angle with evidence of hyperostosis due to increased osteogenesis. We also demonstrated that there was premature closure of the spheno-occipital synchondrosis (SOS), a cartilaginous structure essential to the development of the cranial base. These findings lead to craniofacial abnormalities and could contribute to CM1 and LLCT development in PHP1A. CONCLUSION The prevalence of CM1 is at least 10-fold higher in PHP1A compared to the general population and 20-fold higher when including LLCT. This is independent of the GH deficiency that is found in approximately two-thirds of patients with PHP1A. In light of potential serious consequences of CM1, clinicians should have a low threshold for brain imaging. Investigations of our AHO mouse model revealed aberrant cranial formation including a smaller cranium, increased cranial dome angle, hyperostosis, and premature SOS closure rates, providing a potential etiology for the increased prevalence of CM1 and LLCT in PHP1A.
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Affiliation(s)
- Neetu Krishnan
- Department of Pediatrics, Division of Pediatric Endocrinology & Diabetes, University of Connecticut School of Medicine, Farmington, Connecticut, United States of America
- Albright Center, Division of Pediatric Endocrinology & Diabetes, Connecticut Children’s, Farmington, Connecticut, United States of America
| | - Patrick McMullan
- Department of Pediatrics, Division of Pediatric Endocrinology & Diabetes, University of Connecticut School of Medicine, Farmington, Connecticut, United States of America
- Department of Reconstructive Sciences, Center for Regenerative Medicine and Skeletal Development, University of Connecticut School of Dental Medicine, Farmington, Connecticut, United States of America
| | - Qingfen Yang
- Department of Pediatrics, Division of Pediatric Endocrinology & Diabetes, University of Connecticut School of Medicine, Farmington, Connecticut, United States of America
- Department of Reconstructive Sciences, Center for Regenerative Medicine and Skeletal Development, University of Connecticut School of Dental Medicine, Farmington, Connecticut, United States of America
| | - Alexzandrea N. Buscarello
- Albright Center, Division of Pediatric Endocrinology & Diabetes, Connecticut Children’s, Farmington, Connecticut, United States of America
| | - Emily L. Germain-Lee
- Department of Pediatrics, Division of Pediatric Endocrinology & Diabetes, University of Connecticut School of Medicine, Farmington, Connecticut, United States of America
- Albright Center, Division of Pediatric Endocrinology & Diabetes, Connecticut Children’s, Farmington, Connecticut, United States of America
- Department of Reconstructive Sciences, Center for Regenerative Medicine and Skeletal Development, University of Connecticut School of Dental Medicine, Farmington, Connecticut, United States of America
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Mohamed FF, Ge C, Hallett SA, Bancroft AC, Cowling RT, Ono N, Binrayes AA, Greenberg B, Levi B, Kaartinen VM, Franceschi RT. Control of craniofacial development by the collagen receptor, discoidin domain receptor 2. eLife 2023; 12:e77257. [PMID: 36656123 PMCID: PMC9977278 DOI: 10.7554/elife.77257] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 01/18/2023] [Indexed: 01/20/2023] Open
Abstract
Development of the craniofacial skeleton requires interactions between progenitor cells and the collagen-rich extracellular matrix (ECM). The mediators of these interactions are not well-defined. Mutations in the discoidin domain receptor 2 gene (DDR2), which encodes a non-integrin collagen receptor, are associated with human craniofacial abnormalities, such as midface hypoplasia and open fontanels. However, the exact role of this gene in craniofacial morphogenesis is not known. As will be shown, Ddr2-deficient mice exhibit defects in craniofacial bones including impaired calvarial growth and frontal suture formation, cranial base hypoplasia due to aberrant chondrogenesis and delayed ossification at growth plate synchondroses. These defects were associated with abnormal collagen fibril organization, chondrocyte proliferation and polarization. As established by localization and lineage-tracing studies, Ddr2 is expressed in progenitor cell-enriched craniofacial regions including sutures and synchondrosis resting zone cartilage, overlapping with GLI1 + cells, and contributing to chondrogenic and osteogenic lineages during skull growth. Tissue-specific knockouts further established the requirement for Ddr2 in GLI +skeletal progenitors and chondrocytes. These studies establish a cellular basis for regulation of craniofacial morphogenesis by this understudied collagen receptor and suggest that DDR2 is necessary for proper collagen organization, chondrocyte proliferation, and orientation.
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Affiliation(s)
- Fatma F Mohamed
- Department of Periodontics & Oral Medicine, University of Michigan School of DentistryAnn ArborUnited States
| | - Chunxi Ge
- Department of Periodontics & Oral Medicine, University of Michigan School of DentistryAnn ArborUnited States
| | - Shawn A Hallett
- Department of Periodontics & Oral Medicine, University of Michigan School of DentistryAnn ArborUnited States
| | - Alec C Bancroft
- Center for Organogenesis and Trauma, Department of Surgery, University of Texas SouthwesternDallasUnited States
| | - Randy T Cowling
- Division of Cardiovascular Medicine, University of California, San DiegoSan DiegoUnited States
| | - Noriaki Ono
- Department of Diagnostic and Biomedical Sciences, University of Texas Health Science Center at Houston School of DentistryHoustonUnited States
| | - Abdul-Aziz Binrayes
- Department of Prosthetic Dental Sciences, College of Dentistry, King Saud UniversityRiyadhSaudi Arabia
| | - Barry Greenberg
- Division of Cardiovascular Medicine, University of California, San DiegoSan DiegoUnited States
| | - Benjamin Levi
- Center for Organogenesis and Trauma, Department of Surgery, University of Texas SouthwesternDallasUnited States
| | - Vesa M Kaartinen
- Department of Biologic & Materials Science, University of Michigan School of DentistryAnn ArborUnited States
| | - Renny T Franceschi
- Department of Periodontics & Oral Medicine, University of Michigan School of DentistryAnn ArborUnited States
- Department of Biological Chemistry, School of Medicine, University of MichiganAnn ArborUnited States
- Department of Biomedical Engineering, University of MichiganAnn ArborUnited States
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Daboul A, Krüger M, Ivanonvka T, Obst A, Ewert R, Stubbe B, Fietze I, Penzel T, Hosten N, Biffar R, Cardini A. Do brachycephaly and nose size predict the severity of obstructive sleep apnea (OSA)? A sample-based geometric morphometric analysis of craniofacial variation in relation to OSA syndrome and the role of confounding factors. J Sleep Res 2022; 32:e13801. [PMID: 36579627 DOI: 10.1111/jsr.13801] [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: 09/14/2022] [Revised: 10/27/2022] [Accepted: 11/25/2022] [Indexed: 12/30/2022]
Abstract
Obstructive sleep apnea is a common disorder that leads to sleep fragmentation and is potentially bidirectionally related to a variety of comorbidities, including an increased risk of heart failure and stroke. It is often considered a consequence of anatomical abnormalities, especially in the head and neck, but its pathophysiology is likely to be multifactorial in origin. With geometric morphometrics, and a large sample of adults from the Study for Health in Pomerania, we explore the association of craniofacial morphology to the apnea-hypopnea index used as an estimate of obstructive sleep apnea severity. We show that craniofacial size and asymmetry, an aspect of morphological variation seldom analysed in obstructive sleep apnea research, are both uncorrelated to apnea-hypopnea index. In contrast, as in previous analyses, we find evidence that brachycephaly and larger nasal proportions might be associated to obstructive sleep apnea severity. However, this correlational signal is weak and completely disappears when age-related shape variation is statistically controlled for. Our findings suggest that previous work might need to be re-evaluated, and urge researchers to take into account the role of confounders to avoid potentially spurious findings in association studies.
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Affiliation(s)
- Amro Daboul
- Department of Prosthodontics, Gerodontology and Biomaterials, University Medicine Greifswald, Greifswald, Germany
| | - Markus Krüger
- Department of Prosthodontics, Gerodontology and Biomaterials, University Medicine Greifswald, Greifswald, Germany
| | - Tatyana Ivanonvka
- Department of Electrical Engineering, Media and Computer Science East Bavarian Technical University of Applied Sciences Amberg-Weiden, Amberg, Germany
| | - Anne Obst
- Department of Prosthodontics, Gerodontology and Biomaterials, University Medicine Greifswald, Greifswald, Germany
| | - Ralf Ewert
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Beate Stubbe
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Ingo Fietze
- Interdisciplinary Sleep Medicine Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Penzel
- Interdisciplinary Sleep Medicine Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Norbert Hosten
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Reiner Biffar
- Department of Prosthodontics, Gerodontology and Biomaterials, University Medicine Greifswald, Greifswald, Germany
| | - Andrea Cardini
- Dipartimento di Scienze Chimiche e Geologiche, Università di Modena e Reggio Emilia, Modena, Italy.,School of Anatomy, Physiology and Human Biology, The University of Western Australia, Crawley, Western Australia, Australia
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Feng B, Yu X, Wang Y, Ouyang W, Wu F, Yu M, Chen Q. Using the anterior cranial base to provide a reliable reference plane for patients with or without facial asymmetry. Am J Orthod Dentofacial Orthop 2022; 162:e230-e245. [PMID: 36055884 DOI: 10.1016/j.ajodo.2022.07.002] [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: 12/01/2021] [Revised: 07/01/2022] [Accepted: 07/01/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION This study aimed to investigate the midsagittal reference plane (MSP) reliability derived from the 3-dimensional characteristics of patients with or without facial asymmetry in the anterior cranial base (ACB). METHODS We divided the cone-beam computed tomography (CBCT) images of 60 adult patients into maxillofacial symmetry and asymmetry groups. The ACB models were 3-dimensionally constructed, and then symmetrical characteristics were evaluated with surface asymmetry for each group. The reliability of the MSP derived from the symmetry of the anterior cranial base (MSPACB) was assessed in comparison with the true craniofacial symmetry plane determined using the morphometric method. RESULTS The ACB was symmetrical, as demonstrated by slight surface asymmetry. The MSPACB was reliable for maxillofacial asymmetrical analysis as the intraobserver and interobserver measurements using the MSPACB were of excellent agreement, and there was no significant difference between MSPACB and morphometric method in asymmetrical measurements in both groups. The MSPACB remained stable (maximum deviation <0.32 mm) when cranial landmark identification errors (1 mm and 4 mm) were simulated. CONCLUSIONS MSPACB is reliable for patients with or without facial asymmetry in maxillofacial asymmetry analysis, which is beneficial to patients with severe midfacial asymmetry or trauma when conventional landmarks are displaced or disappear. When using MSPACB for patients with cranial malformations or those whose ACBs differ from normal dimensions, caution should be taken.
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Affiliation(s)
- Bin Feng
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, and Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, China
| | - Xiaowen Yu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, and Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, China
| | - Yang Wang
- Department of Oral Medical Imaging, West China School of Stomatology, Sichuan University, and State Key Laboratory of Oral Diseases, Chengdu, China
| | - Wangtao Ouyang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, and Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, China
| | - Fuli Wu
- School of Computer Science and Technology, Zhejiang University of Technology, Hangzhou, China.
| | - Mengfei Yu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, and Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, China.
| | - Qianming Chen
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, and Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, China
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17
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Kravchik MV, Zolotenkova GV, Grusha YO, Pigolkin YI, Fettser EI, Zolotenkov DD, Gridina NV, Badyanova LV, Alexandrov AA, Novikov IA. Age-related changes in cationic compositions of human cranial base bone apatite measured by X-ray energy dispersive spectroscopy (EDS) coupled with scanning electron microscope (SEM). Biometals 2022; 35:1077-1094. [PMID: 35922585 DOI: 10.1007/s10534-022-00425-1] [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: 03/30/2022] [Accepted: 07/19/2022] [Indexed: 11/25/2022]
Abstract
One of the most common scientific methods to study the chemical composition of bone matter is energy-dispersive X-ray spectroscopy (EDS). However, interpretation of the data obtained can be quite complicated and require a thorough understanding of bone structure. This is especially important when evaluating subtle changes of chemical composition, including the age-related ones. The aim of current study is to create a method of processing the obtained data that can be utilized in clinical medicine and use it to evaluate the age evolution of bone chemical composition. To achieve this goal, an elemental composition of 62 samples of cadaver compact bone, taken from the skull base (age: Me = 57.5; 21/91(min/max); Q1 = 39.5, Q3 = 73.75), was studied with EDS. We used the original method to estimate the amount of Mg2+ cations. We detected and confirmed an increase of Mg2+ cation formula amount in the bone apatite, which characterizes age-related resorption rate. Analysis of cation estimated ratio in a normative bone hydroxylapatite showed an increase of Mg2+ amount (R = 0.43, p = 0.0005). Also, Ca weight fraction was shown to decrease with age (R = - 0.43, p = 0.0005), which in turn confirmed the age-dependent bone decalcification. In addition, electron probe microanalysis (EPMA) and X-ray diffraction analysis (XRD) were performed. EDS data confirmed the EPMA results (R = 0.76, p = 0.001). In conclusion, the proposed method can be used in forensic medicine and provide additional data to the known trends of decalcification and change of density and crystallinity of mineral bone matter.
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Affiliation(s)
- M V Kravchik
- Scientific Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021.
| | - G V Zolotenkova
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation, 119495
| | - Y O Grusha
- Scientific Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation, 119495
| | - Y I Pigolkin
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation, 119495
| | - E I Fettser
- Scientific Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation, 119495
| | - D D Zolotenkov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation, 119495
| | - N V Gridina
- Design Information Technologies Center Russian Academy of Sciences, Odintsovo, Russian Federation, 143000
| | - L V Badyanova
- Prokhorov General Physics Institute of the Russian Academy of Sciences, Moscow, Russian Federation, 119991
| | - A A Alexandrov
- Prokhorov General Physics Institute of the Russian Academy of Sciences, Moscow, Russian Federation, 119991
| | - I A Novikov
- Scientific Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
- Prokhorov General Physics Institute of the Russian Academy of Sciences, Moscow, Russian Federation, 119991
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Hallett SA, Zhou A, Herzog C, Arbiv A, Ono W, Ono N. Cranial Base Synchondrosis Lacks PTHrP-Expressing Column-Forming Chondrocytes. Int J Mol Sci 2022; 23:ijms23147873. [PMID: 35887221 PMCID: PMC9315528 DOI: 10.3390/ijms23147873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/12/2022] [Accepted: 07/16/2022] [Indexed: 02/04/2023] Open
Abstract
The cranial base contains a special type of growth plate termed the synchondrosis, which functions as the growth center of the skull. The synchondrosis is composed of bidirectional opposite-facing layers of resting, proliferating, and hypertrophic chondrocytes, and lacks the secondary ossification center. In long bones, the resting zone of the epiphyseal growth plate houses a population of parathyroid hormone-related protein (PTHrP)-expressing chondrocytes that contribute to the formation of columnar chondrocytes. Whether PTHrP+ chondrocytes in the synchondrosis possess similar functions remains undefined. Using Pthrp-mCherry knock-in mice, we found that PTHrP+ chondrocytes predominantly occupied the lateral wedge-shaped area of the synchondrosis, unlike those in the femoral growth plate that reside in the resting zone within the epiphysis. In vivo cell-lineage analyses using a tamoxifen-inducible Pthrp-creER line revealed that PTHrP+ chondrocytes failed to establish columnar chondrocytes in the synchondrosis. Therefore, PTHrP+ chondrocytes in the synchondrosis do not possess column-forming capabilities, unlike those in the resting zone of the long bone growth plate. These findings support the importance of the secondary ossification center within the long bone epiphysis in establishing the stem cell niche for PTHrP+ chondrocytes, the absence of which may explain the lack of column-forming capabilities of PTHrP+ chondrocytes in the cranial base synchondrosis.
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Affiliation(s)
- Shawn A. Hallett
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI 48109, USA; (S.A.H.); (A.Z.); (A.A.)
| | - Annabelle Zhou
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI 48109, USA; (S.A.H.); (A.Z.); (A.A.)
| | - Curtis Herzog
- Department of Oral and Maxillofacial Surgery, University of Michigan School of Dentistry, Ann Arbor, MI 48109, USA;
| | - Ariel Arbiv
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI 48109, USA; (S.A.H.); (A.Z.); (A.A.)
| | - Wanida Ono
- Department of Orthodontics, University of Texas Health Science Center at Houston School of Dentistry, Houston, TX 77054, USA;
| | - Noriaki Ono
- Department of Diagnostic and Biomedical Sciences, University of Texas Health Science Center at Houston School of Dentistry, Houston, TX 77054, USA
- Correspondence: ; Tel.: +1-713-486-0539
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Hallett SA, Ono W, Franceschi RT, Ono N. Cranial Base Synchondrosis: Chondrocytes at the Hub. Int J Mol Sci 2022; 23:7817. [PMID: 35887171 PMCID: PMC9317907 DOI: 10.3390/ijms23147817] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/10/2022] [Accepted: 07/13/2022] [Indexed: 01/04/2023] Open
Abstract
The cranial base is formed by endochondral ossification and functions as a driver of anteroposterior cranial elongation and overall craniofacial growth. The cranial base contains the synchondroses that are composed of opposite-facing layers of resting, proliferating and hypertrophic chondrocytes with unique developmental origins, both in the neural crest and mesoderm. In humans, premature ossification of the synchondroses causes midfacial hypoplasia, which commonly presents in patients with syndromic craniosynostoses and skeletal Class III malocclusion. Major signaling pathways and transcription factors that regulate the long bone growth plate-PTHrP-Ihh, FGF, Wnt, BMP signaling and Runx2-are also involved in the cranial base synchondrosis. Here, we provide an updated overview of the cranial base synchondrosis and the cell population within, as well as its molecular regulation, and further discuss future research opportunities to understand the unique function of this craniofacial skeletal structure.
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Affiliation(s)
- Shawn A. Hallett
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI 48109, USA; (S.A.H.); (R.T.F.)
| | - Wanida Ono
- Department of Orthodontics, University of Texas Health Science Center at Houston School of Dentistry, Houston, TX 77054, USA;
| | - Renny T. Franceschi
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI 48109, USA; (S.A.H.); (R.T.F.)
| | - Noriaki Ono
- Department of Diagnostic and Biomedical Sciences, University of Texas Health Science Center at Houston School of Dentistry, Houston, TX 77054, USA
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The Emerging Role of Cell Transdifferentiation in Skeletal Development and Diseases. Int J Mol Sci 2022; 23:ijms23115974. [PMID: 35682655 PMCID: PMC9180549 DOI: 10.3390/ijms23115974] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 02/04/2023] Open
Abstract
The vertebrate musculoskeletal system is known to be formed by mesenchymal stem cells condensing into tissue elements, which then differentiate into cartilage, bone, tendon/ligament, and muscle cells. These lineage-committed cells mature into end-stage differentiated cells, like hypertrophic chondrocytes and osteocytes, which are expected to expire and to be replaced by newly differentiated cells arising from the same lineage pathway. However, there is emerging evidence of the role of cell transdifferentiation in bone development and disease. Although the concept of cell transdifferentiation is not new, a breakthrough in cell lineage tracing allowed scientists to trace cell fates in vivo. Using this powerful tool, new theories have been established: (1) hypertrophic chondrocytes can transdifferentiate into bone cells during endochondral bone formation, fracture repair, and some bone diseases, and (2) tendon cells, beyond their conventional role in joint movement, directly participate in normal bone and cartilage formation, and ectopic ossification. The goal of this review is to obtain a better understanding of the key roles of cell transdifferentiation in skeletal development and diseases. We will first review the transdifferentiation of chondrocytes to bone cells during endochondral bone formation. Specifically, we will include the history of the debate on the fate of chondrocytes during bone formation, the key findings obtained in recent years on the critical factors and molecules that regulate this cell fate change, and the role of chondrocyte transdifferentiation in skeletal trauma and diseases. In addition, we will also summarize the latest discoveries on the novel roles of tendon cells and adipocytes on skeletal formation and diseases.
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21
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Influence of Nonsyndromic Bicoronal Synostosis and Syndromic Influences on Orbit and Periorbital Malformation. Plast Reconstr Surg 2022; 149:930e-942e. [PMID: 35286288 DOI: 10.1097/prs.0000000000009051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Oculoorbital disproportion in patients with craniosynostosis has similarities and dissimilarities between syndromic and nonsyndromic cases. The authors hypothesized that these two conditions have specific individual influences as they relate to development of the orbital and periorbital skeletons. METHODS A total of 133 preoperative computed tomography scans (nonsyndromic bicoronal synostosis, n = 38; Apert syndrome bicoronal synostosis subtype, n = 33; Crouzon syndrome bicoronal synostosis subtype, n = 10; controls, n = 52) were included. Craniometric and volumetric analyses related to the orbit and periorbital anatomy were performed. RESULTS Orbital cavity volume was mildly restricted in nonsyndromic bicoronal synostosis (7 percent, p = 0.147), but more so in Apert and Crouzon syndromes [17 percent (p = 0.002) and 21 percent (p = 0.005), respectively]. The sphenoid side angle in Apert syndrome was wider than when compared to Crouzon syndrome (p = 0.043). The ethmoid side angle in Apert patients, however, was narrower (p = 0.066) than that in Crouzon patients. Maxilla anteroposterior length was more restricted in Apert syndrome than Crouzon syndrome (21 percent, p = 0.003) and nonsyndromic cases (26 percent, p < 0.001). The posterior nasal spine position was retruded in Crouzon syndrome (39 percent, p < 0.001), yet the anterior nasal spine position was similar in Apert and Crouzon syndromes. CONCLUSIONS Orbit and periorbital malformation in syndromic craniosynostosis is likely the combined influence of syndromic influences and premature suture fusion. Apert syndrome expanded the anteriorly contoured lateral orbital wall associated with bicoronal synostosis, whereas Crouzon syndrome had more infraorbital rim retrusion, resulting in more severe exorbitism. Apert syndrome developed maxillary hypoplasia, in addition to the maxillary retrusion, observed in Crouzon syndrome and nonsyndromic bicoronal synostosis patients. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, II.
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22
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Nachmani A, Masalha M, Biadsee A, Nageris B, Ben-Dov T, Kassem F. Differences in craniofacial morphology between platybasic and nonplatybasic patients with velopharyngeal dysfunction and control subjects. Am J Orthod Dentofacial Orthop 2022; 162:e5-e16. [PMID: 35491327 DOI: 10.1016/j.ajodo.2021.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 12/01/2021] [Accepted: 12/01/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION This study aimed to identify the characteristics of cranial-base morphology in platybasic and nonplatybasic patients with palatal anomalies and velopharyngeal dysfunction (VPD) compared with control subjects to investigate structural factors related to craniofacial morphology that affect the nasopharyngeal space and may influence velopharyngeal function, and to develop precise treatments for specific patients with VPD. METHODS Three hundred eighty-six patients with VPD and various palatal anomalies were studied retrospectively. The control group included 126 healthy patients with normal speech. Lateral cephalometric images assessed craniofacial morphology. RESULTS Nonplatybasic patients and control subjects had larger SNA, S-Ba-Ptm, and N-Ba-PP angles (in the craniomaxillary complex), and platybasic patients had larger nasopharyngeal ANS-Ptm-Ve and Ba-S-Ptm angles and longer Ve-T and Ve-Ba distances than the nonplatybasic patients. All study patients had larger ANB, Gn-Go-Ar, and PP-MP angles (in the craniomandibular complex). Nonplatybasic patients had smaller Ba-SN angles than platybasic patients and controls because of more acute N-S-Ptm angle. Among the nonplatybasic patients, Ve-T length tended to be shorter (with no significant difference between groups) and located more inferiorly (because of the smallest ANS-Ptm-Ve angle) in relation to the maxilla. Thus, the nasopharynx was narrower horizontally but longer vertically than in patients with platybasia. CONCLUSIONS Cranial-base flexure influences the shape of the skull base and facial-skeletal structure and may alter the pharyngeal space between them. This finding should help improve preoperative planning regarding the effect of the pharyngeal flap height relative to the nasopharynx and oropharynx ratio that affects surgical outcomes, such as resonance and residual VPD. In patients with Class III malocclusion and maxillary constriction, careful planning of presurgical orthodontic treatment is needed in maxillary advancement procedures. Orthodontic and surgical collaboration can help prevent postoperative VPD, especially in platybasic patients.
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Affiliation(s)
- Ariela Nachmani
- Faculty of Communication Disorders, Hadassah Academic College, Jerusalem, Israel; Department of Communication Disorders, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Muhamed Masalha
- Department of Otolaryngology, Head and Neck Surgery, Emek Medical Center, Afula, Israel; The Ruth and Bruce Rappaport School of Medicine, The Technion Institute of Technology, Haifa, Israel
| | - Ameen Biadsee
- Department of Otolaryngology-Head and Neck Surgery, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ben Nageris
- Department of Otolaryngology-Head and Neck Surgery, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tom Ben-Dov
- Department of Otolaryngology-Head and Neck Surgery, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Firas Kassem
- Department of Otolaryngology-Head and Neck Surgery, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Utsunomiya N, Katsube M, Yamaguchi Y, Yoneyama A, Morimoto N, Yamada S. The first 3D analysis of the sphenoid morphogenesis during the human embryonic period. Sci Rep 2022; 12:5259. [PMID: 35347174 PMCID: PMC8960892 DOI: 10.1038/s41598-022-08972-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 03/08/2022] [Indexed: 11/16/2022] Open
Abstract
The sphenoid has a complicated shape, and its morphogenesis during early development remains unknown. We aimed to elucidate the detailed morphogenesis of the sphenoid and to visualize it three-dimensionally using histological section (HS) and phase-contrast X-ray CT (PCX-CT). We examined 54 specimens using HS and 57 specimens using PCX-CT, and summarized the initial morphogenesis of the sphenoid during Carnegie stage (CS) 17 to 23. The 3D models reconstructed using PCX-CT demonstrated that some neural foramina have the common process of "neuro-advanced" formation and revealed that shape change in the anterior sphenoid lasts longer than that of the posterior sphenoid, implying that the anterior sphenoid may have plasticity to produce morphological variations in the human face. Moreover, we measured the cranial base angle (CBA) in an accurate midsagittal section acquired using PCX-CT and found that the CBA against CS was largest at CS21. Meanwhile, CBA against body length showed no striking peak, suggesting that the angulation during the embryonic period may be related to any developmental events along the progress of stages rather than to a simple body enlargement. Our study elucidated the normal growth of the embryonic sphenoid, which has implications for the development and evolution of the human cranium.
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Affiliation(s)
- Natsuko Utsunomiya
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.,Congenital Anomaly Research Center, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Motoki Katsube
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Yutaka Yamaguchi
- Congenital Anomaly Research Center, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Naoki Morimoto
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shigehito Yamada
- Congenital Anomaly Research Center, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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24
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Wang X, Wang H, You J, Zheng R, Xu Y, Fan F. Craniofacial development in patients of Tessier No.0 cleft with a bifid nose using 3D computed tomography. Front Pediatr 2022; 10:979345. [PMID: 36090555 PMCID: PMC9449123 DOI: 10.3389/fped.2022.979345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/02/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Considerable studies have focused mainly on the facial deformity of Tessier No.0 cleft with a bifid nose, but the deformity of the skull is not well understood. Therefore, our study aimed to explore the evolution of cranial dysmorphology and the chronology of Tessier No.0 cleft with a bifid nose, by three-dimensional measurements. METHODS Ninety-six non-surgical patients and computed tomographic scans were included (Tessier No.0 cleft with a bifid nose, n = 48; controls, n = 48) and divided into five age subgroups. Craniofacial cephalometric measurements were analyzed by Mimics software. RESULTS The widening of nasal bone was the most remarkable and persistent from 2 years old appropriately. The overall cranial base length in patients compared with controls increased 11.8% (p < 0.01) on average. The middle and posterior cranial fossa increasing accounted for most of this change. The cranial base angles also showed increased obviously. By analyzing the linear of the nasopharynx and respiratory tract, it was found that its development did not affect respiration. CONCLUSIONS The cranial base deformity of Tessier No.0 cleft with a bifid nose consists of the whole skull base and particularly the middle and posterior cranial base length increase. At the same time, there may be late closure of the spheno-occipital synchondrosis and sella displacement. We believe this study is unique in providing valuable data for elucidating the pathological and morphological abnormalities of skull base development in Tessier No.0 cleft with a bifid nose.
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Affiliation(s)
- Xin Wang
- Department of Rhinoplasty, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huan Wang
- Department of Rhinoplasty, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianjun You
- Department of Rhinoplasty, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ruobing Zheng
- Department of Rhinoplasty, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yihao Xu
- Department of Rhinoplasty, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fei Fan
- Department of Rhinoplasty, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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25
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Growth of the Craniofacial Complex. Pediatr Dent 2022. [DOI: 10.1007/978-3-030-78003-6_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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26
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Zhang H, Louie KW, Kulkarni AK, Zapien‐Guerra K, Yang J, Mishina Y. The Posterior Part Influences the Anterior Part of the Mouse Cranial Base Development. JBMR Plus 2021; 6:e10589. [PMID: 35229066 PMCID: PMC8861986 DOI: 10.1002/jbm4.10589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/21/2021] [Indexed: 11/13/2022] Open
Abstract
The cranial base is a critical structure in the head, which is composed of endoskeletal and dermal skeletal. The braincase floor, part of the cranial base, is a midline structure of the head. Because it is a midline structure connecting the posterior skull with the facial region, braincase floor is critical for the orientation of the facial structure. Shortened braincase floor leads to mid‐facial hypoplasia and malocclusions. During embryonic development, elongation of the braincase floor occurs through endochondral ossification in the parachordal cartilage, hypophyseal cartilage, and trabecular cartilage, which leads to formation of basioccipital (BO), basisphenoid (BS), and presphenoid (PS) bones, respectively. Currently, little is known about whether maturation of parachordal cartilage, hypophyseal cartilage, and trabecular cartilage occurs in a simultaneous or sequential manner and if the formation of one impacts the others. Our previous studies demonstrated that loss of function of ciliary protein Evc2 leads to premature fusion in the intersphenoid synchondrosis (ISS). In this study, we take advantage of Evc2 mutant mice to delineate the mechanism governing synchondrosis formation. Our analysis supports a cascade mechanism on the spatiotemporal regulation of the braincase floor development that the hypertrophy of parachordal cartilage (posterior side) impacts the hypertrophy of hypophyseal cartilage (middle) and trabecular cartilage (anterior side) in a sequential manner. The cascade mechanism well explains the premature fusion of the ISS in Evc2 mutant mice and is instructive to understand the specifically shortened anterior end of the braincase floor in various types of genetic syndromes. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Honghao Zhang
- Department of Biologic and Materials Sciences & Prosthodontics, School of Dentistry University of Michigan Ann Arbor MI USA
| | - Ke'ale W Louie
- Department of Biologic and Materials Sciences & Prosthodontics, School of Dentistry University of Michigan Ann Arbor MI USA
| | - Anshul K Kulkarni
- Department of Biologic and Materials Sciences & Prosthodontics, School of Dentistry University of Michigan Ann Arbor MI USA
| | - Karen Zapien‐Guerra
- Department of Biologic and Materials Sciences & Prosthodontics, School of Dentistry University of Michigan Ann Arbor MI USA
| | - Jingwen Yang
- Department of Biologic and Materials Sciences & Prosthodontics, School of Dentistry University of Michigan Ann Arbor MI USA
| | - Yuji Mishina
- Department of Biologic and Materials Sciences & Prosthodontics, School of Dentistry University of Michigan Ann Arbor MI USA
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27
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Hsieh YL, Wei X, Wang Y, Zhang H, Qi S, Xie D, Mishina Y, Mendonça D, Hatch N, Liu F. Chondrocyte Tsc1 controls cranial base bone development by restraining the premature differentiation of synchondroses. Bone 2021; 153:116142. [PMID: 34365025 PMCID: PMC8543925 DOI: 10.1016/j.bone.2021.116142] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/30/2021] [Accepted: 08/02/2021] [Indexed: 02/05/2023]
Abstract
Cranial base bones are formed through endochondral ossification. Synchondroses are growth plates located between cranial base bones that facilitate anterior-posterior growth of the skull. Coordinated proliferation and differentiation of chondrocytes in cranial base synchondroses is essential for cranial base bone growth. Herein, we report that constitutive activation of the mechanistic target of rapamycin complex 1 (mTORC1) signaling via Tsc1 (Tuberous sclerosis 1) deletion in chondrocytes causes abnormal skull development with decreased size and rounded shape. In contrast to decreased anterior-posterior growth of the cranial base, mutant mice also exhibited significant expansion of cranial base synchondroses including the intersphenoid synchondrosis (ISS) and the spheno-occipital synchondrosis (SOS). Cranial base synchondrosis expansion in TSC1-deficient mice was accounted for by an expansion of the resting zone due to increased cell number and size without alteration in cell proliferation. Furthermore, our data showed that mTORC1 activity is inhibited in the resting and proliferating zone chondrocytes of wild type mice, and Tsc1 deletion activated mTORC1 signaling of the chondrocytes in the resting zone area. Consequently, the chondrocytes in the resting zone of TSC1-deficient mice acquired characteristics generally attributed to pre-hypertrophic chondrocytes including high mTORC1 activity, increased cell size, and increased expression level of PTH1R (Parathyroid hormone 1 receptor) and IHH (Indian hedgehog). Lastly, treatment with rapamycin, an inhibitor of mTORC1, rescued the abnormality in synchondroses. Our results established an important role for TSC1-mTORC1 signaling in regulating cranial base bone development and showed that chondrocytes in the resting zone of synchondroses are maintained in an mTORC1-inhibitory environment.
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Affiliation(s)
- Yuan-Lynn Hsieh
- Department of Biologic & Materials Sciences and Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, MI 48109, USA
| | - Xiaoxi Wei
- Department of Biologic & Materials Sciences and Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, MI 48109, USA; Department of Orthodontics, Hospital of Stomatology Jilin University, Changchun, Jilin 130021, China
| | - Yating Wang
- Department of Biologic & Materials Sciences and Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, MI 48109, USA; State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Other Research Platforms & Department of Orthodontics and Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China
| | - Honghao Zhang
- Department of Biologic & Materials Sciences and Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, MI 48109, USA
| | - Shuqun Qi
- Department of Biologic & Materials Sciences and Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, MI 48109, USA
| | - Di Xie
- Department of Biologic & Materials Sciences and Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, MI 48109, USA
| | - Yuji Mishina
- Department of Biologic & Materials Sciences and Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, MI 48109, USA
| | - Daniela Mendonça
- Department of Biologic & Materials Sciences and Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, MI 48109, USA
| | - Nan Hatch
- Department of Orthodontics and Pediatric Dentistry, University of Michigan School of Dentistry, Ann Arbor, MI 48109, USA
| | - Fei Liu
- Department of Biologic & Materials Sciences and Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, MI 48109, USA.
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28
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Wan Y, Szabo-Rogers HL. Chondrocyte Polarity During Endochondral Ossification Requires Protein-Protein Interactions Between Prickle1 and Dishevelled2/3. J Bone Miner Res 2021; 36:2399-2412. [PMID: 34423861 DOI: 10.1002/jbmr.4428] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/19/2021] [Accepted: 08/18/2021] [Indexed: 12/26/2022]
Abstract
The expansion and growth of the endochondral skeleton requires organized cell behaviors that control chondrocyte maturation and oriented division. In other organs, these processes are accomplished through Wnt/planar cell polarity (Wnt/PCP) signaling pathway and require the protein-protein interactions of core components including Prickle1 (PK1) and Dishevelled (DVL). To determine the function of Wnt/PCP signaling in endochondral ossification of the cranial base and limb, we utilized the Prickle1Beetlejuice (Pk1Bj ) mouse line. The Pk1Bj allele has a missense mutation in the PK1 LIM1 domain that results in a hypomorphic protein. Similar to human patients with Robinow syndrome, the Prickle1Bj/Bj mouse mutants lack growth plate expansion resulting in shorter limbs and midfacial hypoplasia. Within the Prickle1Bj/Bj limb and cranial base growth plates we observe precocious maturation of chondrocytes and stalling of terminal differentiation. Intriguingly, we observed that the growth plate chondrocytes have randomized polarity based on the location of the primary cilia and the location of PRICKLE1, DVL2, and DVL3 localization. Importantly, mutant PK1Bj protein has decreased protein-protein interactions with both DVL2 and DVL3 in chondrocytes as revealed by in vivo co-immunoprecipitation and proximity ligation assays. Finally, we propose a model where the interaction between the Prickle1 LIM1 domain and DVL2 and DVL3 contributes to chondrocyte polarity and contributes to proximal-distal outgrowth of endochondral elements. © 2021 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Yong Wan
- Department of Oral and Craniofacial Sciences, School of Dental Medicine, Center for Craniofacial Regeneration, University of Pittsburgh, Pittsburgh, PA, USA
| | - Heather L Szabo-Rogers
- Department of Oral and Craniofacial Sciences, School of Dental Medicine, Center for Craniofacial Regeneration, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Developmental Biology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,McGowan Institute for Regenerative Medicine, Pittsburgh, PA, USA
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Effect of Early Spheno-Occipital Synchondrosis Fusion in Preadolescent Patients With Syndromic Craniosynostosis on Craniofacial Skeletal Patterns: A Preliminary Study Using Cephalometric Analysis. J Craniofac Surg 2021; 33:179-182. [PMID: 34560746 DOI: 10.1097/scs.0000000000008191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT The purpose of this study was to investigate the effects of early spheno-occipital synchondrosis (SOS) fusion in preadolescent patients with syndromic craniosynostosis (SC) on the craniofacial skeletal patterns. Twenty preadolescent SC patients were divided into the fused SOS (FS, n = 10; 8 Crouzon and 2 Apert) and not-fused SOS groups (NFS, n = 10; 9 Crouzon and 1 Apert). Lateral cephalograms (mean age: 9.60 years, cervical vertebral maturation index: stage I and II) were used to investigate the skeletal sagittal (ANB) and vertical patterns (SN-GoMe), upward inclination of the anterior cranial base (ACB; SN-FH), degree of midface hypoplasia (MH, SNA), retrusive position of orbitale (SNO), and forward position of the condyle in relation to sella (saddle angle). Using the ordinal values calculated by ethnic norm (criteria: moderate, over ±1 standard deviation, severe, over ±2 standard deviation), statistical analysis was performed. The FS group showed a higher percentage of severe MH than the NFS group (70% versus 10%, P < 0.05). Although the 2 groups did not differ in the distribution of ANB, SN-GoMe, saddle angle, and SN-FH (all P > 0.05), the FS group showed relatively higher percentages of severe Class III (100% versus 70%), severe hyper-divergent pattern (40% versus 10%), severely forward condyle position (30% versus 0%), and moderate and severe upward anterior cranial base inclination (90% versus 50%) than the NFS group. However, the 2 groups exhibited the same distribution of moderately and severely retrusive orbitale position ([50%, 20%], P > 0.05). Early SOS fusion in preadolescent SC patients might not be related to retrusive orbitale position, but to severe MH.
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30
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Respective Roles of Craniosynostosis and Syndromic Influences on Cranial Fossa Development. Plast Reconstr Surg 2021; 148:145-156. [PMID: 34181610 DOI: 10.1097/prs.0000000000008101] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Little is known about the detailed growth of the cranial fossae, even though they provide an important structural connection between the cranial vault and the facial skeleton. This study details the morphologic development of isolated cranial vault synostosis and associated syndromes on cranial fossa development. METHODS A total of 125 computed tomographic scans were included (nonsyndromic bicoronal synostosis, n = 36; Apert syndrome associated with bicoronal synostosis, n = 24; Crouzon syndrome associated with bicoronal synostosis, n = 11; and controls, n = 54). Three-dimensional analyses were produced using Materialise software. RESULTS The regional anterior and middle cranial fossae volumes of nonsyndromic bicoronal synostosis are characterized by significant increases of 43 percent (p < 0.001) and 60 percent (p < 0.001), respectively, and normal posterior cranial fossa volume. The cranial fossae depths of nonsyndromic bicoronal synostosis were increased, by 37, 42, and 21 percent (all p < 0.001) for anterior, middle, and posterior cranial fossae, respectively, accompanying the shortened cranial fossae lengths. The volume and morphology of all cranial fossae in Apert syndrome nearly paralleled nonsyndromic bicoronal synostosis. However, Crouzon syndrome had reduced depths of cranial fossae, and more restricted fossa volumes than both Apert syndrome and nonsyndromic bicoronal synostosis. CONCLUSIONS Cranial vault suture synostosis is likely to be more influential on cranial fossae development than other associated influences (genetic, morphologic) in Apert and Crouzon syndromes. Isolated Apert syndrome pathogenesis is associated with an elongation of the anterior cranial fossa length in infants, whereas in Crouzon syndrome, there is a tendency to reduce cranial fossa depth, suggesting individual adaptability in cranial fossae development related to vault synostosis.
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Lu X, Forte AJ, Alperovich M, Alonso N, Persing JA. Does different cranial suture synostosis influence orbit volume and morphology in Apert syndrome? Int J Oral Maxillofac Surg 2021; 51:338-346. [PMID: 34400025 DOI: 10.1016/j.ijom.2021.07.019] [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: 02/10/2021] [Revised: 07/25/2021] [Accepted: 07/28/2021] [Indexed: 10/20/2022]
Abstract
This study was performed to compare the orbital and peri-orbital morphological variations in Apert syndrome patients with different cranial vault suture synostosis, so as to provide an anatomic basis for individualized surgical planning. Computed tomography scans of 57 unoperated Apert syndrome patients and 59 controls were subgrouped as follows: type I, bilateral coronal synostosis; type II, pansynostosis; type III, perpendicular combinations of cranial vault suture synostoses. Orbit bony cavity volume was significantly reduced in type I and type II, by 19% (P < 0.001) and 24% (P < 0.001), respectively. However, the reduction of orbital cavity volume in type III did not reach statistical significance. Globe volume projection beyond the orbital rim, however, increased by 76% (P < 0.001) in type III, versus an increase of 54% (P < 0.001) in type I and 53% (P < 0.001) in type II, due to different ethmoid and sphenoid bone malformations. Maxillary bone volume was only significantly reduced in type I bicoronal synostosis (by 24%, P = 0.048). Both type I and type II developed relatively less zygoma and sphenoid bone volume. Different cranial vault suture synostoses have varied influence on peri-orbital development in Apert syndrome. Instead of mitigating the abnormalities resulting from bicoronal synostosis in type I, additional midline suture synostosis worsens the exorbitism due to a more misshaped ethmoid.
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Affiliation(s)
- X Lu
- Division of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, Connecticut, USA.
| | - A J Forte
- Division of Plastic and Reconstructive Surgery, Mayo Clinic Florida, Jacksonville, Florida, USA.
| | - M Alperovich
- Division of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, Connecticut, USA.
| | - N Alonso
- Department of Plastic Surgery, University of São Paulo, São Paulo, Brazil.
| | - J A Persing
- Division of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, Connecticut, USA.
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32
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Lu X, Forte AJ, Junn A, Dinis J, Alperovich M, Alonso N, Persing JA. Orbitofacial morphology changes with different suture synostoses in Crouzon syndrome. J Craniomaxillofac Surg 2021; 50:406-418. [DOI: 10.1016/j.jcms.2021.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 05/24/2021] [Accepted: 06/15/2021] [Indexed: 11/28/2022] Open
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33
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Fonteles CSR, Finnell RH, George TM, Harshbarger RJ. Craniosynostosis: current conceptions and misconceptions. AIMS GENETICS 2021. [DOI: 10.3934/genet.2016.1.99] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AbstractCranial bones articulate in areas called sutures that must remain patent until skull growth is complete. Craniosynostosis is the condition that results from premature closure of one or more of the cranial vault sutures, generating facial deformities and more importantly, skull growth restrictions with the ability to severely affect brain growth. Typically, craniosynostosis can be expressed as an isolated event, or as part of syndromic phenotypes. Multiple signaling mechanisms interact during developmental stages to ensure proper and timely suture fusion. Clinical outcome is often a product of craniosynostosis subtypes, number of affected sutures and timing of premature suture fusion. The present work aimed to review the different aspects involved in the establishment of craniosynostosis, providing a close view of the cellular, molecular and genetic background of these malformations.
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Affiliation(s)
- Cristiane Sá Roriz Fonteles
- Finnell Birth Defects Research Laboratory, Dell Pediatric Research Institute, The University of Texas at Austin, USA
| | - Richard H. Finnell
- Finnell Birth Defects Research Laboratory, Dell Pediatric Research Institute, The University of Texas at Austin, USA
- Department of Nutritional Sciences, Dell Pediatric Research Institute, The University of Texas at Austin, USA
| | - Timothy M. George
- Pediatric Neurosurgery, Dell Children's Medical Center, Professor, Department of Surgery, Dell Medical School, Austin, TX, USA
| | - Raymond J. Harshbarger
- Plastic Surgery, Craniofacial Team at the Dell Children's Medical Center of Central Texas, Austin, USA
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Chen J, Tang W, Lin C, Hong Y, Mao C, Lai Y, Liao C, Lin M, Chen W. Defining the critical period of hedgehog pathway inhibitor-induced cranial base dysplasia in mice. Dev Dyn 2021; 250:527-541. [PMID: 33165989 DOI: 10.1002/dvdy.270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 10/13/2020] [Accepted: 11/02/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The hedgehog signaling pathway is critical for developmental patterning of the limb, craniofacial and axial skeleton. Disruption of this pathway in mice leads to a series of structural malformations, but the exact role and critical period of the Hh pathway in the early development of the cranial base have been rarely described. RESULTS Embryos exposed to vismodegib from E7.5, E9.5, and E10.5 had a higher percentage of cranial base fenestra. The peak incidence of hypoplasia in sphenoid winglets and severe craniosynostosis in cranial base synchondroses was observed when vismodegib was administered between E9.5 and E10.5. Cranial base craniosynostosis results from accelerating terminal differentiation of chondrocytes and premature osteogenesis. CONCLUSIONS We define the critical periods for the induction of cranial base deformity by vismodegib administration at a meticulous temporal resolution. Our findings suggest that the Hh pathway may play a vital role in the early development of the cranial base. This research also establishes a novel and easy-to-establish mouse model of synostosis in the cranial base using a commercially available pathway-selective inhibitor.
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Affiliation(s)
- Jiangping Chen
- Fujian Key Laboratory of Oral Diseases & Stomatological Key lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, Fujian, China
- Department of Oral and Maxillofacial Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
- Institute of Stomatology, Fujian Medical University, Fuzhou, Fujian, China
| | - Wenbing Tang
- Department of Stomatology, Central Hospital of Guangdong Nongken, Zhanjiang, Guangdong, China
| | - Chengquan Lin
- Fujian Key Laboratory of Oral Diseases & Stomatological Key lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, Fujian, China
- Department of Oral and Maxillofacial Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
- Institute of Stomatology, Fujian Medical University, Fuzhou, Fujian, China
| | - Yuhang Hong
- Fujian Key Laboratory of Oral Diseases & Stomatological Key lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, Fujian, China
- Department of Oral and Maxillofacial Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
- Institute of Stomatology, Fujian Medical University, Fuzhou, Fujian, China
| | - Chuanqing Mao
- Fujian Key Laboratory of Oral Diseases & Stomatological Key lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, Fujian, China
- Department of Oral and Maxillofacial Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
- Institute of Stomatology, Fujian Medical University, Fuzhou, Fujian, China
| | - Yongzhen Lai
- Department of Oral and Maxillofacial Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Caiyu Liao
- Fujian Key Laboratory of Oral Diseases & Stomatological Key lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, Fujian, China
- Department of Oral and Maxillofacial Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
- Institute of Stomatology, Fujian Medical University, Fuzhou, Fujian, China
| | - Minkui Lin
- Fujian Key Laboratory of Oral Diseases & Stomatological Key lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, Fujian, China
- Institute of Stomatology, Fujian Medical University, Fuzhou, Fujian, China
| | - Weihui Chen
- Fujian Key Laboratory of Oral Diseases & Stomatological Key lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, Fujian, China
- Department of Oral and Maxillofacial Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
- Fujian Biological Materials Engineering and Technology Center of Stomatology, Fuzhou, Fujian, China
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Milella M, Franklin D, Belcastro MG, Cardini A. Sexual differences in human cranial morphology: Is one sex more variable or one region more dimorphic? Anat Rec (Hoboken) 2021; 304:2789-2810. [PMID: 33773067 DOI: 10.1002/ar.24626] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/25/2021] [Accepted: 03/01/2021] [Indexed: 01/06/2023]
Abstract
The quantification of cranial sexual dimorphism (CSD) among modern humans is relevant in evolutionary studies of morphological variation and in a forensic context. Despite the abundance of quantitative studies of CSD, few have specifically examined intra-sex variability. Here we quantify CSD in a geographically homogeneous sample of adult crania, which includes Italian individuals from the 19th and 20th centuries. Cranial morphology is described with 92 3D landmarks analyzed using Procrustean geometric morphometrics (PGMM). Size and shape variables are used to compare morphological variance between sexes in the whole cranium and four individual regions. The same variables, plus Procrustes form, are used to quantify average sex differences and explore classification accuracy. Our results indicate that: (a) as predicted by Wainer's rule, males present overall more variance in size and shape, albeit this is statistically significant only for total cranial size; (b) differences between sexes are dominated by size and to a lesser extent by Procrustes form; (c) shape only accounts for a minor proportion of variance; (d) the cranial base shows almost no dimorphism for shape; and (e) facial Procrustes form is the most accurate predictor of skeletal sex. Overall, this study suggests developmental factors underlying differences in CSD among cranial regions; stresses the need for population-specific models that describe craniofacial variation as the basis for models that facilitate the estimation of sex in unidentified skeletal remains; and provides one of the first confirmations of "Wainer's rule" in relation to sexual dimorphism in mammals specific to the human cranium.
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Affiliation(s)
- Marco Milella
- Department of Physical Anthropology, Institute of Forensic Medicine, University of Bern, Bern, Switzerland
| | - Daniel Franklin
- Centre for Forensic Anthropology, The University of Western Australia, Crawley, Western Australia, Australia
| | - Maria Giovanna Belcastro
- Department of Biological, Geological and Environmental Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Andrea Cardini
- Centre for Forensic Anthropology, The University of Western Australia, Crawley, Western Australia, Australia.,Dipartimento di Scienze Chimiche e Geologiche, Università di Modena e Reggio Emilia, Modena, Italy
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Developmental Abnormalities of the Skull Base in Patients with Turner Syndrome. CURRENT HEALTH SCIENCES JOURNAL 2021; 46:329-335. [PMID: 33717506 PMCID: PMC7948014 DOI: 10.12865/chsj.46.04.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/18/2020] [Indexed: 12/02/2022]
Abstract
The skull base is one of the most complex anatomic structures of the skeleton that is responsible for protecting and supporting the brain and is also involved in the development of the facial structures. The main objective of our study was to evaluate skull base abnormalities in a group of patients diagnosed with Turner syndrome by assessing lateral cephalometric radiographs. A total of 7 patients diagnosed with Turner syndrome in the Endocrinology Department of the Emergency Clinical County Hospital of Craiova were included in the study. The following cephalometric variables were measured in our study: total skull base (N-Ba): Nasion (N)-Basion (Ba); anterior skull base (N-S): Nasion (N)-Sella (S); posterior skull base (S-Ba): Sella (S)-Basion (Ba). Regarding the investigated cephalometric variables, the mean±standard deviation (SD) recorded values in our study were 86.34±4.26mm for the total skull base (N-Ba), 63.87±2.54mm for the anterior skull base (N-S) and 38.33±4.87mm for the posterior skull base (S-Ba). The results of our study were compared to the ones provided by one of the most representative studies described in the literature. A reduced size of the posterior base of the skull is considered pathognomonic in subjects diagnosed with Turner syndrome. Also, the posterior base of the skull directly influences the maxillomandibular skeletal relationships and it is therefore necessary to calculate this cephalometric variable, which is easily highlighted on a lateral cephalometric radiograph.
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Fountain DM, Smith MJ, O'Leary C, Pathmanaban ON, Roncaroli F, Bobola N, King AT, Evans DG. The spatial phenotype of genotypically distinct meningiomas demonstrate potential implications of the embryology of the meninges. Oncogene 2021; 40:875-884. [PMID: 33262459 PMCID: PMC8440207 DOI: 10.1038/s41388-020-01568-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/05/2020] [Accepted: 11/11/2020] [Indexed: 12/29/2022]
Abstract
Meningiomas are the most common primary brain tumor and their incidence and prevalence is increasing. This review summarizes current evidence regarding the embryogenesis of the human meninges in the context of meningioma pathogenesis and anatomical distribution. Though not mutually exclusive, chromosomal instability and pathogenic variants affecting the long arm of chromosome 22 (22q) result in meningiomas in neural-crest cell-derived meninges, while variants affecting Hedgehog signaling, PI3K signaling, TRAF7, KLF4, and POLR2A result in meningiomas in the mesodermal-derived meninges of the midline and paramedian anterior, central, and ventral posterior skull base. Current evidence regarding the common pathways for genetic pathogenesis and the anatomical distribution of meningiomas is presented alongside existing understanding of the embryological origins for the meninges prior to proposing next steps for this work.
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Affiliation(s)
- Daniel M Fountain
- Geoffrey Jefferson Brain Research Centre, Salford Royal NHS Foundation Trust and the University of Manchester, Manchester, UK.
| | - Miriam J Smith
- Manchester Centre for Genomic Medicine, Manchester Academic Health Sciences Centre (MAHSC), St Mary's Hospital, School of Biological Sciences, Division of Evolution and Genomic Sciences, University of Manchester, Manchester, UK
| | - Claire O'Leary
- Geoffrey Jefferson Brain Research Centre, Salford Royal NHS Foundation Trust and the University of Manchester, Manchester, UK
| | - Omar N Pathmanaban
- Geoffrey Jefferson Brain Research Centre, Salford Royal NHS Foundation Trust and the University of Manchester, Manchester, UK
| | - Federico Roncaroli
- Geoffrey Jefferson Brain Research Centre, Salford Royal NHS Foundation Trust and the University of Manchester, Manchester, UK
| | - Nicoletta Bobola
- School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Andrew T King
- Geoffrey Jefferson Brain Research Centre, Salford Royal NHS Foundation Trust and the University of Manchester, Manchester, UK
| | - Dafydd Gareth Evans
- Manchester Centre for Genomic Medicine, Manchester Academic Health Sciences Centre (MAHSC), St Mary's Hospital, School of Biological Sciences, Division of Evolution and Genomic Sciences, University of Manchester, Manchester, UK
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The Skull's Girder: A Brief Review of the Cranial Base. J Dev Biol 2021; 9:jdb9010003. [PMID: 33498686 PMCID: PMC7838769 DOI: 10.3390/jdb9010003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/14/2021] [Accepted: 01/19/2021] [Indexed: 12/11/2022] Open
Abstract
The cranial base is a multifunctional bony platform within the core of the cranium, spanning rostral to caudal ends. This structure provides support for the brain and skull vault above, serves as a link between the head and the vertebral column below, and seamlessly integrates with the facial skeleton at its rostral end. Unique from the majority of the cranial skeleton, the cranial base develops from a cartilage intermediate-the chondrocranium-through the process of endochondral ossification. Owing to the intimate association of the cranial base with nearly all aspects of the head, congenital birth defects impacting these structures often coincide with anomalies of the cranial base. Despite this critical importance, studies investigating the genetic control of cranial base development and associated disorders lags in comparison to other craniofacial structures. Here, we highlight and review developmental and genetic aspects of the cranial base, including its transition from cartilage to bone, dual embryological origins, and vignettes of transcription factors controlling its formation.
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Scariot R, Olsson B, da Silva M, Lago C, Calixto R, Ramazzotto L, Barbosa Rebellato N, Kirschneck C, Garcia Paula-Silva F, Küchler E. Single nucleotide polymorphisms in runt-related transcription factor 2 and bone morphogenetic protein 2 impact on their maxillary and mandibular gene expression in different craniofacial patterns - A comparative study. Ann Maxillofac Surg 2021; 11:222-228. [PMID: 35265489 PMCID: PMC8848693 DOI: 10.4103/ams.ams_40_21] [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: 02/10/2021] [Revised: 09/24/2021] [Accepted: 11/09/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction: This study aimed to evaluate if single nucleotide polymorphisms (SNPs) in runt-related transcription factor 2 (RUNX2) and bone morphogenetic protein 2 (BMP2) are associated with different craniofacial patterns. Furthermore, we also investigated if RUNX2 and BMP2 expression in the maxilla and mandible are differently expressed according to facial phenotypes and influenced by the SNPs in their encoding genes. Orthognathic patients were included. Materials and Methods: Lateral cephalometric radiographs were used to classify facial phenotypes based on Steiner's ANB and Ricketts’ NBa-PtGn angles. Bone samples from 21 patients collected during orthognathic surgery were used for the gene expression assays. DNA from 129 patients was used for genotyping the SNPs rs59983488 and rs1200425 in RUNX2 and rs235768 and rs1005464 in BMP2. The established alpha was 5%. Results: A statistically significant difference was observed in the relative BMP2 expression in the mandible between Class I and III participants (P = 0.042). Homozygous GG (rs59983488) had higher RUNX2 expression (P = 0.036) in the mandible. In maxilla, GG (rs1200425) had a higher BMP2 expression (P = 0.038). Discussion: In conclusion, BMP2 is expressed differently in the mandible of Class I and Class III participants. Genetic polymorphisms in RUNX2 and BMP2 are associated with their relative gene expression.
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Daher MT, Bausero P, Agbulut O, Li Z, Parlakian A. Bcl11b/Ctip2 in Skin, Tooth, and Craniofacial System. Front Cell Dev Biol 2020; 8:581674. [PMID: 33363142 PMCID: PMC7758212 DOI: 10.3389/fcell.2020.581674] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/19/2020] [Indexed: 12/20/2022] Open
Abstract
Ctip2/Bcl11b is a zinc finger transcription factor with dual action (repression/activation) that couples epigenetic regulation to gene transcription during the development of various tissues. It is involved in a variety of physiological responses under healthy and pathological conditions. Its role and mechanisms of action are best characterized in the immune and nervous systems. Furthermore, its implication in the development and homeostasis of other various tissues has also been reported. In the present review, we describe its role in skin development, adipogenesis, tooth formation and cranial suture ossification. Experimental data from several studies demonstrate the involvement of Bcl11b in the control of the balance between cell proliferation and differentiation during organ formation and repair, and more specifically in the context of stem cell self-renewal and fate determination. The impact of mutations in the coding sequences of Bcl11b on the development of diseases such as craniosynostosis is also presented. Finally, we discuss genome-wide association studies that suggest a potential influence of single nucleotide polymorphisms found in the 3’ regulatory region of Bcl11b on the homeostasis of the cardiovascular system.
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Affiliation(s)
- Marie-Thérèse Daher
- Biological Adaptation and Ageing, Inserm ERL U1164, UMR CNRS 8256, Institut de Biologie Paris-Seine, Sorbonne Université, Paris, France
| | - Pedro Bausero
- Biological Adaptation and Ageing, Inserm ERL U1164, UMR CNRS 8256, Institut de Biologie Paris-Seine, Sorbonne Université, Paris, France
| | - Onnik Agbulut
- Biological Adaptation and Ageing, Inserm ERL U1164, UMR CNRS 8256, Institut de Biologie Paris-Seine, Sorbonne Université, Paris, France
| | - Zhenlin Li
- Biological Adaptation and Ageing, Inserm ERL U1164, UMR CNRS 8256, Institut de Biologie Paris-Seine, Sorbonne Université, Paris, France
| | - Ara Parlakian
- Biological Adaptation and Ageing, Inserm ERL U1164, UMR CNRS 8256, Institut de Biologie Paris-Seine, Sorbonne Université, Paris, France
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Role of the fibroblast growth factor 19 in the skeletal system. Life Sci 2020; 265:118804. [PMID: 33245964 DOI: 10.1016/j.lfs.2020.118804] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/10/2020] [Accepted: 11/18/2020] [Indexed: 02/05/2023]
Abstract
Fibroblast growth factor family (FGFs) is a kind of cytokine that plays an important role in growth, development, metabolism and disease. During bone development, multiple FGFs and fibroblast growth factor receptors (FGFRs) play important roles. Previous reports have elucidated the great importance of FGF1, 2, 4, 6, 7, 8, 9, 10, and 18 in bone development, and FGF21 and 23 in bone homeostasis and bone regulation. FGF19 was initially found in the human foetal brain, and its gene location is related to osteoporosis pseudoglioma syndrome. Presently, gene chip detection has repeatedly found that FGF19 shows spatiotemporal specificity of gene expression in bone development and bone-related diseases, as well as differences in the protein level, indicating that FGF19 affects the skeletal system. Considering the current insufficient understanding of FGF19 and its potential function in the skeletal system, this review aims to introduce the background of FGF19 in bone, summarise the research progress of FGF19 in the skeletal system, and discuss the role and therapeutic potential of FGF19 in bone development and bone-related diseases.
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Classification of Subtypes of Crouzon Syndrome Based on the Type of Vault Suture Synostosis. J Craniofac Surg 2020; 31:678-684. [PMID: 32068731 DOI: 10.1097/scs.0000000000006173] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Patients with Crouzon syndrome develop various types of anatomic deformities due to different forms of craniosynostosis, yet they have similar craniofacial characteristics. However, exact homology is not evident. Different pathology then may be best treated by different forms of surgical technique. Therefore, precise classification of Crouzon syndrome, based on individual patterns of cranial suture involvement is needed. METHODS Ninety-five computed tomography (CT) scans (Crouzon, n = 33; control, n = 62) were included in this study. All the CT scans are divided into 4 types based on premature closure of sutures: class I = coronal and lambdoidal synostosis; class II = sagittal synostosis; class III = pansynostosis; and class IV = "Others." The CT scan anatomy was measured by Materialise software. RESULTS The class III, pansynostosis, is the most prevalent (63.6%). The classes I, III, and IV of Crouzon have significantly shortened entire anteroposterior cranial base length, with the shortest base length in class III. The external cranial measurements in class I show primarily a decreased posterior facial skeleton, while the class III presented with holistic facial skeleton reduction. Class II has the least severe craniofacial malformations, while class III had the most severe. CONCLUSION The morphology of patients with Crouzon syndrome is not identical in both cranial base and facial characteristics, especially when they associated with different subtypes of cranial suture synostosis. The classification of Crouzon syndrome proposed in this study, summarizes the differences among each subgroup of craniosynostosis suture involvement, which, theoretically, may ultimately influence both the timing and type of surgical intervention.
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Lu X, Forte AJ, Park KE, Allam O, Mozaffari MA, Alperovich M, Steinbacher DM, Alonso N, Persing JA. Sphenoid Bone Structure and Its Influence on the Cranium in Syndromic Versus Nonsyndromic Craniosynostosis. J Craniofac Surg 2020; 32:67-72. [DOI: 10.1097/scs.0000000000006914] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Shpargel KB, Mangini CL, Xie G, Ge K, Magnuson T. The KMT2D Kabuki syndrome histone methylase controls neural crest cell differentiation and facial morphology. Development 2020; 147:dev.187997. [PMID: 32541010 DOI: 10.1242/dev.187997] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 06/02/2020] [Indexed: 12/13/2022]
Abstract
Kabuki syndrome (KS) is a congenital craniofacial disorder resulting from mutations in the KMT2D histone methylase (KS1) or the UTX histone demethylase (KS2). With small cohorts of KS2 patients, it is not clear whether differences exist in clinical manifestations relative to KS1. We mutated KMT2D in neural crest cells (NCCs) to study cellular and molecular functions in craniofacial development with respect to UTX. Similar to UTX, KMT2D NCC knockout mice demonstrate hypoplasia with reductions in frontonasal bone lengths. We have traced the onset of KMT2D and UTX mutant NCC frontal dysfunction to a stage of altered osteochondral progenitor differentiation. KMT2D NCC loss-of-function does exhibit unique phenotypes distinct from UTX mutation, including fully penetrant cleft palate, mandible hypoplasia and deficits in cranial base ossification. KMT2D mutant NCCs lead to defective secondary palatal shelf elevation with reduced expression of extracellular matrix components. KMT2D mutant chondrocytes in the cranial base fail to properly differentiate, leading to defective endochondral ossification. We conclude that KMT2D is required for appropriate cranial NCC differentiation and KMT2D-specific phenotypes may underlie differences between Kabuki syndrome subtypes.
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Affiliation(s)
- Karl B Shpargel
- Department of Genetics and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599-7264, USA
| | - Cassidy L Mangini
- Department of Genetics and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599-7264, USA
| | - Guojia Xie
- Laboratory of Endocrinology and Receptor Biology, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Kai Ge
- Laboratory of Endocrinology and Receptor Biology, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Terry Magnuson
- Department of Genetics and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599-7264, USA
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Abstract
BACKGROUND Apert syndrome is frequently combined with respiratory insufficiency, because of the midfacial deformity which, in turn, is influenced by the malformation of the skull base. Respiratory impairment resulting from Apert syndrome is caused by multilevel limitations in airway space. Therefore, this study evaluated the segmented nasopharyngeal and laryngopharyngeal anatomy to clarify subcranial anatomy in children with Apert syndrome and its relevance to clinical management. METHODS Twenty-seven patients (Apert syndrome, n = 10; control, n = 17) were included. All of the computed tomographic scans were obtained from the patients preoperatively, and no patient had confounding disease comorbidity. Computed tomographic scans were analyzed using Surgicase CMF. Craniometric data relating to the midface, airway, and subcranial structures were collected. Statistical significance was determined using t test analysis. RESULTS Although all of the nasal measurements were consistent with those of the controls, the nasion-to-posterior nasal spine, sphenethmoid-to-posterior nasal spine, sella-to-posterior nasal spine, and basion-to-posterior nasal spine distances were decreased 20 (p < 0.001), 23 (p = 0.001), 29 (p < 0.001), and 22 percent (p < 0.001), respectively. The distance between bilateral gonions and condylions was decreased 17 (p = 0.017) and 18 percent (p = 0.004), respectively. The pharyngeal airway volume was reduced by 40 percent (p = 0.01). CONCLUSION The airway compromise seen in patients with Apert syndrome is attributable more to the pharyngeal region than to the nasal cavity, with a gradually worsening trend from the anterior to the posterior airway, resulting in a significantly reduced volume in the hypopharynx.
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BOTELHO RICARDOV, BOTELHO PEDROB, DINIZ JULIETEM. Where does the cranial base flexion take place in humans? AN ACAD BRAS CIENC 2020; 92:e20190825. [DOI: 10.1590/0001-3765202020190825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 10/03/2019] [Indexed: 05/30/2023] Open
Affiliation(s)
| | - PEDRO B. BOTELHO
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Brazil
| | - JULIETE M. DINIZ
- Instituto de Assistência ao Servidor Público Estadual/ IAMSPE, Brazil
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YANO WATARU, EGI NAOKO, TAKANO TOMO, OGIHARA NAOMICHI. Subspecies and sexual craniofacial size and shape variations in Japanese macaques ( Macaca fuscata). ANTHROPOL SCI 2020. [DOI: 10.1537/ase.2005052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- WATARU YANO
- Laboratory of Biology, National Defense Medical College, Tokorozawa
| | - NAOKO EGI
- Phylogeny and Systematics section, Primate Research Institute, Kyoto University, Inuyama
| | | | - NAOMICHI OGIHARA
- Laboratory of Human Evolutionary Biomechanics, Department of Biological Sciences, The University of Tokyo, Tokyo
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Tepedino M, Laurenziello M, Guida L, Montaruli G, Troiano G, Chimenti C, Colonna M, Ciavarella D. Morphometric analysis of sella turcica in growing patients: an observational study on shape and dimensions in different sagittal craniofacial patterns. Sci Rep 2019; 9:19309. [PMID: 31848435 PMCID: PMC6917804 DOI: 10.1038/s41598-019-55916-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 12/04/2019] [Indexed: 11/09/2022] Open
Abstract
The aim of this study was to evaluate the differences in sella dimensions and shape between growing patients with Class I, Class II, and Class III skeletal malocclusions, evaluated through morphometric analysis. Seventy-eight subjects aged between 9 and 13 years were selected and assigned to either the Class I, Class II, or Class III groups according to the measured ANB angle (the angle between the Nasion, skeletal A-point and skeletal B-point). Six landmarks were digitised to outline the shape of the sella turcica. Linear measurements of the sella length and depth were also performed. Procrustes superimposition, principal component analysis, and canonical variate analysis were used to evaluate the differences in sella shape between the three groups. A one-way MANOVA and Tukey’s or Games-Howell tests were used to evaluate the presence of differences in sella dimensions between the three groups, gender, and age. The canonical variate analysis revealed a statistically significant difference in sella shape between the Class I and the Class II groups, mostly explained by the CV1 axis and related to the posterior clinoidal process and the floor of the sella. No differences were found regarding linear measurements, except between subjects with different age. These differences in sella shape, that are present in the earlier developmental stages, could be used as a predictor of facial growth, but further studies are needed.
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Affiliation(s)
- Michele Tepedino
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Michele Laurenziello
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Laura Guida
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Graziano Montaruli
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Giuseppe Troiano
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Claudio Chimenti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Marco Colonna
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Domenico Ciavarella
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
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Özalp H, Aktekin M, Hamzaoğlu V, Vayisoğlu Y, Karataş MA, Karşıyaka D, Uzmansel D, Bozdoğan Arpacı R, Cayan F, Eti CM, Kanık A, Baskan FC, Aladağ ZC, Ertaş E, Dağtekin A, Avcı E, Bağdatoğlu C, Ümit Talas D. The Comparison of the Right and Left Sigmoid Sinus Cross-Sectional Areas in Fetal Period and the Factors Affecting the Venous Dominance. J Int Adv Otol 2019; 15:409-414. [PMID: 31846921 PMCID: PMC6937183 DOI: 10.5152/iao.2019.5876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 01/09/2019] [Accepted: 02/28/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Skull base is an important and a challenging area for surgeons. Success in skull base surgery depends on various factors such as pre-operative evaluation, appropriate surgical technique, anesthesia duration, intraoperative neuromonitorization and wound care. MATERIALS AND METHODS This study was performed in the Anatomy dissection laboratory of M.U. Medical Faculty (Ethical committee approval number 2010-103). Twelve fetuses between 17-33 gestational weeks fixed with formaldehyde were enrolled to the study. RESULTS This study was planned to investigate the cross sectional areas of the sigmoid sinus in three levels to compare the right-left sides and the probable relationship among the levels in fetuses to further delineate the developmental factors on jugular foramen asymmetry. The cross-sectional measurements of sigmoid sinus lumen were done on 3 levels which are described as A1 level; sinodural angle, A2 level; the midpoint between the sinodural angle and endocranial orifice and A3 level as the entrance (endo-cranial orifice) of the jugular foramen. There is a strong positive correlation between left (L) A1 and L A2 and also the same for L A1 and right (R) A2. These strong and positive correlations are all valid between L A2-L A3, L A2-R A2, L A2-R A3, L A3-R A3, R A1-R A2. CONCLUSION Multicenter studies would be beneficial to investigate the topic with greater number of fetuses also on the different regions for genetic differences.
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Affiliation(s)
- Hakan Özalp
- Department of Neurosurgery, Mersin University School of Medicine, Mersin, Turkey
| | - Mustafa Aktekin
- Department of Anatomy, Acıbadem Mehmet Ali Aydınlar University, School of Medicine, İstanbul, Turkey
| | - Vural Hamzaoğlu
- Department of Neurosurgery, Mersin University School of Medicine, Mersin, Turkey
| | - Yusuf Vayisoğlu
- Department of Neurosurgery, Mersin University School of Medicine, Mersin, Turkey
| | - Mehmet Ali Karataş
- Department of Neurosurgery, Mersin University School of Medicine, Mersin, Turkey
| | | | - Deniz Uzmansel
- Department of Anatomy, Mersin University School of Medicine, Mersin, Turkey
| | | | - Filiz Cayan
- Department of Gynecology and Obstetrics, Mersin University School of Medicine, Mersin, Turkey
| | - Can Mehmet Eti
- Department of Otorhinolaryngology, Mersin University School of Medicine, Mersin, Turkey
| | - Arzu Kanık
- Department of Biostastistics, Mersin University School of Medicine, Mersin, Turkey
| | | | | | - Elif Ertaş
- Department of Biostastistics, Mersin University School of Medicine, Mersin, Turkey
| | - Ahmet Dağtekin
- Department of Neurosurgery, Mersin University School of Medicine, Mersin, Turkey
| | - Emel Avcı
- Department of Neurosurgery, Mersin University School of Medicine, Mersin, Turkey
| | - Celal Bağdatoğlu
- Department of Neurosurgery, Mersin University School of Medicine, Mersin, Turkey
| | - Derya Ümit Talas
- Department of Otorhinolaryngology, Mersin University School of Medicine, Mersin, Turkey
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50
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What Is the Skull Structure Influence of Squamosal Suture Synostosis in Nonsyndromic and Syndromic Crouzon Craniosynostosis? J Craniofac Surg 2019; 30:1671-1675. [DOI: 10.1097/scs.0000000000005396] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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