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Romeo DJ, Becerra SL, Barrero CE, Massenburg BB, Du S, Ng JJ, Wu M, Swanson JW, Taylor JA, Bartlett SP. Validating the Supraorbital Notch-Nasion-Supraorbital Notch Angle as a Marker for Metopic Craniosynostosis Severity. J Craniofac Surg 2024; 35:1035-1039. [PMID: 38743289 DOI: 10.1097/scs.0000000000010302] [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: 01/10/2024] [Accepted: 02/18/2024] [Indexed: 05/16/2024] Open
Abstract
OBJECTIVE Metopic craniosynostosis (MCS) can be difficult to differentiate from metopic ridge (MR) or normal frontal morphology. This study assess whether the supraorbital notch-nasion-supraorbital notch (SNS) angle can help identify MCS. METHODS Records of 212 patients with preoperative three-dimensional computed tomography scans were examined. The SNS angles, surgeon craniofacial dysmorphology rankings, and CranioRate metopic severity scores (MSSs) were compared with the Spearman rank correlation coefficient. Receiver operating characteristic (ROC) curves with Youden J-statistic and cross-validation of regression models assessed the ability of these measures to predict surgery. RESULTS A total of 212 patients were included, consisting of 78 MCS, 37 MR, and 97 controls. Both the mean SNS angle (MCS: 111.7 ± 10.7 degrees, MR: 126.0 ± 8.2 degrees, controls: 130.7 ± 8.8 degrees P < 0.001) and MSS (MCS: 5.9 ± 2.0, MR: 1.4 ± 1.9, controls: 0.2 ± 1.9, P < 0.001) were different among the cohorts. The mean SNS angle (111.5 ± 10.7 versus 129.1 ± 8.8, P < 0.001) was lower in those who had surgery and CranioRate score (5.9 ± 2.1 versus 0.8 ± 2.2, P < 0.001) was higher in those who underwent surgery. SNS angles were positively correlated with surgeon craniofacial dysmorphology rankings ( r = 0.41, P < 0.05) and CranioRate MSS ( r = 0.54, P < 0.05). The ROC curve requiring high sensitivity revealed an SNS angle of 124.8 degrees predicted surgery with a sensitivity of 88.7% and a specificity of 71.3%. A ROC curve using the CranioRate MCC values ≥3.19 predicted surgery with 88.7% sensitivity and 94.7% specificity. CONCLUSION Orbital dysmorphology in patients with MCS is well captured by the supraorbital-nasion angle. Both the SNS angle and CranioRate MSS scores accurately predict surgical intervention.
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Affiliation(s)
- Dominic J Romeo
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
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Bloch K, Geoffroy M, Taverne M, van de Lande L, O'Sullivan E, Liang C, Paternoster G, Moazen M, Laporte S, Khonsari RH. New diagnostic criteria for metopic ridges and trigonocephaly: a 3D geometric approach. Orphanet J Rare Dis 2024; 19:204. [PMID: 38762603 PMCID: PMC11102612 DOI: 10.1186/s13023-024-03197-8] [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: 05/13/2023] [Accepted: 04/29/2024] [Indexed: 05/20/2024] Open
Abstract
BACKGROUND Trigonocephaly occurs due to the premature fusion of the metopic suture, leading to a triangular forehead and hypotelorism. This condition often requires surgical correction for morphological and functional indications. Metopic ridges also originate from premature metopic closure but are only associated with mid-frontal bulging; their surgical correction is rarely required. Differential diagnosis between these two conditions can be challenging, especially in minor trigonocephaly. METHODS Two hundred seven scans of patients with trigonocephaly (90), metopic rigdes (27), and controls (90) were collected. Geometric morphometrics were used to quantify skull and orbital morphology as well as the interfrontal angle and the cephalic index. An innovative method was developed to automatically compute the frontal curvature along the metopic suture. Different machine-learning algorithms were tested to assess the predictive power of morphological data in terms of classification. RESULTS We showed that control patients, trigonocephaly and metopic rigdes have distinctive skull and orbital shapes. The 3D frontal curvature enabled a clear discrimination between groups (sensitivity and specificity > 92%). Furthermore, we reached an accuracy of 100% in group discrimination when combining 6 univariate measures. CONCLUSION Two diagnostic tools were proposed and demonstrated to be successful in assisting differential diagnosis for patients with trigonocephaly or metopic ridges. Further clinical assessments are required to validate the practical clinical relevance of these tools.
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Affiliation(s)
- Kevin Bloch
- Service de chirurgie maxillofaciale et chirurgie plastique, Hôpital Necker - Enfants malades, Assistance Publique - Hôpitaux de Paris, CRMR CRANIOST, Faculté de Médecine, Université Paris Cité, Paris, France
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Institute of Technology, Paris, France
| | - Maya Geoffroy
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Institute of Technology, Paris, France
- Laboratoire 'Forme et Croissance du Crâne', Hôpital Necker - Enfants malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Maxime Taverne
- Laboratoire 'Forme et Croissance du Crâne', Hôpital Necker - Enfants malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Lara van de Lande
- Craniofacial Unit, Great Ormond Street Hospital for Children; UCL Great Ormond Street Institute of Child Health, London, UK
- Department of Oral and Maxillofacial Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands
| | | | - Ce Liang
- Department of Mechanical Engineering, University College London, London, UK
| | - Giovanna Paternoster
- Service de Neurochirurgie, Hôpital Necker - Enfants malades, Assistance Publique - Hôpitaux de Paris, CRMR CRANIOST, Paris, France
| | - Mehran Moazen
- Department of Mechanical Engineering, University College London, London, UK
| | - Sébastien Laporte
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Institute of Technology, Paris, France
| | - Roman Hossein Khonsari
- Service de chirurgie maxillofaciale et chirurgie plastique, Hôpital Necker - Enfants malades, Assistance Publique - Hôpitaux de Paris, CRMR CRANIOST, Faculté de Médecine, Université Paris Cité, Paris, France.
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Institute of Technology, Paris, France.
- Laboratoire 'Forme et Croissance du Crâne', Hôpital Necker - Enfants malades, Assistance Publique - Hôpitaux de Paris, Paris, France.
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Al-Murad BM, Radwan MA, Zaki IA, Soliman MM, Al-Shareef EM, Gaban AM, Al-Mukhlifi YM, Kefi FZ. Exploring Different Management Modalities of Nonsyndromic Craniosynostosis. Cureus 2024; 16:e60831. [PMID: 38910614 PMCID: PMC11190809 DOI: 10.7759/cureus.60831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2024] [Indexed: 06/25/2024] Open
Abstract
Craniosynostosis is an atypical skull shape characterized by the premature fusion of cranial sutures. It is one of the most common congenital anomalies encountered by craniofacial surgeons, with a prevalence of one in every 2000-2500 births. It is classified into two main types: syndromic and nonsyndromic. In syndromic, the patient presents with other abnormalities involving the trunk, face, or extremities. While in nonsyndromic the only anomy is the premature fusion, which usually involves one suture; the most common subtypes are unicoronal, sagittal, bicoronal, metopic, and lambdoid. As a consequence, premature fusion before its natural time restricts the space for the brain to grow, increases intracranial pressure, causes damage to the brain tissue, and affects the development of the child. This review comprehensively provides a detailed overview of nonsyndromic craniosynostosis and aims to highlight the importance of early and accurate diagnosis, and determining the most suitable intervention, whether surgical or conservative modalities. The optimal treatment approach produces the most favorable aesthetic and functional outcomes.
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Affiliation(s)
| | | | - Ibrahim A Zaki
- General Practice of Pediatrics, Batterjee Medical College, Jeddah, SAU
| | | | | | | | - Yara M Al-Mukhlifi
- Medical School, King Saud Bin Abdualziz University for Health and Sciences, Riyadh, SAU
| | - Fatma Z Kefi
- Medical School, Batterjee Medical College, Jeddah , SAU
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Magnet R, Bloch K, Taverne M, Melzi S, Geoffroy M, Khonsari RH, Ovsjanikov M. Assessing craniofacial growth and form without landmarks: A new automatic approach based on spectral methods. J Morphol 2023; 284:e21609. [PMID: 37458086 DOI: 10.1002/jmor.21609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 05/19/2023] [Accepted: 05/29/2023] [Indexed: 07/18/2023]
Abstract
We present a novel method for the morphometric analysis of series of 3D shapes, and demonstrate its relevance for the detection and quantification of two craniofacial anomalies: trigonocephaly and metopic ridges, using CT-scans of young children. Our approach is fully automatic, and does not rely on manual landmark placement and annotations. Our approach furthermore allows to differentiate shape classes, enabling successful differential diagnosis between trigonocephaly and metopic ridges, two related conditions characterized by triangular foreheads. These results were obtained using recent developments in automatic nonrigid 3D shape correspondence methods and specifically spectral approaches based on the functional map framework. Our method can capture local changes in geometric structure, in contrast to methods based, for instance, on global shape descriptors. As such, our approach allows to perform automatic shape classification and provides visual feedback on shape regions associated with different classes of deformations. The flexibility and generality of our approach paves the way for the application of spectral methods in quantitative medicine.
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Affiliation(s)
- Robin Magnet
- LIX, École Polytechnique, IP Paris, Palaiseau, France
| | - Kevin Bloch
- Laboratoire "Forme et Croissance du Crâne", Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Faculté de Médecine, Université Paris Cité, Paris, France
| | - Maxime Taverne
- Laboratoire "Forme et Croissance du Crâne", Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Faculté de Médecine, Université Paris Cité, Paris, France
| | - Simone Melzi
- Department of Informatics, Systems and Communication, University of Milano-Bicocca, Milan, Italy
| | - Maya Geoffroy
- Laboratoire "Forme et Croissance du Crâne", Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Faculté de Médecine, Université Paris Cité, Paris, France
| | - Roman H Khonsari
- Laboratoire "Forme et Croissance du Crâne", Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Faculté de Médecine, Université Paris Cité, Paris, France
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Anthropometric cranial measurements in metopic craniosynostosis/trigonocephaly: diagnostic criteria, classification of severity and indications for surgery. J Craniofac Surg 2021; 33:161-167. [PMID: 34690312 DOI: 10.1097/scs.0000000000008196] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Metopic craniosynostosis is the second most frequent type of craniosynostosis. When the phenotypic presentation has been deemed severe the treatment is surgical in nature and is performed in infancy with fronto-orbital advancement and cranial vault remodeling. At the time of this writing, there is no consensus regarding an objective evaluation system for severity, diagnostic criteria, or indications for surgery. This study aims to review the anthropometric cranial measurements and the relative diagnostic criteria/classification of severity/surgical indications proposed so far for this skull malformation, and to investigate if there is any scientific support for their utility.
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Appropriateness of Computed Tomography Scanning in the Diagnosis of Craniosynostosis. J Craniofac Surg 2021; 33:222-225. [PMID: 34267136 DOI: 10.1097/scs.0000000000007928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Although physicians from a variety of specialties encounter infants with possible craniosynostosis, judicious use of computed tomography (CT) imaging is important to avoid unnecessary radiation exposure and healthcare expense. The present study seeks to determine whether differences in specialty of ordering physician affects frequency of resulting diagnostic confirmations requiring operative intervention. METHODS Radiology databases from 2 institutions were queried for CT reports or indications that included "craniosynostosis" or "plagiocephaly." Patient demographics, specialty of ordering physician, confirmed diagnosis, and operative interventions were recorded. Cost analysis was performed using the fixed unit cost for a head CT to calculate the expense before 1 study led to operative intervention. RESULTS Three hundred eighty-two patients were included. 184 (48.2%) CT scans were ordered by craniofacial surgeons, 71 (18.6%) were ordered by neurosurgeons, and 127 (33.3%) were ordered by pediatricians. One hundred four (27.2%) patients received a diagnosis of craniosynostosis requiring operative intervention. Craniofacial surgeons and neurosurgeons were more likely than pediatricians to order CT scans that resulted in a diagnosis of craniosynostosis requiring operative intervention (P < 0.001), with no difference between craniofacial surgeons and neurosurgeons (P = 1.0). The estimated cost of obtaining an impact CT scan when ordered by neurosurgeons or craniofacial surgeons as compared to pediatricians was $2369.69 versus $13,493.75. CONCLUSIONS Clinicians who more frequently encounter craniosynostosis (craniofacial and neurosurgeons) had a higher likelihood of ordering CT images that resulted in a diagnosis of craniosynostosis requiring operative intervention. This study should prompt multi-disciplinary interventions aimed at improving evaluation of pretest probability before CT imaging.
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Birgfeld CB, Heike C. Distinguishing Between Lambdoid Craniosynostosis and Deformational Plagiocephaly: A Review of This Paradigm Shift in Clinical Decision-Making and Lesson for the Future. Craniomaxillofac Trauma Reconstr 2020; 13:248-252. [PMID: 33456695 DOI: 10.1177/1943387520965801] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The cause of occipital asymmtery can be either extrinsic or intrinsic. Intrinsic causes include lambdoid craniosynsotosis. This condition is generally treated with cranial vault expansion surgery. Extrinsic causes include deformational plagiocephaly, which became commonplace after the "Back to Sleep Campaign" instituted in the 1980s by the American Academy of Pediatrics. The treatment of this condition is non surgical. Dr. Joseph Gruss was instumental in differentiating between these conditions and reducing the number of unnecessary surgeries that were previously being performed.
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Affiliation(s)
- Craig B Birgfeld
- Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Carrie Heike
- Seattle Children's Hospital, University of Washington, Seattle, WA, USA
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A Comparison of Intracranial Volumes and Metopic Index in Patients With Isolated Metopic Ridge, Metopic Craniosynostosis, and Normal Healthy Children. J Craniofac Surg 2020; 32:108-112. [PMID: 33186289 DOI: 10.1097/scs.0000000000007044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Previous research has shown that patients with metopic craniosynostosis have significantly reduced intracranial volumes (ICVs) compared to normal healthy children. Furthermore, the metopic index (ratio of midfrontozygomatic diameter to maximal cranial width) has been described as an anthropometric cranial index for patients with metopic craniosynostosis. We aimed to determine whether patients with isolated metopic ridge have significantly different ICVs or metopic indices than normal children and patients with metopic craniosynostosis. METHODS A retrospective chart review of all patients with a diagnosis of a metopic ridge or metopic craniosynostosis was performed from 2000 to 2015 at Rady Children's Hospital. Patients were grouped based on computed tomographic scans consistent with metopic craniosynostosis versus metopic ridge. RESULTS Data were available for 15 metopic ridge patients, 74 metopic craniosynostosis patients, and 213 normal patients. Mean metopic ridge ICV was greater than mean metopic craniosynostosis ICV at 4 to 6 months and 7 to 12 months. Controlling for age and sex, the difference in ICV associated with metopic ridging was 197.484 cm3 and 137.770 cm3 at 4 to 6 and 7 to 12 months, respectively. Similarly, mean metopic index was significantly greater in metopic ridge patients compared to mean metopic craniosynostosis at 4 to 6 months and at 7 to 12 months. CONCLUSIONS Our study provides volumetric and anthropometric data to support the hypothesis that isolated metopic ridge is an intermediate phenotype between metopic craniosynostosis and normal cranial anatomy. We hope that characterizing the spectrum of disease involving premature closure of the metopic suture with regard to ICV and metopic index will aid physicians in their management of patients with isolated metopic ridge.
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