Zygomaticotemporal synostosis: a rare cause of progressive facial asymmetry

Fusion of Lateral Calvarial Sutures on Volume-Rendered Computed Tomography Reconstructions in Patients With Known Craniosynostosis

INTRODUCTION

After treating a child with familial sagittal craniosynostosis, clinocephaly, and bilateral parietomastoid/posterior squamosal suture fusion, the authors wondered if major-suture synostosis and clinocephaly were associated with abnormal fusion of minor lateral calvarial sutures.

METHODS

The authors reviewed all preoperative volume-rendered head computed tomography reconstructions performed for craniosynostosis at their institution from 2010 through 2014 and determined whether the sphenoparietal, squamosal, and parietomastoid sutures were open, partially fused, or fused. The authors determined whether any sutures were abnormally fused based upon a previous study from their center, in which abnormal fusion was defined as either 1 of 3 abnormal fusion patterns or abnormally-early fusion. The authors then determined the rate of abnormal fusion of these sutures and whether abnormal fusion was associated with (1) major-suture craniosynostosis, (2) type of craniosynostosis (sutures involved; single-suture versus multisuture; syndromic versus nonsyndromic), and (3) clinocephaly.

RESULTS

In 97 included children, minor lateral sutures were abnormally fused in 8, or 8.2%, which was significantly higher than in children without craniosynostosis from our earlier study. Abnormal minor lateral suture fusion was not associated with the type of single-suture synostosis or with multisuture synostosis but was associated with syndromic synostosis. Four of 8 children with abnormal minor lateral suture fusion had multisuture synostosis and 6 had syndromic synostosis. Lateral sutures were abnormally fused in 1 of 4 subjects with clinocephaly, which was not significant.

CONCLUSION

Abnormal minor lateral calvarial suture fusion is significantly associated with major-suture craniosynostosis, especially syndromic synostosis.

Morphometric and morphological evaluation of temporozygomatic suture anatomy in dry adult human skulls

This study aims to evaluate the position, morphometric, and morphological features of the temporozygomatic suture (TZS) located on the zygomatic arch (ZA) in dry adult human skulls. Thirty-two crania were evaluated. Measurements for the TZS were carried out using the ImageJ software. Morphometric measurements were carried out bilaterally in 23 crania and unilaterally in 9 crania (right: 4, left: 5). A total of 55 TZSs were analyzed. Localization of the TZS was determined according to the reference landmarks on the ZA. Morphologic features of the TZS evaluated in terms of "joint shape type" and "suture margin pattern". Descriptive statistics of the morphometric and morphologic variables were calculated. A statistically significant difference between the right and left sides was observed for the localization of the TZS (p < 0.05). TZS is located more anteriorly on the left side than the right side. Based on the "joint shape type", four types of TZS were observed: Type 1 (angular) (34.55%), Type 2 (curvy) (34.55%), Type 3 (oblique) (14.55%), Type 4 (horizontal) (16.36%). Based on the "suture margin pattern", five types of TZS were observed: Type A (linear) (12.73%), Type B (denticulate) (34.55%), Type C (serrated) (23.64%), Type D (mixt) (21.82%), Type E (fused) (7.27%). No significant association between the type and lateralization was found for both morphologic classifications. To the best of our knowledge, this is the first published report regarding the localization and morphologic classification of the TZS in adult human crania. Considering the TZS with its morphometric and morphological features may contribute to clinical or forensic medical evaluations.

The 27 Facial Sutures: Timing and Clinical Consequences of Closure

SUMMARY

Facial sutures contribute significantly to postnatal facial development, but their potential role in craniofacial disease is understudied. Since interest in their development and physiology peaked in the mid-twentieth century, facial sutures have not garnered nearly the same clinical research interest as calvarial sutures or cranial base endochondral articulations. In addition to reinforcing the complex structure of the facial skeleton, facial sutures absorb mechanical stress and generally remain patent into and beyond adolescence, as they mediate growth and refine the shape of facial bones. However, premature closure of these sites of postnatal osteogenesis leads to disrupted growth vectors and consequent dysmorphologies. Although abnormality in individual sutures results in isolated facial deformities, we posit that generalized abnormality across multiple sutures may be involved in complex craniofacial conditions such as syndromic craniosynostosis. In this work, the authors comprehensively review 27 key facial sutures, including physiologic maturation and closure, contributions to postnatal facial development, and clinical consequences of premature closure.

Unilateral synostosis of the zygomaticotemporal suture associated with mandibular coronoid process impingement in a dog

A 13-month-old dog was investigated for the complaint of open-mouth locked jaw. There were not any previous episodes of trauma witnessed. Computed tomographic evaluation revealed unilateral zygomaticotemporal synostosis and associated craniofacial asymmetry, with impingement of the mandibular coronoid process resulting in unilateral temporomandibular joint subluxation. Closed reduction of the subluxation was not maintained. Partial zygomaticotemporal suturectomy resulted in resolution of the clinical signs. To the author's knowledge, isolated zygomaticotemporal synostosis with associated temporomandibular subluxation has not been reported in the dog.

Squamosal Suture Synostosis: Incidence, Associations, and Implications for Treatment

Squamosal suture craniosynostosis is thought to be a relatively rare entity. In the authors' experience, it is underreported in imaging examinations and the existing literature. The authors sought to determine the incidence of squamosal synostosis, whether it is increasing in frequency, and its relationship with synostosis of the major calvarial sutures.Patients undergoing computed tomography imaging for suspected craniosynostosis over a 15-year period were reviewed by a plastic surgeon and pediatric neuroradiologist. Patients with synostosis of the squamosal sutures were identified and involvement of additional sutures, gender, and the presence of a known syndromic diagnosis were recorded. Patients greater than 4 years of age or those with prior craniofacial surgery were excluded.One hundred twenty-five patients met inclusion criteria, 26 of whom had squamosal suture synostosis (26/125, 20.8%). Squamosal synostosis was found in isolation in 3 patients (3/26, 11.5%), with 1 additional major suture in 10 patients (10/26, 38.5%), and ≥2 major sutures in 13 patients (13/26, 50%). Squamosal synostosis was more common in patients with a syndromic diagnosis (11/26 syndromic, 15/99 nonsyndromic, P < 0.001). Eleven of 26 patients with squamosal synostosis were identified in the radiology report (42.3%).Craniosynostosis of the squamosal suture is much more common than previously reported and can contribute to abnormal head shape in isolation, or in combination with major sutures. Squamosal suture synostosis is underdiagnosed clinically and radiologically, although insufficient evidence exists to determine if its true incidence is increasing.

Endoscope-assisted strip craniectomy and postoperative helmet therapy for treatment of craniosynostosis

Object

The primary goals of treatment in the infant with craniosynostosis are to correct the deformity and allow for adequate brain growth in as safe and effective a manner as possible. Herein, the authors present the results of treating craniosynostosis using an endoscope-assisted strip craniectomy and postoperative helmet therapy (EASC + PHT) in the hopes of providing further evidence of its role in the treatment of multiple different forms of craniosynostosis. This is a retrospective review of the patients treated with this technique at Children's Hospital Boston.

Methods

The electronic medical records of all children with craniosynostosis treated using this technique were reviewed retrospectively. A priori, data were collected for deformity type, patient age at surgery, number of transfusions, operative time, length of hospital stay, and anthropometric measurements.

Results

One hundred seventy-three patients (61 females and 112 males) were treated at our institution between July 2004 and March 2011 with EASC + PHT. The mean operative time was 46.30 minutes. Eight (4.6%) of the 173 patients received blood transfusions. The average length of hospital stay was 1.35 days, with the majority of patients being discharged the day after surgery. All complications and any patient who required additional craniofacial reconstructions are discussed. In addition, a subgroup analysis was done for patients who had undergone surgery and had longer than 1 year of follow-up.

Conclusions

The authors' growing database of patients supports the experiences described by others that early treatment of craniosynostosis with an EASC + PHT is a safe and efficacious technique. In addition, cost reduction due to decreased hospital stay and limitation of blood transfusions are demonstrable benefits associated with the use of this technique.