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Kronig SAJ, Kronig ODM, Zurek M, Van Adrichem LNA. Orbital volume, ophthalmic sequelae and severity in unilateral coronal synostosis. Childs Nerv Syst 2021; 37:1687-1694. [PMID: 33566143 PMCID: PMC8084761 DOI: 10.1007/s00381-021-05065-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 01/27/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Unilateral coronal synostosis (UCS) results in an asymmetrical skull, including shallow and asymmetrical orbits, associated with reduced orbital volume and high prevalences of ophthalmic sequelae. Aim is to link orbital volumes in patients with UCS to severity according to UCSQ (Utrecht Cranial Shape Quantifier) and presence of ophthalmic sequelae. METHODS We included preoperative patients with UCS (≤ 18 months). Orbital volume was measured on CT scans by manual segmentation (Mimics software (Materialise, Leuven, Belgium)), and severity of UCS was determined by UCSQ. Orbital volume of affected side was compared to unaffected side using Wilcoxon signed rank test. Orbital volume ratio was calculated (affected/unaffected volume) and compared to the category of UCSQ by Kruskal-Wallis test. Opthalmic sequelae were noted. RESULTS We included 19 patients (mean age 7 months). Orbital volume on affected side was significantly lower (p = 0.001), mean orbital volume ratio was 0.93 (SD 0.03). No significant differences in group means of orbital volume ratio between different levels of severity of UCSQ were found (Kruskal-Wallis H (2) = 0.873; p > 0.05). Ophthalmic sequelae were found in 3 patients; one had adduction impairment and strabismus (mild UCS), one had astigmatism (moderate UCS), and one had abduction impairment (on both ipsi- and contralateral side) and vertical strabismus (severe UCS). CONCLUSION No association between orbital volume ratio and severity of UCS was found. Side-to-side asymmetry in orbital volume was noted. No association between either preoperative orbital volume ratio or severity of UCS and the presence of preoperative ophthalmic sequelae was found.
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Affiliation(s)
- Sophia A. J. Kronig
- Department of Plastic and Reconstructive Surgery and Hand Surgery, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Otto D. M. Kronig
- Department of Plastic and Reconstructive Surgery and Hand Surgery, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Marcel Zurek
- Department of Ophthalmology, Erasmus University Medical Centre (Erasmus MC), Rotterdam, The Netherlands
| | - Léon N. A. Van Adrichem
- Department of Plastic and Reconstructive Surgery and Hand Surgery, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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Chieffo DPR, Arcangeli V, Bianchi F, Salerni A, Massimi L, Frassanito P, Tamburrini G. Single-suture craniosynostosis: is there a correlation between preoperative ophthalmological, neuroradiological, and neurocognitive findings? Childs Nerv Syst 2020; 36:1481-1488. [PMID: 32006097 DOI: 10.1007/s00381-020-04521-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 01/25/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND In spite of literature data stating that children with single-suture craniosynostosis have an increased risk for neuropsychological deficits, no data are present clarifying the potential risk factors. METHODS All children with non-syndromic single-suture craniosynostosis operated on from January 2014 to January 2017 were enrolled. A comprehensive neurocognitive and neuro-ophthalmological evaluation was performed before surgery and 6 months after surgery. A further neurocognitive evaluation was performed 12 months after surgery. All children had a preoperative CT/MR study. RESULTS One hundred forty-two patients were enrolled; 87 are affected by sagittal craniosynostosis, 38 by trigonocephaly, and 17 by plagiocephaly. A global neurocognitive impairment was documented in 22/87 children with scaphocephaly, 5/38 children with trigonocephaly, and 6/17 children with anterior plagiocephaly. There was a significant relationship between results of the ophthalmological evaluation, global IQ, and CT findings at diagnosis (r = 0.296, p < 0.001; r =0.187, p 0.05). Though a significant recovery was documented after surgery, a persistence of eye coordination deficits was present at 6 months in 1 out of 3 children with abnormal preoperative exams. A significant correlation was found between pathological CT findings and persistence of below average neuro-ophthalmological and neurocognitive findings 6 months after surgery, as well as between CT findings and neurocognitive scores at the 1 year follow-up (r = 0.411; p < 0.01). CONCLUSION The presence of neuroradiological abnormalities appears to be related to both ophthalmological and neurocognitive deficits at diagnosis. This relationship is maintained in spite of the surgical treatment in children who show the persistence of ophthalmological and neurocognitive deficits during the follow-up.
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Affiliation(s)
- D P R Chieffo
- Institute of Pediatric Neurology, Fondazione Policlinico Gemelli IRCCS, Catholic University Medical School, Rome, Italy
| | - V Arcangeli
- Institute of Pediatric Neurology, Fondazione Policlinico Gemelli IRCCS, Catholic University Medical School, Rome, Italy
| | - F Bianchi
- Pediatric Neurosurgery, Institute of Neurosurgery, Fondazione Policlinico Gemelli IRCCS, Catholic University Medical School, Rome, Italy.
| | - A Salerni
- Institute of Ophthalmology, Fondazione Policlinico Gemelli IRCCS, Catholic University Medical School, Rome, Italy
| | - L Massimi
- Pediatric Neurosurgery, Institute of Neurosurgery, Fondazione Policlinico Gemelli IRCCS, Catholic University Medical School, Rome, Italy
| | - P Frassanito
- Pediatric Neurosurgery, Institute of Neurosurgery, Fondazione Policlinico Gemelli IRCCS, Catholic University Medical School, Rome, Italy
| | - G Tamburrini
- Pediatric Neurosurgery, Institute of Neurosurgery, Fondazione Policlinico Gemelli IRCCS, Catholic University Medical School, Rome, Italy
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Yang B, Ni J, Li B. 3D morphological change of skull base and fronto-temporal soft-tissue in the patients with unicoronal craniosynostosis after fronto-orbital advancement. Childs Nerv Syst 2018; 34:947-955. [PMID: 29335798 DOI: 10.1007/s00381-018-3721-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 01/03/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE This study aims to comprehensively evaluate the deformation of the skull base and fronto-temporal soft tissue in the patients with anterior plagiocephaly over 1 year of age by three-dimensional (3D) imaging after fronto-orbital advancement (FOA). METHODS We quantitatively analyzed the surgical results and outcome of FOA performed in 10 patients with anterior plagiocephaly. The measurements of the skull base and fronto-temporal soft tissue were performed based on 3D computed tomography (CT) scan. We assessed symmetry of the skull base and fronto-temporal soft tissue change. RESULTS The mean age of patients at FOA was 38.9 months. A significant asymmetry of the skull base was found in all the patients. The growth of the anterior and middle fossae was restricted and the deformation of the fronto-temporal region was marked by soft tissue measurements in different grades. On the follow-up CT images 23.6 months after surgery, there was prominent change (p < 0.05) between the two hemibases (CSO^ ratio) and between the lengths and angles of the anterior and middle cranial hemi-fossae (CX, CSX^, XSM^, XM ratio), especially in grade IIA. Anterior cranial vault asymmetry index obviously decreased to - 1.2 from 12% after surgery (p < 0.05). What's more, ACA^ was also proved to be less after surgical correction (19.91° versus 8.29°, p < 0.01) in grade IIA. The change of fronto-temporal soft tissue was significant such as the frontal angle, the angle of the frontal plane, the fontal-temporal angle, and the angle of the temporal plane in different grades. CONCLUSIONS The asymmetry of the skull base and the deformation of the fronto-temporal region can be presented by intracranial view at over 1 year of age in different grades. FOA can correct the skeletal malformation of the fronto-temporal region as well as soft tissue and the asymmetry of the skull base was improved after surgical treatment.
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Affiliation(s)
- Bin Yang
- Centre of Maxillofacial Surgery and Digital Plastic Surgery, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100041, People's Republic of China.
| | - Jian Ni
- Centre of Maxillofacial Surgery and Digital Plastic Surgery, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100041, People's Republic of China
| | - Binghang Li
- Centre of Maxillofacial Surgery and Digital Plastic Surgery, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100041, People's Republic of China
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Elbanoby T. Craniofacial Distraction in the Management of Anterior Plagiocephaly: A Novel Idea and a Systematic Review of the Literature. Pediatr Neurosurg 2018; 53:193-199. [PMID: 29408824 DOI: 10.1159/000486202] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 12/10/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND The objective of this work is to present a review of all reports involving the management of unicoronal synostosis with distraction osteogenesis (DO). Also, we have innovated a new method in the treatment of cases of anterior plagiocephaly at a young age using DO. METHODS We present a case in which anterior plagiocephaly was treated by DO of both metopic and hemicoronal sutures in a 4-month-old female patient. A comprehensive systematic literature review was completed using the search terms "distraction osteogenesis," "unicoronal synostosis," "anterior plagiocephaly," and "craniosynostosis." We excluded all experimental articles and reviewed clinical reports detailing the use of DO in the management of unicoronal synostosis. RESULTS The study sample of this review consisted of 16 reports published over a period of 17 years that were analyzed in detail. The total number of patients treated by DO was 120, and the mean age at operation was 12 months. In the case presented, successful correction of the unicoronal synostosis was achieved. CONCLUSION Hemicoronal and metopic suture distraction in anterior plagiocephaly achieves considerable improvement in the midline shift of the anterior cranial base and naso-orbital complex.
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Affiliation(s)
- Tarek Elbanoby
- Plastic and Burn Surgery Department, Al-Azhar University, Cairo, Egypt
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Song HB, Yang HK, Baek RM, Hwang JM, Kim N, Wang KC, Kim S. Effect of fronto-orbital advancement on astigmatism in patients with anterior plagiocephaly. J Craniomaxillofac Surg 2016; 44:1504-1507. [PMID: 27567360 DOI: 10.1016/j.jcms.2016.04.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 03/30/2016] [Accepted: 04/19/2016] [Indexed: 11/20/2022] Open
Abstract
The purpose of this study was to determine the effect of unilateral fronto-orbital advancement (FOA) or bilateral FOA on ocular aspects of plagiocephaly. A retrospective review of ocular findings in 16 patients with plagiocephaly was performed. Patients were divided into 2 groups: 12 patients who underwent bilateral FOA (bFOA) and 4 patients who underwent unilateral FOA (uFOA), and ocular findings were compared. One-half of patients showed strabismus in both groups, and all had exotropia. Hypertropia was found only on the same side of the plagiocephaly in 17% of the bFOA group and 25% of the uFOA group. One-third of the patients in the bFOA group and one-half of patients in the uFOA group had oblique muscle dysfunction. In terms of astigmatism, the degree of with-the-rule astigmatism on the contralateral side was larger in the bFOA group compared to the uFOA group (p = 0.030). The degree of with-the-rule astigmatism was larger on the contralateral side than the ipsilateral side (p = 0.005) in the bFOA group. Patients with abnormalities in ductions/versions had larger astigmatism on the contralateral side than those without abnormalities in ductions/versions. In conclusion, bilateral FOA could induce unwanted outcomes of larger astigmatism on the contralateral side. Astigmatism should be carefully evaluated after bilateral FOA.
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Affiliation(s)
- Hyun Beom Song
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea
| | - Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea; Department of Ophthalmology, Seoul National University Bundang Hospital, South Korea
| | - Rong-Min Baek
- Department of Plastic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea
| | - Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea; Department of Ophthalmology, Seoul National University Bundang Hospital, South Korea.
| | - Namju Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea; Department of Ophthalmology, Seoul National University Bundang Hospital, South Korea
| | - Kyu-Chang Wang
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital & Neurological Research Institute, SNUMRC, Seoul, South Korea
| | - Sukwha Kim
- Department of Reconstructive Plastic Surgery, Seoul National University College of Medicine, Division of Pediatric Plastic Surgery, Seoul National University Children's Hospital, Seoul, South Korea
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Linz C, Gerdes ABM, Meyer-Marcotty P, Müller-Richter U, Böhm H, Ernestus RI, Kübler A, Alpers GW, Schweitzer T. Perception of children's faces with unilateral coronal synostosis--an eye-tracking investigation. Childs Nerv Syst 2016; 32:135-41. [PMID: 26231563 DOI: 10.1007/s00381-015-2798-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 06/19/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE Premature unilateral coronal craniosynostosis results in distinctive cranial and facial abnormalities of varying severity, including orbital dystopia and an abnormal head shape. As the face is affected, these children may encounter stigmatization. To avoid this scenario, many parents elect for their child to undergo surgical correction. Laypeople's perception of children with either untreated or treated unilateral coronal craniosynostosis (UCS) has not yet been objectively evaluated. METHODS This study introduces eye tracking as an objective instrument in order to evaluate the perception of 14 children with coronal synostosis, both pre- and postoperatively. Age-matched healthy children served as a control group. Using standardized photos, the involuntary eye movements and the fixations of 30 unaffected laypeople were evaluated. RESULTS In the untreated children, whose faces were characterized by striking orbital dystopia, the eyes drew more attention than those of the healthy children. The results of our study demonstrate that the operative correction of unilateral coronal synostosis results in the normalization of the asymmetry of the fronto-orbital region, whereas the C-shaped deformity of the midface, which is not addressed via surgery, subsequently attracts more attention. CONCLUSION Eye tracking objectively evaluates both the perception of craniofacial abnormalities and the extent of the approximation of normality after surgical correction. We introduce eye tracking as an objective measurement tool for craniofacial abnormalities for the first time.
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Affiliation(s)
- Christian Linz
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital of Würzburg, Pleicherwall 2, 97070, Würzburg, Germany.
| | - Antje B M Gerdes
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | | | - Urs Müller-Richter
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital of Würzburg, Pleicherwall 2, 97070, Würzburg, Germany
| | - Hartmut Böhm
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital of Würzburg, Pleicherwall 2, 97070, Würzburg, Germany
| | - Ralf-Ingo Ernestus
- Department of Neurosurgery, University Hospital of Würzburg, Würzburg, Germany
| | - Alexander Kübler
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital of Würzburg, Pleicherwall 2, 97070, Würzburg, Germany
| | - Georg W Alpers
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Tilmann Schweitzer
- Department of Neurosurgery, Section of Pediatric Neurosurgery, University Hospital of Würzburg, Würzburg, Germany
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Silveira Camargos I, Metzler P, Persing J, Alcon A, Steinbacher DM. Nasal soft-tissue and vault deviation in unicoronal synostosis. J Plast Reconstr Aesthet Surg 2015; 68:615-21. [PMID: 25863706 DOI: 10.1016/j.bjps.2015.02.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 11/26/2014] [Accepted: 02/02/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND Unicoronal synostosis (UCS) results in nasal root deviation toward the fused side of the face, resulting in an apparent nasal dorsal deviation to the non-fused side. The impact of the altered radix position on the osteocartilaginous vault and nasal soft tissue has not been analyzed. The purpose of this study is to morphometrically assess the nasal structure and deviation in UCS. We hypothesize the proximal etiology exerts an impact on the distal nasal form, compared to controls. METHODS Demographic data were tabulated and computed tomographic information recorded. Three-dimensional reconstruction was created and analyzed digitally (using Surgi Case). Morphometric landmarks were determined and used to perform measurements on the nasal soft tissue and osseous skull surface to evaluate nasal deviation within a midsaggital plane (MSP). RESULTS Forty three-dimensional CT scans of 20 UCS patients and 20 control subjects were analyzed. The deviation angle of the nose to the non-fused side was 6.6 ± 2.9° in the bony layer. In the soft-tissue layer, the deviation angle of the nasal dorsum line to the non-fused side was 5.4 ± 3.4°. The tip of the nose showed a significant deviation to the non-fused side (2.2 ± 1.2 mm). Paired landmarks (alares, inferior lateral nostril bases) related to the MSP showed a greater distance on the non-fused side. Paired landmarks related to an intrinsic nasal midline (Nsup-ANS; tip-columella line (TCL)) did not show any significant differences. CONCLUSION UCS confers osteocartilaginous and soft-tissue nasal deviation, with the distal nose toward the non-fused side. The nasal root inclination underpins this asymmetry across the midsaggital reference plane. However, the nose in isolation exhibits balanced side-side proportions.
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Affiliation(s)
- Isadora Silveira Camargos
- Plastic and Reconstructive Surgery, Yale University School of Medicine, 330 Cedar St, BB 3rd Floor, New Haven, CT 06520, USA
| | - Philipp Metzler
- Plastic and Reconstructive Surgery, Yale University School of Medicine, 330 Cedar St, BB 3rd Floor, New Haven, CT 06520, USA
| | - John Persing
- Plastic and Reconstructive Surgery, Yale University School of Medicine, 330 Cedar St, BB 3rd Floor, New Haven, CT 06520, USA
| | - Andre Alcon
- Plastic and Reconstructive Surgery, Yale University School of Medicine, 330 Cedar St, BB 3rd Floor, New Haven, CT 06520, USA
| | - Derek M Steinbacher
- Plastic and Reconstructive Surgery, Yale University School of Medicine, 330 Cedar St, BB 3rd Floor, New Haven, CT 06520, USA.
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Gupta M, Pai AA, Bhattacharya A, Ramachandra R, Sawarappa R, Mohapatra S, Kanoi A. Anterior plagiocephaly in an atypical case of apert syndrome. World J Plast Surg 2013; 2:115-8. [PMID: 25489515 PMCID: PMC4238339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 02/10/2013] [Indexed: 11/25/2022] Open
Abstract
Apert syndrome is a congenital craniosynostosis syndrome comprising of bilateral coronal synostosis , symmetric syndactyly of hands and feet and midface hypoplasia. We present an atypical phenotype of this syndrome with right sided unilateral coronal synostosis. However, type I apert hand and other clinical and radiological features suggestthe diagnosis. Genetic analysis revealed an absence of the specific missense mutations in the FGFR 2 gene that is found in patients with this syndrome. We conclude that this patient represented a rare atypical variant of Apert syndrome. Further analysis is required to map the associated genotype.
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Affiliation(s)
- Madhumita Gupta
- Correspondence Author: Madhumita Gupta, MD, MBBS,
MS, MCh ,Department of Plastic Surgery, SSKM Hospital, India. Tel: +919836548574 (M),
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