Frontobiparietal remodeling with or without a widening bridge for sagittal synostosis: comparison of 2 cohorts for aesthetic and functional outcome
Marie‐Lise C. van VeelenDalibor MihajlovićRúben DammersHester F. LingsmaLéon N. A. van AdrichemIrene M. J. Mathijssen
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OBJECT Various techniques to correct sagittal synostosis have been described. The authors of this study assess the results of 2 techniques for late complete cranial remodeling and test the hypothesis that adding a widening bridge would improve outcome. METHODS In this retrospective study, the authors evaluated patients with nonsyndromic sagittal synostosis-those who underwent frontobiparietal remodeling (FBR) and those who underwent modified FBR (MFBR) involving the introduction of a bony bridge to increase the width of the skull. Outcomes for both groups are described in terms of the aesthetic results assessed on photographs and any changes in the cranial index (CI) and head circumference over time, the presence of papilledema, and complaints of headache. The effect of the surgical technique on CI and head circumference over time was assessed using linear regression analysis, with adjustment for preoperative CI and head circumference. RESULTS Sixty-nine patients with isolated sagittal synostosis were included in this study: 35 underwent MFBR and 34 underwent the original technique of FBR. The mean follow-up period was 7 years. In the 1st year after surgery, mean CI improved by 9% in the FBR group and by 12% in the MFBR group. One year after surgery, CI in the MFBR group was on average 4.7% higher than that in the FBR group (p < 0.001). During follow-up, CI decreased in both groups; however, at all time points CI was significantly higher in the MFBR group than in the FBR group. The impact of surgical technique on CI was less important than the impact of preoperative CI (R(2)= 0.26 vs 0.54), and this applied at all time points during follow-up. Head circumference declined during follow-up in both groups. It was influenced by preoperative head circumference, but not by surgical technique. Aesthetic outcome, prevalence of headache (42%), and papilledema (7%) were comparable in both groups. CONCLUSIONS Adding a widening bridge to late complete remodeling significantly improved CI and helped to prevent CI from decreasing in the long term. This addition did not affect the head circumference growth curve. Despite a mean head circumference remaining at +1 SD, patients continued to develop papilledema postoperatively (7%).Keywords:
Synostosis
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Studies focusing on biological differences among groups have been a widespread area of anthropological research for decades. One of the most common means of assessing biological differences is through comparing craniofacial metrics. Craniofacial growth is under genetic control but strongly influenced by environmental factors, including artificial cranial modification (ACM). Some scholars believe ACM affects craniofacial metrics, but other scholars disagree. This study seeks to remedy this debate. A total of 218 adult crania (101 unmodified, 117 modified) from coastal and inland sites of three northern Chilean valleys were surveyed and examined for craniofacial metric changes through the use of modern orthodontic cephalometric analyses. Unmodified crania were statistically tested with the hierarchical linear analysis test to determine if there were any differences based on site, region (coast vs. inland), period, or sex within the unmodified sample, followed by a comparison of these data to modified cranial data. Statistical tests, specifically the ANOVA test, of the data determined that ACM affected some but not all craniofacial measurements utilized in this study. This conclusion, coupled with the varying conclusions of similar previously conducted studies, suggests that scholars must be cautious in employing modified crania and craniofacial metrics in any study of biological affinities.
Crania
Cephalometry
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Intentional cranial modification has a long history, being a ubiquitous practice in many cultures around the world for millennia. The crania excavated at the Hirota site on Tanegashima Island, Kagoshima Prefecture, Japan, has been previously noted to have a marked tendency toward a short head and a flattened occipital bone, which has been suggested to be the result of artificial cranial deformation. However, whether this deformation was intentional or caused by unintentional habits remains unclear. This study aimed to investigate the characteristics of the cranial shape of the Hirota site to clarify whether the crania were intentionally modified. In the examination of Hirota crania, Kyushu Island Jomon and Doigahama Yayoi crania were added as comparative data and contrasted with three-dimensional (3D) surface scan imaging and two-dimensional outline-based geometric morphometric analysis, combined with objective assessments of potential cranial modification. The results showcased Hirota's short and flattened cranial morphology, indicating clear alignment with our hypothesis that Hirota samples are morphologically different from Doigahama and Jomon samples. No sex-based differences were found. Morphological abnormalities in cranial sutures were visually assessed utilizing novel 3D visualization methods of cranial outer surfaces. Based on a comprehensive review of the results, we concluded that Hirota site crania were intentionally modified. Although the motivation of the practice is unclear, the Hirota people may have deformed their crania to preserve group identity and possibly aid in the long-distance trade of shellfish, as seen archaeologically.
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Complex craniofacial synostosis is a group of rare genetic disorders characterized by premature closure of the sutures in the craniofacial skeleton and which to varying degrees affects the extremities.On the basis of relevant literature, we present a review of syndromal craniofacial synostosis.Phenotypically, the complex craniofacial syndromes have many similarities. Synostosis of the sutures of the cranial vault can result in a variety of skull deformations, depending on the sutures involved, the sequence of premature closure, and the time of closure. Synostosis of the sutures in the skull base and facial skeleton leads to shallow orbits, exophthalmus, hypertelorism, midface retrusion, and prognathia.Precise diagnosis of complex craniofacial syndromes may be difficult solely on the basis of a clinical examination. However, several of the most common syndromes are caused by mutations in genes that code for fibroblast growth-factor receptors. Children with a suspected complex craniofacial syndrome should be referred to genetic testing.
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Cranial vault
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Distance analysis and factor analysis, based on Q-mode correlation coefficients, were applied to 23 craniofacial measurements in 1,802 recent and prehistoric crania from major geographical areas of the Old World. The major findings are as follows: 1) Australians show closer similarities to African populations than to Melanesians. 2) Recent Europeans align with East Asians, and early West Asians resemble Africans. 3) The Asian population complex with regional difference between northern and southern members is manifest. 4) Clinal variations of craniofacial features can be detected in the Afro-European region on the one hand, and Australasian and East Asian region on the other hand. 5) The craniofacial variations of major geographical groups are not necessarily consistent with their geographical distribution pattern. This may be a sign that the evolutionary divergence in craniofacial shape among recent populations of different geographical areas is of a highly limited degree. Taking all of these into account, a single origin for anatomically modern humans is the most parsimonious interpretation of the craniofacial variations presented in this study. © 1996 Wiley-Liss, Inc.
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Divergence (linguistics)
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Although processes of cranial modification have been documented throughout the world, the effects on craniofacial landmarks are poorly understood. Such understanding is needed to assist the further understanding of craniofacial morphology and dysmorphology and in the interpretation of craniometric studies assessing issues of biological distance. Samples of both clinically normal and modified crania recovered from the same archeological site in Peru were studied using a three-dimensional approach to evaluate differences in landmark location. The crania were associated with the Ancón site from the central coast, corresponding to the Late Intermediate period (ad 900-1300). Analysis revealed that vault modification had no significant effect on the locations of landmarks of the facial and basal regions. As expected, differences were found on some landmarks of the cranial vault.
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Abstract A total of 104 adult human crania (95 American Indian and 9 Labrador Eskimo) are used in this evaluation of a discriminant functional analysis for determining race and sex from eight cranial measurements. The methods used are those given by Giles and Elliot ('62). The study shows that non‐deformed American Indian crania are racially misclassified as American White and Negro in 35.6% of the cases when using this metrical method. Deformed Indian crania are racially misclassified 60.0% and 4.4% of the time as White and Negro respectively. The determination of sex on male crania, regardless of deformation, is as accurate as, or better than, the visual method of identification. The female crania, however, are shown to be incorrectly sexed in nearly 50% of the cases, with one non‐deformed group (Palus) running as high as 80.0%. This evaluation suggests, therefore, that discriminant functional analyses for race and / or sex determinations are not applicable to problems of human identification unless the crania are from that population on which these functions were established.
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In this passage,59 Human Bones are observed,measured,analyzed and compared, which came from 49 graves of the Shijia Cemetery in Fushun County Liaoning Province.4 Human Bones are particularly studied. Shijia crania belong to Asiatic Mongoloids.Compared with modern Asiatic Mongoloids, the result shows that Shijia crania are the most similar groups to North Asiatic Mongoloids and Northeast Asiatic Mongoloids on the anthropology characteristic,but there are many differences with South Asiatic Mongoloids.The closest ancient crania are Boyisiman crania,Xiajiadian superstratum crania and Sanling crania.But with Wanfabozi kistvaen crania,there are many differences.
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A new classification of malformations of the face and cranium is proposed, based on embryologic studies and observations concerning a great number of patients seen by the authors. First of all, one should distinguish between cerebral craniofacial (with brain and/or eyes involved) and craniofacial malformations. Craniofacial malformations may be characterized by dysostosis and by synostosis. Malformations with dysostosis may be produced by transformation as well as differentiation defects. Synostosis is always caused by a differentiation defect. A new nomenclature is introduced.
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A patient with craniofacial synostosis and vitamin D–resistant rickets who underwent successful Le Fort II advancement is presented. The association of premature cranial synostosis with a variety of metabolic and hematological disorders is discussed.
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Abstract A study of anthropometric variation and craniofacial growth in individuals with the Prader‐Labhart‐Willi syndrome (PLWS) illustrates the utility of anthropometry in clinical evaluation and research. Anthropometric measurements, including head length and breadth, minimum frontal diameter, and head circumference, were obtained on 38 PLWS individuals (21 with chromosome 15 deletions) with an age range from 2 weeks to 39 years. No anthropometric differences were found between the two chromosome subgroups. A relative deceleration in the growth of certain craniofacial dimensions (head circumference and length) is suggested by the negative correlations between age and Z‐scores for the measurements. Raw values for minimum frontal diameter and head breadth were near or below the 5th percentile curve, while almost all values for head length and circumference fell within normal limits. The data support suggestions that dolichocephaly be considered an early diagnostic feature of PLWS. Furthermore, the status of narrow bifrontal diameter as a major feature of PLWS is confirmed.
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Circumference
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