Cephalic index and horizontal point of maximum width in children with normal brain development in China.

BACKGROUND: To identify the normal range and distribution in the cephalic index(CI) and horizontal point of maximum width(H-PMW) of Chinese children with normal brain development. METHODS: We retrospectively analyzed Chinese Han children who visited our hospitals between June 2015 and June 2020 because of headache or suspected head injuries. 456 children (257 males, 199 females; aged 0-15 years) were enrolled and divided into 7 groups by age. The values of CI and H-PMW were measured using thin-slice brain computed tomography images. RESULTS: The overall mean CI was 86.6 ± 5.2. The mean CI for males was 87.0 ± 5.1, and that for females was 86.0 ± 5.2. The overall mean H-PMW was 53.7 ± 2.4. The mean H-PMW for males was 53.8 ± 2.5, and that for females was 53.5 ± 2.3. The averages CI reached the maximum (89.98) at the age of 4-6 months, then began to decrease, decreased to the minimum (84.31) at the age of 2-3 years, and then gradually increased, and reached 86.17 at the age of 8-15 years. The average H-PMW was the smallest (52.17) at the age of 4-6 months, and reached 54.88 at the age of 8-15 years. CONCLUSION: The CI and H-PMW values of Chinese normal children reported in this study will provide a valuable reference to diagnose cranial deformities, assess the severity of the disease and the effectiveness of the treatment.

Spring forces and calvarial thickness predict cephalic index changes following spring-mediated cranioplasty for sagittal craniosynostosis.

BACKGROUND: Variables interacting to predict outcomes following spring-mediated cranioplasty (SMC) for non-syndromic craniosynostosis, including spring parameters and calvarial thickness, are poorly understood. This study assessed interactions between spring parameters and calvarial thickness to predict changes in cephalic index (CI) following SMC. METHODS: Patients undergoing SMC for non-syndromic sagittal craniosynostosis at our institution between 2014 and 2021 were included. Calvarial thickness was determined from patient preoperative CTs using Materalise Mimics at 27 points in relation to the sagittal suture. Linear mixed effects models were used to determine interactions between anterior, middle, and posterior calvarial thickness with spring force and length. RESULTS: Sixty-nine patients undergoing surgery at mean age 3.7 months were included in this study. Stronger posterior spring force interacted with thinner posterior calvarial thickness to predict greater changes in CI at 3 months postoperatively (p = 0.022). When evaluating spring force and calvarial thickness set distances from the sagittal suture, stronger posterior spring force interacted with thinner posterior calvarial thickness 5 mm (p = 0.043) and 10 mm (p = 0.036) from the sagittal suture to predict changes in CI. Interactions between spring parameters and calvarial thickness in the anterior and middle positions did not significantly predict changes in CI. CONCLUSIONS: Stronger posterior spring force interacted with thinner posterior calvaria to predict greater changes in CI 3 months following SMC for non-syndromic sagittal craniosynostosis. These results suggest dynamic interactions between several variables may impact outcomes following SMC.

Retrospective Investigation of Cranial Volume and Cephalic Index in Patients with Nonsyndromic Sagittal Synostosis Operated by Total Vault Remodeling.

BACKGROUND: Premature fusion of cranial sutures affects skull development and leads to head deformity. Intracranial pressure increase and brain growth restriction can occur in untreated craniosynostosis. Operative treatment aims to achieve an immediate and long-lasting correction of skull shape that is close to the average and to prevent or release possible increased intracranial pressure by increasing the intracranial volume (ICV) or normalizing the ICV if it is already below the standards. This study was designed to evaluate the effect of a total calvarial reconstruction on skull development in patients with nonsyndromic sagittal synostosis. MATERIAL AND METHODS: The study population included 19 male and 5 female patients with isolated nonsyndromic sagittal suture synostosis. During the operation, temporarily fixed prebent metal plates provided an intraoperative reference for the desired cranial expansion gain of height and shortening. Preoperative and postoperative ICVs and cephalic indices were measured on computed tomography datasets using the software program ImageJ and were compared with one another and with normative data. RESULTS: The male population presented with a preoperative mean ICV of 863.3 cm³. A postoperative mean ICV increase of 243.5 cm³ (p < 0.001) and a further ICV enlargement (p < 0.001) was measured. The mean CI changed from 71.0% preoperatively to 75.4% postoperatively (p = 0.002) and decreased insignificantly in the follow-up (p = 0.546). The female population had a preoperative mean ICV of 804.9 cm³. Postoperatively, the mean ICV increased by 211.1 cm³ (p = 0.043) and also increased in the follow-up (p = 0.043). Their mean CI values increased from 66.5% preoperatively to 72.8% (p = 0.043) postoperatively and decreased insignificantly in the follow-up (p = 0.345). CONCLUSION: This method of total vault remodeling provides reliable ICV increase and improvement in length and width of skull proportions beyond the immediate postoperative period together with an ICV increase.

Comparing Cephalic Index and Midsagittal Vector Analysis in Assessing Morphology in Sagittal Synostosis: A CT-Based Morphometric Analysis.

INTRODUCTION: Assessment of cranial dysmorphism in sagittal synostosis is often subjective but objective measures can be applied. These include cephalic index (CI) and midsagittal vector analysis (MSVA). OBJECTIVE: To assess discriminant validity, construct validity, and responsiveness of CI and MSVA measured from computed tomography (CT) in patients with sagittal synostosis. METHODS: Patients with nonsyndromic isolated sagittal synostosis with complete preoperative (n = 30) and postoperative (n = 13) CT data were included. Age-matched control group (n = 24) comprised of normocephalic patients who underwent CT for reasons related to trauma. OUTCOME MEASURES: Retrospective CT evaluation of CI and MSVA was conducted and correlated with a dysmorphism numeric rating scale (D-NRS) that measured surgeon-rated severity of sagittal synostosis. Responsiveness of CI and MSVA was evaluated using dysmorphism global rating of change (D-GRC). RESULTS: Thirty patients with sagittal synostosis were demographically similar to 24 normocephalic patients. The difference in CI and MSVA was statistically significant between normocephalic and scaphocephalic patients. Cephalic index had a good correlation with D-NRS (r = -0.665, ρ = -0.667), but not with MSVA (r = 0.250, ρ = 0.203). Change in CI (r = 0.738, ρ = 0.657) was well correlated with D-GRC, but not with MSVA (r = -0.409, ρ = -0.301). CONCLUSION: Cephalic index appears to quantify the severity of sagittal synostosis better than MSVA. Cephalic index also has better responsiveness than MSVA to measure a reduction in severity of disease; however, MSVA is a better descriptive craniometric measurement. Midsagittal vector analysis was able to quantify the shift in morphology in sagittal synostosis following surgical treatment.

Changes in intracranial volume and cranial shape in modern Koreans over four decades.

OBJECTIVES: This study investigated whether there was any secular change in cranial vault morphology among Koreans born between the 1930s and 1970s, a period of dramatic shift in Korea's socioeconomic conditions. MATERIALS AND METHODS: Using three-dimensional MRI volumetry, we obtained the intracranial volume (ICV) and craniometric measurements of 115 healthy Koreans: 58 individuals (32 males and 26 females) born in the 1930s (1926-1936) and 57 (28 males and 29 females) born in the 1970s (1972-1979). RESULTS: The intracranial volume of males was 1502.3 ± 110.3 cm3 for the 1930s group and 1594.1 ± 99.5 cm3 for the 1970s group, and for females, it was 1336.0 ± 53.0 cm3 for the 1930s group and 1425.9 ± 79.6 cm3 for the 1970s group. On average, ICV increased by 94 cm3 in males and by 90 cm3 in females. Cranial measurements for the 1970s group were significantly larger than the 1930s group for both sexes except in female cranial length. Each measurement was significantly correlated with ICV [cranial height (R = 0.720), breadth (R = 0.706), and length (R = 0.531)]. The cephalic index decreased from 0.846 to 0.828 in males, indicating the cranium became narrower relative to the cranial length. In females, the cephalic index increased from 0.831 to 0.850. Sex and birthyear were marginally interrelated in cephalic indices. DISCUSSION: From the 1930s to 1970s, the Korean Peninsula experienced important historical shifts, and we speculate that the consequent shift in socioeconomic status is the most likely factor responsible for Koreans' cranial vault remodeling.

The three-dimensional course of cranial development of very preterm infants during the first year of life.

BACKGROUND: Cranial measurements are crucial for evaluating preterm general development because they are a surrogate tool for evaluating brain growth. Usually, they are based on tape-measured head circumference; however, a three-dimensional (3D) approach expands the diagnostic spectrum to the evaluation of cranial volume and shape. AIMS: Very preterm (vPT) infants face multiple risks and obstacles in their early development. In this study, we analyze the risk for cranial anomalies of vPT compared with term-born (TB) infants during the first year of life. STUDY DESIGN AND SUBJECTS: In this single-centre prospective cohort study, 23 vPT and 24 TB healthy infants were assessed. At term equivalent age (TEA) of vPT and time of birth of TB, and 1, 3, 6 and 12 months of postmenstrual age, respectively, a 3D head scan was performed and cephalometrically evaluated regarding cranial growth (head circumference, cranial volume) and shape. RESULTS: Head circumference and cranial volume showed a similar course in vPT and TB. Cranial shape differed significantly between vPT and TB. At TEA, vPT showed longer and narrower heads (dolichocephaly), a difference that disappeared around the 6th month of life. Presence of plagiocephaly was initially similar in vPT and TB, with an increasing difference between both groups with a peak at six months when 34.8 % of the vPT versus none of the TB showed a moderate to severe plagiocephaly (p = 0.004). In vPT, cranial volume significantly correlated with cranial shape, whereas dolichocephaly at TEA had no influence on the further course of plagiocephaly. CONCLUSION: Cranial development of vPT follows a different course than of TB in terms of cranial shape anomalies, while cranial growth remains unaffected. German Clinical Trials Register number: DRKS00022558.

Exploring Craniofacial Anthropometry in the Ethnic Adult Population of Meghalaya, Northeast India: A Cross-Sectional Study.

Craniofacial anthropometry is important for identity, diagnosis of congenital anomalies etc. The incidence of craniofacial abnormalities is high in the Southeast Asian region. The population of Meghalaya differs in features from other states of Northeast India and the neighbouring East Asia. The objective was to study the craniofacial anthropometric features of the ethnic adults in the Meghalaya state of Northeast India. This cross-sectional study was conducted from 2022 to 2023 in the ENT OPD. OPD patients of Meghalayan ethnicity were included in the study. Head length (HL), head breadth (HB), Cephalic index (CI), intercanthal distance (ICD), lateral canthal distance (LCD) and ear length (EL) were measured. A total of 104 adults were included. The majority of the individuals belonged to the Khasi community 51 (49%) followed by the Garo community 27 (26%) and the Jaintia community 26 (25%). The mean ± S.D age of the total sample population was 29.5 ± 8.4 years. The mean CI of the total sample population was 79.13 (mesocephalic). No statistically significant difference was noted between male-female CI in the total and subpopulation groups. In our study, the common head types were dolichocephalic (29%), brachycephalic (29%), mesocephalic (21%), hyperbrachycephalic (16%) and ultrabrachycephalic (5%). A statistically significant difference was noted between Khasi and Jaintia in HL, HW, CI, LCD; between Khasi and Garo in HL, ICD, LCD and between Garo and Jaintia in HW, CI, ICD. We believe our conventional craniofacial anthropometry data could add to the pool of regional anthropometry data and be used for future scientific purposes like anthropology, maxillofacial surgeries, designing helmets, forensic analysis, and gender differentiation.

Cephalic Index Variation in the Indigenous Population of Tribal Districts in Himachal Pradesh.

Introduction The cephalic index (CI) is the most commonly used index to determine the race of an individual. It is calculated as the ratio of the breadth of the skull to the length of the skull multiplied by 100. The CI of an individual can be influenced by factors such as race, ethnicity, genetic predisposition, lifestyle choices, nutritional habits, environmental factors, and climatic conditions. Material and methods This study was carried out on 413 individuals in the tribal districts of Himachal Pradesh (Kinnaur, Spiti, and Lahaul), with 247 (59.8%) male and 166 (40.2%) female subjects. Measurements of the skull were taken using a spreading caliper. The CI was calculated using Hardlika's method and data were analyzed using IBM SPSS version 27 (IBM Corp., Armonk, NY, US). Results The head shapes of the majority of the tribal population of Himachal Pradesh are mesocephalic, with the mean CI for males and females being 78.90 and 79.81, respectively, without any significant difference. The mean CI of the overall population is 79.27. The majority population of the Kinnaur district is brachycephalic, while the Spiti and Lahaul populations are mesocephalic with females predominately brachycephalic and males predominately mesocephalic. Conclusion The Indigenous population of Himachal Pradesh is mesocephalic with females predominately brachycephalic.

Age at Tumor Diagnosis in 14,636 Canine Cases from the Pathology-Based UNIPI Animal Cancer Registry, Italy: One Size Doesn't Fit All.

Cancer is the most common cause of death in adult dogs. All dogs would benefit from early diagnosis, but there are no specific guidelines regarding the schedule of cancer screening in companion animals. The aim of this study was to retrospectively evaluate the age at diagnosis in Italian oncological canine patients. A total of 14,636 canine histologically confirmed neoplastic cases were coded according to the Vet-ICD-O-canine-1 and stratified by malignancy, sex, neutering status, breed, cephalic index, body size, and tumor type. Differences in age distribution were analyzed and the influence of these variables on the time of first malignancy diagnosis was assessed using an event history analysis model. The median age at diagnosis for benign and malignant tumors was 9 and 10 years, respectively. Intact and purebred dogs were diagnosed earlier, but the median age differed significantly by breed. The earliest age at diagnosis was recorded for lymphomas and mast cell tumors. The model showed an accelerating effect of large size, brachy- and dolichocephaly, and sexual integrity in female dogs on the time of malignancy diagnosis. Our results confirm that a "one-size-fits-all" approach to cancer screening is not accurate in dogs and provide relevant data that may lead to the establishment of breed-based screening schedules.

Calvarial vault remodeling including pterional decompression for the treatment of nonsyndromic scaphocephaly patients: technical note and retrospective case series.

OBJECTIVE: Surgical techniques to correct scaphocephaly often rely on the implantation of foreign material and/or postoperative helmet therapy and possibly result in minimal correction of frontal bossing. Moreover, foreign material and helmet therapy are associated with extra medical care and financial costs. Frontal bossing is perceived as a prominent, disfiguring feature of scaphocephaly. Herein, authors present the results of a total cranial vault remodeling technique that corrects scaphocephaly features without relying on foreign material or postoperative helmet therapy. It includes frontal release and pterional decompression, which aim to correct frontal bossing. METHODS: All patients who had been operated on for isolated scaphocephaly at a single institution between January 2011 and December 2020 were included in this retrospective review. Operation time, transfusion volume, hospital stay, complications, cephalic index (CI), and bossing angle (BA) were analyzed. RESULTS: Sixty-five patients with nonsyndromic scaphocephaly were included in this analysis. Imaging to calculate the CI and BA preoperatively, immediately postoperatively, and 1 year postoperatively was available in 22 and 20 patients, respectively. The mean CI increased from 69.2% preoperatively to 74.6% postoperatively and 75.5% 1 year postoperatively. The mean BA decreased from 114.5° preoperatively to 111.6° postoperatively and 108.9° 1 year postoperatively. The mean operating time was 2 hours 4 minutes, and the median blood transfusion volume was 100 ml. There were no major complications or reoperations. CONCLUSIONS: The described total cranial vault remodeling technique is a safe procedure that mitigates total treatment burden, as no helmet therapy or implantation of foreign material is needed. It is effective in correcting CI and results in significant frontal bossing correction. The latter is attributed to a distinctive feature of the technique: frontal release and pterional decompression.

Evaluating Cranial Growth in Japanese Infants Using a Three-dimensional Scanner: Relationship between Growth-related Parameters and Deformational Plagiocephaly.

In this study, we aimed to evaluate the longitudinal changes in the cranial shape of healthy Japanese infants using a three-dimensional scanner and construct a normal values database for the growth process. Preterm infants (gestational age < 37 weeks), infants with neonatal asphyxia (5-minute Apgar score of <7), and patients who started helmet therapy for deformational plagiocephaly were excluded from this study. The first scan was performed at approximately 1 month of age, followed by two scans conducted at 3 and 6 months of age. The parameters considered were as follows: cranial length, width, height, circumference, volume, cranial vault asymmetry index, and cephalic index. A cranial vault asymmetry index >5% was defined as deformational plagiocephaly. Changes in each parameter were examined using repeated-measures analysis of variance classified by sex and deformational plagiocephaly status. The rate of increase in each parameter was also examined. In total, 88 infants (45 boys and 43 girls) were included in this study. All growth-related parameters were noted to increase linearly with time. Sex differences were observed in all parameters except cranial length. Deformational plagiocephaly was found to have no effect on growth-related parameters. Cranial volume increased by 60% from 1 to 6 months of age. The growth almost uniformly influenced the rate of increase in volume in each coordinate axis direction. Overall, the mean trends in three-dimensional parameters in infants up to 6 months of age were obtained using a three-dimensional scanner. These trends could be used as a guide by medical professionals involved in cranioplasty.

Cranial shapes of Japanese preterm infants at one month of age using a three-dimensional scanner.

BACKGROUND: Recently, cranial shape measurements of preterm infants have been performed using handheld three-dimensional (3D) scanners and can now be objectively quantified. AIMS: To measure the cranial shapes of Japanese preterm infants at one month of age using a 3D scanner, compare these values with those of healthy term infants, and examine the risk factors for dolichocephaly. STUDY DESIGN: A multicenter, retrospective cohort study. SUBJECTS: Preterm infants born at <37 weeks of gestation and staying in the neonatal intensive care unit or visiting an outpatient clinic for a one-month checkup between April 2020 and March 2022. OUTCOME MEASURES: A 3D scanner was used to quantify cranial shape. Comparison was made with full-term, one-month-old infants. RESULTS: Ninety-four preterm infants (42 boys) and 165 full-term infants were enrolled. Preterm infants had a significantly lower cephalic index (77.9% and 85.0%, p < 0.01) and a higher incidence of dolichocephaly (54.3% and 13.3%, p < 0.01) compared to term infants. No significant difference in incidence of deformational plagiocephaly was found between the groups (41.5% vs. 47.3%, p = 0.44). The risk of dolichocephaly was significantly higher for female sex (odds ratio [OR], 3.32; 95% confidence interval, 1.30-8.50), cesarean section (OR, 4.07; 95% confidence interval, 1.23-13.5), and use of mechanical ventilation (OR, 4.66; 95% confidence interval, 1.09-20.0). CONCLUSIONS: Japanese preterm infants at the first month of life had longer heads than full-term infants; the risk factors identified were female sex, cesarean section, and use of mechanical ventilation.

Cephalic Index of Korean Children With Normal Brain Development During the First 7 Years of Life Based on Computed Tomography.

OBJECTIVE: To identify the normal range, distribution, and age-dependent differences in the cephalic index (CI) of Korean children with normal brain development and develop a classification of the current CI for Korean children up to 7 years of age. METHODS: We retrospectively analyzed 1,389 children who visited our hospital in the emergency room between October 2015 and September 2020 because of suspected head injuries. Finally, 1,248 children (741 male and 507 female) were enrolled after excluding abnormal medical or familial history and divided into 10 groups by age. The CI was measured using brain computed tomography and calculated according to the following equation: cephalic width/cephalic length×100. RESULTS: The averages of CI by age groups were as follows: 89.29 (0-3 months group, n=44); 91.41 (4-6 months group, n=63); 89.68 (7-9 months group, n=62); 87.52 (10-12 months group, n=41); 87.64 (≥2 years group, n=243); 86.63 (≥3 years group, n=178); 85.62 (≥4 years group, n=232); 85.77 (≥5 years group, n=201); 85.15 (≥6 years group, n=75); and 85.34 (≥7 years group, n=109). The CI of Korean children in normal brain development was confirmed to be large, showing a notable difference compared to that of Caucasians. CONCLUSION: The current CI of Korean children will provide a valuable reference for diagnosing and treating cranial deformities, especially dolichocephaly and brachycephaly as well as to monitor the morphology of the cranium in clinics.

Comparing Caliper versus Computed Tomography Measurements of Cranial Dimensions in Children.

OBJECTIVES/HYPOTHESIS: We have found no study assessing the accuracy of caliper cranium measurements compared to computed tomography (CT) measurements of the head. The objective of this study was to assess the reliability of caliper measurements in comparison to CT measurements. STUDY DESIGN: Retrospective chart review. METHODS: This study includes all patients evaluated for head shape abnormality between 2010 and 2019 at a single academic medical center. Eighty-nine patients who had CT head scans were identified, and their caliper measurements of anterior-posterior and transverse head dimensions were documented. RESULTS: There was no statistically significant difference between the CT and caliper measurements. CONCLUSION: Caliper measurements are a simple and reliable way to assess cranial vault proportionality with growth after cranial vault reconstruction. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:773-775, 2021.

Establishment of Cephalic Index Using Cranial Parameters by Computed Tomography in a Sampled North Indian Population.

BACKGROUND: Cephalic index (CI) also called cranial index is the ratio of maximum breadth to a maximum length of head. The purpose of the study was to study anthropometry of cranial parameters using the computed tomography (CT) scans to establish the CI of the sampled population in North India. MATERIALS AND METHODS: The cross-sectional study was carried on the subjects of age group ranging from 6 to 95 years of either sex (total 1000 subjects; 540 male and 460 female) in the radio-diagnosis department of Era's Medical College Lucknow, UP, India. The measurement of maximum cranial breadth (MCB) and maximum cranial length (MCL) were taken on a CT scan machine and recorded for analysis. When associating the measures of precision for different subgroups, a one-way analysis of variance (ANOVA) was used for modest and efficient errors. Multivariate logistic regression analysis was used to identify factors affecting the CI estimation like age, interzygomatic length (IZL), orbital length (OL), MCB, and MCL. RESULT: Out of 1000 studied subjects, the majority 234 (23.4%) of the subjects belong to the 21-30 years age group. MCB of heads and MCL of heads in different ages and on applying the one-way ANOVA association was statistically significant and CI was statistically insignificant. Pearson correlation between the CI and other parameters like age, MCB of heads, and MCL of heads, and a statistically significant correlation was seen with each other. Dolichocephalic types of the skull are found more in male subjects, and brachycephalic type of skull is more common in female subjects. CONCLUSION: The average CI of our study was 76.67±3.18. This shows that northern India's dominant head shape, especially in the Lucknow region, was dolichocephaly. Thus, the CT scan is proven an essential modality in the assessment of cranial parameters in anthropometry.

Cephalic index, facial index and dental parameters: A correlative study to evaluate their significance in facial reconstruction.

Background: It becomes extremely challenging for forensic artists to reconstruct the highly decomposed faces, especially during mass disasters. It would be of great help for the identifying team of experts if there was a method to determine the facial and cephalic dimensions. This study aims to provide a method to generate a simplified method to calculate the facial and cephalic indices of an individual based on the dentition since human dentition remains almost intact in most scenarios. Materials and Methods: The sample consisted of 200 participants with the age range of 18-23 years belonging to Kerala. The cephalic and facial indices were measured using a caliper. The interincisal, intercanine, interpremolar and intermolar widths of maxillary dentition were measured on study models using a digital vernier caliper. The mean cranial and facial index were calculated and were correlated with interdental measurements. Results: It was concluded that dominant head types in Kerala males were dolichocephalic (50.2%) followed by mesocephalic (29.8%). In females, the dominant head types were dolichocephalic (42.7%) followed by mesocephalic (42.2%). In the facial types, majority of individuals were found to be leptoprosopic. A good correlation was found between the intercanine width with facial width and cranial width and a simplified formula were derived to estimate the cranial and facial index for this population. Conclusion: The results of the study suggest that the facial index and cranial index of a particular population can be evaluated from interdental measurements of the maxillary cast, especially the intercanine width.

Pediatric cranial deformations: demographic associations.

OBJECTIVE: No study has established a relationship between cranial deformations and demographic factors. While the connection between the Back to Sleep campaign and cranial deformation has been outlined, considerations toward cultural or anthropological differences should also be investigated. METHODS: The authors conducted a retrospective review of 1499 patients (age range 2 months to less than 19 years) who presented for possible trauma in 2018 and had a negative CT scan. The cranial vault asymmetry index (CVAI) and cranial index (CI) were used to evaluate potential cranial deformations. The cohort was evaluated for differences between sex, race, and ethnicity among 1) all patients and 2) patients within the clinical treatment window (2-24 months of age). Patients categorized as "other" and those for whom data were missing were excluded from analysis. RESULTS: In the CVAI cohort with available data (n = 1499, although data were missing for each variable), 800 (56.7%) of 1411 patients were male, 1024 (79%) of 1304 patients were Caucasian, 253 (19.4%) of 1304 patients were African American, and 127 (10.3%) of 1236 patients were of Hispanic/Latin American descent. The mean CVAI values were significantly different between sex (p < 0.001) and race (p < 0.001). However, only race was associated with differences in positional posterior plagiocephaly (PPP) diagnosis (p < 0.001). There was no significant difference in CVAI measurements for ethnicity (p = 0.968). Of the 520 patients in the treatment window cohort, 307 (59%) were male. Of the 421 patients with data for race, 334 were Caucasian and 80 were African American; 47 of the 483 patients with ethnicity data were of Hispanic/Latin American descent. There were no differences between mean CVAI values for sex (p = 0.404) or ethnicity (p = 0.600). There were significant differences between the mean CVAI values for Caucasian and African American patients (p < 0.001) and rate of PPP diagnosis (p = 0.02). In the CI cohort with available data (n = 1429, although data were missing for each variable), 849 (56.8%) of 1494 patients were male, 1007 (67.4%) of 1283 were Caucasian, 248 (16.6%) of 1283 were African American, and 138 patients with ethnicity data (n = 1320) of Hispanic/Latin American descent. Within the clinical treatment window cohort with available data, 373 (59.2%) of 630 patients were male, 403 were Caucasian (81.9%), 84 were African American (17.1%), and 55 (10.5%) of 528 patients were of Hispanic/Latin American descent. The mean CI values were not significantly different between sexes (p = 0.450) in either cohort. However, there were significant differences between CI measurements for Caucasian and African American patients (p < 0.001) as well as patients of Hispanic/Latin American descent (p < 0.001) in both cohorts. CONCLUSIONS: The authors found no significant associations between cranial deformations and sex. However, significant differences exist between Caucasian and African American patients as well as patients with Hispanic/Latin American heritage. These findings suggest cultural or anthropological influences on defining skull deformations. Further investigation into the factors contributing to these differences should be undertaken.

Ancient to modern secular changes in the cranial/cephalic index in Korea: historical brachycephalization and recent debrachycephalization.

We investigated changes in the cranial/cephalic index of the Korean population in millennia, centuries, and recent decades. Secular changes of Korean's cephalic index in history were studied using the data of archaeology literature and our measurement data of different adult skull sets for the fifteenth-nineteenth century Joseon people, the Korean War victims (1950-1953), and the Korean skeletons collected by medical schools in the 1960s. A change in head shape during the last century was also estimated by the analysis on Korean cephalometric datasets of Korean Research Institute of Standards and Science. In brief, over the past 2000 years, the crania of Korean people have steadily changed from mesocephalic to brachycephalic, mainly due to the cranial length shortening. Brachycephalization accelerated at the beginning of the twentieth century and continued until the early twenty-first century, largely caused by increased cephalic breadth. We also note that debrachycephalization began in birth cohorts around 1965 for males and around 1970 for females. Taken together, we figure out that the head shape of Korean people has been gradually shortened over millennia and then has undergone dramatic shortening in the last century. In recent decades, however, the changing pattern has reversed to debrachycephalization, for which we discussed about the possible causes in the present report.

Significant Factors in Cranial Remolding Orthotic Treatment of Asymmetrical Brachycephaly.

This retrospective chart review focuses on determining the most effective time to begin cranial remolding orthosis (CRO) treatment for infants with asymmetrical brachycephaly. Subjects with asymmetrical brachycephaly started CRO treatment between 3 and 18 months of age. These infants had a cranial vault asymmetry index (CVAI) ≥ 3.5 and a cranial index (CI) ≥ 90. Subjects were excluded if they had any comorbidities affecting growth, dropped out of treatment, were lost to follow-up, or were noncompliant. Factors which were found to statistically influence treatment outcomes were subject initial age, initial CVAI, and initial CI. Overall, younger subjects were more likely to achieve a corrected head shape. The presence of prematurity or torticollis had statistically nonsignificant effects on the success of treatment. Initial CI was found to be a stronger predictor than initial CVAI as to which subjects achieved correction. The less severe the starting CI, the more likely the subject was to achieve full correction. The clinical understanding is that it requires more cranial growth to "round out" a full posterior skull flattening than an asymmetry. Based on the study results, infants with asymmetrical brachycephaly should be treated as early as possible to increase chances of achieving full correction of the deformity.