Intracranial volume change in childhood.

OBJECT: The goal of this study was to construct a model of normal changes in intracranial volume occurring throughout childhood from age 7 days to 15 years. METHODS: Using the technique of segmentation on magnetic resonance images obtained in healthy children, intracranial volume was measured and plotted against age. CONCLUSIONS: Intracranial volume in the first few months of life is on average 900 cm3 in males and 600 cm3 in females. By the age of 15 years, it increases up to 1500 cm3 in males and 1300 cm3 in females, increased by factors of 1.6 and 2.1, respectively. By the time the child reaches 2 years of age, intracranial volume has reached 77% (1150 cm3 in males and 1000 cm3 in females) and, by 5 years, 90% (1350 cm3 in males and 1200 cm3 in females) of the volume observed at age 15 years. The change in intracranial volume that occurs with age is not linear, but there seems to be a segmental pattern. Three main periods can be distinguished, each lasting approximately 5 years (0-5, 5-10, and 10-15 years), during which the growth of intracranial volume is linear. Throughout childhood, males have higher intracranial volumes than females, with a similar growth pattern.

Intracranial volume change in craniosynostosis.

OBJECT: There is still controversy regarding the optimum time to perform surgery for craniosynostosis. Some recommend surgery soon after birth and others delay until the age of 12 months. Intracranial pressure has been measured in an attempt to provide a scientific rationale, but many questions remain unanswered. To date, little attention has been given to intracranial volume and its changes during the first few years of life in children with craniosynostosis. The authors' goal was to focus on intracranial volume during this period and to compare measurements obtained in patients with craniosynostosis with measurements obtained in healthy individuals. METHODS: Using the technique of segmentation, the intracranial volume of 84 children with various forms of craniosynostosis was measured on preoperative computerized tomography scans. The change in average volume that occurs with increasing age was calculated and compared with a model of normal intracranial volume growth. The age at presentation for children with craniosynostosis was 1 to 39 months; 76% of the patients were younger than 12 months. In eight patients in whom only one cranial expansion procedure was performed, postoperative intracranial volumes were measured as well. Several interesting observations emerged. 1) There was little difference in head growth between boys and girls with craniosynostosis during the first few months of life. After the age of 12 months, however, the difference in intracranial volume normally seen between the two genders was observed in the craniosynostosis group as well. 2) Excluding children with complex pansynostosis, who have smaller heads, children with all other types of craniosynostosis have similar head growth after the 1st year of life, with no difference between the number of and type of suture affected. Children with Apert's syndrome develop greater than normal intracranial volumes after the 1st year of life. 3) Although children with craniosynostosis are born with a smaller intracranial volume, by the age of 6 months volume has reached normal levels, and from that point on volume follows the pattern of normal head growth. 4) Children who presented after the age of 6 months and later developed recurrent craniosynostosis after initial successful treatment had a small intracranial volume at their initial presentation. 5) Of the patients whose postoperative intracranial volumes were measured, all but one had preoperative volumes at or above normal values, and their postoperative volumes were considerably higher than normal for their age. These children all followed a growth curve parallel to that of healthy children but at higher volume value. One patient with a smaller-than-normal initial intracranial volume was surgically treated at a very young age and, despite cranial expansion surgery, postoperative volume did not reach normal levels. It is postulated that this was due to the fact that the operation was performed at a time when craniosynostosis was still active. CONCLUSIONS: The results of this study indicate that the underlying mechanism leading to craniosynostosis and constriction of head volume "exhausts" its effect during the first few months of life. Measurement of intracranial volume in clinical practice could be used to "fine tune" the optimum time for surgery. In late-presenting children, this may be useful in predicting possible recurrence.

Pleomorphic salivary adenoma in an adolescent.

This case study illustrates an unusual condition in childhood, pleomorphic salivary adenoma in a 12-year-old. The management, pathology and treatment are discussed with emphasis on the practitioner to be vigilant for rare conditions. A review of the literature on childhood salivary tumours illustrates the rare nature of this pathology.

Osseointegrated implants in the management of childhood ear abnormalities: the initial Birmingham experience.

Over a four-year period 72 children with ear abnormalities have been referred for assessment by the extraoral osseointegrated implant team at The Queen Elizabeth Hospital, Birmingham. Thirty-two children have been judged suitable for rehabilitation. Twelve children have completed rehabilitation using bone-anchored hearing aids and/or auricular prostheses. Two fixtures (seven per cent of those loaded) have dislodged and required replacement. Audiological assessment of the bone-anchored hearing aid users shows only small improvements in their aided thresholds, compared to thresholds obtained with their previous aid. However all now have thresholds of 30 dB(A) or better and report a marked improvement in sound quality. When surveyed, hearing aid and prosthesis users report high levels of satisfaction with this form of rehabilitation. The technique adds a new dimension to the management of children with aural anomalies. The approach and results of a multidisciplinary programme are reported.

Recurrent bilateral coronoid hyperplasia: an unusual case.

A case of bilateral coronoid hyperplasia is presented. The possible aetiology of this rare condition is discussed. This case is unusual in that true synovial joints were demonstrated bilaterally between the coronoid processes and the zygomatic bones and following a bilateral coronoidectomy, the coronoid hyperplasia with marked limitation of jaw opening fully recurred, which has not been described previously. After a further coronoidectomy with return of function to the temporomandibular joints, a change from a retrognathic mandibular relationship to a gross prognathic position occurred. The management problems encountered with this case are discussed along with a documented account of the treatment provided over a 12-year period.

Lingual access for third molar surgery: a 20-year retrospective audit.

We describe a technique for obtaining lingual access for the insertion of a wide metal retractor to protect the lingual nerve from accidental damage during third molar surgery. We also report an audit of a single practice over a 20-year period using the technique described. The approach involves raising soft tissues on the lingual side of the lower third molar tooth to allow insertion of a broad Hovell's lingual retractor. We conclude that raising lingual tissues to form a wide tension-free flap and inserting a specifically designed retractor does not increase the incidence of lingual nerve morbidity. Indeed, the overall incidence of lingual nerve damage was particularly low compared with those in other published series.

Accidental full thickness burn of the ear lobe following division of the great auricular nerve at parotidectomy.

Division of the great auricular nerve is commonly performed during superficial parotidectomy and leads to anaesthesia of the ear lobe. In the case presented here, this gave rise to an accidental self-inflicted thermal burn of the ear lobe. This might have been avoided had the posterior branch of the nerve been preserved.

Modified retractor for use in sectioning the inferior alveolar nerve.

We designed a modified tonsillar blade to retract the tissues medial to the ramus of the mandible to gain access to the inferior alveolar nerve at the lingula.

Alveolar soft part sarcoma of the tongue.

We report a case of alveolar soft part sarcoma--a rare malignancy that presented as a swelling at the base of the tongue in a 5-year-old child. Only about one-quarter of the few reported cases arise within the head and neck, the tongue and orbit being the favoured sites.

Therapeutic arterial embolisation of vascular lesions in the maxillofacial region.

The technique of therapeutic arterial embolisation involves the introduction of a thrombus-inducing material into the lumen of a blood vessel to occlude the vessel and reduce the blood supply to a lesion or to a specific part of the body. It is particularly useful in the maxillofacial region in the management of vascular lesions where marked diminution in blood flow can be achieved. This paper reviews the procedure and the materials for embolisation, and describes four patients for whom it was of considerable assistance.

Marsupialization of a large unilateral mandibular dentigerous cyst in a 6-year-old boy--a case report.

This paper describes the case of a 6-year-old boy who presented with an asymptomatic large unilateral dentigerous cyst related to an unerupted 6. It was marsupialized under general anaesthetic, and subsequently resolved rapidly. The pathogenesis and aetiology of dentigerous cysts is discussed, together with alternative treatment modalities. This paper illustrates that a conservative surgical approach to the management of a dentigerous cyst in a child can be very successful. By preserving the associated permanent tooth, marsupialization minimizes any disruption to future dental development.

The value of computerized tomography in oral surgery.

Computerized tomography is known to be of value in the assessment of malignant tumors of the head and neck. In addition, it can be helpful in the diagnosis of maxillofacial injuries, especially of the midface, and blowout fractures of the orbital walls. The present article reviews its possible role in the management of patients with expanding and infiltrating lesions of the jaws. An important feature of the technique is that soft tissues can be clearly demarcated from the surrounding structures. In addition, views are possible in both axial and coronal planes. Since 1977, CT has been employed in more than twenty patients with benign or locally invasive jaw lesions and has demonstrated a high degree of accuracy. However, a much larger series is necessary to assess the reliability of the technique and to define its role in the preoperative investigation of patients with this type of problem.

Surgical management of craniosynostosis.

With an incidence of approximately 1 in 2,000 per head of population, most neurosurgeons are presented at times with the problem of craniosynostosis. This paper summarises the different clinical effects of different skull deformities, and describes the present state of the art with regard to surgical management.

Management of anterior encephalocele.

The authors report their experience with anterior encephalocele, comprising 11 congenital and 11 traumatic cases. Unlike occipital encephaloceles, anterior lesions are usually associated with normal mental development. Surgery aims to restore normal anatomy with repair of the defective dura, bone and skin. Indications, surgical methods and outcome are discussed.