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.

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.

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.

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.

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.

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.

Relationship between facial asymmetry and positional plagiocephaly analyzed by three-dimensional computed tomography.

PURPOSE: A relationship between positional cranial deformation and facial asymmetry has been suggested; however, details regarding this relationship remain to be clarified. This study aimed to elucidate the relationship between facial asymmetry and positional plagiocephaly using three-dimensional computed tomography (3D-CT). METHODS: One-hundred-and-twenty-nine patients were included, and cranial vault asymmetry index (CVAI) and cephalic index (CI) were used as indicators of positional cranial deformation. Temporal muscle was constructed using 3D-CT data, and its volume was measured. VRL, Me (vertical reference line (VRL)-anterior nasal spine (ANS) and menton (Me) line) angle and the frontal occlusal plane (FOP) angle were measured. RESULTS: CVAI and VRL, Me angle (R2 = 0.31, P < 0.0001), VRL, Me angle and temporal muscle volume (R2 = 0.13, P < 0.0001), and FOP angle and VRL, Me angle were significantly correlated (R2 = 0.32, P < 0.0001), but CVAI and FOP angle were not (R2 = 0.08). Multiple linear regression analysis indicated that CVAI, FOP angle, and variable temporal muscle volume were significant predictors of VRL, Me angle [(F (5, 123) = 14.94, P < .0001, R2 = 0.38)]. CONCLUSIONS: Our results revealed that mandibular deviation was associated with contralateral head slant and ipsilateral increase in temporal muscle volume. Positional plagiocephaly may be a cause of facial asymmetry, and such deviations may occur in the temporal muscle.

Fusion patterns of major calvarial sutures on volume-rendered CT reconstructions.

OBJECTIVE: Recently, the authors investigated the normal course of fusion of minor lateral calvarial sutures on "3D" volume-rendered head CT reconstructions in pediatric trauma patients. While evaluating these reconstructions, they found many more fused sagittal sutures than expected given the currently accepted prevalence of sagittal craniosynostosis. In the present study, using the same set of head CT reconstructions, they investigated the course of fusion of the sagittal as well as the lambdoid, coronal, and metopic sutures. METHODS: They reviewed all volume-rendered head CT reconstructions performed in the period from 2010 through mid-2012 at Children's Hospital Colorado for trauma patients aged 0-21 years. Each sagittal, lambdoid, coronal, or metopic suture was graded as open, partially fused, or fused. The cephalic index (CI) was calculated for subjects with fused and partially fused sagittal sutures. RESULTS: After exclusions, 331 scans were reviewed. Twenty-one subjects (6%) had fusion or partial fusion of the sagittal suture. Four of the 21 also had fusion of the medial lambdoid and/or coronal sutures. In the 17 subjects (5%) with sagittal suture fusion and no medial fusion of adjacent sutures, the mean CI was 77.6. None of the 21 subjects had been previously diagnosed with craniosynostosis. Other than in the 21 subjects already mentioned, no other sagittal or lambdoid sutures were fused at all. Nor were other coronal sutures fused medially. Coronal sutures were commonly fused inferiorly early during the 2nd decade of life, and fusion progressed superiorly and medially as subjects became older; none were completely fused by 18 years of age. Fusion of the metopic suture was first seen at 3 months of life; fusion was often not complete until after 2 years. CONCLUSIONS: The sagittal and lambdoid sutures do not usually begin to fuse before 18 years of age. However, more sagittal sutures are fused before age 18 than expected given the currently accepted prevalence of craniosynostosis. This finding is of unknown significance, but likely many of them do not need surgery. The coronal suture often begins to fuse inferiorly early in the 2nd decade of life but does not usually complete fusion before 18 years of age. The metopic suture often starts to fuse by 3 months of age, but it may not completely fuse until after 2 years of age.

Osteoclastic craniectomy for scaphocephaly in infants results in physiological head shapes.

INTRODUCTION: Sagittal synostosis leading to scaphocephaly is the most common type of craniostenosis being operated. Different treatment options are known, but the optimal treatment method is still controversial. Head growth indicated by measurements of the head´s circumference and cephalic index (CI) are valid surrogate parameters for normal head shapes in children. The aim of the study was to analyze if osteoclastic craniectomy (OC) in scaphocephaly children at four to ten months of age results in normal head shapes. PATIENTS AND METHODS: Twenty-seven patients with scaphocephaly underwent OC between 2003 and 2011. The mean patient age at the time of surgery was 6.75 months. The body weight was between 6.1 and 9.3 kg, mean 8.0 kg. The average duration of surgery was 108 minutes. The mean blood loss during the procedure was 168 ml and the mean amount of erythrocyte transfusion was 152 ml. The mean time spent on the ICU was 1.48 days and the mean of total hospital stay was 5.81 days. The operative method is described. During the mean follow-up time of 6.3 years (min 3.8, max 10.4, median 7.1) focus was set on the patient´s head growth and cephalic index (CI) following OC. For statistical reason the follow up period was divided into three groups: follow up 2-4 years, 5-7 years and 8-10 years. RESULTS: For all cases the total head growth was 9.5cm (mean) during the follow up period of 6.3 years. Analyzing the mean head growth by bootstrapping analysis, the three observational groups showed a significant increase of the head circumference in all cases being analyzed: group 1 p=0.003, group 2 p=0.005 and group 3 p=0.028 Evaluation of the CI showed a statistically significant change from a pathologic value of 0.67 (mean) preoperatively to a normal value of 0.78 (mean) postoperatively during the follow up analyzing all patients. To precise these findings, the bootstrapping analysis showed in the first period an increase of the mean CI not reaching statistical significance (p=0.351). Analyzing the second and third period the CI significantly increased in both groups (p=0.016 and p=0.037). All patients showed a nearly complete re-ossification during the follow up period. No secondary operation was necessary in any patient of this cohort. CONCLUSION: As shown in this single-center observational study, the surgical intervention significantly improved the cephalic index and resulted in a symmetric head shape with excellent aesthetic appearance. The results were not dependent on postoperative helmet therapy, and compliance of caregivers. Re-ossification reached 100% within the observation period. According to these data, we recommend osteoclastic craniectomy as the method of choice in infants six to twelve months of age.