Late adult skeletofacial growth after adolescent Herbst therapy: a 32-year longitudinal follow-up study.

INTRODUCTION: The aim of this longitudinal 32-year follow-up investigation was to analyze the very long-term effects of Herbst treatment on the dentoskeletal structures. We followed 14 patients from a sample of 22 with Class II Division 1 malocclusions who were consecutively treated with the banded Herbst appliance at ages 12 to 14 years. The subjects were reexamined after therapy at the ages of 20 years (when the radius epiphysis/diaphysis plate was closed) and 46 years. METHODS: Lateral head films were analyzed from before (T1) and after (T2) treatment, and at 6 years (T3) and 32 years (T4) after treatment. RESULTS: (1) In the standard analysis (angular measurements) during the T2 to T3 period of 6 years, significant skeletal changes were the following: increase of the SNB (1.0°; P <0.01), decrease of the ANB (0.9°; P <0.01), and decrease of the ML/NSL (2.5°; P <0.001). During the T3 to T4 period of 24 years, no further significant angular changes occurred. (2) In the analysis of the sagittal changes in the occlusion (linear measurements) during the T2 to T3 period of 6 years, the mandible (6.1 mm; P <0.001) and the maxilla (3.0 mm; P <0.01) grew forward. During the T3 to T4 period of 24 years, the mandible (2.8 mm; P <0.01) and the maxilla (3.1 mm; P <0.01) continued to grow forward. Thus, during the total posttreatment (T2-T4) period of 32 years, there was continuous forward growth of the mandible (8.9 mm; P <0.001) and the maxilla (6.1 mm; P <0.001). (3) The analysis of superimposed lateral head films showed in all 14 subjects large amounts of sagittal and vertical skeletofacial growth during T3 to T4. CONCLUSIONS: In all 14 subjects, large amounts of sagittal and vertical skeletofacial growth occurred after the age of 20 years. However, the question of when, during the period from 20 to 46 years, growth had come to an end remains open. Closure of the radius epiphysis/diaphysis plate is not useful as an indicator for completed skeletofacial growth. Our findings indicate the importance of considering late adult skeletofacial growth in dentofacial orthopedics, orthognathic surgery, and tooth implantology with respect to treatment timing, posttreatment retention, and relapse.

Are gender differences in external noses caused by differences in nasal septal growth?

BACKGROUND: The nasal septum plays an important role in nasal growth, but there have been few reports on the relationship between the septum and nasal growth. The authors investigated the relationship between septa and external noses using computed tomography during the growth period. METHODS: One hundred and ninety-eight patients under the age of 21 were enrolled in this study between 2008 and 2012. The authors evaluated a total of 9 measurement items (five for nasal bones and septa, and four for external noses). RESULTS: In the final age group, most measurement items were significantly larger in males than in females. However, there was no remarkable difference between male and female growth processes. Nasal bridge length and nasal height were significantly correlated with the nasal bone or septum in almost all age groups. The relative proportion of the cartilaginous septum decreased significantly with age, and was negatively correlated with the perpendicular plate in all age groups. CONCLUSIONS: Nasal septa and external noses were both larger in males than in females at the beginning of the study period, although not significantly. The differences became significant throughout the study due to differential increases between the sexes during the monitored growth spurts.

Tonsillotomy versus tonsillectomy--a randomized trial regarding dentofacial morphology and post-operative growth in children with tonsillar hypertrophy.

OBJECTIVES: The primary aim of this study was to analyse two different methods of tonsil surgery, tonsillectomy (TE) and tonsillotomy (TT), regarding post-operative dentofacial growth in children with tonsillar hypertrophy. A secondary aim was to analyse these results in relation to cephalometric standards. MATERIAL AND METHODS: The study group consisted of 64 subjects (39 boys and 25 girls), mean age 4.8 years ± 4 months. They were randomized to a complete removal of the pharyngeal tonsil, TE, (n = 31) or a partial removal, TT, (n = 33). Pre-operative and 2 years post-operative study material were obtained and analysed. The results were compared with cephalometric standards. RESULTS: Pre-operative, children with hypertrophic tonsils displayed an increased vertical relation (P < 0.05) compared with cephalometric standards. Post-operative, no significant difference could be detected between the two surgical procedures regarding dentofacial growth. Mandibular growth with an anterior inclination was significant (P < 0.001/TE, P < 0.01/TT) for both groups. An increased upper and lower incisor inclination was noted (P < 0.01/TE,TT). The vertical relation decreased (P < 0.001/TE, P < 0.05/TT) as well as the mandibular angle (P < 0.01/TE, P < 0.001/TT). Reduction was also significant for the sagittal intermaxillar (P < 0.001/TE,TT) relation. These post-operative results, together with a more prognatic mandible (P < 0.05/TE,TT) and chin (P < 0.001/TE, P < 0.01/TT), might indicate a more horizontal direction of mandibular growth. CONCLUSION: TE and TT yielded equal post-operative dentofacial growth in children treated for hypertrophic tonsils. This result should be considered when deciding upon surgical technique.

Alteration of maxillary and mandibular growth of adult patients with unoperated isolated cleft palate.

OBJECTIVE: The objective of this study was to investigate the effects of cleft palate itself on the growth of maxilla and mandible. PATIENTS AND METHODS: Fifty-two adult female patients with unoperated isolated cleft palate and 52 adult female individuals with normal occlusion were included in our study. Computer software was used for lateral cephalometry measurement. Manual measurement was performed for dental cast measurements, and sample t test analysis was applied to analyze the differences between the 2 groups using SPSS 17.0. RESULTS: The sella-nasion-subspinale point angle, subspinale-nasion-supramentale point angle, and maxillary arch length of the cleft group were significantly smaller than those of the control group (P < 0.01). Both maxillary and mandibular posterior dental arch widths of the cleft group were significantly larger compared with the control group (P < 0.01), whereas the sella-nasion-supramentale point angle, mandible arch length, palate height, and palate shelf inclination did not differ between the 2 groups. The measurements did not differ between the submucosal cleft and the overt cleft patients. CONCLUSIONS: Cleft palate itself has adverse effects on the maxilla growth with shorter maxillary arch length and wider posterior dental arch width.

Effect of complete dentures on craniofacial growth of an ectodermal dysplasia patient: a clinical report.

The aim of this clinical report was to observe the effect of complete dentures on craniofacial growth and development of an ectodermal dysplasia (ED) patient. A complete anodontia patient diagnosed with ED was successfully rehabilitated with conventional complete dentures at the ages of 5, 8, and 10 years. Three sets of complete dentures were made with age-appropriate denture teeth and a bilaterally balanced lingualized occlusal scheme. Periodic follow-up and adjustment when needed was done to maintain proper oral function and esthetics. Serial cephalometric analysis exhibited a marked restriction of forward growth at the anterior nasal spine (ANS) point between 5 and 10 years of age, although there was little change from average in the anteroposterior length of the mandibular body and the height of the mandibular ramus. So, while maxillary growth was reduced, mandibular growth did not significantly change. Cast analysis showed that the increase in arch length was greater than in arch width for both the maxilla and mandible. There was little increase in alveolar ridge height in the anterior region but a considerable increase in the height of the alveolar ridge in the middle and the posterior region. Our findings concluded that the absence of teeth did not affect the growth of the jaws, and it is probable that the denture flange did not arrest the jaw growth, but rather improved the masticatory function by providing good denture stability and retention.

Timing of palate repair affecting growth in complete unilateral cleft lip and palate.

OBJECTIVE: To evaluate the facial morphology characteristics of patients with complete unilateral cleft lip and palate (UCCLPs) who had undergone cleft palate repair at different times. DESIGN: This study included 46 nonsyndromic UCCLPs and 38 age and sex matched non-cleft patients. 35 cephalometric measurements were used to evaluate the facial morphology. Student's t-test, one-way ANOVA and rank sum tests were used for comparison. Significant difference was defined at 95% level. RESULTS: The data showed that UCCLPs who had palatoplasty between 7 and 12 years had greater PMP-A, PMP-ANS, Ba-ANS, Ba-A, Ba-N-ANS than those operated on before 4 years of age, and UCCLPs who had palatoplasty at 4-12 years had smaller Y-axis angle than those operated on before 4 years of age. CONCLUSIONS: The maxillary sagittal length increased gradually as von Langenbeck repair was delayed. UCCLPs who underwent palate repair using von Langenbeck technique at 4-12 years had a more protrusive maxilla and less clockwise rotated mandible than those repaired before 4 years. UCCLPs operated using the von Langenbeck technique at 4-12 years had better head-face morphology than those operated on before 4 years. There was no difference in facial morphology among UCCLPs with palate repair at 4-12 years.

Influences of palatoplasty by the push-back procedure on craniofacial morphology and growth.

PURPOSE: For patients with a cleft palate, the push-back procedure which accompanies posterior shifting of palatal flap is thought to be most effective way of. achieving adequate velopharyngeal function. In this study, we aimed to evaluate the influences of the push-back procedure on the craniofacial morphology and its growth. MATERIAL AND METHODS: Using cephalometry we compared the craniofacial morphology and growth of three groups of Japanese children, living in the same region (Hokkaido, Japan). 1) 28 children (13 girls and 15 boys) with operated submucous cleft palates at the ages of 9 and 14 respectively. 2) 12 age-matched children (7 girls and 5 boys) with unoperated submucous cleft palates. 3) 60 age-matched non-cleft children (30 girls and 30 boys) with normal occlusion. None of them received dentofacial orthopaedic treatment. RESULTS: While the patients who had been operated on had significant differences in posterior upper facial height and inclination of the palatal plane when compared with non-cleft children or unoperated cleft children, they showed no statistically significant difference in anteroposterior positioning of anterior part of the maxilla, compared with the unoperated. CONCLUSIONS: The influences of palatoplasty by the push-back procedure with posterior positioning of the palatal flaps on craniofacial morphology are additional to the cleft palate, and of minor concern.

Effects of induced precocious puberty on cranial growth in female Wistar rats.

This investigation examined the effects of pharmacologically induced precocious puberty on cranial growth in Wistar rats. Forty-eight female newborn Wistar rats were divided into two groups: a control group (C) and an experimental group (E), with four subgroups of six animals each. The time interval from birth until sacrifice differed between the subgroups, and was set at 30, 60, 90, and 120 days. An intramuscular single dose (300 µg) of steroid hormone danazol was administered on day 5 after birth, as a means of inducing precocious puberty. Alizarin (2 mg/100 g) was administered to three animals in each subgroup three days prior to sacrifice. Body mass and dates corresponding to the beginning of the oestrous cycle were recorded. Craniometric measurements were undertaken. Histological analysis using light and fluorescence microscopy was then carried out to qualitatively and quantitatively evaluate the spheno-occipital synchondrosis and to visualize bone deposition patterns. The results were analysed with a Student's t-test and analysis of variance. Precocious puberty was effectively induced and differences between groups denoted an earlier maturation in the experimental rats. In qualitative analysis, a significant increase of total synchondrosis width was noted only in group E60, in comparison with C60, and an increase in the E90 subgroup cortical bone width compared with the C90 subgroup. Histomorphometrically, a statistical difference between total width values of subgroups E60 (434.3 µm) and C60 (323.5 µm) was detected. However, body mass and macroscopic measurements did not show statistically significant differences. An appropriate model for studying bone growth associated with precocious puberty in Wistar female rats was not achieved using steroid hormone danazol, when evaluated at 30 day intervals.

Pediatric nasal injuries and management.

Although serious trauma injuries are uncommon in the pediatric population, nasal injuries are a more common problem. In this population, many physicians are uncomfortable managing these injuries. The evaluation and treatment of nasal trauma differ considerably in children compared with adult nasal fractures. Poor patient cooperation during the physical exam coupled with significant anatomic differences can present the nasal surgeon with a difficult diagnostic dilemma. The surgical management of pediatric nasoseptal injuries is not without controversy, as disturbing the nasal growth centers can have significant effect on future nasal and midfacial development. This article reviews the diagnostic and therapeutic challenges presented by these injuries for children and provides recommendations to successfully manage nasal injuries in this population.

Repositioning of the masseter muscle and its effect on skeletal growth.

OBJECTIVE: The aim of this study was to establish a model to aid in understanding the influences of bilateral masseter muscle relocation on the bone and muscle, and to determine the influences of bilateral masseter muscle relocation on mandibular growth pattern in rabbits. STUDY DESIGN: Ten 3-month-old growing white New Zealand rabbits were included. Digital lateral cephalometric radiographs were obtained before operation and 6 months after surgery. The Co-Gn, gonial angle, FMA, ANS-Me, GoGn-SN, Y-axis, and Jarabak values were compared by using Student t test. RESULTS: There was a statistically significant difference between the groups in the gonial angle (P < .05). Vertical height values (GoGn-SN, FMA, Y-axis, and ANS-Me) showed statistically significant increases in animals in the control group. In contrast, vertical height values in the experimental group did not show statistically significant increase. CONCLUSIONS: Anterior relocation of the masseteric muscle influenced the direction of vertical growth significantly compared with the control group.

Craniofacial morphology in children with operated complete unilateral cleft lip and palate.

The objective of the study was to compare the craniofacial characteristics of children with operated unilateral complete cleft lip and palate (UCLP) with those of noncleft children. Lateral and posteroanterior cephalometric radiographs of subjects with UCLP and controls who were matched for sex, age, and ethnic origin were analyzed and compared. There were a total of 21 subjects with UCLP (10 boys and 11 girls) from the Orthodontic Department of Selcuk University and 15 controls (7 boys and 8 girls) from the Orthodontic Department of Ankara University. The nasal bone length in the group with cleft did not differ significantly from that in the control group. Subjects with UCLP included in the study appeared to have shorter faces, smaller mandibulae, greater lateral orbital width, and smaller sella turcicae compared with controls. Unilateral cleft lip and palate affects the intracranial morphology as well as dentofacial structures.

Influence of the Furlow palatoplasty for patients with submucous cleft palate on facial growth.

The purpose of this study was to investigate the facial growth in patients with submucous cleft palate operated on using the Furlow palatoplasty. A total of 30 patients with submucous cleft palate underwent Furlow palatoplasty from 1993 to 1998. The mean follow-up period was 4 years and 3 months. Twenty-five of 30 patients were followed up. Mid-facial growth was measured using lateral cephalograms in 18 patients whose age was greater than 8 years. The parameters obtained in the lateral cephalogram were compared with those of a healthy population in Korea. Eleven (61.1%) of 18 patients observed were within the clinical normal range for the age group for the parameter of the span between the anterior nasal spine and posterior nasal spine, 6 patients (33.3%) were over the range, and 1 patient (5.6%) was below the range. For the sella-nasion-subspinale angle, 55.6% of patients were within the clinical normal range, 27.8% were over the range, and 16.6% were below the range. For the sella-nasion-supramentale angle, 55.6% of patients were within the clinical normal range, 22.2% were over the range, and 22.2% were below the range. For the sella-nasion-subspinale-sella-nasion-supramentale angle, 72.2% of patients were within the clinical normal range, 27.8% were over the range, and none were below the range. For the span between the basion and posterior nasal spine, 50.0% of patients were within the clinical normal range, 27.8% were over the range, and 22.2% were below the range. In conclusion, our results suggest that the Furlow palatoplasty is a useful procedure as an initial treatment of submucous cleft palate and that this technique has a less harmful effect on facial growth because there is no excessive surgical intervention on the hard palate and alveolar process.

Interstitial growth of bone revisited.

The distance between two or more metallic implants placed within the same flat bones (mandible, nasal, frontal, hyoplastron, hypoplastron) of young pigs, rabbits, and turtles followed by means of serial radiographs, remained the same for periods as long as 546 days. Thus, it is concluded that there is no interstitial growth. In 1743, Duhamel demonstrated that long bones grow at their ends and that there is no interstitial growth. This report is unique in that it demonstrates by use of radiopaque implants and serial radiographs that there is no interstitial growth of flat bones, which grow by apposition and resorption, and not endochondrally, such as occurs in long bones.

[Facial developmental irregularities of the face- in children with Binder's syndrome with regard to indirect angular measurements]. / Nieprawidlowosci rozwojowe twarzy u dzieci z zespolem Bindera w swietle posrednich pomiarów katowych.

UNLABELLED: Binder's syndrome is a disorder characterised by the underdevelopment of maxilla and nose. PURPOSE: The paper presents an attempt to analyse the developmental irregularities, described by angular features in patients with the syndrome. PATIENTS AND METHODS: The research was performed on 4 children aged 5-12 with maxillonasal dysplasia. Before orthodontic and surgical treatment standardised photographs of the head -- anterior and lateral (right and left) were taken. Seven angular measurements were taken on the standardised lateral photographs. The same measurements were made in the group of 30 girls and 60 boys aged 5-12 years. THE RESULTS of measurements were normalized into means and standard deviation of analogous features for normal persons in groups of sex and age, then every angle of the face was counted. From all angular features, three (fronto-nasal angle, inclination of upper lip angle and inclination of chin angle) were characterised by higher means in children with maxillonasal dysplasia. The most favourable mean of normalised value referred to the fronto-nasal angle and was 2.9. CONCLUSIONS: On the basis of this analysis it was affirmed that people with Binder's syndrome are characterised by a flat nose and strong inclination of upper lip and chin, resulting in characteristic concave facial profile. The most visible malformations of the face concern the inclination of the nose. The smallest deviation is localised in the area of the nose and lips.

Facial growth after middle turbinate resection: an experimental study in the rabbit.

BACKGROUND: The aim of this study was to determine the effects of total middle turbinate resection on midfacial growth through a morphometric analysis on an animal model. METHODS: Twenty-eight male New Zealand white rabbits were used. The animals were divided into three groups: group 1, elevation and relocation of the nasal bone was performed; group 2, concha resection was performed; group 3, control group with no surgical procedure. The surgery was done at 8-10 weeks of age and the skull of each subject was sampled as they reached maturity. The determined distances then were measured by using landmarks identified on skull. The supplied data were evaluated by using the Mann-Whitney U test. RESULTS: Deviation of the nasal axis to the opposite side of the resected concha and an increase in the width of nasal bone were observed only in group 2. In group 1, an increase of nasal bone length and zygomaticonasal distances was determined in both the operated and the unoperated sides of nasal bones. CONCLUSION: This animal experiment showed that operations on the nasal bone or concha resection affected the midfacial growth in rabbits. The effects of middle turbinate resection to midfacial development should be evaluated by additional studies. We recommend only limited, conservative surgical procedures on the middle turbinate, saving all the vital mucosa, periosteum, and bone.

Long-term results of the two-stage palatoplasty/Hotz' plate approach for complete bilateral cleft lip, alveolus and palate patients.

PURPOSE: To investigate the effects of the two-stage palatoplasty combined with the Hotz' plate on craniofacial development in patients with bilateral complete clefts. MATERIAL AND METHODS: Lateral and frontal cephalograms of two-stage palatoplasty/Hotz' plate group (n=10), one-stage palatoplasty group (n=11), and a non-cleft group (n=11), were evaluated at 6, 8, 10 and 12 years of age. The unpaired Student's t-test and Scheffe's F test (p<0.05) were applied. RESULTS: At 6 years the posterior upper facial height (PUFH) and PUFH/PFH ratio were greater in the two-stage group. At 10 years the PUFH, maxillary depth, convexity and ANB angle were greater in the same group. At 12 years, maxillary depth and ANB angle were also greater in this group. In the one-stage group, the L1/Mp. angle, PUFH and PUFH/PFH ratio were smaller when compared with the non-cleft group, whereas the palatal plane/SN angle was greater. In both cleft groups, the I.I. angle and tongue-PTM' distance were greater, and the U1/SN angle was smaller when compared with non-clefts. The UC-UC' and the ratios UC/MAX and UC/LC of both cleft groups were also smaller when compared with non-clefts. The ratio UM/MAX of the one-stage group was smaller when compared with the non-cleft group. CONCLUSION: The two-stage palatoplasty in combination with application of the Hotz' plate had good effects on the maxillary growth up to the age of 12 years.

Gross growth and regrowth of sutures: reflections on some personal research.

A series of experiments was performed on young monkeys, rabbits, and turtles to study gross sutural growth of bones. Radiopaque implants in conjunction with serial, direct gross, and indirect radiographic measurements were employed. Differences in growth were observed in the monkey among five facial sutures and also the same suture at different times. Growth was greatest at the zygomaticotemporal suture and least at the premaxillomaxillary suture. In the rabbit, the nasal bone side of the frontonasal suture grew about twice as fast as the frontal bone side. In the turtle shell, the midsagittal suture grew faster than the transverse suture. In all of the animals, the rate of sutural growth decreased with an increase in age. No gross regional growth disturbance was noted after resection of the frontonasal, midpalatine, or transpalatine sutures. The frontonasal suture reformed presumably because of the underlying nasomucoperiosteum, as in a cranial suture, presumably because of the underlying dura. After extirpation of the midpalatine suture with the formation of a complete cleft and despite no underlying membrane, a new suture reformed in an eccentric position in a number of instances. Bone growth at sutures is secondary or compensatory to some other factors.

Surgery of the lateral nasal wall and ethmoid: effects on sinonasal growth: an experimental study in rabbits.

OBJECTIVE: To assess the impact of lateral nasal wall surgery on sinonasal growth METHODS: Twenty young New Zealand White rabbits, 6 weeks of age, were included in this experimental study. Surgery was performed on two groups of ten animals each (series I and II). Entrance to the left nasal cavity is achieved through the nasal dorsum via mobilization and rotation of the left nasal bone. Series I: partial resection of the lateral nasal wall (including the ostium to the maxillary sinus) on the left side. Series II: partial resection of the lateral nasal wall and anterior ethmoid. Follow-up period was 20 weeks. Twenty rabbits served as controls. RESULTS: In series I, all skulls have grown normally. In series II the nasal dorsum has also developed symmetrically. Snout length and growth of upper jaw are normal; there is no malocclusion. Three skulls show a slight deviation of the nasal dorsum (two to the left, one to the right). Morphometric measurements of 20 points on the skulls show no significant difference between the control group and the experimental series I and II. CONCLUSION: This experimental study demonstrates that visually controlled partial resection of the bony sinonasal wall, with or without resection of the anterior ethmoid does not affect later development of nose and upper jaw on condition that eventually underlying cartilage is preserved. Contradictory results from other experimental studies, previously published and concerning negative effects of sinus surgery, might be attributed to surgical traumatization of intranasal cartilage structures, in particular, the upper lateral cartilages.

A cephalometric study of facial growth in van der Woude syndrome.

OBJECTIVE: To test the hypothesis that maxillary growth and lower lip form in patients with van der Woude syndrome (VDW) is different from patients with non-syndromic cleft lip and palate. DESIGN AND SETTING: Retrospective, case-control study at a tertiary cleft center, Chang Gung Memorial Hospital, Taipei, Taiwan. PATIENTS AND PARTICIPANTS: Records of 53 patients with VDW, who presented for treatment during the years 1968 through 1998 were obtained. Twenty-three of 53 patients had received at least one lateral cephalogram during the course of their treatment. Of these 23, in 17 it was possible to find non-syndromic case controls with identical cleft type, sex, and method of cleft palate repair, with year of birth matching within 1 year of the corresponding VDW patient. For these 17 pairs of VDW and non-syndromic cleft controls, cephalogram acquisition dates were checked to see how well the corresponding pairs matched. A total of 43 pairs of cephalograms were deemed to be acceptably matched because the ages at acquisition differed by less than 15% of the VDW patient's age. MAIN OUTCOME MEASURES: Thirteen measurements were derived from the 11 standard lateral cephalometric landmarks recorded on each cephalogram. The data were classified into five groups according to age at time of cephalogram, and sets of paired non-syndromic cleft and VDW measurements were tested for differences using a Wilcoxon signed rank sum test in two ways, first including all cleft types and then including only those patients with complete bilateral cleft lip and palate. A longitudinal growth analysis considering the movement of the skeletal A and B points was performed on the patients with complete bilateral cleft lip and palate. RESULTS: For the osseous measurements, anteroposterior maxillary length as described by the anterior nasal spine (ANS)-posterior maxillary point distance was statistically significantly shorter in the VDW patients of age 13 years and older, by 5.3 mm. Maxillary height, as described by the nasion-ANS distance was shorter in the VDW patients, closely approaching statistical significance in the age range 7 through 11 years. The lip soft tissue measurements showed significantly greater protrusion over several age ranges in the VDW patients. The longitudinal growth analysis showed a significantly more inferior vertical position of the B point in the controls. CONCLUSIONS: This study demonstrates a few statistically significant differences in maxillary growth and lip conformation between VDW and matching controls. Small sample sizes for each age group hamper the ability to fully interpret or generalize the pattern of these differences.

The effect of neurocranial surgery on basicranial morphology in isolated sagittal craniosynostosis.

OBJECTIVE: Isolated sagittal craniosynostosis produces a scaphocephalic neurocranium associated with abnormal basicranial morphology, providing additional evidence of the developmental relationship of the neurocranium and basicranium. Corrective surgical procedures vary, but the immediate impact of the surgical procedure is restricted to the neurocranium. This study addresses the secondary effects of neurocranial surgery on the cranial base. DESIGN: Three-dimensional (3-D) computed tomography (CT) scans were obtained for preoperative (n = 25) and postoperative (n = 12) patients with isolated sagittal synostosis. Landmark data from 14 landmarks on and around the cranial base were collected from 3-D CT reconstructions and analyzed using Euclidean distance matrix analysis. Subsamples of age-matched patients were used to identify basicranial differences in pre- and postoperative patients and to compare postoperative growth patterns identified in longitudinal data with preoperative growth patterns characterized in cross-sectional data. RESULTS: Statistically significant differences (p < or = 0.10) were found in the morphology of the cranial base in preoperative and postoperative patients. The relative positions of the landmarks nasion, right asterion, and left asterion are similar in preoperative and postoperative patients. However, the position of these landmarks relative to the cranial base is different in the two groups, being positioned relatively more anteriorly in postoperative patients. In addition, we found that the cranial base angle, on average, neither increases nor decreases in the first postoperative year. These morphological differences are associated with divergent growth trajectories in the operated and unoperated cranial base. CONCLUSION: Regardless of specific procedure, neurocranial surgery in sagittal synostosis patients affects growth patterns of the cranial base. The lack of change in the postoperative cranial base angle suggests that neurocranial surgery alleviates the occipital rotation and decreased cranial base angle described in the sagittal synostosis basicranium.