An osteological assessment of cyclopia by micro-CT scanning.

PURPOSE: Imaging modalities such as micro-CT scanning and three-dimensional reconstruction are providing a mechanism for detailed analysis of skeletal components not only of normal specimens but also through revisitation of the abnormal. The aim of this study was to analyse the craniofacial skeleton of five human fetuses with cyclopia by means of micro-CT scanning and three-dimensional reconstruction. MATERIALS AND METHODS: The study consisted of five cyclopean individuals from the paediatric collection of the School of Anatomical Sciences, University of the Witwatersrand. The specimens ranged in age from 22 to 42 weeks of gestation. The osteological features of each bone of the skull were analysed with the aid of micro-CT scanning and analysis using VG studiomax software. RESULTS: A detailed analysis of all the bones of the skull revealed that the upper two-thirds of the viscerocranium and the anterior region of the basicranium were the most affected regions of the cyclopean fetuses. The ethmoid, nasal, inferior concha and the lacrimal bones were absent in all the cases of cyclopia. Major abnormalities were found in the premaxillary region which affected the development of the anterior dentition. CONCLUSION: This study supports the suggestion that the malformations of the visceral bones are secondary to defective development of the presphenoid and mesethmoid cartilages. The ethmoidal bones are important midline struts during normal development and their absence in cyclopia leads to non-laterality of facial features.

Infant/toddler motor skills as predictors of cognition and language in children with and without positional skull deformation.

PURPOSE: To estimate associations between early motor abilities (at two age points, 7 and 18 months on average) and cognitive/language outcomes at age 3. To determine whether these associations are similar for children with and without positional plagiocephaly and/or brachycephaly (PPB). METHODS: The Bayley Scales of Infant/Toddler Development 3 were given at all age points to 235 children with PPB and 167 without PPB. Linear regressions assessed longitudinal associations between fine and gross motor scales and cognition/language. Item analyses examined the contributions of specific motor skills. RESULTS: Associations between 7-month motor skills and cognition/language were modest overall (effect sizes [ES] = - 0.08 to 0.10, p = .13 to .95). At 18 months, both fine and gross motor skills were associated with outcomes for children with PPB (ES = 0.21 to 0.41, p < .001 to .01), but among those without PPB, only fine motor skills were associated with outcomes (ES = 0.21 to 0.27, p < .001 to .001). CONCLUSIONS: Toddlers' motor skills were associated with cognition and language at 3 years, particularly among children with PPB. Interventions targeting early motor development in infants and toddlers with PPB may have downstream benefits for other outcomes.

MICROCOMPUTED TOMOGRAPHIC, MORPHOMETRIC, AND HISTOPATHOLOGIC ASSESSMENT OF CONGENITAL BONE MALFORMATIONS IN TWO NEOTROPICAL VIPERIDS.

Congenital malformations have been reported in all classes of vertebrates and may be a determinant of life span and survival. In reptiles, the incidence of congenital malformations can be associated with genetic and environmental causes, including pollution. The characterization of pathological processes involved in the development of congenital malformations of bone in snakes is rare in the literature, but is of great relevance in the field of reptile conservation and environmental health. We describe congenital bone lesions in 50 newborn jararaca (Bothrops jararaca) and 26 South American rattlesnakes (Crotalus durissus terrificus) born from wild-caught pregnant females in Southeastern Brazil. Lesions were evaluated by morphometric quantitative analysis, x-ray microtomography, and histopathologic descriptive analysis. Morphometric analysis showed that jararaca presented more severe axial lesions (kyphosis, scoliosis, and kyphoscoliosis) than rattlesnakes. Female rattlesnakes presented more severe axial lesions than did males. In rattlesnakes, spinal deformities were more frequently diagnosed in the caudal segment of the body. We present x-ray microtomographic assessments and images of malformed snakes (n=9) and characterized novel malformations, such as the agenesis of frontal, parietal, and supraoccipital bones in a jararaca specimen. Histopathologic findings included vertebral body fusion, myositis, coagulation necrosis, and disorganization of periaxial muscle fibers. The new methods and results presented in this study will be useful and informative for future research in pathology, teratology, embryology, and ecotoxicology in snakes.

Assessment of Deformational Plagiocephaly Severity and Neonatal Developmental Delay.

Deformational plagiocephaly (DP) in infants has been associated with developmental delay that can last until adolescence. Despite this association and a 5-fold increase in incidence of DP over the past 2 decades, there are currently no guidelines regarding screening for developmental delay or identification of which infants with DP are at the greatest risk of delay. A prospective, nonrandomized study was performed. Infants diagnosed with DP who had no prior intervention were eligible for enrollment. Cranial deformity was measured by cross-cranial measurements using calipers, and developmental delay was measured using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III). Correlation between cranial deformity and developmental delay was analyzed using a linear regression. Twenty-seven infants, ages 4.0 to 11.0 months (mean = 6.61 months) diagnosed with DP were studied. Developmental delay was observed on the composite language (n = 3 of 27, 11%), and composite motor (n = 5 of 23, 22%) scales, but not the cognitive scale. Severity of cranial deformity did not correlate with scores on any Bayley-III scales (cognitive R = 0.058, P = 0.238; composite language R = 0.03, P = 0.399; composite motor R = 0.0195, P = 0.536). This study demonstrates that severity of cranial deformity cannot be used to predict presence or degree of developmental delay. Craniofacial surgeons should be aware of this risk and consider developmental screening based on clinical suspicion.

The metopic index: an anthropometric index for the quantitative assessment of trigonocephaly from metopic synostosis.

OBJECTIVE Because the metopic suture normally fuses during infancy, there are varying degrees of severity in head shape abnormalities associated with premature fusion. A method for the objective and reproducible assessment of metopic synostosis is needed to guide management, as current methods are limited by their reliance on aesthetic markers. The object of this study was to describe the metopic index (MI), a simple anthropometric cranial measurement. The measurements can be obtained from CT scans and, more importantly, from palpable cranial landmarks, and the index provides a rapid tool for evaluating patients in both pre- and postoperative settings. METHODS High-resolution head CT scans obtained in 69 patients (age range 0-24 months) diagnosed with metopic craniosynostosis were retrospectively reviewed. Preoperative 3D reconstructions were available in 15 cases, and these were compared with 3D reconstructions of 324 CT scans obtained in a control group of 316 infants (age range 0-24 months) who did not have any condition that might affect head size or shape and also in a subset of this group, comprising 112 patients precisely matched to the craniosynostosis patients with respect to age and sex. Postoperative scans were available and reviewed in 9 of the craniosynostosis patients at a mean time of 7.1 months after surgical repair. 3D reconstructions of these scans were matched with controls based upon age and sex. RESULTS The mean preoperative MI for patients with trigonocephaly was 0.48 (SD 0.05), significantly lower than the mean values of 0.57 (SD 0.04) calculated on the basis of all 324 scans obtained in controls (p < 0.001) and 0.58 (SD 0.04) for the subset of 112 age- and sex-matched controls (p < 0.001). For 7 patients with both pre- and postoperative CT scans available for evaluation, the mean postoperative MI was 0.55 (SD 0.03), significantly greater than their preoperative MIs (mean 0.48 [SD 0.04], p = 0.001) and comparable to the mean MI of the controls (p = 0.30). In 4 patients, clinically obtained postoperative MIs by caliper measurement were comparable to measurements derived from CT (p = 0.141). CONCLUSIONS The MI is a useful measurement of the severity of trigonocephaly in patients with metopic synostosis. This simple quantitative assessment can potentially be used in the clinical setting to guide preoperative evaluation, surgical repair, and postoperative degree of correction.

Computed tomography assessment of peripubertal craniofacial morphology in a sheep model of binge alcohol drinking in the first trimester.

Identification of facial dysmorphology is essential for the diagnosis of fetal alcohol syndrome (FAS); however, most children with fetal alcohol spectrum disorders (FASD) do not meet the dysmorphology criterion. Additional objective indicators are needed to help identify the broader spectrum of children affected by prenatal alcohol exposure. Computed tomography (CT) was used in a sheep model of prenatal binge alcohol exposure to test the hypothesis that quantitative measures of craniofacial bone volumes and linear distances could identify alcohol-exposed lambs. Pregnant sheep were randomly assigned to four groups: heavy binge alcohol, 2.5 g/kg/day (HBA); binge alcohol, 1.75 g/kg/day (BA); saline control (SC); and normal control (NC). Intravenous alcohol (BA; HBA) or saline (SC) infusions were given three consecutive days per week from gestation day 4-41, and a CT scan was performed on postnatal day 182. The volumes of eight skull bones, cranial circumference, and 19 linear measures of the face and skull were compared among treatment groups. Lambs from both alcohol groups showed significant reduction in seven of the eight skull bones and total skull bone volume, as well as cranial circumference. Alcohol exposure also decreased four of the 19 craniofacial measures. Discriminant analysis showed that alcohol-exposed and control lambs could be classified with high accuracy based on total skull bone volume, frontal, parietal, or mandibular bone volumes, cranial circumference, or interorbital distance. Total skull volume was significantly more sensitive than cranial circumference in identifying the alcohol-exposed lambs when alcohol-exposed lambs were classified using the typical FAS diagnostic cutoff of ≤10th percentile. This first demonstration of the usefulness of CT-derived craniofacial measures in a sheep model of FASD following binge-like alcohol exposure during the first trimester suggests that volumetric measurement of cranial bones may be a novel biomarker for binge alcohol exposure during the first trimester to help identify non-dysmorphic children with FASD.

Outcomes of cranioplasty with synthetic materials and autologous bone grafts.

OBJECTIVE: Using current surgical methods, cranioplasty is associated with a high complication rate. We analyzed if there are preexisting medical conditions associated with complications and compared the effect of different implant materials on the degree of complications. METHODS: A retrospective review of the medical records of all patients who underwent cranioplasty for cranial bone defects during the period 2002-2012 was conducted, and 100 consecutive cranioplasty procedures that met eligibility criteria were identified. Patients were analyzed in 4 groups, which were created based on the cranioplasty material: autograft (n = 20), bioactive fiber-reinforced composite (n = 20), hydroxyapatite (n = 31), and other synthetic materials (n = 29). Survival estimates were constructed with Kaplan-Meier curves, and the differences between categorical variable levels were determined using a log-rank test. Multiple comparisons were adjusted using a Sidák correction. RESULTS: During a median follow-up time of 14 months (interquartile range 3-39 months), 32 of 100 patients (32.0%) developed at least 1 complication. A minor complication occurred in 13 patients (13.0%), whereas 19 patients (19.0%) developed a major complication, which required reoperation or removal of the implant. In the autograft subgroup, 40.0% of patients required removal of the cranioplasty. The 3-year survival of the autograft subgroup was lower compared with other subgroups of synthetic materials. In hydroxyapatite and bioactive fiber-reinforced composite groups, fewer complications were observed compared with the autograft group. CONCLUSIONS: Based on these results, synthetic materials for cranial bone defect reconstruction exhibit more promising outcomes compared with autograft. There were differences in survival rates among synthetic materials.

The aesthetic outcome of surgical correction for sagittal synostosis can be reliably scored by a novel method of preoperative and postoperative visual assessment.

BACKGROUND: Aims of surgical correction for isolated sagittal synostosis are functional and aesthetic. Multiple surgical techniques exist; however, reliable assessment of aesthetic outcome is poorly documented, limiting direct comparisons. The pinched appearance of the temporal regions is particularly challenging to correct. A visual analogue scale was designed to grade skull shape in patients who had total or subtotal calvarial remodeling for isolated sagittal synostosis. METHODS: Twenty-two assessors graded preoperative and postoperative photographs from 42 consecutive cases of sagittal synostosis under a single surgeon. Five aspects were graded (i.e., narrow elongated skull, frontal bossing, temporal pinching, occipital bullet, and overall shape) from 0 (normal) to 100 (severe). Interobserver and intraobserver agreement were analyzed by calculating within-subject standard deviation, coefficient of variation, and intraclass correlation coefficient. Linear regression analysis determined predictors of outcome. RESULTS: Surgery improved outcome dramatically across all five aspects of skull shape, with a 72.6 to 76.4 percent decrease in severity score. Improvements in severity score were greater after total calvarial remodeling, and type of calvarial remodeling (total versus subtotal) was an independent predictor of outcome in all aspects of skull shape (p≤0.001). Temporal pinching was improved in a subset of patients who also had onlay bone grafts in this region. CONCLUSIONS: Calvarial remodeling is a powerful technique for improving skull shape. A panel can detect gross and subtle aesthetic changes after surgical correction of sagittal synostosis using a visual analogue scale, with moderate interobserver and intraobserver agreement. This provides a tool for future outcome assessment. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Cephalometric assessment of craniofacial dysmorphologies in relation with Msx2 mutations in mouse.

OBJECTIVES: To determine the role of Msx2 in craniofacial morphology and growth, we used a mouse model and performed a quantitative morphological characterization of the Msx2 (-/-) and the Msx2 (+/-) phenotype using a 2D cephalometric analysis applied on micrographs. MATERIALS AND METHODS: Forty-four three-and-a-half-month-old female CD1 mice were divided into the following three groups: Msx2 (+/+) (n = 16), Msx2 (+/-) (n = 16), and Msx2 (-/-) (n = 12). Profile radiographs were scanned. Modified cephalometric analysis was performed to compare the three groups. RESULTS: Compared with the wild-type mice, the Msx2 (-/-) mutant mice presented an overall craniofacial size decrease and modifications of the shape of the different parts of the craniofacial skeleton, namely the neurocranium, the viscerocranium, the mandible, and the teeth. In particular, dysmorphologies were seen in the cochlear apparatus and the teeth (taurodontism, reduced incisor curvature). Finally contrary to previous published results, we were able to record a specific phenotype of the Msx2 (+/-) mice with this methodology. This Msx2 (+/-) mouse phenotype was not intermediate between the Msx2 (-/-) and the wild-type animals. CONCLUSION: Msx2 plays an important role in craniofacial morphogenesis and growth because almost all craniofacial structures were affected in the Msx2(-/-) mice including both intramembranous and endochondral bones, the cochlear apparatus, and the teeth. In addition, Msx2 haploinsufficiency involves a specific phenotype with subtle craniofacial structures modifications compared with human mutations.

The inter-rater and intra-rater reliability of a modified "severity scale for assessment of plagiocephaly" among physical therapists.

Infants with congenital muscular torticollis (CMT) are at risk of developing skull asymmetry. The aim of this study was to investigate the inter-rater and intra-rater reliability of a modified "severity scale for assessment of plagiocephaly" among physical therapists (PT). Thirty-nine members of a network of PTs working with infants with CMT participated in the study. Photos of infants were used in this study. They were taken from above (superior view) to estimate posterior flattening and forehead asymmetry, and from the front (anterior view) to estimate neck involvement and facial asymmetry. The photos were coded and sent to the PTs together with instructions and a protocol for estimation. A second estimate was carried out with the same photos in a different order. The PTs also answered questions concerning their experience of CMT and the scale used. The participants had worked as PTs for an average of 20 years, and with CMT for an average of 7 years. The inter-rater reliability kappa was 0.71, and the intra-rater reliability was mean 0.68. Intra-rater reliability was significantly higher for years of experience and for years working with CMT. There was no significant impact on reliability in relation to how many infants the PTs usually examine yearly, whether they found the scale easy to use, or how much experience they had using it. In conclusion, the modified "severity scale for assessment of plagiocephaly" has satisfying statistical agreement. Reliability is affected by the number of years of experience of the PTs.

A case study of a high-status human skeleton from Pacopampa in Formative Period Peru.

The Pacopampa site is located in the northern highlands of Peru and is an archaeological site belonging to the Formative Period (2500-1 BC). The excavation of the Pacopampa site yielded unusual human skeletons from the main platform of a ceremonial center of the site during the 2009 field season. The skeletal remains were associated with a pair of gold earplugs, a pair of gold earrings, and shell objects. This specimen is possibly a female aged 20-39 years. Detailed examination of the neurocranium revealed the presence of artificial cranial deformation with decreased cranial length, increased cranial breadth, and lateral bulging of the parietal bones. The estimated stature of this individual was 162 cm, which is about 15 cm higher than that of contemporary females of Pacopampa and about 20-25 cm higher than that of other Formative Period sites in northern Peru. The peculiarity of this individual, detected not only in the cultural artifacts but also in the physical features, is possible evidence for social stratification in the Formative Period.

Hospital use and associated costs of children aged zero-to-two years with craniofacial malformations in Massachusetts.

BACKGROUND: Craniofacial malformations (CFMs) are among the most common and correctable birth defects in the United States, often requiring multiple medical and surgical treatments. However, population-based data on hospital utilization and costs are sparse. METHODS: This retrospective cohort study used linked data from the Massachusetts Pregnancy to Early Life Longitudinal Data System. Cases were children born during 1998-2002 in Massachusetts hospitals to Massachusetts residents, alive at age two years, and ascertained by the Massachusetts Birth Defects Monitoring Program as having a CFM (orofacial cleft, craniosynostosis, microtia/anotia). Mean and median number of inpatient days and hospital facility costs (excluding professional fees) during birth and postbirth hospitalizations to age two years are presented by defect type and pattern for cases and compared to Massachusetts children without CFMs. RESULTS: Children with CFMs (N = 649) mostly had orofacial clefts (73%), and 73% had no other major birth defect. Both mean (12.0) and median (6) number of inpatient days from birth to age two years among children with CFMs were three times higher than among all other children. Mean incremental hospital cost of children who survived to age two years with CFMs compared to those with no CFM was $4,901 more during the birth hospitalization and $12,858 more for postbirth hospitalizations, or $17,760 overall. CONCLUSION: In the first two years of life, children with CFMs incur increased hospital costs compared to other children without such conditions, with substantial heterogeneity by defect and pattern type.

Sagittal suture overlap in cephalopelvic disproportion: blinded and non-participant assessment.

OBJECTIVE: To determine the role of assessment of overlap of fetal skull bones (molding) in intrapartum prediction of cephalopelvic disproportion (CPD). DESIGN: Prospective cross-sectional study. SETTING: South African high-risk obstetric unit that receives referrals from other facilities. POPULATION: Women of at least 37 weeks' gestation in the active phase of labor, with singleton vertex presentations and live fetuses, and without previous cesarean sections. METHOD: The researcher was blinded to parity and previous clinical information on the women, and not involved in their obstetric care. The researcher performed clinical assessments, including estimation of level of head, cervical dilatation, head flexion, position, overlap of fetal skull bones, caput succedaneum and asynclitism. A single assessment was done on each woman. MAIN OUTCOME MEASURE: CPD, defined as cesarean section for poor progress in labor. RESULTS: The author examined 504 women, and CPD occurred in 113 (22.4%). In multivariate logistic regression analysis, sagittal suture overlap was independently associated with CPD. Other factors associated were maternal height, duration of labor, birth weight, and the interaction between caput succedaneum and cervical dilatation at the time of examination. Lambdoid suture overlap was not significantly associated with CPD, and could be determined in only 66.5% of examinations because of frequent head deflexion. CONCLUSION: Assessment of sagittal suture overlap, but not lambdoid suture overlap, is useful for prediction of CPD. Knowledge of sagittal suture overlap may assist in decisions on clinical management where there is poor progress in a trial of labor.

Head shape and size of adult males as possible indicators of childhood stress in northern Jordan (1900-1978): a study in human biology and political economy.

Stature, sitting height, stature by weight, and head circumference change with varying economic conditions during early childhood. Our hypothesis is that adult head shape, as well as head size, is influenced by changes in childhood nutrition. When economic conditions are bad, nutrition and health suffer, and the result is dolichocephaly. To test this hypothesis, we measured the head length, width, and circumference of 398 adult males in Jordan. Fifty-six percent are ethnic Jordanians, and 44% are ethnic Palestinians. We divided the modern history of Jordan and the West Bank into four periods developed from historical economic data. The results of the study show that the cephalic index (CI) among Jordanians increased significantly with economic improvement but decreased slightly during the best economic period, whereas CI remained stable across all periods among Palestinians. The pattern among Jordanians can be explained in terms of maternal environment and early childhood nutrition. The lack of pattern in Palestinians may be due to changing nursing practices, bottle feeding, or sleeping position. When economic conditions were bad, Jordanian mothers and infants suffered from malnutrition and deficits in health care services during pre- and postnatal periods. Infants were born with very low birth weight and longer heads. However, the highest mean value of head size, circumference, among Jordanians and Palestinians is obtained from individuals who were children during the bad economic period, an unexpected result. No significant linear or quadratic trend was found for either Palestinians' or Jordanians' head circumference over time.

Interpretation of skeletal variations for human risk assessment: delayed ossification and wavy ribs.

Delayed (or incomplete) ossification of developing fetal bones and wavy ribs are some of the most common skeletal variations encountered in regulatory guideline developmental toxicity studies. Although they tend to be regarded as minor effects, they can be quite sensitive and consequently may influence the study lowest-observed-adverse-effect levels (LOAELs), and thus, impact classification, labeling, and risk assessment. In this study, we review the underlying mechanisms of these skeletal variations, evaluate different scenarios in which they have been observed, offer guidance for their interpretation, and comment on their use for risk assessment. Both minor delays in ossification and wavy ribs seem to be readily repairable via postnatal skeletal remodeling, are not mechanistically linked to malformation, and often are seen in the presence of maternal or fetal toxicity. As such, these minor variations would not generally be considered adverse in and of themselves but should be interpreted in the context of other maternal and fetal findings, information available on normal skeletogenesis patterns, mode of action of the test agent, and historical control incidence using a weight of evidence approach.

A new method for assessment of craniofacial malformations.

Many assessments of craniofacial malformations are generally undertaken to assist in surgical intervention including physical examination, cephalometric radiographs in anteroposterior and lateral views, stereolithographic models, and anthropometric measurements integrated with three-dimensional computed tomography (3-D CT) reconstructions to quantify skeletal deformities. In the present report, the use of 3-D Malformation Analysis, a three-dimensional methodology for planning craniofacial operative procedures, is presented. In addition to cephalometric and anthropometric databases, the measurements from 3-D surface reconstructions from CT were used intraoperatively to establish the correct position of skeletal segments.

Computed tomography assessment of Apert syndrome.

Apert syndrome, or acrocephalosyndactyly type I, is a craniofacial dysostosis, an autosomal dominant condition characterized by severe developmental disturbances of the craniofacial region including bilateral coronal synostosis associated with midface hypoplasia, exophthalmia, hypertelorism, and symmetric syndactyly of the hands and feet. The aim of this study is to assess the clinical and computed tomography imaging patterns of non-operated patients with Apert syndrome, correlating the bone abnormalities of the cranium, face and the skull base. The study population consisted of 5 patients with Apert syndrome. As part of the craniofacial assessment of the imaging center's routine, all patients underwent clinical evaluation and CT (computed tomograph) exam. Three-dimensional images were generated from helical CT scans, using an independent workstation, to evaluate the craniofacial abnormalities of the syndrome. Clinical exam determined that syndactyly of the hands and feet, pseudocleft in the midline palate and midface hypoplasia were features observed in all of the Apert patients. 3D-CT showed that some abnormalities such as bilateral coronal synostosis, calvarial midline defect and reduction in the antero-posterior dimension of the anterior, medial and posterior cranial fossae were present in all cases. In conclusion, the correlation of clinical and CT imaging findings can be useful to assess the main features observed in Apert patients, improving the criteria for examining the patient and diagnosing this condition, and contributing to the therapeutic planning and surgical follow-up.

Computed tomography assessment of Apert syndrome

A síndrome de Apert, também denominada acrocefalossindactilia tipo I, é uma disostose craniofacial de caráter hereditário autossômico dominante. Caracteriza-se por distúrbio severo de desenvolvimento na região craniofacial, incluindo sinostose bilateral da sutura coronal, associada a hipoplasia maxilar, exoftalmia, hipertelorismo e sindactilia simétrica de mãos e pés. O presente trabalho tem por objetivo o estudo de pacientes portadores da síndrome de Apert, não-operados, correlacionando os achados clínicos com os obtidos por meio da tomografia computadorizada (TC). Foram analisados 5 pacientes, sendo todos submetidos ao exame clínico e à tomografia computadorizada. Reconstruções tridimensionais (3D-TC) foram obtidas a partir de um tomógrafo helicoidal, utilizando uma estação de trabalho independente, para avaliação das alterações craniofaciais provocadas pela síndrome. A análise clínica determinou que sindactilia de mãos e pés, pseudofenda na linha média do palato e hipoplasia da maxila são achados observados em todos os pacientes. A 3D-TC mostrou que algumas alterações como sinostose bilateral das suturas coronais, defeito na linha média da calvária e redução na dimensão ântero-posterior da fossa craniana anterior, média e posterior estavam presentes em todos os casos. A combinação e correlação entre os achados clínicos e os observados na 3D-TC pode ser útil na avaliação das alterações observadas na síndrome de Apert, possibilitando melhora no estudo do paciente e promovendo informações importantes no diagnóstico, planejamento terapêutico e acompanhamento cirúrgico.

[The delivery of qualified care to patients with maxillary and craniofacial pathology]. / K voprosu ob okazanii kvalifitsirovannoi pomoshchi bol'nym s cheliustno- i cherepno-litsevoi patologiei.

Problems of timely qualified care of patients with craniofacial injuries are discussed. The number of patients with deformations developing as a result of unqualified care is increasing. The authors validate the need in specialized centers of craniofacial surgery. Special attention is paid to the problem of training highly qualified specialists in this sphere.