The character of parietal and orbital alterations in the superfamily Hominoidea (families Hominidae [exclusive of Homo] and Hylobotidae).

Parietal external surface disruption routinely referred to as porotic hyperostosis, and orbital alterations (cribra orbitalia), have been attributed to anemia-related bone marrow hyperplasia in humans. A recent study in humans identified that they were actually vascular in nature. Skeletons were examined and epi-illumination surface microscopy was performed on the parietal region and orbit of 156 Hominidae and 123 Hylobotidae to assess if these phenomena were trans-phylogenetic. Trans-cortical channels were recognized on the basis of visualized ectocranial surface defects penetrating the parietal; cribra orbitalia, by alteration of the normally smooth orbital roof appearance. Trans-cortical parietal channels, ranging in size from 20 to 100 µm, are rare in Gorilla and Pan troglodytes and absent in Pan paniscus. They are universally present in adult Pongo abeli and in Hylobatidae, independent of species. Cribra orbitalia was common in Hylobotidae, Pongo pygmaeus and P. abelii, less prevalent in adult P. troglodytes, and not recognized in any Gorilla gorilla or P. paniscus examined. The proliferative form predominated, with the exception of Hylobates concolor and muelleri, in which uncalcified vascular grooves predominated. No correlation was observed between the presence of either trans-cortical channels or cribra orbitalia and fractures, osteoarthritis, or inflammatory arthritis. Parietal alterations observed in apes are trans-cortical channels, analogous to those observed in humans, and do not represent porosity. Similarly, cribra orbitalia in apes is confirmed as vascular in nature. The proliferative form apparently represents calcification of blood vessel walls, indistinguishable from observations in humans. Predominant presence in adults rather than in juveniles suggests that both forms are acquired rather than developmental in derivation. Sex and bone alteration/disease-independence suggests that mechanical, endocrine, and inflammatory phenomena do not contribute to the development of either. Further, independent occurrence of trans-cortical channels and cribra orbitalia suggests that they do not have a shared etiology.

Could mastication modify the shape of the orbit? A scannographic study in humans.

PURPOSE: Since prehistory, changes of the facial skeleton have been related to the modification of diet. More recent studies have shown changes in the morphology of the mandible and maxilla due to variations of strain during mastication. The temporal muscle (TM) is a strong masticatory muscle, with its insertions extending through the temporal fossa. Our objective is to observe the relations between the TM and the lateral orbital wall (LOW) which could indicate an influence of mastication on the shape of the LOW. METHODS: We conducted a retrospective study using 100 CT scans. The length of the lateral orbital wall (LLOW), the angle between LOW and the medial orbital wall (MOW), the cross-sectional areas of LOW and of the TMs were measured on both sides of each CT scan. The correlation between TMs and other three parameters was studied by Pearson correlations. RESULTS: A correlation was found between TMs and LOWs, a lower with LLOW, and a very weak and negative correlation between LOW/MOW angle. CONCLUSIONS: Anatomical knowledge about TM and investigation of masticatory strains lead us to think that mastication have minimal effect on the morphology of the LOW, only on the frontal process of zygomatic. This may explain, in part, why the LOW is the strongest wall of the orbit.

Normative Data of the Interorbital Distance in Thai Population.

The incidence of the patients with craniofacial anomalies was high in southeast-Asian countries, for example, fronto-ethmoidal encephalo-menigocele or craniosynostosis. These craniofacial anomalies usually involve orbits, so a surgical orbital reconstruction is always required.Various methods have been used in the past to indirectly analyze the craniofacial region. Plain skull radiography, anthropometry, and cephalometry provided the limited information of interorbital distance in terms of accuracy whereas the interorbital distance is crucial to be reconstructed, increasing or decreasing. The accurate normal interorbital distance which grows by age as other craniofacial structures is the important data in the part of interorbital and orbital reconstruction. To date, the normative data of the bony interorbital distance among Thai population have not been established.The purpose of this study is to provide normal values and the growth patterns of the bony interorbital distances and other dimensions of the orbit according to age among Thai population through the axial computed tomography. Comparisons can then be made between normal values and those for an individual patient or those for a group of patients, for example, those with front-ethmoidal meningoencephalocele, Crouzon, or Treacher-Collins syndrome, or among values for individual patients at different time intervals.A retrospective study of computed tomography (CT) scan series of 698 normal orbits from 349 skeletally normal subjects (202 men and 147 women) was enrolled. The age range of the patients was 0 to 21 years (mean, 10.2 years; SD, 5.8 years). A series of 12 measurements were obtained from the CT scans of each subject. All CT images were obtained from patients who underwent CT of the facial bone, brain, and orbits at the Department of Radiology of 3 big hospital in Bangkok-Ramathibodi, Samitivej Srinakarin, and Bangkok hospital-since 2010 to 2015.The normal measurement values in the orbital region through the CT images, as the normal periorbital growth curve, will help improving diagnostic accuracy, staging of reconstruction, precision of corrective surgery, and follow-up of the Thai patients with craniofacial abnormalities such as front-ethmoidal meningoencephalocele, hypertelorism. These data may also apply to the related population in the southeast-Asian countries.

Temporal Progression of Craniofacial Dysmorphology in Unilateral Coronal Synostosis: A Mechanistic Hypothesis.

AIM: This study chronicles skull base and face development in nonsyndromic unilateral coronal synostosis (UCS) during infancy, to characterize the mechanistic progression of facial dysmorphology. METHODS: Computed tomography scans from 51 subjects were reviewed (26 UCS, 25 controls) and data were reconstructed. Patients were stratified into 5 age groups. A series of measurements were taken from the reconstructions. RESULTS: All patients had a unilaterally fused coronal suture at the time of analysis. Asymmetry of the sphenoid wings was present across all age groups. The sphenoid wing ipsilateral to the fused suture consistently had a more acute angle from the midline. At 19 days of age, ipsilateral nasal root and cribriform plate deviation are noted, as well as increased contralateral zygoma antero-posterior length. Patients younger than 2 months also had elongated posterior cranial bases. At 2 to 3 months of age, the cranial base widens in the anterior portion of the middle cranial fossa with an increased ipsilateral pterion to sella distance. The most delayed change observed was the increase in contralateral orbital rim angle at 7 to 12 months of age compared to normal. CONCLUSION: After suture fusion, sphenoid wing changes are among the earliest restructural malformations to take place. This suggests that the cascade of dysmorphology in UCS originates in the cranial vault, then progresses to the skull base, and lastly to the facial structures. Ipsilateral orbital changes are early facial changes in UCS that begin before 2 months of age. This is then followed by changes in the contralateral face later in development.

Bony orbital maldevelopment after enucleation.

One common belief in ophthalmology is that enucleation at an early age will result in bony orbital maldevelopment and facial asymmetry. However, the age range in which enucleation is associated with risk of orbital maldevelopment and the extent of asymmetry remains controversial. In this study, patients who had undergone unilateral enucleation at different ages without orbital implantation were analysed to investigate bony orbital development after enucleation. A total of 87 Chinese adult patients were included. Their bony orbital volume and orbital aditus area were measured using three-dimensional reconstructive models based on patients' computer tomography scans. The ratio of the parameter values of the affected orbit to the unaffected orbit was calculated and described as the orbital symmetry index. The results showed that the bony orbit grew until approximately 18 years old. Enucleation after that age did not affect the orbit, whereas enucleation before that age led to significant orbital maldevelopment. The relative reduction ranged up to 20% in orbital volume and 17% in the orbital aditus area. The extent of orbital maldevelopment was correlated to the age of enucleation. The symmetry index of orbital volume = -0.0003x(2)  + 0.0159x + 0.8112 (x = the age of enucleation). The symmetry index of the orbital aditus area = -0.0002x(2)  + 0.0119x + 0.8504 (x = the age of enucleation). The regression formulae were used to predict the severity of orbital asymmetry after unilateral enucleation, and evaluate the necessity and efficacy of interventions following enucleation.

Normative biometrics for fetal ocular growth using volumetric MRI reconstruction.

OBJECTIVE: To determine normative ranges for fetal ocular biometrics between 19 and 38 weeks gestational age (GA) using volumetric MRI reconstruction. METHOD: The 3D images of 114 healthy fetuses between 19 and 38 weeks GA were created using super-resolution volume reconstructions from MRI slice acquisitions. These 3D images were semi-automatically segmented to measure fetal orbit volume, binocular distance (BOD), interocular distance (IOD), and ocular diameter (OD). RESULTS: All biometry correlated with GA (Volume, Pearson's correlation coefficient (CC) = 0.9680; BOD, CC = 0.9552; OD, CC = 0.9445; and IOD, CC = 0.8429), and growth curves were plotted against linear and quadratic growth models. Regression analysis showed quadratic models to best fit BOD, IOD, and OD and a linear model to best fit volume. CONCLUSION: Orbital volume had the greatest correlation with GA, although BOD and OD also showed strong correlation. The normative data found in this study may be helpful for the detection of congenital fetal anomalies with more consistent measurements than are currently available. © 2015 John Wiley & Sons, Ltd.

Pediatric Orbital Depth and Growth: A Radiographic Analysis.

BACKGROUND: Orbital reconstruction requires knowledge of orbital depth in order to prevent optic nerve injury. Numerous analyses of adult orbital dimensions have been undertaken previously in order to characterize this measurement, including skull specimen and computerized tomography studies. However, there is a paucity of information regarding the pediatric orbit. METHODS: The authors used pediatric magnetic resonance imaging (MRI) studies in order to quantify the change in orbital depth in relationship to patient age, and to develop methods to estimate and calculate orbital depth for individual pediatric patients. MRIs of the head in normal pediatric patients were reviewed retrospectively. Orbital depths were measured and correlated with age and cephalometric dimensions. In a randomly selected subgroup of patients, measurements were repeated by an independent investigator to determine interobserver reliability. RESULTS: Measurements were obtained in 72 patients ranging from 3 months to 18 years of age (mean=7.8 years). There was a significant exponential relationship between orbital depth and patient age (r=0.81, F(2,69)=143.97, P<0.001). Depth increased more rapidly in the first 6 years of life, but leveled off in the early teen years toward a horizontal asymptote of approximately 45 mm. There was also a significant relationship between orbital depth and the sum of the biparietal width plus the anterior-posterior length (r=0.72, F(2,69)=87.44, P<0.0001). There was high interobserver reliability in measurements between 2 independent investigators (r=0.79, P<0.0001). CONCLUSION: In children, orbital depth increases predictably with rising age and increasing head size. Knowledge of this growth curve and the relationship between head size and orbital depth can complement careful surgical dissection to improve safety and efficacy in pediatric orbital reconstructions.

[Measurement of orbital development in children from birth to 6 years of age].

OBJECTIVE: An evaluation of orbital development in children from birth to 6 years of age was conducted in order to provide normal reference values for clinical use. METHODS: Retrospective cohort study. By combining multi-section helical computerized tomography (CT) imaging with a computer-aided design system (BrainLAB, Munich, Germany; iPlan Cranial Software, version 2.5), we measured the orbital volume of 100 emergency children (200 eyes), who underwent computerized tomography (CT) scanning due to mild injury in Beijing Tongren Hospital and had normal CT findings. From birth to 6 years of age, according to the age of < 1 years of age for the treatment of 0 year old group, aged 1 years old and < 2 years old for 1 year old group, and so on, divided into 7 groups. Among the 50 male and female patients, the ages are 0-6 years. All of these were in order to analyze the relationship between the age and orbital volume with unary linear correlation and regression. The comparison of orbital volume between females and males was performed using two independent t-tests. Comparisons of bilateral orbital volumes were performed using a paired t-test. RESULTS: The average orbital volume of children was initially (12.57 ± 3.80) cm(3) at birth, and then increased to (19.34 ± 1.86) cm(3) at 6 years of age, with an average annual growth of 1.13 cm(3). There was a positive linear relationship between orbital volume and age in children from birth to 6 years of age, yielding the regression equation: Y (orbital volume) = 13.582 + 1.042 × X(age). There is no statistic difference on the orbital volume between boys and girls (t = 1.073, 0.533, 1.808, 1.039, 1.346, 0.983, 1.774, P > 0.05). In addition, no statistic difference was found between the left and right orbital volume (t = 1.059, P = 0.292). The growth curves for all groups almost overlapped with each other. CONCLUSIONS: There is a positive linear relationship between orbital volume and age in children from 0 to 6. The bilateral orbital volumes were almost the same. There is no statistic difference on the orbital volume between boys and girls.

The assessment of relationship between the skull base development and the severity of frontal plagiocephaly after bilateral fronto-orbital advancement in the early life.

PURPOSE: The deformation of the skull base in patients with unilateral frontal plagiocephaly (UFP) is well known, but the mechanism is not still clear. We analyzed the skull base in the patients with UFP who underwent fronto-orbital advancement (FOA) in the early life during the last decade. METHODS: We assessed the treatment results and outcome of FOA performed in six patients, four girls and two boys younger than 2 years, in the last decade. Also, the basal cranium's angles were measured by 3D reconstruction images on computed tomography (CT) scan. RESULTS: The mean patients' age at FOAs was 11 months. Two cases were classified as grade 2A, two cases as grade 2B, and two cases as grade 3 (the classification of Di Rocco and Velardi). The ethmoidal axis was deviated a mean of 8.2° to the affected side. The mean angle between the petrosal pyramids and the midline (anterior-petrosal-sagittal angle, APSA) was 75.3° on the affected side and 66.2° on the normal side. The mean difference of APSA was 9.2°. On the follow-up CT images 5 years after surgery, the deviations of the ethmoidal axis clearly decreased, 5.7°, but the differences of APSA did not change, 8.8°. CONCLUSIONS: The midline distortion of anterior skull base should be considered to be spontaneously corrected during the follow-up periods in patients with all types of UFP who underwent FOA, unlike posterior skull base in the patients with grades 2B and 3 classification.

Cephalometric evaluation of ocular protrusion at stages of growth.

The sagittal relationships between the orbital globe and the ocular orbit have great importance in aesthetic and functional evaluations. These relationships are useful in diagnosis and treatment of some malformations in which the orbital volume is reduced such as craniostenosis. The aim of the present study was the cephalometric evaluation of the ocular protrusion at different growth stages. Ninety-two patients with negative history of craniosynostosis, severe myopia, and skeletal class I were selected for the present study. Lateral teleradiography x-ray was performed for all the patients, and 5 groups were carried out based on the dentition phase. Cephalometric analyses were performed on the lateral teleradiography x-ray. Mean values of ocular protrusion (B-Or post) for females and males were found and digitized for the 5 groups tested. All other sagittal and vertical measurements were successfully computed by the trained operator. B-Or post showed values between -14.93 mm and -16.90 mm among the groups. The cephalometric analysis proposed in the present study allowed to successfully evaluate sagittal and vertical relationship of the orbital globe and the orbital cavity in growing patients. Moreover, the B-Or post maintained its value during growth in the present study.

Changing ocular prostheses in growing children: a 5-year follow-up clinical report.

Eye loss in children can be caused by trauma, glaucoma, or cancer, and may result in anxiety and depression. Recovery after eye loss involves a replacement with a custom-made eye prosthesis, but, as the patient ages, changes in the size and shape of the eye socket can result in a sunken appearance of the child's prosthetic eye. This article describes the fabrication of a custom-made eye and the necessity of changing ocular prostheses for a growing child, with a 5-year follow-up.

Do long-faced subjects really have a long anterior face? A longitudinal study.

INTRODUCTION: The aims of this study were to investigate and compare the anterior facial heights of children with long, normal, and short faces during growth and to discover whether long-faced subjects have long dimensions in both the upper and lower anterior facial heights compared with the others. METHODS: Longitudinal lateral cephalometric data of 167 children (83 girls, 84 boys) from 6 to 14 years of age were used. Total anterior face height, upper anterior face height, lower anterior face height, and the closest distance from the Frankfort horizontal plane to nasion were measured. The samples were classified as long-faced, normal-faced, and short-faced according to the ratio of lower to total face heights at 14 years old. All data were analyzed statistically and compared between the groups according to age. RESULTS: The mean lower anterior face height in the long-faced group was larger than in the normal-faced and short-faced groups for all ages in both sexes. In contrast, subjects in the normal-faced group had a longer mean upper anterior face height than did subjects in the long-faced and short-faced groups. In addition, the mean upper anterior face height of the short-faced group was larger than the long-faced group for girls at all ages and for boys at 12 to 14 years. CONCLUSIONS: The long-faced children did not have longer upper facial heights compared with normal-faced and short-faced children, and their long faces were mainly determined by the length of the lower face.

Orbital Development in Children with Retinoblastoma: An Imaging-Based Study.

PURPOSE: To examine whether children treated for Retinoblastoma (Rb) have impaired orbital development. METHODS: A retrospective case series was performed among children with Rb treated at a single medical center from 2004 to 2020. Orbital volumes and measurements were assessed by 3-dimensional image processing software. The main outcome measures were differences in orbital growth between Rb and non-Rb eyes assessed at last follow-up. RESULTS: Among 44 patients included (mean age 16.09 ± 18.01 months), a positive correlation between age and orbital volume was observed only in the uninvolved, healthy eyes (p = .03). In unilateral cases, orbital growth in the horizontal, vertical, and depth planes was smaller on the affected side compared to the healthy eyes (p < .05). Orbits that underwent enucleation showed decreased growth over time compared to those treated conservatively (p = .017). CONCLUSIONS: Orbital growth rate is slower in the orbits of children treated for Rb compared to healthy orbits. Enucleation negatively affects orbital growth.

Orbital development as a function of age in indigenous North American skeletons.

PURPOSE: Infants with orbital hemangiomas and vascular malformations often develop expanded orbits or regional hyperostosis. Treatment in these cases depends, in part, on the stage of orbital development at the time of intervention; yet, orbital development with respect to age is not well-known. The authors sought to determine the rate of orbital development and the age of orbital maturation in a single ethnic population. METHODS: Skeletons recovered in North America and housed at the Peabody Museum of Archaeology and Ethnology, Harvard University, were inspected. The age of specimen was determined by dentition. Orbital volume was measured using 1-mm glass beads and a graduated cylinder. Linear measurements were taken with calipers and paper rulers. The measurements were plotted against age, and statistical analysis was performed. Relevant literature was reviewed. RESULTS: Of the hundreds of skeletons examined, 42 were sufficiently intact for orbital measurement. The specimens represented a period of up to 1000 years. Thirty-two were pediatric (defined prenatal to 18 years) and 10 were adults. Mean adult orbital volume was 26.2 ml. Based on the regression analysis, 60% of adult orbital volume was achieved at 4.35 years, 75% at 9.36 years, and 90% at 17.13 years of age. Linear dimensions progressively increased with age. CONCLUSIONS: This largest direct-measure study of pediatric orbital volume suggests that orbital growth continually decelerates from birth until maturity at 22 years. With 50% of orbital growth occurring by 16 months of age, surgeons removing periocular vascular anomalies after that age should consider concurrent skeletal management.

Age-related changes in the pediatric human orbit on CT.

PURPOSE: The purpose of this study was to characterize the relationships among orbital dimensions, globe diameter, and subject age. METHODS: A cross-sectional, retrospective analysis of 124 CT scans of subjects with no appreciable orbital or globe disease was performed by 1 observer (G.K.E.). Seventeen length measurements and 5 angle measurements of various aspects of the orbit were obtained. Subjects of similar age were grouped and analysis was performed to define the changes in these parameters in association with age. RESULTS: One hundred twenty-four CT scans of 124 subjects without identifiable globe or orbital disease were included in this study. Twenty-one subjects ≥ 17 years of age were considered mature adults and grouped together, while the remaining 106 subjects were grouped according to age. Intraobserver variability between orbital measurements was excellent, r > 0.95 (p ≤ 0.01) for most measurements. There was no difference between right and left orbital measurements, as each was highly correlated to its contralateral counterpart. Globe diameter and all length measurements except globe protrusion increased most rapidly over the first 12 to 24 months and reached 86% to 96% of their respective adult means by age 8 years. Globe diameter and linear orbital measurements were highly correlated. Globe protrusion and measurements of orbital angles exhibited a different pattern. CONCLUSIONS: The pattern of human orbital growth is strongly correlated with the pattern of ipsilateral globe growth. This change is most rapid during the first 12 to 24 months of life and maintains a significant pace until reaching 86% to 96% of adult values for most parameters at age 8 years. After this age, the rate slows considerably until maturity. With this attempt to define normal age-related orbital change, the authors report a pattern of growth which may be clinically applicable in the management of pediatric anophthalmos.

Long follow-up of cranofacial cleft treated by the folded vascularized calvarial bone.

Craniofacial clefts are relatively rare. Tessier proposed a classification of craniofacial clefts. A Tessier no. 10 cranial facial defect is very rare. There are few reports regarding the reconstruction of the orbital rim and roof of a Tessier number 10 cleft. In this paper, we present the reconstruction of the orbital rim and roof by a folded vascularized calvarial bone and the long-term follow-up results.

[Give attention to standardized management of orbital development in Chinese with microphthalmos or anophthalmos].

Congenital and acquired microphthalmos or anophthalmos are common ocular disorders that cause facial disfigurement in children. It is important to have timely and reasonable treatment to promote orbital growth. At present status, many patients miss the optimum opportunity for orbital reconstruction because of non-standardized management in China. The correct management for promoting orbital growth in microphthalmos or anophthalmos is thus elaborated. Conformers with progressively increasing size can be used in children at 1-3 years of age; while orbital implants could be used after 3-5 years of age. Rational and regular evaluation of the efficacy is critical for guiding the treatment process.

Abnormal orbital growth in children submitted to enucleation for retinoblastoma treatment.

Enucleation is typically performed for the treatment of advanced retinoblastoma in children. After enucleation, the orbit undergoes abnormal development. In this study, orbital asymmetry was calculated using computed tomography measurements obtained from patients who experienced enucleation for unilateral retinoblastoma. Influence factors analyzed included: type of treatment, use of orbital implants, and patient's age at diagnosis. A total of 42 children underwent enucleation with a mean follow-up period of 4.8 years. For 28 patients, treatment included enucleation alone, 14 patients received enucleation plus radiation therapy. Thirty patients kept orbital implants long term. The mean orbital volume asymmetry for treated versus contralateral orbits was 16.8%. Mean asymmetry in orbital volume was greater for patients who underwent enucleation combined to radiation therapy (23.7% vs. 13.3%, P=0.05) and for patients without long-term maintenance of the prosthetic implants (29.3% vs. 11.8%, P<0.01). In conclusion, orbital volume is abnormally affected in children after enucleation of 1 eye for the treatment of retinoblastoma, and computed tomography can precisely quantify the asymmetry that develops. Orbital implants improve volumetric growth after enucleation, with 2-fold greater orbital asymmetry achieved without an implant.

The Sarnat studies in craniofacial biology.

Dr. Bernard Sarnat is one of plastic surgery's greatest laboratory investigators. His contributions to our understanding of modern craniofacial molecular biology are immense. His landmark studies continue to influence the way we approach and treat patients today. This article outlines his classic investigations of the craniofacial skeleton, with particular interest in lower face, midface, and upper face development; cranial suture and cranial base biology; and tooth and dental development. In this article, a brief summary of Dr. Sarnat's investigations are followed by how these data have had an important clinical impact.

Pediatric orbital fractures.

The clinical presentation and management of pediatric orbital fractures have many unique features that differentiate them from orbital injuries encountered in the adult population. An understanding of the particular anatomic and mechanical properties of pediatric orbital bone and soft tissue helps to explain most of these differences. This article reviews the epidemiology, anatomy, growth implications, pathomechanics, particular clinical features, assessment, and surgical management of pediatric orbital fractures.