Maturation of bone-conduction transcranial and forehead attenuation using a measure of sound pressure in the ear canal.

OBJECTIVE: Although it is understood that bone-conduction (BC) hearing is different between infants and adults, few studies have attempted to explain why these differences exist. The main objective in this study was to better understand how properties of the developing skull contribute to the maturation of BC sensitivity through an indirect measurement of BC attenuation across the skull. DESIGN: Estimation of transcranial and forehead attenuation of pure-tone BC stimuli was conducted using sound pressure in the ear canal for a transducer placed on the skull ipsi- and contralateral to the probe ear and at the forehead. STUDY SAMPLE: Seventy-six individuals participated in the study, including 59 infants and children (1 month-7 years) and 17 adults. RESULTS: BC attenuation was greatest for young infants, and decreased throughout maturation. Attenuation from the forehead to the ipsilateral temporal bone was also greater compared to the transcranial measures for infants and children older than 10 months. CONCLUSIONS: These results provide evidence that physical maturation of the skull contributes to infant-adult differences in BC attenuation. Clinicians may consider these results, in combination with previous studies using physiological measures, when fitting infants and young children with bone-anchored hearing systems.

Longitudinal study of cephalometric soft tissue profile traits between the ages of 6 and 18 years.

OBJECTIVE: To study the longitudinal changes in 19 soft tissue cephalometric traits (according to the Bergman cephalometric soft tissue facial analysis). MATERIALS AND METHODS: Cephalograms and photographs of 40 subjects (20 male, 20 female, from the Burlington Growth Centre) that were obtained at ages 6, 9, 12, 14, 16, and 18 years were used. Subjects were orthodontically untreated whites and had Class I dentoskeletal relationships (ideal overjet and overbite). Images were obtained with the lips in a relaxed position or lightly touching. RESULTS: Three groups of soft tissue traits were identified: (1) traits that increased in size with growth (nasal projection, lower face height, chin projection, chin-throat length, upper and lower lip thickness, upper lip length, and lower lip-chin length); (2) traits that decreased in size with growth (interlabial gap and mandibular sulcus contour [only in females]); and (3) traits that remained relatively constant during growth (facial profile angle, nasolabial angle, lower face percentage, chin-throat/lower face height percentage, lower face-throat angle, upper incisor exposure, maxillary sulcus contour, and upper and lower lip protrusion). CONCLUSION: Current findings identify areas of growth and change in individuals with Class I skeletal and dental relationships with ideal overjet and overbite and should be considered during treatment planning of orthodontic and orthognathic patients.

Craniofacial features of children with celiac disease.

BACKGROUND AND GOALS: Growth retardation is one of the most important signs of childhood celiac disease (CD); however, it is not very well known whether craniofacial growth is also affected. We aimed to carry out a detailed craniofacial morphological study to derive a conclusion on the craniofacial features of children with CD. PARTICIPANTS AND METHODS: Eighty-four 2-16-year-old children with biopsy-proven CD and 84 age-matched and sex-matched healthy children were included. Of these, 37 children (44.0%) had been newly diagnosed and 47 (56.0%) were on a gluten-free diet. Anteroposterior and lateral photographs were evaluated using the Scion Image software program for the measurements of the distances between reference points on the face. RESULTS: Except for nasofrontal angle (nfa), nasolabial angle (nla), pronasale height (prnh), nasal dorsum height (ndh), and nasal radix height (nrh), all measurements were significantly greater in patients compared with controls. In celiac children, all facial proportions except forehead/face height (t-gl/t-gn) and nose length/face height (n-ns/t-gn) were significantly different from those of controls. Except for nla, prnh, ndh, nrh, t-gl/t-gn, face height to total face height ratio (sn-gn/t-gn), n-sn/t-gn, ear length to face height ratio (s-sba/t-gn), and face width to face height ratio (z-z/t-gn), all measurements were statistically different in those on a gluten-free diet and newly diagnosed children. CONCLUSION: Most of the facial measurements and proportions of celiac children were different from those of controls. Our data confirm those of a previous study reporting that the forehead proportion is not altered in childhood CD. Pathophysiological mechanisms underlying these alterations are not clear but disruptions of growth during certain critical periods may be responsible.

Evaluation of some facial anthropometric parameters in an Iranian population: infancy through adolescence.

OBJECTIVES: By finding the mean value of anthropometric parameters in normal samples of a population, it is possible to create a template for facial analysis. The aim of our study was to measure the anthropometric parameters in 0- to 12-year-old girls of Fars ethnic origin in the Northeast of Iran. STUDY DESIGN: Six hundred sixty-two newborn to 12-year-old girls of Fars ethnic origin participated in the study. A digital camera was used to take frontal full-face photographs of each child. Thirteen measurements were taken with the Smile Analyzer software: al-al, ch-ch, en-en, ex-ex, ft'-ft', go'-go', t-t, zy'-zy', n'-gn', n'-sn, t-g', t-gn', t-sn. Data were analyzed using the SPSS software at the significance level of 0.05. RESULTS: In almost all parameters, we found significant growth acceleration between 2 and 4 years as well as 5 and 6 years of age. Another growth spurt was seen between 9 and 11 years, although it was less noticeable. Comparing the linear regression equations suggests that different craniofacial dimensions do not grow similarly. CONCLUSIONS: By age, craniofacial dimensions change at different rates. Different craniofacial dimensions do not grow at consistent rates. Some parts grow slower compared with others. The intercanthal width has the slowest growth. Facial height shows the fastest growth.

New method for analysis of facial growth in a pediatric reconstructed mandible.

INTRODUCTION: The aim of this article was to present a new method of analysis for the assessment of facial growth and morphology after surgical resection of the mandible in a growing patient. METHODS: This was a 2-year longitudinal study of facial growth in a child who had undergone segmental resection of the mandible with immediate reconstruction as a treatment for juvenile aggressive fibromatosis. Three-dimensional digital stereo-photogrammteric cameras were used for image acquisition at several follow-up intervals: immediate, 6 months, and 2 years postresection. After processing and superimposition, shell-to-shell deviation maps were used for the analysis of the facial growth pattern and its deviation from normal growth. The changes were seen as mean surface changes and color maps. An average constructed female face from a previous study was used as a reference for a normal growth pattern. RESULTS: The patient showed significant growth during this period. Positive changes took place around the nose, lateral brow area, and lower lip and chin, whereas negative changes were evident at the lower lips and cheeks area. An increase in the vertical dimension of the face at the chin region was also seen prominently. CONCLUSIONS: Three-dimensional digital stereo-photogrammetry can be used as an objective, noninvasive method for quantifying and monitoring facial growth and its abnormalities.

Craniofacial growth in patients with FGFR3Pro250Arg mutation after fronto-orbital advancement in infancy.

BACKGROUND: The facial features of children with FGFR3Pro250Arg mutation (Muenke syndrome) differ from those with the other eponymous craniosynostotic disorders. We documented midfacial growth and position of the forehead after fronto-orbital advancement (FOA) in patients with the FGFR3 mutation. METHODS: We retrospectively reviewed all patients who had an FGFR3Pro250Arg mutation and craniosynostosis. Only patients who had FOA in infancy or early childhood were included. The clinical records were evaluated for type of sutural fusion; midfacial hypoplasia and other clinical data, including age at operation; type of procedures and fixation (wire vs resorbable plate); frequency of frontal readvancement, forehead augmentation, midfacial advancement; and complications. Preoperative and postoperative sagittal orbital-globe relationship was measured by direct anthropometry. Outcome of FOA was graded according to the Whittaker classification as category I, no revision; category II, minor revisions, that is, foreheadplasty; category III, alternative bony work; category IV; redo of initial procedure (ie, secondary FOA). Midfacial position was determined by clinical examination and lateral cephalometry. RESULTS: A total of 21 study patients with Muenke syndrome (8 males and 13 females) were analyzed. The types of craniosynostosis were bilateral coronal (n=15), of which 3 also had concurrent sagittal fusion, and unilateral coronal (n=5). Two patients had early endoscopic suturectomy, but later required FOA. Mean age at FOA was 22.9 months (range, 3-128 months). Secondary FOA was necessary in 40% of patients (n=8), and secondary foreheadplasty in 25% (n=5) of patients. No frontal revisions were needed in the remaining 35% of patients (n=7). Mean age at initial FOA was significantly younger in the group requiring repeat FOA or foreheadplasty compared with patients who did not require revision (P<0.05). Location of synostosis, type of fixation, and bone grafting did not significantly affect the need for revision. Only 30% (n=6) of patients developed midfacial retrusion. CONCLUSIONS: The frequency of frontal revision in patients with Muenke syndrome who had FOA in infancy and early childhood is lower than previously reported. Age at forehead advancement inversely correlated with the incidence of relapse and need for secondary frontal procedures. Midfacial retrusion is relatively uncommon in FGFR3Pro250Arg patients.

On the origin of bitemporal hollowing.

INTRODUCTION: Long-term results after cranioplasty for trigonocephaly often show bitemporal hollowing and a residual hypotelorism. Both findings fuel the perception that the growth of the periorbital region and the forehead as a whole continues to be restricted, even after correction. The aim of this study was to evaluate the growth process of the periorbital region after correction for trigonocephaly in the long term. MATERIALS AND METHODS: From 1972 to 2004, 184 patients underwent a cranioplasty for the correction of nonsyndromatic trigonocephaly. Cephalometric analysis was performed in 33 of these patients who had their radiographs taken on the same day as the photograph, at least 1 year postoperative and before the age of 6 years. Cephalic landmarks were used to analyze the growth of the forehead. Because of the lack of standardized cephalograms, growth ratios were used instead of absolute measurements. For visual analysis, normal anteroposterior photographs were used, which were taken on the same day as the radiograph. Two observers evaluated the anteroposterior photographs for the presence and level of temporal hollowing. A score of 0 (normal), 1 (moderate deformity), or 2 (severe deformity) was assigned to each of the photographs. RESULTS: A significant relation was found between a severe deformation seen at postoperative photographic evaluation and a lower growth ratio. The preoperative photo score was not of predicting value for the postoperative growth ratio and therefore, indirectly, for the postoperative photo score. The mean preoperative photo score dropped 5% after surgery. The age at operation had no influence on this postoperative photo score. The experience of the surgeon, however, was a significant contributing factor. CONCLUSIONS: Temporal hollowing seems to be of bony origin and can be explained by skeletal growth inhibition in the affected area. When present immediately after operation, they seem to persist through the years, which makes surgical skill another factor of importance.

Three-dimensional analysis of facial morphology surface changes in untreated children from 12 to 14 years of age.

INTRODUCTION: The developing face is of interest to orthodontists, especially if orthodontic treatment can influence the outcome of facial growth. New 3-dimensional (3D) modalities have enabled clinicians to better understand the facial changes in a developing child. METHODS: Fifty-nine children with normal body mass indexes were evaluated with a previously validated 3D laser imaging device over a 2-year period. Surface changes were evaluated on normal and average faces. These changes were seen as mean surface changes and color maps. RESULTS: The results suggest that the surface areas of change in average faces were generally downward and forward with respect to the nose and soft-tissue nasion. The lips also translated in a downward direction as the nose grew, and there was a general increase in the vertical dimension. Some subjects were in the "great changes" category, boys significantly more so than girls. CONCLUSIONS: The following conclusions can be made from this 3D study of changes of facial morphology in children: (1) surface changes are greater in boys than in girls; (2) differences in the timing of surface changes in boys and girls are clinically significant, with boys exhibiting more changes later; (3) positive surface changes occur in the nose, brows, lips, and vertical dimensions of the face; (4) the eyes deepen, and the cheeks become flatter; and (5) 3D imaging is a useful tool in analyzing changes to the face over time.

[Prenatal ultrasonic measurements of the eye and the interorbital distance]. / Mesures échographiques anténatales de l'oeil et de la distance interorbitaire.

OBJECTIVES: The two-fold objective of this study was to ascertain whether the antero-posterior diameter of the fetal eye is comparable to the transversal diameter and to establish nomograms based on the measurements obtained for ocular diameter (OD), mean interorbital distance (MIOD) and the MIOD/biparietal diameter (BPD) ratio related to gestational age. TYPE: A prospective monocentric study based on 398 sonographic fetal eye measurements. RESULTS: The antero-posterior and transverse ocular diameters of the fetal eye remain comparable throughout pregnancy (R = 0.997, p < 0.0001). They were related to gestational age and BPD. The MIOD/BDP ratio decreased with gestational age. The OD/BPD ratio remained nearly constant. Nomograms were established for OD, MIOD and the MIOD/BPD ratio related to gestational age. DISCUSSION AND CONCLUSION: The fetal eye can be measured on any diameter provided the sonographic scan for the measurement is flawless. Nomograms and values are given. Hyper- and hypotelorism and microphthalmia can be found in numerous malformative syndromes. Previously published tables are not well-suited to the French population.

Growth of the fetal forehead and normative dimensions developed by three-dimensional ultrasonographic technology.

Sonographic imaging of the fetal face is important since a number of chromosomal aberrations are associated with facial malformations. In the past, imaging of the fetal forehead and diagnosis of frontal bossing had been based on subjective evaluation using two-dimensional ultrasonography. The purpose of this study was to evaluate quantitatively the fetal forehead using three-dimensional technology to generate normative data throughout gestation. This should allow the objective diagnosis of abnormal growth of the fetal forehead, such as frontal bossing. We also report a case of a fetus with frontal bossing in whom the generated nomogram was applied. A cross-sectional study was performed in 130 normal healthy singleton pregnancies between 16 and 38 weeks' gestation. Using three-dimensional ultrasonography, a line connecting the apex of the philtrum and the nasion was drawn across the anterior forehead, which delineated the area of the forehead for analysis. The forehead length, forehead height, and forehead area under the curve were measured and the forehead index was calculated. A second order polynomial growth function was noted throughout gestation for the forehead length (r = 0.93), forehead height (r = 0.97), and forehead area (r = 0.97). The fetal forehead index remained relatively constant throughout gestation. The results of this study provide normative data of fetal forehead length, width, and area using three-dimensional ultrasonographic technology. Normative dimensions of the fetal forehead developed and presented herein are expected to serve as a basis for the objective assessment of presumed fetal facial abnormalities and may facilitate the detection of the associated syndromes. This is demonstrated in our case report of an achondroplastic fetus in whom all forehead dimensions were above the 95th percentile.

Anthropometric growth study of the head.

Five measurements of the head were taken between 1 year and 18 years of age in 1,537 North American Caucasians. By 1 year of age, the circumference (87.5%) and length (87.1%) of the head showed the highest levels of developmental level compared with their adult size. By 5 years, the developmental level of all measurements in head width, head length, and circumference increased, closely approaching maturation. Head length reached full maturation at 10 years in females (182.7 mm), and at 14 years in males (189.2 mm). In females, head width showed the most advanced maturation at 14 years (142.7 mm). In males, most of the head measurements matured at 15 years of age. Adult head height was approached at 13 years in both sexes (113.3 mm in males and 109.8 mm in females). Early rapid growth in head height and head length took place between 1 and 4 years of age, and between 1 and 6 years in forehead width. The head width and head circumference showed continuous but mild growth rates throughout this period.

Trigonocephaly: clinical and cephalometric assessment of craniofacial morphology in operated and nontreated patients.

Craniofacial parameters were studied clinically and by cephalometry in 11 trigonocephalic patients from infancy to 4 years of age. Six of the most severe patients had surgery between 6 and 18 months of age. Analysis of morphology indicated that bony interorbital distance was reduced in patients selected for surgery and hypotelorism persisted at final examination. All patients demonstrated orbital width measurements above the mean for the norm, while orbital height was essentially normal. All but one of the patients had a variably prominent forehead bony ridge that was eliminated or reduced as a result of surgery and/or growth. However, the forehead of most patients, whether operated or not, was too narrow when compared to normal skulls. Thus, although some of the striking features of trigonocephaly are eliminated, minor characteristics of the anomaly still persevere at 4 years of age.