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1.
Am J Orthod Dentofacial Orthop ; 157(2): 194-204, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32005471

RESUMO

INTRODUCTION: This study aimed to compare the effects of a novel magnetic palatal expansion appliance (MPEA) during the expansion and maintenance period with that of a screw expansion appliance. METHODS: Based on previous research, the MPEA had a reactivation system that was modified for a broader working range and more stable expansion. Thirty-six male beagle dogs were assigned to a magnetic expansion (ME; n = 12), screwed expansion (SE; n = 12) or control (n = 12) group. Half of the dogs from each group were evaluated only during 5 weeks of activation, whereas the rest were evaluated for 5 weeks of activation and 8 additional weeks of retention. Nonmagnetic metal marking implants were implanted on both sides of the midpalatal suture of all dogs. Three-dimensional assessment of treatment and posttreatment dental and skeletal effects were conducted using cone-beam computed tomography. The width of the midpalatal suture, mineralization and deposition rate of bone, and fluorescence integral optical density were calculated during the expansion and retention periods using tetracycline fluorescence labeling. RESULTS: There were increases in the value of all cone-beam computed tomography parameters in the SE and ME groups during the expansion period, and the increase was significantly greater than that of the control group (P <0.01). However, there was no significant difference in the values of any parameters during the retention period. The width of the midline sutures, mineralization and deposition rate of bone, and integral optical density in the 2 experimental groups were significantly higher than those of the control group (P <0.01), and there was no significant difference between the SE and ME groups. After the retention period, the values of all tetracycline fluorescence evaluation parameters of the experimental groups decreased significantly. CONCLUSIONS: The novel MPEA with a reactivation system was able to expand the midpalatal suture effectively. Dental and skeletal expansion effects are similar to those of the screw expansion appliance. Wearing the appliance as a retainer can effectively maintain the expansion effect. The new bone formation rate was accelerated during the expansion process and decreased to normal levels during the retention period.


Assuntos
Fenômenos Magnéticos , Técnica de Expansão Palatina , Animais , Tomografia Computadorizada de Feixe Cônico , Suturas Cranianas , Cães , Masculino , Maxila , Palato , Dente
2.
Int. j. morphol ; 38(1): 69-73, Feb. 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1056399

RESUMO

Wormian (sutural) bones are accessory small bones located on the skull. These bones consist of extra ossification centers around cranial sutures. This study was carried out in 28 dry human skulls with unknown age and sex in the Department of Anatomy, Cukurova University. The aim of the study was to investigate incidence and to determine morphologic and morphometric characteristics of wormian (sutural) bones. Total incidence of wormian bone presence was 42.86 % (n=12) and most of them were located on lambdoid suture (57.14 %). Wormian bones were seen at lambdoid suture at a rate of 62.5 %, occipito-mastoid suture 9.37 %, asterion 18.76 %, lambda 9.37 %, and were not seen on pterion, bregma, parietotemporal, sagittal and coronal sutures. Wormian bones were seen on left side at a rate of 65.62 % and 34.38 % on right side of skull. According to our study, wormian bone shapes were seen as quadrangular (56.26 %), triangular (15.62 %) and irregular (28.12 %). The mean values of wormian bones were as follows; vertical diameter: 12.29±4.48 mm and horizontal diameter: 10.93±4.39 mm. For cephalic index, the result of our study shows that most of our skulls with or without wormian bones belong to dolichocephalic group. Knowledge of variations and characteristics of skull is important for forensic medicine, anatomy, radiology and neurosurgery fields and for literature data or clinical practices.


Los huesos wormianos o huesos suturales, son pequeños huesos accesorios ubicados en el cráneo. Estos huesos consisten en centros de osificación adicionales alrededor de las suturas craneales. Este estudio se realizó en 28 cráneos humanos secos con edad y sexo desconocidos en el Departamento de Anatomía de la Universidad de Cukurova. El objetivo del estudio fue investigar la incidencia y determinar las características morfológicas y morfométricas de los huesos wormianos. La incidencia total de presencia de hueso wormiano fue del 42,86 % (n = 12) y la mayoría de estos se localizó en sutura lambdoidea (57,14 %). Los huesos wormianos se observaron en la sutura lambdoidea a una tasa del 62,5 %, sutura occipito-mastoidea 9,37 %, asterion 18,76 %, lambda 9,37 %, y no se observaron en suturas pterion, bregma, parietotemporal, sagital y coronal. Los huesos wormianos se observaron en el lado izquierdo a una tasa del 65,62 % y del 34,38 % en el lado derecho del cráneo. Según nuestro estudio, las formas óseas se consideraron cuadrangulares (56,26 %), triangulares (15,62 %) e irregulares (28,12 %). Los valores medios de los huesos wormianos fueron los siguientes; diámetro vertical: 12,29 ± 4,48 mm y diámetro horizontal: 10,93 ± 4,39 mm. Referente al índice cefálico, el resultado de nuestro estudio muestra que la mayoría los cráneos con o sin huesos wormianos pertenecen al grupo dolicocefálico. El conocimiento de las variaciones y características del cráneo es importante para la medicina forense, la anatomía, la radiología y los campos de neurocirugía, como asimismo para los datos de la literatura o las prácticas clínicas.


Assuntos
Humanos , Suturas Cranianas/anatomia & histologia
4.
Forensic Sci Int ; 307: 110111, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31901460

RESUMO

Cranial suture closure has been recognized for over a century as a useful trait for age estimation. Although this indicator has become a standard feature of age assessment protocols in skeletal remains, serious questions have been raised about its reliability. This article attempts to provide a comprehensive review of cranial suture closure as an age indicator from several perspectives, including its anatomy and history, as well as issues relating to validation, statistics, and the potential of technological advancements to improve outcomes. We further suggest a path forward for the use of cranial suture closure as an estimator of age. Although its unreliability has been widely reported, cranial suture closure still appears to have value as an aging method, and it is hoped that the information contained in this article can serve as a stepping stone toward more effective use of this indicator. The cranium is often more durable than other skeletal elements in both archaeological and forensic circumstances, so maximizing the effectiveness of cranial indicators is an important goal. It is hoped that recent advancements in technology and in analytical approaches to the cranial sutures could breathe some new life into this feature as an indicator of age.


Assuntos
Determinação da Idade pelo Esqueleto/métodos , Suturas Cranianas/crescimento & desenvolvimento , Suturas Cranianas/diagnóstico por imagem , Antropologia Forense/métodos , História do Século XX , História do Século XXI , Humanos , Osteogênese , Estatística como Assunto , Tomografia Computadorizada por Raios X
5.
Plast Reconstr Surg ; 145(2): 493-503, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985646

RESUMO

BACKGROUND: Secondary fusion of initially patent cranial sutures after primary correction of nonsyndromic craniosynostosis is rarely reported. This study's aim is to report the incidence and analyze whether there are variables that may predispose to such fusion. METHODS: A single-institution, retrospective, case-control study was conducted of all nonsyndromic patients who underwent operative treatment for craniosynostosis from April of 2008 to May of 2017. Patients with less than 1 year of follow-up and/or without a 1-year postoperative computed tomographic scan were excluded. Preoperative, intraoperative, and postoperative variables were analyzed using univariate and multivariate analyses. RESULTS: Sixty-six patients were included in the study, with a mean 2.57-year postoperative follow-up. Six patients (8.8 percent) were found to have secondary craniosynostosis, all of whom had fusion of sutures that were initially patent and refusion of the primary pathologic suture(s). Fifty percent of secondary fusions presented as pansynostosis. On univariate analysis, suturectomy with barrel staving (p < 0.01) was significantly associated with secondary suture fusion. On multivariate analysis, bilambdoid suture involvement (p = 0.03) and suturectomy with barrel staving (p = 0.01) were significantly associated with secondary suture fusion. CONCLUSIONS: Secondary cranial suture fusion may be a relatively common complication after primary craniosynostosis correction. Suturectomy with barrel staving was independently associated with secondary craniosynostosis. Wide surgical separation of the dura from the cranium and osteotomies across patent sutures may predispose to secondary craniosynostosis. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.


Assuntos
Suturas Cranianas/cirurgia , Craniossinostoses/cirurgia , Estudos de Casos e Controles , Pré-Escolar , Craniossinostoses/diagnóstico , Feminino , Humanos , Lactente , Masculino , Recidiva , Reoperação , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Tomografia Computadorizada por Raios X , Resultado do Tratamento
6.
Cell Prolif ; 53(1): e12697, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31713930

RESUMO

OBJECTIVES: miR-21 can promote osteoblast differentiation of periodontal ligament stem cells. However, the effect of miR-21 on bone remodelling in the midpalatal suture is unclear. This study aimed to elucidate the effects of miR-21 on the midpalatal suture bone remodelling by expanding the palatal sutures. MATERIALS AND METHODS: miR-21 deficient (miR-21-/- ) and wild-type (WT) mice were used to establish animal models by expanding the palatal sutures. Micro-CT, haematoxylin-eosin (HE) staining, tartrate-resistant acid phosphatase (TRAP) staining, fluorescence labelling and immunohistochemistry were used to investigate the function of miR-21 in midpalatal suture bone remodelling. Besides, bone mesenchymal stem cells (BMSCs) derived from both miR-21-/- and WT mice were cultured. The MTT, CCK8, EdU analysis, transwell and wound healing test were used to assess the effects of miR-21 on the characteristics of cells. RESULTS: The expression of ALP was suppressed in miR-21-/- mice after expansion except 28 days. The expression of Ocn in WT mice was much higher than that of miR-21-/-  mice. Besides, with mechanical force, miR-21 deficiency downregulated the expression of Opg, upregulated the expression of Rankl, and induced more osteoclasts as TRAP staining showed. After injecting agomir-21  to miR-21-/- mice, the expression of Alp, Ocn and Opg/Rankl were rescued. In vitro, the experiments suggested that miR-21 deficiency reduced proliferation and migration ability of BMSCs. CONCLUSIONS: The results showed that miR-21 deficiency reduced the rate of bone formation and prolonged the process of bone formation. miR-21 regulated the bone resorption and osteoclastogenesis by affecting the cell abilities of proliferation and migration.


Assuntos
Células da Medula Óssea/metabolismo , Remodelação Óssea , Suturas Cranianas/metabolismo , Células-Tronco Mesenquimais/metabolismo , MicroRNAs/metabolismo , Palato/metabolismo , Estresse Mecânico , Animais , Células da Medula Óssea/citologia , Diferenciação Celular , Proliferação de Células , Suturas Cranianas/citologia , Regulação da Expressão Gênica , Células-Tronco Mesenquimais/citologia , Camundongos , Camundongos Knockout , MicroRNAs/genética , Osteoprotegerina/biossíntese , Osteoprotegerina/genética , Palato/citologia , Ligante RANK/biossíntese , Ligante RANK/genética , Fosfatase Ácida Resistente a Tartarato/biossíntese , Fosfatase Ácida Resistente a Tartarato/genética
7.
J Craniomaxillofac Surg ; 47(12): 1891-1897, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31812312

RESUMO

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


Assuntos
Craniossinostoses/cirurgia , Craniotomia/métodos , Criança , Pré-Escolar , Suturas Cranianas , Feminino , Cabeça , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
8.
Cuad. Hosp. Clín ; 60(2): 16-21, dic. 2019. ilus.
Artigo em Espanhol | LILACS, LIBOCS | ID: biblio-1046710

RESUMO

INTRODUCCIÓN: la importancia de conocer las diferentes reparaciones anatómicas que involucran la parte ósea de la fosa posterior con estructuras neurovasculares, disminuye la incidencia de complicaciones relacionadas con su acceso dentro del procedimiento neuroquirúrgico. MATERIALES Y MÉTODOS: estudio descriptivo basado en la evaluación de 90 hemicráneas secas, del Museo de Anatomía de la Universidad Mayor de San Andrés. RESULTADOS: la prevalencia de asterión tipo I fue de 28.9%, mientras que la de tipo II fue de 71.1%. La prevalencia del número de venas emisarias fue: una vena 54.4%, dos venas 42.2% y tres venas 3.3%. Los promedios para las características morfométricas son los siguientes: de Asterion a protuberancia occipital externa de 68.8 mm, de Asterion a cresta suprameatal de 50.1 mm, de Asterion a vena emisaria de 54.1 mm, de Asterion a Vértice del proceso mastoideo de 54.1 mm y de asterion a plano horizontal de Francfort 14.6 mm. La ubicación del asterión en el seno transverso fue la siguiente: al mismo nivel del seno, 47.8% de los casos, en el codo en 13.3%, superior al seno 31.1% e inferior a este en el 7.8%. CONCLUSIONES: hay una diferencia en algunos resultados morfométricos del asterión con respecto a otros autores, lo que podría determinar una configuración craneal diferente para nuestra población. Esto debe considerarse para evitar complicaciones durante el período transoperatorio en una cirugía de fosa posterior. Estos resultados reflejan la necesidad de realizar un estudio con una población más grande para obtener resultados reales, estableciendo así parámetros de corte que nos permitirán tener nuestra propia bibliografía sobre cómo proceder en nuestra actividad quirúrgica.


INTRODUCTION: the importance of knowing the different anatomical repairs that involve the bony part of the posterior fossa with neurovascular structures, decreases the incidence of complications related to its access within the neurosurgical procedure. MATERIALS AND METHODS: descriptive study based on the evaluation of 90 dry hemicranial, from the Anatomy Museum of the Universidad Mayor de San Andrés. RESULTS: the prevalence of asterion type I was 28.9%, while that of type II was 71.1%. The prevalence of the number of emissary veins was: One vein 54.4%, Two veins 42.2% and Three veins 3.3%. The averages for morphometric characteristics are as follows: from Asterion to external occipital protuberance 68.8 mm, from Asterion to suprameatal crest 50.1 mm, from Asterion to emissary vein 54.1 mm, from Asterion to Vertex from the mastoid process 54.1 mm and from asterion to horizontal plane of Frankfurt 14.6 mm. The location of asterion in the transverse sinus was the following: at the same level of the sinus 47.8% of the cases, in the elbow in 13.3%, superior to the sinus 31.1% and inferior to this in the 7.8%. CONCLUSIONS: there is a difference in some morphometric results of the asterion with respect to other authors, which could determine a different cranial configuration for our population. This should be considered to avoid complications during the transoperative period in a posterior fossa surgery. These results reflect the need to carry out a study with a larger population, in order to have real results, thus establishing cutting parameters that will allow us to have our own bibliography on how to proceed in our surgical activity.


Assuntos
Humanos , Cefalometria , Suturas Cranianas/anatomia & histologia , Processo Mastoide/anatomia & histologia
11.
J Craniofac Surg ; 30(8): e753-e755, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31689738

RESUMO

BACKGROUND: Asterion is identified as the connection point of sutura parietomastoidea, sutura occipitomastoidea, and sutura lambdoidea. The location of asterion, which is primarily preferred as a landmark during posterolateral surgical approach for intracranial operations, shows many variables. The aim of this study was to identify the surface location of the asterion and determine the distances between intracranial anatomical structures and asterion. METHODS: At this present study, 11 hemicraniums (22 asterion points), situated at the laboratory of Department of Anatomy, Faculty of Medicine, Bursa Uludag University, were used. The asterion points which the sesamoid bone located were classified as type I and the ones which sesamoid bone did not locate were classified as type II. According to the proximity of asterion with sinus transversus, 3 groups were classified. About 19 parameters were measured related to asterion. The obtained data were analyzed in SPSS 22. RESULTS: As a result of findings, while sesamoid bone was seen at 7 asterion points (type I), at 15 points sesamoid bone was not detected (type II) (respectively, 31.81%, 68.19%). It was identified that 15 asterion points were at the surface, 5 ones were average 3.42 ±â€Š2.52 mm over, 2 ones average 3.21 ±â€Š2.26 mm below of the projection of sinus transversus. Statistically significance was not seen between the measurements taken from left and right sides. DISCUSSION AND CONCLUSION: Asterion is an important landmark for the retrosigmoid approaches. The surface and intracranial location of the asterion and proximity with dural sinuses are important for surgeons not to cause fatal subdural hematomas during the approaches using "Burr Hole" technic in neurochirurgie operations.


Assuntos
Suturas Cranianas , Humanos , Seios Paranasais/cirurgia
12.
J Craniofac Surg ; 30(8): 2640-2645, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31609958

RESUMO

INTRODUCTION: Over 500,000 bone grafting procedures are performed every year in the United States for neoplastic and traumatic lesions of the craniofacial skeleton, costing $585 million in medical care. Current bone grafting procedures are limited, and full-thickness critical-sized defects (CSDs) of the adult human skull thus pose a substantial reconstructive challenge for the craniofacial surgeon. Cell-based strategies have been shown to safely and efficaciously accelerate the rate of bone formation in CSDs in animals. The authors recently demonstrated that supraphysiological transplantation of macrophages seeded in pullalan-collagen composite hydrogels significantly accelerated wound healing in wild type and diabetic mice, an effect mediated in part by enhancing angiogenesis. In this study, the authors investigated the bone healing effects of macrophage transplantation into CSDs of mice. METHODS: CD1 athymic nude mice (60 days of age) were anesthetized, and unilateral full-thickness critical-sized (4 mm in diameter) cranial defects were created in the right parietal bone, avoiding cranial sutures. Macrophages were isolated from FVB-L2G mice and seeded onto hydroxyapatite-poly (lactic-co-glycolic acid) (HA-PLGA) scaffolds (1.0 × 10 cells per CSD). Scaffolds were incubated for 24 hours before they were placed into the CSDs. Macrophage survival was assessed using three-dimensional in vivo imaging system (3D IVIS)/micro-CT. Micro-CT at 0, 2, 4, 6, and 8 weeks was performed to evaluate gross bone formation, which was quantified using Adobe Photoshop. Microscopic evidence of bone regeneration was assessed at 8 weeks by histology. Bone formation and macrophage survival were compared at each time point using independent samples t tests. RESULTS: Transplantation of macrophages at supraphysiological concentration had no effect on the formation of bones in CSDs as assessed by either micro-CT data at any time point analyzed (all P > 0.05). These results were corroborated by histology. 3D IVIS/micro-CT demonstrated survival of macrophages through 8 weeks. CONCLUSION: Supraphysiologic delivery of macrophages to CSDs of mice had no effect on bone formation despite survival of transplanted macrophages through to 8 weeks posttransplantation. Further research into the physiological effects of macrophages on bone regeneration is needed to assess whether recapitulation of these conditions in macrophage-based therapy can promote the healing of large cranial defects.


Assuntos
Macrófagos/transplante , Animais , Regeneração Óssea/fisiologia , Colágeno , Suturas Cranianas , Diabetes Mellitus Experimental , Durapatita , Hidrogéis , Camundongos , Camundongos Nus , Osteogênese/fisiologia , Osso Parietal/fisiopatologia , Crânio/cirurgia , Tecidos Suporte , Microtomografia por Raio-X
13.
Prog Orthod ; 20(1): 38, 2019 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-31591660

RESUMO

BACKGROUND: The aim of this study was to evaluate the midpalatal suture maturation stages in adolescents and young adults using cone-beam computed tomography (CBCT). METHODS: The sample comprised 200 CBCT scans of individuals aged 10 to 25 years old (95 males and 105 females) divided into three groups, adolescents (n = 48), post-adolescents (n = 52), and young adults (n = 100). The Planmeca ProMax 3D software was used for the midpalatal suture maturation stage evaluation according to Angieleri's method, using cross-sectional axial slice. Two previously calibrated examiners analyzed the images and classified according to five different maturation stages. A, B, and C stages were considered with open midpalatal suture, and D and E were considered without open midpalatal suture. Association tests were performed using chi-square test also, and a binary logistic regression was evaluated (P < 0.05). RESULTS: The possibility to find open midpalatal suture in individuals of 10 to 15 years old was 70.8%, in subject aged 16 to 20 and 21 to 25 years old was 21.2% and 17%, respectively. Furthermore, this possibility in individuals older than 16 years was greater in males than in females. CONCLUSIONS: The possibility to find open midpalatal suture in post-adolescents and young adults is greater than the orthodontists considered years ago. Furthermore, men are more likely to find midpalatal suture opening. These implications might be considered by the orthodontists when maxillary expansion is required. Besides, the ossification of the middle palatal suture is very variable, and therefore, the use of CBCT might be recommended to clarify this possibility.


Assuntos
Tomografia Computadorizada de Feixe Cônico , Suturas Cranianas , Adolescente , Adulto , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Maxila , Técnica de Expansão Palatina , Suturas , Adulto Jovem
14.
Neurochirurgie ; 65(5): 228-231, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31586456

RESUMO

INTRODUCTION: The aim of this article was to provide an overview of ultrasound (US) techniques for the investigation of cranial sutures in infants. MATERIAL AND METHODS: We first describe a high-resolution sonography technique and its limitations. We then analyze the reliability, effectiveness and role of ultrasonography in routine practice using a PubMed literature review. RESULTS: Ten studies reported excellent correlations between ultrasonography and 3D-CT. Cranial US for the diagnosis of a closed suture had 100% sensitivity in 8 studies and 86-100% specificity before the age of 12 months. Negative findings mean imaging investigation can be stopped. If ultrasonography confirms diagnosis, neurosurgical consultation is required. Thus, 3D-CT can be postponed until appropriate before surgery. CONCLUSION: Cranial suture ultrasound is an effective and reliable technique for the diagnosis of craniosynostosis. It has many advantages: it is fast and non-irradiating, and no sedation is required. It should be used as first-line imaging in infants below the age of 8-12 months when craniosynostosis is clinically suspected.


Assuntos
Suturas Cranianas/diagnóstico por imagem , Craniossinostoses/diagnóstico por imagem , Ultrassonografia/métodos , Humanos , Imageamento Tridimensional , Lactente , Recém-Nascido , Reprodutibilidade dos Testes , Tomografia Computadorizada por Raios X
15.
J Craniofac Surg ; 30(8): 2593-2596, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31577650

RESUMO

OBJECTIVE: Severe hydrocephalic macrocephaly can cause significant morbidity in infants due to positioning difficulties, skin breakdown, and poor cosmesis. Many surgeons over the past decades have described a variety of surgical techniques of reduction cranioplasty. In this article, the authors describe a novel technique for skull reduction cranioplasty with modified bilateral Pi craniectomy. METHODS: Anterior coronal and posterior lambdoid bone cuts are performed to extend inferiorly toward the sqamous bone. Last bone cuts are made connecting the parasagittal burr holes bilaterally, thus isolating and de-roofing of the sagittal suture. Bilateral peninsular bone flaps are reduced medially aiming to approximate the upper borders of both flaps. Edges of frontal and occipital bone can be resected and shaved to achieve smooth round contour of the reconstruct. The final reconstruct can be fixated with metal meshes. RESULTS: In our technique, modified bilateral Pi craniectomy is simple and effective reduction cranioplasty technique, as the technique does not require bone graft resection and reconstruction of the grafts making the time of the surgery short with decreased possible complications. Also, the amount of bone resection, bone bending, and shaving of the bone edges can be controlled and adjusted during the. An important issue is that this technique avoids posterior skull reconstruction which is more risky, as many patients are bed ridden with secondary compressed and flat occiput. CONCLUSIONS: Modified bilateral Pi craniectomy is a simple and effective technique for cranial vault reduction, especially in flat-occiput cases. Good understanding of the structural abnormality and the pathophysiological mechanisms of the possible complications is very important for performing proper surgical reconstruction.


Assuntos
Craniotomia/métodos , Transplante Ósseo/métodos , Pré-Escolar , Suturas Cranianas/cirurgia , Humanos , Masculino , Procedimentos Cirúrgicos Reconstrutivos/métodos , Crânio/cirurgia , Retalhos Cirúrgicos/cirurgia , Telas Cirúrgicas , Resultado do Tratamento , Trepanação
16.
Neurochirurgie ; 65(5): 239-245, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31562880

RESUMO

The metopic suture (MS) is one of the main sutures of the calvaria; premature closure is responsible for trigonocephaly, while persistence (metopism) is considered a normal variant. The ages of onset and completion of MS closure and prevalence of metopism in normal children are poorly documented. We studied the pattern of MS closure on 3D-CT scans of 477 children admitted for head trauma since 2012. We also studied the prevalence of trigonocephaly and the sex ratio in our clinical series of patients with all types of synostosis diagnosed during the last 4 decades. In the majority of children, MS closure started at 4 months and was complete at 9 months. The prevalence of metopism was stable after 1 year of age, at 5.1%; it was more than twice as frequent in girls (F/M ratio 2.1, non-significant). Our trigonocephaly series and the literature show a steady increase in prevalence over recent decades. During the same period, the prevalence of metopism decreased steadily. Data from comparative anatomy and paleoanthropology suggest that postnatal MS persistence in our species results from the risk of dystocia caused by the closed pelvis associated with bipedalism. The increasing incidence of trigonocephaly appears to parallel the fall in prevalence of metopism. The increasing use of cesarean section may have eliminated a potent selection factor in favor of postnatal persistence of the MS.


Assuntos
Suturas Cranianas/anormalidades , Suturas Cranianas/cirurgia , Criança , Pré-Escolar , Suturas Cranianas/diagnóstico por imagem , Craniossinostoses/diagnóstico por imagem , Craniossinostoses/epidemiologia , Craniossinostoses/cirurgia , Feminino , Humanos , Imageamento Tridimensional , Lactente , Masculino , Gravidez , Prevalência , Tomografia Computadorizada por Raios X
17.
Neurochirurgie ; 65(5): 258-263, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31562881

RESUMO

INTRODUCTION: Some metabolic bone disorders may result in the premature closure of one or more calvarial sutures during childhood, potentially leading to a cranioencephalic disproportion. The aim of this paper is to review the characteristics and consequences of craniosynostosis associated with metabolic disorder. MATERIAL AND METHODS: A review of the literature on metabolic forms of craniosynostosis was performed. RESULTS: The most common forms of craniosynostosis associated with metabolic bone disorder were isolated sagittal suture fusion with or without scaphocephaly, and sagittal suture fusion associated with coronal suture fusion (oxycephaly) or also with lambdoid suture fusion (pansynostosis). Synostosis may be well-tolerated, but in some subjects results in neurodevelopmental and functional impairment that is sometimes severe. CONCLUSION: The impact of metabolic synostosis is very variable, depending on the specific underlying metabolic disease, with a large spectrum of morphological and functional consequences. Diagnosis should be early and management should be carried out by a multidisciplinary team with expertise in both rare skeletal disorders and craniosynostosis. The impact of emergent medical therapies recently developed for some of these diseases will be assessed by systematic coherent follow-up of international registries.


Assuntos
Doenças Ósseas Metabólicas/complicações , Doenças Ósseas Metabólicas/patologia , Craniossinostoses/etiologia , Craniossinostoses/patologia , Suturas Cranianas/patologia , Humanos , Minerais/metabolismo , Mucopolissacaridoses/complicações , Mucopolissacaridoses/patologia , Raquitismo/complicações
18.
Neurochirurgie ; 65(5): 232-238, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31563615

RESUMO

BACKGROUND: Scaphocephaly is usually defined as the deformation of the skull resulting from the premature fusion of the sagittal suture. It is the most common type of craniosynostosis, and can be easily recognized on simple clinical examination. Its pathophysiology is easy to understand and to confirm on neuroradiological examination. In contrast, surgical indications are still somewhat controversial, the dispute mainly concerning therapeutic versus esthetic objectives. In recent years, however, several studies have challenged these basic and relatively simplistic interpretations of the pathophysiology of the condition. MATERIALS AND METHODS: To assess the heterogeneity of scaphocephaly, we reviewed cases of scaphocephaly operated on at the Hôpital Femme-Mère-Enfant, Lyon University Hospital, France during a 10-year period (2008-2017) and performed a review of the literature on scaphocephaly and sagittal suture closure. RESULTS: During the 10-year period, 401 children were operated on for a scaphocephaly at the Hôpital Femme Mère Enfant, Lyon University Hospital. Mean age at surgery was 1.14 years, for a median 0.7 years (range, 4 months to 8. 5 years). Several subtypes could be distinguished according to morphology, intracranial findings on imaging, patient age, and etiology associated to the sagittal synostosis. Two main surgical techniques were used to correct the malformation, depending on patient age, type of deformation and the surgeon's preference: cranial vault remodeling with occipital pole widening, with the patient in a prone position, and parietal enlargement with or without forehead remodeling, in dorsal decubitus. CONCLUSIONS: The complexity and heterogeneous nature of sagittal synostoses depend on different pathogenic mechanisms leading to and interfering with the skull abnormalities: abnormalities of CSF dynamics, possibly associated with systemic alterations, accounting for the varied postoperative morphological and functional course, in terms of cognitive impairment and late complications (notably intra-cranial pressure elevation). However, the real impact of such heterogeneous clinical presentations on surgical indications and surgical results remains to be elucidated.


Assuntos
Suturas Cranianas/patologia , Suturas Cranianas/cirurgia , Craniossinostoses/patologia , Craniossinostoses/cirurgia , Fatores Etários , Criança , Pré-Escolar , Suturas Cranianas/diagnóstico por imagem , Craniossinostoses/diagnóstico por imagem , Progressão da Doença , Feminino , Testa/anormalidades , Testa/cirurgia , Humanos , Lactente , Hipertensão Intracraniana , Masculino , Osso Occipital/anormalidades , Osso Occipital/cirurgia , Posicionamento do Paciente , Crânio/anormalidades , Crânio/cirurgia
20.
J Orofac Orthop ; 80(5): 266-273, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31420685

RESUMO

PURPOSE: Spheno-occipital synchondrosis (SOS) plays a significant role in the anterior growth of the midface. Orthopaedic forces acting during rapid maxillary expansion (RME) are transferred to the skull base and thus could alter the morphology of SOS. The aim of this study was to assess the influence of experimental RME on the rats' SOS by means of micro-computed tomography (micro-CT). METHODS: In all, 40 male 8­week-old Wistar rats were enrolled into the study, among which 30 underwent experimental RME for 7, 14 and 21 days by means of custom designed spring-coil expander. Specimens were scanned by micro-CT and median palatal suture area, maxillary skeletal base and SOS width were analysed. RESULTS: Experimental RME resulted in a significant increase of the median palatal suture space and maxillary skeletal base which was particularly pronounced between day 14 and 21 of expansion. SOS width increased significantly during the first 7 days at the lowest point of the synchondrosis. However, the SOS width assessed at its highest point was temporarily even decreased between days 8 and 14 of therapy. CONCLUSIONS: Early SOS widening could be identified in the lowest part before median palatal suture opening. Similarly, narrowing of the SOS at its top was observed before the most significant median palatal suture expansion. Thus it can be hypothesized that changes within the SOS complex result from the transmission of the orthopaedic forces rather than from a displacement of the maxillary halves.


Assuntos
Suturas Cranianas , Técnica de Expansão Palatina , Animais , Masculino , Maxila , Ratos , Ratos Wistar , Microtomografia por Raio-X
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