A Three-Dimensional-Based Morphometric Analysis of a Standardized Overcorrection Technique for Fronto-Orbital Advancement in Metopic Craniosynostosis

2021 ◽  
pp. 105566562110628
Author(s):  
Miles J. Pfaff ◽  
Madeleine K. Bruce ◽  
Sarah Erpenbeck ◽  
Aditya Mittal ◽  
Justin W. Beiriger ◽  
...  
Keyword(s):  
Morphometric Analysis ◽  
Three Dimensional ◽  
Ct Scans ◽  
Computed Tomographic ◽  
Metopic Synostosis ◽  
Long Term Follow Up ◽  
Z Scores ◽  
3D Photogrammetry ◽  
Age And Sex

Introduction The concept of “overcorrection” for trigonocephaly has been reported to achieve both anterior cranial fossa expansion and normalization of craniofacial form. The purpose of this study is to describe in detail a standardized technique to fronto-orbital advancement utilizing the concept of “overcorrection” and objectively evaluate intermediate results. Methods This retrospective study included patients with isolated metopic synostosis who underwent surgery via the proposed surgical technique and age and sex-matched unaffected controls. Craniofacial morphometric analysis was performed on pre-, immediate post-, and intermediate postoperative (>2 years) three-dimensional (3D)-rendered computed tomographic (CT) scans and photographs. Key CT-based measurements included interzygomaticofrontal suture distance (IZFS), endocranial bifrontal angle (ECA), and temporal expansion. 3D photogrammetry was performed using established measurements and associated Z-scores converted. A Paired t-test and analysis of variance were performed when appropriate. Results Forty-one patients were included. A comparison of pre- and immediate postoperative CT scans demonstrated statistically significant increases in all measurements. Subset analysis of 12 patients with intermediate follow-up (age: 39.6 ± 3.6 months) demonstrated significant differences from preoperative values except for IZFS, which decreased from immediate postoperative values and was smaller than age- and sex-matched controls. 3D photogrammetry demonstrated a mean Z-score above the norm for frontal breath. 3D photogrammetry is also positively correlated with CT-based measurements. Conclusions This standardized “overcorrection” approach for trigonocephaly can provide the appropriate changes to maintain a normal ECA despite a reduction in bifrontal width over time. 3D photogrammetry positively correlated with CT-based measurements and may provide useful information when following patients clinically. Long-term follow-up assessment to determine the necessary degree of overcorrection at skeletal mature is needed.

Evaluation of the Child with Asymptomatic Proteinuria

1984 ◽  
Vol 5 (8) ◽  
pp. 248-254
Author(s):  
Leonard G. Feld ◽  
Morris J. Schoeneman ◽  
Frederick J. Kaskel
Keyword(s):  
Routine Examination ◽  
End Stage Renal Failure ◽  
Persistent Proteinuria ◽  
Orthostatic Proteinuria ◽  
Long Term Follow Up ◽  
End Stage ◽  
Age And Sex ◽  
Asymptomatic Proteinuria

Asymptomatic proteinuria is defined as the discovery of proteinuria on a routine examination without evidence of clinical disease. The prevalence is dependent on the age and sex of the child, as well as the circumstances under which the testing is performed. In the majority of cases, patients have transient or orthostatic proteinuria. The physician can assure the patient and parents that the prognosis is excellent. However, appropriate long-term follow-up is essential. On the other hand, persistent proteinuria represents a spectrum from a benign disorder to a disease which can progress to end-stage renal failure.

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

2016 ◽  
Vol 18 (3) ◽  
pp. 275-280 ◽  
Author(s):  
Joanna Y. Wang ◽  
Amir H. Dorafshar ◽  
Ann Liu ◽  
Mari L. Groves ◽  
Edward S. Ahn
Keyword(s):  
Quantitative Assessment ◽  
Surgical Repair ◽  
Preoperative Evaluation ◽  
Ct Scans ◽  
Control Group ◽  
3D Reconstructions ◽  
Metopic Synostosis ◽  
The Mean ◽  
Age Range ◽  
Age And Sex

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.

scholarly journals Interdisciplinary management of an impacted dilacerated maxillary central incisor

2018 ◽  
Vol 23 (3) ◽  
pp. 37-46
Author(s):  
Harpreet Singh ◽  
Pranav Kapoor ◽  
Poonam Sharma ◽  
Pooja Dudeja ◽  
Raj Kumar Maurya ◽  
...  
Keyword(s):  
Interdisciplinary Approach ◽  
Longitudinal Axis ◽  
Interdisciplinary Management ◽  
Central Incisor ◽  
Maxillary Central Incisor ◽  
Computed Tomographic ◽  
Long Term Follow Up ◽  
Root Treatment

ABSTRACT Introduction: Tooth dilacerations are dental anomalies characterized by an abrupt deviation in the longitudinal axis of a tooth. They may occur either in the crown, between the crown and root, or in the root. Although not so common, impacted maxillary incisors exhibiting root dilaceration pose a diagnostic and treatment challenge to the clinician. Description: This case report describes the management of a horizontally impacted and dilacerated maxillary central incisor in a 12-year-old girl. Cone-beam computed tomographic scans were used to accurately localize the position of the dilacerated tooth, and to assess the extent of root formation and degree of dilaceration present in the root. Treatment included surgical exposure and orthodontic traction, followed by root canal treatment and apicoectomy. Results: Through a meticulously planned interdisciplinary approach, the impacted dilacerated central incisor was properly aligned and demonstrated good stability after the long-term follow-up. Conclusion: Taking into consideration the concerns and expectations of the patient, communicative feedback between the oral surgeon, orthodontist and endodontist helped achieving successful esthetic, structural and functional outcome in the present case.

scholarly journals Pediatric Mandibular Resection and Reconstruction: Long-Term Results with Autogenous Rib Grafts

2010 ◽  
Vol 3 (1) ◽  
pp. 25-32 ◽  
Author(s):  
André M. Eckardt ◽  
Enno-Ludwig Barth ◽  
Johannes Berten ◽  
Nils-Claudius Gellrich
Keyword(s):  
Tumor Resection ◽  
Three Dimensional ◽  
Bone Defects ◽  
Long Term Results ◽  
Benign Tumors ◽  
Tumor Surgery ◽  
Bone Augmentation ◽  
Facial Skeleton ◽  
Computed Tomographic

Reconstruction of mandibular defects following tumor resection in infants is a particular challenge. Although autogenous rib grafts have no relevance in the restoration of mandibular bone defects occurring after ablative tumor surgery due to limited bone stock and the availability of other donor areas, they are a useful surgical alternative following tumor surgery in infants. We here report on a 2, 5, 8, and 15-year follow-up of four children who were diagnosed with benign tumors of the mandible with osseous destruction at the age of 4, 6, 15, and 18 months, respectively. Histologic diagnoses were melanotic neuroectodermal tumor ( n=2), hemangioendothelioma of the mandible ( n=1), and ameloblastoma ( n=1). Following continuity resection of the mandible, lateromandibular bone defects were restored using autogenous rib grafts. Both clinical and radiologic follow-up visits were performed for all children to assess growth of the facial skeleton and the mandible. One child was already further reconstructed using bone augmentation at the age of 15 years. Cephalometric measurements on panorex films and three-dimensional computed tomographic scans revealed a slight vertical growth excess and transversal growth inhibition of the reconstructed mandible compared with the nonoperated side. Although further growth of rib grafts is difficult to predict and occlusal disharmony may occur due to physiologic maxillary growth and growth of the unaffected mandible, we believe that autogenous rib grafts can be ideally used for the restoration of mandibular continuity defects in newborns and young children. Clinical follow-up visits on a yearly basis and orthodontic controls are useful for early orthodontic treatment of growth deficits. Further corrective surgery with bone augmentation or osseous distraction is required following completion of growth of the facial skeleton.

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