The use of a single-piece bone flap for cranial reshaping in anterior craniosynostosis patients: clinical experience and a description of a novel technique

Background Craniosynostosis is known as premature closure of one or more of the cranial sutures. Anterior craniosynostosis involves anterior plagiocephaly and trigonocephaly. One of the issues in anterior craniosynostosis skull reshaping is maintaining an aesthetically pleasing forehead curve. Therefore, in this article, we demonstrate our novel technique to use a single-piece bone flap for cranial reshaping of the anterior mold in patients diagnosed with anterior craniosynostosis. A retrospective record review of patients who underwent single piece bone flap cranial reshaping for correction of unicoronal synostosis (UCS) and metopic synostosis (MS) at an Academic Institute in Riyadh, Saudi Arabia, between 2018 and 2020, was conducted. Results Six non-syndromic consecutive patients were included. Three of the patients had MS. The mean age at surgery was 11.16 months (range, 6–19 months). The average OR time was 315 min (range, 263–368 min). The average intraoperative blood loss was 225 ml (range, 100–400 ml). All patients had achieved acceptable functional and aesthetic results. Conclusion Our novel technique is an innovative and efficient reconstructive technique to simultaneously address MS and UCS and minimize intraoperative bleeding and surgery time. However, more studies with more cases are required.

Ten questions about intracranial epidural hematoma

Introduction: Intracranial epidural hematoma (EH) is considered a neurosurgical emergency. Its knowledgement has been increasingly prominent in literature. Methods: a literature review was performed on ten questions related to intracranial EH, such as age, sex, causes, location, imaging findings, neurological examination, lucid interval, hematoma size, treatment and prognosis. Conclusion: EH affects more young adult males. It does not cross the lines of cranial sutures. The lucid interval has been commonly described, however, it is not pathognomonic of EH, and may occur in other lesions of expanding mass. The computed tomography (CT) scan of the skull has been the exam of choice. The size influences prognosis and sequelae, when small and asymptomatic the treatment has been conservative and, if bulky, it requires surgical intervention. Early recognition and appropriate treatment for a good prognosis is of great importance.

Possibilities of the ultrasonography in the diagnosis of craniosynostosis in children of the first year of life

Craniosynostosis is a premature closure of the skull sutures, manifested by deformation of the head requiring surgical treatment. An instrumental examination of the state of the cranial sutures is necessary for the differential diagnosis of craniosynostosis and benign positional deformities of the skull in infants. Traditionally, radiation methods, such as X-ray and computed tomography with three-dimensional reconstruction, are used for this purpose. Over the past two decades, we have accumulated a large amount of data on the high information content of the ultrasound method in assessing the state of the cranial sutures in children. Ultrasound examination is widely available, easy to perform, reproducible; it does not require sedation of the patient and does not carry radiation exposure, which is especially important when examining young children. A negative result of the study makes it possible to exclude the diagnosis of craniosynostosis, while the detection of suture fusion serves as an indication for referring the child to visit a surgeon and further examination. The ultrasound method should be more widely used as a screening method for detecting head deformity and suspicion of craniosynostosis in children of the first year of life.

Study on Morphometric Features of Coronal Suture Along with it Absence and Craniosynostosis

Background: Cranial sutures are syndesmosis between the cranial bones. The coronal suture is oblique in direction and extends between the frontal and the parietal bones. Craniosynostosis is a rare birth defect that occurs when the coronal suture in the skull fuses prematurely, but the brain continues to grow and develop. This leads to a misshapen head. There are a number of forms of this defect, such as coronal, sagittal, lambdoid, and metopic. Materials and Methods: Total 500 skulls were used for study, coronal suture length measured by thread method, distance between Nasion to bregma and midsupraorbital rim to coronal suture were measured. For finding skull with absence of coronal, sagittal, lambdoid, and metopic suture, we examined many skulls during routine osteology classes of Medical, Dental and other medical sciences students. Around 500 skull observed and we find only one skull with absence of left coronal suture completely. Results: The length of coronal suture was 24.8+1.4cm length, the distance between nasion to bregma was 126.7 +10.25 mm and Midsupraorbital rim to cranial suture was 102.76+8.64mm We have found only one skull with absence of coronal suture. Some of the skulls shows partly fusion of sagittal, coronal sutures. The skull with complete absence of coronal suture showing the features of other sutures clearly and right side of coronal suture is showing the complete suture. The skull was not damaged and it is in perfect condition which was using by students for their osteology study. Conclusion: We found the skull with absence of left coronal suture, which may resulted due to craniosynostosis. It may be due to hot climate in India also might be resulted for absence of suture. KEY WORDS: Birth defect, Skull, Coronal suture, Craniosynostosis.

Case Report and Review of the Literature: Congenital Diaphragmatic Hernia and Craniosynostosis, a Coincidence or Common Cause?

Congenital diaphragmatic hernia (CDH) is a life-threatening birth defect that presents as either an isolated diaphragm defect or as part of a complex disorder with a wide array of anomalies (complex CDH). Some patients with complex CDH display distinct craniofacial anomalies such as craniofrontonasal dysplasia or craniosynostosis, defined by the premature closure of cranial sutures. Using clinical whole exome sequencing (WES), we found a BCL11B missense variant in a patient with a left-sided congenital diaphragmatic hernia as well as sagittal suture craniosynostosis. We applied targeted sequencing of BCL11B in patients with craniosynostosis or with a combination of craniosynostosis and CDH. This resulted in three additional BCL11B missense mutations in patients with craniosynostosis. The phenotype of the patient with both CDH as well as craniosynostosis was similar to the phenotype of previously reported patients with BCL11B missense mutations. Although these findings imply that both craniosynostosis as well as CDH may be associated with BCL11B mutations, further studies are required to establish whether BCL11B variants are causative mutations for both conditions or if our finding was coincidental.

Study of Sexual Dimorphism in the Closure of Sagittal Suture – A Postmortem Study

Background: Performing identity is a prime task in medicolegal and postmortem examinations. Age is the first parameter that has to be determined followed by sex. There are several techniques through which sex can be determined. As well there are different anatomical, physiological and pathological parameters determination of sex. Aim: To determine the sexual dimorphism in the cranial sagittal suture closure macroscopically. Methods: All the cases for this purpose had been selected from those brought for autopsy in the Department of Forensic Medicine and Toxicology, King Edward Medical University Lahore during the year 2016. Results: The statistical analysis revealed early closure in males than in females both ectocranially and endocranially with advancing age in the sagittal suture of cranial vault. The p value was found significant being less than 0.05 thereby establishing the fact that sexual dimorphism in the cranial sagittal suture exists. Conclusion: Conclusively the determination of sex is possible from the pattern of Cranial Sutures closure on autopsy table. Key words: Sex, Sagittal, Suture, Cranial

Estimativa de Idade em Remanescentes Ósseos: Contribuições dos Ossos da Cabeça e do Pescoço

A estimativa da idade a partir de remanescentes ósseos é um desafio da ciência forense, principalmente em adultos. Os ossos da cabeça, do pescoço e os dentes apresentam maior resistência e, frequentemente, são as únicas peças disponíveis para perícia. Este estudo teve como objetivo revisar criticamente os métodos disponíveis para a estimativa de idade a partir remanescentes ósseos da cabeça e do pescoço, bem como dos dentes na prática forense. Foi realizada uma revisão da literatura, utilizando a base de dados PubMed para as buscas com os seguintes descritores: “cranial sutures”, “teeth mineralization”, “cervical vertebrae”, “hyoid”, “age estimation” e “human identification”. As buscas de artigos foram restritas aos últimos dez anos. Contudo, livros, artigos clássicos e teses foram incluídos, mesmo que tenham sido publicados há mais tempo. A revisão da literatura mostrou que a idade de fechamento das suturas deve ser utilizada em associação com outro parâmetro devido à ocorrência de variações frequentes. O ângulo da mandíbula pode oferecer informações importantes para estimar a idade, porém a mineralização dentária a partir da utilização de exames de imagem ou técnicas histológicas oferecem subsídios para estimar a idade com maior acurácia. Os ossos do pescoço podem ajudar a estimar a idade, porém não devem ser utilizados isoladamente. Em conclusão, os dentes e ossos da cabeça e do pescoço podem ser utilizados em complemento à análise de outros ossos para estimativa de idade. Contudo, quando são as únicas peças disponíveis, o grau de fechamento das suturas, o ângulo da mandíbula e a mineralização dentária podem oferecer subsídios suficientes para estimar a idade, principalmente quando analisados juntamente a exames de imagem, técnicas histológicas e em associação com os ossos do pescoço.

A new odontocete (Inioidea, Odontoceti) from the late Neogene of North Carolina, USA

A new monotypic genus of Neogene odontocete (Isoninia borealis) is named on the basis of a partial skull (CMM-V-4061). The holotype was found on the riverbed of the Meherrin River (North Carolina, USA) and probably originated from the Miocene marine Eastover Formation. Deep interdigitation of the cranial sutures indicates that this individual was mature. The new taxon differs from all other delphinidans in the unique combination of the following characters: anteriorly retracted premaxillae and maxillae; premaxillae not contacting nasals; thick nasals with ventrolateral margins deeply imbedded within corresponding troughs in the frontals (this is an apomorphy); nasals with transversely convex dorsal surface; nearly symmetrical vertex; os suturarum (or interparietal or extra folds of the frontals) at the vertex; large dorsal infraorbital foramen level with the posterior margin of the external bony nares; and a postorbital recess on the ventrolateral face of the frontal below and behind the postorbital process of the frontal. This odontocete exhibits two small but pronounced concavities on the cerebral face of the frontal/presphenoid that are presumed to have held vestigial olfactory bulbs in life. Inioidea is only diagnosed by a single unequivocal synapomorphy: width across nasals and nares subequal. Isoninia shares this feature with other inioids and forms the basis for the placement of Isoninia within this clade. A relatively high vertex coupled with a supraoccipital that is deeply wedged between the frontals suggests placement of this new inioid species within the family Iniidae. This is the second inioid described from the Eastover Formation (the other being Meherrinia isoni). This new species adds new cranial morphology and a new combination of cranial characters to this taxonomically small but growing group of mostly marine and mostly Western Hemisphere odontocetes (urn:lsid:zoobank.org:pub:E8B817CA-B250-42B3-9365-36EFBFE351C9).