Telescoping with Multiple Revolution Cranial Osteotomies in Patients with Simple Craniosynostosis

Simple craniosynostosis is a cranial deformity that occurs secondary to a premature closure of one or more sutures, with a consequent alteration in cranial growth and cerebral expansion. The cranial alteration presents as flattening parallel to the compromised suture, with compensatory bulging in a perpendicular vector. The surgical treatment consists in cranial decompressions with suturectomies and simultaneous cranioplasties. Dynamic multiple revolution osteotomies allow the design of bone flaps that can help with decompression and correct secondary deformities caused by the synostosis. This multicenter descriptive case series study assessed 52 patients (12 plagiocephaly, 29 scaphocephaly, 7 brachycephaly and 4 trigonocephaly) operated in Cali, Colombia. In each case, suturectomy and telescoping with multiple revolution cranial osteotomies were designed to correct each particular deformity. No clinical complications were observed in the postoperative period (1, 90, and 180 days), and excellent outcomes with no re ossification of sutures and maintenance of the cranioplasty, based on clinical observation and findings in the 3D reconstruction scans.

Comparative between Syndromic and Nonsyndromic Craniosynostosis: A Literature Review

Craniosynostosis (CS) refers to the premature fusion in the perinatal stage of one or multiple skull sutures, also denominated synostoses (sagittal, metopic, uni and bilateral coronal, and lamboidal), which are commonly accompanied by facial, trunk, and limb deformities. During normal human body and head development, cranial growth achieves approximately 80% of the adult size at birth and its definitive size between 2.5 and 3 years of age. In the fetal or newborn skull, the flat bones are separated by four fontanelles and six major cranial sutures that participate in this process. Hereby presented the literature review of syndromic and non-syndromic craniosynostosis.

Effects of Histamine Receptor Antagonist Cetirizine on Orthodontic Tooth Movement

Many patients regularly take histamine receptor antagonists, such as cetirizine, to prevent allergic reactions, but these antiallergic drugs may have inadvertent effects on orthodontic treatment. In previous studies, histamine has been shown to modulate the sterile inflammatory reaction underlying orthodontic tooth movement. Pertinent effects of histamine antagonization via cetirizine during orthodontic treatment, however, have not been adequately investigated. We thus treated male Fischer344 rats either with tap water (control group) or cetirizine by daily oral gavage corresponding to the clinically used human dosage adjusted to the rat metabolism (0.87 mg/kg) or to a previously published high dosage of cetirizine (3 mg/kg). Experimental anterior movement of the first upper left molar was induced by insertion of a nickel-titanium (NiTi) coil spring (0.25 N) between the molar and the upper incisors. Cone-beam computed tomography (CBCT), micro-computed tomography (µCT) images, as well as histological hematoxylin-eosin (HE), and tartrate-resistant acid phosphatase (TRAP) stainings were used to assess the extent of tooth movement, cranial growth, periodontal bone loss, root resorptions, and osteoclast activity in the periodontal ligament. Both investigated cetirizine dosages had no impact on the weight gain of the animals and, thus, animal welfare. Neither the extent of tooth movement, nor cranial growth, nor root resorption, nor periodontal bone loss were significantly influenced by the cetirizine dosages investigated. We, thus, conclude that histamine receptor antagonist cetirizine can be used during orthodontic treatment to prevent allergic reactions without clinically relevant side effects on orthodontic tooth movement.

Краниологический аспект генезиса населения тропической транссахарской Африки

This article continues a study of cranial growth on the example of the population of tropical Trans-Saharan Africa. The cranial samples of Gabon, basin of the Congo River (the Western part), and East African farmers and Capoids – Bushmen and Hottentots (the Eastern part) were analyzed. Male and female cranial samples were studied separately. Crania of some samples clustered according to the type of growth processes in the crania. Comparative analysis showed that the cranial samples (and clusters inside them) from the West of the studied region, as a whole, differ significantly from those from the East in the shape of the skull. This is clearly seen in the male sample, but less obvious in the female one. The overall size of the cranium in the West is significantly more variable than in the East. This is because of a Pygmy admixture in the population of equatorial rainforest, which are associated with a small size of the cranium. There is no such difference between East African farmers and the craniologically similar Capoids (Bushmen and Hottentots). This leads to two main conclusions. First, the population of the Western (humid) part of Equatorial Africa formed as a mixture of larger-headed agricultural groups with Pygmies, who had smaller crania. Second, the agricultural population of the Eastern (more arid) part of the studied territory is almost identical in craniological terms to the Capoids (Bushmen and Hottentots) of South Africa, while differs significantly from the pastoralist population of this territory.

Comparative analysis of cranial vault remodeling versus endoscopic suturectomy in the treatment of unilateral lambdoid craniosynostosis

OBJECTIVEUnilateral lambdoid synostosis is the premature fusion of a lambdoid suture or sutures and represents the least common form of craniosynostosis, occurring in 1 in 40,000 births. Cranial vault remodeling (CVR) and endoscopic suturectomy with helmet therapy (ES) are surgical approaches that are used to allow for normal brain growth and improved craniofacial symmetry. The authors conducted a comparative outcomes analysis of patients with lambdoid synostosis undergoing either CVR or ES.METHODSThe authors conducted a retrospective consecutive cohort study of patients with nonsyndromic lambdoid synostosis who underwent surgical correction identified from a single-institution database of patients with craniosynostosis seen between 2000 and 2018. Cranial growth was measured in head circumference percentile and z score.RESULTSNineteen patients (8 female and 11 male) with isolated unilateral lambdoid synostosis were identified (8 right and 11 left). Six underwent CVR and 13 underwent ES. No statistically significant differences were noted between surgical groups with respect to suture laterality, the patient’s sex, and length of follow-up. Patients treated with ES presented and underwent surgery at a younger age than those treated with CVR (p = 0.0002 and p = 0.0001, respectively). Operating and anesthesia time, estimated blood loss, and ICU and total hospital days were significantly lower in ES (all p < 0.05). No significant differences were observed in pre- and postoperative head circumference percentiles or z scores between groups up to 36 months postoperatively. No patients required reoperation as of last follow-up.CONCLUSIONSEndoscopic management of lambdoid synostosis is safe, efficient, and efficacious in terms of intraoperative and long-term cranial growth outcomes when compared to CVR. The authors recommend this minimally invasive approach as an option for correction of lambdoid synostosis in patients presenting early in their course.

Craniosynostosis Part I: Pathophysiology and Patient Evaluation

Craniosynostosis is the premature fusion and obliteration of one or more cranial sutures. As a result, cranial growth can only occur parallel to the involved suture(s) resulting in predictable head shape morphologies. More importantly, the restricted cranial growth can also have a deleterious effect on the growing brain with increased intracranial pressures leading to abnormal neurocognitive development, blindness, and death. Craniosynostosis can either be syndromic or non-syndromic; and therefore, patient evaluation should be performed in a multi-disciplinary team setting for comprehensive care. Physical exam focuses on head shape morphology, associated anomalies, and signs of intracranial pressure. Imaging with 3D CT is gold standard at confirming diagnosis and extent of suture involvement. Early diagnosis is key for planning optimal intervention. This review contains 14 figures, 4 tables and, 42 references. Keywords: craniosynostosis, virchow’s law, plagiocephaly, trigonocephaly, scaphocephaly, brachycephaly, Apert Syndrome, Crouzon Syndrome, Pfeiffer Syndrome, intracranial pressure