Assessment of patients with craniosynostosis

The term craniosynostosis denotes the pathological partial or complete absence of one or more cranial sutures which manifests as abnormal skull growth. Although it is often referred to as premature fusion this is misleading as only the metopic suture fuses in the normal physiological state. The remaining sutures change and mature in macroscopic and microscopic form during growth but remain present. This chapter discusses the assessment of patients with craniosynostosis.

Personalized Bone Reconstruction and Regeneration in the Treatment of Craniosynostosis

Craniosynostosis (CS) is the second most prevalent craniofacial congenital malformation due to the premature fusion of skull sutures. CS care requires surgical treatment of variable complexity, aimed at resolving functional and cosmetic defects resulting from the skull growth constrain. Despite significant innovation in the management of CS, morbidity and mortality still exist. Residual cranial defects represent a potential complication and needdedicated management to drive a targeted bone regeneration while modulating suture ossification. To this aim, existing techniques are rapidly evolving and include the implementation of novel biomaterials, 3D printing and additive manufacturing techniques, and advanced therapies based on tissue engineering. This review aims at providing an exhaustive and up-to-date overview of the strategies in use to correct these congenital defects, focusing on the technological advances in the fields of biomaterials and tissue engineering implemented in pediatric surgical skull reconstruction, i.e., biodegradable bone fixation systems, biomimetic scaffolds, drug delivery systems, and cell-based approaches.

Analysis of lateral teleroentgenograms in pediatric patients with grade III vertical disocclusion of the dentition

Aim of the study was to study lateral TRG in 43 patients with grade III vertical disocclusion of the dentition at the age of 7 to 18 years. Material and methods. Lateral telerentgenogram were used to study the angle indices SN-NL, SN-ML, NL-ML, showing the ratio of the upper and lower jaw relative to the base of the skull and relative to each other. The highest values of the SN-NL angle were observed in children of 1 group at the age of 18 years 9.0, in 2 group at the age of 18 years 9.3, in 3 group at the age of 17 years 8.9. The lowest values of the SN-NL angle were observed in children of group 1 at the age of 7, 8, 10 years 7.5, in group 2 at the age of 7 years 8.5, in group 3 at the age of 7 years 8.4. The highest values of the SN-ML angle were observed in children of group 1 at the age of 15, 16, 17, 18 years 33, in group 2 at the age of 18 years 37, in group 3 at the age of 17, 18 years 36. The lowest indices of the angle SN-ML was the children 1 age group 12 years 31 in group 2 at the age of 11 33, group 3, ages 11, 12, and 13 34. The highest values of NL-ML 34 angle were observed in children aged 17 years from group 1, in group 2 at age 17, 18 years 33, in group 3 at age 13, 14 and 18 years 30. In children of group 1 aged 7, 8, 11, 2 groups at the age of 9, 10 and 3 groups at the age of 8 years identified the least parameters of an angle NL-ML 28, 28, 27, respectively. Results. As a result of the study, it was noted that in children with vertical dysocclusion of the dentition of the third degree, the angles SN-NL, SN-ML, NL-ML have high indicators, which characterizes the vertical type of skull growth.

Computational modelling of patient specific spring assisted lambdoid craniosynostosis correction

Lambdoid craniosynostosis (LC) is a rare non-syndromic craniosynostosis characterised by fusion of the lambdoid sutures at the back of the head. Surgical correction including the spring assisted cranioplasty is the only option to correct the asymmetry at the skull in LC. However, the aesthetic outcome from spring assisted cranioplasty may remain suboptimal. The aim of this study is to develop a parametric finite element (FE) model of the LC skulls that could be used in the future to optimise spring surgery. The skull geometries from three different LC patients who underwent spring correction were reconstructed from the pre-operative computed tomography (CT) in Simpleware ScanIP. Initially, the skull growth between the pre-operative CT imaging and surgical intervention was simulated using MSC Marc. The osteotomies and spring implantation were performed to simulate the skull expansion due to the spring forces and skull growth between surgery and post-operative CT imaging in MSC Marc. Surface deviation between the FE models and post-operative skull models reconstructed from CT images changed between ± 5 mm over the skull geometries. Replicating spring assisted cranioplasty in LC patients allow to tune the parameters for surgical planning, which may help to improve outcomes in LC surgeries in the future.

The Zika virus: outcome and follow up in Brazil’s northeast women

The World Health Organization (WHO) declared a Public Health Emergency of Inter- national Concern in response to a cluster of microcephaly (restricted fetal brain and skull growth) and neurological disorders likely associated with Zika virus. A Short Communication that focus on The exponential increase and extreme severity of Zika virus (ZIKV), contrasting with evidence that Include: discovery or development of new information’s, novelty in modeling scientific, elucidation of mechanisms editorials and channels of information.

Muenke syndrome: long-term outcome of a syndrome-specific treatment protocol

OBJECTIVEThe authors evaluated the long-term outcome of their treatment protocol for Muenke syndrome, which includes a single craniofacial procedure.METHODSThis was a prospective observational cohort study of Muenke syndrome patients who underwent surgery for craniosynostosis within the first year of life. Symptoms and determinants of intracranial hypertension were evaluated by longitudinal monitoring of the presence of papilledema (fundoscopy), obstructive sleep apnea (OSA; with polysomnography), cerebellar tonsillar herniation (MRI studies), ventricular size (MRI and CT studies), and skull growth (occipital frontal head circumference [OFC]). Other evaluated factors included hearing, speech, and ophthalmological outcomes.RESULTSThe study included 38 patients; 36 patients underwent fronto-supraorbital advancement. The median age at last follow-up was 13.2 years (range 1.3–24.4 years). Three patients had papilledema, which was related to ophthalmological disorders in 2 patients. Three patients had mild OSA. Three patients had a Chiari I malformation, and tonsillar descent < 5 mm was present in 6 patients. Tonsillar position was unrelated to papilledema, ventricular size, or restricted skull growth. Ten patients had ventriculomegaly, and the OFC growth curve deflected in 3 patients. Twenty-two patients had hearing loss. Refraction anomalies were diagnosed in 14/15 patients measured at ≥ 8 years of age.CONCLUSIONSPatients with Muenke syndrome treated with a single fronto-supraorbital advancement in their first year of life rarely develop signs of intracranial hypertension, in accordance with the very low prevalence of its causative factors (OSA, hydrocephalus, and restricted skull growth). This illustrates that there is no need for a routine second craniofacial procedure. Patient follow-up should focus on visual assessment and speech and hearing outcomes.

ENHANCEMENT OF RESEARCH METHOD FOR SPATIAL LOCATION OFTEMPOROMANDIBULAR ELEMENTS AND MAXILLARY AND MANDIBULAR MEDIALINCI

This work reveals the analysis outcomes for craniometric and morphometric parameters of the temporomandibular joints and incisal dentofacial segments obtained through studying 157 computer tomograms and lateral skull teleradiographies from people with physiological occlusion of permanent teeth in the first mature age period. Detailed investigation of the spatial arrangement of the craniofacial structures allowed developing, substantiating and testing a method of computer tomograms combination of the mandibular joint and dentofacial segments of the mandibular and maxillary medial incisors with head teleradiographies in the lateral projection. This algorithm allowed increasing the measurements reliability (linear, angular) in the sagittal plane, identifying the degree of complexity and justifying the choice of tactics for the planned treatment, describing the facial skull growth type (horizontal, vertical and neutral), as well as evaluating the effectiveness of orthodontic treatment at all stages.