Skull base growth in craniosynostosis

Muenke syndrome (FGFR3-related craniosynostosis): expansion of the phenotype and review of the literature

Muenke syndrome is an autosomal dominant disorder characterized by coronal suture craniosynostosis, hearing loss, developmental delay, carpal and tarsal fusions, and the presence of the Pro250Arg mutation in the FGFR3 gene. Reduced penetrance and variable expressivity contribute to the wide spectrum of clinical findings in Muenke syndrome. To better define the clinical features of this syndrome, we initiated a study of the natural history of Muenke syndrome. To date, we have conducted a standardized evaluation of nine patients with a confirmed Pro250Arg mutation in FGFR3. We reviewed audiograms from an additional 13 patients with Muenke syndrome. A majority of the patients (95%) demonstrated a mild-to-moderate, low frequency sensorineural hearing loss. This pattern of hearing loss was not previously recognized as characteristic of Muenke syndrome. We also report on feeding and swallowing difficulties in children with Muenke syndrome. Combining 312 reported cases of Muenke syndrome with data from the nine NIH patients, we found that females with the Pro250Arg mutation were significantly more likely to be reported with craniosynostosis than males (P < 0.01). Based on our findings, we propose that the clinical management should include audiometric and developmental assessment in addition to standard clinical care and appropriate genetic counseling.

Frontosphenoidal synostosis: a rare cause of unilateral anterior plagiocephaly

INTRODUCTION

When a child walks in the clinic with a unilateral frontal flattening, it is usually associated in our minds with unilateral coronal synostosis. While the latter might be the most common cause of anterior plagiocephaly, it is not the only one. A patent coronal suture will force us to consider other etiologies, such as deformational plagiocephaly, or synostosis of another suture. To understand the mechanisms underlying this malformation, the development and growth of the skull base must be considered.

MATERIALS AND METHODS

There have been few reports in the literature of isolated frontosphenoidal suture fusion, and we would like to report a series of five cases, as the recognition of this entity is important for its treatment.

CONCLUSION

Frontosphenoidal synostosis must be searched in the absence of a coronal synostosis in a child with anterior unilateral plagiocephaly, and treated surgically.

Craniofacial levels and the morphological maturation of the human skull

It is well known that the human skull achieves adult size through a superior-inferior gradient of maturation. Because the basicranium matures in size before the face, it has been suggested that the form of the basicranium might have ontogenetic knock-on effects on that of the face. However, although sequential spatially organized maturation of size is well described in the cranium, the maturation of skull shape is not. Knowledge of the maturation of shape is important, nevertheless, because it is claimed that the early determination of the spatial configuration of basicranial components, where the facial skeleton attaches, is relevant in the spatio-temporal ontogenetic cascade from basicranium to face. This paper examines the ontogeny of various components of the human skull in 28 individuals from the longitudinal Denver Growth Study. Sixty-six landmarks and semilandmarks were digitized on 228 X-rays and analysed using geometric morphometric methods. Bootstrapped confidence intervals for centroid size support previous studies suggesting a supero-inferior gradient of growth maturation (size over time), while developmental maturation (shape over time) is more complex. A sequence of shape maturation is described, in which the earliest structure to mature in shape was the midline cranial base (7-8 years), followed by the lateral cranial floor (11-12), midline neurocranium (9-10) and facial and mandibular structures (15-16). The absolute ages of shape maturation of the latter three depended on the criterion of maturity used, which was not the case for the basicranial components. Additionally, ontogenetic dissociations were found between the maturation of size and shape of the midline cranial base and lateral floor, possibly underlining its role as structural 'interface' between brain and facial ontogeny. These findings imply potential for bidirectional developmental influences between the lateral cranial floor and the face until about 11-12 years. The findings are discussed with regard to their relevance for palaeoanthropology and especially the evolutionary and developmental bases of skull morphological variation.

Correlated variation between the lateral basicranium and the face: A geometric morphometric study in different human groups

OBJECTIVES

The significance of the cranial base in the contribution of normal and pathologic facial patterns is uncertain. The aim of this study was to explore and compare patterns of morphological covariation between the face and the lateral basicranium (anterior and middle cranial fossae) with covariation patterns between the face and the midline cranial base.

DESIGN

We employed 2D geometric morphometrics and partial least squares analysis to quantify and compare correlation coefficient between principal variation patterns between basicranial and facial structures in lateral radiographs from 143 humans from Japan (N=45), Europe (N=65) and Africa (N=34).

RESULTS

In both comparisons basicranial patterns co-varied with dolichofacial and brachyfacial morphologies. The findings showed that the midline cranial base is not significantly correlated of common facial patterns (r=0.37, P=0.09). Instead, the lateral basicranium is significantly (P=0.000), and significantly higher (r=0.6) correlated with facial variation than is the midline cranial base.

CONCLUSIONS

The lateral basicranium may be of higher morphogenetic relevance for influencing facial variation than previously thought. This influence may be of clinical importance for the generation of skeletal class II or class III malocclusions. Further research should expand on geometric morphometric analysis of ontogenetic and clinical 3D data in order to advance in the understanding of these complex developmental relationships.

Craniofacial surgery: complications and their prevention

This article focuses on the management of perioperative complications in surgery dealing with structures of the craniofacial complex. A brief review of applicable surgical techniques is given, beginning with single-suture craniosynostoses and moving on to the more complex syndromic craniofacial disorders. Distinctive complications associated with each technique are discussed.