Norms of size and annual increments of six anatomical measures of the cranium in boys and girls from four to fifteen years of age

Rehabilitation of pediatric retinoblastoma patients with ocular prostheses and their subsequent modifications: A 15-year retrospective study

PURPOSE

Enucleation is a common treatment modality performed for pediatric retinoblastoma patients, and the resultant defects are reconstructed using an ocular prosthesis. The prostheses are modified or replaced periodically, as the child develops due to orbital growth and patient-error. The purpose of this report is to evaluate the replacement frequency of prostheses in the pediatric oncologic population.

METHODS

A retrospective review was completed by the two senior research investigators, of patients that had ocular prostheses fabricated following enucleation of their retinoblastoma from 2005 to 2019 (n = 90). Data collected from the medical records of the patient included the pathology, date of surgery, date of prosthesis delivery, and the replacement schedule of the ocular prosthesis.

RESULTS

During the 15-year study period, 78 enucleated observations (ocular prosthesis fabricated) were included for analysis. The median age of the patients at the time of delivery of their first ocular prosthesis was calculated to be 2.6 years (range 0.3-18 years). The median time to the first modification of the prosthesis was calculated to be 6 months. The time to modification of the ocular prosthesis was further stratified by age.

CONCLUSION

Pediatric patients require modification of their ocular prostheses throughout their growth and development period. Ocular prostheses are reliable prostheses with predictable outcomes. This data is helpful to set an expectation among the patient, parent, and provider.

Intracranial Volumes of Healthy Children in the First 3 Years of Life: An Analysis of 270 Magnetic Resonance Imaging Scans

BACKGROUND

There is a paucity of data on normal intracranial volumes for healthy children during the first few years of life, when cranial growth velocity is greatest. The aim of this study was to generate a normative predictive model of intracranial volumes based on brain magnetic resonance imaging from a large sample of healthy children to serve as a reference tool for future studies on craniosynostosis.

METHODS

Structural magnetic resonance imaging data for healthy children up to 3 years of age was acquired from the National Institutes of Health Pediatric MRI Data Repository. Intracranial volumes were calculated using T1-weighted scans with FreeSurfer (version 6.0.0). Mean intracranial volumes were calculated and best-fit logarithmic curves were generated. Results were compared to previously published intracranial volume curves.

RESULTS

Two-hundred seventy magnetic resonance imaging scans were available: 118 were collected in the first year of life, 97 were collected between years 1 and 2, and 55 were collected between years 2 and 3. A best-fit logarithmic growth curve was generated for male and female patients. The authors' regression models showed that male patients had significantly greater intracranial volumes than female patients after 1 month of age. Predicted intracranial volumes were also greater in male and female patients in the first 6 months of life as compared to previously published intracranial volume curves.

CONCLUSIONS

To the authors' knowledge, this is the largest series of demographically representative magnetic resonance imaging-based intracranial volumes for children aged 3 years and younger. The model generated in this study can be used by investigators as a reference for evaluating craniosynostosis patients.

Normative Data of the Interorbital Distance in Thai Population

The incidence of the patients with craniofacial anomalies was high in southeast-Asian countries, for example, fronto-ethmoidal encephalo-menigocele or craniosynostosis. These craniofacial anomalies usually involve orbits, so a surgical orbital reconstruction is always required.Various methods have been used in the past to indirectly analyze the craniofacial region. Plain skull radiography, anthropometry, and cephalometry provided the limited information of interorbital distance in terms of accuracy whereas the interorbital distance is crucial to be reconstructed, increasing or decreasing. The accurate normal interorbital distance which grows by age as other craniofacial structures is the important data in the part of interorbital and orbital reconstruction. To date, the normative data of the bony interorbital distance among Thai population have not been established.The purpose of this study is to provide normal values and the growth patterns of the bony interorbital distances and other dimensions of the orbit according to age among Thai population through the axial computed tomography. Comparisons can then be made between normal values and those for an individual patient or those for a group of patients, for example, those with front-ethmoidal meningoencephalocele, Crouzon, or Treacher-Collins syndrome, or among values for individual patients at different time intervals.A retrospective study of computed tomography (CT) scan series of 698 normal orbits from 349 skeletally normal subjects (202 men and 147 women) was enrolled. The age range of the patients was 0 to 21 years (mean, 10.2 years; SD, 5.8 years). A series of 12 measurements were obtained from the CT scans of each subject. All CT images were obtained from patients who underwent CT of the facial bone, brain, and orbits at the Department of Radiology of 3 big hospital in Bangkok-Ramathibodi, Samitivej Srinakarin, and Bangkok hospital-since 2010 to 2015.The normal measurement values in the orbital region through the CT images, as the normal periorbital growth curve, will help improving diagnostic accuracy, staging of reconstruction, precision of corrective surgery, and follow-up of the Thai patients with craniofacial abnormalities such as front-ethmoidal meningoencephalocele, hypertelorism. These data may also apply to the related population in the southeast-Asian countries.

Midfacial growth patterns in males from newborn to 5 years old based on computed tomography

OBJECTIVES

Growth patterns of the human facial skeleton have been of great interest and importance for biological anthropologists, forensic scientists, craniofacial surgeons, and orthopedists. Nevertheless, growth trends of the facial skeleton in infancy and early childhood are still poorly known and clinical CT data have been insufficiently used for studying craniofacial ontogeny. The purpose of this study was to provide a comprehensive quantitative description of human midfacial ontogeny in infancy and early childhood, and to contribute to debates regarding the role of modularity vs. integration in shaping the human face.

METHODS

Our dataset includes 146 high resolution clinical CT datasets of males from the 2nd to 6th years of life and 101 dataset of infants (males) in the 1st year of life. Forty landmarks were collected from each 3D reconstructed skull, then 25 linear measurements describing the morphological features of the facial skeleton were calculated. The integration/modularity issue was addressed via comparison of intragroup correlation matrices at different ages.

RESULTS

Growth trends for all the measurements are presented in charts and tables of statistical parameters that can be used as normative data. The midfacial variables display a great diversity of growth patterns. The correlation structure of the measurements is different at different ages.

CONCLUSIONS

Variables commonly assigned to the same unit of the facial skeleton can exhibit rather different growth trends, but some measurements display seemingly coordinated patterns of growth change. The level of interindividual variation of most measurements is stable after the second half of the first year of life.

The effect of enucleation on orbital growth in patients with retinoblastoma

PURPOSE

To measure orbital volume using serial magnetic resonance imaging (MRI) scans to determine the effect of enucleation on orbital growth over time.

METHODS

The medical records of patients who underwent unilateral enucleation for retinoblastoma with a minimum of 2 MRIs were retrospectively reviewed. Orbital asymmetry was calculated using MRI measurements. Nonlinear and linear mixed effect regression models were used to predict the effect of age at time of enucleation on degree of orbital asymmetry.

RESULTS

A total of 27 patients were included (mean age at enucleation, 2 years; range, 2.5 months to 5 years). Age at scan (P = 0.046) and age at enucleation (P = 0.0006) were found to have a significant effect on orbital asymmetry. Change in orbital asymmetry over time was more pronounced after enucleation in children enucleated at <1 (P < 0.0001) or <2 years of age (P = 0.0109). Younger age at enucleation was associated with a greater degree of asymmetry over time, although this effect was extinguished for patients enucleated after the age of 3 years.

CONCLUSIONS

In patients with retinoblastoma, enucleation with orbital implant before 3 years of age has a significant effect on orbital volume asymmetry. After the age of 3, this effect appears to be less detrimental to the degree of orbital asymmetry.

Intracranial volumes in a large series of healthy children

BACKGROUND

Craniosynostosis alters the normal growth of the infant skull and can influence intracranial pressure and intracranial volume. The purpose of this study was to measure intracranial volumes in a large series of healthy children to serve as a reference for further studies exploring the impact of craniosynostosis and vault remodeling on intracranial growth.

METHODS

A total of 123 children were included in this study from a retrospective review of pediatric emergency room visits for evaluation of head trauma where a head computed tomography scan was performed. Intracranial volumes were obtained using a semiautomated image segmentation technique and volume-rendering software.

RESULTS

Volume measurements were obtained and plotted against age, and a best fit curve approximation was derived. In this study of healthy children, intracranial volume doubled by 9 months of age and tripled by 6 years of age.

CONCLUSIONS

This large study contributes to the existing data demonstrating intracranial volumes in healthy children up to 6 years of age. These data can be used by clinicians as a reference in the assessment of a child presenting with cranial dysmorphology.

Orbital growth retardation in retinoblastoma survivors: work in progress

BACKGROUND

Orbital growth retardation, after enucleation and/or external beam radiation for retinoblastoma (RB), is a serious late effect. We measured orbital volumes of RB survivors treated at Hadassah University Hospital, Jerusalem, between 1980-1998.

PROCEDURE

Forty-five orbits of 28 children with RB (17 bilateral, 11 unilateral) were examined. Thirty-six orbits were irradiated, 19 enucleated, and 10 both enucleated and irradiated. The orbital volumes were calculated from a three-dimensional orbital CT reconstruction. The orbits of RB survivors were compared to age-matched controls.

RESULTS

The mean age at diagnosis was 13 months, mean follow-up time was 56 months. The mean volume of RB orbits (14.4 cc) was statistically significantly smaller than control orbits (17.8 cc). There was no difference between the mean volume of orbits treated with enucleation, irradiation or both. The orbital volume of children treated before the age of 12 months was statistically significantly smaller than those treated later. There was no difference between mean volume of fellow orbits in unilateral RB and controls. The mean orbital asymmetry index in control children (2.6%) was statistically significantly smaller than in RB survivors (14%).

CONCLUSIONS

There was a significant orbital growth retardation after enucleation and/or irradiation for RB. There was no difference between mean orbital volumes after enucleation, radiation or both. Orbital growth retardation was most prominent in children treated in the first year of life. Although small in number, our study suggests that deferring enucleation and/or irradiation until after the age of 12 months may reduce long-term complications.

Growth of the pediatric skull base: assessment using magnetic resonance imaging

Minimal information is available concerning the gross anatomic changes that occur with skull base development in children. Because clinical and autopsy material to evaluate skull base growth in this population is rare, the author of this study evaluated normal magnetic resonance imaging (MRI) scans in 76 children ranging in age from newborn to 18 years. Growth of the basicranium was assessed in three dimensions: anterior-posterior, medial-lateral, and superior-inferior. In each dimension, growth was noted to be rapid until age 6 years, with relatively slower growth thereafter. In the superior-inferior and anterior-posterior dimensions, both the amount of growth and the asymptotic value were noted to be greater in males than in females (P < .05). The findings of this study can help surgeons select the appropriate operative approach for skull base masses in children. Certain approaches may involve significant morbidity, including mandibulotomy, loss of teeth, oral contamination, and external auditory canal closure. Representative cases managed through an extrapharyngeal transcervical approach are reviewed.

Frontonasal and craniofrontonasal dysplasia: preoperative quantitative description of the cranio-orbito-zygomatic region based on computed and conventional tomography

The unoperated crano-orbito-zygomatic complex of 18 children (mean 4.7 years) with frontonasal dysplasia (FND) and 12 children (mean 1.1 years) with crainofrontonasal dysplasia (CFND) was quantified by 15 standard measurements performed on either computed tomography scans or facial tomograms. The results were compared with age-matched control values. In the FND group, the mean anterior interorbital and mid-interorbital distances were significantly increased at 148% and 118% of normal, and in the CFND patients, at 177% and 140% of normal. Excessive medial orbital wall protrusion (mean, 145% of normal in FND and 177% in CFND), shortened zygomatic arch lengths (mean, 94% of normal in FND and 91% in CFND), and reduced cephalic lengths (mean, 96% of normal in FND and 83% in CFND) were all observed. An expanded interzygomatic buttress distance was documented only in the CFND group, at 11% of normal. The clinical presentation of craniofacial deformities such as FND and CFND can be objectively described by a numerical analysis of the bony pathology.

Craniofacial skeletal measurements based on computed tomography: Part II. Normal values and growth trends

Current diagnosis and surgical correction of craniofacial anomalies would benefit from accurate quantitative and standardized points of reference. A retrospective study was undertaken to define normal values for a series of craniofacial measurements and to evaluate the growth patterns of the craniofacial complex through axial computed tomography (CT). Fifteen measurements were taken from 542 CT scan series of skeletally normal subjects. The measurement values were then divided into 1-year age categories from 1 to 17 years, and into four age groups for those under 1 year of age. The normal range and growth pattern of measurement values for the cranial vault, orbital region, and upper midface are presented. The overall size of the cranio-orbito-zygomatic skeleton reaches more than 85 percent of adult size by age 5 years. The cranial vault grows rapidly in the first year of life but growth levels off early. The upper midface grows at a slower rate in infancy, but continues to grow later in childhood and early adolescence. Knowledge of the differential growth patterns and normal measurement values in the craniofacial region will help improve diagnostic accuracy, staging of reconstruction, precision of corrective surgery, and follow-up of patients.

A polynomial approach to craniofacial growth: description and comparison of adolescent males with normal occlusion and those with untreated Class II malocclusion

Orthogonal polynomials are used to model the craniofacial growth of adolescent boys, aged 11 through 14 years, and to evaluate variation between normal occlusion and untreated Class II malocclusion. The results show linear growth (velocity) for the maxillary measures; their angular relationships to the cranial base remain stable throughout the age range. Mandibular measures show growth velocity and acceleration, indicating the adolescent growth spurt. For the majority (80%) of measures, boys with normal occlusion and those with Class II malocclusion were not significantly different. Mean growth velocity of basion-nasion is significantly greater for subjects with Class II, Division 1 malocclusion. Total mandibular length and the ANB angle display significant mean size (constant) differences between boys with normal occlusion and boys with untreated Class II malocclusion. The groups are comparable in growth velocity and acceleration, indicating that the size differences are established before 11 years of age and maintained during adolescence.

Sexual dimorphism in the growth of the cranium

The major sexual dimorphisms in body size appear at puberty but, by then, 95% of the growth of the cranium is completed. As sexual dimorphism in the cranium is as great as for other parts of the body, this suggests that it must appear at an earlier age, and that cranium/body size ratios for the two sexes will vary during growth. Results from a longitudinal study of Montreal children are used to investigate this phenomenon. The effect is expressed quantitatively by proportional growth and growth velocity curves, based on the final size of boys, which show that the dimorphism indeed makes an early appearance. The data are also analyzed on an age scale relative to the ages of peak growth velocity in stature, derived from the individual growth curves. This shows that although there is a minor pubertal spurt in growth for the external cranial dimensions of boys, it contributes relatively little to the final dimorphism in cranial size. To summarize this aspect of growth, an index of cephalization is calculated: head length X head width/stature. Cross-sectional standards for the change of the mean index with age show a linear decline for boys and girls until puberty, with a constant difference between them. After puberty, the index becomes equal in the two sexes. Individual development curves for the index are however not linear.

Timing and sequence of eruption of permanent teeth in a longitudinal sample of children from Oregon

A longitudinal sample of children was examined for timing and sequence of eruption of permanent teeth. Separate consideration was given to 124 boys and 163 girls from the Child Study Clinic longitudinal growth study. Girls show more variability in age at eruption than boys, and eruption is generally earlier in girls. The degree of variation in sequences of eruption of the first seven permanent teeth is distinct. The most common sequence in girls' maxillas occurred in only 11.4% of subjects; in boys, the most common sequence appeared in 13.4% of subjects. Predictability efficiency of eruption of the first three permanent teeth is not higher than 0.74.

Thickness of the normal skull in the American Blacks and Whites

Normal skull thickness has been measured in a general hospital population of 300 blacks and 200 whites in America. In both groups, there is a rapid increase in skull thickness during the first two decades of life, followed by a small uniform increase reaching a peak in the fifth and sixth decades. The sex differences are variable, but in certain age groups the females in both races have significatly thicker parietal and occipital bones than their male counterpart. The frontal bone is thicker in the white male than in the black, and the parietooccipital thicker in the blacks than in the whites. Some suggestions are offered to explain the sex and racial difference noted.