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Kronig SA, Kronig OD, Vrooman HA, Van Adrichem LN. UCSQ Method Applied on 3D Photogrammetry: Non-Invasive Objective Differentiation Between Synostotic and Positional Plagiocephaly. Cleft Palate Craniofac J 2023; 60:1273-1283. [PMID: 35538856 PMCID: PMC10515447 DOI: 10.1177/10556656221100679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Objective differentiation between unilateral coronal synostosis (UCS) and positional posterior plagiocephaly (PPP) based on 3D photogrammetry according to Utrecht Cranial Shape Quantificator (UCSQ). DESIGN Retrospective study. SETTING Primary craniofacial center. PATIENTS, PARTICIPANTS Thirty-two unoperated patients (17 UCS; 15 PPP) (age < 1 year). INTERVENTIONS Extraction of variables from sinusoid curves derived using UCSQ: asymmetry ratio forehead and occiput peak, ratio of gradient forehead and occiput peak, location forehead and occiput peak. MAIN OUTCOME MEASURE(S) Variables, derived using 3D photogrammetry, were analyzed for differentiation between UCS and PPP. RESULTS Frontal peak was shifted to the right side of the head in left-sided UCS (mean x-value 207 [192-220]), and right-sided PPP (mean x-value 210 [200-216]), and to the left in right-sided UCS (mean x-value 161 [156-166]), and left-sided PPP (mean x-value 150 [144-154]). Occipital peak was significantly shifted to the right side of the head in left-sided PPP (mean x-value 338 [336-340]) and to the left in right-sided PPP (mean x-value 23 [14-32]). Mean x-value of occipital peak was 9 (354-30) in left- and 2 (350-12) in right-sided UCS. Calculated ratio of gradient of the frontal peak is, in combination with the calculated asymmetry ratio of the frontal peak, a distinctive finding. CONCLUSIONS UCSQ objectively captures shape of synostotic and positional plagiocephaly using 3D photogrammetry, we therefore developed a suitable method to objectively differentiate UCS from PPP using radiation-free methods.
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Affiliation(s)
- Sophia A.J. Kronig
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, The Netherlands
| | - Otto D.M. Kronig
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, The Netherlands
| | - Henri A. Vrooman
- Department of Radiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Léon N.A. Van Adrichem
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, The Netherlands
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Lee J, Naran S, Mazzaferro D, Wes A, Anstadt EE, Taylor J, Goldstein J, Bartlett S, Losee J. Frontofacial Features of Unilateral Lambdoid Craniosynostosis: A Multicenter Assessment. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5011. [PMID: 37360231 PMCID: PMC10287130 DOI: 10.1097/gox.0000000000005011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 03/29/2023] [Indexed: 06/28/2023]
Abstract
Unilateral lambdoid craniosynostosis is differentiated from deformational plagiocephaly primarily by assessing the cranium from posterior and bird's-eye views. Findings include posterior displacement of the ipsilateral ear, ipsilateral occipitomastoid bossing, ipsilateral occipitoparietal flattening, contralateral parietal bossing, and contralateral frontal bossing. Diagnosis based off facial morphology may be an easier approach because the face is less obstructed by hair and head-coverings, and can easily be assessed when supine. However, frontofacial characteristics of unilateral lambdoid craniosynostosis are not well described. Methods A retrospective cohort review of patients with isolated, unilateral lambdoid craniosynostosis from the Children's Hospital of Pittsburgh and the Children's Hospital of Philadelphia was performed. Preoperative frontal and profile photographs were reviewed for salient characteristics. Results Nineteen patients met inclusion criteria. Eleven patients had left lambdoid craniosynostosis, and eight had right lambdoid craniosynostosis. All patients were nonsyndromic. Patients demonstrated contralateral parietal bossing and greater visibility of the ipsilateral ear. Contralateral frontal bossing was mild. The orbits were tall and turricephaly was present in varying severity. Facial scoliosis as a C-shaped deformity was present in varying severity. The nasal root and chin pointed to the contralateral side. Conclusions The combination of greater visibility of the ipsilateral ear, contralateral parietal bossing, and C-shaped convex ipsilateral facial scoliosis are hallmark frontofacial features of unilateral lambdoid craniosynostosis. Although the ipsilateral ear is more posterior, the greater visibility may be attributed to lateral displacement from the mastoid bulge. Evaluation of long-term postoperative results is needed to assess if this pathognomonic facial morphology is corrected following posterior vault reconstruction.
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Affiliation(s)
- Jonathan Lee
- From the Division of Plastic and Reconstructive Surgery, Baystate Health System, Springfield, Mass
| | - Sanjay Naran
- Division of Pediatric Plastic Surgery, Advocate Children's Hospital, Park Ridge, Ill
- Division of Pediatric Plastic Surgery, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, Pa
- Section of Plastic and Reconstructive Surgery, University of Chicago Medicine and Biological Sciences, Chicago, Ill
| | - Daniel Mazzaferro
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Ari Wes
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Erin E Anstadt
- Division of Pediatric Plastic Surgery, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Jesse Taylor
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Jesse Goldstein
- Division of Pediatric Plastic Surgery, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Scott Bartlett
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Joseph Losee
- Division of Pediatric Plastic Surgery, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, Pa
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Elawadly A, Smith L, Borghi A, Nouby R, Silva AHD, Dunaway DJ, Jeelani NUO, Ong J, James G. 3-Dimensional Morphometric Outcomes After Endoscopic Strip Craniectomy for Unicoronal Synostosis. J Craniofac Surg 2023; 34:322-331. [PMID: 36184769 DOI: 10.1097/scs.0000000000009010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 07/07/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Endoscopic strip craniectomy with postoperative helmeting (ESCH) for unicoronal synostosis has shown to be a less morbid procedure when compared with fronto-orbital remodeling (FOR). We aim in this pilot study to report objective methods and quantitative morphologic outcomes of endoscopically treated unicoronal synostosis using 3-dimensional surface scans. METHODS Our electronic records were reviewed for ophthalmological, neurodevelopmental outcomes, and helmet-related complications. For morphologic outcomes, the following parameters were used: Cranial Index, Cranial Vault Asymmetry Index, Anterior Symmetry Ratio (ASR), and Root Mean Square between the normal and synostotic sides of the head. Three-dimensional stereophotogrammetry scans were evaluated at 3 time points preoperative, 6 months post-op, and at the end of the treatment, which was compared with age-matched scans of normal controls and FOR patients. Nonparametric tests were used for statistical analysis. RESULTS None of the ESCH cases developed strabismus, major neurodevelopmental delay, or helmet complications. All morphologic parameters improved significantly at 6 months post-op except for the Cranial Vault Asymmetry Index. The ASR was the only parameter to change significantly between 6 months post-op and final scans. At end of helmet treatment, ASR and Root Mean Square differed significantly between the ESCH and both FOR and control groups. CONCLUSIONS Endoscopic strip craniectomy with postoperative helmeting for single unicoronal synostosis had excellent clinical outcomes. Most of the improvement in head morphology occurred in the first 6 months of treatment. Despite the normalization of the overall head shape, there was residual asymmetry in the frontal and temporal regions of the head.
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Affiliation(s)
- Ahmed Elawadly
- Craniofacial Unit, Great Ormond Street Hospital
- Great Ormond Street Institute of Child Health, University College London, London, UK
- Neurosurgery Department, Aswan University, Aswan
| | - Luke Smith
- Craniofacial Unit, Great Ormond Street Hospital
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Alessandro Borghi
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Radwan Nouby
- Neurosurgery Department, Assuit University, Assuit, Egypt
| | | | - David J Dunaway
- Craniofacial Unit, Great Ormond Street Hospital
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Noor Ul O Jeelani
- Craniofacial Unit, Great Ormond Street Hospital
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Juling Ong
- Craniofacial Unit, Great Ormond Street Hospital
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Greg James
- Craniofacial Unit, Great Ormond Street Hospital
- Great Ormond Street Institute of Child Health, University College London, London, UK
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Santiago GS, Santiago CN, Chwa ES, Purnell CA. Positional Plagiocephaly and Craniosynostosis. Pediatr Ann 2023; 52:e10-e17. [PMID: 36625797 DOI: 10.3928/19382359-20221114-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Along with the decrease in sudden infant death syndrome due to the successful "Back to Sleep" Campaign, there was a reciprocal increase in cases of positional plagiocephaly (PP). The prevalence of PP significantly rose from approximately 5% to upward of 46% at age 7 months. Consequently, clinicians have seen a surge in the number of patients presenting with head shape abnormalities. Not only does this increase in patient volume pose a logistical problem to clinics, but it also poses a potential risk to patients with craniosynostosis, whose head shape anomalies are similar to a "needle in a haystack" of patients with more common PP. This review explores the causes, risk factors, and treatment options of PP and craniosynostosis, along with the differential of head shape anomalies based on phenotypic presentation. In doing so, we hope to provide pediatric care clinicians with the tools necessary to effectively evaluate and manage patients with head shape abnormalities. [Pediatr Ann. 2023;52(1):e10-e17.].
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Management of Sagittal and Lambdoid Craniosynostosis: Open Cranial Vault Expansion and Remodeling. Oral Maxillofac Surg Clin North Am 2022; 34:395-419. [PMID: 35752548 DOI: 10.1016/j.coms.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The prevalence of sagittal and lambdoid suture craniosynostosis differs considerably, as they are notably the most and least prevalent sutures involved in isolated suture craniosynostosis, respectively. The goals of reconstructing the cranial vault in both entities is the same: to release the fused suture, expand cranial volume, restore normal head shape and morphology, and allow for normal growth of the cranial vault. With regards to sagittal suture synostosis, opinions vary on whether reconstruction should focus on either the anterior or poster cranial vault. In contrast, the poster cranial vault is always targeted in lambdoid suture craniosynostosis.
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Yasonov SA, Lopatin AV, Kugushev AY. Craniosynostosis of the Sphenofrontal Suture: Definition of the Main Signs of Craniofacial Deformity. Ann Maxillofac Surg 2017; 7:222-227. [PMID: 29264289 PMCID: PMC5717898 DOI: 10.4103/ams.ams_96_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Aims The aim of this study is to compare clinical features of sphenofrontal craniosynostosis (SFC) and unilateral coronary craniosynostosis. Settings and Design This was a retrospective study with two groups of patients with sphenofrontal and coronary craniosynostosis. Materials and Methods This was a retrospective study of the 1999-2016 archive data in Russian Children's Clinical Hospital. Ninety-five patients were diagnosed with frontal plagiocephaly. Eighty-three had deformations of unilateral craniosynostosis of coronary suture, 12 had premature closures of sphenofrontal suture. The age at the time of diagnosis varied from 5 months to 2, 5 years. Results SFC is featured by ipsilateral flattening of forehead and supraorbital margin, and ipsilateral dystopia of supraorbital margin downward. X-ray signs are the closure of sphenofrontal suture on the lesion side with open and symmetrically located remaining skull sutures and contralateral deviation of the midline of the ethmoid. Conclusions SFC distinguishes from other plagiocephalias by following signs: supraorbital margin on the affected side is shifted downward; tip of the nose is displaced toward the affected side, root of the nose toward the healthy side. These signs facilitate correct diagnosis and treatment tactics.
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Affiliation(s)
- Sergey Alexandrovich Yasonov
- Department of Cranio-Maxillofacial Surgery, Federal State Budgetary Organization, Russian Children's Clinical Hospital, Moscow, Russia
| | - Andrey Vyacheslavovich Lopatin
- Department of Cranio-Maxillofacial Surgery, Federal State Budgetary Organization, Russian Children's Clinical Hospital, Moscow, Russia
| | - Alexandr Yurievich Kugushev
- Department of Cranio-Maxillofacial Surgery, Federal State Budgetary Organization, Russian Children's Clinical Hospital, Moscow, Russia
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Abstract
After the “Back to Sleep” campaign, promoted in 1992 by the American Academy of Paediatrics to prevent the Sudden Infant Death Syndrome (SIDS), it was recommended to place babies in a supine sleeping position. The incidence of SIDS has fallen dramatically since 1992, whereas there has been a major increase in the incidence of occipital plagiocephaly (OP). We report the data relative to the OP cases observed in the Paediatric Department of Padua Hospital between 1998 and 2003. 122 (63%) of the 194 cases of craniosynostosis observed presented OP. The 64 children that took part to the study were contacted and underwent neurological examination with an evaluation of skull shape and previous radiograms. We proposed to parents a questionnaire to define the risk factors and estimate the skull deformity over time. 58 of the 64 children presented positional plagiocephaly (PP), six had synostotic plagiocephaly (SP). Since 1998 there has been a progressive increase in cases of PP. There is a male prevalence (65%), but no side prevalence. Firstborns accounted for 33 (51%), whereas 11 were preterm infants (17%). 82% had a gestational age between the 38th and 40th week. The mean value of the Apgar Index was 8 at the first minute and 9 at the 5th minute. At birth the clinical presentation was: occipital flattening already present at birth in 23 children, preferential head orientation in 18, congenital torticollis in 12, ear asymmetry in 12, frontal bossing in ten. We noticed a mild developmental delay in 8 children (13%). The maximum degree of cranial asymmetry was observed in two peaks in cases of PP: at the third and fourth months (34 cases) and then at the sixth and seventh months (13 cases). The SP presented a progressive exacerbation of the deformity until surgery (done at the sixth to seventh months). PP improved by hygienic postural norms in six months; only three patients required surgery for aesthetic reasons. We observed a strict correlation between side of flattening and sleep head position ( χ2 test, p-value=2,256e-09) and a higher degree of occipital flattening at birth in patients with associated congenital torticollis (Mann-Whitney test, p-value=0.002744). In conclusion, OP is a common condition but essentially benign; it does not cause medical consequences but aesthetic problems. It is necessary to recognize the mild deformity in the newborns so as to intervene early with hygienic postural norms that can correct the asymmetry. The diagnosis is largely clinical and only in case of doubt are radiological examinations required (ultrasonography for sutures, 3D CT scans).
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Affiliation(s)
- S. Stefani
- Department of Paediatrics, University of Padua, Padua, Italy
| | - P. Drigo
- Department of Paediatrics, University of Padua, Padua, Italy
| | - R. Faggin
- Department of Paediatrics, University of Padua, Padua, Italy
| | - A.M. Laverda
- Department of Paediatrics, University of Padua, Padua, Italy
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Abstract
Reconstruction for single sutural synostosis typically involves cranial reshaping to correct for compensatory growth changes. Current remodeling techniques involve obliteration of both pathologic and normal sutures. Presented here is a case report describing a new approach to the treatment of single cranial synostosis. The concept involves excision of the offending suture and transient plating of the remaining functional sutures. Compensatory sutures are then allowed to direct the growth forces to the area of the synostosis, leading to the reversal of the compensatory shape deformity. This more natural approach leaves functioning sutures intact and allows for their active participation in the reshaping process.
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9
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Matushita H, Alonso N, Cardeal DD, Andrade FGD. Major clinical features of synostotic occipital plagiocephaly: mechanisms of cranial deformations. Childs Nerv Syst 2014; 30:1217-24. [PMID: 24728485 DOI: 10.1007/s00381-014-2414-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 03/27/2014] [Indexed: 01/21/2023]
Abstract
PURPOSE The clinical diagnosis of most common single-suture craniosynostosis is easily set, based on the stereotype of deformities and knowledge of the mechanisms of cranial deformations. However, synostosis of unilateral lambdoid suture, probably due to its lower incidence and similarity with other non-synostotic deformities affecting the posterior portion of the skull, makes its clinical diagnosis more difficult and imprecise. The aim of this study is to evaluate the most easily and accurate clinical characteristics to be recognized in the synostotic occipital plagiocephaly. METHODS This study consisted of clinical evaluation of eight patients with synostotic occipital plagiocephaly, whose diagnosis was further corroborated by computed tomography. RESULTS We identified the following: unilateral occipital flattening in eight out of eight patients (100 %), bulging of ipsilateral mastoid process in eight out of eight (100 %), "edge effect" of ipsilateral lambdoid suture in eight out of eight (100 %), inferior deviation of the ear in eight out of eight (100 %), "Dumbo" ears in eight out of eight (100 %), horizontal slant of the bimastoid line in seven out of eight (87.5 %), tilt of the head viewed from behind in seven out of eight (87.5 %), trapezoidal contour of the skull in top view in six out of eight (75 %), contralateral parietal bossing in six out of eight (75 %), and bossing of the contralateral forehead three out of eight (37.5 %). CONCLUSIONS The most important clinical features specific to the clinical diagnosis of synostotic occipital plagiocephaly, not present in the positional posterior plagiocephaly, were bulging of the ipsilateral mastoid process, edge effect of the synostotic lambdoid suture, tilt of the head, and slant of the bimastoid line viewed from behind, inferior deviation of the ear, and contralateral parietal bossing.
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Affiliation(s)
- Hamilton Matushita
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of São Paulo, São Paulo, Brazil,
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Clinical and imaging findings in children with non-syndromic lambdoid synostosis. Eur J Pediatr 2014; 173:435-40. [PMID: 24162514 DOI: 10.1007/s00431-013-2186-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 10/09/2013] [Accepted: 10/10/2013] [Indexed: 10/26/2022]
Abstract
UNLABELLED True unilateral lambdoid synostosis is a very rare type of craniosynostosis. Patients present with unilateral posterior plagiocephaly. The differentiation between frequent, simple positional (deformational) posterior plagiocephaly and lambdoid synostosis is not easy and to date subject of controversy. Accurate and early diagnosis is important, because treatment is different. Simple positional plagiocephaly responds to conservative treatment, but craniosynostosis may require neurosurgical intervention. We analyzed clinical presentation of five patients in whom non-syndromic lambdoid synostosis was confirmed by CT imaging, in one additionally by high-resolution ultrasound, and finally neurosurgical intervention. However, clinical inspection alone did not reliably identify infants with lambdoid synostosis. CONCLUSION Diagnosis of lambdoid synostosis is not always possible based on clinical inspection alone. To confirm the diagnosis imaging is recommended. There is evidence that high-resolution ultrasound can be used first-line in the future.
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Deformational plagiocephaly, brachycephaly, and scaphocephaly. Part I: terminology, diagnosis, and etiopathogenesis. J Craniofac Surg 2011; 22:9-16. [PMID: 21187783 DOI: 10.1097/scs.0b013e3181f6c313] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Cranial deformation is the most common cause of abnormal head shape. Intentional and unintentional alterations of cranial form are associated with the application of external pressure to the growing infant head, and such changes have been recorded throughout man's history. Recent changes in Western sleeping practices, instituted to reduce the incidence of sudden infant death syndrome, have led to a dramatic rise in the incidence of cranial deformation and renewed interest in this subject. This 2-part review presents a pragmatic clinical approach to this topic including a critical review of the literature as it applies to each aspect of this common diagnosis: historical perspective, terminology, differential diagnosis, etiopathogenesis and predisposing factors, and prevention and treatment.
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Lessard S, Gagnon I, Trottier N. Exploring the impact of osteopathic treatment on cranial asymmetries associated with nonsynostotic plagiocephaly in infants. Complement Ther Clin Pract 2011; 17:193-8. [PMID: 21982132 DOI: 10.1016/j.ctcp.2011.02.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To document the evolution of cranial asymmetries in infants with signs of nonsynostotic occipital plagiocephaly (NSOP) who were to undergo a course of four osteopathic treatments (in addition to the standard positioning recommendations) as well as to determine the feasibility of using this methodology to conduct a randomized clinical trial investigating the impact of osteopathic intervention for infants with NSOP. DESIGN Pilot clinical standardization project using pre-post design in which 12 infants participated. Ten infants presented an initial Oblique Diameter Difference Index (ODDI) over 104% and five of them had an initial moderate to severe Cranial Vault Asymmetry (CVA) (over 12mm). INTERVENTIONS Infants received four osteopathic treatments at 2-week intervals. MAIN OUTCOME MEASURES Anthropometric, plagiocephalometric as well as qualitative measures were administered pre-intervention (T1), during the third treatment (T2) and two weeks after the fourth treatment (T3). RESULTS Participants showed a significant decrease in CVA (p=0.02), Skull Base Asymmetry (SBA) (p=0.01), Trans-Cranial Vault Asymmetry (TCVA) (p<0.003) between the first and third evaluations. CONCLUSIONS These clinical findings support the hypothesis that osteopathic treatments contribute to the improvement of cranial asymmetries in infants younger than 6.5 months old presenting with NSOP characteristics.
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Abstract
Supernumerary cranial sutures represent a rare cause of plagiocephaly. In the case of an extra suture dividing the parietal bone, the presenting features are often inconsistent with the typical presentation of deformational or synostotic plagiocephaly. Disagreement exists as to how the presence of this suture affects the shape of the skull. We present a case of a supernumerary suture in the parietal bone leading to plagiocephaly and discuss the role this suture plays in cranial growth.
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15
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Abstract
Craniosynostosis is characterized by the fusion of sutures. It presents with an abnormal head shape. This article examines this defect and discusses its embryologic origin. A systemic physical assessment guide serves as a tool to enhance early recognition of this defect. Pictorial examples increase understanding of the defect. A discussion of treatment and nursing implications, with an emphasis on family support, is provided.
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Kaifu Y, Baba H, Kurniawan I, Sutikna T, Saptomo EW, Jatmiko, Awe RD, Kaneko T, Aziz F, Djubiantono T. Brief communication: “Pathological” deformation in the skull of LB1, the type specimen ofHomo floresiensis. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2009; 140:177-85. [DOI: 10.1002/ajpa.21066] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Craniosynostosis in the Middle Pleistocene human Cranium 14 from the Sima de los Huesos, Atapuerca, Spain. Proc Natl Acad Sci U S A 2009; 106:6573-8. [PMID: 19332773 DOI: 10.1073/pnas.0900965106] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We report here a previously undescribed human Middle Pleistocene immature specimen, Cranium 14, recovered at the Sima de los Huesos (SH) site (Atapuerca, Spain), that constitutes the oldest evidence in human evolution of a very rare pathology in our own species, lambdoid single suture craniosynostosis (SSC). Both the ecto- and endo-cranial deformities observed in this specimen are severe. All of the evidence points out that this severity implies that the SSC occurred before birth, and that facial asymmetries, as well as motor/cognitive disorders, were likely to be associated with this condition. The analysis of the present etiological data of this specimen lead us to consider that Cranium 14 is a case of isolated SSC, probably of traumatic origin. The existence of this pathological individual among the SH sample represents also a fact to take into account when referring to sociobiological behavior in Middle Pleistocene humans.
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Comparison of Computed Tomographic Imaging Measurements with Clinical Findings in Children with Unilateral Lambdoid Synostosis. Plast Reconstr Surg 2009; 123:300-309. [DOI: 10.1097/prs.0b013e31819346b5] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nuysink J, van Haastert IC, Takken T, Helders PJM. Symptomatic asymmetry in the first six months of life: differential diagnosis. Eur J Pediatr 2008; 167:613-9. [PMID: 18317801 PMCID: PMC2292481 DOI: 10.1007/s00431-008-0686-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Revised: 01/27/2008] [Accepted: 01/29/2008] [Indexed: 12/01/2022]
Abstract
Asymmetry in infancy is a clinical condition with a wide variation in appearances (shape, posture, and movement), etiology, localization, and severity. The prevalence of an asymmetric positional preference is 12% of all newborns during the first six months of life. The asymmetry is either idiopathic or symptomatic. Pediatricians and physiotherapists have to distinguish symptomatic asymmetry (SA) from idiopathic asymmetry (IA) when examining young infants with a positional preference to determine the prognosis and the intervention strategy. The majority of cases will be idiopathic, but the initial presentation of a positional preference might be a symptom of a more serious underlying disorder. The purpose of this review is to synthesize the current information on the incidence of SA, as well as the possible causes and the accompanying signs that differentiate SA from IA. This review presents an overview of the nine most prevalent disorders in infants in their first six months of life leading to SA. We have discovered that the literature does not provide a comprehensive analysis of the incidence, characteristics, signs, and symptoms of SA. Knowledge of the presented clues is important in the clinical decision making with regard to young infants with asymmetry. We recommend to design a valid and useful screening instrument.
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Affiliation(s)
- Jacqueline Nuysink
- Department of Pediatric Physical Therapy & Exercise Physiology, Wilhelmina Children's Hospital, University Medical Center, KB 02.056.0, P.O. Box 85090, 3508 AB Utrecht, The Netherlands.
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Smartt JM, Reid RR, Singh DJ, Bartlett SP. True Lambdoid Craniosynostosis: Long-Term Results of Surgical and Conservative Therapy. Plast Reconstr Surg 2007; 120:993-1003. [PMID: 17805129 DOI: 10.1097/01.prs.0000278043.28952.e8] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND True lambdoid synostosis is a rare malformation. Few clinical reports have examined the efficacy of conservative or surgical management in the care of these patients. METHODS All patients with a diagnosis of true lambdoid synostosis treated by the senior author (S.P.B.) at The Children's Hospital of Philadelphia between 1990 and 2005 were included in the study. Both qualitative and quantitative assessments of craniofacial growth were performed following either conservative or surgical management. Qualitative assessments were made based on preoperative and postoperative photographs, computed tomographic scans, and a review of patient charts. A quantitative assessment of ear position was performed using craniometric analysis and the appropriate statistical tests. RESULTS The study included nine patients--six who underwent surgical intervention and three who did not undergo transcranial surgery to date. The authors' analysis of patient data revealed a predictable craniofacial dysmorphism manifest as occipital flattening, an ipsilateral occipitomastoid bulge, and a pronounced hemifacial deficiency. Generally, these malformations improved following operative management. A quantitative analysis of preoperative and postoperative ear position displayed no statistically significant vertical or anteroposterior displacement. In one untreated patient, true lambdoid synostosis resulted in persistent severe asymmetry of the cranial vault and facial skeleton. CONCLUSIONS True lambdoid synostosis, if left untreated, results in pronounced craniofacial asymmetry. Although a diversity of clinical presentations exists, diagnostic features include occipital flattening, an ipsilateral occipitomastoid bulge, and a contralateral hemifacial deficiency. Posterior vault switch cranioplasty is an effective treatment for true lambdoid synostosis when performed in the first year of life.
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Affiliation(s)
- James M Smartt
- Philadelphia, Pa. From the Division of Plastic Surgery, The Children's Hospital of Philadelphia, and the Department of Surgery, University of Pennsylvania Medical Center
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Kapp-Simon KA, Speltz ML, Cunningham ML, Patel PK, Tomita T. Neurodevelopment of children with single suture craniosynostosis: a review. Childs Nerv Syst 2007; 23:269-81. [PMID: 17186250 DOI: 10.1007/s00381-006-0251-z] [Citation(s) in RCA: 175] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2006] [Revised: 07/21/2006] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Rates of neurocognitive risk range from 35-50% of school-aged children with isolated single suture craniosynostosis (SSC). It has been hypothesized that early surgical intervention to release suture fusion reduces risk for increased intracranial pressure (ICP) and the corresponding risk to neurodevelopment. However, studies assessing children with SSC have been inconsistent in finding an association between neurocognitive development, age of surgery, and ICP. REVIEW SSC produces notable distortion of the cranial vault and underlying brain mass. Although a linear relationship between skull distortion, ICP, and neurocognitive deficits has generally been assumed, recent studies have postulated an interactive process between the skull and developing brain that results in neuroanatomical changes that are not limited to areas directly beneath the fused suture. The specific neuropsychological deficits identified in children with SSC including problems with attention and planning, processing speed, visual spatial skills, language, reading, and spelling may be related to the anatomic differences that persist after correction of suture fusion. CONCLUSIONS Available literature on neurocognitive development of children with SSC is suggestive of mild but persistent neuropsychological deficits, which become more significant as cognitive demands increase at school age. Anatomical studies of children without SSC are beginning to identify particular groups of brain structures that if disrupted or malformed, may be associated with specific cognitive deficits. Controlled research investigating the relationship between persistent anatomical changes and neurocognitive functioning of school-aged children with SSC is needed.
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Affiliation(s)
- Kathleen A Kapp-Simon
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Sergueef N, Nelson KE, Glonek T. Palpatory diagnosis of plagiocephaly. Complement Ther Clin Pract 2006; 12:101-10. [PMID: 16648087 DOI: 10.1016/j.ctcp.2005.11.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2005] [Revised: 10/31/2005] [Accepted: 11/02/2005] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The term plagiocephaly, from the Greek plagios (oblique) and kephalê (head), means distortion of the head, and refers clinically to cranial asymmetry. Cranial Osteopathy, since it was first proposed, has focussed upon the diagnosis and treatment of birth trauma and cranial asymmetries, and consequently specific therapy for plagiocephalic deformities has been described. Osteopathic manipulation also has been proposed as a treatment for torticollis, a condition associated with plagiocephaly. For these reasons, we decided to look at the mechanics of the occipital bone and the adjacent atlas and bones of the cranial base, in relation to functional plagiocephaly. METHODS The records of 649 children seen in an osteopathic practice in Lyon, France, were reviewed retrospectively, in compliance with the legal requirements of the Commission Nationale de l'Informatique et des Libertés (CRIL) and the Helsinki accord, for gender, age at presentation, birth history, obstetrical data (breech presentation, vacuum extraction, forceps delivery or Caesarean section), presenting complaint, side of posterior plagiocephaly, side of frontal plagiocephaly, torticollis, motion pattern of the occipital bone upon the atlas, and motion pattern of the spheno-occipital synchondrosis. RESULTS We found significant correlations between plagiocephaly (right/left) and primipara (P=0.024), use of forceps (P=0.055) and extractor suction (P=0.055). Correlations were also found between flattening of the occiput (right/left) and lateral strain of the spheno-occipital synchondrosis (P=0.002) and between plagiocephaly (right/left) and occipito-atlantal motion (P=0.000). CONCLUSION We found a significant correlation between the lateral strain pattern of the spheno-occipital synchondrosis and plagiocephaly and between rotational dysfunction of the occiput upon the atlas and the side of posterior plagiocephaly. We suggest that thorough neonatal osteopathic examination can identify individuals predisposed to develop posterior plagiocephaly.
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MESH Headings
- Atlanto-Occipital Joint/physiopathology
- Axis, Cervical Vertebra/physiopathology
- Biomechanical Phenomena
- Cervical Atlas/physiopathology
- Delivery, Obstetric/adverse effects
- Delivery, Obstetric/methods
- Extraction, Obstetrical/adverse effects
- Extraction, Obstetrical/instrumentation
- Extraction, Obstetrical/methods
- Female
- France
- Humans
- Infant
- Infant, Newborn
- Male
- Neonatal Screening/methods
- Occipital Bone/physiopathology
- Osteopathic Medicine/methods
- Palpation/methods
- Parity
- Plagiocephaly, Nonsynostotic/diagnosis
- Plagiocephaly, Nonsynostotic/etiology
- Plagiocephaly, Nonsynostotic/physiopathology
- Pregnancy
- Range of Motion, Articular
- Retrospective Studies
- Risk Factors
- Rotation
- Torticollis/etiology
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Affiliation(s)
- Nicette Sergueef
- Department of Osteopathic Manipulative Medicine, Midwestern University, 555 31st Street, Downers Grove, IL, USA
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Abstract
Over the past decade there has been a dramatic increase in referrals to specialty clinics, craniofacial centers, plastic surgeons, and neurosurgeons for assessment and treatment of deformational plagiocephaly (DP). Though considered a medically benign condition, preliminary reports suggest that DP may be associated with developmental problems. However, mechanisms to account for this association have not been hypothesized or empirically tested. Although treatment justifications often center on prevention of atypical appearance, little is known about the cosmetic outcomes of treated and untreated children. In this review we hypothesize different etiological pathways linking DP with neurodevelopment (e.g., environmental positioning limitations with and without underlying CNS pathology). We outline directions for research on incidence and prevalence, developmental outcomes, sex differences, determinants of treatment participation, and craniofacial appearance. Despite the paucity of existing research, preliminary findings suggest that children with this condition should be screened and monitored for developmental delays or deficits, as we await more conclusive information from future studies.
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Affiliation(s)
- Brent Collett
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
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