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Remesz R, Khurelbaatar T, Rabey KN, Doschak MR, Romanyk DL. Three-dimensional morphometric analysis of cranial sutures - A novel approach to quantitative analysis. Bone Rep 2023; 19:101714. [PMID: 37767331 PMCID: PMC10520544 DOI: 10.1016/j.bonr.2023.101714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/16/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
Objective Differences in complexity of cranial suture forms on the endocranial (i.e., deep) and ectocranial (i.e., superficial) skull surfaces have been noted in the literature, indicating through thickness three-dimensional (3D) suture variability depending on the chosen section and necessity for considering the complete 3D structure in many cases. This study aims to evaluate the variability of suture morphology through the skull thickness using a rat model, and to provide more robust metrics and methodologies to analyze suture morphology. Design X-ray micro-computed tomographic (μCT) imaging methods were utilized in order to provide internal structure information. Methods were developed to isolate and analyze sutures widths and linear interdigitation index (LII) values on each adjacent offset transverse plane of the μCT datasets. LII was defined as the curved path length of the suture divided by the linear length between the ends of the region of interest. Scans were obtained on 15 female rats at ages of 16, 20, and 24 weeks (n = 5/age). Samples were imaged at 18 μm resolutions with 90 kV source voltage, 278 μA source amperage, and 0.7° increments. Suture widths and LII values were compared using a Kruskal-Wallis test. Results 3D variability in local suture widths within individuals, as well as through thickness variabilities in planar widths and LII was observed. Kruskal-Wallis tests for bulk through thickness averaged suture widths and LII were found to be statistically insignificant, despite clear geometric differences through suture thicknesses. Conclusion Although the bulk morphometric variability between age groups was found to be statistically insignificant, the 3D variability within individuals point to the importance of analyzing suture form using 3D metrics when studying suture development, response to functional activity, or morphometry in general.
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Affiliation(s)
- Ross Remesz
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB, Canada
| | | | - Karyne N. Rabey
- Division of Anatomy, Department of Surgery, University of Alberta, Edmonton, AB, Canada
- Department of Anthropology, University of Alberta, Edmonton, AB, Canada
| | - Michael R. Doschak
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Dan L. Romanyk
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB, Canada
- School of Dentistry, University of Alberta, Edmonton, AB, Canada
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Di Rocco F, Proctor MR. Technical evolution of pediatric neurosurgery: craniosynostosis from 1972 to 2023 and beyond. Childs Nerv Syst 2023; 39:2779-2787. [PMID: 37584742 DOI: 10.1007/s00381-023-06113-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 08/01/2023] [Indexed: 08/17/2023]
Abstract
Very few clinical entities have undergone so many different treatment approaches over such a short period of time as craniosynostosis. Surgical treatments for this condition have ranged from simple linear craniectomies, accounting for the specific role of cranial sutures in assuring the normal growth of the skull, to more complex cranial vault reconstructions, based on the perceived role of the skull base in affecting the growth of the skull. While a great deal of evolution has occurred, there remains controversy regarding the ideal treatment including the best surgical technique, the optimal age for surgery, and the long-term morphological and neurodevelopmental outcomes. The evolution of the surgical management of craniosynostosis in the last 50 years has been affected by several factors. This includes the awareness of needing to operate on affected children during infancy to achieve the best results, the use of multistage operations, the availability of more sophisticated surgical tools, and improved perioperative care. In some forms of craniosynostosis, the operations can be carried out at a very young age with low morbidity, and with the postoperative use of a molding helmet, springs, or distractors, these operations prove to be as effective as traditional larger cranial reconstructions performed in older children. As a consequence, complex surgical operations have become progressively less utilized. A second relevant advance was the more recent advent of a molecular diagnosis, which allowed us to understand the pathogenesis of some associated malformations and neurodevelopmental issues that were observed in some children despite appropriate surgical treatment. Future research should focus on improving the analysis of longer-term outcomes and understanding the natural history of craniofacial conditions, including what issues persist despite optimal surgical correction. Progress in molecular investigations concerning the normal and pathological development of cranial sutures could be a further significant step in the management of craniosynostosis, possibly favoring a "medical" treatment in the near future. Artificial intelligence will likely have a role in establishing the diagnosis with less reliance on radiographic studies and in assisting with surgical planning. Overall, much progress has been made, but there remains much to do.
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Affiliation(s)
- Federico Di Rocco
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, INSERM 1033, Université de Lyon, Centre de Reference Malformations Craniofaciales, Lyon, France
| | - Mark R Proctor
- Department of Neurosurgery, Boston Children's Hospital/Harvard Medical School, 300 Longwood Ave, Boston, MA, 02459, USA.
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Kara M, Ricci V, Pirri C, Sekizkardeş M, Cocco G, Stecco C, Kaymak B, Özçakar L. Sonographic guide for botulinum toxin injections for chronic migraine headache: EURO-MUSCULUS/USPRM approach. Clin Neurol Neurosurg 2023; 232:107883. [PMID: 37467578 DOI: 10.1016/j.clineuro.2023.107883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/01/2023] [Accepted: 07/05/2023] [Indexed: 07/21/2023]
Abstract
Application of botulinum toxin A (BoNT-A) into the muscles of the head and neck area has become a widespread and reliable treatment modality for chronic migraine. The mechanism of action for BoNT-A is the inhibition of acetylcholine and local nociceptive peptide release at the terminal nerve endings. Cranial sutures have the highest concentration of nociceptive structures; therefore BoNT-A injection into the suture lines - as opposed to head and neck muscles - has been proposed for the treatment of chronic migraine. Nerve endings in sutures rapidly absorb BoNT-A and transfer it across the afferent nerve fibers in dura mater via orthodromic and antidromic transmission. In this article, ultrasound-guided BoNT-A application around the cranial sutures will be illustrated. It is noteworthy that suture injections would be safer and more efficient when applied with such guidance.
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Affiliation(s)
- Murat Kara
- Hacettepe University Medical School, Department of Physical and Rehabilitation Medicine, Ankara, Turkey
| | - Vincenzo Ricci
- Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy.
| | - Carmelo Pirri
- Department of Neuroscience, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy
| | - Merve Sekizkardeş
- Marmara University, Pendik Training and Research Hospital, Department of Physical and Rehabilitation Medicine, İstanbul, Turkey
| | - Giulio Cocco
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Aging Sciences, University "G. d'Annunzio", Chieti, Italy
| | - Carla Stecco
- Department of Neuroscience, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; Centre for Mechanics of Biological Materials, University of Padova, 35131 Padova, Italy
| | - Bayram Kaymak
- Hacettepe University Medical School, Department of Physical and Rehabilitation Medicine, Ankara, Turkey
| | - Levent Özçakar
- Hacettepe University Medical School, Department of Physical and Rehabilitation Medicine, Ankara, Turkey
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Hernández-Alfaro F, Ghuloom M, Giralt-Hernando M, Lázaro-Abdulkarim A, Valls-Ontañón A. Transmucosal pterygomaxillary disjunction using a piezoelectric device, in the context of the minimally invasive Le Fort I osteotomy protocol. Int J Oral Maxillofac Surg 2022:S0901-5027(22)00317-4. [PMID: 35989230 DOI: 10.1016/j.ijom.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 11/22/2022]
Abstract
The aim of this study was to assess the accuracy and clinical implications of pterygomaxillary junction (PMJ) disjunction with a transmucosal PMJ osteotomy using a piezoelectric hand-piece device, in the context of Le Fort I osteotomy, by evaluating the level of PMJ disarticulation and the need for bone trimming around the pedicle. An ambidirectional 1-month follow-up cohort study was designed involving consecutive patients undergoing minimally invasive maxillary Le Fort I osteotomy through the twist technique. Two cohorts were defined according to whether or not the transmucosal PMJ osteotomy was performed. The site of PMJ disjunction was analysed radiographically. A total of 114 patients were included in the study, 57 in each group. The overall accuracy of the PMJ disjunction path was higher in the test group (43.9%) than in the control group (15.8%). Multiple logistic regression analysis identified the need for bone trimming (odds ratio 0.02; P < 0.001) and removal of the upper third molar (odds ratio 0.17; P < 0.001) as relevant factors. In conclusion, compared with the originally described twist technique, combination of the latter with the PMJ osteotomy increased its accuracy at the level of the PMJ. As a result, there is a decrease in resistance during down-fracture and decrease in the need for bone trimming around the pedicle, with preservation of the minimally invasive concept.
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Remesz R, Khurelbaatar T, Grotski M, Popowics T, Rafferty K, Herring SW, Addison O, Doschak MR, Romanyk DL. Cranial suture morphometry and mechanical response to loading: 2D vs. 3D assumptions and characterization. Biomech Model Mechanobiol 2022. [PMID: 35666355 DOI: 10.1007/s10237-022-01588-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 04/23/2022] [Indexed: 11/02/2022]
Abstract
Cranial sutures are complex soft tissue structures whose mechanics are often studied due to their link with bone growth in the skull. Researchers will often use a cross-sectional two-dimensional slice to define suture geometry when studying morphometry and/or mechanical response to loading. However, using a single cross section neglects the full suture complexity and may introduce significant errors when defining their form. This study aims to determine trends in suture path variability through skull thickness in a swine model and the implications of using a 'representative' cross section on mechanical modeling. To explore these questions, a mixture of quantitative analysis of computed tomography images and finite element models was used. The linear interdigitation and width of coronal and sagittal sutures were analyzed on offset transverse planes through the skull thickness. It was found that sagittal suture width and interdigitation were largely consistent through the skull thickness, whereas the coronal suture showed significant variation in both. The finite element study found that average values of displacement and strain were similar between the two-dimensionally variable and three-dimensionally variable models. Larger ranges and more complex distributions of strain were found in the three-dimensionally variable model. Outcomes of this study indicate that the appropriateness of using a representative cross section to describe suture morphometry and predict mechanical response should depend on specific research questions and goals. Two-dimensional approximations can be sufficient for less-interdigitated sutures and when bulk site mechanics are of interest, while taking the true three-dimensional geometry into account is necessary when considering spatial variability and local mechanical response.
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Li J, Chen Z, Zhong W, Yang H, Li Y. A study of 285 cases of cranial vault suture closure in Chinese adults. Surg Radiol Anat 2022; 44:361-368. [PMID: 35076751 DOI: 10.1007/s00276-021-02854-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/25/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To examine the presence and characteristics of cranial vault suture closure in Chinese adults and to explore whether craniosacral therapy (CST) manipulation is rational from the anatomical perspective. METHODS Anthropological non-metric observation and craniometry were used to study 285 dry skull specimens of Chinese adults. RESULTS A total of 91 specimens with closed extracranial sutures were observed, with an occurrence rate of 31.93%. Based on the mode of closure, there were 32 cases of single type closure, with sagittal suture closure predominating with 20 cases (21.98%); 59 cases of composite closure, with a partial closure of coronal suture + sagittal suture + lambdoid suture predominating with 26 cases (28.57%). In terms of the degree of closure, there were 13 cases (14.28%) of sagittal suture grade 0 closure and 78 cases (85.72%) of grade 1 - 4 closure; 34 cases (37.36%) of coronal suture grade 0 closure and 57 cases (62.64%) of grade 1 - 4 closure; 47 cases (51.65%) of lambdoid suture grade 0 closure and 44 cases (48.35%) of grade 1 - 4 closure. The segment and degree of coronal suture closure (46, 80.7%) and lambdoid suture (31, 70.45%) were mostly left-right symmetrical. The bone surfaces on either side of the cranial vault sutures are embedded in each other, forming a rough, complex and interlocking bone-suture-bone structure. CONCLUSION This study observed the closure of the cranial vault suture, summarized its characteristics, and explored the irrationality of the CST manipulation. The anatomical characteristics of the cranial suture dictate that manipulation cannot push the cranial suture at will.
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Affiliation(s)
- JunHua Li
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, 510515, China
| | - ZuJiang Chen
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, 510515, China
| | - WeiXing Zhong
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Han Yang
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, 510515, China
| | - YiKai Li
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, 510515, China.
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Ting MC, Farmer DT, Teng CS, He J, Chai Y, Crump JG, Maxson RE. Embryonic requirements for Tcf12 in the development of the mouse coronal suture. Development 2022; 149:273884. [PMID: 34878091 PMCID: PMC8783042 DOI: 10.1242/dev.199575] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 11/22/2021] [Indexed: 01/07/2023]
Abstract
A major feature of Saethre-Chotzen syndrome is coronal craniosynostosis, the fusion of the frontal and parietal bones at the coronal suture. It is caused by heterozygous loss-of-function mutations in either of the bHLH transcription factors TWIST1 and TCF12. Although compound heterozygous Tcf12; Twist1 mice display severe coronal synostosis, the individual role of Tcf12 had remained unexplored. Here, we show that Tcf12 controls several key processes in calvarial development, including the rate of frontal and parietal bone growth, and the boundary between sutural and osteogenic cells. Genetic analysis supports an embryonic requirement for Tcf12 in suture formation, as combined deletion of Tcf12 in embryonic neural crest and mesoderm, but not in postnatal suture mesenchyme, disrupts the coronal suture. We also detected asymmetric distribution of mesenchymal cells on opposing sides of the wild-type frontal and parietal bones, which prefigures later bone overlap at the sutures. In Tcf12 mutants, reduced asymmetry is associated with bones meeting end-on-end, possibly contributing to synostosis. Our results support embryonic requirements of Tcf12 in proper formation of the overlapping coronal suture.
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Affiliation(s)
- Man-chun Ting
- Department of Biochemistry and Molecular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - D'Juan T. Farmer
- Department of Stem Cell Biology and Regenerative Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Camilla S. Teng
- Department of Biochemistry and Molecular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA,Department of Stem Cell Biology and Regenerative Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Jinzhi He
- Center for Craniofacial Molecular Biology, School of Dentistry, University of Southern California, Los Angeles, CA 90033, USA
| | - Yang Chai
- Center for Craniofacial Molecular Biology, School of Dentistry, University of Southern California, Los Angeles, CA 90033, USA
| | - J. Gage Crump
- Department of Stem Cell Biology and Regenerative Medicine, University of Southern California, Los Angeles, CA 90033, USA,Authors for correspondence (, )
| | - Robert E. Maxson
- Department of Biochemistry and Molecular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA,Department of Stem Cell Biology and Regenerative Medicine, University of Southern California, Los Angeles, CA 90033, USA,Authors for correspondence (, )
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Muroi A, Enomoto T, Ihara S, Ishikawa E, Inagaki T, Matsumura A. Developmental changes in the occipital cranial sutures of children less than 2 years of age. Childs Nerv Syst 2021; 37:567-572. [PMID: 32767105 DOI: 10.1007/s00381-020-04844-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 07/28/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The occipital bone is located on the boundary between the membranous and cartilage bones and contains a wide variety of accessory sutures. In this study, we describe the age distribution of pediatric patients who are less than 2 years of age with occipital cranial sutures using a three-dimensional computed tomography (3D-CT). METHODS A total of 167 consecutive patients who are less than 2 years of age and underwent computed tomography for head trauma were included in this study. RESULTS Based on the results of this study, various types of sutures were observed among the pediatric participants. In particular, superior median fissures, mendosal sutures, other interparietal segment's accessory sutures, and interparietal sutures were noted in 21%, 35%, 9%, and 6% of the participants, respectively. Additionally, Wormian bones within the lambdoid suture were noted in 32% of the patients. The median age of children with superior median fissure and mendosal suture was 0 month. Meanwhile, superior median fissure was not observed among children older than 5 months of age. In this population, 13 patients (8%) were found to have skull fracture. CONCLUSIONS Knowledge of the normal cranial anatomy and developmental patterns of cranial sutures is crucial in the evaluation of questionable fractures in the occipital region. A combination of 3D-CT and axial bone window imaging is useful in differentiating normal structures from pathological changes in the cranium.
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Affiliation(s)
- Ai Muroi
- Division of Pediatric Neurosurgery, Ibaraki Children's Hospital, Mito, Ibaraki, Japan. .,Department of Neurosurgery, University of Tsukuba, Tsukuba, Ibaraki, Japan.
| | - Takao Enomoto
- Department of Neurosurgery, Tsukuba Central Hospital, Ushiku, Tsukuba, Japan
| | - Satoshi Ihara
- Division of Neurosurgery, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Takayuki Inagaki
- Division of Pediatric Neurosurgery, Ibaraki Children's Hospital, Mito, Ibaraki, Japan
| | - Akira Matsumura
- Department of Neurosurgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Kronig ODM, Kronig SAJ, Van Adrichem LNA. New method for quantification of severity of isolated scaphocephaly linked to intracranial volume. Childs Nerv Syst 2021; 37:1175-1183. [PMID: 33070215 PMCID: PMC8009791 DOI: 10.1007/s00381-020-04932-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/13/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim is to implement Utrecht Cranial Shape Quantificator (UCSQ) for quantification of severity of scaphocephaly and compare UCSQ with the most used quantification method, cranial index (CI). Additionally, severity is linked to intracranial volume (ICV). METHODS Sinusoid curves of 21 pre-operative children (age < 2 years) with isolated scaphocephaly were created. Variables of UCSQ (width of skull and maximum occiput and forehead) were combined to determine severity. CI was calculated. Three raters performed visual scoring for clinical severity (rating of 6 items; total score of 12 represents most severe form). Pearson's correlation test was used for correlation between UCSQ and visual score and between both CIs. ICV was calculated using OsiriX. ICV was compared to normative values and correlated to severity. RESULTS Mean UCSQ was 22.00 (2.00-42.00). Mean traditional CI was 66.01 (57.36-78.58), and mean visual score was 9.1 (7-12). Correlations between both traditional CI and CI of UCSQ and overall visual scores were moderate and high (r = - 0.59; p = 0.005 vs. r = - 0.81; p < 0.000). Mean ICV was 910 mL (671-1303), and ICV varied from decreased to increased compared to normative values. Negligible correlation was found between ICV and UCSQ (r = 0.26; p > 0.05) and between ICV and CI and visual score (r = - 0.30; p > 0.05 and r = 0.17; p > 0.05, respectively). CONCLUSION Our current advice is to use traditional CI in clinical practice; it is easy to use and minimally invasive. However, UCSQ is more precise and objective and captures whole skull shape. Therefore, UCSQ is preferable for research. Additionally, more severe scaphocephaly does not result in more deviant skull volumes.
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Affiliation(s)
- Otto D. M. Kronig
- grid.7692.a0000000090126352Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Utrecht, Netherlands ,grid.7692.a0000000090126352Department of Plastic and Reconstructive Surgery and Hand Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Sophia A. J. Kronig
- grid.7692.a0000000090126352Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Léon N. A. Van Adrichem
- grid.7692.a0000000090126352Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Utrecht, Netherlands
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Kong L, Wang Y, Ji Y, Chen J, Cui J, Shen W. Isolation and Characterization of Human Suture Mesenchymal Stem Cells In Vitro. Int J Stem Cells 2020; 13:377-385. [PMID: 32587131 PMCID: PMC7691854 DOI: 10.15283/ijsc20024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 05/31/2020] [Accepted: 06/06/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Cranial sutures play a critical role in adjustment of skull development and brain growth. Premature fusion of cranial sutures leads to craniosynostosis. The aim of the current study was to culture and characterize human cranial suture mesenchymal cells in vitro. METHODS The residual skull tissues, containing synostosed or contralateral suture from three boys with right coronal suture synostosis, were used to isolate the suture mesenchymal cells. Then, flow cytometry and multilineage differentiation were performed to identify the typical mesenchymal stem cell (MSC) properties. Finally, we used quantitative real-time polymerase chain reaction (RT-PCR) to detect the mRNA expression of osteogenesis and stemness related genes. RESULTS After 3 to 5 days in culture, the cells migrated from the tissue explants and proliferated parallelly or spirally. These cells expressed typical MSC markers, CD73, CD90, CD105, and could give rises to osteocytes, adipocytes and chondrocytes. RT-PCR showed relatively higher levels of Runx2, osteocalcin and FGF2 in the fused suture MSCs than in the normal cells. However, BMP3, the only protein of BMP family that inhibits osteogenesis, reduced in synostosed suture derived cells. The expression of effector genes remaining cell stemness, including Bmi1, Gli1 and Axin2, decreased in the cells migrated from the affected cranial sutures. CONCLUSIONS The MSCs from prematurely occlusive sutures overexpressed osteogenic related genes and down-regulated stemness-related genes, which may further accelerate the osteogenic differentiation and suppress the self-renewal of stem cells leading to craniosynostosis.
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Affiliation(s)
- Liangliang Kong
- Department of Plastic Surgery, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Yuan Wang
- Department of Plastic Surgery, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Yi Ji
- Department of Plastic Surgery, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Jianbing Chen
- Department of Plastic Surgery, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Jie Cui
- Department of Plastic Surgery, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Weimin Shen
- Department of Plastic Surgery, Children’s Hospital of Nanjing Medical University, Nanjing, China
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Shah FA, Ruscsák K, Palmquist A. Transformation of bone mineral morphology: From discrete marquise-shaped motifs to a continuous interwoven mesh. Bone Rep 2020; 13:100283. [PMID: 32577436 PMCID: PMC7305389 DOI: 10.1016/j.bonr.2020.100283] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/17/2020] [Indexed: 12/24/2022] Open
Abstract
Continual bone apposition at the cranial sutures provides the unique opportunity to understand how bone is built. Bone harvested from 16-week-old Sprague Dawley rat calvaria was either (i) deproteinised to isolate the inorganic phase (i.e., bone mineral) for secondary electron scanning electron microscopy or (ii) resin embedded for X-ray micro-computed tomography, backscattered electron scanning electron microscopy, and micro-Raman spectroscopy. Interdigitated finger-like projections form the interface between frontal and parietal bones. Viewed from the surface, bone mineral at the mineralisation front is comprised of nanoscale mineral platelets arranged into discrete, ~0.6–3.5 μm high and ~0.2–1.5 μm wide, marquise-shaped motifs that gradually evolve into a continuous interwoven mesh of mineralised bundles. Marquise-shaped motifs also contribute to the burial of osteoblastic–osteocytes by contributing to the roof over the lacunae. In cross-section, apices of the finger-like projections resemble islands of mineralised tissue, where new bone apposition at the surface is evident as low mineral density areas, while the marquise-shaped motifs appear as near-equiaxed assemblies of mineral platelets. Carbonated apatite content is higher towards the internal surface of the cranial vault. Up to 4 μm from the bone surface, strong Amide III, Pro, Hyp, and Phe signals, distinct PO43− bands, but negligible CO32– signal indicate recent bone formation and/or delayed maturation of the mineral. We show, for the first time, that the extracellular matrix of bone is assembled into micrometre-sized units, revealing a superstructure above the mineralised collagen fibril level, which has significant implications for function and mechanical competence of bone. The mineralisation front at cranial sutures of 16-week-old rats was investigated Interdigitated finger-like projections extend between frontal and parietal bones Micrometre-sized, marquise-shaped motifs of bone apatite at the mineralisation front Distinct motifs evolve into interwoven mesh of mineralised bundles Cranial bones are more mineralised at the internal surface (towards the dura mater)
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Affiliation(s)
- Furqan A Shah
- Department of Biomaterials, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Krisztina Ruscsák
- Department of Biomaterials, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders Palmquist
- Department of Biomaterials, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Rachwalski M, Khonsari RH, Paternoster G. Current Approaches in the Development of Molecular and Pharmacological Therapies in Craniosynostosis Utilizing Animal Models. Mol Syndromol 2019; 10:115-123. [PMID: 30976284 DOI: 10.1159/000493535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The development of the craniofacial skeleton is a spatial and temporal process where cranial sutures play a role in the regulation of morphogenesis and growth. Disruption of these cellular and molecular interactions may lead to craniosynostosis, the premature obliteration of one or more cranial sutures, yielding skull growth restriction and malformation perpendicular to the affected suture. Facial deformity and various functional CNS anomalies are other frequent complications. Cranial vault expansion and reconstructive surgery remain the mainstay of treatment but pose an elevated risk of morbidity for the infant. While the etiology of nonsyndromic craniosynostosis remains to be deciphered, gain-of-function mutations in FGFR1-3 and TWIST1 were found to be responsible for more than 3/4 of the most commonly encountered craniofacial syndromes. Animal models have been invaluable to further dissect the role of genes within the cranial sutures and for the development of alternative nonsurgical treatment strategies. In this review, we will present various molecular and pharmacological approaches for the treatment of craniosynostosis that have been tested using in vitro and in vivo assays as well as discuss their potential application in humans focusing on the case of tyrosine kinase inhibitors.
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Affiliation(s)
- Martin Rachwalski
- Imagine Institute of Genetic Diseases, INSERM U1163, Université Paris Descartes, Sorbonne Paris Cité, Departments of Malades, Paris, France.,Pediatric Neurosurgery, Hôpital Universitaire Necker-Enfants Malades, Paris, France.,Maxillofacial and Plastic Surgery, Hôpital Universitaire Necker-Enfants Malades, Paris, France.,National Reference Center for Craniofacial Anomalies, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Roman H Khonsari
- Imagine Institute of Genetic Diseases, INSERM U1163, Université Paris Descartes, Sorbonne Paris Cité, Departments of Malades, Paris, France.,Maxillofacial and Plastic Surgery, Hôpital Universitaire Necker-Enfants Malades, Paris, France.,National Reference Center for Craniofacial Anomalies, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Giovanna Paternoster
- Pediatric Neurosurgery, Hôpital Universitaire Necker-Enfants Malades, Paris, France.,National Reference Center for Craniofacial Anomalies, Hôpital Universitaire Necker-Enfants Malades, Paris, France
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Ruan WH, Han WQ, Huang ML, Huang KL, Jin LL. Premaxillary-maxillary suture development in the first trimester : An ultrasound study. J Orofac Orthop 2019; 80:25-31. [PMID: 30607434 DOI: 10.1007/s00056-018-0163-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 10/20/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Our study was designed to investigate premaxillary-maxillary suture growth in fetuses from the first trimester of pregnancy using the B‑ultrasound technique in order to determine the suture fusion time. METHODS We selected 169 healthy Han singleton pregnancies as subjects. All subjects received routine pregnancy tests and were divided into three groups based on the gestational age of the fetus: group 1, the 11th gestational week; group 2, the 12th gestational week; and group 3, the 13th gestational week. Fetal biometric measurements were recorded during consecutive prenatal ultrasonographic examinations. These measurements included nuchal translucency thickness, crown-rump length, and premaxillary-maxillary length. Intergroup comparisons were performed using analysis of variance (ANOVA). RESULTS The premaxillary-maxillary suture grows gradually and its measured length at the 11th, 12th and 13th week was 0.54 cm, 0.65 cm, and 0.74 cm, respectively. We observed a significant linear correlation between the premaxillary-maxillary length and the week of gestation in the first trimester. The growth rate of the maxilla at the 11th, the 12th and the 13th week are significantly different with a descending order of growth rates being week 12, week 11 and week 13, with the 12th week rate being the most rapid. CONCLUSION The premaxillary and maxillary growth at 11 and 12 gestational weeks in the first trimester steadily accelerated, peaking at the 12th week. The rate of growth slows down after week 12 which may be associated with the fusion of the premaxillary-maxillary suture.
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Kutkowska-Kaźmierczak A, Gos M, Obersztyn E. Craniosynostosis as a clinical and diagnostic problem: molecular pathology and genetic counseling. J Appl Genet 2018; 59:133-47. [PMID: 29392564 DOI: 10.1007/s13353-017-0423-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 12/11/2017] [Accepted: 12/20/2017] [Indexed: 12/16/2022]
Abstract
Craniosynostosis (occurrence: 1/2500 live births) is a result of premature fusion of cranial sutures, leading to alterations of the pattern of cranial growth, resulting in abnormal shape of the head and dysmorphic facial features. In approximately 85% of cases, the disease is isolated and nonsyndromic and mainly involves only one suture. Syndromic craniosynostoses such as Crouzon, Apert, Pfeiffer, Muenke, and Saethre-Chotzen syndromes not only affect multiple sutures, but are also associated with the presence of additional clinical symptoms, including hand and feet malformations, skeletal and cardiac defects, developmental delay, and others. The etiology of craniosynostoses may involve genetic (also somatic mosaicism and regulatory mutations) and epigenetic factors, as well as environmental factors. According to the published data, chromosomal aberrations, mostly submicroscopic ones, account for about 6.7-40% of cases of syndromic craniosynostoses presenting with premature fusion of metopic or sagittal sutures. The best characterized is the deletion or translocation of the 7p21 region containing the TWIST1 gene. The deletions of 9p22 or 11q23-qter (Jacobsen syndrome) are both associated with trigonocephaly. The genes related to the pathogenesis of the craniosynostoses itself are those encoding transcription factors, e.g., TWIST1, MSX2, EN1, and ZIC1, and proteins involved in osteogenic proliferation, differentiation, and homeostasis, such as FGFR1, FGFR2, RUNX2, POR, and many others. In this review, we present the clinical and molecular features of selected craniosynostosis syndromes, genotype-phenotype correlation, family genetic counseling, and propose the most appropriate diagnostic algorithm.
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Yoshimura K, Kobayashi R, Ohmura T, Kajimoto Y, Miura T. A new mathematical model for pattern formation by cranial sutures. J Theor Biol 2016; 408:66-74. [PMID: 27519950 DOI: 10.1016/j.jtbi.2016.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 06/23/2016] [Accepted: 08/06/2016] [Indexed: 10/21/2022]
Abstract
Cranial sutures are narrow mesenchymal tissues that connect skull bones to each other. Given that they serve as growth centers in the skull, these undifferentiated tissues play crucial roles in skull development. Cranial sutures are also of clinical importance, because the premature fusion of skull bones results in a pathological condition called craniosynostosis. In newborns, skull sutures are wide and straight; during adolescence, they become thinner and start winding to form an interdigitating pattern. From a functional aspect, as the degree of interdigitation becomes larger, the strength of the connection between bones increases. However, the mechanisms underlying the maintenance of mesenchymal narrow bands or formation of interdigitation remain poorly understood. In the present study, we presented a new mathematical model that can reproduce the suture width maintenance and interdigitation formation. We can predict the width of the mesenchyme bands and wavelengths of suture interdigitations from the model.
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Affiliation(s)
| | - Ryo Kobayashi
- Department of Mathematical and Life Science, Graduate School of Science, Hiroshima University, Higashihiroshima, Hiroshima, Japan
| | | | | | - Takashi Miura
- Department of Anatomy and Cell Biology, Kyushu University Graduate School of Medicine, Fukuoka, Japan
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Schweitzer T, Kunz F, Meyer-Marcotty P, Müller-Richter UDA, Böhm H, Wirth C, Ernestus RI, Linz C. Diagnostic features of prematurely fused cranial sutures on plain skull X-rays. Childs Nerv Syst 2015; 31:2071-80. [PMID: 26298825 DOI: 10.1007/s00381-015-2890-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 08/17/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE The characteristic features of prematurely fused craniosynostosis in plain radiographs have already been described in literature, but there is no clinical trial investigating the individual features of every single form of craniosynostosis. We described suture-specific characteristics as well as its frequency of appearance in plain radiographs in every different form of craniosynostosis. Intraoperative findings served as control to confirm the diagnosis. METHODS One hundred twenty-seven children with prematurely fused cranial sutures who underwent a skull X-ray from 2008 to 2012 were investigated in the present study. In detail, 34 children with frontal, 60 with sagittal, 13 with unilateral and 14 with bilateral coronal synostosis and 3 with unilateral lambdoid craniosynostosis as well as 3 children with a bilateral lambdoid synostosis were included. RESULTS Typical radiological characteristics in craniosynostosis exist. These features as well as its frequency in craniosynostosis in plain skull radiographs are presented. In all cases, these typical features enabled a correct diagnosis, which was confirmed by intraoperative findings. CONCLUSION The frequency of the appearance of typical features is listed and may serve as a "mental internal check list" in the radiological approach to craniosynostosis. The study points out the value of plain skull X-rays as it enabled proper diagnosis in all investigated 127 cases.
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Affiliation(s)
- Tilmann Schweitzer
- Department of Neurosurgery, Section of Pediatric Neurosurgery, University Hospital of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany.
| | - Felix Kunz
- Department of Orthodontics, University Hospital of Würzburg, Würzburg, Germany
| | | | | | - Hartmut Böhm
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Clemens Wirth
- Department of Pediatric Radiology, Institute of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Ralf-Ingo Ernestus
- Department of Neurosurgery, University Hospital of Würzburg, Würzburg, Germany
| | - Christian Linz
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital of Würzburg, Würzburg, Germany
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Homayounfar N, Park SS, Afsharinejad Z, Bammler TK, MacDonald JW, Farin FM, Mecham BH, Cunningham ML. Transcriptional analysis of human cranial compartments with different embryonic origins. Arch Oral Biol 2015; 60:1450-60. [PMID: 26188427 DOI: 10.1016/j.archoralbio.2015.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 06/11/2015] [Accepted: 06/12/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Previous investigations suggest that the embryonic origins of the calvarial tissues (neural crest or mesoderm) may account for the molecular mechanisms underlying sutural development. The aim of this study was to evaluate the differences in the gene expression of human cranial tissues and assess the presence of an expression signature reflecting their embryonic origins. METHODS Using microarray technology, we investigated global gene expression of cells from the frontal and parietal bones and the metopic and sagittal intrasutural mesenchyme (ISM) of four human foetal calvaria. qRT-PCR of a selected group of genes was done to validate the microarray analysis. Paired comparison and correlation analyses were performed on microarray results. RESULTS Of six paired comparisons, frontal and parietal compartments (distinct tissue types of calvaria, either bone or intrasutural mesenchyme) had the most different gene expression profiles despite being composed of the same tissue type (bone). Correlation analysis revealed two distinct gene expression profiles that separate frontal and metopic compartments from parietal and sagittal compartments. TFAP2A, TFAP2B, ICAM1, SULF1, TNC and FOXF2 were among differentially expressed genes. CONCLUSION Transcriptional profiles of two groups of tissues, frontal and metopic compartments vs. parietal and sagittal compartments, suggest differences in proliferation, differentiation and extracellular matrix production. Our data suggest that in the second trimester of human foetal development, a gene expression signature of neural crest origin still exists in frontal and metopic compartments while gene expression of parietal and sagittal compartments is more similar to mesoderm.
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Affiliation(s)
- Negar Homayounfar
- Center for Developmental Biology and Regenerative Medicine, Seattle Children's Research Institute, 1900 - 9th Avenue, Seattle, WA 98101, United States; Department of Oral Health Sciences, Dental School, University of Washington, United States; Department of Endodontics, Prosthodontics and Operative Dentistry, School of Dentistry, University of Maryland, Baltimore, United States.
| | - Sarah S Park
- Center for Developmental Biology and Regenerative Medicine, Seattle Children's Research Institute, 1900 - 9th Avenue, Seattle, WA 98101, United States
| | - Zahra Afsharinejad
- Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, # 100, Seattle, WA 98105-6099, United States
| | - Theodor K Bammler
- Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, # 100, Seattle, WA 98105-6099, United States
| | - James W MacDonald
- Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, # 100, Seattle, WA 98105-6099, United States
| | - Federico M Farin
- Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, # 100, Seattle, WA 98105-6099, United States
| | - Brigham H Mecham
- Trialomics, 1700 7th Avenue, # 116, Seattle, WA 98101, United States
| | - Michael L Cunningham
- Center for Developmental Biology and Regenerative Medicine, Seattle Children's Research Institute, 1900 - 9th Avenue, Seattle, WA 98101, United States; Seattle Children's Craniofacial Center, 4800 Sand Point Way NE, Seattle, WA 98105, United States
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Gufler H, Preiß M, Koesling S. Visibility of sutures of the orbit and periorbital region using multidetector computed tomography. Korean J Radiol 2014; 15:802-9. [PMID: 25469093 PMCID: PMC4248637 DOI: 10.3348/kjr.2014.15.6.802] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 07/16/2014] [Indexed: 11/21/2022] Open
Abstract
Objective Knowledge of cranial suture morphology is crucial in emergency medicine, forensic medicine, and maxillofacial reconstructive surgery. This study assessed the visibility of sutures of the orbit and periorbital region on multidetector computed tomography. Materials and Methods Multidetector computed tomography scans of 200 patients (127 males, 73 females; mean age 51.3 years; range, 6-92 years) were evaluated retrospectively. The slice thicknesses varied from 0.5 to 1 mm, and the tube current from 25 to 370 mAs, depending on the CT indication. The visibility of sutures was estimated according to a 4-point scale from "not visible" to "well visible". The chi-squared test was used to test the association of the visibility of sutures with the slice thickness, tube current, and age of patients. Statistical significance was assumed at p < 0.05. Results Overall, best visibility was found for the sutura frontozygomatica (98%), sutura frontonasalis (88.5%), and sutura sphenozygomatica (71.5%), followed by the sutura zygomaticomaxillaris (65.8%), sutura temporozygomatica (41.8%), sutura frontomaxillaris (44.5%), and sutura sphenofrontalis (31%). Poor visibility was found for the sutura frontolacrimalis (16.8%) and sutura frontoethmoidalis (1.3%). The sutura ethmoidomaxillaris, sutura lacrimomaxillaris, and sutura ethmoidolacrimalis were not visible. Conclusion Although the sutures of the superior, lateral, and inferior orbit are well visible, those of the medial orbit are poorly visible on CT scans.
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Affiliation(s)
- Hubert Gufler
- Department of Diagnostic Radiology, Martin-Luther-University Halle-Wittenberg, 06120 Halle (Saale), Germany
| | - Markus Preiß
- Department of Diagnostic Radiology, Martin-Luther-University Halle-Wittenberg, 06120 Halle (Saale), Germany
| | - Sabrina Koesling
- Department of Diagnostic Radiology, Martin-Luther-University Halle-Wittenberg, 06120 Halle (Saale), Germany
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Sim SY, Yoon SH, Kim SY. Quantitative analysis of developmental process of cranial suture in korean infants. J Korean Neurosurg Soc 2012; 51:31-6. [PMID: 22396840 PMCID: PMC3291703 DOI: 10.3340/jkns.2012.51.1.31] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 01/05/2012] [Accepted: 01/25/2012] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The purpose of this study was to elucidate the anatomical development of physiologic suture closure processes in infants using three dimensional reconstructed computed tomography (CT). METHODS A consecutive series of 243 infants under 12 months of age who underwent three dimensional CT were included in this study. Four major cranial sutures (sagittal, coronal, lambdoidal and metopic suture) were classified into four suture closure grades (grade 0=no closure along the whole length, grade 1=partial or intermittent closure, grade 2=complete closure with visible suture line, grade 3=complete fusion (ossification) without visible suture line), and measured for its closure degree (suture closure rates; defined as percentage of the length of closed suture line divided by the total length of suture line). RESULTS Suture closure grade under 12 months of age comprised of grade 0 (n=195, 80.2%), grade 1 (n=24, 9.9%) and grade 2 (n=24, 9.9%) in sagittal sutures, whereas in metopic sutures they were grade 0 (n=61, 25.1%), grade 1 (n=167, 68.7%), grade 2 (n=6, 24%) and grade 3 (n=9, 3.7%). Mean suture closure rates under 12 months of age was 58.8% in metopic sutures, followed by coronal (right : 43.8%, left : 41.1%), lambdoidal (right : 27.2%, left : 25.6%) and sagittal sutures (15.6%), respectively. CONCLUSION These quantitative descriptions of cranial suture closure may help understand the process involved in the cranial development of Korean infants.
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Affiliation(s)
- Sook Young Sim
- Department of Neurosurgery, National Medical Center, Seoul, Korea
| | - Soo Han Yoon
- Department of Neurosurgery, Ajou University School of Medicine, Suwon, Korea
| | - Sun Yong Kim
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
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