Validity of the Maturation Stage Method in the Individual Assessment of Midpalatal Suture Ossification Before Maxillary Expansion: A Systematic Review / Validez del Método de la Etapa de Maduración en la Evaluación Individual de la Osificación de la Sutura Palatina Mediana Previo a la Expansión Maxilar: Una Revisión Sistemática

In 2013, midpalatal suture maturation stage assessment was proposed for the evaluation of patients before performing maxillary expansion. In this study, we aimed to analyze the association between the midpalatal suture maturation stages assessed by CBCT, according to the method described by Angelieri et al., and other objective methods used to assess skeletal maturation or bone fusion. A computerized database search was conducted using PubMed, Cochrane Library, SciELO, LILACS, Web of Science, and Scopus, without language restriction. Unpublished literature was searched on ClinicalTrials.gov, the National Research Register, and Pro-Quest Dissertation Abstracts and Thesis database. Authors were contacted when necessary, and reference lists of the included studies were screened. Search terms included midpalatal suture, maturation, correlation, diagnostic performance, classification, evaluation, assessment, and relationship. Quality assessment was performed using the Observational Cohort and Cross-Sectional Studies tool developed by the National Heart, Lung, and Blood Institute. Eleven studies met the inclusion criteria. Of all the studies included, 81.9% had fair qualit y and 18.1% good quality, respectively. Eight out of eleven studies assessed the correlation between the midpalatal suture maturation method and the skeletal maturity evaluated by CVM method (Spearman's correlation coefficient: 0.244-0.908). Two out of eleven studies evaluated the correlation between midpalatal suture maturation method and the skeletal maturity assessed by HWM method (Spearman's correlation coefficient: 0.904-0.905) Even though midpalatal suture maturation stage assessment needs an exhaustive training and calibration process, it is a valid method to evaluate skeletal maturation or bone fusion. From a clinical perspective, for patients at CS4, CS5 and CS6, an assessment of the midpalatal suture on CBCT is indicated. A similar assessment should be done in patients at SMI 7-9.

En 2013, se propuso un nuevo método para la evaluación del estadio de maduración de la sutura palatina mediana para la evaluación de los pacientes antes de realizar la expansión maxilar. En este estudio, nuestro objetivo fue analizar la asociación entre las etapas de maduración de la sutura palatina mediana evaluada en CBCT, según el método descrito por Angelieri et al., y otros métodos objetivos utilizados para evaluar la maduración esquelética o la fusión ósea. Se realizó una búsqueda en las bases de datos PubMed, Cochrane Library, SciELO, LILACS, Web of Science y Scopus, sin restricción de idioma. Se buscó literatura no publicada en ClinicalTrials.gov, el Registro Nacional de Investigación y la base de datos Pro-Quest Dissertation Abstracts and Thesis. Se estableció contacto con los autores cuando fue necesario y se revisaron las listas de referencias de los estudios incluidos. Los términos de búsqueda incluyeron sutura palatina mediana, maduración, correlación, rendimiento diagnóstico, clasificación, evaluación, valoración y relación. La evaluación de la calidad se realizó mediante la herramienta de Estudios transversales y de cohortes observacionales desarrollada por el Instituto Nacional del Corazón, los Pulmones y la Sangre. Once estudios cumplieron con los criterios de inclusión. Del total de estudios incluidos, el 81.9% tuvo calidad regular y el 18.1% calidad buena, respectivamente. Ocho de once estudios evaluaron la correlación entre el método de maduración de la sutura palatina mediana y la madurez esquelética evaluada por el método CVM (coeficiente de correlación de Spearman: 0.244-0.908). Dos de once estudios evaluaron la correlación entre el método de maduración de la sutura palatina mediana y la madurez esquelética evaluada por el método HWM (coeficiente de correlación de Spearman: 0.904-0.905). Aunque la evaluación del estado de maduración de la sutura palatina mediana necesita un proceso exhaustivo de entrenamiento y calibración, es un método válido para evaluar la maduración esquelética o la fusión ósea. Desde una perspectiva clínica, para pacientes en CS4, CS5 y CS6, está indicada una evaluación de la sutura palatina mediana en CBCT. Se debe realizar una evaluación similar en pacientes con SMI 7-9.

Persistência da sutura metópica em crânios secos adultos do Nordeste brasileiro: análise antropológica forense / Persistence of metopic suture in adult dry skulls from Northeast Brazil: a forensic anthropological analysis / Persistencia de la sutura metópica en cráneos secos adultos del Nordeste de Brasil: análisis antropológico forense

A sutura metópica forma-se aproximadamente no primeiro trimestre da vida intrauterina entre os dois centros de ossificação que irão formar o osso frontal. Há controvérsias na literatura em relação ao momento em que essa sutura oblitera, mas se sabe que ocorre antes dos dez anos de idade; entretanto, essa sutura pode não obliterar e persistir ao longo da vida do indivíduo. Este trabalho objetivou relatar a persistência da sutura metópica em crânios secos de esqueletos humanos adultos pertencentes ao Centro de Estudos em Antropologia Forense da Faculdade de Odontologia da Universidade de Pernambuco (CEAF/FOP/UPE), com a finalidade de demonstrar a importância para a perícia antropológica forense. Dentre os 426 examinados, foram identificados dez crânios (2,4%) com a presença de sutura metópica completa, sendo 5 do sexo masculino e 5 do feminino, compreendendo uma faixa etária de 29 a 86 anos. A persistência da metópica possui relevância forense, afinal as variações anatômicas são vistas como estruturas que não são consequência de uma patologia e que diferem do encontrado na população geral, tornando o indivíduo que as possui ainda mais único. Dessa forma, essa variação anatômica pode atuar como auxiliar no processo de identificação humana na perícia antropológica forense... (AU)

The metopic suture forms approximately in the first trimester of intrauterine life between the two ossification centers that will form the frontal bone. There are controversies in the literature as to when this suture obliterates, but it is known to occur before the age of ten; however, this suture may not obliterate and persist throughout the individual's life. This work aimed to report the persistence of the metopic suture in dried skulls of adult human skeletons belonging to the Center for Studies in Forensic Anthropology of the School of Dentistry of the University of Pernambuco (CEAF/FOP/UPE) in order to demonstrate its importance for forensic anthropology. Among the 426 skeletons examined, ten skulls (2.4%) with complete metopic sutures were identified, five male and five female, ranging in age from 29 to 86 years. The persistence of metopic sutures has forensic relevance, after all, anatomical variations are seen as structures that are not a consequence of pathology and that differs from what is found in the general population, making the individual who has them even more unique. Thus, this anatomical variation can act as an aid in the process of human identification in forensic anthropology... (AU)

La sutura metópica se forma aproximadamente en el primer trimestre de vida intrauterina entre los dos centros de osificación que formarán el hueso frontal. Existen controversias en la literatura sobre el momento en que se oblitera esta sutura, pero se sabe que ocurre antes de los diez años; sin embargo, esta sutura puede no obliterarse y persistir durante toda la vida del individuo. Este estudio tuvo como objetivo informar sobre la persistencia de la sutura metópica en cráneos desecados de esqueletos humanos adultos pertenecientes al Centro de Estudos em Antropologia Forense de la Faculdade de Odontologia da Universidade de Pernambuco (CEAF/FOP/UPE), con el fin de demostrar su importancia para la antropología forense. Entre los 426 esqueletos examinados, se identificaron diez cráneos (2,4%) con presencia de sutura metópica completa, 5 masculinos y 5 femeninos, con edades entre 29 y 86 años. La persistencia de la sutura metópica tiene relevancia forense, después de todo las variaciones anatómicas son vistas como estructuras que no son consecuencia de una patología y que difieren de lo que se encuentra en la población general, haciendo aún más único al individuo que las presenta. Así pues, esta variación anatómica puede servir de ayuda en el proceso de identificación humana en antropología forense... (AU)

Proposal for the Modification of the Method to Evaluate the Midpalatal Suture Maturation Status / Proposta de Modificação do Método para Avaliação do Status da Sutura Palatina Mediana

The objective of present research was to propose a new definition for the midpalatal suture (MPS) maturational stages through reevaluation of intermediate stages B, C and D. The sample was composed by 158 cone-beam computed tomography (CBCT) of individuals between 11 and 20 years of age (±15.4 years, 86 females and 71 males), divided into two groups: 74 individuals aged 11-15 years and 84 individuals aged 16-20 years. The CBCT scans were applied to evaluate midpalatal suture maturation status and comprised stages previously classified as B (29), C (92) and D (37). Each axial image was subdivided into six parts in the anteroposterior direction, and each portion was classified according to MPS maturational evaluation methodology. New definitions of stages were proposed. The reliability of the method was tested by two examiners and the intra- and inter-examiner concordances were defined for each evaluation through weighted kappa coefficients and 95% confidence intervals. The chi-square test was used to compare the groups. In all statistical tests, a significance level of 5% was adopted. Two new maturational stages were defined: sub-stage C- and sub-stage C+, with prevalence of 12% and 8.9%, respectively, in 11 to 20-year-olds. The redefinition and validation of the maturational stages of MPS, considering the sub-stages C- and C+, may allow to elucidate the difference in the prognosis of Rapid Maxillary Expansion among individuals aged 11 to 20 years. This data should be confirmed through a clinical study.(AU)

O objetivo da presente pesquisa foi propor uma nova definição para os estágios maturacionais da sutura palatina média (MPS) por meio da reavaliação dos estágios intermediários B, C e D. A amostra foi composta por 158 tomografias computadorizadas de feixe cônico (TCFC) de indivíduos entre 11 e 20 anos de idade (±15,4 anos, 86 do sexo feminino e 71 do sexo masculino), divididos em dois grupos: 74 indivíduos de 11 a 15 anos e 84 indivíduos de 16 a 20 anos. Os exames de TCFC foram aplicados para avaliar o estado de maturação da sutura palatina média e compreenderam os estágios previamente classificados como B (29), C (92) e D (37). Cada imagem axial foi subdividida em seis partes no sentido anteroposterior, e cada porção foi classificada de acordo com a metodologia de avaliação maturacional MPS. Novas definições de estágios foram propostas. A confiabilidade do método foi testada por dois examinadores e as concordâncias intra e interexaminadores foram definidas para cada avaliação por meio de coeficientes kappa ponderados e intervalos de confiança de 95%. O teste do qui-quadrado foi utilizado para comparar os grupos. Em todos os testes estatísticos adotou-se o nível de significância de 5%. Dois novos estágios maturacionais foram definidos: subestágio C- e subestágio C+, com prevalência de 12% e 8,9%, respectivamente, em jovens de 11 a 20 anos. A redefinição e validação dos estágios maturacionais da MPS, considerando os subestágios C- e C+, podem permitir elucidar a diferença no prognóstico da Expansão Rápida da Maxila entre indivíduos de 11 a 20 anos. Esses dados devem ser confirmados por meio de um estudo clínico.(AU)

Recent Methods Used for Analysis of Midpalatal Suture Closure Before Maxillary Expansion in Humans: A Systematic Review

The evaluation of the maturation of the midpalatal suture is highly important before making the clinical decision on whether to correct a transverse discrepancy in a conventional or surgical way. For this purpose, there are methods such as hand and wrist analysis, evaluation of maturation of the cervical vertebrae, and evaluation by means of occlusal radiographs. The main objective of this systematic review is to identify in the current literature the use of new methods and technologies to evaluate the maturation of the midpalatal suture before performing maxillary expansion. A bibliographic search was carried out using PubMed, Cochrane Library, SciELO, LILACS, Web of Science and Scopus using the terms midpalatal suture, cranial sutures, palate, maturation, interdigitation, ossification, maxillary expansion, evaluatio n, assessment and assess. The 119 articles were obtained, of which only 7 meet the selection criteria, which describe qualitative, quantitative and semiquantitative evaluation methods. During the last few years, due to advances in technology and science, various promising methods and techniques have been proposed for the evaluation of median palatal suture maturation. The quality of the available evidence is not enough to support the use of any one of these methods on their own. We recommend that clinicians use multiple diagnostic methods for an objective assessment of the maturation of the midpalatal suture, to guide them in their clinical decisions.

La evaluación de la maduración de la sutura palatina mediana es de suma importancia antes de tomar la decisión clínica sobre si corregir una discrepancia transversal de forma convencional o quirúrgica. Para ello existen métodos como el análisis de la mano y la muñeca, la evaluación de la maduración de las vértebras cervicales y la evaluación mediante radiografías oclusales. El objetivo principal de esta revisión sistemática es identificar en la literatura actual el uso de nuevos métodos y tecnologías para evaluar la maduración de la sutura palatina mediana antes de realizar la expansión maxilar. Se realizó una búsqueda bibliográfica en PubMed, Cochrane Library, SciELO, LILACS, Web of Science y Scopus, utilizando los términos "midpalatal suture", "cranial sutures", "palate, maturation", "interdigitation", "ossification", "maxillary expansion", "evaluation",y "assessment". Se obtuvieron 119 artículos, de los cuales solo 7 cumplieron con los criterios de selección. Estos, describen métodos de evaluación cualitativos, cuantitativos y semicuantitativos. Durante los últimos años, debido a los avances tecnológicos y científicos, se han propuesto varios métodos y técnicas prometedoras para la evaluación de la maduración de la sutura palatina media. La calidad de la evidencia disponible no es suficiente para apoyar el uso de alguno de estos métodos por sí solo. Recomendamos que los profesionales utilicen una combinación de métodos de diagnóstico, que permitan una evaluación objetiva de la maduración de la sutura palatina mediana y ayuden a guiarlos en sus decisiones clínicas.

A cone-beam computed tomography evaluation of three-dimensional changes of circummaxillary sutures following maxillary protraction with alternate rapid palatal expansions and constrictions / 北京大学学报(医学版)

OBJECTIVE@#To assess three-dimensional (3D) changes of circummaxillary sutures following maxillary protraction with alternate rapid palatal expansions and constrictions (RPE/C) facemask protocol in maxillary retrusive children, and to investigate the relationship between the changes of circum-maxillary sutures and zygomaticomaxillary suture (ZMS) maturation, and to explore the factors of maxilla forward movement with RPE/C and facemask.@*METHODS@#In the study (clinical trial registration No: ChiCTR2000034909), 36 maxillary retrusive patients were recruited and block randomized to either the rapid palatal expansion (RPE) group or the RPE/C group. Patients aged 7 to 13 years, Class Ⅲ malocclusion, anterior crossbite, ANB less than 0°, Wits appraisal less than -2 mm, and A-Np less than 0 mm were included in the study. The RPE group received rapid palatal expansion, whereas the RPE/C group received alternate rapid palatal expansions and constrictions, and both with facemask protraction. Head orientations of cone-beam computed tomography (CBCT) images were implemented by Dolphin 11.7. 3D measurements of circummaxillary sutures on CBCT images were evaluated using Mimics 10.01 before (T0) and after treatment (T1). The changes were analyzed with independent t test, two-way ANOVA, Pearson correlation and regression analysis.@*RESULTS@#Two subjects in the RPE/C group were lost to follow-up. A total of 34 patients reached the completion criteria and were analyzed. Compared with the RPE group, sagittal changes of circummaxillary sutures were significantly increased in the RPE/C group with 1.21 mm advancement of zygomaticotemporal suture, 2.20 mm of ZMS, 1.43 mm of zygoma-ticofrontal suture (P < 0.05, respectively). Except for the zygomaticotemporal suture, the rest forward sagittal changes of other circummaxillary sutures showed no major difference in terms of the ZMS maturation. The Spearman's correlation in RPE/C indicated a strong positive correlation of sagittal changes between ZMS and point A (P < 0.01) with a regression analysis R2=42.5%.@*CONCLUSION@#RPE/C might be more effective on the treatment of maxillary retrusive children. As one of the major mechanical loading sutures during orthopedic therapy, ZMS showed a strong positive correlation with point A on sagittal changes.

Cleidocranial dysplasia and novel RUNX2 variants: dental, craniofacial, and osseous manifestations

Abstract Cleidocranial dysplasia (CCD) is a skeletal disorder affecting cranial sutures, teeth, and clavicles, and is associated with the RUNX2 mutations. Although numerous patients have been described, a direct genotype-phenotype correlation for RUNX2 has been difficult to establish. Further cases must be studied to understand the clinical and genetic spectra of CCD. Objectives To characterize detailed phenotypes and identify variants causing CCD in five unrelated patients and their family members. Methodology Clinical and radiographic examinations were performed. Genetic variants were identified by exome and Sanger sequencing, data were analyzed by bioinformatics tools. Results Three cases were sporadic and two were familial. Exome sequencing successfully detected the heterozygous pathogenic RUNX2 variants in all affected individuals. Three were novel, comprising a frameshift c.739delA (p.(Ser247Valfs*)) in exon 6 (Patient-1), a nonsense c.901C>T (p.(Gln301*)) in exon 7 (Patient-2 and affected mother), and a nonsense c.1081C>T (p.(Gln361*)) in exon 8 (Patient-3). Two previously reported variants were missense: the c.673C>T (p.(Arg225Trp)) (Patient-4) and c.674G>A (p.(Arg225Gln)) (Patient-5) in exon 5 within the Runt homology domain. Patient-1, Patient-2, and Patient-4 with permanent dentition had thirty, nineteen, and twenty unerupted teeth, respectively; whereas Patient-3 and Patient-5, with deciduous dentition, had normally developed teeth. All patients exhibited typical CCD features, but the following uncommon/unreported phenotypes were observed: left fourth ray brachymetatarsia (Patient-1), normal clavicles (Patient-2 and affected mother), phalangeal malformations (Patient-3), and normal primary dentition (Patient-3, Patient-5). Conclusions The study shows that exome sequencing is effective to detect mutation across ethnics. The two p.Arg225 variants confirm that the Runt homology domain is vital for RUNX2 function. Here, we report a new CCD feature, unilateral brachymetatarsia, and three novel truncating variants, expanding the phenotypic and genotypic spectra of RUNX2 , as well as show that the CCD patients can have normal deciduous teeth, but must be monitored for permanent teeth anomalies.

Maduración de la Sutura Palatina Media En Adolescentes y Adultos Jóvenes Chilenos: Estudio Transversal / Midpalatal Sutural Maturation in Chilean Adolescents and Young Adults: Cross-sectional Study

RESUMEN: Objetivo: Evaluar la maduración de la sutura palatina media en adolescentes y adultos jóvenes chilenos, mediante valoración morfológica de imágenes de tomografía computarizada de haz cónico del maxilar. Material y método: Se analizó la sutura palatina media de 150 sujetos entre 15 y 30 años, seleccionados desde la base de datos radiológicos de un centro universitario de salud. La maduración sutural fue evaluada en el corte axial, utilizando el método de Angelieri y cols., clasificándola en cinco etapas (A, B, C, D y E). Se utilizaron las pruebas de correlación de Pearson para medir la concordancia intra e interexaminador, y T-Student para las diferencias entre sexos. Resultados: El estado de maduración más frecuente fue C (43,3%), seguido por E (33,3%) y D (22%). En hombres, la etapa C fue más frecuente (49%), mientras que en mujeres fue la etapa E (39%). Sin embargo, no se encontraron diferencias estadísticamente significativas entre ambos sexos. Conclusiones: Aunque la mayoría de la muestra presentó una etapa tardía de maduración sutural, el 45% presentó estados de maduración sutural donde sería posible la expansión de naturaleza no quirúrgica. Debido a la variabilidad observada en adolescentes y adultos jóvenes, se recomienda la evaluación individual con imagenología 3D.

ABSTRACT: Objective: To evaluate midpalatal suture maturation in Chilean adolescents and young adults through morphological assessment of cone-beam computed tomography images of the maxilla. Materials and methods: Analysis of the midpalatal suture of 150 subjects aged between 15 and 30 was performed, selected from a university clinical center radiological database. Sutural maturation was evaluated in the axial cross-section, using the method described by Angelieri et al., classifying it in five stages (A, B, C, D and E). Pearson's correlation tests were used to assess intra- and inter-examiner agreement, and T-Student for assessing differences between genders. Results: The most frequent maturation stage was C (43.3%), followed by E (33.3%) and D (22%). In men, stage C was more frequent (49%), while in women it was stage E (39%). However, no statistically significant differences were found between genders. Conclusions: Although the majority of the sample presented a late stage of sutural maturation, 45% presented states of sutural maturation where the expansion of a non-surgical nature would be possible. Due to the variability observed in adolescents and young adults, individual evaluation with 3D imaging is recommended.

De novo ALX4 variant detected in child with non-syndromic craniosynostosis

Current understanding of the genetic factors contributing to the etiology of non-syndromic craniosynostosis (NSC) remains scarce. The present work investigated the presence of variants in ALX4, EFNA4, and TWIST1 genes in children with NSC to verify if variants within these genes may contribute to the occurrence of these abnormal phenotypes. A total of 101 children (aged 45.07±40.94 months) with NSC participated in this cross-sectional study. Parents and siblings of the probands were invited to participate. Medical and family history of craniosynostosis were documented. Biological samples were collected to obtain genomic DNA. Coding exons of human TWIST1, ALX4, and EFNA4 genes were amplified by polymerase chain reaction and Sanger sequenced. Five missense variants were identified in ALX4 in children with bilateral coronal, sagittal, and metopic synostosis. A de novo ALX4 variant, c.799G>A: p.Ala267Thr, was identified in a proband with sagittal synostosis. Three missense variants were identified in the EFNA4 gene in children with metopic and sagittal synostosis. A TWIST1 variant occurred in a child with unilateral coronal synostosis. Variants were predicted to be among the 0.1% (TWIST1, c.380C>A: p. Ala127Glu) and 1% (ALX4, c.769C>T: p.Arg257Cys, c.799G>A: p.Ala267Thr, c.929G>A: p.Gly310Asp; EFNA4, c.178C>T: p.His60Tyr, C.283A>G: p.Lys95Glu, c.349C>A: Pro117Thr) most deleterious variants in the human genome. With the exception of ALX4, c.799G>A: p.Ala267Thr, all other variants were present in at least one non-affected family member, suggesting incomplete penetrance. Thus, these variants may contribute to the development of craniosynostosis, and should not be discarded as potential candidate genes in the diagnosis of this condition.

Age Estimation in Han Adults by Thin-Layer CT Scan of Cranial Sutures / 法医学杂志

Objective To explore the value of degree of cranial suture closure in forensic adult age estimation by thin-layer CT scan and establish an adult age estimation model of the Han nationality. Methods Thin-layer CT scan samples of the heads of 220 healthy Sichuan Han adults （110 males, 110 females） aged 20 to 70 were collected, of which 20 samples （10 males, 10 females） were randomly selected as test samples. The sagittal suture, coronal suture （both left and right） and lambdoid suture （both left and right） were respectively and equally divided into 2 segments, and every segment was equally divided into 10 layers and the corresponding multiplanar reformation （MPR） images were selected. The closure of cranial sutures on MPR images was classified into the grades 1-7. The correlations between cranial sutures and age were analyzed to build regression equation for age estimation. Results The degree of closure of sagittal suture, coronal suture （both left and right） and lambdoid suture （both left and right） was positively correlated with age. The coefficient of determination （R2） of regression equation was 0.419 in males, 0.589 in females, and 0.522 in all samples. The results of the verification test showed that the mean absolute error （MAE） was 6.39 years in males, 6.16 years in females, and 6.29 years in all samples. Conclusion There was a higher accuracy in adult age estimation by thin-layer CT scan of cranial sutures. The age of Han nationality adults can be estimated by the degree of cranial sutures closure.

Recent progress of related factors, prevention and treatment for skull deformity / 中国医师杂志

Skull deformity is common ailment of infants,and maybe cause developmental deformity,with high incidence in China.In this article,we reviewed the related factors,prevention and treatment for skull deformity,aimed at providing references for its further application.

Evaluación tomográfica de la fontanela anterior de pacientes pediátricos en la ciudad de Quito / Tomographic evaluation of the anterior fontanelle in pediatric patients in the Quito city

INTRODUCCIÓN. La evaluación del tamaño y osificación de las suturas craneales pudo determinar alteraciones del desarrollo cerebral. El estudio realizó la evaluación tomográfica del tamaño de la fontanela anterior y determinó el porcentaje de osificación en función de la edad. MATERIALES Y MÉTODOS. Se realizó un estudio retrospectivo, observacional, en el que se evaluó 367 tomografías computarizadas de cráneo en niños y niñas hasta 2 años de edad, desde enero de 2012 hasta agosto de 2015, en cuatro centros de imagen de la ciudad de Quito, Ecuador. RESULTADOS. El tamaño promedio de la fontanela anterior medida en tomografía computarizada con la fórmula de Popich y Smith, fue de 48,43 mm SD (15,15mm) en hombres y 37,36mm SD (13,97mm) en mujeres, en el grupo de edad de 0 a 3 meses, sin diferencia estadística significativa (p=> 0,05). El 8,0% de los pacientes tuvo una fontanela osificada a la edad de 5 meses. La edad media de osificación de la fontanela fue 18 meses. En el grupo de edad de 21 a 24 meses el porcentaje de osificación fue de 82,0%. CONCLUSIÓN. Este estudio proporcionó valores de referencia que detallaron el porcentaje de tamaño y osificación de la fontanela anterior en función de la edad. Existió amplia variabilidad del tamaño medio de la fontanela anterior, lo cual sugiere que el cierre prematuro o tardío podría considerarse como variantes de la normalidad.

INTRODUCTION. The evaluation of the size and ossification of the cranial sutures could determine alterations in brain development. The study performed the tomographic evaluation of the size of the previous source and determined the percentage of ossification in the function of age. MATERIALS AND METHODS. A retrospective, observational study was conducted in which 367 cranial CT scans were evaluated in children up to 2 years of age, from January 2012 to August 2015, in four imaging centers in the city of Quito, Ecuador. RESULTS The average size of the previous source in computed tomography with the formula of Popich and Smith was 48,43 mm SD (1515 mm) in men and 37,36 mm SD (13,97 mm) in women, in the group of age from 0 to 3 months, without significant statistical difference (p=> 0.05). 8,0% of patients had a source after 5 months. The average age of the source of the source was 18 months. In the age group from 21 to 24 months, the percentage of ossification was 82,0%. CONCLUSIONS This study provides reference values that detail the percentage of size and the classification of the previous source in the function of age. There is wide variability of the average size of the previous source, which implies premature closure or possible delay as variants of normality.

Hallazgos de la ecoencefalografía transfontanelar en niños con fontanela anterior abierta y factores de riesgo asociados / Findings of trans-fontanel echography in children with open fontanel and associated risk factors

Fundamento: el uso del ultrasonido en pediatría favorece el diagnóstico primario de algunas enfermedades. El ultrasonido transfontanelar es el más usado para detectar alteraciones intracraneales.Objetivo: identificar tipo de hallazgo ultrasonográfico en niños con fontanela anterior abierta y factores de riesgo asociados. Métodos: estudio descriptivo realizado en el Hospital Pediátrico de Cienfuegos de enero de 2014 a enero de 2015. Se incluyeron todos los pacientes con fontanela anterior abierta e indicación de ultrasonido transfontanelar. Se analizaron: edad del niño, sexo, edad materna, complicaciones del embarazo, tipo de parto, complicaciones al nacimiento, variantes anatómicas intracerebrales y malformaciones intracerebrales. Resultados: se estudiaron 221 pacientes entre uno y 24 meses con una media de cuatro meses; el 59,3 % masculinos; existieron alteraciones ultrasonográficas en el 21,3 % (66 % masculinos). La asimetría ventricular estuvo como variante anatómica más frecuente (6,8 %) seguida de macrocefalia benigna (5,9 %) y cavum septum pellucidum (4,1 %). La principal malformación fue la mega cisterna magna (1,4 %) seguida del quiste del tercer ventrículo (0,9 %) y del quiste subependimario (0, 5 %). El parto distócico y la hipertensión arterial en la madre, la prematuridad y la enfermedad hipóxico isquémica en el niño, fueron los factores de riesgo más observados. Conclusiones: la ultrasonografía cerebral es un método útil, no invasivo y de fácil interpretación para la determinación precoz de entidades nosológicas en el infante, mientras permanece abierta su fontanela anterior. La interacción de factores de riesgo tanto maternos como en el niño incide en la aparición de malformaciones intracerebrales.

Foundation: the use of ultrasound in pediatrics favors the primary diagnosis of some diseases. Trans-fontanel ultrasound is the most used to detect intracranial disturbances. Objective: to identify the type of ultrasound finding in children with open front fontanel and associated risk factors. Methods: decriptive study realized at the Pediatric Hospital of Cienfuegos from January 2014 to January 2015. All patients with open front fontanel and indicated trans-fontanel ultrasound were included. Children´s age and sex were analyzed and mother´s age, pregnancy complications, type of delivery and its complications, anatomic intracerebral variants and malformations as well. Results: 221 patients were studied between 1 and 24 months old with a mean of four months; 59.3% were male; ultrasonography disturbances in 21,3% (66% male). Ventricular Asymmetry was the most frequent anatomic variant. (6.8%) followed by benign macro-cephalic (5.9 %) and cavum septum pellucidum (4,1 %). The main malformation was mega cisterna magna (1,4 %) followed by subependymal cyst (0, 5 %). Dystocic delivery and maternal arterial hypertension, prematurity and hypoxic ischemic disease were the most frequently observed risk factors. Conclusion: brain ultrasonography is a useful, non-invasive method of easy interpretation for the early determination of nosology conditions of children, while the front fontanel is still opened. The interaction of risk factors in the mother so as in the child influence in the appearance of intra-cerebral malformations.

Clinical Study on Acupuncture at Cranial Sutures plus Rehabilitation Training for Post-stroke Spastic Palsy / 上海针灸杂志

Objective To observe the clinical efficacy of acupuncture at cranial sutures plus rehabilitation training in treating post-stroke spastic palsy.Method Sixty patients with post-stroke spastic palsy were randomized into a treatment group and a control group, 30 cases each. The treatment group was intervened by acupuncture at cranial sutures plus rehabilitation training, while the control group was intervened by rehabilitation training alone. The Modified Ashworth Scale (MAS), Fugl-Meyer Assessment, and activities of daily living (ADL) in the Modified Barthel Index (MBI) were observed before and after the treatment for the two groups.Result After the intervention, there was a significant difference in MAS score between the two groups (P<0.05). The FMA and ADL scores were changed significantly after the treatment in both groups (P<0.05). The FMA and ADL scores in the treatment group were significantly different from those in the control group after the treatment (P<0.05).Conclusion Acupuncture at cranial sutures plus rehabilitation is an effective approach in treating post-stroke spastic palsy.

A new method for sex estimation from maxillary suture length in a Thai population / 대한해부학회지

Sex estimation is one of the crucial procedures in the biological profile identification of human skeletal remains. Knowing sex of unknown case can lead to accurate and appropriate methods for predicting age, stature, ancestry, or even personal identification. Skull is one of the most reliable one among other skeletons and it is usually retained for both archaeological and forensic contexts. Although many morphological features and metric measurements of skull have been studied for sexing, but to the best of our knowledge is no study on maxillary suture length for sex estimation. Therefore, this study aims to develop a new sex estimation method for a Thai population by determining three maxillary suture lengths: anterior, transverse, and posterior maxillary suture, by computerizing amount of pixel obtained from photographs of these sutures. The present study was conducted on 190 Thai bone samples of which 96 were males and 94 were females. Independent t test revealed statistically significant difference (P < 0.01) between males and females in all maxillary suture measurements. Equations derived from prediction model, which required three maxillary suture lengths gave 76.8421% accuracy from the leave-one-out cross validation in estimating sex percentage accuracies in predicting sex from these equations, which were relatively moderate. This study provides a novel and objective sex estimation method for Thais. It suggests that maxillary suture length can be applied for sex estimation. The new computerized technique will contribute basis knowledge and method for sex estimation, especially when only base of skull is available in forensic circumstance.

Craneosinostosis: Revisión de literatura / Craniosynostosis: Literature review

Las craneosinostosis consisten en el cierre prematuro parcial o total de una o más suturas craneales, con una incidencia de 1 de cada 1000 a 3000 nacidos vivos, con mayor prevalencia en varones. Dentro del contexto de las craneosinostosis primaria, la escafocefalia o craneosinostosis sagital es la forma más frecuente y conocida. Al presentarse en un período de vida donde el crecimiento cráneo cerebral es muy importante, ocasiona en los niños una deformidad craneal característica que debe ser corregida, ya que en caso contrario y al ser progresiva, la afectación estética puede ser muy indeseable; las alteraciones funcionales que se pueden presentar van desde aumento de la presión intracraneana, hasta convulsiones, entre otras. Se realizó una búsqueda en bases de datos como PUDMED, RIMA, MEDLINE, MEDSCAPE de revisiones de temas, guías de manejo, artículos y análisis estadísticos, en idioma inglés, donde se encontraron 1.469 referencias. Después de una primera mirada de los artículos a través de sus resúmenes comprendidos en el periodo de tiempo año 2000 a 2014, finalmente se seleccionaron 50 artículos en texto completo abarcando el tema en su totalidad que cumplían los requisitos de búsqueda.

The craniosynostosis consist of full or partial premature closure of one or more cranial sutures, with an incidence of 1 in 1000 3000 live births, with higher prevalence in males. Within the context of primary craniosynostosis, sagittal craniosynostosis scaphocephaly or is the most common and known form. To occur over a period of life where growth cranium is very important causes in children a characteristic skull deformity should be corrected, since otherwise and being progressive, aesthetic involvement can be very undesirable; functional alterations that may occur include increased intracranial pressure, seizures and others. A search was conducted in databases such as PUBMED, RIMA, MEDLINE, Medscape reviews issues, management guides, articles and statistical analysis, in english, where they found 1,469 references. After a first look at the articles through their summaries included in the period 2000 to 2014, finally 50 articles were selected in full text covering the subject fully meeting the conditions search.

Craniosynostosis : Updates in Radiologic Diagnosis

The purpose of this article is to review imaging findings and to discuss the optimal imaging methods for craniosynostosis. The discussion of imaging findings are focused on ultrasonography, plain radiography, magnetic resonance imaging and computed tomography with 3-dimensional reconstruction. We suggest a strategy for imaging work-up for the diagnosis, treatment planning and follow-up to minimize or avoid ionized radiation exposure to children by reviewing the current literature.

Development and Growth of the Normal Cranial Vault : An Embryologic Review

Understanding the development of a skull deformity requires an understanding of the normal morphogenesis of the cranium. Craniosynostosis is the premature, pathologic ossification of one or more cranial sutures leading to skull deformities. A review of the English medical literature using textbooks and standard search engines was performed to gather information about the prenatal development and growth of the cranial vault of the neurocranium. A process of morphogenic sequencing begins during prenatal development and growth, continues postnatally, and contributes to the basis for the differential manner of growth of cranial vault bones. This improved knowledge might facilitate comprehension of the pathophysiology of craniosynostosis.

An assessment of the maxilla after rapid maxillary expansion using cone beam computed tomography in growing children

INTRODUCTION: With the advent of cone beam computed tomography (CBCT), it is now possible to quantitatively evaluate the effects of rapid maxillary expansion (RME) on the entire maxillary complex in growing patients. OBJECTIVE: The purpose of this study is to use three-dimensional images to evaluate the displacement that occurs at the circummaxillary sutures (frontonasal, zygomaticomaxillary, intermaxillary, midpalatal, and transpalatal sutures) following rapid maxillary expansion in growing children. METHODS: The CBCT scans of 25 consecutively treated RME patients (10 male, 15 female) with mean age of 12.3 ± 2.6 years, were examined before expansion and immediately following the last activation of the expansion appliance. RESULTS: Statistically significant (P < 0.05) amounts of separation were found for the displacement of the bones of the frontonasal suture, the intermaxillary suture, the zygomaticomaxillary sutures, and the midpalatal suture. The change in angulation of the maxillary first molars due to RME was also statistically significant. There was no statistically significant displacement of the transpalatal suture. CONCLUSIONS: Rapid maxillary expansion results in significant displacement of the bones of circummaxillary sutures in growing children. .

INTRODUÇÃO: com o advento da tomografia computadorizada de feixe cônico (TCFC), hoje é possível avaliar quantitativamente os efeitos da expansão rápida da maxila (ERM) em todo o complexo maxilar em pacientes em crescimento. OBJETIVO: este estudo usou imagens tridimensionais para avaliar o deslocamento das suturas circum-maxilares (frontonasal, intermaxilar, palatina mediana e palatina transversa) após a expansão rápida da maxila em crianças em crescimento. MÉTODOS: imagens de TCFC de 25 pacientes tratados consecutivamente com ERM (10 meninos, 15 meninas) com idade média de 12,3 ± 2,6 anos foram obtidas e examinadas antes da expansão e imediatamente após a última ativação do aparelho expansor. RESULTADOS: houve deslocamento estatisticamente significativo (p < 0,05) dos ossos da sutura frontonasal, intermaxilar, zigomaticomaxilar e palatina mediana. A alteração na angulação dos primeiros molares superiores devido à ERM também foi estatisticamente significativa. Não houve deslocamento estatisticamente significativo da sutura palatina transversa. CONCLUSÕES: a expansão rápida da maxila resultou em deslocamentos significativos dos ossos das suturas circum-maxilares em crianças em crescimento. .

Feasibility of combining anterior and posterior fontanelle acoustic windows for median sagittal plane in fetal cranial ultrasound scanning / 中华围产医学杂志

Objective To explore the feasibility of combining anterior and posterior fontanelle acoustic windows for fetal median sagittal plane cranial scanning in prenatal ultrasound.Methods From July 5 to August 25 in 2012,200 pregnant women in Huai'an First Hospital at 22 to 24 gestational weeks accepted transabdominal uhrasonography,with anterior fontanelle,longitudinal suture and posterior fontanelle as acoustic windows to obtain the median sagittal plane.In the mean time,ten aborted or induced fetuses (with malformations or maternal complications) underwent cranial ultrasound with the same acoustic windows.The successful rates of obtaining median sagittal plane were calculated.Data were analyzed by Chi-square test.Results (1) Among the ten aborted or induced fetuses,all median sagittal planes were successfully obtained through anterior,posterior fontanelle,or longitudinal suture alone.(2) Among the 200 cases of prenatal uhrasonography,the successful rate of obtaining median sagittal plane through posterior fontanelle alone was 76.0％(152/200),which was higher than that through anterior fontanelle alone [59.5％ (119/200),x2=12.5,P＜0.01].The successful rate was 95.5％ (191/200) when combining the anterior and posterior fontanelle,which was higher than that through anterior fontanelle or posterior fontanelle alone (x2 =74.3 and 31.1,both P＜0.01).The successful rate of obtaining median sagittal plane through posterior fontanelle was 67.3％ (65/102) in cephalic presentation,which was also higher than that through anterior fontanelle [37.3％ (38/102),x2 =14.3,P＜0.01].The successful rate was 88.8％ (87/98) through posterior fontanelle in non-cephalic presentation,which was similar to that through anterior fontanelle [82.7％(81/98),x2 =1.5,P＞0.05].When both anterior and posterior fontanelle applied,the successful rate in cephalic presentation was 9.8％ (10/102),lower than that in non-cephalic presentation fetuses [71.4％ (70/98),x2 =79.1,P＜0.01].Conclusions The successful rate in obtaining median sagittal plane through posterior fontanelle is higher than that through anterior fontanelle,and might be increased when both anterior and posterior fontanelle were used.

Observing fetal cranial sutures and fontanels with three-dimensional ultrasonography / 中国医学影像技术

Objective To assess the application value of three-dimensional (3D) ultrasound in visualizing fetal cranial sutures and fontanels. Methods One hundred women at different pregnant ages (16-19~+ weeks, 20-24~+ weeks, 25-29~+ weeks, 30-34~+ weeks, respectively) underwent 3D ultrasound, in order to observe the cranial sutures and fontanels of fetuses. Results ①Most cranial sutures and fontanels (70.00%-98.00%) could be visualized with 3D ultrasound. However, the sagittal suture revealed a lower displaying rate (53.00%) than others. ②At different pregnant ages, there was no significant difference of displaying rate of the metopic, coronal, squamoal sutures and the sphenoid, mastoid fontanels between fetuses and there was significant difference of displaying rate of the anterior and post fontanels, sagittal and lambdoid sutures. Conclusion 3D ultrasound can be used as an effective method for visualizing fetal cranial sutures and fontanels.