Incidence of Metopic Suture in Adult Human Crania in Uttar Pradesh

Introduction: Failure of ossification in the vertical direction between the two halves of the frontal bone is called a metopic suture; this suture is present in between the superciliary arch and tubers of the frontal bone so it is also called a median frontal suture. At birth, the frontal bone present is two half, in the 1st year they contact each other, and within the 7th to 8th year, they fused together. Sometimes, bones may not be fused completely and it becomes metopic fontanelle. MaterialsandMethods: The goal of the current study was to determine the prevalence of metopic suture in adult human skulls in Uttar Pradesh. One hundred and fifty macerated skulls of undetermined age and sex were used for this. The anatomical departments of Teerthankar Mahaveer Medical College and Research Center (Moradabad), King George Medical College (Lucknow), SRMS Institute of Medical Science (Bareilly), Govt. Medical College Kannauj, and Govt. Medical College Saharanpur provided these skulls. Results: This study has found the incidence of metopic sutures of about 12.90%. The two types of metopic sutures were found in this study, namely complete metopic suture 4.52% and incomplete metopic suture 8.38% in which found 0.64% “V” shape metopic suture. Conclusion: Themorphological study of metopic sutures on adult crania is useful for anatomists, experts in forensic medicine, and neurologists for performing surgical procedures in this area

Craneosinostosis, una perspectiva pediátrica / Craniosynostosis, a pediatric perspective

La craneosinostosis se define como el cierre prematuro de una o más suturas del cráneo, que se manifiesta por una forma anormal de la cabeza. Es una condición infrecuente, pero requiere ser reconocida y derivada oportunamente a Neurocirugía para prevenir complicaciones. El objetivo de esta revisión es describir las características clínicas y genéticas más frecuentes de esta patología, su clasificación de acuerdo a la forma del cráneo y los signos más característicos para lograr reconocerla oportunamente. Se realizó una búsqueda de artículos científicos en bases de datos Pubmed, Scielo y EMBASE con las palabras craneosinostosis, plagio, escafo y braquicefalia. Se seleccionaron artículos en español e inglés que describieran las características de la patología y su manejo, optando por revisiones sistemáticas o recomendaciones de sociedades científicas cuando estuvieran disponibles. La craneosinostosis puede presentarse en forma aislada o asociada a otras deformidades. Su clasifi cación depende de la(s) sutura(s) afectada(s), lo que lleva a la forma característica del cráneo y de la presencia de otras malformaciones. Suele diagnosticarse y derivarse de forma tardía, lo que se asocia a complicaciones como hipertensión endocraneana y alteración del desarrollo encefálico. La cirugía precoz tiene menor comorbilidad y mejores resultados estético. En conclusión, la forma anormal del cráneo debe hacer sospechar la presencia de craneosinostosis, aunque se presente en forma aislada. El manejo quirúrgico antes del año de vida se asocia a mejor pronóstico.

Craniosynostosis is defined as the premature fusion of one or more skull sutures, characterized by an abnormal shape of the head. It is a rare condition but should be recognized and timely referred to Neurosurgery in order to prevent complications. The objective of this review is to describe the most frequent clinical and genetic characteristics of this pathology, its classification according to the shape of the skull, and the most characteristic signs to achieve timely recognition. A search for scientific articles in Pubmed, Scielo, and EMBASE databases was performed using the terms craniosynostosis, plagiocephaly, scaphocephaly, and brachycephaly. We selected articles in Spanish and English that described the characteristics of the pathology and about its management, choosing systematic reviews or recommendations from scientific societies when available. Craniosynostosis may occur in isola tion or associated with other deformities. Its classification depends on the affected suture(s), leading to the characteristic shape of the skull and the presence of other malformations. This condition is usually diagnosed and referred late, which is associated with complications such as intracranial hy pertension and impaired brain development. Early surgery has less comorbidity and better esthetic results. In conclusion, the abnormal shape of the skull must raise the suspicion of craniosynostosis, even if it occurs in isolation. Surgical management before one year of life is associated with a better prognosis.

Multiple osteotomies with combined distraction osteogenesis for non-syndromic scaphocephaly / 中华整形外科杂志

Objective@#To evaluate the clinical effect of multiple osteotomies combined with distraction osteogenesis in the treatment of non-syndromic scaphocephaly infants and young children.@*Methods@#Clinical records of 8 non-syndromic scaphocephaly patients, during January 2017 to October 2018, from the Department of Burn and Plastic Surgery, Children′s Hospital of Nanjing Medical University, were retrospectively analyzed. There were 3 males and 5 females, aged from 3 to 28 months, with an average of 13 months. Among them, 4 cases were typical scaphocephaly, 2 cases were anterior scaphocephaly and 2 cases were posterior scaphocephaly. According to the subtypes of scaphocephaly, different osteotomy methods and distraction directions were designed. The cranial vault was osteotomized by piezosurgery osteotomy in a multiple way. The dura did not separate from cranial flap. The internal distractors were installed subsequently. After a mean latency period of 5 days, the devices were activated at a rate of 0.4-0.6 mm/d. Distractor was extended twice a day. After 10-15 days activation period and 6 months consolidation, all the distractors were removed. Three-dimensional CT scans were performed before and after operation to measure the anteroposterior and bitemporal diameters, so as to calculate the cranial index.@*Results@#Follow-up ranged from 6 to 14 months (average, 10 months). The average anteroposterior length of 8 children was(158.2±12.9) mm before operation, and (145.5±14.2) mm after operation, which was shortened(12.6±3.4) mm. Bitemporal diameters was(99.6±8.6) mm preoperatively and(113.9±7.5) mm postoperatively, which was widened (14.2±2.8) mm. Preoperative and postoperative cranial index was 63.2 and 78.3, respectively. The scaphocephalic head shape was significantly improved in all patients. There was no serious complications such as skull necrosis or intracranial infection.@*Conclusions@#Different types of multiple osteotomy combined with distraction osteogenesis are useful to correct various scaphocephaly of infants and children, by improving skull shape and cranial index.

Uso de almohadas de gel en recién nacidos de pretérmino se asocia a disminución de deformidad craneana / Using gel pillows in preterm infants is related to decreased cranial deformity

Introducción: la escafocefalia posicional, deformidad craneana típica del recién nacido prematuro, presumiblemente es debida a un inicio anticipado de presión sobre la calota, a un inadecuado control motor que determina un menor cambio de posición y un mayor tiempo de presión asimétrica sobre la calota. El descenso de la presión de puntos de apoyo asimétricos sobre el cráneo podría disminuir la escafocefalia. La superficie de gel puede bajar la presión localizada en el cráneo al disminuir la rigidez de la superficie de contacto. Los estudios existentes, escasos, no son concluyentes al respecto. Objetivo: Mostrar la relación entre el uso de almohadas de gel y la reducción de escafocefalia en recién nacidos de pretérmino. Método: Estudio longitudinal de pacientes prematuros hospitalizados en el servicios de neonatología de un hospital terciario, que utilizaron almohadas de gel por 5 semanas consecutivas, durante al menos el 90 por ciento del tiempo que permanecieron en decúbito. Se realizaron mediciones craneales, considerando el índice de deformidad craneana; la primera medición fue previo al uso de almohadas y luego semanalmente hasta completar 5 semanas. Resultados: 17 pacientes completaron las 5 semanas de protocolo. Edad promedio: 28,9 semanas de gestación (rango 28 a 34). Peso promedio: 1058 grs. (rango 720 a 2000). El índice de deformidad craneana varió desde 70,36 (DE 4,7) al inicio del estudio a 76,95 (DE 3,03) al término del estudio, con una diferencia significativa (p< 0,05). Conclusión: Este trabajo mostró una relación entre reducción del grado de escafocefalia, expresada en el IC, con el uso de almohadas de gel por un período de 5 semanas en RNPT.

Introduction: the positional scaphocephaly is the preterm infants’ typical cranial deformity. And probably is due to improper motor control, which determines minor change in position and longer asymmetric pressure on the skull. Decreasing the pressure of asymmetric support points on the skull, might decrease scaphocephaly. Gel’s surface may decrease localized pressure in the skull thus decreasing the stiffness of the contact surface. There are scarce reports about this issue and all are inconclusive. Objective: To show the relationship between the use of gel pillows and reduction of scaphocephaly in preterm infants. Method: Longitudinal study of preterm infants hospitalized in neonatology service of a tertiary hospital. They used gel pillows for 5 consecutive weeks, for at least 90 percent of the time in prone position. Cranial measurements were performed, considering the index of cranial deformity, the first measurement before to the use of pillows and then weekly until 5 weeks. Results: 17 patients completed the 5-week protocol. Average age 28.9 weeks of gestation (range 28-34), average weight 1058 g. (range 720-2000). The index of cranial deformity ranged from 70.36 (SD 4.7) at baseline to 76.95 (3.03) at the end of the study with a significant difference (p <0.05). Conclusions This study showed a relationship between the degree of reduction of scaphocephaly expressed in the IC, using gel pillows for a period of 5 weeks in preterm infants.

Indicadores de severidad de la craneosinostosis no sindrómica: Cuantificación de malformaciones sagitales y metópicas / Severity indices for non-syndromic craniosynostosis: quantifying sagittal and metopic malformations

En este trabajo se presenta un nuevo conjunto de indicadores de severidad que combinan diversos rasgos craneales para cuantificar las craneosinostosis aisladas de tipo sagital y metópica. La utilidad de los indicadores se evaluó examinando las tomografías computarizadas del cráneo de un grupo de infantes afectados por craneosinostosis aislada y un grupo de infantes no afectados. La base de datos contiene estudios de 90 pacientes con craneosinostosis sagital, 40 con craneosinostosis metópica y 60 pacientes no afectados. Los indicadores de severidad se obtienen a partir de un conjunto de indices de severidad por medio de un método estadístico de regresión logística regularizada conocido como red elástica. Los índices de severidad son medidas univariadas de forma que se calculan a partir de tres planos de análisis. Los planos se estiman a partir de referencias anatómicas cerebrales radiológicamente identificables. El desempeño de los indicadores se midió estimando el grado de separación lineal (GSL), que cuantifica la capacidad de un indicador para distinguir cráneos sagitales o metópicos de cráneos no afectados. Los indicadores de severidad propuestos alcanzan un GSL del 95.83% y 98.9% en las poblaciones sagitales vs. controles y metópicos vs. controles, respectivamente. Los resultados obtenidos en este trabajo sugieren que es posible construir indicadores multivariables de severidad que son clínicamente reproducibles y cuantifican efectivamente aspectos de la morfología craneal codificada por medio de un conjunto de índices de severidad.

This work develops a new set of severity scores that combine several cranial features in order to quantify sagittal and metopic craniosynostosis. Computed tomography head scans were obtained from 90 children affected with single-suture sagittal synostosis, 40 children with single-suture metopic synostosis, and 60 age-matched nonsynostotic controls. Tridimensional reconstructions of the skull were used to trace image analysis planes defined in terms of skull-base plane and internal landmarks. For each patient, a new set of descriptive measures or severity indices of skull shape malformation were computed. A statistical classification approach (regularized logistic regression) was used for combining individual severity indices into summarizing severity scores. The linear separation index that measures the ability of a classification function to separate the affected (sagittal or metopic) and nonsynostotic populations was used to evaluate the severity scores. The proposed scores are sensitive measures of the calvarial malformation that achieve linear separation indices of 95.83% and 98.9% for sagittal vs. control and metopic vs. control populations, respectively. As opposed to individual severity indices, the summarizing severity scores encapsulate a number of distinctive calvarial features associated with sagittal and metopic synostoses crania. The proposed scores enable quantitative analysis in clinical settings of skull features observed in isolated sagittal and metopic synostoses that may not be accurately detected by separate analysis of individual severity indices.

Immediate Spontaneous Shape Correction Using Expantile Zigzag Craniectomy in Infantile Scaphocephaly: Is There an Improvement in the Developmental Quotient Following Surgery?

There is still debate over which method of the surgery is the most appropriate for the treatment of scaphocephalic infants. In addition, change in psychomotor development following these procedures is a very complex issue that has not yet been resolved. In this paper, the authors describe a surgical technique for immediate spontaneous shape correction of infantile scaphocephaly. There were significant differences between pre- and postoperative cephalic index. We also describe an improvement in the developmental quotient following surgery. Therefore, this expantile zigzag craniectomy should be recommended to correct for isolated sagittal craniosynostosis in infants.