Craniofacial anthropometry in a Turkish population.

OBJECTIVE: To present norms and demonstrate the anthropometric variations in fronto-occipital circumference, inner and outer canthal distances, near and distant [far] anatomical interpupillary distance, canthal index, and circumference-interorbital index across age and sex in urban Turkish subjects. PARTICIPANTS: Three thousand four hundred forty-eight subjects (1852 male, 1596 female) aged 7 to 40 years were included in this study. METHODS: Three age groups were studied: children aged 7 to 15 years, young adults aged 16 to 25 years, and adults aged 26 to 40 years. Mean values for each measured parameter were determined at each age between 7 and 25 years. Subjects were also divided into nine age subgroups to observe the change of each parameter with advancing age. RESULTS: The fronto-occipital circumference and outer canthal distance of males was significantly (p <.001) wider than females in all age groups. The near and distant interpupillary distances of male subjects were, on average, wider than the female subjects with greater differences with advancing age. Across all subjects aged 7 to 40 years, the mean of all measured parameters and calculated indexes of men and boys was significantly different from girls and women (p <.001). The mean for interpupillary distances in our study in both sexes were found to be similar to Arabian, Hong Kong, and British children; larger than those of Chinese, Black, Indian, and Caucasians; and smaller than those of Mexican children and a mixed European population. CONCLUSION: This study clearly shows the anthropometric variation for fronto-occipital circumference, inner canthal distance, outer canthal distance, near and distant interpupillary distance, canthal index, and circumference-interorbital index with age. These developmental data and the normal values of these measurements in healthy subjects are useful for dysmorphologists in the early identification of some craniofacial syndromes, hyper- and hypotelorism, and congenital or posttraumatic telecanthus and of planning surgical intervention. We suggest that the comparison of craniofacial dimensions of a patient must be performed with normal standards specific for age as well as sex and race.     

Comparison of triple image area using panoramic radiography of child and adult dry skull.

AIM: The objective of this study was to compare the zone of simple, double and triple images in a dry infant cranium against an adult completely formed one when panoramic X-ray photography's were taken. STUDY DESIGN: We took 96 panoramic X-ray photography's to a dry infant cranium placing a metallic spherical object of 8mm in different anatomical points for later to observe, identify and analyse the image of the object in each of them and determine if the images appeared as simple, double or triple. RESULTS: The 57.15% of images obtained were simple, 16.66 % were double and 26.19% triple. The area of triple and double images in the infant cranium did not involve anatomical important structures. CONCLUSIONS: The area where triple and double images appear was located in the occipital part in the infantile cranium with respect to the adult skull. On the basis of these results we can suggest that the X-ray photography must not be used as the main radiological support in the making of decisions in patients with craniofacial alterations.     

Facial anthropometry in cleft patients: a historical appraisal.

OBJECTIVE: To present a historical appraisal of the use of anthropological and cephalometrical facial soft tissue measurements in cleft patients. DESIGN: The McDowell Indexes and a Medline search were used to trace references up to 1999. Also, references listed with chapters and articles on facial clefts were searched for anthropometrical studies. Twenty-six retrieved articles and book chapters on soft tissue anthropometry and 12 cephalometric publications on soft tissue measurements on radiographs and plaster casts of cleft patients were reviewed. RESULTS AND CONCLUSIONS: Since 1931, the facial soft tissue appearance of cleft patients has been evaluated by means of anthropometric and cephalometric techniques. Not all of the older studies were performed in a statistically correct fashion. Many of the conclusions of the studies overlap despite differences in technique of assessment. Most studies demonstrate the deficient growth of the maxilla and the deformities of the facial profile in cleft patients.     

Reconstruction of skull bone defects using the hydroxyapatite cement with calvarial split transplants.

PURPOSE: We sought to present a new method for primary reconstruction of traumatic or tumor calvarial defects. PATIENTS AND METHODS: Forty-one patients underwent reconstruction of calvarial bone defects between October 1998 and December 2001. Among them were 19 patients who needed reconstruction of the calvaria due to traumatic bone loss. Five of these trauma cases had insufficient primary reconstruction of the calvaria. Tumor resection caused calvarial defects in 22 patients. For primary reconstruction of the skull bone defects, calvarial split grafts were used to cover the defect as accurately as possible. The monocortical layers of the calvaria were fixed with titanium miniplates. Irregular defects surrounding the transplanted regions were filled with hydroxyapatite cement. In one case of posttraumatic bone loss, hydroxyapatite cement alone was sufficient to reconstruct the defect. RESULTS: The follow-up of each patient was at least 6 months; the longest period was 38 months. Evaluated clinical and radiologic results are stable, showing no measurable side effects. CONCLUSION: Hydroxyapatite cement alone or in combination with calvarial split grafts gave clinically and aesthetically stable results in the reconstruction of skull bone defects. The cement can be used for many reconstruction possibilities in craniofacial surgery.     

Statistical estimation of resin composite polymerization sufficiency using microhardness.

With respect to determining sub-surface resin polymerization sufficiency, this study compared a traditional method of applying linear regression to bottom- to top-surface Knoop hardness ratios to an alternative method based on nonlinear regression. Inverse linear regression on ratios was used to estimate the exposure duration required for 80% bottom-surface hardness with respect to the top, in six light-by-material groups. Alternatively, a one-phase, two-parameter, exponential association of the form Y=Y(max)(1-e(-kt)) (where Y(max) is maximum hardness, k is a rate constant, and t is exposure duration), was used to model hardness. Inverse nonlinear regression estimated, for each condition, the exposure duration required for the bottom surface to achieve 80% of corresponding condition (light and material) top-surface Y(max). Mathematically, analysis of ratios was demonstrated to yield potentially less precise and biased estimates. Nonlinear regression yielded better statistical fit and provided easily accessible tests for differences in k across light-system groups. Another recently proposed nonlinear model for polymerization, Y=Y(max)kt(n)/(1+kt(n)), was also considered. While this new model has substantially greater phenomenological and mechanistic justification, we found that the model-fitting process was more sensitive to initial parameter values and sometimes yielded untenable results when applied to our data. However, we believe that these problems would not occur if sample points are well distributed across a wide range of exposure durations, and that the model, Y=Y(max)kt(n)/(1+kt(n)), should be considered for such data sets.     

Repair of human skull defects using osteoinductive bone alloimplants

To estimate the efficacy of cranioplasty in clinical practice, autolyzed, antigen-extracted, allogenic (AAA) bone was prepared from cortical bones of human organ donors. AAA bone implants consisted of completely demineralized bone powder, completely demineralized pliable bone chips, surface-demineralized bone chips with pliable crevices, surface-demineralized rigid bone chips, or combinations thereof. 21 patients received AAA bone cranioplasties and were followed-up for between 12 and 58 months (average: 29 months). No infection or rejection of any of the AAA bone implants occurred. X-ray assessments as well as bone scintigraphies revealed osseous integration and remodelling of the AAA bone implants with minimal resorption, with the exception of completely demineralized AAA bone chips which showed partial resorption (2 cases). However, the partial resorption of completely demineralized AAA bone chips ceased after the implants had been remodelled. In 4 cases, the osteosynthesis material was removed between 10 and 18 months after the cranioplasty. In another case, a re-entry was necessary because of recurrence of an intracranial tumor. All of these five AAA bone reconstructions showed bleeding surfaces and osseous consolidations at the time of re-entry. A bone biopsy taken from one of these cranioplasties showed osteoinduction on the surface of the AAA bone implants. This first clinical review of cranial reconstructions using osteoinductive AAA bone implants emphasizes the therapeutical application of AAA bone for cranioplasty. Large AAA bone chips from human skull bones facilitate the reproduction of the skull's convexity especially when combined with preoperative stereolithography-based planning.     

Upper lip asymmetry perception using three-dimensional anthropometry in patients with unilateral cleft lip deformity

Conventional anthropometry using photographs has been widely used, but it does not provide accurate length. For upper lip asymmetry analysis, three-dimensional photographic system (3D VECTRA; Canfield, Fairfield, NJ) was used to calculate the ratio of cleft-side and noncleft-side curvature lengths. Thirty patients with unilateral cleft lip were analyzed. Three-dimensional photographic system was used to calculate the length ratio of upper lip of cleft and noncleft sides. In addition, two-dimensional photographs were analyzed by 10 plastic surgeons, and upper lip asymmetry was scored using a visual analog scale (VAS). Pearson analysis was used to identify relations between the ratios and the VAS scores. Intrarater reliability for the VAS scores ranged from 0.653 to 0.925, and interrater reliability was 0.611. Pearson correlation coefficients for each ratio and the VAS score were 0.412 (P = 0.024) for cleft-side to noncleft-side curvature length ratio of Cupid’s bow, 0.250 (P = 0.182) for cleft-side to noncleft-side curvature length ratio from the commissure to the lowest point of the nasal ala, 0.214 (P = 0.018) for linear length ratio of Cupid’s bow, and 0.356 (P = 0.153) for linear length ratio from the commissure to the lowest point of the nasal ala. Analysis of upper lip asymmetry in unilateral cleft lip patients using the three-dimensional photographic system is more accurate than two-dimensional anthropometry. Horizontal curvature length ratio was the most strongly correlated with VAS score.     

Posterolateral skull base reconstruction using the supraclavicular artery island flap

The supraclavicular artery island (SAI) flap is a viable fasciocutaneous option for the reconstruction of head and neck defects. Although authors have reported success using SAI flaps for various reconstructive indications, concerns of a tenuous blood supply and distal ischemia have previously limited its use in the posterolateral skull base. This case series reports the outcomes of 5 consecutive patients receiving SAI flaps for posterolateral skull base reconstruction. All flaps were harvested in less than 1 hour with primary closure of all donor sites. A single patient developed superficial necrosis of the distal flap, which was repaired with a full-thickness skin graft. There were no other complications, and no donor site morbidity was observed. The SAI flap is an excellent option for the reconstruction of posterolateral skull base defects. The close color match, easy harvest within 1 hour, lack of microsurgical anastomosis, and absence of donor site morbidity support its continued utilization.     

三维CT在颅底影像诊断中的应用

目的　探索三维 Ｃ Ｔ 成像在颅底中的应用价值。方法　对２５ 个病例的颅底行 Ｃ Ｔ横断扫描,采用表面阴影显示（ Ｓ Ｓ Ｄ）法进行颅底骨三维重建,分析病变引起颅底骨质改变在三维重建图像上的表现。结果　４ 例颅底骨折的三维重建提供了更多的骨折征象。１５ 例颅底病变术前或术后三维重建为手术方案制定、术后评价、随访及进一步治疗提供了客观真实的立体参考资料。６ 例三叉神经痛射频治疗过程中三维重建有利于制定更安全可靠的穿刺进针线路。结论　在二维 Ｃ Ｔ 基础上的三维成像对检查解剖结构复杂而不规则的颅底是非常有意义的 。     

Crouzon twins with cloverleaf skull malformations.

We describe unique monozygotic twins with Crouzon's disease and cloverleaf-shaped skull deformities who have been closely followed since birth. Their abnormal skull shapes were identified during antenatal ultrasound examination. The twins had gross exophthalmos and hydrocephalus with papilledema, so early calvarial decompression surgery was required. Although born to healthy parents of normal appearance, a third cousin of the twins had a milder form of Crouzon's disease, and there was a family history of high-arched palate on the twins' paternal side. Because Crouzon's disease is an uncommon condition and the cloverleaf skull shape is unusual in patients with Crouzon's disease, identical twins with this constellation of deformities must be exceptionally rare.     

Cloverleaf skull anomaly with extreme orbitostenosis.

A neonate presented with cloverleaf skull anomaly and severe proptosis requiring urgent cranioplasty to attain eyelid closure. Despite this, she experienced exposure keratitis and corneal perforations. A ventriculoperitoneal shunt was performed subsequently to relieve hydrocephalus, but respiratory problems eventually led to her death at 6 months. This case highlights the complexity of the problems encountered in the cloverleaf skull anomaly, and a brief review discussing its management is included. Despite improvements in treatment of this condition, the overall prognosis remains poor.     

Craniosynostosis and skull molding

On February 20-23, 1997 in Scottsdale, Arizona, a symposium was held that was sponsored by the Plastic Surgery Educational Foundation, the American Society of Maxillofacial Surgeons, and the Joint Section on Pediatric Neurological Surgery of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons. The chairs of the meeting were Jeffrey C. Posnick and Harold L. Rekate. The symposium examined issues relating to craniosynostosis and skull molding. The program consisted of three parts. Day 1 focused on the basic concepts of craniosynostosis and skull molding. Day 2 focused on evaluation and treatment of craniosynostosis. Day 3 focused on the diagnosis and treatment of craniofacial syndromes. The symposium was significant because it brought craniofacial and pediatric neurosurgeons together for the first time at a combined meeting to discuss important aspects of craniosynostosis and skull molding. This article summarizes the presentations made at the meeting.     

The influence of involuntary facial movements on craniofacial anthropometry: a survey using a three-dimensional photographic system

In the modern anthropometry of complex structures, such as the face, different technical approaches for acquisition of three-dimensional data have become increasingly more common. Results of meticulous evaluations have shown high degrees of precision and accuracy under both ideal and clinical circumstances. However, the question remains as to which level of accuracy is adequate to meet clinical needs. Apart from the measuring technique itself, potential sources of error must be identified and dealt with. Subjects’ involuntary facial movements can potentially influence clinical reliability. The 3dMDface™ system was used clinically to investigate the influence of involuntary facial movements. Other factors of influence were systematically excluded. The mean technical error of the system (0.09 mm) was investigated in a previous study and taken into account for interpretation of the data. The handling of the system was straightforward for both acquisition and analysis of data. Including technical error and the influence of involuntary facial movements, the mean global error was 0.41 mm (range 0–3.3). Taking into account the technical error of the system known from the previous study, involuntary facial movements account for a mean error of 0.32 mm. This range of involuntary facial movements clearly exceeds the known technical error of the three-dimensional photographic system used. Given this finding, future research should shift its focus from the analysis of the technical aspects of such systems to other influential factors.