Craniofacial characteristics and cosmetic satisfaction of patients with sagittal and metopic synostosis: a case–control study using 3D photogrammetric imaging

Purpose The aim of this study was to investigate the craniofacial and aesthetic characteristics of adult metopic and sagittal craniosynostosis patients operated on in early childhood compared to controls. The goal was to find objective measurements that would correlate with the patient’s subjective self-evaluation of their own cosmetic appearance. Methods The study population consisted of 49 patients from whom 41 had premature fusion of the sagittal and in 8 of metopic suture. There were 65 age and gender matching controls from The Finish National Register. The 3D photogrammetric models were created from all patients and controls. The images were analysed using Rapidform 2006. Facial landmarks were set by the standard Farkas points. Facial symmetry parameters were calculated by using the landmarks and the mirror shell of the face. Aesthetic evaluation was done from standard photographs using panels. Subjective satisfaction with one’s own appearance was evaluated using questionnaires. Results Patients had the greatest asymmetry in the forehead area when compared to controls (symmetry percentage 59% versus 66%, p = 0.013). In the control group, the gap between the eyes was smaller than in the case group, resulting in an absolute 2 mm difference (p = 0.003). The area of the chin and the landmarks were more located on the left side in the patient group, resulting in up to a 1.1 mm difference between the groups (p = 0.003). Only a weak association was found between craniofacial symmetry and appearance evaluations. Conclusion Patients operated on because of sagittal and metopic synostoses were found to have facial asymmetry at long follow-up. However, the differences were < 3 mm and not clinically important. The long-term aesthetical outcome of the surgery performed because of sagittal or metopic craniosynostosis based on the 3D image evaluation was good.

Study on Morphometric Features of Coronal Suture Along with it Absence and Craniosynostosis

Background: Cranial sutures are syndesmosis between the cranial bones. The coronal suture is oblique in direction and extends between the frontal and the parietal bones. Craniosynostosis is a rare birth defect that occurs when the coronal suture in the skull fuses prematurely, but the brain continues to grow and develop. This leads to a misshapen head. There are a number of forms of this defect, such as coronal, sagittal, lambdoid, and metopic. Materials and Methods: Total 500 skulls were used for study, coronal suture length measured by thread method, distance between Nasion to bregma and midsupraorbital rim to coronal suture were measured. For finding skull with absence of coronal, sagittal, lambdoid, and metopic suture, we examined many skulls during routine osteology classes of Medical, Dental and other medical sciences students. Around 500 skull observed and we find only one skull with absence of left coronal suture completely. Results: The length of coronal suture was 24.8+1.4cm length, the distance between nasion to bregma was 126.7 +10.25 mm and Midsupraorbital rim to cranial suture was 102.76+8.64mm We have found only one skull with absence of coronal suture. Some of the skulls shows partly fusion of sagittal, coronal sutures. The skull with complete absence of coronal suture showing the features of other sutures clearly and right side of coronal suture is showing the complete suture. The skull was not damaged and it is in perfect condition which was using by students for their osteology study. Conclusion: We found the skull with absence of left coronal suture, which may resulted due to craniosynostosis. It may be due to hot climate in India also might be resulted for absence of suture. KEY WORDS: Birth defect, Skull, Coronal suture, Craniosynostosis.

BILATERAL COMPLETE FORAMEN OF CIVININI ON ARTIFICIALLY DEFORMED SKULL

The study aimed to investigate the foramen of Civinini using craniological material. 75 skulls were examined, foramen of Civinini was found on one artificially deformed female skull (1.3%) from a catacomb burial, dated I-VII centuries AD. The study used cranioscopic and craniometric methods. Artificial deformation of the skull was classified according to Georg K. Neumann (1942) and was identified as parallelo-fronto-occipital, subtype-saddle-like depression. The skull was metopic; the metopic suture length was 111.11 mm. The initial segment of the metopic suture, 5.26 mm long, was weakly serrated. The Foramen of Civinini was complete and bilateral. The length of the left foramen of Civinini was 3.77 mm, the width was 3.48 mm. The foramen spinosum was absent on the left side; in the basal norm, the pterygospinous bar divided the foramen ovale into two parts, as it were. The length of the right foramen of Civinini was 4.14 mm, the width was 6.19 mm, in other words, the size of the foramen was larger than that of the left one. As on the left side, the pterygospinous bar divided the foramen ovale into two parts in the basal norm.

Congenital Cyst and Fistula of the Dorsum of the Nose: A Case Report and Literature Review

Congenital cyst and fistula of the dorsum of the nose is a rare congenital entity. We report a new case of dorsum nasal fistula in a 5 years old male patient that communicates the frontal region with the subcutaneous surface. Radiologic imaging showed a median 5mm defect, in the projection of the metopic suture that leads to a communication between the frontal region and the skin figure. Complete resection was performed by an external approach with vertical incision of the cyst. The histological diagnosis was consistent with a dermoid fistulized cyst. The follow-up displayed unremarkable finding, the patient did not present any diplopia nor decreased visual acuity, or any signs of meningitis or cerebrospinal fluid rhinorrhoea, or saddle nose.

Assessment of patients with craniosynostosis

The term craniosynostosis denotes the pathological partial or complete absence of one or more cranial sutures which manifests as abnormal skull growth. Although it is often referred to as premature fusion this is misleading as only the metopic suture fuses in the normal physiological state. The remaining sutures change and mature in macroscopic and microscopic form during growth but remain present. This chapter discusses the assessment of patients with craniosynostosis.