RESUMEN

BACKGROUND: Midpalatal suture (MPS) repair in growing patients after RPE has been previously reported. However, differences between young and adult patients for timing and pattern of MPS repair after rapid maxillary expansion are expected. The aim of this study was to evaluate the midpalatal suture repair pattern after miniscrew-assisted rapid palatal expansion (MARPE) in adult patients. MATERIALS AND METHODS: The study included 21 patients (six males, 15 females) successfully treated with MARPE with a mean initial age of 29.1 years of age (SD = 8.0; range = 20.1-45.1). MPS repair was evaluated using maxillary axial and coronal sections derived from CBCT exams taken 16 months after the expansion (SD = 5.9). Objective and subjective assessments of MPS repair were performed. Objective assessments were performed measuring MPS bone density at anterior, median and posterior region of hard palate. Pre-expansion and post-retention bone density changes were evaluated using paired t tests (p < 0.05). Midpalatal suture bone repair was scored 0 to 3 considering, respectively, the complete absence of bone repair in the MPS, the repair of less than 50% of the MPS, the repair of more than 50% of the MPS and the complete repair of the MPS. Intra- and interexaminer reliability evaluation were assessed using Kappa coefficient. RESULTS: The objective evaluation showed a significant higher bone density at the pre-expansion stage in all palatal regions. The reliability of the subjective method was adequate with intra- and interexaminer agreements varying from 0.807 to 0.904. Scores 1, 2 and 3 were found in 19.05%, 38.09% and 42.86% of the sample, respectively. The most common region demonstrating absence of bone repair was the middle third. The anterior third of the midpalatal suture was repaired in all patients. CONCLUSIONS: A decreased bone density was observed after the retention period when compared to pre-expansion stage. Most adult patients demonstrated incomplete repair of the midpalatal suture 16 months after MARPE. However, adequate bone repair covering more than half of the hard palate extension was observed in 80.95% of the patients.

Asunto(s)

Suturas Craneales , Técnica de Expansión Palatina , Adulto , Tomografía Computarizada de Haz Cónico/métodos , Suturas Craneales/diagnóstico por imagen , Suturas Craneales/cirugía , Femenino , Humanos , Masculino , Maxilar/diagnóstico por imagen , Maxilar/cirugía , Hueso Paladar/diagnóstico por imagen , Hueso Paladar/cirugía , Paladar Duro/diagnóstico por imagen , Paladar Duro/cirugía , Reproducibilidad de los Resultados , Suturas

RESUMEN

BACKGROUND: Sagittal craniosynostosis may present with complete or partial fusion of the sagittal suture, but relationships between degree of sagittal suture fusion and head shape are currently poorly described. The aim of this study was to characterize sagittal suture fusion patterns and determine associations with head shape in a cohort of patients with nonsyndromic sagittal craniosynostosis. METHODS: Patients with nonsyndromic sagittal craniosynostosis at a tertiary care center with available computed tomography imaging were included in this study. The anterior and posterior distances of sagittal suture patency were measured along 3-dimensional parietal bones. Degree of sagittal suture fusion was compared to head shape characteristics, including cephalic index (CI), frontal bossing, and occipital bulleting. RESULTS: Ninety patients (69 male) were included in this retrospective study. The sagittal suture was on average 85.6±20.1% fused, and 45 (50.0%) patients demonstrated complete fusion of the sagittal suture. CI was associated with increased degree of fusion for the anterior one-half (ρ=0.26, P =0.033) and anterior one-third (ρ=0.30, P =0.012) of the sagittal suture. Complete fusion of the anterior one-third of the sagittal suture predicted higher CI (ß=13.86, SE=6.99, z =-0.25, P =0.047). Total degree of sagittal suture fusion was not predictive of CI or head shape in any analysis. CONCLUSIONS: Decreased fusion of the anterior one-third of the sagittal suture, but not total suture, may paradoxically predict increased severity of scaphocephaly as quantified by CI in nonsyndromic sagittal craniosynostosis.

Asunto(s)

Craneosinostosis , Anomalías Maxilomandibulares , Humanos , Masculino , Lactante , Estudios Retrospectivos , Craneosinostosis/diagnóstico por imagen , Craneosinostosis/cirugía , Suturas Craneales/diagnóstico por imagen , Suturas Craneales/cirugía , Tomografía Computarizada por Rayos X , Suturas

RESUMEN

Scaphocephaly (SC) is defined as an elongation of the anteroposterior axis of the skull resulting from the abnormal fusion of the sagittal suture. This study describes the "Peau d'ours" technique and results for correcting SC. We conducted a consecutive and retrospective analysis of patients treated from 2011 to 2016. We evaluated the gender, age, and surgical outcomes. A total of 53 patients were enrolled with a mean age of 19 months old. The advantages of this technique are healthy coronal and lambdoid suture preservation and symmetrical parietal bone flap opening. This technique is safe and simple to reproduce, allowing good surgical outcomes with a low incidence of secondary craniosynostosis. This technique is ideal for patients older than six months old.

Asunto(s)

Craneosinostosis , Suturas Craneales/cirugía , Craneosinostosis/cirugía , Humanos , Lactante , México , Estudios Retrospectivos , Cráneo/cirugía

RESUMEN

PURPOSE: Studies have examined the impact of fusion of the sagittal suture in the skull base while others have evaluated the growth of the skull base before and after surgery. This study aims to perform the anthropometric measures of the skull base in children with scaphocephaly to evaluate the influence of surgical repair in the remodeling of the skull base and anthropometric measures. METHODS: Twenty-one children with diagnosis of scaphocephaly were operated between April 2007 and October 2008, and anthropometric measures at the skull base were performed before and after a year of surgery. The measures were the cranial index (CI), distance between the crista galli and tuberculum sellar (CG-TS), distance between the crista galli and the internal auditory meatus (CG-IAM), distance between the oval foramen (OF-OF), distance between the internal auditory meatus (IAM-IAM), the angle of the skull base (Â1), and the angle between the nasion, center of sella, and basion (Â2). RESULTS: There was a normalization of the CI in all children, confirming an appropriate cranial remodeling. The CG-TS measure evaluated the anterior skull base, with proportional growth of 12.5%. The mediolateral growth was observed by the increase of OF-OF measures by 8.5% and IAM-IAM by 9.5%. The CG-TS measure grew by 7.2%. There was no statistical difference in the angles analyzed. CONCLUSION: Surgical treatment of scaphocephaly led to remodeling of the skull base, confirmed by the changes of anthropometric measures taken before and after a year of surgery.

Asunto(s)

Craneosinostosis , Niño , Suturas Craneales/cirugía , Craneosinostosis/cirugía , Hueso Etmoides , Huesos Faciales , Humanos , Lactante , Cráneo , Base del Cráneo/cirugía

RESUMEN

PURPOSE: How different from "normal" are the cranial base and vault of infants with nonsyndromic, single-suture sagittal synostosis (NSSS)? This study quantitatively addresses this question utilizing computed tomography (CT) analytic technology. METHOD: Head CT scans of infants with NSSS and normocephalic controls were analyzed using Mimics to calculate craniometric angles, distances, and segmented volumes. Craniometric measurements and asymmetry indices were compared between NSSS and control groups using linear regressions controlling for age. Ratios of anterior-, middle-, and posterior-to-total cranial vault volume were compared between groups using beta regressions controlling for age. RESULTS: Seventeen patients with NSSS and 19 controls were identified. Cranial index and interoccipital angle were significantly smaller in NSSS compared with controls (P = 0.003 and <0.001, respectively). Right-but not left-external acoustic meatus angle and internal acoustic meatus-to-midline distance were significantly greater in NSSS than in controls (P = 0.021 and 0.016, respectively). NSSS patients and controls did not significantly differ in any asymmetry indices, except for the articular fossa angle asymmetry index (P = 0.016). Anterior vault volume proportion was greater in NSSS relative to controls (proportion ratio = 1.63, P < 0.001). NSSS trended toward a smaller posterior vault volume proportion (P = 0.068) yet did not differ in middle vault volume proportion compared with controls. CONCLUSION: In this small study, patients with nonsyndromic, single-suture sagittal craniosynostosis had relatively similar cranial base measurements, and larger anterior vault volumes, when compared with controls. Further work is needed to confirm the possibility of rightward asymmetry of the anterior cranial base.

Asunto(s)

Cefalometría , Suturas Craneales/cirugía , Craneosinostosis/cirugía , Base del Cráneo/cirugía , Craneosinostosis/diagnóstico por imagen , Conducto Auditivo Externo/diagnóstico por imagen , Conducto Auditivo Externo/cirugía , Femenino , Humanos , Lactante , Masculino , Base del Cráneo/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos

RESUMEN

BACKGROUND: Asymmetric multisutural craniosynostosis (AMC) is characterized by fusion of a midline suture combined with unilateral fusion of at least 1 nonmidline suture. Due to its rarity, complexity, and high rate of reoperation, the purpose of this study is to evaluate outcomes of our staged approach to AMC. METHODS: Patients treated for craniosynostosis between January 2004 and December 2013 were identified retrospectively. Only patients with AMC and a minimum follow-up of 2 years were included. The 3-staged algorithm includes: extended strip craniectomy of fused sutures; postoperative helmet molding; and fronto-orbital advancement versus a touch-up procedure. Morphologic, aesthetic, and functional outcomes were evaluated. RESULTS: Nine patients (6.8% of cases) were treated for AMC (mean follow-up: 4.1 years). Sixty-seven percent of patients (6 of 9) demonstrated signs of elevated intracranial pressure. Patients were divided into 2 groups: "Group A" included patients treated according to the staged algorithm (n = 5); "Group B" included those treated by traditional techniques (n = 4). Group A underwent their first calvarial vault procedure earlier than those from Group B (2.7 vs. 13.2 months; P < 0.02). Postoperatively, no Group A patients had developmental delay, signs of elevated intracranial pressure, or reoperation. Three of 5 patients (60%) were rated Whitaker Classification II and the others (40%) rated Whitaker Classification III. CONCLUSIONS: Asymmetric multisutural synostosis results in a complex and evolving deformity involving the entire craniofacial complex. However, when asymmetric multisutural synostosis is approached in stages with early intervening helmet therapy, acceptable functional and appearance-related outcomes can be obtained with minimal complications. LEVEL OF EVIDENCE: III.

Asunto(s)

Algoritmos , Suturas Craneales/cirugía , Craneosinostosis/cirugía , Craneotomía/métodos , Intervención Médica Temprana , Progresión de la Enfermedad , Femenino , Humanos , Lactante , Hipertensión Intracraneal/cirugía , Masculino , Reoperación , Estudios Retrospectivos

RESUMEN

OBJECTIVES: The objective is to describe a new surgical procedure developed in the San Jose Pediatric University Hospital for the management of syndromic synostosis of the metopic suture in a patient clinically diagnosed with Saethre-Chotzen syndrome. METHODS: The diagnosis of Saethre-Chotzen syndrome, bilateral coronal sutures, and metopic suture synostoses was made through photographic, anthropometric, exophthalmometric, and computed tomography analysis. The keel-like frontal bone deformity was corrected following resection using a fusiform osteotomy, remodelling was obtained by milling the edges, and the bony fragments were repositioned and fixed on the posterior wall of the frontal bone. Additionally, a fronto-orbital advancement with a self-stabilizing bar was performed. RESULTS: The 1-year postoperative results showed improvement in the position of the fronto-orbital bar, adequate cranial expansion, satisfactory correction of the upper facial third alteration, and correction of the keel-like deformity. CONCLUSIONS: The surgical approach has not previously been described in the literature and offers an alternative management for syndromic craniosyntostosis of the metopic suture, avoiding skull irregularities.

Asunto(s)

Acrocefalosindactilia/cirugía , Craneosinostosis/cirugía , Acrocefalosindactilia/diagnóstico , Suturas Craneales/cirugía , Craneosinostosis/diagnóstico , Craneosinostosis/genética , Femenino , Estudios de Seguimiento , Hueso Frontal/anomalías , Hueso Frontal/cirugía , Historia Antigua , Humanos , Lactante , Recién Nacido , Enfermedades del Prematuro/diagnóstico , Enfermedades del Prematuro/cirugía , Osteotomía/métodos , Fenotipo , Síndrome , Tomografía Computarizada por Rayos X

RESUMEN

Multisuture craniosynostosis with a mild cloverleaf deformity is rare but associated with high morbidity and mortality. Conventional treatment to alleviate intracranial hypertension in a young infant involves multisuturectomy and relies on passive correction of the deformity followed by additional staged reconstruction later in infancy. Early regional craniectomy and rigid reconstruction have been described, but the cranial bone has limited stability to tolerate plate fixation and extensive dissection of the bone-dura interface may devascularize the cranial bone flap and limit its durability. The authors report an interesting technique to treat a mild form of cloverleaf skull deformity using early, nondevascularizing osteotomies followed by application of semiburied cranial distractors in multiple planes to increase intracranial volume and treat the deformity, and its attendant volumetric constriction, in a single stage.

Asunto(s)

Craneosinostosis/cirugía , Craneotomía/métodos , Osteogénesis por Distracción/métodos , Procedimientos de Cirugía Plástica/métodos , Suturas Craneales/anomalías , Suturas Craneales/cirugía , Craneotomía/instrumentación , Estudios de Seguimiento , Hueso Frontal/cirugía , Humanos , Imagenología Tridimensional/métodos , Recién Nacido , Fijadores Internos , Hipertensión Intracraneal/cirugía , Masculino , Órbita/cirugía , Osteogénesis por Distracción/instrumentación , Hueso Parietal/cirugía , Procedimientos de Cirugía Plástica/instrumentación , Tomografía Computarizada por Rayos X/métodos , Procedimientos Quirúrgicos Ultrasónicos/métodos

RESUMEN

BACKGROUND: The premature fusion of unilateral coronal suture can cause a significant asymmetry of the craniofacial skeleton, with an oblique deviation of the cranial base that negatively impacts soft tissue facial symmetry. The purpose of this study was to assess facial symmetry obtained in patients with unilateral coronal synostosis (UCS) surgically treated by 2 different techniques. We hypothesized that nasal deviation should not be addressed in a primary surgical correction of UCS. METHODS: Consecutive UCS patients were enrolled in a prospective study and randomly divided into 2 groups. In group 1, the patients underwent total frontal reconstruction and transferring of onlay bone grafts to the recessive superior orbital rim (n = 7), and in group 2, the patients underwent total frontal reconstruction and unilateral fronto-orbital advancement (n = 5). Computerized photogrammetric analysis measured vertical and horizontal axis of the nose and the orbital globe in the preoperative and postoperative periods. Intragroup and intergroup comparisons were performed. RESULTS: Intragroup preoperative and postoperative comparisons showed a significant (all P < 0.05) reduction of the nasal axis and the orbital-globe axis in the postoperative period in the 2 groups. Intergroup comparisons showed no significant difference (all P > 0.05). CONCLUSIONS: Facial symmetry was achieved in the patients with UCS who underwent surgery regardless of surgical approach evaluated here. Our data showed a significant improvement in nasal and orbital-globe deviation, leading us to question the necessity of primary nasal correction in these patients.

Asunto(s)

Trasplante Óseo , Craneosinostosis/cirugía , Craneotomía/métodos , Asimetría Facial/diagnóstico , Nariz/cirugía , Osteotomía/métodos , Procedimientos de Cirugía Plástica/métodos , Adulto , Anciano , Niño , Suturas Craneales/cirugía , Craneosinostosis/complicaciones , Asimetría Facial/etiología , Asimetría Facial/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Órbita/cirugía , Osteotomía/estadística & datos numéricos , Fotogrametría , Periodo Posoperatorio , Estudios Prospectivos , Procedimientos de Cirugía Plástica/estadística & datos numéricos , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Procedimientos Innecesarios

RESUMEN

A disjunção palatina foi descrita pela primeira vez em 1861, desde então é tem sido utilizada amplamente para correção da atresia maxilar. Sabe-se que com o aumento da idade o prognóstico para a disjunção piora. A expansão palatina é uma opção viável para pacientes adultos, desde que a deficiência transversal seja leve ou moderada. A disjunção palatina assistida cirurgicamente é uma alternativa de tratamento eficiente para pacientes em que a maturação das suturas craniofaciais está em estágio mais avançado. A disjunção palatina apoiada em mini-implantes é uma nova proposta de tratamento para a mordida cruzada posterior, que tem como objetivo alcançar a ampliação do arco dentário superior em adultos jovens, sem causar dano ao periodonto. O objetivo do estudo foi analisar os benefícios advindos desta nova técnica e reconhecer as principais indicações da disjunção maxilar apoiada por mini-implantes como método terapêutico. Foi realizada uma revisão de literatura através de um levantamento bibliográfico de artigos científicos nas principais bases de dados nacionais e internacionais. A disjunção palatina apoiada em mini-implante é um método promissor para a correção de deficiências transversais, mas ainda deve ser melhor estudada para que se estabeleça um protocolo de instalação, ativação e avaliação da manutenção dos resultados a longo prazo

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The palatal disjunction was first described in 1861, since then it has been widely used for the correction of transverse maxillary deficiency. It is known that with the increasing of age the prognostics for the disjunction worsens Palatal expansion is a viable option for adult patients, as long as the transversal deficiency is light or moderate. The surgically assisted palatal disjunction is an efficient treatment alternative for patients in which the maturation of craniofacial sutures are in a more advanced stage. The palatal disjunction supported in mini-implants is a new proposition of treatment for the posterior cross bite, which has as objective to reach the enlargement of the superior dental arch in young adults, without causing damage to the periodontal. The technique shows good results also on the mixed and deciduous denture, including when associated with the facial mask used for Angle's bad occlusion of class III. The purpose of this paper was to study and analyze the benefits arising from this new technique and recognize the primary indications of palatal disjunction supported by mini implants as a therapeutic method. A literary revision was performed through a bibliographical research of scientific papers from national and international data base. The palatal disjunction supported by mini implants is a promising method for correcting transversal deficiencies, however it should be better studied in order to establish a protocol of installation, activation and maintenance's evaluation of the results in long term.

Asunto(s)

Humanos , Masculino , Femenino , Aumento de la Cresta Alveolar/tendencias , Tornillos Óseos/estadística & datos numéricos , Suturas Craneales/cirugía , Técnica de Expansión Palatina/efectos adversos , Prótesis e Implantes/estadística & datos numéricos

RESUMEN

The treatment of a transverse maxillary deficiency in skeletally mature individuals should include surgically assisted rapid palatal expansion. This study evaluated the distribution of stresses that affect the expander's anchor teeth using finite element analysis when the osteotomy is varied. Five virtual models were built and the surgically assisted rapid palatal expansion was simulated. Results showed tension on the lingual face of the teeth and alveolar bone, and compression on the buccal side of the alveolar bone. The subtotal Le Fort I osteotomy combined with intermaxillary suture osteotomy seemed to reduce the dissipation of tensions. Therefore, subtotal Le Fort I osteotomy without a step in the zygomaticomaxillary buttress, combined with intermaxillary suture osteotomy and pterygomaxillary disjunction may be the osteotomy of choice to reduce tensions on anchor teeth, which tend to move mesiobuccally (premolar) and distobuccally (molar).

Asunto(s)

Diente Premolar/patología , Análisis de Elementos Finitos , Maxilar/cirugía , Diente Molar/patología , Métodos de Anclaje en Ortodoncia/métodos , Técnica de Expansión Palatina , Adulto , Proceso Alveolar/patología , Fenómenos Biomecánicos , Simulación por Computador , Diseño Asistido por Computadora , Suturas Craneales/cirugía , Humanos , Maxilar/patología , Osteotomía Maxilar/métodos , Modelos Biológicos , Osteotomía Le Fort/métodos , Técnica de Expansión Palatina/instrumentación , Hueso Paladar/patología , Hueso Paladar/cirugía , Hueso Esfenoides/patología , Estrés Mecánico , Raíz del Diente/patología , Interfaz Usuario-Computador , Cigoma/cirugía

RESUMEN

Craniosynostosis in Apert syndrome is routinely treated by wide frontal and bilateral supraorbital reshaping and posterior cranial decompression. Dynamic cranial vault expansion has proved to be useful in craniofacial surgery, and its use has extended to syndromic patients. Although a controversy remains between conventional osteotomy and application of the spring-mediated technique in surgical treatment of craniosynostosis, there have been several positive clinical reports on expansion techniques for nonsyndromic and syndromic craniosynostosis. Simultaneous fronto-orbital advancement and posterior cranial vault expansion have been applied successfully to 2 patients of Apert syndrome, without intraoperative complications or postoperative morbidity and improving final cranial shape.

Asunto(s)

Acrocefalosindactilia/cirugía , Hueso Frontal/cirugía , Hueso Occipital/cirugía , Órbita/cirugía , Implantes Absorbibles , Placas Óseas , Hilos Ortopédicos , Suturas Craneales/cirugía , Craneotomía/instrumentación , Craneotomía/métodos , Humanos , Lactante , Masculino , Hueso Parietal/cirugía

Asunto(s)

Suturas Craneales/anomalías , Suturas Craneales/cirugía , Fracturas Craneales/diagnóstico , Fracturas Craneales/cirugía , Femenino , Humanos

RESUMEN

BACKGROUND: The use of springs in cranial expansion has demonstrated to be effective for craniosynostosis treatment. The spring-exerted expansile action has been observed when springs are placed both in the sagittal and parasagittal regions, mainly in scaphocephaly. In this study, a variation in cephalometric measurements under expansible spring action on the skull base was analyzed. METHODS: Thirteen 4-week-old New Zealand white rabbits were divided into 4 groups: group 1, in which only amalgam markers were used (control); group 2, in which amalgam markers were used, and a sagittal suturectomy was performed; group 3, in which amalgam markers were used, and a sagittal suturectomy was performed with placement of expansible springs in the interparietal region; and group 4, in which markers were used, and a linear parasagittal craniectomy was performed with spring placement. All animals were killed at weeks 2, 4, 8, and 12. Radiologic control with cephalometric study was performed. RESULTS: Distraction of amalgam markers in the groups with springs was greater than in those without springs. A proportional change in the angles measured through craniometry was observed in these groups. CONCLUSIONS: The experimental rabbit model was shown to be adequate to the analysis proposed by the study. Under the action of springs, the groups with sagittal and parasagittal osteotomy were found to present a similar distraction of amalgam markers. A concomitant change in cephalometric measurements occurred, suggesting a change in the skull base mediated by expansible springs placed both in the sutural and nonsutural sites.

Asunto(s)

Cefalometría/métodos , Osteogénesis por Distracción/instrumentación , Cráneo/anatomía & histología , Animales , Aleaciones de Cromo/química , Suturas Craneales/cirugía , Craneotomía/instrumentación , Craneotomía/métodos , Módulo de Elasticidad , Diseño de Equipo , Femenino , Marcadores Fiduciales , Procesamiento de Imagen Asistido por Computador/métodos , Modelos Animales , Alambres para Ortodoncia , Osteogénesis por Distracción/métodos , Hueso Parietal/cirugía , Conejos , Base del Cráneo/anatomía & histología , Estrés Mecánico , Factores de Tiempo

Asunto(s)

Suturas Craneales/anomalías , Suturas Craneales/cirugía , Fracturas Craneales/diagnóstico , Fracturas Craneales/cirugía , Suturas Craneales/diagnóstico por imagen , Diagnóstico Diferencial , Femenino , Humanos , Recién Nacido , Procedimientos de Cirugía Plástica , Fracturas Craneales/diagnóstico por imagen , Tomografía Computarizada por Rayos X

RESUMEN

OBJECTIVE: The aim of this study was to classify the opening of the midpalatal suture (MPS) after surgically assisted rapid maxillary expansion (SARME) with disjunction of the pterygomaxillary suture through computed tomography (CT) analysis. STUDY DESIGN: Seventy adults with bilateral transverse deficiency of the maxilla underwent SARME with pterygomaxillary disjunction. Seventy tomographies were performed before the surgery and 70 were performed after the final activation. The Hass appliance was used in 29 patients and Hyrax in 41 patients. The MPS opening was classified into 2 types: type I, total MPS opening from the anterior nasal spine to the posterior nasal spine, and type II, total MPS opening from the anterior nasal spine to the transverse palatine suture, with partial or nonexistent opening posterior to transverse palatine suture. RESULTS: Type I opening was observed in 22 patients (31.5%), and type II opening in 48 patients (68.5%). In 5 cases, the opening posterior to the transverse palatine suture was paramedian. CONCLUSION: Computed tomography allows the evaluation and classification of midpalatal suture openings after SARME with pterygomaxillary disjunction in type I (total) and type II (partial) MPS openings.

Asunto(s)

Suturas Craneales/diagnóstico por imagen , Osteotomía Le Fort/métodos , Técnica de Expansión Palatina , Hueso Paladar/diagnóstico por imagen , Tomografía Computarizada Espiral , Adolescente , Adulto , Suturas Craneales/cirugía , Femenino , Humanos , Masculino , Maxilar/anomalías , Maxilar/cirugía , Persona de Mediana Edad , Hueso Nasal/diagnóstico por imagen , Hueso Nasal/cirugía , Diseño de Aparato Ortodóncico , Retenedores Ortodóncicos , Osteotomía Le Fort/clasificación , Técnica de Expansión Palatina/instrumentación , Hueso Paladar/cirugía , Estudios Retrospectivos , Hueso Esfenoides/diagnóstico por imagen , Hueso Esfenoides/cirugía , Adulto Joven

RESUMEN

Purpose: The use of springs in cranial expansion has proven to be effective in the treatment of craniosynostosis. Spring-mediated expansion has been studied both in the sagittal and in parasagittal regions, especially in scaphocephaly. A rabbit model was used in the present study to analyze the effects of springs on the cranial vault and sutures. Methods: Thirteen 4-week-old New Zealand rabbits were divided into 4 groups: in group I, only amalgam markers were used as control; in group II, amalgam markers were used and sagittal suturectomy was performed; in group III, amalgam markers were used, a sagittal suturectomy was performed and an expansible spring was fitted in the interparietal region and in group IV, markers were used and linear parasagittal craniectomy was carried out with springs. Animals were sacrificed after 2, 4, 8 and 12 weeks. Radiological control and histological analysis were performed in the area of spring implantation. RESULTS: In the groups using springs distraction of the craniectomy borders was greater than in those that did not use springs. New bone formation was observed in all groups, and was faster in group II. Bone growth started from the borders and depth. Bone regeneration presented a similar histological pattern in the groups with spring in the sagittal and parasagittal region. Conclusion: The rabbit model proved to be adequate for the analysis proposed by the study. The use of springs in the groups with sagittal and parasagittal osteotomy led to a similar distraction of amalgam markers and both groups had similar ossification histological pattern.

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Objetivo: O uso de molas na expansão craniana tem provado ser efetivo no tratamento da craniossinostoses. A expansão com molas tem sido estudada nas regiões sagital e parassagital, especialmente nas escafocefalias. Um modelo com coelho foi usado no presente estudo para analizar os efeitos das molas sobre a calota craniana e suturas. Métodos: Treze coelhos Nova Zelândia, com quarto semanas de vida, foram divididos em quatro grupos: no grupo I, somente marcadores de amálgama foram implantados como controle; no grupo II, marcadores de amálgama foram implantados e foi retirada a sutura sagital; no grupo III, marcadores de amálgama foram implantados, foi retirada a sutura sagital e foi colocada uma mola expansora na região interparietal e no grupo IV, marcadores de amálgamas foram implantados, uma craniectomia linear parassagital foi realizada e foi colocada uma mola expansora. Os animais foram sacrificados com 2, 4, 8 e 12 semanas. Foi realizado controle radiológico e histológico nas áreas de implantação das molas. RESULTADOS: Nos grupos que utilizaram molas a distração das margens ósseas de craniectomia foi maior do que nos grupos que não utilizaram molas. Neoformação óssea foi observada em todos os grupos, tendo sido mais rápida no grupo II. O crescimento ósseo teve início a partir das margens e da profundidade. A regeneração óssea apresentou padrões histológicos similares nos grupos com o uso de molas na região sagital e parassagital. Conclusões: O modelo experimental com coelho provou ser adequado para a análise proposta pelo estudo. O uso das molas nos grupos com osteotomia sagital e parassagital promoveu uma distração similar dos marcadores de amálgamas e ambos os grupos tiveram padrão histológico de ossificação similar.

Asunto(s)

Animales , Femenino , Conejos , Suturas Craneales/cirugía , Craneosinostosis/cirugía , Osteogénesis , Suturas Craneales/patología , Amalgama Dental , Amalgama Dental/farmacocinética , Dispositivos de Fijación Ortopédica , Cráneo/patología , Cráneo/cirugía

RESUMEN

PURPOSE: The use of springs in cranial expansion has proven to be effective in the treatment of craniosynostosis. Spring-mediated expansion has been studied both in the sagittal and in parasagittal regions, especially in scaphocephaly. A rabbit model was used in the present study to analyze the effects of springs on the cranial vault and sutures. METHODS: Thirteen 4-week-old New Zealand rabbits were divided into 4 groups: in group I, only amalgam markers were used as control; in group II, amalgam markers were used and sagittal suturectomy was performed; in group III, amalgam markers were used, a sagittal suturectomy was performed and an expansible spring was fitted in the interparietal region and in group IV, markers were used and linear parasagittal craniectomy was carried out with springs. Animals were sacrificed after 2, 4, 8 and 12 weeks. Radiological control and histological analysis were performed in the area of spring implantation. RESULTS: In the groups using springs distraction of the craniectomy borders was greater than in those that did not use springs. New bone formation was observed in all groups, and was faster in group II. Bone growth started from the borders and depth. Bone regeneration presented a similar histological pattern in the groups with spring in the sagittal and parasagittal region. CONCLUSION: The rabbit model proved to be adequate for the analysis proposed by the study. The use of springs in the groups with sagittal and parasagittal osteotomy led to a similar distraction of amalgam markers and both groups had similar ossification histological pattern.

Asunto(s)

Suturas Craneales/cirugía , Craneosinostosis/cirugía , Osteogénesis , Animales , Suturas Craneales/patología , Amalgama Dental/farmacocinética , Femenino , Dispositivos de Fijación Ortopédica , Conejos , Cráneo/patología , Cráneo/cirugía

Asunto(s)

Humanos , Instrumentos Quirúrgicos , Equipos y Suministros , Agujas/clasificación , Suturas/normas , Suturas Craneales/cirugía

RESUMEN

UNLABELLED: Scaphocephaly is the most frequent craniosynostosis. Many correction techniques have been proposed. Their relevance is not completely appreciated by means of the Cranial Index, which cannot differentiate specifically the anterior and posterior modifications.The aim of this study was to propose a new fronto-occipital morphologic evaluation technique and its validation in normal and scaphocephalic patients, operated or nonoperated. PATIENTS AND METHODS: Two evaluation measures (indices) were developed for frontal and occipital deformities, traced over a standard skull radiograph. It was initially applied in 16 normal skull radiographs. Forty-two scaphocephalies were evaluated before and after linear perisutural craniectomy technique. Short- and long-term evaluations were performed in the 42 operated cases, with a follow-up period of 10 or more years.The created indices were named Frontal Sagittal Index (FSI) and Occipital Sagittal Index (OSI). They are proportional measures between 2 cranial lengths. RESULTS: A significant difference was found for the FSI and the OSI between scaphocephalies and normal skulls. A significant difference was also found between indices before and after surgery, whether it was short- or long-term follow-up. No significant differences were found between the indices for the short- and long-term follow-up. CONCLUSIONS: The FSI and the OSI were more precise measuring methods than the Cranial Index for the scaphocephaly anterior posterior morphologic evaluation and follow-up. There was also a stability of the results in the long-term follow-up with the technique used. We recommend these indices for the presurgical and result evaluation rather than the Cephalic Index.

Asunto(s)

Craneosinostosis/diagnóstico por imagen , Craneosinostosis/cirugía , Estudios de Casos y Controles , Suturas Craneales/anomalías , Suturas Craneales/cirugía , Craneotomía/métodos , Femenino , Hueso Frontal/diagnóstico por imagen , Hueso Frontal/cirugía , Humanos , Lactante , Recién Nacido , Masculino , Hueso Occipital/diagnóstico por imagen , Hueso Occipital/cirugía , Radiografía , Resultado del Tratamiento