Top

Published in:

01-05-2018 | Paediatric Neuroradiology

Quantitative evaluation of facial hypoplasia and airway obstruction in infants with syndromic craniosynostosis: relationship with skull base and splanchnocranium sutural pattern

Published in: Neuroradiology | Issue 5/2018

Abstract

Purpose

Craniosynostostic syndromes are due to multisuture synostoses and affect the entire craniofacial skeleton. This study analyzed the facial complex and airways to quantify the relationship between insufficient facial growth, airways obstruction, and the sutural pattern of the splanchnocranium and cranial fossae.

Methods

Preoperative high-resolution CT images in 19 infants with syndromic craniosynostosis were quantitatively analyzed. Because all children showed involvement of minor sutures/synchondroses coursing in the posterior cranial fossa, they were divided into three groups according to the synostotic involvement of “minor” sutures/synchondroses coursing in anterior (ACF) and middle (MCF) cranial fossae: group 1 (ACF), group 2 (MCF), and group 3 (ACF-MCF). Analysis of the facial complex and airway was performed. Each group was compared with age-matched healthy subjects.

Results

Premature closure of skull base synchondroses of ACF and MCF was found only in groups MCF and ACF-MCF. Group MCF showed synostosis in the posterior branch of the coronal ring and reduced anterior hemifossae lengths while group ACF-MCF showed synostosis in the anterior branch of the coronal ring and reduced middle hemifossae lengths. No group showed reduced maxillary or mandibular volumes but group MCF showed synostosis of the zygomaticomaxillary sutures and maxillary retrusion. All groups showed reduced airway volume but group 2 had a higher degree of airway hypoplasia.

Conclusion

The skull base synostotic process drives the changes in facial complex growth and airway obstruction. Premature closure of synchondroses/sutures in the posterior branch of the coronal ring causes insufficient facial growth, maxillary retrusion, and more severe airway reduction.

Shetye PR, Davidson EH, Sorkin M, Grayson BH, McCarthy JG (2010) Evaluation of three surgical techniques for advancement of the midface in growing children with syndromic craniosynostosis. Plast Reconstr Surg 126(3):982–994. https://doi.org/10.1097/PRS.0b013e3181e6051e00006534-201009000-00031 CrossRefPubMed

Saltaji H, Altalibi M, Major MP, Al-Nuaimi MH, Tabbaa S, Major PW, Flores-Mir C (2014) Le Fort III distraction osteogenesis versus conventional Le Fort III osteotomy in correction of syndromic midfacial hypoplasia: a systematic review. J Oral Maxillofac Surg 72(5):959–972. https://doi.org/10.1016/j.joms.2013.09.039 CrossRefPubMed

Anantheswar YN, Venkataramana NK (2009) Pediatric craniofacial surgery for craniosynostosis: our experience and current concepts: parts—2. J Pediatr Neurosci 4(2):100–107. https://doi.org/10.4103/1817-1745.57328JPN-4-100 CrossRefPubMedPubMedCentral

Derderian C, Seaward J (2012) Syndromic craniosynostosis. Semin Plast Surg 26(2):64–75. https://doi.org/10.1055/s-0032-132006426064 CrossRefPubMedPubMedCentral

Tahiri Y, Paliga JT, Vossough A, Bartlett SP, Taylor JA (2014) The spheno-occipital synchondrosis fuses prematurely in patients with Crouzon syndrome and midface hypoplasia compared with age- and gender-matched controls. J Oral Maxillofac Surg 72(6):1173–1179. https://doi.org/10.1016/j.joms.2013.11.015 CrossRefPubMed

Calandrelli R, D’Apolito G, Gaudino S, Sciandra MC, Caldarelli M, Colosimo C (2014) Identification of skull base sutures and craniofacial anomalies in children with craniosynostosis: utility of multidetector CT. Radiol Med 119(9):694–704. https://doi.org/10.1007/s11547-014-0387-y CrossRefPubMed

Calandrelli R, D’Apolito G, Gaudino S, Stefanetti M, Massimi L, Di Rocco C, Colosimo C (2014) Radiological assessment of skull base changes in children with syndromic craniosynostosis: role of “minor” sutures. Neuroradiology 56(10):865–875. https://doi.org/10.1007/s00234-014-1392-5 CrossRefPubMed

Weissheimer A, Menezes LM, Sameshima GT, Enciso R, Pham J, Grauer D (2012) Imaging software accuracy for 3-dimensional analysis of the upper airway. Am J Orthod Dentofacial Orthop 142(6):801–813. https://doi.org/10.1016/j.ajodo.2012.07.015 CrossRefPubMed

Faul F, Erdfelder E, Lang AG, Buchner A (2007) G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39(2):175–191CrossRefPubMed

10.

Ko EW, Chen PK, Tai IC, Huang CS (2012) Fronto-facial monobloc distraction in syndromic craniosynostosis. Three-dimensional evaluation of treatment outcome and facial growth. Int J Oral Maxillofac Surg 41(1):20–27. https://doi.org/10.1016/j.ijom.2011.09.012 CrossRefPubMed

11.

Nout E, Bannink N, Koudstaal MJ, Veenland JF, Joosten KF, Poublon RM, van der Wal KG, Mathijssen IM, Wolvius EB (2012) Upper airway changes in syndromic craniosynostosis patients following midface or monobloc advancement: correlation between volume changes and respiratory outcome. J Craniomaxillofac Surg 40(3):209–214. https://doi.org/10.1016/j.jcms.2011.04.017 CrossRefPubMed

12.

Sculerati N, Gottlieb MD, Zimbler MS, Chibbaro PD, McCarthy JG (1998) Airway management in children with major craniofacial anomalies. Laryngoscope 108(12):1806–1812CrossRefPubMed

13.

Bannink N, Nout E, Wolvius EB, Hoeve HL, Joosten KF, Mathijssen IM (2010) Obstructive sleep apnea in children with syndromic craniosynostosis: long-term respiratory outcome of midface advancement. Int J Oral Maxillofac Surg 39(2):115–121. https://doi.org/10.1016/j.ijom.2009.11.021 CrossRefPubMed

14.

Paliga JT, Goldstein JA, Vossough A, Bartlett SP, Taylor JA (2014) Premature closure of the spheno-occipital synchondrosis in Pfeiffer syndrome: a link to midface hypoplasia. J Craniofac Surg 25(1):202–205. https://doi.org/10.1097/SCS.0000000000000386 CrossRefPubMed

15.

Boutros S, Shetye PR, Ghali S, Carter CR, McCarthy JG, Grayson BH (2007) Morphology and growth of the mandible in Crouzon, Apert, and Pfeiffer syndromes. J Craniofac Surg 18(1):146–150. https://doi.org/10.1097/01.scs.0000248655.53405.a7 CrossRefPubMed

16.

Forte AJ, Alonso N, Persing JA, Pfaff MJ, Brooks ED, Steinbacher DM (2014) Analysis of midface retrusion in Crouzon and Apert syndromes. Plast Reconstr Surg 134(2):285–293. https://doi.org/10.1097/PRS.000000000000036000006534-201408000-00026 CrossRefPubMed

17.

Carinci F, Avantaggiato A, Curioni C (1994) Crouzon syndrome: cephalometric analysis and evaluation of pathogenesis. Cleft Palate Craniofac J 31(3):201–209. https://doi.org/10.1597/1545-1569(1994)031<0201:CSCAAE>2.3.CO;2 CrossRefPubMed

18.

Grayson BH, Weintraub N, Bookstein FL, McCarthy JG (1985) A comparative cephalometric study of the cranial base in craniofacial anomalies: part I: tensor analysis. Cleft Palate J 22(2):75–87PubMed

19.

Langford RJ, Sgouros S, Natarajan K, Nishikawa H, Dover MS, Hockley AD (2003) Maxillary volume growth in childhood. Plast Reconstr Surg 111(5):1591–1597. https://doi.org/10.1097/01.PRS.0000057971.87632.37 CrossRefPubMed

20.

Roche J, Frawley G, Heggie A (2002) Difficult tracheal intubation induced by maxillary distraction devices in craniosynostosis syndromes. Paediatr Anaesth 12(3):227–234CrossRefPubMed

21.

Purushothaman R, Cox TC, Maga AM, Cunningham ML (2011) Facial suture synostosis of newborn Fgfr1(P250R/+) and Fgfr2(S252W/+) mouse models of Pfeiffer and Apert syndromes. Birth Defects Res A Clin Mol Teratol 91(7):603–609. https://doi.org/10.1002/bdra.20811 CrossRefPubMed

22.

Tamburrini G, Caldarelli M, Massimi L, Gasparini G, Pelo S, Di Rocco C (2012) Complex craniosynostoses: a review of the prominent clinical features and the related management strategies. Childs Nerv Syst 28(9):1511–1523. https://doi.org/10.1007/s00381-012-1819-4 CrossRefPubMed

23.

Wery MF, Nada RM, van der Meulen JJ, Wolvius EB, Ongkosuwito EM (2015) Three-dimensional computed tomographic evaluation of Le Fort III distraction osteogenesis with an external device in syndromic craniosynostosis. Br J Oral Maxillofac Surg 53(3):285–291. https://doi.org/10.1016/j.bjoms.2014.12.016 CrossRefPubMed

Title: Quantitative evaluation of facial hypoplasia and airway obstruction in infants with syndromic craniosynostosis: relationship with skull base and splanchnocranium sutural pattern
Publication date: 01-05-2018
Published in: Neuroradiology / Issue 5/2018
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI: https://doi.org/10.1007/s00234-018-2005-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Quantitative evaluation of facial hypoplasia and airway obstruction in infants with syndromic craniosynostosis: relationship with skull base and splanchnocranium sutural pattern

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 5/2018

Safety of cerebral angiography and neuroendovascular therapy in patients with chronic kidney disease

Beyond fractional anisotropy in amyotrophic lateral sclerosis: the value of mean, axial, and radial diffusivity and its correlation with electrophysiological conductivity changes

Structural connectome with high angular resolution diffusion imaging MRI: assessing the impact of diffusion weighting and sampling on graph-theoretic measures

Hemodynamic vascular biomarkers for initiation of paraclinoid internal carotid artery aneurysms using patient-specific computational fluid dynamic simulation based on magnetic resonance imaging

Correction to: Reducing task-based fMRI scanning time using simultaneous multislice echo planar imaging

Roles of the apparent diffusion coefficient and tumor volume in predicting tumor grade in patients with choroid plexus tumors