Craniofacial malformation caused by premature fusion of cranial suture of infants has a serious impact on their growth. The purpose of skull remodeling surgery for infants with craniosynostosis is to expand the skull and allow the brain to grow properly. There are no standardized treatments for skull remodeling surgery at the present, and the postoperative effect can be hardly assessed reasonably. Children with sagittal craniosynostosis were selected as the research objects. By analyzing the morphological characteristics of the patients, the point cloud registration of the skull distortion region with the ideal skull model was performed, and a plan of skull cutting and remodeling surgery was generated. A finite element model of the infant skull was used to predict the growth trend after remodeling surgery. Finally, an experimental study of surgery simulation was carried out with a child with a typical sagittal craniosynostosis. The evaluation results showed that the repositioning and stitching of bone plates effectively improved the morphology of the abnormal parts of the skull and had a normal growth trend. The child's preoperative cephalic index was 65.31%, and became 71.50% after 9 months' growth simulation. The simulation of the skull remodeling provides a reference for surgical plan design. The skull remodeling approach significantly improves postoperative effect, and it could be extended to the generation of cutting and remodeling plans and postoperative evaluations for treatment on other types of craniosynostosis.
Child ; Computer Simulation ; Cranial Sutures/surgery* ; Craniosynostoses/surgery* ; Humans ; Infant ; Skull/surgery*

OBJECTIVETo explore the histological change in suture of zygomatic bone for the zygomatic suture direct distraction osteogenesis.

METHODSThe zygomatic bone was distracted by 3-D external distraction appliance without osteotomy. The specimens were taken 1, 3, 5 and 8 weeks after, and then examined histologically and compared with the blank contralateral side.

RESULTSThere were lots of fibroblasts, osteoblasts and capillary vessels in the distracted suture tissues one week after distraction, and the fibers were observed to connect the sides of suture and arranged orderly. The surfaces of the expanded suture were irregular. Bone formation was active in the expanded side. The bone trabeculae were mature and oriented in the direction of distraction in the distracted sides at 3 weeks. A great amount of new woven bones were found in 5-week specimen. New bones were formed completely 8 weeks after the distraction.

CONCLUSIONSNew bone formed rapidly in the distracted side of zygomatic bone under suture distraction osteogenesis without osteotomy.

Animals ; Cranial Sutures ; pathology ; surgery ; Female ; Goats ; Male ; Osteogenesis, Distraction ; Zygoma ; pathology ; surgery

OBJECTIVETo study the technique of total calvaria reconstruction for sagittal synostosis.

METHODS11 children with sagittal synostosis were treated. The David II procedure was used to reconstruct the calvarial gap in 6 cases; Osteotomies with reversal change was performed on 2 cases; Plum-plasty of the calvaria was performed on 3 cases.

RESULTSThe 11 cases were cured with satisfactory head shape.

CONCLUSIONSThe David II procedure is applicable for patient of 1 approximately 3 months. The technique of floating skull flap plasty and plum-plasty of the calvaria can be performed on patients older than 3 months.

Cranial Sutures ; abnormalities ; Craniosynostoses ; surgery ; Female ; Humans ; Infant ; Male ; Reconstructive Surgical Procedures ; methods

OBJECTIVETo investigate the biomechanical changes with different directions distraction at midface.

METHODSAn anteriorly directed 500 g force was applied to the floor of apertura piriforms in different directions to the occlusal plane. Three-dimensional finite element analysis was used to evaluate the biomechanical change of craniofacial complex.

RESULTSAs the force direction was moved downward, the sagittal distraction length of the craniofacial complex decreased and vertical movement changed from upward to downward. The craniofacial complex was moved anteriorly when the downward force was applied about 20-30 degrees to the occlusal plane. The forces could generate the uniform stress distribution in the craniofacial sutures and avoid counterclockwise rotation of the maxilla.

CONCLUSIONSThe craniofacial complex can be effectively distracted anteriorly when the downward force is applied to the floor of aperture piriforms in direction of 20-30 degrees to the occlusal plane.

Biomechanical Phenomena ; Computer-Aided Design ; Cranial Sutures ; Finite Element Analysis ; Humans ; Mandible ; physiology ; surgery

OBJECTIVE: To analyze the clinical and genetic characteristics of an infant with craniosynostosis. METHODS: An infant who was admitted to Wuhan Children's Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology in April 2021 due to widening of the lateral ventricles for over a month was selected as the study subject. Clinical data of the patient was collected. Peripheral blood samples were collected from the infant and her parents for chromosomal karyotyping and whole exome sequencing. Candidate variant was verified by Sanger sequencing and bioinformatic analysis. Relevant literature was retrieved from the PubMed, Wanfang and CNKI databases (up to December 2021) by using key words including ERF gene, craniosynostosis, ERF mutation, craniosynostosis and ERF-related craniosynostosis. RESULTS: The infant, a 1-month-and-16-day-old female, was found to have sagittal synostosis by cranial X-ray radiography. Genetic testing revealed that she has harbored a heterozygous c.787C>T (p.Q263*) variant of the ERF gene, which was not found in either parent. Based on the guidelines from the American College of Medical Genetics and Genomics (ACMG), the variant was predicted as pathogenic (PVS1+PS2+PM2_Supporting). In total 63 relevant cases were retrieved from the database, and a total of 64 individuals were analyzed by genetic testing. Most of the cases were sporadic and males. Multiple cranial sutures (including at least two of the sagittal suture, coronal suture, lambdoid suture, and frontal suture) were involved in 45.45% of the cases, and those with sagittal suture closure only have accounted for 20.00%. The main clinical manifestations have included hypertelorism, exophthalmos, development delay, malar dysplasia, etc. Chiari type 1 malformation may present in some patients. Variants of the ERF gene have mainly included splicing and deletional variants, and there was a strong genetic heterogeneity among the infants and their pedigrees. CONCLUSION The c.787C>T (p.Q263*) variant of the ERF gene probably underlay the craniosynostosis of this infant. Above finding has enriched the phenotype ~ genotype spectrum of the ERF gene.
Female ; Humans ; Cranial Sutures/surgery* ; Craniosynostoses/genetics* ; Genetic Testing ; Mutation ; Repressor Proteins/genetics* ; Infant

OBJECTIVETo investigate the technique of skull reconstruction for the congenital craniosynostosis.

METHODSMany technique of skull plasty were adopted to correct the congenital craniosynostosis. We advanced fronto-orbital, reversal change of the frontal bone to correct the brachycephalic, hydrocephaly acrocephaly, which were supported by parietal bone. Plum-plasty of the calvaria was performed for sagittal synostosis; Fronto-orbital plasty correct the trigonocephaly; for single coronal synostosis, which result to frontal plagiocephaly,we reversed both frontal sides, advanced orbital strip and tilted the invalid side . The post plagiocephaly because of single Lambdoid synostosis, we performed of plum-plasty, reversal change of total occipital. Fronota-facial advancement cured the brachycephalic complicating with Apert or Crouzon which caused by coronal synostosis and cranial basal suture synostosis.

RESULTS37 cases were recovery without complication. The figures were improved.

CONCLUSIONSBig calvarial flap plasty is an optimal technique to correct the congenital craniosynostosis. But it is not substituted by bone lengthening and minimally invasive technique.

Child, Preschool ; Cranial Sutures ; abnormalities ; Craniosynostoses ; surgery ; Female ; Humans ; Infant ; Male ; Reconstructive Surgical Procedures ; methods ; Skull ; surgery

OBJECTIVETo explore the ultrastructure of the palate-maxillary sutures under tensile forces by transmission electron microscope (TEM).

METHODSThe Suture expanders were made in NiTi-Shape memory alloy (NiTi-SMA). The maximum force was 3.5 N. Fourteen 8-month old mongrel dogs were used in the study. They were divided into three groups, (1) experimental group, (2) control group, (3) sham group. In the experiment and control groups, an 8 mm wide cleft was made by surgery. The suture expanders were fixed onto the palatine bones of the experimental group. The dogs of the experimental group were executed after 3, 7, 14, 28, 56 days of suture expansion. The change of suture tissue was examined by TEM.

RESULTSThe cleft of the experiment group were closed at the ninth day of expansion. At the beginning, tissue rupture, exudation, death of fibroblasts, disruption of collagen and tear vessels were seen at the early stage of suture expansion. Then highly active functional manifestations were seen in both osteocytic and fibrocytic populations. At last, normal structure restored.

CONCLUSIONSCell types and functional condition could be distinguished clearly by TEM. It suggests that the suture expansion should be the process of tissue repair and regeneration. The suture cells response, especially, the osteogenic response were the major factor of increasing suture width.

Alloys ; Animals ; Bone Regeneration ; Cranial Sutures ; surgery ; Dogs ; Maxilla ; surgery ; ultrastructure ; Microscopy, Electron, Transmission ; Nickel ; Osteogenesis ; Osteogenesis, Distraction ; Palate, Hard ; surgery ; ultrastructure ; Tensile Strength ; Titanium

OBJECTIVETo retrospectively investigate the effectiveness of sphenzygomatic suture as a guide in the reduction of zygomatic complex fracture.

METHODS55 cases of zygomatic complex fracture classified according to Zingg classification were treated, sphenozygomatic suture in group 1 (n = 36) was reduced first, then the other fracture line was reduced, in group 2 (n = 19), malar bone was reduced according to superficial fracture line. Patients were followed up for 4 weeks to 3 months, aesthetic result and X-ray symmetry were observed.

RESULTSAll patients in group 1 were restored with satisfactory facial contour, 35 cases got precise reduction, 5 cases in group 2 were asymmetry.

CONCLUSIONDuring open reduction of complex zygomatic fracture, sphenozygomatic suture should be reduced at first as a guide, so as to get precise zygomatic complex reconstruction and normal aesthetic outcome.

Adolescent ; Adult ; Cranial Sutures ; Female ; Follow-Up Studies ; Fracture Fixation ; methods ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Sphenoid Bone ; surgery ; Zygoma ; surgery ; Zygomatic Fractures ; surgery