DOCSLIB.ORG

Endoscopic Treatment of Combined Metopic-Sagittal Craniosynostosis

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Endoscopic Treatment of Combined Metopic-Sagittal Craniosynostosis CLINICAL ARTICLE J Neurosurg Pediatr 26:113–121, 2020 Endoscopic treatment of combined metopic-sagittal craniosynostosis Ema Zubovic, MD,1 Gary B. Skolnick, BS,1 Sybill D. Naidoo, PhD, RN, CPNP,1 Mark Bellanger, CPed, COA, ATC,3 Matthew D. Smyth, MD,2 and Kamlesh B. Patel, MD, MSc1 1Division of Plastic & Reconstructive Surgery, Department of Surgery, and 2Department of Neurosurgery, Washington University School of Medicine in St. Louis; and 3Orthotic and Prosthetic Lab, St. Louis, Missouri OBJECTIVE Combined metopic-sagittal craniosynostosis is traditionally treated with open cranial vault remodeling and fronto-orbital advancement, sometimes in multiple operations. Endoscopic treatment of this multisuture synostosis pres- ents a complex challenge for the surgeon and orthotist. METHODS The authors retrospectively analyzed the preoperative and 1-year postoperative CT scans of 3 patients with combined metopic-sagittal synostosis, all of whom were treated with simultaneous endoscope-assisted craniectomy of the metopic and sagittal sutures followed by helmet therapy. Established anthropometric measurements were applied to assess pre- and postoperative morphology, including cranial index and interfrontal divergence angle (IFDA). Patients’ measurements were compared to those obtained in 18 normal controls. RESULTS Two boys and one girl underwent endoscope-assisted craniectomy at a mean age of 81 days. The mean preoperative cranial index was 0.70 (vs control mean of 0.82, p = 0.009), corrected postoperatively to a mean of 0.82 (vs control mean of 0.80, p = 0.606). The mean preoperative IFDA was 110.4° (vs control mean of 152.6°, p = 0.017), cor- rected postoperatively to a mean of 139.1° (vs control mean of 140.3°, p = 0.348). The mean blood loss was 100 mL and the mean length of stay was 1.7 days. No patient underwent reoperation. The mean clinical follow-up was 3.4 years. CONCLUSIONS Endoscope-assisted craniectomy with helmet therapy is a viable single-stage treatment option for combined metopic-sagittal synostosis, providing correction of the stigmata of trigonoscaphocephaly, with normalization of the cranial index and IFDA. https://thejns.org/doi/abs/10.3171/2020.2.PEDS2029 KEYWORDS metopic-sagittal synostosis; endoscopic; craniosynostosis; multisuture; craniofacial OMBINED synostosis of the metopic and sagittal su- The risk of potential surgical and anesthetic morbidity tures is exceedingly rare, representing just 0.5%– is increased with multiple open transcranial operations in 2% of all craniosynostosis cases.1,2 Trigonoscapho- the 1st year of life. For single-suture craniosynostosis, en- Ccephaly, the result of simultaneous frontal, temporal, and doscopic procedures have been shown to decrease blood biparietal growth restriction, presents a more complex loss, operating time, length of hospital stay, and cost rela- reconstructive challenge than either metopic or sagittal tive to open approaches.4–8 In patients with isolated metopic synostosis alone. Traditional practice has been a 2-stage or sagittal synostosis, equivalent morphological outcomes open surgical repair to address each synostosis separately. have been achieved with endoscope-assisted craniectomy Czerwinski et al. suggested an initial procedure to repair followed by postoperative molding helmet therapy.9–14 To the sagittal synostosis when patients are 6–8 months of our knowledge, there has been no report in the literature of age, followed by correction of the metopic synostosis by single-stage endoscope-assisted craniectomy with molding fronto-orbital advancement at 10–12 months of age, allow- helmet therapy for combined metopic-sagittal synostosis. ing for a more stable fronto-orbital bandeau reconstruc- In this report, our aim was as follows: to 1) present our tion.3 More recently, Dobbs et al. published the first report experience in endoscopic treatment of combined metopic- of single-stage open repair for combined metopic-sagittal sagittal synostosis, demonstrating our operative technique synostosis.1 and postoperative helmet therapy protocol; 2) objectively ABBREVIATIONS IFDA = interfrontal divergence angle; ZF-G-ZF angle = glabella and bilateral zygomaticofrontal sutures; ZF-ZF = interzygomaticofrontal. SUBMITTED January 10, 2020. ACCEPTED February 18, 2020. INCLUDE WHEN CITING Published online April 17, 2020; DOI: 10.3171/2020.2.PEDS2029. ©AANS 2020, except where prohibited by US copyright law J Neurosurg Pediatr Volume 26 • August 2020 113 Unauthenticated | Downloaded 10/06/21 05:19 AM UTC Zubovic et al. evaluate the postoperative morphological outcomes of is taken to remove the bone in segments after controlling patients treated endoscopically; and 3) compare these pa- any emissary veins with bipolar electrocautery. The an- tients to normal controls as an evaluation of success in terior remainder of the fused metopic suture is resected, normalization of cranial and facial morphology. tapering to the level of the nasofrontal suture. The ma- jority of the 1-cm strip craniectomy is done under direct Methods visualization. Completion of suturectomy is confirmed by endoscopic visualization of the nasal upper lateral carti- After obtaining institutional review board approval, we lages (Fig. 1), the tips of which are seen at the nasofrontal identified 3 patients treated endoscopically for combined junction under the nasal bones. The nasal bones are not metopic-sagittal craniosynostosis at our institution be- resected. Floseal (Baxter International) is placed in the tween 2012 and 2017. All 3 underwent endoscope-assisted craniectomy defect. The skin incision is closed in layered craniectomy performed by the same craniofacial surgeon fashion with resorbable suture and skin glue. (K.B.P.) and neurosurgeon (M.D.S.), followed by custom molding helmet therapy until 1 year of age. Sagittal Suturectomy Preoperative Evaluation After completion of the metopic suturectomy and skin closure, the patient is repositioned in the sphinx position After preoperative evaluation by both treating surgeons, and sterile preparation and draping is repeated. Hair is patients underwent preoperative low-dose CT imaging to clipped, and 2 new 2.5-cm transverse incisions are made confirm the clinical diagnosis of metopic-sagittal cranio- just posterior to the anterior fontanelle and just anterior synostosis. Our practice is to offer both open and endo- to lambda. Subgaleal dissection is again extended across scopic treatment options to eligible patients younger than the fused sagittal suture, connecting the 2 access incisions. 5 months of age, and only open treatment to older patients. Burr holes are made to the side of the fused sagittal suture We prefer patients to be 2–3 months of age for endoscopic through each access incision, then widened with curettes treatment to allow the orthotist to take advantage of the 14,15 and Kerrison punches, and osteotomies are extended rapid skull growth of early infancy. Endoscopic treat- across midline. After mobilization of the dura, the wedge ment of multisuture synostosis places more complex de- of cranial bone between the anterior osteotomy and the mands on postoperative molding helmet therapy, which are posterior aspect of the anterior fontanelle is excised under best met by early initiation of helmet therapy. Patients meet direct visualization with Tessier bone scissors. An endo- the orthotist and undergo scanning for a custom molding scope is introduced into the epidural space posteriorly, and helmet in the week before surgery, in order to ensure hel- the dura is dissected from the inner table. A 2-cm-wide met availability in the immediate postoperative period. segment of the fused sagittal suture is excised with para- median cuts by using Tessier bone scissors and extracted Operative Technique through the anterior incision. Finally, the remaining bone We initially performed this procedure with the patient anterior to lambda is freed and excised. Bone edges are entirely in the prone sphinx position, but our preferred again coagulated with suction electrocautery, under visu- technique is now to complete the metopic suturectomy alization by 0° endoscope. Floseal is again placed in the with the patient supine, repositioning to the sphinx po- craniectomy defect and access incisions are closed in the sition for the sagittal suturectomy. This allows for more same fashion as above. complete visualization and more facile instrumentation Patients without significant comorbidities are typically for each approach. We have previously published exam- admitted overnight to a regular surgical ward and hemato- ples of patient positioning for endoscopic repairs of me- crit is measured 4 hours postoperatively. Discharge home topic14 and sagittal13 synostosis. on postoperative day 1 is standard. Patients using a local orthotist are typically fitted with their helmet prior to hos- Metopic Suturectomy pital discharge; those using a more distant orthotic com- The patient is positioned supine, with the head elevat- pany have a helmet fitting appointment within the first 3 ed in a Mayfield headrest above the level of the heart to postoperative days. Edema control with head elevation and minimize blood loss. Intravenous dexamethasone and 24 hours of intravenous dexamethasone (beginning with tranexamic acid are administered. After sterile prepara- the intraoperative dose) are essential to allow early helmet tion, draping, and infiltration of local anesthesia, a 2.5-cm fitting. transverse incision is made in the frontal hairline, and sub- galeal dissection is extended
Load more

Recommended publications
  • Study of Wormian Bones on Dry Human Skull and Its Sexual Dimorphism in the Region of Andhra Pradesh
    Original Research Article Study of Wormian Bones on Dry human skull and its sexual dimorphism in the region of Andhra Pradesh Shone Vasudeo Durge Assistant Professor, Dept. of Anatomy, Fathima Institute of Medical Sciences, Ramarajupalli, Andhra Pradesh Corresponding Author: E-mail: [email protected] Abstract This study was aimed at identifying the wormian bone and their overall incidence in respect to their number and location in the region of Andhra Pradesh. Overall incidence of wormian bones was more in female (47.72%) than in male skulls (41.66%). They occurred more frequently at lambdoid suture (38%). Wormian bones along the coronal suture, Bregma and Asterion were seen only in male skulls, while intra-orbital wormian bones and wormian bones at Pterion were seen only in female skulls. This study concludes by stating that, there exists a moderate degree of sexual dimorphism among the wormian bones with respect to overall incidence, number and location. Keywords- Skull, Sexual dimorphism, Wormian bones, Lambda, Asterion. Background knowledge of WBs is important in the diagnosis of Wormian bones, also known as intra-sutural bones, these disorders (Cremin, Goodman, Spranger et al., are extra bone pieces that occur within a suture in the 1982). It was reported that their incidence is well suited cranium. These are irregular isolated bones that appear for comparative studies as an anthropological marker or in addition to the usual centers of ossification of the an indicator of population distance (Gumusburun, cranium and, although unusual, are not rare. They occur Sevim, Katkici et al., 1997). Their knowledge is of most frequently in the course of the lambdoid suture, interest to the human anatomy, physical anthropology which is more tortuous than other sutures.
    [Show full text]
  • CLOSURE of CRANIAL ARTICULATIONS in the SKULI1 of the AUSTRALIAN ABORIGINE by A
    CLOSURE OF CRANIAL ARTICULATIONS IN THE SKULI1 OF THE AUSTRALIAN ABORIGINE By A. A. ABBIE, Department of Anatomy, University of Adelaide INTRODUCTION While it is well known that joint closure advances more or less progressively with age, there is still little certainty in matters of detail, mainly for lack of adequate series of documented skulls. In consequence, sundry beliefs have arisen which tend to confuse the issue. One view, now disposed of (see Martin, 1928), is that early suture closure indicates a lower or more primitive type of brain. A corollary, due to Broca (see Topinard, 1890), that the more the brain is exercised the more is suture closure postponed, is equally untenable. A very widespread belief is based on Gratiolet's statement (see Topinard, 1890; Frederic, 1906; Martin, 1928; Fenner, 1939; and others) that in 'lower' skulls the sutures are simple and commence to fuse from in front, while in 'higher' skulls the sutures are more complicated and tend to fuse from behind. This view was disproved by Ribbe (quoted from Frederic, 1906), who substituted the generalization that in dolicocephals synostosis begins in the coronal suture, and in brachycephals in the lambdoid suture. In addition to its purely anthropological interest the subject raises important biological considerations of brain-skull relationship, different foetalization in different ethnological groups (see Bolk, 1926; Weidenreich, 1941; Abbie, 1947), and so on. A survey of the literature reveals very little in the way of data on the age incidence of suture closure. The only substantial contribution accessible here comes from Todd & Lyon (1924) for Europeans, but their work is marred by arbitrary rejection of awkward material.
    [Show full text]
  • MBB: Head & Neck Anatomy
    MBB: Head & Neck Anatomy Skull Osteology • This is a comprehensive guide of all the skull features you must know by the practical exam. • Many of these structures will be presented multiple times during upcoming labs. • This PowerPoint Handout is the resource you will use during lab when you have access to skulls. Mind, Brain & Behavior 2021 Osteology of the Skull Slide Title Slide Number Slide Title Slide Number Ethmoid Slide 3 Paranasal Sinuses Slide 19 Vomer, Nasal Bone, and Inferior Turbinate (Concha) Slide4 Paranasal Sinus Imaging Slide 20 Lacrimal and Palatine Bones Slide 5 Paranasal Sinus Imaging (Sagittal Section) Slide 21 Zygomatic Bone Slide 6 Skull Sutures Slide 22 Frontal Bone Slide 7 Foramen RevieW Slide 23 Mandible Slide 8 Skull Subdivisions Slide 24 Maxilla Slide 9 Sphenoid Bone Slide 10 Skull Subdivisions: Viscerocranium Slide 25 Temporal Bone Slide 11 Skull Subdivisions: Neurocranium Slide 26 Temporal Bone (Continued) Slide 12 Cranial Base: Cranial Fossae Slide 27 Temporal Bone (Middle Ear Cavity and Facial Canal) Slide 13 Skull Development: Intramembranous vs Endochondral Slide 28 Occipital Bone Slide 14 Ossification Structures/Spaces Formed by More Than One Bone Slide 15 Intramembranous Ossification: Fontanelles Slide 29 Structures/Apertures Formed by More Than One Bone Slide 16 Intramembranous Ossification: Craniosynostosis Slide 30 Nasal Septum Slide 17 Endochondral Ossification Slide 31 Infratemporal Fossa & Pterygopalatine Fossa Slide 18 Achondroplasia and Skull Growth Slide 32 Ethmoid • Cribriform plate/foramina
    [Show full text]
  • Ectocranial Suture Closure in Pan Troglodytes and Gorilla Gorilla: Pattern and Phylogeny James Cray Jr.,1* Richard S
    AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 136:394–399 (2008) Ectocranial Suture Closure in Pan troglodytes and Gorilla gorilla: Pattern and Phylogeny James Cray Jr.,1* Richard S. Meindl,2 Chet C. Sherwood,3 and C. Owen Lovejoy2 1Department of Anthropology, University of Pittsburgh, Pittsburgh, PA 15260 2Department of Anthropology and Division of Biomedical Sciences, Kent State University, Kent, OH 44242 3Department of Anthropology, The George Washington University, Washington, DC 20052 KEY WORDS cranial suture; synostosis; variation; phylogeny; Guttman analysis ABSTRACT The order in which ectocranial sutures than either does with G. gorilla, we hypothesized that this undergo fusion displays species-specific variation among phylogenetic relationship would be reflected in the suture primates. However, the precise relationship between suture closure patterns of these three taxa. Results indicated that closure and phylogenetic affinities is poorly understood. In while all three species do share a similar lateral-anterior this study, we used Guttman Scaling to determine if the closure pattern, G. gorilla exhibits a unique vault pattern, modal progression of suture closure differs among Homo which, unlike humans and P. troglodyte s, follows a strong sapiens, Pan troglodytes,andGorilla gorilla.BecauseDNA posterior-to-anterior gradient. P. troglodytes is therefore sequence homologies strongly suggest that P. tr og lodytes more like Homo sapiens in suture synostosis. Am J Phys and Homo sapiens share a more recent common ancestor Anthropol 136:394–399, 2008. VC 2008 Wiley-Liss, Inc. The biological basis of suture synostosis is currently Morriss-Kay et al. (2001) found that maintenance of pro- poorly understood, but appears to be influenced by a liferating osteogenic stem cells at the margins of mem- combination of vascular, hormonal, genetic, mechanical, brane bones forming the coronal suture requires FGF and local factors (see review in Cohen, 1993).
    [Show full text]
  • INCIDENCE of TYPES of PTERION in SOUTH INDIANS – a STUDY on CADAVERIC DRY SKULLS Manjunath Halagatti 1, Channabasanagouda *2
    International Journal of Anatomy and Research, Int J Anat Res 2017, Vol 5(3.2):4290-94. ISSN 2321-4287 Original Research Article DOI: https://dx.doi.org/10.16965/ijar.2017.313 INCIDENCE OF TYPES OF PTERION IN SOUTH INDIANS – A STUDY ON CADAVERIC DRY SKULLS Manjunath Halagatti 1, Channabasanagouda *2. 1 Assistant Professor, Department of Anatomy, Koppal Instistute of Medical Sciences, Koppal, Karnataka, India. *2 Associate Professor, Department of Anatomy, Koppal Instistute of Medical Sciences, Koppal, Karnataka, India. ABSTRACT Introduction : Pterion is an important landmark in the temporal fossa. It is a significant area for the surface location of anterior branch of middle meningeal artery and stem of lateral sulcus of the cerebrum. Based upon the pattern of articulation of the bones, different varieties of pterion have been encountered. Knowing about the incidence of types of pterion is very important for neurosurgeons, anthropologists, forensic scientists and radiologists. Materials and methods : Current study was done on 282 dry adult human cadaveric skulls (564 sides), for the incidence of different types of pterion. Types of pterion are – sphenoparietal type, frontotemporal type, stellate type and epipteric type. Results : Out of the 564 pteria,we have identified 455 sphenoparietal type, 77 frontotemporal type, 17 stellate type and 15 epipteric types. The incidence of different types of pteria have been correlated and compared with the data available from previous studies. Conclusion : The current study on incidence of types of pterion will add further knowledge to the available data about types of pterion and it will be of immense help for neurosurgeons, orthopedic surgeons, pediatricians, radiologists and anthropologists for proper diagnostic and therapeutic purposes.
    [Show full text]
  • 1 TERMINOLOGIA ANTHROPOLOGICA Names of The
    TERMINOLOGIA ANTHROPOLOGICA Names of the parts of the human body, terms of aspects and relationships, and osteological terminology are as in Terminologia Anatomica. GENERAL TERMS EXPLANANTION ADAPTATION Adjustment and change of an organism to a specific environment, due primarily to natural selection. ADAPTIVE RADIATION Divergence of an ancestral population through adaption and speciation into a number of ecological niches. ADULT Fully developed and mature individual ANAGENESIS The progressive adaption of a single evolutionary line, where the population becomes increasingly specialized to a niche that has remained fairly constant through time. ANCESTRY One’s family or ethnic descent, the evolutionary or genetic line of descent of an animal or plant / Ancestral descent or lineage ANTEMORTEM Biological processes that can result in skeletal modifications before death ANTHROPOCENTRICISM The belief that humans are the most important elements in the universe. ANTHROPOLOGY The study of human biology and behavior in the present and in the past ANTHROPOLOGIST BIOLOGICAL A specialist in the subfield of anthropology that studies humans as a biological species FORENSIC A specialist in the use of anatomical structures and physical characteristics to identify a subject for legal purposes PHYSICAL A specialist in the subfield of anthropology dealing with evolutionary changes in the human bodily structure and the classification of modern races 1 SOCIAL A specialist in the subfield of anthropology that deals with cultural and social phenomena such as kingship systems or beliefs ANTHROPOMETRY The study of human body measurement for use in anthropological classification and comparison ARCHETYPE That which is taken as the blueprint for a species or higher taxonomic category ARTIFACT remains of past human activity.
    [Show full text]
  • Endoscopic-Assisted Repair of Craniosynostosis
    Neurosurg Focus 19 (6):E6, 2005 Endoscopic-assisted repair of craniosynostosis GREGORY J. A. MURAD, M.D., MARK CLAYMAN, M.D., M. BRENT SEAGLE, M.D., SNO WHITE, M.D., LEIGH ANN PERKINS, A.R.N.P., AND DAVID W. PINCUS, M.D., PH.D. Department of Neurosurgery, Divisions of Plastic Surgery and Pediatric Anesthesiology, and the University of Florida Craniofacial Center, University of Florida College of Medicine, Gainesville, Florida Object. The goal of the craniofacial surgeon has always been the correction of form and function with prevention of associated morbidity and death. Through the pioneering work of Jimenez and Barone, minimally invasive ap- proaches to the surgical correction of craniosynostosis are now gaining wider acceptance. Here the authors review the technique for endoscopic-assisted repair of craniosynostosis from the perspective of a new minimally invasive ap- proach. They also assess the safety, efficacy, and results of the early treatment of infants with craniosynostosis in a small series of children who underwent surgery at this institution. Methods. Data regarding synostosis type, operative time, patient age, blood loss, transfusion rates, duration of hos- pitalization, and complications were collected. Nineteen patients (12 girls and seven boys) between the ages of 1.2 and 5 months of age were treated with the endoscope-assisted technique. The mean operative time was 97 minutes. Five (26%) of 19 children received a blood transfusion. Most patients were discharged home the morning after surgery. The clinical courses of two patients who required additional major craniofacial reconstructions are discussed. There were no deaths, dural sinus tears, cerebrospinal fluid leaks, neurological injuries, or infections, and there were no compli- cations related to the use of helmet therapy.
    [Show full text]
  • Bekah's Normal Labor Assignment #7
    1 1. How many different elements, or “parts”, are there to the fetal skull? There are 51 bony elements of the fetal skull. These elements are separated by either cartilage or connective tissue as the newborn skull is only partially ossified at the time of birth. 2. What are sutures? What are fontanels? Sutures: In the newborn skull, there are gaps between the edges of membranous bones. These gaps, which are spanned by a flexible bridge of membranous tissue, are called sutures. Sutures allow moulding or movement of the bony plates in labor and they also allow the baby’s brain to grow rapidly after birth. Fontanels: These are located where sutures intersect. They are membrane and skin- covered openings and spaces. The anterior and posterior fontanelles are the most important clinically. 3. Explain suture and fontanel locations, shapes, and functions in detail along with their names. Sutures • Sagittal suture—divides the cranial vault in half, runs between the parietal bones and it originates at the anterior fontanelle and ends at the posterior fontanelle. • Lambdoidal sutures (2)—these run from the posterior fontanelle down and around to the border of the occipital vault. These separate the interparietal portion of the occiput from the two parietal bones. • Coronal sutures (2)—these run transverse and downward from the anterior fontanelle to the sphenoid fontanelle on either side. The coronal sutures separate the parietal and frontal bones. • Frontal suture—this is location between the two frontal bones. It is an anterior continuation of the sagittal suture. It may be mistaken for the sagittal suture in deflexed presentations during an internal exam.
    [Show full text]
  • Homo Erectus? L’Épaisseur Crânienne Et Sa Constitution Interne : Autapomorphies De L’Espèce Homo Erectus ?
    Bulletins et mémoires de la Société d’Anthropologie de Paris 18 (3-4) | 2006 2006(3-4) Are thickened cranial bones and equal participation of the three structural bone layers autapomorphic traits of Homo erectus? L’épaisseur crânienne et sa constitution interne : autapomorphies de l’espèce Homo erectus ? Antoine Balzeau Édition électronique URL : https://journals.openedition.org/bmsap/1528 DOI : 10.4000/bmsap.1528 ISSN : 1777-5469 Éditeur Société d'Anthropologie de Paris Édition imprimée Date de publication : 1 décembre 2006 Pagination : 145-163 ISSN : 0037-8984 Référence électronique Antoine Balzeau, « Are thickened cranial bones and equal participation of the three structural bone layers autapomorphic traits of Homo erectus? », Bulletins et mémoires de la Société d’Anthropologie de Paris [En ligne], 18 (3-4) | 2006, mis en ligne le 14 juin 2010, consulté le 01 juin 2021. URL : http:// journals.openedition.org/bmsap/1528 ; DOI : https://doi.org/10.4000/bmsap.1528 Les contenus des Bulletins et mémoires de la Société d’Anthropologie de Paris sont mis à disposition selon les termes de la licence Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. Bulletins et Mémoires de la Société d’Anthropologie de Paris, n.s., t. 18, 2006, 3-4, p. 145-163 ARE THICKENED CRANIAL BONES AND EQUAL PARTICIPATION OF THE THREE STRUCTURAL BONE LAYERS AUTAPOMORPHIC TRAITS OF HOMO ERECTUS? L’ÉPAISSEUR CRÂNIENNE ET SA CONSTITUTION INTERNE : AUTAPOMORPHIES DE L’ESPÈCE HOMO ERECTUS ? 1 Antoine BALZEAU ABSTRACT Numerous studies have proposed different lists of morphological features to define the species of Homo erectus; among these, some are considered to be autapomorphic.
    [Show full text]
  • Morphological Study of Wormian Bones in Dried Human Skulls
    ISSN: 0975-8585 Research Journal of Pharmaceutical, Biological and Chemical Sciences Morphological Study of Wormian Bones in Dried Human Skulls Shivaleela C1, Kumar GV2*, Malipatil SB3, and Sandhya K3 1Assistant professor in Anatomy, Sri Siddhartha medical college, Tumkur, Karnataka, India. 2Assistant professor in Pediatrics, Sri Siddhartha medical college, Tumkur Karnataka, India. 3Professor in Anatomy, M R Medical College, Gulbarga, Karnataka, India. ABSTRACT Wormian bones may be defined as those accidental or intercalated bones found in the cranium having no regular relation to their normal ossific centres. They are associated with cranial and central nervous system abnormalities. Knowledge of presence of wormian bones is of radiological importance and useful for the neurosurgeons, radiologists and anthropologists. The present study was carried out on 108 dried adult human skulls. The various sutures were examined systematically for the presence or absence of wormian bones. The findings were documented and the photographs of relevant wormian bones were taken using a digital camera. The Incidence was 43.52 %. Many skulls had combination of wormian bones at different sites. 33.33% skulls had wormian bones at the lambdoid suture. 11.11% had at asterion and 1.85% at pterion. Wormian bone at lambda observed in 8.33%and 3.7% at temporoparietal suture. 2.78% skulls had wormian bones at coronal suture and 0.92% at sagittal suture. The present study indicates that wormian bones may be present in the coronal, sagittal sutures and at pterion, asterion in addition to the usual site in the lambdoid suture. It is important for neurosurgeons and radiologists to be aware of the presence of wormian bones in these sutures as they may be mistaken for fractures in cases of head injuries.
    [Show full text]
  • Reconciling Artificial Intelligence and Non-Bayesian Models For
    Folia Morphol. Vol. 80, No. 3, pp. 625–641 DOI: 10.5603/FM.a2020.0149 O R I G I N A L A R T I C L E Copyright © 2021 Via Medica ISSN 0015–5659 eISSN 1644–3284 journals.viamedica.pl Unification of frequentist inference and machine learning for pterygomaxillary morphometrics A. Al-Imam1, 2 , I.T. Abdul-Wahaab1, 3, V.K. Konuri4, A. Sahai5, 6, A.K. Al-Shalchy7, 8 1Department of Anatomy and Cellular Biology, College of Medicine, University of Baghdad, Iraq 2Queen Mary University of London, the United Kingdom 3Department of Radiology, College of Medicine, University of Baghdad, Iraq 4Department of Anatomy, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India 5Dayalbagh Educational Institution, Deemed University, Dayalbagh, Agra, India 6International Federation of Associations of Anatomists, Seattle, United States of America 7Neurosurgical Unit, Department of Surgery, College of Medicine, University of Baghdad, Iraq 8The Royal College of Surgeons, United Kingdom [Received: 17 September 2020; Accepted: 24 November 2020; Early publication date: 30 December 2020] Background: The base of the skull, particularly the pterygomaxillary region, has a sophisticated topography, the morphometry of which interests pathologists, maxillofacial and plastic surgeons. The aim of the study was to conduct ptery- gomaxillary morphometrics and test relevant hypotheses on sexual and laterali- ty-based dimorphism, and causality relationships. Materials and methods: We handled 60 dry skulls of adult Asian males (36.7%) and females (63.3%). We calculated the prime distance D [prime] for the imaginary line from the maxillary tuberosity to the midpoint of the pterygoid process between the upper and the lower part of the pterygomaxillary fissure, as well as the parasagittal D [x-y inclin.] and coronal inclination of D [x-z inclin.] of the same line.
    [Show full text]
  • Anatomical Observations on Os Inca and Associated Cranial Deformities
    Folia Morphol. Vol. 64, No. 2, pp. 118–121 Copyright © 2005 Via Medica C A S E R E P O R T ISSN 0015–5659 www.fm.viamedica.pl Anatomical observations on os inca and associated cranial deformities Srijit Das, Rajesh Suri, Vijay Kapur Department of Anatomy, Maulana Azad Medical College, Bahadur Shah Zafar Marg, New Delhi, India [Received 27 October 2004; Revised 21 February 2005; Accepted 22 February 2005] The present study describes the presence of os inca, incomplete metopic suture with asymmetrical frontal sinuses and multiple sutural deformities in a skull bone. Os inca has been reported to be associated with other cranial deformities. How- ever, the present study, besides reporting os inca and associated sutural abnor- malities, also highlights the presence of an unusual pterion in such cases. The aim is to provide anatomical insight into the morphology of sutures, frontal sinuses and associated cranial abnormalities. These are important findings which may be relevant for surgeons and radiologists in clinical practice Key words: frontal sinus, metopic suture, os inca, wormian bone INTRODUCTION complete metopic suture as that which extends from Supernumerary bones represent additional ossi- the nasion to the coronal suture or to a point 2 cm fication centres near the sutures [28]. These super- anterior to it and incomplete metopic suture as one numerary bones are frequently found in the lamb- which might be present anywhere in the upper, mid- doid suture and also near the fontanelles [28]. An dle or lower part of the frontal bone [1, 2]. isolated bone which is found at the lambda is known Incidence of metopism is reported to be 7–10% in as the “Inca Bone” or “Goethe’s ossicles” [28].
    [Show full text]