Three-dimensional vector analysis provides accurate, comprehensive description of cranial morphology with quantitative graphic output. The method enables development of an extensive pediatric normative craniofacial database. Future application of these data will facilitate analysis of cranial anomalies and assist with clinical assessment.
Careful selection of face donors based on compatibility criteria will aid in ensuring that the posttransplant outcome is morphologically similar to the recipient's native face.
Some patients with sagittal synostosis present with a fused metopic suture. We hypothesize that premature metopic suture fusion consistently and identifiably alters form associated with sagittal synostosis. We previously validated three-dimensional vector analysis as a tool for the study of cranial morphology and used it herein to distinguish between dysmorphologies of isolated sagittal synostosis (ISS) and combined sagittal-metopic synostosis (CSM). Preoperative computed tomographic scans for patients with ISS and CSM were compared with matched normative counterparts. Premature metopic suture fusion was defined by established radiographic criteria. Color-coded point clouds were created for each scan, with color gradient based on patient deviation from normal across the dysmorphic skull. Standard deviation data were evaluated in 7 cranial regions and compared between ISS and CSM. Mean ISS and CSM point clouds were evaluated. Using three-dimensional vector analysis, standard anthropometric data/indices were determined and compared between the 2 groups. Differences in ISS and CSM regional deviations and index measurements were not statistically significant. Mean ISS and CSM representations depicted similar overall morphology. Using accepted criteria for identification of metopic synostosis in CSM, only subtle differences appear between the 2 populations on average. Expected morphologic changes associated with metopic synostosis are present in only a small number of patients with CSM, arguing against our hypothesis, and calling into question the criteria used to identify premature metopic suture fusion. Normal metopic suture fusion occurs for a continuum of time. Our findings suggest that the normal continuum may begin earlier than the literature suggests. In the setting of sagittal synostosis, the influence of metopic suture fusion and treatment is best determined by individual morphologic analysis.
Zolpidem is a non-benzodiazepine sedative hypnotic that binds to the benzodiazepine binding site on the gammaaminobutyric acid type A (GABA-A) receptors. It is the most commonly prescribed sleep medication which has been shown to be effective for treating insomnia on a short-term basis with fewer side effects than traditional benzodiazepines, which are feared for their abuse and dependence potential. Many studies have reported efficacy and safety of zolpidem in treatment of insomnia keeping in mind about its low abuse, and dependence capability. We present a case of zolpidem dependence in a 36-year-old male to emphasize that zolpidem also should be judiciously prescribed under supervision so that it does not develop tolerance, abuse and dependence.
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