Classification System for Sagittal Craniosynostosis

Abstract

These studies were carried out in the maxillofacial unit, surgical specialties hospital, medical city, Baghdad, included 55 patients with orofacial tumors; their ages ranged from 2 days to 14 years (mean, 7 years). Twenty-eight of them were girls, and 27 were boys. Tumors included 20 cases of benign tumors and 35 cases malignant. Treatment modalities ranged from complete surgical excision, surgical shaving operations, and deep x-ray therapy (DXT; radiotherapy) for some benign tumors. The management of malignant tumors was carried out by the use of chemotherapy, chemotherapy and DXT to radical surgery, or radical surgery with DXT. Reconstruction of the mandible was carried out using a rib graft or a block of a corticocancellous bone graft from the iliac crest with reimplantation of the condyle after resection from the tumor and fixed by rigid fixation to the bone graft. Temporary reconstruction of the mandible done by Kirschner wire for malignant tumors required a postsurgical DXT. A temporalis muscle flap was used for the augmentation of the orbit with a frontoorbital flap after radical excision of a malignant tumor of the orbit, and a silastic implant (silicon rubber) was used for reconstruction of the orbital floor. A long-term follow-up ranged from 2 to 15 years. The aim of this study was to present a certain number of cases with an interesting pathologic tumor condition showing peculiar behaviors; the management of these cases was a challenge to our surgical experience.

Craneosinostosis: Revisión de literatura

“…Pacientes con craneosinostosis sagital son más difíciles de tratar con cirugía de remodelación convencional si son mayores de un año. [44][45][46] Se han realizado varias pruebas utilizando diversas escalas reconocidas en los niños con craneosinostosis, las cuales mostraron cambios en la comunicación receptiva y expresiva en el área de comunicación receptiva del Battelle que evalúan la discriminación, reconocimiento y comprensión de sonidos de voz o el seguir órdenes sencillas, mientras que el área de comunicación expresiva evalúa la producción de sonidos y palabras. El que no se hayan encontrado déficits en el área cognitiva en estos pacientes podría estar indicando que el retraso cognitivo identificado utilizando las escalas Bayley de desarrollo, es secundario a las deficiencias en el lenguaje que presentan estos pacientes, ya que el índice de desarrollo mental que reporta el Bayley tiene un componente de lenguaje.…”

Objective classification system for sagittal craniosynostosis based on suture segmentation

“…15 These anatomical structures are difficult to be fully described by feature descriptors. However, the abnormal deformations of infant cranial vault are mainly caused by fusion of the individual sutures, 27,28 suggesting attributes of sutures are essential and decisive for the classification of sagittal CSO.…”

“…Important factors essential in the selection of the spring force include the suture involved and the subtypes of sagittal CSO. 15,16 For example, sagittal CSO with an elongated occiput needs a stronger posterior spring, while one with no predominant characteristics typically needs a midrange anterior and posterior spring. 16 In order to optimize the selection of the spring force, an automated system for segmentation and characterization of sutures and further classification of the sagittal CSO, as a preliminary stage of the automated selection of the spring force, would be helpful.…”

“…15,17,18 Taking into account the three rules of compensatory growth, 19 Massimi et al 17 and Jane et al 18 classified sagittal CSO into three main variants: The anterior type shows evident frontal bossing. The posterior type is characterized by a narrowing of the posterior regions of the skull with protuberance of the occipital bones.…”

“…The traditionally described characteristics, such as frontal bossing, biparietal narrowing, and occipital lengthening, however, are inconsistently present. 15 David et al, based on the presence of a single dominant characteristic as seen on CT scans, stratified the sagittal synostosis into four subtypes: anterior (tight retrocoronal band), central (heaped-up sagittal ridge), posterior (prominent occiput), and complex (no specific dominant feature). 15 In light of this classification system, David's group modified the type, strength, and number of springs to improve the predictability of the clinical outcome of springassisted surgery.…”