Evaluating the Efficacy of Monobloc Distraction in the Crouzon-Pfeiffer Craniofacial Deformity Using Geometric Morphometrics

Visser, R.G.F.; Ruff, Clifford; Angullia, Freida; Ponniah, Allan; Jeelani, Owase; Britto, Jonathan A.; Dunaway, David

doi:10.1097/prs.0000000000003016

Cited by 19 publications

(23 citation statements)

References 35 publications

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“…Recently, GM has been recognized as a useful method for presurgical simulation or evaluation of surgical outcomes in the craniofacial surgery field (Nikkhah et al, 2013; Visser et al, 2017). Visser et al (2017) indicated that predictions of the long-term effects of surgery may be future challenges for the application of GM. Our method of producing growth allometry is suitable for clinical studies focused on the prediction of postsurgical growth.…”

Section: Discussionmentioning

confidence: 99%

“…Three-dimensional images have been commonly used to examine development. However, it is difficult to quantify and understand the shape differences in 3 dimensions with conventional morphometrics (Nikkhah et al, 2013; Visser et al, 2017). With conventional methods such as cephalometry, we usually determine landmarks first.…”

Section: Introductionmentioning

confidence: 99%

“…Hence, GM has been commonly applied to evaluate the shape differences in facial skeletons among species in anthropology (Neaux et al, 2013). Recently, GM has been used for craniofacial surgery; however, most studies applied GM only for assessing surgical effects or presurgical simulations (Nikkhah et al, 2013; Dadáková et al, 2016; Visser et al, 2017). In this study, we applied GM as an additional analysis step to estimate and visualize the growth trajectory of the craniofacial skeleton.…”

Section: Introductionmentioning

confidence: 99%

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Critical Growth Processes for the Midfacial Morphogenesis in the Early Prenatal Period

Katsube

Yamada

Yamaguchi

et al. 2019

The Cleft Palate-Craniofacial Journal

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Background: Congenital midfacial hypoplasia often requires intensive treatments and is a typical condition for the Binder phenotype and syndromic craniosynostosis. The growth trait of the midfacial skeleton during the early fetal period has been assumed to be critical for such an anomaly. However, previous embryological studies using 2-dimensional analyses and specimens during the late fetal period have not been sufficient to reveal it. Objective: To understand the morphogenesis of the midfacial skeleton in the early fetal period via 3-dimensional quantification of the growth trait and investigation of the developmental association between the growth centers and midface. Methods: Magnetic resonance images were obtained from 60 human fetuses during the early fetal period. Three-dimensional shape changes in the craniofacial skeleton along growth were quantified and visualized using geometric morphometrics. Subsequently, the degree of development was computed. Furthermore, the developmental association between the growth centers and the midfacial skeleton was statistically investigated and visualized. Results: The zygoma expanded drastically in the anterolateral dimension, and the lateral part of the maxilla developed forward until approximately 13 weeks of gestation. The growth centers such as the nasal septum and anterior portion of the sphenoid were highly associated with the forward growth of the midfacial skeleton (RV = 0.589; P < .001). Conclusions: The development of the midface, especially of the zygoma, before 13 weeks of gestation played an essential role in the midfacial development. Moreover, the growth centers had a strong association with midfacial forward growth before birth.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Critical Growth Processes for the Midfacial Morphogenesis in the Early Prenatal Period

Katsube

Yamada

Yamaguchi

et al. 2019

The Cleft Palate-Craniofacial Journal

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“…Seventy-eight skin landmarks were placed on all pre-and post-operative facial skin iso-surfaces. Seventy-eight bone landmarks [4] on the 'moving' (operated) bone iso-surfaces ( Fig. 2).…”

Section: Landmarkingmentioning

confidence: 99%

A novel RBF-based predictive tool for facial distraction surgery in growing children with syndromic craniosynostosis

Angullia

Fright

Richards³

et al. 2019

Int J CARS

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Purpose Predicting changes in face shape from corrective surgery is challenging in growing children with syndromic craniosynostosis. A prediction tool mimicking composite bone and skin movement during facial distraction would be useful for surgical audit and planning. To model surgery, we used a radial basis function (RBF) that is smooth and continuous throughout space whilst corresponding to measured distraction at landmarks. Our aim is to showcase the pipeline for a novel landmark-based, RBF-driven simulation for facial distraction surgery in children. Methods An individual's dataset comprised of manually placed skin and bone landmarks on operated and unoperated regions. Surgical warps were produced for 'older' monobloc, 'older' bipartition and 'younger' bipartition groups by applying a weighted least-squares RBF fitted to the average landmarks and change vectors. A 'normalisation' warp, from fitting an RBF to craniometric landmark differences from the average, was applied to each dataset before the surgical warp. The normalisation was finally reversed to obtain the individual prediction. Predictions were compared to actual post-operative outcomes. Results The averaged change vectors for all groups showed skin and bone movements characteristic of the operations. Normalisation for shape-size removed individual asymmetry, size and proportion differences but retained typical pre-operative shape features. The surgical warps removed the average syndromic features. Reversing the normalisation reintroduced the individual's variation into the prediction. The mid-facial regions were well predicted for all groups. Forehead and brow regions were less well predicted. Conclusions Our novel, landmark-based, weighted RBF can predict the outcome for facial distraction in younger and older children with a variety of head and face shapes. It can replicate the surgical reality of composite bone and skin movement jointly in one model. The potential applications include audit of existing patient outcomes, and predicting outcome for new patients to aid surgical planning.

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“…However, quantitative outcome data for both differential and unidirectional monobloc distraction has been sparsely reported. 1,[3][4][5][6][7][8][9][10][11][12] Notably lacking is quantitative data in the growing, skeletally immature patient who has undergone monobloc distraction.…”

mentioning

confidence: 99%

Monobloc Differential Distraction Osteogenesis

Polley

Figueroa²,

Girotto

et al. 2021

Journal of Craniofacial Surgery

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Midface advancement at the monobloc level can be the seminal life event for patients with craniofacial dysostosis. Monobloc reconstruction, when planned appropriately, can simultaneously and definitively address multiple functional and aesthetic deficiencies in these patients. The application of distraction has reduced the morbidity experienced with traditional monobloc surgery. The purpose of this study is to report on the outcomes, stability, and growth in younger patients after monobloc advancement in syndromic craniosynostosis patients. The authors report a consecutive series of thirty patients with craniofacial dysostosis treated through monobloc differential distraction osteogenesis. Detailed history, photographic, and long-term radiographic data are reviewed, including a subset of patients who were skeletally immature at the time of their treatment. Differential distraction allows control of midface pitch, roll, and yaw, optimizing functional and aesthetic outcomes. There were no infectious complications requiring reoperation. The average surgical age for all patients was 12.5 years. For the 7 patients age <7 years, average age was 6 years. For all patients, the mean horizontal movement was 12 mm at nasion and 10 mm at A-point. At mean follow-up (4.8 years entire group and 6.2 years age <7 years group) a positive horizontal advancement of 1.1 mm at nasion and 0.8 mm at A-point was observed. More pronounced positive horizontal changes were seen in the age <7 years group. Monobloc differential distraction osteogenesis affords safe and precise repositioning of the midface. The advancement is skeletally stable and young patients show moderate continued growth.

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Evaluating the Efficacy of Monobloc Distraction in the Crouzon-Pfeiffer Craniofacial Deformity Using Geometric Morphometrics

Abstract: Therapeutic, IV.

Cited by 19 publications

References 35 publications

Critical Growth Processes for the Midfacial Morphogenesis in the Early Prenatal Period

Critical Growth Processes for the Midfacial Morphogenesis in the Early Prenatal Period

A novel RBF-based predictive tool for facial distraction surgery in growing children with syndromic craniosynostosis

Monobloc Differential Distraction Osteogenesis

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