The 27 Facial Sutures: Timing and Clinical Consequences of Closure

Wang, Maxwell M; Haveles, Christos S; Zukotynski, Brian; Reid, Russell R.; Lee, Justine C.

doi:10.1097/prs.0000000000008816

Cited by 8 publications

(17 citation statements)

References 116 publications

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“…8 We hypothesize that his midface retrusion may have developed as a result of several influences, including coronal and/or facial sutural fusion and intrinsic mesenchymal growth patterns of the maxilla. 9,10 Although a single occurrence precludes generalization to all cases of Apert syndrome or syndromic craniosynostosis, we provide well-evidenced support via sequential CT scans and clinical photographs that progressive midface retrusion can develop even in the absence of premature SOS fusion.…”

Section: Surgical Interventions In Syndromic Craniosynostosismentioning

confidence: 60%

Delayed Postnatal Synostosis without Spheno-occipital Synchondrosis Fusion: A Curious Case of Apert Syndrome

Ng,

Massenburg,

et al. 2024

Plastic and Reconstructive Surgery - Global Open

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Summary: Apert syndrome classically presents with craniosynostosis at birth, most commonly of the bilateral coronal sutures, which may lead to cephalocranial disproportion and elevated intracranial pressure, the latter of which is associated with optic atrophy, visual loss, and developmental delays. A small number of patients with syndromic craniosynostosis demonstrate open sutures at birth; however, all previously reported patients of this subtype have been reported to develop premature suture fusion in the early postnatal period and/or require cranial vault expansion for increased intracranial pressure. Here, we report on a patient with Apert syndrome who did not have closed sutures at birth, and only began to demonstrate unilateral coronal suture fusion between ages 4 and 6 years, yet neither developed phenotypic signs of craniosynostosis nor evidence of intracranial hypertension. Moreover, despite demonstrating patency of the spheno-occipital synchondrosis, the patient developed progressive midface hypoplasia, requiring a subcranial Le Fort 3 advancement with external distraction at age 9. Now at skeletal maturity, this patient has a normal cranial shape and will likely never require cranial vault surgery for functional or aesthetic concerns. We are not aware of any prior reports of a patient with Apert syndrome who did not require intracranial surgery over long-term follow-up.

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Section: Surgical Interventions In Syndromic Craniosynostosismentioning

confidence: 60%

Delayed Postnatal Synostosis without Spheno-occipital Synchondrosis Fusion: A Curious Case of Apert Syndrome

Ng,

Massenburg,

et al. 2024

Plastic and Reconstructive Surgery - Global Open

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“…The frontosphenoidal suture begins to ossify from the beginning of about 30 years, to completely obliterate towards about 60 or 80 years [ 30 , 32 ]. The frontonasal suture ossifies completely by approximately 60 years of age [ 34 ]. The frontomasillary sutures begin to obliterate only after about 70 years of age, while the frontozygomatic suture begins to close after about 80 years of age [ 34 ].…”

Section: Reviewmentioning

confidence: 99%

Rethinking the Origin of the Primary Respiratory Mechanism

Bordoni,

Escher

2023

Cureus

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Spheno-occipital synchondrosis (SOS) is the joint regarded as the most important foundation for understanding cranial osteopathy and craniosacral therapy. SOS is the origin of the primary respiratory mechanism (PRM), a movement between the posterior surface of the body of the sphenoid bone and the anterior surface of the base of the occipital bone. From the PRM perspective, an alteration of the position between the two bone surfaces would create cranial and/or craniosacral dysfunction. These positional alterations of the SOS (in adults and children) would determine specific and schematical movements of the bones of the entire skull, whose movements are recognizable by palpation by trained operators. PRM expression is influenced by other elements, such as movement of the cranial bones, inherent movement of the central nervous system, cyclic movement of cerebrospinal fluid (CSF), mechanical tension of the cranial meninges, and passive movement of the sacral bone between the iliac bones. The article reviews the most up-to-date information on the evolution of cranial sutures/joints and meninges in adulthood, the fluctuations of the CSF, brain, and spinal mass movements. Research should reconsider the motivations that induce the operator to discriminate the palpable cranial rhythmic impulse, and probably, to rethink new cranial dysfunctional patterns.

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“…22,[25][26][27] The combined physiologic role of absorbing mechanical stress, providing structural support, and acting as sites of primary bone osteogenesis through coordinated osteoblast-and osteoclast-driven apposition are a potential mechanism of how minor sutures help direct skull growth and refine skull shape. [28][29][30] The purpose of this study is to examine whether a relationship exists between early minor suture fusion in Crouzon syndrome and midface growth restriction, and if so, to identify which suture(s) or synchondrose(s) are implicated. To do so we present an anatomic study comparing CT cephalometric measures of unoperated infants and children with Crouzon syndrome, relative to unaffected controls.…”

Section: Introductionmentioning

confidence: 99%

“…22,25-27 The combined physiologic role of absorbing mechanical stress, providing structural support, and acting as sites of primary bone osteogenesis through coordinated osteoblast- and osteoclast-driven apposition are a potential mechanism of how minor sutures help direct skull growth and refine skull shape. 28-30…”

Section: Introductionmentioning

confidence: 99%

Impact of Minor Suture Fusion on Midface Hypoplasia in Syndromic Craniosynostosis

Layton

Bins

Lor

et al. 2023

FACE

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Purpose: Early onset of minor suture fusion in syndromic craniosynostosis is associated with midface dysplasia and is a common indication for craniofacial surgery. However, the potential effects of fusion severity on craniofacial growth patterns are not well understood. This study seeks to describe the impact of minor suture fusion severity on midface morphology in Crouzon syndrome. Methods: Pre-operative computed tomography images (CT) of 63 patients with Crouzon syndrome and 63 normocepahlic controls were included. Degree of suture fusion was assessed for the frontosphenoidal, sphenethmoidal, sphenosquamosal, sphenopetrosal, spheno-occipital synchondrosis, frontoethmoidal, and zygomaticosphenoidal sutures. Each suture was graded on a 5-point scale. The sella (S), nasion (N), A point (A), basion (BA), and anterior nasal spine (ANS) landmarks were used to calculate the SNA angle, BA-ANS length of the lower midface, and N-S length of the upper midface. Multiple linear regressions were used to analyze data. Results: The mean age was 43 months and 44% were female. The control group was significantly older ( P < .01) than the patients with Crouzon syndrome. Advanced fusion of the spheno-occipital synchondrosis in Crouzon syndrome correlates with regression of the BA-ANS length by 0.563 mm per incremental increase in suture fusion ( P < .01). Additionally, the lower midface (BA-ANS) was restricted to a greater degree than the upper midface (N-S) with progressive suture fusion in all patient types with ratios of these rates ranging between 0.602 and 0.89 for the 7 sutures analyzed. Suture fusion severity did not impact the SNA angle in any of the analyses performed. Conclusion: The severity of sheno-occipital synchondrosis fusion in Crouzon syndrome contributes to midface hypoplasia. Similarly, all anterior skull base sutures limited lower midface growth to a greater degree than the upper midface.

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The 27 Facial Sutures: Timing and Clinical Consequences of Closure

Cited by 8 publications

References 116 publications

Delayed Postnatal Synostosis without Spheno-occipital Synchondrosis Fusion: A Curious Case of Apert Syndrome

Delayed Postnatal Synostosis without Spheno-occipital Synchondrosis Fusion: A Curious Case of Apert Syndrome

Rethinking the Origin of the Primary Respiratory Mechanism

Impact of Minor Suture Fusion on Midface Hypoplasia in Syndromic Craniosynostosis

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