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Abnormalities of the cranial base in synostotic frontal plagiocephaly
D L Abramson1, I P Janecka, J B Mulliken
1Division of Plastic Surgery, Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Insights
Synostotic frontal plagiocephaly causes cranial base deformities. Infants with this condition show elongated foramina ovale and shortened eustachian tubes on the affected side, impacting skull base angulation.
Area of Science:
- Craniofacial Surgery
- Pediatric Neurosurgery
- Medical Imaging
Background:
- Skeletal abnormalities in the cranial base are common in craniosynostosis.
- Cranial base angulation is a known feature of synostotic frontal plagiocephaly (unilateral coronal synostoses).
Purpose of the Study:
- To analyze and document specific cranial base deformities in infants with synostotic frontal plagiocephaly before surgical intervention.
- To quantify differences in basilar structures between the synostotic and normal sides of the skull base.
Main Methods:
- Computed tomographic (CT) scans with 1.5-mm slice thickness were used.
- Analysis focused on four infants with synostotic frontal plagiocephaly.
- Measurements included the length of the foramina ovale, eustachian tubes, and sphenotemporal angles, comparing affected and unaffected sides.
Main Results:
- The foramen ovale was 21% longer on the synostotic side compared to the normal side.
- The eustachian canal was 11% shorter on the synostotic side.
- The average sphenotemporal angle was 121 degrees on the synotic side versus 149 degrees on the nonsynostotic side.
Conclusions:
- Cranial base deformities, including elongation of anterior structures and shortening of posterior structures, can be identified pre-surgically.
- These findings provide a baseline for evaluating the effects of surgical correction, such as fronto-orbital advancement, on basilar abnormalities.
Abstract:
Skeletal abnormalities of the cranial base in various craniosynostoses are well known. Cranial base angulation has been documented in synostotic frontal plagiocephaly--"unilateral coronal synostoses." We analyzed four infants with synostotic frontal plagiocephaly, focusing on computed tomographic images through the cranial base. The scans were performed on a GE advantage spiral with 1.5-mm images. The anatomical structures examined were length of the foramina ovale, length of the eustachian tubes, and sphenotemporal angles. Ratios for these measures were calculated comparing the normal and synostotic sides. The foramen ovale was 21% longer on the synostotic side; the eustachian canal was 11% shorter on the synostotic side. The average sphenotemporal angle on the synotic side was 121 degrees compared with 149 degrees on the nonsynostotic side. Deformities of the cranial base (i.e., elongation of structures anterior to the synostosis and shortening of the structures posterior to the synostosis) can be documented before surgical correction of synostotic frontal plagiocephaly. Follow-up computed tomographic studies will permit study of the effect of fronto-orbital advancement and modeling on these basilar abnormalities.