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Published on: October 20, 2023
Rapid palatal expansion in patients with craniosynostosis: a case report
G D'Alessandro1, A Faggella, G Piana
1Department of Dental Science, Dental School, University of Bologna, Bologna, Italy. dr.dalessandro@gmail.com
Insights
Sagittal craniosynostosis, a premature skull suture fusion, can occur independently of palate suture fusion. Orthopedic treatment with a rapid palatal expander successfully corrected associated dental arch issues.
Area of Science:
- Craniofacial surgery
- Orthodontics
- Pediatric genetics
Background:
- Craniosynostoses are congenital conditions involving premature fusion of cranial sutures, leading to skull deformities.
- Genetic factors, including fibroblast growth factor receptor gene mutations, are implicated but not fully understood.
- The resulting skull deformation impacts facial growth and development.
Observation:
- A case report details a child with sagittal craniosynostosis and an ogival palate.
- The patient presented with insufficient space for superior canine eruption.
- This specific presentation highlights a potential disconnect between cranial and palatal suture involvement.
Findings:
- Orthopedic treatment using a rapid palatal expander was administered.
- The device widened the upper jaw and improved nasal cavity dimensions.
- Treatment outcomes were comparable to those in unaffected individuals.
Implications:
- Sagittal craniosynostosis may not always involve the median palatine suture.
- Orthopedic interventions like palatal expansion can effectively manage associated dental arch discrepancies.
- This suggests a targeted approach to treatment based on specific craniofacial presentations.
Abstract:
The craniosynostoses represent a group of pathologies characterised by the premature fusion (during prenatal or perinatal stages or early infancy) of one or more of the cranial sutures. Its genetic origins are not completely clear although mutations in the genes that code for fibroblast growth factor receptors have been described; depending upon the gene involved, the type of mutation and the embryological period in which the mutation itself occurs, a type of craniosynostosis arises that may involve one or more cranial sutures. The premature fusion results in a lack of growth in the regions corresponding to the cranial vaults, with compensatory growth occurring in other regions and the consequent deformation of the skull. Here, a case report is presented of a Caucasian male child affected by craniostenosis of the sagittal suture with a orthodontic-orthopedic diagnosed ogival palate and insufficient space for the eruption of the superior canines. The patient was treated by fitting a rapid palatal protractor, an orthopedic device that acts upon the median palatine suture of the palate increasing the transverse diameter of the upper jaw and causes the widening and lowering of the floor of the nasal cavity. The results obtained were equivalent to those obtained in subjects with no past medical history of craniosynostosis. This clinical study demonstrated that the premature fusion of the mid-sagittal suture of the skull, that characterises sagittal craniosynostoses, can occur without the involvement of the median suture of the palate, rendering expansion possible by means of orthopedic treatment.
