The hyoid bone in Malay infants with cleft lip and palate

Copyright © 2006 The American Cleft Palate-Craniofacial AssociationObjectiveTo compare morphological and positional variations of the hyoid bone in unoperated infants with cleft lip and palate (CL/P) with those in noncleft infants.DesignRetrospective, cross sectional.Patients and methodsThree-dimensional computed tomography scans were obtained from 29 unoperated CL/P infants of Malay origin aged between 0 and 12 months and from 12 noncleft infants in the same age range. Observations were made and measurements were obtained with a software package developed at the Australian Craniofacial Unit. The sizes of the hyoid bones and the position of the hyoid body and epiglottis in relation to the cervical spine were measured. Anatomical anomalies of the hyoid and prevalence of aspiration pneumonia were also documented.ResultsThe hyoid bones and epiglottis were found to be located more inferiorly in CL/P infants compared with the noncleft infants. Also, 17% (5/29) of the CL/P infants had nonossified hyoid bodies.ConclusionThe results suggest that there are differences in the location and genesis of the hyoid bone in infants with CL/P that warrant further investigation.Zainul A. Rajion, Grant C. Townsend, David J. Netherway, Peter J. Anderson, Toby Hughes, Ibrahim L. Shuaib, Ahmad Sukari Halim, Abdul Rani Samsudin, Neil R. McLean, David J. Davi

Three-dimensional computed tomography cephalometry of plagiocephaly: Asymmetry and shape analysis

Copyright © 2006 The American Cleft Palate-Craniofacial AssociationObjectiveTo investigate facial asymmetry associated with both deformational and synostotic plagiocephaly and to identify variables based on skeletal landmarks that distinguish the conditions and quantify severity.DesignRetrospective, cross sectional.SettingAustralian Craniofacial Unit, Adelaide.Main outcome measuresProportional differences between bilateral distances and principal component (PC) analysis of the skeletal landmarks.PatientsThe three-dimensional positions of 78 osseous landmarks were determined from computed tomography (CT) scans of 21 patients with deformational plagiocephaly (DP), 20 patients with unilateral coronal synostosis (UCS), and 2 patients with unilateral lambdoid synostosis (ULS).ResultsFor both DP and UCS, significant asymmetry was found for the orbital depths, mandibular lengths, maxillary depths, zygomatic arch lengths, lateral base of the parietal bone, and the angle between the anterior and the posterior cranial base projected onto the axial plane. The small sample size for ULS precluded definitive statistical statements but allowed some useful comparisons with the other conditions. The first three PC scores were able to distinguish among the three conditions and which side was affected.ConclusionsThe asymmetry of the cranial base and facial structures, arising from localized abnormality or deformational forces in either the frontal or the occipital regions, can be quantified by a plethora of bilateral features or summarized by PC analysis.D.J. Netherway, A.H. Abbott, N. Gulamhuseinwala, K.L. McGlaughlin, P.J. Anderson, G.C. Townsend, D.J. Davi

Analysis of intracranial volume in Apert Syndrome genotypes

Objective: Apert syndrome is caused by a mutation of the fibroblastic growth factor type 2 gene and in nearly all of the cases where the mutation has been identified it occurs in one of two adjacent sites of the gene, either position 252 or position 253. There is currently uncertainty whether a worse neurosurgical outcome occurs in association with a particular genotype. We investigated whether there were clinically subtle (but relevant) morphological differences in the craniofacial skeleton, which would result in differences in the intracranial volume, which might account for apparent differences in surgical outcome. Method: Three-dimensional CT scans of pre-operative Apert syndrome whose genotype had been identified had the intracranial volume measured using the Cavalieri estimator with correction for partial voluming effects. The values were compared to age and sex normals and then the two genotypes compared. Results: Intracranial volumes were measured for 22 cases, 16 with the 252 mutation and 6 with the 253 mutation. Conclusions: All cases except two had greater than their sex- and age-adjusted mean normal intracranial volumes. For the 252 and 253 genotypes there were no discernible differences in intracranial volumes between the two genotypes

CT-determined intracranial volume for a normal population

Intracranial volume comparisons of patients with craniosynostosis and normal have been contrary to expectations, leading to questioning of the validity of the current normal reference material. Computed tomography-determined intracranial volume is presented for a white normal population. Specifically, intracranial volumes for 157 subjects (82 female and 75 male) were measured from computed tomography data using the Cavalieri estimator: volume determination was based on measuring the area in each computed tomography section. Monomolecular and Gompertz models were applied to find curves of best fit to the intracranial volume as a function of the age. The best fit was obtained using the monomolecular model when the response variable was the logarithmically transformed intracranial volume, and the independent variable was the logarithm of the age from conception. For example, the mean (standard deviation) for male subjects at 1 year and 20 years were 1,125.6 (89.6) ml and 1,472.9 (117.2) ml, respectively, and for female subjects 1,024.9 (84.0) ml and 1,321.7 (108.3) ml, respectively. Although the shape and rate of increase of the female and male curves is similar, the female mean is 1.3 standard deviations below the male mean at 20 years. These curves were compared with the commonly referenced curves of Blinkov (1941), Lichtenberg (1960), and Dekaban (1977). Our male curve is substantially higher than these curves in the age range 8 months to 4 years. Our female curve, however, is approximately 1 standard deviation below Lichtenberg's curve from birth to 7 months. There are then only minor differences between our female curve and Lichtenberg's curve until his curve crosses ours at 41 months, where they significantly diverge from approximately 4.5 years. Our curves indicate that 95% of the final intracranial volume has been attained by 42 months for girls and 46 months for boys.Abbott, Amanda H., Netherway, David J., Niemann, David B., Clark, Bruce, Yamamoto, Mitsohiro, Cole, Joshua, Hanieh, Ahmad, Moore, Mark H. and David, David J

A three-dimensional computed tomographic analysis of the cervical spine in unoperated infants with cleft lip and palate

Copyright © 2006 The American Cleft Palate-Craniofacial AssociationObjectiveTo investigate anatomical variations and abnormalities of cervical spine morphology in unoperated infants with cleft lip and palate.DesignRetrospective cross-sectional investigation of infants born with nonsyndromic cleft lip and palate using computed tomography scans acquired for investigation of a spectrum of clinical conditions.SettingComputed tomography scan data were obtained from 29 unoperated cleft lip and palate infants and 12 noncleft infants of Malay origin, ages 0 to 12 months.MethodsObservational study of cervical spine computed tomography scans. Heights of cervical vertebral bodies (C2-C7) and intervertebral spaces were measured from landmarks identified from computed tomography reformats and three-dimensional computed tomography reconstructions. Linear modeling of heights and spaces, with age as a covariate, was undertaken to identify differences between the samples.ResultsAnomalous features observed in the cleft lip and palate sample included short posterior arch of C1 (2/29), abnormal development of the anterior arch of C1 (2/29), and fusions of the posterior arch of C2 and C3 (2/29). No anomalies of the cervical spine were observed in the noncleft sample. Although the heights of three cervical vertebral bodies were significantly smaller and two intervertebral spaces were significantly larger in infants with cleft lip and palate compared with noncleft infants (p ConclusionThere was evidence for subtle upper spinal anomalies in the infant cleft lip and palate population. Our finding of reduced size of some cervical vertebral bodies may reflect delayed upper spinal development in infants with cleft lip and palate.Zainul A. Rajion, Grant C. Townsend, David J. Netherway, Peter J. Anderson, Asilah Yusof, Toby Hughes, Ibrahim L. Shuaib, Ahmad Sukari Halim, Abdul Rani Samsudin, David J. Davi