Component bone marker displacements revealed by image-corrected cephalometric analysis

Abstract

Displacement of bony component anatomy has not been comprehensively described in human cranial development. In this study, tantalum implants were used to define cranial bone position on serial cephalometric surveys. Image correction (ICCA method) was used to eliminate artifactual shift of component markers before serial analysis was used to define implant movement. In addition, applicable normative standards were used to assess all case presentations. Three normal subjects comprised a normal mixed longitudinal sample aged 2 to 84 months. Two plagiocephaly subjects were studied, one from 6 to 77 months and the other from 16 to 44 months of age. Three syndromic craniosynostosis subjects demonstrated both abnormal and normalized growth following craniotomy, from 14 to 45, from 0.5 to 5.5, and from 2 to 75 months of age. A pattern of backward rotation of cranial component anatomy was observed in three normal subjects and two plagiocephaly subjects. The posterior fossa (PF) showed the greatest growth activity, with displacement adjustments throughout the study, and the anterior cranial fossa (ACF) least growth activity, with imperceptible frontal bone movement after age 3 years. After traditional bifrontal craniotomy, an abnormal displacement growth pattern was observed from age 14 to 45 months in the patient with syndromic craniosynostosis (Pfeiffer syndrome). Extensive fronto-parietal “bossing” and grossly deficient movement in the PF were observed. However, after a bifrontal craniotomy that also crossed lambdoid sutures, a normalized pattern of displacement growth was observed in two Apert syndrome patients. These two patients with extensive syndromic craniosynostosis had cranial component pattern adjustments as in the normal and plagiocephalic subjects.