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Birth Defects Research Jan 2022Retinoic acid signaling plays a critical role during embryogenesis and requires tight regulation. Exposure to exogenous retinoic acid during fetal development is known...
BACKGROUND
Retinoic acid signaling plays a critical role during embryogenesis and requires tight regulation. Exposure to exogenous retinoic acid during fetal development is known to have teratogenic effects, producing a recognizable embryopathy.
CASE
We describe a case of retinoic acid embryopathy secondary to maternal isotretinoin use until the ninth week of gestation and expand the phenotype to include the rare features of parietal bone agenesis and athelia. Histology of the parietal region showed fibrous tissue with no intramembranous ossification. The fetus also had multiple craniofacial dysmorphisms, thymic agenesis, and transposition of the great arteries with double outlet right ventricle and subaortic perimembranous ventricular septal defect. Neuropathology revealed enlarged ventricles with agenesis of the cerebellar vermis, focal duplication of the central canal and scattered parenchymal ependymal rests, and possible cerebral heterotopias with associated abnormal neuronal lamination. A chromosomal microarray was normal.
CONCLUSION
Parietal bone agenesis and athelia are both rare congenital anomalies not previously reported in retinoic acid embryopathy. However, retinoic acid or its degrading enzyme has been demonstrated to exert effects in both of these developmental pathways, offering biological plausibility. We propose that this case may represent an expansion of the phenotype of retinoic embryopathy.
Topics: Abnormalities, Drug-Induced; Abnormalities, Multiple; Breast Diseases; Congenital Microtia; Female; Fetal Diseases; Humans; Parietal Bone; Phenotype; Tamoxifen; Transposition of Great Vessels; Tretinoin
PubMed: 34773723
DOI: 10.1002/bdr2.1965 -
Clinical Biomechanics (Bristol, Avon) Jun 2021Craniosynostosis in newborns is caused by the premature closure of the cranial sutures leading to cranial vault deformity. It results in aesthetic imbalance and...
BACKGROUND
Craniosynostosis in newborns is caused by the premature closure of the cranial sutures leading to cranial vault deformity. It results in aesthetic imbalance and developmental disabilities and surgery is frequent during the first months of growth. Our study focused on scaphocephaly defined as the premature closure of the sagittal suture. We hypothesised that the effective mechanical properties of sutures were altered as compared to those of the parietal adjacent tissue considered as control.
METHODS
The population consisted of seven males and four females (mean age 4.9 months). Sixteen suture samples and thirty-four parietal tissue samples were harvested during corrective surgery and investigated by using three-point bending tests to obtain the structure-stiffness of specimens. An energy model was used to derive the effective Young's modulus. A histological study complemented the experimental protocol.
FINDINGS
Fused sutures were thicker than adjacent bone and the natural curvature of sutures did not influence the static mechanical response. The stiffness of stenotic sutures was significantly higher than that of the parietal bone. The effective Young's modulus of stenotic sutures was significantly lower than that of the parietal adjacent tissue. The parietal tissue showed a parallel bone architecture whereas the central stenotic tissue was disorganised with more vascularisation.
INTERPRETATION
The stenotic suture differed in structural and mechanical terms from the adjacent bone during calvarial growth in the first year of life. Our study emphasised the alteration of effective tissue properties in craniosynostosis.
Topics: Cranial Sutures; Craniosynostoses; Female; Humans; Infant; Infant, Newborn; Male; Skull; Sutures
PubMed: 34000627
DOI: 10.1016/j.clinbiomech.2021.105369 -
American Journal of Orthodontics and... Mar 2023Orthopedic appliances continue to be used for various sagittal, vertical, and transverse corrections of the maxilla. Although cranial growth can continue to adulthood,...
INTRODUCTION
Orthopedic appliances continue to be used for various sagittal, vertical, and transverse corrections of the maxilla. Although cranial growth can continue to adulthood, no study has drawn attention to the effects of headgear forces on the calvarium, in which anchorage is taken. This study focused on the different biomechanical responses on the calvarium of young children wearing a high-pull headgear of varying forces, using a 3-dimensional finite element analysis and the possible implications of such changes on the human skull.
METHODS
A 3-dimensional finite element model of a 9-year-old child was designed from the computed tomography scan. The material properties of the juvenile skull were assigned. Varying orthopedic forces (400, 500, and 600 g of force) were applied, and the magnitude of displacement and stresses generated on the cranial bones and sutures were interpreted using ANSYS software (version 12.1; Canonsburg, Pa).
RESULTS
Maximum displacement was found for the parietal bone in the inferior direction; parietal and temporal bones in the transverse direction; and frontal, parietal, and temporal bones in the sagittal direction. The least displacement was noted for the occipital bone in all the 3-dimensions. The maximum stresses were concentrated over the region of the lateral margins of the piriform aperture and the medial walls of the orbit. Higher stress values were also found on the parietal bone adjacent to the sagittal suture. The highest value of stresses among the sutures of the craniofacial complex was found to be in the region of the frontonasal, frontomaxillary, and nasomaxillary sutures.
CONCLUSIONS
The effects of displacement and stresses obtained from this study suggest a restriction to the growth of the cranial vault and its normal mobility, in turn altering the intracranial tension and causing altered cranial morphology in young, growing children undergoing high-pull headgear therapy. The human cranial system is dynamic throughout life and may be restricted or altered by hereditary or environmental factors.
Topics: Child; Humans; Child, Preschool; Finite Element Analysis; Computer Simulation; Maxilla; Temporal Bone; Cranial Sutures; Biomechanical Phenomena; Stress, Mechanical
PubMed: 36464568
DOI: 10.1016/j.ajodo.2021.12.020 -
Cirugia Y Cirujanos 2022Depressed skull fractures are the result of trauma injuries. They are present in approximately 3% of patients who arrive to an emergency room with skull trauma. The main...
OBJECTIVE
Depressed skull fractures are the result of trauma injuries. They are present in approximately 3% of patients who arrive to an emergency room with skull trauma. The main objective of surgical repair in depressed fractures is correction of cosmetic deformity and the prevention of infections.
MATERIAL AND METHODS
A retrospective and transversal study was performed by our department between April 2016 and May 2017. Sixteen patients that underwent a craniotomy for skull trauma with depressed fracture were included in the study. The diagnosis was made by simple cranial CT scan alongside a three-dimensional reconstruction.
RESULTS
Of the sixteen patients included, 5 were females (31.2%) and 11 males (68.8%). Twelve of the cases were an exposed fracture. In 7 cases, the fracture was located at parietal bone; 5 were located at frontal bone and 4 at the temporal bone. The average Glasgow coma score in the sample was 13. There were no complications nor deaths.
CONCLUSIONS
The remodeling and repositioning of the autologous bone graft allow an adequate cosmetic result and it also avoids the placement of implants without increasing the costs and additional risks.
Topics: Male; Female; Humans; Skull Fracture, Depressed; Retrospective Studies; Craniotomy; Frontal Bone; Craniocerebral Trauma; Fractures, Bone; Schools
PubMed: 36327480
DOI: 10.24875/CIRU.21000016 -
Skeletal Radiology Aug 2021Osteosarcoma is the most common primary bone tumor and usually involves the long bones. Osteosarcoma of the skull, on the other hand, is relatively rare. Here, we...
Osteosarcoma is the most common primary bone tumor and usually involves the long bones. Osteosarcoma of the skull, on the other hand, is relatively rare. Here, we present a 29-year-old man with a growing mass in the skull he first noticed after a fall while skateboarding. The initial clinical diagnosis was hematoma. While undergoing an evacuation surgery for a hematoma, a suspicious mass was detected which was biopsied. Histopathological evaluation showed high-grade osteosarcoma. The patient was referred to our hospital where he underwent definitive resection followed by adjuvant chemotherapy. His course was complicated by wound infection. Even though osteosarcoma of the skull is a rare finding, it should be suspected in a patient with a skull mass, and the history of prior head trauma does not exclude the diagnosis.
Topics: Adult; Bone Neoplasms; Humans; Male; Osteosarcoma; Parietal Bone; Sarcoma; Skull Neoplasms
PubMed: 33604706
DOI: 10.1007/s00256-021-03726-7 -
Journal of the Mechanical Behavior of... Aug 2017Parietal graft lifts are trained on human or animal specimens or are directly performed on patients without extensive training. In order to prevent harm to the patient...
Parietal graft lifts are trained on human or animal specimens or are directly performed on patients without extensive training. In order to prevent harm to the patient resulting from fast rotating machinery tools, the surgeon needs to apply appropriate forces. Realistic haptics are essential to identify the varying parietal bone layers and to avoid a penetration of the brain. This however, requires experience and training. Therefore, in this study, bone surrogate materials were evaluated with the aim to provide an anatomically correct artificial skull cap with realistic haptic feedback for graft lift training procedures. Polyurethane composites made of calcium carbonate and calcium phosphate were developed and were used to create customized bone surrogates, imitating both cancellous and cortical bone. Mechanical properties of these surrogates were validated for drilling, milling and sawing by comparison with human parietal bones. For that, surgical tool tips were automatically inserted into artificial and human bones in a customized test bench and the maximum axial insertion forces were analyzed. Axial tool insertion measurements in human parietal bones resulted in mean maximum forces of 1.8±0.5N for drilling, 1.7±0.3N for milling and 0.9±0.1N for sawing. Calcium carbonate-based materials achieved higher forces than the human bone for drilling and milling, and lower forces for sawing. The calcium phosphate-based bone surrogates showed comparable axial insertions forces for all investigated tools and were identified as a suitable surrogate for drilling (p=0.87 and 0.41), milling (p=0.92 and 0.63) and sawing (p=0.11 and 0.76) of the cortical layer and the cancellous bone, respectively. In conclusion, our findings suggest, that a suitable material composition for artificial parietal bones has been identified, mimicking the properties of human bone during surgical machinery procedures. Thus, these materials are suitable for surgical training and education in simulator training.
Topics: Feedback; General Surgery; Humans; Mechanical Phenomena; Orthopedics; Polyurethanes; Simulation Training; Skull
PubMed: 28448921
DOI: 10.1016/j.jmbbm.2017.04.021 -
Turkish Neurosurgery 2023To understand the characterization of the ossification process both in the synostotic suture, and the adjacent parietal bone.
AIM
To understand the characterization of the ossification process both in the synostotic suture, and the adjacent parietal bone.
MATERIAL AND METHODS
The surgical procedure for the 28 patients diagnosed with sagittal synostosis consisted of removing the synostotic bone as a whole, if possible, "Barrel-Stave" relaxation osteotomies, and strip osteotomies to the parietal and temporal bones perpendicular to the synostotic suture. The synostotic (group I) and parietal (group II) bone segments are obtained during osteotomies. Atomic absorption spectrometry was used to determine the amount of calcium in both groups, which is an indicator of ossification. Scanning electron microscopy and immunohistochemistry were employed to assess trabecular bone formation, osteoblastic density, and osteopontin, which is one of the in vivo indicators of new bone formation.
RESULTS
Histopathologically, trabecular bone formation scores did not indicate any significant difference between the groups. However, the osteoblastic density and calcium accumulation in group I were higher than those in group II, and the difference was significant. Osteopontin staining scores in cells showing membranous and cytoplasmic staining with osteopontin antibodies significantly increased in group II.
CONCLUSION
In this study, we found reduced differentiation of osteoblasts despite their increase in number. Moreover, the osteoblastic maturation rate was low in synostotic sutures, bone resorption becomes slower than new bone formation, and the remodeling rate is low in sagittal synostosis.
Topics: Humans; Child; Infant; Osteopontin; Cranial Sutures; Parietal Bone; Calcium; Craniosynostoses; Sutures
PubMed: 36951024
DOI: 10.5137/1019-5149.JTN.41370-22.2 -
The Journal of Craniofacial Surgery Jan 2016A patient with unicoronal craniosynostosis was treated by an open cranial vault remodeling procedure at 11 months of age. A calvarial defect persists at the site of the... (Review)
Review
A patient with unicoronal craniosynostosis was treated by an open cranial vault remodeling procedure at 11 months of age. A calvarial defect persists at the site of the sagittal suture at 7 years follow-up. This unexpected outcome led us to evaluate current literature on incidence and possible causes of incomplete reossification after craniosynostosis surgery.English literature was searched from 1982 to 2013. Variables of interest were incidence, diagnose, type of surgery, age at operation, possible causes for incomplete reossification, and duration and type of follow-up.Incidence in unselected cohorts ranged from 0.5% to 18.2%. Incomplete reossification has been reported in syndromical and nonsyndromical cases, after multiple types of surgery for any type of suture. Follow-up was done by palpation, radiology or both, for a period of 6 to 264 months.Higher age at operation and a dura tear are associated with an increased risk of incomplete reossification.Type and duration of follow-up is inhomogeneous and there is a wide variety in the terminology used for incomplete reossification.To improve international communication on this topic, more long-term studies, using a consistent type and length of follow-up and uniform terminology are needed.
Topics: Cranial Sutures; Craniosynostoses; Female; Follow-Up Studies; Frontal Bone; Humans; Infant; Osteogenesis; Parietal Bone; Postoperative Complications; Plastic Surgery Procedures; Treatment Outcome; Wound Healing
PubMed: 26745196
DOI: 10.1097/SCS.0000000000002319 -
Genesis (New York, N.Y. : 2000) Jan 2019The skull bones must grow in a coordinated, three-dimensional manner to coalesce and form the head and face. Mammalian skull bones have a dual embryonic origin from... (Review)
Review
The skull bones must grow in a coordinated, three-dimensional manner to coalesce and form the head and face. Mammalian skull bones have a dual embryonic origin from cranial neural crest cells (CNCC) and paraxial mesoderm (PM) and ossify through intramembranous ossification. The calvarial bones, the bones of the cranium which cover the brain, are derived from the supraorbital arch (SOA) region mesenchyme. The SOA is the site of frontal and parietal bone morphogenesis and primary center of ossification. The objective of this review is to frame our current in vivo understanding of the morphogenesis of the calvarial bones and the gene networks regulating calvarial bone initiation in the SOA mesenchyme.
Topics: Animals; Bone Development; Epigenesis, Genetic; Gene Expression Regulation, Developmental; Humans; Skull
PubMed: 30155972
DOI: 10.1002/dvg.23248 -
BMJ Case Reports May 2021A female infant presented at 31 days of life following a head injury with concerning features for non-accidental injury. Examination revealed a noticeable depression in...
A female infant presented at 31 days of life following a head injury with concerning features for non-accidental injury. Examination revealed a noticeable depression in the left temporoparietal region with a concave depression of the left parietal bone on CT imaging. After careful consideration of the history and examination findings, along with standard investigations for non-accidental injury, the infant was diagnosed with faulty fetal packing (also known as congenital vault depression). The defect had almost completely resolved by follow-up at 5 months. This case represented a diagnostic conundrum not previously reported in the literature.
Topics: Bandages; Craniocerebral Trauma; Female; Humans; Infant; Parietal Bone
PubMed: 34059535
DOI: 10.1136/bcr-2020-240302