Anterior Bulging Research Articles

Arthroscopically assisted internal fixation of the symptomatic unstable os acromiale with absorbable screws

Symptomatic meso- type os acromiale is a common pathology with inconsistent outcomes of treatment with various surgical techniques. We report the outcome of a new technique for arthroscopic fusion of symptomatic os acromiale with absorbable screws. The study included 8 shoulders in 8 patients with symptomatic meso- type os acromiale who were treated with the use of a new technique for arthroscopic fusion with absorbable screws. The mean age was 54 years (range, 38-67 years), and the mean time from onset of symptoms to surgery was 18 months (range, 9-25 months). No patients reported a specific traumatic event before the onset of symptoms, and all noted the insidious onset of pain with no precipitating event. The average length of follow-up was 22 months (range, 12-36 month). The average Constant score improved from 49 points (range, 35-57 points) to 81 points (range, 75-86 points). The average satisfaction score improved from 4.5 of 10 (range, 2-6) to 8.5 of 10 (range 7-9). All patients made a good clinical recovery at 3 to 6 months after surgery. At the last follow-up, full radiographic union was observed in 6 patients, partial union in 1 patient, and persistent radiologic nonunion in 1 patient. Anterior bulging of the absorbable screws was noted in 2 patients, and the screws were trimmed 6 months after the first procedure. We have found that this new arthroscopic technique of fixation of os acromiale with absorbable screws provides promising clinical, cosmetic, and radiologic results with high patient satisfaction.

Infecciones periamigdalinas: estudio prospectivo de 100 casos consecutivos

IntroductionPeritonsillar infection is the most frequent complication of acute tonsillitis. Peritonsillar infections are collections of purulent material, usually located between the tonsillar capsule and the superior constrictor of the pharynx. Peritonsillar infection can be divided into abscess and cellulitis. Material and methodsWe prospectively analysed the clinical data from 100 patients with peritonsillar infection from 2008 to 2010. The diagnosis of abscess or peritonsillar cellulitis was primarily based on obtaining pus through fine-needle aspiration. ResultsSeventy-seven per cent of patients had no history of recurrent tonsillitis and 55% were receiving antibiotic treatment. Sixty-two cases were peritonsillar abscess and the rest were cellulitis. Trismus, uvular deviation and anterior pillar bulging were statistically associated with peritonsillar abscess (P<.005). All patients were admitted to hospital and treated with puncture-drainage, intravenous antibiotics (amoxicillin/clavulanate in 83% of cases) and a single dose of steroids. All patients were discharged on oral antibiotic therapy. The mean length of hospital stay was 3 days and the recurrence rate was 5%. ConclusionsDue to the absence of clinical practice guidelines, there are different therapeutic protocols. According to our experience, puncture-aspiration and administration of intravenous antibiotics is a safe, effective way to treat these patients. To determine the efficacy and safety of outpatient management, controlled studies would be needed.

Anterior femoroacetabular impingement: An update

Anterior femoroacetabular impingement can cause early hip osteoarthritis. The typical patient is an adult younger than 50 years of age, often with a history of sporting activities. The main symptom is intermittent pain triggered by static flexion (low seats) or dynamic flexion (during sporting or occupational activities that require repeated hip flexion). The characteristic physical finding is pain triggered by placing the hip in internal rotation and 70 to 110° of flexion. In additional to anteroposterior and false-profile radiographs, lateral Dunn or Ducroquet views should be obtained on both sides to visualize the anterior part of the head-neck junction. Instead of being concave, the head-neck junction is either flat or convex, causing a cam effect that damages the labrum and anterosuperior cartilage. Non-sphericity of the femoral head with an anterior ovoid bulge induces a similar cam effect. In pincer impingement, which is less common, over-coverage by the anterosuperior acetabular rim pinches the labrum between the rim and the femoral head-neck junction when the hip is flexed. Pincer impingement is related to acetabular retroversion or protrusion. Arthrography coupled with computed tomography or magnetic resonance imaging visualizes the morphological abnormalities (e.g., ovoid shape of the femoral head or retroversion of the acetabulum) and detects secondary lesions such as labral tears or separation or damage to the anterosuperior cartilage. Arthroscopy allows removal of the damaged labrum and correction of the morphological abnormalities via femoroplasty to restore the normal concave shape of the neck and/or acetabuloplasty to eliminate over-coverage. Short- or mid-term results are satisfactory in 75 to 80% of patients. However, the presence of degenerative lesions in about two-thirds of patients at the time of arthroplastic surgery limits the probability of achieving good long-term results.

Bilateral Circumscribed Posterior Keratoconus: Visualization by Ultrasound Biomicroscopy and Slit-Scanning Topography Analysis

This paper documents a rare nonprogressive developmental disorder—bilateral circumscribed posterior keratoconus—in a 60-year-old man referred for a cataract surgery. For the first time ultrasound biomicroscopy was used to visualise the local anterior bulging of the posterior corneal surface with concomitant thinning of the stroma. The amount of localized posterior depression, corneal thickness and the refractive power of both the posterior and anterior corneal curvature were measured using slit-scanning topography analysis (Orbscan).

A New Heterolobosean Amoeba Solumitrus palustris n. g., n. sp. Isolated from Freshwater Marsh Soil

During the course of research on the bacterial feeding behavior and resistance of amoebae to virulent pathogens, we isolated a new strain of amoeba from organic rich soil at the margin of freshwater swamp in the northeastern United States. Light microscopic morphology is characteristically heterolobosean, resembling vahlkampfiids, including a broadened, limax shape, and eruptive locomotion, but occasionally becoming more contracted and less elongated with lateral or anterior bulges and somewhat branching sparse, uroidal filaments. Electron microscopic evidence, including mitochondria with flattened cristae surrounded by rough endoplasmic reticulum, further indicates a heterolobosean affinity. The solitary nucleus contains a centrally located nucleolus. Cysts are rounded with occasionally an eccentrically located nucleus. The cyst walls are relatively thin, becoming crenated, and loosely enclosing the cyst when mature. Molecular genetic evidence places this isolate among the Heterolobosea, branching most closely in a clade including Allovahlkampfia spelaea and previously isolated, un-named strains of soil amoebae. Based on differentiated features, including morphology of the uroid, cyst wall structure, and molecular genetic evidence that distinguish it from A. spelaea, a new genus and species, Solumitrus palustris, is proposed for this new heterolobosean.

Porohyperelastic Finite Element Modeling of Abdominal Aortic Aneurysms

Abdominal aortic aneurysm (AAA) is the gradual weakening and dilation of the infrarenal aorta. This disease is progressive, asymptomatic, and can eventually lead to rupture--a catastrophic event leading to massive internal bleeding and possibly death. The mechanical environment present in AAA is currently thought to be important in disease initiation, progression, and diagnosis. In this study, we utilize porohyperelastic (PHE) finite element models (FEMs) to investigate how such modeling can be used to better understand the local biomechanical environment in AAA. A 3D hypothetical AAA was constructed with a preferential anterior bulge assuming both the intraluminal thrombus (ILT) and the AAA wall act as porous materials. A parametric study was performed to investigate how physiologically meaningful variations in AAA wall and ILT hydraulic permeabilities affect luminal interstitial fluid velocities and wall stresses within an AAA. A corresponding hyperelastic (HE) simulation was also run in order to be able to compare stress values between PHE and HE simulations. The effect of AAA size on local interstitial fluid velocity was also investigated by simulating maximum diameters (5.5 cm, 4.5 cm, and 3.5 cm) at the baseline values of ILT and AAA wall permeability. Finally, a cyclic PHE simulation was utilized to study the variation in local fluid velocities as a result of a physiologic pulsatile blood pressure. While the ILT hydraulic permeability was found to have minimal affect on interstitial velocities, our simulations demonstrated a 28% increase and a 20% decrease in luminal interstitial fluid velocity as a result of a 1 standard deviation increase and decrease in AAA wall hydraulic permeability, respectively. Peak interstitial velocities in all simulations occurred on the luminal surface adjacent to the region of maximum diameter. These values increased with increasing AAA size. PHE simulations resulted in 19.4%, 40.1%, and 81.0% increases in peak maximum principal wall stresses in comparison to HE simulations for maximum diameters of 35 mm, 45 mm, and 55 mm, respectively. The pulsatile AAA PHE FEM demonstrated a complex interstitial fluid velocity field the direction of which alternated in to and out of the luminal layer of the ILT. The biomechanical environment within both the aneurysmal wall and the ILT is involved in AAA pathogenesis and rupture. Assuming these tissues to be porohyperelastic materials may provide additional insight into the complex solid and fluid forces acting on the cells responsible for aneurysmal remodeling and weakening.

Fecaloma in an iatrogenic diverticulum: an unusual complication of the procedure for prolapsed hemorrhoids (PPH)

The procedure for prolapsed hemorrhoids (PPH) is associated with low levels of postoperative pain but may be followed by unusual and severe postoperative complications. We report a case of a 62-year-old woman affected by tenesmus, obstructed defecation and vaginal bulging 2 years after a PPH procedure performed in another institution. Clinical examination and colonoscopy revealed a mass within the anterior rectal wall bulging into the vaginal and rectum lumen 3 cm above the dental line, mimicking a stromal tumor. Magnetic resonance imaging (MRI) confirmed the presence of an avascular mass, 4 cm in diameter, confined to the anterior rectal wall (Figs. 1, 2). Intraoperative findings revealed a calcified fecaloma enclosed in a mucousal rectal diverticulum communicating with the rectal lumen with a little opening at the level of the staple line (Figs. 3, 4).

Female duplication of kidney ureter and bladder:9 cases report

Objective To report the experiences on the diagnosis and treatment of duplication of kidney ureter and bladder. Methods Nine cases of duplication of kidney ureter and bladder from 1996 to 2008 were reviewed.Six cases of duplicated kidney ureter occurred in the left side and 2 cases in the right side,1 case bilateral kidney ureteral duplication.Of 8 cases with unilateral duplicated,duplicated bladders were incompleteness.And the patient with bilateral duplicated,whose duplicated bladder was completeness,was diagnosed with duplication of urethra,uterine,bilateral ovary and oviduet tubes,and also suffered from duplicated uterine prolapse Ⅱ,vaginal anterior wall bulging and duplicated vesicocele.There were two cases whose duplicated kidney losed function because of severe hydronephrosis,and 7 cases existed kidney secretion function. Excision of duplicated kidney ureter and bladder were performed on 2 cases with non-functional duplicated kidney.6 cases had undergone duplicated bladder excision and duplicated ureteral bladder replantation.The special case had undergone duplicated urinary bladder urethra uterine and bilateral annexes excision,and duplicated ureteral bladder replantation. Results The operation was successful in all paients without leakage and ureter stump syndrome.Three months after operation,ureter bladder imaging showed no ureteral reflux in 7 cases of ureteral bladder replantation.IVU were reviewed 12 months after operation:2 cases undergoing duplicated kidney excision showed that the function of residual kidney were normal,7 cases of replantation that the shape and function of sick side kidney and duplicated kidney were good. The patient who suffered from duplicated uterine simultaneously got pregnancy 1.5 years after operation. Conclsions Image examinations may help to diagnose the duplication of kidney ureter and bladder. The main treatment is surgery. Understanding the function of duplicated kidney and the shape of kidney ureter and bladder should be considered before operation. The goal of surgery should be relieving pain,protecting the function of duplicated kidney and minimizing the risk of infection. Key words: Female; Urogenital abnormalities; Ureterovesical reimplantation

Dynamic magnetic resonance imaging for assessment of minimally invasive pelvic floor reconstruction with polypropylene implant

Introduction The purpose of the study was to assess the usefulness of dynamic MRI in patients with pelvic organ prolapse after pelvic floor repair with polypropylene mesh. Materials and methods Fifteen consecutive patients (mean age 66.5 years) who were scheduled for either anterior ( n = 9) or posterior ( n = 6) pelvic floor repair were prospectively evaluated by clinical assessment and dynamic MRI 1 day before and 3 months after surgery. MRI diagnoses and MRI measurements of relevant anatomical points at rest and on straining were analysed before and after surgery. Results At follow-up assessment 93.3% of all patients were clinically cured. Dynamic MRI showed newly developed ( n = 6) or increased ( n = 6) pelvic organ prolapse in 80% ( n = 12) of all patients 3 months after pelvic floor repair. Most of them ( n = 11; 91.7%) affected the untreated pelvic floor compartment. On straining anatomical points of reference in the anterior pelvic floor compartment were significantly ( p < 0.05) elevated after anterior repair and rectal bulging was significantly ( p = 0.036) reduced after posterior pelvic floor repair. Conclusions In this study dynamic MRI could verify the effective support of anterior and posterior pelvic floor structures by anterior and posterior polypropylene implant respectively. But dynamic MRI demonstrates if one compartment of the pelvic floor is repaired another compartment frequently (73.3%) develops dysfunction. These results did not correspond to clinical symptoms on short-term follow-up (3 months). Studies with long-term follow-up are necessary to prove if dynamic MRI can reliably identify clinically significant pelvic organ prolapse after pelvic floor repair before the onset of symptoms.

Description of Trichotokara nothriae n. gen. et sp. (Apicomplexa, Lecudinidae) – An intestinal gregarine of Nothria conchylega (Polychaeta, Onuphidae)

The trophozoites of a novel gregarine apicomplexan, Trichotokara nothriae n. gen. et sp., were isolated and characterized from the intestines of the onuphid tubeworm Nothria conchylega (Polychaeta), collected at 20 m depth from the North-eastern Pacific Coast. The trophozoites were 50–155 μm long with a mid-cell indentation that formed two prominent bulges (anterior bulge, 14–48 μm wide; posterior bulge, 15–55 μm wide). Scanning electron microscopy (SEM) demonstrated that approximately 400 densely packed, longitudinal epicytic folds (5 folds/μm) inscribe the surface of the trophozoites, and a prominently elongated mucron (14–60 μm long and 6–12 μm wide) was covered with hair-like projections (mean length, 1.97 μm; mean width, 0.2 μm at the base). Although a septum occurred at the junction between the cell proper and the mucron in most trophozoites, light microscopy (LM) demonstrated that the cell proper extended into the core of the mucron as a thin prolongation. A spherical nucleus (8–20 μm) was situated in the middle of the trophozoites, and gamonts underwent caudal syzygy. The small subunit (SSU) rDNA sequence and molecular phylogenetic position of T. nothriae was also characterized. The sequence from this species was the most divergent of all SSU rDNA sequences currently known from gregarines and formed a weakly supported clade with Lecudina polymorpha, which also possesses densely packed epicyctic folds (3–5 folds/μm) and a prominently elongated mucron.

Anterior external bony ear canal bulge

To study the prevalence of anterior external bony ear canal bulge. Hundred patients each of the sexes among three races in Malaysia were studied with an otoscope and microscope. Anterior external ear canal wall bulge is seen in 34% of the Malays, 32% of the Chinese and 29.5% of the Indians In about one third of the population in Malaysia an anterior canal wall bulge is seen.

Facet distraction spacers for treatment of degenerative disease of the spine: Rationale and an alternative hypothesis of spinal degeneration

Facet distraction spacers for treatment of degenerative disease of the spine: Rationale and an alternative hypothesis of spinal degeneration

Morphological changes induced by Caesalpinia bonducella seed extract on rat sperm: scanning electrone microscope study

Morphological changes in the sperm of albino rats observed under scanning electron microscope illustrate the disturbance in the plasma membrane, as well as in the acrosomal membrane upon treatment with graded doses of an alcoholic seed extract of Caesalpinia bonducella. Considerable changes in the shape and size of the sperm head were observed, with the middle region of the sperm head being slightly constricted dorsoventrally. Most sperm appeared morphologically abnormal in the head region showing the distortion at the anterior region and bulging of the acrosomal membrane when compared with the control. The results of this study suggest that such effects might have resulted from general disturbance in proteins and alteration in the cauda epididymal milieu, probably due to an androgen deficiency consequent to the treatment with Caesalpinia bonducella.

A Holistic Evaluation of Risk Factors for Work-Related Musculoskeletal Distress Among Asymptomatic Sonographers Performing Neurosonology

A pilot study was conducted to gather holistic data points on female sonographers who executed neonatal neurosonography over four portable scanning sessions. The hypothesis was that specific risk factors contributed to work-related musculoskeletal distress in the hand and wrist as a result of neonatal neurosonography. A preexperimental pre-post research design was used to gather data on work demands, self-rated physical and mental health, posture/position during scanning, physiologic change, and pain scores. No statistically significant changes were detected between pre-post measures for work demands, physical and mental health, or pain scores as a result of portable scanning sessions. The physiologic changes, between scanning sessions, were recorded with the use of a hand-carried sonographic unit. Sonographic measures were less than the published criteria for carpal tunnel syndrome with a proximal cross-sectional area ≥10 mm 2 and an anterior bulge of the retinaculum of &gt;4 mm. Sonography documented a statistically significant cross-sectional area change, within the median nerve, at the distal radius only after the first scanning session. Power and spectral Doppler was used to document perineural vascular flow within the median nerve, but it was not consistently obtained to allow for a rigorous comparison between pre- and postscanning sessions. This is the first pilot study to explore using a hand-carried sonographic unit to document change in the median nerve for an isolated sonographic examination. The results are only reflective of these particular participants, but much larger N and shorter scanning sessions are needed to confirm the hypothesis proposed.

Feasibility of Using a Hand-Carried Sonographic Unit for Investigating Median Nerve Pathology

Numerous research studies describe the prevalence of work-related musculoskeletal disorders (WRMSD) in diagnostic medical sonographers, but little research has investigated contributing factors and biological changes in symptomatic individuals. Improved image quality and portability, combined with lower cost and dynamic capabilities, have led to increased use of sonography over magnetic resonance imaging (MRI) in musculoskeletal evaluations. The purpose of this pilot study was to develop a valid and reliable sonographic protocol for the evaluation of work-related median nerve pathology with a hand-carried sonographic unit. A GE Logiq i (Milwaukee, Wisconsin) hand-carried unit with a 12-MHz linear transducer was used to collect nine longitudinal and transverse images of the median nerve at various anatomical locations in the distal upper extremity of three healthy volunteers. Doppler waveforms were also collected in the median nerve sheath. Qualitative review indicated high-quality images with well-defined structures, resulting in valid measures between multiple researchers of anterior-posterior diameter, cross-sectional area, anterior transverse carpal ligament bulge, and Doppler flow. The use of a hand-carried sonographic unit appears to be a feasible alternative to MRI to detect musculoskeletal changes in symptomatic sonographers. Additional basic and clinical studies are necessary to validate the use of hand-carried sonography as a measure of biological changes in longitudinal WRMSD research.

Degenerative lumbar intervertebral instability: what is it and how does imaging contribute?

IntroductionAlthough low back pain (LBP) is the most commonrheumatologic symptom that leads to consultation with ageneral practitioner, the identification of a specific symp-tomatic cause remains elusive in the majority of patientswith mechanical LBP. Degenerative lumbar intervertebralinstability as a cause of chronic LBP is an important factorin determining indications for spinal surgery.The concept of lumbar instability remains a subject ofconsiderable debate. In spite of many efforts, a widelyaccepted definition of the condition has not been clearlyestablished. The best diagnostic methods and the mostefficacious treatment approaches are controversial, and therelationship between radiologic evidence of instability andsymptom production is not always clear cut.This perspective discusses the role of imaging as apotential unifier of varied clinical labels and therapeuticoptions.PathomechanismsA workable definition of instability is based on a loss ofmotion segment stiffness, such that force application to thatsegment produces greater displacement than would be seenin a normal state [1, 2]. In a biomechanical sense, stiffnessis defined as the ratio of the load applied to a structure andthe resulting motion. Stability to the lumbar spine isprovided by the restraining structures working in conjunc-tion (i.e., disks, joints, ligaments, and muscles) [3].Degenerative processes, leading to laxity of restrainingstructures, result in altered equilibrium and instability [2–6]. The degenerative processes of the lumbar spinegenerally initiate from the intervertebral disk with progres-sive biochemical and structural changes leading to amodification in its physical properties of elasticity andmechanical resistance and eventual collapse of the inter-vertebral disk.Three clinically relevant consequences of acquiredcollapse of the intervertebral disk are: (a) pathologicchanges in the vertebral bodies, with osteophyte develop-ment; (b) anterior bulging of the flaval ligaments andposterior bulging of the posterior longitudinal ligament,with consequential narrowing of the central spinal canal;and (c) posterior bulging of redundant posterior disksurface, with narrowing of the central spinal canal and ofthe inferior recesses of the neural foramina. Moreover,weakening of the disk structure permits the adjacentvertebrae to slide back and forth over each other, resultingin laxity of the ligamentous network binding the vertebrae

High Dose Calcitriol in Osteopetrorickets

Osteopetrorickets is a rare autosomal recessive disorder of osteoclast function characterized by abnormally dense bone and failure of resorption of calcified cartilage. Rickets is a paradoxical complication of osteopetrosis, resulting from the inability of the osteoclasts to maintain a normal calcium-phosphorus balance in the extracellular fluid. We report a patient with an unusual case of infantile osteopetro-rickets who was admitted with anterior fontanel bulging and was treated with haploidentical bone marrow transplantation.

The Prevalence and Characteristics of Thoracic Magnetic Resonance Imaging Findings in Men

A cross-sectional study of thoracic magnetic resonance image (MRI) findings. To examine the prevalence of different thoracic MRI findings for T6-T12 and their associations with age and one another by level. There is a dearth of descriptive epidemiology of thoracic MRI findings in the general population. Thoracic MRIs of 524 men were assessed qualitatively and quantitatively for a variety of findings, including disc bulging, height and signal, vertebral deformities, endplate irregularities, osteophytes, and hemangiomas. Descriptive statistics, correlation coefficients and STATA's survey analysis were used. In the lower thoracic spine, 5.4% to 9.5% of the discs, depending on level, were qualitatively assessed as moderately to severely narrowed. Anterior bulging was more common than posterior, which was relatively rare and mild when present. Signal was lower in the midthoracic than lower discs. At least 1 moderate or severe vertebral deformity was found in 6.1% of the subjects, suggesting fracture, and hemangiomas were identified in 2.3% of subjects. Disc signal correlated most highly with age (r = 0.31-0.42). Qualitatively assessed disc height narrowing (r = 0.29-0.46) and quantitative disc height (r = 0.11-0.29) were associated with disc signal. Upper and lower endplate irregularities were associated with one another (r = 0.17-0.32), as were bulging and osteophytes, anteriorly (r = 0.35-0.61) and posteriorly (r = 0.26-0.45). Degenerative MRI findings beyond a mild grade were not commonly observed in the thoracic spine among 35-70-year-old men. Posterior bulges, in particular, were rare. The highest correlation with age existed for disc signal. Different MRI findings were associated with one another, but the magnitude of association varied by level. The effects of individual judgments and disc level on prevalence rates were apparent.

Progression and Determinants of Quantitative Magnetic Resonance Imaging Measures of Lumbar Disc Degeneration

A longitudinal study. Our goal was to explore the role of digital magnetic resonance imaging (MRI) data, by extending our earlier 5-year follow-up study of progression of lumbar spine degeneration with quantitative measures of disc degeneration. A longitudinal study is optimal for investigating disc degeneration but only a few studies (with small sample sizes) or short follow-up studies include repeated MRI data. Subjects consisted of 134 male monozygotic twins (age 35-69 years). Quantitative MRI measures included changes in disc bulging and height. Inter-rater reliability coefficients were between 0.77 and 0.96. At baseline and follow-up, an extensive interview about exposures to suspected determinants was conducted. Reduction in disc height and increases in bulges (worsening) were seen in 2/3 of subjects. The mean reduction in disc height was 2.2% to 3.6%. A mean increase in bulging of 7% to 10% was found in the L1-L4 discs and 4% in L4-S1 discs. Although the mean changes were small, few reverse changes were observed. Familial aggregation, a proxy for genetic influences, explained 17% of changes in disc height, and 11% and 0% of changes in the sizes of anterior and posterior bulges in the regression models. Higher maximal occupational lifting (AR2 = 4.9%) and smoking (AR2 = 3.5%) during follow-up predicted more disc height reduction. Greater increases in bulging (AR2 = 7.4%-10.2%) were predicted by smaller bulges at baseline. The mean annual changes in disc heights (<1%) and bulges (<2%) were small, and included both decreases and increases, with only a few subjects showing more major changes in either direction. The role of genetics was largest except in posterior bulges, but lifting and smoking were also associated with disc height reduction but none of the other studied risk factors were associated with anterior or posterior disc bulging. Different degenerative findings have different determinants of progression.

Craniofacial Dysmorphology of Carpenter Syndrome: Lessons from Three Affected Siblings

Carpenter syndrome, or acrocephalopolysyndactyly type II, is a disorder associated with an autosomal recessive pattern of inheritance. Because of its rarity, limited insight into the anomalies associated with this syndrome exist and little long-term follow-up of affected patients is available. This study is a retrospective review of the clinical history, medical imaging, and therapeutic interventions for three full siblings with Carpenter syndrome over an 18-year period. The medical records were abstracted for kindred analysis, gestational and delivery history, health issues related to Carpenter syndrome, and therapeutic interventions, including indications for, age at, and outcome of. All three children had craniosynostosis, acral deformities, and other associated anomalies. The pattern of craniosynostosis, at birth, varied among the three siblings: one had fusion of the metopic and sagittal sutures and the other two had bilateral coronal, metopic, and anterior sagittal synostoses. All three siblings demonstrated marked absence or underdevelopment of the anterior cranial fossa and bulging of the middle cranial fossa. There was no correlation between the degree of craniofacial dysmorphology and brain dysmorphology in any of the three individuals. Computed tomographic scan data of osseous and brain anatomy and clinical photographs of treatment outcomes are provided to demonstrate the long-term craniofacial development and growth in treated individuals with Carpenter syndrome. The diverse anatomical variation seen in these three individuals supports the notion of marked phenotypic variability within this disorder. This spectrum of information should aid members of craniofacial teams in appreciating this variability and thereby facilitating the diagnosis and management of individuals with Carpenter syndrome.