Cranial Base In Patients Research Articles

Effect of Beta Thalassemia Major on Anterior Cranial Base in Cephalometric Analysis

Background: Thalassemia is a group of hemolytic diseases caused by genetic disorders resulting from a decrease in the synthesis of the alpha or beta chains of hemoglobin (Hb). A particular craniofacial cephalometric picture is found in the form of mild skeletal class II clinical manifestations. The anterior cranial base becomes a benchmark or reference sector in the measurement of dentofacial structures on cephalometric radiographs because it is considered relatively stable throughout craniofacial growth. Objective: The purpose of this systematic literature review was to determine the effect of beta thalassemia major on the length of the anterior cranial base observed through cephalometric analysis. Methods: References were selected using the PubMed, Science Direct, and Google Scholar databases published from January 2007 to December 2021. The complete articles that met the inclusion and exclusion criteria were then assessed using the Critical Appraisal Skills Program bias assessment and summarized to obtain demographic data and the length of the patient's anterior cranial base in the journal. Results: This systematic literature review succeeded in synthesizing 6 journals consisting of case-control studies with low bias assessment results in 4 journals and moderate bias assessment in 2 journals. All journals in this systematic literature review stated that the length of the anterior cranial base in patients with beta thalassemia major was not much different from the control group seen in cephalometric analysis. Conclusion: There is no effect on the length of the anterior cranial base in patients with beta thalassemia major based on measurements on cephalometric analysis.

Morphometric evaluation of sella turcica and cranial base in patients with congenital absence of teeth.

To evaluate the size and shape of sella turcica and cranial base in patients with different degrees of congenital absence of teeth. The subjects comprised 322 patients from the Department of Orthodontics, West China Hospital of Stomatology, Sichuan University from 2020 to 2021. Based on the number of congenital absence of teeth, the patients were divided into three groups: control group (without loss of teeth, n=112), group Ⅰ (loss of 1-2 teeth, n=104), and group Ⅱ (loss of 3 or more teeth, n=106). Uceph cephalometric software was used to measure the linear and angular parameters of cranial base. The length, depth, and diameter of sella turcica were also calculated. The shape of sella turcica was described as normal or with aberrations. Analysis of variance, Kruskal-Wallis H test, chi-square test, and Fisher's exact test were conducted with SPSS 21.0. No statistical differences were observed in the length, depth, and diameter of sella turcica and parameters related to the cranial base among the three groups (P>0.05). The incidence of sella turcica bridge among the three groups was statistically significant (P=0.013). The incidence was higher in the study group compared with the control group (P<0.05), and no significant difference was observed between groups Ⅰ and Ⅱ (P>0.05). Although the linear size of sella turcica and parameters related to the cranial base was not statistically different between normal subjects and patients with congenital absence of teeth, the incidence of sella turcica bridge was higher in patients with congenital absence of teeth, suggesting the possibly abnormal anatomical morphology of sella turcica in this population.

Postoperative change of skull base of craniosynostoses treated by frontorbital advancement by using 3-D digital technique

Objective To investigate the deformity of cranial base in patients with craniosynostosis and to evaluate the effect of modified fronto-orbital advancement (FOA) for craniosynostosis using three-dimensional digital technology. Methods From January 2010 to December 2016, 10 cases of craniosynostosis were included in the study. All patients underwent modified FOA, we quantitatively analysed the pre-operative deformity and the surgical outcome of FOA performed in ten patients with craniosynostosis. The measurements of skull base were performed based on 3D computed tomography (CT) scan. We assessed the symmetry of skull base and the deflection of anterior cranial fossa. Results The mean patients＇ age at FOAs was 3.2 years. A significant asymmetry of skull base was found in all patients. The growth of anterior and middle fossae was restricted. On the follow-up CT images 23.6 months after surgery, there was prominent change (P<0.05) between the two hemibases (CSO^ ratio) and between the lengths and angles of anterior and middle cranial hemi-fossae (CX, CSX^, XSM^ratio). Anterior cranial vault asymmetry index obviously decreased from 12.4% to 1.05% before surgery (P<0.05). In addition, anterior cranial vault deflection angle proved to also be less after surgical correction (20.33°±9.19° versus 13.13°±5.28°, P<0.05) . Conclusions The asymmetry of skull base can be presented by intracranial view at over 1 year of age. FOA can correct the skeletal malformation of frontotemporal region and the asymmetry of skull base is improved after surgical treatment. Key words: Craniosynostosis; Morphology of skull base; Fronto-orbital advancement; Three-dimensional digital technology

Evaluación cefalométrica de la longitud y deflexión de la base craneal anterior en pacientes con diferente patrón esquelético

Objetivo: Evaluar las diferencias en la longitud y deflexión de la base craneal anterior en pacientes con diferente patrón esquelético. Materiales y método: El diseño del estudio fue observacional, descriptivo y transversal. La muestra fue distribuida en tres grupos y conformada por radiografías cefalométricas de 310 pacientes, cuyo rango de edad fue de 6 a 12 años. Se obtuvieron las radiografías cefalometricas de cada paciente, las cuales fueron evaluadas a través del trazado cefalométrico. Las variables evaluadas fueron: longitud de la línea sella-nasion y el ángulo formado entre la línea sella-nasion y el plano horizontal de Frankfort. Los datos se analizaron estadísticamente utilizando las pruebas Kruskal-Wallis y U Mann-Whitney (p&lt;0,05). Resultados: De acuerdo con el análisis estadístico, se encontraron diferencias significativas en la longitud y deflexión de la base craneal anterior en el grupo con patrón esquelético clase III (60,40+4,31 mm, 7+2,11º) en comparación a la clase I (68,36+3,76 mm, 8,13+2,64º) y clase II (68,76+3,56 mm, 8,63+2,43º). La longitud y deflexión de la base craneal anterior presentaban diferencias significativas según género, sin embargo no se encontraron diferencias significativas en relación a la edad. Conclusiones: La longitud y deflexión de la base craneal anterior es similar en niños con patrón esquelético de clase I y clase II pero diferente en clase III.

Meningoencephalocele: a late complication of Le Fort III midfacial advancement in a patient with Crouzon syndrome

Complications of Le Fort III midfacial advancement include CSF rhinorrhea, meningitis, and ocular and cerebral injury. This report reviews the anatomy of the Le Fort III osteotomies and their relevance to the unusual complication of meningoencephalocele. In this report, a young male patient with Crouzon syndrome underwent subcranial midfacial advancement at the age of 10 years for obstructive sleep apnea and ocular exposure. He presented 4 years later complaining of nasal obstruction. On physical examination, a mucous-covered mass was noted in the left upper nasal vault medial to the turbinates. Computed tomography scanning and MR imaging confirmed the diagnosis of frontoethmoidal meningoencephalocele. Repair of the meningoencephalocele was accomplished using a combined neurosurgery and plastic surgery approach. Meningoencephalocele is a rare complication of subcranial midfacial advancement. The abnormal anatomy of the anterior cranial base in patients with syndromic craniosynostosis places them at greater risk for fracture of the cribriform plate and dural tears during this procedure. Unrecognized dural injury is the etiology of this complication in this young patient; however, elevated intracranial pressure may have been a confounding factor. Attention to the anatomy of the anterior cranial base, as seen on sagittal CT images, will aid in preventing this complication.

The risk of nasal osteotomies after ethmoid sinus surgery.

To assess whether there is an increased risk of osteotomies causing fractures that extend into the orbit or cranial base in patients who undergo ethmoid sinus surgery. Anatomic investigation in a cadaver model. Twenty-eight medial and lateral osteotomies were performed in 14 fresh-frozen cadaver heads after bilateral sphenoethmoidectomies (endoscopic technique, n = 26; external technique, n = 2). Anatomic examination performed by inspection after removal of dorsal nasal skin followed by rigid endoscopic intranasal examination. Complete osteotomies were obtained in every case. There were no major comminutions along the osteotomies, but there was a 25% rate of minor comminutions. In no case did fractures extend into either the orbit or the base of the skull. In every case, the path of the osteotome was separated from the ethmoid surgical cavity by a relatively thick buttress of bone composed of the anterior lacrimal crest and the ascending process of the maxilla. The enlarged maxillary ostia created by the sinus surgery was not altered by the osteotomies or by dorsal narrowing. Nasal osteotomies can be performed with minimal risk of comminution or uncontrolled extension of the fracture lines following extensive ethmoid and sphenoid sinus surgery. These findings may not apply in patients with preexisting injuries or when osteotomies do not preserve the triangular nasal buttress.

The cranial base in obstructive sleep apnea

Purpose : The purpose of this investigation was to determine if there are cranial base differences in adults with obstructive sleep apnea (without identifiable craniofacial abnormalities) when compared with those of adults without airway problems. Methods : Cephalometric analysis of the cranial base of 52 patients with documented sleep apnea were compared with 96 normal adult patients. Each of the groups was subdivided based on skeletal profiles (Class I, II, III). Cephalometric measurements included cranial base flexure angle and anterior and posterior cranial base lengths. Standard analysis of variance and Students' t test were used to determine level of significance. Results : The cranial base flexure angle in patients with documented sleep apnea was significantly more acute than that found in the nonapnea group. Patients with a skeletal Class III profile had the most acute cranial base flexure whereas those with Class II profiles had the most obtuse angles. This pattern was true for apnea and nonapnea groups. No cranial base length differences could be found in either group. Conclusion : The results of this study demonstrate that there were abnormalities of the cranial base in patients with obstructive sleep apnea. Abnormalities of the cranial base seen in “nonsyndrome” obstructive sleep apnea patients are similar to those seen in patients with certain identifiable syndromes. This may suggest that sleep apnea is a reflection of a form of craniofacial syndrome.

A radiographic comparison of the cranial base in patients with craniosynostosis

A radiographic comparison of the cranial base in patients with craniosynostosis