Cranial Morphology Research Articles

Dietary niche partitioning in Early Jurassic ichthyosaurs from Strawberry Bank.

Jurassic ichthyosaurs dominated upper trophic levels of marine ecosystems. Many species coexisted alongside each another, and it is uncertain whether they competed for the same array of food or divided dietary resources, each specializing in different kinds of prey. Here, we test whether feeding differences existed between species, applying finite element analysis to ichthyosaurs for the first time. We examine two juvenile ichthyosaur specimens, referred to Hauffiopteryx typicus and Stenopterygius triscissus, from the Strawberry Bank Lagerstätte, a shallow marine environment from the Early Jurassic of southern England (Toarcian, ~183 Ma). Snout and cranial robusticity differ between the species, with S. triscissus having a more robust snout and cranium and specializing in slow biting of hard prey, and H. typicus with its slender snout specializing in fast, but weaker bites on fast-moving, but soft prey. The two species did not differ in muscle forces, but stress distributions varied in the nasal area, reflecting differences when biting at different points along the tooth row: the more robustly snouted Stenopterygius resisted increases or shifts in stress distribution when the bite point was shifted from the posterior to the mid-point of the tooth row, but the slender-snouted Hauffiopteryx showed shifts and increases in stress distributions between these two bite points. The differences in cranial morphology, dentition and inferred stresses between the two species suggest adaptations for dietary niche partitioning.

Pelvic sexual dimorphism and its association with cranial morphology in Neotropical spiny rats (Rodentia, Echimyidae)

Pelvic sexual dimorphism and its association with cranial morphology in Neotropical spiny rats (Rodentia, Echimyidae)

Mosaic Evolution of the Skull in Labrid Fishes Involves Differences in Both Tempo and Mode of Morphological Change.

Modularity is a ubiquitous feature of organismal design that plays an important role in structuring patterns of morphological diversification. Modularity can facilitate evolutionary changes by allowing subsets of traits to coevolve as integrated units and follow quasi-independent evolutionary trajectories, a pattern that may be particularly consequential in the case of highly complex morphological structures. Here we examine modularity in a complex and highly kinetic structure, the teleost skull, and ask if a modular organization of the skull has influenced the diversification dynamics of the shapes of its osteological components across the labrid phylogeny. We compiled one of the largest 3D morphological data sets of fishes to date and used geometric morphometrics to quantify patterns of cranial shape evolution across 184 species of wrasses (Labridae). We then tested several hypotheses of modularity inspired by functional and developmental relationships between cranial bones and compared phenotypic rates among modules. We also compared the fit of models of trait evolution for the entire skull and the various articulated bones that it comprises. Our analyses indicated strong support for a 2-module hypothesis, one that encompasses the oral and pharyngeal jaws and another module comprised of the neurocranium, hyoid apparatus, and operculum. This functional hypothesis yielded one of the highest significant rate differentials across modules, yet we also found that the best-fitting models of trait evolution differed among skull bones. These results suggest that modularity can influence morphological diversification in complex biological structures via differences in both the tempo and mode of evolutionary change. [3D geometric morphometrics, cranial morphology, evolutionary modularity, Labridae, phenotypic rates, structural complexity.].

Clinical utility of new bone imaging using zero-echo-time sequence in neurosurgical procedures: Can zero-echo-time be used in clinical practice in neurosurgery?

The purpose of this study was to evaluate the clinical usefulness of zero-echo-time (ZTE)-based magnetic resonance imaging (MRI) in planning the optimum surgical approach and applying ZTE for anatomical guidance during transcranial surgery. Eleven of 26 patients who underwent transcranial surgery and carotid endarterectomy and in whom ZTE-based MRI and magnetic resonance angiography (MRA) data were obtained were analyzed by creating ZTE/MRA fusion images and 3D ZTE-based MRI models. We examined whether these images and models can be substituted for computed tomography imaging for neurosurgical procedures. Furthermore, the clinical usability of the 3D ZTE-based MRI models was evaluated by comparing them with actual surgical views. Zero-echo-time/MRA fusion images and 3D ZTE-based MRI models clearly illustrated the cranial and intracranial morphology without radiation exposure or the use of iodinated contrast medium. The models allowed determination of the optimum surgical approach to cerebral aneurysms, brain tumors near the brain surface, and cervical internal carotid artery stenosis by visualizing the relationship of lesions with adjacent bone structures. However, ZTE-based MRI did not provide useful information for surgery for skull base lesions such as vestibular schwannoma because bone structures of the skull base often include air components, which cause signal disturbance in MRI. Zero-echo-time sequences on MRI allowed distinct visualization of not only bone but also vital structures around the lesion. This technology has low invasiveness for patients and was useful for preoperative planning and guidance of the optimum approach during surgery in a subset of neurosurgical diseases.

Suction feeding of West African lungfish (Protopterus annectens): An XROMM analysis of jaw mechanics, cranial kinesis, and hyoid mobility.

ABSTRACTSuction feeding in fishes is characterized by rapid cranial movements, but extant lungfishes (Sarcopterygii: Dipnoi) exhibit a reduced number and mobility of cranial bones relative to actinopterygian fishes. Despite fusion of cranial elements, lungfishes are proficient at suction feeding, though the impacts of novel cranial morphology and reduced cranial kinesis on feeding remain poorly understood. We used X-ray reconstruction of moving morphology (XROMM) to study the kinematics of seven mobile elements (neurocranium, upper jaw, lower jaw, tongue, ceratohyal, clavicle, and cranial rib) and two muscles (costoclavicular portion of the hypaxialis and rectus cervicis) during the feeding strikes of West African lungfish (Protopterus annectens). We found that feeding by P. annectens on non-evasive prey is relatively slow, with a mean time to peak gape of 273 ms. Lower jaw depression and clavicular rotation were hinge-like, with one degree of freedom, but the ceratohyals rotated in a complex motion involving depression and long-axis rotation. We quantified the relative contributions to oral cavity volume change (RCVC) and found that oral cavity expansion is created primarily by ceratohyal and clavicle motion. P. annectens suction feeds relatively slowly but successfully through muscle shortening of hypaxial and rectus cervicis muscles contributing to hyoid mobility.

Craniofacial morphology in adults with osteogenesis imperfecta-A cross-sectional study.

The aim of this study was to compare the craniofacial and neurocranial morphology of adults with osteogenesis imperfecta (OI) with controls and to elucidate whether osseous origin impacts on morphological deviations in OI. Fifty-four adults (mean age 45.8) with OI type I, 14 adults (mean age 42.6) with OI types III/IV and 49 adult controls (mean age 41.0) were included. All participants had European ethnicity. Cranial morphology was assessed by 2D-cephalometry. Comparison between groups was made by multiple regression analyses. Comparison between OI groups and controls: (1) Dimension of the maxilla and mandible, respectively was reduced (P < .01), and in relation to the posterior cranial base, the maxilla was retro-positioned (P < .001), and the mandible was prognathic (P < .001). (2) The anterior face height was reduced (P < .04), and in OI types III/IV only, the maxilla was posteriorly inclined (P < .001). (3) Anterior cranial base (P < .001) and the dimension sella-frontale (P < .02) were short. (4) The sagittal dimension of the posterior cranial fossa was increased (P < .01), and the vertical dimension was reduced (P < .01). Adults with OI had a hypoplastic, retro-positioned and posteriorly inclined maxilla, a hypoplastic and forward-positioned mandible, and a reduced anterior face height. Deviations were seen in morphology of the posterior cranial fossa. The impact of OI on cranial morphology was generally more evident in OI type III/IV than in OI type I. OI impacts on osseous cranial structures irrespective of bony origin being intramembranous or endochondral.

New well-preserved materials of Glossotherium chapadmalense (Xenarthra, Mylodontidae) from the Pliocene of Argentina shed light on the origin and evolution of the genus

ABSTRACT Fossil remains of extinct mylodontine sloths have been discovered in numerous localities throughout the American supercontinent, but knowledge of them is still mainly centered on the Pleistocene forms rather than their Neogene relatives. In this contribution, previously unpublished cranial and postcranial materials herein ascribed to Glossotherium chapadmalense (Kraglievich), coming from the Pliocene Chapadmalal Formation (Province of Buenos Aires, Argentina), are presented. These remains are described and compared with those of other mylodontine species from South and North America, providing an exhaustive characterization of cranial morphology in G. chapadmalense and some preliminary insights into its postcranial anatomy. The results have revealed a unique combination of differences and similarities of this enigmatic species with the larger-sized representatives of Glossotherium. In addition, these materials allowed shedding light on the long-standing uncertainties regarding its taxonomic status, as this form has been alternately considered to belong to the genera Glossotherium or Glossotheridium over the last century. As a result, the genus Glossotherium was present, at least, at the Early–Late Pliocene transition in the Pampean region of Argentina, and is recorded by the Upper Pleistocene throughout the entire South American continent. The radiation of the Pleistocene species is associated with a consistent body mass increase that was probably a response to the cooling temperatures and higher predation pressure in South America during the Late Pliocene–Early Pleistocene. These phenomena were probably driven by the stable emergence of the Panamanian Isthmus around 3 Ma and the successive faunal turnover pulses of the Great American Biotic Interchange.

Convergence and constraint in the cranial evolution of mosasaurid reptiles and early cetaceans

AbstractThe repeated return of tetrapods to aquatic life provides some of the best-known examples of convergent evolution. One comparison that has received relatively little focus is that of mosasaurids (a group of Late Cretaceous squamates) and archaic cetaceans (the ancestors of modern whales and dolphins), both of which show high levels of craniodental disparity, similar initial trends in locomotory evolution, and global distributions. Here we investigate convergence in skull ecomorphology during the initial aquatic radiations of these groups. A series of functionally informative ratios were calculated from 38 species, with ordination techniques used to reconstruct patterns of functional ecomorphospace occupation. The earliest fully aquatic members of each clade occupied different regions of ecomorphospace, with basilosaurids and early russellosaurines exhibiting marked differences in cranial functional morphology. Subsequent ecomorphological trajectories notably diverge: mosasaurids radiated across ecomorphospace with no clear pattern and numerous reversals, whereas cetaceans notably evolved toward shallower, more elongated snouts, perhaps as an adaptation for capturing smaller prey. Incomplete convergence between the two groups is present among megapredatory and longirostrine forms, suggesting stronger selection on cranial function in these two ecomorphologies. Our study highlights both the similarities and divergences in craniodental evolutionary trajectories between archaic cetaceans and mosasaurids, with convergences transcending their deeply divergent phylogenetic affinities.

A Pleistocene Fight Club revealed by the palaeobiological study of the Dama-like deer record from Pantalla (Italy)

Here, we report on the exceptionally well-preserved deer record from the locality of Pantalla (central Italy), dated in the Early Pleistocene (ca. 2.1–2.0 million years ago). The fossils show a combination of characters that allows an unambiguous attribution to ‘Pseudodama’ nestii, of which they represent one of the most informative collections to date. Our comparisons—also conducted through CT-based methods on endocranial structures—reveal that the cranial and postcranial skeleton of ‘P.’ nestii displays a mosaic of intermediate characters between extant Dama and Cervus, but also that the affinities with Dama are prevalent. Some Cervus-like features especially in cranial morphology, can be interpreted as plesiomorphic characters supporting a basal position of ‘Pseudodama’ among the Cervini. Interestingly, three bone anomalies are described in the two male crania of ‘P.’ nestii from Pantalla and are interpreted as palaeotraumatological evidence resulting from different injuries suffered by the deer during their life. This allows opening a treasure trove of information on paleobiological aspects, including ontogeny and antler cycle and function.

Global patterns of the cranial form of modern human populations described by analysis of a 3D surface homologous model

This study assessed the regional diversity of the human cranial form by using geometric homologous models based on scanned data from 148 ethnic groups worldwide. This method adopted a template-fitting technique for a nonrigid transformation via the iterative closest point algorithm to generate the homologous meshes. Through the application of principal component analysis to 342 sampled homologous models, the largest variation was detected in overall size, and small South Asian crania were clearly verified. The next greatest diversity was found in the length/breadth proportion of the neurocranium, which showed the contrast between the elongated crania of Africans and the globular crania of Northeast Asians. Notably, this component was slightly correlated with the facial profile. Well-known facial features, such as the forward projection of the cheek among Northeast Asians and compaction of the European maxilla, were reconfirmed. These facial variations were highly correlated with the calvarial outline, particularly the degree of frontal and occipital inclines. An allometric pattern was detected in facial proportions in relation to overall cranial size; in larger crania, the facial profiles tend to be longer and narrower, as demonstrated among many American natives and Northeast Asians. Although our study did not include data on environmental variables that are likely to affect cranial morphology, such as climate or dietary conditions, the large datasets of homologous cranial models will be usefully available for seeking various attributions to phenotypic skeletal characteristics.

Machine Learning in Metopic Craniosynostosis: Does Phenotypic Severity Predict Long-Term Esthetic Outcome?

There have been few longitudinal studies assessing the effect of preoperative phenotypic severity on long-term esthetic outcomes in metopic craniosynostosis. This study evaluates the relationship between metopic severity and long-term esthetic outcomes using interfrontal angle (IFA) and CranioRate, a novel metopic synostosis severity measure. Patients with metopic craniosynostosis who underwent bifrontal orbital advancement and remodeling between 2012 and 2017 were reviewed. Preoperative computed tomography head scans were analyzed for IFA and CranioRate, a machine learning algorithm which generates quantitative severity ratings including metopic severity score (MSS) and cranial morphology deviation (CMD). Long-term esthetic outcomes were assessed by craniofacial surgeons using blinded 3-rater esthetic grading of clinical photos. Raters assessed Whitaker score and the presence of temporal hollowing, lateral orbital retrusion, frontal bone irregularities and/or "any visible irregularities." Preoperative scans were performed at a mean age of 7.7±3.4 months, with average MSS of 6/10, CMD of 200/300, and IFA of 116.8±13.8 degrees. Patients underwent bifrontal orbital advancement and remodeling at mean 9.9±3.1 months. The average time from operation to esthetic assessment was 5.4±1.0 years. Pearson correlation revealed a significant negative correlation between MSS and age at computed tomography ( r =-0.451, P =0.004) and IFA ( r =-0.371, P =0.034) and between IFA and age at surgery ( r =-0.383, P =0.018). In multinomial logistic regression, preoperative MSS was the only independent predictor of visible irregularities (odds ratio=2.18, B =0.780, P =0.024) and preoperative IFA alone significantly predicted Whitaker score, with more acute IFA predicting worse Whitaker score (odds ratio=0.928, B =-0.074, P =0.928). More severe preoperative phenotypes of metopic craniosynostosis were associated with worse esthetic dysmorphology. Objective measures of preoperative metopic severity predicted long-term esthetic outcomes.

Using Eye-Tracking Technology to Quantify the Effect of Experience and Education on Forensic Anthropological Analyses

The human interpretation of analytical outputs is a significant challenge in forensic science, making it vital to explore the application of protocols as we enhance our practices. This study assesses decision making in forensic anthropological analyses utilizing eye-tracking technology to quantify an observer’s estimate of confidence and reliability. Ten individuals with varying levels of education and experience were asked to score cranial morphologies for two human crania. Each participant’s fixation points, fixation duration, and visit count and duration were assessed using Tobii™ Pro 2 eye-tracking glasses. Mid-facial morphologies capturing relative widths were the quickest scored traits, with an overall median time of 14.59 seconds; more complex morphological assessments took longer. Using time as a proxy for confidence, Kruskal-Wallis rank sum results indicate individuals with less experience differed significantly from individuals with greater experience (p = 0.01) although differences in level of education were not significant. Interestingly, intraclass correlation coefficients (ICC) indicate interobserver reliability is high between observers, suggesting experience only slightly improves agreement. These preliminary results suggest experience is more important than level of education. Through empirical decision making studies, forensic anthropologists can improve practices—increasing the transparency of evaluative decision making by targeting confusing or problematic aspects of a data collection practice, and in so doing, enhance training.

Measure of Frontal Morphology in Sagittal Craniosynostosis: The Frontal Bossing Index

Background: Frontal bossing is a prominent forehead feature common in sagittal craniosynostosis (SC). Assessment of severity of frontal bossing is limited by the use of serial CT imaging or complex computer programing. Three-dimensional measurements of cranial surface morphology provide a radiation-free alternative for assessing cranial shape. This study describes the creation of a frontal bossing index (FBI), a novel tool using surface morphology to assess the frontal severity in patients with SC. Methods: Surface imaging from CT scans or 3D photographs of 359 individuals with sagittal craniosynostosis and 224 normocephalic individuals were compared to identify differences in frontal morphology. Cartesian grids were created on each individual’s surface mesh using equidistant axial and sagittal planes yielding 33 unique points of intersection on the forehead. Area under the curve (AUC) analyses were performed to identify frontal points with the greatest discrepancy between groups. Results: All points in the SC population had significantly greater protrusion than corresponding points in the control group. The largest differences were located in the superior lateral regions. Combining the superior- and lateral-most points gave the maximal AUC (0.9707) and was therefore selected to generate the frontal bossing index (FBI). The FBI distinguished between the 2 groups with a sensitivity of 93.5% and specificity of 92.9%. Conclusions: The frontal bossing index is a useful tool for evaluating the severity of the frontal region in patients with SC, comparing outcomes of differing surgical techniques, and tracking frontal changes in individuals over time, without the need for radiation.

Swimming behavior and hydrodynamics of the Chinese cavefish Sinocyclocheilus rhinocerous and a possible role of its head horn structure.

The blind troglobite cavefish Sinocyclocheilus rhinocerous lives in oligotrophic, phreatic subterranean waters and possesses a unique cranial morphology including a pronounced supra-occipital horn. We used a combined approach of laboratory observations and Computational Fluid Dynamics modeling to characterize the swimming behavior and other hydrodynamic aspects, i.e., drag coefficients and lateral line sensing distance of S. rhinocerous. Motion capture and tracking based on an Artificial Neural Network, complemented by a Particle Image Velocimetry system to map out water velocity fields, were utilized to analyze the motion of a live specimen in a laboratory aquarium. Computational Fluid Dynamics simulations on flow fields and pressure fields, based on digital models of S. rhinocerous, were also performed. These simulations were compared to analogous simulations employing models of the sympatric, large-eyed troglophile cavefish S. angustiporus. Features of the cavefish swimming behavior deduced from the both live-specimen experiments and simulations included average swimming velocities and three dimensional trajectories, estimates for drag coefficients and potential lateral line sensing distances, and mapping of the flow field around the fish. As expected, typical S. rhinocerous swimming speeds were relatively slow. The lateral line sensing distance was approximately 0.25 body lengths, which may explain the observation that specimen introduced to a new environment tend to swim parallel and near to the walls. Three-dimensional simulations demonstrate that just upstream from the region under the supra-occipital horn the equipotential of the water pressure and velocity fields are nearly vertical. Results support the hypothesis that the conspicuous cranial horn of S. rhinocerous may lead to greater stimulus of the lateral line compared to fish that do not possess such morphology.

Relating Metopic Craniosynostosis Severity to Intracranial Pressure.

A subset of patients with metopic craniosynostosis are noted to have elevated intracranial pressure (ICP). However, it is not known if the propensity for elevated ICP is influenced by the severity of metopic cranial dysmorphology. Children with nonsyndromic single-suture metopic synostosis were prospectively enrolled and underwent optical coherence tomography to measure optic nerve head morphology. Preoperative head computed tomography scans were assessed for endocranial bifrontal angle as well as scaled metopic synostosis severity score (MSS) and cranial morphology deviation score determined by CranioRate, an automated severity classifier. Forty-seven subjects were enrolled between 2014 and 2019, at an average age of 8.5 months at preoperative computed tomography and 11.8 months at index procedure. Fourteen patients (29.7%) had elevated optical coherence tomography parameters suggestive of elevated ICP at the time of surgery. Ten patients (21.3%) had been diagnosed with developmental delay, eight of whom demonstrated elevated ICP. There were no significant associations between measures of metopic severity and ICP. Metopic synostosis severity score and endocranial bifrontal angle were inversely correlated, as expected ( r =-0.545, P <0.001). A negative correlation was noted between MSS and formally diagnosed developmental delay ( r =-0.387, P =0.008). Likewise, negative correlations between age at procedure and both MSS and cranial morphology deviation was observed ( r =-0.573, P <0.001 and r =-0.312, P =0.025, respectively). Increased metopic severity was not associated with elevated ICP at the time of surgery. Patients who underwent later surgical correction showed milder phenotypic dysmorphology with an increased incidence of developmental delay.

Air Breathing and Suction Feeding Kinematics in the West African Lungfish, Protopterus annectens.

Research on the water-to-land transition tends to focus on the locomotor changes necessary for terrestriality. However, the evolution from water breathing to air breathing was also a necessary precursor to the invasion of land. Air is approximately 1000 times less dense and 50 times less viscous, and contains hundreds of times more oxygen than water. However, unlike the transition to terrestrial locomotion, breathing air does not require body weight support, so the evolution of air breathing may have necessitated smaller changes to morphology and function. We used X-ray reconstruction of moving morphology to compare the cranial kinematics of aquatic buccal pumping, such as that seen in suction feeding, with the aerial buccal pumping required for lung ventilation in the West African lungfish (Protopterus annectens). During buccal pumping behaviors, the cranial bones and associated soft tissues act as valves and pumps, and the sequence of their motions controls the pattern of fluid flow. Both behaviors are characterized by an anterior-to-posterior wave of expansion and an anterior-to-posterior wave of compression. We found that the pectoral girdle and cranial rib rotate consistently during air breathing and suction feeding, and that the muscle between them shortens during buccal expansion. Overall, we conclude that the major cranial bones maintain the same basic functions (i.e., acting as valves or pumps, or transmitting power) across aquatic and aerial buccal pumping. The cranial morphology that enables aquatic buccal pumping is well suited to perform air breathing and accommodates the physical differences between air and water.

A Miopetaurista (Rodentia, Sciuridae) cranium from the Middle Miocene of Bavaria (Germany) and brain evolution in flying squirrels

AbstractFlying squirrels (Sciurinae, Pteromyini) are the most successful group of gliding mammals. However, their fossil record mostly consists of isolated dental remains that provide very limited insights into their palaeobiology and evolution. The first skeleton of a fossil flying squirrel, belonging to the species Miopetaurista neogrivensis, has been described only recently. It presents all the diagnostic gliding‐related postcranial features of its extant relatives and shows that this group has undergone very little morphological change for almost 12 myr. However, the associated cranium is badly crushed, and particular details of the cranial morphology cannot be described. Here, we describe a well‐preserved cranium of the closely related Miopetaurista crusafonti from 12.5–12.0 Ma from Bavaria (Germany). Its cranial morphology is found to be almost identical to extant large flying squirrels, even in details such as the position of the foramina. The virtual endocast also shows close affinities to living large flying squirrels in morphology and in the relative volume of different brain regions, showing diagnostic features such as the size reduction of petrosal lobules and olfactory bulbs. However, the encephalization quotient (EQ) and neocortical ratio are lower than observed in extant flying squirrels. EQ is known to increase through time in squirrels, but might also be related to locomotion, given that arboreal and gliding squirrels display higher EQs than terrestrial ones. Because Miopetaurista was certainly a glider, its comparatively lower EQ and neocortical size support the existence of an independent trend of increasing EQ and neocortical complexity in this flying squirrel subclade.

In service to the sultan: Biological affinity analysis of Vlach Ottoman vassals from the Šarić Struga and Koprivno‐Križ sites in southern Croatia

AbstractAs a cultural isolate and historically labeled ethnicity, the extent of biological divergence between Vlachs and non‐Vlachs in Southeast Europe is not well understood. Here, we present a comparison of metric and non‐metric cranial morphology designed to investigate the degree to which a Vlach sample (n = 32) from the Ottoman period in southern Croatia is biologically differentiated from non‐Vlach communities. By calculating Relethford–Blangero distances using cranial measurements and conducting a mean measure of divergence test based on cranial non‐metric traits, we investigated morphological relationships between the Vlach sample and other regional samples. Results from both metric and non‐metric analyses indicate a close biological relationship with the non‐Vlach community who lived nearby. Lacking substantial differences from the local non‐Vlach community, the Vlach ethnicity may have been distinct based on socioeconomic rather than biological factors. This research points to an ethnogenesis more cultural than biological for this historical context.

Cranial Morphology Associated With Syndromic Craniosynostosis: A Potential Detection of Abnormality in Patient's Cranial Growth Using Angular Statistics.

Apert, Crouzon, and Pfeiffer syndromes are common genetic syndromes related to syndromic craniosynostosis (SC), whereby it is a congenital defect that occurs when the cranial growth is distorted. Identifying cranial angles associated with these 3 syndromes may assist the surgical team to focus on a specific cranial part during the intervention planning, thus optimizing surgical outcomes and reducing potential morbidity. The aim of this study is to identify the cranial angles, which are associated with Apert, Crouzon, and Pfeiffer syndromes. The cranial computed tomography scan images of 17 patients with SC and 22 control groups aged 0 to 12 years who were treated in the University Malaya Medical Centre were obtained, while 12 angular measurements were attained using the Mimics software. The angular data were then divided into 2 groups (patients aged 0 to 24 months and >24 months). This work proposes a 95% confidence interval (CI) for angular mean to detect the abnormality in patient's cranial growth for the SC syndromes. The 95% CI of angular mean for the control group was calculated and used as an indicator to confirm the abnormality in patient's cranial growth that is associated with the 3 syndromes. The results showed that there are different cranial angles associated with these 3 syndromes. All cranial angles of the patients with these syndromes lie outside the 95% CI of angular mean of control group, indicating the reliability of the proposed CI in the identification of abnormality in the patient's cranial growth.

Review of Current Morphometric Standards in Craniosynostosis

Background/Purpose: In craniosynostosis, diagnostic imaging is crucial for identifying skull abnormalities, planning for surgical correction, and post-operative and follow-up evaluations. However, classifying postoperative corrected skull morphology is a highly subjective task for all craniofacial surgeons. Initially, many surgeons utilized the Whittaker categorization test as the post-operative outcome measure, which is based on the subjective esthetic appearance as determined by the surgeon, patient, and patient’s family. While the advancement of 3D imaging and anthropometric measurements techniques has allowed various research groups to produce normative skull models to serve as treatment guides, it is still difficult to determine the objective morphological standard. The purpose of this study is to review the current standards for classifying normal skull morphology. Methods: This paper is a review of the current surgical standards of normal cranial morphology. A systematic literature review following PRISMA guidelines was performed; all published studies over a 40-year period from 1980 to 2020 were reviewed that assessed cranial morphology of healthy pediatric samples. Results: A review of the strategies utilized by some of the major medical device manufacturers in craniosynostosis correction surgery is presented. Many of these companies have progressed to using 3D normative skull construction and 3D surface analysis to measure cranial morphology. However, many variations remain among industry standards. Conclusion: Normative head shapes and cohort data matched to similar population groups have a crucial function in the diagnosis, pre-operative planning, and post-operative evaluations in craniofacial surgery. However, industry standards for “normal head shape” utilized in surgical analysis and planning remain diverse and can be somewhat opaque to the craniofacial community. Despite the advancement of 3D imaging techniques, most reported outcomes following craniofacial surgical interventions are still subjectively defined.