Craniofacial Configuration Research Articles

Third molar agenesis relates to human craniofacial form.

To investigate the association between the number of third molars and craniofacial shape. The study sample comprised 470 individuals (194 males and 276 females), out of whom 310 (124 males, mean age: 14.6 years and 186 females, mean age: 14.1 years) had a full permanent dentition including third molars and 160 (70 males, mean age: 13.7 years and 90 females, mean age: 13.9 years) had at least one missing third molar. Pre-orthodontic treatment cephalometric images were digitized using 127 landmarks to describe the shape of the entire craniofacial configuration, the cranial base, the maxilla, and the mandible. The shapes of the various configurations were described by principal components (PCs) of shape. The effect of third molar agenesis on craniofacial shape was evaluated with multivariate regression models, considering shape PCs as the dependent variables, and age and sex as predictors. There was a strong association between third molar agenesis and the shape of all craniofacial configurations in both sexes. Individuals with missing third molars presented a less convex craniofacial configuration, a shorter anterior facial height and a more retrusive maxilla and mandible. In cases with third molar agenesis only in one jaw, shape differences were also evident in the opposing jaw. Interpretation of study outcomes should take into consideration the two-dimensional data and the analysis of only white-European subjects. There is a strong association between third molar formation and craniofacial shape. The effect is rather generalized than local and is potentially linked to an ongoing evolutionary mechanism that leads to smaller and fewer teeth, as well as smaller craniofacial configurations, in modern humans.

Nasofacial Anthropometric Study among Adult Santals and Bangalees of Northern Area of Bangladesh

Introduction: Anthropology is the science of human body morphology.In forensic medicine, anthropometric measurementsare usually used to identify an individual.Medical scientists, as well as anthropology experts, use facial measurements forseveral purposes such as identification of congenital and traumatic abnormalities.Facial measurements are interestingly variedbetween diverse races and ethnicities. Objective: The objective of this study was to determine the facial and nasal anthropometric measurements of adult Santals and Bangalees residing in Northern area of Bangladesh and to determine their status in relation to other population studied elsewhere. Design: It was a cross sectional comparative study. Material sand Method: This cross sectional study was conducted in the anatomy department of Rajshahi Medical College,during the period of January 2021 to December 2021.This study was performed on 300 individuals (150 Bangalee and 150Santal) with normal craniofacial configuration, without history of trauma in the face and no history of nose and face cosmeticsurgery such as Septoplasty or Septorhinoplasty..Purposive sampling technique was adopted in this study. Results: Most common type of face in both the Santals (92%) and the Bangalee (99.30%) respondents in Northern area of Bangladesh was Hyperleptoprosopic type of face. Leptorrhine type was predominant (84%) nasal type among the Bangaleeand 51.30% Mesorrhine and 48% Platyrrhine type were predominant nasal type among the adult Santals. Conclusions: Findings of this study will provide to build database for nasofacial, maxillofacial, cosmetic surgeons &orthodontist which help them in making diagnosis of congenital and traumatic nasofacial anomalies & planning theirreconstructive surgeries. The findings of the study may also help forensic experts in identifying the victims and assailants ofcriminal cases.

Gender Determination Using Nasofacial Anthropometry in the Iranian Population

Objectives: The aim of this study is to predict the gender among Iranian population by determining the facial and nasal indices.
 Methods: Four hundred healthy individuals including 200 males and 200 females (age range of 20-25 years) with normal craniofacial configuration took part in the present study. Facial and nasal variables including facial length (FL), facial width (FW), facial index (FI), nasal length (NL), nasal height (NH), nasal width (NW), and nasal index (NI) measured and SPSS 22.0 software was used for statistical analysis.
 Results: The mean age was 22.16±2.44 years. The mean FL, FW, FI, NL, NW, and NI were 11.53±0.592 cm, 12.54±1.41 cm, 92.67±6.24 cm, 6.02±0.53 cm, 2.78±0.25 cm, and 90.79±8.22 cm, respectively. There were significant differences in the mean value of all nasofacial parameters (P<0.05). The most prominent face and nose types were hyperleptoprosopic (46%) and platyrrhine (57.75%) among Iranian population. The highest sensitivity and specificity to predict the gender dimorphism were related to FL and FW (.990 and 0.97) and (.970 and 0.94), respectively.
 Conclusion: Nasofacial parameters such as FL and FW that are able to sexual dimorphism with high sensitivity and specificity can be helpful in forensic medicine. Also, the nasofacial parameters are useful in in reconstructive, and aesthetic surgeries.

Correlation Between Degree of Mandibular Incisors Crowding, Lower Incisor Position and Vertical Craniofacial Configuration in Different Malocclusions

Objective: To evaluate the correlation between the degree of mandibular incisor crowding, lower incisor position and vertical craniofacial configuration in different malocclusions.
 Study Design: Cross-sectional analytical study.
 Place and Duration of Study: Orthodontics department, Armed Forces Institute of Dentistry, Rawalpindi Pakistan, from Jan to Dec 2018.
 Methodology: This study was conducted on 100 pre-treatment study casts and lateral cephalographs of orthodontic, aged 10 to 26 years. Patients who presented with complaints of lower incisors crowding were included in the study. The cephalogram tracings, calculations and lower incisor crowding measurements were taken. All the fifteen parameters of vertical craniofacial configuration, lower incisors position and sagittal skeletal base relationship were measured.
 Result: Out of 100 patients, 45 were males and 55 were females with a mean age of 16.11 ± 3.53 years. According to this study, there was no statistically significant correlation between the degree of lower incisor crowding and vertical facial proportions and incisor position in studied malocclusions.
 Conclusion: The lower incisor crowding was a local and independent discrepancy. It was a frequently encountered problem, successful therapy depends upon several contributing factors that must be identified for successful management.

Cloverleaf Skull Syndrome: A Rare Case Report

Cloverleaf deformity is an extremely rare skull deformity that occurs when several joints (sutures) between a baby's skull bones begin to fuse too early. Also known as Kleeblattschädel syndrome, the cloverleaf deformity causes bulging at the front and sides of the skull, resembling a cloverleaf shape. Cloverleaf skull syndrome is an abnormal configuration of the calvaria classified as craniosynostosis, consisting of premature ossification of cranial sutures. It is a deformity characterized by a remarkable enlargement of the head, with a trilobed configuration of the frontal view, resembling a three leaved clover(1) The first report about such a syndrome in the literature occurred in 1973 and, over the years only some tens of cases have been documented worldwide(3). The present report describes a case of a severe craniofacial condition that is known as "cloverleaf skull syndrome". At Physical examination multiple malformations were observed, with altered craniofacial configuration, low set ear, hypertelorism, exopthalmos, syndactyly, closed anterior fontanelle, high arched palate, bilateral CTEV. The vast majority of patients with kleeblattschädel have intellectual impairment and hydrocephalus. It is usually seen in thanatophoric dysplasia: classically type II only, severe Apert syndrome, severe Crouzon syndrome, Boston-type craniosynostosis & Carpenter syndrome.(5)Craniosynostosis has an incidence of 1 in 2100 to 1 in 2500 live births with multi-suture craniosynostosis constituting about 5% of all the cases [9]. This condition is associated with a variety of presentations including optic atrophy, hydrocephalus, respiratory problems, cleft palate, and disorders of hearing and speech.[10] These cases are very rare & so shall be reported promptly to deal with management part of this disease. An expert team of maxillofacial, plastic, and neurosurgeons is needed to handle such complex conditions which involve the correction of the bony deformity.

Third Molar Agenesis Is Associated with Facial Size.

Simple SummaryMissing third molars is a common occurrence in modern humans with a prevalence of approximately 20% in the general population. The absence of those teeth, however, is not found in other human predecessors. Therefore, there is speculation whether the congenital absence of third molars is part of an evolutionary mechanism that leads to smaller jaws, smaller and fewer teeth, or if their absence is associated with more local developmental factors. In this study, we assessed the size of the cranial base, the maxilla, the mandible and the entire craniofacial complex in individuals missing one or more third molars and compared them with a group with no missing teeth. We showed that in cases with one or more missing third molars, there is a significant decrease in the size of the maxilla, the mandible as well as the entire facial configuration. Additionally, the more missing third molars, the smaller the jaws and the face were. These findings suggest that isolated third molar agenesis is part of a developmental mechanism related to craniofacial size reduction. Whether this mechanism is part of an evolutionary process in humans remains to be seen.Individuals with congenitally missing permanent teeth, other than third molars, present smaller craniofacial configurations compared to normal controls. However, it is not known if agenesis of third molars is part of the same mechanism. Therefore, this study assessed individuals with and without isolated third molar agenesis and tested the relation of this condition to the size of their facial configurations, using geometric morphometric methods. We show that the absence of one or more third molars is associated with a smaller maxilla, smaller mandible and a smaller overall facial configuration. The effect was larger as the number of missing third molars increased. For example, the size of the mandibular centroids in five 16-year-old females with no, one, two, three or four missing third molars showed a size reduction of approximately 2.5 mm per missing third molar. In addition, in cases with third molar agenesis in one jaw only, the effect was also evident on the opposite jaw. Our findings suggest that isolated third molar agenesis is part of a developmental mechanism resulting also in craniofacial size reduction. This might be the effect of an evolutionary process observed in humans, leading to fewer and smaller teeth, as well as smaller facial structures.

Cro-Magnon and Qafzeh - Vive La Differences

The obligatory use of cooking by the Mousterian occupants of the north temperate zone relaxed the forces of selection maintaining archaic tooth size and led to the reductions that shaped modern human face form from the Middle East to the Atlantic coast. The delay in the spread of cooking techniques accounts for the later onset of dental reduction to the south. The development and use of projectiles in the African Middle Stone Age led to gracilization and the earlier appearance of "modern" post-cranial and reflected cranial form in Africa. The subsequent adoption of the use of projectiles elsewhere was followed by gracilization and the appearance of "modern" post-cranial morphology. The craniofacial form of Cro-Magnon allies it with the living populations of northwestern Europe, specifically with the fringes in Scandinavia and England, but not with the European continent. Qafzeh represents the pattern still found in sub-Saharan Africa, particularly West Africa. Although the craniofacial configuration in both is "modern," the dentition of Qafzeh is archaic in size and form. Qafzeh is a logical representative of the ancestral form for sub-Saharan Africans but not for Cro-Magnon and subsequent Europeans.

<b>Morphometric analysis of three normal facial types in mixed dentition using posteroanterior cephalometric radiographs: preliminary results

The aim of the present investigation was to evaluate the craniofacial features of subjects with normal occlusion with different vertical patterns in the mixed dentition using morphometric analysis (Thin-Plate Spline analysis - TPS) applied to posteroanterior (PA) films. The sample comprised 39 individuals (18 females and 21 males), all in mixed dentition, aged from 8.4 to 10 years with satisfactory occlusion and balanced profile and with no history of orthodontic or facial orthopedic treatment. The sample was divided into three groups (mesofacial, brachyfacial and dolichofacial) according to the facial types proposed by Ricketts (1989). The average craniofacial configurations of each study group were obtained by orthogonal superimposition of Procrustes, thereby eliminating size differences and allowing only shape differences between groups to be analyzed by viewing the TPS deformation grid. Significant differences were found among the three facial types but were more remarkable between mesofacials and dolichofacials than between mesofacials and brachyfacials. TPS morphometric analysis proved efficient for accurate visualization of transverse and vertical differences among facial types even before pubertal growth spurt. These differences cannot be easily detected by traditional posteroanterior cephalometry.

Variations in skull base morphology during phylogenesis and different hypotheses

The relationships between the craniofacial structures at the base of the skull are modified during ontogenesis and phylogenesis. The scientific community is in agreement regarding the major role that the skull base has in the hominization and the etiopathology of maxillofacial dysmorphia.Comparing ancient fossils to current populations, the origin and interpretations of the various skull base morphologies, more specifically the sphenoidal angle, are complicated. Therefore, different hypotheses are advanced. Most compare them to the larger characteristics of human evolution. In this article, they are presented as to how each author developed their respective hypotheses.The knowledge of these hypotheses helps in the comprehension of the evolutionary mechanisms of basal craniofacial configurations of modern man.

Craniofacial morphology in ancient and modern Greeks through 4,000 years.

Multiple 20th century studies have speculated on the anthropological similarities of the modern inhabitants of Greece with their ancient predecessors. The present investigation attempts to add to this knowledge by comparing the craniofacial configuration of 141 ancient (dating around 2,000-500 BC) and 240 modern Greek skulls (the largest material among relevant national studies). Skulls were grouped in age at death, sex, era and geographical categories; lateral cephalograms were taken and 53 variables were measured and correlated statistically. The craniofacial measurements and measurements of the basic quadrilateral and cranial polygon were compared in various groups using basic statistical methods, one-way ANOVA and assessment of the correlation matrices. Most of the measurements for both sexes combined followed an akin pattern in ancient and modern Greek skulls. Moreover, sketching and comparing the outline of the skull and upper face, we observed a clock-wise movement. The present study confirms that the morphological pattern of Greek skulls, as it changed during thousands of years, kept some characteristics unchanged, with others undergoing logical modifications. The analysis of our results allows us to believe that the influence upon the craniofacial complex of the various known factors, including genetic or environmental alterations, is apt to alter its form to adapt to new conditions. Even though 4,000 years seems too narrow a span to provoke evolutionary insights using conventional geometric morphometrics, the full presentation of our results makes up a useful atlas of solid data. Interpreted with caution, the craniofacial morphology in modern and ancient Greeks indicates elements of ethnic group continuation within the unavoidable multicultural mixtures.

Thin-plate spline analysis of craniofacial morphology in subjects with adenoid or tonsillar hypertrophy

ObjectiveTo compare the skeletal features of subjects with adenoid hypertrophy with those of children with tonsillar hypertrophy using thin-plate spline (TPS) analysis. Materials and methodsA group of 20 subjects (9 girls and 11 boys; mean age 8.4±0.9 years) with adenoid hypertrophy (AG) was compared with a group of 20 subjects (10 girls and 10 boys; mean age 8.2±1.1 years) with tonsillar hypertrophy (TG). Craniofacial morphology was analyzed on the lateral cephalograms of the subjects in both groups by means of TPS analysis. A cross-sectional comparison was performed on both size and shape differences between the two groups. ResultsAG exhibited statistically significant shape and size differences in craniofacial configuration with respect to TG. Subjects with adenoid hypertrophy showed an upward dislocation of the anterior region of the maxilla, a more downward/backward position of the anterior region of the mandibular body and an upward/backward displacement of the condylar region. Conversely, subjects with tonsillar hypertrophy showed a downward dislocation of the anterior region of the maxilla, a more upward/forward position of the anterior region of the mandibular body and a downward/forward displacement of the condylar region. ConclusionsSubjects with adenoid hypertrophy exhibited features suggesting a more retrognathic mandible while subjects with tonsillar hypertrophy showed features suggesting a more prognathic mandible.

Morphometric analysis of treatment effects of bone-anchored maxillary protraction in growing Class III patients

The aim of the present morphometric investigation was to evaluate the effects of bone-anchored maxillary protraction (BAMP) in the treatment of growing patients with Class III malocclusion. The shape and size changes in the craniofacial configuration of a sample of 26 children with Class III malocclusions consecutively treated with the BAMP protocol were compared with a matched sample of 15 children with untreated Class III malocclusions. All subjects in the two groups were at a prepubertal stage of skeletal development at time of first observation. Average duration of treatment was 14 months. Significant treatment-induced modifications involved both the maxilla and the mandible. The most evident deformation consisted of marked forward displacement of the maxillary complex with more moderate favourable effects in the mandible. Deformations in the vertical dimension were not detected. The significant deformations were associated with significant differences in size in the group treated with the BAMP protocol.

Thin-plate spline analysis of the cranial base in African, Asian and European populations and its relationship with different malocclusions

Objectives To test the hypothesis that midline basicranial orientation and posterior cranial base length are discriminating factors between adults of different populations and its potential maxillo/mandibular disharmonies. Design Twenty-nine 2D landmarks of the midline cranial base, the face and the mandible of dry skull X-rays from three major populations (45 Asians, 34 Africans, 64 Europeans) were digitized and analysed by geometric morphometrics. We used, first, MANOVA to test for mean shape differences between populations; then, principal components analysis (PCA) to assess the overall variation in the sample and finally, canonical variate analysis (CVA) with jack-knife validations ( N = 1000) to analyse the anatomical features that best distinguished among populations. Results Significant mean shapes differences were shown between populations ( P < 0.001). CVA revealed two significant axes of discrimination ( P < 0.001). Jack-knife validation correctly identified 92% of 15,000 unknowns. In Africans the whole cranial base is rotated into a forward–downward position, while in Asians it is rotated in the opposite way. The Europeans occupied an intermediate position. African and Asian samples showed a maxillo/mandibular prognathism. African prognathism was produced by an anterior positioned maxilla, Asian prognathism by retruded anterior cranial base and increase of the posterior cranial base length. Europeans showed a trend towards retracted mandibles with relatively shorter posterior cranial bases. Conclusions The results supported the hypothesis that basicranial orientation and posterior cranial base length are valid factors to distinguish between geographic groups. The whole craniofacial configuration underlying a particular maxillo-facial disharmony must be considered in diagnosis, growth predictions and resulting treatment planning.

A Premolar Extraction Case Using the Invisalign® System

Invisalign therapy is an orthodontic treatment method using removable transparent polyurethane splints. Its applicability in extraction cases is limited. This case report documents the treatment with Invisalign of a patient in whom four premolars had to be extracted due to dental crowding. The patient's primary objective was to undergo treatment to resolve her anterior crowding as esthetically inconspicuously as possible. Diagnostic findings were: constriction of the maxillary and mandibular arch with anterior dental crowding; proclination and anteposition of the anteriors; neutroclusion with an overjet of 6 mm and an overbite of 1 mm. The radiographs showed a mesial tilt of the lower canines and premolars and a mild skeletal Class II relationship with a vertical craniofacial configuration. Treatment was initiated by extracting the four first premolars and placing the attachments (Tetric Ceram composite). After the Invisalign aligners had been worn, the anterior segment was uprighted and retracted, the crowding resolved, and the arches well-aligned. The patient's neutroclusion was maintained, physiological anterior relations in the sagittal and vertical planes were achieved, and the lower canines and premolars were uprighted. Active treatment lasted 1 year and 8 1/2 months and involved 43 maxillary and 28 mandibular aligners. Particularly in cases with an extended indication for this new treatment modality, due consideration must be given to the importance of comprehensive and meticulous diagnostics and treatment planning, and a solid grasp of the biological and mechanical fundamentals.

Thin-plate Spline Analysis of the Effects of Face Mask Treatment in Children with Maxillary Retrognathism

Face mask therapy is indicated for growing patients who suffer from maxillary retrognathia. Most previous studies used conventional cephalometric analysis to evaluate the effects of face mask treatment. Cephalometric analysis has been shown to be insufficient for complex craniofacial configurations. The purpose of this study was to investigate changes in the craniofacial structure of children with maxillary retrognathism following face mask treatment by means of thin-plate spline analysis. Thirty children with skeletal Class III malocclusions who had been treated with face masks were compared with a group of 30 untreated gender-matched, age-matched, observation period-matched, and craniofacial configuration-matched subjects. Average geometries, scaled to an equivalent size, were generated by means of Procrustes analysis. Thin-plate spline analysis was then performed for localization of the shape changes. Face mask treatment induced a forward displacement of the maxilla, a counterclockwise rotation of the palatal plane, a horizontal compression of the anterior border of the symphysis and the condylar region, and a downward deformation of the menton. The cranial base exhibited a counterclockwise deformation as a whole. We conclude that thin-plate spline analysis is a valuable supplement to conventional cephalometric analysis.

No correlation between primary mandibular anterior crowding and vertical craniofacial configuration or lower incisor inclination.

The aim of the present study was to evaluate the correlation between primary mandibular anterior crowding and vertical craniofacial configuration or sagittal lower incisor inclination. The collective comprised 100 consecutive patients (50 males, 50 females) subject to 4 selection criteria: mandibular anterior crowding > or = 1.0 mm, no previous orthodontic therapy, completely preserved deciduous canines and molars, and lateral cephalograms of good diagnostic quality before initiation of orthodontic treatment. Study casts of all patients were used to measure the mesiodistal width of the incisors and deciduous canines as well as the anterior arch circumference. The difference between the 2 represented the amount of crowding. On all cephalograms 16 parameters of vertical craniofacial configuration and 9 parameters of lower incisor inclination were measured. For error evaluation all measurements were repeated independently on 10 randomly selected study casts and cephalograms. This error amounted for the combined tooth width to 0.51% +/- 0.81, for arch circumference to 0.03% +/- 0.68, and for all cephalometric parameters to 0.38% +/- 4.81. For all parameters, arithmetic means, standard deviations and ranges were calculated. Further, correlation coefficients were calculated between anterior crowding and all 25 cephalometric parameters. The arithmetic mean of crowding was m = 2.0 +/- 1.3 mm with a range of 1.0 to 6.6 mm. The values of all cephalometric parameters were close to well accepted norms in the literature. The correlation coefficients between crowding and all cephalometric parameters varied from r = 0.0 to 0.3. According to this study there is no correlation between primary mandibular anterior crowding and vertical craniofacial configuration or sagittal lower incisor inclination.

A longitudinal study on growth in untreated children with angle class II, division 1 malocclusion

The aim of this longitudinal study was to analyze growth-related changes in untreated Class II, Division 1 subjects. Forty untreated Swedish children with Angle Class II, Division 1 malocclusion were cephalometrically examined. The average age of the total group was 10.1 years at the first examination and 12.0 at the second. In addition to statistical comparisons of the average values of variables at both time points, multivariate analyses (harmony box according to Hasund and Segner, regression equation analyses) were also performed. This permitted individual evaluation of skeletal structures, position of incisors, and the soft tissue profile relative to the given craniofacial configuration. With the ANB angle remaining unchanged, both jaws were transposed ventrally. The reduction of the angle between the palatal and mandibular planes and the gonial angle was accompanied by anterior rotation of the mandible. The lower incisors protruded, and upper and lower first molars exhibited a translation to ventrocaudal. According to harmony box analysis, the most frequent cause of a distal relationship between the 2 jaws was a disharmoniously anterior shift of the maxilla. This was confirmed by the additional analysis of the available unpublished raw data from untreated Norwegian and Munich Class II/1 subjects and from other studies. In such cases, orthodontic treatment methods exerting a growth-inhibitory effect on the maxilla should be used.

Thin-plate spline analysis of treatment effects of rapid maxillary expansion and face mask therapy in early Class III malocclusions.

An effective morphometric method (thin-plate spline analysis) was applied to evaluate shape changes in the craniofacial configuration of a sample of 23 children with Class III malocclusions in the early mixed dentition treated with rapid maxillary expansion and face mask therapy, and compared with a sample of 17 children with untreated Class III malocclusions. Significant treatment-induced changes involved both the maxilla and the mandible. Major deformations consisted of forward displacement of the maxillary complex from the pterygoid region and of anterior morphogenetic rotation of the mandible, due to a significant upward and forward direction of growth of the mandibular condyle. Significant differences in size changes due to reduced increments in mandibular dimensions were associated with significant shape changes in the treated group.

Hallermann–Streiff syndrome: A review

The Hallermann-Streiff syndrome is characterized by dyscephaly, hypotrichosis, microphthalmia, cataracts, beaked nose, micrognathia, and proportionate short stature. Cause is unknown; sporadic occurrence is the rule. Data presented in this review include the characteristics of pregnancy, growth and development, principal manifestations, radiographic and ophthalmological characteristics, and the results of cephalometric study. Potential complications in the syndrome are related to the narrow upper airway associated with the craniofacial configuration. Severe complications may include early pulmonary infection, respiratory embarrassment, obstructive sleep apnea, and anesthetic risk. Topics for future study are suggested.

Craniofacial configuration and postcranial development of a hydrocephalic child (ca. 2500 B.C.–500 A.D.): With a review of cases and comment on diagnostic criteria

Hydrocephalus is a severe disorder of the central nervous system characterized by absorption blockage of the cerebral spinal fluid (CSF). The archaeological record of the condition ranges in time from 10,000 B.C. to 1670 A.D. and consists of 30 possible cases worldwide. A review of this material reveals that diagnostic criteria which fully delineate the condition have not been established. Previously, no attempt has been made to differentiate the two major categories of hydrocephalus and their subgroupings, or to identify other conditions which might result in similar morphologies. A partial child's skeleton from the Middle Period (ca. 2500 B.C. to 500 A.D.) of Central California Prehistory is described in light of an extensive clinical literature. Examination of this individual reveals a unique craniofacial configuration and malformed postcrania. Bony criteria for a differential diagnosis of hydrocephalus are established and applied to this individual. Based on these criteria, the individual is diagnosed as having a chronic form of noncommunicating hydrocephalus. Blockage of the CSF pathway most likely occurred in the aqueduct of Sylvius with a partial occlusion of the foramen of Monro or a frontal cyst. In addition, femoral development is suggestive of partial paralysis.