Relationships between the frontal sinus and climatic conditions: a skeletal approach to cold adaptation

Previous studies in physical anthropology, using superficial facial features, show that the relationship between human facial morphology and climate is not clear. An alternate approach to the problem is the investigation of the deeper facio-anatomical structures (i.e., cranial sinuses and/or foramina) in relation to climatic variables. The present investigation statistically analyses the relationship between climatic conditions (wind chill equivalent temperatures and absolute humidities) and the occurrence and size of frontal sinuses in 153 Eskimo crania. Conditional results from tests of significance of differences and correlation suggest a relationship between low wind chill equivalent temperatures and small frontal sinus surface areas. These results are interpreted in light of cranial sinus function and environmental physiology.     

Craniofacial deformity in patients with uncorrected congenital muscular torticollis: an assessment from three-dimensional computed tomography imaging

Congenital muscular torticollis is caused by idiopathic fibrosis of the sternocleidomastoid muscle that restricts movement and pulls the head toward the involved side. Deformation of the craniofacial skeleton will develop if the restriction is not released and result in aesthetic and functional problems. The purpose of this study was to use three-dimensional computed tomography imaging for qualitative and quantitative evaluation of the craniofacial deformity in a series of patients with uncorrected congenital muscular torticollis, and to assess age as a precipitating factor for severity of the deformity. A total of 14 patients from 1 month to 24 years of age were included. The skull images were rotated into standard orientation and reconfigured for evaluation of the cranium, endocranial base, and facial skeletal structures. The midlines of cranial base and facial bone, angle of midline deviation, width of each hemicranium and hemiface, and the orbital index were defined and measured. The results showed that the cranium and cranial base deformation took place as early as in infant stage, with the most prominent change occurring in the posterior cranial fossa. Facial bone asymmetry started to appear after 5 years of age, at which time the mandibular and occlusal abnormalities were observed. The deformity of the orbits and maxilla occurred at an older age, characterized by the deviation and decreased vertical height on the affected side. The severity of the observed deformities increased with age. The angle of midline deviation was 2.48 +/- 1.68 degrees in the cranial base and 3.26 +/- 3.28 degrees on the facial bone. Both of the midline deviations were significantly correlated with age. Compared with the contralateral side, the width of the ipsilateral posterior hemicranium was longer (54.36 +/- 6.72 mm versus 50.81 +/- 6.55 mm), and the width of the ipsilateral lower hemiface was shorter (35.30 +/- 7.27 mm versus 43.49 +/- 11.34 mm). Both differences were statistically significant. Measurement of the orbital index demonstrated a significantly flatter orbit on the ipsilateral side (89.48 +/- 0.11 versus 92.74 +/- 0.08). This study showed that the cranium and cranial base deformity occurred early in patients with uncorrected torticollis, while the facial bone deformity occurred in childhood stage. The cranial and facial deformity became more severe with age. Early release of the muscle restriction is advised to prevent craniofacial deformation.     

The craniofacial skeleton in anencephalic human fetuses. II. Calvarium.

A detailed study of the calvarium of twelve anencephalic and four normal human fetuses 26 to 40 weeks gestational age using gross dissection, alizarin red S staining, silver nitrate radiography and histology revealed dramatic alterations in the presence, form, location and relationship of the individual bones. In the larger dorsal cranial defects the interparietal portions of the occipital bone were relocated anteriorly to approximate the frontal bone. The occipital components were rotated anterolaterally and inferiorly with lack of fusion of the chondrocranium posterior to the foramen magnum. The squamae of the frontal bone were collapsed horizontally and reduced in size to lie peripheral to the anterior cranial fossa forming most of the orbital roofs. In anencephaly the bones derived from the chondrocranium were not as severely affected morphologically as those derived from the neurocranium. The sutures were narrow and smooth instead of wide and serrated as in the normally developing calvarium. In general the degree of maldevelopment was proportional to the extent of the dorsal cranial defect in anencephaly.     

Frontal cranioplasty: risk factors and choice of cranial vault reconstructive material

A study of patients with large cranial defects involving the frontal bone, frontal sinus, nose, and orbit does not support the contention that there is a clear superiority of reconstructive material despite a history of previous bone infection. No patient with an isolated cranial reconstruction experienced an infection despite location in the area of the frontal sinus or the use of acrylic material. All patients experiencing infection underwent simultaneous reconstruction of the frontal cranium and nose and three- or four-wall reconstruction of the orbit, where the frontal sinus had previously been eliminated and where a previous bone infection had been present. Risk factors associated with cranioplasty were timing (p = 0.001) and cranial vault reconstruction in communication with previously infected ethmoid sinuses and the nose (p = 0.03). A history of previous bone infection suggests increased risk (p = 0.15). The choice of reconstructive material was not significant, although acrylic cranioplasties did not experience the complications expected from a review of the literature.     

南京1号直立人头骨与肯尼亚KNM-ER 3733人类头骨化石的形态比较

KNM-ER 3733人类头骨化石的年代为距今1.78百万年,1975年发现于肯尼亚。Walker和Leakey注意到这具头骨与周口店直立人的在脑颅形态上很相近,但二者在年代上相差大约1百万年,故认为直立人形态在这1百万年期间是稳定的。长期来此观点缺乏更多的人类化石证据来支持。1993年在中国发现了南京1号人类头骨化石。该头骨与KNM-ER 3733头骨一样兼具脑颅和面颅,且都属于成年女性个体,但南京1号人类头骨化石的年代比KNM-ER 3733人类头骨化石的要晚大约1百万年。因此,南京1号人类头骨是目前所知的可用来验证直立人头骨形态是否在1百万年期间保持稳定的唯一合适的人类头骨化石材料。形态比较表明,这两个人类头骨化石的脑颅虽然在眶上圆枕上沟的发育程度、眶后收缩的程度、额骨横向隆起的程度、角圆枕和乳后突的发育与否、顶骨形状以及骨壁厚度的表现上有所差异,但有更多的形态性状显示出相近。这些相近表现在脑颅的长、宽、高值上;颅容量上;脑颅的低矮性上;脑颅最大宽之位置上;额骨、顶骨、枕骨之矢弧值的比例上;眶上圆枕的纤细上;顶骨的大小和矢向扁平性上;颞线位置和颞鳞顶缘的形状上;枕鳞的低宽形状上;上枕鳞与下枕鳞之间的转折形状和比例上;枕骨圆枕和枕骨圆枕上沟的发育程度上等。这两具头骨的面颅虽然有同属突颌型的面角、皆发育有鼻骨间嵴、两鼻骨组成的上部宽度与下部宽度皆差别很大,但有更多的形态性状显示出差别。这些差别表现在面型上、颜面上部扁平度上、眶形和眶型上、上颌额突外侧面的朝向上、鼻骨横向隆起程度上、鼻梁外突程度上、鼻型上、颧骨下缘外展程度上、颊高上、颧上颌下缘的形状上、上颌颧突基部的位置上以及颧结节的位置上等。因此,南京1号头骨与KNM-ER 3733头骨之间在脑颅上显示出较多的相近性状,在面颅上则显示出较多的相异性状。脑颅方面的相近性状大多具有分类上的鉴别价值。这两个头骨脑颅形态的相近支持把KNM-ER 3733头骨鉴定为"直立人"的观点;也提示了南京1号头骨的脑颅似乎保持着1百多万年前的"祖先"形态。如果直立人的某些成员在至少1百万年期间保持着形态稳定的话,则这种形态上的稳定主要是表现在脑颅形态上。这两具头骨的面颅形态上较大差异的意义,目前尚不清楚。     

Split-thickness skin grafting of the myelomeningocele defect: a subset at risk for late ulceration

The appropriate method and timing of the management of the myelomeningocele defect have prompted considerable discussion. Use of split-thickness skin grafts acutely has accomplished wound closure with low morbidity and mortality. This study was designed to address the question of long-term suitability of the technique of split-thickness skin grafting of the myelomeningocele patient. The incidence of late and/or severe skin ulceration and the presence of gibbus deformity were correlated with the method of skin closure. Long-term follow-up revealed a higher incidence of chronic skin ulceration in the split-thickness skin graft group as compared with the primary closure group. All skin breakdowns appeared in the presence of a gibbus deformity, and gibbus deformity was more prevalent in the split-thickness skin graft group. The incidence of skin ulceration and gibbus deformity was site-dependent. A thoracic or thoracolumbar myelomeningocele repair with split-thickness skin graft was significantly more likely to be complicated by skin problems than the defect in the lumbar, lumbosacral, or sacral region. This relationship was secondary to the frequency of gibbus deformity in the more cephalad defects than defects caudad. A treatment plan is outlined that is based on the primary variable of the location of the myelomeningocele and secondarily by defect size.     

Toward CT-based facial fracture treatment

Facial fractures have formerly been classified solely by anatomic location. CT scans now identify the exact fracture pattern in a specific area. Fracture patterns are classified as low, middle, or high energy, defined solely by the pattern of segmentation and displacement in the CT scan. Exposure and fixation relate directly to the fracture pattern for each anatomic area of the face, including frontal bone, frontal sinus, zygoma, nose, nasoethmoidal-orbital region, midface, and mandible. Fractures with little comminution and displacement were accompanied by subtle symptoms and required simple treatment; middle-energy injuries were treated by standard surgical approaches and rigid fixation. Highly comminuted fractures were accompanied by dramatic instability and marked alterations in facial architecture; only multiple surgical approaches to fully visualize the "buttress" system provided alignment and fixation. Classification of facial fractures by (1) anatomic location and (2) pattern of comminution and displacement define refined guidelines for exposure and fixation.     

Button osteoma: its etiology and pathophysiology

The present study investigates a circumscribed bony overgrowth on the cranial vault, known as button osteoma (BtO) and referred to here as button lesion (BtL). We discuss its anthropological implications. Data on its histology, location, and population distribution (by age, race, and gender) are provided. Microscopically, BtL is composed of well-organized dense lamellated bone which is poorly vascularized and with very few osteocytes. It forms a dome-shaped roof over an underlying diploeized area which includes the ectocranial table. The frequency of BtL is similar in modern (37.6%) and archaeological (41.1%) populations, in blacks, whites, males, and females, and correlates with age. It is rare in nonhuman primates. Fifty-five percent of the human skulls studied by us had BtL only on the parietal, 23.6% on the frontal, and 3.6% on the occipital bones. Fifteen percent had BtL on both the frontal and parietal bones. No lateral preference was found. Most skulls with BtL (64.1%) had only one lesion, 20.4% had two BtL, and 15.4% demonstrated multiple BtL. The average number of button osteomas on an affected skull was 1.97. The frequency of large osteomas (0.5-1.0 cm) was similar in young and old age groups. The demographic characteristics of BtL, mainly its high frequency among ancient and modern populations, its independence of sex and race, its scarcity in other primates, and the fact that its macro- and microstruture are indicative of an hamartoma (and not an osteoma or exostosis) suggest an evolutionary background to the phenomenon.     

The role of primary bone grafting in complex craniomaxillofacial trauma

The role of craniofacial surgical techniques and immediate bone grafting in the management of complex craniofacial trauma has been reviewed. Four hundred and one patients with complex facial injuries have been treated. Two hundred and forty-one primary bone and cartilage grafts have been performed in 66 patients. Complex facial injuries should be managed by direct exposure, reduction, and fixation of all fractures utilizing interfragmentary wiring. Very comminuted or absent bone is replaced by immediate bone grafting, producing a stable skeleton without the need for external fixation devices. Associated mandibular fractures are managed with rigid internal fixation utilizing A-O technique. Results of immediate bone grafting have been excellent, and complications are rare. All deformities should be corrected, whenever possible, during the initial operation. This one-stage reconstruction of even the most complex facial injuries will prevent severe postoperative traumatic deformity and disability that may be extremely difficult or impossible to correct secondarily.     

The inhibition of skeletal changes in a rat burn model with a local muscle flap

The effects of early wound closure using a local muscle flap on the development of periosteal new bone formation in a rat burn model were studied. Following a full-thickness burn to one hind limb, periosteal new bone formation along the tibial diaphysis was measured by the use of the fluorochrome agent calcein and an image-analysis system. Prostaglandin E levels, a known inflammatory mediator, from the bone beneath the burn also were measured. Periosteal new bone formation was inhibited by 50 percent in animals that had debridement and wound closure with a gastrocnemius muscle flap and skin graft on postburn day 2 compared to untreated controls or animals closed with skin grafts only. There was a trend toward reduced prostaglandin E measurements from tibial sections in the early closure group compared to untreated controls. This study demonstrates that early wound closure using a local muscle flap inhibits the periosteal new bone formation which is possibly associated with the inflammation in a rat burn model.     

The effect of total maxillary advancement on facial growth.

The effect of total maxillary advancement on the growing skull was examined in 25 pigs, subjected to facial operations of varied severity at the age of 5 weeks (elevation of periosteum, simple osteotomy, and osteotomy immobilized by wire fixation, with or without bone grafts) and in controls. When the animals were killed 8 months later, the body weight had increased tenfold and the skull size had doubled. In 5 pigs whose maxillae were advanced 10 mm by bone grafts, the relative increase in length was not maintained. The overall skull length showed no difference from the control measurements. The extent of the growth in the area adjacent to the osteotomy was less than in the controls, but the same as in pigs subjected to periosteal elevation only. Scattered areas of bone damage were seen with no consistent pattern. Incision of the periosteum over the frontal bone decreased the local blood supply, increased the adherence of the periosteum to the bone, and affected bone growth locally.     

现代各主要人群额骨3D几何形态的对比

额骨是连接面颅和脑颅的重要头骨组成部分,关于现代各个人种的额骨形态是否存在明显的差别,这些人种额骨的基本形态如何,变异范围以及与其他人群的相似与差异等问题都尚未完全厘清。而额骨的很多特征由于技术手段的限制很难进行测量和准确的描述比较。鉴于这些问题,本文将采用基于三维表面半标志点的几何形态测量方法,研究东亚现代人额骨的表面形态及其变异范围,并与欧洲,东南亚,美洲,非洲以及澳洲的现代人群的额骨形态进行对比,为对比不同人群的形态研究建立基础数据。结果显示,额骨形态的变异主要表现在:1)额骨鳞部的额结节和正中矢状脊共同向前隆起或回缩以及相对额骨宽度;2)眉弓的粗壮程度,额结节的侧向发育程度和正中矢状脊的发育情况。为了进一步揭示中国现代人与其他人群在额骨形态上的关系,本文还探讨了额骨大小在不同人群中的差异。结果显示,东亚现代人和欧洲现代人额骨中心大小值的中位数最大,澳洲现代人的最小。东亚现代人的额骨形态与澳洲,欧洲和非洲均有非常显著的差异。为了检验额骨的形态是否与遗传距离一致,作者还对额骨形态距离和遗传距离做了相关性分析。结果显示,不同人群的额骨形态与其遗传距离呈显著的相关性,说明本研究结果中不同人群额骨形态上的差异大小可以在一定程度上反映其遗传距离,并可能进一步反映人群历史。东亚现代人的额骨平均形态在与各个人群比较过程中表现出一致性特征,可能在一定程度上反映了东亚现代人群的进化过程是相对独立的。未来额骨的三维几何形态测量可通过扩大标本数量进一步探讨不同性别和不同演化阶段之间的差异。     

The fate of plates and screws after facial fracture reconstruction.

Rigid plate and screw fixation is the mainstay of treatment for complex fractures of the facial skeleton. Complications of plate and screw fixation include prominence, infection, exposure, and migration. Five hundred and seven patients undergoing plate and screw fixation for facial fractures (1112 fractures) from 1983 to 1988 were followed for complications. Sixty-one patients (12 percent) required hardware removal. The location on the facial skeleton influenced symptoms and the rate of hardware removal. Infection and exposure may be decreased with antiseptic irrigations, avoiding mucosal damage, attention to proper mucosal closure, and correct placement of plates. Prominence may be decreased by the use of microplates in the supraorbital, frontal, and naso-orbital-ethmoid locations.     

Cranial osteochondroma in a white-tailed deer (Odocoileus virginianus)

A large osteochondroma of the skull was diagnosed in a young adult free-ranging white-tailed deer (Odocoileus virginianus) from Wyoming. The 4.8-kg neoplasm primarily involved the left frontal bone with extension into the cranial cavity. Microscopically, the neoplasm was composed of well differentiated trabecular bone and islands of cartilage. This neoplasm is rare in domestic species and has not been reported in cervids. Though benign in morphology, the location and size of the neoplasm was probably responsible for debilitation of the deer.     

An ectocranial lesion on the Middle Pleistocene human cranium from Hulu Cave, Nanjing, China

The earlier Middle Pleistocene human partial cranium from Hulu Cave, Tangshan, Nanjing (Hulu 1) exhibits an ectocranial lesion which covers most of the anterior neurocranium, largely between the temporal lines and extending from the supratoral sulcus to the anterior parietal bone. The endocranial surfaces and the remainder of the cranium (upper facial skeleton, lateral frontal bone, posterior parietal bones, and mid-occipital bone) are normal. The healed lesion exhibits both resorption and the laying down of new bone. Differential diagnosis suggests that the lesion was caused by either trauma (broad compressive trauma, tensile trauma to the scalp, or partial scalp removal) or burning (with damage to scalp and superficial neurocranium). Dietary deficiencies, infection, and neoplastic disorders do not fit the lesion characteristics. The Hulu 1 specimen therefore joins a growing sample of Pleistocene Homo remains with nonfatal and nontrivial disorders.     

Accurate,firm stabilization using external pins: a proposal for closed reduction of unfavorable nasal bone fractures and their simple classification

Nasal bone fractures are the most common among facial fractures and are the third most common fractures in the human frame. Although many forms of treatment have been introduced, controversy regarding the optimal treatment still remains. Nasal bone fractures are complex, with significantly varying types that are often undermanaged in closed reduction procedures. The authors' experiences with nasal bone fractures have shown that the baseline for surgical intervention depends on the type of fracture and the method of maintenance after reduction, both of which have considerable impact on the final result. Therefore, it is very important and challenging to determine the proper method of reduction and maintenance. The periosteal covering plays an important role in the splinting action after closed reduction, but sagging, depression, and instability remain major complications in some cases. The authors devised a new method of accurate, firm stabilization of the fractured nasal bone by using external pins in those unfavorable fractures determined radiologically to gain optimal reduction and fixation. In the present study, fractures were grouped into favorable and unfavorable fractures, the latter being those that remained unstable or impacted even after reduction and thus needed open reduction. Unfavorable fractures were divided into four subclasses according to radiologic findings: (1) type I (frontal), including chip or tip fractures, which often depress the upper lateral cartilage and tend to sag after reduction; (2) type II (lateral), or laterally depressed segmental fractures with a lateral shift of the arch in fragments or as a unit; (3) type III (mixed), or type II with septal involvement; and (4) type IV (complex), including open or multiple comminuted fractures. After an initial evaluation to determine the fracture type, closed reduction and external fixation were performed for types I, II, and III fractures and open reduction was performed for type IV fractures 5 to 7 days after the fracture. Closed reduction with the use of external pins was done in eight cases: type I (two), type II (four), and type III (two). The mean age of the patients was 27.8 years, and the average follow-up period was 11.7 months. Functional and aesthetic results were satisfactory. This new method for support and fixation is an alternative to the conventional closed reduction and a promising way to prevent secondary deformity.     

Growth changes in measurements of upper facial positioning

Growth changes in the position of the midline upper face are examined for samples of Pan troglodytes, Gorilla gorilla, and modern humans. Horizontal and vertical distances between nasion and the anterior end of the cribriform plate are plotted against stage of dental development. Kendall's nonparametric correlations between facial positioning and stage of dental development are tested for significance. In African apes, the upper face becomes more projecting and positioned higher relative to the anterior cranial base. The extent of this horizontal and vertical separation reflects primarily facial size. In modern humans, the upper face becomes more projecting but is relatively stable in its vertical position. Comparison of Pan and modern human crania in the youngest dental age category indicates that the upper face of modern humans is positioned lower early in postnatal life. The position of the upper face (glabella) relative to the anterior and posterior cranial base is presented for several fossil hominid crania. The fossil crania are similar to Pan and modern humans in facial projection relative to the anterior cranial base. However, glabella is positioned low in the fossil crania. Total facial projection (relative to hormion) for Sts 5 is similar to the mean for Gorilla. Fossil Homo and robust australopithecine crania display very projecting upper faces. We suggest that the upper face of Homo is projecting due to the length of the anterior cranial fossa, while robust australopithecines possess a thick frontal bone.     

Temporal fossa bone grafts: a new technique in craniofacial surgery

The calvarium has become an increasingly popular bone-graft donor site. Previously described harvesting techniques are often difficult to perform and may produce unsatisfactory bone fragments. However, full-thickness bone grafts taken from the region of the temporal fossa, beneath the temporaiis muscle, have proven to be of high quality and technically easy to obtain. In our experience with eight patients, temporal fossa bone grafts were used primarily around the orbit, including reconstruction of the orbital floor, frontal bone, and zygoma. The procedure begins with a hemicoronal or bicoronal incision; the temporalis muscle is reflected, and an underlying bone plate up to 4 X 6 cm is removed. The resulting bone graft is consistently 3 to 4 mm in thickness. The cranial defect is packed with bone debris, and the muscle is replaced. This technique has proven to be safe, technically simple, consistently productive of high-quality bone grafts, and within discernible donor-site deformity.     

Head and Neck Veins of the Mouse. A Magnetic Resonance,Micro Computed Tomography and High Frequency Color Doppler Ultrasound Study

To characterize the anatomy of the venous outflow of the mouse brain using different imaging techniques. Ten C57/black male mice (age range: 7-8 weeks) were imaged with high-frequency Ultrasound, Magnetic Resonance Angiography and ex-vivo Microcomputed tomography of the head and neck. Under general anesthesia, Ultrasound of neck veins was performed with a 20MHz transducer; head and neck Magnetic Resonance Angiography data were collected on 9.4T or 7T scanners, and ex-vivo Microcomputed tomography angiography was obtained by filling the vessels with a radiopaque inert silicone rubber compound. All procedures were approved by the local ethical committee. The dorsal intracranial venous system is quite similar in mice and humans. Instead, the mouse Internal Jugular Veins are tiny vessels receiving the sigmoid sinuses and tributaries from cerebellum, occipital lobe and midbrain, while the majority of the cerebral blood, i.e. from the olfactory bulbs and fronto-parietal lobes, is apparently drained through skull base connections into the External Jugular Vein. Three main intra-extracranial anastomoses, absent in humans, are: 1) the petrosquamous sinus, draining into the posterior facial vein, 2) the veins of the olfactory bulb, draining into the superficial temporal vein through a foramen of the frontal bone 3) the cavernous sinus, draining in the External Jugular Vein through a foramen of the sphenoid bone. The anatomical structure of the mouse cranial venous outflow as depicted by Ultrasound, Microcomputed tomography and Magnetic Resonance Angiography is different from humans, with multiple connections between intra- and extra- cranial veins.     

The use of cranial bone grafts in the closure of alveolar and anterior palatal clefts

A method is described for harvesting cancellous bone from the diploic space. In our opinion, this is the material of choice for bone grafting alveolar clefts in the 7- to 11-year age group. The procedure could be performed at an earlier age if the maxillary segments are under orthopedic control and in proper alignment. Success of the procedure depends on proper orthodontic preparation of the maxillary segments and careful, complete closure of the soft tissues across the anterior palatal cleft, the nasal lining defect, and the anterior alveolus. Results have been encouraging in terms of bone formation, and tooth migration into the bone graft can be expected if there has been no damage to the dental sac. Closure of the alveolar defect at the time of the primary lip closure would preclude the eventual need for a bone graft, but it cannot be accomplished without early, precise alignment of the maxillary segments if extensive periosteal denudation is to be avoided. The age beyond which periosteal closure alone will be inadequate to provide sufficient bone formation and should be supplemented by a bone graft remains to be established.