Search Results (43)

This study presents a paleopathological analysis of individual T4.2 from the archaeological site of the castle of Zorita de los Canes (Guadalajara, Spain). The individual exhibits ultradolichocephaly and was dated between the 13th and 15th centuries. Based on the context, the individual could have been a member of the military–religious Order of Calatrava. Standard bioanthropological and paleopathological methods were applied. The results indicate a male aged between 45 and 49 years with a maximum cranial length and width of 230 mm and 122 mm, respectively. The cranial index (53%) allows him to be classified as ultradolichocephalic. The remains present craniosynostosis at the sagittal, squamosal and sphenofrontal sutures, together with underdevelopment of the skull base width and a dolichognathic mandible with the possible presence of type III prognathism. The left hemimandible and hemimaxilla display a large amount of tartar covering the occlusal, labial and lingual areas of the teeth completely. The right hemimandible and hemimaxilla exhibit almost no tartar, and some teeth were lost in vivo. In addition, two stab wounds—to the external occipital protuberance and to the left temple—as well as a contused injury in the left tibia, can be observed without evidence of bone remodeling. Differential diagnosis indicates a case consistent with Crouzon syndrome. This individual is of particular significance because he was a possibly knight of the Order of Calatrava who presents a syndromic craniosynostosis consistent with Crouzon syndrome and exhibits lesions, which may suggest that he could have died in battle. Full article

The Arhgap29 gene encodes Rho-GTPase-activating protein 29 (Arhgap29), which plays a crucial role in embryonic tissue development. Mutations in the Arhgap29 gene are significantly associated with non-syndromic cleft lip and palate (NSCL/P). Our study demonstrated that the deletion of Arhgap29 leads to syndromic cleft lip and palate (SCL/P) characteristics in mice, where, in addition to cleft palate, the mice exhibit craniofacial and systemic skeletal abnormalities. However, the mechanisms underlying these skeletal abnormalities remain unclear. Through micro-CT imaging, histological analysis, and transcriptomic methods, we discovered that the knockout of Arhgap29 delays the fusion of Meckel’s cartilage, widens cranial sutures, reduces bone quality, and alters the expression of osteoblasts and osteoclasts in the mandible. Digit defects, including ectrodactyly and impaired endochondral ossification, were also observed. Immunohistochemical analysis demonstrated the expression of Arhgap29 in both osteoblasts and osteoclasts, indicating its dual role in maintaining matrix homeostasis and regulating bone resorption equilibrium. Transcriptomic analysis revealed disrupted calcium and MAPK signaling pathways, while in vitro studies demonstrated impaired osteogenesis in Arhgap29-deficient calvarial cells, mirroring the in vivo defects. Furthermore, spatial transcriptomics linked the loss of Arhgap29 to defective bone differentiation and protein synthesis. Our findings underscore the critical role of Arhgap29 in the development of the mandible and digits, suggesting its potential as a pathogenic gene associated with syndromic cleft lip and palate (SCL/P). Full article

Sutures such as fibrous joints in craniofacial bones provide a niche for Gli1+ mesenchymal stem cells (MSCs) in promoting calvarial bone development and growth. However, the underlying molecular mechanism behind the fate of the Wnt/β-catenin regulation of Gli1+ MSCs during calvarial bone formation remains unclear. Here, we showed that β-catenin was colocalized with Gli1+ lineage cells near the osteogenic front within a suture, and postnatal skull development was delayed via a conditional knockout of Ctnnb1 in Gli1+ MSCs. Calcein–Alizarin Red dual staining revealed that Wnt/β-catenin signal inhibition impaired the rate of bone formation. Furthermore, immunofluorescent staining indicated that Wnt/β-catenin signaling was crucial in facilitating the proliferative capacity of Gli1+ MSCs and their commitment to the osteogenic lineage. Notably, activating hedgehog (Hh) signaling partially restored the suture morphology in Ctnnb1 knockout mice. Collectively, our findings revealed the crosstalk between Wnt and Hh signaling modulates the fate of Gli1+ MSCs during calvarial bone formation. Full article

Objective: To review recent advancements in cranial cruciate ligament disease (CCLD) in dogs, focusing on diagnostic innovations and treatment options. Study Design: Literature review. Animals or Sample Population: Not applicable. Methods: Analysis of current literature on diagnostic tools and treatment techniques for CCLD, with emphasis on recent trends and advancements. Results: Enhanced diagnostic tools, such as Computed Tomography (CT), offer detailed anatomical insights, improving the accuracy of CCLD assessments. Treatment approaches include extra-articular techniques like lateral fabellar suture stabilization, intra-articular methods with natural and synthetic implants, and advanced surgical procedures such as Tibial Plateau Leveling Osteotomy (TPLO), Tibial Tuberosity Advancement (TTA), and arthroscopy. Recent trends favor combining techniques, such as TPLO with lateral fabellar sutures or arthroscopy with TPLO, to optimize outcomes. Intra-articular techniques, while promising, may face challenges related to graft choice and tunnel placement. Conclusions: A multifaceted approach integrating advanced diagnostics and tailored treatments enhances patient outcomes for CCLD. Ongoing advancements in both diagnostic and therapeutic strategies are crucial for effective management. Clinical Significance/Impact: This review highlights recent advancements and research in diagnostic and therapeutic strategies for CCLD, providing valuable insights for veterinary surgeons and researchers. The integration of these advanced approaches is essential for improving clinical outcomes in canine CCLD management. Full article

External undesirable vibrations from the environment can affect the performance of vibration-sensitive equipment. Passive isolators are simpler, lighter, and cheaper, and constrained layer damping is a low-cost yet effective method of vibration dampening. Traditional methods of improving constrained layer damping include increasing the number of layers or directly connecting one end of the constraining layers to the base structure. The drawback of these methods is the requirement to increase the overall thickness. Also, like most passive isolators, it has a limitation on stability, which is usually solved by external mechanical limiters. The novel concept of an auxetic composite sandwich addresses both issues of having an external limiter by using the constraining layer for load bearing and enhancing damping performance without increasing the overall thickness, achieved through an auxetic interlayer and deforming axis-symmetrically. The rotating triangle auxetic interlayer is selected based on biomimicry of animals that endure impact and pressure, such as cranial sutures, beaks, ammonoid and turtle shells. Finite element analysis shows significantly higher damping ratio at the beginning of free vibration, and experiment results show an eightfold increase in damping ratio (from 0.04 to 0.29). Additionally, settling time to 0.25 g is reduced from 70.7 ms to 60.9 ms as acceleration is increased from 0.5 g to 4 g. Power spectrum density shows better attenuation, three to four times better than the plain model. The successful demonstration of the concept motivates further study to understand the performance of auxetic patterns in enhancing constrained layer damping. Full article

Cranial sutures play critical roles in load distribution and neuroprotection, with their biomechanical performance intimately linked to morphological complexity. The purpose of this study was to investigate the effect of different morphologies of cranial sutures on their biomechanical behavior. Based on the different morphologies of the cranial sutures, six groups of finite element models (closed, straight, sine wave, tight sinusoidal wave, layered sinusoidal wave, and layered sinusoidal wave + sutural bone) of the bone–suture–bone composite structures that ranged from simple to complex were constructed. Each model was subjected to 50 kPa impact and 98 N bilateral tensile loads to evaluate von Mises stress and total deformation variations across all groups under combined loading conditions. Key findings reveal that morphological complexity directly governs stress dynamics and mechanical adaptation; layered sinusoidal configurations delayed peak stress by 19–36% and generated elevated von Mises stresses compared to closed sutures, with stress concentrations correlating with interfacial roughness. Under impact, sutures exhibited localized energy dissipation (<0.2 μm deformation), while tensile loading induced uniform displacements (≤11 μm) across all morphologies (p > 0.05), underscoring their dual roles in localized energy absorption and global strain redistribution. Craniosacral therapy relevant forces produced sub-micron deformations far below pathological thresholds (≥1 mm), which implies the biomechanical safety of recommended therapeutic force. Staggered suture–bone in open sutures (31.93% closure rate) enhances shear resistance, whereas closed sutures prioritize rigidity. The findings provide mechanistic explanations for suture pathological vulnerability and clinical intervention limitations, offering a quantitative foundation for future research on cranial biomechanics and therapeutic innovation. Full article

The present study describes the case of a severe surgical complication in a 42-year-old female patient undergoing bimaxillary orthognathic surgery for the correction of skeletal class III, where a detachment of the surgical plates and fibrous healing of the palatal suture occurred. The aim of this study was to enlighten two important concepts: (I) how occlusal and mandible position changes can be well tolerated by the temporomandibular joint even in the case of a failed orthognathic surgery; (II) how a prosthodontic approach based on the search for occlusal stabilization made it possible to manage a complicated clinical case. Clinical Presentation: Clinically, the patient presented an occlusal instability and a split and mobile maxillary bone with respect to the cranial base. The case was resolved using full-mouth prosthodontic rehabilitation to fix the occlusal instability and guide maxillofacial surgeons, establishing the new occlusal position during an orthognathic reintervention. Clinical Relevance: The function was reestablished independently on any treatment planning centered on the temporomandibular joint repositioning concepts. However, although neuromuscular plasticity and the patient’s adaptation skills can explain the clinical success in such complex rehabilitations, these findings must be interpreted with caution due to the limited generalizability inherent to the study’s design. Full article

Objectives: This study aimed to compare the effects of surgically assisted rapid palatal expansion (SARPE) techniques and their combinations on the stresses (von Mises, maximum principal, and minimum principal) and displacements that occur in the maxilla, facial bones, and maxillary teeth using three-dimensional finite element analysis (FEA). Methods: SARPE was simulated using seven different osteotomy techniques. The FEA models were simulated with a combination of various osteotomies, including midpalatal and lateral osteotomies, lateral osteotomy with a step, and separation of the pterygomaxillary junction. For each osteotomy variant, the instantaneous displacements and stresses resulting from forces applied by a 1 mm expansion of a tooth-borne appliance were evaluated. Results: Midpalatal osteotomy increased lateral displacement in the alveolar bone margins and intermaxillary suture while significantly reducing stresses around the intermaxillary suture. The addition of a pterygomaxillary osteotomy to the midpalatal and lateral osteotomies effectively reduced stresses in the posterior maxilla and cranial structures while enhancing lateral displacement. Although lateral osteotomy significantly reduced stresses in the midface, its effect on maxillary expansion was limited. Stepped lateral osteotomy had minimal effects on transverse displacement and stress reduction. Conclusions: Increasing the number of osteotomies reduced stress levels in the maxilla while enhancing lateral displacement. These results highlight the importance of selecting the most appropriate osteotomy technique to achieve optimal outcomes. Full article

Craniosynostoses (CRS) are caused by the premature fusion of one or more cranial sutures, with isolated nonsyndromic CRS accounting for most of the clinical manifestations. Such premature suture fusion impacts both skull and brain morphology and involves regions far beyond the immediate area of fusion. The combined use of different neuroimaging tools allows for an accurate depiction of the most prominent clinical–radiological features in nonsyndromic CRS but can also contribute to a deeper investigation of more subtle alterations in the underlying nervous tissue organization that may impact normal brain development. This review paper aims to provide a comprehensive framework for a better understanding of the present and future potential applications of neuroimaging techniques for evaluating nonsyndromic CRS, highlighting strategies for optimizing their use in clinical practice and offering an overview of the most relevant technological advancements in terms of diagnostic performance, radiation exposure, and cost-effectiveness. Full article

Positional plagiocephaly is a deformational cranial flattening frequently treated in pediatric neurosurgical practice. Positional maneuvers and orthotic helmet therapy are preferred therapeutic options for moderate-to-severe forms. Treatment response seems to be age-dependent. Nevertheless, predictive data are vague, and cost-efficiency might be a limiting factor for treatment. The purpose of this study was to investigate the early predictive value of sonographic parameters on the efficacy of orthotic helmet therapy through the assessment of changes in skull shape and correlation of the parameters with caliper cephalometry values and with age. A consecutive cohort of 49 patients < 10 months of age, undergoing orthotic helmet therapy for positional plagiocephaly, was recruited prospectively. The authors routinely assessed the patency of the lambdoid sutures by ultrasound and the following additional skull parameters were measured: suture width, adjacent full bone thickness, adjacent cortical bone thickness and occipital angle. Caliper cephalometric values, as well as demographic and clinical data were collected. Retrospective data analysis showed an inverse relation between both cortical and full skull bone thickness and early treatment efficacy, defined by a reduction in the occipital angle. The improvement of sonographic parameters correlated with the development of cranial caliper cephalometry values. In conclusion, the sonographic assessment of skull bone thickness is a safe and cost-effective tool to predict the early efficacy of orthotic helmet therapy in positional plagiocephaly and might, therefore, help the clinician to foresee the potential evolution of the deformity. Full article

Background: Neither radiological phenotypic characteristics nor reconstruction CT scan has been used to study the early anatomical disruption of the cranial bone in children with the so-called idiopathic type of West syndrome. Material and Methods: The basic diagnostic measures and the classical antiepileptic treatments were applied to these children in accordance with the conventional protocol of investigations and treatment for children with West syndrome. Boys from three unrelated families were given the diagnosis of the idiopathic type of West syndrome, aged 7, 10 and 12 years old. Parents underwent extensive clinical examinations. Three parents (age range of 28–41 year) were included in this study. All children showed a history of intellectual disabilities, cryptogenic epileptic spasms and fragmented hypsarrhythmia. These children and their parents were referred to our orthopedic departments because of variable skeletal deformities. Variable forms of skeletal deformities were the motive for the families to seek orthopedic advice. A constellation of flat foot, torticollis and early-onset osteoarthritis were observed by the family doctor. Apparently, and from the first clinical session in our practice, we felt that all these children are manifesting variable forms of abnormal craniofacial contour. Thereby, we immediately performed detailed cranial radiological phenotypic characterization of every affected child, as well as the siblings and parents, and all were enrolled in this study. All affected children underwent whole-exome sequence analysis. Results: The craniofacial phenotype of all children revealed apparent developmental anatomical disruption of the cranial bones. Palpation of the skull bones showed unusual palpable bony ridges along different sutural locations. A 7-year-old child showed abnormal bulging over the sagittal suture, associated with bilateral bony ridges over the squamosal sutures. AP skull radiograph of a 7-year-old boy with West syndrome showed facial asymmetry with early closure of the metopic suture, and other sutures seemed ill-defined. A 3D reconstruction CT scan of the skull showed early closure of the metopic suture. Another 3D reconstruction CT scan of the skull while the patient was in flexion showed early closure of the squamosal sutures, pressing the brain contents upward, causing the development of a prominent bulge at the top of the mid-sagittal suture. A reformatted 3D reconstruction CT scan confirmed the bilateral closure of the squamosal suture. Examination of the parents revealed a similar skull radiographic abnormality in his mother. A 3D reformatted frontal cranial CT of a 35-year-old mother showed early closure of the metopic and sagittal sutures, causing a mid-sagittal bony bulge. A 10-year-old boy showed an extremely narrow frontal area, facial asymmetry and a well palpable ridge over the lambdoid sutures. A 3D axial reconstruction CT scan of a 10-year-old boy with West syndrome illustrated the asymmetry of the posterior cranial bones along the lambdoid sutures. Interestingly, his 28-year-old mother has been a client at the department of spine surgery since she was 14 years old. A 3D reconstruction CT scan of the mother showed a noticeable bony ridge extending from the metopic suture upwards to involve the sagittal suture (red arrow heads). The black arrow shows a well demarcated bony ridge over the squamosal suture. A 3D reconstruction CT scan of the skull and spine showed the thick bony ridge of the metopic and the anterior sagittal as well as bilateral involvement of the squamosal, causing apparent anterior narrowing of the craniofacial contour. Note the lumbar scoliosis. A 12-year-old boy showed brachycephaly. A lateral skull radiograph of a 12-year-old boy with West syndrome showed premature sutural fusion, begetting an abnormal growth pattern, resulting in cranial deformity. The nature of the deformity depends on which sutures are involved, the time of onset and the sequence in which individual sutures fuse. In this child, brachycephalic secondary to craniosynostosis, which occurred because of bilateral early ossification of the coronal sutures, led to bi-coronal craniosynostosis. Thickened frontal bones and an ossified interclinoid ligament of the sella turcica were encountered. The lateral skull radiograph of a 38-year-old mother with a history of poor schooling achievements showed a very similar cranial contour of brachycephaly, thickening of the frontal bones and massive ossification of the clinoid ligament of the sella turcica. Maternal history revealed a history of multiple spontaneous miscarriages in the first trimester of more than five times. Investigating his parents revealed a brachycephalic mother with borderline intelligence. We affirm that the pattern of inheritance in the three boys was compatible with the X-linked recessive pattern of inheritance. Whole-exome sequencing showed non-definite phenotype/genotype correlation. Conclusions: The aim of this study was sixfold: firstly, to refute the common usage of the term idiopathic; secondly, we feel that it could be possible that West syndrome is a symptom complex rather than a separate diagnostic entity; thirdly, to further detect the genetic carrier, we explored the connection between the cranial bones in children with West syndrome with what has been clinically observed in their parents; fourthly, the early life anatomical disruptions of the cranial bones among these children seem to be heterogeneous; fifthly, it shows that the progressive deceleration in the development of this group of children is highly connected to the progressive closure of the cranial sutures; sixthly, we affirm that our findings are novel. Full article

Few studies analyze the morphology and anatomy of the bat skull, and most of them are incomplete. Some of the difficulties stem from the fact that, in the representatives of the order Chiroptera, the interosseous sutures disappear by fusing together before active flight begins, which takes place over only a few months. This study presents a detailed morphological and anatomical description of the skull of a juvenile specimen of Myotis myotis (Borkhausen, 1797). Juvenile skulls are difficult to preserve and often incomplete. Previously inconsistent terminology related to bones, sutures, and other cranial structures was unified, which will provide insight on the distribution of each structure in both juvenile and adult specimens to be investigated. The description fill in the gaps in knowledge about the cranial structures of Myotis myotis and the representatives of the family Vespertilionidae. This will allow for precise descriptions of the skulls of bats. Full article

Acquired cranial defects are a prevalent condition in neurosurgery and call for cranioplasty, where the missing or defective cranium is replaced by an implant. Nevertheless, the biomaterials in current clinical applications are hardly exempt from long-term safety and comfort concerns. An appealing solution is regenerative cranioplasty, where biomaterials with/without cells and bioactive molecules are applied to induce the regeneration of the cranium and ultimately repair the cranial defects. This review examines the current state of research, development, and translational application of regenerative cranioplasty biomaterials and discusses the efforts required in future research. The first section briefly introduced the regenerative capacity of the cranium, including the spontaneous bone regeneration bioactivities and the presence of pluripotent skeletal stem cells in the cranial suture. Then, three major types of biomaterials for regenerative cranioplasty, namely the calcium phosphate/titanium (CaP/Ti) composites, mineralised collagen, and 3D-printed polycaprolactone (PCL) composites, are reviewed for their composition, material properties, and findings from clinical trials. The third part discusses perspectives on future research and development of regenerative cranioplasty biomaterials, with a considerable portion based on issues identified in clinical trials. This review aims to facilitate the development of biomaterials that ultimately contribute to a safer and more effective healing of cranial defects. Full article

Medical-grade stainless steel (MSS) is one of the most widely used materials for implantable devices in biomedical applications, including orthopedic stents, dental implants, cardiovascular stents, cranial fixations, and surgical suture materials. Implants are exposed to corrosive body fluids containing chlorides, proteins, and amino acids, resulting in corrosion, wear, toxicity, inflammation, infection, and failure. MSS-based materials exhibit improved corrosion and mechanical resistance and suppress the degradation and release of toxic metal ions. Although MSS is manufactured with a passivating metal oxide layer, its anti-corrosion performance against chlorides and chemicals in body fluids is insufficient. Implants require biocompatibility, bioactivity, hemocompatibility, and sustainability. Antimicrobial activity and sustained drug release are also crucial factors. Therefore, stainless steel with desirable multifunction is in great clinical demand. This comprehensive review summarizes recent advances in the surface modification of MSS-based implants and their biomedical applications, especially in dentistry. Full article

Sagittal craniosynostosis, a rare but fascinating craniofacial anomaly, presents a unique challenge for both diagnosis and treatment. This condition involves premature fusion of the sagittal suture, which alters the normal growth pattern of the skull and can affect neurological development. Sagittal craniosynostosis is characterised by a pronounced head shape, often referred to as scaphocephaly. Asymmetry of the face and head, protrusion of the fontanel, and increased intracranial pressure are common clinical manifestations. Early recognition of these features is crucial for early intervention, and understanding the aetiology is, therefore, essential. Although the exact cause remains unclear, genetic factors are thought to play an important role. Mutations in genes such as FGFR2 and FGFR3, which disrupt the normal development of the skull, are suspected. Environmental factors and various insults during pregnancy can also contribute to the occurrence of the disease. An accurate diagnosis is crucial for treatment. Imaging studies such as ultrasound, computed tomography, magnetic resonance imaging, and three-dimensional reconstructions play a crucial role in visualising the prematurely fused sagittal suture. Clinicians also rely on a physical examination and medical history to confirm the diagnosis. Early detection allows for quick intervention and better treatment outcomes. The treatment of sagittal craniosynostosis requires a multidisciplinary approach that includes neurosurgery, craniofacial surgery, and paediatric care. Traditional treatment consists of an open reconstruction of the cranial vault, where the fused suture is surgically released to allow normal growth of the skull. However, advances in minimally invasive techniques, such as endoscopic strip craniectomy, are becoming increasingly popular due to their lower morbidity and shorter recovery times. This review aims to provide a comprehensive overview of sagittal craniosynostosis, highlighting the aetiology, clinical presentation, diagnostic methods, and current treatment options. Full article