Journal articles on the topic 'Suture fusion'
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Boyajian, Michael K., Hanny Al-Samkari, Dennis C. Nguyen, Sybill Naidoo, and Albert S. Woo. "Partial Suture Fusion in Nonsyndromic Single-Suture Craniosynostosis." Cleft Palate-Craniofacial Journal 57, no. 4 (February 4, 2020): 499–505. http://dx.doi.org/10.1177/1055665620902299.
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Introduction: Partial synostosis of cranial sutures has been shown to have clinical and diagnostic significance. However, there is limited published information about how suture fusion progresses over time. In this study, we evaluate patients with nonsyndromic single-suture synostosis. We aim to define the incidence of partial versus complete suture fusion and whether a correlation exists between the degree of suture fusion and age. Methods: Two hundred fifty-four patients with nonsyndromic single-suture synostosis were evaluated. Preoperative computed tomography (CT) scans were rendered in 3-dimensions, all sutures were visualized and assessed for patency or fusion, and length of fusion was measured. Findings were grouped according to suture type (sagittal, coronal, metopic, or lambdoid), the degree of fusion (full, >50%, or <50%), and patient age at time of CT scan (0-90, 91-180, 181-360, or >360 days). Data were analyzed to correlate patient age versus the degree of suture fusion. Results: For all patients, 72% had complete and 28% had partial synostosis. Ratios of full to partial fusion for each suture type were as follows: sagittal 97:36, coronal 35:22, metopic 46:4, and lambdoid 4:10. The sagittal, coronal, and metopic groups demonstrated greater probabilities of complete suture fusion as patient age increases ( P = .021, P < .001, P = .001, respectively). This trend was also noted when all sutures were considered together by age-group ( P < .001). Conclusion: We note a partial suture fusion rate of 28.3%. Our analysis shows a correlation between the extent of suture synostosis and patient age. Finally, we demonstrate that different sutures display different patterns of partial and complete fusion.
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Wilkinson, C. Corbett, Cesar A. Serrano, Brooke M. French, Sarah J. Graber, Emily Schmidt-Beuchat, Lígia Batista-Silverman, Noah P. Hubbell, and Nicholas V. Stence. "Fusion patterns of minor lateral calvarial sutures on volume-rendered CT reconstructions." Journal of Neurosurgery: Pediatrics 26, no. 2 (August 2020): 200–210. http://dx.doi.org/10.3171/2020.2.peds1952.
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OBJECTIVESeveral years ago, the authors treated an infant with sagittal and bilateral parietomastoid suture fusion. This made them curious about the normal course of fusion of “minor” lateral sutures (sphenoparietal, squamosal, parietomastoid). Accordingly, they investigated fusion of these sutures on 3D volume-rendered head CT reconstructions in a series of pediatric trauma patients.METHODSThe authors reviewed all volume-rendered head CT reconstructions obtained from 2010 through mid-2012 at Children’s Hospital Colorado in trauma patients aged 0–21 years. Each sphenoparietal, squamosal, and parietomastoid suture was graded as open, partially fused, or fused. In several individuals, one or more lateral sutures were fused atypically. In these patients, the cephalic index (CI) and cranial vault asymmetry index (CVAI) were calculated. In a separately reported study utilizing the same reconstructions, 21 subjects had fusion of the sagittal suture. Minor lateral sutures were assessed, including these 21 individuals, excluding them, and considering them as a separate subgroup.RESULTSAfter exclusions, 331 scans were reviewed. Typically, the earliest length of the minor lateral sutures to begin fusion was the anterior squamosal suture, often by 2 years of age. The next suture to begin fusion—and first to complete it—was the sphenoparietal. The last suture to begin and complete fusion was the parietomastoid. Six subjects (1.8%) had posterior (without anterior) fusion of one or more squamosal sutures. Six subjects (1.8%) had fusion or near-complete fusion of one squamosal and/or parietomastoid suture when the corresponding opposite suture was open or nearly open. The mean CI and CVAI values in these subjects and in age- and sex-matched controls were normal and not significantly different. No individuals had a fused parietomastoid suture with open squamosal and/or sphenoparietal sutures.CONCLUSIONSFusion and partial fusion of the sphenoparietal, squamosal, and parietomastoid sutures is common in children and adolescents. It usually does not represent craniosynostosis and does not require cranial surgery. The anterior squamosal suture is often the earliest length of these sutures to fuse. Fusion then spreads anteriorly to the sphenoparietal suture and posteriorly to the parietomastoid. The sphenoparietal suture is generally the earliest minor lateral suture to complete fusion, and the parietomastoid is the last. Atypical patterns of fusion include posterior (without anterior) squamosal suture fusion and asymmetrical squamosal and/or parietomastoid suture fusion. However, these atypical fusion patterns may not lead to atypical head shapes or a need for surgery.
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Bradley, James P., Jamie P. Levine, Christopher Blewett, Thomas Krummel, Joseph G. Mccarthy, and Michael T. Longaker. "Studies in Cranial Suture Biology: In Vitro Cranial Suture Fusion." Cleft Palate-Craniofacial Journal 33, no. 2 (March 1996): 150–56. http://dx.doi.org/10.1597/1545-1569_1996_033_0150_sicsbv_2.3.co_2.
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The biology underlying craniosynostosis remains unknown. Previous studies have shown that the underlying dura mater, not the suture itself, signals a suture to fuse. The purpose of this study was to develop an in vitro model for cranial-suture fusion that would still allow for suture-dura interaction, but without the influence of tensional forces transmitted from the cranial base. This was accomplished by demonstrating that the posterior frontal mouse cranial suture, known to be the only cranial suture that fuses in vivo, fuses when plated with its dura in an organ-culture system. In such an organ-culture system, the sutures are free from both the influence of dural forces transmitted from the cranial base and from hormonal influences only available in a perfused system. For the cranial-suture fusion in vitro model study, the sagittal sutures (controls that remain patent in vivo) and posterior frontal sutures (that fuse in vivo) with the underlying dura were excised from 24-day-old euthanized mice, cut into 5 × 4 × 2-mm specimens, and cultured in a chemically defined, serum-free media. One hundred sutures were harvested at the day of sacrifice, then every 2 days thereafter until 30 days in culture, stained with H & E, and analyzed. A subsequent cranial-suture without dura in vitro study was performed in a similar fashion to the first study, but only the calvariae with the posterior frontal or sagittal sutures (without the underlying dura) were cultured. Results from the cranial-suture fusion in vitro model study showed that all sagittal sutures placed in organ culture with the underlying dura remained patent. More importantly, the posterior frontal sutures with the underlying dura, which were plated-down as patent at 24 days of age, demonstrated fusion after various growth periods in organ culture. In vitro posterior frontal mouse-suture fusion occurred in an anterior-to-posterior direction but in a delayed fashion, 4 to 7 days later than in vivo posterior frontal mouse-suture fusion. In contrast, the subsequent cranial-suture without dura in vitro study showed patency of all sutures, including the posterior frontal suture. These data from in vitro experiments indicate that: (1) mouse calvariae, sutures, and the underlying dura survive and grow in organ-culture systems for 30 days; (2) the local dura, free from external influences transmitted from the cranial base and hormones from distant sites, influences the cells of its overlying suture to cause fusion; and (3) without dura influence, all in vitro cranial sutures remained patent. By first identifying the factors involved in dural-suture signaling and then regulating these factors and their receptors, the biologic basis of suture fusion and craniosynostosis may be unraveled and used in the future to manipulate pathologic (premature) suture fusion.
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Cyprus, Garrett N., Jefferson W. Overlin, Rafael A. Vega, Ann M. Ritter, and René Olivares-Navarrete. "Spatial regulation of gene expression in nonsyndromic sagittal craniosynostosis." Journal of Neurosurgery: Pediatrics 22, no. 6 (December 2018): 620–26. http://dx.doi.org/10.3171/2018.6.peds18229.
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OBJECTIVECranial suture patterning and development are highly regulated processes that are not entirely understood. While studies have investigated the differential gene expression for different sutures, little is known about gene expression changes during suture fusion. The aim of this study was to examine gene expression in patent, fusing, and fused regions along sagittal suture specimens in nonsyndromic craniosynostosis patients.METHODSSagittal sutures were collected from 7 patients (average age 4.5 months) who underwent minimally invasive craniotomies at the Children’s Hospital of Richmond at VCU under IRB approval. The sutures were analyzed using micro-CT to evaluate patency. The areas were classified as open, fusing, or fused and were harvested, and mRNA was isolated. Gene expression for bone-related proteins, osteogenic and angiogenic factors, transforming growth factor–β (TGF-β) superfamily, and Wnt signaling was analyzed using quantitative polymerase chain reaction and compared with normal sutures collected from fetal demise tissue (control).RESULTSMicro-CT demonstrated that there are variable areas of closure along the length of the sagittal suture. When comparing control samples to surgical samples, there was a significant difference in genes for Wnt signaling, TGF-β, angiogenic and osteogenic factors, bone remodeling, and nuclear rigidity in mRNA isolated from the fusing and fused areas of the sagittal suture compared with patent areas (p < 0.05).CONCLUSIONSIn nonsyndromic sagittal craniosynostosis, the affected suture has variable areas of being open, fusing, and fused. These specific areas have different mRNA expression. The results suggest that BMP-2, FGFR3, and several other signaling pathways play a significant role in the regulation of suture fusion as well as in the maintenance of patency in the normal suture.
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Wilkinson, C. Corbett, Nicholas V. Stence, Cesar A. Serrano, Sarah J. Graber, Lígia Batista-Silverman, Emily Schmidt-Beuchat, and Brooke M. French. "Fusion patterns of major calvarial sutures on volume-rendered CT reconstructions." Journal of Neurosurgery: Pediatrics 25, no. 5 (May 2020): 519–28. http://dx.doi.org/10.3171/2019.11.peds1953.
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OBJECTIVERecently, the authors investigated the normal course of fusion of minor lateral calvarial sutures on “3D” volume-rendered head CT reconstructions in pediatric trauma patients. While evaluating these reconstructions, they found many more fused sagittal sutures than expected given the currently accepted prevalence of sagittal craniosynostosis. In the present study, using the same set of head CT reconstructions, they investigated the course of fusion of the sagittal as well as the lambdoid, coronal, and metopic sutures.METHODSThey reviewed all volume-rendered head CT reconstructions performed in the period from 2010 through mid-2012 at Children’s Hospital Colorado for trauma patients aged 0–21 years. Each sagittal, lambdoid, coronal, or metopic suture was graded as open, partially fused, or fused. The cephalic index (CI) was calculated for subjects with fused and partially fused sagittal sutures.RESULTSAfter exclusions, 331 scans were reviewed. Twenty-one subjects (6%) had fusion or partial fusion of the sagittal suture. Four of the 21 also had fusion of the medial lambdoid and/or coronal sutures. In the 17 subjects (5%) with sagittal suture fusion and no medial fusion of adjacent sutures, the mean CI was 77.6. None of the 21 subjects had been previously diagnosed with craniosynostosis. Other than in the 21 subjects already mentioned, no other sagittal or lambdoid sutures were fused at all. Nor were other coronal sutures fused medially. Coronal sutures were commonly fused inferiorly early during the 2nd decade of life, and fusion progressed superiorly and medially as subjects became older; none were completely fused by 18 years of age. Fusion of the metopic suture was first seen at 3 months of life; fusion was often not complete until after 2 years.CONCLUSIONSThe sagittal and lambdoid sutures do not usually begin to fuse before 18 years of age. However, more sagittal sutures are fused before age 18 than expected given the currently accepted prevalence of craniosynostosis. This finding is of unknown significance, but likely many of them do not need surgery. The coronal suture often begins to fuse inferiorly early in the 2nd decade of life but does not usually complete fusion before 18 years of age. The metopic suture often starts to fuse by 3 months of age, but it may not completely fuse until after 2 years of age.
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Chim, Harvey, Sunil Manjila, Alan R. Cohen, and Arun K. Gosain. "Molecular signaling in pathogenesis of craniosynostosis: the role of fibroblast growth factor and transforming growth factor–β." Neurosurgical Focus 31, no. 2 (August 2011): E7. http://dx.doi.org/10.3171/2011.5.focus1197.
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The interplay of signals between dura mater, suture mesenchyme, and brain is essential in determining the fate of cranial sutures and the pathogenesis of premature suture fusion leading to craniosynostosis. At the forefront of research into suture fusion is the role of fibroblast growth factor and transforming growth factor–β, which have been found to be critical in the cell-signaling cascade involved in aberrant suture fusion. In this review, the authors discuss recent and ongoing research into the role of fibroblast growth factor and transforming growth factor–β in the etiopathogenesis of craniosynostosis.
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Regelsberger, Jan, Tobias Schmidt, Björn Busse, Julia Herzen, Michael Tsokos, Michael Amling, and Felix Beckmann. "Synchrotron–microcomputed tomography studies of normal and pathological cranial sutures: further insight." Journal of Neurosurgery: Pediatrics 5, no. 3 (March 2010): 238–42. http://dx.doi.org/10.3171/2009.10.peds09138.
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Object Both CT and high-frequency ultrasound have been shown to be reliable diagnostic tools used to differentiate normal cranial sutures from suture synostosis. In nonsynostotic plagiocephaly, overlapping of the bony plates and the so-called “sticky suture” is still controversial and is believed to represent a pathological fusion process. Synchrotron–microcomputed tomography (SRmCT) studies were undertaken to determine whether positional head deformities can be assumed to be true suture pathologies. Methods Morphological features and growth development of 6 normal cranial sutures between the ages of 3 and 12 months were analyzed histologically. Additionally 6 pathological sutures, including sagittal synostosis and nonsynostotic plagiocephaly (NSP), were compared with the group of normal sutures by histological and SRmCT studies. Synchrotron-microcomputed tomography is a special synchrotron radiation source with a high photon flux providing a monochromatic x-ray beam with a very high spatial resolution. Morphological characteristics of the different suture types were evaluated and bone density alongside the sutures was measured to compare the osseous structure of the adjacent bony plates of normal and pathological sutures. Results Histologically jointlike osseous edges of the normal sutures were seen in the 1st month of life and interlocking at the age of approximately 12 months. During this 1st year, bone thickness increases and suture width decreases. The SRmCT studies showed that: 1) sutures and adjacent bones in NSP are comparable to normal sutures in terms of their morphological aspects; 2) bone densities in the adjacent bony plates of NSP and normal sutures are not different; 3) thickening of the diploe with ridging of the bone in sagittal synostosis is associated with significantly higher bone density; 4) synostotic sutures are only partially fused but vary in their extent; and 5) nonfused sections in sagittal synostosis behave like normal sutures without any signs of pathological bone formation. Conclusions Sutures in patients with NSP were found without any morphological irregularities or different osseous structures alongside those compared with normal sutures. Thus, a true suture pathology or osseous change of the adjacent bony plates is highly unlikely in NSP. Even though the number of specimens is limited in this series, cranial suture fusion seems to start at one undetermined point and spread along the suture, whereas other parts of the same suture are not involved according to morphological aspects and bone density measurements of the adjacent bones. This theory may represent a dynamic fusion process completed over time but just starting too early.
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Moursi, Amr M., Phillip L. Winnard, Alissa V. Winnard, John M. Rubenstrunk, and Mark P. Mooney. "Fibroblast Growth Factor 2 Induces Increased Calvarial Osteoblast Proliferation and Cranial Suture Fusion." Cleft Palate-Craniofacial Journal 39, no. 5 (September 2002): 487–96. http://dx.doi.org/10.1597/1545-1569_2002_039_0487_fgfiic_2.0.co_2.
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Objective: Craniosynostosis has been associated with fibroblast growth factors (FGFs) and their receptors. The purpose of this study was to quantitatively determine the effect of FGF2 on rat calvarial osteoblasts and a rat cranial suture formation model. Design: Fetal rat calvarial osteoblasts were cultured with and without FGF2. Cell attachment and proliferation was determined by alamarBlue dye assay and cell morphology by toluidine-blue staining. In rat calvarial organ culture, postnatal day 15 rat calvariae with dura mater were placed in serum-free media with and without FGF2. A unique quantitative analysis of suture fusion was developed by obtaining measurements of suture bridging in histological serial sections at progressive stages of fusion. Results: Attachment for cells treated with FGF2 was similar to control. In contrast, proliferation was higher for cells treated with FGF2 while maintaining an osteoblastic morphology. After 5 days in organ culture, FGF2-treated posterior frontal sutures showed a dramatic increase in fusion, compared with untreated controls. This increased fusion was maintained throughout days 7 and 10 in culture. Also, fusion was enhanced on the dural side of the suture, as is normally observed in vivo, and the normal tissue architecture was maintained. Conclusions: These results indicate that FGF2 can promote rat osteoblast attachment and normal cell morphology as well as induce cell proliferation. In calvarial organ culture, FGF2 treatment produced an enhanced suture fusion. These results provide further support for a critical role for FGF2 in cranial suture development. These studies also present a new quantitative approach to evaluating the effect of suture-perturbing growth factors on cranial suture fusion.
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Moursi, Amr M., Phillip L. Winnard, Doug Fryer, and Mark P. Mooney. "Delivery of Transforming Growth Factor-β2-Perturbing Antibody in a Collagen Vehicle Inhibits Cranial Suture Fusion in Calvarial Organ Culture." Cleft Palate-Craniofacial Journal 40, no. 3 (May 2003): 225–32. http://dx.doi.org/10.1597/1545-1569_2003_040_0225_dotgfa_2.0.co_2.
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Objective To determine whether antibody perturbation of Tgf-β, delivered in a collagen gel, could inhibit cranial suture fusion. Design Attachment and proliferation of osteoblasts cultured on a collagen gel with or without anti-Tgf-β2 antibody were determined by AlamarBlue dye assay and cell morphology by toluidine-blue staining. In rat calvarial organ culture, collagen gel with and without anti-Tgf-β2 antibody was injected subperiosteally over the posterior frontal suture of postnatal day 15 rat calvariae. A quantitative analysis of suture fusion was used to measure suture bridging in histological serial sections at various time points. Results Attachment and proliferation for cells cultured on collagen gel with anti-Tgf-β2 antibody were similar to collagen gel controls. Although proliferation was lower than on tissue culture plastic, cells treated with anti-Tgf-β2 antibody maintained an osteoblastic morphology. After 7, 10, and 15 days in organ culture, anti-Tgf-β2 antibody treatment caused a reduction in the percent bridging of posterior frontal sutures, compared with controls. Sutures exposed to anti-Tgf-β2 antibody and fibroblast growth factor-2 concurrently did not show an inhibition of bony bridging. Conclusions These results support previous reports suggesting a role for Tgf-β2 in cranial suture fusion. In cell culture the collagen gel, both with and without anti-Tgf-β2 antibody, promoted similar osteoblast attachment, proliferation, and osteoblastic morphology. In organ culture anti-Tgf-β2 antibody was delivered in a bioactive state via a collagen gel to inhibit cranial suture fusion. Also, the results suggest that the inductive effect of fibroblast growth factor-2 is not dependent on Tgf-β2 activity. Together, these results provide further support for the role of Tgf-β2 in cranial suture fusion.
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Poisson, Elyane, James J. Sciote, Richard Koepsel, Gregory M. Cooper, Lynne A. Opperman, and Mark P. Mooney. "Transforming Growth Factor-β Isoform Expression in the Perisutural Tissues of Craniosynostotic Rabbits." Cleft Palate-Craniofacial Journal 41, no. 4 (July 2004): 392–402. http://dx.doi.org/10.1597/02-140.1.
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Objective To describe the expression patterns of the various transforming growth factor-β (Tgf-β) isoforms, known to be involved in suture development, in the perisutural tissues of rabbits with naturally occurring craniosynostosis and relate such differential expression to the pathogenesis of premature suture fusion. Method Twenty-one coronal sutures were harvested from six wild-type control New Zealand White rabbits and five rabbits with familial coronal suture synostosis at 25 days of age for histomorphometric and immunohistochemical analyses. Tgf-β isoform immunoreactivity was assessed using indirect immunoperoxidase procedures with specific antibodies. Results Synostosed sutures had significantly (p < .01) greater bone area and relatively more osteoblasts and osteocytes in the osteogenic fronts, compared with wild-type sutures. Tgf-β isoform immunoreactivity showed differential staining patterns between wild-type and synostosed perisutural tissues. In wild-type sutures, Tgf-β1 and Tgf-β3 immunoreactivity was significantly (p < .001) greater than Tgf-β2 staining in all perisutural tissues. In synostosed sutures, the opposite pattern was observed, with Tgf-β2 immunoreactivity significantly (p < .001) greater than Tgf-β1 and Tgf-β3 in the osteogenic fronts, dura mater, and periosteum. Conclusions Findings from this study suggest that an overexpression of Tgf-β2, either in isolation or in association with an underexpression of Tgf-β1 and Tgf-β3, may be related to premature suture fusion (craniosynostosis) in this pathological rabbit model. These abnormal expression patterns may be involved in premature suture fusion either through increased cell proliferation, decreased apoptosis of the osteoblasts or both at the osteogenic fronts.
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Mooney, Mark P., Jocelyn M. Shand, Anne Burrows, Timothy D. Smith, John F. Caccamese, Gregory M. Cooper, James J. Cray, et al. "Rescue of Premature Coronal Suture Fusion with TGF-β2 Neutralizing Antibody in Rabbits with Delayed-Onset Synostosis." Cleft Palate-Craniofacial Journal 55, no. 6 (February 26, 2018): 844–55. http://dx.doi.org/10.1597/16-065.
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Objectives: An overexpression of Tgf-β2 leads to calvarial hyperostosis and suture fusion in individuals with craniosynostosis. Inhibition of Tgf-β2 may help rescue fusing sutures and restore normal growth. The present study was designed to test this hypothesis. Design: Twenty-eight New Zealand White rabbits with delayed-onset coronal synostosis had radiopaque markers placed on either side of the coronal sutures at 10 days of age. The rabbits were randomly assigned to: (1) sham control rabbits (n = 10), (2) rabbits with control IgG (100 μg/suture) delivered in a collagen vehicle (n = 9), and (3) rabbits with Tgf-β2 neutralizing antibody (100 μg/suture) delivered in a collagen vehicle (n = 9). Longitudinal growth data were collected at 10, 25, 42, and 84 days of age. Sutures were harvested at 84 days of age for histomorphometry. Results: Radiographic analysis showed significantly greater ( P < .05) coronal suture marker separation, craniofacial length, cranial vault length, height, shape indices, cranial base length, and more lordotic cranial base angles in rabbits treated with anti-Tgf-β2 antibody than in controls at 42 and 84 days of age. Histologically, rabbits treated with anti-Tgf-β2 antibody at 84 days of age had patent and significantly ( P < .05) wider coronal sutures and greater sutural area compared to controls. Conclusions: These data support our hypothesis that antagonism of Tgf-β2 may rescue fusing coronal sutures and facilitate craniofacial growth in this rabbit model. These findings also suggest that cytokine therapy may have clinical significance in infants with progressive postgestational craniosynostosis.
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Cohen, M. Michael, and Sven Kreiborg. "Suture formation, premature sutural fusion, and suture default zones in Apert syndrome." American Journal of Medical Genetics 62, no. 4 (April 24, 1996): 339–44. http://dx.doi.org/10.1002/(sici)1096-8628(19960424)62:4<339::aid-ajmg3>3.0.co;2-m.
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Satya Sueningrat, Anak Agung Ngurah Bagus. "Diagnosis dan Penanganan Kraniosinostosis." Cermin Dunia Kedokteran 48, no. 12 (December 8, 2021): 718. http://dx.doi.org/10.55175/cdk.v48i12.1578.
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<p>Kraniosinostosis mengacu pada penutupan prematur satu atau lebih sutura tulang tengkorak. Akibatnya terjadi deformitas bentuk kepala karena kompensasi pertumbuhan sejajar dengan sutura yang menyatu. Insiden kraniosinostosis primer sekitar 1 per 2.000 kelahiran; penyebabnya sebagian besar belum diketahui. Diagnosis berdasarkan gambaran klinis yaitu mengecilnya ukuran tengkorak dan adanya perubahan bentuk tengkorak seiring dengan fusi sutura.</p><p>Craniosynostosis refers to the premature closure of one or more sutures that normally divide the skull bones. The result is a deformity of the head shape due to compensated growth parallel to the fused sutures. The incidence of primary craniosynostosis is approximately 1 per 2,000 births and the cause is mostly still unknown. Diagnosis is based on clinical features of skull size decrease and changes in skull shape with suture fusion.</p>
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Bradley, James P., Jamie P. Levine, Christopher Blewett, Thomas Krummel, Joseph G. McCarthy, and Michael T. Longaker. "Studies in Cranial Suture Biology:In VitroCranial Suture Fusion." Cleft Palate-Craniofacial Journal 33, no. 2 (March 1996): 150–56. http://dx.doi.org/10.1597/1545-1569(1996)033<0150:sicsbv>2.3.co;2.
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Francel, Paul C., T. S. Park, Jeffrey L. Marsh, and Bruce A. Kaufman. "Frontal plagiocephaly secondary to synostosis of the frontosphenoidal suture." Journal of Neurosurgery 83, no. 4 (October 1995): 733–36. http://dx.doi.org/10.3171/jns.1995.83.4.0733.
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✓ Frontal plagiocephaly may arise from either synostotic or deformational forces. Deformational causes of frontal plagiocephaly can be distinguished from synostotic causes by differences seen on physical examination, which can then be confirmed by skull x-ray films and if necessary three-dimensional computerized tomography (CT). Unilateral coronal synostosis is the main synostotic cause of frontal plagiocephaly, although it has also been seen with fusion of the frontozygomatic suture. In several syndromes presenting with bilateral coronal synostosis, fusion of the frontosphenoidal and frontoethmoidal sutures is also present. The authors report, for perhaps the first time, a case showing synostotic frontal plagiocephaly secondary to fusion of the frontosphenoidal suture alone. Although the phenotypic appearance is superficially similar to that seen in unilateral coronal synostosis, analysis of the cranial base shows markedly different effects: angulation of the anterior cranial base with respect to the posterior cranial base away from the synostotic side and angulation of the posterior cranial base with respect to the midpalatal suture also away from the synostotic side. In unilateral coronal synostosis, both angulations are toward the synostotic side. These effects on the cranial base alter its relationship to the cranial vault and the facial skeleton. Most important, frontal plagiocephaly secondary to fusion of the frontosphenoidal suture should not be overlooked as being deformational. Because this fusion is difficult or impossible to visualize by skull x-ray films, three dimensional CT must be obtained in cases that are not clearly identified as deformational plagiocephaly by physical examination.
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Whitton, Alaina, Sharon L. Hyzy, Chelsea Britt, Joseph K. Williams, Barbara D. Boyan, and Rene Olivares-Navarrete. "Differential spatial regulation of BMP molecules is associated with single-suture craniosynostosis." Journal of Neurosurgery: Pediatrics 18, no. 1 (July 2016): 83–91. http://dx.doi.org/10.3171/2015.12.peds15414.
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OBJECTIVE The aim of this study was to examine messenger RNA (mRNA) levels of bone morphogenetic protein (BMP) ligands, receptors, and soluble inhibitors in cells isolated from single-suture synostoses from fused coronal, metopic, sagittal, and lambdoid sutures. METHODS Cells were isolated from bone collected from patients undergoing craniotomies at Children's Healthcare of Atlanta. Real-time polymerase chain reaction was used to examine mRNA levels in cells isolated from fused sutures or patent sutures in comparison with levels in normal bone from the same patient. RESULTS Cells isolated from fused sutures in cases of sagittal and coronal synostosis highly expressed BMP2, while cells isolated from fused metopic or lambdoid synostosis expressed high BMP4. Noggin, a BMP inhibitor, was lower in fused sutures and had high expression in patent sutures. CONCLUSIONS These results suggest that BMPs and inhibitors play a significant role in the regulation of suture fusion as well in the maintenance of patency in the normal suture.
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Tedman, R. "Sex- and age-related variations in cranial measurements and suture closure in the Australian sea lion, Neophoca cinerea (Peron, 1816)." Australian Journal of Zoology 51, no. 5 (2003): 463. http://dx.doi.org/10.1071/zo02077.
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A total of 65 skulls of the Australian sealion, Neophoca cinerea, was examined to investigate the extent to which sexual dimorphism is reflected in cranial dimensions (n = 32) and skull growth, and to determine whether cranial sutures (n = 18) can be useful in age determination. All adult skull dimensions studied display significant sexual dimorphism. Skull growth ceases close to 4–7 years of age for females (Suture Fusion Rating, SFR 25–34) but skull growth in males continues until at least 16 years of age. In animals with a SFR ≥� 25, male skulls have a minimum condylobasal length of 272 mm, whereas female skulls have a maximum condylobasal length of 259 mm. The relatively early closure of the cranial vault sutures (cessation of brain growth) is balanced by the continued growth of the bony projections that provide muscle attachment (e.g. mastoid width). The later fusion of the snout and palate sutures corresponds with the continued growth of the snout and palate to match the prolonged growth of the mandibles. The upper sixth postcanine tooth was present in 43% of the adult female skulls, but only 15% of the adult male skulls. The data suggest that it may be possible to determine age(s) from examination of the sequence of fusion of cranial sutures as well as by calculation of an overall suture fusion rating for the skull.
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Aguilar, Oscar Josue Montes, Karmen Karina Alaniz Sida, Leonardo Álvarez Betancourt, Manuel Dufoo Olvera, Guillermo Ivan Ladewig Bernaldez, Ramón López López, Edith Oropeza Oropeza, and Héctor Alonso Tirado Ornelas. "Variability in wound closure technique in midline posterior lumbar fusion surgery. International survey and standardized closure technique proposal." Surgical Neurology International 13 (November 18, 2022): 534. http://dx.doi.org/10.25259/sni_872_2022.
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Background: Surgical wound complications represent an important risk factor, particularly in multilevel lumbar fusions. However, the literature regarding optimal wound closure techniques for these procedures is limited. Methods: We performed an online survey of 61 spinal surgeons from 11 countries, involving 25 different hospitals. The study included 26 neurosurgeons, 21 orthopedists, and 14 residents (Neurosurgery – 6 and orthopedics 8). The survey contained 17 questions on demographic information, closure techniques, and the use of drainage in posterior lumbar fusion surgery. We then developed a “consensus technique.” Results: The proposed standardized closure techniques included: (1) using subfascial gravity drainage (i.e., without suction) with drain removal for <50 ml/day or a maximum duration of 48 h, (2) paraspinal muscle, fascia, and supraspinous ligament closure using interrupted-X stitches 0 or 1 Vicryl or other longer-lasting resorbable suture (i.e., polydioxanone suture), (3) closure of subcutaneous tissue with interrupted inverted Vicryl 2-0 sutures in two planes for subcutaneous tissue greater >25 mm in depth, and (4) skin closure with simple interrupted nylon 3-0 sutures. Conclusion: There is great variability between closure techniques utilized for multilevel posterior lumbar fusion surgery. Here, we have described various standardized/evidence-based proven techniques for the closure of these wounds.
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Khaleel N, Angadi A V, Muralidhar P S, Shabiya M, Chandrika C, and Shaik Hussain Saheb. "Study on Morphometric Features of Coronal Suture Along with it Absence and Craniosynostosis." International Journal of Anatomy and Research 9, no. 4 (December 5, 2021): 8151–55. http://dx.doi.org/10.16965/ijar.2021.172.
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Background: Cranial sutures are syndesmosis between the cranial bones. The coronal suture is oblique in direction and extends between the frontal and the parietal bones. Craniosynostosis is a rare birth defect that occurs when the coronal suture in the skull fuses prematurely, but the brain continues to grow and develop. This leads to a misshapen head. There are a number of forms of this defect, such as coronal, sagittal, lambdoid, and metopic. Materials and Methods: Total 500 skulls were used for study, coronal suture length measured by thread method, distance between Nasion to bregma and midsupraorbital rim to coronal suture were measured. For finding skull with absence of coronal, sagittal, lambdoid, and metopic suture, we examined many skulls during routine osteology classes of Medical, Dental and other medical sciences students. Around 500 skull observed and we find only one skull with absence of left coronal suture completely. Results: The length of coronal suture was 24.8+1.4cm length, the distance between nasion to bregma was 126.7 +10.25 mm and Midsupraorbital rim to cranial suture was 102.76+8.64mm We have found only one skull with absence of coronal suture. Some of the skulls shows partly fusion of sagittal, coronal sutures. The skull with complete absence of coronal suture showing the features of other sutures clearly and right side of coronal suture is showing the complete suture. The skull was not damaged and it is in perfect condition which was using by students for their osteology study. Conclusion: We found the skull with absence of left coronal suture, which may resulted due to craniosynostosis. It may be due to hot climate in India also might be resulted for absence of suture. KEY WORDS: Birth defect, Skull, Coronal suture, Craniosynostosis.
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Perlyn, Chad A., Gillian Morriss-Kay, Tron Darvann, Marissa Tenenbaum, and David M. Ornitz. "Model for the Pharmacologic Treatment of Crouzon Syndrome." Neurosurgery 59, no. 1 (July 1, 2006): 210–15. http://dx.doi.org/10.1227/01.neu.0000224323.53866.1e.
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Abstract OBJECTIVE Crouzon syndrome is caused by mutations in FGFR2 leading to constitutive activation of receptors in the absence of ligand binding. The syndrome is characterized by premature fusion of the cranial sutures that leads to abnormal skull shape, restricted brain growth, and increased intracranial pressure. Surgical remodeling of the cranial vault is currently used to treat affected infants. The purpose of this study was to develop a pharmacologic strategy using tyrosine kinase inhibition as a novel treatment for craniosynostotic syndromes caused by constitutive FGFR activation. METHODS Characterization of cranial suture fusion in Fgfr2C342Y/+ mutant mice, which carry the most common Crouzon mutation, was performed using MicroCT analysis from embryogenesis through maturation. Whole calvarial cultures from wild-type and Fgfr2C342Y/+ mice were then established and calvaria cultured for 2 weeks in the presence of DMSO control or PD173074, an FGFR tyrosine kinase inhibitor. Paraffin sections were prepared to show suture morphology and calcium deposition. RESULTS In untreated Fgfr2C342Y/+ cultures, the coronal suture fused bilaterally with loss of overlap between the frontal bone and parietal bone. Calvaria treated with PD173074 (2 (M) showed patency of the coronal suture and were without evidence of any synostosis. CONCLUSION: We report the successful use of PD173074 to prevent in-vitro suture fusion in a model for Crouzon syndrome. Further studies are underway to develop an in-vivo treatment protocol as a novel therapeutic modality for FGFR associated craniosynostotic syndromes.
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Johnston, Stephen S., Brian Po-Han Chen, Giovanni A. Tommaselli, Simran Jain, and John B. Pracyk. "Barbed and conventional sutures in spinal surgery patients: an economic and clinical outcomes comparison." Journal of Wound Care 29, Sup5a (May 1, 2020): S9—S20. http://dx.doi.org/10.12968/jowc.2020.29.sup5a.s9.
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Objective: To compare economic and clinical outcomes of barbed sutures versus conventional sutures alone in wound closure for patients undergoing spinal surgery. Method: A retrospective study using the Premier Healthcare Database. The database was searched for patients who underwent elective inpatient spinal surgery (fusion or laminectomy) for a spinal disorder between 1 January 2014 and 30 June 2018 (first=index admission). Using billing records for medical supplies used during the index admission, patients were classified into mutually-exclusive groups: patients with any use of STRATAFIX (Ethicon, US) knotless tissue control devices (barbed sutures group); or patients with use of conventional sutures alone (conventional sutures group). Outcomes included the index admission's length of stay, total and subcategories of hospital costs, non-home discharge, operating room time (ORT, minutes), wound complications and readmissions within ≤90 days. Propensity score matching and generalised estimating equations were used to compare outcomes between the study groups. Results: After matching, 3705 patients were allocated to each group (mean age=61.5 years [standard deviation, SD±12.9]; 54% were females). Compared with the conventional suture group, the barbed suture group had significantly lower mean ORT (239±117 minutes, versus 263±79 minutes conventional sutures, p=0.015). Operating room costs were also siginificantly lower in the barbed suture group ($6673±$3976 versus $7100±$2700 conventional sutures, p=0.020). Differences were statistically insignificant for other outcomes (all p>0.05). Subanalysis of patients undergoing fusions of ≥2 vertebral joints yielded consistent results. Conclusion: In this study, wound closure incorporating barbed sutures was associated with lower ORT and operating room costs, with no significant difference in wound complications or readmissions, when compared with conventional sutures alone.
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Beuriat, Pierre-Aurélien, Alexandru Szathmari, Julie Chauvel-Picard, Arnaud Gleizal, Christian Paulus, Carmine Mottolese, and Federico Di Rocco. "Coronal and lambdoid suture evolution following total vault remodeling for scaphocephaly." Neurosurgical Focus 50, no. 4 (April 2021): E4. http://dx.doi.org/10.3171/2021.1.focus201004.
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OBJECTIVE Different types of surgical procedures are utilized to treat craniosynostosis. In most procedures, the fused suture is removed. There are only a few reports on the evolution of sutures after surgical correction of craniosynostosis. To date, no published study describes neosuture formation after total cranial vault remodeling. The objective of this study was to understand the evolution of the cranial bones in the area of coronal and lambdoid sutures that were removed for complete vault remodeling in patients with sagittal craniosynostosis. In particular, the investigation aimed to confirm the possibility of neosuture formation. METHODS CT images of the skulls of children who underwent operations for scaphocephaly at the Hôpital Femme Mère Enfant, Lyon University Hospital, Lyon, France, from 2004 to 2014 were retrospectively reviewed. Inclusion criteria were diagnosis of isolated sagittal synostosis, age between 4 and 18 months at surgery, and availability of reliable postoperative CT images obtained at a minimum of 1 year after surgical correction. Twenty-six boys and 11 girls were included, with a mean age at surgery of 231.6 days (range 126–449 days). The mean interval between total vault reconstruction and CT scanning was 5.3 years (range 1.1–12.2 years). RESULTS Despite the removal of both the coronal and lambdoid sutures, neosutures were detected on the 3D reconstructions. All combinations of neosuture formation were seen: visible lambdoid and coronal neosutures (n = 20); visible lambdoid neosutures with frontoparietal bony fusion (n = 12); frontoparietal and parietooccipital bony fusion (n = 3); and visible coronal neosutures with parietooccipital bony fusion (n = 2). CONCLUSIONS This is the first study to report the postoperative skull response after the removal of normal patent sutures following total vault remodeling in patients with isolated sagittal synostosis. The reappearance of a neosuture is rather common, but its incidence depends on the type of suture. The outcome of the suture differs with the incidence of neosuture formation between these transverse sutures. This might imply genetic and functional differences among cranial sutures, which still have to be elucidated.
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Singh, Neetu. "A CADAVERIC STUDY OF SEEMANTA MARMA." International Journal of Research in Ayurveda and Pharmacy 13, no. 5 (October 15, 2022): 67–69. http://dx.doi.org/10.7897/2277-4343.1305125.
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Background: The marma sharira is a prime territory of Rachana sharira. Sushruta had elaborated marma sharira at a certain depth. Marma (vital area) is described in the Hindu scripture Atharva Veda. During the Vedic era, the Marma Sharira had particular importance in the case of war field. The seemanta marma is shira marma, kalantara pranahara. The nature of this marma is sandhi marma. Aims: There are very few studies regarding the cadaveric study of seemanta marma. This study aims to identify the possible anatomical structure and analyze those structures. Perhaps it could be helpful for future scholars of Ayurveda. Material and method: The review was performed based on traditional Ayurvedic classics and contemporary medical sciences, journals, publications, articles, e-journals etc. The region of seemanta marma and surrounding area was dissected, and complete anatomical study was done. Discussion: The term seemanta indicates that the bony joint is present in the skull region. The joints present in the skull region are mainly sutural joints and fibrous, which provide malleable head quality. There are five major sutures in adult like coronal suture, sagittal suture, lambdoid suture and two squamous sutures, the frontal sutures present in infant and children. Conclusion: It has a significant role during delivery and brain development, which allows normal vaginal birth of the head. It also offers normal cranial growth by proper fusion if the premature fusion of sutures occurs (craniosynostosis), which results in cranial malformation.
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Ruan, W. H., J. N. Winger, J. C. Yu, and J. L. Borke. "Induced Premaxillary Suture Fusion: Class III Malocclusion Model." Journal of Dental Research 87, no. 9 (September 2008): 856–60. http://dx.doi.org/10.1177/154405910808700901.
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The etiology of class III malocclusion remains unknown. The present study investigates the relationship between craniofacial morphology and premaxillary suture fusion to test the hypothesis that class III malocclusion may be related to premaxillary suture fusion. Cyanoacrylate was applied to immobilize the left premaxillary suture in the experimental group. Sham surgeries in rats were used for controls. Dental impressions and radiographs were taken before and after surgery for comparison of craniofacial differences between groups. Overall cranial base lengths, craniofacial widths, and craniofacial angulations related to the anterior base showed significant differences between groups. At the end of the experiment, the growth of the snout in the experimental group was inhibited and deviated to the treated side, while no obvious change was seen in the control group. The results show that induced premaxillary suture fusion can affect craniofacial morphology and indicate that premature premaxillary suture fusion may result in class III malocclusion.
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Bajwa, Mandeep, Dilip Srinivasan, Hiroshi Nishikawa, Desiderio Rodrigues, Guirish Solanki, and Nicholas White. "Normal Fusion of the Metopic Suture." Journal of Craniofacial Surgery 24, no. 4 (July 2013): 1201–5. http://dx.doi.org/10.1097/scs.0b013e31829975c6.
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Runyan, Christopher M., Wen Xu, Michael Alperovich, Jonathan P. Massie, Gina Paek, Benjamin A. Cohen, David A. Staffenberg, Roberto L. Flores, and Jesse A. Taylor. "Minor Suture Fusion in Syndromic Craniosynostosis." Plastic and Reconstructive Surgery 140, no. 3 (September 2017): 434e—445e. http://dx.doi.org/10.1097/prs.0000000000003586.
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Roe, Benson B., and Paul B. Kelly. "Follow-up on Suture Knot Fusion." Annals of Thoracic Surgery 40, no. 6 (December 1985): 636. http://dx.doi.org/10.1016/s0003-4975(10)60371-2.
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Angelieri, Fernanda, Lorenzo Franchi, Lucia H. S. Cevidanes, Bruno Bueno-Silva, and James A. McNamara Jr. "Prediction of rapid maxillary expansion by assessing the maturation of the midpalatal suture on cone beam CT." Dental Press Journal of Orthodontics 21, no. 6 (December 2016): 115–25. http://dx.doi.org/10.1590/2177-6709.21.6.115-125.sar.
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ABSTRACT Rapid maxillary expansion (RME) primarily involves the mechanical opening of the midpalatal suture of the maxillary and palatine bones. The fusion of the midpalatal suture determines the failure of RME, a common event in late adolescents and young adults. Recently, the assessment of the maturation of midpalatal suture as viewed using cone beam computed tomography (CBCT) has been introduced. Five maturational stages of the midpalatal suture have been presented: Stage A = straight high-density sutural line, with no or little interdigitation; Stage B = scalloped appearance of the high-density sutural line; Stage C = two parallel, scalloped, high-density lines that lie close to each other, separated in some areas by small low-density spaces; Stage D = fusion of the palatine bone where no evidence of a suture is present; and Stage E = complete fusion that extends also anteriorly in the maxilla. At Stage C, less skeletal response would be expected than at Stages A and B, as there are many bony bridges along the suture. For patients at Stages D and E, surgically assisted RME would be necessary, as the fusion of the midpalatal suture already has occurred either partially or totally. This diagnostic method can be used to estimate the prognosis of the RME, mainly for late adolescents and young adults for whom this procedure is unpredictable clinically.
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Tombeng, Marthinson Andrew, and I. Wayan Niryana. "Open suturectomy management in craniosynostosis of bilateral coronal and metopic suture." Neurologico Spinale Medico Chirurgico 4, no. 1 (March 31, 2021): 15–18. http://dx.doi.org/10.36444/nsmc.v4i1.145.
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Craniosynostosis is a cranial deformation that is characterized by the premature fusion of one or more of the cranial sutures. Synostosis of multiple suture is a rare case and can be treated with open suturectomy procedure which is one of the surgical management by removing the fused suture with the purpose to allow the constricted area to expand with the growing brain. We present a case of a 2-month-old male infant with abnormal head shape since birth with a non-contrast 3D computed tomography (CT) scan of the head confirmed closure of the bilateral coronal and metopic suture. Open suturectomy was performed with no post operative complications. Open suturectomy technique can be performed in the management of multisutural craniosynostosis as indicated. The diagnosis of which suture are affected, the timing of surgery, and the prevention of surgical complication such as excessive blood loss are the important factors need to be considered.
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Hashiba, Kiyoshi, Carlos Alberto Cappellanes, Pablo Rodrigo de Siqueira, Antonio Carlos Conrado, Bruno Ribeiro, Fernando Pavinato Marson, and Bruno Gregnanin Pedron. "Applying basic principles of surgery may pave the way for more effective endoscopic bariatric techniques." Endoscopy International Open 09, no. 07 (June 17, 2021): E1049—E1054. http://dx.doi.org/10.1055/a-1451-3854.
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Abstract Background and study aims In the last decade, gastroenterologists have been attempting to use endoscopy to reproduce the great success of traditional surgical suture techniques. Despite recent advances, we still lack a reliable method that results in a permanent suture with minimal incidence of suture failure. This was an experimental study in pigs with an innovative technique that applied basic surgical concepts to endoscopy to evaluate the effectiveness of a novel suture technique. Methods The procedures were performed on six live pigs under general anesthesia. Endoscopic mucosal resection (EMR) first was performed in the stomach, exposing the submucosal or muscularis propria layers. A novel device, a transparent chamber cap (DASE), was developed to aspirate the gastric wall, allowing the sutures to reach deep layers. The aspiration was performed with a standard gastroscope to which the novel cap was distally attached. Three sutures aligned were defined as a plication. Each pig received two or three plications and was placed on a liquid diet for 14 days after the procedure. The pigs were sacrificed at 4 and 8 weeks and the sutures were reviewed. Results The technique was feasible in all animals. Of 16 plications, only one failed. One perforation occurred after EMR. There were no other complications or adverse events. Permanent fusion of the gastric wall was confirmed by histology in all cases. Conclusions This study showed that basic principles of surgery can be applied endoscopically to ensure a permanent suture with reduced chances of failure. These findings can help to pave the way for more effective bariatric endoscopic techniques.
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Drage, Harriet B., Lukáš Laibl, and Petr Budil. "Postembryonic development of Dalmanitina, and the evolution of facial suture fusion in Phacopina." Paleobiology 44, no. 4 (November 2018): 638–59. http://dx.doi.org/10.1017/pab.2018.31.
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AbstractA large sample of postembryonic specimens of Dalmanitina proaeva elfrida and D. socialis from the Upper Ordovician (Sandbian to Katian) Prague Basin allows for the first reasonably complete ontogenetic sequence of Dalmanitoidea (Phacopina). The material provides an abundance of morphological information, including well-preserved marginal spines in protaspides and meraspides, and hypostome external surfaces throughout. The development of D. proaeva elfrida is unusual due to variability in timing of the first trunk articulation. This broadens our developmental understanding of Phacopina, a diverse group of phacopid trilobites, and also allows us to study the evolution of their specializations in exoskeletal molting behavior. Adult phacopines, unlike most other trilobites, had fused facial sutures. This means that rather than molting through the sutural gape mode, characterized by opening of the facial sutures and separation of the librigenae, they disarticulated the entire cephalon in Salter’s mode of molting. For other phacopine clades (Phacopoidea) the transition to Salter’s mode occurs during the meraspid period or at the onset of holaspis, and its developmental timing is intraspecifically fixed. However, owing to the large sample size, we can see that facial suture fusion likely occurred later in Dalmanitina, usually during the holaspid period, and was intraspecifically variable with holaspides of varying sizes showing unfused sutures. Further, D. proaeva elfrida specimens showed an initial librigenal–rostral plate fusion event, where the librigenae began as separate entities but appear fused with the rostral plate as one structure (the “lower cephalic unit”) from M1, and are discarded as such during molting. Dalmanitoidea is considered to represent the first phacopine divergence, occurring earliest in the fossil record. This material therefore provides insight into how linked morphologies and behaviors evolved, potentially suggesting the timing of facial suture fusion in Phacopina moved earlier during development and became more intraspecifically fixed over geological time.
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Mooney, Mark P., Annie M. Burrows, Timothy D. Smith, H. Wolfgang Losken, Lynne A. Opperman, Jason Dechant, Amy M. Kreithen, et al. "Correction of Coronal Suture Synostosis Using Suture and Dura Mater Allografts in Rabbits with Familial Craniosynostosis." Cleft Palate-Craniofacial Journal 38, no. 3 (May 2001): 206–25. http://dx.doi.org/10.1597/1545-1569_2001_038_0206_cocssu_2.0.co_2.
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Objective: Resynostosis following surgical correction of craniosynostosis is a common clinical correlate. Recent studies suggest that the dura mater is necessary to maintain suture patency. It has also been hypothesized that dura mater from synostotic individuals may provide aberrant biochemical signals to the osteogenic fronts of the calvaria, which result in premature suture fusion and subsequent resynostosis following surgery. This study was designed to test this hypothesis by surgically manipulating the coronal suture and dura mater in rabbits with familial craniosynostosis to prevent postsurgical resynostosis. Design: Craniofacial growth and histomorphometric data were collected from 129 rabbits: 72 normal controls and 57 rabbits with bilateral coronal suture synostosis (15 unoperated on controls; 13 surgical controls; 9 dura mater transplant only; 10 suture transplant only; and 10 suture and dura mater transplant). At 10 days of age, all rabbits had radiopaque amalgam markers placed on either side of the coronal, frontonasal, and anterior lambdoidal sutures. At 25 days of age, 42 synostosed rabbits had a 3 to 5-mm wide coronal suturectomy. Coronal sutures and/or underlying dura mater allografts were harvested from same-aged, wild-type, isohistogenic control rabbits and transplanted onto the dura mater of synostosed host rabbits. Serial radiographs were taken at 10, 25, 42, and 84 days of age, and the suturectomy sites were harvested at 84 days of age in 44 rabbits and serially sectioned for histomorphometric examination. Results: Results revealed that cranial vault growth was significantly (p < .05) improved following surgical release of the fused coronal suture compared with synostosed rabbits who were not operated on but was still significantly different (p < .05) from that of normal control rabbits. By 84 days of age, significant (p < .05) differences were noted in calvarial suture marker separation, cranial vault shape indices, and cranial base angles between rabbits with and without dura mater allografts, probably as a result of resynostosis of the suturectomy site or suture-only allografts. Qualitative histological examination revealed that at 84 days of age rabbits with suture and dura allografts had patent coronal sutures, suture-only allografts had fused coronal sutures with extensive endosteal hyperostosis, dura mater–only allografts had some new bone in the suturectomy site that resembled rudimentary osteogenic fronts, and suturectomy controls had extensive endosteal bone formation and resynostosis of the suturectomy site. Significantly (p < .05) more bone was found in the suturectomy sites of rabbits without dura mater allografts compared with rabbits with dura mater allografts. Conclusions: Results support the initial hypothesis that normal dura mater allografts will maintain suture or suturectomy site patency and allow unrestricted craniofacial growth. However, it is still unclear whether the dura mater from normal rabbits was providing biochemical signals to the transplanted sutures or suturectomy sites or simply acting as a barrier to prevent abnormal biochemical signals from the dura mater of synostosed rabbits from reaching the calvaria. The clinical and therapeutic implications of these procedures are discussed.
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Sivakumaran, Rajitha. "The Impact of Sex and Ancestry on Cranial Sutures in the Hamann Todd Collection." NEXUS: The Canadian Student Journal of Anthropology 22 (November 11, 2014): 68–80. http://dx.doi.org/10.15173/nexus.v22i1.11.
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Cranial suture closure has been regarded as an unreliable method for age estimation due to the large amount ofvariability in the commencement, progression and termination of fusion. The Hamann Todd Osteological Collectionwas used to examine the sagittal, coronal and lambdoid sutures in an attempt to determine the impact of sex and ancestry on synostosis. The sagittal does not appear to be impacted by sex, but in the coronal and lambdoid sutures,significant sex-based differences were noted. Generally, females exhibited greater progression than males, butsynostosis was more strongly related to age in males. Stronger age-score correlations were present in black individuals compared to white individuals. This questions the application of current cranial aging methods, which do not address sex- and population-based differences in the commencement, progression and termination ofsutural fusion.
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Lobb, David C., Smruti K. Patel, Brian S. Pan, and Jesse Skoch. "Partial suturectomy for phenotypical craniosynostosis caused by incomplete fusion of cranial sutures: a novel surgical solution." Neurosurgical Focus 50, no. 4 (April 2021): E6. http://dx.doi.org/10.3171/2021.1.focus201024.
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OBJECTIVE Patients presenting with head shape changes phenotypical for craniosynostosis may have incomplete fusion of the involved sutures. The surgical literature is lacking in appropriate management strategies for these patients. In this paper, the authors evaluate their experience with a novel treatment strategy: suturectomy of only the fused portion followed by helmeting therapy in patients with skull deformity secondary to incomplete suture synostosis. METHODS Patients with craniosynostosis with incomplete suture fusion requiring operative intervention between 2018 and 2020 were included for evaluation. Patients were selected for partial suturectomy if the patent portion of the suture had a normal appearance. All patients underwent craniectomy of the involved portion of the synostosed suture. Intraoperative ultrasound was used to reassess the degree of fusion at the time of surgery and incision planning. A 2- to 3-cm strip craniectomy was performed under direct visualization through a single minimal access incision. Postoperative helmeting was utilized for all patients. Demographic and perioperative data were collected, including laser scan data in the form of cranial index (CI) and cranial vault asymmetry (CVA), defined as the difference between two diagonal measurements, from the frontozygomaticus to the opposite eurion. RESULTS Four males and 1 female with a mean age of 2.8 months (range 1.1–3.9 months) at presentation were included. All patients had incomplete sagittal synostosis (one patient also had an incomplete left lambdoid synostosis and another had an incomplete left coronal synostosis). The mean age at surgery was 3.5 months (range 2.0–4.7 months) without any major complications. All patients were compliant with postoperative helmeting. The average age at the last follow-up was 12.8 months (range 5.3–23.7 months) with a mean follow-up duration of 9.3 months (range 0.5–19.6 months). Final laser scan evaluations were available for 3 patients and showed an improvement of the CI from an average of 71.3 (range 70–73) to 84.3 (range 82–86). The CVA improved from an average of 9.67 mm (range 2–22 mm) to 1.67 mm (range 1–2 mm). CONCLUSIONS Minimally invasive direct excision of the involved portion of fused cranial sutures followed by helmet therapy for phenotypical craniosynostosis is a safe and effective treatment strategy. This technique is suitable for very young patients and appears to offer similar outcomes to complete suturectomy. Further studies are required to see if this approach reduces the deformity severity for patients requiring vault remodeling later in life.
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Moazen, Mehran, Neil Curtis, Paul O'Higgins, Marc E. H. Jones, Susan E. Evans, and Michael J. Fagan. "Assessment of the role of sutures in a lizard skull: a computer modelling study." Proceedings of the Royal Society B: Biological Sciences 276, no. 1654 (September 2, 2008): 39–46. http://dx.doi.org/10.1098/rspb.2008.0863.
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Sutures form an integral part of the functioning skull, but their role has long been debated among vertebrate morphologists and palaeontologists. Furthermore, the relationship between typical skull sutures, and those involved in cranial kinesis, is poorly understood. In a series of computational modelling studies, complex loading conditions obtained through multibody dynamics analysis were imposed on a finite element model of the skull of Uromastyx hardwickii , an akinetic herbivorous lizard. A finite element analysis (FEA) of a skull with no sutures revealed higher patterns of strain in regions where cranial sutures are located in the skull. From these findings, FEAs were performed on skulls with sutures (individual and groups of sutures) to investigate their role and function more thoroughly. Our results showed that individual sutures relieved strain locally, but only at the expense of elevated strain in other regions of the skull. These findings provide an insight into the behaviour of sutures and show how they are adapted to work together to distribute strain around the skull. Premature fusion of one suture could therefore lead to increased abnormal loading on other regions of the skull causing irregular bone growth and deformities. This detailed investigation also revealed that the frontal–parietal suture of the Uromastyx skull played a substantial role in relieving strain compared with the other sutures. This raises questions about the original role of mesokinesis in squamate evolution.
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Hermann, Christopher D., Megan A. Richards, Regina Chang, Rene Olivares-Navarrete, Joseph K. Williams, Robert E. Guldberg, Brani Vidakovic, Zvi Schwartz, and Barbara D. Boyan. "Biphasic Fusion of the Murine Posterior Frontal Suture." Plastic and Reconstructive Surgery 131, no. 4 (April 2013): 727–40. http://dx.doi.org/10.1097/prs.0b013e3182827585.
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Warren, Stephen M., Lisa J. Brunet, Richard M. Harland, Aris N. Economides, and Michael T. Longaker. "The BMP antagonist noggin regulates cranial suture fusion." Nature 422, no. 6932 (April 2003): 625–29. http://dx.doi.org/10.1038/nature01545.
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Im, Michael J., Jonathan M. Winograd, Paul N. Manson, and Craig A. Vander Kolk. "Iron-Induced Rat Coronal Suture Fusion In Vitro." Journal of Craniofacial Surgery 8, no. 4 (July 1997): 262–69. http://dx.doi.org/10.1097/00001665-199707000-00007.
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Cray, James, Gregory M. Cooper, Mark P. Mooney, and Michael I. Siegel. "Ectocranial suture fusion in primates: pattern and phylogeny." Journal of Morphology 275, no. 3 (October 21, 2013): 342–47. http://dx.doi.org/10.1002/jmor.20218.
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Bradley, James P., Jamie P. Levine, Joseph G. McCarthy, and Michael T. Longaker. "Studies in Cranial Suture Biology: Regional Dura Mater Determines in Vitro Cranial Suture Fusion." Plastic and Reconstructive Surgery 100, no. 5 (October 1997): 1091–99. http://dx.doi.org/10.1097/00006534-199710000-00001.
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Weis, K., and V. S. Polito. "Cytochemistry and ultrastructure of the dehiscence zone of almond (Prunus dulcis) fruits." Canadian Journal of Botany 68, no. 1 (January 1, 1990): 63–72. http://dx.doi.org/10.1139/b90-010.
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At maturity, the almond pericarp dehisces along the ventral suture, a region that originates by fusion of epidermal cells and subsequently differentiates into a separation layer. We have characterized the ontogeny of the fusion–dehiscence zone with emphasis on cell wall characteristics by using cytochemical methods for detection of pectin, cutin, cellulose, and lignin to examine the middle lamellae and primary and secondary walls in dehiscence-zone cells. Carpel margins became united postgenitally along opposing epidermal layers giving rise to the suture. Fusion-zone cells host epidermal characteristics, elaborated broad pectinaceous walls, and ultimately formed a discrete band of cells that dehisced along the original line of fusion by dissolution of cell wall pectins. Treatment of treeborne fruits with 1 ppm ethylene gas or extraction of sectioned material with cell wall hydrolases resulted in cell wall changes similar to those in predehiscent fruits.
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Narula, Khyati, Siddarth Shetty, Nandita Shenoy, and N. Srikant. "Evaluation of the degree of fusion of midpalatal suture at various stages of cervical vertebrae maturation." APOS Trends in Orthodontics 9 (December 31, 2019): 235–40. http://dx.doi.org/10.25259/apos_76_2019.
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Introduction: Rapid palatal expansion was initially done during circumpubertal age. However, the correct evidence suggests visualizing the patency of midpalatal suture (MPS) radiologically at different chronological age as there can be early or late fusion of suture in some cases. Objective: This study was aimed at assessing the fusion of MPS at different stages of cervical vertebrae maturation and to find any correlation between them from the patients of two South Indian districts. Design and Setting: A total of 144 subjects aged 10–20 years were included in our study. Materials and Methods: Skeletal age based on cervical vertebrae was assessed from lateral cephalograms. MPS staging was done by two observers using cone-beam computed tomography at 2-time intervals. Inter- and intra- examiner reliability for suture staging was analyzed by kappa statistics. Correlation of skeletal age to sutural maturation was done using Kendall’s tau-b test. Results: A fair agreement was obtained by kappa test for inter (0.313) and intraexaminer reliability (0.219 for first and 0.451 for the second observer) for 144 subjects. Kendall’s tau-b test showed a significant correlation between skeletal age and suture maturation, with the maximum association between CS 4 skeletal age and Stage C of MPS, with P < 0.001. Conclusion: A strong correlation was found between skeletal age and sutural fusion. Predominantly, Stage C coincided with CS 4 with greater gender predilection toward females.
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Adamo, Matthew A., and Ian F. Pollack. "A single-center experience with symptomatic postoperative calvarial growth restriction after extended strip craniectomy for sagittal craniosynostosis." Journal of Neurosurgery: Pediatrics 5, no. 1 (January 2010): 131–35. http://dx.doi.org/10.3171/2009.8.peds09227.
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Object Sagittal synostosis accounts for the most common form of craniosynostosis, occurring with an incidence of 1 in 2000–5000 live births. In most cases of single-suture, nonsyndromic sagittal synostosis, a single operation is all that is required to achieve a reasonable cosmetic result. However, there are a number of patients who may experience symptomatic postoperative calvarial growth restriction secondary to fibrosis of newly formed bone and pericranium that replace the surgically removed sagittal suture, or due to fusion of other previously open sutures leading to increased intracranial pressure, necessitating a second operation. Methods A retrospective review was conducted of all cases involving infants who had undergone an extended sagittal strip craniectomy with bilateral parietal wedge osteotomies at our institution between 1990 and 2006 for single-suture, nonsyndromic sagittal craniosynostosis. The frequency with which subsequent operations were required for cranial growth restriction was then defined. Results There were a total of 164 patients with single-suture nonsyndromic sagittal synostosis. Follow-up data were available for 143 of these patients. The average age at time of initial operation was 5.25 months, and the mean duration of follow-up was 43.85 months. There were 2 patients (1.5%) who required a second operation for symptomatic postoperative calvarial growth restriction. Conclusions Recurrence of synostosis with resultant increased intracranial pressure in cases of single-suture, nonsyndromic sagittal craniosynostosis is an uncommon event, but does occur sporadically and unpredictably. Therefore, we recommend routine neurosurgical follow up for at least 5 years, with regular ophthalmological examinations to assess for papilledema.
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Audibert, Priscila, César Jaeger Drehmer, Daniel Danilewicz, and Larissa Rosa de Oliveira. "Do cranial suture age and growth layer groups correlate in South American pinnipeds?" Journal of the Marine Biological Association of the United Kingdom 98, no. 3 (January 23, 2017): 635–44. http://dx.doi.org/10.1017/s0025315416001739.
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Age is one of the most important life history parameters required to understand the dynamics of mammalian populations. Growth Layers Groups (GLGs) are incremental units of calcified tissue in the teeth (dentine and cementum), which represent a pattern of cyclical deposition that can be counted. However, the estimation of absolute age in GLGs demands a skull with teeth, the permission to destroy part of a tooth, equipment to cut the teeth, and experienced GLGs readers. In 1954 Sivertsen proposed an alternative method using cranial suture age (CSA) to establish age categories. However, there are no studies validating the CSA in relation to GLGs. Thus, this study examined whether there is a correlation between age categories proposed by the CSA and chronological age in years from GLGs of South American fur seals (Arctocephalus australis) (N = 52) and of South American sea lions (Otaria flavescens) (N = 37). 93% of the skulls of A. australis and 83.8% of O. flavescens corresponded accurately to the age in years estimated by each cranial suture age range. These results indicated the existence of high correspondence between the CSA and the GLGs age (r: 0.491 for A. australis and r: 0.675 for O. flavescens). However, an adaptation to Sivertsen's method is recommended: using only eight sutures (excluding the premaxillary-maxillary suture for CSA analysis, due to its late fusion), and updating the intervals for cranial sutures, that correspond to 16–32 = adults, 11–15 = young and 8–10 = pups.
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Helfer, Talita Micheletti, Alberto Borges Peixoto, Gabriele Tonni, and Edward Araujo Júnior. "Craniosynostosis: prenatal diagnosis by 2D/3D ultrasound, magnetic resonance imaging and computed tomography." Medical Ultrasonography 18, no. 3 (September 18, 2016): 378. http://dx.doi.org/10.11152/mu.2013.2066.183.3du.
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Craniosynostosis is defined as the process of premature fusion of one or more of the cranial sutures. It is a common condition that occurs in about 1 to 2,000 live births. Craniosynostosis may be classified in primary or secondary. It is also classified as nonsyndromic or syndromic. According to suture commitment, craniosynostosis may affect a single suture or multiple sutures. There is a wide range of syndromes involving craniosynostosis and the most common are Apert, Pffeifer, Crouzon, Shaethre-Chotzen and Muenke syndromes. The underlying etiology of nonsyndromic craniosynostosis is unknown. Mutations in the fibroblast growth factor (FGF) signalling pathway play a crucial role in the etiology of craniosynostosis syndromes. Prenatal ultrasound`s detection rate of craniosynostosis is low. Nowadays, different methods can be applied for prenatal diagnosis of craniosynostosis, such as two-dimensional (2D) and three-dimensional (3D) ultrasound, magnetic resonance imaging (MRI), computed tomography (CT) scan and, finally, molecular diagnosis. The presence of craniosynostosis may affect the birthing process. Fetuses with craniosynostosis also have higher rates of perinatal complications. In order to avoid the risks of untreated craniosynostosis, children are usually treated surgically soon after postnatal diagnosis.
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Roth, Douglas A., James P. Bradley, Jamie P. Levine, Heather F. McMullen, Joseph G. McCarthy, and Michael T. Longaker. "Studies in Cranial Suture Biology: Part II. Role of the Dura in Cranial Suture Fusion." Plastic & Reconstructive Surgery 97, no. 4 (April 1996): 693–99. http://dx.doi.org/10.1097/00006534-199604000-00001.
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Siismets, Erica M., and Nan E. Hatch. "Cranial Neural Crest Cells and Their Role in the Pathogenesis of Craniofacial Anomalies and Coronal Craniosynostosis." Journal of Developmental Biology 8, no. 3 (September 9, 2020): 18. http://dx.doi.org/10.3390/jdb8030018.
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Craniofacial anomalies are among the most common of birth defects. The pathogenesis of craniofacial anomalies frequently involves defects in the migration, proliferation, and fate of neural crest cells destined for the craniofacial skeleton. Genetic mutations causing deficient cranial neural crest migration and proliferation can result in Treacher Collins syndrome, Pierre Robin sequence, and cleft palate. Defects in post-migratory neural crest cells can result in pre- or post-ossification defects in the developing craniofacial skeleton and craniosynostosis (premature fusion of cranial bones/cranial sutures). The coronal suture is the most frequently fused suture in craniosynostosis syndromes. It exists as a biological boundary between the neural crest-derived frontal bone and paraxial mesoderm-derived parietal bone. The objective of this review is to frame our current understanding of neural crest cells in craniofacial development, craniofacial anomalies, and the pathogenesis of coronal craniosynostosis. We will also discuss novel approaches for advancing our knowledge and developing prevention and/or treatment strategies for craniofacial tissue regeneration and craniosynostosis.
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Vaca, Elbert E., Neil Sheth, Chad A. Purnell, Jennifer L. McGrath, and Arun K. Gosain. "Secondary Suture Fusion after Primary Correction of Nonsyndromic Craniosynostosis." Plastic and Reconstructive Surgery 145, no. 2 (February 2020): 493–503. http://dx.doi.org/10.1097/prs.0000000000006491.
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Domeshek, Leahthan F., Rajesh R. Das, John A. Van Aalst, Srinivasan Mukundan, and Jeffrey R. Marcus. "Influence of Metopic Suture Fusion Associated With Sagittal Synostosis." Journal of Craniofacial Surgery 22, no. 1 (January 2011): 77–83. http://dx.doi.org/10.1097/scs.0b013e3181f6c56b.
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Hens, Samantha M., and Kanya Godde. "New Approaches to Age Estimation Using Palatal Suture Fusion." Journal of Forensic Sciences 65, no. 5 (June 17, 2020): 1406–15. http://dx.doi.org/10.1111/1556-4029.14485.
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