Craniofacial growth following experimental craniosynostosis and craniectomy in rabbits

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✓ Premature fusion of the coronal suture was produced in 9-day-old rabbits by immobilization of the suture area bilaterally with methyl-cyanoacrylate adhesive. The effects of suture fusion and its surgical release on suture growth and on skull morphology were evaluated by radiographic cephalometry. Immobilization resulted in significant changes in the angular dimensions in the vault toward an anteroposterior shortening. No permanent deformity was observed in the angular relationship between the cranial base and the facial skeleton. Craniectomy at 30 days, when a skull deformity had been established, resulted in rapid separation of the bones at the suture site which returned the deformed skull to a normal configuration by 90 days of age. Surgical removal of a normal suture in a control group also resulted in accelerated separation of the bones at the excised suture site, but it was less than after removal of an immobilized suture. The experimental data indicate that premature fusion of rapidly growing sutures results in consistent skull deformity. Early release of the fusion, when this is the primary abnormality, will result in spontaneous correction of the deformity.

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Address reprint requests to: George T. Rodeheaver, Ph.D., Department of Plastic Surgery, Box 332, University of Virginia Medical Center, Charlottesville, Virginia 22901.

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Figures

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    Graphic description of the experimental groups and surgical procedures.

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    Cephalogram (positive print) of a 30-day-old rabbit. The cephalometric landmarks, lines, and angles used for the recording of changes in cranial morphology are given (compare text). The arrow points to the coronal suture area.

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    Graph showing growth in the coronal suture in the different experimental groups as revealed by changes in marker distance with age. Note growth restriction following immobilization, and accelerated growth after craniectomy.

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    Histological section of a coronal suture 3 weeks after the immobilization procedure. A bone bridge (B) has formed across the ectocranial part of the suture (S). It delimits the suture from the inflammatory periosteal tissue (P) and the acrylic. Hemalum-eosin, × 12.

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    Alterations in cranial morphology with age in the different experimental groups as revealed by changes in the different angular dimensions on the cephalograms. For definition of the angles, see text. Black circles = sham treated at Day 9; black squares = immobilized at Day 9; white squares = craniectomized at Day 30 following immobilization at Day 9; white circles = craniectomized at Day 30 after sham treatment at Day 9. Initial measurements are performed at Day 9, and the subsequent changes are recorded at Days 30, 60, and 90. Upper: Effect of suture immobilization (black squares) compared to sham treatment (black circles). Note the deviation of angular dimensions after immobilization, especially those of the posterior part of the vault. Center: Effect of craniectomy of an immobilized suture at Day 30 (white squares) on subsequent cranial growth. Note the catch-up growth following craniectomy of the immobilized suture by which the angles of the vault come close to those of sham-treated animals. Note also the over-correction, especially for the dimension BO′/JO. Lower: Effect of craniectomy of a normal suture (white circles) on subsequent cranial growth. Note that the angular dimensions following craniectomy of a normal suture do not markedly differ from those of sham-treated controls.

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