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The estimation of the post-traumatic survival time (PTST) in case of bone injuries remains a tricky issue in the forensic field, especially when dealing with dry bones. Newer high-resolution imaging, and in particular microcomputed tomography (micro-CT), has the potential to significantly improve our abilities to interpret antemortem and perimortem lesions and accurately date fractures in a less destructive analysis. In this paper, nine costal fractures of known post-traumatic ages were analyzed through gross examination, conventional radiography, and microcomputed tomography, in order to test the potential of microcomputed tomography for dating fractures. As a result, microcomputed tomography provided images of high quality and definition and allowed the observation of the internal microarchitecture of the fractures and calluses. While microcomputed tomography cannot substitute histological examination for the estimation of the post-traumatic survival time, it constitutes a potent and helpful complementary tool for the analysis of bone trauma.

Siedlecki Zygmunt, ShaikFasiA., Nowak Karol, Grzyb Sebastian, Śniegocki Maciej. Historical overview of cranial bone implants: own material or artificial prostheses - short review. Journal of Education, Health and Sport.2021;11(02):36-40. eISSN 2391-8306. DOI http://dx.doi.org/10.12775/JEHS.2021.11.02.004 https://apcz.umk.pl/czasopisma/index.php/JEHS/article/view/JEHS.2021.11.02.004 https://zenodo.org/record/4529046 The journal has had 5 points in Ministry of Science and Higher Education parametric evaluation. § 8. 2) and § 12. 1. 2) 22.02.2019. © The Authors 2021; This article is published with open access at Licensee Open Journal Systems of Nicolaus Copernicus University in Torun, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike. (http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 28.01.2021. Revised: 05.02.2021. Accepted: 10.02.2021. Historical overviewof cranial bone implants: own material or artificial prostheses - shortreview Zygmunt Siedlecki1, Fasi A. Shaik2, Karol Nowak1, Sebastian Grzyb3, Maciej Śniegocki1 Department of Neurosurgery, Neurotraumatology and Pediatric Neurosurgery, The Ludwik Rydygier Collegium Medicum in Bydgoszcz, The Nicolaus Copernicus University in Toruń Department of Biotechnology, University of Wolverhampton, United Kingdom. Present: Jain University, India Department of Clinical Pharmacology, The Ludwik Rydygier Collegium Medicum in Bydgoszcz, The Nicolaus Copernicus University in Toruń Corresponding address: Dr. med. Zygmunt Siedlecki Department of Neurosurgery, Neurotraumatology and Pediatric Neurosurgery, the Ludwik Rydygier Collegium Medicum in Bydgoszcz, ul. Skłodowskiej-Curie 9 85-094 Bydgoszcz tel.: + 48 606 302680 e-mail: siedlecki@cm.umk.pl Abstract We present a brief report on the different types of skull bone prosthesesused in cranioplasty. Skull defects, most often resulting from severe head injuries, have been known since the times of Ancient Egypt. Ethnographic reports indicate that at that time the skull defects were restored with golden plates. In the following centuries of medical development, especially in modern centuries, cranioplasty has been performed more widely. Cranioplasty began to be performed also in defects after craniectomy. Such craniectomies have been performed for treatment brain hemorrhages, strokes, tumors with severe edema. A common dilemma is whether artificial prostheses are better or own bone material. We present a brief historical overview and the actual state based on the procedures performed in our neurosurgical department in Collegium Medicum in Bydgoszcz. Keywords:cranioplasty, bone defect, implants, history

During a surgical procedure, the surgeon may remove tissue to be preserved and stored for replantation or autotransplantation on or in the same individual during a subsequent procedure. The AORN "Guideline for autologous tissue management" provides guidance to perioperative personnel for preserving and handling autologous tissue (eg, cranial bone flaps, parathyroid tissue, skin, vessels) that will be replanted or autotransplanted in the same facility in which the tissue was surgically removed. This article discusses guideline recommendations on packaging, labeling, storing, and disposing of autologous tissue. A scenario describes how an interdisciplinary team uses the AORN guideline and Guideline Essentials to identify recommendations and tools to incorporate into their policy and procedures after their facility receives a citation during a regulatory site visit. Perioperative RNs should review the entire guideline for additional information when creating and updating policies and procedures on autologous tissue management.

Objectives: the aim of the study was the evaluation of healing in bony defects comparing milled teeth versus beta tricalcium phosphate (B-TCP) as bone graft materials. Materials and methods: Forty-five male albino rats, were divided into three groups each group included 15 rats; one control and two experimental groups. Under general anesthesia, 1.5 cm incision was created to expose the cranial bone. Then two bone defects (each one with a diameter of 3 millimeter) were created one in each parital sides. In Group I (control group): the two bony defects (30 bony defects) were left to heal without any intervention. While, in Group II & III the bony defects were completely filled with (B-TCP) and milled teeth, respectively. At the 7th, 15th, and 30 days postoperatively five rates were randomly selected from each group to be sacrificed. Results: histomorophometric and histological results showed a higher level of bone regeneration in the two experimental groups than that of the control group all over the study period, moreover there was a significant increase in the amount of (newly formed bone) in the milled teeth than in the (B-TCP) group. The remaining particles of the two graft materials was significantly less in the milled teeth group than in the (B-TCP) group during the whole study time. Conclusion: Bone activity, formation and maturity were ahead in tooth ash filled calvarial bony defects.

Timing of cranial trauma is challenging in forensic cases and literature on the subject is scarce. This study analysed the macroscopic fracture patterns of perimortem cranial fractures and compared them to experimentally reproduced cranial fractures on dry human craniums. The results showed nine traits associated with fresh cranial fractures: undulated margin, flake defects, peels with peel defects, fissures, crushed margins, bridge, bone scales and beveling. All the traits appear on the outer table or on the inner table of the cranium. Although not all characteristics must be present at the same time in all cranial fractures, they do define a new perimortem fracture pattern. Statistical analyses showed that six of these traits (undulated margins, flake defects, crushed margins, bone scales, fissures and peels) are distinctly related with perimortem (fresh) bone conditions. Considering the most discriminant perimortem traits, a decision-making algorithm is developed as a probabilistic approach to distinguish peri- from postmortem cranial fractures with an accuracy of 87%. This algorithm allows the forensic practitioner to incorporate more confidence during cranial trauma evaluation.

We analyzed the cell characteristics, neuroprotective, and transplantation effects of human cranial bone-derived mesenchymal stem cells (hcMSCs) in ischemic stroke model rats compared with human iliac bone-derived mesenchymal stem cells (hiMSCs). The expressions of brain-derived neurotrophic factor (BDNF) and vascular endothelial growth factor (VEGF ) as neurotrophic factors were analyzed in both MSCs. hiMSCs or hcMSCs were intravenously administered into ischemic stroke model rats at 3 or 24 h after middle cerebral artery occlusion (MCAO) and neurological function was evaluated. The survival rate of neuroblastoma × glioma hybrid cells (NG108-15) after 3 or 24 h oxidative or inflammatory stress and the neuroprotective effects of hiMSCs or hcMSCs-conditioned medium (CM) on 3 or 24 h oxidative or inflammatory stress-exposed NG108-15 cells were analyzed. The expressions of BDNF and VEGF were higher in hcMSCs than in hiMSCs. hcMSCs transplantation at 3 h after MCAO resulted in significant functional recovery compared with that in the hiMSCs or control group. The survival rate of stress-exposed NG108-15 was lower after 24 h stress than after 3 h stress. The survival rates of NG108-15 cells cultured with hcMSCs-CM after 3 h oxidative or inflammatory stress were significantly higher than in the control group. Our results suggest that hcMSCs transplantation in the early stage of ischemic stroke suppresses the damage of residual nerve cells and leads to functional recovery through the strong expressions of neurotrophic factors. This is the first report demonstrating a functional recovery effect after ischemic stroke following hcMSCs transplantation.

In this article, we present a skull database containing 500 healthy skulls segmented from high-resolution head computed-tomography (CT) scans and 29 defective skulls segmented from craniotomy head CTs. Each healthy skull contains the complete anatomical structures of human skulls, including the cranial bones, facial bones and other subtle structures. For each craniotomy skull, a part of the cranial bone is missing, leaving a defect on the skull. The defects have various sizes, shapes and positions, depending on the specific pathological conditions of each patient. Along with each craniotomy skull, a cranial implant, which is designed manually by an expert and can fit with the defect, is provided. Considering the large volume of the healthy skull collection, the dataset can be used to study the geometry/shape variabilities of human skulls and create a robust statistical model of the shape of human skulls, which can be used for various tasks such as cranial implant design. The craniotomy collection can serve as an evaluation set for automatic cranial implant design algorithms.

Background:. The surgical correction of metopic craniosynostosis usually relies on the subjective judgment of surgeons to determine the configuration of the cranial bone fragments and the degree of overcorrection. This study evaluates the effectiveness of a new approach for automatic planning of fronto-orbital advancement based on statistical shape models and including overcorrection. Methods:. This study presents a planning software to automatically estimate osteotomies in the fronto-orbital region and calculate the optimal configuration of the bone fragments required to achieve an optimal postoperative shape. The optimal cranial shape is obtained using a statistical head shape model built from 201 healthy subjects (age 23 ± 20 months; 89 girls). Automatic virtual plans were computed for nine patients (age 10.68 ± 1.73 months; four girls) with different degrees of overcorrection, and compared with manual plans designed by experienced surgeons. Results:. Postoperative cranial shapes generated by automatic interventional plans present accurate matching with normative morphology and enable to reduce the malformations in the fronto-orbital region by 82.01 ± 6.07%. The system took on average 19.22 seconds to provide the automatic plan, and allows for personalized levels of overcorrection. The automatic plans with an overcorrection of 7 mm in minimal frontal breadth provided the closest match (no significant difference) to the manual plans. Conclusions:. The automatic software technology effectively achieves correct cranial morphometrics and volumetrics with respect to normative cranial shapes. The automatic approach has the potential to reduce the duration of preoperative planning, reduce inter-surgeon variability, and provide consistent surgical outcomes.

The calvarium can provide large amount of good quality corticocancellous autogenous bone graft. Although many studies have highlighted the advantages of the split cranial bone graft, there is no published work available in the literature about the fate of donor site of the split cranial bone graft. The present study was undertaken to assess the donor site as regards to the thickness, volume, and the density of the residual bone over a period of 12 months in the postoperative period. A total of 30 patients in the age group of 15 to 43 years were studied from January 2015 to January 2016. Postoperative computer tomography scans were taken at 2 weeks, 6 months, and 1 year postoperative to measure the bone thickness, volume, and density at the donor site of the split cranial bone graft harvest. The bone thickness at the donor site showed progressive increase in the thickness over the period of study and the average increase in thickness was about 12.4% at the end of 1 year. The average increase in volume at the donor site was of 2.65% after 12 months. Similarly, the average bone density increased by 3.7% at the end of 1 year. This prospective study conclusively proves that the residual bone at the donor site of the split cranial bone graft harvest site continues to grow in thickness and density over a period of 1 year.

Objective To evaluate the quality of life in patients with moderate or large cranial bone defects before and after late cranioplasty. Methods Authors performed a prospective clinical trial including all consecutive patients that filled inclusion criteria during a period of 1 year. All patients answered the quality of life SF-36 questionnaire in 5 different times. Besides authors gathered information about the primary trauma and demographic characteristics. Results A total of 70 consecutive patients were admitted to the hospital during the study period, and 62 were included in the project. Cranioplasty statistically improved patients' quality of life in all 8 domains after a 24 months follow-up. Conclusion Cranioplasty has a significant impact over the quality of life in brain trauma victims who survived the primary trauma and harbor a large cranial bone defect.

Currently, the diagnosis of bone flap osteomyelitis (BFO) remains a challenge for medical imaging. The present study aimed to identify predictive scintigraphic patterns of BFO. This retrospective study reviewed planar bone scan of patients with suspected BFO between 2010, and 2016. A total of 15 patients were included. Final diagnosis of BFO was obtained by histological and bacteriological documentation. Eight scintigraphic signs potentially helpful were reviewed and correlated with the final diagnosis individually or in combination through Fischer exact test. Eight patients out of 15 (53.3%) were diagnosed with BFO. Radionuclide uptake inside the bone flap during blood-pool phase was predictive for BFO (p = 0.007) with 75.0% sensitivity 100% specificity, and 86.7% accuracy. In combination, radionuclide uptake inside the bone flap or a spreading wavefront between blood-pool and delayed phases was associated with BFO (p = 0.007). It did not improve diagnostic performance. Using well-defined and reproducible scintigraphic signs, bone scan is helpful for the diagnosis of BFO.

Background: Reconstruction of the cranial bone flap after craniocerebral surgery is crucial for preservation of skull symmetry, maintenance of aesthetics, brain protection, as well avoiding complications like floating or sunken skull flaps. A host of techniques and materials for fixation of the cranial flaps have emerged over the past several decades.Aim of Study: The aim of this study was to compare the clinical outcomes of bone flap fixation using peek-based (cranial loop) versus titanium-based (skull fix) fixation systems.Patients and Methods: Between July 2013 and December 2016 a series of 54 patients undergoing either an emergency or an elective craniotomy for different intracranial lesions in which the original bone flaps were refixed using cranial loop in 27 patients and skull fix in 27 patients. Clinical and radio-logical outcomes and complication rates were compared between these 2 groups.Results: Satisfactory results were achieved in both fixation systems. Epidural collection occurred in 4 patients 3 in skull fix and one in cranial loop, subdural collection in 4 patients 2 in cranial loop and one in skull fix treated conservatively. One case with cranial loop experienced a bone flap dislocation which was revised and refixed. Subcutaneous effusion occurred in two patients one in skull fix and one in cranial loop. One patient in skull fix developed a mild postoperative wound infection. Post-operative imaging showed satisfactory ana-tomical and morphological position of the flap in all patients.Conclusion: Skull fix and cranial loop are reasonable alternatives to present craniotomy fixation methods. They are easy to use, fast, safe, reliable with very acceptable cosmetic results. The main advantage of the cranial loop might ultimately lie in the absence of artifacts on post-operative CT or MR imaging.

Background: Bone wax, a haemostatic agent, is widely used in craniospinal surgical procedures for a long time, in spite of controversial results regarding its negative in- fluence upon bone regeneration. In this experimental study, the effects of Ankaferd Blood Stopper (ABS), as an alternative haemostatic agent, were evaluated through histochemical, immunohistochemical and scintigraphic studies. Materials and methods: The total of 30 adult female Wistar albino rats was randomly divided into three groups: intact control group (n = 10), bone wax group (n = 10), and ABS group (n = 10). Surgically, a 3.0 mm hole in diameter was drilled on the right side of calvarium of the rats using a Class Mini Grinder set in all three groups, as described previously. At the end of 8 weeks, bone healing and connective tissue alterations surrounding drilled calvarial defect areas of the rats were determined via haematoxylin and eosin and the Mallory's trichrome staining and anti-bone sialoprotein immunohistochemistry. Image Pro Express 4.5 programme was used for histomorpho- metric calculation of new bone and fibrotic tissue areas. All statistical analyses were made with SPSS 25.0 and analysis of variance (one-way ANOVA) followed by Bon- ferroni post hoc test was performed, p < 0.001 was considered as significance level. Results: Histomorphometrically, it was found that he had the largest hole diameter and the least fibrotic scar area in the bone-wax group. In the bone wax group, it was observed that the material closed the hole and there was only a fibrotic scar tissue in the area between the bone tissue at the edge of the hole and bone wax, and a fibrotic tissue was formed in the bone wax area. During the histological procedure, this bone-wax material was poured and the sections were seen as a gap in this area. In the ABS haemostat group, the smallest hole diameter and the least fibrotic scar tissue were observed. Fibrotic scar tissue close to each other was found in the ABS haemostat and bone wax groups. Histological analysis of samples also showed a statistical significance for fibrotic connective tissue area between groups (p < 0.05). Scintigraphically, osteoblastic activity related to blood flow in the animal taken from the group with application of ABS haemostat was more pronounced compared to the other two groups. Conclusions: In our study, it has been concluded that the ABS yields affirmative effects on the bone healing, while bone wax leads to negative impact on the bone regeneration. Scintigraphic, histochemical and immunohistochemical data support the affirmative impact of the ABS haemostat application upon the bone regeneration apart from the quick stop of haemorrhage. (Folia Morphol 2022; 81, 3: 739-748)

Background Cell-based therapies with mesenchymal stem cells (MSCs) are considered as promising strategies for spinal cord injury (SCI). MSCs have unique characteristics due to difference in the derived tissues. However, relatively few studies have focused on differences in the therapeutic effects of MSCs derived from different tissues. Here, the therapeutic effects of adipose tissue-derived MSCs (aMSCs), bone marrow-derived MSCs (bMSCs), and cranial bone-derived MSCs (cMSCs) on chronic SCI model rats were compared. Methods MSCs were established from adipose tissue, bone marrow, and cranial bone collected. Neurotrophic factor expression of each MSC type was analyzed by real-time PCR. SCI rats were established with the weight-drop method and transplanted intravenously with MSCs at 4 weeks after SCI. Hind-limb motor function was evaluated from before injury to 4 weeks after transplantation. Endogenous neurotrophic factor and neural repair factor expression in spinal cord (SC) tissue were examined by real-time PCR and western blot analyses. Furthermore, the neurotrophic effects (i.e., neurite formation and elongation) of each MSC type were verified by co-culture with NG108-15 neural cells. Results Although there were no differences in the expression levels of cell surface markers and multipotency, expression of Bdnf, Ngf, and Sort1 (Nt-3) was relatively higher in cMSCs. Transplantation of cMSCs improved motor function of chronic SCI model rats. Although there was no difference in the degree of engraftment of transplanted cells in the injured SC tissue, transplantation of cMSCs enhanced Bdnf, TrkB, and Gap-43 mRNA expression and synaptophysin protein expression in injured SC tissue. In vitro, cMSCs co-cultured with NG108-15 cells promoted neurite formation and elongation. Conclusion As compared with MSCs derived other tissues, cMSCs highly express many neurotrophic factors which improved motor function in chronic SCI model rats by promoting endogenous neurotrophic and neural plasticity factors. These results suggest the efficacy of cMSCs in cell-based therapy for chronic SCI.

Surgery in patients with craniosynostosis is a common treatment to correct the deformed skull shape, and it is necessary to verify the surgical effect of correction on the regional cranial bone. We propose a quantification method for evaluating surgical effects on regional cranial bones by comparing preoperative and postoperative skull shapes. To divide preoperative and postoperative skulls into two frontal bones, two parietal bones, and the occipital bone, and to estimate the shape deformation of regional cranial bones between the preoperative and postoperative skulls, an age-matched mean-normal skull surface model already divided into five bones is deformed into a preoperative skull, and a deformed mean-normal skull surface model is redeformed into a postoperative skull. To quantify the degree of the expansion and reduction of regional cranial bones after surgery, expansion and reduction indices of the five cranial bones are calculated using the deformable registration as deformation information. The proposed quantification method overcomes the quantification difficulty when using the traditional cephalic index(CI) by analyzing regional cranial bones and provides useful information for quantifying the surgical effects of craniosynostosis patients with symmetric and asymmetric deformities.

Spontaneous reossification is a very rare phenomenon following a large calvarial defect, particularly in adults. A 29-year-old woman with acute subdural hematoma and brain edema underwent emergent decompressive craniectomy and evacuation of hematoma. Follow-up examination 2 years later showed a well-formed bone along the craniectomy site. To our knowledge, this is the first case report with total spontaneous reossification in adults. A literature review is provided, and the physiology of the process is suggested. Pericranium, diploe, and, above all, dura mater collaborate in spontaneous bone formation. All these layers are very important, and they must be respected during dissection.

This chapter reviews the multiple choices in bone graft donor sites, indications, techniques, maxillofacial reconstruction outcomes and the associated morbidities.

The authors present a case series of patients with composite loss of nasal skin cover and lining following road accidents. The nasal skeletal framework in all these cases was also severely communited. The reconstruction of all the these was achieved in 1 operation. The authors have utilized islanded supratrochlear artery based paramedian forehead skin and pericranial flap for reconstruction of both skin and lining defects. The nasal skeletal framework was restored with the help of cantilevered split cranial bone graft. In all but 1 patient, the reconstruction was done in the emergency setting at the time of initial admission itself. One patient had infected wound that necessitated an initial debridement and split skin grafting. In this case, the definitive reconstruction was done after a gap of 3 months.A long-term follow-up of these patients is presented.

The neurocranium changes rapidly in early childhood to accommodate the growing brain. Developmental disorders and environmental factors such as sleep position may lead to abnormal neurocranial maturation. Therefore, it is important to understand how this structure develops, in order to provide a baseline for early detection of anomalies. However, its anatomy has not yet been well studied in early childhood due to the lack of available imaging databases. In hospitals, CT is typically used to image the neurocranium when a pathology is suspected, but the presence of ionizing radiation makes it harder to construct databases of healthy subjects. In this study, instead, we use a dataset of MRI data from healthy normal children in the age range of 6 months to 36 months to study the development of the neurocranium. After extracting its outline from the MRI data, we used a conformal geometry-based analysis pipeline to detect local thickness growth throughout this age span. These changes will help us understand cranial bone development with respect to the brain, as well as detect abnormal variations, which will in turn inform better treatment strategies for implicated disorders.

Background The repair of critical-sized bone defect represents a challenging problem in bone tissue engineering. To address the most important problem in bone defect repair, namely insufficient blood supply, this study aimed to find a method that can promote the formation of vascularized bone tissue. Method The phenotypes of ASCs and EPCs were identified respectively, and ASCs/EPCs were co-cultured in vitro to detect the expression of osteogenic and angiogenic genes. Furthermore, the co-culture system combined with scaffold material was used to repair the critical-sized bone defects of the cranial bone in rats. Results The co-culture of ASCs/EPCs could increase osteogenesis and angiogenesis-related gene expression in vitro. The results of in vivo animal experiments demonstrated that the ASC/EPC group could promote bone regeneration and vascularization in the meantime and then significantly accelerate the repair of critical-sized bone defects. Conclusion It is feasible to replace traditional single seed cells with ASC/EPC co-culture system for vascularized bone regeneration. This system could ultimately enable clinicians to better repair the defect of craniofacial bone and avoid donor site morbidity.

Sagittal craniosynostosis is the most common craniosynostosis and the premature closure of the sagittal suture makes the skull shape biparietal narrow and elongated. Surgery in infants with sagittal craniosynostosis is a common treatment for correcting the shape of the deformed skull, but the evaluation of the morphological improvement of the skull before and after operation is made by the surgeon’s subjective judgment. Therefore, we propose an efficient method to quantify the shape of the skull before and after surgery based on the mean normal skull model to assess the surgical outcome. In the preprocessing step, to construct the skull model from the pre- and post-operative CT images, each skull model is constructed consisting of the outer surface of the skull. To distinguish individual cranial bones separated by sutures, mean normal skull model is composed of five cranial bones. In the skull model deformation step, to distinguish from the whole bone of the preoperative skull model to the regional bone, the mean normal skull model is deformed into a preoperative skull model, and the deformed mean normal skull model is again deformed into a postoperative skull model. In the regional skull shape index calculation step, to evaluate the degree of expansion and reduction of postoperative skull relative to the preoperative skull, the regional skull shape index is calculated. Experimental results showed that our regional skull shape index can quantify the degree of expansion and reduction of the postoperative skull relative to the preoperative skull of each cranial bone.

OBJECTIVEThere is an unmet need to perform imaging in young children and obtain CT-equivalent cranial bone images without subjecting the patients to radiation. In this study, the authors propose using a high-resolution fast low-angle shot golden-angle 3D stack-of-stars radial volumetric interpolated breath-hold examination (GA-VIBE) MRI sequence that is intrinsically robust to motion and has enhanced bone versus soft-tissue contrast.METHODSPatients younger than 11 years of age, who underwent clinical head CT scanning for craniosynostosis or other cranial malformations, were eligible for the study. 3D reconstructed images created from the GA-VIBE MRI sequence and the gold-standard CT scan were randomized and presented to 3 blinded reviewers. For all image sets, each reviewer noted the presence or absence of the 6 primary cranial sutures and recorded on 5-point Likert scales whether they recommended a second scan be performed.RESULTSEleven patients (median age 1.8 years) underwent MRI after clinical head CT scanning was performed. Five of the 11 patients were sedated. Three clinicians reviewed the images, and there were no cases, either with CT scans or MR images, in which a reviewer agreed a repeat scan was required for diagnosis or surgical planning. The reviewers reported clear imaging of the regions of interest on 99% of the CT reviews and 96% of the MRI reviews. With CT as the standard, the sensitivity and specificity of the GA-VIBE MRI sequence to detect suture closure were 97% and 96%, respectively (n = 198 sutures read).CONCLUSIONSThe 3D reconstructed images using the GA-VIBE sequence in comparison to the CT scans created clinically acceptable cranial images capable of detecting cranial sutures. Future directions include reducing the scan time, improving motion correction, and automating postprocessing for clinical utility.

The formation of the head and face is a complex process which involves many different signaling cues regulating the migration, differentiation, and proliferation of the neural crest. This highly complex process is very error prone, resulting in craniofacial defects in nearly 10,000 births in the United States annually. Due to the highly conserved mechanisms of craniofacial development, animal models are widely used to understand the pathogenesis of various human diseases and assist in the diagnosis and generation of preventative therapies and treatments. Here, we provide a brief background of craniofacial development, and discuss several rare diseases affecting craniofacial bone development. We focus on rare congenital diseases of the cranial bone, facial jaw bones, and two classes of diseases, ciliopathies and RASopathies. Studying the animal models of these rare diseases sheds light not only on the etiology and pathology of each disease, but also provides meaningful insights towards the mechanisms which regulate normal development of the head and face.

To clarify the clinical outcomes of cranioplasty with cryopreserved bone flaps and identify risk factors related to bone flap infection and resorption after cranioplasty with cryopreserved bone flaps.A total of 946 patients (989 bone flaps) underwent decompressive craniectomy and delayed cranioplasty via the use of cryopreserved autogenous cranial bone flaps. Cranial bone flaps were removed during the initial craniectomy and reserved in liquid nitrogen (-196°C) with dimethyl sulfoxide as a cryoprotectant. Cranioplasty subsequently was performed once the brain injury had healed. Data regarding complications and clinical outcomes were recorded and the potential risk factors were analyzed.Data from 960 flaps were available for analysis. The overall complication rate was 15.83% (152 of 960). Bone resorption occurred in 42 flaps in 37 patients (4.38%). The bone flaps resorption rate was greater in patients ≤18 years than in patients18 years (9.38% vs. 3.61%, P0.05). Cryopreservation for more than 365 days tended to result in a greater bone resorption rate (6.88% vs. 2.92%, P0.01). Skull bone grafts infection occurred in 39 flaps in 34 patients (4.06%). The bone graft infection rate was greater in emergency craniectomy cases (8.81% vs. 2.59%, P0.01) and in patients with diabetes (10.53% vs. 3.07%, P0.01).Cryopreservation of autologous cranial bone flaps is safe and effective for cranioplasty. Cranioplasty with cryopreserved autologous cranial bone flaps should be performed no more than 1 year after craniectomy. Emergency craniectomy and patients with diabetes require special attention.

Cranioplasty is generally defined as the procedure to reconstruct cranial bone defect arising from congenital or acquired process. As a surgical remedy, it can restore the function of original anatomical structure and produce a satisfactory cosmetic outcome. Although with available options for treating pediatric cranioplasty, large format (ie,25 cm) cranioplasty of the aborted one with a composite defect is still a challenging procedure for plastic surgeons. The authors herein present a case of child who suffered failed cranioplasty with polyetheretherketone caused by postoperative infection, leading to skin ulcer and exposure of the polyetheretherketone. The treatments of the patient are performed sequentially. After thorough debridement of the wound, vacuum-assisted wound closure and autologous split-thickness skins are successively used to cover the defect following finally adopted strategy of tissue expansion of the scalp with a 3-dimensional-printed epoxide acrylate maleic composite material to repair the large-sized cranial defect.

Objective The aim of this study was to test the bone thickness and potential screw length for osteosynthesis of condylar base fractures (according to the Loukota classification) with an experimental titanium plate, placed in an ideal position against 2 types of conventional plates. Study Design After exclusion of completely edentulous mandibles, 28 dentate macerated mandibles available at the time of the study were included. Linear regression models 1 and 2 compared the sums of the 2 cranial bone thicknesses and the 3 caudal thicknesses among the 3 different plate designs, and linear models 3 and 4 tested the bone thickness in the 2 most cranial screw axes. Results Linear models 1 and 2 revealed significantly higher potential screw lengths for the experimental oblique plate. Equally, linear models 3 and 4 indicated significantly higher bone thickness for the novel oblique plate. Conclusion The novel proposed oblique plate allows for favorable plate positioning in a biomechanically ideal location with sufficient amounts of local bone for stable plate fixation. When plates with 15-degree angulated screw holes are used, stable bicortical plate fixation can be achieved.

Background Bone-exposed wounds with intact or defected periosteum are difficult to heal. To provide relevant experimental evidence for guidance of clinical therapy, we established a rabbit model to compare the efficacies of negative pressure wound therapy (NPWT) and conventional guaze dressing therapy on the healing of cranial bone-exposed wounds. Methods Full-thickness excisional circular wounds of 2.0 cm in diameter with exposed bones covered with or without periosteum were created at the parietal regions in 88 rabbits that were further randomly divided into the following treatment groups: periosteum-intact wounds treated with conventional vaseline gauze dressings (P + Control group), periosteum-intact wounds treated with NPWT (P + NPWT group), periosteum-lacking wounds treated with conventional vaseline gauze dressings (P-Control group), and periosteum-lacking wounds treated with NPWT (P-NPWT group). The wounds of NPWT groups were treated using a negative pressure therapy assembly that was set at a continuous pressure of -125 mm Hg for 7 days, then covered with vaseline gauze. The wound healing rates, wound infection rates, hydroxyproline content, and wound tissue histology were determined and evaluated. Results The NPWT shortened the wound healing time by approximately 5 days when compared with the conventional gauze therapy. The histological characterization of wound tissues showed that NPWT decreased the inflammatory cells infiltration, accelerated reepithelialization and facilitated the organization of collagen fibers into neat layers on postoperative day (POD) 10. The NPWT enhanced bacterial clearances, reduced infection rates and increased the hydroxyproline contents in both types of wounds on PODs 10 and 15. The immunohistochemical staining of CD31 showed the NPWT treatment resulted in a significantly increased and persistent angiogenesis, and the wounds treated with NPWT showed well developed and more functional vessels at POD 7 compared with control. Conclusions The NPWT is a more effective therapy for bone-exposed wounds than conventional guaze dressing therapy. The NPWT can promote bone-exposed wounds healing by increasing collagen contents and vessels densities while reducing inflammatory cells infiltration, reducing wound infection rates, and inducing an ordered collagen arrangement.

Postoperative radiation can cause ulcer formation, leading to the denudation of skin over alloplastic materials. The influence of backscatter radiation from fixation devices has not been investigated. The aim of this study is to evaluate backscatter dose variations for different cranial bone fixation devices in an experimental model designed to simulate postoperative radiotherapy. The authors assessed the radiation backscatter doses associated with resorbable (PLLA-PGA) and titanium plates. The samples were irradiated with 6 and 10 MV photon beams from a linear accelerator. Measurements were obtained using an ionization chamber and radiochromic films cut from the same batch. As a result, the backscatter radiation of water and PLLA-PGA proportionally decreased as the depth increased. However, the backscatter radiation of the titanium plate increased just above the plate. This depth lies in the region of the scalp. Each material showed a dose of radioactivity that was higher at 10 MV than that at 6 MV. These devices showed a significant difference, which suggested that these materials amplified the dose compared with water at 6 MV. In conclusion, it is supposed that PLLA-PGA should be used to fix the cranium to decrease the potential for radiation ulcers.

Focal palatitis (also known as focal palatine erosion) is thought to be a developmental disease, specifically of cheetah in captivity raised on a commercial diet. The lack of chewing is thought to cause the mandibular molar to change angulation, contacting the palate and causing the lesions. We followed the development of five captive cheetah cubs, born within 2 weeks of each other, at the same facility. This longitudinal study followed the cubs cephalometrically from 7-months-old to 25-months-old. Of each cub we made a lateral and dorsoventral radiograph at 7, 13, 20, and 25-months-old. For each radiograph at each age, a predefined series of measurements were made including the angle of the molar. The latter was measured as the angle of the bisecting line running through the apex of the caudal molar root intersecting with a line drawn at the ventral margin of the mandible. The results confirmed that the cheetah skull and neurocranium follows the same neural growth pattern as has been described for other mammalians. Similarly the maxillofacial component follows the same somatic growth as seen in all mammalians excluding humans and non-human primates, where a pubertal growth spurt is present. Finally the angle of the mandibular molar at 7 months differed significantly from the angle at the other ages, however there were no statistical difference in the angulation of the molar after eruption (13 months and older ages). In these five cheetah the lack of chewing (as seen in captivity with a commercial or meat only based diet) did not alter the angulation of the mandibular molar, nor did the mandibular molars super erupt in these patients at 25-months-of-age.

This chapter provides a summary of calvarial bone graft utilization and technique. The authors provide a brief review of the anatomy, graft type selection, and procedural steps. The needs of the recipient site dominate decision-making regarding the calvarial graft. These needs include structural integrity, size, shape, and fixation of the graft. Autogenous calvarial grafting is a valuable technique for any surgeon working in craniofacial surgery. With proper consideration of recipient site needs and harvest technique, autogenous calvarial grafting is a useful procedure with benefits outweighing the inherent surgical risks. Also discussed is virtual surgical planning (VSP), which has contributed an additional option for calvarial defect reconstruction by broadening the treatment options to include custom three-dimensional printed polyether ether ketone (PEEK) inlays.

Bony and cartilage defects of the nose should be reconstructed for both esthetic and functional purposes. In the past, autogenous bones, such as rib bones, cranial bones, and other bone grafts, have been used to reconstruct bony defects of the nose. Rib and ear cartilage have been used to reconstruct cartilage defects of the nose. A congenital subtotal bony-cartilaginous defect of the nose was reconstructed using cranial bone for the nasal bony defect, ear cartilage for the tip cartilage deficiency, and rib cartilage for the septal defect, in the present patient.

A 57-year-old male presented with severely altered mental status in the setting of diabetic ketoacidosis. Neuroimaging revealed two intracranial masses. Days following surgical resection of an olfactory groove meningioma, the patient developed Serratia marcescens bacteremia along with an enlarging epidural and subgaleal fluid collection. Subgaleal fluid aspiration was also positive. The patient later returned to the operating room for wound washout where purulent collections were discovered in the subgaleal, epidural, and left subdural spaces. The wound was evacuated and the bone flap was thoroughly cleansed with betadine and soaked in peroxide prior to replacement. Four drains were placed (two subgaleal and two epidural) with two serving as inlets and two as outlets. Continuous irrigation of the subgaleal and epidural spaces with gentamicin solution was performed for five days. The bone flap was successfully salvaged and the patient was discharged from inpatient rehab three weeks following washout.

A 63-year-old woman was referred to our PET/MRI platform to evaluate the possible relapse of a meningeal metastasis, complicating an invasive ductal carcinoma of the left breast. This metastasis was diagnosed on a left hemiparesis and treated by surgery and radiation therapy. One year later, the same symptoms led to another brain MRI examination that found a contrast-enhanced lesion in the operating site. We decided to perform a F-DOPA PET/MRI to document this lesion, which confirmed the diagnosis of a probable relapse and revealed a focal uptake on the bone flap.

This is the procedure carried out to etract beam-like specimens from the parietal bone of horse skull.

Aim Manual cranial bone tissue techniques (CBTT) are used by physiotherapists as a tool for assessment and treatment of complaints in the craniocervical, face, and head regions. The goal of this study was to determine whether CBTT were able to discriminate between subjects with cervical and/or temporomandibular disorders (TMD) and a healthy group. In addition, the inter-rater reliability when applying CBTT was also investigated. Methods A cross-sectional study was conducted and included 60 participants. Six standardized passive techniques were applied and judged for resistance, compliance, and sensory answer. In order to evaluate the inter-rater reliability of these techniques a cohort of participants was measured twice (by two evaluators) prospectively. A logistic regression model and Receiver Operating Curve (ROC) analyses were used to determining the discriminative validity of these techniques. Results Logistic regression identified a significant difference for five techniques for resistance and/or compliance and/or the sensory answer between the groups. Based on the Area Under the Curve (AUC) analysis, the discriminative ability of the temporal rotation to distinguish between the groups was fair to good (for resistance AUC = 0.7775 and for compliance AUC = 0.8065). The highest agreement between the two assessors was for the resistance with occipital compression (73%) technique. Conclusion This study highlights that some of the CBTT could be potentially useful in distinguishing subjects with cervical and/or TMD from healthy subjects. Inter-rater reliability was moderate. CBTT could be potentially integrated in the examination of participants with complaints in the craniofacial region.

The most typical feature of Treacher Collins-Franceschetti syndrome is the antimongoloid slant of the palpebral fissures. This is due to absence or hypoplasia of the zygomatic-malar buttress and ectropion of the lower lid. Reconstruction with cranial bone grafts, upper lid flaps, and lateral canthopexy consents progressive normalization of facial features.