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Objective: The objective of this study was to investigate the longitudinal changes in cranial growth following fronto-orbital advancement (FOA) surgery in patients with unilateral and bilateral coronal craniosynostosis., Methods: This retrospective review analyzed head circumference (HC) and CT data during preoperative (T0), immediate postoperative (T1), and final follow-up (T2) visits in 40 patients (23 female, 17 male) who underwent FOA using either the open approach or distraction osteogenesis (DO) between 1987 and 2018. The mean follow-up period was 90.62 months. The z-scores of HC, CT-based intracranial volume, anteroposterior diameter (APD), biparietal diameter (BPD), and cranial height (CH) were calculated using sex- and age-specific standards. Logistic regression analysis was performed., Results: While the z-scores of HC, intracranial volume, and BPD remained within the normal range, the z-scores of APD fluctuated between -2 and -1, and the z-scores of CH were > 2, indicating a substantial elevation compared with norms from T0 to T2. Age at surgery significantly influenced the z-scores of HC, BPD, and CH at T2 (all p < 0.05). Delayed surgical timing was correlated with increased BPD and CH z-scores from T1 to T2 (p = 0.007 and 0.019, respectively). The DO for FOA resulted in elevated HC z-scores at T2 and increased APD from T0 to T1, followed by a significant APD relapse from T1 to T2., Conclusions: These findings suggest that delayed surgical timing may support better cranial growth, as indicated by increased HC at long-term follow-up. However, delayed timing is also associated with worsening abnormally elevated CH. Despite the immediate APD expansion and long-term HC increase with DO, potential relapse warrants caution. While intentional overcorrection of APD is recommended, careful consideration of surgical timing and planning is essential.

Purpose: To examine whether children treated for Retinoblastoma (Rb) have impaired orbital development., Methods: A retrospective case series was performed among children with Rb treated at a single medical center from 2004 to 2020. Orbital volumes and measurements were assessed by 3-dimensional image processing software. The main outcome measures were differences in orbital growth between Rb and non-Rb eyes assessed at last follow-up., Results: Among 44 patients included (mean age 16.09 ± 18.01 months), a positive correlation between age and orbital volume was observed only in the uninvolved, healthy eyes ( p  = .03). In unilateral cases, orbital growth in the horizontal, vertical, and depth planes was smaller on the affected side compared to the healthy eyes ( p  < .05). Orbits that underwent enucleation showed decreased growth over time compared to those treated conservatively ( p  = .017)., Conclusions: Orbital growth rate is slower in the orbits of children treated for Rb compared to healthy orbits. Enucleation negatively affects orbital growth.

Parietal external surface disruption routinely referred to as porotic hyperostosis, and orbital alterations (cribra orbitalia), have been attributed to anemia-related bone marrow hyperplasia in humans. A recent study in humans identified that they were actually vascular in nature. Skeletons were examined and epi-illumination surface microscopy was performed on the parietal region and orbit of 156 Hominidae and 123 Hylobotidae to assess if these phenomena were trans-phylogenetic. Trans-cortical channels were recognized on the basis of visualized ectocranial surface defects penetrating the parietal; cribra orbitalia, by alteration of the normally smooth orbital roof appearance. Trans-cortical parietal channels, ranging in size from 20 to 100 µm, are rare in Gorilla and Pan troglodytes and absent in Pan paniscus. They are universally present in adult Pongo abeli and in Hylobatidae, independent of species. Cribra orbitalia was common in Hylobotidae, Pongo pygmaeus and P. abelii, less prevalent in adult P. troglodytes, and not recognized in any Gorilla gorilla or P. paniscus examined. The proliferative form predominated, with the exception of Hylobates concolor and muelleri, in which uncalcified vascular grooves predominated. No correlation was observed between the presence of either trans-cortical channels or cribra orbitalia and fractures, osteoarthritis, or inflammatory arthritis. Parietal alterations observed in apes are trans-cortical channels, analogous to those observed in humans, and do not represent porosity. Similarly, cribra orbitalia in apes is confirmed as vascular in nature. The proliferative form apparently represents calcification of blood vessel walls, indistinguishable from observations in humans. Predominant presence in adults rather than in juveniles suggests that both forms are acquired rather than developmental in derivation. Sex and bone alteration/disease-independence suggests that mechanical, endocrine, and inflammatory phenomena do not contribute to the development of either. Further, independent occurrence of trans-cortical channels and cribra orbitalia suggests that they do not have a shared etiology., (© 2020 Wiley Periodicals LLC.)

Purpose: Since prehistory, changes of the facial skeleton have been related to the modification of diet. More recent studies have shown changes in the morphology of the mandible and maxilla due to variations of strain during mastication. The temporal muscle (TM) is a strong masticatory muscle, with its insertions extending through the temporal fossa. Our objective is to observe the relations between the TM and the lateral orbital wall (LOW) which could indicate an influence of mastication on the shape of the LOW., Methods: We conducted a retrospective study using 100 CT scans. The length of the lateral orbital wall (LLOW), the angle between LOW and the medial orbital wall (MOW), the cross-sectional areas of LOW and of the TMs were measured on both sides of each CT scan. The correlation between TMs and other three parameters was studied by Pearson correlations., Results: A correlation was found between TMs and LOWs, a lower with LLOW, and a very weak and negative correlation between LOW/MOW angle., Conclusions: Anatomical knowledge about TM and investigation of masticatory strains lead us to think that mastication have minimal effect on the morphology of the LOW, only on the frontal process of zygomatic. This may explain, in part, why the LOW is the strongest wall of the orbit.

Accurate eye movements are crucial for vision, but the development of the ocular motor system, especially the molecular pathways controlling axon guidance, has not been fully elucidated. This is partly due to technical limitations of traditional axon guidance assays. To identify additional axon guidance cues influencing the oculomotor nerve, an ex vivo slice assay to image the oculomotor nerve in real-time as it grows towards the eye was developed. E10.5 Isl MN -GFP embryos are used to generate ex vivo slices by embedding them in agarose, slicing on a vibratome, then growing them in a microscope stage-top incubator with time-lapse photomicroscopy for 24-72 h. Control slices recapitulate the in vivo timing of outgrowth of axons from the nucleus to the orbit. Small molecule inhibitors or recombinant proteins can be added to the culture media to assess the role of different axon guidance pathways. This method has the advantages of maintaining more of the local microenvironment through which axons traverse, not axotomizing the growing axons, and assessing the axons at multiple points along their trajectory. It can also identify effects on specific subsets of axons. For example, inhibition of CXCR4 causes axons still within the midbrain to grow dorsally rather than ventrally, but axons that have already exited ventrally are not affected.

In the mare, foaling is a critical unpredictable event due to a wide range of gestational length and the absence of clear signs of impending parturition. To predict foaling, pH, inversion sodium potassium and increase of calcium concentration in mammary secretions are used. The aim of this study was to find how many days are left until parturition knowing mare's age (A) and parity (P) combined with ultrasonographic measurements of the fetal orbit in Standardbred mares with normal pregnancy. Eighty healthy Standardbred mares with normal pregnancy were hospitalized for attended delivery. Information about mare's age, parity and breeding date were recorded at admission. Transrectal ultrasonography were routinely performed at admission and every 10 days until parturition using a B-mode real time portable unit equipped with a 5-7.5 MHz linear transducer. The images of the fetal orbit were acquired when cornea, anterior and posterior chamber, vitreous body, lens and optic nerve were visible. Longitudinal diameter (LD) was considered as the distance between the two ocular poles, within the vitreous body; transverse diameter (TD), perpendicular to LD and bisecting the lens, was measured as the distance between cornea and retina. At delivery, length of pregnancy and gestational age at each exam were registered. For each ultrasound examination, days before parturition (DBP) were calculated. Seventy-eight Standardbred mares with normal pregnancies were included in the study. Mares' mean age was 9 ± 5 years old (range 4-20 years) and mean gestation length was 341 ± 7 days (range 327-366 days). Thirty-three mares were primiparous and 45 mares were multiparous. Data were analyzed using a regression tree: P, A, LD and TD were used as covariates. DBP was used as the variable of interest. Nine terminal nodes were identified based on the selected covariates. The first split is produced by the TD: fetuses with TD greater or equal than 2.97 cm are further split according to LD, with a threshold of 3.28 cm. The next split is dictated by A; after a further split on LD, the first terminal node is built, containing 34 fetuses with average DBP equal to 10 days. If the A is ≥ 9.5 years a further split is on P: when mares are multiparous, the TD built two different nodes. Since prediction of mare's foaling date is an important factor in stud farm management, the regression model developed may help the veterinarian to estimate the DBP in Standardbred mares with normal pregnancy., (Copyright © 2018. Published by Elsevier Inc.)

The incidence of the patients with craniofacial anomalies was high in southeast-Asian countries, for example, fronto-ethmoidal encephalo-menigocele or craniosynostosis. These craniofacial anomalies usually involve orbits, so a surgical orbital reconstruction is always required.Various methods have been used in the past to indirectly analyze the craniofacial region. Plain skull radiography, anthropometry, and cephalometry provided the limited information of interorbital distance in terms of accuracy whereas the interorbital distance is crucial to be reconstructed, increasing or decreasing. The accurate normal interorbital distance which grows by age as other craniofacial structures is the important data in the part of interorbital and orbital reconstruction. To date, the normative data of the bony interorbital distance among Thai population have not been established.The purpose of this study is to provide normal values and the growth patterns of the bony interorbital distances and other dimensions of the orbit according to age among Thai population through the axial computed tomography. Comparisons can then be made between normal values and those for an individual patient or those for a group of patients, for example, those with front-ethmoidal meningoencephalocele, Crouzon, or Treacher-Collins syndrome, or among values for individual patients at different time intervals.A retrospective study of computed tomography (CT) scan series of 698 normal orbits from 349 skeletally normal subjects (202 men and 147 women) was enrolled. The age range of the patients was 0 to 21 years (mean, 10.2 years; SD, 5.8 years). A series of 12 measurements were obtained from the CT scans of each subject. All CT images were obtained from patients who underwent CT of the facial bone, brain, and orbits at the Department of Radiology of 3 big hospital in Bangkok-Ramathibodi, Samitivej Srinakarin, and Bangkok hospital-since 2010 to 2015.The normal measurement values in the orbital region through the CT images, as the normal periorbital growth curve, will help improving diagnostic accuracy, staging of reconstruction, precision of corrective surgery, and follow-up of the Thai patients with craniofacial abnormalities such as front-ethmoidal meningoencephalocele, hypertelorism. These data may also apply to the related population in the southeast-Asian countries.

Aim: This study chronicles skull base and face development in nonsyndromic unilateral coronal synostosis (UCS) during infancy, to characterize the mechanistic progression of facial dysmorphology., Methods: Computed tomography scans from 51 subjects were reviewed (26 UCS, 25 controls) and data were reconstructed. Patients were stratified into 5 age groups. A series of measurements were taken from the reconstructions., Results: All patients had a unilaterally fused coronal suture at the time of analysis. Asymmetry of the sphenoid wings was present across all age groups. The sphenoid wing ipsilateral to the fused suture consistently had a more acute angle from the midline. At 19 days of age, ipsilateral nasal root and cribriform plate deviation are noted, as well as increased contralateral zygoma antero-posterior length. Patients younger than 2 months also had elongated posterior cranial bases. At 2 to 3 months of age, the cranial base widens in the anterior portion of the middle cranial fossa with an increased ipsilateral pterion to sella distance. The most delayed change observed was the increase in contralateral orbital rim angle at 7 to 12 months of age compared to normal., Conclusion: After suture fusion, sphenoid wing changes are among the earliest restructural malformations to take place. This suggests that the cascade of dysmorphology in UCS originates in the cranial vault, then progresses to the skull base, and lastly to the facial structures. Ipsilateral orbital changes are early facial changes in UCS that begin before 2 months of age. This is then followed by changes in the contralateral face later in development.

Objective: The aim of this study was to map out the developmental curve of the orbital volume of Chinese children aged 1-15 years., Methods: CT scanning was performed on 109 children and the orbital volume, interlateral orbital rim distance (IORD), and extent of exophthalmos were measured on the CT images and plotted against age., Results: The development of the orbit structure followed a biphasic pattern. The first growth phase was before 3 years and the second growth phase was between 7 years and 12 years of age. The growth speed in the first phase was about 3 times that of the second one (first vs second phase: 2.28 cm 3 /year vs 0.67 cm 3 /year for orbital volume, 5.01 mm/year vs 1.57 mm/year for IORD, 1.29 mm/year vs 0.42 mm/year for the exophthalmos). During development, there was no significant difference between the left and right orbits. There was no significant difference between boys and girls before 12 years of age. However, after 12 years of age, boys had significantly larger orbital volumes (22.16±2.28 cm 3 /year vs 18.57±1.16 cm 3 /year, p<0.001) and a greater IORD (96.29±3.18 mm/year vs 91.00±4.54 mm/year, p<0.001) than girls., Conclusions: In Chinese children, the development of orbital volume follows a biphasic pattern and a sex difference becomes significant after the age of 12 years., Competing Interests: Competing interests: None declared., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Purpose: To measure orbital volume using serial magnetic resonance imaging (MRI) scans to determine the effect of enucleation on orbital growth over time., Methods: The medical records of patients who underwent unilateral enucleation for retinoblastoma with a minimum of 2 MRIs were retrospectively reviewed. Orbital asymmetry was calculated using MRI measurements. Nonlinear and linear mixed effect regression models were used to predict the effect of age at time of enucleation on degree of orbital asymmetry., Results: A total of 27 patients were included (mean age at enucleation, 2 years; range, 2.5 months to 5 years). Age at scan (P = 0.046) and age at enucleation (P = 0.0006) were found to have a significant effect on orbital asymmetry. Change in orbital asymmetry over time was more pronounced after enucleation in children enucleated at <1 (P < 0.0001) or <2 years of age (P = 0.0109). Younger age at enucleation was associated with a greater degree of asymmetry over time, although this effect was extinguished for patients enucleated after the age of 3 years., Conclusions: In patients with retinoblastoma, enucleation with orbital implant before 3 years of age has a significant effect on orbital volume asymmetry. After the age of 3, this effect appears to be less detrimental to the degree of orbital asymmetry., (Copyright © 2017 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.)

Background: To determine three-dimensional spatial orbit skeletal changes in adolescents over a 19 to 24 months observation period assessed through cone-beam computed tomography (CBCT)., Methods: The sample consisted of 50 adolescents aged 11 to 17. All were orthodontic patients who had two CBCTs taken with an interval of 19 to 24 months between images. The CBCTs were analyzed using the third-party software Avizo. Sixteen anatomical landmarks resulting in 24 distances were used to measure spatial structural changes of both orbits. Reliability and measurement error of all landmarks were calculated using ten CBCTs. Descriptive and t-test statistical analyses were used to determine the overall changes in the orbits., Results: All landmarks showed excellent reliability with the largest measurement error being the Y-coordinate of the left most medial point of the temporalis grooves at 0.95 mm. The mean differences of orbital changes between time 1 and time 2 in the transverse, antero-posterior and vertical directions were 0.97, 0.36 and 0.33 mm respectively. Right to left most antero-inferior superior orbital rim distance had the greatest overall transverse change of 4.37 mm. Right most posterior point of lacrimal crest to right most postero-lateral point of the superior orbital fissure had the greatest overall antero-posterior change of 0.52 mm. Lastly, left most antero-inferior superior orbital rim to left most antero-superior inferior orbital rim had the greatest overall vertical change of 0.63 mm., Conclusions: The orbit skeletal changes in a period of 19-24 months in a sample of 11-17 year olds were statistically significant, but are not considered to be clinically significant. The overall average changes of orbit measurements were less than 1 mm.

Background: Assessment of the growth of bony orbit in children with blind microphthalmia is essential to its management. In this study, variables were measured to evaluate the development of the bony microphthalmic orbits after treatment with self-inflating hydrogel expanders., Methods: This is a retrospective study with an interventional case series. Thirteen pediatric patients with congenital unilateral blind microphthalmia who had undergone tissue expansion with hydrogel expanders and computed tomography (CT) scanning before and after operation were included in the study. The orbital volume, depth, width, and height and retardation of the orbital rims before and after treatment were measured and analyzed using the iPlan Cranial Software., Results: The mean age at the time of first implantation was 44 months (range, 3-113 months). Of the 13 patients, eleven received orbital expansion, while two received socket expansion. In the orbital expansion group, the mean microphthalmic/contralateral ratio (MCR) of orbital volume was 79.3% before surgery, which increased to 89.8% 3 years post operation (P < 0.001). The mean MCR of orbital width also increased from 88.8% to 91.8% (P = 0.003). The development of inferior and lateral rims showed the greatest retardation before treatment; the retardation of these two rims decreased significantly at the final measurement (P = 0.004). It is also noted that the development of the microphthalmic orbits was limited in the two patients who only underwent socket expansion., Conclusions: The affected orbit enlarged in children with congenital blind microphthalmia following treatment with hydrogel expanders; this suggested that microphthalmia-associated orbital asymmetry can be treated with self-inflating hydrogel expanders., (Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Most studies on craniofacial morphology have focused on adult individuals, but patterns of variation are the outcome of genetic and epigenetic variables that interact throughout ontogeny. Among cranial regions, the orbits exhibit morphological variation and occupy an intermediate position between neurocranial and facial structures. The main objective of this work was to analyze postnatal ontogenetic variation and covariation in the morphology of the orbital region in a cross-sectional series of humans from 0 to 31 years old. Landmarks and semilandmarks were digitized on the orbital rim, as well as in neighboring neural and facial structures. Data were analyzed using geometric morphometrics. Results indicated that orbital size increases during the first years of postnatal life, while the shape of the orbital aperture does not change significantly with age. In general, the pattern and magnitude of shape covariation do not vary markedly during postnatal life although some subtle shifts were documented. Additionally, the shape of the orbital aperture is more related to the anterior neurocranium than to zygomatic structures, even when the allometry is adjusted. Although we expected some influence from postnatal craniofacial growth and from some functional factors, such as mastication, on the development of the orbits, this assumption was not completely supported by our results. As a whole, our findings are in line with the prediction of an early influence of the eyes and extraocular tissues on orbital morphology, and could be interpreted in relation to processes promoting early neural development that coordinately affects orbital traits and the neurocranial skeleton., (© 2015 Wiley Periodicals, Inc.)

One common belief in ophthalmology is that enucleation at an early age will result in bony orbital maldevelopment and facial asymmetry. However, the age range in which enucleation is associated with risk of orbital maldevelopment and the extent of asymmetry remains controversial. In this study, patients who had undergone unilateral enucleation at different ages without orbital implantation were analysed to investigate bony orbital development after enucleation. A total of 87 Chinese adult patients were included. Their bony orbital volume and orbital aditus area were measured using three-dimensional reconstructive models based on patients' computer tomography scans. The ratio of the parameter values of the affected orbit to the unaffected orbit was calculated and described as the orbital symmetry index. The results showed that the bony orbit grew until approximately 18 years old. Enucleation after that age did not affect the orbit, whereas enucleation before that age led to significant orbital maldevelopment. The relative reduction ranged up to 20% in orbital volume and 17% in the orbital aditus area. The extent of orbital maldevelopment was correlated to the age of enucleation. The symmetry index of orbital volume = -0.0003x(2)  + 0.0159x + 0.8112 (x = the age of enucleation). The symmetry index of the orbital aditus area = -0.0002x(2)  + 0.0119x + 0.8504 (x = the age of enucleation). The regression formulae were used to predict the severity of orbital asymmetry after unilateral enucleation, and evaluate the necessity and efficacy of interventions following enucleation., (© 2015 Anatomical Society.)

Objective: Frontoorbital advancement (FOA) in patients with non-syndromic craniosynostosis mainly addresses the aesthetic and functional correction of the frontoorbital region. To help define the operative strategy and any follow-up assessments after surgical correction, objective parameters describing the critical regions of skull deformity are essential. Based on 3D morphometric analysis, new parameters for the documentation of changes of the frontoorbital bandeau were developed in a prospective study., Methods and Materials: In a prospective series, 13 children with non-syndromic craniosynostosis (seven metopic, four unilateral coronal, and two bilateral coronal) treated with frontoorbital advancement, underwent detailed morphometric and volumetric evaluation using a 3D light optical scan system (3D-Shape, Erlangen, Germany). Measurements were obtained preoperatively and at 3, 6 and 12 months postoperatively with newly developed parameters generated by cephalometric analysis software (Onyx Ceph, Image Instruments, Chemnitz, Germany)., Results: In most patients, frontoorbital advancement resulted in stable long-term results without growth inhibition and with normalization or improvement of ongoing skull development. The mean frontal angle was 145° and the frontoparietal angle 137-140°. The cephalic index was normalized or markedly improved. Head circumference and head height increased significantly (p = 0.001 and p = 0.002, respectively). These changes were confirmed in all postoperative measurements., Conclusion: During the 12-month follow-up period all angle parameters proved to be stable and no major impairment of normal skull growth was observed after FOA. The frontoorbital angle is a useful parameter in evaluating long-term outcome. The frontoparietal angle is important for the stability of the frontoparietal region, in which a certain growth inhibition may be observed postoperatively., (Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Objective: To assess growth of the middle/posterior cranial base during adolescence based on landmarks located on serial three-dimensional cone-beam computerized tomography (CBCT) images., Materials and Methods: CBCT scans from 62 adolescents (11 to 17 years) at baseline and 12 months were used. Eleven landmarks in the cranial base were identified. Linear landmark distances were compared over the two time points using basic descriptive statistics. Shape analysis was carried out using R (R Foundation for Statistical Computing, Austria). Discrete curves were obtained and aligned via a Procrustes transformation and examined for group dimorphism and longitudinal change., Results: Mean differences between linear distances in the cranial base were within 1mm, apart from the difference between the right and left auditory external meatuses, which was 2.25 mm. No statistically significant longitudinal differences in shape were found in relation to the peak growth period., Conclusion: Cranial base growth was minimal over the observation period. There were no differences in terms of the amount and pattern of growth. The cranial base is said to complete most of its growth by age 12, but this has only been verified through two-dimensional studies. Our findings using CBCT confirm this, and support the use of the cranial base as a stable anatomical reference structure for superimpositioning., (Copyright © 2015 CEO. Published by Elsevier Masson SAS. All rights reserved.)

Background: Orbital reconstruction requires knowledge of orbital depth in order to prevent optic nerve injury. Numerous analyses of adult orbital dimensions have been undertaken previously in order to characterize this measurement, including skull specimen and computerized tomography studies. However, there is a paucity of information regarding the pediatric orbit., Methods: The authors used pediatric magnetic resonance imaging (MRI) studies in order to quantify the change in orbital depth in relationship to patient age, and to develop methods to estimate and calculate orbital depth for individual pediatric patients. MRIs of the head in normal pediatric patients were reviewed retrospectively. Orbital depths were measured and correlated with age and cephalometric dimensions. In a randomly selected subgroup of patients, measurements were repeated by an independent investigator to determine interobserver reliability., Results: Measurements were obtained in 72 patients ranging from 3 months to 18 years of age (mean=7.8 years). There was a significant exponential relationship between orbital depth and patient age (r=0.81, F(2,69)=143.97, P<0.001). Depth increased more rapidly in the first 6 years of life, but leveled off in the early teen years toward a horizontal asymptote of approximately 45 mm. There was also a significant relationship between orbital depth and the sum of the biparietal width plus the anterior-posterior length (r=0.72, F(2,69)=87.44, P<0.0001). There was high interobserver reliability in measurements between 2 independent investigators (r=0.79, P<0.0001)., Conclusion: In children, orbital depth increases predictably with rising age and increasing head size. Knowledge of this growth curve and the relationship between head size and orbital depth can complement careful surgical dissection to improve safety and efficacy in pediatric orbital reconstructions.

Objective: An evaluation of orbital development in children from birth to 6 years of age was conducted in order to provide normal reference values for clinical use., Methods: Retrospective cohort study. By combining multi-section helical computerized tomography (CT) imaging with a computer-aided design system (BrainLAB, Munich, Germany; iPlan Cranial Software, version 2.5), we measured the orbital volume of 100 emergency children (200 eyes), who underwent computerized tomography (CT) scanning due to mild injury in Beijing Tongren Hospital and had normal CT findings. From birth to 6 years of age, according to the age of < 1 years of age for the treatment of 0 year old group, aged 1 years old and < 2 years old for 1 year old group, and so on, divided into 7 groups. Among the 50 male and female patients, the ages are 0-6 years. All of these were in order to analyze the relationship between the age and orbital volume with unary linear correlation and regression. The comparison of orbital volume between females and males was performed using two independent t-tests. Comparisons of bilateral orbital volumes were performed using a paired t-test., Results: The average orbital volume of children was initially (12.57 ± 3.80) cm(3) at birth, and then increased to (19.34 ± 1.86) cm(3) at 6 years of age, with an average annual growth of 1.13 cm(3). There was a positive linear relationship between orbital volume and age in children from birth to 6 years of age, yielding the regression equation: Y (orbital volume) = 13.582 + 1.042 × X(age). There is no statistic difference on the orbital volume between boys and girls (t = 1.073, 0.533, 1.808, 1.039, 1.346, 0.983, 1.774, P > 0.05). In addition, no statistic difference was found between the left and right orbital volume (t = 1.059, P = 0.292). The growth curves for all groups almost overlapped with each other., Conclusions: There is a positive linear relationship between orbital volume and age in children from 0 to 6. The bilateral orbital volumes were almost the same. There is no statistic difference on the orbital volume between boys and girls.

Objective: To determine normative ranges for fetal ocular biometrics between 19 and 38 weeks gestational age (GA) using volumetric MRI reconstruction., Method: The 3D images of 114 healthy fetuses between 19 and 38 weeks GA were created using super-resolution volume reconstructions from MRI slice acquisitions. These 3D images were semi-automatically segmented to measure fetal orbit volume, binocular distance (BOD), interocular distance (IOD), and ocular diameter (OD)., Results: All biometry correlated with GA (Volume, Pearson's correlation coefficient (CC) = 0.9680; BOD, CC = 0.9552; OD, CC = 0.9445; and IOD, CC = 0.8429), and growth curves were plotted against linear and quadratic growth models. Regression analysis showed quadratic models to best fit BOD, IOD, and OD and a linear model to best fit volume., Conclusion: Orbital volume had the greatest correlation with GA, although BOD and OD also showed strong correlation. The normative data found in this study may be helpful for the detection of congenital fetal anomalies with more consistent measurements than are currently available. © 2015 John Wiley & Sons, Ltd., (© 2015 John Wiley & Sons, Ltd.)

Objective: The aim of this study is to analyze the craniofacial morphology in patients with unrepaired isolated cleft palate (UICP) at childhood, adolescence and adulthood, in order to assess the influence of nonsurgical factors on the craniofacial growth in these patients., Material and Methods: Lateral and posteroanterior cephalograms of 106 non-syndromic UICP patients and 102 normal matched controls were obtained and analyzed. Patients and controls were divided into three subgroups: children (5-7 years), adolescents (12-14 years), and adults (>18 years)., Results: UICP patients in childhood showed a shortened cranial basal length; reduced bony nasopharyngeal height; short maxillary depth and height with a posterior positioned maxilla and an increased width of the nasal cavity, maxilla and orbit; and a shortened mandibular length and height. UICP patients in adulthood showed a normal nasopharyngeal and mandibular morphology. However, the patients in this subgroup still showed a shortened cranial basal length, and short maxillary depth and anterior height with increased width of the nasal cavity, maxilla and orbit., Conclusions: Craniofacial morphology and growth in patients with UICP were significantly affected by nonsurgical factors. Growth of the cranial base and upper face were absolutely reduced, while growth of the bony nasopharynx and mandible were only postponed., (Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Background: Enucleation in young children often results in retarded orbital growth ipsilaterally. The need for an implant that will naturally grow with the child, like Dermis-fat Graft (DFG), for managing the anophthalmia has been of interest over the years., Objective: To evaluate the use of DFG as an implant for volume replacement post-enucleation., Study Design: A prospective non-comparative case series involving 18 consecutive children who had DFG either primarily or secondarily in conjunction with enucleation for intraocular pathologies, from December 2007 to September 2012, at the ophthalmology unit, Korle-Bu. Data from patients who had a minimum of three months follow up(FUP) were analysed., Outcome Measures: Complete covering of DFG with healthy conjunctiva, increase in volume of DFG, and presence or absence of complications., Results: Fifteen patients were analysed, aged nine months to ten years (mean (SD), 3.7±2.7years). Eight (53.3%) were females. Thirteen (86.7%) DFGs were secondary and 2(13.3%) primary. Indications for enucleation were intraocular retinoblastoma (n=10, 66.7%), unexplained retinal detachment mimicking retinoblastoma (n=3,20.0%), anterior staphyloma (n=1,6.7%) and medulloepithelioma (n=1,6.7%). Fourteen (93.3%) patients showed increase in volume of DFG. Time for Conjunctival reepithelialisation of the dermal surface was four to fourteen weeks (mean/median=5.5/4.0). Complications encountered were infection (n=1,6.7%), infection with necrosis (n=1,6.7%), melanosis /keratinization (n=2, 13.3%) and cysts(n=2,13.3%). The patients were followed up for 3 to 54 months (mean/median 20.13 /16.00)., Conclusion: DFG for management of post-enucleation anophthalmia in Ghanaian children showed 93.3% success.

Objective: To compare the treatment effects between skeletal anchored facemask (SAFM) and tooth-borne facemask (TBFM) on different maturation stages and vertical skeletal patterns., Materials and Methods: In this retrospective study, 28 patients who were treated with TBFM treatment and 19 patients who were treated with SAFM were reviewed. Cephalograms at the beginning and end of facemask application were obtained and assessed. Each treatment group was divided according to skeletal maturity and facial angle type. Nonparametric Mann-Whitney U-test was used for comparisons of maturity stage and vertical skeletal type between the treatment groups., Results: SAFM produced a significant increase in the anterior-posterior position of orbitale (SNOr) and A point (N. per. to A). The high mandibular plane angle group of SAFM revealed greater anterior movement than that of TBFM without opening of the mandibular plane. In the SAFM group, the angulation of the maxillary incisors was retroclined at CVM3 compared to CVM4. In the younger group (CVM3), SAFM showed greater changes in the variables of orbitale (2.909°) and maxillary length (5.818 mm), compared to TBFM., Conclusions: Compared with the TBFM group, the findings suggest significant advantages for the SAFM group for relative skeletal maturity and vertical skeletal pattern.

Introduction: The aims of this study were to investigate and compare the anterior facial heights of children with long, normal, and short faces during growth and to discover whether long-faced subjects have long dimensions in both the upper and lower anterior facial heights compared with the others., Methods: Longitudinal lateral cephalometric data of 167 children (83 girls, 84 boys) from 6 to 14 years of age were used. Total anterior face height, upper anterior face height, lower anterior face height, and the closest distance from the Frankfort horizontal plane to nasion were measured. The samples were classified as long-faced, normal-faced, and short-faced according to the ratio of lower to total face heights at 14 years old. All data were analyzed statistically and compared between the groups according to age., Results: The mean lower anterior face height in the long-faced group was larger than in the normal-faced and short-faced groups for all ages in both sexes. In contrast, subjects in the normal-faced group had a longer mean upper anterior face height than did subjects in the long-faced and short-faced groups. In addition, the mean upper anterior face height of the short-faced group was larger than the long-faced group for girls at all ages and for boys at 12 to 14 years., Conclusions: The long-faced children did not have longer upper facial heights compared with normal-faced and short-faced children, and their long faces were mainly determined by the length of the lower face., (Copyright © 2014 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

The sagittal relationships between the orbital globe and the ocular orbit have great importance in aesthetic and functional evaluations. These relationships are useful in diagnosis and treatment of some malformations in which the orbital volume is reduced such as craniostenosis. The aim of the present study was the cephalometric evaluation of the ocular protrusion at different growth stages. Ninety-two patients with negative history of craniosynostosis, severe myopia, and skeletal class I were selected for the present study. Lateral teleradiography x-ray was performed for all the patients, and 5 groups were carried out based on the dentition phase. Cephalometric analyses were performed on the lateral teleradiography x-ray. Mean values of ocular protrusion (B-Or post) for females and males were found and digitized for the 5 groups tested. All other sagittal and vertical measurements were successfully computed by the trained operator. B-Or post showed values between -14.93 mm and -16.90 mm among the groups. The cephalometric analysis proposed in the present study allowed to successfully evaluate sagittal and vertical relationship of the orbital globe and the orbital cavity in growing patients. Moreover, the B-Or post maintained its value during growth in the present study.

Eye loss in children can be caused by trauma, glaucoma, or cancer, and may result in anxiety and depression. Recovery after eye loss involves a replacement with a custom-made eye prosthesis, but, as the patient ages, changes in the size and shape of the eye socket can result in a sunken appearance of the child's prosthetic eye. This article describes the fabrication of a custom-made eye and the necessity of changing ocular prostheses for a growing child, with a 5-year follow-up., (Copyright © 2014 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Objective: To investigate the constancy of the angle between the Frankfort horizontal plane (FH) and the sella-nasion line (SN) using longitudinal data., Materials and Methods: Longitudinal lateral cephalometric data of 223 children (116 girls and 107 boys) from 6 to 14 years of age were used. The angle between FH and SN (SNFH), the distance from FH to the nasion (NFH), the distance from FH to the sella (SFH), and the differences between the NFH and SFH (Δ) were also measured. All data were analyzed statistically using independent t-tests and mixed-effect regression model analysis., Results: The mean SNFH values showed some minor fluctuations, ranging from 9.26° to 9.74° in girls and 8.45° to 8.95° in boys. The mean NFH and SFH values gradually increased according to age irrespective of sex. There were statistically significant differences by sex for all measurements at several ages. The annual change in SFH and Δ showed sexual dimorphism., Conclusions: There are variations among individuals in the angle between the FH and SN. However, within an individual, the angle does not vary significantly over time during the observation period.

Purpose: The deformation of the skull base in patients with unilateral frontal plagiocephaly (UFP) is well known, but the mechanism is not still clear. We analyzed the skull base in the patients with UFP who underwent fronto-orbital advancement (FOA) in the early life during the last decade., Methods: We assessed the treatment results and outcome of FOA performed in six patients, four girls and two boys younger than 2 years, in the last decade. Also, the basal cranium's angles were measured by 3D reconstruction images on computed tomography (CT) scan., Results: The mean patients' age at FOAs was 11 months. Two cases were classified as grade 2A, two cases as grade 2B, and two cases as grade 3 (the classification of Di Rocco and Velardi). The ethmoidal axis was deviated a mean of 8.2° to the affected side. The mean angle between the petrosal pyramids and the midline (anterior-petrosal-sagittal angle, APSA) was 75.3° on the affected side and 66.2° on the normal side. The mean difference of APSA was 9.2°. On the follow-up CT images 5 years after surgery, the deviations of the ethmoidal axis clearly decreased, 5.7°, but the differences of APSA did not change, 8.8°., Conclusions: The midline distortion of anterior skull base should be considered to be spontaneously corrected during the follow-up periods in patients with all types of UFP who underwent FOA, unlike posterior skull base in the patients with grades 2B and 3 classification.

Background: The purpose of this study was to characterize soft-tissue profile changes following Le Fort III (midface) distraction in growing patients with syndromic craniosynostosis., Methods: The cohort consisted of 20 syndromic patients who underwent Le Fort III osteotomy with midface advancement using a rigid external distraction device. The mean age at surgery was 5.7 years (range, 3 to 12.5 years). Lateral cephalograms were obtained preoperatively (time 1), after distraction device removal (time 2), and 1 year after distraction (time 3). Ten skeletal hard-tissue and 11 soft-tissue profile landmarks were identified and digitized at time points 1, 2, and 3. The x and y displacement of each landmark was studied to determine the ratios for soft- to hard-tissue change., Results: The horizontal ratio of soft- to hard-tissue change for nasal dorsum to orbitale was 0.73:1 and the soft-tissue tip of nose to the anterior nasal spine was 0.86:1. The horizontal ratio of soft-tissue A point to hard-tissue A point was 0.88:1. The horizontal ratio of the upper lip position to the labial surface of maxillary incisor was 0.88:1. The ratio for nasal tip elevation to the anterior nasal spine advancement was 0.27:1., Conclusions: The result of this study supported the hypothesis that there exists a linear relationship between soft- and hard-tissue changes in the horizontal direction for the midface landmarks following Le Fort III distraction. However, there was a nonlinear relationship between soft- and hard-tissue changes in the vertical direction., Clinical Question/level of Evidence: Therapeutic, IV.

Craniofacial clefts are relatively rare. Tessier proposed a classification of craniofacial clefts. A Tessier no. 10 cranial facial defect is very rare. There are few reports regarding the reconstruction of the orbital rim and roof of a Tessier number 10 cleft. In this paper, we present the reconstruction of the orbital rim and roof by a folded vascularized calvarial bone and the long-term follow-up results.

Purpose: The purpose of this study was to characterize the relationships among orbital dimensions, globe diameter, and subject age., Methods: A cross-sectional, retrospective analysis of 124 CT scans of subjects with no appreciable orbital or globe disease was performed by 1 observer (G.K.E.). Seventeen length measurements and 5 angle measurements of various aspects of the orbit were obtained. Subjects of similar age were grouped and analysis was performed to define the changes in these parameters in association with age., Results: One hundred twenty-four CT scans of 124 subjects without identifiable globe or orbital disease were included in this study. Twenty-one subjects ≥ 17 years of age were considered mature adults and grouped together, while the remaining 106 subjects were grouped according to age. Intraobserver variability between orbital measurements was excellent, r > 0.95 (p ≤ 0.01) for most measurements. There was no difference between right and left orbital measurements, as each was highly correlated to its contralateral counterpart. Globe diameter and all length measurements except globe protrusion increased most rapidly over the first 12 to 24 months and reached 86% to 96% of their respective adult means by age 8 years. Globe diameter and linear orbital measurements were highly correlated. Globe protrusion and measurements of orbital angles exhibited a different pattern., Conclusions: The pattern of human orbital growth is strongly correlated with the pattern of ipsilateral globe growth. This change is most rapid during the first 12 to 24 months of life and maintains a significant pace until reaching 86% to 96% of adult values for most parameters at age 8 years. After this age, the rate slows considerably until maturity. With this attempt to define normal age-related orbital change, the authors report a pattern of growth which may be clinically applicable in the management of pediatric anophthalmos.

Among primates, partial or complete posterior closure of the orbit has been widely accepted as a shared derived characteristic justifying an exclusive tarsier-anthropoid clade, while some regard the tarsier lateral orbit as an elaborated postorbital bar (POB). To test these competing hypotheses while minimizing the confounding effect of tarsier orbital hypertrophy, we compared tarsiers and other primates at early (fetal and newborn) ages using dissection, micro-CT scans and soft tissue histology. Our findings demonstrate unanticipated variation in the anatomy and development of the zygomaticofrontal (ZFA) articulation, which forms the orbit's lateral framework. Tarsiers uniquely exhibit a combination of two features: absence of a pre- and peri-natal frontal spur to join with the zygomatic to form the ZFA; and, the spur's substitution by an elaborate ligament, which envelops the eye laterally as an expansive postorbital membrane (POM) that merges with the anterolateral fontanelle of the lateral cranial vault. In lacking a frontal spur, tarsiers are distinct from strepsirhines, while the ligamentous structure of the POM distinguishes its ZFA from that of anthropoids, which is a typical facial suture at and prior to birth. The POM of tarsiers may be thought of as an accessory fontanelle, a structural compromise that provides flexible stability and spatial separation of bones while anticipating rapid postnatal growth of an enormously enlarged eye. We regard the tarsier POM as part of a neomorphic eyeball hypertrophy complex, and reject the hypothesis of derived homology of the postorbital septa of adult tarsiers and anthropoids on histological, developmental and functional grounds., (Copyright © 2013 Wiley Periodicals, Inc.)

Purpose: Infants with orbital hemangiomas and vascular malformations often develop expanded orbits or regional hyperostosis. Treatment in these cases depends, in part, on the stage of orbital development at the time of intervention; yet, orbital development with respect to age is not well-known. The authors sought to determine the rate of orbital development and the age of orbital maturation in a single ethnic population., Methods: Skeletons recovered in North America and housed at the Peabody Museum of Archaeology and Ethnology, Harvard University, were inspected. The age of specimen was determined by dentition. Orbital volume was measured using 1-mm glass beads and a graduated cylinder. Linear measurements were taken with calipers and paper rulers. The measurements were plotted against age, and statistical analysis was performed. Relevant literature was reviewed., Results: Of the hundreds of skeletons examined, 42 were sufficiently intact for orbital measurement. The specimens represented a period of up to 1000 years. Thirty-two were pediatric (defined prenatal to 18 years) and 10 were adults. Mean adult orbital volume was 26.2 ml. Based on the regression analysis, 60% of adult orbital volume was achieved at 4.35 years, 75% at 9.36 years, and 90% at 17.13 years of age. Linear dimensions progressively increased with age., Conclusions: This largest direct-measure study of pediatric orbital volume suggests that orbital growth continually decelerates from birth until maturity at 22 years. With 50% of orbital growth occurring by 16 months of age, surgeons removing periocular vascular anomalies after that age should consider concurrent skeletal management.

Objective: To evaluate the facial morphology characteristics of patients with complete unilateral cleft lip and palate (UCCLPs) who had undergone cleft palate repair at different times., Design: This study included 46 nonsyndromic UCCLPs and 38 age and sex matched non-cleft patients. 35 cephalometric measurements were used to evaluate the facial morphology. Student's t-test, one-way ANOVA and rank sum tests were used for comparison. Significant difference was defined at 95% level., Results: The data showed that UCCLPs who had palatoplasty between 7 and 12 years had greater PMP-A, PMP-ANS, Ba-ANS, Ba-A, Ba-N-ANS than those operated on before 4 years of age, and UCCLPs who had palatoplasty at 4-12 years had smaller Y-axis angle than those operated on before 4 years of age., Conclusions: The maxillary sagittal length increased gradually as von Langenbeck repair was delayed. UCCLPs who underwent palate repair using von Langenbeck technique at 4-12 years had a more protrusive maxilla and less clockwise rotated mandible than those repaired before 4 years. UCCLPs operated using the von Langenbeck technique at 4-12 years had better head-face morphology than those operated on before 4 years. There was no difference in facial morphology among UCCLPs with palate repair at 4-12 years., (Copyright © 2012 European Assocation for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Every surgeon operating on the face, and particularly around the eye, should possess a working knowledge of the critical details related to development of the human orbit and recognized changes that occur during the course of aging. The anatomy of the orbit and periorbital region is complex, and the diagnosis and treatment of patients with orbital/periorbital disease requires expertise in congenital differences and awareness of the changes that occur as individuals age., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Purpose: To evaluate the asymmetry of bilateral orbital development in Chinese children with congenital microphthalmia and to provide a criterion for tailoring treatment timing and therapy., Design: Retrospective cohort study., Methods: By combining multisection helical computerized tomography imaging with a computer-aided design system, we measured 38 children between 0 and 6 years of age with congenital microphthalmia and 70 normal children of the same age group. Variables were measured, including orbital volume, depth, width, and height and eyeball volume. Displacement of the orbital rims was calculated by mirroring the unaffected orbit across the midsagittal plane of body., Results: Significant differences were observed between the orbital volume, eyeball volume, orbital width, and orbital height of the affected and unaffected sides of children with congenital microphthalmia (P < .001). The difference between the orbital depth of the affected and unaffected sides was not significant (P = .055). Growth of the inferior and lateral rims retarded by an average of 3 mm, whereas that of the medial and superior rims retarded by less than 1 mm., Conclusions: The amount of decrease in orbital volume of children with congenital microphthalmia is related to the severity of the disease (decrease in size of the eye), rather than to age. Retarded orbital development is evident primarily in the inferior and lateral rims, correlating mostly with zygomatic and then maxilla and frontal bone. The growth of the affected orbit slows down or even stagnates by 3 years of age. Intervention therapy before 3 years of age was critical., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Enucleation is typically performed for the treatment of advanced retinoblastoma in children. After enucleation, the orbit undergoes abnormal development. In this study, orbital asymmetry was calculated using computed tomography measurements obtained from patients who experienced enucleation for unilateral retinoblastoma. Influence factors analyzed included: type of treatment, use of orbital implants, and patient's age at diagnosis. A total of 42 children underwent enucleation with a mean follow-up period of 4.8 years. For 28 patients, treatment included enucleation alone, 14 patients received enucleation plus radiation therapy. Thirty patients kept orbital implants long term. The mean orbital volume asymmetry for treated versus contralateral orbits was 16.8%. Mean asymmetry in orbital volume was greater for patients who underwent enucleation combined to radiation therapy (23.7% vs. 13.3%, P=0.05) and for patients without long-term maintenance of the prosthetic implants (29.3% vs. 11.8%, P<0.01). In conclusion, orbital volume is abnormally affected in children after enucleation of 1 eye for the treatment of retinoblastoma, and computed tomography can precisely quantify the asymmetry that develops. Orbital implants improve volumetric growth after enucleation, with 2-fold greater orbital asymmetry achieved without an implant.

Background: The authors previously established an animal model of radiation-induced craniofacial bone growth inhibition and demonstrated the effectiveness of cytoprotection in preserving growth using amifostine, but the mechanism is unclear. The objective of this study was to investigate the acute and long-term histopathologic effects of single-dose orthovoltage irradiation on craniofacial bone with and without cytoprotection., Methods: Sixty infant New Zealand White rabbits (7-week-old) were randomized into three groups (n = 20 per group): group 1, 0-Gy, sham irradiation; group 2, 35-Gy single-dose orthovoltage irradiation; and group 3, cytoprotection with amifostine before irradiation. Orbitozygomatic complex bone was harvested from animals 12 hours after irradiation and at skeletal maturity (21 weeks of age). Histologic parameters measured included native bone cell (osteoblast, osteoclast, and osteocyte) populations, periosteal proliferation indices (MIB-1 stains), bone turnover rates [triple fluorochromes: tetracycline administered at 7 weeks of age (before irradiation), alizarin complexone at 12 weeks, and calcein at 16 weeks of age], and endosteal space fibrosis levels., Results: Orthovoltage irradiation significantly (p < 0.05) reduced osteoblast and osteoclast counts 12 hours after irradiation (age, 7 weeks) with or without pretreatment with amifostine but had no effect on osteocyte populations. Long-term analysis at age 21 weeks demonstrated significantly (p < 0.05) increased osteoblast counts, reduced endosteal space fibrosis, reduced periosteal proliferation indices, and improved bone turnover (fluorochrome stains) in amifostine-treated animals., Conclusion: This study suggests that amifostine cytoprotection is mediated through a combination of reduced cellular injury with enhanced promotion of cellular bone rebuilding potential.

The Mexican tetra, Astyanax mexicanus, exists as two morphs of a single species, a sighted surface morph and a blind cavefish. In addition to eye regression, cavefish have an increased number of taste buds, maxillary teeth and have an altered craniofacial skeleton compared to the sighted morph. We investigated the effect the lens has on the development of the surrounding skeleton, by ablating the lens at different time points during ontogeny. This unique long-term study sheds light on how early embryonic manipulations on the eye can affect the shape of the adult skull more than a year later, and the developmental window during which time these effects occur. The effects of lens ablation were analyzed by whole-mount bone staining, immunohistochemisty and landmark based morphometric analyzes. Our results indicate that lens ablation has the greatest impact on the skeleton when it is ablated at one day post fertilisation (dpf) compared to at four dpf. Morphometric analyzes indicate that there is a statistically significant difference in the shape of the supraorbital bone and suborbital bones four through six. These bones expand into the eye orbit exhibiting plasticity in their shape. Interestingly, the number of caudal teeth on the lower jaw is also affected by lens ablation. In contrast, the shape of the calvariae, the length of the mandible, and the number of mandibular taste buds are unaltered by lens removal. We demonstrate the plasticity of some craniofacial elements and the stability of others in the skull. Furthermore, this study highlights interactions present between sensory systems during early development and sheds light on the cavefish phenotype.

Dr. Bernard Sarnat is one of plastic surgery's greatest laboratory investigators. His contributions to our understanding of modern craniofacial molecular biology are immense. His landmark studies continue to influence the way we approach and treat patients today. This article outlines his classic investigations of the craniofacial skeleton, with particular interest in lower face, midface, and upper face development; cranial suture and cranial base biology; and tooth and dental development. In this article, a brief summary of Dr. Sarnat's investigations are followed by how these data have had an important clinical impact.

The clinical presentation and management of pediatric orbital fractures have many unique features that differentiate them from orbital injuries encountered in the adult population. An understanding of the particular anatomic and mechanical properties of pediatric orbital bone and soft tissue helps to explain most of these differences. This article reviews the epidemiology, anatomy, growth implications, pathomechanics, particular clinical features, assessment, and surgical management of pediatric orbital fractures.

In adults, obesity has been associated with disinhibited eating, decreased cortical gray matter (GM) volume, and lower performance on cognitive assessments. Much less is known about these relationships in adolescence and there are no studies assessing behavioral, cognitive, and neurostructural measures in the same group of study participants. This study examined the relationship between obesity, executive function, disinhibition, and brain volumes in relatively healthy youth. Participants included 54 obese and 37 lean adolescents. Participants received a cognitive battery, questionnaires of eating behaviors, and magnetic resonance imaging (MRI). Neuropsychological assessments included tasks targeting frontal lobe function. Eating behaviors were determined using the Three Factor Eating Questionnaire (TFEQ), and structural MRIs were performed on a 1.5 T Siemens Avanto MRI System (Siemens, Erlangen, Germany) to determine brain GM volumes. Lean and obese adolescents were matched on age, years of education, gender, and socioeconomic status. Relative to lean adolescents, obese participants had significantly higher ratings of disinhibition on the TFEQ, lower performance on the cognitive tests, and lower orbitofrontal cortex (OFC) volume. Disinhibition significantly correlated with BMI, Stroop color-word score, and OFC volume. This is the first report of these associations in adolescents and point to the importance of better understanding the associations between neurostructural deficits and obesity.

Aims: To determine the impact of enucleation with hydroxyapatite implant on bony orbital development in survivors of retinoblastoma (RB) by measuring orbital volume based on CT imaging., Methods: The authors used CT images obtained at a median age of 6 years to measure orbital volume of RB and contralateral orbits in 18 patients who underwent enucleation with hydroxyapatite implant for RB. Comparison of the orbital volume of RB and contralateral orbits was done using the Wilcoxon rank sum test., Results: The mean age at diagnosis and operation was 29±23 months, and the mean follow-up was 49±31 months. The mean volume difference between RB and contralateral orbits was 0.93±1.13 cm(3). RB orbits with hydroxyapatite implant were statistically significantly smaller than contralateral orbits (p=0.002). The age at operation was significantly negatively correlated with orbital volume difference (p=0.033). Orbital volume differences for children treated by enucleation before the age of 12 months were also statistically significantly larger than those treated later. (p=0.03)., Conclusion: Significant orbital growth retardation remained after enucleation, even with a hydroxyapatite implant for the RB orbit. Orbital growth retardation was correlated with operation age and also more prominent in children treated in the first year of life.

Background: The facial features of children with FGFR3Pro250Arg mutation (Muenke syndrome) differ from those with the other eponymous craniosynostotic disorders. We documented midfacial growth and position of the forehead after fronto-orbital advancement (FOA) in patients with the FGFR3 mutation., Methods: We retrospectively reviewed all patients who had an FGFR3Pro250Arg mutation and craniosynostosis. Only patients who had FOA in infancy or early childhood were included. The clinical records were evaluated for type of sutural fusion; midfacial hypoplasia and other clinical data, including age at operation; type of procedures and fixation (wire vs resorbable plate); frequency of frontal readvancement, forehead augmentation, midfacial advancement; and complications. Preoperative and postoperative sagittal orbital-globe relationship was measured by direct anthropometry. Outcome of FOA was graded according to the Whittaker classification as category I, no revision; category II, minor revisions, that is, foreheadplasty; category III, alternative bony work; category IV; redo of initial procedure (ie, secondary FOA). Midfacial position was determined by clinical examination and lateral cephalometry., Results: A total of 21 study patients with Muenke syndrome (8 males and 13 females) were analyzed. The types of craniosynostosis were bilateral coronal (n=15), of which 3 also had concurrent sagittal fusion, and unilateral coronal (n=5). Two patients had early endoscopic suturectomy, but later required FOA. Mean age at FOA was 22.9 months (range, 3-128 months). Secondary FOA was necessary in 40% of patients (n=8), and secondary foreheadplasty in 25% (n=5) of patients. No frontal revisions were needed in the remaining 35% of patients (n=7). Mean age at initial FOA was significantly younger in the group requiring repeat FOA or foreheadplasty compared with patients who did not require revision (P<0.05). Location of synostosis, type of fixation, and bone grafting did not significantly affect the need for revision. Only 30% (n=6) of patients developed midfacial retrusion., Conclusions: The frequency of frontal revision in patients with Muenke syndrome who had FOA in infancy and early childhood is lower than previously reported. Age at forehead advancement inversely correlated with the incidence of relapse and need for secondary frontal procedures. Midfacial retrusion is relatively uncommon in FGFR3Pro250Arg patients.

The orbital cavity, covering the globe and basement of the lids, is partially or totally impaired by tumors arising from inside or outside. In childhood, the reduction of contents jeopardizes the size of the orbit. Reconstruction is always difficult, particularly after exenteration, and a well-made prosthesis is much better than a poor reconstruction., (Copyright 2010 Elsevier Masson SAS. All rights reserved.)

Despite the attainment of several adult cranial dimensions relatively early in childhood, skeletal maturity and, by consequence, adult form are typically defined by the eruption of the third molars around 17 years of age. This in turn serves as the division between subadults and adults, which is then applied to population studies of biological variation. Specifically, comparative data sets of adult measurements are not directly applied to individuals who do not have complete skeletal growth, as it is believed that the confounding effects of allometry may skew the results. The present study uses geometric morphometrics techniques to investigate the appropriateness of this division with respect to three-dimensional anatomical landmarks. Twenty-six landmarks were collected from a single population of 24 crania partitioned into 4 age groups spanning late adolescence to midadulthood. Generalized Procrustes and multivariate statistical analyses were performed on the landmark data. Results showed no significant morphological differences between the teen and young adult age groups, whereas significant shape and size differences were found in older adults relative to their younger cohorts. Moreover, no growth-related shape variation (ie, allometry) was detected within the sample. These findings suggest that adult form is attained several years earlier than commonly thought and corroborate other research that suggest that subtle changes in cranial morphology continue throughout adulthood.

Objective: The coronal ring of patients with unilateral coronal synostosis (UCS) presents premature fusion. This study aims to elucidate whether or not the dynamic behavior of the orbit in response to intracranial pressure (ICP) differs between patients in whom the premature fusion exists only in the frontoparietal suture (FPS) and those in whom the premature fusion extends to the frontosphenoidal suture (FSS)., Methods: A total of 15 UCS patients were included in the present study. Patients in whom premature fusion was seen inside the FPS and those in whom premature fusion extended to the FSS were categorized as FP Only (4.2 +/- 1.4 m/o) and FP + FS groups (4.6 +/- 2.2 m/o), respectively. On the basis of computed tomography (CT) data, computer-aided design models were produced. Pressure of 15 mm Hg was applied to the neurocranium of each skull model to simulate ICP. Using the finite element method, the displacements presented by each model's orbits were calculated. Displacements of the two groups were compared., Results: The orbit demonstrated greater displacement in the FP Only group than in the FP + FS group, suggesting that premature closure of the FSS disturbs growth of the orbit in response to ICP., Conclusion: In performing surgical treatment for UCS, the degree of fusion that the FSS presents should be evaluated carefully. In cases in which the FSS presents premature fusion, it is recommended to release the fusion at an early stage of cranial growth to improve the appearance of the orbital region.

Evolutionary change in encephalization within and across mammalian clades is well-studied, yet relatively few comparative analyses attempt to quantify the impact of evolutionary change in relative brain size on cranial morphology. Because of the proximity of the braincase to the orbits, and the inter-relationships among ecology, sensory systems and neuroanatomy, a relationship has been hypothesized between orbit orientation and encephalization for mammals. Here, we tested this hypothesis in 68 fossil and living species of the mammalian order Carnivora, comparing orbit orientation angles (convergence and frontation) to skull length and encephalization. No significant correlations were observed between skull length and orbit orientation when all taxa were analysed. Significant correlations were observed between encephalization and orbit orientation; however, these were restricted to the families Felidae and Canidae. Encephalization is positively correlated with frontation in both families and negatively correlated with convergence in canids. These results indicate that no universal relationship exists between encephalization and orbit orientation for Carnivora. Braincase expansion impacts orbit orientation in specific carnivoran clades, the nature of which is idiosyncratic to the clade itself.