Katsube Motoki, Yamada Shigehito, Yamaguchi Yutaka, Takakuwa Tetsuya, Yamamoto Akira, Imai Hirohiko, Saito Atsushi, Shimizu Akinobu, Suzuki Shigehiko
1 Department of Plastic and Reconstructive Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
2 Congenital Anomaly Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Cleft Palate Craniofac J. 2019 Sep;56(8):1026-1037. doi: 10.1177/1055665619827189. Epub 2019 Feb 17.
Congenital midfacial hypoplasia often requires intensive treatments and is a typical condition for the Binder phenotype and syndromic craniosynostosis. The growth trait of the midfacial skeleton during the early fetal period has been assumed to be critical for such an anomaly. However, previous embryological studies using 2-dimensional analyses and specimens during the late fetal period have not been sufficient to reveal it.
To understand the morphogenesis of the midfacial skeleton in the early fetal period via 3-dimensional quantification of the growth trait and investigation of the developmental association between the growth centers and midface.
Magnetic resonance images were obtained from 60 human fetuses during the early fetal period. Three-dimensional shape changes in the craniofacial skeleton along growth were quantified and visualized using geometric morphometrics. Subsequently, the degree of development was computed. Furthermore, the developmental association between the growth centers and the midfacial skeleton was statistically investigated and visualized.
The zygoma expanded drastically in the anterolateral dimension, and the lateral part of the maxilla developed forward until approximately 13 weeks of gestation. The growth centers such as the nasal septum and anterior portion of the sphenoid were highly associated with the forward growth of the midfacial skeleton (RV = 0.589; < .001).
The development of the midface, especially of the zygoma, before 13 weeks of gestation played an essential role in the midfacial development. Moreover, the growth centers had a strong association with midfacial forward growth before birth.
先天性面中部发育不全通常需要强化治疗，是Binder综合征和综合征性颅缝早闭的典型病症。胎儿早期面中部骨骼的生长特征被认为对此类异常情况至关重要。然而，以往使用二维分析和胎儿晚期标本的胚胎学研究不足以揭示这一点。
通过对生长特征进行三维量化以及研究生长中心与面中部之间的发育关联，了解胎儿早期面中部骨骼的形态发生。
获取60例胎儿早期的磁共振图像。使用几何形态计量学对面颅骨骼随生长的三维形状变化进行量化和可视化。随后计算发育程度。此外，对生长中心与面中部骨骼之间的发育关联进行统计学研究并可视化。
颧骨在前后外侧维度急剧扩展，上颌骨外侧部分向前发育直至妊娠约13周。鼻中隔和蝶骨前部等生长中心与面中部骨骼的向前生长高度相关（RV = 0.589；P <.001）。
妊娠13周前，面中部尤其是颧骨的发育在面中部发育中起重要作用。此外，生长中心与出生前面中部的向前生长有很强的关联。
