Rosenberg P, Arlis H R, Haworth R D, Heier L, Hoffman L, LaTrenta G
Division of Plastic and Reconstructive Surgery, New York Hospital, NY, USA.
Plast Reconstr Surg. 1997 Apr;99(5):1396-407. doi: 10.1097/00006534-199704001-00030.
Craniofacial synostosis designates premature fusion in sutures of the cranial vault (calvarium). When craniofacial synostosis is associated with a syndrome (e.g., Apert, Crouzon), premature fusion of the cranial base has been postulated to occur as well. This study was designed to determine whether the primary growth disturbance in craniofacial synostosis is located at the cranial base (i.e., spheno-occipital synchondrosis) or the calvarial vault (i.e., coronal and sagittal sutures) or both. Sixty newborn New Zealand White rabbits were randomly assigned to six groups: (I) calvarial control, (II) cranial base control, (III) cranial base immobilization, (IV) coronal suture immobilization, (V) coronal and sagittal suture immobilization, and (VI) cranial base and coronal and sagittal suture immobilization. An anterior cervical microsurgical approach to the cranial base was used, while cranial vault sutures were exposed through a bicoronal scalp incision. All sutures were fused by periosteal abrasion and application of methyl cyanoacrylate. Cephalograms were taken at 30, 60, and 90 days postoperatively to assess craniofacial growth. Linear and angular measurements of facial, calvarial, and basicranial growth were subjected to multivariate analysis. Analysis indicated that (1) craniofacial length was shortened most significantly by cranial base fusion, (2) cranial base fusion and cranial vault fusion had an additive effect on craniofacial length restriction, (3) the anterior cranial base was significantly shortened by cranial base and cranial vault fusion (p < 0.05), (4) the posterior cranial base was shortened by cranial base fusion only (p < 0.05), and (5) cranial base fusion alone significantly flattened the cranial base angle (p < 0.05), whereas cranial vault fusion alone did not. These results suggest that cranial base fusion alone may account for many dysmorphic features seen in craniofacial synostosis. This model is consistent with the findings of other investigators and confirms both a primary directive and translational role of the cranial base in craniofacial growth.
颅面部缝早闭指的是颅顶（颅骨）缝线的过早融合。当颅面部缝早闭与某种综合征（如Apert综合征、Crouzon综合征）相关时，有人推测颅底也会发生过早融合。本研究旨在确定颅面部缝早闭中主要的生长障碍是位于颅底（即蝶枕软骨结合）、颅顶（即冠状缝和矢状缝）还是两者皆有。60只新生新西兰白兔被随机分为六组：（I）颅顶对照组，（II）颅底对照组，（III）颅底固定组，（IV）冠状缝固定组，（V）冠状缝和矢状缝固定组，以及（VI）颅底、冠状缝和矢状缝固定组。采用经颈前路显微手术入路处理颅底，而通过双冠状头皮切口暴露颅顶缝线。所有缝线均通过骨膜磨损和应用氰基丙烯酸甲酯进行融合。术后30天、60天和90天拍摄头颅侧位片以评估颅面部生长情况。对面部、颅顶和颅底生长的线性和角度测量进行多变量分析。分析表明：（1）颅底融合对颅面部长度缩短的影响最为显著；（2）颅底融合和颅顶融合对颅面部长度受限有累加效应；（3）颅底和颅顶融合显著缩短了前颅底（p < 0.05）；（4）仅颅底融合缩短了后颅底（p < 0.05）；（5）单独的颅底融合显著使颅底角变平（p < 0.05），而单独的颅顶融合则没有这种情况。这些结果表明，单独的颅底融合可能是颅面部缝早闭中许多畸形特征的原因。该模型与其他研究者的发现一致，并证实了颅底在颅面部生长中的主要导向作用和转化作用。
