Cephalometric examinations on x-ray films to evaluate postoperative cranial growth in children with craniosynostosis

Objective: A preoperative CT scan seems indispensible for the evaluation of the bones and soft tissue in children with craniosynostoses. Regular posto perative follow-up is limited because of general anaesthesia and radiation exposure. Therefore, cranial growth of these children has hardly been exami ned so far. A method is needed to replace CT for this indication and to all ow differentiated growth analysis besides clinical inspection, Methods: 15 children (7 trigonocephalies, 4 plagiocephalies, 4 syndromal craniosynostos es) were operated on using a standardized bilateral frontoorbital advanceme nt. Using conventional pre- and postoperative skull roentgenograms, a crani ometric analysis according to the modified method of Schmid et at. [13] was carried out, Results: A supernormal opening of the frontal angle (the fore head area) and an increase of length of the frontal base were found. Skull height and skull width were positively influenced: the growth of the dorsal skull base remained retarded in length postoperatively. There was metrical ly identifiable reorganization of areas distant from operation area. Result s were validated by comparison with normal subjects and patient populations known from the published literature. Conclusion: The presented method is e asy, safe and exposure-reduced, and is able to assess the growth of differe nt skull areas by means of distance and angle measurements. It should be us ed regularly in routine postoperative control of craniosynostoses. CT exami nations should be limited to special questions of the soft tissue.