Sagittal craniosynostosis, a rare but fascinating craniofacial anomaly, presents a unique challenge for both diagnosis and treatment. This condition involves premature fusion of the sagittal suture, which alters the normal growth pattern of the skull and can affect neurological development. Sagittal craniosynostosis is characterised by a pronounced head shape, often referred to as scaphocephaly. Asymmetry of the face and head, protrusion of the fontanel, and increased intracranial pressure are common clinical manifestations. Early recognition of these features is crucial for early intervention, and understanding the aetiology is, therefore, essential. Although the exact cause remains unclear, genetic factors are thought to play an important role. Mutations in genes such as FGFR2 and FGFR3, which disrupt the normal development of the skull, are suspected. Environmental factors and various insults during pregnancy can also contribute to the occurrence of the disease. An accurate diagnosis is crucial for treatment. Imaging studies such as ultrasound, computed tomography, magnetic resonance imaging, and three-dimensional reconstructions play a crucial role in visualising the prematurely fused sagittal suture. Clinicians also rely on a physical examination and medical history to confirm the diagnosis. Early detection allows for quick intervention and better treatment outcomes. The treatment of sagittal craniosynostosis requires a multidisciplinary approach that includes neurosurgery, craniofacial surgery, and paediatric care. Traditional treatment consists of an open reconstruction of the cranial vault, where the fused suture is surgically released to allow normal growth of the skull. However, advances in minimally invasive techniques, such as endoscopic strip craniectomy, are becoming increasingly popular due to their lower morbidity and shorter recovery times. This review aims to provide a comprehensive overview of sagittal craniosynostosis, highlighting the aetiology, clinical presentation, diagnostic methods, and current treatment options.

Facial asymmetry is often seen in patients with skeletal mandibular prognathism and is associated with deformities in the maxillofacial and head regions. The maxillofacial deviation is three-dimensional and affects not only the lateral deviation of the mandible and midface, but also the cranium. This study conducted a three-dimensional morphological evaluation of the cranial base morphology of patients with skeletal mandibular prognathism (ANB < 0°, Wits < 0 mm) with the aim of examining the relationship between deformities of the head region and facial asymmetry. Data obtained from computed tomography conducted during the initial examination of patients with and without skeletal mandibular prognathism with facial asymmetry were used. Differences in the position of structures present in the cranial base were measured, and the association between cranial deformities and mandibular deviation was assessed. The middle cranial base area and the lateral deviation of the mandibular fossa were significantly larger in patients with facial asymmetry compared to those without facial asymmetry. In addition, a correlation between the amount of mandibular deviation and the area of the anterior cranial base was identified in patients with significant cranial deformity (p = 0.012). Given the identified association between the structure of the head region and facial asymmetry, further studies are needed to determine the factors implicated in the growth process.

The assessment of cranial deformation is relevant in the field of medicine dealing with infants, especially in paediatric neurosurgery and paediatrics. To address this demand, the smartphone-based solution PhotoMeDAS has been developed, harnessing mobile devices to create three-dimensional (3D) models of infants\' heads and, from them, automatic cranial deformation reports. Therefore, it is crucial to examine the accuracy achievable with different mobile devices under similar conditions so prospective users can consider this aspect when using the smartphone-based solution. This study compares the linear accuracy obtained from three smartphone models (Samsung Galaxy S22 Ultra, S22, and S22+). Twelve measurements are taken with each mobile device using a coded cap on a head mannequin. For processing, three different bundle adjustment implementations are tested with and without self-calibration. After photogrammetric processing, the 3D coordinates are obtained. A comparison is made among spatially distributed distances across the head with PhotoMeDAS vs. ground truth established with a Creaform ACADEMIA 50 while-light 3D scanner. With a homogeneous scale factor for all the smartphones, the results showed that the average accuracy for the S22 smartphone is -1.15 ± 0.53 mm, for the S22+, 0.95 ± 0.40 mm, and for the S22 Ultra, -1.8 ± 0.45 mm. Worth noticing is that a substantial improvement is achieved regardless of whether the scale factor is introduced per device.

OBJECTIVE: The aim of this study was to determine the effects on facial and cranial symmetry through molding helmet therapy in infants with positional plagiocephaly. A 3D asymmetry index (3DAI), which measures both cranial and facial symmetry, was introduced and compared to the Cranial Vault Asymmetry Index (CVAI).
METHODS: Optical 3D-scans of children with positional plagiocephaly were evaluated retrospectively. Pre- and post-therapeutic asymmetry values of the cranium and face were determined and paired t-tests were applied. Pearson correlations were calculated for facial and cranial asymmetries.
RESULTS: 65 children (age: 3-6 months) were included. Asymmetry values (mean/standard deviation, pre- and post-therapeutic) were for 3DAI determinations: cranium: 9.96/1.84-8.11/1.74 p < 0.001; face: 4.70/1.06-3.89/0.91 p < 0.001; and for CVAI measurements: 9.10/3.29-5.88/2.78 p < 0.001. No correlation was found between facial and cranial asymmetry (p > 0.05).
CONCLUSIONS: Symmetry values improved significantly in post therapeutic 3D-scans for both asymmetry indices. The analysis of cranial symmetry by 3DAI should be preferred over the CVAI because it gives more comprehensive information, including the symmetry of the entire cranial surface and the face.

The aim of the study was to explore the sonographic findings of fetuses with craniosynostosis and investigate their prognosis. We conducted a 5-year, multicenter retrospective study and collected data on patients with craniosynostosis diagnosed in the perinatal period. Of 41 cases, 30 cases (73%) were syndromic craniosynostosis, eight cases (20%) were non-syndromic craniosynostosis and the other three cases (7%) were secondary craniosynostosis of chromosomal deletion syndromes. The prenatal ultrasound detection rate was 61%. Half of the cases of syndromic craniosynostosis detected during the perinatal period were Pfeiffer syndrome; there were also six cases of Apert syndrome, three cases of Crouzon syndrome and other rare form of syndromic craniosynostosis (Beare-Stevenson syndrome, Saethre-Chotzen syndrome, cranioectodermal dysplasia, and thanatophoric dysplasia). Abnormal shape of the skull was the most common finding leading to prenatal diagnosis of craniosynostosis. Abnormal head biometry, which was the second most frequent finding, was closely correlated with deformation of the cranial shape. Three cases presented with ventriculomegaly and exophthalmos but normal cranial shape and size. The overall survival rate of infants with syndromic craniosynostosis was 79%, while all of the infants with non-syndromic craniosynostosis survived. In conclusion, prenatal diagnosis of craniosynostosis is difficult, especially when dysmorphic change of the fetal cranium is not evident. Abnormal head biometry and ventriculomegaly could potentially be additional markers of fetal craniosynostosis and consequently increase the prenatal detection rate.

In recent years finite element analysis (FEA) has emerged as a useful tool for the analysis of skeletal form-function relationships. While this approach has obvious appeal for the study of fossil specimens, such material is often fragmentary with disrupted internal architecture and can contain matrix that leads to errors in accurate segmentation. Here we examine the effects of varying the detail of segmentation and material properties of teeth on the performance of a finite element model of a Macaca fascicularis cranium within a comparative functional framework. Cranial deformations were compared using strain maps to assess differences in strain contours and Procrustes size and shape analyses, from geometric morphometrics, were employed to compare large scale deformations. We show that a macaque model subjected to biting can be made solid, and teeth altered in material properties, with minimal impact on large scale modes of deformation. The models clustered tightly by bite point rather than by modeling simplification approach, and fell out as being distinct from another species. However localized fluctuations in predicted strain magnitudes were recorded with different modeling approaches, particularly over the alveolar region. This study indicates that, while any model simplification should be undertaken with care and attention to its effects, future applications of FEA to fossils with unknown internal architecture may produce reliable results with regard to general modes of deformation, even when detail of internal bone architecture cannot be reliably modeled.