The Journal of Craniofacial Surgery
Correspondence
REFERENCES 1. Molendijk J, Van Der Wal KG, Koudstaal MJ. Surgical treatment of frontal sinus fractures: the simple percutaneous reduction revised. Int J Oral Maxillofac Surg 2012;41:1192Y1194 2. Thiagarajan B. Fracture frontal bone and its management. Online J Otolaryngol 2013;3:1Y16. Available at: www.scopemed.org/?mno=34021. Accessed August 15, 2013 3. Piccolino P, Vetrano S, Mundula P, et al. Frontal bone fractures: new technique of closed reduction. J Craniofac Surg 2007;18:695Y698 4. Gerbino G, Roccia F, Benech A, et al. Analysis of 158 frontal sinus fractures: current surgical management and complications. J Craniomaxillofac Surg 2000;28:133Y139 5. Doonquah L, Brown P, Mullings W. Management of frontal sinus fractures. Oral Maxillofac Surg Clin North Am 2012;24:265Y274 6. Strong EB. Frontal sinus fractures: current concepts. Craniomaxillofac Trauma Reconstr 2009;2:161Y175 7. Ioannides C. Fractures of the frontal sinus: classification and its implications for surgical treatment. Am J Otolaryngol 1999;20:273Y280 8. Gabrielli MF, Gabrielli MA, Hochuli-Vieira E, et al. Immediate reconstruction of frontal sinus fractures: review of 26 cases. J Oral Maxillofac Surg 2004;62:582Y586 9. Bell RB. Management of frontal sinus fractures. Oral Maxillofac Surg Clin North Am 2009;21:227Y242 10. Jardim ECG, Santiago-Ju´nior JF, Guastaldi FPS, et al. Fratura do seio frontal: relato de caso. Revista Odontolo´gica de Ara0atuba 2010;31:35Y39 11. Gazio?lu N, Ulu MO, Ozlen F, et al. Acute traumatic orbital encephalocele related to orbital roof fracture: reconstruction by using porous polyethylene. Ulus Travma Acil Cerrahi Derg 2008;14:247Y252 12. Rubin PA, Bilyk JR, Shore JW. Orbital reconstruction using porous polyethylene sheets. Ophthalmology 1994;101:1697Y1708 13. Da Silva JJ, Neto RA, Pereira AM, et al. Fratura tardia de seio frontal: relato de caso clı´nico. Rev cir Traumatol buco-maxilo-fac 2005;5:51Y56 14. Zavattero E, Boffano P, Bianchi FA, et al. The use of titanium mesh for the reconstruction of defects of the anterior wall of the frontal sinus. J Craniofac Surg 2013;24:690Y691 15. Mokal NJ, Desai MF. Titanium mesh reconstruction of orbital roof fracture with traumatic encephalocele: a case report and review of literature. Craniomaxillofac Trauma Reconstr 2012;5:11Y18 16. Lazaridis N, Makos C, Iordanidis S, et al. The use of titanium mesh sheet in the fronto-zygomatico-orbital region. Case reports. Aust Dent J 1998;43:223Y228 17. Manson PN, Markowitz B, Mirvis S, et al. Toward CT-based facial fracture treatment. Plast Reconstr Surg 1990;85:202Y212 18. Manolidis S, Hollier LH Jr. Management of frontal sinus fractures. Plast Reconstr Surg 2007;120:32Y48 19. Tiwari P, Higuera S, Thornton J, et al. The management of frontal sinus fractures. J Oral Maxillofac Surg 2005;63: 1354Y1360 20. Mara˜o HF, Gulinelli JL, Pereira CC, et al. Use of titanium mesh for reconstruction of extensive defects in fronto-orbito-ethmoidal fracture. J Craniofac Surg 2010;21:748Y750
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in skull shape. The occurrence is È1 in 2100 to 2500 births, which makes it a fairly common pediatric anomaly.1,2 The most commonly involved suture seems to be the sagittal with male preponderance (3:1),3,4 but there is much less information about rarely expected synostotic patterns, such as closure of the squamosal suture.5,6 Two cases of nonsyndromic craniosynostosis were found in a late seventh- to eighth-century cemetery at Dunaszentgyo¨rgy-Kasza´sTanya of the so-called Avar population, situated in central Hungary.7 Anthropological examination and pathological observation were conducted on the fragmented remains. The interest of this presentation can be not only the presence of other pathological alterations on the skeletons and their possible linkage with cranial suture closure, but also even the rarity of archaeological infant findings with craniosynostosis.8 In the fragmentary skeletal remains of an infant, approximately 4 to 5 years of age, except the bregma area, whole fusion of the sagittal suture can be seen, whereas other sutures remain patent (Fig. 1). No signs of ridging, frontal bossing, or metabolic diseases were found on the strongly fragmentary remains, but signs of artificial cranial modification can be seen on the skull vault (Fig. 1). This practice was noted in the Carpathian Basin from as early as the second century9 to the eighth century,10 and several deformed crania had been excavated from cemeteries of the Avar population from the sixth to eighth centuries.10 The suggestion for the sutural effects of fronto-occipital cranial modification is based on the fact that the tensile forces created by the deforming apparatus can influence suture patency and cause a significantly higher incidence in sagittal suture closure.11 However, no significant literatures have given any additional confirmation to this theory yet, and the child in this case was at such a young age when, in our opinion, the slight modification did not explain the suture synostosis. In a moderately preserved remains of a 13- to 14-year-old child, the whole left temporal area was obliterated, including the squamosal, the sphenosquamosal and the parietomastoid sutures (Fig. 2). No signs of endocranial lesion, porotic hyperostosis, or enamel hypoplasia were observable on the skull, but there was significant deformity especially of the femur, which suggests disturbances in bone mineralization due to a possible inefficiency in vitamin D metabolism. Bending of the diaphysis of both femurs can be seen, with a remarkable difference in the diameter: the right femur was significantly more robust than the left one because of build-up of bone (Fig. 2). The pathological findings in this case suggest a link between craniosynostosis and the signs of some kind of metabolic disturbance, probably rickets disease. However, although most of the cases in clinical diagnoses report the preferential involvement of the
Two Suture Craniosynostoses: A Presentation That Needs to Be Noted To the Editor: Craniosynostosis is the premature fusion of the cranial sutures, which occurs in early childhood and can cause severe alterations in craniofacial development and even mental retardation, or can go almost unnoticed, causing only a slight deformity
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FIGURE 1. Sagittal synostosis with open coronal and lambdoid sutures and signs of artificial cranial modification on the frontal bone. The arrows show the presumed margins of the bandage used (Obj. nr. 349, S-355).
* 2014 Mutaz B. Habal, MD
Copyright © 2014 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
The Journal of Craniofacial Surgery
& Volume 25, Number 2, March 2014
FIGURE 2. Craniosynostosis of the left squamosal area and femurs show bowing with an increased diameter of the right femur (Obj. nr. 373, S-387).
sagittal suture in correlation to rickets, some occasional examples can be found in the literature with other affected sutural areas as well.12Y15 Katalin Wolff, MSc Department of Forensic and Insurance Medicine Semmelweis University Budapest, Hungary
[email protected] Zsolt Bernert, MSc Department of Anthropology Hungarian Natural History Museum Budapest, Hungary Tı´mea Balassa, MSc Department of Physiology and Neurobiology Eo¨tvo¨s Lora´nd University Budapest, Hungary Tama´s Szeniczey, BSc Department of Biological Anthropology Eo¨tvo¨s Lora´nd University Budapest, Hungary Csaba Ka´lma´n Kiss, MA National Heritage Protection Centre Hungarian National Museum Budapest, Hungary Tama´s Hajdu, PhD Department of Biological Anthropology Eo¨tvo¨s Lora´nd University Budapest, Hungary
REFERENCES 1. Boulet SL, Rasmussen SA, Honein MA. A population-based study of craniosynostosis in metropolitan Atlanta, 1989Y2003. Am J Med Genet A 2008;146A:984Y991 2. Lajeunie E, Le Merrer M, Bonaiti-Pellie C, et al. Genetic study of nonsyndromic coronal craniosynostosis. Am J Med Genet 1995;55:500Y504 3. Lajeunie E, Le Merrer M, Bonaiti-Pellie C, et al. Genetic study of scaphocephaly. Am J Med Genet 1996;62:282Y285
Correspondence
4. Wilkie AO, Wall SA. Craniosynostosis: novel insights into pathogenesis and treatment. Curr Opin Neurol 1996;9:146Y152 5. Duncan WN, Stojanowski CM. A case of squamosal craniosynostosis from the 16th century southeastern United States. Int J Osteoarchaeol 2008;18:407Y420 6. Smartt JM Jr, Singh DJ, Reid RR, et al. Squamosal suture synostosis: a cause of atypical skull asymmetry. Plast Reconstr Surg 2012;130:165Y176 7. Kiss CK. Dunaszentgyo¨rgy-Kasza´s Tanya (Tolna megye, RM20. leljhely). In: Kvassay J, ed. E´vko¨nyv e´s jelente´s a Kultura´lis O¨ro¨kse´gve´delmi Szakszolga´lat 2009. e´vi felta´ra´sairo´l [Field Service for Cultural Heritage 2009 Yearbook and Review of Archaeological Investigations]. Budapest, Hungary: Magyar Nemzeti Mu´zeum Nemzeti ¨ ro¨kse´gve´delmi Ko¨zpont, 2012:17Y18 O 8. Giuffra V, Sbrana F, Caramella D, et al. Syndromic craniosynostosis in a modern-age skeleton from Siena, Italy. J Craniofac Surg 2011;22: 1743Y1745 9. Hajdu T, Bernert Z. Embertani adatok a Tisza-vide´k szarmata e´s gepida kora´hoz [Anthropological data to Sarmatian and Gepid age of the Tisza region]. Tisicum 2007;16:327Y344 10. Bereczki Z, Marcsik A. Artificial cranial deformation in Hungary. In: Mednikova M, ed. Artificial Deformation of Human Head in Eurasian Past. OPUS. 2006;5:96Y114 11. White CD. Sutural effects of fronto-occipital cranial modification. Am J Phys Anthropol 1996;100:397Y410 12. Currarino G. Sagittal synostosis in X-linked hypophosphatemic rickets and related diseases. Pediatr Radiol 2007;37:805Y812 13. Inman PC, Mukundan S Jr, Fuchs HE, et al. Craniosynostosis and rickets. Plast Reconstr Surg 2008;121:217eY218e 14. Murthy AS. X-linked hypophosphatemic rickets and craniosynostosis. J Craniofac Surg 2009;20:439Y442 15. Shetty AK, Thomas T, Rao J, et al. Rickets and secondary craniosynostosis associated with long-term antacid use in an infant. Arch Pediatr Adolesc Med 1998;152:1243Y1245
Rapidly Growing Eccrine Porocarcinoma of the Face in a Pregnant Woman To the Editor: Eccrine porocarcinoma (EPC) is a very rare malignant sweat gland tumor, and its occurrence on the face is especially rare. It originates from the intraepidermal ductal portion of the eccrine sweat gland, and it usually occurs on the preexisting lesion of benign eccrine poroma.1 We report an extremely rare case of EPC that appeared in the philtrum of the face of a very young (25-year-old) patient, with the tumor size sharply increasing during pregnancy. A 25-year-old patient in the 28th week of pregnancy presented with an erythematous protruding mass above the upper lip (Fig. 1). The patient first perceived the presence of a nodule, approximately 3 mm in diameter, above her upper lip 2 years earlier. The nodule grew to approximately 2 cm in diameter within 3 to 4 months of pregnancy. Moreover, a black coloration and erosion had developed on the tumor during the previous 3 months, but the patient had not sought treatment because of the pregnancy. The patient had never incurred injury to the tumor region and had not taken any specific drugs. No enlargement of the lymph nodes in the head and neck region was noted. She complained of mild tenderness around the tumor site, which showed no discharge. Considering that the patient was a pregnant woman in her 32nd week of pregnancy, wide resection was performed under local anesthesia. After confirming that the margin of the isolated specimen was tumor-free, primary closure was performed.
* 2014 Mutaz B. Habal, MD
Copyright © 2014 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
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