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Masters Degrees (Anatomy)

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Browsing Masters Degrees (Anatomy) by Author "Madaree, Anil."

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    Anterior synostotic plagiocephaly: a quantitative analysis of craniofacial features using computed tomography.
    (2021) Mohan, Nivana.; Lazarus, Lelika.; Madaree, Anil.; Harrichandparsad, Rohen.
    Anterior synostotic plagiocephaly (ASP) is caused by the premature fusion of one coronal suture, which results in severe craniofacial asymmetry that can be challenging to correct. The various methods of the surgical procedures, as well as the distinctive facial characteristics of ASP, have been well documented. However, there is a paucity of literature pertaining to the quantitative analysis of the craniofacial features that are affected in ASP. This study used preoperative computed tomography (CT) scans to document and compare the morphometry of the anterior cranial fossa (ACF), orbit, and ear on the ipsilateral (synostotic) and contralateral (non-synostotic) sides in a select South African population of patients diagnosed with ASP. The dimensions of the ACF, orbit and the position of the ear on the ipsilateral and contralateral sides were measured using a set of anatomical landmarks on two-dimensional (2D) CT scans of 18 consecutive patients diagnosed with non-syndromic ASP. The differences between the ipsilateral and contralateral sides were computed and expressed as a percentage of the contralateral side. The findings of this study revealed that there was side-to-side asymmetry in the ACF, orbit, and ear. All ACF parameters decreased significantly (t-test; p<0.001) on the ipsilateral side when compared to the contralateral side, resulting in the volume of the ACF being the most affected (-27.7%). In terms of the orbit, on the ipsilateral side, the length-infraorbital rim (IOR), height, and surface area parameters increased significantly (t-test; p<0.001), with the height being the most affected (24.6%). The remaining orbital parameters (length-supraorbital rim (SOR), breadth and volume) decreased significantly (t-test; p<0.001), with the length-SOR parameter being the most affected (-10.8%). Furthermore, the ipsilateral SOR was noted to be displaced more cranially by an average of 3.89mm from the contralateral SOR. With regards to the position of the ipsilateral ear, it was found to be displaced anteriorly (9.33mm) and caudally (5.87mm) from the contralateral ear. This study augments the existing literature by providing actual values to corroborate the hallmark characteristics of ASP. These measures may help surgeons plan the technique and extent of surgical correction of the affected craniofacial structures during corrective surgery as it will provide them with an indication of the extent of the deformity on the ipsilateral side as compared to the contralateral side. The results of this study have the potential to propose a grading system in ASP patients according to severity of the condition if the sample size is increased.
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    Scaphocephaly in a select South African population: a morphometric analysis of the cranial fossae and ventricular access points.
    (2021) Bisetty, Vensuya.; Lazarus, Lelika.; Madaree, Anil.; Harrichandparsad, Rohen.
    Scaphocephaly is a cranial deformity that results from premature fusion of the sagittal suture and is characterized by an elongated and narrowed skull. Patients with this condition present with varying clinical features including frontal bossing and occipital protrusion. This study comprised two subsets, analysing different aspects related to this cranial deformity. Most morphological and morphometrical studies in patients with scaphocephaly focus on the cranial vault. Literature on the morphometry of the cranial base and its fossae in these patients is sparse. Therefore, the first subset aimed to analyse and compare the morphometry of the cranial fossae in patients with scaphocephaly. Due to varying cranial morphology among patients with these deformities, ventricular access using conventional techniques is often a challenge. Although ventricular access may not be frequently required in paediatric scaphocephalic patients, it is vital that an ideal location of the access points be established for safe ventricular catheterization. Accordingly, the second subset aimed to document the morphometry of Kocher’s and Frazier’s points in scaphocephalic patients using known craniometric and surface anatomical landmarks. Dimensions of the anterior, middle and posterior cranial fossae (ACF, MCF and PCF) were measured using select anatomical landmarks on computed tomography (CT) scans of 24 consecutive patients diagnosed with scaphocephaly between 2014 and 2020, and 14 non-affected/ normal paediatric patients selected as controls. Parameters of Kocher’s and Frazier’s points were measured in relation to known cranial surface anatomical landmarks on scans of the scaphocephalic patients utilized in subset 1. The study found that ACF and PCF are most affected in scaphocephalic patients, with elongation along the anteroposterior (AP) plane (lengths) (ACF, p=0.041 and PCF, p=0.018). Minimal changes were observed in the transverse plane (widths) in scaphocephaly versus non-affected/normal controls. Regarding subset 2, Kocher’s point was located between 91.6mm and 140mm posterior to the nasion, and between 20.5mm and 34.6mm lateral to the midline in patients with scaphocephaly. Frazier’s point was located between 60.9mm and 82.8mm superior to the inion, and 25.9mm and 41.4mm lateral to the midline. Parameters measured in the AP plane were found to be more affected than those measured lateral from the midline. This study contributes to the literature by providing novel morphometric data based on a select South African population. Data obtained could aid craniofacial surgeons in understanding which cranial fossa is most affected in scaphocephaly and to what extent, to decide on the most appropriate method of treatment. Additionally, the study concluded that the traditional landmarks used for ventricular access are relatively unreliable in scaphocephalic patients. This study provides data for neurosurgical consideration regarding ventricular catheterization procedures in patients with scaphocephaly.
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    Trigonocephaly in a select South African population: A morphometric analysis utilising specific anatomical cranial landmarks.
    (2024) Barnes, Courtney; Lazarus, Lelika.; Madaree, Anil.
    Trigonocephaly is a congenital abnormality that is caused by the premature fusion of the metopic suture. A triangular shaped forehead, shortening of the anterior cranial fossa (ACF), hypotelorism, narrowing of the bitemporal region, and widening of the occipitoparietal region are some of the cranial and facial deformities that patients with trigonocephaly present with. Literature on the morphometry of the ACF and cranial base is scarce in patients with trigonocephaly; most studies focus on the morphometric changes that occur to the entire cranium rather than the cranial base. Therefore, this study aimed to investigate the morphometric changes that occurred to the ACF and orbits in trigonocephaly patients and to determine whether compensatory growth of the middle and posterior cranial fossae (MCF and PCF) was evident via volumetric assessment. Additionally, the identification of various cranial parameters in order to assess the severity of patients with trigonocephaly remains controversial. Thus, this study also aimed to describe an improved grading system in the assessment of trigonocephaly within a select South African population. Dimensions of the ACF and of the orbits, and volumetric assessment of all three cranial fossae were measured using specific anatomical cranial landmarks on preoperative computed tomography (CT) scans of 15 patients with a radiographic confirmed diagnosis of non-syndromic, isolated trigonocephaly between 2012 and 2023, and eight non-affected age-matched pediatric patients were selected as the control group. ACF dimensions in younger and trigonocephaly patients who were classified as severe, were observed to be larger compared to control patients, whilst in older and trigonocephaly patients who were classified as severe, ACF dimensions were observed to be smaller compared to control patients. MCF volume showed significance (p=0.050), whilst ACF and PCF volumes, respectively showed no significance (p=0.170 and p=0.821) when trigonocephaly patients were compared to controls. Additionally, maximum compensatory growth occurred in the PCF compared to the MCF in trigonocephaly patients. The overall dimensions of the orbit showed no significance between trigonocephaly and control patients. However, significant findings were observed in the correlation analysis between the interorbital distance and other orbital parameters and ACF angles when trigonocephaly patients were compared to control patients. Furthermore, more complex orbital morphologies were observed in trigonocephaly patients in younger age groups, compared to less complex orbital morphologies which were observed in older age groups. This study provides novel morphometric and morphological data within a specific South African population. The data obtained could further assist craniofacial surgeons by providing a relationship between the degree of severity and choice of surgical intervention. Additionally, the orbital data obtained could indicate to surgeons the morphological changes that occur in the orbits, and provide an insight into the evolution of the deformity in pediatric patients with trigonocephaly in order to obtain as near to normal orbital features.