Rakityansky Mikhail Mikhailovich

Introduction. A number of diseases, including craniosynostosis, basal encephaloceles, and fibrous dysplasia, can be accompanied by deformities in the facial skeleton and the skull base. To quantify the degree of pathological deformity and the dynamics of skull bone growth in these patients, data from healthy children’s growth processes is needed. The aim of this study is to describe the normal growth of the main craniometric variables of the facial skeleton and the anterior skull base in healthy children aged 0 to 18 years old, and to create percentile standards for these variables.

Materials and methods. Our study uses cross-sectional retrospective computed tomography (CT) data of the head and face of 1,034 children, aged 0-18 years, who had sustained traumatic brain injuries without damage to the bone structures. Craniometric landmarks used in anthropological and medical craniometry were mapped onto 3D models of patient skull. Twenty linear distances between the landmarks, as well as the volumes of the left orbit and nasal cavity, were calculated. The data were analyzed separately for male and female participants. The RefCurv version 0.4.2 software was used to create percentile reference curves using the LMS method.

Results. The gender and age-related characteristics of the growth dynamics of the various structures of the facial skeleton and anterior base of the skull are characterized. The centile standards for normal variability of the craniometric data are provided for use in medical practice.

Conclusion. This study provides the most comprehensive data on the growth patterns of the facial skeleton and the anterior part of the skull base in healthy children aged between birth and 18 years old. The dimensions of the cribriform plate at birth are close to the adult size and change little during postnatal ontogenesis. The features of the orbital region reach 55-60% of the adult size at birth, grow very rapidly in the first year of life, and by the age of 5 constitute 80-85% of the adult size. The latitudinal dimensions of the facial skeleton, such as the width of the pyriform aperture, the zygomatic and inferior orbital diameters, as well as the sagittal dimensions of the nasal cavity reach about 50-55% of the adult size at birth and then grow uniformly, reaching 65-70% of the definitive value by the second year of life, and, with the exception of the width of the nose, about 80% by the age of 5. The height dimensions of the facial skeleton (the height of the pyriform aperture, face, maxilla, choanae and alveolar process), at birth are only about 40% of the adult size, but then grow rapidly, reaching about 70% of the definitive value by the age of 5. According to the relative sizes of most of the variables, a higher maturity level in girls at the time of birth is revealed, which persists until puberty. A pronounced pubertal acceleration of growth is observed only in boys, based on the following characteristics: the width of the orbit, the length of the medial wall of the orbit, the height of the upper jaw, the height of the nose, the lower length of the nasal septum, the volume of the nasal cavity, and the width of the cribriform plate. Understanding the differences in the developmental dynamics of various skull structures, as well as sex differences in these dynamics and the use of growth standards, is essential for an objective evaluation of the extent of pathological changes to these structures and for planning treatment and monitoring its outcomes.

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