A new predictive modality of cranial bone thickness.

The objective of this study was to evaluate A-mode ultrasound in the assessment of cranial bone thickness utilizing an in vivo animal model. A prospective study was performed that identified four standardized calvarial points in 10 Landrace porcine skulls. The individual points were scanned with an A-mode ultrasonic transducer to obtain bone thickness measurements. The same points were measured subsequently using digital calipers for objective comparison. The accuracy of each of the measurement modalities was evaluated for inter- and intrarater reliability. The association between ultrasonic and caliper measurements was evaluated using Student's t-test, Pearson's correlation coefficient, and linear regression models to assess the effect of confounding variables. The mean difference between the ultrasonic and the caliper values was 0.31 +/- 0.22 mm (standard deviation). The statistical analyses employed strongly supported the predictive value of ultrasound as a function of the true calvarial thickness (p < 0.05, r > 0.88, R2 = 0.89). The results suggest that ultrasound is an accurate reflection of cranial bone thickness in an in vivo animal skull model. The development of a portable, noninvasive ultrasonic device can have substantial clinical implications for craniomaxillofacial surgery.

[1]  J. Posnick,et al.  Craniofacial skeletal measurements based on computed tomography: Part II. Normal values and growth trends. , 1992, The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association.

[2]  J. Marsh,et al.  Craniofacial Onlay Bone Grafting: A Prospective Evaluation of Graft Morphology, Orientation, and Embryonic Origin , 1990, Plastic and Reconstructive Surgery.

[3]  I. Munro,et al.  Combined Report of Problems and Complications in 793 Craniofacial Operations , 1979, Plastic and reconstructive surgery.

[4]  I. Jackson,et al.  Skull bone grafts in maxillofacial and craniofacial surgery. , 1986, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[5]  A Kulali,et al.  Single-table autogenous calvarial grafting for cranioplasty. , 1991, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[6]  L. Whitaker,et al.  The Early Revascularization of Membranous Bone , 1985, Plastic and reconstructive surgery.

[7]  A. Smith,et al.  The split calvarial graft donor site in the elderly: a study in cadavers. , 1989, Plastic and reconstructive surgery.

[8]  D. Neth,et al.  Comparison of ossification of demineralized bone, hydroxyapatite, Gelfoam, and bone wax in cranial defect repair. , 1996, The Journal of craniofacial surgery.

[9]  J. McCarthy,et al.  The Calvarial Donor Site: An Anatomic Study in Cadavers , 1985, Plastic and reconstructive surgery.

[10]  P. Branemark.  Osseointegration and its experimental background. , 1983, The Journal of prosthetic dentistry.

[11]  J. Converse,et al.  Bone grafts in surgery of the face. , 1954, The Surgical clinics of North America.

[12]  M B Habal,et al.  Bone grafting in craniofacial surgery. , 1994, Clinics in plastic surgery.

[13]  J. McCarthy,et al.  The Spectrum of Calvarial Bone Grafting: Introduction of the Vascularized Calvarial Bone Flap , 1984, Plastic and reconstructive surgery.

[14]  I. Jackson,et al.  Nasal Bone Grafting Using Split Skull Grafts , 1983, Annals of plastic surgery.

[15]  J. Gateno,et al.  The use of ultrasound to determine the position of the mandibular condyle. , 1993, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[16]  R. Goode,et al.  Cranial bone grafts for post‐traumatic facial defects , 1987, The Laryngoscope.

[17]  W. Koenig,et al.  Cranial Bone Grafting in Children , 1995, Plastic and reconstructive surgery.

[18]  T. Turvey,et al.  Use of autogenous cranial bone grafts in maxillofacial surgery: a preliminary report. , 1986, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[19]  T. Todd,et al.  Thickness of the male white cranium , 1924 .

[20]  H. Cushing.  A study of a series of wounds involving the brain and its enveloping structures , 1917 .

[21]  H. Reychler,et al.  The diagnostic limitations of ultrasonography in maxillofacial surgery. , 1987, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[22]  R. Meyer.  Secondary and Functional Rhinoplasty: The Difficult Nose , 1988 .

[23]  R. Silbey,et al.  Diagnostic use of ultrasound in diseases of the head and neck , 1980, The Laryngoscope.

[24]  Roche Af,et al.  Increase in cranial thickness during growth. , 1953 .

[25]  M. Keen.  Complications of harvesting cranial bone grafts. , 1995, Plastic and Reconstructive Surgery.

[26]  P. C. Gautier-Smith.  Parasagittal and falx meningiomas , 1970 .

[27]  C. H. Herndon,et al.  The fate of autogenous and homogenous bone grafts. , 1955, The Journal of bone and joint surgery. American volume.

[28]  S. Wolfe.  The Utility of Pericranial Flaps , 1978, Annals of Plastic Surgery.

[29]  K R Kattan,et al.  Thickness of the normal skull in the American Blacks and Whites. , 1975, American journal of physical anthropology.

[30]  U. Bite,et al.  Update on Cranial Bone Grafts in Craniofacial Surgery , 1987, Annals of plastic surgery.

[31]  B A Rahn,et al.  Fixation Effects on Membranous and Endochondral Onlay Bone‐Graft Resorption , 1988, Plastic and reconstructive surgery.

[32]  R. Riley,et al.  Cranial bone grafting in facial aesthetic and reconstructive contouring. , 1987, Archives of otolaryngology--head & neck surgery.

[33]  A. Figueroa,et al.  Iliac Versus Cranial Bone for Secondary Grafting of Residual Alveolar Clefts , 1991, Plastic and reconstructive surgery.

[34]  L. Peer.  The fate of autogenous human bone grafts , 1950 .

[35]  H. Kaplan,et al.  The venous sinuses of the cerebral dura mater. I. Anatomical structures within the superior sagittal sinus. , 1972, Archives of neurology.

[36]  H. Plasse,et al.  Frontal bone reconstruction with split calvarial and cancellous iliac bone. , 1989, Ear, nose, & throat journal.

[37]  Wolfe Sa,et al.  Complications associated with the harvesting of cranial bone grafts. , 1995 .

[38]  T Albrektsson,et al.  Integration of screw implants in the rabbit: a 1-year follow-up of removal torque of titanium implants. , 1987, The International journal of oral & maxillofacial implants.

[39]  M. Maves,et al.  Calvarial Bone Grafting of Facial Defects , 1986, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[40]  I. Jackson,et al.  The skull as a bone graft donor site. , 1983 .

[41]  J. McCarthy,et al.  Report on a series of 50 craniofacial operations. , 1975, Plastic and reconstructive surgery.

[42]  O. Antonyshyn,et al.  Cranioplasty: indications, technique, and early results of autogenous split skull cranial vault reconstruction. , 1995, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[43]  F. Marchand.  Der Process der Wundheilung : mit Einschluss der Transplantation , 1901 .

[44]  M. Edwards,et al.  Autogeneic skull bone grafts to reconstruct large or complex skull defects in children and adolescents. , 1987, Neurosurgery.

[45]  M. Abramson,et al.  Membranous vs Endochondral Bone Autografts , 1974 .

[46]  J. Mulliken,et al.  Donor-site morbidity after harvesting rib and iliac bone. , 1984, Plastic and reconstructive surgery.

[47]  L. Sargent,et al.  Membranous bone healing and techniques in calvarial bone grafting. , 1989, Clinics in plastic surgery.

[48]  S. Wolfe.  Autogenous bone grafts versus alloplastic material in maxillofacial surgery. , 1982, Clinics in plastic surgery.

[49]  W. Dandy.  AN OPERATIVE TREATMENT FOR CERTAIN CASES OF MENINGOCELE (OR ENCEPHALOCELE) INTO THE ORBIT , 1929 .

[50]  L. Hopkins,et al.  Superior sagittal sinus laceration complicating an autogenous calvarial bone graft harvest: report of a case. , 1990, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[51]  A Tjellström,et al.  Osseointegrated implants for replacement of absent or defective ears. , 1990, Clinics in plastic surgery.

[52]  J. Stuzin,et al.  Saddle nasal deformity. , 1988, Clinics in Plastic Surgery.

[53]  R. Riley,et al.  Facial contouring with outer-table calvarial bone. A 4-year experience. , 1989, Archives of otolaryngology--head & neck surgery.

[54]  E. Manders,et al.  Ultrasonic observation of facial bone fractures: report of cases. , 1996, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[55]  K. Salyer,et al.  Bone grafts in craniofacial surgery. , 1987, Clinics in plastic surgery.

[56]  D. L. Hykes,et al.  Ultrasound Physics and Instrumentation , 1985 .

[57]  J. Posnick,et al.  Craniofacial Skeletal Measurements Based on Computed Tomography: Part I. Accuracy and Reproducibility , 1992 .

[58]  J M Psillakis,et al.  Repair of large defect of frontal bone with free graft of outer table of parietal bones. , 1979, Plastic and reconstructive surgery.

[59]  S. Krupp.  Problems in craniofacial surgery , 1977 .

[60]  I. Jackson,et al.  Experience in the use of calvarial bone grafts in orbital reconstruction. , 1992, The British journal of oral & maxillofacial surgery.

[61]  J. Grotting,et al.  Vascularized Outer‐Table Calvarial Bone Flaps , 1986, Plastic and reconstructive surgery.

[62]  G. Wilkes,et al.  The Long-Term Survival of Onlay Bone Grafts— A Comparative Study in Mature and Immature Animals , 1985, Annals of plastic surgery.

[63]  P. Tessier.  Autogenous bone grafts taken from the calvarium for facial and cranial applications. , 1982, Clinics in plastic surgery.

[64]  A Tjellström,et al.  Removal torque of osseointegrated craniofacial implants: a clinical study. , 1988, The International journal of oral & maxillofacial implants.

[65]  L A Whitaker,et al.  Membranous versus Endochondral Bone: Implications for Craniofacial Reconstruction , 1983, Plastic and reconstructive surgery.

[66]  Early single-stage repair of complex craniofacial trauma. , 1992 .

[67]  S. Berkowitz,et al.  The Use of Cranial Bone Grafts in the Closure of Alveolar and Anterior Palatal Clefts , 1983, Plastic and reconstructive surgery.