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Craniofacial Sutures. Development, Disease and Treatment
Available online at www.sciencedirect.com
British Journal of Oral and Maxillofacial Surgery 46 (2008) 613
Book review Craniofacial Sutures. Development, Disease and Treatment Frontiers of Oral Biology, D.P. Rice, P. Sharpe (Eds.), Volume 12, Publisher Karger, Price £109-60, ISSN: 14202433, ISBN: 978-3-8055-8326-8. This is volume 12 in the Frontiers of Oral Biology series. It is a multi-author text with chapters devoted to craniofacial and sutural biology at a genetic and molecular level. As such, the appeal will be limited. There are five sections, namely developmental anatomy including molecular control mechanisms, sutural form and position from an evolutionary perspective, an overview of the commoner syndromic and non-syndromic craniosynostoses and finally current treatments and future trends. The developmental anatomy of craniofacial sutures details the embryonic origins and ossification times of the skull and facial bones. Variations in the anatomy of the different sutures are discussed as are known genetic triggers. This progresses into the key mechanisms controlling bone and suture formation including the interactions between the different tissue types. The importance of tissue interactions for example the influence of the dura on cranial sutures is highlighted. A working knowledge of genetics and genetic terminology is assumed. All bones will remodel under load, but so too do the sutures. Tension results in fibrous sutures abutting thin, elongated bones and compression in narrow sutures with thicker adjacent bone. This correlates well with the clinical picture. It is interesting that these changes are independent of the dura which clearly influences skull development. The chapter on investigation of craniosynostosis correctly recognises that diagnosis is clinical and that there is little, if any, role for plane films. CT is the investigation of choice, supplemented with MR when the soft tissues need further assessment. The clinical features of the various craniosynostotic conditions are well described as is the genetic background for each of the syndromes. It is recognised that much work is needed
on the non-syndromic conditions where little is known about the underlying causes. This work is important as many centres are reporting an increasing incidence, particularly of metopic suture synostosis. The role of the genes, fibroblast growth factor receptor mutations, transforming growth factor ß and bone morphogenic proteins on growth are well presented, but perhaps of limited interest to the clinician. Little has changed in the overall treatment of craniosynostosis since Paul Tessier’s work in the mid 1960s. Complex surgical re-modelling of the skull and face remain the gold standard. The final chapter presents an overview of the procedures and suggests that novel therapeutic strategies may complement or even replace surgery. However, down regulation of FGF signalling, modulation of TGFß isoforms and changes in the balance between BMP agonists and antagonists remain ideals. The practical application of these techniques in humans is still some way off. All of the chapters are comprehensively referenced with both historical and contemporary papers. Tables are included within each chapter and they are easy to read and follow. The line diagrams are of high quality but are often too small and complex to be easily understood. The patient photographs are also too small such that it is difficult to identify the key differences between the various conditions. The authors bring differing approaches to each chapter, but editorial style is consistent and there is a logical layout to the book that is easy to follow. Different chapters will appeal to different groups; there are few individuals for whom the whole book will have relevance. This is a book for the library. Stephen Dover ∗ University Hospital Birmingham NHS Foundation Trust, UK ∗ Tel.:
+0121 627 8277. E-mail address: [email protected] Available online 21 July 2008
0266-4356/$ – see front matter © 2008 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.bjoms.2008.05.003
British Journal of Oral and Maxillofacial Surgery 46 (2008) 613
Book review Craniofacial Sutures. Development, Disease and Treatment Frontiers of Oral Biology, D.P. Rice, P. Sharpe (Eds.), Volume 12, Publisher Karger, Price £109-60, ISSN: 14202433, ISBN: 978-3-8055-8326-8. This is volume 12 in the Frontiers of Oral Biology series. It is a multi-author text with chapters devoted to craniofacial and sutural biology at a genetic and molecular level. As such, the appeal will be limited. There are five sections, namely developmental anatomy including molecular control mechanisms, sutural form and position from an evolutionary perspective, an overview of the commoner syndromic and non-syndromic craniosynostoses and finally current treatments and future trends. The developmental anatomy of craniofacial sutures details the embryonic origins and ossification times of the skull and facial bones. Variations in the anatomy of the different sutures are discussed as are known genetic triggers. This progresses into the key mechanisms controlling bone and suture formation including the interactions between the different tissue types. The importance of tissue interactions for example the influence of the dura on cranial sutures is highlighted. A working knowledge of genetics and genetic terminology is assumed. All bones will remodel under load, but so too do the sutures. Tension results in fibrous sutures abutting thin, elongated bones and compression in narrow sutures with thicker adjacent bone. This correlates well with the clinical picture. It is interesting that these changes are independent of the dura which clearly influences skull development. The chapter on investigation of craniosynostosis correctly recognises that diagnosis is clinical and that there is little, if any, role for plane films. CT is the investigation of choice, supplemented with MR when the soft tissues need further assessment. The clinical features of the various craniosynostotic conditions are well described as is the genetic background for each of the syndromes. It is recognised that much work is needed
on the non-syndromic conditions where little is known about the underlying causes. This work is important as many centres are reporting an increasing incidence, particularly of metopic suture synostosis. The role of the genes, fibroblast growth factor receptor mutations, transforming growth factor ß and bone morphogenic proteins on growth are well presented, but perhaps of limited interest to the clinician. Little has changed in the overall treatment of craniosynostosis since Paul Tessier’s work in the mid 1960s. Complex surgical re-modelling of the skull and face remain the gold standard. The final chapter presents an overview of the procedures and suggests that novel therapeutic strategies may complement or even replace surgery. However, down regulation of FGF signalling, modulation of TGFß isoforms and changes in the balance between BMP agonists and antagonists remain ideals. The practical application of these techniques in humans is still some way off. All of the chapters are comprehensively referenced with both historical and contemporary papers. Tables are included within each chapter and they are easy to read and follow. The line diagrams are of high quality but are often too small and complex to be easily understood. The patient photographs are also too small such that it is difficult to identify the key differences between the various conditions. The authors bring differing approaches to each chapter, but editorial style is consistent and there is a logical layout to the book that is easy to follow. Different chapters will appeal to different groups; there are few individuals for whom the whole book will have relevance. This is a book for the library. Stephen Dover ∗ University Hospital Birmingham NHS Foundation Trust, UK ∗ Tel.:
+0121 627 8277. E-mail address: [email protected] Available online 21 July 2008
0266-4356/$ – see front matter © 2008 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.bjoms.2008.05.003