A 3-Dimensional Morphometric Analysis of 4 Midsagittal Planes for CT Scan Reference Determination in Children with Syndromic Craniosynostosis

Objective To identify the suitable and practical midsagittal plane (MSP) reference for computed tomography (CT) scan skull analysis in patients with syndromic craniosynostosis. Design Retrospective study. Setting Tertiary referral hospital. Patients and Participants A total of 19 full skull CT scans of syndromic craniosynostosis patients. Methods Seven craniofacial landmarks located on the midline and 4 MSPs that was previously published and clinically recognized (Planes: SPBaS, SPNSANS, SPLOrPo and SPZFTP) were constructed from the CT images. The absolute distance of every plane from 7 landmarks were then calculated. These distances were subsequently subjected to statistical analysis. Main Outcome Measure(s) The absolute distance of different MSPs from 7 landmarks. Results The distances of landmarks measured to SPBaS were the highest, with the most prominent fluctuation. The fluctuation of the SPNSANS, SPLOrPo and SPZFTP had similar direction changes, with the latter being the closest. Pairwise comparisons demonstrated statistical differences ( P < .008 using the Bonferroni correction) between the measured distances of A point (M = 0.25, SD = 0.16) and B point (M = 2.21, SD = 1.6) to SPNSANS. There were statistical significances between distances of B point (M = 1.68, SD = 1.07) and CG point (M = 0.55, SD = 0.37) to SPZFTP plane. There was no statistical significance on each landmark to SPLOrPo. Conclusions The study demonstrates that SPBaS is not recommended for MSP reference. While SPNSANS should be carefully selected, the application of SPLOrPo and SPZFTP are interchangeable, with the SPZFTP plane slightly exaggerating the mandible deviation relative to the superior and posterior of the midface.