title: Generation of normative pediatric skull models for use in cranial vault remodeling procedures.
abstract: OBJECTIVE
  While the goal of craniofacial reconstruction surgery is to restore the cranial head shape as much towards normal as possible, for the individual patient, there is, in fact, no normal three-dimensional (3D) model to act as a guide. In this project, we generated a library of normative pediatric skulls from which a guiding template could be fabricated for a more standardized, objective and precise correction of craniosynostosis.
  
  
  METHODS
  Computed tomography data from 103 normal subjects aged 8-12 months were compiled and a 3D computational model of the skull was generated for each subject. The models were mathematically registered to a baseline model for each month of age within this range and then averaged, resulting in a single 3D point cloud. An external cranial surface was subsequently passed through the point cloud and its shape and size customized to fit the head circumference of individual patients.
  
  
  RESULTS
  The resultant fabricated skull models provide a novel and applicable tool for a detailed, quantitative comparison between the normative and patient skulls for preoperative planning and practice for a variety of craniofacial procedures including vault remodeling. Additionally, it was possible to extract the suprafrontal orbit anatomy from the normative model and fabricate a bandeau template to guide intraoperative reshaping.
  
  
  CONCLUSIONS
  Normative head shapes for pediatric patients have wide application for craniofacial surgery including planning, practice, standarized operative repair, and standardized measurement and reporting of outcomes.
authors.affiliation: Centre for Image Guided Innovation & Therapeutic Intervention, The Hospital for Sick Children, Toronto, Ontario, Canada. nikoo.saber@sickkids.ca
authors.forename: Nikoo R
authors.initials: NR
authors.lastname: Saber
authors.forename: John
authors.initials: J
authors.lastname: Phillips
authors.forename: Thomas
authors.initials: T
authors.lastname: Looi
authors.forename: Zoha
authors.initials: Z
authors.lastname: Usmani
authors.forename: Jonathan
authors.initials: J
authors.lastname: Burge
authors.forename: James
authors.initials: J
authors.lastname: Drake
authors.forename: Peter C W
authors.initials: PC
authors.lastname: Kim
mesh_terms: D002508:Cephalometry; D002648:Child; D003398:Craniosynostoses / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D010372:Pediatrics; D019651:Plastic Surgery Procedures / Q000379:methods; D012886:Skull / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed
references.citation: J Craniofac Surg. 2011 Sep;22(5):1810-3
references.pmid: 21959440
references.citation: Plast Reconstr Surg. 2009 Dec;124(6):2076-2084
references.pmid: 19952665
references.citation: J Oral Maxillofac Surg. 2008 Aug;66(8):1766-72
references.pmid: 18634973
references.citation: J Craniomaxillofac Surg. 2008 Mar;36(2):109-16
references.pmid: 18280173
references.citation: J Craniofac Surg. 2009 Jan;20(1):178-9
references.pmid: 19165021
references.citation: IEEE Trans Pattern Anal Mach Intell. 2010 Dec;32(12):2262-75
references.pmid: 20975122
references.citation: Eur J Radiol. 2009 Aug;71(2):253-6
references.pmid: 18562144
references.citation: J Craniofac Surg. 2006 Mar;17(2):241-5
references.pmid: 16633169