Crane

Question 1

Skalp cyst

Answer 1

ectodermal cyst
-epidermoid
-dermoid
menigocele
encephalocele
hemangioma
lymphangioma
Sinus pericranii: soft tissue mass with erosion of both tables and an emisary vessel

Question 2

Skull with bone defects

Answer 2

Acalvaria: normal brain covered by skin
Acrania: dysplastic brain covered by meninges
Exencephaly: acrania with abnormal brain. Associated with amniotic band sequence and limb body wall complex.
Anencephaly: acrania and complete absence of normal brain above brainstem

Question 3

Crane malfrmation with cephalocele

Answer 3

most are occipital but in southeast Asia frontoethmoidal
Solitary
With
-ciliopathies: Meckel gruber
-muscular dystrophies: Walker-Warburg
-Chiari III

Question 4

Parietal foramina

Answer 4

60%
When enlarged:
bilateral and symetric defect of ossification of the membranous skull

Question 5

Fontanela localization

Answer 5

at the corners of parietal bones

Question 6

Wormian bones

Answer 6

Intrasutural bones
Causes:
-Hypo T3
Cleidocranial dysplasia
-Osteogenesis imperfecta
-Menkes (copper deficiciency)
Progeria
-hypophosphatasia
-pyknodysostosis

Question 7

Bathrocephaly

Answer 7

normal bulg from the lambda suture, down

Question 8

Craniosynostosis

Answer 8

• Scaphocephaly (dolicocephaly) sagittal suture closure, long narrow head
• Brachycephaly (bradycephaly): bilateral coronal suture closure. Hypertelorism, proptosis
• Trigonocephaly: metopic closure, omaga sign
• Turricephaly: bilateral lamdoid
• Plagiocephaly: unilateral coronal or lambdoid
• Cloverleaf: multiple sutures

Question 9

Causes of craniosynostosis

Answer 9

Primary
-FGFR1 (Pfeiffer sx), FGFR 2 (Apert, Pfaiffer, Cruzon), FGFR 3
Secondary
-metabolic (hyperthyroidism, rickets)
-mucopolysaccharidoses
-Hematologic (thalassemia, sickle cell, polycytemia)
-teratogens

Question 10

Positional plagiocephaly

Answer 10

parallelogram skull shape

Question 11

Acrocephalosyndactyly

Answer 11

Calvarial anomalies with polydactyly and syndactyly

• Alpert. Bicoronal synostosis with symmetric syndactyly (2,3,4 fingers) with mitten hand
• Crouzon syndrome: brachycephaly, facial dysostosis with hooked parrot nose and samll maxilla, bilateral exophtalmos

Question 12

Craniofacial syndromes

Answer 12

• Goldenhar: epibulbar demoids, preauricular appendages, mandibular hypoplasia, microtia and vertebral anomalies. Colobomas in 60%
• hemifacial microsomia: asymetric facial hypoplasia, microsomia, unilateral microtia and ipsilateral mandibular hypoplasia. Autosomal or X-linked
• Treacher Collins: AD. variable penetrance. Bilateal symmetric micrognathia, narrow face, depressed cheekbones, malformed smalll ears, conductive hearing loos
• Pierre Robin sequence: micrognathia, cleft palate and glossoptosis. Can have cardiovascular (septal defects, ductus arteriosus) and skeletal anomalies

Question 13

Lacunar skull of the newborn

Answer 13

Develops during fetal life and disapearing by 4-5 months
soap bubble rarefactions in the upper part of the calvarium
associated to
-meningomyelocele
-myelocele
-encephalocele
-Chiari II

Question 14

Most common skull lesions in children

Answer 14

dermoid tumor 60%
cephalohematomas 9%
LCH 7%
occut meningoceles/encephaloceles 4%
infection

Question 15

Neoplasias

Answer 15

Secondary tumor:
-Leukemia
-neuroblastoma
-small round cell (Ewing, meduloblastoma, retinoblastoma)
-LCH
Primary tumors: rare
-osteochondromas, osteoblastomas, AB, osteomas, Ostemoa osteoide
-Neurofibroma
Venolymphatic malformation

Question 16

Odontogenic cysts

Answer 16

Periapical
Pericoronal (developmental)
odontogenic keratocyst: skallops, erodes toot, resorbs root. Associated to NBCCS

Question 17

Odontogenic solid tumor

Answer 17

Ameloblastoma: solid and cystic, bubbly

odontoma: the most common odontogenic tumo
cementoma: sclerotic with lucent halo

Question 18

Fibro-osseus mandibular tumors

Answer 18

ossifying fibroma
juvenile ossifying fibroma
fibrous dysplasia
central giant cell granuloma (associated to Noonan)

Question 19

Mandibular malignant tumors

Answer 19

More common non primary

• neuroblastoma
• lymphoma/leukemia
• Ewing sarcoma
• Osteosarcoma
• rhabdomyosarcoma
• Chondrosarcoma

Question 20

Cherubism

Answer 20

progressive painless cheek swelling secondary to multilocular giant cell containing cystic lesions
eyes rised to heaven
before 5 yo and progressive
Can be familiar

Question 21

Caffey disease

Answer 21

Infantile cortical hyperostosis
assymetric polyostotic process with acute inflammation of periosseous and periosteal
mandible involved in 80%

Question 22

Hemorraghe in neonatal scalp

Answer 22

• Caput succedaneum: swelling of skalp with edema and blood
• Subgaleal hematoma (hygroma): Between skalp and periostium. CSF and blood accumulation, rupture of emisary vein, occupying a potential space. Crosses sutures. can be asociated to fracture, more common in parietal region. Elarge rapidly
• Cephalhematoma: subperiosteal collection confined by sutures, parietal and occipital bone. Formes external shell of bone

Question 23

Neonatal fracture

Answer 23

12% fracture post delivery
depressed fractures
parietal and occipital bone
most secondary to instrumentation

Question 24

Expected widened sutures

Answer 24

Long use of prostaglandine E

Question 25

Criteria for head CT after trauma

Answer 25

less than 2 yo
-altered mental status
-palpable fracture
-occipital, parietal or temporal skalp hematoma
-loss of consiousness more than 5 sec
-severe mechanism of injury
-not acting normal
more than 2 yo
-altered mental status
-signs of basilar skull fx
-loss of consciousness
-vomiting
-severe mechanism
-severe headache

Question 26

Leptomeningeal cyst

Answer 26

growing fracture of childhood
uncomon after 5 yo
transmision of pulsation of brain, with atrophy of bone unprotected by dura, with development of a larger defect over the years