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Midface Anomalies in Children¹

¹ From the Department of Radiology, Vanderbilt Children's Hospital, 1161 21st Ave S, D-1120 Medical Center North, Nashville, TN 37232-2675 (L.H.L.); and the Department of Radiology, Children's Medical Center of Dallas, Dallas, Tex (T.N.B., J.M.J., N.K.R.). Received April 6, 1999; revision requested June 11 and received July 21; accepted July 23. Address correspondence to L.H.L. (e-mail:lisa.lowe@mcmail.vanderbilt.edu).

A variety of congenital midface anomalies occur in children. High-resolution computed tomography (CT) and magnetic resonance (MR) imaging have proved helpful in determining the nature and extent of dysplasia, thereby facilitating treatment planning. A classification system has been developed that groups these anomalies into four categories based on embryogenesis and anatomic location. These categories comprise anomalies that are related to the nasal cavity, nasofrontal region, nasolacrimal apparatus, and craniofacial syndromes. CT is the imaging modality of choice in children with possible choanal atresia, pyriform aperture stenosis, or anomalies of the nasolacrimal duct (eg, nasolacrimal duct stenosis, dacryocystoceles). MR imaging is the modality of choice in patients with congenital midface masses (eg, dermoid and epidermoid cysts, nasal gliomas, encephaloceles) and craniofacial syndromes (eg, Apert syndrome, Crouzon syndrome, Treacher Collins syndrome). In many cases, however, both CT and MR imaging are required to adequately evaluate midface anomalies. Familiarity with the characteristic imaging features of these anomalies along with knowledge of midface embryogenesis and normal developmental anatomy is essential to prevent misinterpretation of anatomic variations that may simulate disease.

Index Terms: Apert syndrome, 24.1499 • Brain, hernia, 13.1461 • Brain neoplasms, 13.363 • Crouzon syndrome, 24.1499 • Dermoid, 261.3622 • Epidermoid, 261.3622 • Face, abnormalities, 24.166, 24.1664 • Lacrimal duct and gland, 223.1492 • Nose, abnormalities, 261.1492, 261.1493, 261.361 • Treacher Collins syndrome, 24.1664

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