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44Chapter2ThemeancranialshapescreatedinthisstudycouldadditionallybeusedfortheevaluationofindividualcasesTheaveragecranialshapeofaspecificagegroupcouldbecompareddirectlyto3Dphotographsor3D-CTscansofpatientsandallowadirectevaluationofthecranialshapein3DInadditiontothegraphsandtablesthesupplementaryvideos(OnlineComplementaryMaterial)provideanoptimalinsightandunderstandingofthenormalevolutionovertimeAnenormousincreasein thecranialsizecanbenoted while thecolourshighlight thedifferenceingrowthfocusduringthefirst24monthsoflife Thisstudyisnovelinusingalargenumberoftimeintervalstoevaluatecranialgrowthin3DAllCImeasurementswithinthefirst24monthsofagewereintherangeof75to78Inlinewiththeliteraturethe3DphotographsCT-HT,andCT-STalldemonstratedlowervaluesat24months920AfterthisperiodCT-HTandCT-STrespectivelyshowedanincreaseinCIupuntiltheageof48monthstowards78and80whichisinlinewiththefindingsofFarkasetal21andDekaban4TheCIresultsarelowerthanthosereportedbyMeyer-MarcottyetalwhoestablishedanaverageCIof84at6monthsofageand82at12monthsofageasmeasuredon3Dphotographsofhealthyinfants8LikusetalalsopresentedalargerCIof83onaveragemeasuredonCTscans1DelyeetalmeasuredameanCIof84onCTscansofhealthyinfantsof6and12months2 ThisindicatesthatthesubjectsusedinthisstudyhaveslightlymoreelongatedheadshapesWethereforebelieveitisimportanttoestablishreferencemeasurementsobtainedfromapopulationthatisagoodrepresentationofthepopulationofpatientstreatedinalocalcentreHeadcircumferencemeasuredon3DphotographsshowedalmostidenticaltrendswhencomparedtothenationwidegrowthstudyintheNetherlandswhichincluded14500boysandgirlsofDutchorigin(Figure5)22Inthepresentstudyonlythedataforthe24monthsagegroupofbothsexesshoweda+1standarddeviationhighercircumferencewhichcouldalsobeaconsequenceofhairinthesubjectsatthisageSincesexualdimorphismispresentatanearlystageoflifeadistinctionbetweenmalesandfemaleswasmadeinthisstudy2324Meyer-Marcottyetalhavealreadydescribedsignificantlylargervaluesforlengthcircumferenceandvolumeincreasebetween6and12monthsoflifeinmales89Joffeetalmeasuredslightlylargercranialcircumferencesatbirth6monthsand12monthsinmales25Althoughthesestudiesusedfewertimeintervalsthesexualdimorphismwithmalespresentinglargervaluesisinlinewiththefindings
