Copyright @ 200 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.8

Literature ScansNew World Cranial Deformation Practices:Historical Implications for Pathophysiologyof Cognitive Impairment inDeformational Plagiocephaly

G. Lekovic, MD J. Lekovic, MD

B. Baker, MD M. Preul, MD

Neurosurgery 2007;60(6)1137  Y 1147.

This article is an interesting discussion of the pathophysiology associated with defor-mational plagiocephaly from a historicalperspective. As the authors highlight, defor-

mational plagiocephaly resulting from either inten-tional or de novo forces has been described insocieties throughout history. Modern research linkssignificant cranial deformity with alterations inmental ability; however, the prevalence and impactof these defects on historical societies remain unchar-acterized. Here, Lekovic et al discuss findings fromtheir anthropologic study of deformational plagio-cephaly in various civilizations throughout time.

In investigating this complex topic, the authorsreviewed anthropologic data as well as the museumcollections of Arizona State University and San DiegoMuseum of Man.

Here, they examined skeletal evidence, ancientart, and relics from ancient cultures, such as the Maya.The authors describe the use of binding boards andstones to intentionally produce deformational plagi-ocephaly as a symbol of ethnicity or status.

Prompted by contemporary reports linking sig-nificant cranial deformity with impaired cognitivedevelopment, Lekovic et al then assessed the impactof deformational plagiocephaly on affected membersof these societies throughout history. Although theauthors recognize that anthropological evidence withwhich to evaluate this topic is scarce, they cite severalhistorical sources. Early reports by noted explorersLewis and Clark, as well as Samuel Morton, describelarge populations of native Americans with bothsubstantial cranial deformity and normal intelligence.In addition, the authors argue that any adverse effectsresulting from intentional cranial manipulationwould most likely have discouraged the continuationof this elective practice.

Overall, this is an interesting study on a large,challenging topic over an extended period of time. Asa result of their thoughtful approach to and rationalexecution of project design, Lekovic et al have pro-vided novel insight into the incidence and character

of deformational plagiocephaly in various ancientcivilizations throughout time.

Marcus J. Ko, MDLarry Hollier, MD, FACS

Houston, Texas, USAlarryh@bcm.tmc.edu

The Plight of Children

J. Grosfield

Annals of Surgery 2007;246(3):343  Y 350.

The present article represents the keynoteaddress of Dr Jay Grosfield, president of theAmerican Surgical Association, at the 2007annual association meeting. As a long-

practicing pediatric surgeon, Dr Grosfield remainsa prominent figure in contemporary surgery, as wellas a passionate child advocate. In his presidentialaddress, Dr Grosfield highlights the current situationof children across the globe, identifies continuingthreats to pediatric welfare, and discusses possiblesolutions to these obstacles.

At a rate of 1 death every 30 seconds, the WorldHealth Organization estimates that 10.6 millionchildren die before reaching their 5th birthday.While younger children often fall victim to pneu-monia, diarrhea, malaria, and malnutrition, adoles-cents face the additional threats of regional conflictand labor abuses stemming from local poverty. Inareas of armed conflict, children are frequentlykilled or maimed by bullets, bombs, landmines, orother acts of terror. Young boys are often forced intolocal militias, kept in line with drug use, andmurdered upon attempt to escape. The UnitedNations currently lists 12 governments, 85 armedgroups, and 25 countries that violate the UnitedNations Convention on the Rights of Children forusing child soldiers. In addition, childhood exploita-tion through forced labor and prostitution is also aworldwide problem. Even in developed countries,such as the United States, homelessness remains alarge problem for children. Recent surveys estimatethat 1.6 million homeless children currently residewithin US borders. Many of these ‘‘unseen’’ childrenmust submit to forced labor or roles in the sex industryto provide sustenance. In these environments, healthrisks are compounded, yet access to medical care iseven more limited.

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Copyright @ 200 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.8

In addition to condemning childhood labor andmilitary involvement, the developed world mustcontinue to improve neonatal care, increase nutritionavailability, and reduce childhood illness. Affectingthese policies requires pressure on legislators andcontinued pressure by formidable lobbying groups,such as the American Academy of Pediatrics,American Medical Association, American HeartAssociation, and a variety of parent/public coali-tions. At the national level, Dr Grosfield advises thatmodifications in Medicaid and State Children’sHealth Insurance Program are necessary to provideour nation’s children with adequate health coverage.While the author recognizes the success of many whomatured in a single-parent household, he citesseveral reasons for continued concentration on the2-parent family nucleus. In addition, Dr Grosfieldadvises more parent-child interaction time. Today’schildren spend a majority of their time in the care of someone other than their parent(s), and Dr Grosfield

highlights the need for increased parental input andresponsible guidance.

Despite the significant obstacles in today’sworld, we must ensure our children have anopportunity to thrive in a safe, stable, and nurturingenvironment. Not only will investing in children’shealth care result in better growth, general well- being, and improved school performance, but pre-emptive investments will increase productivity andlessen health care costs in the long term. While ourchildren’s actions will impact the global economyand shape our society tomorrow, our responsibledecisions today must set the ground work for theirsuccess and future welfare of our nation.

Patrick Cole, MDLarry Hollier, MD, FACS

Houston, Texas, USAlarryh@bcm.tmc.edu

CORRECTION

Belli E, Matteini C, D’ Andrea GC, Mazzone N. Navigator system guided endoscopic intraoralapproach for remodeling of mandibular condyle in Garre syndrome. J Craniofac Surg 2007;18(6):1410 Y 1415.

One of the coauthors’ names was omitted from the above article which ran in the November issue.We regret the omission.

LITERATURE SCANS /  Cole and Hollier

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