Literature Scans

New World Cranial Deformation Practices: Historical Implications for Pathophysiology of Cognitive Impairment in Deformational Plagiocephaly G. Lekovic, MD B. Baker, MD
Neurosurgery 2007;60(6)1137Y1147.

of deformational plagiocephaly in various ancient civilizations throughout time. Marcus J. Ko, MD Larry Hollier, MD, FACS Houston, Texas, USA larryh@bcm.tmc.edu

J. Lekovic, MD M. Preul, MD

The Plight of Children

his article is an interesting discussion of the pathophysiology associated with deformational plagiocephaly from a historical perspective. As the authors highlight, deformational plagiocephaly resulting from either intentional or de novo forces has been described in societies throughout history. Modern research links significant cranial deformity with alterations in mental ability; however, the prevalence and impact of these defects on historical societies remain uncharacterized. Here, Lekovic et al discuss findings from their anthropologic study of deformational plagiocephaly in various civilizations throughout time. In investigating this complex topic, the authors reviewed anthropologic data as well as the museum collections of Arizona State University and San Diego Museum of Man. Here, they examined skeletal evidence, ancient art, and relics from ancient cultures, such as the Maya. The authors describe the use of binding boards and stones to intentionally produce deformational plagiocephaly as a symbol of ethnicity or status. Prompted by contemporary reports linking significant cranial deformity with impaired cognitive development, Lekovic et al then assessed the impact of deformational plagiocephaly on affected members of these societies throughout history. Although the authors recognize that anthropological evidence with which to evaluate this topic is scarce, they cite several historical sources. Early reports by noted explorers Lewis and Clark, as well as Samuel Morton, describe large populations of native Americans with both substantial cranial deformity and normal intelligence. In addition, the authors argue that any adverse effects resulting from intentional cranial manipulation would most likely have discouraged the continuation of this elective practice. Overall, this is an interesting study on a large, challenging topic over an extended period of time. As a result of their thoughtful approach to and rational execution of project design, Lekovic et al have provided novel insight into the incidence and character
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J. Grosfield
Annals of Surgery 2007;246(3):343Y350.

he present article represents the keynote address of Dr Jay Grosfield, president of the American Surgical Association, at the 2007 annual association meeting. As a longpracticing pediatric surgeon, Dr Grosfield remains a prominent figure in contemporary surgery, as well as a passionate child advocate. In his presidential address, Dr Grosfield highlights the current situation of children across the globe, identifies continuing threats to pediatric welfare, and discusses possible solutions to these obstacles. At a rate of 1 death every 30 seconds, the World Health Organization estimates that 10.6 million children die before reaching their 5th birthday. While younger children often fall victim to pneumonia, diarrhea, malaria, and malnutrition, adolescents face the additional threats of regional conflict and labor abuses stemming from local poverty. In areas of armed conflict, children are frequently killed or maimed by bullets, bombs, landmines, or other acts of terror. Young boys are often forced into local militias, kept in line with drug use, and murdered upon attempt to escape. The United Nations currently lists 12 governments, 85 armed groups, and 25 countries that violate the United Nations Convention on the Rights of Children for using child soldiers. In addition, childhood exploitation through forced labor and prostitution is also a worldwide problem. Even in developed countries, such as the United States, homelessness remains a large problem for children. Recent surveys estimate that 1.6 million homeless children currently reside within US borders. Many of these unseen children must submit to forced labor or roles in the sex industry to provide sustenance. In these environments, health risks are compounded, yet access to medical care is even more limited.

Copyright @ 2008 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.

LITERATURE SCANS / Cole and Hollier

In addition to condemning childhood labor and military involvement, the developed world must continue to improve neonatal care, increase nutrition availability, and reduce childhood illness. Affecting these policies requires pressure on legislators and continued pressure by formidable lobbying groups, such as the American Academy of Pediatrics, American Medical Association, American Heart Association, and a variety of parent/public coalitions. At the national level, Dr Grosfield advises that modifications in Medicaid and State Childrens Health Insurance Program are necessary to provide our nations children with adequate health coverage. While the author recognizes the success of many who matured in a single-parent household, he cites several reasons for continued concentration on the 2-parent family nucleus. In addition, Dr Grosfield advises more parent-child interaction time. Todays children 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 and responsible guidance. Despite the significant obstacles in todays world, we must ensure our children have an opportunity to thrive in a safe, stable, and nurturing environment. Not only will investing in childrens health care result in better growth, general wellbeing, and improved school performance, but preemptive investments will increase productivity and lessen health care costs in the long term. While our childrens actions will impact the global economy and shape our society tomorrow, our responsible decisions today must set the ground work for their success and future welfare of our nation.

Patrick Cole, MD Larry Hollier, MD, FACS Houston, Texas, USA larryh@bcm.tmc.edu

CORRECTION Belli E, Matteini C, D Andrea GC, Mazzone N. Navigator system guided endoscopic intraoral approach for remodeling of mandibular condyle in Garre syndrome. J Craniofac Surg 2007;18(6): 1410Y1415. One of the coauthors names was omitted from the above article which ran in the November issue. We regret the omission.

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Copyright @ 2008 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.