Appendix 2.qxd

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on the adult skull. The skull of the infant, and more so in the neonate by necessity, is immensely malleable, with the pliability of a milk carton. As a mainly cartilaginous structure at birth, the infant skull is ultraresponsive to direct molding pressures. The evolution of the neurocranium, through different growth centers, as well as the main sutural features of the skull and face are shown in Figure A2.1. The cranial bones are unconnected by sutures at birth and some of the cranial bones, known as composite bones (e.g. occiput, sphenoid, temporal) comprise several parts, allowing scope for the rapid growth of the brain (Carreiro 2003). The neonatal cranium is remarkably soft and unstructured, to allow folding of the cranium as it passes through the birth canal, where it is particularly vulnerable to deformation during the birth process (see Figs A2.2 and A2.3). Cranial distortion can be created by prebirth influences, via trauma (seat-belt compression during an automobile accident, for example) or if the womb is crowded (perhaps by a twin) or if chemical influences distort development (drugs, toxins and/or nutritional deficits). Far more likely to produce damage, however, are the influences of the powerful forces acting upon the supple skull during the birth process. Among the factors which can produce cranial damage during birth are (Biedermann 1992, 2001): 399

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تاریخ انتشار 2005