Craniofacial Surgery

A Healthcare System Still in Turmoil: Looking for Light at the End of the Tunnel No abstract available

M. Samuel Noordhoff, 1927 to 2018: True Pioneer in the Old World No abstract available

Unique Osteoid Osteoma of the Frontal Sinus From the Late Roman Empire No abstract available

A Plastic Surgeon Striving for Anatomical Knowledge No abstract available

What is the Functional Difference Between Sagittal With Metopic and Isolated Sagittal Craniosynotosis? Introduction: The purpose of this study is to understand the neurological differences between patients born with combined sagittal and metopic craniosynostosis (SMc) and isolated sagittal craniosynostosis (ISc) by studying aberrations in functional brain connectivity and white matter microstructure, before surgery, utilizing functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI). Methods: The authors collected DTI and resting-state (ie, no sedation and asleep) functional connectivity MRI data in 10 infant patients preoperatively: 5 in the SMc group (4.3 ± 1 months) and 5 in the ISc group (4.8 ± 1.1 months). Resting state fMRI imaging and DTI data were acquired using a 3-T Siemens Trio MRI system (Erlangen, Germany) while the infant patients slept. fMRI data were corrected for movement using SPM, underwent cerebrospinal fluid and white matter signal regression and further analyzed with BioImageSuite. For the DTI data, 3 diffusion runs were averaged, processed utilizing FMRIB Software Library, and analyzed statistically using BioImageSuite. Results: Comparing the SMc versus ISc groups, SMc demonstrated that there was increased connectivity, statistically significant differences, in neural networks between children with sagittal synostosis alone versus those with sagittal with metopic synostosis, in the right BA 31 and BA 23 (corresponding to the posterior cingulate cortex (PCC) (P < 0.001). Analysis of the DTI revealed increased fractional anisotropy (normal maturation of white tracts) in the SMc group in the cingulum compared to the ISc group (P < 0.05). Differences in the functional networks include increased connectivity right frontoparietal network (RFPN) in ISc and increased connectivity in the primary visual network (V1) in SMc (P < 0.001). Conclusion: The SMc had increased connectivity as measured by fMR in the PCC, an area associated with attention deficit hyperactivity disorder. The DTI analysis demonstrated an increase in fractional anisotropy of the cingulum in the SMc group, a white matter tract projecting from the cingulate cortex; connections of the limbic (emotional regulation) system are instrumental. In SMc, increase of connectivity in the PCC correlates with an increase in maturation of the cingulum compared to ISc. There is increased connectivity of the RFPN network in the ISc and increased connectivity of the V1 network in the SMc patients. The SMc group has increased connectivity in the PCC, the original seed of the DMN network, and decreased connectivity to the RFPN network. The pattern of increased connectivity in the area of the DMN and decreased connectivity in the RFPN network is similar to the trend when comparing ADHD patients to normal controls. SMc has more similar functional network connectivity to ADHD as compared to ISc.

Commentary on "What Is the Functional Difference Between Sagittal With Metopic and Isolated Sagittal Craniosynostosis?" No abstract available

Correlation Between Mandible and External Ear in Patients with Treacher-Collins Syndrome Background: Patients with Treacher-Collins syndrome (TCS) are frequently affected by congenital ear deformities. The external ear in patients with TCS tends to have both abnormal morphology and reduced overall volume. Previous studies considered a correlation exists between TCS mandibular skeletal features and external ear volume. The purpose of this study was to assess the external ear volume in patients with TCS 3-dimensionally. Furthermore, this study evaluated the relationship between mandibular morphology, external ear profile, and external ear volume. Methods: A total of 36 nonoperated patients with TCS were compared to 39 age- and gender-matched normal controls. Morphologic variables of the mandible and the external ear were compared between TCS group and controls by 3-dimensional cephalometrics. The external ear volume and morphologic variables were analyzed with independent sample T-tests and Pearson correlation coefficient analyses (level of evidence: level III). Results: The external ear volume was reduced by approximately 50% in patients with TCS compared to controls (P < 0.001). External ear length and width were positively correlated with external ear volume (length: r = 0.809, P < 0.001 on left and r = 0.732, P < 0.001 on right; width: r = 0.518, P = 0.001 on left and r = 0.447, P < 0.010 on right). A negative correlation of right ear inclination angle and external ear volume was shown in patients with TCS (r = −0.396, P = 0.027). However, no correlation was shown for the mandibular anatomic variables. Conclusions: Three-dimensional analysis confirmed that external ear volume is significantly reduced in patients with TCS. The external ear dimensions and orientation correlated significantly with ear volume. There was no intrinsic association between the severity of mandibular deformity and external ear volume.

Complications Associated With Anterior Iliac Bone Grafting for the Reconstruction of Dentoalveolar Defects The aim of this study is to evaluate donor- and recipient-site complications of iliac bone grafting for the reconstruction of atrophic jaws. Our study includes 86 consecutive patients with atrophic jaws who underwent iliac bone grafting surgery. At the donor site, hematoma, infection, paresthesia, chronic pain, prolonged gait disturbance, fracture of the ilium, and esthetic concerns; at the recipient site, hematoma, infection, prolonged pain, graft exposure, graft loss, and loss of the implants were evaluated. Grafting was successfully performed in all patients. The mean follow-up period was 35 months. Prolonged gait disturbance (20.9%) and paresthesia (9.3%) were the most frequently observed donor-site complications. At the recipient site, hematoma (8.1%), infection (12.8%), prolonged pain (11.6%), partial graft exposure (33.7%), total graft exposure (7%), partial graft loss (17.4%), and total graft loss (5.8%) were observed. Reconstruction of atrophic jaws can be achieved successfully with iliac bone grafting. However, there are possible donor- and recipient-site complications that have to be taken into consideration.

Difference in Degrees of Satisfaction with Orthognathic Surgery and Orthodontic Treatment between Skeletal Class III and Cleft Patients Objective: The aim of this study was to compare the degrees of satisfaction with orthognathic surgery and orthodontic treatment between skeletal Class III and cleft patients. Materials and Methods: The samples consisted of Class III group (N = 25) and Cleft group (N = 16). The Modified Orthognathic Quality of Life Questionnaires, which had 5 domains (oral function [OF], awareness of dentofacial deformity [ADD], social relationship [SR], facial esthetics [FE], and nose/lip esthetics [NLE]), were evaluated with 5 rates (0 [very satisfactory] to 4 [very unsatisfactory]) at initial visit (T1), just before surgery (T2), 3 to 6 months after surgery (T3), and at debonding or 1 year after surgery (T4). The scores at each stage, amount of change between stages, and effect size (ES) in the 5 domains were investigated. Results: Compared to Class III group, Cleft group exhibited lower satisfaction scores of NLE domain during all stages (all P < 0.001) and of SR domain and total domains at T4 stage (P < 0.05, P < 0.01). Cleft group showed significant improvement of satisfaction scores in FE domain during T1-T2 (P < 0.01), in SR, FE, NLE, and total domains during T2-T3 (all P < 0.01), in OF, SR, and total domains during T3-T4 (P < 0.05, P < 0.01, P < 0.01), and in all domains during T1-T4 (ADD, P < 0.05; OF, SR, and NLE, P < 0.01; FE and total, P < 0.001). Cleft group exhibited large improvement of ES only at SR and FE domains during T2-T3 (−0.81 and −1.09, respectively). Conclusions: Owing to lower satisfaction of NLE domain at all stages in cleft patients, clinicians should recommend adjunctive cosmetic surgery for nose and lip after completion of treatment.

Incidence and Severity of Maxillofacial Injuries During the Syrian Civil War in Syrian Soldiers and Civilians Purpose: The aim of this study was to assess the maxillofacial injuries (MFIs) and our surgical approaches in the Syrian Civil War that emerged during the spring of 2011, among Syria's government and Syrians. Patients and Methods: The present study is a prospective clinical study of injured patients at Turkey's Border Hospitals during the Syrian Civil Conflict. Patients' data cover to all emergency and plastic surgery hospitals throughout Turkey. We assessed the patients' data according to location of trauma, duration of hospitalization, the severity and etiology of MFIs with the Injury Severity Score. Results: MFIs were found in 112 of the 956 wounded. The injuries occurred in 69 civilians (61.6%) and 43 soldiers (38.3%). The mean age ranged from 8 to 66 (mean: 29,1 ± 12). Eighty-two percent or higher rates of the injuries needed >4 days' hospitalization. We observed the mortality at a rate of 13.3% for the MFIs. Majority of the MFIs were accompanied by >3 concomitant injuries (n = 59; 52.6%). Most of the facial injuries were located at Mandibula (n = 75; 66.9%), Maxilla (n = 69; 61.6%) and orbitofrontal (n = 52; 46.4%) regions. Conclusions: Severity and incidence of MFIs were extremely high compared with previously published studies of other wars, especially affecting the civilians in the Syrian Civil War. The high rates of LeFort III fractures exhibit its devastating damages on civilians.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com