Craniofacial Surgery - Current Issue
- Treatment of Deformational Plagiocephaly With PhysiotherapyNon-synostotic plagiocephaly consists in an asymmetry of the skull due to mechanical forces applied in utero or postnatally: main differential diagnosis is with true synostotic asymmetry, which is caused by the premature closure of a suture. The correction of positional forms is mostly conservative, with 3 main strategies: counterpositioning, physiotherapy and helmet therapy. There is no synthesized evidence on which is the most effective.1,2 The
- Spontaneous Idiopathic Cerebrospinal Fluid RhinorrheaCerebrospinal fluid rhinorrhea is described as cerebrospinal fluid flow through the nose due to the abnormal connection of the subarachnoid space and sinonasal cavity. Spontaneous idiopathic rhinorrhea is a rarely seen disease. Besides the patient's clinical presentation detailed radiological evaluation and other invasive procedures must be carried out to confirm the diagnosis. Its treatment is compelling due to high recurrence rates. In the trea
- Perioperative Management and Factors Associated With Transfusion in Cranial Vault ReconstructionBackground: Bleeding is the most common adverse event in patients undergoing cranial vault reconstruction. The authors compare the transfusion rates against a national sample to determine whether the patients experience lower transfusion rates. Methods: The authors queried the Pediatric National Surgical Quality Improvement Program (Peds-NSQIP) for patients who underwent cranial vault reconstruction (CPT 61559) and compared them to patien
- A Consistent, Reliable Landmark to Assist in Placement of Orbital Floor Reconstruction Plates After Blowout FracturesObjective: To define a reliable and consistent landmark, the superior posterior wall of the maxillary sinus, and to describe how this landmark can be used when repairing orbital floor fractures. Methods: Retrospective chart review. Patients >18 years old diagnosed with unilateral orbital floor and/or zygomaticomaxillary complex fractures. Main outcomes: The distance from the inferior orbital rim to the superior posterior wall of the
- Perioperative Outcomes Following Pediatric Cranial Vault Remodeling: Are Improvements Possible?Purpose: The Pediatric Craniofacial Collaborative Group recently reported pooled perioperative data from 31 North American centers performing open cranial vault remodeling procedures. The authors sought to determine if outcomes were different at a single higher-volume center and if identified, ascertain reasons for any differences and propose strategies for improvement. Methods: A retrospective review was performed of all open pediatric c
- Incidence of Preventable Nonfatal Craniofacial Injuries and Implications for Facial TransplantationIntroduction: The number of patients who may benefit from evaluation for face transplantation in the United States (US) remains largely unknown. The goal of our study was to better delineate the pool of patients who might benefit from face transplant evaluation based on the characteristics and mechanisms of injury of previously reported face transplant recipients. Methods: The authors utilized data from the National Electronic Injury Surv
- Management of Frontal Bone FracturesBackground: The purpose of this study was to examine a level 1 trauma center's 12-year experience treating frontal sinus fractures with regards to patient demographics, management strategies, and treatment outcomes. Methods: An institutional review board-approved retrospective review of all facial fractures at a level 1 trauma center was performed for the years 2000 to 2012. Patient demographics, location of fractures, concomitant injurie
- Delayed Dural Arteriovenous Fistula at the Transverse-Sigmoid Sinus Secondary to Petroclival Meningioma Surgery Via Far Lateral ApproachIntracranial dural arteriovenous fistulas (DAVFs) are typified by pathological anastomoses between meningeal arteries and dural venous sinuses or cortical veins. There are many causes contributing to the etiology of DAVFs. Among the variable causes, acquired DAVFs secondary to craniotomy had rarely been reported, especially for delayed DAVFs at the transverse-sigmoid sinus. Till now, there are only 12 published cases of delayed DAVFs at the trans
- Defining the Zygomaticosphenoidal Angle as a Guide to Anatomic Zygomaticomaxillary Complex Fracture ReductionBackground: Alignment of the zygomaticosphenoid suture is fundamental to reduction of zygomaticomaxillary complex fractures. To prevent a rotational deformity, the correct angle of the zygoma relative to the cranial base must be restored. Clinically, this can be a challenge, especially when there is comminution of the zygomaticosphenoid suture. Defining a zygomaticosphenoidal angle would provide a reference for use with stereotactic navigation
- A Novel Use of Buccal Fat Pad Flap for Immediate Reconstruction of Palatal Tumor Resection DefectIntegrity of the palatal mucosa may be disrupted due to various pathological and congenital factors. In maxillofacial defects, the buccal fat pad has been used frequently to repair the palatal region and close oro-nasal communications. In this case report, the use of buccal fat pad for the closure of a surgical palatal defect is presented with a 3-year follow-up. A 75-year-old female patient visited our clinic with a complaint of a non-adaptive m
- Computer-Assisted Design and Manufacturing Assists Less Experienced Surgeons in Achieving Equivalent Outcomes in Cranial Vault ReconstructionPurpose: The purpose of this study was to assess whether long-term outcomes were equivalent between computer-assisted design and manufacturing (CAD/CAM) -assisted cranial vault reconstruction performed by an inexperienced surgeon, with fewer years of surgical experience, and traditional reconstruction performed by senior surgeons with many decades of experience. Methods: An Institutional Review Board-approved retrospective cohort study wa
- Lateral Osteotomy Fixation Technique in RhinoplastyRhinoplasty is the most challenging facial aesthetic surgical procedure according to many plastic surgeons. Nasal bone osteotomies, especially lateral osteotomies, have a complicated history. If lateral osteotomy is not stable after osteotomy during intraoperative period, stabilization is attempted with internal and external nasal splints but it is not possible to be confident about the stabilization since it is not fully fixed and cannot be obse
- Pediatric Maxillofacial Trauma Patterns Among Different Types of Road Traffic AccidentsBackground: Traffic accidents are one of the most leading cause of maxillofacial trauma. Defining the bone fracture patterns in different type of traffic accidents may enable for appropriate surgical approach. Objectives: This study research the pattern of pediatric maxillofacial fractures in terms of different type of traffic road accidents and age groups. Methods: The data on road traffic accidents that caused maxillofacial trauma
- Subperiosteal Dissection in Orbital Blowout Fracture: Technical Tips Including the Use of Modified Periosteal ElevatorOrbital blowout fractures are common. The same goes for its surgical complications when the efficiency of the dissection of entrapped or herniated intraorbital contents into the fracture could not be completely and safely dissected out. The authors describe a modification of the commonly used Howarth periosteal elevator for dissection of intraorbital content displacement or herniation on orbital blowout fracture. The instrument was modified by ma
- Risk Factors for Readmission After Cleft Lip RepairBackground: Cleft lip is the most common craniofacial malformation with an incidence of 1 in 700 live births. Our study sought to evaluate incidences and risk factors readmission following CLP repair using a well-validated national surgical database. Methods: All cleft lip repairs performed between 2012 and 2016 were identified in the American College of Surgeons National Surgical Quality Improvement Program Pediatric Database. Patient de
- Anterior Segmental Osteotomy Using Customized Spider-Plates Based on Computer-aided Surgery SystemAnterior segmental osteotomy (ASO) is considered the treatment modality of choice in patients with the bimaxillary dentoalveolar protrusion. However, this meticulous surgical technique accompanies a number of possible disadvantages. The considerable time required before, during, and after the operation, limited movement of the segment, damage of the mental nerve, loss of tooth vitality, loss of a tooth or teeth, or indeed total loss of the anteri
- Management of Pediatric Condyle FracturesIntroduction: Mandibular condyle fractures are a common type of facial fracture in children. The authors aimed to examine the demographics, etiology, treatment, and outcomes of these fractures managed in a single pediatric trauma unit. Materials and Methods: A retrospective review was performed of patients presenting to a pediatric hospital between 2003 and 2016 with mandibular condyle fractures. Initial data was extracted from a dedicate
- Strategy of Mandibular Central Arch Reconstruction After Firearm InjuryGunshot wounds can cause extensive destruction of soft tissue and bone, and the maxillofacial region is often affected. The reconstructive treatment is complex due to the difficulty to reestablish the central arch mandibular contour and volume. Moreover, the goal is to avoid postoperative infections and obtain bone graft neovascularization. Therefore, this report shows a clinical case of a patient presenting mandibular deformity with a mandibular
- Long-Term Outcomes for Adult Patients With Cleft Lip and PalateThe purpose of this study was to evaluate a single center's experience with adult patients who had cleft lip, cleft palate, or both. The authors aimed to identify common long-term needs in this patient population and evaluated the relationship of team-based care in meeting those needs. To do so, the authors retrospectively reviewed chart records from a single private practice and tertiary referral cleft center for all patients who were ≥15 years
- A Novel Technique Using W-Shaped Steel Wire Suspension System to Improve the Stability of Rigid External Distraction Devise in a Child With Apert SyndromeRigid external distraction device (RED) is an efficient and reliable technique for syndromic craniosynostosis patient's postoperative midface distraction. But the instability of the RED is still a major complication. In this case, the authors reported a novel and simple method to solve the RED movement after Le Fort III osteotomy by using W-shaped steel wire suspension system in a child with Apert syndrome whose bilateral temporal bone is extreme
- Contemporary Characterization of Injury Patterns, Initial Management, and Disparities in Treatment of Facial Fractures Using the National Trauma Data BankBackground: Contemporary description of facial fracture patterns and factors associated with early operative intervention at trauma centers is lacking. The purpose of this study was to characterize injuries and initial treatment patterns of patients suffering from facial fractures. Methods: Using the National Trauma Databank from 2007 to 2015, patients suffering from facial fractures were included. Demographics, injury characteristics, an
- The Characteristics of Lower Eyelid Reverse Ptosis After Reconstruction of Orbital Floor Wall Fracture Using Transconjunctival ApproachThe purpose of this study was to evaluate the changes of lower eyelid position and the incidence of reverse ptosis after reconstruction of orbital floor fracture. The authors retrospectively reviewed the clinical records of patients who received reconstruction of orbital floor wall fractures between 2014 and 2017. Digital photographs were taken preoperatively, and at 1 week, 1 month, and 3 months postoperatively. Main measurements were marginal r
- Postoperative Management of Zygomatic Arch Fractures: In-House Rapid Prototyping System for the Manufacture of Protective Facial ShieldsZygomatic fractures account for 10% to 15% of all facial fractures. The surgical management of isolated zygomatic arch fractures usually requires open reduction treatment without fixation through an intraoral access. Therefore, the main problem in the non-fixed treatment of zygomatic arch fractures is related to the difficulty in obtaining a stable reduction for a period long enough to guarantee the physiological bone healing process. We propose
- Application of a Lateral Pedicled Cranial Bone Flap for the Treatment of Secondary Zygomaticomaxillary DefectsThis study aimed to evaluate the effect of laterally-based pedicled cranial bone flap (LBPCBF) for the repair of secondary zygomaticomaxillary defects. Between December 2014 and December 2016, 6 patients with unilateral zygomaticomaxillary defects were selected; of these, 5 had trauma, and 1 was exposed to titanium mesh in the infraorbital area due to radiotherapy following total maxillectomy for right maxillary squamous cell carcinoma. Preoperat
- Coordination of the Fetal Medicine Institute and the Cleft and Craniofacial Center: Application to Early Management of Infants With Cleft Lip and PalateBackground/Purpose: The primary objective of this study is to describe the authors’ experience at the Children's National Health System with the coordination of the Fetal Medicine Institute and the Cleft and Craniofacial Center. This collaboration highlights the accuracy and completeness of prenatal diagnosis of cleft abnormalities with expedient postnatal management. Methods: With Institutional Review Board approval, the authors retrospe
- Imaging Diagnosis of Von Hippel-Lindau SyndromeIntroduction: Von Hippel-Lindau (VHL) syndrome is a group of rare autosomal dominant hereditary diseases that involve multiple organs. Due to its high recurrence rate and complex and diverse clinical manifestations, VHL is prone to being either misdiagnosed or missed entirely. Therefore, patients with VHL syndrome have a poor prognosis. Clinical features: This study reports the details of 2 patients, a 55-year-old male and a 37-year-old f
- Craniofacial Morphometric Features Associated With Pericondylar Fractures of the MandibleThe research aimed at investigating potential correlations between craniofacial morphological measurements and mandibular pericondylar fractures, based on a retrospective study of 380 mandible fractures treated in our department, during 2010 to 2017. Predictors included morphological measurements and features. Primary outcome was presence of pericondylar fracture; 133 pericondylar fractures were found, including subcondylar, condylar neck, and co
- Orbital Decompression for Treatment of Acute Visual Loss After Facial TraumaInjury to the orbital region represents a significant proportion of emergency department attendances and it is a common injury in patients with multisystem trauma. To date, trauma remains a leading cause of monocular blindness. Traumatic optic neuropathy may be caused by direct trauma to the optic nerve and from compression caused by foreign bodies and bone fragments. Indirect trauma can lead to visual loss from transmitted force to the optic c
- Cranioplasty With Autogenous Frozen and Autoclaved Bone: Management and Treatment OutcomesCranioplasty is a widely employed procedure for restoration of calvarial form and shape. The use of autogenous bone flap offers biological reconstruction with minimal donor site morbidity. One of the options to re-use bone autograft is low temperature preservation followed by autoclaving during cranioplasty. A retrospective evaluation of 12 patients with a mean age of 32.58 ± 10.04 years who underwent frozen autogenous autoclaved bone cranioplast
- Early Pediatric Nasal Reconstruction Utilizing the Tagliacozzi FlapThe Tagliacozzi cross arm flap has been historically described for repair of large nasal defects. The authors report what we believe is the youngest case in modern literature of nasal reconstruction with a Tagliacozzi flap, in a 6-year-old girl. Due to her poor face and scalp skin quality, the more modern reconstructive options of a forehead flap or free tissue transfer were not deemed suitable. Two delay procedures and a complex splint were requ
- Traumatic Telecanthus and Posterior Lacrimal Crest Avulsion in a Six-Year-Old ChildPediatric facial fractures are uncommon, especially orbital fractures, which can be unnoticed in 30% of the cases. Any delay regarding either diagnosis or treatment implies the risk of long-term sequels. Limited data exists concerning craniofacial fractures in children, especially the ones compromising the orbital substructures. Distribution varies upon several series; however, there is inexistence of literature regarding specific and isolated fr
- Morphology, Incidence of Bridging, Dimensions of Sella Turcica, and Cephalometric Standards in Three Different Racial GroupsThis study aims to assess the morphological appearance, incidence of bridging, linear dimensions of sella turcica and establish cephalometric standards in Bosnian, Chinese and Nepalese subjects. This retrospective study examined digital standardized lateral cephalograms of 540 subjects, which consisted of 116 females and 64 males with an age range of 8 to 28 years. The sella morphology, bridging, and size were analyzed on the lateral cephalograms
- Nasal Reconstruction Following a Dog BiteBite wounds in the nose region may lead to serious esthetic problems and functional losses. The authors describe a dog bite to his nose, resulting in a defect involving the entire tip of the nose and a part of the surrounding subunits. He was repaired with forehead flap and auricular conchal cartilage acutely. To the authors’ knowledge, there are very few cases of acute repair in the literature. The authors also made a literature review on this s
- Polymorphisms in FGF3, FGF10, and FGF13 May Contribute to the Presence of Temporomandibular Disorders in Patients Who Required Orthognathic SurgeryBackground: To evaluate whether genetic polymorphisms in FGF3, FGF10, and FGF13 are associated with temporomandibular disorders (TMD) in patients that presented dentofacial deformities requiring orthognathic surgery. Material and Methods: The sample comprised a total of 113 patients of both sexes. The diagnosis of TMD was performed before orthognathic surgery between Research Diagnostic Criteria for Temporomandibular Disorders (RDC-TMD).
- Treatment of Traumatic Depressed Compound Skull FracturesBackground: A skull fracture widely occurs in patients with traumatic brain injury, leading to intracranial hematoma, brain contusion, and intracranial infection. It also influences the prognosis and death of patients. This study aimed to discuss cases of patients with comminuted skull fractures. Methods: From October 2015 to December 2018, 38 patients with comminuted skull fractures were admitted to the hospital. All patients underwent t
- Reconstruction of a Large Posttraumatic Mandibular Defect Using Bone Tissue Engineering With Fresh-Frozen Humeral Allograft Seeded With Autologous Bone Marrow Aspirate and Vascularized With a Radial Forearm FlapIntroduction: Currently, vascularized autologous bone transplantation is considered the gold standard for large mandibular continuity defect reconstruction. Donor site morbidity is a major concern. Therefore, bone tissue engineering (BTE) seems to be the ideal solution. Fresh-frozen bone allograft is the closest material to autologous bone. The purpose of this clinical report is to show a new technique of large mandibular continuity defect rec
- Primary Lash PtosisIntroduction: Lash ptosis is often an overlooked sign that may coexist with congenital and acquired blepharoptosis. This is a report of case series of patients presented in an oculoplastic clinic with visual field loss associated with lash ptosis. On examination, the primary pathology was attributed to lash ptosis dehiscence. Methods: All patients underwent anterior lamellar repositioning and were followed for an average of 15 (10–24) mon
- Orbital Observation Chart: Significant in Orbital Fractures or Not?Purpose: The study was conducted to assess the efficacy of orbital chart in detecting postoperative complications of orbital fractures. Materials and Methods: A retrospective study was conducted in the Department of OMFS, SDM College of Dental Sciences, Dharwad from January 2011 to December 2016. It included all the patients with orbital fractures who underwent surgical intervention for reduction of the fracture in the study. We recorded
- Combined Use of Specially-Designed Digital Surgical Guides and Pre-Formed Reconstruction Plate to Treat Bilateral Mandibular FractureThis paper describes the application of a modified digital surgical guide, an occlusal template and a pre-formed reconstruction titanium plate in the open reduction and internal fixation of a bilateral mandibular fracture. Bilateral mandibular fracture is a commonly encountered simple type of fracture. However, even for an experience surgeon, achieving precise treatment remains a challenge due to the movable temporomandibular joint, unstable frac
- The Postoperative Morphometrics of Orbital and Maxillary Area for CraniosynostosisPurpose: One of the most characteristic features in premature craniosynostosis is fronto-orbital retrusion. The standardized surgical technique of fronto-orbital advancement (FOA) can treat this (some) deformity, such as bilateral coronal synostosis. The purpose of the study is to investigate an available method to assess the postoperative outcome of the craniofacial surgery. Methods: From 2010 to 2015, 6 pediatric patients were taken the
- Bicanalicular Lacerations: Clinical Characteristics and Surgical Outcomes With a New Bicanalicular Silicone StentBackground: Bicanalicular lacerations are relatively rare and more of a surgical challenge in clinical practice. The purpose of this study is to evaluate the clinical characteristics and surgical outcomes of bicanalicular lacerations with a new bicanalicular silicone stent at a tertiary eye care center. Methods: All patients who underwent bicanalicular lacerations repair from January 2013 and December 2018 were retrospectively reviewed. D
- Three-Dimensional Analysis of Cortical Bone Thickness in Individuals With Non-Syndromic Unilateral Cleft Lip and PalatePurpose: The aim of this study was to measure the cortical bone thickness of the infrazygomatic crest area in individuals with unilateral cleft lip and palate using cone beam computed tomography for placement of miniplates used for bone anchored maxillary protraction. Materials and Methods: CBCT scans were obtained from 31 non-syndromic UCLP children diagnosed with maxillary hypoplasia (17 males, 14 females, mean age: 11.9 years). 5 horiz
- Experience of Replantation and Reconstruction in Total Scalp, Partial Forehead, and Ear AvulsionsIn this study, the authors present the challenges of replantation and management of 2 patients who have total scalp, partial forehead and ear avulsion. A 39-year-old male farmer was admitted to the emergency room with the total scalp, forehead, partial right eyebrow and upper eyelid amputation after his hair was catched by an agricultural machine. Anastomoses of 2 arteries and 2 veins in the occipital region were done first. Anastomosis of the ri
- The Role of Ultrasound in the Diagnosis of Pediatric Nasal FracturesBackground: Nasal fractures are the most commonly encountered facial fracture in children presenting to emergency departments. Though plain radiographs have long been used to aid the diagnosis of fractures, its limited diagnostic accuracy has led to the increasing use of ultrasound. Ultrasound offers a cheap, safe, and readily available imaging modality. Evidence in the adult population has shown ultrasound to be far more accurate in identifyi
- Is Bilateral Sagittal Split Osteotomy of the Mandible With no Step Possible? A Modification in the TechniqueThe mandibular ramus sagittal osteotomy is a usual procedure used to correct deformities of the lower third of the face. Modifications of the procedure will be presented to avoid the presence of palpable gap at mandibular body, easily seen in greater movements.
- The Clinical Application of Nerve Injury Unit Mode in Patients with Moderate or Severe Traumatic Brain InjuryObjective: To explore the efficacy of nerve injury unit mode and conventional management mode for the treatment of patients with moderate or severe traumatic brain injury (TBI). Methods: Eighty patients with TBI in our hospital from July 2016 to December 2017 were included as observation groups (Treated with injury unit mode). Eighty-three patients with TBI from January 2015 to June 2016 were included as control group (Treated with conven
- The Anatomy of the Sigmoid-Transverse Junction According to the Tentorial AngleDural sinuses have critical importance during intracranial approaches. Detailed anatomical knowledge of the dural sinuses is crucial for surgeons to reduce unexpected venous bleeding. The aim of this study was to investigate anatomical relation of sigmoid sinus and tentorium cerebelli according to clinically palpable landmarks and cranial morphometry. The authors evaluated 222 individuals’ (94 women, 128 men) 3-dimensional computed tomography ang
- Self-Made Rapid Prototyping Technique for Orbital Floor Reconstruction: Showcases for Technical DescriptionBackground: Restoring the orbital cavity integrity in orbital floor defects is a challenging issue due to the anatomical complexity of the floor's surface. This is a showcase for technical description of a novel “in house” rapid prototyping protocol aimed to customize implant for orbital floor reconstruction. Methods: The authors present 4 cases to show our Computer-aided-design and Computer-aided-manufacturing digital workflow. The syste
- Management of Pediatric Mandibular Fractures Using Resorbable PlatesIntroduction: Despite there being several clinical studies reporting promising outcomes of resorbable plates for fixation of pediatric mandible fractures, the literature is devoid of large studies or comprehensive reviews assessing safety rates, complications and long-term outcomes. The purpose of the current review is to obtain a global consensus, shed light on efficacy and complications, and provide the reader with evidence-based data to hel
- Apart From Surgical Procedures, Another Important Point to Note in Lacrimal Canalicular Lacerations: Traumatic Retinal TearsBackground: To evaluate fundus examinations in terms of traumatic retinal tears or dialysis that may be related to canalicular lacerations (CLs). Materials and Methods: This retrospective study was conducted on patients with CL repair from June 1, 2009 to May 30, 2018. The authors collected the data from the patients’ medical records, including their demographic details, mechanism and setting of injury, associated ocular injuries, type of
- Risk Factors for Anterior Hypopituitarism in Patients With Traumatic Brain InjuryBackground: Hypopituitarism is a common but potentially undiagnosed complication in patients who suffer traumatic brain injury (TBI). The identification of risk factors of hypopituitarism after TBI is vital to establish a rational testing approach for these patients. Methods: The authors retrospectively reviewed the case records of patients with TBI, who underwent pituitary function evaluation in our department between January 2014 and De
- Surgical Treatment for Facial Port Wine Stain by Prefabricated Expanded Cervical Flap Carried by Superficial Temporal ArteryBackground: Port wine stain (PWS) is a congenital benign vascular malformation. Laser treatment is the main therapy for PWS. But some patients are not sensitive to it, and failed laser treatment will leave scars on face. Hence in this study, the authors used prefabricated flap carried by superficial temporal artery to treat PWS. Methods: Nine patients diagnosed with large-scaled PWS (occupying more than half of the cheek) from January 200
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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00302841026182,
00306932607174,
alsfakia@gmail.com,
Anapafseos 5 Agios Nikolaos 72100 Crete Greece,
Medicine by Alexandros G. Sfakianakis
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