Surgical Management of Complex Syndromic Craniosynostosis: Experience With a Rare Genetic Variant Patients with syndromic craniosynostosis (CS) can present with both intracranial and extracranial manifestations. Extracranial features include proptosis, exorbitism, and midface hypoplasia. Intracranial manifestations can include elevated intracranial pressure (ICP), brainstem compression, foramen magnum stenosis or jugular foramen hypoplasia with resultant venous hypertension and anomalous drainage. While fronto-orbital advancement, cranial vault remodeling, and posterior fossa decompression are standard surgical approaches to normalizing orbito-cranial volume and morphology, associated hydrocephalus, anomalous venous drainage, and tonsillar herniation often affect the timing, safety, and selection of corrective interventions. The surgical decision-making to circumvent venous emissaries, effectively time treatment of hydrocephalus, and address posterior versus anterior pathology primarily has not been widely described in the literature, and is important in the development of guidelines in these complex cases. In this report, we describe the surgical management of a patient with Jackson-Weiss syndrome presenting with delayed, but rapidly progressive bilateral lambdoid CS, severe proptosis, midface hypoplasia, elevated ICP, hydrocephalus, tonsillar ectopia, and severe venous hypertension with anomalous drainage. We review the literature related to management of complex synostosis and present our surgical decision-making in the setting of complex syndromic synostosis to aid in the formation of guidelines toward approaching these cases. Address correspondence and reprint requests to Thomas Imahiyerobo, MD, Columbia University Medical Center, 161 Fort Washington Ave, New York, NY 10032; E-mail: ti2156@cumc.columbia.edu Received 11 February, 2019 Accepted 10 August, 2019 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

A Simple Combination Approach for Costal Cartilage Augmentation Rhinoplasty Autologous costal cartilage graft is optimal for augmentation rhinoplasty but with complications including markedly visible graft margins and dorsal contour irregularities. Therefore, the authors introduced the diced costal cartilage graft to smoothen the margins of bilateral spreader graft for nasal dorsum augmentation. A total of 6 patients were recruited for this augmentation rhinoplasty. The pre- and postoperative photographs were taken for improvement evaluation. During a mean follow-up of 15 months, none of the patients developed major complications that may require removal or revision of the costal cartilage grafts. Five patients (80%) were very satisfied with the aesthetic outcome. This simple algorithm facilitates the substantial augmentation and removes the visibility of dorsal graft in the costal cartilage rhinoplasty for the East Asian population. Address correspondence and reprint requests to Xiaoxi Lin, MD, PhD, Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China; E-mail: linxiaoxi@126.com Received 22 May, 2019 Accepted 14 August, 2019 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

Latissimus Dorsi-Myocutaneous Flap in the Repair of Titanium Mesh Exposure and Scalp Defect After Cranioplasty Titanium mesh was widely used for cranium defect repair but associated with high complication rates. In this study, the authors describe a method using latissimus dorsi-myocutaneous flap in the repair of titanium mesh exposure and scalp defect after cranioplasty, and the plate retaining is also achieved. Fifteen patients from April 2012 to May 2016 underwent this procedure, the age ranged from 32 to 62 years and 47 years old on average, and all the patient had plate exposure combined with surgical site infection and variation of scalp defect. All the patients had fully flap survive, and follow up ranged from 6 months to 24 months, 1 patient had titanium mesh re-expose and received additional operation to remove the plate. The free latissimus dorsi musculocutaneous flap could supply large size of bulky tissue coverage with good blood supply and strong anti-infection ability. This method was an option for retaining the titanium mesh and repairing the exposure for the mild infection with small size scalp defect patient. Address correspondence and reprint requests to Xianjie Ma, MD, PhD, Department of Plastic Surgery, Xijing Hospital, Air Force Medical University, Xi’an 710032, China; E-mail: majing@fmmu.edu.cn; Wensen Xia, Department of Plastic Surgery, Xijing Hospital, Air Force Medical University, Xi’an, 710032, China; E-mail: xiawensen@fmmu.edu.cn Received 10 June, 2019 Accepted 14 August, 2019 LD and YD contributed equally to this article. The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

Nonmineralized and Mineralized Silk Fibroin/Gelatin Hybrid Scaffolds: Chacterization and Cytocompatibility In Vitro for Bone-Tissue Engineering In this study, nonmineralized silk fibroin/gelatin (SF/G) hybrid scaffolds and the mineralized SF/G/hydroxyapatite (SF/G/HA) hybrid scaffolds were fabricated using vacuum freeze-drying method and biomineralization technique. The morphology and mechanical properties of the 2 hybrid scaffolds were characterized. Furthermore, the cytotoxic profiles of the hybrid scaffolds were investigated in vitro by seeding the human osteoblast cells (hFOB1.19). The 2 hybrid scaffolds were both highly porous and the pore sizes of the SF/G as well as SF/G/HA hybrid scaffolds were 260 ± 58 μm and 210 ± 35 μm, respectively. Compared with the SF/G hybrid scaffold, the SF/G/HA hybrid scaffolds exhibited significantly enhanced compressive strength and modulus. Significant early cell adhesion and proliferation on the SF/G hybrid scaffolds were observed, while SF/G/HA hybrid scaffolds effectively improved osteogenic differentiation of hFOB1.19 after 10 days of coculture. The results confirmed that the 2 hybrid scaffolds were both cytocompatible and had almost no negative effects on the hFOB1.19 in vitro. However, the SF/G/HA hybrid scaffolds tended to be more promising for application in bone-tissue engineering with good mechanical property and osteogenic differentiation. Address correspondence and reprint requests to Dr Dapeng Xu, MS, Department of Oral and maxillofacial Surgery, Yantai Stomatological Hospital Affiliated to Binzhou Medical College, No. 142 North Great Street, Zhifu District, Yantai, Shandong 264000, China; E-mail: dapengxuoms@outlook.com Received 11 April, 2019 Accepted 17 August, 2019 XM and KG are co-first authors. This research is supported by major projects of Yantai Science and Technology Program (no: 2016WS056). The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

Security Hi-Tech Individual Extra-Light Device Mask 3.0: A Continuous Evolution In 2008, the authors presented their Security Hi-tech Individual Extra-Light Device Mask (SHIELD), a customizable protective shield based on the (soccer) player's face cast. In 2017, the authors presented an update in the realization process, based on computer-aided design/computer-aided manufacturing technology, and called it SHIELD 2.0. Now, the authors present a further update in the realization process. Address correspondence and reprint requests to Valentino Vellone, MD, Via Pietro da Cortona, 8, 00196, Roma (RM), Italy; E-mail valentino.vellone@gmail.com Received 30 April, 2019 Accepted 26 August, 2019 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

Modeling and Clinical Application of Incision Space in Facial Contour Surgery Virtual simulation surgical system is a good way to develop surgical instruments, make surgical plan, and train surgeons. At present, due to the deformation of intraoperative soft tissue after retraction and the lack of effective data collection, the surgical simulation of facial contour surgery can only be conducted according to the preoperative computed tomography data. Due to the difficulty of obtaining real operative spatial data, it is difficult for the virtual surgery trajectory planning process to yield a good effect on surgeon training. In this study, an optical tracking device was used to record the actual posture of surgical instruments, patient position, and incision space in the surgical environment, so as to construct a more accurate actual surgical space. The clinical data obtained in this study can be used for virtual simulation of surgical instrument movement and osteotomy, as well as selection, planning, and teaching purposes of surgical programs. Address correspondence and reprint requests to Le Xie, PhD, Institute of Forming Technology & Equipment, Shanghai Jiao Tong University, 1954 Hua Shan Road, Shanghai, 200030, China; E-mail: lexie@sjtu.edu.cn; Xianxian Yang, MD, PhD, Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Road, Shanghai, 200011, China; E-mail: daisywisdom8@hotmail.com Received 19 June, 2019 Accepted 17 August, 2019 Li Lin and Mengzhe Sun contributed equally to this study. This work was supported by the Natural Science Foundation of China (no. 61672341), the Project of Science and Technology Commission of Shanghai municipality (nos. 17441903800, 18DZ2201900, and 19441912300), the Project of SJTU Medical and Engineering Cross Fund (no. YG2017ZD03), the Shanghai Municipal Education Commission – Gaofeng Clinical Medicine Grant Support (no. 20161420), and the Shanghai Jiao Tong University and Chinese University of Hong Kong Joint Research Fund Programme. The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

Delayed Infection Occurring Seventeen Years After Cranioplasty: Are Previously Implanted Materials Permanently Safe? Crainoplasty following decompressive craniotomy is widely applied clinically. Here, a 55-year-old male had clinical presentation of fever, headache, and ulceration at the anterior scalp of left ear, with 4 to 5 mL pus induction per day, where he accepted cranioplastic surgery 17 years ago using the material of medical silicone rubber. The results of experimental test and magnetic resonance imaging indicated a sign of infection. The authors reported a rarely delayed infection 17 years after cranioplastic surgery. The over long-term risks for the previously transplanted materials should be recognized. Address correspondence and reprint requests to Weihong Wang, MM, Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Jixi 218, Hefei 230022, China; E-mail: ayneurosurgeon@tom.com Received 16 May, 2019 Accepted 26 August, 2019 ZL and LY contributed equally to this work. The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

Hidden Preauricular Sinus as a Cause of Persistent Infection After Facelift The facelift is one of the most popular cosmetic surgery methods of antiaging. There are many complications in facelift, but infections rarely occur relatively. The authors would like to introduce a patient who developed infection after a facelift procedure. The cause of the infection was preauricular sinus, one of the congenital anomalies. The patient was treated with complete excision of sinus tract and the patient was treated without any further complications. Based on this clinical report, surgeons performing cosmetic surgery need to be interested in rare congenital lesions such as preauricular sinus. Address correspondence and reprint requests to Hwan Jun Choi, MD, PhD, Department of Plastic and Reconstructive Surgery, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Bongmyeong-dong, Dongnam-gu, Cheonan-si, Chungcheongnam-do 330-721, Korea; E-mail: iprskorea@gmail.com Received 22 July, 2019 Accepted 5 September, 2019 This work was supported by Soonchunhyang University research fund. The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

Social Consequences of Injuries in Pediatric Facial Trauma After Motocyle Accident No abstract available

Applying the Chinese Wood Joinery Mortise-and-Tenon Principle to Repair Widening Surface Scars We applied the classical Chinese wood joinery mortise-and-tenon principle to repair widening surface scars caused by incision tension. Along the outer margin of surface scars, the top half of the scar tissue was cut and removed. The authors designed serial tenon structures on the retained dermal surface of the scar and a series of corresponding mortise structures in the dermal tissue on the opposite side of the incision. Finally, the mortise and tenon structures were integrated and sutured, resulting in tensionless closure. Thirty-two surface scars were repaired with this method. The follow-up time ranged from 6 to 24 months. The incisions healed in the form of fine linear scars. No widening scars were observed in this series. The proposed mortise-and-tenon scar repair technique can effectively reduce incision tension and thus reduce scar formation at the incision site. The authors recommend this technique as an alternative effective method for revising widening surface scars. Address correspondence and reprint requests to Wen Chen, MD, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing 100144, China; E-mail: chenwencw@163.com Received 9 July, 2019 Accepted 12 August, 2019 The authors report no conflicts of interest. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jcraniofacialsurgery.com). © 2019 by Mutaz B. Habal, MD.