Background: This study was designed to examine long-term skull growth following single sutural synostosis corrections and evaluate surgical outcomes. Methods: A retrospective outcome assessment of all children treated with a single-stage, open-remodeling procedure for sagittal, metopic, unilateral coronal, lambdoid performed. Long-term assessed from serial anthropometric measurements taken up 11 years postoperatively (mean, 4 years). Results: Of 296 consecutive patients, complete records...

Little is known about long-term outcomes after Le Fort III halo distraction, such as indications for amount of relapse, and maxillary growth.During a 5-year period, 51 osteotomies were performed; 41 these by distraction the treatment craniofacial dysostosis (Apert syndrome, 25; Crouzon nine; Pfeiffer four; other, three). Patient records reviewed 104 cephalograms analyzed.The average age was 8 years, hospitalization 5.3 days (3.6 second half this series). The 26 mm (range, 14 to 44 mm),...

The first combined evaluation of morbidity and mortality rates in craniofacial surgery was published 30 years ago; many surgeons believe these procedures have since become safer. authors performed a contemporary to help more accurately counsel families about current risks, gain insight into reducing future incidences.This study used two methodologies capture all serious morbidities mortalities associated with major between 1990 2008: comprehensive two-center retrospective review (Dallas...

Background: Numerous publications have examined technique-specific results in treating sagittal synostosis, but there are scant data examining long-term outcomes. This retrospective study was designed to evaluate a large series of surgically repaired children with craniosynostosis and examine cranial growth following correction. Methods: From 1990 2003, 132 synostosis were evaluated 89 treated (single-stage posterior remodeling) patients retrospectively reviewed (43 excluded for multisutural...

With the introduction of smaller plating systems, many surgeons have adopted their use for craniofacial procedures in infants and small children. We encountered some previously undescribed problems associated with plates screws These can be classified into three general areas: 1) Plate displacement. This occurs after placement metal on outside infant calvaria. subsequent growth, these may found along inner cortex skull screw points embedded through dura. 2) isolation. In certain locations...

Treatment of the craniofacial dysostoses (e.g., Crouzon, Apert, Pfeiffer, Saethre-Chotzen syndromes) is critically dependent on successful advancement midface with a Le Fort III procedure. The purpose this retrospective clinical outcome study was to evaluate new technique for distracting procedure and compare its results in growing children those standard osteotomy. records 22 were reviewed; 10 patients (mean age, 6.5 years) underwent procedure, 12 7.5 distraction group included two separate...

Background: Computed tomographic scan evaluation is the current standard of care for diagnosing craniosynostosis. Recent publications, and National Cancer Institute, have raised concerns about ionizing radiation associated with computed scans in children (e.g., developmental delays, tumor induction). The authors sought to ascertain diagnostic accuracy physical examination evaluating single-sutural craniosynostosis assess need surgical correction. Methods: This prospective, multicenter,...

Background: A multidisciplinary meeting was held from March 4 through 6, 2010, in Atlanta, Georgia, to conceptualize, map out, and operationalize the variables most relevant care of patients with craniosynostosis. In this article, authors highlight development craniofacial neurologic surgery parameters care. Methods: Fifty-two conference attendees, representing a broad range expertise craniosynostosis 16 professional societies, participated working group. Literature expert opinion were used...

Background: The authors catalogued phenotypic variability among children with Apert syndrome, reviewed surgical outcomes (particularly respect to their treatment goals of avoiding preventable developmental delays and reducing operative interventions), examined correlations that might stimulate improved paradigms. Methods: A case series review all syndrome patients, treated by a single surgeon, including variations, mutational analyses, assessments, treatments, was performed. Results: Over...

OBJECTIVE This study examines a series of patients with hypophosphatemic rickets and craniosynostosis to characterize the clinical course associated craniofacial anomalies. METHODS A 20-year retrospective review identified secondary at 3 major centers. Parameters examined included sex, age diagnosis head shape anomaly, affected sutures, etiology rickets, presenting symptoms, number type surgical interventions, diagnoses. literature was performed optimize treatment recommendations. RESULTS...

Background: The cephalic index is often used to evaluate sagittal craniosynostosis corrections; however, validation of this measure remains untested. Methods: A three-part study was designed (1) determine the normal distribution indices in untreated craniosynostosis; (2) examine values treated children, subsequently determined require secondary surgery; and (3) explore correlation between a photography-based assessment scaphocephaly severity index. Results: Of 392 preoperatively measured...

The vast majority of infants and children undergoing craniosynostosis correction receive a blood transfusion. risks transfusion include, but are not limited to, acute hemolytic reactions (≈1 250,000), human immunodeficiency virus 200,000), hepatitis B C 30,000 each), transfusion-related lung injuries 5000). This prospective, single-blinded, randomized study was undertaken to examine the safety efficacy preoperative single weekly dosing with erythropoietin (epoetin alfa) in reducing rate...

Certain procedures for facial advancement may carry greater risk than others. While many believe that separating the cranial base by monobloc leads to a higher complication rate, no comparative series between Le Fort III and advancements has ever been reported. We reviewed our of these different techniques. Over 15-year period, 29 patients underwent 30 surgical procedures, with either midfacial or frontofacial advancement. The average age at time surgery was 12 years, range from 3 26 years....

Sixty-three nonconsecutive patients have undergone resection of the retro-orbicularis oculus fat (ROOF) in conjunction with aesthetic blepharoplasty. In these patients, a consistent and useful ability to soften flatten heaviness bulkiness lateral upper orbital region was seen. Two developed postoperative hematoma, two different had transient dry-eye symptoms following Twenty percent degree numbness supraorbital nerve region, all noted some over brow region. No patient demonstrated...

Background: Pfeiffer syndrome is rarely encountered, even at major craniofacial centers. Published reports indicate high mortality rates (25 to 85 percent) for severely affected subtypes. The authors reviewed their surgically treated patients improve outcomes. Methods: conducted a 17-year, single-center, retrospective outcome assessment of all children syndrome, with data summarized using descriptive statistics. Results: Of 802 craniosynostosis, 28 were identified syndrome: 17 classified as...

Almost all patients who undergo major craniosynostosis corrections receive allogenic blood transfusions. This study of intraoperative salvage was undertaken in an attempt to further reduce the need for transfusions and enhance safety these complex procedures. prospective nonrandomized series included 60 consecutive children undergoing cranial vault remodeling, primarily treatment (single-suture syndromic). A single craniofacial surgeon performed operations, using a cell-saver equipped with...

Craniosynostosis affecting the lambdoid suture is uncommon. The definition of craniosynostosis solely applies to those cases demonstrating true obliteration, similar other forms craniosynostosis. In patients presenting with posterior plagiocephaly, must be differentiated from much more common positional molding. It can occur in a unilateral form, bilateral or as part complex children craniofacial syndromes, synostosis most often seen within context pansynostotic picture. Chiari malformations...

This retrospective review of infectious complications was undertaken at two craniofacial centers (Dallas and Philadelphia). Fourteen infections were identified over a 6.5-year period in 567 intracranial procedures primarily for craniosynostosis. There no infants under 13 months age cases meningitis. The overall infection rate 2.5 percent, 85 percent occurred secondary reoperative cases. Tracheostomies not as risk factor infection. No difference found rates between patients with shaved...

Munro, Ian R. M.A., M.B., B.Chir., F.R.C.S.(C), and; Fearon, Jeffrey A. M.D. Author Information

LEARNING OBJECTIVES:: After studying this article, the participant should be able to: 1. Review biomechanical principles and pertinent cellular molecular biology of distraction osteogenesis craniofacial skeleton. 2. Describe clinical indications applications 3. maxillary, mandibular, midface, calvarial procedures in osteogenesis. 4. Discuss outcomes complications skeleton.The year 2002 marked end first decade In short period, its application has increased exponentially. More than 3000 cases...

Background: Complex craniosynostoses (i.e., multisutural, nonsyndromic) are rare and present unique treatment challenges. The authors sought to assess long-term outcomes, including postsurgical growth development, develop evidence-based algorithms. Methods: A retrospective review of all patients identified as having multiple sutural synostosis excluding bicoronal FGFR- TWIST-associated synostoses was conducted. Data were summarized using descriptive statistics. Results: Over an 18-year...

The optimal management of Chiari malformations in the setting craniosynostosis is not well established. In this report authors describe their outcomes with combined technique simultaneous suboccipital decompression (SOD) during posterior cranial vault remodeling (PCVR).A retrospective review was performed all patients undergoing PCVR and SOD. Demographic data, diagnosis, imaging studies, operative intervention, clinical follow-up were evaluated.Thirty-four identified as having undergone a...

Midfacial advancements improve function and normalize appearance in growing children with syndromic craniosynostosis yet carry substantial risks while often offering only transient benefits. The authors sought to evaluate outcomes the number of required, at skeletal maturity.The performed a retrospective review all undergoing rigid external distraction Le Fort III advancement who had reached maturity, including examinations, photographic scoring, cephalometric, anthropometric polysomnography...