MaxilloFacial

• Guidelines of Care: Quality Indicators for Advancement, Improvement, and Patient Safety in Craniofacial Surgery

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Habal, Mutaz B.

  No abstract available

• The Special Field of Neuroplastic Surgery

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Gordon, Chad R.

  No abstract available

• The Future of Clinical Craniofacial Research: A Collaborative International Craniofacial Registry

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Rogers, Gary F.

  No abstract available

• The Neuroplastic Surgery Fellowship Experience: Where Tradition Meets Innovation

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Mitchell, Kerry-Ann S.; Shay, Tamir; Huang, Judy; Brem, Henry; Manson, Paul; Gordon, Chad R.

  No abstract available

• The Global Craniofacial Surgery Deficit

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Makhoul, Alan T.; Pontell, Matthew E.; Drolet, Brian C.; Perdikis, Galen; Nthumba, Peter M.

  No abstract available

• Scientific Integrity and Mr He's Jade

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Hwang, Kun

  No abstract available

• Craniofacial Dysmorphology in Unilateral Coronal Synostosis Using Three-Dimensional Landmark-Based Analysis With Generalized Procrustes Superimposition

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Rutland, John W.; Delman, Bradley N.; Bellaire, Christopher; Napoli, James G.; Shuman, William; Rutland, Emily A.; Ranti, Daniel; Margulies, Ilana G.; Goel, Pedram; Sayegh, Farah; Urata, Mark M.; Taub, Peter J.

  Background: Geometric morphometric analysis with Procrustes superimposition is an advanced computational tool that can be used to quantify dynamic changes in complex three-dimensional structures. The present study couples high resolution CT imaging with a Geometric Morphometric approach in order to further understand the complex dysmorphology that occurs in unilateral coronal synostosis (UCS). Methods: Forty-one UCS patients and 41 age- and sex-matched controls received high-resolution CT imaging. Thirty-one anatomical landmarks were identified on each imaging set. A geometric morphometric workflow was used to perform a Procrustes superimposition to register landmarks into a common space. Procrustes-aligned landmarks were used to derive angle calculations, lengths, and other anatomical measurements. Three-dimensional coordinates were also used to perform a principal components analysis (PCA). Results: Unilateral coronal synostosis patients exhibited significant angular deviation at the levels of the inferior skull base, mid-posterior fossa, and vertex. Both left- and right-sided UCS patients showed increased lengthening in the transverse (left-right) dimension, exhibiting increased length between the left and right EAC (P = 0.047). Conversely, UCS patients revealed shortening in the midline AP dimension as evidenced by the decreased Nasal root-Lambda (P < 0.0001) and Nasal root-superior dorsum sellae (P = 0.01) distances compared with controls. PCA revealed that 25.26% of variation in shape among the patients sampled to be driven by flattening of the skull and that18.93% of variation was driven by right-sided deformity and mediolateral expansion. Conclusions: Significant dysmorphology between UCS patients and controls was quantified using Geometric Morphometric approach, which may be useful in further characterizing the dynamic craniofacial changes in UCS.

• Ultrasound-Activated Bioresorbable Osteosynthesis in the Treatment of Craniosynostosis

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Chen, Youbai; Niu, Zehao; Zhang, Haizhong; Zhang, Qixu; August, Meredith; Han, Yan

  The purpose of this study is to estimate the incidence of fixation-related complications following ultrasound-activated biodegradable osteosynthesis (UBO) in the treatment of craniosynostosis. The authors searched MEDLINE, PubMed, Embase, Google Scholar, and Cochrane Library from January 2005 to January 2020 for clinical studies reporting the use of UBO for fixation in the treatment of craniosynostosis. The primary outcome was the incidence of fixation-related complications, including unstable fixation; swelling, plate visibility, or palpability; infection; inflammation, sinus formation, and discharge; implant exposure; reoperation or implant removal. The pooled incidence rates were estimated using random-effects models. Of 155 studies identified, 10 were included, representing 371 patients. Forty-six (12.4%) patients presented fixation-related complications. The incidence rates of swelling/visibility/palpability, infection, and reoperation/implant removal were pooled based on the available data. The pooled incidence rate of chronic swelling/visibility/palpability was 0.21 (95% confidence interval [CI], 0.05–0.43). Sensitivity analysis by omitting the outlier study demonstrates that the incidence of swelling/visibility/palpability was 0.07 (95% CI, 0.04–0.11). The pooled incidence rate of infection and reoperation/implant removal was 0.07 (95% CI, 0.01–0.16) and 0.04 (95% CI, 0.01–0.09), respectively. Results show that although UBO can provide stable fixation, chronic swelling/visibility/palpability, infection, and reoperation for removal are not uncommon. Based on the literature, the authors recommend judicious use of UBO in patients with large frontorbital advancement and in the area of the coronal suture or other sites with thin overlying skin/subcutaneous tissue. The high possibility of chronic swelling/palpability/visibility during degradation, needs to be discussed preoperatively.

• A Novel Sand Dollar and Staves Technique for Unilateral Lambdoid Craniosynostosis

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Abu-Ghname, Amjed; Masoumy, Mohamad; Basagaoglu, Berkay; Dempsey, Robert F.; Dauser, Robert C.; Maricevich, Renata S.

  Background: Unilateral lambdoid synostosis (ULS) is the rarest form of craniosynostosis. Due to the associated cranio-caudal shift seen in ULS, surgical correction is technically challenging from a morphological standpoint. Herein, the authors present a novel "Sand-Dollar and Staves" technique for the repair of ULS. Methods: A zigzag coronal incision is performed, and an anteriorly-based pericranial flaps are elevated. Prefabricated cutting guides are placed and the calvarium is marked. To treat the flattening on the ipsilateral side, a wedged suturectomy is performed with additional barrel staves. A large circle centered over the bulging on the contralateral side is cut out above the open lambdoid suture. This piece is barrel staved in a radial fashion, leaving the center intact and creating a Sand-Dollar appearance. This disk is then flattened and trimmed. The modified Sand-Dollar is fixed using an absorbable plating system. While gentle pressure is applied to the Sand-Dollar piece as it is being secured, the ipsilateral side demonstrates compensatory filling. Results are evaluated using the Whitaker Classification. Results: Four patients underwent surgical correction with this technique. The procedure was performed at mean age of 11.7 months. The mean operative time was 2.5 hours. Intraoperative blood loss was 50 to 100 ml. Total hospitalization time was 2 to 3 days. No post-operative complications were encountered. Whitaker scores ranged from 1 to 1.5. The mean follow-up was 10 months. Conclusion: The Sand-Dollar and Staves procedure is a novel, single-stage approach for the management of ULS with decreased operative time, blood loss, and hospital stay with satisfactory aesthetic outcomes.

• Serial Posterior Cranial Vault Distraction for the Treatment of Complex Craniosynostosis

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Veith, Jacob; Johns, Dana; Mehta, Sagar T.; Hosein, Ray; Tuncer, Fatma Betul; Tyrell, Richard; Kestle, John R.W.; Siddiqi, Faizi; Gociman, Barbu

  Posterior cranial vault distraction is an important modality in the management of craniosynostosis. This surgical technique increases intracranial volume and improves cranial aesthetics. A single procedure is often inadequate in patients with complex multisuture craniosynostosis, as some will go on to develop intracranial hypertension despite the operation. Considering the negative effects of intracranial hypertension, some patients may warrant 2 planned distractions to prevent this scenario from ever occurring. Three patients with complex multiple-suture synostosis and severe intracranial volume restriction (occipital frontal head circumferences [OFCs] <1st percentile) were treated with 2 planned serial posterior cranial vault distractions at the institution between 2013 and 2018. Demographics, intraoperative data, and postoperative distraction data were collected. The OFC was recorded pre- and postdistraction, at 3- and 6-month follow-up appointments. Patients had a corrected average age of 18 weeks at the time of their initial procedure. There was an average of 38 weeks between the end of consolidation and the time for their 2nd distraction procedure. There was an average age of 79 weeks at the time of the 2nd procedure. All patients had a substantial increase in OFC and improvement of the posterior calvarium shape. The average increase in OFC was 5.2 cm after first distraction and 4.3 cm after 2nd distraction. No postoperative complications were encountered. Planned serial posterior cranial vault distraction is a safe and effective strategy for increasing intracranial volume, improving aesthetic appearance, and preventing the consequences of intracranial hypertension in patients with multisuture craniosynostosis and severe intracranial volume restriction.

• The Sensitivity and Specificity of Parental Report of Concern for Identifying Language Disorder in Children With Craniosynostosis

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Kilcoyne, Sarah; Rajan, Sindhu Menon; Dalton, Louise; Judge, Andy; Overton, Sarah; Wall, Steven; Johnson, David

  Many factors that may co-occur with craniosynostosis, such as oral structural anomalies, hearing impairment, visual impairment, cognitive difficulties and psychosocial factors, may predispose this population to communication difficulties. At the Oxford Craniofacial Unit, children's speech, language and communication are regularly monitored in accordance with a systematic developmental screening protocol developed by the Speech and Language Therapists in the 4 United Kingdom (UK) Highly Specialized Craniofacial Centers. In addition to routine assessments, when parents attend routine multidisciplinary clinic appointments, they are asked about their child's communication development, and whether they have any concerns. A retrospective review was undertaken of parental concerns about hearing, speech development, behavior, physical development, concentration, school and friendships as indicated by parents on the Oxford Craniofacial Unit Pre-Clinic Questionnaire. The areas of concern were then correlated with the results of a standardized, guided parent questionnaire about children's language development, (Children's Communication Checklist - 2 (CCC-2)), to determine whether parental concern alone is a reliable way of identifying whether patients require further assessment for Language Disorder associated with Craniosynostosis. Participants were parents of 89 monolingual English-speaking children with craniosynostosis (62 male; 27 female), age range four to 13 years (mean age = 8 years 7 months), receiving active care at the Oxford Craniofacial Unit (June 2017-July 2018). Results of the pre-clinic questionnaire indicated that 6% of parents had concerns about their child's communication development. Results of the CCC-2 indicated that 29/89 (32.6%) of children required further assessment for Language Disorder associated with Craniosynostosis. When language difficulties were identified on the CCC-2, only 14% (n = 4/29) parents indicated concern on the pre clinic questionnaire. Results indicated that parental concern about behavior was the most important factor in identifying language disorder (P = 0.023). Results reinforce that the pre-clinic questionnaire is useful for identifying areas of parental concern. Results also indicate that parental concern alone is not sufficient to identify language disorder, and that further, detailed assessment is warranted. The results are consistent with previously reported links between behavior and language in the general population.

• Forehead Widening in Nonsyndromic Scaphocephaly Operated After 12 Months of Age

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Paternoster, Giovanna; Jing, X.L.; Haber, Samer E.; James, Syril; Legros, Christophe; Liu, X.X.; Khonsari, Hossein Roman; Zerah, Michel; Meyer, Philippe; Arnaud, Eric

  Aim and Scope: Our standard management is to operate isolated sagittal synostosis around 4 months of age because of morphological and cognitive outcomes. However, some patients present late and the likelihood of spontaneous remodeling is low in isolated sagittal craniosynostosis operated on after 12 months of age with a limited technique. The preliminary result of a modified technique for forehead remodeling and subtotal calvarial remodeling in nonsyndromic scaphocephalic children with late presentation is presented. Patients and Methods: All patients older than 1 with isolated sagittal synostosis assessed between 2011 and 2015, over 1 year of age at the time of surgery, with available pre and postoperative computed tomography-scans, were retrospectively included into the study. The following parameters were collected: (1) age at surgery, (2) duration of the procedure, (3) surgical technique, (4) fronto-nasal angle before and after surgery and (5) forehead width before and after surgery. Results: Ten patients aged between 15 months and 6 years were retrospectively included. Delayed surgery was due to late presentation or initial parental reluctance. All patients presented with a transversal narrowing of the forehead and an anterior bulge. Mean age at surgery was 28 months and mean follow up was 23 months (1–4 years). Measurements showed significant improvement of both the fronto-nasal angle and the width of the forehead. Conclusions: Late-presenting scaphocephalic patients operated on after 12 months of age require forehead remodeling to achieve satisfactory aesthetic results. Modified forehead remodeling by splitting the forehead sagittally into 2 symmetrical halves and adding a midline bone strip is a safe and feasible way to widen the forehead. Long term follow-up is needed to assess this modified technique.

• Achieving the Optimal Aesthetic Benefit While Correcting Midface Deficiency: Utilizing A High Winged Le Fort I in Cleft and Craniofacial Patients

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Strong, Amy L.; Ulma, Raquel M.; Duncan, Anthony; Vercler, Christian J.; Buchman, Steven R.

  Craniofacial anomalies are congenital disorders that affect the cranium and facial bones, with cleft lip and palate being the most common. These anomalies are often associated with abnormal development of pharyngeal arches and can result in the development of class III malocclusion and severe maxillary retrusion. Current treatment includes orthodontic decompensation and Le Fort I osteotomy to correct the maxillomandibular relationship. However, the traditional Le Fort I (LFI) advancement does not fully address the lack of skeletal volume in the midface. The high winged Le Fort I osteotomy (HWLFI) is an excellent surgical option for simultaneous correction of the midface deficiency and malocclusion while restoring optimal esthetic convexity. A retrospective chart review was conducted to include all cleft and craniofacial patients who underwent HWLFI advancement from 2002 to 2018. Patients had a minimum of 12 months of follow-up. Patient data and complications were reviewed. Standardized facial photographs were analyzed for esthetic improvement, occlusion, and beneficial salutary effects on the midface. Forty-three patients met the inclusion criteria. The mean age at surgery was 18.9 years. The mean follow-up was 32 months. Early complications included infection (9.3%) and temporary nerve paresthesia (2.3%). Late complications included infection (6.5%), wound dehiscence (4.3%), and painful hardware (2.3%). One patient (2.3 percent) had clinically significant relapse that required surgery. Postoperatively, patients demonstrated excellent midface projection and correction of the skeletal malocclusion. The HWLFI advancement significantly improves both the malocclusion and esthetic concerns of cleft and craniofacial patients by reestablishing maximal midfacial support. Important advantages of the HWLFI are avoidance of alloplastic implant use and extensive and potentially unstable surgical procedures that increase orbital volume.

• Craniofacial Collaboration UK: Developmental Outcomes in 5-Year-Old Children With Sagittal Synostosis

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Care, Helen; Kennedy-Williams, Patrick; Culshaw, Laura; Cunliffe, Alexandra; Denly, Susie; Horton, Jo; Kearney, Anna; O'Leary, Gemma; Piggott, Katie; Pinckston, Molly; Rooney, Natasha; Wall, Steven; Johnson, David; Dalton, Louise

  The Craniofacial Collaboration UK (CC-UK) is a joint initiative that seeks to address some of the limitations of previous developmental research with this patient group by providing systematically collected, robust data from clinically and chronologically homogenous representative samples of children. The current paper outlines the developmental outcomes at the age of 5 for children who had previously undergone primary surgery for single-suture sagittal synostosis (SS). It shows broad consistencies with the previous CC-UK work, indicating that the majority of children with SS will perform within the average range compared to peers across a number of developmental, behavioral and emotional domains. However, the group mean for children with SS indicates significantly greater difficulties with fine motor skills and hyperactivity, relative to normative data. Unexpectedly, children with SS had significantly better problem solving skills. While it is reassuring that the majority of children are broadly developing in line with their unaffected peers, these small but significant differences may be early indicators of some of the subtle difficulties documented in older children with craniosynostosis. Longitudinal follow up is therefore important to understand the developmental trajectory for children with SS and identification of potentially 'at risk' sub groups within this diagnostic cohort.

• Long-Term Morphologic Changes on Sagittal Synostosis Patients Who Underwent a Modified Pi Technique

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Monte, Thais Miguel; Denadai, Rafael; Raposo-Amaral, Cesar Augusto; Ghizoni, Enrico; Raposo-Amaral, Cassio Eduardo

  Background: There are paucity of studies focused on the long-term assessment of the craniofacial changes after a pi-plasty procedure and self-reported quality of life outcomes. Thus, this study aimed to assess long-term morphologic changes and quality of life of patients with sagittal synostosis who underwent surgery with a modified pi-plasty. Methods: Consecutive patients with sagittal synostosis who underwent surgery and had more than 5 years of follow-up and standard preoperative and 1, 3, and 5 years right profile view photographs were included. Nasofrontal angle and angle of total facial convexity were evaluated using computerized photogrammetric measurements. Additionally, quality of life outcome was evaluated by the Quality of Life Scale Short Form. Results: The total facial convexity angle and nasofrontal angle increased significantly (P < 0.05), with a P-value of 0.013 and 0.012, respectively. Patients had quality of life scores >80 in all of the 4 domains, with the highest scores being: physical health domain 80.0 ± 0, psychologic domain 85.0 ± 5, social relationships domain 86.6 ± 0, and environmental domain 98.13 ± 2.42. Conclusion: Facial angles significantly changed over 5 years of follow-up. Self-reported quality of life instrument showed that patients are satisfied with their own appearance, contributing positively to their quality of life.

• Long-Term Neurocognitive Outcomes in Sagittal Synostosis: The Impact of Reoperation

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Chuang, Carolyn; Chaunzwa, Tafadzwa L.; Wu, Robin; Singh, Anusha; Patel, Anup; Yang, Jenny F.; Hashim, Peter W.; Travieso, Roberto; Terner, Jordan S.; Mayes, Linda C.; Duncan, Charles C.; Jane, John A. Jr.; Lin, Kant Y.; Bridgett, David J.; Persing, John A.

  Introduction: Optimal age at surgery in nonsyndromic sagittal craniosynostosis continues to be debated. Previous reports suggest that earlier age at whole vault cranioplasty more frequently requires reoperation. It is unknown, however, whether reoperation affects neurocognitive outcome. This study examined the impact of reoperation on neurocognitive outcome in children with nonsyndromic sagittal craniosynostosis using comprehensive neurocognitive testing. Methods: Forty-seven school-age children (age 5–16 years) with nonsyndromic sagittal craniosynostosis who underwent whole-vault cranioplasty were included in this analysis. Participants were administered a battery of standardized neuropsychological testing to measure neurocognitive outcomes. Results: Thirteen of the 47 participants underwent reoperation (27.7%); 11 out of the 13 reoperations were minor revisions while 2 reoperations were cranioplasties. Reoperation rate was not statistically different between patients who had earlier surgery (at age ≤6 months) versus later surgery (at age >6 months) (P > 0.05). Nonreoperated patients who had only one later-in-life surgery did not perform statistically better than reoperated patients on any outcome measure of neurocognitive function, including IQ, academic achievement, visuomotor integration, executive function, and behavior. Comparing reoperated earlier surgery patients with nonreoperated later surgery patients, reoperated earlier surgery patients had higher full-scale and verbal IQ (P < 0.05), scored higher on word reading, reading comprehension, spelling, numerical operations, and visuomotor integration (P < 0.05), and had fewer indicators of suspected learning disabilities (P < 0.01) compared to nonreoperated later surgery patients. Conclusion: Reoperation rate after whole vault cranioplasty was 27.7%, with few cases of repeat cranioplasty (4.2% of all patients). Reoperation was not associated with worse neurocognitive outcome. Reoperated earlier surgery patients in fact performed better in IQ, academic achievement and visuomotor integration when compared to nonreoperated later surgery patients.

• Posterior Cranial Vault Distraction (PCVD): Common Complication Rates and Strategies of Prevention and Management

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Hassan, Abbas M.; Chappell, Ava G.; Murthy, Nikhil; Stoehr, Jenna R.; Alden, Tord; Gosain, Arun K.

  Background: Posterior cranial vault distraction (PCVD) is a well-established procedure to treat infants with craniosynostosis. Craniofacial surgeons have seen an evolution in the complications following PCVD. This report aims to demonstrate the rates of common complications from PCVD, and to identify strategies for prevention and management of these complications. Methods: A formal literature review of studies on postoperative complications from PCVD was conducted to identify the breadth of reported complications from PCVD and rates of occurrence. Results: A total of 776 articles were captured by our search strategy. Nineteen original articles met inclusion criteria, with a total of 342 patients. The average rate of reported complications was 25%, range (0%–100%). The most commonly reported complication was postoperative infection (23.7%), followed by cerebrospinal fluid leak (20.3%) and device failure (15.3%). Postoperative infection, device exposure, iatrogenic vascular injury, cerebrospinal fluid leak, and other complications have the potential to disrupt distraction and increase morbidity and mortality. Conclusions: By continuing to identify and evaluate complications, prevention strategies can be determined and standardized to decrease complications from PCVD. These efforts uphold the ultimate goal for surgeons involved in the treatment of craniosynostosis: to provide safe, effective surgical care.

• Sphenoid Bone Structure and Its Influence on the Cranium in Syndromic Versus Nonsyndromic Craniosynostosis

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Lu, Xiaona; Forte, Antonio Jorge; Park, Kitae Eric; Allam, Omar; Mozaffari, Mohammad Ali; Alperovich, Michael; Steinbacher, Derek M.; Alonso, Nivaldo; Persing, John A.

  Background: Little is known about the detailed growth of the sphenoidal and temporal bones, even though they contribute significantly to the cranial base and cranial fossa skeletons. They also serve to connect the cranial vault with facial structure. This study details their morphologic development in isolated bicoronal synostosis and associated syndromes. Methods: Eighty-one CT scans were included (nonsyndromic bicoronal synostosis, n = 28; Apert syndrome associated with bicoronal synostosis, n = 19; Crouzon syndrome associated with bicoronal synostosis, n = 8; and controls, n = 26), and measured using Materialize software. Results: Sphenoidal and temporal bone volumes in nonsyndromic bicoronal synostosis are reduced 23% (P = 0.005) and 24%(P = 0.003) at 6 months of age, compared to controls. Apert and Crouzon syndrome patients developed similar reduced volumes. The greater wing of the sphenoid and pterygoid processes in nonsyndromic bicoronal synostosis are initially inferiorly rotated at 2 months of age, by 9.60° (P = 0.002) and 4.33° (P = 0.023), respectively. In Apert syndrome, these rotations were reduced by 4.82° (P = 0.003) and 12.60° (P < 0.001), (like Crouzon syndrome). However, in Apert syndrome, the length of pterygoid processes is shortened by 11% (P = 0.018) compared to nonsyndromic bicoronal synostosis. Crouzon syndrome skulls did not develop a statistically significant shortening relative to nonsyndromic bicoronal synostosis. Mediolateral expansion of the sphenoid in nonsyndromic bicoronal synostosis was less than normal (P = 0.023), and it was further reduced in syndromic skulls. Conclusion: Isolated bicoronal synostosis tends to reduce the volume of sphenoidal and temporal bones, and inferior and posterior rotation of the entire sphenoid. Syndromic conditions restrict sphenoidal rotation, and limit the expansion of sphenoidal greater wing and pterygoid plate.

• Neurologic Characterization of Craniosynostosis: Can Direct Brain Recordings Predict Language Development?

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Wu, Robin; Nie, James; Abraham, Paul; Halligan, Taylor; Gabrick, Kyle; Peck, Connor J.; Sawh-Martinez, Rajendra; Steinbacher, Derek M.; Alperovich, Michael; McPartland, James; Persing, John A.

  Purpose: Nonsyndromic craniosynostosis (NSC) is associated with language deficits. Conventional tests, such as the Bayley Scales of Infant Development (BSID), may not reflect accurate long-term cognition. Alternatively, mismatch negativity (MMN) waves recorded via electroencephalogram (EEG) measure neural responses to speech and may objectively predict language development. This study aimed to (1) correlate infant MMN to future language achievement and (2) compare MMN among subtypes of NSC. Methods: Pre and postoperatively (mean operative age 9.5 months), NSC participants received the BSID and EEG phoneme-discrimination paradigm(80 dB,250 Hz). The MMN was the largest negative amplitude in the difference wave 80 to 300 ms after stimuli. To measure cognitive outcome, patients completed a neurodevelopmental battery (Wechsler-Abbreviated Scale of Intelligence and Wechsler-Fundamentals) at >6 years of age. Results: Eleven NSC patients with EEG testing in infancy were neurocognitively tested (average age 8.0 years; 27% female; 55% sagittal, 27% metopic, 9% unicoronal, 9% sagittal/metopic). The left frontal cluster MMN strongly correlated with word-reading (r = 0.713, P = 0.031), reading-comprehension (r = 0.745, P = 0.021), and language-composites (r = 0.0771, P = 0.015). Conversely, BSID scores did not yield significant predictive value (r < 0.5, P > 0.05). Follow-up event related potentials (ERP) comparison included 39 normal control, 18 sagittal, 17 metopic, 6 unilateral-coronal infants. Preoperatively, sagittal (P = 0.003) and metopic (P = 0.003) patients had attenuated left frontal MMN compared to controls. Postoperatively, the sagittal cohort was normalized to controls while metopic patients retained attenuations (P = 0.041). Conclusion: ERP assessment in NSC had significantly better predictive value for future neurocognition than the BSID. Preoperatively, sagittal and metopic patients had attenuated neural response to language; postoperatively, sagittal patients had improved responses in comparison to metopic patients. Use of ERP assessment may help tailor treatment for language deficits earlier in development.

• Open Reduction, Internal Fixation, or Maxillo-Mandibular Fixation for Isolated, Unilateral, Tooth-Bearing, Mandibular Body Fractures in Children

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Lopez, Joseph; Reategui, Alvaro; Yesantharao, Pooja S.; Yang, Robin; Redett, Richard J.; Manson, Paul N.; Dorafshar, Amir

  Background: Mandibular body fractures can cause severe and long-term morbidity in the pediatric population. Nonetheless, there is insufficient data on the treatment and management of this specific fracture type in children. This study aimed to investigate the etiology, treatment, and outcomes of pediatric mandibular body fractures by analyzing our institution's experience managing these uncommon injuries Methods: This was a 30-year retrospective, longitudinal cohort study of pediatric patients presenting to a single institution with isolated, unilateral, mandibular body fractures. Patient data was extracted from electronic medical records, while subgroup analysis was completed by dentition stage. Results: A total of 14 patients met inclusion criteria, of whom 8 (57.1%) had deciduous, 3 (21.4%) had mixed, and 3 (21.4%) had permanent dentition. Deciduous dentition patients with displaced, mobile or comminuted fractures underwent open reduction and internal fixation (ORIF), while those with nondisplaced and/or nonmobile fractures received soft diet or closed treatment with maxillomandibular fixation. For the mixed dentition cohort, all patients (100%) received closed treatment with maxillomandibular fixation. Among permanent dentition patients, most patients (66.6%) underwent ORIF regardless of fracture severity. The post-ORIF complication rate was 20% (dental maleruption). Conclusions: Isolated, unilateral mandible body fractures are relatively uncommon in the pediatric population, and management differs by dentition stage and injury pattern. While isolated body fractures had considerable associated morbidity, this fracture pattern did not result in major growth restrictions or malformations.

• Effect of Operative Timing and Bone Grafting on Postoperative Cephalometric Indices in Nonsyndromic Sagittal Synostosis

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Varman, Rahul M.; Van Spronsen, Nicole; Nagy, Laszlo; Demke, Joshua

  Surgical repair of sagittal suture craniosynostosis is highly variable, and optimal timing/use of bone grafts remains a subset of parameters that continue to be studied. We sought to compare cephalometric outcomes of early surgical intervention without bone grafting compared to later intervention with bone grafting. Patients undergoing primary surgical repair of nonsyndromic sagittal suture craniosynostosis between 2015 and 2019 were followed with preoperative measurements of cephalic index along with postoperative measurements at 6 months to 1 year, respectively. Nineteen patients undergoing cranial vault reconstruction were studied in 2 groups, namely those younger than 6 months who did not have bone grafting performed during primary repair (31.6%) and patients 6 months and older who underwent cranial vault reconstruction with bone grafting during primary repair (68.4%). Mean 6-month to 1-year postoperative cranial index was significantly increased in both groups (P < 0.001). The average cephalic index change for both groups (younger than 6 months without bone grafting, CI value change 9; 6 months and older with bone grafting; CI value change 6) was not significantly different with regards to 95% confidence interval (P = 0.30). Patients older than 6 months of age undergoing cranial vault reconstruction with bone grafting have similar cephalometric outcomes as their younger counterparts undergoing cranial vault remodeling without bone grafting. Bone grafting in the appropriate cohort may improve functional and esthetic outcomes without compromising primary surgical goals of improving cranial vault cephalometric indices.

• Midface Morphology and Growth in Syndromic Craniosynostosis Patients Following Frontofacial Monobloc Distraction

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Tonello, Cristiano; Cevidanes, Lucia H.S.; Ruellas, Antonio C.O.; Alonso, Nivaldo

  Background: Facial advancement represents the essence of the surgical treatment of syndromic craniosynostosis. Frontofacial monobloc distraction is an effective surgical approach to correct midface retrusion although someone consider it very hazardous procedure. The authors evaluated a group of patients who underwent frontofacial monobloc distraction with the aim to identify the advancement results performed in immature skeletal regarding the midface morphologic characteristics and its effects on growth. Methods: Sixteen patients who underwent frontofacial monobloc distraction with pre- and postsurgical computed tomography (CT) scans were evaluated and compared to a control group of 9 nonsyndromic children with CT scans at 1-year intervals during craniofacial growth. Three-dimensional measurements and superimposition of the CT scans were used to evaluate midface morphologic features and longitudinal changes during the craniofacial growth and following the advancement. Presurgical growth was evaluated in 4 patients and postsurgical growth was evaluated in 9 patients. Results: Syndromic maxillary width and length were reduced and the most obtuse facial angles showed a lack in forward projection of the central portion in these patients. Three-dimensional distances and images superimposition demonstrated the age did not influence the course of abnormal midface growth. Conclusion: The syndromic midface is hypoplastic and the sagittal deficiency is associated to axial facial concavity. The advancement performed in mixed dentition stages allowed the normalization of facial position comparable to nonsyndromic group. However, the procedure was not able to change the abnormal midface architecture and craniofacial growth.

• Congenital Ossification Defects of the Frontal Bone: Description of a Novel Clinical Entity and the Management of Four Patients

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Roumeliotis, Grayson; Inciarte, Maria; Thomas, Gregory; Wall, Steven; Mathijssen, Irene; Johnson, David

  Embryologic development of the frontoorbital region is complex and is affected by a series of pathologies. These primarily represent failures of fusion at the interface between the frontal bones and the skull base or between the frontal bones themselves, or frontal bone defects in association with atypical craniofacial clefts or cutis aplasia. Isolated ossification defects in the frontal bones themselves are rare, with only 1 case having been previously reported. In that report, the defect was effectively managed with an alloplastic cranioplasty. However, long term results were not presented. Here, we describe 4 cases of isolated frontal bone aplasia their management using autologous bone.

• Technical Strategy Using Piezosurgery to Correct Flattened Supraorbital Rim in Unilateral Coronal Craniosynostosis

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Furtado, Leopoldo Mandic Ferreira; da Costa Val Filho, José Aloysio; de Guimarães Mourão, Rômulo Tscherbakowski Nunes; dos Santos Júnior, Luiz Carlos; de Macedo Machado Filho, Guaracy; Pedrosa, Lucas Dantas

  The surgical correction of orbital deformities in patients with unilateral coronal craniosynostosis is challenging. Traditional techniques have shown the persistence of orbital flattening. This study presents a new strategy for remodeling the compromised orbit, using the piezosurgery technique, which improves the orbital curvature.

• A Compact Surgical Robot System for Craniomaxillofacial Surgery and its Preliminary Study

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Xu, Cheng; Lin, Li; Zhou, Chaozheng; Xie, Le

  Craniomaxillofacial surgery has the characteristics of complex anatomical structure, narrow surgical field, and easy damage to nerves, blood vessels, and other structures. Compared with the traditional bare-hand operation, robot-assisted craniofacial surgery is expected to achieve a more stable and accurate surgical operation. So we have developed a robot-assisted craniofacial surgery system. A compact mechanism design was adopted for the robot system, integrates with visual and force perception modules. The motion analysis and working space analysis are carried out on the mechanical structure. The binocular vision module is integrated and the robot hand-eye calibration process was completed. The target tracking method based on staple is used to achieve tracking and monitoring of the target area. A distributed robot control system based on CAN bus technology is designed, and a position-based visual servo control method is adopted. Then the precision test of the robot system prototype and the drilling experiment of the 3D printed mandible model were carried out. The average pixel error of the vision module is 0.15 pixels. Based on the staple tracking method, the average center error rate of the image is 0.3175 mm, and the overlap rate is 88.76%. The drilling experiment of the mandible model showed that the average entrance position error is 1.76 ± 0.36 mm, the average target position error is 1.62 ± 0.27 mm, and the angle error is 5.36 ± 0.31 degrees. The designed craniofacial robot system can better assist surgeons to complete the mandibular osteotomy.

• A Comparison of Intracranial Volumes and Metopic Index in Patients With Isolated Metopic Ridge, Metopic Craniosynostosis, and Normal Healthy Children

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  McKee, Ryan M.; Kamel, George N.; Cronin, Brendan J.; Ewing, Emily; Lance, Samuel H.; Gosman, Amanda A.

  Background: Previous research has shown that patients with metopic craniosynostosis have significantly reduced intracranial volumes (ICVs) compared to normal healthy children. Furthermore, the metopic index (ratio of midfrontozygomatic diameter to maximal cranial width) has been described as an anthropometric cranial index for patients with metopic craniosynostosis. We aimed to determine whether patients with isolated metopic ridge have significantly different ICVs or metopic indices than normal children and patients with metopic craniosynostosis. Methods: A retrospective chart review of all patients with a diagnosis of a metopic ridge or metopic craniosynostosis was performed from 2000 to 2015 at Rady Children's Hospital. Patients were grouped based on computed tomographic scans consistent with metopic craniosynostosis versus metopic ridge. Results: Data were available for 15 metopic ridge patients, 74 metopic craniosynostosis patients, and 213 normal patients. Mean metopic ridge ICV was greater than mean metopic craniosynostosis ICV at 4 to 6 months and 7 to 12 months. Controlling for age and sex, the difference in ICV associated with metopic ridging was 197.484 cm3 and 137.770 cm3 at 4 to 6 and 7 to 12 months, respectively. Similarly, mean metopic index was significantly greater in metopic ridge patients compared to mean metopic craniosynostosis at 4 to 6 months and at 7 to 12 months. Conclusions: Our study provides volumetric and anthropometric data to support the hypothesis that isolated metopic ridge is an intermediate phenotype between metopic craniosynostosis and normal cranial anatomy. We hope that characterizing the spectrum of disease involving premature closure of the metopic suture with regard to ICV and metopic index will aid physicians in their management of patients with isolated metopic ridge.

• Secondary Coronal Synostosis After Early Surgery for Sagittal Craniosynostosis: Implications for Cranial Growth

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Unander-Scharin, Jesper; Nysjö, Johan; Enblad, Per; Nowinski, Daniel

  Secondary Coronal Synostosis (SCS) in patients operated for non-syndromic Sagittal Craniosynostosis is a postoperative phenomenon with unclear implications. The aim of this study was to investigate whether SCS is a negative or a benign occurrence in the postoperative course. The authors hypothesized that SCS is related to reduced cranial growth and intracranial hypertension. Thirty-one patients operated for SC at an early age with the H-craniectomy technique were included in the study. Associations between SCS and cranial shape, growth, and signs of intracranial hypertension were analyzed. Intracranial volume distribution was assessed by measuring partial intracranial volumes defined by skull base landmarks. A total of 12/31 patients developed SCS during the postoperative course. The presence of SCS was associated with a higher prevalence of gyral impressions and a larger normalization of Cranial Index due to less growth in the anteroposterior plane. The SCS group had a smaller postoperative intracranial volume due to less posterior intracranial volume as well as less growth in head circumference. Whether this is a growth restriction caused by the SCS or a secondary effect of less primary brain growth remains to be determined. However, the correlation between SCS, less cranial growth and gyral impressions does imply that SCS should be taken into consideration during clinical follow-up as a potentially adverse event.

• Discussion of Secondary Coronal Synostosis After Early Surgery for Sagittal Craniosynostosis: Implications for Cranial Growth

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Hamidian Jahromi, Alireza; Wallace, Robert D.; Konofaos, Petros

  No abstract available

• Adult Cranioplasty and Perioperative Patient Safety: Does Plastic Surgery Facility Volume Matter?

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Rochlin, Danielle H.; Sheckter, Clifford C.; Khosla, Rohit K.; Lorenz, Hermann Peter

  Cranioplasty lies at the intersection of neurosurgery and plastic surgery, though little is known about the impact of plastic surgery involvement. The authors hypothesized that adult cranioplasty patients at higher volume plastic surgery facilities would have improved inpatient outcomes. Adult cranioplasty encounters were extracted from the National Inpatient Sample from 2012 to 2014 based on International Classification of Diseases, Ninth Revision (ICD-9) codes. Regression models included the following variables: age, gender, race/ethnicity, Elixhauser Comorbidity Index, payer, hospital size, region, and urban/teaching status. Outcomes included odds of receiving a flap, perioperative patient safety indicators, and mortality. The weighted sample included 49,305 encounters with diagnoses of neoplasm (31.2%), trauma (56.4%), infection (5.2%), a combination of these diagnoses (3.9%), or other diagnoses (3.2%). There were 1375 inpatient mortalities, of which 10 (0.7%) underwent a flap procedure. On multivariable regression, higher volume plastic surgery facilities and all diagnoses except uncertain neoplasm were associated with an increased likelihood of a flap procedure during the admission for cranioplasty, using benign neoplasm as a reference (P < 0.001). Plastic surgery facility volume was not significantly associated with likelihood of a patient safety indicator event. The highest volume plastic surgery quartile was associated with lower likelihood of inpatient mortality (P = 0.008). These findings support plastic surgery involvement in adult cranioplasty and suggest that these patients are best served at high volume plastic surgery facilities.

• Distinguishing Craniomorphometric Characteristics of Unilateral Lambdoid Craniosynostosis

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Allam, Omar; Park, Kitae E.; Pourtaheri, Navid; Mozaffari, Mohammad Ali; Smetona, John; Lu, Xiaona; Ahmad, Maham; Persing, John A.; Alperovich, Michael

  Background: Unilateral lambdoid synostosis (ULS) represents the rarest form of single suture nonsyndromic craniosynostosis. Differentiating between posterior deformational plagiocephaly (DP) and ULS has been difficult due to overlapping clinical findings. Past analyses have been limited by sample size. This study was undertaken to clarify anatomical features of ULS. Methods: A multiinstitution study was undertaken, analyzing CT imaging from patients with documented ULS to determine clinical and pathological characteristics. Similar analyses were performed on DP patients to differentiate the 2 conditions. Results: Twenty-seven ULS patient scans and 10 DP scans were included. For ULS patients mean age was 6.6 months, majority male (75%), and majority left-sided ULS (71%). The synostosed side ear was anteriorly displaced in 100% of ULS patients, mean difference of 9.6° (P < 0.001), and inferiorly in 96.3% of patients, mean difference of 4.4 mm, relative to the nonsynostosed side. The posterior fossa deflection (PFD) was deviated 5.9° toward the synostosed side relative to the anterior midline. In DP, there was no significant difference between sides in EAC measurements. The PFD and EAC displacements were significantly smaller in DP relative to ULS (P < 0.001 for each). An ipsilateral mastoid bulge was found in 100% of ULS and 0% of DP on CT imaging. Conclusion: Contrary to some previously published findings, the ear is more anteriorly displaced ipsilateral to the fused lambdoid suture in 100% of ULS patients. Ear position alone is not a reliable indicator to differentiate between DP and ULS. A mastoid bulge is a more reliable indicator of ULS.

• Ultra-Low-Dose Computed Tomography Protocol for Preoperative Evaluation in Children With Craniofacial Anomalies

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Komarraju, Aparna; Mehta, Sagar T.; Glacier, Charles; Nabaweesi, Rosemary; Choudhary, Arabinda; Ramakrishnaiah, Raghu

  Purpose: Preoperative three-dimensional computed tomography is currently the gold standard imaging modality in patients with craniofacial anomalies. In these patients, bone structural evaluation is paramount for surgical planning and evaluation of brain parenchyma is often secondary. With the significant complexity of these patients, a majority of patients undergo multiple Computed Tomography (CT) studies from infancy into adulthood. This study presents an ultra-low-dose CT protocol that limits the radiation exposure per CT scan in patients with craniofacial anomalies. Material and Methods: A total of 200 consecutive patients who underwent head CT for preoperative evaluation of craniofacial anomalies at Tertiary Children's Hospital were included in the study. The kVp, (KiloVoltage Peak) mA (milliAnperage), CT dose index (CTDI), and dose-length product (DLP) were documented from the dose page. Patients were stratified based on age for determining age specific effective dose and for age matched comparison. The age specific effective dose was derived by using the established conversion factor as described in the paper. (1) Standard t test was performed to determine the statistical significance of radiation dose reduction. The Institutional Review Board approved the study and data was collected from 2012–2014. Findings: Of the 200 patients assessed in our study, 90 patients had low-dose CT scans and 110 patients had ultra-low-dose CT scans of the head. All patients had diagnostic quality CT studies. The low-dose CT was performed at 120 kVp and 100 mA. The ultra-low-dose CT was performed at 80 kVp and fixed 80 mA. The minimum, maximum and mean effective dose before the introduction of the ultra-low-dose protocol was 0.8 mSv, 6.9 mSV and 2.82 mSv. The minimum, maximum and mean effective dose after the introduction of the ultra-low-dose protocol was 0.6 mSv, 3.8 mSV, and 1.37 mSv. The reduction in the effective radiation dose was statistically significant (standard t test; P = 0.0001). Conclusion: Compared to the regular low-dose protocol, the ultra-low-dose CT protocol provided appropriate diagnostic images with a significantly decreased radiation dose.

• Feeding, Communication, Hydrocephalus, and Intracranial Hypertension in Patients With Severe FGFR2-Associated Pfeiffer Syndrome

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Kilcoyne, Sarah; Potter, Katherine Ruth; Gordon, Zoe; Overton, Sarah; Brockbank, Sally; Jayamohan, Jayaratnam; Magdum, Shailendra; Smith, Martin; Johnson, David; Wall, Steven; Wilkie, Andrew O.M.

  Background: Pfeiffer syndrome is associated with a genetic mutation of the FGFR2 (or more rarely, FGFR1) gene, and features the combination of craniosynostosis, midface hypoplasia, broad thumbs and broad great toes. Previous research has identified a wide spectrum of clinical phenotypes in patients with Pfeiffer syndrome. This study aimed to investigate the multifactorial considerations for speech, language, hearing and feeding development in patients with severe genetically-confirmed Pfeiffer syndrome. Methods: A 23-year retrospective case-note review of patients attending the Oxford Craniofacial Unit was undertaken. Patients were categorized according to genotype. Patients with mutations located in FGFR1, or outside the FGFR2 IgIII domain-hotspot, or representing known Crouzon/Pfeiffer overlap substitutions were excluded. Twelve patients with severe FGFR2-associated Pfeiffer syndrome were identified. Results: Patients most commonly had pansynostosis (n = 8) followed by bicoronal (n = 3), and bicoronal and sagittal synostosis (n = 1). Seven patients had a Chiari I malformation. Four patients had a diagnosis of epilepsy. Ten patients had with hydrocephalus necessitating ventriculoperitoneal shunt insertion. Feeding difficulties were common (n = 10/12) and multifactorial. In 5/12 cases, they were associated with pansynostosis, hydrocephalus, tracheostomy and tube feeding in infancy. Hearing data were available for 10 patients, of whom 9 had conductive hearing loss, and 8 required hearing aids. Results indicated that 3/4 patients had expressive language difficulties, 3/4 had appropriate receptive language skills. 6/12 patients had a speech sound disorder and abnormal resonance. Conclusion: This study has identified important speech, language, hearing and feeding issues in patients with severe FGFR2-associated Pfeiffer syndrome. Results indicate that a high rate of motor-based oral stage feeding difficulties, and pharyngeal stage swallowing difficulties necessitating regular review by specialist craniofacial speech and language therapists

• Orthognathic Surgery in Craniosynostosis

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Ferri, Joël; Schlund, Matthias; Touzet-Roumazeille, Sandrine

  Introduction: Craniosynostosis is characterized by the fusion of 1 or more sutures of the skull leading to craniofacial deformations. Our aim is to describe the dental malocclusion associated with craniosynostosis, syndromic, or nonsyndromic, and also the treatment used and its stability. Material and Methods: This retrospective study included all patients who presented at our Department for facial growth monitoring and occlusal management following syndromic and nonsyndromic craniosynostosis. Inclusion began in January 1996 and ended in December 2015 to ensure sufficient follow-up. Orthognathic surgery was performed after the end of growth. Dental occlusion was evaluated clinically and radiographically. Results: Fifty-five patients were included with 18 syndromic cases. The majority of patients presented with class III malocclusion (69.1%), especially syndromic cases (94.7%) and brachycephalies (96.3%). Conversely, scaphocephalies are associated with class II malocclusions. Thirty-nine patients underwent orthodontic treatment associated with orthognathic surgery to correct their malocclusion. In 4 cases, optimal dental occlusion was achieved with orthodontic treatment alone. Forty patients achieved stable optimal final dental occlusion. Optimal dental occlusion was achieved in 76.9% of the nonsurgically treated craniosynostosis patients and 68.9% of the surgically treated craniosynostosis patients. Discussion: Sutural fusion induces a facial growth restrictions and dental malocclusions. Several mechanisms may be responsible for these malocclusions: positional anomaly of the jaws due to the cranial deformity, associated anomaly of the facial sutures, or osteocartilagenous system diseases. Early craniosynostosis management does not avoid the occurrence of malocclusion, which will require orthodontic treatment and orthognathic surgery for their management.

• Nationwide Perioperative Analysis of Endoscopic Versus Open Surgery for Craniosynostosis: Equal Access, Unequal Outcomes

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Rochlin, Danielle H.; Sheckter, Clifford C.; Lorenz, Hermann Peter; Khosla, Rohit K.

  The purpose of this study is to evaluate national differences in inpatient outcomes and predictors of treatment type for endoscopic versus open surgery for craniosynostosis, with particular consideration of racial, socioeconomic, and geographic factors. The 2016 Kids' Inpatient Database was queried to identify patients aged 3 years or younger who underwent craniectomy for craniosynostosis. Multivariable regression modeled treatment type based on patient-level (gender, race, income, comorbidities, payer) and facility-level (bed size, region, teaching status) variables, and was used to assess outcomes. The weighted sample included 474 patients, of whom 81.9% (N = 388) of patients underwent open repair and 18.1% (N = 86) underwent endoscopic repair. A total of 81.1% of patients were under 1 year of age and 12.0% were syndromic. Patients were more likely to be treated open if they were older (odds ratio [OR] 3.07, P = 0.005) or syndromic (OR 8.56, P = 0.029). Patients who underwent open repair were more likely to receive transfusions (OR 2.86, P = 0.021), and have longer lengths of stay (OR 1.02, P < 0.001) and more costly hospitalizations (OR 5228.78, P = 0.018). Complications did not significantly vary between procedure type. The authors conclude that United States national data confirm benefits of endoscopic surgery, including a lower risk of transfusion, shorter hospital stay, and lower hospital costs, without a significant change in the rate of inpatient complications. Racial, socioeconomic, and geographic factors were not significantly associated with treatment type or perioperative surgical outcomes. Future studies are needed to further investigate the influence of such variables on access to craniofacial care.

• Discussion of Nationwide Perioperative Analysis of Endoscopic Versus Open Surgery for Craniosynostosis: Equal Access, Unequal Outcomes

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Uygur, Safak; Konofaos, Petros

  No abstract available

• Evolution of Surgical Management of Sagittal Synostosis

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Bradford, Perry S.; Ishaque, Mariam; Shaffrey, Ellen; Schaeffer, Christine V.; Jr, John A. Jane; Syed, Hasan; Black, Jonathan

  Numerous methods for surgical correction of sagittal synostosis have been described in the literature, yielding similar outcomes. At the authors' institution, surgical approaches to correct this condition have evolved over the past few decades, including Π, H-type craniectomies (Renier), endoscopic suturectomy, and our current technique, the FLAG procedure. Our aim is to review the evolution of these surgical techniques at our institution and compare patient outcomes. A retrospective review was performed on consecutive patients undergoing correction for craniosynostosis from 2008 to 2018. All patients with a diagnosis of nonsyndromic isolated sagittal craniosynostosis were included and classified into one of 4 groups by the type of surgical correction performed (H-type, FLAG, endoscopic, other). The authors identified 166 consecutive patients with a mean age at time of surgery of 6.7 ± 4.0 months. 91 (54.8%) carried a diagnosis of nonsyndromic sagittal synostosis. 63 patients underwent H-type procedures, 9 underwent FLAG procedures, 5 underwent endoscopic procedures, and 14 were classified as other (distraction or other implant). Perioperatively, the FLAG group had the shortest ICU stay (1.3 days, P < 0.05), postoperative transfusion requirement (42cc pRBC, P < 0.001), and complication rate (0.0%). The endoscopic group had the shortest surgical time at 2.00 hours (p < 0.001). No statistically significant difference in cranial index or revision procedures between the four groups was identified. Overall, the mean length of follow-up was 25.3 months. All procedures had similar results for cranial index with decreased surgical time, transfusion volume, and hospital stay seen in FLAG and endoscopic groups.

• Beauty Is in the Eye of the Beholder: Esthetic Outcome Assessment in Smile Reanimation Surgery in Patients With Facial Palsy

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  van Veen, Martinus M.; Broekstra, Dieuwke C.; Mureau, Marc A.M.; Werker, Paul M.N.; Dijkstra, Pieter U.

  Layperson assessments are becoming increasingly important in the evaluation of surgical procedures of the face, including smile reanimation. In this study, the authors set out to answer 3 questions: (1) are esthetic scores more dependent on the assessor or the person that is being assessed, (2) how does smile reanimation change esthetic scores, (3) do sex and age of the patient and assessor explain some of the esthetic outcomes? Thirty-five assessors scored pre and postoperative photographs of 21 facial palsy patients undergoing smile reanimation. Linear mixed-effect models were used to investigate the effects of assessor and patient factors on esthetic outcome assessments, to examine changes after smile reanimation, and to determine whether sex and age explained part of the esthetic outcomes. Fifty-eight percent of variation in the esthetic scores can be explained by some assessors being more positive in their esthetic scoring compared to other assessors. Twenty-nine percent was attributed to patient baseline esthetic scores. Overall esthetic scores improved after smile reanimation. Sex and age of the patient and assessor could not explain variation in the esthetic scores. Esthetic appearance highly depends on "who is looking." These findings are important for preoperative counseling, and for those treating and educating patients with facial palsy.

• Spring-Assisted Surgery for Treatment of Sagittal Craniosynostosis

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Jones, Veronica Morgan; Thomas, Sydney Gillian; Siska, Robert; Massary, Dominic; David, Lisa Renee; Dillingham, Claire Sanger; Crihan, Anatolie; Railean, Silvia; Runyan, Christopher M.

  Craniosynostosis (CSS), the premature fusion of calvarial sutures, most commonly involves the sagittal suture. Cranial vault remodeling (CVR) is a traditional method of CSS correction. Minimally invasive methods are becoming widely accepted, including spring-assisted surgery (SAS). The equipment required for SAS is minimal therefore adaptable to resource challenged health systems. This paper outlines the experience of SAS in Moldova. A retrospective study was performed for patients treated with SAS for sagittal CSS from 2011 to 2018 in Moldova. Perioperative data were recorded including age, length of surgery, blood loss, volume transfused and length of stay. Four patients had pre- and post-operative computed tomography (CT) scans which were used to calculate changes in cephalic index, normative cephalic index, and intracranial volume. Thirteen patients underwent SAS. Diagnoses were made clinically and confirmed with CT. Mean age at surgery was 4.0 months, and length of surgery 62.7 minutes. All but one patient received a blood transfusion, as is standard of practice in Moldova. The mean length of post-operative recovery in ICU was 30.9 hours. No complications required surgical revision. Springs were removed after 4 to 5 months. All patients had a subjective improvement in scaphocephaly. Based on the available CT scans, an increase in cephalic index (7.3%), normative cephalic index (11.8%), and intracranial volume (38.1%) was observed. One patient underwent SAS at 11 months and required cranioplasty for asymmetry at the time of spring removal. SAS is a safe and cost-effective method of CSS correction that can be utilized in countries with limited health system resources.

• Rotation of the Ipsilateral Supraorbital Rim Around the Horizontal Axis in Unilateral Coronal Synostosis: A Craniometric Analysis of the Emergence Profile

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Margulies, Ilana G.; Sanati-Mehrizy, Paymon; Goel, Pedram; Graziano, Francis; Bui, Anthony H.; Som, Peter M.; Urata, Mark M.; Taub, Peter J.

  Introduction: Unilateral coronal synostosis (UCS) results in well-defined dysmorphic changes including sphenoid malposition yielding posterior displacement of the supraorbital rim. Although variation in the ipsilateral supraorbital rim emergence profile has been suggested, it has not been previously investigated. The authors sought to characterize the emergence profile of the ipsilateral supraorbital rim in UCS through craniometric analysis. Methods: Thirty-five nonsyndromic UCS patients (0–18 months) with CT images obtained before operative intervention and 16 control patients (0–24 months, 32 orbits) were included. Craniometric measurements were performed to quantify the emergence profile of the ipsilateral supraorbital rim and locate the likely apex of rotation. Results: The ipsilateral supraorbital rim was significantly rotated around the horizontal axis when measured in reference to the 0° vertical in UCS versus control patients by an average difference of 7.3° to 11.3° across age groups (P < 0.05). No significant effect modification was detected between age and UCS on ipsilateral supraorbital rim emergence profile (P > 0.05). Additional angles with vertices around the superior orbital circumference were then measured to locate the likely apex of rotation and revealed a significant decrease in the posterior orbital roof to 0° horizontal in UCS patients by an average of 9.3° to 22.1° in children under 1 year old (P < 0.01). Conclusion: Variation in the emergence profile of the ipsilateral supraorbital rim in UCS is quantified, and the apex of this rotation likely lies at the posterior orbital roof. The novel quantification and characterization of this deformity will better direct the operative approach and enable a more accurate correction.

• Orthognatic Quality of Life: What Are We Measuring?

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Vidakovic, Renata; Zigante, Martina; Perkovic, Vjera; Zibar Belasic, Tihana; Uhac, Mia; Spalj, Stjepan

  Objective: To assess properties of Orthognathic Quality of Life Questionnaire in Croatian cultural context by analyzing: how dentofacial deformity influences quality of life (QoL), what aspects of QoL are patients' primary motives to undergo orthognathic surgery, what changes after surgery and how personality traits influence QoL. Materials and Methods: A total of 472 subjects (65% females) aged 12 to 45 years (median 20) were included. Orthognathic Quality of Life Questionnaire, Oral Health Impact Profile, Psychosocial Impact of Dental Aesthetics Questionnaire, Orofacial Aesthetics Scale, Self-Esteem Scale, Multidimensional Perfectionism Scale, and Big Five Inventory were used. The subjects' dentofacial deformity and malocclusion severity was assessed by Index of Complexity, Outcome and Need, and Index of Orthodontic Treatment Need. Results: Social aspect is mostly influenced by dentofacial deformity (P < 0.05). Impaired oral function was the primary motive to undergo orthognathic surgery (P < 0.001). Social aspect and aesthetic concern mostly decreased after the surgery (P < 0.001). Self-esteem was the strongest predictor of the orthognathic QoL, the increase of self-esteem decreases the QoL impairment. Neuroticism and extraversion were in the background of problems in social interactions and facial aesthetic concerns, while perfectionism affected social contacts (r = 0.284–0.410; P < 0.001). Only awareness of deformity did not correlate to any of the other instruments. Conclusion: Impaired oral function seems to be the most powerful motive for orthognathic surgery, but social aspects and facial aesthetic concern are more accurate indicators of conditions and changes. Self-esteem is the strongest personality trait influencing orthognathic QoL.

• Facial Contour Rejuvenation by Reduction Malarplasty Combined With Second-Stage Fat Grafting

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Gao, Bowen; Yuan, Yukun; Li, Ke; Li, Zengguang; Yu, Lianggang

  Background: With aging, the facial contour shows a double-concave deformity. Conventional facial contouring procedure, including face lifting and fat grafting, cannot yield a smooth facial contour line. This study was the first to propose a combination of reduction malarplasty and 2nd-stage autologous fat grafting so as to achieve the aesthetic goals of facial contour rejuvenation. Methods: The study group comprised patients seeking facial contour rejuvenation from January 2017 to May 2018 (28 patients: 28 females and 0 males) at the Department of Plastic Surgery, Tian Tan Pu Hua Hospital. All of the cases underwent bilateral malarplasty with 2nd-stage autologous facial fat grafting. Radiologic and photographic documentation was completed preoperatively. The mean follow-up period was 12 months. Patients' pre-op photographs and 3 months follow-up pictures were blindly assessed. Results: Most of the patients were satisfied with their results after 1-time fat grafting. Eleven patients demanded re-injection after the 1st fat grafting in temporal area, and 6 patients demanded 3rd time fat grafting in temporal area. Eleven patients demanded re-injection insubmalar area, and 8 patients demanded 3rd time fat grafting in submalar area. Meanwhile, 9 of those patients underwent fat grafting in other sites other than temporal and submalar region. The amount of fat injected was also recorded in this study. The appearance of double-concave deformity was greatly improved in all cases. Complications included infection (3.6%), hematoma (7.1%), and malar prominence relapse (7.1%), and so on. Conclusion: Reduction malarplasty combined with several times of fat grafting could effectively overcome the malar prominence and soft tissue deflation. Complications were minimal after these procedures. Therefore, this technique is useful to restore the youthful facial contour in Asian patients with aging double-concave deformity.

• Apert Hand Reconstruction: Do Partial-Thickness Skin Grafts Result in Flexion Scar Contracture?

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Raposo-Amaral, Cassio Eduardo; Oliveira, Yuri Moresco; Denadai, Rafael; Raposo-Amaral, Cesar Augusto

  Background: Hand reconstruction for patients with Apert syndrome is a critical step in comprehensive care and enables this population to gain significant hand function. Digit separation for Apert syndrome, as described in most algorithms, is finalized using local flaps and full-thickness skin grafts. The objective of this study is to report our experience using local flaps and partial-thickness skin grafts after digit separation for Apert hand reconstruction. Methods: An observational retrospective study was performed with Apert patients whose hands were reconstructed between January 2007 and July 2019 using local flaps and partial-thickness skin grafts after digit separation. Demographic data and outcome data were verified and recorded. Results: Out of a total of 75 Apert patients who underwent hand reconstruction, 12 underwent hand reconstruction utilizing local flaps and partial-thickness skin grafts. The average patient age at the time of the first procedure was 1.9 years. These 12 patients were stratified according to Upton hand severity, 3 being type I (25%), 3 being type II (25%) and 6 being type III (50%). Mean follow up provided to all patients in this study was 1.8 years and donor site-related complications were seen in 2 patients (16.6%). No flexion scar contracture was observed in any of the patients who received partial-thickness skin grafts. Conclusions: The use of local flaps along with partial-thickness skin grafts to finalize digit separation for patients with Apert syndrome is an effective technique that reduces donor site morbidity and does not result in flexion scar contracture.

• Comprehensive Treatment and Vascular Architecture Characteristic of High-Flow Vascular Malformations in Periorbital Regions

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Yang, Peng; Ren, Jian; Yu, Jia-Xing; Zhai, Xiao-Dong; Hu, Peng; Hong, Tao; Zhang, Hong-Qi

  Objective: This study analyzed the vascular architecture characteristics of high-flow vascular malformations (VMs) in periorbital regions, as well as the treatment and imaging prognosis of occlusion degree of the outflow veins. Method: The clinical data of 24 patients with high-flow VMs in periorbital regions treated in our center from 2012 to 2019 were analyzed retrospectively, and the vascular architecture characteristics, treatment methods, and follow-up results were recorded. Results: The vascular architecture of high-flow VMs in periorbital regions which usually contained the intracranial feeding arteries (24/24,100.0%) and intracranial outflow veins (18/24, 75.0%). The average age of first diagnosis was 23 ± 16 years; the average age of treatment was 37 ± 10 years; the median follow-up time was 42.5 months. Twenty-four patients with high-flow VMs in periorbital regions had 58 treatments in all. The imaging cure was achieved in 6 patients by complete occlusion of outflow veins, and no recurrence was found by DSA. Eighteen patients who get incomplete occlusion of outflow veins were given 49 treatments, and 8 patients had imaging recurrence. Seven patients (7/24, 29.2%) had treatment-related complications in all. Conclusions: Patients with high-flow VMs in periorbital regions are the most complex cases. The prognosis of patients whose outflow veins can be completely occluded is relatively good. The stepwise embolization while preserving organ function is advisable. Nevertheless, the incidence of treatment complications is still high.

• Surgical and Patient-Reported Outcomes in Patients With PEEK Versus Titanium Cranioplasty Reconstruction

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Asaad, Malke; Taslakian, Editt N.; Banuelos, Joseph; Abu-Ghname, Amjed; Bite, Uldis; Mardini, Samir; Van Gompel, Jamie J.; Sharaf, Basel

  Background: Several materials are available for cranioplasty reconstruction and consensus regarding the ideal material is lacking. The goal of this study is to present surgical and patient-reported outcomes with PEEK versus Titanium alloplastic cranioplasty. Methods: A retrospective review of all patients who underwent alloplastic cranioplasty with PEEK or Titanium from 2010 to 2017 was conducted. Patient demographics and complications were abstracted and analyzed. Information regarding patient-reported outcomes was collected through a telephone survey. Results: A total of 72 patients (median age 55 years) who underwent 77 cranioplasties were identified (38% PEEK, n = 29; 62% Titanium, n = 48). Overall complication rates were similar between the PEEK (24%, n = 7) and Titanium groups (23%, n = 11), P = 0.902. Similarly, implant failure was similar between the 2 groups (7% in PEEK (n = 2), 13% in Titanium (n = 6), P = 0.703). History of radiation was associated with increased rate of infection in patients with Titanium mesh cranioplasty (38% in radiated patients (n = 3), 3% in nonradiated patients (n = 1), P = 0.012) but not PEEK implants (0% infection rate in radiated patients (n = 0), 15% in nonradiated patients (n = 4), P = 1.000). A total of 24 patients (33% response rate) participated in the telephone survey. All PEEK cranioplasty patients who responded to our survey (n = 13) reported good to excellent satisfaction, while 72% of our titanium mesh cohort (n = 8) described good or excellent satisfaction and 27% (n = 3) reported acceptable result. Conclusion: Cranial reconstruction is associated with high satisfaction among cranioplasty patients with PEEK or Titanium showing comparable complications, failure, and patient-reported satisfaction rates. Patients with history of radiotherapy demonstrated a higher infection rate when titanium mesh was used.

• Discussion of Surgical and Patient-Reported Outcomes in Patients With PEEK Versus Titanium Cranioplasty Reconstruction

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Mitchell, Kerry-Ann; Gordon, Chad

  No abstract available

• Early Recognition of Raised Intracranial Pressure in Craniosynostosis Using Optical Coherence Tomography

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Rufai, Sohaib R.; Jeelani, Noor ul Owase; McLean, Rebecca J.

  Objective: Craniosynostosis can be associated with raised intracranial pressure (ICP), which can pose deleterious effects on the brain and vision if untreated. Estimating ICP in children is challenging, whilst gold standard direct intracranial measurement of ICP is invasive and carries risk. This systematic review aims to evaluate the role of optical coherence tomography (OCT), a noninvasive imaging technique, for detecting raised ICP in children with craniosynostosis. Methods: The authors conducted a systematic review of the literature published from inception until 19 August, 2019 in the Cochrane Central Register of Controlled Trials, PubMed, MEDLINE, and EMBASE. Eligible studies evaluated the role of OCT in detecting raised ICP in children aged 0 to 16 years with craniosynostosis. Main outcome measures were sensitivity and specificity of OCT parameters for raised ICP. Quality assessment was performed using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-sectional Studies. Results: Out of 318 records identified, data meeting the inclusion criteria were obtained from 3 studies. The quality of 2 studies was poor whilst 1 was fair. Optical coherence tomography demonstrated higher sensitivity and specificity for detecting raised ICP compared to fundus examination, clinical history, radiological testing, and visual field testing. Conclusions: This systematic review demonstrated a lack of quality evidence for OCT as a screening tool for children with craniosynostosis. Further research is required to clarify the strength of OCT in this role and to determine which OCT parameters are most appropriate.

• Orbital Osteomyelitis in the Pediatric Patient

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Hu, Allison C.; Ng, Wendy K.Y.

  Orbital osteomyelitis in the pediatric patient is a rare clinical entity with limited reports in the literature. Outcomes for orbital osteomyelitis can be potentially fatal, and effective diagnosis and treatment often requires an extensive differential and multidisciplinary team approach. As such, the authors systematically evaluated a pooled analysis of patients in published studies to better understand the clinical trends of this condition. Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement guidelines, the authors queried the PubMed, Cochrane Library, and ISI Web of Science databases. A total of 23 patients (47.8% males) participated in 10 studies between 1977 and 2017. Average age of included patients was 7.3 ± 5.3 years old with follow-up of 8.7 ± 9.8 months. Over half of the patients present with fistula (65.2%) and/or fever (43.5%). Sequestrum formation was common (52.2%) but only seen in chronic osteomyelitis patients. The most frequently infected orbital bone was the frontal bone (n = 10, 43.5%). Nearly all patients were cultured (82.6%) and received imaging, such as computerized tomography (43.5%) or X-ray (47.8%). Streptococcus pyogenes was the most common organism isolated (21.7%), while trauma was the most common source of infection (26.1%). Most patients were treated successfully with combined surgical debridement and antibiotics (73.9%). Significant differences between acute and chronic orbital osteomyelitis patients include clinical presentation, use of magnetic resonance imaging, methicillin-resistant Staphylococcus aureus infection, and procedure only treatments. The studies reviewed here provide a comprehensive overview of the clinical presentation, infection sources, diagnostic modalities, common organisms, and treatment options involved in pediatric orbital osteomyelitis.

• Novel Surgical Approach to Acalvaria

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Caycedo, Diego J.; Castillo-Huila, Juan P.; Zapata-Copete, James A.; Santacruz, Luis Fernando

  Acalvaria, also known as acrania, is a rare congenital anomaly which is characterized by a complete or partial defect of the calvarium. Due to the low number of patients reported, there is no a standard for the treatment of this condition; thereby, the objective is to present a new surviving patient with acalvaria and a novel surgical approach to treat it, giving craniofacial surgeons and neurosurgeons more tools to face it. In this article, the authors present a reproducible surgical approach in patients with partial acalvaria, which consist in use the present bone as a graft to cover the defect, giving a temporal but stable coverture. No other calvaria graft has been published along the available literature, since only around 4 patients are acalvaria survivors worldwide. However, the authors need to make a longer follow-up to establish the usefulness of the technique in long term. Other limitation is the future procedures needed to a better function and aesthetic.

• Long-Term Outcomes of Zygomaticomaxillary Reconstruction With Autologous Bone Grafts Supported by Pedicled Buccal Fat Pad Flap

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Chu, Hanwen; Huang, Linjian; Xu, Feifei; Chen, Guanfu; Xu, Xin

  Purpose: The purpose of this study was to investigate the effectiveness of the pedicle buccal fat pad flap combined with autogenous bone grafts to reconstruct zygomaticomaxillary defects after tumor resection. Materials and Methods: A retrospective case series analysis of 11 patients that underwent zygomaticomaxillary reconstruction after tumor resection with autologous bone grafts supported by pedicle buccal fat pad flap as the lining of the maxillary sinus from January 2009 to December 2015 was performed. All the patients underwent computed tomography to measure the aesthetic appearance, bone graft formation, mucosa of the maxillary sinus, and their response to treatment, including complications. Results: With a mean follow-up period of 4.7 years, all patients were pleased with the symmetrical contours of zygomaticomaxillary and symptom improvements of the maxillary sinus except for one patient who complained of transient infraorbital numbness. Recurrence, bone infection or necrosis, and other complications were not observed in the follow-up period. Conclusion: Pedicled buccal fat pad flap promotes wound healing and prevents the exposure of bone grafts to the maxillary sinus. This technique may be a promising treatment option when reconstructing complicated zygomaticomaxillary defects.

• A Progressive Enlarging Intraparenchymal Pericatheter Cyst and Cerebral Spinal Fluid Edema Following Ommaya Reservoir Placement

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Chen, Yan; Fu, Xiaoling; Wang, Jing; Cui, Lihong; Wang, Chunyan; Yuan, Xunhui; An, Yanyan

  Spread of cerebral spinal fluid (CSF) into the brain parenchyma is a very rare complication of Ommaya reservoir placement and can take form of CSF edema or an intraparenchymal pericatheter cyst. Herein, we described an extremely rare case of a progressive enlarging intraparenchymal pericatheter cyst and CSF edema in a patient with cerebral cysticercosis following Ommaya reservoir placement. A heightened index of suspicion of this rare complication is required to prevent misdiagnosis as a tumor or brain abscess that may lead to unnecessary surgical explorations.

• Total Cranial Reconstruction for the Treatment of Sagittal Craniosynostosis in Children

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Wang, Jing; Yan, Qing; He, Junping; Gao, Zhe; Qiu, Dezhi; Zheng, Lei; Zhang, Xianli; Qian, Jing; Wang, Gang

  Objective: To study the effect of total cranial reconstruction for sagittal synostosis (scaphocephaly) deformity in Chinese children. Methods: A retrospective analysis was performed involving 23 children with isolated non-syndromic sagittal synostosis who were treated by total calvarial vault remodeling after 1 year of age from May 2015 to June 2019 in the Department of Neurosurgery, Children's Hospital of Nanjing Medical University. The authors reconstruct patients' pre- and post-operative cranial thin-section CT scan images and those of the control group. The cephalic index (traditional, normative), intracranial volume, horizontal point of maximum width (H-PMW), vertical point of maximum width (V-PMW), frontal to head height ratio and occipital to head height ratio data were analyzed using a paired t test or Wilcoxon signed-rank test. Results: Twenty-three patients met the inclusion criteria, including 19 males and 4 females. The ratio of males to females was 4.7:1. All patients underwent total cranial reconstruction. The average age was 26.52 months (13–48 months), the average operation time was 214.13 minutes (150–265 minutes), and the average amount of suspended erythrocytes was 200 ml (100–400 ml). The cranial morphology of all patients improved significantly after the operation. The traditional cephalic index (pre-operative: 0.70 (0.04); post-operative: 0.78 (0.02)) and normative cephalic index (pre-operative: 0.68 (0.03); post-operative: 0.77 (0.02)) were significantly increased (P < 0.0001). The mean horizontal point of maximum width improved from 0.54 to 0.56 (P = 0.0043), the mean vertical point of maximum width decreased from 0.59 to 0.54 (P = 0.0006), the frontal height decreased from 0.89 to 0.77 (P < 0.0001), and the occipital height improved from 0.78 to 0.88 (P < 0.0001). The intracranial volume increased from 1287.35 to 1426.90 cm3 (P < 0.0001). All of the children had a good skull shape and no recurrence of deformity. Conclusions: Total calvarial reconstruction can effectively correct scaphocephaly in Chinese children, expand cranial volume, reduce cranial height, shorten fronto-occipital diameters and enlarge biparietal diameters.

• Management of Pediatric Orbital Fractures

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Wolff, Amir; Ohayon, Chaim; Emodi, Omri; Sviri, Gill E.; Shapira, Vladimir; Rachmiel, Adi

  Introduction: Although uncommon in children, orbital fractures can be devastating to both vision and appearance. Due to the scarce information in the literature, the authors here present our experience and management with all pediatric orbital fracture patients. Material and methods: A 6-years retrospective study was conducted on pediatric patients presented with orbital wall fracture (OFx). All patients (n = 43) were grouped for comparison based on the treatment method. The cohorts were analyzed for demographics data, location of fracture, type of material used for reconstruction, complication rate and follow up length. Data was analyzed utilizing SPSS for χ2 test. Results: The majority of patients were male (86%) and the mean age of patients was 12.09 ± 4 years. Mean follow-up time was 237 ± 72 days. Most of Patients 31 (72%) underwent surgical intervention. A higher rate of complications was observed in the surgically treated group (32%) compared to the conservative group (8%) regardless to the defect size. Subgroup analysis of the surgery treated group revealed that large size defect had inferior outcome compared to small size defect. Conclusion: The consequences of treatment on long-term growth and development must be a cornerstone when choosing the optimal therapeutic method. Conservative management should be considered first in the absence of significant clinical pathologies. In addition, when surgery is indicated the least invasive procedure should be applied. The use of autogenous bone graft is preferable over alloplastic materials, however, when there is insufficient bone quantity the use of alloplastic materials is not contraindicated for reconstruction.

• Multifactor Prognostic Evaluation of Postoperative Craniopharyngiomas

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Yang, Fengyu; Liu, Wei; Cheng, Dekui; Zhang, Hongliang; Li, Ziji; Cao, Zhigang; Zhang, Jinwu; Lv, Bingke; Feng, Yugong; Li, Huanting

  Purpose: To evaluate various factors that could be associated with the postoperative prognosis of patients with craniopharyngiomas and provide evidence for the proper surgical course and optimal outcome assessments of craniopharyngiomas. Methods: We performed a retrospective study and reviewed 68 patients with craniopharyngiomas who received surgery from May 2013 to October 2018. The relationships between the disease prognosis and age, gender, onset symptoms, size of tumor, degree of calcification, consistency, QST classification, adhesion strength, and pathological types were analyzed. Results: There were no significant associations between the prognosis and age, gender, number of onset symptoms, and pathological types (P > 0.05). The severity of onset symptoms, tumor diameter, and degree of calcification was significantly associated with the prognosis (P < 0.05). There were significant different prognoses between patients with cystic and solid, mixed tumors (P < 0.05). The prognosis of patients with T type tumors was different from that of patients with either Q or S type tumors (P < 0.05). The prognoses of patients with either loose or tight type tumors were significantly different from those of patients with either invasive or fusion type tumors (P < 0.05). Conclusion: Clinical and pathological variables, such as onset symptoms, size of tumor, degree of calcification, consistency, QST classification, and the degree of adhesion strength, were important factors in evaluating the prognosis of patients with craniopharyngiomas.

• The Effect of Cranial Shape on Esthetic Self-Worth in Bald Men

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Feijen, Michelle Marlena Wilhelmina; van Cruchten, Cas; van der Hulst, Rene Remmelt Willie Johan

  During the last 3 decades, the incidence of positional plagiocephaly and brachycephaly has increased. Treatment options are conservative and can include physiotherapy and molding helmet therapy. The decision to start therapy is based on patient history and subjective assessment of cranial shape by the physician and the parents. To determine the impact of these deformations on esthetic self-worth, as well as cranial shape, this study was conducted on a population of adult bald men. Participants were asked to fill in a questionnaire about the amount of comments received on cranial shape, as well as grade their general esthetic and grade craniofacial features using a visual analogue scale. The cranial proportions and symmetry were measured using plagiocephalometry. 50 adult bald men were included in this study. The prevalence of nonsynostotic plagiocephaly was 12%; the prevalence of nonsynostotic brachycephaly was 0%. No significant correlation was found between plagiocephaly or brachycephaly, cranial circumference, width or length and amount of comments on cranial shape, cosmetic assessment of appearance or cosmetic assessment of cranial shape. On average, teeth and eyes were given the highest cosmetic value, eyebrows and chin were given the lowest scores. Cranial shape does not have a significant impact on the amount of comments received on cranial shape, nor the cosmetic assessment of either overall appearance or cranial shape in bald men. For bald men, eyes and teeth are more important craniofacial features in cosmetic assessment. There is no clear esthetic need to treat deviating cranial shape with helmet therapy in male patients.

• Assesing Intraoperative Virtual Navigation on My Craniofacial Surgery Fellowship for Orbital Fractures Repair: Is it Useful?

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  García-Cano, Eugenio; Malagón-Hidalgo, Héctor Omar; Gónzalez-Magaña, Fernando; Monroy-Cedillo, Jose Luis.

  Orbital fractures pose specific challenge in its surgical management. One of the greatest challenges is to obtain satisfactory restoration of normal orbital volume and globe projection following traumatic injury, due to the inability of the surgeon to gain adequate visibility and to verify proper implant position and placement during the operation. Surgical navigation is a very helpful tool when dealing with the reconstruction of such orbital fractures. During the training of the craniofacial fellowship learning to recognize the orbital floor boundaries is essential for the correct implant placement for reconstruction, their identification is a critical step, which may be assisted by intraoperative virtual navigation. Six patients were surgically treated for orbital floor fracture with intraoperative virtual navigation. The clinical evaluation showed no complications such as enophtalmos, exophtalmos or dystopia in all the patients 2 months post operatively and a correct implant/graft position. During surgery, navigation provides exact determination of transverse, cranio-caudal and postero-anterior dimensions within the orbit and precise control of the position of implants/bone grafts. This tool aids consistently on the craniofacial surgery fellow's formation, as it facilitates the identification of the bony floor boundaries and verifies the correct placement of the implants/bone grafts. It is routinely use could help to avoid implants/bone grafts misplacement not only for craniofacial surgeon's fellow, but for all the orbital surgeons.

• Mandibular Angle Contouring Using Porous Polyethylene Stock or PEEK-based Patient Specific Implants. A Critical Analysis

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Olate, Sergio; Uribe, Francisca; Huentequeo-Molina, Claudio; Goulart, Douglas R.; Sigua-Rodriguez, Eder A.; Alister, Juan Pablo

  Contour augmentation and mandibular angle modification surgery is becoming increasingly. The aim of this research is to compare technique and outcomes in augmentations done with standard implants or PEEK-based patient specific implants (PSI) in mandibular angle. Data from surgical planning, operative and post-operative of 6 months follow-up were revised for 21 patients who were submitted to facial surgery using a stock implant obtained from companies currently on the market or 3D implants created with CAD/CAM technology using PEEK 3D printing. Surgical time, intra-operative and post-operative complications were compared, analyzing the advantages and disadvantage of each technique. Statistical analyses using t-test and chi-squared were performed considering P value< 0.05 for statistical differences. Twelve patients were operated on with stock implants and nine patients with PSI. The surgical time was 15 minutes less for the 3D implant surgeries (P = 0.021) and intraoperatively only the stock implants needed modifications with wear and adaptation methods; post-operative infections were observed in both groups with no significant differences (P > 0.05). The 3D implants had greater levels of facial symmetry than the stock implants, although they did not present significant differences.Considering the limitations of this study, mandibular angle implants with a PEEK-based 3D CAD/CAM are efficient, stable and have a low complication rate; the CAD/CAM strategy is useful in facial surgery and can be integrated as a standard for surgical planning in facial makeover surgery.

• A Technique for Minimizing the Need for Hemotransfusion in Non-Syndromic Craniosynostosis Surgery

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Furtado, Leopoldo Mandic Ferreira; da Costa Val Filho, José Aloysio; Hon, Yang Pol; Sandes, Bruno Lacerda; Brandão Vianna, Bruna Silviano; Valadares, Friederike Wolff; dos Santos, Andre Ribeiro

  Surgery for craniosynostosis is associated with excessive blood loss, as well as morbidity and mortality risks. This study investigated the effectiveness of a surgical technique for nonsyndromic craniosynostosis intervention in controlling bleeding, assessed based on the volume of blood transfused. The cohort included 73 children who underwent nonsyndromic craniosynostosis surgery during a 3-year period. Retrospective evaluation of patient parameters included sex, weight, and age at the time of surgery; type of craniosynostosis; duration of surgery; hemoglobin concentration before and after surgery; rate of transfusion; and volume of transfused blood (mL/kg). The surgical technique involved skin incision and subgaleal dissection using electrocautery with a Colorado needle tip. The pericranium was not removed but instead kept in situ, and orbiectomy was performed using piezosurgery. Of the 73 children in the cohort, 75.3% underwent fronto-orbital advancement and were included in the analysis. The average age was 10.9 months (range: 4–96 months), with 68.5% boys and 31.5% girls (P < 0.001). The most common type of craniosynostosis was trigonocephaly (57.5%), followed by scaphocephaly (19.2%). The mean duration of the surgery was 2 hours and 55 minutes. Blood transfusion was needed in 56.2% of patients, with a mean volume of 8.7 mL/kg body weight transfused intraoperatively. No complications or fatalities were observed. These results suggested that meticulous, continuous control of homeostasis is paramount in minimizing blood loss during surgical repair of nonsyndromic craniosynostosis.

• Primary Palatoplasty With Intravelar Veloplasty Using Acellular Dermal Matrix Interpositional Graft

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Yi, Chang Ryul; Jeon, Dong-Nyeok; Choi, Jong-Woo; Oh, Tae Suk

  The aim of this study was to analyze the effect of acellular dermal matrix (ADM) on fistula formation after primary palatoplasty using intravelar veloplasty for levator veli palatini muscle repair. This single-center retrospective study included patients who underwent primary palatoplasty with intravelar veloplasty for reorientation of the levator veli palatini muscles between April 2014 and March 2018. In the control group (group A) conventional intravelar veloplasty was performed, while in the ADM group (group B) intravelar veloplasty using ADM was performed. The study sample was composed of 162 patients, 81 in each of the 2 groups (A and B). In group B, securely dissected muscles were overlapped, and a pentagon-shaped ADM (AlloDerm, LifeCell Corp., Branchburg, NJ) of 1.6 mm mean thickness, 11.3 mm mean width, and 14.4 mm mean length was designed, and placed under the repaired levator muscle sling. The outcome variable was the occurrence of oronasal fistula within the first 6 months after surgery. Postoperative fistula formation was reported in 6 patients in group A (7.4%) and in 5 patients in group B (6.2%). There was no statistically significant difference between the 2 groups (P = 0.755). There were 7 cases of ADM exposure and 2 cases of wound dehiscence in group B. The results of this study demonstrated that ADM use did not have any disadvantage with respect to oronasal fistula complications after intravelar veloplasty for levator veli palatini muscle repair.

• Sirolimus as a Potential Treatment for Sturge-Weber Syndrome

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Sun, Buhao; Han, Tao; Wang, Yuan; Gao, Qingwen; Cui, Jie; Shen, Weimin

  Background: Sturge-Weber syndrome (SWS) is a rare neurocutaneous syndrome characterized by port-wine stain, leptomeningeal angiomatosis, and glaucoma. Due to the involvement of the nervous system, patients are often accompanied with epilepsy. It reported that 75% of patients with SWS did not respond to standard antiepileptic drugs. Although hemispherectomy is effective in treating these patients, the application of it has been limited due to high risk and huge trauma. Recent studies have shown that sirolimus has a positive on complex vascular malformations and seizures, so the authors attempted to treat them by using sirolimus. Methods: The authors retrospectively analyzed 6 patients with SWS who were refractory to antiepileptic drugs and accepted oral sirolimus in their department between 2017 and 2020. Results: All 6 patients were responsive to oral sirolimus treatment. Epilepsy was controlled in all patients, no epilepsy relapsed in 6 patients during the follow-up period. The facial port-wine stain of the patients were all lightened and the hypertrophy of pathological tissue was improved. Only minor adverse reactions occurred during the treatment. Conclusions: Oral sirolimus could control the occurrence of epilepsy and improve the appearance, with minor and tolerable adverse reactions. Sirolimus is especially suitable for patients with severe epilepsy, failure, or contraindications of antiepileptic drugs; it could be an alternative method for patients who are unwilling to accept the risks of neurosurgery.

• Severe Cloverleaf Skull Deformity in c.1061C>G (p.Ser354Cys) Mutated Fibroblast Growth Factor Receptor 2 Gene in Crouzon Syndrome

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Chaisrisawadisuk, Sarut; Hammam, Elie; Molloy, Cindy J.; Barnett, Christopher; Anderson, Peter J.; Moore, Mark H.

  Cloverleaf skull deformity (CSD), or Kleeblattschädel, is a condition with severe and unpatterned multisuture craniosynostosis, resulting in a trilobar-shaped skull. This deformity mainly comprises a cranio-orbito-facial malformation that leads to a spectrum of multidisciplinary issues. Several syndromes are associated with CSD, such as Crouzon syndrome (CS). Here, we report the case of an infant with CS and the pathogenic c.1061C>G (p.Ser354Cys) variant of the fibroblast growth factor receptor 2 (FGFR2) gene. The child presented with the severe form of CSD despite having a normal, mid-trimester, sonographic scan.

• A Novel IRF6 Variant Detected in a Family With Nonsyndromic Cleft Lip and Palate by Whole Exome Sequencing

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Wang, Yanyang; Ma, Cui; Jiang, Chanyuan; Zhang, Yongbiao; Wu, Di

  Nonsyndromic cleft lip with or without cleft palate (NSCL/P) is the most common congenital craniofacial malformation, and its harmful effects on affected individuals and families are apparent. The causative genes and their mechanisms are not completely clear, although several studies have been conducted. Accordingly, in the present study, we recruited a Han Chinese family with hereditary NSCL/P to explore the possible causative variants of this disease using whole exome sequencing. Bioinformatics screening and analysis, mutation function prediction, species conservation analysis, and homology protein modeling were used to identify the variants and evaluate their influence. A mutation in the interferon regulatory factor 6 (IRF6) gene (c.961C>T; p.Val321Met) was detected as a candidate causative variant and predicted to be deleterious. The codon was found to be conserved in many species, and the residue change caused by this mutation changed the structure of IRF6 to a certain degree. The findings suggest that this IRF6 variant is probably the pathogenic cause of NSCL/P in this family. Our results further provide evidence that IRF6 variants play a role in the etiology of NSCL/P.

• Undiagnosed Normocephalic Pancraniosynostosis Presenting as Bilateral Abducens Nerve Palsy

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Baron, Marissa E.; Dvoracek, Lucas A.; Bykowski, Michael R.; Goldstein, Jesse A.; Losee, Joseph E.

  Primary pancraniosynostosis is a rare variant of craniosynostosis in which the major cranial sutures prematurely fuse. Single-suture craniosynostosis is often recognized early in life due to an abnormal head shape. In contrast, primary pancraniosynostosis may be diagnosed later in life due to a grossly normal head shape and size. As such, these children can present with symptoms related to chronically elevated intracranial pressure (eg, vision loss or cognitive impairment). This report highlights a patient with primary pancraniosynostosis associated with unique neurologic sequelae—namely, bilateral abducens nerve palsy. A 9-year-old boy presented to the ophthalmologist with a 1-month history of double vision, drifting of his right eye toward the nasal bridge, and intracranial hypertension evident with papilledema. Physical examination was notable for mild bitemporal narrowing. A computed tomography study demonstrated radiologic thumbprinting, diffuse osseous sclerosis, and fusion of the bilateral coronal, sagittal, metopic, and lambdoid sutures. The patient underwent emergent cranial vault expansion with fronto-orbital advancement. Papilledema had resolved 4 months following surgery. At 2-year follow-up, abducens nerve palsy and head shape were significantly improved. This study brings attention to an unreported presenting symptom of pancraniosynostosis (bilateral abducens nerve palsy). This information may lead to quicker diagnosis and treatment of pancraniosynostosis-induced intracranial hypertension, which is critical to prevent long-term sequelae.

• Usefulness of Tranexamic Acid Administration During Sagittal Split Ramus Osteotomy

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Yoshida, Mitsuhiro; Ono, Shigehiro; Shimizu, Yoshitaka; Oue, Kana; Mukai, Akari; Doi, Mitsuru; Irifune, Masahiro

  Tranexamic acid has been used to reduce intraoperative bleeding; however, its effect on anti-inflammation and the amount of drainage after orthognathic surgery is yet to be determined. Therefore, we aimed to examine the effect of tranexamic acid on intraoperative bleeding volume and operation time, amount of drainage, and anti-inflammation after orthognathic surgery. Forty healthy women who underwent bilateral sagittal split ramus osteotomy under general anesthesia participated in this study. The amount of intraoperative bleeding, the operation time, the amount of drainage, and the C-reactive protein level were compared between patients intravenously administered with tranexamic acid before surgery (before-surgery group) and those administered with the drug after surgery (after-surgery group). All data were analyzed using the Student t-test. Results were considered to be statistically significant when P < 0.05. Although no significant difference was found in the amount of drainage between the groups (P > 0.05), significant variations were detected in the amount of bleeding during surgery (before-surgery group: 161.7 ± 45.3 mL versus after-surgery group: 270.2 ± 24.0 mL; P = 0.0009), operation time (before-surgery group: 141.3 ± 16.8 min versus after-surgery group: 166.8 ± 24.9 min; P = 0.03), and postoperative C-reactive protein level (before-surgery group: 3.77 ± 0.40 mg/dL versus after-surgery group: 5.02 ± 0.75 mg/dL; P = 0.012) between the groups. In conclusion, administering tranexamic acid before surgery was found to significantly decrease bleeding, reduce operation time, and suppress postoperative inflammation.

• The Impact on Nasal Septal Anatomy and Physiology Following Le Fort I Osteotomy for Orthognathic Surgery

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Eliason, Michael J.; Schafer, Jeffrey; Archer, Benjamin; Capra, Gregory

  Orthognathic surgery utilizing a Le Fort I osteotomy is performed by oral and maxillofacial surgeons to correct midface and dental occlusal abnormalities. However, the potential sequelae on sinonasal function have had minimal discussion in the literature. The objective of this study was to assess the impact on nasal septum anatomy and physiology following Le Fort I osteotomy for maxillary repositioning surgery. Thirty patients who previously underwent elective orthognathic surgery with Le Fort I osteotomy were enrolled retrospectively to assess the change in their nasal septal anatomy and nasal breathing. Pre- and postoperative computed tomography (CT) scans were used to determine axial displacement of the septum, in both degrees and millimeters, at 4 different standardized anatomic sites following the surgery. These objective anatomic measurements were then compared to the patient's perception of nasal congestion and difficulty breathing via the validated Chronic Sinusitis Survey-Duration Based (CSS-D). Comparison of the CTs before and after surgery demonstrated a new deviation of the nasal septum in all 30 patients, with maximal axial displacements up to 7.22 mm and a mean of 2.64 mm. Postoperative angular displacement changes ranged from minimal to 24°. The CTs showed persistence of a new septal perforation in 20% (6 of 30 patients) following surgery. The CSS-D results demonstrated a mean worsening of nasal breathing and congestion scores from 1.4 before surgery to 3.0 at least 8 weeks after surgery (P < 0.001). Orthognathic surgery utilizing Le Fort I osteotomy may result in persistent nasal septal perforations, new displacement of the nasal septum, and increased perception of nasal dyspnea not previously reported. Further understanding of anatomic changes and nasal airway obstruction that may be caused following such operations warrants further study in order to improve surgical technique and postoperative outcomes.

• Neo-Sagittal Suture Formation After Cranial Vault Remodeling in Sagittal Craniosynostosis

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Chaisrisawadisuk, Sarut; Anderson, Peter J.; Moore, Mark H.

  Craniosynostosis is a condition where the cranial sutures are early fused. Sagittal suture synostosis is found to be the most prevalent. Many techniques ranging from simple suture excision to wide suturectomy have been developed for treating this condition. While repeated fusion of previously excised involved sutures is common, neosuture formation has been identified in many recent reports after craniosynostosis surgery. In this case report, the authors present a finding of the neosuture formation in a patient presented with sagittal craniosynostosis after wide suturectomy with total cranial vault remodeling so that the pathologically fused suture can be reversed.

• Traditional Versus Virtual Surgery Planning of the Fronto-Orbital Unit in Anterior Cranial Vault Remodeling Surgery

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Ganesh, Praveen; Mahipathy, Surya Rao Rao Venkata; Rajan, Vivakaran Thanga Thirupathi; Sundaramurthy, Narayanamurthy; Durairaj, Alagar Raja; Jayachandiran, Anand Prasath; Nagarjuna, Muralidhara

  Background: Craniosynostosis correction surgery is a complex procedure, which involves complete dismantling and reassembly of the cranial vault components. The traditional planning method for these surgeries results in increased intra-operative time owing to its highly subjective nature. The advent of virtual surgical planning (VSP) platform has lead to a greater pre-operative insight and precision outcome in calvarial remodeling surgeries. The purpose of this paper is to evaluate intra-operative time and blood loss difference as a measure of surgical efficiency between VSP based template guided Anterior Cranial Vault Reconstruction (ACVR) with Fronto-Orbital Unit Advancement (FOUA) and the traditional surgeries. Methods: Data were collected from patients who underwent ACVR with FOUA in our unit. Patients were divided into 2 groups, Template Fronto-Orbital Unit (TFOU) group and Non-template Fronto-Orbital Unit (NFOU) group. In TFOU group, Virtual planning along with fabrication of Template guide was carried out. Patients undergoing ACVR using traditional techniques were categorized as NFOU group. A comparative prospective analysis was carried out in terms of Intra-operative time duration and blood loss. Student 't' test was used to compare the means of the 2 groups. Results: A total of 10 patients were included in the present study. There were 5 control (NFOU) and 5 TFOU cases. There was a significant decrease in the operating time in TFOU group compared to the NFOU group. TFOU group also showed reduced intra-operative bleed compared to the NFOU group. Conclusion: Virtual surgical planning (VSP) and 3D modeling with prefabricated template guide augurs reliable outcomes and portends the possibility of lesser intra-operative time. It is a valuable tool, which offers enormous benefits in terms of precise pre-surgical planning with predictive results.

• Digital Analysis of Cranial Sutures Computed Tomography Data in Adolescents

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Du, Shanshan; Zhang, Chen; Bi, Hongsen; Yang, Xin; Lv, Yi; Zhi, Juan; Zhao, Zhenmin; Wang, Junchen

  To investigate the degree of fusion in sutures of the skull, the authors analyzed cranial computed tomography (CT) data using digital technologies to obtain the density values of coronal, sagittal, and lambdoid sutures in Chinese Han adolescents. The authors selected 80 patients who had undergone maxillofacial surgery. They were divided by age into a 9- to 12-year-old group and a 13 to 15-year-old group. The grayscale value of the cranial CT suture was segmented and measured using Mimics 20.0 software. The Mimics software measurement data were imported into SPSS 21.0 for data comparison and analysis. The mean grayscale value of coronal sutures was 1203.25 and the standard deviation was 220.48, while the mean grayscale value of sagittal sutures was 1113.76 and the standard deviation was 197.83. The mean grayscale value of lambdoid sutures was 1106.37, and the standard deviation was 200.01. The grayscale values of coronal sutures were higher than those of sagittal sutures or lambdoid sutures. Further paired sample t tests were performed on the 3 types of cranial sutures. The differences between coronal and sagittal sutures and between coronal and lambdoid sutures were both substantial with statistical significance. Nevertheless, the difference between sagittal and lambdoid sutures was not significant. Further, an independent sample t-test, showed the grayscale values of coronal, sagittal and lambdoid sutures in the 9–12-year)ear-old group were significantly lower than those in the 13 to 15-year-old group (P < 0.001). Through digital technologies, the research findings are more precise and accurate, which is of great significance to research on maxillofacial and associated anatomy.

• Spontaneous Bone Flap Resorption Following Cranioplasty Using Autologous Bone

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  da Costa Benalia, Victor Hugo; Pedrozo, Charles Alfred Grander; Kormanski, Matheus Kohama; Veiga, José Carlos Esteves; de Aguiar, Guilherme Brasileiro

  Cranioplasty is a common neurosurgical procedure. The main reasons for performing cranioplasty are, in addition to aesthetic correction and protection of the brain, the reestablishment of the adequate flow of cerebrospinal fluid and the prevention of complications inherent to the perpetuation of bone failure. In our institution the patient's autologous bone remains the best method for performing cranioplasty, despite the existence of other heterologous grafts and bone substitutes. Despite representing for us, the best material for cranioplasty, the use of autologous grafting is subject to complications. In this paper, the authors present the case of a patient who underwent cranioplasty with autologous bone that progressed with spontaneous resorption of the bone flap. The authors herein briefly discuss the case and review the literature on the subject, with an emphasis on the factors that can lead to such an outcome.

• Syndrome of the Trephined Related to Inflation of a Scalp Tissue Expander

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Stewart, Christopher M.; Deibert, Christopher P.; Thompson, Peter W.

  Syndrome of the Trephined (SoT) is a severe complication following decompressive craniectomy. Urgent cranioplasty fully reverses the neurologic symptoms of SoT. This article presents a recent case of SoT following inflation of a scalp tissue expander. A review of the literature was performed and case details obtained from the electronic medical record. Our patient had a large craniectomy defect following traumatic brain injury. A scalp tissue expander was used before secondary cranioplasty. The patient suffered severe neurologic decline temporally related to tissue expander inflation, which was fully reversed following expander removal and urgent cranioplasty. SoT can be a neurologically devastating complication which can resolve following urgent cranioplasty. To our knowledge, this is the first description of SoT resulting from inflation of a scalp tissue expander. Familiarity with this syndrome is critical for the plastic surgery provider, who may be called upon to assist with these urgent cases.

• Use of Onlay Hydroxyapatite Cement for Secondary Cranioplasty

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Brussius Coelho, Marcio; Rtshiladze, Michael; Aggarwala, Shivani; Hunt, Jeremy; Peltz, Tim; Gardner, Danielle; Gianoutsos, Mark

  Background: Children who undergo bi-fronto-orbital advancement (BFOA) frequently develop a contour deformity on the temporal and supra-orbital region, with an incidence reported as high as 55% and 75%, respectively. Up to 20% of patients may require correction. Hydroxyapatite cement (HAC) is a good alternative to autogenous tissue. The available literature on its use focusses on the reconstruction of bone defects, but little has been published on its efficacy and safety as an onlay graft over intact cranium. Objectives: To describe our institution's experience with HAC in the pediatric population. Methods: Retrospective chart review from 1998 to 2018 on all patients from the Craniofacial Unit at the Sydney Children's Hospital who had either coronal or metopic craniosynostosis and underwent BFOA and later in life required cranioplasty with HAC for contour repair. Findings: We have performed 166 BFOA and nineteen secondary cranioplasties for contour repair using onlay HAC. The mean age at the time of operation was 14 years. Bi-coronal craniosynostosis was most frequently associated with secondary cranioplasty and 37% had an associated syndrome. The mean volume of HAC used was 37 mL. There was only 1 patient who had a complication (5.3%) and required partial removal of allograft. The mean length of admission was 2 days. Mean follow up time of 22.4 months. Conclusions: HAC represents a safe option when used correctly, with low rates of complication and satisfactory cosmetic outcomes.

• Variations in Postoperative Management of Pediatric Open-Vault Craniosynostosis

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Srivatsa, Shachi; Heiman, Adee J.; Gray, Megan C.; Carpenter, Courtney; Patel, Ashit

  Craniosynostosis is the premature fusion of 1 or more of the calvarial sutures causing a secondary distortion of the skull shape due to lack of growth perpendicular to the fused suture and compensatory overgrowth parallel to the suture. Open vault craniosynostosis repair requires extensive dissection and reshaping of the skull and can be associated with significant pain, commonly undervalued, and underreported in the pediatric cohort. Although there is an extensive body of literature focusing on the operative treatment of craniosynostosis, there is little consensus about optimal postoperative management protocols, including pain control regimens. The purpose of this study was to assess variation in immediate postoperative management protocols within the United States. A Qualtrics-based survey was submitted to all 112 American Cleft Palate-Craniofacial Association-approved craniofacial teams regarding their routine postoperative management protocol. Nineteen responses were obtained. All surgeons reported routine post-op intensive care unit stay. Mean overall length of stay was 3.5 days. Pain control agents included acetaminophen (100%), intravenous opioids (95%), oral opioids (79%), and ketorolac (53%). Eighty-eight percent of surgeons reported utilizing vital signs and observational parameters for pain assessment with 47% reporting the use of a formal pain scale. Sixty-three percent of those surveyed used a drain, 88% used a foley catheter, 75% used postoperative prophylactic antibiotics, and 75% routinely used arterial line monitoring postoperatively. The results of this survey will be the basis for future direction in understanding the efficacy of differing management protocols and further study of pain management in the pediatric craniosynostosis population.

• Crouzon Syndrome and Acanthosis Nigricans With Fibrous Dysplasia of the Maxilla: An Unreported Suggested Triad

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Olshinka, Asaf; Tal, David; Gillman, Leon; Ad-El, Dean; Kalish, Eyal; Kropach, Nesia; Yaacobi, Dafna Shilo; Kornreich, Liora; Staffenberg, David A.

  The aim of this report is to describe the combination of Crouzon syndrome and acanthosis nigricans with fibrous dysplasia of the maxilla. The diagnosis of fibrous dysplasia was confirmed clinically and pathologically during Le Fort III osteotomy and midface advancement with distraction osteogenesis. Crouzon syndrome with acanthosis nigricans is a known syndrome with an incidence of 1:1,000,000. This is the first report in the literature of Crouzon syndrome and acanthosis nigricans combined with fibrous dysplasia. As all 3 pathologies are related to fibroblasts, they may be different manifestations of malfunction of a single molecular pathway. The detection of fibrous dysplasia in a patient with Crouzon syndrome and acanthosis nigricans is important because it may complicate midface osteotomies and fixation of the hardware on the bones during craniofacial surgery.

• Intravenous Recombinant Tissue-Type Plasminogen Activator Thrombolysis for Acute Central Retinal Artery Occlusion

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Wang, Xiaotang; Liu, Yong; Suo, Yan; Qin, Dan; Ren, Meixia; Lei, Runjia; Zhang, Yanchun; Wang, Ying

  Introduction: Central retinal artery occlusion (CRAO), an ocular stroke, causes severe and permanent visual impairment. Thrombolytic therapy is currently the main treatment option for CRAO. Intravenous thrombolysis with recombinant tissue-type plasminogen activator (rt-PA) has been extensively applied in the treatment of CRAO with the proven advantages of effectiveness and safety. This meta-analysis aimed to assess the efficacy of intravenous rt-PA thrombolysis for the management of CRAO by evaluating the pooled evidence. Methods: A comprehensive literature search of electronic databases including PubMed, OVID, and Cochrane Library was conducted up to and including March 2019. All studies reporting visual outcomes after CRAO with thrombolytic therapy were collected. Data on visual acuity and adverse events were recorded and assessed in this analysis. Data were inputted into the statistical software of STATA. The studies were weighed by the inverse of the variance and merged in a random-effects model. Results: The systematic review process yielded 7 eligible studies including 121 patients with CRAO who received the intravenous rt-PA treatment. Sixty-two patients showed improvement in visual acuity (52.0%; 95% CI, 34.0%–70.0%) following rt-PA intravenous thrombolytic therapy. The observed improvement rate in the intravenous rt-PA treatment group was significantly higher than the conservative treatment group (40.4% vs. 13.0%; OR = 5.16; 95% CI, 1.90–14.05). The incidence rate of complications was relatively low (11 out of the 121 patients). Hemorrhage (9/11) was the major reported complication. Mortality was zero. Discussion: This meta-analysis indicated that intravenous rt-PA thrombolysis could be an effective and safe strategy for the management of CRAO. However, a more detailed large-scale clinical trial is warranted to strengthen the evidence-based therapeutic guidance.

• Orbital Hypertelorism Correction With Inverted-U Osteotomy: Indications and Advantages

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Huang, Qinghua; Yang, Bin; Li, Binghang; Ma, Hengyuan

  This study aimed to explore the clinical effects of inverted-U osteotomy in correcting orbital hypertelorism and to further explore its indications and advantages; 4 patients with orbital hypertelorism and premature closure of unilateral coronal suture underwent inverted-U osteotomy. The interorbital distance was measured using three-dimensional digital technology pre- and postoperatively. Virtual preoperative planning and three-dimensional cutting guide were used to minimize surgical risk and increase the precision of periorbital osteotomy. The procedure was successfully performed on 4 patients; the average orbital medial wall distance was reduced from 34.9 mm to 23.1 mm. Inverted-U osteotomy is a modified surgical method especially applicable to orbital hypertelorism with premature closure of unilateral coronal suture. Advantages include less surgical trauma, a shorter operative time, and better correction results.

• Virtual Planning for Exchange Cranioplasty in Cranial Vault Remodeling

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Lu, Stephen M.; Pessino, Kenneth; Gray, Rachel L.; Rodgers, Shaun D.; Schneider, Steven J.; Bastidas, Nicholas

  The use of virtual surgical planning and computer-aided design/computer-aided manufacturing has gained popularity in the surgical correction of craniosynostosis. This study expands the use of virtual surgical planning and computer-aided design/computer-aided manufacturing in cranial vault reconstruction by using these methods to reconstruct the anterior vault using a single endocortically-plated unit constructed from the posterior calvarium. This technique was designed to reduce the risk of undesirable contour deformities that can occur when multiple bone grafts are used to reconstruct the anterior vault and fronto-orbital rim. Six patients were included in this study, all of which had nonsyndromic craniosynostosis. Excellent aesthetic outcomes were obtained in all patients, without complication. Additionally, the placement of a single reconstructive unit constructed from the posterior calvarium was efficient, aesthetically pleasing, and minimized postoperative contour deformities secondary to bone gaps, resorption, and often palpable resorbable plates.

• Complications Due to Cranial Distraction for Craniosynostosis

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Noto, Mariko; Imai, Keisuke; Masuoka, Takeshi; Sakahara, Daisuke; Kunihiro, Noritsugu

  Background: Complications of cranial distraction techniques can arise perioperatively. This study assessed long-term clinical outcomes following cranial distraction for craniosynostosis. We analyzed factors involved in those complications. Methods: We retrospectively assessed outcomes from 120cases treated with cranial distraction for craniosynostosis between 1997 and 2019. Age at surgery, type of craniosynostosis, length of advancement, and complications were reviewed. We analyzed cases in which clinical characteristics and medical data appeared to increase the risk of complications. Results: Of the 120 patients (65 males, 55 females), 79 had syndromic craniosynostosis and 41 had nonsyndromic craniosynostosis. Type of craniosynostosis was scaphocephaly in 17 patients, trigonocephaly in 4, plagiocephaly in 15, brachycephaly in 57, oxycephaly in 14, cloverleaf in 10, and others in 3. Mean age at surgery was 18.6 months (range, 3–525 months). Mean total length of advancement was 32.3 mm (range, 5.5–62.0 mm). No deaths were encountered. Complications included cerebrospinal fluid leaks in 5 patients, epidural abscess in 1, local infections in 33, device problems in 20, erosions and/or ulcers in 23 and decubitus ulcers in 8. Comparisons of complications and factors: Local infection showed no significant correlation with type of craniosynostosis, nor with the total length of advancement. Plate displacement showed significant relationships with total length of advancement, or with age at surgery (P < 0.01) Conclusion: These results suggested that local infection occurred independent of the type of craniosynostosis. Plate displacement and ulcers appear to occur more easily among patients with longer lengths of advancement or with surgery at a younger age, due to the weakness of the cranial bones.

• Vascular Complications in Le Fort I Osteotomy: Incidence, Reasons, and Management of the Intraoperative Hemorrhage

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Ulker, Omer; Demirbas, Ahmet Emin; Kutuk, Nukhet; Kilic, Erdem; Alkan, Alper

  Purpose: The aim of this study was to investigate the incidence, types, and reasons for the intraoperative hemorrhage during Le Fort I osteotomy. Methods: The study sample was composed of the population of the patients who underwent orthognathic surgery from April 2011 to February 2017. The vascular complications of the patients who underwent Le Fort I osteotomy during the surgery were identified. Type of the bleeding, suspected vessel, amount of the intraoperative blood loss, cause, and management of the bleeding were specified and investigated. Descriptive statistics were computed for each study variable. Results: A total of 200 patients underwent Le Fort I osteotomy. The sample's mean age was 22.4 ± 5.8 and 55.5% of patients were female. The intraoperative vascular complication was seen in only 10 (5%) samples. The suspected source of the hemorrhage was the descending palatine artery (DPA) in 8 (4%) cases, while the pterygoid venous plexus in the other 2 (1%) cases. The cause of the bleeding was suspected down-fracture in 8 cases, while pterygomaxillary junction (PMJ) separation in the other 2 cases. DPA was ligated with ligation clips and cauterized in arterial injury cases. The hemorrhage was taken under control using a hemostatic matrix with thrombin (Surgiflo, Ethicon, USA) in the venous bleeding cases. Conclusions: The down-fracture of the maxilla was found to be more related to the occurrence of vascular complications. Severe bleeding was managed by the use of the hemostatic matrix with thrombin and this hemostatic agent can be used to control this type bleedings in orthognathic surgery.

• Cerebrospinal Fluid Leak After Septoplasty in Crouzon Syndrome

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Demir, Berat; Abuzaid, Ghazi; Binnetoglu, Adem

  Crouzon syndrome presents with craniofacial deformities due to early fusion of cranial sutures. Deviation of the nasal septum could be seen clinically in Crouzon syndrome. Cerebrospinal fluid leaks (CSF) after septoplasty are extremely rare and typically present with simple rhinorrhea, meningitis, and pneumocephalus. Herein, we report an adult patient with Crouzon syndrome who experienced CSF complication after septoplasty surgery. Supplemental Video: CSF leak repair operation, http://links.lww.com/SCS/B930

• Isolated Frontosphenoidal Craniosynostosis: The Alder Hey Experience and a Novel Algorithm to Aid Diagnosis

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Hennedige, Anusha; Bridle, Robyn; Richardson, David; Duncan, Christian; Parks, Christopher; Sinha, Ajay; Ellenbogen, Jonathan

  Unilateral synostotic frontal plagiocephaly is most commonly due to a premature fusion of the frontoparietal suture. However, the coronal ring comprises of major and minor sutures and these sutures in isolation or in combination can result in similar clinical presentations which can make diagnosis challenging and result in a delay in referral to a craniofacial surgeon for timely management. Isolated frontosphenoidal craniosynostosis is a rare clinical entity with only 49 cases reported in the English literature to date. The authors present our series of 4 patients to add to this cohort of patients and describe key characteristics to distinguish frontoparietal from isolated frontosphenoidal synostosis and introduce a means of differentiating these 2 diagnoses from posterior deformational plagiocephaly and unilateral lambdoid synostosis. All previous case reports have been diagnosed after radiological imaging but the authors have devised a novel algorithm to aid the clinician in diagnosis of craniosynostosis before any radiological imaging.

• The Umbrella Technique for the Closure of Cerebrospinal Fluid Fistula

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Maggiore, Giandomenico; Locatello, Luca Giovanni; Cannavicci, Angelo; Bruno, Chiara; Gallo, Oreste

  The diagnosis and management of cerebrospinal fluid (CSF) rhinorrhea remains an important challenge in the field of rhinology. In this study, the authors want to propose a technique for transnasal endoscopic closure of CSF fistulas, tested for the first time on 2 adult fresh cadaveric specimens. The authors think that the use of a device similar to the umbrella device, used to close cardiac atrial defects, may also be valid for the closure of defects at the level of the anterior skull base.

• Treatment of Osteomyelitic Bone Following Cranial Vault Reconstruction With Delayed Reimplantation of Sterilized Autologous Bone: A Novel Technique for Cranial Reconstruction in the Pediatric Patient

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Vingan, Perri; Halsey, Jordan N.; Gagliardo, Christina; Battiato, Jennifer A.; Fried, Arno; Ciminello, Frank S.

  Craniosynostosis, a deformity of the skull caused by premature fusion of ≥1 cranial sutures, is treated surgically via endoscopic approaches or cranial vault remodeling. Postoperative infection is rare. Management of postoperative surgical site infections often involves culture-directed intravenous antibiotics and debridement, with removal of osteomyelitic bone and hardware in refractory cases. Removal of autologous bone in a pediatric patient presents a reconstructive challenge, as alloplastic options are not optimal in a growing child, especially in the setting of infection. Moreover, infants and small children have limited autologous bone options for reconstruction. We present our case of a young child who developed an infectious complication following cranial vault remodeling. The patient's demographic information, clinical presentation and postoperative course, radiologic features, surgical interventions, and treatment outcomes were reviewed. In our case, autologous osteomyelitic bone underwent tissue processing to eradicate the infection and complete skull reconstruction using the patient's own processed autologous bone was performed in a delayed fashion. The patient is now 1 year postoperative with no recurrence of infection. We present this case as a novel technique to eradicate infection in autologous bone, allowing for delayed autologous cranial reconstruction.

• Minimally Invasive Treatment With a Patient Specific Implant in Reconstruction of Isolated Anterior Wall Fracture of the Frontal Sinus

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Helmers, Renée; Klop, Cornelis; Schreurs, Ruud; de Lange, Jan; Dubois, Leander

  Isolated fractures of the anterior wall of the frontal sinus are most often treated through a coronal approach. Although the coronal approach is a relatively easy procedure, the size of the incision is causing more problems related to patient morbidity and recovery time than smaller approaches. A novel, minimal invasive procedure for reconstruction of the anterior wall fracture of the frontal sinus is presented in this article. An endoscopic assisted approach to camouflage the defect of the anterior wall and restore the contour of the frontal bone with a titanium patient specific implant is described in 2 patients. The aim of this procedure is to evaluate the effect on the operating time, recovery time, length of hospital stay and facial scarring compared to the conventional coronal approach. Postoperative evaluation was performed by superimposing pre and postoperative 3D stereophotographs and computed tomography scans. A distance map demonstrated an accurate reconstruction of the preoperatively planned contour. Postoperative recovery of both patients was quick and uneventful with no complications. The use of endoscopically inserted patient specific implant for contour reconstruction in anterior wall fractures of the frontal sinus seems to offer a predictable and minimal invasive alternative to the conventional approach.

• The Effects of Age and Race on Calvarium, Tegmen, and Zygoma Thickness

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Saltagi, Mohamad Z.; Schueth, Elizabeth; Nag, Amit; Rabbani, Cyrus; MacPhail, Margaret E.; Nelson, Rick F.

  Objective: Temporal bone spontaneous cerebrospinal fluid (sCSF) leaks are characterized by defects in the tegmen along with calvarial thinning without associated thinning of the extracranial zygoma. The authors sought to determine the effect of age and race on calvarial, tegmen, and zygoma thickness. Study Design: Retrospective cohort study. Setting: Tertiary Referral Center. Patients: A total of 446 patients with high-resolution head computer tomography (CT) imaging from 2003 to 2018. Intervention(s): Calvarial, tegmen, and zygoma thicknesses were measured using 3D slicer. Main Outcome Measure(s): Effects of age and race on calvarium, tegmen, zygoma thickness. Results: Among all patients, increased age was associated with increased thickness of the calvarium [95% CI, 0.0002 to 0.007 mm/year, P < 0.05] and tegmen [95% CI, 0.00039 to 0.0075 mm/year, P = 0.03], but decreased thickness of the zygoma [95% CI, −0.013 to −0.005 mm/year, P < 0.001]. When compared to white patients, black patients had thicker mean [SD] calvaria (2.63 [0.61] versus 3.30 [0.79] mm; difference, 0.67 mm; [95% CI, 0.57 to 0.77]; Cohen d, 1.02), tegmen (0.73 [0.34] versus 0.92 [0.36] mm; difference 0.19 mm; [95% CI, 0.101 to 0.279]; Cohen d, 0.533) and zygoma (4.89 [0.81] versus 5.55 [0.91] mm; difference, 0.66 mm; [95% CI, 0.53 to 0.79]; Cohen d, 0.78). Conclusions: Racial differences exist in calvarial and zygoma thickness. Aging generally leads to increased calvarium and tegmen thickness, suggesting that early onset of obesity and comorbid conditions known to thin the skull base may predispose patients to developing sCSF leaks by reversing the effects of age.

• Artists With Anatomical Knowledge After Anathomia (1316) and Before Fabrica (1543)

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Hwang, Kun

  In the Renaissance, anatomical science was a major source of inspiration for artists. By the 15th century, interest had emerged in anatomy, and the artists of the period dissected cadavers. The aim of this paper was to analyze the works of 15th century artists who had a good knowledge of human anatomy. In PubMed and Google, "Renaissance" and "artist" and ("anatomy" or "cadaver" or "corpse") were searched. In the book Lives of the Painters, Sculptors, and Architects by Vasari, the terms "cadaver" or "dissect" or "corps" or "anatomy" were searched. Fourteen artists (Donato di Niccolò di Betto Bardi, Piero della Francesca Andrea del Castagno, Antonio del Pollaiuolo, Andrea del Verrocchio, Leonardo da Vinci, Michelangelo di Lodovico Buonarroti Simoni, Domenico di Pace Beccafumi, Baccio Bandinelli, Giovanni Antonio Lappoli, Rosso Fiorentino, Silvio Cosini of Fiesole, Jan van Calcar, and Taddeo Zucchero) who learned anatomy or performed dissections were identified, and artworks representing their knowledge of human anatomical structures were analyzed. In this review, we identified artists who had a good knowledge of anatomy and applied anatomical knowledge of features such as muscle shape and volume in their works. The artists sought to accurately portray facial expressions, positions, reflexive motions, and draped clothing. Observation of living subjects is the primary source of artists' expertise. Dissection provides fixed model without flowing blood, which cannot be used as an animated model. It is thought that these artists learned about the origins of vivid expressions from the anatomy of the muscles lying beneath the skin.

• Optic Canal Analysis in Syndromic Craniosynostosis: Volumetric and Surface Area Validation Study Using Different Measurement Modalities

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Hariri, Firdaus; Zainudin, Nur Afiqah Aina; Anuar, Ahmad Muizz Shariful; Ibrahim, Norliza; Abdullah, Norli Anida; Aziz, Izhar Abdul; Ramli, Norlisah; Rahman, Zainal Ariff Abdul

  Background: In syndromic craniosynostosis (SC), unlike persistent corneal irritation due to severe exophthalmos and increased intracranial pressure, optic canal (OC) stenosis has been scarcely reported to cause visual impairment. This study aimed to validate the OC volumetric and surface area measurement among SC patients. Methods: Sixteen computed tomography scan of SC patients (8 months–6 years old) were imported to Materialise Interactive Medical Image Control System (MIMICS) and Materialise 3-matics software. Three-dimensional (3D) OC models were fabricated, and linear measurements were obtained. Mathematical formulas were used for calculation of OC volume and surface area from the 3D model. The same measurements were obtained from the software and used as ground truth. Data normality was investigated before statistical analyses were performed. Wilcoxon test was used to validate differences of OC volume and surface area between 3D model and software. Results: The mean values for OC surface area for 3D model and MIMICS software were 103.19 mm2 and 31.27 mm2, respectively, whereas the mean for OC volume for 3D model and MIMICS software were 184.37 mm2 and 147.07 mm2, respectively. Significant difference was found between OC volume (P = 0.0681) and surface area (P = 0.0002) between 3D model and software. Conclusion: Optic canal in SC is not a perfect conical frustum thus making 3D model measurement and mathematical formula for surface area and volume estimation not ideal. Computer software remains the best modality to gauge dimensional parameter and is useful to elucidates the relationship of OC and eye function as well as aiding intervention in SC patients.

• Enhancing Distraction Osteogenesis With Carbon Fiber Reinforced Polyether Ether Ketone Bone Pins and a Three-Dimensional Printed Transfer Device to Permit Artifact-Free Three-Dimensional Magnetic Resonance Imaging

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Eley, Karen A.; Moazen, Mehran; Delso, Gaspar; Javidan, Maryam; Kaggie, Joshua; Kalaskar, Deepak M.; Knowles, Jonathan C.; Owji, Nazanin; Watt-Smith, Stephen R.

  Objectives: To: (1) design an artifact-free 3D-printed MR-safe temporary transfer device, (2) engineer bone-pins from carbon fiber reinforced polyether ether ketone (CFR-PEEK), (3) evaluate the imaging artifacts of CFR-PEEK, and (4) confirm the osteointegration potential of CFR-PEEK, thus enhancing 3D-planning of bony advancements in hemifacial microsomia using sequential magnetic resonance imaging (MRI). Study Design: Engineered CRF-PEEK bone pins and a 3D printed ex-fix device were implanted into a sheep head and imaged with MRI and computed tomography . The osseointegration and bony compatibility potential of CFR-PEEK was assessed with scanning electron microscopy images of MC3T3 preosteoblast cells on the surface of the material. Results: The CFR-PEEK pins resulted in a signal void equivalent to the dimension of the pin, with no adjacent areas of MR-signal loss or computed tomography artifact. MCT3 cells adhered and proliferated on the surface of the discs by forming a monolayer of cells, confirming compatibility and osseointegration potential. Conclusion: A 3D printed transfer device could be utilized temporarily during MRI to permit artifact-free 3D planning. CFR-PEEK pins eliminate imaging artifact permitting sequential MRI examination. In combination, this has the potential to enhance distraction osteogenesis, by permitting accurate three-dimensional planning without ionizing radiation.

• Review of "The Construction of Surgical Trust" by Salim SY et al in Ann Surg 271:391-398, 2020

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Turner, Acara; Hollier, Larry H. Jr

  No abstract available

• Review of "Telemedicine for Surgical Consultations – Pandemic Response or Here to Stay?" by Sorensen MJ, et al. Ann Surg 2020;272(3):e174–e180

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Grush, Andrew E.; Hollier, Larry H. Jr

  No abstract available

• Implementing Patient-Reported Outcome Measures in Routine Cleft-Craniofacial Practice

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Denadai, Rafael; Lo, Lun-Jou

  No abstract available

• Pediatric Otoplasty: Differences in Operative Time and Inpatient Stay Based on Surgical Specialty Training

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Kafle, Samipya; Torabi, Sina J.; Salehi, Parsa P.; Lee, Yan Ho

  No abstract available

• Introduction to Updated Guideline on Treatment and Management of Craniosynostosis

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Mathijssen, Irene M.J.

  No abstract available

• Updated Guideline on Treatment and Management of Craniosynostosis

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Mathijssen, Irene M.J.; Working Group Guideline Craniosynostosis

  No abstract available

• Accidental Insertion of a Piercing Needle in Tongue

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Sasaki, Ryo; Okamoto, Toshihiro; Akagi, Yuichi; Ando, Tomohiro

  Tongue piercing causes various complications, including bleeding, pain and infection and it cause potential life-threatening complications. An 18-year-old woman presents with losing a needle in mouth. She attempted to perform tongue piercing using piercing needle by herself at home, and it was lost in mouth. The patient showed speech difficulty, but no active bleeding and edema of the floor of mouth. Computed tomography showed approximately 50 mm needle like structure in tongue. General anesthesia was performed with nasal intubation using video laryngoscope. The surgeon found the needle could be hold in the tongue by fingers. The needle in the tongue was holding by left fingers, and 10 mm skin incision was made by right hand. The needle tip was pushed to the incision line and it was removed. There was no bleeding immediate after needle removal. She could speak immediate after surgery. Two days after surgery, the patient discharged with no complications.

• Surgical Ciliated Cysts in Orthognathic Surgery

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Soares, José Castro; Villalba, Natalia Casañas; Sanromán, Jacinto Fernández; Ferro, Martin Fernández; Fernández, Pablo López; Betancourt, Annahys López; López, Alberto Costas

  Surgical ciliated cysts (SCC) are rare entities that were first described in the Japanese literature after treatment for chronic maxillary sinusitis. Classically associated with surgery to the maxillary sinus, they have also been reported in association with orthognathic surgery, bone grafting, and trauma. These lesions can develop from a few months up to several years after the surgical procedure. The authors report 2 new cases of SCC after a LeFort I osteotomy for class III dentofacial deformity correction. One of them presented with bilateral lesions and suffered from a recurrence after 5 years, 2 rare events associated with SCC. A review of the literature of the past 5 years was undertaken, in order to ascertain the reported time of follow-up and recurrence. A PubMed search retrieved a total of 15 articles with 17 cases reported. Nine cases were associated with orthognathic surgery, 4 with Caldwell-Luc procedures, 2 with sinus lift and 2 with trauma. The mean follow-up after removal of the SCC was of 8.6 months. Four cases did not specify the follow up time; 1 case was lost to follow-up. No relapses were reported. Like what happens with the primary lesion, a recurrence can take place several years after removal. It is the authors' opinion that adequate long-term follow-up must be granted for a timely diagnosis and treatment of relapsed SCC.

• Secondary Rhinoplasty in Binder Syndrome: Considerations and Management of Complex Problem With Heterologous Bone Graft

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Barbera, Giorgio; Raponi, Ingrid; Nocini, Riccardo; Della Monaca, Marco; Priore, Paolo; Valentini, Valentino

  Binder Syndrome occurs in less than 1 per 10,000 live births. Mean features of the syndrome include arhinoid face, abnormal position of the nasal bones, intermaxillary hypoplasia with associated malocclusion, reduced or absent anterior nasal spine, atrophy of the nasal mucosa and absence of the frontal sinus. Treatment of these facial deformities is obviously surgical. In the present work, the authors describe, step by step, their technique in secondary rhinoplasty in a 36-years-old patient affected by Binder Syndrome. In this case, the authors used autologous cartilage graft and heterologous bone graft. Satisfying results are achieved in 12 months of follow-up: graft resorption is acceptable, position of the graft is stable, the authors have no signs of infection and the patient is satisfied with the aesthetical and functional results. The authors believe that the first option, in complex nose's reconstruction, is the use of autologous grafts but, the use of cartilage heterologous bone graft should be taken in account, in the future, as a secondary option in Binder Syndrome and in malformed patients.

• Angiomyolipoma of the Hard Palate

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Akçay, Hüseyin; Adak, Berat Metin

  Angiomyolipoma (AML) is a tumor which commonly affects the kidney. Few authors have been reported AML in the oral cavity. In this clinical report, an AML of the hard palate will be presented in a 48-year-old patient. The AML contains mature adipose tissue, thick-walled blood vessels, and irregular bundle of smooth muscle. The AML is sometimes associated with tuberous sclerosis. Although the renal AMLs are often invasive, they involve regional nodes and may recur, extrarenal AMLs are commonly well demarcated, show no recurrence and may simply be removed. The AML usually behaves in a benign fashion.

• The Pericranial Flap as a Salvage Procedure in Pediatric Neurosurgical Complications

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Karami, Reem A.; Atallah, Georgio M.; Ghanem, Odette Abou; Abu Sittah, Ghassan; Ibrahim, Amir E.

  The pericranium is a vascularized structure that can be used for the treatment of complex scalp and skull defects. It is also utilized as a prophylactic measure to prevent wound complications in high-risk patients. In this study, we looked at the use of the pericranial flap in pediatric patients. A retrospective chart review was done in the American University of Beirut Medical Center from February 2010 to 2020. Ten pediatric patients were identified who required either prophylactic pericranial flap (n  =  3) or for treatment of a chronic draining sinus (n =  7). Patients were followed up for an average of 23 days. There were no cases of infection, hematoma, seroma, or meningitis. Only 1 case developed dehiscence of the skin. It was managed conservatively and healed within 2 weeks. The pericranial flap is a workhorse flap for scalp and skull reconstruction, with no donor site morbidity and thus should always be considered.

• Endonasal Transpterygoid Surgery for Adult Mature Teratoma in the Sphenoid Bone

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Zhou, Yicui; Pan, Chunchen; Guo, Tao; Wang, Yinfeng; Zhao, Yi; Sun, Jingwu

  Teratomas are germline tumors commonly composed of multiple cell types derived from embryonic germ cell layers. Teratomas in head and neck region are exceptionally rare and present during the neonatal and infantile period. We describe a male adult with a mature teratoma originating from sphenoid body. A 24-year-old male patient presented with left-sided intermitted headache and facial numbness. Radiographic imaging showed a 3 cm × 2.3 cm mass with heterogeneous density in the sphenoid region. The endoscopic sphenoid sinus opening surgery was performed through endonasal transpterygoid approach. The final pathologic diagnosis was confirmed as mature teratoma. The patient has been followed-up for 18 months without recurrence. We suggest endonasal transpterygoid approach could be an effective and safe treatment for patients with mature teratoma in the sphenoid bone.

• Adults With Unilateral Cleft Lip and Palate Present Reduced Internal Nasal Volumes: Findings of a Three-Dimensional Morphometric Assessment in Cone-Beam Computed Tomography Scans

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  dos Inocentes, Renan Jhordan Mettelziefen; Marzano-Rodrigues, Maria Noel; de Espíndola, Guilherme Gonçalves; García-Usó, Michele; Yatabe-Ioshida, Marília Sayako; Trindade, Inge Elly Kiemle; Trindade-Suedam, Ivy Kiemle

  The main purpose was to assess and compare nasal cavity (NC) volumes among adults with unilateral (UCLP) and bilateral cleft lip and palate (BCLP) and in noncleft controls (CON), by means of cone-beam computed tomography (CBCT) three-dimensional reconstructions. Forty-five scans of individuals with class III skeletal pattern, matched by age, were gathered in 3 groups: UCLP (n = 15), BCLP (n = 15) and (CON) (n = 15). The NC volume was assessed three-dimensionally, using Dolphin 11.8 software. Descriptive normally distributed data was presented as mean (±SD). Comparisons of NC volume among groups was performed using ANOVA test (P ≤ 0.05). The NC mean volumes corresponded to 14.7(±2.2) cm3 (UCLP), 17.1(±2.2) cm3 (BCLP) and 18.1(±3.8) cm3 (CON), respectively. UCLP individuals presented a significantly reduced NC volume when compared to controls (P = 0.006). No differences were observed between UCLP versus BCLP or BCLP versus CON. The intraclass correlation coefficient suggested a high intra- and inter-examiners agreement (>.075). Individuals with unilateral cleft lip and palate presented reduced NC when compared to individuals without cleft lip and palate. CBCT scans can be considered a highly accurate tool for morphometric assessments of craniofacial structures.

• Familial Tuberculum Sellae Meningiomas

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Zhou, Peng; Wei, Li; Shi, Jia; Shao, Naiyuan

  Objectives: The aim of this study was to study and explore the genetic mechanism of familial meningiomas through 3 cases of familial tuberculum sellae meningioma. Methods: A retrospective analysis of clinical data of 3 cases of familial tuberculum sellae meningioma patients, and the pathological results of types and immunohistochemical results of the 3 patients were compare. Reults: Three cases of postoperative pathology were meningiomas (mixed type), immunohistochemical examination showed that Vimentin, epithelial membrain antigen , and Ki67 were positive. Conclusions: The occurrence of meningiomas is associated with ≥1 chromosomal deletions, and the absence of certain tumor suppressor genes may be the genetic basis for the familial growth of meningiomas.

• Implant-Supported Maxillary and Mandibular Rehabilitation in a Patient With Hallermann-Streiff Syndrome

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  von Marttens, Alfredo; Perilla, Andres; Wen, Schilin; Acuña, Pablo; Beltrán, Víctor

  Hallermann-Streiff syndrome is a rare congenital abnormality involving multiple craniofacial malformations, such as micrognathia, prominent frontal and nasal bones, vision defects, and dental anomalies. In most patients, patients affected with this disease have multiple dental problems involving a severe loss of teeth and maxillary atrophy. Specialized individual and multidisciplinary treatments are often required in these patients. The objective of this report was to demonstrate the rehabilitation approach of a patient with Hallermann-Streiff syndrome using total implant-support prostheses, with optimal aesthetic and functional results, which significantly improved the patient's quality of life.

• Roberts Syndrome With a Bilateral Cleft Lip and Palate

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Máximo, Geiza; Raposo-Amaral, Cesar Augusto; Paez, Ana Beatriz Affonseca; Raposo-Amaral, Cassio Eduardo

  Roberts syndrome (RBS) is a rare craniofacial anomaly associated with tetraphocomelia, growth and mental retardation, cardiac and renal abnormalities. The RBS is caused by homozygous mutation in the ESCO2 gene on chromosome 8p21. In this report, the authors describe a 5-year-old female infant with RBS and bilateral cleft lip and cleft palate, an extremely rare condition.

• Epidermoid and Dermoid Cysts of the Head and Neck

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Pupic-Bakrac, Jure; Pupic-Bakrac, Ana; Bacic, Ivan; Kolega, Marija Škara; Skitarelic, Neven

  Epidermoid and dermoid cysts (ECs and DCs) are congenital anomalies occurring in areas of embryonic fusion. Their incidence in the head and neck region is low and ranges from 1.6% to 7%. The aim of this study is to report on the clinical characteristics, treatment, and outcome of 22 patients from a single-institution experience. A retrospective analysis of patients treated for ECs and DCs of the head and neck over a 12-year period was performed. The present study included 22 patients (male/female ratio 1:1). The mean age of presentation was 11.68 years. The lesions were distributed in the orbital regions in 7 (31.82%) patients, auricular regions in 6 (27.27%), neck regions in 5 (22.73%), floor of the mouth in 3 (13.64%), and nose in 1 (4.55%). Complete surgical excision was performed as a definitive treatment method in 21 patients (95.45%). The mean size of the excised lesions was 21.36 mm at the widest length (range: 10–70 mm). On the basis of histopathological examinations, 15 (71.43%) lesions were classified as ECs and 6 (28.57%) as DCs. Post-operative complications were noted in 3 (14.29%) patients––2 (9.52%) with recurrences and 1 (4.76%) with hypertrophic scarring. All of these patients were successfully cured after a second surgery. The ECs and DCs of the head and neck present an interesting diagnostic and therapeutic challenge. Successful management depends on a thorough knowledge of their clinical and radiological features.

• A New and Different Lip Augmentation Material Containing Cartilagenous Tissues Harvested From Rhinoplasty

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Emsen, Ilteris Murat

  Lips are an important unit of the lower face. In the literatures, not so many augmentation methods are seen except the fat graft, filler material, alloplastic prosthesis, fascia grafts. Each one has both advantages and disadvantages. The most valuable method for lip augmentation should be minimally invasive, low cost, and resistant to resorption. The authors are presenting different and novel graft material for lip augmentation. The method has some important advantages such as both long lasting result and no cost, and not any donor area morbidity.

• Correction of Temporal Hollowing With the Superior Gluteal Artery Perforator Free Flap

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Lee, Yoon Jae; Lee, Chae Rim; Moon, Suk-Ho; Jun, Young Joon; Oh, Deuk Young

  Temporal hollowing is most frequently an acquired deformity and can be caused by volume defects of bone, soft tissue, or both. Recently, surgical reconstruction with autogenous fat or allografts has been introduced, but these materials can be resorbed over time and may also lead to infection. Herein, the authors present 2 cases demonstrating the treatment of temporal hollowing with a superior gluteal artery perforator (SGAP) free flap. Both patients had a history of traffic accidents and subsequent craniectomy because of subdural hemorrhage, followed by cranioplasty. An SGAP free flap was selected to reconstruct the soft tissue temporal defect in both patients. Pre-operatively, computed tomography (CT) angiography was used to locate the superior temporal artery (STA). A preauricular incision provided surgical access to the STA, and a subcutaneous pocket was created. The STA and SGAP artery and vein anastomoses were performed. Before flap insetting, it was de-epithelized, and its volume and shape trimmed to fit into the temporal defect. The patients' post-operative courses were without complications, and facial symmetry was achieved. This is the first case report describing the microvascular reconstruction of temporal hollowing with an SGAP free flap. The SGAP free flap is permanent and highly vascularized with no risk of infection. These case reports illustrate a unique reconstruction technique that resulted in a satisfactory outcome for the patients.

• First Report of Pai Syndrome With Upper Alveolar Cavernous Hemangioma: Diagnosis and Surgical Treatment

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Demir, Can Ilker; Yasar, Emrah Kagan; Bayrak, Büsra Yaprak; Isik, Halil; Alagöz, Murat Sahin

  This case describes the surgical methodology and the procedure for follow-up in a patient who had midline cleft of the upper lip, mid-alveolar cleft, double frenulum, and alveolar mass. Our patient is the first who meets the criteria for Pai syndrome with cavernous hemangioma and is also the fourth case with concomitant double frenulum.

• Skull Base Sphenoid Bone: A Potential Route of Brain Abscesses Induced by Odontogenic Infection

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Lou, Yiting; Feng, Bin; Hong, Hui; Ying, Binbin; Yu, Mengfei; Wang, Huiming

  Odontogenic foci are rarely linked with brain abscesses. The lack of an effective approach to match the causative origin with the infection can lead to late medical response of patients. Here we present a case of a 53-year-old man with brain abscesses that was probably caused by odontogenic foci. The imaging examinations clearly showed the periodontitis of mandibular left second molar and the destruction of greater sphenoid wing. Therefore, possible routes of extension through masticator space abscesses were indicated. For early infection of the maxillofacial space caused by potential odontogenic lesions, oral surgeons should eliminate the potentially odontogenic foci and use computerized tomography imaging to determine the existence of bone destruction around the oral cavity such as the skull to prevent further bone defect complications such as brain abscesses.

• Traumatic Buccal and Inferior Alveolar Pseudoaneurysm Associated With Von Willebrand Disease: A Challenging Case Treated by Endovascular Approach

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Vanzin, José Ricardo; Sawazaki, Renato; Manzato, Luciano Bambini; Giacomelli, Richard; Mileto, Tiago Nascimento; Yépez, Franklin David Gordillo; Santos, Moema Nenê

  Pseudoaneurysm resulting from the external carotid artery or its branches after trauma to the maxillofacial region is unlikely, even more so, in a patient with von Willebrand disease. This study aimed to report a challenging case of pseudoaneurysm of the buccal artery and inferior alveolar artery due to a mandible fracture in a traumatized patient with undiagnosed von Willebrand disease. This reported case was conducted by a multidisciplinary team, covering the departments of maxillofacial surgery, interventional neuroradiology, neurosurgery, and hematology. From a fracture of the lower jaw and the appropriate course of action, bleeding episodes followed until intervention with embolization therapy. To our knowledge, this is the first case reported in the literature of a patient with those conditions.

• Castleman Disease: An Unusual Cause of an Isolated Neck Mass

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Abuzayed, Bashar; Said, Anas; Jamous, Osama; Al-Abadi, Husesein; Al-Ashqar, Omar; Alawneh, Khaled

  A 15-year old female patient was complaining from swelling in the left side of the neck since 3 months. Physical examination showed palpable and mobile left supraclavicular neck mass in the carotid triangle, uvula deviation to the left side and normal vocal cords position and function. Neck imagings showed well-defined, well-encapsulated left neck mass in the left carotid sheath pushing the internal jugular vein anteriorly and the common carotid artery posteriorly. The mass was extending from the level of C4 superiorly and the supraclavicular region inferiorly. Patient was operated with left anterior approach and circumferential dissection and enucleation was performed. Post-operative period was uneventful and devoid of any complications or deficits. Histopathological examination revealed Castleman disease.

• Algorithm for Treatment of Supernumerary Nasal Tooth

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  de Souza Santos, Anderson Maikon; de Lima-Neto, Tiburtino José; Mendes, Bruno Coelho; Hochuli Vieira, Eduardo; Sverzut, Alexander Tadeu; Luna, Anibal Henrique Barbosa

  The presence of a tooth in the nasal cavity is a rare condition. There is an even more rare association, which is the presence with the mineral's deposition and formation of rhinoliths. This report shows a case of rare nasal tooth associated with rhinolithiasis and describes its surgical treatment based on an algorithm. The diagnosis was made by endoscopy with the aid of computed tomography, followed by surgical endoscopy excision. The algorithm and the proposed treatment was successful in its execution and the patient presents no complaints or complications at 3 years after surgery.

• Endoscopic Resection of a T-Shaped Benign Fibrous Histiocytoma at the Skull Base in a Pediatric Patient

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Li, Chen; Wang, Xingdong; Li, Yuping; Zhang, Xiaobiao; Dong, Lun; Zhang, Hengzhu

  Background: Benign fibrous histiocytoma (BFH) is a benign tumor composed of cells with characteristics of histiocytes and with fibroblastic components. BFHs are rare lesions, especially in the skull base. Clinical Presentation: Here, the authors report the case of a 9-year-old girl presented with reduced binocular vision for 2 months. The computerized tomography (CT) of the tumor appearance was high-density annular sclerosis. The tumor was removed via nasal endoscopic approach. Final pathologic diagnosis was benign fibrous histiocytoma. The post-operative period was uneventful after 8 months, and the visual acuity was improved to some extent. Discussion and Conclusion: This is the first case of BFH in a pediatric patient that was removed by endoscope. For similar case, endoscopic resection might be the first choice, including pediatric patient. Moreover, the CT feature and literature review may provide further insight into the diagnosis and management.

• Large Congenital Facial Teratoma Associated With Neurological Migration Disorder (Polymicrogyria) and Absent Corpus Callosum

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Kelemen, Noemi; Mota, Ashley; Bains, Robert D.; Liddington, Mark I.

  Background: Herein, the author report a severe case of large facial mixed germ line tumor associated with neuronal migration disorder, polymicrogyria, and corpus callosum agenesis. This specific association has not been reported as yet. Method: A 33-year-old primiparous woman at 38th week, delivered 3820 g male baby, via Cesarian section. Postpartum profuse bleeding was noticed from a large, ulcerative, 7 cm exophytic left facial mass, which was controlled nonoperatively. The treatment included surgical excision and 560 g of large facial tumor. Histology results revealed mixed germ line tumor with grade 3, immature teratoma. Results: Four months postoperatively the teratoma recurred in the buccal, tonsillar, and parapharyngeal areas. Fourteen months following the initial surgical excision the patient died from airway obstruction. Conclusion: Due to poor initial prognosis further treatment of the facial malignancy was not feasible. However, initial, early postnatal, excisional surgery provided a prolonged and better quality of life for the patient and family.

• Coexistence of Cerebral Calcified Cavernous Malformation and Developmental Venous Anomaly

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Aydin, Fahri; Ogul, Hayri

  Cerebral cavernous malformations are common vascular malformation of the central nervous system. It may cause various symptoms, such as seizures, intracranial hemorrhage, but most are asymptomatic and diagnosed incidentally. The authors present a case of a 75-year-old man who has a complaint about a headache. On radiological imaging, we descripted that the patient has a calcified cavernoma and a meningioma synchronously. Cavernoma with calcification associated with developmental venous anomaly is a rare condition.

• Clinical Evaluation a New Treatment for Infection After Ventriculoperitoneal Shunt

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Liu, Guanzheng; Liu, Junchao; Zhang, Haijun; Xue, Changli; Wu, Henghao; Zhang, Shengxu; Li, Gejun; Zhang, Wanhong; Zheng, Guangming

  To explore a new surgical treatment for infection and obstruction of ventriculoperitoneal shunt in hydrocephalus. Two cases of post-operative infection of ventriculoperitoneal shunt were analyzed retrospectively. One case was cryptococcal infection, the other case was Acinetobacter lwoffii. The number of cerebrospinal fluid cells was high, the infection of ventriculoperitoneal shunt was generally complicated with abdominal obstruction, and the hydrocephalus was aggravated again, The authors try to pull out the drainage tube at the end of abdominal cavity for external drainage, combined with intravenous antibiotics, completely control of infection, and then use the original shunt device for intraventricular jugular shunt. The authors explore that this method is simple, safe and effective, and it is an effective and feasible method for the treatment of infection after ventriculoperitoneal shunt.

• Endoscopic Orbital Reconstruction With Temporalis Muscle Flap

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Sibar, Serhat; Karasu, Oguzhan

  Temporalis muscle flap is one of the most commonly used flaps in orbital reconstruction. Although multiple case series in the literature have reported elevation of the flap with an open incision and a retrograde approach from the periorbital region, to the best of the authors' knowledge, no studies have reported the use of an endoscopic method. Therefore, the authors' study presents endoscopy-assisted temporalis muscle reconstruction of a defect that occurred in the periorbital region following orbital exenteration. Minimal scarring and morbidity are some of the advantages of endoscopic methods, and healing without complications was achieved in our patient during the postoperative period. To the authors' knowledge, their study is the first to report the use of temporalis muscle flap in endoscopy-assisted periorbital reconstruction, which is a preferred method for endoscopic surgery.

• Reconstruction of a Hemirhinectomy Defect Using a Three-Dimensional Printed Custom Soft Tissue Cutting Guide

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Brower, Jonathan P.; Crozier, Joseph W.; McIntire, Damon R. T.; Boyajian, Michael K.; Woo, Albert S.

  The 3-stage paramedian forehead flap is the gold standard for subtotal and complete nasal defects, but significant surgeon artistry and experience are required to achieve good, consistent results. The authors describe the use of virtual surgical planning and three-dimensional printing to create a patient-specific soft tissue cutting guide for the design of a forehead flap in the reconstruction of a hemirhinectomy defect. Application of this technology to these challenging reconstructive scenarios promises to improve accessibility and consistency of results.

• Management of Proximal Segment of the Anterior Cerebral Artery Aneurysms

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Jin, Ke; Jin, Yichao; Lv, Tao; Xiao, Zhipeng; Zhang, Xiaohua

  The authors reported 2 cases with proximal anterior cerebral artery (A1) aneurysms, and one was treated with aneurysm clipping, whereas another was treated with coil embolization. The authors suggest both endovascular surgery and aneurysm clipping are good options for A1 aneurysms.

• Anterior Cartilage Rasping During Otoplasty Performed With an Adson Brown Cartilage Forceps

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Rauso, Raffaele; Lo Faro, Carmelo; Rugge, Luigi; Califano, Luigi; Tartaro, Gianpaolo

  Protruding ears are a common occurrence and can affect the aesthetics and psychosocial aspects of patients. Hundreds of procedures have been described over the years to correct the 2 main deformities related to protruding ears: conchal hypertrophy and anti-helical fold absence. For the rasping technique, the rasp is inserted posteriorly, from the side where the skin is excised; The ending part of the forceps looks like a small rasp, it worked very well and the surgery was completed without problems The authors think this tip could be a useful "tool" for all the surgeons used to perform cartilage rasping "in case of necessity" when rasp is not available.

• A New Surgical Method for Medial Ectropion Repair: Fixing the Lower Eyelid Retractor to the Back of the Tarsal Plate

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Kokubo, Kenichi; Katori, Nobutada; Hayashi, Kengo; Fujii, Akiko; Kitamura, Sho; Maeda, Chie; Haga, Shoko; Kawabata, Tomotaka; Maegawa, Jiro

  Involutional ectropion is a disease in which the eyelids are everted outwards, and because the eyelids move away from the eyeballs, the ocular surface and conjunctiva are exposed causing inflammation, pain, photophobia, foreign body sensation, epiphora, and blurred vision. It is thought to be caused by horizontal and vertical laxity. Various surgical methods have reportedly been used to correct involutional ectropion. Shortening the lower eyelid retractor (LER) is an indispensable surgical operation for medial ectropion. When the LER is shortened, it is usually fixed to the lower edge of the tarsal plate. Herein we describe a new type of surgery that has now been performed on 6 eyes in 4 patients. The procedure involves separating the conjunctiva from the tarsal plate, inserting the LER between the conjunctiva and the tarsal plate, and then fixing it to the back of the tarsal plate. In all 6 eyes, the lower eyelid now contacts the eyeball, and morphological improvements were achieved. This new surgical method is a useful way to raise the tarsal plate.

• Cranioplasty for Skull Defect With Polypropylene Abdominal Wall Mesh

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Abuzayed, Bashar; Al-Abadi, Husesein; Jamous, Osama; Said, Anas; Alawneh, Khaled

  Cranioplasty is a routine procedure in the practice in neurosurgery and craniofacial surgery. For the closure of the cranial defect, it may be difficult or impossible to split the bone sufficiently to obtain enough bone for complete closure of the defect in younger children. Thus, sometimes there is the need to use allografts, which may not be widely available in rural practice. We present 2 cases of cranioplasty with widely available and used polypropylene abdominal wall mesh. To add rigidity to the construct, the mesh was organized in a multilayered fashion. Postoperative follow-up showed good functional and cosmetic results.

• Pre-Planned Cranioplasty Using Computer-Assisted Designed Temporalis Muscle Augmentation in Patients With Decompressive Craniectomy Involving Resection of the Temporalis Muscle

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Park, Gwangtae; Kim, Jonghoon; Chang, Chulhoon; Jung, Youngjin

  Background: Decompressive craniectomy (DC) is the last-resort surgical procedure to reduce intracranial pressure and prevent secondary brain injury. Additional resection of the temporalis muscle and fascia can achieve a higher extracranial herniation volume compared to the standard DC technique at the expense of cosmetic problems for the patients. Various methods have been used to augment temporal fossa hollowing. Methods: To improve the cosmetic outcome, the authors report a patient who had a skull defect restored using a precisely shaped implant engineered via a computer using the opposite temporalis muscle as a mirror image. Polyether-ether-ketone cranioplasty was performed for the 52-year-old man with temporal hollowing after DC with resection of the temporalis muscle and fascia, due to a ruptured cerebral arteriovenous fistula. Results: The shape of the patient's surgical side was restored and not asymmetrical. The patient was very satisfied Conclusion: In the case of cranioplasty (CP) in patients with DC with resection of the temporalis muscle, CP with implants that include the opposite muscle may increase patient satisfaction without the risk of additional complications.

• Progressive Postnatal Pansynostosis in Crouzon Syndrome

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Geisler, Emily L.; Hallac, Rami R.; Perez, Jeyna K.; Kane, Alex A.

  Crouzon syndrome is a known craniosynostosis syndrome with a heterogenous presentation. Suture closure can rapidly develop postnatally and involve multiple sutures, requiring vigilant clinical monitoring to prevent delay in diagnosis and developing intracranial hypertension. The authors present the case of a male patient with Crouzon syndrome who developed postnatal pansynostosis at 18 months of age when several missed appointments led to diagnosis after complete closure of all sutures and signs of elevated intracranial pressure. Posterior cranial vault distraction was performed soon after, and the patient improved clinically. There is a need for improved monitoring and management of these patients to prevent delay in diagnosis and potential permanent sequelae as well as minimizing radiation exposure through watchful CT scanning.

• Three-Dimensional Analysis of Craniofacial Structures of Individuals With Nonsyndromic Unilateral Complete Cleft Lip and Palate

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Parveen, Shahistha; Husain, Akhter; Johns, Gejo; Mascarenhas, Rohan; Reddy, Srinivas Gosla

  Cleft lip and palate (CLP) is one of the most common congenital deformities. Primary surgeries at an early age result in scar formation, which may impede the growth of craniofacial structures of the maxilla. Orthodontist's role in the management of individuals with CLP is important and starts from the time of birth. The knowledge of craniofacial structures in individuals with a cleft is essential for treatment planning. The purpose of this study was to analyze and compare craniofacial structures of cleft and noncleft side of individuals with non-syndromic unilateral complete cleft lip and palate (NSUCCLP) using cone-beam computed tomography (CBCT). CBCT scans of individuals with NSUCCLP (n = 42) were retrieved from the databases of two cleft centers, which followed the same protocols for timing and type of primary surgeries and secondary alveolar bone grafting (SABG). DICOM files of CBCT scans were integrated into Dolphin 3D software, and analysis was carried out in multiplanar views. The craniofacial structures of individuals with NSUCCLP were analyzed using fourteen parameters. Measurements were also recorded between the cleft and noncleft sides for comparison. The volume of the maxilla was generated by isolating it from adjacent structures on a 3D reconstructed model. MAWC, MAWPM1, MAWPM2, MAWM1, and MV of the cleft side was less than noncleft side (P < 0.05). MHP @ N Aper is less on the noncleft side (P < 0.05). There is an asymmetry of structures around the dentoalveolar and nasal region; however, asymmetries were not affected at deeper structures of the craniofacial region of individuals with NSUCCLP.

• Orbitofrontal Reconstruction With a Three-Dimensional Titanium Patient-Specific Implant After Intraosseous Haemangioma Resection

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Sesqué, Alexandre; Dang, Nathalie Pham; Coste, Aurélien; Barthélémy, Isabelle; Depeyre, Arnaud

  Background: Intraosseous hemangiomas are rare benign tumors that can develop in the skull. Orbitofrontal localization is uncommon. The complexity of orbitofrontal anatomy results in difficult reconstruction following trauma or tumoral resection. Case presentation: A 50-year-old woman with a right orbitofrontal intraosseous hemangioma was referred to our department. The authors decided to perform tumoral bone resection and orbitofrontal reconstruction using virtual surgical planning in collaboration with Materialize engineers (Materialise, Leuven, Belgium). Three cutting guides and a patient-specific 3-dimensional (3D) titanium implant were designed and manufactured in 3 weeks. Surgery was performed with a double surgical team composed of maxillofacial surgeons and neurosurgeons. No perioperative or post-operative complications occurred. Post-operatively, the patient was completely asymptomatic and clinical examination showed symmetrical and satisfactory facial morphology. Conclusion: Virtual surgical planning, design of patient-specific guides and manufacturing of implants make surgery easier and increase surgical precision. This technique is recommended for wide use in cases of oncological or complex trauma craniomaxillofacial reconstruction.

• Enhanced Recovery After Surgery Protocol for Primary Cleft Palate Repair: Improving Transition of Care

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Moffitt, Joseph K.; Cepeda, Alfredo Jr; Ekeoduru, Rhashedah A.; Teichgraeber, John F.; Nguyen, Phuong D.; Greives, Matthew R.

  Background: Enhanced recovery after surgery (ERAS) protocols have been adopted for many types of surgery. Postoperative pain following palatoplasty may cause feeding and swallowing difficulty. Our study evaluated the use of ERAS protocols to improve the management of pain following primary palatoplasty as well as in the transition of care from inpatient to outpatient. Methods: An Institutional Review Board approved retrospective analysis was performed for patients who previously underwent primary palatoplasty before ERAS implementation. Separately, an Institutional Review Board approved prospective trial of patients undergoing primary palatoplasty was performed and these patients were managed with ERAS protocols. Data were obtained for length of stay, pain scale scores, milligrams of morphine administered, and inpatient readmissions/emergency department visits. Outpatient medication logs were used to follow pain medicine usage, and a satisfaction survey was administered at the first postoperative visit. Results: Data were obtained retrospectively for 56 patients and prospectively for 57 patients who underwent primary palatoplasty. Patients in the ERAS protocol received significantly less milligrams of morphine on postoperative day 1 through day 4 than those patients in the usual care group P < 0.05. No significant difference was observed for length of stay, oral intake prior to discharge, or inpatient face, legs, activity, cry, consolability pain scale scores. Outpatient medication logs showed a continued decrease in narcotic usage at home with no spike post discharge day 1. Parents reported high satisfaction levels for inpatient pain management (4.66 ± 0.49) and even higher satisfaction levels for understanding (5.0 ± 0) and management of pain at home (4.92 ± 0.29). Return visits to the hospital for pain management following primary palatoplasty decreased from 7.1% (4) following the previous protocol to 0% with the new ERAS protocol (P = 0.057). Conclusion: The ERAS protocols provide improved inpatient pain management following primary palatoplasty as evidence by decreased total narcotic pain medication usage. The use of multimodality therapy and increased patient education regarding non-narcotic medications can improve the transition of care from inpatient to outpatient, without sacrificing patient/parent satisfaction. The results of this study merit future study into more restricted use of opioid pain medications with greater emphasis on the use of multimodal therapeutics as primary agents as opposed to adjuncts.

• Discussion of Enhanced Recovery After Surgery Protocol for Primary Cleft Palate Repair: Improving Transition of Care

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Rossell-Perry, Percy

  No abstract available

• Advantages of Small Bone-Window Craniotomy Under Microscope Combined Postoperative Intracranial Pressure Monitoring in the Treatment of Hypertensive Intracerebral Hemorrhage

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Men, Donghai; Huang, Zixiong; Yin, Yanqing; Wu, Weichuan; Li, Wensheng; Liu, Huanqiang; Xu, Chengjie

  Objective: The aim of this study is to analyze the clinical effect of small bone-window craniotomy with microscope combined postoperative ICP monitoring, and further explore an appropriate treatment for HICH patients. Methods: One hundred fifty patients with HICH were selected according to inclusion and exclusion criteria and divided into 3 groups at random, 50 each group. Patients in 3 groups were treated with conventional craniotomy, small bone-window craniotomy and small bone-window craniotomy combined ICP monitoring respectively. The surgical efficiency, treatment effect and outcomes were recorded and analyzed. Results: The intraoperative blood loss and operation time of small window groups were significantly less than that of conventional group, and the hematoma clearance rate in small window groups were significantly higher than in conventional group (P < 0.05). Compared with conventional group, the hospital stays and mannitol dose used were less in small window groups and least in small window combined ICP monitoring group (P < 0.05). The complication rate in small window combined ICP monitoring group was 10%, which was significantly lower than in conventional group (26%, P < 0.05), while no significant difference was found between small window group (18%) compared with the other 2 groups respectively (P > 0.05). The difference of morality rate between 3 groups wasn't significant (P > 0.05). Three treatment significantly increased the Barthel index score, and the improvement of small window combined ICP monitoring group was significantly higher than in other 2 groups respectively (P < 0.05), while the difference between this two groups wasn't significant (P > 0.05). Conclusion: Small bone-window craniotomy is more efficient and convenient than conventional craniotomy in the treatment of HICH. In the meantime, small bone-window craniotomy simultaneous with ICP monitoring significantly improved clinical effect and treatment outcomes of HICH patients.

• The Oculocardiac Reflex: Its Evolution and Management

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Yoo, Jason J.; Gishen, Kriya E.; Thaller, Seth R.

  Introduction: The oculocardiac reflex is initiated by a pressure stimulus to the orbit or periorbital structures causing in bradycardia transmitted via the trigeminal-vagus nerve reflex arc. While this most frequently occurs with ophthalmologic surgeries, trauma to the orbit and periorbital structures can result in bradycardia and even in some cases, asystole. The aim of this case report and review of the literature is to identify and examine recent studies of the oculocardiac reflex related to facial trauma and to identify associated patient age, symptoms, and fracture patterns. Methods: A literature search was performed using the database within PubMed.gov using the term "oculocardiac." Results were reviewed for case reports or series related to facial trauma from the year 2000 to 2019. Studies were then evaluated for fracture pattern, presence of entrapment, patient symptoms, and age. Results: The initial search resulted in 109 articles. A total of 22 articles were case reports or series of trauma patients. Twenty articles met inclusion criteria. Median age was 22 years. Eleven patients sustained orbital floor fractures. Four patients sustained medial wall fractures. Three patients had concomitant orbital floor and zygomatic fractures, and 4 with concomitant orbital floor and medial wall fractures. The most common extracardiac symptom experienced was nausea and vomiting (15/23) followed by diplopia (10/23). Status of entrapment was available in 20 patients of which entrapment was reported in fourteen (14/20). Clinical Report: A 26-year old male presents after blunt trauma to the face resulting in a left orbital floor, rim, and maxillary fractures. Extraocular movements were initially intact and the patient had no diplopia. He developed bradycardia to 30 to 40 bpm just prior to induction of anesthesia. He was found to have developed entrapment of the inferior rectus muscle. The orbital floor and rim were repaired with complete resolution of bradycardia. Conclusion: Patients who sustain maxillofacial trauma involving the orbit are at risk of developing the oculocardiac reflex. Patients tend to be younger. The orbital floor is more commonly the site of traumatic injury. Nausea and vomiting are common encountered symptoms. The oculocardiac reflex, clinicians must recognize, is not static but may evolve over a patient's clinical course as seen in our patient.

• Cleft Lip Repair in Premature Infants With Cardiac Risk Factors

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Kalmar, Christopher L.; Patel, Vijay A.; Taylor, Jesse A.

  Despite cleft lip repair having demonstrated safety when performed in the outpatient setting, patients with comorbidities are significantly more likely to be hospitalized overnight. There are several comorbidities overrepresented with inpatient admission, but only cardiac risk has any association with adverse outcomes in premature patients. The severity of cardiac risk is significantly associated with adverse events at all degrees of prematurity (P all ≤0.002). In premature patients with major cardiac risk factors, adverse events are significantly associated with younger age (P = 0.016) and lower weight (P = 0.013). Performing cleft lip repair on children older than 125 days (P < 0.001, before cutoff: 50.0% vs after cutoff: 6.4%) and weight greater than 10 lbs (P < 0.001, before cutoff: 56.4% vs after cutoff: 6.1%) provides a significant reduction in postoperative adverse events in premature patients with major cardiac risk factors.

• Oral Surgery in Patients With Sturge-Weber Syndrome

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Carvalho, Vinícius Almeida; Dallazen, Eduardo; Statkievicz, Cristian; da Rosa, Denise Furtado; Stabile, Glaykon Alex Vitti; Pereira-Stabile, Cecilia Luiz; Iecher Borges, Hedelson Odenir

  The Sturge-Weber syndrome (SSW) is a congenital neurocutaneous malformation, with angiomas involving the leptomeningea and facial skin. This syndrome is characterized by corticocerebral angiomatosis, cerebral calcifications, ocular affections, mental retardation, increased risk of stroke, counterlateral hemiplegia, and seizures. Another important feature of SSW is the flameus nevus on the face. In the oral cavity, SSW appears as hemangiomatous lesions affecting the mucous membranes and occasionally the dental pulp. Gingival hyperplasia may be present due to the use of anticonvulsant drugs. The present article reports the management of 2 female patients with Sturge-Weber syndrome who required oral surgery in regions affected by hemangiomatous lesions. In the first case, no hemostatic agents were necessary. On the other hand, the second case required the use of several hemostatic agents to control hemorrhage during surgery. Both patients recovered uneventfully without episodes of bleeding or infection.

• Ossified Encapsulated Cephalhematoma

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Chaisrisawadisuk, Sarut; Tiong, Hung Bing; Lipsett, Jill; Anderson, Peter J.

  Ossified cephalhematoma is a rare congenital condition that may be found if newborn cephalhematoma is not resolved. Here, however, the authors report an exceptional case of an 8-month-old baby presenting with an ossified cephalhematoma in the right parieto-occipital area. Pre-operative imaging showed a calcified subperiosteal hematoma. He underwent hematoma excision with bone contouring procedures. A histopathological study showed hemosiderin-laden macrophages with blood and pseudocyst walls. The authors also discuss the possible pathogenesis of the ossified cephalhematoma and its treatment.

• Open Reduction and Internal Fixation Strategy For Treatment of Comminuted Mandibular Fracture

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Ma, Yanbo; Hao, Xiuyan; Zhao, Yantao

  Purpose: The aim of this study was to evaluate the treatment strategy of open reduction and internal fixation (ORIF) for comminuted mandibular fracture (CMF). Methods: Clinical studies about CMF were collected. Detailed information was extracted, and data were analyzed and merged from included articles. Results: Twelve studies, including 338 patients with CMF, were reported. A total of 256 patients receive ORIF among these 338 patients, and exhibited followed characteristics: ORIF usually were performed several days after injury; the extraoral approach for ORIF was used for 103 patients among 205 patients who received ORIF with definite information about surgical approach; titanium mesh, or reconstruction plate, combined with mini-plates was used in 17 and 194 patients, respectively; intermaxillary fixation (IMF) usually persisted about 1 to 3 weeks after ORIF; most patients exhibited satisfactory effect without serious complications, and the complication rate varied from 0 to 42%. Conclusions: ORIF strategy for treatment of CMF including: ORIF was a priority choice for CMF. ORIF usually was performed at several days after injury. Reconstruction plate, or titanium mesh, combined with mini-plates was recommended for ORIF surgery. After ORIF, IMF usually was recommended for about 1 to 3 weeks.

• Posterior Based Triangular Mucosal Advancement Flap for Surgical Correction of Scleroderma-Induced Microstomia

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Kao, Tuan-Yu; Kim, Tae-Seup; Alqussair, Ali; Choi, Jin-Young

  Systemic sclerosis is a complex autoimmune connective tissue disease of unknown cause that causes sclerosis and inflammation of the skin and subcutaneous tissue. Sclerosis involving the face can lead to microstomia, leading to difficulties with mastication, phonation, and oral hygiene. Although many agents have been used to treat internal organ involvement, they often have compromised efficacy on cutaneous manifestation including facial dermal sclerosis. In this case presentation, we will introduce a surgical technique to correct scleroderma-induced microstomia.

• An Investigation of Tongue-Palatal Contact Changes in Patients With Skeletal Mandibular Lateral Deviation After Sagittal Split Ramus Osteotomy

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Kaku, Masato; Kojima, Shotoku; Yamamoto, Ichiro; Yamamoto, Taeko; Kagawa, Haruka; Shimoe, Saiji; Tanimoto, Kotaro

  This study aimed to investigate the changes in tongue-palatal contact patterns in patients with mandibular lateral deviation by electropalatography (EPG) before and after sagittal split ramus osteotomy (SSRO). Ten mandibular asymmetry patients who underwent SSRO participated in the study. Tongue-palatal contact patterns for the production of /t/ and /s/ sounds were observed using EPG before surgery and 3 months after surgery, and the changes in EPG pattern were examined. The number of electrode contacts in the 2 vertical columns of the EPG plate was calculated both in the mandibular deviation side and the nondeviation side. The EPG patterns for /t/ and /s/ showed asymmetry before surgery but became normal after surgery. Before surgery, the number of electrode contacts in the 2 vertical columns in the mandibular deviation side was significantly lower than that in the nondeviation side and the normal participants during /t/ and /s/ articulation. However, the number of electrode contacts in the deviation side significantly increased after surgery. This study demonstrated that the tongue-palatal contact patterns for /t/ and /s/ articulation shifted to the direction of mandibular deviation and improved after SSRO.

• Columellar Wound Immediately After Open Rhinoseptoplasty Treated With Application of DuoDERM Extra Thin

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  In, Seung Min; An, Hong Geun; Kim, Jong-Yeup; Lee, Ki-Il

  Most patients who undergo open rhinoseptoplasty do not develop any wound at the transcolumellar incision site. However, some patients require wound care immediately post-operation. Dressing is difficult to perform in the columellar region because of the location. Here, we report 2 cases of columellar wound as a complication of open rhinoseptoplasty. A patient developed mild wound dehiscence immediately after primary rhinoseptoplasty, whereas another developed partial columellar skin necrosis after the revision operation. We applied DuoDERM Extra Thin dressing (ConvaTec Group, Deeside, UK) for columellar wound and achieved healing. DuoDERM Extra Thin can be a simple and easy dressing material for immediate care of transcolumellar wounds.

• A Rare Complication of Tonsillectomy: Glossopharyngeal Neuralgia

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Erdogan, Banu Atalay; Batum, Kübra

  Tonsillectomy is one of the most frequently performed surgical operations in otolaryngology clinics. While postoperative pain is frequently encountered, severe pain such as glossopharyngeal neuralgia is extremely rare.

• Management of an Unusual Blow-In Orbital Roof Fracture Associated an Intracranial Hematoma

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Pereira, Rodrigo dos Santos; Silva, Jonathan Ribeiro da; Guerra, Raphael Capelli; Ferreira, Túlio Vidal; Mota, João Manoel; Latini, Gustavo Lima

  Pure orbital wall fractures represent until 25% of the facial fractures and its reconstruction it's considering a challenge for the maxillofacial surgeons. There are many biomaterials used to repair these fractures according to the literature however, the most common are the titanium mesh and autogenous bone graft. The aim of this work is to report a rare case of blow-in roof orbital fracture associated to an intracranial hematoma in the cranium base.

• Posttraumatic Giant Intradiploic Epidermoid Cyst of Orbital Roof

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Zhang, Feng; Xu, Yi-Nong; Zhao, Wei; Wang, Yu-Hai; He, Jian-Qing

  Epidermoid cysts are rare benign tumors that account for 0.3% to 1.8% of all intracranial space-occupying lesions. They are usually congenital in origin and are thought to derived from ectodermal cell inclusions occurring during closure of the neural tube around third to fifth week of gestation. They are most commonly located in the cerebellopontine angle and the parasellar area, and their location in the diploic space is very rare. In this article, a case of giant epidermoid cyst located in the orbital roof intradiploic space is presented with clinical, radiologic features and surgical treatment.

• A Simple Solution for Infractured Lateral Nasal Osteotomy Lines During Revision or Primary Rhinoplasty: Osseos Stabilization With Polydioxanone Sutures

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Yasar, Emrah Kagan; Demir, Can Ilker; Alagoz, Murat Sahin

  In addition to precautions taken with perioperative surgical techniques, nasal packing and external nasal splinting are frequently employed to ensure the stability of the nasal bones following osteotomies performed during rhinoplasty. However, despite these precautions, nasal bone fragments, generally caused by trauma or healing problems, can approach the midline, progress in a posterior direction and heal with malunion in an infractured manner. Since cavities on the infractured side can result in asymmetries and/or airway narrowing, revision osteotomy is required to correct these problems. Subsequent potential recurrent infractures caused by nasal fragments can easily be prevented with late-absorbed sutures passing through the neighboring holes and opening near the osteotomy lines. This technique would be useful for both primary and secondary rhinoplasty, but especially in secondary rhinoplasty operations. (Level of Evidence: Level IV)

• Circumscribed Myositis Ossificans of the Masseter Muscle

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Li, Yang; Park, Hong-Ju; Jung, Seunggon; Kook, Min-Suk

  The authors report a case of myositis ossificans traumatica of the masseter muscles. A 21-year-old man developed masseter myositis after orthognathic surgery to treat facial asymmetry. The myositis may have been triggered by factors such as calcification of a hematoma, periosteum implantation after surgical trauma, and local soft tissue injury. An intraoral incision was made to excise the ectopic bone, resulting in resolution of the patient's symptoms including limited oral opening.

• A Guide to Developing Safety Protocols for International Craniofacial Outreach Programs During the COVID-19 Era

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Salehi, Parsa P.; Johnson, Adam B.; Rubinstein, Brian; Pahlavan, Nima; Azizzadeh, Babak; Hamdan, Usama S.

  The ongoing COVID-19 outbreak has created obstacles to health care delivery on a global scale. Low- and middle-income countries (LMICs), many of which already suffered from unmet surgical and medical needs, are at great risk of suffering poor health outcomes due to health care access troubles brought on by the pandemic. Craniofacial outreach programs (CFOP)—a staple for craniofacial surgeons—have historically provided essential care to LMICs. To date, there has not been literature discussing the process of resuming CFOP mission trips. Herein, we propose a roadmap to help guide future journeys, as well as summarize practical considerations.

• Etiogenic Mechanisms for Dysgeusia in SARS-CoV-2 Infection

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Harikrishnan, Pandurangan

  No abstract available

• The Importance of Dental Military Officers During the COVID-19 Pandemic

  Fri, 01 Jan 2021 00:00:00 GMT-06:00
  Galletti, Cezar Angelo Jr; Correa, Ademir Euzebio; Ogata, Celso Komoguchi; Oliveira, Adriana Maria Finotti Fernandes; de Oliveira, Mauricio Santos; de Oliveira, Maria Cecilia Querido

  No abstract available

  

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