| 1. |
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| 2. |
- Alinasab, Babak, et al.
(författare)
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The Supratarsal Approach for Correction of Anterior Frontal Bone Fractures
- 2018
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Ingår i: The Journal of Craniofacial Surgery. - Philadelphia, PA : Lippincott Williams & Wilkins. - 1049-2275 .- 1536-3732. ; 29:7, s. 1906-1909
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Tidskriftsartikel (refereegranskat)abstract
- Background: To approach isolated anterior frontal bone fracture, coronal incision is the common surgical access of choice. This approach has complications such as aesthetically undesirable scarring and alopecia along the incision line. An alternative approach to these fractures is through a supratarsal incision. The aim of the present study was to correct the frontal bone fracture, through supratarsal approach.Methods: Six consecutive patients with frontal bone fracture were operated through supratarsal incision and evaluated regarding: patient cosmetic satisfaction, forehead contour, scarring, sensibility and motility in forehead and upper eyelids.Results: Seven months (6–12) postoperatively, all the patients had normal mobility in the forehead and the upper eyelids and 17% (n = 1) had hypoesthesia of superior orbital nerve. The forehead contour was excellent in all patients. About 83% (n = 5) of the patients were very satisfied and 17% (n = 1) were satisfied with the surgical result.Conclusion: Correction of anterior frontal bone fracture through a supratarsal approach appears to be safe and offers a sufficient exposure to the frontal bone fracture correction with excellent contouring results and no noticeable scarring.
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| 3. |
- Ashammakhi, Nureddin, et al.
(författare)
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Modelling Brain in a Chip
- 2023
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Ingår i: The Journal of Craniofacial Surgery. - : Ovid Technologies (Wolters Kluwer Health). - 1049-2275 .- 1536-3732. ; 34:3, s. 845-847
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 4. |
- Consolo, Ugo, et al.
(författare)
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Histologic and Biomechanical Evaluation of the Effects of Implant Insertion Torque on Peri-Implant Bone Healing
- 2013
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Ingår i: The Journal of craniofacial surgery (Print). - : Lippincott Williams & Wilkins. - 1049-2275 .- 1536-3732. ; 24:3, s. 860-865
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to evaluate histologically and biomechanically the peri-implant bone healing around implants placed with high torque after a follow-up of 8 and 12 weeks. A total of 12 implants were placed in the lower edge of the mandible of 2 sheep. In each sheep, 3 implants were placed with a low torque (<25 N center dot cm, LT group) as a control, and 3 implants were placed with a high insertion torque (maximum torque, HT group). The sheep were killed after 8 and 12 weeks of healing, and the implants were examined for removal torque, resonance frequency analysis, and histologic analysis. The mean insertion torque in the LT group was 24 N center dot cm, whereas it was 105.6 N center dot cm in HT. All the implants osseointegrated and histologic analysis showed similar aspects of the peri-implant bone tissue for both groups and both healing times. Mean removal torque values for LT implants were 159.5 and 131.5 N center dot cm after 8 and 12 weeks, respectively, whereas those for the HT were 140 and 120 N center dot cm at 8 and 12 weeks, respectively. Implant stability quotient values were 26.6 and 76 for the LT group and 74 and 76 for the HT group at 8 and 12 weeks, respectively. It could be concluded that high implant insertion torque does not induce adverse reaction in cortical bone and does not lead to implant failure.
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| 5. |
- Demirtas, Nihat, et al.
(författare)
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Recurrent cherubism in an adult patient
- 2015
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Ingår i: The Journal of craniofacial surgery (Print). - : Lippincott Williams & Wilkins. - 1049-2275 .- 1536-3732. ; 26:3, s. E225-E227
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Tidskriftsartikel (refereegranskat)abstract
- Cherubism is an uncommon, nonneoplastic, fibro-osseous disorder of the jaws in childhood and adolescence. It affects the jaw bones by deforming the cortical shell. Clinical features include progressive painless and mostly bilateral expansion of the mandible and/or maxilla. Because fibrous connective tissue replaces osseous tissue, radiographic features generally include expansile osteolytic lesions and a ground-glass appearance. Several treatment protocols for cherubism have been recommended in the literature; however, despite surgical curettage treatment, recurrences may occur. Our aim was to emphasize the high recurrence rate of cherubic lesions. In this article, we present cherubism in a young girl that relapsed after 5 surgical operations before her appearance to our clinic.
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| 6. |
- Ellabban, Mohamed A., et al.
(författare)
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Assessment of Freestyle Local Facial Perforator Flaps for Coverage of Facial Defects
- 2021
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Ingår i: The Journal of Craniofacial Surgery. - : Wolters Kluwer. - 1049-2275 .- 1536-3732. ; 32:2, s. e122-e125
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To assess local freestyle facial perforator flaps in the reconstruction of small to medium-sized facial defects.MATERIALS AND METHODS: In a case series, local freestyle perforator flaps were used in Suez Canal University Hospital to reconstruct 28 facial defects in 26 patients between 2017 and 2019. Adequate perforators were identified near those defects and flaps were designed as propeller or VY advancement. Four scales from the FACE-Q (satisfaction with facial appearance, satisfaction with the outcome, psychological function, and appearance-related psychosocial distress) and 2 scales from the SCAR-Q (Appearance scale and Symptom scale) were used as well as the observer part of the Patient and Observer Scar Assessment Scale. The mean follow up period was 10 months.RESULTS: Complete reconstruction was achieved in all cases with a high rate of patient satisfaction which was assessed by FACE-Q and SCAR-Q. Moreover, observer assessment by Patient and Observer Scar Assessment Scale score showed high patient satisfaction with the scars with a mean (SD) 15.5 (3.4) and there was a positive correlation between subjective and objective: results (r2 from 0.27 to 0.41, P < 0.01). Regarding complications, bulkiness occurred in 2 flaps, congestion in 2 flaps, dehiscence in 1 flap, and tip necrosis in 5 flaps. Accordingly, secondary intervention in the form of medicinal leech therapy was used in 3 flaps, delayed closure for the dehisced flap and debulking for 1 flap.CONCLUSIONS: Local freestyle perforator flap reconstruction is one of the recommended techniques for small to medium-sized facial defects which gives a high aesthetic outcome and patient satisfaction.
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| 7. |
- Engstrom, Olof, et al.
(författare)
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Proboscis Lateralis : A Novel Surgical Technique Using Tape Elongation and One-Stage Tunneling
- 2022
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Ingår i: The Journal of Craniofacial Surgery. - : Ovid Technologies (Wolters Kluwer Health). - 1049-2275 .- 1536-3732. ; 33:4, s. E438-E439
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Tidskriftsartikel (refereegranskat)abstract
- Proboscis lateralis is a rare craniofacial anomaly characterized by a tubular, trunk-like appendage, often arising from the medial canthal region. It can occur in isolation or in association with a variety of other anomalies. Several treatment options have been described depending on the characteristics of the defect, but due to its infrequency, the body of knowledge is limited. Here, the authors present a case of proboscis lateralis in an 18-month-old girl, being successfully treated with a novel technique including tape elongation and a 1 stage tunneling procedure.
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| 8. |
- Gaillard, Linda
(författare)
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A Photo Score For Aesthetic Outcome In Sagittal Synostosis : An ERN CRANIO Collaboration.
- 2023
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Ingår i: The Journal of Craniofacial Surgery. - 1049-2275 .- 1536-3732.
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Tidskriftsartikel (refereegranskat)abstract
- European Reference Network (ERN) CRANIO is focused on optimizing care for patients with rare or complex craniofacial anomalies, including craniosynostosis and/or rare ear, nose, and throat disorders. The main goal of ERN CRANIO is to collect uniform data on treatment outcomes for multicenter comparison. We aimed to develop a reproducible and reliable suture-specific photo score that can be used for cross-center comparison of phenotypical severity of sagittal synostosis and aesthetic outcome of treatment. We conducted a retrospective study among nonsyndromic sagittal synostosis patients aged <19 years. We included preoperative and postoperative photo sets from 6 ERN CRANIO centers. Photo sets included bird's eye, lateral, and anterior-posterior views. The sagittal synostosis photo score was discussed in the working group, and consensus was obtained on its contents. Interrater agreement was assessed with weighted Fleiss' Kappa and intraclass correlation coefficients.The photo score consisted of frontal bossing, elongated skull, biparietal narrowness, temporal hollowing, vertex line depression, occipital bullet, and overall phenotype. Each item was scored as normal, mild, moderate, or severe. Results from 36 scaphocephaly patients scored by 20 raters showed kappa values ranging from 0.38 [95% bootstrap CI: 0.31, 0.45] for biparietal narrowness to 0.56 [95% bootstrap CI: 0.47, 0.64] for frontal bossing. Agreement was highest for the sum score of individual items [intraclass correlation coefficients agreement 0.69 [95% CI: 0.57, 0.82]. This is the first large-scale multicenter study in which experts investigated a photo score to assess the severity of sagittal synostosis phenotypical characteristics. Agreement on phenotypical characteristics was suboptimal (fair-moderate agreement) and highest for the summed score of individual photo score items (substantial agreement), indicating that although experts interpret phenotypical characteristics differently, there is consensus on overall phenotypical severity.
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| 9. |
- Gaillard, Linda
(författare)
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A Suture-specific Photo Score for Metopic Synostosis
- 2024
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Ingår i: The Journal of Craniofacial Surgery. - : Wolters Kluwer. - 1049-2275 .- 1536-3732. ; 35:1, s. 75-79
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Tidskriftsartikel (refereegranskat)abstract
- Head shape assessments in children with metopic synostosis are a relevant outcome measure in addition to functional measures, such as neurocognitive outcomes, behavioral outcomes, and visual functioning outcomes. However, consensus on head shape assessments in children with metopic synostosis is lacking. The aim of this study is to develop a reproducible and reliable suture-specific photo score that can be used for cross-center comparison of phenotypical severity of metopic synostosis and evaluation of esthetic outcome of treatment later in childhood. We conducted a retrospective study among nonsyndromic metopic synostosis patients aged <18 years. Preoperative and postoperative photosets of patients with metopic synostosis from 6 expert centers were included. The photo score was discussed in the group of expert craniofacial plastic surgeons and pediatric neurosurgeons. Interrater reliability was determined with modified weighted Fleiss' kappa and intraclass correlation coefficients. Correlation between individual photo score items with overall phenotype was assessed using Spearman correlation analyses. The metopic synostosis photo score contained the following items: "wedging of the forehead", "hypotelorism", "temporal hollowing", "biparietal widening,"and an assessment of "overall phenotype". Items were scored on a 4-point ordinal scale ranging from normal to severe. We found moderate interrater reliability for all items, but substantial agreement for the summed scores. Correlation with overall phenotype was lowest for biparietal widening. To conclude, although agreement on individual photo score items was suboptimal, the agreement on the summed score was substantial, which indicates there is consensus on the overall severity of the metopic synostosis phenotype.
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| 10. |
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| 11. |
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| 12. |
- Klein, Holger Jan, et al.
(författare)
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Contemporary Concepts of Primary Dynamic Facial Nerve Reconstruction in the Oncologic Patient
- 2019
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Ingår i: The Journal of craniofacial surgery (Print). - : LIPPINCOTT WILLIAMS & WILKINS. - 1049-2275 .- 1536-3732. ; 30:8, s. 2578-2581
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Tidskriftsartikel (refereegranskat)abstract
- Transection of the facial nerve and its branches during extensive ablative procedures in the oncologic patient causes loss of control of facial mimetic muscles with severe functional and aesthetic sequelae. In such patients with advanced tumorous disease, copious comorbidities, and poor prognosis, rehabilitation of the facial nerve has long been considered of secondary priority. However, recent advances in primary facial nerve reconstruction after extensive resection demonstrated encouraging results focusing on rapid and reliable restoration of facial functions. The authors summarize 3 innovative approaches of primary dynamic facial nerve reconstruction by using vascularized nerve grafts, dual innervation concepts, and intra-facial nerve transfers.
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| 13. |
- Mellgren, Jonas, 1997, et al.
(författare)
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Spring-Assisted Surgery of Unilambdoid Craniosynostosis
- 2024
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Ingår i: JOURNAL OF CRANIOFACIAL SURGERY. - 1049-2275 .- 1536-3732. ; 35:3, s. 715-720
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Tidskriftsartikel (refereegranskat)abstract
- Craniosynostosis is traditionally treated with extensive cranial vault reconstructions (CVRs). Although less invasive techniques, such as endoscopic strip craniectomy with postoperative helmet therapy, have been successful, they also present difficulties. An alternative method is distraction osteogenesis using either manually controlled devices or specially designed springs. In this study, the authors provide the first comparison of spring-assisted surgery (SAS) with CVR for the treatment of unilambdoid synostosis (ULS). Fourteen consecutive patients (8 CVR and 6 SAS) treated for ULS at Sahlgrenska University Hospital between 2005 and 2018 were included. Skull shape and deviations were evaluated using previously defined measurement points on 3-dimensional computed tomography scans preoperatively, at spring removal, and at 3 years of age. Posterior and middle cranial fossa (PCF and MCF, respectively), skull-base cant, facial twist, and mastoid bulge (MB) were measured, and clinical data were obtained from chart reviews. The results indicated that at the 3-year follow-up, PCF, MCF, and MB improved in both groups, with no significant difference in outcome observed between methods. In the SAS group, duration of operation [61 +/- 27 min (mean +/- SD)] and perioperative bleeding (3.5 +/- 2.8 mL/kg body weight) were both significantly lower relative to the CVR group (P<0.05). These findings showed that both SAS and CVR resulted in similar improvements in treating ULS, although neither produced complete normalization of skull shape. The results suggest that early diagnosis and operation allow less extensive SAS to be performed without adversely affecting the results.
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| 14. |
- Nowinski, Daniel, et al.
(författare)
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Complex Pediatric Orbital Fractures Combined With Traumatic Brain Injury : Treatment and Follow-Up
- 2010
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Ingår i: The Journal of craniofacial surgery (Print). - 1049-2275 .- 1536-3732. ; 21:4, s. 1054-1059
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Tidskriftsartikel (refereegranskat)abstract
- The treatment of orbital fractures aims at the restoration of orbital anatomy and prevention of posttraumatic sequels. The treatment of facial fractures in patients with traumatic brain injury may necessitate a postponement of fracture surgery to allow for brain recovery. However, such delay of reconstruction in complex orbital fractures may lead to inferior results. Fourteen pediatric patients with complex orbital fractures were retrospectively reviewed. Eleven patients (79%) had brain injury, with a mean Glasgow Coma Scale score of 8.6 at initial evaluation. Fracture patterns were highly complex with many bilateral and multiple orbital wall fractures. Six patients (43%) had injuries to the medial canthal tendon, as part of a naso-orbito-ethmoid fracture. Mean follow-up time was 4.7 years (range, 1.2-13.1 years). Eleven patients (79%) had reconstructive surgery early (within 3 weeks), and 3 (29%) patients had the surgery postponed. Four patients had secondary surgeries for enophthalmos and medial canthal dislocation. Eighty-two percent of patients with brain injury had a good overall neurologic outcome (Glasgow Outcome Scale score of 1 or 2). Sixty-seven percent of patients had a good aesthetic outcome without any need for revisional surgery. Medial canthal injury and late surgery both correlated with an inferior aesthetic result. In conclusion, good results with respect to mental outcome and aesthetics can be achieved in highly complex orbital fractures combined with brain injury. Delayed surgery and medial canthal tendon injury predispose for posttraumatic sequels and secondary surgery.
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| 15. |
- Nowinski, Daniel, et al.
(författare)
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Computer-navigated contouring of craniofacial fibrous dysplasia involving the orbit
- 2011
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Ingår i: The Journal of craniofacial surgery (Print). - 1049-2275 .- 1536-3732. ; 22:2, s. 469-472
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Tidskriftsartikel (refereegranskat)abstract
- Virtual surgical planning and computer-aided surgery were used to treat a mono-ostotic fibrous dysplasia of the right zygoma. Mirroring of the contralateral zygoma sets the target for the contouring of the affected zygomatic bone. An optical system for computer-guided surgery was used. Instruments were calibrated and visualized in real time on screen. Achievement of the virtually set target for the orbitozygomatic anatomy was assessed during surgery. Postoperative computed tomography and clinical follow-up confirmed an excellent result with regard to facial symmetry and eye bulb position. The volume of the orbit was increased from 24.2 to 26.0 mL compared with a contralateral orbital volume of 25.7 mL. Computer-guided surgery may be a useful tool in the surgical reduction of craniofacial fibrous dysplasia.
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| 16. |
- Nowinski, Daniel, et al.
(författare)
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Treatment of Orbital Fractures : Evaluation of Surgical Techniques and Materials for Reconstruction
- 2010
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Ingår i: The Journal of craniofacial surgery (Print). - 1049-2275 .- 1536-3732. ; 21:4, s. 1033-1037
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Tidskriftsartikel (refereegranskat)abstract
- Reconstruction of the fractured orbit serves to prevent functional and aesthetic posttraumatic sequels. In 2004, the surgical protocol at our unit was modified with respect to techniques for surgical access, types, and materials for reconstruction. The modifications were as follows: (a) introduction of medial orbital wall reconstructions through a bicoronal approach, (b) transconjunctival approach instead of the subciliary approach, and (c) porous polyethylene or porous polyethylene-titanium instead of autologous bone grafts. To evaluate the different surgical techniques and materials used, orbital reconstructions performed at our unit from 2000 to 2007 were retrospectively studied. In total, 177 primary or first-time secondary reconstructions were performed in 176 patients. The overall rate of early complications requiring medical or surgical intervention was 6.4%, and the reoperation rate was 3.4%. There were no statistically significant differences in the frequency of cicatricial eyelid complications between the subciliary and the transconjunctival approaches. There was a reduction in operative time with the use of implants compared with the use of bone. The overall rate of infections was 2%; however, there were no infections in the group treated with implants. Seven patients had secondary surgery for persistent enophthalmos, 4 of them due to defects in the medial orbital wall that had not been corrected at the time of primary reconstruction of the orbital floor. In conclusion, porous polyethylene/porous polyethylene-titanium is a safe material for orbital reconstructions. Reconstruction of the medial orbital wall is important to prevent posttraumatic enophthalmos, particularly in combined medial wall-orbital floor fractures.
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| 17. |
- Oldén, Alexandra, et al.
(författare)
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Factors Affecting Complete Oral Rehabilitation in Patients With Vascularized Free Fibula Flap Mandibular Reconstruction : A 10-Year Retrospective Study
- 2023
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Ingår i: The Journal of Craniofacial Surgery. - : Wolters Kluwer. - 1049-2275 .- 1536-3732. ; 34:6, s. 1635-1639
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Tidskriftsartikel (refereegranskat)abstract
- The fibula is the preferred bone flap for mandibular reconstructions due to its many advantages, including the possibility to insert dental implants. All patients who received a mandibular reconstruction with a vascularized free fibula flap at the Uppsala University Hospital between 2009 and 2019 were retrospectively examined regarding the proportion of implant insertion and factors that affected implant outcome. Forty-one patients had 42 fibula flap reconstructions. Eleven patients (27%) received dental implants and 8 (20%) completed dental rehabilitation. Patient death and cancer recurrence were the main reasons for not receiving implants. The survival rates of implants placed in irradiated and nonirradiated fibulas were 15% and 76%, respectively. Less than 20% of reconstructed patients received an implant-supported prosthesis. Implants placed in an irradiated fibula should be considered at high risk for implant loss.
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| 18. |
- Rahbin, Samin, et al.
(författare)
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The Volume Difference Along the External Surface of the Zygomatic Bone
- 2022
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Ingår i: The Journal of Craniofacial Surgery. - Philadephia, PA, United states : Lippincott Williams & Wilkins. - 1049-2275 .- 1536-3732. ; 33:2, s. 463-468
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Tidskriftsartikel (refereegranskat)abstract
- This study introduced the volume difference along the external surface (VDAES) of the zygomatic bone as a novel approach to assess zygomatic bone asymmetry and was the first to describe a distinctive, 4-step method of measuring it. VDAES has a potential to be used as an objective tool to evaluate dislocation and can assist surgeons in predicting risks of long-term cosmetic complications in patients with zygomaticomaxillary complex fractures. After having measured 100 healthy study participants, the observed median VDAES was 1.48 cm3 for all study participants, 2.02 cm3 for males, and 1.09 cm3 for females, with the gender difference being significant (P = 0.003). Additional studies are needed to test the hypothesis of whether VDAES is more relevant than conventional methods of clinically evaluating zygomatic bone asymmetry.
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| 19. |
- Saiepour, Daniel, et al.
(författare)
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Radiologic and Long-Term Clinical Outcome From Treatment of Isolated Medial Orbital Wall Blowout Fractures
- 2012
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Ingår i: The Journal of craniofacial surgery (Print). - 1049-2275 .- 1536-3732. ; 23:5, s. 1252-1255
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Tidskriftsartikel (refereegranskat)abstract
- Blowout fractures in the medial orbital wall may lead to enophthalmos, ocular dysmotility, and diplopia. Ten consecutive patients with unilateral, isolated fractures of the medial orbital wall were retrospectively studied. The radiologic accuracy of the medial orbital wall reconstructions and the long-term clinical outcomes were assessed. All cases were treated through a bicoronal approach and by use of porous polyethylene-titanium implants. The total fracture area and the orbital volume increase from the blowout were measured on computed tomographic scans. Next, we evaluated the reconstruction in the posterior part of the medial wall. This was done by calculating the ratio between the defect area and the implant area located behind the anterior ethmoidal canal. The patients were examined at least 1 year after the operation, and the rates of enophthalmos and diplopia were evaluated. The mean fracture defect area was 2.45 cm(2) (range, 0.41-4.16 cm(2)), and the mean volume increase from the blowout fractures was 1.82 cm(3) (range, 0.53-2.76 cm(3)). The orbital volume was accurately restored in all patients. However, the ratio of implant to defect area behind the anterior ethmoidal canal ranged from 0% to 100% (mean, 47.3%). None of the patients had enophthalmos or diplopia at the long-term follow-up. The results confirm that restoration of orbital volume is important to prevent postoperative enophthalmos in isolated medial orbital blowout fractures. Complete reconstruction of the most posterior part of the medial orbital wall seems to be of lesser importance.
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| 20. |
- Scholin, Johnna Sahlsten, et al.
(författare)
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Ethical Challenges for Plastic Surgery in Treating Internationally Adopted Children With Cleft Lip and Palate
- 2024
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Ingår i: JOURNAL OF CRANIOFACIAL SURGERY. - : LIPPINCOTT WILLIAMS & WILKINS. - 1049-2275 .- 1536-3732. ; 35:5, s. 1425-1431
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Tidskriftsartikel (refereegranskat)abstract
- A large number of children with cleft lip and palate (CLP) were adopted to Sweden in the last decade, mainly from China. Most of the children arrived with unoperated palates and at later ages than earlier years. This article aims to present an overview of ethical challenges within the practice of international adoption of children with CLP from the perspective of plastic surgery in a welfare health care system. An overview of CLP treatment is presented, followed by a normative discussion and ethical analysis using the 4 principles of Beauchamp and Childress: non-maleficence, beneficence, autonomy, and justice. The following themes and subthemes were analyzed: the search for normality and the potential challenge of being adopted and having CLP-treatment autonomy of the child and future preferences, adoptive parents' expectations of plastic surgery, the journey of the adoptee and the adoptive parents; and general issues-reconstructive possibilities and consequences of CLP in the country of origin, information to the adoptive parents, health care needs, and reconstructive possibilities for children with CLP in the receiving country. Clinical implications are discussed, and suggestions for future research are provided.
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| 21. |
- Selvaggi, Gennaro, 1973, et al.
(författare)
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Ethical Considerations in Surgery for Single-suture Craniosynostosis.
- 2023
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Ingår i: The Journal of craniofacial surgery. - 1049-2275 .- 1536-3732. ; 34:7, s. 1922-1926
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Tidskriftsartikel (refereegranskat)abstract
- Single-suture craniosynostosis (SSC) describes the premature fusion of one cranial suture, which restricts cranial growth and consequently results in unaffected regions presenting a compensatory expansion. Surgery can redistribute intracranial volume, reduce the risk of elevated intracranial pressure, and improve head shape, potentially leading to improved neurocognitive function and social acceptance. However, there is limited evidence that surgery for SSC improves neurocognitive function and social acceptance. Given the inherent surgical risks and uncertainty of outcomes, the conditions under which this surgery should be allowed remain uncertain. Here, we discuss ethical questions regarding the permissibility of surgery, value of neurocognitive function and social acceptance, research ethics associated with SSC, patient autonomy and parental roles, and the process of recommending surgery and obtaining consent. Because surgery for SSC has become a routine procedure, its practice now presents a relatively low risk of complications. Furthermore, having acquired an understanding of the risks associated with this surgery, such knowledge fulfils the principle of non-maleficence although not beneficence. Thus, we advocate that surgery should only be offered within Institutional Review Board-approved research projects. In these situations, decisions concerning enrollment in scientific research involves health care providers and parents or guardians of the child, with the former acting as gate-keepers upon recognition of a lack of coping skills on the part of the parent or guardian in dealing with unforeseen outcomes. To minimize associated surgical risks and maximize its benefits, there exists a moral obligation to refer patients only to highly specialized centers.
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| 22. |
- Skogh, Ann-Charlott Docherty, et al.
(författare)
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Variation in Calvarial Bone Healing Capacity : A Clinical Study on the Effects of BMP-2-Hydrogel or Bone Autograft Treatments at Different Cranial Locations
- 2013
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Ingår i: The Journal of craniofacial surgery (Print). - 1049-2275 .- 1536-3732. ; 24:2, s. 339-343
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Tidskriftsartikel (refereegranskat)abstract
- Background: Bone morphogenetic protein-2 (BMP-2) together with a suitable carrier is an attractive option that may be used for craniofacial bone reconstruction. In this prospective randomized study, a hyaluronan-based hydrogel with BMP-2 was used to achieve bone healing in standardized critical-size cranial defects in humans after neurosurgery. Methods: Twelve patients were randomized into the treatment group (N = 6) or control group (N = 6). In the treatment group, holes made during craniotomy were treated with hydrogel with BMP-2, 250 mu g/mL, or hydrogel without BMP-2. In the remaining hole/s in the same patient, Spongostan (Ethicon) alone or Tisseel (Baxter) mixed with autologous bone matrix were used as negative and positive controls, respectively. In the control group, the holes were treated with Spongostan or Tisseel mixed with bone autograft. Bone healing was assessed with CT scans after 3 and 6 months. Bone areas in treated defects were measured and statistical analysis was performed. Results: Independent of location, bone healing in defects treated with Tisseel with autograft, hydrogel alone, or hydrogel with BMP-2 was significantly increased compared to negative control (P < 0.001, P = 0.002, and P = 0.005, respectively). In general, all defects healed significantly better in the frontal bone as compared to parietal-temporal location, except for defects treated with Tisseel and autograft, which healed well independently of location. No local or systemic side effects, including excessive bone overgrowth or inflammatory reaction, were seen in treated patients. Conclusions: Tissue engineering of bone with hyaluronan-based hydrogel shows good healing of cranial defects, comparable with bone autografts. The hydrogel itself may represent a novel alternative to autologous bone transplants in craniofacial bone repair. The study also reveals a general superior healing capacity in the frontal bone as compared to parietal/temporal bones.
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| 23. |
- Smektala, Tomasz, et al.
(författare)
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Three-Dimensional Eyeball and Orbit Volume Modification After LeFort III Midface Distraction
- 2015
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Ingår i: The Journal of craniofacial surgery (Print). - 1049-2275 .- 1536-3732. ; 26:5, s. 1652-1655
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Tidskriftsartikel (refereegranskat)abstract
- The aim of our study was to evaluate orbital volume modification with LeFort III midface distraction in patients with craniosynostosis and its influence on eyeball volume and axial diameter modification. Orbital volume was assessed by the semiautomatic segmentation method based on deformable surface models and on 3-dimensional (3D) interaction with haptics. The eyeball volumes and diameters were automatically calculated after manual segmentation of computed tomographic scans with 3D slicer software. The mean, minimal, and maximal differences as well as the standard deviation and intraclass correlation coefficient (ICC) for intraobserver and interobserver measurements reliability were calculated. The Wilcoxon signed rank test was used to compare measured values before and after surgery. P < 0.05 was considered statistically significant. Intraobserver and interobserver ICC for haptic-aided semiautomatic orbital volume measurements were 0.98 and 0.99, respectively. The intraobserver and interobserver ICC values for manual segmentation of the eyeball volume were 0.87 and 0.86, respectively. The orbital volume increased significantly after surgery: 30.32% (mean, 5.96 mL) for the left orbit and 31.04% (mean, 6.31 mL) for the right orbit. The mean increase in eyeball volume was 12.3%. The mean increases in the eyeball axial dimensions were 7.3%, 9.3%, and 4.4% for the X-, Y-, and Z-axes, respectively. The Wilcoxon signed rank test showed that preoperative and postoperative eyeball volumes, as well as the diameters along the X- and Y-axes, were statistically significant. Midface distraction in patients with syndromic craniostenosis results in a significant increase (P < 0.05) in the orbit and eyeball volumes. The 2 methods (haptic-aided semiautomatic segmentation and manual 3D slicer segmentation) are reproducible techniques for orbit and eyeball volume measurements.
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| 24. |
- Stenson Zerpe, Anna, et al.
(författare)
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Parents' Experiences of Their Child's Craniosynostosis and the Initial Care Process
- 2020
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Ingår i: The Journal of craniofacial surgery (Print). - 1049-2275 .- 1536-3732. ; 31:1, s. 251-256
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Tidskriftsartikel (refereegranskat)abstract
- Craniosynostosis is usually diagnosed in early infancy. Treatment almost always involves surgery and care is optimally organized around an interdisciplinary team of specialists at a craniofacial center. This study aimed to investigate Swedish parents' experiences of having a child with craniosynostosis and their perceptions of the initial care process. Semistructured telephone interviews were conducted with 20 parents (10 fathers and 10 mothers) of children with nonsyndromic craniosynostosis who were undergoing surgery at the Uppsala Craniofacial Center. A thematic data analysis revealed 6 themes presented in a timeline following the parents' journey from detection of their child's abnormal skull shape to waiting for surgery: Detection of the abnormal skull shape, thoughts, and feelings before the appointment with the craniofacial team, an appointment with the craniofacial team, searching the Internet and social media, waiting for surgery, and suggestions for improvement. Although meeting with the craniofacial team was considered informative, parents expressed concerns about surgery and their infant's long-term prognosis were evident. Most parents had no previous knowledge about craniosynostosis and craniofacial syndromes and wished for more information already at the time of its detection. The Internet was used both at the time of suspicion that something was wrong with the child and later to learn about risks and consequences, alternative treatments and prognosis.
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| 25. |
- Svee, Andreas, et al.
(författare)
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Early Release of Interalveolar Synechiae Under General Anesthesia Through Fiberscopic Nasal Intubation
- 2012
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Ingår i: The Journal of craniofacial surgery (Print). - 1049-2275 .- 1536-3732. ; 23:4, s. E299-E302
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Tidskriftsartikel (refereegranskat)abstract
- This article presents a treatment strategy for early release of interalveolar synechiae, aiming to facilitate early oral feeding and prevent temporomandibular joint ankylosis. The treatment results of 2 patients with van der Woude syndrome were retrospectively studied. Both patients underwent early surgical release of interalveolar synechiae under general anesthesia through fiberscopic nasal intubation. The 2 patients were treated at the ages of 6 and 14 days, respectively. The interincisival distances increased from 5 and 6 mm preoperatively to 11 and 10 mm immediately after surgery. This was increased further to 25 and 20 mm at long-term follow-up (6 and 24 months). In conclusion, synechiae between the upper and lower jaws can be safely treated at a very early age under general anesthesia with fiberscopic nasotracheal intubation. The purpose of early intervention in these cases is to facilitate oral feeding and prevent temporomandibular joint ankylosis.
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| 26. |
- Söfteland, Madiha Bhatti, 1977, et al.
(författare)
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Correction of Unicoronal Synostosis With Springs: Two Patients With Improved Facial Symmetry
- 2024
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Ingår i: JOURNAL OF CRANIOFACIAL SURGERY. - 1049-2275 .- 1536-3732. ; 35:1, s. 10-12
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Surgical correction of unicoronal synostosis (UCS) entails extensive cranioplasties which do not address facial scoliosis. This paper presents the first results with springs that motivated the shift from extensive cranioplasties to dynamic techniques for surgical correction of UCS.Methods: Two cases of UCS were operated with a linear osteotomy combined with springs. The deviation in facial symmetry (orbital dystopia angle) and skull base angles were measured on pre and postoperative computed tomography scans until 3 years of age.Results: The facial scoliosis was corrected. At spring removal, the orbital dystopia angle had gone from a 9.2 to 13.2-degree deviation preoperatively to a 0.5 to 0.9-degree overcorrection compared with the ideal 0-degree deviation. Also, the skull base deviation improved.Conclusion: Linear osteotomy combined with springs corrects the facial scoliosis in UCS. These cases indicate that dynamic methods may be beneficial for improving the results of surgical correction of UCS.
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| 27. |
- Tarnow, Peter, et al.
(författare)
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Incidence of Non-Syndromic and Syndromic Craniosynostosis in Sweden
- 2022
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Ingår i: The Journal of Craniofacial Surgery. - : Wolters Kluwer. - 1049-2275 .- 1536-3732. ; 33:5, s. 1517-1520
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Tidskriftsartikel (refereegranskat)abstract
- Premature craniosynostosis is a rare condition, with a wide range of incidence estimations in the literature. The aim of this study was to establish the current incidence among the Swedish population. Since the surgical care for these children is centralized to the 2 centers of Sahlgrenska University Hospital and Uppsala University Hospital, the 2 craniofacial hospital registries were examined for surgically treated children, all having a computed tomography verified diagnosis. Results show an incidence of 7.7 cases per 10,000 live births, including 0.60/10,000 syndromic craniosynostosis. Due to information programs among health care staff and a system for early diagnosis through rapid communication, these results seem to mirror the true incidence of craniosynostosis in the Swedish population. The updated incidence data will facilitate healthcare planning and make future studies of possible changes in craniosynostosis incidence more accurate.
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| 28. |
- Thor, Andreas, et al.
(författare)
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Clinical, Morphological, and Molecular Evaluations of Bone Regeneration With an Additive Manufactured Osteosynthesis Plate
- 2016
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Ingår i: Journal of Craniofacial Surgery. - 1049-2275 .- 1536-3732. ; 27:7, s. 1899-1904
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Tidskriftsartikel (refereegranskat)abstract
- There is limited information on the biological status of bone regenerated with microvascular fibula flap combined with biomaterials. This paper describes the clinical, histological, ultrastructural, and molecular picture of bone regenerated with patient-customized plate, used for mandibular reconstruction in combination with microvascular osteomyocutaneous fibula flap. The plate was virtually planned and additively manufactured using electron beam melting. This plate was retrieved from the patient after 33 months. Microcomputed tomography, backscattered-scanning electron microscopy, histology, and quantitative-polymerase chain reaction were employed to evaluate the regenerated bone and the flap bone associated with the retrieved plate. At retrieval, the posterior two-thirds of the plate were in close adaptation with the underlying flap, whereas soft tissue was observed between the native mandible and the anterior one-third. The histological and structural analyses showed new bone regeneration, ingrowth, and osseointegration of the posterior two-thirds. The histological observations were supported by the gene expression analysis showing higher expression of bone formation and remodeling genes under the posterior two-thirds compared with the anterior one-third of the plate. The observation of osteocytes in the flap indicated its viability. The present data endorse the suitability of the customized, additively manufactured plate for the vascularized fibula mandibular reconstruction. Furthermore, the combination of the analytical techniques provides possibilities to deduce the structural and molecular characteristics of bone regenerated using this procedure.
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| 29. |
- Tovar, Nick, et al.
(författare)
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Modification of Xenogeneic Graft Materials for Improved Release of P-15 Peptides in a Calvarium Defect Model
- 2014
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Ingår i: The Journal of craniofacial surgery (Print). - : Lippincott Williams & Wilkins. - 1049-2275 .- 1536-3732. ; 25:1, s. 70-76
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Tidskriftsartikel (refereegranskat)abstract
- Particulate bone augmentation is an established clinical alternative to regenerate bone. However, in regions of poor bone quality or previously infected sites, the clinical outcomes are more inconsistent. For that purpose, peptides have been added to particulate materials in an attempt to render them with antibacterial properties or to improve their osseoconductivity. For instance, competence-stimulating peptide (CSP) has been studied to decrease the division rate of Streptococcus mutans. Also, the addition of a specific short amino acid sequence peptide derived from type I collagen (P-15) to the bone substitutes has been introduced in an attempt to increase its osseoconductivity. The present study hypothesized that xenogeneic graft materials with and without CSP would present improved host-to-biomaterial response when used in combination with P-15. Particulate graft materials with and without P-15, OsteoGraf with CSP and OsteoGraf, were implanted in an 8-mm rabbit calvarial defect for 4 weeks, and thereafter, histological and histomorphometrical evaluation was performed. The results showed that both OsteoGraf and CSP groups with the addition of P-15 induced bone growth towards the center of the defect. Furthermore, the addition of CSP to Osteograf showed a tendency to increase its osteoconductivity when combined with P-15. The results of the current study suggested that P-15 had some impact on osteogenesis; however, the effect differed between different bone substitute materials. Further investigation is necessary to clarify its effectiveness when used in combination with bone substitutes.
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| 30. |
- Unander-Scharin, Jesper, et al.
(författare)
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Does Coronal Suturectomies and Occipital Barrel Staves Make a Difference in Early Reconstruction for Sagittal Craniosynostosis?
- 2021
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Ingår i: The Journal of Craniofacial Surgery. - : Ovid Technologies (Wolters Kluwer Health). - 1049-2275 .- 1536-3732. ; 32:7, s. 2421-2425
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Tidskriftsartikel (refereegranskat)abstract
- Background: Various surgical methods are used for early treatment of nonsyndromic sagittal craniosynostosis. The craniofacial centers in Uppsala and Helsinki fundamentally both use the H-Craniectomy: Renier's technique. However, the Helsinki group systematically adds coronal suturectomies to prevent secondary coronal synostosis and posterior barrel staves to address posterior bulleting. The effects of these additions in early treatment of sagittal craniosynostosis are currently unknown.Methods: Thirty-six patients from Uppsala and 27 patients from Helsinki were included in the study. Clinical data and computed tomography scans were retrieved for all patients.Results: The Helsinki patients had a smaller preoperative Cranial index (CI) (65 vs 72) and a smaller preoperative width (10.1 vs 11.2). There was no difference in postoperative CI, corresponding to a difference in change in CI. Regression analysis indicated that the larger change in CI in the Helsinki group was mainly due to a lower preoperative CI allowing for a larger normalization. The Helsinki patients had less growth in length (1.5 vs 2.1 cm) and more growth in width (2.3 vs 1.9 cm). There were no differences in head circumference or surgical complications. Secondary coronal synostosis was present in 43% of the Uppsala group at 3 years of age, while calvarial defects located at sites of previous coronal suturectomies and posterior barrel staving were seen in the Helsinki group 1 year postoperatively.Conclusions: Lower preoperative CI appears to be the main factor in determining the amount of normalization in CI. Prophylactic coronal suturectomies do not seem to benefit preservation of coronal growth function since the modification correlates to less sagittal growth and more growth in width.
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| 31. |
- Unander-Scharin, Jesper, et al.
(författare)
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Secondary Coronal Synostosis After Early Surgery for Sagittal Craniosynostosis : Implications for Cranial Growth
- 2020
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Ingår i: The Journal of Craniofacial Surgery. - : Lippincott Williams & Wilkins. - 1049-2275 .- 1536-3732. ; 32:1, s. 113-117
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 32. |
- Vejbrink Kildal, Villiam, et al.
(författare)
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Anatomical features in lower lip depressor muscles for optimization of myectomies in marginal mandibular nerve palsy
- 2021
-
Ingår i: The Journal of Craniofacial Surgery. - : Wolters Kluwer. - 1049-2275 .- 1536-3732. ; 32:6, s. 2230-2232
-
Tidskriftsartikel (refereegranskat)abstract
- Introduction: Myectomies of the lower-lip depressor muscles, with the aim to improve facial balance in unilateral facial paralysis, have unexplained high recurrence rates. A potential explanation is that these recurrences are due to inadequate resection through the muscle width, leaving lateral muscle fibers intact.Aim: Revisit the anatomy of the lower-lip depressor muscles and suggest an optimization of the surgical technique. Perform a literature review to identify recurrence rates and surgical technique of the procedure.Materials and Methods: Ten fresh hemifaces were dissected. The following measurements of depressor labii inferioris and depressor anguli oris were made: the widths of the muscles, the distance from the mandibular midline to the lateral borders of the muscles, and the intraoral distance from the lateral canine to the lateral border of depressor anguli oris. A literature review was performed.Results: The width of depressor labii inferioris was 20 ± 4 mm and depressor anguli oris 14 ± 3 mm. The distance from the midline to the lateral border of depressor labii inferioris was 32 ± 4 mm and 54 ± 4 mm for depressor anguli oris. The literature review revealed a mean recurrence rate of 21%.Discussion: A potential optimization of the surgical technique in lower-lip depressor myectomies is to extend the muscle resection laterally. To ensure inclusion of the whole width of the depressor muscles and decrease the recurrence rates of the procedure, the measurements presented in this study should be kept in mind during surgery.
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| 33. |
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| 34. |
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| 35. |
- Bernhardt, Peter, 1966, et al.
(författare)
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A novel quantitative image-based method for evaluating cranial symmetry and its usefulness in patients undergoing surgery for unicoronal synostosis.
- 2013
-
Ingår i: The Journal of craniofacial surgery. - 1536-3732. ; 24:1, s. 166-9
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Tidskriftsartikel (refereegranskat)abstract
- Background: Unicoronal synostosis presents with cranial asymmetry. Fixed points are difficult to identify; surgical results are therefore difficult to evaluate. The aim of this study was to develop a computer-based method for evaluation of forehead symmetry to enable evaluation of surgical results in unicoronal synostosis. Methods: The MATLAB tool was programmed to segment computed tomographic images, leaving the outermost contour. Cephalometric images were segmented manually due to lower contrast. A center-point (O) and an end-point were manually defined in the midline of the forehead and at the nonfused coronal suture, respectively. The program then found a point (p) on the fused side, at the same distance from the O as the end-point. The contours of the left and right side of the forehead were thereafter superimposed, and the position of minimal area mismatch of the sides was identified. To correct for growth between preoperative images and follow-up, the number of mismatching pixels was related to the area outlined by the contour of the forehead, the end-point and p. Two quantities, the relative symmetry change and the absolute symmetry change, were defined and evaluated by repeated measurements on spherical and elliptical phantoms and 15 patients. Results: Measurements with the MATLAB program were reliable with an SD of 0.26% to 5.39% for the expected range of differences. The SD was lower for measurements on computed tomographic images than for measurements on cephalometric images. The SD was also lower in patients with large surgical improvement than in patients with little improvement. The results support the use of relative symmetry change to evaluate surgical results. Conclusions: Our new computer-based method is capable of measuring forehead symmetry with good precision. This method can be used for systematic evaluation of surgical outcome for unicoronal synostosis and other asymmetric skull deformities.
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| 36. |
- Bevilacqua, Ruggero, et al.
(författare)
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Spring-Assisted Surgery in the Treatment of Complex Craniosynostosis
- 2018
-
Ingår i: Journal of Craniofacial Surgery. - 1049-2275. ; 29:4, s. 920-924
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Tidskriftsartikel (refereegranskat)abstract
- Multisutural nonsyndromic craniosynostosis is a rare group of malformations, whose frequency has been reported between 3% and 7% of all craniosynostosis. The clinical diagnosis can be difficult and computed tomography is usually required. Surgical treatment is challenging and staged procedures are performed in up to 80% of patients. The aim of the present study was to determine the reoperation rate and to evaluate the surgical outcomes by measuring intracranial volume (ICV) preoperatively and at follow-up, and comparing it to a control group. Perioperative variables and reoperation rate were recorded. Fifty-one patients presented with a complex pattern of synostosis without a recognizable syndrome (5% of cases of total patients evaluated). Fifteen patients have been treated with spring-assisted surgery, either alone or in combination with a foreheadplasty. The mean follow-up was 6.2 years. The mean preoperative ICV of the patients was smaller, but not significantly, than in the normal population (P = 0.13). Postoperatively, the mean ICV was similar to that of the control group at 1 year (P = 0.92), while at 3 years it was appreciably smaller, although not significantly different (P = 0.06). Five patients (33%) went through a secondary skull expansion for either raised intracranial pressure or cosmetic reasons. Spring-assisted surgery seems to temporarily expand ICV in children with complex synostosis and lower the reoperation rate, thus reducing the need for a second procedure. A longer follow-up would be necessary to further investigate the effects of springs over time.
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| 37. |
- Davis, Charles, et al.
(författare)
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Do expansile cranial springs erode through the cranium?
- 2009
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Ingår i: The Journal of craniofacial surgery. - 1536-3732. ; 20:1, s. 168-70
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Tidskriftsartikel (refereegranskat)abstract
- Expansile cranial springs are used in selected cases of craniosynostosis. The spring exerts moderate force against the relatively thin skull. We investigated whether the spring erodes through the bone and the clinical significance of any erosion relative to the cranial expansion achieved. METHODS: New Zealand white rabbits (n = 10) underwent sagittal suturectomy and spring insertion. Amalgam markers were placed perpendicular to the expected direction of suture erosion. A control group (n = 10) underwent suturectomy. Radiological evaluation was performed for 7 weeks to check for migration of the spring foot. RESULTS: The mean cranial thickness was 1.4 mm at the site of spring insertion. This compared with 1.8 mm in 7 children undergoing spring cranioplasty. The mean spring force was 9.4 N. In sagittal synostosis, the mean spring force used is 7 to 10 N.The cranial width increased 11.02 mm in the spring treatment group compared with 0.23 mm in the control group (P < 0.001). Spring erosion occurred in 4 (20%) of the 20 spring ends. Mean spring erosion for the treatment group was 0.18 mm. This was 3.2% of the mean increase in cranial width. The maximum percentage spring erosion versus cranial expansion in an individual rabbit was 14.17%. There was no statistical difference in cranial expansion between the rabbits in whom bone erosion did and did not occur. CONCLUSIONS: The degree of spring force required to effectively expand the cranium may cause bone erosion in some individuals. This degree of spring erosion was of minimal clinical significance in this animal model.
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| 38. |
- Davis, Charles, et al.
(författare)
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Frontobasal suture distraction corrects hypotelorism in metopic synostosis.
- 2009
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Ingår i: The Journal of craniofacial surgery. - 1536-3732. ; 20:1, s. 121-4
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Spring-assisted cranioplasty has been demonstrated to correct hypotelorism associated with metopic synostosis. In addition, the fronto-orbital axis rotates toward a more normal orientation. We postulated that spring-induced shear forces and subsequent displacement across the frontobasal sutures are the primary initial mechanisms for change in cranio-orbital morphology. METHODS: Sixteen consecutive patients (32 orbits) with trigonocephaly operated on between 1999 and 2004 were studied retrospectively. After frontal remodeling, a spring was placed across the released metopic suture. Preoperative and 6-week postoperative cephalograms were used to measure the relative translation of the medial orbital wall from the midline at fixed vertical distances above and below the frontoethmoidal suture (FES). The vertical height of the spring above the frontonasal suture and the patient's age were analyzed with respect to the increase in bony interorbital distance (BIOD). RESULTS: There were significant increases in movement of the medial orbital wall above the FES at each measurement point (P < 0.001). There was no significant postoperative movement of the medial orbital wall below the FES at any measurement point. The relative movements above the suture suggest a degree of plastic deformation adjacent to the suture.There was no significant correlation between the age of patient or the height of the spring above the frontonasal suture and the increase in BIOD. CONCLUSION: Tensile spring forces are transmitted directly to the frontoethmoid suture. Most initial increases in BIOD and altered intraorbital morphology are due to distraction of cranial base sutures rather than plastic deformation.
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| 39. |
- Davis, Charles, et al.
(författare)
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"Spectaclesplasty" periorbital rotation advancement in Crouzon syndrome.
- 2008
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Ingår i: The Journal of craniofacial surgery. - 1049-2275. ; 19:3, s. 652-8
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Tidskriftsartikel (refereegranskat)abstract
- Facial deformity in Crouzon syndrome is characterized by exophthalmos, exorbitism, mild hypertelorism, and maxillary hypoplasia with a Class III occlusion. The G?teborg craniofacial unit corrects this deformity in selected patients by the 2-stage procedure of "spectaclesplasty" followed by a Le Fort I maxillary osteotomy at skeletal maturity. "Spectacles" is a reference to the bilateral circumferential periorbital bony skeleton, and a spectaclesplasty is a differential rotation and advancement of this complex. Spectaclesplasty has been integrated as part of our protocol in managing Crouzon syndrome from birth to maturity. All patients who have undergone spectaclesplasty were retrospectively reviewed. A composite scoring system analyzing periorbital anatomy and aesthetics was used to compare the preoperative and most recent postoperative photographs. Complications and the need for ancillary procedures were recorded. Twenty-one patients have undergone spectaclesplasty since this technique was introduced in 1984. Mean follow-up time is 5 years 10 months. Compared with their preoperative aesthetics, the improvement was rated as excellent for 8 patients (38%), very good for 7 patients (33%), good for 5 patients (24%), and minimal for 1 patient (5%). No patient was rated as having no improvement. Mean perioperative blood loss was 111% of estimated red cell mass. Mean operative time was 6.4 hours. The mean duration of stay in the intensive care unit was 28 hours, and the mean hospital stay was 11 days. There were few complications and no incidences of mortality. Spectaclesplasty yields high-quality aesthetic results in most cases. It is our impression that spectaclesplasty en bloc rotation advancement of the periorbital bony skeleton can be safely performed before skeletal maturity of the lower face. Correction of the bony periorbital anatomy in early adolescence is important in alleviating psychosocial distress in this age group. In our hands, spectaclesplasty produces a more normal anatomic position of the periorbital soft tissues facilitating both function and aesthetics.
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| 40. |
- Davis, Charles, et al.
(författare)
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Spring-assisted remodeling for ventricular shunt-induced cranial deformity.
- 2008
-
Ingår i: The Journal of craniofacial surgery. - 1049-2275. ; 19:3, s. 588-92
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Tidskriftsartikel (refereegranskat)abstract
- Ventricular shunt overdrainage may cause cranial vault collapse, deformation, and secondary craniosynostosis. There is a paucity of information in the literature about this condition or successful low morbidity methods to reshape the cranial vault. Spring-assisted cranioplasty was developed in the G?thenborg Craniofacial Unit and is part of our routine protocol for the treatment of selected patients with craniosynostosis. The same treatment principles were applied to skull deformity secondary to ventricular shunt-associated deformity. Four patients with scaphocephaly secondary to ventricular shunting were treated using expansile springs. Three patients had a secondary sagittal synostosis requiring osteotomy. A further patients' sagittal suture was still patent, and this was expanded without osteotomy. Near normalization of the cranial index and significant aesthetic improvement of the cranial vault were noted in all cases. The mean preoperative cranial index increased from 0.60 to 0.71 within 4 months after surgery. The limited dissection and short operative time enabled minimal morbidity and blood loss compared with that expected with traditional craniofacial reshaping techniques. Patients with ventricular shunt-associated cranial deformity often have associated medical problems. Cranial bone is often in short supply and its quality less than optimal. In this situation, spring-assisted surgery is straightforward and offers significant advantages over traditional craniofacial reshaping techniques.
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| 41. |
- Davis, Charles, et al.
(författare)
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Spring expansion is influenced by cranial biomechanics.
- 2010
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Ingår i: The Journal of craniofacial surgery. - 1536-3732. ; 21:3, s. 843-6
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Tidskriftsartikel (refereegranskat)abstract
- Spring cranioplasty is used in selected cases of craniosynostosis. A rabbit model was used to determine (1) if cranial biomechanics modify the expected rate of spring expansion, (2) the residual spring force in situ after cranial expansion, and (3) if the spring weakens during clinical use.
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| 42. |
- dos Santos, Daniela Micheline, et al.
(författare)
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Prosthesis auricular with osseointegrated implants and quality of life.
- 2010
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Ingår i: The Journal of craniofacial surgery. - 1536-3732. ; 21:1, s. 94-6
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Tidskriftsartikel (refereegranskat)abstract
- Implants in craniofacial reconstructions improve prostheses retention and stability, comfort, and safety for the patient. According to biomechanical principles, the treatment success regarding osseointegration maintenance depends on an adequate surgery technique associated to a retention system that provides favorable tension distribution to implants. Implants in the mastoid area are a very important aid for retention of auricular prostheses. Color stability of resin and silicone is an important factor for longevity of auricular prostheses, and the high degree of satisfaction of patients with head and neck defects receiving epithesial reconstruction in the maxillofacial region is demonstrated.
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| 43. |
- Düppe, Katarina, et al.
(författare)
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Evaluation of Facial Anthropometry Using Three-Dimensional Photogrammetry and Direct Measuring Techniques
- 2018
-
Ingår i: Journal of Craniofacial Surgery. - 1049-2275. ; 29:5, s. 1245-1251
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Tidskriftsartikel (refereegranskat)abstract
- In this study, 14 standard facial distances on 10 adult volunteers were measured directly with a caliper and indirectly on two-dimensional images using the 3dMDtrio system. Two raters performed the measurements with at least 1 week between rating sessions. The intra- and inter-rater reliabilities and agreement of the measurements were calculated using intra-class correlation coefficient (ICC), mean absolute difference (MAD), and Bland-Altman plots with limits of agreement (LOA). The 2 raters had an average discrepancy (MAD) of 1.6mm when their digital measurements were compared to their direct measurements. The reliability of the digital and direct methods varied greatly depending on which of the 14 anthropometric distances that was being assessed. Only 6 digitally and 5 directly measured anthropometric distances showed both an ICC >0.75 and a MAD <1mm, in the intra-rater as well as the inter-rater measurements. The Bland-Altman plots and LOA displayed the same pattern. In summary, the digital and direct methods were generally compatible in terms of reliability and agreement. However, the reliability and agreement between the 14 anthropometric measurements varied considerably, indicating that poor landmark identification is the main limitation to both modern and traditional measuring techniques in the face. Consequently, some anthropometric landmarks warrant further definition or prior anthropometric training by the evaluators. The authors also recommend that the MADs and LOAs provided in this report are put into relation to the facial distance that is being evaluated and its clinical context.
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| 44. |
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| 45. |
- Fischer, Sara, et al.
(författare)
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Comparisons of Intracranial Volume and Cephalic Index After Correction of Sagittal Craniosynostosis With Either Two or Three Springs
- 2021
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Ingår i: The Journal of craniofacial surgery. - 1536-3732. ; 32:8, s. 2636-2640
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Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT: In this retrospective study, the authors determined changes in intracranial volume (ICV) and cephalic index (CI) in patients with sagittal craniosynostosis and operated with craniotomy combined with either 2 or 3 springs. The authors included patients (n=112) with complete follow-up that had undergone surgical correction for isolated sagittal craniosynostosis with craniotomy combined with springs between 2008 and 2017. All patients underwent computed tomography examination preoperative, at the time of spring extraction, and at 3years of age. Intracranial volume was measured using a semiautomatic MATLAB program, and CI was calculated as the width/length of the skull. The authors found that craniotomy combined with 2 springs increased the ICV from a preoperative value of 792±113mL (mean±standard deviation) to 1298±181mL at 3years of age and increased the CI from 72.1±4.1 to 74.6±4.3, whereas craniotomy combined with 3 springs increased the ICV from 779±128mL to 1283±136mL and the CI from 70.7±4.3 to 74.8±3.7. The relative increase in ICV was 65±21% in the two-spring group and 68±34% in the three-spring group (P value=0.559), and the relative increase in CI was 3.6±3.3% in the two-spring group as compared with 6.0±5.0% in the three-spring group (P=0.004). These findings demonstrated that use of 3 springs resulted in additional absolute and relative CI-specific effects as compared with 2 springs during the time when the springs were in place, with this effect maintained at 3years of age.
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| 46. |
- Gewalli, Fredrik, 1956, et al.
(författare)
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Nasomaxillary reconstruction in Binder syndrome: bone versus cartilage grafts. A long-term intercenter comparison between Sweden and Mexico.
- 2008
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Ingår i: The Journal of craniofacial surgery. - 1536-3732. ; 19:5, s. 1225-36
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Tidskriftsartikel (refereegranskat)abstract
- Maxillonasal dysplasia is characterized by a concave facial profile and a flat nose. The etiology of Binder syndrome is skeletal hypoplasia around the piriform aperture and excavations-fossae prenasales, bilaterally in the nasal floor-which are pathognomonic. There is no real shortage of the soft tissues. In 2 medical centers in Sweden and Mexico, different grafts were used for reconstruction, but the focus was similar, filling out the maxilla anterior to the nasal floor and supporting the nasal framework to normalize tip projection. The basis for this study was to compare the long-term results between bone grafts in Sweden and cartilage grafts in Mexico. Sixteen patients from both groups were available for long-term follow-up. Simplified digital analysis of anthropometric variables were performed in the short-term and long-term follow-ups. The Swedish group had primary at the mean age of 21.3 years, whereas mean follow-up period was 16.8 years later. The Mexican group had primary at the age of 13.6 years, and the follow-up period was 8.4 years. Secondary correction was necessary in 25% of the patients in the bone graft group (Sweden) and in 19% of patients in the cartilage group (Mexico). Bone grafts slightly relapsed in tip projection and remodeled to some extent in the nasolabial angle. Cartilage grafts showed stability in the tip projection quotients and resulted in a postoperative normalization of the nasolabial angle but developed a slight relapse between the short-term and long-term follow-ups. Both techniques were stable in nose tip-length ratio, and a normalization of anthropometric variables was demonstrated in all the long-term follow-ups. Both the bone and cartilage graft techniques at the 2 centers rendered the intended result of an increased and normalized angle of convexity of the face and nasal tip projection. An experience in the properties and behavior of either graft is necessary to get a long-term stable outcome.
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| 47. |
- Ghensi, P., et al.
(författare)
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Effect of Oral Administration of Bromelain on Postoperative Discomfort After Third Molar Surgery
- 2017
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Ingår i: Journal of Craniofacial Surgery. - : Ovid Technologies (Wolters Kluwer Health). - 1049-2275. ; 28:2
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Tidskriftsartikel (refereegranskat)abstract
- Introduction:The purpose of this prospective randomized controlled clinical trial was to evaluate the effect of oral administration of bromelain on discomfort after mandibular third molar surgery. Materials and Methods: Eighty-four consecutive patients requiring surgical removal of a single mandibular impacted third molar under local anesthesia were randomly assigned to receiving no drug (control group, Group A), postoperative 40mg bromelain every 6 hours for 6 days (Group B), preoperative 4mg dexamethasone sodium phosphate as a submucosal injection (Group C), and preoperative 4 mg dexamethasone sodium phosphate as a submucosal injection plus postoperative 40mg bromelain every 6 hours for 6 days (Group D). Standardized surgical and analgesic protocols were adopted. Maximum interincisal distance and facial contours were measured at baseline and on postoperative days 2 and 7. Pain was measured objectively by counting the number of analgesic tablets required. Patient perception of the severity of symptoms was assessed with a follow-up questionnaire (PoSSe scale). Results: On postoperative day 2, there was a statistically significant reduction in facial edema in both Groups C and D compared with the control group, but no statistically significant differences were observed between Group B and the control group. At evaluation on postoperative day 7, Group D showed a statistically significant reduction in postoperative swelling compared with the control group. The combined use of bromelain and dexamethasone (Group D) induced a statistically significant reduction in the total number of analgesic tablets taken after surgery compared with the control group. The treatment groups had a limited, nonsignificant effect on trismus when compared with the control group. Conclusions: Bromelain used singly showed moderate anti-inflammatory efficacy, reducing postoperative swelling, albeit not to any significant extent compared with no drug administration. The combined use of bromelain and dexamethasone sodium phosphate yielded the best results in terms of control of postoperative discomfort.
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| 48. |
- Gudnadottir, Gunnhildur, et al.
(författare)
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Pediatric Orbital Fractures: Outcomes in Relation to Time of Surgery
- 2023
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Ingår i: Journal of Craniofacial Surgery. - : Ovid Technologies (Wolters Kluwer Health). - 1049-2275. ; 34:3, s. 976-978
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Tidskriftsartikel (refereegranskat)abstract
- Introduction:Orbital trapdoor fractures in children and adolescents can cause persistent problems with vision and appearance. Early surgery is recommended, although, because of the rarity of these fractures, there is a lack of evidence regarding the optimal timing of surgery.The objective of this study was to examine the effect of the time from trauma to surgery on the recovery time and severity of diplopia in children and adolescents with orbital trapdoor fractures. Materials and Methods:A retrospective cohort study was performed of all orbital fractures in children and adolescents aged 0 to 20 years, treated at a tertiary referral center in 2005-2017. Data relating to demographics, cause of injury, surgery, time of follow-up, and final outcomes were extracted. The cases of trapdoor fracture were specifically examined with regard to the time from trauma to surgery and diplopia at last follow-up, which was the primary outcome. Results:One hundred thirty-five patients, aged 2.4 to 20 years (mean 17.0), were treated for orbital fractures during the period; 37 (27%) had an isolated orbital floor fracture and 12 (9%) had a trapdoor fracture. All patients with trapdoor fractures underwent surgery; the mean time to surgery was 11.9 days in 2007-2011 and 1.1 days in 2012-2017. Although statistical significance cannot be proven in this small and retrospective study, a shorter time from trauma to surgery seems to lead to fewer problems with diplopia and 2 patient cases that highlight this are presented. Conclusions:Delayed surgical intervention in pediatric orbital trapdoor fractures increases the risk of delayed recovery and persistent diplopia. Other factors, such as the degree of muscle incarceration and necrosis and the surgeon's experience and skill, may, however, also influence the outcomes.
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| 49. |
- Kölby, David, 1993, et al.
(författare)
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Craniotomy of the Fused Sagittal Suture Over the Superior Sagittal Sinus Is a Safe Procedure
- 2017
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Ingår i: Journal of Craniofacial Surgery. - : Ovid Technologies (Wolters Kluwer Health). - 1049-2275. ; 28:3, s. 666-669
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Spring-assisted cranioplasty to correct sagittal synostosis is based on midline craniotomy through the closed sagittal suture, over the superior sagittal sinus (SSS). The aim of the present study was to evaluate the perioperative safety of this technique. Materials and Methods: This is a retrospective study of all patients operated with median craniotomy and springs from 1998 to the end of 2015. For comparison, all Pi-plasties performed during the same time interval were also evaluated. The safety measures were evaluated based on incidence of damage to SSS, incidence of dural tears, perioperative blood loss, operative time, and hospital stay. Results: In the group that had undergone midline craniotomy combined with springs (n = 225), 4 perioperative damages to SSS and 1 dural tear were seen. The perioperative blood loss was 62.8 +/- 65.3mL (mean +/- standard deviation). The operative time was 67.9 +/- 21.5 minutes and the hospital stay was 4.8 +/- 1.1 days. In the group that had undergone pi-plasty (n = 105), no damages to SSS but 3 dural tears were seen. The perioperative blood loss was 352.8 +/- 174.4 mL. The operative time was 126.0 +/- 31.7 minutes and the hospital stay was 7.1 +/- 1.4 days. Conclusion: Craniotomy SSS in sagittal synostosis is a safe procedure with low morbidity in terms of damage to the SSS. Midline craniotomy combined with springs has significantly lower preoperative blood loss, operative time, and hospital stay (P < 0.001 for all) compared to pi-plasty.
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| 50. |
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