| 1. |
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| 2. |
- Fischer, Sara, et al.
(författare)
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Intracranial volume is normal in infants with sagittal synostosis.
- 2015
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Ingår i: Journal of plastic surgery and hand surgery. - 2000-6764. ; 49:1, s. 62-64
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Premature sagittal synostosis results in an elongated, narrow skull shape, scaphocephaly. It has been unclear whether the intracranial volume (ICV) of these children is different from that of normal children. The aim of the present study was to precisely determine the ICV in a large cohort of children with premature sagittal synostosis and to compare it to the ICV of a sex- and age-matched control group. All patients (n = 143) with isolated sagittal synostosis registered in the Göteborg Craniofacial Registry until the end of 2012 with a preoperative CT examination were identified. For each case, a sex- and age- (±30 days) matched control was identified from children who had undergone CT for post-traumatic or neurological reasons. The ICV was measured in a semi-automatic MATLAB program with functions such as region growing, watershed, and thresholding in axial CT slices. The ICV was calculated using the Cavalieri principle. The mean (± SEM) values of ICV for children with sagittal synostosis and for corresponding controls were 866 ± 13 ml and 870 ± 15 ml, respectively. The mean ages of these groups were 173 ± 8 days and 172 ± 8 days, respectively. Subgroup analysis of sex and age at CT (≤180 days and >180 days) did not reveal any differences in ICV between cases and controls. Precise determination of ICV in addition to the use of adequate controls has made it possible to conclude that children with premature isolated sagittal synostosis have a normal ICV.
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| 3. |
- Hagmarker, Linn, et al.
(författare)
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A new quantitative image-based method for evaluation of bony temporal hollowing in metopic synostosis
- 2016
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Ingår i: Journal of Plastic Surgery and Hand Surgery. - : Medical Journals Sweden AB. - 2000-656X .- 2000-6764. ; 50:6, s. 343-348
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Premature craniosynostosis is a congenital disorder causing a skull deformity. For both functional and cosmetic reasons, the deformity is surgically treated with a cranioplasty before the age of 1 year. Temporal hollowing is a common and undesirable remaining deformity after cranioplasty for metopic synostosis. The most common method to determine the degree of temporal hollowing is subjective judgement of the temporal region. The aim of the present project was to develop a quantitative semi-automatic computer tool for objective measurement of bony temporal hollowing. Methods: Using MATLAB, a tool was developed to segment computed tomography images, defining the outermost contour. The images were dorsally limited to the widest point of the head. In each case, a sex-and age-matched control was identified and the contours compared. The bony temporal hollowing of the cases was calculated. Results: The intra-user coefficient of variation (CV) was 5.0% (95% CI = 4.2%-6.2%) and the inter-user CV was 3.0% (95% CI = 2.1%-8.6%). For clinical testing purposes, the tool was used in 14 patients, seven of whom had been operated on with a spring-assisted cranioplasty and seven with a cranioplasty using a bone graft. Conclusions: In summary, this study presents a new tool for objective measurement of the surgical result after cranioplasty for metopic synostosis.
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| 4. |
- Kljajić, Marizela, et al.
(författare)
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The Cognitive Profile of Children with Non-syndromic Craniosynostosis
- 2019
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Ingår i: Plastic and reconstructive surgery. - 1529-4242. ; 143:5
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Tidskriftsartikel (refereegranskat)abstract
- Long-term neuropsychological and cognitive outcomes in patients with non-syndromic craniosynostosis have proven difficult to evaluate objectively due to methodological problems with published studies based on their small and biased samples of patients, wide age ranges, and testing with unacceptable psychometric properties. This study evaluated full-scale intelligence quotient (FSIQ) and its subscales in a cohort with a small selection bias.Patients (aged 7-16 years) born with non-syndromic craniosynostosis and surgically treated were tested using the Wechsler Intelligence Scale for Children, Fourth Edition (WISC-IV). Ninety-one patients were invited, and 73 patients were tested.There was no difference in FSIQ between patients having undergone operations for sagittal synostosis or metopic synostosis and norms provided by the test. Patients operated on for sagittal synostosis showed a significantly higher perceptual reasoning IQ, but also significantly lower working-memory IQ and processing-speed IQ as compared with the norms. Patients operated on for metopic synostosis showed no differences in any IQ index as compared with the norm. Additionally, attrition analysis showed no differences in background factors between responders and non-responders.These results derived from a group of patients with uniform age range, and tested using an established tool revealed that non-syndromic children having undergone surgery for craniosynostosis exhibited average intellectual ability. However, the analysis indicated possible issues with working memory and processing speed in patients operated on for sagittal synostosis, highlighting impairments potentially associated with neuropsychological problems and that might contribute to learning disabilities.
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| 5. |
- Söfteland, Madiha Bhatti, 1977, et al.
(författare)
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Temporal Deformity Objectively Measured before and after Surgery for Metopic Synostosis: Retrusion Rather than Hollowing
- 2017
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Ingår i: Journal of Craniofacial Surgery. - 1049-2275. ; 28:7, s. 1757-1760
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Tidskriftsartikel (refereegranskat)abstract
- The temporal contour deformity typical of metopic synostosis is often referred to as temporal hollowing, but has not been quantitatively defined. This deformity is present before surgery and remains to a varying extent at long-term follow-up. The present study aimed to objectively evaluate the degree of this contour deformity in metopic synostosis before and after surgical correction. All children surgically treated for metopic synostosis at Sahlgrenska University Hospital between 2002 and 2014 (n = 120) with appropriate computed tomography scans (n = 160) performed preoperatively and/or at follow-up at 3 years of age were included. Depending on age, 1 of 2 surgical techniques was used. Children presenting before the age of 6 months were treated with frontal remodeling in combination with a spring (S group), whereas children older than 6 months were treated with a bone transplant (BT group). The bony temporal deformity was measured with a semiautomatic MATLAB program and patients were compared to sex-and age-matched controls. The deformity was significantly reduced in both groups (P < 0.001). In the S group, it was reduced from a mean ± standard deviation of 3.6 ± 1.9% to 1.0 ± 1.2% and in the BT group, it was reduced from 3.3% ± 1.4% to 1.1% ± 0.8%. The contour deformity in metopic synostosis is present both before and after surgery and should therefore be termed temporal retrusion (TR). This assessment method enables objective comparison of TR before and after surgical correction and is a potential tool to evaluate TR in metopic synostosis. © 2017 by Mutaz B. Habal, MD.
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| 6. |
- Söfteland, Madiha Bhatti, 1977, et al.
(författare)
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The Degree of Surgical Frontal Volume Correction in Metopic Synostosis Determines Long-Term Outcomes
- 2017
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Ingår i: Journal of Craniofacial Surgery. - : Ovid Technologies (Wolters Kluwer Health). - 1049-2275. ; 28:5, s. 1161-1163
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Tidskriftsartikel (refereegranskat)abstract
- Metopic synostosis results in a keel-shaped forehead, reduced frontal intracranial volume (ICV), and lower frontal to total volume ratio. The ratio improves with cranioplasty, but at 3 years of age, the ratio is still not normalized when compared to that in normal children. The aim of the present study was to investigate whether a low frontal to total ICV ratio at 3 years of age was due to relapse or insufficient correction.All children surgically treated for metopic synostosis in combination with a spring at Sahlgrenska University Hospital with subsequent spring extraction between 2002 and 2008 (n=20) were included. A MATLAB program was used to measure frontal and total ICV.Preoperatively, the frontal to total ICV ratio was 9.81.3% (mean +/- standard deviation). At spring removal, 6 months after cranioplasty, the ratio had increased to 11.8 +/- 2.4%. At 3 years of age, the ratio was 11.6 +/- 1.9%. In age-matched normal children, the ratio was 14.4 +/- 1.9% preoperatively, 15.3 +/- 2.2% at time of spring extraction, and 13.4 +/- 1.4% at 3 years of age.Cranioplasty thus improved the frontal to total ICV ratio, but did not normalize it. The ratio did not change from 6 months after the cranioplasty to 3 years of age. These results indicate that a more pronounced frontal volume correction during cranioplasty is necessary to achieve a normalized distribution of ICV in metopic synostosis.
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| 7. |
- Bevilacqua, Ruggero, et al.
(författare)
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Spring-Assisted Surgery in the Treatment of Complex Craniosynostosis
- 2018
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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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| 8. |
- Hallen, T., et al.
(författare)
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Cranioplasty without Periosteal Dissection Reduces Blood Loss in Pi-Plasty Surgery for Sagittal Synostosis
- 2017
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Ingår i: Pediatric Neurosurgery. - : S. Karger AG. - 1016-2291 .- 1423-0305. ; 52:4, s. 284-287
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Tidskriftsartikel (refereegranskat)abstract
- Background/Aims: Cranioplasty is often accompanied by a substantial oozing bleeding from the bone surface and bone edges. Our aim was to measure if strict subgaleal dissection without any periosteal release reduces blood loss during pi-plasty surgery for sagittal synostosis. Method: A group of 32 children who underwent pi-plasty surgery at the Sahlgrenska University Hospital between 2010 and 2014 for premature sagittal synostosis with traditional subgaleal dissection combined with incision and release of the periosteum adjacent to the osteotomy lines was compared to a group of 7 children who underwent pi-plasty with strict subgaleal dissection and osteotomy through the bone with the periosteum attached. Information about blood loss and body weight was extracted from medical records. Results: The blood loss in the group of 7 children with strict subgaleal dissection was 102 +/- 86 mL (mean +/- SD) (10 +/- 7 mL/kg) compared to 320 +/- 119 mL (32 +/- 12 mL/kg) in the control group with traditional periosteal release (p < 0.001). Conclusion: Intact periosteum at the osteotomy lines significantly reduces blood loss in pi-plasty surgery for sagittal synostosis. The mechanism is likely because of preserved veins between the bone surface and periosteum.
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| 9. |
- 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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| 10. |
- Maltese, Giovanni, 1974, et al.
(författare)
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Spring-assisted surgery in the treatment of sagittal synostosis: A systematic review.
- 2015
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Ingår i: Journal of plastic surgery and hand surgery. - 2000-6764. ; 49:3, s. 177-182
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Background: Premature sagittal synostosis (SS) can be surgically corrected using extensive cranioplasties or using less invasive methods, e.g. spring-assisted surgery (SAS). Aim: The aim of the present study was to perform a proper systematic review of springs in the treatment of SS. Methods: A literature search was performed with the assistance of a professional librarian in the databases PubMed, EMBASE, and The Cochrane Library between 1997 and September 2013. Studies that fulfilled the PICO (patients, interventions, controls, outcome) criteria were included. All studies were graded for methodological quality according to MINORS, and all retrospective studies were assessed according to a scale developed for retrospective studies in paediatric surgery. The quality of evidence was rated according to GRADE. Results: A total of 241 abstracts were extracted in the literature search. Five studies met the PICO criteria. Two of these five were considered as preliminary reports and excluded. Assessment according to MINORS showed a mean score of 21, i.e. fair quality. The clinical outcome regarding cephalic index did not differ between the surgical techniques, but the quality of evidence, according to GRADE, that SAS was equally efficient, was very low. Clinical outcome regarding operation time, blood loss, ICU stay and hospital stay was in favour for SAS, but the quality of evidence was low. Conclusions: This systematic review has revealed that the level of evidence for SAS being an equally efficient surgical method as more extensive cranioplasties for SS is low or very low. The results point out the need for well-designed prospective studies within craniofacial surgery.
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| 11. |
- Paganini, Anna, 1979, et al.
(författare)
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In search of a single standardised system for reporting complications in craniofacial surgery: a comparison of three different classifications.
- 2019
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Ingår i: Journal of plastic surgery and hand surgery. - 2000-6764. ; 59:6, s. 321-7
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Tidskriftsartikel (refereegranskat)abstract
- Comparing complication rates between centres is difficult due to the lack of unanimous criteria regarding what adverse events should be defined as complications and how these events should be compiled. This study analysed all adverse events in a cohort of craniofacial (CF) operations over a 10-year period and applied three different scales (Clavien-Dindo, Leeds and Oxford) for systematic comparison. A total of 1023 consecutive CF procedures in 641 patients was identified. The Clavien-Dindo scale captured 74 complications in 74 procedures (7.2%), whereas the Leeds and Oxford scales captured 163 complications in 134 procedures (13.1%) and 85 complications in 83 procedures (8.1%), respectively. The Clavien-Dindo scale appeared less suitable for CF surgery, because it is predominantly adapted to severe complications and also regards blood transfusion as a complication. The Leeds scale provided a detailed picture of all complications, as well as minor events, whereas the Oxford scale captured all major complications well but applied less accurate definitions for the minor events. Our findings contribute to the benchmarking of complications between CF centres and suggest that both the Leeds and the Oxford scale appear relevant, depending on the emphasis required for major and minor complications and inter-centre audits, respectively.
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| 12. |
- Säljö, Karin, 1981, et al.
(författare)
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Craniosynostosis: A Reversible Pathology?
- 2019
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Ingår i: The Journal of craniofacial surgery. - 1536-3732. ; 30:6, s. 1628-1630
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Tidskriftsartikel (refereegranskat)abstract
- The formation of the cranial sutures, in utero, occurs when the ossification of the skull bones reaches predestined positions around gestational week 15 to 20. Craniosynostosis, and the consequent skull shape deformities, is treated with surgery including osteotomies of the fused sutures. The occasional appearance of a new suture in the osteotomy lines has previously been described as sporadic events. In this retrospective study, a 4-year consecutive series of osteotomies combined with springs for craniosynostosis were systematically analysed regarding the appearance of neosutures. In total, 84 patients were included and in 16 patients (19%) a new radiologically normal suture appeared in a part of the suture that was completely closed preoperatively. Additionally, in 7 patients (8%) a new suture appeared in a part of the suture that had a discernible suture prior to surgery.In conclusion, in this consecutive and well-defined patient cohort operated for craniosynostosis, the formation of a neosuture is not a rare, and speculatively not a random, event. The appearance of a new suture long after the normal time period for suture formation in utero indicates that the craniosynostosis may just as well be caused by disturbed formation of the suture as actual premature closure.
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| 13. |
- Tengström, Emin, et al.
(författare)
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Minnen från studenttiden vid Göteborgs universitet
- 2018
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Bok (övrigt vetenskapligt/konstnärligt)abstract
- Boken ger några självbiografiska exempel på hur livet som student vid GU kunde te sig under senare halvan av 1900-talet (från 40-tal till 90-tal). Bland de teman som tas upp kan nämnas den studiesociala situationen, studentlivet i allmänhet, studierna inom ett antal ämnesområden, erfarenheterna och upplevelserna av den utbildning om erbjöds samt de dåtida ekonomiska förutsättningarna för studierna. Författare är Emin Tengström, Britta Olinder, Martin Fritz, Allan Svensson, Mats Oscarson, Britt-Mari Näsström, Peter Sjögren, Peter Tarnow och Henrik Zetterberg.
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| 14. |
- Silva, Ingrid, et al.
(författare)
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Quality of life in patients undergoing orthognathic surgery - A two-centered Swedish study
- 2016
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Ingår i: Journal of Cranio-Maxillofacial Surgery. - : Elsevier BV. - 1010-5182 .- 1878-4119. ; 44:8, s. 973-978
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Tidskriftsartikel (refereegranskat)abstract
- Aim: Surgical corrections of dentofacial deformities have both physical and psychological impact on quality of life (QoL). The objectives of the present study were to evaluate the impact of oral health related problems on QoL before and after a combination of orthodontic treatment and orthognathic surgery. Additionally, the study aimed to identify correlations between different dentofacial patterns and possible improvements due to treatment. Material and methods: In a prospective study, we evaluated fifty patients before start of treatment, 6 weeks and 6 months postoperatively. The questionnaires used were: OHIP-14 (Short Form Oral Health Impact Profile), a condition-specific QOL approach (Orthognathic Quality of Life Questionnaires; OQLQ) and a social-demographic questionnaire. Results: There was a statistically significant improvement in the OHIP domains from baseline to 6 months follow-up and for the OQLQ the improvement was significant both at 6 weeks and 6 months in relation to the baseline data. Conclusion: Significant improvement of quality of life over time is proved by both OHIP-14 and OQLQ in the present study. Socio-demographic and holistic considerations are important when evaluating treatment outcome after combined orthodontic and orthognatic surgery. However, longer follow-up would be beneficial. (C) 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.
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| 15. |
- Suska, Felicia, 1974, et al.
(författare)
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Electron Beam Melting Manufacturing Technology for Individually Manufactured Jaw Prosthesis: A Case Report
- 2016
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Ingår i: Journal of Oral and Maxillofacial Surgery. - : Elsevier BV. - 0278-2391 .- 1531-5053. ; 74:8
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Tidskriftsartikel (refereegranskat)abstract
- In the field of maxillofacial reconstruction, additive manufacturing technologies, specifically electron beam melting (EBM), offer clinicians the potential for patient-customized design of jaw prostheses, which match both load-bearing and esthetic demands. The technique allows an innovative, functional design, combining integrated porous regions for bone ingrowth and secondary biological fixation with solid load-bearing regions ensuring the biomechanical performance. A patient-specific mandibular prosthesis manufactured using EBM was successfully used to reconstruct a patient's mandibular defect after en bloc resection. Over a 9-month follow-up period, the patient had no complications. A short operating time, good esthetic outcome, and high level of patient satisfaction as measured by quality-of-life questionnaires-the European Organisation for Research and Treatment of Cancer QLQ-C30 (30-item quality-of-life core questionnaire) and H&N35 (head and neck cancer module)-were reported for this case. Individually planned and designed EBM-produced prostheses may be suggested as a possible future alternative to fibular grafts or other reconstructive methods. However, the role of porosity, the role of geometry, and the optimal combination of solid and porous parts, as well as surface properties in relation to soft tissues, should be carefully evaluated in long-term clinical trials. (C) 2016 American Association of Oral and Maxillofacial Surgeons
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