Le Fort I sliding osteotomy--a procedure for stable inferior repositioning of the maxilla.

INTRODUCTION: Inferior repositioning of the maxilla for correction of vertical maxillary deficiency has been found to be associated with instability and a tendency to relapse. This can not be completely controlled by using bone grafts as relapse commences before complete integration of the graft. METHODS: Improved stability was sought by using rules of geometry when displacing the maxilla down a sloping plane. Anterior and inferior sliding of the maxilla after a double 'M'-shaped Le Fort I osteotomy was performed to preserve bony contact at the medial and lateral maxillary buttresses. The plan of this technique was derived from model surgery when true changes at the Le Fort I level were visualized. PATIENTS: 15 patients with class III-malocclusion and anterior vertical deficiency of the maxilla were surgically treated using this technique. RESULTS: Bony contact at the maxillary buttresses after anterior and inferior displacement was possible in patients with less than 6mm movement in a sagittal direction. Only minor skeletal relapse (mean: 0.4mm) was observed in the follow-up period (mean 14.2 months). CONCLUSION: The procedure should be considered whenever vertical maxilla relapse is of concern after anterocaudal displacement.

Surgical correction of scaphocephaly: experiences with a new procedure and follow-up investigations.

Introduction: Simple resection of the sagittal suture and the use of alloplastic material or extensive skull resections have long been proven to be unsatisfactory in the treatment of sagittal synostosis. In contrast to these experiences, the immediate correction of skull shape seems to yield the best results without significant morbidity. Patients: Thirty-six scaphocephalic infants with an average age of 6.5 (3.5-14) months underwent operation by our craniofacial team since 1994. Methods: Wide resection of the sagittal suture was used in combination with a bone-strip resection along the coronal and lambdoid sutures. Occasionally partial resection and reshaping of the frontal or occipital bone was necessary to correct an extremely bulging skull. The cranial growth and shape was monitored by anthropometric skull measurements in the last 20 patients. Results: Except in two cases, in which the dura mater was minimally injured intraoperatively, no complications occurred in any patient. Craniofacial oedema always occurred but disappeared after 72 h. The immediate correction of the skull shape was successful in all cases and was completed within 6 months postoperatively. There was no iatrogenic bone defect one year after surgery. Postoperative skull shape and growth was normal. Conclusion: These procedures seem to be effective in the treatment of scaphocephalus. Further normalization of skull shape is achieved by unrestricted postoperative brain growth. Copyright 2001 European Association for Cranio-Maxillofacial Surgery.

Standardized evaluation and documentation of findings in patients with craniosynostosis.

Surgical correction of craniosynostosis is usually performed according to standard procedures. However, a standard for clinical examination and report of findings for patients with craniosynostosis does not exist as yet. To compare findings from different hospitals, a documentation system was developed by a national craniosynostosis group. This system comprises a two-page document, clinical photographs, radiographs, CT scans, anthropometric measurements and molecular genetic findings. Data from craniosynostosis patients collected from participating hospitals are stored in a database, which facilitates online access.The documentation system was developed in cooperation with the group during 3 years since 1996. It was evaluated as being practicable and reliable and enables a comparability of findings reported in different hospitals. Molecular genetic analysis was found to support the investigation of patients with craniosynostosis and should therefore be integrated in the clinical evaluation. Copyright 2001 European Association for Cranio-Maxillofacial Surgery.