Fixed posterior cranial vault expansion technique.

BACKGROUND: Different techniques to reshape the posterior skull vault have been developed in the last decades, all sharing the same goals of increasing the skull volume, decreasing the intracranial pressure (ICP), correcting the cranial dysmorphy, and contributing to a better growth of the skull. Though over the last years most refinements in these techniques have focused on the use of hardware as distractors or springs, the fixed posterior vault expansion remains a valuable procedure for cranial remodeling. METHODS: We describe in details the technique used for fixed posterior vault expansion in children that is applied at the French Referral center for Craniosynostosis of Lyon, France. DISCUSSION: The fixed posterior vault expansion increases the risk of perioperative complications due to the elevation of the posterior bone flap from the dura but allows an immediate decompression and correction of the shape, simplifying the postoperative course.

Impact of the COVID-19 Pandemic on Head and Neck Cancer Management: The Experience of the Maxillo-Facial Surgery Department of a French Regional Referral Center in a High-Incidence Area.

Background: Cancer patients are at a high risk of complications in cases of infection, and head and neck cancers (HNC) are no exception. Since late 2019, SARS-CoV-2 has caused a global health crisis, with high rates and severe forms of the disease in cancer patients. Hospitalization, surgery and radiotherapy were rapidly described as increasing the risk of infection. Since March 2020, the Amiens University Hospital (France) has been taking care of COVID-19 patients while its maxillofacial surgery department managed HNC patients without interruption, even during lockdown periods. However, many questions concerning the impact on patient care were still pending. The aim of this study is to describe HNC management in our center during the first epidemic peak and to evaluate the impact of containment measures on patient treatment. Methods: We retrospectively included 44 HNC patients treated in our department between 1 March and 31 August 2020. Two groups were defined according to the period of care: lockdown (March to May) and lighter restrictions (June to August). Results: The results show typical epidemiological characteristics, maintained management times and non-downgraded procedures. Conclusions: Thus, during the first epidemic peak, continuity of care and patients' safety could be ensured thanks to adequate means, adapted procedures and an experienced surgical team.

Predictive Value of Sonographic Parameters on the Effects of Cranial Molding Helmet Therapy in Infants with Positional Plagiocephaly.

Positional plagiocephaly is a deformational cranial flattening frequently treated in pediatric neurosurgical practice. Positional maneuvers and orthotic helmet therapy are preferred therapeutic options for moderate-to-severe forms. Treatment response seems to be age-dependent. Nevertheless, predictive data are vague, and cost-efficiency might be a limiting factor for treatment. The purpose of this study was to investigate the early predictive value of sonographic parameters on the efficacy of orthotic helmet therapy through the assessment of changes in skull shape and correlation of the parameters with caliper cephalometry values and with age. A consecutive cohort of 49 patients < 10 months of age, undergoing orthotic helmet therapy for positional plagiocephaly, was recruited prospectively. The authors routinely assessed the patency of the lambdoid sutures by ultrasound and the following additional skull parameters were measured: suture width, adjacent full bone thickness, adjacent cortical bone thickness and occipital angle. Caliper cephalometric values, as well as demographic and clinical data were collected. Retrospective data analysis showed an inverse relation between both cortical and full skull bone thickness and early treatment efficacy, defined by a reduction in the occipital angle. The improvement of sonographic parameters correlated with the development of cranial caliper cephalometry values. In conclusion, the sonographic assessment of skull bone thickness is a safe and cost-effective tool to predict the early efficacy of orthotic helmet therapy in positional plagiocephaly and might, therefore, help the clinician to foresee the potential evolution of the deformity.