Supra-apical midfacial osteotomies--new surgical techniques and their application.

Four types of so-called "supra-apical midfacial osteotomies" are described in the detail. These are recommended for correction of the severely hypoplastic midface in the paranasal and hyponasal areas. A moderate vertical elongation of the midface is also achieved with these osteotomies. Their use in patients with cleft deformities to reduce the risk of hypernasality is recommended.

Reliability and feasibility of prediction tracing in orthognathic surgery.

Review of 40 prediction tracings showed that 60% of these showed inaccuracy when compared with post-operative tracings. 33% of inaccurate prediction tracings were associated with inaccuracy of surgery. 83% of all prediction tracing for planning bimaxillary procedures and 40% of all prediction tracing for planning unimaxillary procedures were inaccurate. Some factors which may be responsible for inaccuracy of prediction tracing are discussed.

The specific psychosocial effects of orthognathic surgery.

This study was to test the validity of patients' opinions and provide a more accurate method than previously reported of assessing the specific psycho-social effects of orthognathic surgery. Questionnaires were used preoperatively and postoperatively providing a longitudinal sample, while those patients who only completed questionnaires either before or after surgery provided cross-sectional samples. Different questionnaires were used to provide data on a 'Body Satisfaction Scale', 'Fear of Negative Evaluation', 'Social Avoidance and Distress', and a 'General Health Questionnaire'. The results indicate that surgery produced an improvement in body image, particularly in the evaluation of facial attractiveness.

Lower blepharoplasty post-orbicularis approach to the orbit--a prospective study.

Fifty patients (55 incisions) requiring exploration for repair of zygomatico-orbital trauma were admitted to a prospective study using a uniform and standardised technique for the approach to the orbital rim and floor--the lower blepharoplasty incision combined with a post-orbicularis dissection. A post-operative 'Frost suture' was used in the majority of cases. The incidence of post-operative ectropion is compared to the incidence noted in a previous retrospective study (Pospisil & Fernando, 1984) and factors relating to the occurrence of ectropion are discussed.

Pneumosinus dilatans.

Deformity of the forehead is usually the first clinical presentation of the abnormally enlarged paranasal sinuses caused by pneumosinus dilatans. The diagnosis and surgical treatment of two cases are reported. The type of osteotomy described is recommended as a method of surgical treatment of this condition.

Review of the lower blepharoplasty incision as a surgical approach to zygomatic-orbital fractures.

The use of a lower blepharoplasty incision as a surgical approach to zygomatico-orbital fractures is described. A series of 27 cases is presented. The incidence of transient and permanent post-surgical ectropion is discussed and correlated with the degree of post-traumatic oedema, age and sex of the patients, the form of dissection and the method of closure.

Nasal symmetry after primary cleft lip repair: comparison between Delaire cheilorhinoplasty and modified rotation-advancement.

PURPOSE: Periosteal musculoaponeurotic (PMAS) reconstruction is a key objective in primary repair of the cleft lip. The reconstructed muscles provide a sound framework and stimulus for development of the nasolabial region. In this study two primary cleft lip repair techniques were retrospectively studied to determine if one [Delaire (Del)] which involves PMAS repair around the cleft results in more nasolabial symmetry than a technique that does not fully addressed the musculature [modified Rotation-Advancement, (mR-A)]. PATIENTS AND METHODS: Four-and 5-year-old children with complete unilateral cleft lip and palate were recalled for study (n = 33 children; Del group, 16; mR-A group, 17). Clinical and photographic records were obtained and anthropometric analyses determined for comparison between groups. RESULTS: In the mR-A group, noses had more asymmetrical tips, were shorter, projected less, and tended to be flatter or wider. Nasal indices tended to support these findings. Nasal height was similar for the mR-A and Del groups. When comparing cleft versus noncleft sides, alar width and length and nostril length were significantly different for both cleft groups. CONCLUSIONS: It appears from this study that reconstruction of the PMAS of the nasolabial region during primary cleft lip repair may positively influence growth and development of the nose in unilateral cleft lip and palate patients.

The need for orthognathic surgery in patients born with complete cleft palate or complete unilateral cleft lip and palate.

The purpose of the study was three fold: (1) to assess the need for orthognathic surgery in complete cleft palate and complete cleft lip and palate patients treated in Liverpool, (2) to determine the effect of timing of operation, technique and the number of operations on the need for orthognathic surgery and (3) to establish a more standardised method of assessing the need of orthognathic surgery in cleft lip and palate patients.