Percentile-based assessment of craniosynostosis.

Perioperative assessment of craniosynostosis is based mostly on subjective scores. In this study, we sought to find an objective method to assess cranial deformation based on normative craniofacial percentiles. Anthropometric datasets from 104 (79 males, 25 females) patients with craniosynostoses were included. Anthropometric data were compared with normative age-dependent percentiles. Deviations above the 90th or below the 10th percentile were defined as significant cranial deformation. The cohort comprised 69 children with sagittal, 22 metopic, nine coronal, two bicoronal, one lambdoid, and one with coronal + lambdoid craniosynostosis. Most children with sagittal synostosis were above the 90th percentile for cranial circumference and length, whereas only 27.9% were below the 10th percentile for cranial width. Most (83%) children with scaphocephaly had cranial indices below the 10th percentile. For trigonocephaly, we found normal cranial circumference values in most patients (10th-90th percentile), 40.9% were above the 90th percentile for cranial length, and 63.1% and 57.9% were above the 90th percentiles for sagittal and transverse circumferences. For unicoronal synostosis transverse circumference was above the 90th percentile in 83.3% of children. Matching of anthropometric data of craniosynostosis patients with craniofacial norms could be useful in grading the clinical picture and potentially adapting the operative procedure.

Retrospective analysis of autologous blood use in bimaxillary repositioning osteotomy surgery: a quality improvement study.

BACKGROUND: Multiple studies have considered the necessity of preoperative autologous blood donation before bimaxillary orthognathic osteotomies. In the context of a quality improvement project, this topic was also investigated in our institution. Furthermore, the transfusion practice was analyzed and the correlations between patient, operative variables, and blood loss were studied. STUDY DESIGN AND METHODS: In accordance with the recommendations of the Federal Medical Association and the Federal Ministry for Health and Social Security, a transfusion demand list was compiled using data of 82 patients who underwent bimaxillary orthognathic surgery between 1997 and 2005. The maximum blood loss tolerable without transfusion (MBL) was calculated for each patient on the basis of sex, weight, height, and preoperative hematocrit (Hct). This was compared with the actual transfusion and blood loss data. RESULTS: An autologous blood donation was carried out in 65 of 82 patients (79.3%). Sixty-two of 65 autologous blood donors (95.4%) and 2 of 17 patients (11.8%) without autologous blood donation received transfusion. The actual blood loss did not exceed the calculated MBL in 48 of the 82 cases. Nevertheless, 31 of these 48 patients (64.6%) received transfusions. For patients with a low calculated MBL, only a trend to a higher transfusion rate was observed, although the actual blood loss in these cases more often exceeded the individually calculated MBL (p < 0.01). In addition, transfusion triggers (Hct 0.22 or hemoglobin 7.5 g/dL) were also more often seen in cases with low calculated MBL (p < 0.05). CONCLUSIONS: In this study, an inappropriate transfusion practice in patients undergoing bimaxillary orthognathic osteotomies after preoperative autologous blood donation was detected. Calculation of the individual MBL should be used to help identify patients at high risk for transfusion and guide adequate methods to decrease the need of homologous blood.