Radical one-stage correction of craniofacial anomalies.

The authors present their experience in the surgical treatment of 66 patients with craniofacial anomalies, and discuss selection of patients, surgical technique, complications, and results.

Deformities of the midface resulting from malunited orbital and naso-orbital fractures.

In midfacial fractures the crucial area is the upper portion of the midfacial skeleton which lodges the orbits, the interorbital space with its anatomic relationship with the anterior cranial fossa, the lacrimal apparatus, the levator muscle, and the skeletal structures of the nose. Because of the severity of the injuries in a multisystem injured patient, these fractures may be neglected or receive inadequate primary treatment. In some cases the damage is so extensive that primary treatment can only accomplish part of the task. Late reconstruction is necessary, therefore, and is the subject of this paper.

Reconstruction of acquired ear defects with transauricular flaps.

Retroauricular flaps based superiorly, inferiorly, or posteriorly may be tunneled through the ear to close a variety of acquired ear defects in a single-stage procedure. The technique is particularly helpful for larger, nonmarginal deformities in which both skin and perichondrium have been excised.

Report on a series of 50 craniofacial operations.

We present a retrospective study of 50 patients who have undergone craniofacial surgery. The indications, types of osteotomies, complications, and other aspects are reported.

Internal brain herniation in a patient with Apert's syndrome.

Patients with Apert's syndrome typically exhibit craniosynostosis, exorbitism, midface hypoplasia, and symmetric syndactyly. There have also been occasional descriptions of the variable dysmorphology of the inner surface of the calvarium. We present a patient with Apert's syndrome who had an intracranial herniation of a portion of the frontal lobe through a ridge of ossified dura. The ridge and the gliotic cortical tissue were removed when the patient underwent repair of the hypertelorism at age six. Bone grafts for this repair were fashioned in part from the resected ridge. We believe this finding may be the result of a small dural tear that occurred during prior surgery.

Correction of ocular hypertelorism.

36 patients with congenital hypertelorism, eight with Crouzon's disease, and three with a posttraumatic deformity, were operated with Tessier's technique with some modifications, i.e. the dura is not separated from the cribriform plate avoiding olfactory damage. The entire procedure for hypertelorism could be carried out in less than 5 h but correction of Crouzon's disease required 6-8 h, and longer in older patients. There was only one intraoperative anesthesic death in a 3-year-old child. One cardiac arrest recovered. Nine staphylococcus infections were superficial and readily treated. There was postoperative cerebral edema in one case and convulsions following surgery in another. Anticonvulsants and steroids were subsequently routinely employed. There were no SF fistulas. Excellent cosmetic results are due primarily to the skill of the plastic surgeons.

Early and late surgery in craniofacial dysostosis: a longitudinal cephalometric study.

Longitudinal clinical and cephalometric case studies are presented for two groups of patients with craniofacial dysostosis. The first sample includes two infants who underwent an extensive stripping procedure that was extended inferiorly to involve not only the coronal, but also the sphenozygomatic suture. The second sample includes two adolescents with midfacial hypoplasia who underwent a fronto-orbital-maxillary advancement. The extensive cranial stripping procedure had a favourable impact upon growth and development of the craniofacial structures, and longitudinal studies suggest the importance of promoting the growth potential of the bones contiguous to the affected sutures. Craniofacial surgery performed on adolescents results in a dramatic translocation of the skeletal and soft-tissue structures of the face. In contrast to early surgical intervention in infants in whom growth of the effected areas essential to the development of face and cranium was crucial, late surgery appeared to have little, if any, impact upon the development of the craniofacial skeletal structures that had been operated on.