Integrated Endoscopic Craniosynostosis Surgery and Cranial Orthosis Program.

INTRODUCTION: Craniosynostosis results from premature fusion of the cranial sutures. There has been a continuous evolution of surgical correction techniques from an extensive open procedure to the minimally invasive technique. AIMS AND OBJECTIVES: This novel surgical technique has never been previously done in the UAE and this article documents the experience of the first team to endoscopically correct craniosynostosis with planning, surgical techniques, and customized helmet therapy. METHODS: A retrospective case series of 16 nonsyndromic craniosynostosis patients with unicoronal (6), sagittal (5), bicoronal (1), frontosphenoidal (2), and metopic craniosynostoses (2) was corrected endoscopically and followed up with customized cranial helmet. Preoperative and postoperative photography, along with anthropometric measurements were taken. RESULTS: The mean age of all patients at the time of surgery was 101 (90-117) days, mean duration of surgery was 70 minutes (38-129), mean blood loss was 120 mL (100-150), and mean duration of hospital stay 4 days (4-5). No complications and mortality were reported. Mean number of helmets was 2 (1-3). Cranial index improved in all patients with sagittal and bicoronal craniosynostosis. Close cooperation with the orthotist ensured timely helmet therapy and accurate laser scanning documentation in head molding. CONCLUSIONS: This case series has demonstrated that endoscopically craniosynostosis correction is safe, effective, and reliable and is the first reported series from the Middle East. The authors believe that every patient with nonsyndromic single­suture craniosynostosis should be offered endoscopic correction before the age of 6 months. The orthotist forms an important part of the Multi-disciplinary team, enabling successful outcomes.

EarWell Infant Ear Molding Device: Experience and Parent Survey.

BACKGROUND: EarWell infant ear molding device is a noninvasive, nonsurgical option to treat ear deformities in early infancy. There are no studies involving the parents' perspective to the use of the EarWell. AIM: To investigate our experience with EarWell infant ear molding device and to assess the parents' satisfaction. STUDY DESIGN: A retrospective case series study of infants with congenital ear deformities who were treated with EarWell device from October 2021 to November 2022. Demographic and clinical data were collected. Clinical photographs were obtained before, during, and after treatment. Parents' satisfaction level was assessed through telephone encounters and surveys, and issues associated with device application were identified. Clinical improvement of ear deformity was graded into poor, fair, good, and excellent. RESULTS: A total of 9 patients with congenital ear deformities were identified and included in this study (7 bilateral deformities and 2 unilateral deformities). The mean adjusted age of the initial treatment is 17 weeks (4-23 weeks), and the mean treatment duration is 5.7 weeks. The authors received full 8 responses from the parents' survey, and all parents were satisfied with post-treatment results (4 satisfied, 1 fully satisfied, and 2 very satisfied). Issues associated with device application were 3 superficial skin ulcers and 4 skin irritation. Clinical Improvement grades were: 5 excellent improvement, 2 good improvement, and 2 fair improvement. CONCLUSIONS: On the basis of our experience, the EarWell device has shown a high success rate and a low complication rate. It is well accepted by parents, but it needs close follow-up to detect minor device-related issues. The device is safe for multiple skin types.

Endoscopic-assisted Surgery in the Treatment of Isolated Frontosphenoidal Craniosynostosis.

Isolated frontosphenoidal craniosynostosis is extremely rare, due to which diagnosis can be challenging. All the isolated cases reported have been treated by open surgical technique. We present a unique case report of an infant with an isolated frontosphenoidal synostosis corrected by a novel endoscopic surgical technique. The patient was a 5-month-old boy with worsening abnormal head shape indicating progressive right frontal bossing, left orbital displacement, and right occipital plagiocephaly. Computed tomography scan confirmed the diagnosis of left isolated frontosphenoidal craniosynostosis. Endoscopic-assisted surgical release was done starting with a 2.5-cm incision in the left temple area followed by a 2-cm strip osteotomy to excise the fused frontosphenoidal suture. Custom-made orthotic helmet therapy was started 2-weeks postsurgery, with excellent progress noted in the head shape confirmed by laser scans. The benefits of the endoscopic technique include smaller incision, decreased blood loss and need for blood transfusion, and decreased stay in hospital. This is the first case report showing the application of a novel endoscopic-assisted surgical treatment in an isolated frontosphenoidal craniosynostosis with no complications noted.

An anatomical composite nasal lining subunit technique in primary cleft nose correction.

Current primary cleft nose correction techniques are associated with a significant rate of long term alar collapse. The nasal lining on the cleft side has been observed to be distorted and deficient. Nasal endoscopy was used to map the two dimensional topography of the anterior nasal airway lining in a normal and patient with unilateral cleft lip. The vestibular nasal subunit was noted to have a triple structural overlap (Lateral crus, valve and vestibule units). A nasal lining subunit based surgical strategy was designed, based on the subunit principle. The lateral crural tethering was released and differential repositioning of the cartilage/lining complex performed. The difference in domal height between the cleft and non-cleft sides was translated into a superior and medial advancement of the cartilage/lining composite subunit. The valve sub-unit defect was resurfaced with a vermilion full thickness graft, taken at the time of primary cleft lip repair. Primary septal relocation was performed and no percutaneous cartilage sutures were done. Pre and post-operative anthropometry measurements were obtained, and repeated at follow up. Complete nasal correction was seen in the unilateral cleft lip patient and was noted to be stable at 1 year follow-up. A novel nasal cartilage/lining subunit topographical map is proposed and forms the basis for a surgical strategy addressing comprehensive correction of the unilateral cleft nasal deformity.

Nitroglycerin patch use in digital ischemia secondary to sepsis: a case report.

Sepsis results in intense disturbances in homoeostasis and is responsible for considerable morbidity and mortality in early infancy. Owing to insufficiency on part of infant to develop adequate inflammatory response to localize the infection, they usually progress to disseminated systemic infection, pneumonia and/or meningitis. We present the case of a 26 weeks preterm boy with acute digital ischemia in right index finger progressing to impending gangrene as a manifestation of septicemia. Use of topical nitroglycerin patch with meticulous monitoring successfully alleviated the impending peripheral gangrene without any adverse effects.

Topical negative pressure therapy: does it accelerate neovascularisation within the dermal regeneration template, Integra? A prospective histological in vivo study.

BACKGROUND: The use of topical negative pressure (TNP) dressings with dermal regeneration template (DRT), Integra, has improved outcomes and simplified aftercare. Previous clinical studies have suggested accelerated vascularisation; with a reduction in the duration of the 1st stage after the application of Integra, from 2 to 4 weeks to as little as 4 days, but with no histological evidence. However, histological studies, without TNP, have shown that vascularisation occurs between the second and the fourth week. This study set out to examine histologically the rate of DRT neovascularisation when combined with TNP. METHODS: Eight patients with nine reconstruction sites were enlisted. Unmeshed Integra and fibrin sealant to promote adherence were used. TNP was applied for the duration between the 1st and the 2nd stages. Patients underwent serial biopsies on days 7, 14, 21 and 28 post-application. The biopsies were stained with H&E and endothelial markers CD31 and CD34. Template vascularisation was assessed as a percentage of the template depth in which patent, canalised vascular channels could be demonstrated. RESULTS: The median percentage of the template depth which demonstrated canalised channels was 0%, 20%, 61% and 80% for days, 7, 14, 21 and 28, respectively. CONCLUSION: The application of TNP dressings to dermal templates can reduce shearing forces, restrict seroma and haematoma formation, simplify wound care and improve patient tolerance. However, this study could not demonstrate that TNP accelerates neovascularisation as verified by the presence of histologically patent vascular channels.