Endoscopic intracranial craniofacial and monobloc osteotomies with the aid of a malleable high-speed pneumatic drill: a cadaveric and clinical study.

Endoscopic techniques are now an accepted part of the surgical armamentarium and are used routinely in a number of aesthetic and reconstructive procedures. Endoscopic techniques are now being used commonly by plastic surgeons in forehead and face lifts. In both craniofacial surgery and in neurosurgery, the application of endoscopy potentially allows the surgical team to perform wide dissection of the dura mater in a minimally invasive fashion, thereby potentially reducing the risk of dural and brain injury. Also reduced by this surgical approach is potential injury to the major venous structures, such as the sagittal sinus, along with overall reduced bleeding. After an extensive laboratory study of 10 cadaveric dissections, the authors have refined a new endoscopic technique for completing an endoscopic intracranial craniofacial osteotomy. This study was conducted in the Department of Pathology at the University of Brno (Czech Republic), and was performed as a cooperative multicenter project between the University of Palermo, the Albert Einstein College of Medicine/ Montefiore Medical Center, the Hospital Infantil de Mexico, "Federico Gomez," and the Medtronic Midas Rex Institute, (Fort Worth, TX). During this cadaveric anatomic study and using small trephinations and skin incisions the authors were able to develop several different craniofacial and endoscopic monobloc procedures. To accomplish intracranial and facial osteotomies, a new malleable high-speed drill was designed for use in the endoscopic craniofacial approach. Using these newly developed cadaveric techniques and instrumentation, the authors performed two intracranial craniofacial procedures on children with congenital craniofacial anomalies. There would appear to be several significant advantages for the craniofacial patient as result of these new techniques: reduced surgical trauma, operative bleeding, surgical time, and hospitalization, along with a reduced risk of infection. It became quickly apparent, as a result of these cadaveric studies, that the learning curve for this endoscopic procedure is quite steep. Tutino M, Chico F, Tutino M, Goodrich JT, Ortiz Monasterio F. Endoscopic intracranial craniofacial and monobloc osteotomies with the aid of a malleable high-speed pneumatic drill: a cadaveric and clinical study.

Nasal correction in Binder's syndrome: the evolution of a treatment plan.

Maxillofacial dysplasia, or Binder's Syndrome is a challenge for the surgeon. The evolution of a surgical treatment plan has led to improved facial contour and patient self-image. We studied 27 patients with maxillonasal dysplasia of variable degrees, both on a short- and long-term basis. In some patients, surgical treatment began as early as 3 years of age, while others were treated as teenagers or young adults. Surgical options included cartilaginous onlay grafts to the pyriform area, nasal dorsal grafts (linear or L-strut in design), and columellar strut grafts. Le Fort osteotomies were reserved for those patients with Class III malocclusion (15% in this series). The overall goals were to augment skeletal deficiencies of the midface and begin the soft tissue expansion process as early as possible. From our long-term follow-ups (up to 15 years) it has become apparent that surgical treatment should begin early. This leads to improved self-image by the child's preschool years, taking advantage from their youthful skin elasticity. In the young patient, sequential lengthening procedures of the dorsum and columella are beneficial. Paranasal and midfacial augmentation is reserved until midfacial growth is near complete when the patient is in their midteenage years.

Congenital facial palsy and crossed facial nerve grafts: age and outcome.

Crossed facial nerve grafts for treating unilateral permanent facial palsy in association with hemifacial microsomia were studied in 18 patients, ages ranging from 2 months to 10 years. Patients were divided into groups according to the age at the time of indication of surgery. It is concluded that crossed nerve grafting for facial palsy associated with hemifacial microsomia appears to be an adequate procedure especially when the surgery is indicated soon after birth.

Surgery of the non-Indo-European face.

The severely deviated nose represents a complex cosmetic and functional problem. This article analyzes the types of deformities present in a severely deviated nose, reviews the existing methods of correction, and proposes a new method of internal cartilage splinting to correct the more severe deformities.