Is reverse frontal cranioplasty eligible for the correction of both the forehead deformities and the intracranial hypertension in craniosynostosis? Comparison of the preoperative and postoperative intracranial volumes.

BACKGROUND: This study aimed to describe the surgical technique of reverse frontal cranioplasty (RFC), the aesthetical modification as well as the modification of intracranial volume (ICV) to assess its potential eligibility for the treatment of the intracranial hypertension (IH). MATERIALS AND METHODS: A retrospective monocentric study included the patients with a history of craniosynostosis with a forehead deformity who underwent RFC. A subjective outcome questionnaire (SOQ) was conducted with each patient or their parent to determine their level of satisfaction after RFC. Pre- and postoperative computed tomography (CT) scans were analyzed and compared to investigate the ICV change and fronto-nasal angle. RESULTS: Eleven patients were included in the study (6 female and 5 male) with a mean age of 10.9 years old (range 3-23 years) and an average follow-up of 4.5 years (1-11 years). All patients responded to the questionnaire with a high level of overall satisfaction (mean 9.1/10). The mean preoperative FNA was 134° ± 5° while the mean postoperative angle was 126.4° ± 6, corresponding to an average decrease of 7.6° (95% CI, 4.0-11.2°; p < 0.001). One patient with preoperative IH had a clinical recurrence during the follow-up. The ICV was significantly higher after the surgery (p < 0.0001), with an average increase of 3.2% (95% CI, 2.3-4.1%). CONCLUSION: Reverse (RFC) is a useful technique for the correction of the frontal malformations related to craniosynostosis, such as a sloping forehead and/or a lack of the supraorbital projection. Regarding the limited gain of intracranial volume (ICV), it should not be used alone as primary cranial expansion surgery for craniosynostosis with intracranial hypertension (IH).

Abalakov: Posterior mandibular anchorage technique for orthodontic treatment.

INTRODUCTION: Abalakov is a mountaineering technique consisting in drilling two holes that intersect to form a V in order to thread a rope through to make an anchorage point. This technique can be applied to orthodontic treatment and constitutes a posterior mandibular orthodontic anchorage. TECHNICAL NOTE: The technique can be performed on its own during local anaesthesia or during surgery for the extraction of wisdom teeth. The posterior anchorage point is located in the ramus of the mandible. It consists in drilling two holes that intersect to form a V and then threading a steel wire through to make an anchorage point. DISCUSSION: This technique is simple, inexpensive, fast and non-invasive, providing an anchorage system with immediate loading and which is not dependent on the quality of the bone.

Optimized centrifugation preparation of the platelet rich plasma: Literature review.

Nowadays, the Platelet Rich Plasma (PRP) is frequently used for its therapeutic effects on wound healing, and this due to secretion of many growth factors. However, no standardized procedure has been set up. The aim of this article is to check the various preparations (centrifugation time and speed). This review recorded all the international articles published between 2007 and 2018, for which the assessment criteria were the platelet concentration and/or the growth factor release rate. A multitude of protocols has been looked at with a simple or double centrifugation. All of them have shown an increase in the platelet concentration allowing a therapeutic effect. However, when the centrifugation force is extended, platelets can possibly be altered. The diversity of methods can be linked to the use of various centrifuges. A procedure with simple centrifugation would be a good compromise for the day-to-day use of the PRP in surgery.

Virtual 3D planning of osteotomies for craniosynostoses and complex craniofacial malformations.

INTRODUCTION AND OBJECTIVES: Computer-assisted surgery has been more and more widely used in craniofacial surgery in recent years. It is useful in many situations: stereolithographic models, surgical simulations of osteotomies and bone repositioning, and cutting guides and customized implants. The present paper argues that computer-assisted surgery is particularly useful in complex cases such as rare malformations, or to address the sequelae of previous surgeries. The various advantages of the technique are emphasized from a surgical and from a teaching standpoint. MATERIALS AND METHODS: Forty cases of various computer-assisted surgeries were analyzed, allowing a comprehensive review of outcomes in cases such as craniosynostosis, complex craniosynostosis, hypertelorism, craniosynostosis sequelae and cranio-facial and orbital trauma. RESULTS: Results were promising in all of the cases reviewed, except in a few cases for which computer-assisted surgery with cutting guides may not be necessary. In these specific cases, the pedagogical input is nevertheless interesting for residents and students. CONCLUSION: Computer-assisted surgery is revolutionizing the surgical approach to complex craniofacial malformations, as well as easing management of less complex ones. It is likely that in the years to come this technique will supersede previous ones. However, using this technique implies being willing to rely on a non-human device. We need to consider computer-assisted surgery as a tool that can change surgical practices. The surgeon can rely on it, yet nothing will replace his/her eye and experience. It is the combination of both this experience and the appropriate use of computer-assisted surgery that, ultimately, leads to successful surgery.