Cranial auto graft expansion (CAGE) technique for cranial vault expansion.

We present a method for cranial vault expansion that provides a strong construct, leaves small skull defects, and provides bony coverage of the sagittal sinus. The resultant small defects optimize the possibility for spontaneous reossification while avoiding large calvarial defects. This method has been used in 2 children who developed clinical evidence of total cranial growth restriction.

Correlation of complications of body contouring surgery with increasing body mass index.

BACKGROUND: There have been conflicting reports regarding the incidence of postoperative complications in body contouring procedures in obese and morbidly obese patients. Our subjective impression has been that the complication rate is significantly higher for these patients than it is for other weight groups. OBJECTIVE: The purpose of our study was to conduct a retrospective chart review to delineate our institution's complication rate in body contouring operations across all weight groups and to identify predictors of poor outcomes/complications that would help guide patient selection. METHODS: The records of 129 patients who underwent a single body contouring procedure at The Penn State Hershey Medical Center from 1993 to 2002 were reviewed. Patients were categorized based on their body mass index into the following weight groups: ideal, overweight, obese, morbidly obese, and severely morbidly obese. The complications were grouped into minor, major, or combined (minor or major). Patients who underwent combined procedures were excluded from the study. RESULTS: There was a statistically significant association between minor (P = .0006), major (P = .0098), and combined (P < .0001) complications and weight group. More specifically, the percentage of complications increased as weight category increased. The percentage of minor complications increased from 3.3% in the ideal weight group to 46.9% in the severely morbidly obese group. Similarly, the percentage of major complications increased from 6.6% in the ideal weight group to 43.7% in the severely morbidly obese group. Both major and minor complications saw the largest increase in complication rates between the morbidly obese and severely morbidly obese groups. Furthermore, those in the obese (odds ratio [OR] = 6.43; P = .0115), morbidly obese (OR = 5.54; P = .0237), and severely morbidly obese (OR = 19.80; P < .0001) weight groups were more likely to experience minor or major complications than those in the ideal weight group. CONCLUSIONS: This study demonstrates two points: (1) it confirms that there is a significant increase in the occurrence of complications among morbidly obese and severely morbidly obese patients undergoing a single body contouring procedure, and (2) it shows there is an increase in the occurrence of complications with worsening degree of obesity. The (post-weight loss) body mass index at the time of body contouring surgery is a predictor for postoperative complications.

Endoscopic excision of a supraorbital schwannoma.

Patients with neurofibromatosis 1 frequently require multiple tumor excisions over the course of many years. Minimally invasive techniques of excision offer promise in reducing morbidity and scarring in a group of patients with well-circumscribed benign tumors in aesthetically sensitive areas. The safety and efficacy of endoscopic approaches to a variety of conditions affecting the craniofacial frontal region are well established. This report describes the endoscopic excision of a benign supraorbital nerve schwannoma in a 5-year-old girl.