Mid-Term Dental and Nerve-Related Complications of Infant Distraction for Robin Sequence.

Background: Mandibular distraction is effective for relieving airway obstruction in Robin sequence; however, mid-term dental and nerve-related complications have not been adequately studied.

Methods: Records were reviewed for patients with a single distraction in infancy using internal devices. Follow-up was 5 years or longer.

Primary Abbe Flap for Median Cleft Lip Deformity: New Trends on an Old Concept.

Objective: The authors present our experience using primary Abbe flaps for median cleft lip.

Methods: The records of 9 patients who underwent primary Abbe flaps were reviewed for indications, operative details, and complications. Flap design is discussed, including the "W" method to facilitate columellar reconstruction.

Initial Experience With a New Intraoral Midface Distraction Device.

Maxillary hypoplasia that necessitates surgical advancement affects approximately 25% of patients born with cleft lip and palate. Syndromic conditions such as Crouzon may also be accompanied by significant maxillary hypoplasia. Severe maxillary hypoplasia can result in airway obstruction, malocclusion, proptosis, and facial disfigurement.

Immediate mandibular distraction in mandibular hypoplasia and upper airway obstruction.

Distraction osteogenesis of the mandible has become an alternative to tracheostomy in infants and children who present with upper airway obstruction due to micrognathia. To avoid prolonged intubation during distraction, we have implemented a protocol of immediate distraction at the time of distractor placement, which results in acute airway improvement. Over 2 years, 22 patients with micrognathia and severe airway obstruction have undergone mandibular distractor placement.

Maxillary advancement in patients with severe maxillary hypoplasia: role of adjuvant stabilization techniques and materials.

Background: Maxillary advancement in patients with orofacial clefts or craniofacial syndromes can be technically challenging. We present our experience with the use of adjunctive stabilization materials and techniques in patients undergoing single-stage maxillary advancements of more than 6.0 mm.

Disappearing dermoid: fact or fiction?

Dermoid cysts are common periorbital lesions. They usually present early in life as mobile, palpable, well-circumscribed masses near the lateral brow. Transcranial extension of a superficial, nonmidline, periorbital dermoid cyst is rare.

Does use of bupivacaine-soaked pledgets aid in the care of postoperative cleft palate patients?

Unlabelled: Bupivacaine-soaked pledgets have been shown to decrease postoperative pain in patients requiring iliac crest harvesting, even with the use of field blocks. This finding was applied to cleft palate repair.

Methods: A retrospective review of cleft palate cases over a 1-year period, 6 months with hemostatic pledgets, and 6 months with bupivacaine-soaked hemostatic pledgets.

Use of hydroxyapatite cement in pediatric craniofacial reconstructive surgery: strategies for avoiding complications.

The emergence of powdered hydroxyapatite (HA) has dramatically expanded the repertoire of reconstructive tools for craniofacial surgeons. Although several groups have reported mixed success using HA powder, to date there have been few large series retrospective reviews of HA use in an exclusively pediatric population. The purpose of our study was to assess the incidence of complications using a single surgeon's experience in an entirely pediatric cohort of patients.

Prevention and correction of airway compromise in rhinoplasty.

Recognition of patients who are at high risk for developing postrhinoplasty airway obstruction is essential. These patients may be at risk because of certain anatomic characteristics or may have a preexisting degree of airway obstruction from previous nasal surgery. Every surgeon who performs esthetic or reconstructive rhinoplasty procedures should be familiar with anatomic variants predisposing to airway obstruction and surgical techniques for airway improvement.

Measurement of torque during mandibular distraction.

In a prospective study, 26 patients aged 9 days to 12 years old underwent mandibular distraction. There were 18 bilateral and 8 unilateral distractions performed. Five patients had previous distraction.

Resorbable distraction of the mandible: technical evolution and clinical experience.

The author has used various designs of single-stage resorbable distractors to lengthen the mandible in 100 patients aged 7 days to 16 years (mean, 4.24 y; 49 girls, 51 boys) with predictable results and minimal morbidity since 2002. The range of distraction was 15 to 30 mm (mean, 25.

Surgical treatment of the nasal-maxillary complex in adolescents with cleft lip and palate.

Rather than treating nasal, maxillary, and soft tissue deformities as separate problems, the author has approached the deformities as a single aesthetic and functional unit, the nasal-maxillary complex. This complex includes the maxilla, nose, and overlying soft tissues, including the upper lip. Successful reconstruction is based on a thorough knowledge of the underlying anatomy and physiology of these structures.

Intralesional laser therapy treatment for hemangiomas: technical evolution.

The authors have treated over 500 consecutive pediatric patients with voluminous hemangiomas (thickness of over 10 mm), since 1996. They were all treated with intralesional laser therapy using the potassium, titanyl, phosphate (KTP) laser. Since the initiation of KTP laser therapy for deep hemangiomas in 1996, the authors have significantly modified their treatment regimen.

Crouzon syndrome.

Background: Crouzon syndrome is a rare genetic disorder characterized by distinctive malformations of the skull and facial region. Premature cranial suture closure is the most common skull abnormality. Optic disc edema and proptosis are among the most common ocular findings.

Surgical correction of velopharyngeal insufficiency in children with velocardiofacial syndrome.

Background: The surgical management of velopharyngeal insufficiency in children with velocardiofacial syndrome is inherently more difficult, with the need for revision being high. The purpose of this report was to evaluate and document the authors' experience with sphincter pharyngoplasty in the management of velopharyngeal insufficiency in children with velocardiofacial syndrome, and compare outcome.

Methods: In part I, 32 patients with velocardiofacial syndrome underwent sphincter pharyngoplasty for velopharyngeal insufficiency between January of 1987 and March of 2001.

Application of the spanning plate concept to frontal orbital advancement: techniques and clinical experience in 60 patients.

Frontal orbital advancement (FOA), is the procedure of choice in treatment of coronal and metopic synostosis. Resorbable plates and screws have been widely accepted for use in pediatric craniofacial surgery, including FOA. We have applied the concept of extended resorbable spanning plates to FOA for metopic, unilateral, and bilateral coronal synostosis in infants and children during a 5-year period.

Neurocutaneous melanosis.

Neurocutaneous melanosis (NCM) is a rare phakomatosis characterized by a focal or diffuse proliferation of melanin-producing cells in both the skin and the leptomeninges. This syndrome is believed to result from an error in the morphogenesis of embryonal neuroectoderm. Two-thirds of patients with NCM have giant congenital melanocytic nevi, and the remaining one-third have numerous lesions but no giant lesions.

Mandibular distraction osteogenesis in Pierre Robin sequence: application of a new internal single-stage resorbable device.

Pierre Robin sequence may result in physiologically significant obstructive apnea in the neonatal and infant period. This may be life threatening and is most often treated by tracheostomy. To avoid tracheostomy or allow for early decannulation in severely affected infants and children, the authors have developed a new class of neonatal and infant mandibular bone distraction devices.

Resorbable PLLA-PGA plate and screw fixation in pediatric craniofacial surgery: clinical experience in 1883 patients.

The need to provide rigid bony fixation in the surgical treatment of craniofacial deformities has inspired an on-going evolution of surgical innovations and implants. Because of the young age of many treated craniosynostosis patients and the unique pattern of cranial vault growth, the extensive implantation of metal devices is potentially problematic. The use of resorbable plate and screw devices offers all of the benefits of rigid fixation without many of their potential risks.

American society of maxillofacial surgeons outcome study: preoperative and postoperative neurodevelopmental findings in single-suture craniosynostosis.

The purpose of this study was to prospectively determine the neurodevelopmental effects associated with single-suture, nonsyndromic craniosynostosis before and after surgery. Children diagnosed with single-suture craniosynostosis were evaluated by a psychologist using the Bayley Scales of Infant Development-Second Edition (BSID-II) within 2 months before and again 1 year after surgical correction. The BSID-II is a widely used measure of infant cognitive and motor development.

Resorbable bone distraction: current status and future directions.

Distraction osteogenesis of the craniofacial skeleton has been one of the most exciting developments of the last decade. Parallel development of new biocompatible and resorbable materials inspired the authors to combine these technologies to create a new class of single-stage resorbable bone distraction devices. The authors present their experience to date in 50 patients whom have undergone distraction osteogenesis using resorbable devices.

An outcome evaluation of sphincter pharyngoplasty for the management of velopharyngeal insufficiency.

Sphincter pharyngoplasty is frequently used for the management of children with velopharyngeal insufficiency. The purpose of this study was to evaluate outcome and revision rates of sphincter pharyngoplasty at the authors' institution. Two hundred fifty patients underwent sphincter pharyngoplasty for velopharyngeal insufficiency between January of 1987 and March of 2001.

Predicting the risk of reoperation in metopic synostosis: a quantitative CT scan analysis.

Children with metopic synostosis have a well-described clinical picture of trigonocephaly, often with hypotelorbitism. The craniofacial disorder itself is well recognized; however, objective prognostic factors for predicting the risk of reoperation are not well known. In 39 children with metopic synostosis, measurements of the cranial length, cranial width, anterior intercoronal distance, anterior interorbital distance (intercanthal distance), lateral orbital distance, and interzygomatic buttress distance were taken from preoperative computed tomographic (CT) scans and were normalized relative to each child's age.