An Analysis of Aesthetic Refinements in 120 Secondary Cleft Rhinoplasties.

Background: Secondary cleft nose rhinoplasty remains a challenging procedure. Cartilage memory and scar contraction are problematic factors. The need for more detailed procedures for secondary reconstruction in this patient population has arisen.

Prenatal ultrasound parameters in single-suture craniosynostosis.

Introduction: Although single-suture craniosynostosis is diagnosed sporadically during pregnancy, timely referral is critical for its treatment. Additionally, craniosynostosis leads to increased maternofetal trauma during birth. In the Netherlands, 95% of pregnant women receive a standard ultrasound at around 20 weeks of gestation, potentially an ideal setting for detecting craniosynostosis prenatally.

Insight into the Pathophysiologic Mechanisms behind Cognitive Dysfunction in Trigonocephaly.

Background: The relationship between trigonocephaly and cognitive problems might be explained by: secondary mechanical factors related to growth restriction of the skull, and primary structural defects caused by a shared mechanism related to brain developmental disorder(s) and skull malformation. However, because the exact pathophysiology remains unknown, we examined the pathophysiologic mechanisms behind cognitive dysfunction in patients with trigonocephaly, with an aim of providing a model for cognitive dysfunction based on routinely available variables.

Methods: Included were 72 patients with trigonocephaly who were operated on.

Rotational Advancement in Cleft Nose Rhinoplasty - Buccal Mucosal Grafts Serve as a Powerful Tool.

Objective: Our aim was to analyze our technique of a modified rotational advancement in conjunction with buccal mucosal grafts (BMGs) in a subgroup of severe cleft cases.

Design: A retrospective clinical and photographic evaluation was conducted. Columella angle (CA) and tip projection (TPR) served as instruments in a photometric analysis.

Nasal sequelae of Treacher Collins syndrome.

Objective: This study aimed to determine external and endonasal deformity, and satisfaction with nasal functioning and appearance, in Treacher Collins syndrome.

Study Design: A cross-sectional cohort study was conducted.

Methods: Eleven adult patients with Treacher Collins syndrome were compared with 151 controls in terms of satisfaction with nasal functioning and appearance by means of the Nasal Appearance and Function Evaluation Questionnaire.

Unilateral versus bilateral correction of unicoronal synostosis: an analysis of long-term results.

Introduction: Hollowing of the temporal region is a common problem after cranioplasty for unicoronal synostosis. In this study, first, the development of temporal hollowing pre- and postoperatively is evaluated. Second, the origin of temporal hollowing is investigated by comparing two operative techniques.

Cognitive and behavioral functioning in 82 patients with trigonocephaly.

Background: The main objective of the present study was to assess the prevalence rates of attention deficit hyperactivity disorder, oppositional defiant disorder, conduct disorder, and features of autism spectrum disorders in trigonocephalic patients, using validated instruments and by ruling out the confounding influence of IQ. The second aim was to assess the association between extracranial anomalies and cognitive and/or behavioral problems in patients with trigonocephaly.

Methods: Objectives were studied in 82 trigonocephalic patients aged 4 to 18 years at the Erasmus Medical Center in Rotterdam, The Netherlands.

Metopic synostosis.

Premature closure of the metopic suture results in a growth restriction of the frontal bones, which leads to a skull malformation known as trigonocephaly. Over the course of recent decades, its incidence has been rising, currently making it the second most common type of craniosynostosis. Treatment consists of a cranioplasty, usually preformed before the age of 1 year.

Long-term results after 40 years experience with treatment of rare facial clefts: Part 1--Oblique and paramedian clefts.

Background: Oblique and paramedian rare facial clefts impose a major reconstructive challenge and long-term assessments of the outcomes remain scarce. This study provides new details regarding surgical techniques and timing, influence of growth, and difficulties of this pathology on the long-term; a guideline for surgical treatment is given.

Methods: Twenty-nine adults with an oblique or paramedian facial cleft and surgically treated in the authors' unit between 1969 and 2009, were included.

Long-term results after 40 years experience with treatment of rare facial clefts: Part 2--Symmetrical median clefts.

Background: Median facial clefts are reconstructive challenges, requiring multiple operations throughout life. Long-term results are often still far from ideal and could be improved. Due to surgical intervention and diminished intrinsic growth potential, surgical results may change from initially good into a progressively disappointing outcome.

Internal carotid dissection after Le Fort III distraction in Apert syndrome: a case report.

A 10-year-old girl with Apert syndrome underwent a Le Fort III osteotomy with the positioning of internal and external distraction devices. The operation was straightforward with no intraoperative complications. Very soon after completion of surgery an anisocoria (unilateral dilation of a pupil) was noticed.

Papilledema in isolated single-suture craniosynostosis: prevalence and predictive factors.

The purpose of this retrospective study was to assess the prevalence of papilledema in patients with isolated craniosynostosis. Second, we wanted to assess if the presence of ventricular dilatation on computed tomography (CT) scan is a predictive factor for the occurrence of papilledema. We included 205 consecutive children with an isolated single-suture craniosynostosis, who had at least 1 fundus examination.

The risk of psychopathology in children with craniosynostosis.

Background: The purpose of this study was to assess the prevalence of behavioral and emotional problems in patients with craniosynostosis and to determine the prospective association of a beaten-copper pattern before 18 months of age with behavioral and emotional problems in patients with craniosynostosis.

Methods: The authors performed a follow-up study of 115 craniosynostosis patients at the Erasmus Children's University Hospital in Rotterdam. Behavioral and emotional problems were assessed with the Child Behavior Checklist at a mean age of 8 years.

Guidelines for reconstruction of the eyelids and canthal regions.

A large number of reports are available on the options for reconstructing specific defects of the eyelids or (peri) orbital area, which may complicate decision making in choosing the most optimal technique for a particular defect. Based on more than 40 years' experience in reconstruction of eyelids and periorbital defects, combined with an extensive literature review, general principles on reconstruction are presented and illustrated. Surgical techniques are outlined with respect to anatomical layer, depth, size and location of the defect.

On the origin of bitemporal hollowing.

Introduction: Long-term results after cranioplasty for trigonocephaly often show bitemporal hollowing and a residual hypotelorism. Both findings fuel the perception that the growth of the periorbital region and the forehead as a whole continues to be restricted, even after correction. The aim of this study was to evaluate the growth process of the periorbital region after correction for trigonocephaly in the long term.

The increase of metopic synostosis: a pan-European observation.

Metopic synostosis is thought to have an incidence of about 1 in 15,000 births. Traditionally, this makes it the third most frequent single-suture craniosynostosis, after scaphocephaly (1 in 4200-8500) and plagiocephaly (1 in 11,000). Our units have, independently from each other, noted a marked increase in the number of metopic synostosis over the recent years.

Unblocking the nose by unplugging the ear: the use of foam ear defenders as a splint following secondary cleft rhinoplasty.

Objective: The functional and aesthetic result from secondary cleft rhinoplasty is commonly impaired by a bulge in the lateral nasal vestibule, which can relapse in the postoperative period despite careful intraoperative correction. We aim to improve our results by using a foam ear defender as a postoperative splint to prevent relapse.

Design: Case series of 10 patients with photographs of a typical clinical case.

Early beaten-copper pattern: its long-term effect on intelligence quotients in 95 children with craniosynostosis.

Object: The aim of this study was to analyze the presence of beaten-copper patterns (BCPs) in children with craniosynostosis before 18 months of age and its association with their IQ at a later age.

Methods: The authors conducted a retrospective analysis of 538 cephalograms (obtained at a mean patient age of 1.16 years) from 95 patients.

The frontosphenoidal suture: fetal development and phenotype of its synostosis.

Background: Isolated synostosis of the frontosphenoidal suture is very rare and difficult to diagnose. Little has been reported on the clinical presentation and fetal development of this suture.

Objective: To understand the development of the frontosphenoidal suture and the outcome of its synostosis.

Papilledema in patients with Apert, Crouzon, and Pfeiffer syndrome: prevalence, efficacy of treatment, and risk factors.

Patients with syndromic craniosynostosis are at risk for elevated intracranial pressure because of various physiologic and anatomic abnormalities. The aims of this study were to determine the prevalence of papilledema in syndromic craniosynostosis, to evaluate the results of the treatment, and to examine the risk factors. This is a retrospective study on 84 patients with Apert, Crouzon, or Pfeiffer syndrome.

Bitemporal depressions after cranioplasty for trigonocephaly: a long-term evaluation of (supra) orbital growth in 92 patients.

Long-term results after cranioplasty for trigonocephaly often show bitemporal depressions and a residual hypotelorism. Both findings fuel the perception that the growth of the periorbital region and the forehead as a whole continues to be restricted, even after correction. The aim of this study is to evaluate the growth process of the periorbital region after correction for trigonocephaly in the long term.

Trigonocephaly in Muenke syndrome.

Saethre-Chotzen syndrome is caused by mutations in the TWIST gene on chromosome 7p21.2. However, Muenke et al.

Prevention of halo pin complications in post-cranioplasty patients.

Introduction: Distraction Osteogenesis has been successfully implemented in the treatment of maxillary hypoplasia. By using the Rigid External Distraction device (RED) the maxilla can be advanced without the need for bone grafts, providing more stability to the repositioned maxilla.

Background: The introduction of the RED system in craniofacial surgery has given rise to previously unseen problems.