Extended Release Liposomal Bupivacaine Injection (Exparel) for Early Postoperative Pain Control Following Palatoplasty.

Introduction: Liposomal bupivacaine (LB) is a long-acting local anesthetic reported to decrease postoperative pain in adults. The authors demonstrate the safe use of LB in pediatric patients with improved pain control following palatoplasty.

Materials And Methods: Retrospective patient series of all single-surgeon palatoplasty patients treated at a tertiary craniofacial center from August 2014 to December 2015 were included.

Applications of Computer Technology in Complex Craniofacial Reconstruction.

Background: To demonstrate our use of advanced 3-dimensional (3D) computer technology in the analysis, virtual surgical planning (VSP), 3D modeling (3DM), and treatment of complex congenital and acquired craniofacial deformities.

Methods: We present a series of craniofacial defects treated at a tertiary craniofacial referral center utilizing state-of-the-art 3D computer technology. All patients treated at our center using computer-assisted VSP, prefabricated custom-designed 3DMs, and/or 3D printed custom implants (3DPCI) in the reconstruction of craniofacial defects were included in this analysis.

Extended Release Liposomal Bupivacaine Injection (Exparel) for Early Postoperative Pain Control Following Pharyngoplasty.

Background: Liposomal bupivacaine (LB, Exparel) is a long-acting local anesthetic reported to decrease postoperative. The authors demonstrate the first safe use of LB in pediatric patients with improved pain control following pharyngoplasty.

Methods: Retrospective case-control of all the patients who underwent pharyngoplasty at a tertiary craniofacial center from March 2010 to June 2016.

Correction of a Posttraumatic Orbital Deformity Using Three-Dimensional Modeling, Virtual Surgical Planning with Computer-Assisted Design, and Three-Dimensional Printing of Custom Implants.

We describe a case of complex, posttraumatic skull and orbital deformities that were evaluated and treated with advanced computer technology, including virtual surgical planning, three-dimensional (3D) modeling, and printed patient custom implants (PCI) fabricated by 3D printing. A 50-year-old man presented to our craniofacial referral center 1 year after failed reduction of complex left orbital, zygomatic, and frontal bone fractures due to a motorcycle collision. The patient's chief complaint was debilitating diplopia in all fields of gaze.

Progressive Surgical Autonomy in a Plastic Surgery Resident Clinic.

Background: Resident clinics are thought to catalyze educational milestone achievement through opportunities for progressively autonomous surgical care, but studies are lacking for general plastic surgery resident clinics (PSRCs). We demonstrate the achievement of increased surgical autonomy and continuity of care in a PSRC.

Methods: A retrospective review of all patients seen in a PSRC from October 1, 2010, to October 1, 2015, was conducted.

Palate Fracture Repair With Light-Cured Resin Splint: Technical Note.

Palate fractures are rare, and their treatment is a matter of debate. Although some investigators have favored rigid plate fixation, others have reported successful treatment without it. Sagittal split and comminuted fractures can require rigid fixation to reduce the maxillary width; however, additional stabilization is needed.

Paramedian forehead flap to treat chronically infected base of skull defect in a posttraumatic patient.

Frontal sinus cranialization with obliteration of the frontal sinus outflow tracts is rarely needed but may be required with extensive comminution of the anterior and posterior walls of the frontal sinus. There is little in the literature about treatment of chronic larger defects of the anterior cranial fossa that communicate with the nose and drain externally after cranialization. We present a 49-year-old man who experienced extensive facial trauma requiring cranialization of the frontal sinus.

Orbital reconstruction for pulsatile exophthalmos secondary to sphenoid wing dysplasia.

Sphenoid wing dysplasia or absence of the greater sphenoid wing is a rare condition that is considered pathopneumonic for neurofibromatosis type 1 (NF1). It occurs in 4% to 11% of NF1 patients, and its precise cause is unclear. Some cases appear to be congenital, while others have demonstrated it to be a progressive degeneration of the orbital wall.

Surgical management of Gorlin syndrome: a 4-decade experience using local excision technique.

Basal cell nevus syndrome (aka Gorlin syndrome, Gorlin-Goltz syndrome, nevoid basal cell carcinoma syndrome, and fifth phacomatosis) is a rare but well-described autosomal dominant condition with variable penetrance. We present a female patient who has been successfully treated using local surgical excision and diligent skin surveillance for more than 4 decades, demonstrating that simple local incision is an efficacious and reasonable surgical alternative that may circumvent the specialization and expense of Mohs technique.

Changes in airflow dynamics after creation of pharyngeal flaps in nonsyndromic children.

Velopharyngeal insufficiency is a common problem in the cleft palate population that may require a pharyngeal flap. Sleep disordered breathing is a common complication of this surgery and a baseline sleep study is often performed before undergoing the procedure. Few postoperative sleep studies are ever done and little is known about the effects that pharyngeal flaps have on airflow dynamics.

Use of osteogenesis distractors in cloverleaf skull reconstruction.

Cloverleaf skull deformity (Kleeblattschädel-Syndromen, trilobular skulls) results from synostosis of multiple cranial sutures. The number of sutures involved, the pathogenesis of the synostosis, and the associated anomalies and syndromes are variable. All forms of cloverleaf skull are associated with a high morbidity and mortality.

Congenital granular cell tumour of the newborn: A case report and literature review.

A congenital granular cell tumour is rare, and presents in newborns as a mass arising from the alveolus. While its pathogenesis is unclear, it has no malignant potential and may, occasionally, spontaneously regress postpartum. Successful treatment usually consists of conservative simple excision.

Incidence and management of zygomatic fractures at a level I trauma center.

Purpose: The purpose of this study is to evaluate current treatment of zygomatic fractures presenting at a level I trauma center.

Methods: Radiology records over a 1-year period were retrospectively reviewed to determine all patients diagnosed with fractures through the zygoma. A total of 1049 computed tomography maxillofacial scans were reviewed which identified 243 patients with fractures through the zygoma.

Cornu cutaneum in a patient of African descent: implications and management of an uncommon lesion.

Cornu cutaneum, or giant cutaneous horn (GCH), is an uncommon but disfiguring lesion that may cause the patient considerable distress. The aesthetic implications of such lesions are obvious. The etiology and treatment of GCH are more obscure, both to patients and physicians alike.

Nasoethmoid orbital fractures: diagnosis and treatment.

Blunt trauma to the midface frequently results in fractures of the nasoethmoid orbital skeleton. These complex injuries are often misdiagnosed or inadequately treated and are perhaps the most difficult of all facial fractures to treat. The purpose of this article is to describe the author's technique for the diagnosis and treatment of these complex fractures.

The specialized wound care center: a 7-year experience at a tertiary care hospital.

Multidisciplinary wound care centers have proliferated as a result of an increasing need for care of nonhealing wounds. Information regarding types of wounds treated, length of treatment, compliance with treatment, and rates of healing was collected from a tertiary care hospital-based wound center over a 7-year period. Venous stasis ulcers were the most common type of wound treated (21%) and were also the most likely to heal.

Giant basal cell carcinoma surgical management and reconstructive challenges.

Basal cell carcinoma is exceedingly common, but tumors >5 cm in size or giant basal cell carcinomas (GBCCs) are rare. We retrospectively review 10 GBCCs in 8 patients treated by aggressive surgical excision and reconstruction in a single operative procedure. With the exception of 1 chest lesion, all GBCCs involved the face or scalp.

Management of a circumferential lower extremity degloving injury with the use of vacuum-assisted closure.

A 58-year-old male presented with a large circumferential degloving injury and was immediately taken to the operating room for further assessment of his wound. At that time, a plastic surgeon was consulted to manage the wound due to its size and significant soft tissue loss. The decision was made to manage the patient's wound with the vacuum-assisted closure (VAC) device to prepare the wound bed for grafting.

Necrobiotic xanthogranuloma of the chest wall.

Necrobiotic xanthogranuloma is a rare disease that usually presents with indurated yellow red nodules or plaques in the dermis or subdermal tissues. The pathogenesis of this disease is unknown and the limited number of cases has made long-term studies difficult. We report the case of a 61-year-old woman seen in our office for a 5 x 5-cm lesion of her chest wall.

Ablepharon-macrostomia syndrome.

We report three new cases of ablepharon-macrostomia syndrome (AMS) and give a 10-year follow-up on a newborn reported in an abstract. These four patients, as well as those previously reported, all had absent hair, brows, and lashes, absent or short eyelids, macrostomia, ear anomalies, redundant skin, and abnormal genitalia. Many have persistent visual problems, often related to early corneal exposure.