Alterations in Sphenoid Anatomy in Craniosynostosis: Implications for Fronto-Orbital Advancement.

Objective: Fronto-orbital advancement involves removal of the fronto-orbital bandeau. Visualization of the saw blade is lost as it passes through the fronto-orbital-sphenoid junction (FOSJ), placing the temporal lobe at risk of injury. We aim to provide a 3D analysis of the space surrounding this osteotomy to differentiate various types of craniosynostoses.

Virtual Reality Planning in Reconstructive Surgery for Orbital Prosthetic Rehabilitation Using ImmersiveTouch Platform: Preliminary Report.

Background/purpose: Virtual reality (VR) is emerging as an effective and intuitive surgical planning and 3D visualization tool. Digital surgical planning is the gold standard for planning the placement of implants in maxillofacial prosthetics, but the field lacks a platform exclusively designed to perform the task. Virtual reality planning (VRP) specific for maxillofacial prosthetics offers the clinician improved control of the presurgical planning and the potential to limit the need to adapt other advanced segmentation software.

Optimizing Facial Esthetic Outcomes: Adding Distraction Osteogenesis to Your Classic Orthognathic Surgery Armamentarium.

Classical orthognathic procedures have long been known to improve the facial esthetic contours and proportions of face by restoring the skeletal foundation, on which the soft-tissue drapes. Distraction osteogenesis was introduced to solve complex skeletal abnormalities in patients with craniofacial conditions that could not be solved by classical orthognathic surgery techniques. The gradual expansion in this group of patients showed not only greater skeletal stability, but the expansion at various tissue planes improved the facial appearance.

Patient-specific Composite Anatomic Models: Improving the Foundation for Craniosynostosis Repair.

Preoperative surgical planning incorporating computer-aided design and manufacturing is increasingly being utilized today within the fields of craniomaxillofacial, orthopedic, and neurosurgery. Application of these techniques for craniosynostosis reconstruction can include patient-specific anatomic reference models, "normal" reference models or patient-specific cutting/marking guides based on the presurgical plan. The major challenge remains the lack of tangible means to transfer the preoperative plan to the operating table.

Discussion on Ultrasound Diagnosis of Prenatal Cleft Lip: How does Its Accuracy Affects the Family? Prenatal Counseling for Clefts: The University of Illinois at Chicago, Craniofacial Center's Protocols and Experience.

Prenatal diagnosis of cleft lip and palate as well as other craniofacial differences is now possible with a significant level of accuracy due to sonographic and other evaluations. Thus, prospective parents have the opportunity to be informed ahead of time about these conditions making them better prepared to deal with their child after birth. The role of the plastic surgeon and other craniofacial team members in prenatal consultations is becoming increasingly important and well accepted.

Skeletal and Dental Habilitation of Residual Alveolar and Maxillary Clefts.

Management of residual clefts of the alveolus and maxilla requires the coordinated effort of multiple members of the craniofacial team including surgeon, orthodontist, and when teeth are hypoplastic or absent, the prosthodontist to achieve complete habilitation. Such cooperation among specialists begins early in the patient's life and continues through completion of care.Although numerous publications on this topic exist, few present definitive multidisciplinary reconstructive outcomes with longterm results.

Delay in Cleft Lip and Palate Surgical Repair: An Institutional Review on Cleft Health Disparities in an Urban Population.

Access to specialized medical care is critical to decrease complications and minimize long-term morbidity, yet racial disparities in cleft surgery persist as time to initial reconstruction remains delayed among minority patients. Research has demonstrated an average 3-week delay in surgery for minority patients nationally. A retrospective chart review of patient demographics, visit timing, and surgical history was performed for patients who underwent primary cleft lip with or without palate (CL + P) reconstruction between 2002 and 2016 at an urban craniofacial center.

Three-Dimensionally Printed Hyperelastic Bone Scaffolds Accelerate Bone Regeneration in Critical-Size Calvarial Bone Defects.

Background: Autologous bone grafts remain the gold standard for craniofacial reconstruction despite limitations of donor-site availability and morbidity. A myriad of commercial bone substitutes and allografts are available, yet no product has gained widespread use because of inferior clinical outcomes. The ideal bone substitute is both osteoconductive and osteoinductive.

Use of a Waterproof Camera Immersed in Povidone-Iodine to Improve Intraoperative Photography.

Intraoperative photography has the potential to raise costs and introduce possible contamination but is essential for documentation in plastic surgery. The authors evaluate their use of a waterproof camera immersed in povidone-iodine for taking intraoperative photographs in an efficient manner. A waterproof camera is immersed in povidone-iodine during surgery and photographs are taken as needed by the operating surgeon or assistant without a change of gloves.

The Median Mandibular Symphysis Tessier 30 Cleft:: 3D Imaging Analysis and Review of the Literature.

Atypical craniofacial clefts of the upper facial region have been well documented; however, the mandibular clefts remain rare and reported as isolated case reports. We report a case of a median mandibular cleft within the context of a Tessier 0-14 axis that we have followed over a 5-year period without surgical/orthodontic intervention. The mandibular symphysis cleft remained open without evidence of the fusion, in contrast to ossification of the metopic dysraphism.

Virtual surgical planning and 3D printing in prosthetic orbital reconstruction with percutaneous implants: a technical case report.

Osseointegrated titanium implants to the cranial skeleton for retention of facial prostheses have proven to be a reliable replacement for adhesive systems. However, improper placement of the implants can jeopardize prosthetic outcomes, and long-term success of an implant-retained prosthesis. Three-dimensional (3D) computer imaging, virtual planning, and 3D printing have become accepted components of the preoperative planning and design phase of treatment.

Application of virtual surgical planning with computer assisted design and manufacturing technology to cranio-maxillofacial surgery.

Computer aided design and manufacturing (CAD/CAM) technology today is the standard in manufacturing industry. The application of the CAD/CAM technology, together with the emerging 3D medical images based virtual surgical planning (VSP) technology, to craniomaxillofacial reconstruction has been gaining increasing attention to reconstructive surgeons. This article illustrates the components, system and clinical management of the VSP and CAD/CAM technology including: data acquisition, virtual surgical and treatment planning, individual implant design and fabrication, and outcome assessment.

Complications of pediatric facial fractures.

Pediatric facial fractures account for only 5% of all facial fractures, with even a much lower incidence in children younger than 5 years (1%-1.5%). The evolution of principles in the management of pediatric facial fractures and the differences in management between adult and pediatric patients have been well documented in the literature.

Retrograde fiberoptic technique to avoid tracheostomy in a patient with a tracheocutaneous fistula and Treacher Collins syndrome.

Children with Treacher Collins syndrome have multiple craniofacial abnormalities that can cause difficulty ventilating and intubating under general anesthesia. We describe a unique technique to secure an endotracheal tube via a retrograde technique using patent tracheocutaneous fistula and fiberoptic bronchoscopy. In this setting, the presence of a tracheocutaneous fistula spared tracheostomy in this patient.

Three-dimensional facial surface analysis of patients with skeletal malocclusion.

Three-dimensional (3D) laser surface scanning analysis has taken hold in orthodontics, as well as craniomaxillofacial and plastic surgery as a new tool that can navigate away from the limitations of conventional two-dimensional methods. Various techniques for 3D reconstruction of the face have been used in diagnosis, treatment planning and simulation, and outcomes follow-up. The aim of the current prospective study was to present some technical aspects for the assessment of facial changes after orthodontic and orthognathic surgery treatment using 3D laser surface scanning.

CT analysis after distraction osteogenesis in Pierre Robin Sequence.

Objectives/hypothesis: Early mandibular lengthening by distraction osteogenesis provides an alternative to traditional methods of airway management in infants with Pierre Robin sequence (PRS). Little evidence in the medical literature quantitatively demonstrates the changes in skeletal, soft tissue, and hypopharyngeal spaces with mandibular distraction.

Study Design: Prospective analysis of a cohort of three patients with PRS.

Three-dimensional cephalometric study of upper airway space in skeletal class II and III healthy patients.

Because the pharynx and the dentofacial structures have close relationship, a mutual interaction can be expected to occur between them. The literature presents skeletal malocclusion as etiology for airway morphology changes and/or vice versa. The present three-dimensional cephalometric study from computed tomography scans was carried out to investigate upper airway space in normal nasal breathing patients presenting skeletal pattern of classes II and III.

Our experience with virtual craniomaxillofacial surgery: planning, transference and validation.

Clinical application of virtual craniomaxillofacial surgery (VCMS) planning is demonstrated with four typical cases. An integral component to success is transferring the surgical plan to the operating environment within a reasonable time frame through the design and fabrication of surgical guides and implants.

Cranial base angulation in Brazilian patients seeking orthodontic treatment.

The relationship between cranial base flexion and facial prognathism has been of interest to orthodontists, orthognathic maxillofacial surgeons, and plastic surgeons. This study aimed to identify the cranial base flexion of adults with anteroposterior skeletal disharmony. Because the sample was representing a mixed racial population, the authors performed an investigation to confirm an association with other researches performed in different parts of the world.

The structural implications of a unilateral facial skeletal cleft: a three-dimensional finite element model approach.

Objective: For children born with a unilateral facial skeletal cleft, oral motor function is impaired and skeletal development and growth are asymmetrical with regard to the midsagittal plane. This study was designed to verify that a unilateral skeletal cleft and its dimensions (i.e.

Statistical shape analysis of metopic craniosynostosis: a preliminary study.

This preliminary study was conducted to explore different analytical shape methods for use in evaluating children born with cranial vault deformities. Twenty skull outlines from patients with metopic craniosynostosis were ascribed landmarks. Scale, location, and rotational factors were removed using Procrustes analysis.

Technical note: "look-ahead" navigation method for K-wire fixation in rhinoplasty.

Objective: The Kirschner wire (K-wire) technique for fixation of rib cartilage grafts to the maxilla is a powerful tool in rhinoplasty. It gives the nose unparalleled anterior projection. However, the technique is challenging because of poor maxillary visualization through the open rhinoplasty approach.

The LeFort I transmaxillary approach to skull base tumors.

This article discusses the surgical approach using the LeFort I and its variations to the extracranial skull base for removal of craniocervical lesions from the sphenoid to the fourth cervical vertebra between the carotids. Clival lesions with superior and inferior extension and nasopharyngeal lesions can be accessed by this approach. The outcome of surgical, radiation, and chemotherapeutic treatment is beyond the scope of this brief article, which focuses on the technical aspects of cranial base tumor exposure.