Speech outcomes following pharyngeal flap in patients with velocardiofacial syndrome.

Background: Velocardiofacial syndrome is the most common defined disorder associated with palatal insufficiency. The authors' purpose is to evaluate one surgeon's experience with correction of velopharyngeal insufficiency in velocardiofacial syndrome using a tailored pharyngeal flap.

Methods: The authors reviewed the records of all children with velocardiofacial syndrome and velopharyngeal insufficiency who were managed with a pharyngeal flap between 1983 and 2009.

Quantitative computed tomographic scan and polysomnographic analysis of patients with syndromic midface hypoplasia before and after Le Fort III distraction advancement.

Background: Distraction advancement has been advocated for treatment of obstructive sleep apnea associated with congenital midface hypoplasia. The purpose of this study was to relate changes in maxillary position to changes in obstructive sleep apnea measures on polysomnography in a consecutive series of patients.

Methods: Among 26 syndromic pediatric patients undergoing Le Fort III distraction over a 5-year period, 15 had documented obstructive sleep apnea with an apnea hypopnea index greater than 5.

Presurgical orthodontics versus no presurgical orthodontics: treatment outcome of surgical-orthodontic correction for skeletal class III open bite.

Background: It has long been claimed that presurgical orthodontics is crucial to the outcome of surgical-orthodontic treatment for dentofacial deformity. However, in the literature, the effect of presurgical orthodontics on the treatment outcome remains controversial. The purpose of the study was therefore to investigate the effect of presurgical orthodontics on the treatment outcome in terms of facial aesthetics, occlusion, stability, and efficiency.

Computed tomographic analysis of temporal maxillary stability and pterygomaxillary generate formation following pediatric Le Fort III distraction advancement.

Background: Le Fort III distraction requires generation of bone in the pterygomaxillary region. The authors performed retrospective digital analysis on temporal fine-cut computed tomographic images to quantify both radiographic evidence of pterygomaxillary region bone formation and relative maxillary stability.

Methods: Fifteen patients with syndromic midface hypoplasia were included in the study.

Long-term comparison of four techniques for obtaining nasal symmetry in unilateral complete cleft lip patients: a single surgeon's experience.

Background: This study was the result of a constant evaluation of surgical techniques and results to obtain excellence in primary cleft rhinoplasty.

Methods: This was a retrospective study from 1992 to 2003 comparing the long-term outcomes of four techniques of nasal reconstruction. There were 76 patients divided into four groups: group I (n = 23 patients), primary rhinoplasty alone; group II (n = 16 patients), nasoalveolar molding alone; group III (n = 14 patients), nasoalveolar molding plus primary rhinoplasty; and group IV (n = 23 patients), nasoalveolar molding plus primary rhinoplasty plus overcorrection.

Two-stage palate repair with delayed hard palate closure is related to favorable maxillary growth in unilateral cleft lip and palate.

Background: Two-stage palate repair with delayed hard palate closure is generally advocated because it allows the best possible postoperative maxillary growth. Nevertheless, in the literature, it has been questioned whether maxillary growth is better following use of this protocol. The authors therefore aimed to investigate whether stage of palate repair, one-stage versus two-stage, had a significant effect on facial growth in patients with unilateral cleft lip and palate.

Major morbidity and mortality rates in craniofacial surgery: an analysis of 8101 major procedures.

Background: The first combined evaluation of morbidity and mortality rates in craniofacial surgery was published 30 years ago; many surgeons believe these procedures have since become safer. The authors performed a contemporary evaluation of craniofacial morbidity and mortality rates to help surgeons more accurately counsel families about current risks, and to gain insight into reducing future incidences.

Methods: This study used two methodologies to capture all serious morbidities and mortalities associated with major craniofacial procedures between 1990 and 2008: a comprehensive two-center retrospective review (Dallas and Seattle), and an Internet-based survey sent to all North American craniofacial centers.

Mercedes Benz pattern craniosynostosis.

Background: The complex craniosynostoses, which include all nonsyndromic multiple sutural fusions, represent a small fraction of patients presenting with craniosynostosis. Among these are a trisutural fusion, dubbed the "Mercedes Benz pattern," involving the sagittal and both lambdoid sutures. The purpose of this report is to review the authors' series of this unusual form of craniosynostosis, to identify associated anomalies, and to assess treatment outcomes.

A new method for the second-stage auricular projection of the Nagata method: ultra-delicate split-thickness skin graft in continuity with full-thickness skin.

Background: Staged auricular reconstruction remains mainstream among the various techniques of microtia reconstruction using autogenous costal cartilage. The initial stage involves fabrication and implantation of the cartilage framework, followed by projection of the reconstructed auricle in the second stage. During the projection stage, the line of incision is usually made close to the helical rim, from the superoanterior margin of the helical rim to the region of the lobule.

Single-splint technique in orthognathic surgery: intraoperative checkpoints to control facial symmetry.

Background: Despite the most meticulous preoperative planning and execution, intraoperative soft-tissue response to dentoskeletal changes is often different from those statistically predicted, especially when midline asymmetry is present. A "single-splint" technique for bimaxillary surgery, with intraoperative adjustments and checkpoints, was developed in an attempt to overcome these limitations. The purpose of this study was therefore to determine whether this technique can improve the midline symmetry of facial soft tissues.

Pfeiffer syndrome: a treatment evaluation.

Background: Pfeiffer syndrome is rarely encountered, even at major craniofacial centers. Published reports indicate high mortality rates (25 to 85 percent) for severely affected subtypes. The authors reviewed their surgically treated patients to improve outcomes.

The role of congenital muscular torticollis in the development of deformational plagiocephaly.

Background: Numerous risk factors have been associated with the development of deformational plagiocephaly, although the etiology remains unclear. Torticollis and sternocleidomastoid imbalance are implicated, but reporting is variable. The authors sought to determine the incidence of torticollis/sternocleidomastoid imbalance in deformational plagiocephaly.

Single sutural craniosynostoses: surgical outcomes and long-term growth.

Background: This study was designed to examine long-term skull growth following single sutural synostosis corrections and to evaluate surgical outcomes.

Methods: A retrospective outcome assessment of all children treated with a single-stage, open-remodeling procedure for sagittal, metopic, unilateral coronal, and unilateral lambdoid synostosis was performed. Long-term growth was assessed from serial anthropometric measurements taken up to 11 years postoperatively (mean, 4 years).

Symptom outcomes following cranial vault expansion for craniosynostosis in children older than 2 years.

Background: Most craniosynostosis cases are treated by cranial expansion before 1 year of age. Occasionally, patients present at a later age with nonspecific symptoms of increased intracranial pressure. The purpose of this study was to review the symptoms of patients undergoing late cranial vault expansion.

Single-splint technique for correction of severe facial asymmetry: correlation between intraoperative maxillomandibular complex roll and restoration of mouth symmetry.

Background: One of the most difficult problems to treat is the patient presenting with severe facial asymmetry and malocclusion whose chief complaint is the need for facial improvement. A canted intercommissural plane appears to be a major contributor to the patient's perception of facial asymmetry, but little is known about its correction. The authors adjust the intercommissural plane intraoperatively by modifying the maxillomandibular roll.

Zygomatic arch deformation: an anatomic and clinical study.

Purpose: Trauma to the zygomatic arch classically leads to 1 of 3 injury patterns: fracture with medial displacement, fracture with posterior telescoping, or explosive burst with lateral displacement. We identified an additional injury pattern whereby the arch undergoes significant bending in the axial plane without fracture.

Patients And Methods: In the anatomical part of the study, computed tomography (CT) scans of patients with arch deformation without fracture were analyzed for location, degree, and type of arch bending.

Relationship between rapid maxillary expansion and nasal cavity size and airway resistance: short- and long-term effects.

Introduction: The availability of new, reliable, objective, and 3-dimensional techniques to assess the effects of rapid maxillary expansion on the morphology of the maxillary dental arch, nasal cavity dimensions, and nasal airway resistance led to the development of this research.

Methods: Thirty-eight subjects participated in this study (mean age, 13 years). Data were collected before expansion, when the expander was stabilized, when the expander was removed, and 9 to 12 months after the expander was removed.

Comparison of a modifiable cranial cup versus repositioning and cervical stretching for the early correction of deformational posterior plagiocephaly.

Background: Deformational occipital flattening is the most common cause of abnormal head shape. Current treatment calls for repositioning and cervical stretching in infants younger than 5 months. The authors assessed the effectiveness of a modifiable cranial cup compared to repositioning and cervical stretching to correct early deformational plagiocephaly.

The biophysics of mandibular fractures: an evolution toward understanding.

Background: Predicting outcomes based on a variety of fixation techniques remains problematic in the treatment of mandible fractures. There is inherent difficulty in comparing the hundreds of published articles on the subject because of the large number of variables, including injury patterns, assessment techniques, treatment approach, device selection and application, and definition of outcome.

Methods: The authors review the behavior of the human mandible.

Facial asymmetry in unilateral coronal synostosis: long-term results after fronto-orbital advancement.

Background: Unilateral coronal synostosis causes asymmetry of the forehead and face. The authors set out to document asymmetry and rotation of the middle/lower facial soft tissues using three-dimensional photogrammetry in adolescent and adult patients with unilateral coronal synostosis who underwent correction in infancy.

Methods: All patients older than 10 years who had bilateral fronto-orbital advancement in infancy for nonsyndromic unilateral coronal synostosis were eligible for this study.

Rare craniofacial clefts: a surgical classification.

The Tessier classification is the current standard for identifying and reporting rare craniofacial clefts. This numerically based system describes 16 different primary clefts, with additional possible combinations that can significantly raise the total number of potentially describable clefts. Problems with this system include a complexity that requires most surgeons to consult a diagram to describe the location of a cleft.

Optic nerve compression in craniofacial fibrous dysplasia: the role and indications for decompression.

Background: Fibrous dysplasia is a benign bone disorder in which craniofacial bones are involved in approximately one-fifth of cases. Optic nerve compression is one of its most potentially devastating complications. The approach to visual disturbance caused by disease involvement of the optic canal has been varied and controversial.