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Timing of Treatment for Craniosynostosis and Faciocraniosynostosis: A 20-Year Experience
Published in Niall MH McLeod, Peter A Brennan, 50 Landmark Papers every Oral & Maxillofacial Surgeon Should Know, 2020
The authors described more unusual situations in which alternative approaches may be required. These included multi-suture craniosynostoses, patients with brain malformations, and those with craniosynostoses and hydrocephalus. They felt that in patients with multi-sutural synostoses at risk of severe brain constriction and raised intracranial pressure, the surgery should be undertaken as soon as possible, depending on the condition of the patient. Surgical management should aim to reposition the supra-orbital bar in a normal position so that the upper forehead is well contoured. The remaining bony pieces are positioned loosely on the rest of the vault with the brain to act as a natural expander. In patients with anomalies due to brain malformation, functional prognosis is not as good. Where the brain is not obviously constricted, surgery is delayed until 3–9 months of age. The authors highlighted the complexities in the timing of treatment for patients with craniosynostosis and hydrocephalus due to the potential for “dead space” to be created, and subsequent complications related to this, if treated concurrently. They advised assessment on a case by case basis.
The Anatomy of Joints Related to Function
Published in Verna Wright, Eric L. Radin, Mechanics of Human Joints, 2020
The anatomic classification of joints is based upon the nature of the intervening tissues, which may be collagenous fibers or cartilage (both synarthroses) or the familiar complex of structures that together form a synovial (diarthrodial) joint. Additionally, bones that are initially separate may become joined by a continuation of their matrix to form a synostosis. This is usually the result of a normal developmental, growth, or aging process (as in the fusion of ilium, ischium, and pubis to form a single innominate bone), or it may be the result of a pathological process, such as fusion across the sacroiliac joints in ankylosing spondylitis.
Clefts and craniofacial
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
The general aim is to determine whether the patient has a deformational synostosis or true CS – and if the latter, which one? Possible diagnoses may be suggested by specific features, e.g. turribrachycephaly plus No hand abnormality – CrouzonSpade, mitten or hoof hand – ApertBroad thumbs ± ankylosis of elbow – PfeifferLow forehead, ptosis, short stature – Saethre–ChotzenDry frizzy hair, grooved nails, bifid nasal tip – craniofrontonasal dysplasiaScaphocephaly – Carpenter
Correction of 4th and 5th metacarpal synostosis in a skeletally mature hand using de-rotational osteotomies
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
Christopher D. Liao, Feras Yamin, Roger L. Simpson
There are currently no concrete guidelines for treatment of metacarpal synostosis, which is complicated by the absence of a universal, treatment-directed classification scheme. With respect to the three aforementioned classification schemes, the patient described in our report could be best classified as either a Foucher Class-Ya, Buck-Gramcko Wood Class-IIIB, or Type-B1 according to the system devised by Liu et al. [4–6] Within our review, only one study specified the surgical management of Foucher-Ya synostosis using a trapezoidal bone graft and progressive lengthening but admitted a suboptimal cosmetic outcome [5]. In the original publication by Buck-Gramcko and Wood, there was no specific surgical approach outlined for Class-IIIB synostoses [4]. For Type-B1 synostoses, Liu et al. reported satisfactory results after utilizing an opening wedge adduction osteotomy of the 5th metacarpal with bone grafting and an additional wedge osteotomy of the 4th metacarpal [6].
In search of a single standardised system for reporting complications in craniofacial surgery: a comparison of three different classifications
Published in Journal of Plastic Surgery and Hand Surgery, 2019
Anna Paganini, Madiha Bhatti-Söfteland, Sara Fischer, David Kölby, Emma Hansson, Justine O’Hara, Giovanni Maltese, Peter Tarnow, Lars Kölby
At our centre, sequential operations for syndromic cases, such as Crouzon and Pfeiffer, include frontal advancement combined with posterior springs at an early age, followed by ‘spectaclesplasty’ to correct exorbitism, and finally, Le Fort I or III to correct the midface and occlusion in adolescence. Such an approach spreads out the surgical trauma and makes the surgery less extensive than when all procedures are performed in a single operation. Our conservative use of Le Fort III and monobloc procedures might also have contributed to a lower CR than that seen in other centres [19,20]. In our material, there was no mortality. However, this has been reported [1,21]. A particular complication (i.e. prolonged wound healing), was relatively frequent in metopic synostosis as compared with other single-suture synostoses; however, this has not been previously described. One possible explanation could be the relatively tense skin closure after increase in the frontal volume achieved by frontal remodelling.
Brachial distal biceps injuries
Published in The Physician and Sportsmedicine, 2019
Drew Krumm, Peter Lasater, Guillaume Dumont, Travis J. Menge
The LABCN is the most commonly injured structure during both single-incision and dual-incision techniques. The nerve should be retracted laterally during each approach, as paresthesias or neuromas may develop 5–7% of time during the superficial dissection [6]. Another study by Bisson et al. showed 16% of patients with the two-incision technique had nerve complications, with the LABCN being the most common injury [26]. Injury to the radial and/or posterior interosseous nerve is more common with a single-incision approach. It has been reported in 5% of cases, most commonly due to improper retractor placement around the radial tuberosity [6]. This can be avoided by keeping the forearm fully supinated. Kelly et al. studied complications of patients undergoing the dual-incision distal bicep repair and found 4% of patients developed lateral antebrachial cutaneous paresthesias and 3% of patients had superficial radial nerve paresthesias. Furthermore, the single-incision technique resulted in a lower incidence of heterotopic ossification and synostosis compared to the dual-incision technique. Synostosis may lead to decreased pronation and supination of the forearm. This risk can be reduced by avoiding dissection between the radius and ulna and copious irrigation [27].