Pub Date : 2025-02-05DOI: 10.1016/j.jcms.2025.01.001
Naveen Kumar Jayakumar, Sneha Pendem, Ravi Pavan Vudatha, M S Muthu
Syndromic craniosynostosis is a complex condition involving the craniofacial skeleton, often requiring surgical midface advancement (SMA) to address functional and aesthetic concerns. A systematic review of literature was conducted on the impact of Lefort III/monobloc advancement on midface growth of children with syndromic craniosynostosis. Comprehensive search of multiple databases yielded 21 studies that met the inclusion criteria. Data extraction and risk-of-bias assessment were performed using standardized tools. The review included 309 children who underwent SMA at a median age of 7-8 years. While some studies reported positive post-operative growth, others found no evidence of growth. The type of surgical intervention (osteotomy vs. distraction) and age at surgery did not consistently influence growth outcomes. Vertical growth of the midface was uninterrupted post-operatively, whereas sagittal growth was minimal. This systematic review highlights the variability in midface growth outcomes following LeFort III/monobloc advancement in children with syndromic craniosynostosis. Further research is needed to elucidate the factors influencing growth and to optimize surgical techniques for improved outcomes.
{"title":"Impact of Lefort III/ monobloc advancement on midface growth in children with syndromic craniosynostosis: A systematic review.","authors":"Naveen Kumar Jayakumar, Sneha Pendem, Ravi Pavan Vudatha, M S Muthu","doi":"10.1016/j.jcms.2025.01.001","DOIUrl":"https://doi.org/10.1016/j.jcms.2025.01.001","url":null,"abstract":"<p><p>Syndromic craniosynostosis is a complex condition involving the craniofacial skeleton, often requiring surgical midface advancement (SMA) to address functional and aesthetic concerns. A systematic review of literature was conducted on the impact of Lefort III/monobloc advancement on midface growth of children with syndromic craniosynostosis. Comprehensive search of multiple databases yielded 21 studies that met the inclusion criteria. Data extraction and risk-of-bias assessment were performed using standardized tools. The review included 309 children who underwent SMA at a median age of 7-8 years. While some studies reported positive post-operative growth, others found no evidence of growth. The type of surgical intervention (osteotomy vs. distraction) and age at surgery did not consistently influence growth outcomes. Vertical growth of the midface was uninterrupted post-operatively, whereas sagittal growth was minimal. This systematic review highlights the variability in midface growth outcomes following LeFort III/monobloc advancement in children with syndromic craniosynostosis. Further research is needed to elucidate the factors influencing growth and to optimize surgical techniques for improved outcomes.</p>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-05DOI: 10.1016/j.jcms.2025.01.032
Elise Le Coq, Anne-Sophie Delemazure, Emmanuelle Mourrain-Langlois, Pierre Corre, Hélios Bertin, Soizic Tiriau
Chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory disease with clinical and radiological symptoms that overlap with fibrous dysplasia (FD), particularly in children. This study aimed to compare the clinical and radiological features of craniofacial CRMO and FD in a pediatric population. Seven children with CRMO and 14 with FD were retrospectively identified in our tertiary centre between 2012 and 2022. Their clinical, radiological, and biological (when available) data were collected. Two experienced radiologists reviewed imaging modalities following a standardized form, including characteristics of the lesions, soft-tissue involvement, and signal abnormalities (MRI). Swelling and pain were common symptoms in the CRMO group (7/7 and 5/5, respectively), compared with 11/14 and 2/14 patients in the FD group. Imaging (CT scan) comparisons revealed a predominance of erosive lesions, cortical interruption, periosteal apposition, and soft-tissue involvement in CRMO compared with FD (4/5 vs 0/6, p1 = 0.01; 5/5 vs 1/6, p2 = 0.01; 5/5 vs 0/6, p3 = 0.002; and 4/5 vs 0/6, p4 = 0.02, respectively). Hyperosteosis was mainly associated with FD lesions (6/6 vs 2/5, p = 0.06). Knowledge of the clinical and radiographic differences between CRMO and FD could help clinicians to differentiate between the two diseases.
{"title":"Comparative study of radio-clinical parameters in pediatric forms of fibrous dysplasia and chronic recurrent multifocal osteomyelitis.","authors":"Elise Le Coq, Anne-Sophie Delemazure, Emmanuelle Mourrain-Langlois, Pierre Corre, Hélios Bertin, Soizic Tiriau","doi":"10.1016/j.jcms.2025.01.032","DOIUrl":"https://doi.org/10.1016/j.jcms.2025.01.032","url":null,"abstract":"<p><p>Chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory disease with clinical and radiological symptoms that overlap with fibrous dysplasia (FD), particularly in children. This study aimed to compare the clinical and radiological features of craniofacial CRMO and FD in a pediatric population. Seven children with CRMO and 14 with FD were retrospectively identified in our tertiary centre between 2012 and 2022. Their clinical, radiological, and biological (when available) data were collected. Two experienced radiologists reviewed imaging modalities following a standardized form, including characteristics of the lesions, soft-tissue involvement, and signal abnormalities (MRI). Swelling and pain were common symptoms in the CRMO group (7/7 and 5/5, respectively), compared with 11/14 and 2/14 patients in the FD group. Imaging (CT scan) comparisons revealed a predominance of erosive lesions, cortical interruption, periosteal apposition, and soft-tissue involvement in CRMO compared with FD (4/5 vs 0/6, p<sub>1</sub> = 0.01; 5/5 vs 1/6, p<sub>2</sub> = 0.01; 5/5 vs 0/6, p<sub>3</sub> = 0.002; and 4/5 vs 0/6, p<sub>4</sub> = 0.02, respectively). Hyperosteosis was mainly associated with FD lesions (6/6 vs 2/5, p = 0.06). Knowledge of the clinical and radiographic differences between CRMO and FD could help clinicians to differentiate between the two diseases.</p>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-04DOI: 10.1016/j.jcms.2025.01.026
Güven Ozan Kaplan, Rabia Yudum Somuncu, Ahmet İlkay Işıkay, Özgür Canbay, Mert Calis, Gökhan Tunçbilek
Fronto-orbital advancement and remodeling (FOAR) is associated with substantial blood loss, making it crucial to understand the factors influencing intraoperative blood loss during this procedure. A total of 231 craniosynostosis patients who underwent FOAR between 2003 and 2023 were retrospectively reviewed. Younger patients (<18 months) demonstrated higher weight-adjusted blood loss. Patients with multiple suture synostosis, syndromic craniosynostosis, elevated intracranial pressure (ICP), and dural tears had significantly higher total and weight-adjusted blood loss. Blood loss showed a moderate positive correlation with operative time. Additionally, patients administered tranexamic acid during surgery experienced significantly lower blood loss. Multiple linear regression analysis identified the presence of a syndrome, dural tears, and operative time as statistically significant predictors of both total and weight-adjusted blood loss. Patients with higher intraoperative transfusion volumes demonstrated a continued higher need for transfusions during the postoperative period. In conclusion, significant risk factors for increased blood loss during FOAR include syndromic craniosynostosis, multiple suture synostosis, elevated ICP, dural tears, and prolonged operative time. Tranexamic acid demonstrates beneficial effects in reducing blood loss. Patients requiring higher intraoperative transfusion volumes should be closely monitored postoperatively for ongoing transfusion needs. Clinicians should consider these risk factors and adjust their approaches to enhance patient safety.
{"title":"Factors influencing blood loss in fronto-orbital advancement and remodeling: A retrospective review of 231 cases.","authors":"Güven Ozan Kaplan, Rabia Yudum Somuncu, Ahmet İlkay Işıkay, Özgür Canbay, Mert Calis, Gökhan Tunçbilek","doi":"10.1016/j.jcms.2025.01.026","DOIUrl":"https://doi.org/10.1016/j.jcms.2025.01.026","url":null,"abstract":"<p><p>Fronto-orbital advancement and remodeling (FOAR) is associated with substantial blood loss, making it crucial to understand the factors influencing intraoperative blood loss during this procedure. A total of 231 craniosynostosis patients who underwent FOAR between 2003 and 2023 were retrospectively reviewed. Younger patients (<18 months) demonstrated higher weight-adjusted blood loss. Patients with multiple suture synostosis, syndromic craniosynostosis, elevated intracranial pressure (ICP), and dural tears had significantly higher total and weight-adjusted blood loss. Blood loss showed a moderate positive correlation with operative time. Additionally, patients administered tranexamic acid during surgery experienced significantly lower blood loss. Multiple linear regression analysis identified the presence of a syndrome, dural tears, and operative time as statistically significant predictors of both total and weight-adjusted blood loss. Patients with higher intraoperative transfusion volumes demonstrated a continued higher need for transfusions during the postoperative period. In conclusion, significant risk factors for increased blood loss during FOAR include syndromic craniosynostosis, multiple suture synostosis, elevated ICP, dural tears, and prolonged operative time. Tranexamic acid demonstrates beneficial effects in reducing blood loss. Patients requiring higher intraoperative transfusion volumes should be closely monitored postoperatively for ongoing transfusion needs. Clinicians should consider these risk factors and adjust their approaches to enhance patient safety.</p>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jcms.2024.11.002
Lee Mui Lee , Yao Min Zhu , Rong Yang , Si Yu Li , Xiao Liang , Yu Meng Wang
Background
This study aims to assess the therapeutic efficacy of a modified arthroscopy discopexy suturing technique in combination with an anterior disc repositioning splint (ARS) for the treatment of early phase anterior disc displacement without reduction (ADDwoR) patients.
Methods
During 2021–2022, early phase ADDwoR cases were included and underwent modified arthroscopy discopexy suturing surgery and ARS therapy after surgery. Pre- and post-surgical evaluation parameters include the visual analogue scale (VAS) for pain, maximum mouth opening (MMO), and disc-condyle relationship on MRI. Patients were followed up for a period of 6 months after surgery. Statistical significance was considered when p < 0.05.
Results
A total of 31 unilateral early phase ADDwoR cases were included, with an average age of 26.97. The VAS scores of pain decreased from 4.87 to 1.61, while MMO increased from 23.13 mm to 39.35 mm(p < 0.05). MRI evaluations at 1 month and 6 months post-surgical revealed a disc reduction rate of 93.55% and 90.32%, respectively.
Conclusion
The modified arthroscopy discopexy suturing technique combined with ARS therapy after surgery proves to be an effective, minimally invasive and simplified approach for the treatment of early phase ADDwoR patients.
研究背景本研究旨在评估改良关节镜下椎间盘切除缝合术与椎间盘前路复位夹板（ARS）相结合治疗早期椎间盘前移不缩小症（ADDwoR）患者的疗效：方法：2021-2022年间，纳入早期ADDwoR病例，接受改良关节镜椎间盘切除缝合手术，术后接受ARS治疗。手术前后的评估参数包括疼痛的视觉模拟量表（VAS）、最大张口度（MMO）和核磁共振成像上的椎间盘与椎髁关系。术后对患者进行了为期 6 个月的随访。统计意义以 p 为准：共纳入 31 例单侧 ADDwoR 早期病例，平均年龄为 26.97 岁。疼痛的 VAS 评分从 4.87 分降至 1.61 分，而 MMO 则从 23.13 mm 增至 39.35 mm（p 结论：ADDwoR 患者的疼痛评分从 4.87 分降至 1.61 分，而 MMO 则从 23.13 mm 增至 39.35 mm：改良关节镜椎间盘切除缝合技术结合术后 ARS 治疗被证明是治疗早期 ADDwoR 患者的一种有效、微创和简化的方法。
{"title":"Early management of anterior disc displacement without reduction: Evaluating the effectiveness of modified arthroscopy discopexy with anterior disc repositioning splint","authors":"Lee Mui Lee , Yao Min Zhu , Rong Yang , Si Yu Li , Xiao Liang , Yu Meng Wang","doi":"10.1016/j.jcms.2024.11.002","DOIUrl":"10.1016/j.jcms.2024.11.002","url":null,"abstract":"<div><h3>Background</h3><div>This study aims to assess the therapeutic efficacy of a modified arthroscopy discopexy suturing technique in combination with an anterior disc repositioning splint (ARS) for the treatment of early phase anterior disc displacement without reduction (ADDwoR) patients.</div></div><div><h3>Methods</h3><div>During 2021–2022, early phase ADDwoR cases were included and underwent modified arthroscopy discopexy suturing surgery and ARS therapy after surgery. Pre- and post-surgical evaluation parameters include the visual analogue scale (VAS) for pain, maximum mouth opening (MMO), and disc-condyle relationship on MRI. Patients were followed up for a period of 6 months after surgery. Statistical significance was considered when <em>p</em> < 0.05.</div></div><div><h3>Results</h3><div>A total of 31 unilateral early phase ADDwoR cases were included, with an average age of 26.97. The VAS scores of pain decreased from 4.87 to 1.61, while MMO increased from 23.13 mm to 39.35 mm(p < 0.05). MRI evaluations at 1 month and 6 months post-surgical revealed a disc reduction rate of 93.55% and 90.32%, respectively.</div></div><div><h3>Conclusion</h3><div>The modified arthroscopy discopexy suturing technique combined with ARS therapy after surgery proves to be an effective, minimally invasive and simplified approach for the treatment of early phase ADDwoR patients.</div></div>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"53 2","pages":"Pages 97-103"},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142734805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jcms.2024.11.012
Alexander J. Kammien, Olivier F. Noel, Abidemi Aregbe, James E. Clune
Purpose
Prior studies characterizing surgically managed frontal sinus fractures are small, institutional studies from major trauma centers (1–5). The current study characterizes the concomitant injuries and complications following open treatment of frontal sinus fractures across the United States.
Methods
Patients who underwent open treatment for a frontal sinus fracture between 2010 and 2022 were identified in a United States administrative database. Patients <18 years old and with <90 days of follow-up were excluded. Type of fracture (simple or complex), frontal sinus obliteration and concomitant fractures (facial, vertebral, extremity) were identified. 90-day surgical site infection, sinusitis, meningitis, brain abscess and cerebrospinal fluid leak were identified, as well as mucocele any time after surgery.
Results
There were 1492 adult patients with open treatment of frontal sinus fractures: 654 (44%) with simple fractures and 838 (56%) with complex fractures. There were 157 (11%) patients with frontal sinus obliteration. Concomitant fractures included facial (715 patients, 48%), vertebral (55, 4%), upper extremity (40, 3%) and lower extremity (53, 4%). Within 90 days of surgery, 155 (10%) patients had a complication: surgical site infection (42, 2.8%), sinusitis (29, 1.9%), meningitis (25, 1.7%), brain abscess (23, 1.5%), and cerebrospinal fluid leak (63, 4.2%). There were 11 (0.7%) patients who developed a mucocele, and <11 (<0.7%) underwent reduction of contour deformity. On multivariate analysis, complex frontal sinus fracture and concomitant vertebral/extremity fracture were associated with increased likelihood of a complication.
Conclusion
Over the last thirteen years, complication rates are low following surgically managed frontal sinus fractures. Comminuted fractures and those involving the posterior table increase the likelihood of a complication, likely due to increased injury severity. The results of the current study generally align with the published single-institution studies on complications of frontal sinus fractures treated with surgery. These findings from a large, nationwide cohort strengthen prior conclusions and increase the generalizability of reported complication rates.
{"title":"Complications following open treatment of frontal sinus fracture: A nationwide analysis of 1492 patients","authors":"Alexander J. Kammien, Olivier F. Noel, Abidemi Aregbe, James E. Clune","doi":"10.1016/j.jcms.2024.11.012","DOIUrl":"10.1016/j.jcms.2024.11.012","url":null,"abstract":"<div><h3>Purpose</h3><div>Prior studies characterizing surgically managed frontal sinus fractures are small, institutional studies from major trauma centers (1–5). The current study characterizes the concomitant injuries and complications following open treatment of frontal sinus fractures across the United States.</div></div><div><h3>Methods</h3><div>Patients who underwent open treatment for a frontal sinus fracture between 2010 and 2022 were identified in a United States administrative database. Patients <18 years old and with <90 days of follow-up were excluded. Type of fracture (simple or complex), frontal sinus obliteration and concomitant fractures (facial, vertebral, extremity) were identified. 90-day surgical site infection, sinusitis, meningitis, brain abscess and cerebrospinal fluid leak were identified, as well as mucocele any time after surgery.</div></div><div><h3>Results</h3><div>There were 1492 adult patients with open treatment of frontal sinus fractures: 654 (44%) with simple fractures and 838 (56%) with complex fractures. There were 157 (11%) patients with frontal sinus obliteration. Concomitant fractures included facial (715 patients, 48%), vertebral (55, 4%), upper extremity (40, 3%) and lower extremity (53, 4%). Within 90 days of surgery, 155 (10%) patients had a complication: surgical site infection (42, 2.8%), sinusitis (29, 1.9%), meningitis (25, 1.7%), brain abscess (23, 1.5%), and cerebrospinal fluid leak (63, 4.2%). There were 11 (0.7%) patients who developed a mucocele, and <11 (<0.7%) underwent reduction of contour deformity. On multivariate analysis, complex frontal sinus fracture and concomitant vertebral/extremity fracture were associated with increased likelihood of a complication.</div></div><div><h3>Conclusion</h3><div>Over the last thirteen years, complication rates are low following surgically managed frontal sinus fractures. Comminuted fractures and those involving the posterior table increase the likelihood of a complication, likely due to increased injury severity. The results of the current study generally align with the published single-institution studies on complications of frontal sinus fractures treated with surgery. These findings from a large, nationwide cohort strengthen prior conclusions and increase the generalizability of reported complication rates.</div></div>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"53 2","pages":"Pages 129-133"},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142734800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jcms.2024.11.010
Petar Suton , Ivica Luksic , Marko Lucijanic
Survivors of head and neck squamous cell carcinoma face excess mortality from multiple causes. However, impact and patterns of all-cause mortality remains unknown in oral cancer patients. The aim of this study was to analyse these patterns in long-term survivors. We retrospectively studied clinically node-negative (cN0) oral cancer patients primarily surgically treated at tertiary cancer center. A total of 152 patients were identified. Median follow-up of our cohort was 59 months. A total of 76 patients died. Thirty-four (22.4%) patients died from primary tumor recurrence and 42 (27.6%) patients died from competing causes. The most common competing causes of death were: cardiovascular disease (n = 18; 42.9%), followed by second primary cancer (SPC) (n = 11; 26.2%). Lung cancer accounted for 54.5% (6 of 11) of SPC associated deaths. Patients with cN0 oral cancer treated with up-front surgery are potentially highly curable for index cancer but face significant risks of mortality from causes other than disease recurrence. Nearly one-third of these patients died from competing causes of death which are major cause of mortality after the fourth year of follow-up period. This study highlights the importance of adjusted follow-up strategies addressing this population specific risks.
{"title":"Comparison of oral cancer versus competing factors as cause of death: Single institution experience with long-term follow up","authors":"Petar Suton , Ivica Luksic , Marko Lucijanic","doi":"10.1016/j.jcms.2024.11.010","DOIUrl":"10.1016/j.jcms.2024.11.010","url":null,"abstract":"<div><div>Survivors of head and neck squamous cell carcinoma face excess mortality from multiple causes. However, impact and patterns of all-cause mortality remains unknown in oral cancer patients. The aim of this study was to analyse these patterns in long-term survivors. We retrospectively studied clinically node-negative (cN0) oral cancer patients primarily surgically treated at tertiary cancer center. A total of 152 patients were identified. Median follow-up of our cohort was 59 months. A total of 76 patients died. Thirty-four (22.4%) patients died from primary tumor recurrence and 42 (27.6%) patients died from competing causes. The most common competing causes of death were: cardiovascular disease (n = 18; 42.9%), followed by second primary cancer (SPC) (n = 11; 26.2%). Lung cancer accounted for 54.5% (6 of 11) of SPC associated deaths. Patients with cN0 oral cancer treated with up-front surgery are potentially highly curable for index cancer but face significant risks of mortality from causes other than disease recurrence. Nearly one-third of these patients died from competing causes of death which are major cause of mortality after the fourth year of follow-up period. This study highlights the importance of adjusted follow-up strategies addressing this population specific risks.</div></div>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"53 2","pages":"Pages 85-89"},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142734796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jcms.2024.11.009
Qin-Chuan Liang , Xu Kang , Ping-Ping Gao , Ze-Yang Xia , Yong Sun , Nan Bao
The aim of this study was to investigate the efficacy of non-detachable free-floating bone flap posterior cranial vault release (FFBF-PCVR) in syndromic craniosynostosis.
A retrospective review was completed of subjects who underwent FFBF-PCVR at 4 time-points: within 3 months preoperatively, 7 days postoperatively, 3 months postoperatively and at the last follow-up postoperatively. Volumetric and craniometric data, the ratio of ventricular diameter, and the cerebellar tonsillar descent were measured after FFBF-PCVR by using computed tomographic and magnetic resonance imaging.
A total of 19 patients underwent FFBF-PCVR. The mean age was 11.7 months (range 4–36 months). The mid cranial height, posterior cranial height, and anterior posterior diameter length significantly increased from preoperative to postoperative 7 days, from postoperative 7 days to postoperative3 months, and from postoperative 3 months to the last follow-up. There was a significant increase in pre- to 7 days postoperative intracranial volume (1195.21 ± 246.56 cm³, p < 0.001; respectively), 3 months postoperative intracranial volume (1228.03 ± 249.61 cm³, p < 0.001; respectively), and intracranial volume at last follow-up (1390.25 ± 219.99 cm³, p < 0.001; respectively). There was a significant increase in 7 days' postoperative to 3 months' postoperative intracranial volume (p < 0.001; respectively), and intracranial volume at last follow-up (p < 0.001; respectively). There was a significant increase in 3 months postoperative to intracranial volume at last follow-up (p < 0.001). The mean intracranial volume increased by an average of 36.6 percent (range, 18.1 to 79.2 percent) at last follow-up. The degree of hydrocephalus in the preoperative child was (45.77% ± 9.17%), and at the last follow-up after surgery, the degree of hydrocephalus was (35.02 ± 9.50%), p < 0.01). Preoperatively, 14 patients (73.7 percent) had radiographic evidence of Chiari malformation type I. The cerebellar tonsillar descent, measured using pre- and postoperative MRI, decreased in all patients after FFBF-PCVR (preoperative: 7.5 ± 1.4 mm, postoperative: 5.3 ± 1.7 mm; p = 0.001).
FFBF-PCVR can efficiently expand the posterior cranial vault with only one surgical procedure. Moreover, it helps to relieve hydrocephalus and cerebellar tonsillar herniation.
{"title":"Free-floating bone flap posterior cranial vault release in syndromic craniosynostosis","authors":"Qin-Chuan Liang , Xu Kang , Ping-Ping Gao , Ze-Yang Xia , Yong Sun , Nan Bao","doi":"10.1016/j.jcms.2024.11.009","DOIUrl":"10.1016/j.jcms.2024.11.009","url":null,"abstract":"<div><div>The aim of this study was to investigate the efficacy of non-detachable free-floating bone flap posterior cranial vault release (FFBF-PCVR) in syndromic craniosynostosis.</div><div>A retrospective review was completed of subjects who underwent FFBF-PCVR at 4 time-points: within 3 months preoperatively, 7 days postoperatively, 3 months postoperatively and at the last follow-up postoperatively. Volumetric and craniometric data, the ratio of ventricular diameter, and the cerebellar tonsillar descent were measured after FFBF-PCVR by using computed tomographic and magnetic resonance imaging.</div><div>A total of 19 patients underwent FFBF-PCVR. The mean age was 11.7 months (range 4–36 months). The mid cranial height, posterior cranial height, and anterior posterior diameter length significantly increased from preoperative to postoperative 7 days, from postoperative 7 days to postoperative3 months, and from postoperative 3 months to the last follow-up. There was a significant increase in pre- to 7 days postoperative intracranial volume (1195.21 ± 246.56 cm³, p < 0.001; respectively), 3 months postoperative intracranial volume (1228.03 ± 249.61 cm³, p < 0.001; respectively), and intracranial volume at last follow-up (1390.25 ± 219.99 cm³, p < 0.001; respectively). There was a significant increase in 7 days' postoperative to 3 months' postoperative intracranial volume (p < 0.001; respectively), and intracranial volume at last follow-up (p < 0.001; respectively). There was a significant increase in 3 months postoperative to intracranial volume at last follow-up (p < 0.001). The mean intracranial volume increased by an average of 36.6 percent (range, 18.1 to 79.2 percent) at last follow-up. The degree of hydrocephalus in the preoperative child was (45.77% ± 9.17%), and at the last follow-up after surgery, the degree of hydrocephalus was (35.02 ± 9.50%), p < 0.01). Preoperatively, 14 patients (73.7 percent) had radiographic evidence of Chiari malformation type I. The cerebellar tonsillar descent, measured using pre- and postoperative MRI, decreased in all patients after FFBF-PCVR (preoperative: 7.5 ± 1.4 mm, postoperative: 5.3 ± 1.7 mm; p = 0.001).</div><div>FFBF-PCVR can efficiently expand the posterior cranial vault with only one surgical procedure. Moreover, it helps to relieve hydrocephalus and cerebellar tonsillar herniation.</div></div>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"53 2","pages":"Pages 114-121"},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142734807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jcms.2024.11.015
Güven Ozan Kaplan , Mert Calis , Kutluhan Yusuf Küçük , Halil İbrahim Altunbulak , Elif Günay Bulut , Gökhan Tunçbilek
In the initial report describing the fronto-orbital distraction technique, bone segments were advanced preserving their attachments with the dura. This approach does not allow for the remodeling of the frontal segment. However, in the technique described herein, the fronto-orbital segment is separated from dura, remodeled, and advanced as a bone graft using distractors. Twenty-seven craniosynostosis patients that underwent fronto-orbital advancement and remodeling using distraction osteogenesis were retrospectively reviewed. The mean age at the time of surgery was 19.03 ± 9.19 months; the mean follow-up was 86.04 ± 34.98 months. The mean distraction amount was over 19 mm. No significant difference was found between frontal and occipital bone density measurements at the cortex and medulla. The mean total defect area was 4.79 ± 4.43 cm2 and the mean number of bone defects was 4.8 ± 2.2. The cephalic index decreased from 98.56 ± 6.39 to 87.63 ± 4.54, and 59.3% of the patients reached the normal range in the late postoperative period. Fronto-orbital advancement and remodeling using distraction osteogenesis appears to be safe and effective. Distraction of the frontal bone as a graft does not lead to bone resorption, and new bone formation and improvements in head shape can be achieved.
{"title":"Long-term results of fronto-orbital advancement and remodeling using distraction osteogenesis in craniosynostosis patients","authors":"Güven Ozan Kaplan , Mert Calis , Kutluhan Yusuf Küçük , Halil İbrahim Altunbulak , Elif Günay Bulut , Gökhan Tunçbilek","doi":"10.1016/j.jcms.2024.11.015","DOIUrl":"10.1016/j.jcms.2024.11.015","url":null,"abstract":"<div><div>In the initial report describing the fronto-orbital distraction technique, bone segments were advanced preserving their attachments with the dura. This approach does not allow for the remodeling of the frontal segment. However, in the technique described herein, the fronto-orbital segment is separated from dura, remodeled, and advanced as a bone graft using distractors. Twenty-seven craniosynostosis patients that underwent fronto-orbital advancement and remodeling using distraction osteogenesis were retrospectively reviewed. The mean age at the time of surgery was 19.03 ± 9.19 months; the mean follow-up was 86.04 ± 34.98 months. The mean distraction amount was over 19 mm. No significant difference was found between frontal and occipital bone density measurements at the cortex and medulla. The mean total defect area was 4.79 ± 4.43 cm<sup>2</sup> and the mean number of bone defects was 4.8 ± 2.2. The cephalic index decreased from 98.56 ± 6.39 to 87.63 ± 4.54, and 59.3% of the patients reached the normal range in the late postoperative period. Fronto-orbital advancement and remodeling using distraction osteogenesis appears to be safe and effective. Distraction of the frontal bone as a graft does not lead to bone resorption, and new bone formation and improvements in head shape can be achieved.</div></div>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"53 2","pages":"Pages 154-161"},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jcms.2024.11.014
Tanya Wolffenbuttel , Sara Ajami , Alessandro Borghi , Silvia Schievano , David Dunaway , Noor ul Owase Jeelani , Maarten Koudstaal
Head shape changes following spring-cranioplasty for craniosynostosis (CS) can be difficult to predict. While previous research has indicated a connection between surgical outcomes and calvarial bone microstructure ex-vivo, there exists a demand for identifying imaging biomarkers that can be translated into clinical settings and assist in predicting these outcomes. In this study, ten parietal (8 males, age 157 ± 26 days) and two occipital samples (males, age 1066 and 1162 days) were collected from CS patients who underwent spring cranioplasty procedures. Samples’ microstructure were examined using clinical imaging modalities (dental CBCT, C-arm CT) and micro-CT. Cranial index (CI) was measured to evaluate patients' head shape before and after surgery, with an investigation into their relationship with morphometric measurements. Bone cross-sectional thickness (CsTh) showed significant correlation to CI increase post-SAC for C-arm CT (ρ = −0.857, p = 0.014) and 8.9 μm micro-CT (ρ = −0.857, p = 0.014). In addition, bone volume (BV) was correlated to CI increase for CBCT (ρ = −0.643, p = 0.013), 50 μm micro-CT (ρ = −0.857, p < 0.001) and 90 μm micro-CT (ρ = −0.679, p = 0.008). High correlation with micro-CT resampled to match respective voxel sizes was demonstrated for both CBCT and C-arm CT measurements of CsTh and BV (ρ ≥ 0.860, p < 0.001). This preliminary study demonstrates the potential of clinical CT devices to aid in pre-surgical decision making in CS.
{"title":"Cone beam CT for the assessment of bone microstructure to predict head shape changes after spring-assisted craniosynostosis surgery","authors":"Tanya Wolffenbuttel , Sara Ajami , Alessandro Borghi , Silvia Schievano , David Dunaway , Noor ul Owase Jeelani , Maarten Koudstaal","doi":"10.1016/j.jcms.2024.11.014","DOIUrl":"10.1016/j.jcms.2024.11.014","url":null,"abstract":"<div><div>Head shape changes following spring-cranioplasty for craniosynostosis (CS) can be difficult to predict. While previous research has indicated a connection between surgical outcomes and calvarial bone microstructure ex-vivo, there exists a demand for identifying imaging biomarkers that can be translated into clinical settings and assist in predicting these outcomes. In this study, ten parietal (8 males, age 157 ± 26 days) and two occipital samples (males, age 1066 and 1162 days) were collected from CS patients who underwent spring cranioplasty procedures. Samples’ microstructure were examined using clinical imaging modalities (dental CBCT, C-arm CT) and micro-CT. Cranial index (CI) was measured to evaluate patients' head shape before and after surgery, with an investigation into their relationship with morphometric measurements. Bone cross-sectional thickness (CsTh) showed significant correlation to CI increase post-SAC for C-arm CT (ρ = −0.857, p = 0.014) and 8.9 μm micro-CT (ρ = −0.857, p = 0.014). In addition, bone volume (BV) was correlated to CI increase for CBCT (ρ = −0.643, p = 0.013), 50 μm micro-CT (ρ = −0.857, p < 0.001) and 90 μm micro-CT (ρ = −0.679, p = 0.008). High correlation with micro-CT resampled to match respective voxel sizes was demonstrated for both CBCT and C-arm CT measurements of CsTh and BV (ρ ≥ 0.860, p < 0.001). This preliminary study demonstrates the potential of clinical CT devices to aid in pre-surgical decision making in CS.</div></div>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"53 2","pages":"Pages 142-153"},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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