Sir:FigureThe craniofacial cleft is a rare congenital craniomaxillofacial anomaly caused by embryonic developmental abnormality. It exits in a multitude of patterns, varies in degree of severity, and involves multiple anatomical regions and organs in the face. Since the nineteenth century, many experts have been endeavoring to study the malformation and to design varying classification methods based on different aspects.1–3 Of the available classification methods in the literature, the most popular and clinically accepted one is the Tessier classification because of its many distinct merits.4 In particular, it can enable communication and discussion among physicians.5 In clinical practice, however, the Tessier classification indeed has some inconveniences. Actually, it only uses the numbers 0 to 14 to simply present the malformations, although the manifestations of craniofacial clefts are very complex. If a physician does not check the patient or review the case record, he or she cannot determine the actual condition of a patient from only the diagnosis provided by the Tessier classification. For example, if a patient is diagnosed as Tessier cleft no. 4, one cannot image the concrete conditions of the patient's soft tissues, bone, eyelids, lacrimal system, and so forth. Therefore, it is necessary to establish a classification method of craniofacial clefts that can provide a clear mental image of the patient's conditions and facilitate communication among physicians. For this reason, we have combined the idea of the Eight Diagrams of China and the Tessier classification into a spectacle frame diagram (Fig. 1).Fig. 1: A spectacle frame classification of the craniofacial clefts.In this spectacle frame diagram, the numbers 0 to 14 still have the same meaning as those of the Tessier classification on a one-to-one basis for soft-tissue craniofacial clefts. However, LS represents the lacrimal system deformities; N illustrates the nasal bone cleft or coloboma; and the three Ms symbolize the maxilla cleft or coloboma, each showing one-third part of the maxilla according to the different craniofacial clefts. Z represents the zygomatic bone and arch cleft or coloboma, and the three Fs show the frontal bone cleft or coloboma. Like M, each F shows a different one-third part of the frontal bone. U represents the upper eyelid cleft or coloboma and L is the lower eyelid cleft or coloboma. According to the clinical features and image examination of patients, one can blacken the corresponding areas of this spectacle frame diagram simply to represent the situation of soft-tissue cleft, maxilla, frontal bone, nasal bone, eyelids, lacrimal system, and other features. This method has been attempted for the purpose of describing symbolically the patient's representation in our practice (Fig. 2). The initial experience suggests that the advantages of our method include the following: (1) it is easily to display the true cleft in every patient, including untreated and treated patients, without any detail overlooked; (2) it is more favorable for description and communication among physicians; and (3) it can avoid the time-consuming review of the case history in every consultation.Fig. 2: (Above) A child with bilateral Tessier cleft no. 4 and Tessier cleft no. 2 on the left side with bilateral lower eyelid coloboma and lacrimal system deformity. (Below) The complex conditions of the patient can be represented by the spectacle frame diagram. The condition of the patient can be shown simply by the corresponding black areas.It must be emphasized that this spectacle frame diagram is not a new one but is only a modification of the Tessier classification as a supplement to a certain extent. In our experience, this simple symbolic diagram is able to describe rare craniofacial clefts in detail and is better than the other classifications for communication and for the medical record. It may be helpful for clinical physicians in the diagnosis and treatment of craniofacial clefts. Xiao-Jun Tang, M.D. Lai Gui, M.D. Zhi-Yong Zhang, M.D. Lin Yin, M.D. Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China Philippe Pellerin, M.D. Service de Chirurgie Plastique et Reconstructrice, Centre des Brûlés Hôpital Roger Salengro, Lille, France DISCLOSURE The authors have no financial interest to declare in relation to the content of this article. No external funds were received. PATIENT CONSENT Parents or guardians provided written consent for use of the patient's image.
Objective To explore a new method for correction of malar-zygomatic deficiency through an intraoral incision. Methods From Apr.2000 to Dec.2007,28 L-shaped zygomatic osteotomies have been performed through an intraoral incision. The external rotation was stabilized with interposed coral graft or bone graft. Results During 3 months to 5 years of follow-up,all the 28 cases 'deformities of malar-zygomatic deficiency were corrected. The method remodeled a natural cheek bone contour. The width and the projection of malar-zygomatic complex were increased. All patients obtained good results. Conclusion The L-shaped zygomatic osteotomy is a new and expedient technique for correction of malar-zygomatic deficiency with low complication.
To investigate the surgical therapy of midline skull defect accompanied with frontal sinus injury.11 cases with midline skull defect accompanied with frontal sinus injury were treated. Free temporal fascia was transplanted to close the top of frontal sinus after curettage of the frontal sinus wall. Then titanium prostheses were used to repair the skull defects at the same stage in 10 patients. 1 patient received skull defect repair at the second stage operation.Good results were achieved in 10 cases. The titanium prosthesis had to be taken out in one case due to frontal sinusitis and the anastomosis of frontal sinus and nasal cavity was performed.In patients with midline skull defect accompanied with frontal sinus injury, free temporal fascia could be used to close the top of frontal sinus after curettage of frontal sinus wall. If there is no infection or mild infection in frontal sinus, the skull defect repair could be performed in the same stage. If there is severe frontal sinusitis, the defect repair should be done at the second stage.
To study the clinical characteristics and the treatment of periorbital injuries.61 cases were treated, including 30 cases orbitozygomatic fracture, 6 cases of frontal-orbital fracture, 8 cases of naso-ethmoid-orbital fracture, 7 cases of blow -out fracture and 10 cases of complicated fracture. The patients were diagnosed after physical examination and other examination, like CT. Through bicoronal or local mini incision at the end of eyebrow, combined with subciliary incision and local wound approach, the fractured sites were exposed completely. Then the fractured fragments were repositioned and fixed rigidly. The orbital wall was reconstructed with titanium net and Medpor.The wounds healed primarily. Good cosmetic and functional results achieved in most of the patients. 4 cases underwent second-stage ophthalmectomy. 2 patients had diplopia after operation, but improved gradually. 3 cases of blepharoptosis needed further treatment.Early diagnosis and treatment is very important for periorbital injuries. Fracture reposition and orbital wall reconstruction should he performed at early period.
OBJECTIVE To investigate a technique for correction of severe microgenia. METHODS The mandibular symphysis was exposed through intraoral mucous incision. Two parallel osteotomies were performed under mental foramen. The mobilized segments were advanced like two steps and fixed rigidly with miniplate. RESULTS From June, 2004 to Dec, 2005, 10 cases with severe microgenia were treated with this technique. The duration of follow-up was six months. The mean chin advancement was 1.1 cm and the mean chin vertical increase was 0.7 cm. All the patients healed very well with satisfactory aesthetic result. CONCLUSIONS With this two-step genioplasty, the chin can be moved to ideal position with a natural appearance. It is a reliable method for severe microgenia.
The three-dimensional (3D) craniofacial measurements were studied through the quantitative computed tomography (CT). The dynamic database of quantitative measurement of three-dimensional craniofacial bone was established as mandible in physiological position.170 aesthetics female were examined by spiral volumetric CT (GE SR-7000). 3D craniofacial bone images were reformatted and 3D measurements were performed in SUN Workstation respectively. 33 points were defined in the 3-d craniofacial structure in screen, 14 distances and 11 angles were measured, and 12 ratios were calculated in each case. All data were transferred into the database based on the SPSS software. There is all information of one case (such as number, sex, age, distances, angers) in one row; each column is a measurement item. The mean, standard deviation, standard error, medium, coefficient of variation and 95% confidence interval of data can be calculated and the correlation, regression between several groups of measurement item can be proceeded by computer automatically in the dynamic database.3D craniofacial bone imagings were displayed in arbitrary views without disturbing superposition by using cutting, rotating and 3D measurement procedures. The large data volume provides more information of special relationship of skull base, zygomatic bone, maxilla, mandible and vertebra. The coefficient of variation of skull base is less than them of maxilla and mandible. The standard deviation of ratios is further smaller than the standard deviation of distances and angles. With stepwise regression, the equation is (Go - Go) Y = 0.578X1 + 0.754X2 + 0.228X3 - 0.579X4 - 14.672; (Tz- Tz) : Y = 0.775X1 + 0.161X2 + 0.348X3 + 0.201X4 + 27.730.The database offers reference of the studying of growth rule of craniofacial bone of aesthetics female. It will help improve diagnostic accuracy, staging of reconstruction, precision of corrective surgery, and follow-up patients.
To investigate the effect of the anticoagulants on PRP quality, so as to clarify the appropriate anticoagulant used in PRP production.The microstructure change of platelets collected via heparin, citrate, acid citrate dextrose (ACD) and citrate-theophylline-adenosine-dipyridamole ( CTAD) was observed by TEM following time course. The extent of spontaneous activation of platelets in four groups was detected by measuring sP-selectin in plasma. The TGF-β1 release amount of activated PRP of four groups was measured.CTAD is superior to other anticoagulants in maintaining the integrity of platelet structures for a long time and preventing platelet spontaneous activation. ACD slightly surpassed heparin and citrate in above two aspects. ACD-PRP and CTAD-PRP released significantly more TGF-β1 compared with heparin and citrate.The PRP quality and biological effects were strongly associated with the type of Anticoagulants. ACD and CTAD are optimal anticoagulants in PRP production for they can maintain platelet viability at a high level.
Acquired orbital deformity is a common disease in the practice of craniofacial surgery. Defective orbital volume and abnormality of eyeball position are the most important characteristics of pathologic changes. This study includes 87 cases of acquired orbital deformity, which received surgery for volume aberration from 2002 to present. Among them, 73 cases received orbital volume expansion surgery and 14 cases received reduction surgery. Coronal scalp, lower eyelid, or intraoral gingival-buccal incisions were carried out for the approach. In some patients, the original scar around the orbit was chosen for the incision. Operation aims were reduction of orbit and reconstruction of the orbital wall integrity. Operative methods were osteotomy for reduction and implantation of autologous bone or artificial materials. Orbital volume and eyeball position were restored to normal in all patients after the operation, and no serious complications occurred. Treatment of acquired orbital deformity should make restoration of orbital volume as the most important target of therapy. Autologous bone should be the material of first choice, and the selection and amount of implanted material should be decided by the specialty and experience of the physician.
Objective To explore the comprehensive treatment of hemifacial microsomia. Methods Medpor implantation combined with horizontal osteotomy of chin through intraoral approach as the main method to correct facial asymmetry. Results This method was applied in 14 patients with hemifacial microsomia. All patients obtained good results. Conclusion Medpor implantation combined with horizontal osteotomy of chin is an ideal method for the treatment of hemifacial microsomia. Other auxiliary methods are also necessary to gain the perfect results of the comprehensive treatment.
Parry-Romberg syndrome is characterized by a progressive hemifacial atrophy involving the skin, subcutaneous tissue, and underlying bone structures. The aim of plastic surgical treatment is to restore a harmonious and symmetrical appearance to facial deficits. The authors report that 17 patients with Parry-Romberg syndrome were treated with combined techniques in multiple stages. Revascularized free flaps, including 12 anteriolateral thigh adipofascial flaps and two latissimus dorsi flaps, were used for soft tissue augmentations in the first stage. Additional procedures, including dermis grafting, lipoinjection, placement of Medpor implant, and plastic techniques, such as genioplasty, liposuction revision, and others, were used for bone augmentations or corrections of minor deficits in the second or third stage. Generally, it took an average of 3.5 procedures to obtain satisfying results. Postoperative courses were smooth in 15 patients except for two hematoma complications in two cases. Transferred tissues had partial fat liquefying and subcutaneous indurations 6 months postoperatively in two cases. All patients received good or improved aesthetic outcomes. Combined treatments are needed to correct facial contour deformities resulting from Parry-Romberg syndrome.
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