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Steven R. Cohen, Ralph E. Holmes, Hal S. Meltzer, Michael L. Levy and Miles Z. Beckett

Object

Resorbable polymer implants have become a compelling option in the treatment of acquired and congenital craniofacial deformities. In particular, the resorbable polylactide and polyglycolide polymers have demonstrated excellent safety profiles in multiple in vitro, animal, and clinical studies and are currently being used in a wide variety of craniofacial applications. In pediatric craniofacial reconstruction a desirable attribute of fixation is early resorption, which may limit the duration of any effect on cranial growth. In this paper the authors discuss the biomaterial properties of a fast resorbing polymer (FRP) and the clinical results in a series of patients who participated in a 6- to 12-month study.

Methods

The authors performed craniofacial reconstruction by using FRP implants in 29 patients beginning in August 2002. All patients experienced maintenance of stable bone fixation followed by bone healing. Cosmetic results were rated satisfactory or excellent, except for one unsatisfactory cosmetic result caused by disease progression.

Conclusions

Results of this study support the effectiveness of an FRP implant in a variety of craniofacial surgical procedures including craniosynostoses, fibrous dysplasia, cranial defects, and encephaloceles.

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Fred J. Epstein, Donald Wood-Smith, John M. Converse, M. Vallo Benjamin, Melvin H. Becker and Joseph Ransohoff

R econstructive surgery is assuming an increasingly important role in the management of craniofacial anomalies, the most common of which are orbital hypertelorism and the craniofacial dysostoses of Crouzon and Apert. Orbital hypertelorism involves an increased distance between the medial orbital walls. First described by Greig 2 in 1924, the term applied only to the deformity that was apparently the result of an arrest in medial migration of the orbits leaving an abnormally large distance between the medial orbital walls. However, it is commonly associated

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Harold J. Hoffman and E. Bruce Hendrick

T he craniofacial dysmorphic states have come under increasing scrutiny in recent years because of the interest of plastic and neurological surgeons in the reconstructive surgery of these anomalies 13 and the interest of geneticists in their etiology. 2 Furthermore, the excellent cosmetic results achieved by modern surgical techniques have indirectly helped to increase the incidence of the disorder: patients who would have been socially ostracized are now marrying, and in cases where the disorder is due to an autosomal dominant gene, are producing offspring

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M. Yashar S. Kalani, Maziyar A. Kalani, Samuel Kalb, Felipe C. Albuquerque, Cameron G. McDougall, Peter Nakaji, Robert F. Spetzler, Randall W. Porter and Iman Feiz-Erfan

radiation therapy, chemotherapy, hormone therapy, and surgery, the latter being the gold standard. 8 Craniofacial exposures provide safe routes to locations in the skull base once considered inaccessible for curative resection. Direct anterior approaches to the anterior and midline skull base have important advantages over lateral approaches. In this article, we describe our clinical experience with one such approach for the resection of JNAs. Experience has shown that combined intracranial and extracranial surgical exposures can be used to gain access to deep

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Neurosurgical Forum: Letters to the Editor To The Editor Roy Ogle , Ph.D. University of Virginia Charlottesville, Virginia 637 637 Our recently published textbook, Craniofacial Surgery: Science and Surgical Technique , was reviewed by Harvey B. Sarnat, Bernard G. Sarnat, and Kenneth E. Salyer in the J Neurosurg 96: 150, January, 2002. We are grateful to the reviewers for their comprehensive and generous assessment of our text; however, the reviewers mention perceived errors associated with Fig. 4-1 in

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John Persing, John A. Jane Jr. and John A. Jane Sr.

, and the optimal surgical management of this condition. Now that we have objective measures to assist in this process, as well as a better understanding of the basic pathology, a more appropriate and effective management strategy can be developed. Potential neurological sequelae should be the focus of attention. We are indebted to the many investigative and surgical pioneers who have brought forth many advancements in the conceptions and treatment of craniosynostosis over the last 200 years. We hope you enjoy this issue of Neurosurgical Focus on craniofacial

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Robert F. Spetzler, James M. Herman, Stephen Beals, Edward Joganic and John Milligan

T echnical advances and a better understanding of the anatomy of the anterior cranium have led to the development of more extensive surgical approaches to the cranial base. Through the combined efforts of neurosurgeons, head and neck surgeons, and craniofacial surgeons, the standard transbasal approach to the frontal fossa has been modified to include removal of the orbital roofs, nasion, and ethmoid sinuses. 4, 6, 7, 12, 14–16, 18 This approach has further been combined with facial disassembly procedures to provide extensive midline exposure to the midface

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Jane C. S. Perrin, Martin H. Weiss and David Yashon

of caring for twins with hereditary Crouzon's syndrome from birth, and planning early preventive surgical procedures to avert possible blindness and mental retardation. Case Reports Monochorionic twin boys were born of a 19-year-old healthy mother with borderline intelligence and a 25-year-old father with craniofacial dysostosis, average intelligence, and amaurosis. Pregnancy was uneventful and delivery uncomplicated at 36½ weeks' gestation. There were no other affected relatives. Case 1 In Twin B, features of Crouzon's syndrome were noted at birth

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Jason A. Ellis, Juan C. Mejia Munne and Christopher J. Winfree

literature consists mainly of case reports and small case series. Thus the risks and benefits of trigeminal branch stimulation remain unclear. We report, to our knowledge, the largest consecutive series of trigeminal branch electrode placements in patients with craniofacial pain in an effort to shed further light on this promising treatment modality. Methods Data Collection and Analysis A retrospective chart review of all patients who underwent trigeminal branch electrode placement by the senior author (C.J.W.) between 2006 and 2013 was performed. Hospital

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Enrina Diah, David E. Morris, Lun-Jou Lo and Yu-Ray Chen

F ibrous dysplasia is a common benign osseous tumor that frequently occurs in the craniofacial region. The precise origin of this entity is still not clearly understood, yet it is well known that normal bone is gradually replaced by an abnormal proliferation of fibrous connective tissue. The disease typically presents in the first or second decade of life and then slowly progresses until the patient reaches the approximate age of 30 years. 12 There are several variants of FD; the monostotic form affects a single anatomical region, whereas the polyostotic