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Facial Plastic Surgery Clinics of North America

Lisa M Morris, Sherard A Tatum
No abstract text is available yet for this article.
November 2016: Facial Plastic Surgery Clinics of North America
Sven-Olrik Streubel, David M Mirsky
Facial trauma causes significant of morbidity in the United States. With injuries varying widely, the clinical benefits of antibiotics use in facial fracture treatment are not easily determined. The pediatric population is more predisposed to craniofacial trauma secondary to their increased cranial mass to body ratio. All patients with traumatic injury should be assessed according to the Advanced Trauma Life Support protocol. This article discusses the types and prevalence of injuries and approaches to management...
November 2016: Facial Plastic Surgery Clinics of North America
Daniel Alam, Yaseen Ali, Christopher Klem, Daniel Coventry
Orbito-malar reconstruction after oncological resection represents one of the most challenging facial reconstructive procedures. Until the last few decades, rehabilitation was typically prosthesis based with a limited role for surgery. The advent of microsurgical techniques allowed large-volume tissue reconstitution from a distant donor site, revolutionizing the potential approaches to these defects. The authors report a novel surgery-based algorithm and a classification scheme for complete midface reconstruction with a foundation in the Gillies principles of like-to-like reconstruction and with a significant role of computer-aided virtual planning...
November 2016: Facial Plastic Surgery Clinics of North America
Randall A Bly, Amit D Bhrany, Craig S Murakami, Kathleen C Y Sie
Microtia reconstruction is a challenging endeavor that has seen significant technique evolution. It is important to educate patients and their families to determine the best hearing rehabilitation and ear reconstructive options. Microtia is often associated with aural atresia, hearing loss, and craniofacial syndromes. Optimal care is provided by multiple disciplines, including a reconstructive surgeon, an otologic surgeon, an audiologist, and a craniofacial pediatrician. Microtia management includes observation, prosthetic ear, autologous cartilage reconstruction, or alloplastic implant placement...
November 2016: Facial Plastic Surgery Clinics of North America
Lisa E Ishii
Facial nerve paralysis, although uncommon in the pediatric population, occurs from several causes, including congenital deformities, infection, trauma, and neoplasms. Similar to the adult population, management of facial nerve disorders in children includes treatment for eye exposure, nasal obstruction/deviation, smile asymmetry, drooling, lack of labial function, and synkinesis. Free tissue transfer dynamic restoration is the preferred method for smile restoration in this population, with outcomes exceeding those of similar procedures in adults...
November 2016: Facial Plastic Surgery Clinics of North America
Keimun A Slaughter, Tiffany Chen, Edwin Williams
Classification of vascular lesions based of off the biological behavior has greatly facilitated more accurate diagnoses, optimally defined treatment plans, and better outcomes. Treatment of vascular lesions has taken a more conservative surgical approach with reliance on select medical treatment options, which has greatly reduced morbidity and mortality resulting from extensive surgery. A multidisciplinary approach involving multiple surgical and pediatric subspecialties has led to advancement in both understanding and ideal treatment strategies of these lesions...
November 2016: Facial Plastic Surgery Clinics of North America
Ryan Winters
Tessier's classification system for rare craniofacial clefts remains the most widely used today. It denotes the position of the cleft process in a schema based around the orbit, and facilitates communication between surgeons regarding these complicated conditions. Tessier's classification is reviewed in detail, and a separate discussion of hypertelorism (increased distance between the bony orbits) follows, focusing on orbital hypertelorism in the setting of craniofacial clefts.
November 2016: Facial Plastic Surgery Clinics of North America
James C Wang, Laszlo Nagy, Joshua C Demke
Syndromic craniosynostosis affects up to 1:30,000 live births with characteristic craniofacial growth restrictions, deformities, and other associated abnormalities, such as carpal-pedal anomalies and cognitive function impairment. More than 150 syndromes are associated with craniosynostosis. This article describes some commonalities and distinguishing features and management of syndromic synostosis. Also addressed is secondary synostosis, which is often found in syndromic children with problems related to microcephaly, hydrocephalus, or shunt-induced craniosynostosis, although pathophysiologically and genetically different...
November 2016: Facial Plastic Surgery Clinics of North America
Lisa M Morris
This article provides an overview of etiology, epidemiology, pathology, diagnosis, and treatment of nonsyndromic craniosynostosis, including sagittal, metopic, coronal, lambdoid, and complex synostosis. Detailed discussion is presented regarding indications for surgical intervention and management options, including frontoorbital advancement, cranial vault reconstruction, endoscopic strip craniectomy, spring-assisted strip craniectomy, and cranial vault distraction osteogenesis. Deformational plagiocephaly is also presented with treatment options including repositioning, physical therapy, and helmet therapy...
November 2016: Facial Plastic Surgery Clinics of North America
Kathleyn A Brandstetter, Krishna G Patel
Craniofacial microsomia (CFM) encompasses a broad spectrum of phenotypes. It is thought to result from defective development of the first and second pharyngeal arch structures, and generally presents with anomalies of the mandible and other facial bones, ears, and overlying soft tissues. The cause of CFM is thought to involve both extrinsic and genetic risk factors. Several classification systems have been developed to help stratify patients based on the severity of their defects. Treatment of patients includes repair of bony asymmetry as well as soft tissue defects and auricular anomalies...
November 2016: Facial Plastic Surgery Clinics of North America
Celeste Gary, Jonathan M Sykes
Intermediate and definitive cleft rhinoplasties are a challenging part of definitive cleft care. The anatomy of the cleft nose is severely affected by the structural deficits associated with congenital orofacial clefting. A comprehensive understanding of the related anatomy is crucial for understanding how to improve the appearance and function in patients with secondary cleft nasal deformities. Timing of intermediate and definitive rhinoplasty should be carefully considered. A thorough understanding of advanced rhinoplasty techniques is an important part of providing adequate care for patients with these deformities...
November 2016: Facial Plastic Surgery Clinics of North America
Jeremy D Meier, Harlan R Muntz
Velopharyngeal dysfunction (VPD) can significantly impair a child's quality of life and may have lasting consequences if inadequately treated. This article reviews the work-up and management options for patients with VPD. An accurate perceptual speech analysis, nasometry, and nasal endoscopy are helpful to appropriately evaluate patients with VPD. Treatment options include nonsurgical management with speech therapy or a speech bulb and surgical approaches including double-opposing Z-plasty, sphincter pharyngoplasty, pharyngeal flap, or posterior wall augmentation...
November 2016: Facial Plastic Surgery Clinics of North America
Ashley M Dao, Steven L Goudy
Repair of the cleft palate intends to establish the division between the oral and nasal cavity, thereby improving feeding, speech, and eustachian tube dysfunction all while minimizing the negative impact on maxillary growth. Before palate repair candidacy, timing and surgical method of repair is dependent on comorbid conditions, particularly cardiac disease, mandibular length, and palate width. Additionally, management of the alveolar cleft and the indications for gingivoperiosteoplasty versus secondary alveolar bone grafting is a controversial topic that weighs the risks and benefits of potentially sparing the patient an additional surgery against iatrogenic restriction of facial growth and malocclusion...
November 2016: Facial Plastic Surgery Clinics of North America
Aditi A Bhuskute, Travis T Tollefson
Cleft lip and palate are the fourth most common congenital birth defect. Management requires multidisciplinary care owing to the complexity of these clefts on midface growth, dentition, Eustachian tube function, and lip and nasal cosmesis. Repair requires planning, but can be performed systematically to reduce variability of outcomes. The use of primary rhinoplasty at the time of cleft lip repair can improve nose symmetry and reduce nasal deformity. Use of nasoalveolar molding ranging from lip taping to the use of preoperative infant orthopedics has played an important role in improving functional and cosmetic results of cleft lip repair...
November 2016: Facial Plastic Surgery Clinics of North America
Ann W Kummer
Children with craniofacial anomalies often demonstrate disorders of speech and/or resonance. Anomalies that affect speech and resonance are most commonly caused by clefts of the primary palate and secondary palate. This article discusses how speech-language pathologists evaluate the effects of dental and occlusal anomalies on speech production and the effects of velopharyngeal insufficiency on speech sound production and resonance. How to estimate the size of a velopharyngeal opening based on speech characteristics is illustrated...
November 2016: Facial Plastic Surgery Clinics of North America
Jill M Merrow
The instinctual drive to gain nourishment can become complicated by structural differences, physiologic instability and environmental influences. Infants with craniofacial anomalies may experience significant feeding and swallowing difficulties related to the type and severity of the anomalies present as well as social-emotional interactions with caregivers. Typical outcome measures and feeding goals are discussed. Details regarding clinical and instrumental evaluation, including fiberoptic endoscopic evaluation of swallowing and modified barium swallow study, as well as management techniques are reported...
November 2016: Facial Plastic Surgery Clinics of North America
Lauren A Bohm, James D Sidman, Brianne Roby
This article reviews the presentation of children with craniofacial anomalies by the most common sites of airway obstruction. Major craniofacial anomalies may be categorized into those with midface hypoplasia, mandible hypoplasia, combined midface and mandible hypoplasia, and midline deformities. Algorithms of airway interventions are provided to guide the initial management of these complex patients.
November 2016: Facial Plastic Surgery Clinics of North America
Howard M Saal
There are thousands of craniofacial disorders, each with a different etiology. All cases of orofacial clefts have an underlying genetic cause, ranging from multifactorial with an underlying genetic predisposition to chromosomal and single-gene etiologies. More than 50% of cases of Pierre Robin sequence are syndromic and 25% of craniosynostoses are syndromic. Clinical genetics evaluation is important for each patient with a craniofacial condition to make a proper diagnosis, counsel the family, and assist in management...
November 2016: Facial Plastic Surgery Clinics of North America
Mark K Wax
No abstract text is available yet for this article.
August 2016: Facial Plastic Surgery Clinics of North America
William Walsh Thomas, Lou Bucky, Oren Friedman
Nasal injectables and surface treatments alter the appearance of the nose both primarily and following nasal surgery. Fillers such as hyaluronic acids, calcium hydroxyapatite, and fat have a variety of advantages and disadvantages in eliminating small asymmetries postrhinoplasty. All nasal injectables have rare but severe ocular and cerebral ischemic complications. The injection of steroids following nasal reconstruction has a role in preventing supratip swelling and can improve the appearance of grafts to the nose...
August 2016: Facial Plastic Surgery Clinics of North America
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