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Cranial distraction

Dong Ha Park, Soo Han Yoon
OBJECTIVE: Among shunt complications, the post-shunt slit ventricle (PSSV) and the post-shunt craniosynostosis (PSCS) may be managed by shunt valve upgrade and/or cranial expansion surgery. Here, we analyzed 26 children with PSSV and/or PSCS who received simple generalized cranial expansion, i.e., total calvarial trans-sutural distraction osteogenesis (TC-TSuDO). METHODS: Among 254 children with shunt surgery, 26 children received TC-TSuDO. These 26 children included of 14 with PSSV, 4 with PSCS, and 8 with both PSSV and PSCS...
October 3, 2016: World Neurosurgery
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
Arman T Serebrakian, Michael S Golinko, Michael Alperovich, Christopher M Runyan, David A Staffenberg
Craniofacial microsomia remains the second most common craniofacial deformity after cleft lip and palate. Mandibular pathology has been classically scored from type I to type III by the modified Pruzansky-Kaban classification. The authors report a case of a 5-year-old patient with Goldenhar syndrome and bilateral type III craniofacial macrosomia. The patient had absence of bilateral glenoid fossas, condyles, coronoids, and rami as well as hypoplasia of the symphysis, parasymphysis, and mandibular body. Reconstruction was performed using 2 costochondral rib autografts to reconstruct a ramus and assist in the development of a neo-glenoid fossa at the cranial base...
October 2016: Journal of Craniofacial Surgery
Jan-Falco Wilbrand, Hans-Peter Howaldt, Marcus Reinges, Petros Christophis
OBJECTIVE: Premature craniosynostosis of the lambdoid suture is rare. The use of differential diagnosis to rule out positional occipital plagiocephaly is crucial. Nevertheless, once diagnosed, lambdoid craniosynostosis requires corrective surgery to prevent intracranial harm and aesthetic stigma by significant dyscrania. Operative correction of the lambdoid fusion is often performed by suturectomy and helmet therapy, total occipital remodeling interventions, transposition of occipital bone flaps, or occipital advancement procedures either with or without distraction osteogenesis...
August 6, 2016: Journal of Cranio-maxillo-facial Surgery
P Guerreschi, A Wolber, Y Bennis, M Vinchon, V Martinot-Duquennoy
Distraction osteogenesis, initially developed by Ilizarov for limb, is the tissular extension caused by the progressive space of the osseous pieces following an osteotomy. Distraction is osteogenesic and histogenic. Twenty-five years ago, at the instigation of McCarthy, this technique was used to handle the craniofacial malformations in the various floors of the face : mandibular, mediofacial and cranial. The most wide-spread protocols respect a latency period from 0 to 7 days, a rhythm of distraction from 1 to 2mm a day in 2 at 4 times and a period of consolidation from 4 to 8 weeks...
October 2016: Annales de Chirurgie Plastique et Esthétique
Dana Johns, Erin Anstadt, Daniel Donato, John Kestle, Jay Riva-Cambrin, Faizi Siddiqi, Barbu Gociman
Posterior cranial vault distraction (PCVD) has become an important modality in the management of complex craniosynostosis to increase intracranial volume and improve the cranial vault appearance. This technique can safely be performed as early as 3 months of age for the initial management of patients with complex craniosynostosis. A retrospective review was performed of all the patients with syndromic, multiple-suture synostosis treated with PCVD at Primary Children's Hospital in Salt Lake City, Utah, between 2012 and 2014...
September 2016: Craniomaxillofacial Trauma & Reconstruction
Azusa Shimizu, Yuzo Komuro, Kazuaki Shimoji, Masakazu Miyajima, Hajime Arai
Posterior cranial vault distraction is considered to be more effective for increasing intracranial volume than fronto-orbital advancement or anterior cranial vault expansion, but the changes in intracranial volumes after posterior cranial vault distraction remain unclear. The changes in intracranial volume were investigated in patients of premature craniosynostosis treated by this technique. Seven patients, 3 boys and 4 girls aged from 5 months to 3 years 3 months (mean 23 months) at operation, with craniosynostosis underwent posterior cranial vault distraction at Juntendo University Hospital from 2011 to 2014...
July 2016: Journal of Craniofacial Surgery
Jing Li, Patrick A Gerety, Wen Xu, Scott P Bartlett, Jesse A Taylor
There is a growing literature on the advantages of posterior cranial vault distraction osteogenesis (PVDO) in infants, particularly those with syndromic and multisuture craniosynostosis. This study aims to compare perioperative outcomes of PVDO in older patients to those of infants. A prospective craniofacial database was queried for patients aged 5 and older undergoing PVDO; controls were diagnosis-matched infants. Demographic, perioperative, and distraction data was compared using a 2-sample t test and Fisher exact test...
July 2016: Journal of Craniofacial Surgery
Philipp Winkels, Antonio Pozzi, Robert Cook, Peter Böttcher
OBJECTIVES: To evaluate the Leipzig Stifle Distractor (LSD) for arthroscopic evaluation of the medial meniscus. STUDY DESIGN: Prospective clinical multi-center study. ANIMALS: 64 stifles of 64 dogs (mean body weight 35 kg) with suspected cranial cruciate ligament rupture. METHODS: The LSD was used to distract the medial compartment and to evaluate the medial meniscus. The degree of exposure of the caudal pole of the medial meniscus (CMM) and ease of diagnosis was quantified after either distraction with the LSD or manipulation of the stifle with valgus stress and external rotation...
July 2016: Veterinary Surgery: VS
Akira Gomi, Ataru Sunaga, Hideaki Kamochi, Hirofumi Oguma, Yasushi Sugawara
In this review, we discuss in detail our current procedure for treating craniosynostosis using multidirectional cranial distraction osteogenesis (MCDO). The MCDO method allows all phenotypes of skull deformity to be reshaped by distraction osteogenesis, except in patients who are 5 months of age or younger and patients with posterior cranial vault problems. We report the results of clinical data of 36 children with craniosynostosis who underwent MCDO between 2005 and 2014 in our institute. This method has the following benefits, such as a high flexibility of reshaping, shorter treatment period and less invasive secondary intervention...
May 2016: Journal of Korean Neurosurgical Society
Hiroaki Sakamoto, Yasuhiro Matsusaka, Noritsugu Kunihiro, Keisuke Imai
Syndromic craniosynostosis has severe cranial stenosis and deformity, combined with hypoplastic maxillary bone and other developmental skeletal lesions. Among these various lesions, upper air way obstruction by hypoplastic maxillary bone could be the first life-threatening condition after birth. Aggressive cranial vault expansion for severely deformed cranial vaults due to multiple synostoses is necessary even in infancy, to normalize the intracranial pressure. Fronto-orbital advancement (FOA) is recommended for patients with hypoplastic anterior part of cranium induced by bicoronal and/or metopic synostoses, and posterior cranial vault expansion is recommended for those with flattening of the posterior part of the cranium by lambdoid synostosis...
May 2016: Journal of Korean Neurosurgical Society
Hamed Aminiahidashti, Sajad Shafiee, Mohammad Sazegar, Nazanin Nosrati
INTRODUCTION: The abducent nucleus is located in the upper part of the rhomboid fossa beneath the fourth ventricle in the caudal portion of the pons. The abducent nerve courses from its nucleus, to innervate the lateral rectus muscle. This nerve has the longest subarachnoid course of all the cranial nerves, it is the cranial nerve most vulnerable to trauma. It has been reported that 1% to 2.7% of all head injuries are followed by unilateral abducent palsy, but bilateral abducent nerve palsy is extremely rare...
February 2016: Trauma Monthly
Cory M Resnick, Stephen Alex Rottgers, Christopher C Langenfeld, John B Mulliken, Bonnie L Padwa
The major limitation of the rigid external devices currently used for midfacial distraction after subcranial Le Fort III osteotomies is the ductile wire that connects the midface to the device, which makes it difficult to control the vector and force during distraction. The authors describe a novel external appliance that addresses this and other problems of contemporary devices, and application of a custom cranial template that facilitates precise placement of the device to achieve the planned vector of distraction...
June 2016: Journal of Craniofacial Surgery
Yoshiaki Sakamoto, Tomoru Miwa, Hideo Nakajima, Kazunari Yoshida, Kazuo Kishi
BACKGROUND: Posterior cranial vault distraction osteogenesis is a common treatment for syndromal patients of brachycephaly and oxycephaly. Although posterior distraction can increase intracranial volume, the flattened head phenotype is difficult to correct. The authors examined a new posterior distraction technique termed double-door distraction for improvement of the flattened head phenotype. METHODS: From 2010 to 2013, 6 patients with flattened posterior craniums were operated on using the double-door distraction technique...
June 2016: Journal of Craniofacial Surgery
Yoshinori Okamoto, Mikio Nakajima, Tsuyoshi Jotoku, Shuhei Otsuki, Masashi Neo
BACKGROUND: In posterior-stabilized (PS) total knee arthroplasty (TKA), various post-cam designs can be used. A larger cam of the femoral component may tighten the extension gap. Few studies have investigated the relationship between capsular release around the intercondylar notch and the extension gap. The aim of this study was to assess the effect of capsular release around the intercondylar notch on the extension gap. METHODS: Forty-eight patients (54 knees) who underwent PS rotating-platform TKA (PFC Sigma RP-F) were enrolled retrospectively...
August 2016: Knee
Gerhard S Mundinger, Shady A Rehim, Owen Johnson, Joy Zhou, Anne Tong, Christopher Wallner, Amir H Dorafshar
BACKGROUND: Distraction osteogenesis has been proposed as an alternative to cranial remodeling surgery for craniosynostosis, but technique descriptions and outcome analyses are limited to small case series. This review summarizes operative characteristics and outcomes of distraction osteogenesis and presents data comparing distraction osteogenesis to cranial remodeling surgery. METHODS: A systematic review of the literature was undertaken. Descriptive analysis, operative technical data, outcomes, or postoperative complications of distraction osteogenesis for craniosynostosis were included...
September 2016: Plastic and Reconstructive Surgery
Jordan W Swanson, Fares Samra, Andrew Bauder, Brianne T Mitchell, Jesse A Taylor, Scott P Bartlett
BACKGROUND: The authors hypothesize that early posterior vault distraction osteogenesis safely confers considerable cranial vault remodeling, sufficient to enable fronto-orbital advancement to be delayed to a later age, with improved outcomes. METHODS: The authors conducted a retrospective cohort study of children with syndromic craniosynostosis treated before (2003 to 2008) or after (2009 to 2014) implementation of posterior vault distraction osteogenesis. RESULTS: Sixty children with syndromic craniosynostosis presented during the study period...
May 2016: Plastic and Reconstructive Surgery
Shannon Wong, Eric S Nagengast, Jason Miller
Normocephalic pancraniosynostosis is a rare form of craniosynostosis that usually presents later in life secondary to a delayed onset of symptoms and the presence of a normal head shape. Since its initial description in the literature in 2010, normocephalic pancraniosynostosis remains a rare clinical entity that has only been reported in 6 patients. Surgical treatment in the 2 published reports has been by staged total calvarial reconstruction or anterior cranial vault remodeling with bilateral frontoorbital advancement...
May 2016: Journal of Craniofacial Surgery
Lisa Morris
Many procedures exist for treatment of craniosynostosis. The goal of all surgical interventions is to correct the skull deformities associated with the synostosis and to prevent the sequela of elevated intracranial pressure. Open cranial vault reconstructions address these issues at the time of surgery, but have the potential for increased blood loss and longer hospital stays. Minimally invasive procedures have shorter operative times and decreased blood loss, but rely on the cranial abnormality to improve over time with helmets or distraction devices...
April 2016: Facial Plastic Surgery: FPS
Federico Di Rocco, Alexandru Szathmari, Carmine Mottolese
BACKGROUND: Posterior cranial vault distraction osteogenesis is currently used to enlarge the cranial volume and control the intracranial pressure. This procedure carries the risk of hardware dislocation, and especially in infants, as their skull being thin, the screws may damage the underlying dura. TECHNICAL NOTE: In this paper, the authors describe a simple method to fixate the internal distractor to the skull vault in case of thin calvaria using metallic wires...
June 2016: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
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