The Journal of craniofacial surgery
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Computer-aided jaw surgery has been extensively studied recently. The purpose of this study was to determine the clinical feasibility of performing bimaxillary orthognathic surgery without intermediate splint using virtual surgical planning and rapid prototyping technology. ⋯ Results from this study suggested that it was feasible to perform bimaxillary orthognathic surgery without intermediate splint. Virtual surgical planning and the guiding splints facilitated the diagnosis, treatment planning, accurate osteotomy, and bony segments repositioning in orthognathic surgery.
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The objectives of this work are to report the outcomes of our finding during microvascular decompression (MVD) for patients with recurrent trigeminal neuralgia (TN) and to introduce the sling retraction technique. ⋯ Arachnoid adhesion of the Teflon felt and vascular compression to the nerve were main causes of recurrence. The sling retraction technique is still an effective and useful treatment for recurrent TN after MVD.
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Surgery for craniosynostosis is associated with the potential for significant blood loss. Multiple technologies have been introduced to reduce the volume of blood transfused. These are preoperative autologous donation; preoperative erythropoietin; intraoperative cell salvage (CS); acute normovolemic hemodilution; antifibrinolytic drugs such as tranexamic acid, ε-aminocaproic acid, and aprotinin; fibrin sealants or fibrin glue; and postoperative drain reinfusion. ⋯ The production of high-quality evidence on the interventions to minimize blood loss and transfusion in children undergoing surgery for craniosynostosis is difficult. Most of the literature is nonrandomized and noncomparative. Several areas remain unaddressed. Erythropoietin and tranexamic acid are comparatively well studied; CS, acute normovolemic hemodilution, and aprotinin are less so. There is only 1 comparative study on the use of fibrin glue and drain reinfusion, with no studies on preoperative autologous donation and [Latin Small Letter Open E]-aminocaproic acid. Tranexamic acid is clinically effective in reducing allogeneic blood transfusion. There is some evidence that CS and erythropoietin may be clinically effective. None of the interventions studied are shown to be cost-effective because of lack of evidence.
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Secondary cranioplasty with customized craniofacial implants (CCIs) are often used to restore cerebral protection and reverse syndromes of the trephined, and for reconstruction of acquired cranial deformities. The 2 most widely used implant materials are polyetheretherketone and poly(methylmethacrylate) (PMMA). Previous series with CCIs report several major complications, including implant infection leading to removal, extended hospital stays, and surgical revisions. With this in mind, we chose to review our large case series of 22 consecutive PMMA CCI cranioplasties treated by a single craniofacial surgeon. ⋯ In this consecutive series, PMMA CCIs were associated with a very low complication rate, suggesting that PMMA may be a preferred material for CCI fabrication. However, with 10% (2/20) of patients experiencing PTH and dissatisfaction related to asymmetry, future research must be directed at modifying CCI shape, to address the overlying soft-tissue deformity. If successful, this may increase patient satisfaction, prevent PTH, and avoid additional costs of revision surgery.
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Freeman-Sheldon syndrome is a congenital disorder that has been suggested to be associated with malignant hyperthermia. Clinical features of the Freeman-Sheldon syndrome include flexion contractures and characteristic facial features, including microstomia and a whistling shape to the lips. We report a case of malignant hyperthermia in a 3-year-old girl with microstomia but no other features of Freeman-Sheldon syndrome. The purpose of this report was to review the diagnosis and treatment of malignant hyperthermia as craniofacial surgeons have an increased exposure to this rare and potentially fatal condition.