The Journal of craniofacial surgery
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Comparative Study
Comparative analysis of tranexamic acid use in minimally invasive versus open craniosynostosis procedures.
Intraoperatively administered tranexamic acid (TXA) lessens blood loss during orthopedic and cardiovascular surgery. Its use for craniosynostosis surgery warrants investigation. Therefore, we analyzed our use of TXA during minimally invasive (MI) and open craniosynostosis procedures. ⋯ Intraoperative TXA administration is safe with modest benefit suggested, especially in the MI group. Calculated blood loss correlated well with EBL at lower blood loss volumes, implicating it as a potential measurement of true blood loss.
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Case Reports
White-eyed medial wall blowout fracture mimicking head injury due to persistent oculocardiac reflex.
White-eyed medial wall blowout fracture associated with muscle entrapment is rare. It may present with symptoms consistent with an intracranial injury, delaying the diagnosis and putting the patient at risk for permanent damage. ⋯ Patients with white-eyed medial wall blowout fracture with muscle entrapment can present with oculocardiac reflex symptoms, pain, diplopia, and strabismus in the absence of any signs on ocular examination except for abnormal motility. Computed tomography imaging of the orbit should be performed to confirm the diagnosis, followed by immediate surgical intervention to avoid ischemia and permanent injury.
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Patients with syndromic craniosynostosis have many problems involving the upper airway, laryngotracheal airway, and tracheobronchial tree. Evaluation of tracheobronchial disorders in syndromic craniosynostosis is very important for accurately diagnosing these problems. We have used three-dimensional computed tomography (CT) imaging of the tracheobronchial tree (three-dimensional tracheal CT imaging) since a multidetector CT was installed in our hospital in 2004. ⋯ Four were confirmed to have abnormalities on either bronchoscopy or three-dimensional tracheal CT imaging, whereas 5 patients were apparently free of abnormalities as determined by both modalities. In conclusion, it was possible to accurately assess the configuration of the tracheobronchial system using both three-dimensional tracheal CT imaging and bronchoscopy. Our results suggest these examinations to be very useful for assessing the optimal timing of decannulation and respiratory function prognosis.
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Although the mechanism by which retinoic acid (RA) induces cleft palate has been intensely investigated, some controversies remain. Some researchers argue that RA inhibits apoptosis, resulting in a failure of palatal shelves to fuse, whereas others propose that RA disrupts elevation or retards the growth of palatal shelves. This study investigated the mechanism underlying RA-induced formation of cleft palate in the rat, focusing mainly on the role of apoptosis. ⋯ Apoptotic manifestations did not differ between RA-induced cleft palates and control palates, suggesting that apoptosis makes a minimal contribution to the cleft palate formed in response to RA. Instead, growth retardation of the palatal shelves appears to play a major role in RA-induced cleft palate.
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Comparative Study
Comparison of spring-mediated cranioplasty to minimally invasive strip craniectomy and barrel staving for early treatment of sagittal craniosynostosis.
The treatment of sagittal craniosynostosis has evolved from early strip craniectomy to total cranial vault remodeling and now back to attempts at minimally invasive correction. To optimize outcomes while minimizing morbidity, we currently use 2 methods of reconstruction in patients younger than 9 months: spring-mediated cranioplasty (SMC) and minimally invasive strip craniectomy with parietal barrel staving (SCPB). The purpose of this study was to compare the safety and efficacy of the 2 methods. ⋯ Complications included 1 spring dislodgment in an SMC that did not require additional management and 1 undercorrection in the SCPB group. Both SMC and SCPB are safe, effective means of treating sagittal craniosynostosis. Spring-mediated cranioplasty has become our predominant means of treatment of scaphocephaly in patients younger than 9 months because of its improved morbidity profile.