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Blondin MS, Dunson B, Runyan CM. Practical Considerations in Computerized Surgical Planning for Frontofacial Surgery. Semin Plast Surg 2024; 38:224-233. [PMID: 39118862 PMCID: PMC11305831 DOI: 10.1055/s-0044-1786802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
The field of frontofacial surgery has advanced considerably, building on the pioneering techniques of Paul Tessier, with computerized surgical planning (CSP) emerging as a critical component. CSP has enhanced the precision and efficiency of surgeries for craniofacial dysostoses and hypertelorism, resulting in improved outcomes. This review delves into the importance of understanding orbital anatomy and the crucial bony and soft tissue landmarks essential to the application of CSP in frontofacial procedures, encompassing Le Fort III and monobloc advancements, as well as the correction of hypertelorism.
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Affiliation(s)
- Mario S. Blondin
- Department of Plastic and Reconstructive Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Blake Dunson
- Department of Plastic and Reconstructive Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Christopher M. Runyan
- Department of Plastic and Reconstructive Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
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Santiago G, Santiago C, Nguyen A, Choudhary A, Zhao L, Alkureishi LWT, Patel PK, Purnell CA. Alterations in Sphenoid Anatomy in Craniosynostosis: Implications for Fronto-Orbital Advancement. Cleft Palate Craniofac J 2024:10556656241245514. [PMID: 38567431 DOI: 10.1177/10556656241245514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE Fronto-orbital advancement involves removal of the fronto-orbital bandeau. Visualization of the saw blade is lost as it passes through the fronto-orbital-sphenoid junction (FOSJ), placing the temporal lobe at risk of injury. We aim to provide a 3D analysis of the space surrounding this osteotomy to differentiate various types of craniosynostoses. DESIGN Retrospective cohort. SETTING Institutional. PATIENTS Thirty patients with isolated unicoronal synostosis, nonsyndromic bicoronal synostosis, metopic synostosis, Apert syndrome, Crouzon syndrome, and Muenke syndrome. INTERVENTIONS CT scans conducted between 2 months to 2 years of age were 3D reconstructed to compare craniometrics against normal controls. MAIN OUTCOME MEASURE(S) Craniometrics. RESULTS The mean bone thickness of the FOSJ at the level of the supraorbital rim was significantly small for the Apert, unicoronal and bicoronal groups. The mean vertical height of the middle cranial fossa from the lesser sphenoid wing was significantly greater in the unicoronal group. The mean vertical height of the tip of the temporal lobe from the lateral sphenoid ridge was greater in the unicoronal, isolated bicoronal, and Apert groups. The mean corneal protrusion beyond the lateral orbital rim was significantly greater in the Apert and unicoronal groups. The mean horizontal depth of the orbit was smallest in the Apert group. The mean vertical distance between the dacryon and the foramen cecum, and the mean volume of temporal lobe beneath the sphenoid shelf were the largest in the Apert group. CONCLUSIONS Patients with Apert syndrome have the most unfavorable morphology of the anterior and middle cranial fossae.
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Affiliation(s)
- Gaia Santiago
- Division of Plastic, Reconstructive and Cosmetic Surgery, University of Illinois College of Medicine, Chicago, IL, USA
| | - Chiara Santiago
- Division of Plastic, Reconstructive and Cosmetic Surgery, University of Illinois College of Medicine, Chicago, IL, USA
| | - Alvin Nguyen
- Division of Plastic, Reconstructive and Cosmetic Surgery, University of Illinois College of Medicine, Chicago, IL, USA
| | - Akriti Choudhary
- Division of Plastic, Reconstructive and Cosmetic Surgery, University of Illinois College of Medicine, Chicago, IL, USA
| | - Linping Zhao
- Division of Plastic, Reconstructive and Cosmetic Surgery, University of Illinois College of Medicine, Chicago, IL, USA
| | - Lee W T Alkureishi
- Division of Plastic, Reconstructive and Cosmetic Surgery, University of Illinois College of Medicine, Chicago, IL, USA
- Department of Plastic and Reconstructive Surgery, Shriners Children's Hospital, Chicago, IL, USA
| | - Pravin K Patel
- Division of Plastic, Reconstructive and Cosmetic Surgery, University of Illinois College of Medicine, Chicago, IL, USA
- Department of Plastic and Reconstructive Surgery, Shriners Children's Hospital, Chicago, IL, USA
| | - Chad A Purnell
- Division of Plastic, Reconstructive and Cosmetic Surgery, University of Illinois College of Medicine, Chicago, IL, USA
- Department of Plastic and Reconstructive Surgery, Shriners Children's Hospital, Chicago, IL, USA
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Podolsky DJ, Wong C, Hopper RA. Simulation in Craniosynostosis Surgery. Plast Reconstr Surg 2024; 153:220e-222e. [PMID: 37344937 DOI: 10.1097/prs.0000000000010879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Affiliation(s)
- Dale J Podolsky
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Posluns Center for Image-Guided Innovation and Therapeutic Intervention, Toronto, Ontario, Canada
| | - Clara Wong
- Department of Electrical Engineering, McMaster University, Hamilton, Ontario, Canada
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Bader ER, Ammar A, Fortunel AN, De la Garza Ramos R, Tepper O, Kobets AJ. Open craniofacial reconstruction for coronal craniosynostosis. NEUROSURGICAL FOCUS: VIDEO 2021; 4:V18. [PMID: 36284853 PMCID: PMC9542383 DOI: 10.3171/2021.1.focvid20122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/19/2021] [Indexed: 11/06/2022]
Abstract
Here the authors demonstrate open craniofacial reconstruction for the correction of craniosynostosis, using techniques refined by Dr. James T. Goodrich at Montefiore Medical Center. They present the operative management of a case of unilateral coronal synostosis in a 12-month-old child, who presented with right forehead prominence and calvarial asymmetry. The patient had an excellent correction of her head shape with an uneventful postoperative course. This video highlights the authors’ multidisciplinary approach to complete cranial vault remodeling, utilizing a Marchac bandeau construct and split calvarial graft mosaic technique. The video can be found here: https://vimeo.com/519489422.
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Affiliation(s)
| | | | | | | | - Oren Tepper
- Division of Plastic and Reconstructive Surgery, Montefiore Medical Center, Bronx, New York
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