The Journal of craniofacial surgery
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Case Reports
Complete osseous regeneration of a large skull defect in a patient with cutis aplasia: a conservative approach.
Cutis aplasia (or aplasia cutis congenita) is a congenital absence of all skin layers, often extending through bone. This defect usually occurs in the scalp and can be extensive, exposing the dura mater, and deeper meninges. Treatment regimens for cutis aplasia have included early operative intervention, including skin and bone grafts, local scalp flaps, or free flaps to close the defect. ⋯ The intensive therapeutic intervention in this case report allowed early discharge from the hospital, a gradual amelioration of the patient's alopecia as the hair-bearing scalp slowly covered the defect, and precluded the need for any subsequent bony reconstruction of the cranial vault. We hypothesize that conservative treatment of cutis aplasia maintains dural induction of osseous regeneration, and any treatment plan for bony defects of cutis aplasia should consider maintenance of dural integrity. Although further investigation is warranted, an initial trial of antimicrobial dressing care might optimally promote secondary closure of the cranial vault without the need for surgical intervention.
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The appropriate age for otoplasty remains controversial. Most surgeons wait until the child is aged 5 years or older to perform otoplasty. In this article, the results are reported in a series of 12 patients in whom otoplasty was performed before the age of 4 years. ⋯ No auricular growth disturbances were noted as a result of the surgery. Recurrent auricular prominence was noted in only 1 (8%) of the 12 patients, comprising 4.8% of the operated ears. Experience using this approach demonstrates that otoplasty can be performed from the age of 9 months or older with safety, reliability, and a high level of satisfaction on the part of the affected families.