The Journal of craniofacial surgery
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Ultrasonography (US) was recently reported as a reliable modality for diagnosing nasal bone fractures. However, whether US is reliable as a screening tool in the pediatric emergency department (ED) remains unknown. This prospective cohort study had a 2-fold aim: to assess the utility of US in the diagnosis of pediatric nasal bone fracture, and to evaluate the validity of our protocol for managing pediatric nasal bone fractures (Fuchu-Kids algorithm). ⋯ Using our algorithm, the majority of patients with nasal bone fracture were successfully diagnosed and screened out successfully. Repeated US imaging is effective when clinical symptoms persist even if the first US imaging was negative for nasal bone fracture. However, a detailed medical interview and clinical examination are mandatory, regardless of the use of US.
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Conjoined twinning is a rare anomaly, with an incidence of approximately 1 in 100,000 live births. There is a high perinatal mortality rate, but twins who survive pose reconstructive challenges that require meticulous preoperative planning. The authors describe the senior surgeon's career experience with conjoined twin separation, and the evolution of medical modeling and 3-dimensional imaging as a critical component in presurgical planning. ⋯ The overall survival rate after separation was 70%. The imaging methods used were computed tomography scan with 3-dimensional reconstruction, plaster molds, medical modeling with composite printing, and virtual surgical planning. The use of imaging and medical modeling in presurgical planning has proven to be an important element in optimizing the outcomes for patients with this rare anomaly.
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Midface advancement is a keystone intervention in the treatment plan of syndromic hypoplasia of the midface. Although earlier authors had been using a combination of smaller incisions to acquire enough access to perform the different osteotomies, Tessier popularized the bicoronal incision. This approach can be time-consuming however and leaves an ear-to-ear scar. The authors describe an endoscopically assisted piezo-electric Le Fort III osteotomy performed through minimal invasive access. The cutaneous incision was limited to a single-short mid-glabellar vertical scar (8 mm) to perform the nasofrontal and septum osteotomy. Further osteotomies are performed through a 1.5 cm intraoral incision and a transconjunctival approach with a retrocaruncular extension. A lateral canthotomy was avoided to lower the risk of postoperative eyelid malposition. ⋯ The minimally invasive Le Fort III approach is feasible and efficacious for clinical use in a cadaveric setup.