The Journal of craniofacial surgery
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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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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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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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Review Case Reports
Salvage of calvarial bone graft using acellular dermal matrix in nasal reconstruction and secondary rhinoplasty for frontonasal dysplasia.
Frontonasal dysplasia is a severe malformation composed of cranial, ophthalmic, nasal, upper lip, and palatal deformities. Reconstruction in these patients requires complex craniofacial efforts. A 19-year-old woman with frontonasal dysplasia was treated at our institution where she had undergone multiple prior reconstructive surgeries including facial bipartition and cantilevered calvarial bone graft for nasal reconstruction. ⋯ Its use also avoids further donor site morbidity. We suggest acellular dermal matrix as a graft material in revision rhinoplasties for cases of acquired nasal contour deformity and threatened bone graft extrusion. This is the first report known to the authors using acellular dermal matrix during staged nasal reconstruction in a patient experiencing frontonasal dysplasia.