The Journal of craniofacial surgery
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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.
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The International Task Force on Volunteer Cleft Missions was set up to provide a report to be presented at the Eighth International Congress of Cleft Palate and Associated Craniofacial Anomalies on September 12, 1997, in Singapore. The aim of the report was to provide data from a wide range of different international teams performing volunteer cleft missions and, thereafter, based on the collected data, to identify common goals and aims of such missions. Thirteen different groups actively participating in volunteer cleft missions worldwide were selected from the International Confederation of Plastic and Reconstructive Surgery's list of teams actively participating in volunteer cleft missions. ⋯ All efforts should be made, and care taken, to ensure that there is minimal morbidity and no mortality. Finally, as ambassadors of goodwill and humanitarian aid, the participants must make every effort to understand and respect local customs and protocol. The main aims are to provide top-quality surgical service, train local doctors and staff, develop and nurture fledgling cleft programs, and, finally, make new friends.
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Mandibular fractures, resulting from either trauma or reconstructive surgery, can be challenging craniofacial problems. The morbidity of failed fracture healing is significant and may require bone grafting. Donor site morbidity and finite amounts of autogenous bone are major drawbacks of autogenous bone grafting. ⋯ We have demonstrated the ability of type I collagen to promote healing of a membranous bony defect that would not otherwise heal at 6 weeks. The suitability of type I collagen as a carrier matrix provides ample opportunity for tissue-engineered approaches to further facilitate bony defect healing. Promoting bone formation through tissue engineering matrices offers great promise for skeletal healing and reconstruction.
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Since April 1997 at St. Mary's Craniofacial Unit, simulated surgery using a three-dimensional solid model made preoperatively was carried out, which enable sufficient autologous blood banking before the surgery. This study was conducted in eight patients presenting with plagiocephaly, brachycephaly, and oxycephaly consisting of simple craniosynostosis and syndromic craniosynostosis. ⋯ Also, 2 cases in the later-term group (cases 3 and 4) were able to avoid homologous blood transfusion, and they had autologous blood transfusion of 30 to 33 ml/kg. The surgical techniques will be improved with repeated cases of simulated surgery, aiming for the minimum invasive surgery. Also, the use of autologous blood transfusion is expected to increase as a less invasive surgery.
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Comparative Study
Subgaleal versus subperiosteal dissection in fronto-orbital advancement procedures.
Extensive cranioorbital surgery for craniosynostosis in young children can produce excessive blood loss. Thus, to overcome the disadvantage of unappropriated blood loss and translocation of the osteosynthesis material, we performed a subgaleal dissection in infants and compared the subperiosteal with the subgaleal surgical approach in 29 children who underwent surgery for craniosynostosis. ⋯ Blood loss was less in the group with subgaleal elevation of the forehead (mean = 163 ml) compared with the subperiosteal group, which had a mean 266 ml blood loss. The subgaleal dissection caused less bleeding and tethering of the advanced bone.