Contemporary management of craniosynostosis

412 Symposia In 1965, the discovery of a family of bone morphogenetic proteins (BMPs) changed the way bone grafting would be viewed. Dr. Marshall Urist was able to grow ectopic bone in the muscle of various animals by implanting demineralised bone matrix. Today we are able to use this technology to augment deficient alveolar ridges, atrophic maxillary sinuses, and socket defects without a second site surgery. However, there are still bone defects which can only be treated with block grafts and associated techniques requiring major surgical incisions for augmentation. These procedures carry a certain complication rate with wound dehiscence being the major finding. This dehiscence often leads to the loss of the entire graft. Utilising dynamic cell therapy treatment in conjunction with the graft can reduce the incidence of wound dehiscence and promote increased healing. The cell therapy supports soft tissue regeneration through adding an array of cytokines and growth factors known to be associated with all phases of the wound healing. This discussion will focus on the use of bone proteins and cell therapy for augmentation procedures that previously were treated with conventional grafting techniques. Case histories will be utilised to illustrate the behaviour of these new and exciting therapies.

with immediate repositioning or distraction techniques. Both external and internal distraction approaches are available and can be selected depending on the indication for treatment and age group. When these patients reach puberty, orthodontic treatment is desirable to prepare the dental arches for subsequent procedures to continue the correction of the progressively worsening mid-facial hypoplasia. The number and nature of procedures required to produce the best outcome is variable and there is a paucity of discussion in the literature regarding adolescent skeletal correction. During infancy, parents or carers should be counselled that for optimum results, multiple procedures may be required depending on the severity of the condition and the secondary growth disturbance from each surgical intervention. Protocols are difficult to develop for craniofacial anomalies but following the initial procedures, post-pubertal treatment planning should initially concentrate on improving orbital contour in order to prepare for definitive skeletal occlusal correction post-growth. Further surgery to address temporal hollowing and aesthetic rhinoplasty can subsequently be included. Several cases illustrating these pathways are presented. doi:10.1016/j.ijom.2009.03.060

doi:10.1016/j.ijom.2009.03.059

Symposium 11: Craniofacial Surgery SL11.1 Treatment strategies for total skeletal correction in craniofacial patients from birth to adulthood A. Heggie The Melbourne Craniofacial Unit, Department of Plastic and Maxillofacial Surgery, Royal Children’s Hospital of Melbourne, Australia

The pathway for the skeletal correction of patients with syndromic craniosynostosis varies between Units but generally there is agreement that in infancy, a fronto-orbital advancement or monobloc is performed to minimise the deformity, alleviate raised intracranial pressure and to take advantage of rapid bone formation in the first 24 months of life. Following this initial procedure, mid-facial advancement has been undertaken to correct the mid-facial deficiency by Le Fort III advancement

SL11.2 Orbital malposition in craniofacial surgery for congenital deformities L. Clauser Department of Cranio Maxillo Facial Surgery, Centre for Craniofacial Deformities and Orbital Surgery, St. Anna Hospital and University of Ferrara, Ferrara, Italy

A patient with orbital malposition associated with craniofacial deformities requires functional, morphological and psychosocial considerations. Congenital malposition of the orbits, globe and adnexa are multiple and of different type. We know that the orbit influences the development of the craniofacial skeleton during the growth as well as influences the development of structures such as the globe, eyelids, lacrimal ducts, extraocular muscles and conjunctiva. The orbital skeleton is involved in almost all craniofacial deformities: craniosynostosis, syndromal craniofacial synostosis, hypertelorbitism, hypotelorbitism, orbital dystopia, microphthalmia.

One of the main concepts in craniofacial surgery is that the surgical act must be three-dimensional, considering that in each deformity the main movement for correcting the wrong position follows the distorted orbital axis. As an example in hypertelorbitism the main movement is transversal, in orbital distopia is vertical, in orbitostenosis the main movement is in the sagittal direction. When moving orbits the surgeon must take into consideration the useful orbit, which is the part of the orbit that lies 1 cm in front of the orbital foramen. The author exposes the experience of his team in treating different types of orbital malposition in congenital craniofacial deformities. doi:10.1016/j.ijom.2009.03.061

SL11.3 Contemporary management of craniosynostosis R.L. Ruiz Pediatric Craniomaxillofacial Surgery, Arnold Palmer Hospital for Children, and Department of Surgery, University of Central Florida College of Medicine, Orlando, FL, United States

Craniosynostosis is defined as a premature fusion of one or more of the cranial vault sutures and is associated with significant neurologic and morphologic consequences. The surgical management of craniosynostosis requires release of the affected suture in order to allow for unrestricted development of the visceral components (eg, brain, eyes), and the threedimensional reconstruction of dysmorphic skeletal components, which establishes normal anatomic contour and position. This session will focus on the diagnostic and surgical approaches for craniosynostosis during infancy. Specific clinical findings, radiographic studies, and contemporary operative techniques will be covered using clinical examples of each. Particular details associated with the timing of surgery and the role for endoscopic modalities will also be reviewed. doi:10.1016/j.ijom.2009.03.062

SL11.4 Endocrine orbitopathy: an algorithm of treatment L. Clauser Department of Cranio Maxillo Facial Surgery, Centre for Craniofacial Deformities and Orbital Surgery, St. Anna Hospital and University of Ferrara, Ferrara, Italy