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Cranioplasty and cerebrovascular perfusion
Int. J. Oral Maxillofac. Surg. 2007; 36: 995–998 doi:10.1016/j.ijom.2007.08.066, available online at http://www.sciencedirect.com
O4. Craniofacial surgery O4.1 ‘‘Face-off’’ incision—a concept D. Das*, N. Iyer, J. Nagaraj M.M. College of Dental Sciences & Research, M.M. University, Mullana, Ambala District, Haryana, India
reported. But only seven cases of isolated bony syngnathia have been reported to our knowledge. Three new cases are described with 3D CT scan and medical models and the existent literature is reviewed. Based on these cases a management is discussed.
resin prosthesis in management of craniofacial defects is safe and reliable option devoid of complications resulting in satisfactory outcome in terms of aesthetics, function and improvement of cerebral function. doi:10.1016/j.ijom.2007.08.069
Source and distribution of nerves and blood vessels, zones of aesthetics, planes of fascia and muscles, and relationship of incision lines with sites of bone surgery generally guide the location of incisions. Due to these factors maxillofacial incisions are classified into circumfacial, intraoral or periorbital incision. The hemicoronal and bicoronal incision, modified preauricular incisions, retromandibular and submandibular incisions and incision for parotidectomy are examples of circumfacial incisions. This presentation propounds the concept of a unified ‘‘Faceoff’’ incision which forms a comprehensive guide for the optimal placement of one, more or all of the circumfacial incisions. It exemplifies how all these incisions are an integral part or fractions of the unified incision and should not be regarded as discretely separate. doi:10.1016/j.ijom.2007.08.067
O4.2 Congenital bony syngnathia— management A. Kumar*, G. Uma Maheshwari, Gandhiraj Tamilnadu Govt. Dental College and Hospital, Chennai 03, India Congenital bony syngnathia is an extremely rare condition characterized by bony fusion of maxilla and mandible. Numerous cases with combination of cleft palate, aglossia, popliteal pterygium syndrome and vander woude syndrome have been 0901-5027/110995 + 04 $30.00/0
doi:10.1016/j.ijom.2007.08.068
O4.4 O4.3 Cranioplasty and cerebrovascular perfusion S. Kaushik*, H.C. Pathak, Jacob, T. Roy No. 1 Air Force Dental Centre, Air Force Station Palam, Delhi Cantt, New Delhi 110010, India Objective: Cranial defect transmits atmospheric pressure on to intracranial contents especially blood vessels affecting cerebral blood flow. The aim of this study was to evaluate the efficacy of improving cerebrovascular perfusion by heat cured acrylic resin implant in the management of craniofacial defects. Material and methods: Twelve patients with craniofacial defect were treated for secondary reconstruction with acrylic resin plate prosthesis implants. Cerebral vascular flow and perfusion studies were undertaken pre- and post-operatively by using Technetium 99 and SPECT. Results: Follow up of all the 12 cases of craniofacial defects after secondary reconstruction with custom made heat cure acrylic prosthesis for periods ranging from 3 months to 1 year showed no untoward complications and reasonably good esthetics, function and alleviation of pre surgical complaints were achieved. Cerebral perfusion studies showed normalization of vascular flow in the affected hemisphere. Conclusion: Reconstruction with custom made heat cure polymethyl methacrylate
Craniosynostosis—revisited S.K. Roy Chowdhury Oral & Maxillofacial Surgery, Army Dental Centre (R & R), Delhi Cantt 110010, India Background: Craniosynostosis and craniofacial dysostosis syndromes inhibit normal growth of the affected suture(s). Prompt diagnosis and management prevents disturbances in brain growth and severe cosmetic defects. The latest modality is using a combination of craniotomy, principles of DO along with a combination of rigid fixation of fragments using bioresorbable/titanium plates. Methods: Twenty children of age group between 4 months and 2 years were treated. Ten cases were treated using the principle of DO (43.47%) and 13 cases (56.52%) were operated for craniotomy and rigid fixation with bioresorbable plating system. Patients were evaluated postoperatively at a regular interval of 3 months, 6 months and 1 year. Result: No evidence of neosynostosis, malpositioned cranial segments, restriction of growth or calvarial expansion noted. Neoosteoid tissue formation in cases operated with distraction noted. Improvement of preoperative neurological deficits evident (87.5%). 10– 15% collapse of segment seen at end of 1 year in plating cases. Conclusion: DO provides a viable alternative to the traditional fixation techniques used for treating
O4. Craniofacial surgery O4.1 ‘‘Face-off’’ incision—a concept D. Das*, N. Iyer, J. Nagaraj M.M. College of Dental Sciences & Research, M.M. University, Mullana, Ambala District, Haryana, India
reported. But only seven cases of isolated bony syngnathia have been reported to our knowledge. Three new cases are described with 3D CT scan and medical models and the existent literature is reviewed. Based on these cases a management is discussed.
resin prosthesis in management of craniofacial defects is safe and reliable option devoid of complications resulting in satisfactory outcome in terms of aesthetics, function and improvement of cerebral function. doi:10.1016/j.ijom.2007.08.069
Source and distribution of nerves and blood vessels, zones of aesthetics, planes of fascia and muscles, and relationship of incision lines with sites of bone surgery generally guide the location of incisions. Due to these factors maxillofacial incisions are classified into circumfacial, intraoral or periorbital incision. The hemicoronal and bicoronal incision, modified preauricular incisions, retromandibular and submandibular incisions and incision for parotidectomy are examples of circumfacial incisions. This presentation propounds the concept of a unified ‘‘Faceoff’’ incision which forms a comprehensive guide for the optimal placement of one, more or all of the circumfacial incisions. It exemplifies how all these incisions are an integral part or fractions of the unified incision and should not be regarded as discretely separate. doi:10.1016/j.ijom.2007.08.067
O4.2 Congenital bony syngnathia— management A. Kumar*, G. Uma Maheshwari, Gandhiraj Tamilnadu Govt. Dental College and Hospital, Chennai 03, India Congenital bony syngnathia is an extremely rare condition characterized by bony fusion of maxilla and mandible. Numerous cases with combination of cleft palate, aglossia, popliteal pterygium syndrome and vander woude syndrome have been 0901-5027/110995 + 04 $30.00/0
doi:10.1016/j.ijom.2007.08.068
O4.4 O4.3 Cranioplasty and cerebrovascular perfusion S. Kaushik*, H.C. Pathak, Jacob, T. Roy No. 1 Air Force Dental Centre, Air Force Station Palam, Delhi Cantt, New Delhi 110010, India Objective: Cranial defect transmits atmospheric pressure on to intracranial contents especially blood vessels affecting cerebral blood flow. The aim of this study was to evaluate the efficacy of improving cerebrovascular perfusion by heat cured acrylic resin implant in the management of craniofacial defects. Material and methods: Twelve patients with craniofacial defect were treated for secondary reconstruction with acrylic resin plate prosthesis implants. Cerebral vascular flow and perfusion studies were undertaken pre- and post-operatively by using Technetium 99 and SPECT. Results: Follow up of all the 12 cases of craniofacial defects after secondary reconstruction with custom made heat cure acrylic prosthesis for periods ranging from 3 months to 1 year showed no untoward complications and reasonably good esthetics, function and alleviation of pre surgical complaints were achieved. Cerebral perfusion studies showed normalization of vascular flow in the affected hemisphere. Conclusion: Reconstruction with custom made heat cure polymethyl methacrylate
Craniosynostosis—revisited S.K. Roy Chowdhury Oral & Maxillofacial Surgery, Army Dental Centre (R & R), Delhi Cantt 110010, India Background: Craniosynostosis and craniofacial dysostosis syndromes inhibit normal growth of the affected suture(s). Prompt diagnosis and management prevents disturbances in brain growth and severe cosmetic defects. The latest modality is using a combination of craniotomy, principles of DO along with a combination of rigid fixation of fragments using bioresorbable/titanium plates. Methods: Twenty children of age group between 4 months and 2 years were treated. Ten cases were treated using the principle of DO (43.47%) and 13 cases (56.52%) were operated for craniotomy and rigid fixation with bioresorbable plating system. Patients were evaluated postoperatively at a regular interval of 3 months, 6 months and 1 year. Result: No evidence of neosynostosis, malpositioned cranial segments, restriction of growth or calvarial expansion noted. Neoosteoid tissue formation in cases operated with distraction noted. Improvement of preoperative neurological deficits evident (87.5%). 10– 15% collapse of segment seen at end of 1 year in plating cases. Conclusion: DO provides a viable alternative to the traditional fixation techniques used for treating