Modifications for the fisher technique for unilateral cleft repair

64 A modified approach to surgical correction of brachycephaly A. Greenstein ∗ , M. Sangra, D. Koppel, M. Halsnad Royal Hospital for Children, Glasgow, Scotland, United Kingdom Background: Remodelling procedures for the correction of brachycephaly has traditionally been carried out by the craniofacial surgeon utilising techniques such as cranial vault remodelling and fronto-orbital advancement remodelling (FOAR). However, some centres are now moving away from this tradition to embrace the use of internal distractors for posterior cranial vault expansion. This presentation highlights such a case. Objectives: The purpose of this report is to highlight a modified approach to the surgical correction of brachycephaly using posterior distractors instead of cranial vault remodelling and FOAR. Methods: For our index case we used internal distractors over a two-week period to expand the posterior cranial vault, by over 20 mm. This was a strategy applied to manage intracranial hypertension in a child for whom a fronto-orbital advancement and remodelling would have normally been delayed until the child was older. Findings: After the removal of the internal distractors we found favourable remodelling of the occiput and an improvement of lowered intracranial pressure. Conclusions: This case has given some support to recent findings that correcting brachycephaly with posterior cranial vault expansion by the use internal distractors may have long-term benefits for the patient in terms of future corrective surgery and the management of intracranial pressure. It is anticipated that the remodelling effect may lend to the possibility of favourable anterior cranial vault and midface development that may in itself lessen the impact for secondary procedures to correct midface hypoplasia later on in childhood. http://dx.doi.org/10.1016/j.ijom.2017.02.232 The benefits of differential fronto-orbital advancement remodelling and midface monobloc advancement with on table external distractors for the management and complexities of craniofacial manifestations of Pfeiffer syndrome

twelve months of age followed by a secondary procedure to correct the midface hypoplasia. This case was fairly unique in that both fronto-orbital advancement remodelling (FOAR) and midface monobloc advancement were carried out on the table concurrently with differential advancement using the aid of an external distractor. Results: We found that early correction with FOAR and monobloc midface differential advancement with on table distractors gave a more predictable outcome in the form of airway management and protection of the eyes. Conclusion: The use of on table distractors for differential advancement for the correction of craniosynostosis and midface hypoplasia with FOAR and monobloc advancement allows for a more predictable outcome strategy for airway management and eye protection in an attempt to minimise tracheostomies and secondary procedures. http://dx.doi.org/10.1016/j.ijom.2017.02.233 Modifications for the fisher technique for unilateral cleft repair D. Hoffman Staten Island University Hospital, United States Background: Dr David Fisher described the anatomical subunit approximation technique for the repair of unilateral cleft lips.1 This technique varied significantly from the Millard procedure which is the one that is most commonly used. There are several advantages to this newer procedure. This author has presented a comparison of the two techniques at previous meeting, and has shown some of these advantages.2 This presentation will do the following: 1. Present long-term results on the Fisher cleft lip repair of up to eight years follow-up. 2. Discuss modifications of the original technique. 3. Present adjunctive treatments for preoperative and postoperative care including Dynacleft taping and nasal molding 4. Explain the use of the technique in a range of severities of cleft deformities 5. Explain how to use the method for secondary repair.

References A. Greenstein ∗ , R. Sangra, D. Koppel, M. Halsnad Royal Hospital for Children, Glasgow, Scotland, United Kingdom Background: Pfeiffer syndrome is a rare genetic disorder that presents many challenges to both medical and surgical specialities as well as allied medical professionals in a multidisciplinary team. Surgical correction and timing of surgery for craniofacial abnormalities is crucial in optimising the delivery of care throughout the life and development of the patient. Objectives: To describe the benefits of large immediate on table distraction on a patient presenting with Pfeiffer syndrome and undergoing correction for craniosynostosis and midface hypoplasia. Methods: Current procedures to correct syndromic patients presenting with craniosynostosis and midface hypolplasia usually result in multiple corrective surgery undertaken at specific times in the management of craniosynostosis. This usually occurs before

1. Fisher, D. M. (2005). Unilateral cleft lip repair: an anatomical subunit approximation technique. Plast Reconstr Surg, 116, 61–71. 2. Hoffman, D., & Dyleram, D. (2011). Comparison of the Millard and Fisher technique for closure of the unilateral cleft lip. Int J Oral Maxillofac Surg, 40, e14. http://dx.doi.org/10.1016/j.ijom.2011.07.1061

http://dx.doi.org/10.1016/j.ijom.2017.02.234 Evaluation of airway and obstructive sleep apnoea in cleft lip and cleft palate adolescents using cone-beam computed tomography — a retrospective study R. Joy ∗ , S. Edwards, D. Gupta, P. Afzali, R.S. Conley, K.A. Kelly, L. O’Brien University of Michigan, Ann Arbor, MI, United States Background: Abnormalities of the final conformation and function of the upper airway exists in cleft lip and/or cleft palate