The effect of cranial base surgery on congenital craniofacial deformities

Oral Presentation involved side. EMG recordings were obtained preoperatively and postoperatively at 1-week, 3 months and 6 months. Findings: The difference in EMG root mean square (RMS) values of affected side when compared to the preoperative values of normal side was found to be statistically significant (p < 0.000) preoperatively, and 1-week and 3-month postoperatively, while it was statistically not significant (p = 1) at 6-month postoperatively. Conclusion: EMG can be used as a diagnostic tool for TMJ ankylosis patients. Increased activity of masseter and anterior temporalis might contribute to reankylosis. So evaluating their EMG over a period of 6 months might predict recurrence. http://dx.doi.org/10.1016/j.ijom.2015.08.551 The effect of cranial base surgery on congenital craniofacial deformities M. Galiè ∗ , G. Elia, L.C. Clauser Unit of Cranio Maxillo Facial Surgery, Center for Orbital Pathology & Surgery, Reference Center for Rare Diseases, EACMFS Teaching Center Network, St. Anna Hospital and University, Ferrara, Italy Background: Craniofacial surgery and syndromology during the last two decades have undergone a tremendous evolution by different approaches, assessments and also surgical techniques. The cranial base is a “constructional template” for facial development, normal or abnormal. Method: A retrospective review (1998–2014) of nonsyndromic (trigono, scapho, plagio, brachy) and syndromic craniofacial dysostosis (Apert, Crouzon, Saethre-Chotzen, Pfeiffer), as well as BETS-type syndrome (with Brachycephaly, Euryprosopia, Telorbitism, Scaphomaxilla) (Paul Tessier – Cannes-La Napoule 1985) and the effect of surgery on anterior cranial base development is reported. Findings: In non-syndromic craniosynostosis early skeletal release with total fronto orbital remodelling at 6–8 months, as an unique procedure, usually expands the cranial base. Techniques depend on the synostosis. More complex is the approach and the results in syndromic cases where a severe misshapen cranium and face are almost always present. In Apert and Crouzon the anterior cranial base is foreshortened and the middle cranial fossae rotated in a more vertical position. In Saethre-Chotzen the asymmetric involvement of coronal sutures produces bandeau retrusion and facial asymmetry. Conclusions: Surgical management of syndromic cases is complex. Orbito-maxillo-mandibular surgery must be considered (traditional vs DO). In craniosynostosis molecular pathogenesis is still poorly understood. Known genes account for less than 40%. Further identification of genes involved in suture patterning is necessary especially in syndromic forms. As the study of cranial suture biology has evolved from morphologic descriptions to molecular analysis, the opportunity for treatment of craniofacial deformities to progress in a similar fashion does exist. http://dx.doi.org/10.1016/j.ijom.2015.08.552

e63

Neonatal & pediatric micrognathia: distraction osteogenesis and principles of treatment M. Galiè ∗ , L.C. Clauser Unit of Cranio Maxillo Facial Surgery, Center for Orbital Pathology & Surgery, Reference Center for Rare Diseases, EACMFS Teaching Center Network, St. Anna Hospital and University, Ferrara, Italy Background: Distraction Osteogenesis (DO) has been one of the most innovative concepts in craniomaxillofacial syndromology and surgery through the last 25 years. After a quarter of century of extensive use DO has today specific indications for congenital craniofacial and cleft deformities. Method: A retrospective review (2008–2014) of craniofacial syndromes and syndromic micrognathia undergoing mandibular lengthening in neonatal age or during growth [Pierre Robin Sequences (PRS), Cerebro-Costo-Mandibular Syndrome (CCMS), Auriculo Condylar Syndrome (ACS), Craniofacial Microsomia–Tessier Cleft 7, Treacher-Collins Syndrome (TCS) is reported. All patients were evaluated by a multidisciplinary Team, included fibroscopic assessment. Findings: The mean mandibular advancement was 18 mm, with changes in maxillo-mandibular relationships and a slight overcorrection. PRS newborns with severe respiratory distress requiring intubation were successfully early extubated after rapid mandibular distraction and newborns with tracheotomy was early decannulated. Pre-distraction and post- distraction lateral CT scans demonstrated the significative improvement in the airway space. Improvement in feeding was seen following mandibular distraction. Conclusions: In congenital craniomaxillofacial anomalies distraction is indicated during growth. Mandibular advancement can be safely and effectively used to avoid or remove tracheostomy in neonates with severe airway obstruction caused by micrognatia in Pierre Robin Sequence. In syndromic micrognathia early mandibular distraction seems to be an appropriate indication. Benefits are functional, morphological, and aesthetic with consistent psychological and familiar positive effects. An increased incidence in TMJ complication during distraction osteogenesis in neonates has been recently reported, especially in syndromic patients. http://dx.doi.org/10.1016/j.ijom.2015.08.553 Facial lipostructure in craniofacial congenital deformities M. Galiè ∗ , G. Elia, L.C. Clauser Unit of Cranio Maxillo Facial Surgery, Center for Orbital Pathology & Surgery, Reference Center for Rare Diseases, EACMFS Teaching Center Network, St. Anna Hospital and University, Ferrara, Italy Background: The use of adipose tissue transfer for the correction of maxillofacial defects was reported for the first time at the end of the 19th century and has been the subject of numerous studies. Focusing attention on the face, in 1988 Sydney R. Coleman systematized the technique. Structural Fat Grafting (SFG) differs from other fat grafting techniques, given its delicate aspiration to protect the fragile adipocytes, purification of the material, and its reinsertion using microinjections to redefine facial contours.