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Plastic Surgery E-Book

Plastic Surgery E-Book

Eduardo D Rodriguez | Joseph E Losee | Peter C. Neligan

(2017)

Additional Information

Book Details

Abstract

Completely revised to meet the demands of today’s trainee and practicing plastic surgeon, Craniofacial, Head and Neck Surgery Pediatric Plastic Surgery, Volume 3 of Plastic Surgery, 4th Edition, features new full-color clinical photos, dynamic videos, and authoritative coverage of hot topics in the field. Editor-narrated PowerPoint presentations offer a step-by-step audio-visual walkthrough of techniques and procedures in plastic surgery.

  • Offers evidence-based advice from a diverse collection of experts to help you apply the very latest advances in craniofacial, head and neck, and pediatric plastic surgery and ensure optimal outcomes.
  • Provides updated coverage of: Aesthetic reconstruction of the nose; Orbito-maxillary reconstruction; Cheek and lip reconstruction; Facial paralysis; Facial transplant; and Surgical management of migraine headaches.
  • Highlights the latest information on Computerised surgical planning in orthognathic surgery; Computerised surgical planning in craniofacial, head and neck surgery; and Rotation advancement.
  • Includes brand-new color clinical photos, videos, and lectures.

Table of Contents

Section Title Page Action Price
Front Cover cover
Plastic Surgery i
Copyright Page iv
Table Of Contents v
Video Contents xii
Lecture Video Contents xvii
Preface to the Fourth Edition xxi
List of Editors xxii
List of Contributors xxiii
Acknowledgments xl
Dedication xli
1 Head, neck, and craniofacial surgery 1
1 Anatomy of the head and neck 2
Synopsis 2
The fascial planes of the head and neck and the facial nerve 2
The fascia in the face 4
The fascia in the temporal region 5
The fascia in the neck 6
Retaining ligaments and adhesions of the face 7
The prezygomatic space 9
The malar fat pad and the subcutaneous fat compartments of the face 9
The buccal fat pad 9
The facial nerve 10
Frontal (temporal) branch 11
Zygomatic and buccal branches 12
Marginal mandibular 12
Cervical branch 13
Connection with sensory nerves 13
The scalp 13
The musculature 13
Frontalis, galeal fat pad, and the glide plane 13
Corrugators 14
Procerus 15
Depressor supercilii 15
Midfacial muscles 15
Muscles of mastication 15
The temporalis muscle 15
The masseter muscle 15
The medial pterygoid muscle 15
The lateral pterygoid muscle 15
Actions of muscle of mastication 15
The pterygomasseteric sling 16
The aesthetic importance of the masseter and the temporalis muscle 16
The sensory innervation 16
Anatomy of the ear 18
Anatomy of the eyelids 18
Anatomy of the nose 20
Access the complete reference list online at http://www.expertconsult.com 20
References 21.e1
I Craniofacial Trauma 22
2 Facial trauma 22
Synopsis 22
Introduction 22
Historical perspective 22.e1
Basic science 22
Global considerations 22
Diagnosis and patient presentation 23
Evaluation for immediate life-threatening injuries 23
Systematic evaluation of the head and neck 23
Eye examination 23
Ear examination 24
Nose examination 24
Cheek examination 24
Oral cavity and mouth 24
Neck examination 24
Diagnostic studies 24
Plain films 24
CT 25
Consultation with other providers 25
Ophthalmology 25
Dental/OMFS 25
Treatment and surgical techniques 25
Anesthesia for treatment 25
Topical 25
Local infiltration 25
Facial field block 25
Forehead, anterior scalp to vertex, upper eyelids, glabella (supraorbital, supratrochlear, infratrochlear nerves) 25
Lateral nose, upper lip, upper teeth, lower eyelid, most of medial cheek (infraorbital nerve) 25
Lower lip and chin (mental nerve) 25
Posterior auricle, angle of the jaw, anterior neck (cervical plexus: great auricular, transverse cervical) 26
Ear (auriculotemporal nerve, great auricular nerve, lesser occipital nerve, and auditory branch of the vagus (Arnold’s) nerve) 27
General treatment considerations 27
Irrigation and debridement 27
Abrasions 28
Traumatic tattoo 28
Simple lacerations 29
Complex lacerations 29
Avulsions 29
Secondary intention healing 31
Treatment of specific areas 31
Scalp 31
Eyebrows 33
Local flap 33
Local graft 36
Eyelids 36
Ears 37
Anatomy 37
Hematoma 38
Lacerations 39
Auditory canal stenosis 40
Partial amputation with a wide pedicle 40
Complete amputation of all or part of the ear with the amputated part available 40
Nose 41
Abrasions 41
Lacerations 41
Lining 41
Framework 41
Skin covering 42
Avulsions 42
Amputation 42
Cheek 43
Repair of parotid duct 43
Facial nerve injury 43
Mouth and oral cavity 43
The oral cavity 44
Oral mucosa repair 44
The lips 44
Neck 44
Conclusion 46
Access the complete reference list online at http://www.expertconsult.com 46
References 46.e1
3 Facial injuries 47
Synopsis 47
Introduction 47
Historical perspective 47.e1
Initial assessment 47
Clinical examination of the face 47
Computerized tomographic scans 49
Timing of treatment 49
Upper facial fractures 49
Frontal bone and sinus injury patterns 49
Clinical examination 49
Nasofrontal outflow tract 49
Radiography 50
Surgical treatment 50
Complications 50
Orbital fractures 50
Surgical anatomy of the orbit 50
Orbital physical examination 51
Radiographic evidence of fracture 51
Indications for surgical treatment 51
Blow-out fractures of the floor of the orbit 52
Medial orbital wall fractures 52
Blow-out fractures in younger individuals 52
Surgical treatment 53
The timing of surgical intervention 53
Operative technique for orbital fractures 53
Endoscopic approaches for orbital floor fractures 53
Cutaneous exposures 53
Surgical technique 53
The forced duction test 53
Restoration of continuity of the orbital floor 54
Bone grafts for orbital floor reconstruction 54
Inorganic implants 54
Postoperative care 54
Complications of orbital fractures 54
Diplopia 54
Enophthalmos 55
Retrobulbar hematoma 55
Ocular (globe) injuries and blindness 55
Implant migration, late hemorrhage around implants, and implant fixation 55
Ptosis of the upper lid 55
Scleral show, ectropion, and entropion – vertical shortening of the lower eyelid 55
Infraorbital nerve anesthesia 55
The “superior orbital fissure” syndrome and the “orbital apex” syndrome 55
Midfacial fractures 56
Nasal fractures 56
Types and locations of nasal fractures 56
Fractures and dislocations of the nasal septum 56
The treatment of nasal fractures 57
Open reduction and the use of supporting k wires 57
Treatment of fractures and dislocations of the septum 57
Complications of nasal fractures 58
Nasoethmoidal orbital fractures 59
Surgical pathology 59
Interorbital space 59
Traumatic telecanthus and hypertelorism 59
Clinical examination 59
Radiographs 60
Classification of nasoethmoidal orbital fractures 60
Treatment of nasoethmoidal orbital fractures 60
The importance of the “central fragment” in nasoethmoidal orbital fractures 61
Canthal reattachment 62
Lacrimal system injury 62
Complications of nasoethmoidal orbital fractures 62
Fractures of the zygoma 62
Physical diagnosis and surgical pathology of zygoma fractures 62
Anterior approaches 63
“Minimalist” approaches for fractures without zygomaticofrontal suture diastasis 63
Fractures with zygomaticofrontal (Z-F) suture diastasis 63
Coronal incisions (posterior approach) 64
Treatment of fractures of the zygoma 64
Closed reduction 64
Buttress articulations and alignment for complete open reduction 64
Methods of reduction 64
Reduction through the maxillary sinus 64
Temporal approach 64
Fixation required to achieve stability 65
Surgical techniques for fixation following reduction 65
Delayed treatment of fractures of the zygoma 65
Complications of zygomatic fractures 65
Bleeding and maxillary sinusitis 65
Late complications 65
Orbital complications 65
Numbness 65
Oral–antral fistula 66
Plate complications 66
Midface buttresses 66
Clinical examination 66
Inspection 66
Palpation 66
Digital manipulation 67
Malocclusion of the teeth 67
Cerebral spinal rhinorrhea or otorrhea 67
Radiological examination 67
Treatment of maxillary fractures 67
Alveolar fractures 67
Le Fort classification of facial fractures 67
Goals of Le Fort fracture treatment 67
Transverse (Guerin) fractures or Le Fort I level fractures 67
Pyramidal fractures or Le Fort II level fractures 67
Craniofacial dysjunction or Le Fort III fractures 68
Surgical technique 68
Le Fort I level fractures 68
Le Fort II level fractures 69
Le Fort III fractures 69
Postoperative care of maxillary fractures 69
Complications of maxillary fractures 69
Airway 69
Bleeding 69
Infection 70
Cerebrospinal fluid rhinorrhea 70
Blindness 70
Late complications 70
Nonunion and bone grafting 70
Malunion 70
Malocclusion 70
Nasolacrimal duct injury 70
Lower facial fractures 70
Mandible fractures 70
Dental wiring and fixation techniques 71
Arch bars 71
IMF screws 71
Classification 71
Clinical examination and diagnosis 71
Direction and angulation of the fracture line 71
Indications for ORIF of mandibular fractures 72
Treatment of class I fractures 72
General principles of reduction and fixation 72
Treatment of class II fractures 72
Comminuted fractures 73
Class III fractures 73
Extraoral approach to open reduction 73
Intraoral approach to open reduction 74
Selection of internal fixation devices for mandibular fractures: how much fixation is enough 74
Champy or miniplate system 74
Lag screw technique 75
Third molars in mandibular angle fractures 75
Antibiotic use 75
Treatment principles of mandibular fractures 75
Complications after fracture treatment 76
Malocclusion 76
Hardware infection and screw migration 76
Increased facial width and rotation of the mandible 76
Non-union 76
Osteomyelitis 76
Condylar and subcondylar fractures 76
Edentulous mandible fractures 76
Panfacial injuries 77
Treatment of panfacial fractures 77
Order of the procedure 78
Complications of panfacial fractures 78
Postoperative care 79
Gunshot wounds of the face 79
Low velocity gunshot wounds 79
Intermediate and high velocity ballistic injuries to the face 79
Access the complete reference list online at http://www.expertconsult.com 80
References 81.e1
II Head and Neck Reconstruction 82
4 Surgical treatment of migraine headaches 82
Synopsis 82
Introduction 82
Basic science/disease process 82
Historical perspective 84.e1
Diagnosis and patient presentation 84
Preoperative history and examination 84
Patient selection 84
Trigger sites 84
The role of botulinum toxin injection 84
Surgical technique 86
Deactivation of frontal trigger site 86
Transpalpebral approach 86
Complications 86
Endoscopic approach 86
Complications 87
Deactivation of temporal triggers 87
2 Pediatrics 485
I Clefts 486
20 Embryology of the craniofacial complex 486
Synopsis 486
Introduction 486
The craniofacial complex 486
Distinguishing head from tail 487
Patterning the craniofacial complex 487
Genesis of the cranial neural crest 487
Exodus of the neural crest 488
Differentiation of the cranial neural crest 489
Organization of the pharyngeal arches 490
Disorders of arch development 491
Building the face 492
Facial fusions and clefting defects 493
Palatogenesis 493
The neurocranial base 494
Cranial vault and sutures 494
Conclusions 495
Access the complete reference list online at http://www.expertconsult.com 496
References 496.e1
21.1 Overview of the unilateral cleft lip and nose deformity 497
Synopsis 497
Introduction 497
Historical perspective 497.e1
Embryology 497
Epidemiology 498
Anatomy 499
Presurgical infant orthopedics 499
Taping 499
Lip–nose adhesion 499
Latham device 499
Naso-alveolar molding 500
Surgical techniques 500
The Randall–Tennison repair 500
The rotation-advancement repair 500
Extended Mohler repair 500
Fisher anatomic subunit repair 500
Postoperative considerations 500
Complications 501
Access the complete reference list online at http://www.expertconsult.com 501
References 501.e1
21.2 Rotation advancement cheiloplasty 502
Synopsis 502
Introduction 502
Preoperative plan 502
Multidisciplinary care 502
First visit 502
Nasoalveolar molding/nasal molding 502
Modified Grayson’s technique 503
Liou’s technique (Modified Figueroa technique) 503
Nasoalveolar molding with a spring device 503
Nasal molding with silicone nasal conformer 503
Operative techniques 503
Treatment plan for lip repair in Chang Gung Craniofacial Center 503
Rotation advancement cheiloplasty for complete clefts (Videos 21.2.1 and 21.2.2 ) 503
Markings 503
Cupid’s bow, vermilion, commissure, columellar base, and alar base 503
Base of philtral column on the cleft side 503
Proposed point of medial nasal sill 504
Measurements 504
Peaking of Cupid’s bow 505
Lateral lip height and length 505
White skin roll 506
Vermilion width 506
Incision lines 507
Incisions on the non-cleft side 507
Mohler incision 507
Simple rotation incision 507
Adequate rotation 508
Muscle dissection on the rotation flap 509
C-flap and footplate of medial crura 509
Septal dissection 509
Incisions on the cleft side lateral lip element 509
White skin roll flap and L-flap 509
Inferior turbinate (T) flap 509
Incision and dissection 509
Removal of fat pad under the vestibulum 510
Creation of the orbicularis marginalis flap 510
Nasal floor reconstruction and alar base repositioning 510
Muscle reconstruction 513
Philtral column reconstruction 514
Insertion of the WSR flap 514
Incisions for the triangular vermilion flap 514
Closure of the free border of the lip 514
Incisions on nasal floor 514
Final skin closure on lip 515
Adjustments during the final stage 515
Long vertical length of cleft side lip 515
Short vertical length of cleft side lip 515
Long horizontal length of cleft side lip 516
Short horizontal length of cleft side lip 516
Long vertical height of non-cleft side lip 516
Free border of the lateral lip 517
Semi-open rhinoplasty 518
Incision 518
Release of fibrofatty tissue from LLCs 518
Repositioning of LLCs 518
Trimming the excessive skin 518
Alar base position 518
Creation of the alar–facial groove 518
Rotation advancement cheiloplasty for incomplete clefts 518
Markings and incisions 519
Nasal floor incision 519
Dissection of muscle and elevation of OM flap 520
Nasal floor reconstruction 520
Muscle reconstruction 520
Nasal correction 520
Excessive free border 520
Complete cleft of primary palate 521
Microform cleft lip 523
Postoperative care 524
Postoperative maintenance of nasal shape 526
Outcomes, prognosis, and complications 526
Long-term results of lip morphology 526
Long-term result of nasal morphology 526
Satisfaction of patients 526
Complications 527
Summary 527
Access the complete reference list online at http://www.expertconsult.com 527
References 527.e1
21.3 Extended Mohler repair 528
Synopsis 528
Introduction 528
Treatment philosophy 529
Nasoalveolar molding 529
Gingivoperiosteoplasty 529
Tension-free reconstruction 529
No lip adhesion 529
Primary nasal repair 530
Nasal floor closure 530
Evolution of technique 530
Markings 531
Technical aspects of surgery 533
Downward rotation of Cupid’s bow 533
Preparation of the medial lip element 533
L-flap dissection 534
Lateral lip element dissection 534
Intranasal mucosa reconstruction 534
Oral mucosa reconstruction 535
Primary rhinoplasty Part I 535
Alar base repositioning 536
Orbicularis oris repair 536
Upper lip skin and vermillion repair 536
Primary rhinoplasty Part II 537
Postoperative care 537
Results 538
Access the complete reference list online at http://www.expertconsult.com 539
References 539.e1
21.4 Unilateral cleft lip repair, anatomic subunit approximation technique 540
Synopsis 540
Preoperative assessment 540
Pre-surgical orthopedics 540
Surgical plan: anatomical subunit approximation technique 540
Primary nasal correction 544
Operative technique 544
Postoperative care 545
Access the complete reference list online at http://www.expertconsult.com 545
References 545.e1
22 Repair of bilateral cleft lip 546
Synopsis 546
Introduction 546
Principles 546
Third and fourth dimensions 547
Historical perspective 547.e1
The premaxilla 547.e1
Labial closure 547.e1
Muscular closure 547.e1
Nasal inattention 547.e1
Secondary nasal correction 547.e1
Primary repair of the bilateral cleft lip nasal deformity 547.e2
Presentation 547
Preoperative dentofacial orthopedics 548
Operative techniques 549
Bilateral cleft, complete cleft lip, and palate 549
Markings 549
Labial dissection 550
Alveolar closure 550
Labial closure 551
Nasal dissection and positioning the lower lateral cartilages 551
Final touches 552
Postoperative care 553
Technical modifications for bilateral variations 554
Late presentation of bilateral complete cleft lip/palate 554
Binderoid bilateral complete cleft lip/palate 554
Bilateral complete cleft lip and intact secondary palate 554
Bilateral incomplete cleft lip 555
Asymmetrical bilateral (complete/incomplete) cleft lip 555
Outcomes 558
Photography 559
Revision rate 559
Direct anthropometry 561
Indirect anthropometry 561
Photogrammetry 561
Stereophotogrammetry 563
Conclusion 564
Access the complete reference list online at http://www.expertconsult.com 564
References 564.e1
23 Cleft palate 565
Synopsis 565
Historical perspective 565.e1
Basic science 565
Embryology 565
Anatomy of the velar muscles 565
Ear pathology 565
Patient presentation 566
Cleft palate with cleft lip and alveolus 566
Clefts of the secondary palate 567
Submucous cleft palate 567
Pierre Robin sequence 567
Syndromes 570
22q chromosomal deletion 570
Growth 570
Feeding and swallowing 570
Speech 571
Timing of palate repair 572
Speech 572
Maxillary growth 573
Treatment/surgical technique 573
Technical considerations 573
Hard versus soft palate closure 573
von Langenbeck 573
V-Y pushback (Veau–Wardill–Kilner) 573
Two-flap palatoplasty 575
Vomer flaps 575
Intravelar veloplasty 575
Double opposing Z-plasty (Furlow) 577
Two-stage palate repair 578
Postoperative care 579
Outcomes of cleft palate repair 579
Fistula 579
Speech outcomes/velopharyngeal insufficiency 579
Maxillary growth 579
Conclusion 580
Access the complete reference list online at http://www.expertconsult.com 580
References 580.e1
24 Alveolar clefts 581
Synopsis 581
Introduction 581
Historical perspective 581.e1
Basic science/disease process 581
Anatomy of the alveolar cleft 581
Dental development 581
Diagnosis/patient presentation 582
Gingivoperiosteoplasty 582
Primary bone grafting 582
Secondary bone grafting 582
Bone morphogenetic protein-2 584
Late bone grafting 584
Alveolar distraction 584
Treatment/surgical technique 585
Gingivoperiosteoplasty 585
Primary bone grafting 586
Secondary bone grafting 586
Horizontal TDO of a tooth-bearing alveolar segment 588
Vertical alveolar TDO 588
Outcomes, prognosis, and complications 588
Gingivoperiosteoplasty 588
Primary bone grafting 590
Secondary bone grafting 590
Bone morphogenetic protein-2 591
Late bone grafting 591
Graft site augmentation 591
Access the complete reference list online at http://www.expertconsult.com 591
References 592.e1
25 Orthodontics in cleft lip and palate management 593
Synopsis 593
Introduction 593
Infancy 594
Unilateral cleft lip 594
Bilateral cleft lip 594
Primary dentition 595
Posterior crossbite 595
Anterior crossbite 595
Transitional dentition 595
Orthodontic tooth movement to regenerate a homologous lyophilized bone graft combined with platelet rich plasma to reconstruct the alveolar cleft: “Chinchilla–Asensio Approach” 597
Orthodontic protocol – pre-graft 598
Pre-graft orthopedics and orthodontics 598
Surgical protocol 598
Orthodontic protocol – post-graft 599
Outcomes and benefits 599
Other considerations 600
Permanent dentition 602
Orthognathic surgery and distraction procedures for the cleft patient 606
Growth and orthodontic treatment 614
Conclusion 615
Access the complete reference list online at http://www.expertconsult.com 618
References 618.e1
26 Velopharyngeal dysfunction 619
Synopsis 619
Introduction 619
Anatomy and physiology of the velopharynx 619
Anatomy 619
Physiology 621
Basic science/disease process of velopharyngeal dysfunction 621
Velopharyngeal insufficiency 621
Velopharyngeal incompetence 623
Velopharyngeal mislearning 624
Combined types 624
Diagnosis/patient presentation 624
Patient history and physical exam 624
Perceptual speech evaluation 624
Indirect measures of velopharyngeal closure for speech 626
Imaging 627
Static radiographs 627
Multiview videofluoroscopy (Videos 26.1 and 26.2 ) 627
Nasopharyngoscopy 627
Treatment/surgical techniques 628
Preoperative evaluation 628
Furlow double-opposing Z-palatoplasty (Fig. 26.10) 629
Posterior pharyngeal flap (Fig. 26.11) 630
Sphincter pharyngoplasty (Fig. 26.12) 632
Posterior pharyngeal wall augmentation 633
Surgical management in the 22q11.2 deletion syndrome 634
Non-surgical treatment options 634
Prosthetic treatment 634
Behavioral speech therapy approaches 635
Access the complete reference list online at http://www.expertconsult.com 635
References 636.e1
27 Secondary deformities of the cleft lip, palate, and nose 637
Synopsis 637
Introduction 637
Examination and evaluation 637
Unilateral cleft lip 637
Vermilion/Mucosa 638
Vermilion notching 638
Mucosal excess 638
Skin 639
Short lip 639
Long lip 639
White roll discontinuity 640
Poor scarring 640
Muscle 642
Dehiscence 642
Bilateral cleft lip 642
Vermilion/Mucosa 642
Vermilion deficiency – whistle deformity 642
Vermilion excess 642
Mucosal excess 643
Skin 644
Poor scarring 644
Skin deficiency 645
Skin excess 645
Muscle 645
Dehiscence 645
Cleft palate 645
Velopharyngeal insufficiency 645
Workup and algorithm 646
Fistula closure 646
Furlow palatoplasty 648
Posterior pharyngeal flap 650
Sphincter pharyngoplasty 651
Posterior pharyngeal wall augmentation 651
Cleft nasal deformity 652
Intermediate rhinoplasty 653
Secondary cleft rhinoplasty – unilateral 653
Incision 654
The septum 654
The nasal tip 654
Nasal vestibule 654
Nasal dorsum 654
Nasal alae 655
Bilateral cleft nasal deformity 655
Conclusion 657
Access the complete reference list online at http://www.expertconsult.com 658
References 659.e1
28 Cleft and craniofacial orthognathic surgery 660
Synopsis 660
Introduction 660
Historical perspective 660.e1
Basic science 660
Growth and development 660
Diagnosis/patient preparation 661
Preoperative evaluation 661
The cleft and craniofacial team 661
The history and physical examination 661
Patient selection 662
Cephalometric and dental evaluation 662
Model surgery 663
Isolated mandibular surgery 663
Isolated maxillary and two-jaw surgery 663
3D CT modeling 663
Developing a treatment plan 663
Treatment/surgical technique 664
General principles and pertinent anatomy 664
Le Fort I osteotomy 665
Surgically assisted rapid palatal expansion 666
Bilateral sagittal split osteotomy (BSSO) 666
Intraoral vertical ramus osteotomy 667
Two-jaw surgery 667
Genioplasty 667
Cleft surgery 667
Distraction osteogenesis 670
Basic approaches to commonly encountered problems 670
Skeletal class II malocclusion 670
Skeletal class III malocclusion 671
Maxillary constriction 671
Apertognathia 671
Vertical maxillary excess 671
Short lower face 671
Postoperative care 671
Outcomes, prognosis, and complications 671
Secondary procedures 677
References 677
II Craniofacial 678
29 Pediatric facial fractures 678
Synopsis 678
Introduction 678
Historical perspective 678.e1
General principles 678
Epidemiology 678
Associated injuries 679
Growth, development, and fracture patterns 679
Diagnosis and presentation 681
Treatment 682
Outcomes, prognosis, and complications 682
Growth outcomes 683
Secondary procedures 684
Cranial base and skull fractures 685
Diagnosis and presentation 685
Treatment 686
Outcomes, prognosis, and complications 688
Orbital fractures 688
Diagnosis and presentation 688
Treatment 689
Outcomes, prognosis, and complications 690
Nasal and naso-orbito-ethmoid fractures 690
Diagnosis and presentation 690
Treatment 691
Outcomes, prognosis, and complications 691
Maxillary, zygomaticomaxillary complex and midface fractures 692
Diagnosis and presentation 692
Treatment 692
Outcomes, prognosis, and complications 693
Mandible fractures 693
Diagnosis and presentation 693
Treatment 693
Nondisplaced fractures 693
Condylar fractures 693
Displaced fractures 694
Outcomes, prognosis, and complications 695
Conclusions 695
Access the complete reference list online at http://www.expertconsult.com 695
References 695.e1
30 Orbital hypertelorism 696
Synopsis 696
Introduction 696
Historical perspective 696.e1
Basic science and disease process 696
Diagnosis of hypertelorism and patient presentation in facial clefts 697
Median facial clefts 697
Tessier classification of facial clefts 697
Diagnosis of hypertelorism and patient presentation in faciocraniosynostosis 698
Crouzon’s syndrome 698
Pfeiffer’s syndrome 698
Apert’s syndrome (acrocephalosyndactyly) 699
Craniofrontonasal dysplasia 699
Patient selection 699
Orbital shift or bipartition? 699
Treatment/surgical technique 699
Surgical principles in facial clefts 699
Surgical techniques in facial clefts 700
Principles 700
Infrafrontal correction of hypertelorism 700
Box-shift osteotomies (symmetrical orbital hypertelorism) 702
Frontal craniectomy 702
Osteotomies of the orbit 703
Bipartition with intracranial approach (large symmetrical hypertelorism with arched palate) 703
Asymmetrical cases 703
Timing and indications for surgery in faciocraniosynostosis 704
Orbits 704
Face 704
Surgical technique of hypertelorism correction in faciocraniosynostosis 705
Hypertelorism correction by bipartition in combination with Le Fort III osteotomy (Figs. 30.9 and 30.10) 705
Coronal approach 705
Subcranial osteotomies 705
Osteosynthesis and grafts 705
Postoperative care 705
Outcomes, prognosis, and complications 706
Secondary procedures 708
Refinements in hypertelorism correction (in clefts or craniosynostotic patients) 709
Canthus correction 709
Scalp and eyebrows 709
Nose 709
Eyelids and orbits 709
Oculomotor disorders 709
Recurrences of hypertelorism 709
Craniofacial surgery is teamwork 710
Access the complete reference list online at http://www.expertconsult.com 710
References 710.e1
31 Craniofacial clefts 711
Synopsis 711
Introduction 711
Classifications of craniofacial clefts 711
I: Median craniofacial hypoplasia (tissue deficiency and/or agenesis) 712
A. Holoprosencephalic spectrum (alobar brain) 712
B. Median cerebrofacial hypoplasia (lobar brain) 712
C. Median facial hypoplasia 712
D. Microforms of median facial hypoplasia 712
II: Median craniofacial dysraphia 713
A. True median cleft 713
B. Anterior encephaloceles 713
III: Median craniofacial hyperplasia (tissue excess or duplication) 713
Epidemiology and etiologic factors 714
Embryologic craniofacial development 714
Failure of fusion 715
Neuromeric theory 716
Patient selection 716
Distinctive features of Tessier craniofacial clefts 716
Number 0 cleft 716
Median craniofacial hypoplasia (deficiency of midline structures) 717
Soft-tissue deficiencies 718
Skeletal deficiencies 718
Median craniofacial dysraphia (normal tissue volume but clefted) 718
Index 961
A 961
B 963
C 964
D 970
E 971
F 972
G 976
H 976
I 978
J 978
K 978
L 978
M 979
N 981
O 983
P 984
R 987
S 988
T 990
U 992
V 993
W 994
Z 994
Inside Back Cover ibc1