Occipitofrontal switch for correction of anterior plagiocephaly planned through virtual mock surgery

Background: Unilateral coronal synostosis causing anterior plagiocephaly can result in restricted brain development and severe facial deformities. Various surgical procedures have been described for the correction of this deformity. Cranial vault remodeling, however, is associated with several complications. Occipitofrontal switching is a novel technique which utilizes a part of the contralateral occipital bone to reconstruct the frontal area. This is the first such case reported from India and first report where virtual mock surgery has been utilized for precision and improving outcome in this elegant procedure. Case Description: A 5-year-old girl presented with left anterior plagiocephaly. 3D image of her skull was reconstructed using Geomagic Freeform software (3D Systems, Rock Hill, SC). Measurements were accurately drawn and the procedure was practised virtually before performing the occipitofrontal switch on the patient. There were minimal blood loss and postoperative morbidity. One year follow-up of the patient showed optimal correction of the defect in the forehead region, symmetrical shape of the frontal and occipital region and symmetrical brows. Conclusion: The technique of occipitofrontal switch for correction of anterior plagiocephaly is an elegant procedure with good functional and aesthetic outcome.

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657 ROUTINE ESOPHAGRAMS FOLLOWING HIATUS HERNIA REPAIR MINIMISES REOPERATIVE MORBIDITY: A MULTICENTER COMPARATIVE COHORT STUDY

Diseases of the Esophagus ◽

10.1093/dote/doab052.657 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Author(s):

David Liu ◽

Melissa Wee ◽

James Grantham ◽

Bee Ong ◽

Stephanie Ng ◽

...

Keyword(s):

Hernia Repair ◽

Hiatus Hernia ◽

Functional Outcomes ◽

Gastric Resection ◽

Postoperative Morbidity ◽

Early Complications ◽

Esophageal Obstruction ◽

Comparative Cohort Study ◽

One Year

Abstract Hiatus hernia repairs are common. Early complications such as re-herniation, esophageal obstruction and perforation, although infrequent, incur significant morbidity. Here, we determine whether routine postoperative esophagrams following hiatus hernia repair may expedite the surgical management of these complications, reduce reoperative morbidity, and improve functional outcomes. Methods Analysis of a prospectively-maintained database of 1829 hiatus hernia repairs undertaken in 14 hospitals from 1 January 2000 to 30 September 2020. 1571 (85.9%) patients underwent a postoperative esophagram which was reviewed. An early (<14 days) reoperation was performed in 44 (2.4%) patients. Results Compared to those without an esophagram, patients who received one prior to reoperation (n = 37) had a shorter time to diagnosis (2.4 vs. 3.9 days, p = 0.041) and treatment (2.4 vs. 4.3 days, p = 0.037) of their complications. This was associated with decreased open surgery (10.8% vs. 42.9%, p = 0.034), gastric resection (0.0% vs. 28.6%, p = 0.022), postoperative morbidity (13.5% vs. 85.7%, p < 0.001), ICU admission (16.2% vs. 85.7%, p < 0.001), and length-of-stay (7.3 vs. 18.3 days, p = 0.009). Furthermore, patients who underwent early reoperations for asymptomatic re-herniation had less complications and superior functional outcomes at one-year follow-up than those who needed surgery for symptomatic recurrences later on. Conclusion Postoperative esophagrams decreases the morbidity associated with early and late reoperations following hiatus hernia repair, and should be considered for routine use.

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Piezo-Assisted Turbinoplasty: A Novel Rapid and Safe Technique

Facial Plastic Surgery ◽

10.1055/s-0039-3401803 ◽

2019 ◽

Vol 36 (03) ◽

pp. 235-241

Author(s):

Enrico Robotti ◽

Ali Khazaal ◽

Francesco Leone

Keyword(s):

Postoperative Bleeding ◽

Novel Technique ◽

Turbinate Hypertrophy ◽

Safe Technique ◽

One Year ◽

The Ideal

AbstractConsensus is still lacking on the ideal treatment of turbinate hypertrophy concurrent with rhinoseptoplasty. A novel technique of turbinoplasty consisting of incision-bone fracturing by the use of piezoelectric technique—intramucosal microcauterization—lateralization is described in detail. A series of 157 consecutive patients is reviewed with a maximum follow-up of one year. The technique is fast and easy and allows predictability in avoiding postoperative bleeding and preventing remedialization of the lateralized turbinates. Due to the technology required, its use is suggested especially when piezo is employed during other steps of rhinoseptoplasty.

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Surgical Correction of Metopic Craniosynostosis: A 3-D Photogrammetric Analysis of Cranial Vault Outcomes

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665618775729 ◽

2018 ◽

Vol 56 (2) ◽

pp. 231-235 ◽

Cited By ~ 4

Author(s):

Olivia E. Linden ◽

Vanessa M. Baratta ◽

Jose A. Gonzalez ◽

Margaret E. Byrne ◽

Petra M. Klinge ◽

...

Keyword(s):

Average Distance ◽

Cranial Vault ◽

3 Dimensional ◽

Postoperative Time ◽

The Face ◽

Academic Teaching Hospital ◽

One Year ◽

Cranial Vault Remodeling ◽

Metopic Craniosynostosis

Objective: To evaluate 3-dimensional (3-D) photogrammetry as a tool for assessing the postoperative head shape of patients who had undergone cranial vault remodeling for metopic synostosis. Design: We prospectively analyzed images of patients with metopic craniosynostosis who had undergone anterior cranial vault remodeling and age-matched controls. To ensure standardized facial orientation, each 3-D image was positioned to “best fit” the preoperative face by aligning 6 soft tissue landmarks. Forehead measurements were taken from a standardized position behind the surface of the face to landmarks placed in a ray configuration across the forehead. Setting: Academic teaching hospital. Patients, Participants: Thirteen pediatric patients with metopic craniosynostosis who had undergone anterior cranial vault remodeling and age-matched controls. Interventions: Images were taken preoperatively, immediately postoperatively, and over 1-year postoperatively. Main Outcome Measures: Forehead contours preoperatively and postoperatively, with statistics performed using a multivariate analysis of variance shape analysis. Results: Mean postoperative follow-up was 1.8 (0.6) years. The average distance from the origin to forehead landmarks was 55.1 (3.4) mm preoperatively, 59.3 (0.7) mm immediate postoperatively, 59.1 (1.0) mm 1-year postoperatively, and 59.4 (0.6) mm in controls. Postoperative metopic forehead contours varied significantly from preoperative contours ( P < .01), while there was no statistical difference between the 2 postoperative time points ( P = .70). One-year postoperative patients were not significantly different from their age-matched controls ( P > .99). Conclusions: Preoperative metopic forehead contours varied significantly from postoperative contours. Cranial reconstructions approximated the foreheads of normal controls, and reconstructions were stable at more than 1-year follow-up.

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