Do standard surgical techniques lead to satisfying aesthetic results in nonsyndromic sagittal suture synostosis?

2021 ◽  
pp. 1-6
Author(s):  
Matthias Millesi ◽  
Markus Preischer ◽  
Andrea Reinprecht
Keyword(s):  
Surgical Outcome ◽  
Surgical Procedure ◽  
Surgical Techniques ◽  
Surgical Correction ◽  
Sagittal Suture ◽  
Aesthetic Outcome ◽  
Head Shape ◽  
The Aesthetic ◽  
Normal Head

OBJECTIVE Surgical correction of synostotic cranial sutures is typically performed early in an affected child’s life. Depending on the severity of the cranial synostoses, different aspects of the surgical treatment may have varying degrees of importance. In this sense, the aesthetic appearance in children with normal neurological development in single-suture synostosis plays an important role in self-perception and social acceptance for both the patients themselves and their caregivers. Therefore, in this study, the authors aimed to evaluate the aesthetic outcome after surgical correction in a cohort of patients with nonsyndromic sagittal suture synostosis. METHODS Between December 2002 and December 2019, a total of 99 patients underwent surgical correction of a synostotic sagittal suture at the Medical University of Vienna. Depending on their age, patients underwent either an extended midline strip craniectomy (EMSC) (< 4 months) or a modified pi procedure (MPP) (≥ 4 months). After the surgical procedure, the outcome was evaluated by the treating neurosurgeon at 1- and 12-month follow-up visits, and after approximately 5 years, before the patient entered elementary school. In addition to that, the patients’ caregivers were asked to evaluate the aesthetic outcome of the surgical procedure after 12 months. These results were then compared to evaluate potential differences in the perception of the surgical outcome. RESULTS After 12 months, the majority of the included patients were evaluated as having a good aesthetic outcome by the treating neurosurgeon (97%) and by their caregivers (89%). These differences did not show statistical significance (p = 0.11). Similarly, no differences in the aesthetic outcome depending on the surgical procedure performed could be found (p = 0.55). At the last follow-up visit, before entering elementary school, all available patients had an excellent or good surgical outcome. Moreover, the majority of caregivers (73%) reported that their child had a normal head shape appearance after surgical correction. CONCLUSIONS The results of this study have suggested that surgical correction of sagittal suture synostosis by simple operative techniques leads to a good aesthetic outcome and a normal head shape appearance in the majority of patients. An analysis of the evaluation of the surgical outcome by either the treating neurosurgeon or the patient caregivers showed comparable results and, thus, early intervention with simple surgical techniques can be recommended.

Reconstruction of unicoronal plagiocephaly with a hypercorrection surgical technique

2011 ◽  
Vol 31 (2) ◽  
pp. E4 ◽  
Author(s):  
John M. Mesa ◽  
Frank Fang ◽  
Karin M. Muraszko ◽  
Steven R. Buchman
Keyword(s):  
Surgical Technique ◽  
Surgical Repair ◽  
Surgical Techniques ◽  
Senior Author ◽  
Surgical Correction ◽  
Surgical Reconstruction ◽  
Calvarial Bone ◽  
The Mean ◽  
The Aesthetic

Object Successful surgical repair of unicoronal plagiocephaly remains a challenge for craniofacial surgeons. Many of the surgical techniques directed at correcting the stigmata associated with this craniofacial deformity (for example, ipsilateral supraorbital rim elevation [vertical dystopia], ipsilateral temporal constriction, C-shaped deformity of the face, and so on) are not long lasting and often result in deficient correction and the need for secondary revision surgery. The authors posit that the cause of this relapse was intrinsic deficiencies of the current surgical techniques. The aim of this study was to determine if correction of unilateral coronal plagiocephaly with a novel hypercorrection surgical technique could prevent the relapse of the characteristics associated with unicoronal plagiocephaly. Methods The authors performed a retrospective analysis of 40 consecutive patients who underwent surgical repair of unicoronal plagiocephaly at their institution between 1999 and 2009. In all cases, the senior author (S.R.B.) used a hypercorrection technique for surgical reconstruction. Hypercorrection consisted of significant overcorrection of the affected ipsilateral frontal and anterior temporal areas in the sagittal and coronal planes. Demographic, perioperative, and follow-up data were collected for comparison. The postsurgical appearance of the forehead was documented clinically and photographically and then evaluated and scored by 2 independent graders using the expanded Whitaker scoring system. A relapse was defined as a recurrence of preoperative features that required secondary surgical correction. Results The mean age of the patients at the time of the operation was 13 months (range 8–28 months). The mean follow-up duration was 57 months (range 3 months to 9.8 years). The postsurgical hypercorrection appearance persisted on average 6–8 months but gradually dissipated and normalized. No patients exhibited a relapse of unicoronal plagiocephalic characteristics that required surgical correction. In all cases the aesthetic results were excellent. Only 3 patients required reoperation for the management of persistent calvarial bone defects (2 cases) and removal of a symptomatic granuloma (1 case). Conclusions Our study demonstrates that patients who undergo unicoronal plagiocephaly repair with a hypercorrection surgical technique avoid long-term relapse. Our results suggest that the surgical technique used in the correction of unilateral coronal synostosis is strongly associated with the prevention of postsurgical relapse and that the use of this novel method decreases the need for surgical revision.

scholarly journals SR and LR Union Suture for the Treatment of Myopic Strabismus Fixus: Is Scleral Fixation Necessary?

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Carol P. S. Lam ◽  
Jason C. S. Yam ◽  
Flora H. S. Lau ◽  
Dorothy S. P. Fan ◽  
C. Y. Wong ◽  
...  
Keyword(s):  
Hong Kong ◽  
Retrospective Review ◽  
Surgical Outcome ◽  
Surgical Techniques ◽  
Effective Procedure ◽  
Successful Outcome ◽  
Range Of Movement ◽  
Scleral Fixation ◽  
Fixation Group

Purpose. To evaluate and compare the effectiveness of scleral fixation SR and LR union suture and nonscleral fixation union suture for the treatment of myopic strabismus fixus.Methods. Retrospective review of 32 eyes of 22 patients with myopic strabismus fixus who had undergone union suture of superior rectus (SR) and lateral rectus (LR) with or without scleral fixation, and follow-up longer than 6 months at Hong Kong Eye Hospital from 2006 to 2013. Surgical techniques and outcomes in terms of ocular alignment are analyzed.Results. There is significant overall improvement both in postoperative angle of esodeviation (P<0.01) and postoperative range of movement (P=0.042). Comparing between the sclera fixation group (11 eyes) versus nonscleral fixation group (21 eyes), the postoperative horizontal deviation, the postoperative vertical deviation, successful outcome, and the change in horizontal deviation were not significantly different (P>0.05).Conclusions. Union suture of SR and LR is an effective procedure in correcting myopic strabismus fixus. Fixation of the union suture to the sclera does not improve surgical outcome.

The Pouch and Tunnel Technique for the Management of Adjacent Gingival Recession Defects: Surgical Correction and One-Year Follow-Up

2010 ◽  
Vol 11 (5) ◽  
pp. 41-48 ◽  
Author(s):  
Vikas Deo ◽  
Ashok Bhati ◽  
Tony Kurien
Keyword(s):  
Surgical Techniques ◽  
Gingival Recession ◽  
Surgical Correction ◽  
Long Term Results ◽  
Recipient Site ◽  
Dental Esthetics ◽  
Tunnel Technique ◽  
Flap Design ◽  
One Year

Abstract Aim The aim of this report is to present a minimally invasive periodontal plastic surgical method for the treatment of gingival augmentation coronal to area of recession on the facial aspect of the mandibular central incisors. Background Gingival recession is a relatively common condition patients may discuss with their general dental practitioner. Several improvements in the available corrective surgical techniques have evolved, especially in flap design of periodontal cosmetic surgeries, which can produce a favorable final treatment outcome. Case Description A 21-year-old male patient diagnosed with Miller class II marginal tissue recession on the facial surface of the mandibular right and left central incisors was treated with a subepithelial connective tissue autograft underneath a supraperiosteal pouch and tunnel recipient site for multiple areas of gingival recession This flap design allowed intimate contact of donor tissue to the recipient site. One-year follow-up examination of the surgical site revealed excellent and stable root surface coverage. Summary The use of a technique that involves preservation of papilla height and ensures maximum blood supply to the graft helps to attain excellent esthetic and functional long-term results. Clinical Significance Given the increasing patient concerns about dental esthetics, the surgical treatment modality presented can be beneficial in efforts to meet the esthetic and functional demands of patients, thereby contributing positively to treatment acceptance and the overall outcome. Citation Kurien T, Deo V, Bhati A. The pouch and tunnel technique for the management of adjacent gingival recession defects: Surgical correction and one-year follow-up. J Contemp Dent Pract [Internet]. 2010 October; 11(5):041- 048. Available from: http://www.thejcdp.com/ journal/view/volume11-issue5-deo

scholarly journals Repair of chronic Achilles tendon rupture using Bosworth’s technique

2020 ◽  
pp. 221049172097271
Author(s):  
Dhruba Narayan Borah ◽  
Siddhartha Rai ◽  
Herman Conrad Frank ◽  
Anshuman Dutta
Keyword(s):  
Achilles Tendon ◽  
Functional Outcome ◽  
Scoring System ◽  
Surgical Procedure ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Surgical Techniques ◽  
Distal Stump ◽  
Zone Ii

Background: A large number of ruptures of the Achilles tendon occurs in the watershed hypovascular region (zone II) of the tendon which is approximately 2–6 cm proximal to the insertion of tendon at calcaneum. Chronic Achilles tendon rupture in the watershed area makes end to end repair of tendon less feasible and the neglected distal stump is often inapt for repair. A number of surgical techniques have been described for repair of chronic Achilles tendon in zone II. Our study was conducted with the objective of determining the efficacy and functional outcome of Bosworth’s technique that involves gastrocnemius-soleus turndown of proximal Achilles tendon. Materials and Methods: The study was conducted in a total of five patients with chronic tear of Achilles tendon and the Bosworth technique was used for repair in all the patients. All the patients were followed up for a period of 1 year and the functional outcome was assessed by scoring system devised by Leppilahti et al. Results: four out of the five patients showed excellent functional at the end of 1 year follow up. A good functional outcome was seen in one of the patients. All the patients were able to resume work 6 months postoperatively. Conclusion: The Bosworth’s technique is an excellent surgical procedure for repair of chronic Achilles tendon rupture in the watershed zone of the tendon.

scholarly journals Surgical treatment of premature sagittal synostosis

1997 ◽  
Vol 55 (3A) ◽  
pp. 403-407 ◽  
Author(s):  
Geraldo Pianetti
Keyword(s):  
First Year ◽  
Blood Transfusions ◽  
Sagittal Suture ◽  
Head Shape ◽  
Sagittal Synostosis ◽  
Aesthetic Result ◽  
The Third ◽  
Radiologic Findings ◽  
Skull Measurements ◽  
The Aesthetic

A series of 50 consecutive children with premature sagittal synostosis is reported. All were treated surgically; 43 were male, 47 were leukodermic and two are siblings. In the pre-operative examination, the head shape, skull measurements and radiologic findings were evaluated; 38 children were operated on before six months of age and 12 of them, between six and 12 months of age. The surgical technique used was a wide biparietal craniectomy. Blood transfusions were occasional, being necessary for only six (12%) children. The children were admitted at the day of surgery and discharged between the second and the third post-operative day. No local or general complications were observed and no one died. The aesthetic result was considered good. The altered skull measurements before surgery reached normalization as far as the end of the first year after the treatment. It may be concluded that wide biparietal craniectomy is a procedure of great effectiveness in the treatment of the premature fusion of the sagittal suture.

scholarly journals 57 The Use of a Hemi Glabella Flap for Reconstruction of Medial Canthus Defects

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
P Tan ◽  
J Agilinko ◽  
A Khalil
Keyword(s):  
Donor Site ◽  
Advancement Flap ◽  
Senior Author ◽  
Lateral Nasal Wall ◽  
Oral Antibiotics ◽  
Aesthetic Outcome ◽  
Medial Canthus ◽  
Complex Anatomy ◽  
The Aesthetic

Abstract Background Medial canthal reconstruction is a challenging task due to the complex anatomy. The glabellar flap is a common viable technique; however, this results in narrowing of the eyebrows, bulky nasal dorsum and horizontal scarring which is aesthetically displeasing. The senior author in this paper has developed an intuitive modification to the technique. Method A rotational advancement flap involving the upper lateral nasal wall with the hemi glabella was formed and transferred to the medial canthal defect. The donor site was closed in a V-Y manner. Complete closure of defect was achieved in all patients. Results Reconstruction using the Hemi-Glabellar technique was performed on 12 patients following resection of BCC in or near the medial canthus area. Superficial cellulitis was noted in 2 patients, they were managed oral antibiotics. There was bruising in 7 patient which resolve spontaneously in 4-7 days. All patients had a good outcome at 2 months and 6 months follow up. There was no flap loss and all patients were satisfied with the aesthetic outcome. Conclusions The technique highlighted can be performed easily and is applicable to reconstruction to defects of the medial canthus with excellent aesthetic outcomes with an inconspicuous scar and supple skin with matching colour

Designing a Trifoliate Flap for Isolated Congenital Alar Rim Defect in Pediatric Patients

2021 ◽  
pp. 229255032110196
Author(s):  
Shi-Yan Li ◽  
Bao-Fu Yu ◽  
Shu-Yi Wei ◽  
Ning Yin ◽  
Zong-Jiang Yao ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Standard Technique ◽  
Aesthetic Outcome ◽  
Flap Surgery ◽  
Rotation Flap ◽  
Alar Retraction ◽  
Surgical Suture ◽  
The Aesthetic ◽  
Alar Rim

Isolated congenital alar rim defects are extremely rare, and there has been no standard technique for the reconstruction of remarkable aesthetic deformity. Herein, we introduce a trifoliate flap for the correction of isolated congenital alar rim defects in pediatric patients. Fifteen cases undergoing nasal alar sulcus rotation flap surgery were analyzed retrospectively. This rotation flap including 3 triangles was a modified flap based on prior studies. Clinical medical notes and photographs were reviewed. Patients’ (or their parents) reported satisfactions with aesthetic outcome were also evaluated during the post-operative follow-up period. In all patients, the isolated congenital alar rim defects were successfully reconstructed. The rotation flap survived and the wound healed primarily. The follow-up period ranged from 6 to 22 months (average 11 months). There were no incidents of flap loss, step-off deformities, nasal obstruction, or alar retraction. At follow-up of post-operative 3 months, pale red scars were observed in the operative area in few patients (2/15). However, these scars gradually became invisible at post-operative 6 months. All patients (or their parents) were satisfied with the aesthetic outcome of this operation. This newly designed trifoliate flap can be an alternative method for the reconstruction of isolated congenital alar rim defects in pediatric patients. The scars of this procedure can be unobvious with fine surgical suture.

Hypospadias

2017 ◽  
Author(s):  
Peter Cuckow
Keyword(s):  
Surgical Outcome ◽  
Congenital Anomalies ◽  
Surgical Repair ◽  
Surgical Correction ◽  
Two Stage ◽  
Moderate Severity ◽  
Long Term Follow Up ◽  
One Year

Hypospadias is one of the commonest congenital anomalies, with an incidence of approximately 1:250–300. Approximately 80% of cases are of mild to moderate severity and are amenable to single-stage surgical correction at around one year of age. Proximal or complicated cases account for the remaining 20% and these are being increasingly managed by a two-stage approach. While successful surgical repair can help to minimize any long-term psychological morbidity, a minority of patients will nevertheless experience significant psychological problems related to their condition. Long-term follow-up and support may therefore be beneficial for patients with severe forms of hypospadias. The experience and commitment of the surgeon, coupled with regular audit of results are the most important determinants of a successful surgical outcome.

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