Craniofacial Unit

Paris, France

Craniofacial Unit

Paris, France

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PubMed | Craniofacial Unit and A B Shetty Memorial Institute of Dental science
Type: Journal Article | Journal: Indian journal of dentistry | Year: 2015

India accounts for the majority of oral cancer cases occurring worldwide. The metastasis of oral cancer to the regional lymph nodes and distant sites determines the prognosis and the survival rate of this disease.The aim and objectives of this study were to evaluate the accuracy of preoperative clinical methods such as palpation, ultrasonography (USG), and computed tomography (CT) in comparison with postoperative histopathological findings in determination of metastatic cervical lymph nodes and also to assess whether combining these techniques increases the specificity and sensitivity of lymph node metastasis in oral squamous cell carcinoma (SCC).Totally, 26 consecutive biopsy proven cases of oral SCC were included, and the nodal status was evaluated by palpation, CT and ultrasound (US) and confirmed by histopathological examination. The results were presented in terms of sensitivity, specificity, predictive values, accuracy, and P value.Palpation, USG, and CT findings were compared with histopathologic findings by Fishers exact test and the P value for palpation, US and CT were 0.003, 0.000, 0.000, respectively, which are statistically significant.US examination combined with CT gives a better assessment of the neck for nodal metastasis.


Hayhurst C.,Alder Hey Childrens NHS Foundation Trust | Williams D.,Alder Hey Childrens NHS Foundation Trust | Yousaf J.,Alder Hey Childrens NHS Foundation Trust | Ichardson D.R.,Craniofacial Unit | And 2 more authors.
Journal of Neurosurgery: Pediatrics | Year: 2013

Object. Skull base tumors in children are rare but require complex approaches with potential morbidity to the developing craniofacial skeleton, in addition to tumor-related morbidity. Reports of long-term clinical and functional outcome following skull base approaches in children are scarce. The authors report long-term outcome in children with tumors undergoing multidisciplinary skull base surgery. Methods. A retrospective analysis was undertaken of children undergoing surgery at a single institution between 1998 and 2008 for benign and malignant lesions of the anterior, middle, or posterior cranial base. Patients with craniopharyngioma, pituitary tumors, and optic glioma were excluded. Histology, surgical morbidity, length of hospital stay, progression-free survival, and adjuvant therapy were recorded. Functional and cognitive outcome was assessed prospectively using the Late Effects Severity Score (LESS). Results. Twenty-three children ranging in age from 13 months to 15 years underwent skull base approaches for resection of tumors during the study period. The median follow-up duration was 60 months. Tumor types included meningioma, schwannoma, rhabdomyosarcoma, neuroblastoma, angiofibroma, and chordoma. Complete resection was achieved in 12 patients (52%). Thirteen patients (57%) had benign histology. The median hospital stay was 7 days. There were 3 deaths, 1 perioperative and 2 from tumor progression. Two patients had CSF leakage (9%) and 2 developed meningitis. Two children (9%) had residual neurological deficit at last follow-up evaluation. Thirteen (59%) of 22 surviving patients received adjuvant therapy. The majority of the patients remain in mainstream education and 19 of the 20 surviving children have an LESS of 3 or lower. Conclusions. Children tolerate complex skull base procedures well, with minimal surgical-related morbidity as well as good long-term tumor control rates and functional outcomes from maximal safe resection combined with adjuvant treatment when required. ©AANS, 2013.


Di Rocco F.,Craniofacial Unit | Di Rocco F.,Necker Enfants Malades Hospital | Arnaud E.,Craniofacial Unit | Marchac D.,Craniofacial Unit | And 4 more authors.
Child's Nervous System | Year: 2012

Introduction: Trigonocephaly secondary to the premature fusion of the metopic synostosis is associated to a risk of cerebral compression and several craniofacial morphological alterations. Numerous surgical techniques have been proposed. They all carry a risk of secondary temporal hollowing Purpose: The aim of this paper is to describe the surgical technique used for trigonocephaly at the craniofacial unit of Hopital Necker Enfants Malades (French National Referral Center for Faciocraniosynostosis) focusing on its advantages and limitations. Resorbable osteosynthesis should be part of the current techniques. © 2012 Springer-Verlag.


Di Rocco F.,Craniofacial Unit | Di Rocco F.,Necker Enfants Malades Hospital | Gbulie U.B.,Craniofacial Unit | Meyer P.,APHP | Arnaud E.,Craniofacial Unit
Journal of Craniofacial Surgery | Year: 2014

Background: Many techniques and protocols are currently used in the treatment of scaphocephaly worldwide, including total calvarial remodeling and minimally invasive strip craniectomies. This study reviews current techniques and protocols used in young infants (aged ≤6 months) as well as the outcomes in terms of reoperation rates. Methods: A short questionnaire was designed including questions about the preferred surgical techniques, transfusion protocols, and reoperation rates. Surgeons from the International Society of Craniofacial Surgery and the International Society for Pediatric Neurosurgery were requested to respond to this questionnaire online or by e-mail. Responses during a 2-week period were collated and analyzed using Fisher exact test. Results: A total of 91 surgeons responded from the craniofacial centers around the world, of which 93.4% completed the questionnaire. Most respondents were from North America and Europe (35% and 20%, respectively). The operative volume was less than 15 cases per year in 56%, and the bicoronal skin incision was most commonly used (81%). Postoperative drainage was not performed by 55% but was statistically more common with use of the bicoronal incision (P = 0.029). Of the respondents, 66% used calvarial remodeling, and 34% strip craniectomy. Blood was most commonly transfused at a hemoglobin level under 8 g/dL (31%), with a mean transfusion rate of 66%. Of the respondents, 44% transfused in more than 90% of the cases, whereas only 18% transfused in 20% or less of the cases. The mean reoperation rate for secondary fusion was 1.7%, and 41% of the respondents claimed a 0% reoperation rate. A statistically higher frequency of reoperation was reported by centers with a case load of more than 15 cases per year (P = 0.035), and no statistical correlation was found with the type of surgical technique. Conclusions: Our survey of neurosurgeons and craniofacial plastic surgeons worldwide shows that for young infants treated for scaphocephaly, the bicoronal incision is most commonly used and a greater number of surgeons do not use drains. A great variability in the transfusion protocols used in the care of these patients as well as a low reoperation rate were also found. The latter however may suggest a lack of strict monitoring in most centers. Overall, this study presents a snapshot of the current surgical treatment of this subset of patients and should serve as a basis for quality improvement and outcome monitoring in their surgical management. Copyright © 2014 by Mutaz B. Habal, MD.


Di Rocco F.,Craniofacial Unit | Knoll B.I.,Craniofacial Unit | Arnaud E.,Craniofacial Unit | Blanot S.,APHP Hopital Necker Enfants Malades | And 4 more authors.
Child's Nervous System | Year: 2012

Objective: The aim of this paper is to describe the surgical technique, originally devised by Dr. Renier which is currently used to treat children with scaphocephaly under 6 months of age at the Craniofacial Unit of Hopital Necker Enfants Malades (French National Referral Center for Faciocraniosynostosis), focusing on its advantages and limitations. © 2012 Springer-Verlag.


Marchac D.,Craniofacial Unit | Sati S.,Craniofacial Unit | Renier D.,Craniofacial Unit | Deschamps-Braly J.,Craniofacial Unit | Marchac A.,Craniofacial Unit
Plastic and Reconstructive Surgery | Year: 2012

BACKGROUND: This report documents the authors' experience with 95 hypertelorism corrections performed since 1971. The authors note their findings regarding outcomes, preferred age at surgery, technique, and stability of results with growth. METHODS: Patients were classified into three groups: midline clefts (with or without nasal anomalies, Tessier 0 to 14); paramedian clefts (symmetric or asymmetric with or without nasal anomalies); and hypertelorism with craniosynostosis. The authors developed a hypertelorism index to measure longitudinal orbital position. RESULTS: A total of 70 box osteotomies were performed. Twelve of 95 patients had a bipartition. Six of 95 patients underwent a unilateral orbital box displacement or a three-wall mobilization, and seven of 95 had a medial wall osteotomy. Eighty patients were graded 1 to 4 using the Whitaker scale. Fifty-nine of 80 patients received a grade of 1, 15 patients received a grade of 2, five patients received a grade of three, four patients initially scored a 4, and three patients underwent reoperation and were rescored as 1. The authors developed a hypertelorism index to rate 28 patients with long-term follow-up. None showed deterioration of results over the long term. The complication rate was 4 percent. CONCLUSION: The most interesting finding was that an initially good result in terms of orbital correction, whatever the severity, remains good with time, and facial balance improves after completion of growth. Copyright © 2012 by the American Society of Plastic Surgeons.


Pavri S.N.,Yale University | Arnaud E.,Craniofacial Unit | Renier D.,Craniofacial Unit | Persing J.A.,Yale University
Journal of Craniofacial Surgery | Year: 2015

Background: The coronal incision is a standard surgical approach in craniofacial surgery. It has undergone many modifications during the years in an attempt to optimize the esthetic appearance of the scar, including the sawtooth "stealth incision" and the sinusoidal incision. Methods: We describe an alternative coronal approach extending posteriorly from the postauricular region over the occiput, resulting in an axial scar. Results and Discussion: The posterior coronal incision provides equivalent exposure of the craniofacial skeleton while placing the scar in an esthetically optimal location that is much more likely to be camouflaged by hair, especially in patients with thinning hair or male-pattern baldness. It avoids a vertical temporal scar that is prone to widening and also allows the incision to be placed remotely from any neurosurgical hardware in the frontotemporal region. It may be used in craniofacial or neurosurgical procedures requiring access to the posterior or anterior cranial vaults or the upper craniofacial skeleton down to the maxillary alveolar rim. Copyright © 2014 by Mutaz B. Habal, MD.


Arnaud E.,Craniofacial Unit | Marchac A.,Craniofacial Unit | Jeblaoui Y.,Craniofacial Unit | Renier D.,Craniofacial Unit | Di Rocco F.,Craniofacial Unit
Child's Nervous System | Year: 2012

Introduction: A posterior flatness of the skull vault can be observed in infants with brachycephaly. Such posterior deformation favours the development of turricephaly which is difficult to correct. To reduce the risk of such deformation, an early posterior skull remodelling has been suggested. Translambdoid springs can be used to allow for a distraction through the patent lambdoid sutures and obtain a progressive increase of the posterior skull volume. Surgical technique: The procedure consists in a posterior scalp elevation, the patient being on a prone position. Springs made of stainless steel wire (1.5 mm in diameter) are bent in a U-type fashion, and strategically positioned across both lambdoid sutures. No drilling is usually necessary, as the lambdoid suture can be gently forced with a subperiosteal elevator in its middle and an indentation can be created with a bony rongeur on each side of the open suture to allow for a self-retention of bayonet-shaped extremity of the spring. Careful attention is addressed to the favoured prone position during the post-operative period. After a delay of 3-6 months, the springs can be removed during a second uneventful procedure, with limited incisions, usually as a preliminary step of the subsequent frontal remodelling. Conclusion: The concept of spring-assisted expansion across patent sutures under 6 months of age was confirmed in our experience (19 cases). Insertion of the springs allowed for immediate distraction across the suture. A posterior remodelling of the skull could be achieved with minimal morbidity allowing to delay safely a radical anterior surgery. © 2012 Springer-Verlag.


PubMed | Craniofacial Unit
Type: Journal Article | Journal: Plastic and reconstructive surgery | Year: 2012

This report documents the authors experience with 95 hypertelorism corrections performed since 1971. The authors note their findings regarding outcomes, preferred age at surgery, technique, and stability of results with growth.Patients were classified into three groups: midline clefts (with or without nasal anomalies, Tessier 0 to 14); paramedian clefts (symmetric or asymmetric with or without nasal anomalies); and hypertelorism with craniosynostosis. The authors developed a hypertelorism index to measure longitudinal orbital position.A total of 70 box osteotomies were performed. Twelve of 95 patients had a bipartition. Six of 95 patients underwent a unilateral orbital box displacement or a three-wall mobilization, and seven of 95 had a medial wall osteotomy. Eighty patients were graded 1 to 4 using the Whitaker scale. Fifty-nine of 80 patients received a grade of 1, 15 patients received a grade of 2, five patients received a grade of three, four patients initially scored a 4, and three patients underwent reoperation and were rescored as 1. The authors developed a hypertelorism index to rate 28 patients with long-term follow-up. None showed deterioration of results over the long term. The complication rate was 4 percent.The most interesting finding was that an initially good result in terms of orbital correction, whatever the severity, remains good with time, and facial balance improves after completion of growth.Therapeutic, IV.


Marchac A.,Craniofacial Unit | Arnaud E.,Craniofacial Unit
Journal of Craniofacial Surgery | Year: 2012

Background: The adaptation of distraction osteogenesis (DO) to the midface and cranium in the 1990s and the advancements that followed at the turn of the century resulted in a shift of paradigm in craniofacial surgery. Because skeletal advancement was not sudden anymore, but incremental, the monobloc advancement became safer to perform. Because bone was generated in the distraction gap, bone grafts were no longer needed, and younger patients could benefit from craniofacial advancement. Today, DO is the most powerful tool to simultaneously correct both exorbitism and the respiratory impairment of the faciocraniosynostosis, but practices vary greatly between teams. Methods: Current practices, controversies, and near-term future applications will be outlined and discussed. Results: Our current treatment strategy for faciocraniosynostosis is based on early intervention (G18 months of age) to prevent irreversible brain damage. In the first 6 months of life, infants with faciocraniosynostosis receive posterior vault decompression. We currently use posterior vault distraction, using 2 internal distractors. Around 18 months of age, a frontofacial monobloc advancement with DO is performed. It further decompresses the brain, improves respiratory function, and corrects exorbitism. Because we operate at such an early age, we favor internal over external distractors. In severe faciocraniosynostosis, when midface hypoplasia causes major exorbitism endangering the eye or causes respiratory distress requiring a tracheotomy, we do not hesitate to perform a frontofacial monobloc advancement with DO before the age of 18 months, reinforcing the frontozygomatic junction with a plate and placing a transzygomatic pin. The pin is then connected to a traction rope. We frequently use the external distractors, which allow precise control over the rotation of the maxilla and are well tolerated after 5 years of age. When midface hypoplasia is very severe, we combine external and internal distractors. Conclusions: The ongoing debate between proponents of internal versus external distractors or 1-stage versus 2-stage approach is based mostly on anecdotal data. Multicenter prospective studies are necessary to bring objective data to answer these questions. © 2012 Mutaz B. Habal, MD.

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