RESUMO

ABSTRACT: The purpose of this study was to review our institution's experience using helmet molding therapy in children with isolated non-syndromic sagittal craniosynostosis before placement of cranial springs and provide objective measurements of craniometric changes to help determine its role in treatment.Patients who underwent preoperative helmet molding therapy for sagittal craniosynostosis were retrospectively reviewed. Three-dimensional surface tomography scans were used to measure head circumference, cranial width, cranial length, cranial index (CI), and cranial vault asymmetry.Seventeen patients underwent orthotic helmeting therapy before spring mediated cranial vault expansion. Patients spent a median of 48 days (interquartile range [IQR] 32, 57) in preoperative orthotic helmeting therapy. There were increases in both cranial width and length post-helmeting (median: 107.5 mm [IQR 104.8, 110.4] versus 115.6 mm [IQR 114.5, 119.3]; P < 0.001) (median: 152.8 mm [IQR 149.2, 154.9] versus 156.8 mm [IQR 155.0, 161.5]; P < 0.001), respectively. There was a greater increase in cranial width (P = 0.015). Consequently, patients' CI improved after preoperative helmeting (median: 0.702 [IQR 0.693, 0.717] versus 0.739 [0.711, 0.752]; P < 0.001). There was no evidence of growth restriction from helmeting (pre-helmeting Head circumference [HC]: median 96.8 percentile [IQR 90.6, 99.9] versus post-helmeting HC: 98.7 percentile [IQR 94.7, 99.8]; P = 0.109).Preoperative helmeting in patients with non-syndromic isolated sagittal craniosynostosis can be used to improve CI before surgical correction. Significant benefits can be achieved in shorter preoperative helmeting durations than previously reported with no evidence of cranial growth restriction, which supports its feasibility and utility in children undergoing spring mediated cranial vault expansion.

Assuntos

Craniossinostoses , Anormalidades Maxilomandibulares , Cefalometria/métodos , Criança , Craniossinostoses/diagnóstico por imagem , Craniossinostoses/cirurgia , Dispositivos de Proteção da Cabeça , Humanos , Lactente , Estudos Retrospectivos , Crânio/cirurgia , Resultado do Tratamento

RESUMO

ABSTRACT: Previous literature has documented changes in nasal obstruction after acute LeFort I osteotomy. However, there is a paucity of studies that evaluate distraction-mediated LeFort I (DO-LFI) without concomitant intranasal interventions using the nasal obstruction symptom evaluation (NOSE) scale in Class III patients. The purpose of this study is to objectively evaluate nasal obstruction quality of life through the NOSE scale in patients undergoing DO-LFI. Inclusion into the study required both a preoperative (1 year ≤ date of service) and postoperative (≥6 months and ≤2 years) NOSE scale administration. Nasal obstruction symptom evaluation scales were compared using Wilcoxon signed rank test. There was a significant difference in composite NOSE scales, x̃ = 8.0 (interquartile range: 4.0-11.0), x̃ = 1.0 (interquartile range: 1.0-3.0), P < 0.017, preoperatively and postoperatively respectfully. Additionally, when looking at individual components of the NOSE scale, nasal congestion or stuffiness, and trouble breathing through nose were significantly improved after DO-LFI (P < 0.017). Nasal blockage or obstruction (P > 0.084) and trouble breathing when exercising (P > 0.076) trended towards significant improvement, as well. Trouble sleeping did not differ, P > 0.611. We elucidate, in this pilot study, that there is an association between DO-LFI and patient reported nasal obstructive symptoms. Future prospective studies utilizing the NOSE scale are needed to determine causality.

Assuntos

Obstrução Nasal , Rinoplastia , Humanos , Obstrução Nasal/etiologia , Obstrução Nasal/cirurgia , Septo Nasal/cirurgia , Osteotomia , Projetos Piloto , Estudos Prospectivos , Qualidade de Vida , Resultado do Tratamento

RESUMO

BACKGROUND: The purpose of this manuscript is to introduce a novel endoscopic-assisted approach for creation of osteotomies and distractor hardware placement for unicoronal craniosynostosis. METHODS: Only three small incisions are performed, one at the anterior fontanelle, pterional region, and upper lateral blepharoplasty location. Unicoronal strip craniectomy and osteotomies in temporal bone, nasofrontal junction, lateral orbital rim, sphenoid wing, orbital roof, and contralateral frontal bone are performed through these incisions with the assistance of a 30° 5-mm endoscope. One linear cranial distractor is inserted through the pterional incision and fixated across the unicoronal suturectomy. RESULTS: Endoscopic-assisted fronto-orbital distraction osteogenesis has been performed on 3 patients with unicoronal craniosynostosis. Median age at surgery was 5.4 months (95%CI 5.0-6.1). Median operative duration was 98 minutes (95%CI 91-112), and estimated blood loss was 25 mL (95%CI 15-150). Median length of distraction achieved was 25.7 mm (95%CI 21.9-28.0), based on lateral skull x-rays obtained on the last day of activation. Distractors were removed 2.3 months postoperatively (95%CI 2.1-3.1), and operative duration of distractor removal was 20 minutes (95%CI 19-29). There was 1 complication, a transient cerebrospinal fluid leak thought to have been caused by a pinpoint injury to the dura at the nasofrontal junction, which was managed expectantly and resolved spontaneously by the fourth postoperative day. CONCLUSIONS: Endoscopic-assisted fronto-orbital distraction osteogenesis is a promising treatment modality for children with unicoronal craniosynostosis combining the benefits of distraction osteogenesis with a minimally invasive approach. Additional experience and follow-up are needed to determine its utility, safety, and longevity.

Assuntos

Craniossinostoses , Osteogênese por Distração , Criança , Craniossinostoses/cirurgia , Craniotomia , Endoscopia , Osso Frontal/cirurgia , Humanos , Lactente

RESUMO

PURPOSE: The purpose of this study is to quantitatively establish the volumetric changes observed with posterior vault distraction osteogenesis in the anterior, middle, and posterior thirds of the cranial vault; characterize change in cranial length, width, and height, correlating these changes to demographic variables that may help identify why younger kids gain more volume; and describe the short-term position of the transport segment. METHODS: Multisuture craniosynostosis patients who underwent posterior vault distraction osteogenesis were retrospectively reviewed. Pediatric, dose-reduced, thin cut helically acquired head computed tomography scans were analyzed on Materialise Mimics v22 (Materialise, Ghent, Belgium). Pre and post-PVDO and "old" and "young" cohort were compared. RESULTS: Twenty-one patients met inclusion criteria. The change in cranial length was significantly less at a median of 14.9 mm [Interquartile range (IQR) 11.8, 31.6] compared to the X-ray measured AP distraction distance (30 mm [IQR 24, 33]; P < 0.001) and significantly less than the theoretically calculated distance (23 mm [IQR 19, 31]; P = 0.012). Median anterior cranial height was shorter post PVDO (82.9 mm, [IQR 64.8, 92.6] versus 78.7 mm [IQR 57.0, 88.7]; P = 0.030). The younger cohort saw a greater increase in total intracranial volume (median 335.1 mL [IQR 163.2, 452.3, median 37.1%] versus 144.6 mL [IQR 119.0, 184.8, median 12.0%]; P = 0.011). CONCLUSIONS: This is the first study to quantify volumetric changes to the anterior, middle, and posterior cranial vaults and demonstrates benefits of preforming PVDO at a younger age to help control turricephaly and produce greater percentage volumetric increases.

Assuntos

Craniossinostoses , Osteogênese por Distração , Cefalometria , Criança , Craniossinostoses/diagnóstico por imagem , Craniossinostoses/cirurgia , Humanos , Lactente , Estudos Retrospectivos , Crânio/diagnóstico por imagem , Crânio/cirurgia

RESUMO

Congenital sphenoid wing dysplasia is one of the major diagnostic criteria for neurofibromatosis type 1, and is often considered pathognomonic for the disease. Between 5% and 12% of neurofibromatosis type 1 cases have evidence of sphenoid wing dysplasia. Sequelae of this deficiency include slow expansion of the middle temporal fossa and progressive herniation of the temporal lobe into the orbital cavity, resulting in pulsatile exophthalmos. Herein, we report a patient with greater sphenoid wing agenesis and middle temporal fossa enlargement requiring transcranial orbital reconstruction in the absence of neurofibromatosis. To our knowledge, this represents a novel craniofacial phenotype of sphenoid wing agenesis in the absence of neurofibromatosis previously not described in the literature.

Assuntos

Anormalidades Craniofaciais , Osteogênese por Distração , Osso e Ossos , Anormalidades Craniofaciais/cirurgia , Previsões , Humanos , Osteogênese

RESUMO

Infection with Zika virus is an emerging public health crisis. We observed prolonged detection of virus RNA in vaginal mucosal swab specimens and whole blood for a US traveler with acute Zika virus infection who had visited Honduras. These findings advance understanding of Zika virus infection and provide data for additional testing strategies.

Assuntos

RNA Viral/sangue , Vagina/virologia , Infecção por Zika virus/virologia , Adulto , Animais , Chlorocebus aethiops , Meios de Cultivo Condicionados/química , Feminino , Honduras , Humanos , RNA Viral/urina , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Saliva/virologia , Fatores de Tempo , Viagem , Estados Unidos , Vagina/metabolismo , Células Vero , Zika virus/genética , Zika virus/crescimento & desenvolvimento , Infecção por Zika virus/sangue , Infecção por Zika virus/fisiopatologia , Infecção por Zika virus/urina