Craniofacial Field Research Articles

Impact of Gender-Affirming Surgery on Craniofacial Exposure for Plastic and Reconstructive Surgery Training: A Preliminary, Single-Institution Study

Objective: Current available plastic surgery positions in craniofacial surgery are not commensurate with the growing number of trained plastic surgery residents and fellows interested in the field. Despite this, there is growing demand for surgery in other areas of the craniofacial field, such as facial gender-affirming surgery (GAS), in which academic plastic surgery programs can increase resident and fellow case exposure. The present study sought to characterize the increase in craniofacial surgery exposure with the introduction of a GAS rotation among plastic surgery residents at one academic medical center. Methods: A single-center retrospective review of ten plastic surgery resident case logs between 2013 and 2021 was carried out. Case logs were evaluated for case frequency per year in craniofacial surgery and breast reconstruction surgery, which was used as a control. Case frequency was compared before and after the introduction of the GAS rotation in 2017. Results: Craniofacial surgery exposure increased from an average of 26 to 45 cases per resident per year after the introduction of a GAS rotation and overall increased from 17 to 29 cases per year. The average breast reconstruction caseload remained similar at the same time, from an average of 37 to 36 cases per year per resident. Conclusions: The introduction of a GAS rotation at one institution increased craniofacial surgery exposure for plastic surgery residents. Increasing craniofacial surgery exposure is crucial in the competitive landscape for job opportunities, further increasing resident exposure to the transgender and gender-diverse population, and expanding care for this patient population.

3D-printed porous polyether-ether-ketone composite scaffolds for better osteogenic activity

Due to excellent biocompatibility and favorable mechanical properties, polyether-ether-ketone (PEEK) scaffolds are becoming the next-generational orthopaedic implants, but the bioinertness limits their application. In this study, to improve the osteogenic activity of PEEK scaffolds, porous composite scaffolds containing PEEK and biphasic calcium phosphate (BCP) were achieved by 3D printing, which exhibited equilateral triangular profile with the porosity of 69.4 ± 6.3 % and elastic modulus of 186.2 ± 10.9 MPa. The EDS mapping images and XPS spectra indicated increased P and Ca elements in PEEK-BCP scaffolds. The results of in vitro and in vivo evaluations demonstrated that the introduction of BCP significantly increased the osteogenic capacity of PEEK scaffolds and the obvious bone ingrowth could be observed. In conclusion, compared with pure PEEK scaffolds, PEEK-BCP scaffolds with better osteogenic activity are more promising in the orthopaedic and craniofacial field.

Surgery for Craniosynostosis: Developing a Psychosocial Booklet for Families.

Parents of children with craniosynostosis may experience psychological distress, particularly during intensive periods of treatment. Yet, recent research indicates parents may not be accessing the support they need to cope with common challenges. The aim was to develop an evidence-based booklet to promote psychological health in families undergoing surgery and to assess the acceptability of the booklet among the craniosynostosis community. Researchers collaborated with UK charity Headlines Craniofacial Support, 5 parent representatives, and 2 specialist clinical psychologists to develop the booklet based on data obtained from online focus groups, individual interviews, and written accounts. The draft booklet was attached to an online acceptability survey and distributed to a broader group of parents and multidisciplinary craniofacial specialists for feedback. A total of 52 complete responses to the online acceptability survey were received, and acceptability (measured by the number of respondents who would recommend the booklet) was 100%. All respondents supported the UK-wide distribution of the booklet. Evidence for psychological intervention in the craniofacial field remains scarce, and specialist teams may be under-resourced to effectively screen and support families. It is hoped this booklet can begin to address the gap in psychological support for families affected by craniosynostosis.

Antibacterial and osteoinductive properties of wollastonite scaffolds impregnated with propolis produced by additive manufacturing

Biocompatible ceramic scaffolds offer a promising approach to address the challenges in bone reconstruction. Wollastonite, well-known for its exceptional biocompatibility, has attracted significant attention in orthopedics and craniofacial fields. However, the antimicrobial properties of wollastonite have contradictory findings, necessitating further research to enhance its antibacterial characteristics. This study aimed to explore a new approach to improve in vitro biological response in terms of antimicrobial activity and cell proliferation by taking advantage of additive manufacturing for the development of scaffolds with complex geometries by 3D printing using propolis-modified wollastonite. The scaffolds were designed with a TPMS (Triply Periodic Minimal Surface) gyroid geometric shape and 3D printed prior to impregnation with propolis extract. The paste formulation was characterized by rheometric measurements, and the presence of propolis was confirmed by FTIR spectroscopy. The scaffolds were comprehensively assessed for their mechanical strength. The biological characterization involved evaluating the antimicrobial effects against Staphylococcus aureus and Staphylococcus epidermidis, employing Minimum Inhibitory Concentration (MIC), Zone of Inhibition (ZOI), and biofilm formation assays. Additionally, SaOs-2 cultures were used to study cell proliferation (Alamar blue assay), and potential osteogenic was tested (von Kossa, Alizarin Red, and ALP stainings) at different time points. Propolis impregnation did not compromise the mechanical properties of the scaffolds, which exhibited values comparable to human trabecular bone. Propolis incorporation conferred antibacterial activity against both Staphylococcus aureus and Staphylococcus epidermidis. The implementation of TPMS gyroid geometry in the scaffold design demonstrated favorable cell proliferation with increased metabolic activity and osteogenic potential after 21 days of cell cultures.

Exploring the Effects of Low-Level Laser Therapy on the Cytocompatibility and Osteo/Odontogenic Potential of Gingival-Derived Mesenchymal Stem Cells: Preliminary Report

Numerous tissue engineering uses for gingival-derived mesenchymal stem cells (GMSCs) have been demonstrated. Recently, low-level laser therapy (LLLT) has been projected as a factor that can improve MSCs’ regeneration capacity. Therefore, the aim of this research was to examine the impact of LLLT at 1.5 J/cm2 and 3 J/cm2 on the viability and osteo/odontogenic potential of GMSCs. An MTT assay was performed to detect viability. Osteo/odontogenic differentiation was evaluated using Alizarin Red S staining and qRT-PCR for the evaluation of the RUNX2, OC, DMP1, and DSPP genes. A two-way ANOVA with Tukey’s post hoc test was used to determine the statistical significance between groups. The results revealed that LLLT of both energy densities had no cytotoxic effect on GMSC viability. LLLT of 1.5 J/cm2 demonstrated better viability than the higher energy density (3 J/cm2). Furthermore, the osteo/odontogenic differentiation potential was promoted following LLLT radiation, where both groups exhibited mineralized nodule formation, with the low-energy laser having a significantly higher Alizarin Red S stain level. A qRT-PCR analysis revealed higher expression levels of osteogenic and odontogenic markers in the LLLT groups compared to the control group. In conclusion, this study showed the potential application of LLLT as a non-toxic and effective strategy to enhance the regenerative capacity of GMSCs for tissue engineering and clinical treatments in the oral and craniofacial fields.

Advances and Prospects in Materials for Craniofacial Bone Reconstruction.

The craniofacial region is composed of 23 bones, which provide crucial function in keeping the normal position of brain and eyeballs, aesthetics of the craniofacial complex, facial movements, and visual function. Given the complex geometry and architecture, craniofacial bone defects not only affect the normal craniofacial structure but also may result in severe craniofacial dysfunction. Therefore, the exploration of rapid, precise, and effective reconstruction of craniofacial bone defects is urgent. Recently, developments in advanced bone tissue engineering bring new hope for the ideal reconstruction of the craniofacial bone defects. This report, presenting a first-time comprehensive review of recent advances of biomaterials in craniofacial bone tissue engineering, overviews the modification of traditional biomaterials and development of advanced biomaterials applying to craniofacial reconstruction. Challenges and perspectives of biomaterial development in craniofacial fields are discussed in the end.

Our problems and observations in 3D facial implant planning

BackgroundThree-dimensional renderings of two-dimensional computed tomography data have allowed for more precise analysis in the craniofacial field. Design, engineering, architecture, and other industries have paved the way for the manipulation and printing of three-dimensional objects.The usual planning is only carried out based on the bony structures, often without taking into consideration the presence of soft tissues and soft structures. During our practice, we have found ourselves facing the challenge posed by these structures; the aim of this article is to discuss our experience in designing implants presenting our tips and tricks for a better planning leading to an easy and reliable positioning.Case presentationWe have retrieved all patients in 5 years among those who underwent computer-aided design/computer-aided manufacturing implant placement in the last 5 years in order to review the eventual problems and the solutions found.A total number of 25 patients were retrieved and, among them, 10 patients were selected, in which planning inaccuracy caused difficulties during implant placement and which then led to induced changes during the planning of similar cases or in which the problems were noted before or during the planning which led to changes in the plan to address those problems.Six of the selected cases were polyetheretherketone facial implants for the correction of residual deformities in malformed or deformed patients.One case was a delayed orbital reconstruction with a titanium implant.Two cases were titanium functional and anatomical reconstruction of the mandible in patients with failed post-oncological reconstructions.There was 1 case with a mandibular ramus complex and hard-to-treat fracture.ConclusionsThe planning of the implant mostly relies on hard tissue three-dimensional reconstruction, but it should not be limited at what is immediately evident. A surgeon’s clinical experience should always guide the process, with knowledge of the patient’s anatomy and evaluation of the quality and of the soft tissue response being taken into consideration. The implant should always be tailored not only based on the bone defect and evaluations but also using the patient’s previewed and actual anatomy, evaluating eventual interferences and pitfalls.

A Booklet to Promote Psychological Health in New Families Affected by Craniosynostosis.

Recent research indicates that parents of children with craniosynostosis may be at risk of emotional distress. Yet, parents may not be accessing the support they need to cope with common challenges. The aim of this project was to develop a research-informed booklet to promote psychological health in new families, and to assess acceptability of the booklet within the craniosynostosis community. The first draft was designed in close collaboration with leading UK charity Headlines Craniofacial Support 5 parent representatives, and 3 specialist clinical psychologists via online focus groups. The draft booklet, attached to an online acceptability survey, was distributed to a broader group of parents and multidisciplinary specialists working in craniofacial teams in England for feedback. A total of 44 complete responses to the online acceptability survey were received. Acceptability (measured by the number of respondents who would recommend the booklet) was 100%. All respondents reported they "agreed" or "strongly agreed" with the UK-wide distribution of the booklet. Evidence for psychological intervention in the craniofacial field remains scarce, and specialist teams may be under-resourced to effectively screen and support parents. It is hoped this booklet will begin to address the gap in psychological support for new families affected by craniosynostosis.

An Observational Study on Cephalometric Characteristics and Patterns Associated with the Prader–Willi Syndrome: A Structural Equation Modelling and Network Approach

Examining specific patterns of major cranio-facial alterations through cephalometric measurements in order to improve the Prader–Willi (PWS) syndrome diagnostic poses a major challenge of identifying interlinkages between numerous credentials. These interactions can be captured through probabilistic models of conditional independence between heterogeneous variables. Our research included 18 subjects (aged 4 to 28 years) genetically diagnosed with Prader–Willi syndrome and a healthy control group (matched age and sex). A morphometric and cephalometric analysis was performed upon all the subjects in order to obtain the needed specific data. We have, therefore, firstly deployed several integrated Gaussian graphical models (GGMs) to capture the positive and negative partial correlations and the intensity of the connections between numerous credentials configured to determine specific cranio-facial characteristics of patients with PWS compared to others without this genetic disorder (case-control analysis). Afterwards, we applied structural equation modelling (SEM) with latent class analysis to assess the impact of these coordinates on the prevalence of the Prader–Willi diagnostic. We found that there are latent interactions of features affected by external variables, and the interlinkages are strapping particularly between cranial base (with an important role in craniofacial disharmonies) and facial heights, as important characteristic patterns in determining the Prader–Willi diagnostic, while the overall patterns are significantly different in PWS and the control group. These results impact the field by providing an enhanced comprehensive perspective on cephalometric characteristics and specific patterns associated with Prader–Willi syndrome that can be used as benchmarks in determining the diagnostic of this rare genetic disorder. Furthermore, the two innovative exploratory research tools applied in this paper are very useful to the craniofacial field to infer the connections/dependencies between variables (particularly biological variables and genes) on cephalometric characteristics and specific patterns associated with Prader–Willi syndrome.

Isolation and Time-Lapse Imaging of Primary Mouse Embryonic Palatal Mesenchyme Cells to Analyze Collective Movement Attributes.

Development of the palate is a dynamic process, which involves vertical growth of bilateral palatal shelves next to the tongue followed by elevation and fusion above the tongue. Defects in this process lead to cleft palate, a common birth defect. Recent studies have shown that palatal shelf elevation involves a remodeling process that transforms the orientation of the shelf from a vertical to a horizontal one. The role of the palatal shelf mesenchymal cells in this dynamic remodeling has been difficult to study. Time-lapse-imaging-based quantitative analysis has been recently used to show that primary mouse embryonic palatal mesenchymal (MEPM) cells can self-organize into a collective movement. Quantitative analyses could identify differences in mutant MEPM cells from a mouse model with palate elevation defects. This paper describes methods to isolate and culture MEPM cells from E13.5 embryos-specifically for time-lapse imaging-and to determine various cellular attributes of collective movement, including measures for stream formation, shape alignment, and persistence of direction. It posits that MEPM cells can serve as a proxy model for studying the role of palatal shelf mesenchyme during the dynamic process of elevation. These quantitative methods will allow investigators in the craniofacial field to assess and compare collective movement attributes in control and mutant cells, which will augment the understanding of mesenchymal remodeling during palatal shelf elevation. Furthermore, MEPM cells provide a rare mesenchymal cell model for investigation of collective cell movement in general.

South African speech-language therapists’ opinion of their training in cleft lip and palate and craniofacial deformities

BackgroundSpeech care of cleft lip and/or palate (CLP) and craniofacial deformities (CFD) is complex and lengthy and requires collaboration amongst different disciplines. Consequently, it is important to provide academic educational models that include didactics, online learning and clinical exposure in CLP and CFD treatment, and participation in established cleft palate multidisciplinary team management.ObjectivesTo obtain information regarding: (1) the perceived adequacy of CLP and CFD academic education of speech-language therapists (SLTs); (2) the professional services that SLTs offer to CLP and CFD patients; and (3) the educational needs of SLTs in this field.MethodA 54-item online survey to collect quantitative data was conducted by telephone and email using a randomised sample of SLTs in different areas of South Africa.ResultsThe questionnaire was completed by 123 SLTs, 70% of whom had more than 10 years of professional experience. Of the respondents, 81% acknowledged their limited clinical exposure during their academic education. Only 42% of the professionals offer treatment for CLP and CFD patients. Of the respondents, 96% agreed on the need to improve CLP and CFD academic education, and the majority recommended certified courses, continued-education workshops and online resources.ConclusionThe findings indicate that SLTs academic training is perceived to be significantly limited in the cleft palate and craniofacial fields. Thus, there is a strong need at the undergraduate level for clinical training and exposure to multidisciplinary management. At post-graduate level there is a need to establish an educational strategy to meet the needs of SLTs providing CLP and CFD care. Participants suggested that programmes for continuing professional education, degree courses and online resources be designed to provide practising clinicians with updated information and guidance in management of CLP and CFD patients.

Titanium Surface Properties Influence the Biological Activity and FasL Expression of Craniofacial Stromal Cells.

Mesenchymal stromal cells (MSCs) can be easily isolated form craniofacial bones during routine dentistry procedures. Due to their embryological origin from neural crest, they represent a suitable cell population to study cell-biomaterial interaction in the craniofacial field, including osteoinductive/osteointegrative processes. The biological and immunomodulatory properties of MSCs may be influenced by chemistry and topography of implant surfaces. We investigated if and how three different titanium surfaces, machined (MCH), sandblasted with resorbable blasting medium (RBM), and Ca++-nanostructured (NCA), may affect biological activity, osseointegration, and immunomodulatory properties of craniofacial MSCs. Cell proliferation, morphology, osteogenic markers, and FasL were evaluated on MSCs isolated from the mandibular bone after seeding on these three different surfaces. No statistically significant differences in cell proliferation were observed whereas different morphologies and growth patterns were detected for each type of surface. No difference in the expression of osteogenic markers was revealed. Interestingly, FasL expression, involved in the immunomodulatory activity of stem cells, was influenced by surface properties. Particularly, immunofluorescence analysis indicated that FasL expression increased on MCH surface compared to the others confirming the suggested role of FasL in promoting osteogenic differentiation. Titanium surface treatments and topography might reflect different biological behaviours of craniofacial MSCs and influence their osseointegration/immunomodulation properties.

Effects of PMMA and Cross-Linked Dextran Filler for Soft Tissue Augmentation in Rats.

This study was conducted for evaluation of the ability to maintain efficacy and biocompatibility of cross-linked dextran in hydroxypropyl methylcellulose (DiHM) and cross-linked dextran mixed with PMMA in hydroxypropyl methylcellulose (PDiHM), compared with hyaluronic acid (HA) filler. Saline and HA solution was administered in the negative and positive control groups, and DiHM and PDiHM were administered in the test groups (n = 10 in each group). The site of cranial subcutaneous injection was the mid-point of the interpupillary line, and the site of intraoral submucosal injection was the ridge crest 2 mm below the cervical line of the mandibular left incisor. Before and immediately after filler injection, intraoral photos and lateral cephalometric radiographs were taken for analysis and comparison of the effect of the filler on the injection sites. The filler injected areas were converted into sequential size changes (%) of the baseline. Histomorphologic examination was performed after 12 weeks. The smallest value in the filler injected area was observed during the experimental period in the normal saline group (p < 0.001), which was almost absorbed at 4 weeks (7.19% ± 12.72%). The HA group exhibited a steady decrease in sequential size and showed a lower value than the DiHM and PDiHM groups (saline < HA < DHiM, PDHiM, p < 0.001). DiHM and PDiHM tended to increase for the first 4 weeks and later decreased until 12 weeks. In this study on DiHM and PDiHM, there was no histological abnormality in cranial skin and oral mucosa. DiHM and PDiHM filler materials with injection system provide an excellent alternative surgical method for use in oral and craniofacial fields.

3D Printed Titanium Implant for the Skull Reconstruction: A Preliminary Case Study

The skull defect can be made after the trauma, oncologic problems or neurosurgery. The skull reconstruction has been the challenging issue in craniofacial fields for a long time. So far the skull reconstruction with autogenous bone would be the standard. Although the autogenous bone would be the ideal one for skull reconstruction, donor site morbidity would be the inevitable problem in many cases. Meanwhile various types of allogenic and alloplastic materials have been also used. However, skull reconstruction with many alloplastic material have produced no less complications including infection, exposure, and delayed wound healing. Because the 3D printing technique evolved so fast that 3D printed titanium implant were possible recently. The aim of this trial is to try to restore the original skull anatomy as possible using the 3D printed titanium implant, based on the mirrored three dimensional CT images based on the computer simulation. Preoperative computed tomography (CT) data were processed for the patient and a rapid prototyping (RP) model was produced. At the same time, the uninjured side was mirrored and superimposed onto the traumatized side, to create a mirror-image of the RP model. And we fabricated Titanium implant to reconstruct three-dimensional orbital structure in advance, using the 3D printer. This prefabricated Titanium-implant was then inserted onto the defected skull and fixed. Three dimensional printing technique of titanium material based on the computer simulation turned out to be very successful in this patient. Individualized approach for each patient could be an ideal way to manage the traumatic patients in near future.

Endothelial cells regulate neural crest and second heart field morphogenesis.

ABSTRACTCardiac and craniofacial developmental programs are intricately linked during early embryogenesis, which is also reflected by a high frequency of birth defects affecting both regions. The molecular nature of the crosstalk between mesoderm and neural crest progenitors and the involvement of endothelial cells within the cardio–craniofacial field are largely unclear. Here we show in the mouse that genetic ablation of vascular endothelial growth factor receptor 2 (Flk1) in the mesoderm results in early embryonic lethality, severe deformation of the cardio–craniofacial field, lack of endothelial cells and a poorly formed vascular system. We provide evidence that endothelial cells are required for migration and survival of cranial neural crest cells and consequently for the deployment of second heart field progenitors into the cardiac outflow tract. Insights into the molecular mechanisms reveal marked reduction in Transforming growth factor beta 1 (Tgfb1) along with changes in the extracellular matrix (ECM) composition. Our collective findings in both mouse and avian models suggest that endothelial cells coordinate cardio–craniofacial morphogenesis, in part via a conserved signaling circuit regulating ECM remodeling by Tgfb1.

La pro-naso-ethmoïdo-maxillie (PNEM) : une dysmorphose spécifique

Naso-ethmoido-maxillary protrusion (NEMP) is a rare dental and facial dysmorphosis, with excessive growth of basicranium, ethmoid, maxillary, and nasal bones. The clinical presentation includes nasal and upper lip protrusion, telecanthus, a class 2 malocclusion with maxillary protrusion and exoclusion. The craniofacial field is increased in Delaire's analysis. Contrary to isolated maxillary protrusion secondary to membranous ossification dysfunction, NEMP is a constitutional anomaly resulting from an excessive primary growth of the chondrocranium. The therapeutic management of NEMP should take into account these specificities.

Participación chilena en reuniones IADR mundiales, 2001-2012

IntroductionInternational Association for Dental Research (IADR) general session is one of the most important annual congress in the dental and craniofacial field. The aim of this research is to characterize the participation of dental researchers affiliated to Chilean institutions in IADR general sessions over 2001–2012 period. MethodologyBibliometric study. Search was performed in the web platform Conference Exchange™ for IADR, for general sessions from 2001 to 2012, for the term “Chile”, including all presentations with at least one author with an affiliation to some Chilean institutions. The following variables were evaluated: Session, author, institution, international cooperation and topic area. Results158 presentations were found, annual average of 13.2 (15.3), in 87.3% there were 1 to 6 authors per presentation. Major participant institution was Universidad de Chile (43%), followed by Universities of Talca (15.8%), Finis Terrae (11.4%) and los Andes (10.8%); topics with more participations were Periodontology (13.9%), Cariology (12.7%) and Epidemiology (12.7%); 26% of the presentations had participation of foreign institutions. DiscussionThese results reinforce previous bibliometrics reports, but highlight two private universities in the top positions. The assessment of participation in IADR General Sessions is an important index of scientific production of Chilean dentistry, complementing the bibliometric assessments focused on ISI publications, allowing a better understanding of knowledge generation in this field.

Analysis of dental and craniofacial research programs supported by National Natural Science Foundation

Objective To enhance the fund efficiency of dental research programs supported by National Natural Science Foundation (NSFC) and to reveal the achievements and progresses of the funds.Methods The data of programs in dental and craniofacial field supported by NSFC from 1999 to 2006 and completed between 2003 and 2009 were collected based on the final reports by the investigators.The data of personnel training,research publication,patent,awards,and academic communication at domestic and international levels were all collected and analysed. Results There were 307 grants in total,including 185 general programs,73 Young Scientists Funds,13 regional funds,3 Key Programs,1 National Science Fund for Distinguished Young Scholars and 32 others.An average of 4 postgraduate students was trained by each program.In general,the outcomes of general programs were better than those of Young Scientists Fund,and the latter was better than regional fund.There was steady increase each year in the amount of papers published in SCI journals,and about half of the investigators published SCI papers.In addition,9 patents were registered and 13 prizes were won, and the investigators participated 610 domestic and international exchanges.Conclusions The continuously increase of NSFC support in dental field has led to substantial achievement,although patent application,the quality of papers and novel ideas need to be improved. Key words: National Natural Science Foundation; Dental research; Performance analysis

Dental Approach to Craniofacial Syndromes: How Can Developmental Fields Show Us a New Way to Understand Pathogenesis?

The paper consists of three parts. Part 1: Definition of Syndromes. Focus is given to craniofacial syndromes in which abnormal traits in the dentition are associated symptoms. In the last decade, research has concentrated on phenotype, genotype, growth, development, function, and treatment. Part 2: Syndromes before Birth. How can the initial malformation sites in these syndromes be studied and what can we learn from it? In this section, deviations observed in syndromes prenatally will be highlighted and compared to the normal human embryological craniofacial development. Specific focus will be given to developmental fields studied on animal tissue and transferred to human cranial development. Part 3: Developmental Fields Affected in Two Craniofacial Syndromes. Analysis of primary and permanent dentitions can determine whether a syndrome affects a single craniofacial field or several fields. This distinction is essential for insight into craniofacial syndromes. The dentition, thus, becomes central in diagnostics and evaluation of the pathogenesis. Developmental fields can explore and advance the concept of dental approaches to craniofacial syndromes. Discussion. As deviations in teeth persist and do not reorganize during growth and development, the dentition is considered useful for distinguishing between syndrome pathogenesis manifested in a single developmental field and in several fields.

Sublobar dysplasia—A clinicopathologic report after successful epilepsy surgery

We report the clinical presentation, neuroradiologic characteristics, and detailed histopathologic findings in a unique case of drug-resistant focal epilepsy due to sublobar dysplasia (SLD), treated successfully by resection of the malformed cortex. Histopathology with leptomeningeal and subcortical heterotopia, disturbance of cortical lamination and marked cortical and subcortical astrocytosis, but absence of balloon cells, points to a disorder of neuronal migration and organization rather than proliferation in SLD. The additional presence of a lateral proboscis and meningocele in our case as well as further associated callosal and cerebellar anomalies may suggest an etiologic unknown damage of pathways controlling the embryogenesis of craniofacial field processes.