Unilateral Deformity Research Articles

Euclidean distance matrix analysis of surgical changes in prepubertal craniofacial microsomia patients treated with an inverted L osteotomy.

Correction of craniofacial microsomia (CFM) presents several challenges concerning the modality of surgical intervention. The aim of this study was to assess early and late surgical outcome, by undertaking Euclidean distance matrix analysis (EDMA) of CFM patients exhibiting an unilateral mandibular deformity that was surgically corrected by an inverted L osteotomy and autogenous bone graft. Longitudinal study. Preoperative, approximately =1-year postoperative and approximately 3-year postoperative assessments of 14 consecutive children (mean age 9 years) with CFM. Posteroanterior cephalographs were scanned and five homologous mandibular landmarks were digitized in triplicate (< 1% digitization error). Average mandibular geometries, scaled to an equivalent size, were generated using a generalized rotational fit program (Procrustes superimposition) and subjected to EDMA. The mean pre- and both postoperative mandibular configurations differed statistically (p < .01). Early postoperative improvements in mandibular form were noted; increases in length arising in the treated mandibular body (approximately =19%) and ramus (approximately =13%). Comparing early and late postoperative configurations, a decrease of approximately =22% in the late postoperative mandibular body length was evident, but the ramus maintained steady vertical growth (approximately =7%). Comparing the preoperative and late postoperative configurations, the decrease observed in the mandibular body on the treated side was reduced to approximately =8% while the ramus maintained good growth (approximately =20%) on that side. Mandibular morphology is improved significantly in CFM patients surgically treated by an inverted L osteotomy, but relapse in the mandibular body is evident after approximately =3 years. Nevertheless, ramus growth proceeds well after the surgical reconstruction.

Distraction osteogenesis: a new surgical technique for use with the multiplanar mandibular distractor.

If distraction osteogenesis is to reach its full potential and achieve the level of accuracy that is possible with orthognathic surgery, its outcomes need to be as predictable. To this end, the authors developed a planning process for distraction osteogenesis similar to that used in orthognathic surgery. However, the success of the planning process depends on the authors' ability to execute the plan at the time of surgery. As a result, the authors needed to develop a surgical technique that would enable them to precisely install the distractor as indicated in the presurgical plan. The surgical technique presented in this article was developed for this purpose. The authors used this technique in seven patients (four boys and three girls; age range, 4 to 10 years). Four patients presented with unilateral deformities, and three patients presented with bilateral deformities. The follow-up period in this group of patients ranged from 12 to 33 months. The purpose of the technique is to replicate the position of the distractor on the mandible as determined by the presurgical plan. To this purpose, a custom drill guide and a surgical template have been developed. Both of these are used following the principles of triangulation to establish the pin position and orientation of the distractor. In the authors' hands, the use of this surgical technique has resulted in outcomes close to those predicted by the planning process.

Unilateral external fixators in the correction of deformities of the extremities

The introduction of joints in unilateral fixators enables these for multiple deformity corrections. Lengthening and shortening is achieved by changing the length of the fixator telescope. Axial corrections are performed by additive or subtractive techniques using uniplanar joints or by angulation procedures. Translation is done by direct movements of the bone fragments or by metaphyseal "double angulation". Derotation preferably is done as an acute procedure or in the "ring part" of a hybrid frame. Unilateral fixators are used to correct and temporarily stabilize until the correction is held by the intramedullary nail.

The Use of Nasal Splints in the Primary Management of Unilateral Cleft Nasal Deformity. Yeow VK, Chen PK, Chen YR, et al. Plast Reconstr Surg 103:1347, 1999

The Use of Nasal Splints in the Primary Management of Unilateral Cleft Nasal Deformity. Yeow VK, Chen PK, Chen YR, et al. Plast Reconstr Surg 103:1347, 1999

Unilateral sensorineural hearing loss and its aetiology in childhood: the contribution of computerised tomography in aetiological diagnosis and management

Objectives: The objective of this study was to identify factors correlated with the CT outcome and to examine the contribution of the CT scan in the aetiological diagnosis and management of unilateral sensorineural hearing loss in childhood. Methods: The records of 35 consecutively investigated patients by the Audiology Department of Great Ormond Street Hospital between January 1996 and June 1998 were reviewed. The CT results, population sample characteristics, initiation of further investigations after the CT results and management decisions based on the CT results were tabulated and analysed. Results: In a series of 35 consecutively investigated children with unilateral sensorineural hearing loss, 11 CT scans were identified as abnormal. The CT findings were: labyrinthitis ossificans (3), unilaterally dilated vestibular aqueduct (2), bilaterally dilated vestibular aqueduct (2), unilateral deformity of the cochlea (‘Mondini’) (1), unilateral severe labyrinthine dysplasia (1), unilateral markedly narrow internal acoustic meatus (1), bilaterally dilated lateral semicircular canals (1). The presence of progressive hearing loss was a significant predictor of abnormal CT outcome, while the severity of hearing loss was not. The CT scans offered valuable information regarding the aetiological diagnosis in all cases and, in addition, prompted the appropriate vestibular rehabilitation in three cases, further investigations in four (with dilated vestibular aqueduct) and hearing preservation counselling in two (bilateral DVA) (seven out of 35=20%). Conclusion: All children with unilateral sensorineural hearing loss should have a CT scan of the petrous pyramids/IAMs performed at some stage, as not only aetiology but also prognosis and management of these cases may be significantly influenced by the CT outcome.

The use of nasal splints in the primary management of unilateral cleft nasal deformity.

Primary surgical correction of the cleft lip nasal deformity is routinely performed at the Craniofacial Center at Chang Gung Memorial Hospital. Over time, however, there is a tendency for the lower lateral cartilage to retain its memory and, subsequently, recreate the preoperative nasal deformity. Therefore, it is current practice to use a nostril retainer for a period of at least 6 months to maintain the corrected position of the nose. The aim of this study was to qualitatively assess the benefit of postoperative nasal splinting in the primary management of unilateral cleft nasal deformity. Data from two groups of 30 patients with complete unilateral cleft lips each were retrospectively collected and analyzed. The first group served as a control (no nasal splints), and the second group used the nasal retainer compliantly for at least 6 months postoperatively. All patients had their primary lip repair at 3 months of age. A photographic evaluation of the results when the patients were between 5 and 8 years of age was conducted. The parameters used to assess the nasal outcome were nostril symmetry, alar cartilage slump, alar base level, and columella tilt. The first scores were based on residual nasal deformity, and the second set were based on overall appearance. It was found that the mean scores of residual nasal deformity for all four parameters in patients who used the nasal stent were statistically better than the scores of patients who did not (p values ranged from 0.0001 to 0.005). The overall appearance scores for the four parameters in the patients who used the nasal stent after surgery were also statistically better than the scores for those who did not (p values ranged from 0.0001 to 0.01). The results show that postoperative nasal splinting in the primary management of the unilateral cleft nasal deformity serves to preserve and maintain the corrected position of the nose after primary lip and nasal correction, resulting in a significantly improved aesthetic result. Therefore, it is recommended that all patients undergoing primary correction of complete unilateral cleft deformity use the nasal retainer postoperatively for a period of at least 6 months.

The Surgical Technique for the Unilateral Cleft Lip-Nasal Deformity: Operative Videotape and Syllabus.

The Surgical Technique for the Unilateral Cleft Lip-Nasal Deformity: Operative Videotape and Syllabus.

Computer-aided navigation in secondary reconstruction of post-traumatic deformities of the zygoma

Augmented reality technology was used in 5 patients for secondary reconstruction of post-traumatic unilateral deformities of the zygomaticomaxillary complex. Three electromagnetic sensors interfaced to a computer-aided navigation system (ARTMA Biomedical Inc.) were utilized. The computer navigation procedure was planned by drawing graphic lines on the CT scan at the level of the zygomatic arch, representing the outer surface of the zygoma. The desired position of the displaced zygoma was planned by mirroring from the healthy side, using a virtual mid-sagittal plane. These virtual graphics were presented intraoperatively on a TV monitor and also on the surgeon's see-through head-mounted display. Correct reduction was assumed when the virtual line representing the position of the zygoma before the osteotomy reached the virtual line defined preoperatively as the desired position. The advantages of the technique presented are that a complete exposure of the zygomatic bone is no longer necessary, and coronal and subciliary incisions may be avoided unless enophthalmos correction has to be carried out, which was in fact necessary in 2 patients. The results of zygomatic reconstruction have been satisfactory in all 5 patients.

The Lambda Flap for Secondary Cleft Lip Repair

A modified Abbe flap of the lambda figure type, designed by the author and used before or after secondary cleft lip repair in 146 consecutive cases since 1990 is described.This series consisted of 71 cases with unilateral deformity and 75 cases with bilateral deformity at adolescent or adult ages. The technical details of this method and representative cases with the results are shown. The philtrum is created by incising the two branches of the lambda flap obliquely at 45 degrees to the skin surface in the lower lip, then matching them in the central recipient bed of the deficient upper lip.The resultant upper lip is not only full and slack, but also attractive with an acute cubic contour of the philtrum. Furthermore, the residual scar at the donor site is concealed in the mentolabial fold.

The Lambda Flap for Secondary Cleft Lip Repair

A modified Abbe flap of the lambda figure type, designed by the author and used before or after secondary cleft lip repair in 146 consecutive cases since 1990 is described. This series consisted of 71 cases with unilateral deformity and 75 cases with bilateral deformity at adolescent or adult ages. The technical details of this method and representative cases with the results are shown. The philtrum is created by incising the two branches of the lambda flap obliquely at 45 degrees to the skin surface in the lower lip, then matching them in the central recipient bed of the deficient upper lip. The resultant upper lip is not only full and slack, but also attractive with an acute cubic contour of the philtrum. Furthermore, the residual scar at the donor site is concealed in the mentolabial fold.

Quantification of the radial torsion angle with computerized tomography in cadaver specimens.

Torsion of a long bone is the twist along its longitudinal axis; torsion of the radius is defined by the angle between the proximal and distal metaphyses in the transverse plane. Measurement of the radial torsion angle provides a means of detection and quantification of malrotation after a fracture. The purpose of the current study was to develop and standardize a technique for the measurement of torsion of the radius. Axial computerized tomographic images of thirty-nine pairs of dry cadaver specimens of normal radii, and an additional four pairs of radii with a unilateral deformity of the distal metaphysis that was consistent with a previous fracture, were studied and a measurement protocol was established. The radial torsion angle was measured by three independent observers on two separate occasions. Reproducibility of the technique was determined with use of the intraclass correlation coefficient to express both interobserver and intraobserver reliability. Consistency of measurements between observers and by the same observer was high, with intraclass correlation coefficients ranging from 0.87 to 0.94. The mean torsion angle for the eighty-two normal radii in the study was 32.6 degrees (95 per cent confidence interval of the mean, 30.3 to 34.9 degrees; range, 1.4 to 58.8 degrees). There were small variations in torsion angle between the two radii of each normal pair (mean side-to-side difference, 4.9 degrees; 95 per cent confidence interval of the mean, 3.5 to 6.3 degrees). The mean torsion angle of the four radii with a malunited fracture was 10.4 degrees (95 per cent confidence interval of the mean, 5.7 to 15.1 degrees), and the mean side-to-side difference in the pairs containing these radii was 24.1 degrees (95 per cent confidence interval of the mean, 8.5 to 39.6 degrees; p < 0.0001 compared with the normal radii).

Modification of the Abbé flap for reconstruction of the vermilion tubercle and Cupid's bow in cleft lip patients

Purpose: This article reports on the modification of the Abbé flap for correction of mild tightness of the corrected cleft lip deformity. Patients and Methods: Twelve patients with a moderately tight lip deformity, from 16 to 35 years old, underwent this procedure. Nine had a unilateral deformity and 3 a bilateral deformity. The flap, which was taken from the central portion of the lower lip vermilion, was designed to repair the vermilion tubercle and the Cupid's bow. A tiny portion of skin was included to facilitate closure of the donor site. It was inserted into the center of the upper lip and the pedicle was divided 1 week after operation. Results: Each patient showed a more natural contour of the vermilion tubercle and the Cupid's bow. The scarring of the donor site was inconspicuous. Conclusions: Use of modified Abbé flap to reconstruct the contour of the vermilion tubercle and the Cupid's bow makes the upper lip look more natural.

Clinical screening for congenital dislocation of the hip.

The hips of 20,417 newborns were examined within the first three days after birth and at the age of two to three months, from 1985 to 1990. One hundred and twenty-four children had abnormal findings in one or both hips and treatment was instituted. After an average duration of follow-up of six years (range, four to nine years), 122 (98 per cent) of the children had normally developed hip joints. One child had unilateral deformity of the femoral head due to ischemia, and another had bilateral anteversion as the only abnormal finding. A survey of the medical records of the only orthopaedic clinic in Stara Zagora that has a pediatric ward in which patients with hip problems are managed revealed no cases of congenital dislocation of the hip diagnosed after the age of three months in the infants born from 1985 to 1990. Clinical screening for congenital dislocation of the hip was effective in this group of patients, and a good result was noted in all but two patients who were treated for such a dislocation. Thus, a screening program is of value in the examination of all infants.

An anomalous muscle in children with congenital talipes

An anomalous calf flexor muscle has been observed in five children (involving 7 feet) in 125 surgical corrections of congenital talipes equinovarus deformity (5.6%). The sex, frequency of bilateral to unilateral deformity, position of the child in the family, maternal age, birth weight, gestation period, and type of delivery did not distinguish these children from those without the anomalous muscle, but they did have a greater frequency of first-degree relatives with talipes. © 1996 Wiley-Liss, Inc.

An anomalous muscle in children with congenital talipes.

An anomalous calf flexor muscle has been observed in five children (involving 7 feet) in 125 surgical corrections of congenital talipes equinovarus deformity (5.6%). The sex, frequency of bilateral to unilateral deformity, position of the child in the family, maternal age, birth weight, gestation period, and type of delivery did not distinguish these children from those without the anomalous muscle, but they did have a greater frequency of first-degree relatives with talipes.

Associated changes in the function of both feet in patients with unilateral foot deformity

Associated changes in the function of both feet in patients with unilateral foot deformity

A controlled prospective trial of a foot orthosis for juvenile hallux valgus

In a survey of 6000 children between 9 and 10 years of age, 122 were found to have unilateral or bilateral hallux valgus. These children were randomly assigned to no treatment or to the use of a foot orthosis. About three years later 93 again had radiography. The metatarsophalangeal joint angle had increased in both groups but more so in the treated group. During the study, hallux valgus developed in the unaffected feet of children with unilateral deformity, despite the use of the orthosis.

Monobloc Correction of External Nasal Deviations

Nine patients (7 men, 2 women) with external nasal deviation underwent corrective procedures using a monobloc nasal osteotomy technique. The deformities ranged from mild to severe. Eight patients had post-traumatic deviations, whereas 1 had a unilateral cleft nasal deformity. For this monobloc technique, osteotomies were performed at unequal levels to correct the height difference, no periosteal undermining was performed, and septal dissection was undertaken only after monobloc repositioning. There was no need for grafts or microplate fixation. Minimum follow-up was 8 months. All patients had improvement in their external deviation, 1 patient was mildly undercorrected, and only 1 patient (cleft nasal) required a radical submucosal resection.

Development of a strain of rabbits with congenital simple nonsyndromic coronal suture synostosis. Part I: Breeding demographics, inheritance pattern, and craniofacial anomalies.

The lack of an animal model of congenital coronal suture (CS) synostosis has prompted the widespread use of an experimental rabbit model using adhesive immobilization of the CS. Such postnatal models have helped make significant scientific contributions but may still not fully represent all aspects of the human congenital condition. In the March 1993 issue of The Cleft Palate-Craniofacial Journal we reported a female rabbit born in our laboratory with complete bilateral CS synostosis. This follow-up study presents our attempts to breed this animal and establish a strain of craniosynostotic rabbits. To date, we have accomplished 10 back- and intercrosses with these animals and have produced a total of 71 live offspring; 10 animals exhibited complete nonsyndromic unilateral (plagiocephalic) or bilateral (brachycephalic) CS synostotic deformities at birth, and 19 animals exhibited partial CS synostosis that showed more than 75% growth retardation across the CS (well below the 95% confidence interval for normals). Results revealed that gestational time and litter size averages were consistent with those reported for the strain, although the average litter size decreased with increased inbreeding. By 1.5 weeks of age the completely synostosed animals already exhibited brachycephalic cranial vaults and midfacial hypoplasia compared to unaffected siblings. Initial pedigree analysis suggested an autosomal dominant inheritance pattern with incomplete penetrance and variable expressivity. The development of such a congenital rabbit model may prove useful in helping to understand the etiopathogenesis of this condition in human populations.

Primary Nasoplasty In Unilateral And Bilateral Cleft Nasal Deformity

A six-step nasoplasty for the primary correction of the unilateral and bilateral cleft nasal deformity is presented. A review of the evolution of primary nasal reconstruction and preliminary results of the method are described and illustrated.