WP Chung O T in Craniofacial Surgery 9781496348265

First page 1 Next page Last page

Operative Techniques in Craniofacial Surgery , 1e Published May 2019

SAMPLE CHAPTER PREVIEW

Visit wisepress.com for more information

When you have to be right

Operative Techniques in Craniofacial Surgery, 1e ISBN 978-1-4963-4826-5 Price £195.00/ €220.00

Part of the best-selling Operative Techniques series, Operative Techniques in Plastic Surgery provides superbly illustrated, authoritative guidance on operative techniques along with a thorough understanding of how to select the best procedure, how to avoid complications and what outcomes to expect. This stand-alone book offers focused, easy-to-follow coverage of injuries and diseases afflicting the craniofacial region, all taken directly from the larger text. It covers nearly all plastic surgery operations for this area that are in current use, and is ideal for residents and physicians in daily practice.

Features include:

Editors and contributors are globally renowned authorities in their respective subspecialties and are known for their surgical expertise. Perfect for a quick preoperative review of the steps of a procedure.

Hundreds of full-color intraoperative photographs and illustrations, as well as numerous high- quality videos, capture procedures step by step and help you immediately apply your knowledge.

Comprehensively covers craniosynostosis, orbital dystopias, maxillary surgery, mandibular surgery, skull defects, frontal sinus surgery, trauma surgery, and much more.

Published May 2019 Sample Chapter Preview

When you have to be right

Contributors

James P. Bradley, MD Vice Chairman, Professor, Northwell Plastic Surgery Zucker School of Medicine Hofstra/Northwell Lake Success, New York Colin M. Brady, MD Pediatric Plastic and Craniofacial Surgeon Children’s Healthcare of Atlanta Atlanta, Georgia Derek A. Bruce, MB, ChB, FAANS, FACS, FAPP Professor of Neurosurgery & Pediatrics Center for Neuroscience & Behavioral Medicine Children’s National Medical Center Washington, District of Columbia Nicole C. Cabbad, MD, MBA Craniofacial Plastic Surgeon Department of Plastic and Reconstructive Surgery Nicklaus Children’s Hospital Miami, Florida Rawad S. Chalhoub, MD Post Graduate Year 1 Plastic and Reconstructive Surgery American University of Beirut Medical Center Beirut, Lebanon Vincent A. Chavanon, MD Chief Resident Division of Plastic Surgery Department of Surgery Mount Sinai Hospital New York, New York Jessica A. Ching, MD Co-Director, Craniofacial Clinic Assistant Professor of Plastic Surgery Associate Program Director of Plastic Surgery Department of Surgery University of Florida Gainesville, Florida Eric Lowry Cole, MD Director, Craniofacial and Pediatric Plastic Surgery Assistant Professor Plastic Surgery University of Texas Medical Branch League City, Texas

Haithem M. Elhadi Babiker, MD, DMD, FAAP, FACS Assistant Professor, University of Cincinnati Medical Center Division of Pediatric Plastic & Craniofacial Surgery Cincinnati Children’s Hospital Medical Center Cincinnati, Ohio Stephen B. Baker, MD, DDS Professor and Program Director Director, Center for Facial Restoration Department of Plastic Surgery MedStar Georgetown University Hospital Washington, District of Columbia Medical Director, Craniofacial Program Inova Children’s Hospital Falls Church, Virginia Reena Bakshi, MD Research Fellow Department of Surgery University of California, Los Angeles

Samer Abouzeid, MD, DDS Lecturer Plastic, Reconstructive and Craniofacial Surgery Department Faculty of Medicine of the Saint Joseph University Lecturer Faculty of Dental Medicine of the Saint Joseph University Attending Plastic, Reconstructive and Craniofacial Surgery Department Hotel Dieu de France the Saint Joseph University Hospital Beirut, Lebanon Ghassan S. Abu-Sittah, MBchB, FRCS(Plast) Assistant Professor of Surgery Head of Division of Plastic & Reconstructive Surgery American University of Beirut Medical Center Beirut, Lebanon Co-Director, Conflict Medicine Program, Global Health Institute Honorary Senior Clinical Lecturer, Queen Mary University of London Division of Plastic Surgery College of Human Medicine Spectrum Health/Michigan State University Grand Rapids, Michigan Oluwaseun A. Adetayo, MD, FAAP, FACS Assistant Professor of Plastic Surgery Section Chief of Pediatric Plastic Surgery Bernard & Millie Duker Children’s Hospital Director, Cleft-Craniofacial Center at Albany Medical Center Albany Medical Center Albany, New York Michael Alperovich, MD, MSc Assistant Professor of Plastic Surgery Department of Surgery Yale University School of Medicine New Haven, Connecticut London, United Kingdom Nicholas S. Adams, MD Clinical Instructor

Los Angeles, California Scott P. Bartlett, MD Mary Downs Endowed Chair in

Craniofacial Treatment and Research The Children’s Hospital of Philadelphia Professor of Surgery The Perelman School of Medicine

University of Pennsylvania Philadelphia, Pennsylvania Joseph Baylan, MD Resident Physician School of Medicine Stanford University Palo Alto, California Craig Birgfeld, MD Associate Professor Division of Plastic Surgery Department of Surgery

University of Washington Seattle Children’s Hospital Harborview Medical Center Seattle, Washington Nataliya Biskup, MD Cosmetic and Reconstructive Plastic Surgeon Plastic Surgery Center Wichita, Kansas

Chung-Cranio1e9781496348265-FM.indd 6

3/8/2019 8:57:51 PM

vii

Contributors

David Charles A. Fisher, MD Clinical Assistant Professor of Surgery University of North Carolina School of Medicine Assistant Professor of Surgery Division of Plastic Surgery Department of Surgery Carolinas Medical Center Charlotte, North Carolina Roberto L. Flores, MD Joseph G. McCarthy Associate Professor of Reconstructive Plastic Surgery Director of Cleft Lip and Palate Hansjorg Wyss Department of Plastic Surgery NYU Langone Health New York, New York Christopher R. Forrest, MD, MSc FRCSC, FACS Professor and Chair Division of Plastic and Reconstructive Surgery Department of Surgery University of Toronto Chief, Division of Plastic and Reconstructive Surgery Medical Director, The Centre for Craniofacial Care and Research The Hospital for Sick Children Chair, Division of Plastic and Reconstructive Surgery Department of Surgery Toronto, Ontario, Canada Brad M. Gandolfi, MD Craniofacial Plastic and Reconstructive Surgeon Paramus, New Jersey Ravi Garg, MD Chief Resident Plastic and Reconstructive Surgery University of Wisconsin Madison, Wisconsin Patrick A. Gerety, MD Assistant Professor of Surgery Division of Plastic Surgery Indiana University and Riley Hospital for Children Indianapolis, Indiana Christopher B. Gordon, MD, FACS, FAAP Professor Division of Plastic Surgery Department of Surgery Cincinnati Children’s Hospital Medical Center Cincinnati, Ohio

Amir H. Dorafshar, MD, FACS, FAAP Professor (PAR), Chief and Program Director Division of Plastic and Reconstructive Surgery Rush University Medical Center Chicago, Illinois Gaby Doumit, MD, MSc, FRCSC, FACS Assistant Professor of Surgery Department of Plastic and Craniofacial Surgery University of Montreal Montreal, Canada David J. Dunaway, CBE, FDSRCS, FRCS(plast) Professor Craniofacial Unit Great Ormond Street Hospital for Children London, United Kingdom Ahmed Elsherbiny, MSc, MD Associate Professor of Plastic Surgery Director of Sohag Cleft Clinic Sohag University Hospital Sohag, Egypt Omri Emodi, DMD Vice Chair Department of Oral and Maxillofacial Surgery Rambam Health Care Campus Clinical Lecture in Oral and Maxillofacial Surgery Ruth & Bruce Rappaport Faculty of Medicine Technion—Israel Institute of Technology Haifa, Israel Barry L. Eppley, MD, DMD Clinical Professor of Plastic Surgery Indiana University School of Medicine IU Health Hospitals Indianapolis, Indiana Detlev Erdmann, MD, PhD, MHSc Professor of Surgery Division of Plastic, Reconstructive, Maxillofacial and Oral Surgery Duke University Medical Center Chief, Section of Plastic Surgery Durham VA Medical Center Section Chief, Plastic & Reconstructive Surgery Durham Veterans Administration Medical Center Durham, North Carolina

Patrick Colley, MD Assistant Professor Otolaryngology–Head and Neck Surgery Icahn School of Medicine–Mount Sinai Hospital New York, New York Lisa R. David, MD, MBA, FACS Chairman Department of Plastic and Reconstructive Surgery Professor of Plastic and Reconstructive Surgery and Pediatrics Residency Program Director Wake Forest University Baptist Medical Center Winston-Salem, North Carolina Alessandro de Alarcon, MD, MPH Associate Professor Director, Center for Pediatric Voice Disorders Medical Director, Complex Airway Cincinnati Children’s Hospital Medical Center University of Cincinnati Cincinnati, Ohio Arlen Denny, MD, FACS, FAAP Professor Plastic Surgery Neurosurgery Pediatrics Medical College of Wisconsin Director Craniofacial Surgery Fellowship Retired Children’s Hospital of Wisconsin Milwaukee, Wisconsin Claire Sanger Dillingham, DO Associate Professor Department of Plastic and Reconstructive Surgery Wake Forest Baptist Medical Center Winston-Salem, North Carolina Cone Health Department of Plastic and Reconstructive Surgery Greensboro, North Carolina Robert C. Dinsmore, MD, FACS Staff Surgeon Medical College of Georgia at Augusta University Chief of Plastic Surgery at Charlie Norwood VA Associate Professor of Surgery Section of Plastic and Reconstructive Surgery Department of Surgery Augusta, Georgia

Chung-Cranio1e9781496348265-FM.indd 7

3/8/2019 8:57:51 PM

viii

Contributors

Kristen Klement, MD Craniofacial Fellow

Robert J. Havlik, MD Chairman and George Korkos Professor

Alexander Govshievich, MDCM Senior Resident Plastic and Reconstructive Surgery University of Montreal Montreal, Canada Samita Sally Goyal, MD Medical College of Wisconsin Milwaukee, Wisconsin Frank R. Graewe, MBChB, MMed, FCS Extraordinary Associate Professor Division of Plastic Surgery Stellenbosch University Stellenbosch, South Africa John H. Grant III, MD James C. Lee Chair in Pediatric Plastic Surgery Director UAB Cleft and Craniofacial Center Chief of Pediatric Plastic Surgery Professor of Surgery, Division of Plastic Surgery Children’s of Alabama University of Alabama, Birmingham Birmingham, Alabama Joseph Gruss, MD, FRCS Marlys C. Larson Professor and Chair in Craniofacial Surgery Professor Division of Plastic Surgery Department of Surgery Attending Plastic Craniofacial Surgery University of Washington Seattle, Washington Jeffrey A. Hammoudeh, MD, DDS Associate Professor of Surgery University of Southern California Associate Professor Division of Plastic and Maxillofacial Surgery Department of Surgery Children’s Hospital Los Angeles Los Angeles, California Raymond J. Harshbarger, MD Chief of Plastic Surgery Dell Children’s Medical Center Associate Professor of Surgery Dell Medical School UT Austin Austin, Texas Mahmoud Hassouba, MD Craniofacial and Pediatric Plastic Surgery Fellow Plastic Surgery Cincinnati Children’s Hospital Medical Center Cincinnati, Ohio

Department of Plastic Surgery Medical College of Wisconsin Milwaukee, Wisconsin Deepak G. Krishnan, DDS, FACS Associate Professor of Surgery & Residency Program Director Oral & Maxillofacial Surgery University of Cincinnati Medical Center Cincinnati, Ohio Edward W. Kubek, MD The Carolinas Cleft and Craniofacial Clinic at David Matthews Plastic Surgery Charlotte, North Carolina Anand R. Kumar, MD, FACS, FAAP Chairman, Department of Plastic and Reconstructive Surgery Residency Program Director, Department of Plastic and Reconstructive Surgery Director, Cleft and Craniofacial Center, Vascular Anomalies Center Division Chief, Pediatric Plastic and Craniomaxillofacial Surgery Dewayne Greenwood Richey II Endowed Professor of Plastic and Reconstructive Surgery and Pediatrics Department of Plastic and Reconstructive Surgery Case Western Reserve University School of Medicine Cleveland, Ohio Amy Lee, MD, FAANS Attending Pediatric Neurosurgery Associate Professor, University of Washington Associate Residency Program Director Seattle Children’s Hospital Seattle, Washington Jean-Francois Lefaivre, MD Clinical Associate Professor of Surgery University of North Carolina School of Medicine Associate Professor of Surgery

Department of Plastic Surgery Medical College of Wisconsin Milwaukee, Wisconsin

Matthew A. Hiersche, MD Division of Plastic Surgery Valley Children’s Hospital Madera, California Richard A. Hopper, MD, MS Marlys C. Larson Chair of Pediatric Craniofacial Surgery Professor, Division of Plastic Surgery University of Washington Chief, Division of Craniofacial and Plastic Surgery Surgical Director, Craniofacial Center Seattle Children’s Hospital Seattle, Washington Reza Jarrahy, MD, FACS, FAAP Associate Clinical Professor Division of Plastic and Reconstructive Surgery Department of Pediatrics Noor ul Owase Jeelani, MBA, MPhil (Medical Law), FRCS (Neuro.Surg.) Head of Clinical Services— Neurosurgery Consultant Paediatric Neurosurgeon Great Ormond Street Hospital London, United Kingdom UCLA Medical Center Los Angeles, California Dana Johns, MD Assistant Professor Division of Plastic and Reconstructive Surgery University of Utah Hospital Salt Lake City, Utah Richard E. Kirschner, MD Robert F. and Edgar T. Wolfe Foundation Endowed Chair in Plastic Nationwide Children’s Hospital Professor of Surgery and Pediatrics Senior Vice Chair, Department of Plastic Surgery The Ohio State University College of Medicine Columbus, Ohio and Reconstructive Surgery Chief, Section of Plastic and Reconstructive Surgery John N. Jensen, MD Associate Professor Department of Plastic Surgery Medical College of Wisconsin Milwaukee, Wisconsin

Carolinas Medical Center Division of Plastic Surgery Department of Surgery Charlotte, North Carolina James Y. Liau, MD, FACS Associate Professor Division Plastic Surgery University of Kentucky Lexington, Kentucky

Chung-Cranio1e9781496348265-FM.indd 8

3/8/2019 8:57:51 PM

Contributors

Rogerio I. Neves, MD, PhD, FACS Professor of Surgery, Pharmacology and Medicine Deputy Director, Penn State Melanoma and Skin Cancer Center Melanoma and Cutaneous Malignancies Disease Team Leader Director, Cutaneous Oncology Program

Mohamad Masoumy, MD, MS Resident Section of Plastic and Reconstructive Surgery Department of Surgery Medical College of Georgia

Shelby R. Lies, MD Assistant Professor Department of Plastic Surgery University of Texas Southwestern Medical Center Dallas, Texas Alexander Y. Lin, MD, FACS Alan A. and Edith L. Wolff Endowed Chair in Craniofacial, Maxillofacial, and Pediatric Plastic Surgery Associate Professor of Surgery and Orthodontics Division of Plastic Surgery Saint Louis University School of Medicine Director, St. Louis Cleft-Craniofacial Center Section Chief of Pediatric Plastic Surgery SSM Health Cardinal Glennon Children’s Hospital at SLU St. Louis, Missouri Joseph Lopez, MD, MBA Plastic Surgery Resident Department of Plastic & Reconstructive Surgery Johns Hopkins Hospital Baltimore, Maryland H. Peter Lorenz, MD Chief of Pediatric Plastic Surgery Stanford Children’s Health Director, Craniofacial Surgery Fellowship Professor of Surgery (Plastic and Reconstructive) Department of Surgery Stanford University School of Medicine Palo Alto, California Michael Lypka, MD, DMD, FACS, FAAP, FRCD(C) Associate Professor of Surgery School of Medicine University of Missouri–Kansas City Adjunct Associate Professor School of Dentistry University of Missouri–Kansas City Division of Orthodontics Attending Physician Children’s Mercy Hospital Division of Plastic and Craniofacial Surgery Kansas City, Missouri Mark C. Martin, MD, DMD, FRCSC Professor of Plastic Surgery Associate Program Director Department of Plastic Surgery Loma Linda University Medical Center Loma Linda, California

Augusta University Augusta, Georgia

Penn State Cancer Institute Division of Plastic Surgery Department of Surgery College of Medicine Pennsylvania State University

David Matthews, MD The Carolinas Cleft and Craniofacial Clinic at David Matthews Plastic Surgery Charlotte, North Carolina Kibwei A. McKinney, MD Assistant Professor Department of Otolaryngology– Head and Neck Surgery University of Oklahoma Health Sciences Center Oklahoma City, Oklahoma Brad Morrow, MD Pediatric Plastic Surgery Fellow Division of Plastic and Reconstructive Surgery The Hospital for Sick Children Toronto, Ontario, Canada Ananth S. Murthy, MD Associate Professor of Surgery Northeastern Ohio Medical University Rootstown, Ohio Chief, Division of Plastic Surgery Raja A. Naddaf, DMD, OMFS Attending Surgeon Department of Oral and Maxillofacial Surgery Rambam Medical Center Haifa, Israel Arthur J. Nam, MD, MS Assistant Professor Division of Plastic, Reconstructive, and Maxillofacial Surgery R Adams Cowley Shock Trauma Center University of Maryland School of Medicine Baltimore, Maryland Director, Craniofacial Clinic Akron Children’s Hospital Akron, Ohio

Hershey, Pennsylvania Eugenia K. Page, MD Fellow Division of Plastic Surgery Emory University Division of Plastic and Maxillofacial Surgery Department of Surgery Emory University/Children’s Healthcare of Atlanta Atlanta, Georgia Brian S. Pan, MD Associate Professor of Surgery– Clinical Division of Craniofacial and Pediatric Plastic Surgery Cincinnati Children’s Hospital Medical Center Cincinnati, Ohio Prasanth Patcha, MD, MEng Resident Section of Plastic and Reconstructive Surgery Department of Surgery Medical College of Georgia Augusta University Augusta, Georgia Parit A. Patel, MD, MBA Private Practice Plastic Surgery Clinic of Chicago Chicago, Illinois John A. Persing, MD Irving and Silik Polayes Professor and Chief of Plastic Surgery Professor of Neurosurgery Yale University School of Medicine New Haven, Connecticut Michael Robert Pharaon, MD Craniofacial Surgeon Department of Plastic & Reconstruction Surgery Straub & Kapiolani Medical Centers Honolulu, Hawaii

Chung-Cranio1e9781496348265-FM.indd 9

3/8/2019 8:57:51 PM

Contributors

Srinivas M. Susarla, DMD, MD Assistant Professor Division of Plastic Surgery Department of Surgery Assistant Professor Department of Oral and Maxillofacial Surgery University of Washington Seattle, Washington Peter J. Taub, MD, FACS, FAAP Professor, Surgery, Pediatrics, Dentistry, and Neurosurgery Professor, Medical Education Division of Plastic and Reconstructive Surgery Residency Program Director Chief, Craniomaxillofacial Surgery Icahn School of Medicine at Mount Sinai Chief, Pediatric Plastic Surgery Director, Mount Sinai Cleft and Craniofacial Center Director, Mount Sinai Vascular Anomalies Program Kravis Children’s Hospital at Mount Sinai New York, New York Jesse A. Taylor, MD, FACS, FAAP Peter Randall Endowed Chair and Chief Division of Plastic Surgery Children’s Hospital of Philadelphia The University of Pennsylvania Philadelphia, Pennsylvania Yeshaswini Thelekkat, MDS Senior Lecturer; Consultant Oral and Maxillofacial Surgeon Oral Diagnostics and Surgical Sciences Division School of Dentistry International Medical University Kuala Lumpur, Malaysia Sunil Tholpady, MD, PhD, FACS, FAAP Assistant Professor of Plastic Surgery Indiana University School of Medicine Indianapolis, Indiana Anthony P. Tufaro, DDS, MD, FACS Chief of Plastic Surgery Professor of Surgery, Plastic Surgery and Surgical Oncology University of Oklahoma Health Sciences Center Oklahoma City, Oklahoma Gökhan Tunçbilek, MD, PhD Faculty of Medicine Department of Plastic Reconstructive and Aesthetic Surgery Hacettepe University Ankara, Turkey

Rajendra Sawh-Martinez, MD, MHS Craniofacial Surgery Fellow Section of Plastic and Reconstructive Surgery Department of Surgery Yale University School of Medicine New Haven, Connecticut Warren Schubert, MD, FACS Chair, Department of Plastic & Hand Surgery Regions Hospital Professor of Surgery and Orthopaedics University of Minnesota St. Paul, Minnesota Michelle Scott, DDS, MBA Craniofacial Orthodontist Department of Plastic Surgery Children’s Hospital of Philadelphia Philadelphia, Pennsylvania Brent A. Senior, MD, FACS, FARS Nathaniel and Sheila Harris Distinguished Professor of Otolaryngology/Head and Neck Surgery Professor of Neurosurgery Vice Chair of Clinical Affairs, Otolaryngology/Head and Neck Surgery Chief, Division of Rhinology, Allergy, and Endoscopic Skull Base Surgery University of North Carolina at Chapel Hill Chapel Hill, North Carolina Dekel Shilo, DMD, PhD Department of Oral & Maxillofacial Surgery Rambam Health Care Campus Haifa, Israel John W. Siebert, MD Professor Division of Plastic and Reconstructive Surgery University of Wisconsin Hospital and Clinics Madison, Wisconsin Matthew M. Smith, MD Director of Hand and Upper Extremity Surgery Grandview Medical Center Birmingham, Alabama Derek M. Steinbacher, MD, DMD, FACS Director of Craniofacial Craniomaxillofacial Surgery Yale Plastic Surgery New Haven, Connecticut

John W. Polley, MD Clinical Professor Department of Surgery Michigan State University College of Human Medicine Plastic Surgeon Pediatric Plastic and Craniofacial Surgery Helen DeVos Children’s Hospital Grand Rapids, Michigan Kathlyn Kruger Powell, DMD, MD Assistant Professor Department of Oral and Maxillofacial Surgery School of Dentistry University of Alabama at Birmingham Birmingham, Alabama David B. Powers, MD, DMD, FACS, FRCS (Ed) Director, Duke Craniomaxillofacial Trauma Program Associate Professor of Surgery Division of Plastic, Reconstructive, Maxillofacial & Oral Surgery Director, Craniomaxillofacial Trauma and Reconstruction Fellowship Duke University Medical Center Durham, North Carolina Adi Rachmiel, DMD, PhD Chair, Department of Oral and Maxillofacial Surgery Rambam Health Care Campus Clinical Professor The Rappaport Faculty of Medicine Technion—Israel Institute of Technology Haifa, Israel Scott J. Rapp, MD, FACS Pediatric Cleft and Craniofacial Plastic Surgeon Senior Research Investigator Department of Surgery Shriners Burn Hospital Cincinnati Cincinnati, Ohio Staff Surgeon Division of Plastic Surgery Department of Surgery Kenneth E. Salyer, MD, FACS, FAAP Founder and Chairman of the Board World Craniofacial Foundation Clinical Professor Department of Biomedical Sciences Baylor College of Dentistry Texas A&M University Dallas Dallas, Texas Norton Health Care Louisville, Kentucky

Chung-Cranio1e9781496348265-FM.indd 10

3/8/2019 8:57:51 PM

Contributors

Wen Xu, MD The Perelman School of Medicine at the University of Pennsylvania The Children’s Hospital of Philadelphia Philadelphia, Pennsylvania Akira Yamada, MD, PhD Professor of Surgery Feinberg School of Medicine Northwestern University Ann & Robert H. Lurie Children’s Hospital of Chicago Department of Plastic Surgery Chicago, Illinois Kristen S. Yee, MD UCSF Benioff Children’s Hospital Oakland, Staff Surgeon Chief of Facial Trauma Santa Rosa Memorial Hospital Santa Rosa, California Jack C. Yu, DMD, MD, MS, ED Director of Craniofacial Center Children’s Hospital of Georgia Milford B. Hatcher Professor of Surgery Section of Plastic Surgery

Howard D. Wang, MD Resident Department of Plastic and Reconstructive Surgery Johns Hopkins/University of Maryland Baltimore, Maryland Nezar Watted, DMD Clinic and Policlinics of Dental, Oral and Maxillofacial Disease of Bavarian Julius-Maximillian University Hospital of Wuerzburg

Leo J. Urbinelli, MD, MA Associate Director, Cleft & Craniofacial Unit Assistant Professor, Plastic & Reconstructive Surgery Oregon Health & Sciences University Doernbecher Children’s Hospital Portland, Oregon John van Aalst, MD, MA, FACS, FAAP Professor and Director Division of Pediatric and Craniofacial Plastic Surgery Cincinnati Children’s Hospital Medical Center Cincinnati, Ohio Henry C. Vasconez, MD, FACS, FAAP William S. Farish Endowed Chair of Plastic Surgery Professor of Surgery and Pediatrics Chief of Plastic Surgery at the Veterans Administration MC, Lexington Associate Program Director, UK Plastic Surgery Residency Program University of Kentucky College of Medicine Lexington, Kentucky Timothy W. Vogel, MD North Jersey Brain and Spine Center Pediatric Neurosurgery and Craniofacial Surgery Hackensack University Medical Hackensack, New Jersey Mark E. Walker, MD, MBA Section of Plastic and Reconstructive Surgery Department of Surgery Yale University School of Medicine

University Wuerzburg Wuerzburg, Germany

Joseph K. Williams, MD Chief of Plastic Surgery Children’s Healthcare of Atlanta Clinical Professor Division of Plastic Surgery

Emory University Adjunct Professor Department of Pediatrics

Emory University Atlanta, Georgia S. Anthony Wolfe, MD, FACS, FAAP Chief of Plastic Surgery Nicklaus Children’s Hospital Miami, Florida Benjamin C. Wood, MD, MBA Adjunct Associate Professor Plastic and Reconstructive Surgery University of North Carolina at Chapel Hill Chapel Hill, North Carolina Jeyhan S. Wood, MD Assistant Professor Director of Craniofacial and Pediatric Plastic Surgery Department of Surgery University of North Carolina Chapel Hill Chapel Hill, North Carolina

Augusta University Augusta, Georgia

Yale New Haven Hospital New Haven, Connecticut

Chung-Cranio1e9781496348265-FM.indd 11

3/8/2019 8:57:51 PM

Preface

knowledge in a standardized template for ease of reference in preparation for the surgical procedures. We hope that you will enjoy our effort, and we want to thank you for your interest in our arduous journey to create the most comprehensive text- book to enhance your practice. Kevin C. Chung, MD, MS Chief of Hand Surgery, Michigan Medicine Director, University of Michigan Comprehensive Hand Center Charles B. G. de Nancrede Professor of Surgery Chief of Hand Surgery, Michigan Medicine Professor of Plastic Surgery and Orthopaedic Surgery Assistant Dean for Faculty Affairs

I am pleased to share with you this comprehensive textbook on craniofacial topics. Under the outstanding leadership of Dr. John Van Aalst and many contributing authors, this book pro- vides comprehensive treaties on injuries and diseases afflicting the craniofacial region. This anatomic region is richly served by various specialties including plastic surgeons, oral maxillo- facial surgeons, otolaryngologists, dentists, speech therapists, and many others who work collaboratively to achieve predict- able outcomes. The authors for this book were selected based on their expertise in the care of the craniofacial region. I am absolutely convinced that this is the definitive procedural textbook for this anatomic region, because it efficiently guides the readers by using highly illustrated step-by-step approaches to achieve safe and expected outcomes. We strived to consolidate the

Associate Director of Global REACH University of Michigan Medical School Ann Arbor, Michigan

xii

Chung-Cranio1e9781496348265-FM.indd 12

3/8/2019 8:57:51 PM

Contents

15 Endoscopically Assisted Approaches for Craniosynostosis 98 Timothy W. Vogel and Brian S. Pan SECTION II ORBITAL DYSTOPIAS 16 Box and U-Shaped Osteotomies 104

Contributors vi Preface xii

SECTION I CRANIOSYNOSTOSIS 1 Fronto-Orbital Advancement 2

Rajendra Sawh-Martinez and John A. Persing 2 Fronto-Orbital Distraction 13 Jesse A. Taylor and Wen Xu 3 Posterior Cranial Vault Expansion 21 Alexander Y. Lin 4 Posterior Cranial Vault Distraction Osteogenesis 31 Richard A. Hopper and Amy Lee 5 Total Cranial Vault Remodeling 38 Akira Yamada, Kenneth E. Salyer, Derek A. Bruce, and Frank R. Graewe 6 Spring-Assisted Surgery for Sagittal Synostosis 45 Lisa R. David and Claire Sanger Dillingham 7 Transparietal/Transtemporal Distraction for Sagittal Craniosynostosis 53 Kristen Klement and Arlen Denny 8 Monobloc Frontofacial Advancement 58 S. Anthony Wolfe and Nicole C. Cabbad 9 Monobloc Distraction 67 Peter J. Taub and Vincent A. Chavanon 10 Split Calvarial Bone Graft Harvest 72 Peter J. Taub 11 Cranioplasty Reconstruction With Autogenous Rib Graft 77 Scott J. Rapp 12 Three-Dimensional Implant Reconstruction for the Cranial Vault 83 Barry L. Eppley and Sunil Tholpady 13 Alloplastic Reconstruction of the Calvarium 87 Peter J. Taub 14 Craniopagus Twins 91 David J. Dunaway and Noor Ul Owase Jeelani

Sunil Tholpady, Robert J. Havlik, and Barry L. Eppley

17 Facial Bipartition 110

Jessica A. Ching and Christopher R. Forrest 18 Orbital Expansion for Anophthalmia and Microphthalmia 123 Brad Morrow and Rogerio I. Neves

SECTION III MAXILLARY SURGERY 19 Surgically Assisted Rapid Palatal Expansion (SARPE) 130 Omri Emodi, Nezar Watted, and Adi Rachmiel 20 Premaxillary Segment Setback 135 Omri Emodi 21 Le Fort I Osteotomy and Advancement 139 Kathlyn Kruger Powell, Ahmed Elsherbiny, and John H. Grant III 22 Le Fort I Distraction Osteogenesis 152 Nicholas S. Adams and John W. Polley 23 Segmental Le Fort I Advancement: Two and Three Piece 160 Leo J. Urbinelli and Jeffrey A. Hammoudeh 24 Le Fort II Osteotomy and Advancement 170 Adi Rachmiel, Dekel Shilo, and Omri Emodi 25 Le Fort II Advancement With Distraction Osteogenesis 174 Eugenia K. Page, Colin M. Brady, and Joseph K. Williams 26 Le Fort III Advancement 184 Ghassan S. Abu-Sittah and Rawad S. Chalhoub 27 Le Fort III Osteotomy With External Distraction 189 Gökhan Tunçbilek

xiii

Chung-Cranio1e9781496348265-FM.indd 13

3/8/2019 8:57:52 PM

xiv

Contents

28 Minimal Access Le Fort III Osteotomy for Midface Hypolasia 202 Scott J. Rapp and Christopher B. Gordon 29 Secondary Alveolar Bone Grafting of the Cleft Alveolar Defect in Cleft Palate 211 Richard E. Kirschner, Michelle Scott, and Matthew A. Hiersche 30 Surgical Management of Facial Clefts 218 David Matthews, Samer Abouzeid, and Edward W. Kubek 31 Gingivoperiosteoplasty 224 Mark C. Martin 32 BMP Use in the Craniofacial Skeleton 231 James P. Bradley and Kristen S. Yee SECTION IV MANDIBULAR SURGERY 33 Costochondral Reconstruction for Absent Temporomandibular Joint 239 Patrick A. Gerety and Scott P. Bartlett 34 Prosthetic Reconstruction of the Temporomandibular Joint 244 Anthony P. Tufaro and Srinivas M. Susarla 35 Osteocutaneous Parascapular Flap for Mandibular Reconstruction 251 Ravi Garg and John W. Siebert 36 Reverse Distraction to Create a Temporomandibular Joint 259 Joseph Lopez and Anand R. Kumar 37 Bilateral Sagittal Split Osteotomy for Mandibular

44 Osseous Genioplasty 318

Mark E. Walker and Derek M. Steinbacher 45 Alloplastic Chin Augmentation 326 Barry L. Eppley and Sunil Tholpady 46 Surgical Removal of Fibrous Dysplasia From the Craniofacial Skeleton 330 Alexander Govshievich and Gaby Doumit SECTION V SKULL DEFECTS 47 Autologous Bone Harvest to Correct Open Skull Defects 342 Michael Robert Pharaon SECTION VI FRONTAL SINUS 48 Frontal Sinus Cranialization 347 Mohamad Masoumy, Prasanth Patcha, Robert C. Dinsmore, and Jack C. Yu 49 Frontal Sinus Obliteration With Fat 354 Matthew M. Smith and Alessandro de Alarcon 50 Pericranial Flap Harvest for Frontal Sinus Obliteration 358 Mahmoud Hassouba and John A. van Aalst 51 Endoscopic Correction of Frontal Sinus Fractures 362 Patrick Colley, Kibwei A. McKinney, and Brent A. Senior 52 Operative Management of a Late Presentation of Frontal Sinus Mucocele 369 Kibwei A. McKinney and Brent A. Senior SECTION VII ORBITAL TRAUMA 53 Correction of Orbital Floor Blow-Out Fractures: Variation 1 377 Jean-Francois Lefaivre and David Charles A. Fisher 54 Correction of Orbital Floor Blow-Out Fractures: Variation 2 384 Henry C. Vasconez 55 Correction of Lateral Orbital Wall Fractures 391 Parit A. Patel 56 Medial Orbital Wall Fractures 397 Brad M. Gandolfi, Reena Bakshi, and Reza Jarrahy 57 Correction of Orbital Roof Fractures 407 Samita Sally Goyal and John N. Jensen 58 Secondary Correction of Enophthalmos 415 David Matthews, Samer Abouzeid, and Edward W. Kubek

Deficiency 265 Stephen B. Baker 38 Inverted L Osteotomy for Mandibular Surgery 274 Raymond J. Harshbarger 39 Intraoral Vertical Ramus Osteotomy of the Mandible 280

Deepak G. Krishnan and Haithem M. Elhadi Babiker

40 Internal Mandibular Distraction 286 Michael Alperovich and Roberto L. Flores 41 External Mandibular Distraction for Micrognathia 291 Haithem M. Elhadi Babiker 42 External Transfacial Mandibular Distraction 301 Brian S. Pan 43 Mandibular Setback 307 Haithem M. Elhadi Babiker and Deepak G. Krishnan

Chung-Cranio1e9781496348265-FM.indd 14

3/8/2019 8:57:52 PM

Contents

69 Open Treatment of Mandible Fractures 475 Joseph Baylan and H. Peter Lorenz 70 Open Treatment of Condyle Fractures 483 Michael Lypka 71 Management of Mandibular Coronoid Fractures 491 Raja A. Naddaf 72 Surgical Correction of Nonunion of Mandible Fracture 495 Howard D. Wang, Arthur J. Nam, and Amir H. Dorafshar SECTION XII PANFACIAL TRAUMA 73 Surgical Correction of Panfacial Fractures 502 Detlev Erdmann and David B. Powers SECTION XIII PEDIATRIC TRAUMA 74 Pediatric Orbital Fractures 511 James Y. Liau 75 Surgical Correction of Pediatric Midface Fractures 518 Eric Lowry Cole and Shelby R. Lies 76 Management of Pediatric Mandible Fractures 526 Nataliya Biskup and Brian S. Pan

SECTION VIII NASAL FRACTURES 59 Closed Nasal Fracture Correction 421 Benjamin C. Wood 60 Open Treatment of Nasal Fractures 425 Jeyhan S. Wood SECTION IX NOE FRACTURES 61 Naso-Orbital-Ethmoid (NOE) Fractures 433 Craig Birgfeld and Joseph Gruss SECTION X MAXILLARY TRAUMA 62 Closed Reduction of Zygomatic Arch Fractures 439 Oluwaseun A. Adetayo 63 Open Correction of Zygomatic Fractures 444 Warren Schubert and Yeshaswini Thelekkat 64 Addressing Late Malpositioning of the Zygomaticomaxillary Complex 452 Warren Schubert and Yeshaswini Thelekkat 65 Correction of Le Fort I Fracture 457 Ananth S. Murthy 66 Correction of Le Fort II Fracture 461 Nataliya Biskup and John A. van Aalst 67 Correction of Le Fort III Fractures 465 Joseph Lopez and Amir H. Dorafshar SECTION XI MANDIBULAR TRAUMA 68 Maxillomandibular Fixation of Mandible Fractures 471 Joseph Baylan and Dana Johns

Index 533

Chung-Cranio1e9781496348265-FM.indd 15

3/8/2019 8:57:52 PM

Video Clips

Chapter 2 Cranial Vault Expansion Chapter 9 Monobloc Distraction Chapter 23 Segmental Le Fort I Advancement: Two and Three Piece Chapter 29 Secondary Alveolar Bone Grafting of the Cleft Alveolar Defect in Cleft Palate Chapter 37 Right-Side Osteotomy Splitting Right Side Nerve Verifying Split Left-Side Osteotomy and ST Dissection Left-Side Osteotome and Split Applying Wire Loops Verification

Chapter 53 Correction of Orbital Flow Blow-Out Fractures: Variation 1 Chapter 54 Correction of Orbital Floor Blow-Out Fractures: Variation 2 Chapter 60 Open Reduction for Nasal Fracture Chapter 73 Midface Exposure

Zygomaticofacial Repair, Part 1 Zygomaticofacial Repair, Part 2 Zygomaticofacial Repair, Part 3

xvi

Chung-Cranio1e9781496348265-FM.indd 16

3/8/2019 8:57:52 PM

1 C H A P T E R

Section I: Craniosynostosis

Fronto-Orbital Advancement

Rajendra Sawh-Martinez and John A. Persing

DEFINITION

■■ Retrusion of the supraorbital rims bilaterally and flaring of the parietal bones as a form of compensation for con- tinuing brain growth bilaterally ■■ The orbits are symmetrical in appearance. ■■ The squamous temporal bones are not convex, but flat- tened in profile and retrusive. ■■ Hypotelorism PATHOGENESIS ■■ Craniosynostosis occurs as nonsyndromic forms and as part of a varied number of syndromic patterns. ■■ Metopic and coronal synostoses are believed to have a positive family history in approximately 10% of cases. ■■ Ephrin-A4 has been implicated in nonsyndromic cranio- synostosis, whereas FGFR3 and TWIST gene mutations may be linked to familial inheritance of craniosynostosis. 5 ■■ Syndromic craniosynostosis cases are linked to var- ied genetic mutations corresponding to the underlying syndrome. ■■ Multiple environmental factors have been suggested as pro- moters or risk factors for synostosis, including abnormal intrauterine position, multiple gestation, antenatal head compression, and infants large for their gestational age. ■■ Additionally, maternal smoking, advanced maternal age, gestation at high altitude, fertility treatments, and endocrine abnormalities have also been associated with the develop- ment of craniosynostosis. ■■ The natural history of all forms of craniosynostosis is that they are, at the very least, stable, if not progressive during early childhood due to the expanding brain. Compensatory abnormalities increase the discrepancy between the fused bones and the remainder of the skull. ■■ The main theories of pathogenesis of premature fusion relate to timing of the fusion as either a primary event or a second- ary occurrence as the effect of a yet undetermined cause. ■■ Despite ongoing research on the underlying mechanisms, general principles dominate the resultant morphology. 1,6,7 ■■ Prematurely fused bones act as a single bone plate with lim- ited growth potential. ■■ Asymmetrical, increased bone deposition occurs at perim- eter sutures directed away from the affected bone plate. ■■ Unaffected, adjacent perimeter sutures compensate more in growth than do distant unaffected sutures. PATIENT HISTORY AND PHYSICAL FINDINGS Metopic craniosynostosis 4,6,8

■■ Fronto-orbital advancement is a series of adjustments to modifications of anatomy in coronal and metopic synostosis. ■■ Fronto-orbital advancement strives to approximate normal- ity of deficient supraorbital rim and adjacent frontal and temporal bone deformities. ■■ Unilateral coronal synostosis (UCS), bilateral coronal syn- ostosis, and metopic synostosis have unique fronto-orbital deformities, which require individualized treatment for optimal results. Periorbital deformities are characterized by flattening of the frontal bone ipsilateral to the fused half of the coronal suture. 1,2 ■■ Recession of the ipsilateral supraorbital rim ■■ Overprojection anteriorly of the ipsilateral zygoma ■■ Convex deformity of the squamous temporal bone ■■ Diminished mediolateral dimension of the orbit com- pared to normal ■■ Increased vertical height of the ipsilateral orbit ■■ Enlarged and more superiorly positioned ipsilateral orbital roof and accompanying greater wing of the sphe- noid (harlequin deformity) ■■ Depression of contralateral orbital roof/supraorbital rim ■■ Ipsilateral nasal radix deviation ■■ Contralateral chin point deviation ■■ Bilateral coronal synostosis ■■ Characterized by premature fusion of the coronal sutures bilaterally and brachycephaly (shortening) of the antero- posterior dimension of the skull, to include the anterior cranial fossa with compensatory widening of the skull 3 ■■ The frontal bones bilaterally, and the supraorbital rim adjacent to them, are hypoplastic and retrusive, relative to normal frontal bone development. ■■ Squamous temporal bone is more convex in form than normal. ■■ The zygomas are deficient in the anteroposterior projection. ■■ The malar area, as well as the midface, may be more sig- nificantly retruded in patients with syndromic forms of bilateral coronal synostosis. ■■ Metopic synostosis ■■ Fusion of the metopic suture, associated with ridging of the midline frontal bone structure, and symmetric retru- sion of the lateral frontal bones bilaterally 4 ■■ Unilateral coronal synostosis ■■

ANATOMY

■■ Premature fusion of the metopic suture.

Chung-Cranio1e9781496348265-ch001.indd 2

2/22/2019 7:17:10 PM

Chapter 1 Fronto-Orbital Advancement

■■ Key relevant anatomic features include the following: ■■ Central ridging/bulged metopic suture ■■ Characteristic triangular-shaped forehead (bilateral fronto-orbital hypoplasia) occurs to varying degrees, with classification schemes related to the severity of angulation ■■ Hypotelorism ■■ Lateral orbital rim posteriorly displaced and hypoplastic ■■ Flattened profile of the squamosal bone ■■ Biparietal widening of the skull Unilateral coronal craniosynostosis 6,9,10 ■■ Premature bony bridging of the coronal suture, typically in the approximate midpoint of the course of the coronal suture ■■ Patent sagittal suture is displaced away from the fused suture posteriorly and toward it anteriorly. ■■ Key features: ■■ Flattened ipsilateral forehead ■■ Contralateral forehead bossing ■■ Intrinsic orbital changes (pathognomonic harlequin deformity) ●● Ipsilateral flattened supraorbital rim and vertically taller/narrower orbit with steep superior orbital fissure and greater/lesser sphenoid wings ●● Depression (inferior displacement) of contralateral supraorbital rim ■■ Squamosal-temporal bone convexity ■■ Depression of the free border of the superolateral orbital rim ■■ Protrusive zygoma, ipsilateral to the coronal fusion ■■ Raised eyebrow and widened palpebral opening ipsilat- eral to the fused suture ■■ Root of nose deviation toward the affected (fused) side and nasal tip towards the contralateral (open) side ■■ Ear displacement anteriorly/superiorly, ipsilateral to fused suture ■■ Contralateral chin point deviation ■■ Base of skull deformity ●● Severity can be determined by evaluating the sphenope- trosal angle and the degree of angulation from midline structures (cribriform plate) ipsilateral to fusion 2,6,9 Bilateral coronal craniosynostosis 2 ■■ Bilateral premature fusion of the coronal suture with sym- metric foreshortened anterior cranial base ■■ Key features: ■■ Bilateral retrusion of frontal bone and supraorbital rims ■■ Bilateral lateral bulge of squamous temporal bones ■■ Increased biparietal diameter ■■ Syndromic vs nonsyndromic features include midface hypoplasia and mandibular deformity in syndromic cases ■■ Frontosphenoidal synostosis 11–13 ■■ Rare case of anterior plagiocephaly ■■ Often misdiagnosed ■■ Requires 3D CT reconstruction to identify in isolated cases ■■ Angulation of the anterior cranial base ■■ Deflection of the anterior cranial fossa opposite to fused suture ■■ Altered relationship between cranial vault and facial skel- eton, resulting in a phenotype similar to UCS ■■ Contralateral bossing and ipsilateral brow depression ■■ Nasal tip deviation reported in 50% of cases

■■ Harlequin deformity may not be present or be minimally evident. ■■ Key orbital/ophthalmologic evaluation ■■ Orbital size/shape ■■ Globe position/prominence ■■ Corneal inflammation (exposure) ■■ Distinct structural differences between ipsilateral and con- tralateral orbits ■■ Extraocular movement (strabismus), particularly superior oblique dysfunction ■■ Visual acuity ■■ Lid margin and levator function (anterior plagiocephaly) ■■ Supratarsal crease reduction (anterior plagiocephaly) ■■ Hypertelorism (brachycephaly) in some syndromic cases ■■ Malar recession in syndromic cases ■■ The definitive diagnostic study for craniosynostosis is a CT scan demonstrating fusion of a cranial vault suture. ■■ However, imaging of cranial anatomy has been used less frequently, as the typical clinical structure in the individual forms of craniosynostosis is more recognized. ■■ This has been highlighted by concerns related to exposure of infants to ionizing radiation by CT scan and for seda- tion and anesthetics often required to obtain MR scans. ■■ Ultrasound examinations, except in the very young, are not accurate enough to serve as a definitive diagnostic source and therefore used infrequently. ■■ Occasional cases of craniosynostosis are best examined using CT scan, with 3D reconstruction, which may help in certain forms of craniosynostosis for planning of surgery ( FIG 1 ). ■■ With a typical clinical exam, or confirmatory CT scan, cra- nioplasty is typically performed early in life to take advan- tage of the potential for better intellectual development (up to 6 months of age). 4,7 ■■ The counterargument to earlier surgery is the potential increase in the number of cases requiring revision surgery, as structurally it is more difficult to account for continuing growth when surgery is performed at earlier stages of life. ■■ Bone manipulation and stabilities are enhanced in older-age children beyond 6 months of age, but the issue of deleteri- ous impact on brain development is now creating more con- cern , leading to promoting delayed surgery. 14,15 ■■ An advantage of earlier surgery is better malleability of bone. ■■ Larger bone defects may fill in secondarily by subsequent growth of the brain and dura. ■■ Potentially improved neurologic outcome ■■ Disadvantages of early surgery include the following: ■■ Increased risk for proportionate blood loss with smaller amounts of volume lost ■■ A potential increased requirement for repeat surgeries in the future ■■ Advantages of later surgery (delayed to 1 year of age): ■■ More mature brain and bone systems to be operated on ■■ Blood loss is not as strong a concern due to increased body weight and proportionate circulating blood volume. ■■ Structures may be fixed in place more securely with lesser concern about growth restriction.

IMAGING

SURGICAL MANAGEMENT

Chung-Cranio1e9781496348265-ch001.indd 3

2/22/2019 7:17:10 PM

Operative Techniques in Plastic Surgery: Craniofacial

FIG 1 • 3D CT reconstruction of craniosynostosis subtypes. Metopic cranio- synostosis (trigonocephaly) in frontal view ( A ), oblique view ( B ), and top-down view ( C ). Unilateral coronal craniosynostosis (anterior plagiocephaly) in frontal view ( D ), oblique view ( E ), top-down view ( F ). Bilateral coronal craniosynostosis (brachycephaly) in frontal view ( G ), right lateral view ( H ), left lateral view ( I ), and top-down view (J) .

count, preparation for blood replacement, monitoring for air emboli (Doppler, end-tidal CO 2 , mean arterial pressure, CVP), and, in selected cases, coagulation studies to support reduction in blood. ■■ Plan for admission to a postoperative care setting consistent with potential need for urgent care.

■■ Disadvantages: ■■ Bone defects are more difficult to “fill in” nonoperatively. ■■ Bone is more difficult to remodel at approximately 1 year of age. ■■ Potential reduction in brain function related to delay

Preoperative Planning

Positioning

■■ Generally, once the decision to perform surgery has been made, and with confirmatory clinical and/or CT exam, preparation includes appropriate supports from blood loss to include monitoring, review of current status of blood

■■ Typically, the patient is placed supine for optimal supraor- bital rim advancement regardless of etiology of the nonsyn- dromic craniosynostosis.

Chung-Cranio1e9781496348265-ch001.indd 4

2/22/2019 7:17:15 PM

Chapter 1 Fronto-Orbital Advancement

Approach

■ This procedure also addresses the issues of reducing the like- lihood of postoperative depressions in the anterior temporal fossa and adds forward, stable projection of the supraor- bital rim, without the added potential for restricting post- operative growth due to rigid fixation.

■■ Fronto-orbital advancement via the tilt procedure is the authors’ preferred approach. 16–19 ■■ It has the main advantage of potentially greater preservation of baseline blood supply to the osteotomy segments.

T E C H N I Q U E S

■ Incisions for the Tilt Procedure

■ All incisions should include injection of local anes- thetic with epinephrine and intraoperative use of clot- ting agents (such as aminocaproic acid and tranexamic acid). ■ Exposure of the frontal and periorbital regions bilaterally is appropriate for both coronal synostosis and metopic synostosis to assess symmetry ( TECH FIG 1D ). ■ Intraoperative confirmation of fused sutures is made. ■ Subperiosteal dissection is performed at the level of the orbital rims to expose the deficient projection of the rims ( TECH FIG 1E ). ■ General and specific operative steps and modifica- tions are given below based on the individual sutural pathology.

■■ Incision line is posteriorly inclined from the region just anterior to the ear, to the occiput below the level of the hair whorl to minimize scar visibility and ease of the visualization of the skull 20 ( TECH FIG 1A,B ). ■■ For the posteriorly inclined coronal incision, care must be taken to preserve the ascending branch of the superfi- cial temporal artery to maintain appropriate vascularity for the scalp ( TECH FIG 1C ). ■■ An alternative to this incision is to do either a straight coronal incision that is slightly posteriorly inclined or a stealth incision. ■■ These alternatives, however, have more potential vis- ible scarring and take longer to both incise and close.

Parietal branch of the superficial temporal artery and vein

Frontal branch of superficial temporal artery and vein

Superficial temporal artery and vein

Occipital artery and vein

TECH FIG 1 • A,B. Preferred incision line is placed posteriorly toward the occiput below hair whorl to maximize skull exposure and minimize scar visibility postoperatively.

Chung-Cranio1e9781496348265-ch001.indd 5

2/22/2019 7:17:17 PM

Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20

Made with FlippingBook flipbook maker