2015 HSC Section 1 Book of Articles

Maxillofacial surgery

FIGURE 4. 6-month-old male with Apert syndrome and bicoronal synostosis.

with single suture synostosis [16]. Fearon et al. [17] showed that 66 out of 67 such patients at four different centers were accurately diagnosed by clinical exam prior to confirmation with a CT. Ultra- sonography has also been used as a nonionizing technique for the diagnosis of craniosynostosis in patients up to 12 months of age, after which time narrowing of the sutures and increased bony thick- ness makes ultrasonography less reliable [16]. A study by Regelsberger et al. [18] showed no missed diagnoses of sutural synostosis with ultrasonogra- phy in 26 patients.

Historically, craniosynostosis surgery began as a simple suturectomy. Interestingly, it seems that surgical treatment has come full circle from strip craniectomies, to extensive cranial vault remodel- ing, and back to the minimally invasive in the form of endoscopic suturectomies and spring- mediated cranioplasties. Lane and Lannelogue independently described strip craniectomies for craniosynostosis in the 1890s. Their techniques were quickly adopted by others. The technique was fraught with reossification of sutures and an unacceptably high mortality rate of 15 out of 33 patients, as shown in one review by Jacobi [19]. Surgery evolved decades later to the extensive cranial vault remodeling after Tessier’s work in the 1960s [20]. His work involved direct removal of the bone and contouring and offered

OPERATIVE TREATMENT There are disagreements among centers on the optimal timing and best operative procedure.

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