This video documents the steps typically followed during open reduction of isolated, depressed zygomatic arch fractures. The patient’s hair was shaven for clarity and for proper marking of key anatomic landmarks. Such landmarks are shown and discussed in sequence with the key surgical steps.
Marcus Couey, DDS, MD; Eric Reimer, DDS; Andrew Bhagyam, DDS; Phillip Freeman, DDS, MD; Jose M Marchena, DMD, MD
The University of Texas Health Science Center at Houston, School of Dentistry, Department of Oral & Maxillofacial Surgery
Following a post-traumatic head injury from a gun shot wound in a seven year old African American female, a 3D CT was performed to assess for correction of a large cranial calavarial defect using a custom PMMA implant. A trilaminar Cranioplasty was planned using an absorbable plate underlay, demineralized bone graft in between and an onlay of absorbable plate. A post-operative CT was obtained showing the implant in a good position.
Pierre Robin sequence (PRS) is a craniofacial malformation characterized by micrognathia and glossoptosis, with or without cleft palate. A subset of infants with PRS will suffer from airway obstruction severe enough to merit surgical intervention. Surgeries for PRS include tongue lip adhesion, tracheotomy, gastrostomy, and bilateral mandibular distraction osteogenesis. Distraction osteogenesis refers to a process in which a bone is lengthened after an initial osteotomy by means of separating the two resulting segments slowly over time. In the neonatal mandible, hardware used for distraction may be implanted beneath the skin or affixed externally. Each device has its advantages and disadvantages, however external devices are less expensive, do not typically require preoperative computed tomography scanning, may be adjusted easily throughout the distraction process, and are easily removed following consolidation, avoiding a second invasive procedure and lengthy anesthetic. This video presents the technique of neonatal mandibular distraction osteogenesis using multivector external distractors.
The goal of auricular reconstruction is to achieve a natural appearance of the reconstructed side with a form that resembles the normal ear and endures over a lifetime. For severe deformities in which major cartilaginous elements are missing, established reconstructive techniques using alloplastic constructs wrapped in temporoparietal fascia or carved costal cartilage grafts may be employed. For cases of minor deformity in which all named cartilaginous components are present, albeit deficient compared to the normal side, transfer of autologous auricular skin and cartilage may be used to achieve symmetry between normal and abnormal ears. This video presents the surgical technique and results of a grade 1 microtia reconstruction using autologous auricular cartilage transfer. This two-stage method of reconstruction avoids the use of autologous rib or alloplastic materials and often avoids the use of skin grafting altogether.
The transconjunctival approach was first described by Bourquet in 1924 and then modified by Tessier in 1973 for exposure of the orbital floor and maxilla for the treatment of facial trauma.
This approach can be carried out either in a preseptal plane by separating the orbital septum from within the eyelid (preseptal approach) or posterior to the septum and eyelid (retroseptal approach) by making an incision through the bulbar conjunctiva directly above the orbital rim.
The main advantage of the retroseptal approach is that it does not involve dissection and disruption of the eyelid itself, therefore, reducing the incidence of post-operative lid laxity and position abnormalities.
This video will show a retroseptal approach to an orbital floor blowout fracture. A lateral inferior cantholysis is performed to facilitate eversion and retraction of the lower eyelid.
In this video, we showcase the bilateral subcranial Le Fort III osteotomies with midface distraction using Kawamoto distractors.
The surgery was performed in a 4-year-old boy with Crouzon Syndrome to correct his severe proptosis, increase the nasopharyngeal airway space and improve his severe negative overjet. Internal distractors were chosen to achieve maximum correction at this age.
The patient undergoing surgery had no intraoperative or postoperative complications. A full separation of his facial bones was achieved. The patient had an uneventful recovery period, and there was a significant improvement in his proptosis and malocclusion.
Santiago Gonzalez, BS, BA (1); Michael Golinko, MD, MS (2)
1. University of Arkansas for Medical Sciences – College of Medicine
4301 W. Markham, #550
Little Rock, AR
72205
2. Vanderbilt University Medical Center, Department of Plastic Surgery
2900 Children’s Way, 9th Floor Doctor’s Office Tower
Nashville TN 37232
The following video demonstrates the author’s method for repairing wide unilateral complete cleft lip and cleft nasal deformities. Details of surgical markings as well as nuances of technique are demonstrated. Video documentation of immediate results as well as progress of healing over the following year are included.
This video shows a pediatric patient with Van der Woude syndrome. He has lip pits that are classic for this syndrome and his family desired surgical correction. This video outlines and shows the steps of the modified simple excision technique as well as discussing tips for a successful surgery.
This video demonstrates an open anterior cranial vault reconstruction for metopic craniosynostosis on a 5-month-old female.
This video demonstrates how to perform a tongue reduction using a Y-V advancement technique for pediatric macroglossia.
