61. Hospital Links sagittal synostosis = fusion of the midline sagittal suture, growth fails to occuracross the head and excessive growth occurs from front to back leading to http://www.headlines.org.uk/SingleSuture.htm

Single Suture Craniosynostosis Back One of the UK Supra Regional Hospitals can give you more advice SINGLE SUTURE CRANIOSYNOSTOSIS : in the vast majority of cases the compensatory growth of the normal sutures is generally sufficient to allow the developing brain to grow without causing raised pressure. However, in a certain percentage of cases the restriction is such that the pressure within the skull rises (raised intracranial pressure). There are a number of reasons why surgery may be indicated for the treatment of an established disfigurement to attempt to prevent the progression of a developing disfigurement to relieve raised intracranial pressure to decrease the risk of developing raised intracranial pressure or other functional pressure-related affects. Types of single suture craniosynostosis: Sagittal synostosis = fusion of the midline sagittal suture, growth fails to occur across the head and excessive growth occurs from front to back leading to Scaphocephaly = boat shaped head Metopic synostosis = fusion of the anterior midline suture with failure of adequate transverse growth in the forehead, and compensatory growth posteriorly and laterally leading to

62. Craniosynostosis Isolated sagittal synostosis (the suture that runs from the anterior fontanelle tothe posterior fontanelle) occurs in about 55% of cases and isolated coronal http://www.drhull.com/EncyMaster/C/craniosynostosis.html

Help for sleepless parents Encyclopedia Index C craniosynostosis Search craniosynostosis Craniosynostosis, or premature fusion of the skull plates, occurs in about one in 2,000 infants. It can be an isolated abnormality or part of a broader malformation syndrome The joints between the plates are called the sutures . Craniosynostosis occurs when for whatever reason, sporadic or as part of a larger problem, one or more of these sutures fuse prematurely. Constrained abnormally in one part of the skull, brain growth forces the remainder of the skull to expand out of proportion, leading to abnormal skull shape. Isolated sagittal synostosis (the suture that runs from the anterior fontanelle to the posterior fontanelle) occurs in about 55% of cases and isolated coronal suture synostosis (the suture that runs down laterally from the anterior fontanelle) occurs in 20% of cases. Diagnosis of craniosynostosis is by xrays, and increasingly by CT scan . Early evaluation and possible neurosurgical intervention is imperative, since the synostosis may be a marker for a larger pattern of abnormalities, and if synostosis is left uncorrected, head and facial shape can be severely affected. There is also concern that some forms of synostosis can cause damage to the infant brain by constraint of normal brain growth.

63. Stephen B. Baker, DDS, MD — Publications Delayed cranial vault reconstruction for sagittal synostosis in older children. DelayedCranial Vault Reconstruction for sagittal synostosis in Older Children. http://www.georgetownplastics.com/baker/publications.htm

Home Practice Profile Physician Profile Publications Office Hours Insurance Info Driving Directions Contact ... Back to Division of Plastic Surgery Published Articles Textbooks Baker SB , Wolford L, Fonseca RJ, (eds). Oral and Maxillofacial Surgery, Vol. 6-Cleft, Craniofacial, and Cosmetic Surgery. W. B. Saunders Co., Philadelphia, PA. 2000. Chapters Maull D, Baker SB Baker SB Baker SB , Dayan J. Rigid Fixation of Facial Fractures. Fonseca RJ, Walker RV (eds): Oral and Maxillofacial Trauma 2nd ed., Vol. II. Philadelphia, WB Saunders, (in press). Losee J, Baker SB , Bartlett SP. Reconstruction: Facial syndromes. Mathes SJ, Hentz VR (eds.), Plastic Surgery, 2nd Ed. In press Baker SB , Betts NJ. Mandibular Angle Fractures. AAOMS Knowledge Update Vol. II. American Association of Oral and Maxillofacial Surgeons, Rosemont , IL, 1998 Baker SB , Dalrymple DR, Barber HD, Betts NJ. Rigid Fixation of Facial Fractures. Fonseca RJ, Walker RV (eds): Oral and Maxillofacial Trauma, Vol. II. Philadelphia, WB Saunders, 1997. Peer-Reviewed Publications Baker SB , Slemp AE, Whitaker LA. Surgical management of the craniofacial manifestations of craniometaphyseal dysplasia. Accepted Plast. Reconstr. Surg. 10/2000.

64. Craniofacial And Maxillofacial Surgery In Children And Young Adults 10. Trigonocephaly Metopic Synostosis 11. Scaphocephaly sagittal synostosis 12.Posterior Plagiocephaly Unilateral Lambdoid Synostosis and Skull Molding 13. http://www.drposnick.com/thebook/toc.html

The Book Introduction Table of Contents Case Photographs Ordering Information Craniofacial and Maxillofacial Surgery in Children and Young Adults Table of Contents I. Basic Concepts and Future directions for the Treatment of Craniomaxillofacial Deformities 1. Looking Back, Looking Ahead: How We Arrived at Our Current Thinking About Craniofacial and Maxillofacial Surgery 2. Craniofacial Growth and Development: Normal and Deviant Patterns 3. Quantitative Computed Tomographic Scan Analysis: Normal Values and Growth Patterns 4. Anthropometric Surface Measurements in the Analysis of Craniomaxillofacial Deformities: Normal Values and Growth Trends 5. Dysmorphology, Syndromology, Genetics, and Ethical Considerations 6. Fetal Surgery (Repair) and wound Healing Enhancement: Now and in the Future 7. Engineering Tissues for the Face and Facial Skeleton 8. Craniofacial Reconstruction Through Osteotomies and Gradual Distraction of the Skeletal Parts: Biologic Basis, Current Problems, and Future Directions

65. Genes At Work - Topics In Genetics on clinical examination. sagittal synostosis is most commonly diagnosedand represents over 50% of the synostoses. This type of http://www.umdnj.edu/genesatwork/topics/pediatrics/02_pediatrics.htm

Craniosynostoses: Genetic Considerations by Beth A. Pletcher, MD, May 1999 In addition to simple synostosis, there are over 75 syndromes described where craniosynostosis is a feature. When craniosynostosis occurs in the context of growth retardation, multiple congenital anomalies and/or mental retardation, one should always consider a cytogenetic cause. For example, metopic suture synostosis is quite common in deletion 9p which is also associated with dysmorphic facial features and developmental delay. A cloverleaf cranial deformity is a severe defect resulting in a trilobular head shape and is seen in both thanatophoric dysplasia and two subtypes of Pfeiffer syndrome. Recent advances in molecular genetics have greatly expanded our understanding of some of the more well known syndromic craniofacial syndromes. While in the past patients have been categorized by clinical features alone, the discovery of several "craniofacial genes" in recent years has forced clinicians to rethink their diagnostic approach. It has been shown that mutations (genetic typos) within the same gene can result in several different craniofacial syndromes. Furthermore, mutations in different genes can also result in the same collection of clinical features and identical diagnoses. In order to put this in perspective, it may be useful to review some of the more common craniofacial disorders and their clinical descriptions.

66. Craniosynostosis sagittal synostosis Before Surgery. What Is Craniosynostosis? sagittal synostosisOne Year After Surgery. What Is the Recommended Treatment for my Child? http://www.jpanchal.com/Craniosynostosis.htm

Jayesh Panchal jayesh-panchal@ouhsc.edu Home Up Contact Us ... About Jayesh Panchal Frequently Asked Questions About Craniosynostosis Sagittal synostosis Before Surgery What Is Craniosynostosis? Craniosynostosis is the medical condition when two or more of the normally separate bones of the skull grow together too soon. This premature union of bones interferes with normal skull and brain growth causing deformity of the head. Whether or not craniosynostosis affects brain development is much debated among experts in the field. Treatment recommendations for an infant with craniosynostosis depend upon which separation ("suture") has grown together ("fused"), the infant's general health and development, and how severe the deformity is. Certain suture fusions only deform the top of the head, while others also cause obvious facial deformity. Surgery is recommended for children with moderate to severe deformity affecting the top of the head and for most infants with deformity affecting both the head and the face. Sagittal Synostosis One Year After Surgery What Is the Recommended Treatment for my Child?

67. Jayesh Panchal 10. Panchal J, Pilgram T, Marsh J L. Photographic assessment of head shapefollowing sagittal synostosis surgery. Plastic and Reconstructive http://www.jpanchal.com/resume.asp

CURRICULUM VITAE JAYESH PANCHAL Current Status: Associate Professor Chief, Section of Plastic Surgery University of Oklahoma Health Sciences Center Address: WP 2220 Section of Plastic Surgery 920 S.L.Young Blvd. Oklahoma City OK 73104 USA Telephone: Business: 405-271-4864 Home : 405-844- 9534 E-Mail: Business: jayesh-panchal@ouhsc.edu Home: jpanchal@cox.net Education: M.D. October 1978-84 Grant Medical College University of Bombay M.S. (Gen. Surg) July 1984-87 Grant Medical College University of Bombay Fellow Royal College Of Surgeons (General Surgery) May 1990 Royal College of Surgeons and Physicians of Glasgow Fellow Royal College Of Surgeons (General Surgery) June 1990 Royal College Of Surgeons of Edinburgh Fellow Royal College of Surgeons (Plastic Surgery) September 1990-95 Royal College of Surgeons of Edinburgh. Executive Health MBA May 2001 Major: Health University of Oklahoma GPA 3.8 Postgraduate Training: 8/1/90 to 5/31/91 Junior Resident, Plastic Surgery, Leicester Royal Infirmary, Leicester, England 6/1/91 to 5/31/92 Junior Resident, Plastic Surgery, Kingston General Hospital, Hull, England

68. Johns Hopkins Magazine June 1998 CT, Richtsmeier and several collaborators at the Craniofacial Center embarked onan ambitious experiment to understand a condition called sagittal synostosis. http://www.jhu.edu/~jhumag/0698web/joan.html

JUNE 1998 CONTENTS AUTHOR'S NOTEBOOK RELATED SITES A talented scientist and a devoted mother, Joan Richtsmeier was on top of the world. Then, against all odds, the parallel tracks of her life intersected, in a way she never could have expected. When Life Imitates Science By Melissa Hendricks Photos by Steven Rubin BEFORE EVERYTHING IN HER WORLD CHANGED, Joan Richtsmeier had been listening raptly to a speaker in a stately auditorium at the University of Chicago. It was the summer of 1994 and the finest minds in the field of vertebrate structure had come from all over the world to attend the conference. Richtsmeier, who had been invited to lead a workshop, was elated. At the workshop she planned to unveil to her international colleagues a new technique for measuring structure and growth. She had already used these methods to study skull growth in patients with severely disfigured faces and skulls, and hoped that the new tools would one day help refine surgical procedures for correcting such psychologically devastating conditions. There were other measures of success in her life. At age 38, Richtsmeier, a biological anthropologist, had already been named associate professor at the Johns Hopkins School of Medicine. She had recently published several articles in major research journals. Her students praised her in their written evaluations.

69. Neurological Surgery, Buffalo, New York - Services: Craniosynostosis also correcting the head shape. Infants with sagittal synostosis areusually treated by 34 months of age. In these cases a strip http://neurosurgerybuffalo.com/Services/Craniosynostosis.html

Craniosynostosis Background Craniosynostosis The next most common form of synostosis involves one or both coronal sutures. In the case of one-sided involvement, the forehead just above the eye becomes flattened and is taller than normal (see Figure 3). The opposite side of the forehead may stick out a bit more than normally. The top of the nose is shifted towards the side that is flattened and the tip is pointed towards the opposite side. If both coronal are fused, the head is very short from front to back and tall, particularly in the front. Both sides of the forehead are quite flattened (Figure 4). True lambdoid synostosis is actually quite rare and produces a head shape that is quite different from the head shape that is typical of occipital plagiocephaly (OP). Whereas the head in OP is shaped like a parallelogram the head shape and true lambdoid synostosis is akin to a trapezoid. The ear on the affected side is pushed further back and the forehead on the affected side is pulled back rather than pushed forward as in OP. Diagnosis Craniosynostosis can be diagnosed by skull x-rays which usually reveal that the affected suture is not visible on x-ray (normal sutures appear as dark gaps between the whitish bone on each side) (see Figure 6). There is also often heaping of the bone at the site of the fused suture. A computed tomography (CT) scan, as well as 3-dimentional CT can supplement skull x-rays. In addition to the primary changes seen at the suture there can also be secondary changes seen in the alteration of how the skull has formed, particularly in its shape.

70. CRANIOSYNOSTOSIS 4) The periosteum overlying the suture may be involved. ASSOCIATED DISORDERSThe sagittal synostosis is rarely associated with other abnormalities. http://www.thamburaj.com/craniosynostosis.htm

Craniosynostosis: Dr. A. Vincent Thamburaj. N eurosurgeon, Apollo Hospitals, Chennai , India. Craniosynostosis is the premature partial or complete ossification of one or more of the sutures separating the membranous bones of the skull. Primary craniosynostosis is almost always present prenatally except in some with cranio facial syndromes of Crouzan's, Apert's and Carpenter's type in whom progressive postnatal closure may occur. It is called 'simple' when one suture is involved,’ compound' when more than one is involved. Secondary stenosis occurs in children with microcephaly and in some who have had shunts in place for hydrocephalus. In some Rickets, Hyperthyroidism, Thalassaemia, or Mucopolysaccharidosis may be associated. PATHOGENESIS: The cranial vault develops intramembranous bone formation between the periosteum and the dura. This process begins during the 6th week of embryonic development. The posterior fontanel closes at 3 mths of age and the anterior one, at 8mths of age. The bones ossify by the end of first year. The skull growth ceases by 10-12 yrs of age. The ossification of the cranial sutures occurs by the 4th-5th decade. The base develops from a series of primordial cartilages that undergo ossification. The growth of the base proceeds at a slower rate. The skull contains two types of sutures- syndesmoses and synchondroses.

71. CE: Endoscopic Strip Craniectomy: A Minimally Invasive Treatment For Early Corre Lane, 1892). In 1890, Lannelongue treated sagittal synostosis withbilateral strip craniectomies (Lannelongue, 1890). However, the http://www.aann.org/ce/0603/jnn06-03b.htm

Chapters Commercial Support Job Mart Exhibiting ... Online Store Abstract: Fig 1. Sutures of infant skull when viewed from above Although the condition was recognized in the days of Galen and Hippocrates (Cohen, 1986), the first craniectomy to remove a stenosed suture was performed by Lane in 1888 to treat microcephaly (Lane, 1892). In 1890, Lannelongue treated sagittal synostosis with bilateral strip craniectomies (Lannelongue, 1890). However, the strip craniectomy was abandoned because results were not that pleasing. Over the years, many calvarial remodeling techniques have been used to correct craniosynostosis. Some of these techniques can last several hours, requiring blood transfusions to correct estimated blood loss percentages from 25% to 500% (Jimenez, 2002). Most patients undergoing these procedures had significant facial swelling and remained hospitalized for up to 1 week. Costs for these procedures currently average about $51,000 at University of Missouri Healthcare. Because of the problems with calvarial remodeling, a less invasive technique was developed, which combined the old approach of strip craniectomy with modern endoscopic technology. The results were further enhanced through the use of a molding helmet to overcome the dural forces that would otherwise cause the head to revert to its former shape. By contrast, costs for the endoscopic strip craniectomy are $14,000 or less. This article discusses the outcomes and nursing care of patients undergoing endoscopic strip craniectomy for craniosynostosis.

72. Displaying Medical Dictionary Terms Starting With Letter SA sagittal line sagittal plane sagittal section sagittal split mandibular osteotomysagittal sulcus sagittal suture sagittal synostosis sagittalis sagittarius http://www.books.md/S/SA.php

Home S /SA Medical Dictionary Search Engine Advertise on this site! A service of health-link-net.com Browse Dictionary Alphabetically A B C D ... Z Displaying all terms starting with letter SA SA-induced protein kinase saan sabadilla sabal ... Home

73. Joan Richtsmeier--Penn State, Department Of Anthropology Richtsmeier, JT, T Cole, CJValeri, G Krovitz S Lele 1998 Preoperative morphologyand development in sagittal synostosis. J. Craniof. Genet. Devel. http://146.186.95.23/richtsmeier.html

Joan T. Richtsmeier Professor of Biological Anthropology Office : 320 Carpenter Building Telephone Fax Email jta10@psu.edu Vitae EDUCATION B.A., St. Mary’s College 1977 M.A., University of Nebraska 1980 Ph.D. Northwestern University, 1985 AREAS OF SPECIALIZATION: Dr. Richtsmeier has worked on the problem of determining the contribution of growth pattern to morphology. Methods developed to study this problem have been applied to the difference in craniofacial growth patterns between primate species, between the sexes, and between children with craniofacial anomalies and unaffected children. Dr. Richtsmeier is currently working to characterize the relationship between the genes mutated in premature cranial suture fusion (craniosynostosis) and the craniofacial phenotypes associated with these mutations. Finally, Dr. Richtsmeier is working to understand the influence of aneuploidy in the production of the phenotype by studying a mouse model for Down syndrome. RESEARCH ACTIVITIES AND INTERESTS: Dr. Richtsmeier is interested in growth and evolution of the skull. Her work is largely in the area of

74. Doctor Appointments Of Multiples. Neurological Examination sagittal synostosis with macrocephaly. Cosmetic effectsof the sagittal synostosis. April 23, 1991 Travis home from the hospital. http://quads9.homestead.com/Doctors.html

@import url(http://www.homestead.com/~media/elements/Text/font_styles.css); Doctors visits on just one of the Quadruplets November 20, 1990 His stay in the hospital was 2 mos. and 4 days. November 23, 1990 Dr. Morgan Pediatric Surgery 1200 S. Kuhl ave. Orlando Florida 32806 1 Bradicardia and 2 Apnia alarms since comming home 11-20-1990 November 28, 1990 Dr. Howard Finer Pediatrics 974 Douglas ave. Suite 102 Alt. Springs January 4, 1991 3 Bradicardia alarms since last visit on 11-26-1990 January 7, 1991 Dr. Gruenberg The eye Doctor at 9:15 am. to see the eye Doctor. January 10, 1991 Dr. Oetjen January 24, 1991 4 month check up. Pt brought in by dad, Pt coughing and crying. Pt is 4 months old. Weight 10 lbs. 9 oz., length 21 1/2., head circumference 15 1/4 inches. January 24, 1991 Arnold Palmer Hospita l, had ultrasound on head and chest x-ray done at A.P. hospitial. Amoxil 75mg. 10 days. for EARS B-mode echoencephalogram. The head appears elongated in the AP diameter and some what narrow transversely, but the underlying brain appears normal. Febuary 7, 1991

75. Curriculum Vitae For Dr. Todd Maugans - UVM Neurosurgery Maugans TA, McComb JG, Levy ML Surgical management of sagittal synostosis acomparative analysis of strip craniectomy and calvarial vault remodeling. http://www.med.uvm.edu/neurosurgery/cv_maugans.html

T odd A. Maugans M.D. Assistant Professor of Neurosurgery Director of Pediatric Neurosurgery Division of Neurosurgery University of Vermont/Fletcher Allen Health Care Medical Education Temple University School of Medicine Philadelphia, Pennsylvania, 1985 Internship, Residency, Fellowship Surgical Internship: Dartmouth-Hitchcock Medical Center, 1986 Family Practice Residency: University of Vermont School of Medicine, Burlington, Vermont, 1987-1990 Neurosurgery Residency: Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, 1995-1999 Pediatric Neurosurgery Fellowship: Children's Hospital Los Angeles, Los Angeles, California, 1997-1998 Board Certification American Board of Neurological Surgeons, Board Eligible, 1997 American Board of Family Practice, Diplomat, 1990 National Board of Medical Examiners, Diplomat, 1986 Areas of Clinical Subspeciality Expertise Pediatric Neurosurgery and Adult General Neurosurgery Areas of Clinical and Basic Science Research Head Injury, Pathophysiology of Hydrocephalus and Shunt Failures Professional Societies: 1995-present American Association of Neurological Surgeons 1995-present Congress of Neurological Surgeons Professional Services: 1994-present Journal Reviewer, Journal of Neurosurgery

76. Craniosynostosis hypotelorism). sagittal synostosis. Scaphocephaly, boatshaped skulliscaused by an early closure of fusion of the sagittal suture. http://www.stlouischildrens.org/articles/content.asp?pageid=P01833

77. University Of Michigan Department Of Plastic Surgery - Pediatric Surgery Procedu The most common type of suture synostosis is sagittal synostosis. In this type,the suture that runs from the front to the back fuses prematurely. http://www.med.umich.edu/surg/plastic/patient_family_care/pediatrc/pedproc.htm

top top top top ... Feeding the newborn with cleft lip and palate The cleft of the lip can be unilateral or bilateral. The repair of the child's lip generally takes place at age 10 to 12 weeks, although optimum timing of repairs may differ from child to child. The repair of the cleft lip is done in the operating room under general anesthesia. There are several methods of repairing the cleft lip, and the surgeon will choose the type of repair that is appropriate depending on the type of cleft lip your baby has. In the cleft lip operation, incision are made and the pieces of lip are brought together to form a full lip. post operative instructions The repair of the cleft palate is usually done at six to eighteen months of age. Although the child may look normal from the outside, the cleft palate should be closed for several reasons, namely to improve speech and to separate the mouth and the nasal cavity. More than one operation may be necessary to close the cleft palate. The cleft palate operation is done under general anesthesia in the operating room. The operation involves making several incisions in the pieces of the palate and putting the pieces of the palate together in several layers; the layer which is the floor of the nose, the muscles in the middle of the palate, and the skin that is the roof of the mouth.

78. NYU School Of Medicine - Institute Of Reconstructive Plastic Sugery sagittal synostosis results from premature closure of the sagittal ormidline suture which runs from the front to the back of the skull. http://www.med.nyu.edu/irps/craniosynostosis.html

The Craniosynostosis Division of the Institute of Reconstructive Plastic Surgery At the Institute of Reconstructive Plastic Surgery at the NYU Medical Center, patients with Craniosynostosis are evaluated and treated by a multidisciplinary team emphasizing comprehensive care beginning at birth and continuing until the completion of facial growth. The team consists of specialists from Plastic Surgery, Dermatology, Genetics, Neurosurgery, Nursing, Ophthalmology, Otolaryngology, Orthodontics, Prosthodontics, Pediatrics, psychology and Speech Pathology. What is Craniosynostosis? Are there different types of Craniosynostosis? What are the different types of Craniosynostosis? What are the different types of the craniofacial synostosis syndrome? ... What are the functions of the craniofacial team members? What is Craniosynostosis? Diagram Showing the Cranial Sutures The seven bones that compose the skull of a newborn are separated by soft spots called sutures. In the front of the skull these sutures intersect in the fontanelle, which is the large soft spot located above the baby's forehead. Craniosynostosis is a term that describes premature or earty closure of one or more of these sutures. The deformity which results depends on which suture(s) is involved. The cause of this condition is not known. Some of the craniosynostosis conditions can be inherited or passed between generations of families. Consequently, it is important that all affected children have a genetics evaluation.

79. OmrÃ¥de HPRAS - Claes Lauritzen 59. Lauritzen C, Friede H, Stephensen H, Lilja J Sahlin P. Treatmentof sagittal synostosis by dynamic skull shortening. In Craniofacial http://www.sahlgrenska.se/templates/Page____14860.aspx

Kontakt Hem Om du blir sjuk F¶rlossningsv¥rd Patient och anh¶rig Hitta r¤tt p¥ SU ... V¥rdgivarinfo Tillbaka Plastikkirurgi Avdelning 37 Avdelning 41 Broschyrer Fotoavdelning ... Universitetsdel Claes Lauritzen Befattning : Professor, Docent, –verl¤kare, Chef f¶r Kraniofaciala enheten Forskningsomr¥de : Kraniofacial kirurgi Examen : M.D., Ph.D. Telefon Fax E-post : claes.lauritzen@plast.gu.se (OBS - Ej f¶r patienter) Bibliography 1. Lauritzen, C. A new and easier way to anastomose microvessels: An experimental study in rats. Scand J Plast Reconstr Surg 1978;12:291. 5. Lauritzen, C. The microvascular sleeve anastomosis. Thesis. Medicinska fakulteten, G¶teborgs universitet. 1979. 6. Lauritzen, C. Wound healing of the microvascular sleeve anastomosis. I Symposium on Wound Healing (ed. B¶rje Sundell), ESPO, sid 125-131. 1979. 16. Lauritzen, C. A presentation of the sleeve anastomosis. Scand J Plast Reconstr Surg 1982, Suppl 19. 17. Lauritzen, C. Experimental studies on absorbable vascular grafts for microsurgery. Scand J Plast Reconstr Surg 1983;17:133. 22. Lauritzen, C. The sleeve anastomosis revisited. Ann Plast Surg 1984;13(2):145.

80. Neurosurgeons For Kids - Childhood Visual Pathway Glioma date has been a wound infection in a repeat operation done for pansynostosis ina patient born with unilateral coronal and sagittal synostosis who developed http://www.pedneurosurgery.com/PedNeuroSite/Neurosurgeons for kids - Childhood V

U ltra Early Repair of Bilateral Coronal Craniosynostosis: SURGICAL TECHNIQUE AND TECHNOLOGICAL IMPROVEMENT Eric R.Trumble MD, Jeffrey M. Hartog, DMD MD, Chris A. Gegg MD DESCRIPTION INTRODUCTION CASE DISCUSSION ... CONCLUSION DESCRIPTION Craniosynostosis is a common congenital defect requiring surgical intervention by a trained team in order to maximize cosmetic outcome and minimize risk of neurological injury. Recent technological improvements in surgical fixation devices have allowed earlier repair of craniosynostosis, leading to better cosmetic outcomes. The incidence of neurological compromise in non-syndromic craniosynostosis diagnosed early approaches 0%. In this article, we discuss a recent case of bilateral coronal synostosis diagnosed immediately after birth. Radiographic imaging studies (axial and three-dimensional reconstruction) are reviewed pre- and post-operatively. Literature is then reviewed and justification for reducing the tine necessary to wait pre-operativey to maximize normal outcome in patients with congenital skull deformities is discussed. Ultra-early repair of bilateral coronal synostosis can be safely performed on infants within the first week of life. Back to top INTRODUCTION Craniosynostosis is premature closure of the cranial sutures and may affect any of the sutures. Coronal synostosis affects 1/10,000 live births. Untreated, coronal synostosis leads to progressive skull and facial abnormalities, classically ipsilateral frontal bone and orbital flattening, harlequin eye deformity, and a tendency for a towering configuration of the skull. The only treatment for true craniosynostosis is surgical reconstruction. The earlier the surgical reconstruction is performed, the less the long-term cosmetic deformity. Additionally, intracranial hypertension has been described in as many as 55% of patients with single suture synostosis. With each successive suture closure, the incidence of normal intracranial pressure is essentially halved. Elevated intracranial pressure has been shown to reduce intelligence over a prolonged period.

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