Daniel Marchac

Combined report of problems and complications in 793 craniofacial operations.

We report the experiences in 6 major craniofacial centers, with similar teams but in different parts of the world, in a total of 793 craniofacial operations. The mortality rate was 1.6%. Complications developed in 16.5% of the cases (including infections in 4.4%). This surgery has many potential advantages, not least of which is its psychosocial effects on previously disfigured patients. Certain problems seem inherent, however, for there are not yet any satisfactory solutions to them. Some of the factors that reduce morbidity and improve results include the use of hypotensive anesthesia, a reduction in operating time, rigid stabilization of the mobilized bones at the end of the operation, a diminution in the number of incisions, and extensive antibiotic therapy.

Radical forehead remodeling for craniostenosis.

A normal forehead has two parts, shaped differently: (1) the lower part (corresponding to the supraorbital rim and glabellar area) set at a steep angle to the nose; (2) the upper part, sloping gently backward. To reproduce this normal anatomy in cases of cranostenosis affecting the frontal area, we found it essential to mobilize and reshape a supraorbital bar of bone and to transfer a suitable piece of the cranial vault in one piece to make a new upper forehead. By this method we have treated 18 patients with oxycephaly since 1973, with good results. We have also operated on babies with craniostenosis to try to solve simultaneously the functional and the cosmetic problems. In faciocraniostenosis, there are dominant malformations at the base of the skull, but an isolated frontal advancement of two cm has produced gratifying early results.

The operative treatment of isolated craniofacial dysostosis (plagiocephaly) : a comparison of the unilateral and bilateral techniques

Both the safety and efficacy of the treatment of isolated craniofacial dysostosis (plagiocephaly) in infancy have been demonstrated. Opinions remain divided, however, as to the optimal type of procedure to be undertaken. In an attempt to answer this question, we have retrospectively evaluated a study population of 48 children operated on in infancy by either a unilateral or bilateral approach. Results of treatment at a minimal follow-up of 3 years were assessed based on preoperative and postoperative photographs and direct patient examination. Based on this retrospective comparison of the unilateral and bilateral approaches to the treatment of isolated craniofacial dysostosis, we conclude that (1) either approach as specifically outlined will give excellent results in the majority of patients, (2) there is no statistically significant difference in the results obtained by using either procedure, (3) in the majority of instances, less than ideal correction was manifested by contour irregularities evident in the temporal and/or lateral forehead region, and strict attention should be given to these areas in an attempt to further improve results, and (4) in those cases where significant protrusion is observed on the “normal side,” a bilateral approach is preferable.

Postoperative mental and morphological outcome for nonsyndromic brachycephaly.

&NA; Bilateral coronal synostosis causes functional and morphological problems that require fronto‐orbital advancement in infancy to correct the brachycephalic deformity and to prevent mental impairment caused by the intracranial hypertension. In this study, 99 children with isolated cases of brachycephaly were prospectively followed to study their preoperative and postoperative mental outcome, which was evaluated using developmental or intelligence quotients. Several factors were analyzed: age before treatment, age at the time of surgery, and the correlation between mental assessments before and after surgery. In a subgroup or patients tested for the FGFR3 P250R mutation (n = 48), mental and morphological assessments were analyzed. Before surgery, mental status was better in the patients tested before 1 year of age (p < 0.001). The preoperative mental assessment always correlated with the postoperative assessment (p < 0.0001). The postoperative mental outcome was better when surgery was performed before the patient reached 1 year of age (p < 0.02). Although both the morphological and functional outcomes were better in the subgroup of noncarriers of the mutation, the differences were not statistically significant. Prominent bulging of the temporal fossae was frequently responsible for poor morphological outcome in carriers of the mutation. This study confirms the need for early corrective surgery before 1 year of age in brachycephalic patients to prevent impairment of their mental development. Suboptimal morphological and mental outcomes can be expected in patients with nonsyndromic brachycephaly who carry the FGFR3 P250R mutation. Primary correction of the temporal bulging should be performed in conjunction with fronto‐orbital advancement to improve the morphological outcome in patients with the mutation.

Orbital expansion for anophthalmia and micro-orbitism.

In severe cases of microphthalmos or anophthalmos, the bony orbital cavity is often too small to allow one to create a satisfactory socket for a prosthesis. An omnidirectional expansion of the orbit, by osteotomies done in a step-like fashion, allows the creation of a larger bony cavity and improves the symmetry of the face. The risks of the craniotomy and of the mobilization of the free bone pieces are discussed.

Case report: Reconstruction of the mid-face in an adult, after gangrenous destruction in infancy.

We report a case of an adult mid-face reconstruction for a deformity occurring in infancy, using a Le Fort III advancement first to restore the contour of the skeleton. This was followed by a scalping forehead flap for the nasal reconstruction, and a fleur-de-lis Abbe flap for reconstruction of the lip and nasal vestibule.

Giant breast implant for unilateral aplasia. Case report.

The authors present a patient who had aplasia of the right breast associated with absence of the pectoralis muscles and a chest wall deformity. The insertion of combined breast-chest wall implants improved her appearance markedly.

Transatlantic Innovations: a new approach to international ideas and technology.

Background: In April of this past year, Transatlantic Innovations brought a variety of organizations and industry together for an international exchange of ideas, new technology, and current trends in plastic surgery. Methods: The meeting was highly interactive and included audience response devices. The focus was on 10 major areas: (1) new surgical techniques; (2) composite allografts versus conventional techniques, facing the future; (3) interspecialty collaboration versus competition; (4) the business of plastic surgery, best practices; (5) the image of the plastic surgeon, branding yourself; (6) medical tourism; (7) publicity; (8) the regulation of innovation, U.S. Food and Drug Administration and European Medicines Agency perspective; (9) the future of plastic surgery, cutting edge technologies; and (10) applications and controversies in fat grafting. The meeting concluded with the 8th International Committee for Quality Assurance, Medical Technologies and Devices in Plastic Surgery Consensus Conference with the development of a consensus statement. Results: Through an interactive audience response system, additional questions and attitudes were asked of the audience and, in real time, international differences were identified, which led to further discussions from panelists. Responses were identified in three major groups: European Union, North America, and the Rest of the World. Responses and data are included in this article. Conclusions: The meeting brought participants, industry, regulators, and educators from both sides of the Atlantic. The interaction of these groups in these outlined topics brought a unique perspective to the meeting and, in the end, volumes of data. We have more in common than we believe. It is our anticipation that as we as plastic surgeons move forward, we can use these interactions to help our own practices but more specifically the specialty as a whole.