Donald Wood-Smith

Report on a series of 50 craniofacial operations.

We present a retrospective study of 50 patients who have undergone craniofacial surgery. The indications, types of osteotomies, complications, and other aspects are reported.

Early and late surgery in craniofacial dysostosis: A longitudinal cephalometric study☆☆☆

Longitudinal clinical and cephalometric case studies are presented for two groups of patients with craniofacial dysostosis. The first sample includes two infants who underwent an extensive stripping procedure that was extended inferiorly to involve not only the coronal, but also the sphenozygomatic suture. The second sample includes two adolescents with midfacial hypoplasia who underwent a fronto-orbital-maxillary advancement. The extensive cranial stripping procedure had a favourable impact upon growth and development of the craniofacial structures, and longitudinal studies suggest the importance of promoting the growth potential of the bones contiguous to the affected sutures. Craniofacial surgery performed on adolescents results in a dramatic translocation of the skeletal and soft-tissue structures of the face. In contrast to early surgical intervention in infants in whom growth of the effected areas essential to the development of face and cranium was crucial, late surgery appeared to have little, if any, impact upon the development of the craniofacial skeletal structures that had been operated on.

Reconstruction of acquired ear defects with transauricular flaps

Retroauricular flaps based superiorly, inferiorly, or posteriorly may be tunneled through the ear to close a variety of acquired ear defects in a single-stage procedure. The technique is particularly helpful for larger, nonmarginal deformities in which both skin and perichondrium have been excised.

A new technique for the correction of orbital hypertelorism

Orbital hypertelorism is one of the most severe congenital deformities, frequently achieving monstrous proportions because of the wide divergence between the ocular globes. It is complicated by ocular anomalies; prominent among which are strabismus and amblyopia. The etiology is for the most part congenital although traumatic hypertelorism is seen and careful differentiation must be made between the true and false varieties of the deformity. The basis of intercanthal distance is a poor criterion of hypertelorism and we prefer the use of the distance between the anterior lacrimal crests as a more reliable means of measurement and have checked all our cases by the use of anterior‐posterior skull laminagrams.

Correction of Ocular Hypertelorism

36 patients with congenital hypertelorism, eight with Crouzons disease, and three with a posttraumatic deformity, were operated with Tessiers technique with some modifications, i.e. the dura is not separated from the cribriform plate avoiding olfactory damage. The entire procedure for hypertelorism could be carried out in less than 5 h but correction of Crouzons disease required 6-8 h, and longer in older patients. There was only one intraoperative anesthesic death in a 3-year-old child. One cardiac arrest recovered. Nine staphylococcus infections were superficial and readily treated. There was postoperative cerebral edema in one case and convulsions following surgery in another. Anticonvulsants and steroids were subsequently routinely employed. There were no SF fistulas. Excellent cosmetic results are due primarily to the skill of the plastic surgeons.