J.L. Russell

The Leeds method for titanium cranioplasty construction.

raniofacial bone loss from injury, infection, or resection of alignant disease is a considerable clinical problem, particlarly in large defects. Titanium is our current material of hoice for reconstruction of large craniofacial defects. In Leeds we produce between 40 and 50 titanium cranioplasties each year, which are made using the craniectomy bone flap as a template, or using stereolithographic models (Fig. 1A).

Construction of titanium cranioplasty plate using craniectomy bone flap as template.

In recent times a steady rise in cranioplasty operations has been noted because of increasing utilisation of decompressive craniectomy for trauma as well as stroke patients. A variety of techniques have been utilised for cranioplasty, with their own benefits and limitations. Titanium cranioplasty is one of the well-established and widely used techniques, with most centres utilising computer-assisted reconstruction for manufacture of titanium plates. In this paper we present a novel method for making titanium cranioplasty plates using the craniectomy bone flap as a template and the results of our experience. To date we have performed 51 cranioplasties using this method. The surgical results have been comparable to those obtained using the computer-assisted model technique. The construction cost for titanium cranioplasty plates using this method has been £360 cheaper per plate compared with the computer-assisted method. In addition, the CT workload and radiation exposure have been reduced.

Computed tomography in the diagnosis of maxillofacial trauma

A study of 34 patients who were investigated for maxillofacial trauma using high resolution computed tomography (CT) scanning is presented. The areas where this increasingly available technique offers more accurate information than conventional plain radiographs are discussed.

A large teratoma of the hard palate : a case report

Congenital teratoma is a rare malformation, and few papers have been published about it. We present a large teratoma that arose from the hard palate in a neonate. The obstructive mass caused maternal polyhydramnios and was identified prenatally by ultrasonography. The mother went into labour at 35 weeks gestation at home. The child was in respiratory distress as a result of airway obstruction, and a tracheostomy was done when she was 4hours old. She also had major cardiac abnormalities. The palatal mass was removed successfully at 4 weeks of age. The typical components of a teratoma were identified including immature neural glial tissue.

Frontal sinus mucocele in association with fibrous dysplasia: review and report of two cases

We present two paediatric cases of fibrous dysplasia (FD) who presented to the craniofacial neurosurgical clinic with ophthalmological symptoms associated with sinus mucoceles. The first patient presented with a history of orbital cellulitis and an increasing bony swelling around the orbit associated with proptosis. Radiological imaging revealed monostotic FD associated with an obstructive mucocele in the frontal sinus with extension into the orbit. The second patient presented with recurrent conjunctivitis, painful proptosis, rhinitis and a bony peri-orbital swelling. Both patients had histological diagnoses of frontal mucoceles invading the orbit in association with FD. They both underwent frontal craniotomies and excision of the mucocele/fibrous dysplastic complex. In summary, mucocele development is an unusual complication of FD, likely to occur secondary to occlusion of the sinus drainage system. Orbital involvement may lead to visual disturbance caused by pressure effects. A multi-disciplinary approach including maxillofacial surgeons, plastic surgeons and neurosurgeons is advocated.

Surgical correction of midline nasal dermoid sinus cysts.

Nasal dermoid sinus cysts (NDSCs) are rare congenital anomalies affecting approximately 1 in 30,000 live births. Nasal dermoid sinus cysts are unsightly, prone to infection, and, importantly, may communicate with the central nervous system. Treatment is complete surgical excision. This study retrospectively evaluated management of a large single-center cohort of intracranial NDSCs.Nineteen patients with NDSC were identified from all patients presenting to the Leeds craniofacial service between June 2000 and August 2008. Patient demographics, clinical presentation, preoperative investigations, and surgical procedures undertaken were analyzed.Mean age at presentation and surgery were 6.3 and 7.6 years, respectively. Fifty-three percent were males. Computed tomography (CT) and magnetic resonance imaging (MRI) were performed in 15 and 17 patients, respectively. One patient (5.3%) required local excision only. Eighteen (96.7%) underwent a bicoronal approach, and 13 (68.4%) of these required a craniotomy. The dura was opened in 7 (36.8%) patients. Neither CT nor MRI predicted the presence or absence of intracranial extension in all patients. Positive and negative predictive values for intracranial extension were 85.7% and 50% for CT and were 100% and 50.0% for MRI. Mean follow-up of 4.1 years shows no deep recurrences and 5 (26.3%) were superficial nasal recurrences only.A multidisciplinary approach can achieve good results with infrequent intracranial recurrence. We used a bicoronal approach to facilitate craniotomy when required intraoperatively because imaging is unable to diagnose intracranial extension with sufficient accuracy.

THE USE OF COMPUTED TOMOGRAPHY IN THE MANAGEMENT OF FACIAL TRAUMA BY BRITISH ORAL AND MAXILLOFACIAL SURGEONS

A survey of 184 British oral and maxillofacial surgeons on their use of computed tomography (CT) in the management of craniofacial trauma showed that the majority of the 116 surgeons who replied used this form of imaging for frontal, nasoethmoidal, and orbital fractures. Only 6% of respondents reported no advantage in CT imaging over plain radiography. The access to CT scanners and the value of the reports in the management of patients was rated as satisfactory by 75% of respondents, and a similar percentage reported that CT service was becoming increasingly available to their units.

Inner table corticectomy of the fronto-orbital bar in correction of metopic and coronal craniosynostoses.

Abstract Fronto-orbital advancement is an established method for correction of metopic and coronal craniosynostoses. Many techniques involve creation of a single fronto-orbital bar that is then shaped with osteotomies with or without bone grafting. We present a technique that minimizes osteotomy of the frontal bar and gives superior lateral brow aesthetics. Standard fronto-orbital bar bone cuts are made without a midline osteotomy. Selective inner table corticectomy of the fronto-orbital bar allows the bone to become malleable without greensticking. The need for osteotomy of the fronto-orbital bar is obviated. An additional bandeau is created from the temporoparietal calvaria. The malleable fronto-orbital bar is then fixed to this bandeau. The frontal bar and bandeau complex is then advanced in a conventional manner. The remaining frontal calvaria is then rotated creating a more vertical forehead. This technique has been used in Leeds for more than 10 years with good cosmetic results. It has become our standard method for management of the fronto-orbital bar in correction of nonsyndromic metopic and coronal craniosynostoses.