Dorseystroud3682

BACKGROUND Mandibular reconstruction is considered one of the most complex reconstructive surgeries in the field of craniomaxillofacial surgery. With the introduction of microvascular reconstructive surgery, free fibula flap become the gold standard for reconstruction of mandibular defects. For optimum restoration of the patient's esthetics and function, the free fibular flap should be recontoured to follow the natural premorbid state of the mandible. Virtual surgical planning using preoperative computed tomographic (CT) data can be rendered into 3-dimensional (3D) model for digitalized simulation of the bony resection and reconstruction with reported high accuracy. METHODS Ten patients were included in the study for delayed mandibular reconstruction using free fibular flap. For all the patients, preoperative CT scan for the skull and lower limbs were obtained and integrated into the software for virtual planning and guides fabrications. Postoperative CT was obtained and rendered 3D model to be superimposed on the preoperative record for assessment of the virtual planning accuracy by different linear and angular measurements. RESULTS No statistically significant difference was found between virtual group and postoperative group where P = 0.067, regarding average of linear measurements of all patients. Statistically significant difference was found between virtual group and postoperative group in measurements from axial plane where P = 0.004. No statistically significant difference was found between virtual group and postoperative group where P = 0.723, regarding angles between fibular segments. CONCLUSION Virtual surgical planning for mandibular reconstruction offers high reproducibility and precision, reducing the side errors, besides its time saving advantage for both the operator and the patient. A question that remains unanswered is at what level of surgical correction does the public perceive a head shape to be "normal" or "acceptable?" For most cases of non-syndromic asymptomatic craniosynostosis, the parents desire for surgical correction is to improve the cosmetic appearance of head shape. At the time of this writing, the intraoperative surgeons' perspective of what constitutes an acceptable head shape is the target for surgical correction. In introducing an improved objectively cosmetic goal, an appropriate outcome measure would be to assess what the general public considers a normal or acceptable head shape in children with craniosynostosis. METHOD Twenty-two unique images were presented via an online crowdsourcing survey of a severe case of non-syndromic sagittal craniosynosis gradually corrected to an age and gender matched normalized head shape. Participants were recruited via the Sick Kids Twitter account. Participants were invited to rate the head shapes as "normal" or "abnormal." RESULTS The 538 participants completed the online survey. Participants were able to reliably and consistently identify normal and abnormal head shapes with a Kappa Score >0.775. Furthermore, participants indicated that a correction of 70% is required in order for the cranial deformity to be regarded as "normal." This threshold closely reflects a normal Cranial Index, which is a widely used morphometric outcome in craniosynostosis. CONCLUSION Crowdsourcing provides an ideal method for capturing the general population's perspective on what constitutes a normal and acceptable head shape in children with sagittal craniosynostosis. Laypersons are able to reliably and consistently distinguish cranial deformities from a "normal" head shape. The public indicates a threshold correction of 70% in sagittal craniosynosis to regard it as a "normal" head shape.Cross-sectional imaging studies or catheter angiogram are the imaging modalities of choice to evaluate bypass patency after extra- to intracranial (EC-IC) bypass surgery. Although providing accurate results, these imaging modalities are time-consuming and/or present radiation risk for the patient. Ultrasound imaging is a fast and widely available imaging modality, but is limited in this setting due to the non-sonolucent autologous bone flap covering the bypass after surgery. The recently FDA approved clear polymethyl methacrylate (PMMA) cranioplasty implant overcomes this limitation by its sonolucent characteristic, but has not yet been used in the setting of EC-IC bypass surgery. Here, the authors describe for the first time the feasibility of an elective sonolucent cranioplasty to monitor flow and patency of an EC-IC bypass in real time using ultrasound. This moyamoya patient underwent a direct superficial temporal artery to middle cerebral artery (STA-MCA) bypass, after which a PMMA implant was used to close the craniotomy defect, instead of reimplanting the autologous bone flap. Immediate postoperative bedside transcranioplasty ultrasound confirmed bypass patency and allowed for quantitative flow measurements as well as for exclusion of postoperative hemorrhage. Brincidofovir datasheet Postoperative CTA and catheter angiogram confirmed patency of the bypass without complications. This report shows for the first time that this technique is feasible and permits bedside transcranioplasty ultrasound assessment of bypass flow in real time, confirmed with angiography. This technique may permit easy comparison of baseline findings with follow up assessments and facilitate less invasive monitoring of bypass patency.Custom made cranioplasty (CM CPL) represents the gold standard for cranial defect reconstruction, allowing an adequate protection of the brain with good cosmetic results. Nevertheless, it is an expensive procedure, requiring time for preparation of the prothesis. Aim of this study is to evaluate whether and in what cases handmade cranioplasty (HM CPL) still represents a valid alternative to CM CPL.Therefore, all consecutive cranioplasties in our center from 2013 to 2019 have been analyzed. Size and location of cranial defect have been considered, as the cause of decompression. Morbidity rate and final outcome have been evaluated. Series includes 143 patients (61% males, mean age 60 years, SD16). HM CPL was performed in 59 cases (41.2%) and CM in the remaining 84 (58.8%). HM CPL was preferred for smaller cranial defects (p 0.22), inferior to 100 cm (p 0.01) located in fronto-parietal-occipital area (p 0.01). Furthermore, HM CPL results in the first choice after removal of infiltrative tumors (p 0.02). Surgical complications consisted in 14 (9%) infections, 8 hematomas (5.