Transcranial decompression of the optic nerve in the osseous canal in Crouzon's disease.
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Biomedical subjects
Publications and source records attributed to D Wood-Smith.
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36 patients with congenital hypertelorism, eight with Crouzon's disease, and three with a posttraumatic deformity, were operated with Tessier's 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 Crouzon's 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.
The authors present their experience in the surgical treatment of 66 patients with craniofacial anomalies, and discuss selection of patients, surgical technique, complications, and results.
In midfacial fractures the crucial area is the upper portion of the midfacial skeleton which lodges the orbits, the interorbital space with its anatomic relationship with the anterior cranial fossa, the lacrimal apparatus, the levator muscle, and the skeletal structures of the nose. Because of the severity of the injuries in a multisystem injured patient, these fractures may be neglected or receive inadequate primary treatment. In some cases the damage is so extensive that primary treatment can only accomplish part of the task. Late reconstruction is necessary, therefore, and is the subject of this paper.
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