PubMed · 2773492
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Progress symposium--Progress in craniofacial surgery.. https://pubmed.ncbi.nlm.nih.gov/2773492/
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The two most significant recent developments in the treatment of facial trauma are the introduction of plating systems, which provide rigid internal fixation and the development of surgical approaches that allow wide exposure of the entire facial skeleton while minimizing external incisions. These approaches (referred to as extended access/internal approaches) are hemicoronal and coronal flaps, the sublabial approach to the midface, the transconjunctival approach to the orbital floor and orbital rim, and the intraoral management of mandibular fractures. These approaches work well, and have become standard techniques for managing facial trauma; however, each one has definite technical points that need to be adhered to to assure their success. Additionally, there are situations where these approaches are not appropriate and, in fact, may even be detrimental. This article outlines our approach to facial trauma using these extended access/internal approaches and discusses the important technical factors of each approach. Our experience in treating 113 patients with 119 fractures and 161 approaches over the last 2 years is presented and the role extended access/internal approaches have played is reviewed. The indications, limitations, and possible complications associated with each approach are outlined.
Much attention has been focused on the mechanisms responsible for the elevation and fusion of the palatal processes during formation of the secondary palate. In a former publication this closure, defined as fusion of the palatal shelves along their length, was described as occurring at a period in osseous palatal development characterized by incipient ossification of the maxillae and palatine bones, and at a stage in early mandibular development when the mandibular condyle has not developed. The purpose of the present study was to examine the osseous maturation of the cranial base at the time of palatal closure. The investigation was based on 62 human embryos and fetuses, CRL 22-57 mm, and general skeletal hand and foot maturation CNO = 0-0 to CNO = 8-1 (CNO, Composite Number of Ossified bones in hand and foot). From the fetuses, cranial tissue was dissected out and skeletal maturity was determined radiographically according to formerly described skeletal maturity stages in the cranial base. The study revealed that the soft tissue palatal shelves always elevate and fuse along their length at a specific, well-defined stage of maturity in the cranial base. The cranial base development in this stage is characterized by unossified cartilage. This information is essential for understanding abnormal skeletal development of the oral and nasal cavities.
We present a 6-month-old, developmentally retarded male with a congenital scalp defect and associated valvular pulmonary stenosis. Review of the literature revealed one other report on a newborn with the same apparently unique association.