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Monobloc and bipartition in craniofacial surgery
Alistair R M Cobb1, Peter Boavida, Rosanne Docherty
1Craniofacial Centre, Great Ormond Street Hospital for Children, Great Ormond St, London WC1N 3JH, United Kingdom. alicobb@yahoo.com
The Journal of Craniofacial Surgery
|January 26, 2013
Summary
Frontofacial monobloc advancement surgery in children can cause frontal lobe changes in 64% of cases due to retraction. However, these changes did not lead to adverse neurologic or cognitive outcomes.
Area of Science:
- Craniofacial Surgery
- Pediatric Neurosurgery
- Radiology
Background:
- Frontofacial monobloc advancement with osteogenic distraction is a common surgical treatment for complex craniosynostosis syndromes in children.
- Subfrontal osteotomy requires extradural retraction of frontal lobes, potentially causing changes.
Purpose of the Study:
- To determine the frequency and degree of radiologically identifiable frontal lobe changes after monobloc advancement.
- To assess if these changes impact patient outcomes.
Main Methods:
- Retrospective review of clinical records and CT imaging of 50 patients undergoing monobloc frontofacial distraction advancement.
- Assessment of patient and surgical factors and surgical outcomes.
- Review of MRI scans where available for comparison.
Main Results:
- 18 patients (36%) had no frontal lobe changes.
- 32 patients (64%) showed changes related to retraction during subfrontal osteotomy.
- No correlation found between changes and diagnosis, age, phenotype severity, surgery type, or adverse events.
- No evidence linked changes to neurologic problems or reduced cognitive function.
Conclusions:
- A high incidence of frontal lobe changes is evident on neuroimaging after frontofacial monobloc procedures.
- While no disability was reported, further neuropsychological testing and technique refinement are recommended to minimize these changes.
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