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Calvarial remodelling surgery: Neurosurgical experience of multidisciplinary craniofacial reconstruction
Abdul Ghaffar1, Zahid Hussain2, Shahzad Ahmed Qasmi2
1Consultant and Advisor Neurosurgery Pak Army, CMH Rawalpindi Cantt.
Insights
Craniofacial reconstruction surgery for craniosynostosis and clefts showed good safety and cosmetic outcomes. Most pediatric patients experienced improved appearance and stable head growth, with a low mortality rate.
Area of Science:
- Plastic Surgery
- Pediatric Surgery
- Craniofacial Surgery
Background:
- Craniosynostosis and clefts are congenital conditions requiring surgical intervention.
- Craniofacial reconstruction aims to correct deformities, improve function, and enhance aesthetics.
- Evaluating surgical outcomes is crucial for optimizing patient care.
Purpose of the Study:
- To assess the safety and outcomes of craniofacial reconstruction in pediatric patients.
- To evaluate both cosmetic and functional results of surgical procedures.
- To identify factors contributing to optimal treatment outcomes.
Main Methods:
- A quasi-experimental study involving pediatric patients undergoing calvarial reconstructive procedures.
- Surgical techniques included fronto-orbital advancement, total calvarial remodeling, and box flap reconstruction.
- Data collected included operative details, complications, and patient outcomes.
Main Results:
- 45 pediatric patients (53.3% male) underwent surgery for craniosynostosis (80%) or clefts (20%).
- High rates of improved appearance (91.1%) and stable head growth were observed.
- Complications included minor wound infections (13.3%) and one mortality (2.2%).
Conclusions:
- Multidisciplinary treatment and early detection are key for optimal craniofacial reconstruction.
- The study highlights the safety and efficacy of surgical techniques for craniosynostosis and clefts.
- Positive cosmetic and functional results were achieved in the majority of patients.
Objective:
To evaluate the safety, cosmetic and functional outcome of craniofacial reconstruction surgery for primary craniosynostosis and clefts.
Methods:
This quasi-experimental study was conducted at the Combined Military Hospital, Rawalpindi, Pakistan, from June 2011 to December 2014, and comprised paediatric patients undergoing calvarial reconstructive procedures. Fronto-orbital advancement and reconstruction, total calvarial remodelling and box flap reconstruction techniques were used. Parameters recorded were anomaly, procedure, hospital and intensive care unit stay, theatre time, blood transfusion, dural tears, mortality, wound infection, haematoma/seroma, dehiscence, seizures and cosmetic acceptance. Data was analysed using SPSS 17.
Results:
Of the 45 patients, 24(53.3%) were boys and 21(46.7%) were girls with an overall mean age of 14.1±21.95 months. Besides, 36(80%) patients were operated for craniosynostosis and 9(20%) for tessier clefts. Surgical techniques of Fronto-orbital advancement and reconstruction, total calvarial remodelling and box flap were used on 18(40%), 18(40%) and 9(20%) patients, respectively. The mean theatre time was 315.33±74.67 minutes (range: 240-390minutes). The mean blood transfusion was 313.34±135.84ml (range: 200-600ml). Major wound infection was seen in 1(2.2%) patient and minor wound infection occurred in 6(13.3%) cases. Post-operative seizures were seen in 1(2.2%). Improved appearance and stable head growth were seen in 41(91.1%) patients. Only 1(2.2%) patient did not survive the procedure.
Conclusions:
Early detection of craniosynostosis, neurological assessment, radiological evaluation, differentiating between primary and secondary craniosynostosis and multidisciplinary treatment of craniofacial reconstruction led to optimal treatment.
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