Preface: Common Procedures in Cleft and Craniofacial Surgery xi
David M. Yates and Mark A. Miller
Erratum xiii
Unilateral Cheilorhinoplasty 1
Suzanne Barnes, Patrick Christopher, Suganya Appugounder, and Paul Kloostra
Introduction 1
Anatomy and Nomenclature 1
Anatomic Distortion 1
Anatomic Landmarks 1
Greater Segment 2
Lesser Segment 3
Basic Incision Design 4
Greater Segment 4
Lesser Segment 4
Modifications 5
Short philtral column 5
Deficient vermillion 5
Lesser segment lip height 5
Oral and Nasal Incisions 7
Dissection 7
Greater segment 7
Lesser Segment` 8
Reconstruction 9
Mucosa and Muscle 9
Skin and Vermillion 9
Transfixion Sutures 9
Final Photographs and Dressing 9
Pearls and pitfalls 10
Clinics care points 11
Disclosure 11
Primary Unilateral Cleft Lip Repair Using the Modified Millard Technique 13
Ashley E. Manlove and Alexis M. Linnebur
Introduction 13
Preoperative planning 13
Patient preparation and positioning 13
Surgical approach and procedure 13
Closure 16
Postoperative care 16
Disclosure 17
Primary Bilateral Cleft Lip Repair Using the Modified Millard Technique 19
Ashley E. Manlove and Alexis M. Linnebur
Introduction 19
Surgical technique 19
Preoperative planning 19
Patient preparation and positioning 19
Surgical approach and procedure 20
Closure 21
Postoperative care 23
Potential complications 23
Rehabilitation and recovery 24
Clinical results 25
Summary 25
Disclosure 25
Primary Palatoplasty 27
Gerardo P. Romeo and Sharon Aronovich
Modern-day “straight-line” repair 27
Technique 27
Double-opposing Z-plasty (colloquially “Furlow” technique) 33
Technique 33
Clinics care points 36
Disclosure 36
Bone Graft and Reconstruction of the Cleft Maxilla: Alveolar Bone Graft and Midface Distraction 37
Aaron Wallender and Joshua Stone
Introduction 37
Bone morphogenetic protein 37
Preoperative planning 38
Prep and patient positioning 39
Surgical procedure 39
Anterior iliac crest bone graft 39
Alveolar cleft bone grafting 40
Segmental maxillary distraction osteogenesis 40
Potential complications 44
Cleft site complications 44
Autogenous bone grafting complications 44
Complications of rh-BMP-2 use 44
Segmental distraction complications 44
Immediate postoperative care 44
Pearls and pitfalls 44
Summary 44
The Cleft Nasal Deformity 45
Weston Santee, David M. Yates, and Angelo Cuzalina
Introduction 45
Content 45
Normal nose anatomy 45
Cleft nose deformity 45
Technique 46
Closure 56
Dressing 56
Postoperative care and complications 56
Summary 56
Clinics care points 56
Neonatal Mandibular Distraction 59
Michael A. Perrino
Introduction 57
Principles in distraction osteogenesis 57
Patient evaluation 58
Technique for mandible osteotomies and internal distractor device placement 59
Device removal 61
Considerations and common complications 61
Summary 62
Clinics care points 62
Endoscopic Approaches to Craniosynostosis 63
David F. Jimenez and Hwi Sean Moon
Introduction: nature of the problem 63
Surgical technique 63
Preoperative planning 63
Preparation and patient positioning 64
Surgical approach 64
Surgical procedure 66
Potential complications 69
Pearls and pitfalls 70
Immediate postoperative care 73
Rehabilitation and recovery 73
Summary 73
Acknowledgment 73
Disclosure 73
Fronto-orbital Advancement and Anterior Cranial Vault Reconstruction 75
Carlos R. Hernandez, Mark Miller, and Ramon L. Ruiz
Surgical technique: fronto-orbital advancement and anterior cranial vault reshaping 76
Step 1: patient preparation 76
Step 2: tarsorrhaphy 76
Step 3: incision design 77
Step 4: osteotomy marking 79
Step 5: craniotomy 79
Step 6: fronto-orbital osteotomy 79
Step 7: orbital reshaping 79
Step 8: bandeau placement 80
Step 9: frontal bone reshaping 80
Step 10: closure 82
Avoidance and management of intraoperative complications 82
Postoperative considerations 83
Summary 83
Clinics care points 83
Craniofacial Syndromes: The Le Fort III Osteotomy for Correction of Severe Midface Hypoplasia 85
Daniel Schlieder and Michael R. Markiewicz
Introduction: nature of the problem 85
Surgical technique 86
Preoperative Planning 86
Patient Preparation and Patient Positioning 87
Surgical Approach--External Distraction Approach 87
Surgical Procedure 88
Potential Complications 89
Immediate Postoperative Care 91
Rehabilitation and Recovery 91
Surgical technique—internal distraction approach 91
Preoperative Planning 91
Patient Preparation and Patient Positioning 93
Surgical Approach—Internal Distraction Approach 93
Potential Complications 95
Immediate Postoperative Care 98
Rehabilitation and Recovery 98
Clinical results in the literature 98
Summary 98
Orbital Hypertelorism 101
Stavan Y. Patel and Ghali E. Ghali
Introduction: nature of the problem 101
What is orbital hypertelorism? 101
Causes of hypertelorism? 101
Goals and timing of treatment? 101
Who should evaluate the patient? 101
When to perform surgery? 101
What type of surgery should be performed? 102
Surgical technique 102
Preoperative planning 102
Preparing and positioning 102
Surgical approach 103
Potential complications 106
Intraoperative complications 106
Immediate postoperative complications 107
Delayed postoperative complications 107
Pearls and pitfalls 107
Immediate postoperative care 111
Rehabilitation and recovery 111
Clinics care points 111
Summary 111
Three Techniques for Reconstruction of Congenital Microtia: Porous Implant Ear Reconstruction, Auricular Reconstruction Using Autologous Rib, and Osseointegrated Craniofacial Implants with Auricular Prosthesis 113
Sheryl Lewin, Rachel Bishop, Jennifer E. Woerner, and David Yates
Introduction 113
Porous implant ear reconstruction protocol: Sheryl Lewin, MD 113
Preoperative planning 113
Implant preparation 114
Skin and temporoparietal fascial flap dissection 114
Temporoparietal fascial flap coverage 115
Skin coverage 115
Tragal reconstruction 116
Dressing 116
Auricular reconstruction using autogenous rib: 2-stage approach--David Yates, DMD, MD, FACS 116
Stage 1: Auricular reconstruction using harvested rib cartilage 116
Stage 2: Lifting of the ear 119
Auricle reconstruction with osteointegrated craniofacial implants and prosthesis: Rachel Bishop, DDS, MD, and Jennifer Woerner, DMD, MD 120
Surgical planning 120
Procedure 123
Complications 125
Clinics care points 128
Disclosure 128
