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Contents

        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