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78 Cleft Palate Journal, January 1987, Vol 78 Cleft Palate Journal, January 1987, Vol. 24 No. 1 ABSTRACTS ALBIN RE, HENDEE RW, O'DONNELL RS, MajJurE JA. Trigonocephaly: refinements in recon- struction. Experience with 33 patients. Plast Reconstr Surg 1985; 76:202-209. Trigonocephaly, synostosis of the metopic cranial suture, accounts for about 5 percent of all craniostenoses. The authors believe that computerized tomography is rarely necessary for the diagnosis, and the clinical ap- pearance is of a forehead with a sharp midline ridge, flat frontal eminences, and a narrow foreshortening. Hypotelorism is present, and the orbits are oval with the longer vertical axes. Surgical correction is indicated to provide adequate room for brain growth and to improve appearance. Eighty percent of affected children demonstrate delays on developmental and behavioral testing. The technique reported includes removing the entire frontal bone segment from 1.0 to 1.5 cm superior to the superior orbital rim and laterally to the coronal craniectomy. The supraorbital rim fragment is removed after osteotomies through both frontozygomatic su- tures and the glabella. Osteotomies centrally open the keel-shaped area of the supraorbital rim fragment and close the lateral extremities of this section, and the frontal segment is cut into multiple fragments, which are then pieced together for a more normally shaped forehead. These two segments when attached are reattached at the glabella. A 2.5 to 3.0 cm strip is left open along the coronal suture. Early operation (between 2 and 6 months of age) is advocated. A mean follow-up of 22.8 months is reported with no deaths, infections, or damage to visual or cerebral functions. (Trier) Reprints: Richard E. Albin, M.D., Ph.D. The Craniofacial Center 1700 Marion Street Denver, Colorado 80218 BEnnUN RD, MULLuIKEN JB, KaABAN LB, MURRAY JE. Microtia: a microform of hemifacial micro- somia. Plast Reconstr Surg 1985; 76:859-863. Because of a suspected common origin of microtia and hemifacial microsomia, the authors studied all pa- tients with a diagnosis of isolated microtia in a 10-year period. Of the 74 patients, 49 were males, 25 females; the right ear was involved in 42 cases, and the left ear was involved in 22. Nine patients had facial paralysis, always on the side of the ear deformity. Stenoses or atresia of the external auditory canal was seen on radio- logic examination with an abnormal facial nerve canal in 38 cases and alterations of middle ear structures in 32 cases. Nine patients had either an overt cleft of the secondary palate or a submucous cleft, and four patients had velopharyngeal incompetence. Eleven patients with microtia were found to have skeletal asym- metry. The authors conclude that microtia and hemifacial microsomia are the result of a similar mechanism localized to second branchial arch development. Unlike hemifacial microsomia and microtia, mandibulofacial dysostosis tends to be bilateral, is characterized by more severe middle ear anomalies, and does not involve the facial nerve. (Trier) Reprints: John B. Mulliken, M.D. The Children's Hospital 300 Longwood Avenue Boston, Massachusetts 02115 BLACKWELL SJ, PARRY SW, RosBERG BC, HUANG TT. Onlay cartilage graft of the alar lateral crus for cleft lip nasal deformities. Plast Reconstr Surg 1985; 76:402-408. Two basic architectural principles have been used to correct the problems of asymmetry and inadequate nasal tip projection in patients with a residual cleft lip nasal deformity: composite rotation of the ala; and correction of the cartilaginous framework and soft tissue by alar cartilage transposition, relocation, suture suspension and by cartilage grafting. Sixteen patients with a follow-up of 13 to 40 months underwent surgery consisting of exposure of the alar cartilage as a bipedicle flap using rim and intercartilaginous incisions, exci- sion of fibrofatty and perichondrial tissue from the dorsum of the alar cartilage so as to leave a 2 to 4 mm wide intact strip of cartilage. The domes of the remaining alar cartilage were scored and layered strips of resected alar cartilage sutured to the remaining alar cartilage on the cleft side. Additional procedures such as septoplasty, rhinoplasty, and bone-grafting of the nose were also carried out. (Trier) Reprints: Steven J. Blackwell, M.D. Department of Surgery Plastic Surgery Division University of Texas Medical Branch 301 University Blvd. Galveston, Texas 71550 ABSTRACTS 79 Dapo DV, KERNAHAN DA. Radiographic analysis of the midface of a stillborn infant with a unilateral cleft lip and palate. Plast Reconstr Surg 1986; 78:238-241. The midface of a full-term stillborn infant with a right complete unilateral cleft lip and palate was studied with plain-film radiography and tomography, xeroradiography, and computerized axial tomography. Gross skeletal and soft-tissue deficiencies on the cleft side were evident as compared to the noncleft side, and these deficiencies involved the entire bony maxillary complex and antrum, the orbit, and the nasal pyramid and intranasal structures. The area on the cleft side was 19 percent less than the noncleft side, and the maximal anteroposterior dimension was 16 percent less. The cleft bony palatal shelf was 12.5 mm wide compared to 20 mm on the noncleft side. The findings demonstrate the deficient and abnormal functional matrix inher- ent in the cleft condition. (Author's abstract) _- Reprints: Diane V. Dado, M.D. Division of Plastic and Reconstructive Surgery Stritch School of Medicine 2160 South First Avenue Maywood, Illinois, 60153 DIGNAN P ST J, MARTIN LW, ZENNI JR EJ. Pierre Robin anomaly with accessory metacarpal of the index fingers. The Catel-Manzke syndrome. Clin Genet 1986; 29:168-173. A 22-year-old female with the Pierre Robin anomaly and bilateral index finger malformations is described. Hypertelorism, full cheeks, posteriorly rotated ears with prominent antihelix, short neck, simian creases, bilateral fifth finger clinodactyly, and short toes with hypoplastic small nails were also present. Her mother had a subsequent pregnancy that resulted in the delivery at 26 weeks of a stillborn female fetus with cleft palate, index finger anomalies, and congenital heart disease. These two patients are the first females reported with this group of anomalies. The etiology of this combination of malformations, the Catel-Manzke syndrome is unknown. (Author's Abstract) (Sarnas) Reprints: Dr. Peter Dignan Children's Hospital Research Fund Department of Pediatrics University of Cincinatti Elland and Bethesda Avenues Cincinatti, Ohio 45229 GARGAN TG, McKinnon M, MuUuLuIKEN JB. Midline cervical cleft. Plast Reconstr Sufg 1985; 76:225-229. Twelve cases of midline cervical clefts were reported from a series of 672 cases of thyroglossal and other branchial cleft sinuses seen over a 30-year period. Eleven of the patients were female. The clefts were marked by overlying atrophic, erythematous, raised skin that contained no skin appendages. Clefts varied from 6 to 14 mm in width and were of varying lengths between the manubrium and mandible. A thick, fibrous band was deep to the skin and extended to the pretracheal fascia. The defect appears to be due to failure of mesodermal growth or mergence along the branchial arches as a consequence of abnormality in the timing of migrating cells, or a deficiency of cells derived from the neural crest. The defect may include a cleft mandible and tongue and absence of the hyoid. Treatment is excision of the abnormal skin and subjacent fibrous band and closure of the skin with multiple Z-plasties. (Trier) Reprints: Thomas J. Gargan, M.D. 4545 E. 9th Avenue Denver, Colorado 80220 80 Cleft Palate Journal, January 1987, Vol. 24 No. 1 HENDEL PM. The harvesting of cranial bone grafts: a guided osteotome. Plast Reconstr Surg 1985; 76:642-644. Cranial bone grafts are readily obtained when full-thickness bone is removed by the neurosurgeon. The inner table is replaced and the outer table used for graft material. Other techniques use bone dust resulting from use of the cranial perforator or a hand-held osteotome during manual tangential osteotomy. The author reports the use of a curved osteotome with lateral guards to control depth of cuts. Parallel outer table cuts of the same width as the osteotome are made in the skull with a transverse saw cut at one end, and the osteo- tome elevates bone between the parallel cuts. Additional parallel cuts are made to provide access for the os- teotome to safely remove additional cranial bone. (Trier) Reprints: Philip M. Hendel, F.R.C.S. Department of Surgery Tulane University School of Medicine 1430 Tulane Avenue New Orleans, Louisiana 70112 HEsTER TR, JurKIEwIcz MJ, MEyER R, CUNNINGHAM S, Eros T. Total reconstruction of the ''end-stage'' cleft lip and palate deformity. Plast Reconstr Surg 1985; 76:539-551. The "end-stage"' cleft lip and palate deformity refers to a constellation of deformities in the skeletally ma- ture young adult who has had multiple operations and who still presents with maxillary retrusion, malocclu- sion, lip deformity and nasal deformity. After completion of preoperative dental and orthodontic treatment, an operative approach was used based on wide skeletonization and exposure of the maxilla and nasal skeleton. A tracheotomy was used to allow adequate exposure of the nasal skeleton without distortion. The upper lip was split; rim incisions permitted nasal skeleton exposure; and upper buccal sulcus incisions exposed the maxilla. A LeFort 1 or "1.5" osteotomy permitted maxillary advancement with iliac or cranial bone grafts and cor- rection of arch collapse. Oronasal fistula closure and alveolar bone grafting were performed as needed. Nasal deformity was corrected by columellar cranial bone grafts and rhinoplasty, and columellar lengthening and lip deformity were corrected by Abbe flaps. Sixteen patients were treated over the past 5 years. (Trier) Reprints: T. Roderick Hester Jr., M.D. Emory University Clinic 1365 Clifton Road, N.E. Atlanta, Georgia 30322 KinnEBrEw MC, PannBAackER MD, Rampp DL.
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