OBSERVATIONS AND COMMENTARY 1987 Meeting of the Craniofacial Society The speech therapists, to whom the meeting of Great Britain undoubtedly belonged, solved the problem of the natural interest of each specialty to hear The Annual Meeting of the British Craniofa- highly technical papers on their own specialty cial Society was held in Edinburgh, August 30 by holding a workshop the following day. through September 1, 1987. Internal and peer audit seems to be on a flood The area of cleft lip and palate once again tide at present, and their discussion at this meet- dominated the annual meeting of the Craniofa- ing will lend impetus to clinicians to join in the cial Society, held in the delightfully converted Craniofacial Society's cleft palate index, to es- chapel that serves as lecture theatre for the tablish what data banks exist in this country. Royal College of Surgeons of Edinburgh under The Society was delighted that Miss Muriel the Presidency of Miss R. Razzell. Three- Morley was able to come to receive an Honor- quarters of the 26 papers were cleft lip and pal- ary Membership of the Society, and an excel- ate oriented, three concerned facial syndromes lent guest lecture was given by Miss Margaret (Down, Binder's, and Pierre Robin), and three Edwards, who also accepted Honorary Mem- were on craniofacial surgery. bership. Most stimulating was the concern of the ma- The Society flourishes with 155 members (al- jority of speakers to choose aspects of their most equal numbers of oral surgeons, orthodon- work of real relevance and interest to other spe- tists, and plastic surgeons with speech thera- cialties. For example, the progress report from pists close behind, and a handful of scientists). Margaret Copeland of the 4-month-old palate More active participation would be welcomed repairs by Mr. Desai from Stoke Mandeville from other closely concerned specialties, such showed very high levels of intelligibility, while as pediatrics, ENT surgery, and audiology. The Mr. Brian Christie produced encouraging, al- Society also welcomes participation from over- beit not yet proven, data to show no gross ab- seas, and we were particularly pleased to have normality from this early surgery. Taken with Dr. Mary Ann Witzel from Toronto. the comparative study of early and delayed hard palate repair by Mrs. Harding Bell from Mr. Campbell's series in Cambridge, which showed R.W. Pigott, M.D. more impairment of articulation in the delayed Hon. Editorial Representative repair group, the message to the surgeons con- The Craniofacial Society of Great Britain cerning palate repairs was to do them early and Bristol do them all. Great Britain 417 ABSTRACTS ANTONYSHYN O, COLCLEUGH RG, ANDERSON C. Growth potential in suture bone inlay grafts: a comparison of vascularized and free calvarial bone grafts in order to determine the effects of such grafts on craniofacial development. Plast Reconstr Surg 1987; 79:1-11. The authors wished to determine the growth potential of vascularized and free calvarial bone grafts in order to determine the effects of such grafts on craniofacial development. Collie dogs served as the experi- mental model; in a group of six dogs, a skeletal defect was created in the right zygomaticomaxillary suture area, the ipsilateral zygomatic arch was resected, and a calvarial bone graft from the coronal suture pedicled on the temporalis muscle was fixed in the defect. In the control group consisting of five dogs an identical defect was created, the zygomatic arch resected and muscle dissected, but a free calvarial bone graft from the coronal suture area was transplanted and fixed in place. Greta Gutta-percha radiopaque points were used to determine transsutural growth on serial cephalograms. Direct osteometry was also used to evaluate the results of the free and vascularized calvarial bone grafts. No growth occurred in the free grafts. Less growth restriction occurred with the vascularized grafts. Deformity of the skull resulted from denuding in the temporoparietal region of periosteum when the flaps were raised. Transsutural growth in the vascularized grafts persisted for the duration of maxillary development, despite cessation of skeletal growth at the calvarial donor sites. (Trier) Reprints: Dr. O. Antonyshyn Division of Plastic and Reconstructive Surgery University of Western Ontario London, Ontario N6A 3K7 ANTONYSHYN O0, COLCLEUGH RG, ANDERSON C. Growth potential in onlay bone grafts: a com- parison of vascularized and free calvarial bone and suture bone grafts. Plast Reconstr Surg 1987; 79:12-20. This study was designed to compare the potential for appositional bone growth in vascularized and free onlay calvarial bone grafts. Grafts were applied as supraperiosteal onlays. The studies were done in 8 week-old beagle puppies. Pedicled bone grafts were transplanted on one side, whereas on the other side free grafts were performed. Sides having pedicled grafts and free grafts were alternated. New bone formation was evaluated by triple-color fluorochrome labeling. The length, width, and thickness of each bone graft was recorded at the time of grafting and again at 28 weeks of age, at the time of harvesting of the grafts. The percent growth in every dimension was significantly greater in vascularized grafts as compared with free grafts. The architecture of vascularized grafts was preserved, whereas free grafts contained multiple small resorption cavities. Vascularized grafts showed active new bone formation, whereas free grafts did not. Active new bone formation was evident in the vascularized grafts, but bone resorption and delay in sub- periosteal new bone formation was noted in the free grafts. (Trier) Reprints: Dr. O. Antonyshyn Division of Plastic and Reconstructive Surgery University of Western Ontario London, Ontario N6A 3K7 BARTHOLOMEW DW, JABS EW, Levin LS, RiBovIcH R. Single maxillary central incisor and coloboma in hypomelanosis of Ito. Clin Genet 1987; 31:370-373. The combination of an iris coloboma, single deciduous maxillary incisor, and Incontinentia Pigmenti Achromians (IPA) is reported in a 16-month-old black female. Serial examination during the first year showed a head circumference consistently at the third percentile, despite weight and length at the fiftieth percentile. There was evidence of delayed motor development. At age 14 months, her third tooth erupted-a single maxillary central incisor-followed by the laterals. A dolichocephalic skull with increased frontal illumina- tions, depressed nasal bridge, and torus palatinus was noted. Spinal fusion of C-2 to C-3 was found, but 418 ABSTRACTS 419 seems not to have been associated with IPA. The authors point out that this unique sequence of abnormalities was not previously described in IPA. The authors suggest an etiology of faulty migration of neural crest cells early in uterine life or ectodermal-mesenchymal interaction at the cellular level. (Sarnas) Reprints: Dr. D. Bartholomew Division of Pediatric Genetics CMSC 1004 The Johns Hopkins Hospital Baltimore, MD 21205 Boo-CHAI K. Primary repair of the unilateral cleft lip nose in the Oriental: a 20 year follow-up. Plast Reconstr Surg 1987; 80:185-194. The photographs of a consecutive series of 10 Oriental patients who underwent primary nasal recon- struction at the time of cleft lip repair are shown. The patients have all had only one operation and none underwent any subsequent revision. Lip repair was carried out by flap technique. Nasal reconstruction was performed by extending the superior buccal sulcus incision up along the frontal process of the maxilla, making an alar rim incision from columellar base to alar base, and splitting the ala into a skin and a chondrocutaneous layer (vestibular skin). Alar undermining is extensive: laterally to the alar-cheek area, medially including the columella, and between the medial crura down to the anterior nasal spine and the contralateral ala. Superior undermining extended to the level of the inner canthus. No transfixion sutures are used. The author depends on the thick nostril wall, postoperative scar tissue, and the normal position of the alar base to keep the alar arch elevated. (Trier) Reprints: Dr. Khoo Boo-Chai 621 Geylang Road Singapore 1438 BraUuTIGam B, BENDER SW. EEC-Syndrom-Mogliche Assoziation mit Alpha- 1-Antitrypsinmangel. Dtsch Z Mund Kiefer Gesichts Chir 1987; 11:309-315. Three patients are described who suffer from the syndrome of ectrodactyly, ectodermal dysplasia, and cleft lip and palate. However, in one of the patients there was no lobster claw deformity. In addition, the authors have found a deficit in the alpha-1-antitrypsin concentration in the serum in all three patients. The significance of this finding is not yet known. (Gundlach) Reprints: Dr. Dr. Barbara Brautigam Klinikum der Johann-Wolfgang-Goethe-Universitat Abteilung fiir Mund-, Kiefer- und Gesichtschirurgie Theodor-Stern-Kai 7, Haus 21 D-6000 Frankfurt am Main Federal Republic of Germany Davin DJ, CoOOTER RD. Craniofacial infection in 10 years of transcranial surgery. Plast Reconst Surg 1987; 80:213-223. An analysis of 170 patients undergoing transcranial procedures was carried out to determine the inci- dence of postoperative infection and its relationship to preoperative microbiology, surgical factors, antibiotic prophylaxis, and postoperative management. The age of patients varied between 5 weeks and 58 years. There were 131 children and 33 adults. The 170 operations were performed on 164 patients, since 6 patients had two transcranial procedures. Fifty-two percent of the patients had craniosynostoses. All craniofacial patients had preoperative microbiology swabs of their scalp, conjunctivae, nose, and throat. Antibiotic prophylaxis was carried out with alternating methicillin and ampicillin in the first 5 years. During the next 2 years, combined flucloxacillin and ampicillin were given for 48 hours after the procedure. In the final 2 years, flucloxacillin and metronidazole were given preoperatively and continued for 48 hours postoperatively. Six patients did not receive antibiotics. Infections occurred in 11 or 6.5 percent of the patients, with an infection rate in children of only 2.2 percent but of 23.5 percent in adults.