Growth alterations have been described in patients operated on for oral clefts. The purpose of this work was to analyze the craniofacial and palate morphology and dimensions of young adults operated ...on for oral clefts in early childhood in Spain. Eighty-three patients from eight different hospitals were divided into four groups based on their type of cleft: cleft lip (CL, n = 6), unilateral cleft lip and palate (UCLP, n = 37), bilateral cleft lip and palate (BCLP, n = 16), and cleft palate only (CPO, n = 24). A control group was formed of 71 individuals. Three-dimensional (3D) digital models were obtained from all groups with an intraoral scanner, together with cephalometries and frontal, lateral, and submental facial photographs. Measurements were obtained and analyzed statistically. Our results showed craniofacial alterations in the BCLP, UCLP, and CPO groups with an influence on the palate, maxilla, and mandible and a direct impact on facial appearance. This effect was more severe in the BCLP group. Measurements in the CL group were similar to those in the control group. Cleft characteristics and cleft type seem to be the main determining factors of long-term craniofacial growth alterations in these patients. Prospective research is needed to clearly delineate the effects of different treatments on the craniofacial appearance of adult cleft patients.
Background
Recent reports indicate that tufted angioma is a rare vascular neoplasm that manifests more frequently at birth than previously thought. Few studies specifically address congenital ...presentation.
Objectives
We analyzed the clinicopathological characteristics, clinical course, and treatment of congenital tufted angioma (cTA) and evaluated variables that were indicative of problematic lesions.
Methods
We performed an observational retrospective study of 30 patients with cTA in 9 Spanish hospitals over a 14‐year period. Histopathology and immunohistochemistry studies were performed.
Results
Congenital tufted angioma mainly affected the limbs (56.67%), followed by the face and/or neck (23.33%). Almost three‐quarters of facial cTA were located over the mandibular area. Immunohistochemically, proliferating cells expressed markers of endothelial cells, with some clusters of cells, especially at the periphery of the aggregates, showing positivity for podoplanin. As no associated complications were observed in 66.67% of cases, no treatment was started.
Limitations
Data were collected retrospectively.
Conclusions
Our findings emphasize the clinical features and course of cTA. The possibility of cTA should be considered when a poorly defined congenital infiltrative vascular tumor with(out) overlying hirsutism appears over the mandibular area. Location on the face and/or neck requires a more comprehensive workup, since potentially severe complications often appear early.
We define the histopathologic findings and review the clinical and radiologic characteristics of rapidly involuting congenital hemangioma (RICH). The features of RICH are compared to the equally ...uncommon noninvoluting congenital hemangioma (NICH) and common infantile hemangioma. RICH and NICH had many similarities, such as appearance, location, size, and sex distribution. The obvious differences in behavior served to differentiate RICH, NICH, and common infantile hemangioma. Magnetic resonance imaging (MRI) of the three tumors is quite similar, but some RICH also had areas of inhomogeneity and larger flow voids on MRI and arterial aneurysms on angiography. The histologic appearance of RICH differed from NICH and common infantile hemangioma, but some overlap was noted among the three lesions. RICH was composed of small-to-large lobules of capillaries with moderately plump endothelial cells and pericytes; the lobules were surrounded by abundant fibrous tissue. One-half of the specimens had a central involuting zone(s) characterized by lobular loss, fibrous tissue, and draining channels that were often large and abnormal. Ancillary features commonly found were hemosiderin, thrombosis, cyst formation, focal calcification, and extramedullary hematopoiesis. With one exception, endothelial cells in RICH (as in NICH) did not express glucose transporter-1 protein, as does common infantile hemangioma. One RICH exhibited 50% postnatal involution during the 1st year, stopped regressing, was resected at 18 months, and was histologically indistinguishable from NICH. In addition, several RICH, resected in early infancy, also had some histologic features suggestive of NICH. Furthermore, NICH removed early (2-4 years), showed some histologic findings of RICH or were indistinguishable from RICH. We conclude that RICH, NICH, and common infantile hemangioma have overlapping clinical and pathologic features. These observations support the hypothesis that these vascular tumors may be variations of a single entity ab initio. It is unknown whether the progenitor cell for these uncommon congenital vascular tumors is the same as for common infantile hemangioma.
Primary aesthetic hairline lowering, also known as forehead reduction, is a relatively unexplored procedure, and the perceived satisfaction with outcome has not been previously discussed in ...scientific literature. The objectives of this study were to review the surgical technique and to analyze outcome assessing objective reduction, improvement of facial balance, patient satisfaction, and complications.
This was a prospective cohort study of patients seeking aesthetic forehead reduction since 2010. Inclusion criteria were as follows: women with a high but stable hairline. We excluded smokers, those seeking combined surgery, and those who had history of scalp surgery or hair loss. All patients were operated following the same protocol. Forehead reduction was measured comparing the pre- and postoperative distance from the glabella to the trichion. Improvement in facial balance was assessed comparing the pre- and postoperative quotient between the upper and middle thirds of the face. The forehead FACE-Q tool and the Vancouver Scar Scale were used to assess patient satisfaction. All complications were registered with a minimum follow-up of 6 months.
Twenty-six women aged 16 to 56 years were included. The average reduction was 2.03 cm. The facial balance quotient improved from 1:1.44 preoperatively to 1:1.05 postoperatively (p < 0.01). Both the forehead FACE-Q and the Vancouver Scar Scale showed significantly positive results. Complications included transient scalp numbness in 23 subjects, small areas of scar widening in 3 patients, and minor seroma in 1 patient.
With meticulous execution, aesthetic forehead reduction in female patients is effective and safe, resulting in high patient satisfaction.
The FACE-Q is owned by the Memorial Sloan Kettering Cancer Center (MSKCC) and was used with permission for this research.
Abstract Frontonasal dysplasia is an unusual congenital condition with a wide phenotypic range. Because of this, only a small number of cases and their management have been reported in the ...literature. The ideal surgical procedures to correct mild cases of frontonasal dysplasia, and the time to perform them, are still controversial. The case of a 9-month-old girl with a mild form of this condition (a congenital bifid nose and a duplicated frenulum), and its surgical management, is presented. The surgery achieved an early improvement of the patient's appearance and she had no complications. In the future, it is probable that she will need secondary rhinoplasty to aid in the projection of the tip and refine the shape of the nose.
Abstract Background Raising mucoperiosteal flaps in traditional palatoplasty impairs mid-facial growth. Hyaluronic acid-based hydrogels have been successfully tested for minimally invasive ...craniofacial bone generation in vivo as carriers of bone morphogenetic protein-2 (BMP-2). We aimed to develop a novel flapless technique for cleft palate repair by injecting a BMP-2 containing hydrogel. Material and methods Dog pups with congenital cleft palate were either non-treated ( n = 4) or treated with two-flap palatoplasty ( n = 6) or with the proposed injection/adhesion technique ( n = 5). The experimental approach was to inject a hyaluronic acid-based hydrogel containing hydroxyapatite and BMP-2 subperiosteally at the cleft palate margins of pups aged six weeks. At week ten, a thin strip of the medial edge mucosa was removed and the margins were closed directly. Occlusal photographs and computed tomography (CT) scans were obtained up to week 20. Results Four weeks after the gel injection the cleft palate margins had reached the midline and engineered bone had enlarged the palatal bones. Removal of the medial edge mucosa and suturing allowed complete closure of the cleft. Compared to traditional palatoplasty, the injection/adhesion technique was easier, and the post-surgical recovery was faster. CT on week 20 revealed some overlapping or “bending” of palatal shelves in the two-flap repair group, which was not observed in the experimental nor control groups. Conclusion A minimally invasive technique for cleft palate repair upon injectable scaffolds in a dog model of congenital cleft palate is feasible. Results suggest better growth of palatal bones. This represents an attractive clinical alternative to traditional palatoplasty for cleft palate patients.
Fournier's gangrene is a necrotizing fasciitis of the scrotal and inguinal region, associating high mortality and complication rates. It is extremely rare in the neonatal period and may be life ...threatening. We present an exceptional case of a 24-day-old boy who consulted to the emergency department for fever (39 °C) and an indurated, fluctuating and painful erythema in both groins, left hemiscrotum, left anterior femoral region and perineum for the last 6 hours. Blood analysis showed increased acute phase reactants without leukocytosis. Ultrasound revealed significant soft-tissue involvement. Due to high clinical suspicion and hemodynamic instability (tachycardia and prolonged capillary filling), urgent fasciotomy, placement of Penrose drains and intensive irrigation was performed. Wound care with irrigations was performed 3 times a day. During the 12 days neonatal intensive care unit admission, he required hemodynamic support and orotracheal intubation and sedation for pain control. Broad-spectrum antibiotic therapy (with cefotaxime, clindamycin and cloxacillin) was administered for 2 weeks. Ampicillin-sensitive Streptococcus pyogenes (Group A) was isolated in blood culture at 4th day of admission allowing antibiotic de-escalation. He was discharged on postoperative day 24. He has minimal, inconspicuous scars and no functional sequelae. Fever in neonates requires close observation considering the use of empirical broad-spectrum antibiotics and hospitalization. Early diagnosis, prompt surgical management and broad-spectrum antibiotic therapy are essential to prevent complication. Early fasciotomy with intensive irrigation and close survey may avoid extensive skin debridement.
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