Background
Previous studies have shown that open cranial vault remodeling does not fully
address the endocranial deformity. This study aims to compare endoscopic-assisted
suturectomy with postoperative molding helmet therapy to traditional open reconstruction
by quantifying changes in cranial base morphology and posterior cranial vault
asymmetry.
Methods
Anthropometric measurements were made on pre- and 1-year postoperative
three-dimensionally reconstructed computed tomography scans of 12 patients with
unilateral lambdoid synostosis (eight open and four endoscopic-assisted). Cranial base
asymmetry was analyzed using: posterior fossa deflection angle (PFA), petrous ridge
angle (PRA), mastoid cant angle (MCA), and vertical and anterior-posterior (A-P)
displacement of external acoustic meatus (EAM). Posterior cranial vault asymmetry was
quantified by volumetric analysis.
Results
Preoperatively, patients in the open and endoscopic groups were statistically
equivalent in PFA, PRA, MCA, and A-P EAM displacement. At one year postoperatively, open
and endoscopic patients were statistically equivalent in all measures. Mean
postoperative PFA for the open and endoscopic groups was 6.6 and 6.4 degrees, PRA
asymmetry was 6.4 and 7.6 percent, MCA was 4.0 and 3.2 degrees, vertical EAM
displacement was −2.3 and −2.3 millimeters, and A-P EAM displacement was
6.8 and 7.8 millimeters, respectively. Mean volume asymmetry was significantly improved
in both open and endoscopic groups, with no difference in postoperative asymmetry
between the two groups (p=0.934).
Conclusions
Patients treated with both open and endoscopic repair of lambdoid synostosis
show persistent cranial base and posterior cranial vault asymmetry. Results of
endoscopic-assisted suturectomy with postoperative molding helmet therapy are similar to
those of open calvarial vault reconstruction.
Background:
Implant based breast reconstruction is the most common method of breast reconstruction in the United States but the outcomes of subsequent implant based reconstruction after a tissue expander (TE) complication are rarely studied. The purpose of this study is to determine the long term incidence of implant loss in patents with a previous TE complication.
Methods:
This is a retrospective review of the long term outcomes of all patients with TE complications at a large academic medical center from 2003–2013. Patients with subsequent TE or implant complications were compared to those with no further complications to assess risk factors for additional complications, or reconstructive failure.
Results:
One hundred sixty-two women were included in this study. The mean follow up was 8.3 ± 3.1 years. Forty-eight women (30%) went on to have a second TE or implant placed. They did not differ from women who went on to autologous reconstruction or no further reconstruction. Of these, 34 women (71%) had no further complications, and 38 women (79%) had a successful implant based reconstruction at final follow-up. There were no patient or surgical factors significantly associated with a second complication or implant loss.
Conclusions:
Following TE complications, it is reasonable to offer women a second attempt at tissue expansion and implant placement. This study demonstrates that long term success rates are high and there are no definitive patient or surgical factors that preclude a second attempt at implant based breast reconstruction.
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