Background: Fat grafting is widely utilized in craniofacial surgery. The authors describe a series of consecutive patients who underwent orthognathic surgery with fat grafting by the senior author and review relevant literature in the field; fat grafting technique is discussed in detail. The authors also highlight 3 patients to illustrate postoperative outcomes. Methods: A retrospective cohort of consecutive orthognathic surgery patients was reviewed. Age, sex, BMI, procedure, area of harvest, location of injection, donor site complications, and need for repeat fat grafting were analyzed. Inclusion criteria included history of orthognathic surgery and concomitant fat grafting performed by the senior author in 2015. Results: Fifty-three orthognathic surgery patients with concurrent fat grafting were reviewed. The cohort comprised 20 males (37.7%) and 33 females (62.3%). Thirty-three patients (62.3%) underwent Le Fort I operations either in conjunction with genioplasty and/or bilateral sagittal split osteotomies. Twenty-eight patients (52.8%) underwent second operations involving additional fat grafting. The majority of these patients (15/28, 53.6%) received additional fat grafting during ensuing rhinoplasty. There were no donor site complications (ie, infection, wound breakdown) recorded in the authors’ patient cohort. Amount of fat injected averaged 13.1 cc (range 5–25 cc). Follow-up generally occurred through the 1-year mark. Conclusions: Fat grafting is a proven technique to facilitate optimal postoperative wound-healing in orthognathic surgery. The senior author uses Telfa processing and the Coleman system to deliver the fat atraumatically. The authors’ cohort of consecutive patients corroborates the benefits of fat grafting in craniofacial surgery; the authors observe wound-healing benefits, enhanced aesthetic outcomes and an anti-inflammatory effect with this technique.

Children who present in a delayed fashion with unrepaired craniosynostosis have high rates of debilitating headaches, developmental delays, head shape anomalies, and Chiari malformation. Five patients reporting preoperative headaches noted subjective improvements in headaches following delayed operation. Cranial reconstruction can be safely performed at an older age and is appropriate to consider in carefully selected patients for aesthetic and/or functional concerns.

Therapeutic, IV.

No abstract

Background: Orbital floor fractures are common injuries treated by multiple surgical subspecialties. Controversy exists regarding the operative indications. This study sought to correlate radiographic characteristics of orbital floor fractures with validated patient reported outcome measures following non-operative management. Materials and Methods: Patients who underwent non-operative management of an orbital floor fracture at Yale New Haven Hospital from 2013 to 2018 were queried retrospectively. Patients with GCS < 15 and/or distracting facial soft tissue or bony injuries were excluded from analysis. CT images, demographic information, and FACE-Q patient reported outcomes (Satisfaction with Eyes, Psychological Function, Social Function, and Appearance Related Psychosocial Distress) were reviewed. Statistical analysis was performed with SPSS with statistical significance set at P < .05. Results: Eighteen patients were included in the study. The mean time between injury and completion of the survey was 3.6 years. Fifty-six percent of patients had a right-sided fracture. The mean fracture area was 73.6 mm2 (Range:15–172 mm2), and 913 mm3 (Range: 0–3106) was the mean volume displaced into the maxillary sinus. The unaffected inferior rectus muscle shape (height/width) was 0.5 (Range: 0.2–0.98) compared to 0.8 (Range 0.4–1.6) for the affected inferior rectus. After controlling for the time interval between survey and injury, gender, income, and education, rounding of the inferior rectus muscle was a significant predictor of appearance related psychosocial distress (P = 0.006). Inferior rectus rounding was stratified into “severe” (75%) and “moderate” (25%) categories. Severe rounding was associated with a larger orbital floor fracture area (110 versus 64 mm2; P = 0.074), volume displaced into the maxillary sinus (1,716 versus 610 mm3; P = 0.024), and worse appearance-related psychosocial distress (70 versus 25; P = 0.013). Sixty-one percent of patients followed up in clinic with a mean duration of 194 days. Conclusion: Prior studies have correlated presenting radiographic findings to follow-up clinical findings. However, this study is the first to assess long-term outcomes using validated patient-reported questionnaires. Inferior rectus muscle belly rounding significantly correlated with appearance related psychosocial distress. This radiographic finding may be valuable to consider in orbital floor fracture management.

Craniosynostosis is the premature fusion of cranial sutures, occurring at a rate of approximately 1 in 2000 live births; it is usually diagnosed and treated within the first year-of-life. Some diagnoses are delayed and only detected later in childhood or adolescence when symptoms of increased intracranial pressure (ICP) arise such as headaches and vision changes. We present a case of occult craniosynostosis in which a relatively normocephalic 17-year-old male presented with debilitating headaches, optic nerve edema, and developmental delay consistent with probable ICP elevation. CT scan demonstrated pan-suture craniosynostosis. Invasive monitoring confirmed increased ICP for which he underwent cranial remodeling and expansion. While the functional benefits of cranial remodeling are still vigorously debated, this patient's headaches resolved postoperatively. Clinicians should be cognizant of cases of occult craniosynostosis, obtain the appropriate preoperative evaluations, and recognize the utility of cranial remodeling in appropriately selected patients.

No abstract

The aim of this study was to investigate the temporal evolution of subsidence following trapeziectomy and its correlation with clinical outcomes. METHODS:An IRB-approved retrospective review of patients who underwent trapeziectomy for osteoarthritis of the first carpometacarpal joint was conducted (2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019). Patients with osteoarthritis of the metacarpophalangeal joint of the thumb, or wrist were excluded. Demographic information and clinical outcome data were collected. Connolly-Rath scores were determined. Subsidence was measured as the ratio of the difference between the trapezial space (TS = distance from base of thumb metacarpal to scaphoid) preoperatively and postoperatively over the TS preoperatively, and classified as severe (≥70%), or mild-moderate (<70%). The average rate of increase in subsidence was calculated. Student t-tests were used to compare continuous variables. Pain scores were compared using a Mann-Whitney U test. A Chi-square test was used to assess the difference in proportions of Conolly-Rath scores, and 95% confidence intervals were calculated for the proportion of good outcomes. Pearson's correlation test was used to assess the relationships between subsidence and outcomes. RESULTS:One hundred forty-one trapeziectomies were included. Average age at surgery was 60 ± 11 years; 84% of patients were women. An average of 2.34 ± 1.6 x-rays per hand were analyzed up to 12 years postoperatively. Median subsidence was 70% (56%-81%). The subsidence increased by 41.7 ± 98.6% per week, before 16 weeks and 0.9 ± 4.0% per week, thereafter.