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Craniosynostosis: Current Perspectives
This issue of the Oral and Maxillofacial Surgery Clinics of North America focuses on the contemporary management of craniosynostosis. Craniosynostosis remains a diagnosis not infrequently encountered by the practicing oral and maxillofacial surgeon, whether in the context of providing craniofacial surgical care in infancy, adjunctive procedures during dentofacial development, or orthognathic surgery at skeletal maturity. In this regard, oral and maxillofacial surgeons play a key role in the longitudinal management of patients with craniosynostosis. (Source: Oral and Maxillofacial Surgery Clinics)
Source: Oral and Maxillofacial Surgery Clinics - July 22, 2022 Category: ENT & OMF Authors: Srinivas M. Susarla Tags: Preface Source Type: research

Craniosynostosis: Current Perspectives
ORAL AND MAXILLOFACIAL SURGERY CLINICS OF NORTH AMERICA (Source: Oral and Maxillofacial Surgery Clinics)
Source: Oral and Maxillofacial Surgery Clinics - July 22, 2022 Category: ENT & OMF Authors: Srinivas M. Susarla Source Type: research

Copyright
ELSEVIER (Source: Oral and Maxillofacial Surgery Clinics)
Source: Oral and Maxillofacial Surgery Clinics - July 22, 2022 Category: ENT & OMF Source Type: research

Contributors
RUI P. FERNANDES, MD, DMD, FACS, FRCS(Ed) (Source: Oral and Maxillofacial Surgery Clinics)
Source: Oral and Maxillofacial Surgery Clinics - July 22, 2022 Category: ENT & OMF Source Type: research

Contents
Srinivas M. Susarla (Source: Oral and Maxillofacial Surgery Clinics)
Source: Oral and Maxillofacial Surgery Clinics - July 22, 2022 Category: ENT & OMF Source Type: research

Forthcoming Issues
Education in Oral and Maxillofacial Surgery: An Evolving Paradigm (Source: Oral and Maxillofacial Surgery Clinics)
Source: Oral and Maxillofacial Surgery Clinics - July 22, 2022 Category: ENT & OMF Source Type: research

Fronto-Orbital Advancement for Metopic and Unilateral Coronal Craniosynostoses
Fronto-orbital advancement remains a powerful technique for the correction of anterior cranial vault differences related to metopic (trigonocephaly) or unilateral coronal (anterior plagiocephaly) craniosynostoses. Traditional fronto-orbital advancement requires access to the forehead and superior 2/3 of the orbit via a coronal incision. The frontal bone and orbital segment (bandeau) are then separated from the skull and reshaped. In patients with metopic craniosynostosis, the bandeau and frontal bone will need to be advanced and widened. In patients with unilateral coronal craniosynostosis, the bandeau will need to be “u...
Source: Oral and Maxillofacial Surgery Clinics - July 1, 2022 Category: ENT & OMF Authors: Benjamin B. Massenburg, Philip D. Tolley, Amy Lee, Srinivas M. Susarla Source Type: research

Subcranial Midface Advancement in Patients with Syndromic Craniosynostosis
Patients with syndromic craniosynostosis can present with midface hypoplasia, abnormal facial ratios, and obstructive sleep apnea. These symptoms can all be improved with midface advancement, but it is essential to evaluate the specific morphologic characteristics of each patient ’s bony deficiencies before offering subcranial advancement. Midface hypoplasia in Crouzon syndrome is evenly distributed between the central and lateral midface and reliably corrected with Le Fort III distraction. In contrast, the midface hypoplasia in Apert/Pfeiffer syndromes occurs in both an a xial and a sagittal plane, with significantly mo...
Source: Oral and Maxillofacial Surgery Clinics - July 1, 2022 Category: ENT & OMF Authors: Benjamin B. Massenburg, Srinivas M. Susarla, Hitesh P. Kapadia, Richard A. Hopper Source Type: research

Orthognathic Surgery  in Patients with Syndromic Craniosynostosis
Patients with syndromic and nonsyndromic synostosis may have end-stage skeletal discrepancies involving the lower midface and mandible, with associated malocclusion. While orthognathic surgical procedures in this population can be reliably executed, the surgeon must be aware of the unique morphologic characteristics that accompany the primary diagnoses as well as the technical challenges associated with performing Le Fort I osteotomies in patients who have undergone prior subcranial midface distraction. (Source: Oral and Maxillofacial Surgery Clinics)
Source: Oral and Maxillofacial Surgery Clinics - July 1, 2022 Category: ENT & OMF Authors: Jesse T. Han, Mark A. Egbert, Russell E. Ettinger, Hitesh Kapadia, Srinivas M. Susarla Source Type: research

Historical Perspectives on the Management of Craniosynostosis
The history of craniofacial surgery is one of many fundamental advances by monumental figures. Although craniosynostosis has been known to exist for multiple centuries, modern management has evolved over roughly the last century. An overview of early history, early scientific exploration, the advancement of surgical treatment of craniofacial deformities and the current state of craniosynostosis management is discussed. To fully appreciate the evolution of craniosynostosis surgery, one must understand the gradual advancements that have brought the specialty to this modern era. (Source: Oral and Maxillofacial Surgery Clinics)
Source: Oral and Maxillofacial Surgery Clinics - July 1, 2022 Category: ENT & OMF Authors: Tyler J. Holley, Nathan J. Ranalli, Barry Steinberg Source Type: research

Syndromic Craniosynostosis
Syndromic craniosynostosis (CS) represents a relatively uncommon disease process that poses significant reconstructive challenges for the craniofacial surgeon. Although there is considerable overlap in clinical features associated with various forms of syndromic CS, key extracranial features and close examination of the extremities help to distinguish the subtypes. While Virchow ’s law can easily guide the diagnosis of single suture, nonsyndromic CS, syndromic CS traditionally results in atypical presentations inherent to multiple suture fusion. Coronal ring involvement in isolation or associated with additional suture f...
Source: Oral and Maxillofacial Surgery Clinics - July 1, 2022 Category: ENT & OMF Authors: Sameer Shakir, Craig B. Birgfeld Source Type: research

Epidemiology, Genetics, and Pathophysiology of Craniosynostosis
Craniosynostosis, the premature fusion of the infant cranial skulls, can be recognized by characteristic head shape differences that worsen with head growth. Craniosynostosis can be syndromic or nonsyndromic and can involve one suture or multiple sutures. Timely cranial vault surgery is recommended to expand and reshape the skull, with a goal of preventing increased intracranial pressure and providing sufficient space for brain growth. Several gene variants and environmental exposures are known to increase the risk of single suture craniosynostosis (SSC), including in utero constraint, exposure to specific toxins and medic...
Source: Oral and Maxillofacial Surgery Clinics - July 1, 2022 Category: ENT & OMF Authors: Matthew Blessing, Emily R. Gallagher Source Type: research

Management of Unicoronal and Metopic Synostoses
Early endoscopic-assisted correction of unicoronal and metopic synostosis is an excellent, safe, cost-effective, and highly effective option for affected patients. Although open calvarial remodeling has a place in the armamentarium of the craniofacial team, the skull base changes seen in endoscopic-assisted techniques are unparalleled. The procedures are associated with low morbidity and no mortality. There is minimal blood loss, decreased operating time, significantly reduced blood transfusion rates, decreased hospitalization length, decreased cost, and less pain and swelling. Early diagnosis and referral for surgical eva...
Source: Oral and Maxillofacial Surgery Clinics - July 1, 2022 Category: ENT & OMF Authors: Gabriel M. Hayek, David F. Jimenez, David M. Yates Source Type: research

Multidisciplinary Care Considerations for Patients with Craniosynostosis
Infants and children with craniosynostosis require multidisciplinary care, and this is best accomplished when care is provided on a craniofacial team. Most patients with craniosynostosis will have non-syndromic presentations; however, longitudinal care remains critical to ensure appropriate growth and development throughout childhood. In patients with syndromic craniosynostoses, coordinated longitudinal care becomes even more paramount because of the high level of complexity across many different specialties or disciplines. Care delivery that includes perspective and expertise from multiple disciplines is important to help...
Source: Oral and Maxillofacial Surgery Clinics - July 1, 2022 Category: ENT & OMF Authors: Emily R. Gallagher, G. Kyle Fulton, Srinivas M. Susarla, Craig B. Birgfeld Source Type: research

Management of Minor Suture Craniosynostosis
Although most reported cases of minor suture involvement include multiple sutures, isolated suture involvement has been reported. Morphologic differences such as scaphocephaly and anterior plagiocephaly have been reported. Management should involve proper identification and multidisciplinary treatment. Surgical treatment should involve the expansion of the cranial vault as well as the correction of the deformity. (Source: Oral and Maxillofacial Surgery Clinics)
Source: Oral and Maxillofacial Surgery Clinics - June 30, 2022 Category: ENT & OMF Authors: Alisa O. Girard, Robin Yang Source Type: research