Thirteen bone tumours that were invading the craniofacial skeleton were operated on by intracranial procedures. The resected tumorous bone was autoclaved and put back. Follow up of no less than one year included 122mTc scanning, computed tomography, radiography, bone biopsy and clinical examination. In every case, when rigidly fixed, most of the autoclaved bone was gradually revitalised by invading new and normal bone. We conclude that autoclaved bone will be replaced by normal bone, and that the present technique is justified for reconstruction of complicated structures or large areas of bone after operations for tumours invading the craniofacial skeleton.

Craniofacial parameters were studied clinically and by cephalometry in 11 trigonocephalic patients from infancy to 4 years of age. Six of the most severe patients had surgery between 6 and 18 months of age. Analysis of morphology indicated that bony interorbital distance was reduced in patients selected for surgery and hypotelorism persisted at final examination. All patients demonstrated orbital width measurements above the mean for the norm, while orbital height was essentially normal. All but one of the patients had a variably prominent forehead bony ridge that was eliminated or reduced as a result of surgery and/or growth. However, the forehead of most patients, whether operated or not, was too narrow when compared to normal skulls. Thus, although some of the striking features of trigonocephaly are eliminated, minor characteristics of the anomaly still persevere at 4 years of age.

One hundred and sixty-five patients with localized cancer of the lower lip were excised and reconstructed over a 25-year period using Bengt Johanson's step technique. Eight-eight percent of the tumors were less than 2 cm in size and 65% were of high histopathological differentiation. Fifty-six percent were reconstructed with bilateral step flaps. Nine local recurrences appeared in 5 patients, none of whom died of lip cancer. Eight patients later developed regional metastases and 3 of these patients died of lip cancer. The 5-year survival rate was 98%. The step technique is recommended for reconstruction of lip defects of up to 2/3 of the lower lip and may, in larger resections, be combined with either a fan flap or an Estlander flap. The outstanding functional results are due to the use of adjacent tissue for the reconstruction which preserves the normal arrangement of muscles, vessels and nerves.

Our results of bone grafting to the alveolar process during the mixed dentition were investigated in 55 consecutively treated patients (66 clefts). The amount of remaining bone and gingival retraction at the tooth mesial to the cleft after 3 and 12 months was measured and correlated with the following anatomical conditions present during surgery: width of the cleft, rotation of the adjacent incisor, stage of eruption of the tooth distal to the cleft. It was also considered if any deciduous lateral incisor or canine was extracted during surgery and if any flap dehiscence took place postoperatively. It was found that flap dehiscence resulted in significantly less bone at 3 months and at 1 year after surgery. Furthermore, extraction of a deciduous tooth was found to be significantly correlated to less bone 1 year after surgery, in which cases there were also persisting gingival retractions. The other factors had no significant influence on the outcome of surgery.

Cephalometric radiographs and dental study casts were analyzed in a group of 23 seven-year-old cleft lip and palate patients, 16 with unilateral and 7 with bilateral cleft. The patients' primary surgical procedures had been completed except for closure of the cleft in the hard palate. For comparison, similar records from another group of patients, 18 with unilateral and 8 with bilateral cleft lip and palate, were studied. In these cases the cleft of the hard palate had been repaired in infancy, using a vomer flap procedure. The results indicated that midfacial growth and dental occlusion of the unilateral cleft sample was significantly better in patients whose closure of the hard palatal cleft had been delayed to the stage of mixed dentition than where repair had been performed with a vomer flap in infancy. No differences were found, however, between similar subgroups with bilateral cleft lip and palate.

Fibrous dysplasia may affect the jaws as a monostotic lesion which most often ceases to be active at the end of normal bone growth. In some cases there is no stabilization on completion of normal skeletal growth. This may lead to severe malformation and functional disturbance to the face. In these cases, the patient must be followed regularly and resection of the deformed tissue must be performed repeatedly as the recurrences appear. Attention is also brought to the fact that fibrous dysplasia may be difficult to separate from chronic sclerosing osteomyelitis, a condition that should be treated differently.

Craniofacial surgical techniques have yielded better methods of treating severe craniofacial trauma. In this paper surgical techniques are discussed in principle and specifically presented through case reports. We conclude that the most important factors for successful reconstruction after craniofacial trauma are to do as much as possible the first time, to obtain wide exposure, to ensure rigid fixation of bone pieces and grafts, and to make use of a workbench procedure where bone fragments are assembled on a side table for subsequent reattachment to the head.

The degree of normalization of the shape of the skull was studied in 12 craniosynostosis patients who had been treated with different types of craniotomies in infancy. Three diagnoses were represented: isolated bicoronal synostosis; Crouzon's syndrome; and Apert's syndrome; there were four subjects in each group. Selected cranial dimensions were measured on roentgencephalograms taken in infancy and at follow-up examinations at 2 to 3 years of age. The measurements were compared with control values obtained from patients with cleft lip. Cranial dimensions in the synostosis patients seldom corresponded well with the values of the controls, either before or after surgery. Cranial height, in particular, was increased, especially in patients with Crouzon's or Apert's syndrome. This resulted in modulus values above the control mean for 11 of the 12 patients at the follow-up examinations.

Craniofacial surgical techniques have yielded as an important spin-off better methods of treating severe craniofacial trauma. In this paper surgical techniques are discussed. It was concluded that the most important factors for successful reconstruction after craniofacial trauma is to do as much as possible the first time, to obtain wide exposure, ensure rigid fixation of bone pieces and grafts and to make use of a work bench procedure where bone fragments are assembled on a side table for subsequent reattachment to the head.

Children with severe craniofacial anomalies and breathing problems are rare, and the accumulated experience of their treatment is limited. LeFort III midface advancements have been tried by many craniofacial teams, but no consensus has yet been reached as to the effectiveness of this procedure. In this report of seven patients with craniofacial malformations and severe breathing problems, three had a LeFort III midface advancement, one had release of bilateral temporomandibular joint ankylosis, and two had tonsillectomies. Two patients without a tracheostomy suffocated, four had a long-term tracheostomy, and one was cured by a unilateral tonsillectomy. It was concluded that LeFort III midface advancement is ineffective in these types of cases without a very stable postoperative retention, and it was suggested that all patients with severe craniofacial anomalies and breathing problems, regardless of their planned subsequent treatment, should have a tracheostomy as an initial measure.

1976, P. 569-580). Both syndromes follow an autosomal dominant mode of transmission. Most cases of Crouzon’s syndrome are familial, whereas the majority of cases with Apert’s syndrome are sporadic cases representing new mutations. The development of advanced and refined meth- ods for craniofacial surgery has renewed interest in patients with cranial and craniofacial malforma- tions. New surgical methods have made it possible to improve both function and cosmetic appearance in patients with severe malformations such as those seen in Crouzon’s and Apert’s syndromes. This sur- gery is very specialized and is only performed in a few centres in the world. One such centre is locali- zed in Goteborg, Sweden. The patients treated here come from the whole of Scandinavia. This centralization gives the unique opportunity to per- form large-scale studies on different pathogenetic aspects of craniosynostosis. Very few chromosome studies by banding technique on patients with cra- niosynostosis syndromes have been reported. In a survey of six patients with chromosome 7 short- arm-terminal deletions involving the 7p2 region, MCPHERSON et al. (1976) and DHADIAL and SMITH (1979) found five patients with craniosynostosis. These findings led them to suggest the existence of a 7p- syndrome typical of craniosynostosis. They also proposed that the amount of missing material from chromosome 7 was related to the variability in the phenotypic expression. This hypothesis will be tested in the present report, which deals with

In CF surgery blockage of the nasolacrimal system is sometimes found. Most commonly this is seen in facial clefts and post-traumatic conditions. In this paper an anatomical classification is outlined, which divides the lacrimal passage system into 4 separate parts, each requiring special consideration in the planning of surgical correction. A new technique of transposing the upper punctum and canaliculus into the lower eyelid is also described. This can be used where the lower punctum has been damaged and the upper punctum is intact, but is unable to prevent epiphora.

A prospective double blind study using Varidase or Trypure on 2nd degree local burns in 18 patients was performed. No difference in cleaning or healing effect was revealed. In 6 out of 11 Trypure-treated and 1 out of 12 Varidase-treated patients treatment had to be discontinued because of intolerable pain. This difference was statistically significant.

The hospital records of 406 patients treated for basal cell carcinomas were reviewed. Seventy-nine percent of the tumors were located to the head and neck area. All tumors were excised with a macroscopic margin of at least 3 mm. The surgical defects were closed primarily in 351 cases (74%), skin grafted in 108 cases (22%) and covered with local flaps in 18 cases (4%). Twenty patients (4%) required re-excision because of microscopically inadequate margins. Recurrence of the tumor was seen in 11 patients (2%).