Rate of Body Dysmorphic Disorder Among Patients Seeking Facial Plastic Surgery Canice E Crerand, PhD, , , PhD David B Sarwer, PhD, , , PhD Leanne Magee, BA, , , BA Lauren M Gibbons, BA, , , BA Michael R Lowe, PhD, , , PhD Scott P Bartlett, MD, , , MD Daniel G Becker, MD, , , MD Paul M Glat, MD, , , MD Donato LaRossa, MD, , , MD David W Low, MD, , and , MD Linton A Whitaker, MD, , MD Canice E Crerand, PhD , David B Sarwer, PhD , Leanne Magee, BA , Lauren M Gibbons, BA , Michael R Lowe, PhD , Scott P Bartlett, MD , Daniel G Becker, MD , Paul M Glat, MD , Donato LaRossa, MD , David W Low, MD , and Linton A Whitaker, MD Psychiatric Annals, 2013;34(12):958–965Published Online:December 01, 2004https://doi.org/10.3928/0048-5713-20041201-19Cited by:45View Full TextPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinkedInRedditEmail SectionsMore1. Phillips KA, Diaz S. Gender differences in body dysmorphic disorder. J Nerv Ment Dis. 1997;185(9):570-577. Google Scholar2. Phillips KA, Grant JE, Siniscalchi J, Albertini RS. Surgical and non-psychiatric medical treatment of patients with body dysmorphic disorder. Psvchosomatics. 2001;42(6):504-510. Google Scholar3. Veale D, Boocock A, Gournay K, et al. Body dysrflorphic disorder. A survey of fifty cases. Br J Psychiatry. 1996;169(2):196-201. Google Scholar4. Phillips KA, McElroy SL, Keck PE Jr, Pope HG Jr, Hudson JI. Body dysinorphic disorder: 30 cases of imagined ugliness. Am J Psychiatry, 1993;150(2):302-308. Google Scholar5. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed [text revision]. Washington, DC: American Psychiatric Publishing; 2000. Google Scholar6. Faravelli C, Salvatori S, Galassi F, et al. Epidemiology of somatoform disorders: a community survey in Florence. Sac Psychiatry Psychiatr Epidemiol. 1997:32(1):24-29. Google Scholar7. Otto MW, Wilhelm S, Cohen LS, Harlow BL. Prevalence of body dysmorphic disorder in a community sample of women. Am J Psychiatry. 2001;158(12):2061-2063. Google Scholar8. Bohne A, Keulhen NJ, Wilhelm S, Deckersbach T, Jenike MA. Prevalence of symptoms of body dysmorphic disorder and its correlates: a cross-cultural comparison. Psychosomatics, 2002;43(6):486-490. Google Scholar9. Bohne A, Wilhelm S, Keuthen NJ, et al. Prevalence of body dysmorphic disorder in a German college student sample. Psychiatry Res. 2002;109(1):101-104. Google Scholar10. Cansever A, Uzun O, Donmez E, Ozsahin A. The prevalence and clinical features of body dysmorphic disorder in college students: a study in a Turkish sample. Cpmpr Psychiatry. 2003;44(1):60-64. Google Scholar11. Sarwer DB, Cash TF, Magee L, et al. Female college students and cosmetic surgery: an investigation of experiences, attitudes, and body image. Plastic and Reconstructive Surgery. In press. Google Scholar12. Aouizerate B, Pujol H, Grabet D, et al. Body dysmorphic disorder in a sampie of cosmetic surgery applicants. Eur Psychiatry. 2003;18(7):365-368 Google Scholar13. Ishigooka J, Iwao M, Suzuki M, et al. Demographic features of patients seeking cosmetic surgery. Psychiatry Clin Neurosci. 1998;52(3):283-287. Google Scholar14. Sarwer DB, Wadden TA, Pertschuk MJ, Whitaker LA. Body image dissatisfaction and body dysmorphic disorder in 100 cosmetic surgery patients. Plast Reconstr Surg. 1998;101(6):1644-1649. Google Scholar15. Dufresne RG, Phillips KA, Vittorio CC, Wilkel CS. A screening questionnaire for body dysmorphic disorder in a cosmetic dermatologic surgery practice. Dermatol Surg. 2001;27(5):457-462. Google Scholar16. Phillips KA, Dufresne RG Jr, Wilkel CS, Vittorio CC. Rate of body dysmorphic disorder in dermatology patients. J Am Acad Dermatol. 2000;42(3):436-441. Google Scholar17. Uzun O, Basoglu C, Akar A, et al. Body dysmorphic disorder in patients with acne. Compr Psychiatry. 2003;44(5):415-419. Google Scholar18. 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Body image: extent of disturbance, associated features, theoretical models, assessment methodologies, intervention strategies, and a proposal for a new DSM-IV diagnostic category - Body Image Disorder. In: Hersen M. Eisler RM, Miller PM, eds. Progress in Behavior Modification. Sycamore, IL: Sycamore Publishing Company; 1992:3-54. Google Scholar35. Thompson JK, Heinberg LJ, Altabe M, Tantleff-Dunn S. Exacting Beauty: Theory. Assessment, and Treatment of Body Image Disturbance. Washington, DC: American Psychological Association; 1999. Google Scholar36. Phillips KA, Atala KD, Pope HG. Diagnostic instruments for body dysmorphic disorder. In: 1995 Annual Meeting New Research Program and Abstracts. Washington, DC: American Psychiatric Association; 1995:157. Google Scholar37. Huck SW, Cormier WC. Reading Statistics and Research. 2nd ed. New York, NY: Harper Collins; 1996. 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Salari N, Kazeminia M, Heydari M, Darvishi N, Ghasemi H, Shohaimi S and Mohammadi M (2022) Body dysmorphic disorder in individuals requesting cosmetic surgery: A systematic review and meta-analysis, Journal of Plastic, Reconstructive & Aesthetic Surgery, 10.1016/j.bjps.2022.04.098, 75:7, (2325-2336), Online publication date: 1-Jul-2022. Spataro E, Kandathil C, Saltychev M, Olds C and Most S (2020) Correlation of the Standardized Cosmesis and Health Nasal Outcomes Survey With Psychiatric Screening Tools, Aesthetic Surgery Journal, 10.1093/asj/sjaa004, 40:12, (1373-1380), Online publication date: 19-Nov-2020. Crerand C, Rumsey N, Kazak A, Clarke A, Rausch J and Sarwer D (2020) Sex differences in perceived stigmatization, body image disturbance, and satisfaction with facial appearance and speech among adolescents with craniofacial conditions, Body Image, 10.1016/j.bodyim.2020.01.005, 32, (190-198), Online publication date: 1-Mar-2020. 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Collins B, Gonzalez D, Gaudilliere D, Shrestha P and Girod S (2014) Body Dysmorphic Disorder and Psychological Distress in Orthognathic Surgery Patients, Journal of Oral and Maxillofacial Surgery, 10.1016/j.joms.2014.01.011, 72:8, (1553-1558), Online publication date: 1-Aug-2014. Metcalfe D, Duggal C, Gabriel A, Nahabedian M, Carlson G and Losken A (2014) Prevalence of Body Dysmorphic Disorder Among Patients Seeking Breast Reconstruction, Aesthetic Surgery Journal, 10.1177/1090820X14531775, 34:5, (733-737), Online publication date: 1-Jul-2014. Elliott C, Hartmann A, Greenberg J, Wilson A and Wilhelm S (2014) Body Dysmorphic Disorder The Wiley Handbook of Anxiety Disorders, 10.1002/9781118775349.ch25, (535-547) Picavet V, Gabriëls L, Jorissen M and Hellings P (2011) Screening tools for body dysmorphic disorder in a cosmetic surgery setting, The Laryngoscope, 10.1002/lary.21728, 121:12, (2535-2541), Online publication date: 1-Dec-2011. Holman W (2011) "My Penis Is Shrinking and People Can Tell": A Confusing Case of Apparent Body Dysmorphic Disorder, Social Work in Mental Health, 10.1080/15332985.2011.579801, 9:5, (319-335), Online publication date: 1-Sep-2011. Sarwer D (2011) Discussion: High Prevalence of Body Dysmorphic Disorder Symptoms in Patients Seeking Rhinoplasty, Plastic and Reconstructive Surgery, 10.1097/PRS.0b013e31821e7248, 128:2, (518-519), Online publication date: 1-Aug-2011. Cadogan J and Bennun I (2011) Face value: an exploration of the psychological impact of orthognathic surgery, British Journal of Oral and Maxillofacial Surgery, 10.1016/j.bjoms.2010.07.006, 49:5, (376-380), Online publication date: 1-Jul-2011. Sarwer D, Crerand C and Magee L (2010) Body Dysmorphic Disorder in Patients Who Seek Appearance-Enhancing Medical Treatments, Oral and Maxillofacial Surgery Clinics of North America, 10.1016/j.coms.2010.07.002, 22:4, (445-453), Online publication date: 1-Nov-2010. Ragan J, Greenberg J, Beeger E, Sedovic M and Wilhelm S (2010) Body dysmorphic disorder Cognitive-behavioral Therapy with Adults, 10.1017/CBO9780511781919.013, (149-162) Sarwer D (2010) INVITED COMMENTARY, Cognitive and Behavioral Practice, 10.1016/j.cbpra.2010.02.005, 17:3, (278-282), Online publication date: 1-Aug-2010. Crerand C and Sarwer D (2010) Cosmetic Treatments and Body Dysmorphic Disorder, Psychiatric Annals, 40:7, (344-348), Online publication date: 1-Jul-2010. Crerand C, Menard W and Phillips K (2010) Surgical and Minimally Invasive Cosmetic Procedures Among Persons With Body Dysmorphic Disorder, Annals of Plastic Surgery, 10.1097/SAP.0b013e3181bba08f, 65:1, (11-16), Online publication date: 1-Jul-2010. Sarwer D (2010) Psychosocial Issues in Body Contouring Body Contouring, 10.1007/978-3-642-02639-3_64, (641-649), . De Jongh A, Aartman I, Parvaneh H and Ilik M (2009) Symptoms of body dysmorphic disorder among people presenting for cosmetic dental treatment: a comparative study of cosmetic dental patients and a general population sample, Community Dentistry and Oral Epidemiology, 10.1111/j.1600-0528.2009.00469.x, 37:4, (350-356), Online publication date: 1-Aug-2009. Crerand C, Infield A and Sarwer D (2009) Psychological Considerations in Cosmetic Breast Augmentation, Plastic Surgical Nursing, 10.1097/01.PSN.0000347725.13404.5f, 29:1, (49-57), Online publication date: 1-Jan-2009. Sarwer D, Grossbart T and Baker A (2009) Understanding the Cosmetic Surgery Patient Atlas of Cosmetic Surgery, 10.1016/B978-1-4160-3662-3.10001-0, (3-9), . Sarwer D and Infield A Body Image and Other Psychological Issues in Breast Augmentation Breast Augmentation, 10.1007/978-3-540-78948-2_14, (117-125) Crerand C, Franklin M and Sarwer D (2008) MOC-PS(SM) CME Article: Patient Safety: Body Dysmorphic Disorder and Cosmetic Surgery, Plastic and Reconstructive Surgery, 10.1097/PRS.0b013e3181888ffd, 122:Supplement, (1-15), Online publication date: 1-Oct-2008. Daines S and Mobley S (2008) Considerations in Male Aging Face Consultation: Psychologic Aspects, Facial Plastic Surgery Clinics of North America, 10.1016/j.fsc.2008.03.001, 16:3, (281-287), Online publication date: 1-Aug-2008. Sarwer D, Thompson J, Mitchell J and Rubin J (2008) Psychological Considerations of the Bariatric Surgery Patient Undergoing Body Contouring Surgery, Plastic & Reconstructive Surgery, 10.1097/PRS.0b013e3181772aa8, 121:6, (423e-434e), Online publication date: 1-Jun-2008. Sarwer D and Crerand C (2008) Body dysmorphic disorder and appearance enhancing medical treatments, Body Image, 10.1016/j.bodyim.2007.08.003, 5:1, (50-58), Online publication date: 1-Mar-2008. Sarwer D and Fabricatore A (2008) Psychiatric Considerations of the Massive Weight Loss Patient, Clinics in Plastic Surgery, 10.1016/j.cps.2007.08.006, 35:1, (1-10), Online publication date: 1-Jan-2008. Sarwer D (2007) The Psychological Aspects of Cosmetic Breast Augmentation, Plastic and Reconstructive Surgery, 10.1097/01.prs.0000286591.05612.72, 120:Supplement 1, (110S-117S), Online publication date: 1-Dec-2007. Bowe W, Leyden J, Crerand C, Sarwer D and Margolis D (2007) Body dysmorphic disorder symptoms among patients with acne vulgaris, Journal of the American Academy of Dermatology, 10.1016/j.jaad.2007.03.030, 57:2, (222-230), Online publication date: 1-Aug-2007. Crerand C, Infield A and Sarwer D (2007) Psychological Considerations in Cosmetic Breast Augmentation, Plastic Surgical Nursing, 10.1097/01.PSN.0000290284.49982.0c, 27:3, (146-154), Online publication date: 1-Jul-2007. Jakubietz M, Jakubietz R, Kloss D and Gruenert J (2007) Body Dysmorphic Disorder: Diagnosis and Approach, Plastic and Reconstructive Surgery, 10.1097/01.prs.0000259205.01300.8b, 119:6, (1924-1930), Online publication date: 1-May-2007. Sarwer D, Crerand C and Gibbons L (2007) Psychological Aspects of Cosmetic Surgery Anesthesia in Cosmetic Surgery, 10.1017/CBO9780511547218.018, (182-198) McKay D, Gosselin J and Gupta S (2007) Body Dysmorphic Disorder Obsessive-Compulsive Disorder, 10.1016/B978-008044701-8/50012-7, (177-195), . Crerand C, Franklin M and Sarwer D (2006) Body Dysmorphic Disorder and Cosmetic Surgery, Plastic and Reconstructive Surgery, 10.1097/01.prs.0000242500.28431.24, 118:7, (167e-180e), Online publication date: 1-Dec-2006. Darisi T, Thorne S and Iacobelli C (2005) Influences on Decision-Making for Undergoing Plastic Surgery: A Mental Models and Quantitative Assessment, Plastic and Reconstructive Surgery, 10.1097/01.PRS.0000177691.81162.e5, 116:3, (907-916), Online publication date: 1-Sep-2005. Request Permissions InformationCopyright 2013, SLACK IncorporatedPDF download • 10.6 MB Published online12/01/04

The purpose of this work was to develop a simple yet comprehensive classification scheme dedicated to congenital nasal anomalies. To date, no such classification system has been proposed and widely used. A 22-year retrospective review was performed. Two hundred sixty-one patients with congenital nasal anomalies were identified. From this extensive database, a systematic morphogenic classification system was devised. Congenital nasal deformities were classified into four categories. Type I, hypoplasia and atrophy, represents paucity, atrophy, or underdevelopments of skin, subcutaneous tissue, muscle, cartilage, and/or bone. Type II, hyperplasia and duplications, representing anomalies of excess tissue, ranging from duplications of parts to complete multiples, are categorized here. In the type III category, clefts, the comprehensive and widely utilized Tessier classification of craniofacial clefts is applied. Type IV deformities consist of neoplasms and vascular anomalies. Both benign and malignant neoplasms are found in this category.

Only the metopic suture normally fuses during early childhood; all other cranial sutures normally fuse much later in life. Despite this, metopic synostosis is one of the least common forms of craniosynostosis. The temporal sequence of normal physiologic metopic suture fusion remains undefined and controversial. Therefore, diagnosis of metopic synostosis on the basis of computed tomography images alone can prove misleading. The present study sought to determine the normal sequence of metopic suture fusion and characterize both endocranial and ectocranial suture morphology. An analysis of computed tomography scans of 76 trauma patients, ranging in age from 10 days to 18 months, provided normative craniofacial data that could be compared to similar data obtained from the preoperative computed tomography scans of 30 patients who had undergone surgical treatment for metopic synostosis. Metopic suture fusion was complete by 6 to 8 months in all nonsynostotic patients, with initiation of suture fusion evident as early as 3 months of age. Fusion was found to commence at the nasion, proceed superiorly in progressive fashion, and conclude at the anterior fontanelle. Although an endocranial ridge was not commonly seen in synostotic patients, an endocranial metopic notch was virtually diagnostic of premature suture fusion and was seen in 93 percent of synostotic patients. A metopic notch was not seen in any nonsynostotic patient. The morphologic and normative craniofacial data presented permit diagnosis of metopic synostosis based on computed tomography images obtained beyond the normal fusion period.

A retrospective analysis of seven patients with clinically severe trigonocephaly was performed, including a review of preoperative and postoperative computed tomography scans. A method of analyzing the trigonocephalic deformity was developed. This is based on determination of the angular severity of the forehead (110 +/- 4 degrees) and the length of half of the supraorbital bar (40 +/- 3 mm). This central angle was found to be relatively constant in this population. Using simple trigonometric relationships, a rationale for the alternative method of reconstruction used in these patients is presented. This technique is based on transverse expansion of the supraorbital bar, transposition of the lateral orbital rim, expansion of the temporal fossa, and recontouring the orbital aperture. As a separate consideration and step, the bony interorbital distance is widened.

The term Baller-Gerold syndrome was coined by Cohen [1979: Birth Defects 15(5B): 13-63] to designate the phenotype of craniosynostosis and radial aplasia. It is thought to be a rare autosomal recessive condition, which, in some patients, presents with additional abnormalities, such as polymicrogyria, mental retardation or anal atresia. A phenotypic overlap of Baller-Gerold and Roberts-SC phocomelia syndrome was noted when a patient with bicoronal synostosis and bilateral radial hypoplasia was found to have premature centromere separation, a finding characteristic of Roberts syndrome [Huson et al.,1990: J Med Genet 27:371-375]. Other cases of presumed Baller-Gerold syndrome were rediagnosed as Fanconi pancytopenia, Rothmund-Thomson syndrome or VACTERL association. These reports led to a narrowed redefinition of Baller-Gerold syndrome based on the exclusion of cytogenetic and hematopoetic abnormalities and the absence of additional malformations in patients with craniosynostosis and preaxial upper limb abnormalities. Here we report on a patient with unilateral radial aplasia and bicoronal synostosis without additional malformations and without chromosome breakage, who fits this narrow definition of Baller-Gerold syndrome. We identified a novel TWIST gene mutation in this patient, a Glu181Stop mutation predicting a premature termination of the protein carboxy-terminal to the helix 2 domain. This report provides further evidence that Baller-Gerold is of heterogeneous cause, and a thorough evaluation is indicated to identify a possibly more specific diagnosis, including Saethre-Chotzen syndrome. This differential diagnosis is of particular importance, as it is an autosomal dominant trait. Therefore, the recurrence risk for parents of an affected child can be 50% if one parent carries the mutation, as opposed to the 25% recurrence risk for autosomal recessive inheritance. Offspring of the affected patient also have a 50% risk to inherit the mutation, while the risk to bear an affected offspring for an autosomal recessive trait is very low.

This study assessed the body image concerns of reconstructive plastic surgery patients, Forty-three reconstructive surgery patients completed two measures of body image. Responses were compared with a group of patients seeking cosmetic procedures, The two groups did not differ in the degree of dissatisfaction with their overall appearance or dissatisfaction with the specific feature for which they were seeking surgery, Reconstructive patients did consider themselves less healthy and less invested in their appearance than did cosmetic patients, Seven of the reconstructive surgery patients (all scar revision patients) reported a level of dissatisfaction and preoccupation consistent with the psychiatric diagnostic of body dysmorphic disorder. These results underscore the importance of screening for body image dissatisfaction in persons with an objective deformity, Plastic surgeons are in an optimal position to identify body image concerns in these patients and provide appropriate referrals for psychotherapy.

This article discusses the psychology of cosmetic surgery. A review of the research on the psychological characteristics of individuals who seek cosmetic surgery yielded contradictory findings. Interview-based investigations revealed high levels of psychopathology in cosmetic surgery patients, whereas studies that used standardized measurements reported far less disturbance. It is difficult to fully resolve the discrepancy between these two sets of findings. We believe that investigating the construct of body image in cosmetic surgery patients will yield more useful findings. Thus, we propose a model of the relationship between body image dissatisfaction and cosmetic surgery and outline a research agenda based upon the model. Such research will generate information that is useful to the medical and mental health communities and, ultimately, the patients themselves. © 1998 Elsevier Science Ltd

This article reviews the history of psychological investigations of cosmetic surgery patients. These studies have been designed to address two fundamental questions: (1) Are there "patient types" or forms of psychopathology that serve as contraindications to cosmetic surgery? and (2) What is the likelihood of psychological change following cosmetic surgery? This review suggests that the research has not fully answered these questions. In response, we propose a new direction for psychological investigation, focusing on issues of body image in cosmetic surgery patients. We discuss the relationship between body image and cosmetic surgery and pose several relevant questions for future research.

To determine whether the autosomal dominant fibroblast growth factor receptor 3 (FGFR3) Pro250Arg mutation causes anterior plagiocephaly, patients with either apparently sporadic unicoronal synostosis (N = 37) or other forms of anterior plagiocephaly (N = 10) were studied for this mutation. Of 37 patients with unicoronal synostosis, 4 tested positive for the Pro250Arg mutation in FGFR3, and 33 were negative for this mutation. In three mutation positive patients with full parental studies, a parent with an extremely mild phenotype was found to carry the same mutation. None of the 6 patients with nonsynostotic plagiocephaly and none of the 4 patients with additional suture synostosis had the FGFR3 mutation. Because it is impossible to predict the FGFR3 Pro250Arg mutation status based on clinical examination alone, all patients with unicoronal synostosis should be tested for it. To assess their recurrence risk, all parents of mutation positive patients should be tested regardless of their clinical findings, because the phenotype can be extremely variable and without craniosynostosis. (J Pediatr 1998;132:714-6.)

This study was the first empirical investigation of body image dissatisfaction and body dysmorphic disorder in cosmetic surgery patients. Of 132 women, 100 women (response rate, 76 percent) completed two body image measures prior to surgery, the Multidimensional Body-Self Relations Questionnaire and the Body Dysmorphic Disorder Examination Self-Report Cosmetic surgery patients did not demonstrate greater dissatisfaction with their overall appearance compared with the reported normal values of the measures. However, when asked about the specific bodily feature they were considering for cosmetic surgery, they reported significantly greater dissatisfaction than a normative sample. In addition, ? percent of the sample met diagnostic criteria for body dysmorphic disorder, a potential psychiatric contraindication to cosmetic surgery. Implications of these findings are discussed with respect to the nature of body image dissatisfaction and the prevalence of body dysmorphic disorder in cosmetic surgery populations.

The underlying basis of many forms of syndromic craniosynostosis has been defined on a molecular level. However, many patients with familial or sporadic craniosynostosis do not have the classical findings of those craniosynostosis syndromes. Here we present 61 individuals from 20 unrelated families where coronal synostosis is due to an amino acid substitution (Pro250Arg) that results from a single point mutation in the fibroblast growth factor receptor 3 gene on chromosome 4p. In this instance, a new clinical syndrome is being defined on the basis of the molecular finding. In addition to the skull findings, some patients had abnormalities on radiographs of hands and feet, including thimble-like middle phalanges, coned epiphyses, and carpal and tarsal fusions. Brachydactyly was seen in some cases; none had clinically significant syndactyly or deviation of the great toe. Sensorineural hearing loss was present in some, and developmental delay was seen in a minority. While the radiological findings of hands and feet can be very helpful in diagnosing this syndrome, it is not in all cases clearly distinguishable on a clinical basis from other craniosynostosis syndromes. Therefore, this mutation should be tested for in patients with coronal synostosis.

The 45% of posterior crossbites in patients born with plagiocephaiy was tested to be significantly higher statistically (P < .001) than the 18% reported in the orthodontic literature among school children in the U.S. and Scandinavian countries. This data present some limitations in that the responses may be attributed to parental concerns. However, the authors are currently recording the presence of crossbites in patients with plagiocephaly not included in this paper since 1995 as part of the initial examinations. To date, the new patients seen have consistently upheld the authors' observations. There have been 10 new patients with plagiocephaly and 5 exhibited posterior crossbites. Further studies are now including CT scans in addition to oral examinations.

Although patients with posterior plagiocephaly may demonstrate no radiologic evidence of lambdoid synostosis, several studies have indicated that the lambdoid sutures of patients with "molding" deformities are functionally and metabolically abnormal. In order to gain insight into the processes involved in the development of posterior plagiocephaly, we conducted a morphological analysis of calvaria of patients with posterior skull asymmetries.

We report on a child with frontonasal malformation (FNM) and cloacal exstrophy, a combination of findings that have not been reported previously. In FNM and cloacal exstrophy, associated malformations are rare. FNM and cloacal exstrophy both represent abnormalities of the development of the midline field; this combination of anomalies in this patient suggests an impairment of caudal and cranial midline development during blastogenesis.

Recent clinical reports have documented a potential problem associated with the use of microfixation in the growing craniofacial skeleton, i.e., the finding of microplates and microscrews within the endocranial cavity during repeat surgery. This animal experiment using Yorkshire pigs was designed to determine if this type of passive internal displacement could be demonstrated in an animal model, the frequency of internal displacement, and the potential consequence of such events from a neurohistological standpoint. Ten female Yorkshire piglets underwent left unilateral fronto-orbital advancement at age 3 weeks, fixation being achieved with microplates and screws. The position of the hardware was determined by direct inspection, after they were killed at 6 months of age (skeletal maturity). Ten microplates (28%) showed complete intracranial translocation, whereas nine (27%) remained on the ectocranial surface. The majority, 16 (44%), were between the outer and inner cortices of the calvaria. Gross examination of the brain tissue underlying the translocated hardware showed indentation "pits" forming as a result of such translocation. Histological examination of the cerebrum and meninges of these pits revealed loss of the most superficial connecting cell layer, with focal neuronal distortion. The leptomeninges were intact and there was no cerebritis, gliosis, or hypoxic change. These findings confirm that in this pig model microfixation hardware will undergo passive intracranial ranial translocation and that there are demonstrable histological alterations in the underlying brain and meninges. The long-term effects of these observed anatomical changes are unknown.

The migration or passive intracranial translocation of microplates and screws in the pediatric craniofacial patient has been reported. A retrospective review was undertaken to clarify the incidence of microplate translocation and identify potential clinical implications. Computed tomographic imaging demonstrated internalization of microfixation in 14 of 27 pediatric patients. Statistically significant factors for microplate translocation include longer plates (p < 0.05) and those placed in the temporal region (p < 0.001). Younger patients and those with syndromic craniofacial dysostosis also had a higher incidence of translocation. Specific complications relating to the translocation of microplates were not found in any patient. The direct effects of translocated microplates and screws on the underlying brain and dura remain unclear.