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J C Posnick

Publications and source records attributed to J C Posnick.

At least 19 recordsLinked to original sources
PubMed2000

The craniofacial dysostosis syndromes: current surgical thinking and future directions.

Craniofacial dysostosis is the term applied to familial forms of craniosynostosis in which the sutural involvement generally includes the cranial vault, cranial base, and midfacial skeletal structures. The syndromic forms of craniofacial dysostosis were initially described by Carpenter, Apert, Crouzon, Saethre and Chotzen, Pfeiffer, and others. In addition to the dysmorphic cranial features, affected individuals may have profound alterations in facial skeletal development. Surgical reconstruction requires thoughtfully sequenced and staged procedures with consideration for the individual's specific malformations, craniofacial growth patterns, and psychosocial needs. Management of the craniofacial dysostosis syndromes is surgical, but the indications and the timing, type, and effectiveness of each stage of reconstruction have not been well evaluated and remains as much an art as a science. This article reviews the specific characteristic clinical features of the craniofacial dysostosis syndromes and presents current philosophy and rationale for the staging of reconstruction.

Craniofacial Dysostosis↗
PubMed2000

Treacher Collins syndrome: current evaluation, treatment, and future directions.

OBJECTIVE: Treacher Collins syndrome (TCS) is an inherited disorder in which there are general bilateral symmetric anomalies of the structures within the first and second branchial arches. In general, there is complete penetrance and variable expressivity of the trait. The craniofacial rehabilitation of a child with TCS is tailored to the extent of the deformities involved: the orbitozygomatic region, the maxillomandibular region, the nose, facial soft tissues, and external and middle ear structures. CONCLUSION: This article reviews the range of clinical features and specific dysmorphology observed in TCS. Functional and aesthetic objectives are discussed, and a comprehensive staged reconstructive approach is outlined, which may be used as a roadmap for treatment planning.

Adult↗
PubMed1998

Fibrous dysplasia of the craniomaxillofacial region: current clinical perspectives.

Fibrous dysplasia is a benign fibro-osseous disease of bone of unknown etiology. Its occurrence in the craniomaxillofacial skeleton is frequent and varies in severity from an asymptomatic monostotic lesion to polyostotic involvement resulting in progressive functional deficit and aesthetic problems. With the advent of refined instrumentation and craniofacial surgical techniques, a more aggressive, non-disabling approach to these benign yet deforming fibro-osseous growths is possible. In some patients, complete excision of the involved bone with graft reconstruction of the resultant defect with primary autogenous bone may be possible. Lifelong continuous ongoing monitoring of the involved region is required throughout the patient's life.

Adolescent↗
PubMed1998

Craniosynostosis and skull molding.

On February 20-23, 1997 in Scottsdale, Arizona, a symposium was held that was sponsored by the Plastic Surgery Educational Foundation, the American Society of Maxillofacial Surgeons, and the Joint Section on Pediatric Neurological Surgery of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons. The chairs of the meeting were Jeffrey C. Posnick and Harold L. Rekate. The symposium examined issues relating to craniosynostosis and skull molding. The program consisted of three parts. Day 1 focused on the basic concepts of craniosynostosis and skull molding. Day 2 focused on evaluation and treatment of craniosynostosis. Day 3 focused on the diagnosis and treatment of craniofacial syndromes. The symposium was significant because it brought craniofacial and pediatric neurosurgeons together for the first time at a combined meeting to discuss important aspects of craniosynostosis and skull molding. This article summarizes the presentations made at the meeting.

Animals↗
PubMed1997

Binder syndrome: staging of reconstruction and skeletal stability and relapse patterns after LeFort I osteotomy using miniplate fixation.

The present study prospectively assesses the skeletal stability in a consecutive series of Binder syndrome patients (n = 7), aged 16 to 20 years, who underwent LeFort I osteotomy fixed with miniplates and the associated morbidity. All patients underwent a one-piece LeFort I osteotomy fixed with four miniplates in conjunction with orthodontic treatment during the period of 1986-1992. Five of seven patients underwent iliac grafting to their deficient premaxilla and interpositionally at their osteotomy sites. Six of seven patients underwent bone graft augmentation of their deficient nose (four costochondral, one cranial, and one iliac). Serial cephalometric radiographs were taken at standard intervals after surgery (1 week, 6-8 weeks, 1 year). Horizontal, anterior vertical, and posterior vertical directional changes were then measured at each interval. With the radiographs superimposed, the amount of change was measured by the method of anatomic best fit. The 1-year postoperative cephalograms also were assessed for overjet and overbite. The medical records were reviewed for morbidity. Each patient had a complete set of longitudinal records. Follow-up ranged from 1.5 to 5.5 years at the close of the study. Perioperative morbidity was unremarkable, other than one patient whose cranial bone graft dehiscence through the nasal skin required regrafting. The mean (effective) maxillary advancement for the group was 6.0 mm, with 5.9 mm maintained 1 year later. The mean anterior vertical change of the maxilla was 4.2 mm, with 3.1 mm maintained; whereas the mean posterior vertical change was 2.8 mm, with 2.2 mm maintained. All patients maintained a positive overjet and overbite at 1 year. In our series, a staged reconstructive approach for Binder syndrome was carried out in the teenage years and included orthodontic treatment, orthognathic surgery, and nasal augmentation. The extent of skeletal relapse of the LeFort I osteotomy fell within a range that could be managed effectively to maintain a long-term positive overjet and overbite.

Adolescent↗
PubMed1997

The craniofacial dysostosis syndromes. Staging of reconstruction and management of secondary deformities.

During the past several decades, since the introduction of craniofacial surgery by Dr. Tessier in 1967, craniomaxillofacial surgery has advanced in many ways. Craniosynostosis is a common craniofacial malformation and requires a thoughtful team approach to select the preferred timing and technical aspects of reconstruction. The current approach to the correction of the deformities associated with the craniofacial dysostosis syndromes is to stage the reconstruction to coincide with facial growth patterns, visceral function, and psychosocial development. Recognition of the need for a staged reconstructive approach serves to clarify the objectives of each phase of treatment both for the clinicians and family. By continuing to define our rationale for the timing, method, and extent of surgical intervention and then objectively evaluating both functional and morphologic outcomes, we will improve the outlook for patients affected by these disorders.

Craniofacial Dysostosis↗
PubMed1997

The treatment of secondary and residual dentofacial deformities in the cleft patient. Surgical and orthodontic therapy.

The methods described to manage secondary jay deformities, resulting malocclusion, residual oronasal fistulas, and bony defects in adolescents born with a cleft are safe and reliable when carried out by an experienced cleft surgeon and team. They enhance the patient's quality of life and well-being. They also provide a stable foundation in which final soft-tissue lip and nose revisions may be carried out.

Adolescent↗
PubMed1996

Orthognathic surgery for the cleft lip and palate patient.

A thoughtful staged reconstruction for the cleft lip and palate patient is the preferred approach. The primary lip and palate repair performed during infancy and early childhood provides the foundation for normal speech, occlusion, facial appearance, and self-esteem. A long-term negative effect of these early surgical interventions is a significant incidence of maxillary growth restriction that produces secondary deformities of the jaws and dentition. This article reviews the variations in presentation, surgical and orthodontic techniques, and the results that we have achieved in patients born with a cleft who underwent primary repair in childhood, had a jaw deformity and malocclusion in adolescence, and underwent orthognathic surgery combined with orthodontic treatment for facial reconstruction and dental rehabilitation.

Adolescent↗
PubMed1996

Unilateral coronal synostosis (anterior plagiocephaly): current clinical perspectives.

Unilateral coronal synostosis is a frequently seen form of craniosynostosis that results in an anterior plagiocephalic shape to the ipsilateral forehead and orbit. Compensatory bulging of the contralateral side always occurs and most surgeons agree that a bilateral reconstruction is required. Details of the timing and techniques to achieve a symmetrical, proportional upper face will vary according to the craniofacial center's philosophy, but a team approach, with the pediatric craniofacial surgeon and the pediatric neurosurgeon working together, is an essential ingredient to achieving an unobstrusive face in a child born with unilateral coronal synostosis. More accurate methods of documenting the presenting deformity and the initial and late reconstructive results are needed.

Adult↗
PubMed1996

Alteration in facial sensibility in adolescents following sagittal split and chin osteotomies of the mandible.

Static two-point discrimination, pressure, and vibratory threshold values were measured bilaterally at standard coordinates in the area of the face innervated by the mental nerve in 115 adolescents (230 nerves). The patients were divided into four groups: normal adolescents who had not undergone any orthognathic surgery (group I controls, n = 134 nerves, mean age 18 years, SD = 3), those 1 year after undergoing bilateral sagittal split osteotomies of the mandible (group II, n = 14 nerves, mean age 19 years, SD = 2), those 1 year after undergoing an osteoplastic genioplasty (group III, n = 40, mean age 19 years, SD = 3), and those 1 year after undergoing a combination of bilateral sagittal split osteotomies and an osteoplastic genioplasty (group IV, n = 42 nerves, mean age 19 years, SD = 3). Subjective residual numbness at the 1 year postoperative interval was reported by 2 of 7 patients in group II, 2 of 20 patients in group III, and 14 of 21 patients (67 percent) in group IV. Long-term subjective numbness involved only the chin skin in 16 of 18 patients experiencing residual numbness and was perceived as problematic in the remaining 2 (group IV) patients whose subjective numbness also was measured objectively in the chin, lower lip (mucosa and skin), and gingiva. Objectively, the mean threshold values of the three sensory modalities tested were higher in group IV patients than in the remaining groups at all coordinates tested, but significant differences (p < 0.05) were found only between the mean two-point discrimination of group IV patients and the control group in the region of the chin skin. The high percentage of patients documented to have subjective and objective sensory disturbance after undergoing a combination of sagittal split osteotomies of the mandible and an osteoplastic genioplasty (group IV) may be explained by the "double crush syndrome."

Adolescent↗
PubMed1996

Monobloc and facial bipartition osteotomies for reconstruction of craniofacial malformations: a study of extradural dead space and morbidity.

This study evaluated the presence of extradural dead space following a monobloc or facial bipartition osteotomy and examined its natural history and relationship to postoperative infection and the presence of a ventriculoperitoneal shunt at the time of osteotomy in a consecutive series of patients with craniofacial dysostosis, frontonasal dysplasia, midline cranio-orbital clefts, and orbital hypertelorism. Only patients followed for at least 1 year were included in the study (range 1.3 to 5.5 years). The 23 patients studied were divided into three groups: 10 patients (mean age 9 years) underwent a monobloc osteotomy with advancement, 7 (mean age 8 years) a facial bipartition osteotomy with advancement, and 6 (mean age 7 years) a facial bipartition osteotomy without advancement. Standard craniofacial computed tomographic (CT) scans were obtained for each patient early after surgery (within 2 weeks in 13 patients and at 6 to 8 weeks in 10 patients) and again 1 year after surgery in every case. The extradural dead space was measured from a reproducible axial CT scan slice for each patient at each postoperative interval. An initial dead space was documented in the retrofrontal region of the anterior cranial fossa when the reconstruction incorporated forward projection of the osteotomy parts. This space was found to be obliterated by the expanded brain by 6 to 8 weeks in the patients examined by CT scan slice for each patient at each postoperative in all patients. Perioperative complications also were documented. The presence of a ventriculoperitoneal shunt at the time of osteotomy (7 of 23 patients) did not increase the risk of complications or alter the pattern of dead space closure after operation. Two patients developed infectious complications that were managed without long-term consequences.

Adolescent↗
PubMed1996

Symposium "Implantable Materials in Facial Aesthetic and Reconstructive Surgery: Biocompatibility and Clinical Applications". American Society of Maxillofacial Surgeons. Montreal, Quebec, October 6, 1995.

On October 6, 1995, the American Society of Maxillofacial Surgeons sponsored a 1-day symposium entitled "Implantable Materials in Facial Aesthetic and Reconstructive Surgery: Biocompatibility and Clinical Applications." The symposium examined issues relating to the biocompatibility and clinical role of alloplastic materials commonly used for facial bone and soft-tissue replacement and augmentation. It provided a forum for the interaction of basic scientists, clinicians, and manufacturers. Clinical and laboratory data concerning a variety of implantable materials were presented and discussed. The program consisted of three parts. The first session was designed to provide historical and scientific background as well as perspective on legal issues surrounding the use of implantable biomaterials. The second session involved the presentation of clinical data on bone and bone substitutes for augmentation of the facial skeleton. The third session was devoted to clinical reports of bone and bone substitutes used for the reconstruction of cranial vault and cranial base skull defects.

Biocompatible Materials↗