PubMed · 2719608
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D J David, M H Moore. 1989. Craniofacial surgery: the interface.. https://doi.org/10.1111/j.1445-2197.1989.tb01570.x
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We present a child with cardio-facio-cutaneous (CFC) syndrome with inadequate weight gain due to inadequate food intake. After correction of hyperemesis due to intestinal malrotation, she continued to fail to feed due to poor suck reflex. A review documented digestive system findings in 26 of 57 reported patients with CFC syndrome. Thus, digestive system dysfunction and malformation may represent an additional manifestation of the CFC syndrome.
In a total of 618 pregnant women between 9 and 37 weeks' gestation, the fetal face was evaluated by two-dimensional and three-dimensional ultrasound imaging as part of a level III screening evaluation for fetal anomalies. A three-dimensional endovaginal probe (5 MHz) was used for examinations at between 9 and 15 weeks, and an abdominal three-dimensional probe (3.5 MHz) was used after 15 weeks. Three different three-dimensional image display modes were employed: (1) the orthogonal display; (2) the surface display; and (3) the transparent display. When we studied the three-dimensional orthogonal displays in a 125 cases evaluated by abdominal ultrasound, we found that the facial profile shown in the two dimensional image represented the true mid-sagittal profile in only 69.6% of the cases. In the remaining 30.4%, the profile view deviated from a true mid-sagittal section by up to 20 degrees in one or two planes. In a total of 25 facial anomalies detected by abdominal ultrasound, 20 were clearly demonstrated by both two-dimensional and three-dimensional technology. In the remaining five cases, three-dimensional ultrasound revealed or confirmed an additional defect or abnormality: a narrow cleft lip in an unfavorable position of the fetal face (n = 2), a unilateral orbital hypoplasia (n = 1), a cranial ossification defect (n = 1) and a flat profile in the presence of marked oligohydramnios (n = 1). When transvaginal scanning was used, there were cases in which a detailed surface image of the fetal face could be obtained as early as 9 weeks' gestation. Abdominal scanning routinely yielded high-quality surface images by 20 weeks. Three-dimensional ultrasound consistently displayed facial abnormalities with greater accuracy and clarity than conventional two-dimensional imaging. This particularly applied to chromosomal aberrations and syndromes associated with subtle facial abnormalities requiring a detailed evaluation. Not only does three-dimensional ultrasound help in appreciating the severity of a fetal defect, but it can also provide more convincing evidence of a normal fetus than conventional two-dimensional sonograms.
Conventional free-tissue transfer without complication requires a microsurgical facility that includes a team of trained and experienced microvascular surgeons, expensive equipment, and other associated paraphernalia. To obviate the need for an operating microscope, or even magnifying loupes, an alternative technique for free-tissue transfer has been developed by the author and utilized over the past 12 years. The method involves the use of modified fasciocutaneous flaps with long vascular pedicles. No extra training, microvascular expertise, equipment, or expense are involved, and a general plastic surgeon can utilize the technique. The procedure has had particular use in underprivileged, third-world, plastic surgery units. Advantages and disadvantages of the procedure are discussed.