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Joseph G. Mccarthy - One of the best experts on this subject based on the ideXlab platform.

  • Long-term evaluation of midface position after Le Fort III advancement: a 20-plus-year follow-up.
    Plastic and Reconstructive Surgery, 2012
    Co-Authors: Stephen M. Warren, Barry H. Grayson, Pradip R. Shetye, Sacha I. Obaid, Joseph G. Mccarthy
    Abstract:

    BACKGROUND Patients with syndromic cranioSynostosis and midface hypoplasia are often treated with Le Fort III advancement. The authors present four patients with extraordinarily long-term follow-up (in excess of 20 years). METHODS An institutional review board-approved retrospective chart review was performed on all patients with syndromic Craniofacial Synostosis who underwent Le Fort III advancement. Patients with greater than 20 years of cephalometric and photographic records were identified. Lateral cephalograms were obtained preoperatively, immediately postoperatively, at 1-year follow-up, and at long-term follow-up. Cephalograms were traced, digitized, and averaged. Fifty cephalometric landmarks were identified for serial measurements. RESULTS Of the four patients identified, one had Apert syndrome and three had Crouzon syndrome. Average age at the time of Le Fort III advancements was 11 years (range, 4 to 20 years). Average length of postoperative follow-up was 25 years (± 5 years). No patient had significant anterior midfacial growth following Le Fort III advancement. Both young patients (

  • syndromes involving cranioSynostosis and midface hypoplasia
    Otolaryngologic Clinics of North America, 2000
    Co-Authors: Timothy J Katzen, Joseph G. Mccarthy
    Abstract:

    Hippocrates probably first described craniostenosis in 100 bc. He noted abnormal calvarial appearances and associated these malformations with the pattern of cranial suture involvement. Celsus (25 bc to ad 50) described skulls without sutures but failed to give specific details. A Greek physician at the time of the Emperor Julian, Oribasios, reported cranial deformities in association with palatine deformities. In 1557, Lycosthene described an infant with deformities of the skull and limbs; presumably, this condition was acrocephalosyndactyly, which was described further in 1906 by Apert. In 1912, Crouzon described a mother and daughter, who had the same malformation of the face and head and coined the term hereditary Craniofacial dysostosis . In 1866, Von Graefe described an association between craniostenosis and blindness; Friedenwald (1893) 29 and Meltzer (1908) 48 established the association between cranioSynostosis and optic atrophy. CranioSynostosis is a term that describes premature fusion of one or more sutures in the cranial vault. This condition can present in two ways— as an isolated finding or in association with a multitude of other clinical entities (i.e., syndromic cranioSynostosis). This article discusses the genetics, presentation, and management of syndromic craniosynostoses and their associated midfacial hypoplasia. The most common Craniofacial Synostosis syndromes are Apert's syndrome, Crouzon's syndrome, Pfeiffer's syndrome, Saethre-Chotzen syndrome, and Carpenter's syndrome.

  • Airway management in children with major Craniofacial anomalies
    Laryngoscope, 1998
    Co-Authors: Nancy Sculerati, Marc D. Gottlieb, Marc S. Zimbler, Patricia D. Chibbaro, Joseph G. Mccarthy
    Abstract:

    Objectives: Delineation of clinical characteristics affecting the airway in a cohort of Craniofacially deformed children. What factors differ between patients requiring and those not requiring surgical airway intervention ? What factors predispose to the need for tracheotomy? When can decannulation be expected if tracheotomy is required? What interventions aid decannulation ? Study Design: Five-year retrospective chart review at tertiary center. Methods: Two hundred fifty-one patients met the following entry criteria: enrollment in the New York University Institute of Reconstructive and Plastic Surgery's Craniofacial Clinic and admission to Tisch Hospital in Manhattan for surgery from 1990 to 1994. Hospital, clinic, and departmental office records were reviewed. All patients had major Craniofacial bony anomalies and underwent administration of general anesthesia at least once. Results: Nearly 20% of all children required tracheotomy (47/251). Craniofacial Synostosis patients (Crouzon, Pfeiffer, or Apert syndrome) had the highest rate of tracheotomy (48% [28/59]). Mandibulofacial dysostoses patients (Treacher Collins or Nager syndrome) had the next highest rate (41% [28/59]). Patients with oculo-auriculo-vertebral sequence were less likely to undergo tracheotomy (22% [9/41]). Children with cranioSynostosis rarely required a surgical airway, unless there was marked associated facial dysmorphism (1% [1/72]). The duration of cannulation was related to the age at tracheotomy in a bimodal distribution. Generally, tracheotomies required before age 4 years remained for several years, whereas those placed after age 4 were removed after several weeks. The presence of a cleft palate correlated with reduced risk for tracheotomy, but the presence of a ventriculoperitoneal shunt correlated with an increased risk for tracheotomy. Procedures selectively used to improve the airway included midface advancement, mandibular expansion, tonsillectomy and adenoidectomy, uvulopalatopharyngoplasty, anterior tongue reduction, and endoscopic tracheal granuloma excision. Conclusions: The likelihood for surgical airway management is related to specific Craniofacial diagnosis. The length of tracheal cannulation is greatest for infants and young children who manifest severe airway compromise, often because of nasal obstruction in combination with other anatomic factors. Early tracheotomy is advocated for these patients to promote optimal growth and development. Choanal atresia is often misdiagnosed in these infants; nasal obstruction is actually secondary to midface retrusion. Staged surgical interventions can allow eventual successful decannulation in nearly all cases of Craniofacial syndromes.

  • Intracranial hypertension in a patient with Craniofacial Synostosis and patent sutures.
    Journal of Craniofacial Surgery, 1997
    Co-Authors: Joseph K. Williams, Jeffrey H Wisoff, Michael T. Longaker, Joseph G. Mccarthy
    Abstract:

    CranioSynostosis is often associated with restrictive cranial vault deformities, diminished intracranial volume, and intracranial hypertension. Advances in imaging techniques have provided a method of intracranial volume analysis that has demonstrated a more complicated relationship between Craniofacial abnormalities and elevated intracranial pressures. Studies have confirmed a decrease in intracranial volume in the presence of cranioSynostosis, but this association is not found in every patient. We report an unusual case of elevated intracranial pressure in a patient with the clinical stigmata of Crouzon's syndrome but with patent cranial vault sutures.

  • twenty year experience with early surgery for cranioSynostosis i isolated Craniofacial Synostosis results and unsolved problems
    Plastic and Reconstructive Surgery, 1995
    Co-Authors: Joseph G. Mccarthy, Barry H. Grayson, Scot Bradley Glasberg, Court B Cutting, Fred J Epstein, Gregg Ruff, Charles H Thorne, Jeffrey H Wisoff, Barry M. Zide
    Abstract:

    Early surgery for isolated cranioSynostosis is designed to improve morphology, to prevent functional disturbances, and equally important, to enhance the psychosocial development of the child. As the first of a two-part series, 104 patients with isolated Craniofacial Synostosis were retrospectively a

Barry M. Zide - One of the best experts on this subject based on the ideXlab platform.

Jeffrey H Wisoff - One of the best experts on this subject based on the ideXlab platform.

Barry H. Grayson - One of the best experts on this subject based on the ideXlab platform.

  • Long-term evaluation of midface position after Le Fort III advancement: a 20-plus-year follow-up.
    Plastic and Reconstructive Surgery, 2012
    Co-Authors: Stephen M. Warren, Barry H. Grayson, Pradip R. Shetye, Sacha I. Obaid, Joseph G. Mccarthy
    Abstract:

    BACKGROUND Patients with syndromic cranioSynostosis and midface hypoplasia are often treated with Le Fort III advancement. The authors present four patients with extraordinarily long-term follow-up (in excess of 20 years). METHODS An institutional review board-approved retrospective chart review was performed on all patients with syndromic Craniofacial Synostosis who underwent Le Fort III advancement. Patients with greater than 20 years of cephalometric and photographic records were identified. Lateral cephalograms were obtained preoperatively, immediately postoperatively, at 1-year follow-up, and at long-term follow-up. Cephalograms were traced, digitized, and averaged. Fifty cephalometric landmarks were identified for serial measurements. RESULTS Of the four patients identified, one had Apert syndrome and three had Crouzon syndrome. Average age at the time of Le Fort III advancements was 11 years (range, 4 to 20 years). Average length of postoperative follow-up was 25 years (± 5 years). No patient had significant anterior midfacial growth following Le Fort III advancement. Both young patients (

  • twenty year experience with early surgery for cranioSynostosis i isolated Craniofacial Synostosis results and unsolved problems
    Plastic and Reconstructive Surgery, 1995
    Co-Authors: Joseph G. Mccarthy, Barry H. Grayson, Scot Bradley Glasberg, Court B Cutting, Fred J Epstein, Gregg Ruff, Charles H Thorne, Jeffrey H Wisoff, Barry M. Zide
    Abstract:

    Early surgery for isolated cranioSynostosis is designed to improve morphology, to prevent functional disturbances, and equally important, to enhance the psychosocial development of the child. As the first of a two-part series, 104 patients with isolated Craniofacial Synostosis were retrospectively a

  • twenty year experience with early surgery for cranioSynostosis ii the Craniofacial Synostosis syndromes and panSynostosis results and unsolved problems
    Plastic and Reconstructive Surgery, 1995
    Co-Authors: Joseph G. Mccarthy, Barry H. Grayson, Scot Bradley Glasberg, Court B Cutting, Fred J Epstein, Gregg Ruff, Charles H Thorne, Jeffrey H Wisoff, Barry M. Zide
    Abstract:

    As the second of a two-part series, 76 patients with panSynostosis and Craniofacial Synostosis syndromes were retrospectively analyzed. Diagnoses included panSynostosis (7), craniofrontonasal dysplasia (8), and Apert (24), Crouzon (15), and Pfeiffer (15) syndromes.All patients underwent primary fron

  • The Le Fort III advancement osteotomy in the child under 7 years of age.
    Plastic and Reconstructive Surgery, 1990
    Co-Authors: Joseph G. Mccarthy, Barry H. Grayson, Gregory S. Latrenta, Arnold S. Breitbart, Fred L. Bookstein
    Abstract:

    This is a longitudinal study of 12 patients with Craniofacial Synostosis syndromes (Crouzon's, Apert's, Pfeiffer's) who underwent Le Fort III advancement under the age of 7 years (average age 5.1 years, range 4.0 to 6.7 years). The average follow-up was 5.0 years and included clinical, dental, and cephalometric examinations according to a prescribed protocol. The study demonstrated that the procedure could be safely performed in the younger child with an acceptable level of morbidity. There was a remarkable degree of postoperative stability of the maxillary segment. However, although vertical (inferior) growth or movement of the midfacial segment was demonstrated, there was minimal, if any, anterior or horizontal growth. Any occlusal disharmony developing during the period of follow-up could be attributed to anticipated mandibular development and could be corrected by orthognathic surgery. The roles of surgical overcorrection and anterior-pull headgear therapy after release of intermaxillary fixation are also discussed. The Le Fort III osteotomy is justifiably indicated during early childhood for psychological and physiologic reasons.

Charles H Thorne - One of the best experts on this subject based on the ideXlab platform.