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Craniofacial deformities such as positional skull deformities are widespread in infants. The early detection of these deformities is crucial for the effective treatment and the associated minimization or prevention of visual and pathological abnormalities. This paper presents a solution for the early detection of craniofacial deformities using easy available materials in both the domestic and clinical environments. For this purpose, suitable web technologies as well as webserver systems are used in the context of app and server development. Users can use the app to take a bird's eye view of the child's head and use a 50ct coin as scale to then automatically obtain calculated clinical parameters which they can compare with clinical standard values to rule in or out a skull deformity. The concept represents a way to compensate for the lack of specialists in craniofacial surgery as well as knowledge gaps and to digitize care concepts in the healthcare system.

Objective The treatment of a positional head deformity in infancy is a controversial issue. The aim of this study was to explore the effects of helmet therapy on positional plagiocephaly and brachycephaly. Patients and Methods We determined cranial vault shape parameters in 348 healthy children during the second year of life, combined them with preexisting data from more than 400 subjects younger than 12 months, and related retrospectively the data of 1,531 children obtained before and after treatment with individual molding helmets to these newly generated normative values. Results The number of subjects with cranial vault asymmetry values > 97th percentile decreased by 85.5% from 1,361 before to 197 (p 97th percentile declined by 87.7% from 1,353 to 167 (p 97th percentile diminished by 66.8% from 885 to 294 (p Conclusions These findings do not finally prove, but they support the idea that helmet treatment is effective and meaningful in preventing permanent head deformities in infants with severe deformation. The normative anthropometric data generated in this study will allow investigating the natural course and effects of various therapies on infant cranial shape objectively.

Tumoren, die in der Tiefe des retromaxillaren oder orbitoethmoidalen Raums gelegen sind, stellen im Hinblick auf ihre vollstandige Resezierbarkeit eine Herausforderung an ein meist interdisziplinares Team von Kopf-Hals-Chirurgen dar. Endoskopische transnasale oder transsinusoidale Herangehensweisen sind haufig nicht mit letzter Sicherheit in der Lage, eine In-sano-Resektion dieser schwierig zu behandelnden Tumorentitaten im mund-, kiefer- und gesichtschirurgischen Bereich zu bewerkstelligen. Verschiedene operative Zugangswege zu tief gelegenen Strukturen des Viszerokraniums durch temporare Osteotomien des Gesichtsskeletts sollen anhand entsprechender Patientenfalle und intraoperativer Situsfotografien erlautert werden. Wir prasentieren die Indikation und die Praparation verschiedener transfazialer und transskeletaler Osteotomien zur Resektion tiefliegender Tumoren des Viszerokraniums. Auch in Zeiten minimalinvasiver und narbenfreier Chirurgie haben ausgedehnte chirurgische Zugange zum Viszerokranium ihre bestandige Rechtfertigung. Transfaziale Zugange wie der nasomaxillofaziale oder der maxillofaziale Zugang sowie die Jochbeinosteotomie oder die Zungen- und Mundbodenexkorporation erlauben eine gute chirurgische Ubersicht, beinhalten ein geringes intraoperatives Risiko und erzeugen ein i. Allg. zu vernachlassigendes asthetisches Stigma. Transskeletale Zugange im Gesichtsbereich entsprechen nicht dem aktuell-modernen Konzept der minimalinvasiven Chirurgie. Sie bieten jedoch bei geringem perioperativem Risikoprofil eine exzellente Ubersicht, ein gutes Komplikationsmanagement und eine radikale Resezierbarkeit auch ausgedehnter Tumoren in schwierig zu erreichenden Bereichen des Viszerokraniums.

ObjectiveTo photogrammetrically objectify changes in nonsynostotic craniofacial deformity in orthotically treated versus untreated infants.DesignA statistical retrospective pairwise comparison of two respective three-dimensional (3D) photo scans of 80 children performed in a 6-month time lag.PatientsTwo comparable samples of children (40 treated, 40 untreated) with nonsynostotic cranial deformity.InterventionsRespective 3D photo scans were matched using Cranioform Analytics 4.0 software.Main Outcome MeasuresMedian change of 30° Cranial Vault Asymmetry Index (CVAI), modified CVAI (CVAImod), Cranial Index (CI), and posterior symmetry ratio (PSR).ResultsWe found an improvement in Δ30° CVAI by 3.3% (treated) and by 1.31% (untreated), respectively. CVAImodimproved by 3.46% in the treated group and by 1.55% in the untreated group. CI improved by 4.41% in the treated group and by 3.68% in the untreated group, and PSR improved by 0.71 in the treated group and 0.49 in the untreated group. Although improvement of cranial asymmetry was higher in those children treated with an individual molding orthosis, we could not document a statistically significant difference between the two groups.ConclusionsHelmet therapy may be less appropriate for the correction of brachycephaly than for cranial asymmetry. Nonsynostotic cranial deformity shows some spontaneous correction. Photogrammetry presents an accurate method to objectify craniofacial changes in early infancy.

Positional head deformity in early childhood is asserted to be a benign and in some cases spontaneously correcting entity encountered in craniofacial surgery. Although many authors have stated that helmet therapy is indicated in moderate and severe cases of deformational plagiocephaly and brachycephaly; others have reported resolution of these conditions within the first 2 to 3 years of life. A recent randomized controlled trial found that helmet therapy does not have beneficial effects for patients with positional head deformity.The authors evaluated the clinical course of positional cranial deformation during a period of 5 years and compared the anthropometric parameters of orthotically treated versus untreated children within this timeframe.Although the patients were matched with respect to their cranial deformation at baseline, there were significant differences in the cranial vault asymmetry (CVA), cranial vault asymmetry index (CVAI), and oblique cranial length ratio (OCLR) between Groups 1 and 2 at the initial point (P0.05). The mean CVA was 0.95 cm in Group 1 (no helmet) and 1.74 cm in Group 2 (helmet). The mean CVAI at baseline was 7.25 for Group 1 and 13.77 for Group 2. Approximately 5 years after the first examination, the authors found clear improvement in the mean CVA in Group 2 (ΔCVA 1.35 cm) compared with Group 1 (ΔCVA 0.01 cm) and the mean CVAI.In contrast to recently published studies, the authors found clear improvement in nonsynostotic head deformity treated with an individual molding helmet and no clear evidence of improvement of absolute measurements in untreated cranial deformity within a 5-year follow-up period.

Objective To evaluate the impact of stretching exercises versus available bedding pillows on positional head deformities. Study design Fifty children aged 5 months or younger with positional head deformity were included in this prospective clinical trial (n = 20 plagiocephaly, n = 10 brachycephaly, n = 20 combination). A random distribution was performed for treatment with the bedding pillow alone (n = 25) or with stretching exercises (n = 25) for 6 weeks. Anthropometric caliper measurements were done before and after that interval. Cranial vault asymmetry index (CVAI) and cranial index (CI) were calculated and analyzed using a descriptive statistical general linear model. Results ΔCVAI in the stretching group was 2.09% for plagiocephaly and 2.34% for combined head deformities. Using the bedding pillow, ΔCVAI was 3.01% in plagiocephal children and 2.86% for combined head deformity. The ΔCI in the stretching group was 0.94% for isolated brachycephal children and 2.24% for combined head deformity. ΔCI in the pillow group was 3.63% for brachycephaly and 3.23% in children with combined head deformities, respectively. Conclusions Bedding pillows and stretching exercises both resulted in improvements in positional cranial deformation. For children with combined plagiocephaly and brachycephaly, improvement in cranial asymmetry was slightly greater when using bedding pillows versus stretching.

Objective Helmet therapy is an established method to correct positional head deformity in early infancy. Side effects such as skin erythema or pressure sores are well known for helmet therapy, but not yet adequately discussed in current literature. Patients and methods Retrospectively, all patient-sheets of infants treated by individual orthotic therapy in the years 2007 and 2008 were sighted and complications were noted. Complications were classified and sorted by their frequency and descriptive statistics was performed. The treatment to cure complications was recorded and success in complication control was analysed. Results Altogether, 410 patients fit the inclusion criteria for this investigation. Complications were apportioned into pressure sores, local ethanol erythema, unsatisfying fit of the helmet or loss of the helmet, skin infection, failed correction of head deformity, and subcutaneous abscess in one case. Non-compliance is to be noticed in a high number, but mainly occurred towards the end of the treatment period. Conclusion Helmet therapy represents a safe therapeutic tool for the correction of positional cranial deformity. Complications have to be clear in number and severity for parental elucidation. Most complications can easily be avoided or eliminated by proper instruction of the parents.

Introduction Embolia cutis medicamentosa (Nicolau syndrome) is a rare iatrogenic event of tissue necrosis after intramuscular or intraarticular application of cristalloid suspensions. Clinically, it presents as a livid discoloration of the skin, local pain, and signs of inflammation. Methods This article presents the first case of Nicolau syndrome after the endodontic application of calcium hydroxide paste into the distal root canal of tooth 18. The patient presented to the Department for Maxillofacial Surgery and hospitalized for several days. Results The application of calcium hydroxide paste led to a thrombosis of the inferior alveolar artery and various branches of the maxillary artery. A definite necrosis of the left-side infraorbital skin area and concomitant hypaesthesia of the infraorbital nerve and of the mental nerve were observed. Conclusions Calcium hydroxide paste is appropriate for the medicamentous treatment of root canals, but is not suitable to stanch bleeding from periapical arteries.

Objectives Since the "back to sleep" campaign initiated by the American Pediatric Society in 1992, an increasing incidence of positional cranial deformity in early infancy has been widely observed. Anthropometric caliper measurements present the most practical tool for diagnosis and decision making although their value is being controversially discussed in literature. Patients and methods Our study included 30 randomly chosen infants who had been diagnosed with plagiocephaly, brachycephaly, or a combination of both conditions. The 10 patients in each group were then measured anthropometrically by three examiners. The following parameters were measured six times in a standard manner and with a standard head position by each examiner: circumference, length, width, and oblique distance from the fronto-temporal area (ft) to the lambdoid suture on each side of the head (ld). Inter- and intra-observer variabilities for every value were statistically evaluated by a variance components estimation procedure. Results Both inter- and intra-observer agreement had very low variability. Overall, mean inter-observer variability was lower than 0.182mm 2 , and mean intra-observer variability was lower than 1.131mm 2 . Altogether, interobserver variability as well as intraobserver variability had a maximum of about 2 mm measurement variance. Conclusions Standardized measurements are highly reproducible to quantify early childhood head deformity. Standard head position is indispensable for reliable measurement. Repeatability of anthropometric measurements is essential to define diagnoses and severity codes and to develop treatment concepts.