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Abstract: The wall separating the face and the cranium was broken by Paul Tessier and Grard Guiot in the 1960s, making it possible to perform a combined operation around the orbits and forehead, and opening up close cooperation between plastic surgeons and neurosurgeons, especially for treatment of the major malformations such as hypertelorism of major facial retrusions. The principles of mobilization of the orbits to correct teleorbitism or orbital dystopia are recalled with reference to the different variations and with clinical examples. Facial advancement to correct the retrusions created by faciocraniosynostosis is explained with the many possible variants, combined with a intracranial approach or not, with or without a bipartition. The indications are discussed as is the risk linked to combined advancement of face and forehead. The progressive bone elongation principle introduced by Ilizarov for the limbs has been applied to the face at the mandibular level by McCarthy, with great success. The distraction of bone structures is now also applied at the level of the midface and makes it possible to overcome the retraction of soft tissues and lower the risk of relapse of facial retrusion. Many technical problems have still to be solved, but the results are already very promising. Many other applications of the distraction principle will be developed for the midface level, with other technical improvements such as the use of absorbable mini-plates and screws.

The association of oxycephaly and rickets is noted in sixteen children whose cases are reviewed. The high incidence of raised intracranial pressure (73%), papilloedema (12.5%) and retarded mental development (53%) in this group is emphasised.

Cranio-facial prinicples have been applied to the treatment of craniosynostosis by the senior author since 1973, and original techniques have been developed for the treatment of oxycephaly, trigonocephaly, plagio-cephaly brachycephaly and scaphocephaly; 156 patients have been operated upon. There is now enough follow-up material to establish that the good morphological results obtained initially are maintained through growth, and that there is a definite improvement in affected facial structures when early correction has been performed. The functional results have also been very satisfactory and reoperation for insufficient release has been rare. A multidisciplinary approach is highly recommended, and this type of surgery should be performed- in a pediatric neuro-surgical environment.

L’oxycephalie est mal définie dans la littérature. L’analyse de la présente série d’oxycéphalies vise à en préciser le cadre nosologique et les risques fonctionnels.

We report a case of an extremely rare craniofacial condition, which, to our knowledge, has previously been reported once only. A male infant presented with a giant congenital bone defect of the skull, in the vertex region (10 x 20 cm) and without scalp deficiency, Minimal turricephaly and moderate orbital hypertelorism were associated with slight limb abnormalities, but psychometrical assessments appeared normal, Nonsurgical treatment was initially decided upon, but spontaneous reossifieation was so moderate that skull reconstruction was carried out at 28 months of age because of the risk of trauma, A full-size resin cephalic skeletal reconstruction was obtained according to three-dimensional computed tomography using stereolithographic techniques, A titanium plate was customised on the resin model for ideal adaptation to the convex skull defect (8 x 16 cm), Surgery was simply performed, consisting of a preliminary undermining between the dura mater and the scalp and screwing of the custom titanium plate, The initial follow-up was uneventful.

The use of a fibrin and thrombin tissue glue administered in aerosol form has been evaluated in 65 patients undergoing a face lift. In 55 cases the glue was applied to the undermined areas bilaterally, and appeared to decrease postoperative oedema and bruising. In a further 10 cases the adhesive was used on one side only. In 5 of these patients there was no difference between the two sides, while in 5 cases the glued side was judged superior. With this technique drains and dressings are not necessary in the postoperative period and patients find this especially convenient.

We present a technique using expanded forehead skin to allow excision and resurfacing of giant hairy nevi of the face. In each of three young patients an expanded scalping forehead flap provided pleasing coverage and permitted primary closure of the donor site. We believe that the superiority of this technique compared to other reconstructive options justifies the multiplicity of operative stages.

The intracranial volume of 104 children with Cranio synostosis was measured. Premature fusion of skull sutures is thought to deny the growing brain room to expand, but contrary to traditional teaching the intracranial volume of such children is often within normal limits.

Utilization of two short incisions, one in the axilla and one periareolar, facilitates the introduction and positioning of the polyurethane coated implants. The creation of a tunnel between the two incisions, and opened at both ends, enables the prosthesis to be pushed from above through the axilla and to be pulled by the plastic sleeve from below the areola. The periareolar incision also helps with the precise positioning of the prosthesis. This approach has been utilized for subglandular placement. Healing of the short incisions has been satisfactory.

Utilization of two short incisions, one in the axilla and one periareolar, facilitates the introduction and positioning of the polyurethane coated implants. The creation of a tunnel between the two incisions, and opened at both ends, enables the prosthesis to be pushed from above through the axilla and to be pulled by the plastic sleeve from below the areola. The periareolar incision also helps with the precise positioning of the prosthesis. This approach has been utilized for subglandular placement. Healing of the short incisions has been satisfactory.

Summary An international, interdisciplinary craniofacial surgery group of Munich, Innsbruck and Paris presents recent achievements in the operative correction of severe craniofacial anomalies. Indications, preoperative planning, operative techniques and results are shown in cases of microsomia, Binder syndrome, craniosynostosis, Apert's syndrome, Crouzon's disease, hypertelorism.

Summary The international interdisciplinary committee for craniofacial surgery in Munich, Innsbruck, and Paris presented treatment results for the following complex anomalies: dysostosis otomandibularis, Binder syndrome, Franceschetti-Treacher-Collins syndrome, brachyacrodysplasia, M. Crouzon, M. Apert, orbital hypertelorism, anophthalmia, dysostosis cleidocranialis, and facial clefts. In addition, craniofacial surgery was illustrated in tumor and trauma.