9), steel wires, wires made of improved alloys have given way to plates and screws made of materials which are biologically non-corrosive locally or systemically neutral (Fig. When bone or bones are moved to their appropriate place the methods to secure their new positions have evolved over the years for e.g. The lacrimal apparatus has been saved and left in situ.Ĩ. The supra-orbital and supra- trochlear vessels have been skeletonised by small osteotomies around their foramena and the inferior dissection has been done by a trans- conjunctival approach. 8: After the scalp flap is raised beyond the supra-orbital ridges the eyeballs are almost completely eviscerated and hang on the optic nerve. Separate temporal fascia flaps can also be raised for the same purpose for which gaeleal flaps are used (Fig. More often than not the temporalis muscle is raised from its fan shaped attachment subperiosteally for better access to the lateral part of the temporal bone to facilitate osteotomies of the orbits in that area. Over the vault the epicranial flap is raised separately (also called the Galeal flap) and is based on the vascular network of the temporal vessels (Fig. The supra trochlear and supra orbital vessels are preserved. The flap while being raised is kept above the level of the epicranium (Galea) up to the supraorbital ridges and is then deepened below the epicranium so that when the orbits are approached a circumferential subperiosteal dissection can be undertaken to eviscerate the eyeball which will then hang only on the optic nerve as the orbital osteotomies are performed (Fig. 6) to prevent a linear scarred depression after healing. The incision is taken in a zig-zag manner (Fig. This allows adequate redrapingover the newly arranged skeleton. For surgical work in the anterior half ( bicoronal stenosis, anterior brachycephaly, plagiocephaly due to uni-coronal stenosis and hypertelorism) a transverse incision well behind the coronal suture (site) is now a standard choice. Surgical approach: Incisions are planned according to the condition being treated. For any procedure on the calvarium, the superior sagittal venous sinus enclosed between two layers of the dura which runs in a mid line from the front to the back must always be kept safe lest torrential and life threatening bleeding might be caused (Fig. Plagiocephaly will be dealt with in a separate section.Ħ. This procedure is usually denoted by the name calveriectomy. 5: Almost the whole of the calvarium has been osteotomised and refashioned in a case of sagittal stenosis which had lead to a very long skull (Scaphocephaly). For more extensive defects, when the whole of the calvarium is osteotomised and manipulated, and allowed to lie in a new position the term used for the procedure is calvariectomy (Fig. in brachycephaly, and then put back in a new position and a defect is left behind, a craniectomy is said to be performed (Fig. 3), a craniotomy is said to be performed. When a bone flap is removed only for access for e.g. However the treatment of hypertelorism by whatever cause is postponed till two years of age (please see next chapter).ĥ. As age advances, an osteotomy with a forceps or a power driven saw might need to be used (Fig. The age at which surgery should be undertaken will depend upon when the patient first comes for treatment but when the deformity is recognized early, the ideal age at which to operate is about around six months to a year (the earlier the better) because bones are soft and can be moulded by hands or can be “green stick fractured”. 2: A part of the skull removed and is being cut with a power driven instrument which will allow manual moulding to alter its shape.Ĥ.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |