Objective: This study is to investigate the effectiveness of philtrum repairment for-microform cleft lip, using muscle tension line group reconstruction. Methods: This is a retrospective study of 19 consecutively primary microform cleft lip repairment patients, from January 2015 to December 2017. All the patients were provided muscle tension line reconstruction (group 1) or traditional muscle repairment by horizontal mattress sutures (group 2). The philtral ridge and dimple were evaluated by scores. The statistical analyses were performed using unpaired t-test by Prism 6.0 software. Results: The philtral ridge score was higher in group 1 than group 2 (4.15±0.56 vs. 2.73±0.32, P<0.01). The philtral dimple score of group 1 increased either, when compared with group 2 (2.36±0.50 vs.1.45±0.28, P=0.0004). Conclusions Functional reconstruction of philtrum, using muscle tension line group repair, has satisfactory results in philtral ridge and philtral dimple.

Objective: The purpose of this study was to measure intracranial volumes in normal children of different ages and to explore the growth of intracranial volumes. Methods: A total of 151 normal children (male, 96; female, 55) were included in this study who were subjected to computed tomography (CT) for head trauma in the pediatric emergency room from June 1, 2015 to July 31, 2015. All of them had no congenital deformities and depressed fracture of the skull. Total, anterior, middle and posterior intracranial volumes were measured using a DICOM viewer. The Graphad Prism 6.0 was applied to analyze the data and plot the best fit logarithmic growth curve and liner regression and the comparison of the growth curves between different groups was done. Results: The intracranial volumes had a rapid growth within 2 years old. The girls′ total intracranial volumes were smaller than the boys′ of the same age. There was a significant difference of linear regression slope between anterior intracranial volumes and posterior intracranial volumes within 2 years old (P<0.01). Conclusions There is a rapid growth of intracranial volumes of normal children within 2 years old. The posterior intracranial volumes are expanded faster than the anterior intracranial volumes in the first two years. The girls′ intracranial volumes are smaller than the boys′.

Objective: To explore the effect of managing syndromic craniosynostosis using posterior vault distraction osteogenesis. Methods: The authors conducted a retrospective cohort study of four children with syndromic craniosynostosis treated between 2015 January to 2016 March using posterior vault distraction osteogenesis. The posterior craniotomy was performed from vertex, biparietally to a point above the occipital protuberance. Two distraction devices were fixed in the parasagittal, collinear position. After a latency of 3 days, the device was activated at 0.5 mm/day. After the distraction, the consolidation period was about 6 months. Results: The average distraction distance was 27.3 mm(range, 25 to 30 mm). Cerebrospinal fluid leak happened in one patient. After taken the 3D CT scan, all of them were undertaken the second operation of removing the distraction devices. All the patients were followed up at a mean of 12.8 months (range, 7 to 20 months). Conclusions It is effective to enlarge the posterior cranial vault using distraction osteogenesis for the syndromic craniosynostosis.

Objective: In clinical, cephalic index is the most common method to evaluate scaphocephaly. However, cephalic index alone is not sufficient to describe the nuances of skull shape. The authors hypothesize that the location of euryon could be a valuable and practical index as the supplement of cephalic index to better describe the skull. Methods: This is a retrospective study. CT scans of 17 scaphocephaly patients and 17 normal controls were included. Eight of 17 scaphocephaly patients have 6 months postoperative CT scan. The preoperative location of euryon of scaphocephaly patients was compared to that of the controls and postoperative. The horizontal location of euryon was defined as the ratio of the distance, from the most prominent point of forehead to euryon, to anteroposterior cranial length. The vertical location of euryon was defined as the ratio of the vertical distance, from the nasion to euryon, to cranial height. Results: Both the horizontal and vertical locations of euryon of preoperative scaphocephaly patients were significantly decreased compared to normals (46.50%±4.02% vs. 50.39%±2.21%, t=3.49, P=0.0014; 35.78%±8.62% vs. 52.6%±8.08%, t=5.86, P<0.001). Both the postoperative horizontal vertical locations of euryon were significantly increased, when compared to preoperative (47.25%±4.23% vs. 44.02%±3.72%, t=2.42, P=0.045; 42.39%±9.06% vs. 35.18%±5.36%, t=2.554, P=0.0379). Conclusions The location of euryon could be a practical and valuable index to describe the nuances of skull shape.

Objective:To explore the complications of case with craniosynostosis after cranial vault remolding.Methods:The clinical data with craniosynostosis who underwent cranial vault remolding in our hospital from January 2012 to January 2018 were selected and retrospectively analyzed.Results:There were 61 children, including 42 males and 19 females. Among them 17 with scaphocephaly, mean age at surgery was 8.2 months (range, 6-48 months); 13 with trigonocephaly, mean age at surgery 13 months (range, 6-29 months) ; 17 with plagiocephaly, mean age at surgery 15.2 months (range, 7-48 months); 14 with syndromic craniosynostosis, mean age 18.7 months (range, 6-60 months). Complications occurred in 15 cases of 13 children, including 1 death case (1.6%), who died of severe pneumonia from adenovirus infection in pediatric intensive care unit(PICU). Two cases suffered with cerebrospinal fluid leakage (3.3%) , which was self-healed after 2 weeks; three with dural defects(4.9%) , which were treated with dural repair and manual patch covering; 5 with conjunctivitis(8.2%), which was cured with eyedrops; 1 with occipital pressure ulcers(1.6%), which was cured with debridement and dressing; 3 with occipital bald(4.9%), one of which was caused by the above-mentioned occipital pressure ulcers. These three cases are followed up for further observations.Conclusions:Complications related to cranial vault remolding have various manifestations, and severe cases can be life-threatening. It is very important to actively prevent and promptly treat relevant issues after surgery.

Objective:To investigate the effect of tranexamic acid on perioperative hemorrhage of cranioplasty for craniosynostosis.Methods:A retrospective analysis was performed on the clinical data of children who received cranial remodeling from the Children’s Hospital of Fudan University from February 2015 to October 2018. The patients were divided into two groups: tranexamic acid treatment group (TXA group) and no tranexamic acid treatment group (control group). The average intraoperative blood loss, the average amount of blood transfusion, postoperative average amount of blood transfusion, average drainage volume, and changes of postoperative hemoglobin and blood coagulation function were observed. The measurement data were described by M ( Q1, Q3) and analyzed with Mann-Whitney U test. Results:A total of 41 patients were included in this study. There were 26 patients in TXA group, 18 males and 8 females, aged 9.5 (7.0, 38.8) months; in the control group, there were 15 patients, 10 males and 5 females, aged 9.2 (6.6, 18.3) months. The results showed that there was no significant difference in preoperative hemoglobin level between the two groups ( P>0.05). The hemoglobin level of TXA group was higher than that of control group immediately after operation and 24 h and 72 h after operation ( P<0.05). Total intraoperative blood loss and blood loss per kilogram of body weight in TXA group were lower than those in control group [150.0 (57.5, 225.0) ml vs. 200.0(80.0, 300.0) ml, P<0.05; 13.6(6.8, 18.5) ml/kg vs. 15.8(7.0, 27.0) ml/kg, P<0.01]. The amount of intraoperative transfusion volume per kilogram of body weight in TXA group was less than that in control group [15.0(8.8, 17.7) ml/kg vs.17.1 (13.0, 23.3) ml/kg, P<0.05]. There were no significant differences between the two groups in postoperative total transfusion volume, transfusion volume per kilogram of body weight, total drainage volume and drainage volume per kilogram of body weight ( P>0.05). There was no significant difference in prothrombin time (PT), activated partial thromboplastin time (APTT) and fibrinogen between the two groups before and after surgery ( P<0.05). Conclusion:TXA can reduce the amount of blood loss and blood transfusion in craniosynostosis in children.

Objective:To investigate the maxillofacial morphological development of children with different types of cleft palate after cleft palate repair.Methods:The clinical data of children who underwent cleft palate repair in the Department of Plastic Surgery, Children’s Hospital of Fudan University from January 2015 to December 2020 and normal children during the same period were retrospectively analyzed. All the included children were treated by the same physician at 8 to 18 months of age with loose incision and Langenbeck repair for cleft palate. X-ray cephalometric data and facial three-dimensional scanning data were obtained from the maxillofacial database of the Plastic Surgery Department of the hospital. According to the type and age of cleft palate, the children with cleft palate were divided into 6 groups: Group 1, 8 months to 1 years old children with grade Ⅰ cleft palate before operation; Group 2, 8 months to 1 year old children with grade Ⅱ-Ⅲ cleft palate before operation; Group 3, 2-3 years old children with grade Ⅰ cleft palate after operation; Group 4, 2-3 years old children with grade Ⅱ-Ⅲ cleft palate after operation; Group 5, 4-6 years old children with grade Ⅰ cleft palate after surgery; Group 6, 4-6 years old children with grade Ⅱ-Ⅲ cleft palate after operation. According to age, normal children were divided into three groups: Group 7, 8 months to 1 year old normal children; Group 8, 2-3 years old normal children; Group 9, 4-6 years old normal children. Analysis of variance was used to compare the measurement data of normal distribution between groups. Dunnett- t test was used to compare the maxillofacial features of children with grade Ⅰ cleft palate and grade Ⅱ-Ⅲ cleft palate with normal children of the same age. Results:A total of 183 children with cleft palate were included, including 84 females and 99 males, aged (3.6±2.1) years. There were 302 normal children, including 114 females and 188 males, aged (4.1±1.9) years. Groups 1 to 9 included 23, 46, 19, 37, 23, 35, 83, 105 and 114 children, respectively. The analysis result showed that the horizontal length, vertical height and angle of maxillary and mandibular were not significantly different from that of normal children of the same age in the preoperative cephalometric and three-dimensional scanning result of the children with grade Ⅰ and Ⅱ-Ⅲ cleft palate. However, the horizontal length, vertical height and angle of maxillary and mandibular were significantly different from that of normal children of the same age at 2-3 years and 4-6 years after surgery. Moreover, the difference between maxillofacial characteristics of children with grade Ⅱ-Ⅲ cleft palate and normal children of the same age is more significant than that of children with grade Ⅰ cleft palate.Conclusion:Maxillofacial morphological development is inhibited at different ages in children with different types of cleft palate after repair, which is manifested as the backward development of maxillofacial horizontal length, vertical height and angle of maxillary and mandible. Moreover, the maxillofacial morphological development inhibition was more serious in children with grade Ⅱ-Ⅲ cleft palate than in children with grade Ⅰ cleft palate.

Objective:To summarize the surgery effect of tongue volume reduction for macroglossia patients with Beckwith-Wiedemann syndrome (BWS).Methods:The clinical data of children diagnosed as BWS based on clinic symptoms and gene tests, who received operation in Department of Plastic Surgery, Children’s Hospital of Fudan University from July 2012 to December 2019 were analyzed retrospectively. All the patients underwent dorsal tongue bell-shaped resection and ventral V-shaped resection. By pulling tongue tip, the tongue body was cut and dissected along the marking line followed by suturing the muscle layer of the central part of the tongue tissue. Intermittent mattress suture of the dorsal and ventral mucous wounds of the tongue. After operation, all patients kept the trachea intubation and were transferred to PICU for further treatment and received early nasal feeding. The short-term postoperative complications, and long-term follow-up of the tongue body shape and clinical symptoms were recorded.The clinical effect was evaluated by onesurgeon and the parents.The effect was graded into four levels: dissatisifaction, average, satisifaction and great satisifaction.Results:A total of 61 children were included in this study, including 30 males and 31 females, with an average age of 8.5 months. The length of the tongue exposed outside at the resting state was 1.34-2.62 cm, with a median of 1.87 cm. Symmetric hypertrophy was found in 52 cases (85.2%), lateral hypertrophy in 9 cases (14.8%). There were 3 cases with respiratory obstruction (4.9%), 35 cases with salivation (57.4%), 4 cases suffering difficulty of feeding and dysphagia (6.6%). All children underwent the operation successfully, and the average operation time was 35.8 min. Among the short-term complications, there were 3 ventral wounds dehiscence, none of which needed sutured again. By prolonging nasal feeding time, the wounds were all healed in the secondary stage. Respiratory obstruction occurred in 1 patient after operation, and the symptoms were relieved after tongue retraction. The mean follow-up time was 3.3 years (2 months to 7 years), and 1 patient was inadequately corrected and good condition was got after second aryoperation. The remaining children obtained satisfactory resting tongue position and appearance, and the postoperative clinical symptoms were improved. In the long-term follow-up, the comprehensive evaluation results of the resting tongue position and clinical symptoms of the children by surgeon and parents were satisfied in 10 cases (16.4%), very satisfied in 50 cases (82.0%), and average in 1 case (insufficient correction after the first operation).Conclusions:Central resection and volume reduction of tongue body is a simple, effective and safe surgical technique in children with giant tongue diagnosed as BWS.

Objective:To summarize the surgery effect of tongue volume reduction for macroglossia patients with Beckwith-Wiedemann syndrome (BWS).Methods:The clinical data of children diagnosed as BWS based on clinic symptoms and gene tests, who received operation in Department of Plastic Surgery, Children’s Hospital of Fudan University from July 2012 to December 2019 were analyzed retrospectively. All the patients underwent dorsal tongue bell-shaped resection and ventral V-shaped resection. By pulling tongue tip, the tongue body was cut and dissected along the marking line followed by suturing the muscle layer of the central part of the tongue tissue. Intermittent mattress suture of the dorsal and ventral mucous wounds of the tongue. After operation, all patients kept the trachea intubation and were transferred to PICU for further treatment and received early nasal feeding. The short-term postoperative complications, and long-term follow-up of the tongue body shape and clinical symptoms were recorded.The clinical effect was evaluated by onesurgeon and the parents.The effect was graded into four levels: dissatisifaction, average, satisifaction and great satisifaction.Results:A total of 61 children were included in this study, including 30 males and 31 females, with an average age of 8.5 months. The length of the tongue exposed outside at the resting state was 1.34-2.62 cm, with a median of 1.87 cm. Symmetric hypertrophy was found in 52 cases (85.2%), lateral hypertrophy in 9 cases (14.8%). There were 3 cases with respiratory obstruction (4.9%), 35 cases with salivation (57.4%), 4 cases suffering difficulty of feeding and dysphagia (6.6%). All children underwent the operation successfully, and the average operation time was 35.8 min. Among the short-term complications, there were 3 ventral wounds dehiscence, none of which needed sutured again. By prolonging nasal feeding time, the wounds were all healed in the secondary stage. Respiratory obstruction occurred in 1 patient after operation, and the symptoms were relieved after tongue retraction. The mean follow-up time was 3.3 years (2 months to 7 years), and 1 patient was inadequately corrected and good condition was got after second aryoperation. The remaining children obtained satisfactory resting tongue position and appearance, and the postoperative clinical symptoms were improved. In the long-term follow-up, the comprehensive evaluation results of the resting tongue position and clinical symptoms of the children by surgeon and parents were satisfied in 10 cases (16.4%), very satisfied in 50 cases (82.0%), and average in 1 case (insufficient correction after the first operation).Conclusions:Central resection and volume reduction of tongue body is a simple, effective and safe surgical technique in children with giant tongue diagnosed as BWS.

Objective:To explore the complications of case with craniosynostosis after cranial vault remolding.Methods:The clinical data with craniosynostosis who underwent cranial vault remolding in our hospital from January 2012 to January 2018 were selected and retrospectively analyzed.Results:There were 61 children, including 42 males and 19 females. Among them 17 with scaphocephaly, mean age at surgery was 8.2 months (range, 6-48 months); 13 with trigonocephaly, mean age at surgery 13 months (range, 6-29 months) ; 17 with plagiocephaly, mean age at surgery 15.2 months (range, 7-48 months); 14 with syndromic craniosynostosis, mean age 18.7 months (range, 6-60 months). Complications occurred in 15 cases of 13 children, including 1 death case (1.6%), who died of severe pneumonia from adenovirus infection in pediatric intensive care unit(PICU). Two cases suffered with cerebrospinal fluid leakage (3.3%) , which was self-healed after 2 weeks; three with dural defects(4.9%) , which were treated with dural repair and manual patch covering; 5 with conjunctivitis(8.2%), which was cured with eyedrops; 1 with occipital pressure ulcers(1.6%), which was cured with debridement and dressing; 3 with occipital bald(4.9%), one of which was caused by the above-mentioned occipital pressure ulcers. These three cases are followed up for further observations.Conclusions:Complications related to cranial vault remolding have various manifestations, and severe cases can be life-threatening. It is very important to actively prevent and promptly treat relevant issues after surgery.