[Plagiocephaly. Craniofacial asymmetry with variable curling-up]. / La plagiocéphalie. Asymétrie cranio-faciale à enroulement variable.

The plagiocephaly syndrome is an asymmetrical cranial deformity due to premature synostosis of a coronal hemi-suture. The predominant alteration is at the spheno-frontal suture. The classification is attempted between the isolated plagiocephaly (P) an plagiocephaly with hypertelorism, on one side, that are to be distinguished from complex asymmetrical cranio-facial deformities. The frontal P. are differentiated from occipital P (pachycephaly) and from mixed hemi-cranial P. The deformity affects the fronto-orbital region situated anterior to the synostosis. The coronal suture incurves around a pivot formed by the lateral orbital pillar and the pterion, giving rise to a set of facial and cranial deformities, variable according to the precocity and the topography of the synostosis. Investigating the syndrome is clinical and radiological. The deformity reveals itself in 88% of cases, the affects are mainly orbital and ophthalmologic. The authors insist on the necessity of a bilateral orbito-fronto-nasal osteotomy, as a therapeutic act that gives better harmony on short and long term; on the other hand, they draw the attention to the importance of abolishing the synostocic lock by the resection of the lesser wing of the sphenoid extended till the superior orbital fissure and the resection of the outher periosteal layer of the dura matter which allows a remodeling effect the growing brain. The results and complications are evaluated on 44 operated children.

[Electroencephalographic impact of propofol anesthesia]. / Retentissement électroencéphalographique de l'anesthésie au propofol.

Two groups of patients were studied. In group A, propofol was used alone, given by repeat injections of 2.5 mg X kg-1 in 30 s, in 5 patients undergoing percutaneous thermocoagulation of the Vth cranial nerve. In group B, a series of 12 patients undergoing lumbar disc hernia surgery, propofol was given as a bolus of 2.5 mg X kg-1 in 60 s followed by an infusion of 7 to 12 mg X kg-1 X h-1 together with vecuronium and fentanyl. The EEG recording was carried out during the whole length of anaesthesia and for 1 h after its end. The recordings were all stereotyped, within five successive phases: the awake physiological pattern (phase 0) was desynchronized a mean 52 s after the start of the propofol injection; it was followed by an increase in amplitude of the alpha rhythm (phase I); within a mean of 132 s were seen phases II to V. Phase V corresponded to surgical anaesthesia and could be kept up by a rate of infusion of 9 mg X kg-1 X h-1 propofol. An increase in this rate gave rise to burst suppressions which lasted as much as 15 s or more, and disappeared very quickly when the infusion rate was slowed. After stopping the anaesthesia, the EEG phases were quickly reversed, V to 0: in a mean of 11.1 min, the EEG pattern had returned to the awake state (extremes 4.3 to 19 min).(ABSTRACT TRUNCATED AT 250 WORDS)

[Anesthesia and postoperative care in reconstructive surgery of cranio-facial dysmorphias in children (about 100 cases) (author's transl)]. / Anesthésie-réanimation dans la chirurgie réparatrice des dysmorphies cranio-faciales de l'enfant. A propos de 100 cas.

Hundred cases of anesthesia for surgery in craniofacial dysmorphias in children are reported. 40 children were below 2 years of age, 14 were 2-5 years old and 46 were 5 to 15 years old. Surgery was of 3-12 hours duration (mean: 5 h 30). The type of anesthesia given was either a neuroleptanalgesia or a narconeuroleptanalgesia. Per- and post-operative intensive cares are discussed. 7 complications occurred during surgery, 11 complications occurred during the post-operative course: the origin of those complications is discussed as well as their treatment.