Sternal cleft and pectus excavatum: an overlooked congenital association?

BACKGROUND: Sternal cleft (SC), a rare thoracic malformation, is associated with pectus excavatum (PE) in 2.6-5% of cases. It remains unclear if these conditions are congenitally linked or if SC repair triggers PE. To investigate the potential higher frequency of PE in SC cases, we conducted a retrospective study of our SC patients. METHODS: We assessed PE incidence, progression, and management in SC patients treated at our institute from 2006 to 2022. When available, we collected pre-SC repair CT scan data, calculating the Haller Index (HI) and Correction Index (CI) and compared them to a selected control group. RESULTS: Among 8 SC patients, 7 had concomitant PE (87.5%), varying in severity. PE management ranged from observation to thoracoplasty, depending on its degree. We observed a significant pre-operative CI difference between SC and control group patients (p < 0.00001). In the last two SC repair cases, we attempted concurrent PE prevention or treatment. CONCLUSION: Our findings suggest an underestimated association between PE and SC in the existing literature. SC patients may exhibit a predisposition to PE from birth, which may become more apparent with growth after SC repair. Consequently, PE prevention or treatment should be considered during SC repair procedures.

Congenital hemivertebrae combined with situs inversus totalis: A rare case report.

RATIONALE: Situs inversus totalis is a rare malposition of organs that typically involves lesions in the respiratory, circulatory, or urinary systems. Cases of congenital hemivertebrae combined with situs inversus totalis are extremely rare and have limited reports. PATIENT CONCERNS: We report a 2.5 years old girl with 2 congenital hemipyramids and complete visceral inversion who ultimately underwent hemilaminectomy. DIAGNOSIS: Congenital hemivertebrae combined with situs inversus totalis. INTERVENTION: The patient underwent hemilaminectomy. OUTCOMES: The spinal deformity was corrected. LESSONS: For patient with spinal deformities combined with situs inversus totalis, surgery can be an effective treatment method. But we also need to be vigilant about the dysfunction of various systems.

Pectus Arcuatum: A Pectus Unlike Any Other.

BACKGROUND: Pectus arcuatum is often mistaken for a type of pectus carinatum. However, pectus arcuatum is a unique clinical form of pectus caused by premature obliteration of the sternal sutures (manubrial sternum, four sternebrae and xiphoïd process), whereas pectus carinatum is due to abnormal growth of the costal cartilage. In order to better describe pectus arcuatum, we analysed the files of patients with pectus arcuatum followed in our centers. METHODS: Multicenter retrospective study of young patients' files diagnosed with pectus arcuatum. RESULTS: The clinical diagnosis of pectus arcuatum was made in 34 patients with a mean age at diagnosis of 10.3 years (4-23 years). A chest profile X-ray or a CT scan was performed in 16 patients (47%) and confirmed the diagnosis of PA by the presence of a sternal fusion. It was complete in 12 patients. A malformation was associated in 35% of cases (Noonan syndrome 33%, scoliosis 25% or cardiopathy 16%). 11 patients (32%) had a family history of skeletal malformation. Orthopedic treatment was initiated in 3 patients without any success. 11 patients underwent surgical correction, which was completed in 7 of them. CONCLUSION: The diagnosis of pectus arcuatum is based on clinical experience and if necessary, on a profile chest X-ray showing the fusion of the sternal pieces. It implies the search for any associated malformations (musculoskeletal, cardiac, syndromic). Bracing treatment is useless for pectus arcuatum. Corrective surgery, based on a sternotomy associated with a partial chondro-costal resection, can be performed at the end of growth. LEVEL OF EVIDENCE: IV.

Indication of C2-C7 Cervical Laminoplasty with Muscle and Ligament Preservation in Patients with Kyphosis.

OBJECTIVE: Cervical laminoplasty is generally not indicated in patients with kyphosis because of poor outcomes. Therefore, data on the effectiveness of posterior structure-preserving techniques in patients with kyphosis are limited. This study investigated how laminoplasty with muscle and ligament preservation can benefit patients with kyphosis via risk factor analyses of postoperative complications. METHODS: Clinicoradiological outcomes of 106 consecutive patients, including patients with kyphosis, who had undergone C2-C7 laminoplasty in a muscle- and ligament-preserving fashion, were retrospectively analyzed. Surgical outcomes, including neurological recovery, were assessed, and sagittal parameters were measured on radiographs. RESULTS: Surgical outcomes of patients with kyphosis were comparable to outcomes of other patients except for axial pain (AP), which was significantly more frequent in patients with kyphosis. Moreover, AP was significantly associated with alignment loss (AL) >0°. Substantial local kyphosis (local kyphosis angle >10°) and greater value of range of motion (ROM) during flexion minus ROM during extension were identified as risk factors for AP and AL >0°, respectively. Receiver operating characteristic curve analysis indicated ROM during flexion minus ROM during extension cutoff value of 0.7° for predicting AL >0° in patients with kyphosis (sensitivity: 77%; specificity: 84%). Substantial local kyphosis combined with ROM during flexion minus ROM during extension >0.7° had 56% sensitivity and 84% specificity for predicting AP in patients with kyphosis. CONCLUSIONS: Although patients with kyphosis had a significantly higher incidence of AP, C2-C7 cervical laminoplasty with muscle and ligament preservation may not be contraindicated in selected patients with kyphosis by risk stratification for AP and AL using newly identified risk factors.

Aesthetic Outcome of Primary Rhinoplasty of Saddle Nose Deformity in Naso-Orbital Ethmoidal Fractures in Asian Patients.

BACKGROUND: Saddle nose deformity following naso-orbital ethmoidal (NOE) fractures remain a challenging problem for the reconstructive surgeon. Early reduction and internal fixation allow for fracture stabilization but is unable to address the problem of the depressed nasal dorsum, especially after soft tissue shrinkage. The aim of this study is to evaluate the outcome of primary rhinoplasty in patients with NOE fractures. MATERIALS AND METHODS: From 2016 to 2019, 9 patients presented to our department with NOE fractures complicated by saddle nose deformity underwent primary nasal reconstruction at the time of their fracture fixation. Life size (1:1) frontal and lateral postoperative photographs were taken. Three objective measurements were made, including the nasofrontal angle, tip projection, and radix projection. These measurements were compared between normal persons (group 1), preoperative patients (group 2), and postoperative patients (group 3). Nose aesthetic assessment was carried out via a panel assessment using a Visual Analog Scale of 5. Patient satisfaction was further assessed subjectively by the patient themselves using the Visual Analog Scale. RESULTS: When comparing group 3 to 2, a significant reduction in the nasofrontal angles was found with an accompanying increase in the radix and tip projection ( P <0.05). No statistical significance between normal persons and postprimary rhinoplasty patients was noted between groups 1 and 3. Average patient satisfaction scored 3.86±1.07 compared with 3.63±0.84 by laypersons and 4±0.77 by specialists' panel. CONCLUSION: Primary nasal reconstruction may be an alternative method for achieving optimum results following NOE fractures preventing the development of secondary saddle nose deformity with a shortened nose which may potentially be more difficult to correct.

Primary closure of a sternal cleft in the neonatal period.

Sternal cleft is a rare malformation of the midline fusion of the sternal bars; the most common form is the superior partial defect. Surgical correction with primary closure is the gold standard. It is recommended that the procedure be performed before 3 months of age because of the greater compliance and maximal flexibility of the thoracic wall.  These features ensure a safer repair with a low risk of complications and allow for a less extensive procedure that does not require the use of additional techniques. A midline incision is performed in the anterior thoracic wall, and the major pectoralis flaps are raised. The main surgical goal is to change the remaining sternum from a U to a V shape. Transfixing interrupted sutures are placed in the cartilaginous borders for midline closure. Hemodynamics and ventilation are monitored at this time. Closure is performed by layers.

Congenital Superior Sternal Cleft Isolated in a Newborn: Report of a Rare Case and a Literature Review.

BACKGROUND Sternal cleft is a greatly rare congenital thoracic deformity, arising from a failure of the sternal bars fusion process that should be completed in the fetal period, the incidence of which is less than 0.15%. CASE REPORT Herein, we present a case report of a newborn girl having a superior congenital sternal cleft. After the baby was born, scar-like tissue was found in the middle of the chest and extended to the root of the umbilical cord. Based on the imaging data, this newborn was diagnosed with sternal cleft belonging to the superior sternal cleft and not associated with other congenital deformities. CONCLUSIONS As a rare congenital thoracic deformity, postpartum diagnosis of the sternal cleft mainly is currently based on medical imaging, including thoracic computed tomography (CT), three-dimensional (3D) reconstruction CT, and magnetic resonance imaging (MRI). Sternum cleft not only affects the aesthetic appearance but also leads to the destruction of the bone structure of the thorax, resulting in opposing thoracic movements. Therefore, early diagnosis and early treatment play significant roles in the treatment of this congenital sternal deformity. Regardless of whether there are clinical symptoms of sternal cleft, primary repair surgery must be done as soon as possible and during the neonatal period is best, in which simple surgical techniques achieve remarkable effects.

Case Report: Bilateral Epiphysiodesis Due to Extreme Tall Stature in a Girl With a De Novo DNMT3A Variant Associated With Tatton-Brown-Rahman Syndrome.

Objective: To present a rare clinical case of a patient with Tatton-Brown-Rahman syndrome and the outcome of tall stature management with bilateral epiphysiodesis surgery at the distal femur and proximal ends of tibia and fibula. Study Design: Clinical case report. Results: This is a 20-year-old female with a history of proportional tall stature, developmental psychomotor and language delay with autism spectrum behavior and distinctive facial features. At 12 years and 2 months of age she was in early puberty and 172.5 cm tall (+ 2.8 SDS) and growing approximately 2 SDS above midparental target height of 173 cm (+ 0.9 SDS). A bone age assessment predicted an adult height of 187.1 cm (+3.4 SDS). To prevent extreme tall stature, bilateral epiphysiodesis surgery was performed at the distal femur and proximal ends of tibia and fibula at the age of 12 years and 9 months. After the surgery her height increased by 12.6 cm to 187.4 cm of which approximately 10.9 cm occurred in the spine whereas leg length increased by only 1.7 cm resulting in a modest increase of sitting height index from 50% (-1 SDS) to 53% (+ 0.5 SDS). Genetic evaluation for tall stature and intellectual disability identified a de novo nonsense variant in the DNMT3A gene previously associated with Tatton-Brown-Rahman syndrome. Conclusion: Tatton-Brown-Rahman syndrome should be considered in children with extreme tall stature and intellectual disability. Percutaneous epiphysiodesis surgery to mitigate extreme tall stature may be considered.

Isolated central sterna clefts: A rare congenital malformation.

Sternal cleft is a rare congenital anomaly which is generally observed at birth. The aetiology remains obscure. Superior clefts are more frequent than inferior ones, and isolated central clefts are extremely rare. Surgery is recommended to protect the heart and other mediastinal contents from trauma and also to improve respiratory dynamics. We present the case of a newborn with isolated central clefts and we will give a review of the literature.

Congenital Kyphosis: Progressive Correction With an Instrumented Posterior Epiphysiodesis: A Preliminary Report.

PURPOSE: Congenital kyphosis is a rare condition. In this case series we sought to identify the outcomes and complications of posterior instrumented fusion and the resultant epiphysiodesis effect in uniplanar congenital kyphosis in pediatric patients. METHOD: Pediatric patients were included if treated for a uniplanar congenital kyphotic deformity treated with posterior instrumented spinal fusion between October 2006 and August 2017, with a minimum of 2 years of follow-up. Patients were excluded if a coronal deformity >10 degrees was present. RESULTS: Six patients met the inclusion criteria. Mean age at surgery was 3.6 years. The mean kyphotic deformity before surgery was 49.7 degrees. All patients underwent posterior instrumented fusion with autogenous iliac crest graft and a cast or brace postoperatively. One patient showed a loss of motor evoked potential on prone positioning which returned to normal on supine positioning. No patient showed any postoperative neurological deficits. One patient was diagnosed with a wound infection which was successfully treated with oral antibiotics.By a follow-up of 5.4 years (range, 2.2 to 10.9 y) there was no failure of instrumentation. An epiphysiodesis effect (a difference of ≥5 degrees in the kyphotic deformity measured between the immediate postoperative and final follow-up lateral whole spine XR) of 16.2 degrees (range, 7.2 to 30.9 degrees) was seen in 5 patients. The mean annual epiphysiodesis effect was 2.7 degrees (95% confidence interval, 1.4-4.1 degrees). No kyphosis proximal to the instrumentation was observed for the duration of follow-up. CONCLUSION: Posterior instrumented fusion and epiphysiodesis is safe and effective. The epiphysiodesis effect occurs in 5/6 of cases, and our data suggests that the procedure is associated with an acceptable blood loss and a low incidence of neurological complications.

Reconstruction of Congenital Sternal Cleft: A Systematic Review of the Literature.

INTRODUCTION: Sternal cleft (SC) is a rare congenital deformity that results from failure of sternal bar fusion. Sternal cleft can be categorized as superior partial, inferior partial, or complete. Each form of SC can present as an isolated defect or in association with other congenital deformities, which presents a unique challenge for reconstructive surgeons. In our systematic review, we aim to summarize the published experience on repair of SCs and present a pragmatic approach to help guide reconstructive planning. METHODS: A systematic review was performed to identify all reported SC cases in literature that underwent sternal reconstruction. RESULTS: Seventy-one studies were identified from 1970 to 2019, which included a total of 115 patients. Superior partial SC was the most common SC variant, accounting for 65.2% (75/115) of all reported cases. There were 31 cases of complete SC (27.0%) and 9 cases (7.8%) of inferior partial SC; 49.6% of the patients (57/115) in our review had isolated SC without any other congenital deformities. Sixty-seven patients (60.3%) were treated with primary closure, with or without secondary maneuvers, such as chondrotomies, cartilage resection, or periosteal flaps. Alternative methods included interposition grafts, with autologous rib graft in 18 patients (15.8%), permanent mesh in 8 patients (7.0%), acellular dermal matrix in 5 patients (4.4%), sternal plate flap in 5 patients (4.4%), and nonthoracic autologous bone grafts in 4 patients (3.5%). CONCLUSIONS: Our review supports that primary closure should be attempted regardless of patient age. For wider sternal gap, reconstruction with an autologous local graft or flap should be considered. When the patient does not have sufficient autologous tissue for a successful sternal reconstruction, alloplastic or allograft interposition options are a reasonable choice.

Risk and Predictive Factors for Proximal Junctional Kyphosis in Patients Treated by Lenke Type 5 Adolescent Idiopathic Scoliosis Correction.

OBJECTIVE: Proximal junctional kyphosis (PJK) is a common sagittal complication of adolescent idiopathic scoliosis (AIS) after corrective surgery, leading to new deformities, pain, and, even, revision surgery. In the present study, we investigated the risk and predictive factors for PJK in patients who had undergone Lenke type 5 AIS correction to identify the parameters relevant to intraoperative guidance. METHODS: A total of 35 patients with Lenke type 5 AIS who had undergone corrective surgery at our hospital from January 2008 to February 2016 were divided into the PJK (n = 15) and non-PJK (n = 20) groups. Correlation and receiver operating characteristic curve analyses were performed to screen the parameters for significance and calculate the thresholds. A survival analysis was performed to examine the differences between the 2 groups. RESULTS: Independent t tests revealed significant differences between the 2 groups in the preoperative pelvic incidence, preoperative pelvic tilt, postoperative proximal junctional angle (PJA), and postoperative thoracic kyphosis (TK). The postoperative PJA, postoperative TK, and other parameters correlated significantly with changes in the PJA at the final follow-up. The receiver operating characteristic curves revealed that the postoperative PJA and postoperative TK effectively predicted for the occurrence of PJK, with a threshold of 9.45° and 25.25°, respectively. The estimated survival times were 14.7 months for a PJA >9.45° and TK >25.25°, 19.2 months for a PJA >9.45°, and 33.9 months for TK >25.25°. CONCLUSIONS: The results of the present study have shown that the postoperative PJA and postoperative TK can be used to effectively predict for the occurrence of PJK in patients with Lenke type 5 AIS after corrective surgery, with a threshold of 9.45° and 25.25°, respectively.

Determination of congenital absence of palmaris longus tendon with clinical examination and ultrasonography.

OBJECTIVES: The tendon of the palmaris longus is commonly used as a tendon graft in many reconstructive surgeries. Palmaris longus absence (PLA) was found in 15% among individuals worldwide. In this prospective study, we aimed to conduct an incidence study in which physical examination methods were confirmed by ultrasonography in PLA, and to evaluate the relationship of absence with age, gender, laterality and dominant hand. METHODS: The study included 490 cases. They were initially tested to evaluated by physical examination using the Schaeffer's and Hiz-Ediz test for the assessment of the palmaris longus tendon. Additional ultrasonography was performed to confirm its absence in 129 wrists of 78 cases whose tendons could not be visualized or palpated. RESULTS: The incidence of tendon absence was 13% by physical examination methods. According to the final results when we added ultrasonography to physical examination methods, the incidence of unilateral, bilateral and overall absence of the palmaris longus were 5%, 9% and 11% respectively. There was no statistically significant difference between individuals with and without PLA in terms of gender, side, age and dominant hand (p = 0.796, p = 0.622, p = 0.397 and p = 0.187, respectively). However, bilateral PLA was statistically significantly higher than unilateral in both genders (p = 0.011). CONCLUSIONS: We think that agenesis should be proven accurately by ultrasonographic examination for the final result before any surgical procedure with palmaris longus tendon. Furthermore measuring the diameter of the palmaris longus tendon by preoperative ultrasonography can be useful for surgeons who plan a procedure that requires specific measurements.

Comparison of Proximal Junctional Failure and Functional Outcomes Across Varying Definitions of Proximal Junctional Kyphosis.

BACKGROUND: Proximal junctional kyphosis (PJK) is a well-recognized complication following surgery for adult spinal deformity (ASD); however, definitions for PJK and its clinical implications can significantly vary by study. This study compares multiple definitions of PJK and describes incidence and clinical significance by definition. METHODS: From 2014 to 2019, patients with ASD who underwent spinal fusion were identified. Nine definitions of PJK were created based on previously established definitions using the following upper instrumented vertebra +2 (UIV+2) sagittal Cobb measurements: A= ≥10 postoperative AND preoperative, B = ≥10 postoperative, C = ≥10 preoperative, D = ≥15 postoperative AND preoperative, E = ≥15 postoperative, F = ≥15 preoperative, G = ≥20 postoperative AND preoperative, H = ≥20 postoperative, I = >20 preoperative. Incidence of PJK was calculated by definition. Area under the curve (AUC) was calculated based on a receiver operating characteristic to assess ability to predict proximal junctional failure (PJF). Univariate analysis was performed to assess association with postoperative Oswestry Disability Index (ODI) scores. RESULTS: Across 82 patients, the incidence of PJK and AUC by definition was as follows: A = 47%, 0.47; B = 72%, 0.65; C = 49%, 0.45; D = 27%, 0.46; E = 57%, 0.62; F = 27%, 0.46; G = 10%, 0.55; H = 40%, 0.71; I = 10%, 0.55. No definition was associated with postoperative ODI scores (P < 0.05). CONCLUSIONS: The incidence of PJK significantly decreased with stricter definitions. Definitions utilizing only postoperative UIV+2 values had higher incidences but were more likely to capture patients who developed PJF. No definition was associated with postoperative ODI scores. UIV+2 ≥20 was best in distinguishing patients who developed PJF.

Repair of soft tissue and extensor tendon defects on the dorsum of the hand by transfer of dorsal foot flap and extensor digitorum brevis tendon in a 3-year-old child: A case report.

RATIONALE: Repair of soft tissue defects on the dorsum of the hand with accompanying tendon defects is a challenging problem in clinical practice. PATIENT CONCERNS: Here, we describe the case of a 3-year-old boy with a 1-week old soft tissue injury with infection due to a soft tissue defect on the dorsum of his right hand, and further describe its treatment. DIAGNOSIS: A diagnosis of a soft tissue defect of the dorsum with extensor tendon defects in the fore, middle, ring, and little fingers of the right hand was made. INTERVENTIONS: The defects were repaired using a dorsal foot flap combined with the extensor digitorum brevis tendon, under spinal anesthesia, and a small dose of the sedative phenobarbital (Lumina) was administered via pump injection after the surgery. OUTCOMES: The patient was followed-up for 6 months. The shape of the dorsal hand flap recovered satisfactorily and the skin color was almost normal. Protective sensation was restored and the tendon graft functioned well in vivo. Satisfactory outcomes were achieved in the flexion and extension of each finger. LESSONS: This case study provides evidence that for soft tissue defects on the dorsum of the hand with tendon defects, 1-stage transfer of a dorsal foot flap with the extensor digitorum brevis tendon can be effective for recovery of appearance and extensor function. In case of infant patients, postoperative use of low-dose sedation can effectively reduce the risk of vascular crisis, thus promoting survival of the flap graft, and ensuring the success of the operation.

Percutaneous Osteotomies in Pediatric Deformity Correction.

Lower extremity deformities in children rely on osteotomies for correction. Percutaneous osteotomies offer a method for cutting bone that is advantageous for soft tissue healing. These low-energy osteotomies preserve the blood supply to bone, which maximizes the ability of bone to heal. Some of these techniques are technically demanding and should be performed first with an experienced operator. The key to maintaining safety in these osteotomies is to remain in a subperiosteal location. The categories of percutaneous osteotomy include multiple drill hole osteotomy, corticotomy, and Gigli saw osteotomy. This article discusses the advantages and indications for each type of osteotomy.

Tibial and femoral osteotomies in varus deformities - radiological and clinical outcome.

BACKGROUND: Varus deformities of the knee are frequently corrected by osteotomies, which should be performed at the level of origin. But in contrast to high tibial osteotomies (HTO), little data exists for distal femoral osteotomies (DFO). This study evaluates radiological and clinical outcomes after valgisation osteotomies in the proximal tibia and distal femur. METHODS: We used an observational cohort study design and prospectively performed preoperative long standing radiographs (LSR), lateral x-rays and clinical questionnaires (SF-36, Lysholm score, VAS). Postoperative LSR and lateral x-rays were obtained on average 18 months postoperative and postoperative clinical questionnaires at final visit (mean follow up 46 months). A subgroup analysis of the different surgical techniques (oHTO vs. cDFO) was performed, with regards to radiological and clinical outcomes. RESULTS: Finally 28 osteotomies with medial tibial opening (oHTO) or lateral femoral closing (cDFO) wedge osteotomies in 25 consecutive patients (mean age 40 years) were identified. There were 17 tibal and 11 femoral procedures. All osteotomies were performed at the origin of deformity, which was of different etiology. The average deviation of the final HKA compared to the preoperative planning was 2.4° ± 0.4°. Overall, there was a significant improvement in all clinical scores (SF-36: 61.8 to 79.4, p < 0.001; Lysholm-score: 72.7 to 90.4, p < 0.001; VAS: 3 to 1, p < 0.001). There was no significant correlation between surgical accuracy and outcome scores. CONCLUSION: Valgisation osteotomies lead to a significant improvement in all clinical scores with the demonstrated treatment protocol. An appreciable proportion of varus deformities are of femoral origin. Since cDFO provides comparable radiological and clinical results as oHTO, this is an important treatment option for varus deformities of femoral origin.

Recurrent Slipping Rib Syndrome: Initial Experience with Vertical Rib Stabilization Using Bioabsorbable Plating.

Background: Slipping rib syndrome (SRS) is an often underdiagnosed cause of lower chest wall and abdominal pain. The diagnosis of SRS is established by physical examination with or without dynamic ultrasound. The pain can be debilitating and surgical excision of the nonattached, subluxing cartilages is curative for most patients, but frustratingly, up to a quarter of patients have transient or limited relief and require reoperation. Some of these patients were found to have subluxation of the remaining bony ribs, suggesting that excision of rib cartilage alone may not be curative in a subset of patients. Materials and Methods: A retrospective review was performed of 3 patients with recurrent slipping rib pain and hypermobile bony ribs on reoperation. In an effort to stabilize the hypermobile ribs, vertical bioabsorbable plating across their ribs was performed. The plates secure the ribs apart from each other, preventing the movement of ribs against each other and therefore the pain. Results: All patients tolerated the procedure well. Mean length of stay was 2.6 days. Mean follow-up is 7 months and all report significant improvement in pain. Conclusions: Rib plating allows stabilization of hypermobile ribs, while preserving the patient's anatomical rib cage, and is a safe treatment for recurrent pain after the initial procedure. This is a novel approach in patients with recurrent slipping rib symptoms.

Surgical Repair of Complete Congenital Sternal Cleft Associated With Pectus Excavatum.

Complete congenital cleft sternum associated with pectus excavatum is a rare abnormality. Case reports and case series currently provide the technical standards for comparison in surgical repair. We present a case report of surgical repair of cleft sternum and anterior pericardial defect associated with pectus excavatum in a 13-year-old girl. The surgical repair of the cleft sternum and pectus excavatum was performed with a modified Ravitch procedure, closure of the defect with stainless steel wires, and insertion of a pectus bar. Preoperative imaging is important in better defining the defect.

Short Face Dentofacial Deformities: Changes in Social Perceptions, Facial Esthetics, and Occlusion After Bimaxillary and Chin Orthognathic Correction.

The purpose of this study was to document changes in social perceptions and facial esthetics, and document occlusion outcomes in a series of short face (SF) dentofacial deformity (DFD) subjects. The investigators hypothesized that subjects would achieve positive change in social perceptions and facial esthetics, and maintain a long-term corrected occlusion after undergoing bimaxillary and chin osteotomies.A retrospective cohort study was implemented. Photographic records and occlusion parameters were studied preoperatively and >2 years after surgery. The first outcome variable was social perceptions of SF subjects, judged by laypersons. The second outcome variable was facial esthetics, judged by professionals. The third outcome variable was occlusion maintained long-term.Fifteen subjects met inclusion criteria. Mean age at operation was 33 years. Consistent facial contour deformities at presentation included deficient maxillary dental show and downturned oral commissures. As a group, there was improvement (P < 0.05) in 11 of 12 social perceptions, judged by laypersons, all subjects achieved correction of the facial esthetic parameters studied by professionals, and all subjects maintained a favorable occlusion long-term.In SF DFD subjects, bimaxillary and chin surgery proved effective to improve social perceptions, to correct facial contour deformities, and in achieving a long-term corrected occlusion.