Executive Editor: Edward Ellis III, Daniel Buchbinder General Editor: Daniel Buchbinder

Authors: Scott Bartlett, Michael Ehrenfeld, Gerson Mast, Adrian Sugar

Congenital deformities

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Glossary

Bilateral coronal synostosis

Please select a treatment option:
Treatment Main indication Skill Equipment
Bilateral orbital advancement Cranial vault deformity, increased intracranial pressure, or eye protection. Highly experienced and skilled surgeon Simple surgical and imaging resources

Unilateral coronal synostosis

Please select a treatment option:
Treatment Main indication Skill Equipment
Unilateral orbital advancement Cranial vault deformity, increased intracranial pressure, or eye protection. Highly experienced and skilled surgeon Simple surgical and imaging resources
Bilateral orbital advancement Cranial vault deformity, increased intracranial pressure, or eye protection. Highly experienced and skilled surgeon Simple surgical and imaging resources

Metopic synostosis

Please select a treatment option:
Treatment Main indication Skill Equipment
Bilateral orbital advancement and expansion Cranial vault deformity, increased intracranial pressure, or eye protection. Highly experienced and skilled surgeon Simple surgical and imaging resources

Unilateral lambdoid synostosis

Please select a treatment option:
Treatment Main indication Skill Equipment
Posterior vault reshaping Cranial vault deformity and increased intracranial pressure. Highly experienced and skilled surgeon Simple surgical and imaging resources

Sagittal synostosis

Please select a treatment option:
Treatment Main indication Skill Equipment
Posterior reshaping Limited posterior skull deformity. Highly experienced and skilled surgeon Simple surgical and imaging resources
Anterior reshaping with widening Anterior skull deformity with narrowing. Highly experienced and skilled surgeon Simple surgical and imaging resources
Anterior reshaping Limited anterior skull deformity. Highly experienced and skilled surgeon Simple surgical and imaging resources
Early surgical treatment Sagittal craniosynostosis detected early. This is a minimally invasive treatment of sagittal synostosis. Highly experienced and skilled surgeon Simple surgical and imaging resources
Total vault reshaping Significant skull deformities, with or without increased intracranial pressure. Highly experienced and skilled surgeon Simple surgical and imaging resources

Syndromic synostosis

Please select a treatment option:
Treatment Main indication Skill Equipment
Posterior vault expansion by distraction osteogenesis Syndromic craniosynostosis affecting the posterior skull e.g. turribrachycephaly. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bilateral orbital advancement Syndromic synostosis affecting the anterior craniofacial skeleton. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Le Fort III - Conventional Syndromic craniosynostosis affecting the midface. Highly experienced and skilled surgeon Simple surgical and imaging resources
Le Fort III - Distraction osteogenesis Syndromic craniosynostosis affecting the anterior craniofacial skeleton. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Le Fort III Monoblock - Conventional Syndromic craniosynostosis affecting the anterior craniofacial skeleton. Highly experienced and skilled surgeon Simple surgical and imaging resources
Le Fort III Monoblock - Distraction osteogenesis Syndromic craniosynostosis affecting the anterior craniofacial skeleton. Highly experienced and skilled surgeon Simple surgical and imaging resources

Intraorbital hypertelorism

Please select a treatment option:
Treatment Main indication Skill Equipment
Four wall box osteotomy of the orbits Intraorbital hypertelorism. Highly experienced and skilled surgeon Simple surgical and imaging resources

Intraorbital hypertelorism with midface defect

Please select a treatment option:
Treatment Main indication Skill Equipment
Symmetric facial bipartition Combined intraorbital hypertelorism and midface deformity. Highly experienced and skilled surgeon Simple surgical and imaging resources

Interorbital hypertelorism

Please select a treatment option:
Treatment Main indication Skill Equipment
Medial Orbital Composite - Unit Translocation Interorbital hypertelorism resulting from central encephalocele. Highly experienced and skilled surgeon Simple surgical and imaging resources

Treacher Collins Syndrome

Please select a treatment option:
Treatment Main indication Skill Equipment
Cleft palate repair Treacher Collins Syndrome with cleft palate. Some specialized surgical experience Simple surgical and imaging resources
Orbit malar construction with vascularized bone graft Treacher Collins Syndrome with severe malar and/or orbital deformity. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Orbit malar construction with free bone graft Treacher Collins Syndrome with orbital/malar deformity. Some specialized surgical experience Simple surgical and imaging resources
Distraction osteogenesis of the mandibular ramus Treacher Collins Syndrome with vertically short posterior mandible. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Conventional orthognathic surgery Treacher Collins Syndrome in skeletally mature patients with maxillomandibular deformity. Highly experienced and skilled surgeon Simple surgical and imaging resources
Soft tissue corrections Treacher Collins Syndrome with soft tissue deformity (e.g. colobomata lateral or facial clefts). Highly experienced and skilled surgeon Basic equipment only
Mandibular advancement by distraction osteogenesis Treacher Collins Syndrome with severe mandibular hypoplasia in young patients. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Unilateral cleft lip and or palate

Please select a treatment option:
Treatment Main indication Skill Equipment
Alveolar bone grafting Cleft patients with significant unilateral alveolar defect. Some specialized surgical experience Basic equipment only
Le Fort I osteotomy - Conventional Skeletally mature cleft patients with maxillary hypoplasia. Some specialized surgical experience Simple surgical and imaging resources
Le Fort I osteotomy - Distraction Skeletally mature cleft patients with significant vertical and horizontal maxillary deficiency. Some specialized surgical experience Full specialized surgical and imaging resources
Le Fort II osteotomy Skeletally mature cleft patients with significant naso-maxillary deficiency. Highly experienced and skilled surgeon Simple surgical and imaging resources

Bilateral cleft lip and or palate

Please select a treatment option:
Treatment Main indication Skill Equipment
Alveolar bone grafting Cleft patients with significant bilateral alveolar defect. Some specialized surgical experience Basic equipment only
Le Fort I osteotomy - Conventional Skeletally mature cleft patients with maxillary hypoplasia. Some specialized surgical experience Simple surgical and imaging resources
Le Fort I osteotomy - Distraction Skeletally mature cleft patients with significant vertical and horizontal maxillary deficiency. Some specialized surgical experience Full specialized surgical and imaging resources
Le Fort II osteotomy Skeletally mature cleft patients with significant naso-maxillary deficiency. Highly experienced and skilled surgeon Simple surgical and imaging resources

Bilateral cleft lip and or palate with displaced premaxilla

Please select a treatment option:
Treatment Main indication Skill Equipment
Alveolar bone grafting Cleft patients with significant bilateral alveolar defect and a severely malpositioned premaxilla which cannot be moved by orthodontics. Some specialized surgical experience Basic equipment only
Le Fort I osteotomy - Conventional Skeletally mature cleft patients with maxillary hypoplasia. Some specialized surgical experience Simple surgical and imaging resources
Le Fort I osteotomy - Distraction Skeletally mature cleft patients with significant vertical and horizontal maxillary deficiency. Some specialized surgical experience Full specialized surgical and imaging resources
Le Fort II osteotomy Skeletally mature cleft patients with nasal maxillary deficiency. Highly experienced and skilled surgeon Simple surgical and imaging resources

Pruzansky I

Please select a treatment option:
Treatment Main indication Skill Equipment
Facial reanimation Skeletally mature HFM Pruzansky I patients with facial nerve palsy. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Excision of ear tags HFM Pruzansky I patients with preauricular ear tags. Basic surgical experience, no specialized skills Basic equipment only
Autogenous ear construction Skeletally mature HFM Pruzansky I patients with significant ear deformity. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bone anchored ear prosthesis Skeletally mature HFM Pruzansky I patients with significant ear deformity. Some specialized surgical experience Full specialized surgical and imaging resources
Soft tissue augmentation Skeletally mature HFM Pruzansky I patients with significant soft tissue deformity (rare). Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Conventional orthognathic surgery Skeletally mature HFM Pruzansky I patients with maxillomandibular deformities, with or without malocclusion. Some specialized surgical experience Simple surgical and imaging resources
Genioplasty Skeletally mature HFM Pruzansky I patients with asymmetric chin deformity. Some specialized surgical experience Simple surgical and imaging resources

Pruzansky IIa

Please select a treatment option:
Treatment Main indication Skill Equipment
Facial reanimation Skeletally mature HFM Pruzansky IIa patients with residual soft tissue deformity and facial nerve palsy after skeletal correction. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Excision of ear tags HFM Pruzansky IIa patients with preauricular ear tags. Basic surgical experience, no specialized skills Basic equipment only
Autogenous ear construction Skeletally mature HFM Pruzansky IIa patients with significant ear deformity. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bone anchored ear prosthesis Skeletally mature HFM Pruzansky IIa patients with significant ear deformity. Some specialized surgical experience Full specialized surgical and imaging resources
Construction of zygomatic arch Skeletally mature HFM Pruzansky IIa with zygomatic deformity. Some specialized surgical experience Simple surgical and imaging resources
Soft tissue augmentation Skeletally mature HFM Pruzansky IIa patients with significant soft tissue deformity (rare). Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Lateral augmentation by osteotomy Skeletally mature HFM Pruzansky IIa patients with residual asymmetry of the mandible after skeletal correction. Highly experienced and skilled surgeon Simple surgical and imaging resources
Lateral augmentation by distraction osteogenesis Skeletally mature HFM Pruzansky IIa patients with residual asymmetry of the mandible after skeletal correction. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Four wall box osteotomy Skeletally mature HFM Pruzansky IIa patients with severe dystopia of the orbit. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Rotational osteotomies including inverted L-osteotomy Skeletally mature HFM Pruzansky IIa patients with significant facial cant and short ramus height on affected side. Highly experienced and skilled surgeon Simple surgical and imaging resources
Mandibular advancement by distraction osteogenesis Significant AP mandibular deficiencies in growing HFM Pruzansky IIa patients. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bimaxillary distraction osteogenesis Young adolescents (12-14 years of age) HFM Pruzansky IIa patients with significant occlusal cant due to mandibular asymmetry. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Distraction osteogenesis of mandibular ramus Young HFM Pruzansky IIa patients with significant vertical ramus deformities. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Pruzansky IIb

Please select a treatment option:
Treatment Main indication Skill Equipment
Facial reanimation Skeletally mature HFM Pruzansky IIb patients with residual soft tissue deformity and facial nerve palsy after skeletal correction. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Excision of ear tags HFM Pruzansky IIb patients with preauricular ear tags. Basic surgical experience, no specialized skills Basic equipment only
Autogenous ear construction Skeletally mature HFM Pruzansky IIb patients with significant ear deformity. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bone anchored ear prosthesis Skeletally mature HFM Pruzansky IIb patients with significant ear deformity. Some specialized surgical experience Full specialized surgical and imaging resources
Construction of Zygomatic arch and Glenoid fossa Skeletally mature HFM Pruzansky IIb patients with zygomatic and glenoid fossa deformity. Some specialized surgical experience Simple surgical and imaging resources
Lateral movement of zygomatic arch and glenoid fossa Skeletally mature HFM Pruzansky IIb patients with malpositioned, reasonably formed, zygomatic arch and glenoid fossa. Highly experienced and skilled surgeon Simple surgical and imaging resources
Lateral augmentation by distraction osteogenesis Skeletally mature HFM Pruzansky IIb patients with residual asymmetry of the mandible after skeletal correction. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Lateral augmentation by osteotomy Skeletally mature HFM Pruzansky IIb patients with residual asymmetry of the mandible after skeletal correction. Highly experienced and skilled surgeon Simple surgical and imaging resources
Soft tissue augmentation Skeletally mature HFM Pruzansky IIb patients with significant soft tissue deformity. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Four wall box osteotomy Skeletally mature HFM Pruzansky IIb patients with severe dystopia of the orbit. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Rotational osteotomies including inverted L-osteotomy Skeletally mature HFM Pruzansky IIb patients with significant facial cant and short ramus height on affected side. Highly experienced and skilled surgeon Simple surgical and imaging resources
Mandibular advancement by distraction osteogenesis Significant AP mandibular deficiencies in growing HFM Pruzansky IIb patients. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bimaxillary distraction osteogenesis Young adolescents (12-14 years of age) HFM Pruzansky IIb patients with significant occlusal cant due to mandibular asymmetry. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Construction of mandibular ramus and condyle Skeletally mature HFM Pruzansky IIb patients with significantly deficient mandibular ramus and condyle. Highly experienced and skilled surgeon Simple surgical and imaging resources
Lateral movement of mandibular ramus and condyle Skeletally mature HFM Pruzansky IIb patients with malpositioned, reasonably formed, mandibular condyle and glenoid fossa. Highly experienced and skilled surgeon Simple surgical and imaging resources
Distraction osteogenesis of mandibular ramus Young HFM Pruzansky IIb patients with significant vertical ramus deformities. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Pruzansky III

Please select a treatment option:
Treatment Main indication Skill Equipment
Correction of macrostomia HFM Pruzansky III patients, with presence of macrostomia. Some specialized surgical experience Basic equipment only
Facial reanimation Skeletally mature HFM Pruzansky III patients with residual soft tissue deformity and facial nerve palsy after skeletal correction. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Excision of ear tags HFM Pruzansky III patients with preauricular ear tags. Basic surgical experience, no specialized skills Basic equipment only
Autogenous ear construction Skeletally mature HFM Pruzansky III patients with significant ear deformity. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bone anchored ear prosthesis Skeletally mature HFM Pruzansky III patients with significant ear deformity. Some specialized surgical experience Full specialized surgical and imaging resources
Construction of Zygomatic arch and Glenoid fossa Skeletally mature HFM Pruzansky III patients with a significant zygomatic and glenoid fossa deformity or absence. Some specialized surgical experience Simple surgical and imaging resources
Lateral augmentation by distraction osteogenesis Skeletally mature HFM Pruzansky III patients with residual asymmetry of the mandible after skeletal correction. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Lateral augmentation by osteotomy Skeletally mature HFM Pruzansky III patients with residual asymmetry of the mandible after skeletal correction. Highly experienced and skilled surgeon Simple surgical and imaging resources
Soft tissue augmentation Skeletally mature HFM Pruzansky III patients with significant soft tissue deformity. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Four wall box osteotomy Skeletally mature HFM Pruzansky III patients with severe dystopia of the orbit. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Rotational osteotomies including inverted L-osteotomy Skeletally mature HFM Pruzansky III patients with significant facial cant and short ramus height on affected side. Highly experienced and skilled surgeon Simple surgical and imaging resources
Mandibular advancement by distraction osteogenesis Significant AP mandibular deficiencies in growing HFM Pruzansky III patients. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bimaxillary distraction osteogenesis Young adolescents (12-14 years of age) HFM Pruzansky III patients with significant occlusal cant due to mandibular asymmetry. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Construction of mandibular ramus and condyle Skeletally mature HFM Pruzansky III patients with significantly deficient mandibular ramus and condyle. Highly experienced and skilled surgeon Simple surgical and imaging resources
Distraction osteogenesis of mandibular ramus Skeletally mature HFM Pruzansky III patients with less severe deficiency of mandibular ramus and condyle or after initial incomplete ramus construction. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Limited fibrous dysplasia

Please select a treatment option:
Treatment Main indication Skill Equipment
Observation Minimal clinical signs Basic surgical experience, no specialized skills Basic equipment only
Partial ostectomy and contouring The disease is limited to a small anatomic area Some specialized surgical experience Simple surgical and imaging resources
Radical excision and reconstruction The disease is limited to a small anatomic area Highly experienced and skilled surgeon Simple surgical and imaging resources

Extensive fibrous dysplasia

Please select a treatment option:
Treatment Main indication Skill Equipment
Observation Minimal clinical signs Basic surgical experience, no specialized skills Basic equipment only
Partial ostectomy and contouring The disease is extensive involving multiple facial bones Some specialized surgical experience Simple surgical and imaging resources

Fibrous dysplasia involving optic nerve

Please select a treatment option:
Treatment Main indication Skill Equipment
Observation Minimal clinical signs Basic surgical experience, no specialized skills Basic equipment only
Optic nerve decompression with limited resection Cases in which the optic canal is involved and progressive loss of vision occurs Highly experienced and skilled surgeon Full specialized surgical and imaging resources
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v1.0 2012-07-07