Thanapaisal Chaiwit, Chowchuen Bowornsilp, Chowchuen Prathana
Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
J Med Assoc Thai. 2010 Oct;93 Suppl 4:S24-33.
Craniofacial surgery for craniosynostosis is one of the most challenging reconstructive procedures. Restoration of particular functional and anatomic requirements is important for development from infancy to adulthood. The purpose of this study is to present the authors' experience of craniofacial surgery for management of patients with craniosynostosis in Srinagarind Hospital, Khon Kaen, Thailand, addressing the challenges of diagnosis, management and outcomes, which may be adapted in other developing countries.
This paper presents the cranial and associated deformities, diagnosis, radiologic findings, preoperative evaluation, craniofacial and maxillary surgeries and outcome(s) of patients with craniosynostosis. The care team, made up of neurosurgeons, plastic surgeons, radiologists, ophthalmologists and pediatricians, established the Tawanchai Center's protocol for craniosynostosis, to manage the timing of craniofacial procedures from infancy to adulthood.
The physical examination and radiologic findings of three patients, two with sagittal synostosis and one with plagiocephaly are reported. The clinical, craniofacial and maxillofacial surgeries and long-term outcomes of another three patients were studied one with Apert syndrome and two with Crouzon syndrome. All the latter three patients were lost to follow-up after the initial post-surgical visit. At that time, there were appropriate surgical results vis-a-vis appearance and satisfaction from the perspective of the two patients with Crouzon syndrome and their families. One of the patients with Crouzon syndrome received normal education supported by a successful family, while the other was still continuing her studies at school with good progress. The patient with Apert syndrome continued to live with his parents. Additional reconstructive surgery is recommended for all three patients. Economic problems and lack of adequate information were the main reasons for their discontinuing follow-up appointments.
Systematic physical examination and radiologic assessments by the craniofacial team are critically important for diagnosis, evaluation, planning of management and outcome assessment of the patients with craniosynostosis. In Thailand and other developing countries, the challenges in management of these patients are the development of standard craniofacial surgery, craniofacial team management and well-coordinated care, planned surgeries and outcome assessments from infancy to adolescence. A supportive government health system and establishment of a craniofacial center and foundation is needed in order to support and provide proper care for these groups of patients.
针对颅缝早闭的颅面外科手术是最具挑战性的重建手术之一。恢复特定的功能和解剖学要求对从婴儿期到成年期的发育至关重要。本研究的目的是介绍作者在泰国孔敬诗里拉医院对颅缝早闭患者进行颅面外科手术的经验，探讨诊断、治疗及预后方面的挑战，这些经验可供其他发展中国家借鉴。
本文介绍了颅缝早闭患者的颅骨及相关畸形、诊断、影像学表现、术前评估、颅面及上颌骨手术情况及预后。由神经外科医生、整形外科医生、放射科医生、眼科医生和儿科医生组成的医疗团队制定了塔万猜中心的颅缝早闭治疗方案，以管理从婴儿期到成年期颅面手术的时机。
报告了3例患者的体格检查及影像学表现，其中2例矢状缝早闭，1例斜头畸形。对另外3例患者进行了临床、颅面及颌面外科手术及长期预后研究，1例患有阿佩尔综合征，2例患有克鲁宗综合征。后3例患者在术后首次随访后均失访。当时，从2例克鲁宗综合征患者及其家属的角度来看，手术外观及满意度方面均取得了适当的效果。其中1例克鲁宗综合征患者在家庭的支持下接受了正常教育，另1例仍在学校继续学业，进展良好。阿佩尔综合征患者继续与父母生活。建议对所有3例患者进行额外的重建手术。经济问题和信息不足是他们中断随访预约的主要原因。
颅面外科团队进行系统的体格检查和影像学评估对于颅缝早闭患者的诊断、评估、治疗规划及预后评估至关重要。在泰国和其他发展中国家，管理这些患者面临的挑战包括标准颅面外科手术的发展、颅面团队管理及协调良好的护理、从婴儿期到青春期的计划性手术及预后评估。需要一个支持性的政府卫生系统以及建立颅面中心和基金会，以便为这些患者群体提供支持和适当的护理。
