Charles H. Thorne, M.D.

An evidence-based approach to augmentation mammaplasty
Thorne, Charles H
2010 Dec;126(6):2184-2188, Plastic & reconstructive surgery
The Maintenance of Certification module series is designed to help the clinician structure his or her study in specific areas appropriate to his or her clinical practice. This article is prepared to accompany practice-based assessment of preoperative assessment, anesthesia, surgical treatment plan, perioperative management, and outcomes. In this format, the clinician is invited to compare his or her methods of patient assessment and treatment, outcomes, and complications, with authoritative, information-based references.This information base is then used for self-assessment and benchmarking in parts II and IV of the Maintenance of Certification process of the American Board of Plastic Surgery. This article is not intended to be an exhaustive treatise on the subject. Rather, it is designed to serve as a reference point for further in-depth study by review of the reference articles presented
— id: 114869, year: 2010, vol: 126, page: 2184, stat: Journal Article,

The tear trough and lid/cheek junction: anatomy and implications for surgical correction
Haddock, Nicholas T; Saadeh, Pierre B; Boutros, Sean; Thorne, Charles H
2009 Apr;123(4):1332-1340, Plastic & reconstructive surgery
BACKGROUND: The tear trough and the lid/cheek junction become more visible with age. These landmarks are adjacent, forming in some patients a continuous indentation or groove below the infraorbital rim. Numerous, often conflicting procedures have been described to improve the appearance of the region. The purpose of this study was to evaluate the anatomy underlying the tear trough and the lid/cheek junction and to evaluate the procedures designed to correct them. METHODS: Twelve fresh cadaver lower lid and midface dissections were performed (six heads). The orbital regions were dissected in layers, and medical photography was performed. RESULTS: In the subcutaneous plane, the tear trough and lid/cheek junction overlie the junction of the palpebral and orbital portions of the orbicularis oculi muscle and the cephalic border of the malar fat pad. In the submuscular plane, these landmarks differ. Along the tear trough, the orbicularis muscle is attached directly to the bone. Along the lid/cheek junction, the attachment is ligamentous by means of the orbicularis retaining ligament. CONCLUSIONS: The tear trough and lid/cheek junction are primarily explained by superficial (subcutaneous) anatomical features. Atrophy of skin and fat is the most likely explanation for age-related visibility of these landmarks. 'Descent' of this region with age is unlikely (the structures are fixed to bone). Bulging orbital fat accentuates these landmarks. Interventions must extend significantly below the infraorbital rim. Fat or synthetic filler may be best placed in the intraorbicularis plane (tear trough) and in the suborbicularis plane (lid/cheek junction)
— id: 98782, year: 2009, vol: 123, page: 1332, stat: Journal Article,

Discussion. Psychosocial predictors of an interest in cosmetic surgery among young Norwegian women: a population-based study
Thorne, Charles H
2009 Dec;124(6):2149-2150, Plastic & reconstructive surgery
— id: 135216, year: 2009, vol: 124, page: 2149, stat: Journal Article,

Discussion: do plastic surgeons have cosmetic surgery?
Thorne, Charles H
2009 Dec;124(6):2170-2170, Plastic & reconstructive surgery
— id: 105526, year: 2009, vol: 124, page: 2170, stat: Journal Article,

Otoplasty
Thorne, Charles H
2008 Jul;122(1):291-292, Plastic & reconstructive surgery
— id: 80316, year: 2008, vol: 122, page: 291, stat: Journal Article,

The incidence of late cephalohematoma following craniofacial surgery
Ghali, Shadi; Knox, Kevin R; Boutros, Sean; Thorne, Charles H; McCarthy, Joseph G
2007 Sep 15;120(4):1004-1008, Plastic & reconstructive surgery
BACKGROUND: Cranial vault remodeling procedures are carried out for both syndromic and nonsyndromic craniosynostosis as well as to correct some acquired deformities of the cranial vault. These procedures improve not only cosmesis but also neurological symptoms. The purpose of this study was to determine the incidence of 'late' cephalohematoma, an underreported complication following these complex procedures. METHODS: A total of 113 patients underwent 127 cranial vault remodeling procedures using autogenous bone over a 6-year period. All patients who developed a late cephalohematoma 75 days or more after surgery were recorded. The time, size, and location of the cephalohematoma, the treatment performed, and the length of follow-up were also recorded. Ages at initial operation and postoperative follow-up were compared between patient groups for statistical differences. RESULTS: Of the 113 patients, 17 developed 18 late cephalohematomas. The incidence for this complication was 15 percent. The median age at operation for all patients was 10 months, and most late cephalohematomas occurred 208 days later (range, 77 to 1416 days), at 12 to 24 months of age. Fronto-orbital advancement was the most commonly performed procedure, and 83.3 percent of late cephalohematomas occurred in the frontal region. No cephalohematomas became infected or required any operative intervention, but they were aspirated. CONCLUSIONS: Surgeons should inform prospective parents of patients undergoing cranial vault remodeling procedures of this potential complication. This will improve parental awareness and possible avoidance strategies in future patients. Further evaluation and follow-up are required to determine the minimum length of postoperative time after which late cephalohematomas do not occur
— id: 74118, year: 2007, vol: 120, page: 1004, stat: Journal Article,

Transient syringomyelia leading to acute neurological deterioration after repair of a lipomyelomeningocele: case report
Post, Nicholas H; Wisoff, Jeffrey H; Thorne, Charles H; Weiner, Howard L
2007 Aug;61(2):E426-E426, Neurosurgery
OBJECTIVE: Transient paraplegia in the immediate postoperative period after lipomyelomeningocele repair is uncommon and is not discussed in the literature. We present the unique case of a patient who developed transient paraplegia 48 hours after lipomyelomeningocele repair attributable to the acute development of a thoracic syrinx. CLINICAL PRESENTATION: At birth, the patient was noted to have a large skin-covered mass in the lumbosacral region. On neurological examination, both iliopsoas and quadriceps exhibited 3/5 motor function, and the plantar flexors and dorsiflexors exhibited 1/5 motor function. Urodynamic studies were normal. Magnetic resonance imaging demonstrated the presence of a lipomyelomeningocele associated with tethering of the spinal cord in the lumbosacral region. INTERVENTION: At 5 months of age, the patient underwent repair of the lipomyelomeningocele. After surgery, the patient developed progressive paraplegia along with bowel and bladder dysfunction. Given the concern about a postoperative hematoma resulting in cauda equina syndrome, the patient returned to the operating room for a wound exploration. No compressive lesion such as a hematoma was found at surgery. A postoperative magnetic resonance imaging scan obtained afterward, however, demonstrated the presence of a large thoracic syrinx. CONCLUSION: Syrinx formation can occur as early as 48 hours after lipomyelomeningocele repair, leading to progressive lower extremity weakness and bowel and bladder incontinence. In the immediate postoperative period, an acute syrinx can mimic cauda equina syndrome, and a magnetic resonance imaging scan is necessary to distinguish between these two entities. In this patient, the syrinx was transient and resolved without a shunting procedure
— id: 74117, year: 2007, vol: 61, page: E426, stat: Journal Article,

Aesthetic management of the ear as a donor site
Thorne, CH
2007 SEP 15 ;120(4):909-909, Plastic & reconstructive surgery
— id: 74174, year: 2007, vol: 120, page: 909, stat: Journal Article,

Experience with fibrin glue in rhytidectomy
Thorne, CH
2007 SEP 15 ;120(4):1052-1052, Plastic & reconstructive surgery
— id: 74175, year: 2007, vol: 120, page: 1052, stat: Journal Article,

The adductor flap: a new method for transferring posterior and medial thigh skin
Angrigiani, C; Grilli, D; Thorne, C H
2001 Jun;107(7):1725-1731, Plastic & reconstructive surgery
Skin flaps from the medial aspect of the thigh have traditionally been based on the gracilis musculocutaneous unit. This article presents anatomic studies and clinical experience with a new flap from the medial and posterior aspects of the thigh based on the proximal musculocutaneous perforator of the adductor magnus muscle and its venae comitantes. This cutaneous artery represents the termination of the first medial branch of the profunda femoris artery and is consistently large enough in caliber to support much larger skin flaps than the gracilis musculocutaneous flap. In all 20 cadaver dissections, the proximal cutaneous perforator of the adductor magnus muscle was present and measured between 0.8 and 1.1 mm in diameter, making it one of the largest skin perforators in the entire body. Based on this anatomic observation, skin flaps as large as 30 x 23 cm from the medial and posterior aspects of the thigh were successfully transferred. Adductor flaps were used in 25 patients. On one patient the flap was lost, in one the flap demonstrated partial survival, and in 23 patients the flaps survived completely. The flap was designed as a pedicle island flap in 14 patients and as a free flap in 11. When isolating the vascular pedicle for free tissue transfer, the cutaneous artery is dissected from the surrounding adductor magnus muscle and no muscle is included in the flap. Using this maneuver, a pedicle length of approximately 8 cm is isolated. In addition to ample length, the artery has a diameter of approximately 2 mm at its origin from the profunda femoris artery. The adductor flap provides an alternative method for flap design in the posteromedial thigh. Because of the large pedicle and the vast cutaneous territory that it reliably supplies, the authors believe that the adductor flap is the most versatile and dependable method for transferring flaps from the posteromedial thigh region
— id: 115253, year: 2001, vol: 107, page: 1725, stat: Journal Article,

Auricular reconstruction: indications for autogenous and prosthetic techniques
Thorne CH; Brecht LE; Bradley JP; Levine JP; Hammerschlag P; Longaker MT
2001 Apr 15;107(5):1241-1252, Plastic & reconstructive surgery
Learning Objectives: After studying this article, the participant should be able to: 1. Describe the alternatives for auricular reconstruction. 2. Discuss the pros and cons of autogenous reconstruction of total or subtotal auricular defects. 3. Enumerate the indications for prosthetic reconstruction of total or subtotal auricular defects. 4. Understand the complexity of and the expertise required for prosthetic reconstruction of auricular defects.The indications for autogenous auricular reconstruction versus prosthetic reconstruction with osseointegrated implant-retained prostheses were outlined in Plastic and Reconstructive Surgery in 1994 by Wilkes et al. of Canada, but because of the relatively recent Food and Drug Administration approval (1995) of extraoral osseointegrated implants, these indications had not been examined by a surgical unit in the United States. The purpose of this article is to present an evolving algorithm based on an experience with 98 patients who underwent auricular reconstruction over a 10-year period. From this experience, the authors conclude that autogenous reconstruction is the procedure of choice in the majority of pediatric patients with microtia. Prosthetic reconstruction of the auricle is considered in such pediatric patients with congenital deformities for the following three relative indications: (1) failed autogenous reconstruction, (2) severe soft-tissue/skeletal hypoplasia, and/or (3) a low or unfavorable hairline. A fourth, and in our opinion the ideal, indication for prosthetic ear reconstruction is the acquired total or subtotal auricular defect, most often traumatic or ablative in origin, which is usually encountered in adults. Although prosthetic reconstruction requires surgical techniques that are less demanding than autogenous reconstruction, construction of the prosthesis is a time-consuming task requiring experience and expertise. Although autogenous reconstruction presents a technical challenge to the surgeon, it is the prosthetic reconstruction that requires lifelong attention and may be associated with late complications. This article reports the first American series of auricular reconstruction containing both autogenous and prosthetic methods by a single surgical team
— id: 20645, year: 2001, vol: 107, page: 1241, stat: Journal Article,

Moebius syndrome: the new finding of hypertrophy of the coronoid process
Turk AE; McCarthy JG; Nichter LS; Thorne CH
1999 Jan;10(1):93-96, Journal of craniofacial surgery
The first detailed description of congenital facial paralysis was reported by Moebius in 1888. It is characterized by either unilateral or bilateral paralysis of the facial muscles and an associated abducens palsy. The present report is of two patients with Moebius syndrome, who were also diagnosed with trismus at birth. Each patient also demonstrated bilateral hypertrophy of the coronoid process of the mandible. In effect, the zygoma obstructed the excursion of the mandible because of a 'coronoid block.' A three-dimensional computed tomography scan demonstrated normal temporomandibular joints but bilateral hypertrophy of the coronoid processes and micrognathia. Both patients demonstrated less than 10 mm of oral excursion. Bilateral coronoidectomies were performed through an intraoral approach. The oral excursions after surgery increased to at least 20 mm. In each of these patients, the coronoid process was enlarged relative to the zygoma, which was of normal size and configuration. The trismus was associated with blocking of the coronoid by the anterior zygoma, preventing open or full excursion of the hypoplastic mandibles. Moebius syndrome can have a variable presentation at birth. In two patients, the authors describe a new finding of hypertrophy of the coronoid process and trismus secondary to obstruction of the coronoid by the hypertrophic zygomas during oral excursions. Each patient is described, and a review of the literature is discussed
— id: 7458, year: 1999, vol: 10, page: 93, stat: Journal Article,

A virtual reality system for bone fragment positioning in multisegment craniofacial surgical procedures
Cutting C; Grayson B; McCarthy JG; Thorne C; Khorramabadi D; Haddad B; Taylor R
1998 Dec;102(7):2436-2443, Plastic & reconstructive surgery
This article reports our clinical experience since 1994 with rigid-motion tracking of bone fragments during craniofacial surgical procedures, using a virtual reality approach. Three noncollinear infrared diodes are fixed to the skull base. A pointer is used to register anatomic features on the patient to those on the computerized tomography-based model of the patient within a computer work station. Three diodes are then attached to each fragment just before the osteotomy is completed. Rigid motions of the fragment are thus tracked and reported to the surgeon by using virtual reality techniques. Errors in fragment positioning are reported both graphically and numerically with respect to a precomputed optimum fragment position. This guidance system allows multisegment midface osteotomies to be performed more precisely. The main problems encountered so far have been devascularization-infection and difficulties in maintaining correct position during application of rigid fixation. Devascularization-infection problems have been addressed by minimizing surgical exposure of the bone. Soft-fixation plates and temporary Kirschner wire fixation have helped with intermediate positioning, but an intraoperative mechanical positioning device would be useful in the future
— id: 7541, year: 1998, vol: 102, page: 2436, stat: Journal Article,

The use of a subatmospheric pressure dressing to salvage a Gustilo grade IIIB open tibial fracture with concomitant osteomyelitis to avert a free flap
Greer S; Kasabian A; Thorne C; Borud L; Sims CD; Hsu M
1998 Dec;41(6):687-687, Annals of plastic surgery
— id: 57159, year: 1998, vol: 41, page: 687, stat: Journal Article,

Grabb and Smith's plastic surgery
Grabb, William C.; Smith, James Walter; Aston, Sherrell J.; Beasley, Robert W.; Thorne, Charles; Grabb, William C
Philadelphia : Lippicott-Raven, c1997,
— id: 578, year: 1997, vol: , page: , stat: ,

A prospective study of the relationship between strabismus and head posture in patients with frontal plagiocephaly
Gosain AK; Steele MA; McCarthy JG; Thorne CH
1996 Apr;97(5):881-891, Plastic & reconstructive surgery
A prospective study was performed on 16 unoperated patients with frontal plagiocephaly to characterize the relationship between strabismus and abnormal head posture. Serial eye examinations were performed preoperatively and for 24 to 46 months following fronto-orbital advancement. In 14 patients (88 percent), preoperative clinical examination and CT scan indicated coronal plagiocephaly (synostotic); unicoronal synostosis was documented during fronto-orbital advancement in all these patients. Ten patients had abnormal head posture on preoperative examination, 9 of whom had strabismus at some time during the study. These 9 patients all had unicoronal synostosis with ipsilateral strabismus and a contralateral head tilt. All had eye muscle findings consistent with superior oblique paresis, although in 2 patients these signs first developed following fronto-orbital advancement. Strabismus resolved spontaneously in 2 patients between 2 and 8 months following fronto-orbital advancement; the remaining 7 patients underwent extraocular muscle surgery following fronto-orbital advancement, with early resolution of strabismus in all cases. The head tilt resolved or improved significantly in all 9 patients following resolution of the strabismus. Two patients had recurrent superior oblique paresis following surgical correction, necessitating secondary strabismus surgery. The present study indicates that extraocular muscle dysfunction is the major cause of abnormal head posture in patients with coronal plagiocephaly and emphasizes the need for long-term ophthalmologic surveillance in these patients
— id: 7000, year: 1996, vol: 97, page: 881, stat: Journal Article,

The "back to sleep campaign" and deformational plagiocephaly: is there cause for concern?
Turk AE; McCarthy JG; Thorne CH; Wisoff JH
1996 Jan;7(1):12-18, Journal of craniofacial surgery
In April 1992, the American Academy of Pediatrics recommended back or side sleeping for healthy newborns to reduce the risk of sudden infant death syndrome. Subsequently, the US Public Health Service organized a health care coalition to promote a 'Back to Sleep Campaign' to advocate back or side sleeping for infants. Since 1992, our craniofacial anomalies center has witnessed a marked increase in the incidence of infants with defomational changes of the cranium and face. The purpose of this project was to study the etiologies of deformational plagiocephaly and possible correlation with infant head position. We reviewed 52 consecutive patients presenting with deformational plagiocephaly from January 1992 to December 1994. A diagnosis of deformational plagiocephaly was determined by (1) history (date when head shape change was first noted), (2) clinical examination (occipital flattening, contralateral forehead flattening, lowering of the eyebrow, and ear shearing), and (3) skull radiographs (patent cranial sutures). All infants had medical photography to document baseline craniofacial morphology and any follow-up changes after nonsurgical therapy. Cranial asymmetry was first noted after birth at a mean time of 3.6 months. All infants were initially positioned on their back/side. In 52 patients, 61% had right-sided flattening of the occiput (vs 39% left-sided). All infants had flattening of the occiput, contralateral brow lowering or inferior displacement of the brow, contralateral forehead flattening, and posterioinferior displacement of the ear. All skull radiographs demonstrated patent sutures. Follow-up of patients ranged from 3 to 22 months with a mean of 10.5 months. Follow-up clinical examination and photography demonstrated significant improvement of cranial form in all patients with recommended frequent head turning (73%), helmet molding (23%), and surgery (4%). Our unit has seen an increase in the number of infants with deformational plagiocephaly over the last three years. All of the affected infants in this study had been managed according to the officially recommended protocol of back/side positioning. These findings suggest a possible relationship between this type of infant positioning and the development of a deformational plagiocephaly. However, cranial asymmetry in this group of patients decreased significantly with nonsurgical therapy. We have not recommended cranial vault remodeling surgery for the mild and moderate types of this deformity. However, if there is evidence of increasing asymmetry of deformational plagiocephalic infants during follow-up and evidence of severe variants of these deformities, surgical correction of the cranial vault is recommended
— id: 12656, year: 1996, vol: 7, page: 12, stat: Journal Article,

A new musculocutaneous island flap from the distal thigh for recurrent ischial and perineal pressure sores
Angrigiani, C; Grilli, D; Siebert, J; Thorne, C
1995 Sep;96(4):935-940, Plastic & reconstructive surgery
In the paraplegic patient who has had previous surgeries for pressure sores, local tissue is frequently unavailable for further use. The posterolateral aspect of the thigh, however, is almost always available and provides an excellent reconstructive alternative for this difficult problem. In 1983, Baek described the skin territory supplied by the third perforator of the profunda femoris artery. A musculocutaneous flap can be raised consisting of the same skin territory and a portion of the biceps femoris muscle (short head) through which the third perforator courses. In addition, the distal part of the vastus lateralis muscle, which is supplied by a muscular branch of the same perforator, can be included in the flap. The flap is elevated as an island based on the profunda femoris artery and accompanying venae comitantes. A substantial soft-tissue mass can be transposed easily to the perineum. Standard latex injection techniques were used in 12 fresh cadaver dissections prior to use of this flap in 16 clinical cases. Selective india ink injections into the third perforator of the profunda femoris artery in 6 cadavers confirmed the perfusion of the overlying skin territory. Recurrent ischial and perineal wounds were closed successfully with this musculocutaneous flap in all 16 clinical cases
— id: 115256, year: 1995, vol: 96, page: 935, stat: Journal Article,

Tricalcium phosphate and osteogenin: a bioactive onlay bone graft substitute
Breitbart AS; Staffenberg DA; Thorne CH; Glat PM; Cunningham NS; Reddi AH; Ricci J; Steiner G
1995 Sep;96(3):699-708, Plastic & reconstructive surgery
The disadvantages of autogenous bone grafts has prompted a search for a dependable onlay bone graft substitute. A combination of tricalcium phosphate, a resorbable ceramic, and osteogenin, an osteoinductive protein, was evaluated as an onlay bone graft substitute in a rabbit calvarial model. Twenty-eight tricalcium phosphate implants (15 mm diameter x 5 mm; pore size, 100-200 microns) were divided into experimental and control groups and placed on the frontal bone of 14 adult New Zealand White rabbits. In the experimental animals, 185 micrograms of osteogenin was added to each implant. In the control animals, the implants were placed untreated. Implants were harvested at intervals of 1, 3, and 6 months, and evaluated using hematoxylin and eosin histology, microradiography, and histomorphometric scanning electron microscope backscatter image analysis. At 1 month there was minimal bone ingrowth and little tricalcium phosphate resorption in both the osteogenin-treated and control implants. At 3 months, both the osteogenin-treated and control implants showed a modest increase in bone ingrowth (8.85 percent versus 5.87 percent) and decrease in tricalcium phosphate (32.86 percent versus 37.08 percent). At 6 months, however, the osteogenin-treated implants showed a statistically significant increase in bone ingrowth (22.33 percent versus 6.96 percent; p = 0.000) and decrease in tricalcium phosphate (27.25 percent versus 37.80 percent; p = 0.004) compared with the control implants. The bone within the control implants was mostly woven at 6 months, whereas the osteogenin-treated implants contained predominantly mature lamellar bone with well-differentiated marrow. All implants maintained their original volume at each time interval studied. The tricalcium phosphate/osteogenin composite, having the advantage of maintaining its volume and being replaced by new bone as the tricalcium phosphate resorbs, may be applicable clinically as an onlay bone graft substitute
— id: 56744, year: 1995, vol: 96, page: 699, stat: Journal Article,

Twenty-year experience with early surgery for craniosynostosis: I. Isolated craniofacial synostosis--results and unsolved problems
McCarthy JG; Glasberg SB; Cutting CB; Epstein FJ; Grayson BH; Ruff G; Thorne CH; Wisoff J; Zide BM
1995 Aug;96(2):272-283, Plastic & reconstructive surgery
Early surgery for isolated craniosynostosis is designed to improve morphology, to prevent functional disturbances, and equally important, to enhance the psychosocial development of the child. As the first of a two-part series, 104 patients with isolated craniofacial synostosis were retrospectively analyzed. Diagnoses included bilateral coronal (10), unilateral coronal (57), metopic (29), and sagittal synostosis (8). All patients underwent primary fronto-orbital advancement-calvarial vault remodeling procedures at less than 18 months of age (mean 8.1 months). Thirteen percent of patients (14) required a secondary cranial vault operation (mean age 22.6 months) to address residual deficits in craniofacial form. Perioperative complications were minimal (5.0 percent), and there was no mortality. Average length of postoperative follow-up was 46.0 months. By the classification of Whitaker et al., which assesses surgical results, 87.5 percent of patients were considered to have at least satisfactory craniofacial form (category I-II) at latest evaluation. Overall rates of hydrocephalus, shunt placement, and seizures (3.8, 1.0, and 2.9 percent, respectively) were low. Among the isolated craniosynostoses, unilateral coronal synostosis/plagiocephaly poses the most complex problems, including vertical orbital dystopia, nasal tip deviation, and residual craniofacial asymmetry; there is also a wide spectrum of findings and growth patterns in this subgroup
— id: 12744, year: 1995, vol: 96, page: 272, stat: Journal Article,

Twenty-year experience with early surgery for craniosynostosis: II. The craniofacial synostosis syndromes and pansynostosis--results and unsolved problems
McCarthy JG; Glasberg SB; Cutting CB; Epstein FJ; Grayson BH; Ruff G; Thorne CH; Wisoff J; Zide BM
1995 Aug;96(2):284-295, Plastic & reconstructive surgery
As the second of a two-part series, 76 patients with pansynostosis and craniofacial synostosis syndromes were retrospectively analyzed. Diagnoses included pansynostosis (7), craniofrontonasal dysplasia (8), and Apert (24), Crouzon (15), and Pfeiffer (15) syndromes. All patients underwent primary fronto-orbital advancement-calvarial vault remodeling procedures at less than 18 months of age (mean 6.1 months). Twenty-eight patients (36.8 percent) required a secondary cranial vault operation (mean age 28.4 months). Additionally, a major tertiary procedure was necessary in 5 patients to deal with persistent unacceptable craniofacial form. To address the associated finding of midface hypoplasia, 64.8 percent (n = 35) of patients underwent Le Fort III midface advancement or had that procedure recommended for them. The remainder were awaiting appropriate age for this reconstruction. The more extensive pathologic involvement of the pansynostosis and craniofacial syndrome group is illustrated. As compared with the isolated craniofacial synostosis group previously reported, the incidence of major secondary procedures (36.8 versus 13.5 percent), perioperative complications (11.3 versus 5.0 percent), follow-up complications (44.7 versus 7.7 percent), hydrocephalus (42.1 versus 3.9 percent), shunt placement (22.4 versus 1.0 percent), and seizures (11.8 versus 2.9 percent) was significantly increased. Complex problems including those of increased intracranial pressure, airway obstruction, and recurrent turricephaly or cranial vault maldevelopment are repeatedly encountered. In addition, that early fronto-orbital advancement-cranial vault remodeling failed to promote midface development and hypoplasia of this region is almost a consistent finding in the craniofacial syndromic group. The average length of postoperative follow-up was 6 years. According to the classification of Whitaker et al., which assesses surgical results, 73.7 percent of patients were considered to have at least satisfactory craniofacial form (category I-II) at latest evaluation. An algorithmic approach to the treatment of all patients with craniosynostosis is presented utilizing early surgical intervention as the key element
— id: 12743, year: 1995, vol: 96, page: 284, stat: Journal Article,

Introduction of an intraoral bone-lengthening device
McCarthy JG; Staffenberg DA; Wood RJ; Cutting CB; Grayson BH; Thorne CH
1995 Sep;96(4):978-981, Plastic & reconstructive surgery
It has been demonstrated that distraction osteogenesis is an effective clinical tool with applications for the entire human skeleton. Therapeutic exploitation in the correction of the asymmetrical and hypoplastic mandible has been reported previously. However, the main criticism of this technique has been the residual cutaneous scars resulting from the surgical incision and the path of the expansion device. In order to obviate the need for skin incisions, we have developed and demonstrated the feasibility of a miniaturized mandibular bone lengthener that is suitable for intraoral placement. Ten growing mongrel dogs were studied. Under general anesthesia, a buccal mucosal incision was made along the oblique line, and the body and ramus of the mandible were exposed in a supraperiosteal plane. Two 2.0-mm half-pins were placed percutaneously in the area of the angle of the mandible, and two other pins were placed 3.5 cm anteriorly. The clamps of the lengthening device were then attached to the half-pins in an intraoral position. An osteotomy was made by connecting percutaneously made drill holes between the clamps in a line positioned posterior to the third molar. The mucosa was closed loosely over the device. Distraction was commenced on the eighth postoperative day. The results were assessed with pre- and post-lengthening photographs, cephalograms, and CT scans with three-dimensional reconstruction. All animals demonstrated a contralateral cross-bite. The newly developed bone also was examined histologically. The intraoral method of mandibular lengthening offers the same advantages of extraoral lengthening but without the need for a cutaneous incision and resulting scar
— id: 56775, year: 1995, vol: 96, page: 978, stat: Journal Article,

Frontonasal encephalocele and associated congenital brain tumor
McDonald WS; Zagzag D; Thorne CH
1995 Sep;6(5):386-389, Journal of craniofacial surgery
A rare case of frontonasal encephalocele associated with a congenital brain tumor is presented. We describe our combined extracranial and intracranial approach to correction of frontonasal encephaloceles. A discussion of frontonasal encephaloceles and neonatal brain tumors follows, with a discussion of embryopathogenesis and surgical correction
— id: 9353, year: 1995, vol: 6, page: 386, stat: Journal Article,

Craniofacial clefts
Thorne CH
1993 Oct;20(4):803-814, Clinics in plastic surgery
No major breakthroughs have occurred since Kawamoto last discussed this topic in the Clinics in 1976. Advances such as early surgery, cranial bone grafting, modern methods of fixation, and tissue expansion have been applied with success to craniofacial clefts as in the treatment of other craniofacial deformities. Twenty years have passed since Tessier first presented his classification of craniofacial clefts, and that interval has served to reinforce the magnitude of Tessier's contribution to craniofacial surgery
— id: 6534, year: 1993, vol: 20, page: 803, stat: Journal Article,

SAGITTAL SYNOSTOSIS - QUANTITATIVE ASSESSMENT OF PRESENTING DEFORMITY AND SURGICAL RESULTS BASED ON CT SCANS - DISCUSSION
THORNE, CH
1993 NOV ;92(6):1025-1026, Plastic & reconstructive surgery
— id: 52175, year: 1993, vol: 92, page: 1025, stat: Journal Article,

APLASIA-CUTIS-CONGENITA OF THE SCALP - ISSUES IN ITS MANAGEMENT
ABBOTT, R; CUTTING, CB; WISOFF, JH; THORNE, CH; EPSTEIN, FJ
1992 JUN ;17(4):182-184, Pediatric neurosurgery
Two cases of aplasia cutis congenita with associated bony defects are presented to highlight the dangers of delayed coverage of exposed dura. Management of one case was complicated by repeated local and systemic sepsis and the other by repeated, life-threatening hemorrhage. Early, definitive coverage of these defects using full thickness skin flaps avoids the risks of hemorrhage and should, if the recipient bed is clean, lessen the incidence of complicating sepsis
— id: 33467, year: 1992, vol: 17, page: 182, stat: Journal Article,

Membranous bone lengthening: a serial histological study
Karp NS; McCarthy JG; Schreiber JS; Sissons HA; Thorne CH
1992 Jul;29(1):2-7, Annals of plastic surgery
Bone lengthening using the process of corticotomy and gradual distraction of callus is applicable to the membranous bone of the canine mandible. In this study the precursors to bone formation, in the area between the distracted bone edges, are analyzed in an attempt to determine the mechanism of bone formation. Ten mongrel dogs 5 months of age were studied. A unilateral, periosteal-preserving angular corticotomy was performed, and an external bone-lengthening device was fixed to the mandible. After 10 days of external fixation, the mandible was lengthened 1 ml per day for 20 days and then held in external fixation for 8 weeks. The dogs were killed for histological and microradiographic study at 10 and 20 days of distraction, and at 14, 28, and 56 days after the completion of distraction. It was observed that the gap between the distracted bone edges is first occupied by fibrous tissue. As distraction proceeds, the fibrous tissue becomes longitudinally oriented in the direction of distraction. Early bone formation advances along the fibrous tissue, starting from the cut bone ends. Eventually the area is converted to mature cortical bone. Bone is formed predominantly by intramembranous ossification. This mechanism is similar to that of bone formation during long bone lengthening
— id: 13540, year: 1992, vol: 29, page: 2, stat: Journal Article,

Lengthening the human mandible by gradual distraction [see comments]
McCarthy JG; Schreiber J; Karp N; Thorne CH; Grayson BH
1992 Jan;89(1):1-8, Plastic & reconstructive surgery
Lengthening of the mandible by gradual distraction was performed on four young patients (average age 78 months). The amount of mandibular bone lengthening ranged from 18 to 24 mm; one patient with Nager's syndrome underwent bilateral mandibular expansion. Following the period of expansion, the patients were maintained in external fixation for an average of 9 weeks to allow ossification. The patients were followed for a minimum of 11 months to a maximum of 20 months with clinical and dental examinations as well as photographic and radiographic documentation. The technique holds promise for early reconstruction of craniofacial skeletal defects without the need for bone grafts, blood transfusion, or intermaxillary fixation
— id: 13732, year: 1992, vol: 89, page: 1, stat: Journal Article,

Gunshot wounds to the face. Current concepts
Thorne CH
1992 Jan;19(1):233-244, Clinics in plastic surgery
The primary goal in reconstructing a gunshot wound to the face is identical to that for a major injury of the hand or lower extremity: primary healing of the soft tissue. This prevents the cascade of soft-tissue infection, further delay in healing, bone graft infection, and soft-tissue contracture. Current craniofacial techniques and methods of fixation allow for concomitant bony reconstruction without compromising primary healing of the soft tissues. The result is not only that the soft tissue is healed but also that the original contour, stretch, and pliability are maintained. Once the soft tissue collapses around inadequate bony reconstruction, it is difficult to restore the original situation. Despite the techniques outlined, there is no substitute for sound surgical judgment. Inevitably, cases will arise when the ideal reconstruction cannot be performed because of other injuries, inappropriate initial management at referring institutions, or medical complications. Compromises are then required in the interest of the patient's overall care, with the knowledge that the best chance to restore the anatomy of the hard and soft tissue is in the first few days after the injury
— id: 13754, year: 1992, vol: 19, page: 233, stat: Journal Article,

Aplasia cutis congenita of the scalp: issues in its management
Abbott R; Cutting CB; Wisoff JH; Thorne CH; Epstein FJ
1991 92;17(4):182-184, Pediatric neurosurgery
Two cases of aplasia cutis congenita with associated bony defects are presented to highlight the dangers of delayed coverage of exposed dura. Management of one case was complicated by repeated local and systemic sepsis and the other by repeated, life-threatening hemorrhage. Early, definitive coverage of these defects using full thickness skin flaps avoids the risks of hemorrhage and should, if the recipient bed is clean, lessen the incidence of complicating sepsis
— id: 14208, year: 1991, vol: 17, page: 182, stat: Journal Article,

Bone lengthening in the craniofacial skeleton
Karp, N S; Thorne, C H; McCarthy, J G; Sissons, H A
1990 Mar;24(3):231-237, Annals of plastic surgery
The process of bone lengthening by cortical fracture and gradual distraction of callus has become well established in the enchondral bones of the extremities. In this study the principles of bone lengthening were applied to the membranous bone of the craniofacial skeleton using the growing dog mandible as a model. Six mongrel dogs five months of age were studied. A unilateral, periosteal-preserving angular corticotomy was performed, and an external minilengthening device was fixed to the mandible perpendicular to the corticotomy. After 10 days of external fixation, the mandible was lengthened 1 mm/day for 20 days and then held in external fixation for 56 days (8 weeks) after which all dogs were killed. Anthropometric measurements and histological analysis of the specimens confirmed that bone lengthening had occurred and that new cortical bone was formed in the expanded areas
— id: 99050, year: 1990, vol: 24, page: 231, stat: Journal Article,

The effect of early fronto-orbital advancement on frontal sinus development and forehead aesthetics
McCarthy JG; Karp NS; LaTrenta GS; Thorne CH
1990 Dec;86(6):1078-1084, Plastic & reconstructive surgery
The frontal sinuses make an important contribution to normal forehead and glabellar contour. This study was designed to test our clinical impression that early fronto-orbital ('frontal bone') advancement could have an adverse effect on frontal sinus development and consequently on forehead aesthetics. A retrospective study was conducted on 11 patients who had undergone fronto-orbital advancement and also had a long period of follow-up at the Institute of Reconstructive Plastic Surgery at New York University. The longitudinal cephalometric data were compared with unoperated controls. With one exception, no patient who underwent bilateral fronto-orbital advancement developed a frontal sinus, and all such patients had a flattened brow contour when compared with unoperated patients, of whom 82 percent developed at least one frontal sinus. Of the three patients who underwent unilateral fronto-orbital advancement for plagiocephaly (flattened forehead), two developed a frontal sinus but only on the unoperated side and one developed bilateral frontal sinuses. The two patients with unilateral frontal sinus development had a particularly obvious deformity resulting from normal glabellar projection on the unoperated side and a flattened contour on the operated side. Fronto-orbital advancement affects forehead aesthetics and should be performed only in infant patients with moderate to severe deformities. patients with plagiocephaly whose deformity is sufficiently severe to warrant surgery should preferably undergo bilateral fronto-orbital advancement (by the technique described) rather than unilateral advancement in order to avoid the brow asymmetry that results from unilateral frontal sinus development
— id: 14259, year: 1990, vol: 86, page: 1078, stat: Journal Article,