Five-year follow-up outcomes of comprehensive rehabilitation in Korean siblings with cerebral, ocular, dental, auricular, skeletal anomalies (CODAS) syndrome: A case report

RATIONALE

Cerebral, ocular, dental, auricular, skeletal anomalies (CODAS) syndrome is a very rare multisystem disorder, which shows malformations of the central nervous system, ears, eyes, teeth, and skeleton that was first reported in 1991. Only a few cases that sporadically occurred have been reported worldwide. The research investigating the pathogenesis and patterns of CODAS inheritance is still ongoing. There is no satisfactory treatment for this rare genetic disease yet. Due to the lack of curative medical treatment, rehabilitation could play a major role in treatment for genetic disease.

PATIENT CONCERNS

To our best knowledge, the 2 children described in this study are the only CODAS syndromes siblings reported in the world so far. These Korean siblings show highly distinctive features consisting of developmental delay, cataracts, vulnerability to tooth decay, epiphyseal dysplasia, and anomalous ears.

DIAGNOSES

CODAS syndrome.

INTERVENTIONS

Comprehensive long-term rehabilitation treatment during 5 years.

OUTCOMES

We report on the progress of the comprehensive long-term rehabilitation treatment at 5-year follow-up. Their fine motor and language skills development improved similarly to that of same-aged children. We observed the positive effect of rehabilitation on the quality of life.

LESSONS

The therapy of genetic disorders is challenging for pediatric neurologists and pediatric physiatrists. We suggest that rehabilitation is the best treatment currently available for this genetic disease that yields satisfactory therapeutic effect.

Availability of cosmetic treatment using novel cosmetics-based material on patients with craniofacial concavity

PURPOSE

Patients treated with maxillofacial prosthetics often experience emotional problems because of the remaining facial skin concavity such as a surgical scar. In such cases, cosmetic treatment can potentially correct their skin tone imperfections and deformities. This study aimed to evaluate the clinical availability of novel cosmetics-based material for craniofacial small concavity by initiating a cosmetic treatment in a preliminary case.

METHODS

Eighteen patients with aesthetic problems such as craniofacial deformities, small defects, and concavities on their faces underwent cosmetic treatment that was performed by makeup practitioners. Data were collected from the patient's charts and a survey questionnaire. A visual analog scale was used to conduct a survey regarding the satisfaction levels of the patients following cosmetic treatment with a novel cosmetics-based material. The cosmetic treatment was performed for a concavity on the left midface of a 67-year-old woman with partial maxillectomy. The novel cosmetics-based material was manufactured from a semi-translucent oil base.

RESULTS

The satisfaction level of the patient increased after undergoing the cosmetic treatment. Regarding clinical applications, the novel cosmetics-based material can help reduce their cosmetic disturbance and restore the small deformity.

CONCLUSIONS

These results suggest that the cosmetic treatment with the novel cosmetics-based material can be used as a subsidiary method for facial prostheses or an independent new method for correcting patients' small craniofacial concavity and for reducing visible deformity.

The role of plastic surgeon in complex cephalic malformations. Our experience

AIM

Our aim is focused on the field of action of plastic surgery in the cephalic malformation and on description of the surgical indications and techniques for their correction.

MATERIAL OF STUDY

We looked at 27 patients from 2006 to 2012 with cephalic district deformities. All patients underwent surgical and rehabilitative treatments.

RESULTS

After a median follow-up from one to five years, in most cases we reached both morphological and functional reconstruction, alone or in a surgical team together with other surgical disciplines.

DISCUSSION

The correction of craniofacial malformations makes use of a surgical discipline particularly demanding, which must associate a basic surgical training with a learning techniques specific to the area and a knowledge of craniofacial malformation.

CONCLUSIONS

The surgical treatment of craniofacial malformations can be seen only through a joint neurosurgical and plastic-maxillo-facial surgery, guided by knowledge of the malformation, under the close supervision of anesthetists and pediatricians. This surgery is not limited to remodel the morphology but has its bases on the recovery of the functions, maintained by rehabilitation treatment.

Facially disfigured children--dedicated approach and rehabilitation

Facial disfigurement following congenital anomalies or acquired defects due to accidents or scars results in mental trauma and other related consequences. A multidisciplinary team approach with special importance to rehabilitation is required in handling such patients.

Visible difference amongst children and adolescents: issues and interventions

Whether present at birth or acquired later in life, a visible difference (disfigurement) can have considerable psychological ramifications for children and adolescents. Whilst many young people adapt to the demands placed upon them and appear relatively unaffected, others report difficulties including adverse effects on body image, quality of life, self-esteem and difficulty with social encounters. This review examines the issues experienced by those affected, summarizes the factors identified as exacerbating or ameliorating any difficulties, then considers the particular pressures associated with developmental stages and the issues for family members. The current provision of care, the potential benefit of psychosocial interventions and the challenges faced by researchers in this area are explored.

Can't they like me as I am? Psychological interventions for children and young people with congenital visible disfigurement

This paper describes the psychological challenges for children and young people with a congenital visible disfigurement. These challenges are outlined in a developmental framework and case histories are used to illustrate a range of interventions. The model underlying assessment and intervention moves away from dysfunction and disability and outcomes are defined by psychological strengths, resilience and coping strategies. For those living with a visible disfigurement, who needs rehabilitation?

Prosthodontic and psychological factors in treating patients with congenital and craniofacial defects

This article addresses treatment of patients with various types of congenital defects, including partial and total anodontia, hypohydrotic ectodermal dysplasia, dentinogenesis imperfecta, and cleft lip and palate. The psychosocial aspects of these patients and rehabilitation with removable, fixed, and implant-supported prostheses are discussed. The factors to be considered are altered anatomy, lack of teeth or malformed teeth, teeth in abnormal positions, lack of facial growth, and altered arch development. The short- and long-term treatment of patients in these categories is discussed.

Erfahrungen mit einem subperiostalen Plattensystem aus Titan („Ti-Epiplating-System”) zur epithetischen Rehabilitation von Mittelgesichts- und Orbitadefekten

BACKGROUND

Since Tjellstrom introduced in 1977 percutaneous osseointegration, the importance of osseointegrated implants has increased in the head and neck region. Implants and craniofacial surgery technology have been permanently improved and the use of extraoral osseointegration has expanded considerably. The surgical reconstruction of the exenterated orbit provides often only poor aesthetic results. Therefore the rehabilitation of complex midfacial structures is an indication for osseointegrated retained facial prostheses.

METHODS AND MATERIAL

The international literature has been reviewed concerning the topic of osseointegration for the retention of orbital and midfacial prostheses. A new plate-like implant system is introduced. We report about our experiences with the "Ti-Epiplating System".

DISCUSSION

The "Ti-Epiplating System" is available since 2001. For every location in the head and neck there exists a specially shaped plate. The "Ti-Epiplating System" is fixed subperiostally with normal bone screws, the same as used in traumatology. In cases of extended resections with less bone substance left, the application is simplified. The osseointegration time is reduced to a minimum of 6 weeks. Postoperative radiation is possible.

CONCLUSION

The improved application of the "Ti-Epiplating System" is beneficial in the reconstruction of extended craniofacial defects with osseointegrated implants.

O significado do trabalho em equipe na reabilitação de pessoas com malformação craniofacial congênita

Este estudo objetivou compreender o significado do trabalho em equipe dos profissionais de reabilitação em anomalias craniofaciais. Realizou-se análise fenomenológica por contemplar a compreensão e interpretação do sentido considerando o sujeito. Entrevistou-se 12 profissionais de diferentes áreas, norteadas pela questão: O que significa para você trabalhar em equipe na reabilitação de anomalias craniofaciais? Resgatando-se os temas: Capacitação para o trabalho, Dificuldade para trabalho em equipe, Relação com paciente e família, Condições de trabalho e A inserção do profissional na equipe. A análise visou refletir o fenômeno engendrando convergências e divergências destacando a explicitação das diferenças e aprendizado contínuo.

The treatment of the positional plagiocephaly with a new thermoplastic orthotic device

INTRODUCTION

An increasing number of infants presenting with posterior cranial asymmetry are referred to the paediatric neurosurgeon for clinical evaluation. Most of these cranial dysmorphisms cannot be due to lambdoidal sinostosis, since they originate from pre- (intrauterine constraint) or postnatal (prematurity, torticollis, sleeping position) predisposing factors that have deformed the cranial vault. In the literature there is broad consensus about the conservative management of this nonsynostotic plagiocephaly by means of "positional therapy" or "orthoplasty moulding" with cranial helmets or bands. Some reports can be found about the effectiveness of so-called dynamic orthotic cranioplasty (DOC) to improve the cranial asymmetry.

TECHNICAL NOTE

In order to simplify the manufacturing procedure and improve the modulation of the corrective forces, we have designed a new orthotic device (thermoplastic orthotic device, TOD) using thermoplastic materials that can be moulded directly on the infant's head.

CONCLUSION

With this technique it is no longer necessary to take any cranial impressions and the orthotic device can be easily remodelled, ensuring perfect adaptability of the device to the cranial vault throughout the entire treatment. Moreover, the superior flexibility of this orthosis allows modulation of the corrective forces.

[Contribution of the clinical psychologists to rehabilitation of children with craniofacial abnormalities]

This paper describes the role of the clinical psychologist collaborating in an interdisciplinary rehabilitation team for children with severe congenital craniofacial disorders. This includes: 1. Psychological counseling during the initial period of responding to the traumatic experience of the child's birth; 2. Preparing the child and parents for surgery and hospitalisation; 3. Developmental assessment and counseling in parenting and educational issues; 4. Prevention of social-emotional disorders and psychological support for the long-term adjustment to facial difference.

[Treatment of non-synostotic, pediatric skull deformities with dynamic head orthosis]

In all craniofacial deformities the differential diagnosis between synostotic and non-synostotic conditions must be made. While the first group is usually subject to intracranial surgical intervention, the treatment of non-synostotic deformities is the subject of controversial discussion. Often associated with premature birth, restrictive intrauterine environment or torticollis, these conditions; also defined as positional deformations, can lead to severe plagiocephalic head shapes. Dynamic orthotic cranioplasty is a conservative method of treating these deformities in early childhood by means of an individually fabricated orthotic head band. The principle is that dynamic pressure is applied to prominent parts while leaving space for growth in depressed areas. In accordance with this principle, various deformities can be addressed. Through clinical, anthropometric and radiographic evaluation it has been shown that dynamic orthotic cranioplasty can correct positional deformation of the cranial vault, skull base and upper face with no relapse following treatment. It must be emphasised that the method is simple, easy to handle and very effective when treatment starts within the first 6 months of life. Therefore, its potential should be recognised by paediatricians and craniofacial surgeons.