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Soft-Tissue Manipulation Contributes to Craniofacial Symmetry as Importantly as Does Implant Reconstruction in Cranioplasty for Skull Defects
Muh-Shi Lin, M.D., Ph.D.
The Journal of Neuropsychiatry and Clinical Neurosciences 2013;25:E52-E53. doi:10.1176/appi.neuropsych.12080189
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Conflicts of interest: No competing financial interests.

Dept. of Surgery Faculty of Medicine, School of Medicine National Yang-Ming University Taipei, Taiwan
Dept. of Surgery School of Medicine Taipei Medical University Taipei, Taiwan
Dept. of Neurosurgery Taipei City Hospital, Zhong Xiao Branch Taipei, Taiwan
Division of Neurosurgery, Dept. of Surgery New Taipei City Hospital New Taipei City, Taiwan

Correspondence: Muh-Shi Lin, M.D., Ph.D.; e-mail: neurosurgery2005@yahoo.com.tw

Copyright © 2013 American Psychiatric Association


To the Editor: Under critical circumstances, such as diffuse cerebral edema caused by major traumatic brain injury and ischemic and hemorrhagic stroke, a wide decompressive craniectomy (DC) saves life and might improve the long-term outcome. However, another nightmare begins in surviving patients because they must endure skull defects unless reconstructive surgery is performed. The gross external appearance of the skull after craniectomy negatively affects patients physically and mentally, especially young patients who are concerned about their appearance.

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FIGURE 1. Soft-Tissue Manipulation for Restoring Craniofacial Symmetry

[A]: Thoroughly reflecting the temporalis muscle above the dura (epidural space), with tissueless margins of the skull defect for enhancing implant reduction; [B]: complete reflection (double arrow) of entire temporalis muscle above the dura, showing intact arachnoid membrane (single arrow); [C]: reflected temporalis muscle is tacked in place and reattached to the implants, using suspensory vicryl sutures to restore original anatomy (arrows in [C] and [D]).



Kung  WM;  Lin  MS:  A simplified technique for polymethyl methacrylate cranioplasty: combined cotton stacking and finger fracture method.  Brain Inj 2012; 26:1737–1742
[CrossRef] | [PubMed]
Kung  WM;  Lin  FH;  Hsiao  SH  et al:  New reconstructive technologies after decompressive craniectomy in traumatic brain injury: the role of three-dimensional titanium mesh.  J Neurotrauma 2012; 29:2030–2037
[CrossRef] | [PubMed]
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