Craig B Birgfeld

Publications of Craig B Birgfeld

• Photographic protocol for image acquisition in craniofacial microsomia.

  Authors: Carrie L Heike, Laura P Stueckle, Erik T Stuhaug, Luiz A Pimenta, Amelia F Drake, Daniela Vivaldi, Kathleen Cy Sie, Craig B Birgfeld

  Head & face medicine. 12/2011; 7:25.

  ABSTRACT: Craniofacial microsomia (CFM) is a congenital condition associated with orbital, mandibular, ear, nerve, and soft tissue anomalies. We present a standardized, two-dimensional, digitalABSTRACT: Craniofacial microsomia (CFM) is a congenital condition associated with orbital, mandibular, ear, nerve, and soft tissue anomalies. We present a standardized, two-dimensional, digital photographic protocol designed to capture the common craniofacial features associated with CFM.

• A phenotypic assessment tool for craniofacial microsomia.

  Authors: Craig B Birgfeld, Daniela V Luquetti, Alexander J Gougoutas, Scott P Bartlett, David W Low, Kathy C Y Sie, Kelly N Evans, Carrie L Heike

  Plastic and reconstructive surgery. 01/2011; 127(1):313-20.

  Craniofacial microsomia is one of the most common conditions treated by craniofacial teams. However, research regarding the cause of this condition or the surgical outcomes of treatment is scant.Craniofacial microsomia is one of the most common conditions treated by craniofacial teams. However, research regarding the cause of this condition or the surgical outcomes of treatment is scant. This is attributable to the lack of diagnostic criteria and the wide phenotypic spectrum. Standardized description of the craniofacial malformations associated with craniofacial microsomia is a necessary first step for multicenter, interdisciplinary research into this complex condition. The authors used the previously published pictorial Orbit, Mandible, Ear, Nerve, and Soft tissue-Plus classification scheme to assign a phenotypic severity score to patients with craniofacial microsomia treated at the Craniofacial Center at Seattle Children's Hospital. The authors modified the tool based on feedback from multidisciplinary focus groups. The authors also developed a standardized photographic protocol to facilitate assessment of patients using two-dimensional images. Feedback from focus groups was synthesized to create a phenotypic assessment tool for craniofacial microsomia based on the pictorial Orbit, Mandible, Ear, Nerve, and Soft tissue-Plus classification system. This tool allows for more comprehensive description of the phenotype of craniofacial microsomia and is found to be effective for clinical use within a multidisciplinary craniofacial team. In addition, the photographic protocol for patients with craniofacial microsomia allows for classification from a two-dimensional photographic database, thereby facilitating research using archived photographs. The phenotypic assessment tool for craniofacial microsomia protocol provides a simple and standardized method for practitioners and researchers to classify patients with craniofacial microsomia. We anticipate that this tool can be used in multicenter investigational studies to evaluate the cause of this condition, its natural history, and comparative effectiveness research.

• Midface growth in patients with ectrodactyly-ectodermal dysplasia-clefting syndrome.

  Authors: Craig B Birgfeld, Patricia Glick, Davinder Singh, Don LaRossa, Scott Bartlett

  Plastic and reconstructive surgery. 08/2007; 120(1):144-50.

  BACKGROUND: Ectrodactyly-ectodermal dysplasia-clefting syndrome is an autosomal dominant disorder involving abnormalities of the hands, feet, skin, and teeth and clefts of the lip and palate.BACKGROUND: Ectrodactyly-ectodermal dysplasia-clefting syndrome is an autosomal dominant disorder involving abnormalities of the hands, feet, skin, and teeth and clefts of the lip and palate. Patients with this syndrome have abnormal facial features--namely, clefts of the lip and palate--and abnormal dentition, which could affect the growth of their midface region. The purpose of this study was to describe characteristics of midface growth in patients with this syndrome. METHODS: A retrospective chart review was conducted for eight postoperative patients seen at the cleft clinic at The Children's Hospital of Philadelphia between 1987 and 2004. Clinical notes and operative reports were reviewed. The surgeon's assessment and cephalometric measurements were analyzed. The cephalometric values were compared with Bolton standards for normal facial growth to determine deficiency. RESULTS: All eight patients displayed midface disproportion. Five of the eight were found to have some degree of midface retrusion. The upper anterior facial height was found to be deficient for half of the patients. Six patients had deficient lower facial height and four had deficient total face height. Two of these patients have undergone midface distraction osteogenesis. CONCLUSIONS: The authors' study identified a subset of patients within the cleft clinic who carry the diagnosis of ectrodactyly-ectodermal dysplasia-clefting syndrome. The patients tend to have poor dentition that, coupled with clefts of the lip and palate, inhibits normal midface growth and can require surgical correction. The need for orthognathic surgery seems to be greater than that seen in patients who have clefts of the lip and palate but do not carry the syndrome.

• The periglabellar flap for closure of central forehead defects.

  Authors: Craig B Birgfeld, Benjamin Chang

  Plastic and reconstructive surgery. 08/2007; 120(1):130-3.

  BACKGROUND: Central forehead defects are difficult for the plastic surgeon. Constraints include tissue match, hair-bearing scalp, proximity of eyelids and eyebrows, and a cosmetically prominentBACKGROUND: Central forehead defects are difficult for the plastic surgeon. Constraints include tissue match, hair-bearing scalp, proximity of eyelids and eyebrows, and a cosmetically prominent location. Tissue expansion requires multiple operations and weeks of expansion. Local flaps result in added scars to the cosmetically sensitive forehead region. However, the forehead also provides consistent patterns of rhytides that can be used to camouflage local flap scars. This article describes a local flap for reconstructing central forehead skin defects that achieves tissue coverage with a cosmetically appealing result. METHODS: Six patients with central forehead cutaneous malignancies were reviewed; their defects were too large to close primarily. The defects were closed using bilateral periglabellar local advancement flaps with Burow's triangles, with scars in the natural skin creases of the aging forehead. The superior triangles were oriented horizontally, which placed incisions within the frontalis muscle forehead creases. The inferior triangles were oriented obliquely within skin creases of the corrugator muscles. Central vertical incisions remained and blended inconspicuously into the aging forehead. RESULTS: Five patients with central forehead melanomas and one patient with Mohs' defects after excision of basal cell carcinoma were referred by their dermatologists (age range, 60 to 83 years; mean, 72 years). Defects ranged from 2.1 to 5.3 cm in greatest diameter (mean, 3.7 cm). All were closed with the periglabellar flap. One minor complication of hematoma was treated with aspiration in the office. All six patients were satisfied with the results of their reconstruction. CONCLUSION: For central forehead skin defects up to 5 cm in diameter, the periglabellar flap offers a reconstructive option that uses local tissue and hides scars within natural forehead wrinkles, providing an aesthetically pleasing result.

• Total face reconstruction using a pre-expanded, bilateral, extended, parascapular free flap.

  Authors: Craig B Birgfeld, David W Low

  Annals of plastic surgery. 06/2006; 56(5):565-8.

  A 37-year-old male sustained extensive, self-inflicted gasoline burns to his head, face, chest, upper extremities, and anterior thighs. Although he underwent initial resuscitation and skin graftingA 37-year-old male sustained extensive, self-inflicted gasoline burns to his head, face, chest, upper extremities, and anterior thighs. Although he underwent initial resuscitation and skin grafting at a regional burn center, he presented to our clinic with thick, unstable burn scars covering his face and scalp. He had multiple functional and esthetic needs that are described. He required approximately 30 x 35 cm of skin to resurface his entire face and anterior scalp. His back and buttocks were his only unscarred, potential donor sites. Authors have described use of a bilateral parascapular free flap for similar deformities. This patient required pre-expansion of this free flap to maximize available tissue and minimize the donor defect. This technique provided this patient with a large area of healthy skin and soft tissue that will ultimately provide this patient with an improved functional and esthetic result.