Tristan de Chalain

Tristan de Chalain
University of Auckland · Department of Paediatrics: Child and Youth Health

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52
Publications
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1,645
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Publications

Publications (52)
Article
Full-text available
Background The CLEFT-Q is a new patient-reported outcome instrument designed to measure outcomes that matter to patients. The aim of this qualitative study was to establish content validity of the CLEFT-Q in patients who differ by age and culture. Methods Patients aged between 6 and 29 years were recruited from plastic surgery clinics in Canada, I...
Article
An association between positional plagiocephaly and developmental problems has previously been noted, but whether delays persist over time has not been established. This study aimed to determine developmental outcomes for children with deformational plagiocephaly over 1 year of follow up. This was a longitudinal cohort study of 126 infants with def...
Article
Randomized controlled trials of treatment for deformational plagiocephaly and brachycephaly have been lacking in the literature. Infants (n = 126) presenting to a plagiocephaly clinic were randomized to either positioning strategies or to positioning plus the use of a Safe T Sleep™ positioning wrap. Head shape was measured using a digital photograp...
Article
A patient with Klippel-Feil syndrome, which was associated with Pierre Robin sequence, bilateral mandibular duplication, and occipital clefts, is described. The management, surgery, and possible etiology are discussed in relation to the relevant literature.
Article
There is wide international variation in the protocols used for middle ear disease management in cleft palate patients. Ventilation tube (grommet) insertion may occur routinely at the time of palatoplasty or selectively on a separate occasion if symptomatic middle ear disease develops. The audiological and otologic outcomes of cleft palate patients...
Article
A unilateral upper lateral orbital cleft, fitting the description of the extremely rare Tessier cleft number 9 is reported. The management and surgery of this patient are discussed, and the relevant literature is reviewed. The usefulness of three-dimensional computed tomography reconstructions and plastic models in planning the surgery is discussed...
Article
We present an audit of primary cleft palate surgery at our unit, including rates of oronasal fistula development, speech outcomes, and rates of velopharyngeal insufficiency requiring secondary surgery. A retrospective study of patients with all cleft palate types, born between January 1990 and December 2004, who underwent primary palatoplasty at Mi...
Article
After more than a century of use, fat grafting is firmly entrenched in the skill set of plastic surgeons. While macrofat grafting is relatively predictable and reliable, microfat grafting by injection is still in the stages of technical evolution. Review of the current literature suggests that revascularization may take up to 21 days to reach the c...
Article
Examination of successive development stages of the leaf of Avicennia marina (Forsk.) Vierh has revealed that although a measure of early schizogeny occurs, formation of the major air spaces is by a process of lysigeny. A developmental sequence terminating in autolysis may be traced within cells forming a localized group, and the end products of th...
Article
The primary study aim was to identify characteristics of torticollis associated with plagiocephaly without synostosis (PWS) and to differentiate this from other forms of torticollis. The three commonest causes of infantile torticollis are idiopathic muscular causes such as sternocleidomastoid fibrosis, structural anomalies in the cervical vertebrae...
Article
Due to the rarity of arteriovenous malformations (AVMs), there is a paucity of information on the outcomes of various treatments. Presently, the mainstays of treatment of an AVM are embolization, surgical excision or a combination of both. A retrospective study of 26 patients with AVMs treated at the Hospital for Sick Children, Toronto, Ontario bet...
Article
Congenital muscular torticollis (CMT) is the most common form of torticollis in children, significantly outnumbering orthopedic, neurologic, and ocular causes. CMT may present as a palpable sternomastoid tumor (SMT) or a simple tightness of the sternocleidomastoid muscle (SCM), designated as idiopathic muscular torticollis (IMT). Muscular torticoll...
Article
The reconstructive surgeon, dealing with both congenital anomalies such as clefts, and post-surgical or post-traumatic defects, may, on occasion be faced with a situation where there is either a unilateral deficit or excess of lip volume, or an asymmetry with bilateral volume inequalities. The classic examples of this are the characteristic whistle...
Article
To gain further insight into the pathogenesis of Parry-Romberg syndrome, a sporadic disease of unknown aetiology characterized by progressive wasting of one side of the face. Cranial MRI was performed in 10 patients with Parry-Romberg syndrome. The central nervous system findings are correlated to clinical findings and a review of the literature. T...
Article
Full-text available
The issue of infant sleeping position has socio-political ramifications. Current recommendations endorse supine sleeping as an aid to reducing the risk of sudden infant death syndrome (SIDS). Persistent sleeping of a newborn infant in the same position may induce plagiocephaly without synostosis (PWS). Parents in our craniofacial clinic, whose chil...
Article
The authors describe the clinical presentation, investigation, and surgical management of two cases of benign ivory osteoma of the craniofacial skeleton. In the first case, a bony mass located over the frontal region had become a cosmetic burden to the patient, and she requested removal with minimal morbidity. Accordingly, an endoscopic procedure,...
Article
There are few reports describing the surgical management and outcome of children suffering purpura fulminans secondary to meningococcal sepsis. New Zealand is in the grips of a meningococcal epidemic, and, with the attendant sequalae of the disease process, the authors sought to formally review the children who have required surgical involvement. A...
Article
Craniofacial microsomia (CFM) involves asymmetric hypoplasia and dysmorphogenesis of the facial skeleton. Certain aspects of CFM may be treated by surgical osteotomy and distraction osteogenesis (DO). Mandibular osteotomy places the inferior alveolar nerve at risk. The aim of this study was to investigate radiological landmark relationships to the...
Article
The cause of cleft lip remains speculative. The nature and extent of pathophysiologic changes in cleft lip muscle are controversial. This study was undertaken to better understand the developmental processes at work. There were two groups of patients. In group 1, 40 fresh tissue specimens were taken from 22 patients who were 2 to 5 months old-their...
Article
Sagittal synostosis is the most common form of craniosynostosis, and there is general agreement that surgery is the treatment of choice to prevent progressive cranial deformity. The results of surgery with traditional techniques are frequently disappointing. Cranial compression by reverse distraction is a promising new technique for the treatment o...
Article
Active counterpositioning and orthotic helmets are the two main nonsurgical management options for positional plagiocephaly. The purpose of this study was to compare these two management regimens. We included a random sample of infants referred between January 1, 1998 and October 31, 1999 to Middlemore Hospital and Auckland Surgical Center, for man...
Article
A large New Zealand Maori family has non-syndromic coronal craniosynostosis, which is inherited as an autosomal dominant mutation with variable expression. The aim of the study is to determine whether the family has the pro250arg mutation in the gene for fibroblast growth factor receptor 3 (FGFR3), a mutation found in patients with various types of...
Article
Background: A large New Zealand Maori family has non-syndromic coronal craniosynostosis, which is inherited as an autosomal dominant mutation with variable expression. The aim of the study is to determine whether the family has the pro250 arg mutation in the gene for fibroblast growth factor receptor 3 (FGFR3), a mutation found in patients with var...
Article
Full-text available
Transplantation of isolated chondrocytes has long been acknowledged as a potential method for rebuilding small defects in damaged or deformed cartilages. Recent advances in tissue engineering permit us to focus on production of larger amounts of cartilaginous tissue, such as might be needed for reconstructive surgery of the entire auricle. In this...
Article
Pigmentation changes after superficial burn injuries are often difficult to predict. We analyzed a sample of patients with burn injuries, looking for clinical indicators of predictable color changes in burn wounds. A sample of 50 children, predominantly those with pigmented skins, who had sustained superficial partial-thickness, (second degree) the...
Article
As part of an ongoing program of research on reconstructive techniques applicable to the growing craniofacial skeleton, this study aimed to characterize a pedicled fasciocutaneous flap on the scalp of a porcine model. Twelve juvenile Yorkshire white pigs were used. The anatomy of the porcine scalp was determined by fresh cadaveric dissection, radio...
Article
: This essay attempts to examine the moral philosophical justification for performing reconstructive plastic surgery on children with non-life threatening congenital anomalies in an era of shrinking resources. Reconstructive plastic surgery is defined in terms of what it is and what it seeks to do. The concepts of aesthetics and what constitutes a...
Article
A case is described in which the 2.7-kg fetus of a nonobese primigravid patient, delivered by midlevel forceps manipulation sustained neurapraxias of both the marginal mandibular branch of the seventh cranial nerve and the upper trunks of the ipsilateral brachial plexus. The pregnancy was uneventful, but labor was complicated by an occipitoposterio...
Article
A case is described in which the 2.7-kg fetus of a nonobese primigravid patient, delivered by midlevel forceps manipulation sustained neurapraxias of both the marginal mandibular branch of the seventh cranial nerve and the upper trunks of the ipsilateral brachial plexus. The pregnancy was uneventful, but labor was complicated by an occipitoposterio...
Article
Skin and soft tissue necrosis may be an unexpected and unpredictable consequence of warfarin therapy, occurring in 0.01% to 0.1% of patients receiving the drug. Classically, the archetypal patient is female, middle-aged or older, and the area of necrosis occurs in areas of abundant fat, such as breast, thigh or abdomen. The onset begins three to 10...
Article
The medicinal leech, Hirudo medicinalis, has been used with increasing frequency for salvage of compromised pedicled flaps and microvascular free-tissue transfers. The data pertaining to 18 cases in which flap salvage with leeches was attempted were reviewed and contrasted with the data from 108 published cases from other centers. A further analysi...
Article
We describe a technique for early correction of the so-called towering skull deformity, or turribrachycephaly. The technique makes use of the natural elasticity and plasticity of cranial bone, and it is best applied during the first year of life. Surgery consist of routine exposure of the cranial bone via a coronal incision. The frontal bone flap i...
Article
Kimura's disease is a benign, but locally injurious disease with a marked predilection for the head and neck. Of uncertain etiology, its tendency to present as a discrete, enlarging mass with associated lymphadenopathy makes it a condition of interest to clinicians who see head and neck pathology. Although rare, there are increasing numbers of repo...
Article
A 5-year review of 43 consecutive patients presenting to Scottish Rite Children's Medical Center with an open myelomeningocele defect was undertaken. The aim of the present study was to analyze the myelomeningocele defects, dimensions, and area to better define those factors that dictate the need for plastic surgical consultation for wound closure....
Article
A 56-year-old woman presented with complaints of a tender nodule in the anterior triangle of her left neck. The nodule, which was easily palpable through the skin, was approximately 1 x 1.5 cm in size and was, at first, thought to be a lymph node. At operation, a large neuroma of the distal terminus of the transected great auricular nerve was found...
Article
A case of purpura fulminans secondary to pneumococcal septicemia is presented in an 8-month-old girl. The purpuric lesions on the fingers of both hands, as well as on the lower extremities, were treated by the local application of medicinal leeches. There was nearly complete salvage of the threatened tissues and the baby made a complete recovery. T...
Article
We have presented an alternative form of management for the difficult ear replant in which conventional venous outflow cannot be reestablished. Early and aggressive medicinal leeching provided an excellent means of venous decompression until neovascularization had taken place. The primary use of leeches in such small composite replants may be super...
Article
It has been noted that major trauma and burns patients who survive beyond 48 h most frequently succumb to sepsis and multiple organ failure. Furthermore, such patients are usually markedly hypermetabolic and in negative nitrogen balance at the time of their demise. Along with many other systemic and immune dysfunctions, the polymorphonuclear white...
Article
This report describes a 6-year-old Mexican boy presenting with inter alia, hitherto unrepaired cervical encephalocele and associated unilateral syndactyly. There was also ipsilateral clinodactyly of the thumb and possible polydactyly of the foot. In addition, there was unilateral fusion of the first and second cervical vertebrae and a Chiari type I...
Article
Full-text available
Hand injuries associated with fish bones and fin spines are not common but can cause morbidity out of proportion to the original injury. This is because such injuries often leave residual fragments of foreign organic matter in the tissues, leading to troublesome secondary infections. This report details 1 year's experience with nine hand infections...
Article
This study aimed to elucidate the influence of the route of administration of exogenous lipid emulsions (Intralipid, Kabivitrum, Stockholm, Sweden) on bacterial translocation and immune suppression in a shocked and resuscitated rat trauma model. Sixty-five male Long-Evans rats were divided into three groups, viz. controls, enterally fed and intrave...
Article
54 cases of Idiopathic Muscular Torticollis (IMT) referred for surgery over a 23-year period and 134 cases referred for physiotherapy over a 5-year period have been reviewed. Long-term cosmetic and functional results for 30% of the surgical cases are presented, with a mean follow-up time of 10.5 years. Demographic features, the role of physiotherap...
Article
The ideal energy substrate for critically ill patients receiving total parenteral nutrition (TPN) remains controversial. While glucose has been proved to have nitrogen sparing properties in postoperative patients, critically ill patients tolerate glucose loads poorly and fat appears to be an obligatory fuel in sepsis. Furthermore, it is not yet cer...
Article
The activity of small experimental animals is difficult to quantify without prolonged observation and note-taking. We describe a relatively cheap and easily constructed device for monitoring and recording activity. Appropriate modifications make the basic device suitable for limited field applications.
Article
The lung is the target organ most frequently involved in the early phase of multiple organ failure. Microembolisation of the pulmonary vasculature by bacterial and non-bacterial particles and debris with failure of the clearance mechanism of the reticuloendothelial system (RES) and depletion of plasma fibronectin have been implicated in the pathoge...
Article
Hypertriglyceridemia is a recognized complication of pregnancy. In patients with familial hypertriglyceridemia, the biochemical changes are greatly enhanced during pregnancy and may be associated with acute pancreatitis, a potentially fatal triad. Three patients were studied, in one of whom previously undiagnosed hyperlipidemia resulted in a fatal...
Article
Over the past few years LHRH agonist analogs have been increasingly used to down-regulate. the pituitary and induce a state of hypogonadotropic hypogonadism. This form of endocrine manipulation has now become a feasible therapy option in a wide range of hormone-dependent diseases [1,2,3].

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