Contents 1 Pinyin 2 Overview 3 Clinical manifestations 4 Diagnosis 5 Treatment Attachment: 1 Acupuncture points for craniofacial cleft 1 Pinyin

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2 Overview

Craniofacial cleft is a congenital defect of the skull. There are two types of clefts: hidden clefts and cystic (or dominant) clefts, with the former being very rare.

Craniofacial clefts occur in the midline of the skull, at the top and bottom of the skull. The occipital region is the most common, but also in the top of the forehead; the base of the skull can be from the root of the nose, nasal cavity, nasopharyngeal cavity or orbital orbital and other parts of the expansion. Individual cases may expand laterally, as in the temporal region (Fig. 446).

(1) Occipital (2) Occipital giant meningeal bulge combined with cranial microdeformity (3) Nasal root at base of skull

(4) Fontanel (5) Temporal (6) Frontal (7) Orbital

Fig. 446 Meningeal bulge at various sites

Cryptic cranial fissure without an external mass. Cystic cranial fissures may be classified as meningocele or meningoencephalocele, the capsule of the latter containing tissue, or partially dilated ventricles, etc. (Fig. 447). In this case the head is often small, and the dilated portion is unusually large. The base of the sac is either large or small.

Fig. 447 Types of cranial clefts

3 Clinical presentation

It varies according to the site and size of the enlargement. The mass may grow gradually with some compression. In the occipital region, a round or oval cystic mass is mostly seen at the occipito-parietal junction; in the nasal root region, a mass protrudes from the root of the nose, the orbital distance widens, the orbital cavity narrows with compression, and the shape of the eye is altered to a triangular shape.

Neurologic symptoms may include mental retardation, convulsions or other brain damage, varying degrees of paralysis, hyperreflexia, cortical dysesthesia, and cerebellar symptoms and signs. Sometimes there are no neurologic symptoms.

4 Diagnosis

Based on the appearance of the bulging mass and the combined neurologic examination, it is not difficult to make a correct diagnosis. A cranial defect can sometimes be palpated at the base of the mass, including a transillumination test to see if it contains brain tissue. A plain radiograph of the skull can determine the location and extent of the bone defect.

5 Treatment

The mainstay of treatment is surgery. Huge type of meningoencephalocele, has caused severe mental retardation, paralysis, blindness and other neurological symptoms are not suitable for surgery, the efficacy of the treatment is not good, other feasible surgery. Opinions differ on the timing of the surgery, which can be performed from 6 months to 1 year after birth, or when the patient is a little older, in order to facilitate tissue repair and plastic surgery.

The goal of the surgery is to remove the bulging mass, including the contents of the capsule if possible. Repair of the dural defects and soft tissue defects is an important step in the surgery. Skull defects are usually not repaired, but certain areas such as frontal bone defects and wide orbital spacing can be corrected surgically.

The surgical approach can be extracranial versus intracranial, with the extracranial approach being used for occipital and parietal expansions and individual cases with small nasal root bone defects; the intracranial approach is mainly used for nasal root, nasopharyngeal, or orbital expansions at the base of the skull (Figs. 448, 49). Or a combined operation may be undertaken.

(1) Surgical approach (2) Exposure of the brain bulge outside the dura (3) After resection of the bulging brain tissue

(4) Plexiglas repair of the skull base defect and repair of the dura

Fig. 448 Repair of brain bulge at the nasal root of the meninges (extradural approach)

(1) Intradural exposure of brain bulge (2) Cranial cleft demonstrated after resection of the bulging brain tissue

(3) After repair of the cranial defect, the dura mater is refolded to cover the defect and sutured

Fig. 449 Repair of meningeal bulge at the root of the nose (intradural approach)

Acupuncture points for the treatment of cranial fissure Medullary foramen

The rendezvous point for the Jiao meridian, the foot-shao-yang bile meridian, the foot-yangming stomach meridian. Hanging is hanging, cranium is the skull, this point is in the temporal sides, such as hanging on the sides of the skull, so it is called hanging ...

Medulla Khong

The meeting point of the Jiao meridian, the foot Shaoyang bile meridian, and the foot Yangming stomach meridian. Hanging is hanging, cranium is the skull, this point in the temporal sides, such as hanging on both sides of the skull, so the name hanging ...

Brainstem

Between the foramen magnum and the pterodactyl. The shape of the brain stem: the lower end is thin, and the spinal cord surface groove fissure continuity, the middle and upper part of the broader. Ventral view: (1) medulla oblongata: main structure ...

Pelvic

Subcutaneous tissues → capitellar tendon membrane on the upper edge of the temporal muscle → subtendinous lax connective tissue → cranial epicondyle. Skin → subcutaneous tissue → capitellar tendon membrane. Nerves in the acupoint area, blood vessels ...

Posterior Parietal