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Fractures in the pediatric population are less common than in adults. Facial fractures represent only 4%-5% of total trauma in infants. Osteogenesis imperfecta is a group of genetic disorders where multiple fractures can occur even in early years of life. Long-term treatment with bisphosphonates is currently used in these children in order to increase bone strength and to alleviate symptoms. This paper reports a rare case of a traumatic fracture of the mandible in a 4-year-old child with osteogenesis imperfecta type I. This is an unusual complication in children, even in this group of patients. Open reduction and rigid fixation are not often described as the best treatment. As there are controversies about the subject, a literature review and discussion are presented.

RESUMEN Las anomalías del cuarto arco branquial son extremadamente infrecuentes y habitualmente se presentan como tumoraciones cervicales asintomáticas o infecciones recurrentes del cuello. El diagnóstico se establece mediante la realización de una adecuada anamnesis y exploración física, así como con pruebas de imagen complementarias. La exéresis quirúrgica completa constituye el gold standard de tratamiento. Presentamos el caso de una neonata con un quiste de la cuarta hendidura branquial que comenzó como una masa laterocervical izquierda asintomática, que fue diagnosticado mediante ecografía y resonancia magnética nuclear y tratado quirúrgicamente de manera precoz.

Purpose The purpose of this study is to assess the incidence of airway anomalies in children with severe craniofacial syndromes and to establish the role of bronchoscopy in the care of these patients. Methods Consecutive children with craniofacial syndromes, including both bony deformities of the skull and face, in which a bronchoscopy was performed between 1995 and 2010 were retrospectively reviewed. Results Thirty-six patients (22 boys, 14 girls; mean age, 39 months) were studied. Craniofacial synostosis was present in 21 patients (Crouzen syndrome, 11; Apert syndrome, 7, Pfeiffer syndrome, 3) and craniofacial dysostosis in 15 (Goldenhart syndrome, 8; Treacher Collins syndrome, 7). In 30 patients (83.3%), bronchoscopy was performed because of respiratory symptoms (apneic episodes, 22; respiratory distress, 13; stridor, 6; cyanosis, 1) and, in the remaining 6 (asymptomatic children), during guided tracheal intubation before a surgical procedure. Airway anomalies were found in 69.4% of patients (70% in symptomatic patients). Management consisted of tracheotomy in 13 patients, adenoidectomy/tonsillectomy in 13, glossopexy in 5, antireflux surgery in 3, and supraglottoplasty in 2. Conclusions Airway anomalies occurred in 70% of children with severe craniofacial syndromes and respiratory symptoms. Bronchoscopy should be performed routinely in this selected group of patients, and the entire airway must be examined. Treatment should be tailored to each individual patient.

Esta revisión presenta la infiltración de grasa autóloga como un procedimiento de gran utilidad para el relleno de las partes blandas faciales con objetivos estéticos o reconstructivos. Se ha realizado una revisión sobre los procedimientos de lipoescultura de la literatura publicada en PubMed. Se describen la técnica de Coleman, la técnica subdérmica, y la infiltración intramuscular, así como sus principales modificaciones, y los agentes estudiados y usados para incrementar la tasa de mantenimiento del injerto graso.This review shows that autologous fat grafting is useful for filling the soft tissues of the face for cosmetic and reconstructive purposes. The literature on liposculpture techniques published on PubMed was reviewed. The Coleman technique, subdermal technique, and intramuscular infiltration are described, in addition to their primary modifications, and the agents used to improve fat graft maintenance were studied.

ResumenEsta revisión presenta la infiltración de grasa autóloga como un procedimiento de gran utilidad para el relleno de las partes blandas faciales con objetivos estéticos o reconstructivos. Se ha realizado una revisión sobre los procedimientos de lipoescultura de la literatura publicada en PubMed. Se describen la técnica de Coleman, la técnica subdérmica, y la infiltración intramuscular, así como sus principales modificaciones, y los agentes estudiados y usados para incrementar la tasa de mantenimiento del injerto graso.AbstractThis review shows that autologous fat grafting is useful for filling the soft tissues of the face for cosmetic and reconstructive purposes. The literature on liposculpture techniques published on PubMed was reviewed. The Coleman technique, subdermal technique, and intramuscular infiltration are described, in addition to their primary modifications, and the agents used to improve fat graft maintenance were studied.

Objective To assess the incidence of airway obstruction symptoms and the presence of obstructive sleep apnea in children with severe craniofacial anomalies by a proactive screening program using a standard questionnaire and cardiorespiratory polygraphy. Patients and methods Children with severe craniofacial anomalies referred to our paediatric airway unit from February 2001 to June 2011 were eligible to be included in this retrospective, single centre study. Symptoms of airway obstruction were proactively investigated using the shorter version of the Pediatric Sleep Questionnaire (PSQ). Obstructive sleep apnea was assessed by means of cardiorespiratory polygraphy. Demographic data and reason for referral were also recorded. Primary outcomes were the prevalence of symptoms of airway obstruction and OSA. Results 44 children (24 girls) with severe craniofacial anomalies (15 Crouzon, 13 Apert, 9 Goldenhar, 5 Treacher-Collins, 2 Pfeiffer) were included, at a mean age of 5 years (range 8 months to 14 years). Reason for referral was routine follow up in 30 patients and overt OSA symptoms and signs in the remaining 14. PSQ results showed symptoms of airway obstruction in 82% of patients, being snoring the most frequent symptom (64.1%) followed by apneas (33.3%). Polygraphic studies showed inconclusive results in 8 children (18.2%), normal apnea–hypopnea index (AHI) in 16 (36.4%), mild obstructive sleep apnea in 9 (20.4%), moderate in 4 (9.1%) and severe obstructive sleep apnea in 7 (15.9%). Conclusions Children with craniofacial anomalies have a high prevalence of symptoms of airway obstruction and obstructive sleep apnea that support a proactive screening strategy in this highly selected population.