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Background: A group of experts from different disciplines was convened to develop guidelines for the management of upper visual field impairments related to eyelid ptosis and dermatochalasis. The goal was to provide evidence-based recommendations to improve patient care., Methods: A multidisciplinary group of experts representing their specialty organizations was selected. A systematic literature review was performed including topics regarding documentation of the underlying cause for visual field impairment, selection of an appropriate surgical repair, assessment of the type of anesthesia, the use of adjunctive brow procedures, and follow-up assessments. The Grading of Recommendations, Assessment, Development, and Evaluation methodology process was used to evaluate the relevant studies. Clinical practice recommendations were developed using BRIDGE-Wiz (Building Recommendations In a Developers' Guideline Editor) software., Results: Each topic area was assessed. A clinical recommendation was made, and the relevant literature was discussed., Conclusions: The review of the literature revealed varied complication rates and diverse treatment modalities for the correction of upper visual field deficit. Strong recommendations could not be made in most topic areas because of a paucity of methodologically sound studies in the literature. More rigorously designed studies are needed to measure outcomes of interest, with fewer sources of potential error or bias., Clinical Question/level of Evidence: Therapeutic, V., (Copyright © 2022 by the American Society of Plastic Surgeons.)

Introduction: The use of distraction for treating craniosynostosis offers the potential to achieve greater calvarial enlargements than with single-staged procedures. However, distraction does require 2 operative procedures and a prolonged treatment course. We sought to compare our experience with these 2 techniques to determine relative effectiveness and to refine indications., Methods: A retrospective case-controlled review of age-matched children with syndromic synostosis undergoing anterior cranial vault enlargement utilizing either distraction or conventional remodeling was performed. Complication and reoperative rates were tracked, and results were assessed using serial anthropometric measurements., Results: Over a 19-month period, 10 children with Apert syndrome underwent calvarial enlargement, 5 by distraction (mean age 28 mo) and 5 by standard remodeling (mean age 31 mo). The average distraction distance was 26 mm. Distraction patients initially underwent 2.25 operations versus 1 operation for the remodeling group. Some aesthetically undesired skull widening was noted in 2/5 patients undergoing distraction (the youngest patients). Anthropometry (length, height, circumference, volume) revealed no significant differences between the 2 treatment groups. With a mean follow-up of 9.7 years, 2/5 distraction patients underwent secondary procedures versus 1/5 of the remodeling group., Conclusions: These analyses revealed less skull enlargement was actually achieved utilizing distraction than anticipated. We were unable to demonstrate any significant advantages of this distraction technique over our remodeling procedures with respect to either anthropometric skull measurements or the avoidance of future enlargement procedures. Given the burdens of distraction, further comparative clinical trials are needed to better refine indications for this emerging technique.

Introduction: Ectopic adrenocorticotropic hormone (ACTH) production is responsible for approximately 15% of the cases of Cushing's syndrome. Bilateral adrenalectomy is the most effective treatment for ectopic ACTH syndrome due to occult or disseminated tumors, but the open approach carries substantial morbidity. In this paper, we review our experience with laparoscopic bilateral adrenalectomy for occult ectopic ACTH syndrome., Materials and Methods: Adrenalectomies performed by the authors were identified and the outcomes of laparoscopic bilateral adrenalectomies for ectopic ACTH syndrome were examined. Bilateral adrenalectomies were performed sequentially in full lateral decubitus, with patient repositioning between the sides., Results: From 2001 to 2006, the authors performed 16 adrenalectomies in 14 patients, with 11 performed laparoscopically. Two women with occult ectopic ACTH syndrome, refractory to medical management, underwent laparoscopic bilateral adrenalectomies. Operative times were 240 and 245 minutes, including repositioning. One patient underwent a simultaneous wedge liver biopsy for a right lobar lesion. There were no complications. Each patient resumed a regular diet on the first postoperative day. Inpatient hospital stays were 3 days each, mainly for steroid-replacement management. Final pathologic diagnoses were diffuse adrenocortical hyperplasia. Both patients noted a quick improvement in Cushing's syndrome symptoms and signs and were maintained on hydrocortisone and fludrocortisone replacement without incident for over 2 years., Conclusions: Laparoscopic bilateral adrenalectomy for ectopic ACTH syndrome refractory to medical management can be performed with low morbidity. Symptoms and signs of hypercortisolism rapidly improve postoperatively.