identified the midline compared to the studies that used skull x-rays or only axial plane CTs. 1,2,10 To the best of our knowledge, this study is the first one that determined the distance of the central sulcus to and the coronal suture in adult Turkish population. CONCLUSIONSIdentifying the central sulcus relative to the coronal suture is essential to preserve the primary motor and/or sensory cortices in neurosurgical procedures. The distance of the central sulcus to the coronal suture is approximately 4.7 cm in adult patients from Turkey, which did not differ according to age or sex. ACKNOWLEDGMENTSThe authors thank Sertac ¸Gu ¨rler, Sedef Pan, Emre Yilmaz, Ali Durmaz, and Fatma Kalpakog ˘lu, and the patients without whom the study could not be done. REFERENCES1. Ebeling U, Rikli D, Huber P, et al. The coronal suture, a useful bony landmark in neurosurgery? Craniocerebral topography between bony landmarks on the skull and the brain.

but also in groups 2 and 3. In our case, the bone defect involved both the periosteum and dura mater, which could not be separated. Therefore, the bone graft could not be transplanted under the periosteum, so was transplanted onto the periosteum, which might explain why the grafted bone developed osteolysis and no osteogenesis occurred. The grafted bone, which was put back into the donor site on the dura and under the periosteum, subsequently returned to the same thickness as that measured before harvest.Large skull defects have various causes in children and require cranioplasty at a relatively young age to protect the brain and for cosmetic purposes. Although autologous bone should be used for cranioplasty in children whenever possible, other cranioplasty materials, such as artificial bone or a frozen bone allograft, may be used. In our patient, we considered that prolonged waiting was not in the interests of day-to-day safety. Given that we could not identify the cause of autologous bone resorption after the first surgery and needed to avoid resorption after a second surgery, we chose artificial bone as the material for cranioplasty. The patient is progressing well and no complications have arisen as a result of use of artificial bone. CONCLUSIONSWe have encountered a case of short-term resorption of grafted bone after split calvarial bone grafting for an occipital skull defect in a patient with multisystem LCH. To our knowledge, this is the first report of such a case. We considered 2 possible explanations for resorption of the autologous bone graft in this patient. The first possibility is that the recipient site may have contained an active lesion. In a case of LCH, even if the clinical and imaging findings indicate that the disease is in remission, treatment should proceed, whereas keeping in mind the possibility of a locally active lesion. A rapid intraoperative pathologic assessment or preoperative biopsy may need to be considered to confirm whether the lesion is active. The second possibility is that bone resorption occurred because the bone graft was placed onto the periosteum. The bone graft should be placed beneath the periosteum whenever possible.

The aim of this paper is to present how to release the nasal mucosa from the hard palate and from the lateral pharyngeal wall using palatal elevator. After mucoperiosteal flap is raised, the nasal mucosa is detached with an instrument pushed laterally behind the palatine vessels to meet the medial pterygoid plate. The palatal elevator is passed around the spine at the posterior medial border of the bony palate and then moved forward in the cleft to separate the nasal mucosa from bone. The palatal elevator is now introduced behind the greater palatine vessels, maintaining contact with the medial pterygoid plate. The elevator is pushed deeply up toward the base of the skull to elevate the lateral pharyngeal mucosa medially. When this mucosa is freed, the elevator can be moved anteriorly to separate the nasal mucosa from nasal side wall and upper surface of the hard palate. After closure of the buccal layer, 2 posterior flaps are joined to the small anterior flap. Finally, an A suture is made to hold the buccal layers together with the nasal mucosa and lateral pharyngeal mucosa to obliterate dead space. Herein, the authors present how to completely free the nasal mucosa from the hard palate and from the lateral pharyngeal wall before medial shifting and suturing. In our series of 60 cases of complete or incomplete cleft palate, fistula rate was low (6.7%), which the authors suggest was due to the low tension of the sutured nasal lining with the released lateral pharyngeal wall.

A review of the cleft lip/palate literature reveals that differential diagnosis of the facial skeleton and musculature is essential to achieve all treatment goals.

Summary: This study presents the outcomes of a conservative approach to greenstick condylar fracture treatment in an elderly patient. Serial changes of the inclination angle were measured in a greenstick fracture of the mandibular subcondyle treated with intermaxillary fixation (IMF). A 64-year-old woman presented to an outpatient clinic complaining of pain on her chin. While waiting for an elevator, she lost consciousness and hit her face on the floor. She had a limited mouth-opening of 13 mm. Panoramic radiography and computed tomography confirmed a greenstick (incomplete) fracture of the left condyle, in which the lateral side of the bone was fractured and the medial side was bent. The medial inclination was approximately 40.4 degrees. On the second post-trauma day, IMF was performed using arch-bars and a prefabricated occlusal stop. Serial Towne’s views were taken. The inclination of the fractured condyle was measured and compared with the contralateral side. The difference in inclination angles (DI) between the fractured and contralateral sides was plotted over time. In SPSS version 19.0, an exponential regression model was constructed. In this patient, a greenstick (incomplete) fracture of the condyle (40.4 degree inclination) was treated with IMF and a pre-fabricated occlusal stop. On day 42 post-IMF, the inclination angle had decreased to 15.6 degrees, only 5.4 degrees greater than the contralateral side. The DI was fitted to exponential regression model (y = 25.111e−0.028x, P = 0.004). This case shows that even in an elderly patient, a greenstick fracture of the mandibular condyle can be treated by vertical lengthening using an occlusal stop and IMF.