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  • 1
    Online Resource
    Online Resource
    Transfacial Two-pin External Mandibular Distraction Osteogenesis: A Technique for Neonatal Airway Obstruction from Robin Sequence
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Plastic and Reconstructive Surgery - Global Open Vol. 11, No. 6 ( 2023-06-15), p. e5085-
    Details
    In: Plastic and Reconstructive Surgery - Global Open, Ovid Technologies (Wolters Kluwer Health), Vol. 11, No. 6 ( 2023-06-15), p. e5085-
    Abstract: Surgical management in those with moderate-to-severe airway obstruction includes tongue-lip adhesion, tracheostomy, and/or mandibular distraction osteogenesis. This article describes a transfacial two-pin external device technique for mandibular distraction osteogenesis, utilizing minimal dissection. Methods: The first percutaneous pin is transcutaneously placed just inferior to the sigmoid notch parallel to the interpupillary line. The pin is then advanced through the pterygoid musculature at the base of the pterygoid plates, toward the contralateral ramus, and exits the skin. A second parallel pin is placed spanning the bilateral mandibular parasymphysis distal to the region of the future canine. With the pins in place, bilateral high ramus transverse corticotomies are performed. Using univector distractor devices, the length of activation varies, with the goal of overdistraction to achieve a class III relationship of the alveolar ridges. Consolidation is limited to a 1:1 period with the activation phase, and removal is performed by cutting and pulling the pins out of the face. Results: To guide optimal transcutaneous pin placement, transfacial pins were then placed through twenty segmented mandibles. Mean upper pin (UP) distance was 20.7 ± 1.1 mm from the tragus. The distance between the cutaneous entry of the UP and lower pin was 23.5 ± 0.9 mm, and the tragion-UP-lower pin angle was 118.7 ± 2.9°. Conclusions: The two-pin technique has potential advantages regarding nerve injury and mandibular growth, given an intraoral approach with limited dissection. It may safely be performed on neonates whose small size may preclude the use of internal distractor devices.
    Type of Medium: Online Resource
    ISSN: 2169-7574
    URL: Article
    DOI: 10.1097/GOX.0000000000005085
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 2723993-7
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  • 2
    Online Resource
    Online Resource
    Public Perceptions of Normal and Ideal Head Shape: A Crowdsourced Survey Analysis
    SAGE Publications ; 2023
    In:  FACE Vol. 4, No. 1 ( 2023-03), p. 33-38
    Details
    In: FACE, SAGE Publications, Vol. 4, No. 1 ( 2023-03), p. 33-38
    Abstract: Cephalic index (CI) is an objective measure of head shape used by craniofacial surgeons to support a diagnosis of head shape abnormality. However, the consensus on what values correspond to a normal head shape are changing following the Back to Sleep campaign. Recent work has shown an increase in mean CI from 74 to 84. Following this shift, no study has been undertaken to evaluate whether the perception of normal head shape has changed as well. Methods: About 1020 subjects, 18 or older, were recruited through Amazon Turk crowdsourcing platform. Subjects were asked to select the head shapes they considered most normal in a series of questions identifying ideal head shape in children 6 months or younger. Demographic information was recorded for study participants to identify differing ethnic perceptions of head shape. Results: The mean cephalic index preferred by a crowdsourced population was 81.84 (SD 2.48). There was a difference in mean preferred CI between people who identified as black (CI = 82.875) and people who identified as white (CI = 81.500; P = .00062). There was no difference in mean preferred CI between males and females. Education level, age healthcare occupation status, medical literacy, and work involving children did not affect preference. Conclusions: The typical head shape has changed following the Back to Sleep campaign and the current perception of head shape aligns with the newly described norm as opposed to the historic population data. Criteria for intervention and outcome goals should be adjusted accordingly.
    Type of Medium: Online Resource
    ISSN: 2732-5016 , 2732-5016
    URL: Article
    DOI: 10.1177/27325016221130938
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
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  • 3
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    Online Resource
    Impact of Minor Suture Fusion on Midface Hypoplasia in Syndromic Craniosynostosis
    SAGE Publications ; 2023
    In:  FACE Vol. 4, No. 1 ( 2023-03), p. 55-63
    Details
    In: FACE, SAGE Publications, Vol. 4, No. 1 ( 2023-03), p. 55-63
    Abstract: Early onset of minor suture fusion in syndromic craniosynostosis is associated with midface dysplasia and is a common indication for craniofacial surgery. However, the potential effects of fusion severity on craniofacial growth patterns are not well understood. This study seeks to describe the impact of minor suture fusion severity on midface morphology in Crouzon syndrome. Methods: Pre-operative computed tomography images (CT) of 63 patients with Crouzon syndrome and 63 normocepahlic controls were included. Degree of suture fusion was assessed for the frontosphenoidal, sphenethmoidal, sphenosquamosal, sphenopetrosal, spheno-occipital synchondrosis, frontoethmoidal, and zygomaticosphenoidal sutures. Each suture was graded on a 5-point scale. The sella (S), nasion (N), A point (A), basion (BA), and anterior nasal spine (ANS) landmarks were used to calculate the SNA angle, BA-ANS length of the lower midface, and N-S length of the upper midface. Multiple linear regressions were used to analyze data. Results: The mean age was 43 months and 44% were female. The control group was significantly older ( P  〈  .01) than the patients with Crouzon syndrome. Advanced fusion of the spheno-occipital synchondrosis in Crouzon syndrome correlates with regression of the BA-ANS length by 0.563 mm per incremental increase in suture fusion ( P  〈  .01). Additionally, the lower midface (BA-ANS) was restricted to a greater degree than the upper midface (N-S) with progressive suture fusion in all patient types with ratios of these rates ranging between 0.602 and 0.89 for the 7 sutures analyzed. Suture fusion severity did not impact the SNA angle in any of the analyses performed. Conclusion: The severity of sheno-occipital synchondrosis fusion in Crouzon syndrome contributes to midface hypoplasia. Similarly, all anterior skull base sutures limited lower midface growth to a greater degree than the upper midface.
    Type of Medium: Online Resource
    ISSN: 2732-5016 , 2732-5016
    URL: Article
    DOI: 10.1177/27325016231153179
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
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  • 4
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    Online Resource
    Measure of Frontal Morphology in Sagittal Craniosynostosis: The Frontal Bossing Index
    SAGE Publications ; 2022
    In:  FACE Vol. 3, No. 3 ( 2022-09), p. 396-402
    Details
    In: FACE, SAGE Publications, Vol. 3, No. 3 ( 2022-09), p. 396-402
    Abstract: Frontal bossing is a prominent forehead feature common in sagittal craniosynostosis (SC). Assessment of severity of frontal bossing is limited by the use of serial CT imaging or complex computer programing. Three-dimensional measurements of cranial surface morphology provide a radiation-free alternative for assessing cranial shape. This study describes the creation of a frontal bossing index (FBI), a novel tool using surface morphology to assess the frontal severity in patients with SC. Methods: Surface imaging from CT scans or 3D photographs of 359 individuals with sagittal craniosynostosis and 224 normocephalic individuals were compared to identify differences in frontal morphology. Cartesian grids were created on each individual’s surface mesh using equidistant axial and sagittal planes yielding 33 unique points of intersection on the forehead. Area under the curve (AUC) analyses were performed to identify frontal points with the greatest discrepancy between groups. Results: All points in the SC population had significantly greater protrusion than corresponding points in the control group. The largest differences were located in the superior lateral regions. Combining the superior- and lateral-most points gave the maximal AUC (0.9707) and was therefore selected to generate the frontal bossing index (FBI). The FBI distinguished between the 2 groups with a sensitivity of 93.5% and specificity of 92.9%. Conclusions: The frontal bossing index is a useful tool for evaluating the severity of the frontal region in patients with SC, comparing outcomes of differing surgical techniques, and tracking frontal changes in individuals over time, without the need for radiation.
    Type of Medium: Online Resource
    ISSN: 2732-5016 , 2732-5016
    URL: Article
    DOI: 10.1177/27325016221116768
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
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  • 5
    Online Resource
    Online Resource
    36. Cephalometric Imaging Sheds Light on the Effects of Mandibular Distraction on Infants with Robin Sequence
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Plastic and Reconstructive Surgery - Global Open Vol. 11, No. 5S ( 2023-05), p. 23-24
    Details
    In: Plastic and Reconstructive Surgery - Global Open, Ovid Technologies (Wolters Kluwer Health), Vol. 11, No. 5S ( 2023-05), p. 23-24
    Type of Medium: Online Resource
    ISSN: 2169-7574
    URL: Article
    DOI: 10.1097/01.GOX.0000937740.04460.d1
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 2723993-7
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  • 6
    Online Resource
    Online Resource
    Morphology of the Occipital Bones and Foramen Magnum Resulting From Premature Minor Suture Fusion in Crouzon Syndrome
    SAGE Publications ; 2023
    In:  The Cleft Palate Craniofacial Journal Vol. 60, No. 5 ( 2023-05), p. 591-600
    Details
    In: The Cleft Palate Craniofacial Journal, SAGE Publications, Vol. 60, No. 5 ( 2023-05), p. 591-600
    Abstract: To identify skull-base growth patterns in Crouzon syndrome, we hypothesized premature minor suture fusion restricts occipital bone development, secondarily limiting foramen magnum expansion. Skull-base suture closure degree and cephalometric measurements were retrospectively studied using preoperative computed tomography (CT) scans and multiple linear regression analysis. Evaluation of multi-institutional CT images and 3D reconstructions from Wake Forest’s Craniofacial Imaging Database (WFCID). Sixty preoperative patients with Crouzon syndrome under 12 years-old were selected from WFCID. The control group included 60 age- and sex-matched patients without craniosynostosis or prior craniofacial surgery. None 2D and 3D cephalometric measurements. 3D volumetric evaluation of the basioccipital, exo-occipital, and supraoccipital bones revealed decreased growth in Crouzon syndrome, attributed solely to premature minor suture fusion. Spheno-occipital (β = −398.75; P  〈  .05) and petrous-occipital (β = −727.5; P  〈  .001) suture fusion reduced growth of the basioccipital bone; lambdoid suture (β = −14 723.1; P  〈  .001) and occipitomastoid synchondrosis (β = −16 419.3; P  〈  .001) fusion reduced growth of the supraoccipital bone; and petrous-occipital suture (β = −673.3; P  〈  .001), anterior intraoccipital synchondrosis (β = −368.47; P  〈  .05), and posterior intraoccipital synchondrosis (β = −6261.42; P  〈  .01) fusion reduced growth of the exo-occipital bone. Foramen magnum morphology is restricted in Crouzon syndrome but not directly caused by early suture fusion. Premature minor suture fusion restricts the volume of developing occipital bones providing a plausible mechanism for observed foramen magnum anomalies.
    Type of Medium: Online Resource
    ISSN: 1055-6656 , 1545-1569
    URL: Article
    DOI: 10.1177/10556656211072762
    RVK:
    XA 36625
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
    detail.hit.zdb_id: 2030056-6
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  • 7
    Online Resource
    Online Resource
    “Primary Correction of the Cleft Nasal Septum: A Systematic Review”
    SAGE Publications ; 2022
    In:  The Cleft Palate-Craniofacial Journal
    Details
    In: The Cleft Palate-Craniofacial Journal, SAGE Publications
    Abstract: Patients affected by cleft lip and palate have a characteristic nasal deformity; however, the treatment timeline varies amongst providers. There has been a shift from a more conservative approach to earlier intervention in order to allow for more normal development of the nose. Form, function, and future development all must be considered. For this reason, this investigation was undertaken to present the current literature available on the effects to all aspects of primary septoplasty in the cleft nasal deformity. An initial list of 222 papers was identified, and it was determined that 16 papers fit the inclusion criteria. Studies were included in which the initial age of operation for the majority of patients was between 3 and 12 months and in which patients underwent septal repositioning at the time of cleft lip repair. These papers were all reviewed by a single author initially, and the results recorded. All results were then verified by a second author for accuracy and completeness. Symmetry was found to be improved by primary septoplasty. Growth was not found to be impaired in any study; data was insufficient to indicate that growth was improved. Obstruction was improved as determined both by imaging, endoscopy, and patient survey. Finally, reoperation rates occurred at an acceptable rate not exceeding that of primary rhinoplasty without septoplasty. Primary septoplasty leads to better aesthetic symmetry and function of the cleft nose without impairing growth. This change is maintained into adulthood often without the need for revisionary surgery.
    Type of Medium: Online Resource
    ISSN: 1055-6656 , 1545-1569
    URL: Article
    DOI: 10.1177/10556656221127539
    RVK:
    XA 36625
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2030056-6
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  • 8
    Online Resource
    Online Resource
    The Need for Additional Surgery after Passive versus Active Approaches to Syndromic Craniosynostosis: A Meta-analysis
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Plastic and Reconstructive Surgery - Global Open Vol. 11, No. 3 ( 2023-03-15), p. e4891-
    Details
    In: Plastic and Reconstructive Surgery - Global Open, Ovid Technologies (Wolters Kluwer Health), Vol. 11, No. 3 ( 2023-03-15), p. e4891-
    Abstract: Endoscopically assisted craniofacial surgery (EACS) has numerous advantages over traditional, open approaches, such as fronto-orbital advancement in treating nonsyndromic craniosynostosis. However, several articles report high reoperation rates in syndromic patients treated with EACS. This meta-analysis and review examines undesirable outcome rates (UORs), defined as reoperation or Whitaker category III/IV, in syndromic patients undergoing primary EACS compared with procedures that actively expand the cranial vault. Methods: PubMed and Embase were searched in June 2022 to identify all articles reporting primary reoperation or Whitaker outcomes for syndromic patients undergoing cranial vault expanding surgery or suturectomy. A meta-analysis of proportions was performed comparing UORs, and a trim-and-fill adjustment method was used to validate sensitivity and assess publication bias. Results: A total of 721 articles were screened. Five EACS articles (83 patients) and 22 active approach articles (478 patients) met inclusion criteria. Average UORs for EACS and active approaches were 26% (14%–38%) and 20% (13%–28%), respectively ( P = 0.18). Reoperation occurred earlier in EACS patients (13.7 months postprimary surgery versus 37.1 months for active approaches, P = 0.003). Relapse presentations and reason for reoperation were also reviewed. Subjectively, EACS UORs were higher in all syndromes except Apert, and Saethre-Chotzen patients had the highest UOR for both approaches. Conclusions: There was no statistically significant increase in UORs among syndromic patients treated with EACS compared with traditional approaches, although EACS patients required revision significantly sooner. Uncertainties regarding the long-term efficacy of EACS in children with syndromic craniosynostosis should be revisited as more data become available.
    Type of Medium: Online Resource
    ISSN: 2169-7574
    URL: Article
    DOI: 10.1097/GOX.0000000000004891
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 2723993-7
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