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  • 1
    Online-Ressource
    Online-Ressource
    NAM Therapy—Evidence-Based Results
    SAGE Publications ; 2020
    In:  The Cleft Palate-Craniofacial Journal Vol. 57, No. 4 ( 2020-04), p. 529-531
    Details
    In: The Cleft Palate-Craniofacial Journal, SAGE Publications, Vol. 57, No. 4 ( 2020-04), p. 529-531
    Kurzfassung: Many orthodontists working on patients with cleft lip and palate (CLP) have shown great enthusiasm for presurgical infant orthopedics (PSIO) to improve surgical outcomes with minimal intervention. Even though every clinician aims to use the best treatment modality for their patients, PSIO effects can be confounded by surgical type and timing of the primary repair, as is discussed in many studies. In such cases, one should be cautious when evaluating the particular outcomes for patients with CLP since it is difficult to differentiate the sole effect of an individual surgical or orthodontic intervention. As with any treatment methodology, nasoalveolar molding (NAM) has both benefits and limitations. Commonly cited concerns with NAM, and PSIO in general, include increased cost, increased burden of care, and a negative impact on maxillary growth. However, NAM cannot be deemed as having apparent long-term negative or positive effects on skeletal or soft tissue facial growth, based on previous studies. A review of the literature suggests that NAM does not alter skeletal facial growth when compared with the samples that did not receive PSIO. Nevertheless, the published studies on NAM show evidence of benefits to the patient, caregivers, the surgeon, and society. These benefits include documented reduction in severity of the cleft deformity prior to surgery and as a consequence improved surgical outcomes, reduced burden of care on the care givers, reduction in the need for revision surgery, and consequent reduced overall cost of care to the patient and society.
    Materialart: Online-Ressource
    ISSN: 1055-6656 , 1545-1569
    URL: Article
    DOI: 10.1177/1055665619899752
    RVK:
    XA 36625
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2020
    ZDB Id: 2030056-6
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 2
    Online-Ressource
    Online-Ressource
    Radiographic Optic Nerve Findings and Their Clinical Implications in the Setting of Craniomaxillofacial Trauma
    SAGE Publications ; 2021
    In:  FACE Vol. 2, No. 4 ( 2021-12), p. 475-479
    Details
    In: FACE, SAGE Publications, Vol. 2, No. 4 ( 2021-12), p. 475-479
    Kurzfassung: Purpose: Computed tomography (CT) scans obtained in the setting of facial trauma often report aberrations in neural anatomy, such as optic nerve stretching. While these findings have not yet been correlated with clinical findings, they raise concern for traumatic optic neuropathy (TON). This study aims to correlate radiographic optic nerve abnormalities with clinical findings in the setting of craniomaxillofacial trauma. Methods: Patient charts were queried based on ICD-9 codes for the presence of an orbital fracture. Patients were included if the CT report mentioned an anatomic abnormality of the optic nerve. Patients who expired within 24 hours of arrival, had an open globe injury, or who were not able to participate in a visual exam were excluded. An additional matched cohort of patients with orbital fractures and without optic nerve abnormalities was selected. The primary endpoint was a clinical diagnosis of TON, and secondary endpoints included the need for ophthalmologic intervention and the presence of abnormal visual acuity. Results: One-hundred and eight patients were included in the study (54 per group). Radiographic optic nerve stretching was not associated with an increased risk of TON (OR: 2.22, 95% CI: 0.71-7.02); however, it was associated with increased risk for abnormal visual acuity (OR: 2.24, 95% CI: 1.01-4.99). There was no increased need for any ophthalmologic intervention (OR: 1.93, 95% CI: 0.86-4.31). Conclusions: Alterations in orbital anatomy on CT are common after orbital fracture and may inappropriately raise concern for TON. This in turn may prompt interfacility transfer and/or emergent ophthalmology consultation. This study demonstrates that radiographic stretching of the optic nerve does not increase the odds for TON in the setting of orbital fractures. While patients with abnormal optic nerve findings did have a higher rate of abnormal visual acuity, this is a common, multifactorial finding in this setting.
    Materialart: Online-Ressource
    ISSN: 2732-5016 , 2732-5016
    URL: Article
    DOI: 10.1177/27325016211036998
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2021
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 3
    Online-Ressource
    Online-Ressource
    Resorbable Versus Titanium Rigid Fixation for Pediatric Mandibular Fractures: A Systematic Review, Institutional Experience and Comparative Analysis
    SAGE Publications ; 2022
    In:  Craniomaxillofacial Trauma & Reconstruction Vol. 15, No. 3 ( 2022-09), p. 189-200
    Details
    In: Craniomaxillofacial Trauma & Reconstruction, SAGE Publications, Vol. 15, No. 3 ( 2022-09), p. 189-200
    Kurzfassung: Pediatric mandible fractures mandate special consideration because of unerupted teeth, mixed dentition, facial growth and the inability to tolerate maxillomandibular fixation. No consensus exists as to whether resorbable or titanium plating systems are superior with regards to clinical outcomes. Objective: This study aims to systematically review and compare the outcomes of both material types in the treatment of pediatric mandible fractures. Methods: After PROSPERO registration, studies from 1990-2020 publishing on outcomes of ORIF of pediatric mandible fractures were systematically reviewed according to PRISMA guidelines. An additional retrospective review was conducted at a pediatric level 1 trauma center. Results: 1,144 patients met inclusion criteria (30.5% resorbable vs. 69.5% titanium). Total complication rate was 13%, and 10% required a second, unplanned operation. Complication rates in the titanium and resorbable groups were not significantly different (14% vs. 10%; P = 0.07), and titanium hardware was more frequently removed on an elective basis (P 〈 0.001). Condylar/sub-condylar fractures were more often treated with resorbable hardware (P = 0.01); whereas angle fractures were more often treated with titanium hardware (P 〈 0.001). Within both cohorts, fracture type did not increase the risk of complications, and comparison between groups by anatomic level did not demonstrate any significant difference in complications. Conclusions: Pediatric mandible fractures requiring ORIF are rare, and hardware-specific outcomes data is scarce. This study suggests that titanium and resorbable plating systems are equally safe, but titanium hardware often requires surgical removal. Surgical approach should be tailored by fracture anatomy, age-related concerns and surgeon preference.
    Materialart: Online-Ressource
    ISSN: 1943-3875 , 1943-3883
    URL: Article
    DOI: 10.1177/19433875211022573
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2022
    ZDB Id: 2493086-6
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
  • 4
    Online-Ressource
    Online-Ressource
    Characteristics of 1616 Consecutive Dog Bite Injuries at a Single Institution
    SAGE Publications ; 2017
    In:  Clinical Pediatrics Vol. 56, No. 4 ( 2017-04), p. 316-325
    Details
    In: Clinical Pediatrics, SAGE Publications, Vol. 56, No. 4 ( 2017-04), p. 316-325
    Kurzfassung: Dog bite injuries remain a common form of pediatric trauma. This single-institution study of 1616 consecutive dog bite injuries over 4 years revealed a much higher prevalence of dog bites as compared with other similar centers. Though inpatient admission was rare (9.8%), 58% of all patients required laceration repair, primarily in the emergency department. Infants were more than 4 times as likely to be bitten by the family dog and more than 6 times as likely to be bitten in the head/neck region. Children ≤5 years old were 62% more likely to require repair; and 5.5% of all patients required an operation. Pit bull bites were implicated in half of all surgeries performed and over 2.5 times as likely to bite in multiple anatomic locations as compared to other breeds. The relatively high regional prevalence and younger age of injured patients as compared with other centers is a topic of further study but should draw attention to interventions that can minimize child risk.
    Materialart: Online-Ressource
    ISSN: 0009-9228 , 1938-2707
    URL: Article
    DOI: 10.1177/0009922816657153
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2017
    ZDB Id: 2066146-0
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
  • 5
    Online-Ressource
    Online-Ressource
    Nationwide Analysis of Complex Midface Advancement in Pediatric Patients
    SAGE Publications ; 2022
    In:  FACE Vol. 3, No. 3 ( 2022-09), p. 438-447
    Details
    In: FACE, SAGE Publications, Vol. 3, No. 3 ( 2022-09), p. 438-447
    Kurzfassung: The purpose of this study was to utilize a multicenter database to better understand preexisting comorbidities, postoperative complications, and hospital financial charges for pediatric patients undergoing complex midface advancement procedures. Methods: Retrospective cohort study was conducted of patients undergoing midface advancement, including Le Fort II (LF2), Le Fort III (LF3), and Monobloc procedures in the United States between 2010 and 2020 using the Pediatric Health Information System. Preexisting comorbidities, postoperative complications, and hospital admission charges among these cohorts were analyzed. Results: During the study interval, 91 patients underwent complex midface reconstruction. Median age was 12.7 years. Postoperative complication rate was 44.0%, and LF2 procedures had fewer surgical complications than LF3 ( P  〈  .001) and Monobloc ( P  〈  .001). Distraction osteogenesis was utilized in 29.7% of midface advancement procedures. LF2 procedures were less likely to require blood transfusions than LF3 ( P  〈  .001) and Monobloc ( P  〈  .001). Hospital admission charges tripled over the last 10 years ( P = .004), and these charges varied significantly across regions of the country ( P  〈  .001). Patients undergoing LF2 had lower hospital admission charges than those undergoing LF3 ( P  〈  .001) and Monobloc ( P  〈  .001). Several patients (30.3%) chose a farther hospital than the one locally available. Conclusions: While midface advancement procedures are conceptually grouped together, LF2 has significantly lower surgical complications, blood transfusions, hospital lengths of stay, hospital admission charges, ICU lengths of stay, and ICU charges than LF3 or Monobloc procedures.
    Materialart: Online-Ressource
    ISSN: 2732-5016 , 2732-5016
    URL: Article
    DOI: 10.1177/27325016221108338
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2022
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
  • 6
    Online-Ressource
    Online-Ressource
    Reductive Otoplasty and Facial Debulking in a Pediatric Patient With PIK3CA -Related Overgrowth
    SAGE Publications ; 2021
    In:  FACE Vol. 2, No. 4 ( 2021-12), p. 514-518
    Details
    In: FACE, SAGE Publications, Vol. 2, No. 4 ( 2021-12), p. 514-518
    Kurzfassung: Overgrowth syndromes encompass a number of rare genetic diseases with heterogeneous clinical phenotypes. Accordingly, there is a strong imperative to collect data and classify these disorders to aid in diagnosis and management. Recent advances in the genetics of overgrowth syndromes have identified mutations in the PIK3CA gene. These somatic mutations manifest in progressive segmental overgrowth of fibrous and adipose tissue and bone, vascular malformations, and in some cases, increased risk for malignancy. Targeted medical therapy is under investigation for the management of PROS, but treatment of overgrowth relies on surgical debulking. Macrotia in PIK3CA-related overgrowth spectrum (PROS) has not been reported in the literature. In this case, we discuss a novel approach to reductive otoplasty and facial soft tissue debulking in a pediatric patient with PROS.
    Materialart: Online-Ressource
    ISSN: 2732-5016 , 2732-5016
    URL: Article
    DOI: 10.1177/27325016211048207
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2021
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
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