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  • 1
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    Online Resource
    Patients With a History of Oronasal Fistula Repair Exhibit Lower Oral Health Measured With Patient-Centric Outcomes Measures
    SAGE Publications ; 2021
    In:  The Cleft Palate-Craniofacial Journal Vol. 58, No. 9 ( 2021-09), p. 1142-1149
    Details
    In: The Cleft Palate-Craniofacial Journal, SAGE Publications, Vol. 58, No. 9 ( 2021-09), p. 1142-1149
    Abstract: Oronasal fistulae following palatoplasty may affect patients’ quality of life by impacting their ability to eat, speak, and maintain oral hygiene. We aimed to quantify the impact of previous oronasal fistula repair on patients’ quality of life using patient-reported outcome psychometric tools. Methods: A cross-sectional study of 8- to 9-year-old patients with cleft palate and/or lip was completed. Patients who had a cleft team clinic between September 2018 and August 2019 were recruited. Participants were divided into 2 groups (no fistula, prior fistula repair). Differences in the individual CLEFT-Q and Child Oral Health Impact Profile-Short Form 19 (COHIP-SF 19) Oral Health scores between the 2 groups were evaluated using a multivariate analysis controlling for Veau classification and syndromic diagnosis. Results: Sixty patients with a history of cleft palate were included. Forty-two (70%) patients had an associated cleft lip. Thirty-two (53.3%) patients had no history of fistula and 28 (46.7%) patients had undergone a fistula repair. CLEFT-Q Dental, Jaw, and Speech Function were all higher in patients without a history of a fistula repair; however, none of these differences were statistically significant. The COHIP-SF 19 Oral Health score demonstrated a significantly lower score in the fistula group, indicating poorer oral health ( P = .05). Conclusions: One would expect that successful repair of a fistula would result in improved function and patient satisfaction, but the consistent trend toward lower CLEFT-Q scores and significantly increased COHIP-SF 19 Oral Health scores in our study group suggests that residual effects linger and that the morbidity of a fistula may not be completely treated with a secondary correction.
    Type of Medium: Online Resource
    ISSN: 1055-6656 , 1545-1569
    URL: Article
    DOI: 10.1177/1055665620981331
    RVK:
    XA 36625
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
    detail.hit.zdb_id: 2030056-6
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  • 2
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    Monobloc Facial Advancement in the World of COVID-19 Testing: A New Potential Risk for Iatrogenic Injury
    SAGE Publications ; 2021
    In:  FACE Vol. 2, No. 1 ( 2021-03), p. 39-44
    Details
    In: FACE, SAGE Publications, Vol. 2, No. 1 ( 2021-03), p. 39-44
    Abstract: Background: Monobloc advancement with distraction is a holistic approach to treat the sequelae of syndromic craniosynostosis. These osteotomies create a communication between the nasal cavity and anterior cranial fossa that must be surgically obliterated to limit the infectious risks. In light of mandatory COVID-19 testing protocols amidst the pandemic, we aim to identify the specific challenges in management and present our strategy to overcome them. Case presentation: We report 2 cases of syndromic craniosynostosis treated with monobloc distraction during the COVID-19 pandemic and highlight safety concerns and our approach to managing these patients by avoiding nasopharyngeal swabs that may potentially penetrate the cranial base and place the patient as risk for iatrogenic injury. Discussion/conclusion: In patients undergoing surgical procedures that create a cranial base defect, caution must be exercised when attempting to test for COVID-19 which may be a source of potential iatrogenic injury. We propose a new algorithm for COVID-19 screening/surveillance following frontofacial advancement. Patients must be screened via alternative testing methods or treated as potential asymptomatic carriers of COVID-19 until postoperative imaging demonstrates complete ossification of the cranial base.
    Type of Medium: Online Resource
    ISSN: 2732-5016 , 2732-5016
    URL: Article
    DOI: 10.1177/2732501620986955
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
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  • 3
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    Home Range, Habitat Use and Food Habits of Re-Introduced Gaur ( Bos Gaurus Gaurus ) in Bandhavgarh Tiger Reserve, Central India
    SAGE Publications ; 2013
    In:  Tropical Conservation Science Vol. 6, No. 1 ( 2013-03), p. 50-69
    Details
    In: Tropical Conservation Science, SAGE Publications, Vol. 6, No. 1 ( 2013-03), p. 50-69
    Abstract: Gaur, which became locally extinct before 1995 in Bandhavgarh Tiger Reserve (BTR), Central India, is an endangered animal per Schedule - I of the Indian Wildlife Protection Act (1972). A re-introduction program was therefore created to rebuild the gaur population in BTR, both to enhance the long-term survival of the species and to restore natural biodiversity. After re-introduction, the home range, habitat use and food habits of gaur (Bos gaurus gaurus) were studied in BTR, India, from January 2011 to January 2012. Nineteen gaurs (five males - three radio-collared and 14 females - nine radio-collared) were re-introduced from Kanha Tiger Reserve to Bandhavgarh Tiger Reserve in January 2011. The reintroduced gaurs were monitored periodically through ground tracking and satellite GPS fixes. The mean annual group size of gaur was estimated at 7.3 ± 0.76 (SE). The overall estimated summer, monsoon and winter home ranges of gaur were 290 km 2 , 137 km 2 and 155 km 2 (Minimum Convex Polygon) respectively. The overall individual male home ranges varied from 135 to 142 km 2, and overall individual female home ranges varied from 32 to 169 km 2 . Radio collared locations were plotted on a classified (LISS III) habitat map of Bandhavgarh Tiger Reserve to evaluate the habitat use and availability in each season. Habitat preference was computed using Bonferroni confidence interval method, compositional analysis and Ivlev's index. In summer, gaur largely preferred grassland (P 〈 0.0001), whereas in monsoon and winter, gaur preferred bamboo mixed forest (P 〈 0.0001). Gaur avoi ded open mixed forest (P 〈 0.0001) and agricultural land in all three seasons. Data on food habits were collected through opportunistic sightings. In total, gaur fed on 68 plant species. The present study has reported first-time information on ranging patterns of reintroduced gaur and their degree of preferences for different vegetation and terrain types across seasons, which will be very useful to the park administration for future conservation of this endangered species and for habitat intervention.
    Type of Medium: Online Resource
    ISSN: 1940-0829 , 1940-0829
    URL: Article
    DOI: 10.1177/194008291300600108
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2013
    detail.hit.zdb_id: 2496920-5
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  • 4
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    Determination of Ethnic Variation in Infant Nasolabial Anthropometry Using 3D Photographs: Implications for Bilateral Cleft Lip Nasal Correction
    SAGE Publications ; 2022
    In:  The Cleft Palate-Craniofacial Journal Vol. 59, No. 6 ( 2022-06), p. 693-700
    Details
    In: The Cleft Palate-Craniofacial Journal, SAGE Publications, Vol. 59, No. 6 ( 2022-06), p. 693-700
    Abstract: We aimed to assess significant ethnic variabilities in infants’ nasolabial anthropometry to motivate variations in surgical correction of a synchronous bilateral cleft lip/nasal anomaly, specifically whether a long columella is a European feature, therefore accepting a short columella and/or delayed columellar lengthening suitable for reconstruction in ethnic patients. Methods: Thirty-three infants without craniofacial pathology (10 African American [AA], 7 Hispanic [H] , and 16 of European descent [C]), ages 3 to 8 months, presenting to the Johns Hopkins All Children’s general pediatric clinic were recruited. Four separate 3D photographs (2 submental and frontal views each) were taken using the Vectra H1 handheld camera (Canfield Imaging). Eighteen linear facial distances were measured using Mirror 3D analysis (Canfield Imaging Systems). Difference between ethnicities was measured using analysis of variance with the Bonferroni/Dunn post hoc comparisons. Pearson correlation was employed for interrater reliability. All statistical analyses were carried out using SPSS version 21.0 (IBM Corp), with statistical significance set at P 〈 .05. Results: Nasal projection (sn-prn) and columella length (sn-c) did not differ significantly between groups ( P = .9). Significant differences were seen between ethnic groups in nasal width (sbal-sbal [C-AA; P = .02]; ac-ac [C-AA; P = .00; H-AA; P = .04] ; al-al [C-AA; P = .00; H-AA; P = .001]) and labial length (sn-ls [C-AA; P = .041] ; sn-sto [C-AA; P = .005]; Cphs-Cphi L [C-AA; P = .013] ; Cphs-Cphi R [C-AA; P = .015]). Interrater reliability was good to excellent and significantly correlated for all measures. Conclusions: African American infants exhibited wider noses and longer lips. No difference was noted in nasal projection or columella length, indicating that these structures should be corrected during the primary cleft lip and nasal repair for all patients and should not be deferred to secondary correction.
    Type of Medium: Online Resource
    ISSN: 1055-6656 , 1545-1569
    URL: Article
    DOI: 10.1177/10556656211024470
    RVK:
    XA 36625
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2030056-6
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  • 5
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    Quantification of Soft Tissue Loss among Patients with Peripheral Arterial Disease
    SAGE Publications ; 2016
    In:  Journal for Vascular Ultrasound Vol. 40, No. 1 ( 2016-03), p. 20-23
    Details
    In: Journal for Vascular Ultrasound, SAGE Publications, Vol. 40, No. 1 ( 2016-03), p. 20-23
    Abstract: Tissue atrophy is known to occur amongst patients with peripheral arterial disease (PAD). We report quantification and assessment of severity of calf tissue atrophy amongst patients with PAD. Patient types Calf atrophy amongst patients who presented for peripheral transluminal angioplasty (PTA) at the Institute for Cardiovascular excellence (ICE) in 2012 was assessed using X-ray methods (n = 48). This cohort has the most severe PAD. Patients suspected of having PAD were assessed using lower extremity arterial ultrasound (LAU) and had their calves measured with a tape. This group had patients with (n = 355) and without (n = 245) PAD. Not all of those with PAD needed angiography and PTA thus these represent patients with moderate to severe PAD. The third cohort included patients from National Health and Nutritional Examination survey (NHANES) and included normal patients without PAD (n = 6391), those with abnormal ankle brachial index (ABI) (n = 422). These represent those with mild to moderate PAD. Amongst NHANES patients, those who either had no ABI or un-interpretable ABI were excluded from analysis (n = 2332). Calf Measurement Tape measurement of calf circumference followed the method adopted in NHANES and identified the widest portion of the calf with the patient in the seated position. Calf circumference from X-ray involved visualization of both edges of soft tissue at calf level. A visible catheter of known size in the same run was used for calibration. Using measured soft tissue diameter from X-ray calf circumference was calculated. Data Analysis Data analysis included descriptive statistics and generalized linear modeling after data cleaning and transformation. Results After adjusting for all other factors, the odds of having PAD per centimeter increase in calf circumference are 0.88. Compared with smokers, nonsmokers' odds of PAD are 0.42. Odds of PAD among nonhypertensives are 0.58 in comparison to the hypertensives. Implications of our findings Among patients who present to the doctors' office for routine assessment, if calf circumference width were to be measured as a part of physical examination using 36.5 cm as a cutoff to help identify PAD patients. These patients could then undergo a more careful assessment for PAD.
    Type of Medium: Online Resource
    ISSN: 1544-3167 , 1544-3175
    URL: Article
    DOI: 10.1177/154431671604000103
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2016
    detail.hit.zdb_id: 2127200-1
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  • 6
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    Quality of life of stroke survivors and their primary caregivers in Pakistan
    SAGE Publications ; 2016
    In:  International Journal of Stroke Vol. 11, No. 3 ( 2016-04), p. NP34-NP35
    Details
    In: International Journal of Stroke, SAGE Publications, Vol. 11, No. 3 ( 2016-04), p. NP34-NP35
    Type of Medium: Online Resource
    ISSN: 1747-4930 , 1747-4949
    URL: Article
    DOI: 10.1177/1747493015626153
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2016
    detail.hit.zdb_id: 2211666-7
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  • 7
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    A Survey of Bone Grafting Practice Patterns in North American Cleft Surgeons
    SAGE Publications ; 2023
    In:  The Cleft Palate Craniofacial Journal Vol. 60, No. 11 ( 2023-11), p. 1366-1375
    Details
    In: The Cleft Palate Craniofacial Journal, SAGE Publications, Vol. 60, No. 11 ( 2023-11), p. 1366-1375
    Abstract: Alveolar bone grafting aims to restore bony continuity of the alveolus and provide optimal periodontal support for teeth adjacent to the cleft. We created a survey of cleft surgeons to assess the current standard of care regarding this procedure. Methods A multiple choice survey was implemented using Qualtrics software and emailed to a list of 708 surgeons from the ACPA membership directory. Correlation between various provider factors and treatment practices was assessed with Fisher's exact test and likelihood ratio tests. Results The response rate was 17.5%. Eighty-seven percent of providers preferred to perform grafts prior to secondary canine eruption while 10% favored before central incisor eruption. Eighty-one percent favored palatal expansion prior to bone grafting. Wide variability existed regarding the time to initiate postoperative orthodontics; 43% waited 4 to 6 months. Sixty-four percent of surgeons now utilize cone beam CT to assess graft take. The majority of respondents utilized cancellous bone autograft (92%) from the anterior iliac crest (97%) as graft material. Seventy percent used three or more modalities for post-operative pain control management. Early career surgeons (0–5 years) appeared more likely to use non-autologous materials ( p  〈  .01) for grafting. Conclusion Alveolar bone grafting prior to secondary canine eruption remains the most common strategy but other protocols are employed. Surgeons utilize multiple modalities for radiographic evaluation and most often use autologous cancellous bone as the primary grafting material. There is no true consensus on the perioperative timing and sequencing of orthodontic manipulation while principles of multimodal perioperative pain control appear widely accepted.
    Type of Medium: Online Resource
    ISSN: 1055-6656 , 1545-1569
    URL: Article
    DOI: 10.1177/10556656221104937
    RVK:
    XA 36625
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
    detail.hit.zdb_id: 2030056-6
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  • 8
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    An Algorithmic Approach for Deploying Buccal Fat Pad Flaps and Buccal Myomucosal Flaps Strategically in Primary and Secondary Palatoplasty
    SAGE Publications ; 2023
    In:  The Cleft Palate Craniofacial Journal Vol. 60, No. 7 ( 2023-07), p. 865-874
    Details
    In: The Cleft Palate Craniofacial Journal, SAGE Publications, Vol. 60, No. 7 ( 2023-07), p. 865-874
    Abstract: Recent publications have introduced the use of buccal myomucosal and fat pad flaps to augment palatal repairs with autologous tissue. We propose a workflow for intraoperative decision-making to introduce these adjuncts into standard palatoplasty procedures. Design/Patients A retrospective chart review of a single-surgeon series of patients undergoing primary and secondary palatoplasties performed between October 2017 and November 2020 was completed after Institutional Review Board approval. Main Outcome Measures Patient demographics, phenotype, operative details, and postoperative complications were recorded. Results Fifty-eight patients were included in a review. For those undergoing primary repair, 23.3% underwent a Furlow palatoplasty alone, 46.3% had a Furlow palatoplasty accompanied with acellular dermal matrix (ADM) and/or a buccal fat flap (BFF). A unilateral buccal myomucosal flap (BMMF) with or without augmentation with BFF or ADM was employed in 16.3% of the cases. Fourteen percent required a bilateral BMMF+/− ADM. Fistula occurrence was 2.3% (n = 1). For revisions, 27% underwent only a conversion Furlow palatoplasty, 26% had a conversion Furlow palatoplasty accompanied with ADM and/or a BFF, 33% had a unilateral BMMF or BMMF/ADM, and 14% required a bilateral BMMF+/− ADM. Conclusions In severe phenotypes or complicated cases, buccal fat flaps and myomucosal flaps may be utilized. This approach has mostly replaced the use of ADM over time. An algorithmic approach to palatoplasty allows surgeons to tailor the extent of surgery to the needs of each patient.
    Type of Medium: Online Resource
    ISSN: 1055-6656 , 1545-1569
    URL: Article
    DOI: 10.1177/10556656221084879
    RVK:
    XA 36625
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
    detail.hit.zdb_id: 2030056-6
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  • 9
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    Design and Validation of a 3D Printed Cranio-Facial Simulator: A Novel Tool for Surgical Education
    SAGE Publications ; 2023
    In:  The Cleft Palate Craniofacial Journal
    Details
    In: The Cleft Palate Craniofacial Journal, SAGE Publications
    Abstract: To assess the ability of current 3D printing technology to generate a craniofacial bony and soft tissue anatomical model for use in simulating the performance of a fronto-orbital advancement (FOA) osteotomy and then to further assess the value of the model as an educational tool. Design Anatomic models were designed with a process of serial anatomic segmentation/design, 3D printing, dissection, and device refinement. A validation study was conducted with 5 junior and 5 senior plastic surgery residents. The validation study incorporated a multiple-choice Knowledge Assessment test (KA), an Objective Structured Assessment of Technical skills (OSATs), a Global Rating Scale (GRS) and a Michigan Standard Simulation Experience Scale (MiSSES). We compared the scores of both the junior and senior residents and compared junior resident scores, before and after viewing a lecture/demonstration. Results MiSSES showed high face validity with a score of 85.1/90, signifying high satisfaction with the simulator learning experience. Simulation and the lecture/demonstration improved the junior resident average KA score from 5.6/10 to 9.6/10 ( P = .02), OSATs score from 32.4/66 to 64.4/66 ( P  〈  .001) and GRS score from 13.9/35 to 27.5/35 ( P  〈  .001). The senior residents OSATs score of 56.3/66 was higher than the pre-lecture juniors (32.4/66) ( P  〈  .001), but lower than the post-lecture juniors (64.4/66) ( P  〈  .001). Conclusion We have successfully fabricated a 3D printed craniofacial simulator capable of being used as an educational tool alongside traditional surgical training. Next steps would be improving soft tissue realism, inclusion of patient and disease specific anatomy and creation of models for other surgical specialties.
    Type of Medium: Online Resource
    ISSN: 1055-6656 , 1545-1569
    URL: Article
    DOI: 10.1177/10556656221151096
    RVK:
    XA 36625
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
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  • 10
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    Administration of Steroids Is Associated With Increased Length of Stay But Not Post-Operative Complications or Readmissions in Patients Undergoing Orthognathic Surgery
    SAGE Publications ; 2021
    In:  FACE Vol. 2, No. 1 ( 2021-03), p. 57-64
    Details
    In: FACE, SAGE Publications, Vol. 2, No. 1 ( 2021-03), p. 57-64
    Abstract: Purpose: The purpose of this study is to examine the association of steroid use during orthognathic surgery and postoperative outcomes including major complications, 90-day all-cause readmission, and postoperative length of stay. Methods: A retrospective review was implemented utilizing the Pediatric Health Information System (PHIS) database from 2004 to 2014 was undertaken. Steroid exposure was defined as having been billed for the generic drug code for Dexamethasone (154035) at any time for up to 7 days from the surgery date. Unadjusted and adjusted random-intercept logistic regression models were utilized to assess the association between steroid exposure and these outcomes. Results: The sample included 5194 patients, 54% of patients were exposed to steroids, with 20.16 % exposed only on the day of surgery, 27.76% on the day of surgery and after, and 6.22% after the day of surgery. In models adjusting for age, sex, race, procedure, hospital variation and complex chronic conditions, the odds-ratio of steroid exposure was 3.46 (95% CI = 2.96-4.03) for an increased length of stay, 1.05 (95% CI = 0.81-1.37) for major complications and 1.20 (95% CI = 0.95-1.52) for 90-day all-cause readmission. Conclusion: The administration of steroids in patients undergoing orthognathic surgery is significantly associated with increased odds of length of stay. This may be due to a large set of patients receiving steroids during orthognathic procedure are less healthy than those not selected to receive steroids, and thereby require an increased length of stay. The limitations of large, administrative databases do not allow determination of this, but future prospective study is warranted.
    Type of Medium: Online Resource
    ISSN: 2732-5016 , 2732-5016
    URL: Article
    DOI: 10.1177/2732501620985738
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
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