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  • 1
    Online Resource
    Online Resource
    Anthropometric Evaluation of Periorbital Region and Facial Projection Using Three-Dimensional Photogrammetry
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Journal of Craniofacial Surgery Vol. 29, No. 8 ( 2018-11), p. 2017-2020
    Details
    In: Journal of Craniofacial Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 29, No. 8 ( 2018-11), p. 2017-2020
    Abstract: Direct anthropometric and three-dimensional (3D) photogrammetry measurements have been used extensively in cleft/craniofacial surgery to assess morphological changes and surgical outcomes. Craniofacial procedures alter the sagittal projection of periorbital bony prominences. Mulliken described a method of measuring their projection relative to the corneal plane but is impractical in clinical practice. Three-dimensional photogrammetry may offer a solution; however, the cornea is not visualized on this. The authors propose to develop new normative measurements of facial projection relative to the pupil. Methods: Five 3D photographs were taken of 5 individuals using Vectra M5 camera. Facial projection measurements were taken of the sagittal projection of the bilateral periorbital landmarks and nasal radix relative to the pupil using Mirror 3D analysis. Standard deviations (SD) were determined for each subject and laterality. Chi-square tests confirmed all SD 〈 1 mm. Intra and inter-rater reliability were confirmed with an intraclass correlation coefficient assessment. Results: Three male and 2 female subjects were photographed with 5 unique images. Standard deviations of repeat measures of all landmarks were 〈 0.5 mm. Chi-square tests confirmed with statistical significance that SD for all values except for the radix was 〈 1 mm ( P 〈 0.05). Intrarater reliability was high for all landmarks (intraclass correlation coefficient coefficients 0.93–0.99). Inter-rater reliability was good for the lateral canthi and excellent for all others. Conclusion: This technique demonstrates repeatability with high reliability on serial photographs and is applicable to measuring surgery effects and growth on facial projection. Establishment of age-specific normative values for landmark projection will refine usage applicability in operative planning.
    Type of Medium: Online Resource
    ISSN: 1049-2275 , 1536-3732
    URL: Article
    DOI: 10.1097/SCS.0000000000004761
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2060546-8
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  • 2
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    Laser ablation of embryonic veins in children
    Wiley ; 2019
    In:  Pediatrics International Vol. 61, No. 4 ( 2019-04), p. 358-363
    Details
    In: Pediatrics International, Wiley, Vol. 61, No. 4 ( 2019-04), p. 358-363
    Abstract: Klippel–Trenaunay syndrome ( KTS ) and related overgrowth syndromes are rare conditions that often present to academic pediatric units and multidisciplinary vascular anomaly clinics. These conditions are commonly associated with abnormalities of the superficial and deep venous structures and carry an increased risk of venous thromboembolism. Methods A retrospective chart review was completed of all patients treated at Johns Hopkins All Children's Hospital with endovenous laser ablation therapy ( EVLT ) for management of dilated embryonic veins in the setting of limb overgrowth. Results Three patients with limb overgrowth underwent EVLT between 2015 and 2017. All patients had successful occlusion of the targeted veins on post‐procedure imaging. One patient developed a cellulitis successfully treated with oral antibiotics. Conclusions Endovenous laser ablation therapy is a well‐tolerated and safe procedure for prophylactic closure of abnormal superficial embryonic veins. This study supports the use of this technique in managing increased thromboembolic risk in this unique patient population and recognizes the need for a long‐term study to determine its efficacy.
    Type of Medium: Online Resource
    ISSN: 1328-8067 , 1442-200X
    URL: Issue
    URL: Article
    DOI: 10.1111/ped.2019.61.issue-4
    DOI: 10.1111/ped.13804
    Language: English
    Publisher: Wiley
    Publication Date: 2019
    detail.hit.zdb_id: 2008621-0
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  • 3
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    The Incidence of Thromboembolic Events During Hospitalizations Following Surgical Resection of Lower Extremity Sarcomas in Children: Utilizing the Pediatric Health Information System Database
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Journal of Pediatric Orthopaedics Vol. 43, No. 4 ( 2023-04), p. 268-272
    Details
    In: Journal of Pediatric Orthopaedics, Ovid Technologies (Wolters Kluwer Health), Vol. 43, No. 4 ( 2023-04), p. 268-272
    Abstract: Venous thromboembolism (VTE) is a frequent occurrence during treatment for adults with sarcoma. The incidence and underlying risk factors of postsurgical VTE in children and adolescents undergoing resection of sarcoma are unknown. Methods: Using International Classification of Disease revision-9 diagnostic and procedure codes, the Pediatric Health Information System database was queried for patients aged 18 years and younger, discharged from 2004 to 2015 with a diagnosis of lower extremity malignant neoplasm who had a tumor resection or amputation performed during the encounter. Malignant neoplasms of the pelvic bones and soft tissues were categorized as “pelvis tumors”, whereas malignant neoplasms of bone and soft tissues of the lower limbs were categorized as “lower limb tumors”. Hospitalizations were evaluated for the occurrence of VTE. Demographic characteristics (age at admission, sex, race, and race/ethnicity) and incidence of VTE were reported. Results: There were 2400 patients identified. Of these, 19 experienced VTE (0.79%) during their surgical hospitalization encounter. By anatomic group, the rate of VTE was 1.4% (CI: 0.5%-3.2%) for tumors in the pelvis and 0.6% (CI: 0.3%-1.0%) in lower limb tumors. Categorizing by age, the incidence of VTE was 1.2% in patients aged zero to 5, 0.3% in patients 6 to 13, and 1.2% in patients 14 to 18 years old. (Table 1). The extremely low rate of VTE occurrence precluded further analysis of risk factors. Conclusions: In this analysis, postsurgical VTE during hospitalization after pelvic and lower extremity sarcoma resection was an uncommon event in children and adolescents. There seemed to be an increased incidence of postsurgical VTE in pelvic tumors when compared with lower limb tumors, however, the rarity of all events precluded formal statistical analysis. A more robust data set would be required to determine if there are subsets of children and adolescents with sarcoma at higher risk of VTE that could benefit from thromboprophylaxis in the postoperative setting. Level of Evidence: Level II.
    Type of Medium: Online Resource
    ISSN: 0271-6798
    URL: Article
    DOI: 10.1097/BPO.0000000000002357
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 2049057-4
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  • 4
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    Postoperative Drain Use in Cranial Vault Remodeling: A Survey of Craniofacial Surgeon Practices and a Review of the Literature
    SAGE Publications ; 2019
    In:  The Cleft Palate-Craniofacial Journal Vol. 56, No. 8 ( 2019-09), p. 1001-1007
    Details
    In: The Cleft Palate-Craniofacial Journal, SAGE Publications, Vol. 56, No. 8 ( 2019-09), p. 1001-1007
    Abstract: The use of subgaleal drains following primary cranioplasty for craniosynostosis has undergone limited investigation. Proposed benefits include prevention of seroma, detection of postoperative bleeding, and cerebrospinal fluid leak. We conducted a systematic review of the literature and surveyed craniofacial surgeons to ascertain the current evidence pertaining to drain use following primary cranioplasty for craniosynostosis and to determine surgical practice patterns. Methods: PubMed and Embase databases were searched to identify relevant articles. Abstracts were reviewed by 2 investigators, and a Cohen κ statistic was calculated. Patient demographic and outcome data were extracted and compared. A 9-question survey was e-mailed to active and associate members of the American Society of Craniofacial Surgeons. Results: A total of 7395 unique citations were identified. Only 2 retrospective chart reviews met inclusion criteria. All objective parameters demonstrated no difference between patients with and without drains. A subjective benefit of limiting facial swelling was proposed without objective analysis. Fifty (32.5%) of the 154 craniofacial surgeons responded to the survey. Forty-two percent used postoperative drains. A significant association ( P = .01) was found between the belief that drains limited facial swelling and their use. Conclusions: The literature examining postoperative drain use in primary cranioplasty for craniosynostosis is restricted. The current studies show no definite benefit to drain use but are limited in their assessment of key outcomes. There is wide variability among surgeons regarding drain use, and this seems to be motivated by belief and tradition.
    Type of Medium: Online Resource
    ISSN: 1055-6656 , 1545-1569
    URL: Article
    DOI: 10.1177/1055665619836509
    RVK:
    XA 36625
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2019
    detail.hit.zdb_id: 2030056-6
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  • 5
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    The Impact of Presurgical Infant Orthopedics on Oronasal Fistula Rates Following Cleft Repair: A Meta-Analysis
    SAGE Publications ; 2019
    In:  The Cleft Palate-Craniofacial Journal Vol. 56, No. 5 ( 2019-05), p. 576-585
    Details
    In: The Cleft Palate-Craniofacial Journal, SAGE Publications, Vol. 56, No. 5 ( 2019-05), p. 576-585
    Abstract: Presurgical infant orthopedics (PSIO) techniques were introduced to improve the outcomes achieved when treating children with complete cleft lip and palate. The effect of PSIO on the incidence of postoperative fistulae has never been reliably demonstrated. We conducted a meta-analysis to assess the effectiveness of PSIO in reducing postoperative fistulas in patients with complete cleft lip and palate. Methods: A search of the PubMed and Embase databases was performed to identify relevant articles that included primary palate repairs of patients with unilateral or bilateral complete clefts, reported the incidence of postoperative fistulae, and explicitly stated if PSIO was used. Details including author, number of subjects, use of PSIO, and fistula rate were cataloged. Results: A review of the PubMed database yielded 1135 unique citations, and Embase yielded 507 articles. Review of these yielded 15 studies, comprising 1241 children, which met inclusion criteria. The overall rate of oronasal fistula development was 7.09%. The average fistula rate for studies using PSIO was 5.93% versus 9.71% in the non-PSIO group. This difference was not statistically significant ( P = .34). Conclusions: The use of PSIO prior to cleft lip and palate repair provides multiple benefits related to facial and nasal form and is supported by a body of literature. The effect of PSIO on the incidence of postoperative fistulae has received less attention in the literature. Our meta-analysis of the available literature does not provide evidence to support the premise that the use of PSIO affects the incidence of fistulae after cleft palate repair.
    Type of Medium: Online Resource
    ISSN: 1055-6656 , 1545-1569
    URL: Article
    DOI: 10.1177/1055665618806104
    RVK:
    XA 36625
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2019
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  • 6
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    Cleft and Craniofacial Team Orthodontic Care in the United States: A Survey of the ACPA
    SAGE Publications ; 2019
    In:  The Cleft Palate-Craniofacial Journal Vol. 56, No. 7 ( 2019-08), p. 860-866
    Details
    In: The Cleft Palate-Craniofacial Journal, SAGE Publications, Vol. 56, No. 7 ( 2019-08), p. 860-866
    Abstract: To better understand the capacity for orthodontic care, service features, and finances among members of the American Cleft Palate-Craniofacial Association (ACPA). Design: Cross-sectional survey. Setting: ACPA-approved multidisciplinary cleft teams. Participants: Cleft team coordinators. Interventions: Coordinators were asked to complete the survey working together with their orthodontists. Main Outcome Measure: Model for orthodontic care. Results: Coordinators from 82 out of 167 teams certified by ACPA completed the survey (response rate = 49.1%). Most orthodontists were private practice volunteers (48%) followed by university/hospital employed (22.8%). Care was often delivered in community private practice facilities (44.2%) or combination of university and private practice facilities (39.0%). Half of teams reported offering presurgical infant orthopedics (PSIO), with nasoalveolar molding being the most common. Cleft/craniofacial patients typically comprise 25% or less of the orthodontists’ practices. The presence of a university/hospital-based orthodontist was associated with higher rates of offering PSIO ( P 〈 .001) and an increased percentage dedication of their practice to cleft/craniofacial care ( P 〈 .001). Conclusion: Orthodontic models across ACPA-certified teams are highly varied. The employment of full-time craniofacial orthodontists is less common but is highly correlated with a practice with a high percentage of cleft care and the offering of advanced services such as PSIO. Future work should focus on how to effectively promote such roles for orthodontists to ensure high-level care for cleft/craniofacial patients requiring treatment from infancy through skeletal maturity.
    Type of Medium: Online Resource
    ISSN: 1055-6656 , 1545-1569
    URL: Article
    DOI: 10.1177/1055665618822235
    RVK:
    XA 36625
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2019
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  • 7
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    Comprehension of Online Educational Material Regarding Orofacial Clefts
    SAGE Publications ; 2019
    In:  The Cleft Palate-Craniofacial Journal Vol. 56, No. 9 ( 2019-10), p. 1206-1212
    Details
    In: The Cleft Palate-Craniofacial Journal, SAGE Publications, Vol. 56, No. 9 ( 2019-10), p. 1206-1212
    Abstract: Cleft lip and palate are among the common birth defects in the United States. Management is complex and may be difficult for parents and patients to understand. The goal of this study was to evaluate the readability of online educational material provided by the American Society of Plastic Surgeons (ASPS) and the American Cleft Palate-Craniofacial Association (ACPA) websites regarding cleft lip and palate and to assess parents’ comprehension. Methods: Parents of children younger than 10 years of age presenting to the plastic and reconstructive surgery clinic at Johns Hopkins All Children’s Hospital for conditions other than cleft lip and palate were recruited for participation. Parents were given the literature published on the ASPS and ACPA web sites to review and were asked to complete a 5-question test specifically targeted to the content of the passage they reviewed. We tested the readability of the 2 online passages using Readability Studio software (Oleander Software Solutions Ltd). Results: Sixty parents completed the study. Across all groups, the mean score was 4.35 of a possible 5. The mean score was 4.4 for the ASPS web site and 4.29 for the ACPA web site. Fifty-three percent of participants answered all questions correctly. No significant difference in scores was noted between web sites ( P = .48). Conclusions: Despite containing content of varying reading-level difficulty, the literature posted on the ACPA and ASPS web sites concerning cleft lip and palate conveyed information equally well to the target parent demographic with high levels of comprehension.
    Type of Medium: Online Resource
    ISSN: 1055-6656 , 1545-1569
    URL: Article
    DOI: 10.1177/1055665619839576
    RVK:
    XA 36625
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2019
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  • 8
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    High-Fidelity Anthropometric Facial Measurements Can Be Obtained From a Single Stereophotograph From the Vectra H1 3-Dimensional Camera
    SAGE Publications ; 2019
    In:  The Cleft Palate-Craniofacial Journal Vol. 56, No. 9 ( 2019-10), p. 1164-1170
    Details
    In: The Cleft Palate-Craniofacial Journal, SAGE Publications, Vol. 56, No. 9 ( 2019-10), p. 1164-1170
    Abstract: Anthropometry is a well-established means of measuring facial morphology. Although reliable, direct anthropometry can be time-consuming and not conducive to a busy clinical practice. The Vectra H1 handheld stereophotogrammetric system requires 3 stereophotographs taken from different perspectives to generate a three-dimensional (3D) surface. The time needed to take the 3 stereophotographs can increase the possibility of involuntary movements, precluding its use to assess young patients. To overcome this limitation, we evaluated if accurate linear facial measurements can be obtained from a single stereophotograph and compare these to the measurements taken by direct anthropometry. Methods: Twenty pediatric patients, aged 0 to 10 years, who were undergoing minor surgical procedures at Johns Hopkins All Children’s Hospital were recruited. Fourteen linear facial distances were obtained from each participant using direct anthropometry under general anesthesia. These same distances were measured using Mirror 3D analysis. Intraclass correlation was used to determine intrarater reliability on duplicate 3D images. Results: Correlation coefficients between 3D imaging in frontal view and direct anthropometric measurements were excellent for 13 measures taken, ranging from 0.8 (subnasale to columella and subnasale to stomion superius) to 0.98 (nasion to subnasale and subnasale to labiale superius). Correlation coefficients between submental view and direct anthropometric measurements were excellent for 13 measures as well, ranging from 0.77 (subnasale to columella) to 0.98 (nasion to subnasale). Conclusions: Linear anthropometric measurements taken from 3D surfaces generated from a single stereophotograph correlate closely with direct anthropometric measures. This improves workflow and applicability of anthropometric studies to our youngest patients.
    Type of Medium: Online Resource
    ISSN: 1055-6656 , 1545-1569
    URL: Article
    DOI: 10.1177/1055665619839577
    RVK:
    XA 36625
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2019
    detail.hit.zdb_id: 2030056-6
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  • 9
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    Clinical Outcomes Utilizing a “Modified Latham” Appliance for Presurgical Infant Orthopedics in Patients With Unilateral Complete Cleft Lip and Palate
    SAGE Publications ; 2019
    In:  The Cleft Palate-Craniofacial Journal Vol. 56, No. 7 ( 2019-08), p. 929-935
    Details
    In: The Cleft Palate-Craniofacial Journal, SAGE Publications, Vol. 56, No. 7 ( 2019-08), p. 929-935
    Abstract: Presurgical infant orthopedic manipulation is utilized prior to cleft lip/nasal repair to facilitate a gingivoperiosteoplasty (GPP) and primary nasolabial repairs. The Latham dentomaxillary advancement appliance uses a screw that must be tightened daily to approximate the cleft segments in unilateral complete clefts. Our cleft center has been utilizing a “modified Latham” appliance since 1987, including an orthodontic elastic power chain to close the gap in a shorter amount of time. We performed a retrospective chart review of all patients undergoing treatment at Johns Hopkins All Children's Hospital (JHACH) with a unilateral complete cleft lip and palate between 1987 and 2017. Patients were identified by the International Classification of Diseases, Ninth Revision code (749.21). The majority of the patients represent the experience of the senior authors (E.R. and R.F.). Two hundred and eighty-one patients with unilateral complete cleft lip/palate were identified. Seventy-five patients were treated with a “modified Latham” appliance prior to their lip repair. The “modified Latham” appliance remained in place on average 20.6 days (range: 4-82), and average hospital stay after placement was 1.18 days. Nearly 96% of patients underwent a successful GPP at the time of nasolabial repair. Modification of the Latham appliance by utilizing an elastic power chain and eliminating the screw allows rapid closure of the alveolar cleft with limited need for adjustments and outpatient visits. Direct approximation of the palatal segments allows successful completion of a GPP in 95.9% of patients with limited dissection.
    Type of Medium: Online Resource
    ISSN: 1055-6656 , 1545-1569
    URL: Article
    DOI: 10.1177/1055665618816892
    RVK:
    XA 36625
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2019
    detail.hit.zdb_id: 2030056-6
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  • 10
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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
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