Pub Date : 2024-09-12DOI: 10.1097/scs.0000000000010607
Molly F MacIsaac,Joshua M Wright,Jamilla Vieux,S Alex Rottgers,Jordan N Halsey
Velopharyngeal dysfunction (VPD) is the inability to achieve proper closure of the velopharyngeal (VP) port, affecting speech and swallowing. After an auditory-perceptual speech evaluation by a speech-language pathologist, objective assessment of the VP port is required to determine the need for surgical intervention. This 3-part series provides a comprehensive discussion on (1) the anatomy and physiology of the velopharyngeal mechanism; (2) fundamental speech terminology and principles of perceptual speech assessment for VPD; and (3) techniques for objective evaluation of the VP port and surgical decision-making process. In part 3, the authors focus on the modalities for objective VP port assessment, including both direct and indirect methods. Direct imaging techniques such as videofluoroscopy, nasoendoscopy, and MRI are detailed for their strengths and limitations in visualizing VP port function and preoperative planning. Indirect assessments, including nasometry and aerodynamic measurements, are also briefly discussed. The decision-making process for surgical intervention is explored, emphasizing factors such as the severity and etiology of VPD, VP closure patterns, palatal length, orientation of the levator veli palatini, and other patient-specific considerations. The authors review the surgical options for repair including palatoplasty procedures (Furlow palatoplasty, straight-line intravelar veloplasty, and palatal lengthening buccal myomucosal flaps) and pharyngoplasty procedures (posterior pharyngeal flaps and sphincter pharyngoplasty), highlighting their indications, techniques, and potential complications. This series serves as an accessible resource, providing the foundational knowledge required for surgical trainees new to this topic.
{"title":"Demystifying Velopharyngeal Dysfunction for Plastic Surgery Trainees Part 3: Objective Assessment and Surgical Decision-Making.","authors":"Molly F MacIsaac,Joshua M Wright,Jamilla Vieux,S Alex Rottgers,Jordan N Halsey","doi":"10.1097/scs.0000000000010607","DOIUrl":"https://doi.org/10.1097/scs.0000000000010607","url":null,"abstract":"Velopharyngeal dysfunction (VPD) is the inability to achieve proper closure of the velopharyngeal (VP) port, affecting speech and swallowing. After an auditory-perceptual speech evaluation by a speech-language pathologist, objective assessment of the VP port is required to determine the need for surgical intervention. This 3-part series provides a comprehensive discussion on (1) the anatomy and physiology of the velopharyngeal mechanism; (2) fundamental speech terminology and principles of perceptual speech assessment for VPD; and (3) techniques for objective evaluation of the VP port and surgical decision-making process. In part 3, the authors focus on the modalities for objective VP port assessment, including both direct and indirect methods. Direct imaging techniques such as videofluoroscopy, nasoendoscopy, and MRI are detailed for their strengths and limitations in visualizing VP port function and preoperative planning. Indirect assessments, including nasometry and aerodynamic measurements, are also briefly discussed. The decision-making process for surgical intervention is explored, emphasizing factors such as the severity and etiology of VPD, VP closure patterns, palatal length, orientation of the levator veli palatini, and other patient-specific considerations. The authors review the surgical options for repair including palatoplasty procedures (Furlow palatoplasty, straight-line intravelar veloplasty, and palatal lengthening buccal myomucosal flaps) and pharyngoplasty procedures (posterior pharyngeal flaps and sphincter pharyngoplasty), highlighting their indications, techniques, and potential complications. This series serves as an accessible resource, providing the foundational knowledge required for surgical trainees new to this topic.","PeriodicalId":501649,"journal":{"name":"The Journal of Craniofacial Surgery","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142225184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-12DOI: 10.1097/scs.0000000000010605
Molly F MacIsaac,Joshua M Wright,Jamilla Vieux,Jordan N Halsey,S Alex Rottgers
The velopharyngeal (VP) port separates the nasopharynx from the oropharynx and is bordered by the velum, lateral pharyngeal walls, and posterior pharyngeal wall. Velopharyngeal dysfunction (VPD) is the inability to achieve proper closure of the VP port, affecting speech and swallowing. This 3-part series provides a comprehensive discussion on (1) the anatomy and physiology of the velopharyngeal mechanism; (2) fundamental speech terminology and principles of perceptual speech assessment for VPD; and (3) techniques for objective evaluation of the VP port and surgical decision-making process. In part 1, the authors focus on the anatomy and physiology of the velopharyngeal port, the anatomy of cleft palate, and the causes of VPD. There are 3 types of VPD: velopharyngeal insufficiency, involving structural deficits; velopharyngeal incompetence, resulting from neuromuscular issues; and velopharyngeal mislearning, due to maladaptive speech habits. VPD is commonly associated with cleft palate due to anatomic disruptions that impair velopharyngeal function. However, there are numerous causes of noncleft VPD, including congenital or acquired structural defects, neuromuscular conditions, and developmental/behavioral factors. Diagnosis and management of VPD require a multidisciplinary approach involving, at a minimum, surgeons and speech-language pathologists. Plastic surgery trainees often receive education on the surgical treatment of VPD, but without a foundational knowledge of the disease spectrum and speech pathology, the complex terminology can impede a thorough understanding of its diagnosis and management. This series serves as an accessible resource, providing the foundational knowledge required for surgical trainees new to this topic.
{"title":"Demystifying Velopharyngeal Dysfunction for Plastic Surgery Trainees-Part 1: Anatomy and Physiology.","authors":"Molly F MacIsaac,Joshua M Wright,Jamilla Vieux,Jordan N Halsey,S Alex Rottgers","doi":"10.1097/scs.0000000000010605","DOIUrl":"https://doi.org/10.1097/scs.0000000000010605","url":null,"abstract":"The velopharyngeal (VP) port separates the nasopharynx from the oropharynx and is bordered by the velum, lateral pharyngeal walls, and posterior pharyngeal wall. Velopharyngeal dysfunction (VPD) is the inability to achieve proper closure of the VP port, affecting speech and swallowing. This 3-part series provides a comprehensive discussion on (1) the anatomy and physiology of the velopharyngeal mechanism; (2) fundamental speech terminology and principles of perceptual speech assessment for VPD; and (3) techniques for objective evaluation of the VP port and surgical decision-making process. In part 1, the authors focus on the anatomy and physiology of the velopharyngeal port, the anatomy of cleft palate, and the causes of VPD. There are 3 types of VPD: velopharyngeal insufficiency, involving structural deficits; velopharyngeal incompetence, resulting from neuromuscular issues; and velopharyngeal mislearning, due to maladaptive speech habits. VPD is commonly associated with cleft palate due to anatomic disruptions that impair velopharyngeal function. However, there are numerous causes of noncleft VPD, including congenital or acquired structural defects, neuromuscular conditions, and developmental/behavioral factors. Diagnosis and management of VPD require a multidisciplinary approach involving, at a minimum, surgeons and speech-language pathologists. Plastic surgery trainees often receive education on the surgical treatment of VPD, but without a foundational knowledge of the disease spectrum and speech pathology, the complex terminology can impede a thorough understanding of its diagnosis and management. This series serves as an accessible resource, providing the foundational knowledge required for surgical trainees new to this topic.","PeriodicalId":501649,"journal":{"name":"The Journal of Craniofacial Surgery","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142197304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-11DOI: 10.1097/scs.0000000000010562
Beita Badiei,Kevin Schlidt,Michael Ha,Caroline Simon,Chinenye Onyima,Jessica El-Mallah,Vivekka Nagendran,Yvonne M Rasko
OBJECTIVEDermatochalasis is a common condition that can cause obstruction of peripheral visual fields and impairment of daily activities. These effects can be addressed with a blepharoplasty, which may be considered a cosmetic procedure by American health insurers. The authors assessed insurance coverage of all indications of blepharoplasty and their medical necessity criteria.METHODSA cross-sectional analysis was conducted of 70 insurance policies for blepharoplasty. The insurance companies were selected based on their state enrollment and market share. A web-based search and telephone interviews were utilized to identify the policies. Medically necessary criteria were extracted from the publicly available policies.RESULTSOf the 70 insurance policies assessed, 67 (96%) provide coverage for blepharoplasty. There were 7 indications for coverage, the most common being dermatochalasis causing functional visual impairment (n = 56, 80%), prosthesis difficulties in an anophthalmic socket (n = 44, 63%), and congenital ptosis (n = 38, 54%). Of companies that indicated coverage for dermatochalasis, 95% required visual field loss testing to qualify for coverage. Significantly more companies required a 30% loss in the superior visual field for coverage versus the literature-recommended amount of 24% loss (n = 14 versus n = 3, 26% versus 6%, P= 0.0067).CONCLUSIONThere is a great discrepancy in insurance policy criteria for coverage of blepharoplasty, especially regarding requirements for visual field testing. Unfortunately, this disparity does not reflect the current literature as to whom may gain significant functional benefit from blepharoplasty.
{"title":"A Cross-Sectional Analysis of American Insurance Coverage of Upper and Lower Lid Blepharoplasty.","authors":"Beita Badiei,Kevin Schlidt,Michael Ha,Caroline Simon,Chinenye Onyima,Jessica El-Mallah,Vivekka Nagendran,Yvonne M Rasko","doi":"10.1097/scs.0000000000010562","DOIUrl":"https://doi.org/10.1097/scs.0000000000010562","url":null,"abstract":"OBJECTIVEDermatochalasis is a common condition that can cause obstruction of peripheral visual fields and impairment of daily activities. These effects can be addressed with a blepharoplasty, which may be considered a cosmetic procedure by American health insurers. The authors assessed insurance coverage of all indications of blepharoplasty and their medical necessity criteria.METHODSA cross-sectional analysis was conducted of 70 insurance policies for blepharoplasty. The insurance companies were selected based on their state enrollment and market share. A web-based search and telephone interviews were utilized to identify the policies. Medically necessary criteria were extracted from the publicly available policies.RESULTSOf the 70 insurance policies assessed, 67 (96%) provide coverage for blepharoplasty. There were 7 indications for coverage, the most common being dermatochalasis causing functional visual impairment (n = 56, 80%), prosthesis difficulties in an anophthalmic socket (n = 44, 63%), and congenital ptosis (n = 38, 54%). Of companies that indicated coverage for dermatochalasis, 95% required visual field loss testing to qualify for coverage. Significantly more companies required a 30% loss in the superior visual field for coverage versus the literature-recommended amount of 24% loss (n = 14 versus n = 3, 26% versus 6%, P= 0.0067).CONCLUSIONThere is a great discrepancy in insurance policy criteria for coverage of blepharoplasty, especially regarding requirements for visual field testing. Unfortunately, this disparity does not reflect the current literature as to whom may gain significant functional benefit from blepharoplasty.","PeriodicalId":501649,"journal":{"name":"The Journal of Craniofacial Surgery","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142197302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-11DOI: 10.1097/scs.0000000000010614
Zhigang He,Xianbin Gu,Lisha Chen,Wenjing Liu,Yangyan Yi,Juanmin Yang
OBJECTIVETo investigate the clinical effect of the double insurance method of flexible suspension and semiflexible suspension in bionic blepharoplasty.METHODSBetween January 2020 and January 2022, a total of 115 patients (230 eyes) underwent double eyelid plastic surgery with flexible suspension and semiflexible suspension. Herein, we present a new type of double eyelid surgery that preserves the orbicular muscle of the anterior tarsus without removing the tissue. First, the loose fatty fascia layer between the anterior tarsus and the orbicularis oculi muscle was completely removed to a distance of 2 mm from the base of the eyelashes, leaving the compact pretarsal levator aponeurosis. Then, the anterior tarsus orbicularis oculi muscle and the upper levator aponeurosis were sutured and fixed (flexible suspension). Finally, the skin and the upper levator aponeurosis were sutured in the flexible suspension space (semiflexible suspension).RESULTSSix months after surgery, the patient's double eyelid shape had recovered well, and the satisfaction rate reached 97.3%. Among the unsatisfied patients, 1 patient had a single-focused shallow eyelid line which was associated with postoperative hematoma, and 2 patients felt that the double eyelid line was narrow. All 3 patients achieved satisfactory results after reoperation.CONCLUSIONSThe bionic double eyelid method with flexible suspension and semiflexible suspension can restore the natural double eyelid anatomy very well by reconstructing the connection between the orbicularis oculi muscle or skin and the upper palpebral levator aponeurosis. After the operation, the incisions healed quickly and smoothly. The eyelid depression and fleshy feeling were not obvious when the eyes were closed. Consequently, the patient's satisfaction was very high.
{"title":"Clinical Efficacy of Bionic Blepharoplasty Using the Flexible Suspension and Semiflexible Suspension Double-Insurance Methods.","authors":"Zhigang He,Xianbin Gu,Lisha Chen,Wenjing Liu,Yangyan Yi,Juanmin Yang","doi":"10.1097/scs.0000000000010614","DOIUrl":"https://doi.org/10.1097/scs.0000000000010614","url":null,"abstract":"OBJECTIVETo investigate the clinical effect of the double insurance method of flexible suspension and semiflexible suspension in bionic blepharoplasty.METHODSBetween January 2020 and January 2022, a total of 115 patients (230 eyes) underwent double eyelid plastic surgery with flexible suspension and semiflexible suspension. Herein, we present a new type of double eyelid surgery that preserves the orbicular muscle of the anterior tarsus without removing the tissue. First, the loose fatty fascia layer between the anterior tarsus and the orbicularis oculi muscle was completely removed to a distance of 2 mm from the base of the eyelashes, leaving the compact pretarsal levator aponeurosis. Then, the anterior tarsus orbicularis oculi muscle and the upper levator aponeurosis were sutured and fixed (flexible suspension). Finally, the skin and the upper levator aponeurosis were sutured in the flexible suspension space (semiflexible suspension).RESULTSSix months after surgery, the patient's double eyelid shape had recovered well, and the satisfaction rate reached 97.3%. Among the unsatisfied patients, 1 patient had a single-focused shallow eyelid line which was associated with postoperative hematoma, and 2 patients felt that the double eyelid line was narrow. All 3 patients achieved satisfactory results after reoperation.CONCLUSIONSThe bionic double eyelid method with flexible suspension and semiflexible suspension can restore the natural double eyelid anatomy very well by reconstructing the connection between the orbicularis oculi muscle or skin and the upper palpebral levator aponeurosis. After the operation, the incisions healed quickly and smoothly. The eyelid depression and fleshy feeling were not obvious when the eyes were closed. Consequently, the patient's satisfaction was very high.","PeriodicalId":501649,"journal":{"name":"The Journal of Craniofacial Surgery","volume":"71 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142197303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-10DOI: 10.1097/scs.0000000000010630
Wei Wang,Ying Wang
OBJECTIVEThis study aims to investigate the relationship between caregivers' perception of child weight, their concern about children's weight, pressed eating behaviors, and children's BMI.METHODSA Child Feeding Questionnaire was administered to 442 primary caregivers of school-aged children (6-12 y old) in Hangzhou, China.RESULTSSignificant differences were observed in age, family average monthly income, and family care type among children with different weight statuses (P<0.05). Caregivers' perception of child weight was positively correlated with children's BMI. Caregivers' perception of child weight and children's BMI were negatively correlated with pressed eating behaviors. Caregivers' perception of the child's weight, BMI, and pressed eating behaviors were positively correlated with caregivers' weight concerns. Caregivers' perception of child weight not only had a direct positive predictive effect on children's BMI but also influenced children's BMI through three paths: via the independent mediation of children's weight concern, the independent mediation of pressed eating behaviors, and the chain mediation of children's weight concern and pressed eating behaviors.CONCLUSIONSCaregivers need to rectify perception biases regarding child weight, adopt reasonable feeding strategies, nurture children's self-regulation abilities regarding diet, and prevent the occurrence of childhood overweight and obesity.
{"title":"Caregivers' Perception of Child Weight and Its Implications on Children's BMI: Examining the Role of Weight Concern and Pressed Eating Behaviors as Mediators.","authors":"Wei Wang,Ying Wang","doi":"10.1097/scs.0000000000010630","DOIUrl":"https://doi.org/10.1097/scs.0000000000010630","url":null,"abstract":"OBJECTIVEThis study aims to investigate the relationship between caregivers' perception of child weight, their concern about children's weight, pressed eating behaviors, and children's BMI.METHODSA Child Feeding Questionnaire was administered to 442 primary caregivers of school-aged children (6-12 y old) in Hangzhou, China.RESULTSSignificant differences were observed in age, family average monthly income, and family care type among children with different weight statuses (P<0.05). Caregivers' perception of child weight was positively correlated with children's BMI. Caregivers' perception of child weight and children's BMI were negatively correlated with pressed eating behaviors. Caregivers' perception of the child's weight, BMI, and pressed eating behaviors were positively correlated with caregivers' weight concerns. Caregivers' perception of child weight not only had a direct positive predictive effect on children's BMI but also influenced children's BMI through three paths: via the independent mediation of children's weight concern, the independent mediation of pressed eating behaviors, and the chain mediation of children's weight concern and pressed eating behaviors.CONCLUSIONSCaregivers need to rectify perception biases regarding child weight, adopt reasonable feeding strategies, nurture children's self-regulation abilities regarding diet, and prevent the occurrence of childhood overweight and obesity.","PeriodicalId":501649,"journal":{"name":"The Journal of Craniofacial Surgery","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142197285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-10DOI: 10.1097/scs.0000000000010609
Nathan Farias,Corey Moore
PURPOSEThe reconstruction of full-thickness nasal defects poses a significant challenge following oncologic resection. This study aims to share a technique using paired pericranial forehead flap (PCF) with contralateral paramedian flap (PMF) for such defects. Patient outcomes were reviewed, and the advantages and disadvantages of the reconstructive technique are discussed.METHODSA retrospective review of a single surgeon practice was done between 2019 and 2024. Cases of nasal reconstruction with a paired PCF and PMF following oncologic resection were reviewed. Defect characteristics, reconstructive technique, and postoperative complications were evaluated. A literature review summarizing the evolution of this technique from inception to April 2024 was conducted using PubMed.RESULTSThe literature review identified 7 reports describing the use of a paired PCF and PMF for nasal reconstruction. The modifications and enhancements described in each study are summarized. The case series included 13 patients requiring oncologic resection for squamous cell carcinoma (8 patients) or basal cell carcinoma (5 patients). Every case required reconstruction of at least 2 nasal subunits, primarily involving the nasal tip, alae, and columella. Reconstruction was performed with the ipsilateral PCF, contralateral PMF, and structural grafts. Auricular cartilage grafts were universally used for structural support, with additional costal cartilage grafts and a split calvaria bone graft in select cases. The technique showed good functional and esthetic outcomes without any notable graft failures or donor site complications.CONCLUSIONSThe combination of an ipsilateral PCF and contralateral PMF is an effective strategy for reconstructing full-thickness nasal defects involving multiple nasal subunits.
{"title":"Full Thickness Nasal Reconstruction With Paired Pericranial and Paramedian Forehead Flaps.","authors":"Nathan Farias,Corey Moore","doi":"10.1097/scs.0000000000010609","DOIUrl":"https://doi.org/10.1097/scs.0000000000010609","url":null,"abstract":"PURPOSEThe reconstruction of full-thickness nasal defects poses a significant challenge following oncologic resection. This study aims to share a technique using paired pericranial forehead flap (PCF) with contralateral paramedian flap (PMF) for such defects. Patient outcomes were reviewed, and the advantages and disadvantages of the reconstructive technique are discussed.METHODSA retrospective review of a single surgeon practice was done between 2019 and 2024. Cases of nasal reconstruction with a paired PCF and PMF following oncologic resection were reviewed. Defect characteristics, reconstructive technique, and postoperative complications were evaluated. A literature review summarizing the evolution of this technique from inception to April 2024 was conducted using PubMed.RESULTSThe literature review identified 7 reports describing the use of a paired PCF and PMF for nasal reconstruction. The modifications and enhancements described in each study are summarized. The case series included 13 patients requiring oncologic resection for squamous cell carcinoma (8 patients) or basal cell carcinoma (5 patients). Every case required reconstruction of at least 2 nasal subunits, primarily involving the nasal tip, alae, and columella. Reconstruction was performed with the ipsilateral PCF, contralateral PMF, and structural grafts. Auricular cartilage grafts were universally used for structural support, with additional costal cartilage grafts and a split calvaria bone graft in select cases. The technique showed good functional and esthetic outcomes without any notable graft failures or donor site complications.CONCLUSIONSThe combination of an ipsilateral PCF and contralateral PMF is an effective strategy for reconstructing full-thickness nasal defects involving multiple nasal subunits.","PeriodicalId":501649,"journal":{"name":"The Journal of Craniofacial Surgery","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142197300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-10DOI: 10.1097/scs.0000000000010626
Bojan Pavlovic,Sasa Jakovljevic,Katarina Jovanovic
Although metastases to the paranasal sinuses are exceedingly rare, when they do occur, renal clear cell carcinoma is the most frequent primary tumor involved. The aim of this work was to present a case of metastatic clear cell renal carcinoma in the frontal sinus and orbit region, 7 years after the initial diagnosis and treatment. The patient was referred to our clinic due to drooping of the left eyelid and displacement of the left eyeball. Computed tomography revealed an expansive lesion in the left frontal sinus and orbit, causing destruction of its anterior, lateral, and roof walls. Profuse bleeding from the tumor and left orbit hindered a comprehensive assessment of tumor extension into the orbit and residual tumor size. Therefore, complete tumor removal was not possible; instead, reduction was achieved. Subsequent histopathologic and immunohistochemical analysis confirmed the lesion as a metastasis of renal cell carcinoma in the sinonasal tract. Unfortunately, 10 weeks later, the patient passed away. Treatment of metastatic clear cell renal carcinoma depends on the localization of the disease as well as the overall condition of the patient. If there is a solitary metastatic lesion, as in the case of the sinonasal region, surgical treatment is recommended. Metastasis of clear cell renal carcinoma to the sinonasal region is a rare occurrence; however, it is essential to consider it in cases of rapidly growing tumor masses, typically presenting with symptoms such as epistaxis and nasal obstruction.
{"title":"Initial Frontal Sinus and Orbit Tumor Signaling Late Distant Metastasis in Kidney Cancer.","authors":"Bojan Pavlovic,Sasa Jakovljevic,Katarina Jovanovic","doi":"10.1097/scs.0000000000010626","DOIUrl":"https://doi.org/10.1097/scs.0000000000010626","url":null,"abstract":"Although metastases to the paranasal sinuses are exceedingly rare, when they do occur, renal clear cell carcinoma is the most frequent primary tumor involved. The aim of this work was to present a case of metastatic clear cell renal carcinoma in the frontal sinus and orbit region, 7 years after the initial diagnosis and treatment. The patient was referred to our clinic due to drooping of the left eyelid and displacement of the left eyeball. Computed tomography revealed an expansive lesion in the left frontal sinus and orbit, causing destruction of its anterior, lateral, and roof walls. Profuse bleeding from the tumor and left orbit hindered a comprehensive assessment of tumor extension into the orbit and residual tumor size. Therefore, complete tumor removal was not possible; instead, reduction was achieved. Subsequent histopathologic and immunohistochemical analysis confirmed the lesion as a metastasis of renal cell carcinoma in the sinonasal tract. Unfortunately, 10 weeks later, the patient passed away. Treatment of metastatic clear cell renal carcinoma depends on the localization of the disease as well as the overall condition of the patient. If there is a solitary metastatic lesion, as in the case of the sinonasal region, surgical treatment is recommended. Metastasis of clear cell renal carcinoma to the sinonasal region is a rare occurrence; however, it is essential to consider it in cases of rapidly growing tumor masses, typically presenting with symptoms such as epistaxis and nasal obstruction.","PeriodicalId":501649,"journal":{"name":"The Journal of Craniofacial Surgery","volume":"182 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142225144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-10DOI: 10.1097/scs.0000000000010582
Kiersten C Woodyard De Brito,Douglas R Dembinski,Nathan G Lawera,Mitchell Buller,Alessandro de Alarcon,Brian S Pan,Jesse Skoch
OBJECTIVENasal dermoid sinus cysts (NDSCs) with intracranial extension in the form of dermal sinus tracts require careful and complete resection to prevent recurrence. Resection techniques necessitate adequate intracranial exposure, but morbidity associated with historical resection approaches has presented unique multidisciplinary challenges for surgeons treating cysts with intracranial extension.METHODSThe authors primarily employed a transnasal approach through a midline nasal incision, utilizing endoscopic or microscopic access between the lateral cartilages for resection of NDSCs with intracranial extension. A retrospective review was completed for patients treated for NDSCs at the authors' pediatric quaternary referral center from 2017 to 2023. Data collection included demographics, comorbidities, perioperative data, pre and postoperative imaging, surgical outcomes, and complications.RESULTSEighteen patients with NDSCs with possible or confirmed intracranial extension were surgically treated from 2017 to 2023. Fifteen were treated with resection performed through a midline transnasal approach with endoscopic assistance, achieving successful total resection while avoiding nasal osteotomy or frontal craniotomy. One patient had a slow cerebrospinal fluid leak from an operative durotomy, successfully treated with a lumbar drain. No other complications occurred. No patients required transfusion. Incision length and postoperative scar burden were less than approaches that used osteotomies or craniotomies and demonstrated excellent cosmetic results. No patients have had cyst recurrence or required reoperation.CONCLUSIONSA transnasal approach through a midline incision with endoscopic assistance is an effective approach for resection of NDSC with intracranial extension, but utility may vary with cyst size and complexity. This approach leverages appropriate exposure for resection with decreased morbidity and decreased incision length through avoidance of osteotomies.
{"title":"Transnasal Endoscopic Approach for Excision of Intracranial Nasal Dermoid Sinus Cysts.","authors":"Kiersten C Woodyard De Brito,Douglas R Dembinski,Nathan G Lawera,Mitchell Buller,Alessandro de Alarcon,Brian S Pan,Jesse Skoch","doi":"10.1097/scs.0000000000010582","DOIUrl":"https://doi.org/10.1097/scs.0000000000010582","url":null,"abstract":"OBJECTIVENasal dermoid sinus cysts (NDSCs) with intracranial extension in the form of dermal sinus tracts require careful and complete resection to prevent recurrence. Resection techniques necessitate adequate intracranial exposure, but morbidity associated with historical resection approaches has presented unique multidisciplinary challenges for surgeons treating cysts with intracranial extension.METHODSThe authors primarily employed a transnasal approach through a midline nasal incision, utilizing endoscopic or microscopic access between the lateral cartilages for resection of NDSCs with intracranial extension. A retrospective review was completed for patients treated for NDSCs at the authors' pediatric quaternary referral center from 2017 to 2023. Data collection included demographics, comorbidities, perioperative data, pre and postoperative imaging, surgical outcomes, and complications.RESULTSEighteen patients with NDSCs with possible or confirmed intracranial extension were surgically treated from 2017 to 2023. Fifteen were treated with resection performed through a midline transnasal approach with endoscopic assistance, achieving successful total resection while avoiding nasal osteotomy or frontal craniotomy. One patient had a slow cerebrospinal fluid leak from an operative durotomy, successfully treated with a lumbar drain. No other complications occurred. No patients required transfusion. Incision length and postoperative scar burden were less than approaches that used osteotomies or craniotomies and demonstrated excellent cosmetic results. No patients have had cyst recurrence or required reoperation.CONCLUSIONSA transnasal approach through a midline incision with endoscopic assistance is an effective approach for resection of NDSC with intracranial extension, but utility may vary with cyst size and complexity. This approach leverages appropriate exposure for resection with decreased morbidity and decreased incision length through avoidance of osteotomies.","PeriodicalId":501649,"journal":{"name":"The Journal of Craniofacial Surgery","volume":"197 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142197283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-10DOI: 10.1097/scs.0000000000010635
Wei Wang,Han Xiaoxu
OBJECTIVETo investigate the status of patients' post-pituitary tumor resection and analyze influencing factors, providing evidence for improved long-term management.METHODSThe authors screened 1209 patients who underwent pituitary tumor resection at Zhejiang University's Second Affiliated Hospital from August 2020 to July 2022 using electronic medical records. Patients were classified into return visits (≥2 reviews/y or within 6 mo) and missing visit groups. Demographic and disease-related data were extracted from inpatient records, whereas return visits and prognosis data were collected from outpatient records and phone inquiries. Propensity score matching (1:1) was used to balance the groups, followed by univariate and multivariate logistic regression analyses to identify influencing factors.RESULTSOf the 1209 patients, 113 were unreachable. The study included 1095 patients, with 553 (50.5%) in the missing visit group and 542 (49.5%) in the return visit group. The authors matched 421 pairs, achieving balanced baseline data. Univariate analysis revealed significant differences in residence, unplanned readmission history, and current outcomes (P < 0.05). Multivariate analysis identified unplanned readmission history (odds ratio = 0.495, 95% CI: 0.307-0.799) as a protective factor. City residents had higher return visit rates than those from other provinces (odds ratio = 0.269, 95% CI: 0.610-1.579).CONCLUSIONPostdischarge return rates for pituitary tumor resection patients are low and influenced by various factors. Improving return visit policies and systems is essential for facilitating outpatient follow-ups.
{"title":"Analysis of the Status Quo and Influencing Factors of Revisiting Patients After Pituitary Tumor Resection: Based on a Chinese Patient Population.","authors":"Wei Wang,Han Xiaoxu","doi":"10.1097/scs.0000000000010635","DOIUrl":"https://doi.org/10.1097/scs.0000000000010635","url":null,"abstract":"OBJECTIVETo investigate the status of patients' post-pituitary tumor resection and analyze influencing factors, providing evidence for improved long-term management.METHODSThe authors screened 1209 patients who underwent pituitary tumor resection at Zhejiang University's Second Affiliated Hospital from August 2020 to July 2022 using electronic medical records. Patients were classified into return visits (≥2 reviews/y or within 6 mo) and missing visit groups. Demographic and disease-related data were extracted from inpatient records, whereas return visits and prognosis data were collected from outpatient records and phone inquiries. Propensity score matching (1:1) was used to balance the groups, followed by univariate and multivariate logistic regression analyses to identify influencing factors.RESULTSOf the 1209 patients, 113 were unreachable. The study included 1095 patients, with 553 (50.5%) in the missing visit group and 542 (49.5%) in the return visit group. The authors matched 421 pairs, achieving balanced baseline data. Univariate analysis revealed significant differences in residence, unplanned readmission history, and current outcomes (P < 0.05). Multivariate analysis identified unplanned readmission history (odds ratio = 0.495, 95% CI: 0.307-0.799) as a protective factor. City residents had higher return visit rates than those from other provinces (odds ratio = 0.269, 95% CI: 0.610-1.579).CONCLUSIONPostdischarge return rates for pituitary tumor resection patients are low and influenced by various factors. Improving return visit policies and systems is essential for facilitating outpatient follow-ups.","PeriodicalId":501649,"journal":{"name":"The Journal of Craniofacial Surgery","volume":"399 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142197286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-10DOI: 10.1097/scs.0000000000010572
Jiwon Do,Ik-Jae Kwon
In a challenging and extremely rare case, a 40-year-old female presented with an orthodontic miniscrew inadvertently lodged in the prevertebral space near the internal carotid artery following an incident at a local clinic. Traditional blind removal techniques posed significant risks due to the miniscrew's dangerous location. An optical navigation system that utilized advanced real-time tracking and 3D imaging to precisely locate and safely remove the foreign body was applied. The successful procedure, confirmed by postoperative imaging, underscored the vital role of navigation-guided surgery in enhancing surgical precision and patient safety in complex cases.
{"title":"Navigation-Guided Surgical Removal of an Orthodontic Miniscrew Accidentally Displaced Into the Prevertebral Space.","authors":"Jiwon Do,Ik-Jae Kwon","doi":"10.1097/scs.0000000000010572","DOIUrl":"https://doi.org/10.1097/scs.0000000000010572","url":null,"abstract":"In a challenging and extremely rare case, a 40-year-old female presented with an orthodontic miniscrew inadvertently lodged in the prevertebral space near the internal carotid artery following an incident at a local clinic. Traditional blind removal techniques posed significant risks due to the miniscrew's dangerous location. An optical navigation system that utilized advanced real-time tracking and 3D imaging to precisely locate and safely remove the foreign body was applied. The successful procedure, confirmed by postoperative imaging, underscored the vital role of navigation-guided surgery in enhancing surgical precision and patient safety in complex cases.","PeriodicalId":501649,"journal":{"name":"The Journal of Craniofacial Surgery","volume":"90 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142197284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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