Pub Date : 2024-05-11DOI: 10.1177/27325016241252953
Gwendolyn E. Daly, Peter Ferrin, J. Carboy, Lori K. Howell, Nathan R Selden, Erik M. Wolfswinkel
Craniosynostosis and positional plagiocephaly (PP) both lead to deformities of the infant skull. In some cases, patients may present with concurrent craniosynostosis and PP. The forces exerted on the skull by both conditions can complicate and delay correct diagnosis and require adjustments to surgical planning. The purpose of this scoping review was to identify and analyze the existing peer-reviewed literature covering the diagnosis and treatment of concurrent craniosynostosis and PP. In accordance with PRISMA guidelines, PubMed, MEDLINE, and EMBASE were searched for articles discussing concurrent diagnoses of craniosynostosis and PP. Out of 633 articles discovered, 7 met inclusion criteria and discussed a cumulative total of 10 patients. The average age of referral to a craniofacial team was 17 ± 22.2 months. The most common reason for referral was craniofacial asymmetry (90%, n = 9). 40% presented with unilateral coronal synostosis (n = 4), 40% with lambdoid synostosis (n = 4), 10% with sagittal synostosis (n = 1), and 10% with metopic synostosis (n = 1). The most commonly reported clinical features were occipital flattening (90%, n = 9), ear displacement (80%, n = 8), and frontal bossing (30%, n = 3). Delayed or incorrect initial diagnosis was noted in 70% (n = 7) of patients. CT scan was the most commonly employed diagnostic tool, utilized in 100% of patients. 70% of patients (n = 7) underwent surgery at an average age of 6.75 ± 3 months. Two studies, accounting for 2 patients reported, noted altering their surgical technique to account for PP in addition to the synostotic suture. Coincident craniosynostosis and PP can pose a complicated diagnostic and therapeutic challenge. An in-depth understanding of the most reliable physical exam findings associated with each type of craniosynostosis combined with PP will facilitate accurate diagnosis. Consideration of the concurrent forces on the skull created by craniosynostosis and PP aid in the design of a tailored surgical plan.
{"title":"Concurrent Craniosynostosis and Positional Plagiocephaly: A Scoping Review","authors":"Gwendolyn E. Daly, Peter Ferrin, J. Carboy, Lori K. Howell, Nathan R Selden, Erik M. Wolfswinkel","doi":"10.1177/27325016241252953","DOIUrl":"https://doi.org/10.1177/27325016241252953","url":null,"abstract":"Craniosynostosis and positional plagiocephaly (PP) both lead to deformities of the infant skull. In some cases, patients may present with concurrent craniosynostosis and PP. The forces exerted on the skull by both conditions can complicate and delay correct diagnosis and require adjustments to surgical planning. The purpose of this scoping review was to identify and analyze the existing peer-reviewed literature covering the diagnosis and treatment of concurrent craniosynostosis and PP. In accordance with PRISMA guidelines, PubMed, MEDLINE, and EMBASE were searched for articles discussing concurrent diagnoses of craniosynostosis and PP. Out of 633 articles discovered, 7 met inclusion criteria and discussed a cumulative total of 10 patients. The average age of referral to a craniofacial team was 17 ± 22.2 months. The most common reason for referral was craniofacial asymmetry (90%, n = 9). 40% presented with unilateral coronal synostosis (n = 4), 40% with lambdoid synostosis (n = 4), 10% with sagittal synostosis (n = 1), and 10% with metopic synostosis (n = 1). The most commonly reported clinical features were occipital flattening (90%, n = 9), ear displacement (80%, n = 8), and frontal bossing (30%, n = 3). Delayed or incorrect initial diagnosis was noted in 70% (n = 7) of patients. CT scan was the most commonly employed diagnostic tool, utilized in 100% of patients. 70% of patients (n = 7) underwent surgery at an average age of 6.75 ± 3 months. Two studies, accounting for 2 patients reported, noted altering their surgical technique to account for PP in addition to the synostotic suture. Coincident craniosynostosis and PP can pose a complicated diagnostic and therapeutic challenge. An in-depth understanding of the most reliable physical exam findings associated with each type of craniosynostosis combined with PP will facilitate accurate diagnosis. Consideration of the concurrent forces on the skull created by craniosynostosis and PP aid in the design of a tailored surgical plan.","PeriodicalId":508736,"journal":{"name":"FACE","volume":"123 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140987408","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 : 2024-05-11DOI: 10.1177/27325016241253276
Gabriella E. Glassman, Joseph K. Williams, Colin M. Brady
Mandibular brown tumors are often radiographically and histologically indistinguishable from cherubism, aneurysmal bone cyst, giant cell granuloma, and odontogenic fibroma. Laboratory findings of hyperparathyroidism (HPT) aid in directing therapy. We present a case of a 14-year-old male with a brown tumor of the mandible associated with secondary HPT due to vitamin D deficiency. Core biopsy exhibited a proliferation of plump spindle cells and osteoclast-like giant cells within variably fibrous stroma. Parathyroid hormone (PTH) levels were elevated to 288 pg/mL (normal 8.5-77.1 pg/mL) and vitamin D was low at a level of 6.9 ng/mL (normal > 20.0 ng/mL). Six months after the introduction of weekly vitamin D supplementation, PTH and vitamin D levels improved but remained abnormal with PTH of 86.8 pg/mL and vitamin D of 9.3 ng/mL. Alongside an improvement in laboratory indices, the tumor character stabilized and became less clinically friable; however, the burden remained unchanged. At 9 months, the patient underwent surgical debulking of the tumor with local soft tissue coverage. A review of pediatric literature was performed, among which 16 patients were identified. Most children who developed brown tumors were found to have secondary HPT and ultimately 44% underwent some degree of surgical debridement of the mass.
下颌骨褐色瘤通常在放射学和组织学上与樱桃核、动脉瘤性骨囊肿、巨细胞肉芽肿和牙源性纤维瘤难以区分。甲状旁腺功能亢进（HPT）的实验室检查结果有助于指导治疗。我们报告了一例14岁男性患者的病例，他患有下颌骨棕色肿瘤，因缺乏维生素D而继发HPT。核心活检结果显示，在不同的纤维基质内有丰满的纺锤形细胞和破骨细胞样巨细胞增生。甲状旁腺激素（PTH）水平升高至288 pg/mL（正常值为8.5-77.1 pg/mL），维生素D水平低至6.9 ng/mL（正常值大于20.0 ng/mL）。每周补充维生素 D 六个月后，PTH 和维生素 D 水平有所改善，但仍不正常，PTH 为 86.8 pg/mL，维生素 D 为 9.3 ng/mL。在实验室指标改善的同时，肿瘤特征也趋于稳定，在临床上变得不那么易碎；然而，肿瘤的负担仍保持不变。9 个月后，患者接受了手术切除肿瘤，并进行了局部软组织覆盖。我们查阅了儿科文献，发现其中有 16 例患者。大多数患棕色瘤的儿童都被发现患有继发性HPT，最终44%的患儿接受了某种程度的肿块手术清创。
{"title":"A Mandibular Brown Tumor: A Pediatric Case Report and Summary of Adolescence Cases","authors":"Gabriella E. Glassman, Joseph K. Williams, Colin M. Brady","doi":"10.1177/27325016241253276","DOIUrl":"https://doi.org/10.1177/27325016241253276","url":null,"abstract":"Mandibular brown tumors are often radiographically and histologically indistinguishable from cherubism, aneurysmal bone cyst, giant cell granuloma, and odontogenic fibroma. Laboratory findings of hyperparathyroidism (HPT) aid in directing therapy. We present a case of a 14-year-old male with a brown tumor of the mandible associated with secondary HPT due to vitamin D deficiency. Core biopsy exhibited a proliferation of plump spindle cells and osteoclast-like giant cells within variably fibrous stroma. Parathyroid hormone (PTH) levels were elevated to 288 pg/mL (normal 8.5-77.1 pg/mL) and vitamin D was low at a level of 6.9 ng/mL (normal > 20.0 ng/mL). Six months after the introduction of weekly vitamin D supplementation, PTH and vitamin D levels improved but remained abnormal with PTH of 86.8 pg/mL and vitamin D of 9.3 ng/mL. Alongside an improvement in laboratory indices, the tumor character stabilized and became less clinically friable; however, the burden remained unchanged. At 9 months, the patient underwent surgical debulking of the tumor with local soft tissue coverage. A review of pediatric literature was performed, among which 16 patients were identified. Most children who developed brown tumors were found to have secondary HPT and ultimately 44% underwent some degree of surgical debridement of the mass.","PeriodicalId":508736,"journal":{"name":"FACE","volume":" 1024","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140989462","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 : 2024-04-14DOI: 10.1177/27325016241246784
Lawrence O. Lin, Annie Orr, Gregory D. Pearson, Jonathan Pindrik, Ammar Shaikhouni, Alyssa Fogolin, I. Khansa
Pediatric patients with medically-intractable epilepsy may require modulation of seizure foci to reduce frequency and severity of seizures. These neuromodulatory procedures, which include responsive neurostimulator (RNS) and deep brain stimulator (DBS), involve the implantation of high-profile and long-term cranial hardware, placing patients at risk of wound healing complications, hardware exposure and infection. A multidisciplinary neurosurgical and plastic surgical approach utilizing pericranial flap coverage of hardware may decrease wound healing complications in these cases. This study compares the wound-healing outcomes in patients undergoing RNS/DBS insertion with and without pericranial flap coverage. A retrospective chart review was conducted of all patients who underwent RNS and DBS insertion with or without pericranial flap coverage at a level 1 pediatric medical center between 2014 and 2022. Wound healing outcomes at 60 days were evaluated. Data were compared using Fisher’s exact test. Twenty-seven patients underwent 29 neuromodulatory epilepsy procedures (14 DBS, 15 RNS). Twenty of the procedures included a pericranial flap to cover hardware. Median length of stay was 2.0 days for both cohorts. Two subjects without pericranial flap reconstruction had a wound healing complication (22.2%), compared to none of the procedures that included a pericranial flap ( P = .09). In pediatric patients undergoing insertion of responsive neurostimulators and deep brain stimulators for medically-intractable epilepsy, a multidisciplinary neurosurgery and plastic surgery approach utilizing pericranial flap reconstruction may reduce the risk of postoperative wound complications.
{"title":"Pericranial Flap Reconstruction in Pediatric Patients Undergoing Neuromodulatory Surgery: Impact on Wound Healing","authors":"Lawrence O. Lin, Annie Orr, Gregory D. Pearson, Jonathan Pindrik, Ammar Shaikhouni, Alyssa Fogolin, I. Khansa","doi":"10.1177/27325016241246784","DOIUrl":"https://doi.org/10.1177/27325016241246784","url":null,"abstract":"Pediatric patients with medically-intractable epilepsy may require modulation of seizure foci to reduce frequency and severity of seizures. These neuromodulatory procedures, which include responsive neurostimulator (RNS) and deep brain stimulator (DBS), involve the implantation of high-profile and long-term cranial hardware, placing patients at risk of wound healing complications, hardware exposure and infection. A multidisciplinary neurosurgical and plastic surgical approach utilizing pericranial flap coverage of hardware may decrease wound healing complications in these cases. This study compares the wound-healing outcomes in patients undergoing RNS/DBS insertion with and without pericranial flap coverage. A retrospective chart review was conducted of all patients who underwent RNS and DBS insertion with or without pericranial flap coverage at a level 1 pediatric medical center between 2014 and 2022. Wound healing outcomes at 60 days were evaluated. Data were compared using Fisher’s exact test. Twenty-seven patients underwent 29 neuromodulatory epilepsy procedures (14 DBS, 15 RNS). Twenty of the procedures included a pericranial flap to cover hardware. Median length of stay was 2.0 days for both cohorts. Two subjects without pericranial flap reconstruction had a wound healing complication (22.2%), compared to none of the procedures that included a pericranial flap ( P = .09). In pediatric patients undergoing insertion of responsive neurostimulators and deep brain stimulators for medically-intractable epilepsy, a multidisciplinary neurosurgery and plastic surgery approach utilizing pericranial flap reconstruction may reduce the risk of postoperative wound complications.","PeriodicalId":508736,"journal":{"name":"FACE","volume":"76 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140706131","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 : 2024-04-08DOI: 10.1177/27325016241246223
Nikki Rezania, Elizabeth S. O’Neill, Kelly A. Harmon, Sydney H. Arnold, Christina Tragos
Congenital midline cervical cleft (CMCC) is a rare congenital abnormality of the ventral neck that is often misdiagnosed. We present a case of a 12-year-old male with a history of incomplete CMCC excision and limited neck extension. We highlight the need for increased awareness of this anomaly and propose a clinical algorithm for clinicians when faced with this rare congenital condition. CMCC typically presents at birth and involves a defect along the midline of the neck, characterized by a nipple-like protrusion of the skin and a fibrous cord with an underlying sinus. Micrognathia and mandibular growth restriction are anticipated consequences of CMCC, requiring early intervention. Current treatment guidelines recommend surgical excision prior to age two using a Z-plasty technique. This report emphasizes the rarity and diagnostic challenges of CMCC. It underscores the significance of accurate identification and appropriate surgical planning in a timely manner. Based on the authors’ experience with this case and a review of the literature, we propose a clinical algorithm aimed to enhance CMCC diagnosis and management.
{"title":"Unveiling a Misdiagnosed Midline Cervical Cleft: A Case Report and Review of the Literature","authors":"Nikki Rezania, Elizabeth S. O’Neill, Kelly A. Harmon, Sydney H. Arnold, Christina Tragos","doi":"10.1177/27325016241246223","DOIUrl":"https://doi.org/10.1177/27325016241246223","url":null,"abstract":"Congenital midline cervical cleft (CMCC) is a rare congenital abnormality of the ventral neck that is often misdiagnosed. We present a case of a 12-year-old male with a history of incomplete CMCC excision and limited neck extension. We highlight the need for increased awareness of this anomaly and propose a clinical algorithm for clinicians when faced with this rare congenital condition. CMCC typically presents at birth and involves a defect along the midline of the neck, characterized by a nipple-like protrusion of the skin and a fibrous cord with an underlying sinus. Micrognathia and mandibular growth restriction are anticipated consequences of CMCC, requiring early intervention. Current treatment guidelines recommend surgical excision prior to age two using a Z-plasty technique. This report emphasizes the rarity and diagnostic challenges of CMCC. It underscores the significance of accurate identification and appropriate surgical planning in a timely manner. Based on the authors’ experience with this case and a review of the literature, we propose a clinical algorithm aimed to enhance CMCC diagnosis and management.","PeriodicalId":508736,"journal":{"name":"FACE","volume":"35 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140728427","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 : 2024-04-03DOI: 10.1177/27325016241244530
Robin J. Evans, Kristen E. Hughes
{"title":"Humility in the Operating Room: The Essential Virtue of the Evidence-Based Surgeon","authors":"Robin J. Evans, Kristen E. Hughes","doi":"10.1177/27325016241244530","DOIUrl":"https://doi.org/10.1177/27325016241244530","url":null,"abstract":"","PeriodicalId":508736,"journal":{"name":"FACE","volume":"12 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140747007","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 : 2024-04-03DOI: 10.1177/27325016241241962
Okensama M. La-Anyane, Nikki Rezania, Kelly A. Harmon, Christina Tragos, John W. Polley, Alvaro A. Figueroa
Background: The use of a rigid external distraction (RED) is recognized as a viable treatment option for patients with severe maxillary and midface hypoplasia. However, there is limited research on the technical placement of the RED device and its impact on patient outcomes. This systematic review examined variations in RED placement as reported in published clinical photos from journal articles, discusses its potential connection to distraction outcomes, and provides suggestions for proper placement of the device. Material and Methods: Articles in which RED was utilized and included clinical photos of patients wearing the RED device were systematically reviewed using PRISMA guidelines. Data extraction and RED placement photo assessment were performed, including subjective analysis of the images and objective angular measurement of device placement. Results: Despite the reporting of satisfactory outcomes in 83% of the reviewed articles, 64% of the photos depicted variations to the recommended halo frame placement. Of these photos, the halo frame was angled inferiorly in 73.8% and 45.16% of those studies depicting inferiorly angled halos reported adverse events. The vertical bar placement was angled posteriorly in 45% of the articles, and 44.4% of these articles reported complications. Conclusion: Photos from the literature show a high variability in RED device placement, with varying outcomes and complication rates. When placed optimally, with consideration to technical placement details such as cranial pin placement and distraction vector angles, the RED system should allow predictable maxillary and midface advancements with minimal complications.
背景：对于严重上颌和中面部发育不良的患者来说，使用硬质外部牵引（RED）被认为是一种可行的治疗方案。然而，关于 RED 装置的技术位置及其对患者治疗效果的影响的研究却很有限。这篇系统性综述研究了期刊文章中发表的临床照片所报告的 RED 置放位置的变化，讨论了其与牵引效果的潜在联系，并为正确放置该装置提供了建议。材料与方法：采用 PRISMA 指南对使用了 RED 并包含佩戴 RED 装置的患者临床照片的文章进行了系统性审查。进行了数据提取和 RED 置放照片评估，包括图像的主观分析和装置置放的客观角度测量。结果：尽管 83% 的综述文章报告了令人满意的结果，但 64% 的照片描述了与推荐的光环框架放置位置不同的情况。在这些照片中，73.8%的照片中的光环框架向下倾斜，在描述光环向下倾斜的研究中，45.16%报告了不良事件。45%的文章将垂直条放置在后方，其中44.4%的文章报告了并发症。结论文献中的照片显示，RED 装置的放置存在很大差异，结果和并发症发生率也各不相同。如果考虑到技术安置细节（如颅针安置和牵引矢量角度），以最佳方式安置，RED 系统应能实现可预测的上颌和中面部前移，并将并发症降至最低。
{"title":"Maxillary and Midface Advancement With Rigid External Distraction: A Review and Technical Recommendations for Optimized Halo Placement","authors":"Okensama M. La-Anyane, Nikki Rezania, Kelly A. Harmon, Christina Tragos, John W. Polley, Alvaro A. Figueroa","doi":"10.1177/27325016241241962","DOIUrl":"https://doi.org/10.1177/27325016241241962","url":null,"abstract":"Background: The use of a rigid external distraction (RED) is recognized as a viable treatment option for patients with severe maxillary and midface hypoplasia. However, there is limited research on the technical placement of the RED device and its impact on patient outcomes. This systematic review examined variations in RED placement as reported in published clinical photos from journal articles, discusses its potential connection to distraction outcomes, and provides suggestions for proper placement of the device. Material and Methods: Articles in which RED was utilized and included clinical photos of patients wearing the RED device were systematically reviewed using PRISMA guidelines. Data extraction and RED placement photo assessment were performed, including subjective analysis of the images and objective angular measurement of device placement. Results: Despite the reporting of satisfactory outcomes in 83% of the reviewed articles, 64% of the photos depicted variations to the recommended halo frame placement. Of these photos, the halo frame was angled inferiorly in 73.8% and 45.16% of those studies depicting inferiorly angled halos reported adverse events. The vertical bar placement was angled posteriorly in 45% of the articles, and 44.4% of these articles reported complications. Conclusion: Photos from the literature show a high variability in RED device placement, with varying outcomes and complication rates. When placed optimally, with consideration to technical placement details such as cranial pin placement and distraction vector angles, the RED system should allow predictable maxillary and midface advancements with minimal complications.","PeriodicalId":508736,"journal":{"name":"FACE","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140747945","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 : 2024-04-01DOI: 10.1177/27325016241245049
Joel M. Prince, Erin Poole, Christian El Amm
Background: Tubercle aesthetics are under-emphasized in unilateral cleft lip repair. Teenagers and adults with repaired cleft lip often display a central whistle deformity medial to the cleft lip scar. Lateral segment vermillion elements that are often discarded at the time of the initial repair can be used for tubercle reconstruction. Methods: We obtained anthropometric measurements of the dry vermilion around the central tubercle in neonates with unilateral cleft lip to determine the extent and morphology of deficiencies. A modification of the Noordhoff vermillion flap is proposed with a trapezoidal configuration to precisely match the measured, dry vermillion deficiency. Results: Photographic documentation illustrates the surgical technique and results. Conclusions: Tubercle reconstruction is described using a modification of the Noordhoff flap. Four-year results are encouraging. Observations through maturity are needed.
{"title":"Modification of Noordhoff Flap for Tubercle Reconstruction in Unilateral Cleft Lip Repair","authors":"Joel M. Prince, Erin Poole, Christian El Amm","doi":"10.1177/27325016241245049","DOIUrl":"https://doi.org/10.1177/27325016241245049","url":null,"abstract":"Background: Tubercle aesthetics are under-emphasized in unilateral cleft lip repair. Teenagers and adults with repaired cleft lip often display a central whistle deformity medial to the cleft lip scar. Lateral segment vermillion elements that are often discarded at the time of the initial repair can be used for tubercle reconstruction. Methods: We obtained anthropometric measurements of the dry vermilion around the central tubercle in neonates with unilateral cleft lip to determine the extent and morphology of deficiencies. A modification of the Noordhoff vermillion flap is proposed with a trapezoidal configuration to precisely match the measured, dry vermillion deficiency. Results: Photographic documentation illustrates the surgical technique and results. Conclusions: Tubercle reconstruction is described using a modification of the Noordhoff flap. Four-year results are encouraging. Observations through maturity are needed.","PeriodicalId":508736,"journal":{"name":"FACE","volume":"1217 28","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140774476","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 : 2024-03-28DOI: 10.1177/27325016241242372
Pearl Shah, Amanda Royek, Anand R. Kumar
Infantile hemangiomas (IHs) are the most common benign tumor of infancy. These tumors may have wide-ranging effects on functional and cosmetic outcomes for patients. With variations in recommendations for surgery among providers, it can be difficult to counsel patients and their families on potential surgical treatment. Through the development of the Case Western Hemangioma Intervention Predictor (CHIP) score, this study aims to improve the consistency of counseling regarding surgery and timing of surgical referral. This was a retrospective review of all patients (179) treated for IHs at a single tertiary care center over 17 years. Patients were divided equally into 2 cohorts. Descriptive statistics and correlation plots were performed on the first cohort to evaluate which disease factors (including size, location, and complications) and patient factors significantly correlated with the decision to pursue surgical treatment (surgical risk). These factors were used to form a CHIP score, which was then validated through logistic regression with length of medical management as a covariate against the second cohort of patients. After controlling for length of medical management to treat IH, lack of medical management, functional impairment, and ulceration were found to be significantly correlated with the risk of surgical intervention ( P < .05). When validated against the second half of our cohort, a CHIP score of 3 (of a maximum score of 3) was found to have a specificity of 92% and a sensitivity of 81% in predicting risk of surgical intervention. IHs can have clinical characteristics that may be predictors of complexity and surgical intervention. The CHIP score can assist in educating patients and families on surgery as a treatment option and guiding appropriate referrals.
{"title":"The CHIP Score: A Valuable Method for Determining Risk of Surgical Intervention for Hemangioma Patients","authors":"Pearl Shah, Amanda Royek, Anand R. Kumar","doi":"10.1177/27325016241242372","DOIUrl":"https://doi.org/10.1177/27325016241242372","url":null,"abstract":"Infantile hemangiomas (IHs) are the most common benign tumor of infancy. These tumors may have wide-ranging effects on functional and cosmetic outcomes for patients. With variations in recommendations for surgery among providers, it can be difficult to counsel patients and their families on potential surgical treatment. Through the development of the Case Western Hemangioma Intervention Predictor (CHIP) score, this study aims to improve the consistency of counseling regarding surgery and timing of surgical referral. This was a retrospective review of all patients (179) treated for IHs at a single tertiary care center over 17 years. Patients were divided equally into 2 cohorts. Descriptive statistics and correlation plots were performed on the first cohort to evaluate which disease factors (including size, location, and complications) and patient factors significantly correlated with the decision to pursue surgical treatment (surgical risk). These factors were used to form a CHIP score, which was then validated through logistic regression with length of medical management as a covariate against the second cohort of patients. After controlling for length of medical management to treat IH, lack of medical management, functional impairment, and ulceration were found to be significantly correlated with the risk of surgical intervention ( P < .05). When validated against the second half of our cohort, a CHIP score of 3 (of a maximum score of 3) was found to have a specificity of 92% and a sensitivity of 81% in predicting risk of surgical intervention. IHs can have clinical characteristics that may be predictors of complexity and surgical intervention. The CHIP score can assist in educating patients and families on surgery as a treatment option and guiding appropriate referrals.","PeriodicalId":508736,"journal":{"name":"FACE","volume":"68 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140371570","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 : 2024-03-27DOI: 10.1177/27325016241242006
Md Kalim Ansari, Akash Ganguly, Tabishur Rahman, Mohd Aswad Khan, G. N, Abhiparna Kundu
Schwannoma, also known as neurilemmoma, is a benign tumor originating from Schwann cells and may involve any nerve in the body but its most common occurrence is in the head and neck region. When it involves a nerve of face, it is often confused with dermoid cyst. We present the case of a 23-year-old male patient with Schwannoma arising from the area just below the lateral canthus of the left eye where the initial diagnostic hypothesis was dermoid cyst but later confirmed as Schwannoma on histopathological analysis.
{"title":"Schwannoma of Facial Region: A Pathology Often Missed in the Initial Diagnostic Hypothesis: A Case Report","authors":"Md Kalim Ansari, Akash Ganguly, Tabishur Rahman, Mohd Aswad Khan, G. N, Abhiparna Kundu","doi":"10.1177/27325016241242006","DOIUrl":"https://doi.org/10.1177/27325016241242006","url":null,"abstract":"Schwannoma, also known as neurilemmoma, is a benign tumor originating from Schwann cells and may involve any nerve in the body but its most common occurrence is in the head and neck region. When it involves a nerve of face, it is often confused with dermoid cyst. We present the case of a 23-year-old male patient with Schwannoma arising from the area just below the lateral canthus of the left eye where the initial diagnostic hypothesis was dermoid cyst but later confirmed as Schwannoma on histopathological analysis.","PeriodicalId":508736,"journal":{"name":"FACE","volume":"27 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140373962","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 : 2024-03-27DOI: 10.1177/27325016241241782
K. A. Alawi, Ruqaya Al Abri, S. A. Shaqsi, Jehad Al Habsi, Ahmed Al Azri, Taimoor Al Balushi
Infantile myofibroma stands as the most prevalent fibrous neoplasm within the pediatric population, despite its rarity. The majority of these tumors manifest within the initial 2 years of life. Clinically, myofibroma lesions are classified into solitary and multicentric tumors. We present a case of infantile myofibroma located within the frontal bone of a 16-month-old infant. Initial evaluation of the swelling and its spread was conducted using CT and MRI scans. Subsequently, the diagnosis was confirmed through a core needle biopsy. The tumor underwent surgical excision with 1 cm safety margin and immediate reconstruction with strips of calvaria bone graft. Histopathology of the specimen showed complete tumor clearance with actual margin of 7 mm. The surgical resection of cranial benign bone tumors should be meticulously planned with a multidisciplinary approach. Wherever possible, immediate reconstruction should be conducted to avoid the morbidity of a subsequent procedure.
{"title":"Infantile Myofibroma of the Frontal Bone: A Case Report","authors":"K. A. Alawi, Ruqaya Al Abri, S. A. Shaqsi, Jehad Al Habsi, Ahmed Al Azri, Taimoor Al Balushi","doi":"10.1177/27325016241241782","DOIUrl":"https://doi.org/10.1177/27325016241241782","url":null,"abstract":"Infantile myofibroma stands as the most prevalent fibrous neoplasm within the pediatric population, despite its rarity. The majority of these tumors manifest within the initial 2 years of life. Clinically, myofibroma lesions are classified into solitary and multicentric tumors. We present a case of infantile myofibroma located within the frontal bone of a 16-month-old infant. Initial evaluation of the swelling and its spread was conducted using CT and MRI scans. Subsequently, the diagnosis was confirmed through a core needle biopsy. The tumor underwent surgical excision with 1 cm safety margin and immediate reconstruction with strips of calvaria bone graft. Histopathology of the specimen showed complete tumor clearance with actual margin of 7 mm. The surgical resection of cranial benign bone tumors should be meticulously planned with a multidisciplinary approach. Wherever possible, immediate reconstruction should be conducted to avoid the morbidity of a subsequent procedure.","PeriodicalId":508736,"journal":{"name":"FACE","volume":"98 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140377291","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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