Pub Date : 2024-01-30DOI: 10.1177/27325016241227446
Katherine G. Holste, Katelyn G. Makar, R. Ulma, H. J. Garton, S. Buchman, Christian J. Vercler, K. Muraszko
Le Fort III osteotomies are used to advance the midface in children with midface hypoplasia and syndromic craniosynostosis. Complications can occur during the subcranial osteotomies, leading todural violations as well as vascular and neurologic injuries. In patients with cerebrospinal fluid (CSF) shunts, CSF leak places them at risk of shunt infection. To avoid these injuries, surgeons may utilize an intracranial approach to gain optimal visualization of the cranial base for the horizontal cut through the ethmoid bone, at the naso-frontal junction, below the cribiform plate. A formal craniotomy to simply assure a safe osteotomy, however, may well be an unnecessary morbidity. The aim of this study was to describe the indications for and technical advantages of image guidance for subcranial Le Fort III osteotomies without a craniotomy. We describe the use of the StealthStation 3-D intraoperative image guidance system for subcranial Le Fort III osteotomies and associated clinical outcomes. An electronic medical record search at a single academic institution identified 10 patients with Current Procedural Terminology codes 21154-21155 (reconstruction midface, Le Fort III). Six patients underwent image-guided subcranial Le Fort III osteotomies between 2008 and 2023. There were no cases of vascular injury, cranial nerve injury, or cerebrospinal fluid leak. No patients with a CSF shunt experienced shunt infection during follow up. Image-guidance provides technical advantages as an alternative approach to subcranial Le Fort III osteotomies while allowing the surgeon to avoid the morbidity of a craniotomy.
Le Fort III 截骨术用于推进中面发育不良和综合颅畸形患儿的中面。颅下截骨术可能会发生并发症，导致硬脑膜损伤以及血管和神经损伤。在脑脊液（CSF）分流患者中，CSF 泄漏会使他们面临分流感染的风险。为了避免这些损伤，外科医生可能会采用颅内入路，以获得最佳的颅底视野，在鼻额交界处、楔形板下方的乙状骨上进行水平切开。然而，为了确保安全截骨而进行的正式开颅手术很可能会造成不必要的发病。本研究的目的是描述在不开颅的情况下进行颅下 Le Fort III 截骨术的图像引导的适应症和技术优势。我们描述了 StealthStation 3-D 术中图像引导系统在颅下 Le Fort III 截骨术中的应用及相关临床结果。通过对一家学术机构的电子病历进行搜索，我们发现了 10 位当前程序术语代码为 21154-21155（重建中面，Le Fort III）的患者。六名患者在 2008 年至 2023 年期间接受了图像引导下的颅下 Le Fort III 截骨术。无血管损伤、颅神经损伤或脑脊液漏病例。在随访期间，没有脑脊液分流患者发生分流感染。作为颅下 Le Fort III 截骨术的替代方法，图像引导具有技术优势，同时允许外科医生避免开颅手术的发病率。
{"title":"Advantages of an Image-Guided Subcranial Technique for Le Fort III Osteotomies for Midface Advancement: A Case Series","authors":"Katherine G. Holste, Katelyn G. Makar, R. Ulma, H. J. Garton, S. Buchman, Christian J. Vercler, K. Muraszko","doi":"10.1177/27325016241227446","DOIUrl":"https://doi.org/10.1177/27325016241227446","url":null,"abstract":"Le Fort III osteotomies are used to advance the midface in children with midface hypoplasia and syndromic craniosynostosis. Complications can occur during the subcranial osteotomies, leading todural violations as well as vascular and neurologic injuries. In patients with cerebrospinal fluid (CSF) shunts, CSF leak places them at risk of shunt infection. To avoid these injuries, surgeons may utilize an intracranial approach to gain optimal visualization of the cranial base for the horizontal cut through the ethmoid bone, at the naso-frontal junction, below the cribiform plate. A formal craniotomy to simply assure a safe osteotomy, however, may well be an unnecessary morbidity. The aim of this study was to describe the indications for and technical advantages of image guidance for subcranial Le Fort III osteotomies without a craniotomy. We describe the use of the StealthStation 3-D intraoperative image guidance system for subcranial Le Fort III osteotomies and associated clinical outcomes. An electronic medical record search at a single academic institution identified 10 patients with Current Procedural Terminology codes 21154-21155 (reconstruction midface, Le Fort III). Six patients underwent image-guided subcranial Le Fort III osteotomies between 2008 and 2023. There were no cases of vascular injury, cranial nerve injury, or cerebrospinal fluid leak. No patients with a CSF shunt experienced shunt infection during follow up. Image-guidance provides technical advantages as an alternative approach to subcranial Le Fort III osteotomies while allowing the surgeon to avoid the morbidity of a craniotomy.","PeriodicalId":508736,"journal":{"name":"FACE","volume":"94 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140483671","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 : 2024-01-30DOI: 10.1177/27325016241227614
Chioma G. Obinero, Alexandra Boyd, Jose E Barrera, Alyssa Valenti, Naikhoba C. O. Munabi, Thomas A. Imahiyerobo, M. Greives
Comprehensive management of cleft lip with or without cleft palate (CL/P) often begins prenatally, continues into adulthood, and involves multidisciplinary collaboration. This study aims to review the current literature and summarize sociodemographic disparities that impact access to care, management, and postoperative outcomes in patients with CL/P. A systematic review was conducted using Pubmed, Embase, and Medline databases. Studies discussing sociodemographic disparities regarding access to care, management, and treatment outcomes for patients with CL/P were included. Studies performed outside the US and published before the year 2000 were excluded. Of 3782 studies initially identified, 26 met the inclusion criteria. Disparities discussed included access to care (n = 11), missed appointments (n = 2), use of nasoalveolar molding [NAM] (n = 3), surgical timing (n = 8), and surgical outcomes (n = 8). Minority race or ethnicity, particularly black, Hispanic, Asian, and Native-American, as well as public insurance were associated with impaired access to care. Other factors causing impaired access to care were non-English primary language and high cost. Predictors for missed appointments were black race and Medicaid insurance. Decreased use of or success with NAM was associated with Asian race, public insurance, and long travel distance to a cleft care center. Factors associated with delayed CL surgery were Asian or black race, Hispanic ethnicity, public insurance, and non-English primary language. Surgical outcomes were assessed using various esthetic, speech, and quality of life measures; factors linked to worse outcomes included black or latin race and public insurance. Patients with CL/P from minority racial or ethnic groups, particularly black, Asian, and Hispanic, as well as those with public insurance are disproportionately impacted by health disparities. Disparities related to age, geographic location, and primary language have also been reported, among others. Statewide or institutional social programs may help address these disparities.
{"title":"Revealing a Cleft in the Community: A Systematic Review of Sociodemographic Disparities Affecting the Care of Patients With Cleft Lip","authors":"Chioma G. Obinero, Alexandra Boyd, Jose E Barrera, Alyssa Valenti, Naikhoba C. O. Munabi, Thomas A. Imahiyerobo, M. Greives","doi":"10.1177/27325016241227614","DOIUrl":"https://doi.org/10.1177/27325016241227614","url":null,"abstract":"Comprehensive management of cleft lip with or without cleft palate (CL/P) often begins prenatally, continues into adulthood, and involves multidisciplinary collaboration. This study aims to review the current literature and summarize sociodemographic disparities that impact access to care, management, and postoperative outcomes in patients with CL/P. A systematic review was conducted using Pubmed, Embase, and Medline databases. Studies discussing sociodemographic disparities regarding access to care, management, and treatment outcomes for patients with CL/P were included. Studies performed outside the US and published before the year 2000 were excluded. Of 3782 studies initially identified, 26 met the inclusion criteria. Disparities discussed included access to care (n = 11), missed appointments (n = 2), use of nasoalveolar molding [NAM] (n = 3), surgical timing (n = 8), and surgical outcomes (n = 8). Minority race or ethnicity, particularly black, Hispanic, Asian, and Native-American, as well as public insurance were associated with impaired access to care. Other factors causing impaired access to care were non-English primary language and high cost. Predictors for missed appointments were black race and Medicaid insurance. Decreased use of or success with NAM was associated with Asian race, public insurance, and long travel distance to a cleft care center. Factors associated with delayed CL surgery were Asian or black race, Hispanic ethnicity, public insurance, and non-English primary language. Surgical outcomes were assessed using various esthetic, speech, and quality of life measures; factors linked to worse outcomes included black or latin race and public insurance. Patients with CL/P from minority racial or ethnic groups, particularly black, Asian, and Hispanic, as well as those with public insurance are disproportionately impacted by health disparities. Disparities related to age, geographic location, and primary language have also been reported, among others. Statewide or institutional social programs may help address these disparities.","PeriodicalId":508736,"journal":{"name":"FACE","volume":"60 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140482425","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 : 2024-01-28DOI: 10.1177/27325016241228873
Jordan P. Steinberg
{"title":"Mon Cher Tony: A Tribute to S. Anthony Wolfe, MD","authors":"Jordan P. Steinberg","doi":"10.1177/27325016241228873","DOIUrl":"https://doi.org/10.1177/27325016241228873","url":null,"abstract":"","PeriodicalId":508736,"journal":{"name":"FACE","volume":"378 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140490821","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 : 2024-01-28DOI: 10.1177/27325016241229899
Bill Hoffman
{"title":"A Man From Miami","authors":"Bill Hoffman","doi":"10.1177/27325016241229899","DOIUrl":"https://doi.org/10.1177/27325016241229899","url":null,"abstract":"","PeriodicalId":508736,"journal":{"name":"FACE","volume":"234 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140491295","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 : 2024-01-28DOI: 10.1177/27325016241229895
David Matthews
{"title":"Independent, Determined, Caring: A Tribute to S. Tony Wolfe","authors":"David Matthews","doi":"10.1177/27325016241229895","DOIUrl":"https://doi.org/10.1177/27325016241229895","url":null,"abstract":"","PeriodicalId":508736,"journal":{"name":"FACE","volume":"323 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140491208","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 : 2024-01-28DOI: 10.1177/27325016241229898
John van Aalst
{"title":"Remembering Our Mentors: Paul Tessier, Ralph Millard, Tony Wolfe, Dave Matthews, Bill Hoffman, Reza Jarrahy, Joe Williams, Jordan Steinberg","authors":"John van Aalst","doi":"10.1177/27325016241229898","DOIUrl":"https://doi.org/10.1177/27325016241229898","url":null,"abstract":"","PeriodicalId":508736,"journal":{"name":"FACE","volume":"263 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140491251","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 : 2024-01-28DOI: 10.1177/27325016241229903
Tony Wolfe
{"title":"A Brief Self-Reflection of a Man and His Life: Anthony Wolfe","authors":"Tony Wolfe","doi":"10.1177/27325016241229903","DOIUrl":"https://doi.org/10.1177/27325016241229903","url":null,"abstract":"","PeriodicalId":508736,"journal":{"name":"FACE","volume":"300 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140491026","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 : 2024-01-25DOI: 10.1177/27325016231226300
Paul F. Martinez, Theresa K. Webster, Thomas A. Imahiyerobo
Cleft lip scar formation is an inevitable consequence of cleft lip repair (CLR) and is exacerbated by the dynamic movement of the middle face. Various methods to correct or prevent these deformities have been described including silicone sheeting, surgical revisions, laser therapy, and more recently, Botulinum toxin-A (Botox) and Dermabond. This study aims to analyze and compare the impact of Botox versus Dermabond on scar appearance after CLR. Following PRISMA guidelines, a systematic review was performed on Medline, Embase, Cochrane, and CINAHL using the following keywords: “Dermabond,” “botulinum toxin,” and “cleft lip.” Outcomes of interest were the rates of scar hypertrophy, scar width, Vancouver scar scale (VSS), visual analog scale (VAS), Hollander wound evaluation scale (HWES), and complications. Nine studies were included of which 4 articles analyzed Botox and 5 analyzed Dermabond. Forest plots for scar width at the first and second time point supported the use of Botox to achieve a smaller scar width with P < .0001 (95% CI: −1.09 [−1.56 to −0.63] and 95% CI: −0.94 [−1.37 to −0.50], respectively). A significant increase in VAS was observed with Botox (95% CI: 1.66 [1.27-2.05], P value < .0001) and VSS was insignificant. Of the articles that analyzed Dermabond, scar appearance was comparable to the traditional suture closure group. There were no feeding complications for either intervention. Pooled forest plots for VAS comparing Botox and Dermabond supported the use of Botox with improved VAS (95% CI: 1.66 [1.27-2.05], P < .0001) compared to Dermabond (95% CI: 0.07 [ −0.48 to 0.61], P = .80). The current literature supports the use of Botox for scar improvement following CLR or revision. However, there is limited data to support Dermabond’s utility in improving scars in CLR, which highlights the need for further studies.
{"title":"Is Botox or Dermabond Superior in the Appearance of the Lip Scar After Primary Cleft Lip Repair and Revision? A Systematic Review and Meta-Analysis","authors":"Paul F. Martinez, Theresa K. Webster, Thomas A. Imahiyerobo","doi":"10.1177/27325016231226300","DOIUrl":"https://doi.org/10.1177/27325016231226300","url":null,"abstract":"Cleft lip scar formation is an inevitable consequence of cleft lip repair (CLR) and is exacerbated by the dynamic movement of the middle face. Various methods to correct or prevent these deformities have been described including silicone sheeting, surgical revisions, laser therapy, and more recently, Botulinum toxin-A (Botox) and Dermabond. This study aims to analyze and compare the impact of Botox versus Dermabond on scar appearance after CLR. Following PRISMA guidelines, a systematic review was performed on Medline, Embase, Cochrane, and CINAHL using the following keywords: “Dermabond,” “botulinum toxin,” and “cleft lip.” Outcomes of interest were the rates of scar hypertrophy, scar width, Vancouver scar scale (VSS), visual analog scale (VAS), Hollander wound evaluation scale (HWES), and complications. Nine studies were included of which 4 articles analyzed Botox and 5 analyzed Dermabond. Forest plots for scar width at the first and second time point supported the use of Botox to achieve a smaller scar width with P < .0001 (95% CI: −1.09 [−1.56 to −0.63] and 95% CI: −0.94 [−1.37 to −0.50], respectively). A significant increase in VAS was observed with Botox (95% CI: 1.66 [1.27-2.05], P value < .0001) and VSS was insignificant. Of the articles that analyzed Dermabond, scar appearance was comparable to the traditional suture closure group. There were no feeding complications for either intervention. Pooled forest plots for VAS comparing Botox and Dermabond supported the use of Botox with improved VAS (95% CI: 1.66 [1.27-2.05], P < .0001) compared to Dermabond (95% CI: 0.07 [ −0.48 to 0.61], P = .80). The current literature supports the use of Botox for scar improvement following CLR or revision. However, there is limited data to support Dermabond’s utility in improving scars in CLR, which highlights the need for further studies.","PeriodicalId":508736,"journal":{"name":"FACE","volume":"26 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139596473","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 : 2024-01-25DOI: 10.1177/27325016231226301
Haley K. Talbot-Stetsko, Katherine G. Holste, Megan Dietze-Fiedler, Geoffrey E. Hespe, Christian J. Vercler, K. Muraszko
The glymphatic system, a relatively recently discovered system for transport of cerebrospinal fluid (CSF) and waste products in the central nervous system, has been implicated in several neurologic disorders. Altered CSF dynamics are seen after decompressive craniectomy, suggesting this procedure may impact glymphatic function. We aimed to systematically review the current literature to understand the effect of the glymphatic system on patients with decompressive craniectomies and Syndrome of the Trephined (SoT). PubMed and Embase were searched for preclinical and clinical studies investigating the glymphatic system and craniectomy, cranioplasty, or SoT in years 2012 to 2023. Sixty-three studies were identified for review. Intracranial oscillations, cerebral perfusion, and arterial pulsations have been identified as major drivers of glymphatic influx. Each of these processes are diminished following craniectomy, suggesting craniectomy may impair glymphatic function. Reductions in brain pulsatility and alterations in glymphatic drainage after craniectomy were accompanied by impaired functional outcomes, as seen in SoT. Radiologically, CSF flow alterations are seen after craniectomies, which improve with cranioplasty. Glymphatic system dysfunction after craniectomy and in SoT may be a potential therapeutic target for patients with iatrogenically altered cranial vault anatomy.
{"title":"The Anatomy and Physiology of the Glymphatic System and Its Role in Craniectomies and Syndrome of the Trephined","authors":"Haley K. Talbot-Stetsko, Katherine G. Holste, Megan Dietze-Fiedler, Geoffrey E. Hespe, Christian J. Vercler, K. Muraszko","doi":"10.1177/27325016231226301","DOIUrl":"https://doi.org/10.1177/27325016231226301","url":null,"abstract":"The glymphatic system, a relatively recently discovered system for transport of cerebrospinal fluid (CSF) and waste products in the central nervous system, has been implicated in several neurologic disorders. Altered CSF dynamics are seen after decompressive craniectomy, suggesting this procedure may impact glymphatic function. We aimed to systematically review the current literature to understand the effect of the glymphatic system on patients with decompressive craniectomies and Syndrome of the Trephined (SoT). PubMed and Embase were searched for preclinical and clinical studies investigating the glymphatic system and craniectomy, cranioplasty, or SoT in years 2012 to 2023. Sixty-three studies were identified for review. Intracranial oscillations, cerebral perfusion, and arterial pulsations have been identified as major drivers of glymphatic influx. Each of these processes are diminished following craniectomy, suggesting craniectomy may impair glymphatic function. Reductions in brain pulsatility and alterations in glymphatic drainage after craniectomy were accompanied by impaired functional outcomes, as seen in SoT. Radiologically, CSF flow alterations are seen after craniectomies, which improve with cranioplasty. Glymphatic system dysfunction after craniectomy and in SoT may be a potential therapeutic target for patients with iatrogenically altered cranial vault anatomy.","PeriodicalId":508736,"journal":{"name":"FACE","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139598047","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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