Pub Date : 2023-11-06DOI: 10.1177/27325016231209403
Gary R. Hoffman, Sophie K. M. Kelly, Hao-Hsuan (Mark) Tsai
Background: In response to the COVID-19 outbreak, the widespread imposition of social distancing and lockdown orders had an unintended secondary effect on reducing and changing the characteristics of facial injury presentations to tertiary referral hospitals. As the pandemic curve plateaued and indeed fell, these restrictions were periodically repealed, engendering an anticipated rise in the frequency facial injuries. Objective: The purpose of this study was to determine whether the frequency and characteristics of facial injury presentations to our tertiary referral hospital returned to pre-COVID levels following the repeal of COVID-19 social distancing and lockdown laws on the far side of the pandemic curve. Methods: The authors designed and implemented a retrospective study of patients who sustained a facial injury over 3 comparable 8-week periods in 2019 (pre-COVID), 2020 (COVID lockdown) and 2023 (post-repeal of COVID lockdown laws). The study was conducted in the Department of Maxillofacial Surgery at a level 1 tertiary referral regional trauma hospital in Newcastle, Australia. Results: The principal finding was an increase in facial injury frequency in the post-COVID cohort (n = 149), compared to the COVID lockdown (n = 37) and pre-COVID groups (n = 103). Across all 3 periods, males consistently outnumbered females, with a common peak in the 20 to 30 age group. Bony injuries predominated in all cohorts, with no difference in management approach. The leading cause of injury pre-COVID was interpersonal violence, which shifted to falls during lockdown and post-COVID. There was also an increase in workplace and animal-related injuries post-COVID. Conclusion: The frequency and characteristics of facial injury presentation finally stabilized and returned to pre-COVID levels following the repeal of social distancing laws. This was most notable as communities entered the far side of the pandemic curve. The findings are in keeping with a very small number of comparable studies sourced from literature.
{"title":"The Epidemiology of Facial Injury on the Far Side of the COVID-19 Pandemic Curve: What Happened After the Repeal of Social Distancing Laws?","authors":"Gary R. Hoffman, Sophie K. M. Kelly, Hao-Hsuan (Mark) Tsai","doi":"10.1177/27325016231209403","DOIUrl":"https://doi.org/10.1177/27325016231209403","url":null,"abstract":"Background: In response to the COVID-19 outbreak, the widespread imposition of social distancing and lockdown orders had an unintended secondary effect on reducing and changing the characteristics of facial injury presentations to tertiary referral hospitals. As the pandemic curve plateaued and indeed fell, these restrictions were periodically repealed, engendering an anticipated rise in the frequency facial injuries. Objective: The purpose of this study was to determine whether the frequency and characteristics of facial injury presentations to our tertiary referral hospital returned to pre-COVID levels following the repeal of COVID-19 social distancing and lockdown laws on the far side of the pandemic curve. Methods: The authors designed and implemented a retrospective study of patients who sustained a facial injury over 3 comparable 8-week periods in 2019 (pre-COVID), 2020 (COVID lockdown) and 2023 (post-repeal of COVID lockdown laws). The study was conducted in the Department of Maxillofacial Surgery at a level 1 tertiary referral regional trauma hospital in Newcastle, Australia. Results: The principal finding was an increase in facial injury frequency in the post-COVID cohort (n = 149), compared to the COVID lockdown (n = 37) and pre-COVID groups (n = 103). Across all 3 periods, males consistently outnumbered females, with a common peak in the 20 to 30 age group. Bony injuries predominated in all cohorts, with no difference in management approach. The leading cause of injury pre-COVID was interpersonal violence, which shifted to falls during lockdown and post-COVID. There was also an increase in workplace and animal-related injuries post-COVID. Conclusion: The frequency and characteristics of facial injury presentation finally stabilized and returned to pre-COVID levels following the repeal of social distancing laws. This was most notable as communities entered the far side of the pandemic curve. The findings are in keeping with a very small number of comparable studies sourced from literature.","PeriodicalId":93749,"journal":{"name":"FACE (Thousand Oaks, Calif.)","volume":"40 8","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135680493","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 : 2023-10-31DOI: 10.1177/27325016231206824
Dani Stanbouly, Fereshteh Goudarzi, Ricardo Grillo, Jeffrey A. Ascherman, Brian Kinard, James C. Melville
Objective: The aim of this study was to determine whether patients with syndromic craniosynostosis (SCS) are at increased risk for abnormal speech and language development (ASLD) relative to patients with non-syndromic craniosynostosis (NSCS). Study Design: A retrospective cohort study was completed using the Kids’ Inpatient Database (KID). All patients with craniosynostosis (CS) were included were included. The primary predictor variable was study grouping (SCS vs NSCS). The primary outcome variable was ASLD. Multivariate logistic regression were performed to identify risk factors for ASLD. Results: The final study sample included a total of 10 089 patients with craniosynostosis (CS) (37.7% female, 51.6% White, mean age 1.78 years). Patients with SCS were at increased risk for ASLD relative to patients with NSCS (OR 2.1, P < .001). After controlling for all other variables, patients with SCS were no longer at increased risk for ASLD relative to patients with NSCS (OR 1.2, P = .442). Conclusions: Relative to NSCS, SCS per se is not a risk factor for ASLD. The significantly greater prevalence of asthma, intracranial hypertension, and compression of brain, all of which are risk factors for ASLD, among patients with SCS explains the greater prevalence of ASLD in SCS relative to NSCS.
目的:本研究的目的是确定综合征性颅缝闭闭(SCS)患者相对于非综合征性颅缝闭闭(NSCS)患者是否有更高的言语和语言发育异常(ASLD)风险。研究设计:使用儿童住院患者数据库(KID)完成回顾性队列研究。所有颅缝闭合(CS)患者均被纳入。主要预测变量为研究分组(SCS vs NSCS)。主要结局变量为ASLD。采用多因素logistic回归来确定ASLD的危险因素。结果:最终的研究样本包括1089例颅缝闭闭(CS)患者(女性37.7%，白人51.6%，平均年龄1.78岁)。与NSCS患者相比，SCS患者发生ASLD的风险增加(OR 2.1, P <措施)。在控制了所有其他变量后，SCS患者与NSCS患者相比，ASLD的风险不再增加(OR 1.2, P = .442)。结论:相对于NSCS, SCS本身不是ASLD的危险因素。在SCS患者中，哮喘、颅内高压和脑压迫的患病率明显高于ASLD，这些都是ASLD的危险因素，这解释了相对于NSCS, SCS中ASLD的患病率更高。
{"title":"Are Patients With Syndromic Craniosynostosis at Greater Risk for Abnormal Speech and Language Development Than Patients With Non-syndromic Craniosynostosis?","authors":"Dani Stanbouly, Fereshteh Goudarzi, Ricardo Grillo, Jeffrey A. Ascherman, Brian Kinard, James C. Melville","doi":"10.1177/27325016231206824","DOIUrl":"https://doi.org/10.1177/27325016231206824","url":null,"abstract":"Objective: The aim of this study was to determine whether patients with syndromic craniosynostosis (SCS) are at increased risk for abnormal speech and language development (ASLD) relative to patients with non-syndromic craniosynostosis (NSCS). Study Design: A retrospective cohort study was completed using the Kids’ Inpatient Database (KID). All patients with craniosynostosis (CS) were included were included. The primary predictor variable was study grouping (SCS vs NSCS). The primary outcome variable was ASLD. Multivariate logistic regression were performed to identify risk factors for ASLD. Results: The final study sample included a total of 10 089 patients with craniosynostosis (CS) (37.7% female, 51.6% White, mean age 1.78 years). Patients with SCS were at increased risk for ASLD relative to patients with NSCS (OR 2.1, P < .001). After controlling for all other variables, patients with SCS were no longer at increased risk for ASLD relative to patients with NSCS (OR 1.2, P = .442). Conclusions: Relative to NSCS, SCS per se is not a risk factor for ASLD. The significantly greater prevalence of asthma, intracranial hypertension, and compression of brain, all of which are risk factors for ASLD, among patients with SCS explains the greater prevalence of ASLD in SCS relative to NSCS.","PeriodicalId":93749,"journal":{"name":"FACE (Thousand Oaks, Calif.)","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135871279","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 : 2023-10-26DOI: 10.1177/27325016231208381
Chelsea L. Wehr, Austin Lignieres, Chioma G. Obinero, Alfredo Cepeda, Antonio Cardenas, F. Kurtis Kasper, Bhavini Acharya, Eliana Bonfante-Mejia, Roy Riascos-Castaneda, Rajan Patel, Brett T. Chiquet, Matthew R. Greives
Purpose: Present a novel technique for fabrication of nasoalveolar molding (NAM) appliances for neonates with cleft lip and palate (CLP) using magnetic resonance imaging (MRI). Study design: Proof-of-concept study. Setting/Participants: One patient with unilateral CLP was recruited for participation in this study at our institution. Interventions: This study employed 2 different methods for creating a NAM appliance, which is used in patients with CLP to improve anatomic positioning of the orofacial cleft in preparation for primary cheiloplasty. The patient underwent intraoral impression for traditional fabrication of a NAM appliance (PMMA-NAM) and also MRI of the face for digital fabrication of a NAM appliance (CAD-NAM). The 2 appliances were then compared using landmarks for measurements. Primary Outcome: Landmark measurements on NAM appliances; Clinical interchangeability of NAM appliances. Results: There was a statistically significant difference in the external arch width between the CAD-NAM and the PMMA-NAM. All other NAM measurements were statistically similar. Additionally, there was clinical success in the interchangeable fit of both appliances on both models. Conclusions: This technique could potentially eliminate the need for creation of an intraoral impression, as well as the adverse events associated with this, in the fabrication of NAM appliances. Larger studies are necessary to further define the efficacy of this novel approach and generalizability to other patients with CLP.
{"title":"MRI Modeling for 3D Printed Fabrication of Nasoalveolar Molding Appliance in Patients With Cleft Lip and Palate","authors":"Chelsea L. Wehr, Austin Lignieres, Chioma G. Obinero, Alfredo Cepeda, Antonio Cardenas, F. Kurtis Kasper, Bhavini Acharya, Eliana Bonfante-Mejia, Roy Riascos-Castaneda, Rajan Patel, Brett T. Chiquet, Matthew R. Greives","doi":"10.1177/27325016231208381","DOIUrl":"https://doi.org/10.1177/27325016231208381","url":null,"abstract":"Purpose: Present a novel technique for fabrication of nasoalveolar molding (NAM) appliances for neonates with cleft lip and palate (CLP) using magnetic resonance imaging (MRI). Study design: Proof-of-concept study. Setting/Participants: One patient with unilateral CLP was recruited for participation in this study at our institution. Interventions: This study employed 2 different methods for creating a NAM appliance, which is used in patients with CLP to improve anatomic positioning of the orofacial cleft in preparation for primary cheiloplasty. The patient underwent intraoral impression for traditional fabrication of a NAM appliance (PMMA-NAM) and also MRI of the face for digital fabrication of a NAM appliance (CAD-NAM). The 2 appliances were then compared using landmarks for measurements. Primary Outcome: Landmark measurements on NAM appliances; Clinical interchangeability of NAM appliances. Results: There was a statistically significant difference in the external arch width between the CAD-NAM and the PMMA-NAM. All other NAM measurements were statistically similar. Additionally, there was clinical success in the interchangeable fit of both appliances on both models. Conclusions: This technique could potentially eliminate the need for creation of an intraoral impression, as well as the adverse events associated with this, in the fabrication of NAM appliances. Larger studies are necessary to further define the efficacy of this novel approach and generalizability to other patients with CLP.","PeriodicalId":93749,"journal":{"name":"FACE (Thousand Oaks, Calif.)","volume":"59 8","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134909268","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 : 2023-10-26DOI: 10.1177/27325016231203517
Dillan F. Villavisanis, Carrie Z. Morales, Connor S. Wagner, Jessica D. Blum, Nancy Folsom, Daniel Y. Cho, Scott P. Bartlett, Jesse A. Taylor, Jordan W. Swanson
Background: Given the relatively resource-intensive burden of treating orofacial clefting and its functional and aesthetic sequelae, it is perhaps unsurprising that lower socioeconomic status is known to have adverse effects on outcomes in patients with cleft lip and/or palate (CL/P). Although outcomes in patients with CL/P are known to be influenced by socioeconomic status, the relationship between socioeconomic status and age-related weight gain has not been described. This study aimed to determine time-specific socioeconomic disparities in weight-for-age Z-scores and failure to thrive in patients with CL/P. Methods: This retrospective study evaluated patients presenting with CL/P from 2009 to 2019 at a tertiary children’s hospital. Failure to thrive status was determined by weight-for-age Z-scores less than −2.00 (second percentile) or from the EHR. Median income by block group was determined from US 2019 census data. Results: Multivariate linear regression models controlled for syndromic status, sex, and race revealed significant associations between median block group income and weight-for-age Z-scores at 4 weeks (β = .14, P = .009), 6 weeks (β = .15, P = .003), and 8 weeks (β = .14, P = .002). Mann Whitney U tests revealed significantly different weight-for-age Z-scores between low-income and high-income groups at 4 weeks ( P = .002), 6 weeks ( P < .001), 8 weeks ( P < .001), 10 weeks ( P = .005), and 12 weeks ( P = .004). Conclusions: Patients with CL/P and lower socioeconomic status may be most susceptible to disparities in weight gain between 4 and 8 weeks of age. Lower socioeconomic status was an independent predictor of failure to thrive for patients with CL/P in this cohort. This study highlights a welcome opportunity for timed intervention in patients with CL/P and lower socioeconomic status.
背景:考虑到治疗唇腭裂的相对资源密集型负担及其功能和美学后遗症，较低的社会经济地位对唇裂和/或腭裂(CL/P)患者的预后有不利影响，这可能不足为奇。虽然已知CL/P患者的预后受社会经济地位的影响，但社会经济地位与年龄相关体重增加之间的关系尚未得到描述。本研究旨在确定CL/P患者在年龄体重z分数和成长失败方面的时间特异性社会经济差异。方法:本回顾性研究评估了一家三级儿童医院2009年至2019年出现CL/P的患者。未能茁壮成长的状态由年龄体重z分数小于- 2.00(第二个百分位数)或EHR确定。按街区组划分的收入中位数是根据美国2019年人口普查数据确定的。结果:控制综合症状态、性别和种族的多元线性回归模型显示，在4周(β = .14, P = .009)、6周(β = .15, P = .003)和8周(β = .14, P = .002)时，中位块组收入和年龄体重z分数之间存在显著关联。Mann Whitney U检验显示，低收入组和高收入组在第4周(P = 0.002)、第6周(P <.001)， 8周(P <0.001)、10周(P = 0.005)和12周(P = 0.004)。结论:CL/P患者和社会经济地位较低的患者可能最容易在4到8周龄之间出现体重增加差异。较低的社会经济地位是本队列中CL/P患者生存失败的独立预测因子。本研究强调了对社会经济地位较低的CL/P患者进行定时干预的一个受欢迎的机会。
{"title":"Socioeconomic Disparities in Failure to Thrive and Weight Gain for Patients With Cleft Lip and Palate","authors":"Dillan F. Villavisanis, Carrie Z. Morales, Connor S. Wagner, Jessica D. Blum, Nancy Folsom, Daniel Y. Cho, Scott P. Bartlett, Jesse A. Taylor, Jordan W. Swanson","doi":"10.1177/27325016231203517","DOIUrl":"https://doi.org/10.1177/27325016231203517","url":null,"abstract":"Background: Given the relatively resource-intensive burden of treating orofacial clefting and its functional and aesthetic sequelae, it is perhaps unsurprising that lower socioeconomic status is known to have adverse effects on outcomes in patients with cleft lip and/or palate (CL/P). Although outcomes in patients with CL/P are known to be influenced by socioeconomic status, the relationship between socioeconomic status and age-related weight gain has not been described. This study aimed to determine time-specific socioeconomic disparities in weight-for-age Z-scores and failure to thrive in patients with CL/P. Methods: This retrospective study evaluated patients presenting with CL/P from 2009 to 2019 at a tertiary children’s hospital. Failure to thrive status was determined by weight-for-age Z-scores less than −2.00 (second percentile) or from the EHR. Median income by block group was determined from US 2019 census data. Results: Multivariate linear regression models controlled for syndromic status, sex, and race revealed significant associations between median block group income and weight-for-age Z-scores at 4 weeks (β = .14, P = .009), 6 weeks (β = .15, P = .003), and 8 weeks (β = .14, P = .002). Mann Whitney U tests revealed significantly different weight-for-age Z-scores between low-income and high-income groups at 4 weeks ( P = .002), 6 weeks ( P < .001), 8 weeks ( P < .001), 10 weeks ( P = .005), and 12 weeks ( P = .004). Conclusions: Patients with CL/P and lower socioeconomic status may be most susceptible to disparities in weight gain between 4 and 8 weeks of age. Lower socioeconomic status was an independent predictor of failure to thrive for patients with CL/P in this cohort. This study highlights a welcome opportunity for timed intervention in patients with CL/P and lower socioeconomic status.","PeriodicalId":93749,"journal":{"name":"FACE (Thousand Oaks, Calif.)","volume":"21 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134908803","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 : 2023-10-23DOI: 10.1177/27325016231206793
Lucas M. Harrison, Rami R. Hallac, James R. Seaward, Alex A. Kane, Yong Jong Park
Objective: This study presents a novel approach that utilizes recombinant human bone morphogenic protein 2 (rhBMP-2) and cellular bone matrix (CBM) for revision alveolar bone graft (ABG) in unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP) patients following failed autologous ABG. Methods: A case series of 14 UCLP and 4 BCLP patients who had failed autologous ABG with revision ABG with rhBMP-2 and CBM. Review of demographics, operative data, Bergland score, and alveolar cleft gap volume was performed. Results: Revision ABG had short operative times and low blood loss in both UCLP and BCLP. No postoperative complications were found in either revision group. Repeat ABG surgery was required in one patient. Bergland score improved from 3.86 ± 0.53to 1.21 ± 0.80 in the UCLP group and from 3.75 ± 0.50to 1.00 ± 0.00 in the BCLP group. The cleft volume decreased by 83.62 ± 9.78% in UCLP and by 86.73 ± 13.65% in the BCLP group. Conclusions: Revision ABG with rhBMP-2 and CBM is a successful and reliable approach. This method has decreased operative time and no postoperative complications. Most patients achieved clinically successful grafting with canine eruption. Both UCLP and BCLP groups saw a significant decrease in alveolar cleft gap volume.
{"title":"Efficacy of rhBMP-2 and Cellular Bone Matrix in the Revision of Alveolar Bone Grafting","authors":"Lucas M. Harrison, Rami R. Hallac, James R. Seaward, Alex A. Kane, Yong Jong Park","doi":"10.1177/27325016231206793","DOIUrl":"https://doi.org/10.1177/27325016231206793","url":null,"abstract":"Objective: This study presents a novel approach that utilizes recombinant human bone morphogenic protein 2 (rhBMP-2) and cellular bone matrix (CBM) for revision alveolar bone graft (ABG) in unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP) patients following failed autologous ABG. Methods: A case series of 14 UCLP and 4 BCLP patients who had failed autologous ABG with revision ABG with rhBMP-2 and CBM. Review of demographics, operative data, Bergland score, and alveolar cleft gap volume was performed. Results: Revision ABG had short operative times and low blood loss in both UCLP and BCLP. No postoperative complications were found in either revision group. Repeat ABG surgery was required in one patient. Bergland score improved from 3.86 ± 0.53to 1.21 ± 0.80 in the UCLP group and from 3.75 ± 0.50to 1.00 ± 0.00 in the BCLP group. The cleft volume decreased by 83.62 ± 9.78% in UCLP and by 86.73 ± 13.65% in the BCLP group. Conclusions: Revision ABG with rhBMP-2 and CBM is a successful and reliable approach. This method has decreased operative time and no postoperative complications. Most patients achieved clinically successful grafting with canine eruption. Both UCLP and BCLP groups saw a significant decrease in alveolar cleft gap volume.","PeriodicalId":93749,"journal":{"name":"FACE (Thousand Oaks, Calif.)","volume":"57 5","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135413449","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 : 2023-10-18DOI: 10.1177/27325016231206114
Edgar Soto, James Johnston, Krista Niedermeier, Ann Carol Braswell, Curtis J. Rozelle, John H. Grant, Rene P. Myers
Background: In infants with craniosynostosis, cranial vault reconstruction is performed to prevent sequela of premature fusion of cranial sutures. Open correction puts patients at risk for complications of major blood loss. We evaluated the impact of tranexamic acid (TXA) in children undergoing open surgical repair of a variety of types of craniosynostosis. Methods: A retrospective review of 102 infants who underwent open cranial vault reconstruction between January 2015 and December 2020 at a tertiary referral hospital was performed. The patients were stratified into TXA or non-TXA based on usage. Outcome measures included volume of blood transfused, perioperative blood loss and any adverse effects were noted. Results: In this cohort 42% of patients were treated with TXA. There was no significant difference between the patient demographics of TXA and non-TXA cohorts with the majority classified as Sagittal Craniosynostosis ( P = .1062), an average weight of 8.89 ± 1.37 kg, and age of 9.02 ± 2.02 months at time of surgery. The non-TXA cohort had longer length of hospital stay ( P = .04). The TXA cohort had an average 100 ml decrease in surgical drain output over the course of their hospital stay ( P = .02). Overall surgical complication was 14% ( P = .18) and clinical outcomes were not significantly different between the cohorts. Conclusions: The receipt of TXA in the interoperative period in patients with craniosynostosis undergoing cranial vault remodeling was associated with a decreased surgical drain output and length of stay.
{"title":"Evaluating Tranexamic Acid Administration in Cranial Vault Reconstruction: The Experience of an Academic Center in the Deep South","authors":"Edgar Soto, James Johnston, Krista Niedermeier, Ann Carol Braswell, Curtis J. Rozelle, John H. Grant, Rene P. Myers","doi":"10.1177/27325016231206114","DOIUrl":"https://doi.org/10.1177/27325016231206114","url":null,"abstract":"Background: In infants with craniosynostosis, cranial vault reconstruction is performed to prevent sequela of premature fusion of cranial sutures. Open correction puts patients at risk for complications of major blood loss. We evaluated the impact of tranexamic acid (TXA) in children undergoing open surgical repair of a variety of types of craniosynostosis. Methods: A retrospective review of 102 infants who underwent open cranial vault reconstruction between January 2015 and December 2020 at a tertiary referral hospital was performed. The patients were stratified into TXA or non-TXA based on usage. Outcome measures included volume of blood transfused, perioperative blood loss and any adverse effects were noted. Results: In this cohort 42% of patients were treated with TXA. There was no significant difference between the patient demographics of TXA and non-TXA cohorts with the majority classified as Sagittal Craniosynostosis ( P = .1062), an average weight of 8.89 ± 1.37 kg, and age of 9.02 ± 2.02 months at time of surgery. The non-TXA cohort had longer length of hospital stay ( P = .04). The TXA cohort had an average 100 ml decrease in surgical drain output over the course of their hospital stay ( P = .02). Overall surgical complication was 14% ( P = .18) and clinical outcomes were not significantly different between the cohorts. Conclusions: The receipt of TXA in the interoperative period in patients with craniosynostosis undergoing cranial vault remodeling was associated with a decreased surgical drain output and length of stay.","PeriodicalId":93749,"journal":{"name":"FACE (Thousand Oaks, Calif.)","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135890071","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 : 2023-10-16DOI: 10.1177/27325016231206596
Restricted accessAbstractFirst published online October 16, 2023Craniomaxillofacial abstracts presented at the 20th Congress of the International Society of Craniofacial SurgeonsOnlineFirsthttps://doi.org/10.1177/27325016231206596
{"title":"Craniomaxillofacial abstracts presented at the 20<sup>th</sup> Congress of the International Society of Craniofacial Surgeons","authors":"","doi":"10.1177/27325016231206596","DOIUrl":"https://doi.org/10.1177/27325016231206596","url":null,"abstract":"Restricted accessAbstractFirst published online October 16, 2023Craniomaxillofacial abstracts presented at the 20th Congress of the International Society of Craniofacial SurgeonsOnlineFirsthttps://doi.org/10.1177/27325016231206596","PeriodicalId":93749,"journal":{"name":"FACE (Thousand Oaks, Calif.)","volume":"85 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136113414","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 : 2023-10-11DOI: 10.1177/27325016231203654
Demetrius M. Coombs, Viren Patel, Nicholas Kochenour, Niyant Patel, Ananth S. Murthy
Background: Recent studies have reported that extracorporeal shock wave therapy (ESWT) enhances bone formation during mandibular distraction osteogenesis. This study seeks to investigate the clinical outcomes in children undergoing ESWT alongside secondary alveolar bone grafting procedures at our institution. Methods: Retrospective review of all children that underwent secondary alveolar cleft bone grafting with adjunctive ESWT between 2019 and 2021. Variables including age, gender, cleft type, cleft width, pre-operative cleft dentition, volume of bone graft placed intraoperatively, ESWT settings, pain medication utilization, length of stay (LOS), follow-up, cone beam computed tomography (CBCT) data, and complications were recorded. Results: Twenty patients met inclusion criteria. Median age at surgery was 9 years (range 8-16). Four (20%) patients were female; 16 (80%) were male. Eight (40%) patients had bilateral alveolar clefts; 12 (60%) had unilateral clefts. All (100%) patients were discharged on the day of surgery. Twelve (60%) patients required a median of 1.3 oxycodone doses post-operatively (range 0-6.5). All patients received ESWT treatments intra and post-operatively. All patients demonstrated an increase in bone graft volume visualized on CBCT: median increase of 6.8% (range 1.3%-35.7%) between 106.5 days (17.5% of ideal visualized, range 5%-42%) and 245.5 days (27.9% of ideal, range 8%-55.7%). Three (15%) patients experienced minor complications. Conclusions: Initial outcomes suggest that ESWT may expedite visualization of bone consolidation and facilitate recovery without increasing complications. ESWT could further represent an opportunity to improve care in craniofacial surgery. Pertinent considerations, the role of standardized assessment protocols, and future directions will be reviewed.
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