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Incidence of Craniofacial Trauma Changes With the Seasons 颅面外伤的发病率随季节变化

FACE (Thousand Oaks, Calif.)

Pub Date : 2023-10-03 DOI: 10.1177/27325016231203361

Sarah G. Wilkins, Hemali P. Shah, Alexandra T. Bourdillon, Parsa P. Salehi, Benjamin Steren, Tareq Sawan, Sina J. Torabi, Yan Ho Lee

Objective: Craniofacial fractures are commonly attributed to exposures that may vary with seasons. While it is commonly thought that summer months tend to have more craniofacial trauma, exact seasonality of such traumas across anatomic sites have not yet been elucidated. We aimed to characterize trends of craniofacial trauma across seasons. Study Design: Retrospective medical record review. Setting: Single-institution study at Level 1 trauma center. Methods: Patient and admission data for craniofacial trauma from June 2013 to June 2019 were systematically extracted by the hospital analyst team using International Classification of Diseases, 10th edition (ICD-10) diagnosis codes. For each ICD-10 diagnosis, anatomic sites affected by trauma were categorized. Trends across seasons and injury site were investigated using Student’s t-test and analysis of variance (ANOVA). Results: Across 925 admissions that met inclusion criteria, the volume of admissions did not significantly differ by season (ANOVA: P = .33). Frequency of admissions for jaw and maxilla fractures was significantly lower in the winter compared to summer (jaw: P = .024; maxilla: P = .018). Number of admissions involving zygoma fractures was lower in the winter compared to summer ( P = .044) and compared to fall ( P = .028). When examining number of fracture sites (eg, 1, 2, or ≥3) for each admission, there was a significantly greater number of admissions with ≥3 fracture sites during summer compared to winter ( P = .017) and fall compared to winter ( P = .011). Conclusion: Rates of craniofacial trauma admissions appear to follow seasonal trends, with significantly fewer craniofacial trauma presentations during winter when compared to summer, especially among non-occipital injuries. These findings, along with future efforts to elucidate seasonal trends nationally, may enable forecasting patterns of fractures to better guide resource allocation and inform prevention strategies.

目的:颅面骨折通常归因于暴露可能随季节变化。虽然人们普遍认为夏季往往有更多的颅面创伤，但这种创伤在解剖部位的确切季节性尚未阐明。我们的目的是描述不同季节颅面创伤的趋势。研究设计:回顾性医疗记录回顾。环境:一级创伤中心的单机构研究。方法:由医院分析团队使用国际疾病分类第10版(ICD-10)诊断代码系统提取2013年6月至2019年6月颅面创伤患者和入院数据。对于每一个ICD-10诊断，受创伤影响的解剖部位被分类。使用学生t检验和方差分析(ANOVA)调查了不同季节和受伤部位的趋势。结果:在925例符合纳入标准的入院患者中，入院人数在不同季节没有显著差异(方差分析:P = 0.33)。颌骨和上颌骨骨折入院的频率在冬季明显低于夏季(颌骨:P = 0.024;上颌骨:P = 0.018)。冬季颧骨骨折入院人数低于夏季(P = 0.044)和秋季(P = 0.028)。当检查每次入院的骨折部位数量(如1、2或≥3)时，夏季入院的骨折部位≥3处的人数明显多于冬季(P = 0.017)，秋季入院的人数明显多于冬季(P = 0.011)。结论:颅面外伤入院率似乎遵循季节性趋势，与夏季相比，冬季颅面外伤的表现明显减少，特别是在非枕部损伤中。这些发现，以及未来在全国范围内阐明季节性趋势的努力，可能有助于预测骨折模式，从而更好地指导资源分配，并为预防策略提供信息。

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引用次数: 0

Book Review: Killer Looks: The Forgotten History of Plastic Surgery in Prisons 书评:《杀手的外表:监狱里被遗忘的整形手术史》

FACE (Thousand Oaks, Calif.)

Pub Date : 2023-10-03 DOI: 10.1177/27325016231203523

Aubrey Schachter, Devra Becker

引用次数: 0

Direct to Surgery? Surgical Outcomes in Pediatric Patients With Facial Infantile Hemangioma: A Retrospective Case-Control Study 直接手术?面部血管瘤患儿的手术疗效:回顾性病例-对照研究

FACE (Thousand Oaks, Calif.)

Pub Date : 2023-10-02 DOI: 10.1177/27325016231202992

Pearl Shah, Anand R. Kumar

Background: The effects of medical pre-treatment prior to surgical excision of infantile hemangiomas (IH) remains understudied. We hypothesized that medical pretreatment may improve outcomes after surgical excision. This study aimed to evaluate the difference in surgical outcomes/complications between direct to surgery (NPT) versus medical pre-treatment prior to surgery (PT). Methods: A retrospective study was conducted at a pediatric tertiary center between 2007 and 2018. Children 0 and 18 years who underwent surgical resection (confirmed GLUT-1 positive IH) were included. Visceral and congenital hemangiomas, PHACE, and vascular malformations/neoplasms were excluded. Pre-treatment was the primary predictor for post-surgical complications. Literature meta-analysis was also performed. Results: Our institution identified 185 IH patients, 85 (46%) underwent surgical resection. Of these, n = 28, (32.9%) had pre-treatment (PT) (8.24% propranolol, 9.41% topical timolol, 12.94% steroids, 2.35% laser); n = 57, (67.1%) had no pre-treatment (NPT). Pre-surgical lesion size was comparable ( P = .829). Surgical outcomes between PT and NPT were comparable for wound dehiscence, infection, scarring, and repeat surgery ( P = .162, 1.0, 1.0, 0.483), including pooled complications ( P = .448). Where documented, PT had higher functional improvement ( P = .039). Results were comparable when selecting for beta-blockers versus NPT. Meta-analysis included 7 studies and 169 patients, 39.1% PT and 68.1% NPT. The most common PT was systemic/intralesional steroids. Five received beta-blockers. All patients had functional improvement where recorded. Complications were slightly higher for PT ( P = .041). Conclusion: The incidence of surgical complications is comparable between direct to surgery and medical pre-treatment patients. Early surgical management without pre-treatment was not associated with improved complications/outcomes except select subgroup analysis identified improved functional outcomes with pre-treatment. Future directions include defining appropriate candidates for early direct to surgery versus best candidates for medical pre-treatment using patient specific variables.

背景:婴儿血管瘤(IH)手术切除前的药物预处理效果仍未得到充分研究。我们假设药物预处理可以改善手术切除后的预后。本研究旨在评估直接手术(NPT)与手术前医学预处理(PT)在手术结果/并发症方面的差异。方法:2007 - 2018年在某儿科三级中心进行回顾性研究。0岁和18岁接受手术切除的儿童(确诊为GLUT-1阳性IH)被纳入研究对象。排除内脏和先天性血管瘤、PHACE和血管畸形/肿瘤。术前治疗是术后并发症的主要预测因素。并进行文献荟萃分析。结果:我院确诊185例IH患者，其中85例(46%)行手术切除。其中，n = 28例(32.9%)接受过术前治疗(8.24%心得安，9.41%局部替马洛尔，12.94%类固醇，2.35%激光);n = 57，(67.1%)未进行预处理(NPT)。术前病变大小比较(P = .829)。PT和NPT的手术结果在伤口裂开、感染、瘢痕形成和重复手术方面具有可比性(P = 0.162, 1.0, 1.0, 0.483)，包括合并并发症(P = 0.448)。在有记录的地方，PT有更高的功能改善(P = 0.039)。当选择β受体阻滞剂和NPT时，结果是相似的。meta分析包括7项研究，169例患者，39.1%为PT, 68.1%为NPT。最常见的PT是全身/局部类固醇。其中5人接受了受体阻滞剂治疗。所有患者的功能均有改善。PT组并发症略高(P = 0.041)。结论:直接手术与内科前治疗患者手术并发症发生率相当。未经预处理的早期手术处理与并发症/结果的改善无关，除了选择亚组分析发现预处理改善了功能结果。未来的方向包括确定早期直接手术的合适候选人和使用患者特定变量进行医学预处理的最佳候选人。

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引用次数: 0

A Perspective on the Evolution of Palatoplasty 腭成形术发展的展望

FACE (Thousand Oaks, Calif.)

Pub Date : 2023-09-26 DOI: 10.1177/27325016231201983

John Smetona, Robert Mann, Joseph E. Losee

引用次数: 0

Impacts of Skeletal Anterior Open Bite Malocclusion on Speech. 骨性前开放咬合畸形对言语的影响

FACE (Thousand Oaks, Calif.)

Pub Date : 2022-06-01 Epub Date: 2022-03-14 DOI: 10.1177/27325016221082229

Mary Morgan Bitler Keyser, Hillary Lathrop, Samantha Jhingree, Natalie Giduz, Clare Bocklage, Sandrine Couldwell, Steven Oliver, Kevin Moss, Sylvia Frazier-Bowers, Ceib Phillips, Timothy Turvey, George Blakey, Ray White, Raymond P White, Dalton L McMichael, David Zajac, Jeff Mielke, Laura Anne Jacox

Introduction: Articulation problems are seen in 80-90% of dentofacial deformity (DFD) subjects compared with 5% of the general population, impacting communication and quality of life, but the causal link is unclear. We hypothesize there are both qualitative (perceptual) and quantitative (spectral) differences in properties of stop (/t/ or /k/), fricative (/s/ or /∫/), and affricate (/t∫/) consonant sounds and that severity of anterior open bite (AOB) jaw disharmonies correlates with degree of speech abnormality.

Methods: To test our hypotheses, surgical orthodontic records and audio recordings were collected from DFD patients (n=39 AOB, 62 controls). A speech pathologist evaluated subjects and recordings were analyzed using spectral moment analysis (SMA) to measure sound frequency distortions.

Results: Perceptually, there is a higher prevalence of auditory and visual speech distortions in AOB DFD patients when compared to controls. Quantitatively, a significant (p<0.01) increase in the centroid frequency (M1) was seen in the /k/, /t/, /t∫/, and /s/ sounds of AOB subjects compared to the controls. Using linear regression, correlations between AOB skeletal severity and spectral distortion were found for /k/ and /t/ sounds.

Conclusions: A higher prevalence of qualitative distortion and significant quantitative spectral distortions in consonant sounds were seen in AOB patients compared to controls. Additionally, severity of skeletal AOB is correlated with degree of distortion for consonant sounds. These findings provide insight into how the surgical and/or orthodontic treatment of AOB may impact speech.

简介80%-90%的牙颌面畸形（DFD）受试者存在发音问题，而普通人群中只有5%的人存在发音问题，这影响了交流和生活质量，但其中的因果关系尚不清楚。我们假设，停顿音（/t/或/k/）、摩擦音（/s/或/∫/）和辅音（/t∫/）在性质上（知觉）和数量上（频谱）都存在差异，而且前开咬合（AOB）颌骨不协调的严重程度与言语异常的程度相关：为了验证我们的假设，我们收集了 DFD 患者的外科正畸记录和录音（n=39 AOB，62 对照组）。语言病理学家对受试者进行了评估，并使用频谱矩分析法（SMA）对录音进行了分析，以测量声音频率失真：结果：从知觉上看，与对照组相比，AOB DFD 患者听觉和视觉语言失真的发生率更高。从数量上看，AOB DFD 患者的听觉和视觉言语失真率明显高于对照组：与对照组相比，AOB 患者辅音的质性失真发生率更高，量性频谱失真也更明显。此外，骨骼性失聪的严重程度与辅音的失真程度相关。这些研究结果为我们提供了洞察力，帮助我们了解 AOB 的手术和/或正畸治疗会如何影响语音。

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引用次数: 0

The Pleiotropic Intricacies of Hedgehog Signaling: From Craniofacial Patterning to Carcinogenesis. 复杂多样的刺猬信号:从颅面模式到癌变。

FACE (Thousand Oaks, Calif.)

Pub Date : 2021-09-01 Epub Date: 2021-06-18 DOI: 10.1177/27325016211024326

Mikhail Pakvasa, Andrew B Tucker, Timothy Shen, Tong-Chuan He, Russell R Reid

Hedgehog signaling was discovered more than 40 years ago in experiments demonstrating that it is a fundamental mediator of limb development. Since that time, it has been shown to be important in development, homeostasis, and disease. The hedgehog pathway proceeds through a pathway highly conserved throughout animals beginning with the extracellular diffusion of hedgehog ligands, proceeding through an intracellular signaling cascade, and ending with the activation of specific target genes. A vast amount of research has been done elucidating hedgehog signaling mechanisms and regulation. This research has found a complex system of genetics and signaling that helps determine how organisms develop and function. This review provides an overview of what is known about hedgehog genetics and signaling, followed by an in-depth discussion of the role of hedgehog signaling in craniofacial development and carcinogenesis.

刺猬信号是在40多年前的实验中发现的，表明它是肢体发育的基本介质。从那时起，它已被证明在发育、体内平衡和疾病中起重要作用。刺猬信号通路在动物中是高度保守的，从刺猬配体的细胞外扩散开始，经过细胞内信号级联，最后以特定靶基因的激活结束。大量的研究已经完成阐明刺猬信号传导机制和调控。这项研究发现了一个复杂的遗传和信号系统，它有助于决定生物体如何发育和运作。本文综述了目前已知的刺猬基因和信号传导，并深入讨论了刺猬信号传导在颅面发育和癌变中的作用。

引用次数: 0

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