An Account of the Inaugural Tessier Skull Exhibition at the University of Paris Descartes.

PubMed

Dusseldorp, Joseph Richard; Firmin, Françoise

2015-10-01

Paul Tessier is widely regarded as the father of modern craniofacial surgery. Upon his passing in 2008, his private collection of human skulls was purchased by the French Association of Facial Surgeons to ensure the collection would remain in France. The first public exhibition of the skulls was held in the medical museum of the University of Paris Descartes in April 2014. From this collection of skulls and the imagination of Tessier an entirely new specialty was created. Modern craniofacial surgery, now is an integral part of any pediatric plastic surgery department. Cranial and facial osteotomies have also become commonplace in both traumatic and aesthetic surgery. The goals for craniofacial deformity are now a return to completely normal appearance and function, as Tessier always believed they should be.

Customized acrylic implants for reconstruction of extensive skull defects: an exception approach for selected patients.

PubMed

Silva, Rafael Denadai Pigozzi DA; Raposo-Amaral, Cesar Augusto; Guidi, Marcelo Campos; Raposo-Amaral, Cassio Eduardo; Buzzo, Celso Luiz

2017-01-01

to present our experience in the surgical treatment of extensive skullcap defects with customized acrylic implants. we conducted a retrospective analysis of patients with extensive skull defects undergoing acrylic cranioplasties between 2004 and 2013. We carefully selected all patients and classified surgical results based on three scales (craniofacial esthetics, improvement of facial symmetry and need for additional surgery). fifteen patients underwent cranioplasty with intraoperative acrylic implants, whether manually customized (46.67%) or made with prototyped three-dimensional biomodels (53.33%). There were two (13.33%) complications (one infection with implant withdrawal and one seroma). We considered the craniofacial aesthetics excellent (50%), the degree of improvement of craniofacial symmetry satisfactory (57.14%), and the overall mean of surgical results according to the need for new surgeries was 1.5±0.52. cranioplasties of patients with extensive skullcap defects should obey careful and predetermined criteria, both for selection and for the acrylic implant customization method. apresentar nossa experiência no tratamento cirúrgico dos defeitos extensos da calota craniana com implantes de acrílico customizados. análise retrospectiva de pacientes com defeitos extensos da calota craniana submetidos à cranioplastias com acrílico entre 2004 e 2013. Todos os pacientes foram criteriosamente selecionados e os resultados cirúrgicos foram classificados com base em três escalas (estética craniofacial, melhora da simetria facial e necessidade de cirurgia adicional). Quinze pacientes foram submetidos à cranioplastia com implantes de acrílico customizados manualmente no intraoperatório (46,67%) e confeccionados com base em biomodelos tridimensionais prototipados (53,33%). Mesmo respeitando critérios de seleção, houve duas (13,33%) complicações (infecção com retirada do implante e seroma). A estética craniofacial foi considerada excelente (50%), o grau de melhora da simetria craniofacial foi considerado satisfatório (57,14%) e a média global dos resultados cirúrgicos de acordo com a necessidade de novas cirurgias foi 1,5±0,52. as cranioplastias dos pacientes com defeitos da calota craniana extensos devem ser criteriosamente indicadas, obedecendo a critérios pré-determinados de seleção dos pacientes, bem como, do método de customização do implante de acrílico.

An assessment of the compliance of systematic review articles published in craniofacial surgery with the PRISMA statement guidelines: A systematic review.

PubMed

Pidgeon, Thomas Edward; Wellstead, Georgina; Sagoo, Harkiran; Jafree, Daniyal J; Fowler, Alexander J; Agha, Riaz A

2016-10-01

Systematic review evidence is increasing within craniofacial surgery. Compliance with recognised reporting guidelines for systematic review evidence has not been assessed. To assess the compliance of systematic reviews published in craniofacial journals with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting criteria. Thomson Reuters impact factor was used to identify three top craniofacial journals. A search for all systematic review articles published in these journals from 1st May 2010 to 30th April 2015 was conducted using MEDLINE PubMed. Two independent researchers assessed each study for inclusion and performed the data extraction. Data included the article reference information; the pathology and interventions examined and compliance of each review article with the PRISMA checklist. 97 studies were returned by the search. 62 studies proceeded to data extraction. The mean percentage of applicable PRISMA items that were met across all studies was 72.5% (range 28.6-96.2%). The area of poorest compliance was with the declaration of a study protocol (19.4% of studies). Only 37.1% of studies declared their source of funding. Compliance of systematic review articles within craniofacial surgery with areas of the PRISMA checklist could be improved. Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Current and emerging basic science concepts in bone biology: implications in craniofacial surgery.

PubMed

Oppenheimer, Adam J; Mesa, John; Buchman, Steven R

2012-01-01

Ongoing research in bone biology has brought cutting-edge technologies into everyday use in craniofacial surgery. Nonetheless, when osseous defects of the craniomaxillofacial skeleton are encountered, autogenous bone grafting remains the criterion standard for reconstruction. Accordingly, the core principles of bone graft physiology continue to be of paramount importance. Bone grafts, however, are not a panacea; donor site morbidity and operative risk are among the limitations of autologous bone graft harvest. Bone graft survival is impaired when irradiation, contamination, and impaired vascularity are encountered. Although the dura can induce calvarial ossification in children younger than 2 years, the repair of critical-size defects in the pediatric population may be hindered by inadequate bone graft donor volume. The novel and emerging field of bone tissue engineering holds great promise as a limitless source of autogenous bone. Three core constituents of bone tissue engineering have been established: scaffolds, signals, and cells. Blood supply is the sine qua non of these components, which are used both individually and concertedly in regenerative craniofacial surgery. The discerning craniofacial surgeon must determine the proper use for these bone graft alternatives, while understanding their concomitant risks. This article presents a review of contemporary and emerging concepts in bone biology and their implications in craniofacial surgery. Current practices, areas of controversy, and near-term future applications are emphasized.

Population pharmacokinetics of epsilon-aminocaproic acid in infants undergoing craniofacial reconstruction surgery

PubMed Central

Stricker, P. A.; Zuppa, A. F.; Fiadjoe, J. E.; Maxwell, L. G.; Sussman, E. M.; Pruitt, E. Y.; Goebel, T. K.; Gastonguay, M. R.; Taylor, J. A.; Bartlett, S. P.; Schreiner, M. S.

2013-01-01

Background Understanding the clinical pharmacology of the antifibrinolytic epsilon-aminocaproic acid (EACA) is necessary for rational drug administration in children. The aim of this study is to determine the pharmacokinetics (PKs) of EACA in infants aged 6–24 months undergoing craniofacial reconstruction surgery. Methods Cohorts of six infants were enrolled sequentially to one of the three escalating loading dose–continuous i.v. infusion (CIVI) regimens: 25 mg kg−1, 10 mg kg−1 h−1; 50 mg kg−1, 20 mg kg−1 h−1; 100 mg kg−1, 40 mg kg−1 h−1. Plasma EACA concentrations were determined using a validated high-performance liquid chromatography-tandem mass spectrometry assay. A population non-linear mixed effects modelling approach was used to characterize EACA PKs. Results Population PK parameters of EACA were estimated using a two-compartment disposition model with weight expressed as an allometric covariate and an age effect. The typical patient in this study had an age of 38.71 weeks and a weight of 8.82 kg. PK parameters for this typical patient were: pre-/postoperative plasma drug clearance of 32 ml min−1 (3.6 ml kg−1 min−1), inter-compartmental clearance of 42.4 ml min−1 (4.8 ml min−1 kg−1), central volume of distribution of 1.27 litre (0.14 litre kg−1), and peripheral volume of distribution of 2.53 litre (0.29 litre kg−1). Intra-operative clearance and central volume of distribution were 89% and 80% of the pre-/postoperative value, respectively. Conclusions EACA clearance increased with weight and age. The dependence of clearance on body weight supports weight-based dosing. Based on this study, a loading dose of 100 mg kg−1 followed by a CIVI of 40 mg kg−1 h−1 is appropriate to maintain target plasma EACA concentrations in children aged 6–24 months undergoing these procedures. PMID:23353035

Population pharmacokinetics of epsilon-aminocaproic acid in infants undergoing craniofacial reconstruction surgery.

PubMed

Stricker, P A; Zuppa, A F; Fiadjoe, J E; Maxwell, L G; Sussman, E M; Pruitt, E Y; Goebel, T K; Gastonguay, M R; Taylor, J A; Bartlett, S P; Schreiner, M S

2013-05-01

Understanding the clinical pharmacology of the antifibrinolytic epsilon-aminocaproic acid (EACA) is necessary for rational drug administration in children. The aim of this study is to determine the pharmacokinetics (PKs) of EACA in infants aged 6-24 months undergoing craniofacial reconstruction surgery. Cohorts of six infants were enrolled sequentially to one of the three escalating loading dose-continuous i.v. infusion (CIVI) regimens: 25 mg kg(-1), 10 mg kg(-1) h(-1); 50 mg kg(-1), 20 mg kg(-1) h(-1); 100 mg kg(-1), 40 mg kg(-1) h(-1). Plasma EACA concentrations were determined using a validated high-performance liquid chromatography-tandem mass spectrometry assay. A population non-linear mixed effects modelling approach was used to characterize EACA PKs. Population PK parameters of EACA were estimated using a two-compartment disposition model with weight expressed as an allometric covariate and an age effect. The typical patient in this study had an age of 38.71 weeks and a weight of 8.82 kg. PK parameters for this typical patient were: pre-/postoperative plasma drug clearance of 32 ml min(-1) (3.6 ml kg(-1) min(-1)), inter-compartmental clearance of 42.4 ml min(-1) (4.8 ml min(-1) kg(-1)), central volume of distribution of 1.27 litre (0.14 litre kg(-1)), and peripheral volume of distribution of 2.53 litre (0.29 litre kg(-1)). Intra-operative clearance and central volume of distribution were 89% and 80% of the pre-/postoperative value, respectively. EACA clearance increased with weight and age. The dependence of clearance on body weight supports weight-based dosing. Based on this study, a loading dose of 100 mg kg(-1) followed by a CIVI of 40 mg kg(-1) h(-1) is appropriate to maintain target plasma EACA concentrations in children aged 6-24 months undergoing these procedures.

Academic Productivity of Faculty Associated With Craniofacial Surgery Fellowship Programs.

PubMed

Ruan, Qing Zhao; Ricci, Joseph A; Silvestre, Jason; Ho, Olivia A; Ganor, Oren; Lee, Bernard T

2017-11-01

The H-index is increasingly being used as a measure of academic productivity and has been applied to various surgical disciplines. Here the authors calculate the H-index of craniofacial surgery fellowship faculty in North America in order to determine its utility for academic productivity among craniofacial surgeons. A list of fellowship programs was obtained from the website of the American Society of Craniofacial Surgery. Faculty demographics and institution characteristics were obtained from official program websites and the H-index was calculated using Scopus (Elsevier, USA). Data were assessed using bivariate analysis tools (Kruskal-Wallis and Mann-Whitney tests) to determine the relationship between independent variables and career publications, H-index and 5-year H-index (H5-index) of faculty. Dunn test for multiple comparisons was also calculated. A total of 102 faculty members from 29 craniofacial surgery fellowship programs were identified and included. Faculty demographics reflected a median age of 48 (interquartile range [IQR] 13), a predominantly male sample (88/102, 89.7%), and the rank of assistant professor being the most common among faculty members (41/102, 40.2%). Median of career publications per faculty was 37 (IQR 52.5) and medians of H-index and H5-index were 10.0 (IQR 13.75) and 3.5 (IQR 3.25), respectively. Greater age, male gender, Fellow of the American College of Surgeons membership, higher academic rank, and program affiliation with ranked research medical schools were significantly associated with higher H-indices. Variables associated with seniority were positively associated with the H-index. These results suggest that the H-index may be used as an adjunct in determining academic productivity for promotions among craniofacial surgeons.

Biomaterials and biologics in craniofacial reconstruction.

PubMed

Engstrand, Thomas

2012-01-01

Complications related to surgery, including infection, wound dehiscence, and implant protrusion, are costly and may cause severe morbidity to patients. The choice of implants materials is critical for a successful outcome, particularly in craniofacial reconstructions. This review discusses the potential benefits and drawbacks of biologically active materials used for craniofacial bone repair as alternatives to inert implant prostheses.

Cleft and Craniofacial Care During Military Pediatric Plastic Surgery Humanitarian Missions.

PubMed

Madsen, Christopher; Lough, Denver; Lim, Alan; Harshbarger, Raymond J; Kumar, Anand R

2015-06-01

Military pediatric plastic surgery humanitarian missions in the Western Hemisphere have been initiated and developed since the early 1990 s using the Medical Readiness Education and Training Exercise (MEDRETE) concept. Despite its initial training mission status, the MEDRETE has developed into the most common and advanced low level medical mission platform currently in use. The objective of this study is to report cleft- and craniofacial-related patient outcomes after initiation and evolution of a standardized treatment protocol highlighting lessons learned which apply to civilian plastic surgery missions. A review of the MEDRETE database for pediatric plastic surgery/cleft and craniofacial missions to the Dominican Republic from 2005 to 2009 was performed. A multidisciplinary team including a craniofacial surgeon evaluated all patients with a cleft/craniofacial and/or pediatric plastic condition. A standardized mission time line included predeployment site survey and predeployment checklist, operational brief, and postdeployment after action report. Deployment data collection, remote patient follow-up, and coordination with larger land/amphibious military operations was used to increase patient follow-up data. Data collected included sex, age, diagnosis, date and type of procedure, surgical outcomes including speech scores, surgical morbidity, and mortality. Five hundred ninety-four patients with cleft/craniofacial abnormalities were screened by a multidisciplinary team including craniofacial surgeons over 4 years. Two hundred twenty-three patients underwent 330 surgical procedures (cleft lip, 53; cleft palate, 73; revision cleft lip/nose, 73; rhinoplasty, 15; speech surgery, 24; orthognathic/distraction, 21; general pediatric plastic surgery, 58; fistula repair, 12). Average follow-up was 30 months (range, 1-60). The complication rate was 6% (n = 13) (palate fistula, lip revision, dental/alveolar loss, revision speech surgery rate). The average pre-surgical (Pittsburgh Weighted Speech Score) speech score was 12 (range, 6-24). The average postsurgical speech score was 6 (range, 0-21). Average hospital stay was 3 days for cleft surgery. There were no major complications or mortality, 1 reoperation for bleeding or infection, and 12 patients required secondary operations for palatal fistula, unsatisfactory aesthetic result, malocclusion, or velopharygeal dysfunction. Military pediatric plastic surgery humanitarian missions can be executed with similar home institution results after the initiation and evolution of a standardized approach to humanitarian missions. The incorporation of a dedicated logistics support unit, a dedicated operational specialist (senior noncommissioned officer), a speech language pathologist, remote internet follow up, an liaison officer (host nation liaison physician participation), host nation surgical resident participation, and support from the embassy, Military Advisory Attachment Group, and United States Aid and International Development facilitated patient accurate patient evaluation and posttreatment follow-up. Movement of the mission site from a remote more austere environment to a centralized better equipped facility with host nation support to transport patients to the site facilitated improved patient safety and outcomes despite increasing the complexity of surgery performed.

Lip line changes in Class III facial asymmetry patients after orthodontic camouflage treatment, one-jaw surgery, and two-jaw surgery: A preliminary study.

PubMed

Lee, Gung-Chol; Yoo, Jo-Kwang; Kim, Seong-Hun; Moon, Cheol-Hyun

2017-03-01

To evaluate the effects of orthodontic camouflage treatment (OCT), one-jaw surgery, and two-jaw surgery on the correction of lip line cant (LLC) and to examine factors affecting the correction of LLC in Class III craniofacial asymmetry patients. A sample of 30 Class III craniofacial asymmetry patients was divided into OCT (n = 10), one-jaw surgery (n = 10), and two-jaw surgery (n = 10) groups such that the pretreatment LLC was similar in each group. Pretreatment and posttreatment cone-beam computed tomography scans were used to measure dental and skeletal parameters and LLC. Pretreatment and posttreatment measurements were compared within groups and between groups. Pearson's correlation tests and multiple regression analyses were performed to investigate factors affecting the amount and rate of LLC correction. The average LLC correction was 1.00° in the one-jaw surgery group, and in the two-jaw surgery group, it was 1.71°. In the OCT group it was -0.04°, which differed statistically significantly from the LLC correction in the other two groups. The amount and rate of LLC correction could be explained by settling of skeletal discrepancies or LLC at pretreatment with goodness of fit percentages of approximately 82% and 41%, respectively. Orthognathic surgery resulted in significant correction of LLC in Class III craniofacial asymmetry patients, while OCT did not.

Trends in Accreditation Council for Graduate Medical Education Accreditation for Subspecialty Fellowship Training in Plastic Surgery.

PubMed

Silvestre, Jason; Serletti, Joseph M; Chang, Benjamin

2018-05-01

The purposes of this study were to (1) determine the proportion of plastic surgery residents pursuing subspecialty training relative to other surgical specialties, and (2) analyze trends in Accreditation Council for Graduate Medical Education accreditation of plastic surgery subspecialty fellowship programs. The American Medical Association provided data on career intentions of surgical chief residents graduating from 2014 to 2016. The percentage of residents pursuing fellowship training was compared by specialty. Trends in the proportion of accredited fellowship programs in craniofacial surgery, hand surgery, and microsurgery were analyzed. The percentage of accredited programs was compared between subspecialties with added-certification options (hand surgery) and subspecialties without added-certification options (craniofacial surgery and microsurgery). Most integrated and independent plastic surgery residents pursued fellowship training (61.8 percent versus 49.6 percent; p = 0.014). Differences existed by specialty from a high in orthopedic surgery (90.8 percent) to a low in colon and rectal surgery (3.2 percent). From 2005 to 2015, the percentage of accredited craniofacial fellowship programs increased, but was not significant (from 27.8 percent to 33.3 percent; p = 0.386). For hand surgery, the proportion of accredited programs that were plastic surgery (p = 0.755) and orthopedic surgery (p = 0.253) was stable, whereas general surgery decreased (p = 0.010). Subspecialty areas with added-certification options had more accredited fellowships than those without (100 percent versus 19.2 percent; p < 0.001). There has been slow adoption of accreditation among plastic surgery subspecialty fellowships, but added-certification options appear to be highly correlated.

Cleft Lip and Palate Surgery

MedlinePlus

... The experts in face, mouth and jaw surgery. Cleft Lip / Palate and Craniofacial Surgery This type of surgery is ... the carefully orchestrated, multiple-stage correctional program for cleft lip and palate patients. The goal is to help restore the ...

Effectiveness of a Novel Augmented Reality-Based Navigation System in Treatment of Orbital Hypertelorism.

PubMed

Zhu, Ming; Chai, Gang; Lin, Li; Xin, Yu; Tan, Andy; Bogari, Melia; Zhang, Yan; Li, Qingfeng

2016-12-01

Augmented reality (AR) technology can superimpose the virtual image generated by computer onto the real operating field to present an integral image to enhance surgical safety. The purpose of our study is to develop a novel AR-based navigation system for craniofacial surgery. We focus on orbital hypertelorism correction, because the surgery requires high preciseness and is considered tough even for senior craniofacial surgeon. Twelve patients with orbital hypertelorism were selected. The preoperative computed tomography data were imported into 3-dimensional platform for preoperational design. The position and orientation of virtual information and real world were adjusted by image registration process. The AR toolkits were used to realize the integral image. Afterward, computed tomography was also performed after operation for comparing the difference between preoperational plan and actual operational outcome. Our AR-based navigation system was successfully used in these patients, directly displaying 3-dimensional navigational information onto the surgical field. They all achieved a better appearance by the guidance of navigation image. The difference in interdacryon distance and the dacryon point of each side appear no significant (P > 0.05) between preoperational plan and actual surgical outcome. This study reports on an effective visualized approach for guiding orbital hypertelorism correction. Our AR-based navigation system may lay a foundation for craniofacial surgery navigation. The AR technology could be considered as a helpful tool for precise osteotomy in craniofacial surgery.

The suture provides a niche for mesenchymal stem cells of craniofacial bones

PubMed Central

Zhao, Hu; Feng, Jifan; Ho, Thach-Vu; Grimes, Weston; Urata, Mark; Chai, Yang

2015-01-01

Bone tissue undergoes constant turnover supported by stem cells. Recent studies showed that perivascular mesenchymal stem cells (MSCs) contribute to the turnover of long bones. Craniofacial bones are flat bones derived from a different embryonic origin than the long bones. The identity and regulating niche for craniofacial bone MSCs remain unknown. Here, we identify Gli1+ cells within the suture mesenchyme as the major MSC population for craniofacial bones. They are not associated with vasculature, give rise to all craniofacial bones in the adult and are activated during injury repair. Gli1+ cells are typical MSCs in vitro. Ablation of Gli1+ cells leads to craniosynostosis and arrest of skull growth, indicating these cells are an indispensible stem cell population. Twist1+/− mice with craniosynostosis show reduced Gli1+ MSCs in sutures, suggesting that craniosynostosis may result from diminished suture stem cells. Our study indicates that craniofacial sutures provide a unique niche for MSCs for craniofacial bone homeostasis and repair. PMID:25799059

Relationship between BMI and Postoperative Complications with Free Flap in Anterolateral Craniofacial Reconstruction

PubMed Central

Yagi, Shunjiro; Toriyama, Kazuhiro; Takanari, Keisuke; Fujimoto, Yasushi; Nishio, Naoki; Fujii, Masazumi; Saito, Kiyoshi; Takahashi, Masakatsu; Kamei, Yuzuru

2016-01-01

Background: Although we have seen tremendous advancement in microsurgery over the last 2 decades and free tissue transfer has become standard for head and neck reconstruction, surgeons still struggle to prevent postoperative complications. We examined the relationship between body mass index (BMI) and postoperative complications in patients undergoing rectus abdominis free flap transfer after anterolateral craniofacial resection. Methods: This was a retrospective review of reconstructive surgery using rectus abdominis musculocutaneous free flap in patients with locally advanced maxillary sinus carcinoma from 2003 to 2014 (n = 35, 27 men and 8 women; average age, 60.9 ± 7.8 years). All patients underwent craniofacial reconstruction after anterior and middle cranial fossa skull base resection and maxillectomy (class IV, subtype a) with palatal resection. Patients were categorized based on sex, BMI, and other parameters. Results: Recipient-site infection occurred in 11 patients (31.4%), cerebrospinal fluid leakage in 6 (17.1%), partial flap necrosis in 2 (5.7%), total flap necrosis in 1 (2.9%), and facial fistula in 4 (11.4%). Women showed partial flap necrosis significantly more frequently (P = 0.047), probably owing to poor vascular supply of the subcutaneous fat layer. Patients with low BMI (<20 kg/m2) showed recipient-site infection (P = 0.02) and facial fistula (P = 0.01) significantly more frequently owing to insufficient tissue volume and poor vascular supply. Conclusion: Postoperative recipient-site infection and facial fistula occurred mainly in low-BMI patients. Surgeons should take care to achieve sufficient donor tissue on low-BMI patients. Using a prosthetic obturator in low-BMI patients for craniofacial reconstruction can be a good alternative option to reduce postoperative complications due to insufficient donor tissue volume. PMID:27257566

Distinct functional and temporal requirements for zebrafish Hdac1 during neural crest-derived craniofacial and peripheral neuron development.

PubMed

Ignatius, Myron S; Unal Eroglu, Arife; Malireddy, Smitha; Gallagher, Glen; Nambiar, Roopa M; Henion, Paul D

2013-01-01

The regulation of gene expression is accomplished by both genetic and epigenetic means and is required for the precise control of the development of the neural crest. In hdac1(b382) mutants, craniofacial cartilage development is defective in two distinct ways. First, fewer hoxb3a, dlx2 and dlx3-expressing posterior branchial arch precursors are specified and many of those that are consequently undergo apoptosis. Second, in contrast, normal numbers of progenitors are present in the anterior mandibular and hyoid arches, but chondrocyte precursors fail to terminally differentiate. In the peripheral nervous system, there is a disruption of enteric, DRG and sympathetic neuron differentiation in hdac1(b382) mutants compared to wildtype embryos. Specifically, enteric and DRG-precursors differentiate into neurons in the anterior gut and trunk respectively, while enteric and DRG neurons are rarely present in the posterior gut and tail. Sympathetic neuron precursors are specified in hdac1(b382) mutants and they undergo generic neuronal differentiation but fail to undergo noradrenergic differentiation. Using the HDAC inhibitor TSA, we isolated enzyme activity and temporal requirements for HDAC function that reproduce hdac1(b382) defects in craniofacial and sympathetic neuron development. Our study reveals distinct functional and temporal requirements for zebrafish hdac1 during neural crest-derived craniofacial and peripheral neuron development.

Craniofacial morphology and sleep apnea in children with obstructed upper airways: differences between genders.

PubMed

Di Francesco, Renata; Monteiro, Roberta; Paulo, Maria Luiza de Melo; Buranello, Fernando; Imamura, Rui

2012-06-01

To correlate sleep apnea with craniofacial characteristics and facial patterns according to gender. In this prospective survey we studied 77 male and female children (3-12 years old) with an upper airway obstruction due to tonsil and adenoid enlargement. Children with lung problems, neurological disorders and syndromes, obstructive septal deviation, previous orthodontic treatment, orthodontic surgeries or oral surgeries, or obesity were excluded. Patients were subjected to physical examinations, nasal fiberoptic endoscopy, teleradiography for cephalometric analysis, and polysomnography. Cephalometric analysis included the following skeletal craniofacial measurements: facial axis (FA), facial depth (FD), mandibular plane angle (MP), lower facial height (LFH), mandibular arch (MA), and vertical growth coefficient (VERT) index. The prevalence of sleep apnea was 46.75% with no statistical difference between genders. Among children with obstructive sleep apnea (Apneia Hypopnea Index - AHI ≥ 1) boys had higher AHI values than girls. A predominance of the dolichofacial pattern (81.9%) was observed. The following skeletal craniofacial measurements correlated with AHI in boys: FD (r(s)=-0.336/p=0.020), MP (r(s)=0.486/p=0.00), and VERT index (r(s)=-0.337/p=0.019). No correlations between craniofacial measurements and AHI were identified in girls. Craniofacial morphology may influence the severity of sleep apnea in boys but not in girls. Copyright © 2012 Elsevier B.V. All rights reserved.

Computer-assisted innovations in craniofacial surgery.

PubMed

Rudman, Kelli; Hoekzema, Craig; Rhee, John

2011-08-01

Reconstructive surgery for complex craniofacial defects challenges even the most experienced surgeons. Preoperative reconstructive planning requires consideration of both functional and aesthetic properties of the mandible, orbit, and midface. Technological innovations allow for computer-assisted preoperative planning, computer-aided manufacturing of patient-specific implants (PSIs), and computer-assisted intraoperative navigation. Although many case reports discuss computer-assisted preoperative planning and creation of custom implants, a general overview of computer-assisted innovations is not readily available. This article reviews innovations in computer-assisted reconstructive surgery including anatomic considerations when using PSIs, technologies available for preoperative planning, work flow and process of obtaining a PSI, and implant materials available for PSIs. A case example follows illustrating the use of this technology in the reconstruction of an orbital-frontal-temporal defect with a PSI. Computer-assisted reconstruction of complex craniofacial defects provides the reconstructive surgeon with innovative options for challenging reconstructive cases. As technology advances, applications of computer-assisted reconstruction will continue to expand. © Thieme Medical Publishers.

Shape-based approach for the estimation of individual facial mimics in craniofacial surgery planning

NASA Astrophysics Data System (ADS)

Gladilin, Evgeny; Zachow, Stefan; Deuflhard, Peter; Hege, Hans-Christian

2002-05-01

Besides the static soft tissue prediction, the estimation of basic facial emotion expressions is another important criterion for the evaluation of craniofacial surgery planning. For a realistic simulation of facial mimics, an adequate biomechanical model of soft tissue including the mimic musculature is needed. In this work, we present an approach for the modeling of arbitrarily shaped muscles and the estimation of basic individual facial mimics, which is based on the geometrical model derived from the individual tomographic data and the general finite element modeling of soft tissue biomechanics.

Virtual Surgical Planning: The Pearls and Pitfalls

PubMed Central

Efanov, Johnny I.; Roy, Andrée-Anne; Huang, Ke N.

2018-01-01

Objective: Over the past few years, virtual surgical planning (VSP) has evolved into a useful tool for the craniofacial surgeon. Virtual planning and computer-aided design and manufacturing (CAD/CAM) may assist in orthognathic, cranio-orbital, traumatic, and microsurgery of the craniofacial skeleton. Despite its increasing popularity, little emphasis has been placed on the learning curve. Methods: A retrospective analysis of consecutive virtual surgeries was done from July 2012 to October 2016 at the University of Montreal Teaching Hospitals. Orthognathic surgeries and free vascularized bone flap surgeries were included in the analysis. Results: Fifty-four virtual surgeries were done in the time period analyzed. Forty-six orthognathic surgeries and 8 free bone transfers were done. An analysis of errors was done. Eighty-five percentage of the orthognathic virtual plans were adhered to completely, 4% of the plans were abandoned, and 11% were partially adhered to. Seventy-five percentage of the virtual surgeries for free tissue transfers were adhered to, whereas 25% were partially adhered to. The reasons for abandoning the plans were (1) poor communication between surgeon and engineer, (2) poor appreciation for condyle placement on preoperative scans, (3) soft-tissue impedance to bony movement, (4) rapid tumor progression, (5) poor preoperative assessment of anatomy. Conclusion: Virtual surgical planning is a useful tool for craniofacial surgery but has inherent issues that the surgeon must be aware of. With time and experience, these surgical plans can be used as powerful adjuvants to good clinical judgement. PMID:29464146

Severe macroglossia after posterior fossa and craniofacial surgery in children.

PubMed

Bouaoud, J; Joly, A; Picard, A; Thierry, B; Arnaud, E; James, S; Hennessy, I; McGarvey, B; Cairet, P; Vecchione, A; Vergnaud, E; Duracher, C; Khonsari, R H

2018-04-01

Massive swelling of the tongue can occur after posterior fossa and craniofacial surgery. Several hypotheses have been proposed to explain the occurrence of such severe postoperative macroglossia, but this phenomenon is still poorly understood. Severe postoperative macroglossia can be a life-threatening condition due to upper airway obstruction. Three cases of severe postoperative macroglossia that occurred after cervical spine, craniofacial, and posterior fossa surgical procedures are reported here. These cases required specialized maxillofacial management and a prolonged stay in the intensive care unit. Causal factors involved in this condition are reported, in order to highlight appropriate prevention and treatment options adapted to the management of paediatric patients. An overview of the current literature on severe postoperative macroglossia in paediatric populations is also provided. Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Goldenhar syndrome: Cardiac anesthesiologist's perspective.

PubMed

Choudhury, Minati; Kapoor, Poonam Malhotra

2017-01-01

Goldenhar syndrome or oculo-auriculo-vertebral dysplasia was defined by Goldenhar in 1952 and redefined by Grolin et al. later. As the name denotes, children with this syndrome present with craniofacial and vertebral anomalies which increase the risk of airway compromise. Neonates and infants with this syndrome often have premature internal organs, low birth weight, and airway disorders. For this reason, safe anesthesia in such infants requires a complete knowledge regarding metabolism and side effects of the drugs. The association of cardiovascular abnormalities is not uncommon and possesses additional challenge for anesthetic management. The aim of this review is to draw attention to the various perioperative problems that can be faced in these infants when they undergo surgery or the correction of the underlying cardiac problem.

The fourth dimension in simulation surgery for craniofacial surgical procedures.

PubMed

Kurihara, T

2001-03-01

The intracranial volume was measured in all 18 cases of craniosynostosis and craniofacial synostosis with 3DCT using a modification of Miyake's formula, with a 6 years' follow-up. 1: There were no cases where the intracranial volume was less than the modified Miyake's formula. 2: Total cranial reshaping, compared to the local forehead advancement, was effective in increasing the intracranial cavity and growth postoperatively. 3: In cases of craniofacial synostosis, there is a possibility that mental retardation will develop if the intracranial volume tends to increase rapidly and more than expected.

Normal/Modern: Reconstructive Surgery in a Mexican Public Hospital.

PubMed

Taylor-Alexander, Samuel

2017-10-01

A growing corpus of anthropological scholarship demonstrates how science and medicine in Mexico are imbued by national concerns with modernization. Drawing on ethnographic research in a public hospital located in the south of Mexico City, I unpack one manifestation of this dynamic, which is the conjugation of the normal and the modern in Mexican reconstructive surgery. The aspiration toward normality underlies everyday clinic practices and relationships in this field, including why parents want surgery for their children and how doctors see their patients and their responsibilities toward them. It is also central to the professional ethic of reconstructive surgeons. I argue that the realities of health care provision in Mexico coalesced with this ethic to produce reconstructive surgeons as political subjects. They aimed to modernize craniofacial surgery in Mexico and so make the bodies of craniofacial patients normal.

Age- and sex-related growth patterns of the craniofacial complex in European children aged 3-6 years.

PubMed

Tutkuviene, Janina; Cattaneo, Cristina; Obertová, Zuzana; Ratnayake, Melanie; Poppa, Pasquale; Barkus, Arunas; Khalaj-Hedayati, Kerstin; Schroeder, Inge; Ritz-Timme, Stefanie

2016-11-01

Craniofacial growth changes in young children are not yet completely understood. Up-to-date references for craniofacial measurements are crucial for clinical assessment of orthodontic anomalies, craniofacial abnormalities and subsequent planning of interventions. To provide normal reference data and to identify growth patterns for craniofacial dimensions of European boys and girls aged 3-6 years. Using standard anthropometric methodology, body weight, body height and 23 craniofacial measurements were acquired for a cross-sectional sample of 681 healthy children (362 boys and 319 girls) aged 3-6 years from Germany, Italy and Lithuania. Descriptive statistics, correlation coefficients, percentage annual changes and percentage growth rates were used to analyse the dataset. Between the ages of 3-6 years, craniofacial measurements showed age- and sex-related patterns independent from patterns observed for body weight and body height. Sex-related differences were observed in the majority of craniofacial measurements. In both sexes, face heights and face depths showed the strongest correlation with age. Growth patterns differed by craniofacial measurement and can be summarised into eight distinct age- and sex-related patterns. This study provided reference data and identified sex- and age-related growth patterns of the craniofacial complex of young European children, which may be used for detailed assessment of normal growth in paediatrics, maxillofacial reconstructive surgery and possibly for forensic age assessment.

Craniofacial Surgery and Adverse Outcomes: An Inquiry Into Medical Negligence.

PubMed

Svider, Peter F; Eloy, Jean Anderson; Folbe, Adam J; Carron, Michael A; Zuliani, Giancarlo F; Shkoukani, Mahdi A

2015-07-01

This study aimed to evaluate factors contributing to medical negligence relevant to craniofacial surgery. Retrospective analysis of verdict and settlement reports on the Westlaw legal database for outcome, awards, physician defendants, and other specific factors raised in malpractice litigation. Of 42 verdicts and settlement reports included, 52.4% were resolved with either an out-of-court settlement or plaintiff verdict, with aggregate payments totaling $50.1M (in 2013 dollars). Median settlements and jury-awarded damages were $988,000 and $555,000, respectively. Payments in pediatric cases ($1.2M) were significantly higher. Plastic surgeons, oral surgeons, and otolaryngologists were the most commonly named defendants. The most common alleged factors included intraoperative negligence (69.0%), permanent deficits (54.8%), requiring additional surgery (52.4%), missed/delayed diagnosis of a complication (42.9%), disfigurement/scarring (28.6%), postoperative negligence (28.6%), and inadequate informed consent (20.6% of surgical cases). Failure to diagnose a fracture (19.0%) and cleft-reparative procedures (14.3%) were the most frequently litigated entities. Medical negligence related to craniofacial surgery involves plaintiffs in a wide age range as well as physician defendants in numerous specialties, and proceedings resolved with settlement and plaintiff verdict involve substantial payments. Cases with death, allegedly permanent injuries, and pediatric plaintiffs had significantly higher payments. © The Author(s) 2015.

Population pharmacokinetics of ϵ-aminocaproic acid in adolescents undergoing posterior spinal fusion surgery.

PubMed

Stricker, P A; Gastonguay, M R; Singh, D; Fiadjoe, J E; Sussman, E M; Pruitt, E Y; Goebel, T K; Zuppa, A F

2015-04-01

Despite demonstrated efficacy of ϵ-aminocaproic acid (EACA) in reducing blood loss in adolescents undergoing spinal fusion, there are no population-specific pharmacokinetic data to guide dosing. The aim of this study was to determine the pharmacokinetics of EACA in adolescents undergoing spinal fusion surgery and make dosing recommendations. Twenty children ages 12-17 years were enrolled, with 10 children in each of two groups based on diagnosis (idiopathic scoliosis or non-idiopathic scoliosis). Previously reported data from infants undergoing craniofacial surgery were included in the model to enable dosing recommendations over a wide range of weights, ages, and diagnoses. A population non-linear mixed effects modelling approach was used to characterize EACA pharmacokinetics. Population pharmacokinetic parameters were estimated using a two-compartment disposition model with allometrically scaled weight and an age effect on clearance. Pharmacokinetic parameters for the typical patient were a plasma clearance of 153 ml min(-1) 70 kg(-1) (6.32 ml min(-1) kg(-0.75)), intercompartmental clearance of 200 ml min(-1) 70 kg(-1) (8.26 ml min(-1) kg(-0.75)), central volume of distribution of 8.78 litre 70 kg(-1) (0.13 litre kg(-1)), and peripheral volume of distribution of 15.8 litre 70 kg(-1) (0.23 litre kg(-1)). Scoliosis aetiology did not have a clinically significant effect on drug pharmacokinetics. The following dosing schemes are recommended according to patient weight: weight <25 kg, 100 mg kg(-1) loading dose and 40 mg kg(-1) h(-1) infusion; weight ≤25 kg-<50 kg, 100 mg kg(-1) loading dose and 35 mg kg(-1) h(-1) infusion; and weight ≥50 kg, 100 mg kg(-1) loading dose and 30 mg kg(-1) h(-1) infusion. An efficacy trial employing this dosing strategy is warranted. NCT01408823. © The Author 2015. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Population pharmacokinetics of ϵ-aminocaproic acid in adolescents undergoing posterior spinal fusion surgery

PubMed Central

Stricker, P. A.; Gastonguay, M. R.; Singh, D.; Fiadjoe, J. E.; Sussman, E. M.; Pruitt, E. Y.; Goebel, T. K.; Zuppa, A. F.

2015-01-01

Background Despite demonstrated efficacy of ϵ-aminocaproic acid (EACA) in reducing blood loss in adolescents undergoing spinal fusion, there are no population-specific pharmacokinetic data to guide dosing. The aim of this study was to determine the pharmacokinetics of EACA in adolescents undergoing spinal fusion surgery and make dosing recommendations. Methods Twenty children ages 12–17 years were enrolled, with 10 children in each of two groups based on diagnosis (idiopathic scoliosis or non-idiopathic scoliosis). Previously reported data from infants undergoing craniofacial surgery were included in the model to enable dosing recommendations over a wide range of weights, ages, and diagnoses. A population non-linear mixed effects modelling approach was used to characterize EACA pharmacokinetics. Results Population pharmacokinetic parameters were estimated using a two-compartment disposition model with allometrically scaled weight and an age effect on clearance. Pharmacokinetic parameters for the typical patient were a plasma clearance of 153 ml min−1 70 kg−1 (6.32 ml min−1 kg−0.75), intercompartmental clearance of 200 ml min−1 70 kg−1 (8.26 ml min−1 kg−0.75), central volume of distribution of 8.78 litre 70 kg−1 (0.13 litre kg−1), and peripheral volume of distribution of 15.8 litre 70 kg−1 (0.23 litre kg−1). Scoliosis aetiology did not have a clinically significant effect on drug pharmacokinetics. Conclusions The following dosing schemes are recommended according to patient weight: weight <25 kg, 100 mg kg−1 loading dose and 40 mg kg−1 h−1 infusion; weight ≤25 kg–<50 kg, 100 mg kg−1 loading dose and 35 mg kg−1 h−1 infusion; and weight ≥50 kg, 100 mg kg−1 loading dose and 30 mg kg−1 h−1 infusion. An efficacy trial employing this dosing strategy is warranted. Clinical trial registration NCT01408823. PMID:25586726

A personal tribute to a great educator: how Henry Kawamoto influenced my interest in facial soft tissue anatomy and changed my plastic surgery career.

PubMed

Stuzin, James M

2012-11-01

Henry Kawamoto remains one of the most influential craniofacial surgeons of the 20th century. A Tessier-trained craniofacial surgeon, Dr. Kawamoto has personally influenced not only the lives of his patients, but significantly also the lives of those craniofacial fellows he educated, passing on the Tessier methodology to future generations. This article serves as an anecdote as to how Dr. Kawamoto's mentoring influenced a personal understanding of facial soft tissue anatomy, leading to improved technical approaches for surgical rejuvenation of the aging face.

Exploring the Medical and Psychosocial Concerns of Adolescents and Young Adults With Craniofacial Microsomia: A Qualitative Study.

PubMed

Hamilton, Kayla V; Ormond, Kelly E; Moscarello, Tia; Bruce, Janine S; Bereknyei Merrell, Sylvia; Chang, Kay W; Bernstein, Jonathan A

2018-01-01

This study explores the experiences of adolescents and young adults with craniofacial microsomia, including the impact of growing up with this craniofacial condition on daily life and sense of self. The results may guide future research on optimally supporting individuals with craniofacial microsomia during this critical life phase. Participants were recruited through a craniofacial center, online patient support groups, and social media sites. Eleven individual semistructured interviews with participants between 12 and 22 years old were conducted by a single interviewer, transcribed, iteratively coded, and thematically analyzed. Five themes were evident in the data: (1) impact on personal growth and character development, (2) negative psychosocial impact, (3) deciding to hide or reveal the condition, (4) desire to make personal surgical decisions, and (5) struggles with hearing loss. We identified both medical and psychosocial concerns prevalent among adolescents with craniofacial microsomia. Although adolescents with craniofacial microsomia exhibit considerable resilience, the challenges they face impact their sense of self and should be addressed through psychosocial support and counseling. Further research should investigate the potential benefit of the wider use of hearing aids, as well as the involvement of patients in decision-making about reconstructive ear surgery.

Adult psychological functioning of individuals born with craniofacial anomalies.

PubMed

Sarwer, D B; Bartlett, S P; Whitaker, L A; Paige, K T; Pertschuk, M J; Wadden, T A

1999-02-01

This study represents an initial investigation into the adult psychological functioning of individuals born with craniofacial disfigurement. A total of 24 men and women born with a craniofacial anomaly completed paper and pencil measures of body image dissatisfaction, self-esteem, quality of life, and experiences of discrimination. An age- and gender-matched control group of 24 non-facially disfigured adults also completed the measures. As expected, craniofacially disfigured adults reported greater dissatisfaction with their facial appearance than did the control group. Craniofacially disfigured adults also reported significantly lower levels of self-esteem and quality of life. Dissatisfaction with facial appearance, self-esteem, and quality of life were related to self-ratings of physical attractiveness. More than one-third of craniofacially disfigured adults (38 percent) reported experiences of discrimination in employment or social settings. Among disfigured adults, psychological functioning was not related to number of surgeries, although the degree of residual facial deformity was related to increased dissatisfaction with facial appearance and greater experiences of discrimination. Results suggest that adults who were born with craniofacial disfigurement, as compared with non-facially disfigured adults, experience greater dissatisfaction with facial appearance and lower self-esteem and quality of life; however, these experiences do not seem to be universal.

Customized "In-Office" Three-Dimensional Printing for Virtual Surgical Planning in Craniofacial Surgery.

PubMed

Mendez, Bernardino M; Chiodo, Michael V; Patel, Parit A

2015-07-01

Virtual surgical planning using three-dimensional (3D) printing technology has improved surgical efficiency and precision. A limitation to this technology is that production of 3D surgical models requires a third-party source, leading to increased costs (up to $4000) and prolonged assembly times (averaging 2-3 weeks). The purpose of this study is to evaluate the feasibility, cost, and production time of customized skull models created by an "in-office" 3D printer for craniofacial reconstruction. Two patients underwent craniofacial reconstruction with the assistance of "in-office" 3D printing technology. Three-dimensional skull models were created from a bioplastic filament with a 3D printer using computed tomography (CT) image data. The cost and production time for each model were measured. For both patients, a customized 3D surgical model was used preoperatively to plan split calvarial bone grafting and intraoperatively to more efficiently and precisely perform the craniofacial reconstruction. The average cost for surgical model production with the "in-office" 3D printer was $25 (cost of bioplastic materials used to create surgical model) and the average production time was 14  hours. Virtual surgical planning using "in office" 3D printing is feasible and allows for a more cost-effective and less time consuming method for creating surgical models and guides. By bringing 3D printing to the office setting, we hope to improve intraoperative efficiency, surgical precision, and overall cost for various types of craniofacial and reconstructive surgery.

Emotional and behavioral reactions to facially deformed patients before and after craniofacial surgery.

PubMed

Barden, R C; Ford, M E; Wilhelm, W M; Rogers-Salyer, M; Salyer, K E

1988-09-01

The present experiment investigated whether observers' emotional and behavioral reactions to facially deformed patients could be substantially improved by surgical procedures conducted by well-trained specialists in an experienced multidisciplinary team. Also investigated was the hypothesis that emotional states mediate the effects of physical attractiveness and facial deformity on social interaction. Twenty patients between the ages of 3 months and 17 years were randomly selected from over 2000 patients' files of Kenneth E. Salyer of Dallas, Texas. Patient diagnoses included facial clefts, hypertelorism, Treacher Collins syndrome, and craniofacial dysostoses (Crouzon's and Apert's syndromes). Rigorously standardized photographs of patients taken before and after surgery were shown to 22 "naive" raters ranging in age from 18 to 54 years. Raters were asked to predict their emotional and behavioral responses to the patients. These ratings indicated that observers' behavioral reactions to facially deformed children and adolescents would be more positive following craniofacial surgery. Similarly, the ratings indicated that observers' emotional reactions to these patients would be more positive following surgery. The results are discussed in terms of current sociopsychologic theoretical models for the effects of attractiveness on social interaction. A new model is presented that implicates induced emotional states as a mediating process in explaining the effects of attractiveness and facial deformity on the quality of social interactions. Limitations of the current investigation and directions for future research are also discussed.

Neural crest development and craniofacial morphogenesis is coordinated by nitric oxide and histone acetylation

PubMed Central

Kong, Yawei; Grimaldi, Michael; Curtin, Eugene; Dougherty, Max; Kaufman, Charles; White, Richard M.; Zon, Leonard I.; Liao, Eric C.

2015-01-01

Cranial neural crest (CNC) cells are patterned and coalesce to facial prominences that undergo convergence and extension to generate the craniofacial form. We applied a chemical genetics approach to identify pathways that regulate craniofacial development during embryogenesis. Treatment with the nitric oxide synthase inhibitor TRIM abrogated first pharyngeal arch structures and induced ectopic ceratobranchial formation. TRIM promoted a progenitor CNC fate and inhibited chondrogenic differentiation, which were mediated through impaired nitric oxide (NO) production without appreciable effect on global protein S-nitrosylation. Instead, TRIM perturbed hox gene patterning and caused histone hypoacetylation. Rescue of TRIM phenotype was achieved with over-expression of histone acetyltransferase kat6a, inhibition of histone deacetylase, and complimentary NO. These studies demonstrate that NO signaling and histone acetylation are coordinated mechanisms that regulate CNC patterning, differentiation and convergence during craniofacial morphogenesis. PMID:24684905

A new custom made bioceramic implant for the repair of large and complex craniofacial bone defects.

PubMed

Brie, Joël; Chartier, Thierry; Chaput, Christophe; Delage, Cyrille; Pradeau, Benjamin; Caire, François; Boncoeur, Marie-Paule; Moreau, Jean-Jacques

2013-07-01

Neurosurgery and Maxillofacial Surgery Departments of Limoges University Hospital Centre have developed a new concept of a custom made ceramic implant in hydroxyapatite (HA) for the reconstruction of large and complex craniofacial bone defects (more than 25 cm(2)). The manufacturing process of the implants used a stereolithography technique that produces implants with three-dimensional shapes derived directly from the scan file of the patient's skull without moulding or machining. Eight patients received 8 implants between 2005 and 2008. The surgical procedure is simple and fast. The post-operative follow-up was 12 months. No major complications (infection or fracture of the implant) were observed. The cosmetic result was considered satisfactory by both patients and surgeons. These new implants are well suited for reconstruction of large craniofacial bone defects (greater than 25 cm(2)) in adults and children over 8 years. Copyright © 2012 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Quantifying Normal Craniofacial Form and Baseline Craniofacial Asymmetry in the Pediatric Population.

PubMed

Cho, Min-Jeong; Hallac, Rami R; Ramesh, Jananie; Seaward, James R; Hermann, Nuno V; Darvann, Tron A; Lipira, Angelo; Kane, Alex A

2018-03-01

Restoring craniofacial symmetry is an important objective in the treatment of many craniofacial conditions. Normal form has been measured using anthropometry, cephalometry, and photography, yet all of these modalities have drawbacks. In this study, the authors define normal pediatric craniofacial form and craniofacial asymmetry using stereophotogrammetric images, which capture a densely sampled set of points on the form. After institutional review board approval, normal, healthy children (n = 533) with no known craniofacial abnormalities were recruited at well-child visits to undergo full head stereophotogrammetric imaging. The children's ages ranged from 0 to 18 years. A symmetric three-dimensional template was registered and scaled to each individual scan using 25 manually placed landmarks. The template was deformed to each subject's three-dimensional scan using a thin-plate spline algorithm and closest point matching. Age-based normal facial models were derived. Mean facial asymmetry and statistical characteristics of the population were calculated. The mean head asymmetry across all pediatric subjects was 1.5 ± 0.5 mm (range, 0.46 to 4.78 mm), and the mean facial asymmetry was 1.2 ± 0.6 mm (range, 0.4 to 5.4 mm). There were no significant differences in the mean head or facial asymmetry with age, sex, or race. Understanding the "normal" form and baseline distribution of asymmetry is an important anthropomorphic foundation. The authors present a method to quantify normal craniofacial form and baseline asymmetry in a large pediatric sample. The authors found that the normal pediatric craniofacial form is asymmetric, and does not change in magnitude with age, sex, or race.

Reconstruction of Craniomaxillofacial Bone Defects Using Tissue-Engineering Strategies with Injectable and Non-Injectable Scaffolds

PubMed Central

Gaihre, Bipin; Uswatta, Suren; Jayasuriya, Ambalangodage C.

2017-01-01

Engineering craniofacial bone tissues is challenging due to their complex structures. Current standard autografts and allografts have many drawbacks for craniofacial bone tissue reconstruction; including donor site morbidity and the ability to reinstate the aesthetic characteristics of the host tissue. To overcome these problems; tissue engineering and regenerative medicine strategies have been developed as a potential way to reconstruct damaged bone tissue. Different types of new biomaterials; including natural polymers; synthetic polymers and bioceramics; have emerged to treat these damaged craniofacial bone tissues in the form of injectable and non-injectable scaffolds; which are examined in this review. Injectable scaffolds can be considered a better approach to craniofacial tissue engineering as they can be inserted with minimally invasive surgery; thus protecting the aesthetic characteristics. In this review; we also focus on recent research innovations with different types of stem-cell sources harvested from oral tissue and growth factors used to develop craniofacial bone tissue-engineering strategies. PMID:29156629

Resonance and speech articulation after midface advancement in craniofacial dysostosis.

PubMed

Bordbar, Patrishia; Blumenow, Wendy; Duncan, Christian; Richardson, David

2012-03-01

This study aimed to analyze changes in resonance and speech articulation after midface advancement in syndromic craniofacial patients and to assess the influence of craniofacial diagnosis and the presence or absence of a cleft palate. This study is a retrospective analysis of resonance and speech articulation in patients after midface advancement. This project was carried out in a multidisciplinary pediatric craniofacial service. Eighteen patients underwent midface advancement between 2002 and 2009. Three were excluded because of inadequate records or presence of tracheostomy. Midface advancement was done by Le Fort III, facial bipartition, or monobloc, either conventional surgery or distraction osteogenesis. Outcomes include perceptual assessment of articulation and resonance using GOS.SP.ASS.98 revised and recommendation for speech surgery. Hypernasality scores decreased in 7 patients (46.7%), and 5 patients were recommended for speech surgery. Hyponasality scores improved in 10 patients (66.7%), were unchanged in 3 patients (20%), and decreased in 2 patients (13%). Articulation changed (improved) in 1 patient (6.7%) only. Hypernasality scores decreased in 33.3% of Crouzon and 71.4% of Apert patients. Five patients had a cleft palate, 4 had Apert syndrome, and hypernasality scores decreased in 3 patients. Of 3 patients with Apert syndrome but no cleft palate, 2 (66.7%) also had a decrease in hypernasality scores. Our findings suggest a high incidence of deterioration in velopharyngeal function after midface advancement, particularly in Apert syndrome, regardless of the presence of a cleft, and an improvement in hyponasality, but minimal change in articulation. Larger prospective multicenter studies are required to investigate these findings further.

A novel osteogenic distraction device for the transversal correction of temporozygomatic hypoplasia.

PubMed

Pagnoni, Mario; Fadda, Maria Teresa; Cascone, Piero; Iannetti, Giorgio

2014-07-01

Hemifacial microsomia (HFM) is a congenital disorder characterized by craniofacial malformation of one or both sides of the lower face. Since these anomalies are associated with soft-tissue deficiencies, corrective surgery is often difficult. Bone grafts have typically been used for augmentation, but distraction osteogenesis now offers an alternative for many craniofacial deficiencies, but there are few if any appropriate distraction devices and surgical procedures for the augmentation of craniofacial transversal dimensions. The aim of this study was to evaluate a technique for guided augmentation of craniofacial transversal dimensions through distraction osteogenesis. We tested the efficacy of a prototype distractor, developed in collaboration with Medartis, using cadavers and demonstrated its application for the correction of the transverse dimension of the temporozygomatic region in a patient with Goldenhar syndrome. CT scans showed a 4-mm transverse augmentation of the bony surface after 9 days and a 10-mm increase after 30 days. Upon removal of the distractor (60 days after the first surgery) CT indicated good bony fusion and a stable result in the transverse plane. Six months after removal of the distractor, 3D computed tomography confirmed the success of the transverse augmentation, as it appeared to be stable and reliable. Distraction osteogenesis, using our device, can be used to correct the transverse dimension of the temporozygomatic region in HFM patients. It should also be considered for the correction of residual postsurgical skeletal deficiency due to surgical relapse or deficient growth, and unsatisfactory skeletal contour. Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Three-Dimensional Printing: Custom-Made Implants for Craniomaxillofacial Reconstructive Surgery

PubMed Central

Matias, Mariana; Zenha, Horácio; Costa, Horácio

2017-01-01

Craniomaxillofacial reconstructive surgery is a challenging field. First it aims to restore primary functions and second to preserve craniofacial anatomical features like symmetry and harmony. Three-dimensional (3D) printed biomodels have been widely adopted in medical fields by providing tactile feedback and a superior appreciation of visuospatial relationship between anatomical structures. Craniomaxillofacial reconstructive surgery was one of the first areas to implement 3D printing technology in their practice. Biomodeling has been used in craniofacial reconstruction of traumatic injuries, congenital disorders, tumor removal, iatrogenic injuries (e.g., decompressive craniectomies), orthognathic surgery, and implantology. 3D printing has proven to improve and enable an optimization of preoperative planning, develop intraoperative guidance tools, reduce operative time, and significantly improve the biofunctional and the aesthetic outcome. This technology has also shown great potential in enriching the teaching of medical students and surgical residents. The aim of this review is to present the current status of 3D printing technology and its practical and innovative applications, specifically in craniomaxillofacial reconstructive surgery, illustrated with two clinical cases where the 3D printing technology was successfully used. PMID:28523082

Craniofacial reconstruction evaluation by geodesic network.

PubMed

Zhao, Junli; Liu, Cuiting; Wu, Zhongke; Duan, Fuqing; Wang, Kang; Jia, Taorui; Liu, Quansheng

2014-01-01

Craniofacial reconstruction is to estimate an individual's face model from its skull. It has a widespread application in forensic medicine, archeology, medical cosmetic surgery, and so forth. However, little attention is paid to the evaluation of craniofacial reconstruction. This paper proposes an objective method to evaluate globally and locally the reconstructed craniofacial faces based on the geodesic network. Firstly, the geodesic networks of the reconstructed craniofacial face and the original face are built, respectively, by geodesics and isogeodesics, whose intersections are network vertices. Then, the absolute value of the correlation coefficient of the features of all corresponding geodesic network vertices between two models is taken as the holistic similarity, where the weighted average of the shape index values in a neighborhood is defined as the feature of each network vertex. Moreover, the geodesic network vertices of each model are divided into six subareas, that is, forehead, eyes, nose, mouth, cheeks, and chin, and the local similarity is measured for each subarea. Experiments using 100 pairs of reconstructed craniofacial faces and their corresponding original faces show that the evaluation by our method is roughly consistent with the subjective evaluation derived from thirty-five persons in five groups.

Stable fixation with absorbable sutures in craniofacial surgery.

PubMed

Linz, C; Kunz, F; Krauß, J; Böhm, H; Wirth, C; Hartmann, S; Wirbelauer, J; Schweitzer, T

2016-05-01

The present study analyses the exclusive use of absorbable suture material (Vicryl(®), Ethicon, Germany) in the fixation of transposed bone segments in craniofacial surgery without modification of the osteotomy design. Among 129 children up to 24 months of age, osteosynthesis was conducted exclusively with Vicryl(®) sutures. The stability of postoperative results was evaluated and possible foreign body reactions were examined within the framework of clinical and radiological routine checks. All examined children exhibited stable postoperative conditions while the length of hospital stay was not affected. X-ray examinations of the skull in two planes demonstrated good bony union in all cases. Relevant foreign body reactions were not observed. The exclusive application of absorbable suture material enables stable and cost effective osteosynthesis. Significant foreign body reactions were not observed. The exclusive use of absorbable sutures did not alter the osteotomy design. Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Craniofacial orthodontics and postgraduate orthodontic training in Nigeria.

PubMed

Isiekwe, G I; Oguchi, C O; daCosta, O O; Utomi, I L

2016-01-01

Craniofacial orthodontics has been shown to be a critical component of the care of patients with craniofacial anomalies such as cleft lip and palate. Thus, the purpose of this study was to assess the perceptions and clinical experience in cleft and craniofacial care, of orthodontic residents in Nigeria. Questionnaires were sent out to orthodontic residents in the six Postgraduate Orthodontic Training Centers in the country at that time. The questionnaires were self-administered and covered areas in beliefs in cleft care and the clinical experience and challenges faced by the residents in the provision of craniofacial orthodontic care at their various institutions. Thirty-three respondents returned completed questionnaires, with a response rate of 97%. All the respondents believed that residents should be involved in cleft and craniofacial care. Postnatal counseling was the clinical procedure in which the residents reported the highest level of clinical experience (47.4%). The least clinical experience was recorded in pre-bone graft orthodontics (7.4%) and orthodontic preparation for orthognathic surgery (5.5%). Some of the challenges highlighted by the residents were low patients turn out for orthodontic care and the absence of multidisciplinary treatment for craniofacial patients in their centers. Orthodontic residents in Nigeria believe that they should be involved in the management of patients with craniofacial anomalies and cleft lip and palate. However, majority of the residents have limited clinical experience in the management of these patients. A lot more needs to be done, to expose orthodontic residents in training, to all aspects of the orthodontic and multidisciplinary team care required for the cleft/craniofacial patient.

A national center for biocomputation: in search of a patient-specific interactive virtual surgery workbench

NASA Technical Reports Server (NTRS)

Ross, M. D.; Montgomery, K.; Linton, S.; Cheng, R.; Smith, J.

1998-01-01

This report describes the three-dimensional imaging and virtual environment technologies developed in NASA's Biocomputation Center for scientific purposes that have now led to applications in the field of medicine. A major goal is to develop a virtual environment surgery workbench for planning complex craniofacial and breast reconstructive surgery, and for training surgeons.

Patient satisfaction after zygoma and mandible reduction surgery: an outcome assessment.

PubMed

Choi, Bong-Kyoon; Goh, Raymond C W; Moaveni, Zachary; Lo, Lun-Jou

2010-08-01

An ovoid and slender face is considered attractive in Oriental culture, and facial bony contouring is frequently performed in Asian countries to achieve this desired facial profile. Despite their popularity, critical analyses of patients' satisfaction after facial-bone contouring surgery is lacking in the current literature. Questionnaires were sent to 90 patients who had undergone zygoma and/or mandibular contouring by a single surgeon at the Craniofacial Center, Chang Gung Memorial Hospital, Taiwan. The number of patients who had mandibular angle reduction and zygoma reduction were 78 and 36, respectively. The questionnaire contained 20 questions, concerning aesthetic and surgical results, psychosocial benefits and general outcome. Medical records were also reviewed for correlation with the questionnaire findings. The survey response rate was 52.2% (47 patients). A total of 95.7% were satisfied with the symmetry of their face after surgery, and 97.9% felt that there was improvement in their final facial appearance. As many as 61.7% could not feel an objectionable new jaw line or bony step and 66.0% could not detect any visible deformity. A total of 87.2% could not detect bony regrowth after surgery. Complication after surgery was experienced by 17.0% of patients, but all of these recovered without long-term consequences. All patients noted a positive psychosocial influence, and 97.9% of patients said that they would undergo the same surgery again under similar circumstances and would recommend the same surgery to friends. The majority of patients with square face seeking facial bone contouring surgery are satisfied with their final appearance. Of equal importance is the ability for this type of surgery to have a positive influence on the patient's psychosocial environment. Copyright 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Nanotechnology applications in plastic and reconstructive surgery: a review.

PubMed

Parks, Joe; Kath, Melissa; Gabrick, Kyle; Ver Halen, Jon Peter

2012-01-01

Although nanotechnology is a relatively young field, there are already countless biomedical applications. Plastic and reconstructive surgery has significantly benefited from nanoscale refinements of diagnostic and therapeutic techniques. Plastic surgery is an incredibly diverse specialty, encompassing craniofacial surgery, hand surgery, cancer/trauma/congenital reconstruction, burn care, and aesthetic surgery. In particular, wound care, topical skin care, implant and prosthetic design, tissue engineering, regenerative medicine, and drug delivery have all been influenced by advances in nanotechnology. Nanotechnology will continue to witness growth and expansion of its biomedical applications, especially those in plastic surgery.

Craniofacial neurofibromatosis: treatment of the midface deformity.

PubMed

Singhal, Dhruv; Chen, Yi-Chieh; Tsai, Yueh-Ju; Yu, Chung-Chih; Chen, Hung Chang; Chen, Yu-Ray; Chen, Philip Kuo-Ting

2014-07-01

Craniofacial Neurofibromatosis is a benign but devastating disease. While the most common location of facial involvement is the orbito-temporal region, patients often present with significant mid-face deformities. We reviewed our experience with Craniofacial Neurofibromatosis from June 1981 to June 2011 and included patients with midface soft tissue deformities defined as gross alteration of nasal or upper lip symmetry. Data reviewed included the medical records and photobank. Over 30 years, 52 patients presented to and underwent surgical management for Craniofacial Neurofibromatosis at the Chang Gung Craniofacial Center. 23 patients (43%) demonstrated gross mid-facial deformities at initial evaluation. 55% of patients with lip deformities and 28% of patients with nasal deformities demonstrated no direct tumour involvement. The respective deformity was solely due to secondary gravitational effects from neurofibromas of the cheek subunit. Primary tumour infiltration of the nasal and/or labial subunits was treated with excision followed by various methods of reconstruction including lower lateral cartilage repositioning, forehead flaps, free flaps, and/or oral commissure suspension. Soft tissue deformities of the midface are very common in patients with Craniofacial Neurofibromatosis and profoundly affect overall aesthetic outcomes. Distinguishing primary from secondary involvement of the midface assists in surgical decision making. Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Genetics Home Reference: blepharocheilodontic syndrome

MedlinePlus

... Palate American Association of Oral and Maxillofacial Surgeons: Cleft Lip/Palate and Craniofacial Surgery MedlinePlus Encyclopedia: Cleft Lip and Palate Repair General Information from MedlinePlus (5 links) Diagnostic ...

Temporomandibular Joint Dysfunction

MedlinePlus

... or applying ice packs. It may also include pain medicines or devices to insert in your mouth. In very rare cases, you might need surgery. NIH: National Institute of Dental and Craniofacial Research

A New Classification of Three-Dimensional Printing Technologies: Systematic Review of Three-Dimensional Printing for Patient-Specific Craniomaxillofacial Surgery.

PubMed

Jacobs, Carly A; Lin, Alexander Y

2017-05-01

Three-dimensional printing technology has been advancing in surgical applications. This systematic review examines its patient-specific applications in craniomaxillofacial surgery. Terms related to "three-dimensional printing" and "surgery" were searched on PubMed on May 4, 2015; 313 unique articles were returned. Inclusion and exclusion criteria concentrated on patient-specific surgical applications, yielding 141 full-text articles, of which 33 craniomaxillofacial articles were analyzed. Thirty-three articles included 315 patients who underwent three-dimensional printing-assisted operations. The most common modeling software was Mimics, the most common printing software was 3D Systems, the average time to create a printed object was 18.9 hours (range, 1.5 to 96 hours), and the average cost of a printed object was $1353.31 (range, $69.75 to $5500). Surgical procedures were divided among 203 craniofacial patients (205 three-dimensional printing objects) and 112 maxillofacial patients (137 objects). Printing technologies could be classified as contour models, guides, splints, and implants. For craniofacial patients, 173 contour models (84 percent), 13 guides (6 percent), two splints (1 percent), and 17 implants (8 percent) were made. For maxillofacial patients, 41 contour models (30 percent), 48 guides (35 percent), 40 splints (29 percent), and eight implants (6 percent) were made. These distributions were significantly different (p < 0.0001). Four studies compared three-dimensional printing techniques to conventional techniques; two of them found that three-dimensional printing produced improved outcomes. Three-dimensional printing technology in craniomaxillofacial surgery can be classified into contour models (type I), guides (type II), splints (type III), and implants (type IV). These four methods vary in their use between craniofacial and maxillofacial surgery, reflecting their different goals. This understanding may help advance and predict three-dimensional printing applications for other types of plastic surgery and beyond.

Report of an unsual case of anophthalmia and craniofacial cleft in a newborn with Toxoplasma gondii congenital infection.

PubMed

Arce-Estrada, Gabriel Emmanuel; Gómez-Toscano, Valeria; Cedillo-Peláez, Carlos; Sesman-Bernal, Ana Luisa; Bosch-Canto, Vanessa; Mayorga-Butrón, José Luis; Vargas-Villavicencio, José Antonio; Correa, Dolores

2017-07-03

We present one unusual case of anophthalmia and craniofacial cleft, probably due to congenital toxoplasmosis only. A two-month-old male had a twin in utero who disappeared between the 7 th and the 14 th week of gestation. At birth, the baby presented anophthalmia and craniofacial cleft, and no sign compatible with genetic or exposition/deficiency problems, like the Wolf-Hirschhorn syndrome or maternal vitamin A deficiency. Congenital toxoplasmosis was confirmed by the presence of IgM abs and IgG neo-antibodies in western blot, as well as by real time PCR in blood. CMV infection was also discarded by PCR and IgM negative results. Structures suggestive of T. gondii pseudocysts were observed in a biopsy taken during the first functional/esthetic surgery. We conclude that this is a rare case of anophthalmia combined with craniofacial cleft due to congenital toxoplasmosis, that must be considered by physicians. This has not been reported before.

[Anterior craniofacial resection: oncologic outcome and complications in a series of 111 cases].

PubMed

Suárez, C; Llorente, J L; Fernández de León, R; Cabanillas, R; Suárez, V; López, A

2004-01-01

Anterior craniofacial resection is a standardized procedure for the treatment of ethmoid and frontal orbital tumors with intracranial invasion. A retrospective review of 111 patients with sinonasal tumors involving the anterior skull base who underwent combined craniofacial surgery. The most frequent pathological entity was adenocarcinoma (54 cases) and other epithelial tumors (29 cases). Five year actuarial survival according to the Kaplan-Meier method was 40%. Survival was affected by the histology of the tumor, brain involvement, and deep soft tissue involvement of the orbit. The UICC staging system did not show statistical prognostic significance. Complications occurred in 39 (35.1%) patients, resulting in 4 (3.6%) postoperative deaths. Major complications included cerebrospinal fluid leak in 18 patients, meningitis in 10, infection in 9, stroke in 4, and pneumocephalus in 4. The extent of the craniofacial resection was the most important factor associated with major complications. Despite the advanced stage of most of the patients, anterior craniofacial resection succeeded in terms of an acceptable survival rate. Nevertheless, significant complications were observed although in most patients were not life-threatening and had no negative impact on the quality of life.

[Orthognathic surgery, master-piece of maxillo-facial surgery].

PubMed

Reychler, H

2001-01-01

Orthognathic surgery is this field of the maxillofacial surgery which aims to reposition the jaws or some segments of these jaws when masticatory dysfunctions are evident. This tridimensional repositioning in the craniofacial skeleton allows to restore the masticatory function by means of osteotomies, which must be followed either by preoperative simulated bony displacements or by callus bone distraction. Not only are the functional benefits evident on the dental, articular and neuromuscular levels, but also a facial esthetic harmony can almost be obtained.

Use of three-dimensional, CAD/CAM-assisted, virtual surgical simulation and planning in the pediatric craniofacial population.

PubMed

Gray, Rachel; Gougoutas, Alexander; Nguyen, Vinh; Taylor, Jesse; Bastidas, Nicholas

2017-06-01

Virtual Surgical Planning (VSP) and computer-aided design/computer-aided manufacturing (CAD/CAM) have recently helped improve efficiency and accuracy in many different craniofacial surgeries. Research has mainly focused on the use in the adult population with the exception of the use for mandibular distractions and cranial vault remodeling in the pediatric population. This study aims to elucidate the role of VSP and CAD/CAM in complex pediatric craniofacial cases by exploring its use in the correction of midface hypoplasia, orbital dystopia, mandibular reconstruction, and posterior cranial vault expansion. A retrospective analysis of thirteen patients who underwent 3d, CAD/CAM- assisted preoperative surgical planning between 2012 and 2016 was performed. All CAD/CAM assisted surgical planning was done in conjunction with a third party vendor (either 3D Systems or Materialise). Cutting and positioning guides as well as models were produced based on the virtual plan. Surgeries included free fibula mandible reconstruction (n = 4), lefort I osteotomy and distraction (n = 2), lefort II osteotomy with monobloc distraction (n = 1), expansion of the posterior vault for correction of chiari malformation (n = 3), and secondary orbital and midface reconstruction for facial trauma (n = 3). The patient's age, diagnosis, previous surgeries, length of operating time, complications, and post-surgery satisfaction were determined. In all cases we found presurgical planning was helpful to improve accuracy and significantly decrease intra-operative time. In cases where distraction was used, the planned and actual vectors were found to be accurate with excellent clinical outcomes. There were no complications except for one patient who experienced a wound infection post-operatively which did not alter the ultimate reconstruction. All patients experienced high satisfaction with their outcomes and excellent subjective aesthetic results were achieved. Preoperative planning using CAD/CAM and VSP allows for safe and precise craniofacial reconstruction in complex pediatric cases with a reduction of operative time. Copyright © 2017 Elsevier B.V. All rights reserved.

Craniofacial resection and its role in the management of sinonasal malignancies.

PubMed

Taghi, Ali; Ali, Ahmed; Clarke, Peter

2012-09-01

Sinonasal malignancy is rare, and its presentation is commonly late. There is a wide variety of pathologies with varying natural histories and survival rates. Anatomy of the skull base is extremely complex and tumors are closely related to orbits, frontal lobes and cavernous sinus. Anatomical detail and the late presentation render surgical management a challenging task. A thorough understanding of anatomy and pathology combined with modern neuroimaging and reliable reconstruction within a multidisciplinary team is imperative to carry out skull base surgery effectively. While endoscopic approaches are gaining credibility, clearly, it will be some time before meaningful comparisons with craniofacial resection can be made. Until then, craniofacial resection will remain the gold standard for managing the sinonasal malignancies of the anterior skull base, as it has proved to be safe and effective.

Cleft Palate-Craniofacial Journal 50th anniversary editorial board commentary: anatomy, basic sciences, and genetics--then and now.

PubMed

Mooney, Mark P; Cooper, Gregory M; Marazita, Mary L

2014-05-01

To celebrate the 50th year of the Cleft Palate-Craniofacial Journal we look back to where we started in 1964 and where we are now, and we speculate about directions for the future in a "Then and Now" editorial series. This editorial examines changing trends and perspectives in anatomical, basic science, and genetic studies published in this 50-year interval. In volume 1 there were 45 total papers, seven (16%) of which were peer-reviewed basic science and genetic articles published: four in anatomy, three in craniofacial biology, and none in genetics. In contrast, in volume 50, of 113 articles there were 47 (42%) peer-reviewed basic science and genetic articles published: 30 in anatomy, five in craniofacial biology, and 12 in genetics. Topical analysis of published manuscripts then and now reveal that similar topics in anatomy and craniofacial biology are still being researched today (e.g., phenotypic variability, optimal timing of surgery, presurgical orthopedics, bone grafting); whereas, most of the more recent papers use advanced technology to address old questions. In contrast, genetic publications have clearly increased in frequency during the last 50 years, which parallels advances in the field during this time. However, all of us have noticed that the more "cutting-edge" papers in these areas are not being submitted for publication to the journal, but instead to discipline-specific journals. Concerted efforts are therefore indicated to attract and publish these cutting-edge papers in order to keep the Cleft Palate-Craniofacial Journal in the forefront of orofacial cleft and craniofacial anomaly research and to provide a valuable service to American Cleft Palate-Craniofacial Association members.

Pharmacokinetic analysis of cloxacillin loss in children undergoing major surgery with massive bleeding.

PubMed Central

Levy, M; Egersegi, P; Strong, A; Tessoro, A; Spino, M; Bannatyne, R; Fear, D; Posnick, J C; Koren, G

1990-01-01

To determine the magnitude of cloxacillin loss during surgical procedures involving significant blood loss and high fluid replacement, we compared the pharmacokinetics of cloxacillin in children during craniomaxillofacial surgery with the disposition of the drug in healthy young adult volunteers with intact circulation. Blood loss during craniofacial operations may exceed blood volume, in some cases by as much as three times. Hemodynamic replacement with electrolyte solutions and blood products, which do not contain the drug, further dilute cloxacillin concentrations. In the patients that we studied, mean drug loss was estimated at 71%. Cloxacillin concentrations in serum fell below the lower range of the MIC for Staphylococcus aureus during significant portions of the surgical procedures. Thus, the traditional dosing of cloxacillin during prolonged operations with massive blood loss is inadequate. A more frequent dosing interval or priming of all replacement fluids with the drug may be required to maintain therapeutic levels. Our findings suggest that massive blood loss is likely to have a dramatic effect on the level of any drug with a small distribution volume. If such a drug is essential to the patient's well-being (e.g., antibiotics, antiarrhythmics, and anticonvulsants), it must be replaced promptly. PMID:2393274

Impact of Subspecialty Fellowship Training on Research Productivity Among Academic Plastic Surgery Faculty in the United States.

PubMed

Sood, Aditya; Therattil, Paul J; Chung, Stella; Lee, Edward S

2015-01-01

The impact of subspecialty fellowship training on research productivity among academic plastic surgeons is unknown. The authors' aim of this study was to (1) describe the current fellowship representation in academic plastic surgery and (2) evaluate the relationship between h-index and subspecialty fellowship training by experience and type. Academic plastic surgery faculty (N = 590) were identified through an Internet-based search of all ACGME-accredited integrated and combined residency programs. Research output was measured by h-index from the Scopus database as well as a number of peer-reviewed publications. The Kruskal-Wallis test, with a subsequent Mann-Whitney U test, was used for statistical analysis to determine correlations. In the United States, 72% (n = 426) of academic plastic surgeons had trained in 1 or more subspecialty fellowship program. Within this cohort, the largest group had completed multiple fellowships (28%), followed by hand (23%), craniofacial (22%), microsurgery (15%), research (8%), cosmetic (3%), burn (2%), and wound healing (0.5%). Higher h-indices correlated with a research fellowship (12.5; P < .01) and multiple fellowships (10.4; P < .01). Craniofacial-trained plastic surgeons demonstrated the next highest h-index (9.8), followed by no fellowship (8.4), microsurgery (8.3), hand (7.7), cosmetic (5.2), and burn (5.1). Plastic surgeons with a research fellowship or at least 2 subspecialty fellowships had increased academic productivity compared with their colleagues. Craniofacial-trained physicians also demonstrated a higher marker for academic productivity than multiple other specialties. In this study, we show that the type and number of fellowships influence the h-index and further identification of such variables may help improve academic mentorship and productivity within academic plastic surgery.

Impact of Subspecialty Fellowship Training on Research Productivity Among Academic Plastic Surgery Faculty in the United States

PubMed Central

Therattil, Paul J.; Chung, Stella; Lee, Edward S.

2015-01-01

Purpose: The impact of subspecialty fellowship training on research productivity among academic plastic surgeons is unknown. The authors’ aim of this study was to (1) describe the current fellowship representation in academic plastic surgery and (2) evaluate the relationship between h-index and subspecialty fellowship training by experience and type. Methods: Academic plastic surgery faculty (N = 590) were identified through an Internet-based search of all ACGME-accredited integrated and combined residency programs. Research output was measured by h-index from the Scopus database as well as a number of peer-reviewed publications. The Kruskal-Wallis test, with a subsequent Mann-Whitney U test, was used for statistical analysis to determine correlations. Results: In the United States, 72% (n = 426) of academic plastic surgeons had trained in 1 or more subspecialty fellowship program. Within this cohort, the largest group had completed multiple fellowships (28%), followed by hand (23%), craniofacial (22%), microsurgery (15%), research (8%), cosmetic (3%), burn (2%), and wound healing (0.5%). Higher h-indices correlated with a research fellowship (12.5; P < .01) and multiple fellowships (10.4; P < .01). Craniofacial-trained plastic surgeons demonstrated the next highest h-index (9.8), followed by no fellowship (8.4), microsurgery (8.3), hand (7.7), cosmetic (5.2), and burn (5.1). Conclusion: Plastic surgeons with a research fellowship or at least 2 subspecialty fellowships had increased academic productivity compared with their colleagues. Craniofacial-trained physicians also demonstrated a higher marker for academic productivity than multiple other specialties. In this study, we show that the type and number of fellowships influence the h-index and further identification of such variables may help improve academic mentorship and productivity within academic plastic surgery. PMID:26664673

Does postoperative 'M' technique massage with or without mandarin oil reduce infants' distress after major craniofacial surgery?

PubMed

de Jong, Marjan; Lucas, Cees; Bredero, Hansje; van Adrichem, Leon; Tibboel, Dick; van Dijk, Monique

2012-08-01

This article is a report of a randomized controlled trial of the effects of 'M' technique massage with or without mandarin oil compared to standard postoperative care on infants' levels of pain and distress, heart rate and mean arterial pressure after major craniofacial surgery. There is a growing interest in non-pharmacological interventions such as aromatherapy massage in hospitalized children to relieve pain and distress but well performed studies are lacking. This randomized controlled trial allocated 60 children aged 3-36 months after craniofacial surgery from January 2008 to August 2009 to one of three conditions; 'M' technique massage with carrier oil, 'M' technique massage with mandarin oil or standard postoperative care. Primary outcome measures were changes in COMFORT behaviour scores, Numeric Rating Scale pain and Numeric Rating Scale distress scores assessed from videotape by an observer blinded for the condition. In all three groups, the mean postintervention COMFORT behaviour scores were higher than the baseline scores, but differences were not statistically significant. Heart rate and mean arterial pressure showed a statistically significant change across the three assessment periods in all three groups. These changes were not related with the intervention. Results do not support a benefit of 'M' technique massage with or without mandarin oil in these young postoperative patients. Several reasons may account for this: massage given too soon after general anaesthesia, young patients' fear of strangers touching them, patients not used to massage. © 2011 Blackwell Publishing Ltd.

The slant of the forehead as a craniofacial feature of impulsiveness.

PubMed

Guerrero-Apolo, J David; Navarro-Pastor, J Blas; Bulbena-Vilarrasa, Antonio; Gabarre-Mir, Julián

2018-03-12

Impulsiveness has been the subject of much research, but little is known about the possible relationship between craniofacial anatomy and impulsiveness. The present study was designed to investigate the relationship between one aspect of craniofacial structure (the angle of inclination of the forehead) and impulsiveness. Photographs in profile were obtained from 131 volunteers who had been fined for driving at high speed and were undergoing a court-mandated driving license point-recovery course. They completed the Barratt Impulsiveness Scale (BIS-11), the Impulsive Behavior Scale (UPPS-P), and Zuckerman's Sensation Seeking Scale (V). The angle of the slant of the forehead was measured with a photographic support and a protractor. High positive concordance was found between forehead inclination and 14 out of the 15 impulsiveness factors studied. The angle of inclination of the forehead was significantly associated with self-reported impulsiveness in this sample of traffic violators.

Three-dimensional planning in craniomaxillofacial surgery

PubMed Central

Rubio-Palau, Josep; Prieto-Gundin, Alejandra; Cazalla, Asteria Albert; Serrano, Miguel Bejarano; Fructuoso, Gemma Garcia; Ferrandis, Francisco Parri; Baró, Alejandro Rivera

2016-01-01

Introduction: Three-dimensional (3D) planning in oral and maxillofacial surgery has become a standard in the planification of a variety of conditions such as dental implants and orthognathic surgery. By using custom-made cutting and positioning guides, the virtual surgery is exported to the operating room, increasing precision and improving results. Materials and Methods: We present our experience in the treatment of craniofacial deformities with 3D planning. Software to plan the different procedures has been selected for each case, depending on the procedure (Nobel Clinician, Kodak 3DS, Simplant O&O, Dolphin 3D, Timeus, Mimics and 3-Matic). The treatment protocol is exposed step by step from virtual planning, design, and printing of the cutting and positioning guides to patients’ outcomes. Conclusions: 3D planning reduces the surgical time and allows predicting possible difficulties and complications. On the other hand, it increases preoperative planning time and needs a learning curve. The only drawback is the cost of the procedure. At present, the additional preoperative work can be justified because of surgical time reduction and more predictable results. In the future, the cost and time investment will be reduced. 3D planning is here to stay. It is already a fact in craniofacial surgery and the investment is completely justified by the risk reduction and precise results. PMID:28299272

Three-dimensional planning in craniomaxillofacial surgery.

PubMed

Rubio-Palau, Josep; Prieto-Gundin, Alejandra; Cazalla, Asteria Albert; Serrano, Miguel Bejarano; Fructuoso, Gemma Garcia; Ferrandis, Francisco Parri; Baró, Alejandro Rivera

2016-01-01

Three-dimensional (3D) planning in oral and maxillofacial surgery has become a standard in the planification of a variety of conditions such as dental implants and orthognathic surgery. By using custom-made cutting and positioning guides, the virtual surgery is exported to the operating room, increasing precision and improving results. We present our experience in the treatment of craniofacial deformities with 3D planning. Software to plan the different procedures has been selected for each case, depending on the procedure (Nobel Clinician, Kodak 3DS, Simplant O&O, Dolphin 3D, Timeus, Mimics and 3-Matic). The treatment protocol is exposed step by step from virtual planning, design, and printing of the cutting and positioning guides to patients' outcomes. 3D planning reduces the surgical time and allows predicting possible difficulties and complications. On the other hand, it increases preoperative planning time and needs a learning curve. The only drawback is the cost of the procedure. At present, the additional preoperative work can be justified because of surgical time reduction and more predictable results. In the future, the cost and time investment will be reduced. 3D planning is here to stay. It is already a fact in craniofacial surgery and the investment is completely justified by the risk reduction and precise results.

Applications of biomaterials in plastic surgery.

PubMed

Kim, Jeff J; Evans, Gregory R D

2012-10-01

The expansion of the application of biomaterials in plastic surgery has led to the increased availability of commercial products in recent years. This overview discusses soft tissue fillers, bioengineered skins, acellular dermal matrices, biomaterials for craniofacial surgery, and peripheral nerve repair. We summarize indications, properties, uses, types, advantages and disadvantages of some of the currently available products from each category. Finally, the current state of development in drug delivery system is also briefly summarized. Published by Elsevier Inc.

3D-Printing Technologies for Craniofacial Rehabilitation, Reconstruction, and Regeneration.

PubMed

Nyberg, Ethan L; Farris, Ashley L; Hung, Ben P; Dias, Miguel; Garcia, Juan R; Dorafshar, Amir H; Grayson, Warren L

2017-01-01

The treatment of craniofacial defects can present many challenges due to the variety of tissue-specific requirements and the complexity of anatomical structures in that region. 3D-printing technologies provide clinicians, engineers and scientists with the ability to create patient-specific solutions for craniofacial defects. Currently, there are three key strategies that utilize these technologies to restore both appearance and function to patients: rehabilitation, reconstruction and regeneration. In rehabilitation, 3D-printing can be used to create prostheses to replace or cover damaged tissues. Reconstruction, through plastic surgery, can also leverage 3D-printing technologies to create custom cutting guides, fixation devices, practice models and implanted medical devices to improve patient outcomes. Regeneration of tissue attempts to replace defects with biological materials. 3D-printing can be used to create either scaffolds or living, cellular constructs to signal tissue-forming cells to regenerate defect regions. By integrating these three approaches, 3D-printing technologies afford the opportunity to develop personalized treatment plans and design-driven manufacturing solutions to improve aesthetic and functional outcomes for patients with craniofacial defects.

3D-Printing Technologies for Craniofacial Rehabilitation, Reconstruction, and Regeneration

PubMed Central

Nyberg, Ethan L.; Farris, Ashley L.; Hung, Ben P.; Dias, Miguel; Garcia, Juan R.; Dorafshar, Amir H.; Grayson, Warren L.

2016-01-01

The treatment of craniofacial defects can present many challenges due to the variety of tissue-specific requirements and the complexity of anatomical structures in that region. 3D-printing technologies provide clinicians, engineers and scientists with the ability to create patient-specific solutions for craniofacial defects. Currently, there are 3 key strategies that utilize these technologies to restore both appearance and function to patients: rehabilitation, reconstruction and regeneration. In rehabilitation, 3D-printing can be used to create prostheses to replace or cover damaged tissues. Reconstruction, through plastic surgery, can also leverage 3D-printing technologies to create custom cutting guides, fixation devices, practice models and implanted medical devices to improve patient outcomes. Regeneration of tissue attempts to replace defects with biological materials. 3D-printing can be used to create either scaffolds or living, cellular constructs to signal tissue-forming cells to regenerate defect regions. By integrating these three approaches, 3D-printing technologies afford the opportunity to develop personalized treatment plans and design-driven manufacturing solutions to improve aesthetic and functional outcomes for patients with craniofacial defects. PMID:27295184

Management options of non-syndromic sagittal craniosynostosis.

PubMed

Lee, Bryan S; Hwang, Lee S; Doumit, Gaby D; Wooley, Joseph; Papay, Francis A; Luciano, Mark G; Recinos, Violette M

2017-05-01

There have been various effective surgical procedures for the treatment of non-syndromic sagittal craniosynostosis, but no definitive guidelines for management have been established. We conducted a study to elucidate the current state of practice and establish a warranted standard of care. An Internet-based study was sent to 180 pediatric neurosurgeons across the country and 102 craniofacial plastic surgeons in fourteen different countries, to collect data for primary indication for surgical management, preference for timing and choice of surgery, and pre-, peri-, and post-operative management options. The overall response rate from both groups was 32% (n=90/284). Skull deformity was the primary indication for surgical treatment in patients without signs of hydrocephalus for both neurosurgeons and craniofacial surgeons (80% and 63%, respectively). Open surgical management was most commonly performed at six months of age by neurosurgeons (46%) and also by craniofacial surgeons (35%). Open surgical approach was favored for patients younger than four months of age by neurosurgeons (50%), but endoscopic approach was favored by craniofacial surgeons (35%). When performing an open surgical intervention, most neurosurgeons preferred pi or reversed pi procedure (27%), whereas total cranial vault remodeling was the most commonly performed procedure by craniofacial surgeons (37%). The data demonstrated a discrepancy in the treatment options for non-syndromic sagittal craniosynostosis. By conducting/comparing a wide survey to collect consolidative data from both groups of pediatric neurosurgeons and craniofacial plastic surgeons, we can attempt to facilitate the establishment of standard of care. Copyright © 2017 Elsevier Ltd. All rights reserved.

CT Imaging Findings after Craniosynostosis Reconstructive Surgery.

PubMed

Ginat, Daniel Thomas; Lam, Daniel; Kuhn, Andrew Scott; Reid, Russell

2018-06-06

Several surgical options are available for treating the different types of craniosynostosis, including fronto-orbital advancement and remodeling, total or subtotal cranial vault remodeling, barrel stave osteotomy with cranial remodeling, endoscopic suturectomy, monobloc advancement and cranioplasty, and revision cranioplasty. High-resolution, low-dose CT with 3D reconstructed images and volumetric analysis can be useful for evaluating the craniofacial skeleton following surgery. The various types of craniosynostosis surgery and corresponding imaging findings are reviewed in this article. © 2018 S. Karger AG, Basel.

Realistic prediction of individual facial emotion expressions for craniofacial surgery simulations

NASA Astrophysics Data System (ADS)

Gladilin, Evgeny; Zachow, Stefan; Deuflhard, Peter; Hege, Hans-Christian

2003-05-01

In addition to the static soft tissue prediction, the estimation of individual facial emotion expressions is an important criterion for the evaluation of the carniofacial surgery planning. In this paper, we present an approach for the estimation of individual facial emotion expressions on the basis of geometrical models of human anatomy derived from tomographic data and the finite element modeling of facial tissue biomechanics.

Active Presurgical Infant Orthopedics for Unilateral Cleft Lip and Palate: Intercenter Outcome Comparison of Latham, Modified McNeil, and Nasoalveolar Molding.

PubMed

Kornbluth, Michelle; Campbell, Richard E; Daskalogiannakis, John; Ross, Elizabeth J; Glick, Patricia H; Russell, Kathleen A; Doucet, Jean-Charles; Hathaway, Ronald R; Long, Ross E; Sitzman, Thomas J

2018-05-01

To compare dental arch relationship, craniofacial form, and nasolabial aesthetic outcomes among cleft centers using distinct methods of presurgical infant orthopedics (PSIO). Retrospective cohort study. Four cleft centers in North America. One hundred ninety-one children with repaired complete unilateral cleft lip and palate (CUCLP). Dental arch relationship was assessed using the GOSLON Yardstick. Craniofacial form was assessed by 12 cephalometric measurements. Nasolabial aesthetics were assessed using the Asher-McDade system. Assessments were performed between 6 and 12 years of age. The center that used no PSIO achieved the most favorable dental arch relationship and maxillomandibular relationship, with a median GOSLON score of 2.3 ( P < .01) and an ANB angle of 5.1° ( P < .05). The proportion of children assigned a GOSLON score of 4 or 5, predictive of the need for orthognathic surgery in adolescence, was 16% at the center that used no PSIO and no secondary surgery, compared to 76% at the centers that used the Latham appliance and early secondary lip and nose surgery ( P < .01). The center that used no PSIO and no secondary surgery achieved significantly less favorable nasolabial aesthetic outcomes than the centers using Latham appliance or nasoalveolar molding (NAM) ( P < .01). Effects of active PSIO are multifaceted and intertwined with use of revision surgery. In our study, centers using either the Latham appliance combined with early revision surgery or the NAM appliance without revision surgery achieved better nasolabial aesthetic outcomes but worse maxillary growth, compared to a center using no PSIO and secondary surgery.

Computer-based planning of optimal donor sites for autologous osseous grafts

NASA Astrophysics Data System (ADS)

Krol, Zdzislaw; Chlebiej, Michal; Zerfass, Peter; Zeilhofer, Hans-Florian U.; Sader, Robert; Mikolajczak, Pawel; Keeve, Erwin

2002-05-01

Bone graft surgery is often necessary for reconstruction of craniofacial defects after trauma, tumor, infection or congenital malformation. In this operative technique the removed or missing bone segment is filled with a bone graft. The mainstay of the craniofacial reconstruction rests with the replacement of the defected bone by autogeneous bone grafts. To achieve sufficient incorporation of the autograft into the host bone, precise planning and simulation of the surgical intervention is required. The major problem is to determine as accurately as possible the donor site where the graft should be dissected from and to define the shape of the desired transplant. A computer-aided method for semi-automatic selection of optimal donor sites for autografts in craniofacial reconstructive surgery has been developed. The non-automatic step of graft design and constraint setting is followed by a fully automatic procedure to find the best fitting position. In extension to preceding work, a new optimization approach based on the Levenberg-Marquardt method has been implemented and embedded into our computer-based surgical planning system. This new technique enables, once the pre-processing step has been performed, selection of the optimal donor site in time less than one minute. The method has been applied during surgery planning step in more than 20 cases. The postoperative observations have shown that functional results, such as speech and chewing ability as well as restoration of bony continuity were clearly better compared to conventionally planned operations. Moreover, in most cases the duration of the surgical interventions has been distinctly reduced.

Porous polymethylmethacrylate as bone substitute in the craniofacial area.

PubMed

Bruens, Marco L; Pieterman, Herman; de Wijn, Joost R; Vaandrager, J Michael

2003-01-01

In craniofacial surgery, alloplastic materials are used for correcting bony defects. Porous polymethylmethacrylate (PMMA) is a biocompatible and nondegradable bone cement. Porous PMMA is formed by the classic bone cement formulation of methylmethacrylate liquid and PMMA powder in which an aqueous biodegradable carboxymethylcellulose gel is dispersed to create pores in the cement when cured. Pores give bone the opportunity to grow in, resulting in a better fixation of the prostheses. We evaluated the long-term results (n = 14), up to 20 years, of augmentations and defect fillings in the craniofacial area, with special interest in possible side effects and bone ingrowth. The evaluation consisted of a questionnaire, a physical examination, and a computed tomography (CT) scan. There were no side effects that could be ascribed to the porous PMMA. Twelve CT scans showed bone ingrowth into the prostheses, proving the validity behind the concept of porous PMMA.

[The history of pediatric plastic surgery].

PubMed

Glicenstein, J

2016-10-01

The history of pediatric plastic surgery is linked to that of paediatrics. Until the early 19th century, there was no children's hospital. Only some operations were performed before the discovery of anesthesia, aseptic and antisepsis: cleft lip repair, amputation for polydactyly. Many operations were described in the 19th century for cleft lip and palate repair, hypospadias, syndactylies. The first operation for protruding ears was performed in 1881. Pediatric plastic surgery is diversified in the 2nd half of the 20th century: cleft lip and palate, burns, craniofacial surgery, hand surgery become separate parts of the speciality. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Complex craniofacial advancement in paediatric patients: Piezoelectric and traditional technique evaluation.

PubMed

Spinelli, Giuseppe; Mannelli, Giuditta; Zhang, Yi Xin; Lazzeri, Davide; Spacca, Barbara; Genitori, Lorenzo; Raffaini, Mirco; Agostini, Tommaso

2015-10-01

The piezoelectric device allows bone cutting without damaging the surrounding soft tissues. The purpose of this study was to assess the role of this surgical instrument in paediatric craniofacial surgery in terms of safety and surgical outcomes. Thirteen consecutive paediatric patients underwent craniofacial Le Fort osteotomies type III and IV. The saw was used on the right side in seven patients and on the left side in six patients; the piezoelectric instrument was used on the right side in six patients and on the left side in seven patients. Intraoperative blood loss, surgical procedure length, incision precision, postoperative haematoma and swelling, and nerve impairment were evaluated to compare the outcomes of both procedures. A longer surgical procedure was observed in 28% of the patients when using the piezoelectric device (p = 0.032), with an intraoperative blood loss reduction of 18% (p = 0.156). Greater precision in bone cutting was reported, together with a reduction in the requirement to protect and incise adjacent soft tissues during piezoelectric osteotomies. There was a lower incidence of postoperative haematoma and swelling following piezo-osteotomy, and a significant reduction in postoperative nerve impairment (p = 0.002). The ultrasonic surgical device guaranteed a clean bone cut, preserving the integrity of the adjacent soft tissues beneath the bone. Although the time required for a piezoelectric osteotomy was longer, the total operation time remained approximately the same. In conclusion, the device's lack of power appears to be a minor problem compared with the advantages, and an ultrasonic device could be considered a valuable instrument for paediatric craniofacial advancement. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

The scope of plastic surgery according to 2434 allopathic medical students in the United States.

PubMed

Kling, Russell E; Nayar, Harry S; Harhay, Michael O; Emelife, Patrick O; Manders, Ernest K; Ahuja, Naveen K; Losee, Joseph E

2014-04-01

The general public and physicians often equate plastic surgery with cosmetic surgery. The authors investigate whether this perception is present in U.S. medical students. A national survey of first- and second-year allopathic medical students was conducted. Students were asked to determine whether 46 specific procedures are performed by plastic surgeons: 12 aesthetic and 34 reconstructive procedures, which were further separated into three subgroups (general reconstruction and breast, craniofacial, and hand and lower extremity). Of the questionnaires sent out, 2434 from 44 medical schools were returned completed (23 percent response rate); 90.7 percent of aesthetic, 66.0 percent of general reconstruction and breast, 51.0 percent of craniofacial, and 33.4 percent of hand and lower extremity procedures were correctly identified. There was no relationship with self-reported interest in plastic surgery (1 = not at all interested to 10 = extremely interested) and the number of correctly identified aesthetic procedures. However, there was a nonlinear relationship with correctly identified reconstructive procedures; compared to those with an interest level of 1 to 5, those who chose 10 scored on average 6.5 points higher (14.2 versus 20.7) (p < 0.01). An anticipated career in surgery was associated with more correctly identified procedures across all sections but neither year (first versus second) nor region (Northeast, South, Central, West) with any section. U.S. medical students are unaware of the true scope of plastic surgery. Early exposure to basic aspects of plastic surgery could serve as a means of increasing interest and knowledge in the field and help educate future generations of referring physicians.

Does industry funding mean more publications for subspecialty academic plastic surgeons?

PubMed

Ruan, Qing Zhao; Cohen, Justin B; Baek, Yoonji; Bletsis, Patrick; Celestin, Arthur R; Epstein, Sherise; Bucknor, Alexandra E M; Lee, Bernard T

2018-04-01

Conflict of interest among physicians in the context of private industry funding led to the introduction of the Physician Payments Sunshine Act in 2010. This study examined whether private industry funding correlated with scholarly productivity in the respective subspecialties of plastic surgery and the wider academic plastic surgery community. Full-time plastic surgeons and their academic attributes were identified via institutional websites. Fellowship-trained individuals were segregated into subspecialties of microsurgery, craniofacial surgery, hand surgery, esthetic surgery, and burn surgery. The Center for Medicare and Medicaid Services Open Payment database was used to extract industry funding information. Each individual's bibliometric data were then collected through Scopus to determine the correlation between selected surgeon characteristics, academic productivity, and industry funding. Nine hundred and thirty-five academic plastic surgeons were identified, with 532 having defined subspecialty training. Academic bibliometrics among subspecialty surgeons were comparable among the five groups with esthetic and craniofacial surgeons displaying a preponderance of attaining more industry funding (P = 0.043) and career publications respectively, with the latter not attaining statistical significance (P = 0.12). Overall, research-specific funding (P = 0.014) and higher funding amounts (P < 0.0001) correlated with higher Hirsch indices in tandem with higher academic rank. A funding level of $2000 appeared to be the approximate cutoff above which scholastic productivity became apparent. Our study demonstrated in detail the association between industry funding and academic bibliometrics in academic plastic surgery of every subspecialty. Even at modest amounts, industry support, especially when research designated, positively influenced research and therefore, academic output. Copyright © 2017 Elsevier Inc. All rights reserved.

The Partnership of Medical Genetics and Oral and Maxillofacial Surgery When Evaluating Craniofacial Anomalies.

PubMed

Lin, Angela E

2015-12-01

A medical geneticist who has an interest in craniofacial anomalies forms a natural partnership with an oral and maxillofacial surgeon, which facilitates patient care. Using complementary diagnostic and therapeutic skills, the search for a recognizable pattern can lead to a syndrome diagnosis. After the initial examination, there is usually genetic testing to confirm the clinical diagnosis. Once established, care coordination and genetic counseling can be provided for the parents and the patient. Enrolling the patient into a research study could be helpful to understand the diagnosis but, in some circumstances, might not have immediate clinical relevance. A multidisciplinary craniofacial team is generally necessary for long-term management. This article discusses illustrative patients evaluated from 2007 through 2011 with the senior oral and maxillofacial surgeon at the Massachusetts General Hospital (Leonard B. Kaban, DMD, MD). These include single patients with the Nablus mask-like facies syndrome and auriculo-condylar syndrome and a series of 20 patients with Gorlin syndrome followed by a multispecialty team. A successful collaboration between a medical geneticist and an oral and maxillofacial surgeon optimizes the treatment of patients with craniofacial anomalies. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

A Band of Surgeons, a Long Healing Line: Development of Craniofacial Surgery in Response to Armed Conflict

DTIC Science & Technology

2010-07-01

Unauthorized reproduction of this article is prohibited. During the same remarkable era, Ralph Buncke added microsurgery to the reconstructive ... reconstruction , war, history, military, surgery (J Craniofac Surg 2010;21: 991 997) The will to conquer is the first condition of victory. Marshal Ferdinand...Homer practicing in Kashi, India. Sushruta’s regional flaps for nasal reconstruction (circa 600 BCE) are the first recorded plastic techniques

Incidence and predictors of difficult laryngoscopy in 11,219 pediatric anesthesia procedures.

PubMed

Heinrich, Sebastian; Birkholz, Torsten; Ihmsen, Harald; Irouschek, Andrea; Ackermann, Andreas; Schmidt, Joachim

2012-08-01

Difficult laryngoscopy in pediatric patients undergoing anesthesia. This retrospective analysis was conducted to investigate incidence and predictors of difficult laryngoscopy in a large cohort of pediatric patients receiving general anesthesia with endotracheal intubation. Young age and craniofacial dysmorphy are predictors for the difficult pediatric airway and difficult laryngoscopy. For difficult laryngoscopy, other general predictors are not yet described. Retrospectively, from a 5-year period, data from 11.219 general anesthesia procedures in pediatric patients with endotracheal intubation using age-adapted Macintosh blades in a single center (university hospital) were analyzed statistically. The overall incidence of difficult laryngoscopy [Cormack and Lehane (CML) grade III and IV] was 1.35%. In patients younger than 1 year, the incidence of CML III or IV was significantly higher than in the older patients (4.7% vs 0.7%). ASA Physical Status III and IV, a higher Mallampati Score (III and IV) and a low BMI were all associated (P < 0.05) with difficult laryngoscopy. Patients undergoing oromaxillofacial surgery and cardiac surgery showed a significantly higher rate of CML III/IV findings. The general incidence of difficult laryngoscopy in pediatric anesthesia is lower than in adults. Our results show that the risk of difficult laryngoscopy is much higher in patients below 1 year of age, in underweight patients and in ASA III and IV patients. The underlying disease might also contribute to the risk. If the Mallampati score could be obtained, prediction of difficult laryngoscopy seems to be reliable. Our data support the existing recommendations for a specialized anesthesiological team to provide safe anesthesia for infants and neonates. © 2012 Blackwell Publishing Ltd.

Effectiveness of Maxillomandibular advancement (MMA) surgery in sleep apnea treatment: Case report.

PubMed

Ferraz, Otávio; Guimarães, Thais M; Rossi, Rowdley R; Cunali, Paulo A; Fabbro, Cibele Dal; Chaves, Cauby M; Maluly, Milton; Bittencourt, Lia; Tufik, Sergio

2016-01-01

Obstructive sleep apnea (OSA) is characterized by episodes of pharyngeal collapse during sleep. Craniofacial alterations such as retrognathia are often found in OSA patients. Maxillomandibular advancement (MMA) surgeries increase the pharyngeal space and are a treatment option for OSA. The aim of this study was to present a successful case of MMA surgery in the treatment of OSA. A patient with moderate OSA (apnea-hypopnea index (AHI)=25.2) and mandibular retrognathism and Maxillomandibular asymmetry underwent MMA surgery. The apnea-hypopnea index (AHI) were considerably improved after six months (IAH =6.7) and one year of treatment (IAH=0.2).

Accessory oral cavity associated with duplication of the tongue and the mandible in a newborn: a rare case of Diprosopus. Multi-row detector computed tomography diagnostic role.

PubMed

Morabito, Rosa; Colonna, Michele R; Mormina, Enricomaria; Stagno d'Alcontres, Ferdinando; Salpietro, Vincenzo; Blandino, Alfredo; Longo, Marcello; Granata, Francesca

2014-12-01

Craniofacial duplication is a very rare malformation. The phenotype comprises a wide spectrum, ranging from partial duplication of few facial structures to complete dicephalus. We report the case of a newborn with an accessory oral cavity associated to duplication of the tongue and the mandible diagnosed by multi-row detector Computed Tomography, few days after her birth. Our case of partial craniofacial duplication can be considered as Type II of Gorlin classification or as an intermediate form between Type I and Type II of Sun classification. Our experience demonstrates that CT scan, using appropriate reconstruction algorithms, permits a detailed evaluation of the different structures in an anatomical region. Multi-row CT scan is also the more accurate diagnostic procedure for the pre-surgical evaluation of craniofacial malformations. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Craniofacial morphology in ancient and modern Greeks through 4,000 years.

PubMed

Papagrigorakis, Manolis J; Kousoulis, Antonis A; Synodinos, Philippos N

2014-01-01

Multiple 20th century studies have speculated on the anthropological similarities of the modern inhabitants of Greece with their ancient predecessors. The present investigation attempts to add to this knowledge by comparing the craniofacial configuration of 141 ancient (dating around 2,000-500 BC) and 240 modern Greek skulls (the largest material among relevant national studies). Skulls were grouped in age at death, sex, era and geographical categories; lateral cephalograms were taken and 53 variables were measured and correlated statistically. The craniofacial measurements and measurements of the basic quadrilateral and cranial polygon were compared in various groups using basic statistical methods, one-way ANOVA and assessment of the correlation matrices. Most of the measurements for both sexes combined followed an akin pattern in ancient and modern Greek skulls. Moreover, sketching and comparing the outline of the skull and upper face, we observed a clock-wise movement. The present study confirms that the morphological pattern of Greek skulls, as it changed during thousands of years, kept some characteristics unchanged, with others undergoing logical modifications. The analysis of our results allows us to believe that the influence upon the craniofacial complex of the various known factors, including genetic or environmental alterations, is apt to alter its form to adapt to new conditions. Even though 4,000 years seems too narrow a span to provoke evolutionary insights using conventional geometric morphometrics, the full presentation of our results makes up a useful atlas of solid data. Interpreted with caution, the craniofacial morphology in modern and ancient Greeks indicates elements of ethnic group continuation within the unavoidable multicultural mixtures.

Application of a Novel Semi-Automatic Technique for Determining the Bilateral Symmetry Plane of the Facial Skeleton of Normal Adult Males.

PubMed

Roumeliotis, Grayson; Willing, Ryan; Neuert, Mark; Ahluwalia, Romy; Jenkyn, Thomas; Yazdani, Arjang

2015-09-01

The accurate assessment of symmetry in the craniofacial skeleton is important for cosmetic and reconstructive craniofacial surgery. Although there have been several published attempts to develop an accurate system for determining the correct plane of symmetry, all are inaccurate and time consuming. Here, the authors applied a novel semi-automatic method for the calculation of craniofacial symmetry, based on principal component analysis and iterative corrective point computation, to a large sample of normal adult male facial computerized tomography scans obtained clinically (n = 32). The authors hypothesized that this method would generate planes of symmetry that would result in less error when one side of the face was compared to the other than a symmetry plane generated using a plane defined by cephalometric landmarks. When a three-dimensional model of one side of the face was reflected across the semi-automatic plane of symmetry there was less error than when reflected across the cephalometric plane. The semi-automatic plane was also more accurate when the locations of bilateral cephalometric landmarks (eg, frontozygomatic sutures) were compared across the face. The authors conclude that this method allows for accurate and fast measurements of craniofacial symmetry. This has important implications for studying the development of the facial skeleton, and clinical application for reconstruction.

Hypophosphatemic rickets and craniosynostosis: a multicenter case series.

PubMed

Vega, Rafael A; Opalak, Charles; Harshbarger, Raymond J; Fearon, Jeffrey A; Ritter, Ann M; Collins, John J; Rhodes, Jennifer L

2016-06-01

OBJECTIVE This study examines a series of patients with hypophosphatemic rickets and craniosynostosis to characterize the clinical course and associated craniofacial anomalies. METHODS A 20-year retrospective review identified patients with hypophosphatemic rickets and secondary craniosynostosis at 3 major craniofacial centers. Parameters examined included sex, age at diagnosis of head shape anomaly, affected sutures, etiology of rickets, presenting symptoms, number and type of surgical interventions, and associated diagnoses. A review of the literature was performed to optimize treatment recommendations. RESULTS Ten patients were identified (8 males, 2 females). Age at presentation ranged from 1 to 9 years. The most commonly affected suture was the sagittal (6/10 patients). Etiologies included antacid-induced rickets, autosomal dominant hypophosphatemic rickets, and X-linked hypophosphatemic (XLH) rickets. Nine patients had undergone at least 1 cranial vault remodeling (CVR) surgery. Three patients underwent subsequent surgeries in later years. Four patients underwent formal intracranial pressure (ICP) monitoring, 3 of which revealed elevated ICP. Three patients were diagnosed with a Chiari Type I malformation. CONCLUSIONS Secondary craniosynostosis develops postnatally due to metabolic or mechanical factors. The most common metabolic cause is hypophosphatemic rickets, which has a variety of etiologies. Head shape changes occur later and with a more heterogeneous presentation compared with that of primary craniosynostosis. CVR may be required to prevent or relieve elevated ICP and abnormalities of the cranial vault. Children with hypophosphatemic rickets who develop head shape abnormalities should be promptly referred to a craniofacial specialist.

Improved Surgery Planning Using 3-D Printing: a Case Study.

PubMed

Singhal, A J; Shetty, V; Bhagavan, K R; Ragothaman, Ananthan; Shetty, V; Koneru, Ganesh; Agarwala, M

2016-04-01

The role of 3-D printing is presented for improved patient-specific surgery planning. Key benefits are time saved and surgery outcome. Two hard-tissue surgery models were 3-D printed, for orthopedic, pelvic surgery, and craniofacial surgery. We discuss software data conversion in computed tomography (CT)/magnetic resonance (MR) medical image for 3-D printing. 3-D printed models save time in surgery planning and help visualize complex pre-operative anatomy. Time saved in surgery planning can be as much as two thirds. In addition to improved surgery accuracy, 3-D printing presents opportunity in materials research. Other hard-tissue and soft-tissue cases in maxillofacial, abdominal, thoracic, cardiac, orthodontics, and neurosurgery are considered. We recommend using 3-D printing as standard protocol for surgery planning and for teaching surgery practices. A quick turnaround time of a 3-D printed surgery model, in improved accuracy in surgery planning, is helpful for the surgery team. It is recommended that these costs be within 20 % of the total surgery budget.

The Use of a Bioadhesive (BioGlue®) Secured Conchal Graft and Mandibular Distraction Osteogenesis to Correct Pediatric Facial Asymmetry as Result of Unilateral Temporomandibular Joint Ankylosis

PubMed Central

Muhammad, Joseph Kamal; Al Hashimi, Bader Abdulla; Al Mansoor, Abu Bakr; Ali, Iqbal

2013-01-01

The rehabilitation of children affected by early traumatic facial deformity is a challenge for both the craniofacial team and the child's family. Although the immediate goals of surgery are to restore both form and function, the psychological needs of the growing child must also be addressed. Early surgery may be required to assist integration of the child into the community and thereby avert both social isolation and stigmatization of the child. Timed correctly, such surgery has the potential to harness the patient's own growth to assist in correction of the deformity and to maintain some of the surgical gains. The use of autogenous tissue rather than nondegradable implants to facilitate craniofacial reconstruction in the growing child avoids some of the concerns associated with permanent implants. These include both their potential to adversely affect growth and to migrate. The purpose of this article is to illustrate how advances in tissue adhesion using protein polymers (BioGlue®; CryoLife, Inc., Kennesaw, GA) and bone regeneration techniques (distraction osteogenesis) have been used to correct the disfiguring and functional problems associated with unilateral temporomandibular joint ankylosis acquired in early childhood. PMID:24436736

Shared Surgical Decision Making and Youth Resilience Correlates of Satisfaction With Clinical Outcomes.

PubMed

Kapp-Simon, Kathleen A; Edwards, Todd; Ruta, Caroline; Bellucci, Claudia Crilly; Aspirnall, Cassandra L; Strauss, Ronald P; Topolski, Tari D; Rumsey, Nichola J; Patrick, Donald L

2015-07-01

The aim of this study was to identify factors associated with youth satisfaction with surgical procedures performed to address oral cleft or craniofacial conditions (CFCs). It was hypothesized that youth mental health, participation in decision making, perceived consequences of living with a CFC, and coping strategies would be associated with satisfaction with past surgeries. A total of 203 youth between the ages of 11 and 18 years (mean age = 14.5, standard deviation = 2.0, 61% male participants, 78% oral cleft) completed a series of questionnaires measuring depression, self-esteem, participation in decision making, condition severity, negative and positive consequences of having a CFC, coping, and satisfaction with past surgeries. Multiple regression analysis using boot-strapping techniques found that youth participation in decision making, youth perception of positive consequences of having a CFC, and coping accounted for 32% of the variance in satisfaction with past surgeries (P < 0.001). Youth age, sex, and assessment of condition severity were not significantly associated with satisfaction with surgical outcome. Depression, self-esteem, and negative consequences of having a CFC were not associated with satisfaction with past surgeries. Youth should be actively involved in the decision for craniofacial surgery. Youth who were more satisfied with their surgical outcomes also viewed themselves as having gained from the experience of living with a CFC. They felt that having a CFC made them stronger people and they believed that they were more accepting of others and more in touch with others' feelings because of what they had been through.

Current surgical practices in cleft care: cleft palate repair techniques and postoperative care.

PubMed

Katzel, Evan B; Basile, Patrick; Koltz, Peter F; Marcus, Jeffrey R; Girotto, John A

2009-09-01

The purpose of this study was to objectively report practices commonly used in cleft palate repair in the United States. This study investigates current surgical techniques, postoperative care, and complication rates for cleft palate repair surgery. All 803 surgeon members of the American Cleft Palate-Craniofacial Association were sent online and/or paper surveys inquiring about their management of cleft palate patients. Three-hundred six surveys were received, a 38 percent response rate. This represented responses of surgeons from 100 percent of American Cleft Palate-Craniofacial Association registered cleft teams. Ninety-six percent of respondents perform a one-stage repair. Eighty-five percent of surgeons perform palate surgery when the patient is between 6 and 12 months of age. The most common one-stage repair techniques are the Bardach style (two flaps) with intravelar veloplasty and the Furlow palatoplasty. After surgery, 39 percent of surgeons discharge patients within 24 hours. Another 43 percent discharge patients within 48 hours. During postoperative management, 92 percent of respondents implement feeding restrictions. Eighty-five percent of physicians use arm restraints. Surgeons' self-reported complications rates are minimal: 54 percent report a fistula in less than 5 percent of cases. The reported need for secondary speech surgery varies widely. The majority of respondents repair clefts in one stage. The most frequently used repair techniques are the Furlow palatoplasty and the Bardach style with intravelar veloplasty. After surgery, the majority of surgeons discharge patients in 1 or 2 days, and nearly all surgeons implement feeding restrictions and the use of arm restraints. The varying feeding protocols are reviewed in this article.

Reliable classification of facial phenotypic variation in craniofacial microsomia: a comparison of physical exam and photographs.

PubMed

Birgfeld, Craig B; Heike, Carrie L; Saltzman, Babette S; Leroux, Brian G; Evans, Kelly N; Luquetti, Daniela V

2016-03-31

Craniofacial microsomia is a common congenital condition for which children receive longitudinal, multidisciplinary team care. However, little is known about the etiology of craniofacial microsomia and few outcome studies have been published. In order to facilitate large, multicenter studies in craniofacial microsomia, we assessed the reliability of phenotypic classification based on photographs by comparison with direct physical examination. Thirty-nine children with craniofacial microsomia underwent a physical examination and photographs according to a standardized protocol. Three clinicians completed ratings during the physical examination and, at least a month later, using respective photographs for each participant. We used descriptive statistics for participant characteristics and intraclass correlation coefficients (ICCs) to assess reliability. The agreement between ratings on photographs and physical exam was greater than 80 % for all 15 categories included in the analysis. The ICC estimates were higher than 0.6 for most features. Features with the highest ICC included: presence of epibulbar dermoids, ear abnormalities, and colobomas (ICC 0.85, 0.81, and 0.80, respectively). Orbital size, presence of pits, tongue abnormalities, and strabismus had the lowest ICC, values (0.17 or less). There was not a strong tendency for either type of rating, physical exam or photograph, to be more likely to designate a feature as abnormal. The agreement between photographs and physical exam regarding the presence of a prior surgery was greater than 90 % for most features. Our results suggest that categorization of facial phenotype in children with CFM based on photographs is reliable relative to physical examination for most facial features.

Synaptic changes in rat maculae in space and medical imaging: the link

NASA Technical Reports Server (NTRS)

Ross, M. D.

1998-01-01

Two different space life sciences missions (SLS-1 and SLS-2) have demonstrated that the synapses of the hair cells of rat vestibular maculae increase significantly in microgravity. The results also indicate that macular synapses are sensitive to stress. These findings argue that vestibular maculae exhibit neuroplasticity to macroenvironmental and microenvironmental changes. This capability should be clinically relevant to rehabilitative training and/or pharmacological treatments for vestibular disease. The results of this ultrastructural research also demonstrated that type I and type II hair cells are integrated into the same neuronal circuitry. The findings were the basis for development of three-dimensional reconstruction software to learn details of macular wiring. This software, produced for scientific research, has now been adapted to reconstruct the face and skull directly from computerized tomography scans. In collaboration with craniofacial reconstructive surgeons at Stanford University Medical Center, an effort is under way to produce a virtual environment workbench for complex craniofacial surgery. When completed, the workbench will help surgeons train for and simulate surgery. The methods are patient specific. This research illustrates the value of basic research in leading to unanticipated medical applications.

Three-Dimensional Bioprinting Materials with Potential Application in Preprosthetic Surgery.

PubMed

Fahmy, Mina D; Jazayeri, Hossein E; Razavi, Mehdi; Masri, Radi; Tayebi, Lobat

2016-06-01

Current methods in handling maxillofacial defects are not robust and are highly dependent on the surgeon's skills and the inherent potential in the patients' bodies for regenerating lost tissues. Employing custom-designed 3D printed scaffolds that securely and effectively reconstruct the defects by using tissue engineering and regenerative medicine techniques can revolutionize preprosthetic surgeries. Various polymers, ceramics, natural and synthetic bioplastics, proteins, biomolecules, living cells, and growth factors as well as their hybrid structures can be used in 3D printing of scaffolds, which are still under development by scientists. These scaffolds not only are beneficial due to their patient-specific design, but also may be able to prevent micromobility, make tension free soft tissue closure, and improve vascularity. In this manuscript, a review of materials employed in 3D bioprinting including bioceramics, biopolymers, composites, and metals is conducted. A discussion of the relevance of 3D bioprinting using these materials for craniofacial interventions is included as well as their potential to create analogs to craniofacial tissues, their benefits, limitations, and their application. © 2016 by the American College of Prosthodontists.

Placento-Cranial Adhesions in Amniotic Band Syndrome and the Role of Surgery in Their Management: An Unusual Case Presentation and Systematic Literature Review.

PubMed

Menekse, Guner; Mert, Mustafa Kurthan; Olmaz, Burak; Celik, Tamer; Celik, Umit Sizmaz; Okten, Ali Ihsan

2015-01-01

Amniotic band syndrome is a group of sporadic congenital anomalies that involve the limbs, craniofacial regions and trunk, ranging from simple digital band constriction to complex craniofacial and central nervous system abnormalities. Placento-cranial adhesions in amniotic band syndrome are extremely rare, and severe conditions are associated with high morbidity and mortality rates. In this study, we pooled placento-cranial adhesion case reports that were published in the medical literature and added an unpublished case from our institution. The purpose of this article was to review and discuss the clinical features and outcomes of placento-cranial adhesions in amniotic band syndrome. © 2015 S. Karger AG, Basel.

Endoscopic-assisted osteotomies for the treatment of craniosynostosis.

PubMed

Hinojosa, J; Esparza, J; Muñoz, M J

2007-12-01

The development of multidisciplinar units for Craniofacial Surgery has led to better postoperative results and a considerable decrease in morbidity in the treatment of complex craniofacial patients. Standard correction of craniosynostosis involves calvarial remodeling, often considerable blood losses that need to be replaced and lengthy hospital stay. The use of minimally invasive techniques for the correction of some of these malformations are widespread and allows the surgeon to minimize the incidence of complications by means of a decreased surgical time, blood salvage, and shortening of postoperative hospitalization in comparison to conventional craniofacial techniques. Simple and milder craniosynostosis are best approached by endoscopy-assisted osteotomies and render the best results. Extended procedures other than simple suturectomies have been described for more severe patients. Different osteotomies resembling standard fronto-orbital have been developed for the correction, and the use of postoperative cranial orthesis may improve the final cosmetic appearance. Thus, endoscopic-assisted procedures differ from the simple strategy of single suture resection that rendered insufficient results in the past, and different approaches can be tailored to solve these cases in patients in the setting of a case-to-case bases.

Association of Patient Age at Gastric Bypass Surgery With Long-term All-Cause and Cause-Specific Mortality.

PubMed

Davidson, Lance E; Adams, Ted D; Kim, Jaewhan; Jones, Jessica L; Hashibe, Mia; Taylor, David; Mehta, Tapan; McKinlay, Rodrick; Simper, Steven C; Smith, Sherman C; Hunt, Steven C

2016-07-01

Bariatric surgery is effective in reducing all-cause and cause-specific long-term mortality. Whether the long-term mortality benefit of surgery applies to all ages at which surgery is performed is not known. To examine whether gastric bypass surgery is equally effective in reducing mortality in groups undergoing surgery at different ages. All-cause and cause-specific mortality rates and hazard ratios (HRs) were estimated from a retrospective cohort within 4 categories defined by age at surgery: younger than 35 years, 35 through 44 years, 45 through 54 years, and 55 through 74 years. Mean follow-up was 7.2 years. Patients undergoing gastric bypass surgery seen at a private surgical practice from January 1, 1984, through December 31, 2002, were studied. Data analysis was performed from June 12, 2013, to September 6, 2015. A cohort of 7925 patients undergoing gastric bypass surgery and 7925 group-matched, severely obese individuals who did not undergo surgery were identified through driver license records. Matching criteria included year of surgery to year of driver license application, sex, 5-year age groups, and 3 body mass index categories. Roux-en-Y gastric bypass surgery. All-cause and cause-specific mortality compared between those undergoing and not undergoing gastric bypass surgery using HRs. Among the 7925 patients who underwent gastric bypass surgery, the mean (SD) age at surgery was 39.5 (10.5) years, and the mean (SD) presurgical body mass index was 45.3 (7.4). Compared with 7925 matched individuals not undergoing surgery, adjusted all-cause mortality after gastric bypass surgery was significantly lower for patients 35 through 44 years old (HR, 0.54; 95% CI, 0.38-0.77), 45 through 54 years old (HR, 0.43; 95% CI, 0.30-0.62), and 55 through 74 years old (HR, 0.50; 95% CI, 0.31-0.79; P < .003 for all) but was not lower for those younger than 35 years (HR, 1.22; 95% CI, 0.82-1.81; P = .34). The lack of mortality benefit in those undergoing gastric bypass surgery at ages younger than 35 years primarily derived from a significantly higher number of externally caused deaths (HR, 2.53; 95% CI, 1.27-5.07; P = .009), particularly among women (HR, 3.08; 95% CI, 1.4-6.7; P = .005). Patients undergoing gastric bypass surgery had a significantly lower age-related increase in mortality than severely obese individuals not undergoing surgery (P = .001). Gastric bypass surgery was associated with improved long-term survival for all patients undergoing surgery at ages older than 35 years, with externally caused deaths only elevated in younger women. Gastric bypass surgery is protective against mortality even for older patients and also reduces the age-related increase in mortality observed in severely obese individuals not undergoing surgery.

Comparison of two nasoalveolar molding techniques in unilateral complete cleft lip patients: a randomized, prospective, single-blind trial to compare nasal outcomes.

PubMed

Chang, Chun-Shin; Wallace, Christopher Glenn; Pai, Betty Chien-Jung; Chiu, Yu-Ting; Hsieh, Yuh-Jia; Chen, I-Ju; Liao, Yu-Fang; Liou, Eric Jen-Wein; Chen, Philip Kuo-Ting

2014-08-01

Nasoalveolar molding became increasingly popular in the 1990s as a means of easing surgery and improving nasal outcomes for cleft lip repairs. In the late 1990s, three orthodontists from our center underwent nasoalveolar molding training: two at the Rush Craniofacial Center, in Chicago; and one at New York University Craniofacial Center. They brought two different nasoalveolar molding techniques back to Chang Gung Craniofacial Center: the modified Figueroa and the modified Grayson techniques. Outcomes following use of these techniques have not previously been compared prospectively. Between May of 2010 and March of 2013, a randomized, prospective, single-blind trial was conducted to compare the number of clinical visits, total costs, complications, and nasal symmetry between the two nasoalveolar molding techniques in 30 patients with unilateral complete cleft lip. There were no differences between nasoalveolar molding techniques in the number of clinical visits, total costs, nostril height, or nostril area ratio. Preoperatively but after nasoalveolar molding, the nostril width ratio was wider for the Figueroa group than for the Grayson group. Six months after surgical correction, there were no differences in nostril height, nostril width, nasal sill height, or nostril area ratio between nasoalveolar molding methods. Alveolar ulceration occurred more frequently in the Grayson group. The modified Grayson technique reduced nostril width more efficiently, but alveolar ulceration was more frequent and no differences in nostril width were found following surgery. Overall, the two nasoalveolar molding techniques produced similar nasal outcomes. Therapeutic, II.

Craniofacial reconstruction with poly(methyl methacrylate) customized cranial implants.

PubMed

Huang, Gary J; Zhong, Susan; Susarla, Srinivas M; Swanson, Edward W; Huang, Judy; Gordon, Chad R

2015-01-01

Secondary cranioplasty with customized craniofacial implants (CCIs) are often used to restore cerebral protection and reverse syndromes of the trephined, and for reconstruction of acquired cranial deformities. The 2 most widely used implant materials are polyetheretherketone and poly(methylmethacrylate) (PMMA). Previous series with CCIs report several major complications, including implant infection leading to removal, extended hospital stays, and surgical revisions. With this in mind, we chose to review our large case series of 22 consecutive PMMA CCI cranioplasties treated by a single craniofacial surgeon. A cohort of 20 consecutive patients receiving 22 PMMA implants during a 2-year period was identified and outcomes reviewed. The mechanism of initial insult, time from craniectomy to cranioplasty, anesthesia time, major and minor postoperative complications, radiation history, and length of follow-up were statistically analyzed. There were no complications related to infection, hematoma/seroma, or cerebrospinal fluid leak (0/22, 0%). Two patients experienced major complications related to persistent temporal hollowing (PTH) following standard CCI cranioplasty, which required revision surgery with modified implants (2/22, 9%). One minor complication of self-resolving transient diplopia was noted (1/22, 5%). In this consecutive series, PMMA CCIs were associated with a very low complication rate, suggesting that PMMA may be a preferred material for CCI fabrication. However, with 10% (2/20) of patients experiencing PTH and dissatisfaction related to asymmetry, future research must be directed at modifying CCI shape, to address the overlying soft-tissue deformity. If successful, this may increase patient satisfaction, prevent PTH, and avoid additional costs of revision surgery.

Comparison of natural head position in different anteroposterior malocclusions.

PubMed

Hedayati, Zohreh; Paknahad, Maryam; Zorriasatine, Farbod

2013-05-01

The facial esthetics after orthodontic treatment and orthognathic surgery may be affected by the patient's natural head position. The purpose of this study was to evaluate the natural head position for the three skeletal classes of malocclusion. Our sample consisted of 102 lateral cephalometric radiographs of patients aged 15 to 18 years; class I (n=32), class II (n=40) and class III (n=30). Nine landmarks of the craniofacial skeleton and three landmarks of the cervical vertebrae were determined. Variables consisted of two angles for cervical posture (OPT/Hor and CVT/Hor), three angles for craniofacial posture (SN/Ver, PNS-ANS/Ver, and ML/Ver ) and five for craniofacial angulation (SN/OPT, SN/CVT, PNS-ANS/OPT, PNS-ANS/CVT, ML/CVT). The data were analyzed statistically using ANOVA and post hoc tests. PNS-ANS/Ver and SN/Ver differed significantly (p<0.05) among the three groups. There were no significant differences between class I and class II malocclusions for the indicator angles of cranial posture except for ML/Ver. The SN/CVT was significantly different for class I compared to class III patients. A head posture camouflaging the underlying skeletal class III was observed in our population. A more forward head posture was observed in skeletal class III participants compared to skeletal class I and II and that class III patients tended to incline their head more ventral compared to class I participants. These findings may have implications for the amount of jaw movements during surgery particularly in patients with a class III malocclusion.

Availability of cosmetic treatment using novel cosmetics-based material on patients with craniofacial concavity.

PubMed

Koyama, Shigeto; Kanetaka, Hiroyasu; Sagehashi, Yoshinori; Sasaki, Keiichi; Sato, Naoko

2018-03-09

Patients treated with maxillofacial prosthetics often experience emotional problems because of the remaining facial skin concavity such as a surgical scar. In such cases, cosmetic treatment can potentially correct their skin tone imperfections and deformities. This study aimed to evaluate the clinical availability of novel cosmetics-based material for craniofacial small concavity by initiating a cosmetic treatment in a preliminary case. Eighteen patients with aesthetic problems such as craniofacial deformities, small defects, and concavities on their faces underwent cosmetic treatment that was performed by makeup practitioners. Data were collected from the patient's charts and a survey questionnaire. A visual analog scale was used to conduct a survey regarding the satisfaction levels of the patients following cosmetic treatment with a novel cosmetics-based material. The cosmetic treatment was performed for a concavity on the left midface of a 67-year-old woman with partial maxillectomy. The novel cosmetics-based material was manufactured from a semi-translucent oil base. The satisfaction level of the patient increased after undergoing the cosmetic treatment. Regarding clinical applications, the novel cosmetics-based material can help reduce their cosmetic disturbance and restore the small deformity. These results suggest that the cosmetic treatment with the novel cosmetics-based material can be used as a subsidiary method for facial prostheses or an independent new method for correcting patients' small craniofacial concavity and for reducing visible deformity. Copyright © 2018 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.

Surgical body modification and altruistic individualism: a case for cyborg ethics and methods.

PubMed

Frank, Arthur W

2003-12-01

Three cases of pediatric surgical body modification--limb lengthening, normalization of genitalia, and craniofacial surgery--are considered through the moral language used by those who experience these surgeries. This language has been described as altruistic individualism. Decision making remains individualist, but it also shows considerable concern for others; egoism is complementary with altruism. The altruistic individualist is one of many incompatible identities that are predicted and described by the figure of the cyborg. Cyborgs suggest both ethics and qualitative methods appropriate to surgically shaped children.

Update on 13 Syndromes Affecting Craniofacial and Dental Structures

PubMed Central

Bartzela, Theodosia N.; Carels, Carine; Maltha, Jaap C.

2017-01-01

Care of individuals with syndromes affecting craniofacial and dental structures are mostly treated by an interdisciplinary team from early childhood on. In addition to medical and dental specialists that have a vivid interest in these syndromes and for whom these syndromes are of evident interest, experts of scientific background—like molecular and developmental geneticists, but also computational biologists and bioinformaticians—, become more frequently involved in the refined diagnostic and etiological processes of these patients. Early diagnosis is often crucial for the effective treatment of functional and developmental aspects. However, not all syndromes can be clinically identified early, especially in cases of absence of known family history. Moreover, the treatment of these patients is often complicated because of insufficient medical knowledge, and because of the dental and craniofacial developmental variations. The role of the team is crucial for the prevention, proper function, and craniofacial development which is often combined with orthognathic surgery. Although the existing literature does not provide considerable insight into this topic, this descriptive review aims to provide tools for the interdisciplinary team by giving an update on the genetics and general features, and the oral and craniofacial manifestations for early diagnosis. Clinical phenotyping together with genetic data and pathway information will ultimately pave the way for preventive strategies and therapeutic options in the future. This will improve the prognosis for better functional and aesthetic outcome for these patients and lead to a better quality of life, not only for the patients themselves but also for their families. The aim of this review is to promote interdisciplinary interaction and mutual understanding among all specialists involved in the diagnosis and therapeutic guidance of patients with these syndromal conditions in order to provide optimal personalized care in an integrated approach. PMID:29311971

Three-Dimensional Analysis and Surgical Planning in Craniomaxillofacial Surgery.

PubMed

Steinbacher, Derek M

2015-12-01

Three-dimensional (3D) analysis and planning are powerful tools in craniofacial and reconstructive surgery. The elements include 1) analysis, 2) planning, 3) virtual surgery, 4) 3D printouts of guides or implants, and 5) verification of actual to planned results. The purpose of this article is to review different applications of 3D planning in craniomaxillofacial surgery. Case examples involving 3D analysis and planning were reviewed. Common threads pertaining to all types of reconstruction are highlighted and contrasted with unique aspects specific to new applications in craniomaxillofacial surgery. Six examples of 3D planning are described: 1) cranial reconstruction, 2) craniosynostosis, 3) midface advancement, 4) mandibular distraction, 5) mandibular reconstruction, and 6) orthognathic surgery. Planning in craniomaxillofacial surgery is useful and has applicability across different procedures and reconstructions. Three-dimensional planning and virtual surgery enhance efficiency, accuracy, creativity, and reproducibility in craniomaxillofacial surgery. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

A 9-year comparison of practice profiles of candidates for primary and recertification examinations of the American Board of Plastic Surgery relative to economic indicators.

PubMed

Gosain, Arun K; Haller, Harold S; Lee, Michelle; Cullison, Terry M; Noone, R Barrett

2013-03-01

This study compared the practice profiles of plastic surgeons applying for recertification/maintenance of certification with those applying for primary certification by the American Board of Plastic Surgery between 2003 and 2011. American Board of Plastic Surgery case logs from both recertification and primary certification candidates from 2003 to 2011 were examined. Deidentified data included operative year, Current Procedural Terminology codes, and the candidate's designation of the case relative to (1) cosmetic or reconstructive and (2) the Maintenance of Certification in Plastic Surgery module (i.e., comprehensive, cosmetic, craniomaxillofacial, and hand). Department of Commerce unemployment data from 2003 to 2011 served as an economic indicator for the period studied. A negative trend in the median number of cases per candidate was observed for both groups for cosmetic, reconstructive, and total number of cases, corresponding to a rise in unemployment. With every 1 percent increase in the unemployment rate, recertification candidates demonstrated a greater loss of cosmetic cases relative to primary candidates and an accelerated decline in reconstructive cases starting in 2007. Distribution of the four Maintenance of Certification modules demonstrated a negative trend for cosmetic and comprehensive cases in both groups. Hand and craniofacial consistently constituted approximately 20 percent of cases for primary and 14 percent of cases for recertification candidates. There was a shift away from hand cases toward craniofacial cases in both groups. Both primary and recertification candidates reported a decline in overall caseload from 2003 to 2011. Negative economic trends have a greater impact on the practice profile of recertification candidates.

Total Face, Eyelids, Ears, Scalp, and Skeletal Subunit Transplant: A Reconstructive Solution for the Full Face and Total Scalp Burn.

PubMed

Sosin, Michael; Ceradini, Daniel J; Levine, Jamie P; Hazen, Alexes; Staffenberg, David A; Saadeh, Pierre B; Flores, Roberto L; Sweeney, Nicole G; Bernstein, G Leslie; Rodriguez, Eduardo D

2016-07-01

Reconstruction of extensive facial and scalp burns can be increasingly challenging, especially in patients that have undergone multiple procedures with less than ideal outcomes resulting in restricting neck and oral contractures, eyelid dysfunction, and suboptimal aesthetic appearance. To establish a reconstructive solution for this challenging deformity, a multidisciplinary team was assembled to develop the foundation to a facial vascularized composite allotransplantation program. The strategy of developing and executing a clinical transplant was derived on the basis of fostering a cohesive and supportive institutional clinical environment, implementing computer software and advanced technology, establishing a cadaveric transplant model, performing a research facial procurement, and selecting an optimal candidate with the aforementioned burn defect who was well informed and had the desire to undergo face transplantation. Approval from the institutional review board and organ procurement organization enabled our face transplant team to successfully perform a total face, eyelids, ears, scalp, and skeletal subunit transplant in a 41-year-old man with a full face and total scalp burn. The culmination of knowledge attained from previous experiences continues to influence the progression of facial vascularized composite allotransplantation. This surgical endeavor methodically and effectively synchronized the fundamental principles of aesthetic, craniofacial, and microvascular surgery to restore appearance and function to a patient suffering from failed conventional surgery for full face and total scalp burns. This procedure represents the most extensive soft-tissue clinical face transplant performed to date. Therapeutic, V.

Systematic review and meta-analysis of the efficacy of hilotherapy following oral and maxillofacial surgery.

PubMed

Bates, A S; Knepil, G J

2016-01-01

Craniofacial surgery causes immediate postoperative pain, oedema, and functional limitations. Hilotherapy delivers cooled water to the face at 15°C and may reduce the postoperative recovery time. This work presents a meta-analysis of short-term postoperative outcomes after hilotherapy. Following a systematic literature search, comparative trials of patients undergoing surgical interventions in the maxillofacial region and receiving either hilotherapy or ice-cooling therapy were included for meta-analysis. Demographics and surgical outcomes were extracted. Data were analysed using Comprehensive Meta-Analysis software. Mean (SEM) data were calculated for demographic variables and standardized mean differences with the 95% confidence interval for surgical outcomes. Five trials were analysed, providing 206 patients for evaluation; mean patient age was 29.4 (9.4) years. Hilotherapy reduced pain (10-point visual analogue scale) at 48 h (P<0.010) and 72 h (P<0.050), as well as postoperative facial oedema (P<0.010), compared to ice-cooling treatment. Trismus and facial neurological scores were also improved (P=0.08). Patients preferred hilotherapy to other cooling methods (P<0.010). Hilotherapy appears to be effective in reducing postoperative facial pain, oedema, and trismus, and in improving patient-reported outcomes. Well-designed randomized controlled clinical trials are required to clarify the procedure-specific efficacy of postoperative hilotherapy and optimal durations of treatment. Copyright © 2015 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

[Biodegradable fixation systems in pediatric craniofacial surgery: 10-year experience with 324 patients].

PubMed

Yasonov, S A; Lopatin, A V; Bel'chenko, V A; Vasil'ev, I G

Over the past 15 years, resorbable materials have been successfully used for osteosynthesis, but their high cost prevents widespread application. However, the use of resorbable systems could be a method of choice, especially in treatment of children in the active growth period. Obviously, biodegradable materials not only are highly competitive with known metal constructs in terms of fixation rigidity, biocompatibility, and a low risk of infection but also have an undeniable advantage, such as gradual resorption allowing quick return of damaged bones to the physiological conditions of functioning. A special feature of bioresorbable systems is that they can be assembled using ultrasonic welding, which greatly facilitates the fixation process and also provides necessary rigidity, even in cases of joining very thin bones when reliable fixation with screws is impossible. Over the past 10 years, we have used biodegradable systems in 324 patients. In 244 of them, we used traditional (plate/screw) systems; in 80 cases, an ultrasonic welding system was chosen for osteosynthesis. In the present work, we discuss, based on clinical evidence, the advantages and disadvantages of both fixation systems for reconstructive craniofacial surgery in children.

A virtual reality atlas of craniofacial anatomy.

PubMed

Smith, Darren M; Oliker, Aaron; Carter, Christina R; Kirov, Miro; McCarthy, Joseph G; Cutting, Court B

2007-11-01

Head and neck anatomy is complex and represents an educational challenge to the student. Conventional two-dimensional illustrations inherently fall short in conveying intricate anatomical relationships that exist in three dimensions. A gratis three-dimensional virtual reality atlas of craniofacial anatomy is presented in an effort to address the paucity of readily accessible and customizable three-dimensional educational material available to the student of head and neck anatomy. Three-dimensional model construction was performed in Alias Maya 4.5 and 6.0. A basic three-dimensional skull model was altered to include surgical landmarks and proportions. Some of the soft tissues were adapted from previous work, whereas others were constructed de novo. Texturing was completed with Adobe Photoshop 7.0 and Maya. The Internet application was designed in Viewpoint Enliven 1.0. A three-dimensional computer model of craniofacial anatomy (bone and soft tissue) was completed. The model is compatible with many software packages and can be accessed by means of the Internet or downloaded to a personal computer. As the three-dimensional meshes are publicly available, they can be extensively manipulated by the user, even at the polygonal level. Three-dimensional computer graphics has yet to be fully exploited for head and neck anatomy education. In this context, the authors present a publicly available computer model of craniofacial anatomy. This model may also find applications beyond clinical medicine. The model can be accessed gratis at the Plastic and Reconstructive Surgery Web site or obtained as a three-dimensional mesh, also gratis, by contacting the authors.

Craniofacial structure variations in patients with palatal anomalies and velopharyngeal dysfunction.

PubMed

Nachmani, Ariela; Aizenbud, Dror; Nageris, Ben; Emodi, Omri; Kassem, Firas

2017-02-01

Cephalometric evaluation of craniofacial and craniopharyngeal morphology is important for understanding the factors affecting velopharyngeal dysfunction (VPD) in patients with palatal anomalies. In this study, 366 patients with VPD were retrospectively stratified into cleft lip and palate (CLP), cleft palate (CP), submucous cleft palate (SMCP), occult submucous cleft palate (OSMCP), and non-CP groups. Lateral cephalometrics were used to assess craniofacial, craniopharyngeal, and velopharyngeal anatomy. The average craniofacial morphology in patients with VPD differed significantly according to the type of palatal anomaly. The non-CP and OSMCP groups differed from the CLP, CP, and SMCP groups in nasopharyngeal size and shape as depicted by a larger ANS-Ptm-Ve angle, a smaller S-N-Ba and NBa-PP angles, and a shorter linear value of S-Ar in the non-CP group. The CLP and CP groups had shorter ANS-Ptm, shorter Ptm-P, and smaller SNA and SNB angles. VPD patients with overt clefts have different skeletal and nasopharyngeal shapes compared to non-CP and OSMCP. Velopharyngeal function assessment should include the size and shape of the nasopharyngeal space in addition to the size and the activity of the velum and posterior and lateral walls of the nasopharynx. This should enable a more precise understanding of VPD pathology, and lead to improvements in the posterior pharyngeal flap technique in order to obtain better postoperative speech outcomes after surgical management of velopharyngeal dysfunction. Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Correction of craniosynostosis using modified spring-assisted surgery.

PubMed

Shen, Weimin; Cui, Jie; Chen, Jianbin; Zou, Jijun; Ji, Yi; Chen, Haini; Xiongzheng, Mu

2015-03-01

The use of springs in craniofacial surgery was originated at Sahlgrenska University Hospital in 1997 as a way of remodeling the cranial vault postoperatively. After a decade of development, spring technology has been improved to a greater extent. However, there still exist some problems, such as the poor consistency of steel wire stretches, the wrong position of steel wire, the problem of increasing the elasticity of springs, and so on. We have designed a spring device for external uses. This device is composed of 3 parts. The first part is the outside of the spring ring. This ring is the same as the internal spring, only a little bigger. The second part is a small U-shaped hook, which is made of titanium plates and linked to the skull portion. The U-shaped hook is approximately 1 cm long and 1 cm wide. The hang is approximately 1 cm long and 0.6 cm wide. The U-shaped level length is 1 cm, but the level width should be equal to or bigger than the thickness of the skull. The third part is a steel wire, which is placed at 1 end of hook. We first conduct a strip craniotomy, then put 2 hooks at the bone ends and, after that, fix hooks on the skull. Finally, we pull the steel wire of the hook end out of the scalp, connect it with the external spring, and draw out the external spring. We performed 24 craniofacial spring placement procedures for 12 patients with craniosynostosis. We used 6 springs for 3 patients who had anterior plagiocephaly, 12 springs for 6 patients who had scaphocephaly, and 3 springs for another patient who had metopic synostosis and holoprosencephaly. We also used 3 springs for 2 patients who had metopic synostosis. The 12 patients have not required further surgeries so far, and there were no major complications. Spring dislodgement had not caused any complication in early cases. We could easily change the position of the spring rings from outside the scalp, regularly correct the elasticity of the spring rings, and replace spring rings to increase the traction. The head shapes of the 12 children have been improved significantly to use external spring rings. This therapeutic modality in craniofacial surgery has allowed minimization of the extent of surgery without compromising clinical outcomes. The authors have shown that the use of external spring techniques is safe and, in selected situations, offer significant advantages over other methods of treatment. It makes up for a number of shortcomings of internal springs.

Computer-assisted midface reconstruction in Treacher Collins syndrome part 1: skeletal reconstruction.

PubMed

Herlin, Christian; Doucet, Jean Charles; Bigorre, Michèle; Khelifa, Hatem Cheikh; Captier, Guillaume

2013-10-01

Treacher Collins syndrome (TCS) is a severe and complex craniofacial malformation affecting the facial skeleton and soft tissues. The palate as well as the external and middle ear are also affected, but his prognosis is mainly related to neonatal airway management. Methods of zygomatico-orbital reconstruction are numerous and currently use primarily autologous bone, lyophilized cartilage, alloplastic implants, or even free flaps. This work developed a reliable "customized" method of zygomatico-orbital bony reconstruction using a generic reference model tailored to each patient. From a standard computed tomography (CT) acquisition, we studied qualitatively and quantitatively the skeleton of four individuals with TCS whose age was between 6 and 20 years. In parallel, we studied 40 controls at the same age to obtain a morphometric database of reference. Surgical simulation was carried out using validated software used in craniofacial surgery. The zygomatic hypoplasia was very important quantitatively and morphologically in all TCS individuals. Orbital involvement was mainly morphological, with volumes comparable to the controls of the same age. The control database was used to create three-dimensional computer models to be used in the manufacture of cutting guides for autologous cranial bone grafts or alloplastic implants perfectly adapted to each patient's morphology. Presurgical simulation was also used to fabricate custom positioning guides permitting a simple and reliable surgical procedure. The use of a virtual database allowed us to design a reliable and reproducible skeletal reconstruction method for this rare and complex syndrome. The use of presurgical simulation tools seem essential in this type of craniofacial malformation to increase the reliability of these uncommon and complex surgical procedures, and to ensure stable results over time. Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Influence of craniofacial surgery on the social attitudes toward the malformed and their handling in different cultures and at different times: a contribution to social world history.

PubMed

Sailer, H F; Kolb, E

1995-07-01

A historic overview including the European, American, Asian, and African continents is given on attitudes toward and the handling of humans with congenital malformations in ancient cultures and on pertinent customs in some prehistoric peoples. Figures of early works of art showing malformed individuals are presented testifying to this worldwide and timeless problem of humankind. In parallel, analogous patient photographs from our hospital before and after reconstructive surgery are shown. Philosophies of ancient Greece, rome, and China on the subject of malformed infants essentially did not differ from the known attitudes of the less developed tribes in Europe and pre-Columbian America, although the means of elimination of unwanted offspring were rather passive (exposure) than active (manual killing). A radical change in attitudes and practices occurred with the spread of the Christian religion and its political installment in Europe. The care for the underprivileged including the malformed ones was considered a Christian duty to be performed with compassion and love. In our century, the clocks have been and apparently are turned back again. Atheistic and Darwinian influences, political atheism, and the belief in "higher ethics" issued by "superman" have led to a relapse into barbarism, also within the medical system. We, as craniofacial surgeons, are privileged to have the means to turn the clocks forward again by rehabilitating the physically most underprivileged: those with conspicuous craniofacial malformations. The necessary techniques exist and are applied, as the figures of patients from our hospital demonstrate, but the will and the emotional strength for their consequent application require more than our hands.

Bilateral meningoencephaloceles with cerebrospinal fluid rhinorrhea after facial advancement in the Crouzon syndrome.

PubMed

Panuganti, Bharat A; Leach, Matthew; Antisdel, Jastin

2015-01-01

Cerebrospinal fluid (CSF) rhinorrhea and encephaloceles are rare complications of craniofacial advancement procedures performed in patients with craniofacial dysostoses (CD) to address the ramifications of their midface hypoplasia including obstructed nasal airway, exorbitism, and impaired mastication. Surgical repair of this CSF rhinorrhea is complicated by occult elevations in intracranial pressure (ICP), potentially necessitating open, transcranial repair. We report the first case in otolaryngology literature of a patient with Crouzon syndrome with late CSF rhinorrhea and encephalocele formation after previous LeFort III facial advancement surgery. Describe the case of a patient with Crouzon syndrome who presented with CSF rhinorrhea and encephaloceles as complications of Le Fort III facial advancement surgery. Review the literature pertaining to the incidence and management of post-operative CSF rhinorrhea and encephaloceles. Analyze issues related to repair of these complications, including occult elevations in ICP, the utility of perioperative CSF shunts, and the importance of considering alternative repair schemes to the traditional endonasal, endoscopic approach. Review of the literature describing CSF rhinorrhea and encephalocele formation following facial advancement in CD, focusing on management strategies. CSF rhinorrhea and encephalocele formation are rare complications of craniofacial advancement procedures. Occult elevations in ICP complicate the prospect of permanent surgical repair, potentially necessitating transcranial repair and the use of CSF shunts. Though no consensus exists regarding the utility of perioperative CSF drains, strong associations exist between elevated ICP and failed surgical repair. Additionally, the anatomic changes in the frontal and ethmoid sinuses after facial advancement present a challenge to endoscopic repair. Otolaryngologists should be aware of the possibility of occult elevations in ICP and sinonasal anatomic abnormalities when repairing CSF rhinorrhea in patients with CD. Clinicians should consider CSF shunt placement and carefully weigh the advantages of the transcranial approach versus endonasal, endoscopic techniques.

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies - USP (HRAC-USP) - Part 2: Pediatric Dentistry and Orthodontics

PubMed Central

FREITAS, José Alberto de Souza; GARIB, Daniela Gamba; OLIVEIRA, Thais Marchini; LAURIS, Rita de Cássia Moura Carvalho; de ALMEIDA, Ana Lúcia Pompéia Fraga; NEVES, Lucimara Teixeira; TRINDADE-SUEDAM, Ivy Kiemle; YAEDÚ, Renato Yassutaka Faria; SOARES, Simone; PINTO, João Henrique Nogueira

2012-01-01

The aim of this article is to present the pediatric dentistry and orthodontic treatment protocol of rehabilitation of cleft lip and palate patients performed at the Hospital for Rehabilitation of Craniofacial Anomalies - University of São Paulo (HRAC-USP). Pediatric dentistry provides oral health information and should be able to follow the child with cleft lip and palate since the first months of life until establishment of the mixed dentition, craniofacial growth and dentition development. Orthodontic intervention starts in the mixed dentition, at 8-9 years of age, for preparing the maxillary arch for secondary bone graft procedure (SBGP). At this stage, rapid maxillary expansion is performed and a fixed palatal retainer is delivered before SBGP. When the permanent dentition is completed, comprehensive orthodontic treatment is initiated aiming tooth alignment and space closure. Maxillary permanent canines are commonly moved mesially in order to substitute absent maxillary lateral incisors. Patients with complete cleft lip and palate and poor midface growth will require orthognatic surgery for reaching adequate anteroposterior interarch relationship and good facial esthetics. PMID:22666849

VERS: a virtual environment for reconstructive surgery planning

NASA Astrophysics Data System (ADS)

Montgomery, Kevin N.

1997-05-01

The virtual environment for reconstructive surgery (VERS) project at the NASA Ames Biocomputation Center is applying virtual reality technology to aid surgeons in planning surgeries. We are working with a craniofacial surgeon at Stanford to assemble and visualize the bone structure of patients requiring reconstructive surgery either through developmental abnormalities or trauma. This project is an extension of our previous work in 3D reconstruction, mesh generation, and immersive visualization. The current VR system, consisting of an SGI Onyx RE2, FakeSpace BOOM and ImmersiveWorkbench, Virtual Technologies CyberGlove and Ascension Technologies tracker, is currently in development and has already been used to visualize defects preoperatively. In the near future it will be used to more fully plan the surgery and compute the projected result to soft tissue structure. This paper presents the work in progress and details the production of a high-performance, collaborative, and networked virtual environment.

[Endoscopically assisted fronto-orbitary correction in trigonocephaly].

PubMed

Hinojosa, J; Esparza, J; García-Recuero, I; Romance, A

2007-01-01

The development of multidisciplinar Units for Craneofacial Surgery has led to a considerable decrease in morbidity even in the cases of more complex craniofacial syndromes. The use of minimally invasive techniques for the correction of some of these malformations allows the surgeon to minimize the incidence of complications by means of a decrease in the surgical time, blood salvage and shortening of postoperative hospitalization in comparison to conventional craniofacial techniques. Simple and milder craniosynostosis are best approached by these techniques and render the best results. Different osteotomies resembling standard fronto-orbital remodelling besides simple suturectomies and the use of postoperative cranial orthesis may improve the final aesthetic appearence. In endoscopic treatment of trigonocephaly the use of preauricular incisions achieves complete pterional resection, lower lateral orbital osteotomies and successful precoronal frontal osteotomies to obtain long lasting and satisfactory outcomes.

Pediatric maxillary fractures.

PubMed

Yu, Jack; Dinsmore, Robert; Mar, Philip; Bhatt, Kirit

2011-07-01

Pediatric craniofacial structures differ from those of adults in many ways. Because of these differences, management of pediatric craniofacial fractures is not the same as those in adults. The most important differences that have clinical relevance are the mechanical properties, craniofacial anatomy, healing capacity, and dental morphology. This article will review these key differences and the management of pediatric maxillary fractures. From the mechanical properties' perspective, pediatric bones are much more resilient than adult bones; as such, they undergo plastic deformation and ductile failure. From the gross anatomic perspective, the relative proportion of the cranial to facial structures is much larger for the pediatric patients and the sinuses are not yet developed. The differences related to dentition and dental development are more conical crowns, larger interdental spaces, and presence of permanent tooth buds in the pediatric population. The fracture pattern, as a result of all the above, does not follow the classic Le Fort types. The maxillomandibular fixation may require circum-mandibular wires, drop wires, or Ivy loops. Interfragmentary ligatures using absorbable sutures play a much greater role in these patients. The use of plates and screws should take into consideration the future development with respect to growth centers and the location of the permanent tooth buds. Pediatric maxillary fractures are not common, require different treatments, and enjoy better long-term outcomes.

Trends and Characteristics of Pediatric Dentistry Patients Treated under General Anesthesia.

PubMed

Rudie, Maxwell N; Milano, Michael M; Roberts, Michael W; Divaris, Kimon

2018-05-11

The aims of this study were to describe the demographic characteristics of pediatric dentistry patients undergoing dental rehabilitation under general anesthesia (DRGA) at UNC-Chapel Hill during the last 13 years and identify factors associated with multiple (1 versus 2 or more) DRGA visits during that timeframe. Administrative claims data were used to identify children and adolescents (age <18 years) who underwent DRGA between 1/1/2002 and 12/31/2014 at the UNC Hospitals system. Information on children's age, sex and all treatment-associated CDT codes were collected. Descriptive statistics and bivariate tests of association were used for data analyses. There were 4,413 DRGAs among 3,973 children (median age=4 years 8 months, males=55%) during the study period. The annual rate of DRGAs increased over time, peaking (n=447) in 2013. Overall, 9% of children had ≥2 visits with repeat rates up to 18%. There was no association between children's sex and receipt of one versus multiple DRGAs; however, craniofacial cases were more likely (p<0.0005) to have multiple DRGAs compared to non-craniofacial ones. DRGAs are on the increase-with the exception of craniofacial and special health care needs patients, multiple DRGAs may be reflective of sub-optimal adherence to preventive and continuing care recommendations.

SURGICAL TREATMENT OF UPPER AND MIDDLE FACIAL ZONE TRAUMAS IN PROGRESS OF CONCOMITANT TRAUMATIC CRANIOFACIAL INJURIES.

PubMed

Lagvilava, G; Gvenetadze, Z; Toradze, G; Devidze, I; Gvenetadze, G

2015-09-01

In 2012-2015, 207 patients with concomitant craniofacial injuries, who underwent surgical treatment, were observed; among them 176 were men and 31- women. Age of the patients ranged from 16 to 60 years. According to localization and severity of trauma and a priority of surgical intervention, the patients conventionally were divided into 3 groups by the authors: I group (65 patients) - craniofacial injuries; the skull as well as upper and middle areas of face (subcranial and frontobasal fractures) were affected (fractured). II group (80 patients) - severe traumatic injuries of upper and especially middle zones of the face, accompanied with closed craniocerebral trauma, no need in neurosurgery. III group (62 patients) -on the background of serious head traumas, the injuries of face bones were less severe (injury of one or two anatomic areas with displacement of fractured fragments but without bone tissue defects) According to the obtained results a priority was always given to the neurosurgery (vital testimony).The reconstructive surgeries on face skeleton was conducted in combination involving neurosurgeons (I group patients). Reconstructive surgeries of facial bones were conducted in the patients of II group, immediately or at primary deferred period of time but in the patients of III group the surgical procedures for removal of early secondary or traumatic residual fractures have been performed. Reposition of the fractured facial bone fragments was performed in an open way and fixation was carried out by titanium plates and mesh cage (at bone tissue defect). For prevention and elimination of post-traumatic inflammatory processes, the final stage of surgical intervention was: sanation of nasal accessory sinuses and catheterization (5-7 days) of external carotid arteries for administration of antibiotics and other medical preparations. Early and differentiated approach to face injuries, worsening in the course of craniocephalic trauma was not revealed in any patient; there was no evidence of development inflammatory processes in traumatic regions; esthetic and functional results obtained after the surgeries of maxillofacial area were assessed as good and satisfactory.

Preliminary development of a workstation for craniomaxillofacial surgical procedures: introducing a computer-assisted planning and execution system.

PubMed

Gordon, Chad R; Murphy, Ryan J; Coon, Devin; Basafa, Ehsan; Otake, Yoshito; Al Rakan, Mohammed; Rada, Erin; Susarla, Srinivas; Susarla, Sriniras; Swanson, Edward; Fishman, Elliot; Santiago, Gabriel; Brandacher, Gerald; Liacouras, Peter; Grant, Gerald; Armand, Mehran

2014-01-01

Facial transplantation represents one of the most complicated scenarios in craniofacial surgery because of skeletal, aesthetic, and dental discrepancies between donor and recipient. However, standard off-the-shelf vendor computer-assisted surgery systems may not provide custom features to mitigate the increased complexity of this particular procedure. We propose to develop a computer-assisted surgery solution customized for preoperative planning, intraoperative navigation including cutting guides, and dynamic, instantaneous feedback of cephalometric measurements/angles as needed for facial transplantation and other related craniomaxillofacial procedures. We developed the Computer-Assisted Planning and Execution (CAPE) workstation to assist with planning and execution of facial transplantation. Preoperative maxillofacial computed tomography (CT) scans were obtained on 4 size-mismatched miniature swine encompassing 2 live face-jaw-teeth transplants. The system was tested in a laboratory setting using plastic models of mismatched swine, after which the system was used in 2 live swine transplants. Postoperative CT imaging was obtained and compared with the preoperative plan and intraoperative measures from the CAPE workstation for both transplants. Plastic model tests familiarized the team with the CAPE workstation and identified several defects in the workflow. Live swine surgeries demonstrated utility of the CAPE system in the operating room, showing submillimeter registration error of 0.6 ± 0.24 mm and promising qualitative comparisons between intraoperative data and postoperative CT imaging. The initial development of the CAPE workstation demonstrated that integration of computer planning and intraoperative navigation for facial transplantation are possible with submillimeter accuracy. This approach can potentially improve preoperative planning, allowing ideal donor-recipient matching despite significant size mismatch, and accurate surgical execution for numerous types of craniofacial and orthognathic surgical procedures.

Influences on decision-making for undergoing plastic surgery: a mental models and quantitative assessment.

PubMed

Darisi, Tanya; Thorne, Sarah; Iacobelli, Carolyn

2005-09-01

Research was conducted to gain insight into potential clients' decisions to undergo plastic surgery, their perception of benefits and risks, their judgment of outcomes, and their selection of a plastic surgeon. Semistructured, open-ended interviews were conducted with 60 people who expressed interest in plastic surgery. Qualitative analysis revealed their "mental models" regarding influences on their decision to undergo plastic surgery and their choice of a surgeon. Interview results were used to design a Web-based survey in which 644 individuals considering plastic surgery responded. The desire for change was the most direct motivator to undergo plastic surgery. Improvements to physical well-being were related to emotional and social benefits. When prompted about risks, participants mentioned physical, emotional, and social risks. Surgeon selection was a critical influence on decisions to undergo plastic surgery. Participants gave considerable weight to personal consultation and believed that finding the "right" plastic surgeon would minimize potential risks. Findings from the Web-based survey were similar to the mental models interviews in terms of benefit ratings but differed in risk ratings and surgeon selection criteria. The mental models interviews revealed that interview participants were thoughtful about their decision to undergo plastic surgery and focused on finding the right plastic surgeon.

Circulatory CNP Rescues Craniofacial Hypoplasia in Achondroplasia.

PubMed

Yamanaka, S; Nakao, Kazumasa; Koyama, N; Isobe, Y; Ueda, Y; Kanai, Y; Kondo, E; Fujii, T; Miura, M; Yasoda, A; Nakao, Kazuwa; Bessho, K

2017-12-01

Achondroplasia is the most common genetic form of human dwarfism, characterized by midfacial hypoplasia resulting in occlusal abnormality and foramen magnum stenosis, leading to serious neurologic complications and hydrocephalus. Currently, surgery is the only way to manage jaw deformity, neurologic complications, and hydrocephalus in patients with achondroplasia. We previously showed that C-type natriuretic peptide (CNP) is a potent stimulator of endochondral bone growth of long bones and vertebrae and is also a potent stimulator in the craniofacial region, which is crucial for midfacial skeletogenesis. In this study, we analyzed craniofacial morphology in a mouse model of achondroplasia, in which fibroblast growth factor receptor 3 (FGFR3) is specifically activated in cartilage ( Fgfr3 ach mice), and investigated the mechanisms of jaw deformities caused by this mutation. Furthermore, we analyzed the effect of CNP on the maxillofacial area in these animals. Fgfr3 ach mice exhibited midfacial hypoplasia, especially in the sagittal direction, caused by impaired endochondral ossification in craniofacial cartilage and by premature closure of the spheno-occipital synchondrosis, an important growth center in craniomaxillofacial skeletogenesis. We crossed Fgfr3 ach mice with transgenic mice in which CNP is expressed in the liver under the control of the human serum amyloid-P component promoter, resulting in elevated levels of circulatory CNP ( Fgfr3 ach /SAP-Nppc-Tg mice). In the progeny, midfacial hypoplasia in the sagittal direction observed in Fgfr3 ach mice was improved significantly by restoring the thickness of synchondrosis and promoting proliferation of chondrocytes in the craniofacial cartilage. In addition, the foramen magnum stenosis observed in Fgfr3 ach mice was significantly ameliorated in Fgfr3 ach /SAP-Nppc-Tg mice due to enhanced endochondral bone growth of the anterior intraoccipital synchondrosis. These results clearly demonstrate the therapeutic potential of CNP for treatment of midfacial hypoplasia and foramen magnum stenosis in achondroplasia.

Racing performance of Standardbred trotting horses undergoing surgery of the carpal flexor sheath and age- and sex-matched control horses.

PubMed

Carmalt, James L; Johansson, Bengt C; Zetterström, Sandra M; McOnie, Rebecca C

2017-07-01

OBJECTIVE To determine factors affecting race speed in Swedish Standardbred horses undergoing surgery of the carpal flexor sheath (CFS), to investigate whether preoperative racing speed was associated with specific intraoperative findings and whether horses returned to racing, and to compare the performance of horses undergoing surgery of the CFS with that of age- and sex-matched control horses. ANIMALS 149 Swedish Standardbred trotters undergoing surgery of the CFS and 274 age- and sex-matched control horses. PROCEDURES Medical records of CFS horses were examined. Racing data for CFS and control horses were retrieved from official online records. Generalizing estimating equations were used to examine overall and presurgery racing speeds and the association of preoperative clinical and intraoperative findings with preoperative and postoperative speeds. Multivariable regression analysis was used to examine career earnings and number of career races. Kaplan-Meier survival analysis was used to compare career longevity between CFS and control horses. RESULTS CFS horses were significantly faster than control horses. The CFS horses that raced before surgery were slower as they approached the surgery date, but race speed increased after surgery. There were 124 of 137 (90.5%) CFS horses that raced after surgery. No intrathecal pathological findings were significantly associated with preoperative racing speed. Career longevity did not differ between CFS and control horses. CONCLUSIONS AND CLINICAL RELEVANCE Horses undergoing surgery of the CFS had a good prognosis to return to racing after surgery. Racing careers of horses undergoing surgery of the CFS were not significantly different from racing careers of control horses.

Disparities in Aesthetic Procedures Performed by Plastic Surgery Residents.

PubMed

Silvestre, Jason; Serletti, Joseph M; Chang, Benjamin

2017-05-01

Operative experience in aesthetic surgery is an important issue affecting plastic surgery residents. This study addresses the variability of aesthetic surgery experience during plastic surgery residency. National operative case logs of chief residents in independent/combined and integrated plastic surgery residency programs were analyzed (2011-2015). Fold differences between the bottom and top 10th percentiles of residents were calculated for each aesthetic procedure category and training model. The number of residents not achieving case minimums was also calculated. Case logs of 818 plastic surgery residents were analyzed. There was marked variability in craniofacial (range, 6.0-15.0), breast (range, 2.4-5.9), trunk/extremity (range, 3.0-16.0), and miscellaneous (range, 2.7-22.0) procedure categories. In 2015, the bottom 10th percentile of integrated and independent/combined residents did not achieve case minimums for botulinum toxin and dermal fillers. Case minimums were achieved for the other aesthetic procedure categories for all graduating years. Significant variability persists for many aesthetic procedure categories during plastic surgery residency training. Greater efforts may be needed to improve the aesthetic surgery experience of plastic surgery residents. © 2016 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com

Initial investigation of the corrosion stability of craniofacial implants.

PubMed

Beline, Thamara; Vechiato Filho, Aljomar José; Wee, Alvin G; Sukotjo, Cortino; Dos Santos, Daniela Micheline; Brandão, Thaís Bianca; Barão, Valentim Adelino Ricardo

2018-01-01

Although craniofacial implants have been used for retention of facial prostheses, failures are common. Titanium undergoes corrosion in the oral cavity, but the corrosion of craniofacial implants requires evaluation. The purpose of this in vitro study was to investigate the corrosion stability of commercially pure titanium (CP Ti) exposed to simulated human perspiration at 2 different pH levels (5.5 and 8). Fifteen titanium disks were divided into 3 groups (n=5 per group). The control group was subjected to simulated body fluid (SBF) (control). Disks from the 2 experimental groups were immersed in simulated alkaline perspiration (SA K P) and simulated acidic perspiration (SA C P). Electrochemical tests, including open circuit potential (3600 seconds), electrochemical impedance spectroscopy, and potentiodynamic tests were performed according to the standardized method of 3-cell electrodes. Data were analyzed by 1-way ANOVA and the Tukey honestly significant difference tests (α=.05). Simulated human perspiration reduced the corrosion stability of CP Ti (P<.05). The SBF group presented the lowest capacitance values (P<.05). SA K P and SA C P groups showed increased values of capacitance and showed no statistically significant differences (P>.05) from each other. The increase in capacitance suggests that the acceleration of the ionic exchanges between the CP Ti and the electrolyte leads to a lower corrosion resistance. SA K P reduced the oxide layer resistance of CP Ti (P<.05), and an increased corrosion rate was noted in both simulated human perspiration groups. Craniofacial implants can corrode when in contact with simulated human perspiration, whereas alkaline perspiration shows a more deleterious effect. Perspiration induces a more corrosive effect than simulated body fluid. Copyright © 2017 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

Facial soft-tissue asymmetry in three-dimensional cone-beam computed tomography images of children with surgically corrected unilateral clefts.

PubMed

Starbuck, John Marlow; Ghoneima, Ahmed; Kula, Katherine

2014-03-01

Cleft lip with or without cleft palate (CL/P) is a relatively common craniofacial malformation involving bony and soft-tissue disruptions of the nasolabial and dentoalveolar regions. The combination of CL/P and subsequent craniofacial surgeries to close the cleft and improve appearance of the cutaneous upper lip and nose can cause scarring and muscle pull, possibly resulting in soft-tissue depth asymmetries across the face. We tested the hypothesis that tissue depths in children with unilateral CL/P exhibit differences in symmetry across the sides of the face. Twenty-eight tissue depths were measured on cone-beam computed tomography images of children with unilateral CL/P (n = 55), aged 7 to 17 years, using Dolphin software (version 11.5). Significant differences in tissue depth symmetry were found around the cutaneous upper lip and nose in patients with unilateral CL/P.

Pediatric Orbital Fractures

PubMed Central

Oppenheimer, Adam J.; Monson, Laura A.; Buchman, Steven R.

2013-01-01

It is wise to recall the dictum “children are not small adults” when managing pediatric orbital fractures. In a child, the craniofacial skeleton undergoes significant changes in size, shape, and proportion as it grows into maturity. Accordingly, the craniomaxillofacial surgeon must select an appropriate treatment strategy that considers both the nature of the injury and the child's stage of growth. The following review will discuss the management of pediatric orbital fractures, with an emphasis on clinically oriented anatomy and development. PMID:24436730

[Osteotomies for treating developmental disorders of the neurocranium and visceral cranium].

PubMed

Mühling, J

1991-02-01

Craniofacial deformities are primarily caused by premature synostosis of cranial sutures. Depending on the involved sutures, typical deformities of the neuro- and visceral cranium are produced. They result in severe functional and aesthetic disturbances. Several osteotomies, which do not only make an aesthetic improvement possible but a correction of severe malfunction, are available for therapy. Preoperative planning and postoperative treatment require the combination of orthodontics and maxillofacial surgery.

Congenital cervical kyphosis in an infant with Ehlers-Danlos syndrome.

PubMed

Kobets, Andrew J; Komlos, Daniel; Houten, John K

2018-07-01

Ehler-Danlos syndome (EDS) refers to a group of heritable connective tissue disorders; rare manifestations of which are cervical kyphosis and clinical myelopathy. Surgical treatment is described for the deformity in the thoracolumbar spine in adolescents but not for infantile cervical spine. Internal fixation for deformity correction in the infantile cervical spine is challenging due to the diminutive size of the bony anatomy and the lack of spinal instrumentation specifically designed for young children. We describe the first case of successful surgical treatment in an infant with a high cervical kyphotic deformity in EDS. A 15-month-old female with EDS presented with several months of regression in gross motor skills in all four extremities. Imaging demonstrated 45° of kyphosis from the C2-4 levels with spinal cord compression. Corrective surgery consisted of a C3 corpectomy and C2-4 anterior fusion with allograft block and anterior fixation with dual 2 × 2 hole craniofacial miniplates, supplemented by C2-4 posterior fusion using four craniofacial miniplates fixated to the lamina. Radiographs at 20 months post-surgery demonstrated solid fusion both anteriorly and posteriorly with maintenance of correction. Ehlers-Danlos syndrome may present in the pediatric population with congenital kyphosis from cervical deformity in addition to the more commonly seen thoracolumbar deformities.

Granisetron plus dexamethasone for prevention of postoperative nausea and vomiting in patients undergoing laparoscopic surgery: A meta-analysis

PubMed Central

Zhu, Min; Zhou, Chengmao; Huang, Bing; Ruan, Lin; Liang, Rui

2017-01-01

Objective This study was designed to compare the effectiveness of granisetron plus dexamethasone for preventing postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic surgery. Methods We searched the literature in the Cochrane Library, PubMed, EMBASE, and CNKI. Results In total, 11 randomized controlled trials were enrolled in this analysis. The meta-analysis showed that granisetron in combination with dexamethasone was significantly more effective than granisetron alone in preventing PONV in patients undergoing laparoscopy surgery. No significant differences in adverse reactions (dizziness and headache) were found in association with dexamethasone. Conclusion Granisetron in combination with dexamethasone was significantly more effective than granisetron alone in preventing PONV in patients undergoing laparoscopic surgery, with no difference in adverse reactions between the two groups. Granisetron alone or granisetron plus dexamethasone can be used to prevent PONV in patients undergoing laparoscopic surgery. PMID:28436248

Granisetron plus dexamethasone for prevention of postoperative nausea and vomiting in patients undergoing laparoscopic surgery: A meta-analysis.

PubMed

Zhu, Min; Zhou, Chengmao; Huang, Bing; Ruan, Lin; Liang, Rui

2017-06-01

Objective This study was designed to compare the effectiveness of granisetron plus dexamethasone for preventing postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic surgery. Methods We searched the literature in the Cochrane Library, PubMed, EMBASE, and CNKI. Results In total, 11 randomized controlled trials were enrolled in this analysis. The meta-analysis showed that granisetron in combination with dexamethasone was significantly more effective than granisetron alone in preventing PONV in patients undergoing laparoscopy surgery. No significant differences in adverse reactions (dizziness and headache) were found in association with dexamethasone. Conclusion Granisetron in combination with dexamethasone was significantly more effective than granisetron alone in preventing PONV in patients undergoing laparoscopic surgery, with no difference in adverse reactions between the two groups. Granisetron alone or granisetron plus dexamethasone can be used to prevent PONV in patients undergoing laparoscopic surgery.

Bone autografting of the calvaria and craniofacial skeleton: historical background, surgical results in a series of 15 patients, and review of the literature.

PubMed

Artico, Marco; Ferrante, Luigi; Pastore, Francesco Saverio; Ramundo, Epimenio Orlando; Cantarelli, Davide; Scopelliti, Domenico; Iannetti, Giorgio

2003-07-01

Although the use of autologous bone for reconstruction of the cranial and facial skeleton underwent a partial reappraisal following the introduction of a vast range of alloplastic materials for this purpose, it has demonstrated definite advantages over the last century and, particularly, during the last decade. Fifteen patients underwent cranial and/or cranio-facial reconstruction using autologous bone grafting in the Department of Neurologic Sciences-Neurosurgery and the Division of Maxillo-Facial Surgery of the Rome "La Sapienza" University between 1987 and 1995. This group of patients consisted of 8 females and 7 males whose average age was 29.5 years (range 7.5 to 59 years, mean age 30). In all these patients cranioplasty and/or cranio-facial reconstruction had been performed to repair bone defects secondary to benign tumors or tumor-like lesions (12 cases), trauma (2 cases), or, in the remaining case, to wound infection after craniotomy for a neurosurgical operation. The results obtained in a series of 15 patients treated using this method are described with reference to the abundant data published on this topic. The mechanical, immunologic, and technical-grafting properties of autologous bone, together with its superior esthetic and psychological effects, probably make it the best material for cranioplasty.

[Short introduction to the history of otorhinolaryngology and craniofacial surgery].

PubMed

Mudry, Albert

2015-01-01

OHNS is a medical specialty born at the end of the 19th century. It is the congruence of otology and laryngology, rapidly associated with rhinology. It went through three chronological steps: construction in the second part of the 19th century, consolidation in the first part of 20th century and extension in the second part of the 20th and beginning of the 21st century. Scientifically, OHNS was set out into five partially layered phases: bedside teaching, introduction of anatomopathology, invention of clinic experiments, expansion of surgery, and use of highly technological advances. The increase of knowledge became progressively exponential due to concomitant progress. It lead to a renewal of the subdivision of the specialty into otology, rhinology, laryngology, head and neck surgery, pediatric OHNS, otoneurology, facioplastic surgery, and phoniatry in the last decades of the 20th century.

Migraine surgery: a plastic surgery solution for refractory migraine headache.

PubMed

Kung, Theodore A; Guyuron, Bahman; Cederna, Paul S

2011-01-01

Migraine headache can be a debilitating condition that confers a substantial burden to the affected individual and to society. Despite significant advancements in the medical management of this challenging disorder, clinical data have revealed a proportion of patients who do not adequately respond to pharmacologic intervention and remain symptomatic. Recent insights into the pathogenesis of migraine headache argue against a central vasogenic cause and substantiate a peripheral mechanism involving compressed craniofacial nerves that contribute to the generation of migraine headache. Botulinum toxin injection is a relatively new treatment approach with demonstrated efficacy and supports a peripheral mechanism. Patients who fail optimal medical management and experience amelioration of headache pain after injection at specific anatomical locations can be considered for subsequent surgery to decompress the entrapped peripheral nerves. Migraine surgery is an exciting prospect for appropriately selected patients suffering from migraine headache and will continue to be a burgeoning field that is replete with investigative opportunities.

Anesthetic Considerations in Patients Undergoing Bariatric Surgery: A Review Article

PubMed Central

Soleimanpour, Hassan; Safari, Saeid; Sanaie, Sarvin; Nazari, Mehdi; Alavian, Seyed Moayed

2017-01-01

Context This article discusses the anesthetic considerations in patients undergoing bariatric surgery in the preoperative, intraoperative, and postoperative phases of surgery. Evidence Acquisition This review includes studies involving obese patients undergoing bariatric surgery. Searches have been conducted in PubMed, MEDLINE, EMBASE, Google Scholar, Scopus, and Cochrane Database of Systematic Review using the terms obese, obesity, bariatric, anesthesia, perioperative, preoperative, perioperative, postoperative, and their combinations. Results Obesity is a major worldwide health problem associated with many comorbidities. Bariatric surgery has been proposed as the best alternative treatment for extreme obese patients when all other therapeutic options have failed. Conclusions Anesthetists must completely assess the patients before the surgery to identify anesthesia- related potential risk factors and prepare for management during the surgery. PMID:29430407

Computer-assisted orthognathic surgery combined with fibular osteomyocutaneous flap reconstruction to correct facial asymmetry and maxillary defects secondary to maxillectomy in childhood.

PubMed

Zhang, Lei; Sun, Hao; Yu, Hong-bo; Yuan, Hao; Shen, Guo-fang; Wang, Xu-dong

2013-05-01

Maxillectomy in childhood not only causes composite primary defects but also secondary malformation of the middle and lower face. In the case presented, we introduced computer-assisted planning and simulation of orthognathic surgery combined with fibular osteomyocutaneous flap reconstruction to correct complex craniofacial deformities. Virtual orthognathic surgery and maxillary reconstruction surgery were undertaken preoperatively. LeFort I osteotomy, with bilateral sagittal split ramus osteotomy and lower border ostectomy, was performed to correct malocclusion and facial asymmetry. Maxillary reconstruction was accomplished using a fibular osteomyocutaneous flap. The patient recovered uneventfully with an adequate aesthetic appearance on 3D computed tomography. Our experience indicates that orthognathic surgery combined with fibular osteomyocutaneous flap reconstruction can used to correct complex facial asymmetry and maxillary defects secondary to maxillectomy. Computer-assisted simulation enables precise execution of the reconstruction. It shortens the free flap ischemia time and reduces the risks associated with microsurgery.

Immune function, pain, and psychological stress in patients undergoing spinal surgery.

PubMed

Starkweather, Angela R; Witek-Janusek, Linda; Nockels, Russ P; Peterson, Jonna; Mathews, Herbert L

2006-08-15

This study was an exploratory repeated measures design comparing patients undergoing two magnitudes of surgery in the lumbar spine: lumbar herniated disc repair and posterior lumbar fusion. The present study evaluated and compared the effect of perceived pain, perceived stress, anxiety, and mood on natural killer cell activity (NKCA) and IL-6 production among adult patients undergoing lumbar surgery. Presurgical stress and anxiety can lead to detrimental patient outcomes after surgery, such as increased infection rates. It has been hypothesized that such outcomes are due to stress-immune alterations, which may be further exacerbated by the extent of surgery. However, psychologic stress, anxiety, and mood have not been previously characterized in patients undergoing spinal surgery. Pain, stress, anxiety, and mood were measured using self-report instruments at T1 (1 week before surgery), T2 (the day of surgery), T3 (the day after surgery), and T4 (6 weeks after surgery). Blood (30 mL) was collected for immune assessments at each time point. Pain, stress, anxiety, and mood state were elevated at baseline in both surgical groups and were associated with significant reduction in NKCA compared with the nonsurgical control group. A further decrease in NKCA was observed 24 hours after surgery in both surgical groups with a significant rise in stimulated IL-6 production, regardless of the magnitude of surgery. In the recovery period, NKCA increased to or above baseline values, which correlated with decreased levels of reported pain, perceived stress, anxiety, and mood state. This study demonstrated that patients undergoing elective spinal surgery are highly stressed and anxious, regardless of the magnitude of surgery and that such psychologic factors may mediate a reduction in NKCA.

The prevalence of iron deficiency anaemia in patients undergoing bariatric surgery.

PubMed

Khanbhai, M; Dubb, S; Patel, K; Ahmed, A; Richards, T

2015-01-01

As bariatric surgery rates continue to climb, anaemia will become an increasing concern. We assessed the prevalence of anaemia and length of hospital stay in patients undergoing bariatric surgery. Prospective data (anaemia [haemoglobin <12 g/dL], haematinics and length of hospital stay) was analysed on 400 hundred patients undergoing elective laparoscopic bariatric surgery. Results from a prospective database of 1530 patients undergoing elective general surgery were used as a baseline. Fifty-seven patients (14%) were anaemic pre-operatively, of which 98% were females. Median MCV (fL) and overall median ferritin (μg/L) was lower in anaemic patients (83 vs. 86, p=0.001) and (28 vs. 61, p<0.0001) respectively. In the elective general surgery patients, prevalence of anaemia was similar (14% vs. 16%) but absolute iron deficiency was more common in those undergoing bariatric surgery; microcytosis p<0.0001, ferritin <30 p<0.0001. Mean length of stay (days) was increased in the anaemic compared to in the non-anaemic group (2.7 vs. 1.9) and patients who were anaemic immediately post-operatively, also had an increased length of stay (2.7 vs. 1.9), p<0.05. Absolute iron deficiency was more common in patients undergoing bariatric surgery. In bariatric patients with anaemia there was an overall increased length of hospital stay. Copyright © 2013 Asian Oceanian Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

Do patients fear undergoing general anesthesia for oral surgery?

PubMed

Elmore, Jasmine R; Priest, James H; Laskin, Daniel M

2014-01-01

Many patients undergoing major surgery have more fear of the general anesthesia than the procedure. This appears to be reversed with oral surgery. Therefore, patients need to be as well informed about this aspect as the surgical operation.

Implant rehabilitation for a patient with Hallerman-Streiff syndrome: a case report.

PubMed

Abadi, Behruz J; Van Sickels, Joseph E; McConnell, Thomas A; Kluemper, G Thomas

2009-01-01

Hallermann-Streiff syndrome is a rare genetic disorder characterized by craniofacial malformations, sparse hair, eye abnormalities, dental defects, degenerative skin changes, and short stature. The syndrome has many implications for dental treatment. Patients typically present with multiple missing and poorly formed teeth. The purpose of this case report is to discuss the overall management of a patient with Hallermann-Streiff syndrome by oral maxillofacial surgery, orthodontic treatment, and prosthodontic reconstruction.

Comparative analysis of T2 selective division of rami-communicantes (ramicotomy) with T2 sympathetic clipping in the treatment of craniofacial hyperhidrosis.

PubMed

Kim, Do Hyung; Paik, Hyo Chae; Lee, Doo Yun

2004-08-01

The main cause of dissatisfaction after sympathetic trunk blocking surgery (T2 sympathectomy, sympathetic clipping) for craniofacial hyperhidrosis is compensatory sweating. Preserving sympathetic trunk may decrease the incidence of compensatory sweating, and we introduce T2 ramicotomy, which may better preserve the sympathetic nerve trunk in order to reduce compensatory sweating. From January 2000 to November 2002, video-assisted thoracoscopic (VAT) T2 sympathetic clipping and VAT ramicotomy were performed in 44 patients suffering from craniofacial hyperhidrosis. Twenty-two patients underwent T2 sympathetic clipping (group 1), and 22 underwent division of T2 rami-communicantes (group 2). We retrospectively analyzed the rate of satisfaction, dryness of face, and grade of compensatory sweating. Both groups were similar with respect to facial dryness (P = 0.099). Group 1: excessive dry 5 patients (22.7%), dry 17 patients (77.3%); group 2: excessive dry 3 patients (13.6%), dry 15 patients (68.1%), and persistent sweating 4 patients (18.3%). The rate of satisfaction was 77.3% in group 1, and 63.6% in group 2 with no significant difference (P > 0.05). The rate of compensatory sweating in group 2 (72.7%) was significantly lower than in group 1 (95.4%) (P < 0.039). The chance of embarrassing and disabling compensatory sweating was lower in group 2 than in group 1; 76.5% (embarrassing in 8 patients, disabling in 9) in group 1, and 36.4% (embarrassing in 7 patients, disabling in 1) in group 2 which was statistically significant (P < 0.006). T2 ramicotomy for craniofacial hyperhidrosis lowers the rate of compensatory sweating and excessive dryness of face compared to T2 clipping.

Speech characteristics in a Ugandan child with a rare paramedian craniofacial cleft: a case report.

PubMed

Van Lierde, K M; Bettens, K; Luyten, A; De Ley, S; Tungotyo, M; Balumukad, D; Galiwango, G; Bauters, W; Vermeersch, H; Hodges, A

2013-03-01

The purpose of this study is to describe the speech characteristics in an English-speaking Ugandan boy of 4.5 years who has a rare paramedian craniofacial cleft (unilateral lip, alveolar, palatal, nasal and maxillary cleft, and associated hypertelorism). Closure of the lip together with the closure of the hard and soft palate (one-stage palatal closure) was performed at the age of 5 months. Objective as well as subjective speech assessment techniques were used. The speech samples were perceptually judged for articulation, intelligibility and nasality. The Nasometer was used for the objective measurement of the nasalance values. The most striking communication problems in this child with the rare craniofacial cleft are an incomplete phonetic inventory, a severely impaired speech intelligibility with the presence of very severe hypernasality, mild nasal emission, phonetic disorders (omission of several consonants, decreased intraoral pressure in explosives, insufficient frication of fricatives and the use of a middorsum palatal stop) and phonological disorders (deletion of initial and final consonants and consonant clusters). The increased objective nasalance values are in agreement with the presence of the audible nasality disorders. The results revealed that several phonetic and phonological articulation disorders together with a decreased speech intelligibility and resonance disorders are present in the child with a rare craniofacial cleft. To what extent a secondary surgery for velopharyngeal insufficiency, combined with speech therapy, will improve speech intelligibility, articulation and resonance characteristics is a subject for further research. The results of such analyses may ultimately serve as a starting point for specific surgical and logopedic treatment that addresses the specific needs of children with rare facial clefts. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Nursing care of the patient undergoing coronary artery bypass grafting.

PubMed

Martin, Caron G; Turkelson, Sandra L

2006-01-01

The role of the professional nurse in the perioperative care of the patient undergoing open heart surgery is beneficial for obtaining a positive outcome for the patient. This article focuses on the preoperative and postoperative nursing care of patients undergoing coronary artery bypass graft surgery. Risk assessment, preoperative preparation, current operative techniques, application of the nursing process immediately after surgery, and common postoperative complications will be explored.

Assessment of facial and cranial development and comparison of anthropometric ratios.

PubMed

Mahdi, Esmaeilzadeh

2012-03-01

Anthropometry is the biologic science of human body measurement. Craniofacial anthropometry discusses the characteristics on the measures of different soft and hard tissues of the head and face, and it is considered an important paraclinical record for the growth and development of the index and also for the diagnosis and curing orthodontic matters. Studying the craniofacial anthropometrics ratios is very useful in sciences such as dentistry, medicine, maxillofacial surgery, growth and development studies, plastic surgery, bioengineering, and nonmedical branches such as respiratory equipment and eye-glasses industries. The aims of this study were to determine Iranian cranial and facial anthropometric ratios and compare anthropometric ratios between Iranian and Canadian populations. This cross-sectional analytical study was done randomly on 564 four-to-eleven-year-old boys from Shirvan (North Khorasan, Iran) with normal face patterns. Facial and cranial ratios were estimated and compared. Data were analyzed by SPSS software. The mean values of these parameters were calculated .Finally, the regression line and the growth coefficient were determined for each parameter. Furthermore, the mean anthropometric measurement of Iranians was compared with Canadians. Student t test was used for comparing the measured values. Iranian population when born has hypereuryprosopic face and hypercephalic cranium form. While getting older, the midface height increases, face becomes more prominent, chin becomes shorter, and the face and cranium change to eurycephalic and hyperleptoprosopic form, respectively. Comparison of results related to the face and cranium size between Iranian and Canadian boys (4-11 years old) showed that many craniofacial ratios have significant differences (P < 0.05). Approximately, all of the anthropometric measurements in Iranian population and Canadians were significantly different. Considering the significant difference in the facial and cranial anthropologic ratios and size among Iranians and Canadians, the results obtained from Canadians should not be applied as criteria for treatment plans. Because of the wide population affinity combinations in Iran, more studies, with wider variations, should be conducted among different Iranian population affinity.

Computer Simulation and Digital Resources for Plastic Surgery Psychomotor Education.

PubMed

Diaz-Siso, J Rodrigo; Plana, Natalie M; Stranix, John T; Cutting, Court B; McCarthy, Joseph G; Flores, Roberto L

2016-10-01

Contemporary plastic surgery residents are increasingly challenged to learn a greater number of complex surgical techniques within a limited period. Surgical simulation and digital education resources have the potential to address some limitations of the traditional training model, and have been shown to accelerate knowledge and skills acquisition. Although animal, cadaver, and bench models are widely used for skills and procedure-specific training, digital simulation has not been fully embraced within plastic surgery. Digital educational resources may play a future role in a multistage strategy for skills and procedures training. The authors present two virtual surgical simulators addressing procedural cognition for cleft repair and craniofacial surgery. Furthermore, the authors describe how partnerships among surgical educators, industry, and philanthropy can be a successful strategy for the development and maintenance of digital simulators and educational resources relevant to plastic surgery training. It is our responsibility as surgical educators not only to create these resources, but to demonstrate their utility for enhanced trainee knowledge and technical skills development. Currently available digital resources should be evaluated in partnership with plastic surgery educational societies to guide trainees and practitioners toward effective digital content.

Retention period after treatment of posterior crossbite with maxillary expansion: a systematic review.

PubMed

Costa, Julia Garcia; Galindo, Thaís Magalhães; Mattos, Claudia Trindade; Cury-Saramago, Adriana de Alcantara

2017-01-01

The aim of this systematic review was to evaluate the duration of the retention period in growing patients undergoing maxillary expansion and its relation with posterior crossbite stability. Search strategies were executed for electronic databases Cochrane Library, Web of Science, PubMed and Scopus, which were completed on January 15, 2016. The inclusion criteria included randomized, prospective or retrospective controlled trials in growing subjects with posterior crossbite; treated with maxillary expanders; retention phase after expansion; post-retention phase of at least 6 months. The exclusion criteria were anterior crossbite, craniofacial anomalies, surgery or another orthodontic intervention; case reports; author's opinions articles, thesis, literature reviews and systematic reviews. The risk of bias of selected articles was assessed with Cochrane risk of bias tool for RCTs and Downs and Black checklist for non-RCTs. A total of 156 titles/abstracts was retrieved, 44 full-texts were examined, and 6 articles were selected and assessed for their methodological quality. The retention period after maxillary expansion ranged between 4 weeks and 16 months. Fixed (acrylic plate, Haas, Hyrax and quad-helix) or removable (Hawley and Hawley expander) appliances were used for retention. Six months of retention with either fixed or removable appliances seem to be enough to avoid relapse or to guarantee minimal changes in a short-term follow-up.

Maxillary Hypoplasia With Congenital Oligodontia Treated by Maxillary Distraction Osteogenesis.

PubMed

Mishima, Sayaka; Yamaguchi, Takako; Watanabe, Takuma; Komatani, Toru; Nakao, Kazumasa; Takahashi, Katsu; Bessho, Kazuhisa

2018-02-27

It is known that congenitally missing teeth can often cause differences in craniofacial morphology; however, there are few reported cases of orthognathic surgical treatment for these patients. Herein, the authors report a rare case of maxillary hypoplasia with congenital oligodontia treated by maxillary distraction osteogenesis with internal device. A 17-year-old male presenting with multiple tooth agenesis and maxillary recession was referred to our hospital for orthognathic surgical treatment. Preoperative simulation surgery was performed using Full-Color 3-dimensional salt model. After surgery, improvement in maxillary recession and occlusal stability was observed. This report demonstrates the advantages of the method used herein, which includes reduction in operating time with increase in the safety of the procedure.

Current concepts in cleft care: A multicenter analysis.

PubMed

Thiele, Oliver C; Kreppel, Matthias; Dunsche, Anton; Eckardt, Andre M; Ehrenfeld, Michael; Fleiner, Bernd; Gaßling, Volker; Gehrke, Gerd; Gerressen, Marcus; Gosau, Martin; Gröbe, Alexander; Haßfeld, Stefan; Heiland, Max; Hoffmeister, Bodo; Hölzle, Frank; Klein, Cornelius; Krüger, Maximilian; Kübler, Alexander C; Kübler, Norbert R; Kuttenberger, Johannes J; Landes, Constantin; Lauer, Günter; Martini, Markus; Merholz, Erich T; Mischkowski, Robert A; Al-Nawas, Bilal; Nkenke, Emeka; Piesold, Jörn U; Pradel, Winnie; Rasse, Michael; Rachwalski, Martin; Reich, Rudolf H; Rothamel, Daniel; Rustemeyer, Jan; Scheer, Martin; Schliephake, Henning; Schmelzeisen, Rainer; Schramm, Alexander; Schupp, Wiebke; Spitzer, Wolfgang J; Stocker, Erwin; Stoll, Christian; Terheyden, Hendrik; Voigt, Alexander; Wagner, Wilfried; Weingart, Dieter; Werkmeister, Richard; Wiltfang, Jörg; Ziegler, Christoph M; Zöller, Joachim E

2018-04-01

The current surgical techniques used in cleft repair are well established, but different centers use different approaches. To determine the best treatment for patients, a multi-center comparative study is required. In this study, we surveyed all craniofacial departments registered with the German Society of Maxillofacial Surgery to determine which cleft repair techniques are currently in use. Our findings revealed much variation in cleft repair between different centers. Although most centers did use a two-stage approach, the operative techniques and timing of lip and palate closure were different in every center. This shows that a retrospective comparative analysis of patient outcome between the participating centers is not possible and illustrates the need for prospective comparative studies to establish the optimal technique for reconstructive cleft surgery. Copyright © 2018 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

An Efficient Method for Hair Containment During Head and Neck Surgery.

PubMed

Zingaretti, Nicola; De Biasio, Fabrizio; Riccio, Michele; Marchesi, Andrea; Parodi, Pier Camillo

2017-11-01

The authors present a simple technique for operations around hair-bearing areas such as during a rhytidectomy. Hair surrounding the surgical field is twisted into bundles and clipped with duckbill clips. The authors repeat the procedure for each strand of hair. Between 5 and 7 duckbill clips may be required per surgery.The clippers are faster, easily applicable, and well performing. They can be used with different hair lengths, and they do not require any additional trimming or shaving; clips also keep the hair firmly in place, and they do not loosen up in the process.This technical note explains a very simple, economical, and less time-consuming method to control hair located around the surgical site. It may be applied to all procedures within the field of the hair-bearing scalp, including craniofacial and maxillofacial surgery.

Actigraphy for Measurement of Sleep and Sleep-Wake Rhythms in Relation to Surgery

PubMed Central

Madsen, Michael T.; Rosenberg, Jacob; Gögenur, Ismail

2013-01-01

Study Objectives: Patients undergoing surgery have severe sleep and sleep-wake rhythm disturbances resulting in increased morbidity. Actigraphy is a tool that can be used to quantify these disturbances. The aim of this manuscript was to present the literature where actigraphy has been used to measure sleep and sleep-wake rhythms in relation to surgery. Methods: A systematic review was performed in 3 databases (Medline, Embase, and Psycinfo), including all literature until July 2012. Results: Thirty-two studies were included in the review. Actigraphy could demonstrate that total sleep time and sleep efficiency was reduced after surgery and number of awakenings was increased in patients undergoing major surgery. Disturbances were less severe in patients undergoing minor surgery. Actigraphy could be used to differentiate between delirious and non-delirious patients after major surgery. Actigraphy measurements could determine a differential effect of surgery based on the patient's age. The effect of pharmacological interventions (chronobiotics and hypnotics) in surgical patients could also be demonstrated by actigraphy. Conclusion: Actigraphy can be used to measure sleep and sleep-wake rhythms in patients undergoing surgery. Citation: Madsen MT; Rosenberg J; Gögenur I. Actigraphy for measurement of sleep and sleep-wake rhythms in relation to surgery. J Clin Sleep Med 2013;9(4):387-394. PMID:23585756

Influence of patient-related and surgery-related risk factors on cognitive performance, emotional state, and convalescence after cardiac surgery.

PubMed

Ille, Rottraut; Lahousen, Theresa; Schweiger, Stefan; Hofmann, Peter; Kapfhammer, Hans-Peter

2007-01-01

Cardiac surgery may account for complications such as cognitive impairment, depression, and delay of convalescence. This study investigated the influence of different risk factors on cognitive performance, emotional state, and convalescence. We included 83 patients undergoing cardiac surgery who had no indication of postoperative delirium. Psychometric testing was performed 1 day before and 7 days after surgery. Neuron-specific enolase (NSE) levels were measured 1 day before and 36 h after surgery. Depression score increased after surgery, but patients showed no clinically significant depression. Postoperative cognitive performance correlated with postoperative depression level and preoperative cognitive performance. Forty-three percent of patients showed postoperative decline. Older patients exhibited a higher postoperative increase in NSE concentrations. Patients undergoing coronary artery bypass grafts or combined procedures exhibited more medical risk factors than those undergoing valve surgery alone. The number of bypass grafts was associated with time of hospitalization, and the number of patient-related risk factors correlated with stay in intensive care unit. For elderly patients undergoing cardiac surgery, older age, total preexisting medical risk factors, and surgery duration seem to be the most important factors influencing cognitive outcome and convalescence. Results show that, also for patients without postoperative delirium, medical risk factors and intraoperative parameters can result in delay of convalescence.

Myenteric plexitis: A frequent feature in patients undergoing surgery for colonic diverticular disease

PubMed Central

Villanacci, Vincenzo; Sidoni, Angelo; Nascimbeni, Riccardo; Dore, Maria P; Binda, Gian A; Bandelloni, Roberto; Salemme, Marianna; Del Sordo, Rachele; Cadei, Moris; Manca, Alessandra; Bernardini, Nunzia; Maurer, Christoph A; Cathomas, Gieri

2015-01-01

Background Diverticular disease of the colon is frequent in clinical practice, and a large number of patients each year undergo surgical procedures worldwide for their symptoms. Thus, there is a need for better knowledge of the basic pathophysiologic mechanisms of this disease entity. Objectives Because patients with colonic diverticular disease have been shown to display abnormalities of the enteric nervous system, we assessed the frequency of myenteric plexitis (i.e. the infiltration of myenteric ganglions by inflammatory cells) in patients undergoing surgery for this condition. Methods We analyzed archival resection samples from the proximal resection margins of 165 patients undergoing left hemicolectomy (60 emergency and 105 elective surgeries) for colonic diverticulitis, by histology and immunochemistry. Results Overall, plexitis was present in almost 40% of patients. It was subdivided into an eosinophilic (48%) and a lymphocytic (52%) subtype. Plexitis was more frequent in younger patients; and it was more frequent in those undergoing emergency surgery (50%), compared to elective (28%) surgery (p = 0.007). All the severe cases of plexitis displayed the lymphocytic subtype. Conclusions In conclusion, myenteric plexitis is frequent in patients with colonic diverticular disease needing surgery, and it might be implicated in the pathogenesis of the disease. PMID:26668745

Myenteric plexitis: A frequent feature in patients undergoing surgery for colonic diverticular disease.

PubMed

Bassotti, Gabrio; Villanacci, Vincenzo; Sidoni, Angelo; Nascimbeni, Riccardo; Dore, Maria P; Binda, Gian A; Bandelloni, Roberto; Salemme, Marianna; Del Sordo, Rachele; Cadei, Moris; Manca, Alessandra; Bernardini, Nunzia; Maurer, Christoph A; Cathomas, Gieri

2015-12-01

Diverticular disease of the colon is frequent in clinical practice, and a large number of patients each year undergo surgical procedures worldwide for their symptoms. Thus, there is a need for better knowledge of the basic pathophysiologic mechanisms of this disease entity. Because patients with colonic diverticular disease have been shown to display abnormalities of the enteric nervous system, we assessed the frequency of myenteric plexitis (i.e. the infiltration of myenteric ganglions by inflammatory cells) in patients undergoing surgery for this condition. We analyzed archival resection samples from the proximal resection margins of 165 patients undergoing left hemicolectomy (60 emergency and 105 elective surgeries) for colonic diverticulitis, by histology and immunochemistry. Overall, plexitis was present in almost 40% of patients. It was subdivided into an eosinophilic (48%) and a lymphocytic (52%) subtype. Plexitis was more frequent in younger patients; and it was more frequent in those undergoing emergency surgery (50%), compared to elective (28%) surgery (p = 0.007). All the severe cases of plexitis displayed the lymphocytic subtype. In conclusion, myenteric plexitis is frequent in patients with colonic diverticular disease needing surgery, and it might be implicated in the pathogenesis of the disease.

Histomorhological and clinical evaluation of maxillary alveolar ridge reconstruction after craniofacial trauma by applying combination of allogeneic and autogenous bone graft.

PubMed

De Ponte, Francesco Saverio; Falzea, Roberto; Runci, Michele; Siniscalchi, Enrico Nastro; Lauritano, Floriana; Bramanti, Ennio; Cervino, Gabriele; Cicciu, Marco

2017-02-01

A variety of techniques and materials for the rehabilitation and reconstruction of traumatized maxillary ridges prior to dental implants placement have been described in literature. Autogenous bone grafting is considered ideal by many researchers and it still remains the most predictable and documented method. The aim of this report is to underline the effectiveness of using allogeneic bone graft for managing maxillofacial trauma. A case of a 30-year-old male with severely atrophic maxillary ridge as a consequence of complex craniofacial injury is presented here. Augmentation procedure in two stages was performed using allogeneic and autogenous bone grafts in different areas of the osseous defect. Four months after grafting, during the implants placement surgery, samples of both sectors were withdrawn and submitted to histological evaluation. On the examination of the specimens, treated by hematoxylin and eosin staining, the morphology of integrated allogeneic bone grafts was revealed to be similar to the autologous bone. Our clinical experience shows how the allogeneic bone graft presented normal bone tissue architecture and is highly vascularized, and it can be used for reconstruction of severe trauma of the maxilla. Copyright © 2017 Daping Hospital and the Research Institute of Surgery of the Third Military Medical University. Production and hosting by Elsevier B.V. All rights reserved.

Local Wound Care for Primary Cleft Lip Repair: Treatment and Outcomes With use of Topical Hydrogen Peroxide.

PubMed

Strong, Amy L; Nauta, Allison C; Kuang, Anna A

2015-12-01

This study highlights and validates a peroxide-based wound healing strategy for treatment of surgically closed facial wounds in a pediatric population. The authors identified pediatric patients undergoing primary cleft lip repair as a specific population to evaluate the outcomes of such a protocol. Through analysis of defined outcome measures, a reliable and reproducible protocol for postoperative wound care following primary cleft lip repair with favorable results is described. This retrospective study analyzes wound healing outcomes in pediatric patients undergoing primary cleft lip repair from 2006 to 2011 at a tertiary academic center. The wound healing protocol was used in both primary unilateral and bilateral repairs. One hundred fortysix patients between the ages of 0 and 4 years underwent primary cleft lip repair and cleft rhinoplasty by a single, fellowship-trained craniofacial surgeon. Postoperatively, wounds were treated with half-strength hydrogen peroxide and bacitracin, as well as scar massage. Incisional dehiscence, hypertrophic scar formation, discoloration, infection, and reoperation were studied. Outcomes were evaluated in light of parent compliance, demographics, preoperative nasoalveolar molding (PNAM), and diagnosis. The authors identified 146 patients for inclusion in this study. There was no wound or incisional dehiscence. One hundred twenty-four patients demonstrated favorable cosmetic outcome. Only 3 (2%) of patients who developed suboptimal outcomes underwent secondary surgical revision (> 1 year after surgery). Demographic differences were not statistically significant, and PNAM treatment did not influence outcomes. These data validate the use of halfstrength hydrogen peroxide and bacitracin as part of a wound healing strategy in pediatric incisional wounds. The use of hydrogen peroxide produced comparable outcomes to previously published studies utilizing other wound healing strategies and, therefore, these study findings support the further use of this regimen for this particular population.

Detection of titanium in human tissues after craniofacial surgery.

PubMed

Jorgenson, D S; Mayer, M H; Ellenbogen, R G; Centeno, J A; Johnson, F B; Mullick, F G; Manson, P N

1997-04-01

Generally, titanium fixation plates are not removed after osteosynthesis, because they have high biocompatability and high corrosion resistance characteristics. Experiments with laboratory animals, and limited studies of analyses of human tissues, have reported evidence of titanium release into local and distant tissues. This study summarizes our results of the analysis of soft tissues for titanium in four patients with titanium microfixation plates. Energy dispersive x-ray analysis, scanning electron microscopy, and electrothermal atomic absorption spectrophotometry were used to detect trace amounts of titanium in surrounding soft tissues. A single metal inclusion was detected by scanning electron microscopy and energy dispersive x-ray analysis in one patient, whereas, electrothermal atomic absorption spectrophotometry analyses revealed titanium present in three of four specimens in levels ranging from 7.92 to 31.8 micrograms/gm of dry tissue. Results from this study revealed trace amounts of titanium in tissues surrounding craniofacial plates. At the atomic level, electrothermal atomic absorption spectrophotometry appears to be a sensitive tool to quantitatively detect ultra-trace amounts of metal in human tissue.

Parameters of care for craniosynostosis.

PubMed

McCarthy, Joseph G; Warren, Stephen M; Bernstein, Joseph; Burnett, Whitney; Cunningham, Michael L; Edmond, Jane C; Figueroa, Alvaro A; Kapp-Simon, Kathleen A; Labow, Brian I; Peterson-Falzone, Sally J; Proctor, Mark R; Rubin, Marcie S; Sze, Raymond W; Yemen, Terrance A

2012-01-01

A multidisciplinary meeting was held from March 4 to 6, 2010, in Atlanta, Georgia, entitled "Craniosynostosis: Developing Parameters for Diagnosis, Treatment, and Management." The goal of this meeting was to create parameters of care for individuals with craniosynostosis. Fifty-two conference attendees represented a broad range of expertise, including anesthesiology, craniofacial surgery, dentistry, genetics, hand surgery, neurosurgery, nursing, ophthalmology, oral and maxillofacial surgery, orthodontics, otolaryngology, pediatrics, psychology, public health, radiology, and speech-language pathology. These attendees also represented 16 professional societies and peer-reviewed journals. The current state of knowledge related to each discipline was reviewed. Based on areas of expertise, four breakout groups were created to reach a consensus and draft specialty-specific parameters of care based on the literature or, in the absence of literature, broad clinical experience. In an iterative manner, the specialty-specific draft recommendations were presented to all conference attendees. Participants discussed the recommendations in multidisciplinary groups to facilitate exchange and consensus across disciplines. After the conference, a pediatric intensivist and social worker reviewed the recommendations. Consensus was reached among the 52 conference attendees and two post hoc reviewers. Longitudinal parameters of care were developed for the diagnosis, treatment, and management of craniosynostosis in each of the 18 specialty areas of care from prenatal evaluation to adulthood. To our knowledge, this is the first multidisciplinary effort to develop parameters of care for craniosynostosis. These parameters were designed to help facilitate the development of educational programs for the patient, families, and health-care professionals; stimulate the creation of a national database and registry to promote research, especially in the area of outcome studies; improve credentialing of interdisciplinary craniofacial clinical teams; and improve the availability of health insurance coverage for all individuals with craniosynostosis.

Interdisciplinary evaluation of consecutive patients with unilateral cleft lip and palate at age 6, 15, and 25 years: a concurrent standardized procedure and documentation by plastic surgeon; speech and language pathologist; ear, nose, and throat specialist; and orthodontist.

PubMed

Tindlund, Rolf S; Holmefjord, Anders; Eriksson, Jens-Christian Haug; Johnson, Gunnar E; Vindenes, Hallvard

2009-09-01

To evaluate surgical results, speech, hearing, and craniofacial morphology after primary cleft repair performed from 1973 to 1979. During the years 1972 to 1985, all primary cleft surgeries were performed by 1 plastic surgeon, using Tennison lip closure combined with a periosteoplasty on the clefted alveolus at age 3 months. By mobilizing mucoperiosteal flaps, bony bridges were induced in the alveolar process in approximately 60% of the cases. All patients had the soft palate closed at age 24 months by a pushback technique. All children with complete unilateral clefts without soft tissue bands (unilateral cleft lip and palate) primary operated on 1973 to 1979 were included in the material, except 3 patients with a syndrome and 2 patients of foreign ethnicity. The material involved 30 consecutive patients with unilateral cleft lip and palate (20 boys and 10 girls; 16 left-sided and 14 right-sided clefts) who were operated on. Standardized records including photos, radiographs, lateral cephalograms, plaster model, and recording of speech and hearing were collected according to the treatment protocol at age 6, 15, and approximately 25 years. Evaluation included craniofacial descriptive cephalometric analysis, dentoalveolar morphology, dentofacial aesthetics, speech concerning articulation and nasality, and hearing status. Number of surgical interventions after primary surgery was recorded. Secondary revisions and candidates for orthognathic surgery are reported. Ten consecutive patients (case nos. 11-20) are demonstrated as clinical reports. : This longitudinal study shows how a multidisciplinary evaluation adequate for intercenter comparison can be performed when standardized procedures, registrations, and documentations are available.

Evolution of Class III treatment in orthodontics.

PubMed

Ngan, Peter; Moon, Won

2015-07-01

Angle, Tweed, and Moyers classified Class III malocclusions into 3 types: pseudo, dentoalveolar, and skeletal. Clinicians have been trying to identify the best timing to intercept a Class III malocclusion that develops as early as the deciduous dentition. With microimplants as skeletal anchorage, orthopedic growth modification became more effective, and it also increased the scope of camouflage orthodontic treatment for patients who were not eligible for orthognathic surgery. However, orthodontic treatment combined with orthognathic surgery remains the only option for patients with a severe skeletal Class III malocclusion or a craniofacial anomaly. Distraction osteogenesis can now be performed intraorally at an earlier age. The surgery-first approach can minimize the length of time that the malocclusion needs to worsen before orthognathic surgery. Finally, the use of computed tomography scans for 3-dimensional diagnosis and treatment planning together with advances in imaging technology can improve the accuracy of surgical movements and the esthetic outcomes for these patients. Copyright © 2015 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

The Inequity of Bariatric Surgery: Publicly Insured Patients Undergo Lower Rates of Bariatric Surgery with Worse Outcomes.

PubMed

Hennings, Dietric L; Baimas-George, Maria; Al-Quarayshi, Zaid; Moore, Rachel; Kandil, Emad; DuCoin, Christopher G

2018-01-01

Bariatric surgery has been shown to be the most effective method of achieving weight loss and alleviating obesity-related comorbidities. Yet, it is not being used equitably. This study seeks to identify if there is a disparity in payer status of patients undergoing bariatric surgery and what factors are associated with this disparity. We performed a case-control analysis of National Inpatient Sample. We identified adults with body mass index (BMI) greater than or equal to 25 kg/m 2 who underwent bariatric surgery and matched them with overweight inpatient adult controls not undergoing surgery. The sample was analyzed using multivariate logistic regression. We identified 132,342 cases, in which the majority had private insurance (72.8%). Bariatric patients were significantly more likely to be privately insured than any other payer status; Medicare- and Medicaid-covered patients accounted for a low percentage of cases (Medicare 5.1%, OR 0.33, 95% CI 0.29-0.37, p < 0.001; Medicaid 8.7%, OR 0.21, 95% CI 0.18-0.25, p < 0.001). Medicare (OR 1.54, 95% CI 1.33-1.78, p < 0.001) and Medicaid (OR 1.31, 95% CI 1.08-1.60, p = 0.007) patients undergoing bariatric surgery had an increased risk of complications compared to privately insured patients. Publicly insured patients are significantly less likely to undergo bariatric surgery. As a group, these patients experience higher rates of obesity and related complications and thus are most in need of bariatric surgery.

In-hospital mortality and morbidity after robotic coronary artery surgery.

PubMed

Cavallaro, Paul; Rhee, Amanda J; Chiang, Yuting; Itagaki, Shinobu; Seigerman, Matthew; Chikwe, Joanna

2015-02-01

The objective of this study was to assess the impact of robotic approaches on outcomes of coronary bypass surgery. Retrospective national database analysis. United States hospitals. A weighted sample of 484,128 patients undergoing isolated coronary artery surgery identified from the Nationwide Inpatient Sample from 2008 through 2010. Robotically assisted coronary artery bypass surgery versus conventional bypass surgery. Robotic approaches were used in 2,582 patients (0.4%). Patients undergoing robotic surgery were less likely to be female (odds ratio [OR] 0.71, 95% confidence interval [CI] 0.57-0.87), present with acute myocardial infarction (OR 0.53, 95% CI 0.38-0.73), or have cerebrovascular disease (OR 0.41, 95% CI 0.23-0.71) compared to patients undergoing conventional surgery. In 59% of robotic cases, a single bypass was performed, and 2 bypasses were performed in 25% of cases. After adjusting for comorbidity, reduced postoperative stroke (0.0% v 1.5%, p = 0.045) and transfusion (13.5% v 24.4%, p = 0.001) rates were observed in patients who underwent robotic single-bypass surgery compared to conventional surgery. In patients undergoing multiple bypass grafts, higher mortality (1.1% v 0.5%), and cardiovascular complications (12.2% v 10.6%) were observed when robotic assistance was used, but the differences were not statistically significant (p = 0.5). The mean number of robotic cases carried out annually at institutions sampled was 6. Robotic assistance is associated with lower rates of postoperative complications in highly selected patients undergoing single coronary artery bypass surgery, but the benefits of this approach are reduced in patients who require multiple coronary artery bypass grafts. Copyright © 2014 Elsevier Inc. All rights reserved.

Bioactive-glass in Oral and Maxillofacial Surgery

PubMed Central

Profeta, Andrea Corrado; Huppa, Christoph

2015-01-01

The use of synthetic materials to repair craniofacial defects is increasing today and will increase further in the future. Because of the complexity of the anatomy in the head and neck region, reconstruction and augmentation of this area pose a challenge to the surgeon. This review discusses key facts and applications of traditional reconstruction bone substitutes, also offering comparative information. It then describes the properties and clinical applications of bioactive-glass (B-G) and its variants in oral and maxillofacial surgery, and provides clinical findings. The discussion of each compound includes a description of its composition and structure, the advantages and shortcomings of the material, and its current uses in the field of osteoplastic and reconstructive surgery. With a better understanding of the available alloplastic implants, the surgeon can make a more informed decision as to which implant would be most suitable in a particular patient. PMID:26889342

Society of Thoracic Surgeons 2008 cardiac risk models predict in-hospital mortality of heart valve surgery in a Chinese population: a multicenter study.

PubMed

Wang, Lv; Lu, Fang-Lin; Wang, Chong; Tan, Meng-Wei; Xu, Zhi-yun

2014-12-01

The Society of Thoracic Surgeons 2008 cardiac surgery risk models have been developed for heart valve surgery with and without coronary artery bypass grafting. The aim of our study was to evaluate the performance of Society of Thoracic Surgeons 2008 cardiac risk models in Chinese patients undergoing single valve surgery and the predicted mortality rates of those undergoing multiple valve surgery derived from the Society of Thoracic Surgeons 2008 risk models. A total of 12,170 patients underwent heart valve surgery from January 2008 to December 2011. Combined congenital heart surgery and aortal surgery cases were excluded. A relatively small number of valve surgery combinations were excluded. The final research population included the following isolated heart valve surgery types: aortic valve replacement, mitral valve replacement, and mitral valve repair. The following combined valve surgery types were included: mitral valve replacement plus tricuspid valve repair, mitral valve replacement plus aortic valve replacement, and mitral valve replacement plus aortic valve replacement and tricuspid valve repair. Evaluation was performed by using the Hosmer-Lemeshow test and C-statistics. Data from 9846 patients were analyzed. The Society of Thoracic Surgeons 2008 cardiac risk models showed reasonable discrimination and poor calibration (C-statistic, 0.712; P = .00006 in Hosmer-Lemeshow test). Society of Thoracic Surgeons 2008 models had better discrimination (C-statistic, 0.734) and calibration (P = .5805) in patients undergoing isolated valve surgery than in patients undergoing multiple valve surgery (C-statistic, 0.694; P = .00002 in Hosmer-Lemeshow test). Estimates derived from the Society of Thoracic Surgeons 2008 models exceeded the mortality rates of multiple valve surgery (observed/expected ratios of 1.44 for multiple valve surgery and 1.17 for single valve surgery). The Society of Thoracic Surgeons 2008 cardiac surgery risk models performed well when predicting the mortality for Chinese patients undergoing valve surgery. The Society of Thoracic Surgeons 2008 models were suitable for single valve surgery in a Chinese population; estimates of mortality for multiple valve surgery derived from the Society of Thoracic Surgeons 2008 models were less accurate. Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Airway Management in a Patient with Wolf-Hirschhorn Syndrome.

PubMed

Gamble, John F; Kurian, Dinesh J; Udani, Andrea G; Greene, Nathaniel H

2016-01-01

We present a case of a 3-month-old female with Wolf-Hirschhorn syndrome (WHS) undergoing general anesthesia for laparoscopic gastrostomy tube placement with a focus on airway management. WHS is a rare 4p microdeletion syndrome resulting in multiple congenital abnormalities, including craniofacial deformities. Microcephaly, micrognathia, and glossoptosis are common features in WHS patients and risk factors for a pediatric airway that is potentially difficult to intubate. We discuss anesthesia strategies for airway preparation and management in a WHS patient requiring general anesthesia with endotracheal intubation.

Airway Management in a Patient with Wolf-Hirschhorn Syndrome

PubMed Central

Udani, Andrea G.

2016-01-01

We present a case of a 3-month-old female with Wolf-Hirschhorn syndrome (WHS) undergoing general anesthesia for laparoscopic gastrostomy tube placement with a focus on airway management. WHS is a rare 4p microdeletion syndrome resulting in multiple congenital abnormalities, including craniofacial deformities. Microcephaly, micrognathia, and glossoptosis are common features in WHS patients and risk factors for a pediatric airway that is potentially difficult to intubate. We discuss anesthesia strategies for airway preparation and management in a WHS patient requiring general anesthesia with endotracheal intubation. PMID:27752382

The national comparative audit of surgery for nasal polyposis and chronic rhinosinusitis.

PubMed

Hopkins, C; Browne, J P; Slack, R; Lund, V; Topham, J; Reeves, B; Copley, L; Brown, P; van der Meulen, J

2006-10-01

This study summarises the results of a National Audit of sino-nasal surgery carried out in England and Wales. It describes patient and operative characteristics as well as patient outcomes up to 36 months after surgery. Prospective cohort study. NHS hospitals in England and Wales. Consecutive patients undergoing surgery for nasal polyposis and/or chronic rhinosinusitis. The total score derived from a 22-item version of the Sino-Nasal Outcome Test (SNOT-22). Lower scores represent better health-related quality of life. A total of 3128 consecutive patients at 87 NHS hospitals were enrolled. There is a large improvement in SNOT-22 scores from the pre-operative period (mean = 42.0) to 3 months after surgery (mean = 25.5). The scores for patients undergoing nasal polypectomy improved from 41.0 before surgery to 23.1 at 3 months after surgery, while the scores for patients undergoing surgery for chronic rhinosinusitis alone improved from 44.2 to 31.2. The SNOT-22 scores reported at 12 and 36 months after surgery were similar to those reported at 3 months. Excessive bleeding occurred in 5% of patients during the operation and in 1% of patients after the operation. Intra-orbital complications were reported in 0.2%. Of those patients undergoing primary surgery for bilateral grade I or II polyposis, 18% had not received a pre-operative course of steroid treatment. At the 36-month follow-up, 11.4% of patients had undergone revision surgery. The audit confirms that sino-nasal surgery is generally safe and effective. There is some evidence that patient selection for surgery could be improved.

Risk of iron overload is decreased in beating heart coronary artery surgery compared to conventional bypass.

PubMed

Mumby, S; Koh, T W; Pepper, J R; Gutteridge, J M

2001-11-29

Conventional cardiopulmonary bypass surgery (CCPB) increases the iron loading of plasma transferrin often to a state of plasma iron overload, with the presence of low molecular mass iron. Such iron is a potential risk factor for oxidative stress and microbial virulence. Here we assess 'off-pump' coronary artery surgery on the beating heart for changes in plasma iron chemistry. Seventeen patients undergoing cardiac surgery using the 'Octopus' myocardial wall stabilisation device were monitored at five time points for changes in plasma iron chemistry. This group was further divided into those (n=9) who had one- or two- (n=8) vessel grafts, and compared with eight patients undergoing conventional coronary artery surgery. Patients undergoing beating heart surgery had significantly lower levels of total plasma non-haem iron, and a decreased percentage saturation of their transferrin at all time points compared to conventional bypass patients. Plasma iron overload occurred in only one patient undergoing CCPB. Beating heart surgery appears to decrease red blood cell haemolysis, and tissue damage during the operative procedures and thereby significantly decreases the risk of plasma iron overload associated with conventional bypass.

Etiologies of pediatric craniofacial injuries: a comparison of injuries involving all-terrain vehicles and golf carts.

PubMed

White, Lauren C; McKinnon, Brian J; Hughes, C Anthony

2013-03-01

To determine incidence and etiologies of craniofacial injuries in the pediatric population through comparison of injuries caused by all-terrain vehicles and golf cart trauma. Case series with chart review. Level 1 trauma center. Retrospective review of pediatric traumas at a tertiary academic medical center from 2003 to 2012 identified 196 patients whose injuries resulted from accidents involving either all-terrain vehicles or golf carts. Data was collected and variables such as age, gender, driver vs. passenger, location of accident, Glasgow coma scale, Injury severity scale, Abbreviated injury scale, and presence or absence of helmet use were examined. 196 pediatric patients were identified: 68 patients had injuries resulting from golf cart accidents, and 128 patients from ATV accidents. 66.4% of ATV-related traumas were male, compared to 52.9% of golf cart-related traumas. Ages of injured patients were similar between the two modalities with average age of ATV traumas 10.8 (±4.0) years and golf cart traumas 10.0 (±4.6) years. Caucasians were most commonly involved in both ATV (79.7%) and golf cart traumas (85.3%). 58.6% of all ATV related trauma and 69.1% of all golf cart trauma resulted in craniofacial injuries. The most common craniofacial injury was a closed head injury with brief loss of consciousness, occurring in 46.1% of the ATV traumas and 54.4% of the golf cart traumas. Temporal bone fractures were the second most common type of craniofacial injury, occurring in 5.5% of ATV accidents and 7.4% of the golf cart traumas. Length of hospital stay and, cases requiring surgery and severity scores were similar between both populations. Intensive care admissions and injury severity scores approached but not reach statistical significance (0.096 and 0.083, respectively). The only statistically significant differences between the two modalities were helmet use (P=0.00018%) and days requiring ventilator assistance (P=0.025). ATVs and golf carts are often exempt from the safety features and regulations required of motor vehicles, and ATV and golf cart accidents represent a significant portion of pediatric traumas. This study found that ATV and golf cart accidents contribute significantly to craniofacial trauma requiring hospitalization, with resultant morbidity and mortality. Further investigation of these injuries and their prevention in the pediatric population is needed before efforts to promote effective safety regulations for such vehicles in the future can be addressed. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Qualitative Methods in the Development of a Bilingual and Bicultural Quality of Life Outcomes Measure for Pediatric Patients With Craniofacial Conditions.

PubMed

Tapia, Viridiana Juarez; Drizin, Julia Helene; Dalle Ore, Cecilia; Nieto, Marcelo; Romero, Yajahira; Magallon, Sandra; Nayak, Rohith; Sigler, Alicia; Malcarne, Vanessa; Gosman, Amanda

2017-05-01

Craniofacial surgeons treat patients with diverse craniofacial conditions (CFCs). Yet, little is known about the health-related quality of life (HRQoL) impact of diverse CFCs. Currently, there are no suitable instruments that measure the HRQoL of patients with diverse CFCs from the perspective of children and parents. The objective of this study was to develop the items and support the content validity of a comprehensive patient and parent-reported outcomes measure. An iterative process consisting of a systematic literature review, expert opinion and in-depth interviews with patients and parents of patients with diverse CFCs was used. The literature review and expert opinion were used to generate in-depth interview questions. We interviewed 127 subjects: 80 parents of patients ages 0 to 18 years or older and 47 patients ages 7 to 18 years or older. English and Spanish speakers were represented in our sample. The majority of subjects originated from the United States and Mexico (83%). Craniofacial conditions included were cleft lip/palate, craniosynostosis, craniofacial microsomia, microtia, and dermatological conditions. Semistructured interviews were conducted until content saturation was achieved. Line-by-line analysis of interview transcripts identified HRQoL themes. Themes were interpreted and organized into larger domains that represent the conceptual framework of CFC-associated HRQoL. Themes were operationalized into items that represent the HRQoL issues of patients for both parent and patient versions. Six final bilingual and bicultural scales based on the domains derived from the literature review, expert opinion, and in-depth interviews were developed: (1) "Social Impact," (2) "Psychological Function," (3) "Physical Function," (4) "Family Impact," (5) "Appearance," And (6) "Finding Meaning." Some cultural differences were identified: in contrast to children from Mexico and other developing nations, families from the United States did not report public harassment or extremely negative public reactions to patients' CFC. Religion and spirituality were common themes in interviews of Spanish-speaking subjects but less common in interviews of English-speaking subjects. Qualitative methods involving pediatric patients with diverse CFCs and their parents in the item development process support the content validity for this bilingual and bicultural HRQoL instrument. The items developed in this study will now undergo psychometric testing in national multisite studies for validation.

Impaired Olfaction and Risk for Delirium or Cognitive Decline After Cardiac Surgery

PubMed Central

Brown, Charles H.; Morrissey, Candice; Ono, Masahiro; Yenokyan, Gayane; Selnes, Ola A.; Walston, Jeremy; Max, Laura; LaFlam, Andrew; Neufeld, Karin; Gottesman, Rebecca F.; Hogue, Charles W.

2014-01-01

Summary Statement Impaired olfaction, identified in 33% of patients undergoing cardiac surgery, was associated with the adjusted risk for postoperative delirium but not cognitive decline. Objectives The prevalence and significance of impaired olfaction is not well characterized in patients undergoing cardiac surgery. Because impaired olfaction has been associated with underlying neurologic disease, impaired olfaction may identify patients who are vulnerable to poor neurological outcomes in the perioperative period. The objective of this study was to determine the prevalence of impaired olfaction among patients presenting for cardiac surgery and the independent association of impaired olfaction with postoperative delirium and cognitive decline. Design Nested prospective cohort study Setting Academic hospital Participants 165 patients undergoing coronary artery bypass and/or valve surgery Measurements Olfaction was measured using the Brief Smell Identification Test, with impaired olfaction defined as an olfactory score < 5th percentile of normative data. Delirium was assessed using a validated chart-review method. Cognitive performance was assessed using a neuropsychological testing battery at baseline and 4–6 weeks after surgery. Results Impaired olfaction was identified in 54 of 165 patients (33%) prior to surgery. Impaired olfaction was associated with increased adjusted risk for postoperative delirium (relative risk [RR] 1.90, 95% CI 1.17–3.09; P=0.009). There was no association between impaired olfaction and change in composite cognitive score in the overall study population. Conclusion Impaired olfaction is prevalent in patients undergoing cardiac surgery and is associated with increased adjusted risk for postoperative delirium, but not cognitive decline. Impaired olfaction may identify unrecognized vulnerability for postoperative delirium among patients undergoing cardiac surgery. PMID:25597555

Cosmetic Surgery Makeover Programs and Intentions to Undergo Cosmetic Enhancements: A Consideration of Three Models of Media Effects

ERIC Educational Resources Information Center

Nabi, Robin L.

2009-01-01

The recent proliferation of reality-based television programs highlighting cosmetic surgery has raised concerns that such programming promotes unrealistic expectations of plastic surgery and increases the desire of viewers to undergo such procedures. In Study 1, a survey of 170 young adults indicated little relationship between cosmetic surgery…

New white matter brain injury after infant heart surgery is associated with diagnostic group and the use of circulatory arrest.

PubMed

Beca, John; Gunn, Julia K; Coleman, Lee; Hope, Ayton; Reed, Peter W; Hunt, Rodney W; Finucane, Kirsten; Brizard, Christian; Dance, Brieana; Shekerdemian, Lara S

2013-03-05

Abnormalities on magnetic resonance imaging scans are common both before and after surgery for congenital heart disease in early infancy. The aim of this study was to prospectively investigate the nature, timing, and consequences of brain injury on magnetic resonance imaging in a cohort of young infants undergoing surgery for congenital heart disease both with and without cardiopulmonary bypass. A total of 153 infants undergoing surgery for congenital heart disease at <8 weeks of age underwent serial magnetic resonance imaging scans before and after surgery and at 3 months of age, as well as neurodevelopmental assessment at 2 years of age. White matter injury (WMI) was the commonest type of injury both before and after surgery. It occurred in 20% of infants before surgery and was associated with a less mature brain. New WMI after surgery was present in 44% of infants and at similar rates after surgery with or without cardiopulmonary bypass. The most important association was diagnostic group (P<0.001). In infants having arch reconstruction, the use and duration of circulatory arrest were significantly associated with new WMI. New WMI was also associated with the duration of cardiopulmonary bypass, postoperative lactate level, brain maturity, and WMI before surgery. Brain immaturity but not brain injury was associated with impaired neurodevelopment at 2 years of age. New WMI is common after surgery for congenital heart disease and occurs at the same rate in infants undergoing surgery with and without cardiopulmonary bypass. New WMI is associated with diagnostic group and, in infants undergoing arch surgery, the use of circulatory arrest.

Modelling human skull growth: a validated computational model

PubMed Central

Marghoub, Arsalan; Johnson, David; Khonsari, Roman H.; Fagan, Michael J.; Moazen, Mehran

2017-01-01

During the first year of life, the brain grows rapidly and the neurocranium increases to about 65% of its adult size. Our understanding of the relationship between the biomechanical forces, especially from the growing brain, the craniofacial soft tissue structures and the individual bone plates of the skull vault is still limited. This basic knowledge could help in the future planning of craniofacial surgical operations. The aim of this study was to develop a validated computational model of skull growth, based on the finite-element (FE) method, to help understand the biomechanics of skull growth. To do this, a two-step validation study was carried out. First, an in vitro physical three-dimensional printed model and an in silico FE model were created from the same micro-CT scan of an infant skull and loaded with forces from the growing brain from zero to two months of age. The results from the in vitro model validated the FE model before it was further developed to expand from 0 to 12 months of age. This second FE model was compared directly with in vivo clinical CT scans of infants without craniofacial conditions (n = 56). The various models were compared in terms of predicted skull width, length and circumference, while the overall shape was quantified using three-dimensional distance plots. Statistical analysis yielded no significant differences between the male skull models. All size measurements from the FE model versus the in vitro physical model were within 5%, with one exception showing a 7.6% difference. The FE model and in vivo data also correlated well, with the largest percentage difference in size being 8.3%. Overall, the FE model results matched well with both the in vitro and in vivo data. With further development and model refinement, this modelling method could be used to assist in preoperative planning of craniofacial surgery procedures and could help to reduce reoperation rates. PMID:28566514

Modelling human skull growth: a validated computational model.

PubMed

Libby, Joseph; Marghoub, Arsalan; Johnson, David; Khonsari, Roman H; Fagan, Michael J; Moazen, Mehran

2017-05-01

During the first year of life, the brain grows rapidly and the neurocranium increases to about 65% of its adult size. Our understanding of the relationship between the biomechanical forces, especially from the growing brain, the craniofacial soft tissue structures and the individual bone plates of the skull vault is still limited. This basic knowledge could help in the future planning of craniofacial surgical operations. The aim of this study was to develop a validated computational model of skull growth, based on the finite-element (FE) method, to help understand the biomechanics of skull growth. To do this, a two-step validation study was carried out. First, an in vitro physical three-dimensional printed model and an in silico FE model were created from the same micro-CT scan of an infant skull and loaded with forces from the growing brain from zero to two months of age. The results from the in vitro model validated the FE model before it was further developed to expand from 0 to 12 months of age. This second FE model was compared directly with in vivo clinical CT scans of infants without craniofacial conditions ( n = 56). The various models were compared in terms of predicted skull width, length and circumference, while the overall shape was quantified using three-dimensional distance plots. Statistical analysis yielded no significant differences between the male skull models. All size measurements from the FE model versus the in vitro physical model were within 5%, with one exception showing a 7.6% difference. The FE model and in vivo data also correlated well, with the largest percentage difference in size being 8.3%. Overall, the FE model results matched well with both the in vitro and in vivo data. With further development and model refinement, this modelling method could be used to assist in preoperative planning of craniofacial surgery procedures and could help to reduce reoperation rates. © 2017 The Author(s).

Examining the "July effect" on patients undergoing pituitary surgery.

PubMed

Bashjawish, Bassel; Patel, Shreya; Kılıç, Suat; Hsueh, Wayne D; Liu, James K; Baredes, Soly; Eloy, Jean Anderson

2018-06-15

Our aim in this study was to assess the impact of the turnover of residents in July on patients undergoing pituitary surgery. This work was a retrospective cohort study of cases from the National Inpatient Sample (NIS). Patients who underwent pituitary surgery from 2005 to 2012 were selected in the NIS. Patients undergoing surgery in July and in non-July months were compared to determine differences in demographics, comorbidities, and complications. Of the 12,939 patients, 1098 (8.5%) underwent pituitary surgery in July. Patients receiving surgery in July had similar demographics and Agency for Healthcare Research and Quality comorbidity values compared with patients receiving surgery in other months. There were no significant differences in mortality, cerebral edema, cerebrospinal fluid leakage, iatrogenic pituitary complications, iatrogenic cerebrovascular accidents, urinary tract infections, pulmonary edema, pulmonary complications, or acute cardiac complications. There were no differences in the rate of postoperative fistulas, hematomas, perforations, or infections. The use of meningeal suturing, pedicled or free-flap reconstruction, and skin reconstruction was more frequent in July. Finally, hospitalization costs in July were similar to costs in other months. The turnover of new residents in July showed no change in complication rates for patients undergoing pituitary surgery. Patient care in July is similar to care during other months, demonstrating that hospitals are adequately supervising surgical residents during this transition. © 2018 ARS-AAOA, LLC.

Providing Preoperative Information for Children Undergoing Surgery: A Randomized Study Testing Different Types of Educational Material to Reduce Children's Preoperative Worries

ERIC Educational Resources Information Center

Fernandes, S. C.; Arriaga, P.; Esteves, F.

2014-01-01

This study developed three types of educational preoperative materials and examined their efficacy in preparing children for surgery by analysing children's preoperative worries and parental anxiety. The sample was recruited from three hospitals in Lisbon and consisted of 125 children, aged 8-12 years, scheduled to undergo outpatient surgery. The…

Medical Student Perception of Plastic Surgery and the Impact of Mainstream Media

PubMed Central

Fraser, S. J.; Al Youha, S.; Rasmussen, P. J.

2017-01-01

Background: Plastic surgery as a discipline is poorly understood by many, including primary care physicians, nurses, medical students, and the public. These misconceptions affect the specialty in a number of ways, including referral patterns and recruitment of medical students into residency programs. The reason for these commonly held misconceptions has not yet been addressed in the plastic surgery literature. As such, we assessed medical students’ knowledge and perceptions of plastic surgery as a discipline and explored factors influencing these opinions. Methods: To assess medical students’ knowledge and perceptions of plastic surgery, we conducted an online survey. A total of 231 medical students responded. Interviews were then conducted with 2 focus groups, in which we explored the survey results and reasons behind these misconceptions. Results: As with previous studies, medical students showed a gap in knowledge with respect to plastic surgery. Although they were generally aware that plastic surgeons perform cosmetic procedures and treat burns, they were largely unaware that plastic surgeons perform hand and craniofacial surgeries. Focus groups revealed that television plays a large role in shaping their ideas of plastic surgery. Conclusion: Medical students have a skewed perception of the discipline of plastic surgery, and this is largely influenced by television. Interventions aimed at educating medical students on the matter are recommended, including a greater presence in the preclerkship medical school curriculum. PMID:29026812

Neurosurgical management of anterior meningo-encephaloceles about 60 cases

PubMed Central

Rifi, Loubna; Barkat, Amina; El Khamlichi, Abdeslam; Boulaadas, Malek; El Ouahabi, Abdessamad

2015-01-01

Anterior meningo-encephaloceles (AME) are congenital malformations characterized by herniation of brain tissue and meninges through a defect in the cranium, in frontal, orbital, nasal and ethmoidal regions. The management of this complex congenital malformation is controversial according to whether use, an intracranial, extra-cranial or combined approach. This is the first largest series published in Africa, in which we present our experience in the operative management of AME; we share our recommendation in technical consideration for surgical approach with review of the literature. All patients beneficed of neuro-radiological investigations including Plan X rays, Spiral Three dimensional CT scan and MRI. Ophthalmologic and maxillo-facial evaluations were done in all the cases. MEA are surgically approached in various ways, mainly on the basis of its location and type, by cranio-facial approach in one-step, or in two stages by intracranial approach followed by facial approach, only by cranial approach or facial approach. The surgical results were evaluated in the follow up on the basis of disappearance of cranio-facial tumefaction with correction of hypertelorism. 60 children with AME were treated in our department between January 1992 and December 2012. The mean age at time of surgery was 14 months (20 days to 18 years) with slight men predominance (28 females/32 males). Cranio-facial team operated 21 patients, 16 were operated in two stages by intracranial approach followed by facial approach, 20 cases beneficed the neurosurgical approach and three only the facial approach Some post operative complications were observed: 2 cases of post operative hydrocephalus underwent shunt; CSF fistulas in three cases cured by spinal drainage, one death due to per operative hypothermia, 3 cases of recurrence how needed second surgery. After mean follow up for 80 months (1 year to 19 years) theses techniques permitted a good cosmetics results in 42 cases, average cosmetics results in 8 cases, poor results in 5 cases and worse cosmetics results in 4 cases, The AME are rare conditions we used the multiples approach first intracranial approach followed by facial approach, but after 1998 we used one-step correction by combined approach, only cranial approach when needed or facial correction. PMID:26448810

Current trends and future perspectives of bone substitute materials - from space holders to innovative biomaterials.

PubMed

Kolk, Andreas; Handschel, Jörg; Drescher, Wolf; Rothamel, Daniel; Kloss, Frank; Blessmann, Marco; Heiland, Max; Wolff, Klaus-Dietrich; Smeets, Ralf

2012-12-01

An autologous bone graft is still the ideal material for the repair of craniofacial defects, but its availability is limited and harvesting can be associated with complications. Bone replacement materials as an alternative have a long history of success. With increasing technological advances the spectrum of grafting materials has broadened to allografts, xenografts, and synthetic materials, providing material specific advantages. A large number of bone-graft substitutes are available including allograft bone preparations such as demineralized bone matrix and calcium-based materials. More and more replacement materials consist of one or more components: an osteoconductive matrix, which supports the ingrowth of new bone; and osteoinductive proteins, which sustain mitogenesis of undifferentiated cells; and osteogenic cells (osteoblasts or osteoblast precursors), which are capable of forming bone in the proper environment. All substitutes can either replace autologous bone or expand an existing amount of autologous bone graft. Because an understanding of the properties of each material enables individual treatment concepts this review presents an overview of the principles of bone replacement, the types of graft materials available, and considers future perspectives. Bone substitutes are undergoing a change from a simple replacement material to an individually created composite biomaterial with osteoinductive properties to enable enhanced defect bridging. Copyright © 2012 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

A bibliometric analysis of the 50 most cited papers in cleft lip and palate.

PubMed

Mahon, Nicola A; Joyce, Cormac W

2015-02-01

Citation analysis is an established bibliometric method which catalogues papers according to the number of times they have been referenced. It is believed that the total number of citations an article receives reflects its importance among its peers. Never before has a bibliometric analysis been performed in the area of Cleft Lip and Palate. Our citation analysis creates a comprehensive list of the 50 most influential papers in this field. Journals specializing in Cleft Palate, Craniofacial, Plastic Surgery, Maxillofacial Surgery, Aesthetics and Radiology were searched to establish which articles most enriched the specialty over the past 70 years. The results show an interesting collection of papers which reveal developing trends in surgical techniques. These landmark papers mould and influence management and decision-making today.

Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on Intraoperative Cranial Nerve Monitoring in Vestibular Schwannoma Surgery.

PubMed

Vivas, Esther X; Carlson, Matthew L; Neff, Brian A; Shepard, Neil T; McCracken, D Jay; Sweeney, Alex D; Olson, Jeffrey J

2018-02-01

Does intraoperative facial nerve monitoring during vestibular schwannoma surgery lead to better long-term facial nerve function? This recommendation applies to adult patients undergoing vestibular schwannoma surgery regardless of tumor characteristics. Level 3: It is recommended that intraoperative facial nerve monitoring be routinely utilized during vestibular schwannoma surgery to improve long-term facial nerve function. Can intraoperative facial nerve monitoring be used to accurately predict favorable long-term facial nerve function after vestibular schwannoma surgery? This recommendation applies to adult patients undergoing vestibular schwannoma surgery. Level 3: Intraoperative facial nerve can be used to accurately predict favorable long-term facial nerve function after vestibular schwannoma surgery. Specifically, the presence of favorable testing reliably portends a good long-term facial nerve outcome. However, the absence of favorable testing in the setting of an anatomically intact facial nerve does not reliably predict poor long-term function and therefore cannot be used to direct decision-making regarding the need for early reinnervation procedures. Does an anatomically intact facial nerve with poor electromyogram (EMG) electrical responses during intraoperative testing reliably predict poor long-term facial nerve function? This recommendation applies to adult patients undergoing vestibular schwannoma surgery. Level 3: Poor intraoperative EMG electrical response of the facial nerve should not be used as a reliable predictor of poor long-term facial nerve function. Should intraoperative eighth cranial nerve monitoring be used during vestibular schwannoma surgery? This recommendation applies to adult patients undergoing vestibular schwannoma surgery with measurable preoperative hearing levels and tumors smaller than 1.5 cm. Level 3: Intraoperative eighth cranial nerve monitoring should be used during vestibular schwannoma surgery when hearing preservation is attempted. Is direct monitoring of the eighth cranial nerve superior to the use of far-field auditory brain stem responses? This recommendation applies to adult patients undergoing vestibular schwannoma surgery with measurable preoperative hearing levels and tumors smaller than 1.5 cm. Level 3: There is insufficient evidence to make a definitive recommendation.  The full guideline can be found at: https://www.cns.org/guidelines/guidelines-manage-ment-patients-vestibular-schwannoma/chapter_4. Copyright © 2017 by the Congress of Neurological Surgeons

ADAM10 is essential for cranial neural crest-derived maxillofacial bone development.

PubMed

Tan, Yu; Fu, Runqing; Liu, Jiaqiang; Wu, Yong; Wang, Bo; Jiang, Ning; Nie, Ping; Cao, Haifeng; Yang, Zhi; Fang, Bing

2016-07-08

Growth disorders of the craniofacial bones may lead to craniofacial deformities. The majority of maxillofacial bones are derived from cranial neural crest cells via intramembranous bone formation. Any interruption of the craniofacial skeleton development process might lead to craniofacial malformation. A disintegrin and metalloprotease (ADAM)10 plays an essential role in organ development and tissue integrity in different organs. However, little is known about its function in craniofacial bone formation. Therefore, we investigated the role of ADAM10 in the developing craniofacial skeleton, particularly during typical mandibular bone development. First, we showed that ADAM10 was expressed in a specific area of the craniofacial bone and that the expression pattern dynamically changed during normal mouse craniofacial development. Then, we crossed wnt1-cre transgenic mice with adam10-flox mice to generate ADAM10 conditional knockout mice. The stereomicroscopic, radiographic, and von Kossa staining results showed that conditional knockout of ADAM10 in cranial neural crest cells led to embryonic death, craniofacial dysmorphia and bone defects. Furthermore, we demonstrated that impaired mineralization could be triggered by decreased osteoblast differentiation, increased cell death. Overall, these findings show that ADAM10 plays an essential role in craniofacial bone development. Copyright © 2016 Elsevier Inc. All rights reserved.

Outcomes of complete vs targeted approaches to endoscopic sinus surgery.

PubMed

DeConde, Adam S; Suh, Jeffrey D; Mace, Jess C; Alt, Jeremiah A; Smith, Timothy L

2015-08-01

Functional endoscopic sinus surgery (FESS) was historically predicated on targeted widening of narrow anatomic structures that caused postobstructive persistent sinus inflammation. It is now clear that chronic rhinosinusitis (CRS) is a multifactorial disease with subsets of patients which may require a more extensive surgical approach. This study compares quality-of-life (QOL) and disease severity outcomes after FESS based on the extent of surgical intervention. Participants with CRS were prospectively enrolled into an ongoing, multi-institutional, observational, cohort study. Surgical extent was determined by physician discretion. Participants undergoing bilateral frontal sinusotomy, ethmoidectomy, maxillary antrostomy, and sphenoidotomy were considered to have undergone "complete" surgery, whereas all other participants were categorized as receiving "targeted" surgery. Improvement was evaluated between surgical subgroups with at least 6-month follow-up using the 22-item Sino-Nasal Outcome Test (SNOT-22) and the Brief Smell Inventory Test (B-SIT). A total of 311 participants met inclusion criteria with 147 subjects undergoing complete surgery and 164 targeted surgery. A higher prevalence of asthma, acetylsalicylic acid (ASA) sensitivity, nasal polyposis, and a history of prior sinus surgery (p ≤ 0.002) was present in participants undergoing complete surgery. Mean improvement in SNOT-22 (28.1 ± 21.9 vs 21.9 ± 20.6; p = 0.011) and B-SIT (0.8 ± 3.1 vs 0.2 ± 2.4; p = 0.005) was greater in subjects undergoing complete surgery. Regression models demonstrated a 5.9 ± 2.5 greater relative mean improvement on SNOT-22 total scores with complete surgery over targeted approaches (p = 0.016). Complete surgery was an independent predictor of greater postoperative SNOT-22 score improvement, yet did not achieve clinical significance. Further study is needed to determine the optimal surgical extent. © 2015 ARS-AAOA, LLC.

ADAM10 is essential for cranial neural crest-derived maxillofacial bone development

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tan, Yu, E-mail: tanyu2048@163.com; Fu, Runqing, E-mail: furunqing@sjtu.edu.cn; Liu, Jiaqiang, E-mail: liujqmj@163.com

Growth disorders of the craniofacial bones may lead to craniofacial deformities. The majority of maxillofacial bones are derived from cranial neural crest cells via intramembranous bone formation. Any interruption of the craniofacial skeleton development process might lead to craniofacial malformation. A disintegrin and metalloprotease (ADAM)10 plays an essential role in organ development and tissue integrity in different organs. However, little is known about its function in craniofacial bone formation. Therefore, we investigated the role of ADAM10 in the developing craniofacial skeleton, particularly during typical mandibular bone development. First, we showed that ADAM10 was expressed in a specific area of themore » craniofacial bone and that the expression pattern dynamically changed during normal mouse craniofacial development. Then, we crossed wnt1-cre transgenic mice with adam10-flox mice to generate ADAM10 conditional knockout mice. The stereomicroscopic, radiographic, and von Kossa staining results showed that conditional knockout of ADAM10 in cranial neural crest cells led to embryonic death, craniofacial dysmorphia and bone defects. Furthermore, we demonstrated that impaired mineralization could be triggered by decreased osteoblast differentiation, increased cell death. Overall, these findings show that ADAM10 plays an essential role in craniofacial bone development. -- Highlights: •We firstly reported that ADAM10 was essentially involved in maxillofacial bone development. •ADAM10 cKO mice present craniofacial dysmorphia and bone defects. •Impaired osteoblast differentiation,proliferation and apoptosis underlie the bone deformity.« less

Preventative Therapeutics for Heterotopic Ossification

DTIC Science & Technology

2015-10-01

in the general population undergoing invasive surgeries such as total hip arthroplasty . There is also a congenital form of it that can affect...insults and can also occur in patients undergoing invasive surgeries, including total hip arthroplasty (6). HO is very common in our wounded service

Modeling human craniofacial disorders in Xenopus

PubMed Central

Dubey, Aditi; Saint-Jeannet, Jean-Pierre

2017-01-01

Purpose of Review Craniofacial disorders are among the most common human birth defects and present an enormous health care and social burden. The development of animal models has been instrumental to investigate fundamental questions in craniofacial biology and this knowledge is critical to understand the etiology and pathogenesis of these disorders. Recent findings The vast majority of craniofacial disorders arise from abnormal development of the neural crest, a multipotent and migratory cell population. Therefore, defining the pathogenesis of these conditions starts with a deep understanding of the mechanisms that preside over neural crest formation and its role in craniofacial development. Summary This review discusses several studies using Xenopus embryos to model human craniofacial conditions, and emphasizes the strength of this system to inform important biological processes as they relate to human craniofacial development and disease. PMID:28255527

A Surgery-first approach in surgical-orthodontic treatment of mandibular prognathism--a case report.

PubMed

Yu, Chung-Chih; Chen, Po-Hsun; Liou, Eric J W; Huang, Chiung-Shing; Chen, Yu-Ray

2010-01-01

The conventional approach in orthodontic surgery treatment of dentofacial anomalies requires a varied period of pre-surgical orthodontic treatment. This presurgical period is considered to be important for adequate surgical treatment and stable results. This period is usually long bothersome for patients because dental decompensation is required and there is consequent deterioration of aesthetics and function, especially in cases of skeletal Class III occlusion. At Chang Gung Craniofacial Center, a surgery-first approach (SFA), i.e. minimal pre-surgical orthodontics, is one of the treatment choices for Class III patients. In this report, we present a 19-year-old man with mandibular prognathism, an anterior open bite and severe dental crowding treated with SFA. The patient received orthognathic surgery a week after bracing of the teeth. The operation and recovery were uneventful as well as the following orthodontic treatment. The total treatment time was only four months, much shorter than with the conventional approach. The patient benefitted from immediate improvement of the facial profile after surgery, and a much shorter total treatment, and the results were not compromised. We believe in selected cases, SFA is a good and effective treatment alternative.

Craniofacial Tissue Engineering by Stem Cells

PubMed Central

Mao, J.J.; Giannobile, W.V.; Helms, J.A.; Hollister, S.J.; Krebsbach, P.H.; Longaker, M.T.; Shi, S.

2008-01-01

Craniofacial tissue engineering promises the regeneration or de novo formation of dental, oral, and craniofacial structures lost to congenital anomalies, trauma, and diseases. Virtually all craniofacial structures are derivatives of mesenchymal cells. Mesenchymal stem cells are the offspring of mesenchymal cells following asymmetrical division, and reside in various craniofacial structures in the adult. Cells with characteristics of adult stem cells have been isolated from the dental pulp, the deciduous tooth, and the periodontium. Several craniofacial structures—such as the mandibular condyle, calvarial bone, cranial suture, and subcutaneous adipose tissue—have been engineered from mesenchymal stem cells, growth factor, and/or gene therapy approaches. As a departure from the reliance of current clinical practice on durable materials such as amalgam, composites, and metallic alloys, biological therapies utilize mesenchymal stem cells, delivered or internally recruited, to generate craniofacial structures in temporary scaffolding biomaterials. Craniofacial tissue engineering is likely to be realized in the foreseeable future, and represents an opportunity that dentistry cannot afford to miss. PMID:17062735

Craniofacial imaging informatics and technology development.

PubMed

Vannier, M W

2003-01-01

'Craniofacial imaging informatics' refers to image and related scientific data from the dentomaxillofacial complex, and application of 'informatics techniques' (derived from disciplines such as applied mathematics, computer science and statistics) to understand and organize the information associated with the data. Major trends in information technology determine the progress made in craniofacial imaging and informatics. These trends include industry consolidation, disruptive technologies, Moore's law, electronic atlases and on-line databases. Each of these trends is explained and documented, relative to their influence on craniofacial imaging. Craniofacial imaging is influenced by major trends that affect all medical imaging and related informatics applications. The introduction of cone beam craniofacial computed tomography scanners is an example of a disruptive technology entering the field. An important opportunity lies in the integration of biologic knowledge repositories with craniofacial images. The progress of craniofacial imaging will continue subject to limitations imposed by the underlying technologies, especially imaging informatics. Disruptive technologies will play a major role in the evolution of this field.

Impact of the viral respiratory season on postoperative outcomes in children undergoing cardiac surgery.

PubMed

Spaeder, Michael C; Carson, Kathryn A; Vricella, Luca A; Alejo, Diane E; Holmes, Kathryn W

2011-08-01

To compare postoperative outcomes in children undergoing cardiac surgery during the viral respiratory season and nonviral season at our institution. This was a retrospective cohort study and secondary matched case-control analysis. The setting was an urban academic tertiary-care children's hospital. The study was comprised of all patients <18 years of age who underwent cardiac surgery at Johns Hopkins Hospital from October 2002 through September 2007. Patients were stratified by season of surgery, complexity of cardiac disease, and presence or absence of viral respiratory infection. Measurements included patient characteristics and postoperative outcomes. The primary outcome was postoperative length of stay (LOS). A total of 744 patients were included in the analysis. There was no difference in baseline characteristics or outcomes, specifically, no difference in postoperative LOS, intensive care unit (ICU) LOS, and mortality, among patients by seasons of surgery. Patients with viral respiratory illness were more likely to have longer postoperative LOS (p < 0.01) and ICU LOS (p < 0.01) compared with matched controls. We identified no difference in postoperative outcomes based on season in patients undergoing cardiac surgery. Children with viral respiratory infection have significantly worse outcomes than matched controls, strengthening the call for universal administration of influenza vaccination and palivizumab to appropriate groups. Preoperative testing for respiratory viruses should be considered during the winter months for children undergoing elective cardiac surgery.

The Role of Palliative Surgery in Gynecologic Cancer Cases

PubMed Central

Hope, Joanie Mayer

2013-01-01

The decision to undergo major palliative surgery in end-stage gynecologic cancer is made when severe disease symptoms significantly hinder quality of life. Malignant bowel obstruction, unremitting pelvic pain, fistula formation, tumor necrosis, pelvic sepsis, and chronic hemorrhage are among the reasons patients undergo palliative surgeries. This review discusses and summarizes the literature on surgical management of malignant bowel obstruction and palliative pelvic exenteration in gynecologic oncology. PMID:23299775

Left atrial concomitant surgical ablation for treatment of atrial fibrillation in cardiac surgery: A meta-analysis of randomized controlled trials

PubMed Central

Wang, Chunguo; Ye, Minhua; Lin, Jiang; Jin, Jiang; Hu, Quanteng; Zhu, Chengchu; Chen, Baofu

2018-01-01

Introduction Surgical ablation is a generally established treatment for patients with atrial fibrillation undergoing concomitant cardiac surgery. Left atrial (LA) lesion set for ablation is a simplified procedure suggested to reduce the surgery time and morbidity after procedure. The present meta-analysis aims to explore the outcomes of left atrial lesion set versus no ablative treatment in patients with AF undergoing cardiac surgery. Methods A literature research was performed in six database from their inception to July 2017, identifying all relevant randomized controlled trials (RCTs) comparing left atrial lesion set versus no ablative treatment in AF patient undergoing cardiac surgery. Data were extracted and analyzed according to predefined clinical endpoints. Results Eleven relevant RCTs were included for analysis in the present study. The prevalence of sinus rhythm in ablation group was significantly higher at discharge, 6-month and 1-year follow-up period. The morbidity including 30 day mortality, late all-cause mortality, reoperation for bleeding, permanent pacemaker implantation and neurological events were of no significant difference between two groups. Conclusions The result of our meta-analysis demonstrates that left atrial lesion set is an effective and safe surgical ablation strategy for AF patients undergoing concomitant cardiac surgery. PMID:29360851

3D craniofacial registration using thin-plate spline transform and cylindrical surface projection

PubMed Central

Chen, Yucong; Deng, Qingqiong; Duan, Fuqing

2017-01-01

Craniofacial registration is used to establish the point-to-point correspondence in a unified coordinate system among human craniofacial models. It is the foundation of craniofacial reconstruction and other craniofacial statistical analysis research. In this paper, a non-rigid 3D craniofacial registration method using thin-plate spline transform and cylindrical surface projection is proposed. First, the gradient descent optimization is utilized to improve a cylindrical surface fitting (CSF) for the reference craniofacial model. Second, the thin-plate spline transform (TPST) is applied to deform a target craniofacial model to the reference model. Finally, the cylindrical surface projection (CSP) is used to derive the point correspondence between the reference and deformed target models. To accelerate the procedure, the iterative closest point ICP algorithm is used to obtain a rough correspondence, which can provide a possible intersection area of the CSP. Finally, the inverse TPST is used to map the obtained corresponding points from the deformed target craniofacial model to the original model, and it can be realized directly by the correspondence between the original target model and the deformed target model. Three types of registration, namely, reflexive, involutive and transitive registration, are carried out to verify the effectiveness of the proposed craniofacial registration algorithm. Comparison with the methods in the literature shows that the proposed method is more accurate. PMID:28982117

3D craniofacial registration using thin-plate spline transform and cylindrical surface projection.

PubMed

Chen, Yucong; Zhao, Junli; Deng, Qingqiong; Duan, Fuqing

2017-01-01

Craniofacial registration is used to establish the point-to-point correspondence in a unified coordinate system among human craniofacial models. It is the foundation of craniofacial reconstruction and other craniofacial statistical analysis research. In this paper, a non-rigid 3D craniofacial registration method using thin-plate spline transform and cylindrical surface projection is proposed. First, the gradient descent optimization is utilized to improve a cylindrical surface fitting (CSF) for the reference craniofacial model. Second, the thin-plate spline transform (TPST) is applied to deform a target craniofacial model to the reference model. Finally, the cylindrical surface projection (CSP) is used to derive the point correspondence between the reference and deformed target models. To accelerate the procedure, the iterative closest point ICP algorithm is used to obtain a rough correspondence, which can provide a possible intersection area of the CSP. Finally, the inverse TPST is used to map the obtained corresponding points from the deformed target craniofacial model to the original model, and it can be realized directly by the correspondence between the original target model and the deformed target model. Three types of registration, namely, reflexive, involutive and transitive registration, are carried out to verify the effectiveness of the proposed craniofacial registration algorithm. Comparison with the methods in the literature shows that the proposed method is more accurate.

Incidence of Speech-Correcting Surgery in Children With Isolated Cleft Palate.

PubMed

Gustafsson, Charlotta; Heliövaara, Arja; Leikola, Junnu; Rautio, Jorma

2018-01-01

Speech-correcting surgeries (pharyngoplasty) are performed to correct velopharyngeal insufficiency (VPI). This study aimed to analyze the need for speech-correcting surgery in children with isolated cleft palate (ICP) and to determine differences among cleft extent, gender, and primary technique used. In addition, we assessed the timing and number of secondary procedures performed and the incidence of operated fistulas. Retrospective medical chart review study from hospital archives and electronic records. These comprised the 423 consecutive nonsyndromic children (157 males and 266 females) with ICP treated at the Cleft Palate and Craniofacial Center of Helsinki University Hospital during 1990 to 2016. The total incidence of VPI surgery was 33.3% and the fistula repair rate, 7.8%. Children with cleft of both the hard and soft palate (n = 300) had a VPI secondary surgery rate of 37.3% (fistula repair rate 10.7%), whereas children with only cleft of the soft palate (n = 123) had a corresponding rate of 23.6% (fistula repair rate 0.8%). Gender and primary palatoplasty technique were not considered significant factors in need for VPI surgery. The majority of VPI surgeries were performed before school age. One fifth of patients receiving speech-correcting surgery had more than one subsequent procedure. The need for speech-correcting surgery and fistula repair was related to the severity of the cleft. Although the majority of the corrective surgeries were done before the age of 7 years, a considerable number were performed at a later stage, necessitating long-term observation.

Current Status of Surgical Planning for Orthognathic Surgery: Traditional Methods versus 3D Surgical Planning

PubMed Central

Hammoudeh, Jeffrey A.; Howell, Lori K.; Boutros, Shadi; Scott, Michelle A.

2015-01-01

Background: Orthognathic surgery has traditionally been performed using stone model surgery. This involves translating desired clinical movements of the maxilla and mandible into stone models that are then cut and repositioned into class I occlusion from which a splint is generated. Model surgery is an accurate and reproducible method of surgical correction of the dentofacial skeleton in cleft and noncleft patients, albeit considerably time-consuming. With the advent of computed tomography scanning, 3D imaging and virtual surgical planning (VSP) have gained a foothold in orthognathic surgery with VSP rapidly replacing traditional model surgery in many parts of the country and the world. What has yet to be determined is whether the application and feasibility of virtual model surgery is at a point where it will eliminate the need for traditional model surgery in both the private and academic setting. Methods: Traditional model surgery was compared with VSP splint fabrication to determine the feasibility of use and accuracy of application in orthognathic surgery within our institution. Results: VSP was found to generate acrylic splints of equal quality to model surgery splints in a fraction of the time. Drawbacks of VSP splint fabrication are the increased cost of production and certain limitations as it relates to complex craniofacial patients. Conclusions: It is our opinion that virtual model surgery will displace and replace traditional model surgery as it will become cost and time effective in both the private and academic setting for practitioners providing orthognathic surgical care in cleft and noncleft patients. PMID:25750846

Pediatric Facial Fractures: Interpersonal Violence as a Mechanism of Injury.

PubMed

Hoppe, Ian C; Kordahi, Anthony M; Lee, Edward S; Granick, Mark S

2015-07-01

Interpersonal violence is a relatively infrequent cause of injury to the craniofacial skeleton in the pediatric population. The presentation of fractures as a result of different causes varies dramatically and can have a direct impact on management. The current study compares facial fractures in a pediatric population as a result of interpersonal violence with other mechanisms of injury. A retrospective review of all of the facial fractures at a level 1 trauma center in an urban environment was performed for the years 2000 to 2012. Patients ≤18 years were included. Patient demographics were collected, as well as location of fractures, concomitant injuries, services consulted, and surgical management strategies. Patients were placed into 2 groups, those sustaining an injury as a result of interpersonal violence and all others. A significance value of 5% was used. During this period, there were 3147 facial fractures treated at our institution, 353 of which were in pediatric patients. Upon further review, 68 patients were excluded because of insufficient data for analysis, leaving 285 patients for review. There were 124 (43.5%) patients identified as sustaining a fracture as a result of interpersonal violence. Those sustaining a fracture as a result of interpersonal violence were statistically (P < 0.05) more likely to be boys and to have sustained a fracture of the mandible. The most common services consulted for this group of patients was plastic surgery and oral and maxillofacial surgery. This group of patients was statistically (P < 0.05) more likely to be admitted specifically for management of a facial fracture and statistically (P < 0.05) more likely to be treated operatively with rigid internal fixation. Those sustaining a fracture as a result of interpersonal violence were significantly less likely to have other systemic injuries such as spinal fractures, intracranial fractures, long bone fractures, and pelvic/thoracic fractures. This group was also more likely to undergo treatment via conservative means. In addition, a significantly higher Glasgow Coma Scale (14.7 vs 12.8) and age (16.0 vs 12.8 years) and a significantly lower hospital length of stay (2.9 vs 7.9 days) was observed in the group subjected to interpersonal violence. Pediatric patients experiencing facial facture as a result of interpersonal violence show a very distinctive pattern of presentation. The energy associated with the injury is likely focused directly at the craniofacial skeleton and therefore other organ systems are spared. This allows more directed fracture management resulting in a shorter hospital stay when necessitating admission. The findings of the current study are important in that such a large proportion of the patients reviewed experienced interpersonal violence, more so than most other similar studies.

Hispanic parents' experiences of the process of caring for a child undergoing routine surgery: a focus on pain and pain management.

PubMed

Olshansky, Ellen; Zender, Robynn; Kain, Zeev N; Rosales, Alvina; Guadarrama, Josue; Fortier, Michelle A

2015-07-01

The purpose was to understand the processes Hispanic parents undergo in managing postoperative care of children after routine surgical procedures. Sixty parents of children undergoing outpatient surgery were interviewed. Data were analyzed using grounded theory methodology. Parents experienced five subprocesses that comprised the overall process of caring for a child after routine surgery: (a) becoming informed; (b) preparing; (c) seeking reassurance; (d) communicating with one's child; and (e) making pain management decisions. Addressing cultural factors related to pain management in underserved families may instill greater confidence in managing pain. © 2015, Wiley Periodicals, Inc.

Reconstructive Surgery of Auricular Defects: An Overview.

PubMed

Ebrahimi, Ali; Kazemi, Alireza; Rasouli, Hamid Reza; Kazemi, Maryam; Kalantar Motamedi, Mohammad Hosein

2015-11-01

Despite the ongoing advances in surgical procedures and promising progress in bioengineering techniques, auricular reconstruction remains a significant challenge in plastic surgery. There are different causes for acquired auricular defects, including trauma, tumor ablation and burns. The management options for upper, middle and lower third auricular defects are briefly reviewed in the current paper. Original research papers investigating the plastic surgeons, otolaryngologists and maxillofacial surgeons in approaching the complicated issue of auricular reconstruction published from January 1995 to December 2014 were aggregated and used in the current study. Utilizing autologous stem cell populations to treat craniofacial defects is a promising field of ongoing investigations. Studies show that cartilage stem/progenitor cells (CSPCs) are highly chondrogenic and can produce elastic reconstructive material with long-term tissue restoration. Auricular reconstruction surgery is a challenging plastic procedure that requires great expertise and expert knowledge of the various techniques available. Novel techniques in the fields of reconstructive bioengineering and regenerative medicine are promising but further research is required before widespread clinical application.

Carotid-cavernous fistula after functional endoscopic sinus surgery.

PubMed

Karaman, Emin; Isildak, Huseyin; Haciyev, Yusuf; Kaytaz, Asim; Enver, Ozgun

2009-03-01

Carotid-cavernous fistulas (CCFs) are anomalous communications between the carotid arterial system and the venous cavernous sinus. They can arise because of spontaneous or trauma causes. Most caroticocavernous fistulas are of spontaneous origin and unknown etiology. Spontaneous CCF may also be associated with cavernous sinus pathology such as arteriosclerotic changes of the arterial wall, fibromuscular dysplasia, or Ehler-Danlos syndrome. Traumatic CCFs may occur after either blunt or penetrating head trauma. Their clinical presentation is related to their size and to the type of venous drainage, which can lead to a variety of symptoms, such as visual loss, proptosis, bruit, chemosis, cranial nerve impairment, intracranial hemorrhage (rare), and so on. Treatment by endovascular transarterial embolization with electrolytically detachable coils is a very effective method for CCF with good outcomes. Carotid-cavernous fistulas have been rarely reported after craniofacial surgery and are uncommon pathologies in otolaryngology practice. In this study, we report a 40-year-old woman with CCF secondary to blunt trauma of functional endoscopic sinus surgery.

Enhanced Recovery After Surgery Program Implementation in 2 Surgical Populations in an Integrated Health Care Delivery System.

PubMed

Liu, Vincent X; Rosas, Efren; Hwang, Judith; Cain, Eric; Foss-Durant, Anne; Clopp, Molly; Huang, Mengfei; Lee, Derrick C; Mustille, Alex; Kipnis, Patricia; Parodi, Stephen

2017-07-19

Novel approaches to perioperative surgical care focus on optimizing nutrition, mobility, and pain management to minimize adverse events after surgical procedures. To evaluate the outcomes of an enhanced recovery after surgery (ERAS) program among 2 target populations: patients undergoing elective colorectal resection and patients undergoing emergency hip fracture repair. A pre-post difference-in-differences study before and after ERAS implementation in the target populations compared with contemporaneous surgical comparator groups (patients undergoing elective gastrointestinal surgery and emergency orthopedic surgery). Implementation began in February and March 2014 and concluded by the end of 2014 at 20 medical centers within the Kaiser Permanente Northern California integrated health care delivery system. A multifaceted ERAS program designed with a particular focus on perioperative pain management, mobility, nutrition, and patient engagement. The primary outcome was hospital length of stay. Secondary outcomes included hospital mortality, home discharge, 30-day readmission rates, and complication rates. The study included a total of 3768 patients undergoing elective colorectal resection (mean [SD] age, 62.7 [14.1] years; 1812 [48.1%] male) and 5002 patients undergoing emergency hip fracture repair (mean [SD] age, 79.5 [11.8] years; 1586 [31.7%] male). Comparator surgical patients included 5556 patients undergoing elective gastrointestinal surgery and 1523 patients undergoing emergency orthopedic surgery. Most process metrics had significantly greater changes in the ERAS target populations after implementation compared with comparator surgical populations, including those for ambulation, nutrition, and opioid use. Hospital length of stay and postoperative complication rates were also significantly lower among ERAS target populations after implementation. The rate ratios for postoperative complications were 0.68 (95% CI, 0.46-0.99; P = .04) for patients undergoing colorectal resection and 0.67 (95% CI, 0.45-0.99, P = .05) for patients with hip fracture. Among patients undergoing colorectal resection, ERAS implementation was associated with decreased rates of hospital mortality (0.17; 95% CI, 0.03-0.86; P = .03), whereas among patients with hip fracture, implementation was associated with increased rates of home discharge (1.24; 95% CI, 1.06-1.44; P = .007). Multicenter implementation of an ERAS program among patients undergoing elective colorectal resection and patients undergoing emergency hip fracture repair successfully altered processes of care and was associated with significant absolute and relative decreases in hospital length of stay and postoperative complication rates. Rapid, large-scale implementation of a multidisciplinary ERAS program is feasible and effective in improving surgical outcomes.

Blood glucose management in the patient undergoing cardiac surgery: A review

PubMed Central

Reddy, Pingle; Duggar, Brian; Butterworth, John

2014-01-01

Both diabetes mellitus and hyperglycemia per se are associated with negative outcomes after cardiac surgery. In this article, we review these associations, the possible mechanisms that lead to adverse outcomes, and the epidemiology of diabetes focusing on those patients requiring cardiac surgery. We also examine outpatient and perioperative management of diabetes with the same focus. Finally, we discuss our own efforts to improve glycemic management of patients undergoing cardiac surgery at our institution, including keys to success, results of implementation, and patient safety concerns. PMID:25429332

A novel protocol for antibiotic prophylaxis based on preoperative kidney function in patients undergoing open heart surgery under cardiopulmonary bypass.

PubMed

Odaka, Mizuho; Minakata, Kenji; Toyokuni, Hideaki; Yamazaki, Kazuhiro; Yonezawa, Atsushi; Sakata, Ryuzo; Matsubara, Kazuo

2015-08-01

This study aimed to develop and assess the effectiveness of a protocol for antibiotic prophylaxis based on preoperative kidney function in patients undergoing open heart surgery. We established a protocol for antibiotic prophylaxis based on preoperative kidney function in patients undergoing open heart surgery. This novel protocol was assessed by comparing patients undergoing open heart surgery before (control group; n = 30) and after its implementation (protocol group; n = 31) at Kyoto University Hospital between July 2012 and January 2013. Surgical site infections (SSIs) were observed in 4 control group patients (13.3 %), whereas no SSIs were observed in the protocol group patients (P < 0.05). The total duration of antibiotic use decreased significantly from 80.7 ± 17.6 h (mean ± SD) in the control group to 55.5 ± 14.9 h in the protocol group (P < 0.05). Similarly, introduction of the protocol significantly decreased the total antibiotic dose used in the perioperative period (P < 0.05). Furthermore, antibiotic regimens were changed under suspicion of infection in 5 of 30 control group patients, whereas none of the protocol group patients required this additional change in the antibiotic regimen (P < 0.05). Our novel antibiotic prophylaxis protocol based on preoperative kidney function effectively prevents SSIs in patients undergoing open heart surgery.

A comparison of trends in operative approach and postoperative outcomes for colorectal cancer surgery.

PubMed

Addae, Jamin K; Gani, Faiz; Fang, Sandy Y; Wick, Elizabeth C; Althumairi, Azah A; Efron, Jonathan E; Canner, Joseph K; Euhus, David M; Schneider, Eric B

2017-02-01

Data-assessing trends and perioperative outcomes relative to surgical approach for colorectal cancer (CRC) surgery are lacking. We report national trends of CRC surgery and compare postoperative outcomes by surgical approach. A total of 261,886 patients undergoing surgery for CRC were identified using the Nationwide Inpatient Sample from 2009 to 2012. Trends in surgical approach were assessed using the Cochrane-Armitage test of trends. Multivariable logistic and linear regression analyses were performed to compare length of stay (LOS), postoperative complications, and cost by surgical approach. At the time of surgery, 57.5% underwent an open procedure, whereas 42.4% underwent either a laparoscopic (39.9%) or robotic (2.5%) colorectal surgery. The use of minimally invasive surgery increased over time (2009 versus 2012: 37.3% versus 46.8%; P < 0.001). Postoperative morbidity was 15.9% and was higher after open surgery (open versus laparoscopic versus robotic: 18.4% versus 12.4% versus 13.3%; P < 0.001). Patients who underwent a minimally invasive surgery had shorter LOS (laparoscopic: OR, 0.55, 95% CI, 0.52-0.58; robotic: OR, 0.58; 95% CI, 0.49-0.69; both P < 0.001). Robotic surgery was consistently associated with the highest mean costs followed by laparoscopic and open surgery (P < 0.001). Patients undergoing minimally invasive colorectal surgery had a lower postoperative morbidity and shorter LOS compared with patients undergoing open colorectal surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

Repair of Frontoethmoidal Encephalocele in the Philippines: An Account of 30 Cases Between 2008-2013.

PubMed

Marshall, Amanda-Lynn; Setty, Pradeep; Hnatiuk, Mark; Pieper, Daniel R

2017-07-01

Frontoethmoidal encephalocele is a congenital abnormality of the anterior skull base involving herniation of cranial contents through a midline skull defect. Patency of the foramen cecum, along with other multifactorial variables, contributes to the development of frontoethmoidal encephaloceles. Because of limited resources, financial constraints, and lack of surgical expertise, repair of frontoethmoidal encephaloceles is limited in developing countries. Between 2008 and 2013 an interdisciplinary team composed of neurosurgeons, craniofacial surgeons, otolaryngologists, plastic surgeons, and nursing personnel, conducted surgical mission trips to Davao City in Mindanao, Philippines. All patients underwent a combined extracranial/intracranial surgical approach, performed in tandem by a neurosurgeon and a craniofacial surgeon, to detach and remove the encephalocele. This procedure was followed by reconstruction of the craniofacial defects. A total of 30 cases of frontoethmoidal encephalocele were repaired between 2008 and 2013 (20 male; 10 female). The average age at operation was 8.7 years, with 7 patients older than 17 years. Of the 3 subtypes, the following breakdown was observed in patients: 18 nasoethmoidal; 9 nasofrontal; and 3 naso-orbital. Several patients showed concurrent including enlarged ventricles, arachnoid cysts (both unilateral and bilateral), and gliotic changes, as well as orbit and bulbus oculi (globe) deformities. There were no operative-associated mortalities or neurologic deficits, infections, or hydrocephalus on follow-up during subsequent trips. Despite the limitations of performing advanced surgery in a developing country, the combined interdisciplinary surgical approach has offered effective treatment to improve physical appearance and psychological well-being in afflicted patients. Copyright © 2017 Elsevier Inc. All rights reserved.

OCT imaging of craniofacial anatomy in xenopus embryos (Conference Presentation)

NASA Astrophysics Data System (ADS)

Deniz, Engin; Jonas, Stephan M.; Griffin, John; Hooper, Michael C.; Choma, Michael A.; Khokha, Mustafa K.

2016-03-01

The etiology of craniofacial defects is incompletely understood. The ability to obtain large amounts of gene sequence data from families affected by craniofacial defects is opening up new ways to understand molecular genetic etiological factors. One important link between gene sequence data and clinical relevance is biological research into candidate genes and molecular pathways. We present our recent research using OCT as a nondestructive phenotyping modality of craniofacial morphology in Xenopus embryos, an important animal model for biological research in gene and pathway discovery. We define 2D and 3D scanning protocols for a standardized approach to craniofacial imaging in Xenopus embryos. We define standard views and planar reconstructions for visualizing normal anatomy and landmarks. We compare these views and reconstructions to traditional histopathology using alcian blue staining. In addition to being 3D, nondestructive, and having much faster throughout, OCT can identify craniofacial features that are lost during traditional histopathological preparation. We also identify quantitative morphometric parameters to define normative craniofacial anatomy. We also note that craniofacial and cardiac defects are not infrequently present in the same patient (e.g velocardiofacial syndrome). Given that OCT excels at certain aspects of cardiac imaging in Xenopus embryos, our work highlights the potential of using OCT and Xenopus to study molecular genetic factors that impact both cardiac and craniofacial development.

[Fitting of the reconstructed craniofacial hard and soft tissues based on 2-D digital radiographs].

PubMed

Feng, Yao-Pu; Qiao, Min; Zhou, Hong; Zhang, Yan-Ning; Si, Xin-Qin

2017-02-01

In this study, we reconstructed the craniofacial hard and soft tissues based on the data from digital cephalometric radiographs and laser scanning. The effective fitting of the craniofacial hard and soft tissues was performed in order to increase the level of orthognathic diagnosis and treatment, and promote the communication between doctors and patients. A small lead point was put on the face of a volunteer and frontal and lateral digital cephalometric radiographs were taken. 3-D reconstruction system of the craniofacial hard tissue based on 2-D digital radiograph was used to get the craniofacial hard tissue model by means of hard tissue deformation modeling. 3-D model of facial soft tissue was obtained by using laser scanning data. By matching the lead point coordinate, the hard tissue and soft tissue were fitted. The 3-D model of the craniofacial hard and soft tissues was rebuilt reflecting the real craniofacial tissue structure, and effective fitting of the craniofacial hard and soft tissues was realized. The effective reconstruction and fitting of the 3-D craniofacial structures have been realized, which lays a foundation for further orthognathic simulation and facial appearance prediction. The fitting result is reliable, and could be used in clinical practice.

Influence of prenatal EGCG treatment and Dyrk1a dosage reduction on craniofacial features associated with Down syndrome.

PubMed

McElyea, Samantha D; Starbuck, John M; Tumbleson-Brink, Danika M; Harrington, Emily; Blazek, Joshua D; Ghoneima, Ahmed; Kula, Katherine; Roper, Randall J

2016-11-15

Trisomy 21 (Ts21) affects craniofacial precursors in individuals with Down syndrome (DS). The resultant craniofacial features in all individuals with Ts21 may significantly affect breathing, eating and speaking. Using mouse models of DS, we have traced the origin of DS-associated craniofacial abnormalities to deficiencies in neural crest cell (NCC) craniofacial precursors early in development. Hypothetically, three copies of Dyrk1a (dual-specificity tyrosine-(Y)-phosphorylation regulated kinase 1A), a trisomic gene found in most humans with DS and mouse models of DS, may significantly affect craniofacial structure. We hypothesized that we could improve DS-related craniofacial abnormalities in mouse models using a Dyrk1a inhibitor or by normalizing Dyrk1a gene dosage. In vitro and in vivo treatment with Epigallocatechin-3-gallate (EGCG), a Dyrk1a inhibitor, modulated trisomic NCC deficiencies at embryonic time points. Furthermore, prenatal EGCG treatment normalized some craniofacial phenotypes, including cranial vault in adult Ts65Dn mice. Normalization of Dyrk1a copy number in an otherwise trisomic Ts65Dn mice normalized many dimensions of the cranial vault, but did not correct all craniofacial anatomy. These data underscore the complexity of the gene–phenotype relationship in trisomy and suggest that changes in Dyrk1a expression play an important role in morphogenesis and growth of the cranial vault. These results suggest that a temporally specific prenatal therapy may be an effective way to ameliorate some craniofacial anatomical changes associated with DS.

Circulating and Urinary miR-210 and miR-16 Increase during Cardiac Surgery Using Cardiopulmonary Bypass - A Pilot Study.

PubMed

Mazzone, Annette L; Baker, Robert A; McNicholas, Kym; Woodman, Richard J; Michael, Michael Z; Gleadle, Jonathan M

2018-03-01

A pilot study to measure and compare blood and urine microRNAs miR-210 and miR-16 in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) and off-pump coronary artery bypass grafting surgery. Frequent serial blood and urine samples were taken from patients undergoing cardiac surgery with CPB (n = 10) and undergoing off-pump cardiac surgery (n = 5) before, during, and after surgery. Circulating miR-210 and miR-16 levels were determined by relative quantification real-time polymerase chain reaction. Levels of plasma-free haemoglobin (fHb), troponin-T, creatine kinase, and creatinine were measured. Perioperative serum miR-210 and miR-16 were elevated significantly compared to preoperative levels in patients undergoing cardiac surgery with CPB (CPB vs. Pre Op and Rewarm vs. Pre Op; p < .05 for both). There were increases of greater than 200% in miR-210 levels during rewarming and immediately postoperatively and a 3,000% increase in miR-16 levels immediately postoperatively in urine normalized to urinary creatinine concentration. Serum levels of miR-16 were relatively constant during off-pump surgery. miR-210 levels increased significantly in off-pump patients perioperatively ( p < .05 Octopus on vs. Pre Op); however, the release was less marked when compared to cardiac surgery with CPB. A significant association was observed between both miR-16 and miR-210 and plasma fHb when CPB was used ( r = -.549, p < .0001 and r = -.463, p < .0001 respectively). Serum and urine concentrations of hypoxically regulated miR-210 and hemolysis-associated miR-16 increased in cardiac surgery using CPB compared to off-pump surgery. These molecules may have utility in indicating severity of cardiac, red cell, and renal injury during cardiac surgery.

Gene Therapy for Bone Defects in Oral and Maxillofacial Surgery: A Systematic Review and Meta-Analysis of Animal Studies.

PubMed

Fliefel, Riham; Kühnisch, Jan; Ehrenfeld, Michael; Otto, Sven

2017-02-15

Craniofacial bone defects are challenging problems for maxillofacial surgeons over the years. With the development of cell and molecular biology, gene therapy is a breaking new technology with the aim of regenerating tissues by acting as a delivery system for therapeutic genes in the craniofacial region rather than treating genetic disorders. A systematic review was conducted summarizing the articles reporting gene therapy in maxillofacial surgery to answer the question: Was gene therapy successfully applied to regenerate bone in the maxillofacial region? Electronic searching of online databases was performed in addition to hand searching of the references of included articles. No language or time restrictions were enforced. Meta-analysis was done to assess significant bone formation after delivery of gene material in the surgically induced maxillofacial defects. The search identified 2081 articles, of which 57 were included with 1726 animals. Bone morphogenetic proteins were commonly used proteins for gene therapy. Viral vectors were the universally used vectors. Sprague-Dawley rats were the frequently used animal model in experimental studies. The quality of the articles ranged from excellent to average. Meta-analysis results performed on 21 articles showed that defects favored bone formation by gene therapy. Funnel plot showed symmetry with the absence of publication bias. Gene therapy is on the top list of innovative strategies that developed in the last 10 years with the hope of developing a simple chair-side protocol in the near future, combining improvement of gene delivery as well as knowledge of the molecular basis of oral and maxillofacial structures.

A Three-Dimensional Statistical Average Skull: Application of Biometric Morphing in Generating Missing Anatomy.

PubMed

Teshima, Tara Lynn; Patel, Vaibhav; Mainprize, James G; Edwards, Glenn; Antonyshyn, Oleh M

2015-07-01

The utilization of three-dimensional modeling technology in craniomaxillofacial surgery has grown exponentially during the last decade. Future development, however, is hindered by the lack of a normative three-dimensional anatomic dataset and a statistical mean three-dimensional virtual model. The purpose of this study is to develop and validate a protocol to generate a statistical three-dimensional virtual model based on a normative dataset of adult skulls. Two hundred adult skull CT images were reviewed. The average three-dimensional skull was computed by processing each CT image in the series using thin-plate spline geometric morphometric protocol. Our statistical average three-dimensional skull was validated by reconstructing patient-specific topography in cranial defects. The experiment was repeated 4 times. In each case, computer-generated cranioplasties were compared directly to the original intact skull. The errors describing the difference between the prediction and the original were calculated. A normative database of 33 adult human skulls was collected. Using 21 anthropometric landmark points, a protocol for three-dimensional skull landmarking and data reduction was developed and a statistical average three-dimensional skull was generated. Our results show the root mean square error (RMSE) for restoration of a known defect using the native best match skull, our statistical average skull, and worst match skull was 0.58, 0.74, and 4.4  mm, respectively. The ability to statistically average craniofacial surface topography will be a valuable instrument for deriving missing anatomy in complex craniofacial defects and deficiencies as well as in evaluating morphologic results of surgery.

Comparative investigation of the effectiveness of face-to-face verbal training and educational pamphlets on readiness of patients before undergoing non-emergency surgeries

PubMed Central

Noorian, Cobra; Aein, Fereshteh

2015-01-01

Background: The thought of having a surgery can be stressful for everyone. Providing the necessary information to the patient can help both the patient and the treatment team. This study was conducted to compare the effectiveness of face-to-face verbal training and educational pamphlets on the readiness of patients for undergoing non-emergency surgeries. Materials and Methods: The study was a before–after randomized clinical trial. 90 patients scheduled to undergo non-emergency surgery who referred to Shahrekord Ayatollah Kashani Hospital in 2013 were distributed randomly and gradually into two experimental groups (group of face-to-face verbal training and group of educational pamphlet) and one control group. Dependent variable of the study was pre-surgery readiness. Data analysis was carried out by using SPSS statistical software. Statistical analysis were analysis of variance (ANOVA) and correlation test. Results: Results showed that the mean scores of pre-surgery readiness in both interventional groups were significantly higher than that in the control group after the intervention (P < 0.05). However, there was no significant difference between the two experimental groups (P > 0.05). Conclusions: Each of the methods of face-to-face verbal education and using the pamphlet could be equally effective in improving the readiness of the patients undergoing surgery. Therefore, in environments where the health care providers are facing with the pressure of work and lack of sufficient time for face-to-face verbal training, suitable educational pamphlets can be used to provide the necessary information to patients and prepare them for surgery. PMID:26097859

Managing hip fracture and lower limb surgery in the emergency setting: Potential role of non-vitamin K antagonist oral anticoagulants.

PubMed

Fisher, William

2017-06-01

Trauma, immobilization, and subsequent surgery of the hip and lower limb are associated with a high risk of developing venous thrombo-embolism (VTE). Individuals undergoing hip fracture surgery (HFS) have the highest rates of VTE among orthopedic surgery and trauma patients. The risk of VTE depends on the type and location of the lower limb injury. Current international guidelines recommend routine pharmacological thromboprophylaxis based on treatment with heparins, fondaparinux, dose-adjusted vitamin K antagonists and acetylsalicylic acid for patients undergoing emergency HFS; however, not all guidelines recommend pharmacological prophylaxis for patients with lower limb injuries. Non-vitamin K antagonist oral anticoagulants (NOACs) are indicated for VTE prevention after elective hip or knee replacement surgery, but at present are not widely recommended for other orthopedic indications despite their advantages over conventional anticoagulants and promising real-world evidence. In patients undergoing HFS or lower limb surgery, decisions on whether to anticoagulate and the most appropriate anti-coagulation strategy can be guided by weighing the risk of thromboprophylaxis against the benefit in relation to each patient's medical history and age. In addition, the nature and location of the fracture, operating times and times before fracture fixation should be considered. The current review discusses the need for anticoagulation in patients undergoing emergency HFS or lower limb surgery together with the current guidelines and available evidence on the use of NOACs in this setting. Appropriate thromboprophylactic strategies and practical advice on the peri-operative management of patients who present to the Emergency Department on a NOAC before emergency surgery are further outlined.

Comparative investigation of the effectiveness of face-to-face verbal training and educational pamphlets on readiness of patients before undergoing non-emergency surgeries.

PubMed

Noorian, Cobra; Aein, Fereshteh

2015-01-01

The thought of having a surgery can be stressful for everyone. Providing the necessary information to the patient can help both the patient and the treatment team. This study was conducted to compare the effectiveness of face-to-face verbal training and educational pamphlets on the readiness of patients for undergoing non-emergency surgeries. The study was a before-after randomized clinical trial. 90 patients scheduled to undergo non-emergency surgery who referred to Shahrekord Ayatollah Kashani Hospital in 2013 were distributed randomly and gradually into two experimental groups (group of face-to-face verbal training and group of educational pamphlet) and one control group. Dependent variable of the study was pre-surgery readiness. Data analysis was carried out by using SPSS statistical software. Statistical analysis were analysis of variance (ANOVA) and correlation test. Results showed that the mean scores of pre-surgery readiness in both interventional groups were significantly higher than that in the control group after the intervention (P < 0.05). However, there was no significant difference between the two experimental groups (P > 0.05). Each of the methods of face-to-face verbal education and using the pamphlet could be equally effective in improving the readiness of the patients undergoing surgery. Therefore, in environments where the health care providers are facing with the pressure of work and lack of sufficient time for face-to-face verbal training, suitable educational pamphlets can be used to provide the necessary information to patients and prepare them for surgery.

Oophorectomy (Ovary Removal Surgery)

MedlinePlus

... also be robotically assisted in certain cases. During robotic surgery, the surgeon watches a 3-D monitor and ... weeks after surgery. Those who undergo laparoscopic or robotic surgery may return to full activity sooner — as early ...

Spinal fusion surgery: From relief to insecurity.

PubMed

Damsgaard, Janne B; Jørgensen, Lene B; Norlyk, Annelise; Birkelund, Regner

2017-02-01

During their decision-making process patients perceive surgery as a voluntary yet necessary choice. Surgery initiates hope for a life with less pain but also creates a feeling of existential insecurity in terms of fear, isolation and uncertainty. The aim of this study was to explore how patients experience their situation from the point of making the decision to undergo spinal fusion surgery to living their everyday life after surgery. A phenomenological-hermeneutic study design was applied based on the French philosopher Paul Ricoeur's theory of interpretation. Data were collected through observations and semi-structured interviews. The recommendation and decision to undergo spinal fusion surgery felt like a turning point for the patients and brought hope of regaining their normal lives, of being a more resourceful parent, partner, friend and colleague with no or less pain. Thus, deciding to undergo surgery created a brief feeling of relief. However, life with back pain had changed the patients' understanding of themselves. Consequently, some patients postoperatively experienced insecurity and a weakened self-image with difficulties creating meaning in their lives. Being recommended and undergoing spinal fusion surgery initiates hope for a life with less pain and altered life conditions. At the same time, paradoxically, this creates a feeling of existential insecurity in terms of facing the surgery and the future to come. It is, therefore, important to recognise and include the patients' everyday life experiences concerning how they give (or may not give) meaning to their illness, i.e. their understanding of how it is affecting them. These aspects are essential for the patients' definition and re-definition of themselves and thus crucial to draw upon in the relationship and communication between patient and healthcare professional. Copyright © 2016 Elsevier Ltd. All rights reserved.

Pre-operative assessment of patients undergoing endoscopic, transnasal, transsphenoidal pituitary surgery.

PubMed

Lubbe, D; Semple, P

2008-06-01

To demonstrate the importance of pre-operative ear, nose and throat assessment in patients undergoing endoscopic, transsphenoidal surgery for pituitary tumours. Literature pertaining to the pre-operative otorhinolaryngological assessment and management of patients undergoing endoscopic anterior skull base surgery is sparse. We describe two cases from our series of 59 patients undergoing endoscopic pituitary surgery. The first case involved a young male patient with a large pituitary macroadenoma. His main complaint was visual impairment. He had no previous history of sinonasal pathology and did not complain of any nasal symptoms during the pre-operative neurosurgical assessment. At the time of surgery, a purulent nasal discharge was seen emanating from both middle meati. Surgery was abandoned due to the risk of post-operative meningitis, and postponed until the patient's chronic rhinosinusitis was optimally managed. The second patient was a 47-year-old woman with a large pituitary macroadenoma, who presented to the neurosurgical department with a main complaint of diplopia. She too gave no history of previous nasal problems, and she underwent uneventful surgery using the endoscopic, transnasal approach. Two weeks after surgery, she presented to the emergency unit with severe epistaxis. A previous diagnosis of hereditary haemorrhagic telangiectasia was discovered, and further surgical and medical intervention was required before the epistaxis was finally controlled. Pre-operative otorhinolaryngological assessment is essential prior to endoscopic pituitary or anterior skull base surgery. A thorough otorhinolaryngological history will determine whether any co-morbid diseases exist which could affect the surgical field. Nasal anatomy can be assessed via nasal endoscopy and sinusitis excluded. Computed tomography imaging is a valuable aid to decisions regarding additional procedures needed to optimise access to the pituitary fossa.

Cardiac perioperative complications in noncardiac surgery.

PubMed

Radovanović, Dragana; Kolak, Radmila; Stokić, Aleksandar; Radovanović, Zoran; Jovanović, Gordana

2008-01-01

Anesthesiologists are confronted with an increasing population of patients undergoing noncardiac surgery who are at risk for cardiac complications in the perioperative period. Perioperative cardiac complications are responsible for significant mortality and morbidity. The aim of the present study was to determine the incidence of perioperative (operative and postoperative) cardiac complications and correlations between the incidence of perioperative cardiac complications and type of surgical procedure, age, presence of concurrent deseases. A total of 100 patients with cardiac diseases undergoing noncardiac surgery were included in the prospective study (Group A 50 patients undergoing intraperitoneal surgery and Group B 50 patients undergoing breast and thyroid surgery). The patients were followed up during the perioperative period and after surgery until leaving hospital to assess the occurrence of cardiac events. Cardiac complications (systemic arterial hypertension, systemic arterial hypotension, abnormalities of cardiac conduction and cardiac rhythm, perioperative myocardial ischemia and acute myocardial infarction) occurred in 64% of the patients. One of the 100 patients (1%) had postoperative myocardial infarction which was fatal. Systemic arterial hypertension occured in 57% of patients intraoperatively and 33% postoperatively, abnormalities of cardiac rhythm in 31% of patients intraoperatively and 17% postoperatively, perioperative myocardial ischemia in 23% of patients intraoperatively and 11% of postoperatively. The most often cardiac complications were systemic arterial hypertension, abnormalities of cardiac rhythm and perioperative mvocardial ischemia. Factors independently associated with the incidence of cardiac complications included the type of surgical procedure, advanced age, duration of anaesthesia and surgery, abnormal preoperative electrocardiogram, abnormal preoperative chest radiography and diabetes.

Determinants of distance walked during the six-minute walk test in patients undergoing cardiac surgery at hospital discharge

PubMed Central

2014-01-01

Introduction The aim of this study was to identify the determinants of distance walked in six-minute walk test (6MWD) in patients undergoing cardiac surgery at hospital discharge. Methods The assessment was performed preoperatively and at discharge. Data from patient records were collected and measurement of the Functional Independence Measure (FIM) and the Nottingham Health Profile (NHP) were performed. The six-minute walk test (6MWT) was performed at discharge. Patients undergoing elective cardiac surgery, coronary artery bypass grafting or valve replacement were eligible. Patients older than 75 years who presented arrhythmia during the protocol, with psychiatric disorders, muscular or neurological disorders were excluded from the study. Results Sixty patients (44.26% male, mean age 51.53 ± 13 years) were assessed. In multivariate analysis the following variables were selected: type of surgery (P = 0.001), duration of cardiopulmonary bypass (CPB) (P = 0.001), Functional Independence Measure - FIM (0.004) and body mass index - BMI (0.007) with r = 0.91 and r2 = 0.83 with P < 0.001. The equation derived from multivariate analysis: 6MWD = Surgery (89.42) + CPB (1.60) + MIF (2.79 ) - BMI (7.53) - 127.90. Conclusion In this study, the determinants of 6MWD in patients undergoing cardiac surgery were: the type of surgery, CPB time, functional capacity and body mass index. PMID:24885130

Osteoporosis in Cervical Spine Surgery.

PubMed

Guzman, Javier Z; Feldman, Zachary M; McAnany, Steven; Hecht, Andrew C; Qureshi, Sheeraz A; Cho, Samuel K

2016-04-01

Retrospective administrative database analysis. To investigate the effect of osteoporosis (OS) on complications and outcomes in patients undergoing cervical spine surgery. OS is the most prevalent degenerative human bone disease, and spine surgeons will inevitably perform procedures on patients with OS. These patients might present a difficult patient cohort because many fixation techniques depend on bone quality and adequate bone healing--both of which are compromised in OS. The nationwide inpatient sample was queried using the Ninth Revision, Clinical Modification procedural codes for cervical spine procedures and diagnosis codes for degenerative conditions of cervical spine from 2002 to 2011. Patients were separated into two cohorts, those patients with OS and those without OS. Demographics, hospital characteristics, and adjusted complication likelihood were analyzed. Multivariate regression analysis was performed to determine odds of revision surgery in patients with OS. Of all patients undergoing degenerative cervical spine surgery, 2% were identified as having OS (32,557 of a sample of 1,602,129 patients). Osteoporotic patients were more likely to undergo posterior cervical spine fusion when compared with those patients without OS (11.3% vs. 5.4%, P < 0.0001). Moreover, circumferential fusion was performed 3 times more frequently in the osteoporotic cohort. Adjusted complications showed increased odds for postoperative hemorrhage (odds ratio = 1.70, 95% confidence interval = 1.46-1.98, P < 0.0001). Patients with OS stayed in the hospital longer (3.5 vs. 2.5 days, P < 0.0001) and had 30% costlier hospitalizations. Multivariate for revision surgery indicated that osteoporotic patients had significantly increased odds of revision surgery (odds ratio = 1.54, P ≤ 0.0001) when referenced to non-osteoporotic patients undergoing cervical spine surgery. Osteoporotic patients were more likely to undergo revision surgery, have longer hospitalizations, and have higher hospitalization costs, than their non-osteoporotic counterparts. 3.

Impaired olfaction and risk of delirium or cognitive decline after cardiac surgery.

PubMed

Brown, Charles H; Morrissey, Candice; Ono, Masahiro; Yenokyan, Gayane; Selnes, Ola A; Walston, Jeremy; Max, Laura; LaFlam, Andrew; Neufeld, Karin; Gottesman, Rebecca F; Hogue, Charles W

2015-01-01

To determine the prevalence of impaired olfaction in individuals presenting for cardiac surgery and the independent association between impaired olfaction and postoperative delirium and cognitive decline. Nested prospective cohort study. Academic hospital. Individuals undergoing coronary artery bypass, valve surgery, or both (n = 165). Olfaction was measured using the Brief Smell Identification Test, with impaired olfaction defined as an olfactory score below the fifth percentile of normative data. Delirium was assessed using a validated chart review method. Cognitive performance was assessed using a neuropsychological testing battery at baseline and 4 to 6 weeks after surgery. Impaired olfaction was identified in 54 of 165 participants (33%) before surgery. Impaired olfaction was associated with greater adjusted risk of postoperative delirium (relative risk = 1.90, 95% confidence interval = 1.17-3.09, P = .009). There was no association between impaired olfaction and change in composite cognitive score in the overall study population. Impaired olfaction is prevalent in individuals undergoing cardiac surgery and is associated with greater adjusted risk of postoperative delirium but not cognitive decline. Impaired olfaction may identify unrecognized vulnerability to postoperative delirium in individuals undergoing cardiac surgery. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

Short-term intravenous antimicrobial prophylaxis for elective rectal cancer surgery: results of a prospective randomized non-inferiority trial.

PubMed

Ishibashi, Keiichiro; Ishida, Hideyuki; Kuwabara, Kouki; Ohsawa, Tomonori; Okada, Norimichi; Yokoyama, Masaru; Kumamoto, Kensuke

2014-04-01

To investigate the non-inferiority of postoperative single-dose intravenous antimicrobial prophylaxis to multiple-dose intravenous antimicrobial prophylaxis in terms of the incidence of surgical site infections (SSIs) in patients undergoing elective rectal cancer surgery by a prospective randomized study. Patients undergoing elective surgery for rectal cancer were randomized to receive a single intravenous injection of flomoxef (group 1) or five additional doses (group 2) of flomoxef after the surgery. All the patients had received preoperative oral antibiotic prophylaxis (kanamycin and erythromycin) after mechanical cleansing within 24 h prior to surgery, and had received intravenous flomoxef during surgery. A total of 279 patients (including 139 patients in group 1 and 140 in group 2) were enrolled in the study. The incidence of SSIs was 13.7% in group 1 and 13.6% in group 2 (difference [95% confidence interval]: -0.2% [-0.9 to 0.7%]). The incidence of SSIs was not significantly different in patients undergoing elective rectal surgery who were treated using a single dose of postoperative antibiotics compared to those treated using multiple-dose antibiotics when preoperative mechanical and chemical bowel preparations were employed.

Predictors of in-hospital mortality amongst octogenarians undergoing emergency general surgery: a retrospective cohort study.

PubMed

Wilson, Iain; Paul Barrett, Michael; Sinha, Ashish; Chan, Shirley

2014-11-01

Elderly patients are often judged to be fit for emergency surgery based on age alone. This study identified risk factors predictive of in-hospital mortality amongst octogenarians undergoing emergency general surgery. A retrospective review of octogenarians undergoing emergency general surgery over 3 years was performed. Parametric survival analysis using Cox multivariate regression model was used to identify risk factors predictive of in-hospital mortality. Hazard ratios (HR) and corresponding 95% confidence interval were calculated. Seventy-three patients with a median age of 84 years were identified. Twenty-eight (38%) patients died post-operatively. Multivariate analysis identified ASA grade (ASA 5 HR 23.4 95% CI 2.38-230, p = 0.007) and chronic obstructive pulmonary disease (COPD) (HR 3.35 95% CI 1.15-9.69, p = 0.026) to be the only significant predictors of in-hospital mortality. Identification of high risk surgical patients should be based on physiological fitness for surgery rather than chronological age. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

[The effect of "hospital clowns" on distress and maladaptive behaviours of children who are undergoing minor surgery].

PubMed

Meisel, Victoria; Chellew, Karin; Ponsell, Esperança; Ferreira, Ana; Bordas, Leonor; García-Banda, Gloria

2009-11-01

The presence of clowns in health care settings is a program used in many countries to reduce distress in children who are undergoing surgery. The aim of the present study is to determine the effect of the presence of clowns on children's distress and maladaptive behaviours while in hospital for minor surgery. The sample consisted of 61 pediatric patients (aged 3-12 years) undergoing general anesthesia for minor surgery. Participants were assigned to two groups: experimental and control group. The child's distress was assessed using FAS (Facial Affective Scale). Postoperative maladaptive behaviors were evaluated one week after surgery, using the PHBQ (Post-Hospital Behavior Questionnaire). Our results suggest that clowns are not able to reduce the child's level of distress. However, postoperative maladaptive behaviours in the experimental group decreased, but the decrease was not statistically significant. Further research is needed to determine the effects of clowns in hospitals, taking into account age, sex, parents' presence, and diverse hospital settings.

A pragmatic multi-centre randomised controlled trial of fluid loading and level of dependency in high-risk surgical patients undergoing major elective surgery: trial protocol

PubMed Central

2010-01-01

Background Patients undergoing major elective or urgent surgery are at high risk of death or significant morbidity. Measures to reduce this morbidity and mortality include pre-operative optimisation and use of higher levels of dependency care after surgery. We propose a pragmatic multi-centre randomised controlled trial of level of dependency and pre-operative fluid therapy in high-risk surgical patients undergoing major elective surgery. Methods/Design A multi-centre randomised controlled trial with a 2 * 2 factorial design. The first randomisation is to pre-operative fluid therapy or standard regimen and the second randomisation is to routine intensive care versus high dependency care during the early post-operative period. We intend to recruit 204 patients undergoing major elective and urgent abdominal and thoraco-abdominal surgery who fulfil high-risk surgical criteria. The primary outcome for the comparison of level of care is cost-effectiveness at six months and for the comparison of fluid optimisation is the number of hospital days after surgery. Discussion We believe that the results of this study will be invaluable in determining the future care and clinical resource utilisation for this group of patients and thus will have a major impact on clinical practice. Trial Registration Trial registration number - ISRCTN32188676 PMID:20398378

Avoiding endotracheal intubation of neonates undergoing laser surgery for retinopathy of prematurity.

PubMed

Woodhead, D D; Lambert, D K; Molloy, D A; Schmutz, N; Righter, E; Baer, V L; Christensen, R D

2007-04-01

Respiratory support of neonates during and following laser surgery for retinopathy of prematurity (ROP) is commonly accomplished using endotracheal intubation and mechanical ventilation. However, most patients undergoing ROP surgery have been weaned off mechanical ventilation days or weeks before the surgery. When they are electively re-intubated for ROP surgery, it can be difficult to extubate them postoperatively. One of the three level III neonatal intensive care units (NICUs) in the Intermountain Healthcare system initiated a program of using nasopharyngeal prongs, rather than endotracheal intubation, for respiratory support during ROP surgery. We performed an historic cohort analysis of all neonates undergoing ROP surgery during their NICU stay at the three level III NICU's between 1 January 2002 and 31 March 2006. Data collected included birth weight, gestational age at delivery and corrected gestational age at ROP surgery, whether or not they were intubated in the days immediately preceding the ROP surgery, whether or not they were electively intubated for the ROP surgery, the respiratory modality used during and the 3 days following ROP surgery, and all blood gas determinations and respiratory charges during this period. Fifty-four patients underwent ROP surgery during this period. All 23 from NICUs 'A' and 'B' had endotracheal intubation for surgery, while in NICU 'C' 24 were managed using nasopharyngeal prongs. The birth weights of those intubated for surgery (661+/-180 g, mean+/-s.d.) were similar to those not intubated (732+/-180 g). Similarly, the gestational age at birth did not differ between those intubated for surgery (25.2+/-1.3 week) and those not (25.6+/-2.1 week). The day following surgery, 77% (23/30) of those who had been intubated for surgery remained intubated and on mechanical ventilation, whereas only one (4%) of those not intubated for surgery was intubated in the postoperative period (P<0.001). On day 3 following surgery, 50% (15/30) of those intubated for surgery remained intubated and on mechanical ventilation, whereas none of those not intubated for surgery were intubated (P<0.001). Management with nasopharyngeal prongs did not result in higher PCO(2)s, or lower pH values, during or after surgery. Respiratory charges for the 3 days following surgery were 1762+/-678 dollars (mean+/-s.d.)/patient among those intubated versus 357+/-352 dollars/patient for those managed with nasopharyngeal prongs (P<0.001). Neonates undergoing laser surgery for ROP can often be supported intraoperatively and postoperatively using nasopharyngeal prongs, thus avoiding the need for endotracheal intubation.

Management of sickle cell disease in patients undergoing cardiac surgery.

PubMed

Crawford, Todd C; Carter, Michael V; Patel, Rina K; Suarez-Pierre, Alejandro; Lin, Sophie Z; Magruder, Jonathan Trent; Grimm, Joshua C; Cameron, Duke E; Baumgartner, William A; Mandal, Kaushik

2017-02-01

Sickle cell disease is a life-limiting inherited hemoglobinopathy that poses inherent risk for surgical complications following cardiac operations. In this review, we discuss preoperative considerations, intraoperative decision-making, and postoperative strategies to optimize the care of a patient with sickle cell disease undergoing cardiac surgery. © 2017 Wiley Periodicals, Inc.

Face off against ROS: Tcof1/Treacle safeguards neuroepithelial cells and progenitor neural crest cells from oxidative stress during craniofacial development.

PubMed

Sakai, Daisuke; Trainor, Paul A

2016-09-01

One-third of all congenital birth defects affect the head and face, and most craniofacial anomalies are considered to arise through defects in the development of cranial neural crest cells. Cranial neural crest cells give rise to the majority of craniofacial bones, cartilages and connective tissues. Therefore, understanding the events that control normal cranial neural crest and subsequent craniofacial development is important for elucidating the pathogenetic mechanisms of craniofacial anomalies and for the exploring potential therapeutic avenues for their prevention. Treacher Collins syndrome (TCS) is a congenital disorder characterized by severe craniofacial anomalies. An animal model of TCS, generated through mutation of Tcof1, the mouse (Mus musculus) homologue of the gene primarily mutated in association with TCS in humans, has recently revealed significant insights into the pathogenesis of TCS. Apoptotic elimination of neuroepithelial cells including neural crest cells is the primary cause of craniofacial defects in Tcof1 mutant embryos. However, our understanding of the mechanisms that induce tissue-specific apoptosis remains incomplete. In this review, we describe recent advances in our understanding of the pathogenesis TCS. Furthermore, we discuss the role of Tcof1 in normal embryonic development, the correlation between genetic and environmental factors on the severity of craniofacial abnormalities, and the prospect for prenatal prevention of craniofacial anomalies. © 2016 Japanese Society of Developmental Biologists.

Face off against ROS: Tcof1/Treacle safeguards neuroepithelial cells and progenitor neural crest cells from oxidative stress during craniofacial development

PubMed Central

Sakai, Daisuke; Trainor, Paul A.

2016-01-01

One-third of all congenital birth defects affect the head and face, and most craniofacial anomalies are considered to arise through defects in the development of cranial neural crest cells. Cranial neural crest cells give rise to the majority of craniofacial bones, cartilages and connective tissues. Therefore understanding the events that control normal cranial neural crest and subsequent craniofacial development is important for elucidating the pathogenetic mechanisms of craniofacial anomalies and for the exploring potential therapeutic avenues for their prevention. Treacher Collins syndrome (TCS) is a congenital disorder characterized by severe craniofacial anomalies. An animal model of TCS, generated through mutation of Tcof1, the mouse (Mus musculus) homologue of the gene primarily mutated in association with TCS in humans, has recently revealed significant insights into the pathogenesis of TCS. Apoptotic elimination of neuroepithelial cells including neural crest cells is the primary cause of craniofacial defects in Tcof1 mutant embryos. However our understanding of the mechanisms that induce tissue-specific apoptosis remains incomplete. In this review, we describe recent advances in our understanding of the pathogenesis TCS. Furthermore, we discuss the role of Tcof1 in normal embryonic development, the correlation between genetic and environmental factors on the severity of craniofacial abnormalities, and the prospect for prenatal prevention of craniofacial anomalies. PMID:27481486

Influence of Music on Preoperative Anxiety and Physiologic Parameters in Women Undergoing Gynecologic Surgery.

PubMed

Labrague, Leodoro J; McEnroe-Petitte, Denise M

2016-04-01

The aim of this study was to determine the influence of music on anxiety levels and physiologic parameters in women undergoing gynecologic surgery. This study employed a pre- and posttest experimental design with nonrandom assignment. Ninety-seven women undergoing gynecologic surgery were included in the study, where 49 were allocated to the control group (nonmusic group) and 48 were assigned to the experimental group (music group). Preoperative anxiety was measured using the State Trait Anxiety Inventory (STAI) while noninvasive instruments were used in measuring the patients' physiologic parameters (blood pressure [BP], pulse [P], and respiration [R]) at two time periods. Women allocated in the experimental group had lower STAI scores (t = 17.41, p < .05), systolic (t = 6.45, p < .05) and diastolic (t = 2.80, p < .006) BP, and P rate (PR; t = 7.32, p < .05) than in the control group. This study provides empirical evidence to support the use of music during the preoperative period in reducing anxiety and unpleasant symptoms in women undergoing gynecologic surgery. © The Author(s) 2014.

What difference can a minute make? Social skills and first impressions of youth with craniofacial differences.

PubMed

Edwards, Todd C; Topolski, Tari D; Kapp-Simon, Kathleen A; Aspinall, Cassandra L; Patrick, Donald L

2011-01-01

To determine whether raters' first impressions of youth with craniofacial differences are modifiable. Observational study of the association between first impressions and social skills as related to youth aged 11 to 18 years with craniofacial differences. University research offices and clinics. Youth aged 11 to 18 years with (n  =  29) and without (n  =  31) craniofacial differences; adults (n  =  40), dental/medical students (n  =  46), and education students (n  =  29), all without craniofacial differences. Participants were recruited from medical clinics and through community advertising at all three study sites. The First Impressions Rating Scale. After viewing 1-minute portrayals of positive social skills by actors with craniofacial differences, raters' perceptions moved significantly in the positive direction for all 26 attributes on the First Impressions Rating Scale; whereas, after viewing negative social skills, ratings moved significantly in the negative direction for 25 of 26 First Impressions Rating Scale attributes. It appears that first impressions others have of youth with craniofacial differences are significantly affected by how these youth present themselves in social situations, suggesting that positive social skills may help reduce the amount of stigma that youth with craniofacial differences encounter.

[Changes in the distance between carina and orotracheal tube during open or videolaparoscopic bariatric surgery].

PubMed

de Figueiredo Locks, Giovani; Simões de Almeida, Maria Cristina; Sperotto Ceccon, Maurício; Campos Pastório, Karen Adriana

2015-01-01

To examine whether there are changes in the distance between the orotracheal tubeand carina induced by orthostatic retractor placement or by pneumoperitoneum insufflation in obese patients undergoing gastroplasty. 60 patients undergoing bariatric surgery by two techniques: open (G1) or videola-paroscopic (G2) gastroplasty were studied. After tracheal intubation, adequate ventilation of both hemitoraxes was confirmed by lung auscultation. The distance orotracheal tube-carina was estimated with the use of a fiber bronchoscope before and after installation of orthostatic retractors in G1 or before and after insufflation of pneumoperitoneum in patients in G2. G1 was composed of 22 and G2 of 38 patients. No cases of endobronchial intubationwere detected in either group. The mean orotracheal tube-carina distance variation was estimated in -0.03 cm (95% CI 0.06 to -0.13) in the group of patients undergoing open gastroplastyand in -0.42 cm (95% CI -0.56 to -1.4) in the group of patients undergoing videolaparoscopic gastroplasty. The extremes of variation in each group were: 0.5 cm to -1.6 cm in patients under-going open surgery and 0.1 cm to -2.2 cm in patients undergoing videolaparoscopic surgery. There was no significant change in orotracheal tube-CA distance after placementof orthostatic retractors in patients undergoing open gastroplasty. There was a reduction inorotracheal tube-CA distance after insufflation of pneumoperitoneum in patients undergoing videolaparoscopic gastroplasty. We recommend attention to lung auscultation and to signals of ventilation monitoring and reevaluation of orotracheal tube placement after peritoneal insufflation. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

Changes in the distance between carina and orotracheal tube during open or videolaparoscopic bariatric surgery.

PubMed

de Figueiredo Locks, Giovani; Simões de Almeida, Maria Cristina; Sperotto Ceccon, Maurício; Campos Pastório, Karen Adriana

2015-01-01

To examine whether there are changes in the distance between the orotracheal tube and carina induced by orthostatic retractor placement or by pneumoperitoneum insufflation in obese patients undergoing gastroplasty. 60 patients undergoing bariatric surgery by two techniques: open (G1) or videolaparoscopic (G2) gastroplasty were studied. After tracheal intubation, adequate ventilation of both hemitoraxes was confirmed by lung auscultation. The distance orotracheal tube-carina was estimated with the use of a fiber bronchoscope before and after installation of orthostatic retractors in G1 or before and after insufflation of pneumoperitoneum in patients in G2. G1 was composed of 22 and G2 of 38 patients. No cases of endobronchial intubation were detected in either group. The mean orotracheal tube-carina distance variation was estimated in -0.03cm (95% CI 0.06 to -0.13) in the group of patients undergoing open gastroplasty and in -0.42cm (95% CI -0.56 to -1.4) in the group of patients undergoing videolaparoscopic gastroplasty. The extremes of variation in each group were: 0.5cm to -1.6cm in patients undergoing open surgery and 0.1cm to -2.2cm in patients undergoing videolaparoscopic surgery. There was no significant change in orotracheal tube-CA distance after placement of orthostatic retractors in patients undergoing open gastroplasty. There was a reduction in orotracheal tube-CA distance after insufflation of pneumoperitoneum in patients undergoing videolaparoscopic gastroplasty. We recommend attention to lung auscultation and to signals of ventilation monitoring and reevaluation of orotracheal tube placement after peritoneal insufflation. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

Anesthetic complications in dogs undergoing hepatic surgery: cholecystectomy versus non-cholecystectomy.

PubMed

Burns, Brigid R; Hofmeister, Erik H; Brainard, Benjamin M

2014-03-01

To determine if dogs that undergo laparotomy for cholecystectomy suffer from a greater number or magnitude of perianesthetic complications, including hypotension, hypothermia, longer recovery time, and lower survival rate, than dogs that undergo laparotomy for hepatic surgery without cholecystectomy. Retrospective cohort study. One hundred and three dogs, anesthetised between January 2007 and October 2011. The variables collected from the medical record included age, weight, gender, surgical procedure, pre-operative bloodwork, American Society of Anesthesiologists (ASA) status, emergency status, total bilirubin concentration, anesthetic agents administered, body temperature nadir, final body temperature, hypotension, duration of hypotension, blood pressure nadir, intraoperative drugs, anesthesia duration, surgery duration, time to extubation, final diagnosis, days spent in the intensive care unit (ICU), total bill, survival to discharge, and survival to follow-up. No significant difference in body temperature nadir, final temperature, presence of hypotension, duration of hypotension, blood pressure nadir, the use of inotropes, or final outcome was found between dogs undergoing cholecystectomy and dogs undergoing exploratory laparotomy for other hepatic disease. Dogs that had cholecystectomy had longer anesthesia durations and longer surgery durations than dogs that did not have cholecystectomy. No significant differences existed for temperature nadir (34.8 versus 35.3°C; non-cholecystectomy versus cholecystectomy), final temperature (35.6 versus 35.9°C), time to extubation (30 versus 49 minutes), duration of hypotension (27 versus 21 minutes), or MAP nadir (56 versus 55 mmHg). Hypotension occurred in 66% and 74% and inotropes were used in 64% and 53%, for non-cholecystectomy and cholecystectomy patients, respectively. Dogs that underwent cholecystectomies did not suffer a greater number of anesthesia complications than did dogs undergoing hepatic surgery without cholecystectomies. © 2013 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesia and Analgesia.

Clinical feasibility of pre-operative neurodevelopmental assessment of infants undergoing open heart surgery.

PubMed

Campbell, Miranda; Rabbidge, Bridgette; Ziviani, Jenny; Sakzewski, Leanne

2017-08-01

Assessing the neurodevelopmental status of infants with congenital heart disease before surgery provides a means of identifying those at heightened risk of developmental delay. This study aimed to investigate factors impacting clinical feasibility of pre-operative neurodevelopmental assessment of infants undergoing early open heart surgery. Infants who underwent open heart surgery prior to 4 months of age participated in this cross-sectional study. The Test of Infant Motor Performance and Prechtl's Assessment of General Movements were undertaken on infants pre-operatively. When assessments could not be undertaken, reasons were ascribed to either infant or environmental circumstances. Demographic data and Aristotle scores were compared between groups of infants who did or did not undergo assessment. Binary logistic regression was used to explore associations. A total of 60 infants participated in the study. Median gestational age was 38.78 weeks (interquartile range: 36.93-39.72). Of these infants, 37 (62%) were unable to undergo pre-operative assessment. Twenty-four (40%) could not complete assessment due to infant-related factors and 13 (22%) due to environmental-related factors. For every point increase in the Aristotle Patient-Adjusted Complexity score, the infants likelihood of being unable to undergo assessment increased by 35% (odds ratio: 0.35; 95% confidence interval: 1.03-1.77, P = 0.03). Over half of the infants undergoing open heart surgery were unable to complete pre-operative neurodevelopmental assessment. The primary reason for this was infant-related medical instability. Findings suggest further research is warranted to investigate whether the Aristotle Patient-Adjusted Complexity score might serve as an indicator to inform developmental surveillance with this medically fragile cohort. © 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

Citation Rate Predictors in the Plastic Surgery Literature.

PubMed

Lopez, Joseph; Calotta, Nicholas; Doshi, Ankur; Soni, Ashwin; Milton, Jacqueline; May, James W; Tufaro, Anthony P

The purpose of this study is to determine and characterize the scientific and nonscientific factors that influence the rate of article citation in the field of plastic surgery. Cross-sectional study. We reviewed all entries in Annals of Plastic Surgery and Journal of Plastic, Reconstructive, and Aesthetic Surgery from January 1, 2007 to December 31, 2007; and Plastic and Reconstructive Surgery from January 1, 2007 to December 31, 2008. All scientific articles were analyzed and several article characteristics were extracted. The number of citations at 5 years was collected as the outcome variable. A multivariable analysis was performed to determine which variables were associated with higher citations rates. A total of 2456 articles were identified of which only 908 fulfilled the inclusion criteria. Most studies were publications in the fields of reconstructive (26.3%) or pediatric/craniofacial (17.6%) surgery. The median number of citations 5 years from publication was 8. In the multivariable analysis, factors associated with higher citations rates were subspecialty field (p = 0.0003), disclosed conflict of interest (p = 0.04), number of authors (p = 0.04), and journal (p = 0.02). We have found that higher level of evidence (or other study methodology factors) is not associated with higher citation rates. Instead, conflict of interest, subspecialty topic, journal, and number of authors are strong predictors of high citation rates in plastic surgery. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Predicting who will undergo surgery after physiotherapy for female stress urinary incontinence.

PubMed

Labrie, J; Lagro-Janssen, A L M; Fischer, K; Berghmans, L C M; van der Vaart, C H

2015-03-01

To predict who will undergo midurethral sling surgery (surgery) after initial pelvic floor muscle training (physiotherapy) for stress urinary incontinence in women. This was a cohort study including women with moderate to severe stress incontinence who were allocated to the physiotherapy arm from a previously reported multicentre trial comparing initial surgery or initial physiotherapy in treating stress urinary incontinence. Crossover to surgery was allowed. Data from 198/230 women who were randomized to physiotherapy was available for analysis, of whom 97/198 (49 %) crossed over to surgery. Prognostic factors for undergoing surgery after physiotherapy were age <55 years at baseline (OR 2.87; 95 % CI 1.30-6.32), higher educational level (OR 3.28; 95 % CI 0.80-13.47), severe incontinence at baseline according to the Sandvik index (OR 1.77; 95 % CI 0.95-3.29) and Urogenital Distress Inventory; incontinence domain score (OR 1.03; per point; 95 % CI 1.01-1.65). Furthermore, there was interaction between age <55 years and higher educational level (OR 0.09; 95 % CI 0.02-0.46). Using these variables we constructed a prediction rule to estimate the risk of surgery after initial physiotherapy. In women with moderate to severe stress incontinence, individual prediction for surgery after initial physiotherapy is possible, thus enabling shared decision making for the choice between initial conservative or invasive management of stress urinary incontinence.

A strategy for management of intraoperative Addisonian crisis during coronary artery bypass grafting.

PubMed

D'Silva, Celma; Watson, Dale; Ngaage, Dumbor

2012-04-01

Patients with Addison's disease undergoing cardiac surgery are at risk of developing a crisis. There is no consensus on the preoperative and intraoperative management of this group of patients undergoing cardiac surgery so the recommendations for non-cardiac patients are often used. The consensus statement from the international task force of the American College of Critical Care medicine recommends 100 mg of intravenous hydrocortisone for patients with adrenal insufficiency in septic shock, but in patients undergoing surgery, especially with extracorporeal circulation, the dosage may even be higher. We report our management of a patient with well-controlled adrenal insufficiency for 30 years who developed intraoperative Addisonian crisis despite the recommended preoperative corticosteroid supplementation. The importance of adequate corticosteroid supplementation for cardiac surgery patients, adapting the surgical strategy to allow for optimal management of potential complications and close monitoring with heightened awareness are discussed.

Should high risk patients with concomitant severe aortic stenosis and mitral valve disease undergo double valve surgery in the TAVR era?

PubMed

Yu, Pey-Jen; Mattia, Allan; Cassiere, Hugh A; Esposito, Rick; Manetta, Frank; Kohn, Nina; Hartman, Alan R

2017-12-29

Significant mitral regurgitation in patients undergoing transcatheter aortic valve replacement (TAVR) is associated with increased mortality. The aim of this study is to determine if surgical correction of both aortic and mitral valves in high risk patients with concomitant valvular disease would offer patients better outcomes than TAVR alone. A retrospective analysis of 43 high-risk patients who underwent concomitant surgical aortic valve replacement and mitral valve surgery from 2008 to 2012 was performed. Immediate and long term survival were assessed. There were 43 high-risk patients with severe aortic stenosis undergoing concomitant surgical aortic valve replacement and mitral valve surgery. The average age was 80 ± 6 years old. Nineteen (44%) patients had prior cardiac surgery, 15 (34.9%) patients had chronic obstructive lung disease, and 39 (91%) patients were in congestive heart failure. The mean Society of Thoracic Surgeons Predicted Risk of Mortality for isolated surgical aortic valve replacement for the cohort was 10.1% ± 6.4%. Five patients (11.6%) died during the index admission and/or within thirty days of surgery. Mortality rate was 25% at six months, 35% at 1 year and 45% at 2 years. There was no correlation between individual preoperative risk factors and mortality. High-risk patients with severe aortic stenosis and mitral valve disease undergoing concomitant surgical aortic valve replacement and mitral valve surgery may have similar long term survival as that described for such patients undergoing TAVR. Surgical correction of double valvular disease in this patient population may not confer mortality benefit compared to TAVR alone.

Transection Speed and Impact on Perioperative Inflammatory Response - A Randomized Controlled Trial Comparing Stapler Hepatectomy and CUSA Resection.

PubMed

Schwarz, Christoph; Klaus, Daniel A; Tudor, Bianca; Fleischmann, Edith; Wekerle, Thomas; Roth, Georg; Bodingbauer, Martin; Kaczirek, Klaus

2015-01-01

Parenchymal transection represents a crucial step during liver surgery and many different techniques have been described so far. Stapler resection is supposed to be faster than CUSA resection. However, whether speed impacts on the inflammatory response in patients undergoing liver resection (LR) remains unclear. This is a randomized controlled trial including 40 patients undergoing anatomical LR. Primary endpoint was transection speed (cm2/min). Secondary endpoints included the perioperative change of pro- and anti-inflammatory cytokines, overall surgery duration, length of hospital stay, morbidity and mortality. Mean transection speed was significantly higher in patients undergoing stapler hepatectomy compared to CUSA resection (CUSA: 1 (0.4) cm2/min vs. Stapler: 10.8 (6.1) cm2/min; p<0.0001). Analyzing the impact of surgery duration on inflammatory response revealed a significant correlation between IL-6 levels measured at the end of surgery and the overall length of surgery (p<0.0001, r = 0.6188). Patients undergoing CUSA LR had significantly higher increase of interleukin-6 (IL-6) after parenchymal transection compared to patients with stapler hepatectomy in the portal and hepatic veins, respectively (p = 0.028; p = 0.044). C-reactive protein levels on the first post-operative day were significantly lower in the stapler cohort (p = 0.010). There was a trend towards a reduced overall surgery time in patients with stapler LR, especially in the subgroup of patients undergoing minor hepatectomies (p = 0.020). Liver resection using staplers is fast, safe and suggests a diminished inflammatory response probably due to a decreased parenchymal transection time. ClinicalTrials.gov NCT01785212.

Transection Speed and Impact on Perioperative Inflammatory Response – A Randomized Controlled Trial Comparing Stapler Hepatectomy and CUSA Resection

PubMed Central

Schwarz, Christoph; Klaus, Daniel A.; Tudor, Bianca; Fleischmann, Edith; Wekerle, Thomas; Roth, Georg; Bodingbauer, Martin; Kaczirek, Klaus

2015-01-01

Background Parenchymal transection represents a crucial step during liver surgery and many different techniques have been described so far. Stapler resection is supposed to be faster than CUSA resection. However, whether speed impacts on the inflammatory response in patients undergoing liver resection (LR) remains unclear. Materials and Methods This is a randomized controlled trial including 40 patients undergoing anatomical LR. Primary endpoint was transection speed (cm2/min). Secondary endpoints included the perioperative change of pro- and anti-inflammatory cytokines, overall surgery duration, length of hospital stay, morbidity and mortality. Results Mean transection speed was significantly higher in patients undergoing stapler hepatectomy compared to CUSA resection (CUSA: 1 (0.4) cm2/min vs. Stapler: 10.8 (6.1) cm2/min; p<0.0001). Analyzing the impact of surgery duration on inflammatory response revealed a significant correlation between IL-6 levels measured at the end of surgery and the overall length of surgery (p<0.0001, r = 0.6188). Patients undergoing CUSA LR had significantly higher increase of interleukin-6 (IL-6) after parenchymal transection compared to patients with stapler hepatectomy in the portal and hepatic veins, respectively (p = 0.028; p = 0.044). C-reactive protein levels on the first post-operative day were significantly lower in the stapler cohort (p = 0.010). There was a trend towards a reduced overall surgery time in patients with stapler LR, especially in the subgroup of patients undergoing minor hepatectomies (p = 0.020). Conclusions Liver resection using staplers is fast, safe and suggests a diminished inflammatory response probably due to a decreased parenchymal transection time. Trial Registration ClinicalTrials.gov NCT01785212 PMID:26452162

The effect of mannitol on intraoperative brain relaxation in patients undergoing supratentorial tumor surgery: study protocol for a randomized controlled trial

PubMed Central

2014-01-01

Background The risk of brain swelling after dural opening is high in patients with midline shift undergoing supratentorial tumor surgery. Brain swelling may result in increased intracranial pressure, impeded tumor exposure, and adverse outcomes. Mannitol is recommended as a first-line dehydration treatment to reduce brain edema and enable brain relaxation during neurosurgery. Research has indicated that mannitol enhanced brain relaxation in patients undergoing supratentorial tumor surgery; however, these results need further confirmation, and the optimal mannitol dose has not yet been established. We propose to examine whether different doses of 20% mannitol improve brain relaxation in a dose-dependent manner when administered at the time of incision. We will examine patients with preexisting mass effects and midline shift undergoing elective supratentorial brain tumor surgery. Methods This is a single-center, randomized controlled, parallel group trial that will be carried out at Beijing Tiantan Hospital, Capital Medical University. Randomization will be achieved using a computer-generated table. The study will include 220 patients undergoing supratentorial tumor surgery whose preoperative computed tomography/magnetic resonance imaging results indicate a brain midline shift. Patients in group A, group B, and group C will receive dehydration treatment at incision with 20% mannitol solutions of 0.7, 1.0, and 1.4 g/kg, respectively, at a rate of 600 mL/h. The patients in the control group will not receive mannitol. The primary outcome is an improvement in intraoperative brain relaxation and dura tension after dehydration with mannitol. Secondary outcomes are postoperative outcomes and the incidence of mannitol side effects. Discussion The aim of this study is to determine the optimal dose of 20% mannitol for intraoperative infusion. We will examine brain relaxation and outcome in patients undergoing supratentorial tumor surgery. If our results are positive, the study will indicate the optimal dose of mannitol to improve brain relaxation and avoid side effects during brain tumor surgery. Trial registration The study is registered with the registry website http://www.chictr.org with the registration number ChiCTRTRC13003984 (17 December 2013). PMID:24884731

Surgical Orthodontic Treatment for Open Bite in Noonan Syndrome Patient: A Case Report.

PubMed

Kawakami, Masayoshi; Yamamoto, Kazuhiko; Shimomura, Tadahiro; Kirita, Tadaaki

2016-03-01

Noonan syndrome, characterized by short stature, facial anomalies, and congenital heart defects, may also be associated with hematopoietic disorders. Craniofacial anomalies in affected patients include hypertelorism and severe open bite associated with masticatory dysfunction. We treated a Noonan syndrome patient with a skeletal open bite. Surgical orthodontic treatment including two-jaw surgery established a good occlusal relationship after correction of severe anemia. Both upper and lower incisors were moved to upright positions, while clockwise rotation of the palatal plane and decreased mandibular plane angle were accomplished. Lower masticatory activity may affect posttreatment occlusion in such cases.

A novel technique for preventing skin pressure sores using a rubber tube during surgical treatment of mandibular condyle fractures.

PubMed

Kawase-Koga, Yoko; Mori, Yoshiyuki; Hoshi, Kazuhito; Takato, Tsuyoshi

2013-11-01

Craniofacial surgery occasionally results in sores and necrosis of the facial skin because of pressure from surgical instruments. During surgical treatment of mandibular condylar process fractures, the main mandibular fragment is routinely retracted downward using a wire to achieve a satisfactory anatomic reduction. This procedure may injure the facial skin. This potential complication is easily overlooked by medical staff, but it is easily preventable. We herein describe a method of using a rubber tube to avoid causing pressure sores of the facial skin during surgical treatment of mandibular condylar process fractures.

Full-thickness knee articular cartilage defects in national football league combine athletes undergoing magnetic resonance imaging: prevalence, location, and association with previous surgery.

PubMed

Nepple, Jeffrey J; Wright, Rick W; Matava, Matthew J; Brophy, Robert H

2012-06-01

To better define the prevalence and location of full-thickness articular cartilage lesions in elite football players undergoing knee magnetic resonance imaging (MRI) at the National Football League (NFL) Invitational Combine and assess the association of these lesions with previous knee surgery. We performed a retrospective review of all participants in the NFL Combine undergoing a knee MRI scan from 2005 to 2009. Each MRI scan was reviewed for evidence of articular cartilage disease. History of previous knee surgery including anterior cruciate ligament reconstruction, meniscal procedures, and articular cartilage surgery was recorded for each athlete. Knees with a history of previous articular cartilage restoration surgery were excluded from the analysis. A total of 704 knee MRI scans were included in the analysis. Full-thickness articular cartilage lesions were associated with a history of any previous knee surgery (P < .001) and, specifically, previous meniscectomy (P < .001) but not with anterior cruciate ligament reconstruction (P = .7). Full-thickness lesions were present in 27% of knees with a previous meniscectomy compared with 12% of knees without any previous meniscal surgery. Full-thickness lesions in the lateral compartment were associated with previous lateral meniscectomy (P < .001); a similar relation was seen for medial meniscus tears in the medial compartment (P = .01). Full-thickness articular cartilage lesions of the knee were present in 17.3% of elite American football players at the NFL Combine undergoing MRI. The lateral compartment appears to be at greater risk for full-thickness cartilage loss. Previous knee surgery, particularly meniscectomy, is associated with these lesions. Level IV, therapeutic case series. Copyright © 2012 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Compressive cryotherapy versus cryotherapy alone in patients undergoing knee surgery: a meta-analysis.

PubMed

Song, Mingzhi; Sun, Xiaohong; Tian, Xiliang; Zhang, Xianbin; Shi, Tieying; Sun, Ran; Dai, Wei

2016-01-01

This study aims to conduct a meta-analysis to identify and compare the effectiveness of compressive cryotherapy and cryotherapy alone for patients undergoing knee surgery. Postoperative management is an important guarantee for the success of surgery. Cryotherapy and compression are two common nursing techniques after knee surgery, and are considered to be effective for postoperative clinical symptoms such as local pain and swelling. However, no previous meta-analyses have compared the effectiveness of compressive cryotherapy and cryotherapy alone in patients undergoing knee surgery. A meta-analysis of randomized controlled trials (RCTs). We conducted a search in MEDLINE (via Pubmed, 1990-2014), EMBASE (via Elsevier, 1990-2014), Cochrane Central Register of Controlled Trials (The Cochrane Library, 1990-2014), CINAHL (1990-2014) and China National Knowledge Infrastructure (1990-2014) databases for RCTs published in English and Chinese. The primary outcome measure of interest was visual analog scale and girth measure. Finally, a meta-analysis was carried out using RevMan 5.3. Among the 593 RCTs, 10 RCTs were selected and included into this study. These studies included 522 patients who underwent knee surgery. Patients who underwent compressive cryotherapy tended to have less pain than patients who underwent cryotherapy alone at POD2 and POD3, while compressive cryotherapy had a strong tendency towards less swelling over cryotherapy alone at POD1 and POD2. However, there was no significant difference between compressive cryotherapy and cryotherapy alone at the intermediate stage of rehabilitation after knee surgery. All adverse reactions were recorded in all included RCTs. Current evidence suggests that compressive cryotherapy is beneficial to patients undergoing knee surgery at the early rehabilitation stage. At the last stage, the effectiveness of compressive cryotherapy and cryotherapy alone were found to be similar.

Concurrent and Overlapping Surgery: Perspectives from Parents of Adolescents Undergoing Spinal Posterior Instrumented Fusion for Idiopathic Scoliosis.

PubMed

Bryant, Jessica; Markes, Alexander; Woolridge, Tiana; Cerruti, Dede; Dzeng, Elizabeth; Koenig, Barbara; Diab, Mohammad

2018-06-12

Prospective cross-sectional survey. To determine the perspectives of parents of patients undergoing posterior instrumented fusion for adolescent idiopathic scoliosis (AIS) regarding simultaneous surgery and trainee participation. Simultaneous ("at the same time") surgery is under scrutiny by the public, government, payers and the medical community. The objective of this study is to determine the perspectives of parents of patients undergoing posterior instrumented fusion for adolescent idiopathic scoliosis. Our goal is to inform the national conversation on this subject with real patient and family voices. A survey was prospectively administered to 31 consecutive parents of patients undergoing posterior instrumented fusion for adolescent idiopathic scoliosis at a large academic medical center. "Overlapping" was defined as simultaneity during "noncritical" parts of an operation. "Concurrent" was defined as simultaneity that includes "critical" part(s) of an operation. Participants were asked to provide levels of agreement with overlapping and concurrent surgery and anesthesia, as well as with trainee involvement. On average, respondents "strongly agree" with the need to be informed about overlapping or concurrent surgery. They "disagree" with both overlapping and concurrent scheduling, and "disagree" with trainees operating without direct supervision, even for "non-critical" parts. Informing parents about the presence of a back-up surgeon or research demonstrating safety of simultaneous surgery did not make them agreeable to simultaneous scheduling. Parents have a strong desire to be informed of simultaneous spinal surgery as part of consent on behalf of their children. Their disagreement with simultaneous surgery, as well as with trainees operating without direct supervision, suggests discordance with current guidelines and practice and should inform the national conversation moving forward. N/A.

Cerebroprotective effect of piracetam in patients undergoing open heart surgery.

PubMed

Holinski, Sebastian; Claus, Benjamin; Alaaraj, Nour; Dohmen, Pascal Maria; Neumann, Konrad; Uebelhack, Ralf; Konertz, Wolfgang

2011-01-01

Reduction of cognitive function is a possible side effect after the use of cardiopulmonary bypass (CPB) during cardiac surgery. Since it has been proven that piracetam is cerebroprotective in patients undergoing coronary bypass surgery, we investigated the effects of piracetam on the cognitive performance of patients undergoing open heart surgery. Patients scheduled for elective open heart surgery were randomized to the piracetam or placebo group in a double-blind study. Patients received 12 g of piracetam or placebo at the beginning of the operation. Six neuropsychological subtests from the Syndrom Kurz Test and the Alzheimer's Disease Assessment Scale were performed preoperatively and on day 3, postoperatively. To assess the overall cognitive function and the degree of cognitive decline across all tests after the surgery, we combined the six test-scores by principal component analysis. A total of 88 patients with a mean age of 67 years were enrolled into the study. The mean duration of CPB was 110 minutes. Preoperative clinical parameters and overall cognitive functions were not significantly different between the groups. The postoperative combined score of the neuropsychological tests showed deterioration of cognitive function in both groups (piracetam: preoperative 0.19 ± 0.97 vs. postoperative -0.97 ± 1.38, p <0.0005 and placebo: preoperative -0.14 ± 0.98 vs. postoperative -1.35 ± 1.23, p <0.0005). Patients taking piracetam did not perform better than those taking placebo, and both groups had the same decline of overall cognitive function (p = 0.955). Piracetam had no cerebroprotective effect in patients undergoing open heart surgery. Unlike the patients who underwent coronary surgery, piracetam did not reduce the early postoperative decline of neuropsychological abilities in heart valve patients.

Body mass index and complications following major gastrointestinal surgery: A prospective, international cohort study and meta-analysis.

PubMed

Nepogodiev, Dmitri

2018-06-13

Previous studies reported conflicting evidence on the effects of obesity on outcomes after gastrointestinal surgery. The aims of this study were to explore the relationship of obesity with major post-operative complications in an international cohort and to present a meta-analysis of all available prospective data. This prospective, multi-centre study included adults undergoing both elective and emergency gastrointestinal resection, reversal of stoma, or formation of stoma. The primary endpoint was 30-day major complications (Clavien-Dindo grades III-V). A systematic search was undertaken for studies assessing the relationship between obesity and major complications after gastrointestinal surgery. Individual patient meta-analysis (IPMA) was used to analyse pooled results. This study included 2519 patients across 127 centres, of whom 560 (22.2%) were obese. Unadjusted major complication rates were lower in obese versus normal weight patients (13.0% versus 16.2%, respectively), but this did not reach statistical significance (p=0.863) on multivariate analysis for patients having surgery for either malignant or benign conditions. IPMA demonstrated that obese patients undergoing surgery for malignancy were at increased risk of major complications (odds ratio 2.10, 95% confidence interval 1.49-2.96, p<0.001), whereas obese patients undergoing surgery for benign indications were at decreased risk (OR 0.59, 95% CI 0.46-0.75, p<0.001), compared to normal weight patients. In our international data, obesity was not found to be associated with major complications following gastrointestinal surgery. Meta-analysis of available prospective data made a novel finding of obesity being associated with different outcomes depending on whether patients were undergoing surgery for benign or malignant disease. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

The development of the nursing care system for patients with cleft lip-palate and craniofacial deformities at Tawanchai Cleft Center, Srinagarind Hospital, Khon Kaen, Thailand.

PubMed

Pradubwong, Suteera; Pongpagatip, Sumalee; Volrathongchai, Kanittha; Chowchuen, Bowornsilp

2012-11-01

The highest incidence of cleft lip-palate and craniofacial deformities in Thailand occur in the Northeastern Region. There is the necessity for an interdisciplinary care team as well as the specialized care center with systematic coordinated care, thus "Tawanchai Cleft Center" is becoming a superior medical center for patients with cleft lip-palate and craniofacial deformities. Therefore, the development of the nursing care system for patients with cleft lip-palate and craniofacial deformities at Tawanchai Cleft Center, Srinagarind Hospital is extremely important and necessary. To develop the nursing care system appropriate for a super tertiary hospital (Tawanchai Cleft Center). It is a participation study which has 3 steps as follows, 1) Analyzing the situations and collecting the opinions of the 22 Out-patient Surgery Department staff and Tawanchai Cleft Center staff by using 6 questions, 2) Summarizing of the situation analysis from the meetings and the questionnaires, then using such summary as the guidelines for developing the nursing care system from January 2011 onwards, 3) evaluating the satisfaction after the 4 month development period (May-August 2011) with 106 caregivers by using 8 questions and being analyzed by the average value, percentage and standard deviation. 1) The nursing care system consisted of psychosocial care, breast feeding, counseling and other assistance as required. This various assistance responded to the patient/family problems by following the treatment guideline of the multidisciplinary team which uses the continuous evaluation processes for the holistic patient/family care. 2) The patients with complete cleft lip-palate were the most common type, found in 44 cases or 41.53 percent. The highest number of caregivers were mothers which were 68 percent; the average age of those mothers was 36 years old. The highest number of them finished elementary school at 43 percent and 40 percent were farmers. The satisfaction for the services of Tawanchai Cleft Center showed the average for each satisfaction subject all at very good level (x = 3.56, SD = 0.13). The care for patients with CLP and craniofacial deformities at Tawanchai Cleft Center Srinagarind Hospital has been developed in order to have the appropriate nursing care system to provide superior quality care, which provides patient-holistic care, as well as improving effective accessibility to the services. Thus, the patients/caregivers who are satisfied with given services, get continuing monitoring and treatment and are able to live their lives in the society happily.

Preoperative oral carbohydrates and postoperative insulin resistance.

PubMed

Nygren, J; Soop, M; Thorell, A; Sree Nair, K; Ljungqvist, O

1999-04-01

Infusions of carbohydrates before surgery have been shown to reduce postoperative insulin resistance. Presently, we investigated the effects of a carbohydrate drink, given shortly before surgery, on postoperative insulin sensitivity. Insulin sensitivity and glucose turnover ([6, 6,(2)H(2)]-D-glucose) were measured using hyper-insulinemic, normoglycemic clamps before and after elective surgery. Sixteen patients undergoing total hip replacement were randomly assigned to preoperative oral carbohydrate administration (CHO-H, n = 8) or the same amount of a placebo drink (placebo, n = 8) before surgery. Insulin sensitivity was measured before and immediately after surgery. Patients undergoing elective colorectal surgery were studied before surgery and 24 h postoperatively (CHO-C (n = 7), and fasted (n = 7), groups). The fasted group underwent surgery after an overnight fast. In both studies, the CHO groups received 800 ml of an isoosmolar carbohydrate rich beverage the evening before the operation (100g carbohydrates), as well as another 400 ml (50g carbohydrates) 2 h before the initiation of anesthesia. Immediately after surgery, insulin sensitivity was reduced 37% in the placebo group (P < 0.05 vs. preoperatively) while no significant change was found in the CHO-H group (-16%, p = NS). During clamps performed 24h postoperatively, insulin sensitivity and whole-body glucose disposal was reduced in both groups, but the reduction was greater compared to that in the CHO-C group (-49 +/- 6% vs. -26 +/- 8%, P> 0.05 fasted vs. CHO-C). Patients given a carbohydrate drink shortly before elective surgery displayed less reduced insulin sensitivity after surgery as compared to patients undergoing surgery after an overnight fast. Copyright 1999 Harcourt Publishers Ltd.

Impact of bariatric surgery on health care costs of obese persons: a 6-year follow-up of surgical and comparison cohorts using health plan data.

PubMed

Weiner, Jonathan P; Goodwin, Suzanne M; Chang, Hsien-Yen; Bolen, Shari D; Richards, Thomas M; Johns, Roger A; Momin, Soyal R; Clark, Jeanne M

2013-06-01

Bariatric surgery is a well-documented treatment for obesity, but there are uncertainties about the degree to which such surgery is associated with health care cost reductions that are sustained over time. To provide a comprehensive, multiyear analysis of health care costs by type of procedure within a large cohort of privately insured persons who underwent bariatric surgery compared with a matched nonsurgical cohort. Longitudinal analysis of 2002-2008 claims data comparing a bariatric surgery cohort with a matched nonsurgical cohort. Seven BlueCross BlueShield health insurance plans with a total enrollment of more than 18 million persons. A total of 29 820 plan members who underwent bariatric surgery between January 1, 2002, and December 31, 2008, and a 1:1 matched comparison group of persons not undergoing surgery but with diagnoses closely associated with obesity. Standardized costs (overall and by type of care) and adjusted ratios of the surgical group's costs relative to those of the comparison group. Total costs were greater in the bariatric surgery group during the second and third years following surgery but were similar in the later years. However, the bariatric group's prescription and office visit costs were lower and their inpatient costs were higher. Those undergoing laparoscopic surgery had lower costs in the first few years after surgery, but these differences did not persist. Bariatric surgery does not reduce overall health care costs in the long term. Also, there is no evidence that any one type of surgery is more likely to reduce long-term health care costs. To assess the value of bariatric surgery, future studies should focus on the potential benefit of improved health and well-being of persons undergoing the procedure rather than on cost savings.

Preliminary findings on biomarker levels from extracerebral sources in patients undergoing trauma surgery: Potential implications for TBI outcome studies.

PubMed

Wolf, H; Krall, C; Pajenda, G; Hajdu, S; Widhalm, H; Leitgeb, J; Sarahrudi, K

2016-01-01

Despite several experimental studies on the role of S100B and NSE in fractures, no studies on the influence of surgery on the biomarker serum levels have been performed yet. The serum levels of S100B and NSE were analysed in patients with fractures that were located in the spine (group 1, n = 35) or in the lower extremity (group 2, n = 32) pre- and post-operatively. The mean S100B serum level showed a significant increase (p = 0.04) post-surgery in the patients of group 1. In patients undergoing acute surgery (< 24 hours) the mean S100B serum level was 0.23 ± 0.22 μg L(-1) pre-operatively and 1.24 ± 1.38 μg L(-1) post-operatively. Likewise, the mean S100B serum level significantly increased in group 2 after surgery (p < 0.0001). In this group patients undergoing acute surgery showed a mean S100B serum level of 0.23 ± 0.14 μg L(-1) and 1.11 ± 0.73 μg L(-1) pre- and post-operatively. This study demonstrates significant alterations of the biomarker S100B serum levels in patients undergoing surgery. Higher S100B serum levels were found within 24 hours and might be related to the acute fracture. The NSE serum levels were unchanged and this biomarker may offer the probability to serve as a future outcome predictor in studies with patients with traumatic brain injury and additional extracerebral injuries.

People's experiences of suffering a lower limb fracture and undergoing surgery.

PubMed

Forsberg, Angelica; Söderberg, Siv; Engström, Åsa

2014-01-01

To describe people's experiences of suffering a lower limb fracture and undergoing surgery, from the time of injury through to the care given at the hospital and recovery following discharge. There is a lack of research on people's experiences of suffering a lower limb fracture and undergoing surgery - from injury to recovery. A qualitative approach was used. Interviews with nine participants were subjected to thematic content analysis. One theme was expressed: from realising the seriousness of the injury to regaining autonomy. Participants described feelings of frustration and helplessness when realising the seriousness of their injury. The wait prior to surgery was a strain and painful experience, and participants needed orientation for the future. They expressed feelings of vulnerability about being in the hands of staff during surgery. After surgery, in the postanaesthesia unit, participants expressed a need to have control and to feel safe in their new situation. To mobilise and regain their autonomy was a struggle, and participants stated that their recovery was extended. Participants found themselves in a new and unexpected situation and experienced pain, vulnerability and a striving for control during the process, that is, 'from realising the seriousness of the injury to regaining autonomy'. How this is managed depends on how the patient's needs are met by nurses. The nursing care received while suffering a lower limb fracture and undergoing surgery should be situation specific as well as individual specific. The safe performance of technical interventions and the nurse's comprehensive explanations of medical terms may help the patient to feel secure during the process. © 2013 John Wiley & Sons Ltd.

National Institute of Dental and Craniofacial Research

MedlinePlus

... In Skip to Main Content National Institute of Dental and Craniofacial Research (NIDCR) Improving the Nation's Oral ... Researchers NIDCR Strategic Plan The National Institute of Dental and Craniofacial Research remains committed to improving the ...

Is it necessary to shave the pubic and genital regions of patients undergoing endoscopic urological surgery?

PubMed

Menéndez, Violeta; Galán, Juan Antonio; Elia, Matilde; Collado, Argimiro; Lloréns, Francisco; Fernández, Carlos; García-López, Francisco

2004-06-01

To determine whether postoperative urinary infections were related to shaving before undergoing endoscopic urological surgery, 90 patients were randomly assigned to shaving or not shaving. Urinary cultures revealed infection in 10 patients. Half of them had been shaved, suggesting that this practice does not affect the incidence of urinary infections.

Big Data and Machine Learning in Plastic Surgery: A New Frontier in Surgical Innovation.

PubMed

Kanevsky, Jonathan; Corban, Jason; Gaster, Richard; Kanevsky, Ari; Lin, Samuel; Gilardino, Mirko

2016-05-01

Medical decision-making is increasingly based on quantifiable data. From the moment patients come into contact with the health care system, their entire medical history is recorded electronically. Whether a patient is in the operating room or on the hospital ward, technological advancement has facilitated the expedient and reliable measurement of clinically relevant health metrics, all in an effort to guide care and ensure the best possible clinical outcomes. However, as the volume and complexity of biomedical data grow, it becomes challenging to effectively process "big data" using conventional techniques. Physicians and scientists must be prepared to look beyond classic methods of data processing to extract clinically relevant information. The purpose of this article is to introduce the modern plastic surgeon to machine learning and computational interpretation of large data sets. What is machine learning? Machine learning, a subfield of artificial intelligence, can address clinically relevant problems in several domains of plastic surgery, including burn surgery; microsurgery; and craniofacial, peripheral nerve, and aesthetic surgery. This article provides a brief introduction to current research and suggests future projects that will allow plastic surgeons to explore this new frontier of surgical science.

Virtual surgery in a (tele-)radiology framework.

PubMed

Glombitza, G; Evers, H; Hassfeld, S; Engelmann, U; Meinzer, H P

1999-09-01

This paper presents telemedicine as an extension of a teleradiology framework through tools for virtual surgery. To classify the described methods and applications, the research field of virtual reality (VR) is broadly reviewed. Differences with respect to technical equipment, methodological requirements and areas of application are pointed out. Desktop VR, augmented reality, and virtual reality are differentiated and discussed in some typical contexts of diagnostic support, surgical planning, therapeutic procedures, simulation and training. Visualization techniques are compared as a prerequisite for virtual reality and assigned to distinct levels of immersion. The advantage of a hybrid visualization kernel is emphasized with respect to the desktop VR applications that are subsequently shown. Moreover, software design aspects are considered by outlining functional openness in the architecture of the host system. Here, a teleradiology workstation was extended by dedicated tools for surgical planning through a plug-in mechanism. Examples of recent areas of application are introduced such as liver tumor resection planning, diagnostic support in heart surgery, and craniofacial surgery planning. In the future, surgical planning systems will become more important. They will benefit from improvements in image acquisition and communication, new image processing approaches, and techniques for data presentation. This will facilitate preoperative planning and intraoperative applications.

LASIK

MedlinePlus Videos and Cool Tools

... of this Web site is to provide objective information to the public about LASIK surgery. See other ... undergoing LASIK surgery. This web site also provides information on FDA’s role in LASIK surgery, FDA’s current ...

Changes in craniofacial development due to modifications of the treatment of unilateral cleft lip and palate.

PubMed

Smahel, Z; Müllerova, Z; Nejedly, A; Horak, I

1998-05-01

The objective of this study was to evaluate the craniofacial morphology of children with unilateral cleft lip and palate (UCLP) resulting from differing management protocols practiced in Prague from 1945 to 1976. The craniofacial morphologies of four groups of patients were compared. Two groups were assessed retrospectively (individuals born from 1945 to 1963), and two groups were followed on a longitudinal basis (individuals born from 1966 to 1976). The study was conducted at the Cleft Lip and Palate Center at the Department of Plastic Surgery, Prague, which has a catchment area population of 6 million. The subjects were a consecutive series of adult males (n = 84) who had complete UCLP without associated malformations. Patients born from 1945 to 1955 did not receive centralized orthodontic therapy. From 1945 to 1965, the alveolar process in the area of the cleft was not surgically repaired. Primary bone grafting was used for the group born from 1965 to 1972, and primary periosteoplasty was used in the subsequent period. Throughout the period covered by the study, the palate was operated on by pushback and pharyngeal flap surgery. From 1945 to 1965, the lip was repaired initially according to Veau, and later according to Tennison and Randall, and during this time, fixed appliances were used for orthodontic treatment. The results for the period from 1945 to 1955 are characterized by mandibular overclosure with anterior crossbite. Centralized orthodontic treatment in the later period improved sagittal jaw relations due to the posterior displacement of the mandible and an edge-to-edge bite was attained, but maxillary retrusion was unchanged. Primary bone grafting increased retrusion of the maxilla, which was compensated by further posterior displacement of the mandible. An edge-to-edge bite was also obtained. Primary periosteoplasty reduced maxillary retrusion, and the marked proclination of the upper dentoalveolar component with fixed appliances resulted in a positive overjet. It was no longer necessary to push the mandible back to the extent required in bone grafting. Effective orthodontic treatment made the greatest contribution to improved facial development. It allowed compensation of maxillary retrusion by changes in the position of the mandible or by proclination of the upper dentoalveolar component with fixed appliances. The applied surgical methods using primary bone grafting caused deterioration of the anterior growth of the maxilla.

Understanding Cleft and Craniofacial Team Care

MedlinePlus

... Donor Spotlight Fundraising Ideas Vehicle Donation Volunteer Efforts Cleft Lip/Palate & Craniofacial Specialists in Your Area skip to submenu Who We Are What We Do Cleft Lip/Palate & Craniofacial Specialists in Your Area States: A States: ...

Patient expectations for surgery: are they being met?

PubMed

Jones, K R; Burney, R E; Christy, B

2000-06-01

The purpose of the study was to determine patient expectations for the outcomes of three elective surgical procedures, the extent to which patient expectations for surgery were met, the reasons for unmet expectations, and the factors that might predict unmet expectations. Better understanding of these questions might help identify targeted interventions to better prepare patients for specific health care experiences. In a longitudinal, prospective design, a convenience sample of 445 patients (age range, 18 to 86 years) at a general surgery clinic at a major academic medical center was included--177 patients undergoing inguinal hernia repair, 146 undergoing parathyroidectomy, and 122 undergoing cholecystectomy. Patients completed both standardized and newly developed condition-specific health survey instruments. Preoperative interviews were administered, followed by mailed surveys 2 months after surgery. Between 9% and 27% of the respondents reported unmet expectations, with significant variation by condition; reasons included perceived lack of symptom relief, surgical complications, and process of care issues. Patients undergoing parathyroidectomy had a greater probability of unmet expectations. Both feeling prepared for surgery and improved postoperative symptom relief and role functioning reduced the probability of unmet expectations. To reduce the level of unmet expectations, patients need to be prepared both for the surgical experience and for what to expect in the recovery phase. This is especially true for complex illnesses such as primary hyperparathyroidism. Innovative educational strategies to ensure adequate preparation for surgery will be needed, and attention will need to be paid to latent, unstated process measures, if unmet expectations are to be reduced.

Craniofacial Characteristics of Thalassemia Major Patients

PubMed Central

Karakas, Sacide; Tellioglu, Ayfer Metin; Bilgin, Mehmet; Omurlu, Imran Kurt; Caliskan, Sercin; Coskun, Salih

2016-01-01

Objective: Thalassemias major are the most common autosomal recessive disorders; they are characterized by anomalies in the synthesis of the beta chains of hemoglobin and are often associated with varying degrees of craniofacial anomalies. The purpose of this study was to evaluate the craniofacial dimensions of β-thalassemia patients and to identify differences by comparing them to those of a control group. Materials and Methods: The study comprised 43 thalassemia major patients and 26 age- and sex- matched healthy control subjects. Anthropometric measurements were performed in six different craniofacial regions (head, face, nose, mouth, eyes, and ears); a total of 23 craniofacial variables were measured. Results: Craniofacial measurements in the regions of the face, nose, lips and mouth, and ears in the thalassemia major patient group yielded statistically significant differences compared to those in the control group (p<0.05). However, no statistically significant differences were observed in the measurements of the head and eye regions. Conclusion: The study increased our understanding of the craniofacial anatomy of thalassemia major patients and enabled us to obtain quantitative results. PMID:28149147

Reconstruction of late craniofacial deformities after irradiation of the head and face during childhood

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cohen, S.R.; Bartlett, S.P.; Whitaker, L.A.

1990-08-01

Little is known about the results of surgical management of late craniofacial abnormalities arising after irradiation of the head and face for treatment of childhood cancers. The clinical records of 10 children (4 males and 6 females) who received 4500 to 6500 rads (mean 5160 rads) of craniofacial radiation between birth and 8 years of age (mean 5 years) and who subsequently had reconstructive surgery were reviewed. Six of the 10 patients received orbital radiation, 3 received maxillary-midfacial radiation, and 1 patient underwent radiation to the frontal bone. Histologic tumor types included retinoblastoma (4), rhabdomyosarcoma (3), Ewing's sarcoma (2), andmore » neurofibrosarcoma (1). In addition to radiation, 7 of the 10 patients underwent surgical resection or debulking of their tumors and 6 received adjuvant chemotherapy. All patients presented from 4 to 20 years after treatment (mean 10 years) with varying, but severe degrees of soft-tissue and bony hypoplasia of the irradiated territories. Onlay bone grafting with soft-tissue reconstruction by a combination of local pedicle flaps and dermal-fat grafts was initially performed in 9 patients, and an occipitoparietal bone-flap switch procedure was done in 1 patient. Late follow-up ranged from 11 months to 7.5 years (mean 34 months). A total of 8 secondary procedures were necessary in 4 of the 10 patients (40 percent). Of these 4 patients, major revisions were performed in 3 and minor adjustments in 1. In addition, 2 patients in whom secondary procedures had not been done would benefit from further reconstruction. Therapy for cancer of the head and face during childhood has profound and ongoing effects on the growth of soft tissue and bone.« less

An Interdisciplinary Education Initiative to Promote Blood Conservation in Cardiac Surgery.

PubMed

Goda, Tamara S; Sherrod, Brad; Kindell, Linda

Transfusion practices vary extensively for patients undergoing cardiac surgical procedures, leading to high utilization of blood products despite evidence that transfusions negatively impact outcomes. An important factor affecting transfusion practice is recognition of the importance of teams in cardiac surgery care delivery. This article reports an evidenced-based practice (EBP) initiative constructed using the Society of Thoracic Surgery (STS) 2011 Blood Conservation Clinical Practice Guidelines (CPGs) to standardize transfusion practice across the cardiac surgery team at a large academic medical center. Project outcomes included: a) Improvement in clinician knowledge related to the STS Blood Conservation CPGs; and b) Decreased blood product utilization for patients undergoing cardiac surgical procedures. Participants' scores reflected an improvement in the overall knowledge of the STS CPGs noting a 31.1% (p = 0.012) increase in the number of participants whose practice reflected the Blood Conservation CPGs post intervention. Additionally, there was a reduction in overall blood product utilization for all patients undergoing cardiac surgery procedures post intervention (p = 0.005). Interdisciplinary education based on the STS Blood Conservation CPGs is an effective way to reduce transfusion practice variability and decrease utilization of blood products during cardiac surgery.

The effect of music listening on older adults undergoing cardiovascular surgery.

PubMed

Twiss, Elizabeth; Seaver, Jean; McCaffrey, Ruth

2006-01-01

The purpose of this study was to determine the effect of music listening on postoperative anxiety and intubation time in patients undergoing cardiovascular surgery. Coronary artery disease and valvular heart disease affect approximately 15 million Americans and 5 million persons in the U.K. annually, with the majority of these patients being older adults. The anxiety experienced before, during and after surgery increases cardiovascular workload, thereby prolonging recovery time. Music listening as a nursing intervention has shown an ability to reduce anxiety. The study used a randomized control trial design. Sixty adults older than 65 years were randomly assigned to the control and the experimental groups. The experimental group listened to music during and after surgery, while the control group received standard postoperative care. The Spielberger State Trait Anxiety Inventory was administered to both groups before surgery and 3 days postoperatively. The mean of the differences between scores was compared using analysis of variance. Differences in mean intubation time were measured in both groups. Older adults who listened to music had lower scores on the state anxiety test (F = 5.57, p = .022) and had significantly fewer minutes of postoperative intubation (F = 5.45, p = .031) after cardiovascular surgery. Older adults undergoing cardiovascular surgery who listen to music had less anxiety and reduced intubation time than those who did not.

Vocal Cord Paralysis

MedlinePlus

... paralysis. Known causes may include: Injury to the vocal cord during surgery. Surgery on or near your neck or upper ... Factors that may increase your risk of developing vocal cord paralysis include: Undergoing throat or chest surgery. People who need surgery on their thyroid, throat ...

Comparing Coordinated Versus Sequential Salpingo-Oophorectomy for BRCA1 and BRCA2 Mutation Carriers With Breast Cancer.

PubMed

S Chapman, Jocelyn; Roddy, Erika; Panighetti, Anna; Hwang, Shelley; Crawford, Beth; Powell, Bethan; Chen, Lee-May

2016-12-01

Women with breast cancer who carry BRCA1 or BRCA2 mutations must also consider risk-reducing salpingo-oophorectomy (RRSO) and how to coordinate this procedure with their breast surgery. We report the factors associated with coordinated versus sequential surgery and compare the outcomes of each. Patients in our cancer risk database who had breast cancer and a known deleterious BRCA1/2 mutation before undergoing breast surgery were included. Women who chose concurrent RRSO at the time of breast surgery were compared to those who did not. Sixty-two patients knew their mutation carrier status before undergoing breast cancer surgery. Forty-three patients (69%) opted for coordinated surgeries, and 19 (31%) underwent sequential surgeries at a median follow-up of 4.4 years. Women who underwent coordinated surgery were significantly older than those who chose sequential surgery (median age of 45 vs. 39 years; P = .025). There were no differences in comorbidities between groups. Patients who received neoadjuvant chemotherapy were more likely to undergo coordinated surgery (65% vs. 37%; P = .038). Sequential surgery patients had longer hospital stays (4.79 vs. 3.44 days, P = .01) and longer operating times (8.25 vs. 6.38 hours, P = .006) than patients who elected combined surgery. Postoperative complications were minor and were no more likely in either group (odds ratio, 4.76; 95% confidence interval, 0.56-40.6). Coordinating RRSO with breast surgery is associated with receipt of neoadjuvant chemotherapy, longer operating times, and hospital stays without an observed increase in complications. In the absence of risk, surgical options can be personalized. Copyright © 2016 Elsevier Inc. All rights reserved.

Multidisciplinary treatment approach in Treacher Collins syndrome.

PubMed

Hylton, Joseph B; Leon-Salazar, Vladimir; Anderson, Gary C; De Felippe, Nanci L O

2012-01-01

Treacher Collins syndrome (TCS) is a common genetic disorder with high penetrance and phenotypic variability. First and second branchial arches are affected in TCS, resulting in craniofacial and intraoral anomalies such as: severe convex facial profile; mid-face hypoplasia; microtia; eyelid colobomas; mandibular retrognathism; cleft palate; dental hypoplasia; heterotopic teeth; maxillary transverse hypoplasia; anterior open bite; and Angle Class II molar relationship. A high incidence of caries is also a typical finding in TCS patients. Nonetheless, even simple dental restorative procedures can be challenging in this patient population due to other associated medical conditions, such as: congenital heart defects; decreased oropharyngeal airways; hearing loss; and anxiety toward treatment. These patients often require a multidisciplinary treatment approach, including: audiology; speech and language pathology; otorhinolaryngology; general dentistry; orthodontics; oral and maxillofacial surgery; and plastic and reconstructive surgeries to improve facial appearance. This paper's purpose was to present a current understanding of Treacher Collins syndrome etiology, phenotype, and current treatment approaches.

Evidence-based medicine: cleft palate.

PubMed

Chepla, Kyle J; Gosain, Arun K

2013-12-01

After reading this article, the participant should be able to: 1. Describe recent changes in treatment of cleft palate. 2. Compare the efficacy of different surgical treatments. 3. Assess their own knowledge of cleft palate repair. 4. Determine where further individual in-depth study and development are warranted. The Maintenance of Certification in Plastic Surgery series is designed to ensure professional development and measure continued competency within a specialty or subspecialty. The present article provides an evaluation of the interval studies regarding the management of cleft palate with a specific focus on craniofacial growth, speech outcomes, and obstructive sleep apnea since the last Maintenance of Certification in Plastic Surgery article on the subject published in 2010. This purpose of this article is to update plastic and craniomaxillofacial surgeons on recent changes in treatment of cleft palate, provide a means for accurate self-assessment, and guide further individual in-depth study and development.

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP) - Part 5: institutional outcomes assessment and the role of the Laboratory of Physiology.

PubMed

Freitas, José Alberto de Souza; Trindade-Suedam, Ivy Kiemle; Garib, Daniela Gamba; Neves, Lucimara Teixeira das; Almeida, Ana Lúcia Pompéia Fraga de; Yaedú, Renato Yassukata Faria; Oliveira, Thaís Marchini; Soares, Simone; Lauris, Rita de Cássia Moura Carvalho; Yamashita, Renata Paciello; Trindade, Alceu Sergio; Trindade, Inge Elly Kiemle; Pinto, João Henrique Nogueira

2013-01-01

The Laboratory of Physiology provides support for the diagnosis of functional disorders associated with cleft lip and palate and also conducts studies to assess, objectively, the institutional outcomes, as recommended by the World Health Organization. The Laboratory is conceptually divided into three units, namely the Unit for Upper Airway Studies, Unit for Stomatognathic System Studies and the Unit for Sleep Studies, which aims at analyzing the impact of different surgical and dental procedures on the upper airways, stomatognathic system and the quality of sleep of individuals with cleft lip and palate. This paper describes the main goals of the Laboratory in the assessment of procedures which constitute the basis of the rehabilitation of cleft lip and palate, i.e., Plastic Surgery, Orthodontics and Maxillofacial Surgery and Speech Pathology.

Healthcare providers' caring: Nothing is too small for parents and children hospitalized for heart surgery.

PubMed

Wei, Holly; Roscigno, Cecelia I; Swanson, Kristen M

Parents of children with congenial heart disease (CHD) face frequent healthcare encounters due to their child's care trajectory. With an emphasis on assuring caring in healthcare, it is necessary to understand parents' perceptions of healthcare providers' actions when their child undergoes heart surgery. To describe parents' perceptions of healthcare providers' actions when their child is diagnosed with CHD and undergoes heart surgery. This is a qualitative study with in-depth interviews. Parents of children with CHD were interviewed twice after surgery. We analyzed data using directed content analysis guided by Swanson Caring Theory. Findings of the study indicate that parents perceive caring when providers seek to understand them (knowing); accompany them physically and emotionally (being with); help them (doing for); support them to be the best parents they can be (enabling); and trust them to care for their child (maintaining belief). Healthcare providers play an irreplaceable role in alleviating parents' emotional toll when their child undergoes cardiac surgery. Providers' caring is an integral component in healthcare. Copyright © 2017 Elsevier Inc. All rights reserved.

Surgical ablation of atrial fibrillation in patients with a giant left atrium undergoing mitral valve surgery.

PubMed

Kim, Ho Jin; Kim, Joon Bum; Jung, Sung-Ho; Choo, Suk Jung; Chung, Cheol Hyun; Lee, Jae Won

2016-08-01

As the efficacy of surgical ablation for atrial fibrillation (AF) is reported to be suboptimal for patients with a giant left atrium (LA), its routine use on this population has remained controversial. We sought to evaluate the clinical outcomes of patients with a giant LA undergoing mitral valve (MV) surgery with/without the maze procedure. We identified 759 patients with a giant LA (>60 mm) and AF undergoing MV surgery from 1999 through 2012. Of these, 400 underwent MV surgery with the maze procedure (maze group), and the remainder (n=359) underwent MV surgery only (no-maze group). To reduce the impact of selection bias, propensity score analyses were performed based on 25 baseline covariates. Early death occurred in five (1.3%) and nine (2.5%) patients in the maze and the no-maze group, respectively (p=0.28). Freedom from AF at 5 years was 68.9% in the maze group and 9.6% in the no-maze group (p<0.001). After adjustment, the maze group showed a significantly lower risk of death (HR, 0.65; 95% CI 0.44 to 0.98; p=0.038), thromboembolic events (HR, 0.23; 95% CI 0.09 to 0.58; p=0.002) and composite adverse outcomes (death, congestive heart failure and valve-related complications; HR, 0.55; 95% CI 0.42 to 0.71; p<0.001) than the no-maze group. In subgroup analyses, MV surgery with the maze procedure resulted in higher survival and event-free survival in most risk subgroups than without the maze procedure. The concomitant maze procedure improved postoperative rhythm status, clinical outcomes and cardiac functions in patients with a giant LA undergoing MV surgery. This study indicates that the patients with a giant LA undergoing MV surgery may benefit from an addition of the maze procedure. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Applications of Computer Technology in Complex Craniofacial Reconstruction.

PubMed

Day, Kristopher M; Gabrick, Kyle S; Sargent, Larry A

2018-03-01

To demonstrate our use of advanced 3-dimensional (3D) computer technology in the analysis, virtual surgical planning (VSP), 3D modeling (3DM), and treatment of complex congenital and acquired craniofacial deformities. We present a series of craniofacial defects treated at a tertiary craniofacial referral center utilizing state-of-the-art 3D computer technology. All patients treated at our center using computer-assisted VSP, prefabricated custom-designed 3DMs, and/or 3D printed custom implants (3DPCI) in the reconstruction of craniofacial defects were included in this analysis. We describe the use of 3D computer technology to precisely analyze, plan, and reconstruct 31 craniofacial deformities/syndromes caused by: Pierre-Robin (7), Treacher Collins (5), Apert's (2), Pfeiffer (2), Crouzon (1) Syndromes, craniosynostosis (6), hemifacial microsomia (2), micrognathia (2), multiple facial clefts (1), and trauma (3). In select cases where the available bone was insufficient for skeletal reconstruction, 3DPCIs were fabricated using 3D printing. We used VSP in 30, 3DMs in all 31, distraction osteogenesis in 16, and 3DPCIs in 13 cases. Utilizing these technologies, the above complex craniofacial defects were corrected without significant complications and with excellent aesthetic results. Modern 3D technology allows the surgeon to better analyze complex craniofacial deformities, precisely plan surgical correction with computer simulation of results, customize osteotomies, plan distractions, and print 3DPCI, as needed. The use of advanced 3D computer technology can be applied safely and potentially improve aesthetic and functional outcomes after complex craniofacial reconstruction. These techniques warrant further study and may be reproducible in various centers of care.

Construction of a Clinical Decision Support System for Undergoing Surgery Based on Domain Ontology and Rules Reasoning

PubMed Central

Bau, Cho-Tsan; Huang, Chung-Yi

2014-01-01

Abstract Objective: To construct a clinical decision support system (CDSS) for undergoing surgery based on domain ontology and rules reasoning in the setting of hospitalized diabetic patients. Materials and Methods: The ontology was created with a modified ontology development method, including specification and conceptualization, formalization, implementation, and evaluation and maintenance. The Protégé–Web Ontology Language editor was used to implement the ontology. Embedded clinical knowledge was elicited to complement the domain ontology with formal concept analysis. The decision rules were translated into JENA format, which JENA can use to infer recommendations based on patient clinical situations. Results: The ontology includes 31 classes and 13 properties, plus 38 JENA rules that were built to generate recommendations. The evaluation studies confirmed the correctness of the ontology, acceptance of recommendations, satisfaction with the system, and usefulness of the ontology for glycemic management of diabetic patients undergoing surgery, especially for domain experts. Conclusions: The contribution of this research is to set up an evidence-based hybrid ontology and an evaluation method for CDSS. The system can help clinicians to achieve inpatient glycemic control in diabetic patients undergoing surgery while avoiding hypoglycemia. PMID:24730353

Construction of a clinical decision support system for undergoing surgery based on domain ontology and rules reasoning.

PubMed

Bau, Cho-Tsan; Chen, Rung-Ching; Huang, Chung-Yi

2014-05-01

To construct a clinical decision support system (CDSS) for undergoing surgery based on domain ontology and rules reasoning in the setting of hospitalized diabetic patients. The ontology was created with a modified ontology development method, including specification and conceptualization, formalization, implementation, and evaluation and maintenance. The Protégé-Web Ontology Language editor was used to implement the ontology. Embedded clinical knowledge was elicited to complement the domain ontology with formal concept analysis. The decision rules were translated into JENA format, which JENA can use to infer recommendations based on patient clinical situations. The ontology includes 31 classes and 13 properties, plus 38 JENA rules that were built to generate recommendations. The evaluation studies confirmed the correctness of the ontology, acceptance of recommendations, satisfaction with the system, and usefulness of the ontology for glycemic management of diabetic patients undergoing surgery, especially for domain experts. The contribution of this research is to set up an evidence-based hybrid ontology and an evaluation method for CDSS. The system can help clinicians to achieve inpatient glycemic control in diabetic patients undergoing surgery while avoiding hypoglycemia.

COPD is a clear risk factor for increased use of resources and adverse outcomes in patients undergoing intervention for colorectal cancer: a nationwide study in Spain

PubMed Central

Baré, Marisa; Montón, Concepción; Mora, Laura; Redondo, Maximino; Pont, Marina; Escobar, Antonio; Sarasqueta, Cristina; Fernández de Larrea, Nerea; Briones, Eduardo; Quintana, Jose Maria

2017-01-01

Background We hypothesized that patients undergoing surgery for colorectal cancer (CRC) with COPD as a comorbidity would consume more resources and have worse in-hospital outcomes than similar patients without COPD. Therefore, we compared different aspects of the care process and short-term outcomes in patients undergoing surgery for CRC, with and without COPD. Methods This was a prospective study and it included patients from 22 hospitals located in Spain – 472 patients with COPD and 2,276 patients without COPD undergoing surgery for CRC. Clinical variables, postintervention intensive care unit (ICU) admission, use of invasive mechanical ventilation, and postintervention antibiotic treatment or blood transfusion were compared between the two groups. The reintervention rate, presence and type of complications, length of stay, and in-hospital mortality were also estimated. Hazard ratio (HR) for hospital mortality was estimated by Cox regression models. Results COPD was associated with higher rates of in-hospital complications, ICU admission, antibiotic treatment, reinterventions, and mortality. Moreover, after adjusting for other factors, COPD remained clearly associated with higher and earlier in-hospital mortality. Conclusion To reduce in-hospital morbidity and mortality in patients undergoing surgery for CRC and with COPD as a comorbidity, several aspects of perioperative management should be optimized and attention should be given to the usual comorbidities in these patients. PMID:28461746

Measuring quality of life in cleft lip and palate patients: currently available patient-reported outcomes measures.

PubMed

Eckstein, Donna A; Wu, Rebecca L; Akinbiyi, Takintope; Silver, Lester; Taub, Peter J

2011-11-01

Patient-reported outcomes in cleft lip and palate treatment are critical for patient care. Traditional surgical outcomes focused on objective measures, such as photographs, anatomic measurements, morbidity, and mortality. Although these remain important, they leave many questions unanswered. Surveys that include aesthetics, speech, functionality, self-image, and quality of life provide more thorough outcomes assessment. It is vital that reliable, valid, and comprehensive questionnaires are available to craniofacial surgeons. The authors performed a literature review to identify questionnaires validated in cleft lip and palate patients. Qualifying instruments were assessed for adherence to guidelines for development and validation by the scientific advisory committee and for content. The authors identified 44 measures used in cleft lip and palate studies. After 15 ad hoc questionnaires, eight generic instruments, 11 psychiatric instruments, and one non-English language questionnaire were excluded, nine measures remained. Of these, four were never validated in the cleft population. Analysis revealed one craniofacial-specific measure (Youth Quality of Life-Facial Differences), two voice-related measures (Patient Voice-Related Quality of Life and Cleft Audit Protocol for Speech-Augmented), and two oral health-related measures (Child Oral Health Impact Profile and Child Oral Health Quality of Life). The Youth Quality of Life-Facial Differences, Child Oral Health Impact Profile, and Child Oral Health Quality of Life questionnaires were sufficiently validated. None was created specifically for clefts, resulting in content limitations. There is a lack of comprehensive, valid, and reliable questionnaires for cleft lip and palate surgery. For thorough assessment of satisfaction, further research to develop and validate cleft lip and palate surgery-specific instruments is needed.

Comparative study on usefulness of gentamycin-containing collagen implants in the treatment of patients with osteitis and osteomyelitis of the craniofacial skeleton.

PubMed

Zawadzki, Paweł J; Perkowski, Konrad; Kotlarski, Michał; Pietruczuk-Padzik, Anna; Chomicz, Lidia

2017-05-11

Introduction and objective. A reduction in incidences of peri-surgical complications due to infections is achieved by antibiotic prophylaxis The objective of the study was to assess the usefulness of gentamycin-containing collagen implants (GCCI) in the treatment of patients with osteitis and osteomyelitis of the craniofacial skeleton. Materials and method. The retrospective study included 103 patients with osteitis and osteomyelitis. 54 patients were treated intra-operatively with GCCI (Garamycin, EusaPharma, Europe). 49 patients were treated according to standard procedures. Light microscopy and in vitro culture techniques were applied for bacteria specific identification, and to investigate the resistance of detected microbiota to antibiotics. Patients received one dose of antibiotic pre-operatively. Post-operative antibiotic treatment was administered individually, according to clinical course and microbiological tests. The patients were followed-up on days 3, 7 and 14 after discharge for local complications; radiographic follow-up was performed 3, 6 and 12 months after surgery. Results. The course of post-operative antibiotic therapy was shorter in GCCI patients than in the control group (median 1 vs. 7 days); they also required shorter hospitalization (median 3 vs. 4 days). Implantation of GCCI significantly reduced the incidence of local complications (OR 0.30, 95%CI 0.11-0.83, p<0.0001), independently of the use of postoperative antibiotic therapy. On follow-up after 3-12 months, all patients presented with good soft tissue and bone healing. Conclusions. The results of this comparative study advocate the use of GCCI in osteomyelitis of various origin in oral and maxillofacial surgery, as they seemed to reduce the incidence of local complications, shorten antibiotic administration time and hospital stay.

Craniofacial form and function in Metriorhynchidae (Crocodylomorpha: Thalattosuchia): modelling phenotypic evolution with maximum-likelihood methods.

PubMed

Young, Mark T; Bell, Mark A; Brusatte, Stephen L

2011-12-23

Metriorhynchid crocodylomorphs were the only group of archosaurs to fully adapt to a pelagic lifestyle. During the Jurassic and Early Cretaceous, this group diversified into a variety of ecological and morphological types, from large super-predators with a broad short snout and serrated teeth to specialized piscivores/teuthophages with an elongate tubular snout and uncarinated teeth. Here, we use an integrated repertoire of geometric morphometric (form), biomechanical finite-element analysis (FEA; function) and phylogenetic data to examine the nature of craniofacial evolution in this clade. FEA stress values significantly correlate with morphometric values representing skull length and breadth, indicating that form and function are associated. Maximum-likelihood methods, which assess which of several models of evolution best explain the distribution of form and function data on a phylogenetic tree, show that the two major metriorhynchid subclades underwent different evolutionary modes. In geosaurines, both form and function are best explained as evolving under 'random' Brownian motion, whereas in metriorhynchines, the form metrics are best explained as evolving under stasis and the function metric as undergoing a directional change (towards most efficient low-stress piscivory). This suggests that the two subclades were under different selection pressures, and that metriorhynchines with similar skull shape were driven to become functionally divergent.

Post-bariatric surgery body contouring in the NHS: a survey of UK bariatric surgeons.

PubMed

Highton, Lyndsey; Ekwobi, Chidi; Rose, Victoria

2012-04-01

Following massive weight loss, patients are left with folds of redundant skin that may cause physical and psychological problems. These problems can be addressed through body contouring procedures such as abdominoplasty and the thigh lift. Despite an exponential rise in the number of bariatric surgery procedures performed in the United Kingdom, there are no national guidelines on the provision of body contouring procedures after massive weight loss. We conducted a survey of UK Bariatric Surgeons to determine the pre-operative counselling that patients receive on this issue, their opinions towards post-bariatric surgery body contouring and current referral patterns to Plastic Surgery. By exploring the relationship between Bariatric and Plastic Surgery, we aimed to identify how the comprehensive treatment of patients undergoing bariatric surgery could be improved. A questionnaire was sent to 86 surgeon members of the British Obesity and Metabolic Surgery Society. Questionnaires were analysed from the 61/86 respondents (71% response rate). 92% of the responding surgeons feel that patients face functional problems relating to skin redundancy after massive weight loss, and a high percentage of patients complain about this problem. However, only 66% of surgeons routinely counsel patients about these problems before they undergo bariatric surgery. 96% of respondents feel that body contouring for these patients should be funded on the NHS in selected cases. However, it is difficult for patients to access consultation with a Plastic Surgeon and there are no explicit guidelines on the criteria that patients must fulfil to undergo body contouring surgery on the NHS. At present, these criteria are locally determined and represent a postcode lottery. The NICE guidelines on obesity recommend that patients undergoing bariatric surgery should have information on, or access to plastic surgery where appropriate, but this standard is not being achieved. National guidelines on post-bariatric body contouring surgery are needed to improve the comprehensive treatment of these patients. The clinical and cost effectiveness of bariatric surgery has been well established. Further studies focussing on the outcome of body contouring after massive weight loss could support this becoming and integral part of the bariatric surgery pathway. Copyright © 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Clinical and radiological outcomes of transoral endoscope-assisted treatment of mandibular condylar fractures.

PubMed

You, H-J; Moon, K-C; Yoon, E-S; Lee, B-I; Park, S-H

2016-03-01

Fractures of the mandibular condyle are one of the most common craniofacial fractures. However, the diagnosis and treatment of these fractures is controversial because of the multiple surgical approaches available. The purposes of this study were to identify surgery-related technical tips for better outcomes and to evaluate the results as well as complications encountered during 7 years of endoscope use to supplement the limited intraoral approach in the treatment of mandibular condylar fractures. Between 2005 and 2012, 50 patients with condylar fractures underwent endoscope-assisted reduction surgery. Postoperative facial bone computed tomography and panoramic radiography demonstrated adequate reduction of the condylar fractures in all patients. No condylar resorption was detected, and most patients displayed a satisfactory functional and structural recovery. There was no facial nerve damage or transitory hypoesthesia, and there were no visible scars after the surgery. Transoral endoscope-assisted treatment is a challenging but reliable method with lower morbidity and a rapid recovery. Copyright © 2015 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Severe Craniofacial Involvement due to Amniotic Band Sequence.

PubMed

Becerra-Solano, Luis Eduardo; Castañeda-Cisneros, Gema; Corona-Rivera, Jorge Roman; Díaz-Rodríguez, Manuel; Figuera, Luis Eduardo; López-Muñoz, Eunice; Nastasi-Catanese, José Antonio; Toscano-Flores, José Jesús; Ramírez-Dueñas, María de Lourdes; García-Ortíz, José Elias

2018-02-01

Disruptive amniotic band sequence (DABS) is a sporadic, non-familial disorder with unclear etiology. Diagnosis is based on clinical features because there is currently no reliable laboratory diagnostic tests. We describe six cases of DABS with severe craniofacial deformations, three with and three without classical constrictive limb deformation. The craniofacial deformities were delimited by peripheral sharply demarcated scarring. When a sharply demarcated linear disruptive craniofacial lesion is observed, DABS should be considered despite the absence of constrictive limb scarring.

Inspiratory Muscle Training and Functional Capacity in Patients Undergoing Cardiac Surgery.

PubMed

Cordeiro, André Luiz Lisboa; de Melo, Thiago Araújo; Neves, Daniela; Luna, Julianne; Esquivel, Mateus Souza; Guimarães, André Raimundo França; Borges, Daniel Lago; Petto, Jefferson

2016-04-01

Cardiac surgery is a highly complex procedure which generates worsening of lung function and decreased inspiratory muscle strength. The inspiratory muscle training becomes effective for muscle strengthening and can improve functional capacity. To investigate the effect of inspiratory muscle training on functional capacity submaximal and inspiratory muscle strength in patients undergoing cardiac surgery. This is a clinical randomized controlled trial with patients undergoing cardiac surgery at Instituto Nobre de Cardiologia. Patients were divided into two groups: control group and training. Preoperatively, were assessed the maximum inspiratory pressure and the distance covered in a 6-minute walk test. From the third postoperative day, the control group was managed according to the routine of the unit while the training group underwent daily protocol of respiratory muscle training until the day of discharge. 50 patients, 27 (54%) males were included, with a mean age of 56.7±13.9 years. After the analysis, the training group had significant increase in maximum inspiratory pressure (69.5±14.9 vs. 83.1±19.1 cmH2O, P=0.0073) and 6-minute walk test (422.4±102.8 vs. 502.4±112.8 m, P=0.0031). We conclude that inspiratory muscle training was effective in improving functional capacity submaximal and inspiratory muscle strength in this sample of patients undergoing cardiac surgery.

Renal insufficiency predicts mortality in geriatric patients undergoing emergent general surgery.

PubMed

Yaghoubian, Arezou; Ge, Phillip; Tolan, Amy; Saltmarsh, Guy; Kaji, Amy H; Neville, Angela L; Bricker, Scott; De Virgilio, Christian

2011-10-01

Clinical predictors of perioperative mortality in geriatric patients undergoing emergent general surgery have not been well described. The purpose of this study was to determine the incidence of postoperative morbidity and mortality in geriatric patients and factors associated with mortality. A retrospective review of patients 65 years of age or older undergoing emergent general surgery at a public teaching hospital was performed over a 7-year period. Data collected included demographics, comorbidities, laboratory studies, perioperative morbidities, and mortality. Descriptive statistics and predictors of morbidity and mortality are described. The mean age was 74 years. Indications for surgery included small bowel obstruction (24%), diverticulitis (20%), perforated viscous (16%), and large bowel obstruction (9%). The overall complication rate was 41 per cent with six cardiac complications (14%) and seven perioperative (16%) deaths. Mean admission serum creatinine was significantly higher in patients who died (3.6 vs 1.5 mg/dL, P = 0.004). Mortality for patients with an admission serum creatinine greater than 2.0 mg/dL was 42 per cent (5 of 12) compared with 3 per cent (2 of 32) for those 2.0 mg/dL or less (OR, 10.7; CI, 1.7 to 67; P = 0.01). Morbidity and mortality in geriatric patients undergoing emergency surgery remains high with the most significant predictor of mortality being the presence of renal insufficiency on admission.

From 200 BC to 2015 AD: an integration of robotic surgery and Ayurveda/Yoga

PubMed Central

Pillai, Geethakrishnan Gopalakrishna

2016-01-01

Background Among the traditional systems of medicine practiced all over the world, Ayurveda and Yoga has a documented history dating back to beyond 200 BC. Robotic and video assisted thoracic surgery (VATS) is an invention of the 21st century. We aim to quantify the effects of integration of Ayurveda and Yoga on patients undergoing minimally invasive robotic and VATS. Methods Four hundred and fifty-four patients undergoing VATS and robotic thoracic surgery were introduced to a pre and postoperative protocol of Yoga therapy, mediation and oil massages. Yoga exercises included Pranayam, Anulom Vilom, and Oil Massages included Urotarpan. Preoperative and postoperative respiratory functions were recorded. Patient satisfaction questionnaire were noted. Statistical comparison was made to control group undergoing minimally invasive thoracic surgery without integrative medicine. Only one patient refused to undergo Ayurveda therapy and was deleted from the group. Results Acceptability was high among all patients. Preoperative training led to implementation as early as 6 hours post surgery. Pulmonary function test showed significant improvement. All patients suggested an improvement in satisfaction score. Pain score were less in study patients. Quicker mobilization led to early discharge and drain removal. Chronic pain was prevented in patients having oil massages over the healed wound sites. Conclusions Integration of Ayurveda, Yoga and minimally invasive robotic and VATS is acceptable to Indian patients and gives better clinical results and higher patient satisfaction. PMID:26941975

Factors Associated With Work Ability in Patients Undergoing Surgery for Cervical Radiculopathy.

PubMed

Ng, Eunice; Johnston, Venerina; Wibault, Johanna; Löfgren, Håkan; Dedering, Åsa; Öberg, Birgitta; Zsigmond, Peter; Peolsson, Anneli

2015-08-15

Cross-sectional study. To investigate the factors associated with work ability in patients undergoing surgery for cervical radiculopathy. Surgery is a common treatment of cervical radiculopathy in people of working age. However, few studies have investigated the impact on the work ability of these patients. Patients undergoing surgery for cervical radiculopathy (n = 201) were recruited from spine centers in Sweden to complete a battery of questionnaires and physical measures the day before surgery. The associations between various individual, psychological, and work-related factors and self-reported work ability were investigated by Spearman rank correlation coefficient, multivariate linear regression, and forward stepwise regression analyses. Factors that were significant (P < 0.05) in each statistical analysis were entered into the successive analysis to reveal the factors most related to work ability. Work ability was assessed using the Work Ability Index. The mean Work Ability Index score was 28 (SD, 9.0). The forward stepwise regression analysis revealed 6 factors significantly associated with work ability, which explained 62% of the variance in the Work Ability Index. Factors highly correlated with greater work ability included greater self-efficacy in performing self-cares, lower physical load on the neck at work, greater self-reported chance of being able to work in 6 months' time, greater use of active coping strategies, lower frequency of hand weakness, and higher health-related quality of life. Psychological, work-related and individual factors were significantly associated with work ability in patients undergoing surgery for cervical radiculopathy. High self-efficacy was most associated with greater work ability. Consideration of these factors by surgeons preoperatively may provide optimal return to work outcomes after surgery. 3.

Interdisciplinary Care Model Independently Decreases Use of Critical Care Services After Corrective Surgery for Adult Degenerative Scoliosis.

PubMed

Adogwa, Owoicho; Elsamadicy, Aladine A; Sergesketter, Amanda R; Ongele, Michael; Vuong, Victoria; Khalid, Syed; Moreno, Jessica; Cheng, Joseph; Karikari, Isaac O; Bagley, Carlos A

2018-03-01

Interdisciplinary management of elderly patients requiring spine surgery has been shown to improve short- and long-term outcomes. The aim of this study was to determine whether an interdisciplinary team approach mitigates use of intensive care unit (ICU) resources. A unique comanagement model for elderly patients undergoing lumbar fusion surgery was implemented at a major academic medical center. The Peri-operative Optimization of Senior Health Program (POSH) was launched with the aim of improving outcomes in elderly patients (>65 years old) undergoing complex lumbar spine surgery. In this model, a geriatrician evaluates elderly patients preoperatively, comanages daily throughout hospital course, and coordinates multidisciplinary rehabilitation, along with the neurosurgical team. We retrospectively reviewed the first 100 cases after the initiation of the POSH protocol and compared them with the immediately preceding 25 cases to assess the rates of ICU transfer and independent predictors of ICU admission. A total of 125 patients undergoing lumbar decompression and fusion surgery were enrolled in this pilot program. Baseline characteristics and intraoperative variables, as well as number of fusion levels and duration of surgery, were similar between both cohorts. There was a significant difference in the use of ICU services (ICU admission rates) between both cohorts, with the non-POSH cohort having a 3-fold increase compared with the POSH cohort (P < 0.0001). In a multivariate analysis, lack of an interdisciplinary comanagement team approach was an independent predictor for ICU transfers in elderly patients undergoing corrective surgery (odds ratio 8.51, 95% confidence interval 2.972-24.37, P < 0.0001). Our study suggests that an interdisciplinary comanagement model between geriatrics and neurosurgery is independently associated with reduced use of critical care services. Copyright © 2018 Elsevier Inc. All rights reserved.

Hospital of diagnosis and probability of having surgical treatment for resectable gastric cancer.

PubMed

van Putten, M; Verhoeven, R H A; van Sandick, J W; Plukker, J T M; Lemmens, V E P P; Wijnhoven, B P L; Nieuwenhuijzen, G A P

2016-02-01

Gastric cancer surgery is increasingly being centralized in the Netherlands, whereas the diagnosis is often made in hospitals where gastric cancer surgery is not performed. The aim of this study was to assess whether hospital of diagnosis affects the probability of undergoing surgery and its impact on overall survival. All patients with potentially curable gastric cancer according to stage (cT1/1b-4a, cN0-2, cM0) diagnosed between 2005 and 2013 were selected from The Netherlands Cancer Registry. Multilevel logistic regression was used to examine the probability of undergoing surgery according to hospital of diagnosis. The effect of variation in probability of undergoing surgery among hospitals of diagnosis on overall survival during the intervals 2005-2009 and 2010-2013 was examined by using Cox regression analysis. A total of 5620 patients with potentially curable gastric cancer, diagnosed in 91 hospitals, were included. The proportion of patients who underwent surgery ranged from 53.1 to 83.9 per cent according to hospital of diagnosis (P < 0.001); after multivariable adjustment for patient and tumour characteristics it ranged from 57.0 to 78.2 per cent (P < 0.001). Multivariable Cox regression showed that patients diagnosed between 2010 and 2013 in hospitals with a low probability of patients undergoing curative treatment had worse overall survival (hazard ratio 1.21; P < 0.001). The large variation in probability of receiving surgery for gastric cancer between hospitals of diagnosis and its impact on overall survival indicates that gastric cancer decision-making is suboptimal. © 2015 BJS Society Ltd Published by John Wiley & Sons Ltd.

Outcomes in Patients With Hemophilia and von Willebrand Disease Undergoing Invasive or Surgical Procedures.

PubMed

Chapin, John; Bamme, Jaqueline; Hsu, Fraustina; Christos, Paul; DeSancho, Maria

2017-03-01

Adults with hemophilia A (HA), hemophilia B (HB), and von Willebrand disease (VWD) frequently require surgery and invasive procedures. However, there is variability in perioperative management guidelines. We describe our periprocedural outcomes in this setting. A retrospective chart review from January 2006 to December 2012 of patients with HA, HB, and VWD undergoing surgery or invasive procedures was conducted. Type of procedures, management including the use of continuous factor infusion, and administration of antifibrinolytics were reviewed. Adverse outcomes were defined as acute bleeding (<48 hours), delayed bleeding (≥48 hours), transfusion, inhibitor development, and thrombosis. We identified 59 patients with HA and HB. In all, 24 patients had severe hemophilia and 12 had mild/moderate hemophilia. Twelve patients had inhibitors. There were also 5 female carriers of HA and 6 patients with VWD. There were 34 major surgeries (26 orthopedic, 8 nonorthopedic) and 129 minor surgeries. Continuous infusion was used in 55.9% of major surgeries versus 8.5% of minor surgeries. Antifibrinolytics were administered in 14.7% of major surgeries versus 23.2% of minor surgeries. In all, 4 patients developed acute bleeding and 10 patients developed delayed bleeding. Delayed bleeding occurred in 28.6% of genitourinary procedures and in 16.1% of dental procedures. Five patients acquired an inhibitor and 2 had thrombosis. In conclusion, patients with HA, HB, or VWD had similar rates of adverse outcomes when undergoing minor surgeries or major surgeries. This finding underscores the importance of an interdisciplinary management and procedure-specific guidelines for patients with hemophilia and VWD prior to even minor invasive procedures.

Comparison of ketoprofen and carprofen administered prior to orthopedic surgery for control of postoperative pain in dogs.

PubMed

Grisneaux, E; Pibarot, P; Dupuis, J; Blais, D

1999-10-15

To compare analgesic and adverse effects of ketoprofen and carprofen when used to control pain associated with elective orthopedic surgeries in dogs. Prospective randomized clinical trial. 93 client-owned dogs: 46 undergoing reconstruction of the cranial cruciate ligament, 47 undergoing femoral head and neck excision, and 15 control dogs anesthetized for radiographic procedures. Dogs undergoing surgery were randomly given ketoprofen, carprofen, or saline (0.9% NaCl) solution, SC, prior to surgery. Pain score and serum cortisol concentration were recorded for 12 hours after surgery for all dogs. When pain score was > or = 7, oxymorphone was administered i.m. Bleeding time was measured prior to and during surgery. The proportion of dogs that required oxymorphone was significantly higher for the carprofen and placebo groups than for the ketoprofen group. Pain score for the placebo group was significantly higher than for the ketoprofen and carprofen groups, 2, 8, and 9 hours after surgery. Cortisol concentration was significantly higher for the placebo group than for the carprofen group at 4 and 6 hours after surgery. Significant differences were not detected between ketoprofen and carprofen groups with respect to pain score and cortisol concentration. Bleeding time was significantly longer for the ketoprofen group than for the other groups during surgery. One dog treated with ketoprofen developed a hematoma at the surgical site. Ketoprofen and carprofen given prior to surgery were effective for postoperative pain relief in dogs. However, ketoprofen should not be used when noncompressible bleeding may be a problem.

Antimicrobial surfaces for craniofacial implants: state of the art.

PubMed

Actis, Lisa; Gaviria, Laura; Guda, Teja; Ong, Joo L

2013-04-01

In an attempt to regain function and aesthetics in the craniofacial region, different biomaterials, including titanium, hydroxyapatite, biodegradable polymers and composites, have been widely used as a result of the loss of craniofacial bone. Although these materials presented favorable success rates, osseointegration and antibacterial properties are often hard to achieve. Although bone-implant interactions are highly dependent on the implant's surface characteristics, infections following traumatic craniofacial injuries are common. As such, poor osseointegration and infections are two of the many causes of implant failure. Further, as increasingly complex dental repairs are attempted, the likelihood of infection in these implants has also been on the rise. For these reasons, the treatment of craniofacial bone defects and dental repairs for long-term success remains a challenge. Various approaches to reduce the rate of infection and improve osseointegration have been investigated. Furthermore, recent and planned tissue engineering developments are aimed at improving the implants' physical and biological properties by improving their surfaces in order to develop craniofacial bone substitutes that will restore, maintain and improve tissue function. In this review, the commonly used biomaterials for craniofacial bone restoration and dental repair, as well as surface modification techniques, antibacterial surfaces and coatings are discussed.

The ACAPS and SESPRS surveys to identify the most influential innovators and innovations in plastic surgery: no line on the horizon.

PubMed

Hultman, Charles Scott; Friedstat, Jonathan S

2014-01-01

Who and what have been the most influential innovators and innovations in plastic surgery? This historical paper attempts to determine our most important contributors and contributions. We conducted an anonymous, 7-question, web-based survey of all members of the American Council of Academic Plastic Surgeons (ACAPS) and the Southeastern Society of Plastic and Reconstructive Surgeons (SESPRS). We asked respondents to list their top 5 most influential surgeons, the most important publications or bodies of work, and the most important innovations in plastic surgery, past and present. Of the 86 nominees from ACAPS, the 15 most influential surgeons of the past century were Tessier, Buncke, Murray, Millard, Gillies, Mathes, Jurkiewicz, Taylor, Converse, Blair, Kleinert, Edgerton, McCraw, Peacock, and Brown, in that order. The most 10 influential surgeons of the current era are Rohrich, McCarthy, Wei, Lee, Siemionow, Allen, Coleman, Guyuron, Serletti, and Nahai. Of the 112 nominees from SESPRS, the 15 most influential surgeons of the past century were Gillies, Millard, Tessier, Buncke, Murray, Jurkiewicz, Hartrampf, Mathes, Taylor, Bostwick, McCraw, Furlow, Converse, Peacock, and Blair, in that order. The 10 most influential surgeons of the current era are Rohrich, Nahai, Wei, McCarthy, Coleman, MacKinnon, McGrath, Rubin, Guyuron, and Hammond. Pooled from both lists, the 10 most influential publications or bodies of work were Hartrampf's TRAM flap, Millard's cleft lip repair, McCraw/Mathes/Nahai's myocutaneous flaps, Furlow's cleft palate repair, Tessier's cleft classification and craniofacial repairs, Ramirez's components separation, Buncke's replantation/toe-to-thumb transfer, McCarthy's mandibular distraction osteogenesis, Taylor's free flap and angiosome concepts, and Murray's kidney transplant. The top 10 innovations of the 20th century were myocutaneous flaps, microsurgery, craniofacial surgery, skin grafts, transplantation, liposuction, bioimplants, distraction osteogenesis, angiosome anatomy, and rigid fixation. The 10 most important, current innovations are hand/face transplantation, fat grafting, stem cells, neurotoxins and soft-tissue fillers, biologic scaffolds, information technology, tissue engineering and regenerative medicine, negative pressure wound therapy, perforator flaps, and noninvasive imaging. Plastic surgery includes a rich history of both incremental and disruptive innovation, which has endowed our discipline with a competitive advantage over other medical and surgical subspecialties. Based upon our past success in managing change, there may be no limit, or no line on the horizon, as to what is possible, provided that we pursue innovation in a systematic way that combines creativity and discipline.

Laparoscopic surgery for trauma: the realm of therapeutic management.

PubMed

Zafar, Syed N; Onwugbufor, Michael T; Hughes, Kakra; Greene, Wendy R; Cornwell, Edward E; Fullum, Terrence M; Tran, Daniel D

2015-04-01

The use of laparoscopy in trauma is, in general, limited for diagnostic purposes. We aim to evaluate the therapeutic role of laparoscopic surgery in trauma patients. We analyzed the National Trauma Data Bank (2007 to 2010) for all patients undergoing diagnostic laparoscopy. Patients undergoing a therapeutic laparoscopic surgical procedure were identified and tabulated. Mortality and hospital length of stay for patients with isolated abdominal injuries were compared between the open and laparoscopic groups. Of a total of 2,539,818 trauma visits in the National Trauma Data Bank, 4,755 patients underwent a diagnostic laparoscopy at 467 trauma centers. Of these, 916 (19.3%) patients underwent a therapeutic laparoscopic intervention. Common laparoscopic operations included diaphragm repair, bowel repair or resection, and splenectomy. Patients undergoing laparoscopic surgery had a significantly shorter length of stay than the open group (5 vs 6 days; P < .001). Therapeutic laparoscopic surgery for trauma is feasible and may provide better outcomes. Copyright © 2015 Elsevier Inc. All rights reserved.

Efficacy of intravenous fluid warming during goal-directed fluid therapy in patients undergoing laparoscopic colorectal surgery: a randomized controlled trial.

PubMed

Choi, Ji-Won; Kim, Duk-Kyung; Lee, Seung-Won; Park, Jung-Bo; Lee, Gyu-Hong

2016-06-01

To evaluate the clinical efficacy of intravenous (IV) fluid warming in patients undergoing laparoscopic colorectal surgery. Adult patients undergoing laparoscopic colorectal surgery were randomly assigned to receive either IV fluids at room temperature (control group) or warmed IV fluids (warm fluids group). Each patient received a standardized goal-directed fluid regimen based on stroke volume variances. Oesophageal temperature was measured at 15 min intervals for 2 h after induction of anaesthesia. A total of 52 patients were enrolled in the study. The drop in core temperature in the warm fluids group was significantly less than in the control group 2 h after the induction of anaesthesia. This significant difference was seen from 30 min after induction. IV fluid warming was associated with a smaller drop in core temperature than room temperature IV fluids in laparoscopic colorectal surgery incorporating goal-directed fluid therapy. © The Author(s) 2016.

Anteverted internal auditory canal as an inner ear anomaly in patients with craniofacial microsomia.

PubMed

L'Heureux-Lebeau, Bénédicte; Saliba, Issam

2014-09-01

Craniofacial microsomia involves structure of the first and second branchial arches. A wide range of ear anomalies, affecting external, middle and inner ear, has been described in association with this condition. We report three cases of anteverted internal auditory canal in patients presenting craniofacial microsomia. This unique internal auditory canal orientation was found on high-resolution computed tomography of the temporal bones. This internal auditory canal anomaly is yet unreported in craniofacial anomalies. Copyright © 2014. Published by Elsevier Ireland Ltd.

Annexin A2 in Proliferative Vitreoretinopathy

DTIC Science & Technology

2016-10-01

migrate in the presence of macrophages in an in vitro system. In addition, analysis of human retinal tissue from subjects undergoing ocular surgery... tissue from subjects undergoing ocular surgery for PVR reveals the presence of A2- immunoreactive cells that express both macrophage and RPE cell...greatly attenuated in the absence of annexin A2. Task 2: Macrophage depletion and tissue specific knockout. We have completed the characterization

76 FR 38193 - National Institute of Dental & Craniofacial Research; Notice of Closed Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-29

... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Institute of Dental.... Name of Committee: National Institute of Dental and Craniofacial Research Special Emphasis Panel... Officer, Scientific Review Branch, National Inst of Dental & Craniofacial Research, National Institutes of...

76 FR 28793 - National Institute of Dental & Craniofacial Research; Notice of Closed Meetings

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-18

... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Institute of Dental..., Scientific Review Officer, Scientific Review Branch, National Inst of Dental & Craniofacial Research....nih.gov . Name of Committee: National Institute of Dental and Craniofacial Research Special Emphasis...

75 FR 52537 - National Institute of Dental & Craniofacial Research; Notice of Closed Meeting

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2010-08-26

... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Institute of Dental... unwarranted invasion of personal privacy. Name of Committee: National Institute of Dental and Craniofacial... Kelly, Scientific Review Officer, Scientific Review Branch, National Inst of Dental & Craniofacial...

Painful unilateral temporalis muscle enlargement: reactive masticatory muscle hypertrophy.

PubMed

Katsetos, Christos D; Bianchi, Michael A; Jaffery, Fizza; Koutzaki, Sirma; Zarella, Mark; Slater, Robert

2014-06-01

An instance of isolated unilateral temporalis muscle hypertrophy (reactive masticatory muscle hypertrophy with fiber type 1 predominance) confirmed by muscle biopsy with histochemical fiber typing and image analysis in a 62 year-old man is reported. The patient presented with bruxism and a painful swelling of the temple. Absence of asymmetry or other abnormalities of the craniofacial skeleton was confirmed by magnetic resonance imaging and cephalometric analyses. The patient achieved symptomatic improvement only after undergoing botulinum toxin injections. Muscle biopsy is key in the diagnosis of reactive masticatory muscle hypertrophy and its distinction from masticatory muscle myopathy (hypertrophic branchial myopathy) and other non-reactive causes of painful asymmetric temporalis muscle enlargement.

Effect of Intraperitoneal Bupivacaine on Postoperative Pain in the Gynecologic Oncology Patient

PubMed Central

Rivard, Colleen; Vogel, Rachel Isaksson; Teoh, Deanna

2015-01-01

Study Objective To evaluate if the administration of intraperitoneal bupivacaine decreased postoperative pain in patients undergoing minimally invasive gynecologic and gynecologic cancer surgery. Design Retrospective cohort study (Canadian Task Force classification II-3). Setting University-based gynecologic oncology practice operating at a tertiary medical center. Patients All patients on the gynecologic oncology service undergoing minimally invasive surgery between September 2011 and June 2013. Interventions Starting August 2012, intraperitoneal administration of .25% bupivacaine was added to all minimally invasive surgeries. These patients were compared with historical control subjects who had surgery between September 2011 and July 2012 but did not receive intraperitoneal bupivacaine. Measurements and Main Results One-hundred thirty patients were included in the study. The patients who received intraperitoneal bupivacaine had lower median narcotic use on the day of surgery and the first postoperative day compared with those who did not receive intraperitoneal bupivacaine (day 0: 7.0 mg morphine equivalents vs 11.0 mg, p = .007; day 1: .3 mg vs 1.7 mg, p = .0002). The median patient-reported pain scores were lower on the day of surgery in the intraperitoneal bupivacaine group (2.7 vs 3.2, p = .05) Conclusions The administration of intraperitoneal bupivacaine was associated with improved postoperative pain control in patients undergoing minimally invasive gynecologic and gynecologic cancer surgery and should be further evaluated in a prospective study. PMID:26216095

Extent of regional lymph node surgery and impact on outcomes in patients with early-stage breast cancer and limited axillary disease undergoing mastectomy.

PubMed

Picado, Omar; Khazeni, Kristina; Allen, Casey; Yakoub, Danny; Avisar, Eli; Kesmodel, Susan B

2018-06-05

Management of the axilla in patients with early-stage breast cancer (ESBC) has evolved. Recent trials support less extensive axillary surgery in patients undergoing mastectomy. We examine factors affecting regional lymph node (RLN) surgery and outcomes in patients with ESBC undergoing mastectomy. Women with clinical T1/2 N0 M0 invasive BC who underwent mastectomy with 1-2 positive nodes were selected from the National Cancer Database (2004-2015). Axillary surgery was defined by number of RLNs examined: 1-5 sentinel LN dissection (SLND), and ≥ 10 axillary LND (ALND). Binary logistic regression and survival analyses were performed to assess the association between axillary surgery and clinical characteristics, and overall survival (OS), respectively. 34,243 patients were included: 13,821 SLND (40%) and 20,422 ALND (60%). SLND significantly increased from 21% (2004) to 45% (2015) (p < .001). Independent factors associated with SLND were treatment year, non-Academic centers, geographic region, tumor histology, and postmastectomy radiotherapy (PMRT). Multivariable survival analysis showed that ALND was associated with better OS (HR 0.78, 95% CI 0.72-0.83, p < .001) relative to SLND; however, there was no difference in patients with LN micrometastases treated without RT (HR 0.87, 95% CI 0.73-1.05, p = .153) or patients receiving PMRT (HR 0.92, 95% CI 0.76-1.13, p = .433). SLND has significantly increased in patients undergoing mastectomy with limited axillary disease and is influenced by patient, tumor, and treatment factors. Survival outcomes did not differ by axillary treatment for patients with LN micrometastases treated without RT or patients who received PMRT. SLND may be considered in select patients with ESBC and limited axillary disease undergoing mastectomy.

Evaluation of lung volumes, vital capacity and respiratory muscle strength after cervical, thoracic and lumbar spinal surgery.

PubMed

Oliveira, Marcio Aparecido; Vidotto, Milena Carlos; Nascimento, Oliver Augusto; Almeida, Renato; Santoro, Ilka Lopes; Sperandio, Evandro Fornias; Jardim, José Roberto; Gazzotti, Mariana Rodrigues

2015-01-01

Studies have shown that physiopathological changes to the respiratory system can occur following thoracic and abdominal surgery. Laminectomy is considered to be a peripheral surgical procedure, but it is possible that thoracic spinal surgery exerts a greater influence on lung function. The aim of this study was to evaluate the pulmonary volumes and maximum respiratory pressures of patients undergoing cervical, thoracic or lumbar spinal surgery. Prospective study in a tertiary-level university hospital. Sixty-three patients undergoing laminectomy due to diagnoses of tumors or herniated discs were evaluated. Vital capacity, tidal volume, minute ventilation and maximum respiratory pressures were evaluated preoperatively and on the first and second postoperative days. Possible associations between the respiratory variables and the duration of the operation, surgical diagnosis and smoking status were investigated. Vital capacity and maximum inspiratory pressure presented reductions on the first postoperative day (20.9% and 91.6%, respectively) for thoracic surgery (P = 0.01), and maximum expiratory pressure showed reductions on the first postoperative day in cervical surgery patients (15.3%; P = 0.004). The incidence of pulmonary complications was 3.6%. There were reductions in vital capacity and maximum respiratory pressures during the postoperative period in patients undergoing laminectomy. Surgery in the thoracic region was associated with greater reductions in vital capacity and maximum inspiratory pressure, compared with cervical and lumbar surgery. Thus, surgical manipulation of the thoracic region appears to have more influence on pulmonary function and respiratory muscle action.

NUTRITIONAL REPERCUSSIONS IN PATIENTS SUBMITTED TO BARIATRIC SURGERY

PubMed Central

SILVEIRA-JÚNIOR, Sérgio; de ALBUQUERQUE, Maurício Mendes; do NASCIMENTO, Ricardo Reis; da ROSA, Luisa Salvagni; HYGIDIO, Daniel de Andrade; ZAPELINI, Raphaela Mazon

2015-01-01

Background Few studies evaluated the association between nutritional disorders, quality of life and weight loss in patients undergoing bariatric surgery. Aim To identify nutritional changes in patients undergoing bariatric surgery and correlate them with weight loss, control of comorbidities and quality of life. Method A prospective cohort, analytical and descriptive study involving 59 patients undergoing bariatric surgery was done. Data were collected preoperatively at three and six months postoperatively, evaluating nutritional aspects and outcomes using BAROS questionnaire. The data had a confidence interval of 95%. Results The majority of patients was composed of women, 47 (79.7%), with 55.9% of the series with BMI between 40 to 49.9 kg/m². In the sixth month after surgery scores of quality of life were significantly higher than preoperatively (p<0.05) and 27 (67.5 %) patients had comorbidities resolved, 48 (81.3 %) presented BAROS scores of very good or excellent. After three and six months of surgery 16 and 23 presented some nutritional disorder, respectively. There was no relationship between the loss of excess weight and quality of life among patients with or without nutritional disorders. Conclusions Nutritional disorders are uncommon in the early postoperative period and, when present, have little or no influence on quality of life and loss of excess weight. PMID:25861070

A randomized study comparing outcomes of stapled and hand-sutured anastomoses in patients undergoing open gastrointestinal surgery.

PubMed

Chandramohan, S M; Gajbhiye, Raj Narenda; Agwarwal, Anil; Creedon, Erin; Schwiers, Michael L; Waggoner, Jason R; Tatla, Daljit

2013-08-01

Although stapling is an alternative to hand-suturing in gastrointestinal surgery, recent trials specifically designed to evaluate differences between the two in surgery time, anastomosis time, and return to bowel activity are lacking. This trial compared the outcomes of the two in subjects undergoing open gastrointestinal surgery. Adult subjects undergoing emergency or elective surgery requiring a single gastric, small, or large bowel anastomosis were enrolled into this open-label, prospective, randomized, interventional, parallel, multicenter, controlled trial. Randomization was assigned in a 1:1 ratio between the hand-sutured group (n = 138) and the stapled group (n = 142). Anastomosis time, surgery time, and time to bowel activity were collected and compared as primary endpoints. A total of 280 subjects were enrolled from April 2009 to September 2010. Only the time of anastomosis was significantly different between the two arms: 17.6 ± 1.90 min (stapled) and 20.6 ± 1.90 min (hand-sutured). This difference was deemed not clinically or economically meaningful. Safety outcomes and other secondary endpoints were similar between the two arms. Mechanical stapling is faster than hand-suturing for the construction of gastrointestinal anastomoses. Apart from this, stapling and hand-suturing are similar with respect to the outcomes measured in this trial.

Non-cardiac surgery in patients with prosthetic heart valves: a 12 years experience.

PubMed

Akhtar, Raja Parvez; Abid, Abdul Rehman; Zafar, Hasnain; Gardezi, Syed Javed Raza; Waheed, Abdul; Khan, Jawad Sajid

2007-10-01

To study patients with mechanical heart valves undergoing non-cardiac surgery and their anticoagulation management during these procedures. It was a cohort study. The study was conducted at the Department of Cardiac Surgery, Punjab Institute of Cardiology, Lahore and Department of Surgery, Services Institute of Medical Sciences, Lahore, from September 1994 to June 2006. Patients with mechanical heart valves undergoing non-cardiac surgical operation during this period, were included. Their anticoagulation was monitored and anticoagulation related complications were recorded. In this study, 507 consecutive patients with a mechanical heart valve replacement were followed-up. Forty two (8.28%) patients underwent non-cardiac surgical operations of which 24 (57.1%) were for abdominal and non-abdominal surgeries, 5 (20.8%) were emergency and 19 (79.2%) were planned. There were 18 (42.9%) caesarean sections for pregnancies. Among the 24 procedures, there were 7(29.1%) laparotomies, 7(29.1%) hernia repairs, 2 (8.3%) cholecystectomies, 2 (8.3%) hysterectomies, 1(4.1%) craniotomy, 1(4.1%) spinal surgery for neuroblastoma, 1(4.1%) ankle fracture and 1(4.1%) carbuncle. No untoward valve or anticoagulation related complication was seen during this period. Patients with mechanical valve prosthesis on life-long anticoagulation, if managed properly, can undergo any type of non-cardiac surgical operation with minimal risk.

The old and new face of craniofacial research: How animal models inform human craniofacial genetic and clinical data.

PubMed

Van Otterloo, Eric; Williams, Trevor; Artinger, Kristin Bruk

2016-07-15

The craniofacial skeletal structures that comprise the human head develop from multiple tissues that converge to form the bones and cartilage of the face. Because of their complex development and morphogenesis, many human birth defects arise due to disruptions in these cellular populations. Thus, determining how these structures normally develop is vital if we are to gain a deeper understanding of craniofacial birth defects and devise treatment and prevention options. In this review, we will focus on how animal model systems have been used historically and in an ongoing context to enhance our understanding of human craniofacial development. We do this by first highlighting "animal to man" approaches; that is, how animal models are being utilized to understand fundamental mechanisms of craniofacial development. We discuss emerging technologies, including high throughput sequencing and genome editing, and new animal repository resources, and how their application can revolutionize the future of animal models in craniofacial research. Secondly, we highlight "man to animal" approaches, including the current use of animal models to test the function of candidate human disease variants. Specifically, we outline a common workflow deployed after discovery of a potentially disease causing variant based on a select set of recent examples in which human mutations are investigated in vivo using animal models. Collectively, these topics will provide a pipeline for the use of animal models in understanding human craniofacial development and disease for clinical geneticist and basic researchers alike. Copyright © 2016 Elsevier Inc. All rights reserved.

Study on the performance of different craniofacial superimposition approaches (II): Best practices proposal.

PubMed

Damas, S; Wilkinson, C; Kahana, T; Veselovskaya, E; Abramov, A; Jankauskas, R; Jayaprakash, P T; Ruiz, E; Navarro, F; Huete, M I; Cunha, E; Cavalli, F; Clement, J; Lestón, P; Molinero, F; Briers, T; Viegas, F; Imaizumi, K; Humpire, D; Ibáñez, O

2015-12-01

Craniofacial superimposition, although existing for one century, is still a controversial technique within the scientific community. Objective and unbiased validation studies over a significant number of cases are required to establish a more solid picture on the reliability. However, there is lack of protocols and standards in the application of the technique leading to contradictory information concerning reliability. Instead of following a uniform methodology, every expert tends to apply his own approach to the problem, based on the available technology and deep knowledge on human craniofacial anatomy, soft tissues, and their relationships. The aim of this study was to assess the reliability of different craniofacial superimposition methodologies and the corresponding technical approaches to this type of identification. With all the data generated, some of the most representative experts in craniofacial identification joined in a discussion intended to identify and agree on the most important issues that have to be considered to properly employ the craniofacial superimposition technique. As a consequence, the consortium has produced the current manuscript, which can be considered the first standard in the field; including good and bad practices, sources of error and uncertainties, technological requirements and desirable features, and finally a common scale for the craniofacial matching evaluation. Such a document is intended to be part of a more complete framework for craniofacial superimposition, to be developed during the FP7-founded project MEPROCS, which will favour and standardize its proper application. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

A Population-Based Study of 30-day Incidence of Ischemic Stroke Following Surgical Neck Dissection

PubMed Central

MacNeil, S. Danielle; Liu, Kuan; Garg, Amit X.; Tam, Samantha; Palma, David; Thind, Amardeep; Winquist, Eric; Yoo, John; Nichols, Anthony; Fung, Kevin; Hall, Stephen; Shariff, Salimah Z.

2015-01-01

Abstract The objective of this study was to determine the 30-day incidence of ischemic stroke following neck dissection compared to matched patients undergoing non-head and neck surgeries. A surgical dissection of the neck is a common procedure performed for many types of cancer. Whether such dissections increase the risk of ischemic stroke is uncertain. A retrospective cohort study using data from linked administrative and registry databases (1995–2012) in the province of Ontario, Canada was performed. Patients were matched 1-to-1 on age, sex, date of surgery, and comorbidities to patients undergoing non-head and neck surgeries. The primary outcome was ischemic stroke assessed in hospitalized patients using validated database codes. A total of 14,837 patients underwent surgical neck dissection. The 30-day incidence of ischemic stroke following the dissection was 0.7%. This incidence decreased in recent years (1.1% in 1995 to 2000; 0.8% in 2001 to 2006; 0.3% in 2007 to 2012; P for trend <0.0001). The 30-day incidence of ischemic stroke in patients undergoing neck dissection is similar to matched patients undergoing thoracic surgery (0.5%, P = 0.26) and colectomy (0.5%, P = 0.1). Factors independently associated with a higher risk of stroke in 30 days following neck dissection surgery were of age ≥75 years (odds ratio (OR) 1.63, 95% confidence interval (CI) 1.05–2.53), and a history of diabetes (OR 1.60, 95% CI 1.02–2.49), hypertension (OR 2.64, 95% CI 1.64–4.25), or prior stroke (OR 4.06, 95% CI 2.29–7.18). Less than 1% of patients undergoing surgical neck dissection will experience an ischemic stroke in the following 30 days. This incidence of stroke is similar to thoracic surgery and colectomy. PMID:26287406

The association between the transfusion of small volumes of leucocyte-depleted red blood cells and outcomes in patients undergoing open-heart valve surgery.

PubMed

Zittermann, Armin; Koster, Andreas; Faraoni, David; Börgermann, Jochen; Schirmer, Uwe; Gummert, Jan F

2017-02-01

The relationship between the transfusion of red blood cell (RBC) units and outcomes in patients undergoing cardiac surgery is the subject of intense debates. In this study, we investigated the relationship between the transfusion of 1-2 leucocyte-depleted (LD) RBC units and outcomes in patients undergoing open-heart valve surgery. The investigation encompassed consecutive patients undergoing open-heart valve surgery at our institution between July 2009 and March 2015 who received no (RBC- group) or 1-2 units of LD RBC (RBC+ group). End-points were 30-day mortality (primary), the incidence of in-hospital major organ dysfunctions and 1-year mortality (secondary). Propensity score (PS)-adjusted statistical analysis was used to assess the effect of RBC transfusion on end-points. Thirty-day mortality rate was 0.2% (3/1485) in the RBC- group and 0.4% (6/1672) in the RBC+ group, with a PS-adjusted odds ratio (OR) for 30-day mortality of 1.00 (95% CI: 0.21-4.83;P = 0.99). The two groups showed no significant differences in PS-adjusted ORs for major complications, such as stroke, low cardiac output syndrome, thoracic wound infection and prolonged mechanical ventilation (>24 h). The PS-adjusted ORs for prolonged intensive care unit stay (>48 h) were, however, significantly higher in the RBC+ group (OR = 1.34 [95%CI: 1.04-1.72; P = 0.02]) than in the RBC- group. One-year mortality was comparable between groups (PS-adjusted hazard ratio for the RBC+ group: 0.85 [95% CI: 0.42-1.72; P = 0.65]). Our data do not provide evidence that in patients undergoing valve surgery with cardiopulmonary bypass, transfusion of 1-2 units of LD RBC increases operative mortality, the incidence of postoperative complications or 1-year mortality. © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

77 FR 59199 - National Institute of Dental & Craniofacial Research; Notice of Closed Meeting

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Nonsurgical Management of Pediatric Temporomandibular Joint Dysfunction.

PubMed

Scrivani, Steven John; Khawaja, Shehryar Nasir; Bavia, Paula Furlan

2018-02-01

Temporomandibular disorders (TMD) are a subgroup of craniofacial pain problems involving the temporomandibular joint (TMJ), masticatory muscles, and associated head and neck musculoskeletal structures. These disorders are subclassified into TMJ articular disorders and masticatory muscle disorders. Patients with TMD most commonly present with pain, restricted or asymmetric mandibular motion, and TMJ sounds during mandibular movements. The prevalence tends to increase with age. Management of TMJ articular disorders consists of a combination of patient education, home-care plan, biobehavioral therapy, physical therapy, orthotic jaw appliance therapy, pharmacotherapy, and/or surgery. The goal is to increase function, reduce pain, and improve quality of life. Copyright © 2017 Elsevier Inc. All rights reserved.

Effects of preoperative aspirin on cardiocerebral and renal complications in non-emergent cardiac surgery patients: a sub-group and cohort study.

PubMed

Cao, Longhui; Silvestry, Scott; Zhao, Ning; Diehl, James; Sun, Jianzhong

2012-01-01

Postoperative cardiocerebral and renal complications are a major threat for patients undergoing cardiac surgery. This study was aimed to examine the effect of preoperative aspirin use on patients undergoing cardiac surgery. An observational cohort study was performed on consecutive patients (n = 1879) receiving cardiac surgery at this institution. The patients excluded from the study were those with preoperative anticoagulants, unknown aspirin use, or underwent emergent cardiac surgery. Outcome events included were 30-day mortality, renal failure, readmission and a composite outcome--major adverse cardiocerebral events (MACE) that include permanent or transient stroke, coma, perioperative myocardial infarction (MI), heart block and cardiac arrest. Of all patients, 1145 patients met the inclusion criteria and were divided into two groups: those taking (n = 858) or not taking (n = 287) aspirin within 5 days preceding surgery. Patients with aspirin presented significantly more with history of hypertension, diabetes, peripheral arterial disease, previous MI, angina and older age. With propensity scores adjusted and multivariate logistic regression, however, this study showed that preoperative aspirin therapy (vs. no aspirin) significantly reduced the risk of MACE (8.4% vs. 12.5%, odds ratio [OR] 0.585, 95% CI 0.355-0.964, P = 0.035), postoperative renal failure (2.6% vs. 5.2%, OR 0.438, CI 0.203-0.945, P = 0.035) and dialysis required (0.8% vs. 3.1%, OR 0.230, CI 0.071-0.742, P = 0.014), but did not significantly reduce 30-day mortality (4.1% vs. 5.8%, OR 0.744, CI 0.376-1.472, P = 0.396) nor it increased readmissions in the patients undergoing cardiac surgery. Preoperative aspirin therapy is associated with a significant decrease in the risk of MACE and renal failure and did not increase readmissions in patients undergoing non-emergent cardiac surgery.

Postoperative atrial fibrillation and total dietary antioxidant capacity in patients undergoing cardiac surgery: The Polyphemus Observational Study.

PubMed

Costanzo, Simona; De Curtis, Amalia; di Niro, Veronica; Olivieri, Marco; Morena, Mariarosaria; De Filippo, Carlo Maria; Caradonna, Eugenio; Krogh, Vittorio; Serafini, Mauro; Pellegrini, Nicoletta; Donati, Maria Benedetta; de Gaetano, Giovanni; Iacoviello, Licia

2015-04-01

Postoperative atrial fibrillation is a major cause of morbidity and mortality for stroke after cardiac surgery. Both systemic inflammation and oxidative stress play a role in the initiation of postoperative atrial fibrillation after cardiac surgery. The possible association between long-term intake of antioxidant-rich foods and postoperative atrial fibrillation incidence was examined in patients undergoing cardiac surgery. A total of 217 consecutive patients (74% were men; median age, 68.4 years) undergoing cardiac surgery, mainly coronary artery bypass grafting and valve replacement or repair, were recruited from January 2010 to September 2012. Total antioxidant capacity was measured in foods by the Trolox equivalent antioxidant capacity assay. The European Prospective Investigation into Cancer and Nutrition Food Frequency Questionnaire was used for dietary total antioxidant capacity assessment. The association among tertiles of dietary total antioxidant capacity and postoperative atrial fibrillation incidence was assessed using multivariable logistic analysis. The overall incidence of total arrhythmias and postoperative atrial fibrillation was 42.4% and 38.2%, respectively. In multivariable analysis, after adjustment for age, gender, use of hypoglycemic drugs, physical activity, education, previous diagnosis of atrial fibrillation, and total energy intake, patients in the highest tertile of dietary total antioxidant capacity had a lower risk of postoperative atrial fibrillation than patients in the 2 lowest tertiles (odds ratio, 0.46; 95% confidence interval, 0.22-0.95; P = .048). A restricted cubic spline transformation confirmed the nonlinear relationship between total antioxidant capacity (in continuous scale) and postoperative atrial fibrillation (P = .023). When considering only coronary artery bypass grafting, valve replacement/repair, and combined surgeries, the protective effect on postoperative atrial fibrillation of a diet rich in antioxidants was confirmed. Long-term consumption of antioxidant-rich foods is associated with a reduced incidence of postoperative atrial fibrillation in patients undergoing cardiac surgery. Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Major cardiac surgery induces an increase in sex steroids in prepubertal children.

PubMed

Heckmann, Matthias; d'Uscio, Claudia H; de Laffolie, Jan; Neuhaeuser, Christoph; Bödeker, Rolf-Hasso; Thul, Josef; Schranz, Dietmar; Frey, Brigitte M

2014-03-01

While the neuroprotective benefits of estrogen and progesterone in critical illness are well established, the data regarding the effects of androgens are conflicting. Surgical repair of congenital heart disease is associated with significant morbidity and mortality, but there are scant data regarding the postoperative metabolism of sex steroids in this setting. The objective of this prospective observational study was to compare the postoperative sex steroid patterns in pediatric patients undergoing major cardiac surgery (MCS) versus those undergoing less intensive non-cardiac surgery. Urinary excretion rates of estrogen, progesterone, and androgen metabolites (μg/mmol creatinine/m(2) body surface area) were determined in 24-h urine samples before and after surgery using gas chromatography-mass spectrometry in 29 children undergoing scheduled MCS and in 17 control children undergoing conventional non-cardiac surgery. Eight of the MCS patients had Down's syndrome. There were no significant differences in age, weight, or sex between the groups. Seven patients from the MCS group showed multi-organ dysfunction after surgery. Before surgery, the median concentrations of 17β-estradiol, pregnanediol, 5α-dihydrotestosterone (DHT), and dehydroepiandrosterone (DHEA) were (control/MCS) 0.1/0.1 (NS), 12.4/11.3 (NS), 4.7/4.4 (NS), and 2.9/1.1 (p=0.02). Postoperatively, the median delta 17β-estradiol, delta pregnanediol, delta DHT, and delta DHEA were (control/MCS) 0.2/6.4 (p=0.0002), -3.2/23.4 (p=0.013), -0.6/3.7 (p=0.0004), and 0.5/4.2 (p=0.004). Postoperative changes did not differ according to sex. We conclude that MCS, but not less intensive non-cardiac surgery, induced a distinct postoperative increase in sex steroid levels. These findings suggest that sex steroids have a role in postoperative metabolism following MCS in prepubertal children. Copyright © 2013 Elsevier Ltd. All rights reserved.

Outcome of patients with reduced ankle brachial index undergoing open heart surgery with cardiopulmonary bypass.

PubMed

Meyborg, Matthias; Abdi-Tabari, Zila; Hoffmeier, Andreas; Engelbertz, Christiane; Lüders, Florian; Freisinger, Eva; Malyar, Nasser M; Martens, Sven; Reinecke, Holger

2016-05-01

In open heart surgery using cardiopulmonary bypass, perfusion of the lower extremities is markedly reduced which may induce critical ischaemia in patients with pre-existing peripheral artery disease. Whether these patients have an increased risk for amputation and should better undergo peripheral revascularization prior to surgery remains unclear. From 1 January 2009 to 31 December 2010, 785 consecutive patients undergoing open heart surgery were retrospectively included. In 443 of these patients, preoperative ankle brachial index (ABI) measurements were available. The cohort was divided into four groups: (i) ABI < 0.5, (ii) ABI 0.5-0.69, (iii) ABI 0.7-0.89 or (iv) ABI ≥ 0.9. Follow-up data of 413 (93.2%) patients were analysed with regard to mortality and amputations. The groups differed significantly in terms of age, cardiac risk factors, performed cardiac surgery and renal function. Postoperative delayed wound healing was significantly associated with lower ABI (25.9, 15.2, 27.0 and 9.6% in Groups I-IV, respectively, P = 0.003), whereas 30-day mortality was not significantly higher in patients with lower ABI (0, 4.3, 8.1 and 3.9%, respectively, P = 0.4). Kaplan-Meier models showed a significantly lower long-term survival over 4 years in patients with reduced ABI (P = 0.001, long-rank test) while amputations occurred rarely with only one minor amputation in Group II (P = 0.023). Patients with reduced ABIs undergoing heart surgery showed more wound-healing disturbances, and higher long-term mortality compared with those with normal ABIs. However, no perioperative ischaemia requiring amputation occurred. Thus, reduced ABIs were not associated with increased peripheral risks in open heart surgery but ABI may be helpful in selecting the site for saphenectomy to potentially avoid delayed healing of related wounds in legs with severely impaired arterial perfusion. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Materialism, Sociocultural Appearance Messages, and Paternal Attitudes Predict College Women's Attitudes about Cosmetic Surgery

ERIC Educational Resources Information Center

Henderson-King, Donna; Brooks, Kelly D.

2009-01-01

Rates of cosmetic surgery procedures have increased dramatically over the past several decades, but only recently have studies of cosmetic surgery attitudes among the general population begun to appear in the literature. The vast majority of those who undergo cosmetic surgery are women. We examined cosmetic surgery attitudes among 218…

Emotional state and coping style among gynecologic patients undergoing surgery.

PubMed

Matsushita, Toshiko; Murata, Hinako; Matsushima, Eisuke; Sakata, Yu; Miyasaka, Naoyuki; Aso, Takeshi

2007-02-01

The aim of the present study was to investigate changes in emotional state and the relationship between emotional state and demographic/clinical factors and coping style among gynecologic patients undergoing surgery. Using the Japanese version of the Profile of Mood States (POMS), 90 patients (benign disease: 32, malignancy: 58) were examined on three occasions: before surgery, before discharge, and 3 months after discharge. They were also examined using the Coping Inventory for Stressful Situations (CISS) on one occasion before discharge. The scores for the subscales depression, anger, and confusion were the highest after discharge while those for anxiety were the highest before surgery. The average scores of the POMS subscales for all subjects were within the normal range. With regard to the relationship between these emotional states and other factors, multiple regressions showed that the principal determinants of anxiety before surgery were religious belief, psychological symptoms during hospitalization and emotion-oriented (E) coping style; further, it was found that depression after discharge could be explained by chemotherapy, duration of hospitalization, and E coping style. The principal determinants of anger after discharge and vigor before surgery were length of education and E coping style, and severity of disease, chemotherapy, E coping style and task-oriented coping style, respectively. Those of post-discharge fatigue and confusion were length of education, psychological symptoms, and E coping style. In summary it is suggested that the following should be taken into account in patients undergoing gynecologic surgery: anxiety before surgery, depression, anger, and confusion after surgery, including coping styles.

Back school or brain school for patients undergoing surgery for lumbar radiculopathy? Protocol for a randomised, controlled trial.

PubMed

Ickmans, Kelly; Moens, Maarten; Putman, Koen; Buyl, Ronald; Goudman, Lisa; Huysmans, Eva; Diener, Ina; Logghe, Tine; Louw, Adriaan; Nijs, Jo

2016-07-01

Despite scientific progress with regard to pain neuroscience, perioperative education tends to stick to the biomedical model. This may involve, for example, explaining the surgical procedure or 'back school' (education that focuses on biomechanics of the lumbar spine and ergonomics). Current perioperative education strategies that are based on the biomedical model are not only ineffective, they can even increase anxiety and fear in patients undergoing spinal surgery. Therefore, perioperative pain neuroscience education is proposed as a dramatic shift in educating patients prior to and following surgery for lumbar radiculopathy. Rather than focusing on the surgical procedure, ergonomics or lumbar biomechanics, perioperative pain neuroscience education teaches people about the underlying mechanisms of pain, including the pain they will feel following surgery. The primary objective of the study is to examine whether perioperative pain neuroscience education ('brain school') is more effective than classic back school in reducing pain and improving pain inhibition in patients undergoing surgery for spinal radiculopathy. A secondary objective is to examine whether perioperative pain neuroscience education is more effective than classic back school in: reducing postoperative healthcare expenditure, improving functioning in daily life, increasing return to work, and improving surgical experience (ie, being better prepared for surgery, reducing incongruence between the expected and actual experience) in patients undergoing surgery for spinal radiculopathy. A multi-centre, two-arm (1:1) randomised, controlled trial with 2-year follow-up. People undergoing surgery for lumbar radiculopathy (n=86) in two Flemish hospitals (one tertiary care, university-based hospital and one regional, secondary care hospital) will be recruited for the study. All participants will receive usual preoperative and postoperative care related to the surgery for lumbar radiculopathy. The experimental group will also receive perioperative pain neuroscience education comprising one preoperative and one postoperative individual educational session plus an educational booklet. Participants in the control group will receive perioperative back school on top of usual preoperative and postoperative care, comprising one preoperative and one postoperative individual educational session plus an educational booklet. Self-reported pain and endogenous pain modulation (including measurements of simultaneous cortical activation via electroencephalography) will be the primary outcome measures. Secondary outcome measures will include daily functioning, return to work, postoperative healthcare utilisation and surgical experience/satisfaction. Psychological factors will be measured as possible treatment mediators. All assessments will take place in the week preceding surgery (baseline), and at 3 days and 6 weeks after surgery. Intermediate and long-term follow-up assessments will take place at 6, 12 and 24 months after surgery. All data analyses will be based on the intention-to-treat principle. Repeated measures AN(C)OVA analyses will be used to evaluate and compare treatment effects. Baseline data, treatment centre, age and gender will be included as covariates. Statistical, as well as clinically, significant differences will be evaluated and effect sizes will be determined. In addition, the numbers needed to treat will be calculated. This study will determine whether pain neuroscience education is worthwhile for patients undergoing surgery for lumbar radiculopathy. It is expected that participants who receive perioperative pain neuroscience education will report less pain and have improved endogenous pain modulation, lower postoperative healthcare costs and improved surgical experience. Lower pain and improved endogenous pain modulation after surgery may reduce the risk of developing postoperative chronic pain. Copyright © 2016 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.

Preoperative versus postoperative ultrasound-guided rectus sheath block for improving pain, sleep quality and cytokine levels of patients with open midline incisions undergoing transabdominal gynaecological operation: study protocol for a randomised controlled trial.

PubMed

Jin, Feng; Li, Xiao-Qian; Tan, Wen-Fei; Ma, Hong; Lu, Huang-Wei

2015-12-10

Rectus sheath block (RSB) is used for postoperative pain relief in patients undergoing abdominal surgery with midline incision. Preoperative RSB has been shown to be effective, but it has not been compared with postoperative RSB. The aim of the present study is to evaluate postoperative pain, sleep quality and changes in the cytokine levels of patients undergoing gynaecological surgery with RSB performed preoperatively versus postoperatively. This study is a prospective, randomised, controlled (randomised, parallel group, concealed allocation), single-blinded trial. All patients undergoing transabdominal gynaecological surgery will be randomised 1:1 to the treatment intervention with general anaesthesia as an adjunct to preoperative or postoperative RSB. The objective of the trial is to evaluate postoperative pain, sleep quality and changes in the cytokine levels of patients undergoing gynaecological surgery with RSB performed preoperatively (n = 32) versus postoperatively (n = 32). All of the patients, irrespective of group allocation, will receive patient-controlled intravenous analgesia (PCIA) with oxycodone. The primary objective is to compare the interval between leaving the post-anaesthesia care unit and receiving the first PCIA bolus injection on the first postoperative night between patients who receive preoperative versus postoperative RSB. The secondary objectives will be to compare (1) cumulative oxycodone consumption at 24 hours after surgery; (2) postoperative sleep quality, as measured using a BIS-Vista monitor during the first night after surgery; and (3) cytokine levels (interleukin-1, interleukin-6, tumour necrosis factor-α and interferon-γ) during surgery and at 24 and 48 hours postoperatively. Clinical experience has suggested that RSB is a very effective postoperative analgesic technique, and we will answer the following questions with this trial. Do preoperative block and postoperative block have the same duration of analgesic effects? Can postoperative block extend the analgesic time? The results of this study could have actual clinical applications that could help to reduce postoperative pain and shorten hospital stays. Current Controlled Trials NCT02477098 15 June 2015.

Off-pump coronary artery bypass surgery in severe left ventricular dysfunction.

PubMed

Azarfarin, Rasoul; Pourafkari, Leili; Parvizi, Rezayat; Alizadehasl, Azin; Mahmoodian, Roghaiyeh

2010-02-01

Our aim was to examine hospital outcomes of coronary artery bypass surgery in patients with and without left ventricular dysfunction, with regard to the surgical technique (off- or on-pump). Between March 2007 and March 2008, 689 consecutive patients underwent isolated first-time coronary artery bypass; 127 had ejection fractions < or = 30% (group 1) and 562 had ejection fractions >30% (group 2). Data of preoperative risk profiles and hospital outcomes were collected prospectively. Off-pump operations were performed in 49 (38.6%) patients in group 1 and 196 (34.9%) in group 2. The incidences of infectious, neurologic, and cardiac complications postoperatively were significantly higher in group 1. In multivariate analysis, preoperative ejection fraction < or = 30% was found to be an independent risk factor for postoperative complications and hospital mortality. The subgroup of patients undergoing off-pump surgery in both groups had a significantly lower rate of total complications than those undergoing conventional on-pump operations, but no significant difference in mortality was observed between those undergoing off-pump or conventional surgery in either group. Off-pump surgery helped to limit the increased morbidity rate after coronary bypass in patients with ventricular dysfunction.

Longitudinal Perioperative Pain Assessment in Head and Neck Cancer Surgery.

PubMed

Buchakjian, Marisa R; Davis, Andrew B; Sciegienka, Sebastian J; Pagedar, Nitin A; Sperry, Steven M

2017-09-01

To evaluate perioperative pain in patients undergoing major head and neck cancer surgery and identify associations between preoperative and postoperative pain characteristics. Patients undergoing head and neck surgery with regional/free tissue transfer were enrolled. Preoperative pain and validated screens for symptoms (neuropathic pain, anxiety, depression, fibromyalgia) were assessed. Postoperatively, patients completed a pain diary for 4 weeks. Twenty-seven patients were enrolled. Seventy-eight percent had pain prior to surgery, and for 38%, the pain had neuropathic characteristics. Thirteen patients (48%) completed at least 2 weeks of the postoperative pain diary. Patients with moderate/severe preoperative pain report significantly greater pain scores postoperatively, though daily pain decreased at a similar linear rate for all patients. Patients with more severe preoperative pain consumed greater amounts of opioids postoperatively, and this correlated with daily postoperative pain scores. Patients who screened positive for neuropathic pain also reported worse postoperative pain. Longitudinal perioperative pain assessment in head and neck patients undergoing surgery suggests that patients with worse preoperative pain continue to endorse worse pain postoperatively and require more narcotics. Patients with preoperative neuropathic pain also report poor pain control postoperatively, suggesting an opportunity to identify these patients and intervene with empiric neuropathic pain treatment.

3D printing in orthognathic surgery - A literature review.

PubMed

Lin, Hsiu-Hsia; Lonic, Daniel; Lo, Lun-Jou

2018-07-01

With the recent advances in three-dimensional (3D) imaging, computer-assisted surgical planning and simulation are now regularly used for analysis of craniofacial structures and improved prediction of surgical outcomes in orthognathic surgery. A variety of patient-specific surgical guides and devices have been designed and manufactured using 3D printing technology, which rapidly gained widespread popularity to improve the outcomes. The article presents an overview of 3D printing technology for state-of-the-art application in orthognathic surgery and discusses the impacts on treatment feasibility and patient outcome. The current available literature regarding the use of 3D printing methods in orthognathic surgery including 3D computer-aided design/computer-aided manufacturing, rapid prototyping, additive manufacturing, 3D printing, 3D printed models, surgical occlusal splints, custom-made guides, templates and fixation plates is reviewed. A Medline, PubMed, ProQuest and ScienceDirect search was performed to find relevant articles over the past 10 years. A total of 318 articles were found, out of which 69 were publications addressing the topic of this study. An additional 9 hand-searched articles were added. From the review, we can conclude that the use of 3D printing methods in orthognathic surgery provide the benefit of optimal functional and aesthetic results, patient satisfaction, and precise translation of the treatment plan. Copyright © 2018. Published by Elsevier B.V.

77 FR 68136 - National Institute of Dental & Craniofacial Research; Notice of Closed Meeting

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The society for craniofacial genetics and developmental biology 38th annual meeting.

PubMed

Taneyhill, Lisa A; Hoover-Fong, Julie; Lozanoff, Scott; Marcucio, Ralph; Richtsmeier, Joan T; Trainor, Paul A

2016-07-01

The mission of the Society for Craniofacial Genetics and Developmental Biology (SCGDB) is to promote education, research, and communication about normal and abnormal development of the tissues and organs of the head. The SCGDB welcomes as members undergraduate students, graduate students, post doctoral researchers, clinicians, orthodontists, scientists, and academicians who share an interest in craniofacial biology. Each year our members come together to share their novel findings, build upon, and challenge current knowledge of craniofacial biology. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Craniofacial and Dental Development in Costello Syndrome

PubMed Central

Goodwin, Alice F.; Oberoi, Snehlata; Landan, Maya; Charles, Cyril; Massie, Jessica C.; Fairley, Cecilia; Rauen, Katherine A.; Klein, Ophir D.

2014-01-01

Costello syndrome (CS) is a RASopathy characterized by a wide range of cardiac, musculoskeletal, dermatological, and developmental abnormalities. The RASopathies are defined as a group of syndromes caused by activated Ras/mitogen-activated protein kinase (MAPK) signaling. Specifically, CS is caused by activating mutations in HRAS. Although receptor tyrosine kinase (RTK) signaling, which is upstream of Ras/MAPK, is known to play a critical role in craniofacial and dental development, the craniofacial and dental features of CS have not been systematically defined in a large group of individuals. In order to address this gap in our understanding and fully characterize the CS phenotype, we evaluated the craniofacial and dental phenotype in a large cohort (n=41) of CS individuals. We confirmed that the craniofacial features common in CS include macrocephaly, bitemporal narrowing, convex facial profile, full cheeks, and large mouth. Additionally, CS patients have a characteristic dental phenotype that includes malocclusion with anterior open bite and posterior crossbite, enamel hypo-mineralization, delayed tooth development and eruption, gingival hyperplasia, thickening of the alveolar ridge, and high palate. Comparison of the craniofacial and dental phenotype in CS with other RASopathies, such as cardio-facio-cutaneous syndrome (CFC), provides insight into the complexities of Ras/MAPK signaling in human craniofacial and dental development. PMID:24668879

Partial craniofacial duplication: a review of the literature and case report.

PubMed

Costa, Melinda A; Borzabadi-Farahani, Ali; Lara-Sanchez, Pedro A; Schweitzer, Daniela; Jacobson, Lia; Clarke, Noreen; Hammoudeh, Jeffery; Urata, Mark M; Magee, William P

2014-06-01

Diprosopus (Greek; di-, "two" + prosopon, "face"), or craniofacial duplication, is a rare craniofacial anomaly referring to the complete duplication of facial structures. Partial craniofacial duplication describes a broad spectrum of congenital anomalies, including duplications of the oral cavity. This paper describes a 15 month-old female with a duplicated oral cavity, mandible, and maxilla. A Tessier type 7 cleft, midline meningocele, and duplicated hypophysis were also present. The preoperative evaluation, surgical approach, postoperative results, and a review of the literature are presented. The surgical approach was designed to preserve facial nerve innervation to the reconstructed cheek and mouth. The duplicated mandible and maxilla were excised and the remaining left maxilla was bone grafted. Soft tissue repair included closure of the Tessier type VII cleft. Craniofacial duplication remains a rare entity that is more common in females. The pathophysiology remains incompletely characterized, but is postulated to be due to duplication of the notochord, as well as duplication of mandibular growth centres. While diprosopus is a severe deformity often associated with anencephaly, patients with partial duplication typically benefit from surgical treatment. Managing craniofacial duplication requires a detailed preoperative evaluation as well as a comprehensive, staged treatment plan. Long-term follow up is needed appropriately to address ongoing craniofacial deformity. Published by Elsevier Ltd.

Identification of novel craniofacial regulatory domains located far upstream of SOX9 and disrupted in Pierre Robin sequence

PubMed Central

Gordon, Christopher T.; Attanasio, Catia; Bhatia, Shipra; Benko, Sabina; Ansari, Morad; Tan, Tiong Y.; Munnich, Arnold; Pennacchio, Len A.; Abadie, Véronique; Temple, I. Karen; Goldenberg, Alice; van Heyningen, Veronica; Amiel, Jeanne; FitzPatrick, David; Kleinjan, Dirk A.; Visel, Axel; Lyonnet, Stanislas

2015-01-01

Mutations in the coding sequence of SOX9 cause campomelic dysplasia (CD), a disorder of skeletal development associated with 46,XY disorders of sex development (DSDs). Translocations, deletions and duplications within a ~2 Mb region upstream of SOX9 can recapitulate the CD-DSD phenotype fully or partially, suggesting the existence of an unusually large cis-regulatory control region. Pierre Robin sequence (PRS) is a craniofacial disorder that is frequently an endophenotype of CD and a locus for isolated PRS at ~1.2-1.5 Mb upstream of SOX9 has been previously reported. The craniofacial regulatory potential within this locus, and within the greater genomic domain surrounding SOX9, remains poorly defined. We report two novel deletions upstream of SOX9 in families with PRS, allowing refinement of the regions harbouring candidate craniofacial regulatory elements. In parallel, ChIP-Seq for p300 binding sites in mouse craniofacial tissue led to the identification of several novel craniofacial enhancers at the SOX9 locus, which were validated in transgenic reporter mice and zebrafish. Notably, some of the functionally validated elements fall within the PRS deletions. These studies suggest that multiple non-coding elements contribute to the craniofacial regulation of SOX9 expression, and that their disruption results in PRS. PMID:24934569

Craniofacial and dental development in Costello syndrome.

PubMed

Goodwin, Alice F; Oberoi, Snehlata; Landan, Maya; Charles, Cyril; Massie, Jessica C; Fairley, Cecilia; Rauen, Katherine A; Klein, Ophir D

2014-06-01

Costello syndrome (CS) is a RASopathy characterized by a wide range of cardiac, musculoskeletal, dermatological, and developmental abnormalities. The RASopathies are defined as a group of syndromes caused by activated Ras/mitogen-activated protein kinase (MAPK) signaling. Specifically, CS is caused by activating mutations in HRAS. Although receptor tyrosine kinase (RTK) signaling, which is upstream of Ras/MAPK, is known to play a critical role in craniofacial and dental development, the craniofacial and dental features of CS have not been systematically defined in a large group of individuals. In order to address this gap in our understanding and fully characterize the CS phenotype, we evaluated the craniofacial and dental phenotype in a large cohort (n = 41) of CS individuals. We confirmed that the craniofacial features common in CS include macrocephaly, bitemporal narrowing, convex facial profile, full cheeks, and large mouth. Additionally, CS patients have a characteristic dental phenotype that includes malocclusion with anterior open bite and posterior crossbite, enamel hypo-mineralization, delayed tooth development and eruption, gingival hyperplasia, thickening of the alveolar ridge, and high palate. Comparison of the craniofacial and dental phenotype in CS with other RASopathies, such as cardio-facio-cutaneous syndrome (CFC), provides insight into the complexities of Ras/MAPK signaling in human craniofacial and dental development. © 2014 Wiley Periodicals, Inc.

Patient body image, self-esteem, and cosmetic results of minimally invasive robotic cardiac surgery.

PubMed

İyigün, Taner; Kaya, Mehmet; Gülbeyaz, Sevil Özgül; Fıstıkçı, Nurhan; Uyanık, Gözde; Yılmaz, Bilge; Onan, Burak; Erkanlı, Korhan

2017-03-01

Patient-reported outcome measures reveal the quality of surgical care from the patient's perspective. We aimed to compare body image, self-esteem, hospital anxiety and depression, and cosmetic outcomes by using validated tools between patients undergoing robot-assisted surgery and those undergoing conventional open surgery. This single-center, multidisciplinary, randomized, prospective study of 62 patients who underwent cardiac surgery was conducted at Hospital from May 2013 to January 2015. The patients were divided into two groups: the robotic group (n = 33) and the open group (n = 29). The study employed five different tools to assess body image, self-esteem, and overall patient-rated scar satisfaction. There were statistically significant differences between the groups in terms of self-esteem scores (p = 0.038), body image scores (p = 0.026), overall Observer Scar Assessment Scale (p = 0.013), and overall Patient Scar Assessment Scale (p = 0.036) scores in favor of the robotic group during the postoperative period. Robot-assisted surgery protected the patient's body image and self-esteem, while conventional open surgery decreased these levels but without causing pathologies. Preoperative depression and anxiety level was reduced by both robot-assisted surgery and conventional open surgery. The groups did not significantly differ on Patient Satisfaction Scores and depression/anxiety scores. The results of this study clearly demonstrated that a minimally invasive approach using robotic-assisted surgery has advantages in terms of body image, self-esteem, and cosmetic outcomes over the conventional approach in patients undergoing cardiac surgery. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery.

PubMed

Duceppe, Emmanuelle; Parlow, Joel; MacDonald, Paul; Lyons, Kristin; McMullen, Michael; Srinathan, Sadeesh; Graham, Michelle; Tandon, Vikas; Styles, Kim; Bessissow, Amal; Sessler, Daniel I; Bryson, Gregory; Devereaux, P J

2017-01-01

The Canadian Cardiovascular Society Guidelines Committee and key Canadian opinion leaders believed there was a need for up to date guidelines that used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system of evidence assessment for patients who undergo noncardiac surgery. Strong recommendations included: 1) measuring brain natriuretic peptide (BNP) or N-terminal fragment of proBNP (NT-proBNP) before surgery to enhance perioperative cardiac risk estimation in patients who are 65 years of age or older, are 45-64 years of age with significant cardiovascular disease, or have a Revised Cardiac Risk Index score ≥ 1; 2) against performing preoperative resting echocardiography, coronary computed tomography angiography, exercise or cardiopulmonary exercise testing, or pharmacological stress echocardiography or radionuclide imaging to enhance perioperative cardiac risk estimation; 3) against the initiation or continuation of acetylsalicylic acid for the prevention of perioperative cardiac events, except in patients with a recent coronary artery stent or who will undergo carotid endarterectomy; 4) against α 2 agonist or β-blocker initiation within 24 hours before surgery; 5) withholding angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker starting 24 hours before surgery; 6) facilitating smoking cessation before surgery; 7) measuring daily troponin for 48 to 72 hours after surgery in patients with an elevated NT-proBNP/BNP measurement before surgery or if there is no NT-proBNP/BNP measurement before surgery, in those who have a Revised Cardiac Risk Index score ≥1, age 45-64 years with significant cardiovascular disease, or age 65 years or older; and 8) initiating of long-term acetylsalicylic acid and statin therapy in patients who suffer myocardial injury/infarction after surgery. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Incorporating robotic-assisted surgery for endometrial cancer staging: Analysis of morbidity and costs.

PubMed

Bogani, Giorgio; Multinu, Francesco; Dowdy, Sean C; Cliby, William A; Wilson, Timothy O; Gostout, Bobbie S; Weaver, Amy L; Borah, Bijan J; Killian, Jill M; Bijlani, Akash; Angioni, Stefano; Mariani, Andrea

2016-05-01

To evaluate how the introduction of robotic-assisted surgery affects treatment-related morbidity and cost of endometrial cancer (EC) staging. We retrospectively reviewed the records of consecutive patients with stage I-III EC undergoing surgical staging between 2007 and 2012 at our institution. Costs (from surgery to 30days after surgery) were set based on the Medicare cost-to-charge ratio for each year and inflated to 2014 values. Inverse probability weighting (IPW) was used to decrease the allocation bias when comparing outcomes between surgical groups. We focused our analysis on the 251 EC patients who had robotic-assisted surgery and the 384 who had open staging. During the study period, the use of robotic-assisted surgery increased and open staging decreased (P<0.001). Correcting group imbalances by using IPW methodology, we observed that patients undergoing robotic-assisted staging had a significantly lower postoperative complication rate, lower blood transfusion rate, longer median operating time, shorter median length of stay, and lower readmission rate than patients undergoing open staging (all P<0.001). Overall 30-day costs were similar between the 2 groups, with robotic-assisted surgery having significantly higher median operating room costs ($2820 difference; P<0.001) but lower median room and board costs ($2929 difference; P<0.001) than open surgery. Increasing experience with robotic-assisted staging was significantly associated with a decrease in median operating time (P=0.002) and length of stay (P=0.003). The implementation of robotic-assisted surgery for EC staging improves patient outcomes. It provides women the benefits of minimally invasive surgery without increasing costs and potentially improves patient turnover. Copyright © 2016 Elsevier Inc. All rights reserved.

Incorporating 3D laparoscopy for the management of locally advanced cervical cancer: a comparison with open surgery.

PubMed

Raspagliesi, Francesco; Bogani, Giorgio; Martinelli, Fabio; Signorelli, Mauro; Chiappa, Valentina; Scaffa, Cono; Sabatucci, Ilaria; Adorni, Marco; Lorusso, Domenica; Ditto, Antonino

2016-08-03

To test the effects of the implementation of 3D laparoscopic technology for the execution of nerve-sparing radical hysterectomy. Thirty patients undergoing nerve-sparing radical hysterectomy via 3D laparoscopic (3D-LNSRH, n = 10) or open surgery (NSRH, n = 20) were studied prospectively. No significant differences were observed in baseline patient characteristics. Operative times were similar between groups. We compared the first 10 patients undergoing 3D-LNSRH with the last 20 patients undergoing NSRH. Baseline characteristics were similar between groups (p>0.2). Patients undergoing 3D-LNSRH had longer operative time (264.4 ± 21.5 vs 217.2 ± 41.0 minutes; p = 0.005), lower blood loss (53.4 ± 26.1 vs 177.7 ± 96.0 mL; p<0.001), and shorter length of hospital stay (4.3 ± 1.2 vs 5.4 ± 0.7 days; p = 0.03) in comparison to patients undergoing open abdominal procedures. No intraoperative complication occurred. One (10%) patient had conversion to open surgery due to technical difficulties and the inability to insert the uterine manipulator. A trend towards higher complication (grade 2 or worse) rate was observed for patients undergoing NSRH in comparison to 3D-LNSRH (p = 0.06). Considering only severe complications (grade 3 or worse), no difference was observed (0/10 vs 2/20; p = 0.54). 3D-laparoscopic nerve-sparing radical hysterectomy is a safe and effective procedure. The implementation of 3D laparoscopic technology allows the execution of challenging operations via minimally invasive surgery, thus reducing open abdominal procedure rates. Further large prospective studies are warranted.

Development of a teaching tool for women with a gynecologic malignancy undergoing minimally invasive robotic-assisted surgery.

PubMed

Castiglia, Luisa Luciani; Drummond, Nancy; Purden, Margaret A

2011-08-01

Women undergoing minimally invasive robotic-assisted surgery for a gynecologic malignancy have many questions and concerns related to the cancer diagnosis and surgery. The provision of information enhances coping with such illness-related challenges. A lack of print materials for these patients prompted the creation of a written teaching tool to improve informational support. A booklet was developed using guidelines for the design of effective patient education materials, including an iterative process of collaboration with healthcare providers and women who had undergone robotic-assisted surgery, as well as attention to readability. The 52-page booklet covers the trajectory of the woman's experience and includes the physical, psychosocial, and sexual aspects of recovery.

Comparison of Intraoperative Portable CT Scanners in Skull Base and Endoscopic Sinus Surgery: Single Center Case Series

PubMed Central

Conley, David B.; Tan, Bruce; Bendok, Bernard R.; Batjer, H. Hunt; Chandra, Rakesh; Sidle, Douglas; Rahme, Rudy J.; Adel, Joseph G.; Fishman, Andrew J.

2011-01-01

Precise and safe management of complex skull base lesions can be enhanced by intraoperative computed tomography (CT) scanning. Surgery in these areas requires real-time feedback of anatomic landmarks. Several portable CT scanners are currently available. We present a comparison of our clinical experience with three portable scanners in skull base and craniofacial surgery. We present clinical case series and the participants were from the Northwestern Memorial Hospital. Three scanners are studied: one conventional multidetector CT (MDCT), two digital flat panel cone-beam CT (CBCT) devices. Technical considerations, ease of use, image characteristics, and integration with image guidance are presented for each device. All three scanners provide good quality images. Intraoperative scanning can be used to update the image guidance system in real time. The conventional MDCT is unique in its ability to resolve soft tissue. The flat panel CBCT scanners generally emit lower levels of radiation and have less metal artifact effect. In this series, intraoperative CT scanning was technically feasible and deemed useful in surgical decision-making in 75% of patients. Intraoperative portable CT scanning has significant utility in complex skull base surgery. This technology informs the surgeon of the precise extent of dissection and updates intraoperative stereotactic navigation. PMID:22470270

Importance of neoadjuvant chemotherapy in olfactory neuroblastoma treatment: Series report and literature review.

PubMed

Bartel, Ricardo; Gonzalez-Compta, Xavier; Cisa, Enric; Cruellas, Francesc; Torres, Alberto; Rovira, Aleix; Manos, Manel

2017-10-20

Olfactory neuroblastoma (ONB) is a rare entity that constitutes less than 5% of nasosinusal malignancies. Mainstream treatment consists in surgical resection+/-adjuvant radiotherapy. By exposing results observed with apparition of new therapeutic options as neoadjuvant chemotherapy, the objective is to evaluate a series and a review of the current literature. A retrospective review was conducted including patients diagnosed and followed-up for ONB from 2008 to 2015 in our institution. 9 patients were included. Mean follow-up of 52.5 months (range 10-107). Kadish stage: A, 1 patient (11.1%) treated with endoscopic surgery; B, 2 patients (22.2%) treated with endoscopic surgery (one of them received adjuvant radiotherapy); C, 6 patients (66.7%), 4 patients presented intracranial extension and were treated with neoadjuvant chemotherapy followed by surgery and radiotherapy. The other 2 patients presented isolated orbital extension, treated with radical surgery (endoscopic or craniofacial resection) plus radiotherapy. The 5-year disease free and overall survival observed was 88.9%. Neoadjuvant chemotherapy could be an effective treatment for tumor reduction, improving surgical resection and reducing its complications. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.

Effects of Nutritional Prehabilitation, With and Without Exercise, on Outcomes of Patients Who Undergo Colorectal Surgery: a Systematic Review and Meta-analysis.

PubMed

Gillis, Chelsia; Buhler, Katherine; Bresee, Lauren; Carli, Francesco; Gramlich, Leah; Culos-Reed, Nicole; Sajobi, Tolulope T; Fenton, Tanis R

2018-05-08

Although there have been meta-analyses of the effects of exercise prehabilitation on patients undergoing colorectal surgery, little is known about the effects of nutrition-only (oral nutritional supplements and/or counseling) and multi-modal (oral nutritional supplements and/or counseling with exercise) prehabilitation on clinical outcomes and patient function after surgery. We performed a systemic review and meta-analysis to determine the individual and combined effects of nutrition-only and multi-modal prehabilitation, compared with no prehabilitation (control), on outcomes of patients undergoing colorectal resection. We searched MEDLINE, EMBASE, CINAHL, CENTRAL, and ProQuest for cohort and randomized controlled studies of adults awaiting colorectal surgery who received at least 7 days of oral nutrition supplements and/or nutrition counselling with or without exercise. We performed a random effects meta-analysis to estimate the pooled risk ratio for categorical data and the weighted mean difference for continuous variables. The primary outcome was length of hospital stay; the secondary outcome was recovery of functional capacity, based on results of a 6-minute walk test. We identified 9 studies (5 randomized controlled studies and 4 cohort studies) comprising 914 patients undergoing colorectal surgery (438 received prehabilitation and 476 served as controls). Receipt of any prehabilitation significantly reduced days spent in hospital compared with controls (weighted mean difference of length of hospital stay, -2.2 days; 95% CI, -3.5 days to -0.9 days). Only 3 studies reported functional outcomes but could not be pooled due to methodological heterogeneity. In the individual studies, multimodal prehabilitation significantly improved results of the 6-minute walk test at 4 and 8 weeks after surgery compared with standard enhanced recovery pathway care, and at 8 weeks compared with standard enhanced recovery pathway care with added rehabilitation. The 4 observational studies had a high risk of bias. In a systematic review and meta-analysis, we found that nutritional prehabilitation alone, or when combined with an exercise program, significantly reduced length of hospital stay by 2 days in patients undergoing colorectal surgery. There is some evidence that multimodal prehabilitation accelerated the return to pre-surgery functional capacity. Copyright © 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.

Prophylactic antibiotics to prevent surgical site infection after breast cancer surgery.

PubMed

Jones, Daniel J; Bunn, Frances; Bell-Syer, Sophie V

2014-03-09

Surgery has been used as part of breast cancer treatment for centuries; however any surgical procedure has the potential risk of infection. Infection rates for surgical treatment of breast cancer are documented at between 3% and 15%, higher than average for a clean surgical procedure. Pre- and perioperative antibiotics have been found to be useful in lowering infection rates in other surgical groups, yet there is no consensus on the use of prophylactic antibiotics for breast cancer surgery. To determine the effects of prophylactic (pre- or perioperative) antibiotics on the incidence of surgical site infection (SSI) after breast cancer surgery. For this third update we searched the Cochrane Wounds Group Specialised Register (5 December 2013); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); the Database of Abstracts of Reviews of Effects (DARE) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. We applied no language or date restrictions. Randomised controlled trials of pre- and perioperative antibiotics for patients undergoing surgery for breast cancer were included. Primary outcomes were rates of surgical site infection (SSI) and adverse reactions. Two review authors independently examined the title and abstracts of all studies identified by the search strategy, then assessed study quality and extracted data from those that met the inclusion criteria. A total of eleven studies (2867 participants) were included in the review. Ten studies evaluated preoperative antibiotic compared with no antibiotic or placebo. One study evaluated perioperative antibiotic compared with no antibiotic. Pooling of the results demonstrated that prophylactic antibiotics administered preoperatively significantly reduce the incidence of SSI for patients undergoing breast cancer surgery without reconstruction (pooled risk ratio (RR) 0.67, 95% confidence interval (CI) 0.53 to 0.85). Analysis of the single study comparing perioperative antibiotic with no antibiotic found no statistically significant effect of antibiotics on the incidence of SSI (RR 0.11, 95% CI 0.01 to 1.95). No studies presented separate data for patients who underwent reconstructive surgery at the time of removal of the breast tumour. Prophylactic antibiotics administered preoperatively reduce the risk of SSI in patients undergoing surgery for breast cancer. Further studies involving patients undergoing immediate breast reconstruction are needed as studies have identified this group as being at higher risk of infection than those who do not undergo immediate breast reconstruction.

Prophylactic antibiotics to prevent surgical site infection after breast cancer surgery.

PubMed

Cunningham, M; Bunn, F; Handscomb, K

2006-04-19

Surgery has been used as part of breast cancer treatment for centuries; however any surgical procedure has the potential risk of infection. Infection rates for surgical treatment of breast cancer are documented at between three and 15%, higher than average for a clean surgical procedure. Pre and peri-operative antibiotics have been found to be useful in lowering infection rates in other surgical groups, yet there is no current consensus on prophylactic antibiotic use in breast cancer surgery. To determine the effects of prophylactic antibiotics on the incidence of surgical site infection after breast cancer surgery. We searched the Cochrane Wounds and Breast Cancer Groups Specialised Registers, the Cochrane Central Register of Controlled Trials (CENTRAL) issue 1 2006. MEDLINE 2002-2005, EMBASE 1980-2005, NRR issue 1 2005, CINAHL 1982-2004 and SIGLE 1976-2004. Companies and experts in the field were contacted and reference lists were checked. No language restrictions were applied. Randomised controlled trials of pre and peri-operative antibiotics for patients undergoing surgery for breast cancer were included. Primary outcomes were, incidence of breast wound infection and adverse reactions to treatment. Two authors independently examined the title and abstracts of all studies identified by the search strategy, then assessed study quality and extracted data from those that met the inclusion criteria. Six studies met the inclusion criteria. All six evaluated pre-operative antibiotic compared with no antibiotic or placebo. Pooling of the results demonstrated that prophylactic antibiotics significantly reduce the incidence of surgical site infection for patients undergoing breast cancer surgery without reconstruction (pooled RR 0.66, 95% CI, 0.48 to 0.89). No studies presented separate data for patients who underwent reconstructive surgery at the time of removal of the breast tumour. Prophylactic antibiotics reduce the risk of surgical site infection in patients undergoing surgery for breast cancer. The potential morbidity caused by infection, such as delays in wound healing or adjuvant cancer treatments must be balanced against the cost of treatment and potential adverse effects such as drug reactions or increased bacterial resistance. Further studies of patients undergoing immediate breast reconstruction would be useful as studies have identified this group as being at higher risk of infection than those who do not undergo immediate breast reconstruction.

Arthroscopic Surgery or Physical Therapy for Patients With Femoroacetabular Impingement Syndrome: A Randomized Controlled Trial With 2-Year Follow-up.

PubMed

Mansell, Nancy S; Rhon, Daniel I; Meyer, John; Slevin, John M; Marchant, Bryant G

2018-05-01

Arthroscopic hip surgery has risen 18-fold in the past decade; however, there is a dearth of clinical trials comparing surgery with nonoperative management. To determine the comparative effectiveness of surgery and physical therapy for femoroacetabular impingement syndrome. Randomized controlled trial; Level of evidence, 1. Patients were recruited from a large military hospital after referral to the orthopaedic surgery clinic and were eligible for surgery. Of 104 eligible patients, 80 elected to participate, and the majority were active-duty service members (91.3%). No patients withdrew because of adverse events. The authors randomly selected patients to undergo either arthroscopic hip surgery (surgery group) or physical therapy (rehabilitation group). Patients in the rehabilitation group began a 12-session supervised clinic program within 3 weeks, and patients in the surgery group were scheduled for the next available surgery at a mean of 4 months after enrollment. Patient-reported outcomes of pain, disability, and perception of improvement over a 2-year period were collected. The primary outcome was the Hip Outcome Score (HOS; range, 0-100 [lower scores indicating greater disability]; 2 subscales: activities of daily living and sport). Secondary measures included the International Hip Outcome Tool (iHOT-33), Global Rating of Change (GRC), and return to work at 2 years. The primary analysis was on patients within their original randomization group. Statistically significant improvements were seen in both groups on the HOS and iHOT-33, but the mean difference was not significant between the groups at 2 years (HOS activities of daily living, 3.8 [95% CI, -6.0 to 13.6]; HOS sport, 1.8 [95% CI, -11.2 to 14.7]; iHOT-33, 6.3 [95% CI, -6.1 to 18.7]). The median GRC across all patients was that they "felt about the same" (GRC = 0). Two patients assigned to the surgery group did not undergo surgery, and 28 patients in the rehabilitation group ended up undergoing surgery. A sensitivity analysis of "actual surgery" to "no surgery" did not change the outcome. Twenty (33.3%) patients who underwent surgery and 4 (33.3%) who did not undergo surgery were medically separated from military service at 2 years. There was no significant difference between the groups at 2 years. Most patients perceived little to no change in status at 2 years, and one-third of military patients were not medically fit for duty at 2 years. Limitations include a single hospital, a single surgeon, and a high rate of crossover. Registration: NCT01993615 ( ClinicalTrials.gov identifier).

Embryonic development of Python sebae - II: Craniofacial microscopic anatomy, cell proliferation and apoptosis.

PubMed

Buchtová, Marcela; Boughner, Julia C; Fu, Katherine; Diewert, Virginia M; Richman, Joy M

2007-01-01

This study explores the microscopic craniofacial morphogenesis of the oviparous African rock python (Python sebae) spanning the first two-thirds of the post-oviposition period. At the time of laying, the python embryo consists of largely undifferentiated mesenchyme and epithelium with the exception of the cranial base and trabeculae cranii, which are undergoing chondrogenesis. The facial prominences are well defined and are at a late stage, close to the time when lip fusion begins. Later (11-12d), specializations in the epithelia begin to differentiate (vomeronasal and olfactory epithelia, teeth). Dental development in snakes is different from that of mammals in several aspects including an extended dental lamina with the capacity to form 4 sets of generational teeth. In addition, the ophidian olfactory system is very different from the mammalian. There is a large vomeronasal organ, a nasal cavity proper and an extraconchal space. All of these areas are lined with a greatly expanded olfactory epithelium. Intramembranous bone differentiation is taking place at stage 3 with some bones already ossifying whereas most are only represented as mesenchymal condensations. In addition to routine histological staining, PCNA immunohistochemistry reveals relatively higher levels of proliferation in the extending dental laminae, in osseous mesenchymal condensations and in the olfactory epithelia. Areas undergoing apoptosis were noted in the enamel organs of the teeth and osseous mesenchymal condensations. We propose that localized apoptosis helps to divide a single condensation into multiple ossification centres and this is a mechanism whereby novel morphology can be selected in response to evolutionary pressures. Several additional differences in head morphology between snakes and other amniotes were noted including a palatal groove separating the inner and outer row of teeth in the upper jaw, a tracheal opening within the tongue and a pharyngeal adhesion that closes off the pharynx from the oral cavity between stages 1 and 4. Our studies on these and other differences in the python will provide valuable insights into in developmental, molecular and evolutionary mechanisms of patterning.

75 FR 82033 - National Institute of Dental and Craniofacial Research; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-29

... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Institute of Dental... Dental and Craniofacial Research Council. The meeting will be open to the public as indicated below, with... Committee: National Advisory Dental and Craniofacial Research Council. Date: January 24, 2011. Open: 8:30 a...

78 FR 65348 - National Institute of Dental & Craniofacial Research; Amended Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-31

... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Institute of Dental & Craniofacial Research; Amended Notice of Meeting Notice is hereby given of a change in the meeting of the National Institute of Dental and Craniofacial Research Special Emphasis Panel, October 21, 2013, 9:00 a.m...

75 FR 55592 - National Institute of Dental & Craniofacial Research; Amended Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-13

... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Institute of Dental & Craniofacial Research; Amended Notice of Meeting Notice is hereby given of a change in the meeting of the National Advisory Dental and Craniofacial Research Council, September 27, 2010, 8:30 a.m. to September 27...

78 FR 65343 - National Institute of Dental & Craniofacial Research; Amended Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-31

... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Institute of Dental & Craniofacial Research; Amended Notice of Meeting Notice is hereby given of a change in the meeting of the National Institute of Dental and Craniofacial Research Special Emphasis Panel, October 7, 2013, 10:00 a.m...

Which goal for fluid therapy during colorectal surgery is followed by the best outcome: near-maximal stroke volume or zero fluid balance?

PubMed

Brandstrup, B; Svendsen, P E; Rasmussen, M; Belhage, B; Rodt, S Å; Hansen, B; Møller, D R; Lundbech, L B; Andersen, N; Berg, V; Thomassen, N; Andersen, S T; Simonsen, L

2012-08-01

We aimed to investigate whether fluid therapy with a goal of near-maximal stroke volume (SV) guided by oesophageal Doppler (ED) monitoring result in a better outcome than that with a goal of maintaining bodyweight (BW) and zero fluid balance in patients undergoing colorectal surgery. In a double-blinded clinical multicentre trial, 150 patients undergoing elective colorectal surgery were randomized to receive fluid therapy after either the goal of near-maximal SV guided by ED (Doppler, D group) or the goal of zero balance and normal BW (Zero balance, Z group). Stratification for laparoscopic and open surgery was performed. The postoperative fluid therapy was similar in the two groups. The primary endpoint was postoperative complications defined and divided into subgroups by protocol. Analysis was performed by intention-to-treat. The follow-up was 30 days. The trial had 85% power to show a difference between the groups. The number of patients undergoing laparoscopic or open surgery and the patient characteristics were similar between the groups. No significant differences between the groups were found for overall, major, minor, cardiopulmonary, or tissue-healing complications (P-values: 0.79; 0.62; 0.97; 0.48; and 0.48, respectively). One patient died in each group. No significant difference was found for the length of hospital stay [median (range) Z: 5.00 (1-61) vs D: 5.00 (2-41); P=0.206]. Goal-directed fluid therapy to near-maximal SV guided by ED adds no extra value to the fluid therapy using zero balance and normal BW in patients undergoing elective colorectal surgery.

[Preoperatory sonography efficiency in paediatric patients with cholelithiasis undergoing laparoscopic cholecystectomy].

PubMed

Riñón, C; de Mingo, L; Cortés, M J; Ollero, J C; Alvarez, M; Espinosa, R; Rollán, V

2009-01-01

Biliary lithiasis is not much frequent in paediatric patients. The manegement of cholelithiasis in patients undergoing laparoscopic cholecystectomy is still controversial. We propose the preoperatory echographic study of the biliary tree 24-48 h before surgery, as the first choice, instead of the intraoperatory cholangiography. We made a retrospective study of 42 patients undergoing laparoscopic cholecystectomy due to symptomatic biliary lithiasis during the last 15 years, with ages between 18 months and 17-years-old (mean age 9,6-years-old) and weight between 11 and 70 kg (mean weight 42 kg) at the moment of surgery. Six of them had haematological illnesses, 17 came to the hospital because of acute abdominal pain, 10 had been studied because of recurrent abdominal pain and 9 had casual diagnoses. Abdominal sonography was performed in all patients 24-48 hours before surgery. Four children were diagnosed of biliary duct lithiasis: two choledocolithiasis and two stones in the cystic duct. One of the cystic stones was extracted in the operating room and the rest resolved spontaneously. One patient presented dilatation of choledocal duct after surgery, without any stones' evidence. Also this patient resolved spontaneously. We had no complications. Biliary lithiasis is not frequent in children, even if it seems to be increasing. A few of these patients will suffer of choledocolithiasis. The intraoperatory exploration of the biliary tree during laparoscopic surgery is technically difficult due the small size of paediatric patients. Cholangiography is not always successful and can produce some important complications as pancreatitis. Preoperative sonography 24-48 hours before surgery is a safe and efficient method for the diagnosis and follow-up of paediatric patients with biliary lithiasis undergoing laparoscopic cholecystectomy. It is safe enough to be performed without intraoperatory cholangiography.

Zebrafish Craniofacial Development: A Window into Early Patterning

PubMed Central

Mork, Lindsey; Crump, Gage

2016-01-01

The formation of the face and skull involves a complex series of developmental events mediated by cells derived from the neural crest, endoderm, mesoderm, and ectoderm. Although vertebrates boast an enormous diversity of adult facial morphologies, the fundamental signaling pathways and cellular events that sculpt the nascent craniofacial skeleton in the embryo have proven to be highly conserved from fish to man. The zebrafish Danio rerio, a small freshwater cyprinid fish from eastern India, has served as a popular model of craniofacial development since the 1990s. Unique strengths of the zebrafish model include a simplified skeleton during larval stages, access to rapidly developing embryos for live imaging, and amenability to transgenesis and complex genetics. In this chapter, we describe the anatomy of the zebrafish craniofacial skeleton; its applications as models for the mammalian jaw, middle ear, palate, and cranial sutures; the superior imaging technology available in fish that has provided unprecedented insights into the dynamics of facial morphogenesis; the use of the zebrafish to decipher the genetic underpinnings of craniofacial biology; and finally a glimpse into the most promising future applications of zebrafish craniofacial research. PMID:26589928

Influence of the primary cleft palate closure on the future need for orthognathic surgery in unilateral cleft lip and palate patients.

PubMed

Broome, Martin; Herzog, George; Hohlfeld, Judith; de Buys Roessingh, Anthony; Jaques, Bertrand

2010-09-01

The aim of the study was to determine the influence of the dissection of the palate during primary surgery and the type of orthognathic surgery needed in cases of unilateral total cleft. The review concerns 58 children born with a complete unilateral cleft lip and palate and treated between 1994 and 2008 at the appropriate age for orthognathic surgery. This is a retrospective mixed-longitudinal study. Patients with syndromes or associated anomalies were excluded. All children were treated by the same orthodontist and by the same surgical team. Children are divided into 2 groups: the first group includes children who had conventional primary cleft palate repair during their first year of life, with extensive mucoperiosteal undermining. The second group includes children operated on according to the Malek surgical protocol. The soft palate is closed at the age of 3 months, and the hard palate at 6 months with minimal mucoperiosteal undermining. Lateral cephalograms at ages 9 and 16 years and surgical records were compared. The need for orthognathic surgery was more frequent in the first than in the second group (60% vs 47.8%). Concerning the type of orthognathic surgery performed, 2- or 3-piece Le Fort I or bimaxillary osteotomies were also less required in the first group. Palate surgery following the Malek procedure results in an improved and simplified craniofacial outcome. With a minimal undermining of palatal mucosa, we managed to reduce the amount of patients who required an orthognathic procedure. When this procedure was indicated, the surgical intervention was also greatly simplified.

Craniofacial Trauma in Pediatric Patients Following Winnowing Blade Injury-review of Literature

PubMed Central

Huliyappa, Harsha; Ojha, Balakrishna; Chandra, Anil; Singh, Sunil Kumar; Srivastava, Chhitij

2018-01-01

In developing countries, during the harvest season, winnower blade injuries occur very frequently in children and results in lifelong disability. Nine children were managed during 1 month, all resulting due to winnower blade induced craniofacial trauma. PubMed search for “fan blade injury” showed two case series and three case reports. In our study, 88% had compound depressed fracture; brain matter leak in 56%, cerebrospinal fluid (CSF) leak alone in 22%. 66.7% had injury involving the frontal bone. Two patients had eye injury with visual loss. Seven underwent debridement craniectomy, five augmentation duroplasty and three contusectomy. All had vegetable material, sand particles. Complications in 66.6% with two cases of CSF leak settled with lumbar drain, one case of CSF otorrohea, 22.2% of wound infection, 44.4% wound dehiscence requiring redebridement and suturing in five patients. Two patients had postoperative seizures, two patients had hemiparesis both improved. Two low Glasgow Coma Scale remained so on postoperative period. One case of subdural empyema needed debridement and duroplasty with glue. No mortality noted. These findings were consistent with previous reports. Follow-up at 1.5 months showed good functional recovery. Early surgery debridement, steps to minimize postoperative infections, identifying putative risk factors early in the management are the principles of a successful treatment regimen. PMID:29682010

Craniofacial Trauma in Pediatric Patients Following Winnowing Blade Injury-review of Literature.

PubMed

Huliyappa, Harsha; Ojha, Balakrishna; Chandra, Anil; Singh, Sunil Kumar; Srivastava, Chhitij

2018-01-01

In developing countries, during the harvest season, winnower blade injuries occur very frequently in children and results in lifelong disability. Nine children were managed during 1 month, all resulting due to winnower blade induced craniofacial trauma. PubMed search for "fan blade injury" showed two case series and three case reports. In our study, 88% had compound depressed fracture; brain matter leak in 56%, cerebrospinal fluid (CSF) leak alone in 22%. 66.7% had injury involving the frontal bone. Two patients had eye injury with visual loss. Seven underwent debridement craniectomy, five augmentation duroplasty and three contusectomy. All had vegetable material, sand particles. Complications in 66.6% with two cases of CSF leak settled with lumbar drain, one case of CSF otorrohea, 22.2% of wound infection, 44.4% wound dehiscence requiring redebridement and suturing in five patients. Two patients had postoperative seizures, two patients had hemiparesis both improved. Two low Glasgow Coma Scale remained so on postoperative period. One case of subdural empyema needed debridement and duroplasty with glue. No mortality noted. These findings were consistent with previous reports. Follow-up at 1.5 months showed good functional recovery. Early surgery debridement, steps to minimize postoperative infections, identifying putative risk factors early in the management are the principles of a successful treatment regimen.

The Role of Sonic Hedgehog in Craniofacial Patterning, Morphogenesis and Cranial Neural Crest Survival

PubMed Central

Dworkin, Sebastian; Boglev, Yeliz; Owens, Harley; Goldie, Stephen J.

2016-01-01

Craniofacial defects (CFD) are a significant healthcare problem worldwide. Understanding both the morphogenetic movements which underpin normal facial development, as well as the molecular factors which regulate these processes, forms the cornerstone of future diagnostic, and ultimately, preventative therapies. The soluble morphogen Sonic hedgehog (Shh), a vertebrate orthologue of Drosophila hedgehog, is a key signalling factor in the regulation of craniofacial skeleton development in vertebrates, operating within numerous tissue types in the craniofacial primordia to spatiotemporally regulate the formation of the face and jaws. This review will provide an overview of normal craniofacial skeleton development, and focus specifically on the known roles of Shh in regulating the development and progression of the first pharyngeal arch, which in turn gives rise to both the upper jaw (maxilla) and lower jaw (mandible). PMID:29615588

The Role of Sonic Hedgehog in Craniofacial Patterning, Morphogenesis and Cranial Neural Crest Survival.

PubMed

Dworkin, Sebastian; Boglev, Yeliz; Owens, Harley; Goldie, Stephen J

2016-08-03

Craniofacial defects (CFD) are a significant healthcare problem worldwide. Understanding both the morphogenetic movements which underpin normal facial development, as well as the molecular factors which regulate these processes, forms the cornerstone of future diagnostic, and ultimately, preventative therapies. The soluble morphogen Sonic hedgehog ( Shh ), a vertebrate orthologue of Drosophila hedgehog , is a key signalling factor in the regulation of craniofacial skeleton development in vertebrates, operating within numerous tissue types in the craniofacial primordia to spatiotemporally regulate the formation of the face and jaws. This review will provide an overview of normal craniofacial skeleton development, and focus specifically on the known roles of Shh in regulating the development and progression of the first pharyngeal arch, which in turn gives rise to both the upper jaw (maxilla) and lower jaw (mandible).

Involuntary craniofacial lingual movements in intensive care-acquired quadriplegia.

PubMed

Cartagena, A M; Jog, M; Young, G B

2012-02-01

The syndrome of involuntary craniofacial lingual movements in the setting of acute intensive care-acquired quadriplegia (critical illness neuromyopathy) following sepsis-associated encephalopathy has not been previously described. We suggest a localization and treatment for this disabling condition. Three patients (2 female) from our center were quadriplegic from critical illness neuromyopathy when they developed involuntary craniofacial lingual movements following sepsis-associated encephalopathy. Extensive investigations failed to identify an etiology for the abnormal movements. Movements were of large amplitude, of moderate speed, and semi-rhythmic in the jaw, tongue, and palate, persistent and extremely bothersome to all patients. Injection with Botulinum toxin type A was very beneficial. Involuntary craniofacial lingual movements in the setting of flaccid quadriplegia following sepsis-associated encephalopathy are consistent with focal craniofacial brainstem myoclonus and constitutes a new syndrome. Botulinum toxin type A treatment maybe helpful in treatment.

Minimising preoperative anxiety with music for day surgery patients - a randomised clinical trial.

PubMed

Ni, Cheng-Hua; Tsai, Wei-Her; Lee, Liang-Ming; Kao, Ching-Chiu; Chen, Yi-Chung

2012-03-01

The objective of this study was to evaluate the effects of musical intervention on preoperative anxiety and vital signs in patients undergoing day surgery. Studies and systematic meta-analyses have shown inconclusive results of the efficacy of music in reducing preoperative anxiety. We designed a study to provide additional evidence for its use in preoperative nursing care. Randomised, controlled study. Patients (n = 183) aged 18-65 admitted to our outpatient surgery department were randomly assigned to either the experimental group (music delivered by earphones) or control group (no music) for 20 minutes before surgery. Anxiety, measured by the State-Trait Anxiety Inventory, and vital signs were measured before and after the experimental protocol. A total of 172 patients (60 men and 112 women) with a mean age of 40·90 (SD 11·80) completed the study. The largest number (35·7%) was undergoing elective plastic surgery and 76·7% of the total reported previous experience with surgery. Even though there was only a low-moderate level of anxiety at the beginning of the study, both groups showed reduced anxiety and improved vital signs compared with baseline values; however, the intervention group reported significantly lower anxiety [mean change: -5·83 (SD 0·75) vs. -1·72 (SD 0·65), p < 0·001] on the State-Trait Anxiety Inventory compared with the control group. Patients undergoing day surgery may benefit significantly from musical intervention to reduce preoperative anxiety and improve physiological parameters. Finding multimodal approaches to ease discomfort and anxiety from unfamiliar unit surroundings and perceived risks of morbidity (e.g. disfigurement and long-term sequelae) is necessary to reduce preoperative anxiety and subsequent physiological complications. This is especially true in the day surgery setting, where surgical admission times are often subject to change and patients may have to accommodate on short notice or too long a wait that may provoke anxiety. Our results provide additional evidence that musical intervention may be incorporated into routine nursing care for patients undergoing minor surgery. © 2011 Blackwell Publishing Ltd.

The role of Rajyoga meditation for modulation of anxiety and serum cortisol in patients undergoing coronary artery bypass surgery: A prospective randomized control study.

PubMed

Kiran, Usha; Ladha, Suruchi; Makhija, Neeti; Kapoor, Poonam Malhotra; Choudhury, Minati; Das, Sambhunath; Gharde, Parag; Malik, Vishwas; Airan, Balram

2017-01-01

Rajyoga meditation is a form of mind body intervention that is promoted by the Brahma Kumaris World Spiritual University. This form of meditation can be easily performed without rituals or mantras and can be practiced anywhere at any time. The practice of Rajyoga meditation can have beneficial effects on modulating anxiety and cortisol level in patients undergoing major cardiac surgery. A prospective randomized control study was carried out in a single tertiary care center. One hundred and fifty patients undergoing elective coronary artery bypass surgery were enrolled in the study. The patients were randomized in two groups namely, Group 1 (Rajyoga group) and Group 2 (Control Group). Anxiety was measured on a visual analog scale 1-10 before the start of Rajyoga training or patient counseling (T1), on the morning of the day of surgery (T2), on the 2nd postoperative day (T3), and on the 5th postoperative day (T4). The serum cortisol level was measured in the morning of the day of surgery (T1), on the 2nd postoperative day (T2) and on the 5th postoperative day (T3), respectively. In the study, it was seen that the anxiety level of the patients before the surgery (T1) and on the day of surgery (T2) were comparable between the two groups. However on the 2nd postoperative day (T3), the patients who underwent Rajyoga training had lower anxiety level in comparison to the control group (3.12 ± 1.45 vs. 6.12 ± 0.14, P < 0.05) and on the 5th postoperative day (T4) it was seen that Rajyoga practice had resulted in significant decline in anxiety level (0.69 ± 1.1 vs. 5.6 ± 1.38, P < 0.05). The serum cortisol level was also favorably modulated by the practice of Rajyoga meditation. Mindbody intervention is found to effective in reducing the anxiety of the patients and modulating the cortisol level in patients undergoing wellknown stressful surgery like coronary artery bypass surgery.

The Role of Rajyoga Meditation for Modulation of Anxiety and Serum Cortisol in Patients Undergoing Coronary Artery Bypass Surgery: A Prospective Randomized Control Study

PubMed Central

Kiran, Usha; Ladha, Suruchi; Makhija, Neeti; Kapoor, Poonam Malhotra; Choudhury, Minati; Das, Sambhunath; Gharde, Parag; Malik, Vishwas; Airan, Balram

2017-01-01

Introduction: Rajyoga meditation is a form of mind body intervention that is promoted by the Brahma Kumaris World Spiritual University. This form of meditation can be easily performed without rituals or mantras and can be practiced anywhere at any time. The practice of Rajyoga meditation can have beneficial effects on modulating anxiety and cortisol level in patients undergoing major cardiac surgery. Materials and Methods: A prospective randomized control study was carried out in a single tertiary care center. One hundred and fifty patients undergoing elective coronary artery bypass surgery were enrolled in the study. The patients were randomized in two groups namely, Group 1 (Rajyoga group) and Group 2 (Control Group). Anxiety was measured on a visual analog scale 1–10 before the start of Rajyoga training or patient counseling (T1), on the morning of the day of surgery (T2), on the 2nd postoperative day (T3), and on the 5th postoperative day (T4). The serum cortisol level was measured in the morning of the day of surgery (T1), on the 2nd postoperative day (T2) and on the 5th postoperative day (T3), respectively. Results: In the study, it was seen that the anxiety level of the patients before the surgery (T1) and on the day of surgery (T2) were comparable between the two groups. However on the 2nd postoperative day (T3), the patients who underwent Rajyoga training had lower anxiety level in comparison to the control group (3.12 ± 1.45 vs. 6.12 ± 0.14, P < 0.05) and on the 5th postoperative day (T4) it was seen that Rajyoga practice had resulted in significant decline in anxiety level (0.69 ± 1.1 vs. 5.6 ± 1.38, P < 0.05). The serum cortisol level was also favorably modulated by the practice of Rajyoga meditation. Conclusion: Mindbody intervention is found to effective in reducing the anxiety of the patients and modulating the cortisol level in patients undergoing wellknown stressful surgery like coronary artery bypass surgery. PMID:28393774

Preconditioning Shields Against Vascular Events in Surgery (SAVES), a multicentre feasibility trial of preconditioning against adverse events in major vascular surgery: study protocol for a randomised control trial.

PubMed

Healy, Donagh; Clarke-Moloney, Mary; Gaughan, Brendan; O'Daly, Siobhan; Hausenloy, Derek; Sharif, Faisal; Newell, John; O'Donnell, Martin; Grace, Pierce; Forbes, John F; Cullen, Walter; Kavanagh, Eamon; Burke, Paul; Cross, Simon; Dowdall, Joseph; McMonagle, Morgan; Fulton, Greg; Manning, Brian J; Kheirelseid, Elrasheid A H; Leahy, Austin; Moneley, Daragh; Naughton, Peter; Boyle, Emily; McHugh, Seamus; Madhaven, Prakash; O'Neill, Sean; Martin, Zenia; Courtney, Donal; Tubassam, Muhammed; Sultan, Sherif; McCartan, Damian; Medani, Mekki; Walsh, Stewart

2015-04-23

Patients undergoing vascular surgery procedures constitute a 'high-risk' group. Fatal and disabling perioperative complications are common. Complications arise via multiple aetiological pathways. This mechanistic redundancy limits techniques to reduce complications that target individual mechanisms, for example, anti-platelet agents. Remote ischaemic preconditioning (RIPC) induces a protective phenotype in at-risk tissue, conferring protection against ischaemia-reperfusion injury regardless of the trigger. RIPC is induced by repeated periods of upper limb ischaemia-reperfusion produced using a blood pressure cuff. RIPC confers some protection against cardiac and renal injury during major vascular surgery in proof-of-concept trials. Similar trials suggest benefit during cardiac surgery. Several uncertainties remain in advance of a full-scale trial to evaluate clinical efficacy. We propose a feasibility trial to fully evaluate arm-induced RIPC's ability to confer protection in major vascular surgery, assess the incidence of a proposed composite primary efficacy endpoint and evaluate the intervention's acceptability to patients and staff. Four hundred major vascular surgery patients in five Irish vascular centres will be randomised (stratified for centre and procedure) to undergo RIPC or not immediately before surgery. RIPC will be induced using a blood pressure cuff with four cycles of 5 minutes of ischaemia followed by 5 minutes of reperfusion immediately before the start of operations. There is no sham intervention. Participants will undergo serum troponin measurements pre-operatively and 1, 2, and 3 days post-operatively. Participants will undergo 12-lead electrocardiograms pre-operatively and on the second post-operative day. Predefined complications within one year of surgery will be recorded. Patient and staff experiences will be explored using qualitative techniques. The primary outcome measure is the proportion of patients who develop elevated serum troponin levels in the first 3 days post-operatively. Secondary outcome measures include length of hospital and critical care stay, unplanned critical care admissions, death, myocardial infarction, stroke, mesenteric ischaemia and need for renal replacement therapy (within 30 days of surgery). RIPC is novel intervention with the potential to significantly improve perioperative outcomes. This trial will provide the first evaluation of RIPC's ability to reduce adverse clinical events following major vascular surgery. www.clinicaltrials.gov NCT02097186 Date Registered: 24 March 2014.

[Development and evaluation of individualized fluid therapy in the elderly patients with coronary heart disease undergoing gastrointestinal surgery: a randomized, controlled trial].

PubMed

Zheng, Hong; Guo, Hai; Ye, Jian-rong; Chen, Lin

2012-06-01

To develop and evaluate an individualized fluid therapy in the elderly patients with coronary heart disease undergoing gastrointestinal surgery. In this prospective study, 60 coronary heart disease patients undergoing gastrointestinal surgery were included in the First Affiliated Hospital of Xinjiang Medical University from March 2009 to March 2012. Patients were randomized into the intervention group and the control group with 30 patients in each group. Individualized fluid therapy was used during surgery and postoperative period in the ICU, which was determined based on target controlled fluid therapy according to cardiac index, stroke volume, and stroke volume variation. Traditional fluid therapy was used in the control group in the intraoperative and postoperative period. The two groups were compared in terms of postoperative hemodynamic parameters, total fluid volume, incidence of adverse cardiac events, and recovery of bowel function. Compared with the control group, mean arterial pressure was significantly increased at the commencement of the surgery. The cardiac index was significantly elevated during surgery and at the end of the surgery. Stroke volume was significantly increased after induction of anesthesia, during the surgery, and at the early stay of ICU period(all P<0.05). Serum lactic acid in the intervention group was significantly lower at the end of surgery and during ICU stay than that in the control group (all P<0.05). During surgery and 24-hour stay in ICU, the total fluid volume, crystal usage, and urine were significantly less, while colloidal fluid use was significantly more in the intervention group as compared to the control group(all P<0.05). The perioperative adverse cardiac event rate was 36.7%(11/30) in the intervention group, lower than 56.7%(17/30) in the control group, but the difference was no statistically significance(P>0.05). In the intervention group, defecation time, time to first flatus, resumption of liquid intake, length of ICU stay and hospital stay were significantly less compared with the control group(P<0.05). In the elderly patients with coronary arterial disease undergoing gastrointestinal surgery, individualized fluid therapy can effectively decrease adverse cardiac events, improve postoperative gastrointestinal function, and reduce length of hospital stay.

The incidence and causative organisms of infection in elective shoulder surgery.

PubMed

Mayne, Alistair I W; Bidwai, Amit S; Clifford, Rachael; Smith, Matthew G; Guisasola, Inigo; Brownson, Peter

2018-07-01

Deep infection remains a serious complication of orthopaedic surgery. Knowledge of infection rates and causative organisms is important to guide infection control measures. The aim of the present study was to determine infection rates and causative organisms in elective shoulder surgery. Cases complicated by infection were identified and prospectively recorded over a 2-year period. All patients undergoing elective shoulder surgery in the concurrent period at a single Specialist Upper Limb Unit in the UK were identified from the hospital electronic database. In total, 1574 elective shoulder cases were performed: 1359 arthroscopic (540 with implant insertion) and 215 open (197 with implant insertion). The overall infection rate in open surgery of 2.5% was significantly higher than arthroscopic implant cases at 0.7% ( p  < 0.005). The overall infection rate in implant arthroscopic surgery was significantly higher at 0.7% compared to 0% in non-implant related surgery. ( p  < 0.05). Patients undergoing open shoulder surgery have a significantly higher risk of infection compared to arthroscopic shoulder surgery. Arthroscopic surgery with implant insertion has a statistically significantly higher risk of developing deep infection compared to procedures with no implant insertion. We recommend prophylactic antibiotics in open shoulder surgery and arthroscopic shoulder surgery with implant insertion.

A comprehensive analysis of craniofacial trauma.

PubMed

Hussain, K; Wijetunge, D B; Grubnic, S; Jackson, I T

1994-01-01

A review of the literature identified a need for a prospective study of the complete range of craniofacial trauma. The aims of this study were to determine the incidence, etiology, and mechanisms of craniofacial and associated injuries, enabling a greater understanding of their range and magnitude. Nine hundred fifty consecutive patients seen at an urban university hospital with any degree of craniofacial trauma were prospectively investigated. Craniofacial trauma was found to be very common at all ages. The causes were directly related to age, sex, and alcohol consumption, and determine the type and severity of injury. The commonest cause of soft-tissue injury was falls, whereas that of fractures was interpersonal violence. Falls accounted for most of the injuries in children and the elderly, whereas interpersonal violence was mainly responsible for those occurring in patients aged 15 to 50 years. Interpersonal violence mostly involved young male adults: fights occurring mainly between strangers who had consumed excessive amounts of alcohol. Women were usually assaulted by assailants known to them, their partners. Pedestrians showed a propensity to sustain cranial fractures, whereas motor vehicle occupants tended to sustain midfacial fractures and bicyclists mandibular fractures. Pedestrians incurred the severest injuries of all road users, and a significant proportion of road user collisions involved bicyclists. Sports were responsible for a significant proportion of craniofacial injuries in youths and young adults. Craniofacial soft-tissue injuries overall occurred most frequently on the forehead, nose, lips, and chin, and a method for their classification is proposed. The commonest craniofacial fracture was that of the nasal bones (45%), followed by cranial bones (24%), mandible (13%), zygoma (13%), orbital blow-out (3%), and maxilla (2%). The incidence of craniofacial trauma can be greatly reduced by improvements in interior home design, school education in alcohol abuse and handling potentially hostile situations (especially for men), improvement in automotive safety devices and compliance by motor vehicle occupants, and utilization of full-face helmets by bicyclists and motorcyclists.

Levels of the Novel Glycoprotein Lacritin in Human Tears After Laser Refractive Surgery

DTIC Science & Technology

2012-10-01

and HPSE before and after surgery as well as comparison of responses between procedures ( PRK vs . LASIK ). The primary outcome measure is tear lacritin...patients undergoing PRK (photorefractive keratectomy) and LASIK (Laser-assisted in situ keratomileusis) with the possibility of the development of...recombinant lacritin as a novel therapeutic agent for wound healing. Up to 196 patients eligible to undergo PRK or LASIK at the U.S. Army Warfighter

Ambulatory surgery center market share and rates of outpatient surgery in the elderly.

PubMed

Hollenbeck, Brent K; Hollingsworth, John M; Dunn, Rodney L; Zaojun Ye; Birkmeyer, John D

2010-12-01

Relative to outpatient surgery in hospital settings, ambulatory surgery centers (ASCs) are more efficient and associated with a lower cost per case. However, these facilities may also spur higher overall procedure utilization and thus lead to greater overall health care costs. The authors used the State Ambulatory Surgery Database from the State of Florida to identify Medicare-aged patients undergoing 4 common ambulatory procedures in 2006, including knee arthroscopy, cystoscopy, cataract removal, and colonoscopy. Hospital service areas (HSAs) were characterized according to ASC market share, that is, the proportion of residents undergoing outpatient surgery in these facilities. The authors then examined relationships between ASC market share and rates of each procedure. Age-adjusted rates of ambulatory surgery ranged from 190.5 cases per 1000 to 320.8 cases per 1000 in HSAs with low and high ASC market shares, respectively (P < .01). For all 4 procedures, adjusted rates of procedures were significantly higher in HSAs with the highest ASC market share. The greatest difference, both in relative and absolute terms, was observed for patients undergoing cystoscopy. In areas of high ASC market share, the age-adjusted rate of cystoscopy was nearly 3-fold higher than in areas with low ASC market share (34.5 vs 11.9 per 1000 population; P < .01). The presence of an ASC is associated with higher utilization of common outpatient procedures in the elderly. Whether ASCs are meeting unmet clinical demand or spurring overutilization is not clear.

Effects of preoperative aspirin and clopidogrel therapy on perioperative blood loss and blood transfusion requirements in patients undergoing off-pump coronary artery bypass graft surgery.

PubMed

Shim, Jae Kwang; Choi, Yong Seon; Oh, Young Jun; Bang, Sou Ouk; Yoo, Kyung Jong; Kwak, Young Lan

2007-07-01

Preoperative exposure to clopidogrel and aspirin significantly increases postoperative bleeding in patients undergoing on-pump coronary artery bypass graft surgery. Off-pump coronary bypass grafting has been proposed as an alternative technique to attenuate postoperative bleeding associated with clopidogrel. This study aimed to determine the effects of aspirin and clopidogrel therapy on perioperative blood loss and blood transfusion requirements in off-pump coronary artery bypass grafting. One hundred six patients scheduled for off-pump coronary artery bypass grafting were divided into three groups: aspirin and clopidogrel discontinued more than 6 days before surgery (group 1, n = 35), aspirin and clopidogrel continued until 3 to 5 days before surgery (group 2, n = 51), and both medications continued within 2 days of surgery (group 3, n = 20). Thromboelastographic tracings were analyzed before induction of anesthesia. Routine coagulation profiles were measured before and after surgery. A cell salvage device was used during surgery and salvaged blood was reinfused. Chest tube drainage and blood transfusion requirement were recorded postoperatively. Patient characteristics, operative data, and thromboelastographic tracings were similar among the groups. There were significant decreases in hematocrit level and platelet count and prolongation in prothrombin time postoperatively in all groups without any intergroup differences. The amounts of perioperative blood loss and blood transfusion required were all similar among the groups. Preoperative clopidogrel and aspirin exposure even within 2 days of surgery does not increase perioperative blood loss and blood transfusion requirements in patients undergoing elective off-pump coronary artery bypass grafting.

Comparison of Revision Rates of Anterior- and Posterior-Approach Ptosis Surgery: A Retrospective Review of 1519 Cases.

PubMed

Chou, Eva; Liu, Jun; Seaworth, Cathleen; Furst, Meredith; Amato, Malena M; Blaydon, Sean M; Durairaj, Vikram D; Nakra, Tanuj; Shore, John W

To compare revision rates for ptosis surgery between posterior-approach and anterior-approach ptosis repair techniques. This is the retrospective, consecutive cohort study. All patients undergoing ptosis surgery at a high-volume oculofacial plastic surgery practice over a 4-year period. A retrospective chart review was conducted of all patients undergoing posterior-approach and anterior-approach ptosis surgery for all etiologies of ptosis between 2011 and 2014. Etiology of ptosis, concurrent oculofacial surgeries, revision, and complications were analyzed. The main outcome measure is the ptosis revision rate. A total of 1519 patients were included in this study. The mean age was 63 ± 15.4 years. A total of 1056 (70%) of patients were female, 1451 (95%) had involutional ptosis, and 1129 (74.3%) had concurrent upper blepharoplasty. Five hundred thirteen (33.8%) underwent posterior-approach ptosis repair, and 1006 (66.2%) underwent anterior-approach ptosis repair. The degree of ptosis was greater in the anterior-approach ptosis repair group. The overall revision rate for all patients was 8.7%. Of the posterior group, 6.8% required ptosis revision; of the anterior group, 9.5% required revision surgery. The main reason for ptosis revision surgery was undercorrection of one or both eyelids. Concurrent brow lifting was associated with a decreased, but not statistically significant, rate of revision surgery. Patients who underwent unilateral ptosis surgery had a 5.1% rate of Hering's phenomenon requiring ptosis repair in the contralateral eyelid. Multivariable logistic regression for predictive factors show that, when adjusted for gender and concurrent blepharoplasty, the revision rate in anterior-approach ptosis surgery is higher than posterior-approach ptosis surgery (odds ratio = 2.08; p = 0.002). The overall revision rate in patients undergoing ptosis repair via posterior-approach or anterior-approach techniques is 8.7%. There is a statistically higher rate of revision with anterior-approach ptosis repair.

Utility of Inflammatory Marker- and Nutritional Status-based Prognostic Factors for Predicting the Prognosis of Stage IV Gastric Cancer Patients Undergoing Non-curative Surgery.

PubMed

Mimatsu, Kenji; Fukino, Nobutada; Ogasawara, Yasuo; Saino, Yoko; Oida, Takatsugu

2017-08-01

The present study aimed to compare the utility of various inflammatory marker- and nutritional status-based prognostic factors, including many previous established prognostic factors, for predicting the prognosis of stage IV gastric cancer patients undergoing non-curative surgery. A total of 33 patients with stage IV gastric cancer who had undergone palliative gastrectomy and gastrojejunostomy were included in the study. Univariate and multivariate analyses were performed to evaluate the relationships between the mGPS, PNI, NLR, PLR, the CONUT, various clinicopathological factors and cancer-specific survival (CS). Among patients who received non-curative surgery, univariate analysis of CS identified the following significant risk factors: chemotherapy, mGPS and NLR, and multivariate analysis revealed that the mGPS was independently associated with CS. The mGPS was a more useful prognostic factor than the PNI, NLR, PLR and CONUT in patients undergoing non-curative surgery for stage IV gastric cancer. Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

Sevoflurane with or without antiemetic prophylaxis of dexamethasone in spontaneously breathing patients undergoing outpatient anorectal surgery.

PubMed

Wu, Jyh-I; Lu, Shao-Fong; Chia, Yuan-Yi; Yang, Lin-Cheng; Fong, Wen-Po; Tan, Ping-Heng

2009-11-01

To evaluate the prophylactic use of dexamethasone with sevoflurane in outpatient anorectal surgery. Randomized, controlled study. Operating room and Postanesthesia Care Unit of a general hospital. 60 adult, ASA physical status I and II outpatients undergoing anorectal surgery. Patients were randomized to receive either dexamethasone 5 mg intravenously (IV; Group D; n = 30) or an equal volume of saline (Group S; n = 30) before anesthesia induction. Anesthesia was induced with propofol 2.5 mg.kg(-1), fentanyl two microg.kg(-1), and 2% lidocaine one mg.kg(-1) followed by placement of a Laryngeal Mask Airway. Frequency of postoperative nausea and vomiting (PONV), visual analog scale (VAS) pain scores, and patient satisfaction were recorded. Frequency of PONV and VAS pain scores were significantly lower in Group D than Group S (P < 0.05). The time required for "home readiness" was significantly shorter in Group D than Group S (P < 0.05). The prophylactic administration of 5 mg dexamethasone IV can reduce the frequency of PONV, lower VAS pain scores, facilitate recovery to home readiness, and improve satisfaction in outpatients undergoing anorectal surgery.

Contribution of jaw muscle size and craniofacial morphology to human bite force magnitude.

PubMed

Raadsheer, M C; van Eijden, T M; van Ginkel, F C; Prahl-Andersen, B

1999-01-01

The existence of an interaction among bite force magnitude, jaw muscle size (e.g., cross-sectional area, thickness), and craniofacial morphology is widely accepted. Bite force magnitude depends on the size of the jaw muscles and the lever arm lengths of bite force and muscle forces, which in turn are dictated by craniofacial morphology. In this study, the relative contributions of craniofacial morphology and jaw muscle thickness to the bite force magnitude were studied. In 121 adult individuals, both magnitude and direction of the maximal voluntary bite force were registered. Craniofacial dimensions were measured by anthropometrics and from lateral radiographs. The thicknesses of the masseter, temporal, and digastric muscles were registered by ultrasonography. After a factor analysis was applied to the anthropometric and cephalometric dimensions, the correlation between bite force magnitude, on the one hand, and the "craniofacial factors" and jaw muscle thicknesses, on the other, was assessed by stepwise multiple regression. Fifty-eight percent of the bite force variance could be explained. From the jaw muscles, only the thickness of the masseter muscle correlated significantly with bite force magnitude. Bite force magnitude also correlated significantly positively with vertical and transverse facial dimensions and the inclination of the midface, and significantly negatively with mandibular inclination and occlusal plane inclination. The contribution of the masseter muscle to the variation in bite force magnitude was higher than that of the craniofacial factors.

Complications in Women Undergoing Burch Colposuspension Versus Autologous Rectus Fascia Sling for the Treatment of Stress Urinary Incontinence

PubMed Central

Chai, Toby C.; Albo, Michael E.; Richter, Holly E.; Norton, Peggy A.; Dandreo, Kimberly J.; Kenton, Kimberly; Lowder, Jerry L.; Stoddard, Anne M.

2009-01-01

Purpose To determine clinicodemographic factors associated with complications of continence procedures, the impact of concomitant surgeries on complication rates and the relationship between incidence of cystitis and method of post-operative bladder drainage. Materials and Methods Serious adverse events (SAEs) and adverse events (AEs) of the Stress Incontinence Surgical Efficacy Trial (SISTEr), a randomized trial comparing Burch colposuspension to autologous rectus fascial sling, were reviewed. Clinicodemographic variables were analyzed to determine those associated with the development of AEs using logistic regression analysis. Complications were stratified based on the presence or absence of concomitant surgery. Differences in complication rates (controlling for concomitant surgery) and cystitis rates (controlling for method of bladder emptying) were compared using Fisher’s exact test. Results Blood loss (p=0.0002) and operative time (p<0.0001) were significantly associated with development of an AE. Subjects undergoing concomitant surgeries had a significantly higher SAE rate (14.2% vs 7.3%, p=0.01) and AE rate (60.5% vs. 48%, p<0.01) compared to subjects undergoing continence surgery alone. Cystitis rates were higher (p<0.01) in the sling versus the Burch group up to 6 weeks postoperatively regardless of concomitant surgery status. Intermittent self catheterization (ISC) increased the rate of cystitis by 17% and 23% in the Burch and sling groups, respectively. Conclusions Concomitant surgeries at the time of continence surgery increased the risk for complications. Sling surgery was associated with a higher risk of cystitis within the first 6 weeks postoperatively. ISC increased risk of cystitis in both groups. The occurrence of complications was associated with surgical factors, not patient-related factors. PMID:19296969

Features of lateral cephalograms associated with difficult laryngoscopy in Japanese children undergoing oral and maxillofacial surgery.

PubMed

Kohjitani, Atsushi; Miyawaki, Takuya; Miyawaki, Shouichi; Nakamura, Norifumi; Iwase, Yoko; Nishihara, Kazuhide; Ohno, Sachi; Shimada, Masahiko; Sugiyama, Kazuna

2013-11-01

Difficult laryngoscopy and tracheal intubation are occasionally encountered in children with congenital anomalies or micrognathia. However, no study has elucidated anatomical etiology in relation to craniofacial development. Two hundred ten patients aged 8 months-18 years were analyzed. We analyzed the lateral cephalograms of: (i) eight patients in whom laryngoscopy was anticipated as difficult before anesthesia and who were unable to be intubated by direct laryngoscopy and needed fiberoptic bronchoscopy (group A); (ii) 11 patients in whom laryngoscopy was anticipated as difficult before anesthesia but who were able to be intubated by direct laryngoscopy (group B); and (iii) 191 patients in whom laryngoscopy was anticipated as easy before anesthesia and was actually found to be easy (group C). Eight cephalometric parameters were measured and age-parameter relationships were plotted. Logistic regression analysis was performed to characterize group A children for each of the cephalometric variables. Apparently insufficient growth of the mandible was observed in the group A children. Furthermore, the group A children of aged <4 years had undeveloped maxilla, longer mandibular plane-hyoid distances (≥1.3 cm), and deeper depth of the oropharynx; those of aged ≥4 years showed increased inclination of the mandible (sella-nasion plane to mandibular plane angle of ≥46.5°). Difficult laryngoscopy and tracheal intubation are expected in children aged <4 years with lower-positioned hyoid bone caused by caudal larynx as well as undeveloped maxilla and mandible, and in those aged ≥4 years with increased inclination of the mandible as well as undeveloped mandible. © 2013 John Wiley & Sons Ltd.

[Evaluation of selected parameters of blood coagulation and fibrinolysis system in patients undergoing total hip replacement surgery with normovolemic hemodilution procedure and standard enoxaparine prophylaxis].

PubMed

Piecuch, Wiesław; Sokołowska, Bozena; Dmoszyńska, Anna; Furmanik, Franciszek

2003-01-01

The aim of the study was to evaluate selected blood coagulation and fibrinolysis parameters in patients undergoing total hip replacement surgery with normovolemic hemodilution and standard enoksaparine profilaxis. The study included 66 patients undergoing hip replacement surgery. The group consisted of 51 women and 15 men, within the age range of 47-78, the mean age was 64. In 32 (subgroup II) patients the surgery was performed with the use of normovolemic hemodilution, in 34 (subgroup I) the hemodilution procedure was not applied. The enoksaparine as prophylaxis started 12 hours prior to surgery and continued during hospitalisation. The examination of the coagulation system was performed: on the day of the operation in the morning, on the day of the operation in the evening and on the first day after operation. We determined the concentrations of TAT and PAP complexes, prothrombin fragments 1 + 2 (F1 + 2) and d-dimers (DD). 1) during total hip replacement surgery and particularly in the period of the first 12 hours after the procedure marked activation of coagulation and fibrinolysis occurRed; 2) the application of the hemodilution procedure does not influence significantly the degree of coagulation and fibrinolysis disorders in the perioperative period, but could reduced incidence of thromboembolic complications in the postoperative period.

REMIFENTANIL VS FENTANYL DURING DAY CASE DENTAL SURGERY IN PEOPLE WITH SPECIAL NEEDS: A COMPARATIVE, PILOT STUDY OF THEIR EFFECT ON STRESS RESPONSE AND POSTOPERATIVE PAIN.

PubMed

Sklika, Eirini; Kalimeris, Konstantinos; Perrea, Despina; Stavropoulos, Nikolaos; Kostopanagiotou, Georgia; Matsota, Paraskevi

2016-06-01

People with special needs undergoing dental surgery frequently require general anesthesia. We investigated the effect of remifentanil vs fentanyl on stress response and postoperative pain in people with special needs undergoing day-case dental surgery. Forty-six adult patients with cognitive impairment undergoing day-case dental surgery under general anesthesia were allocated to receive intraoperatively either fentanyl 50 μg iv bolus (group F, n = 23) or continuous infusion of remifentanil 0.5-1 μg/kg/min (group R, n = 23). Iintraoperative hemodynamic parameters were recorded and serum inflammatory mediators [tumor necrosis factor-α, substance-P], stress hormons (melatonin, cortisol) and β-endorphin were measured. Postoperative pain was assessed during the first postoperative 12 hours with the Wong-Baker faces pain-rating scale. Demographics were similar in two groups. The two groups did not differ regarding their effects on inflammatory mediators, stress hormons and postoperative pain scores. However, the use of remifentanil prevented intraoperative increases of arterial blood pressure and heart rate. Remifentanil and fentanyl did not affect differently stress and inflammatory hormones during day-case dental surgery, although remifentanil may render intraoperative management of hemodynamic responses easier. Both opioids are equally efficient for postoperative pain management following dental surgery in people with special needs.

From time-based to competency-based standards: core transitional competencies in plastic surgery.

PubMed

Lutz, Kristina; Yazdani, Arjang; Ross, Douglas

2015-01-01

Competency-based medical education is becoming increasingly prevalent and is likely to be mandated by the Royal College in the near future. The objective of this study was to define the core technical competencies that should be possessed by plastic surgery residents as they transition into their senior (presently postgraduate year 3) years of training. A list of potential core competencies was generated using a modified Delphi method that included the investigators and 6 experienced, academic plastic surgeons from across Canada and the United States. Generated items were divided into 7 domains: basic surgical skills, anesthesia, hand surgery, cutaneous surgery, esthetic surgery, breast surgery, and craniofacial surgery. Members of the Delphi group were asked to rank particular skills on a 4-point scale with anchored descriptors. Item reduction resulted in a survey consisting of 48 skills grouped into the aforementioned domains. This self-administered survey was distributed to all Canadian program directors (n = 11) via e-mail for validation and further item reduction. The response rate was 100% (11/11). Using the average rankings of program directors, 26 "core" skills were identified. There was agreement of core skills across all domains except for breast surgery and esthetic surgery. Of them, 7 skills were determined to be above the level of a trainee at this stage; a further 15 skills were agreed to be important, but not core, competencies. Overall, 26 competencies have been identified as "core" for plastic surgery residents to possess as they begin their senior, on-service years. The nature of these skills makes them suitable for teaching in a formal, simulated environment, which would ensure that all plastic surgery trainees are competent in these tasks as they transition to their senior years of residency. Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

[Anaesthetic management of patients in the third trimester of pregnancy undergoing urgent laparoscopic surgery. Experience in a general hospital].

PubMed

López-Collada Estrada, María; Olvera Martínez, Rosalba

2016-01-01

Laparoscopic surgery is well accepted as a safe technique when performed on a third trimester pregnant woman. The aim is to describe the anaesthetic management of a group of patients undergoing this type of surgery. An analysis was made of records of 6 patients in their third trimester of pregnancy and who underwent urgent laparoscopic surgery from 2011 to 2013. The study included 6 patients, with a diagnosis of acute cholecystitis in 4 of them. The other 2 patients had acute appendicitis, both of who presented threatened preterm labour. The most frequent indications for laparoscopic surgery during the last trimester of birth were found to be acute cholecystitis and acute appendicitis. Acute appendicitis is related to an elevated risk of presenting threatened preterm labour. Copyright © 2015 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

Prevalence, Comorbidities, and Risk of Perioperative Complications in Human Immunodeficiency Virus-Positive Patients Undergoing Cervical Spine Surgery.

PubMed

Lovy, Andrew J; Guzman, Javier Z; Skovrlj, Branko; Cho, Samuel K; Hecht, Andrew C; Qureshi, Sheeraz A

2015-11-01

Retrospective database analysis. To evaluate outcomes of human immunodeficiency virus (HIV) positive patients after cervical spine surgery. Highly active antiretroviral medications have qualitatively altered the natural history of HIV, thus increasing the number of HIV-positive patients seeking treatment for chronic degenerative conditions. Minimal data exist on HIV patients undergoing degenerative cervical spine surgery. The Nationwide Inpatient Sample was examined from 2002 to 2011. Hospitalizations were identified using International Classification of Diseases Ninth Revision, Clinical Modification (ICD-9-CM) procedural codes for cervical spine surgery and diagnoses codes for degenerative conditions of the cervical spine, and HIV. Statistical analysis was conducted to evaluate associations between HIV status and perioperative complications. A total of 1,602,129 patients underwent degenerative cervical spine surgery, of which 3700 patients (0.23%) had HIV. The prevalence of HIV increased over the study period from 0.19% to 0.33% (P < 0.001). Patients with HIV were younger (48.6 yrs vs. 53.4 yrs, P < 0.001) and more likely to be male (P < 0.001). HIV patients had significantly greater odds of having chronic pulmonary disease, liver disease, and drug abuse. Unadjusted analysis did not reveal increased rate of acute complications among HIV-positive patients compared with negative controls (3.8% vs. 3.7%, P = 0.62). Multivariate analysis did not identify HIV as a significant predictor of complication (odds ratio = 1.04, P = 0.84). HIV was associated with a 1.5 day increased length of stay AND 1.29 fold increase in median costs compared with controls ($14,551 vs. 18,846, P < 0.001). The prevalence of HIV patients undergoing degenerative cervical spine surgery is increasing. A diagnosis of HIV was not associated with an increased risk of perioperative complication among patients undergoing degenerative cervical spine surgery. Further clinical studies are needed to evaluate predictors of complications among HIV patients and long-term outcomes. 4.

The prevalence of undiagnosed pre-surgical cognitive impairment and its post-surgical clinical impact in elderly patients undergoing surgery for adult spinal deformity.

PubMed

Adogwa, Owoicho; Elsamadicy, Aladine A; Lydon, Emily; Vuong, Victoria D; Cheng, Joseph; Karikari, Isaac O; Bagley, Carlos A

2017-09-01

Pre-existing cognitive impairment (CI) is emerging as a predictor of poor post-operative outcomes in elderly patients. Little is known about impaired preoperative cognition and outcomes after elective spine surgery in this patient population. The purpose of this study was to assess the prevalence of neuro CI in elderly patients undergoing deformity surgery and its impact on postoperative outcomes. Elderly subjects undergoing elective spinal surgery for correction of adult degenerative scoliosis were enrolled in this study. Pre-operative baseline cognition was assessed using the Saint Louis Mental Status (SLUMS) test. SLUMS consists of 11 questions, which can give a maximum of 30 points. Mild CI was defined as a SLUMS score between 21-26 points, while severe CI was defined as a SLUMS score of ≤20 points. Normal cognition was defined as a SLUMS score of ≥27 points. Complication rates, duration of hospital stay, and 30-day readmission rates were compared between patients with and without baseline CI. Eighty-two subjects were included in this study, with mean age of 73.26±6.08 years. Fifty-seven patients (70%) had impaired cognition at baseline. The impaired cognition group had the following outcomes: increased incidence of one or more postoperative complications (39% vs. 20%), higher incidence of delirium (20% vs. 8%), and higher rate of discharge institutionalization at skilled nursing or acute rehab facilities (54% vs. 30%). The length of hospital stay and 30-day hospital readmission rates were similar between both cohorts (5.33 vs. 5.48 days and 12.28% vs. 12%, respectively). CI is highly prevalent in elderly patients undergoing surgery for adult degenerative scoliosis. Impaired cognition before surgery was associated with higher rates of post-operative delirium, complications, and discharge institutionalization. CI assessments should be considered in the pre-operative evaluations of elderly patients prior to surgery.

Tranexamic Acid in Patients Undergoing Coronary-Artery Surgery.

PubMed

Myles, Paul S; Smith, Julian A; Forbes, Andrew; Silbert, Brendan; Jayarajah, Mohandas; Painter, Thomas; Cooper, D James; Marasco, Silvana; McNeil, John; Bussières, Jean S; McGuinness, Shay; Byrne, Kelly; Chan, Matthew T V; Landoni, Giovanni; Wallace, Sophie

2017-01-12

Tranexamic acid reduces the risk of bleeding among patients undergoing cardiac surgery, but it is unclear whether this leads to improved outcomes. Furthermore, there are concerns that tranexamic acid may have prothrombotic and proconvulsant effects. In a trial with a 2-by-2 factorial design, we randomly assigned patients who were scheduled to undergo coronary-artery surgery and were at risk for perioperative complications to receive aspirin or placebo and tranexamic acid or placebo. The results of the tranexamic acid comparison are reported here. The primary outcome was a composite of death and thrombotic complications (nonfatal myocardial infarction, stroke, pulmonary embolism, renal failure, or bowel infarction) within 30 days after surgery. Of the 4662 patients who were enrolled and provided consent, 4631 underwent surgery and had available outcomes data; 2311 were assigned to the tranexamic acid group and 2320 to the placebo group. A primary outcome event occurred in 386 patients (16.7%) in the tranexamic acid group and in 420 patients (18.1%) in the placebo group (relative risk, 0.92; 95% confidence interval, 0.81 to 1.05; P=0.22). The total number of units of blood products that were transfused during hospitalization was 4331 in the tranexamic acid group and 7994 in the placebo group (P<0.001). Major hemorrhage or cardiac tamponade leading to reoperation occurred in 1.4% of the patients in the tranexamic acid group and in 2.8% of the patients in the placebo group (P=0.001), and seizures occurred in 0.7% and 0.1%, respectively (P=0.002 by Fisher's exact test). Among patients undergoing coronary-artery surgery, tranexamic acid was associated with a lower risk of bleeding than was placebo, without a higher risk of death or thrombotic complications within 30 days after surgery. Tranexamic acid was associated with a higher risk of postoperative seizures. (Funded by the Australian National Health and Medical Research Council and others; ATACAS Australia New Zealand Clinical Trials Registry number, ACTRN12605000557639 .).

Correlations of frontal lip-line canting with craniofacial morphology and muscular activity.

PubMed

Cho, Jin-Hyoung; Kim, Eun-Jung; Kim, Byeong-Chae; Cho, Ki-Hyun; Lee, Ki-Heon; Hwang, Hyeon-Shik

2007-09-01

The purpose of this study was to investigate factors affecting lip-line canting by using musculoskeletal analyses. Fifty-six adults with lip-line canting were selected as subjects. They were divided into 3 groups according to the changes of lip line during smiling: increasing (group I), decreasing (group D), and minimal (group M). Lip-line canting at rest was correlated to craniofacial morphology and muscular activity: Regarding craniofacial morphology, various craniofacial measurements in lateral and frontal cephalograms were used, including inclination of the tongue blade placed across both first molars. The zygomaticus major was the focus of the measurement of muscular activity affecting lip-line canting, and its activity during smiling was evaluated by using a needle electrode. In group I, lip-line canting at rest showed a significant correlation with the right-left (R/L) difference of muscular activity, but no significant correlation with the measurements of craniofacial morphology. In group D, lip-line canting showed a positive correlation with the measurements of craniofacial morphology, such as the inclination of the tongue blade, and a negative correlation with the R/L difference of muscular activity. In group M, lip-line canting showed no significant correlation with the R/L difference of muscular activity, but a significant correlation with inclination of the tongue blade. The results indicate that lip-line canting is caused by craniofacial morphology when the change of lip-line canting during smiling is minimal, whereas lip-line canting is affected by the R/L difference of muscular activity in addition to craniofacial morphology when the cant of lip line markedly changes during smiling. The findings suggest that the cause of lip-line canting can be identified easily by the change of canting during smiling, without complicated musculoskeletal analyses.

Management Options and Outcomes for Neonatal Hypoplastic Left Heart Syndrome in the Early Twenty-First Century.

PubMed

Kane, Jason M; Canar, Jeff; Kalinowski, Valerie; Johnson, Tricia J; Hoehn, K Sarah

2016-02-01

Without surgical treatment, neonatal hypoplastic left heart syndrome (HLHS) mortality in the first year of life exceeds 90 % and, in spite of improved surgical outcomes, many families still opt for non-surgical management. The purpose of this study was to investigate trends in neonatal HLHS management and to identify characteristics of patients who did not undergo surgical palliation. Neonates with HLHS were identified from a serial cross-sectional analysis using the Healthcare Cost and Utilization Project's Kids' Inpatient Database from 2000 to 2012. The primary analysis compared children undergoing surgical palliation to those discharged alive without surgery using a binary logistic regression model. Multivariate logistic regression was conducted to determine factors associated with treatment choice. A total of 1750 patients underwent analysis. Overall hospital mortality decreased from 35.3 % in 2000 to 22.9 % in 2012. The percentage of patients undergoing comfort care discharge without surgery also decreased from 21.2 to 14.8 %. After controlling for demographics and comorbidities, older patients at presentation were less likely to undergo surgery (OR 0.93, 0.91-0.96), and patients in 2012 were more likely to undergo surgery compared to those in prior years (OR 1.5, 1.1-2.1). Discharge without surgical intervention is decreasing with a 30 % reduction between 2000 and 2012. Given the improvement in surgical outcomes, further dialogue about ethical justification of non-operative comfort or palliative care is warranted. In the meantime, clinicians should present families with surgical outcome data and recommend intervention, while supporting their option to refuse.

Safety and efficacy of hysteroscopic sterilization compared with laparoscopic sterilization: an observational cohort study.

PubMed

Mao, Jialin; Pfeifer, Samantha; Schlegel, Peter; Sedrakyan, Art

2015-10-13

To compare the safety and efficacy of hysteroscopic sterilization with the "Essure" device with laparoscopic sterilization in a large, all-inclusive, state cohort. Population based cohort study. Outpatient interventional setting in New York State. Women undergoing interval sterilization procedure, including hysteroscopic sterilization with Essure device and laparoscopic surgery, between 2005 and 2013. Safety events within 30 days of procedures; unintended pregnancies and reoperations within one year of procedures. Mixed model accounting for hospital clustering was used to compare 30 day and 1 year outcomes, adjusting for patient characteristics and other confounders. Time to reoperation was evaluated using frailty model for time to event analysis. We identified 8048 patients undergoing hysteroscopic sterilization and 44,278 undergoing laparoscopic sterilization between 2005 and 2013 in New York State. There was a significant increase in the use of hysteroscopic procedures during this period, while use of laparoscopic sterilization decreased. Patients undergoing hysteroscopic sterilization were older than those undergoing laparoscopic sterilization and were more likely to have a history of pelvic inflammatory disease (10.3% v 7.2%, P<0.01), major abdominal surgery (9.4% v 7.9%, P<0.01), and cesarean section (23.2% v 15.4%, P<0.01). At one year after surgery, hysteroscopic sterilization was not associated with a higher risk of unintended pregnancy (odds ratio 0.84 (95% CI 0.63 to 1.12)) but was associated with a substantially increased risk of reoperation (odds ratio 10.16 (7.47 to 13.81)) compared with laparoscopic sterilization. Patients undergoing hysteroscopic sterilization have a similar risk of unintended pregnancy but a more than 10-fold higher risk of undergoing reoperation compared with patients undergoing laparoscopic sterilization. Benefits and risks of both procedures should be discussed with patients for informed decisions making. © Mao et al 2015.

Assessing Species-specific Contributions To Craniofacial Development Using Quail-duck Chimeras

PubMed Central

Fish, Jennifer L.; Schneider, Richard A.

2014-01-01

The generation of chimeric embryos is a widespread and powerful approach to study cell fates, tissue interactions, and species-specific contributions to the histological and morphological development of vertebrate embryos. In particular, the use of chimeric embryos has established the importance of neural crest in directing the species-specific morphology of the craniofacial complex. The method described herein utilizes two avian species, duck and quail, with remarkably different craniofacial morphology. This method greatly facilitates the investigation of molecular and cellular regulation of species-specific pattern in the craniofacial complex. Experiments in quail and duck chimeric embryos have already revealed neural crest-mediated tissue interactions and cell-autonomous behaviors that regulate species-specific pattern in the craniofacial skeleton, musculature, and integument. The great diversity of neural crest derivatives suggests significant potential for future applications of the quail-duck chimeric system to understanding vertebrate development, disease, and evolution. PMID:24962088

Plastic surgery and the biometric e-passport: implications for facial recognition.

PubMed

Ologunde, Rele

2015-04-01

This correspondence comments on the challenges of plastic reconstructive and aesthetic surgery on the facial recognition algorithms employed by biometric passports. The limitations of facial recognition technology in patients who have undergone facial plastic surgery are also discussed. Finally, the advice of the UK HM passport office to people who undergo facial surgery is reported.

Frequency of Dehiscence in Hand-Sutured and Stapled Intestinal Anastomoses in Dogs.

PubMed

Duell, Jason R; Thieman Mankin, Kelley M; Rochat, Mark C; Regier, Penny J; Singh, Ameet; Luther, Jill K; Mison, Michael B; Leeman, Jessica J; Budke, Christine M

2016-01-01

To determine the frequency of dehiscence of hand-sutured and stapled intestinal anastomoses in the dog and compare the surgery duration for the methods of anastomosis. Historical cohort study. Two hundred fourteen client-owned dogs undergoing hand-sutured (n = 142) or stapled (n = 72) intestinal anastomoses. Medical records from 5 referral institutions were searched for dogs undergoing intestinal resection and anastomosis between March 2006 and February 2014. Demographic data, presence of septic peritonitis before surgery, surgical technique (hand-sutured or stapled), surgery duration, surgeon (resident versus faculty member), indication for surgical intervention, anatomic location of resection and anastomosis, and if dehiscence was noted postoperatively were retrieved. Estimated frequencies were summarized and presented as proportions and 95% confidence intervals (CI) and continuous outcomes as mean (95% CI). Comparisons were made across methods of anastomosis. Overall, 29/205 dogs (0.14, 95% CI 0.10-00.19) had dehiscence, including 21/134 dogs (0.16, 0.11-0.23) undergoing hand-sutured anastomosis and 8/71 dogs (0.11, 0.06-0.21) undergoing stapled anastomosis. There was no significant difference in the frequency of dehiscence across anastomosis methods (χ(2), P = .389). The mean (95% CI) surgery duration of 140 minutes (132-147) for hand- sutured anastomoses and 108 minutes (99-119) for stapled anastomoses was significantly different (t-test, P < .001). No significant difference in frequency of dehiscence was noted between hand- sutured and stapled anastomoses in dogs but surgery duration is significantly reduced by the use of staples for intestinal closure. © Copyright 2015 by The American College of Veterinary Surgeons.

A NSQIP Analysis of MELD and Perioperative Outcomes in General Surgery.

PubMed

Zielsdorf, Shannon M; Kubasiak, John C; Janssen, Imke; Myers, Jonathan A; Luu, Minh B

2015-08-01

It is well known that liver disease has an adverse effect on postoperative outcomes. However, what is still unknown is how to appropriately risk stratify this patient population based on the degree of liver failure. Because data are limited, specifically in general surgery practice, we analyzed the model of end-stage liver disease (MELD) in terms of predicting postoperative complications after one of three general surgery operations: inguinal hernia repair (IHR), umbilical hernia repair (UHR), and colon resection (CRXN). National Surgical Quality Improvement Program data on 17,812 total patients undergoing one of three general surgery operations from 2008 to 2012 were analyzed retrospectively. There were 7402 patients undergoing IHR; 5014 patients undergoing UHR; 5396 patients undergoing CRXN. MELD score was calculated using international normalized ratio, total bilirubin, and creatinine. The primary end point was any postoperative complication. The statistical method used was logistic regression. For IHR, UHR, and CRXN, the overall complication rates were 3.4, 6.4, and 45.9 per cent, respectively. The mean MELD scores were 8.6, 8.5, and 8.5, respectively. For every 1-point increase greater than the mean MELD score, there was a 7.8, 13.8, and 11.6 per cent increase in any postoperative complication. The overall 30-day mortality rate was 0.9 per cent. In conclusion, the MELD score continuum adequately predicts patients' increased risk of postoperative complications after IHR, UHR, and CRXN. Therefore, MELD could be used for preoperative risk stratification and guide clinical decision making for general surgery in the cirrhotic patient.

Perioperative depression or anxiety and postoperative mortality in cardiac surgery: a systematic review and meta-analysis.

PubMed

Takagi, Hisato; Ando, Tomo; Umemoto, Takuya

2017-12-01

We performed a systematic review and meta-analysis to determine whether perioperative depression and anxiety are associated with increased postoperative mortality in patients undergoing cardiac surgery. MEDLINE and EMBASE were searched through January 2017 using PubMed and OVID, to identify observational studies enrolling patients undergoing cardiac surgery and reporting relative risk estimates (RREs) (including odds, hazard, or mortality ratios) of short term (30 days or in-hospital) and/or late all-cause mortality for patients with versus without perioperative depression or anxiety. Study-specific estimates were combined using inverse variance-weighted averages of logarithmic RREs in the random-effects models. Our search identified 16 eligible studies. In total, the present meta-analysis included data on 236,595 patients undergoing cardiac surgery. Pooled analysis demonstrated that perioperative depression was significantly associated with increased both postoperative early (RRE, 1.44; 95% confidence interval [CI] 1.01-2.05; p = 0.05) and late mortality (RRE, 1.44; 95% CI 1.24-1.67; p < 0.0001), and that perioperative anxiety significantly correlated with increased postoperative late mortality (RRE, 1.81; 95% CI 1.20-2.72; p = 0.004). The relation between anxiety and early mortality was reported in only one study and not statistically significant. In the association of depression with late mortality, there was no evidence of significant publication bias and meta-regression indicated that the effects of depression are not modulated by the duration of follow-up. In conclusion, perioperative depression and anxiety may be associated with increased postoperative mortality in patients undergoing cardiac surgery.

Open Heart Surgery Does Not Increase the Incidence of Ipsilateral Ischemic Stroke in Patients with Asymptomatic Severe Carotid Stenosis.

PubMed

Castaldo, John E; Yacoub, Hussam A; Li, Yuebing; Kincaid, Hope; Jenny, Donna

2017-10-01

We evaluated the incidence of perioperative stroke following the institution's 2007 practice change of discontinuing combined carotid endarterectomy and open heart surgery (OHS) for patients with severe carotid stenosis. In this retrospective cohort study, we compared 113 patients undergoing coronary artery bypass grafting, aortic valve replacement, or both from 2007 to 2011 with data collected from 2001 to 2006 from a similar group of patients. Our aim was to assess whether the practice change led to a greater incidence of stroke. A total of 7350 consecutive patients undergoing OHS during the specified time period were screened. Of these, 3030 had OHS between 2007 and 2011 but none were combined with carotid artery surgery (new cohort). The remaining 4320 had OHS before 2007 and 44 had combined procedures (old cohort). Of patients undergoing OHS during the 10-year period of observation, 230 had severe (>80%) carotid stenosis. In the old cohort (before 2007), carotid stenosis was associated with perioperative stroke in 2.5% of cases. None of the 113 patients having cardiac procedures after 2007 received combined carotid artery surgery; only 1 of these patients harboring severe carotid stenosis had an ischemic stroke (.9%) during the perioperative period. The difference in stroke incidence between the 2 cohorts was statistically significant (P = .002). The incidence of stroke in patients with severe carotid artery stenosis undergoing OHS was lower after combined surgery was discontinued. Combined carotid and OHS itself seems to be an important risk factor for stroke. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

[Bayes' syndrome in cardiac surgery: prevalence of interatrial block in patients younger than 65 years undergoing cardiac surgery and association with postoperative atrial fibrillation].

PubMed

García-Izquierdo Jaén, Eusebio; Cobo Rodríguez, Pablo; Solís Solís, Luis; Pham Trung, Chinh; Jiménez Sánchez, Diego; Sánchez García, Manuel; Castro Urda, Victor; Toquero Ramos, Jorge; Fernández Lozano, Ignacio

2017-11-03

Interatrial block (IAB) is a well-known entity that is associated with an increased risk of atrial fibrillation (AF). This association is called Bayes' syndrome. The aim of our study was to define the prevalence of IAB among patients younger than 65 years undergoing cardiac surgery and determine whether there is an association between the presence of interatrial conduction delay and postoperative atrial fibrillation (POAF). A total of 207 patients were enrolled. Partial IAB was defined as P-wave>120ms. Advanced IAB was defined as P-wave>120ms+biphasic morphology in the inferior leads. Ocurrence of POAF was assessed and a comparative analysis was conducted between patients that did and did not develop AF. IAB prevalence was 78.3% (partial 66.2%, advanced 12.1%). POAF occurred in 28.5% of all patients, and was more frequent among patients with advanced IAB (44%) compared to 27.7% and 24.4% of POAF among patients with partial IAB and without IAB, respectively. Patients who developed POAF were significantly older, had significantly higher NTproBNP, higher prevalence of atrial enlargement and thyroid disease. After multivariate analysis, advanced IAB was found to be independently associated with POAF. IAB is a frequent finding among patients undergoing cardiac surgery. According to our results, advanced IAB is independently associated with POAF in younger patients (<65 years) undergoing cardiac surgery. Copyright © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.

The effectiveness of age-appropriate pre-operative information session on the anxiety level of school-age children undergoing elective surgery in Jordan.

PubMed

Shaheen, Abeer; Nassar, Omayyah; Khalaf, Inaam; Kridli, Suha Al-Oballi; Jarrah, Samiha; Halasa, Suhaila

2018-06-01

Undergoing surgery is an anxious experience for children. Applying anxiety reduction age-appropriate programs by nurses would be beneficial in reducing anxiety to children. To test the effectiveness of age-appropriate preoperative information session in reducing anxiety levels of school-age children undergoing elective surgery in Jordan. The study used a quasi-experimental design. One hundred and twenty-six children were recruited from an educational hospital in Amman from January to June 2012 and were randomly assigned to intervention and control groups. The anxiety levels of children were assessed using the State Anxiety Scale for children, and children's levels of cooperation after surgery were assessed using Children Emotional Manifestation Scale. The heart rate and blood pressure of children were also measured 1 hour before going to operation room. The study results revealed that children in the intervention group reported lower anxiety levels and more cooperation than children in the control group. Also, they displayed lower heart rate and blood pressure than children in the control group. The application of age-appropriate preoperative intervention for children could be beneficial in decreasing anxiety levels and increasing their cooperation post surgery. © 2018 John Wiley & Sons Australia, Ltd.

Heated wire humidification circuit attenuates the decrease of core temperature during general anesthesia in patients undergoing arthroscopic hip surgery.

PubMed

Park, Sooyong; Yoon, Seok-Hwa; Youn, Ann Misun; Song, Seung Hyun; Hwang, Ja Gyung

2017-12-01

Intraoperative hypothermia is common in patients undergoing general anesthesia during arthroscopic hip surgery. In the present study, we assessed the effect of heating and humidifying the airway with a heated wire humidification circuit (HHC) to attenuate the decrease of core temperature and prevent hypothermia in patients undergoing arthroscopic hip surgery under general anesthesia. Fifty-six patients scheduled for arthroscopic hip surgery were randomly assigned to either a control group using a breathing circuit connected with a heat and moisture exchanger (HME) (n = 28) or an HHC group using a heated wire humidification circuit (n = 28). The decrease in core temperature was measured from anesthetic induction and every 15 minutes thereafter using an esophageal stethoscope. Decrease in core temperature from anesthetic induction to 120 minutes after induction was lower in the HHC group (-0.60 ± 0.27℃) compared to the control group (-0.86 ± 0.29℃) (P = 0.001). However, there was no statistically significant difference in the incidence of intraoperative hypothermia or the incidence of shivering in the postanesthetic care unit. The use of HHC may be considered as a method to attenuate intraoperative decrease in core temperature during arthroscopic hip surgery performed under general anesthesia and exceeding 2 hours in duration.

[Post-surgical morbidity in paediatric patients undergoing surgery for congenital heart disease in the UMAE of Yucatan, Mexico].

PubMed

Castillo-Espínola, Addy; Velázquez-Ibarra, Ana; Zetina-Solórzano, Aurea; Bolado-García, Patricia; Gamboa-López, Gonzalo

To describe the clinical course of paediatric patients undergoing surgery for congenital heart disease in UMAE of Yucatan. Descriptive review was performed on the records of paediatric patients undergoing surgery for congenital heart disease from 1 November 2011 to 30 November 2013. The most frequent heart diseases were persistent ductus arteriosus (37.6%) and transposition of the great vessels. The median intensive care stay was 3 days. Mortality was 11.76%, with septic shock (44.4%) in most cases. The most frequent complications were sepsis (5.9%), low cardiac output syndrome (4.7%), cardiac arrest, and AV block and ventricular tachycardia (2.4% each). There was a moderate positive correlation between surgical complications and survival or death. The number of surgical patients is lower compared to reference centres for cardiovascular surgery. There is a marked tendency to perform corrective and palliative surgeries in specific disease in patients with added risk or 'bad' cardiac anatomy that prevent full correction at the first attempt. Prospective epidemiological and clinical studies should be conducted to understand the behaviour of congenital heart diseases treated in the region. Copyright © 2016 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.

Pharmacokinetics of fentanyl in patients undergoing abdominal aortic surgery.

PubMed

Hudson, R J; Thomson, I R; Cannon, J E; Friesen, R M; Meatherall, R C

1986-03-01

The authors determined the pharmacokinetics of fentanyl 100 micrograms X kg-1 iv in patients undergoing elective abdominal aortic surgery. The mean (+/- SD) age of the ten patients was 67.2 +/- 8.7 yr; their mean weight was 78.5 +/- 13.7 kg. Seven patients had aortic aneurysm repair, and the other three patients had aortobifemoral grafts. Serum fentanyl concentrations were determined from samples drawn at increasing intervals over a 24-h period. A three-compartment pharmacokinetic model was fit to the concentration versus time data. Total drug clearance was 9.8 +/- 1.8 ml X min-1 X kg-1. The volume of distribution at steady-state (Vdss) was 5.4 +/- 1.9 X 1 kg-1. Elimination half-time was 8.7 +/- 2.5 h. There were no significant correlations between these pharmacokinetic parameters and patient's age, duration of aortic cross-clamping, duration of surgery, intraoperative blood loss, or volume of iv fluids given intraoperatively. In healthy volunteers or patients undergoing general surgery, other investigators report mean elimination half-times for fentanyl ranging from 1.7 to 4.4 h. The prolonged elimination half-time in patients having abdominal aortic surgery has important clinical implications. In particular, recovery from large doses will take much longer than would have been anticipated from previously published fentanyl pharmacokinetic data.

Bioresorbable distraction device for the treatment of airway problems for infants with Robin sequence.

PubMed

Breugem, Corstiaan; Paes, Emma; Kon, Moshe; Mink van der Molen, Aebele B; van der Molen, Aebele B Mink

2012-08-01

Pierre Robin sequence is a well known craniofacial entity. There are numerous ways to treat the respiratory insufficiency, but sometimes surgical intervention is needed. Tracheotomy could be associated with morbidity, and distraction osteogenesis has been established as a stable method to obtain a safe airway. Distraction osteogenesis has traditionally been performed with an external device. In this manuscript we describe the feasibility of an internal bioresorbable device. Retrospective descriptive study was performed in a tertiary academic children's hospital. After multidisciplinary team consultation, 12 consecutive patients with Robin sequence were treated with this internal distraction device. The mean age at surgery was 32 days, and the average amount of mandibular distraction was 18 mm. All patients were extubated after an average of 7.5 days after the surgery. The average length of stay in the hospital was 17 days after surgery. There were no major surgical complications. A tracheotomy was prevented in all our patients, and complications were limited. Long-term studies are needed to evaluate the influence that internal distraction has on the growth of the mandible and teeth. The internal distraction system seems safe for infants with micrognathia and has certain benefits when compared to the external distractor.

Nucleus caudalis lesioning: Case report of chronic traumatic headache relief

PubMed Central

Sandwell, Stephen E.; El-Naggar, Amr O.

2011-01-01

Background: The nucleus caudalis dorsal root entry zone (DREZ) surgery is used to treat intractable central craniofacial pain. This is the first journal publication of DREZ lesioning used for the long-term relief of an intractable chronic traumatic headache. Case Description: A 40-year-old female experienced new-onset bi-temporal headaches following a traumatic head injury. Despite medical treatment, her pain was severe on over 20 days per month, 3 years after the injury. The patient underwent trigeminal nucleus caudalis DREZ lesioning. Bilateral single-row lesions were made at 1-mm interval between the level of the obex and the C2 dorsal nerve roots, using angled radiofrequency electrodes, brought to 80°C for 15 seconds each, along a path 1 to 1.2 mm posterior to the accessory nerve rootlets. The headache improved, but gradually returned. Five years later, her headaches were severe on over 24 days per month. The DREZ surgery was then repeated. Her headaches improved and the relief has continued for 5 additional years. She has remained functional, with no limitation in instrumental activities of daily living. Conclusions: The nucleus caudalis DREZ surgery brought long-term relief to a patient suffering from chronic traumatic headache. PMID:22059123

Correction of facial and mandibular asymmetry using a computer aided design/computer aided manufacturing prefabricated titanium implant.

PubMed

Watson, Jason; Hatamleh, Muhanad; Alwahadni, Ahed; Srinivasan, Dilip

2014-05-01

Patients with significant craniofacial asymmetry may have functional problems associated with their occlusion and aesthetic concerns related to the imbalance in soft and hard tissue profiles. This report details a case of facial asymmetry secondary to left mandible angle deficiency due to undergoing previous radiotherapy. We describe the correction of the bony deformity using computer aided design/computer aided manufacturing custom-made titanium onlay using novel direct metal laser sintering. The direct metal laser sintering onlay proved a very accurate operative fit and showed a good aesthetic correction of the bony defect with no reported complications postoperatively. It is a useful low-morbidity technique, and there is no resorption or associated donor-site complications.

Creation of a 3-dimensional virtual dental patient for computer-guided surgery and CAD-CAM interim complete removable and fixed dental prostheses: A clinical report.

PubMed

Harris, Bryan T; Montero, Daniel; Grant, Gerald T; Morton, Dean; Llop, Daniel R; Lin, Wei-Shao

2017-02-01

This clinical report proposes a digital workflow using 2-dimensional (2D) digital photographs, a 3D extraoral facial scan, and cone beam computed tomography (CBCT) volumetric data to create a 3D virtual patient with craniofacial hard tissue, remaining dentition (including surrounding intraoral soft tissue), and the realistic appearance of facial soft tissue at an exaggerated smile under static conditions. The 3D virtual patient was used to assist the virtual diagnostic tooth arrangement process, providing patient with a pleasing preoperative virtual smile design that harmonized with facial features. The 3D virtual patient was also used to gain patient's pretreatment approval (as a communication tool), design a prosthetically driven surgical plan for computer-guided implant surgery, and fabricate the computer-aided design and computer-aided manufacturing (CAD-CAM) interim prostheses. Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

Effects of dexmedetomidine on H-FABP, CK-MB, cTnI levels, neurological function and near-term prognosis in patients undergoing heart valve replacement.

PubMed

Wang, Zhi; Chen, Qiang; Guo, Hao; Li, Zhishan; Zhang, Jinfeng; Lv, Lei; Guo, Yongqing

2017-12-01

This study investigated the effects of dexmedetomidine on heart-type fatty acid binding protein (H-FABP), creatine kinase isoenzymes (CK-MB), and troponin I (cTnI) levels, neurological function and near-term prognosis in patients undergoing heart valve replacement. Patients undergoing heart valve replacement were randomly allocated to remifentanil anesthesia (control group, n=48) or dexmedetomidine anesthesia (observation group, n=48). Hemodynamic parameters were measured before anesthesia induction (T1), 1 min after intubation (T2), 10 min after start of surgery (T3), and on completion of surgery (T4). Levels of plasma H-FABP, CK-MB and cTnI were measured 10 min before anesthesia induction (C1), 10 min after start of surgery (C2), on completion of surgery (C3), 6 h after surgery (C4), and 24 h after surgery (C5). S100β protein and serum neuron-specific enolase (NSE) were detected 10 min before anesthesia induction (C1), and 24 h after surgery (C5). Neurological and cardiac function was evaluated 24 h after surgery. Incidence of cardiovascular adverse events was recorded for 1 year of follow-up. There were no significant differences in the average heart rate between the two groups during the perioperative period. The mean arterial pressure in the observation group was significantly lower than control group (P<0.05). Levels of H-FABP, CK-MB and cTnI at C2, C3, C4 and C5, were significantly higher than C1, but significantly lower in the observation versus control group (P<0.05). Twenty-four hours after surgery, levels of S100β and NSE in both groups were higher than those before induction (P<0.05), but significantly lower in the observation versus control group (P<0.05). Twenty-four hours after surgery, neurological function scores were better, and myocardial contractility and arrhythmia scores significantly lower in the observation versus control group (P<0.05 for all). After follow-up for 1 year, incidence of cardiovascular adverse events was significantly lower in the observation versus control group (P<0.05). Dexmedetomidine anesthesia can effectively maintain hemodynamic stability, reduce myocardial injury and the occurrence of cognitive dysfunction, and improve prognosis in patients undergoing heart valve replacement.

75 FR 13561 - National Institute of Dental & Craniofacial Research; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-22

... & Craniofacial Research; Notice of Meeting Pursuant to section 10(d) of the Federal Advisory Committee Act, as... Craniofacial Research Council. The meeting will be open to the public as indicated below, with attendance... set forth in sections 552b(c)(4) and 552b(c)(6), Title 5 U.S.C., as amended. The grant applications...

78 FR 50066 - National Institute of Dental and Craniofacial Research; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-16

... and Craniofacial Research; Notice of Meeting Pursuant to section 10(d) of the Federal Advisory... National Advisory Dental and Craniofacial Research Council. The meeting will be open to the public as... accordance with the provisions set forth in sections 552b(c)(4) and 552b(c)(6), Title 5 U.S.C., as amended...

Significant factors associated with fatal outcome in emergency open surgery for perforated peptic ulcer.

PubMed

Testini, Mario; Portincasa, Piero; Piccinni, Giuseppe; Lissidini, Germana; Pellegrini, Fabio; Greco, Luigi

2003-10-01

To evaluate the main factors associated with mortality in patients undergoing surgery for perforated peptic ulcer referred to an academic department of general surgery in a large southern Italian city. One hundred and forty-nine consecutive patients (M:F ratio=110:39, mean age 52 yrs, range 16-95) with peptic ulcer disease were investigated for clinical history (including age, sex, previous history of peptic ulcer, associated diseases, delayed abdominal surgery, ulcer site, operation type, shock on admission, postoperative general complications, and intra-abdominal and/or wound infections), serum analyses and radiological findings. The overall mortality rate was 4.0%. Among all factors, an age above 65 years, one or more associated diseases, delayed abdominal surgery, shock on admission, postoperative abdominal complications and/or wound infections, were significantly associated (chi2) with increased mortality in patients undergoing surgery (0.0001

Anxiety Among Patients Undergoing Nail Surgery and Skin Punch Biopsy: Effects of Age, Gender, Educational Status, and Previous Experience.

PubMed

Göktay, Fatih; Altan, Zeynep Müzeyyen; Talas, Anıl; Akpınar, Esma; Özdemir, Ekin Özge; Aytekin, Sema

2016-01-01

Patient anxiety about nail surgery relates mainly to pain associated with needle puncture, anesthetic flow during the procedure, and postoperative care, as well as possible past traumatic experience. The aims of this study were to compare anxiety levels among patients undergoing nail surgery and skin punch biopsy and to assess the effects of demographic characteristics on anxiety. Forty-eight consecutive patients who were referred to a dermatological surgery unit for nail surgery intervention (group 1) and 50 age- and sex-matched patients referred to the same unit for skin punch biopsy (group 2) were enrolled in the study. Patients' anxiety levels were measured using Spielberger's State-Trait Anxiety Inventory. There was no significant difference in median anxiety level between group 1 (42.00; interquartile range, 6.50) and group 2 (41.00; interquartile range, 8.25) (P = .517). The demographic factors of patient sex, educational status, and prior surgery showed no significant effects on anxiety levels. Nail surgery does not seem to cause significantly greater anxiety than skin punch biopsy. © The Author(s) 2015.

Topical versus peribulbar anaesthesia for cataract surgery.

PubMed

Sauder, Gangolf; Jonas, Jost B

2003-12-01

To assess and compare the efficacy and safety of topical versus peribulbar anaesthesia in patients undergoing routine cataract surgery. The unicentre, prospective, randomized, clinical interventional trial included 140 consecutive patients undergoing routine cataract surgery performed by one of two surgeons. The patients were randomly distributed to either peribulbar anaesthesia or topical anaesthesia. To assess intraoperative pain, each patient was asked immediately after surgery to quantitate his/her pain using a 10-point pain rating scale. The study groups did not differ significantly in pain score (p=0.54), duration of surgery (p=0.52), anaesthesia-related intraoperative difficulties (p=0.17), postoperative visual acuity (p=0.94), overall intraoperative surgical complication rate, blood pressure rise (p=0.16) or blood oxygen saturation (p=0.74) Patient comfort and surgery-related complications did not differ between topical anaesthesia and peribulbar anaesthesia. As there are no significant differences between the two techniques in terms of subjective pain experienced by patients, intraoperative complications and postoperative visual outcome, and in view of the minimally invasive character of topical anaesthesia compared to peribulbar anaesthesia, the present study suggests the use of topical anaesthesia for routine cataract surgery.

Msx homeobox gene family and craniofacial development.

PubMed

Alappat, Sylvia; Zhang, Zun Yi; Chen, Yi Ping

2003-12-01

Vertebrate Msx genes are unlinked, homeobox-containing genes that bear homology to the Drosophila muscle segment homeobox gene. These genes are expressed at multiple sites of tissue-tissue interactions during vertebrate embryonic development. Inductive interactions mediated by the Msx genes are essential for normal craniofacial, limb and ectodermal organ morphogenesis, and are also essential to survival in mice, as manifested by the phenotypic abnormalities shown in knockout mice and in humans. This review summarizes studies on the expression, regulation, and functional analysis of Msx genes that bear relevance to craniofacial development in humans and mice. Key words: Msx genes, craniofacial, tooth, cleft palate, suture, development, transcription factor, signaling molecule.

Customized Polymethyl Methacrylate Implants for the Reconstruction of Craniofacial Osseous Defects

PubMed Central

Fernandes da Silva, André Luis; Borba, Alexandre Meireles; Simão, Niverso Rodrigues; Pedro, Fábio Luis Miranda

2014-01-01

Craniofacial defects represent alterations in the anatomy and morphology of the cranial vault and the facial bones that potentially affect an individual's psychological and social well-being. Although a variety of techniques and restorative procedures have been described for the reconstruction of the affected area, polymethyl methacrylate (PMMA), a biocompatible and nondegradable acrylic resin-based implant, is the most widely used alloplastic material for such craniomaxillofacial reconstruction. The aim of this study was to describe a technique for aesthetic and functional preoperative customized reconstruction of craniofacial bone defects from a small series of patients offered by the Brazilian public health system. Three adult male patients attended consultation with chief complaints directly related to their individual craniofacial bone defects. With the aid of multislice computed tomography scans and subsequent fabrication of the three-dimensional craniofacial prototype, custom-made PMMA implants were fabricated preoperatively. Under general anesthesia, with access to the craniofacial defects with a coronal approach, the PMMA implants were adapted and fixated to the facial skeleton with titanium plates and screws. Postoperative evaluation demonstrated uneventful recovery and an excellent aesthetic result. Customized prefabricated PMMA implants manufactured over the rapid prototyping models proved to be effective and feasible. PMID:25093139

Customized polymethyl methacrylate implants for the reconstruction of craniofacial osseous defects.

PubMed

Fernandes da Silva, André Luis; Borba, Alexandre Meireles; Simão, Niverso Rodrigues; Pedro, Fábio Luis Miranda; Borges, Alvaro Henrique; Miloro, Michael

2014-01-01

Craniofacial defects represent alterations in the anatomy and morphology of the cranial vault and the facial bones that potentially affect an individual's psychological and social well-being. Although a variety of techniques and restorative procedures have been described for the reconstruction of the affected area, polymethyl methacrylate (PMMA), a biocompatible and nondegradable acrylic resin-based implant, is the most widely used alloplastic material for such craniomaxillofacial reconstruction. The aim of this study was to describe a technique for aesthetic and functional preoperative customized reconstruction of craniofacial bone defects from a small series of patients offered by the Brazilian public health system. Three adult male patients attended consultation with chief complaints directly related to their individual craniofacial bone defects. With the aid of multislice computed tomography scans and subsequent fabrication of the three-dimensional craniofacial prototype, custom-made PMMA implants were fabricated preoperatively. Under general anesthesia, with access to the craniofacial defects with a coronal approach, the PMMA implants were adapted and fixated to the facial skeleton with titanium plates and screws. Postoperative evaluation demonstrated uneventful recovery and an excellent aesthetic result. Customized prefabricated PMMA implants manufactured over the rapid prototyping models proved to be effective and feasible.

Concurrent cervical and craniofacial pain. A review of empiric and basic science evidence.

PubMed

Browne, P A; Clark, G T; Kuboki, T; Adachi, N Y

1998-12-01

Because many patients present themselves for treatment with both craniofacial and craniocervical pain, 2 questions arise: (1) What are the sensory and motor consequences of dysfunction in either of these areas on the other? (2) Do craniofacial and craniocervical pain have a similar cause? These questions formed the impetus for this review article. The phenomenon of concurrent pain in craniofacial and cervical structures is considered, and clinical reports and opinions are presented regarding theories of cervical-to-craniofacial and craniofacial-to-cervical pain referral. Because pain referral between these 2 areas requires anatomic and functional connectivity between trigeminally and cervically innervated structures, basic neurophysiologic and neuroanatomic literature is reviewed. The published data clearly demonstrate neurophysiologic and structural convergence of cervical sensory and muscle afferent inputs onto trigeminal subnucleus caudalis nociceptive and non-nociceptive neurons. Moreover, changes in metabolic activity and blood flow in the brainstem and cervical dorsal horn of the spinal cord in both monkeys and cats have been demonstrated after electric stimulation of the V1-innervated superior sagittal sinus. In conclusion, the animal experimental data support the findings of human empiric and experimental studies, which suggest that strong connectivity exists between trigeminal and cervical motor and sensory responses.

Determinants of demand for total hip and knee arthroplasty: a systematic literature review

PubMed Central

2012-01-01

Background Documented age, gender, race and socio-economic disparities in total joint arthroplasty (TJA), suggest that those who need the surgery may not receive it, and present a challenge to explain the causes of unmet need. It is not clear whether doctors limit treatment opportunities to patients, nor is it known the effect that patient beliefs and expectations about the operation, including their paid work status and retirement plans, have on the decision to undergo TJA. Identifying socio-economic and other determinants of demand would inform the design of effective and efficient health policy. This review was conducted to identify the factors that lead patients in need to undergo TJA. Methods An electronic search of the Embase and Medline (Ovid) bibliographic databases conducted in September 2011 identified studies in the English language that reported on factors driving patients in need of hip or knee replacement to undergo surgery. The review included reports of elective surgery rates in eligible patients or, controlling for disease severity, in general subjects, and stated clinical experts’ and patients’ opinions on suitability for or willingness to undergo TJA. Quantitative and qualitative studies were reviewed, but quantitative studies involving fewer than 20 subjects were excluded. The quality of individual studies was assessed on the basis of study design (i.e., prospective versus retrospective), reporting of attrition, adjustment for and report of confounding effects, and reported measures of need (self-reported versus doctor-assessed). Reported estimates of effect on the probability of surgery from analyses adjusting for confounders were summarised in narrative form and synthesised in odds ratio (OR) forest plots for individual determinants. Results The review included 26 quantitative studies−23 on individuals’ decisions or views on having the operation and three about health professionals’ opinions-and 10 qualitative studies. Ethnic and racial disparities in TJA use are associated with socio-economic access factors and expectations about the process and outcomes of surgery. In the United States, health insurance coverage affects demand, including that from the Medicare population, for whom having supplemental Medicaid coverage increases the likelihood of undergoing TJA. Patients with post-secondary education are more likely to demand hip or knee surgery than those without it (range of OR 0.87-2.38). Women are as willing to undergo surgery as men, but they are less likely to be offered surgery by specialists than men with the same need. There is considerable variation in patient demand with age, with distinct patterns for hip and knee. Paid employment appears to increase the chances of undergoing surgery, but no study was found that investigated the relationship between retirement plans and demand for TJA. There is evidence of substantial geographical variation in access to joint replacement within the territory covered by a public national health system, which is unlikely to be explained by differences in preference or unmeasured need alone. The literature tends to focus on associations, rather than testing of causal relationships, and is insufficient to assess the relative importance of determinants. Conclusions Patients’ use of hip and knee replacement is a function of their socio-economic circumstances, which reinforce disparities by gender and race originating in the doctor-patient interaction. Willingness to undergo surgery declines steeply after the age of retirement, at the time some eligible patients may lower their expectations of health status achievement. There is some evidence that paid employment independently increases the likelihood of operation. The relative contribution of variations in surgical decision making to differential access across regions within countries deserves further research that controls for clinical need and patient lifestyle preferences, including retirement decisions. Evidence on this question will become increasingly relevant for service planning and policy design in societies with ageing populations. PMID:22846144

National survey of the current management of endometriomas in women undergoing assisted reproductive treatment.

PubMed

Raffi, F; Shaw, R W; Amer, S A

2012-09-01

What is the current management of women with ovarian endometriomas undergoing assisted reproductive treatment (ART) in the UK? It appears that the majority of gynaecologists in the UK offer surgery (mostly cystectomy) for endometriomas prior to ART, regardless of the presence of symptoms. The ideal management of endometriomas in women undergoing ART remains controversial and presents a dilemma to reproductive specialists. This was a national cross-sectional survey. A total of 388 gynaecologists completed the questionnaire. All clinicians fully registered with the Royal College of Obstetricians and Gynaecologists were contacted. An 11-item survey was administered electronically using Survey Monkey software. Quantitative data were analysed using descriptive and comparative statistics. The majority of responders were consultants (65%), 25% practiced ART and 65% performed laparoscopic surgery. Overall, 95% of responders would offer surgery for endometriomas in women undergoing ART, either on the basis of the size (>3-5 cm) of the endometrioma (52%), the presence of symptoms (16%), the presence of multiple/bilateral endometriomas (2%), regardless of the size and symptoms (19%) or only to women undergoing IVF (6%). The remaining 5% of responders would not offer surgery before ART. Excision was the most common surgical modality (68%), followed by ablation (25%). Laparoscopic surgeons were almost twice as likely to 'offer surgery to all patients with endometriomas prior to ART' compared with clinicians performing laparotomy (22 versus 12%, P < 0.001). Our overall response rate, with answers to the questionnaire, was low (15%). However, the response rate amongst reproductive specialists was estimated at 60%. It is possible that there might have been an element of bias towards over-representation of responders who are more concerned about 'normalization' of the pelvic anatomy. Furthermore, our survey relied on self-reporting of practice and it is possible that being presented with a list of 'ideal' options may have resulted in respondent bias. Despite the available evidence that surgery for endometriomas does not improve the outcome of ART and may damage ovarian reserve, it seems that the majority of gynaecologists in the UK offer ovarian cystectomy to their patients.

[Biomaterials in bone repair].

PubMed

Puska, Mervi; Aho, Allan J; Vallittu, Pekka K

2013-01-01

In orthopedics, traumatology, and craniofacial surgery, biomaterials should meet the clinical demands of bone that include shape, size and anatomical location of the defect, as well as the physiological load-bearing stresses. Biomaterials are metals, ceramics, plastics or materials of biological origin. In the treatment of large defects, metallic endoprostheses or bone grafts are employed, whereas ceramics in the case of small defects. Plastics are employed on the artificial joint surfaces, in the treatment of vertebral compression fractures, and as biodegradable screws and plates. Porosity, bioactivity, and identical biomechanics to bone are fundamental for achieving a durable, well-bonded, interface between biomaterial and bone. In the case of severe bone treatments, biomaterials should also imply an option to add biologically active substances.

Fractures of the growing mandible.

PubMed

Kushner, George M; Tiwana, Paul S

2009-03-01

Oral and maxillofacial surgeons must constantly weigh the risks of surgical intervention for pediatric mandible fractures against the wonderful healing capacity of children. The majority of pediatric mandibular fractures can be managed with closed techniques using short periods of maxillomandibular fixation or training elastics alone. Generally, the use of plate- and screw-type internal fixation is reserved for difficult fractures. This article details general and special considerations for this surgery including: craniofacial growth & development, surgical anatomy, epidemiology evaluation, various fractures, the role rigid internal fixation and the Risdon cable in pediatric maxillofacial trauma. It concludes with suggestions concerning long-term follow-up care in light of the mobility, insurance obstacles, and family dynamics facing the patient population.

Craniofacial morphology and dental maturity in children with reduced somatic growth of different aetiology and the effect of growth hormone treatment.

PubMed

Davidopoulou, Sotiria; Chatzigianni, Athina

2017-12-01

Children with reduced somatic growth may present various endocrinal diseases, especially growth hormone deficiency (GHD), idiopathic short stature (ISS), chromosomal aberrations, or genetic disorders. In an attempt to normalize the short stature, growth hormone (GH) is administered to these children. The aim of this literature review was to collect information about the craniofacial morphology and dental maturity in these children and to present the existing knowledge on the effect of GH treatment on the above structures.This review demonstrated that regardless of the origin of the somatic growth retardation, these children show similar craniofacial features, such as short length of the cranial base and the mandible, increased lower facial height, retropositioned mandible, and obtuse gonion angle. On the other hand, dental maturation does not demonstrate a specific pattern. Except for the above findings, muscle alterations seem to be present in individuals with short stature, who present low body muscle mass and strength, while studies on their craniofacial muscles seem to be lacking. After GH administration, the exact amount and pattern of craniofacial growth is unpredictable; however, the facial convexity decreases, mandibular length increases, and posterior facial height increases, while tooth eruption remains unaffected. Thus, it is of great importance to gain more insight into the craniofacial growth of treated and untreated children with reduced somatic growth so that the influence of GH therapy on the various craniofacial structures could be ascertained and proper orthodontic treatment could be selected.

Outcomes of robotic versus laparoscopic surgery for mid and low rectal cancer after neoadjuvant chemoradiation therapy and the effect of learning curve

PubMed Central

Huang, Yu-Min; Huang, Yan Jiun; Wei, Po-Li

2017-01-01

Abstract Randomized controlled trials have demonstrated that laparoscopic surgery for rectal cancer is safe and can accelerate recovery without compromising oncological outcomes. However, such a surgery is technically demanding, limiting its application in nonspecialized centers. The operational features of a robotic system may facilitate overcoming this limitation. Studies have reported the potential advantages of robotic surgery. However, only a few of them have featured the application of this surgery in patients with advanced rectal cancer undergoing neoadjuvant chemoradiation therapy (nCRT). From January 2012 to April 2015, after undergoing nCRT, 40 patients with mid or low rectal cancer were operated using the robotic approach at our institution. Another 38 patients who were operated using the conventional laparoscopic approach were matched to patients in the robotic group by sex, age, the body mass index, and procedure. All operations were performed by a single surgical team. The clinicopathological characteristics and short-term outcomes of these patients were compared. To assess the effect of the learning curve on the outcomes, patients in the robotic group were further subdivided into 2 groups according to the sequential order of their procedures, with an equal number of patients in each group. Their outcome measures were compared. The robotic and laparoscopic groups were comparable with regard to pretreatment characteristics, rectal resection type, and pathological examination result. After undergoing nCRT, more patients in the robotic group exhibited clinically advanced diseases. The complication rate was similar between the 2 groups. The operation time and the time to the resumption of a soft diet were significantly prolonged in the robotic group. Further analysis revealed that the difference was mainly observed in the first robotic group. No significant difference was observed between the second robotic and laparoscopic groups. Although the robotic approach may offer potential advantages for rectal surgery, comparable short-term outcomes may be achieved when laparoscopic surgery is performed by experienced surgeons. However, our results suggested a shorter learning curve for robotic surgery for rectal cancer, even in patients who exhibited more advanced disease after undergoing nCRT. PMID:28984767

Association of ethnicity and acute kidney injury after cardiac surgery in a South East Asian population.

PubMed

Chew, S T H; Mar, W M T; Ti, L K

2013-03-01

Postoperative acute kidney injury (AKI) is a frequent and serious complication after cardiac surgery. Clinical factors alone have failed to accurately predict the incidence of AKI after cardiac surgery. Ethnicity has been shown to be a predictor of AKI in the Western population. We tested the hypothesis that ethnicity is an independent predictor of AKI in patients undergoing cardiac surgery in a South East Asian population. A total of 1756 consecutive patients undergoing cardiac surgery were prospectively recruited. Among them, data of 1639 patients met the criteria for analysis. There were 1182 Chinese, 195 Indian, and 262 Malay patients. The main outcome was postoperative AKI, defined as a 25% or greater increase in preoperative to a maximum postoperative serum creatinine level within 3 days after surgery. Five hundred and seventy-nine patients (35.3%) developed AKI after cardiac surgery. Ethnicity was shown to be an independent predictor of AKI after cardiac surgery with Indians and Malays having a higher risk of developing AKI when compared with Chinese patients (odds ratio: Indian vs Chinese 1.44, Malay vs Chinese 1.51). Indians and Malays have a higher risk of developing AKI after cardiac surgery than Chinese in a South East Asian population. Ethnicity was shown to be an independent predictor of AKI after cardiac surgery.

Geriatric comanagement reduces perioperative complications and shortens duration of hospital stay after lumbar spine surgery: a prospective single-institution experience.

PubMed

Adogwa, Owoicho; Elsamadicy, Aladine A; Vuong, Victoria D; Moreno, Jessica; Cheng, Joseph; Karikari, Isaac O; Bagley, Carlos A

2017-12-01

OBJECTIVE Geriatric patients undergoing lumbar spine surgery have unique needs due to the physiological changes of aging. They are at risk for adverse outcomes such as delirium, infection, and iatrogenic complications, and these complications, in turn, contribute to the risk of functional decline, nursing home admission, and death. Whether preoperative and perioperative comanagement by a geriatrician reduces the incidence of in-hospital complications and length of in-hospital stay after elective lumbar spine surgery remains unknown. METHODS A unique model of comanagement for elderly patients undergoing lumbar fusion surgery was implemented at a major academic medical center. The Perioperative Optimization of Senior Health (POSH) program was launched with the aim of improving outcomes in elderly patients (> 65 years old) undergoing complex lumbar spine surgery. In this model, a geriatrician evaluates elderly patients preoperatively, in addition to performing routine preoperative anesthesia surgical screening, and comanages them daily throughout the course of their hospital stay to manage medical comorbid conditions and coordinate multidisciplinary rehabilitation along with the neurosurgical team. The first 100 cases were retrospectively reviewed after initiation of the POSH protocol and compared with the immediately preceding 25 cases to assess the incidence of perioperative complications and clinical outcomes. RESULTS One hundred twenty-five patients undergoing lumbar decompression and fusion were enrolled in this pilot program. Baseline characteristics were similar between both cohorts. The mean length of in-hospital stay was 30% shorter in the POSH cohort (6.13 vs 8.72 days; p = 0.06). The mean duration of time between surgery and patient mobilization was significantly shorter in the POSH cohort compared with the non-POSH cohort (1.57 days vs 2.77 days; p = 0.02), and the number of steps ambulated on day of discharge was 2-fold higher in the POSH cohort (p = 0.04). Compared with the non-POSH cohort, the majority of patients in the POSH cohort were discharged to home (24% vs 54%; p = 0.01). CONCLUSIONS Geriatric comanagement reduces the incidence of postoperative complications, shortens the duration of in-hospital stay, and contributes to improved perioperative functional status in elderly patients undergoing elective spinal surgery for the correction of adult degenerative scoliosis.

Older Age Confers a Higher Risk of 30-Day Morbidity and Mortality Following Laparoscopic Bariatric Surgery: an Analysis of the Metabolic and Bariatric Surgery Quality Improvement Program.

PubMed

Haskins, Ivy N; Ju, Tammy; Whitlock, Ashlyn E; Rivas, Lisbi; Amdur, Richard L; Lin, Paul P; Vaziri, Khashayar

2018-04-17

There is a paucity of literature describing the association of age with the risk of adverse events following bariatric surgery. The purpose of this study is to investigate the association of age with 30-day morbidity and mortality following laparoscopic bariatric surgery using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. All adult patients undergoing laparoscopic Roux-en-Y gastric bypass (RNGYB) or sleeve gastrectomy (SG) were identified within the MBSAQIP database. Patients were divided into five equal age quintiles. Binary outcomes of interest, including cardiac, pulmonary, wound, septic, clotting, and renal events, in addition to the incidence of related 30-day unplanned reintervention, related 30-day mortality, and a composite morbidity and mortality outcome were compared across the age quintiles and procedures. A total of 266,544 patients met inclusion criteria. Older age was associated with an increased risk of all morbidity outcomes except venous thromboembolism events, 30-day mortality, and the composite morbidity and mortality outcome. Patients who underwent Roux-en-Y gastric bypass had worse outcomes per quintile for almost every outcome of interest when compared to patients who underwent sleeve gastrectomy. Older patients and patients who undergo Roux-en-Y gastric bypass are at an increased risk of perioperative morbidity and mortality following laparoscopic bariatric surgery. Additional studies are needed to determine the association of age with long-term weight loss and cardiometabolic comorbidity resolution following bariatric surgery in order to determine if the increased perioperative risk is offset by improved long-term outcomes in older patients undergoing bariatric surgery.

Independent Association Between Preoperative Cognitive Status and Discharge Location After Surgery: A Strategy to Reduce Resource Use After Surgery for Deformity.

PubMed

Adogwa, Owoicho; Elsamadicy, Aladine A; Sergesketter, Amanda; Vuong, Victoria D; Moreno, Jessica; Cheng, Joseph; Karikari, Isaac O; Bagley, Carlos A

2018-02-01

The aim of this study is to determine whether preoperative scores on a screening measure for cognitive status (the Saint Louis University mental status examination), were associated with discharge to a location other than home in older patients undergoing surgery for deformity. Older patients (≥65 years) undergoing a planned elective spinal surgery for correction of adult degenerative scoliosis were enrolled in this study. Preoperative baseline cognition was assessed using the validated Saint Louis University mental status (SLUMS) test. SLUMS is 11 questions with a maximum of 30 points. Mild cognitive impairment was defined as a SLUMS score of 21-26 points, and severe cognitive impairment as a SLUMS score of 20 points or greater. Normal cognition was defined as a SLUMS score of 27 points or more. Postoperative length of stay and discharge location were recorded on all patients. Eighty-two subjects were included, with mean ± standard deviation age of 73.26 ± 6.08 years; 51% of patients were discharged to a facility (skilled nursing or acute rehabilitation). After adjustment for demographic variables, comorbidities, and baseline cognitive impairment, patients with preoperative cognitive impairment were 4-fold more likely to be discharged to a facility (skilled nursing or acute rehabilitation) compared with patients with normal cognitive status (odds ratio [OR], 3.93). In addition, patients who were not ambulatory before surgery were also more likely to be discharged to a facility (OR, 7.14). In geriatric patients undergoing surgery for deformity correction, cognitive screening before surgery can identify patients with impaired cognitive status who are less likely than those with normal cognitive status to return home after surgery. Copyright © 2017 Elsevier Inc. All rights reserved.

Immediate Single-Stage Reconstruction of Complex Frontofaciobasal Injuries: Part I

PubMed Central

Awadalla, Akram Mohamed; Ezzeddine, Hichem; Fawzy, Naglaaa; Saeed, Mohammad Al; Ahmad, Mohammad R.

2014-01-01

Objective To determine if immediate (within 6 hours of adequate resuscitation) single-stage repair of complex craniofacial injuries could be accomplished with acceptable morbidity and mortality taking into consideration the cosmetic appearance of the patient. Patients and Methods A total of 26 patients (19 men, 7 women) ranging in age from 8 to 58 years with Glasgow Coma Scale scores of 5 to 15 all had a combined single-stage repair of their complex craniofacial injuries within 6 hours of their admission. After initial assessment and adequate resuscitation, they were evaluated with three-dimensional computed tomography of the face and head. Coronal skin flap was used for maximum exposure for frontal sinus exenteration as well as dural repair, cortical debridement, calvarial reconstruction, and titanium mesh placement. Results Neurosurgical outcome at both the early and late evaluations was judged as good in 22 of 26 patients (85%), moderate in 3 of 26 (11%), and poor in 1 of the 26 (3.8%). Cosmetic surgical outcome at the early evaluation showed 17 of 26 (65%) to be excellent, 4 of 26 (15.5%) to be good, 4 patients (15.5%) to be fair, and 1 patient (3.8%) to be poor. At the late reevaluation, the fair had improved to good with an additional reconstructive procedure, and the poor had improved to fair with another surgery. There was no calvarial osteomyelitis, graft resorption, or intracranial abscess. Complications included three patients (11%): one (3.8%) had tension pneumocephaly and meningitis, one (3.8%) had delayed cerebrospinal fluid leak with recurrent attacks of meningitis, and one had a maxillary sinus infection (3.8%) secondary to front maxillary fistula. Conclusion The immediate single-stage repair of complex craniofacial injuries can be performed with acceptable results, a decreased need for reoperation, and improved cosmetic and functional outcomes. PMID:25844296

Patient-reported symptoms and changes up to 1 year after meniscal surgery.

PubMed

Skou, Søren T; Pihl, Kenneth; Nissen, Nis; Jørgensen, Uffe; Thorlund, Jonas Bloch

2018-06-01

Background and purpose - Detailed information on the symptoms and limitations that patients with meniscal tears experience is lacking. This study was undertaken to map the most prevalent self-reported symptoms and functional limitations among patients undergoing arthroscopic meniscal surgery and investigate which symptoms and limitations had improved most at 1 year after surgery. Patients and methods - Patients aged 18-76 years from the Knee Arthroscopy Cohort Southern Denmark (KACS) undergoing arthroscopic meniscal surgery were included in this analysis of individual subscale items from the Knee Injury and Osteoarthritis Outcome Score and 1 question on knee stability. Severity of each item was scored as none, mild, moderate, severe, or extreme. Improvements were evaluated using Wilcoxon's signed-rank test and effect size (ES). Results - The most common symptoms were knee grinding and clicking, knee pain in general, pain when twisting and bending the knee and climbing stairs (88-98%), while the most common functional limitations were difficulty bending to the floor, squatting, twisting, kneeling, and knee awareness (97-99%). Knee pain in general and knee awareness improved most 1 year after meniscal surgery (ES -0.47 and -0.45; p < 0.001), while knee instability and general knee difficulties improved least (ES 0.10 and -0.08; p < 0.006). Interpretation - Adults undergoing surgery for a meniscal tear commonly report clinical symptoms and functional limitations related to their daily activities. Moderate improvements were observed in some symptoms and functional limitations and small to no improvement in others at 1 year after surgery. These findings can assist the clinical discussion of symptoms, treatments, and patients' expectations.

Investigation of the immediate pre-operative physical capacity of patients scheduled for elective abdominal surgery using the 6-minute walk test.

PubMed

Soares, S M T P; Jannuzzi, H P C; Kassab, M F O; Nucci, L B; Paschoal, M A

2015-09-01

To evaluate the effects of repetition of the 6-minute walk test in patients scheduled to undergo abdominal surgery within the next 48 hours, and to verify the physical capacity of these subjects before surgery. Cross-sectional study. University teaching hospital. Forty-two patients scheduled for elective abdominal surgery within the next 48 hours. Distance walked in the 6-minute walk test, heart rate, peripheral oxygen saturation, dyspnoea and leg fatigue. Thirty-one patients (74%) were able to walk for a longer distance when the test was repeated. In these subjects, the mean increase in distance walked was 35.4 [standard deviation (SD) 19.9]m. Heart rate, dyspnoea and leg fatigue increased significantly over time on both tests (P<0.05). The mean heart rate at the end of the sixth minute was significantly higher on the second test (P=0.022). Peripheral oxygen saturation remained above 90% in both tests. The furthest distance walked was, on average, 461.3 (SD 89.7)m. This value was significantly lower than that predicted for the sample (P<0.001). Patients scheduled to undergo abdominal surgery were able to walk further when they performed a second 6-minute walk test. Moreover, they showed reduced physical ability before surgery. These findings suggest that repetition of the 6-minute walk test may increase the accuracy of the distance walked, which is useful for studies assessing the physical capacity of patients undergoing abdominal surgery. Copyright © 2014 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Effects of preemptive analgesia with flurbiprofen ester on lymphocytes and natural killer cells in patients undergoing esophagectomy: A randomized controlled pilot study

PubMed Central

Zhou, Yi; Huang, Jinxi; Bai, Yu; Li, Changsheng

2017-01-01

Background Tumors may induce systemic immune dysfunction, which can be aggravated by surgery and anesthesia/analgesia. Data on the effect of flurbiprofen preemptive analgesia on immune dysfunction is limited. The aim of this study was to investigate the effect of flurbiprofen preemptive analgesia on lymphocytes and natural killer (NK) cells in patients undergoing thoracotomy and thoracoscopy radical esophagectomy, and to explore the analgesic methods suitable for tumor patients. Methods This was a randomized controlled pilot study of 89 patients with esophageal cancer treated with surgery at the Henan Cancer Hospital between January 1, 2015 and December 31, 2016. The patients were divided into three groups: group 1, thoracotomy; group 2, thoracoscopy and laparoscopic surgery; and group 3, flurbiprofen, thoracoscopy, and laparoscopic surgery. CD3+, CD19+, NK, CD4+, and CD8+ cells in whole blood were measured by flow cytometry 30 minutes before surgery (T0), at the end of the thoracic section of the procedure (T1), and at the end of the operation (T2). Results There were no significant differences in CD3+, CD19+, CD8+, NK, and CD4+ cells between the three groups or regarding the time points during the procedure (all P > 0.05). Thoracotomy and thoracoscopy surgery resulted in similar immunological outcomes. Conclusion Flurbiprofen ester preemptive analgesia did not suppress the immune function in patients and could be a safe analgesic method for patients with esophageal cancer undergoing surgery. PMID:28892265

Effects of preemptive analgesia with flurbiprofen ester on lymphocytes and natural killer cells in patients undergoing esophagectomy: A randomized controlled pilot study.

PubMed

Zhou, Yi; Huang, Jinxi; Bai, Yu; Li, Changsheng; Lu, Xihua

2017-11-01

Tumors may induce systemic immune dysfunction, which can be aggravated by surgery and anesthesia/analgesia. Data on the effect of flurbiprofen preemptive analgesia on immune dysfunction is limited. The aim of this study was to investigate the effect of flurbiprofen preemptive analgesia on lymphocytes and natural killer (NK) cells in patients undergoing thoracotomy and thoracoscopy radical esophagectomy, and to explore the analgesic methods suitable for tumor patients. This was a randomized controlled pilot study of 89 patients with esophageal cancer treated with surgery at the Henan Cancer Hospital between January 1, 2015 and December 31, 2016. The patients were divided into three groups: group 1, thoracotomy; group 2, thoracoscopy and laparoscopic surgery; and group 3, flurbiprofen, thoracoscopy, and laparoscopic surgery. CD3+, CD19+, NK, CD4+, and CD8+ cells in whole blood were measured by flow cytometry 30 minutes before surgery (T0), at the end of the thoracic section of the procedure (T1), and at the end of the operation (T2). There were no significant differences in CD3+, CD19+, CD8+, NK, and CD4+ cells between the three groups or regarding the time points during the procedure (all P > 0.05). Thoracotomy and thoracoscopy surgery resulted in similar immunological outcomes. Flurbiprofen ester preemptive analgesia did not suppress the immune function in patients and could be a safe analgesic method for patients with esophageal cancer undergoing surgery. © 2017 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.

Memory Functions following Surgery for Temporal Lobe Epilepsy in Children

ERIC Educational Resources Information Center

Jambaque, Isabelle; Dellatolas, Georges; Fohlen, Martine; Bulteau, Christine; Watier, Laurence; Dorfmuller, Georg; Chiron, Catherine; Delalande, Olivier

2007-01-01

Surgical treatment appears to improve the cognitive prognosis in children undergoing surgery for temporal lobe epilepsy (TLE). The beneficial effects of surgery on memory functions, particularly on material-specific memory, are more difficult to assess because of potentially interacting factors such as age range, intellectual level,…

Reducation of Anxiety in Children Facing Hospitalization and Surgery by Use of Filmed Modeling

ERIC Educational Resources Information Center

Melamed, Barbara G.; Siegel, Lawrence J.

1975-01-01

A group of children (N=60) about to undergo elective surgery for hernias, tonsillectomies, or urinary-genital tract difficulties were shown on hospital admission either a relevant peer modeling film of a child being hospitalized and receiving surgery or an unrelated control film. (Author)

Heritability of Craniofacial Structures in Normal Subjects and Patients with Sleep Apnea

PubMed Central

Chi, Luqi; Comyn, Francois-Louis; Keenan, Brendan T.; Cater, Jacqueline; Maislin, Greg; Pack, Allan I.; Schwab, Richard J.

2014-01-01

Objectives: Accumulating evidence has shown that there is a genetic contribution to obstructive sleep apnea (OSA).The objectives were to use magnetic resonance imaging (MRI) cephalometry to (1) confirm heritability of craniofacial risk factors for OSA previously shown by cephalometrics; and (2) examine the heritability of new craniofacial structures that are measurable with MRI. Design: A sib pair “quad” design examining apneics, apneic siblings, controls, and control siblings. The study design used exact matching on ethnicity and sex, frequency matching on age, and statistical control for differences in age, sex, ethnicity, height, and weight. Setting: Academic medical center. Patients: We examined 55 apneic probands (apnea-hypopnea index [AHI]: 46.8 ± 33.5 events/h), 55 proband siblings (AHI: 11.1 ± 15.9 events/h), 55 controls (AHI: 2.2 ± 1.7 events/h), and 55 control siblings (AHI: 4.1 ± 4.0 events/h). Interventions: N/A. Measurements and Results: Five independent domains reflecting different aspects of the craniofacial structure were examined. We confirmed heritability of sella–nasion–subspinale (38%, P = 0.002), saddle angle (55%, P < 0.0001), mandibular length (24%, P = 0.02) and lower facial height (33%, P = 0.006) previously measured by cephalometry. In addition, the current study added new insights by demonstrating significant heritability of mandibular width (30%, P = 0.005), maxillary width (47%, P < 0.0001), distance from the hyoid bone to the retropogonion (36%, P = 0.0018) and size of the oropharyngeal space (31%, P = 0.004). Finally, our data indicate that heritability of the craniofacial structures is similar in normal patients and those with apnea. Conclusions: The data support our a priori hypothesis that the craniofacial structures that have been associated with obstructive sleep apnea (OSA) are heritable. We have demonstrated heritability for several intermediate craniofacial phenotypes for OSA. Thus, we believe that future studies should be able to identify genes associated with these intermediate craniofacial phenotypes. Citation: Chi L, Comyn FL, Keenan BT, Cater J, Maislin G, Pack AI, Schwab RJ. Heritability of craniofacial structures in normal subjects and patients with sleep apnea. SLEEP 2014;37(10):1689-1698. PMID:25197806

Perioperative management of a child with glutaric aciduria type I undergoing cardiac surgery.

PubMed

Kölker, Stefan; Eichhorn, Joachim; Sebening, Christian; Klein, Berthold; Springer, Wolfgang; Bopp, Christian; Rauch, Helmut

2013-10-01

Patients with glutaric aciduria type I are at risk for acute striatal injury precipitated by catabolic stress. Here, we report the successful interdisciplinary anesthetic and perioperative management of a child with glutaric aciduria type I undergoing cardiac surgery with extracorporeal circulation. Given the central focus on prevention of acute striatal injury, our anesthetic strategy emphasized avoiding a high protein load, high-dose inotropics, especially epinephrine (associated with impaired glucose utilization), deliberate hyperventilation, and other interventions associated with systemic inflammatory response.

Impact of pectoral nerve block on postoperative pain and quality of recovery in patients undergoing breast cancer surgery: A randomised controlled trial.

PubMed

Kamiya, Yoshinori; Hasegawa, Miki; Yoshida, Takayuki; Takamatsu, Misako; Koyama, Yu

2018-03-01

In recent years, thoracic wall nerve blocks, such as the pectoral nerve (PECS) block and the serratus plane block have become popular for peri-operative pain control in patients undergoing breast cancer surgery. The effect of PECS block on quality of recovery (QoR) after breast cancer surgery has not been evaluated. To evaluate the ability of PECS block to decrease postoperative pain and anaesthesia and analgesia requirements and to improve postoperative QoR in patients undergoing breast cancer surgery. Randomised controlled study. A tertiary hospital. Sixty women undergoing breast cancer surgery between April 2014 and February 2015. The patients were randomised to receive a PECS block consisting of 30 ml of levobupivacaine 0.25% after induction of anaesthesia (PECS group) or a saline mock block (control group). The patients answered a 40-item QoR questionnaire (QoR-40) before and 1 day after breast cancer surgery. Numeric Rating Scale score for postoperative pain, requirement for intra-operative propofol and remifentanil, and QoR-40 score on postoperative day 1. PECS block combined with propofol-remifentanil anaesthesia significantly improved the median [interquartile range] pain score at 6 h postoperatively (PECS group 1 [0 to 2] vs. Control group 1 [0.25 to 2.75]; P = 0.018]. PECS block also reduced propofol mean (± SD) estimated target blood concentration to maintain bispectral index (BIS) between 40 and 50 (PECS group 2.65 (± 0.52) vs. Control group 3.08 (± 0.41) μg ml; P < 0.001) but not remifentanil consumption (PECS group 10.5 (± 4.28) vs. Control group 10.4 (± 4.68) μg kg h; P = 0.95). PECS block did not improve the QoR-40 score on postoperative day 1 (PECS group 182 [176 to 189] vs. Control group 174.5 [157.75 to 175]). In patients undergoing breast cancer surgery, PECS block combined with general anaesthesia reduced the requirement for propofol but not that for remifentanil, due to the inability of the PECS block to reach the internal mammary area. Further, PECS block improved postoperative pain but not the postoperative QoR-40 score due to the factors that cannot be measured by analgesia immediately after surgery, such as rebound pain. This trial is registered with the University Hospital Medical Information Network Clinical Trials Registry (UMIN000013435).

Prophylactic antibiotics to prevent surgical site infection after breast cancer surgery.

PubMed

Bunn, Frances; Jones, Daniel J; Bell-Syer, Sophie

2012-01-18

Surgery has been used as part of breast cancer treatment for centuries; however any surgical procedure has the potential risk of infection. Infection rates for surgical treatment of breast cancer are documented at between 3% and 15%, higher than average for a clean surgical procedure. Pre- and perioperative antibiotics have been found to be useful in lowering infection rates in other surgical groups, yet there is no consensus on the use of prophylactic antibiotics for breast cancer surgery. To determine the effects of prophylactic (pre- or perioperative) antibiotics on the incidence of surgical site infection (SSI) after breast cancer surgery. For this second update we searched the Cochrane Wounds Group Specialised Register (searched 31 August 2011); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 3); Ovid MEDLINE (2008 to August Week 3 2011); Ovid MEDLINE (In-Process & Other Non-Indexed Citations 30 August 2011); Ovid EMBASE (1980 to 2011 Week 34); and EBSCO CINAHL (2008 to 25 August 2011). We applied no language or date restrictions. Randomised controlled trials of pre- and perioperative antibiotics for patients undergoing surgery for breast cancer were included. Primary outcomes were rates of surgical site infection (SSI) and adverse reactions. Two review authors independently examined the title and abstracts of all studies identified by the search strategy, then assessed study quality and extracted data from those that met the inclusion criteria. A total of nine studies (2260 participants) is included in the review. Eight studies evaluated preoperative antibiotic compared with no antibiotic or placebo. One study evaluated perioperative antibiotic compared with no antibiotic. Pooling of the results demonstrated that prophylactic antibiotics administered preoperatively significantly reduce the incidence of SSI for patients undergoing breast cancer surgery without reconstruction (pooled risk ratio (RR) 0.71, 95% confidence interval (CI) 0.53 to 0.94). Analysis of the single study comparing perioperative antibiotic with no antibiotic found no statistically significant effect of antibiotics on the incidence of SSI (RR 0.11, 95% CI 0.01 to 1.95). No studies presented separate data for patients who underwent reconstructive surgery at the time of removal of the breast tumour. Prophylactic antibiotics administered preoperatively reduce the risk of SSI in patients undergoing surgery for breast cancer. Further studies involving patients undergoing immediate breast reconstruction are needed as studies have identified this group as being at higher risk of infection than those who do not undergo immediate breast reconstruction.

Validation of the breast evaluation questionnaire for breast hypertrophy and breast reduction.

PubMed

Lewin, Richard; Elander, Anna; Lundberg, Jonas; Hansson, Emma; Thorarinsson, Andri; Claudelin, Malin; Bladh, Helena; Lidén, Mattias

2018-06-13

There is a lack of published, validated questionnaires for evaluating psychosocial morbidity in patients with breast hypertrophy undergoing breast reduction surgery. To validate the breast evaluation questionnaire (BEQ), originally developed for the assessment of breast augmentation patients, for the assessment of psychosocial morbidity in patients with breast hypertrophy undergoing breast reduction surgery. Validation study Subjects: Women with macromastia Methods: The validation of the BEQ, adapted to breast reduction, was performed in several steps. Content validity, reliability, construct validity and responsiveness were assessed. The original version was adjusted according to the results for content validity and resulted in item reduction and a modified BEQ (mBEQ) that was then assessed for reliability, construct validity and responsiveness. Internal and external validation was performed for the modified BEQ. Convergent validity was tested against Breast-Q (reduction) and discriminate validity was tested against the SF-36. Known-groups validation revealed significant differences between the normal population and patients undergoing breast reduction surgery. The BEQ showed good reliability by test-re-test analysis and high responsiveness. The modified BEQ may be reliable, valid and responsive instrument for assessing women who undergo breast reduction.

Does Wait-List Size at Registration Influence Time to Surgery? Analysis of a Population-Based Cardiac Surgery Registry

PubMed Central

Sobolev, Boris; Levy, Adrian; Hayden, Robert; Kuramoto, Lisa

2006-01-01

Objective To determine whether the probability of undergoing coronary bypass surgery within a certain time was related to the number of patients on the wait list at registration for the operation in a publicly funded health system. Methods A prospective cohort study comparing waiting times among patients registered on wait lists at the hospitals delivering adult cardiac surgery. For each calendar week, the list size, the number of new registrations, and the number of direct admissions immediately after angiography characterized the demand for surgery. Results The length of delay in undergoing treatment was associated with list size at registration, with shorter times for shorter lists (log-rank test 1,198.3, p<.0001). When the list size at registration required clearance time over 1 week patients had 42 percent lower odds of undergoing surgery compared with lists with clearance time less than 1 week (odds ratio [OR] 0.58 percent, 95 percent, confidence interval [CI] 0.53–0.63), after adjustment for age, sex, comorbidity, period, and hospital. The weekly number of new registrations exceeding weekly service capacity had an independent effect toward longer service delays when the list size at registration required clearance time less than 1 week (OR 0.56 percent, 95 percent CI 0.45–0.71), but not for longer lists. Every time the operation was performed for a patient requiring surgery without registration on wait lists, the odds of surgery for listed patients were reduced by 6 percent (OR 0.94, CI 0.93–0.95). Conclusion For wait-listed patients, time to surgery depends on the list size at registration, the number of new registrations, as well as on the weekly number of patients who move immediately from angiography to coronary bypass surgery without being registered on a wait list. Hospital managers may use these findings to improve resource planning and to reduce uncertainty when providing advice on expected treatment delays. PMID:16430599

Female plastic surgery patients prefer mirror-reversed photographs of themselves: A prospective study.

PubMed

de Runz, Antoine; Boccara, David; Chaouat, Marc; Locatelli, Katia; Bertheuil, Nicolas; Claudot, Frédérique; Bekara, Farid; Mimoun, Maurice

2016-01-01

The use of a patient's image in plastic surgery is common today. Thus, plastic surgeons should master the use of the image and be aware of the implications of the patients' perception of themselves. The mere-exposure effect is a psychological phenomenon in which a person tends to rate things more positively merely because (s)he is familiar with them. Faces are asymmetric, so faces in photos are different from those observed in mirrors. The main objective of this study was to assess whether patients within a plastic surgery population, particularly those undergoing facial aesthetic surgery, preferred standard photographs or mirror-reversed photographs of themselves. A prospective study was conducted in a plastic surgery department, which included women who were admitted to the hospital the day before their procedures. The patients were separated into the following two groups: Group 1 was composed of patients who were undergoing facial aesthetic surgeries, and Group 2 consisted of other patients who presented to the plastic surgery department for surgery. The patients were required to rate their appreciation of their own faces and to choose between standard and mirror-reversed photos of themselves. A total of 214 patients participated. The median age was 47.9 years (interquartile range (IQR): 36.4-60.6), and the median face appreciation was 5 (IQR: 5-7). The preference for the mirror-reversed photograph was significantly different from chance (p < 0.001, binomial (214, 156, 0.5)); 73% of the patients preferred the mirror-reversed photographs. The proportions of patients who preferred the mirror-reversed photograph differed significantly (p = 0.047) between Groups 1 (84%) and 2 (70%). Plastic surgery patients have a significant preference for mirror-reversed photographs of themselves over standard photographs. This preference is even more pronounced among patients who are undergoing facial aesthetic surgery. III. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Lund-Mackay and modified Lund-Mackay score for sinus surgery in children with cystic fibrosis.

PubMed

Do, Bao Anh; Lands, Larry C; Mascarella, Marco A; Fanous, Amanda; Saint-Martin, Christine; Manoukian, John J; Nguyen, Lily H P

2015-08-01

Patients with cystic fibrosis (CF) frequently present with severe sinonasal disease often requiring radiologic imaging and surgical intervention. Few studies have focused on the relationship between radiologic scoring systems and the need for sinus surgery in this population. The objective of this study is to evaluate the Lund-Mackay (LM) and modified Lund-Mackay (m-LM) scoring systems in predicting the need for sinus surgery or revision surgery in patients with CF. We performed a retrospective chart review of CF patients undergoing computed tomography (CT) sinus imaging at a tertiary care pediatric hospital from 1995 to 2008. Patient scans were scored using both the LM and m-LM systems and compared to the rate of sinus surgery or revision surgery. Receiver-operator characteristics curves (ROC) were used to analyze the radiological scoring systems. A total of 41 children with CF were included in the study. The mean LM score for patients undergoing surgery was 17.3 (±3.1) compared to 11.5 (±6.2) for those treated medically (p<0.01). For the m-LM, the mean score of patients undergoing surgery was 20.3 (±3.5) and 13.5 (±7.3) for those medically treated (p<0.01). Using a ROC curve with a threshold score of 13 for the LM, the sensitivity was 89.3% (95% CI of 72-98) and specificity of 69.2% (95% CI of 39-91). At an optimal score of 19, the m-LM system produced a sensitivity of 67.7% (95% CI of 48-84) and specificity of 84.6% (95% CI of 55-98). The modified Lund-Mackay score provides a high specificity while the Lund-Mackay score a high sensitivity for CF patients who required sinus surgery. The combination of both radiologic scoring systems can potentially predict the need for surgery in this population. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Deep Vein Thrombosis After Complex Posterior Spine Surgery: Does Staged Surgery Make a Difference?

PubMed

Edwards, Charles C; Lessing, Noah L; Ford, Lisa; Edwards, Charles C

Retrospective review of a prospectively collected database. To assess the incidence of deep vein thrombosis (DVT) associated with single- versus multistage posterior-only complex spinal surgeries. Dividing the physiologic burden of spinal deformity surgery into multiple stages has been suggested as a potential means of reducing perioperative complications. DVT is a worrisome complication owing to its potential to lead to pulmonary embolism. Whether or not staging affects DVT incidence in this population is unknown. Consecutive patients undergoing either single- or multistage posterior complex spinal surgeries over a 12-year period at a single institution were eligible. All patients received lower extremity venous duplex ultrasonographic (US) examinations 2 to 4 days postoperatively in the single-stage group and 2 to 4 days postoperatively after each stage in the multistage group. Multivariate logistic regression was used to assess the independent contribution of staging to developing a DVT. A total of 107 consecutive patients were enrolled-26 underwent multistage surgery and 81 underwent single-stage surgery. The single-stage group was older (63 years vs. 45 years; p < .01) and had a higher Charlson comorbidity index (2.25 ± 1.27 vs. 1.23 ± 1.58; p < .01). More multistage patients had positive US tests than single-stage patients (5 of 26 vs. 6 of 81; 19% vs. 7%; p = .13). Adjusting for all the above-mentioned covariates, a multistage surgery was 8.17 (95% CI 0.35-250.6) times more likely to yield a DVT than a single-stage surgery. Patients who undergo multistage posterior complex spine surgery are at a high risk for developing a DVT compared to those who undergo single-stage procedures. The difference in DVT incidence may be understated as the multistage group had a lower pre- and intraoperative risk profile with a younger age, lower medical comorbidities, and less per-stage blood loss. Copyright © 2017 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.

Does specialization improve outcome in abdominal aortic aneurysm surgery?

PubMed

Rosenthal, Rachel; von Känel, Oliver; Eugster, Thomas; Stierli, Peter; Gürke, Lorenz

2005-01-01

Specialization and high volume are reported to be related to a better outcome after abdominal aortic aneurysm repair. The aim of this study was to compare, in patients undergoing abdominal aortic aneurysm repair, the outcomes of those whose surgery was done by general surgeons with the outcomes of those whose surgery was done by specialist vascular surgeons. All patients undergoing abdominal aortic aneurysm repair at the Basel University Hospital (referral center) from January 1990 to December 2000 were included. Patients with endovascular treatment were excluded. Operations in group A (n = 189), between January 1990 and May 1995, were done by general surgeons. Operations in group B (n = 291), between June 1995 and December 2000, were done by vascular surgeons. In-hospital mortality and local and systemic complications were assessed. In-hospital mortality rates were significantly lower for group B (with specialist surgeons) than for group A, both overall (group B, 11.7%; group A, 21.7%; p = .003) and for emergency interventions (group B, 28.1%; group A, 41.9%; p = .042). The reduction in mortality for elective surgery in group B was not statistically significant (group B, 1.1%; group A, 4.9%; p = .054). There were significantly fewer pulmonary complications in group B compared with group A (p = .000). We conclude that in patients undergoing abdominal aortic aneurysm repair, those whose surgery is done by a specialized team have a significantly better outcome than those whose surgery is done by general surgeons.

Viscoelastic blood coagulation measurement with Sonoclot predicts postoperative bleeding in cardiac surgery after heparin reversal.

PubMed

Bischof, Dominique B; Ganter, Michael T; Shore-Lesserson, Linda; Hartnack, Sonja; Klaghofer, Richard; Graves, Kirk; Genoni, Michele; Hofer, Christoph K

2015-01-01

The aim of the study was to determine if Sonoclot with its sensitive glass bead-activated, viscoelastic test can predict postoperative bleeding in patients undergoing cardiac surgery at predefined time points. A prospective, observational clinical study. A teaching hospital, single center. Consecutive patients undergoing cardiac surgery (N = 300). Besides routine laboratory coagulation studies and heparin management with standard (kaolin) activated clotting time, additional native blood samples were analyzed on a Sonoclot using glass bead-activated tests. Glass bead-activated clotting time, clot rate, and platelet function were recorded immediately before anesthesia induction and at the end of surgery after heparin reversal but before chest closure. Primary outcome was postoperative blood loss (chest tube drainage at 4, 8, and 12 hours postoperatively). Secondary outcome parameters were transfusion requirements, need for surgical re-exploration, time of mechanical ventilation, length of intensive care unit and hospital stay, and hospital morbidity and mortality. Patients were categorized into "bleeders" and "nonbleeders." Patient characteristics, operations, preoperative standard laboratory parameters, and procedural times were comparable between bleeders and nonbleeders except for sex and age. Bleeders had higher rates of transfusions, surgical re-explorations, and complications. Only glass bead measurements by Sonoclot after heparin reversal before chest closure but not preoperatively were predictive for increased postoperative bleeding. Sonoclot with its glass bead-activated tests may predict the risk for postoperative bleeding in patients undergoing cardiac surgery at the end of surgery after heparin reversal but before chest closure. Copyright © 2015 Elsevier Inc. All rights reserved.

Use of gonioscopy in medicare beneficiaries before glaucoma surgery.

PubMed

Coleman, Anne L; Yu, Fei; Evans, Stacy J

2006-12-01

The American Academy of Ophthalmology Preferred Practice Patterns for angle closure and open-angle glaucoma (OAG) patients recommends performing bilateral gonioscopy upon initial presentation to evaluate the possibility of narrow angle or angle-closure glaucoma (ACG) and then repeating the examination at least every 5 years. This study aims to assess how commonly eye care providers perform gonioscopy before planned glaucoma surgery in OAG, anatomic narrow angle, and ACG in the Medicare population. Data obtained from a 5% random sample of Medicare beneficiaries undergoing glaucoma surgery in the United States in 1999 were retrospectively reviewed. The proportion of patients with evidence of at least one gonioscopic examination before glaucoma surgery was determined for the period of 1995 to 1999. Demographic and clinical factors potentially influencing the decision to perform gonioscopy were also examined. Overall, gonioscopy is apparently performed in 49% of Medicare beneficiaries during the 4 to 5 years preceding glaucoma surgery. This rate was significantly lower (P < 0.001) in patients with OAG (46%), as compared with anatomic narrow angle (58%) and ACG (57%) patients. Hispanics, elderly (aged 70 to 84), patients undergoing laser iridotomy, and patients receiving care in the New York/New Jersey area all had significantly higher apparent preoperative gonioscopy rates (P < 0.05). Gonioscopy examination before glaucoma surgery in Medicare beneficiaries is underused, undercoded, and/or miscoded, given current recommendations. Underuse is of particular concern in patients undergoing laser iridotomy as it is the diagnostic test of choice in ACG.

Comparison of intraoperative volume and pressure-controlled ventilation modes in patients who undergo open heart surgery.

PubMed

Hoşten, Tülay; Kuş, Alparslan; Gümüş, Esra; Yavuz, Şadan; İrkil, Serhat; Solak, Mine

2017-02-01

Respiratory problems occur more frequently in patients who undergo open heart surgery. Intraoperative and postoperative ventilation strategies can prevent these complications and reduce mortality. We hypothesized that PCV would have better effects on gas exchange, lung mechanics and hemodynamics compared to VCV in CABG surgery. Our primary outcome was to compare the PaO 2 /FiO 2 ratio. Patients were randomized into two groups, (VCV, PCV) consisting of 30 individuals each. Two patients were excluded from the study. I/E ratio was adjusted to 1:2 and, RR:10/min fresh air gas flow was set at 3L/min in all patients. In the VCV group TV was set at 8 mL/kg of the predicted body weight. In the PCV group, peak inspiratory pressure was adjusted to the same tidal volume with the VCV group. PaO2/FiO2 was found to be higher with PCV at the end of the surgery. Time to extubation and ICU length of stay was shorter with PCV. Ppeak was similar in both groups. Pplateau was lower and Pmean was higher at the and of the surgery with PCV compared to VCV. The hemodynamic effects of both ventilation modes were found to be similar. PVC may be preferable to VCV in patients who undergo open heart surgery. However, it would be convenient if our findings are supported by similar studies.

The German Aortic Valve Registry (GARY): in-hospital outcome

PubMed Central

Hamm, Christian W.; Möllmann, Helge; Holzhey, David; Beckmann, Andreas; Veit, Christof; Figulla, Hans-Reiner; Cremer, J.; Kuck, Karl-Heinz; Lange, Rüdiger; Zahn, Ralf; Sack, Stefan; Schuler, Gerhard; Walther, Thomas; Beyersdorf, Friedhelm; Böhm, Michael; Heusch, Gerd; Funkat, Anne-Kathrin; Meinertz, Thomas; Neumann, Till; Papoutsis, Konstantinos; Schneider, Steffen; Welz, Armin; Mohr, Friedrich W.

2014-01-01

Background Aortic stenosis is a frequent valvular disease especially in elderly patients. Catheter-based valve implantation has emerged as a valuable treatment approach for these patients being either at very high risk for conventional surgery or even deemed inoperable. The German Aortic Valve Registry (GARY) provides data on conventional and catheter-based aortic procedures on an all-comers basis. Methods and results A total of 13 860 consecutive patients undergoing repair for aortic valve disease [conventional surgery and transvascular (TV) or transapical (TA) catheter-based techniques] have been enrolled in this registry during 2011 and baseline, procedural, and outcome data have been acquired. The registry summarizes the results of 6523 conventional aortic valve replacements without (AVR) and 3464 with concomitant coronary bypass surgery (AVR + CABG) as well as 2695 TV AVI and 1181 TA interventions (TA AVI). Patients undergoing catheter-based techniques were significantly older and had higher risk profiles. The stroke rate was low in all groups with 1.3% (AVR), 1.9% (AVR + CABG), 1.7% (TV AVI), and 2.3% (TA AVI). The in-hospital mortality was 2.1% (AVR) and 4.5% (AVR + CABG) for patients undergoing conventional surgery, and 5.1% (TV AVI) and AVI 7.7% (TA AVI). Conclusion The in-hospital outcome results of this registry show that conventional surgery yields excellent results in all risk groups and that catheter-based aortic valve replacements is an alternative to conventional surgery in high risk and elderly patients. PMID:24022003

Pediatric considerations in craniofacial trauma.

PubMed

Koch, Bernadette L

2014-08-01

In many respects, craniofacial trauma in children is akin to that in adults. The appearance of fractures and associated injuries is frequently similar. However, the frequencies of different types of fractures and patterns of injury in younger children vary depending on the age of the child. In addition, there are unique aspects that must be considered when imaging the posttraumatic pediatric face. Some of these are based on normal growth and development of the skull base and craniofacial structures, and others on the varying etiologies and mechanisms of craniofacial injury in children, such as injuries related to toppled furniture, nonaccidental trauma, all-terrain vehicle accidents, and impalement injuries. Copyright © 2014 Elsevier Inc. All rights reserved.

[Observational study of craniofacial growth and development in Mexican children].

PubMed

Fijikami, T K; Cedeño Pacheco, E

1991-01-01

The election of a investigation about craniofacial growing and development in Mexican children, was done due to a lack of national information in this rubric and as a fundamental part of the "growing and development in the scholastic" module of the Universidad Autónoma Metropolitana-Xochimilco, which work hypothesis was that "craniofacial growing and development in Mexican, 6 to 12 children in Xochimilco area are due to nutritional deficiency, second dentition eruption delay and dental maloclution "which was totality confirmed in a 100 Mexican facial characteristic children field work study, with cephalometric studies which permit to determine the craniofacial growing standard. This study was corroborated with a 40 children, 4 years later follow up.

Advances in Bioprinting Technologies for Craniofacial Reconstruction.

PubMed

Visscher, Dafydd O; Farré-Guasch, Elisabet; Helder, Marco N; Gibbs, Susan; Forouzanfar, Tymour; van Zuijlen, Paul P; Wolff, Jan

2016-09-01

Recent developments in craniofacial reconstruction have shown important advances in both the materials and methods used. While autogenous tissue is still considered to be the gold standard for these reconstructions, the harvesting procedure remains tedious and in many cases causes significant donor site morbidity. These limitations have subsequently led to the development of less invasive techniques such as 3D bioprinting that could offer possibilities to manufacture patient-tailored bioactive tissue constructs for craniofacial reconstruction. Here, we discuss the current technological and (pre)clinical advances of 3D bioprinting for use in craniofacial reconstruction and highlight the challenges that need to be addressed in the coming years. Copyright © 2016 Elsevier Ltd. All rights reserved.

Predictive value of preoperative electrocardiography for perioperative cardiovascular outcomes in patients undergoing noncardiac, nonvascular surgery.

PubMed

Biteker, Murat; Duman, Dursun; Tekkeşin, Ahmet Ilker

2012-08-01

The utility of routine preoperative electrocardiography (ECG) for assessing perioperative cardiovascular risk in patients undergoing noncardiac, nonvascular surgery (NCNVS) is unclear. There would be an association between preoperative ECG and perioperative cardiovascular outcomes in patients undergoing NCNVS. A total of 660 patients undergoing NCNVS were prospectively evaluated. Patients age >18 years who underwent an elective, nonday case, open surgical procedure were enrolled. Troponin I concentrations and 12-lead ECG were evaluated the day before surgery, immediately after surgery, and on the first 5 postoperative days. Preoperative ECG showing atrial fibrillation, left or right bundle branch block, left ventricular hypertrophy, frequent premature ventricular complexes, pacemaker rhythm, Q-wave, ST-segment changes, or sinus tachycardia or bradycardia were classified as abnormal. The patients were followed up during hospitalization and were evaluated for the presence of perioperative cardiovascular events (PCE). Eighty patients (12.1%) experienced PCE. Patients with abnormal ECG findings had a greater incidence of PCE than those with normal ECG results (16% vs 6.4%; P < 0.001). Mean QTc interval was significantly longer in the patients who had PCE (436.6 ± 31.4 vs 413.3 ± 16.7 ms; P < 0.001). Univariate analysis showed a significant association between preoperative atrial fibrillation, pacemaker rhythm, ST-segment changes, QTc prolongation, and in-hospital PCE. However, only QTc prolongation (odds ratio: 1.15, 95% confidence interval: 1.06-1.2, P < 0.001) was an independent predictor of PCE according to the multivariate analysis. Every 10-ms increase in QTc interval was related to a 13% increase for PCE. Prolongation of the QTc interval on the preoperative ECG was related with PCE in patients undergoing NCNVS. © 2011 Wiley Periodicals, Inc.

Racial Disparities Differ for African Americans and Hispanics in the Diagnosis and Treatment of Penile Cancer.

PubMed

Slopnick, Emily A; Kim, Simon P; Kiechle, Jonathan E; Gonzalez, Christopher M; Zhu, Hui; Abouassaly, Robert

2016-10-01

To evaluate racial disparities in the diagnosis and treatment of penile cancer among a contemporary series of men from a large diverse national data base. Using the 1998-2012 National Cancer Data Base, all men with squamous cell carcinoma (SCC) were stratified by race and ethnicity. Demographic and disease characteristics were compared between groups. Likelihood of undergoing surgery and type of surgery were compared among patients with nonmetastatic disease. Factors influencing disease stage and treatment type were analyzed with univariate and multivariable logistic regressions. Overall survival was examined with Kaplan-Meier and adjusted Cox proportional hazard models. We identified 12,090 men with penile SCC with median age 66 years (range 18-90). Distribution of patients is as follows: 76.8% Caucasian, 10.2% African American (AA), 8.7% Hispanic. On multivariable analysis, Hispanic men are more likely to present with high-risk (≥T1G3) penile SCC (odds ratio [OR] 1.6; confidence interval [CI] 1.20-2.00; P = .001) and tend to undergo penectomy rather than penile-sparing surgery (OR 1.46; CI 1.15-1.85; P = .002) for equal stage SCC compared to Caucasian patients. Whereas AA men are less likely to undergo surgery of any type (OR 0.67; CI 0.51-0.87; P = .003) and have higher mortality rates than Caucasian patients (hazard ratio 1.25; CI 1.10-1.42; P < .001). Hispanic men with penile SCC are more likely to present with high-risk disease and undergo more aggressive treatment than Caucasian patients but have comparable survival. AA men are less likely to undergo surgical management of their disease and have higher mortality rates. Copyright © 2016 Elsevier Inc. All rights reserved.

Oral and cranio-maxillofacial surgery in Byzantium.

PubMed

Mylonas, Anastassios I; Poulakou-Rebelakou, Eleftheria-Fotini; Androutsos, Georgios I; Seggas, Ioannis; Skouteris, Christos A; Papadopoulou, Evangelia Chr

2014-03-01

Byzantine physicians (4th-7th and 8th-12th centuries A.D.), especially those interested in Surgery, developed a number of interesting concepts, views and opinions referring to the field now recognized as Oral and Cranio-maxillofacial Surgery and Pathology. The original texts of Byzantine physicians, written in ancient Greek, and now preserved in the electronic platform Thesaurus Linguae Graecae, at the University of California, Irvine, CA, USA, were investigated in relation to Oral and Cranio-maxillofacial Surgery and Pathology. The most eminent physicians of the Early (4th-7th century A.D.) and Middle (8th-12th century A.D.) Byzantine Period, in particular Oribasius Pergamenus, Aëtius Amidenus, Alexander Trallianus, Theophilus Protospatharius, Paulus Aegineta, Meletius Monachos, and Leo Medicus, in their works deal with topographic and surgical anatomy of the head and neck, and a large list of related topics, including dentoalveolar surgery, oral and cervicofacial infections, trauma of viscerocranium and neurocranium as well as the biomechanics of traumatic brain injuries, temporomandibular joints dysfunction as a consequence of mandibular dislocation, surgical oncology and reconstructive surgery of the head and neck, oral pathology, surgical pathology of salivary glands, therapeutic management of facial nerve dysfunction, preprosthetic surgery, craniofacial surgery, and deformities of the facial skeleton involving anthropologic and craniometric observations. Clinical examination of patients presenting corresponding functional and esthetic problems is considered, using recognizable orthodontic and orthognathic surgical approaches. Finally, specific bandages of the head and neck are described, for treating traumatic injuries of the viscerocranium and neurocranium, diastasis of the cranial sutures, dislocations of the mandible (unilateral and bilateral), as well as inflammatory diseases of the parotids and the neck. Byzantine physicians had been particularly interested in various subjects of the mouth, jaws, face, and head and neck in general, in the frame of course of their general surgery practice. Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

[A Jehovah's Witness child with hemophilia B and factor IX inhibitors undergoing scoliosis surgery].

PubMed

Chau, Anthony; Wu, John; Ansermino, Mark; Tredwell, Stephen; Purdy, Robert

2008-01-01

To describe the successful perioperative hemostatic management of a Jehovah's Witness patient with hemophilia B and anaphylactic inhibitors to factor IX, undergoing scoliosis surgery. A 14 (1/2)-yr-old boy with severe hemophilia B who had a history of anaphylactic inhibitors to factor IX was scheduled to undergo corrective scoliosis surgery. He was initially started on epoetin alfa and iron supplementation to maximize preoperative red cell mass. Additionally, he was placed on a desensitization protocol of recombinant coagulation factor IX (rFIX) and was then treated with activated recombinant coagulation factor VII (rFVIIa) during the postoperative period. Tranexamic acid was given concomitantly. The intraoperative blood loss was approximately 350 mL. The nadir hemoglobin concentration was 111 g.L(-1) on postoperative days one and two. On postoperative day 11, the patient was stable and discharged home with a hemoglobin of 138 g.L(-1). He did not require blood transfusion and no adverse events were observed. The use of rFIX, rFVIIa, erythropoetin, iron, and tranexamic acid before, during and after scoliosis surgery may be a viable and safe option for hemophilia patients with inhibitors, who refuse blood products.

Adolescent bariatric surgery program characteristics: the Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study experience.

PubMed

Michalsky, Marc P; Inge, Thomas H; Teich, Steven; Eneli, Ihuoma; Miller, Rosemary; Brandt, Mary L; Helmrath, Michael; Harmon, Carroll M; Zeller, Meg H; Jenkins, Todd M; Courcoulas, Anita; Buncher, Ralph C

2014-02-01

The number of adolescents undergoing weight loss surgery (WLS) has increased in response to the increasing prevalence of severe childhood obesity. Adolescents undergoing WLS require unique support, which may differ from adult programs. The aim of this study was to describe institutional and programmatic characteristics of centers participating in Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS), a prospective study investigating safety and efficacy of adolescent WLS. Data were obtained from the Teen-LABS database, and site survey completed by Teen-LABS investigators. The survey queried (1) institutional characteristics, (2) multidisciplinary team composition, (3) clinical program characteristics, and (4) clinical research infrastructure. All centers had extensive multidisciplinary involvement in the assessment, pre-operative education, and post-operative management of adolescents undergoing WLS. Eligibility criteria and pre-operative clinical and diagnostic evaluations were similar between programs. All programs have well-developed clinical research infrastructure, use adolescent-specific educational resources, and maintain specialty equipment, including high weight capacity diagnostic imaging equipment. The composition of clinical team and institutional resources is consistent with current clinical practice guidelines. These characteristics, coupled with dedicated research staff, have facilitated enrollment of 242 participants into Teen-LABS. © 2013 Published by Elsevier Inc.

Adolescent Bariatric Surgery Program Characteristics: The Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) Study Experience

PubMed Central

Michalsky, M.P.; Inge, T.H.; Teich, S.; Eneli, I.; Miller, R.; Brandt, M.L.; Helmrath, M.; Harmon, C.M.; Zeller, M.H.; Jenkins, T.M.; Courcoulas, A.; Buncher, C.R.

2013-01-01

Background The number of adolescents undergoing weight loss surgery (WLS) has increased in response to the increasing prevalence of severe childhood obesity. Adolescents undergoing WLS require unique support, which may differ from adult programs. The aim of this study was to describe institutional and programmatic characteristics of centers participating in Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS), a prospective study investigating safety and efficacy of adolescent WLS. Methods Data were obtained from the Teen-LABS database and site survey completed by Teen-LABS investigators. The survey queried (1) institutional characteristics, (2) multidisciplinary team composition, (3) clinical program characteristics, and (4) clinical research infrastructure. Results All centers had extensive multidisciplinary involvement in the assessment, preoperative education and post-operative management of adolescents undergoing WLS. Eligibility criteria, pre-operative clinical and diagnostic evaluations were similar between programs. All programs have well developed clinical research infrastructure, use adolescent-specific educational resources, and maintain specialty equipment, including high weight capacity diagnostic imaging equipment. Conclusions The composition of clinical team and institutional resources are consistent with current clinical practice guidelines. These characteristics, coupled with dedicated research staff, have facilitated enrollment of 242 participants into Teen-LABS. PMID:24491361

Nuclear DNA as Predictor of Acute Kidney Injury in Patients Undergoing Coronary Artery Bypass Graft: A Pilot Study.

PubMed

Likhvantsev, Valery V; Landoni, Giovanni; Grebenchikov, Oleg A; Skripkin, Yuri V; Zabelina, Tatiana S; Zinovkina, Liudmila A; Prikhodko, Anastasia S; Lomivorotov, Vladimir V; Zinovkin, Roman A

2017-12-01

To measure the release of plasma nuclear deoxyribonucleic acid (DNA) and to assess the relationship between nuclear DNA level and acute kidney injury occurrence in patients undergoing cardiac surgery. Cardiovascular anesthesiology and intensive care unit of a large tertiary-care university hospital. Prospective observational study. Fifty adult patients undergoing cardiac surgery. Nuclear DNA concentration was measured in the plasma. The relationship between the level of nuclear DNA and the incidence of acute kidney injury after coronary artery bypass grafting was investigated. Cardiac surgery leads to significant increase in plasma nuclear DNA with peak levels 12 hours after surgery (median [interquartile range] 7.0 [9.6-22.5] µg/mL). No difference was observed between off-pump and on-pump surgical techniques. Nuclear DNA was the only predictor of acute kidney injury between baseline and early postoperative risk factors. The authors found an increase of nuclear DNA in the plasma of patients who had undergone coronary artery bypass grafting, with a peak after 12 hours and an association of nuclear DNA with postoperative acute kidney injury. Copyright © 2017 Elsevier Inc. All rights reserved.

Prevention of Treacher Collins syndrome craniofacial anomalies in mouse models via maternal antioxidant supplementation.

PubMed

Sakai, Daisuke; Dixon, Jill; Achilleos, Annita; Dixon, Michael; Trainor, Paul A

2016-01-21

Craniofacial anomalies account for approximately one-third of all birth defects and are a significant cause of infant mortality. Since the majority of the bones, cartilage and connective tissues that comprise the head and face are derived from a multipotent migratory progenitor cell population called the neural crest, craniofacial disorders are typically attributed to defects in neural crest cell development. Treacher Collins syndrome (TCS) is a disorder of craniofacial development and although TCS arises primarily through autosomal dominant mutations in TCOF1, no clear genotype-phenotype correlation has been documented. Here we show that Tcof1 haploinsufficiency results in oxidative stress-induced DNA damage and neuroepithelial cell death. Consistent with this discovery, maternal treatment with antioxidants minimizes cell death in the neuroepithelium and substantially ameliorates or prevents the pathogenesis of craniofacial anomalies in Tcof1(+/-) mice. Thus maternal antioxidant dietary supplementation may provide an avenue for protection against the pathogenesis of TCS and similar neurocristopathies.

Prevention of Treacher Collins syndrome craniofacial anomalies in mouse models via maternal antioxidant supplementation

PubMed Central

Sakai, Daisuke; Dixon, Jill; Achilleos, Annita; Dixon, Michael; Trainor, Paul A.

2016-01-01

Craniofacial anomalies account for approximately one-third of all birth defects and are a significant cause of infant mortality. Since the majority of the bones, cartilage and connective tissues that comprise the head and face are derived from a multipotent migratory progenitor cell population called the neural crest, craniofacial disorders are typically attributed to defects in neural crest cell development. Treacher Collins syndrome (TCS) is a disorder of craniofacial development and although TCS arises primarily through autosomal dominant mutations in TCOF1, no clear genotype–phenotype correlation has been documented. Here we show that Tcof1 haploinsufficiency results in oxidative stress-induced DNA damage and neuroepithelial cell death. Consistent with this discovery, maternal treatment with antioxidants minimizes cell death in the neuroepithelium and substantially ameliorates or prevents the pathogenesis of craniofacial anomalies in Tcof1+/− mice. Thus maternal antioxidant dietary supplementation may provide an avenue for protection against the pathogenesis of TCS and similar neurocristopathies. PMID:26792133

Sleep disorders and chronic craniofacial pain: Characteristics and management possibilities.

PubMed

Almoznino, Galit; Benoliel, Rafael; Sharav, Yair; Haviv, Yaron

2017-06-01

Chronic craniofacial pain involves the head, face and oral cavity and is associated with significant morbidity and high levels of health care utilization. A bidirectional relationship is suggested in the literature for poor sleep and pain, and craniofacial pain and sleep are reciprocally related. We review this relationship and discuss management options. Part I reviews the relationship between pain and sleep disorders in the context of four diagnostic categories of chronic craniofacial pain: 1) primary headaches: migraines, tension-type headache (TTH), trigeminal autonomic cephalalgias (TACs) and hypnic headache, 2) secondary headaches: sleep apnea headache, 3) temporomandibular joint disorders (TMD) and 4) painful cranial neuropathies: trigeminal neuralgia, post-herpetic trigeminal neuropathy, painful post-traumatic trigeminal neuropathy (PTTN) and burning mouth syndrome (BMS). Part II discusses the management of patients with chronic craniofacial pain and sleep disorders addressing the factors that modulate the pain experience as well as sleep disorders and including both non-pharmacological and pharmacological modalities. Copyright © 2016 Elsevier Ltd. All rights reserved.

Biomaterials for Craniofacial Bone Engineering

PubMed Central

Tevlin, R.; McArdle, A.; Atashroo, D.; Walmsley, G.G.; Senarath-Yapa, K.; Zielins, E.R.; Paik, K.J.; Longaker, M.T.; Wan, D.C.

2014-01-01

Conditions such as congenital anomalies, cancers, and trauma can all result in devastating deficits of bone in the craniofacial skeleton. This can lead to significant alteration in function and appearance that may have significant implications for patients. In addition, large bone defects in this area can pose serious clinical dilemmas, which prove difficult to remedy, even with current gold standard surgical treatments. The craniofacial skeleton is complex and serves important functional demands. The necessity to develop new approaches for craniofacial reconstruction arises from the fact that traditional therapeutic modalities, such as autologous bone grafting, present myriad limitations and carry with them the potential for significant complications. While the optimal bone construct for tissue regeneration remains to be elucidated, much progress has been made in the past decade. Advances in tissue engineering have led to innovative scaffold design, complemented by progress in the understanding of stem cell–based therapy and growth factor enhancement of the healing cascade. This review focuses on the role of biomaterials for craniofacial bone engineering, highlighting key advances in scaffold design and development. PMID:25139365

DOE Office of Scientific and Technical Information (OSTI.GOV)

Noda, Kazuo, E-mail: knoda@kuhp.kyoto-u.ac.jp; Nakamura, Tomoyuki; Komatsu, Yoshihiro

Craniofacial sutures govern the shape of the craniofacial skeleton during postnatal development. The differentiation of suture mesenchymal cells to osteoblasts is precisely regulated in part by signaling through cell surface receptors that interact with extracellular proteins. Here we report that fibulin-5, a key extracellular matrix protein, is important for craniofacial skeletal development in mice. Fibulin-5 is deposited as a fibrous matrix in cranial neural crest-derived mesenchymal tissues, including craniofacial sutures. Fibulin-5-null mice show decreased premaxillary bone outgrowth during postnatal stages. While premaxillo-maxillary suture mesenchymal cells in fibulin-5-null mice were capable of differentiating into osteoblasts, suture cells in mutant mice weremore » less proliferative. Our study provides the first evidence that fibulin-5 is indispensable for the regulation of facial suture mesenchymal cell proliferation required for craniofacial skeletal morphogenesis. - Highlights: • Fibulin-5 is deposited in cranial neural crest-derived mesenchymal tissues. • Fibulin-5-null mice show decreased premaxillary bone growth during postnatal stage. • Fibulin-5 is indispensable for facial suture mesenchymal cell proliferation.« less

PDGFRβ regulates craniofacial development through homodimers and functional heterodimers with PDGFRα.

PubMed

Fantauzzo, Katherine A; Soriano, Philippe

2016-11-01

Craniofacial development is a complex morphogenetic process, disruptions in which result in highly prevalent human birth defects. While platelet-derived growth factor (PDGF) receptor α (PDGFRα) has well-documented functions in this process, the role of PDGFRβ in murine craniofacial development is not well established. We demonstrate that PDGFRα and PDGFRβ are coexpressed in the craniofacial mesenchyme of mid-gestation mouse embryos and that ablation of Pdgfrb in the neural crest lineage results in increased nasal septum width, delayed palatal shelf development, and subepidermal blebbing. Furthermore, we show that the two receptors genetically interact in this lineage, as double-homozygous mutant embryos exhibit an overt facial clefting phenotype more severe than that observed in either single-mutant embryo. We reveal a physical interaction between PDGFRα and PDGFRβ in the craniofacial mesenchyme and demonstrate that the receptors form functional heterodimers with distinct signaling properties. Our studies thus uncover a novel mode of signaling for the PDGF family during vertebrate development. © 2016 Fantauzzo and Soriano; Published by Cold Spring Harbor Laboratory Press.

Health-related quality of life evaluated by the eight-item short form after cardiovascular surgery.

PubMed

Kato, Takayoshi; Tomita, Shinji; Handa, Nobuhiro; Ueno, Yo-ichiro

2010-12-01

Owing to advances in cardiovascular surgery, patients with cardiovascular disease require improvement of health-related quality of life (QOL) than before. We measured the QOL of patients undergoing cardiovascular surgery using the eight-item Short Form (SF-8) and assessed its usefulness. This was a prospective repeated-measures observational study. The SF-8 questionnaire was completed through interviews with 117 consecutive adult patients undergoing cardiovascular surgery at a single center (Nagara Medical Center, Japan) from April 2006 to March 2008. The SF-8 was evaluated before surgery and at 7 days, 1 month, and 6 months after surgery. The physical and mental scores over time were assessed. Regarding physical status, compared with the normal population, the patients' scores were worse preoperatively and had deteriorated 7 days postoperatively; they gradually got closer to preoperative status a month after the procedure. At 6 months after surgery, all physical scores were higher than before surgery. The mental scores, including a mental component summary score, were inferior to those of the normal population until 1 month postoperatively, and they reached those of the normal population at 6 months. The SF-8 changed with the postoperative time course. It was a useful tool for analyzing the physical and mental QOL of patients who underwent cardiovascular surgery.