bluuebunny/crossref_metadata_2025 huggingface dataset:
Postconcussion Syndrome
Authors: McIntyre McKyla , Amiri Mohammadreza , Kumbhare Dinesh
Published: September 2020

After concussion, a subset of patients have persistent symptoms that are functionally limiting and may be difficult to treat. These symptoms were previously captured in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) under the diagnosis of “Post-Concussion Syndrome.” However, in the recently published fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, postconcussion syndrome has been eliminated. The elimination of “Post-Concussion Syndrome” moves the Diagnostic and Statistical Manual of Mental Disorders further away from congruence with the International Classification of Diseases (ICD-10) with respect to the classification of postconcussion symptomology. Although this change likely had the positive effect of reducing misdiagnoses of symptoms due to other causes, the authors highlight the potential issues surrounding the elimination of postconcussion syndrome in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. This opinion piece also emphasizes the multiple diagnostic and therapeutic challenges that may result for those involved in the treatment of, or research regarding, concussion patients with persistent symptoms. Future revisions that provide clear clinical diagnostic criteria may be beneficial.
Predictive Computed Tomography and Clinical Features for Diagnosis of COVID-19 Pneumonia: Compared With Common Viral Pneumonia
Authors: Zhou Cuiping , Luo Lin , Luo Zhendong , Shen Xinping
Published: September 2020

Objective

To determine the predictive computed tomography (CT) and clinical features for diagnosis of COVID-19 pneumonia.

Methods

The CT and clinical data including were analyzed using univariate analysis and multinomial logistic regression, followed by receiver operating characteristic curve analysis.

Results

The factors including size of ground grass opacity (GGO), GGO with reticular and/or interlobular septal thickening, vascular enlargement, “tree-in-bud” opacity, centrilobular nodules, and stuffy or runny nose were associated with the 2 groups of viral pneumonia, as determined by univariate analysis (P < 0.05). Only GGO with reticular and/or interlobular septal thickening, centrilobular nodules, and stuffy or runny nose remained independent risk factors in multinomial logistic regression analysis. Receiver operating characteristic curve analysis showed that the area under curve of the obtained logistic regression model was 0.893.

Conclusion

Computed tomography and clinical features including GGO with reticular and/or interlobular septal thickening, absence of centrilobular nodules, and absence of stuffy or runny nose are potential patients with COVID-19 pneumonia.
Coronary Artery Calcification on Thoracic Computed Tomography Is an Independent Predictor of Mortality in Patients With Bronchiectasis
Authors: Williams Michelle C. , van Beek Edwin J.R. , Hill Adam T. , Murchison John T.
Published: September 2020

Purpose:

Coronary artery calcification (CAC) on thoracic computed tomography (CT) can identify patients at risk of coronary artery disease (CAD) mortality. However, the overlap between bronchiectasis and CAC severity for predicting subsequent outcomes is unknown.

Materials and Methods:

CT images from 362 patients (mean age 66±14 y, 38% male) with known bronchiectasis were assessed. Bronchiectasis severity was assessed using the Bronchiectasis Severity Index (0 to 4, mild; 5 to 8, moderate; and ≥9, severe). CAC was assessed with a visual ordinal score (0, none; 1, mild; 2, moderate; 3, severe) in each of the left main stem, left anterior descending, left circumflex, and right coronary arteries. Vessel CAC scores were summed and categorized as none (0), mild (1 to 3), moderate (4 to 8), and severe (9 to 12).

Results:

Patients with severe bronchiectasis were older (P<0.001), but were not more likely to have a history of CAD, hypertension, or smoking. CAC was present in 196 (54%). Over a mean of 6±2 years, 59 (16%) patients died. Patients with moderate or severe CAC were 5 times more likely to die than patients without CAC (hazard ratio: 5.49, 95% confidence interval: 2.82-10.70, P<0.001). Patients with severe bronchiectasis were 10 times more likely to die than patients with mild bronchiectasis (hazard ratio: 10.11, 95% confidence interval: 4.22-24.27, P<0.001). CAC and bronchiectasis severity were independent predictors of mortality, but age, sex, smoking, and history of CAD or cerebrovascular disease were not.

Conclusions:

CAC is common in patients with bronchiectasis, and both CAC and bronchiectasis severity are independent predictors of mortality.
An Exploration of Multidisciplinary Team Care With Digital Technology for Complicated Cranio-Maxillofacial Bone Defects and Fractures
Authors: Liu Yutong , Wang Yiqun , He Xifan , Li Fangjie , Zhang Sheng , Wang Kai , Chen Lin , Wu Hanjiang
Published: September 2020

Objective:

Early treatment of fractures of the cranio-maxillofacial complex (CMFC) is challenging and likely to result in craniofacial deformity. Multidisciplinary team (MDT) care has developed very rapidly and has recently been accepted in cancer treatment. Therefore, the authors explored the application of MDT care with digital technology in CMFC fractures.

Study Design:

A 29-year-old man presented for treatment of CMFC fractures and bone defects. An MDT of oral surgeons, ophthalmic surgeons, neurological surgeons, and other experts was convened. After CT scan and three-dimensional reconstruction, the authors performed personalized surgery that included 9 specialists over an 8-hour period.

Results:

The operation was successful and all fractures achieved clinical stability. At 1-month follow-up, appropriate appearance and functional recovery had been achieved.

Conclusion:

In this study, MDT care with digital technology was very effective and had low associated costs. The involvement of more disciplines in MDT care may result in fewer complications.
An Update on Maxillary Fractures: A Heterogenous Group
Authors: Cohn Jason E. , Iezzi Zachary , Licata Jordan J. , Othman Sammy , Zwillenberg Seth
Published: September 2020

Background:

The purpose of this study was to review the different types of maxillary fractures and highlight their diagnostic and therapeutic differences.

Methods:

A retrospective chart review of patients who sustained maxillary fractures was conducted through the Einstein Healthcare Network during the years 2016–2017. Descriptive statistics and chi-square analysis were used to categorize continuous and categorical variables, respectively.

Results:

The cohort of patients (n = 141) were predominately African American (62%) and male (75%) with a mean age 45.3 years. The most common maxillary fracture was maxillary sinus (29%), followed by zygomaticomaxillary complex (ZMC) (26%), frontal process (20%), dentoalveolar (16%), and LeFort (9%). Dentoalveolar fractures were mostly evaluated by the oral maxillofacial surgery service (74%), while ZMC and LeFort fractures were more commonly referred to an otolaryngologist (56% and 67%, respectively). Patients with dentoalveolar fractures were more likely to undergo wire splinting (61%). All patients with frontal process and maxillary sinus fractures were managed non-operatively. Most patients with ZMC fractures were managed non-operatively (78%) while the remainder underwent open reduction internal fixation (ORIF) (22%). Patients with LeFort fractures more commonly underwent maxillomandibular fixation (MMF)/ORIF (83%). Dentoalveolar fractures were the most likely to be operated on the same day (93%) while ZMC and LeFort fractures were repaired within 1 week (88% and 100%, respectively).

Conclusion:

Maxillary trauma is very heterogenous in comparison to other maxillofacial trauma patterns. Each fracture type is treated uniquely and can involve one or more provider teams depending on the extent and severity of the injury, as well as hospital resources.
Novel Suturectomy Using Absorbable Plates in Early Surgery for Craniosynostosis
Authors: Sakahara Daisuke , Imai Keisuke , Masuoka Takeshi , Narita Chikayoshi , Matsumoto Kimiyo , Kunihiro Noritsugu
Published: September 2020

Background:

In craniosynostosis patients under 3 months of age, suturectomy is a valuable early treatment improving their outcomes. However, conventional suturectomy might not be in severe patients. The efficacy of our developed suturectomy using absorbable plates was examined.

Methods:

Our method was indicated for craniosynostosis patients under 3 months old who had severe intracranial hypertension, scaphocephaly, plagiocephaly, or trigonocephaly between September 2011 and March 2018. All patients underwent suturectomy, and the bone edges on both sides of the cuts were covered with absorbable plates. Evaluation was conducted with 3-dimensional computed tomography and photographs, and cephalic index, distance from dorsum sellae to forehead on computed tomography were analyzed.

Results:

Twenty-one of the 25 patients were evaluated. The preoperative cranial shapes were 4 brachycephaly, 6 scaphocephaly, 5 oxycephaly, 2 clover-leaf deformity, and 4 plagiocephaly. There were 9 syndromic and 12 nonsyndromic patients. The mean age at the time of surgery was 52.3 days (7–89), and the mean follow-up period was 3.5 years (1–8).

The cephalic index and cranial definition improved in 18 patients. The secondary surgery was not required in four syndromic and none of the 12 nonsyndromic patients. There were no major complications.

Conclusion:

Placement of absorbable plates was able to prevent bone formation during the early postoperative period, and yet also promote bone formation after plate absorption. The authors believe syndromic craniosynostosis patients with severe deformities and nonsyndromic ones with scaphocephaly or plagiocephaly, successfully avoided secondary surgeries. This approach is less invasive for craniosynostosis and is expected to be highly effective.
Investigation of a Valve-Agnostic Cranial Implant for Adult Hydrocephalus Patients Requiring Ventriculoperitoneal Shunting
Authors: Mitchell Kerry-Ann S. , Shay Tamir , Huggins Charity , Maxwell Christina R. , Hedayat Hirad , Huang Judy , Liebman Kenneth , Luciano Mark , Veznedaroglu Erol , Gordon Chad
Published: September 2020

Introduction:

Currently, the most effective treatment strategy for adults with hydrocephalus involves cerebrospinal fluid diversion by means of a shunt system, most commonly ventriculoperitoneal shunts (VPS). Ventriculoperitoneal shunting is associated with high complication and/or revision rates, in part due to the high-profile programmable valve designs. Thus, the valve-agnostic cranial implant (VACI) was designed and investigated as a safe and effective method of reducing the valve's high profile and is currently undergoing clinical trials. As such, the objective of this study was to collate preliminary, multi-institutional data of early outcomes using a VACI approach for patients requiring VPS by way of an Institutional Review Board approved registry.

Methods:

A total of 25 adult patients across 4 institutions and 6 surgeons underwent VACI placement for VPS based on preoperative evaluation and perceived benefit. Patient demographics, operative details, and preliminary outcomes are presented here.

Results:

Valve-agnostic cranial implant placement via a limited size craniectomy at time of shunt revision was performed with no adverse events. Over an average follow-up period of 1 year (394 ± 178 days), 92% of patients experienced no major shunt-related or scalp-related complications. There were 2 cases with a major complication requiring reoperation: 1 shunt tubing extrusion and 1 case of meningitis. The most frequent postsurgical intervention seen in this study was related to adjustment of drainage: a non-invasively performed valve reprogramming after initial shunt placement when proper flow rate is being established. Of the 8 cases of drainage adjustment, all but 1 (88%) were receiving a VPS for the first time, with the exception undergoing a fourth shunt revision. All instances of improper flow were treated non-surgically and remediated effectively via shunt reprogramming in clinic. Removal of the VACI was not indicated in any treatment course. In this way, all complications as they relate to the shunt valve were minor and required nonsurgical intervention, and no complications reported were directly or indirectly caused by using the VACI.

Conclusion:

Preliminary findings from this multicenter trial suggest promising outcomes with a low complication rate for patients with hydrocephalus undergoing VACI placement during VPS. Ongoing research will continue to provide a more robust clinical picture of VACI in hydrocephalus management as more data becomes available.
Traumatic Globe Subluxation Accompanied by Traumatic Optic Neuropathy
Authors: Kim Woojin , Yang Sungwon , Park Jinhwan , Lee Hwa , Baek Sehyun
Published: September 2020

A 52-year-old, alcohol-intoxicated woman suffered periorbital trauma to the left eye and presented to the emergency department with proptosis and complaints of decreased vision in the left eye. Physical examination revealed loss of light perception (LP), relative afferent pupillary defect (RAPD), pupil dilatation, and corneal epithelial defect of the left eye. In addition, the fundus of the left eye was not easily visible due to severe corneal abrasion and edema, but there was no retinal detachment or vitreous hemorrhage on B-scan ultrasonography. Hertel exophthalmometric values differed by 7 mm between the eyes and measured 13 mm in the right eye and 20 mm in the left eye. In addition, she had severely limited left eye movement in all directions. Computerized tomography (CT) imaging of the orbit showed that the left optic nerve extended 15 mm further than the optic nerve of the right eye and retrobulbar hemorrhage of the left eye. The patient underwent emergency lateral canthotomy, cantholysis, and conjunctival incision to release the optic nerve extension and reduce the eyeball subluxation of the left eye. An intraoperative examination demonstrated that all extraocular muscles of the left eye were intact. The left eyeball returned to its normal position after surgery. Two days after surgery, proptosis of the left eye improved significantly, and there was no difference in Hertel exophthalmometric values between the eyes, both eyes measured 13 mm. However, the patient continued to suffer LP, RAPD, and pupil dilatation of the left eye.
Recommended Management of Temporomandibular Joint Dislocation During the COVID-19 Outbreak
Authors: Liu Min , Liu Mingwen , Lv Kun
Published: September 2020

The epidemic of coronavirus disease 2019 (COVID-19) has become a major public health disaster worldwide. From January 23 to March 20, total 17 patients with TMJ dislocation were treated in dental emergency department in School and Hospital of Stomatology, Wuhan University. Almost half of the patients are older than 80 years of age and they have recurrent joint dislocations. They are also at high risk for the COVID-19. The supine position technique method is suggested. The authors consider it necessary to recommend a practical management for TMJ dislocation.
Management of an Unusual Blow-In Orbital Roof Fracture Associated an Intracranial Hematoma
Authors: Pereira Rodrigo dos Santos , Silva Jonathan Ribeiro da , Guerra Raphael Capelli , Ferreira Túlio Vidal , Mota João Manoel , Latini Gustavo Lima
Published: September 2020

Pure orbital wall fractures represent until 25% of the facial fractures and its reconstruction it's considering a challenge for the maxillofacial surgeons. There are many biomaterials used to repair these fractures according to the literature however, the most common are the titanium mesh and autogenous bone graft.

The aim of this work is to report a rare case of blow-in roof orbital fracture associated to an intracranial hematoma in the cranium base.
Craniofacial Dysmorphology in Unilateral Coronal Synostosis Using Three-Dimensional Landmark-Based Analysis With Generalized Procrustes Superimposition
Authors: Rutland John W. , Delman Bradley N. , Bellaire Christopher , Napoli James G. , Shuman William , Rutland Emily A. , Ranti Daniel , Margulies Ilana G. , Goel Pedram , Sayegh Farah , Urata Mark M. , Taub Peter J.
Published: September 2020

Background:

Geometric morphometric analysis with Procrustes superimposition is an advanced computational tool that can be used to quantify dynamic changes in complex three-dimensional structures. The present study couples high resolution CT imaging with a Geometric Morphometric approach in order to further understand the complex dysmorphology that occurs in unilateral coronal synostosis (UCS).

Methods:

Forty-one UCS patients and 41 age- and sex-matched controls received high-resolution CT imaging. Thirty-one anatomical landmarks were identified on each imaging set. A geometric morphometric workflow was used to perform a Procrustes superimposition to register landmarks into a common space. Procrustes-aligned landmarks were used to derive angle calculations, lengths, and other anatomical measurements. Three-dimensional coordinates were also used to perform a principal components analysis (PCA).

Results:

Unilateral coronal synostosis patients exhibited significant angular deviation at the levels of the inferior skull base, mid-posterior fossa, and vertex. Both left- and right-sided UCS patients showed increased lengthening in the transverse (left-right) dimension, exhibiting increased length between the left and right EAC (P = 0.047). Conversely, UCS patients revealed shortening in the midline AP dimension as evidenced by the decreased Nasal root-Lambda (P < 0.0001) and Nasal root-superior dorsum sellae (P = 0.01) distances compared with controls. PCA revealed that 25.26% of variation in shape among the patients sampled to be driven by flattening of the skull and that18.93% of variation was driven by right-sided deformity and mediolateral expansion.

Conclusions:

Significant dysmorphology between UCS patients and controls was quantified using Geometric Morphometric approach, which may be useful in further characterizing the dynamic craniofacial changes in UCS.
The Effects of Age and Race on Calvarium, Tegmen, and Zygoma Thickness
Authors: Saltagi Mohamad Z. , Schueth Elizabeth , Nag Amit , Rabbani Cyrus , MacPhail Margaret E. , Nelson Rick F.
Published: September 2020

Objective:

Temporal bone spontaneous cerebrospinal fluid (sCSF) leaks are characterized by defects in the tegmen along with calvarial thinning without associated thinning of the extracranial zygoma. The authors sought to determine the effect of age and race on calvarial, tegmen, and zygoma thickness.

Study Design:

Retrospective cohort study.

Setting:

Tertiary Referral Center.

Patients:

A total of 446 patients with high-resolution head computer tomography (CT) imaging from 2003 to 2018.

Intervention(s): Calvarial, tegmen, and zygoma thicknesses were measured using 3D slicer.

Main Outcome Measure(s): Effects of age and race on calvarium, tegmen, zygoma thickness.

Results:

Among all patients, increased age was associated with increased thickness of the calvarium [95% CI, 0.0002 to 0.007 mm/year, P < 0.05] and tegmen [95% CI, 0.00039 to 0.0075 mm/year, P = 0.03], but decreased thickness of the zygoma [95% CI, −0.013 to −0.005 mm/year, P < 0.001]. When compared to white patients, black patients had thicker mean [SD] calvaria (2.63 [0.61] versus 3.30 [0.79] mm; difference, 0.67 mm; [95% CI, 0.57 to 0.77]; Cohen d, 1.02), tegmen (0.73 [0.34] versus 0.92 [0.36] mm; difference 0.19 mm; [95% CI, 0.101 to 0.279]; Cohen d, 0.533) and zygoma (4.89 [0.81] versus 5.55 [0.91] mm; difference, 0.66 mm; [95% CI, 0.53 to 0.79]; Cohen d, 0.78).

Conclusions:

Racial differences exist in calvarial and zygoma thickness. Aging generally leads to increased calvarium and tegmen thickness, suggesting that early onset of obesity and comorbid conditions known to thin the skull base may predispose patients to developing sCSF leaks by reversing the effects of age.
Three-Dimensional-Printed Temporal Mandibular Joint for Use in Mandibular Distraction for Patients With Craniofacial Microsomia
Authors: Bradford Perry S. , Black Jonathan S.
Published: September 2020

The objective of this study is to validate the proof of concept of a 3-dimensional (3D)-printed temporal mandibular joint (TMJ) for use in mandibular distraction in patients with severe craniofacial microsomia (CFM). Patients with Pruzansky-Kaban IIB and III have severe condylar dysplasia and abnormal or absent TMJs, often resulting in upper airway obstruction during infancy. As these patients progress, they require subsequent surgeries to correct facial asymmetry and TMJ function. While studies have shown promising outcomes with costochondral grafting or mandibular distraction without a TMJ in the setting of patients with Pruzansky-Kaban IIB and III it is often unsuccessful in avoiding tracheostomy during infancy. Using an adult head and neck cadaver, the right condylar head was removed to emulate a Pruzansky-Kaban III mandible. A 3D model of an adult skull was obtained. The 3D TMJ was replaced into the cadaver and KLS distractor applied in the vertical orientation. The authors achieved adequate distraction using a 3D-printed TMJ. The 3D structure developed here can potentially be used for clinical application in CFM patients with absent or rudimentary TMJ for distraction and further avoidance of the need for tracheostomy for airway obstruction.
Are You Thinking About Going Back to School? An Analysis of Plastic Surgery Residents, Alumni, Faculty, and Program Leaders With Advanced Degrees
Authors: Azoury Saïd C. , Othman Sammy , Milbar Niv , Elfanagely Omar , Piwnica-Worms William , Kozak Geoff , Serletti Joseph M. , Fischer John P. , Kovach Stephen J.
Published: September 2020

Background:

The number of adults with master's, professional, and doctoral degrees has doubled since 2000. The relevance of advanced degrees in plastic surgery has not been explored.

Methods:

Faculty, residents, and recent alumni with advanced degrees from the United States plastic surgery training programs were identified. Degrees were analyzed based on geography, program/hospital rankings, department versus division status, gender, leadership/editorial roles, private versus academic practice, subspecialization training, academic productivity/H-indices, and National Institutes of Health funding.

Results:

A total of 986 faculties, 1001 residents, and 761 alumni credentials from 95 training programs were reviewed: 9.3% of faculties, 7.1% of residents, and 6.3% of alumni have advanced degrees, majority being men (71%). Residency programs ranked top 10 by Doximity or affiliated with a top 10 medical school/hospital have more faculty/residents/alumni with advanced degrees (P < 0.01). Faculty holding PhDs are less likely fellowship trained (52.5% versus 74.0%, P = 0.034). Master's in Business Administration (MBA) is associated with chair/chief status (30.0% versus 8.57%, P = 0.01) or other major academic title (eg, Dean, Director) (70.0% versus 37.14%, P = 0.01). No significant associations exist between degree type and professor status, research productivity, academic versus private practice, or subspecialization (eg, craniofacial surgery).

Conclusion:

The majority of plastic surgeons with advanced degrees have PhDs, although there is an increasing trend of other research degrees (eg, Master's in Public Health) in current trainees. MBA is associated with chair/chief status or other major academic title. Reasons for obtaining an advanced degree and impact on career deserve further attention.
Spring-Assisted Strip Craniectomy Versus Cranial Vault Remodeling: Long-Term Psychological, Behavioral, and Executive Function Outcomes
Authors: Chandler Ludmila , Allam Omar , Park Kitae E. , Smetona John , Gabrick Kyle S. , Wu Robin T. , Morgan Chelsea , Park Sydney E. , Chapman Leah A. , Couture Daniel E. , David Lisa R. , Runyan Christopher M. , Persing John A. , Alperovich Michael
Published: September 2020

Background:

Controversy exists regarding the optimal surgical approach for non-syndromic sagittal synostosis. This study provides the first comparative analysis of the long-term behavioral, psychological, and executive function outcomes for patients who underwent either cranial vault remodeling (CVR) or spring-assisted strip craniectomy (SAS).

Methods:

Thirty-six CVR patients and 39 SAS patients were evaluated. Parents and caregivers completed the Behavior Rating Inventory of Executive Function (BRIEF) and the Behavior Assessment System for Children, Second Edition (BASC-2) to evaluate behavioral, emotional, social, adaptive, and executive functioning skills.

Results:

There were no statistically significant differences between the CVR and the SAS groups (P > 0.05) in any of the BRIEF areas of function. Furthermore, the BASC-2 battery illustrated no significant differences in all areas analyzed except one. Among the 2 groups, the CVR group was rated as having fewer social withdrawal symptoms on the BASC-2 (47.00 ± 10.27) compared to the SAS cohort (54.64 ± 10.96), F = 6.79, P = 0.012, Cohen d = 0.688. However, both means were still within the normal range.

Conclusions:

Children undergoing SAS and CVR procedures for isolated sagittal synostosis were not rated as having clinically significant behavioral, emotional, social, adaptive, or executive functioning problems on parental forms.
Perioperative Outcomes in the Treatment of Isolated Sagittal Synostosis: Cranial Vault Remodeling Versus Spring Mediated Cranioplasty
Authors: Patel Viren , Shakir Sameer , Yang Robin , Humphries Laura S. , McKenna Rachel A. , Heuer Gregory , Lang Shih-Shan , Bartlett Scott P. , Taylor Jesse A. , Swanson Jordan W.
Published: September 2020

Background:

Patients undergoing cranial expansion including spring-mediated cranioplasty (SMC) and cranial vault remodeling (CVR) receive costly and high acuity post-operative intensive care (ICU) given concerns over neurologic and hemodynamic vulnerability. The authors analyzed perioperative and post-operative events for patients presenting with sagittal craniosynostosis (CS) undergoing SMC and CVR in order to compare complication profiles.

Methods:

The authors performed a single center retrospective cohort study of patients undergoing SMC and CVR for the treatment of nonsyndromic, isolated sagittal CS from 2011 to 2018. Perioperative and post-operative factors were collected, focusing on hemodynamic instability and events necessitating ICU care. Mann-Whitney U and Fisher exact tests were used to compare data with significance defined as P < 0.05.

Results:

Among 106 patients, 65 (61%) underwent SMC and 41 (39%) CVR. All CVR patients received prophylactic whole blood transfusion at time of scalp incision. Acute blood loss anemia was the most common post-operative complication, prompting n = 6 (9.2%) and n = 7 (17.1%) blood transfusions in the SMC and CVR cohorts, respectively (P < 0.24). Hemodynamic instability requiring blood transfusion was rare, occurring post-operatively in n = 2 (3.1%) and n = 2 (4.9%) patients in the SMC and CVR cohorts, respectively (P < 0.64). Two patients in the CVR cohort exhibited new neurologic symptoms that self-resolved, compared to no patients in the SMC cohort (P < 0.15).

Conclusion:

Despite differing degrees of operative invasiveness, post-operative hemodynamic and neurologic decompensation following CVR and SMC for isolated sagittal CS repair remains similarly rare. Indications necessitating post-operative intensive care are infrequent. Post-operative hemoglobin monitoring may enable early prediction for hemodynamic instability.
Nasal Septal Hematoma and Abscess in Children: An Uncommon Otorhinolaryngology Emergency Revisited
Authors: Sayin Ibrahim , Yazici Zahide Mine , Abakay Mehmet Akif , Saygan Gulsun Basak , Gunes Selcuk
Published: September 2020

Objective:

To evaluate the demographic factors, trauma type, treatment, and long-term results in patients with nasal septal hematoma (NSH) and nasal septal abscess (NSA) in pediatric age group.

Methods:

Between the years 2006 and 2019, patients who received a diagnosis of NSA and NSH were included for the study. Demographic data, the surgical findings, and long-term follow-up results were recorded.

Results:

A total of 68 patients were identified. Forty-five patients were diagnosed as NSA and 23 patients were diagnosed with NSA. Mean age of the patients was 7.00 ± 3.33 years. Patients did not differ in terms of age, gender, and etiology. Mean duration of the symptoms was significantly high in NSA group (4.11 ± 4.00 days for NSH and 7.61 ± 7.71 days for NSA, P = 0.011). Associated nasal fracture was significantly high in NSH group. Previous nasal examination was significantly high in NSA group. Epistaxis was present significantly high in NSH group (P = 0.013). Fever and purulent nasal discharge was observed significantly high in NSA group. Forty-seven (n = 47) patients can be reevaluated for long-term deformity (NSH, n = 34 [72.34%] and NSA, n = 13 [27.65%]). Mean follow-up period of the patients was 8.7 years. In total, 61.7% of the patients experienced minor or major sequelae. Both NSA and NSH groups did not differ in terms of minor sequelae and major sequelae. No sequleae was significantly high in NSH group (for NSH n = 17/34-(50,0%); for NSA n = 1/13- (7,7%), p = 0.008). Both NSA and NSH groups did not differ in terms of no sequelae and minor sequelae.

Conclusion:

The NSH and NSA are uncommon conditions that needed prompt diagnosis and intervention.
Evaluation of the Effects of ß-Adrenergic Receptor-Propranolol on Osseointegration of the Titanium Implants
Authors: Talo Yildirim Tuba , Dündar Serkan , Bozoğlan Alihan , Karaman Tahir , Tekin Samet , Kahraman Onur Evren
Published: September 2020

This study aimed to investigate the effects of systemic propranol on the osseointegration of titanium implants. After the surgical insertion of titanium implants into the metaphyseal part of the tibial bone, the rats were randomly divided into 2 equal groups: the control (CNT) (n = 10) and propranol group (P) (n = 10); CNT: Rats received no further treatment during the 4 week experimental period after surgery. Rats received 10 mg/kg propranol in every day during the 4 week experimental period in PRP group after the surgical insertion of the implants. After the experimental period, the rats were euthanized, blood serum were collected to biochemical analysis and the implants and surrounding bone tissues were used for the histopathologic analysis. To analysis of the data between tests and controls student T test was used. There were no significant differences in the biochemical parameters (alcaline phosphatase, calcium, phosphor) of the groups (P > 0.05). Bone implant connection (BIC) ratios was detected higher in test animals compared with the controls (P < 0.05). Systemic propranolol may increases titanium implant osseointegration.
Implant Dental Rehabilitation of Fibula-Free Flap Reconstructed Jaws
Authors: Zavattero Emanuele , Ramieri Guglielmo , Agrò Giovanni , Fasolis Massimo , Garzino-Demo Paolo , Borbon Claudia
Published: September 2020

Background:

The possibility of placing dental fixtures in the reconstructed regions allows us to overcome the problems related to dental rehabilitation with removable prosthesis. The aim of this study was to assess the clinic-radiological outcome in a series of patients who underwent fibula flap jaws reconstruction and rehabilitation with implant-supported prosthesis with a minimum follow-up of 24 months.

Material and Methods:

The study included 10 patients who underwent reconstruction with fibula free flap between 2010 and 2018. Albrektsson criteria were used to define the implant survival. The follow-up evaluation was performed according to a standardized protocol including clinical examination, radiological evaluation (panoramic radiograph) and patient interview.

Results:

A total of 45 implants were positioned.

The time between mandibular reconstruction and implant placement ranged from 13 months to 39 months.

The prosthesis used was fixed in 6 cases and supported overdenture in 4 cases.

No implant failure was observed.

Regarding implant survival no infections were observed in these series. Nine patients out of 10 had no pain and signs of mobility. Seven patients out of 10 had absence of peri-implant radiolucency at the panoramic radiograph.

One patient presented with an overgrowth of granulomatous soft tissue around the implant abutments that caused pain.

Conclusions:

Implant placed in vascularized bone grafts are a safe and reliable opportunity to rehabilitate patients following mandibular resection. The results of this series demonstrate a high survival rate for implants placed in reconstructed mandibles with an improvement of the quality of life.
Laryngeal Osteoblastoma: Unusual Location in Arytenoid Cartilage
Authors: Avci Hakan
Published: September 2020

Osteoblastoma is a benign bone tumor with a slow growing and local aggressive nature. This tumor type is usually localized in the cervical vertebra and rarely involves laryngeal cartilage structures. Very few osteoblastoma cases have been reported in the literature. Here we present laryngeal osteoblastoma originating from arytenoid cartilage in a patient with a history of cordectomy due to glottic squamous cell carcinoma.
A Simple Dressing Fixation Method Following Harvest of the Ear Cartilage Graft
Authors: Du Hong , Zhang Dong , Zong Xianlei , Song Guodong , Zhao Jingyi , Yang Changsheng , Guo Xiaoshuang , Lai Chenzhi , Jin Xiaolei
Published: September 2020

Auricular cartilage is a common autologous graft material for rhinoplasty. Even though surgical techniques for the harvest of cartilage graft are well established, the management of the postoperative dressing fixation is still limited. Therefore, the authors propose a simple dressing fixation method in which gauze strips instead of gauze block or wet cotton, the suture of tie-over dressing fixed just through the cartilage rather than the full thickness of the auricle, a vaseline gauze interposed between the stitch knot and the skin and no additional pressure dressings postauricularly. No case of hematoma, infection and skin necrosis of the donor site was observed. This simple and reproducible technique provides perfect and homogeneous adhesion of the dressing all over the conchal cartilage while decreasing the risk of postoperative hematoma and discomfort.
Reconstruction of a Gunshot-Caused Mouth Floor Defect Using a Nasolabial Flap and a De-Epithelialized V-Y Advancement Flap
Authors: Hwang Kun , Ma Sung Hwan
Published: September 2020

We present reconstruction of a gunshot-caused mouth floor defect using a nasolabial flap and a de-epithelialized V-Y advancement flap.

A 58-year-old man presented 14 days after bullet injury passed from anterior chin to the right postauricular area. Upon examination, the central incisors, alveolar bones, and soft tissues of the mouth floor were lost. Bone fragments and failed miniplates were exposed. Pus discharge filled the defect.

On the 23rd post-trauma day, right unilateral nasolabial flap was used to cover the oral side of the mouth floor. This flap was centered on the nasolabial fold and its base was situated on the commissure of the lips. The flap was raised in the soft tissue, just superficial to the facial muscles, transferred into the oral cavity through an incision made in the cheek mucosa, and sutured to the margin of the defect. A de-epithelialized dermal and subcutaneous flap was used to reconstruct the deep portion of the mouth floor through the V-Y advancement method. At the lower border of the mandible, a 3-cm-wide V-Y advancement flap was designed. The de-epithelized portion was inserted into the mouth floor and sutured to the defect margin. On 30th post-trauma day, left commissure-based buccal mucosal flap was used for the gingivobuccal sulcus defect. The apex was near the retromolar trigone. The elevated flap was transferred to the lower gingivobuccal sulcus defect. On POD 28, the nasolabial flap and commissure-based buccal myomucosal flap was divided and inset respectively.

These flaps can be used for moderate-sized mouth floor defects.
Analysis of Head and Neck Primary Cutaneous Mucinous Carcinoma: An Indolent Tumor of the Eccrine Sweat Glands
Authors: Behbahani Sara , Pinto Jessica O. , Wassef David , Povolotskiy Roman , Paskhover Boris
Published: September 2020

Background/Objectives:

Primary cutaneous mucinous carcinoma (PCMC) of the head and neck is a rare pathologic entity that is an adenocarcinoma of the eccrine sweat glands. Though it has low metastatic potential, it does have a significant recurrence rate. Due to its rarity, its clinical features are not well-known.

Methods:

The authors searched the National Cancer Database (NCDB) for all cases of PCMC with primary sites of the skin of the head and neck confirmed histologically diagnosed from 2004 to 2016. Those with missing survival information were excluded. Kaplan-Meier (KM) and Cox proportional-hazards models were used to analyze the epidemiology and survival outcomes of PCMC.

Results:

The authors analyzed 289 cases. Females were more commonly affected (58.8%; P < 0.05) with the most common primary sites being the eyelid (41.9%) and scalp/neck (25.3%). The average age of diagnosis was 63.8 years (± SD 12.5). Almost all patients received surgery as standalone treatment (92.7%) with wide local excision being the common surgery performed (36.3%). Mohs surgery represented 15.2% of surgically treated cases. Mean overall survival (OS) was 11.4 years with 5-year and 10-year OS being 85.0% and 78.0%, respectively. Most cases were localized at diagnosis with only 2% metastatic at presentation. KM analysis indicated that surgical procedure type, age, tumor diameter, Charlson-Deyo Comorbidity Score, facility type, and stage were significant predictors of OS (P < 0.05). Cox proportional-hazards analysis did not reveal independent association of the aforementioned factors with OS.

Conclusion:

Primary cutaneous mucinous carcinoma has an excellent prognosis with 98% of cases being diagnosed in Stage I and Stage II. As most cases present in the eyelid, special attention should be given to surgical treatment to ensure optimal aesthetic outcomes in this sensitive region. This study represents the largest cohort of head and neck PCMC studied to date.
Insertion Tendinosis of Stylomandibular Ligament: Ernest Syndrome
Authors: Jose Anson , Rawat Aditi , Nagori Shakil Ahmed
Published: September 2020

Insertion tendinosis of stylomandibular ligament (SML) or Ernest syndrome is a very rare and under reported head and neck pain disorder. The pain originates from the insertion of stylomandibular region and radiates to the temple, lateral side of the neck and temporomandibular joint (TMJ). The diagnosis is confirmed by palpation of SML and local anesthetic block at the insertion of SML. The authors report 4 patients who presented with chronic pain which radiated to the TMJ and temple and did not respond to conservative management. All patients after diagnosed with Local anesthetic block were given methylprednisolone injection at the insertion of SML. Complete remission of pain was seen at 12 months of follow up without any recurrence. Craniofacial surgeons involved in the treatment of various head and neck pain should include this less documented syndrome in their differential diagnosis when treating TMJ disorders.
Facial Reanimation by Modified Intraoral Temporalis Tendon Transfer With Ancillary Procedures
Authors: Jose Anson , Nagori Shakil Ahmed , Rawat Aditi , Singh Shagun , Roychoudhury Ajoy
Published: September 2020

Facial nerve palsy is an exceedingly debilitating condition, incapacitating functional and aesthetic facets of the face. Orthodromic transfer of temporalis muscle is an easy and predictable technique which offers early animation of oral commissure and lower face. A retrospective chart review of 6 patients of facial palsy treated with orthodromic temporalis tendon transfer for facial reanimation is presented. The technique consisted of intra-oral coronoidectomy followed by attachment of fascia lata grafts from the coronoid to the commissure, the upper and lower lips via small cutaneous incisions. Contraction of the temporalis, pulls the fascia lata extensions thereby reanimating the lower face. 4 male and 2 female patients with an age range of 25 to 49 years were treated. Simultaneous fat grafting (2 patients), depressor labi inferioris muscle resection (2 patients) and wedge excision of nasolabial fold (2 patients) was done as ancillary procedures. Post-operative smile evaluation was carried out using the Terzis and Noah facial grading system. Patients were asked to smile with and without biting, and photographs and video were taken. The results were graded from 1 to 5 based on a 5-point scale (ie, poor, fair, moderate, good, and excellent) by an independent observer. The results were excellent in 1 patient (Terzis grading 5/5) and good in the remaining 5 patients (Terzis grading 4/5). Excursion of the oral commissure ranged from 6 to 10 mm. Our experience indicates that temporalis tendon transfer for facial reanimation has a short learning curve and provides early predictable outcome without significant complications. This single-stage, day-care procedure can be easily incorporated by maxillofacial surgeons to expand their surgical spectrum.
Optimizing Surgical Procedures of Auricular Keloids According to Their Anatomic Morphological Features
Authors: Chuan Li , Congxiao Wang , Luyi Wang , Ying Zhang , Shuyan Qie
Published: September 2020

Background:

Aesthetic surgical reconstruction of auricular keloids is still a conundrum. This study introduces our experiences in analyzing the anatomic morphological features of auricular keloids, and devising optimized surgical procedures accordingly.

Methods:

A total of 129 ears with auricular keloids were classified and operated. All patients were followed up for at least 12 months.

Results:

According to their anatomic positions, auricular keloids were divided into 3 Groups (A, B, and C). The morphological features of keloids were further interpreted according to Chang-Park classification of earlobe keloids. The authors optimized surgical procedures according to the anatomic morphological features from a range of surgical techniques. The recurrence rate of Group C was statistically higher than Group A and B. There was no significant difference in recurrence rate between keloids treated with “primary suture” and “filleted flaps.”

Conclusions:

According to the anatomic positions and morphological features of auricular keloids, we could conveniently devise optimized surgical strategies to obtain aesthetic reconstruction of auricular keloids.
The Role of Autologous Platelet Concentrates in the Treatment of Medication-Related Osteonecrosis of the Jaw
Authors: Ye Peng , Wei Tai , Lu Zhi-Yue , Cai Ye-Jun
Published: September 2020

The frequent refractory response of patients to the treatment of medication-related osteonecrosis of the jaw (MRJON) has attracted clinicians’ attention to several treatments. However, they are at best, palliative, and have a higher failure rate than previous treatments. The present meta-analysis was performed to evaluate the clinical effectiveness of autologous platelet concentrates (APCs) combined with surgery in the treatment of MRONJ. The authors conducted a meta-analysis involving a systematic search of PubMed, EMBASE, Wiley Online Library and the Cochrane Library for eligible studies from their inception to November 2019, in accordance with preselected criteria. The inverse variance method was applied to fixed or random effects models based on the heterogeneity of the studies. Thirteen studies that investigated APCs in the treatment of MRONJ were eligible for inclusion in the meta-analysis of 223 patients and 33 lesions. The pooled success rate of APCs combined with surgery for MRONJ was 90% (95%CI, 80%–97%) and the pooled OR was 7.67 (95%CI, 2.10–27.98), indicating the combination was 7.67 times more effective than surgery alone. The results suggest that the use of APCs is a promising therapeutic regimen, as it provided additional benefits to surgery in the treatment of MRONJ. To achieve the benefits, a tension-free primary closure of the soft tissue is recommended as well. Randomized studies with large sample sizes is warranted to confirm our finding.
The Morpho-Functional Three-Dimensional Analysis for Zygomatic Implants: A Clinical Tool With Surgical Implications
Authors: Fernández-Olarte Humberto , Gómez-Delgado Andrés , Gutiérrez-Quintero Juan G. , Rodríguez-Sáenz Álvaro , Castro-Núñez Jaime
Published: September 2020

Zygomatic implants (ZIs) have been used successfully for the rehabilitation of jaws with severe atrophy for the past 2 decades. The development of computed tomography, three-dimensional (3D) analysis software, and stereolithographic models has positively impacted the development of preoperative planning. This article describes the protocol developed by the Department of Oral and Maxillofacial Surgery of El Bosque University, Bogotá, Colombia, through 10 years of experience, for the installation of ZIs, covering from the times when the implants were placed through intraoperative guidance, until now, in which drilling guides developed by computer-aided design and computer-aided manufacturing are used, without neglecting in their design multiple factors that must be considered. To date, this protocol for the treatment of patients with atrophic jaws through ZIs includes a detailed clinical examination, in which variables such as bone and dental relationship between the jaws, oral opening and dynamic interaction between soft cervicofacial tissues are considered. It also includes a 3D computed tomography planning for the design and preparation of surgical guides whose insertion patterns must be executable during surgery. Together, clinical and imaging analysis converge in what it has been called morpho-functional 3D planning.
The Clinical and Radiologic Features Affecting the Ocular Symptoms in Patients With Paranasal Sinus Mucoceles Involving the Orbit
Authors: Kim Yong-Wan , Yi Keun-Ik , Kang Myoung Joo , Kim Sung-Dong , Mun Sue Jean , Cho Kyu-Sup
Published: September 2020

Introduction:

Paranasal sinus (PNS) mucoceles may involve orbit and have ophthalmic manifestations. The objective of this study was to investigate the clinical and radiological features affecting the ophthalmic manifestations in patients with PNS mucoceles involving the orbit.

Methods:

Fifty-two patients underwent endoscopic sinus surgery for PNS mucoceles with orbital involvement were investigated. Ophthalmic manifestations included exophthalmos, ocular pain, diplopia, visual disturbance. The correlation between ocular symptoms and the mucocele volume, origin site of mucocele, and the involvement of extraocular muscles or optic nerve were evaluated.

Results:

Ophthalmic manifestations were significantly higher in the anterior ethmoid and frontal sinus involvement. Exophthalmos was significantly increased in the involvement of anterior ethmoid sinus, frontal sinus, and superior group ocular muscles, but decreased in the mucocele of maxillary sinus. Ocular pain was significantly lower in the involvement of anterior ethmoid sinus, frontal sinus, and superior group ocular muscle. Diplopia showed no significant differences among clinical and radiological parameters. Visual disturbance was significantly higher in the involvement of posterior ethmoid sinus and sphenoid sinus. The volume of mucocele, relation to optic nerve, adjacent bony change, and duration of ocular symptom had no significant effect on ocular symptoms in patients with PNS mucoceles involving the orbit.

Conclusion:

The volume of mucocele did not affect the ophthalmic manifestations in patients with PNS mucoceles involving the orbit. Exophthalmos, ocular pain, and visual disturbance were significantly correlated with the involved sinus of PNS mucoceles.