bluuebunny/crossref_metadata_2025_split huggingface dataset:
Supraclavicular Flap Reconstruction in Head and Neck Oncologic Surgery
Authors: Karabulut Burak 
Published: March 2020

Abstract
Free flaps have been considered as the gold standard for reconstruction of head and neck region after ablative oncologic surgery. However, the reconstructive surgeon's armamentarium should also involve pedicled flaps for certain situations such as patients having comorbid diseases necessiating shorter duration of surgical procedure. The supraclavicular flap is a pedicled thin fasciacutaneous flap used to reconstruct the defects in head and neck area. The flap has advantages of wide rotation of arc, easy matching with skin color of recipient area and relatively shorter flap harvesting time. Its bloods supply depends on supraclavicular artery which is a branch of transverse cervical artery. Between August 2016 and September 2019, the pedicled supraclavicular flap was used to reconstruct 17 head and neck cancers patients after ablative oncologic surgery. In 15 patients this flap was primary choice and in 2 patients it was used as a salvage reconstructive tool. Two of 17 flaps had very distal partial necrosis. There was no total loss of any flap. Flap harvesting time was always less than 1 hour. Mean duration for drainage tube removal at the donor side was 5 days. Functional outcomes were perfect. In our suggestion pedicled supraclavicular flap is a very good alternative option to free flap reconstruction especially for skin and oral cavity defects.
Orbital Apex Syndrome Causing Blindness Secondary to a Vertical Root Fracture of a Tooth
Authors: Li Jun , Huang Jing , Qiu Yu , Lin Lisong 
Published: March 2020

Abstract
The authors report a case of a 35-year-old man who presented with left maxillary toothache associated with left sided facial pain and a rapidly progressive loss of vision in the left eye. Clinical and radiological assessments revealed it to be an odontogenic orbital apex syndrome secondary to a vertical root fracture of a tooth. The infection was treated and controlled, postoperative follow-up showed no recurrent inflammation and the patient recovered well. However, the vision was lost permanently. Odontogenic orbital apex syndrome is a rare, aggressive disease. Once the infection spreads, it progresses rapidly, becoming a dangerous condition. To achieve better prognosis and improve survival rates, dental practitioners and oral surgeons should be aware of this distinct presentation and should have a high index of suspicion for the complication of tooth-related problems however minor they may seem.
Temporomandibular Joint Ankylosis in Pediatric Patients With Craniofacial Differences: Causes, Recurrence and Clinical Outcomes
Authors: Ramly Elie P. , Yu Jason W. , Eisemann Bradley S. , Yue Olivia , Alfonso Allyson R. , Kantar Rami S. , Staffenberg David A. , Shetye Pradip R. , Flores Roberto L. 
Published: March 2020

Background:
The authors present an institutional experience treating congenital and acquired temporomandibular joint (TMJ) ankylosis, detailing outcomes and potential risk factors of recurrence.

Methods:
Retrospective chart review identified patients with TMJ ankylosis (1976–2019). Clinical records, operative reports, and imaging studies were reviewed for demographics, surgical operations, and ankylosis including maximal interincisal opening (MIO) and re-ankylosis.

Results:
Forty-four TMJs with bony ankylosis were identified in 28 patients (mean age at any initial mandibular surgery: 3.7; range:0–14 years). Follow-up was 13.7 ± 5.9 years. Sixteen (57.1%) patients had bilateral ankylosis; 27(96.4%) had syndromes. Nine patients had congenital ankylosis, 16 had iatrogenic ankylosis (4.5 ± 3.7 years from initial distraction osteogenesis or autologous mandibular reconstruction) referred from outside institutions in 6 instances, and 3 had post-infectious ankylosis. Patients having their first mandibular operation at a younger age had more frequent reoperations for recurrent TMJ ankylosis, although this did not reach statistical significance. Mean improvement in MIO was 21.4 ± 7.3 mm. Ankylosis recurred in 21 (75%) patients. Five patients with congenital TMJ ankylosis required gastrostomy and remained at least partially dependent. Five patients had tracheostomy at the time of TMJ ankylosis surgery: 2 were eventually decannulated and 3 required repeat tracheostomy after ankylosis recurrence and remained tracheostomy-dependent.

Conclusion:
The clinical course of TMJ ankylosis in children affected by craniofacial differences is complex and typically involves a high rate of recurrence and multiple reoperations despite initial improvement in postoperative MIO. Younger age at initial mandibular surgery and number of operations require further investigation as potential predictors of recurrent TMJ ankylosis as well as tracheostomy and gastrostomy dependence.
Assessing Facial Asymmetry in Postoperative Patients With Unilateral Coronal Craniosynostosis
Authors: Gabrick Kyle S. , Wu Robin T. , Singh Anusha , Bartlett Scott P. , Taylor Jesse A. , Persing John A. , Alperovich Michael 
Published: March 2020

Background:
Despite surgical correction of unilateral craniosynostosis (ULC), complex cranial base angulation can result in partial reversion to preoperative deformity with growth and time. Using 3-dimensional imaging, dysmorphic facial features of ULC in school-age patients were quantified and related to how they contribute to overall facial asymmetry and patient-reported outcomes.

Methods:
Children who underwent surgical correction of ULC were recruited from Yale University and Children's Hospital of Philadelphia. The 3D photographs were analyzed utilizing a Procrustes analysis of shape. Pearson's correlation was used to determine dysmorphic features’ impact on overall asymmetry. Patients were stratified into “moderate” and “severe” asymmetry. Finally, asymmetry was correlated to patient-reported outcome scores. Statistical analysis was performed with SPSS-25 with P < 0.05 as statistically significant.

Results:
Twenty-one patients were included with average age at analysis of 12.3 years. Fifty-seven percent of patients had right-sided fusion. The overall Procrustes analysis indicated a root mean square difference of 2.21 mm. Pearson's correlation indicated that the facial middle 3rd (P ≤ 0.001), orbital dystopia (P < 0.001), chin point deviation (P = 0.011), and nasal root angulation (P = 0.019) contributed most to overall asymmetry. Patients in the severe asymmetry cohort had greater facial middle-third asymmetry (P < 0.001) and orbital dystopia (P < 0.001). Asymmetry did not correlate with patient-reported outcomes.

Conclusion:
Patients with ULC have persistent facial asymmetry at school-age with the greatest levels of asymmetry in the facial middle-third, orbit, and nasal root. Beyond the cranial dysmorphology, initial skull base angulation in unilateral coronal craniosynostosis manifests in long-term mid and lower-third facial asymmetry.
Radiographic Predictors of FACE-Q Outcomes Following Non-Operative Orbital Floor Fracture Management
Authors: Gabrick Kyle , Smetona John , Iyengar Rajiv , Dinis Jacob , Chouiari Fouad , Peck Connor J. , Persing John , Alperovich Michael 
Published: March 2020

Background:
Orbital floor fractures are common injuries treated by multiple surgical subspecialties. Controversy exists regarding the operative indications. This study sought to correlate radiographic characteristics of orbital floor fractures with validated patient reported outcome measures following non-operative management.

Materials and Methods:
Patients who underwent non-operative management of an orbital floor fracture at Yale New Haven Hospital from 2013 to 2018 were queried retrospectively. Patients with GCS < 15 and/or distracting facial soft tissue or bony injuries were excluded from analysis. CT images, demographic information, and FACE-Q patient reported outcomes (Satisfaction with Eyes, Psychological Function, Social Function, and Appearance Related Psychosocial Distress) were reviewed. Statistical analysis was performed with SPSS with statistical significance set at P < .05.

Results:
Eighteen patients were included in the study. The mean time between injury and completion of the survey was 3.6 years. Fifty-six percent of patients had a right-sided fracture. The mean fracture area was 73.6 mm2 (Range:15–172 mm2), and 913 mm3 (Range: 0–3106) was the mean volume displaced into the maxillary sinus. The unaffected inferior rectus muscle shape (height/width) was 0.5 (Range: 0.2–0.98) compared to 0.8 (Range 0.4–1.6) for the affected inferior rectus. After controlling for the time interval between survey and injury, gender, income, and education, rounding of the inferior rectus muscle was a significant predictor of appearance related psychosocial distress (P = 0.006). Inferior rectus rounding was stratified into “severe” (75%) and “moderate” (25%) categories. Severe rounding was associated with a larger orbital floor fracture area (110 versus 64 mm2; P = 0.074), volume displaced into the maxillary sinus (1,716 versus 610 mm3; P = 0.024), and worse appearance-related psychosocial distress (70 versus 25; P = 0.013). Sixty-one percent of patients followed up in clinic with a mean duration of 194 days.

Conclusion:
Prior studies have correlated presenting radiographic findings to follow-up clinical findings. However, this study is the first to assess long-term outcomes using validated patient-reported questionnaires. Inferior rectus muscle belly rounding significantly correlated with appearance related psychosocial distress. This radiographic finding may be valuable to consider in orbital floor fracture management.
Frequency and Management of Craniofacial Syndromes
Authors: Vandeput An-Sofie , Carels Carine , Da Costa Senior Oliver , Peeters Hilde , Politis Constantinus 
Published: March 2020

Background:
Craniofacial syndromes occur in approximately 1 in 5600 to 100,000 infants, often resulting in significant morbidity. Due to the heterogeneity of this patient population, no clear consensus consists on optimal treatment modalities and timing. The aim of this study was to analyze the craniofacial syndrome population that were treated at the University Hospital Leuven.

Methods:
A retrospective analysis of patients with a clinical diagnosis of a craniofacial syndrome was performed. Inclusion criteria were patients with a clinical diagnosis of a craniofacial syndrome and that received treatment between “2000–2005” and “2010–2015.” Patients with nonsyndromic conditions were excluded. Data regarding patient characteristics, treatment modalities, and treatment outcomes were analyzed.

Results:
After matching the inclusion criteria, 98 eligible patients, affected by 40 different syndromes were included. In the period of “2000 to 2005,” 48 patients were treated, as compared to 50 patients in the period of “2010 to 2015.” A statistically significant decrease over time is seen for cleft surgery and orthodontic treatment (P = 0.0017 and P = 0.0015, respectively). No statistically significant differences were found concerning the age at which treatment was received (P = 0.42). Significant associations between treatment modalities were found for orthognathic surgery and distraction osteogenesis (P < 0.0001), orthognathic surgery and orthodontic treatment (P < 0.0001), and between orthodontic treatment and distraction osteogenesis (P = 0.03311).

Conclusion:
A decline in cleft reconstruction surgery and orthodontic treatment for patients with craniofacial syndromes was seen over time. A significant association was found between distraction osteogenesis and orthognathic surgery, possibly due to higher reintervention rates for patients treated at a young age.
Prospective validation of the Emergency Surgery Score in emergency general surgery: An Eastern Association for the Surgery of Trauma multicenter study
Authors: Kaafarani Haytham M.A. , Kongkaewpaisan Napaporn , Aicher Brittany O. , Diaz Jose J. , O'Meara Lindsay B. , Decker Cassandra , Rodriquez Jennifer , Schroeppel Thomas , Rattan Rishi , Vasileiou Georgia , Yeh D. Dante , Simonoski Ursula J. , Turay David , Cullinane Daniel C. , Emmert Cory B. , McCrum Marta L. , Wall Natalie , Badach Jeremy , Goldenberg-Sandau Anna , Carmichael Heather , Velopulos Catherine , Choron Rachel , Sakran Joseph V. , Bekdache Khaldoun , Black George , Shoultz Thomas , Chadnick Zachary , Sim Vasiliy , Madbak Firas , Steadman Daniel , Camazine Maraya , Zielinski Martin D. , Hardman Claire , Walusimbi Mbaga , Kim Mirhee , Rodier Simon , Papadopoulos Vasileios N. , Tsoulfas Georgios , Perez Javier Martin , Velmahos George C. 
Published: March 2020

BACKGROUND
The Emergency Surgery Score (ESS) was recently developed and retrospectively validated as an accurate mortality risk calculator for emergency general surgery. We sought to prospectively validate ESS, specifically in the high-risk nontrauma emergency laparotomy (EL) patient.

METHODS
This is an Eastern Association for the Surgery of Trauma multicenter prospective observational study. Between April 2018 and June 2019, 19 centers enrolled all adults (aged >18 years) undergoing EL. Preoperative, intraoperative, and postoperative variables were prospectively and systematically collected. Emergency Surgery Score was calculated for each patient and validated using c-statistic methodology by correlating it with three postoperative outcomes: (1) 30-day mortality, (2) 30-day complications (e.g., respiratory/renal failure, infection), and (3) postoperative intensive care unit (ICU) admission.

RESULTS
A total of 1,649 patients were included. The mean age was 60.5 years, 50.3% were female, and 71.4% were white. The mean ESS was 6, and the most common indication for EL was hollow viscus perforation. The 30-day mortality and complication rates were 14.8% and 53.3%; 57.0% of patients required ICU admission. Emergency Surgery Score gradually and accurately predicted 30-day mortality; 3.5%, 50.0%, and 85.7% of patients with ESS of 3, 12, and 17 died after surgery, respectively, with a c-statistic of 0.84. Similarly, ESS gradually and accurately predicted complications; 21.0%, 57.1%, and 88.9% of patients with ESS of 1, 6, and 13 developed postoperative complications, with a c-statistic of 0.74. Emergency Surgery Score also accurately predicted which patients required intensive care unit admission (c-statistic, 0.80).

CONCLUSION
This is the first prospective multicenter study to validate ESS as an accurate predictor of outcome in the EL patient. Emergency Surgery Score can prove useful for (1) perioperative patient and family counseling, (2) triaging patients to the intensive care unit, and (3) benchmarking the quality of emergency general surgery care.

LEVEL OF EVIDENCE
Prognostic study, level III.
Human mesenchymal stromal cell source and culture conditions influence extracellular vesicle angiogenic and metabolic effects on human endothelial cells in vitro
Authors: Chance Tiffani C. , Herzig Maryanne C. , Christy Barbara A. , Delavan Christopher , Rathbone Christopher R. , Cap Andrew P. , Bynum James A. 
Published: March 2020

BACKGROUND
Mesenchymal stem/stromal cell (MSC)-derived extracellular vesicles (EVs) are a possible cell-free alternative to MSCs because they retain the regenerative potential of MSCs, while still mitigating some of their limitations (such as the possible elicitation of host immune responses). The promotion and restoration of angiogenesis, however, is an important component in treating trauma-related injuries, and has not been fully explored with EVs. Herein, we describe the effects of monolayer adipose-derived EVs, spheroid adipose-derived EVs (SAd-EVs), monolayer bone marrow-derived EVs (MBM-EVs), and spheroid bone marrow-derived EVs (SBM-EVs) on human umbilical vein endothelial cell (HUVEC) tube formation and mitochondrial respiration.

METHODS
The successful isolation of EVs derived from adipose MSCs or bone marrow MSCs in monolayer or spheroid cultures was confirmed by NanoSight (particle size distribution) and Western blot (surface marker expression). The EV angiogenic potential was measured using a 24-hour HUVEC tube formation assay. The EV effects on HUVEC mitochondrial function were evaluated using the Seahorse respirometer machine.

RESULTS
The number of junctions, branches, and the average length of branches formed at 24 hours of tube formation were significantly affected by cell and culture type; overall adipose-derived EVs outperformed bone marrow-derived EVs, and spheroid-derived EVs outperformed monolayer-derived EVs. Additionally, adipose-derived EVs resulted in significantly increased HUVEC mitochondrial maximal respiration and adenosine triphosphate (ATP) production, while only MBM-EVs negatively impacted HUVEC proton leak.

CONCLUSION
Adipose-derived EVs promoted HUVEC tube formation significantly more than bone marrow-derived EVs, while also maximizing HUVEC mitochondria function. Results demonstrate that, as with MSC therapies, it is possible to tailor EV culture and production to optimize therapeutic potential.

LEVEL OF EVIDENCE
Basic or Foundational Research.
Rib fixation in geriatric trauma: Mortality benefits for the most vulnerable patients
Authors: Chen Zhu Roger , de Roulet Amory , Ogami Takuya , Khariton Konstantin 
Published: March 2020

BACKGROUND
Rib fractures in the geriatric trauma population are associated with significant morbidity and mortality. The outcomes of surgical stabilization of rib fractures (SSRF) have not been well defined in this population.

METHODS
Data from the 2016 to 2017 Trauma Quality Improvement Program database were analyzed. Patients older than 65 years admitted with isolated chest wall injury and multiple rib fractures were abstracted from the database. Multivariate propensity score matching was utilized to stratify patients that underwent rib fixation versus nonoperative management. In the matched cohort, we assessed outcomes including mortality, intensive care unit (ICU) and hospital lengths of stay (LOS), tracheostomy rates, and ventilator-associated pneumonia (VAP) rates. We performed a secondary analysis of patients receiving early (<72 hours) versus late SSRF.

RESULTS
Of the 44,450 patients included in the study analysis, 758 (1.7%) underwent SSRF. Patients undergoing SSRF were younger, had a higher prevalence of flail chest, higher rates of emergency room intubation, higher Injury Severity Score, and increased ICU admission rates. The 1:1 propensity score match resulted in 758 patients in each group. The in-hospital mortality rate was significantly lower in patients that underwent SSRF (4.2% vs. 7.3%, p = 0.01). However, the fixation group also had higher rates of tracheostomy during admission (11.2% vs. 4.6%, p < 0.001) and VAP (3.0% vs. 1.6%, p = 0.007). In a secondary matched analysis of 326 pairs of patients undergoing SSRF, we found that early fixation was associated with decreased rates of VAP (1.5% vs. 4.6%, p = 0.01), fewer ventilator days (4 days vs. 7 days, p = 0.003), shorter ICU LOS (6 days vs. 9 days, p = 0.001), and shorter hospital LOS (10 days vs. 15 days, p < 0.001).

CONCLUSION
This study demonstrates a mortality benefit in geriatric trauma patients undergoing SSRF. Early SSRF was observed to be associated with decreased rates of VAP, decreased ICU LOS, and decreased hospital LOS. Early SSRF may be associated with improved outcomes in the geriatric trauma population with multiple rib fractures.

LEVEL OF EVIDENCE
Therapeutic/Care management, level III.
Evaluation and management of blunt cerebrovascular injury: A practice management guideline from the Eastern Association for the Surgery of Trauma
Authors: Kim Dennis Y. , Biffl Walter , Bokhari Faran , Brakenridge Scott , Chao Edward , Claridge Jeffrey A. , Fraser Douglas , Jawa Randeep , Kasotakis George , Kerwin Andy , Khan Uzer , Kurek Stan , Plurad David , Robinson Bryce R.H. , Stassen Nicole , Tesoriero Ron , Yorkgitis Brian , Como John J. 
Published: March 2020

BACKGROUND
Blunt cerebrovascular injuries (BCVIs) are associated with significant morbidity and mortality. This guideline evaluates several aspects of BCVI diagnosis and management including the role of screening protocols, criteria for screening cervical spine injuries, and the use of antithrombotic therapy (ATT) and endovascular stents.

METHODS
Using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, a taskforce of the Practice Management Guidelines Committee of the Eastern Association for the Surgery of Trauma performed a systematic review and meta-analysis of currently available evidence. Four population, intervention, comparison, and outcome questions were developed to address diagnostic and therapeutic issues relevant to BCVI.

RESULTS
A total of 98 articles were identified. Of these, 23 articles were selected to construct the guidelines. In these studies, the detection of BCVI increased with the use of a screening protocol versus no screening protocol (odds ratio [OR], 4.74; 95% confidence interval [CI], 1.76–12.78; p = 0.002), as well as among patients with high-risk versus low-risk cervical spine injuries (OR, 12.7; 95% CI, 6.24–25.62; p = 0.003). The use of ATT versus no ATT resulted in a decreased risk of stroke (OR, 0.20; 95% CI, 0.06–0.65; p < 0.0001) and mortality (OR, 0.17; 95% CI, 0.08–0.34; p < 0.0001). There was no significant difference in the risk of stroke among patients with Grade II or III injuries who underwent stenting as an adjunct to ATT versus ATT alone (OR, 1.63; 95% CI, 0.2–12.14; p = 0.63).

CONCLUSION
We recommend using a screening protocol to detect BCVI in blunt polytrauma patients. Among patients with high-risk cervical spine injuries, we recommend screening computed tomography angiography to detect BCVI. For patients with low-risk risk cervical injuries, we conditionally recommend performing a computed tomography angiography to detect BCVI. We recommend the use of ATT in patients diagnosed with BCVI. Finally, we recommend against the routine use of endovascular stents as an adjunct to ATT in patients with Grade II or III BCVIs.

LEVEL OF EVIDENCE
Guidelines, Level III.