bluuebunny/crossref_metadata_2025_split huggingface dataset:
Unique Techniques Utilizing Rib Grafts for Mandibular Reconstruction in the Pediatric Population
Authors: Liu Alice , Odono Lauren T. , Wlodarczyk Jordan R. , Garg Ravi K. , Hammoudeh Jeffrey A. 
Published: April 2021

Introduction:
Pediatric mandibular reconstruction requires a grafted segment of sufficient height and stability to support dental implant placement. Double barreling and mandibular distraction osteogenesis (MDO) after reconstruction are two techniques to achieve this, but they have only been reported with fibular grafts. Rib grafts not only have a lower donor site morbidity than fibular grafts, but they also provide adequate defect coverage in children. As such, we propose their use with either a double barrel technique or with MDO.

Methods:
Three pediatric patients underwent mandibular resection and reconstruction using rib grafting. One patient underwent single rib graft placement with subsequent vertical rib distraction. In the remaining two patients, a double-barreled rib technique was used, stacked horizontally in one patient and vertically in the other.

Results:
From March 2018 to May 2019, three patients with an average age of 11 underwent resection of mandibular tumors or tumor-like lesions followed by immediate reconstruction with rib graft. Due to postoperative wound complications, the graft was completely removed in one patient. The remaining two patients had an uneventful recovery with dental implants planned for one and fully osseointegrated in the other. None of the patients experienced donor-site complications.

Conclusion:
This case series supports the utility and versatility of autogenous rib grafts as a reconstructive option in children. Not only is rib an excellent bone source with low donor site morbidity, but its height can be augmented through MDO or double barreling, facilitating the successful placement of implants and oral rehabilitation in pediatric patients.
The Impact of Hydrocephalus Shunt Devices on Quality of Life
Authors: Mitchell Kerry-Ann S. , Zelko Ian , Shay Tamir , Horen Sydney , Williams Ally , Luciano Mark , Huang Judy , Brem Henry , Gordon Chad R. 
Published: April 2021

Background:
Despite advances in hydrocephalus shunt technology and improvement in hydrocephalus management, many patients have chronic disability and require multiple surgeries throughout their lifetime. There is limited data from patients’ perspective regarding the impact of shunt devices on quality-of-life.

Methods:
A cross-sectional survey was developed to evaluate the impact of shunt devices on patient quality-of-life. The survey was distributed via social media platforms of the Hydrocephalus Association, and patients self-selected to anonymously complete the online questionnaire. A literature review was performed to contextualize the findings from the survey.

Results:
A total of 562 survey responses were obtained from a network encompassing 35,000 members. The mean age was 30 years old (0.5–87), and 65% identified as female. Eighty one percent underwent at least 1 shunt revision surgery, with a reported average of 10 shunt revision surgeries per patient (1–200 surgeries). Occlusion, shunt migration and infection were the leading causes for revision at 60%, 47%, and 35%, respectively. In addition, 72% of patients reported pain and discomfort from the device, and 68% expressed avoidance of certain activities due to “fear of bumping shunt.” Despite numerous articles discussing shunt technology, a review of the literature indicated a paucity of studies specifically evaluating the burden of shunt devices from a patient/caregiver perspective.

Conclusions:
The findings from this study suggest long-term physical and psychosocial burden associated with shunt devices. Importantly, this study highlights the need for concerted efforts to develop validated tools to study patient reported outcomes as it relates to neurocranial implanted devices.
Inferior Turbinate Mucocele
Authors: Lee Dong Hoon , Lim Sang Chul 
Published: April 2021

Objective:
In what follows, it is extremely rare for the inferior turbinate to occur with a mucocele. The authors aim to evaluate the characteristics, clinical features, and treatment outcome of the inferior turbinate mucocele in our hospital.

Patients and Methods:
Five patients with radiologically confirmed inferior turbinate mucocele between January 2006 and December 2017 were enrolled in this study.

Results:
Out of the 5 patients with inferior turbinate mucocele reviewed, 2 out of the 5 patients had symptoms of nasal obstruction and headache respectively, whereas the other 3 remaining patients were found incidentally by radiological examinations without any nasal symptoms. Four patients were performed the surgery by the transnasal endoscopic marsupialization. One patient had a very small size of an inferior turbinate mucocele and had no symptoms, and in that case the authors decided to do a periodic observation without a surgical intervention. There were no major complications resulting from this surgical intervention, and no recurrence of the inferior turbinate mucocele.

Conclusions:
The inferior turbinate mucocele is an extremely rare disease and can be diagnosed accurately by the use of radiologic examinations. The prevailing discipline is that endoscopic marsupialization is the best treatment for the inferior turbinate mucocele, which is known for showing very good results without recurrence of the condition.
Are Vowels Normalized After Maxillary Osteotomy? An Acoustic Study in Cleft Lip and Palate
Authors: Ho Choco H.Y. , Yu Wilson S. , Tuomainen Jryki , Sell Debbie , Lee Kathy Y.-S. , Tong Michael C.-F. , Pereira Valerie Jane 
Published: April 2021

Background:Maxillary hypoplasia is a common skeletal condition in cleft lip and palate (CLP). Maxillary osteotomy is typically used to reposition the maxilla in CLP with maxillary hypoplasia. Previous studies have suggested that vowel articulations are adjusted postsurgically due to altered vocal tract configuration and articulatory reorganization. This acoustic study aims to investigate whether vowels are normalized postoperatively and to explore the nature of articulatory reorganization.Methods and Procedures:A prospective study was conducted to examine the vowel production of a group of individuals with CLP (N = 17) undergoing maxillary osteotomy and a group of normal controls (N = 20), using speech acoustic data. The data were collected at 0 to 3 months presurgery (T1), 3-months (T2), and 12-months (T3) postsurgery. General linear model repeated measures and independentt-tests were undertaken on F1, F2, and vowel space area.Results:General linear model repeated measures revealed no main effects of time forF1 (F[2, 22] = 1.094,P = 0.352),F2 (F[2, 22] = 1.269,P = 0.301), and vowel space area (F[2, 28] = 0.059,P = 0.943). Independentt-tests showed statistically significant differences (P < 0.05) for all acoustic parameters and all vowels between the CLP and the normal groups at all time points.Conclusions:Vowels were not normalized after maxillary osteotomy despite positive anatomical changes within the oral cavity. Individuals with CLP tended to adjust their vowel articulatory gestures to match presurgical patterns. The nature of articulatory reorganization appears to be prompt, sensory-driven, complete, and permanent.
Augmentation of Supratemporal Hollowing With Silicone Block During Autologous Cranioplasty After Decompressive Craniectomy With Additional Temporalis Resection
Authors: Park Kwang Hyon , Park Bumsoo , Byoun Hyoung Soo , Lim Jeongwook 
Published: April 2021

Abstract
Decompressive craniectomy is a potentially life-saving neurosurgical procedure. In cases of insufficient decompression, uncontrolled intracranial pressure even after sufficient decompression, or when the intracranial pressure is increased due to external factors such as intramuscular hematoma in the temporal muscle, additional temporalis resection may be necessary. However, the hollowing of the supratemporal fossa that occurs after additional temporalis resection can create a major cosmetic problem. Several alternatives are available to fill the hollowing of the supratemporal fossa during cranial reconstruction, but each has a disadvantage, whether it is expensive or difficult to shape for bilateral symmetry. The author solved the cosmetic problem by using a properly carved silicone block to fill the supratemporal fossa while conducting cranioplasty, and here reports it with a literature review.
Craniofacial and Upper Airway Development in Patients With Treacher Collins Syndrome
Authors: Lin Yanxian , Ma Xiaoyang , Huang Yuanliang , Mu Lin , Yang Liya , Zhao Minghao , Xie Fang , Zhang Chao , Xu Jiajie , Lu Jianjian , Teng Li 
Published: April 2021

Abstract
This study evaluated age-associated morphology changes in the cranial base, facial development, and upper airway of patients with Treacher Collins syndrome (TCS). A total of 33 preoperative computed tomographic images (TCS, n = 14; control, n = 19) were included in the study and divided into three age-related subgroups (2–6 years, 7–18 years, and older than 18 years). Linear, angular cephalometric measurements and upper airway volumes were collected. All measurements were analyzed using ProPlan CMF software (version 3.0; Materialize, Leuven, Belgium). The association between aging and upper airway morphology was analyzed. Compared to control subjects, TCS patients had a smaller cranial base, maxilla, and nose; they also had reduced upper airway volume compared to control subjects. The observed differences were most significant in patients between the ages of 7 and 18 years. This study used computed tomography-based three-dimensional analyses to provide a detailed description of age-related changes that occur in craniofacial measurements and upper airway volumes in children, adolescents, and young adult patients with TCS in China. These data can be used to evaluate individual patients with TCS and to select treatment to improve the growth of the craniofacial region.
An Orbital Venous Varix Presenting as a Strain-Induced Lower Eyelid Mass
Authors: Jun Daiwon , Kim Jin Kwan , Kim Jeana , Lee Jung Ho 
Published: April 2021

Abstract
Orbital varix is uncommon disease entity, accounting for less than 1% of orbital tumor. Authors report a case of tumor mimicking lower eyelid varix of inferior palpebral vein induced by forced closure of the patient's eyelids. A 21-year-old female visited our institution with a complaint of eyelid mass that only appeared on frowning. A 0.5 × 1.0 cm2 sized soft, nontender and nonpulsating mass was observed at her left lower eyelid when she frowned. Preoperative ultrasound imaging revealed a hypoechoic cystic lesion above orbicularis oculi muscle. A surgical resection through transconjunctival approach was performed. Congestion of perforating inferior palpebral vein caused by contraction of orbicularis oculi muscle was observed intraoperatively. Histopathology has confirmed dilated venous structures. The symptom was immediately resolved after surgery. No sign of recurrence was detected after two years of follow-up.
Long-Term Complications of Coronavirus Disease 2019; What the Oral Surgeon Needs To Know
Authors: Abu-Hammad Osama , Dar-Odeh Najla , Abu-Hammad Abdalla , Althagafi Nebras , Eshky Rawah , Abu-Hammad Shaden 
Published: April 2021

Abstract
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 manifests mainly as respiratory symptoms. Extrapulmonary manifestations have also been detected and several vital organs may sustain irreversible or long-standing damage. These extrapulmonary manifestations can be detected in cardiovascular, hepatic, renal, and hematologic systems. Maxillofacial surgeons may encounter patients who have recovered from COVID-19 but are still suffering long-term morbidities as a result of this incompletely understood infection. Consequently, they have to be aware of the various systemic complications that may be encountered in these patients as they may interfere with their treatment plan or may necessitate certain modifications and precautions.
In this report the authors present the long-standing systemic complications of COVID-19 reported so far, and discuss their implications within the context of maxillofacial surgery with regards to the modifications and precautions in the process of treatment planning.
Graphical abstract shows the long-term complications of COVID-19 that may complicate maxillofacial surgical procedures.
The Propeller Myocutaneous Flap of the Upper Eyelid: Anatomical Study and its Clinical Implication
Authors: Delia Gabriele , Fazio Antonina , Parafioriti Andrea , Meduri Alessandro , Inferrera Leandro , Stagno d’Alcontres Francesco 
Published: April 2021

Background:
The reconstruction of the upper eyelid and the periorbital region is a challenge for the surgeon. The aims of this reconstruction are to guarantee protection to the eyeball, maintain the visual field, and restore the function of the eyelid without damaging other anatomical structures. In this study, the authors describe the use of a propeller myocutaneous flap based on the small vertical branches of marginal, peripheral ed superficial arcade, for the reconstruction of the upper eyelid or periorbital region.

Materials and Methods:
The authors enrolled 3 patients (Caucasian), between 2018 and 2019, and subjected to reconstructive surgery with the propeller myocutaneous flap of the periorbital region at the Plastic Surgery Unit of the University of Messina. The vascularization of the flap was demonstrated through an anatomical study conducted on cadavers at the dissection laboratories of the University of Bordeaux 2.

Results:
The authors have shown that the myocutaneous flap represents a valid alternative for loss of substance coverage and reconstruction of the upper eyelid or periorbital region, allowing the achievement of a good aesthetic and functional result.

Follow up:
Patients were followed up at 3–6–12 months. No complications were reported (flap retraction, periocular region deformity, donor site morbidity). Furthermore, at the last visit, the scars were almost invisible.

Conclusions:
The use of the propeller myocutaneous flap of the upper eyelid is a valid reconstructive alternative to the standard techniques described so far for the reconstruction of the periorbital region.
Intraoperative Celiac Plexus Block With Preperitoneal Infusion Reduces Opioid Usage in Major Hepato-pancreato-biliary Surgery
Authors: Teo Zhe Hao T. , Tey Boon Lim J. , Foo Chek Wun , Wong Wan Yi , Low Jee Keem 
Published: April 2021

Objective:
Given the role of celiac plexus block (CPB) in the management of chronic pain, we sought to investigate the utility of CPB in the control of postoperative pain in major hepato-pancreato-biliary surgeries.

Summary Background Data:
CPB has been in practice for decades for the management of upper abdominal visceral pain, especially in cancer patients. Typically, in this group of patients with chronic pain, a neurolytic agent is injected to cause irreversible neural damage to achieve pain control. We apply this concept to postoperative pain control by injecting bupivacaine to the celiac plexus instead of a neurolytic agent. We aim to investigate if this novel technique decreases postoperative opioid usage, offers better pain relief and leads to earlier ambulation

Methods:
A retrospective, single institution study comparing consecutive patients who received intraoperative CPB and preperitoneal infusion with patients who received only preperitoneal infusion in open hepato-pancreato-biliary surgery between the years 2016 and 2019 by a single surgeon. Patients with incomplete data on patient-controlled analgesia usage and postoperative ambulation information were excluded.

Results:
Patients with CPB used 31% less morphine on postoperative day 1 compared to patient without CPB and 42% less morphine on postoperative day 2. Overall average morphine usage was significantly lower in patients with CPB. Duration of patient-controlled analgesia was shorter for patient with CPB compared with patient without CPB. The dynamic visual analogue score was marginally better in patients with CPB. Time to ambulation was similar in both groups.

Conclusions:
CPB can be considered as part of a multimodal approach for postoperative pain management in open hepato-pancreato-biliary surgeries.
Laparoscopic Pancreaticoduodenectomy With Transanal Specimen Extraction for Periampullary Tumors
Authors: Meng Haipeng , Wang Song , Liu Jinchao , Zhao Xu , Rong Zhen , Xu Yanling , Yu Gang 
Published: April 2021

Objective:
To explore the possibility of LPD with transanal specimen extraction for periampullary tumors.

Background:
Natural orifice specimen extraction has been widely performed in colorectal surgery. But so far there is no report regarding natural orifice specimen extraction in LPD.

Methods:
Data of 3 patients who underwent LPD with transanal specimen extraction by the same surgeon between July 2018 and March 2019 due to periampullary tumors were evaluated retrospectively.

Results:
All patients underwent LPD with no conversion to open surgery. Specimens were all extracted transanally. No complications occurred except for delayed gastric emptying in 1 patient. The patients’ anorectal function was intact and no opioids were required postoperatively. After a follow-up of 17–25 months, all patients were alive with no tumor recurrence.

Conclusion:
Treatment of periampullary tumors by LPD with transanal specimen extraction is feasible and safe.
Nonintubated Robotic-assisted Thoracic Surgery for Tracheal/Airway Resection and Reconstruction
Authors: Li Shuben , Ai Qing , Liang Hengrui , Liu Hui , Yang Chao , Deng Hongsheng , Zhong Yunpeng , Zhang Jie , He Jianxing 
Published: April 2021

Objective:
We aim to report a novel surgical technique that RATS combined with nonintubated spontaneous ventilation to perform tracheal/airway surgery.

Summary of Background Data:
Our team has demonstrated video-assisted transthoracic surgery can be used for thoracic tracheal diseases with satisfactory outcomes. Our team has also demonstrated that tracheal/airway resection and reconstruction under spontaneous ventilation can improve the anastomosis and operating time. Recently, RATS emerged as an available alternative minimally invasive approach for lung cancer, with lower perioperative mortality and conversion rate to open.

Methods:
Five patients fulfilling the criteria for nonintubated approach underwent RATS tracheal/airway surgery. Patient 1 has a tumor in the thoracic trachea; patient 2 had involving secondary carina; patient 3 had involving trachea carina, and patient 4 had involving left main bronchus. Patient 5 had involving mid-tracheal.

Results:
All patients had an uneventful procedure. The total operative time ranged from 5 hours 5 minutes to 9 hours 55 minutes. The postoperative hospital stays ranged from 4 days to 14 days. Fiber-optic bronchoscopy performed 1 month after the procedure showed good anastomotic healing with no stricture.

Conclusion:
This is the first report on RATS use in tracheal/airway surgery, in combination with nonintubation spontaneous ventilation. In selected patients, this novel combined approach is feasible and safe. A patient can potentially benefit from the combined advantages of both techniques. More cases and longer-term data are required to establish its role in tracheal/airway surgery.
Bound Together: Allyship in the Art of Medicine
Authors: Ellis Danielle 
Published: April 2021

In the setting of the immense social, political, medical, and cultural challenges of last year, medicine has been made acutely aware of its participation in inequity and in response offers allyship as a framework for clinicians to pursue change, using tools already apart of the practice of medicine.
Allyship in the workplace can be summarized as a strategic mechanism used by individuals to become collaborators who fight injustice and promote equity through supportive personal relationships and public acts of sponsorship and advocacy. The idea of allyship may be intimidating, particularly for practitioners and leaders who do not belong to the communities they endeavor to support. But as the article unpacks, practitioners need not look any further for how to be allies than what they practice every day: lifelong learning; humility in complications; an expectation of imperfection; and, bound together with those who suffer, persistence in the pursuit of healing.
From Listening to Action
Authors: Korndorffer James R. , Wren Sherry M. , Pugh Carla M. , Hawn Mary T. 
Published: April 2021

Objective:
The aim of this study was to describe the development and evaluation of a structured department wide cultural competency curriculum.

Summary Background Data:
Despite numerous organizational policies and statements, social injustice and bias still exist. Our department committed to assist individuals of the entire department to develop foundational knowledge and skills to combat implicit bias and systemic racism through the creation of a cultural competency curriculum. The purpose of this manuscript is to detail our curriculum and the evaluation of its effectiveness.

Methods:
Using a well-established curriculum development framework, a cultural competency curriculum was developed focusing on knowledge, skills and attitudes at the individual level, for all members of the department. The curriculum was implemented through 6-hour-long sessions over a 9-week period. Effectiveness was assessed through a post curriculum survey.

Results:
Twenty percent of the respondents had experienced bias based on race, ethnicity, or sexual orientation in the past 12 months, whereas 30% had experienced bias based on sex. Seventy-one percent independently explored related topics. The curriculum was overall well received and generally achieved the goals and objectives.

Conclusion:
Using a standard curriculum development framework, an effective department-wide cultural competency curriculum can be developed and implemented.
Gender Differences in Entrustable Professional Activity Evaluations of General Surgery Residents
Authors: Padilla Elena P. , Stahl Christopher C. , Jung Sarah A. , Rosser Alexandra A. , Schwartz Patrick B. , Aiken Taylor , Acher Alexandra W. , Abbott Daniel E. , Greenberg Jacob A. , Minter Rebecca M. 
Published: April 2021

Objective:
To determine differences in entrustable professional activity (EPA) assessments between male and female general surgery residents.

Summary Background Data:
Evaluations play a critical role in career advancement for physicians. However, female physicians in training receive lower evaluations and underrate their own performance. Competency-based assessment frameworks, such as EPAs, may help address gender bias in surgery by linking evaluations to specific, observable behaviors.

Methods:
In this cohort study, EPA assessments were collected from July 2018 to May 2020. The effect of resident sex on EPA entrustment levels was analyzed using multiple linear and ordered logistic regressions. Narrative comments were analyzed using latent dirichlet allocation to identify topics correlated with resident sex.

Results:
Of the 2480 EPAs, 1230 EPAs were submitted by faculty and 1250 were submitted by residents. After controlling for confounding factors, faculty evaluations of residents were not impacted by resident sex (estimate = 0.09, P = 0.08). However, female residents rated themselves lower by 0.29 (on a 0–4 scale) compared to their male counterparts (P < 0.001). Within narrative assessments, topics associated with resident sex demonstrated that female residents focus on the “guidance” and “supervision” they received while performing an EPA, while male residents were more likely to report “independent” action.

Conclusions:
Faculty assessments showed no difference in EPA levels between male and female residents. Female residents rate themselves lower by nearly an entire post graduate year (PGY) level compared to male residents. Latent dirichlet allocation -identified topics suggest this difference in self-assessment is related to differences in perception of autonomy.