bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of a 5-Item Modified Frailty Index for Risk Stratification in Patients Undergoing Breast Reconstruction
Authors: Hermiz Steven J.R. , Lauzon Steve , Brown Geoffrey , Herrera Fernando A. 
Published: February 2021

Introduction
Frailty can be quantified using an index score to effectively predict surgical outcomes and complications. The modified frailty index (mFI) score includes 5 patient-specific medical history comorbidities including diabetes mellitus, congestive heart failure, hypertension, chronic obstructive pulmonary disease/pneumonia, and nonindependent functional status. The purpose of our study was to apply the 5-item mFI score to predict and minimize complications in patients undergoing breast reconstruction.

Methods
The National Surgical Quality Improvement Program was queried for all patients undergoing primary breast reconstruction from 2016 to 2018. Patients were divided based on timing of reconstruction and type of reconstruction: immediate or delayed, and implant based or autologous based. A validated modified fragility score was applied to all patients. Patients were stratified by mFI scores of 0 (no comorbidities), 1 (1 comorbidity), and 2+ (2 or more comorbidities). Patient demographics and 30-day complications rates were recorded.

Results
A total of 22,700 patients were identified. There were 10,673 patients who underwent immediate breast reconstruction, and 12,027 patients who underwent delayed breast reconstruction. A total of 14,159 patients underwent implant-based, and 8541 underwent autologous-based reconstruction. A total of 16,627 patients had an mFI score of 0, 4923 had a mFI score of 1, and 1150 had a mFI score of 2+. Compared with patients with an mFI score of 0, patients with an mFI score of 2 or greater were more likely to develop a postoperative complication (7.2 vs 12.3; P < 0.0001). Patients undergoing immediate reconstruction were more likely to develop a postoperative complications for every mFI category. The most common complications were wound and hematologic related.

Conclusion
Patients with higher mFI scores are likely to have an increase in postoperative complications after breast reconstruction. Increasing body mass index increases postoperative complications independent of frailty index scores. Patients with increasing frailty index scores undergoing immediate breast reconstruction have a significantly higher risk of postoperative complications compared with delayed reconstruction.
Patients with increasing frailty index scores undergoing autologous breast reconstruction have a significantly higher risk of postoperative complications compared with implant-based reconstruction. High frailty index scores are associated with a higher risk of postoperative complications, reoperation rates, and readmission rates. Patients with higher mFI scores may benefit from a delayed implant-based reconstruction.
Comparison of Lateral Tooth Volume and Morphology Between Buccally and Palatally Localised Unilateral Impacted Maxillary Canine Cases on Cone-Beam Computed Tomography
Authors: Karacin Gizem , Şenişik Neslihan Ebru , Yildirim Derya 
Published: February 2021

Abstract
The aim of this study was to compare the lateral tooth volume and morphology differences between buccally and palatally localized unilateral impacted maxillary canine (IMC) patients with volumetric and linear measurements on cone-beam computed tomography (CBCT) records. CBCT records of 48 individuals with 24-buccally and 24-palatally localized unilateral IMCs were included to the study. The patients comprised 34 females, 14 males, with a mean age of 17.71 (±SD 6.63 years). This split-mouth, retrospective case-control, study consisted of buccally and palatally IMC group, and each group was categorized into 2 sub-groups as impacted and erupted side. Lateral tooth volume, tooth length, mesiodistal-buccolingual crown widths, mesiodistal- buccolingual root widths at cemento–enamel junction (CEJ), at 4 mm apical to CEJ, at 8 mm apical to CEJ, mesiodistal crown-root angle, arch perimeter measurements were performed on CBCT images. The data were analyzed by factorial design repeated measures ANOVA. Bonferroni test was used for post-hoc analysis. The total volume, mesiodistal - buccolingual crown widths, buccolingual root width of lateral incisor at CEJ were statistically smaller in palatally IMC group. The lateral incisor's length, and arch perimeter were statistically shorter, mesiodistal, buccolingual root widths at 8 mm apical to CEJ, and crown-root angle of the lateral were narrower on impacted side than erupted side. The volume and crown widths of lateral incisor are effective in sagittal localization of IMC. The shorter length, narrower apical root morphology and mesially inclined crown-root angle of lateral incisor are noteworthy on impacted sides, regardless of sagittal position of IMC.
Analysis of Gull in Flight Appearance and Related Parameters Following Le Fort I Osteotomy
Authors: Suzen Muazzez , Dilaver Emrah , Uckan Sina 
Published: February 2021

Abstract
The present study aimed to investigate how “Gull in Flight” appearance and alar-columellar relationship change following maxillary surgery. Thirty-three patients who underwent Le Fort I osteotomy with or without mandibular osteotomy were included in this retrospective study. Measurements which were angle of columella triangle, alar-rim angle, columella lobular angle, and distance of points forming “Gull in Flight” appearance were evaluated on pre and postoperative frontal and lateral photos of patients. Data was submitted to statistical analysis and significance level was determined as 0.05. Following Le Fort I surgery, distance of points forming “Gull in Flight” appearance with respect to canthus was decreased significantly (P < 0.05). Positions of these points to each other were not changed (P > 0.05). Every 1 mm maxillary impaction led to 0.58 mm reduction in y3 (the distance from the point that illustrates Gull's body) (P = 0.032). There was a decrease in angle of columella triangle, alar-rim angle and increase in columella lobular angle. However, these changes were not found significant (P > 0.05). Angle of columella triangle was increased 2.51 degree for every 1 mm maxillary advancement (P = 0.028). In conclusion, maxillary surgery had an impact on nasal region from frontal view. However, “Gull in Flight” appearance which is one of the aesthetic parameters in nose was not changed following maxillary surgery.
Primary Palatal Surgery in Nonsyndromic Cleft Palate Children and Velopharyngeal Insufficiency Correction Outcomes
Authors: Carvajal Álvarez Drina C. , Palomares-Aguilera Mirta M. , Meneses Geldres María B. , Villarroel Giugliano Carlos 
Published: February 2021

Abstract
Speech has a very significant impact on the life quality of people with cleft and lip palate. Restore tissue anatomy and functionality is the main aim of primary palatal surgery. Multiple factors are associated with successful handling, including the need for a velopharyngeal insufficiency (VPI) secondary surgery. The study's aim is to determine speech and velopharyngeal function outcomes in children with cleft palate operated in our institution and to determine VPI secondary surgery outcomes, if appropriate. Clinical records of nonsyndromic patients with cleft palate born between January 2009 and December 2012, who performed their multidisciplinary care on our institution, were analyzed retrospectively. One hundred forty-two patients received primary palatal surgery. Eighty (56%) were male and 62 (44%) female. Twenty-two had soft cleft palate, 9 hard and soft cleft palate, 84 unilateral, and 27 bilateral cleft lip and palate. Twelve percent of patients presented palatal fistula, with a significantly higher presentation in Soft Cleft Palate and Hard and Soft Cleft Palate. Twenty-seven patients (19%) had surgical indication for VPI correction, and 20 of them received VPI surgery, before school age. Cleft type and gender were significantly associated with VPI surgery indication rate. Postsurgery, 80% presented normal resonance. Nasal emission improved in 85% of patients. Nasometry decreased from 45% to 31%. Hyponasality increased by 10%. One case presented total flap dehiscence. Preoperative planning must be done carefully and individualized to succeed. Future prospective research that considers all the variables for a correct analysis is advisable, to improve our results.
Mortality Within 30 Days After Head and Neck Free Flap Reconstruction: A Systematic Review
Authors: Chicco Maria , Huang Tony Chieh-Ting , Cheng Hsu-Tang 
Published: February 2021

Objective:
The aim of this systematic review is to analyze the 30-day postoperative mortality in patients undergoing free flap reconstruction for head and neck cancer published in literature and to identify associated factors.

Methods:
The authors performed a literature search between January 1950 and February 2020 in PubMed, EMBASE, and Scopus, using a combination of Medical Subject Headings headings and text keywords related to head and neck cancer; microsurgery or free flap reconstruction; and 30-day mortality. Inclusion criteria were: original studies in English reporting on 30-day mortality after head and neck free flap reconstruction in adult population.

Results:
Thirty-one publications reported on a total of 13,447 patients who underwent head and neck free flap reconstruction. The published 30-day postoperative mortality ranged from 0% to 6.3%, with an average of 1.21%. A number of studies examined the association between mortality and body mass index, American Society of Anesthesiologists, and comorbidity score and age. One study found that underweight patients had significantly higher mortality. Two studies found no association between the American Society of Anesthesiologists score and 30-day postoperative mortality; however, 1 study reported significantly higher mortality with increased comorbidity score. Regarding association with age, 3 studies found significant higher mortality in older patients, while 5 studies found no difference.

Conclusions:
The average 30-day postoperative mortality in patients undergoing head and neck free flap reconstruction is 1.21% and is; therefore, not negligible. Careful patient selection and preoperative optimization are essential in order to reduce mortality in head neck free flap reconstruction.
Autologous Craniofacial Fat Grafting in the Irradiated Field
Authors: Gormley Jessica , Copeland Andrea E. , Augustine Haley , McRae Mark 
Published: February 2021

Abstract
Autologous fat grafting has been used as a reconstructive modality following the treatment of head and neck malignancy. However, it has been criticized for poor graft retention and unpredictable results, which may be further compromised by prior radiation therapy. This systematic review will consolidate the literature on autologous fat grafting in the previously irradiated craniofacial region and report its effects on aesthetic and functional outcomes, volume resorption, and postoperative complications. A computerized search of Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, and Web of Science was performed. Screening and data extraction were performed in duplicate. Data were extracted from the included articles, and outcomes were analyzed categorically. Sixty patients from six studies were included. Mean age was 46.06 years (range 13–73) and 37.5% were female. All studies used the Coleman technique fat grafting or a modified version. A total of 94.9% of patients had significant improvement in aesthetic outcomes and 86.1% in the study specific functional outcomes. Mean graft volume resorption was 41% (range 20%–62%) and there were three (5%) postoperative complications. Autologous fat grafting is increasingly being used to optimize aesthetic outcome following head and neck reconstruction, even in the presence of prior radiation treatment. Although the literature to date is encouraging, the heterogeneity in patient population, intervention, outcome measures, and time horizon limit our ability to draw conclusions about the success of craniofacial fat grafting in the irradiated field. Future research should include a large comparative study as well as a protocol for standardizing outcome measures in this population.
A Mathematical Model to Predict Human Microcephaly
Authors: Damar Cagri , Dogan Ilkay 
Published: February 2021

Background:
Microcephaly (MiC) is defined as head circumference (HC) dimensions smaller than the normal standards.

Objective:
To detect MiC with a mathematical formula.

Materials and Methods:
The 0 to 5 years head HC percentile data for girls and boys reported by the World Health Organization were used. To assess early childhood, these growth standards are available on its website for international use. Mathematical formulas best estimating the 3rd percentile curves were defined using basic regression analysis methods.

Results:
The mathematical models obtained as a result of logarithmic regression analysis with the highest coefficient of determination values (R
2 = 0.991 for girls; R
2 = 0.991 for boys) were identified as the best model. The formulas of HC = 34.025 + 3.283 ∗ ln (age as months), and HC = 35.475 + 3.14 ∗ ln (age as months) were determined for girls and boys, respectively. A limitation of these formulas is that they do not provide the HC at birth (ln (0) = undetermined).

Conclusion:
Microcephaly can be estimated using the mathematical formulas with a calculator without using percentile scales, mobile applications, software, or the Internet.
Nasal and Oral Subunits Reconstruction of Localized Scleroderma Deformities
Authors: Xiao Haitao , Deng Ke , Wang Huaisheng , Xu Xuewen 
Published: February 2021

Abstract
Localized scleroderma is a rare soft tissue disorder characterized by a thickening of the skin from excessive collagen deposits. For patients with face involved, soft tissue depression and atrophy could cause serious facial contour deformity and adversely affect the patients’ quality of social life. However, localized scleroderma cases with delicate facial aesthetic subunits defects were rarely reported to be surgically reconstructed. In this study, we present 2 patients with nasal subunits and oral subunit deformities caused by localized scleroderma respectively. The first patient with a right-side alar defect and nasal dorsum depression, forehead depression and eyebrow depression were treated through a 2-stage surgical approach, with microvascular preauricular and helical rim flap and dermofat graft transplantation. The lower lip and mandible defects of the second patient were reconstructed with a combination of submental flap and fat grafting. The transplanted dermofat graft, fat graft, the microvascular free flap, and the submental flap survived completely and maintained adequate tissue volume and facial contour during the follow-up time of 2 years. Both patients were satisfied with the overall aesthetic results. This clinical report supports the use of microsurgical flap and tissue grafts on the treatment of localized scleroderma (LS) caused facial aesthetic subunits deformities.
Combination of Dermal fat Grafting and Frontalis Suspension Using Polytetrafluoroethylene Sheet for Blepharoptosis With a Deep Sulcus
Authors: Kokubo Kenichi , Katori Nobutada , Hayashi Kengo , Fujii Akiko , Koike Tomoyuki , Kawabata Tomotaka , Maegawa Jiro 
Published: February 2021

Abstract
The frontalis suspension procedure is a common surgical method for patients with severe blepharoptosis. While frontalis suspension is a very effective method, the transplant material may be visualized after surgery in patients with a deep sulcus and severe blepharoptosis. To prevent this complication, we performed a combination of dermal fat grafting and frontalis suspension using a polytetrafluoroethylene sheet in 5 patients (6 eyelids). We followed-up the patients for at least 6 months postoperatively (mean: 6.8 months) and observed no transplant material visualization or occurrence of infection. The mean pre- and postoperative margin reflex distance-1 was –3.75 (–5 to –2) and 2.10 (1–3), respectively. Bulky upper eyelids were observed 6 months postoperatively in 1 patient (2 eyelids). None of the patients underwent reoperation. In conclusion, the combination of frontalis suspension using a polytetrafluoroethylene sheet and dermal fat grafting for severe blepharoptosis and a deep upper eyelid sulcus was effective in preventing visualization of the transplant material.
An Update on Facial Skin Rejuvenation Effectiveness of Mesotherapy EBM V
Authors: Atiyeh Bishara S. , Abou Ghanem Odette 
Published: February 2021

Abstract
Although it appears to be a simple, easy, and financially attractive therapeutic modality, skin rejuvenation mesotherapy is a controversial cosmetic procedure and proof of its efficacy is still lacking. The authors have published a review about this therapeutic modality more than a decade ago. Few clinical studies evaluating its efficacy and safety were available then without any conclusive scientific evidence about its efficacy; nevertheless, mesotherapy has continued to be performed at a relatively high financial cost to patients by many nonmedical and medical professionals for antiaging purposes. The authors have published a review about this therapeutic modality more than a decade ago. The current review is an update aimed at identifying any evidence about the scientific validity and efficacy of this approach that has emerged since then. No clinical valuable new data and new information has been identified. As by American Society of Plastic Surgeons (ASPS) policy statement updated and approved in 2019, mesotherapy for skin rejuvenation is currently not Food and Drug Administration approved. Until more conclusive data is available, skin rejuvenation mesotherapy cannot be recommended for routine skin rejuvenation clinical application.
Characteristics of the Sphenoid Bone in Crouzon Syndrome
Authors: Lü Yang , Gui Lai , Teng Li , Jin Xiaolei , Niu Feng , Song Tao 
Published: February 2021

Background:
The goal of this study is to analyze the safety of reconstructive surgeries for Crouzon syndrome, and to understand the deformities and complications related to the surgical procedure.

Methods:
Thirty-nine subjects underwent preoperative computed tomographic scans were included (Crouzon, n = 19; controls, n = 20) in this study. Craniofacial cephalometric measurements were analyzed by Materialise software.

Results:
The overall average distance from the pterygoid junction to the coronal plane in the patients with Crouzon syndrome was 21.34 mm (standard deviation [SD] 5.13), which was deeper than that in the controls by 35% (P = 0.000).
The overall average distances between the left and right foramen ovale and pterion on the sphenoid bone in the subjects were 64.93 mm (SD 7.56) and 67.83 mm (SD 8.57), which were increased by 13% (P = 0.001) and 14% (P = 0.001) compared with those in the controls.
The overall distances between the most inferior point of the left and right lateral pterygoid plate and the medial pterygoid plate in the subjects were 51.09 mm (SD 6.68) and 51.51 mm (SD 10.98), which was not statically different from the controls (P = 0.887, P = 0.991, respectively).

Conclusions:
This study characterized the surgically relevant anatomy of the sphenoidal bone. The pterygomaxillary junction is located in the posterior of the skull. Though there are some anatomical differences due to age, it is well known that the cranial cavity of the sphenoid side is likely to be enlarged in Crouzon syndrome, which may contribute to the other complications of the disease.
Cleft Care Packages and the Impact on Postoperative Care Following a Primary Cleft Lip Repair
Authors: Roy Michelle G. , Davies Lesley A. , Guillen Diana E. , Sequitin Jeromie D. , Buchanan Edward P. , Maricevich Renata S. , Truong Tuan A. , Monson Laura A. 
Published: February 2021

Objective:
To provide caregivers with all the resources needed to care for a surgical site following a primary cleft lip repair and evaluate its efficacy on postoperative care.

Setting/Participants:
Caregivers of infants ages 3 to 6 months with a cleft lip and/or palate undergoing a primary repair at the Texas Children's Hospital.

Methods:
Packages were given to caregivers at discharge following repair. Packages included instructions and supplies needed for surgical site care. At discharge an advanced practice provider obtained informed consent and a questionnaire that established baseline knowledge of surgical site care. Following the questionnaire, the advanced practice provider demonstrated how to care for the site using the package provided. Assessment of scar healing, nasal stent compliance, and ease of care was evaluated at postoperative follow up.

Results:
Thirty-two families were enrolled in this study. Our data supports that caregivers who are provided resources to care for the site had increased comfort level, preparedness, and compliance rates following a primary cleft lip repair. Eighty-four percent of respondents strongly agreed that the package provided aided in preparedness for site care with 100% of respondents recommending the resources to future families undergoing a cleft lip repair.

Conclusions:
Caregivers feel comfortable and equipped with their ability to care for their child's repaired cleft lip when given the appropriate instructions and supplies. In addition, they would recommend the packages to future families following a repair. Empowering families to be proactive in postoperative care will potentially lead to better outcomes in cleft care.
The Ophthalmopetrosal Sinus of Hyrtl: The Evidence of A Rare Variant
Authors: Mincă Dragoş-Ionuţ , Rusu Mugurel Constantin 
Published: February 2021

Abstract
Hyrtl [Wien Med Wochenschr. 1862;19:291-292] reported firstly the ophtalmopetrosal sinus (OPS) running from the superior orbital fissure and emptying either in the transverse sinus, or in its junction with the superior petrosal sinus. Since then, this anatomic variant was mostly referred and poorly studied. Neither Hyrtl, nor other authors brought any evidence of such OPS. It is hereby reported and proofed such an OPT which was found at dissection. It drained ophthalmic veins and coursed posteriorly, first on the greater wing (alar segment), then on the temporal bone (temporal segment, on the petrosquamous fissure), emptying in the transverse sinus. A lateral type of the superior petrosal sinus connected the OPS and the transverse sinus. The OPS courses on the middle fossa floor, lateral to the Meckel's cavum, foramen ovale, foramen spinosum, and fallopian hiatus. It is a rare thus unexpected finding during specific approaches of the middle fossa floor.