bluuebunny/crossref_metadata_2025_split huggingface dataset:
New Strategies for Tragus and Antitragus Complex Fabrication in Lobule-Type Microtia Reconstruction
Authors: Xu Zhicheng , Zhang Ruhong , Zhang Qun , Xu Feng , Li Datao , Li Yiyuan 
Published: July 2019

Background:
The creation of a high-defining tragus and antitragus complex remains a demanding challenge during staged lobule-type microtia reconstruction. The success of the complex carving relies greatly on proper operation of the cartilage, which is commonly residual cartilage of various sizes. The authors discuss the relevant details for sculpting the tragus and antitragus complex based on cartilage remnants in various conditions.

Methods:
A series of 562 lobule-type microtia patients underwent autogenous costal cartilage auricular reconstruction between 2007 and 2016. Because of the various sizes and shapes of the remnant cartilage used for the tragus and antitragus complex reconstruction, the authors have described possible scenarios for fabrication and introduced relevant tactics for appropriate treatment.

Results:
Corresponding methods for various scenarios in tragus and antitragus complex fabrication have been shown to demonstrate a satisfactory appearance. The results demonstrate the achievement of a harmonious tragus and antitragus complex for the integrity of a constructed ear.

Conclusions:
Proper use of the residual cartilage for tragus and antitragus complex sculpture plays a vital role in acquiring a favorable contour of the auricle in microtia reconstruction. The introduced approach enhances the aesthetics and functionality of the complex for modern life.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Diagnostic Significance of Ultrasonographic Markers and Score in Detection of Gestational Diabetes Mellitus in the Indian Subcontinent
Authors: Patil Vikram , Srinivas Gaana , MS Sujatha , Kiran Das Sudha , Hiremath Rudresh , Shabadi Nayanabai 
Published: July 2019

Abstract
In most countries, only high-risk women are screened for gestational diabetes mellitus (GDM). In addition, a onetime early screening test may miss GDM as it may be diagnosable between 24 and 28 weeks. Thus, it is preferable to have alternative tests to classify women as high risk for GDM and keep them under regular follow-up. A total of 120 women with singleton pregnancies and established maternal and/or pregnancy-related risk factors for GDM and who provided informed consent were subjected to an obstetric ultrasound scan at/or after 24 weeks' gestation followed by administration of a 2-hour 75-g oral glucose tolerance test. Various ultrasound markers were determined/measured. Each ultrasound GDM marker was assigned 1 point to create the ultrasound gestational diabetes screening (UGDS) score. All ultrasound GDM markers positively correlated to the disease (P < 0.0001). The strongest independent predictor of GDM was an immature appearance of placenta (relative risk, 49.09; 95% confidence interval, 7.04–342.28; P < 0.0001). Receiver operator characteristics showed an area under the curve of 96.9%, confirming good ability of the UGDS to discriminate between positive and negative oral glucose tolerance test. A UGDS score of 4, providing diagnostic efficiency of 92%, sensitivity of 93.2%, specificity of 92%, positive predictive value of 85.4%, and negative predictive value of 96.4%, is proposed by this study. This study suggests that ultrasound markers significantly vary in GDM compared with normal pregnancy women and that UGDS is a good predictor of GDM. The UGDS may be considered an adjunct to current screening tools for GDM.
Direct-To-Implant and 2-Stage Breast Reconstruction After Nipple Sparing Mastectomy
Authors: Pallara Tiziano , Cagli Barbara , Fortunato Lucio , Altomare Vittorio , Loreti Andrea , Grasso Antonella , Manna Elena , Persichetti Paolo 
Published: July 2019

Abstract
Breast reconstruction after nipple sparing mastectomy (NSM) plays, nowadays, a fundamental role in breast cancer management. There is no consensus on the best implant-based reconstruction technique, considering 2 stages (expander-prosthesis) or direct-to-implant (DTI). A retrospective review of consecutive adult female patients who underwent NSM with breast reconstruction over a 3-year period (January 2013 to December 2015) was performed. Patients were divided into 2 groups according to the type of reconstruction: expander/prosthesis (group A) and DTI (group B). Anamnestic data were collected. Number and type of procedures, complications and esthetic satisfaction were registered and compared. Fifty-six patients were included in group A (34.6%) and 106 in group B (65.4%). Complications associated with the 2 types of breast reconstruction were not different (P = 0.2). Patients in group A received a higher number of total surgical procedures (considering revisions, lipostructures and contralateral symmetrizations) than those in group B (2.5 ± 0.69 and 1.88 ± 1.02, P = 0.0001). Satisfaction with breast reconstruction resulted higher in group A (7.5 ± 2.6 and 6 ± 1.9, P = 0.0004). At the multivariate analysis, chemotherapy and radiotherapy were not correlated with complications, regardless of the group (odds ratio, 0.91 and 2.74, respectively). Radiotherapy and chemotherapy did not even influence the esthetic result, regardless of the group (P = 0.816 and P = 0.521, respectively). Prosthetic breast reconstructions, both in a single and in 2 stages, are welcomed by patients and have relatively low and almost equivalent complication rates, independent of other factors such as chemotherapy, radiotherapy, lymphadenectomy, smoking and age. In our experience, 2-stage breast reconstruction, although requiring more operations, is associated with a higher esthetic satisfaction. Patients who perform a DTI breast reconstruction after NSM should be informed of the high probability of surgical revision.
Revisiting Nasal Reconstruction After Mohs Surgery
Authors: Vasilakis Vasileios , Nguyen Khang T. , Klein Gabriel M. , Brewer Bruce W. 
Published: July 2019

IntroductionNasal reconstruction after oncologic resection often constitutes a technically demanding task. The aim of this study was to investigate our experience with nasal reconstruction after Mohs micrographic surgery using the following 3 well-established, versatile, and reliable techniques: the bilobed flap, nasolabial flap, and forehead flap.MethodsA single-surgeon retrospective chart review of all patients undergone a bilobed, nasolabial, or forehead flap for nasal reconstruction after Mohs micrographic surgery from 2003 to 2017 was conducted. Data collected for analysis included demographics and defect characteristics. Revisions and complications were analyzed.ResultsA total of 83 patients were included in the study; 52 patients underwent bilobed, 17 patients nasolabial, and 14 patients forehead flaps. All defects involved the middle and lower nasal zones. There was a significant difference in the defect size between the 3 groups (P< 0.001). The mean diameters were as follows: 1.37 cm for the bilobed, 2.22 cm for the nasolabial, and 3.46 cm for the forehead flap groups. Liberal utilization of the bilobed and nasolabial flaps achieved reconstruction of defects larger than typically described in the literature. Reconstruction of all defects, including support for successful restoration of mucosal lining and cartilage when indicated, was achieved. An algorithm dealing with defects larger than 0.5 cm in the middle and distal nasal zones was devised.ConclusionsIn this study, the liberal application of the 3 flaps was described based on an individualized treatment approach. The algorithm provides a simplified approach for larger nasal defects in the middle and lower thirds.
The Correlation of Age and Patterns of Maxillofacial Bone Fractures and Severity of Associated Injuries Caused by Motorcycle Accidents
Authors: Chuang Kai-Ti , Hsieh Frank , Liao Han-Tsung 
Published: July 2019

Background
Every year, there are significant numbers of motorcycle accident casualties in Taiwan. These accidents are the leading cause of maxillofacial trauma. Age should be an important factor of maxillofacial fracture patterns yet there is limited literature on the topic. Therefore, this study aims to evaluate the correlation of age with maxillofacial fracture in motorcycle accidents.

Methods
This is a retrospective descriptive analysis conducted over 2-year period at Linkou Chang Gung Memorial Hospital. We focused on the population of maxillofacial injury caused by motorcycle accidents. Data, including demographics, age, fracture patterns of facial bones, and other associated injuries, were collected.

Results
Among 881 admissions, there were 179 patients in the minor group, 644 patients in the adult group, and 58 patients in the geriatric group. With patterns of maxillofacial fracture, midface fracture was the most common type. The minor group had higher incidence of mandibular fracture. The geriatric group sustained more midface fracture. Associated injuries, such as severe head injuries and c-spine injury, were more likely to occur with the old age victims. The overall mortality rate was 3.1%.

Conclusions
Our study presents the different trends of fracture patterns in different age groups, which is associated with different types of treatment required. We summarized all these data in the hope of providing further assistance to trauma doctor dealing with motorcycle accidents.
Targeting Fibrotic Signaling
Authors: Hetzler Peter Theodore , Dash Biraja C. , Guo Shangqin , Hsia Henry C. 
Published: July 2019

Abstract
Fibrosis is a consequence of aberrant wound healing processes that can be debilitating for patients and often are associated with highly morbid disease processes. Myofibroblasts play an important role in determining an appropriate physiologic response to tissue injury or an excessive response leading to fibrosis. Specifically, “supermature” focal adhesions, α-smooth muscle actin, and the myocardin-related transcription factor/serum response factor pathway likely play a significant role in the differentiation and survival of myofibroblasts in fibrotic lesions. Thus, targeting each of these and disrupting their functioning could lead to the development of therapeutic options for patients suffering from fibrosis and other sequelae of dysregulated wound healing. In this paper, we review the current literature concerning the roles of these three constituents of fibrotic signaling pathways, work already done in attempting to regulate these processes, and discuss the potential of these biomolecular constituents as therapeutic targets in future translational research.
Magnetic Resonance Lymphography of Lymphatic Vessels in Upper Extremity With Breast Cancer–Related Lymphedema
Authors: Sheng Lingling , Zhang Guoyou , Li Shengli , Jiang Zhaohua , Cao Weigang 
Published: July 2019

BackgroundMagnetic resonance lymphangiography (MRL) has been proven to be able to visualize pathological lymphatic networks and accompanying complications through subcutaneous injection of commonly used contrast agents. However, no comprehensive prior studies have previously been reported regarding MRL for the evaluation of upper extremity lymphedema in patients with breast cancer–related lymphedema (BCRL). In this study, we establish a novel MRL protocol to characterize the normal and abnormal characteristics of different clinical stages of BCRL in patients using high-spatial-resolution MRL.MethodsFifty females with unilateral upper extremity BCRL underwent MRL. Lymphatic vessel morphology in normal and affected limbs was compared. The appearance, distribution pattern, morphologic characteristics, and maximum transversal diameter of the lymphatic vessels, dermal backflow, and regeneration of lymphatic vessels were analyzed.ResultsLymph fluid was retained in the subcutis of the affected limbs, and no edema was observed in the subfascial compartment. In stage 1, tortuous and dilated lymphatic vessels exhibited a beaded appearance, and their diameters were larger than those in the contralateral forearm (P< 0.05). In stage 2, the dilated lymphatic vessels exhibited larger diameters. “Dermal backflow” and tiny regenerated lymphatic vessels appeared. The thickened subcutaneous tissue showed a honeycomb pattern induced by soft tissue fibrosis and adipose hypertrophy. In stage 3, disordered and unrecognizable affected lymphatic vessels were observed with many small regenerated lymphatics and confluent dermal backflow; the tissue fibrosis was more serious.ConclusionsEach stage presents different characteristics, and the deformity degree of the lymphatic network is consistent with the severity of the disease. Magnetic resonance lymphangiography could provide adequate information for clinical staging in patients with BCRL.
The Efficacy of Hyaluronidase in Early Surgery of Nasal Bone Fracture
Authors: Kim Joo-Hak , Yang Heesang , Oh Sang-Ha , Song Seung Han , Kyung Hyunwoo 
Published: July 2019

Abstract
A nasal bone fracture is one of the most common facial injuries and is often treated by closed reduction. Typically, 2 to 3 weeks are needed for patients to return to daily life because the operation is performed after swelling around the fracture site is reduced. This study aimed to investigate that hyaluronidase injection could reduce swelling, perform early operation and return to daily life accelerated.
From January 2017 to December 2017, 181 patients with nasal bone fracture were analyzed. 60 patients underwent hyaluronidase injection and massage to reduce edema, then performed surgery within 2 to 4 days. The remaining patients were treated conservatively (massage alone); they then underwent surgery. Ultrasonography was used to measure changes in skin thickness, and the treatment duration, outcome, and patient satisfaction were compared.
The duration from injury to surgery was short in the early operation group, and the period of recovery and return to ordinary life was significantly shorter than in the conventional group. The difference in skin thickness after hyaluronidase injection and massage was 0.8 mm in the early operation group; there was no significant difference in the conventional group. There was no statistically significant difference in satisfaction between the 2 groups, but the mean satisfaction was higher in the early operation group.
In patients with nasal bone fracture after facial trauma, hyaluronidase injection, and massage led to reduced edema. This might improve patient satisfaction by allowing earlier operation and earlier return to daily life.
Comparison of Short-Term Outcomes Between Endoscopic and Microscopic Trans-Sphenoidal Surgery for the Treatment of Pituitary Adenoma
Authors: Li Jie , Ding Wei , Huang Zheng , Xie Bo , Li Zhen-Yan 
Published: July 2019

Objective:
Until today, it is unclear if endoscopic or microscopic transsphenoidal surgery is the most adequate treatment technique for pituitary adenoma, while microscopic transsphenoidal surgery is termed as a fully-established mechanism that has reasonable performances and is well recognized for addressing adenomas of the pituitary gland. The present research work aims at assessing the short-term results of these surgical methodologies in those patients, who have pituitary adenoma.

Methods:
The authors comprehensively searched PubMed, together with EMBASE, and Cochrane Library databases for the purpose of identifying associated investigations. The strength of the relationship was figured out through the calculation of the risk ratio (RR) with corresponding 95% credible interval (95% CI) were put to use for the evaluation of the association.

Results:
An aggregate of 17 retrospective studies that involved 1177 participants were included in the present research work. Our results shed light on the fact that endoscopic transsphenoidal surgery was linked to the lower occurrence of diabetes insipidus (RR = 1.42, 95%CI = 1.03-1.98, P = 0.03), fewer septal perforation (RR = 3.16, 95%CI = 1.27-7.85, P = 0.01), and fewer postoperative complications (RR = 1.29, 95% CI = 1.08–1.56, P = 0.006). Moreover, further analyzing indicated no substantial differences existing between the 2 surgical methods in gross tumor removal, meningitis, epistaxis, and cerebrospinal fluid leak.

Conclusion:
Endoscopic transsphenoidal surgery reduces diabetes insipidus, septal perforation, and postoperative complications in treating those patients, who have pituitary adenoma. Endoscopic transsphenoidal surgery is worth suggesting as a productive as well as secure process for the treatment of pituitary adenoma.
Temporomandibular Joint Ankylosis Leading to Obstructive Sleep Apnea
Authors: Shaeran Tengku Aszraf Tengku , Samsudin A.R. 
Published: July 2019

Abstract
Temporomandibular joint ankylosis in children commonly lead to difficulty in feeding, poor oral hygiene, retrognathic mandible and obstructive sleep apnea. Surgical release of the ankylosis has always been the standard treatment. The authors report a 12 year old boy with unilateral temporomandibular joint ankylosis and obstructive sleep apnea underwent surgical release of the ankylosis with successful gain in mouth opening. However, he continued to suffer from obstructive sleep apnea as confirmed by post-operative polysomnography. Orthognathic surgery for mandibular advancement is not favorable due to his young age and mandibular distraction osteogenesis was not a choice. A mandibular advancement device similar to orthodontic myofunctional appliance was the preferred choice in the post-operative period while waiting for definitive retrognathia surgical treatment after skeletal maturity. Surgical release of temporomandibular joint ankylosis corrects the oral problem but does not adequately address the narrow pharyngeal airway space. Assessment of pharyngeal airway with a high suspicion of obstructive sleep apnea is mandatory in the management of TMJ ankylosis.
Infectious Complications After Open Cranial Vault Remodeling for Craniosynostosis
Authors: Musavi Leila , Lopez Joseph , Cho Regina , Siegel Nicholas , Seal Stella , Dorafshar Amir H. , Steinberg Jordan P. 
Published: July 2019

Background:
Surgical site infection (SSI) after open cranial vault reconstruction (CVR), while relatively uncommon, has received little attention in the literature to date. Here, the authors report our institution's experience with the perioperative management of infectious complications following CVR for craniosynostosis and present the first systematic review of the literature on this topic.

Methods:
The authors performed a retrospective chart review for patients with syndromic and nonsyndromic craniosynostosis who underwent open CVR between 1990 and 2015 at a single institution to determine predictors of SSIs and a systematic review of studies that evaluated for SSI after CVR to ascertain the pooled incidence of SSI, common infectious organisms, and prophylactic antibiotic protocols.

Results:
Out of 548 primary and 163 secondary CVR cases at our institution, 6 primary reconstruction patients (1.09%) and 9 secondary reconstruction patients (5.52%) developed an SSI requiring extended hospital stay or readmission (P <0.001); overall infection rate was 2.11%. Streptococcus and Staphylococcus species were the most common organisms isolated. On multivariate analysis, syndromic status conferred more than 7 times greater odds of SSI (OR 7.7, P = 0.023). Pooled analysis of the literature yielded an overall SSI rate of 1.05% to 2.01%. In contrast to our institutional findings, the most common organisms reported were Candida species and Pseudomonas aeruginosa. The most common prophylactic antibiotic protocol was a first-generation cephalosporin for 24 to 72 hours post-operatively.

Conclusions:
Patients undergoing secondary reconstruction have higher infection rates after CVR, and syndromic status is an important predictor of infection when controlling for other patient factors. Our literature review reveals nosocomial organisms to be the most commonly reported source of infection, though this is contrary to our institutional findings of skin flora being most common. Antibiotic prophylaxis varies institutionally.
Assessing Quality of Life After Orthognathic Surgery in Disabled Patients
Authors: Promerat Alexandra , Touzet-Roumazeille Sandrine , Schlund Matthias , Ferri Joel 
Published: July 2019

Introduction:
Orthognathic surgery is a common procedure in facial deformities treatment but requires a high level of compliance from the patient. Performing this treatment for mentally disabled patients is a subject of discussion. The aim of this study was to evaluate the quality of life (QOL) after orthognathic surgery in disabled patients.

Material and methods:
Eight patients with mental disability who underwent orthognathic surgery between 2007 and 2017 participated in this study. Their family or guardian completed a questionnaire to assess modification in aesthetic, functional, and social abilities after orthognathic surgery. Complications, difficulties in maintaining postoperative cares were also recorded.

Results:
All patients had improvement in global facial aesthetic. 62.5% of the patients had improvement in self-esteem and confidence in social events. Regarding functional aspect, the main improvement was found in chewing (75%) and ability to move the jaw (75%). Two patients (25%) found that jaw noises and pain were worse after surgery. No major complication occurred. Postoperative care was hard to follow but no patient had to stop maxillomandibular fixation.

Conclusion:
On well selected cases, orthognathic surgery is a safe procedure which provides improvement in QOL in disabled patients.
Accuracy of Computer-Aided Design/Computer-Aided Manufacturing-Assisted Mandibular Reconstruction With a Fibula Free Flap
Authors: Geusens Joris , Sun Yi , Luebbers Heinz-Theo , Bila Michel , Darche Vincent , Politis Constantinus 
Published: July 2019

Background:
The recent increase in computer-aided design and computer-aided manufacturing (CAD/CAM)-assisted surgery has warranted a thorough evaluation of the accuracy of virtual plan execution. Mandibular reconstructions with a fibula free flap were evaluated by comparing the fibular segments postoperatively with the virtual surgical plans.

Methods:
This study included computed tomography data for 20 patients (11 males; mean age 61.3 years, range 47–74) that received a mandibular reconstruction with a fibula free flap. Linear distances (superior and inferior borders) of 41 fibula segments and intercoronoid distances were measured.

Results:
The mean difference was 3.11 ± 2.80 mm for superior borders (range 0.02–12.20 mm), and 2.75 ± 2.61 mm for inferior borders (range 0.22–13.58 mm). The mean intercoronoid difference was 3.57 ± 1.80 mm (range 0.91–6.11 mm).

Conclusion:
This study confirmed the presumed accuracy regarding the use of fibular and mandibular cutting guides. CAD/CAM is an attractive technique which enhances efficiency and assurance during surgery and preoperative planning.
An Odontogenic Keratocyst in the Temporal Region
Authors: Zhu Fengshuo , Li Xiaoguang , Liu Zhonglong , He Yue 
Published: July 2019

Abstract
The authors report a very rare patient with ectopic odontogenic keratocyst (OKC) in the temporal region that is distant form the mandible. Based on the interesting report, they discuss about the possible origin and illustrate the development of the ectopic OKC. It shows that the OKC could distally relapse with the help of temporal muscle. The surgeon should be more proactive to deal with the peripheral muscle of lesion.