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Tolley PD, Massenburg BB, Higgins J, Ettinger RE, Susarla SM. Does the Low and Short Medial Cut Affect Lingual Nerve Recovery after Sagittal Split Osteotomy? Plast Reconstr Surg 2024; 154:773e-780e. [PMID: 37678809 DOI: 10.1097/prs.0000000000011047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the recovery of lingual nerve (LN) neurosensory function in patients undergoing sagittal split osteotomy (SSO) with a low and short medial horizontal cut. METHODS This was a prospective study of patients with mandibular deformities undergoing SSO with a low and short medial horizontal cut over a 4-year period. The outcomes of interest were neurosensory recovery of the LN, as assessed objectively using functional sensory recovery (FSR) and subjectively by patient report. RESULTS The sample included 123 SSOs in 62 subjects with a mean age of 19.3 ± 3.1 years. Thirty-seven subjects (61.7%) were female. Mandibular advancements were performed in 52 SSOs (42.3%); mandibular setbacks were performed in 71 SSOs (57.7%). One subject underwent revision BSSO. FSR was achieved at 122 LNs (99.1%) within 6 weeks postoperatively, with 120 sites (97.5%) having S4 sensation at 6 weeks. Decreased LN sensation was reported at 10 (8.3%) sites at 1 week postoperatively. At 6 weeks postoperatively, 118 sites (97.5%) had reported normal sensation. By 12 weeks postoperatively, all LN sites had S4 sensation and there were no subjective complaints. Revision sagittal split osteotomy was associated with prolonged (≥6 weeks) time to S4 sensation ( P = 0.02) and subjective complaint of decreased sensation ( P = 0.02). CONCLUSIONS LN sensory recovery occurs rapidly following the low and short SSO, with 99% of sites achieving FSR and subjectively normal sensation within 6 weeks of surgery and all patients achieving FSR with S4 sensation by 12 weeks postoperatively. LN sensory recovery may be prolonged in patients undergoing revision SSO. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Anstadt EE, Birgfeld CB, Susarla SM. Discussion: Morphologic Severity and Age at Surgery Are Associated with School-Age Neurocognitive Outcomes in Metopic Craniosynostosis. Plast Reconstr Surg 2024; 154:836-838. [PMID: 39314101 DOI: 10.1097/prs.0000000000011156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2024]
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Bhat A, Smart R, Egbert M, Susarla SM. Benign Non-Odontogenic Pathology in Children. Oral Maxillofac Surg Clin North Am 2024; 36:295-302. [PMID: 38402139 DOI: 10.1016/j.coms.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2024]
Abstract
This article provides a comprehensive overview of benign non-odontogenic pathologies. Bone-derived lesions like osteoma, osteoid osteoma, osteoblastoma, and osteochondroma are discussed in detail, emphasizing their radiographic features, locations, and treatment strategies. Cartilage-derived lesions such as chondroma, chondroblastoma, and chondromyxoid fibroma are also examined, noting their typical presentation and management approaches. The article then delves into fibroconnective tissue lesions. Mesenchymal and vascular lesions are detailed regarding their clinical and radiographic characteristics and treatment options. Lastly, nerve-derived lesions like schwannoma and neurofibroma are covered, providing insights into their association with diseases like neurofibromatosis and preferred management strategies.
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Susarla SM, Manson PN. Discussion: A Simplified Approach for Surgical Correction of Vertical Orbital Dystopia: A 45-Year Retrospective Cohort Study. Plast Reconstr Surg 2024; 154:413-414. [PMID: 39046842 DOI: 10.1097/prs.0000000000010858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
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Susarla SM. Pediatric Craniomaxillofacial Pathology. Oral Maxillofac Surg Clin North Am 2024; 36:xi. [PMID: 38760199 DOI: 10.1016/j.coms.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
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Linkugel AD, Markiewicz MR, Edwards S, Susarla SM. Conceptual Principles in Pediatric Craniomaxillofacial Reconstruction. Oral Maxillofac Surg Clin North Am 2024; 36:411-424. [PMID: 38705817 DOI: 10.1016/j.coms.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Pediatric craniomaxillofacial reconstruction must be approached through the lens of growth and durability. A systematic approach of matching defects to donor tissue drives the selection of autologous reconstructive technique. The menu of available methods for reconstruction can be organized in a manner similar to adults, with special considerations for growth and development. Reconstructive surgeons have the opprtunity to promote and maintain young patients' sense of identity during psychosocial development.
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Ruthberg JS, Susarla SM, Bly RA. Head and Neck Vascular Anomalies in Children. Oral Maxillofac Surg Clin North Am 2024; 36:355-368. [PMID: 38632013 DOI: 10.1016/j.coms.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Craniomaxillofacial vascular anomalies encompass a diverse and complex set of pathologies that may have a profound impact on pediatric patients. They are subdivided into vascular tumors and vascular malformations depending on biological properties, clinical course, and distribution patterns. Given the complexity and potential for leading to significant functional morbidity and esthetic concerns, a multidisciplinary approach is generally necessary to optimize patient outcomes. This article reviews the etiology, clinical course, diagnosis, and current management practices related to vascular anomalies in the head and neck.
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Badiee RK, Ettinger RE, Kapadia H, Sheller B, Susarla SM. Does surgical sequencing influence the accuracy of maxillary positioning in bimaxillary cleft orthognathic surgery? Plast Reconstr Surg 2024:00006534-990000000-02373. [PMID: 39046832 DOI: 10.1097/prs.0000000000011634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
PURPOSE To evaluate whether the sequence of osteotomies influences the accuracy of maxillary positioning in patients with cleft palate ± cleft lip undergoing bimaxillary orthognathic surgery (OGS). METHODS This was a prospective study of patients with Veau 2-4 clefts who underwent bimaxillary OGS at tertiary-care children's hospital over a 3-year period. The primary predictor variable was the sequence of osteotomies (maxilla-first versus mandible-first). The primary outcome of interest was the concordance between the planned and achieved maxillary position, as assessed using linear and angular measurements. Secondary study predictors were demographic and surgical variables. Differences between groups were compared using non-parametric independent samples tests for continuous measures (data reported as median and interquartile range, IQR) and chi-squared tests for categorical measures. For all analyses, p≤ 0.05 was considered significant. RESULTS Subjects who underwent maxilla-first (n=15) and mandible-first (n=16) operations were comparable with regard to age, gender, cleft type, skeletal classification, segmental maxillary osteotomy, and magnitude of maxillary movement (p ≥ 0.09). The planned sagittal and vertical positions of the maxilla were similarly accurate between the two groups (p ≥ 0.68). Angular accuracy was also comparable (p ≥ 0.56) between the study groups. CONCLUSION In patients with CP ± CL undergoing bimaxillary orthognathic surgery, use of mandible-first sequencing, when compared to maxilla-first sequencing, does not impact accuracy of maxillary positioning in the immediate post-operative period in well-selected patients.
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Susarla SM, Sheller B, Kapadia H. Discussion: Comparative Assessment of Orthodontic and Aesthetic Outcomes after Orthognathic Surgery with Clear Aligner or Fixed Appliance Therapy. Plast Reconstr Surg 2024; 154:173-174. [PMID: 38923927 DOI: 10.1097/prs.0000000000010910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
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Ettinger RE, Hopper RA, Susarla SM. Discussion: Modification of Sagittal Split Osteotomy in Class II Asymmetry: Optimizing Bone Contact between Proximal and Distal Segments. Plast Reconstr Surg 2024; 153:1152e-1154e. [PMID: 38810161 DOI: 10.1097/prs.0000000000011015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
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Susarla SM, Friedrich JB, Chung KC. The "Loss Years" of Residency Education: Overcoming COVID-19 Learning Gaps among Trainees. Plast Reconstr Surg 2024; 153:1199-1201. [PMID: 38657015 DOI: 10.1097/prs.0000000000011220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
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Chen L, Mercan E, Massenburg BB, Hopper RA, Susarla SM, Lee A, Ellenbogen RG, Birgfeld CB. Comparison of Morphometric Outcomes following Open Posterior Expansion versus Endoscopic Strip Craniectomy for Sagittal Synostosis. Plast Reconstr Surg 2024; 153:1095-1106. [PMID: 37199432 DOI: 10.1097/prs.0000000000010679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
BACKGROUND Open middle and posterior cranial vault expansion (OPVE) or endoscopic (ES) strip craniectomy are two surgical techniques for normalization of head shape in isolated sagittal synostosis. This study aims to compare 2-year cranial morphometrics after these two approaches. METHODS The authors performed morphometric analysis on preoperative [time (T) 0], immediately postoperative (T1), and 2-year (T2) postoperative computed tomographic scans of patients who underwent OPVE or ES before 4 months of age. Perioperative data and morphometrics were compared between the two groups and age-matched controls. RESULTS Nineteen patients were included in the ES cohort, 19 age-matched patients were included in the OPVE cohort, and 57 were included as controls. Median surgery time and blood transfusion volume were less for the ES approach (118 minutes and 0 cc, respectively) compared with OPVE (204 minutes and 250 cc, respectively). Anthropometric measurements after OPVE were closer in normal controls at T1 compared with ES, but the skull shapes were comparable at T2. In the midsagittal plane, anterior vault was higher after OPVE at T2 compared with both ES and controls, but the posterior length was shorter and closer to controls than in the ES cohort. Cranial volumes were like controls for both cohorts at T2. There was no difference in complication rate. CONCLUSIONS Both OPVE and ES techniques result in normalization of cranial shape in patients with isolated sagittal synostosis after 2 years with minimal morphometric differences. Family decision-making between the two approaches should be based on age at presentation, avoidance of blood transfusion, scar pattern, and availability of helmet molding and not on expected outcome. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Amin SN, Siu JM, Purcell PL, Manning JP, Wright J, Dahl JP, Hauptman JS, Hopper RA, Lee A, Manning SC, Perkins JN, Susarla SM, Bly RA. Preoperative Imaging and Surgical Findings in Pediatric Frontonasal Dermoids. Laryngoscope 2024; 134:1961-1966. [PMID: 37776254 DOI: 10.1002/lary.31079] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/21/2023] [Accepted: 09/15/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVE To review cases of congenital frontonasal dermoids to gain insight into the accuracy of preoperative computed tomography (CT) and magnetic resonance imaging (MRI) in predicting intracranial extension. METHODS This retrospective study included all patients who underwent primary excision of frontonasal dermoids at an academic children's hospital over a 23-year period. Preoperative presentation, imaging, and operative findings were reviewed. Receiver operating characteristic (ROC) statistics were generated to determine CT and MRI accuracy in detecting intracranial extension. RESULTS Search queries yielded 129 patients who underwent surgical removal of frontonasal dermoids over the study period with an average age of presentation of 12 months. Preoperative imaging was performed on 122 patients, with 19 patients receiving both CT and MRI. CT and MRI were concordant in the prediction of intracranial extension in 18 out of 19 patients. Intraoperatively, intracranial extension requiring craniotomy was seen in 11 patients (8.5%). CT was 87.5% sensitive and 97.4% specific for predicting intracranial extension with an ROC of 0.925 (95% CI [0.801, 1]), whereas MRI was 60.0% sensitive and 97.8% specific with an ROC of 0.789 (95% CI [0.627, 0.950]). CONCLUSION This is the largest case series in the literature describing a single institution's experience with frontonasal dermoids. Intracranial extension is rare and few patients required craniotomy in our series. CT and MRI have comparable accuracy at detecting intracranial extension. Single-modality imaging is recommended preoperatively in the absence of other clinical indications. LEVEL OF EVIDENCE 4 Laryngoscope, 134:1961-1966, 2024.
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Sanati-Mehrizy P, Hopper RA, Susarla SM. Discussion: Improved Facial and Skull-Base Symmetry following Osteotomy and Distraction of Unilateral Coronal Synostosis. Plast Reconstr Surg 2024; 153:457-460. [PMID: 38266138 DOI: 10.1097/prs.0000000000010778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
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Zammit D, Ettinger RE, Sanati-Mehrizy P, Susarla SM. Current Trends in Orthognathic Surgery. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2100. [PMID: 38138203 PMCID: PMC10744503 DOI: 10.3390/medicina59122100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/14/2023] [Accepted: 11/24/2023] [Indexed: 12/24/2023]
Abstract
Orthognathic surgery has evolved significantly over the past century. Osteotomies of the midface and mandible are contemporaneously used to perform independent or coordinated movements to address functional and aesthetic problems. Specific advances in the past twenty years include increasing fidelity with computer-assisted planning, the use of patient-specific fixation, expanding indications for management of upper airway obstruction, and shifts in orthodontic-surgical paradigms. This review article serves to highlight the contemporary practice of orthognathic surgery.
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Daneshgaran G, Lu GN, Otto R, Susarla SM. Spontaneous Regeneration of the Ramus-Condyle Unit Following Severe Avulsion Injury in a Child. Facial Plast Surg Aesthet Med 2023. [PMID: 38016289 DOI: 10.1089/fpsam.2023.0265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
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Bhat A, Lim R, Egbert MA, Susarla SM. Pediatric Le Fort, Zygomatic, and Naso-Orbito-Ethmoid Fractures. Oral Maxillofac Surg Clin North Am 2023; 35:563-575. [PMID: 37302948 DOI: 10.1016/j.coms.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Fractures of the pediatric midface are infrequent, particularly in children in the primary dentition, due to the prominence of the upper face relative to the midface and mandible. With downward and forward growth of the face, there is an increasing frequency of midface injuries seen in children in the mixed and adult dentitions. Midface fracture patterns seen in young children are quite variable; those in children at or near skeletal maturity mimic patterns seen in adults. Non-displaced injuries can typically be managed with observation. Displaced fractures require treatment with appropriate reduction and fixation and longitudinal follow-up to evaluate growth.
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Pan J, Boop SH, Barber JK, Susarla SM, Durfy S, Ojemann JG, Goldstein HE, Lee A, Browd S, Ellenbogen RG, Hauptman JS. Perioperative complications and secondary retethering after pediatric tethered cord release surgery. J Neurosurg Pediatr 2023; 32:607-616. [PMID: 37728397 DOI: 10.3171/2023.6.peds23259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 06/16/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE Tethered cord syndrome refers to a constellation of symptoms characterized by neurological, musculoskeletal, and urinary symptoms, caused by traction on the spinal cord, which can be secondary to various etiologies. Surgical management of simple tethered cord etiologies (e.g., fatty filum) typically consists of a single-level lumbar laminectomy, intradural exploration, and coagulation and sectioning of the filum. More complex etiologies such as lipomyelomeningoceles or scar formation after myelomeningocele repair involve complex dissection and dural reconstruction. The purpose of this study was to evaluate operative complications and long-term outcomes of secondary retethering related to pediatric tethered cord release (TCR) at a tertiary children's hospital. METHODS Medical records of children who underwent surgery for TCR from July 2014 to March 2023 were retrospectively reviewed. Data collected included demographics, perioperative characteristics, surgical technique, and follow-up duration. Primary outcomes were 60-day postoperative complications and secondary retethering requiring repeat TCR surgery. Univariate and multivariate analyses were performed to identify risk factors associated with complications and secondary retethering. RESULTS A total of 363 TCR surgeries (146 simple, 217 complex) in 340 patients were identified. The mean follow-up was 442.8 ± 662.2 days for simple TCRs and 733.9 ± 750.3 days for complex TCRs. The adjusted 60-day complication-free survival rate was 96.3% (95% CI 91.3%-98.4%) for simple TCRs and 88.7% (95% CI 82.3%-91.4%) for complex TCRs. Lower weight, shorter surgical times, and intensive care unit admission were associated with complications for simple TCRs. Soft-tissue drains increased complications for complex TCRs. The secondary retethering rates were 1.4% for simple TCRs and 11.9% for complex TCRs. The 1-, 3-, and 5-year progression-free survival rates in complex cases were 94.7% (95% CI 89.1%-97.4%), 77.7% (95% CI 67.3%-85.3%), and 62.6% (95% CI 46.5%-75.1%), respectively. Multivariate analysis revealed that prior detethering (OR 8.15, 95% CI 2.33-28.50; p = 0.001) and use of the operative laser (OR 10.43, 95% CI 1.36-80.26; p = 0.024) were independently associated with secondary retethering in complex cases. CONCLUSIONS This is the largest series to date examining postoperative complications and long-term secondary retethering in TCR surgery. Simple TCR surgeries demonstrated safety, rare complications, and low secondary retethering rates. Complex TCR surgeries presented higher risks of complications and secondary retethering. Modifiable risk factors such as operative laser use influenced secondary retethering in complex cases.
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Susarla SM. Pediatric Craniomaxillofacial Trauma. Oral Maxillofac Surg Clin North Am 2023; 35:xiii. [PMID: 37402601 DOI: 10.1016/j.coms.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
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McAvoy M, Hopper RA, Lee A, Ellenbogen RG, Susarla SM. Pediatric Cranial Vault and Skull Base Fractures. Oral Maxillofac Surg Clin North Am 2023; 35:597-606. [PMID: 37442667 DOI: 10.1016/j.coms.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
Cranial vault and skull base fractures in children are distinctly different from those seen in adults. Pediatric skull fractures have the benefit of greater capacity to remodel; however, the developing pediatric brain and craniofacial skeleton present unique challenges to diagnosis, natural history, and management. This article discusses the role of surgical treatment of these fractures, its indications, and techniques.
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Shakir S, Ettinger RE, Susarla SM, Birgfeld CB. Pediatric Panfacial Fractures. Oral Maxillofac Surg Clin North Am 2023; 35:607-617. [PMID: 37280142 DOI: 10.1016/j.coms.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Pediatric panfacial trauma is a rare occurrence with poorly understood implications for the growing child. Treatment algorithms largely mirror adult panfacial protocols with notable exceptions including augmented healing and remodeling capacities that favor nonoperative management, limited exposure to avoid disruption of osseous suture and synchondroses growth centers, and creative fracture fixation techniques in the setting of an immature craniomaxillofacial skeleton. The following article provides a review of our institutional philosophy in the management of these challenges injuries with important anatomic, epidemiologic, examination, sequencing, and postoperative considerations.
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Dabestani PJ, Massenburg BB, Aurit S, Dawson AJ, Susarla SM. Risk factors for inpatient hospital admission following isolated orbital floor fractures. Int J Oral Maxillofac Surg 2023; 52:1039-1048. [PMID: 37003906 DOI: 10.1016/j.ijom.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/11/2023] [Accepted: 03/15/2023] [Indexed: 04/03/2023]
Abstract
Orbital floor fractures are common injuries seen in the emergency department (ED). In this study, the National Trauma Data Bank (NTDB, 2016-2017) was used to identify patients presenting with isolated orbital floor trauma. Patient-specific factors were analyzed to determine associations with management. The sample comprised 912 patients; 285 (31.3%) of these patients were discharged from the ED, 541 (59.3%) were admitted to the hospital but did not undergo an operation, and 86 (9.4%) underwent operative treatment. Pediatric patients and older patients (<18 years and>55 years) were more likely to be admitted than those aged 18-55 years, and pediatric patients were more likely to undergo an urgent operative intervention than those in the other age groups (all P < 0.001). Patients with alcohol use disorder (P = 0.002) and hypertension (P = 0.004) had increased odds of admission. Private and Medicare insurance patients were more likely to be admitted, and self-pay patients less likely (P < 0.001). Older age and Medicaid payor status showed increased odds of a greater hospital length of stay. Biological sex, race/ethnicity, functionally dependent health status, myocardial infarction, steroid use, and substance use disorder were not associated with discharge disposition. There are non-injury related, patient-specific factors that may influence the management of orbital floor fractures.
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Panesar K, Markiewicz MR, Best D, Lee KC, Edwards S, Susarla SM. Pediatric Mandibular Reconstruction. Atlas Oral Maxillofac Surg Clin North Am 2023; 31:177-186. [PMID: 37500201 DOI: 10.1016/j.cxom.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
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Shakir S, Birgfeld CB, Susarla SM. Discussion: Surgical Timing and Neurocognitive Development among Patients with Craniosynostosis: Analysis of Confounders. Plast Reconstr Surg 2023; 151:830-831. [PMID: 36989340 DOI: 10.1097/prs.0000000000010005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
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Ikeda AK, Ettinger RE, Susarla SM, Lu GN. The Effect of COVID-19 Shelter-in-Place Orders on Pediatric Craniofacial Trauma. Facial Plast Surg Aesthet Med 2023; 25:141-144. [PMID: 36315194 DOI: 10.1089/fpsam.2022.0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Objectives: To investigate the impacts of the shelter-in-place orders on the injury patterns among children with craniofacial trauma. Materials and Methods: Pediatric (<18 years old) craniofacial trauma cases presenting to a regional level I trauma center 1 year before and after the initiation of Washington's shelter-in-place order were retrospectively reviewed. Demographic and injury-related variables were recorded, and bivariate and logistic regression analyses were computed. Results: One hundred nineteen children were evaluated over 2-year period (46 pre- and 73 post-shelter-in-place and were comparable in age, gender, and ethnicity (p ≥ 0.17)). The distribution of injury mechanisms between pre- and post-shelter-in-place were significantly different (p = 0.02), with the largest proportional increase in falls (10.5%) and had higher rates of associated brain injury (p ≤ 0.02). After adjusting for effect modifiers and confounders, children presenting during the post-shelter-in-place period were more likely to have associated brain injuries (odds ratio 3.4, 95% confidence interval: 1.11-10.6, p = 0.03). Conclusions: Among pediatric craniofacial injury cases, the shelter-in-place order was associated with a higher likelihood of brain injury and significant changes in injury mechanisms, with a higher proportion of falls.
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