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Wang T, Zhi J, Pan B, Jiang H. The impact of national health insurance on the cost of auricular reconstruction with skin expansion for microtia in China: A single-center retrospective study based on 1290 surgeries. J Plast Reconstr Aesthet Surg 2024; 94:62-71. [PMID: 38763056 DOI: 10.1016/j.bjps.2024.04.067] [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: 03/27/2024] [Accepted: 04/25/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Congenital microtia presents challenges that encompass physical disabilities and psychosocial distress. It is reported that people with low income have a higher possibility of giving birth to babies with congenital malformations. At the end of June 2023, auricular reconstruction was partially incorporated into national health insurance in our hospital. METHODS Briefly, 1290 surgeries, including stage-I and stage-II auricular reconstruction with tissue expansion were performed in 2023, involving 779 patients. Patient data, including age, sex, length of stay, residence, and costs, were retrieved from the electronic medical record system. The final cost before and after health insurance coverage, as well as the medical insurance reimbursement ratio in each province and municipality were statistically analyzed. RESULTS Following insurance coverage, a significant increase in the number of surgeries was observed (514 [39.84%] vs. 776 [60.16%], χ2 = 45.99, p = 0.000), with notable reductions in out-of-pocket costs for unilateral and bilateral stage-I and -II auricular reconstructions ($3915.01 vs. $6645.28, p < 0.05; $11546.80 vs. $5198.08, p < 0.05). Disparities in reimbursement rates across regions were evident, but showed no correlation to the local GDP per capita. There was a positive correlation between the length of stay and inpatient cost. Patient's age was not related to the inpatient cost, but to the length of stay. CONCLUSION The health insurance coverage for microtia treatment significantly alleviated financial burdens on the patients' family and increased the number of auricular reconstruction surgeries. These findings underscore the critical role of insurance coverage in enhancing healthcare accessibility and affordability for patients with congenital microtia.
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Affiliation(s)
- Tiange Wang
- Department of Auricular Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing 100144, People's Republic of China
| | - Jiajun Zhi
- Department of Auricular Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing 100144, People's Republic of China
| | - Bo Pan
- Department of Auricular Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing 100144, People's Republic of China.
| | - Haiyue Jiang
- Department of Auricular Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing 100144, People's Republic of China
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Kim J, Park C, Oh KS, Lim SY. Comprehensive analysis of donor-site chest deformities after autologous costal cartilage microtia reconstruction: A systematic review. J Plast Reconstr Aesthet Surg 2024; 94:128-140. [PMID: 38781833 DOI: 10.1016/j.bjps.2024.05.005] [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: 11/25/2023] [Revised: 04/14/2024] [Accepted: 05/02/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Autologous costal cartilage has gained widespread acceptance as an important material for ear reconstruction in patients with microtia. Despite its recognition as being "worth the trade-off," attention should be directed toward donor-site deformities. This systematic review focused on existing English literature related to microtia reconstruction and aimed to reveal the incidence of chest wall deformities and assess the effectiveness of the various proposed surgical techniques aimed at reducing donor-site morbidities. METHODS A comprehensive search was conducted on Pubmed and OVID using the keywords "microtia," and "chest deformity" or "rib harvest." Articles were screened based on predefined inclusion and exclusion criteria. Data acquisition encompassed patient demographics, employed surgical techniques, methods for evaluating chest deformity, and incidence of associated complications. RESULTS Among the 362 identified articles, 21 met the inclusion criteria. A total of 2600 cases involving 2433 patients with microtia were analyzed in this review. Perichondrium preservation during cartilage harvesting led to a significant reduction in chest deformities. However, the wide incidence range (0% to 50%) and the lack of specific assessment methods suggested potential underestimation. Computed tomography revealed reduced chest wall growth in the transverse and sagittal directions, resulting in decreased thoracic area. Innovative surgical techniques have shown promising results in reducing chest deformities. CONCLUSIONS Although a quantitative analysis was not feasible, objective evidence of deformities was established through computed tomography scans. This analysis highlighted the need for dedicated studies with larger sample sizes to further advance our understanding of chest wall deformities in microtia reconstruction.
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Affiliation(s)
- Jisu Kim
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Chanwoo Park
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kap S Oh
- Department of Plastic surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - So Y Lim
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
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3
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Gutowski KS, Applebaum SA, Thomae BL, Knight KC, Chwa ES, Gosain AK. The Quality and Readability of Online Patient Information on Positional Head Shape Conditions. Cleft Palate Craniofac J 2024; 61:1186-1194. [PMID: 36850070 DOI: 10.1177/10556656231159972] [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: 03/01/2023] Open
Abstract
OBJECTIVE Families increasingly use online resources to acquire medical information about their child's condition with little understanding of the legitimacy of the source of information or of the information itself. We evaluate the quality and readability of online information related to positional head shape conditions and identify unmet needs for healthcare providers to improve online patient education. DESIGN The search terms "flat head baby," "brachycephaly," and "plagiocephaly" were queried on the Google search engine and the first 20 websites for each were reviewed. Included websites were evaluated for quality using the DISCERN Instrument and readability using the Flesch-Kincaid Reading Grade Level (FKGL) and Flesch Reading Ease Score (FRES). Websites were categorized by upload source and results were compared using one-way ANOVA. RESULTS 38 websites met inclusion criteria. There was no significant correlation between DISCERN score and Google search rank between the three search terms. Professional organizations provided websites with the highest mean DISCERN score (56.3) and commercial websites with the lowest score (36.6, P = .003), indicating "good" and "poor" quality content, respectively. Readability assessments showed an overall average FKGL of 9.9 and FRES of 54.4, suggesting "fairly difficult". Hospitals provided the most website results and tended to publish lower quality information, yet are the most readable. CONCLUSIONS High quality websites written at an appropriate reading level for the general public are lacking. A review of online resources for positional head shape conditions can be used to derive recommendations to improve the content of online patient education for pediatric healthcare.
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Affiliation(s)
- Kristof S Gutowski
- Division of Plastic Surgery, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Sarah A Applebaum
- Division of Plastic Surgery, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Benjamin L Thomae
- Division of Plastic Surgery, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Karlee C Knight
- Division of Plastic Surgery, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Emily S Chwa
- Division of Plastic Surgery, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Arun K Gosain
- Division of Plastic Surgery, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
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Widodo DW, Zizlavsky S. Correlation of Grading and Number of Ear Subunits With Auditory Brainstem Response Findings in Children With Microtia. Am J Audiol 2024; 33:503-509. [PMID: 38668691 DOI: 10.1044/2024_aja-23-00162] [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: 06/05/2024] Open
Abstract
PURPOSE The association between microtia severity and hearing function has been thoroughly investigated. This study examined the relationship between microtia grade, number of ear subunits (i.e., helix, antihelix, scapha, triangularis fossa, concha, lobule, tragus, and antitragus) with auditory brainstem response (ABR) findings in children with microtia. STUDY DESIGN A retrospective chart review was employed in this study. METHOD We analyzed the ABR test results and photographs of 22 children with 30 microtia ears at Dr. Cipto Mangunkusumo National Hospital, Jakarta. The ABR test results were acquired using click (air conduction only) and 500-Hz tone burst stimuli (air- and bone-conduction). Ear photographs were overlaid with a template of a normal ear to determine the number of ear subunits present and the subsequent microtia grade. Number of ear subunits and ABR results were analyzed using the chi-square, Mann-Whitney U, and Spearman's correlation tests. RESULTS ABR thresholds for click and 500-Hz tone bursts air-conduction were significantly poorer for ears with a subunit < 5 compared to ears with a subunit ≥ 5. No significant difference was observed in 500 Hz bone-conduction ABR thresholds between these groups. Correlation analysis showed a significant negative correlation between increased ear subunits and click ABR thresholds. No significant correlation was found between ear subunits and 500-Hz air- and bone-conduction ABR thresholds. CONCLUSIONS A higher number of ear subunits are associated with a lower hearing threshold, as assessed using ABR with click stimuli. Therefore, the number of ear subunits and microtia grades can be used to examine the hearing level thresholds in infants and children with microtia. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.25669440.
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Affiliation(s)
- Dini Widiarni Widodo
- Department of Ear Nose Throat-Head Neck Surgery, Faculty of Medicine, University of Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta
| | - Semiramis Zizlavsky
- Department of Ear Nose Throat-Head Neck Surgery, Faculty of Medicine, University of Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta
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Zhou J, Cui R, Lin L. A Systematic Review of the Application of Computational Technology in Microtia. J Craniofac Surg 2024; 35:1214-1218. [PMID: 38710037 DOI: 10.1097/scs.0000000000010210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 03/11/2024] [Indexed: 05/08/2024] Open
Abstract
Microtia is a congenital and morphological anomaly of one or both ears, which results from a confluence of genetic and external environmental factors. Up to now, extensive research has explored the potential utilization of computational methodologies in microtia and has obtained promising results. Thus, the authors reviewed the achievements and shortcomings of the research mentioned previously, from the aspects of artificial intelligence, computer-aided design and surgery, computed tomography, medical and biological data mining, and reality-related technology, including virtual reality and augmented reality. Hoping to offer novel concepts and inspire further studies within this field.
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Affiliation(s)
- Jingyang Zhou
- Ear Reconstruction Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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Velasquillo C, Melgarejo-Ramírez Y, García-López J, Gutiérrez-Gómez C, Lecona H, González-Torres M, Sánchez-Betancourt JI, Ibarra C, Lee SJ, Yoo JJ. Remaining microtia tissue as a source for 3D bioprinted elastic cartilage tissue constructs, potential use for surgical microtia reconstruction. Cell Tissue Bank 2024; 25:571-582. [PMID: 38038782 DOI: 10.1007/s10561-023-10118-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 10/26/2023] [Indexed: 12/02/2023]
Abstract
The absence of ears in children is a global problem. An implant made of costal cartilage is the standard procedure for ear reconstruction; however, side effects such as pneumothorax, loss of thoracic cage shape, and respiratory complications have been documented. Three-dimensional (3D) printing allows the generation of biocompatible scaffolds that mimic the shape, mechanical strength, and architecture of the native extracellular matrix necessary to promote new elastic cartilage formation. We report the potential use of a 3D-bioprinted poly-ε-caprolactone (3D-PCL) auricle-shaped framework seeded with remaining human microtia chondrocytes for the development of elastic cartilage for autologous microtia ear reconstruction. An in vivo assay of the neo-tissue formed revealed the generation of a 3D pinna-shaped neo-tissue, and confirmed the formation of elastic cartilage by the presence of type II collagen and elastin with histological features and a protein composition consistent with normal elastic cartilage. According to our results, a combination of 3D-PCL auricle frameworks and autologous microtia remnant tissue generates a suitable pinna structure for autologous ear reconstruction.
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Affiliation(s)
- Cristina Velasquillo
- Unidad de Ingeniería de Tejidos, Terapia Celular y Medicina Regenerativa, Instituto Nacional de Rehabilitación LGII, Mexico City, Mexico.
| | - Yaaziel Melgarejo-Ramírez
- Laboratorio de Biotecnología, Unidad de Gerociencias, Instituto Nacional de Rehabilitación LGII, Mexico City, Mexico.
| | - Julieta García-López
- Unidad de Ingeniería de Tejidos, Terapia Celular y Medicina Regenerativa, Instituto Nacional de Rehabilitación LGII, Mexico City, Mexico
| | - Claudia Gutiérrez-Gómez
- División de Cirugía Plástica y Reconstructiva, Hospital General Dr. Manuel Gea González, Mexico City, Mexico
| | - Hugo Lecona
- Bioterio y Cirugía Experimental, Instituto Nacional de Rehabilitación, Mexico City, Mexico
| | - Maykel González-Torres
- Laboratorio de Biotecnología, Unidad de Gerociencias, Instituto Nacional de Rehabilitación LGII, Mexico City, Mexico
| | - José Iván Sánchez-Betancourt
- Departamento de Producción Animal. Facultad de Medicina Veterinaria y Zootecnia, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Clemente Ibarra
- Unidad de Ingeniería de Tejidos, Terapia Celular y Medicina Regenerativa, Instituto Nacional de Rehabilitación LGII, Mexico City, Mexico
| | - Sang Jin Lee
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - James J Yoo
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Tsur N, Beer Z, Rittblat M, Yaacobi D, Elmograbi A, Reuven Y. Intelligence among ear deformities and cleft lip and/or alveolus and/or cleft palate patients during 50 years in Israel. Orthod Craniofac Res 2024; 27 Suppl 1:14-20. [PMID: 37650486 DOI: 10.1111/ocr.12709] [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: 10/13/2022] [Revised: 08/02/2023] [Accepted: 08/18/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE We evaluated hearing loss and general intelligence among persons with auricle anomalies and cleft lip and/or alveolus and/or cleft palate (CLAP). METHODS A nationwide cross-sectional study of data recorded during 1966-2019, as mandatory pre-military recruitment of individuals. RESULTS Of 3 182 892 adolescents, 548 were diagnosed with auricle anomalies and 2072 with CLAP. For the latter, the adjusted odds ratios for the low, low to medium and medium general intelligence categories compared to the highest category were 1.4 [95% CI 1.5-1.2], 1.2 [95% CI 1.4-1.1] and 1.1 [95% CI 1.2-0.9] respectively. The corresponding values for the auricle anomalies were not significant. CONCLUSIONS General intelligence was impaired among individuals with CLAP, but no significant correlation was found among individuals suffering from auricle anomalies.
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Affiliation(s)
- Nir Tsur
- Israel Defense Forces, Medical Corps, Ramat Gan, Israel
- Department of Otolaryngology-Head and Neck Surgery, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Zivan Beer
- Israel Defense Forces, Medical Corps, Ramat Gan, Israel
- Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Mor Rittblat
- Israel Defense Forces, Medical Corps, Ramat Gan, Israel
- Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dafna Yaacobi
- Department of Plastic Surgery and Burns, Rabin Medical Center-Beilinson Hospital, Petah Tikva, Israel
| | - Aiman Elmograbi
- Department of Otolaryngology-Head and Neck Surgery, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Yonatan Reuven
- Department of Otolaryngology-Head and Neck Surgery, Schneider Children's Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Díez-Montiel A, Pose-Díez-de-la-Lastra A, González-Álvarez A, Salmerón JI, Pascau J, Ochandiano S. Tablet-based Augmented reality and 3D printed templates in fully guided Microtia Reconstruction: a clinical workflow. 3D Print Med 2024; 10:17. [PMID: 38819536 PMCID: PMC11140883 DOI: 10.1186/s41205-024-00213-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/04/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Microtia is a congenital malformation of the auricle that affects approximately 4 of every 10,000 live newborns. Radiographic film paper is traditionally employed to bidimensionally trace the structures of the contralateral healthy ear in a quasi-artistic manner. Anatomical points provide linear and angular measurements. However, this technique proves time-consuming, subjectivity-rich, and greatly dependent on surgeon expertise. Hence, it's susceptible to shape errors and misplacement. METHODS We present an innovative clinical workflow that combines 3D printing and augmented reality (AR) to increase objectivity and reproducibility of these procedures. Specifically, we introduce patient-specific 3D cutting templates and remodeling molds to carve and construct the cartilaginous framework that will conform the new ear. Moreover, we developed an in-house AR application compatible with any commercial Android tablet. It precisely guides the positioning of the new ear during surgery, ensuring symmetrical alignment with the healthy one and avoiding time-consuming intraoperative linear or angular measurements. Our solution was evaluated in one case, first with controlled experiments in a simulation scenario and finally during surgery. RESULTS Overall, the ears placed in the simulation scenario had a mean absolute deviation of 2.2 ± 1.7 mm with respect to the reference plan. During the surgical intervention, the reconstructed ear was 3.1 mm longer and 1.3 mm wider with respect to the ideal plan and had a positioning error of 2.7 ± 2.4 mm relative to the contralateral side. Note that in this case, additional morphometric variations were induced from inflammation and other issues intended to be addressed in a subsequent stage of surgery, which are independent of our proposed solution. CONCLUSIONS In this work we propose an innovative workflow that combines 3D printing and AR to improve ear reconstruction and positioning in microtia correction procedures. Our implementation in the surgical workflow showed good accuracy, empowering surgeons to attain consistent and objective outcomes.
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Affiliation(s)
- Alberto Díez-Montiel
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, 28007, Spain
- Servicio de Cirugía Oral y Maxilofacial, Hospital General Universitario Gregorio Marañón, Madrid, 28007, Spain
| | - Alicia Pose-Díez-de-la-Lastra
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, 28007, Spain.
- Departamento de Bioingeniería, Universidad Carlos III de Madrid, Leganés, 28911, Spain.
| | - Alba González-Álvarez
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, 28007, Spain
- Departamento de Bioingeniería, Universidad Carlos III de Madrid, Leganés, 28911, Spain
| | - José I Salmerón
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, 28007, Spain
- Servicio de Cirugía Oral y Maxilofacial, Hospital General Universitario Gregorio Marañón, Madrid, 28007, Spain
| | - Javier Pascau
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, 28007, Spain
- Departamento de Bioingeniería, Universidad Carlos III de Madrid, Leganés, 28911, Spain
| | - Santiago Ochandiano
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, 28007, Spain
- Servicio de Cirugía Oral y Maxilofacial, Hospital General Universitario Gregorio Marañón, Madrid, 28007, Spain
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Zhang L, Liang L, Kasimu H, Li W, Liu M, Li H, He S. A 76-base pair duplication within the enhancer region of the HMX1 gene causes sheep microtia. Gene 2024; 909:148307. [PMID: 38395239 DOI: 10.1016/j.gene.2024.148307] [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: 10/18/2023] [Revised: 02/01/2024] [Accepted: 02/20/2024] [Indexed: 02/25/2024]
Abstract
Sheep congenital microtia is characterized by underdeveloped ears and provides an ideal basis for studying human microtia. This study identified the causal mutation and regulatory mechanisms underlying this disorder. Whole-genome association analysis was conducted using 23 ear tissue samples from sheep with microtia and 28 samples from normal-eared sheep. A significant correlation was found between microtia and a 76-base pair duplication in the enhancer region of the HMX1 gene. Further analysis of offspring phenotypes confirmed an autosomal dominant inheritance pattern. Genotypic analysis showed that individuals that are homozygous for this duplication were earless, heterozygous individuals exhibited shortened ears, and wild-type individuals had normal ears. Moreover, luciferase assays confirmed that this duplication increased HMX1 gene expression, and duplication knock-in mice also exhibited shorter and narrower external ears compared to wild-type mice. Transcriptomic analysis further demonstrated that this duplication enhanced HMX1 gene expression in animal models. This study characterized the causal regulatory mutation underlying sheep microtia.
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Affiliation(s)
- Lihua Zhang
- College of Animal Science, Xinjiang Agricultural University, Urumqi, Xinjiang, 830052, China; Key Laboratory of Ruminant Genetics, Breeding & Reproduction, Ministry of Agriculture, Key Laboratory of Animal Biotechnology of Xinjiang, Institute of Biotechnology, Xinjiang Academy of Animal Science, Urumqi, Xinjiang, 830011, China
| | - Long Liang
- Key Laboratory of Ruminant Genetics, Breeding & Reproduction, Ministry of Agriculture, Key Laboratory of Animal Biotechnology of Xinjiang, Institute of Biotechnology, Xinjiang Academy of Animal Science, Urumqi, Xinjiang, 830011, China
| | - Hailati Kasimu
- Key Laboratory of Ruminant Genetics, Breeding & Reproduction, Ministry of Agriculture, Key Laboratory of Animal Biotechnology of Xinjiang, Institute of Biotechnology, Xinjiang Academy of Animal Science, Urumqi, Xinjiang, 830011, China
| | - Wenrong Li
- Key Laboratory of Ruminant Genetics, Breeding & Reproduction, Ministry of Agriculture, Key Laboratory of Animal Biotechnology of Xinjiang, Institute of Biotechnology, Xinjiang Academy of Animal Science, Urumqi, Xinjiang, 830011, China
| | - Mingjun Liu
- Key Laboratory of Ruminant Genetics, Breeding & Reproduction, Ministry of Agriculture, Key Laboratory of Animal Biotechnology of Xinjiang, Institute of Biotechnology, Xinjiang Academy of Animal Science, Urumqi, Xinjiang, 830011, China
| | - Haiying Li
- College of Animal Science, Xinjiang Agricultural University, Urumqi, Xinjiang, 830052, China.
| | - Sangang He
- Key Laboratory of Ruminant Genetics, Breeding & Reproduction, Ministry of Agriculture, Key Laboratory of Animal Biotechnology of Xinjiang, Institute of Biotechnology, Xinjiang Academy of Animal Science, Urumqi, Xinjiang, 830011, China.
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10
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Liu W, Wu Y, Ma R, Zhu X, Wang R, He L, Shu M. Multi-omics analysis of a case of congenital microtia reveals aldob and oxidative stress associated with microtia etiology. Orphanet J Rare Dis 2024; 19:218. [PMID: 38802922 PMCID: PMC11129396 DOI: 10.1186/s13023-024-03149-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 03/27/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Microtia is reported to be one of the most common congenital craniofacial malformations. Due to the complex etiology and the ethical barrier of embryonic study, the precise mechanisms of microtia remain unclear. Here we report a rare case of microtia with costal chondrodysplasia based on bioinformatics analysis and further verifications on other sporadic microtia patients. RESULTS One hundred fourteen deleterious insert and deletion (InDel) and 646 deleterious SNPs were screened out by WES, candidate genes were ranked in descending order according to their relative impact with microtia. Label-free proteomic analysis showed that proteins significantly different between the groups were related with oxidative stress and energy metabolism. By real-time PCR and immunohistochemistry, we further verified the candidate genes between other sporadic microtia and normal ear chondrocytes, which showed threonine aspartase, cadherin-13, aldolase B and adiponectin were significantly upregulated in mRNA levels but were significantly lower in protein levels. ROS detection and mitochondrial membrane potential (∆ Ψ m) detection proved that oxidative stress exists in microtia chondrocytes. CONCLUSIONS Our results not only spot new candidate genes by WES and label-free proteomics, but also speculate for the first time that metabolism and oxidative stress may disturb cartilage development and this might become therapeutic targets and potential biomarkers with clinical usefulness in the future.
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Affiliation(s)
- Wenbo Liu
- The First Affiliated Hospital of Xi'an Jiao Tong University, No.277 Yanta West Road, Xi'an, Shaanxi, 710061, China
| | - Yi Wu
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Rulan Ma
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiao Tong University Medical College, Xi'an, Shaanxi, China
| | - Xinxi Zhu
- The First Affiliated Hospital of Xi'an Jiao Tong University, No.277 Yanta West Road, Xi'an, Shaanxi, 710061, China
| | - Rui Wang
- The First Affiliated Hospital of Xi'an Jiao Tong University, No.277 Yanta West Road, Xi'an, Shaanxi, 710061, China
| | - Lin He
- The First Affiliated Hospital of Xi'an Jiao Tong University, No.277 Yanta West Road, Xi'an, Shaanxi, 710061, China
| | - Maoguo Shu
- The First Affiliated Hospital of Xi'an Jiao Tong University, No.277 Yanta West Road, Xi'an, Shaanxi, 710061, China.
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González-Andrade F, Coello F, López-Pulles R, Fuenmayor G, Andrade E, Vásconez H. Demographic, Functional, and Risk Factors Characterization in Ecuadorian Mestizo Patients With Microtia: A Retrospective Study. J Craniofac Surg 2024:00001665-990000000-01610. [PMID: 38771204 DOI: 10.1097/scs.0000000000010288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 04/15/2024] [Indexed: 05/22/2024] Open
Abstract
OBJECTIVE This paper compares demographic, morphological, functional, and risk factors between isolated and familial forms of microtia in Ecuadorian mestizo patients. METHODS The authors did an epidemiological, and retrospective study with 112 patients divided into isolated microtia (n = 91) and familial microtia (n = 21). Patients with syndromic microtia were not included. RESULTS In isolated microtia, the mean age was 11.80 ± 16.9, and the most prevalent age group was from 5 to 9 years, with 45.0%; males were 58.2%, and 91.2% of patients were born in a city above 2500 meters about sea level. In familial microtia, the mean age was 15.57 ± 17.2. There were no statistically significant differences between the analyzed variables. In isolated microtia, 41.8% of patients had bilateral involvement, 40.7% had grade 1 microtia in the right ear (RE), and grade 1 in the left ear was 47.3%; external auditory canal atresia of RE was present in 62.6%, and in left ear in 31.6%. External auditory canal atresia sidedness was mostly unilateral in both groups. Most patients did not have tags or pits (78% and 81% in RE and 85.7% and 71.4%). Most patients had moderate hearing loss in both ears. CONCLUSION The authors found an association between both microtia forms with external auditory canal atresia in RE; only 20% of patients had unilateral auricular tags or pits in both groups. The authors also found a high incidence (18.75%) of familial microtia, which suggests a distinct pathological genetic component than the more prevalent isolated cases. The authors found a high association of microtia cases from the Ecuadorian highlands above 2500 meters about sea level (over 90%). The presence of "social" intake of alcohol during pregnancy showed over twice the chance of having a child born with microtia.
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Affiliation(s)
- Fabricio González-Andrade
- Indoamerica Technological University, Faculty of Health Sciences and Wellbeing, Machala y Sabanilla
- Central University of Ecuador, Faculty of Medical Sciences, Translational Medicine Unit
| | - Fausto Coello
- Central University of Ecuador, Faculty of Medical Sciences, Translational Medicine Unit
| | - Ramiro López-Pulles
- Central University of Ecuador, Faculty of Medical Sciences, Translational Medicine Unit
| | - Guillermo Fuenmayor
- Central University of Ecuador, Faculty of Medical Sciences, Translational Medicine Unit
| | - Edwin Andrade
- PROAUDIO, Comprehensive Hearing and Language Institute
| | - Henry Vásconez
- San Francisco de Quito University USFQ, Health Sciences College, School of Medical Specialties, Diego de Robles street and Pampite; Quito, Ecuador
- College of Medicine, The University of Kentucky, Lexington, KY
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Wu R, Li X, Meng Z, Li P, He Z, Liang L. Phenotypic and genetic analysis of children with unexplained neurodevelopmental delay and neurodevelopmental comorbidities in a Chinese cohort using trio-based whole-exome sequencing. Orphanet J Rare Dis 2024; 19:205. [PMID: 38764027 PMCID: PMC11103872 DOI: 10.1186/s13023-024-03214-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/10/2024] [Indexed: 05/21/2024] Open
Abstract
BACKGROUND Trio-based whole-exome sequencing (trio-WES) enables identification of pathogenic variants, including copy-number variants (CNVs), in children with unexplained neurodevelopmental delay (NDD) and neurodevelopmental comorbidities (NDCs), including autism spectrum disorder (ASD), epilepsy, and attention deficit hyperactivity disorder. Further phenotypic and genetic analysis on trio-WES-tested NDD-NDCs cases may help to identify key phenotypic factors related to higher diagnostic yield of using trio-WES and novel risk genes associated with NDCs in clinical settings. METHODS In this study, we retrospectively performed phenotypic analysis on 163 trio-WES-tested NDD-NDCs children to determine the phenotypic differences between genetically diagnosed and non-genetically diagnosed groups. Additionally, we conducted genetic analysis of ASD genes with the help of Simons Foundation for Autism Research Institute (SFARI) Gene database to identify novel possible ASD-risk genes underlying genetic NDD conditions. RESULTS Among these 163 patients, pathogenic variants were identified in 82 cases (82/163, 50.3%), including 20 cases with CNVs. By comparing phenotypic variables between genetically diagnosed group (82 cases) and non-genetically diagnosed group (81 cases) with multivariate binary logistic regression analysis, we revealed that NDD-NDCs cases presenting with severe-profound NDD [53/82 vs 17/81, adjusted-OR (95%CI): 4.865 (2.213 - 10.694), adjusted-P < 0.001] or having multiple NDCs [26/82 vs 8/81, adjusted-OR (95%CI): 3.731 (1.399 - 9.950), adjusted-P = 0.009] or accompanying ASD [64/82 vs 35/81, adjusted-OR (95%CI): 3.256 (1.479 - 7.168), adjusted-P = 0.003] and head circumference abnormality [33/82 vs 11/81, adjusted-OR (95%CI): 2.788 (1.148 - 6.774), adjusted-P = 0.024] were more likely to have a genetic diagnosis using trio-WES. Moreover, 37 genes with monogenetic variants were identified in 48 patients genetically diagnosed with NDD-ASD, and 15 dosage-sensitive genes were identified in 16 individuals with NDD-ASD carrying CNVs. Most of those genes had been proven to be ASD-related genes. However, some of them (9 genes) were not proven sufficiently to correlate with ASD. By literature review and constructing protein-protein interaction networks among these 9 candidate ASD-risk genes and 102 established ASD genes obtained from the SFARI Gene database, we identified CUL4B, KCNH1, and PLA2G6 as novel possible ASD-risk genes underlying genetic NDD conditions. CONCLUSIONS Trio-WES testing is recommended for patients with unexplained NDD-NDCs that have severe-profound NDD or multiple NDCs, particularly those with accompanying ASD and head circumference abnormality, as these independent factors may increase the likelihood of genetic diagnosis using trio-WES. Moreover, NDD patients with pathogenic variants in CUL4B, KCNH1 and PLA2G6 should be aware of potential risks of developing ASD during their disease courses.
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Affiliation(s)
- Ruohao Wu
- Department of Children's Neuro-endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, China
- Children's Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou Guangdong, 510120, China
| | - Xiaojuan Li
- Department of Research and Molecular Diagnostics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, China
| | - Zhe Meng
- Department of Children's Neuro-endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, China
- Children's Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou Guangdong, 510120, China
| | - Pinggan Li
- Department of Children's Neuro-endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, China
- Children's Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou Guangdong, 510120, China
| | - Zhanwen He
- Department of Children's Neuro-endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, China.
- Children's Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou Guangdong, 510120, China.
| | - Liyang Liang
- Department of Children's Neuro-endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, China.
- Children's Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou Guangdong, 510120, China.
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Hilewitz D, Olshinka A. Early Non-Surgical Treatment For Microtia Types 1 and 2. J Craniofac Surg 2024:00001665-990000000-01576. [PMID: 38743060 DOI: 10.1097/scs.0000000000010279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 04/04/2024] [Indexed: 05/16/2024] Open
Abstract
Esthetic concerns and psychosocial distress often accompany auricular deformities and malformations in both children and their parents. Approximately 30% of newborns are affected by auricular anomalies, with 15% to 20% resulting in permanent defects. While surgical intervention is typically considered the gold standard for malformations, a non-surgical approach, such as splinting, molding, or other non-invasive techniques, can effectively address deformations if promptly administered by a specialist. Microtia, classified into 4 types, presents challenges ranging from fundamental structural anomalies in types 1 and 2 to severe defects in type 3 and complete absence of the external ear in type 4 (anotia). This study introduces a novel non-invasive treatment modality for microtia types 1 and 2. The cohort consisted of 5 newborns treated for microtia types 1 or 2 between 2022 and 2023. Utilizing the EarWell system, treatment was initiated before 3 weeks of age (mean age: 2 weeks), with an average treatment duration of 6.6 weeks, supplemented by molding treatment as needed. Minor adverse effects, such as simple dermatitis, were observed in 2 patients. All parents expressed high satisfaction with the esthetic outcomes, with 60% reporting extreme satisfaction. The prompt initiation of the treatment protocol for microtia types 1 and 2 led to outstanding and timely outcomes in infants, enhancing the quality of life for both parents and their children. Early intervention for subsequent treatment may improve the condition and, in certain cases, serve as a satisfactory alternative for parents hesitant about further surgical intervention for their children.
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Affiliation(s)
| | - Asaf Olshinka
- Tel Aviv University School of Medicine, Tel Aviv
- Plastic Surgery & Burns Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
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Ronde E, van de Lücht VA, Lachkar N, Ubbink DT, Breugem CC. Stakeholders' Views on Information Needed in a Patient Decision Aid for Microtia Reconstruction. Cleft Palate Craniofac J 2024; 61:854-869. [PMID: 36604964 PMCID: PMC10981206 DOI: 10.1177/10556656221146584] [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: 01/07/2023] Open
Abstract
OBJECTIVE To assess which information about microtia and the possible reconstructive options health care providers (HCPs), patients and parents believe should be included in a patient decision aid (PtDA). DESIGN A mixed-methods study comprised of an online survey of HCPs and focus group discussions with patients and parents. PARTICIPANTS Survey respondents were members of the International Society for Auricular Reconstruction (ISAR). Focus group participants were patients with microtia and their parents, recruited through the microtia outpatient clinic at Amsterdam UMC, and through a Dutch patient organization for cleft and craniofacial conditions. METHODS An online, investigator-made survey was sent to ISAR members in December 2021. Semi-structured focus group discussions were held in February 2022. Quantitative results were summarized, and qualitative results were thematically grouped. RESULTS Thirty-two HCPs responded to the survey (response rate 41%). Most respondents (n = 24) were plastic surgeons, who had a median of 15 years of experience (IQR: 7-23 years). Two focus groups were held with a total of five patients and two parents. HCPs, patients and parents generally agreed on the information needed in a PtDA, emphasizing the importance of realistic expectation management. Patients and parents also considered psychosocial and functional outcomes, patient experiences, as well as patients' involvement in decision-making important. CONCLUSIONS A PtDA for microtia reconstruction should target all patients with microtia, and include information on at least technique-related information, expected esthetic results, possible adverse effects, psychosocial and functional outcomes and patient experiences. Preference eliciting questions should be developed for both pediatric patients and their parents.
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Affiliation(s)
- E.M. Ronde
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development, Amsterdam, the Netherlands
| | - Veronique A.P. van de Lücht
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - N. Lachkar
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Dirk T. Ubbink
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Personalized Medicine, Amsterdam Public Health, Amsterdam, the Netherlands
| | - Corstiaan C. Breugem
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development, Amsterdam, the Netherlands
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Vernice NA, Dong X, Matavosian AA, Corpuz GS, Shin J, Bonassar LJ, Spector JA. Bioengineering Full-scale auricles using 3D-printed external scaffolds and decellularized cartilage xenograft. Acta Biomater 2024; 179:121-129. [PMID: 38494083 DOI: 10.1016/j.actbio.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/10/2024] [Accepted: 03/11/2024] [Indexed: 03/19/2024]
Abstract
Reconstruction of the human auricle remains a formidable challenge for plastic surgeons. Autologous costal cartilage grafts and alloplastic implants are technically challenging, and aesthetic and/or tactile outcomes are frequently suboptimal. Using a small animal "bioreactor", we have bioengineered full-scale ears utilizing decellularized cartilage xenograft placed within a 3D-printed external auricular scaffold that mimics the size, shape, and biomechanical properties of the native human auricle. The full-scale polylactic acid ear scaffolds were 3D-printed based upon data acquired from 3D photogrammetry of an adult ear. Ovine costal cartilage was processed either through mincing (1 mm3) or zesting (< 0.5 mm3), and then fully decellularized and sterilized. At explantation, both the minced and zested neoears maintained the size and contour complexities of the scaffold topography with steady tissue ingrowth through 6 months in vivo. A mild inflammatory infiltrate at 3 months was replaced by homogenous fibrovascular tissue ingrowth enveloping individual cartilage pieces at 6 months. All ear constructs were pliable, and the elasticity was confirmed by biomechanical analysis. Longer-term studies of the neoears with faster degrading biomaterials will be warranted for future clinical application. STATEMENT OF SIGNIFICANCE: Accurate reconstruction of the human auricle has always been a formidable challenge to plastic surgeons. In this article, we have bioengineered full-scale ears utilizing decellularized cartilage xenograft placed within a 3D-printed external auricular scaffold that mimic the size, shape, and biomechanical properties of the native human auricle. Longer-term studies of the neoears with faster degrading biomaterials will be warranted for future clinical application.
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Affiliation(s)
- Nicholas A Vernice
- Laboratory of Bioregenerative Medicine & Surgery, Department of Surgery, Division of Plastic Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Xue Dong
- Laboratory of Bioregenerative Medicine & Surgery, Department of Surgery, Division of Plastic Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Alicia A Matavosian
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, USA
| | - George S Corpuz
- Laboratory of Bioregenerative Medicine & Surgery, Department of Surgery, Division of Plastic Surgery, Weill Cornell Medical College, New York, NY, USA
| | - James Shin
- Department of Radiology, Well Cornell Medicine, New York, NY, USA
| | - Lawrence J Bonassar
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, USA; Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY, USA
| | - Jason A Spector
- Laboratory of Bioregenerative Medicine & Surgery, Department of Surgery, Division of Plastic Surgery, Weill Cornell Medical College, New York, NY, USA; Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, USA; Division of Plastic and Reconstructive Surgery, Department of Surgery, Weill Cornell Medicine, New York, NY, USA.
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16
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Zhou X, Fang J, Wang X, Kuang H, He J, Wang A, Hua X, Zeng X, Zeng S. Epidemiology of congenital malformations of the external ear in Hunan Province, China, from 2016 to 2020. Medicine (Baltimore) 2024; 103:e37691. [PMID: 38608109 PMCID: PMC11018175 DOI: 10.1097/md.0000000000037691] [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: 09/18/2023] [Accepted: 03/01/2024] [Indexed: 04/14/2024] Open
Abstract
To describe the epidemiology of congenital malformations of the external ear (CMEE). Data were obtained from the Birth Defects Surveillance System in Hunan Province, China, 2016 to 2020. The prevalence of CMEEs is defined as the number of cases per 1000 fetuses (births and deaths at 28 weeks of gestation and beyond) (unit: ‰). Prevalence and 95% confidence intervals (CI) were calculated by the log-binomial method. Chi-square trend tests (χ2trend) were used to determine trends in prevalence by year. P < .05 was considered statistically significant. Crude odds ratios (ORs) were calculated to examine the association of sex, residence, and maternal age with CMEEs. Our study included 847,755 fetuses, and 14,459 birth defects were identified, including 1227 CMEEs (accounted for 8.49% of birth defects). The prevalences of birth defects and CMEEs were 17.06‰ (95%CI: 16.78-17.33) and 1.45‰ (95%CI: 1.37-1.53), respectively. A total of 185 microtia-anotias were identified, accounting for 15.08% of CMEEs, with a prevalence of 0.22‰ (95%CI: 0.19-0.25). And 1042 other CMEEs were identified, accounting for 84.92% of CMEEs. From 2016 to 2020, the prevalences of birth defects were 18.20‰, 18.00‰, 16.31‰, 16.03‰, and 16.47‰, respectively, showing a downward trend (χ2trend =8.45, P < .01); the prevalences of CMEEs were 1.19‰, 1.62‰, 1.80‰, 1.21‰, and 1.35‰, respectively, with no significant trend (χ2trend =0.09, P = .77). CMEEs were more common in males than females (1.60‰ vs 1.27‰, OR = 1.26, 95%CI: 1.12-1.41), in urban areas than in rural areas (1.77‰ vs 1.23‰, OR = 1.45, 95%CI: 1.29-1.62). The prevalences of CMEEs for maternal age < 20, 20-24, 25-29, 30-34, and ≥ 35 were 1.75‰, 1.27‰, 1.44‰, 1.47‰, and 1.58‰, respectively, with no significant difference (P > .05, reference: 25-29). Most CMEEs were diagnosed by clinical examinations (92.34%), and most CMEEs were diagnosed postpartum (within 7 days) (96.25%). In summary, we have presented the epidemiology of CMEEs in Hunan Province, China. CMEEs were more common in males than females, in urban areas than rural areas, whereas there was no significant difference in prevalence of CMEEs by maternal age. We inferred that CMEEs may be mainly related to genetics, and the mechanism needs to be examined in the future.
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Affiliation(s)
- Xu Zhou
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, China
| | - Junqun Fang
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, China
| | - Xiaoli Wang
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, China
| | - Haiyan Kuang
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, China
| | - Jian He
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, China
| | - Aihua Wang
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, China
| | - Xinjun Hua
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, China
| | - Xiu Zeng
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, China
| | - Shuxian Zeng
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, China
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Lam DD, Hegde NV, Patel DD, Lakeland DL, Guardino N, Kochhar A, Mariani FV. Histological assessment of microtia cartilage, a potential source of autograft tissue in ear reconstruction. J Anat 2024. [PMID: 38574100 DOI: 10.1111/joa.14044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 04/06/2024] Open
Abstract
Cartilage is a strong and flexible connective tissue that has many forms and functions in our body. While cartilage exhibits some forms of limited repair, for the most part, it is not particularly regenerative. Thus, in situations where patients require cartilage reconstruction, surgeons may use autografts to replace missing or damaged tissue. Cartilage tissues from different regions of the body exhibit histological differences and are in limited supply. Thus, it is important to characterize these differences to determine the most appropriate autograft source. In the case of microtia, a congenital deformity where the pinna is underdeveloped, reconstruction commonly utilizes cartilage sourced from a patient's own costal cartilage. This presents a potential morbidity risk. In this study, we evaluate the histological characteristics of microtia cartilage compared with normal auricular and costal cartilage obtained from human patients undergoing surgical resection. Histochemistry was used to evaluate cellularity, lipid content, and ECM content. Using a Bayesian statistical approach, we determined that while costal cartilage is the standard tissue donor, the microanatomy of microtia cartilage more closely reflects normal auricular cartilage than costal cartilage. Therefore, microtia cartilage may serve as an additional reservoir for cartilage during reconstruction.
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Affiliation(s)
- David D Lam
- Rick and Tina Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
- Department of Otolaryngology Head and Neck Surgery and Communicative Disorders, School of Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Neel V Hegde
- Department of Stem Cell Biology and Regenerative Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
- Department of Pathology and Laboratory Medicine, University of Vermont, Larner College of Medicine, Burlington, Vermont, USA
| | - Divya D Patel
- Department of Stem Cell Biology and Regenerative Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | | | - Nicholas Guardino
- Department of Stem Cell Biology and Regenerative Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Amit Kochhar
- Rick and Tina Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
- Pacific Neuroscience Institute, Santa Monica, California, USA
| | - Francesca V Mariani
- Department of Stem Cell Biology and Regenerative Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
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Bouhadana G, Gornitsky J, Saleh E, El Jalbout R, Borsuk DE, Cugno S. Determination of Novel, Cranium-Based Relationships for Construct Placement in Microtia Reconstruction for Hemifacial Microsomia Patients. Cleft Palate Craniofac J 2024; 61:631-638. [PMID: 36310432 DOI: 10.1177/10556656221135925] [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: 06/16/2023] Open
Abstract
OBJECTIVE Determine if the ideal location of the construct in microtia reconstruction for hemifacial microsomia (HFM) can be more accurately derived from measurements on the cranium. DESIGN High-resolution computerized tomography (CT) images were analyzed through craniometric linear relationships. SETTING Our tertiary care institution from 2000 to 2021. PATIENTS/PARTICIPANTS Patients diagnosed with HFM and microtia, who had high-resolution craniofacial CT scans, yielding 36 patients accounting for 44 CT scans. MAIN OUTCOME MEASURE(S) First, the integrity of the posterior cranial vault among HFM patients was determined. If proven to be unaffected, it could be used as a reference in the placement of the construct. Second, the position of the ear in relation to the cranium was assessed in healthy age-matched controls. Third, if proven to be useful, the concordance of these cranium-based relationships could be validated among our HFM cohort. RESULTS The posterior cranial vault is unaffected in HFM (P > .001). Further, craniometric relationships between the tragus and the Foramen Magnum, as well as between the tragus and the posterior cranium, have been shown to be highly similar and equally precise in predicting tragus position in healthy controls (P > .001). These relationships held true across all age groups (P > .001), and importantly among HFM patients, where the mean absolute difference in predicted tragus position never surpassed 1.5 mm. CONCLUSIONS Relationships between the tragus and the cranium may be used as an alternative to distorted facial anatomy or surgeon's experience to assist in pre-operative planning of construct placement in microtia reconstruction for HFM patients.
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Affiliation(s)
- Gabriel Bouhadana
- Division of Plastic and Reconstructive Surgery, Université de Montréal, Montreal, Quebec, Canada
| | - Jordan Gornitsky
- Division of Plastic and Reconstructive Surgery, Université de Montréal, Montreal, Quebec, Canada
| | - Eli Saleh
- Division of Plastic and Reconstructive Surgery, Université de Montréal, Montreal, Quebec, Canada
| | - Ramy El Jalbout
- Division of Diagnostic Radiology, Université de Montréal, Montreal, Quebec, Canada
| | - Daniel E Borsuk
- Division of Plastic and Reconstructive Surgery, Université de Montréal, Montreal, Quebec, Canada
| | - Sabrina Cugno
- Division of Plastic and Reconstructive Surgery, Université de Montréal, Montreal, Quebec, Canada
- Division of Plastic and Reconstructive Surgery, McGill University, Montreal, Quebec, Canada
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Gao JY, Duan YS, Zheng JQ, Wang QY, Li CL, Xu J. Perioperative position management of 46 cases with simultaneous bilateral auricle reconstruction: A summary of experience. Int J Pediatr Otorhinolaryngol 2024; 179:111905. [PMID: 38493660 DOI: 10.1016/j.ijporl.2024.111905] [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: 09/14/2023] [Revised: 12/01/2023] [Accepted: 02/27/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVES The primary problem in simultaneous bilateral auricle reconstruction is the fragility of the reconstructed ear structure. Postoperative pressure is strictly prohibited to ensure the operation's effectiveness. The study aimed to summarize the experience of perioperative postural management in simultaneous bilateral auricular reconstruction. METHOD This study summarizes the experience of perioperative postural management, providing preoperative sleeping posture adaptability training, neck movement training, standardization of the head position angles and the head suspension time in surgery, using protective headrests, paying attention to the transfer and handover procedures, and using specially designed pillows. RESULTS The comprehensive nursing approach in simultaneous bilateral auricular reconstruction significantly reduced complications, improved patient comfort, and optimized postoperative adaptation. Preoperative posture training, standardized intraoperative head positions, and vigilant postoperative care played pivotal roles, demonstrating positive outcomes in 46 cases. DISCUSSION Perioperative position management can reduce the risk of complications and pressure injuries, improving patients' postoperative comfort, emotional state, tolerance, and adaptability. CONCLUSION All ears were viable and in good shape after long-term follow-up. The experiences discussed in this study can be broadly applied to technically mature ear reconstruction teams.
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Affiliation(s)
- Jia-Ying Gao
- Department of Nursing, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Ya-Shan Duan
- ENT Institute, Eye & ENT Hospital, Fudan University, Shanghai, China; Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Jie-Qing Zheng
- Department of Nursing, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Qian-Ying Wang
- Department of Nursing, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Chen-Long Li
- ENT Institute, Eye & ENT Hospital, Fudan University, Shanghai, China; Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, Shanghai, China.
| | - Jing Xu
- Department of Nursing, Eye & ENT Hospital, Fudan University, Shanghai, China.
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Di Gregorio MF, Der C, Bravo-Torres S, Zernotti ME. Active Bone Conduction Implant and Adhesive Bone Conduction Device: A Comparison of Audiological Performance and Subjective Satisfaction. Int Arch Otorhinolaryngol 2024; 28:e332-e338. [PMID: 38618604 PMCID: PMC11008936 DOI: 10.1055/s-0043-1777416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 11/03/2023] [Indexed: 04/16/2024] Open
Abstract
Introduction Atresia of the external auditory canal affects 1 in every 10 thousand to 20 thousand live births, with a much higher prevalence in Latin America, at 5 to 21 out of every 10 thousand newborns. The treatment involves esthetic and functional aspects. Regarding the functional treatment, there are surgical and nonsurgical alternatives like spectacle frames and rigid and softband systems. Active transcutaneous bone conduction implants (BCIs) achieve good sound transmission and directly stimulate the bone. Objective To assess the audiological performance and subjective satisfaction of children implanted with an active transcutaneous BCI for more than one year and to compare the outcomes with a nonsurgical adhesive bone conduction device (aBCD) in the same users. Methods The present is a prospective, multicentric study. The audiological performance was evaluated at 1, 6, and 12 months postactivation, and after a 1-month trial with the nonsurgical device. Results Ten patients completed all tests. The 4-frequency pure-tone average (4PTA) in the unaided condition was of 65 dB HL, which improved significantly to 20 dB HL after using the BCI for 12 months. The speech recognition in quiet in the unaided condition was of 33% on average, which improved significantly, to 99% with the BCI, and to 91% with the aBCD. Conclusion The aBCD demonstrated sufficient hearing improvement and subjective satisfaction; thus, it is a good solution for hearing rehabilitation if surgery is not desired or not possible. If surgery is an option, the BCI is the superior device in terms of hearing outcomes, particularly background noise and subjective satisfaction.
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Affiliation(s)
| | - Carolina Der
- Department of Otorhinolaryngology, Hospital Dr. Luis Calvo Mackenna, Providencia, Santiago, Chile
| | - Sofia Bravo-Torres
- Department of Audiology, Hospital Dr. Luis Calvo Mackenna, Providencia, Santiago, Chile
| | - Mario Emilio Zernotti
- Department of ENT, Sanatorio Allende, Nueva Córdoba, Córdoba, Argentina
- Speech Therapy School, Faculty of Medical Sciences, Universidad Nacional de Córdoba, Córdoba, Argentina
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21
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Liu Y, Zhao Y, Lin L, Yang Q, Zhang L. Differential Expression of Noncoding RNAs Revealed Enhancer RNA AC016735.2 as a Potential Pathogenic Marker of Congenital Microtia Patients. J Craniofac Surg 2024; 35:00001665-990000000-01401. [PMID: 38456687 PMCID: PMC11045553 DOI: 10.1097/scs.0000000000010046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 01/11/2024] [Indexed: 03/09/2024] Open
Abstract
PURPOSE Congenital microtia is a complex maxillofacial malformation with various risk factors. This study aimed to find potential pathogenic noncoding RNAs for congenital microtia patients. METHODS We collected 3 pairs of residual ear cartilage samples and corresponding normal ear cartilage samples from nonsyndromic congenital microtia patients for microarray experiments. The differentially expressed RNAs were screened, and enrichment analysis and correlation expression analysis were performed to elucidate the function of the differentially expressed genes (DEGs). We further investigated the most significantly differentially expressed long noncoding RNA (lncRNA), AC016735.2, through follow-up analyses including RT-qPCR and Western blotting, to validate its differential expression in residual ear cartilage compared with normal ear cartilage. SiRNA was designed to study the regulatory role of AC016735.2, and cell proliferation experiments were conducted to explore its impact on residual ear chondrocytes. RESULTS Analysis of the microarray data revealed a total of 1079 differentially expressed RNAs, including 305 mRNAs and x lncRNAs, using a threshold of FC>1.5 and P<0.05 for mRNA, and FC>1.0 and P<0.05 for lncRNA. Enrichment analysis indicated that these genes are mainly involved in extracellular matrix regulation and embryonic development. AC016735.2 showed the highest differential expression among the eRNAs, being upregulated in residual ear cartilage. It acts in cis to regulate the nearby coding gene ZFP36L2, indirectly affecting downstream genes such as BMP4, TWSG1, COL2A1, and COL9A2. CONCLUSION Significant differences were observed in the expression of lncRNAs and mRNAs between residual ear cartilage and normal auricular cartilage tissues in the same genetic background of congenital microtia. These differentially expressed lncRNAs and mRNAs may play crucial roles in the occurrence and development of microtia through pathways associated with extracellular matrix regulation and gastrulation. Particularly, AC016735.2, an eRNA acting in cis, could serve as a potential pathogenic noncoding gene.
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Affiliation(s)
- Ying Liu
- Ear Reconstruction Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
- Plastic Surgery Department, Beijing Hospital of Integrated Traditional Chinese and Western Medicine, Beijing, China
| | - Yanyong Zhao
- Ear Reconstruction Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Lin Lin
- Ear Reconstruction Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Qinghua Yang
- Ear Reconstruction Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Ling Zhang
- Laser Treatment Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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22
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Liu Y, Yang L, Chen P, Yang J, Ren R, Li Y, Wang D, Zhao S. Role of early hearing aid experience in speech recognition in patients with bilateral congenital microtia following Bonebridge implantation: a retrospective cohort study. Eur Arch Otorhinolaryngol 2024; 281:1205-1214. [PMID: 37792216 DOI: 10.1007/s00405-023-08210-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/21/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE To identify audiological and demographic variables that predict speech recognition abilities in patients with bilateral microtia who underwent Bonebridge (BB) implantation. METHODS Fifty patients with bilateral microtia and bilateral conductive hearing loss (CHL) who underwent BB implantation were included. Demographic data, preoperative hearing aid use experience, and audiological outcomes (including pure-tone hearing threshold, sound field hearing threshold [SFHT], and speech recognition ability) for each participant were obtained. The Chinese-Mandarin Speech Test Materials were used to test speech recognition ability. The word recognition score (WRS) of disyllabic words at 65 dB SPL signals was measured before and after BB implantation in quiet and noisy conditions. RESULTS The mean preoperative WRS under quiet and noisy conditions was 10.44 ± 12.73% and 5.90 ± 8.76%, which was significantly improved to 86.38 ± 9.03% and 80.70 ± 11.34%, respectively, following BB fitting. Multiple linear regression analysis revealed that lower preoperative SFHT suggested higher preoperative WRS under both quiet and noisy conditions. Higher age at implantation predicted higher preoperative WRS under quiet conditions. Furthermore, patients with more preoperative hearing aid experience and lower postoperative SFHT were more likely to have higher postoperative WRS under both quiet and noisy testing conditions. CONCLUSIONS This study represents the first attempt to identify predictors of preoperative and postoperative speech recognition abilities in patients with bilateral microtia with BB implantation. These findings emphasize that early hearing intervention before implantation surgery, combined with appropriate postoperative fitting, contributes to optimal benefits in terms of postoperative speech recognition ability.
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Affiliation(s)
- Yujie Liu
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Ministry of Education Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing, 100730, China
| | - Lin Yang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Ministry of Education Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing, 100730, China
| | - Peiwei Chen
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Ministry of Education Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing, 100730, China
| | - Jinsong Yang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Ministry of Education Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing, 100730, China
| | - Ran Ren
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Ministry of Education Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing, 100730, China
| | - Ying Li
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Ministry of Education Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing, 100730, China
| | - Danni Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Ministry of Education Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing, 100730, China.
| | - Shouqin Zhao
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Ministry of Education Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing, 100730, China.
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Wang X, Wu P, Fu Y, Yang R, Li C, Chen Y, He A, Chen X, Ma D, Ma J, Zhang T. The circular RNA expression profile of human auricle cartilage and the role of circCOL1A2 in isolated microtia. Cell Signal 2024; 115:111017. [PMID: 38123043 DOI: 10.1016/j.cellsig.2023.111017] [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: 08/02/2023] [Revised: 11/24/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023]
Abstract
Microtia is one of the most common craniofacial birth defects worldwide, and its primary clinical manifestation is auricle deformity. Epigenetic factors are known to contribute to the etiology of microtia, yet the involvement of circular RNAs (circRNAs) in human auricle development and their association with microtia remains poorly understood. In this study, we aimed to analyze differentially expressed circRNAs and explore their functional implications in isolated microtia. By employing circRNA microarray analysis and bioinformatics approaches, we identified 340 differentially expressed circRNAs in auricle cartilage of patients with isolated microtia, comprising 152 upregulated and 188 downregulated circRNAs. A circRNA-mRNA co-expression network was constructed, followed by gene ontology analysis and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis. Subsequently, we selected four significantly upregulated circRNAs from the co-expression network based on their association with cartilage development and validated their expressions in 30 isolated microtia and 30 control clinical auricle cartilage samples. Among these circRNAs, circCOL1A2, the most significantly upregulated circRNA, was selected as a representative circRNA for investigating its role in isolated microtia. Overexpression of circCOL1A2 significantly inhibited chondrocyte proliferation and chondrogenic differentiation of human mesenchymal stem cells. Additionally, circCOL1A2 upregulated Dermatan Sulfate Epimerase Like (DSEL) expression by sponging miR-637 through the competing endogenous RNA (ceRNA) mechanism. Notably, the downregulation of DSEL attenuated the inhibitory effect of circCOL1A2 overexpression on cell proliferation and chondrogenic differentiation. Collectively, these findings highlight the involvement of circCOL1A2 in the pathogenesis of isolated microtia and emphasize the potential significance of dysregulated circRNAs in disease development.
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Affiliation(s)
- Xin Wang
- ENT Institute, Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, Shanghai 200031, China
| | - Peixuan Wu
- Key Laboratory of Metabolism and Molecular Medicine, Ministry of Education, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Fudan University, Shanghai 200032, China.
| | - Yaoyao Fu
- ENT Institute, Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, Shanghai 200031, China
| | - Run Yang
- ENT Institute, Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, Shanghai 200031, China.
| | - Chenlong Li
- ENT Institute, Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, Shanghai 200031, China
| | - Ying Chen
- ENT Institute, Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, Shanghai 200031, China
| | - Aijuan He
- ENT Institute, Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, Shanghai 200031, China
| | - Xin Chen
- ENT Institute, Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, Shanghai 200031, China.
| | - Duan Ma
- Key Laboratory of Metabolism and Molecular Medicine, Ministry of Education, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Fudan University, Shanghai 200032, China.
| | - Jing Ma
- ENT Institute, Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, Shanghai 200031, China.
| | - Tianyu Zhang
- ENT Institute, Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, Shanghai 200031, China; NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai 200031, China.
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Kim HAJ, Namavarian A, Khan U, Levy BB, Ziai H, Talei B, Gantous A. Reconstructive Techniques in Pediatric Congenital Microtia: A Systematic Review and Meta-analysis. Facial Plast Surg 2024. [PMID: 38232751 DOI: 10.1055/a-2247-5109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
Autografts and allografts are commonly used in microtia reconstruction. We aimed to systematically review and compare these reconstructive materials in pediatric congenital microtia reconstruction. A systematic review of the literature was performed. MEDLINE, Embase, PubMed, Web of Science, and CINAHL databases were searched for original studies on congenital microtia reconstruction in pediatric patients since database inception to 2021. Microtia grade was stratified as high or low. Meta-analysis of pooled proportions and continuous variables was performed using inverse variance weighting with a random effects model to compare between the autograft and allograft groups. Sixty-eight studies with a total of 5,546 patients used autografts (n = 5,382) or alloplastic implants (n = 164). Four other studies used prosthesis, cadaveric homografts, or tissue engineering. The allograft group was on average younger than the autograft group (8.4 vs. 11.1 years). There were no syndromic patients in the allograft group, compared to 43% in the autograft group. Patients treated with allografts had higher microtia grade than those treated with autograft (98 vs. 72%). Autografts were more commonly utilized by plastic surgeons and allografts by otolaryngologists (95 vs. 38%). No autografts and 41% of allografts were done concurrently with atresiaplasty or bone conduction implant. Satisfaction rates were similarly high (>90%) with similar complication rates (<10%). Microtia reconstruction using autografts and allografts had similar satisfaction and complication rates. Allografts were preferred for younger patients and concurrent hearing restoration. Further large-scale studies are required to evaluate the long-term efficacy of these reconstructive techniques.
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Affiliation(s)
- Hugh Andrew Jinwook Kim
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Amirpouyan Namavarian
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Urooj Khan
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ben B Levy
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Hedyeh Ziai
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Beverly Hills Center for Facial Plastic Surgery, Beverly Hills, California
| | - Ben Talei
- Beverly Hills Center for Facial Plastic Surgery, Beverly Hills, California
| | - Andres Gantous
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
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25
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Chen P, Liu Y, Yang J, Wang D, Ren R, Li Y, Yang L, Fu X, Dong R, Zhao S. A new active bone-conduction implant: surgical experiences and audiological outcomes in patients with bilateral congenital microtia. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08523-1. [PMID: 38365989 DOI: 10.1007/s00405-024-08523-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/31/2024] [Indexed: 02/18/2024]
Abstract
PURPOSE First-generation bone bridges (BBs) have demonstrated favorable safety and audiological benefits in patients with conductive hearing loss. However, studies on the effects of second-generation BBs are limited, especially among children. In this study, we aimed to explore the surgical and audiological effects of second-generation BBs in patients with bilateral congenital microtia. METHODS This single-center prospective study included nine Mandarin-speaking patients with bilateral microtia. All the patients underwent BCI Generation 602 (BCI602; MED-EL, Innsbruck, Austria) implant surgery between September 2021 and June 2023. Audiological and sound localization tests were performed under unaided and BB-aided conditions. RESULTS The transmastoid and retrosigmoid sinus approaches were implemented in three and six patients, respectively. No patient underwent preoperative planning, lifts were unnecessary, and no sigmoid sinus or dural compression occurred. The mean function gain at 0.5-4.0 kHz was 28.06 ± 4.55-dB HL. The word recognition scores improved significantly in quiet under the BB aided condition. Signal-to-noise ratio reduction by 10.56 ± 2.30 dB improved the speech reception threshold in noise. Patients fitted with a unilateral BB demonstrated inferior sound source localization after the initial activation. CONCLUSIONS Second-generation BBs are safe and effective for patients with bilateral congenital microtia and may be suitable for children with mastoid hypoplasia without preoperative three-dimensional reconstruction.
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Affiliation(s)
- Peiwei Chen
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaomin Lane, Dongcheng District, Beijing, 100730, China
- Key Laboratory of Otolaryngology, Head and Neck Surgery, Beijing Institute of Otolaryngology, Capital Medical University, Ministry of Education, Beijing, China
| | - Yujie Liu
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaomin Lane, Dongcheng District, Beijing, 100730, China
- Key Laboratory of Otolaryngology, Head and Neck Surgery, Beijing Institute of Otolaryngology, Capital Medical University, Ministry of Education, Beijing, China
| | - Jinsong Yang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaomin Lane, Dongcheng District, Beijing, 100730, China
- Key Laboratory of Otolaryngology, Head and Neck Surgery, Beijing Institute of Otolaryngology, Capital Medical University, Ministry of Education, Beijing, China
| | - Danni Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaomin Lane, Dongcheng District, Beijing, 100730, China
- Key Laboratory of Otolaryngology, Head and Neck Surgery, Beijing Institute of Otolaryngology, Capital Medical University, Ministry of Education, Beijing, China
| | - Ran Ren
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaomin Lane, Dongcheng District, Beijing, 100730, China
- Key Laboratory of Otolaryngology, Head and Neck Surgery, Beijing Institute of Otolaryngology, Capital Medical University, Ministry of Education, Beijing, China
| | - Ying Li
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaomin Lane, Dongcheng District, Beijing, 100730, China
- Key Laboratory of Otolaryngology, Head and Neck Surgery, Beijing Institute of Otolaryngology, Capital Medical University, Ministry of Education, Beijing, China
| | - Lin Yang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaomin Lane, Dongcheng District, Beijing, 100730, China
- Key Laboratory of Otolaryngology, Head and Neck Surgery, Beijing Institute of Otolaryngology, Capital Medical University, Ministry of Education, Beijing, China
| | - Xinxing Fu
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaomin Lane, Dongcheng District, Beijing, 100730, China
- Key Laboratory of Otolaryngology, Head and Neck Surgery, Beijing Institute of Otolaryngology, Capital Medical University, Ministry of Education, Beijing, China
| | - Ruijuan Dong
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaomin Lane, Dongcheng District, Beijing, 100730, China
- Key Laboratory of Otolaryngology, Head and Neck Surgery, Beijing Institute of Otolaryngology, Capital Medical University, Ministry of Education, Beijing, China
| | - Shouqin Zhao
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaomin Lane, Dongcheng District, Beijing, 100730, China.
- Key Laboratory of Otolaryngology, Head and Neck Surgery, Beijing Institute of Otolaryngology, Capital Medical University, Ministry of Education, Beijing, China.
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Chen X, Ma J, Zhang T. Genetics and Epigenetics in the Genesis and Development of Microtia. J Craniofac Surg 2024; 35:00001665-990000000-01343. [PMID: 38345940 PMCID: PMC11045557 DOI: 10.1097/scs.0000000000010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/03/2023] [Indexed: 04/28/2024] Open
Abstract
Microtia is a congenital malformation of the external and middle ear associated with varying degrees of severity that range from mild structural abnormalities to the absence of the external ear and auditory canal. Globally, it is the second most common congenital craniofacial malformation and is typically caused by inherited defects, external factors, or the interaction between genes and external factors. Epigenetics notably represents a bridge between genetics and the environment. This review has devoted attention to the current proceedings of the genetics and epigenetics of microtia and related syndromes.
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Affiliation(s)
- Xin Chen
- Department of Facial Plastic and Reconstructive Surgery, ENT Institute, Eye & ENT Hospital, Fudan University
| | - Jing Ma
- Department of Facial Plastic and Reconstructive Surgery, ENT Institute, Eye & ENT Hospital, Fudan University
| | - Tianyu Zhang
- Department of Facial Plastic and Reconstructive Surgery, ENT Institute, Eye & ENT Hospital, Fudan University
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
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Lázaro SF, Tonhati H, Oliveira HR, Silva AA, Scalez DCB, Nascimento AV, Santos DJA, Stefani G, Carvalho IS, Sandoval AF, Brito LF. Genetic parameters and genome-wide association studies for mozzarella and milk production traits, lactation length, and lactation persistency in Murrah buffaloes. J Dairy Sci 2024; 107:992-1021. [PMID: 37730179 DOI: 10.3168/jds.2023-23284] [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: 01/18/2023] [Accepted: 08/30/2023] [Indexed: 09/22/2023]
Abstract
Genetic and genomic analyses of longitudinal traits related to milk production efficiency are paramount for optimizing water buffaloes breeding schemes. Therefore, this study aimed to (1) compare single-trait random regression models under a single-step genomic BLUP setting based on alternative covariance functions (i.e., Wood, Wilmink, and Ali and Schaeffer) to describe milk (MY), fat (FY), protein (PY), and mozzarella (MZY) yields, fat-to-protein ratio (FPR), somatic cell score (SCS), lactation length (LL), and lactation persistency (LP) in Murrah dairy buffaloes (Bubalus bubalis); (2) combine the best functions for each trait under a multiple-trait framework; (3) estimate time-dependent SNP effects for all the studied longitudinal traits; and (4) identify the most likely candidate genes associated with the traits. A total of 323,140 test-day records from the first lactation of 4,588 Murrah buffaloes were made available for the study. The model included the average curve of the population nested within herd-year-season of calving, systematic effects of number of milkings per day, and age at first calving as linear and quadratic covariates, and additive genetic, permanent environment, and residual as random effects. The Wood model had the best goodness of fit based on the deviance information criterion and posterior model probabilities for all traits. Moderate heritabilities were estimated over time for most traits (0.30 ± 0.02 for MY; 0.26 ± 0.03 for FY; 0.45 ± 0.04 for PY; 0.28 ± 0.05 for MZY; 0.13 ± 0.02 for FPR; and 0.15 ± 0.03 for SCS). The heritability estimates for LP ranged from 0.38 ± 0.02 to 0.65 ± 0.03 depending on the trait definition used. Similarly, heritabilities estimated for LL ranged from 0.10 ± 0.01 to 0.14 ± 0.03. The genetic correlation estimates across days in milk (DIM) for all traits ranged from -0.06 (186-215 DIM for MY-SCS) to 0.78 (66-95 DIM for PY-MZY). The SNP effects calculated for the random regression model coefficients were used to estimate the SNP effects throughout the lactation curve (from 5 to 305 d). Numerous relevant genomic regions and candidate genes were identified for all traits, confirming their polygenic nature. The candidate genes identified contribute to a better understanding of the genetic background of milk-related traits in Murrah buffaloes and reinforce the value of incorporating genomic information in their breeding programs.
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Affiliation(s)
- Sirlene F Lázaro
- Department of Animal Sciences, Purdue University, West Lafayette, IN 47907; Department of Animal Science, College of Agricultural and Veterinary Sciences, São Paulo State University (UNESP), Jaboticabal, 14884-900, SP, Brazil
| | - Humberto Tonhati
- Department of Animal Science, College of Agricultural and Veterinary Sciences, São Paulo State University (UNESP), Jaboticabal, 14884-900, SP, Brazil
| | - Hinayah R Oliveira
- Department of Animal Sciences, Purdue University, West Lafayette, IN 47907; Centre for Genetic Improvement of Livestock, Department of Animal Biosciences, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - Alessandra A Silva
- Department of Animal Science, College of Agricultural and Veterinary Sciences, São Paulo State University (UNESP), Jaboticabal, 14884-900, SP, Brazil
| | - Daiane C B Scalez
- Centre for Genetic Improvement of Livestock, Department of Animal Biosciences, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - André V Nascimento
- Department of Animal Science, College of Agricultural and Veterinary Sciences, São Paulo State University (UNESP), Jaboticabal, 14884-900, SP, Brazil
| | | | - Gabriela Stefani
- Department of Animal Science, College of Agricultural and Veterinary Sciences, São Paulo State University (UNESP), Jaboticabal, 14884-900, SP, Brazil
| | - Isabella S Carvalho
- Department of Animal Science, College of Agricultural and Veterinary Sciences, São Paulo State University (UNESP), Jaboticabal, 14884-900, SP, Brazil
| | - Amanda F Sandoval
- Department of Animal Science, College of Agricultural and Veterinary Sciences, São Paulo State University (UNESP), Jaboticabal, 14884-900, SP, Brazil
| | - Luiz F Brito
- Department of Animal Sciences, Purdue University, West Lafayette, IN 47907.
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Yang R, Fu Y, Li C, Chen Y, He A, Jiang X, Ma J, Zhang T. Profiling of Long Non-Coding RNAs in Auricular Cartilage of Patients with Isolated Microtia. Genet Test Mol Biomarkers 2024; 28:50-58. [PMID: 38416666 DOI: 10.1089/gtmb.2023.0360] [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: 03/01/2024] Open
Abstract
Introduction: Microtia is the second most common maxillofacial birth defect worldwide. However, the involvement of long non-coding RNAs (lncRNAs) in isolated microtia is not well understood. This study aimed at identifying lncRNAs that regulate the expression of genes associated with isolated microtia. Methods: We used our microarray data to analyze the expression pattern of lncRNA in the auricular cartilage tissues from 10 patients diagnosed with isolated microtia, alongside 15 control subjects. Five lncRNAs were chosen for validation using real-time quantitative reverse transcription-polymerase chain reaction (qRT-PCR). Results: We identified 4651 differentially expressed lncRNAs in the auricular cartilage from patients with isolated microtia. By Gene Ontology/Kyoto Encyclopedia of Genes and Genomes pathway (GO/KEGG) analysis, we identified 27 differentially expressed genes enriched in pathways associated with microtia. In addition, we predicted 9 differentially expressed genes as potential cis-acting targets of 12 differentially expressed lncRNAs. Our findings by qRT-PCR demonstrate significantly elevated expression levels of ZFAS1 and DAB1-AS1, whereas ADIRF-AS1, HOTAIRM1, and EPB41L4A-AS1 exhibited significantly reduced expression levels in the auricular cartilage tissues of patients with isolated microtia. Conclusions: Our study sheds light on the potential involvement of lncRNAs in microtia and provides a basis for further investigation into their functional roles and underlying mechanisms.
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Affiliation(s)
- Run Yang
- Department of Facial Plastic and Reconstructive Surgery, ENT Institute, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Yaoyao Fu
- Department of Facial Plastic and Reconstructive Surgery, ENT Institute, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Chenlong Li
- Department of Facial Plastic and Reconstructive Surgery, ENT Institute, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Yin Chen
- Department of Facial Plastic and Reconstructive Surgery, ENT Institute, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Aijuan He
- Department of Facial Plastic and Reconstructive Surgery, ENT Institute, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Xin Jiang
- Medical Laboratory of Nantong Zhongke, Department of Bioinformatics, Nantong, Jiangsu, China
| | - Jing Ma
- Department of Facial Plastic and Reconstructive Surgery, ENT Institute, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Tianyu Zhang
- Department of Facial Plastic and Reconstructive Surgery, ENT Institute, Eye & ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
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Vella JB. Pediatric Otoplasty and Auricular Molding. Facial Plast Surg Clin North Am 2024; 32:95-103. [PMID: 37981420 DOI: 10.1016/j.fsc.2023.07.006] [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: 11/21/2023]
Abstract
With the advent of widespread use of commercial ear molding products, the literature addressing the indications for and timing of perinatal intervention in auricular deformations and malformations has increased significantly. Although the rationale for perinatal ear molding seems to be hormonally mediated, the common assertion that breastfeeding may prolong the window of effective intervention remains without convincing evidence. The common auricular anomalies as well as indications, timing, and methodology of effective intervention including ear molding or surgical otoplasty are reviewed herein.
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Affiliation(s)
- Joseph B Vella
- Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Rutgers Cleft and Craniofacial Center, Rutgers-Robert Wood Johnson Medical School, 10 Plum Street, 5th Floor, New Brunswick, NJ 08901, USA.
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Jakob Y, Kern J, Gvaramia D, Fisch P, Magritz R, Reutter S, Rotter N. Suitability of Ex Vivo-Expanded Microtic Perichondrocytes for Auricular Reconstruction. Cells 2024; 13:141. [PMID: 38247833 PMCID: PMC10814984 DOI: 10.3390/cells13020141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/30/2023] [Accepted: 01/02/2024] [Indexed: 01/23/2024] Open
Abstract
Tissue engineering (TE) techniques offer solutions for tissue regeneration but require large quantities of cells. For microtia patients, TE methods represent a unique opportunity for therapies with low donor-site morbidity and reliance on the surgeon's individual expertise. Microtia-derived chondrocytes and perichondrocytes are considered a valuable cell source for autologous reconstruction of the pinna. The aim of this study was to investigate the suitability of perichondrocytes from microtia patients for autologous reconstruction in comparison to healthy perichondrocytes and microtia chondrocytes. Perichondrocytes were isolated via two different methods: explant culture and enzymatic digestion. The isolated cells were analyzed in vitro for their chondrogenic cell properties. We examined migration activity, colony-forming ability, expression of mesenchymal stem cell markers, and gene expression profile. We found that microtic perichondrocytes exhibit similar chondrogenic properties compared to chondrocytes in vitro. We investigated the behavior in three-dimensional cell cultures (spheroids and scaffold-based 3D cell cultures) and assessed the expression of cartilage-specific proteins via immunohistochemistry, e.g., collagen II, which was detected in all samples. Our results show that perichondrocytes from microtia patients are comparable to healthy perichondrocytes and chondrocytes in terms of chondrogenic cell properties and could therefore be a promising cell source for auricular reconstruction.
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Affiliation(s)
- Yvonne Jakob
- Department of Otorhinolaryngology Head and Neck Surgery, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany; (J.K.); (D.G.); (N.R.)
| | - Johann Kern
- Department of Otorhinolaryngology Head and Neck Surgery, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany; (J.K.); (D.G.); (N.R.)
| | - David Gvaramia
- Department of Otorhinolaryngology Head and Neck Surgery, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany; (J.K.); (D.G.); (N.R.)
| | - Philipp Fisch
- Tissue Engineering and Biofabrication Laboratory, Department of Health Sciences & Technology, ETH Zurich, Otto-Stern-Weg 7, CH-8093 Zurich, Switzerland;
| | - Ralph Magritz
- Clinic for Otorhinolaryngology, Oberhavel-Kliniken GmbH, Klinik Henningsdorf, Marwitzer Strasse 91, D-16761 Henningsdorf, Germany;
| | - Sven Reutter
- Department of Otorhinolaryngology Head and Neck Surgery, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany; (J.K.); (D.G.); (N.R.)
| | - Nicole Rotter
- Department of Otorhinolaryngology Head and Neck Surgery, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany; (J.K.); (D.G.); (N.R.)
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Kinter S, Kotlarek K, Meehan A, Heike C. Characterizing Speech Phenotype in Individuals With Craniofacial Microsomia: A Scoping Review. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:485-504. [PMID: 37931079 PMCID: PMC11001184 DOI: 10.1044/2023_ajslp-23-00152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 07/28/2023] [Accepted: 08/25/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION Craniofacial microsomia (CFM) is a complex congenital condition primarily affecting the ear, mandible, facial nerve and muscles, and tongue. Individuals with CFM are at increased risk of hearing loss, obstructive sleep apnea, and feeding/swallowing difficulties. The purpose of this scoping review was to summarize evidence pertaining to speech production in CFM. METHOD All articles reporting any characteristic of speech production in CFM were included and screened by two independent reviewers by title, abstract, and full text. Data charting captured details related to study population and design, CFM diagnostic criteria, speech outcome measurement, and key findings. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist guided reporting of results. Our protocol was registered on the Open Science Framework (https://osf.io/npr94/) and published elsewhere. RESULTS Forty-five articles were included in the detailed review. Most articles originated from the United States, were published in the past decade, and utilized case report/series study design. A speech-language pathologist authored 29%. The prevalence of velopharyngeal insufficiency ranged from 19% to 55% among studies. Oral distortion of alveolar and palatal fricatives and affricates primarily characterized articulation errors. Studies identified increased disordered speech and lower intelligibility in adolescents with CFM compared to unaffected peers. Evidence pertaining to phonatory and respiratory speech findings is limited. CONCLUSIONS Evidence supports that individuals with CFM are at increased risk of both velopharyngeal and articulatory speech differences. Additional information is needed to develop speech screening guidelines for children with CFM. Heterogeneity in study design and outcome measurement precludes comparisons across studies. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24424555.
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Affiliation(s)
- Sara Kinter
- Division of Craniofacial Medicine, Department of Pediatrics, University of Washington, Seattle
- Craniofacial Center, Seattle Children's Hospital, WA
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, WA
| | - Katelyn Kotlarek
- Division of Communication Disorders, College of Health Sciences, University of Wyoming, Laramie
| | - Anna Meehan
- Craniofacial Center, Seattle Children's Hospital, WA
- Center for Clinical and Translational Research, Seattle Children's Research Institute, WA
| | - Carrie Heike
- Division of Craniofacial Medicine, Department of Pediatrics, University of Washington, Seattle
- Craniofacial Center, Seattle Children's Hospital, WA
- Center for Clinical and Translational Research, Seattle Children's Research Institute, WA
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Noroña DM, Chamba WD, Santamaria SR, Sosa MC, Carrera LL, Rodríguez FA, Martinez MA, Izquierdo-Condoy JS. Clinical profiling of pediatric microtia patients: A cross-sectional analysis at a leading pediatric hospital in Ecuador (2015-2022). Birth Defects Res 2024; 116:e2298. [PMID: 38277412 DOI: 10.1002/bdr2.2298] [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: 10/10/2023] [Revised: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND Microtia is a frequent congenital deformity of the pinna, often with hearing loss. This study reviews the clinical profiles of microtia pediatric patients treated at a referral hospital in Quito, Ecuador, from 2015 to 2022. METHODS A cross-sectional descriptive study was carried out based on the analysis of medical records of pediatric patients with microtia treated between January 2015 and December 2022 at the Hospital Pediátrico Baca Ortiz in Quito, Ecuador. Descriptive statistics were used, and the Chi-square test assessed associations between categorical variables. RESULTS Of the 235 patients evaluated, 59.6% were male, 83.4% lived at high altitudes (2500-3500 m), and 19.1% had a family history of microtia. Grade III microtia was diagnosed in 63.8%, predominantly on the right side. Nearly all (99.1%) had hearing loss. Other anatomical alterations were observed in 27.7%, primarily the preauricular appendage. Bone vibrator implantation was a common treatment for 24.3%. Altitude did not show a significant correlation with microtia characteristics. CONCLUSIONS Most patients had grade III microtia with associated hearing loss. Despite the high prevalence at elevated altitudes, no significant altitude-disease correlation was found. The study highlights the need for further research on microtia in regions like Ecuador.
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Schraw JM, Jaime E, Shumate CJ, Canfield MA, Lupo PJ. Prevalence of congenital anomalies according to maternal race and ethnicity, Texas, 1999-2018. Birth Defects Res 2024; 116:e2274. [PMID: 38014617 PMCID: PMC10872311 DOI: 10.1002/bdr2.2274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/05/2023] [Accepted: 11/08/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Few studies of congenital anomalies provide prevalence estimates stratified by maternal race/ethnicity. We sought to determine whether the prevalence of a broad spectrum of anomalies varies among offspring of women from different race/ethnic groups. METHODS We obtained information on cases with anomalies from the population-based Texas Birth Defects Registry, and denominator data on livebirths among Texas residents during 1999-2018 from the Texas Center for Health Statistics. We estimated the prevalence ratio (PR) and 95% confidence interval (CI) of N = 145 anomalies among offspring of Hispanic and non-Hispanic Black relative to non-Hispanic White women using Poisson regression, adjusting for maternal age, education, body mass index, and previous livebirths. We performed a two-stage analysis with a Bonferroni-adjusted p < 1.7 × 10-4 in the initial screening phase to identify anomalies with statistically significant variation. RESULTS There were 7,698,768 livebirths and 1,187,385 anomalies diagnosed in 368,393 cases. The prevalence of any monitored congenital anomaly was similar among offspring of non-Hispanic White (referent), non-Hispanic Black (PR 0.98, CI 0.96-1.00), and Hispanic (PR 0.95, CI 0.93-0.96) women. We observed statistically significant racial/ethnic variation for 42 anomalies. Marked differences were observed when comparing offspring of non-Hispanic Black to non-Hispanic White women with respect to polydactyly (PR 4.38, CI 4.07-4.72), pyloric stenosis (PR 0.34, CI 0.29-0.40), and aortic valve atresia/stenosis (PR 0.51, CI 0.36-0.72). CONCLUSIONS Birth prevalence of many major congenital anomalies varies by maternal race and ethnicity. While the reasons for these differences are likely multifactorial, a thorough understanding of racial and ethnic disparities is useful to stimulate etiologic research.
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Affiliation(s)
- Jeremy M Schraw
- Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Elwin Jaime
- Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Charles J Shumate
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas, USA
| | - Mark A Canfield
- Division of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Austin, Texas, USA
| | - Philip J Lupo
- Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
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Yturralde KJ, Le PB, Martinez OP, Chen E. Brent Technique of Repair Versus Nagata Auricular Reconstruction for Microtia Reconstruction: A Systematic Review and Meta-Analysis. J Craniofac Surg 2024; 35:43-45. [PMID: 37669467 DOI: 10.1097/scs.0000000000009709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/28/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Up to 17.4 in every 10,000 births are affected by microtia, but no consensus exists on a gold standard technique for autogenous repair. In this study, the authors compare 2 common methods-the Brent and Nagata autogenous costal cartilage ear reconstruction techniques. A systematic review of the literature and a quantitative meta-analysis to compare the outcomes of these 2 approaches were performed. The outcomes analyzed included rates of infection, necrosis, cartilage exposure, cartilage resorption, hematoma, wire extrusion, and hypertrophic scar. METHODS A MEDLINE database systematic review with the following keywords: microtia, Brent, and Nagata was performed. Case reports and articles without original data or patient outcomes were excluded. Inclusion methods for study selection are outlined in Supplemental Digital Content 1, http://links.lww.com/SCS/F461 , below. The prevalence of outcomes for each study was analyzed through meta-analysis of proportions using Stata. RESULTS A total of 536 potential studies were retrieved for review. Twelve of these studies met inclusion criteria. Four studies utilized the Brent method of repair with the inclusion of 563 ear reconstructions. Nine studies implemented the Nagata technique in 2304 reconstructions. Two studies directly compared the Brent (327 ears) and Nagata (471 ears) techniques. The calculated rate and 95% confidence intervals are summarized in Supplemental Digital Content 2, http://links.lww.com/SCS/F461 . There were no statistically significant differences in complication rates between the Brent and Nagata microtic reconstruction techniques identified in this study. CONCLUSIONS The Brent and Nagata microtia reconstruction techniques have no difference in the risk of infection, necrosis, cartilage exposure, cartilage resorption, hematoma, wire extrusion, or hypertrophic scars.
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Affiliation(s)
- Kylee J Yturralde
- University of South Carolina School of Medicine, Columbia, Columbia, SC
| | - Paulina B Le
- Prisma Health-Columbia/University of South Carolina School of Medicine, Columbia, SC
| | - O Parker Martinez
- University of South Carolina School of Medicine, Columbia, Columbia, SC
| | - Elliott Chen
- Prisma Health-Columbia/University of South Carolina School of Medicine, Columbia, SC
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Park H, Ahn S. Vascular variation of temporoparietal fascia in microtia associated with hemifacial microsomia. J Craniomaxillofac Surg 2024; 52:40-47. [PMID: 38129190 DOI: 10.1016/j.jcms.2023.12.001] [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: 08/09/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023] Open
Abstract
The study analyzed vascular variations in microtia associated with hemifacial microsomia (HFM). A retrospective analysis was conducted on 47 patients with microtia and HFM, who underwent computed tomography angiography between November 2011 and May 2022. The vascular course and branching supplying the TPF were analyzed. Craniometric measurements were conducted to determine the horizontal distance from the porion and fronto-zygomatic suture (F-Z suture) to the vessels. On the affected side, the TPF was primarily supplied by either the superficial temporal artery (STA) or the postauricular artery-originated STA (Po-STA). The Po-STA (n = 29) was more prevalent than the STA (n = 18), and mostly exhibited a single frontal branch (n = 20). Craniometric analysis revealed that the Po-STA was closer to the porion, ear vestige, and F-Z suture than the STA on the non-affected side. Furthermore, a significant correlation was observed between the severity of mandibular hypoplasia and presence of Po-STA variation (Cramer's V = 0.498, p = 0.005). Microtia associated with HFM exhibits vascular variations in the TPF - in particular, a unique Po-STA variation. The Po-STA is prone to injury during ear reconstruction because of its proximity to the external auditory canal and ear vestige. Surgeons should be cautious of these anatomical variations for safer ear reconstruction procedures, and utilize preoperative imaging for meticulous planning.
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Affiliation(s)
- Hojin Park
- Department of Plastic Surgery, Korea University, College of Medicine, Korea University Anam Hospital, Seoul, South Korea.
| | - Sihyun Ahn
- Department of Plastic Surgery, Korea University, College of Medicine, Korea University Anam Hospital, Seoul, South Korea
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Mohamed EN, Elshahat A, Hany HED, Shafik FR, Lashin R. Segmentation of the 3D printed mirror image auricular model to ease sculpture of the costal cartilages in total auricular aesthetic reconstruction. Asian J Surg 2023; 46:5429-5437. [PMID: 37248160 DOI: 10.1016/j.asjsur.2023.05.040] [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: 01/25/2023] [Revised: 04/06/2023] [Accepted: 05/12/2023] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND Recently, three-dimensional (3D) models have been used more frequently than the traditional two-dimensional (2D) models as an intraoperative guide to ease sculpture of costal cartilages in total auricular aesthetic reconstruction in cases of microtia. Usually, 3D imaging techniques are used to create compact ear models, however, there is insufficient clinical knowledge of using them to create segmented 3D auricular models for cartilage framework reconstruction. IN THIS STUDY: assessment of the advantages of segmentation of 3D models over the traditional compact 3D models in total auricular aesthetic reconstruction has been discussed. PATIENTS AND METHODS In the current study, 16 patients who underwent total auricular aesthetic reconstruction using 3D models were included, patients were divided into two groups (Group I, 8 patients had total auricular aesthetic reconstruction using compact 3D printed mirror image model). Whereas (Group II, 8 patients had total auricular aesthetic reconstruction using segmented 3D printed mirror image model into auricular subunits. Then, each subunit was used for reconstruction of the corresponding part of the auricle. In both groups the patient's unaffected ear was mirrored and used as a reference to reconstruct the affected side. RESULTS The results were evaluated in both groups. The overall operative and carving times were found to be less in Group II; Also, postoperative aesthetic outcome and patient satisfaction were favorable in this group. CONCLUSION Using segmentation of 3D printed models in total auricular aesthetic reconstruction had less intraoperative time, better aesthetic results, and high postoperative patient satisfaction.
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Affiliation(s)
- Eman Nagy Mohamed
- The Department of Plastic, Burn and Maxillofacial Surgery, Faculty of Medicine, Ain- Shams University, Cairo, Egypt.
| | - Ahmed Elshahat
- The Department of Plastic, Burn and Maxillofacial Surgery, Faculty of Medicine, Ain- Shams University, Cairo, Egypt.
| | - Hossam El-Dien Hany
- The Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ain-shams University, Egypt.
| | - Fady Rezk Shafik
- The Department of Plastic, Burn and Maxillofacial Surgery, Faculty of Medicine, Ain- Shams University, Cairo, Egypt.
| | - Riham Lashin
- The Department of Plastic, Burn and Maxillofacial Surgery, Faculty of Medicine, Ain- Shams University, Cairo, Egypt.
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Xiao F, Wu B, Dong C, Cheng G, Cao Y, Wang L, Dong X, Lu Y, Yang L, Chen L, Li L, Pan X, Wei Q, Zhuang D, Chen D, Yin Z, Ni Q, Liu R, Xu S, Li G, Zhang P, Qian Y, Li X, Peng X, Wang Y, Wang H, Zhou W. Genetic spectrums and clinical profiles of critically ill neonates with congenital auricular deformity in the China Neonatal Genomes Project. Hum Genet 2023; 142:1737-1745. [PMID: 37938362 DOI: 10.1007/s00439-023-02612-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/22/2023] [Indexed: 11/09/2023]
Abstract
Congenital auricular deformity (CAD) is a complex phenotype that may occur as a single malformation or part of a congenital syndrome. The genetic architecture and utility of next-generation sequencing (NGS) in a sizable cross-sectional study of critically ill neonates with CAD have not yet been systematically investigated. This cross-sectional study investigated the genetic spectrum in critically ill neonates with CADs. Critically ill neonates with CADs (n = 251) were enrolled between August 8, 2016 and October 1, 2022. All neonates underwent NGS. The outcomes were molecular diagnostic yield, spectrum of genetic events, and clinical findings. Genetic findings were obtained in 107 neonates (42.6%), of which 67.3% (72/107) had pathogenic/likely pathogenic/variants of uncertain significance (P/LP/VUS) gene variations and 32.7% (35/107) had P/LP/VUS copy number variations (CNVs). The diagnostic rates of clinical exome sequencing were similar to those of exome sequencing. The logistic regression model revealed that CAD neonates with craniofacial abnormalities (OR = 4.15, 95% CI 2.29-7.53) or cardiovascular malformation (OR = 2.09, 95% CI 1.14-3.84) are more likely to be attributed to genetic causes. Follow-up analysis revealed that, compared to those in the undiagnosed group, the number of neonates whose care was withdrawn or who died was higher in the genetically diagnosed group (P < 0.05). This study identified a high incidence of genetic causes in critically ill neonates with CADs, with a combination of single-nucleotide variations and CNVs among the genetic causes of CAD. These findings highlight potential of NGS in the genetic testing of critically ill neonates with CADs.
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Affiliation(s)
- Feifan Xiao
- Center for Molecular Medicine, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China
| | - Bingbing Wu
- Center for Molecular Medicine, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China
| | - Chenbin Dong
- Department of Plastic Surgery, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, 201102, China
| | - Guoqiang Cheng
- Division of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Key Laboratory of Neonatal Diseases, Ministry of Health, Shanghai, 201102, China
| | - Yun Cao
- Division of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Key Laboratory of Neonatal Diseases, Ministry of Health, Shanghai, 201102, China
| | - Laishuan Wang
- Division of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Key Laboratory of Neonatal Diseases, Ministry of Health, Shanghai, 201102, China
| | - Xinran Dong
- Center for Molecular Medicine, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China
| | - Yulan Lu
- Center for Molecular Medicine, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China
| | - Lin Yang
- Department of Endocrinology and Inherited Metabolic Diseases, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, 201102, China
| | - Liping Chen
- Department of Neonatology, Jiangxi Provincial Children's Hospital, Nanchang, 330029, Jiangxi, China
| | - Long Li
- Department of Neonatology, People's Hospital of Xinjiang Uygur Autonomous Region, Ürümqi, 830001, Xinjiang, China
| | - Xinnian Pan
- Department of Neonatology, Maternal and Child, Health Care Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530003, Guangxi, China
| | - Qiufen Wei
- Department of Neonatology, Maternal and Child, Health Care Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530003, Guangxi, China
| | - Deyi Zhuang
- Department of Pediatrics, Xiamen Children's Hospital, Xiamen, 361006, Fujian, China
| | - Dongmei Chen
- Department of Neonatal Intensive Care Unit, Quanzhou Maternity and Children's Hospital, Quanzhou, 362000, Fujian, China
| | - Zhaoqing Yin
- Department of Neonatology, The People's Hospital of Dehong, Dehong, 678400, Yunnan, China
| | - Qi Ni
- Center for Molecular Medicine, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China
| | - Rencao Liu
- Center for Molecular Medicine, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China
| | - Suzhen Xu
- Center for Molecular Medicine, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China
| | - Gang Li
- Center for Molecular Medicine, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China
| | - Ping Zhang
- Center for Molecular Medicine, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China
| | - Yanyan Qian
- Center for Molecular Medicine, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China
| | - Xu Li
- Center for Molecular Medicine, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China
| | - Xiaomin Peng
- Center for Molecular Medicine, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China
| | - Yao Wang
- Center for Molecular Medicine, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China
| | - Huijun Wang
- Center for Molecular Medicine, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China.
| | - Wenhao Zhou
- Center for Molecular Medicine, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China.
- Division of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Key Laboratory of Neonatal Diseases, Ministry of Health, Shanghai, 201102, China.
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Nandra N, Jovic TH, Ali SR, Whitaker IS. Models and materials for teaching auricular framework carving: A systematic review. J Plast Reconstr Aesthet Surg 2023; 87:98-108. [PMID: 37826969 DOI: 10.1016/j.bjps.2023.09.044] [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: 10/01/2022] [Revised: 06/09/2023] [Accepted: 09/12/2023] [Indexed: 10/14/2023]
Abstract
INTRODUCTION The process of carving an auricular framework is technically challenging and unique to the patient. As such, there is a need for a robust and reliable training model for practicing and planning ear reconstruction. The aim of this study is to assess the best models and methods available to practice the carving of an auricular framework. METHODS A systematic review was undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines using MEDLINE, Embase, and Cochrane databases. Terms such as "ear", "reconstruction" and "teaching" were searched. RESULTS A total of 354 articles were identified, and 13 studies met the inclusion criteria. Vegetables, animal tissue, synthetic materials, as well as more advanced methods such as 3D-printed moulds, were analysed. The similarity of these materials to human costal cartilage was investigated to determine the best or most suitable ones for the purpose. The methods used in the studies were also analysed. Due to heterogeneity of the studies, it was not possible to conduct a quantitative analysis. CONCLUSION This review identifies that for the junior surgeons at the skill acquisition phase of their training in auricular framework carving repetition using firstly a cheap synthetic material would be most useful, followed by animal cartilage or 3D printing using silicone. These materials bear the most resemblance to human costal cartilage, and by repeating the carvings, proficiency will improve. Those surgeons with an established ear reconstruction practise, wishing to undertake immediate pre-operatively simulation could benefit from cross-sectional imaging and 3D printing of a patient's non-affected ear to ensure a good match.
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Affiliation(s)
- Naomi Nandra
- Reconstructive Surgery and Regenerative Medicine Research Centre. Institute of Life Sciences, Swansea University Medical School, Swansea, UK; Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - Thomas H Jovic
- Reconstructive Surgery and Regenerative Medicine Research Centre. Institute of Life Sciences, Swansea University Medical School, Swansea, UK; Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - Stephen R Ali
- Reconstructive Surgery and Regenerative Medicine Research Centre. Institute of Life Sciences, Swansea University Medical School, Swansea, UK; Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - Iain S Whitaker
- Reconstructive Surgery and Regenerative Medicine Research Centre. Institute of Life Sciences, Swansea University Medical School, Swansea, UK; Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK.
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Pavone P, Pappalardo XG, Parano C, Parano E, Corsello A, Ruggieri M, Cacciaguerra G, Falsaperla R. Severe Unilateral Microtia with Aural Atresia, Hair White Patch, Stereotypes in a Young Boy with De novo 16p13.11 Deletion: Reasons for a New Genotype-Phenotype Correlation. Glob Med Genet 2023; 10:370-375. [PMID: 38053544 PMCID: PMC10695706 DOI: 10.1055/s-0043-1777362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
Background Microtia is an uncommon congenital malformation ranging from mild anatomic structural abnormalities to partial or complete absence of the ear leading to hearing impairment. Congenital microtia may present as a single malformation (isolated microtia) or sometimes associated with other congenital anomalies involving various organs. Microtia has been classified in three degrees according to the complexity of the auricular malformation and to anotia referred to the total absence of the ear. Genetic role in causing auricular malformation has been widely demonstrated, and genotype-phenotype correlation has been reported in cases of syndromic microtia. Case Presentation We report here a young patient with a third degree of scale classification and aural atresia. The patient showed unspecific facial dysmorphism, speech delay, precocious teething, hair white patch, and stereotypic anomalous movements. Genetic analysis displayed a de novo 16p13.11 deletion. Conclusion Microtia with aural atresia is an uncommon and severe birth defect, which affects functional and esthetic aspects, often associated with other malformations. As traumatic this disorder may be for the parents, the microtia and aural atresia are treatable, thanks to the improving and evolving surgical techniques. Based on the genetic analysis and the clinical features observed in the present case, a genotype-phenotype correlation has been proposed.
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Affiliation(s)
- Piero Pavone
- Section of Paediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Xena Giada Pappalardo
- Unit of Catania, Institute for Biomedical Research and Innovation, National Council of Research, Catania, Italy
| | - Claudia Parano
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Enrico Parano
- Unit of Catania, Institute for Biomedical Research and Innovation, National Council of Research, Catania, Italy
| | - Antonio Corsello
- Neonatal Intensive Care Unit, Department of Sciences for Health Promotion, Maternal Infant Care, Internal Medicine and Medical Specialties “G. D'Alessandro,” University Hospital “P. Giaccone,” Palermo, Italy
| | - Martino Ruggieri
- Section of Paediatrics and Child Neuropsychiatry, Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Giovanni Cacciaguerra
- Section of Paediatrics and Child Neuropsychiatry, Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Raffaele Falsaperla
- Neonatal Intensive Care Unit, AUO Policlinico “Rodolico-San Marco,” University of Catania, Catania, Italy
- Acute End Emergency Pediatric Unit, Department of General Pediatrics, AUO Policlinico “Rodolico-San Marco,” University of Catania, Catania, Italy
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40
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Brandt HH, Bodmer D. [Contemporary diagnosis and management of congenital microtia and aural atresia : Part 1: Principles and diagnosis]. HNO 2023; 71:821-832. [PMID: 37921885 PMCID: PMC10663219 DOI: 10.1007/s00106-023-01381-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2023] [Indexed: 11/05/2023]
Abstract
Congenital malformations of the pinna and aural atresia can result in major aesthetic and functional deficits. Knowledge about embryologic developments and established classification systems is an essential requirement when dealing with affected patients. Early detection of deficiencies and introduction of appropriate diagnostic measures is vital to initiate adequate therapies and prevent long-term disabilities. Treatment for malformations of the pinna-if requested-is mostly surgical, infrequently an epithesis is applied. As in other surgical fields, tissue engineering will likely play a crucial role in the future. Treatment of aural stenosis and atresia aims at improvement of hearing levels and prevention of secondary complications like cholesteatoma and chronic otorrhea. Auditory rehabilitation comprises a spectrum from conventional hearing aids to invasive hearing implants, the latter being favored in recent years.
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Affiliation(s)
- Hannes H Brandt
- Klinische Abteilung für Hals‑, Nasen‑, Ohrenkrankheiten, Universitätsklinikum St. Pölten, Dunant-Platz 1, 3100, St. Pölten, Österreich.
- Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Krems, 3500, Dr. Karl-Dorrek-Straße 30, Österreich.
| | - Daniel Bodmer
- Hals-Nasen-Ohren-Klinik, Universitätsspital Basel, Basel, 4031, Petersgraben 4, Schweiz
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41
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Wei Y, Li L, Xie C, Wei Y, Huang C, Wang Y, Zhou J, Jia C, Junlin L. Current Status of Auricular Reconstruction Strategy Development. J Craniofac Surg 2023:00001665-990000000-01239. [PMID: 37983309 DOI: 10.1097/scs.0000000000009908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 10/27/2023] [Indexed: 11/22/2023] Open
Abstract
Microtia has severe physical and psychological impacts on patients, and auricular reconstruction offers improved esthetics and function, alleviating psychological issues. Microtia is a congenital disease caused by a multifactorial interaction of environmental and genetic factors, with complex clinical manifestations. Classification assessment aids in determining treatment strategies. Auricular reconstruction is the primary treatment for severe microtia, focusing on the selection of auricular scaffold materials, the construction of auricular morphology, and skin and soft tissue scaffold coverage. Autologous rib cartilage and synthetic materials are both used as scaffold materials for auricular reconstruction, each with advantages and disadvantages. Methods for achieving skin and soft tissue scaffold coverage have been developed to include nonexpansion and expansion techniques. In recent years, the application of digital auxiliary technology such as finite element analysis has helped optimize surgical outcomes and reduce complications. Tissue-engineered cartilage scaffolds and 3-dimensional bioprinting technology have rapidly advanced in the field of ear reconstruction. This article discusses the prevalence and classification of microtia, the selection of auricular scaffolds, the evolution of surgical methods, and the current applications of digital auxiliary technology in ear reconstruction, with the aim of providing clinical physicians with a reference for individualized ear reconstruction surgery. The focus of this work is on the current applications and challenges of tissue engineering and 3-dimensional bioprinting technology in the field of ear reconstruction, as well as future prospects.
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Affiliation(s)
- Yi Wei
- Center of Burn and Plastic and Wound Healing Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China
| | - Li Li
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan
| | - Cong Xie
- Center of Burn and Plastic and Wound Healing Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China
| | - Yangchen Wei
- Center of Burn and Plastic and Wound Healing Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China
| | - Chufei Huang
- Center of Burn and Plastic and Wound Healing Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China
| | - Yiping Wang
- Center of Burn and Plastic and Wound Healing Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China
| | - Jianda Zhou
- Departments of Plastic and Reconstructive Surgery, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Chiyu Jia
- Center of Burn and Plastic and Wound Healing Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China
| | - Liao Junlin
- Center of Burn and Plastic and Wound Healing Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China
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Zhou X, Cai S, Wang H, Fang J, Gao J, Kuang H, Xie D, He J, Wang A. Update from a cohort study for birth defects in Hunan Province, China, 2010-2020. Sci Rep 2023; 13:20257. [PMID: 37985789 PMCID: PMC10662386 DOI: 10.1038/s41598-023-47741-1] [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: 05/06/2023] [Accepted: 11/17/2023] [Indexed: 11/22/2023] Open
Abstract
To define the relationship between sex, residence, maternal age, and a broad range of birth defects by conducting a comprehensive cross-analysis based on up-to-date data. Data were obtained from the Birth Defects Surveillance System in Hunan Province, China, 2010-2020. Prevalences of birth defects (number of cases per 10,000 fetuses (births and deaths at 28 weeks of gestation and beyond)) with 95% confidence intervals (CI) were calculated by sex, residence, maternal age, year, and 23 specific defects. Cross-analysis of sex, residence, and maternal age was conducted, and crude odds ratios (ORs) were calculated to examine the association of each maternal characteristic with birth defects. A total of 1,619,376 fetuses and 30,596 birth defects were identified. The prevalence of birth defects was 188.94/10,000 (95% CI 186.82-191.05). Birth defects were more frequent in males than females (210.46 vs. 163.03/10,000, OR = 1.30, 95% CI 1.27-1.33), in urban areas than in rural areas (223.61 vs. 162.90/10,000, OR = 1.38, 95% CI 1.35-1.41), and in mothers ≥ 35 than mothers 25-29 (206.35 vs. 187.79/10,000, OR = 1.10, 95% CI 1.06-1.14). Cross-analysis showed that the prevalence of birth defects was higher in urban females than in rural males (194.53 vs. 182.25/10,000), the difference in prevalence between males and females was more significant for maternal age < 20 compared to other age groups (OR = 1.64, 95% CI 1.37-1.95), and the prevalence difference between urban and rural areas is more significant for maternal age 25-34 compared to other age groups (OR = 1.49, 95% CI 1.43-1.57). Cleft palates were more frequent in males, and nine specific defects were more frequent in females. Five specific defects were more frequent in rural areas, and eight were more frequent in urban areas. Compared to mothers 25-29, five specific defects were more frequent in mothers < 20, seven specific defects were more frequent in mothers 20-24, two specific defects were more frequent in mothers 30-34, and ten specific defects were more frequent in mothers ≥ 35. Our data indicate that sex, residence, and maternal age differences in the prevalences of birth defects and most specific defects are common. We have found some new epidemiological characteristics of birth defects using cross-analysis, such as residence is the determining factor for the prevalence of birth defects, the difference in prevalence between males and females was more significant for maternal age < 20 compared to other age groups, the prevalence difference between urban and rural areas is more significant for maternal age 25-34 compared to other age groups. And differences in the epidemiological characteristics of some specific defects from previous studies. Future studies should examine mechanisms. Our findings contributed to clinical counseling and advancing research on the risk factors for birth defects.
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Affiliation(s)
- Xu Zhou
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China.
| | - Shenglan Cai
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Hua Wang
- The Hunan Children's Hospital, Changsha, Hunan, China.
- National Health Commission Key Laboratory of Birth Defects Research, Prevention and Treatment, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China.
| | - Junqun Fang
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China.
| | - Jie Gao
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China.
| | - Haiyan Kuang
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Donghua Xie
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Jian He
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Aihua Wang
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
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Burns HR, Dinis J, Ding Y, Buchanan EP. Seminars in Plastic Surgery: Pediatric Ear Anomalies and Reconstruction. Semin Plast Surg 2023; 37:287-298. [PMID: 38098685 PMCID: PMC10718655 DOI: 10.1055/s-0043-1775888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Congenital ear anomalies affect 15 to 20% of neonates and can be categorized as either auricular deformations or malformations. Deformations involve a fully developed, albeit abnormally shaped, chondrocutaneous framework, which makes them amenable to correction with ear molding within the first few months of life. Malformations involve hypoplastic or fully absent auricular structures that require augmentation with alloplastic and/or autogenous reconstruction. The goal of this article is to outline the various auricular deformities and malformations, followed by a description of the latest clinical management options, both nonsurgical and surgical, by auricular anomaly.
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Affiliation(s)
- Heather R. Burns
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Jacob Dinis
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Yang Ding
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Edward P. Buchanan
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
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44
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Zhang M, Lin J, Zhang J, Han Z, Liu C, Zou Y. A clinical epidemiological study on congenital ear malformation (CEM). Acta Otolaryngol 2023; 143:S17-S24. [PMID: 38071650 DOI: 10.1080/00016489.2023.2276348] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/11/2023] [Indexed: 02/15/2024]
Abstract
BACKGROUND There is no report about the definition, classification and clinical epidemiological study of congenital ear malformation (CEM).Aims/Objectives: To investigate the definition, clinical classification and distribution of a large number of CEM cases, along with the clinical and epidemiological characteristics associated with congenital malformation of the middle and outer ear (CMMOE). MATERIAL AND METHODS A total of 3231 cases (4714 ears) with CEM and related malformations were retrospectively analyzed, including 2,658 cases (4,064 ears) CEM and 573 cases (650 ears) preauricular fistulas and accessory ears, specifically related malformations to CEM. RESULTS Among the 2,658 cases (4,064 ears) CEM, 64.9% cases were male and 35.1% were female. 52.9% cases with bilateral, 29.1% with right and 18.0% with left CEM. A subgroup of 1,050 cases (1,331 ears) was identified as CMMOE out of 1,090 cases (1,379 ears) microtia. In the CMMOE subgroup, 74.0% cases were male, 46.3% on the right side, 26.8% showed bilateral involvement. Out of the CMMOE with available images, there were 947 cases (1,105 ears). Additionally, related malformations including preauricular fistulas and accessory ears, were solely occured in 573 cases (650 ears), except for their occurrence simultaneously with CEM. The classification and distribution of CEM are as follows:1. 2658 cases of CEM (1) 69.9% of them were confined to the ear, including: ① the outer ear 2.6%, the middle ear 17.0% and the inner ear 32.4%, ② two parts simultaneous malformations of the outer ear, the middle ear and the inner ear 17.2%, ③ three parts simultaneous malformations of the outer ear, the middle ear and the inner ear 0.6%, (2) Multiple malformations including in CEM 29.1%; (3) syndromes related to CEM 1.0%.2. 1050 cases of CMMOE (1) 36.3% of them were confined to the middle and outer ears; (2) Multiple malformations associated with CMMOE 61.4%, including hemifacial microsomia 50.5%, accessory ears 9.8%, preauricular fistulas 9.2%, heart malformation 7.1%, and kidney malformation 2.0%; and (3) syndromes related to CMMOE 2.3%, (4) Complications of the ear 16.9%, mainly including otitis media 7.9%, outer ear canal cholesteatoma 6.3%, retroauricular abscess 1.1%, and nasal and pharyngeal complications 18.6%. The proportions of microcia grades I-Ⅴ based on the images of 1105 ears CMMOE were 5.2%, 10.5%, 74.1%, 6.9%, and 3.3%, respectively. Among the 1331 ears CMMOE, the incidence rates of outer ear canal atresia, stenosis, normal, and ossicles malformation were 86.5%, 9.9%, 3.6%, and 98.3%, respectively.Conclusion and Significance: Approximately 69.9% of CEM cases were confined to the ear itself, with the highest proportion being inner ear malformation alone. Multiple malformations were predominantly associated with CMMOE. Syndromes related to CEM were relatively rare. Among cases of microtia, 96.3% were classified as CMMOE. These cases were predominantly observed in males, right ear and exhibited characteristics such as grade III microtia, atresia of the outer ear canal, ossicles malformation, and multiple malformations. The multiple malformations frequently included hemifacial microsomia, accessory ear, preauricular fistula, as well as heart and kidney deformities. CMMOE often coexisted with ear infections, cholesteatoma, and complications in the nasal and pharyngeal regions.
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Affiliation(s)
- Ming Zhang
- Senior Department of Otolaryngology-Head and Neck Surgery, The Sixth Medical Center of PLA General Hospital, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
- State Key Laboratory of Hearing and Balance Science, Beijing, China
| | - JiaHua Lin
- Senior Department of Otolaryngology-Head and Neck Surgery, The Sixth Medical Center of PLA General Hospital, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
- State Key Laboratory of Hearing and Balance Science, Beijing, China
| | - JingDa Zhang
- Health Medical Department, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, PLA General Hospital, Beijing, China
| | - ZeLi Han
- Senior Department of Otolaryngology-Head and Neck Surgery, The Sixth Medical Center of PLA General Hospital, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
- State Key Laboratory of Hearing and Balance Science, Beijing, China
| | - Chang Liu
- Senior Department of Otolaryngology-Head and Neck Surgery, The Sixth Medical Center of PLA General Hospital, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
- State Key Laboratory of Hearing and Balance Science, Beijing, China
| | - YiHui Zou
- Senior Department of Otolaryngology-Head and Neck Surgery, The Sixth Medical Center of PLA General Hospital, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
- State Key Laboratory of Hearing and Balance Science, Beijing, China
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45
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Si N, Zhan G, Meng X, Zhang Z, Huang X, Pan B. Identification of novel mutations in EYA3 and EFTUD2 in a family with craniofacial microsomia: evidence of digenic inheritance. Front Med 2023; 17:1006-1009. [PMID: 37507637 DOI: 10.1007/s11684-023-1000-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 04/01/2023] [Indexed: 07/30/2023]
Affiliation(s)
- Nuo Si
- Plastic Surgery Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100043, China
| | - Guoqin Zhan
- Plastic Surgery Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100043, China
| | - Xiaolu Meng
- Plastic Surgery Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100043, China
| | - Zeya Zhang
- Plastic Surgery Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100043, China
| | - Xin Huang
- Plastic Surgery Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100043, China
| | - Bo Pan
- Plastic Surgery Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100043, China.
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46
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Guo R, Liu T, Wang B, Zhang Q. Management Strategy of Local Subcutaneous Effusion After Auricle Reconstruction. EAR, NOSE & THROAT JOURNAL 2023; 102:667-672. [PMID: 34098768 DOI: 10.1177/01455613211022104] [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: 11/16/2022] Open
Abstract
OBJECTIVES Microtia is a severe congenital malformation of the external ear, and auricular reconstruction is still a challenge for plastic surgeons because of the complicated procedures and rare conditions. This study aimed to describe the location of subcutaneous effusion after auricular reconstruction and explore the clinical efficacy of the indwelling needle puncture drainage method in the treatment of local subcutaneous effusion. METHODS From January 2017 to December 2019, 1240 patients (1296 affected sides) who underwent auricular reconstruction using autogenous cartilage framework in the Plastic Surgery Hospital of Chinese Academy of Medical Science and Peking Union Medical College were selected. The local subcutaneous effusion occurred within 5 days after the drainage tube was removed, and the indwelling needle was used for puncture and drainage in the postoperative treatment. RESULTS A total of 55 patients had subcutaneous effusion after the operation, including 24 cases with Nagata's method and 31 cases with the expanded single-flap method. One patient showed no obvious reduction after puncture and drainage by indwelling needle and improved after the secondary operation. Two patients had slight cartilage absorption. The remaining patients had good results. CONCLUSIONS The method of the indwelling needle for puncture and drainage is easy to operate. The problem of local subcutaneous effusion after auricular reconstruction can be solved and good efficacy can be obtained.
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Affiliation(s)
- Rui Guo
- Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Thirty-three Badachu Road, Shijingshan District, Beijing, China
| | - Tun Liu
- Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Thirty-three Badachu Road, Shijingshan District, Beijing, China
| | - Bingqing Wang
- Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Thirty-three Badachu Road, Shijingshan District, Beijing, China
| | - Qingguo Zhang
- Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Thirty-three Badachu Road, Shijingshan District, Beijing, China
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47
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Hauc SC, Boroumand S, Hosseini H, Ihnat JM, Rivera JC, Almeida MN, Stögner VA, Huelsboemer L, Alperovich M. National Trends in Microtia Repair Cost and Hospital Length of Stay. J Craniofac Surg 2023; 34:2026-2029. [PMID: 37582283 DOI: 10.1097/scs.0000000000009599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/26/2023] [Indexed: 08/17/2023] Open
Abstract
Microtia can have deleterious impacts on the functional, psychological, and aesthetic outcomes of affected young children. Reconstructive procedures can alleviate these negative outcomes and significantly improve the quality of life for patients; however, the cost and length of hospital stay (LOS) for such procedures and the factors that impact them have not been well-characterized. This study seeks to understand the hospital-level (institution type, size, and geographic region) and patient-level factors (race, age, and insurance status) that impact cost and LOS in patients who undergo microtia reconstructive surgery. A retrospective data analysis was conducted utilizing the National Inpatient Sample (NIS) database for the years 2008 to 2015. Inclusion criteria included patients who had an International Classification of Diseases, Ninth Revision (ICD-9) diagnostic code for microtia (744.23) as well as a procedure for microtia correction (186×/187×). A total of 714 microtia repair cases met the inclusion criteria and were sampled from the NIS database. Microtia repair cost was significantly increased on the West Coast compared with the Northeast ($34,947 versus $29,222, P =0.020), increased with patient age ($614/y, P =0.012), and gradually increased from 2008 to 2015 ($25,897-$48,985, P <0.001). Microtia LOS was significantly increased with government-controlled hospitals compared with private hospitals (1.93 versus 1.39 d, P =0.005), increased with patients on Medicaid compared with private insurance (2.33 versus 2.00 d, P =0.036), and overall decreased with patient age (-0.07 d/y, P =0.001). The results not only identify the multifactorial impacts that drive cost and LOS in microtia repair but provide insights into the financial and medical considerations patients and their families must navigate.
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Affiliation(s)
- Sacha C Hauc
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT
| | - Sam Boroumand
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT
| | - Helia Hosseini
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT
| | - Jacqueline M Ihnat
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT
| | - Jean C Rivera
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT
| | - Mariana N Almeida
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT
| | - Viola A Stögner
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Burn Center, Hannover, Germany
| | - Lioba Huelsboemer
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT
| | - Michael Alperovich
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT
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Huang Y, Zhao H, Wang Y, Bi S, Zhou K, Li H, Zhou C, Wang Y, Wu W, Peng B, Tang J, Pan B, Wang B, Chen Z, Li Z, Zhang Z. The application and progress of tissue engineering and biomaterial scaffolds for total auricular reconstruction in microtia. Front Bioeng Biotechnol 2023; 11:1089031. [PMID: 37811379 PMCID: PMC10556751 DOI: 10.3389/fbioe.2023.1089031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/21/2023] [Indexed: 10/10/2023] Open
Abstract
Microtia is a congenital deformity of the ear with an incidence of about 0.8-4.2 per 10,000 births. Total auricular reconstruction is the preferred treatment of microtia at present, and one of the core technologies is the preparation of cartilage scaffolds. Autologous costal cartilage is recognized as the best material source for constructing scaffold platforms. However, costal cartilage harvest can lead to donor-site injuries such as pneumothorax, postoperative pain, chest wall scar and deformity. Therefore, with the need of alternative to autologous cartilage, in vitro and in vivo studies of biomaterial scaffolds and cartilage tissue engineering have gradually become novel research hot points in auricular reconstruction research. Tissue-engineered cartilage possesses obvious advantages including non-rejection, minimally invasive or non-invasive, the potential of large-scale production to ensure sufficient donors and controllable morphology. Exploration and advancements of tissue-engineered cartilaginous framework are also emerging in aspects including three-dimensional biomaterial scaffolds, acquisition of seed cells and chondrocytes, 3D printing techniques, inducing factors for chondrogenesis and so on, which has greatly promoted the research process of biomaterial substitute. This review discussed the development, current application and research progress of cartilage tissue engineering in auricular reconstruction, particularly the usage and creation of biomaterial scaffolds. The development and selection of various types of seed cells and inducing factors to stimulate chondrogenic differentiation in auricular cartilage were also highlighted. There are still confronted challenges before the clinical application becomes widely available for patients, and its long-term effect remains to be evaluated. We hope to provide guidance for future research directions of biomaterials as an alternative to autologous cartilage in ear reconstruction, and finally benefit the transformation and clinical application of cartilage tissue engineering and biomaterials in microtia treatment.
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Affiliation(s)
- Yeqian Huang
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Hanxing Zhao
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China
- Department of Plastic Reconstructive and Aesthetic Surgery, West China Tianfu Hospital, Sichuan University, Chengdu, China
| | - Yixi Wang
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Siwei Bi
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Kai Zhou
- Department of Plastic Reconstructive and Aesthetic Surgery, West China Tianfu Hospital, Sichuan University, Chengdu, China
| | - Hairui Li
- Department of Plastic Reconstructive and Aesthetic Surgery, West China Tianfu Hospital, Sichuan University, Chengdu, China
| | - Changchun Zhou
- National Engineering Research Center for Biomaterials, College of Biomedical Engineering, Sichuan University, Chengdu, China
| | - Yudong Wang
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Wenqing Wu
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Bo Peng
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China
- Department of Plastic Reconstructive and Aesthetic Surgery, West China Tianfu Hospital, Sichuan University, Chengdu, China
| | - Jun Tang
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China
- Department of Plastic Reconstructive and Aesthetic Surgery, West China Tianfu Hospital, Sichuan University, Chengdu, China
| | - Bo Pan
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Baoyun Wang
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China
- Department of Plastic Reconstructive and Aesthetic Surgery, West China Tianfu Hospital, Sichuan University, Chengdu, China
| | - Zhixing Chen
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China
- Department of Plastic Reconstructive and Aesthetic Surgery, West China Tianfu Hospital, Sichuan University, Chengdu, China
| | - Zhengyong Li
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China
- Department of Plastic Reconstructive and Aesthetic Surgery, West China Tianfu Hospital, Sichuan University, Chengdu, China
| | - Zhenyu Zhang
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China
- Department of Plastic Reconstructive and Aesthetic Surgery, West China Tianfu Hospital, Sichuan University, Chengdu, China
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49
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Zielinska D, Yosef HK, Zollitsch T, Kern J, Jakob Y, Gvaramia D, Rotter N, Pontiggia L, Moehrlen U, Biedermann T, Klar AS. Characterization of Distinct Chondrogenic Cell Populations of Patients Suffering from Microtia Using Single-Cell Micro-Raman Spectroscopy. Biomedicines 2023; 11:2588. [PMID: 37761029 PMCID: PMC10526501 DOI: 10.3390/biomedicines11092588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/29/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
Microtia is a congenital condition of abnormal development of the outer ear. Tissue engineering of the ear is an alternative treatment option for microtia patients. However, for this approach, the identification of high regenerative cartilage progenitor cells is of vital importance. Raman analysis provides a novel, non-invasive, label-free diagnostic tool to detect distinctive biochemical features of single cells or tissues. Using micro-Raman spectroscopy, we were able to distinguish and characterize the particular molecular fingerprints of differentiated chondrocytes and perichondrocytes and their respective progenitors isolated from healthy individuals and microtia patients. We found that microtia chondrocytes exhibited lower lipid concentrations in comparison to healthy cells, thus indicating the importance of fat storage. Moreover, we suggest that collagen is a useful biomarker for distinguishing between populations obtained from the cartilage and perichondrium because of the higher spectral contributions of collagen in the chondrocytes compared to perichondrocytes from healthy individuals and microtia patients. Our results represent a contribution to the identification of cell markers that may allow the selection of specific cell populations for cartilage tissue engineering. Moreover, the observed differences between microtia and healthy cells are essential for gaining better knowledge of the cause of microtia. It can be useful for designing novel treatment options based on further investigations of the discovered biochemical substrate alterations.
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Affiliation(s)
- Dominika Zielinska
- Tissue Biology Research Unit, University Children’s Hospital Zurich, 8952 Schlieren, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- Faculty of Medicine, University of Zurich, 8032 Zurich, Switzerland
| | - Hesham K. Yosef
- Faculty of Medicine, University of Zurich, 8032 Zurich, Switzerland
- microphotonXGmbH, 82327 Tutzing, Germany
| | | | - Johann Kern
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | - Yvonne Jakob
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | - David Gvaramia
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | - Nicole Rotter
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | - Luca Pontiggia
- Tissue Biology Research Unit, University Children’s Hospital Zurich, 8952 Schlieren, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- Faculty of Medicine, University of Zurich, 8032 Zurich, Switzerland
| | - Ueli Moehrlen
- Tissue Biology Research Unit, University Children’s Hospital Zurich, 8952 Schlieren, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- Faculty of Medicine, University of Zurich, 8032 Zurich, Switzerland
- Department of Surgery, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
| | - Thomas Biedermann
- Tissue Biology Research Unit, University Children’s Hospital Zurich, 8952 Schlieren, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- Faculty of Medicine, University of Zurich, 8032 Zurich, Switzerland
| | - Agnes S. Klar
- Tissue Biology Research Unit, University Children’s Hospital Zurich, 8952 Schlieren, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- Faculty of Medicine, University of Zurich, 8032 Zurich, Switzerland
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50
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Ronde EM, Nolte JW, Kruisinga FH, Maas SM, Lapid O, Ebbens FA, Becking AG, Breugem CC. Evaluating International Diagnostic, Screening, and Monitoring Practices for Craniofacial Microsomia and Microtia: A Survey Study. Cleft Palate Craniofac J 2023; 60:1118-1127. [PMID: 35469463 PMCID: PMC10466995 DOI: 10.1177/10556656221093912] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023] Open
Abstract
To (1) appraise current international classification and clinical management strategies for craniofacial microsomia (CFM) and microtia, and (2) to assess agreement with the European Reference Network "European Guideline Craniofacial Microsomia" recommendations on screening and monitoring. This was a cross-sectional online survey study. The survey consisted of 44 questions on demographics, diagnostics and classification, obstructive sleep apnea, feeding difficulties, speech and language development, hearing, ocular abnormalities, visual development, orthodontic screening, genetic counselling, psychological wellbeing, and extracraniofacial anomalies. Respondents were participants of 3 international cleft and craniofacial conferences, members of the American Cleft Palate and Craniofacial Association and members of the International Society for Auricular Reconstruction. Respondents were requested to complete 1 questionnaire per multidisciplinary team. Fifty-seven responses were received from 30 countries (response rate ∼3%).The International Consortium for Health Outcomes Measurement diagnostic criteria were used by 86% of respondents, though 65% considered isolated microtia a mild form of CFM. The Orbit, Mandible, Ear, Facial Nerve and Soft Tissue classification system was used by 74% of respondents. Agreement with standardized screening and monitoring recommendations was between 61% and 97%. A majority of respondents agreed with screening for extracraniofacial anomalies (63%-68%) and with genetic counselling (81%). This survey did not reveal consistent agreement on the diagnostic criteria for CFM. Respondents mostly supported management recommendations, but frequently disagreed with the standardization of care. Future studies could focus on working towards international consensus on diagnostic criteria, and exploring internationally feasible management strategies.
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Affiliation(s)
- Elsa M. Ronde
- Amsterdam UMC location University of Amsterdam, Plastic, Reconstructive and Hand Surgery, Amsterdam, the Netherlands
- Amsterdam UMC location University of Amsterdam, Oral and Maxillofacial Surgery, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development, Amsterdam, the Netherlands
| | - Jitske W. Nolte
- Amsterdam UMC location University of Amsterdam, Oral and Maxillofacial Surgery, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Frea H. Kruisinga
- Amsterdam UMC location University of Amsterdam, Pediatrics, Amsterdam, the Netherlands
| | - Saskia M. Maas
- Amsterdam Reproduction and Development, Amsterdam, the Netherlands
- Amsterdam UMC location University of Amsterdam, Clinical Genetics, Amsterdam, the Netherlands
| | - Oren Lapid
- Amsterdam UMC location University of Amsterdam, Plastic, Reconstructive and Hand Surgery, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Fenna A. Ebbens
- Amsterdam UMC location University of Amsterdam, Otorhinolaryngology, Amsterdam, the Netherlands
- Amsterdam Public Health, Ear and Hearing, Amsterdam, the Netherlands
| | - Alfred G. Becking
- Amsterdam UMC location University of Amsterdam, Oral and Maxillofacial Surgery, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Corstiaan C. Breugem
- Amsterdam UMC location University of Amsterdam, Plastic, Reconstructive and Hand Surgery, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development, Amsterdam, the Netherlands
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