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Chia DHL, Sim N. Non-surgical correction of cryptotia. J Plast Reconstr Aesthet Surg 2020; 74:377-381. [PMID: 33071167 DOI: 10.1016/j.bjps.2020.08.133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 03/14/2020] [Accepted: 08/20/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Cryptotia is characterized by an absence of the upper part of the temporoauricular sulcus with the superior third of the auricle buried under the temporal skin. The principle of correction of cryptotia is to achieve both a functional and aesthetic ear. METHODOLOGY A 4-year prospective study was carried out in a single centre on infants with cryptotia. We introduce a two-staged approach for non-surgical correction of cryptotia and a treatment algorithm based on the age of the patient. In the first stage, we unbury the auricle over 2 weeks. The second stage involves 2 additional weeks of helical moulding to correct the underlying or residual deformation. In our algorithm, patients more than 6 weeks of age undergo only the first stage of cryptotia correction, whereas those less than 6 weeks of age progress to the second stage of treatment. RESULTS A total of 5 patients (7 ears) were treated with ages ranging from 1 day to 7 months. Two patients underwent 2-stage treatment and 3 underwent 1-stage treatment. At 1 year, all buried helices remained retracted. Four out of 7 ears treated had "Excellent" outcomes and 3 out of 7 ears had "Good" outcomes. All caregivers were extremely satisfied with the outcomes. CONCLUSION This simple and efficacious two-stage technique and algorithm is effective in the correction of cryptotia, even if the treatment is initiated beyond the traditional moulding window in the first six weeks of life. Using this approach, patients with cryptotia benefit by avoiding or simplifying surgical reconstruction in the future.
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Affiliation(s)
- Dr Hui-Ling Chia
- Consultant Plastic Surgeon, SW1 Plastic Surgery Clinic, 290 Orchard Road, #13-01, Paragon 238859, Singapore; Department of Plastic, Reconstructive and Aesthetic Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore.
| | - Nadia Sim
- Department of Plastic, Reconstructive and Aesthetic Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore.
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Public Perception of Helical Rim Deformities and Their Correction With Ear Molding. J Craniofac Surg 2020; 31:741-745. [PMID: 32176020 DOI: 10.1097/scs.0000000000006400] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Among congenital ear deformities, helical rim deformities are most common. Non-surgical ear molding has emerged as an effective option to treat helical rim deformities and could reduce the need for surgery later in a child's life. Despite this, there has never been a study examining how the general public rates corrections after ear molding. METHODS A retrospective chart review was conducted of all consecutive patients with helical rim deformities treated with InfantEar TM Molding System. Amazon Mechanical Turk (MTurk) was used to survey blinded respondents using photographs of patients' ears to determine the degree of normalcy on a scale of 1 (not normal) to 10 (completely normal) before and after molding. Ratings of ears were compared using a paired t test and percent improvement from baseline. RESULTS A total of 59 ears met criteria for evaluation by 497 MTurk respondents. Average age of patients at the time of treatment was 34.2 ± 16.8 days and mean therapy duration was 31.3 ± 13.1 days. A paired t test analysis found that MTurk respondents identified significant improvement in 91.5% of ears (n = 54) (P < 0.05). The percent improvement in observed helical rim change was on average 82.7 ± 61.1%. CONCLUSION Ear molding is an effective and safe way to address helical rim deformities early in the neonatal period. The general public is able to recognize ears with rim deformities as abnormal, and appreciate the difference in architecture after molding. Crowdsourcing technology offers an opportunity to measure laypeople's perceptions regarding outcomes after ear molding.
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Kong C. Ethical dangers of facial phenotyping through photography in psychiatric genomics studies. JOURNAL OF MEDICAL ETHICS 2019; 45:730-735. [PMID: 31363012 DOI: 10.1136/medethics-2019-105478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/29/2019] [Accepted: 07/14/2019] [Indexed: 06/10/2023]
Abstract
Psychiatric genomics research protocols are increasingly incorporating tools of deep phenotyping to observe and examine phenotypic abnormalities among individuals with neurodevelopmental disorders. In particular, photography and the use of two-dimensional and three-dimensional facial analysis is thought to shed further light on the phenotypic expression of the genes underlying neurodevelopmental disorders, as well as provide potential diagnostic tools for clinicians. In this paper, I argue that the research use of photography to aid facial phenotyping raises deeply fraught issues from an ethical point of view. First, the process of objectification through photographic imagery and facial analysis could potentially worsen the stigmatisation of persons with neurodevelopmental disorders. Second, the use of photography for facial phenotyping has worrying parallels with the historical misuse of photography to advance positive and negative eugenics around race, ethnicity and intellectual disability. The paper recommends ethical caution in the use of photography and facial phenotyping in psychiatric genomics studies exploring neurodevelopmental disorders, outlining certain necessary safeguards, such as a critical awareness of the history of anthropometric photography use among scientists, as well as the exploration of photographic methodologies that could potentially empower individuals with disabilities.
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Affiliation(s)
- Camillia Kong
- Birkbeck University of London Institute for Criminal Policy Research, London, UK
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Cuccolo NG, Zwierstra MJ, Ibrahim AM, Peymani A, Afshar S, Lin SJ. Reconstruction of Congenital Microtia and Anotia: Analysis of Practitioner Epidemiology and Postoperative Outcomes. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2318. [PMID: 31624696 PMCID: PMC6635187 DOI: 10.1097/gox.0000000000002318] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 05/01/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Microtia refers to a congenital malformation of the external ear that is associated with a range of functional, psychosocial, aesthetic, and financial burdens. The aim of this study was to analyze the epidemiology and postoperative complication profile of microtia reconstruction. METHODS A retrospective review was conducted using data from the 2012-2017 the American College of Surgeons National Quality Improvement Program Pediatric databases. Patients with a diagnosis of microtia or anotia were identified using International Classification of Diseases codes. Demographics and postoperative complications were analyzed using Chi-square and t tests for categorical and continuous variables, respectively. Multivariable regression was performed to control for confounding variables. RESULTS A total of 466 cases were analyzed, of which 290 (62.2%) were performed by plastic surgeons and 176 (37.8%) by otolaryngologists (ear, nose, and throat physicians [ENT]). Autologous reconstruction was the predominant approach [76.2% of cases (n = 355)] in this cohort. ENT physicians operated on a significantly younger patient population (mean age 8.4 ± 3.2 years versus 10.0 ± 3.2 years, P< 0.001) and had higher rates of concurrent atresia/middle ear repair [21.0% (n = 37) versus 3.7% (n = 17)] compared with plastic surgeons. The rate of all-cause complications was 5.9% (n = 17) in the plastic surgery cohort and 4.0% (n = 7) in the ENT cohort (P= 0.372). Multivariable regression did not reveal any statistically significant predictors for all-cause complications. CONCLUSIONS Reconstruction of the external ear for patients with microtia/anotia is a safe procedure, with low rates of postoperative complications, readmissions, and reoperations. Autologous reconstruction remains the preferred modality for repair of the external ear and simultaneous atresiaplasty/middle ear repair does not increase the risk of complications.
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Affiliation(s)
- Nicholas G. Cuccolo
- From the Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Mass
| | - Myrthe J. Zwierstra
- From the Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Ahmed M.S. Ibrahim
- From the Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Abbas Peymani
- Department of Plastic, Reconstructive and Hand Surgery, University of Amsterdam, Amsterdam, Netherlands
| | - Salim Afshar
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Mass
| | - Samuel J. Lin
- From the Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
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Michael AI, Jarrett OO. Parental views on plastic surgery for Down syndrome: an African perspective. Pan Afr Med J 2019; 32:207. [PMID: 31312319 PMCID: PMC6620072 DOI: 10.11604/pamj.2019.32.207.18316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 03/10/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction Plastic surgery for Down syndrome has not been embraced in sub-Saharan Africa. This study sought to determine the attitudes of some parents from sub-Saharan Africa to plastic surgery for their Down syndrome child. Methods Consenting parents completed a questionnaire survey instrument that obtained demographic characteristics and contained a likert scale on attitudes to plastic surgery. Internal consistency of the scale was determined with Chronbach's alpha and Pearsons chi square analysis was used to analyze relationships between demographic variables and attitudes scores. Values less than 0.05 were considered statistically significant. Results Most (61.9%) of the 42 consenting mothers were above 35 years of age. The most disturbing of the Down syndrome characteristics were the protruding tongue, 18(42.9%), slanting palpebral fissures, 14(33.3%) and the flattened nasal bridge 14(33.3%). Although the mothers had low awareness of plastic surgery most of them had favourable attitudes towards it. A reliability analysis of the mother's attitudes on the likert scale showed good internal consistency. Chronbachs alpha 0.87. Conclusion The parents in this study have favourable attitudes towards plastic surgery for Down syndrome. The prominent tongue was the most disturbing feature.
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Affiliation(s)
- Afieharo Igbibia Michael
- Department of Plastic, Reconstructive and Aesthetic Surgery, University, College Hospital, Ibadan, Oyo State, Nigeria
| | - Olumide Olatokunbo Jarrett
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Nigeria
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Nario-Redmond MR, Noel JG, Fern E. Redefining Disability, Re-imagining the Self: Disability Identification Predicts Self-esteem and Strategic Responses to Stigma. SELF AND IDENTITY 2013. [DOI: 10.1080/15298868.2012.681118] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Sobieszek D, Lewandowicz E, Iljin A. [New modification of Reynwald macroglossia reduction]. Otolaryngol Pol 2012; 65:423-7. [PMID: 22208939 DOI: 10.1016/s0030-6657(11)70735-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 08/24/2011] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Macroglossia usually occurs as isolated malformation, however it can coexist with some of the hereditary defect. Enlargement of the tongue can cause cosmetic and functional difficulties. AIM The aim of this paper was to analyzed patients with macroglossia operated with own modified Reynwald method. It was based on analysis of surgical treatment and rehabilitation of patients with: Down syndrome, oral-facial-digital syndrome and cerebral palsy, treated at the Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Lodz. MATERIAL AND METHODS 63 patients (32 females and 31 males) with Down syndrome (60), oral-facial-digital syndrome (2) and cerebral palsy (1) were operated at the Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Lodz, because of hypertrophy of the tongue. 42 patients were operated with partial resection of macroglossia, 2 of them with additional correction of the tongue border and 21 patients with own modified Reynwald method. RESULTS Postoperative treatment was non-complicated in all the patients. Early and long-lasting postoperative results were regard as satisfactory, and lead to improvement of basic physiological functions. CONCLUSIONS 1. 3–6 years are the optimal age to partial macroglossia reduction. 2. Analyze of surgical macroglossia treatment showed effectiveness of methods based on partial resection of tongue. Surgical treatment with own modified Reynwald method lead to increase of number of satisfied postoperative results. 3. Partial resection of macroglossia influence on patients look, integration and environment acceptance; in children with deep retardation it simplify nursing.
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Affiliation(s)
- Daria Sobieszek
- Klinika Chirurgii Plastycznej, Rekonstrukcyjnej i Estetycznej Uniwersytetu Medycznego w Łodzi.
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Abstract
In their role as committed advocates, parents of children with Down syndrome have always sought alternative therapies, mainly to enhance cognitive function but also to improve their appearance. Nutritional supplements have been the most frequent type of complementary and alternative therapy used. Cell therapy, plastic surgery, hormonal therapy, and a host of other therapies such as massage therapy have been used. There is a lack of well-designed scientific studies on the use of alternative therapies in individuals with Down syndrome. Antioxidants hold theoretical promise for treatment of the cognitive, immune, malignancy, and premature aging problems associated with Down syndrome. Medications for treatment of Alzheimer's disease may also result in benefit for the population of individuals with Down syndrome.
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Affiliation(s)
- Nancy J Roizen
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, New York 13210, USA.
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Horlock N, Vögelin E, Bradbury ET, Grobbelaar AO, Gault DT. Psychosocial outcome of patients after ear reconstruction: a retrospective study of 62 patients. Ann Plast Surg 2005; 54:517-24. [PMID: 15838214 DOI: 10.1097/01.sap.0000155284.96308.32] [Citation(s) in RCA: 148] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This was a retrospective study examining the psychosocial morbidity of patients before and after ear reconstruction. Semistructured questionnaires were sent to 90 patents with significant congenital or acquired auricular deformity 2.2 years (range 3 months to 5 years) following autogenous or osteointegrated reconstruction. Sixty-two patients (69%) responded. Twenty-two of the patients below 12 years, who had undergone reconstructive surgery, also completed the Childhood Experience Questionnaire. These were compared with a cohort of 362 normal patients. There was significant psychosocial morbidity in both children and adults with auricular deformity. Seventy-one percent of patients reported reduced self-confidence that affected both social life and leisure activity. Teasing was a prominent symptom in both children (88%) and adults (85%) but was a motivational factor for surgery in children only. Dissatisfaction with the appearance (73.1%), on the other hand, was the main reason for treatment in adults. Following ear reconstruction, 74% of adults and 91% of children reported an improvement in self-confidence resulting in enhanced social life and leisure activities in both adults and children. There was no difference between osteointegrated and autogenous reconstruction. Sixty percent of patients reported their result as excellent. The patients scored their result better than the surgeon. We conclude that auricular reconstruction has significant psychosocial benefit in the majority of children and adults despite donor-site morbidity and a range of technical result.
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Affiliation(s)
- Nigel Horlock
- Regional Centre for Plastic and Reconstructive Surgery, Mount Vernon Hospital, Northwood, Middlesex, UK
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Kay JB, Van Tubbergen M, Warschausky S, Buchman SR. Social Response in Children with Severe Cognitive Impairments: Factors in Craniofacial Surgery Decision-Making. Plast Reconstr Surg 2005; 116:408-16; discussion 417-8. [PMID: 16079665 DOI: 10.1097/01.prs.0000172679.15225.db] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The controversy over whether certain pediatric craniofacial operations primarily address "functional" versus "aesthetic" goals has fostered tensions among insurance companies, patients and families, and treatment teams. The authors posit that such operations have objectives and outcomes that can be categorized as "functionally aesthetic" and describe the empirical basis for this assertion. Furthermore, the authors apply this concept to the difficult surgical decision-making process associated with treating children with severe cognitive impairments. METHODS When patients have severe cognitive impairments, the social benefits of treatment may be less clear than for other patients, increasing the complexity of surgery decision-making. The authors discuss the nature of cognitive impairment, its prevalence in patients with craniofacial anomalies, links between social functioning and both cognitive development and appearance, and the importance of social integration for psychological and cognitive functioning. Special issues involved in working with cognitively impaired children are covered, including parent and patient expectations for surgical outcome and the difficulties involved in pain assessment and control. Potential linkages are described for craniofacial surgery, appearance, social functioning, and cognitive development. CONCLUSIONS A craniofacial operation directed at reconstruction of a congenital defect in a child should not be dismissed as simply and purely cosmetic. The authors document and outline the potential ethical issues and social and cognitive benefits that should be considered by insurance companies, patients and families, and treatment teams when determining treatment options for cognitively impaired children with craniofacial anomalies.
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Affiliation(s)
- Joshua B Kay
- Department of Physical Medicine and Rehabilitation, Craniofacial Anomalies Program, University of Michigan, Ann Arbor, Michigan, USA.
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Goeke J, Kassow D, May D, Kundert D. Parental opinions about facial plastic surgery for individuals with down syndrome. MENTAL RETARDATION 2003; 41:29-34. [PMID: 12597721 DOI: 10.1352/0047-6765(2003)041<0029:poafps>2.0.co;2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Facial plastic surgery is an intervention that some have proposed to improve the physical functioning, appearance, and social acceptance of individuals with Down syndrome. Our purpose in this study was to examine the opinions of parents of children with Down syndrome about this practice. Two hundred and fifty parents responded with usable surveys and were generally familiar with the practice, yet the majority of respondents did not support the surgery. The literature on this topic is reviewed, and related issues are discussed.
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Affiliation(s)
- Jennifer Goeke
- Graduate School of Education, 10 Seminary Place, Rutgers University, New Brunswick, NJ 08901, USA
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12
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Die-Trill M, Straker N. Psychological adaptation to facial disfigurement in a female head and neck cancer patient. Psychooncology 1992. [DOI: 10.1002/pon.2960010407] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Bradbury ET, Hewison J, Timmons MJ. Psychological and social outcome of prominent ear correction in children. BRITISH JOURNAL OF PLASTIC SURGERY 1992; 45:97-100. [PMID: 1562855 DOI: 10.1016/0007-1226(92)90165-t] [Citation(s) in RCA: 113] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The effectiveness of surgery to correct prominent ears in relieving the psychosocial distress of children has been analysed in this prospective study. 30 children and their families were assessed preoperatively and again 12 months postoperatively. It was found that whilst prominent ear correction improved the well-being of 90% of the children, there was a small group of acutely distressed children who remained dissatisfied with outcome. These were children who were socially isolated prior to surgery. Careful screening and referral back to the family doctor of the more distressed children is recommended.
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Affiliation(s)
- E T Bradbury
- Department of Plastic Surgery, St Luke's Hospital, Bradford
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Cunningham C, Turner S, Sloper P, Knussen C. Is the appearance of children with Down syndrome associated with their development and social functioning? Dev Med Child Neurol 1991; 33:285-95. [PMID: 1828444 DOI: 10.1111/j.1469-8749.1991.tb14879.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The appearance of 111 children with Down syndrome, aged six to 14 years, was rated by their class teachers as part of a larger study on factors associated with their development, social life-style and family functioning. There were no significant associations between measures of child development, communicative or independent functioning, social life, behaviour problems or with parental stress, parent-child relationships or quality of family life. Typical features of Down syndrome are not major correlates of development and social functioning, and no support could be found to justify routine cosmetic surgery aimed at ameliorating such features.
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Affiliation(s)
- C Cunningham
- Department of Mental Handicap, University of Nottingham
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Poole MD, Walters E, Beardsworth E, Griffiths P. Orbital dystopia: attempts to evaluate the results of surgery. BRITISH JOURNAL OF PLASTIC SURGERY 1991; 44:81-6. [PMID: 2018910 DOI: 10.1016/0007-1226(91)90036-j] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This study has shown that surgery for hypertelorism or vertical orbital dystopia gives very satisfying results overall to the patients and their families and leads to a modest but highly significant objective improvement in appearance after surgery, as perceived by panels of laymen or hospital staff not known to the patients. The complexities of the methodology of panel assessments of appearance are discussed. The results of this study confirm the need to go beyond our traditional methods of assessing surgical outcome simply within our specialty.
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Affiliation(s)
- M D Poole
- Oxford Craniofacial Unit, Radcliffe Infirmary
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Lefebvre AM, Arndt EM. Working with facially disfigured children: a challenge in prevention. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 1988; 33:453-8. [PMID: 3058283 DOI: 10.1177/070674378803300605] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This paper reviews the growing literature on the psychology of appearance and outlines prevention principles for working with facially disfigured children, based on 15 years of psychiatric consultation to a major pediatric craniofacial team.
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Affiliation(s)
- A M Lefebvre
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario
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Affiliation(s)
- S M Pueschel
- Child Development Center, Rhode Island Hospital, Providence
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