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Wireko AA, Ahluwalia A, Ali SH, Shah MH, Aderinto N, Banerjee S, Roy S, Ferreira T, Tan JK, Berjaoui C, Guggilapu S, Quarshie LS, Bharadwaj HR, Adebusoye FT, Abdul-Rahman T, Atallah O. Insights into craniosynostosis management in low- and middle-income countries: A narrative review of outcomes, shortcomings and paediatric neurosurgery capacity. SAGE Open Med 2024; 12:20503121241226891. [PMID: 38249946 PMCID: PMC10798110 DOI: 10.1177/20503121241226891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/27/2023] [Indexed: 01/23/2024] Open
Abstract
Craniosynostosis, marked by premature cranial suture fusion, necessitates prompt intervention to avert developmental, neurological, and aesthetic issues. While high-income countries have advanced in managing this condition, low- and middle-income countries grapple with substantial healthcare access disparities. This narrative review explores current craniosynostosis management in low- and middle-income countries. The review focused on studies published between 2008 and 2023. The focus was neurosurgical outcomes, and the search utilised databases like PubMed, EMBASE, Google Scholar, the Cochrane Library and Scopus, incorporating specific keywords and phrases. An in-depth analysis of 21 included studies reveals noteworthy positive outcomes, including low mortality, successful corrections and sustained efficacy. These advancements stem from enhanced pre-operative strategies, surgical techniques and postoperative care. Nonetheless, challenges persist, encompassing complications, mortality, reoperations, and treatment disparities, particularly in low- and middle-income countries constrained by financial and expertise limitations. The enhancement of clinical practice and the formulation of effective policies in the future entail several key strategies. These include the reinforcement of specialised healthcare infrastructure and diagnostic capabilities, the ongoing training and retention of neurosurgeons, the improvement of funding mechanisms, and the promotion of equitable access. Additionally, a crucial focus is placed on fortifying paediatric neurosurgical care in low- and middle-income countries. The recommendations underscore the importance of collaborative initiatives, the development of specialised healthcare infrastructure, and the implementation of strategic policies to not only advance pediatric neurosurgical care but also to address existing gaps in management.
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Affiliation(s)
| | | | - Syed Hasham Ali
- Faculty of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Nicholas Aderinto
- Internal Medicine Department, Lautech Teaching Hospital, Ogbomosho, Nigeria
| | | | - Sakshi Roy
- School of Medicine, Queen’s University Belfast, Belfast, UK
| | - Tomas Ferreira
- Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | | | - Saibaba Guggilapu
- Faculty of Medicine, Bangalore Medical College and Research Institute, Bangalore, India
| | | | | | | | | | - Oday Atallah
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
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Burns HR, Wang DS, Abu-Ghname A, Dempsey RF. Craniofacial Distraction Osteogenesis. Semin Plast Surg 2023; 37:253-264. [PMID: 38098686 PMCID: PMC10718658 DOI: 10.1055/s-0043-1776298] [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
Distraction osteogenesis (DO) of the craniofacial skeleton has become an effective technique for the treatment of both nonsyndromic and syndromic conditions. The advent of craniofacial DO has allowed for earlier intervention in pediatric patients with less complication risk and morbidity compared to traditional techniques. In this review, we will discuss current application and technique for craniofacial DO by anatomical region and explore future applications in craniofacial surgery.
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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
| | - Daniel S. Wang
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Amjed Abu-Ghname
- 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
| | - Robert F. Dempsey
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
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Raposo-Amaral CE. Discussion: Comparison of Internal and External Distraction in Frontofacial Monobloc Advancement: A Three-Dimensional Quantification. Plast Reconstr Surg 2023; 152:623-627. [PMID: 37647375 DOI: 10.1097/prs.0000000000010538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Affiliation(s)
- Cassio Eduardo Raposo-Amaral
- From the Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital
- Department of Neurology, University of Campinas
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Rostamzad P, Pleumeekers MM, Versnel SL, Loudon SE. Effect of Midface Surgery on Ocular Outcomes in Patients with Orbital and Midface Malformations. J Clin Med 2023; 12:jcm12113862. [PMID: 37298056 DOI: 10.3390/jcm12113862] [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: 04/20/2023] [Revised: 05/26/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
(1) Background: Orbital and midface malformations occur in multiple craniofacial disorders. Depending on the deformity, surgical corrections include orbital box osteotomy (OBO), Le Fort III (LFIII), monobloc (MB), and facial bipartition (FB). The aim of this study was to determine the effect of these procedures on ocular outcomes. (2) Methods: A retrospective analysis was performed. All patients with craniofacial disorders who had previously undergone midface surgery were included. The Wilcoxon signed ranks test was used for statistical analysis. (3) Results: In total, 63 patients were included: two patients were treated by OBO, 20 by LFIII, 26 by MB, and 15 by FB. Pre-operatively, strabismus was present in 39 patients (61.9%), in whom exotropia was most common (n = 27; 42.9%), followed by esotropia (n = 11; 17.5%). Postoperatively, strabismus significantly worsened (p = 0.035) in the overall population (n = 63). Pre-operative binocular vision (n = 33) was absent in nine patients (27.3%), poor in eight (24.2%), moderate in 15 (45.5%), and good in one (3.0%). Postoperatively, binocular vision significantly improved (p < 0.001). Before surgery, the mean visual acuity (VA) in the better eye was 0.16 LogMAR (Logarithm of the Minimum Angle of Resolution), and 0.31 LogMAR in the worse eye. Furthermore, pre-operative astigmatism was present in 46 patients (73.0%) and hypermetropia in 37 patients (58.7%). No statistical difference was found for VA (n = 51; p = 0.058) postoperatively. (4) Conclusions: Midface surgery has a direct and indirect substantial effect on several ocular outcomes. This study emphasizes the importance of appropriate ophthalmological evaluation in patients with craniofacial disorders undergoing midface surgery.
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Affiliation(s)
- Parinaz Rostamzad
- Department of Plastic and Reconstructive Surgery, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Mieke M Pleumeekers
- Department of Plastic and Reconstructive Surgery, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Sarah L Versnel
- Department of Plastic and Reconstructive Surgery, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Sjoukje E Loudon
- Department of Ophthalmology, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands
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Raposo-Amaral CE, Ghizoni E, Raposo-Amaral CA. Apert Syndrome: Selection Rationale for Midface Advancement Technique. Adv Tech Stand Neurosurg 2023; 46:245-266. [PMID: 37318579 DOI: 10.1007/978-3-031-28202-7_13] [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: 06/16/2023]
Abstract
Apert syndrome is characterized by a wide spectrum of craniofacial clinical features that have been successfully addressed via a variety of midface advancement techniques. Although surgeons have individual preferences as to which specific procedures should be performed to best treat Apert patients, craniofacial plastic surgeons, working in tandem with pediatric neurosurgeons, can identify and evaluate functional limitations and facial morphologic disproportions, and establish appropriate criteria for effective midface advancement technique indication and selection. The purpose of this review article is to present and discuss our rationale for midface advancement technique selection based upon the most common craniofacial characteristics presented by Apert syndrome patients. The present article also provides a grading system that stratifies as major, moderate, and mild, the effect of each midface advancement technique on the different types of Apert syndrome facial features. Surgeons should take into consideration the maximum effect and benefit of each craniofacial osteotomy and how these procedures will alter the craniofacial skeleton. By understanding the long-term effect of each osteotomy on the most common craniofacial characteristics of Apert syndrome patients, craniofacial plastic surgeons and neurosurgeons will be able to customize the surgical procedures they perform in order to achieve the best possible outcomes.
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Affiliation(s)
- Cassio Eduardo Raposo-Amaral
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, São Paulo, Brazil
- Department of Neurology, University of Campinas (UNICAMP), São Paulo, Brazil
| | - Enrico Ghizoni
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, São Paulo, Brazil
- Department of Neurology, University of Campinas (UNICAMP), São Paulo, Brazil
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Chen K, Kondra K, Nagengast E, Hammoudeh JA, Urata MM. Syndromic Synostosis: Frontofacial Surgery. Oral Maxillofac Surg Clin North Am 2022; 34:459-466. [PMID: 35786530 DOI: 10.1016/j.coms.2022.03.001] [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: 10/17/2022]
Abstract
Frontofacial surgery, encompassing the monobloc with or without facial bipartition and the box osteotomy, can treat the frontal bone and midface simultaneously, providing comprehensive improvement in facial balance. Complex pediatric patients with genetic syndromes and craniosynostosis are most optimized by an interdisciplinary team of surgeons, pediatricians, geneticists, speech pathologists, audiologists, dietitians, pediatric dentists, orthodontists, and psychosocial support staff to manage the myriad of challenges and complications throughout early childhood and beyond. Despite early treatment of the anterior and posterior cranial vault, these patients frequently have resultant frontal and/or midface hypoplasia and orbital abnormalities that are best managed with simultaneous surgical treatment.
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Affiliation(s)
- Kevin Chen
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, 4650 West Sunset Boulevard, Mailstop 96, Los Angeles, CA 90027, USA
| | - Katelyn Kondra
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, 4650 West Sunset Boulevard, Mailstop 96, Los Angeles, CA 90027, USA
| | - Eric Nagengast
- Division of Plastic and Reconstructive Surgery, Keck Medicine of USC, 1520 San Pablo Street, Los Angeles, CA 90033, USA
| | - Jeffrey A Hammoudeh
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, 4650 West Sunset Boulevard, Mailstop 96, Los Angeles, CA 90027, USA; Division of Plastic and Reconstructive Surgery, Keck Medicine of USC, 1520 San Pablo Street, Los Angeles, CA 90033, USA; Herman Ostrow School of Dentistry, University of Southern California, 925 West 34th Street, Los Angeles, CA 90089, USA; Division of Oral and Maxillofacial Surgery, University of Southern California, 925 West 34th Street, Los Angeles, CA 90089, USA.
| | - Mark M Urata
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, 4650 West Sunset Boulevard, Mailstop 96, Los Angeles, CA 90027, USA; Division of Plastic and Reconstructive Surgery, Keck Medicine of USC, 1520 San Pablo Street, Los Angeles, CA 90033, USA; Herman Ostrow School of Dentistry, University of Southern California, 925 West 34th Street, Los Angeles, CA 90089, USA; Division of Oral and Maxillofacial Surgery, University of Southern California, 925 West 34th Street, Los Angeles, CA 90089, USA
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Udayakumaran S, Krishnadas A, Subash P. Robot-assisted frontofacial correction in very young children with craniofacial dysostosis syndromes: a technical note and early functional outcome. Neurosurg Focus 2022; 52:E16. [PMID: 34973669 DOI: 10.3171/2021.10.focus21515] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 10/19/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In this study, the authors aimed to 1) retrospectively analyze the early functional outcomes in a cohort of very young children with craniofacial dysostoses who underwent robot-assisted frontofacial advancement (RAFFA) or robot-assisted midface distraction (RAMD), and 2) analyze the utility of robotic assistance in improving the accuracy and safety of performing transfacial pin insertion for RAFFA or RAMD. METHODS A retrospective analysis of a cohort of 18 children (age range 1-42 months at presentation), who underwent RAFFA or RAMD from February 2015 to February 2021 in the craniofacial unit at Amrita Institute of Medical Sciences and Research Centre in Kochi, India, was performed. Inclusion criteria were patients who had undergone RAFFA in a single stage or RAMD where the cranial vault had been addressed earlier, had been addressed on follow-up, or had not been addressed and had follow-up of at least 6 months. RESULTS Overall, 18 children with syndromic craniosynostosis underwent LeFort level III midface distraction, with or without RAFFA, from February 2015 to February 2021 at a single center in India. The patients' ages ranged from 6 to 47 months at the time of the procedure. All patients had significant obstructive sleep apnea (OSA), significant ocular issues, and disturbed sleep as determined by the authors' preoperative protocol. Clinically significant intracranial pressure issues were present in 17 patients. None of the patients had injury due to the transfacial pin trajectory such as globe injury, damage to the tooth buds, or the loss of purchase during the active distraction phase. The mean distraction achieved was 23 mm (range 18-30 mm) (n = 16/18). Of the 18 patients, 10 (56%) had an excellent outcome and 6 (33%) had a satisfactory outcome. In all cases, the degree of OSA had significantly reduced after surgery. Eye closure improved in all patients, and complete closure was seen in 11 patients. On follow-up, the functional gain remained in 14 of 16 patients at the final follow-up visit. The distraction results were stable during the follow-up period (mean 36 months [range 6-72 months]). CONCLUSIONS The early RAFFA and RAMD protocols investigated in this study gave a significant functional advantage in very young patients with craniofacial dysostoses. The results have demonstrated the accuracy and safety of robotic assistance in performing transfacial pin insertion for RAFFA or RAMD.
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Affiliation(s)
- Suhas Udayakumaran
- 1Division of Paediatric Neurosurgery and Craniofacial Surgery, Department of Neurosurgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Viswa Vidyapeetham, Kochi, Kerala; and
| | - Arjun Krishnadas
- 2Division of Craniomaxillofacial Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Viswa Vidyapeetham, Kochi, Kerala, India
| | - Pramod Subash
- 2Division of Craniomaxillofacial Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Viswa Vidyapeetham, Kochi, Kerala, India
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