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Berton Q, Arrighi M, Barthélémy I, Garcier JM, Loit MP, Cambier S, Coll G. Reossification of Bone Defects After Surgical Correction of Nonsyndromic Craniosynostosis: A Review and An Original Study. Neurosurgery 2024:00006123-990000000-01045. [PMID: 38323819 DOI: 10.1227/neu.0000000000002854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/17/2023] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Surgical correction of nonsyndromic craniosynostosis (NSC) aims to restore cranial shape. Reossification of bone defects is paramount for the best aesthetic prognosis. However, the literature on the quantitative evaluation of bone defects after NSC surgery is scarce. This study aimed to quantify and analyze the surface area of bone defects after NSC surgery and establish a threshold value for predicting persistent defects. METHODS We conducted a systematic review and a prospective study of 28 children undergoing surgical treatment for NSC. We analyzed 426 defects on the first computed tomography scan (1 year postoperative) and 132 defects on the second computed tomography scan (4.6 years postoperative). Statistical analysis was performed using Spearman's rank correlation coefficient, Mann-Whitney-Wilcoxon rank-sum test, and Youden's J statistic. RESULTS Our systematic review identified three studies reporting on bone defects' surface area and reossification rate. In our study, we found no statistically significant differences in the number or size of defects between sex or type of NSC. The threshold value for the surface area of bone defects above which there was a higher probability of persistent defects was 0.19 cm2 (Youden point), with an 89.47 % probability of persistence. Defects with a surface area below 0.19 cm2 had a considerably lower probability, only 15.07%, of persistence over time. CONCLUSION Our study provides valuable quantitative data for managing bone defects after NSC surgery. Defects with a surface area above 0.19 cm2 should be monitored with radiological imaging because of the risk of persistence. Our findings highlight the importance of developing robust and reproducible methods for the quantitative analysis of bone defects after NSC surgery.
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Affiliation(s)
- Quentin Berton
- Department of Neurosurgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
- INSERM, CIC 1405, CRECHE Unit, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Marta Arrighi
- Department of Neurosurgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
- INSERM, CIC 1405, CRECHE Unit, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Isabelle Barthélémy
- Department of Maxillofacial Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Jean-Marc Garcier
- Service de Radiologie Infantiled'Imagerie Médicale, CHU Clermont-Ferrand, Clermont-Ferrand, France
- Institut Pascal, UMR 6602 CNRS SIGMA UCA, Clermont-Ferrand, France
| | - Marie-Pierre Loit
- Department of Neurosurgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Sébastien Cambier
- DRCI, Biostatistics Unit, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Guillaume Coll
- Department of Neurosurgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
- INSERM, CIC 1405, CRECHE Unit, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
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Martinez JDC, Tellez N, Gonzalez LV, López JP, Rodríguez-Sáenz Á, Orjuela MP, Torres I. Correlation Between Demographic Variables and Complications in Nonsyndromic Craniosynostosis. J Craniofac Surg 2023; 34:e341-e344. [PMID: 36503966 DOI: 10.1097/scs.0000000000009123] [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: 09/01/2022] [Accepted: 09/06/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE This retrospective cross-sectional, observational study aims to determine the correlation between demographic variables and nonsyndromic craniosynostosis. METHODS A cross-sectional study was carried out. The inclusion criteria were nonsyndromic craniosynostosis and the exclusion criteria were patients who did not have complete records. RESULTS The sample included 49 patients and mainly women. Patients with more than 4 days in the intensive care unit were related with more complications. Intracranial Hypertension was seen predominantly in patients between 6 and 8 months P =0007. CONCLUSION Some variables can modificate complications risk but future studies are needed to further investigate the influence of such variables on craniofacial care.
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Affiliation(s)
- Jose Del Carmen Martinez
- Pediatric and Craniomaxillofacial Surgery Service Hospital for Children and Adolescents of Morelense
| | - Nicolas Tellez
- Pediatric and Craniomaxillofacial Surgery Service Hospital for Children and Adolescents of Morelense
| | - Luis Vicente Gonzalez
- La Samaritana University Hospital
- Department of Oral Research, School of Dentistry, University Institution of Colleges of Colombia
| | - Juan Pablo López
- Fundación Santa Fe de Bogotá
- Oral and Maxillofacial Surgery program, El Bosque University
| | | | | | - Ivan Torres
- Pediatric and Craniomaxillofacial Surgery Service Hospital for Children and Adolescents of Morelense
- Craniomaxillofacial Surgery Service Hospital Regional de la Orinoquia, Colombia
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Which centers should be authorized to treat craniosynostosis? A plea for quality and not for quantity. Arch Pediatr 2023; 30:113-117. [PMID: 36509626 DOI: 10.1016/j.arcped.2022.11.021] [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: 05/17/2022] [Accepted: 11/20/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND In centers for craniosynostosis surgery, the volume of activity does not necessarily reflect the quality of the treatment. OBJECTIVE Our aim was to analyze a retrospective series of patients over a period of 6 years in a low-volume craniosynostosis surgery center, and to study indicators that reflect the quality of treatment. PATIENTS AND METHODS The analysis included all patients who underwent a craniofacial surgery for all forms of craniosynostosis during the period 2012-2017 (annual follow-up for 4 years). Data on the type of synostosis, sex, age, weight, type of surgery, duration of surgery, blood transfusion, postinterventional care, and total length of hospital stay were collected. Medical and surgical complications were recorded using the Leeds classification. RESULTS Overall, 42 patients (33 male; 23 cases of scaphocephaly, 13 cases of trigonocephaly, 4 cases of coronal plagiocephaly, 1 case of lambdoid plagiocephaly, and 1 case of brachycephaly) underwent craniofacial surgery with a median age of 7.4 months [4.8; 10.4] and a mean weight of 8.40 ± 1.92 kg at surgery. The median hospital stay was 7 days [6;7] with 1 day in the postinterventional care unit for 83% of patients. The global complication rate was 12% (95% CI: 4%-26%) with three minor cutaneous and two major (cardiovascular and septic) complications. CONCLUSION Complication rates reflect the quality of care in a center that treats craniosynostosis much more than do the number of procedures, mean hospital stay, and blood transfusion rates. It is essential to define new indicators capable of measuring the quality of life linked to surgical procedures and of using them to assess the competence of a center.
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One-piece fronto-orbital distraction osteogenesis without bandeau in patients with coronal craniosynostosis: A five-year follow-up retrospective study of 45 consecutive patients. J Craniomaxillofac Surg 2022; 50:884-893. [PMID: 36635150 DOI: 10.1016/j.jcms.2023.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 01/01/2023] [Accepted: 01/02/2023] [Indexed: 01/06/2023] Open
Abstract
This study aimed to review the surgical outcomes, complications, and long-term relapses in patients with unilateral or bilateral coronal craniosynostosis, who underwent one-piece fronto-orbital distraction osteogenesis (FODO) without bandeau. The cephalic index, frontal angle, and supraorbital symmetry ratio were measured on the initial and follow-up computed tomography images. Esthetic outcomes were evaluated using the Whitaker classification. 45 patients were included in this study. The average follow-up interval was 5.4 ± 1.1 years (range 2.5-8.5 years). In patients with bilateral coronal craniosynostosis, the frontal angle decreased with a relapse ratio of -2.8 ± 4.3% during long-term follow-up compared with that during short-term follow-up (p = 0.028). In patients with unilateral coronal craniosynostosis, the supraorbital symmetry ratio decreased slightly, with a relapse ratio of -3.8 ± 2.6% during long-term follow-up (p = 0.017). Complications included dural tears during osteotomy (n = 2), early distractor removal (n = 2), and wound problems (n = 3). Within the limitations of the study it seems that one-piece fronto-orbital distraction osteogenesis (FODO) generates successful and sustainable results even in the long term. Therefore, this treatment option should be considered for patients with unilateral and bilateral coronal craniosynostoses whenever appropriate.
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Millesi M, Preischer M, Reinprecht A. Do standard surgical techniques lead to satisfying aesthetic results in nonsyndromic sagittal suture synostosis? J Neurosurg Pediatr 2021; 28:502-507. [PMID: 34388704 DOI: 10.3171/2021.4.peds2166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/01/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Surgical correction of synostotic cranial sutures is typically performed early in an affected child's life. Depending on the severity of the cranial synostoses, different aspects of the surgical treatment may have varying degrees of importance. In this sense, the aesthetic appearance in children with normal neurological development in single-suture synostosis plays an important role in self-perception and social acceptance for both the patients themselves and their caregivers. Therefore, in this study, the authors aimed to evaluate the aesthetic outcome after surgical correction in a cohort of patients with nonsyndromic sagittal suture synostosis. METHODS Between December 2002 and December 2019, a total of 99 patients underwent surgical correction of a synostotic sagittal suture at the Medical University of Vienna. Depending on their age, patients underwent either an extended midline strip craniectomy (EMSC) (< 4 months) or a modified pi procedure (MPP) (≥ 4 months). After the surgical procedure, the outcome was evaluated by the treating neurosurgeon at 1- and 12-month follow-up visits, and after approximately 5 years, before the patient entered elementary school. In addition to that, the patients' caregivers were asked to evaluate the aesthetic outcome of the surgical procedure after 12 months. These results were then compared to evaluate potential differences in the perception of the surgical outcome. RESULTS After 12 months, the majority of the included patients were evaluated as having a good aesthetic outcome by the treating neurosurgeon (97%) and by their caregivers (89%). These differences did not show statistical significance (p = 0.11). Similarly, no differences in the aesthetic outcome depending on the surgical procedure performed could be found (p = 0.55). At the last follow-up visit, before entering elementary school, all available patients had an excellent or good surgical outcome. Moreover, the majority of caregivers (73%) reported that their child had a normal head shape appearance after surgical correction. CONCLUSIONS The results of this study have suggested that surgical correction of sagittal suture synostosis by simple operative techniques leads to a good aesthetic outcome and a normal head shape appearance in the majority of patients. An analysis of the evaluation of the surgical outcome by either the treating neurosurgeon or the patient caregivers showed comparable results and, thus, early intervention with simple surgical techniques can be recommended.
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Affiliation(s)
- Matthias Millesi
- Department of Neurosurgery, Medical University of Vienna, Austria
| | - Markus Preischer
- Department of Neurosurgery, Medical University of Vienna, Austria
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Hariri F, Farhana NA, Abdullah NA, Ibrahim N, Ramli NM, Mohd Abdullah AA, May CM, Khaliddin N. Optic canal characteristics in pediatric syndromic craniosynostosis. J Craniomaxillofac Surg 2021; 49:1175-1181. [PMID: 34247917 DOI: 10.1016/j.jcms.2021.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/28/2021] [Accepted: 06/22/2021] [Indexed: 10/21/2022] Open
Abstract
The aim of this study was to compare optic canal parameters of syndromic craniosynostosis patients with those of normal patients to visit the possibility of optic nerve impingement as a cause of visual impairment. Computed tomography scan images were processed using the Materialise Interactive Medical Image Control System (MIMICS) Research 21.0 software (Materialise NV, Leuven, Belgium). Eleven optic canal parameters were measured: 1) height of optic canal on the cranial side, 2) height of optic canal on the orbital side 3) length of the medial wall of the optic canal, 4) length of the lateral canal wall of the optic canal, 5) diameter of the optic canal at five points (Q1-Q4 and mid canal), and 6) area and perimeter of optic canal. These measurements were obtained for both the right and left optic canals. The study sample comprised four Crouzon syndrome, five Apert syndrome, and three Pfeiffer syndrome patients. The age of these syndromic craniosynostosis patients ranged from 2 to 63 months. The height of the optic canal on the orbital side (p = 0.041), diameter of the mid canal (p = 0.040), and diameter between the mid-canal and the cranial opening (Q3) (p = 0.079) for syndromic craniosynostosis patients were statistically narrower compared with those of normal patients when a significance level of 0.1 was considered. Scatter plots for the ages of patients versus the above parameters gave three separated clusters that suggested the arresting of optic canal development with age. The findings from this study demonstrated a narrowing of the optic canal in syndromic craniosynostosis patients, and indicate that optic canal anatomical characteristics may have an association with visual impairment among pediatric syndromic craniosynostosis patients.
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Affiliation(s)
- Firdaus Hariri
- Oro-Craniomaxillofacial Research and Surgical (OCReS) Group, Faculty of Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Nurul Aiman Farhana
- Oro-Craniomaxillofacial Research and Surgical (OCReS) Group, Faculty of Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Norli Anida Abdullah
- Mathematics Division, Centre for Foundation Studies in Science, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Norliza Ibrahim
- Oro-Craniomaxillofacial Research and Surgical (OCReS) Group, Faculty of Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Norlisah Mohd Ramli
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Azlindarita Aisyah Mohd Abdullah
- Department of Ophthalmology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia; Department of Ophthalmology, Faculty of Medicine, Universiti Teknologi MARA, 47000, Sungai Buloh, Selangor, Malaysia
| | - Choo May May
- Department of Ophthalmology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Nurliza Khaliddin
- Department of Ophthalmology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
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Julie CP, Pierre-Aurélien B, Mathieu D, Alexandru S, Carmine M, Christian P, Federico DR, Arnaud G. Is computer-assisted design and manufacturing technology useful in the surgical management of trigonocephaly? J Craniomaxillofac Surg 2021; 49:993-999. [PMID: 34187730 DOI: 10.1016/j.jcms.2021.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 04/15/2021] [Accepted: 06/05/2021] [Indexed: 11/18/2022] Open
Abstract
The aim of this study is to assess the usefulness of CAD/CAM technology in the surgical treatment of trigonocephaly compared to conventional surgical treatment. Children operated from trigonocephaly between 2017 and 2019 at the French Referral Center for craniosynostosis of Femme-Mère-Enfant Hospital of Lyon, France, were included and separated in two groups. Group 1 included children operated on trigonocephaly using CAD-CAM technology; Group 2 included children operated on trigonocephaly without CAD-CAM technology. Age, gender, duration of surgery, complications, blood transfusion and esthetic results were analyzed. The experience of the craniofacial surgeon was also evaluated and quantified in order to weigh the results. Twenty children were included in the study: 10 in the Group 1 and 10 in the Group 2. No statistical difference was observed between these 2 groups concerning the duration of the surgery (137 min ± 39,17 versus 137,2 min ± 64,50; p = 0,85), complications (20% in group 1 versus 10% in group 2; p = 1), the realization of blood transfusion (80% in group 1 versus 70% in group 2) and the esthetic results (5/5 in group 1 versus 4,6/5 in group 2; p = 0,21). However, the use of CAD-CAM technology significantly accelerates the duration of surgery by 25.8 min on average for the surgeon starting in craniofacial surgery (from 197,8 ± 10,21 min without CAD-CAM to 172 ± 18,76 min with CAD-CAM; p = 0.05) but significantly slows the experienced surgeon by 25.4 min on average (from 76,6 ± 8,65 min without CAD-CAM to 102 ± 6,2 min with CAD-CAM; p = 0.01). In the management of trigonocephaly, CAD/CAM technology seems to present a modest interest for the experienced surgeon but presents a real interest for the young surgeon. Within the limitations of the study, it seems that CAD/CAM technology is a relevant addition to the armamentarium of doctors who are in training because surgical time is reduced.
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Affiliation(s)
- Chauvel-Picard Julie
- Department of Pediatric Cranio-Maxillo-Facial Surgery, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677, Bron, France; Department of Cranio-Maxillo-Facial Surgery, Centre Hospitalo-Universitaire Nord, Avenue Albert Raimond, 42000, Saint-Etienne, France; Université Jean Monnet, 6 Rue Basse des Rives, 42100, Saint-Étienne, France.
| | - Beuriat Pierre-Aurélien
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677, Bron, France; Université Claude Bernard Lyon 1, 43 Boulevard Du 11 Novembre 1918, 69100, Villeurbanne, France
| | - Daurade Mathieu
- Department of Pediatric Cranio-Maxillo-Facial Surgery, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677, Bron, France; Université Claude Bernard Lyon 1, 43 Boulevard Du 11 Novembre 1918, 69100, Villeurbanne, France
| | - Szathmari Alexandru
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677, Bron, France
| | - Mottolese Carmine
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677, Bron, France
| | - Paulus Christian
- Department of Pediatric Cranio-Maxillo-Facial Surgery, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677, Bron, France
| | - Di Rocco Federico
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677, Bron, France; Université Claude Bernard Lyon 1, 43 Boulevard Du 11 Novembre 1918, 69100, Villeurbanne, France
| | - Gleizal Arnaud
- Department of Pediatric Cranio-Maxillo-Facial Surgery, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677, Bron, France; Department of Cranio-Maxillo-Facial Surgery, Centre Hospitalo-Universitaire Nord, Avenue Albert Raimond, 42000, Saint-Etienne, France; Université Jean Monnet, 6 Rue Basse des Rives, 42100, Saint-Étienne, France; Université Claude Bernard Lyon 1, 43 Boulevard Du 11 Novembre 1918, 69100, Villeurbanne, France
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Lu X, Forte AJ, Junn A, Dinis J, Alperovich M, Alonso N, Persing JA. Orbitofacial morphology changes with different suture synostoses in Crouzon syndrome. J Craniomaxillofac Surg 2021; 50:406-418. [DOI: 10.1016/j.jcms.2021.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 05/24/2021] [Accepted: 06/15/2021] [Indexed: 11/28/2022] Open
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Correlation between head shape and volumetric changes following spring-assisted posterior vault expansion. J Craniomaxillofac Surg 2021; 50:343-352. [DOI: 10.1016/j.jcms.2021.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 04/20/2021] [Accepted: 05/25/2021] [Indexed: 11/20/2022] Open
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Variations in Postoperative Management of Pediatric Open-Vault Craniosynostosis. J Craniofac Surg 2020; 32:305-309. [PMID: 32969932 DOI: 10.1097/scs.0000000000007094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
ABSTRACT Craniosynostosis is the premature fusion of 1 or more of the calvarial sutures causing a secondary distortion of the skull shape due to lack of growth perpendicular to the fused suture and compensatory overgrowth parallel to the suture. Open vault craniosynostosis repair requires extensive dissection and reshaping of the skull and can be associated with significant pain, commonly undervalued, and underreported in the pediatric cohort. Although there is an extensive body of literature focusing on the operative treatment of craniosynostosis, there is little consensus about optimal postoperative management protocols, including pain control regimens. The purpose of this study was to assess variation in immediate postoperative management protocols within the United States. A Qualtrics-based survey was submitted to all 112 American Cleft Palate-Craniofacial Association-approved craniofacial teams regarding their routine postoperative management protocol. Nineteen responses were obtained. All surgeons reported routine post-op intensive care unit stay. Mean overall length of stay was 3.5 days. Pain control agents included acetaminophen (100%), intravenous opioids (95%), oral opioids (79%), and ketorolac (53%). Eighty-eight percent of surgeons reported utilizing vital signs and observational parameters for pain assessment with 47% reporting the use of a formal pain scale. Sixty-three percent of those surveyed used a drain, 88% used a foley catheter, 75% used postoperative prophylactic antibiotics, and 75% routinely used arterial line monitoring postoperatively. The results of this survey will be the basis for future direction in understanding the efficacy of differing management protocols and further study of pain management in the pediatric craniosynostosis population.
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Osteoclastic craniectomy for scaphocephaly in infants results in physiological head shapes. J Craniomaxillofac Surg 2019; 47:1891-1897. [DOI: 10.1016/j.jcms.2019.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 09/14/2019] [Accepted: 10/27/2019] [Indexed: 11/21/2022] Open
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