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Kurniawan MS, van de Beeten SD, Raat H, Mathijssen IMJ, Dirven CM, van Veelen MLC. Health-related Quality of Life in Children and Adolescents With Sagittal Synostosis. J Craniofac Surg 2023; 34:2284-2287. [PMID: 37681989 PMCID: PMC10597426 DOI: 10.1097/scs.0000000000009733] [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: 07/06/2023] [Accepted: 07/30/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND This study evaluated the health-related quality of life (HR-QoL) in patients with sagittal synostosis (SS), and the influence of frequent headaches and surgical techniques on the HR-QoL. METHOD Patients with SS aged 8 to 18 years were invited to participate between June 2016 and February 2017. The Child Health Questionnaire was used to assess the HR-QoL. A detailed questionnaire was used to assess the severity of headache symptoms. The control group consisted of 353 school children aged 5 to 14 years. RESULTS In all, 95 parents of patients with SS were invited to participate, of whom 68 (71.6%) parents completed the CHQ-PF50. The mean age of the participating patients was 12.4 years (10.8 to 14.2). The Psychosocial- and Physical summary of the patients with SS was similar to the general population. In the distinct CHQ scales, "Family cohesion" ( P =0.02) was higher, and "Mental health" ( P =0.05) was lower compared with the general population. The type and timing of surgery did not affect the HR-QoL. Thirty-two patients (47.1%) reported having headache complaints at least once a month. The CHQ scores of SS patients with frequent headaches had a significantly lower score of mild to large effect than those without headaches. CONCLUSION Patients with SS have a slightly lower to similar HR-QoL compared with the general population. In all, 47.1% of SS patients have frequent headaches, resulting in lower average HR-QoL. The type and timing of surgery did not affect the results. Clinicians should be aware of lower HR-QoL in some subgroups of patients with SS.
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Affiliation(s)
| | | | - Hein Raat
- Department of Public Health, Erasmus University Medical Center Rotterdam, The Netherlands
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Kumari K, Saleh I, Taslim S, Ahmad S, Hussain I, Munir Z, Javed T, Virk MFI, Javed S, Bisharat P, Ur Rehman U. Unraveling the Complexity of Apert Syndrome: Genetics, Clinical Insights, and Future Frontiers. Cureus 2023; 15:e47281. [PMID: 38021759 PMCID: PMC10656109 DOI: 10.7759/cureus.47281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Apert syndrome (AS), also known as type I acrocephalosyndactyly, is a rare congenital condition characterized by craniosynostosis resulting from missense mutations in the fibroblast growth factor receptor 2 (FGFR2) gene. This comprehensive review delves into AS, covering its clinical manifestations, genetics, diagnosis, medical management, psychosocial considerations, and future research directions. AS presents with distinct features, including a brachycephalic skull, midface hypoplasia, and limb anomalies such as syndactyly. It follows an autosomal dominant inheritance pattern with mutations in the FGFR2 gene. Prenatal diagnosis is possible through advanced imaging techniques and molecular testing. The multidisciplinary approach to AS management involves surgical interventions, orthodontics, and psychological support. Although no curative treatment exists, early interventions can significantly improve function and aesthetics. The quality of life for AS patients is influenced by psychosocial factors, necessitating comprehensive support for both patients and their families. Future research directions include gene therapy, understanding cellular responses to FGFR2 mutations, and addressing genetic heterogeneity. Collaborative efforts are vital to advancing knowledge about AS and its genetic underpinnings. Overall, this review serves as a valuable resource for healthcare professionals, educators, and researchers, contributing to a deeper understanding of AS and facilitating advancements in diagnosis and treatment.
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Affiliation(s)
- Kajol Kumari
- Dentistry, Jinnah Sindh Medical University, Karachi, PAK
| | - Inam Saleh
- Paediatrics, University of Kentucky College of Medicine, Lexington, USA
| | - Sanzida Taslim
- Psychiatry, Ross University School of Medicine, Bridgetown, BRB
| | - Sana Ahmad
- Psychiatry, TIME Organization, Inc., Baltimore, USA
| | - Iqbal Hussain
- Internal Medicine, Khyber Medical University, Peshawar, PAK
- Internal Medicine, Lady Reading Hospital, Peshawar, PAK
| | - Zainab Munir
- Emergency Department, Imran Idrees Teaching Hospital, Sialkot, PAK
| | - Tamleel Javed
- Emergency Department, Imran Idrees Teaching Hospital, Sialkot, PAK
| | | | - Saleha Javed
- Emergency Department, Sheikh Zayed Hospital, Rahim Yar Khan, PAK
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Raposo-Amaral CE, Menezes PT, Lemes MV, Medeiros ML, Raposo-Amaral CA, Ghizoni E. Facial Fat Graft Injection Reduces Asymmetry and Improves Forehead Contour in Early Infancy Apert Syndrome Patients. J Craniofac Surg 2023; 34:1934-1937. [PMID: 37594030 DOI: 10.1097/scs.0000000000009610] [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: 06/19/2023] [Accepted: 07/16/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND The objective of this study is to report the outcomes of a modified comprehensive Apert syndrome surgical protocol in which fat injection was performed during early infancy concurrent with postposterior vault distraction osteogenesis (PVDO) distractor removal. METHODS A retrospective study was performed on 40 consecutive young patients with Apert syndrome who underwent PVDO and subsequent distractor removal between 2012 and 2022. Of these 40 patients, 12 patients underwent facial fat injection concurrent with distractor removal to treat residual supraorbital bar recession as part of a modified comprehensive Apert syndrome surgical protocol. Preoperative and postoperative severity of recession and irregularity was graded from 1 to 3, with 1 being less severe and 3 being the most severe. Recession severity was correlated with the number and type of suture fusion. The complication rate was stratified via a Clavien-Dindo scale. RESULTS The average patient age was 14.3±5 months, with 5 males (41.6%) and 7 females (48.3%). The average hospital stay was 1.08 days. The average volume of free fat graft injection was 8.29±5 mL. According to the Likert scale, forehead morphology improved in 91.67% of the patients. Complete resolution of supraorbital bar recession was achieved in seven patients (58.33%), all of whom presenting a single suture synostosis. One patient with a cloverleaf skull presented a type IIIB complication. CONCLUSIONS Facial fat grafting markedly reduces forehead asymmetry and improves forehead contour in Apert syndrome patients following PVDO. Total resolution of forehead recession directly correlated with a single suture fusion.
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Affiliation(s)
- Cassio E Raposo-Amaral
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, São Paulo, Brazil
- Division of Neurosurgery, University of Campinas (UNICAMP), São Paulo, Brazil
| | - Priscila T Menezes
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, São Paulo, Brazil
| | - Marcela V Lemes
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, São Paulo, Brazil
| | - Mateus L Medeiros
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, São Paulo, Brazil
| | - Cesar A Raposo-Amaral
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, São Paulo, Brazil
| | - Enrico Ghizoni
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, São Paulo, Brazil
- Division of Neurosurgery, University of Campinas (UNICAMP), São Paulo, Brazil
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Stock NM, Costa B, Wilkinson-Bell K, Culshaw L, Kearney A, Edwards W. Psychological and Physical Health Outcomes in Adults With Craniosynostosis. Cleft Palate Craniofac J 2023; 60:257-267. [PMID: 34866454 PMCID: PMC9900192 DOI: 10.1177/10556656211059966] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES Within current research, little is known about the long-term outcomes of craniosynostosis. A priority-setting exercise by UK charity Headlines Craniofacial Support identified 2 key questions in this area: (1) What are the long-term physical and psychological effects for individuals with syndromic and non-syndromic craniosynostosis? and (2) Are individuals with craniosynostosis likely to suffer from mental health difficulties, or are they more resilient? The aim of the current study was to conduct an initial investigation of these priority questions. METHODS A comprehensive UK-wide survey consisting of 9 standardized psychological outcome measures and open-ended questions was distributed online. Thirty-six eligible adults (69.4% female) with a mean age of 30.8 years responded to the survey. Participants reported having single suture craniosynostosis (27.8%) or syndromic craniosynostosis (52.8%), with 19.4% being unsure of their diagnosis. Sample means were compared to published norms using independent samples t tests. Qualitative responses were analysed using inductive content analysis. RESULTS Compared to the general population, participants reported significantly less favorable scores related to appearance concerns, attachment in adult relationships, anxiety, optimism, and resilience. Self-worth, depression, and social anxiety scores were similar to norms. Qualitative responses provided additional insight into participants' satisfaction with appearance, physical health, medical treatment, employment, relationships, and recurrence risks. Few participants had accessed psychological support. DISCUSSION This preliminary study illustrates the potential long-term implications for individuals with craniosynostosis. Improved treatment protocols are needed to address physical health concerns in adulthood, while dedicated psychological resources are necessary to promote emotional well-being, social confidence, and resilience.
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Affiliation(s)
- Nicola Marie Stock
- Centre for Appearance Research, University of the West of England,
Coldharbour Lane, Bristol, United Kingdom
- Nicola Marie Stock, Centre for Appearance
Research, University of the West of England, Bristol BS16 1QY, United Kingdom.
| | - Bruna Costa
- Centre for Appearance Research, University of the West of England,
Coldharbour Lane, Bristol, United Kingdom
| | | | - Laura Culshaw
- Alder Hey Craniofacial Unit, Alder Hey Children's NHS Foundation
Trust, Liverpool, United Kingdom
| | - Anna Kearney
- Alder Hey Craniofacial Unit, Alder Hey Children's NHS Foundation
Trust, Liverpool, United Kingdom
| | - Wendy Edwards
- Headlines Craniofacial Support, St Albans, Hertfordshire, United
Kingdom
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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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Park KM, Tripathi NV, Mufarrej FA. Quality of life in patients with craniosynostosis and deformational plagiocephaly: A Systematic Review. Int J Pediatr Otorhinolaryngol 2021; 149:110873. [PMID: 34380097 DOI: 10.1016/j.ijporl.2021.110873] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/30/2021] [Accepted: 08/05/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Craniosynostosis is a bony dysmorphism of the calvarium due to premature suture fusion and is classified as syndromic (part of congenital syndrome) or nonsyndromic (isolated). Deformational plagiocephaly (DP) is due to external positional forces on the skull after birth. This review aims to investigate the various quality of life (QoL) metrics across syndromic, nonsyndromic and DP patients. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a literature search was done through EMBASE, MEDLINE, PubMed and Web of Science. After two stages of screening by two authors, seventeen articles met inclusion criteria; 11 on syndromic, 4 nonsyndromic, and 2 DP. RESULTS The literature suggests syndromic patients have more severe consequences on QoL, especially on psychological well-being, social functioning, and obstructive sleep apnea (OSA), leading to behavioral difficulties. Nonsyndromic patients show a less clear trend across QoL measures, but a majority stated QoL is comparable to the general population. DP patients noted motor development and QoL improvement as well as improved subjective aesthetic outcomes after orthotic helmet molding therapy (HMT). CONCLUSIONS While a majority of literature classifies QoL in syndromic craniosynostosis alone, this review highlights the importance of these factors in nonsyndromic craniosynostosis and plagiocephaly patients. Psychological well-being, social functioning, and secondary health impacts such as OSA are important to consider in comprehensive craniofacial care in all calvaria deformities.
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Affiliation(s)
- Kelley M Park
- Wayne State University School of Medicine, Detroit, MI, USA
| | | | - Faisal Al- Mufarrej
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Wayne State University, Detroit, MI, USA
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Raposo-Amaral CE, Oliveira YM, Denadai R, Raposo-Amaral CA, Ghizoni E. Severe craniolacunae and upper and lower extremity anomalies resulting from Crouzon syndrome, FGFR2 mutation, and Ser347Cys variant. Childs Nerv Syst 2021; 37:2391-2397. [PMID: 33404724 DOI: 10.1007/s00381-020-04993-w] [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: 08/03/2020] [Accepted: 11/30/2020] [Indexed: 02/05/2023]
Abstract
Crouzon syndrome is a rare form of syndromic craniosynostosis (SC) characterized by premature fusion of the cranial and facial sutures, elevated intracranial pressure, varying degrees of ocular exposure due to exorbitism, and airway compromise caused by midface retrusion. Craniolacunae and upper and lower extremity anomalies are not frequently found in Crouzon syndrome. We present a girl with Crouzon syndrome caused by c.1040 C > G, p.Ser347Cys, a pathogenic mutation in the FGFR2 gene with atypical characteristics, including craniolacunae resembling severe Swiss cheese type of bone formation, and upper and lower extremity anomalies which are more commonly associated with Pfeiffer syndrome patients. Distinguishing between severe Crouzon syndrome patients and patients who have mild and/or moderate Pfeiffer syndrome can be challenging even for an experienced craniofacial surgeon. An accurate genotype diagnosis is essential to distinguishing between these syndromes, as it provides predictors for neurosurgical complications and facilitates appropriate family counseling related to long-term outcomes.
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Affiliation(s)
- Cassio Eduardo Raposo-Amaral
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Av. Adolpho Lutz, 100, Caixa Postal: 6028, Campinas, São Paulo, 13084-880, Brazil. .,Department of Neurology, University of Campinas (UNICAMP), São Paulo, Brazil.
| | - Yuri Moresco Oliveira
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Av. Adolpho Lutz, 100, Caixa Postal: 6028, Campinas, São Paulo, 13084-880, Brazil
| | - Rafael Denadai
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Av. Adolpho Lutz, 100, Caixa Postal: 6028, Campinas, São Paulo, 13084-880, Brazil
| | - Cesar Augusto Raposo-Amaral
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Av. Adolpho Lutz, 100, Caixa Postal: 6028, Campinas, São Paulo, 13084-880, Brazil
| | - Enrico Ghizoni
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Av. Adolpho Lutz, 100, Caixa Postal: 6028, Campinas, São Paulo, 13084-880, Brazil.,Department of Neurology, University of Campinas (UNICAMP), São Paulo, Brazil
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Raposo-Amaral CE, Vieira PH, Denadai R, Ghizoni E, Raposo-Amaral CA. Treating Syndromic Craniosynostosis with Monobloc Facial Bipartition and Internal Distractor Devices: Destigmatizing the Syndromic Face. Clin Plast Surg 2021; 48:521-529. [PMID: 34051903 DOI: 10.1016/j.cps.2021.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Monobloc and facial bipartition combined with distraction osteogenesis (MFBDO) has gained popularity over the past several years as a treatment of syndromic craniosynostosis, in part because this surgical technique effectively removes many stigmatic clinical features associated with the syndromic face. The objective of this study is to detail the surgical planning used to achieve medialization of the orbits and describe the authors' experience using MFBDO to destigmatize the syndromic face. By using MFBDO, hypertelorism, vertical orbital dystopia, and downslanting of the palpebral fissure were surgically corrected in all patients, thereby destigmatizing the syndromic face.
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Affiliation(s)
- Cassio Eduardo Raposo-Amaral
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Av Adolpho Lutz, 100, Caixa Postal: 6028, Campinas, São Paulo 13084-880, Brazil; Department of Neurology, University of Campinas (UNICAMP), São Paulo, Brazil.
| | - Pedro Henrique Vieira
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Av Adolpho Lutz, 100, Caixa Postal: 6028, Campinas, São Paulo 13084-880, Brazil
| | - Rafael Denadai
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Av Adolpho Lutz, 100, Caixa Postal: 6028, Campinas, São Paulo 13084-880, Brazil
| | - Enrico Ghizoni
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Av Adolpho Lutz, 100, Caixa Postal: 6028, Campinas, São Paulo 13084-880, Brazil; Department of Neurology, University of Campinas (UNICAMP), São Paulo, Brazil
| | - Cesar Augusto Raposo-Amaral
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Av Adolpho Lutz, 100, Caixa Postal: 6028, Campinas, São Paulo 13084-880, Brazil
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Long-Term Morphologic Changes on Sagittal Synostosis Patients Who Underwent a Modified Pi Technique. J Craniofac Surg 2020; 32:55-57. [PMID: 32833834 DOI: 10.1097/scs.0000000000006843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND There are paucity of studies focused on the long-term assessment of the craniofacial changes after a pi-plasty procedure and self-reported quality of life outcomes. Thus, this study aimed to assess long-term morphologic changes and quality of life of patients with sagittal synostosis who underwent surgery with a modified pi-plasty. METHODS Consecutive patients with sagittal synostosis who underwent surgery and had more than 5 years of follow-up and standard preoperative and 1, 3, and 5 years right profile view photographs were included. Nasofrontal angle and angle of total facial convexity were evaluated using computerized photogrammetric measurements. Additionally, quality of life outcome was evaluated by the Quality of Life Scale Short Form. RESULTS The total facial convexity angle and nasofrontal angle increased significantly (P < 0.05), with a P-value of 0.013 and 0.012, respectively. Patients had quality of life scores >80 in all of the 4 domains, with the highest scores being: physical health domain 80.0 ± 0, psychologic domain 85.0 ± 5, social relationships domain 86.6 ± 0, and environmental domain 98.13 ± 2.42. CONCLUSION Facial angles significantly changed over 5 years of follow-up. Self-reported quality of life instrument showed that patients are satisfied with their own appearance, contributing positively to their quality of life.
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Raposo-Amaral CE, Denadai R, Máximo G, Raposo-Amaral CA, Ghizoni E. Pfeiffer Syndrome: A Therapeutic Algorithm Based on a Modified Grading Scale. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2788. [PMID: 32440448 PMCID: PMC7209848 DOI: 10.1097/gox.0000000000002788] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 02/26/2020] [Indexed: 02/05/2023]
Abstract
Background: Pfeiffer syndrome (PS) is a very rare condition with a wide clinical spectrum. There are only a few studies that address the classification and treatment of PS and take into account the most commonly presented clinical features. Thus, the objectives of this study are to propose an algorithm for PS management based on a modified severity scale and correlate PS severity with tracheostomy placement. Methods: An observational retrospective study was performed on consecutive patients with PS (n = 12), who underwent surgery between 2008 and 2018. Clinical features and findings of all included patients with PS were classified as types A, B, and C, which guided treatment workflow. The Fisher test was used to correlate the severity of patients with PS with tracheostomy placement. Results: There were 12 patients, classified as type A (n = 3), type B (n = 6), and type C (n = 3). All patients who received tracheostomies (n = 6) were stratified into the severe category (n = 9; types B and C) (P < 0.05). There were 4 minor complications, and 1 major complication according to a modified Clavien–Dindo surgical complication scale. Conclusion: A treatment algorithm based on the 3 different Pfeiffer types was proposed. Severity of PS statistically correlates to tracheostomy placement.
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Affiliation(s)
- Cassio Eduardo Raposo-Amaral
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, São Paulo, Brazil.,Department of Neurology, University of Campinas (UNICAMP), São Paulo, Brazil
| | - Rafael Denadai
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, São Paulo, Brazil
| | - Geiza Máximo
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, São Paulo, Brazil
| | | | - Enrico Ghizoni
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, São Paulo, Brazil.,Department of Neurology, University of Campinas (UNICAMP), São Paulo, Brazil
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Bous RM, Hazen RA, Baus I, Palomo JM, Kumar A, Valiathan M. Psychosocial Adjustments Among Adolescents With Craniofacial Conditions and the Influence of Social Factors: A Multi-Informant Study. Cleft Palate Craniofac J 2019; 57:624-636. [PMID: 31769310 DOI: 10.1177/1055665619888308] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Previous studies have investigated psychosocial adjustments among adolescents with cleft lip and/or palate (CL/P), but our understanding of other craniofacial conditions remains limited. The objective of this study is to compare psychosocial adjustments among 3 groups of adolescents: craniofacial conditions other than cleft lip and/or palate (craniofacial anomaly [CFA]), CL/P, and controls (CON). Our secondary objective is to examine how social factors may predict the adjustments levels. DESIGN Cross-sectional, multi-informant, controlled survey study. PARTICIPANTS Aged 11- to 17-year olds. Craniofacial anomaly (n = 49), isolated CL/P (n = 42), and 55 CON. Total = 146. OUTCOME MEASURES The Strengths and Difficulties Questionnaire (self-report, parent report, and teacher report). RESULTS All 3 informant groups displayed similar patterns, where CFA reported the highest difficulties, followed by CL/P, while CON scored the lowest. Parent reports demonstrated significant differences among the 3 groups for most subscales and were emphasized for peer problems. Self-reports showed significant differences between CFA and CON for total scores and peer problems, while teacher reports showed significant differences for peer problems only. Craniofacial anomaly displayed the highest frequency of abnormal psychosocial adjustments, followed by CL/P. Experiencing bullying or teasing predicted increased difficulties, while having a good friend predicted decreased difficulties. CONCLUSIONS Adolescents with CFA, and to a lesser extent CL/P, may be at a higher risk of having psychosocial problems. Peer problems may constitute the biggest challenge that CFA and CL/P confront. Social factors, especially being bullied or having a good friend, may predict the psychosocial well-being of adolescents with craniofacial conditions.
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Affiliation(s)
- Rany M Bous
- Craniofacial, Surgical and Special Care Orthodontics Fellowship Program, Department of Orthodontics, School of Dental Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Rebecca A Hazen
- Departments of Pediatrics and Psychology, Case Western Reserve University School of Medicine.,Division of Developmental/Behavioral Pediatrics and Psychology, Rainbow Babies and Children's Hospital, University Hospital's Cleveland Medical Center, Cleveland, OH, USA
| | - Irene Baus
- Cleft and Craniofacial Center, Rainbow Babies and Children's Hospital, University Hospital's Cleveland Medical Center, Cleveland, OH, USA
| | - J Martin Palomo
- Department of Orthodontics, School of Dental Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Anand Kumar
- Department of Pediatric Plastic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Department of Plastic Surgery, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Manish Valiathan
- Craniofacial, Surgical and Special Care Orthodontics Fellowship Program, Department of Orthodontics, School of Dental Medicine, Case Western Reserve University, Cleveland, OH, USA
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Hand Function in Apert Syndrome. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2230. [PMID: 31333957 PMCID: PMC6571343 DOI: 10.1097/gox.0000000000002230] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 03/05/2019] [Indexed: 02/05/2023]
Abstract
Background: The Michigan Hand Questionnaire is widely used to assess hand outcomes in congenital hand deformities. The purpose of the present study is to compare Apert syndrome hand outcomes according to Upton hand type and age stratification with age-matched unaffected controls. Methods: The Brief Michigan Hand Questionnaire was administered to 39 Apert patients after completion of the digit separation surgical regimen, and 140 age-matched unaffected controls. Patients were divided into 3 groups according to age. In group 1 (from 4 months to 7 years of age), responses were provided by parents of Apert patients, and in group 2 (from 8 to 17 years of age), patients responded with assistance from their parents, and in group 3 (18 years of age or older), responses were provided by the patients themselves. Groups were substratified according to Upton hand type (type I, II, and III). Comparisons were made among groups, subgroups, and controls. Results: Comparisons of hand types for intragroups 1, 2, and 3, did not demonstrate any statistically significant differences (P > 0.05) between hand outcomes according to Upton hand type, regardless of patient age. Comparisons between Apert patients and their age-matched controls demonstrated statistically significant differences (P < 0.05), as the control group had higher outcome scores. Conclusions: Similar hand outcomes scores were achieved by all Apert patients regardless of hand type. Following completion of the digit separation regimen, Apert patients presented hand outcome scores that were lower than those of the patients in the normative control group.
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Long-Term Functional Upper-Extremity Outcomes in Adults with Apert Syndrome. Plast Reconstr Surg 2019; 143:1136-1145. [DOI: 10.1097/prs.0000000000005479] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Raposo-Amaral CE, Denadai R, Furlan P, Raposo-Amaral CA. Treatment of Apert Hand Syndrome. Plast Reconstr Surg 2018; 142:972-982. [PMID: 29994846 DOI: 10.1097/prs.0000000000004815] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Patient-Reported Quality of Life in the Highest Functioning Patients With Treacher Collins Syndrome. J Craniofac Surg 2018; 29:1430-1433. [PMID: 29570515 DOI: 10.1097/scs.0000000000004522] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Treacher Collins syndrome has a wide variation of clinical presentation, including airway obstruction and hearing loss. The objective of this study was to assess patient-rated quality of life in Treacher Collins syndrome, who received multidisciplinary treatment at a specialized craniofacial hospital, and to compare their quality of life with a control sample. METHODS Treacher Collins patients under treatment in a multidisciplinary setting were assessed with the World Health Organization Quality of Life (WHOQOL-100) questionnaire. The Siviero scale was used to classify quality of life as unsatisfactory (scores below 25), intermediate (scores between 25 and 75), and satisfactory (scores above 75). Quality of life comparison between Treacher Collins patients and 2342 unaffected individuals from a previous database was performed using the analysis of variance test. Differences were considered significant at P < 0.05. RESULTS Treacher Collins patients demonstrated an overall intermediate and satisfactory (score >60%) quality of life in almost all WHOQOL-100 facets and domains. The comparison of the scores between unaffected individuals and Treacher Collins patients demonstrated a significant difference (P < 0.05) in the environment domain. CONCLUSION The highest functioning Treacher Collins syndrome patients under multidisciplinary treatment presented intermediate and satisfactory quality of life, consistent with quality of life scores of unaffected controls. In the environment domain, Treacher Collins patients presented even higher scores of quality of life than the control group. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Raposo-Amaral CE, Denadai R, Ghizoni E, Raposo-Amaral CA. Surgical Strategies for Soft Tissue Management in Hypertelorbitism. Ann Plast Surg 2017; 78:421-427. [PMID: 27740959 DOI: 10.1097/sap.0000000000000915] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Feragen KB, Stock NM. Psychological adjustment to craniofacial conditions (excluding oral clefts): A review of the literature. Psychol Health 2016; 32:253-288. [PMID: 27925479 DOI: 10.1080/08870446.2016.1247838] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE A congenital craniofacial anomaly (CFA) is expected to impact upon several domains of psychological, emotional and social functioning, yet no recent reviews have comprehensively summarised the available literature. Further, existing reviews tend to draw upon literature in the field of cleft lip and palate, and do not give substantive attention to other types of CFAs. DESIGN A review of 41 papers published between January 2000 and March 2016 pertaining to psychological adjustment to CFAs. MAIN OUTCOME MEASURES Findings are presented according to key psychological domains: General Psychological Well-being, Quality of Life, Behaviour, Emotional Well-being, Social Experiences, Appearance, and Treatment-Related Experiences. RESULTS Current literature offers a contradictory picture of adjustment to CFAs. Psychological adjustment appeared to be comparable to norms and reference groups in approximately half of the papers related to non-syndromic CFAs, while more variation was found across domains among samples with syndromic CFAs. Associations were found between adjustment, physical health and cognitive function in several papers. The review identified a number of gaps in the literature, such as the inclusion of a wide range of diagnoses within research samples. CONCLUSIONS This review demonstrates the complexity of findings, both within and across domains, and highlights a number of methodological challenges.
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Affiliation(s)
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- b Centre for Appearance Research , University of the West of England , Bristol , UK
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The Quality of Life in Adult Patients With Syndromic Craniosynostosis From Their Perspective. J Craniofac Surg 2016; 27:1510-4. [DOI: 10.1097/scs.0000000000002886] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Residents’ Perceptions of Plastic Surgeons as Craniofacial Surgery Specialists. J Craniofac Surg 2015; 26:2334-8. [PMID: 26501970 DOI: 10.1097/scs.0000000000002081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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A subcranial Le Fort III advancement with distraction osteogenesis as a clinical strategy to approach pycnodysostosis with midface retrusion and exorbitism. J Craniofac Surg 2015; 24:1327-30. [PMID: 23851800 DOI: 10.1097/scs.0b013e31829978a5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Pycnodysostosis is a rare autosomal recessive skeletal disorder involving a constellation of craniofacial manifestations including midface retrusion. We report the case of a 13-year-old girl with pycnodysostosis who presented with exorbitism, midface retrusion, malocclusion, and obstructive sleep apnea. Here, we describe the successful use of subcranial Le Fort III advancement using distraction osteogenesis with internal Kawamoto distracters. After a latency of 5 days, distraction for 10 days, and consolidation for 12 weeks, her midface was advanced by 10 mm with slight overcorrection at the occlusion level. At 2 years postoperatively, the patient had complete remission of her sleep apnea, resolution of her exorbitism, and amelioration of her class III malocclusion to class I. To the best of our knowledge, this is the first report of a successful subcranial Le Fort III midface advancement with distraction osteogenesis for craniofacial reconstruction of a pycnodysostosis. Our report highlights the surgical options that have been described for this craniofacial deformity and presents a novel and expedient approach for patients with pycnodysostosis presenting with exorbitism, midface retrusion, and/or sleep apnea.
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Patient-Reported Quality of Life in Highest-Functioning Apert and Crouzon Syndromes. Plast Reconstr Surg 2014; 133:182e-191e. [PMID: 24469189 DOI: 10.1097/01.prs.0000437260.31693.75] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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