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de Vries IAC, Guillaume CHAL, Penris WM, Eligh AM, Eijkemans RMJC, Kon M, Breugem CC, van Dijk MWG. The relation between clinically diagnosed and parent-reported feeding difficulties in children with and without clefts. Eur J Pediatr 2023; 182:2197-2204. [PMID: 36862223 PMCID: PMC10175319 DOI: 10.1007/s00431-023-04852-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 01/25/2023] [Accepted: 01/30/2023] [Indexed: 03/03/2023]
Abstract
A cleft lip and/or palate (CL/P) is one of the most common craniofacial malformations, occurring worldwide in about one in 600-1000 newborn infants. CL/P is known to influence the feeding process negatively, causing feeding difficulties in 25-73% of all children with CL/P. Because there is a risk for serious complications in these children regarding feeding difficulties, there is often a need for intensive medical counseling and treatment. At this moment, adequate diagnosis and measurement remain a challenge and often lead to a delayed referral for professional help. Since parents play a big part in reporting feeding difficulties, it is important to help objectify parents' experiences, as well as the use of a frontline screening instrument for routine check-ups during medical appointments. The aim of this study is to investigate the relationship between parent perspective and standardized observation by medical professionals on feeding difficulties in 60 children with and without clefts at the age of 17 months. We focus on the information from parents and health professionals by comparing the Observation List Spoon Feeding and the Schedule for Oral Motor Assessment with the validated Dutch translation of the Montreal Children's Hospital Feeding Scale. Conclusion: There is a need for timely and adequate diagnosis and referral when it comes to feeding difficulties in children with CL/P. This study underscores the importance of combining both parental observations and measurements of oral motor skills by healthcare professionals to enable this. What is Known: • Early identification of feeding difficulties can prevent adversely affected growth and development. • Clefts increase the probability of feeding difficulties; however, the diagnostic trajectory is unclear. • The Observation List Spoon Feeding (OSF) and Schedule for Oral Motor Assessment (SOMA) are validated to measure oral motor skills. The Montreal Children's Hospital Feeding Scale Dutch version (MCH-FSD) has been validated for the parental perception of infant feeding difficulties. What is New: • Parents of children with CL/P experience relatively few feeding problems in their child on average. • Oral motor skills for spoon feeding are associated with oral motor skills for solid foods in children with CL/P. • The extent of the cleft is associated with experiencing more feeding difficulties in children with CL/P.
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Affiliation(s)
- Iris A C de Vries
- Department of Paediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508 GA, Utrecht, the Netherlands.
| | - Camille H A L Guillaume
- Department of Paediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508 GA, Utrecht, the Netherlands.,Department of Paediatric Plastic Surgery, Emma Children's Hospital, University of Amsterdam, Amsterdam, the Netherlands
| | - Wouter M Penris
- Faculty of Behavioral and Social Sciences/Applied Linguistics, University of Groningen, Groningen, the Netherlands
| | - Anne Merijn Eligh
- Department of Paediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508 GA, Utrecht, the Netherlands
| | - Rene M J C Eijkemans
- Department of Biostatistics and Research Support, Julius Centre, University Medical Centre, Utrecht, the Netherlands
| | - Moshe Kon
- Department of Paediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508 GA, Utrecht, the Netherlands
| | - Corstiaan C Breugem
- Department of Paediatric Plastic Surgery, Emma Children's Hospital, University of Amsterdam, Amsterdam, the Netherlands
| | - Marijn W G van Dijk
- Heymans Institute for Psychological Research, University of Groningen, Groningen, the Netherlands
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2
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Kon M. Commentary on: computed tomography-derived fractional flow reserve (FFR CT) has no additional clinical impact over the anatomical Coronary Artery Disease - Reporting and Data System (CAD-RADS) in real-world elective healthcare of coronary artery disease. Clin Radiol 2022; 77:891-892. [PMID: 36150936 DOI: 10.1016/j.crad.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/10/2022] [Accepted: 07/11/2022] [Indexed: 11/03/2022]
Affiliation(s)
- M Kon
- Bradford Royal Infirmary, Duckworth Ln, Bradford, BD9 6RJ, UK.
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Otto IA, Bernal PN, Rikkers M, van Rijen MH, Mensinga A, Kon M, Breugem CC, Levato R, Malda J. Human Adult, Pediatric and Microtia Auricular Cartilage harbor Fibronectin-adhering Progenitor Cells with Regenerative Ear Reconstruction Potential. iScience 2022; 25:104979. [PMID: 36105583 PMCID: PMC9464889 DOI: 10.1016/j.isci.2022.104979] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 06/19/2022] [Accepted: 08/16/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Iris A. Otto
- Department of Orthopaedics, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, the Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, the Netherlands
| | - Paulina Nuñez Bernal
- Department of Orthopaedics, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, the Netherlands
| | - Margot Rikkers
- Department of Orthopaedics, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, the Netherlands
| | - Mattie H.P. van Rijen
- Department of Orthopaedics, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, the Netherlands
| | - Anneloes Mensinga
- Department of Orthopaedics, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, the Netherlands
| | - Moshe Kon
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, the Netherlands
| | - Corstiaan C. Breugem
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Emma Children’s Hospital, Meibergdreef 9, Amsterdam, 1105 ZA, the Netherlands
| | - Riccardo Levato
- Department of Orthopaedics, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, the Netherlands
- Department of Clinical Sciences, Faculty of Veterinary Science, Utrecht University, Yalelaan 108, Utrecht, 3584 CM, the Netherlands
- Corresponding author
| | - Jos Malda
- Department of Orthopaedics, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, the Netherlands
- Department of Clinical Sciences, Faculty of Veterinary Science, Utrecht University, Yalelaan 108, Utrecht, 3584 CM, the Netherlands
- Corresponding author
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4
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Otto IA, Capendale PE, Garcia JP, de Ruijter M, van Doremalen RFM, Castilho M, Lawson T, Grinstaff MW, Breugem CC, Kon M, Levato R, Malda J. Biofabrication of a shape-stable auricular structure for the reconstruction of ear deformities. Mater Today Bio 2021; 9:100094. [PMID: 33665603 PMCID: PMC7903133 DOI: 10.1016/j.mtbio.2021.100094] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 01/04/2021] [Accepted: 01/08/2021] [Indexed: 11/04/2022] Open
Abstract
Bioengineering of the human auricle remains a significant challenge, where the complex and unique shape, the generation of high-quality neocartilage, and shape preservation are key factors. Future regenerative medicine–based approaches for auricular cartilage reconstruction will benefit from a smart combination of various strategies. Our approach to fabrication of an ear-shaped construct uses hybrid bioprinting techniques, a recently identified progenitor cell population, previously validated biomaterials, and a smart scaffold design. Specifically, we generated a 3D-printed polycaprolactone (PCL) scaffold via fused deposition modeling, photocrosslinked a human auricular cartilage progenitor cell–laden gelatin methacryloyl (gelMA) hydrogel within the scaffold, and cultured the bioengineered structure in vitro in chondrogenic media for 30 days. Our results show that the fabrication process maintains the viability and chondrogenic phenotype of the cells, that the compressive properties of the combined PCL and gelMA hybrid auricular constructs are similar to native auricular cartilage, and that biofabricated hybrid auricular structures exhibit excellent shape fidelity compared with the 3D digital model along with deposition of cartilage-like matrix in both peripheral and central areas of the auricular structure. Our strategy affords an anatomically enhanced auricular structure with appropriate mechanical properties, ensures adequate preservation of the auricular shape during a dynamic in vitro culture period, and enables chondrogenically potent progenitor cells to produce abundant cartilage-like matrix throughout the auricular construct. The combination of smart scaffold design with 3D bioprinting and cartilage progenitor cells holds promise for the development of clinically translatable regenerative medicine strategies for auricular reconstruction. First application of human auricular cartilage progenitor cells for bioprinting. Dual-printing of hybrid ear-shaped constructs with excellent shape fidelity over time. Strategy and design ensured adequate deposition of cartilage-like matrix throughout large auricular constructs.
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Affiliation(s)
- I A Otto
- Department of Orthopaedics, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, the Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.,Regenerative Medicine Center Utrecht, Utrecht, the Netherlands
| | - P E Capendale
- Department of Orthopaedics, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, the Netherlands.,Regenerative Medicine Center Utrecht, Utrecht, the Netherlands
| | - J P Garcia
- Department of Orthopaedics, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, the Netherlands.,Regenerative Medicine Center Utrecht, Utrecht, the Netherlands
| | - M de Ruijter
- Department of Orthopaedics, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, the Netherlands.,Regenerative Medicine Center Utrecht, Utrecht, the Netherlands
| | - R F M van Doremalen
- Robotics and Mechatronics, Faculty of Electrical Engineering, Mathematics & Computer Science, University of Twente, Enschede, the Netherlands.,Bureau Science & Innovation, Deventer Hospital, Deventer, the Netherlands
| | - M Castilho
- Department of Orthopaedics, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, the Netherlands.,Regenerative Medicine Center Utrecht, Utrecht, the Netherlands
| | - T Lawson
- Departments of Chemistry and Biomedical Engineering, Boston University, Boston, USA
| | - M W Grinstaff
- Departments of Chemistry and Biomedical Engineering, Boston University, Boston, USA
| | - C C Breugem
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Emma Children's Hospital, Amsterdam, the Netherlands
| | - M Kon
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - R Levato
- Department of Orthopaedics, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, the Netherlands.,Regenerative Medicine Center Utrecht, Utrecht, the Netherlands
| | - J Malda
- Department of Orthopaedics, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, the Netherlands.,Regenerative Medicine Center Utrecht, Utrecht, the Netherlands.,Department of Clinical Sciences, Faculty of Veterinary Science, Utrecht University, the Netherlands
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Moriya K, Nishimura Y, Nakamura M, Kon M, Kitta T, Araki A, Miyashita C, Ito S, Cho K, Mitsui T, Murai S, Nonomura K, Kishi R, Shinohara N. Establishment of nocturnal bladder control and behavioral sexual dimorphism in children. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33228-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Jovic TH, Stewart K, Kon M, Whitaker IS. "Auricular reconstruction: A sociocultural, surgical and scientific perspective". J Plast Reconstr Aesthet Surg 2020; 73:1424-1433. [PMID: 32565140 DOI: 10.1016/j.bjps.2020.03.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 03/10/2020] [Accepted: 03/26/2020] [Indexed: 01/21/2023]
Abstract
The functional and sociocultural role of the auricle has been prevalent in art, literature and history for millennia. It is no surprise, therefore, that auricular anomalies can be associated with affective disorders and impaired academic performance in children. The challenge of auricular reconstruction has captured the attention of surgical innovators for millennia with the earliest records of auricular reconstruction documented in the Edwin Smith Surgical Papyrus dating back to 3000 BCE. Since the 19th century, however, the interest in the ambition partial and total auricular reconstruction witnessed a rebirth, with refinements in frame construction, projection and skin coverage improving exponentially over the last two centuries. The gold standard auricular reconstruction practices today have their roots in these historical milestones, and form a solid foundation for the introduction of technological advancements such as 3D bioprinting and composite tissue allotransplantation into future auricular reconstruction practice. The aim of this review is to outline the sociocultural role of the auricle, the history and evolution of auricular reconstruction surgery and to provide an insight into potential future avenues of restoring auricular form and function.
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Affiliation(s)
- Thomas H Jovic
- Reconstructive Surgery & Regenerative Medicine Research Group, Institute of Life Sciences, Swansea University, United Kingdom; Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
| | - Ken Stewart
- Royal Hospital for Sick Children, Edinburgh, United Kingdom
| | - Moshe Kon
- International Society of Auricular Reconstruction (President); Department of Plastic and Reconstructive Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Iain S Whitaker
- Reconstructive Surgery & Regenerative Medicine Research Group, Institute of Life Sciences, Swansea University, United Kingdom; Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom.
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van Wijk MP, Wouters RHP, Bredenoord AL, Kon M, Breugem CC. If it ain't broke don't fix it? Ethics of splinting deformed newborn ears. J Plast Reconstr Aesthet Surg 2019; 72:1396-1402. [PMID: 31097358 DOI: 10.1016/j.bjps.2019.03.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 01/13/2019] [Accepted: 03/24/2019] [Indexed: 11/26/2022]
Abstract
Neonatal ear splinting is a proven and safe method to mold deformed ears into a more common shape. Based on our earlier studies, splinting is recommended only before the age of six weeks and preferably within the first week after birth. This can be done by initiating a system in which this intervention is actively proposed to parents. In this paper, we ethically evaluate such a system. By molding perfectly healthy newborn ears, we reach the boundary between treatment and enhancement. A key question is, therefore, whether we could classify neonatal ear splinting as a therapy. On the level of the individual, the advantages outweigh the drawbacks, but on the level of society, it is more complicated. Making ear deformities a part of official national screening programs fails to meet WHO criteria. Moreover, by systematically offering ear molding, professionals may be promoting guilt or fear of missing the opportunity. Additionally, it could affect societal attitudes toward cosmetic deformities. However, if we argue that on the individual level infants may benefit from ear splinting, then active detection of ear deformities allows parents to choose in a timely way from the full range of options, including splinting and a wait-and-see approach. We are inclined to optimally inform parents without setting up a full-blown public health program. The extent to which it is possible to timely offer splints to parents of newborns depends on the infrastructure of health care systems. The key will be for everyone involved, public or commercial, to responsibly educate and facilitate.
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Affiliation(s)
- M P van Wijk
- Department of Plastic Surgery, Isala Zwolle, the Netherlands.
| | - R H P Wouters
- Department of Medical Humanities, Julius Center, University Medical Center Utrecht, the Netherlands
| | - A L Bredenoord
- Department of Medical Humanities, Julius Center, University Medical Center Utrecht, the Netherlands
| | - M Kon
- Department of Plastic Surgery, Wilhelmina Children's hospital, University Medical Center Utrecht, the Netherlands
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8
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Kolodzynski MN, van Hoorn BT, Kon M, Breugem CC. Abnormal soft palate movements in patients with microtia. J Plast Reconstr Aesthet Surg 2018; 71:1476-1480. [DOI: 10.1016/j.bjps.2018.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 05/19/2018] [Accepted: 06/10/2018] [Indexed: 11/27/2022]
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9
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Matsui Y, Hirooka S, Kon M. Management of injury to ducts of Luschka during cholecystectomy. Ann R Coll Surg Engl 2018; 101:225. [PMID: 29692185 DOI: 10.1308/rcsann.2018.0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Y Matsui
- Kansai Medical University , Osaka , Japan
| | - S Hirooka
- Kansai Medical University , Osaka , Japan
| | - M Kon
- Kansai Medical University , Osaka , Japan
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Hawramy B, Cheyne L, Martin J, Kon M. Role of CT guided lung biopsy in solitary pulmonary nodules with a moderate to high risk of malignancy. Lung Cancer 2018. [DOI: 10.1016/s0169-5002(18)30076-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Maarse W, Boonacker CWB, Swanenburg de Veye HFN, Kon M, Breugem CC, Mink van der Molen AB, van Delden JJM. Parental Attitude Toward the Prenatal Diagnosis of Oral Cleft: A Prospective Cohort Study. Cleft Palate Craniofac J 2018; 55:1055665618763337. [PMID: 29561713 DOI: 10.1177/1055665618763337] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The prenatal diagnosis of oral clefts (OCs) by ultrasound can pose an ethical dilemma. The purpose of this study was to obtain insight into the psychosocial and moral considerations of prospective parents concerning OCs, the burden of OCs and parents' attitude toward possible termination of pregnancy (TOP) in order to improve counseling in the future. DESIGN Between August 2011 and August 2014, a prospective cohort questionnaire study was administered. SETTING Prenatal care clinic of the Wilhelmina's Children hospital, a Tertiary Care Centre. PARTICIPANTS Parents expecting a child with an OC. MAIN OUTCOME MEASURES Expectation of OCs in general and attitudes toward the impact and expected burden of the OC of their child. Furthermore, parents were asked if they had considered TOP. RESULTS Most of the parents described an OC as a cosmetic disability (50.6%) or as "just a little different" (29.4%). These parents expected that the OC would not affect their own happiness and have only minor influence on the happiness of their future child. Health professionals had a considerable influence on parental opinion. A minority (6.4%, 5/85) of the respondents considered TOP, and none of the responders chose to terminate the pregnancy. CONCLUSIONS This study suggests that future parents have very few negative perceptions of OC after prenatal counseling. Caregivers should be aware that their counseling is important for decision-making of parents.
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Affiliation(s)
- Wies Maarse
- 1 Department of Plastic and Reconstructive Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Chantal W B Boonacker
- 2 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Henriette F N Swanenburg de Veye
- 3 Department of Pediatric Psychology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Moshe Kon
- 1 Department of Plastic and Reconstructive Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Corstiaan C Breugem
- 1 Department of Plastic and Reconstructive Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Aebele B Mink van der Molen
- 1 Department of Plastic and Reconstructive Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johannes J M van Delden
- 2 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Kolodzynski MN, van Hövell Tot Westerflier CVA, Kon M, Breugem CC. Cost analysis of microtia treatment in the Netherlands. J Plast Reconstr Aesthet Surg 2017; 70:1280-1284. [PMID: 28734754 DOI: 10.1016/j.bjps.2017.06.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 06/07/2017] [Accepted: 06/09/2017] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Ear reconstruction for microtia is a challenging procedure. Although analyzing esthetic outcome is crucial, there is a paucity of information with regard to financial aspects of microtia reconstruction. This study was conducted to analyze the costs associated with ear reconstruction with costal cartilage in patients with microtia. METHODS Ten consecutive children with autologous ear reconstruction of a unilateral microtia were included in this analysis. All patients had completed their treatment protocol for ear reconstruction. Direct costs (admission to hospital, diagnostics, and surgery) and indirect cost (travel expenses and absence from work) were obtained retrospectively. RESULTS The overall mean cumulative cost per patient was €14,753. Direct and indirect costs were €13,907 and €846, respectively. Hospital admission and surgery cover 55% and 32% of all the costs, respectively. DISCUSSION This study analyzes the costs for autologous ear reconstruction. Hospital admission and surgery are the most important factors of the total costs. Total costs could be decreased by possibly decreasing admission days and surgical time. These data can be used for choosing and developing future treatment strategies.
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Affiliation(s)
- M N Kolodzynski
- Dutch Center for Ear Reconstruction, University Medical Center Utrecht, Heidelberglaan 100, PO Box 85500, 3508 GA Utrecht, The Netherlands.
| | - C V A van Hövell Tot Westerflier
- Dutch Center for Ear Reconstruction, University Medical Center Utrecht, Heidelberglaan 100, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - M Kon
- Dutch Center for Ear Reconstruction, University Medical Center Utrecht, Heidelberglaan 100, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - C C Breugem
- Dutch Center for Ear Reconstruction, University Medical Center Utrecht, Heidelberglaan 100, PO Box 85500, 3508 GA Utrecht, The Netherlands
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Kappen IFPM, Bittermann GKP, Schouten RM, Bittermann D, Etty E, Koole R, Kon M, Mink van der Molen AB, Breugem CC. Long-term mid-facial growth of patients with a unilateral complete cleft of lip, alveolus and palate treated by two-stage palatoplasty: cephalometric analysis. Clin Oral Investig 2017; 21:1801-1810. [PMID: 27638039 PMCID: PMC5442235 DOI: 10.1007/s00784-016-1949-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 08/30/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The aim of this study is to evaluate long-term facial growth in adults previously treated for an isolated unilateral complete cleft lip, alveolus and palate by two-stage palatoplasty. MATERIALS AND METHODS Unilateral cleft lip and palate (UCLP) patients of 17 years and older treated by two-stage palatoplasty were invited for long-term follow-up. During follow-up, lateral cephalograms were obtained (n = 52). Medical history was acquired from their medical files. Outcome was compared to previously published normal values and the Eurocleft study. RESULTS Soft and hard palate closure were performed at the age of 8 (SD 5.9) months and 3 (SD 2.2) years, respectively. The mean maxillary and mandibular angle (SNA, SNB) were 74.9° (SD 4.2) and 75.8° (SD 3.8). Maxillary and maxillomandibular relationships (SNA, ANB) were comparable to all Eurocleft Centres, except for Centre D. We observed a significantly steeper upper interincisor angle compared to the Eurocleft Centres. CONCLUSIONS This study describes the long-term craniofacial morphology in adults treated for a UCLP with hard palate closure at a mean age of 3 years. The mean maxillary angle SNA and mandibular angle SNPg were comparable to previous studies both applying early and delayed hard palate closure. The observed upper incisor proclination is likely caused by orthodontic overcorrection in response to the unfavourable jaw relationships. No clear growth benefit of this protocol could be demonstrated. CLINICAL RELEVANCE The present study shows the long-term craniofacial morphology of UCLP adults after the Utrecht treatment protocol which includes two-stage palate closure.
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Affiliation(s)
- I F P M Kappen
- Department of Plastic Surgery, Wilhelmina Children's Hospital, Lundlaan 6, PO Box 85090, 3508 AB, Utrecht, The Netherlands.
| | - G K P Bittermann
- Department of Maxillofacial Surgery, University Medical Centre Utrecht, Heidelberglaan 100, PO box 85500, 3508 AB, Utrecht, The Netherlands
| | - R M Schouten
- Department of Methodology and Statistics, University of Utrecht, Padualaan 14, 3584 CH, Utrecht, The Netherlands
| | - D Bittermann
- Department of Maxillofacial Surgery, University Medical Centre Utrecht, Heidelberglaan 100, PO box 85500, 3508 AB, Utrecht, The Netherlands
| | - E Etty
- Department of Maxillofacial Surgery, University Medical Centre Utrecht, Heidelberglaan 100, PO box 85500, 3508 AB, Utrecht, The Netherlands
| | - R Koole
- Department of Maxillofacial Surgery, University Medical Centre Utrecht, Heidelberglaan 100, PO box 85500, 3508 AB, Utrecht, The Netherlands
| | - M Kon
- Department of Plastic Surgery, Wilhelmina Children's Hospital, Lundlaan 6, PO Box 85090, 3508 AB, Utrecht, The Netherlands
| | - A B Mink van der Molen
- Department of Plastic Surgery, Wilhelmina Children's Hospital, Lundlaan 6, PO Box 85090, 3508 AB, Utrecht, The Netherlands
| | - C C Breugem
- Department of Plastic Surgery, Wilhelmina Children's Hospital, Lundlaan 6, PO Box 85090, 3508 AB, Utrecht, The Netherlands
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Kappen IFPM, Bittermann D, Janssen L, Bittermann GKP, Boonacker C, Haverkamp S, de Wilde H, Van Der Heul M, Specken TFJMC, Koole R, Kon M, Breugem CC, Mink van der Molen AB. Long-Term Follow-Up Study of Young Adults Treated for Unilateral Complete Cleft Lip, Alveolus, and Palate by a Treatment Protocol Including Two-Stage Palatoplasty: Speech Outcomes. Arch Plast Surg 2017; 44:202-209. [PMID: 28573094 PMCID: PMC5447529 DOI: 10.5999/aps.2017.44.3.202] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 03/03/2017] [Accepted: 03/22/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND No consensus exists on the optimal treatment protocol for orofacial clefts or the optimal timing of cleft palate closure. This study investigated factors influencing speech outcomes after two-stage palate repair in adults with a non-syndromal complete unilateral cleft lip and palate (UCLP). METHODS This was a retrospective analysis of adult patients with a UCLP who underwent two-stage palate closure and were treated at our tertiary cleft centre. Patients ≥17 years of age were invited for a final speech assessment. Their medical history was obtained from their medical files, and speech outcomes were assessed by a speech pathologist during the follow-up consultation. RESULTS Forty-eight patients were included in the analysis, with a mean age of 21 years (standard deviation, 3.4 years). Their mean age at the time of hard and soft palate closure was 3 years and 8.0 months, respectively. In 40% of the patients, a pharyngoplasty was performed. On a 5-point intelligibility scale, 84.4% received a score of 1 or 2; meaning that their speech was intelligible. We observed a significant correlation between intelligibility scores and the incidence of articulation errors (P<0.001). In total, 36% showed mild to moderate hypernasality during the speech assessment, and 11%-17% of the patients exhibited increased nasalance scores, assessed through nasometry. CONCLUSIONS The present study describes long-term speech outcomes after two-stage palatoplasty with hard palate closure at a mean age of 3 years old. We observed moderate long-term intelligibility scores, a relatively high incidence of persistent hypernasality, and a high pharyngoplasty incidence.
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Affiliation(s)
| | - Dirk Bittermann
- Department of Maxillofacial Surgery, University Medical Centre of Utrecht, Utrecht, The Netherlands
| | - Laura Janssen
- Department of Plastic Surgery, University Medical Centre of Utrecht, Utrecht, The Netherlands
| | | | - Chantal Boonacker
- Julius Centre for Health Sciences and Primary Care, University Medical Centre of Utrecht, Utrecht, The Netherlands
| | - Sarah Haverkamp
- Speech and Language Pathology, ENT-Surgery, University Medical Centre of Utrecht, Utrecht, The Netherlands
| | - Hester de Wilde
- Speech and Language Pathology, ENT-Surgery, University Medical Centre of Utrecht, Utrecht, The Netherlands
| | - Marise Van Der Heul
- Speech and Language Pathology, ENT-Surgery, University Medical Centre of Utrecht, Utrecht, The Netherlands
| | - Tom FJMC Specken
- Department of Plastic Surgery, University Medical Centre of Utrecht, Utrecht, The Netherlands
| | - Ron Koole
- Speech and Language Pathology, ENT-Surgery, University Medical Centre of Utrecht, Utrecht, The Netherlands
| | - Moshe Kon
- Department of Plastic Surgery, University Medical Centre of Utrecht, Utrecht, The Netherlands
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Otto IA, van Doremalen RFM, Melchels FPW, Kolodzynski MN, Pouran B, Malda J, Kon M, Breugem CC. Accurate Measurements of the Skin Surface Area of the Healthy Auricle and Skin Deficiency in Microtia Patients. Plast Reconstr Surg Glob Open 2016; 4:e1146. [PMID: 28293505 PMCID: PMC5222650 DOI: 10.1097/gox.0000000000001146] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 10/06/2016] [Indexed: 12/11/2022]
Abstract
Background: The limited cranial skin covering auricular implants is an important yet underrated factor in auricular reconstruction for both reconstruction surgery and tissue engineering strategies. We report exact measurements on skin deficiency in microtia patients and propose an accessible preoperative method for these measurements. Methods: Plaster ear models (n = 11; male:female = 2:1) of lobular-type microtia patients admitted to the University Medical Center Utrecht in The Netherlands were scanned using a micro-computed tomographic scanner or a cone-beam computed tomographic scanner. The resulting images were converted into mesh models from which the surface area could be calculated. Results: The mean total skin area of an adult-size healthy ear was 47.3 cm2, with 49.0 cm2 in men and 44.3 cm2 in women. Microtia ears averaged 14.5 cm2, with 15.6 cm2 in men and 12.6 cm2 in women. The amount of skin deficiency was 25.4 cm2, with 26.7 cm2 in men and 23.1 cm2 in women. Conclusions: This study proposes a novel method to provide quantitative data on the skin surface area of the healthy adult auricle and the amount of skin deficiency in microtia patients. We demonstrate that the microtia ear has less than 50% of skin available compared with healthy ears. Limited skin availability in microtia patients can lead to healing problems after auricular reconstruction and poses a significant challenge in the development of tissue-engineered cartilage implants. The results of this study could be used to evaluate outcomes and investigate new techniques with regard to tissue-engineered auricular constructs.
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Affiliation(s)
- Iris A Otto
- Departments of Plastic, Reconstructive and Hand Surgery and Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology (TU Delft), Delft, The Netherlands; Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands; and Department of Plastic Surgery, Meander Medical Centre, Amersfoort, The Netherlands
| | - Rob F M van Doremalen
- Departments of Plastic, Reconstructive and Hand Surgery and Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology (TU Delft), Delft, The Netherlands; Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands; and Department of Plastic Surgery, Meander Medical Centre, Amersfoort, The Netherlands
| | - Ferry P W Melchels
- Departments of Plastic, Reconstructive and Hand Surgery and Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology (TU Delft), Delft, The Netherlands; Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands; and Department of Plastic Surgery, Meander Medical Centre, Amersfoort, The Netherlands
| | - Michail N Kolodzynski
- Departments of Plastic, Reconstructive and Hand Surgery and Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology (TU Delft), Delft, The Netherlands; Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands; and Department of Plastic Surgery, Meander Medical Centre, Amersfoort, The Netherlands
| | - Behdad Pouran
- Departments of Plastic, Reconstructive and Hand Surgery and Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology (TU Delft), Delft, The Netherlands; Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands; and Department of Plastic Surgery, Meander Medical Centre, Amersfoort, The Netherlands
| | - Jos Malda
- Departments of Plastic, Reconstructive and Hand Surgery and Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology (TU Delft), Delft, The Netherlands; Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands; and Department of Plastic Surgery, Meander Medical Centre, Amersfoort, The Netherlands
| | - Moshe Kon
- Departments of Plastic, Reconstructive and Hand Surgery and Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology (TU Delft), Delft, The Netherlands; Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands; and Department of Plastic Surgery, Meander Medical Centre, Amersfoort, The Netherlands
| | - Corstiaan C Breugem
- Departments of Plastic, Reconstructive and Hand Surgery and Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology (TU Delft), Delft, The Netherlands; Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands; and Department of Plastic Surgery, Meander Medical Centre, Amersfoort, The Netherlands
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16
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Paes EC, de Vries IAC, Penris WM, Hanny KH, Lavrijsen SW, van Leerdam EK, Rademaker MM, Veldhoen ES, Eijkemans RMJC, Kon M, Breugem CC. Growth and prevalence of feeding difficulties in children with Robin sequence: a retrospective cohort study. Clin Oral Investig 2016; 21:2063-2076. [PMID: 27868158 PMCID: PMC5487830 DOI: 10.1007/s00784-016-1996-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 11/01/2016] [Indexed: 01/20/2023]
Abstract
OBJECTIVES In addition to breathing problems, patients with Robin sequence (RS) often encounter feeding difficulties (FD). Data regarding the occurrence of FD and possible influencing factors are scarce. The study aim was to elucidate these factors to improve treatment strategies. MATERIAL AND METHODS A retrospective comparative cohort study was conducted, consisting of 69 infants diagnosed with both RS and a cleft palate and 64 isolated cleft palate only (iCPO) infants. Data regarding FD, growth, and airway intervention were collected during the first 2 years of life. A systematic review of the literature was conducted to identify reported FD in RS patients. RESULTS RS patients had more FD (91 %) than iCPO patients (72 %; p = 0.004). Also, nasogastric (NG)-tube feeding was necessary more frequently and for a longer period (both p < 0.001). Growth was lower in RS than iCPO infants (p = 0.008) and was not affected by the kind of airway management (conservative/surgical; p = 0.178), cleft palate grade (p = 0.308), or associated disorders (p = 0.785). By contrast, surgical intervention subtype did significantly affect growth. Mean reported FD for RS in the literature is 80 % (range = 47-100 %), and 55 % (range = 11-100 %) of infants need NG-tube feeding. CONCLUSIONS FD is present in a large proportion of infants with RS, which indicates the need for early recognition and proper treatment to ensure optimal growth. Growth during the first 2 years of life is significantly lower in RS patients than iCPO patients, which indicates the need for careful attention and long-term follow-up. CLINICAL RELEVANCE This study indicates the need for early recognition and proper treatment of FD in RS to ensure optimal growth. In addition, growth needs careful attention and long-term follow-up.
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Affiliation(s)
- Emma C Paes
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508, GA, Utrecht, The Netherlands.
| | - Iris A C de Vries
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508, GA, Utrecht, The Netherlands
| | - Wouter M Penris
- Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Karlijn H Hanny
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508, GA, Utrecht, The Netherlands
| | - Selma W Lavrijsen
- Department of Pediatrics, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Elselien K van Leerdam
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508, GA, Utrecht, The Netherlands
| | - Maaike M Rademaker
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508, GA, Utrecht, The Netherlands
| | - Esther S Veldhoen
- Department of Pediatrics, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Rene M J C Eijkemans
- Department of Biostatistics and Research Support, Julius Centre, University Medical Centre, Utrecht, The Netherlands
| | - Moshe Kon
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508, GA, Utrecht, The Netherlands
| | - Corstiaan C Breugem
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508, GA, Utrecht, The Netherlands
- Department of Plastic Surgery, Meander Medical Center, Amersfoort, The Netherlands
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17
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Kolodzynski MN, Kon M, Egger S, Breugem CC. Mechanisms of ear trauma and reconstructive techniques in 105 consecutive patients. Eur Arch Otorhinolaryngol 2016; 274:723-728. [PMID: 27714497 PMCID: PMC5281643 DOI: 10.1007/s00405-016-4299-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 09/06/2016] [Indexed: 12/02/2022]
Abstract
Acquired auricular deformities may diminish facial esthetics and cause psychological distress. The aim of this article is to provide an overview of the type of injuries and applied reconstructive techniques in a large academic hospital in The Netherlands. A retrospective chart review was conducted for the last 105 patients who underwent auricular reconstruction for an acquired deformity. Data concerning gender, affected side, cause of injury, anatomical region, the previous and further surgeries, type of cartilage, and skin cover used were collected and analyzed. 105 patients were included. Acquired auricular deformities were mainly caused by bite injuries (22 %), traffic accidents (17 %), burns (9.5 %), and post-otoplasty complications (9.5 %). The upper third of the auricle was most often injured (41 %), followed by the entire auricle (19 %). 70 % of cases required reconstruction with costal cartilage. The most common form of cutaneous cover was a postauricular skin flap (40 % of cases). This study gives a complete overview of causes and treatment of acquired auricular deformities. The results are comparable with the results of similar studies found in literature. Bite wounds are the leading cause of acquired auricular injuries. The upper third is most commonly affected. In the largest percentage of reconstructions, costal cartilage and a postauricular flap were used to correct the deformity.
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Affiliation(s)
- Michail N Kolodzynski
- Department of Plastic and Reconstructive Surgery, Dutch Center for Ear Reconstruction, University Medical Center Utrecht, Heidelberglaan 100, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - Moshe Kon
- Department of Plastic and Reconstructive Surgery, Dutch Center for Ear Reconstruction, University Medical Center Utrecht, Heidelberglaan 100, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Silvan Egger
- Department of Plastic and Reconstructive Surgery, Dutch Center for Ear Reconstruction, University Medical Center Utrecht, Heidelberglaan 100, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Corstiaan C Breugem
- Department of Plastic and Reconstructive Surgery, Dutch Center for Ear Reconstruction, University Medical Center Utrecht, Heidelberglaan 100, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
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18
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Sato K, Tsukada N, Inamura J, Kon M, Ito S, Hirai K, Hosoki T. A case of acquired haemophilia A complicated by peritonitis after distal gastrectomy. Haemophilia 2016; 22:e469-71. [PMID: 27457489 DOI: 10.1111/hae.13039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2016] [Indexed: 11/30/2022]
Affiliation(s)
- K Sato
- Department of Hematology/Oncology, Asahikawa Kosei Hospital, Asahikawa, Japan.
| | - N Tsukada
- Department of Hematology/Oncology, Asahikawa Kosei Hospital, Asahikawa, Japan
| | - J Inamura
- Department of Hematology/Oncology, Asahikawa Kosei Hospital, Asahikawa, Japan
| | - M Kon
- Department of Clinical Laboratory, Asahikawa Kosei Hospital, Asahikawa, Hokkaido, Japan
| | - S Ito
- Department of Oncology for Local Community Cooperation, Asahikawa Medical University Hospital, Asahikawa, Hokkaido, Japan
| | - K Hirai
- Department of Hematology/Gastroenterology, Harada Hospital, Asahikawa, Hokkaido, Japan
| | - T Hosoki
- Department of Hematology/Oncology, Asahikawa Kosei Hospital, Asahikawa, Japan
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19
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Michiura T, Inoue K, Hamada M, Miki H, Inada R, Oishi M, Ozaki T, Mukaide H, Kon M. P-251 Prone-position thoracoscopic esophagectomy (bilateral pulmonary ventilation) for esophageal cancer with respiratory dysfunction. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw199.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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20
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Inada R, Murotani K, Iwamoto S, Kaibori M, Ishizaki M, Iida H, Matsui K, Oishi M, Mastumoto T, Michiura T, Inoue K, Mishima H, Kon M, Hamada M. P-062 Correlation of histological Tumor Regression Grading (TRG) with radiological response and long-term outcome after preoperative chemotherapy for Colorectal Liver Metastases: a propensity score matching analysis. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw199.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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21
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van Hövell Tot Westerflier CVA, van Wijk MP, Kon M. Surgical Correction of the "Sunken Ear": An Auricular Positional Change after Canal Wall Down Mastoidectomy. Otolaryngol Head Neck Surg 2016; 154:1161-3. [PMID: 27143703 DOI: 10.1177/0194599816644589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 03/24/2016] [Indexed: 11/17/2022]
Affiliation(s)
| | - Marieke P van Wijk
- Department of Plastic, Reconstructive and Hand Surgery, Isala Klinieken Zwolle, Zwolle, The Netherlands
| | - Moshe Kon
- DutchCenterforEarReconstruction,DepartmentofPlastic,Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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22
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Jessop ZM, Javed M, Otto IA, Combellack EJ, Morgan S, Breugem CC, Archer CW, Khan IM, Lineaweaver WC, Kon M, Malda J, Whitaker IS. Combining regenerative medicine strategies to provide durable reconstructive options: auricular cartilage tissue engineering. Stem Cell Res Ther 2016; 7:19. [PMID: 26822227 PMCID: PMC4730656 DOI: 10.1186/s13287-015-0273-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Recent advances in regenerative medicine place us in a unique position to improve the quality of engineered tissue. We use auricular cartilage as an exemplar to illustrate how the use of tissue-specific adult stem cells, assembly through additive manufacturing and improved understanding of postnatal tissue maturation will allow us to more accurately replicate native tissue anisotropy. This review highlights the limitations of autologous auricular reconstruction, including donor site morbidity, technical considerations and long-term complications. Current tissue-engineered auricular constructs implanted into immune-competent animal models have been observed to undergo inflammation, fibrosis, foreign body reaction, calcification and degradation. Combining biomimetic regenerative medicine strategies will allow us to improve tissue-engineered auricular cartilage with respect to biochemical composition and functionality, as well as microstructural organization and overall shape. Creating functional and durable tissue has the potential to shift the paradigm in reconstructive surgery by obviating the need for donor sites.
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Affiliation(s)
- Zita M Jessop
- Reconstructive Surgery & Regenerative Medicine Research Group, Swansea University Medical School, Room 509, ILS2, Swansea, SA2 8SS, UK.
- The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, SA6 6NL, UK.
| | - Muhammad Javed
- Reconstructive Surgery & Regenerative Medicine Research Group, Swansea University Medical School, Room 509, ILS2, Swansea, SA2 8SS, UK.
- The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, SA6 6NL, UK.
| | - Iris A Otto
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, 3584 CX, The Netherlands.
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Emman J Combellack
- Reconstructive Surgery & Regenerative Medicine Research Group, Swansea University Medical School, Room 509, ILS2, Swansea, SA2 8SS, UK.
- The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, SA6 6NL, UK.
| | - Siân Morgan
- Reconstructive Surgery & Regenerative Medicine Research Group, Swansea University Medical School, Room 509, ILS2, Swansea, SA2 8SS, UK.
- The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, SA6 6NL, UK.
| | - Corstiaan C Breugem
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Charles W Archer
- Reconstructive Surgery & Regenerative Medicine Research Group, Swansea University Medical School, Room 509, ILS2, Swansea, SA2 8SS, UK.
| | - Ilyas M Khan
- KhanLab, Swansea University, ILS2, Swansea, SA2 8SS, UK.
| | - William C Lineaweaver
- Division of Plastic Surgery, University of Mississippi Medical Center, Jackson, Mississippi, 39216, USA.
| | - Moshe Kon
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Jos Malda
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, 3584 CX, The Netherlands.
- Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Domplein 29, 3512 JE, Utrecht, The Netherlands.
| | - Iain S Whitaker
- Reconstructive Surgery & Regenerative Medicine Research Group, Swansea University Medical School, Room 509, ILS2, Swansea, SA2 8SS, UK.
- The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, SA6 6NL, UK.
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Raphael MF, Breur JMPJ, Vlasveld FAE, Elbert NJ, Liem YTB, Kon M, Breugem CC, Pasmans SGMA. Treatment of infantile hemangiomas: therapeutic options in regard to side effects and adverse events – a review of the literature. Expert Opin Drug Saf 2016; 15:199-214. [DOI: 10.1517/14740338.2016.1130125] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Martine F. Raphael
- Department of Pediatric Dermatology and Allergology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johannes M. P. J. Breur
- Department of Pediatric Cardiology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Florine A. E. Vlasveld
- Department of Pediatric Dermatology and Allergology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Niels J. Elbert
- Department of Pediatric Dermatology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Yves T. B. Liem
- Department of Clinical Pharmacy, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Moshe Kon
- Department of Pediatric Plastic Surgery, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Corstiaan C. Breugem
- Department of Pediatric Plastic Surgery, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Suzanne G. M. A. Pasmans
- Department of Pediatric Dermatology and Allergology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Pediatric Dermatology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
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24
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Hanny KH, de Vries IAC, Haverkamp SJ, Oomen KPQ, Penris WM, Eijkemans MJC, Kon M, Mink van der Molen AB, Breugem CC. Late detection of cleft palate. Eur J Pediatr 2016; 175:71-80. [PMID: 26231683 PMCID: PMC4709386 DOI: 10.1007/s00431-015-2590-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 06/21/2015] [Accepted: 06/26/2015] [Indexed: 11/23/2022]
Abstract
Cleft palate only (CPO) is a common congenital malformation, and most patients are diagnosed within the first weeks after birth. Late diagnosis of the cleft palate (CP) could initially result in feeding and growth impairment, and subsequently speech and hearing problems later in life. The purpose of this study is to retrospectively investigate (1) at which age CPO is diagnosed and (2) how the presence of syndromes and other factors relate to the age at diagnosis. The mean age of all children at our centre with CPO included between 1997 and 2014 at diagnosis (n = 271) was 1 year and 4 months. In all, 24.8% (n = 67) was older than 12 months when diagnosed, and 37.3% (n = 101) of all children had been diagnosed >30 days. These findings remain valid when a cut-off point of 14 days is used (44.3% late). Moreover, the grade of the cleft was a determining factor for successful diagnosis; submucous clefts were detected much later on average (89.3% > 30 days; p = .000). Similar results were found using Kaplan-Meier survival analyses. CONCLUSION CPO is often diagnosed late. Patients diagnosed ≤30 days after birth more often presented with an associated disorder. Early diagnoses became more frequent as the severity of the cleft increased (grades 1-4). Professionals should perform more thorough intra-oral investigations, including manual palpations and visual inspections of the palate; they should be made more aware of the frequent accompanying symptoms. WHAT IS KNOWN The presence of cleft palate only (CPO) is known to negatively affect feeding, hearing, speech and (social) development. Submucous clefts are often underdiagnosed due to their difficulty to detect. As far as we know the literature shows that symptomatic submucous CPs are often diagnosed at an average age of 4.9 years. WHAT IS NEW 37.3% respectively of all children with CPO were diagnosed relatively late (>30 days after birth), 24.8% was older than 12 months when diagnosed. Mean age of all children with CPO was 1 year and 4 months. We conclude that midwives and pediatricians should perform more through intra-oral investigations of all new-borns, including both a manual palpation, als well a visual inspection of the palate.
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Affiliation(s)
- K H Hanny
- Department of Paediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - I A C de Vries
- Department of Paediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - S J Haverkamp
- Department of Speech and Language Therapy, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, The Netherlands
| | - K P Q Oomen
- Department of Otolaryngology-Head and Neck Surgery, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, The Netherlands
| | - W M Penris
- Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - M J C Eijkemans
- Department of Biostatistics and Research Support, Julius Centre, University Medical Centre, Utrecht, The Netherlands
| | - M Kon
- Department of Paediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - A B Mink van der Molen
- Department of Paediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - C C Breugem
- Department of Paediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508 GA, Utrecht, The Netherlands
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Otto IA, Kon M, Schuurman AH, van Minnen LP. Replantation versus Prosthetic Fitting in Traumatic Arm Amputations: A Systematic Review. PLoS One 2015; 10:e0137729. [PMID: 26340003 PMCID: PMC4560425 DOI: 10.1371/journal.pone.0137729] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 08/21/2015] [Indexed: 12/05/2022] Open
Abstract
Background Traumatic arm amputations can be treated with replantation or surgical formalization of the stump with or without subsequent prosthetic fitting. In the literature, many authors suggest the superiority of replantation. This systematic review compared available literature to analyze whether replantation is functionally and psychologically more profitable than formalization and prosthetic fitting in patients with traumatic arm amputation. Methods Functional outcome and satisfaction levels were recorded of patients with amputation levels below elbow, through elbow, and above elbow. Results Functional outcomes of 301 replantation patients and 172 prosthesis patients were obtained. In the replantation group, good or excellent functional scores were reported in 39% of above elbow, 55% of through elbow, and 50% of below elbow amputation cases. Nearly 100% of patients were satisfied with the replanted limb. In the prosthesis group, full use of the prosthesis was attained in 48% of above elbow and in 89% of below elbow amputation patients. Here, 29% of patients elected not to use the prosthesis for reasons including pain and functional superfluity. In both replantation patients and prosthesis wearers, a below elbow amputation yielded better functional results than higher amputation levels. Conclusions Replantation of a traumatically amputated arm leads to good function and higher satisfaction rates than a prosthesis, regardless of the objective functional outcome. Sensation and psychological well-being seem the two major advantages of replantation over a prosthesis. The current review of the available literature shows that in carefully selected cases replantation could be the preferred option of treatment.
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Affiliation(s)
- Iris A. Otto
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- * E-mail:
| | - Moshe Kon
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Arnold H. Schuurman
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- The Hand Clinic, Amsterdam, The Netherlands
| | - L. Paul van Minnen
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Otto IA, Melchels FPW, Zhao X, Randolph MA, Kon M, Breugem CC, Malda J. Auricular reconstruction using biofabrication-based tissue engineering strategies. Biofabrication 2015. [PMID: 26200941 DOI: 10.1088/1758-5090/7/3/032001] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Auricular malformations, which impose a significant social and psychological burden, are currently treated using ear prostheses, synthetic implants or autologous implants derived from rib cartilage. Advances in the field of regenerative medicine and biofabrication provide the possibility to engineer functional cartilage with intricate architectures and complex shapes using patient-derived or donor cells. However, the development of a successful auricular cartilage implant still faces a number of challenges. These challenges include the generation of a functional biochemical matrix, the fabrication of a customized anatomical shape, and maintenance of that shape. Biofabrication technologies may have the potential to overcome these challenges due to their ability to reproducibly deposit multiple materials in complex geometries in a highly controllable manner. This topical review summarizes this potential of biofabrication technologies for the generation of implants for auricular reconstruction. In particular, it aims to discuss how biofabrication technologies, although still in pre-clinical phase, could overcome the challenges of generating and maintaining the desired auricular shapes. Finally, remaining bottlenecks and future directions are discussed.
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Affiliation(s)
- I A Otto
- Department of Orthopaedics, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands. Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands
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Paes EC, van Nunen DPF, Speleman L, Muradin MSM, Smarius B, Kon M, Mink van der Molen AB, Niers TLEM, Veldhoen ES, Breugem CC. Erratum to: a pragmatic approach to infants with Robin sequence: a retrospective cohort study and presence of a treatment algorithm. Clin Oral Investig 2015; 19:1695. [PMID: 26153868 PMCID: PMC4713930 DOI: 10.1007/s00784-015-1520-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Emma C Paes
- Department of Plastic, Reconstructive and Hand Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands,
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Maarse W, Boonacker CWB, Breugem CC, Kon M, Manten GTR, Mink van der Molen AB. A practical prenatal ultrasound classification system for common oral clefts. Prenat Diagn 2015; 35:894-900. [DOI: 10.1002/pd.4631] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Wiesje Maarse
- Department of Plastic and Reconstructive Surgery, Wilhelmina Children's Hospital; University Medical Center Utrecht; Utrecht the Netherlands
| | - Chantal W. B. Boonacker
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; Utrecht the Netherlands
| | - Corstiaan C. Breugem
- Department of Plastic and Reconstructive Surgery, Wilhelmina Children's Hospital; University Medical Center Utrecht; Utrecht the Netherlands
| | - Moshe Kon
- Department of Plastic and Reconstructive Surgery, Wilhelmina Children's Hospital; University Medical Center Utrecht; Utrecht the Netherlands
| | - Gwendolyn T. R. Manten
- Department of Obstetrics and Gynecology, Fetal Medicine Unit, Wilhelmina Children's Hospital; University Medical Center Utrecht; Utrecht the Netherlands
| | - Aebele B. Mink van der Molen
- Department of Plastic and Reconstructive Surgery, Wilhelmina Children's Hospital; University Medical Center Utrecht; Utrecht the Netherlands
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Schreinemakers JRC, Klein-Nulend J, van Lotten ML, Nolte PA, Kon M. Exostoses of the Bony Pyramid of the Nose: A Review About an Adaptive Response to Mechanical Stimuli Exerted by In-Flight Oxygen Masks. Clin Rev Bone Miner Metab 2015. [DOI: 10.1007/s12018-015-9187-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Schreinemakers JRC, Boer C, van Amerongen PCGM, Kon M. Pressure effects on the nose by an in-flight oxygen mask during simulated flight conditions. J ROY ARMY MED CORPS 2015; 162:445-449. [PMID: 26048095 DOI: 10.1136/jramc-2014-000399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 05/12/2015] [Accepted: 05/14/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Dutch F-16 fighter pilots experience oxygen mask inflicted nasal trauma, including discomfort, pain, skin abrasions, bruises and bone remodelling. Pressure and shear forces on the nose might contribute to causing these adverse effects. In this study, it was evaluated how flight conditions affected the exerted pressure, and whether shear forces were present. METHODS The pressure exerted by the oxygen mask was measured in 20 volunteers by placing pressure sensors on the nose and chin underneath the mask. In the human centrifuge, the effects on the exerted pressure during different flight conditions were evaluated (+3Gz, +6Gz, +9Gz, protocolised head movements, mounted visor or night vision goggles, NVG). The runs were recorded to evaluate if the mask's position changed during the run, which would confirm the presence of shear forces. RESULTS Head movements increased the median pressure on the nose by 50 mm Hg and on the chin by 37 mm Hg. NVG, a visor and accelerative forces also increased the median pressure on the nose. Pressure drops on the nose were also observed, during mounted NVG (-63 mm Hg). The recordings showed the mask slid downwards, especially during the acceleration phase of the centrifuge run, signifying the presence of shear forces. CONCLUSIONS The exerted pressure by the oxygen mask changes during different flight conditions. Exposure to changing pressures and to shear forces probably contributes to mask-inflicted nasal trauma.
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Affiliation(s)
- J Rieneke C Schreinemakers
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C Boer
- Department of Anesthesiology, VU University Medical Center, Amsterdam, The Netherlands
| | | | - M Kon
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Macaré van Maurik JFM, Oomen RTW, van Hal M, Kon M, Peters EJG. The effect of lower extremity nerve decompression on health-related quality of life and perception of pain in patients with painful diabetic polyneuropathy: a prospective randomized trial. Diabet Med 2015; 32:803-9. [PMID: 25712758 DOI: 10.1111/dme.12732] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2015] [Indexed: 11/29/2022]
Abstract
AIMS The aim of this study was to assess whether surgical decompression of nerves in the lower extremity in people with painful diabetic polyneuropathy would have an effect on health-related quality of life and to determine minimal clinically important differences in pain and quality of life scores. METHODS The design was a randomized controlled trial in which 42 participants with painful diabetic painful neuroapthy underwent unilateral decompression of nerves in their left or right leg, using the other leg as a control, with 12 months follow-up. Surgical decompression was performed at the tibial, superficial, deep and common peroneal nerves. Preoperatively, and at 6 and 12 months post operatively, a visual analogue scale for pain and the 36 item short-form health survey and EuroQual 5 Dimensions questionnaires were completed. RESULTS At 12 months follow-up, the visual analogue scale was significantly reduced, but decompression surgery did not significantly alter health-related quality of life scores. The minimal clinically important difference for visual analogue scale reduction was determined at 2.9 points decrease, a threshold reached by 42.5% of the study population. CONCLUSIONS Although decompression surgery does not influence health-related quality of life, it achieves a clinically relevant reduction of pain in ~42.5% of people with diabetic peripheral neuropathy. It can therefore be considered for patients who do not adequately respond to pain medication.
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Affiliation(s)
| | - R T W Oomen
- Department of Plastic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M van Hal
- Department of Plastic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Kon
- Department of Plastic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - E J G Peters
- Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
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Spaans AJ, van Minnen LP, Kon M, Schuurman AH, Schreuders ART, Vermeulen GM. In reply. J Hand Surg Am 2015; 40:1059-60. [PMID: 25911215 DOI: 10.1016/j.jhsa.2015.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 02/22/2015] [Indexed: 02/02/2023]
Affiliation(s)
- Anne J Spaans
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - L Paul van Minnen
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Moshe Kon
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Arnold H Schuurman
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - A R Ton Schreuders
- Department of Rehabilitation Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
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Paes EC, van Nunen DPF, Speleman L, Muradin MSM, Smarius B, Kon M, Mink van der Molen AB, Niers TLEM, Veldhoen ES, Breugem CC. A pragmatic approach to infants with Robin sequence: a retrospective cohort study and presence of a treatment algorithm. Clin Oral Investig 2015; 19:2101-14. [PMID: 25680705 PMCID: PMC4592702 DOI: 10.1007/s00784-015-1407-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 01/14/2015] [Indexed: 11/26/2022]
Abstract
Objectives Initial approaches to and treatments of infants with Robin sequence (RS) is diverse and inconsistent. The care of these sometimes critically ill infants involves many different medical specialties, which can make the decision process complex and difficult. To optimize the care of infants with RS, we present our institution’s approach and a review of the current literature. Material and methods A retrospective cohort study was conducted among 75 infants diagnosed with RS and managed at our institution in the 1996–2012 period. Additionally, the conducted treatment regimen in this paper was discussed with recent literature describing the approach of infants with RS. Results Forty-four infants (59 %) were found to have been treated conservatively. A significant larger proportion of nonisolated RS infants than isolated RS infants needed surgical intervention (53 vs. 25 %, p = .014). A mandibular distraction was conducted in 24 % (n = 18) of cases, a tracheotomy in 9 % (n = 7), and a tongue–lip adhesion in 8 % (n = 6). Seventy-seven percent of all infants had received temporary nasogastric tube feeding. The literature review of 31 studies showed that initial examinations and the indications to perform a surgical intervention varied and were often not clearly described. Conclusions RS is a heterogenic group with a wide spectrum of associated anomalies. As a result, the decisional process is challenging, and a multidisciplinary approach to treatment is desirable. Current treatment options in literature vary, and a more uniform approach is recommended. Clinical Relevance We provide a comprehensive and pragmatic approach to the analysis and treatment of infants with RS, which could serve as useful guidance in other clinics.
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Affiliation(s)
- Emma C Paes
- Department of Plastic, Reconstructive and Hand Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - Daan P F van Nunen
- Department of Plastic, Reconstructive and Hand Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Lucienne Speleman
- Department of Otorhinolaryngology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Marvick S M Muradin
- Department of Oral and Cranio-Maxillofacial Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Bram Smarius
- Department of Plastic, Reconstructive and Hand Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Moshe Kon
- Department of Plastic, Reconstructive and Hand Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | | | - Titia L E M Niers
- Department of Pediatrics, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Esther S Veldhoen
- Department of Pediatrics, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Corstiaan C Breugem
- Department of Plastic, Reconstructive and Hand Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands
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Maarse W, Boonacker CWB, Lapid O, Swanenburg De Veye HFN, Weiner Z, Kon M, van Delden JJM, Mink van der Molen AB. Professional opinion on oral cleft during pregnancy: a comparison between Israel and The Netherlands. Prenat Diagn 2015; 35:544-8. [PMID: 25641702 DOI: 10.1002/pd.4570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 12/07/2014] [Accepted: 01/25/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to assess the opinion of obstetric care providers who perform prenatal ultrasounds to screen for anomalies and who advise women about their options, including termination of pregnancy, when an oral cleft is detected. We compared providers' opinions about pregnancy termination for isolated oral cleft in The Netherlands, where the number of terminations is low, and in Israel, where the number is high. METHODS Online questionnaires were used. The questions assessed the providers' views regarding the estimated burden of treatment, the functioning ability, and the level of happiness of children with an oral cleft and their parents. Additionally, we assessed providers' opinions on pregnancy termination for isolated oral cleft. RESULTS In The Netherlands, more professionals considered oral cleft a disability (rate differences 17.8%, 95% confidence interval: 0.5-33.1%) than in Israel. In the Netherlands, 10.6% of respondents (compared with 11.1% in Israel) thought that an isolated cleft was a reason for terminations of pregnancy (TOP) (rate differences 0.6%, 95% confidence interval: -12% to 10.9%). CONCLUSIONS Prenatal care providers in The Netherlands and Israel do not differ in their opinions about the severity of oral cleft and the acceptability of TOP for an isolated oral cleft. This study shows that prenatal care providers' attitudes do therefore not explain the dramatic difference between these countries in the number of TOP for isolated oral cleft.
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Affiliation(s)
- Wies Maarse
- Department of Plastic and Reconstructive Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Chantal W B Boonacker
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Oren Lapid
- Department of Plastic and Reconstructive Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Zeev Weiner
- Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel
| | - Moshe Kon
- Department of Plastic and Reconstructive Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johannes J M van Delden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Aebele B Mink van der Molen
- Department of Plastic and Reconstructive Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
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Kon M, Suzuki E, Dung V, Hasegawa Y, Mitsui T, Muroya K, Ueoka K, Igarashi N, Nagasaki K, Oto Y, Hamajima T, Yoshino K, Igarashi M, Kato-Fukui Y, Nakabayashi K, Hayashi K, Hata K, Matsubara Y, Moriya K, Ogata T, Nonomura K, Fukami M. Molecular basis of non-syndromic hypospadias: systematic mutation screening and genome-wide copy-number analysis of 62 patients. Hum Reprod 2015; 30:499-506. [DOI: 10.1093/humrep/deu364] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Spaans AJ, van Minnen LP, Kon M, Schuurman AH, Schreuders ART, Vermeulen GM. Conservative treatment of thumb base osteoarthritis: a systematic review. J Hand Surg Am 2015; 40:16-21.e1-6. [PMID: 25534834 DOI: 10.1016/j.jhsa.2014.08.047] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 08/06/2014] [Accepted: 08/07/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To provide a systematic review of randomized controlled trials regarding the conservative treatment of thumb base osteoarthritis (OA). METHODS A systematic literature search was conducted in the electronic bibliographic databases Medline (Pubmed) and Embase (both starting year to May 2014) using predetermined criteria for studies on nonoperative treatment of thumb base OA. RESULTS Twenty-three articles fulfilled our inclusion criteria. Systematic evaluation demonstrated the following: (1) Hand therapy can possibly reduce pain. However, owing to the lack of good-quality (randomized controlled) trials with sufficient follow-up time, no proper conclusions can be drawn. (2) Although both steroid and hyaluronate intra-articular injections can provide pain relief, most authors conclude that injection of hyaluronate is more effective. Follow-up is rather short with a maximum of 12 months in 1 study. Furthermore, study comparison is hampered by heterogeneity of study design and outcome parameters. (3) The use of orthoses reduces pain without effect on function, strength, or dexterity. Included studies used various types of orthoses. Follow-up times varied (2 wk-7 y). (4) There is no justification for the use of transdermal steroid delivery. (5) There is insufficient evidence justifying the use of leech therapy. (6) There are no high-level evidence studies specifically evaluating the effect of analgesics and patient education in joint protection in patients with thumb base OA. CONCLUSIONS There are only a few high-quality studies addressing the conservative treatment of trapeziometacarpal OA. Available evidence suggests only some effect of orthoses and intra-articular hyaluronate or steroid injections.
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Affiliation(s)
- Anne J Spaans
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Centre Utrecht, Utrecht; Department of Rehabilitation Medicine, Erasmus Medical Centre Rotterdam, Rotterdam; Xpert Clinic, Hilversum, The Netherlands.
| | - L Paul van Minnen
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Centre Utrecht, Utrecht; Department of Rehabilitation Medicine, Erasmus Medical Centre Rotterdam, Rotterdam; Xpert Clinic, Hilversum, The Netherlands
| | - Moshe Kon
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Centre Utrecht, Utrecht; Department of Rehabilitation Medicine, Erasmus Medical Centre Rotterdam, Rotterdam; Xpert Clinic, Hilversum, The Netherlands
| | - Arnold H Schuurman
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Centre Utrecht, Utrecht; Department of Rehabilitation Medicine, Erasmus Medical Centre Rotterdam, Rotterdam; Xpert Clinic, Hilversum, The Netherlands
| | - A R Ton Schreuders
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Centre Utrecht, Utrecht; Department of Rehabilitation Medicine, Erasmus Medical Centre Rotterdam, Rotterdam; Xpert Clinic, Hilversum, The Netherlands
| | - Guus M Vermeulen
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Centre Utrecht, Utrecht; Department of Rehabilitation Medicine, Erasmus Medical Centre Rotterdam, Rotterdam; Xpert Clinic, Hilversum, The Netherlands
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Hundepool CA, Ultee J, Nijhuis TH, Houpt P, Hovius SE, Jaquet J, Spauwen P, Hofman A, Ritt M, Kon M. Prognostic factors for outcome after median, ulnar, and combined median–ulnar nerve injuries: A prospective study. J Plast Reconstr Aesthet Surg 2015; 68:1-8. [DOI: 10.1016/j.bjps.2014.09.043] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 08/29/2014] [Accepted: 09/15/2014] [Indexed: 11/29/2022]
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Macaré van Maurik JFM, ter Horst B, van Hal M, Kon M, Peters EJG. Effect of surgical decompression of nerves in the lower extremity in patients with painful diabetic polyneuropathy on stability: a randomized controlled trial. Clin Rehabil 2014; 29:994-1001. [PMID: 25381348 DOI: 10.1177/0269215514556298] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 09/29/2014] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To investigate the effect of decompression of nerves in the lower extremity in patients with painful diabetic polyneuropathy on static balance using a sensitive pressure mat system. DESIGN Non-blinded randomized controlled trial. SETTING Single center study performed at the University Medical Center Utrecht between 2010-2013. SUBJECTS Patients with painful diabetic polyneuropathy assessed with the Diabetic Neuropathy Symptom score and Diabetic Neuropathy Examination between 18-90 years. Exclusion criteria were: physical problems leading to instability, BMI>35 kg/m2, ankle fractures in history, amputations proximal to the tarsometatarsal joints, active foot ulcer(s), severe occlusive peripheral vascular diseases. INTERVENTION Unilateral surgical nerve decompression at four sites in the lower extremity, the contralateral limb was used as control (within-patient comparison), with one year follow-up. MAIN MEASURES Preoperatively and 6 and 12 months postoperatively, weight bearing and five variables of sway of the center of pressure were measured with a pressure mat with eyes open and eyes closed. T-test was used for evaluation of postoperative results. RESULTS Thirty-nine Patients met inclusion criteria and were enrolled for stability testing. Postoperatively no significant differences for sway variables and weight bearing were seen compared to preoperatively measurements. CONCLUSIONS There is no evidence that surgical decompression of nerves of the lower extremity influences stability within one year after surgery in patients with painful diabetic polyneuropathy.
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Affiliation(s)
| | - Britt ter Horst
- Department of Plastic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mireille van Hal
- Department of Plastic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Moshe Kon
- Department of Plastic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Edgar J G Peters
- Department of Medicine, VU university Medical Center, Amsterdam, The Netherlands
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Moriya K, Morita K, Mitsui T, Kitta T, Nakamura M, Kon M, Nonomura K. Impact of laparoscopy for diagnosis and treatment in patients with disorders of sex development. J Pediatr Urol 2014; 10:955-61. [PMID: 24768569 DOI: 10.1016/j.jpurol.2014.03.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 03/24/2014] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To review laparoscopy in patients with disorders of sex development (DSD) in order to clarify its usefulness in diagnosis, devising subsequent therapeutic strategies and managing patients with various conditions. PATIENTS AND METHODS Between April 1992 and December 2012, 29 laparoscopic surgeries were performed in 25 DSD patients. Among them, ten were diagnostic laparoscopy including gonadal biopsy, and 19 were therapeutic laparoscopy. Surgical procedures and complications were evaluated. RESULTS For diagnostic laparoscopy, laparoscopic gonadal biopsy was performed in three patients. Inspection, with or without open gonadal biopsy, was performed on four out of seven patients with 46XY DSD or mixed gonadal dysgenesis (MGD). Additional surgery was planned and performed based on diagnostic laparoscopic findings in six out of seven patients. In the three patients with ovotesticular DSD, the gonadal pathology was diagnosed as: testis/ovary in one, testis/ovotestis in one and ovary/ovotestis in one--this was from the laparoscopic inspection and/or gonadal biopsy. However, the final diagnoses were bilateral ovotestis in two patients and ovary/ovotestis in one patient. For therapeutic laparoscopy, surgical procedures were: gonadectomy in 17 patients (bilateral in 13, unilateral in three, partial in two); hysterectomy in two patients; orchiopexy in one; and sigmoid vaginoplasty in one patient (included multiple procedures). There were no severe perioperative complications. In the four patients with a history of diagnostic laparoscopy, no severe intra-abdominal adhesions that would disturb therapeutic laparoscopic surgery were observed. CONCLUSION While diagnostic laparoscopy was helpful in devising a therapeutic surgical strategy in most of the patients with DSD who were suspected as having complex gonadal status or Müllerian duct derivatives, attention must be paid to precisely diagnosing the gonadal status in ovotesticular DSD. On the other hand, therapeutic laparoscopic surgeries were valuable procedures in treating DSD patients, even with a history of previous diagnostic laparoscopy.
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Affiliation(s)
- K Moriya
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-Ku, Sapporo 060-0824, Japan.
| | - K Morita
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-Ku, Sapporo 060-0824, Japan.
| | - T Mitsui
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-Ku, Sapporo 060-0824, Japan.
| | - T Kitta
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-Ku, Sapporo 060-0824, Japan.
| | - M Nakamura
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-Ku, Sapporo 060-0824, Japan.
| | - M Kon
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-Ku, Sapporo 060-0824, Japan.
| | - K Nonomura
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-Ku, Sapporo 060-0824, Japan.
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Abstract
BACKGROUND F-16 pilots wear an in-flight oxygen mask to prevent hypoxemia. In the contact area with the mask, the pilots experience nasal discomfort and pain, and may even develop nasal deformities. A likely cause is the pressure exerted by the mask. In this study the hypothesis was that the change in pressure exerted on the nose would be higher than on the chin, an area free of symptoms. METHODS Six F-16 pilots and five healthy former F-16 pilots volunteered to participate in this observational pilot study. At baseline the pilots donned mask and helmet. The median delta pressure (deltap) recordings at baseline were compared to the exerted deltap during the experimental head movements. RESULTS At baseline, there was no significant difference between the median deltap on the nose and chin (2 vs. 1.6 mmHg, T = 2). Head movements increased the median deltap on the nose by 50 mmHg (T = 0) and on the chin by 31 mmHg (T = 0) when compared to baseline. Head movements also decreased the pressure by -20 mmHg (T = 1.75) on the nose and -11 mmHg (T = 0) on the chin. CONCLUSIONS The data show that the baseline deltap is higher on the nose than on the chin. The head movements both increased and decreased the exerted pressure on the nose and the chin. These observations suggest that further evaluation of the effect of flight conditions on the exerted pressure is worthwhile to understand its contribution to the nasal symptoms.
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van Nunen DPF, Kolodzynski MN, van den Boogaard MJH, Kon M, Breugem CC. Microtia in the Netherlands: clinical characteristics and associated anomalies. Int J Pediatr Otorhinolaryngol 2014; 78:954-9. [PMID: 24745583 DOI: 10.1016/j.ijporl.2014.03.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 03/07/2014] [Accepted: 03/20/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND In Europe there have been few detailed reports on the clinical characteristics of microtia patient populations. The objective of the present study is to contribute to our insight of microtia in Europe by examining the Dutch microtia population treated in the University Medical Center Utrecht (UMCU) with regards to its clinical features and associated anomalies. In addition, an overview of the literature is provided for thorough comparison. METHODS A retrospective chart review was performed for all microtia patients referred to the UMCU for reconstructive surgery of the auricle over the period 1990-2012. Previous studies were identified by a systematic search of the electronic literature databases PubMed and Embase. In a subsequent meta-analysis the results from the literature review were pooled by geographical region to facilitate comparison. RESULTS A total of 204 microtia patients were referred for reconstructive surgery during 1990-2012. This group was characterized by a male predominance of 60.8%. Unilateral disease was observed in 91.7% of patients, affecting the right auricle in 66.3%. In unilateral patients lobule type microtia was seen in 59.9%, (small) concha type in 34.4% and anotia in 5.7%. The more frequent anomalies associated with microtia were atresia of the acoustic meatus (76.0%), preauricular skin tags (30.5%), hemifacial microsomia (27.5%), facial nerve paralysis (8.3%) and congenital heart disease (2.5%). Familial occurrence of microtia was reported for 2.0% of UMCU patients and for 10.0% of patients in the literature. CONCLUSION The clinical characteristics of microtia in the Netherlands correspond to those reported for other patient populations in the literature. Most congenital anomalies associated with microtia in Dutch patients belong to the Oculo-Auriculo-Vertebral Spectrum. The considerable degree of familial microtia observed in the literature points to a substantial genetic component in the etiology of the condition.
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Affiliation(s)
- Daan P F van Nunen
- Division of Plastic and Reconstructive Surgery; University of Utrecht Medical Center, Heidelberglaan 100, PO Box 85500, 3508 GA Utrecht, The Netherlands.
| | - Mischka N Kolodzynski
- Division of Plastic and Reconstructive Surgery; University of Utrecht Medical Center, Heidelberglaan 100, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Marie-José H van den Boogaard
- Department of Medical Genetics; University of Utrecht Medical Center, Heidelberglaan 100, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Moshe Kon
- Division of Plastic and Reconstructive Surgery; University of Utrecht Medical Center, Heidelberglaan 100, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Corstiaan C Breugem
- Division of Plastic and Reconstructive Surgery; University of Utrecht Medical Center, Heidelberglaan 100, PO Box 85500, 3508 GA Utrecht, The Netherlands.
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van Amerongen EA, Creemers LB, Kaoui N, Bekkers JEJ, Kon M, Schuurman AH. The fixation of a collagen type I/III membrane in the distal radioulnar joint of a human cadaver model. Bone Joint J 2014; 96-B:508-12. [PMID: 24692619 DOI: 10.1302/0301-620x.96b4.32829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Damage to the cartilage of the distal radioulnar joint frequently leads to pain and limitation of movement, therefore repair of this joint cartilage would be highly desirable. The purpose of this study was to investigate the fixation of scaffold in cartilage defects of this joint as part of matrix-assisted regenerative autologous cartilage techniques. Two techniques of fixation of collagen scaffolds, one involving fibrin glue alone and one with fibrin glue and sutures, were compared in artificially created cartilage defects of the distal radioulnar joint in a human cadaver. After being subjected to continuous passive rotation, the methods of fixation were evaluated for cover of the defect and pull out force. No statistically significant differences were found between the two techniques for either cover of the defect or integrity of the scaffold. However, a significantly increased mean pull out force was found for the combined procedure, 0.665 N (0.150 to 1.160) versus 0.242 N (0.060 to 0.730) for glue fixation (p = 0.001). This suggests that although successful fixation of a collagen type I/III scaffold in a distal radioulnar joint cartilage defect is feasible with both forms of fixation, fixation with glue and sutures is preferable.
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Affiliation(s)
- E A van Amerongen
- University Medical Center Utrecht, Department of Plastic, Reconstructive and Hand surgery, P. O. Box 85500, 3508 GA, The Netherlands
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de Graaf M, Raphael M, Breugem C, Knol M, Bruijnzeel-Koomen C, Kon M, Breur J, Pasmans S. Response from the authors of ‘Treatment of infantile haemangiomas with atenolol: Comparison with a historical propranolol group’. J Plast Reconstr Aesthet Surg 2014; 67:411-2. [DOI: 10.1016/j.bjps.2013.10.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 10/14/2013] [Indexed: 10/26/2022]
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Overgoor ML, Braakhekke JP, Kon M, De Jong TP. Restoring penis sensation in patients with low spinal cord lesions: The role of the remaining function of the dorsal nerve in a unilateral or bilateral TOMAX procedure. Neurourol Urodyn 2014; 34:343-8. [DOI: 10.1002/nau.22566] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 01/06/2014] [Indexed: 12/23/2022]
Affiliation(s)
- Max L.E. Overgoor
- Department of Plastic; Reconstructive and Hand Surgery; Isala Clinics; Zwolle The Netherlands
| | - Jan P. Braakhekke
- Department of Neurology and Clinical Neurophysiology; Isala Clinics; Zwolle The Netherlands
| | - Moshe Kon
- Division of Plastic; Reconstructive and Hand Surgery; University Medical Centre; Utrecht The Netherlands
| | - Tom P.V.M. De Jong
- Paediatric Renal Centre; Department of Paediatric Urology; University Children's Hospital; UMC Utrecht and AMC Amsterdam; The Netherlands
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Mitsui T, Moriya K, Kitta T, Kon M, Nonomura K. Preoperative renal scar as a risk factor of postoperative metabolic acidosis following ileocystoplasty in patients with neurogenic bladder. Spinal Cord 2014; 52:292-4. [DOI: 10.1038/sc.2013.175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 12/08/2013] [Accepted: 12/17/2013] [Indexed: 11/09/2022]
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Kon M, van Wijk MP. T-bar reconstruction of constricted ears and a new classification. J Plast Reconstr Aesthet Surg 2014; 67:358-61. [PMID: 24461552 DOI: 10.1016/j.bjps.2013.12.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Revised: 11/19/2013] [Accepted: 12/17/2013] [Indexed: 11/27/2022]
Abstract
For the correction of constricted ears, many techniques are described in the literature, the majority based on Tanzer's classification of 1975. The improvements in ear reconstruction published by Brent, Nagata, Firmin and Park make better outcomes possible. It is therefore that a new classification for constricted ears is proposed, together with an alternative technique for correction of group IIA and IIB deformities, using a T-strut of costal cartilage to reconstruct the underdeveloped or missing superior crus of the antihelix.
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Affiliation(s)
- M Kon
- Dutch Center for Ear Reconstruction, Department of Plastic, Reconstructive and Handsurgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - M P van Wijk
- Department of Plastic, Reconstructive and Handsurgery, Isala Klinieken Zwolle, PO Box 10400, 8000 GK Zwolle, The Netherlands.
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Macaré van Maurik JFM, Schouten MEL, ten Katen I, van Hal M, Peters EJG, Kon M. Ultrasound findings after surgical decompression of the tarsal tunnel in patients with painful diabetic polyneuropathy: a prospective randomized study. Diabetes Care 2014; 37:767-72. [PMID: 24379356 DOI: 10.2337/dc13-1787] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE It has been hypothesized that the development of diabetic polyneuropathy (DPN) is due to swelling of the nerve, as well as thickening and stiffening of the surrounding ligaments, causing chronic compression of nerves. We aimed to examine the effect of surgical decompression of the tibial nerve on the mean cross-sectional area (CSA). RESEARCH DESIGN AND METHODS We performed a randomized controlled trial of 42 subjects with painful DPN diagnosed using the Diabetic Neuropathy Score. A computer randomized for the surgery arm of the study. A control group consisting of 38 healthy subjects was included. An experienced sonographer measured the CSA and thickness-to-width (T/W) ratio of the tibial nerve, as well as the thickness of the flexor retinaculum. RESULTS CSA is significantly larger in patients with painful DPN (8.4 ± 3.9 mm(2)) than in control subjects (6.4 ± 1.3 mm(2)), P = 0.007. The T/W ratio in patients with painful DPN is 0.64 and in control subjects 0.59, P = 0.03. Patients with DPN have a significantly thicker retinaculum (1.07 mm) than control subjects (0.84 mm), P < 0.001. Mean follow-up was 28.2 weeks (range 23-45). Difference between baseline and follow-up in the operated leg was 1.49 mm(2) and in the control leg 1.81 mm(2), P = 0.674. CONCLUSIONS Decompression of the tibial nerve does not result in a significant difference between baseline and follow-up in CSA using ultrasound between the operated and control leg. Ultrasound measurements show a significantly increased CSA, a significantly thicker retinaculum, and a significantly increased T/W ratio in patients with painful DPN compared with healthy control subjects. Clinical trial reg. no. NTR2344, www.trialregister.nl.
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Schreinemakers JRC, Oudenhuijzen AJK, van Amerongen PCGM, Kon M. Oxygen mask fit analysis in F-16 fighter pilots using 3D imaging. ACTA ACUST UNITED AC 2013; 84:1029-33. [PMID: 24261054 DOI: 10.3357/asem.3611.2013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND The majority of Dutch F-16 pilots experience in-flight oxygen mask related nasal discomfort and injury. We aimed to analyze the fit of the oxygen mask. METHODS We successfully scanned 35 pilots with a 3D scanner to measure the distance between the contact area on the nose and the oxygen mask in seven points, and the difference (delta) in angle between the nose and the mask relative to the facial midline. Ill fit was defined as > or = 4 mm distance, or delta > or = 4 degree angle. Intraclass correlation coefficients were used to objectify the reproducibility of the measurements. RESULTS There were 35 pilots who had > or = 4 mm distance between the nasal dorsum and the mask and 14 pilots had delta > or = 4 degree angle. Reproducibility of the distance measurements was excellent (R > or = 0.93, CI 95% 0.86-0.96) and of the angle measurements was good (R = 0.72, CI 95% 0.5-0.8). CONCLUSION The room for displacement that we found may be a contributor to the discomfort. It is indicative of an ill fit of the oxygen mask, since all subjects had complaints. We recommend evaluating whether improved fixation of the mask and simultaneous reduction of the pressure on the nose will improve comfort.
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Affiliation(s)
- J Rieneke C Schreinemakers
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
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de Vries IAC, Breugem CC, van der Heul AMB, Eijkemans MJC, Kon M, Mink van der Molen AB. Prevalence of feeding disorders in children with cleft palate only: a retrospective study. Clin Oral Investig 2013; 18:1507-15. [PMID: 24122307 DOI: 10.1007/s00784-013-1117-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 09/24/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The purpose of this study in children with cleft palate only (CPO) is to (1) explore the prevalence of feeding problems on a retrospective basis, (2) investigate rates of nasogastric (NG) feeding, (3) examine the prevalence of associated disorders and/or syndromes (AssD/S), (4) investigate if there are certain risk factors associated with feeding difficulties, NG feeding, and failure of breastfeeding, and (5) investigate the effect of palatoplasty on feeding difficulties. MATERIALS AND METHODS In total, 90 questionnaires were included in this study. The medical records were reviewed. RESULTS Feeding difficulties were reported in 67% (n = 60) of all cases. NG feeding was given in 32% (n = 28) of all children. Forty-nine children (54%) have associated malformations. There is no significant relation for gender, gestational age, and birth weight as risk factors for feeding difficulties, NG feeding, and failure of breastfeeding. The severity of the cleft is significantly related to the prevalence of AssD/S. After palatoplasty, feeding difficulties improved in 79% of the CPO children. CONCLUSIONS AND CLINICAL RELEVANCE First, our results clearly indicate that children with CPO are at high risk of developing feeding difficulties (67%); NG feeding is often necessary (32%). Second, our results also indicate that the more severe the cleft, the more likely the chance for AssD/S. Third, the severity of the cleft is significantly related to the prevalence of AssD/S. Fourth, there is no significant relation for gender, gestational age, and birth weight as risk factors for feeding difficulties, NG feeding, and failure of breastfeeding. Fifth, improvement of feeding difficulties after surgery supports the importance of the soft palate closure in relation to sucking patterns and feeding skills.
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Affiliation(s)
- I A C de Vries
- Department of Paediatric Plastic Surgery, Wilhelmina Children's Hospital, PO Box 85500, 3508, GA, Utrecht, The Netherlands,
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Teunis T, Beekhuizen M, Kon M, Creemers LB, Schuurman AH, van Minnen LP. Inflammatory mediators in posttraumatic radiocarpal osteoarthritis. J Hand Surg Am 2013; 38:1735-40. [PMID: 23932814 DOI: 10.1016/j.jhsa.2013.06.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 06/17/2013] [Accepted: 06/19/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To identify the mediator profile in healthy, pre-osteoarthritis (OA) and end-stage OA radiocarpal joints. We hypothesized that there would be an increase in soluble mediators in posttraumatic wrist OA. METHODS We obtained radiocarpal synovial fluid samples from 3 groups of patients: healthy control (n = 12) samples were collected during wrist ganglion resection; pre-osteoarthritic (n = 16) samples, during a 3-ligament tenodesis procedure for complete scapholunate dissociation; and end-stage OA (n = 20) samples in patients with proven radiological OA changes. Using a multiplex enzyme-linked immunosorbent assay, we measured 12 mediators: interleukin (IL)-1β, tumor necrosis factor-α, oncostatin-M, interferon-γ, IL-4, IL-6, IL-7, IL-8, IL-10, IL-13, IL-1RA, and osteoprotegerin. Statistical analysis was performed using analysis of variance and Bonferroni-corrected post hoc tests. RESULTS Mediators IL-6, IL-10, and interferon-γ were increased in OA wrists compared to healthy and pre-OA samples. Tumor necrosis factor-α, oncostatin-M, osteoprotegerin, IL-8, and IL-1RA were detected but not at increased levels in OA wrists. We found no differences between healthy and pre-OA joints in all 12 mediators. Mediators IL-4, IL-7, IL-13, and IL-1β were not detected in either healthy, pre-OA or end-stage OA samples. CONCLUSIONS We identified no differences between healthy and pre-OA samples, suggesting no alteration in inflammatory status at the time of the 3-ligament tenodesis procedure. Consequently, mechanical disturbance seems to be the driving force toward OA and OA-associated inflammation in this stage of scapholunate dissociation. Increased levels of interferon-γ, IL-6, and IL-10 confirm inflammatory changes in the mechanically disturbed posttraumatic radiocarpal joint.
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Affiliation(s)
- T Teunis
- Department of Plastic Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
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