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Susarla SM. Pediatric Craniomaxillofacial Pathology. Oral Maxillofac Surg Clin North Am 2024:S1042-3699(24)00030-X. [PMID: 38760199 DOI: 10.1016/j.coms.2024.04.002] [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: 05/19/2024]
Affiliation(s)
- Srinivas M Susarla
- Craniofaical Center, Seattle Children's Hospital, 4800 Sand Point Way Northeast, Seattle, WA 98105, USA.
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2
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Linkugel AD, Markiewicz M, Edwards S, Susarla SM. Conceptual Principles in Pediatric Craniomaxillofacial Reconstruction. Oral Maxillofac Surg Clin North Am 2024:S1042-3699(24)00028-1. [PMID: 38705817 DOI: 10.1016/j.coms.2024.03.006] [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] [Indexed: 05/07/2024]
Abstract
Pediatric craniomaxillofacial reconstruction must be approached through the lens of growth and durability. A systematic approach of matching defects to donor tissue drives the selection of autologous donor material. The menu of available techniques for reconstruction can be organized in a ladder, similar to adults, with additional considerations. Reconstructive surgeons have the opportunity to promote and maintain young patients' sense of identity during their psychosocial development.
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Affiliation(s)
- Andrew D Linkugel
- Craniofacial Center, Seattle Children's Hospital, 4800 Sand Point Way NorhtEast, Seattle, WA 98105, USA; Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Michael Markiewicz
- Department of Oral and Maxillofacial Surgery, University at Buffalo School of Dental Medicine, 3435 Main Street, 112 Squire Hall, Buffalo NY 14214, USA
| | - Sean Edwards
- Department of Oral & Maxillofacial Surgery, University of Michigan School of Dentistry, 2200 Vinewood Boulevard, Ann Arbor, MI 48104, USA
| | - Srinivas M Susarla
- Craniofacial Center, Seattle Children's Hospital, 4800 Sand Point Way NorhtEast, Seattle, WA 98105, USA; Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA; Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, WA, USA.
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3
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Susarla SM, Friedrich JB, Chung KC. The "Loss Years" of Residency Education: Overcoming COVID-19 Learning Gaps among Trainees. Plast Reconstr Surg 2024; 153:1199-1201. [PMID: 38657015 DOI: 10.1097/prs.0000000000011220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Affiliation(s)
- Srinivas M Susarla
- From the Craniofacial Center, Seattle Children's Hospital
- Department of Surgery, Division of Plastic Surgery, University of Washington School of Medicine
| | - Jeffrey B Friedrich
- Department of Surgery, Division of Plastic Surgery, University of Washington School of Medicine
| | - Kevin C Chung
- Department of Surgery, Division of Plastic Surgery, University of Michigan Medical School
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4
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Chen L, Mercan E, Massenburg BB, Hopper RA, Susarla SM, Lee A, Ellenbogen RG, Birgfeld CB. Comparison of Morphometric Outcomes following Open Posterior Expansion versus Endoscopic Strip Craniectomy for Sagittal Synostosis. Plast Reconstr Surg 2024; 153:1095-1106. [PMID: 37199432 DOI: 10.1097/prs.0000000000010679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
BACKGROUND Open middle and posterior cranial vault expansion (OPVE) or endoscopic (ES) strip craniectomy are two surgical techniques for normalization of head shape in isolated sagittal synostosis. This study aims to compare 2-year cranial morphometrics after these two approaches. METHODS The authors performed morphometric analysis on preoperative [time (T) 0], immediately postoperative (T1), and 2-year (T2) postoperative computed tomographic scans of patients who underwent OPVE or ES before 4 months of age. Perioperative data and morphometrics were compared between the two groups and age-matched controls. RESULTS Nineteen patients were included in the ES cohort, 19 age-matched patients were included in the OPVE cohort, and 57 were included as controls. Median surgery time and blood transfusion volume were less for the ES approach (118 minutes and 0 cc, respectively) compared with OPVE (204 minutes and 250 cc, respectively). Anthropometric measurements after OPVE were closer in normal controls at T1 compared with ES, but the skull shapes were comparable at T2. In the midsagittal plane, anterior vault was higher after OPVE at T2 compared with both ES and controls, but the posterior length was shorter and closer to controls than in the ES cohort. Cranial volumes were like controls for both cohorts at T2. There was no difference in complication rate. CONCLUSIONS Both OPVE and ES techniques result in normalization of cranial shape in patients with isolated sagittal synostosis after 2 years with minimal morphometric differences. Family decision-making between the two approaches should be based on age at presentation, avoidance of blood transfusion, scar pattern, and availability of helmet molding and not on expected outcome. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Leah Chen
- From the University of Washington School of Medicine
| | - Ezgi Mercan
- Craniofacial Center, Seattle Children's Hospital
| | | | - Richard A Hopper
- Craniofacial Center, Seattle Children's Hospital
- Division of Plastic Surgery, Department of Surgery
| | - Srinivas M Susarla
- Craniofacial Center, Seattle Children's Hospital
- Division of Plastic Surgery, Department of Surgery
| | - Amy Lee
- Craniofacial Center, Seattle Children's Hospital
- Department of Neurological Surgery, University of Washington
| | - Richard G Ellenbogen
- Craniofacial Center, Seattle Children's Hospital
- Department of Neurological Surgery, University of Washington
| | - Craig B Birgfeld
- Craniofacial Center, Seattle Children's Hospital
- Division of Plastic Surgery, Department of Surgery
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5
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Ruthberg JS, Susarla SM, Bly RA. Head and Neck Vascular Anomalies in Children. Oral Maxillofac Surg Clin North Am 2024:S1042-3699(24)00024-4. [PMID: 38632013 DOI: 10.1016/j.coms.2024.03.002] [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] [Indexed: 04/19/2024]
Abstract
Craniomaxillofacial vascular anomalies encompass a diverse and complex set of pathologies that may have a profound impact on pediatric patients. They are subdivided into vascular tumors and vascular malformations depending on biological properties, clinical course, and distribution patterns. Given the complexity and potential for leading to significant functional morbidity and esthetic concerns, a multidisciplinary approach is generally necessary to optimize patient outcomes. This article reviews the etiology, clinical course, diagnosis, and current management practices related to vascular anomalies in the head and neck.
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Affiliation(s)
- Jeremy S Ruthberg
- Department of Otolaryngology-Head and Neck Surgery, University of Washington Medical Center, 1959 Northeast Pacific Street, UW Box 356515, Seattle, WA 98195, USA.
| | - Srinivas M Susarla
- Division of Craniofacial Plastic Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, OB.9.520, Seattle, WA 98105, USA
| | - Randall A Bly
- Department of Otolaryngology-Head and Neck Surgery, University of Washington Medical Center, 1959 Northeast Pacific Street, UW Box 356515, Seattle, WA 98195, USA; Division of Pediatric Otolaryngology-Head and Neck Surgery, University of Washington Medical Center, 1959 Northeast Pacific Street, UW Box 356515, Seattle, WA 98195, USA
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6
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Amin SN, Siu JM, Purcell PL, Manning JP, Wright J, Dahl JP, Hauptman JS, Hopper RA, Lee A, Manning SC, Perkins JN, Susarla SM, Bly RA. Preoperative Imaging and Surgical Findings in Pediatric Frontonasal Dermoids. Laryngoscope 2024; 134:1961-1966. [PMID: 37776254 DOI: 10.1002/lary.31079] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/21/2023] [Accepted: 09/15/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVE To review cases of congenital frontonasal dermoids to gain insight into the accuracy of preoperative computed tomography (CT) and magnetic resonance imaging (MRI) in predicting intracranial extension. METHODS This retrospective study included all patients who underwent primary excision of frontonasal dermoids at an academic children's hospital over a 23-year period. Preoperative presentation, imaging, and operative findings were reviewed. Receiver operating characteristic (ROC) statistics were generated to determine CT and MRI accuracy in detecting intracranial extension. RESULTS Search queries yielded 129 patients who underwent surgical removal of frontonasal dermoids over the study period with an average age of presentation of 12 months. Preoperative imaging was performed on 122 patients, with 19 patients receiving both CT and MRI. CT and MRI were concordant in the prediction of intracranial extension in 18 out of 19 patients. Intraoperatively, intracranial extension requiring craniotomy was seen in 11 patients (8.5%). CT was 87.5% sensitive and 97.4% specific for predicting intracranial extension with an ROC of 0.925 (95% CI [0.801, 1]), whereas MRI was 60.0% sensitive and 97.8% specific with an ROC of 0.789 (95% CI [0.627, 0.950]). CONCLUSION This is the largest case series in the literature describing a single institution's experience with frontonasal dermoids. Intracranial extension is rare and few patients required craniotomy in our series. CT and MRI have comparable accuracy at detecting intracranial extension. Single-modality imaging is recommended preoperatively in the absence of other clinical indications. LEVEL OF EVIDENCE 4 Laryngoscope, 134:1961-1966, 2024.
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Affiliation(s)
- Shaunak N Amin
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
| | - Jennifer M Siu
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Patricia L Purcell
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - James P Manning
- Utah Facial Plastics and Aesthetics, Salt Lake City, Utah, U.S.A
| | - Jason Wright
- Department of Radiology, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - John P Dahl
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Jason S Hauptman
- Division of Pediatric Neurosurgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Richard A Hopper
- Division of Craniofacial Plastic Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Amy Lee
- Division of Pediatric Neurosurgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Scott C Manning
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - J Nathaniel Perkins
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Srinivas M Susarla
- Division of Craniofacial Plastic Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Randall A Bly
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
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Sanati-Mehrizy P, Hopper RA, Susarla SM. Discussion: Improved Facial and Skull-Base Symmetry following Osteotomy and Distraction of Unilateral Coronal Synostosis. Plast Reconstr Surg 2024; 153:457-460. [PMID: 38266138 DOI: 10.1097/prs.0000000000010778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Affiliation(s)
- Paymon Sanati-Mehrizy
- From the Craniofacial Center, Divisions of Plastic and Craniofacial Surgery and Oral and Maxillofacial Surgery, Seattle Children's Hospital
| | - Richard A Hopper
- From the Craniofacial Center, Divisions of Plastic and Craniofacial Surgery and Oral and Maxillofacial Surgery, Seattle Children's Hospital
| | - Srinivas M Susarla
- From the Craniofacial Center, Divisions of Plastic and Craniofacial Surgery and Oral and Maxillofacial Surgery, Seattle Children's Hospital
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Zammit D, Ettinger RE, Sanati-Mehrizy P, Susarla SM. Current Trends in Orthognathic Surgery. Medicina (Kaunas) 2023; 59:2100. [PMID: 38138203 PMCID: PMC10744503 DOI: 10.3390/medicina59122100] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/14/2023] [Accepted: 11/24/2023] [Indexed: 12/24/2023]
Abstract
Orthognathic surgery has evolved significantly over the past century. Osteotomies of the midface and mandible are contemporaneously used to perform independent or coordinated movements to address functional and aesthetic problems. Specific advances in the past twenty years include increasing fidelity with computer-assisted planning, the use of patient-specific fixation, expanding indications for management of upper airway obstruction, and shifts in orthodontic-surgical paradigms. This review article serves to highlight the contemporary practice of orthognathic surgery.
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Affiliation(s)
- Domenick Zammit
- Department of Pediatric Surgery, Division of Plastic Surgery, McGill University Health Center, Montreal Children’s Hospital, Montreal, QC H3Z 1X3, Canada;
| | - Russell E. Ettinger
- Department of Surgery, Division of Plastic Surgery, University of Washington, Seattle, WA 98105, USA
- Craniofacial Center, Seattle Children’s Hospital, Seattle, WA 98105, USA
| | - Paymon Sanati-Mehrizy
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA;
| | - Srinivas M. Susarla
- Department of Surgery, Division of Plastic Surgery, University of Washington, Seattle, WA 98105, USA
- Craniofacial Center, Seattle Children’s Hospital, Seattle, WA 98105, USA
- Department of Oral and Maxillofacial Surgery, University of Washington, Seattle, WA 98195, USA
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Daneshgaran G, Lu GN, Otto R, Susarla SM. Spontaneous Regeneration of the Ramus-Condyle Unit Following Severe Avulsion Injury in a Child. Facial Plast Surg Aesthet Med 2023. [PMID: 38016289 DOI: 10.1089/fpsam.2023.0265] [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: 11/30/2023] Open
Affiliation(s)
- Giulia Daneshgaran
- Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, Washington, USA
| | - G Nina Lu
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Randolph Otto
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Srinivas M Susarla
- Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, Washington, USA
- Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA
- Department of Oral and Maxillofacial Surgery, University of Washington, Seattle, Washington, USA
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Bhat A, Lim R, Egbert MA, Susarla SM. Pediatric Le Fort, Zygomatic, and Naso-Orbito-Ethmoid Fractures. Oral Maxillofac Surg Clin North Am 2023; 35:563-575. [PMID: 37302948 DOI: 10.1016/j.coms.2023.04.004] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Fractures of the pediatric midface are infrequent, particularly in children in the primary dentition, due to the prominence of the upper face relative to the midface and mandible. With downward and forward growth of the face, there is an increasing frequency of midface injuries seen in children in the mixed and adult dentitions. Midface fracture patterns seen in young children are quite variable; those in children at or near skeletal maturity mimic patterns seen in adults. Non-displaced injuries can typically be managed with observation. Displaced fractures require treatment with appropriate reduction and fixation and longitudinal follow-up to evaluate growth.
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Affiliation(s)
- Aparna Bhat
- Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, 1959 NE Pacific Street, B-307, Seattle, WA 98195, USA
| | - Rachel Lim
- Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, 1959 NE Pacific Street, B-307, Seattle, WA 98195, USA
| | - Mark A Egbert
- Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, 1959 NE Pacific Street, B-307, Seattle, WA 98195, USA; Department of Surgery, Division of Plastic Surgery, University of Washington School of Medicine, 1959 NE Pacific Street, B-307, Seattle, WA 98195, USA; Craniofacial Center, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98015, USA
| | - Srinivas M Susarla
- Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, 1959 NE Pacific Street, B-307, Seattle, WA 98195, USA; Department of Surgery, Division of Plastic Surgery, University of Washington School of Medicine, 1959 NE Pacific Street, B-307, Seattle, WA 98195, USA; Craniofacial Center, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98015, USA.
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Susarla SM. Pediatric Craniomaxillofacial Trauma. Oral Maxillofac Surg Clin North Am 2023; 35:xiii. [PMID: 37402601 DOI: 10.1016/j.coms.2023.06.001] [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] [Indexed: 07/06/2023]
Affiliation(s)
- Srinivas M Susarla
- Craniofacial Center, Seattle Children's Hospital, 4800 Sand Point Way Northeast, Seattle, WA 98105, USA.
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12
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Pan J, Boop SH, Barber JK, Susarla SM, Durfy S, Ojemann JG, Goldstein HE, Lee A, Browd S, Ellenbogen RG, Hauptman JS. Perioperative complications and secondary retethering after pediatric tethered cord release surgery. J Neurosurg Pediatr 2023; 32:607-616. [PMID: 37728397 DOI: 10.3171/2023.6.peds23259] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 06/16/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE Tethered cord syndrome refers to a constellation of symptoms characterized by neurological, musculoskeletal, and urinary symptoms, caused by traction on the spinal cord, which can be secondary to various etiologies. Surgical management of simple tethered cord etiologies (e.g., fatty filum) typically consists of a single-level lumbar laminectomy, intradural exploration, and coagulation and sectioning of the filum. More complex etiologies such as lipomyelomeningoceles or scar formation after myelomeningocele repair involve complex dissection and dural reconstruction. The purpose of this study was to evaluate operative complications and long-term outcomes of secondary retethering related to pediatric tethered cord release (TCR) at a tertiary children's hospital. METHODS Medical records of children who underwent surgery for TCR from July 2014 to March 2023 were retrospectively reviewed. Data collected included demographics, perioperative characteristics, surgical technique, and follow-up duration. Primary outcomes were 60-day postoperative complications and secondary retethering requiring repeat TCR surgery. Univariate and multivariate analyses were performed to identify risk factors associated with complications and secondary retethering. RESULTS A total of 363 TCR surgeries (146 simple, 217 complex) in 340 patients were identified. The mean follow-up was 442.8 ± 662.2 days for simple TCRs and 733.9 ± 750.3 days for complex TCRs. The adjusted 60-day complication-free survival rate was 96.3% (95% CI 91.3%-98.4%) for simple TCRs and 88.7% (95% CI 82.3%-91.4%) for complex TCRs. Lower weight, shorter surgical times, and intensive care unit admission were associated with complications for simple TCRs. Soft-tissue drains increased complications for complex TCRs. The secondary retethering rates were 1.4% for simple TCRs and 11.9% for complex TCRs. The 1-, 3-, and 5-year progression-free survival rates in complex cases were 94.7% (95% CI 89.1%-97.4%), 77.7% (95% CI 67.3%-85.3%), and 62.6% (95% CI 46.5%-75.1%), respectively. Multivariate analysis revealed that prior detethering (OR 8.15, 95% CI 2.33-28.50; p = 0.001) and use of the operative laser (OR 10.43, 95% CI 1.36-80.26; p = 0.024) were independently associated with secondary retethering in complex cases. CONCLUSIONS This is the largest series to date examining postoperative complications and long-term secondary retethering in TCR surgery. Simple TCR surgeries demonstrated safety, rare complications, and low secondary retethering rates. Complex TCR surgeries presented higher risks of complications and secondary retethering. Modifiable risk factors such as operative laser use influenced secondary retethering in complex cases.
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Affiliation(s)
- James Pan
- 1Department of Neurological Surgery, University of Washington, Seattle
- 3Division of Neurosurgery, Seattle Children's Hospital, Seattle, Washington
| | - Scott H Boop
- 1Department of Neurological Surgery, University of Washington, Seattle
| | - Jason K Barber
- 1Department of Neurological Surgery, University of Washington, Seattle
| | - Srinivas M Susarla
- 2Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Washington, Seattle; and
| | - Sharon Durfy
- 1Department of Neurological Surgery, University of Washington, Seattle
| | - Jeffrey G Ojemann
- 1Department of Neurological Surgery, University of Washington, Seattle
- 3Division of Neurosurgery, Seattle Children's Hospital, Seattle, Washington
| | - Hannah E Goldstein
- 1Department of Neurological Surgery, University of Washington, Seattle
- 3Division of Neurosurgery, Seattle Children's Hospital, Seattle, Washington
| | - Amy Lee
- 1Department of Neurological Surgery, University of Washington, Seattle
- 3Division of Neurosurgery, Seattle Children's Hospital, Seattle, Washington
| | - Samuel Browd
- 1Department of Neurological Surgery, University of Washington, Seattle
- 3Division of Neurosurgery, Seattle Children's Hospital, Seattle, Washington
| | - Richard G Ellenbogen
- 1Department of Neurological Surgery, University of Washington, Seattle
- 3Division of Neurosurgery, Seattle Children's Hospital, Seattle, Washington
| | - Jason S Hauptman
- 1Department of Neurological Surgery, University of Washington, Seattle
- 3Division of Neurosurgery, Seattle Children's Hospital, Seattle, Washington
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13
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McAvoy M, Hopper RA, Lee A, Ellenbogen RG, Susarla SM. Pediatric Cranial Vault and Skull Base Fractures. Oral Maxillofac Surg Clin North Am 2023; 35:597-606. [PMID: 37442667 DOI: 10.1016/j.coms.2023.04.008] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
Cranial vault and skull base fractures in children are distinctly different from those seen in adults. Pediatric skull fractures have the benefit of greater capacity to remodel; however, the developing pediatric brain and craniofacial skeleton present unique challenges to diagnosis, natural history, and management. This article discusses the role of surgical treatment of these fractures, its indications, and techniques.
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Affiliation(s)
- Malia McAvoy
- Department of Neurosurgery; Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Craniofacial Center, Seattle Children's Hospital, Seattle, WA, USA
| | - Richard A Hopper
- Department of Neurosurgery; Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Craniofacial Center, Seattle Children's Hospital, Seattle, WA, USA
| | - Amy Lee
- Department of Neurosurgery; Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Craniofacial Center, Seattle Children's Hospital, Seattle, WA, USA
| | - Richard G Ellenbogen
- Department of Neurosurgery; Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Craniofacial Center, Seattle Children's Hospital, Seattle, WA, USA
| | - Srinivas M Susarla
- Department of Neurosurgery; Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Craniofacial Center, Seattle Children's Hospital, Seattle, WA, USA.
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14
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Shakir S, Ettinger RE, Susarla SM, Birgfeld CB. Pediatric Panfacial Fractures. Oral Maxillofac Surg Clin North Am 2023; 35:607-617. [PMID: 37280142 DOI: 10.1016/j.coms.2023.04.006] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Pediatric panfacial trauma is a rare occurrence with poorly understood implications for the growing child. Treatment algorithms largely mirror adult panfacial protocols with notable exceptions including augmented healing and remodeling capacities that favor nonoperative management, limited exposure to avoid disruption of osseous suture and synchondroses growth centers, and creative fracture fixation techniques in the setting of an immature craniomaxillofacial skeleton. The following article provides a review of our institutional philosophy in the management of these challenges injuries with important anatomic, epidemiologic, examination, sequencing, and postoperative considerations.
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Affiliation(s)
- Sameer Shakir
- Division of Plastic Surgery, Children's Wisconsin, Milwaukee, WI, USA.
| | - Russell E Ettinger
- Department of Surgery, Division of Plastic Surgery, University of Washington, 4800 Sand Point Way NE, M/S OB.9.520, Seattle, WA 98150, USA; Craniofacial Center, Seattle Children's Hospital, 4800 Sand Point Way NE, M/S OB.9.520, Seattle, WA 98150, USA
| | - Srinivas M Susarla
- Department of Surgery, Division of Plastic Surgery, University of Washington, 4800 Sand Point Way NE, M/S OB.9.520, Seattle, WA 98150, USA; Craniofacial Center, Seattle Children's Hospital, 4800 Sand Point Way NE, M/S OB.9.520, Seattle, WA 98150, USA
| | - Craig B Birgfeld
- Department of Surgery, Division of Plastic Surgery, University of Washington, 4800 Sand Point Way NE, M/S OB.9.520, Seattle, WA 98150, USA; Craniofacial Center, Seattle Children's Hospital, 4800 Sand Point Way NE, M/S OB.9.520, Seattle, WA 98150, USA
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15
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Dabestani PJ, Massenburg BB, Aurit S, Dawson AJ, Susarla SM. Risk factors for inpatient hospital admission following isolated orbital floor fractures. Int J Oral Maxillofac Surg 2023; 52:1039-1048. [PMID: 37003906 DOI: 10.1016/j.ijom.2023.03.005] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/11/2023] [Accepted: 03/15/2023] [Indexed: 04/03/2023]
Abstract
Orbital floor fractures are common injuries seen in the emergency department (ED). In this study, the National Trauma Data Bank (NTDB, 2016-2017) was used to identify patients presenting with isolated orbital floor trauma. Patient-specific factors were analyzed to determine associations with management. The sample comprised 912 patients; 285 (31.3%) of these patients were discharged from the ED, 541 (59.3%) were admitted to the hospital but did not undergo an operation, and 86 (9.4%) underwent operative treatment. Pediatric patients and older patients (<18 years and>55 years) were more likely to be admitted than those aged 18-55 years, and pediatric patients were more likely to undergo an urgent operative intervention than those in the other age groups (all P < 0.001). Patients with alcohol use disorder (P = 0.002) and hypertension (P = 0.004) had increased odds of admission. Private and Medicare insurance patients were more likely to be admitted, and self-pay patients less likely (P < 0.001). Older age and Medicaid payor status showed increased odds of a greater hospital length of stay. Biological sex, race/ethnicity, functionally dependent health status, myocardial infarction, steroid use, and substance use disorder were not associated with discharge disposition. There are non-injury related, patient-specific factors that may influence the management of orbital floor fractures.
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Affiliation(s)
- P J Dabestani
- Division of Plastic and Reconstructive Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - B B Massenburg
- Department of Oral and Maxillofacial Surgery and Department of Surgery, Division of Plastic Surgery, University of Washington, Seattle, Washington, USA
| | - S Aurit
- Division of Plastic and Reconstructive Surgery, Creighton University, Omaha, Nebraska, USA
| | - A J Dawson
- Division of Plastic and Reconstructive Surgery, Creighton University, Omaha, Nebraska, USA
| | - S M Susarla
- Department of Oral and Maxillofacial Surgery and Department of Surgery, Division of Plastic Surgery, University of Washington, Seattle, Washington, USA.
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16
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Tolley PD, Massenburg BB, Higgins J, Ettinger RE, Susarla SM. DOES THE LOW AND SHORT MEDIAL CUT AFFECT LINGUAL NERVE RECOVERY AFTER SAGITTAL SPLIT OSTEOTOMY? Plast Reconstr Surg 2023:00006534-990000000-02107. [PMID: 37678809 DOI: 10.1097/prs.0000000000011047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
PURPOSE To evaluate the recovery of lingual nerve (LN) neurosensory function in patients undergoing sagittal split osteotomy (SSO) with a low and short medial horizontal cut. MATERIALS AND METHODS This was a prospective study of patients with mandibular deformities undergoing SSO with a low and short medial horizontal cut over a 4-year period. The outcomes of interest were neurosensory recovery of the LN, as assessed objectively using functional sensory recovery (FSR) and subjectively by patient report. RESULTS The sample included 123 SSOs in 62 subjects with a mean age of 19.3 ± 3.1 years. Thirty-seven (61.7%) subjects were female. Mandibular advancements were performed in 52 SSOs (42.3%); mandibular setbacks were performed in 71 SSOs (57.7%). One subject underwent revision BSSO. FSR was achieved at 122 LNs (99.1%) within 6-weeks post-operatively, with 120 sites (97.5%) having S4 sensation at 6-weeks. Decreased LN sensation was reported at 10 (8.3%) sites at 1-week post-operatively. At 6-weeks post-operatively, 118 sites (97.5%) had reported normal sensation. By 12-weeks post-operatively, all LN sites had S4 sensation and there were no subjective complaints. Revision sagittal split osteotomy was associated with prolonged (≥6 weeks) time to S4 sensation (p = 0.02) and subjective complaint of decreased sensation (p = 0.02). CONCLUSION LN sensory recovery occurs rapidly following the low and short SSO, with 99% of sites achieving FSR and subjectively normal sensation within 6-weeks of surgery and all patients achieving FSR with S4 sensation by 12-weeks post-operatively. LN sensory recovery may be prolonged in patients undergoing revision SSO.
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Affiliation(s)
- Philip D Tolley
- From: Craniofacial Center, Division of Oral and Maxillofacial Surgery and Division of Plastic and Craniofacial Surgery, Seattle Children's Hospital and Departments of Oral and Maxillofacial Surgery and Surgery, Division of Plastic Surgery, University of Washington, Seattle, WA
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17
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Panesar K, Markiewicz MR, Best D, Lee KC, Edwards S, Susarla SM. Pediatric Mandibular Reconstruction. Atlas Oral Maxillofac Surg Clin North Am 2023; 31:177-186. [PMID: 37500201 DOI: 10.1016/j.cxom.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Affiliation(s)
- Kanvar Panesar
- Department of Oral and Maxillofacial Surgery, University of Washington, Seattle, WA, USA
| | - Michael R Markiewicz
- Department of Oral and Maxillofacial Surgery, University at Buffalo, Buffalo, NY, USA
| | - David Best
- Department of Oral and Maxillofacial Surgery, State University of New York at Buffalo, Buffalo, NY, USA
| | - Kevin C Lee
- Department of Oral and Maxillofacial Surgery, State University of New York at Buffalo, Buffalo, NY, USA
| | | | - Srinivas M Susarla
- University of Washington, Craniofacial Center, Seattle Children's Hospital, Seattle, WA, USA.
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18
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Shakir S, Birgfeld CB, Susarla SM. Discussion: Surgical Timing and Neurocognitive Development among Patients with Craniosynostosis: Analysis of Confounders. Plast Reconstr Surg 2023; 151:830-831. [PMID: 36989340 DOI: 10.1097/prs.0000000000010005] [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: 03/30/2023]
Affiliation(s)
- Sameer Shakir
- From the Craniofacial Center, Seattle Children's Hospital, Division of Craniofacial and Plastic Surgery
- Department of Surgery, Division of Plastic Surgery, University of Washington
| | - Craig B Birgfeld
- From the Craniofacial Center, Seattle Children's Hospital, Division of Craniofacial and Plastic Surgery
- Department of Surgery, Division of Plastic Surgery, University of Washington
| | - Srinivas M Susarla
- From the Craniofacial Center, Seattle Children's Hospital, Division of Craniofacial and Plastic Surgery
- Department of Surgery, Division of Plastic Surgery, University of Washington
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19
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Ikeda AK, Ettinger RE, Susarla SM, Lu GN. The Effect of COVID-19 Shelter-in-Place Orders on Pediatric Craniofacial Trauma. Facial Plast Surg Aesthet Med 2023; 25:141-144. [PMID: 36315194 DOI: 10.1089/fpsam.2022.0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Objectives: To investigate the impacts of the shelter-in-place orders on the injury patterns among children with craniofacial trauma. Materials and Methods: Pediatric (<18 years old) craniofacial trauma cases presenting to a regional level I trauma center 1 year before and after the initiation of Washington's shelter-in-place order were retrospectively reviewed. Demographic and injury-related variables were recorded, and bivariate and logistic regression analyses were computed. Results: One hundred nineteen children were evaluated over 2-year period (46 pre- and 73 post-shelter-in-place and were comparable in age, gender, and ethnicity (p ≥ 0.17)). The distribution of injury mechanisms between pre- and post-shelter-in-place were significantly different (p = 0.02), with the largest proportional increase in falls (10.5%) and had higher rates of associated brain injury (p ≤ 0.02). After adjusting for effect modifiers and confounders, children presenting during the post-shelter-in-place period were more likely to have associated brain injuries (odds ratio 3.4, 95% confidence interval: 1.11-10.6, p = 0.03). Conclusions: Among pediatric craniofacial injury cases, the shelter-in-place order was associated with a higher likelihood of brain injury and significant changes in injury mechanisms, with a higher proportion of falls.
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Affiliation(s)
- Allison K Ikeda
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Russell E Ettinger
- Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Srinivas M Susarla
- Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, Washington, USA.,Department of Oral and Maxillofacial Surgery, University of Washington, Seattle, Washington, USA
| | - G Nina Lu
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
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20
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Martin LD, Chiem JL, Hansen EE, Low DK, Reece K, Casey C, Wingate CS, Bezzo LK, Merguerian PA, Parikh SR, Susarla SM, O'Reilly-Shah VN. Completion of an Enhanced Recovery Program in a Pediatric Ambulatory Surgery Center: A Quality Improvement Initiative. Anesth Analg 2022; 135:1271-1281. [PMID: 36384014 DOI: 10.1213/ane.0000000000006256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Enhanced Recovery After Surgery (ERAS) was first established in 2001 focusing on recovery from complex surgical procedures in adults and recently expanded to ambulatory surgery. The evidence for ERAS in children is limited. In 2018, recognized experts began developing needed pediatric evidence. Center-wide efforts involving all ambulatory surgical patients and procedures have not previously been described. METHODS A comprehensive assessment and gap analysis of ERAS elements in our ambulatory center identified 11 of 19 existing elements. The leadership committed to implementing an Enhanced Recovery Program (ERP) to improve existing elements and close as many remaining gaps as possible. A quality improvement (QI) team was launched to improve 5 existing ERP elements and to introduce 6 new elements (target 17/19 ERP elements). The project plan was broken into 1 preparation phase to collect baseline data and 3 implementation phases to enhance existing and implement new elements. Statistical process control methodology was used. Team countermeasures were based on available evidence. A consensus process was used to resolve disagreement. Monthly meetings were held to share real-time data, gather new feedback, and modify countermeasure plans as needed. The primary outcome measure selected was mean postanesthesia care unit (PACU) length of stay (LOS). Secondary outcomes measures were mean maximum pain score in PACU and patient/family satisfaction scores. RESULTS The team had expanded the pool of active ERP elements from 11 to 16 of 19. The mean PACU LOS demonstrated significant reduction (early in phase 1 and again in phase 3). No change was seen for the mean maximum pain score in PACU or surgical complication rates. Patient/family satisfaction scores were high and sustained throughout the period of study (91.1% ± 5.7%). Patient/family and provider engagement/compliance were high. CONCLUSIONS This QI project demonstrated the feasibility of pediatric ERP in an ambulatory surgical setting. Furthermore, a center-wide approach was shown to be possible. Additional studies are needed to determine the relevance of this project to other institutions.
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Affiliation(s)
- Lynn D Martin
- From the Departments of Anesthesiology & Pain Medicine and Pediatrics
| | - Jennifer L Chiem
- Anesthesiology & Pain Medicine, Seattle Children's Hospital/University of Washington School of Medicine, Seattle, Washington
| | - Elizabeth E Hansen
- Anesthesiology & Pain Medicine, Seattle Children's Hospital/University of Washington School of Medicine, Seattle, Washington
| | - Daniel K Low
- Anesthesiology & Pain Medicine, Seattle Children's Hospital/University of Washington School of Medicine, Seattle, Washington
| | - Kayla Reece
- Department of Perioperative Services, Seattle Children's Hospital, Seattle, Washington; and Departments of
| | - Corrie Casey
- Department of Perioperative Services, Seattle Children's Hospital, Seattle, Washington; and Departments of
| | - Christina S Wingate
- Anesthesiology & Pain Medicine, Seattle Children's Hospital/University of Washington School of Medicine, Seattle, Washington
| | - Leah K Bezzo
- Anesthesiology & Pain Medicine, Seattle Children's Hospital/University of Washington School of Medicine, Seattle, Washington
| | | | - Sanjay R Parikh
- Plastic Surgery, Seattle Children's Hospital/University of Washington School of Medicine, Seattle, Washington
| | - Srinivas M Susarla
- Plastic Surgery, Seattle Children's Hospital/University of Washington School of Medicine, Seattle, Washington
| | - Vikas N O'Reilly-Shah
- Anesthesiology & Pain Medicine, Seattle Children's Hospital/University of Washington School of Medicine, Seattle, Washington
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21
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Susarla SM. Craniosynostosis: Current Perspectives. Oral Maxillofac Surg Clin North Am 2022; 34:xi. [PMID: 35871865 DOI: 10.1016/j.coms.2022.06.005] [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: 11/29/2022]
Affiliation(s)
- Srinivas M Susarla
- Seattle Children's Hospital, Craniofacial Center, 4800 Sand Point Way NE, Seattle, WA 98105, USA.
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22
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Susarla SM. Craniosynostosis: Current Perspectives. Oral Maxillofac Surg Clin North Am 2022. [DOI: 10.1016/s1042-3699(22)00051-6] [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: 10/17/2022]
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23
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Abstract
Patients with syndromic and nonsyndromic synostosis may have end-stage skeletal discrepancies involving the lower midface and mandible, with associated malocclusion. While orthognathic surgical procedures in this population can be reliably executed, the surgeon must be aware of the unique morphologic characteristics that accompany the primary diagnoses as well as the technical challenges associated with performing Le Fort I osteotomies in patients who have undergone prior subcranial midface distraction.
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Affiliation(s)
- Jesse T Han
- Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, WA, USA
| | - Mark A Egbert
- Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, WA, USA; Department of Surgery, Division of Plastic Surgery, University of Washington School of Medicine, Seattle, WA, USA; Craniofacial Center, Seattle Children's Hospital, Seattle, WA, USA
| | - Russell E Ettinger
- Department of Surgery, Division of Plastic Surgery, University of Washington School of Medicine, Seattle, WA, USA; Craniofacial Center, Seattle Children's Hospital, Seattle, WA, USA
| | - Hitesh Kapadia
- Department of Surgery, Division of Plastic Surgery, University of Washington School of Medicine, Seattle, WA, USA; Craniofacial Center, Seattle Children's Hospital, Seattle, WA, USA
| | - Srinivas M Susarla
- Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, WA, USA; Department of Surgery, Division of Plastic Surgery, University of Washington School of Medicine, Seattle, WA, USA; Craniofacial Center, Seattle Children's Hospital, Seattle, WA, USA.
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24
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Abstract
Patients with syndromic craniosynostosis can present with midface hypoplasia, abnormal facial ratios, and obstructive sleep apnea. These symptoms can all be improved with midface advancement, but it is essential to evaluate the specific morphologic characteristics of each patient's bony deficiencies before offering subcranial advancement. Midface hypoplasia in Crouzon syndrome is evenly distributed between the central and lateral midface and reliably corrected with Le Fort III distraction. In contrast, the midface hypoplasia in Apert/Pfeiffer syndromes occurs in both an axial and a sagittal plane, with significantly more nasomaxillary hypoplasia compared with the orbitozygomatic deficiency.
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Affiliation(s)
- Benjamin B Massenburg
- Division of Plastic and Craniofacial Surgery, Seattle Children's Hospital, Craniofacial Center, Seattle, WA, USA; Division of Plastic Surgery, Department of Surgery, University of Washington
| | - Srinivas M Susarla
- Division of Plastic and Craniofacial Surgery, Seattle Children's Hospital, Craniofacial Center, Seattle, WA, USA; Division of Plastic Surgery, Department of Surgery, University of Washington; Department of Oral and Maxillofacial Surgery, University of Washington, Seattle, WA, USA
| | - Hitesh P Kapadia
- Division of Plastic Surgery, Department of Surgery, University of Washington; Division of Craniofacial Orthodontics, Seattle Children's Hospital, Craniofacial Center, Seattle, WA, USA
| | - Richard A Hopper
- Division of Plastic and Craniofacial Surgery, Seattle Children's Hospital, Craniofacial Center, Seattle, WA, USA; Division of Plastic Surgery, Department of Surgery, University of Washington.
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25
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Abstract
Fronto-orbital advancement remains a powerful technique for the correction of anterior cranial vault differences related to metopic (trigonocephaly) or unilateral coronal (anterior plagiocephaly) craniosynostoses. Traditional fronto-orbital advancement requires access to the forehead and superior 2/3 of the orbit via a coronal incision. The frontal bone and orbital segment (bandeau) are then separated from the skull and reshaped. In patients with metopic craniosynostosis, the bandeau and frontal bone will need to be advanced and widened. In patients with unilateral coronal craniosynostosis, the bandeau will need to be "untwisted" to address the supraorbital retrusion on the affected side, the affected orbit will need to be shortened and widened, and the frontal bone flap will need to be proportionately advanced on the affected side. Overcorrection of the affected dimension should be undertaken to account for growth and relapse.
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Affiliation(s)
- Benjamin B Massenburg
- Craniofacial Center, Seattle Children's Hospital and University of Washington School of Medicine, Seattle, WA, USA
| | - Philip D Tolley
- Craniofacial Center, Seattle Children's Hospital and University of Washington School of Medicine, Seattle, WA, USA
| | - Amy Lee
- Craniofacial Center, Seattle Children's Hospital and University of Washington School of Medicine, Seattle, WA, USA
| | - Srinivas M Susarla
- Craniofacial Center, Seattle Children's Hospital and University of Washington School of Medicine, Seattle, WA, USA.
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26
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Gallagher ER, Fulton GK, Susarla SM, Birgfeld CB. Multidisciplinary Care Considerations for Patients with Craniosynostosis. Oral Maxillofac Surg Clin North Am 2022; 34:353-365. [PMID: 35787826 DOI: 10.1016/j.coms.2022.04.001] [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] [Indexed: 11/25/2022]
Abstract
Infants and children with craniosynostosis require multidisciplinary care, and this is best accomplished when care is provided on a craniofacial team. Most patients with craniosynostosis will have non-syndromic presentations; however, longitudinal care remains critical to ensure appropriate growth and development throughout childhood. In patients with syndromic craniosynostoses, coordinated longitudinal care becomes even more paramount because of the high level of complexity across many different specialties or disciplines. Care delivery that includes perspective and expertise from multiple disciplines is important to help patients reach their full potential and optimal outcomes.
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Affiliation(s)
- Emily R Gallagher
- Department of Pediatrics, Division of Craniofacial Medicine, University of Washington and Seattle Children's Hospital, 4800 Sand Point Way Northeast, M/S OB.9.520, PO Box 5371, Seattle, WA 98145-5005, USA; Craniofacial Center, Seattle Children's Hospital, University of Washington, Seattle, WA, USA; Louisiana State University School of Medicine, New Orleans, LA, USA.
| | - G Kyle Fulton
- Louisiana State University School of Medicine, New Orleans, LA, USA
| | - Srinivas M Susarla
- Craniofacial Center, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Craig B Birgfeld
- Craniofacial Center, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
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27
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Ettinger RE, Mercan E, Podolsky D, Susarla SM. DEFINING THE SAFE ZONE FOR THE LOW MEDIAL HORIZONTAL CUT IN THE SAGITTAL SPLIT OSTEOTOMY. J Oral Maxillofac Surg 2022; 80:822-826. [DOI: 10.1016/j.joms.2022.01.003] [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] [Received: 11/05/2021] [Revised: 12/17/2021] [Accepted: 01/03/2022] [Indexed: 10/19/2022]
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28
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Susarla SM, Park J, Sie K. Mask Wear: An Important Consideration in Patients With Microtia. J Oral Maxillofac Surg 2021; 80:590-591. [PMID: 35074284 DOI: 10.1016/j.joms.2021.12.014] [Citation(s) in RCA: 1] [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] [Received: 12/18/2021] [Accepted: 12/20/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Srinivas M Susarla
- Associate Professor, Craniofacial Center, Seattle Children's Hospital, Seattle, WA, Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, WA Department of Surgery, Division of Plastic Surgery, University of Washington School of Medicine, Seattle, WA.
| | - Jason Park
- Assistant Professor, Department of Otolaryngology/Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, TN
| | - Kathleen Sie
- Professor, Division Chief, Craniofacial Center, Seattle Children's Hospital, Department of Otolaryngology/Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA
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29
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Panesar K, Susarla SM. Mandibular Fractures: Diagnosis and Management. Semin Plast Surg 2021; 35:238-249. [PMID: 34819805 DOI: 10.1055/s-0041-1735818] [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] [Indexed: 10/20/2022]
Abstract
Accurate evaluation, diagnosis, and management of mandibular fractures is essential to effectively restore an individual's facial esthetics and function. Understanding of surgical anatomy, fracture fixation principles, and the nuances of specific fractures with respect to various patient populations can aid in adequately avoiding complications such as malocclusion, non-union, paresthesia, and revision procedures. This article reviews comprehensive mandibular fracture assessment, mandibular surgical anatomy, fracture fixation principles, management considerations, and commonly encountered complications. In addition, this article reviews emerging literature examining 3-dimensional printing and intraoperative imaging.
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Affiliation(s)
- Kanvar Panesar
- Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, Washington
| | - Srinivas M Susarla
- Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, Washington.,Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, Washington.,Divisions of Plastic and Craniofacial Surgery and Oral-Maxillofacial Surgery, Craniofacial Center, Seattle Children's Hospital, Seattle, Washington
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30
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Susarla SM, Fernandes R, Parmar S. Gratitude and Hope in Challenging Times. Craniomaxillofac Trauma Reconstr 2021; 14:173. [PMID: 34567417 DOI: 10.1177/19433875211015634] [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: 11/16/2022] Open
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31
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Sobol DL, Hopper JS, Ettinger RE, Dodson TB, Susarla SM. Does the use of a piezoelectric saw improve neurosensory recovery following sagittal split osteotomy? Int J Oral Maxillofac Surg 2021; 51:371-375. [PMID: 34332833 DOI: 10.1016/j.ijom.2021.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/28/2021] [Accepted: 07/09/2021] [Indexed: 11/16/2022]
Abstract
Neurosensory disturbance of the inferior alveolar nerve (IAN) is an adverse effect associated with sagittal split osteotomies (SSO). The purpose of this work was to evaluate neurosensory recovery of the IAN when SSOs were performed with piezoelectric (PZ) versus reciprocating (RP) saws. This was a prospective split-mouth study of patients undergoing bilateral SSO using a PZ saw on one side and an RP saw on the other. The primary outcome of interest was neurosensory recovery, as assessed using the functional sensory recovery (FSR) scale defined by the UK Medical Research Council. Descriptive, bivariate, and regression statistics were computed. Twenty patients (40 SSOs) with a mean age of 19.9 ± 3.2 years were included. The mean mandibular movement did not differ significantly (P = 0.50) between the PZ and RP groups. All patients achieved FSR within 1 year of surgery (range 34-249 days). The median time to FSR overall was comparable between the PZ and RP groups (94.5 days and 101.5 days, respectively; P = 0.20). However, at the time FSR was achieved, PZ SSO sites were more likely to have higher neurosensory scores when compared to RP SSO sites (hazard ratio 2.3, 95% confidence interval 1.1-4.9, P = 0.04).
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Affiliation(s)
- D L Sobol
- Craniofacial Center, Seattle Children's Hospital, Divisions of Oral and Maxillofacial Surgery and Plastic and Craniofacial Surgery, Seattle, WA, USA; Department of Surgery, Division of Plastic Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - J S Hopper
- Craniofacial Center, Seattle Children's Hospital, Divisions of Oral and Maxillofacial Surgery and Plastic and Craniofacial Surgery, Seattle, WA, USA
| | - R E Ettinger
- Craniofacial Center, Seattle Children's Hospital, Divisions of Oral and Maxillofacial Surgery and Plastic and Craniofacial Surgery, Seattle, WA, USA; Department of Surgery, Division of Plastic Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - T B Dodson
- Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, WA, USA
| | - S M Susarla
- Craniofacial Center, Seattle Children's Hospital, Divisions of Oral and Maxillofacial Surgery and Plastic and Craniofacial Surgery, Seattle, WA, USA; Department of Surgery, Division of Plastic Surgery, University of Washington School of Medicine, Seattle, WA, USA; Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, WA, USA.
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32
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Lam AS, Bindschadler MD, Evans KN, Friedman SD, Blessing MS, Bly R, Cunningham ML, Egbert MA, Ettinger RE, Gallagher ER, Hopper RA, Johnson K, Perkins JA, Romberg EK, Sie KCY, Susarla SM, Zdanski CJ, Wang X, Otjen JP, Perez FA, Dahl JP. Accuracy and Reliability of 4D-CT and Flexible Laryngoscopy in Upper Airway Evaluation in Robin Sequence. Otolaryngol Head Neck Surg 2021; 166:760-767. [PMID: 34253111 DOI: 10.1177/01945998211027353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/17/2022]
Abstract
OBJECTIVES To evaluate the performance of 4-dimensional computed tomography (4D-CT) in assessing upper airway obstruction (UAO) in patients with Robin sequence (RS) and compare the accuracy and reliability of 4D-CT and flexible fiber-optic laryngoscopy (FFL). STUDY DESIGN Prospective survey of retrospective clinical data. SETTING Single, tertiary care pediatric hospital. METHODS At initial and 30-day time points, a multidisciplinary group of 11 clinicians who treat RS rated UAO severity in 32 sets of 4D-CT visualizations and FFL videos (dynamic modalities) and static CT images. Raters assessed UAO at the velopharynx and oropharynx (1 = none to 5 = complete) and noted confidence levels of each rating. Intraclass correlation and Krippendorff alpha were used to assess intra- and interrater reliability, respectively. Accuracy was assessed by comparing clinician ratings with quantitative percentage constriction (QPC) ratings, calculated based on 4D-CT airway cross-sectional area. Results were compared using Wilcoxon rank-sum and signed-rank tests. RESULTS There was similar intrarater agreement (moderate to substantial) with 4D-CT and FFL, and both demonstrated fair interrater agreement. Both modalities underestimated UAO severity, although 4D-CT ratings were significantly more accurate, as determined by QPC similarity, than FFL (-1.06 and -1.46 vs QPC ratings, P = .004). Overall confidence levels were similar for 4D-CT and FFL, but other specialists were significantly less confident in FFL ratings than were otolaryngologists (2.25 and 3.92, P < .0001). CONCLUSION Although 4D-CT may be more accurate in assessing the degree of UAO in patients with RS, 4D-CT and FFL assessments demonstrate similar reliability. Additionally, 4D-CT may be interpreted with greater confidence by nonotolaryngologists who care for these patients.
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Affiliation(s)
- Austin S Lam
- Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA.,Department of Otolaryngology-Head & Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Michael D Bindschadler
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington, USA.,Department of Radiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Kelly N Evans
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.,Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA
| | - Seth D Friedman
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington, USA.,Department of Radiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Matthew S Blessing
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.,Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA
| | - Randall Bly
- Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA.,Department of Otolaryngology-Head & Neck Surgery, University of Washington, Seattle, Washington, USA.,Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA
| | - Michael L Cunningham
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.,Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA
| | - Mark A Egbert
- Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA.,Division of Oral and Maxillofacial Surgery, Seattle Children's Hospital, Seattle, Washington, USA.,Department of Oral and Maxillofacial Surgery, University of Washington, Seattle, Washington, USA
| | - Russell E Ettinger
- Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA.,Division of Plastic Surgery, Seattle Children's Hospital, Seattle, Washington, USA.,Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Emily R Gallagher
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.,Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA
| | - Richard A Hopper
- Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA.,Division of Plastic Surgery, Seattle Children's Hospital, Seattle, Washington, USA.,Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Kaalan Johnson
- Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA.,Department of Otolaryngology-Head & Neck Surgery, University of Washington, Seattle, Washington, USA.,Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA
| | - Jonathan A Perkins
- Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA.,Department of Otolaryngology-Head & Neck Surgery, University of Washington, Seattle, Washington, USA.,Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA
| | - Erin K Romberg
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington, USA.,Department of Radiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Kathleen C Y Sie
- Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA.,Department of Otolaryngology-Head & Neck Surgery, University of Washington, Seattle, Washington, USA.,Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA
| | - Srinivas M Susarla
- Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA.,Division of Oral and Maxillofacial Surgery, Seattle Children's Hospital, Seattle, Washington, USA.,Division of Plastic Surgery, Seattle Children's Hospital, Seattle, Washington, USA.,Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Carlton J Zdanski
- Department of Otolaryngology/Head & Neck Surgery and Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Xing Wang
- Biostatistics, Epidemiology and Analytics in Research (BEAR) Core, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Jeffrey P Otjen
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington, USA.,Department of Radiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Francisco A Perez
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington, USA.,Department of Radiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - John P Dahl
- Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA.,Department of Otolaryngology-Head & Neck Surgery, University of Washington, Seattle, Washington, USA.,Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA
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Posnick JC, Susarla SM. Improving Cleft Outcomes: A Retrosynthetic Analysis Approach. J Oral Maxillofac Surg 2021; 79:2392-2395. [PMID: 34171225 DOI: 10.1016/j.joms.2021.05.032] [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: 05/11/2021] [Revised: 05/18/2021] [Accepted: 05/18/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Jeffrey C Posnick
- Professor Emeritus, Plastic and Reconstructive Surgery & Pediatrics, Georgetown University School of Medicine, Washington, DC; Professor of Orthodontics, University of Maryland, Baltimore, College of Dental Surgery, Baltimore, MD; Professor of Oral and Maxillofacial Surgery, Howard University College of Dentistry, Washington, DC; Owner, Posnick MD Consulting, LLC, Potomac, MD.
| | - Srinivas M Susarla
- Associate Professor, Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA; Associate Professor, Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, WA
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Susarla SM, Hopper RA. Commentary on "Airway Growth in Preoperative Patients with Crouzon Syndrome" by Lu et al. Facial Plast Surg Aesthet Med 2021; 23:197-198. [PMID: 33577394 DOI: 10.1089/fpsam.2020.0565] [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: 11/12/2022] Open
Affiliation(s)
- Srinivas M Susarla
- Division of Plastic and Craniofacial Surgery and Department of Surgery, Division of Plastic Surgery, Craniofacial Center, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Richard A Hopper
- Division of Plastic and Craniofacial Surgery and Department of Surgery, Division of Plastic Surgery, Craniofacial Center, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
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35
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Hopper JS, Sobol DL, Ettinger RE, Susarla SM. Mandibular Foramen Position Predicts Inferior Alveolar Nerve Location After Sagittal Split Osteotomy With a Low Medial Cut. J Oral Maxillofac Surg 2021; 79:205-212. [DOI: 10.1016/j.joms.2020.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/22/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022]
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Hopper RA, Susarla SM. Craniomaxillofacial Surgery and the Legacy of Joseph S. Gruss. Craniomaxillofac Trauma Reconstr 2020; 13:246-247. [PMID: 33456694 DOI: 10.1177/1943387520965803] [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: 11/15/2022] Open
Affiliation(s)
- Richard A Hopper
- Department of Surgery, Division of Plastic Surgery.,University of Washington School of Medicine
| | - Srinivas M Susarla
- Department of Surgery, Division of Plastic Surgery.,University of Washington School of Medicine
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Parmar S, Susarla SM, Fernandes RP. Education and Training for Craniomaxillofacial Surgeons in the Context of COVID-19. Craniomaxillofac Trauma Reconstr 2020; 13:149-150. [PMID: 33456679 PMCID: PMC7797963 DOI: 10.1177/1943387520948815] [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: 11/11/2023] Open
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Susarla SM, Mercan E, Evans K, Egbert MA, Hopper RA. Short-term condylar and glenoid fossa changes in infants with Pierre Robin sequence undergoing mandibular distraction osteogenesis. Int J Oral Maxillofac Surg 2020; 50:171-178. [PMID: 32814654 DOI: 10.1016/j.ijom.2020.07.012] [Citation(s) in RCA: 3] [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: 04/20/2020] [Revised: 05/05/2020] [Accepted: 07/07/2020] [Indexed: 11/16/2022]
Abstract
The purpose was to evaluate short-term changes in condylar and glenoid fossa morphology in infants with Pierre Robin sequence (PRS) undergoing early (age <4 months) mandibular distraction osteogenesis (MDO) for the management of severe airway obstruction. Computed tomography data from infants with PRS who had MDO were compared to those of age-matched control infants without facial skeletal dysmorphology. Surface/volume, linear, and angular measurements of the condyle and glenoid fossa were obtained and compared between infants with PRS and controls. Eleven infants with PRS met the inclusion criteria. There were five female and six male subjects with a mean age at the time of MDO of 41±32 days. Prior to MDO, PRS mandibles had a smaller condylar articulating surface area and volume than age-matched control mandibles, with a more laterally positioned condylar axis (P≤0.05). Following MDO, there were significant increases in condylar articulating surface area and volume, approaching those of normal controls, with further lateral translation of the condylar axis (P≤0.05). Condyle and glenoid fossa morphology is largely normalized following early MDO in infants with PRS. The condylar axis translates laterally as a result of MDO; this change is not observed with mandibular growth in infants without PRS.
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Affiliation(s)
- S M Susarla
- Division of Plastic and Craniofacial Surgery, Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA; Division of Oral and Maxillofacial Surgery, Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA.
| | - E Mercan
- Division of Plastic and Craniofacial Surgery, Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA
| | - K Evans
- Division of Craniofacial Medicine, Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA
| | - M A Egbert
- Division of Plastic and Craniofacial Surgery, Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA; Division of Oral and Maxillofacial Surgery, Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA
| | - R A Hopper
- Division of Plastic and Craniofacial Surgery, Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA
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Susarla SM, Ettinger RE, Dodson TB. Is It Necessary to Free the Inferior Alveolar Nerve From the Proximal Segment in the Sagittal Split Osteotomy? J Oral Maxillofac Surg 2020; 78:1382-1388. [DOI: 10.1016/j.joms.2020.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/06/2020] [Accepted: 03/06/2020] [Indexed: 10/24/2022]
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41
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Susarla SM, Hopper RA. Discussion: Outcomes of Intracranial Versus Subcranial Approaches to the Frontofacial Skeleton. J Oral Maxillofac Surg 2020; 78:1617-1619. [PMID: 32439380 DOI: 10.1016/j.joms.2020.04.020] [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: 04/02/2020] [Accepted: 04/10/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Srinivas M Susarla
- Assistant Professor, Division of Plastic and Craniofacial Surgery and Oral-Maxillofacial Surgery, Craniofacial Center, Seattle Children's Hospital, Seattle, WA.
| | - Richard A Hopper
- Endowed Professor and Division Chief, Division of Plastic and Craniofacial Surgery and Oral-Maxillofacial Surgery, Craniofacial Center, Seattle Children's Hospital, Seattle, WA
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Shen JK, Every J, Morrison SD, Massenburg BB, Egbert MA, Susarla SM. Global Interest in Oral and Maxillofacial Surgery: Analysis of Google Trends Data. J Oral Maxillofac Surg 2020; 78:1484-1491. [PMID: 32554065 DOI: 10.1016/j.joms.2020.05.017] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/08/2020] [Accepted: 05/08/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Oral and maxillofacial surgery (OMS) has an expansive scope, with myriad diagnoses treated by practicing surgeons. Patients and referring providers are increasingly turning to Web-based sources to find information about clinical conditions before consultations or in conjunction with ongoing care. The purpose of this study was to examine the current trends of public interest of OMS procedures as assessed by online search trends. MATERIALS AND METHODS A cross-sectional study of Internet search data obtained via Google Trends (GT; Alphabet, Mountain View, CA) was conducted. Data were collected using GT for OMS-related search terms between January 2004 and May 2019. The search terms used in the analysis were "wisdom teeth," "TMJ," "dental implants," "jaw surgery," "jaw fracture," "facial trauma," and "facial cosmetic surgery," defined to be the core surgical aspects of OMS based on public awareness campaigns sponsored by the American Association of Oral and Maxillofacial Surgeons. Relative search volumes, trends over time, geographic trends, and seasonal trends were analyzed. For all analyses, P ≤ .05 was considered significant. RESULTS Overall search volume trends for OMS procedures showed an increase over time, with seasonal and geographic trends. "Wisdom teeth" was the most searched term and had the greatest increase in search volume over time. "Facial trauma" was the least searched term, with no appreciable trend over time. Geographic search volume was greatest in the United States. Seasonal changes were most apparent with searches for "wisdom teeth" and "jaw surgery." CONCLUSIONS Analysis of GT data shows substantial interest in core OMS procedures, with seasonal variations noted for certain areas of practice (third molars and jaw surgery) and consistent interest in other areas (facial cosmetic surgery, dental implant reconstruction, and temporomandibular disorders). The use of GT data may be a powerful tool for predicting demand for OMS services and for public education campaigns.
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Affiliation(s)
- Jacson K Shen
- Resident, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - James Every
- Resident, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Shane D Morrison
- Resident, Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA
| | - Benjamin B Massenburg
- Resident, Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA
| | - Mark A Egbert
- Associate Professor, Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA, and Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, WA
| | - Srinivas M Susarla
- Assistant Professor, Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA, and Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, WA.
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43
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Susarla SM, Dodson TB, Cheng KL. Do Academic Oral and Maxillofacial Surgeons Comply With Best Practices for Reporting the Results of Randomized Clinical Trials? J Oral Maxillofac Surg 2020; 78:771-777. [DOI: 10.1016/j.joms.2019.12.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/27/2019] [Accepted: 12/27/2019] [Indexed: 10/25/2022]
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Chandawarkar A, Birgfeld CB, Yaremchuk MJ, Tufaro AP, Hopper RA, Susarla SM. Pioneers in Modern Craniofacial Surgery: Assessing the Academic Impact of Drs. Joseph Gruss and Paul Manson. Plast Reconstr Surg 2020; 145:814e-817e. [PMID: 32221230 DOI: 10.1097/prs.0000000000006647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The authors conducted this study to assess the impact that Drs. Joseph Gruss and Paul Manson have had on craniofacial surgery through their individual contributions and through their trainees. METHODS This was a retrospective analysis of fellows trained by either Dr. Gruss or Dr. Manson. Demographic and bibliometric measures were recorded for each fellow. Demographic factors included years since completion of fellowship training, current practice of craniomaxillofacial surgery, academic practice, and academic leadership roles. Bibliometric measures included number of publications, number of citations, and h-index. To adjust for scholarly activity before fellowship training, only contributions published after fellowship training were included. RESULTS Over a 39-year period, a total of 86 surgeons completed fellowship training with either of the two principal surgeons. The mean time since completion of training was 18.7 ± 11.4 years. Seventy-nine percent of surgeons had active practices in craniomaxillofacial surgery; 54 percent had academic practices. The mean number of publications was 26.4 ± 69.3, the mean number of citations was 582 ± 2406, and the average h-index was 6.7 ± 10.6. Among academic surgeons, the average h-index was 10.7 ± 13.1, 89 percent practiced in North America, 89 percent had active practices in craniomaxillofacial surgery, and nearly 50 percent had achieved a leadership role. CONCLUSIONS Modern craniofacial reconstruction has evolved from principles used in trauma and correction of congenital differences. The extensive impact that Drs. Paul Manson and Joseph Gruss have had on the field, and plastic surgery at large, is evident through their primary contributions and the immense impact their trainees have had on the field.
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Affiliation(s)
- Akash Chandawarkar
- From the Department of Plastic Surgery, The Johns Hopkins Hospital; the Craniofacial Center, Seattle Children's Hospital; the Division of Plastic Surgery, Department of Surgery, Massachusetts General Hospital; and Division of Plastic Surgery, Department of Surgery, University of Oklahoma School of Medicine
| | - Craig B Birgfeld
- From the Department of Plastic Surgery, The Johns Hopkins Hospital; the Craniofacial Center, Seattle Children's Hospital; the Division of Plastic Surgery, Department of Surgery, Massachusetts General Hospital; and Division of Plastic Surgery, Department of Surgery, University of Oklahoma School of Medicine
| | - Michael J Yaremchuk
- From the Department of Plastic Surgery, The Johns Hopkins Hospital; the Craniofacial Center, Seattle Children's Hospital; the Division of Plastic Surgery, Department of Surgery, Massachusetts General Hospital; and Division of Plastic Surgery, Department of Surgery, University of Oklahoma School of Medicine
| | - Anthony P Tufaro
- From the Department of Plastic Surgery, The Johns Hopkins Hospital; the Craniofacial Center, Seattle Children's Hospital; the Division of Plastic Surgery, Department of Surgery, Massachusetts General Hospital; and Division of Plastic Surgery, Department of Surgery, University of Oklahoma School of Medicine
| | - Richard A Hopper
- From the Department of Plastic Surgery, The Johns Hopkins Hospital; the Craniofacial Center, Seattle Children's Hospital; the Division of Plastic Surgery, Department of Surgery, Massachusetts General Hospital; and Division of Plastic Surgery, Department of Surgery, University of Oklahoma School of Medicine
| | - Srinivas M Susarla
- From the Department of Plastic Surgery, The Johns Hopkins Hospital; the Craniofacial Center, Seattle Children's Hospital; the Division of Plastic Surgery, Department of Surgery, Massachusetts General Hospital; and Division of Plastic Surgery, Department of Surgery, University of Oklahoma School of Medicine
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Cho DY, Evans KN, Weed MC, Lee A, Susarla SM. Bilateral Squamosal Suture Craniosynostosis Presenting with Abducens Nerve Palsy and Severe Papilledema. World Neurosurg 2020; 138:344-348. [PMID: 32217173 DOI: 10.1016/j.wneu.2020.03.079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/17/2020] [Revised: 03/13/2020] [Accepted: 03/13/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Patients with single-suture or minor suture craniosynostosis are typically asymptomatic at early presentation; intervention is aimed at reducing the risk of elevated intracranial pressure and associated developmental sequelae. Patients may be symptomatic in cases of major multisuture syndromic synostoses or delayed diagnosis. Clinical presentation in this context may include headaches, papilledema, cognitive delay, or behavioral issues. Cranial nerve palsies are atypical symptoms of intracranial hypertension in this patient population. CASE DESCRIPTION An 11-month-old, otherwise healthy girl presented with bilateral severe papilledema and left abducens nerve palsy owing to nonsyndromic near-complete bilateral squamosal suture synostosis with associated incomplete sagittal and right lambdoid synostoses. The patient underwent urgent open cranial expansion, with resolution of her papilledema and improvement in eye position and motility. CONCLUSIONS Cranial nerve palsies may be presenting symptoms of intracranial hypertension in patients with craniosynostosis. Multidisciplinary evaluation and treatment is paramount for appropriate management.
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Affiliation(s)
- Daniel Y Cho
- Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, USA
| | - Kelly N Evans
- Department of Pediatrics, University of Washington School of Medicine, Seattle, USA
| | | | - Amy Lee
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, USA
| | - Srinivas M Susarla
- Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, USA; Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, USA.
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Abstract
Nasoalveolar molding (NAM) is a powerful tool in the treatment of patients with unilateral or bilateral cleft lip and palate. The primary goal of NAM is to improve alignment of critical anatomic elements before surgical repair of the unilateral or bilateral cleft lip. Modifications of the position of the alveolar segments and their associated lip elements, the lower lateral cartilages, and the columella achieved with NAM are helpful for creating a suitable platform for tension-free lip repair.
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Affiliation(s)
- Hitesh Kapadia
- Seattle Children's Hospital, Craniofacial Center, 4800 Sand Point Way Northeast, Seattle, WA 98145, USA.
| | - Douglas Olson
- Craniofacial Center of Western New York, Oishei Children's Outpatient Center, 1001 Main Street, Buffalo, NY 14203, USA
| | - Raymond Tse
- Seattle Children's Hospital, Craniofacial Center, 4800 Sand Point Way Northeast, Seattle, WA 98145, USA
| | - Srinivas M Susarla
- Seattle Children's Hospital, Craniofacial Center, 4800 Sand Point Way Northeast, Seattle, WA 98145, USA
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Han JT, Susarla SM, Dodson TB, Lang MS. Are Oral and Maxillofacial Surgeons Prescribing Fewer Opioids and More Non-Narcotic Analgesics for Postoperative Pain After Third Molar Removal? J Oral Maxillofac Surg 2020; 78:358-365. [DOI: 10.1016/j.joms.2019.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 08/12/2019] [Accepted: 08/13/2019] [Indexed: 01/24/2023]
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Abstract
Subcranial and frontofacial distraction osteogenesis have emerged as powerful tools for management of hypoplasia involving the upper two-thirds of the face. The primary goal of subcranial or frontofacial distraction is to improve the orientation of the upper face and midface structures (frontal bone, orbitozygomatic complex, maxilla, nasal complex) relative to the cranial base, globes, and mandible. The various techniques used are tailored for management of specific phenotypic differences in facial position and may include segmental osteotomies, differential vectors, or synchronous maxillomandibular rotation.
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Affiliation(s)
- Richard A Hopper
- Craniofacial Center, Division of Plastic and Craniofacial Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA
| | - Hitesh Kapadia
- Craniofacial Center, Division of Craniofacial Orthodontics, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA
| | - Srinivas M Susarla
- Craniofacial Center, Divisions of Craniofacial and Plastic Surgery and Oral-Maxillofacial Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA.
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Susarla SM, Hauptman J, Ettinger R, Sittler B, Ellenbogen RG. Acellular Dermal Matrix as a Definitive Reconstructive Option for Management of a Large Myelomeningocele Defect in the Setting of Severe Lumbar Kyphosis. World Neurosurg 2019; 129:363-366. [PMID: 31247357 DOI: 10.1016/j.wneu.2019.06.116] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 06/13/2019] [Accepted: 06/14/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Severe kyphosis is infrequently seen in neonates with myelomeningoceles. Spinal skeletal dysmorphology complicates repair, as local tissue may be insufficient to cover the dural repair. Although neonatal kyphectomy has been proposed as a potential solution to this problem, it carries significant potential risks that may not be acceptable to families. CASE DESCRIPTION A neonate presented with a large myelomeningocele defect with associated severe lumbar kyphosis. Kyphectomy was both declined by the family owing to the potential surgical risks and deemed not appropriate by the surgeons based on the challenging anatomic considerations. Soft tissue closure was not possible with local tissue rearrangement. Acellular dermal matrix was used as a definitive soft tissue coverage option, with complete epithelialization noted at 8 weeks postoperatively. CONCLUSIONS Acellular dermal matrix is a potentially useful adjunct for definitive reconstruction of complex neonatal soft tissue defects where local tissue is not available.
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Affiliation(s)
- Srinivas M Susarla
- Division of Plastic and Craniofacial Surgery, Seattle Children's Hospital, Seattle, Washington, USA.
| | - Jason Hauptman
- Division of Neurological Surgery, Seattle Children's Hospital, Seattle, Washington, USA
| | - Russell Ettinger
- Division of Plastic and Craniofacial Surgery, Seattle Children's Hospital, Seattle, Washington, USA
| | - Bay Sittler
- Division of Plastic and Craniofacial Surgery, Seattle Children's Hospital, Seattle, Washington, USA
| | - Richard G Ellenbogen
- Division of Neurological Surgery, Seattle Children's Hospital, Seattle, Washington, USA
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Posnick JC, Susarla SM, Kinard BE. Reconstruction of residual cleft nasal deformities in adolescents: Effects on social perceptions. J Craniomaxillofac Surg 2019; 47:1414-1419. [PMID: 31337566 DOI: 10.1016/j.jcms.2019.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 03/28/2019] [Revised: 06/12/2019] [Accepted: 06/13/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE The investigators hypothesized that a layperson's social perceptions of a primarily repaired adolescent cleft lip and palate (CL/P) patient is more favorable after definitive nasal reconstruction with regard to perceived social traits. METHODS The investigators implemented a survey comparing layperson's social perceptions of 6 personality traits, 6 emotional expression traits, and 7 perceptions of interpersonal experiences before and >6 months after definitive nasal reconstruction in CL/P adolescent subjects by viewing standardized facial photographs. The sample was composed of consecutive CL/P subjects treated by one surgeon using a consistent technique involving a rib cartilage caudal strut graft through an open approach. Five non-cleft adolescent subjects who underwent cosmetic rhinoplasty involving a septal cartilage caudal strut graft through an open approach were used as a comparison group. The outcome variable was change in 6 perceived personality, 6 emotional expression traits studied, and 7 perceptions of interpersonal experiences. Descriptive and bivariate statistics were computed (p-value <0.05). RESULTS The sample was composed of 10 consecutive CL/P subjects and 5 non-cleft adolescent comparison subjects. 500 respondents (raters) completed the survey. The respondents were 54% male with 56% age 25 to 34. After definitive cleft nasal reconstruction, study subjects were perceived to be significantly more attractive (p = 0.04) and less threatening (p = 0.04). They were also perceived as less angry (p < 0.01), sad (p < 0.01), or disgusted (p < 0.01) than prior to surgery. The subjects were also perceived to be less likely to have negative interpersonal experiences (p < 0.01). CONCLUSION We confirmed that laypeople consistently report positive changes in adolescent CL/P subject's perceived social traits after definitive cleft nasal reconstruction. Overall, the positive changes were largely comparable between the cleft and non-cleft groups.
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Affiliation(s)
- Jeffrey C Posnick
- Posnick Center for Facial Plastic Surgery, Clinical Professor of Surgery and Pediatrics, Georgetown University, Washington, DC, USA; University of Maryland School of Dentistry, Baltimore, MD, USA; Howard College of Dentistry, Washington, DC, USA.
| | - Srinivas M Susarla
- Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA; Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, WA, USA
| | - Brian E Kinard
- Posnick Center for Facial Plastic Surgery; Chevy Chase, MD, USA
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