Guidelines for Orbital Defect Assessment and Patient-Specific Implant Design: Introducing OA (Orbital Assessment Algorithm).

Study Design: This study presents a review of the evolutionary development in reconstructive orbital surgery over the past 3 decades. Additionally, it proposes the Orbital Assessment Algorithm (OA) to enhance decision-making for intraorbital reconstruction of post-traumatic orbital deformities.

Objective: The objective of this paper is to provide insights into modern post-traumatic orbital reconstruction from a surgeon's perspective, with a specific focus on adult patients.

Measuring the Unilateral Cleft Lip Nasal Deformity: Lateral Deviation of Subnasale Is a Clinical and Morphologic Index of Unrepaired Severity.

Objective: Objective measurement of pre-operative severity is important to optimize evidence-based practices given that the wide spectrum of presentation likely influences outcomes. The purpose of this study was to determine the correlation of objective measures of form with a subjective standard of cleft severity.

Design: 3D images were ranked according to severity of nasal deformity by 7 cleft surgeons so that the mean rank could be used as the severity standard.

The Ansa Hypoglossi: Quantifying Axonal Density of a Donor Nerve for Facial Reinnervation.

There are a number of nerve grafting options for facial reanimation and the ansa hypoglossi (AH) may be considered in select situations. To compare axonal density, area, and diameter of AH with other nerves more usually used for facial reanimation. AH specimens from patients undergoing neck dissections were submitted in formalin.

Bell's palsy misdiagnosis: characteristics of occult tumors causing facial paralysis.

Objective: The aim of this study was to report the incidence and clinical course of a series of patients who were misdiagnosed with Bell's palsy and were eventually proven to have occult neoplasms.

Methods: Two hundred forty patients with unilateral facial paralysis who were assessed at the facial nerve reanimation clinic, Victoria Hospital, London Health Science Centre, from 2008 through 2017 were reviewed. Persistent paralysis without recovery was the presenting complaint.

Patient and surgical factors that affect the development of velopharyngeal insufficiency.

Velopharyngeal insufficiency (VPI) is a complication that occurs following cleft palate (CP) repair, and the patient/surgical factors that contribute to the development of VPI have not been completely described. The objectives of this study were to identify patient and surgical factors that may increase the risk of development of VPI and to identify whether there are any factors that predispose patients to the development of VPI that requires surgery versus VPI that resolves with non-operative management. Data was prospectively collected for all non-syndromic patients with a CP undergoing primary CP repair by a single surgeon between 2002 and 2018.

Generation of Cross-Specialty Consensus Statements on Soft Tissue Management via a Modified Delphi Method.

Background: Soft tissue management (STM) training programs for surgeons are largely tradition based, and substantial differences exist among different surgical specialties. The lack of comprehensive and systematic clinical evidence on how surgical techniques and implants affect soft tissue healing makes it difficult to develop evidence-based curricula. As a curriculum development group (CDG), we set out to find common grounds in the form of a set of consensus statements to serve as the basis for surgical soft tissue education.

Ten-Year Cephalometric Comparison of Patients With Cleft Palate who Received Treatment With Active or Passive Pre-surgical Orthopedic Devices.

Background: Pre-surgical orthopedic (PSO) devices can be used in the management of patient with cleft lip/palate (CL/P) to narrow the alveolar gap (AG) prior to lip surgery. There are few studies comparing these 2 devices. The objective of this work was to compare the effects of active and passive PSO devices on facial growth in a single surgeon's cohort of patients with CL/P over a 10-year period.

Thematic Analysis of Canadian Patient-Reported Outcomes in Facial Nerve Paralysis: A Combined Interpretive Description and Modified Delphi Approach.

In facial nerve dysfunction literature, subjective reporting tools lack essential construct validity arising from a patient-driven design process. Elicit patient-identified themes of importance pertaining to disease course in facial nerve dysfunction from a variety of etiologies. Twenty participant interviews were conducted from a standardized script and analyzed using a thematic analysis framework.

Static Sling Options for Facial Paralysis: Now Versus 10 Years Ago.

Static facial sling procedures are one of many facial reanimation options to address long-standing and irreversible facial paralysis. The primary goals of static reanimation are to provide symmetry at rest and improve static function at repose. Choosing the best option depends on patient factors, such as age, comorbidities, and injury factors.

Systematic Review of the Long-Term Effects of Presurgical Orthopedic Devices on Patient Outcomes.

Objective: To perform a systematic review of the literature to identify the long-term effects of presurgical orthopedic (PSO) device use on patient outcomes.

Design: A comprehensive literature review of Embase and Ovid databases was performed to identify all English-language publications related to unilateral cleft lip and palate, presurgical devices, and patient outcomes. Studies were excluded if they did not report patient outcomes beyond 2 years of age, did not describe the use of a PSO device, were case reports (n < 10), or were purely descriptive studies.

Feasibility of Surgeon-Delivered Audit and Feedback Incorporating Peer Surgical Coaching to Reduce Fistula Incidence following Cleft Palate Repair: A Pilot Trial.

Background: Improving surgeons' technical performance may reduce their frequency of postoperative complications. The authors conducted a pilot trial to evaluate the feasibility of a surgeon-delivered audit and feedback intervention incorporating peer surgical coaching on technical performance among surgeons performing cleft palate repair, in advance of a future effectiveness trial.

Methods: A nonrandomized, two-arm, unblinded pilot trial enrolled surgeons performing cleft palate repair.

Current approaches to cleft lip revision.

Purpose Of Review: Cleft lip repair requires multidisciplinary follow-up throughout a child's life and often requires lip revision surgery in adolescence to restore function and symmetry of the lip. There is significant variability in the approaches taken for lip repair and therefore a review of current techniques and subsequent guidance to secondary cleft lip repair is warranted.

Recent Findings: New methods of secondary reconstruction can be divided into superficial or muscle related.

Backward Planning a Craniomaxillofacial Trauma Curriculum for the Surgical Workforce in Low-Resource Settings.

Background: Trauma is a significant contributor to global disease, and low-income countries disproportionately shoulder this burden. Education and training are critical components in the effort to address the surgical workforce shortage. Educators can tailor training to a diverse background of health professionals in low-resource settings using competency-based curricula.

Objective Assessment of the Unilateral Cleft Lip Nasal Deformity Using Three-Dimensional Stereophotogrammetry: Severity and Outcome.

Background: Optimization of care to correct the unilateral cleft lip nasal deformity is hampered by lack of objective measures to quantify preoperative severity and outcome. The purpose of this study was to develop a consensus standard of nasal appearance using three-dimensional stereophotogrammetry; determine whether anthropometric measurements could be used to quantify severity and outcome; and determine whether preoperative severity predicts postoperative outcome.

Methods: The authors collected facial three-dimensional images of 100 subjects in three groups: 45 infants before cleft lip repair; the same 45 infants after cleft lip repair; and 45 children aged 8 to 10 years with previous repairs.

Parental Perceptions Following Cleft Lip Repair in Their Children.

Objective: Cleft lip (CL) repair at 3 months is chosen mostly out of convention and offers minimal functional benefit. Potentially, a better cosmetic outcome is possible by delaying repair. This study examines parental perceptions around repair at 3 months to determine if current guidelines are appropriate.

Reliability of Oronasal Fistula Classification.

Objective: Oronasal fistula is an important complication of cleft palate repair that is frequently used to evaluate surgical quality, yet reliability of fistula classification has never been examined. The objective of this study was to determine the reliability of oronasal fistula classification both within individual surgeons and between multiple surgeons.

Design: Using intraoral photographs of children with repaired cleft palate, surgeons rated the location of palatal fistulae using the Pittsburgh Fistula Classification System.

The Effects of Secondary Cleft Procedures on Alar Base Position and Nostril Morphology in Patients with Unilateral Clefts.

Objective: To compare effects of secondary cleft procedures on alar base position and nostril morphology.

Design: Retrospective review.

Setting: Multidisciplinary cleft clinic at tertiary center.

Facial Fractures.

Learning Objectives: After reading this article, the participant should be able to: 1. Demonstrate an understanding of some of the changes in aspects of facial fracture management. 2.

Transnasal tendon suspension for the paralyzed lower eyelid.

Background: Paralytic ectropion is a significantly functional and esthetic problem leading to problems with lacrimation, corneal exposure, and poor palpebral closure. Limitations with traditional corrective procedures include poor apposition of the lid to the globe, suboptimal medial canthal position, and high recurrence rates.

Objective: The objective of this study was to develop a technique of lower-lid suspension using transnasal wiring for the long-term maintenance of lid position.

The effects of nonvascularized versus vascularized bone grafting on calvarial defect healing.

It remains unknown whether bone graft vascularity influences calvarial healing. The purposes of this study were (1) to develop a model to study nonvascularized and vascularized calvarial grafts as well as (2) to compare effects of bone graft vascularity on calvarial healing. Bilateral calvarial defects were created in 26 Wistar rats.

Accounting for cranial vault growth in experimental design.

Objective: Earlier studies have not accounted for continued growth when using the rat calvarial defect model to evaluate bone healing in vivo. The purpose of this study was: 1) to calculate rat cranial vault growth over time; and 2) to determine the effects of accounting for growth on defect healing.

Study Design: Bilateral parietal defects were created in 10 adult Wistar rats.

Neurofibromatosis and velopharyngeal insufficiency: is there an association?

Objective: Velopharyngeal insufficiency (VPI) is an often underrecognized disorder of palatal and nasopharyngeal closure that leads to the production of hypernasal speech. However, the potential clinical association between VPI and neurofibromatosis type 1 (NF1) remains undefined in the literature. The purpose of this study sought to identify and describe the potential clinical association of VPI in NF1 patients.

The pedicled masseter muscle transfer for smile reconstruction in facial paralysis: repositioning the origin and insertion.

Background: The pedicled masseter muscle transfer (PMMT) is introduced as a new reconstructive option for dynamic smile restoration in patients with facial paralysis. The masseter muscle is detached from both its origin and insertion and transferred to a new position to imitate the function of the native zygomaticus major muscle.

Methods: Part one of this study consisted of cadaveric dissections of 4 heads (eight sides) in order to determine whether the masseter muscle could be (a) pedicled solely by its dominant neurovascular bundle and (b) repositioned directly over the native zygomaticus major.

Critical analysis of consecutive unilateral cleft lip repairs: determining ideal sample size.

Objective : Cleft surgeons often show 10 consecutive lip repairs to reduce presentation bias, however the validity remains unknown. The purpose of this study is to determine the number of consecutive cases that represent average outcomes. Secondary objectives are to determine if outcomes correlate with cleft severity and to calculate interrater reliability.