Developing the Aesthetic Postoperative Complication Score (APeCS) for Detecting Major Morbidity in Facial Aesthetic Surgery.

Background: Facial aesthetic surgery encompasses a variety of procedures with complication rates that are difficult to estimate due to a lack of published data.

Objectives: We sought to estimate major complication rates in patients undergoing facial aesthetic procedures and develop a risk assessment tool to stratify patients.

Methods: We utilized the Tracking Operation and Outcomes for Plastic Surgeons (TOPS) database from 2003-2018.

American Society of Plastic Surgeons Evidence-Based Clinical Practice Guideline: Eyelid Surgery for Upper Visual Field Improvement.

Background: A group of experts from different disciplines was convened to develop guidelines for the management of upper visual field impairments related to eyelid ptosis and dermatochalasis. The goal was to provide evidence-based recommendations to improve patient care.

Methods: A multidisciplinary group of experts representing their specialty organizations was selected.

National Trends in Venous Thromboembolism in the Adult Craniofacial Trauma Population.

Unlabelled: Venous thromboembolism (VTE), specifically deep vein thrombosis (DVT) and pulmonary embolism (PE), is a major complication in plastic surgery; however, there is a paucity of evidence about the incidence of VTE in the craniofacial subpopulation. We investigated the incidence and risk factors for VTE in the adult craniofacial trauma population.

Methods: This retrospective review identified patients from the 2016 and 2017 Healthcare Cost and Utilization Project's National Inpatient Sample with a diagnosis for an initial encounter of a facial fracture.

Autoimmune myositis and myasthenia gravis resulting from a combination therapy with nivolumab and ipilimumab for metastatic melanoma.

Checkpoint inhibitors are a novel option in the management of metastatic melanomas and many other malignancies. They are used to promote the activation of cytotoxic T-lymphocytes by inhibiting deactivation signals, enabling the immune response to the tumor. Numerous Immune-related adverse effects caused by checkpoint inhibitors have been reported in the literature.

Predicting the Ideal Patient for Ambulatory Cleft Lip Repair.

Background: The utilization of ambulatory surgical centers (ASCs) for cleft lip repair is increasing to reduce costs. This study better defines the patient population appropriate for ambulatory cleft repair with uplift modeling, a predictive analytics technique.

Methods: Pediatric patients who underwent cleft lip repair were identified in the 2007 to 2011 California Healthcare Cost and Utilization Project State Inpatient Database and State Ambulatory Surgery and Services Database.

Age at Time of Craniosynostosis Repair Predicts Increased Complication Rate.

Objective: This study uses administrative data to assess the optimal timing for surgical repair of craniosynostosis and to identify factors associated with risk of perioperative complications.

Design: Statistical analysis of the Healthcare Cost and Utilization Project Kids' Inpatient Database (2006, 2009, 2012).

Setting: KID-participating hospitals in 44 states.

Le Fort III Distraction With Internal vs External Distractors: A Cephalometric Analysis.

Objective: This study compares the change in midface position following Le Fort III advancement using either rigid external distraction (group 1) or internal distraction (group 2). We hypothesized that, with reference to right-facing cephalometry, internal distraction would result in increased clockwise rotation and inferior displacement of the midface.

Design: Le Fort III osteotomies and standardized distraction protocols were performed on 10 cadaveric specimens per group.

Five-Year Follow-Up of Midface Distraction in Growing Children with Syndromic Craniosynostosis.

Background: Maxillary position in patients with syndromic craniosynostosis after midface distraction has been shown to be stable 1 year postoperatively. The purpose of this study is to assess midfacial position in the growing child with craniosynostosis 5 years after Le Fort III advancement with a rigid external device.

Methods: Seventeen consecutive patients were identified to have the diagnosis of syndromic craniosynostosis and had undergone midface advancement [corrected].

Early Distraction for Mild to Moderate Unilateral Craniofacial Microsomia: Long-Term Follow-Up, Outcomes, and Recommendations.

Background: There is controversy regarding the treatment of young patients with unilateral craniofacial microsomia and moderate dysmorphism. The relative indication for mandibular distraction in such patients poses several questions: Is it deleterious in the context of craniofacial growth and appearance? This study was designed to address these questions.

Methods: A retrospective review of patients undergoing mandibular distraction by a single surgeon between 1989 and 2010 was conducted.

Heads-up 3D Microscopy: An Ergonomic and Educational Approach to Microsurgery.

Traditional microsurgery can lead surgeons to use postures that cause musculoskeletal fatigue, leaving them more prone to work-related injuries. A new technology from TrueVision transmits the microscopic image onto a 3-dimensional (3D) monitor, allowing surgeons to operate while sitting/standing in a heads-up position. The purpose of this study was to evaluate the feasibility of performing heads-up 3D microscopy as a more ergonomic alternative to traditional microsurgery.

Customized "In-Office" Three-Dimensional Printing for Virtual Surgical Planning in Craniofacial Surgery.

Background: Virtual surgical planning using three-dimensional (3D) printing technology has improved surgical efficiency and precision. A limitation to this technology is that production of 3D surgical models requires a third-party source, leading to increased costs (up to $4000) and prolonged assembly times (averaging 2-3 weeks). The purpose of this study is to evaluate the feasibility, cost, and production time of customized skull models created by an "in-office" 3D printer for craniofacial reconstruction.

Unilateral Craniofacial Microsomia: Unrecognized Cause of Pediatric Obstructive Sleep Apnea.

Bilateral craniofacial microsomia causes obstructive sleep apnea (OSA). We hypothesize that unilateral craniofacial microsomia (UCFM) is an underappreciated cause of OSA. The records of all pediatric UCFM patients from 1990 to 2010 were reviewed; only complete records were included in the study.

Comparative Study of Early Secondary Nasal Revisions and Costs in Patients With Clefts Treated With and Without Nasoalveolar Molding.

The present study aims to determine the risk of early secondary nasal revisions in patients with complete unilateral and bilateral cleft lip and palate (U/BCLP) treated with and without nasoalveolar molding (NAM) and examine the associated costs of care. A retrospective cohort study from 1990 to 1999 was performed comparing the risk of early secondary nasal revision surgery in patients with a CLP treated with NAM and surgery (cleft lip repair and primary surgical nasal reconstruction) versus surgery alone in a private practice and tertiary level clinic. The NAM treatment group consisted of 172 patients with UCLP and 71 patients with BCLP, whereas the non-NAM-prepared group consisted of 28 patients with UCLP and 5 with BCLP.

Pediatric frontal sinus fractures: outcomes and treatment algorithm.

Pediatric frontal sinus fractures are a rare clinical entity. Owing to the large amount of force required to fracture the frontal sinus, it is often associated with severe intracranial and craniofacial injuries. The treatment of frontal sinus fractures is controversial, with many different established algorithms based mainly on the adult population.

Thoracic outlet syndrome in the pediatric population: case series.

We present 4 patients, 4 months to 10 years of age, with thoracic outlet syndrome. All were referred to the brachial plexus clinic. Three patients were diagnosed with vascular thoracic outlet syndrome after clinical evaluation and diagnostic imaging.

Maxillary mucocele with proptosis and visual impairment: a late complication of Le Fort III distraction.

Maxillary mucoceles are a relatively rare entity especially following surgical procedures involving osteotomies of the maxilla. The etiology of maxillary mucoceles has been ascribed to facial trauma (fractures), sinus surgery, and chronic inflammatory diseases or infections. Mucoceles can follow injury to the sinus mucosa and/or sinus outflow tract with a resulting expansile cystic mass.

Tissue expander complications in the pediatric burn patient: a 10-year follow-up.

Background: This study is a 10-year follow-up to our previous publication reviewing the complication rates of tissue expansion in the pediatric burn population. The purpose of this study was to determine if our institutional experience with tissue expanders had remained stable during the subsequent 10 years.

Methods: There were 240 patients who were identified at a major pediatric burn center who underwent reconstruction with a tissue expander (256 tissue expanders) from 1996 to 2006.

Extended composite temporoparietal fascial flap: clinical implications for tissue engineering in mandibular reconstruction.

Background: The authors have expanded upon a well-described and widely used flap in the head and neck region. The purpose of the cadaver study was to determine the feasibility, angiosome, and the potential application of this pedicled flap in bone tissue engineering of the mandible.

Methods: A total of 6 fresh human cadaver heads were dissected for a total of 12 flaps.

External fixation in a low-velocity gunshot wound to the mandible.

Low-velocity gunshot wounds to the mandible are complex injuries that can be aesthetically and functionally devastating. Despite advances in plating systems and surgical techniques, repair of such injuries remains a challenging endeavor. Traditionally, external fixation has resulted in longer treatment times and the need for revision surgery.