Revision Palate Surgery.

Oronasal fistulae and velopharyngeal insufficiency are common and interdependent complications after cleft palate surgery. Bone grafting can complement cleft habilitation. Early identification and intervention are vital for optimal outcomes.

Bone Graft Substitutes and Enhancement in Craniomaxillofacial Surgery.

Critical-sized bone defects are a reconstructive challenge, particularly in the craniomaxillofacial (CMF) skeleton. The "gold standard" of autologous bone grafting has been the work horse of reconstruction in both congenital and acquired defects of CMF skeleton. Autologous bone has the proper balance of the protein (or organic) matrix and mineral components with no immune response.

Current trends in unilateral cleft lip repair.

The purpose of this review is to provide an in-depth look at the current perioperative and intraoperative practices for unilateral cleft lip repair. The contemporary literature reveals trends towards incorporation of curvilinear and geometric hybrid lip repairs. Perioperative practices are trending in new directions as well with the use of enhanced recovery after surgery (ERAS) protocols to reduce morbidity and length of stay, continued use of nasoalveolar molding, and a tendency to favor outpatient repair with more utilization of same day surgery centers.

Reducing Risks for Midface and Mandible Fracture Repair.

The midface skeleton provides structural scaffolding to the middle third of the face. Complications associated with fracture repair in these regions can result from incomplete, inaccurate, or delayed assessment, poor initial and subsequent reduction and fixation, infection, uncontrolled hemorrhage, hardware failure and associated soft tissue injuries. A systematic approach to managing the patient with facial trauma that includes Acute Trauma Life Support principles, early reconstruction, and precise reduction and fixation is essential to reducing the short-term and long-term risks of complications.

Enhanced Recovery after Surgery (ERAS) protocols in craniomaxillofacial surgery: an evidence-based review.

Purpose Of Review: Enhanced Recovery after Surgery (ERAS) refers to a patient centered, multidisciplinary team developed pathway aimed at reducing the surgical stress response and facilitating expedited patient postoperative recovery. These protocols have been largely developed in the general surgery literature and have led to vast improvements in the patient experience. With a growing shortage of hospital resources during the height of the COVID-19 pandemic there has been a growing push to apply these principles to a wide variety of specialties.

Prevention and management of oronasal fistulas.

Purpose Of Review: The aim of this article is to present the current opinion on the prevention and management of oronasal fistulas in cleft palate patients.

Recent Findings: Though cleft palate repair has seen numerous modifications and improvements, oronasal fistulas remain one of the most common complications of palatoplasty. There are various techniques available for preventing and managing this complication.

Otitis Media and Hearing Loss in Patients With Nonsyndromic Craniosynostosis: A Multicenter Study.

Objectives: The objectives of this study were to: (1) determine the prevalence of otitis media with effusion in patients with nonsyndromic craniosynostosis; (2) determine the prevalence of hearing loss in patients with nonsyndromic craniosynostosis; and (3) identify potential patterns and outcomes in patients with nonsyndromic craniosynostosis.

Methods: A retrospective chart review was conducted at 2 academic institutions, St Christopher's Hospital for Children and SUNY Upstate Medical University, from January 2015 through August 2018, to identify patients having nonsyndromic craniosynostosis with a concurrent diagnosis of otitis media and/or hearing loss. The demographic data and categorical variables were analyzed using descriptive statistics and chi-square testing, respectively.

The unilateral cleft lip repair.

Objective: To determine if there is a benefit of 2-stage cleft lip repair in regard to improving facial symmetry and facilitating definitive lip, nose, and palate repair.

Study Design: Retrospective chart review of patients born with complete, unilateral cleft lip deformity that underwent a two-stage repair described as a stage 1 straight line repair and a stage 2 modified Millard repair, for which a complete set of records, and peri-operative and post-operative photos were available. All cases were performed by a single surgeon.

The Art of Teaching, Training, and Putting the Scalpel in Residents' Hands.

Surgical education is under tremendous pressure due to ever-increasing medical knowledge and demands on trainees' time. They must continually learn more in less time due to work hour limitations, regulations, and electronic medical record demands. Surgical training must become more efficient.

Comparing Caliper versus Computed Tomography Measurements of Cranial Dimensions in Children.

Objectives/hypothesis: We have found no study assessing the accuracy of caliper cranium measurements compared to computed tomography (CT) measurements of the head. The objective of this study was to assess the reliability of caliper measurements in comparison to CT measurements.

Study Design: Retrospective chart review.

Risk factors for velopharyngeal dysfunction following orthognathic surgery in the cleft population.

Purpose Of Review: This article highlights important trends in speech outcomes following orthognathic surgery in the cleft lip and palate populations. The geometric changes in the velopharyngeal port caused by maxillary advancement by standard means and distraction are only one consideration in predicting speech outcomes. Myriad and variable preoperative risk factors, both anatomic and functional, have been identified in the literature because of weaknesses in experimental design and small patient populations.

Frontal Sinus Fractures: Evolving Clinical Considerations and Surgical Approaches.

Frontal sinus fractures are an uncommon injury of the maxillofacial skeleton, and account for 5-15% of all maxillofacial fractures. As the force of impact increases, fractures may extend beyond the anterior table to involve adjacent skull, posterior table and frontal sinus outflow tract (FSOT). Fractures at these subsites should be evaluated independently to assess the need for and type of operative intervention.

Location of the euryon in scaphocephalic vs. non-scaphocephalic controls: A novel assessment of cranial vault remodeling outcomes.

We describe a novel measurement of cranial morphology in pre- and post-operative scaphocephalic patients to complement the cephalic index. This will better describe restoration of normal skull and head shape, further defining the nuances of the corrected skull. In this retrospective comparative study the location of the euryon on the skull was statistically significantly different in preoperative scaphocephalic patients versus non-scaphocephalic controls.

Skull Base Trauma: Clinical Considerations in Evaluation and Diagnosis and Review of Management Techniques and Surgical Approaches.

Traumatic injuries to the skull base can involve critical neurovascular structures and present with symptoms and signs that must be recognized by physicians tasked with management of trauma patients. This article provides a review of skull base anatomy and outlines demographic features in skull base trauma. The manifestations of various skull base injuries, including CSF leaks, facial paralysis, anosmia, and cranial nerve injury, are discussed, as are appropriate diagnostic and radiographic testing in patients with such injuries.

Long-Term Otologic and Audiometric Outcomes in Patients with Cleft Palate.

Objective Describe longitudinal audiometric and otologic outcomes in patients with cleft palates. Study Design Case series with chart review. Setting Single academic medical center.

Advances in eyelid reconstruction.

Purpose Of Review: To describe the principles of eyelid reconstruction that must balance aesthetic and functional concerns of one of the most important areas of physical beauty on the human body. Our review seeks to give an overview of how to utilize a variety of techniques along the reconstructive ladder from direct closure to complex grafts and local flaps.

Recent Findings: We describe novel modifications of existing flaps that have been traditionally used in eyelid reconstruction along with analysis of many time honored techniques and current research in improving our understanding of the factors which allow a successful reconstruction.

Current surgical management of macroglossia.

Purpose Of Review: To discuss the current surgical management of macroglossia.

Recent Findings: Traditional surgical management of severe macroglossia has been with anterior wedge or keyhole resection. Long-term follow-up has been limited, and only recently have assessments been done regarding functional and aesthetic outcomes.

A comparison between autograft alone, bone cement, and demineralized bone matrix in cranioplasty.

Objectives: To compare bone autograft, bone cement, and demineralized bone matrix in functional and aesthetic outcomes and complications following cranioplasty for reconstruction of cranial defects.

Study Design: Retrospective chart review.

Materials And Methods: A retrospective chart review was performed of patients who underwent cranioplasty at a single institution between 1992 and 2012.

Craniofacial distraction osteogenesis.

Distraction osteogenesis (DO) may be the most versatile tool to become available to the craniofacial surgeon in recent years. It can be used in an ever-expanding register of clinical scenarios and offers major advantages over conventional craniofacial techniques in some circumstances. Craniofacial surgery has significant complications, some of which can be mitigated but not eliminated by choosing DO over conventional approaches.