Evaluation of Helmeting Therapy Duration After Endoscopic Strip Craniectomy for Metopic and Sagittal Craniosynostosis.

Introduction: Endoscopic strip craniectomy (ESC) is a minimally invasive option for early surgical treatment of metopic (MC) and sagittal craniosynostosis (SC). For ESC, however, the postoperative duration and compliance of helmet therapy are crucial to correct MC and SC asymmetry. The purpose of this study is to assess the period of postoperative band therapy and determine differences, if any, between MC and SC.

Do Buccal Flaps Improve Velopharyngeal Insufficiency in Conversion Furlow Palatoplasty for Patients with Cleft Palate?

Summary: Velopharyngeal insufficiency (VPI) is a complication following primary palatoplasty that can lead to hypernasality of the voice and other speech problems. The conversion Furlow palatoplasty for VPI can be performed with the addition of buccal flaps to provide additional tissue for palatal repair. In this study, the authors aimed to determine the effectiveness of buccal flaps with conversion Furlow palatoplasty in secondary management of VPI.

Predictive Factors for Velopharyngeal Insufficiency Following Primary Cleft Palate Repair.

Objective: Velopharyngeal insufficiency (VPI) remains a known complication of primary palatoplasty. We sought to identify factors associated with the incidence of VPI and create a predictive model for VPI development in our population.

Design: A single-institution, retrospective review.

Impact of Cardiac Risk Factors in the Postsurgical Outcomes of Patients With Cleft Lip.

Congenital cardiac comorbidities represent a potentially elevated risk for complications in patients undergoing cleft lip repair. National databases, such as the National Surgical Quality Improvement Program Pediatric (NSQIP-P) allow for analysis of large national datasets to assess these risks and potential complications. The aim of this study is to assess the risk of complications in patients undergoing cleft lip repair with congenital cardiac co-morbidities using the NSQIP-P.

The Epidemiology and Management of Pediatric Maxillary Fractures.

Background: Most literature regarding traumatic Le Fort or maxillary fractures exists in the adult population, with limited information regarding the epidemiology and management of pediatric fractures. The purpose of this study was to evaluate fracture mechanism, surgical management, and associated injuries in pediatric patients with Le Fort fractures.

Methods: A retrospective chart analysis of all pediatric patients age ≤18 years diagnosed with facial fractures at a single level 1 trauma center over a 10-year period (January 2006-December 2015) was performed.

Enhanced Recovery After Surgery Protocol for Primary Cleft Palate Repair: Improving Transition of Care.

Background: Enhanced recovery after surgery (ERAS) protocols have been adopted for many types of surgery. Postoperative pain following palatoplasty may cause feeding and swallowing difficulty. Our study evaluated the use of ERAS protocols to improve the management of pain following primary palatoplasty as well as in the transition of care from inpatient to outpatient.

Is Less Actually More? An Evaluation of Surgical Outcomes Between Endoscopic Suturectomy and Open Cranial Vault Remodeling for Craniosynostosis.

Background: Both open cranial vault remodeling (CVR) and endoscopic suturectomy are effective in treating the anatomical deformity of craniosynostosis. While parents are increasingly knowledgeable about these 2 treatment options, information regarding the perioperative outcomes remains qualitative. This makes preoperative counseling regarding surgical choices difficult.

Cervical Spine Injuries in Pediatric Maxillofacial Trauma: An Under-Recognized Problem.

Pediatric cervical spine injuries (CSI) are uncommon events, but can be devastating injuries. Facial fractures have been associated with injuries to the cervical spine in children, but may be deemed isolated facial fractures and bypass the standard trauma pathway. The objective of this study is to describe the mechanisms, associated injuries and outcomes of pediatric cervical spine injuries in patients with known maxillofacial trauma at a level 1 trauma center.

PBX-WNT-P63-IRF6 pathway in nonsyndromic cleft lip and palate.

Nonsyndromic cleft lip and palate (NSCLP) is one of the most common craniofacial anomalies in humans, affecting more than 135,000 newborns worldwide. NSCLP has a multifactorial etiology with more than 50 genes postulated to play an etiologic role. The genetic pathway comprised of Pbx-Wnt-p63-Irf6 genes was shown to control facial morphogenesis in mice and proposed as a regulatory pathway for NSCLP.

The Trends of Pediatric Facial Fractures Due to Violence in a Level One Trauma Population.

Introduction: Pediatric facial fractures due to intentionally violent mechanisms represent a unique subset of facial fractures. The objective of our research is to identify how violence affects patterns of facial fractures and their management in pediatric patients.

Methods: An IRB approved, retrospective study of our institution's pediatric patients ≤18 years of age who presented with ≥1 facial fracture due to violence from January 2006 to December 2015 was performed.

Factors Associated With Surgical Management for Pediatric Facial Fractures at a Level One Trauma Center.

Pediatric facial fractures present and are managed differently than the adult population. This study describes the pattern and mechanism of facial fractures in children and identifies factors associated with need for surgical management. An IRB-approved retrospective chart analysis of all pediatric patients age ≤ 18 years diagnosed with facial fractures at our level 1 trauma center over a 10-year period (January 2006-December 2015) was performed.

Assessing Burden of Care in the Patient With Cleft Lip and Palate: Factors Influencing Completion and Noncompletion of Nasoalveolar Molding.

Objective: Evaluate the factors that influence caregiver-reported completion of nasoalveolar molding (NAM) therapy for patients with cleft lip and palate.

Design: An IRB-approved 30-question survey.

Setting: Outpatient clinic for patients with cleft lip.

Both the Observer's Expertise and the Subject's Facial Symmetry Can Affect Anatomical Position of the Head.

Purpose: It is easier to judge facial deformity when the patient's head is in anatomic position. The purposes of this study were to determine 1) whether a group of expert observers would agree more than a group of nonexperts on what is the correct anatomic position of the head, 2) whether there would be more variation in the alignment of an asymmetrical face compared with a symmetrical one, and 3) whether the alignments of experts would be more repeatable than those of nonexperts.

Materials And Methods: Thirty-one orthodontists (experts) and 31 dental students (nonexperts) were recruited for this mixed-model study.

Impact of Cardiac Risk Factors in the Postsurgical Outcomes of Patients With Cleft Palate: Analysis of the 2012-2014 NSQIP Database.

Objective: To assess the risk of complication in patients undergoing cleft palate repair with congenital cardiac comorbidities in a large, national cohort.

Design: Retrospective review.

Patients/setting: Using the 2012-2014 National Surgical Quality Improvement Program (NSQIP) Pediatric database, patients undergoing cleft palate repair were selected for analysis.

Knockdown of Crispld2 in zebrafish identifies a novel network for nonsyndromic cleft lip with or without cleft palate candidate genes.

Orofacial development is a multifaceted process involving tightly regulated genetic signaling networks, that when perturbed, lead to orofacial abnormalities including cleft lip and/or cleft palate. We and others have shown an association between the cysteine-rich secretory protein LCCL domain containing 2 (CRISPLD2) gene and nonsyndromic cleft lip with or without cleft palate (NSCLP). Further, we demonstrated that knockdown of Crispld2 in zebrafish alters neural crest cell migration patterns resulting in abnormal jaw and palate development.

Resorbable Plates in Secondary Cleft Nasal Reconstruction.

Objective: The authors report on the use and complications of alloplastic resorbable plates and compare their use to autologous cartilage grafts in secondary cleft nasal reconstruction.

Design: Institutional review board (IRB)-approved retrospective chart review.

Setting: Texas Cleft-Craniofacial Center at the McGovern Medical School at the University of Texas Health Sciences Center at Houston.

Fluctuating asymmetry of the normal facial skeleton.

The purpose of this study was to produce reliable estimations of fluctuating facial asymmetry in a normal population. Fifty-four computed tomography (CT) facial models of average-looking and symmetrical Chinese subjects with a class I occlusion were used in this study. Eleven midline landmarks and 12 pairs of bilateral landmarks were digitized.

There is variability in our perception of the standard head orientation.

The purposes of this study were to determine: (1) whether an observer's perception of the correct anatomical alignment of the head changes with time, and (2) whether different observers agree on the correct anatomical alignment. To determine whether the perception of the correct anatomical alignment changes with time (intra-observer comparison), a group of 30 observers were asked to orient, into anatomical alignment, the three-dimensional (3D) head photograph of a normal man, on two separate occasions. To determine whether different observers agree on the correct anatomical alignment (inter-observer comparison), the observed orientations were compared.

New approach to establish an object reference frame for dental arch in computer-aided surgical simulation.

The purpose of this study was to develop a principal component analysis-based adaptive minimum Euclidean distances (PAMED) approach to establish an optimal object reference frame for symmetrical alignment of the dental arch during computer-aided surgical simulation (CASS). It was compared with our triangular methods and the standard principal component analysis (PCA) method. Thirty sets of maxillary digital models were used.

Design, development and clinical validation of computer-aided surgical simulation system for streamlined orthognathic surgical planning.

Purpose: There are many proven problems associated with traditional surgical planning methods for orthognathic surgery. To address these problems, we developed a computer-aided surgical simulation (CASS) system, the AnatomicAligner, to plan orthognathic surgery following our streamlined clinical protocol.

Methods: The system includes six modules: image segmentation and three-dimensional (3D) reconstruction, registration and reorientation of models to neutral head posture, 3D cephalometric analysis, virtual osteotomy, surgical simulation, and surgical splint generation.

Survey of Parent Experiences in Prenatal Visits for Infants With Cleft Lip and Palate.

Objective: The purpose of this study was to identify the factors that influence the parent's choice of cleft team/surgeon.

Design: A 10-question survey was used to elucidate factors that influenced parents in choosing their cleft surgeon. No identifiers of the origin of the study were used to improve parent objectivity.

Cervical Instability in Pierre Robin Sequence: An Addition to the Algorithm.

Many patients with Pierre Robin sequence (PRS) have associated birth defects, most commonly in association with abnormalities in bone or cartilage formation. Depending on severity, treatment of PRS ranges from nonoperative management with prone positioning to surgical intervention such as distraction osteogenesis. Generally, if a surgical approach is needed, these patients undergo nasal endoscopy or direct laryngoscopy with their intubation, which puts the cervical spine in a position of extreme extension.

An Outcomes Comparison Between Autologous and Alloplastic Cranioplasty in the Pediatric Population.

Background: The use of alloplastic material in cranial reconstruction has been well described in the adult population, especially when a paucity of autologous tissue exists. In children it is unknown how long-term growth, however, may be affected by the implantation of nonexpansible alloplastic material. Therefore, the authors sought to compare the outcomes of pediatric patients undergoing alloplastic versus autologous cranial reconstruction.

Surgical Management of Nasal Airway Obstruction.

The management and diagnosis of nasal airway obstruction requires an understanding of the form and function of the nose. Nasal airway obstruction can be structural, physiologic, or a combination of both. Anatomic causes of airway obstruction include septal deviation, internal nasal valve narrowing, external nasal valve collapse, and inferior turbinate hypertrophy.

A Geometric Classification of Jaw Deformities.

In the United States, the most widely used classification system for jaw deformities is the one provided by the International Classification of Diseases, Clinical Modification (ICD-CM), a taxonomy scheme that is based on the World Health Organization's International Classification of Diseases (ICD). The last iteration of ICD-CM, version 10, sorts jaw deformities according to geometry, into 3 groups: anomalies of jaw size, anomalies of jaw-cranial base relationship, or unspecified. Yet these deformities can affect 6 different geometric attributes: size, position, orientation, shape, symmetry, and completeness.