The First Hybrid International Educational Comprehensive Cleft Care Workshop.

OBJECTIVE: Describe the first hybrid global simulation-based comprehensive cleft care workshop, evaluate impact on participants, and compare experiences based on in-person versus virtual attendance. DESIGN: Cross-sectional survey-based evaluation. SETTING: International comprehensive cleft care workshop. PARTICIPANTS: Total of 489 participants. INTERVENTIONS: Three-day simulation-based hybrid comprehensive cleft care workshop. MAIN OUTCOME MEASURES: Participant demographic data, perceived barriers and interventions needed for global comprehensive cleft care delivery, participant workshop satisfaction, and perceived short-term impact on practice stratified by in-person versus virtual attendance. RESULTS: The workshop included 489 participants from 5 continents. The response rate was 39.9%. Participants perceived financial factors (30.3%) the most significant barrier and improvement in training (39.8%) as the most important intervention to overcome barriers facing cleft care delivery in low to middle-income countries. All participants reported a high level of satisfaction with the workshop and a strong positive perceived short-term impact on their practice. Importantly, while this was true for both in-person and virtual attendees, in-person attendees reported a significantly higher satisfaction with the workshop (28.63 ± 3.08 vs 27.63 ± 3.93; P = .04) and perceived impact on their clinical practice (22.37 ± 3.42 vs 21.02 ± 3.45 P = .01). CONCLUSION: Hybrid simulation-based educational comprehensive cleft care workshops are overall well received by participants and have a positive perceived impact on their clinical practices. In-person attendance is associated with significantly higher satisfaction and perceived impact on practice. Considering that financial and health constraints may limit live meeting attendance, future efforts will focus on making in-person and virtual attendance more comparable.

Breast Implants Follow-up: Results of a Cross-Sectional Study on Patients Submitted to MRI Breast Examinations.

INTRODUCTION: Breast implants follow-up with any type of examination is often neglected; this may cause an error or delay in the diagnosis of complications prosthesis-related such as BIA-ALCL. This study aims to better understand adequate follow-up criteria. METHOD: All female patients undergoing aesthetic breast augmentation and breast MRI in its follow-up conducted from April 2006 to December 2019 were included in this study. The variables analyzed were age, breast implant surgery date, time with the implant, reason for the examination, and the final examination report. A logistic regression analysis was conducted to search for the predictors of positive findings in MRI. A Cox Regression analysis and cumulative risk curves, controlled by age, was performed to investigate the relationship between time with implants and the risk of positive findings in MRI. RESULTS: The patients submitted to MRI had complaints in 29.6% of cases, with pain being the most common, 13.9% of cases. In logistic regression analysis, time with the implant was associated with a higher risk of positive findings in univariate analysis (OR = 1.07, p = 0.036), but not in multivariate analysis. Both pain and breast form changes were independent predictors for positive findings in MRI, OR = 2.79, p = 0.04, and OR = 16.98, p < 0.001, respectively. The cumulative risk of positive findings in MRI increased considerably only after 10 years of implantation. CONCLUSIONS: Time with breast implants may be associated with a higher risk of changes in breast MRI examinations, although this relationship was not significant in multivariate logistic regression analysis. The cumulative risk for positive findings seems to increase considerably only after 10 years of implantation. This study draws attention to the paramount importance of follow-up with a clinical breast examination. Despite time with implants or patients' age, both pain and breast form changes were the most important predictors for MRI alterations. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Otoplasty: Rasps or Puncture Needles? A Clinical Trial.

BACKGROUND: Up to 25% of otoplasties can lead to complications, indicating the need for technical refinement. Stenström's anterior auricular cartilage scoring is used in combination with Mustardé's technique to treat the antihelix deformity in several series, with good results. Both can be performed with different instruments such as rasps or puncture needles. OBJECTIVES: This study aims to compare the use of puncture needles and rasps for anterior cartilage scoring in otoplasty. The association of Stenström and Mustardé were the basic technique. Anatomical and aesthetic endpoints were assessed. We also reviewed postoperative complications. METHODS: Forty-two patients with prominent ears and no previous surgery were randomly assigned needle or rasps technique. They were operated on by the first-year plastic surgery resident in the years of 2014 and 2019. The patients were followed up and reviewed at days 2 and 15, as well as 1, 3 and 6 months postoperatively. The endpoints were evaluated through pre- and postoperative photographs by four experienced plastic surgeons unaware of the techniques used in each case. Patient satisfaction was searched by a "yes" or "no" question. Surgical time and postoperative edema were evaluated in 20 patients (2014 group). RESULTS: There were no statistical differences between the groups in terms of overall results, symmetry, antihelix shape or cartilage fracture. Ninety-five percent of the patients were satisfied with the outcome. The needle technique resulted in less postoperative edema and shorter surgical time. CONCLUSION: Anterior cartilage scoring used in combination with posterior mattress sutures to treat poorly formed antihelical fold has good and similar results when performed with rasps or puncture needles, even in unexperienced hands. The needle has the advantage of leading to a comparable surgical time and less postoperative edema, while not requiring any special surgical instrument. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the table of contents or the online instructions to authors www.springer.com/00266 .

Simulation-Based Comprehensive Cleft Care Workshops: A Reproducible Model for Sustainable Education.

OBJECTIVE: Evaluate simulation-based comprehensive cleft care workshops as a reproducible model for education with sustained impact. DESIGN: Cross-sectional survey-based evaluation. SETTING: Simulation-based comprehensive cleft care workshop. PARTICIPANTS: Total of 180 participants. INTERVENTIONS: Three-day simulation-based comprehensive cleft care workshop. MAIN OUTCOME MEASURES: Number of workshop participants stratified by specialty, satisfaction with the workshop, satisfaction with simulation-based workshops as educational tools, impact on cleft surgery procedural confidence, short-term impact on clinical practice, medium-term impact on clinical practice. RESULTS: The workshop included 180 participants from 5 continents. The response rate was 54.5%, with participants reporting high satisfaction with all aspects of the workshop and with simulation-based workshops as educational tools. Participants reported a significant improvement in cleft lip (33.3 ± 5.7 vs 25.7 ± 7.6; P < .001) and palate (32.4 ± 7.1 vs 23.7 ± 6.6; P < .001) surgery procedural confidence following the simulation sessions. Participants also reported a positive short-term and medium-term impact on their clinical practices. CONCLUSION: Simulation-based comprehensive cleft care workshops are well received by participants, lead to improved cleft surgery procedural confidence, and have a sustained positive impact on participants' clinical practices. Future efforts should focus on evaluating and quantifying this perceived positive impact, as well reproducing these efforts in other areas of need.

Quantifying Dynamic Deformity After Dual Plane Breast Augmentation.

BACKGROUND: Dynamic breast deformity (DBD) is characterized by visible distortion and deformity of the breast due to contraction of the pectoralis major muscle after submuscular breast augmentation; fortunately, in most cases, this is not a clinically significant complaint from patients. The purpose of this study is to present a simple method for objectively measuring DBD in patients submitted to dual plane breast augmentation (DPBA). METHODS: We studied 32 women, between 18 and 50 years old, who underwent primary DPBA with at least 1 year of follow-up. Anthropometric landmarks of the breast were marked, creating linear segments. Standardized photographs were obtained both during no pectoralis contraction (NPC) and during maximum pectoralis muscle contraction (MPC); measurements of the linear segments were taken through ImageJ imaging software, and both groups were compared. RESULTS: We found statistically significant differences in all analyzed segments when comparing measurements of the breasts during NPC and MPC (p < 0.001). CONCLUSION: Our study proposes a novel, standardized method for measuring DBD after DPBA. This technique is reproducible, allowing for objective quantification of the deformity in any patient, which can be valuable for both patients and surgeons, as it allows for a more thorough discussion on DBD, both pre- and postoperatively, and may help both patients and surgeons to make more informed decisions regarding potential animation deformities after breast augmentation. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Respiratory Polysomnographic Findings in Patients Treated Primarily for Unilateral Cleft Lip and Palate.

Cleft lip and palate (CLP) is the most common congenital craniofacial abnormality. Obstructive sleep apnea syndrome (OSAS) is a highly prevalent but underdiagnosed disease and is frequently associated with craniofacial anomalies. There are few studies describing the sleep breathing pattern of children with CLP. This study sought to characterize the respiratory profile of 23 children with unilateral cleft lip and palate, aged 7-12 years, who had undergone cleft lip and nasal repair at age 3-4 months and palatoplasty at 12-15 months, with a particular focus on evaluating the presence of OSAS in children with CLP. Polysomnography was performed and findings were analyzed descriptively. We found a mean and median for apnea/hypopnea index (AHI) of 1.11/h (SD = 0.78) and 0.9/h, respectively. The mean obstructive apnea index (OAI) was 0.27/h (SD = 0.38) and the median, 0.1/h. Nearly 30% of patients had an AHI above 1.4 events/h. There was no significant oxyhemoglobin desaturation in the study group. In this group, the prevalence of OSAS was higher than in noncleft populations when compared to the normality values adopted. This sample of patients with unilateral cleft lip and palate exhibited an increased prevalence of OSAS during the mixed dentition stage. Although the results showed that OSAS was mild, we advise closer observation of these patients. Polysomnography is recommended for the assessment of children with airway abnormalities, to individualize the extent of treatment.

Maxillary Hypoplasia: Differential Diagnosis of Nasal Obstruction in Infants.

Maxillary hypoplasia (MH) is a rare cause of respiratory dysfunction in infants and may occur in association with genetic abnormalities or as an isolated condition. It is included in the differential diagnosis of congenital nasal obstruction. This paper seeks to report a case series of infants with MH, discuss methods for its diagnosis, and compare computed tomography (CT) measurements of nasal cavities of infants with MH and without craniomaxillofacial abnormalities. The therapeutic approach in each patient is also described. All infants with MH admitted to a tertiary hospital between 2012 and 2015 were included. Baseline nasal endoscopy was performed at bedside. The width of the infants' nasal cavities was measured by a radiologist with experience in CT scanning of facial bones. Control patients were infants of matched sex and similar age who underwent head CT scanning for various reasons. Overall, 8 infants with MH and 8 controls were assessed. All nasal cavity dimensions of infants with MH were significantly smaller than those of control subjects. The authors conclude that the diagnosis of MH should be considered in infants with nasal obstruction and nasal cavity narrowing at nasal endoscopy.

Surgical management of a projectile within the temporomandibular joint.

Facial gunshot wounds pose a challenge for head and neck surgeons as it is usually accompanied by significant soft and bone tissue loss and impairment of the stomatognathic system. This article reports the case of a patient who had sustained facial gunshot wound and had the projectile lodged at the upper disk space of the right-side temporomandibular joint, which caused mandible function impairment and pain. The projectile was surgically removed via endaural access, and the patient was later submitted to physiotherapy. After treatment, the function of the joint was reestablished, the pain disappeared, and the aesthetics results were considered excellent, with no sequels. The surgical removal of the projectile of the temporomandibular joint combined with the postsurgical physiotherapy showed to be an efficient treatment to the present case.

Quantitative computed tomography and cranial burr holes: a model to evaluate the quality of cranial reconstruction in humans.

Current methods to evaluate the biologic development of bone grafts in human beings do not quantify results accurately. Cranial burr holes are standardized critical bone defects, and the differences between bone powder and bone grafts have been determined in numerous experimental studies. This study evaluated quantitative computed tomography (QCT) as a method to objectively measure cranial bone density after cranial reconstruction with autografts. In each of 8 patients, 2 of 4 surgical burr holes were reconstructed with autogenous wet bone powder collected during skull trephination, and the other 2 holes, with a circular cortical bone fragment removed from the inner table of the cranial bone flap. After 12 months, the reconstructed areas and a sample of normal bone were studied using three-dimensional QCT; bone density was measured in Hounsfield units (HU). Mean (SD) bone density was 1535.89 (141) HU for normal bone (P < 0.0001), 964 (176) HU for bone fragments, and 453 (241) HU for bone powder (P < 0.001). As expected, the density of the bone fragment graft was consistently greater than that of bone powder. Results confirm the accuracy and reproducibility of QCT, already demonstrated for bone in other locations, and suggest that it is an adequate tool to evaluate cranial reconstructions. The combination of QCT and cranial burr holes is an excellent model to accurately measure the quality of new bone in cranial reconstructions and also seems to be an appropriate choice of experimental model to clinically test any cranial bone or bone substitute reconstruction.

A comparison of the efficacy of autologous fibrin glue/platelet-poor plasma versus suction drainage in preventing hematoma and seroma in rhytidectomy: A randomized, double-blind, controlled study.

BACKGROUND: One of the most feared complications of rhytidectomy is the formation of hematoma and seroma, which may harm patients' health and compromise the surgical outcome. OBJECTIVE: To compare the efficacy of autologous fibrin glue/platelet-poor plasma versus suction drainage in preventing surgical complications such as hematoma and seroma following rhytidectomy procedures. METHODS: A prospective, randomized, double-blind, controlled study was conducted to compare the efficacy of the two interventions. Seventy-two patients were selected and divided into two groups of 36 (autologous fibrin glue versus suction drainage). Forty-eight hours after the procedures, all patients underwent ultrasound examination, always by the same radiologist, to measure the volume of exudate under the facial skin flaps. RESULTS: The mean total volume of exudate was 3.21 mL in the suction drainage group and 1.02 mL in the fibrin glue group, with effect size of 68.1% and confidence interval of 55.3 to 77.2 (P < 0.001). CONCLUSIONS: Results significantly favor the use of fibrin glue and show that it was 68.1% more effective than suction drainage in preventing hematoma or seroma in rhytidectomy procedures.

Reconstruction of parietal bone defects with adiposederived mesenchymal stem cells. Experimental study.

PURPOSE: This study assessed the regeneration potential of mesenchymal stem cells (MSC) from adipose tissue associated with platelet-rich plasma (PRP) in bone regeneration. METHODS: Thirty Wistar rats (Rattus norvegicus albinos) were divided into five groups (according to the grafting material and time to euthanasia): (1) autograft - 14 days (control), (2) autograft - 28 days (control), (3) MSC + PRP - 14 days, (4) MSC + PRP + papaverine - 14 days and (5) MSC + PRP + papaverine - 28 days. After euthanasia, the graft was removed and histological slides were prepared. They were assessed by a blinded pathologist using a previously published histological scale as parameter. RESULTS: There was some degree of neoformed bone trabeculae (NBT) in 93.3% of the samples, as well as osteoblastic activity (OA). The autograft groups (14 and 28 days) had higher levels in the formation of bone trabeculae. Nonparametric data were analyzed using the Wilcoxon-Mann-Whitney test and proved not to be statistically significant at p < 0.05. CONCLUSIONS: Experimental parietal bone reconstruction, combining MSC, PRP and papaverine presented regeneration in all groups with no significant difference among them.

Effects of velopharyngeal dysfunction on middle ear of repaired cleft palate patients.

OBJECTIVE: Cleft palates are strongly associated with the development of otitis media due to the anatomic and functional defect of the soft palate musculature and the associated alterations of velopharyngeal muscle insertion on tubal cartilage, or even intrinsic alterations of the cartilage, which affects eustachian tube function. This study will assess velopharyngeal muscle adequacy after palatoplasty through videonasoendoscopy and verify if there is a correlation with otologic status. DESIGN: Transversal study. SETTING: Otorhinolaryngology and cleft palate outpatient service of the Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil. PATIENTS: Seventy-three patients with cleft palate or cleft lip and palate between the ages of 6 and 12 years who had already undergone palatoplasty. INTERVENTIONS: Videonasoendoscopy for evaluation of velopharyngeal function and videotoscopy to assess middle ear status. MAIN OUTCOME MEASURES: Severity scale for videonasoendoscopic and videotoscopic findings. RESULTS: There was no significant correlation between the videonasoendoscopic and the videotoscopic scores in the population studied. DISCUSSION AND CONCLUSIONS: Intrinsic defects of the eustachian tube cartilage and of the insertion of the velopharyngeal muscles seem to contribute to the evolution of otitis media in patients with cleft palate, in addition to the actual defect of the soft palate. There was no correlation between the severity of the otoscopic findings and the degree of velopharyngeal dysfunction.

The impact of cranioplasty on the patients' quality of life.

OBJECTIVE: To evaluate the quality of life in patients with moderate or large cranial bone defects before and after late cranioplasty. METHODS: Authors performed a prospective clinical trial including all consecutive patients that filled inclusion criteria during a period of 1 year. All patients answered the quality of life SF-36 questionnaire in 5 different times. Besides authors gathered information about the primary trauma and demographic characteristics. RESULTS: A total of 70 consecutive patients were admitted to the hospital during the study period, and 62 were included in the project. Cranioplasty statistically improved patients' quality of life in all 8 domains after a 24 months follow-up. CONCLUSION: Cranioplasty has a significant impact over the quality of life in brain trauma victims who survived the primary trauma and harbor a large cranial bone defect.

Use of derived adipose stem cells to reduce complications of cutaneous scarring in smokers. An experimental model in rats.

PURPOSE: To evaluate the use of adipose-derived stem cells (ADSC) in reducing the necrosis area in an experimental model of cutaneous ischemic flap in rats submitted to subcutaneous nicotine injection to simulate a smoker patient. METHODS: In an experimental study, 30 rats were enrolled and divided into two experimental groups of 15 animals all submitted to a subcutaneous nicotine injection to create ischemic cutaneous flaps on their backs. Other 10 animals were used only to obtain adipose tissue derived stem cells (ADSC). The first group (n=15) received ADSC treatment at the end of surgery while the other group, the control (n=15), received no other interventions. After euthanasia, a decal was performed on the whole area of the flap, accurately defining the transition from necrosis to healthy region. Photos of all animals were collected and evaluated by scales standardized by Paint-Autocad- 2015 software to define the area of flap necrosis in each rat. Student T test was performed to compare the groups, considering a p< 0.05 significant. Data were analyzed using SPSS IBM® 18 version. RESULTS: Through the analysis of the images by the program Paint-Autocad-2015 and the area of decal obtained by the transparent sheet, we obtained a mean of 46% necrosis of the total area of the flap in the treatment group and 69.4% in the control group. In the descriptive analysis, a mean of 3.7 cm of necrosis CI 95% (3.2 - 4.2) was evident in the treatment group whereas a mean value of 5.56 CI 95% (5.2 - 5.9) was found in control group, with p value <0.001 for this comparison. CONCLUSION: The application of adipose-derived stem cells reduces the percentage of necrosis in an experimental model of randomized cutaneous flap in rats submitted to subcutaneous nicotine injection.

Glucose level evaluation in monopedicled rectus abdominis myocutaneous flap after venous occlusion: experimental study in rats.

OBJECTIVE: to validate an experimental model for the measurement of glycemic levels in surgical flaps with the use of common glucometers, and to analyze the diagnostic criteria for hypoperfusion of such flaps. METHODS: we performed vertical myocutaneous rectus abdominis flaps with upper pedicles bilaterally in 20 male Wistar rats, divided into two groups: with and without venous occlusion of the pedicle. We measured glucose levels in the flaps and in the systemic circulation with standard glucometers. We tested the accuracy of alternative diagnostic criteria for the detection of hypoperfusion. RESULTS: from 15 minutes of venous occlusion on, there was a significant reduction in glucose levels measured in the congested flap (p<0.001). Using a minimum difference of 20mg/dl in the glycemic levels between the flap and systemic blood, 30 minutes after occlusion, as a diagnostic criterion, the sensitivity was 100% (95% CI 83.99-100%) and specificity of 90% (95% CI 69.90-97.21%) for the diagnosis of flap congestion. CONCLUSION: It is possible to measure glucose levels in vertical myocutaneous rectus abdominis flaps of Wistar rats, perfused or congested, using a common glucometer. The diagnostic criteria that compare the glucose levels in the flaps with the systemic ones were more accurate in the evaluation of tissue perfusion.

The role of flexible fiberoptic laryngoscopy in Robin Sequence: A systematic review.

OBJECTIVE: Systematically search literature for flexible fiberoptic laryngoscopy (FFL) use in Robin Sequence (RS) patients, in diverse clinical scenarios. DATA SOURCES: Pubmed, LILACS and SCIELO. REVIEW METHODS: Systematic review using a sensitive search strategy focused on RS patients and FFL. RESULTS: There were 48 full text articles included in this systematic review. No summary meta-analytic measurement could be calculated due to heterogeneity of interventions and outcomes. FFL approaches were grouped in five topics, as follows: Endoscopic classification: no evidence on superiority of awake over light sedation and correlation of grading scales with symptom severity. Airway abnormalities: high incidence of concomitant lesions besides glossoptosis. Swallowing evaluation: no validation against fluoroscopy (gold standard) yet. Intubation aid for mechanical ventilation: ultra-thin bronchoscopes improve success rates of intubation. Treatment outcome monitoring: no consensus on ideal parameters to be checked. CONCLUSION: Some applications have their roles already well established in the management of RS patients, like the evaluation of glossoptosis and associated lesions and as an intubation assistance tool, while others need to be the subject of further research, like the exact method of evaluation, its association with clinical manifestations, its role in swallowing investigation and as a postoperative success predictor.

Reconstrução do antebraço com matriz dérmica acelular após excisão de neurofibroma plexiforme gigante: relato de casos / Forearm reconstruction with acellular dermal matrix after giant plexiform neurofibroma excision: case reports

Introdução: O neurinoma plexiforme gigante é um neuroectoderma e uma doença hereditária. É um tumor cutâneo incomum associado à NF1, caracterizado como um tumor benigno da bainha do nervo periférico envolvendo múltiplos fascículos nervosos. Os objetivos da reconstrução da cobertura do antebraço são proteger as estruturas que vão até o punho e a mão e evitar cicatrizes que levem à perda de movimento. Tanto o antebraço quanto a mão desempenham papéis funcionais e sociais. O manejo bem-sucedido de feridas complexas é necessário para a reabilitação funcional geral desses pacientes. Relato do Caso: Paciente do sexo feminino, 31 anos, apresentou-se na divisão de cirurgia plástica com neurofibroma plexiforme gigante no antebraço direito. Após ressecção cuidadosa, todos os tendões anteriores do antebraço foram expostos. O defeito foi coberto com Pelnac T enxertável (espessura de 3mm e tamanho 12 X 24cm2), fixados com pontos monocryl 4-0. Após 10 dias, a matriz dérmica acelular foi removida e um enxerto de malha de pele de espessura parcial foi colocado. No dia 7, a matriz dérmica acelular apresentou bons sinais de ingestão. No dia 17, observamos uma sobrevida do enxerto de 95%. No seguimento de 3 meses, a reconstrução estava estável, sem defeitos de contorno, a mão apresentava amplitude de movimento completa e o paciente não apresentava problemas nas atividades diárias. Conclusões: A matriz dérmica acelular parece ser uma opção útil na cobertura de defeitos complexos no antebraço, permitindo menor morbidade e rápida recuperação funcional.

Introduction: Giant plexiform neurinoma is a neuroectoderm and inherited disease. It is an uncommon skin tumor associated with NF1, characterized as a benign peripheral nerve sheath tumor surrounding multiple nervous fascicles. The goals of forearm coverage reconstruction are to protect the structures running to the wrist and hand and prevent scarring that leads to movement loss. Both forearm and hand play functional and social roles. Successful management of complex wounds is necessary for the overall functional rehabilitation of these patients. Case Report: A 31-year-old woman presented at the plastic surgery division with a giant plexiform neurofibroma in the right forearm. After careful resection, all anterior forearm tendons were exposed. The defect was covered with graftable Pelnac T (thickness of 3mm and sizing 12 X 24cm2), fixed with 4-0 monocryl sutures. After 10 days, the acellular dermal matrix silicone layer was removed, and a split-thickness skin meshed graft was placed. On day 7, the acellular dermal matrix showed good signs of intake. On day 17, we observed a 95% graft survival. At the 3-month follow-up, reconstruction was stable without contouring defects, the hand had full range of motion, and the patient had no problems in daily activities. Conclusions: Acellular dermal matrix appears to be a useful option in covering complex defects in the forearm, allowing for less morbidity and rapid functional recovery.

Early surgical treatment of nonsyndromic craniosynostosis.

BACKGROUND: Craniosynostosis, a premature fusion of cranial sutures, can happen as an isolated defect (nonsyndromic) or as part of a syndrome. It may lead to raised intracranial pressure and deformity of both the cranial and facial skeletons. Early surgery is usually the best treatment choice. The aim of this study was to review the experience of a multidisciplinary staff with the surgical treatment of nonsyndromic craniosynostosis. METHODS: All the nonsyndromic craniosynostosis cases treated surgically from 1991 to 2005 at 2 neurosurgical centers were reviewed. The variables analyzed were sex, age, weight, type of deformity, estimated volemia, surgical technique, surgical time, blood loss, PO hospitalization time, and complications. All data were stored in a database and analyzed with Microsoft Access (Microsoft Corp, Seattle, WA) and SPSS V11.0 (SPSS, Inc, Chicago, IL). RESULTS: The sample consisted of 120 patients (70 males, 50 females). Six patients were excluded because of their atypical timing of treatment (average age, 72 months). The final average age was 7.08 months (variation, 1-18), and the average weight was 7.8 kg. The types of deformities found were scaphocephaly (n = 54, 45%), plagiocephaly (n = 27, 22%), trigonocephaly (n = 19, 16%), brachycephaly (n = 16, 13%), and oxycephaly (n = 4, 3%). The mean surgical time was 186 minutes and the mean PO hospitalization time was 6.8 days. The mortality on this series was 2.6% (3 patients). In the last operated cases, a significant improvement in morbid-mortality was observed. CONCLUSION: A multidisciplinary approach, including neurosurgeons, neurologists, and pediatricians, and appropriate training of the clinical surgical staff can minimize the risks and decrease the complications in the treatment of craniosynostosis, leading to a satisfactory outcome.

Correlation of Vocal Intensity with Velopharyngeal Closing Mechanism in Individuals with and without Complaint of Velopharyngeal Dysfunction.

Introduction Velopharyngeal sphincter is a portion of the muscle of the palatopharyngeal arch that is capable of separating the oral cavity from the nasal cavity. It has not been determined yet whether voice intensity has an influence on this capacity. Velopharyngeal sphincter closure is accomplished by elevating and retracting the soft palate at the same time as the nasopharyngeal walls are constricted. Objective This study aims to correlate voice intensity with velopharyngeal sphincter closure in individuals without velopharyngeal dysfunction and patients with cleft lip and palate. Methods We conducted a cross-sectional, comparative, and contemporary study. The sample consisted of 16 individuals in the control group and 16 individuals in the study group. Patients underwent instrumental assessment, which we subsequently analyzed using a computer program, and a brief medical history review. The mean age of the control group was 27.6 years, whereas the mean age of the case group was 15.6 years. Results Cases showed higher voice intensity in regular and weak fricative sentences when compared with controls. There was no agreement on the analysis of the instrumental assessment between the assessors and the computer program. Regardless of voice intensity, the computer program demonstrated a similar closure pattern. Conclusion The computer program showed similar closure pattern for the three levels of intensity. There was no agreement between the three assessors and the closure pattern determined by the computer program. There was no statistically significant correlation between voice intensity and degree of velopharyngeal sphincter closure.