RESUMO
BACKGROUND: Post-traumatic mandibular malocclusion is a complex condition that poses a significant challenge to reconstructive surgeons. The malocclusion that ensues from bilateral condylar and parasymphseal fractures presents a particular challenge as it leads to bilateral posterior shortening and lingual tilting of dental arch leading to a combination of open anterior bite, crossbite, overbite, underbite, and/or facial asymmetry. The complexity of such malocclusion requires intricate freedom of movement of the mandibular arch that can be achieved by performing a 5-segment mandibular osteotomy. METHOD: This is a case series of 9 adult patients with significant post-traumatic mandibular malocclusion who were treated with 5-segment mandibular osteotomy technique. This article details the demographics, surgical technique and outcomes in this cohort of patients. RESULTS: All 9 patients in this series had condylar fracture as part of the index mandibular trauma. They have a common post-traumatic deformity of the mandibular arch due to shortening of the vertical mandibular height in the fracture site and variable degrees of lingual tilting leading to crossbite. The 5-segment mandibular osteotomy provided an adequate correction of dental and facial deformities in all 9 patients. One patient had a relapse of the dental malocclusion that required postoperative rescue orthodontics. Furthermore, one patient had a significant postoperative hemorrhage that required a facial artery ligation. CONCLUSION: Post-traumatic mandibular malocclusion is a complex deformity that poses a great challenge to practicing surgeons. Five-segment mandibular osteotomy is a technique that provides ample degrees of movement of mandibular segments that is necessary to correct such deformity.
RESUMO
Sagittal craniosynostosis is the most common form of congenital cranial deformity. Surgical interventions are performed either open or endoscopic. Advancements in minimally invasive surgery have enabled the development of the endoscopic suturectomy technique. This is contrasted to the traditional open cranial vault reconstruction. There is a paucity of data comparing the head shape changes from both techniques. This study aims to compare the morphological outcome of endoscopic suturectomy versus total cranial vault reconstruction. METHODS: This is a retrospective comparative study involving 55 cases of sagittal craniosynostosis, 37 of which has open total cranial vault reconstruction and 18 had endoscopic suturectomy procedure. Preoperative and postoperative 3D photographs of both groups were analyzed and compared. The change in correction between preoperative and postoperative state was measured against a crowd-driven standard for acceptable head shape. RESULTS: Total cranial vault had higher percentage change between pre and postoperative cranial index than endoscopic suturectomy (14.7% versus 7.7%, P = 0.003). However, both techniques were able to achieve the minimum standard of 70% correction (TCV 107.5%, ES 100.4%, P = 0.02). CONCLUSION: Total cranial vault and endoscopic suturectomy are effective in correcting scaphocephaly among children with sagittal craniosynostosis. Additionally, both techniques are able to achieve a percentage correction that exceeds the 70% benchmark established by the lay public.
Assuntos
Craniossinostoses , Procedimentos de Cirurgia Plástica , Criança , Craniossinostoses/cirurgia , Endoscopia , Humanos , Lactente , Período Pós-Operatório , Estudos Retrospectivos , Crânio/cirurgia , Resultado do TratamentoRESUMO
Machine learning (ML) revolves around the concept of using experience to teach computer-based programs to reliably perform specific tasks. Healthcare setting is an ideal environment for adaptation of ML applications given the multiple specific tasks that could be allocated to computer programs to perform. There have been several scoping reviews published in literature looking at the general acceptance and adaptability of surgical specialities to ML applications, but very few focusing on the application towards craniofacial surgery. This study aims to present a detailed scoping review regarding the use of ML applications in craniofacial surgery.
Assuntos
Face/cirurgia , Aprendizado de Máquina , Crânio/cirurgia , Bibliometria , Atenção à Saúde , Humanos , PrevalênciaRESUMO
: A question that remains unanswered is at what level of surgical correction does the public perceive a head shape to be "normal" or "acceptable?" For most cases of non-syndromic asymptomatic craniosynostosis, the parents desire for surgical correction is to improve the cosmetic appearance of head shape. At the time of this writing, the intraoperative surgeons' perspective of what constitutes an acceptable head shape is the target for surgical correction. In introducing an improved objectively cosmetic goal, an appropriate outcome measure would be to assess what the general public considers a normal or acceptable head shape in children with craniosynostosis. METHOD: Twenty-two unique images were presented via an online crowdsourcing survey of a severe case of non-syndromic sagittal craniosynosis gradually corrected to an age and gender matched normalized head shape. Participants were recruited via the Sick Kids Twitter account. Participants were invited to rate the head shapes as "normal" or "abnormal." RESULTS: The 538 participants completed the online survey. Participants were able to reliably and consistently identify normal and abnormal head shapes with a Kappa Score >0.775. Furthermore, participants indicated that a correction of 70% is required in order for the cranial deformity to be regarded as "normal." This threshold closely reflects a normal Cranial Index, which is a widely used morphometric outcome in craniosynostosis. CONCLUSION: Crowdsourcing provides an ideal method for capturing the general population's perspective on what constitutes a normal and acceptable head shape in children with sagittal craniosynostosis. Laypersons are able to reliably and consistently distinguish cranial deformities from a "normal" head shape. The public indicates a threshold correction of 70% in sagittal craniosynosis to regard it as a "normal" head shape.
Assuntos
Craniossinostoses/cirurgia , Cabeça , Anormalidades Maxilomandibulares/cirurgia , Criança , Ossos Faciais , Humanos , Inquéritos e QuestionáriosRESUMO
Coronavirus disease 2019 (COVID-19) is an infectious disease that is caused by severe respiratory syndrome coronavirus 2. Although elective surgical procedures are being cancelled in many parts of the world during the COVID-19 pandemic, acute craniomaxillofacial (CMF) trauma will continue to occur and will need to be appropriately managed. Surgical procedures involving the nasal, oral, or pharyngeal mucosa carry a high risk of transmission due to aerosolization of the virus which is known to be in high concentration in these areas. Intraoperative exposure to high viral loads through aerosolization carries a very high risk of transmission, and the severity of the disease contracted in this manner is worse than that transmitted through regular community transmission. This places surgeons operating in the CMF region at particularly high risk during the pandemic. There is currently a paucity of information to delineate the best practice for the management of acute CMF trauma during the COVID-19 pandemic. In particular, a clear protocol describing optimal screening, timing of intervention and choice of personal protective equipment, is needed. The authors have proposed an algorithm for management of CMF trauma during the COVID-19 pandemic to ensure that urgent and emergent CMF injuries are addressed appropriately while optimizing the safety of surgeons and other healthcare providers. The algorithm is based on available evidence at the time of writing. As the COVID-19 pandemic continues to evolve and more evidence and better testing becomes available, the algorithm should be modified accordingly.
Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Traumatismos Faciais , Doenças Maxilares/cirurgia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto , Doença Aguda , COVID-19 , Infecções por Coronavirus/complicações , Infecções por Coronavirus/transmissão , Face , Humanos , Doenças Maxilares/complicações , Doenças Maxilares/virologia , Equipamento de Proteção Individual , Pneumonia Viral/complicações , Pneumonia Viral/transmissão , SARS-CoV-2RESUMO
: Cranial index is a widely used 2-dimensional measure of skull form. It has traditionally been calculated as a ratio of the maximal cranial width divided by the maximal skull length. Nevertheless, the points of maximal skull length change dramatically in sagittal craniosynostosis due to variable degrees of frontal and occipital bossing. Therefore, such anatomical changes influence the calculated cranial index. METHOD: This is a retrospective comparative study of 2 methods of measuring cranial index; the traditional method that measures the skull length from glabella to opithcranion versus a modified method that measures the maximal skull length from the most anterior point of the frontal bossing to opithcranion. Cranial indices for 115 patients of radiologically and clinically diagnosed nonsyndromic sagittal craniosynostosis were calculated using both methods. Correlation and Agreements Limits were calculated for comparison between the 2 methods. RESULTS: Males constituted 74.8% (nâ=â86) of the total sample size with the remaining 29 participants identified as female. The mean age of the study participants was 4.8 months (range 8 days-12 months). The 2 methods were strongly correlated (râ=â0.94). The Agreement Limits were calculated to be between 4.02% and 0.18%. CONCLUSION: Typical anatomical changes such as variable degrees of frontal and occipital bossing influence the accuracy of cranial index measurement in sagittal craniosynostosis. Traditional method of cephalic index measurement could underestimate the severity of scaphocephaly.
Assuntos
Cefalometria/métodos , Craniossinostoses/patologia , Crânio/anatomia & histologia , Cefalometria/normas , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Padrões de Referência , Estudos RetrospectivosRESUMO
BACKGROUND: Research during residency is associated with better clinical performance, improved critical thinking, and increased interest in an academic career. OBJECTIVE: We examined the rate, characteristics, and factors associated with research publications by residents in Oman Medical Specialty Board (OMSB) programs. METHODS: We included residents enrolled in 18 OMSB residency programs between 2011 and 2016. Resident characteristics were obtained from the OMSB Training Affairs Department. In April 2018, MEDLINE and Google Scholar databases were searched independently by 2 authors for resident publications in peer-reviewed journals using standardized criteria. RESULTS: Over the study period, 552 residents trained in OMSB programs; 64% (351 of 552) were female, and the mean age at matriculation was 29.4 ± 2.2 years. Most residents (71%, 393 of 552) were in the early stages of specialty training (R ≤ 3) and 49% (268 of 552) completed a designated research block as part of their training. Between 2011 and 2016, 43 residents published 42 research articles (range, 1-5 resident authors per article), for an overall publication rate of 8%. Residents were the first authors in 20 (48%) publications. Male residents (odds ratio [OR] = 2.07; P = .025, 95% CI 1.1-3.91) and residents who completed a research block (OR = 2.57; P = .017, 95% CI 1.19-5.57) were significantly more likely to publish. CONCLUSIONS: Research training during residency can result in tangible research output. Future studies should explore barriers to publication for resident research and identify interventions to promote formal scholarly activity during residency.
Assuntos
Pesquisa Biomédica , Internato e Residência , Publicações/tendências , Adulto , Bibliometria , Educação de Pós-Graduação em Medicina , Feminino , Humanos , Masculino , Omã , Conselhos de Especialidade ProfissionalRESUMO
OBJECTIVES: Trauma surgeons are essential in hospital-based trauma care systems. However, there are limited data regarding the impact of their presence on the outcome of multi-trauma patients. This study aimed to assess the outcomes of multi-trauma road traffic crash (RTC) cases attended by trauma surgeons versus those attended by non-trauma surgeons at a tertiary hospital in Oman. METHODS: This retrospective study was conducted in December 2015. A previously published cohort of 821 multi-trauma RTC patients admitted between January and December 2011 to the Sultan Qaboos University Hospital, Muscat, Oman, were reviewed for demographic, injury and hospitalisation data. In-hospital mortality constituted the main outcome, with admission to the intensive care unit, operative management, intubation and length of stay constituting secondary outcomes. RESULTS: A total of 821 multi-trauma RTC cases were identified; of these, 60 (7.3%) were attended by trauma surgeons. There was no significant difference in mortality between the two groups (P = 0.35). However, patients attended by trauma surgeons were significantly more likely to be intubated, admitted to the ICU and undergo operative interventions (P <0.01 each). The average length of hospital stay in both groups was similar (2.6 versus 2.8 days; P = 0.81). CONCLUSION: No difference in mortality was observed between multi-trauma RTC patients attended by trauma surgeons in comparison to those cared for by non-trauma surgeons at a tertiary centre in Oman.
Assuntos
Acidentes de Trânsito/mortalidade , Mortalidade Hospitalar , Traumatismo Múltiplo/mortalidade , Cirurgiões , Traumatologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/cirurgia , Omã , Estudos Retrospectivos , Centros de Atenção Terciária , Resultado do Tratamento , Adulto JovemRESUMO
AIMS: Little is known about students' contribution to mainstream New Zealand (NZ) medical literature. This study aimed to analyse the pattern of students' contributions to the New Zealand Medical Journal (NZMJ). METHODS: A retrospective review of all articles authored or co-authored by students, and published in the NZMJ from November 1999 to December 2013. Author and article related information were collected and analysed. RESULTS: There were 288 issues and 4205 articles published between November 1999 and December 2013. Students authored or co-authored 376 (8.9%) articles during this time period. There is an increased trend in the number of articles published during the study period in that students published three times more in 2013 when compared to 2000. Senior medical students and postgraduate students contributed the most with 41.2% and 40.3% of the total student publications respectively. Original articles constituted the most common type of students' publications (67.6%). CONCLUSION: Students contributed substantially to mainstream published NZ medical literature. Students' contribution continues to increase and this reflects the increased participation in research activities. Academic institutions should harness this potential and encourage students to publish their research findings.
Assuntos
Autoria , Pesquisa Biomédica , Publicações/estatística & dados numéricos , Editoração/estatística & dados numéricos , Estudantes de Medicina/estatística & dados numéricos , Humanos , Disseminação de Informação , Nova Zelândia , Estudos RetrospectivosRESUMO
UNLABELLED: Traumatic brain injury (TBI) continues to be the main cause of death among trauma patients. Accurate diagnosis and timely surgical interventions are critical steps in reducing the mortality from this disease. For patients who have no surgically reversible head injury pathology, the decision to transfer to a dedicated neurosurgical unit is usually controversial. OBJECTIVE: To compare the outcome of patients with severe TBI treated conservatively in a specialized neurosurgical intensive care unit (ICU) and those treated conservatively at a general ICU in the Sultanate of Oman. DESIGN: Retrospective cohort study. METHODS: This is a retrospective study of patients with severe TBI admitted to Khoula Hospital ICU (specialized neurosurgical ICU) and Nizwa Hospital ICU (general ICU) in Oman in 2013. Surgically treated patients were excluded. Data extracted included demographics, injury details, interventions, and outcomes. The outcome variables included mortality, length of stay, length of ICU days, and ventilated days. RESULTS: There were 100 patients with severe TBI treated conservatively at Khoula Hospital compared with 74 patients at Nizwa Hospital. Basic demographics were similar between the 2 groups. No significant difference was found in mortality, length of stay, ICU days, and ventilation days. CONCLUSION: There is no difference in outcome between patients with TBI treated conservatively in a specialized neurosurgical ICU and those treated in a general nonspecialized ICU in Oman in 2013. Therefore, unless neurosurgical intervention is warranted or expected, patients with TBI may be managed in a general ICU, saving the risk and expense of a transfer to a specialized neurosurgical ICU.