RESUMEN
Patients afflicted with facial paralysis suffer significant physical and psychosocial effects that can lead to depression and social isolation. Timely diagnosis and initiation of appropriate therapy are keys to achieving good outcomes in the management of facial paralysis. Eye protection is of paramount importance to prevent vision loss in patients with impaired eye closure. Patients should be assessed for signs of depression and treated appropriately.
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Lesiones Oculares/prevención & control , Parálisis Facial/diagnóstico , Parálisis Facial/terapia , Atención Primaria de Salud/organización & administración , Nervio Facial , Femenino , Humanos , MasculinoRESUMEN
Masseter and temporalis muscle transfer is an effective technique for restoring facial symmetry and commissure excursion in flaccid facial paralysis. Adherence to the principles and biomechanics of muscle transfer is essential for achieving optimal results. Muscle transfer has the advantage of being single staged with fast recovery of function. It is particularly useful in patients with low life expectancy or multiple comorbidities where a more complex, multiple stage procedure may be detrimental.
Asunto(s)
Parálisis Facial/cirugía , Colgajos Tisulares Libres/trasplante , Músculo Esquelético/trasplante , Procedimientos de Cirugía Plástica/métodos , Sonrisa , Parálisis Facial/fisiopatología , Humanos , Recuperación de la FunciónRESUMEN
Scars of the cheek resulting from all causes can extol significant psychological toll. The cheek is the largest facial subunit and visually and aesthetically prominent making scars in this region difficult to ignore. An approach to scar management that targets specific characteristics of a scar using a combination of surgical and nonsurgical modalities can significantly improve the appearance of most scars. The ideal time to revise a scar should be based on the extent of scar maturation and presence or absence of any functional distortion.
Asunto(s)
Mejilla , Cicatriz/terapia , Antiinflamatorios/uso terapéutico , Antimetabolitos/uso terapéutico , Mejilla/anatomía & histología , Mejilla/cirugía , Cicatriz/diagnóstico , Cicatriz/psicología , Terapia Combinada , Fluorouracilo/uso terapéutico , Humanos , Láseres de Gas/uso terapéutico , Láseres de Estado Sólido/uso terapéutico , Plasma Rico en Plaquetas , Procedimientos de Cirugía Plástica , Esteroides/uso terapéuticoRESUMEN
IMPORTANCE: Reconstruction of the facial nerve after radical parotidectomy is commonly performed with cable grafting, which is associated with slow recovery of nerve function and synkinesis. OBJECTIVE: To describe facial nerve reconstruction after radical parotidectomy using concurrent masseteric nerve transfer and cable grafting. DESIGN, SETTING, AND PARTICIPANTS: This retrospective medical record review at a tertiary referral hospital included 9 patients who underwent concurrent masseteric nerve transfer and cable grafting for facial nerve reconstruction performed by a single surgeon from January 1, 2014, to October 31, 2015. Final follow-up was completed on March 14, 2016. MAIN OUTCOMES AND MEASURES: Improvement in resting facial symmetry and oral commissure excursion and synkinesis. RESULTS: Nine patients (6 women; mean age, 62.6 years; age range, 51-73 years) underwent immediate facial nerve reconstruction after radical parotidectomy using concurrent cable grafting and masseteric nerve transposition. All patients had return of oral commissure motion within 2 to 7 months after surgery with good excursion and minimal synkinesis. CONCLUSIONS AND RELEVANCE: Masseteric nerve transposition can be combined with cable grafting to improve outcomes in facial rehabilitation after radical parotidectomy. LEVEL OF EVIDENCE: 4.
Asunto(s)
Nervio Facial/cirugía , Parálisis Facial/cirugía , Músculo Masetero/inervación , Transferencia de Nervios/métodos , Neoplasias de la Parótida/cirugía , Procedimientos de Cirugía Plástica/métodos , Complicaciones Posoperatorias/cirugía , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Colgajos Quirúrgicos , Resultado del TratamientoRESUMEN
IMPORTANCE: The mandible is arguably the most frequently fractured facial bone in children. However, facial fractures are rare in children compared with adults, resulting in few large studies on patterns of pediatric facial fractures. OBJECTIVE: To report the patterns, demographics, and cause of pediatric mandible fractures across the United States. DESIGN, SETTING, AND PARTICIPANTS: A retrospective analysis was conducted of the Healthcare Cost and Utilization Project's National Emergency Department Sample from January 1 to December 31, 2012, using the International Classification of Disease, Ninth Revision, codes for mandible fractures (802.20-802.39) among patients 18 years and younger who presented to emergency departments. Demographics, fracture site, and fracture mechanism were analyzed to identify factors associated with fractures. Analysis was conducted from July 9 to July 28, 2015. RESULTS: There were 1984 records, representing a weighted estimate of 8848 cases of pediatric mandible fracture. The mean patient age was 14.0 years (95% CI, 13.6-14.3). The male to female ratio was 4:1 and females were comparatively younger, with a mean age of 12.5 years (95% CI, 11.8-13.1; P < .001). The most frequently fractured sites were the condyle, in 1288 patients (14.6% [95% CI, 12.6%-16.5%]), and the angle, in 1252 patients (14.1% [12.4%-15.9%]). Associated intracranial injuries occurred in 756 patients (8.5% [7.1%-10.0%]), and cervical spine fractures occurred in 393 (4.4% [3.5%-5.4%]). The fracture site and mechanism of injury varied with age and sex. For patients 12 years and younger, the most frequent fracture site was the condyle, accounting for 636 fractures (27.9% [24.2%-31.6%]), and the most frequent cause was falls, accounting for 692 fractures (30.3% [25.9%-34.8%]). In teenaged patients (13-18 years), the angle was the most frequent fracture site, accounting for 1157 fractures (17.6% [15.6%-19.6%]), and the most frequent cause was assault, accounting for 2619 fractures (39.9% [36.4%-43.3%]). For male patients, the angle was the predominant site, accounting for 1053 fractures (15.0% [13.1%-16.8%]), and the leading cause was assault, accounting for 2360 fractures (33.5% [30.2%-36.9%]). For female patients, the condyle was the most frequent site, accounting for 369 fractures (20.3% [16.0%-24.6%]), and the leading cause was falls, accounting for 422 fractures (23.2% [18.6%-28.0%]). CONCLUSIONS AND RELEVANCE: In this study, age and sex disparities among pediatric mandible fractures were identified. Younger patients and female patients tend to have condyle fractures caused more commonly by falls while older patients and male patients tend to have angle fractures caused by assault. LEVEL OF EVIDENCE: NA.
Asunto(s)
Fracturas Mandibulares/epidemiología , Adolescente , Factores de Edad , Niño , Preescolar , Femenino , Humanos , Lactante , Modelos Lineales , Modelos Logísticos , Masculino , Fracturas Mandibulares/etiología , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Estados Unidos/epidemiologíaRESUMEN
PURPOSE OF REVIEW: Patient-specific implant (PSI) is a personalized approach to reconstructive and esthetic surgery. This is particularly useful in maxillofacial surgery in which restoring the complex three-dimensional (3D) contour can be quite challenging. In certain situations, the best results can only be achieved with implants custom-made to fit a particular need. Significant progress has been made over the past decade in the design and manufacture of maxillofacial PSIs. RECENT FINDINGS: Computer-aided design (CAD)/computer-aided manufacturing (CAM) technology is rapidly advancing and has provided new options for fabrication of PSIs with better precision. Maxillofacial PSIs can now be designed using preoperative imaging data as input into CAD software. The designed implant is then fabricated using a CAM technique such as 3D printing. This approach increases precision and decreases or completely eliminates the need for intraoperative modification of implants. The use of CAD/CAM-produced PSIs for maxillofacial reconstruction and augmentation can significantly improve contour outcomes and decrease operating time. SUMMARY: CAD/CAM technology allows timely and precise fabrication of maxillofacial PSIs. This approach is gaining increasing popularity in maxillofacial reconstructive surgery. Continued advances in CAD technology and 3D printing are bound to improve the cost-effectiveness and decrease the production time of maxillofacial PSIs.
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Diseño Asistido por Computadora , Implantes Dentales , Diseño de Prótesis Dental , Medicina de Precisión , HumanosRESUMEN
OBJECTIVES/HYPOTHESIS: To determine whether the type of cleft palate is associated with a need for secondary surgery (oronasal fistula repair, speech surgery) after primary cleft palate repair. STUDY DESIGN: Retrospective analysis of a national pediatric database (2009 Kids' Inpatient Database). METHODS: We identified two distinct cohorts of children who underwent primary and secondary (revision) cleft palate repairs, respectively, from a national, pediatric database (2009 Kids' Inpatient Database). Revision ratios for each cleft palate diagnosis were calculated to identify diagnoses with higher rates of revision. Revision ratio was calculated by dividing the relative frequency of each diagnosis in the secondary repair cohort by the corresponding relative frequency in the primary repair cohort. RESULTS: In 2009, there were 1942 cases of primary cleft palate repair in the 44 states participating in the KID's inpatient database. Fifty-two percent (n=1018) were male. The average age at the time of surgery was 13.36 months. In the same year secondary cleft palate procedures were performed on 724 different patients, 54% (n=388) were males. The average age for secondary procedures was 59 months. Cleft lip and palate diagnoses had higher revision rate ratios (1.92) compared to cleft palate only (0.54) P <0.05. CONCLUSION: Children with an initial diagnosis of cleft lip and palate, which is more severe than cleft palate only, have comparatively higher rates of secondary cleft palate procedures than children with cleft palate only. LEVEL OF EVIDENCE: N/A.
Asunto(s)
Fisura del Paladar/cirugía , Niño , Preescolar , Labio Leporino/cirugía , Fisura del Paladar/diagnóstico , Femenino , Humanos , Lactante , Masculino , Reoperación , Estudios RetrospectivosRESUMEN
OBJECTIVE: To determine national variations in resource utilization for primary repair of cleft lip, identify patient and institutional factors associated with high resource use, and estimate the current incidence of cleft lip in the United States. STUDY DESIGN: Retrospective analysis of a national, pediatric database (2009 Kids' Inpatient Database [KID]). METHODS: Patients aged 1 year and younger were selected using international classification of disease codes for cleft lip and procedure codes for cleft lip repair. A number of demographic variables were analyzed, and hospital charges were considered as a measure of resource utilization. RESULTS: There were 1318 patients identified. The national incidence was 0.09%, with a male to female ratio of 1.8:1. Regional incidence varied from 0.07% (Northeast) to 0.10% (West). The mean age at surgery was 4.2 months. The average length of stay was 1.4 days. The national average hospital charge was $20,147, ranging from $14,635 (South) to $23,663 (West). Teaching hospitals charge an average of $9764 higher than nonteaching hospitals. The strongest predictor of charge was length of stay, increasing charge by $8102 for every additional hospital day (P < .01). CONCLUSION: Regional variations exist in resource utilization for primary cleft lip repair. Resource use is higher in the West and among teaching hospitals.
Asunto(s)
Labio Leporino/cirugía , Recursos en Salud/estadística & datos numéricos , Labio Leporino/epidemiología , Bases de Datos Factuales , Femenino , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Hospitales de Enseñanza/economía , Humanos , Lactante , Tiempo de Internación/economía , Masculino , Estudios Retrospectivos , Estados UnidosRESUMEN
OBJECTIVES/HYPOTHESIS: To estimate the current incidence of cleft palate in the United States and to determine national variations in resource utilization for primary repair of cleft palate. STUDY DESIGN: Retrospective analysis of a national, pediatric database (2009 Kids Inpatient Database). METHODS: Patients aged 3 and below admitted for cleft palate repair were selected, using ICD-9 codes for cleft palate and procedure code for primary (initial) repair of cleft palate. A number of demographic variables were analyzed, and hospital charges were considered as a measure of resource utilization. RESULTS: Primary repair of cleft palate was performed on 1,943 patients. The estimated incidence was 0.11% with male to female ratio of 1.2:1. Regional incidence ranged from 0.09% (Northeast) to 0.12% (Midwest). The mean age at surgery was 13.4 months. The average length of stay was 1.9 days. The average total charge nationwide was $22,982, ranging from $17,972 (South) to $25,671 (Northeast). Average charge in a teaching institution was $4,925 higher than for nonteaching institutions. The strongest predictor of charge was length of stay, increasing charge by $7,663 for every additional hospital day (P < 0.01). CONCLUSIONS: National variations exist in resource utilization for primary repair of cleft palate, with higher charges in Northeastern states and teaching hospitals. The strongest predictor of increased resource use was length of stay, which was significantly higher at teaching institutions.
Asunto(s)
Fisura del Paladar/economía , Fisura del Paladar/cirugía , Preescolar , Fisura del Paladar/epidemiología , Costos y Análisis de Costo , Femenino , Precios de Hospital , Hospitales de Enseñanza/economía , Humanos , Incidencia , Lactante , Tiempo de Internación/economía , Masculino , Estudios Retrospectivos , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVE: To analyze the incidence of postparotidectomy facial nerve dysfunction in pediatric patients and to evaluate the association between patient demographics or underlying pathology and functional outcomes. STUDY DESIGN: Case series with chart review. SETTING: Tertiary-care pediatric hospital. SUBJECTS AND METHODS: We reviewed charts of patients younger than 18 years who underwent parotidectomy performed by a pediatric otolaryngologist between 1999 and 2011 at a tertiary pediatric center. Distributions of postoperative facial nerve dysfunction and timing of recovery were noted. Chi-square and t-test analyses were conducted to determine the association between demographics or pathology and functional outcomes. RESULTS: Forty-three patients met inclusion criteria: 41 underwent superficial parotidectomy, and 2 underwent total parotidectomy. Leading indications for surgery were atypical mycobacterial infection (16/43 [37.2%]) and first branchial cleft anomaly (8/43 [18.6]). The facial nerve was sacrificed in 1 (2%) patient with Ewing's sarcoma involving the nerve. The incidence of immediate facial nerve paresis was 21% (9/43), involving the marginal mandibular nerve (n = 7), buccal branch (n = 1), and both marginal mandibular and frontal branches (n = 1). Full recovery of nerve function in patients with paresis occurred within 1 month (n = 2), 2 months (n = 1), 6 months (n = 3), or 10 months (n = 2). CONCLUSION: Postparotidectomy paresis of distal branches of the facial nerve is a common occurrence in the pediatric population and should be discussed during preoperative evaluation. The risk is comparable to that of the adult population. Age, gender, and pathologic diagnosis were not predictive of postoperative nerve dysfunction.
Asunto(s)
Traumatismos del Nervio Facial/etiología , Traumatismos del Nervio Facial/fisiopatología , Parálisis Facial/etiología , Parálisis Facial/fisiopatología , Enfermedades de las Parótidas/cirugía , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/fisiopatología , Adolescente , Distribución de Chi-Cuadrado , Niño , Preescolar , Femenino , Humanos , Lactante , MasculinoRESUMEN
We describe a novel design and application of the vascularized scapular tip flap in the reconstruction of a temporomandibular joint and mandibular defect.
Asunto(s)
Ameloblastoma/cirugía , Colgajos Tisulares Libres , Neoplasias Mandibulares/cirugía , Reconstrucción Mandibular/métodos , Tumores Neuroendocrinos/cirugía , Escápula/trasplante , Articulación Temporomandibular/cirugía , Adulto , Anciano de 80 o más Años , Femenino , Humanos , Osteotomía Mandibular , ReoperaciónRESUMEN
Laryngotracheoesophageal cleft (LTEC) is a rare congenital anomaly that results from failed posterior fusion of the cricoid cartilage and incomplete development of the tracheoesophageal septum. LTEC presents with increased secretions, respiratory distress, aspiration and recurrent pulmonary infections. The severity of presenting symptoms is dependent on the type of cleft. LTEC is most commonly classified into four types (I, II, III and IV) based on the inferior extent of the cleft. Types III and IV LTEC are associated with high morbidity and mortality and require timely diagnosis and repair for survival. Most patients who survive repair of Type IV LTEC have long-term tracheotomy dependency with minimal chance of decannulation. We report on a case of a long-term survivor of Type IV who has been safely decannulated.
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Anomalías Múltiples/clasificación , Anomalías Múltiples/cirugía , Enfermedades del Sistema Digestivo/clasificación , Enfermedades del Sistema Digestivo/cirugía , Intubación Intratraqueal/instrumentación , Procedimientos de Cirugía Plástica/métodos , Enfermedades de la Tráquea/clasificación , Enfermedades de la Tráquea/cirugía , Anomalías Múltiples/diagnóstico , Remoción de Dispositivos , Estudios de Seguimiento , Humanos , Recién Nacido , Laringe/anomalías , Laringe/cirugía , Masculino , Procedimientos Quirúrgicos Otorrinolaringológicos/métodos , Sobrevivientes , Factores de Tiempo , Tráquea/anomalías , Tráquea/cirugía , Resultado del TratamientoRESUMEN
OBJECTIVE: Many studies have documented associations between inflammation and type 2 diabetes incidence. We assessed potential variability in this association in the major U.S. racial/ethnic groups. RESEARCH DESIGN AND METHODS: Incident type 2 diabetes was assessed among men and women aged 45-84 years without prior clinical cardiovascular disease or diabetes in the prospective Multi-Ethnic Study of Atherosclerosis. Interleukin (IL)-6, fibrinogen, and C-reactive protein (CRP) were measured at baseline (2000-2002); fasting glucose and diabetes medication use was assessed at baseline and three subsequent in-person exams through 2007. Type 2 diabetes was defined as use of diabetes drugs or glucose > or =126 mg/dl. Covariates included baseline demographics, clinic, smoking, alcohol, exercise, hypertension medication, systolic blood pressure, insulin resistance, and BMI. Cox proportional hazards regression was used to calculate hazard ratios (HRs) by quartiles of CRP, IL-6, and fibrinogen. RESULTS: Among 5,571 participants (mean age 61.6 years, 53% female, 42.1% white, 11.5% Chinese, 25.7% black, and 20.7% Hispanic), 410 developed incident diabetes during a median follow-up time of 4.7 years (incidence 16.8 per 1,000 person-years). CRP, IL-6, and fibrinogen levels were associated with incident diabetes in the entire sample. After adjustment, the associations were attenuated; however, quartile 4 (versus quartile 1) of IL-6 (HR 1.5 [95% CI 1.1-2.2]) and CRP (1.7 [1.3-2.4]) remained associated with incident diabetes. In stratified analyses, similar associations were observed among white, black, and Hispanic participants. CONCLUSIONS: Higher levels of inflammation predict short-term incidence of type 2 diabetes in a multiethnic American sample.