A Guide to Developing Safety Protocols for International Craniofacial Outreach Programs During the COVID-19 Era.

ABSTRACT: The ongoing COVID-19 outbreak has created obstacles to health care delivery on a global scale. Low- and middle-income countries (LMICs), many of which already suffered from unmet surgical and medical needs, are at great risk of suffering poor health outcomes due to health care access troubles brought on by the pandemic. Craniofacial outreach programs (CFOP)-a staple for craniofacial surgeons-have historically provided essential care to LMICs. To date, there has not been literature discussing the process of resuming CFOP mission trips. Herein, we propose a roadmap to help guide future journeys, as well as summarize practical considerations.

Prevalence of Renal and Cervical Vertebral Anomalies in Patients With Isolated Microtia and/or Aural Atresia.

OBJECTIVE: The objective of this study was to determine whether patients with isolated microtia or aural atresia have an increased prevalence of renal or cervical vertebral anomalies. DESIGN: The study design was a retrospective medical record review. SETTING: The setting was the following four distinct institutions: an urban tertiary care children's hospital, two urban academic medical centers, and a staff-model health maintenance organization. PARTICIPANTS: Patients diagnosed with microtia, aural atresia, or oculoauriculovertebral spectrum were identified. Patients with facial asymmetry, craniofacial microsomia, and other craniofacial abnormalities or syndromes were excluded. MAIN OUTCOME MEASURES: Main outcome measures were the number of patients with isolated microtia or aural atresia who underwent a renal ultrasound or cervical spine X-ray, the results of those studies, and further evaluation or treatment for any abnormalities found. STATISTICAL ANALYSIS: A binomial analysis using a one-sided 95% confidence level was performed. RESULTS: A total of 514 patients with isolated microtia and/or aural atresia were identified. Of these patients, 145 (28%) had undergone a renal ultrasound and 81 (16%) had undergone cervical spine X-rays. A total of 3 patients (2%) had minimal renal pelviectasis, all of which had resolved on repeat ultrasound and required no treatment. There were no structural renal abnormalities identified, and there were no cervical spine abnormalities identified. CONCLUSIONS: The data suggest that there is no increased prevalence of structural renal or cervical vertebral anomalies in patients with isolated microtia and/or aural atresia. Therefore, these patients do not require routine screening renal ultrasound or cervical spine X-rays.

Neurofibromatosis of the larynx causing stridor and sleep apnea.

BACKGROUND: Neurofibromatosis type 1 can rarely present in the larynx. Patients typically do not present with complete obstructive symptoms, but partial obstruction and stridor. We review our health centers' case series of two patients, the first of whom presented with persistent sleep apnea post tonsillectomy and adenoidectomy, and the second who presented with noisy breathing. Additionally, we will review the literature on the management and treatment options for children with this rare clinical entity. METHODS: Retrospective case review. CASE REPORT & RESULTS: A two-year old male underwent a sleep endoscopy following persistent evidence of obstructive sleep apnea on polysomnography after initial tonsillectomy and adenoidectomy. Family elicited concerns about noisy breathing at night and an accompanying video documented stridor while sleeping during the monitored polysomnography. Flexible fiberoptic laryngoscopy in the operating room revealed what appeared to be a cystic mass along the right aryepiglottic fold causing deviation of the laryngeal introitus towards the contralateral side. Subsequent direct laryngoscopy and excisional biopsy revealed pathology results consistent with a plexiform neurofibroma. A six-month-old patient with stertor and stridor was found to have a laryngeal mass, subglottic stensosis, and progressive airway obstruction due to plexiform neurofirboma in the supraglottis, subglottis, and trachea. We present a series of two patients incidentally diagnosed with neurofibromatosis type 1 by way of a laryngeal neurofibroma and review the literature on management options. Both patients were found to have accompanying café au lait spots. Both patients required tracheostomy for airway management, and one was successfully decannulated. CONCLUSION: Laryngeal neurofibroma is a rare anomaly that can manifest with airway obstruction. Both patients presented here subsequently were noted to have café au lait spots on physical examination. The Otolaryngologist should be reminded of this anomaly when evaluating a child with evidence of a submucosal laryngeal mass. We present our series including that of a patient whose diagnosis was prompted by persistent sleep apnea following adenotonsillectomy tonsillectomy and a patient with airway obstruction and subglottic stenosis due to a neurofibroma. The treatment of choice is complete excision of the neurofibroma while maintaining functionality of the larynx. This can lead to successful decannulation.

Mandibular reconstruction with an alloplastic bone tray in dogs.

OBJECTIVE: Mandibular alloplastic bone trays have an unacceptably high rate of extrusion. The introduction of resorbable mesh has renewed interest in such trays. This study evaluates the effect of resorbable trays on bone graft healing in a dog model. DESIGN: Unilateral, 20-mm mandibular body defects were created in 10 dogs, and repaired with cancellous bone grafts. A resorbable mesh bone tray was applied to 5 animals. All mandibles underwent gross examination, 4-point stress testing, and histologic and radiographic analysis. RESULTS: All animals had excellent bony unions. There was one intraoral mesh exposure. There was no difference between the control and treatment groups with regard to clinical findings, radiologic analysis, stress testing (P = 0.17), or histologic analysis (P = 0.66). CONCLUSION: The metabolic breakdown products of the resorbable mesh do not inhibit bone healing or strength. Resorbable mesh trays are a viable modality for reconstruction of segmental mandibular defects in a dog model.