RESUMEN
Objective: Cleft lip and palate is the most common craniofacial birth anomaly and requires surgery in the first year of life. However, craniofacial surgery training opportunities are limited. The aim of this study was to present and evaluate an open-source cleft lip and palate hybrid (casting and three-dimensional (3D) printing) simulation model which can be replicated at low cost to facilitate the teaching and training of cleft surgery anatomy and techniques. Design: The soft tissue component of the cleft surgery training model was casted using a 3D printed 5-component mold and silicone. The bony structure was designed to simulate the facial anatomy and to hold the silicone soft tissue. Setting: Two groups, one group of trainees and one group of expert surgeons, at University Hospital Basel in Switzerland and Pontifical Catholic University of Chile in Santiago, Chile, tested the cleft lip and palate simulation model. Participants completed a Likert-based face and content validity questionnaire to assess the realism of the model and its usefulness in surgical training. Results: More than 70 % of the participants agreed that the model accurately simulated human tissues found in patients with unilateral cleft lip and palate. Over 60 % of the participants also agreed that the model realistically replicated surgical procedures. In addition, 80-90 % of the participants found the model to be a useful and appropriate tool for teaching the anatomy and surgical techniques involved in performing unilateral cleft lip and palate repair. Conclusion: This open-source protocol provides a cost-effective solution for surgeons to introduce the cleft morphology and surgical techniques to trainees on a regular basis. It addresses the current financial barrier that limits access to commercially available models during the early stages of surgeon training prior to specialization in the field.
RESUMEN
Esta revisión sistemática evaluó el rendimiento de la ultrasonografía (US) en el trauma maxilofacial. Dos investigadores independientes realizaron una búsqueda sistemática de artículos sobre US que evaluaron el diagnóstico de fracturas y/o traumatismos maxilofaciales. Se encontraron doce artículos entre los años 2010 y 2022. Cuatro artículos revisaron fracturas de los huesos nasales, cinco artículos fracturas del complejo cigomático, dos artículos fracturas orbitarias, tres artículos fracturas mandibulares y un artículo el hematoma retrobulbar, considerando que un artículo puede revisar más de un tipo de fractura. Todos los estudios fueron de cohortes retrospectivas o prospectivas. Los valores de sensibilidad y especificidad, informados en rangos de mayor y menor sensibilidad y especificidad en todos los estudios incluidos fueron, respectivamente, del 88-100 % y 88-100 % para las fracturas de los huesos nasales, del 88-100 % y 87-100 % para el arco cigomático, del 88-100 % y 100 % para el reborde infraorbitario, del 87 % y 100 % para el piso de la órbita, del 80-100 % y 100 % para la mandíbula y del 95,7 % y 99,7 % para el hematoma retrobulbar. Con cierto riesgo de sesgo en su aplicabilidad según la herramienta QUADAS-2, la US tiene un buen rendimiento en el diagnóstico de las fracturas faciales. Aunque la US no reemplaza a la TC, es útil en el punto de atención para optimizar las decisiones clínicas, siendo especialmente de ayuda en el trauma facial, el trauma nasal aislado y en grupos radiosensibles como niños y mujeres embarazadas. (AU)
This systematic review assessed the performance of ultrasonography (US) in maxillofacial trauma. A systematic search was performed by two independent researchers for articles on US for diagnosing maxillofacial fractures and/or trauma. Twelve articles were found between 2010 and 2022. Four articles reviewed nasal bone fractures, five articles zygomatic complex fractures, two articles orbital fractures, three articles mandibular fractures, and one article retrobulbar hematoma, considering that an article can review more than one type of fracture. All studies were retrospective or prospective cohorts. Sensitivity and specificity values, reported in ranges of highest and lowest sensitivity and specificity in all included studies, respectively, were 88-100 % and 88-100 % for nasal bone fractures, 88-100 % and 87-100 % for zygomatic arch, 88-100 % and 100 % for the infraorbital rim, 87 % and 100 % for the orbital floor, 80-100 % and 100 % for the mandible, and 95.7 % and 99.7 % for retrobulbar hematoma. With a certain risk of bias in its applicability according to the QUADAS-2 tool, US has a good performance in the diagnosis of facial fractures. Although US does not replace CT, it is useful at the point of care to optimize clinical decisions, being especially helpful in facial trauma, isolated nasal trauma, and in radiosensitive groups such as children and pregnant women. (AU)
