Correlation of Orthognathic Surgical Movements to Perception of Facial Appearance in Patients With Cleft Lip and Palate.

STUDY DESIGN: Cephalometric scans were compared before and after surgery to assess the degree of correction. Correlations between skeletal movements and survey outcomes were determined using multivariate regression analysis. OBJECTIVE: This study aims to identify relationships between subjective observer-reported improvements in esthetics and emotional appearance with specific surgical movements. METHODS: Ten patients at a single tertiary institution (average age: 18.1 ± 0.8), 9 males and 1 female, underwent orthognathic repair and had comprehensive cephalometric records. Standardized anterior posterior and lateral pre and postoperative photographs of patients were included in a survey to clinicians to assess noncognitive domains on a Likert Scale (1-10). CLEFT-Q was administered to gauge patient satisfaction in categories of appearance, speech, and quality of life. RESULTS: Per clinicians, multiple domains increased including facial attractiveness (4.1 ± 0.7 versus 7.3 ± 0.7, P < 0.001), friendliness (4.5 ± 0.4 versus 7.3 ± 0.5, P < 0.001), confidence (4.1 ± 0.4 versus 7.1 ± 0.4, P < 0.001), and recommendation for surgery decreased (8.9 ± 0.1 versus 3.6 ± 0.5, P < 0.001). Speech distress decreased with increased SNA and convexity, whereas Psychological and Social scores decreased with an increased ANB. Functional eating and drinking scores increased with maxillary depth. CONCLUSIONS: Orthognathic surgery improves many noncognitive domains in patients with cleft lip and palate as assessed by both patients and clinicians on all aspects of facial attractiveness and perception. These findings demonstrate objective bases of skeletal adjustments for perceived improvements in facial appearance and emotion.

Shifting Focus: A Clinician's Guide to Understanding Neuroplasticity for Anterior Cruciate Ligament Rehabilitation.

Neuroplasticity after anterior cruciate ligament (ACL) injury has lingering effects throughout rehabilitation and can influence reinjury risk upon returning to sport if not addressed. Various neural compensatory strategies have been identified following ACL injury, which appear to not be rectified with typical therapy. Thus, further consideration is warranted, addressing the neurophysiologic and neurocognitive aspects of injury when developing a rehabilitation program. Integration of external focus of control strategies, neurocognition, motor planning, unanticipated sensory processing, and load management provide an efficient and effective method for improving motor learning and control throughout the rehabilitation process. Rehabilitation exercises that incorporate unique sports-specific challenges can target the visual processing and anticipatory reaction components of motor control to reduce motor errors that increase injury risk when returning to activity. The neurocognitive demands of returning to sport of efficient decision making and motor patterning amid a rapidly changing competitive environment require novel and clinically implemental strategies.