Craniomaxillofacial abstracts from the 66 th annual meeting of the Ohio Valley Society of Plastic Surgeons

The Editorial Board of FACE is pleased to publish the Craniomaxillofacial abstracts from the 66^th annual meeting of the Ohio Valley Society of Plastic Surgeons (OVSPS), held from June 2 to 3, 2023 in Akron, Ohio.

This is the fourth year that FACE has published these abstracts, the first being in 2020, the inaugural year of the journal.

The abstracts were peer-reviewed for the OVSPS meeting and are presented without change.

Enjoy these high-quality abstracts. We look forward to an on-going relationship with the Ohio Valley organization.

John van Aalst,

Editor-in-Chief

10 Year Experience in Burn Eyelid Surgery: A Single Center Retrospective Cohort Study

Tiffany Jeong, Mario Alessandri-Bonetti, Avril Betances, Guy Stofman, Francesco M Egro

University of Pittsburgh School of Medicine

2023-01-30

Presenter: Tiffany Jeong

Affidavit: Tiffany Jeong

Director Name: Francesco Egro

Author Category: Medical Student

Presentation Category: Clinical

Abstract Category: Craniomaxillofacial

There is a paucity of studies on outcomes in eyelid burn treatment, despite concern for permanent ocular damage or loss of vision. This study aims to describe the complication rates in burn eyelid reconstruction at a single center over 10 years. We conducted a retrospective study to review outcomes of eyelid burns undergoing plastic surgery reconstruction between April 2009 and December 2022. Gathered data include demographics, past medical history, type of injury, indication for surgery, procedure performed and complications. A total of 12 patients underwent 48 eyelid surgeries with a mean follow-up time of 11.7±14.5months. In 60.4%(n=29) of the cases, the simultaneous reconstruction of both the upper and lower eyelids was necessary. Acute eyelid burn treatment represented 45.8% of the cases, while in 54.2% of the cases chronic burn sequelae were addressed. The eyelid procedures performed included: full thickness skin graft (45.8%, n=22), flap reconstruction (16.7%, n=8), debridement (14.6%, n=7), Integra (10.4%, n=5), split thickness skin graft (8.3%, n=4), canthoplasty (8.3%, n=4), TheraGenesis (4.2%, n=2), and fractional lasering (2.1%, n=1). The overall complication rate was 58.3% (n=28). The most common complication was ectropion (33.3%, n=16). Other complications included: lagophthalmos (18.75%, n=9), eye injury (18.75%, n=9), contracture (16.7%, n=8), eyelid infection (12.5%, n=6), sepsis (8.3%, n=4), total graft loss (4.2%, n=2), and partial graft loss (4.2%, n=2). Further studies examining the conditions of successful eyelid burn procedures may provide guidance on when patients may benefit from eyelid reconstruction during their burn treatment

A National Database Perspective on Pediatric Non-Accidental Trauma Patients and Differential Outcomes for Facial Trauma Operations Performed by Otolaryngologists and Plastic Surgeons

Joseph W. Mocharnuk, BA, Anne Glenney, BA, Dana Meshkin, BSN, Jesse A. Goldstein, MD, Miles J. Pfaff, MD, Raj M. Vyas, MD

University of Pittsburgh School of Medicine

2023-02-10

Presenter: Joseph Mocharnuk

Affidavit: Joseph Mocharnuk

Director Name: Vu Nguyen, MD

Author Category: Medical Student

Presentation Category: Clinical

Abstract Category: Craniomaxillofacial

Purpose: The Pediatric Health Information System (PHIS) database collects admissions, diagnostic, and treatment data among 44 children's hospitals across the U.S. Non-accidental trauma (NAT) is a prominent cause of trauma mortality in the pediatric population. However, little has been published on national outcomes for NAT cases shared by otolaryngologists and plastic surgeons and their interplay with measures of the social determinants of health (i.e., the Child Opportunity Index or COI). The purpose of this study is to explore this relationship among a subset of NAT patients who underwent these shared facial trauma procedures. Methods: A retrospective review was performed after querying the PHIS database for ICD codes pertaining to pediatric non-accidental trauma. Results: Among the 179,688 NAT cases included in PHIS, 4,462 were associated with facial trauma operations performed by plastic surgeons and otolaryngologists. Of these procedures, 2,741 had an otolaryngologist as treating physician, and 1,721 had a plastic surgeon treating physician. The average COI of patients of otolaryngologist-treated patients (44.3 ± 2.4) was significantly higher (p-value <0.0001) than plastic-surgeon-treated patients (mean COI: 28.9 ± 3.1), indicating increased socioeconomic strain. Controlling for this difference in COI, the average length of stay among plastic surgeons for the same subset of procedures was significantly lower by an average of 3.89 days (p-value <0.0001) compared to otolaryngologists. Conclusion: This study offers a national perspective on the relationship between social determinants of health and length of stay in pediatric non-accidental trauma patients who underwent procedures for facial trauma that are performed by both otolaryngologists and plastic surgeons.

A Review of Private Insurance Policies: Coverage of Fat Grafting for Breast and Head & Neck Reconstruction

Yusuf Surucu, MD; Bahaa Shaaban, MD; Pooja Humar, BS; Elizabeth A. Moroni, MD MHA; Rakan Saadoun, MD; M. Saad Hafeez, MD; Yadira Villalvazo, MD; Jeffrey H. Kozlow, MD; J. Peter Rubin, MD

University of Pittsburgh

2023-02-10

Presenter: Yusuf Surucu

Affidavit: I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting.

Director Name: J. Peter Rubin, MD, MBA

Author Category: Fellow Plastic Surgery

Presentation Category: Clinical

Abstract Category: Craniomaxillofacial

Purpose: The Women's Health and Cancer Rights Act of 1998 codified access to reconstructive surgery for breast cancer patients. Correspondingly, fat grafting, when used for oncologic breast reconstruction, is routinely covered by insurance providers. However, we suspect that fat grafting applications for other reconstructive goals, particularly to the face, are not as widely covered or reimbursed. Methods: Policies of private medical insurance companies were examined for information regarding coverage or reimbursement of fat grafting after breast or head and neck reconstruction. Keywords including "fat grafting," "lipofilling," "reconstructive surgery," "cosmetic surgery," "breast reconstruction," and "facial reconstruction" were used on each company's website. Results: The 25 largest private insurance companies based on collected premiums were included in this study. Eight companies deemed fat grafting for breast reconstruction to be medically necessary, 12 regarded it to be experimental, 1 considered it to be cosmetic, and 1 left the decision to the surgeon's discretion. For facial reconstruction, only 3 companies report fat grafting as medically necessary, 11 deem it as experimental, 5 consider it cosmetic, and 3 rely on the discretion of the surgeon. Eleven companies report covering fat grafting for breast reconstruction, while only 5 private companies include coverage for facial fat grafting. Conclusion: While fat grafting is widely used to reconstruct the breast and face, there is significant variability in private insurance coverage forthis procedure. Moving forward, we aim to compare policies from commercial insurance companies with state-level Medicare and Medicaid guidelines regarding fat grafting.

An Analysis of Craniofacial Surgery Fellowship Websites and Social Media Presence

Isabel Ho, BA Howard D. Wang, MD

Case Western Reserve University School of Medicine; University Hospitals Rainbow Babies and Children

2023-01-29

Presenter: Isabel Ho, BA

Affidavit: I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. All of the work on this project represents the original work of the medical student.

Director Name: Howard Wang

Author Category: Medical Student

Presentation Category: Clinical

Abstract Category: Craniomaxillofacial

Background: Applying to craniofacial surgery fellowship is a competitive process, and applicants may find it challenging to determine which programs are the best fit. We sought to evaluate the quality of information available on craniofacial surgery fellowship websites (CFWs), identify areas for improvement, and evaluate social media presence. Methods: Individual CFWs were identified from the ASCFS directory and Google search. Demographic information was collected from the ASCFS directory, and CFWs were evaluated for qualitative information. Social media presence was assessed by querying Facebook, Instagram, and Twitter for official and active accounts. Results: Thirty-one programs were identified. While most ASCFS listings included addresses (93.6%) and program coordinator contact (87.1%), only half included program director contact. The majority of CFWs included a procedure list (71.0%), research opportunities (58.1%), current fellows (56.7%), and didactic schedules (71.0%). Few CFWs included case logs (16.1%), call schedule (22.6%), salary/benefits (25.8%), and alumni information (38.7%). Regarding social media presence, only three craniofacial fellowship programs were on Facebook (9.7%), two on Instagram (6.5%), and none on Twitter. In comparison, affiliated plastic surgery residencies were more active on Instagram (64.5%), Facebook (38.7%), and Twitter (25.8%). Conclusion: There are several potential areas for improvement of CFWs, including maintaining an updated ASCFS directory of CFWs. Programs may consider adding information about case logs, call schedule, and alumni career path. Creating comprehensive websites and increasing social media presence would provide a valuable source of information to potential applicants and serve as an effective tool for recruitment.

Alleviating Cosmetic Injectable Pain: A Novel Vibrational Anaesthesia Device For The Lip

Logan Grant Galbraith, BA¹, Mohammad Fahad Butt, BS¹, Daniel Moy, BS¹, Arya Andre Akhavan, MD²

¹Northeast Ohio Medical University College of Medicine, Rootstown, OH, USA,

²Icahn School of Medicine at Mount Sinai, New York, NY, USA.

2023-01-15

Presenter: Mohammad Fahad Butt

Affidavit: Logan Grant Galbraith, Mohammad Fahad Butt, Daniel Moy

Director Name: Arya Andre Akhavan

Author Category: Medical Student

Presentation Category: Clinical

Abstract Category: Aesthetics

Purpose: Recent literature explores the use of high-frequency vibration as a pain reduction tool. In the "gate control theory" of pain signaling, it is thought that vibration near the site of injection activates larger nerve fibers which inhibit pain signals in smaller nerve fibers; and that ultimately, mechanical vibration signals outcompete pain signals in the dorsal horns of the spinal cord, decreasing pain sensation. Some surgeons use vibrational tools at the site of injection to decrease perceived pain. Methods: Patent databases and prior scientific literature pertaining to vibrational anaesthesia were reviewed. Input and opinions were gathered from patients who regularly received cosmetic injections and physicians who regularly performed them. Results: Patent and literature reviews did not reveal any devices specifically designed for vibrational anaesthesia at the lips, and in fact suggested that most vibratory devices used by surgeons are everyday consumer facial massagers. The vibrational intensity of these devices fails to meet the strength recommended in the literature for maximal pain relief. Analysis of the current literature suggested that an optimal device for vibrational anaesthesia of the lip would A) nearly circumferentially encompass the lip, and B) create a targeted intense vibrational frequency. Conclusion: We present a novel device that applies targeted vibrations for pain relief specific to lip injections. Future work includes a clinical trial to compare effectiveness against current "facial massagers", and will use the "split-lip" method in Guney et al's 2017 article "The Efficacy of Vibration Anesthesia on Reducing Pain Levels During Lip Augmentation: Worth the Buzz?"

A Review on the State of Preclinical Mentorship Programs in Plastic and Reconstructive Surgery

Bryce Dzubara, Nojan Bajestani, Stephanie Paras, Eric Min, Shuchi Sharma, Juhi Katta, Cristiane Ueno MD

Cristiane Ueno MD

2023-01-25

Presenter: Stephanie Paras

Affidavit: This work is the original work of The Ohio State University College of Medicine Plastic and Reconstructive Surgery Interest Group, comprised of the author's listed in the abstract. Stephanie is a member of this group and has contributed a significant and appropriate portion of the created work.

Director Name: Cristiane Ueno

Author Category: Medical Student

Presentation Category: Clinical

Abstract Category: General Reconstruction

Plastic and reconstructive surgery is consistently one of the most competitive medical specialties in the Match. The average USMLE standardized test scores and applicant research productivity continue to rise, while match rates are among the lowest of all medical specialties. In this competitive landscape, early exposure and excellent mentorship are paramount to student match success. However, preclinical students are not adequately exposed to plastic surgery. A literature review of preclinical plastic surgery mentorship programs was conducted in PubMed and Embase to identify extracurricular mentorship opportunities specifically involving preclinical students in plastic surgery. A total of 68 references were identified, and 19 duplicates were removed. A total of 19 studies passed initial screenings and were assessed for full-text eligibility, but only 2 studies were included after 17 studies did not meet inclusion criteria. A thorough review of the included studies indicated that preclinical medical students achieve self-identified goals and generate longitudinal benefits in plastic surgery by participating in mentorship programs. However, the limited number of studies in this review highlights a lack of available documented plastic surgery mentorship programs and reveals a knowledge gap concerning the successful creation of such programs. Broadening analysis to other surgical subspecialties, mentorship programs provide medical students with the necessary opportunities to gain exposure, cultivate interest, and match successfully. Moreover, future plastic surgery mentorship programs can potentially replicate successful mentorship programs in other specialties to address the lack of formalized mentorship opportunities for preclinical medical students in plastic surgery.

Implementation of a Plastic and Reconstructive Surgery Mentorship Program

Bryce P.G. Dzubara, Nojan Bajestani, Cristiane Ueno MD

The Ohio State University College of Medicine

2023-01-25

Presenter: Bryce Dzubara

Affidavit: This work is the original work of the author's listed, who are members of the Plastic and Reconstructive Surgery Interest Group at The Ohio State University College of Medicine. Bryce, the presenter for this project, has contributed a substantial majority to the creation and implementation of this project, approximating 85% of total work.

Director Name: Cristiane Ueno

Author Category: Medical Student

Presentation Category: Clinical

Abstract Category: General Reconstruction

Purpose: The purpose of the Plastic and Reconstructive Surgery Mentorship Program (PRSMP) is to increase preclinical medical student exposure to and interest in plastic surgery via education and mentorship. Methods: Participants are paired with faculty mentors for one academic semester. Participants objectives include the following: 1. Meet with mentor in clinic ≥ 3 times. 2. Meet with mentor to observe a surgical procedure ≥ 3 times. 3. Attend Grand Rounds for the Department of Plastic and Reconstructive Surgery ≥ 5 times. 4. Discuss a clinical topic relevant to plastic surgery in a presentation ≥ 2 times. Program success is tracked via participant surveys and outcomes, including the number of PRSMP members who go on to perform research, complete sub-internships, apply, and match in plastic surgery. Results: A total of 19 first-year medical students were accepted, and 12 students consented to completing surveys regarding their experiences. A survey administered several weeks after program initiation garnered a 100% response rate (12/12). At the time of survey completion, 100% of consenting participants had communicated with their mentor, and 58.3% had met with their mentor in person; 33.3% had shadowed both clinically and operatively, and 75% reported progress in completing program objectives. When asked to rate their satisfaction with the program on a scale of 1 (poor) to 5 (ideal), the average response was 4.33±0.89. Conclusion: Interested preclinical medical students find the PRSMP to be a satisfactory and achievable extracurricular mentorship opportunity in plastic surgery.

Assessing Rates of Hearing Loss across Types and Syndromic Status of Craniosynostosis

Eric Min BA, Adriane Baylis PhD, Tran Bourgeois MPH, Ursula Findlen PhD, Alyssa Fogolin BS, John Munday MS, Ibrahim Khansa MD, Gregory Pearson MD

Ohio State University College of Medicine

2023-02-01

Presenter: Eric Min

Affidavit: All coauthors appropriately participated in all aspects of this project. Eric Min has participated in greater than 50% of the study design, data acquisition, data analysis, and abstract proposal. I support the submission of this abstract.

Director Name: Gregory Pearson

Author Category: Medical Student

Presentation Category: Clinical

Abstract Category: Craniomaxillofacial

Background: Craniosynostosis, the premature fusion of one or more cranial sutures, typically requires surgical intervention during infancy. The prevalence and types of hearing loss (HL) seen in patients with non-syndromic craniosynostosis is relatively unknown, as most studies have focused on hearing profiles of children with associated syndromes. The purpose of this study was to describe and compare HL among children with various craniosynostosis types and syndromic status. Methods: A retrospective cohort study was conducted on children with craniosynostosis at a tertiary pediatric hospital between 2011-2021. Patients missing data on HL were excluded. Univariable multinomial logistic regression was used to explore risk of HL. Results: Among 157 patients, 63% (n=99) had normal hearing (NH), 27% (n=43) had transient hearing loss (THL), and 10% (n=15) had permanent hearing loss (PHL). Syndromic patients were more likely than non-syndromic patients to experience THL than NH (OR 4.75, 95% CI [1.72, 13.14], P < .05) and PHL than NH (OR 5.41, 95% CI [1.46, 19.95], P < .05). Patients with bicoronal craniosynostosis were more likely than patients with sagittal craniosynostosis to experience THL than NH (OR 23.33, 95% CI [5.56, 97.84], P < .05) and PHL than NH (OR 28, 95% CI [1.94, 404.72], P < .05). Conclusion: Children with craniosynostosis have an increased risk for hearing loss. Syndromic patients have higher rates of THL and PHL compared to their non-syndromic peers. Clinicians should advocate for audiologic evaluation and management of all patients to minimize long term risks of speech-language and cognitive-behavioral development.

Bibliometric analysis of peer-reviewed literature on Corneal Neurotization

Gunel Guliyeva, MD¹, Asim Ali, MD, FRCSC², Gregory Borsche MD^l

¹Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center

²Indiana University Division of Plastic Surgery

2023-02-01

Presenter: Gunel Guliyeva

Affidavit: Gregory H. Borschel The student did more than 65% of the work.

Director Name: Gregory H. Borschel

Author Category: Resident Plastic Surgery

Presentation Category: Clinical

Abstract Category: General Reconstruction

Abstract

Purpose: After the first peer-reviewed publication in 2009, Corneal Neurotization caused a paradigm shift in the management of Neuropathic Keratopathy. Since then, a massive proliferation of research has been published in this field. Nonetheless, bibliometric analysis to measure research in Corneal Neurotization research is still missing. Materials and Methods: PubMed and Google Scholar were queried to identify publications in English describing Corneal Neurotization techniques, original research, case reports, and case series. Web of Science, Scopus, and Google Scholar were used to extract the h-indexes, Journal Impact Factors, and citations. Results: Out of 755 studies, 37 fulfilled the inclusion criteria. These papers were published between 2009 and 2021. While the country with the highest number (15) of publications was the USA, the journal with the highest number (7) of publications was Cornea. Most of the articles (22) were published in Ophthalmology journals, while six were published in the Plastic Surgery literature. Conclusion: Two periods and three major centers of Corneal Neurotization research were identified. Researchers from the USA, Canada, and Italy authored the majority of the articles.

Characteristics driving "inappropriate" transfer of pediatric mandibular fracture patients

Lucille Cheng, BA; Zhazira Irgebay, BA; Anne E. Glenney, BA; Jesse Goldstein, MD

University of Pittsburgh Medical Center

2023-02-08

Presenter: Lucille Cheng

Affidavit: Certified

Director Name: Vu T. Nguyen

Author Category: Medical Student

Presentation Category: Clinical

Abstract Category: Craniomaxillofacial

Mandibular fractures are among the most common pediatric facial fracture. Conservative treatment (i.e. jaw rest, chewing gum) are the most typical treatment methods and are widely available. However, pediatric patients are often transferred, leading to costly "inappropriate" transfers which often place undue burden on families while diverting resources from urge nt cases. This study evaluates factors influencing "inappropriate" transfer, defined as a patient receiving conservative treatment post-transfer to a children's hospital. A retrospective review was performed of patients under 18 years of age who were evaluated for mandibular fractures at a pediatric level I trauma center between 2006 and 2021. Variables studied included demographics, etiology, medical history, associated injuries, treatments, and outcomes. 532 pediatric patients (141 female, 391 male) were included; more than half (56.77%, n = 302) were transferred. Of 302 total transfers, 178 (58.9%) were inappropriate. Subsequent treatment (conservative vs. surgical) did not differ significantly between transfer and non-transfer groups (p=0.72). Uninsured patients (p=0.038) or those with concomitant soft tissue injury (p=0.019) were more likely to be transferred. Trauma level, cause of injury, gender, and presence of other concomitant fractures did not significantly influence transfer rate. Uninsured pediatric mandibular fracture patients were more likely to be transferred than their insured peers regardless of presenting trauma level. There was no difference in the rate of surgical management between transferred vs. non-transferred patients. Concurrent soft-tissue injuries were a significant factor influencing "inappropriate" transfers. We recommend research and innovation in remote plastic surgery consultations for pediatric patients who may not benefit from urgent transfer.

Cranioplasty Outcomes in a Multidisciplinary Neuroplastic Surgery Program: A Single Center Experience

Jaeda Robinson, BS, Taborah Z. Zaramo BS, Hunter Stecko, BS, Kerry-Ann Mitchell MD PhD

The Ohio State University Department of Plastic and Reconstructive Surgery

2023-02-10

Presenter: Jaeda Robinson

Affidavit: This work is original

Director Name: Gregory D. Pearson, MD

Author Category: Medical Student

Presentation Category: Clinical

Abstract Category: Craniomaxillofacial

Background: Although cranioplasty is a commonly performed procedure to repair skull defect after traumatic brain injury or surgical interventions, 20- 30% require reoperation due to surgery related complications. Studies suggest that a regimented, multidisciplinary approach may decrease risk of complications, particularly in high-risk patients. The objective of this study was to evaluate surgical outcomes of adult patients undergoing cranioplasty utilizing an algorithmic, multidisciplinary approach in a newly developed Neuroplastic Surgery Program. Methods: We performed a retrospective chart review of adult patients who underwent cranioplasty in the Neuroplastic Surgery Program at The Ohio State University between 2020-2022. Patient demographics, medical comorbidities, cranioplasty indication, timing of cranioplasty, type of implant material, and surgical outcomes were curated from charts. Major complications were those requiring readmission or reoperation, while all others were considered minor. Results: Thirteen consecutive cases met the inclusion criteria (three males, nine females). The average age was 59 years old, BMI 28.01, and post-surgical follow up time 5 months. All patients had significant risk factors for wound healing complications at baseline, with 6 patients having at least one previous cranioplasty failure, 3 patients with diabetes, and 4 with previous calvarial radiation. Two patients (16%) had a major complication, of which one was a hematoma requiring evacuation and one was a wound dehiscence requiring revision. There were no infections or hardware exposure. Conclusions: These early outcomes from high-risk patients undergoing cranioplasty suggest that a multidisciplinary, algorithmic approach may decrease the risk of surgery related complications and improve patient outcomes.

Critical Analysis of Feeding Outcomes After Surgical Intervention for Pierre Robin Sequence

Pooja Humar, BS; Anne Glenney, BA; Lucille Cheng, BS; Alexander Comerci, BS; Joseph Mocharnuk, BA; Lucas Dvoracek, MD; Jesse Goldstein, MD

University of Pittsburgh Medical Center

2023-01-31

Presenter: Pooja Humar

Affidavit: All work on this project represents the original work of the included authors

Director Name: J. Peter Rubin

Author Category: Medical Student

Presentation Category: Clinical

Abstract Category: Craniomaxillofacial

Background: Feeding and swallowing dysfunction pose significant morbidity to patients with Pierre Robin Sequence (PRS). We present an analysis of feeding and swallowing outcomes following mandibular distraction osteogenesis (MDO) or supraglottoplasty in pediatric PRS patients. Methods: A retrospective review of PRS patients seen at a single institution from 2010-2016 was conducted. Patients were separated into categories including MDO, supraglottoplasty, and no surgical intervention. Medical history, pre- and post-intervention modified barium swallow (MBS) studies, and polysomnography data was collected. Results: This cohort includes 93 patients with PRS; 47 (50.5%) underwent MDO, 13 (14.0%) underwent supraglottoplasty, 3 patients underwent both (3.22%), and 30 patients had no surgical intervention. 54.8% of patients had a congenital cardiac anomaly and 61.3% had an airway anomaly. Post-procedure MBS demonstrated significant improvement in sucking tongue movements (p=0.048) and vallecular space obliteration (p=0.001) in patients who underwent MDO while patients who underwent supraglottoplasty had significant improvements in laryngeal penetration (p=0.003). 16.7% of patients were deemed unsafe for oral feeding after supraglottoplasty compared to only 6.82% after MDO. Average post-operative total Apnea-Hypopnea Index (AHI) was significantly smaller in patients who underwent surgical intervention compared to those who did not (16.32 vs. 23.2, p<0.01), but there was no significant difference in post-operative total AHI between operative groups (p=0.54). Conclusions: Patients who underwent MDO or supraglottoplasty showed improvements in post-procedure MBS. However, patients with PRS who underwent supraglottoplasty had a higher rate of adverse feeding outcomes. These findings support additional research on outcomes associated with treatment modality for PRS patients.

Demographics, Injury Patterns, and Associated Injuries in 3,334 Pediatric Facial Fracture Patients Treated at a Single Institution

Anne E. Glenney, BA; Zhazira Irgebay, BA; Erin Anstadt, MD; Lucas A Dvoracek, MD; Joseph W. Mocharnuk, BA; Justin W. Beiriger, BSE; John Smetona, MD; Richard A. Saladino, MD; Joseph E. Losee, MD; Jesse A. Goldstein, MD

University of Pittsburgh Medical Center (UPMC)

2023-01-30

Presenter: Anne E. Glenney

Affidavit: Vu Nguyen

Director Name: Vu Nguyen

Author Category: Medical Student

Presentation Category: Clinical

Abstract Category: Craniomaxillofacial

Background: Pediatric craniofacial fractures are fundamentally distinct from their adult counterparts due to unique injury patterns and effect on future growth. Understanding patterns and injury context informs management and risk mitigation. Previous studies include only inpatients, operative patients, or are specialty-specific, while this study presents a comprehensive assessment of all pediatric facial fracture patients seen at a single institution. Methods: Patients under 18 years old who were evaluated for facial fractures at a Level I pediatric trauma center between 2006 and 2021were reviewed. Sub-analysis was performed for groups defined by age. Variables studied included demographics, etiology, fracture pattern, associated injuries, management and outcomes. Results: 3,334 patients were included. Mean age at presentation was 11.5 years. The majority were Caucasian (82.6%) and male (68.4%). Sports were the leading cause of injury in older patients (42.2% of patients over 12 years), compared to activities of daily living in patients under 6 years (45.5%). Thirty-two percent of patients were hospitalized, 6.0% required ICU care, and 48.4% required surgery. Frequency of ICU admission decreased with age (p<0.001), while operative intervention increased with age (p<0.001). Zygomaticomaxillary complex (p=0.002) and nasal fractures (p<0.001) were common in older patients, while younger patients experienced more skull (p<0.001) and orbital fractures (p<0.001). The most common associated injuries were soft tissue (55.7%) and neurologic (23.6%). Conclusions: This large-scale study provides updated characterization of craniofacial fractures in the pediatric population, providing a necessary framework for future studies on outcomes assessments and preventative care.

Determining Chin Dimensions for Feminizing Genioplasty: An Anatomical Study

R'ay Fodor, BA&Sc, Abir Kalandar, MD; Antonio Rampazzo, MD, PhD; Raymond Isakov, MD; Cecile Ferrando, MD MPH; Francis Papay, MD; Bahar Bassiri Gharb, MD, PhD

Cleveland Clinic Department of Plastic Surgery, Cleveland Clinic Lerner College of Medicine

2023-02-01

Presenter: R'ay Fodor

Affidavit: I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. R'ay Fodor participated in data collection, ran all the data analyses used herein, and wrote the abstract.

Director Name: Frank Papay

Author Category: Medical Student

Presentation Category: Clinical

Abstract Category: Craniomaxillofacial

Background: Feminizing genioplasty warrants reduction of the chin to achieve a feminine chin shape. This study aims to compare female and male skeletal chin dimensions to provide indications for surgical planning of feminizing genioplasty. Methods: Dry skulls stored at Cleveland Museum of Natural history were included for analysis. Maxillae and mandibles that had alveolar height loss and damaged teeth were excluded. Sex, age, ethnic origin, chin height, width, projection, and shape were documented. Results: Forty-three male (43.58±12.52 year-old) and 43 female (40.48±12.04 year-old) skulls were included. In each group, 25 skulls were of African origin and 18 were of European origin. Male chin height (24.44± 1.96 mm) and lower facial height (LFH, 69.41±5.79 mm) were greater than females' (chin height 21.53±2.25 mm; LFH 64.03 ±6.07 mm) (p<0.0001). Male chin width was wider between parasagittal lines (male 33.08±2.12; female 31.30±2.26; p=0.0001) and inter-mental foramina (male 45.23±2.72 mm; female 44.00±2.59 mm; p=0.017). Chin width to zygomatic width ratio (male 0.25±0.02; female 0.25±0.02; p=0.8) and chin projection (male, 75.40±7.96mm; female, 75.63±7.02mm; p=0.89) did not differ according to sex. Intergonial width was significantly larger in men (men, 97.15±6.85mm; female, 90.57±5.20mm; p<0.0001). Ethnic differences were only noted in males for chin heights (African, 24.89±2.02mm; European, 23.82±1.73mm; p=0.038) and chin widths in the parasagittal plane (African, 33.70±2.30mm; European, 32.22±1.51mm; p=0.011). Male chins displayed prominent lateral tubercles and square shape; female chins were round. Conclusions: The most important factor in chin feminization is correction of the shape. Height and width reduction are not necessary in most subjects.

Development of A Novel Translational Animal Model of Autologous Cranioplasty Using Cryopreserved Bone

Taborah Zaramo, BS, Nojan Bajestani, BS, Kerry-Ann Mitchell MD-PhD

The Ohio State University Department of Plastic and Reconstructive Surgery

2023-02-10

Presenter: Taborah Zaramo

Affidavit: This is original work

Director Name: Gregory D. Pearson, MD

Author Category: Medical Student

Presentation Category: Basic Science Research

Abstract Category: Craniomaxillofacial

Background:Decompressive craniectomy (DC) is a lifesaving procedure wherein a large segment of the skull is removed to relieve intracranial pressure. The bone is stored in a freezer until brian swelling resolves, at which time it is replaced in a cranioplasty surgery. Efforts to study cryopreserved bone healing are limited by the lack of an appropriate animal model.The goal of this study was to develop and characterize a mouse model of DC to study reconstruction of large size skull defects. Methods: A critical sized defect was performed in C57BL/6 mice using published techniques. The calvarial bone was cryopreserved at -80 degrees for the study animals and later replaced at 1 week post operatively, while it was replaced during the same operation for the control animals. Mice were scarificed at 2, 4, and 8 after bone replacement and the skull was extracted. Micro-CT scan and immunofluorescence was used to characterize bone healing. Results: Surgery was performed on a total of 8 mice thus far, with two mice per group. There were no mortalities related to the surgeries. Micro-CT data demonstrated incomplete bone healing at 2 and 4 weeks post operatively in both control and cryopreserved bone, with complete healing at 8 weeks. Conclusion: These preliminary studies demonstrate feasibility of performing decompressive craniectomy in mice, and cranioplasty using cryopreserved calvarial bone. This will be a critical model not only for evaluating strategies to optimize cryopreserved bone healing, but also to develop innovative approaches for repairing large size bone defects.

Evaluating Hearing Outcomes in Microtia Reconstruction: A Comparison Meta-Analysis Study Using Bone Anchored Hearing Aids (BAHA) versus Canaloplasty with Middle Ear Ossicular Reconstruction

Vikas S. Kotha MD, Anthony DeLeonibus MD, Alison Jin BA, Francis Papay MD, Bahar Bassiri Gharb MD PhD, Antonio Rampazzo MD PhD

Cleveland Clinic Foundation

2023-02-10

Presenter: Vikas Kotha, MD

Affidavit: Certify this is the author's own work and has not been published or presented before.

Director Name: Steven Bernard, MD

Author Category: Resident Plastic Surgery

Presentation Category: Clinical

Abstract Category: Craniomaxillofacial

Background: Binaural hearing restoration after external ear reconstruction in patients with microtia continues to be sought by patients and families. The optimal surgical method for hearing restoration using either bone anchored hearing aids (BAHA) or canaloplasty with middle ear ossicular reconstruction (MEOR) remains understudied. Methods: A retrospective metanalysis evaluating hearing outcomes after BAHA implantation or MEOR was performed using PUBMED, EMBASE and MEDLINE following PRISMA guidelines (79 studies). Primary predictor variables were auricular reconstruction method (alloplastic vs. autologous) and type/timing of hearing intervention. Primary outcomes were hearing outcomes, and postoperative complications. Hearing success was defined as postintervention pure tone average (PTA), air-bone gap (ABG) <30 dB, hearing gain >30 dB. Standard statistical analysis was performed with SPSS27 software. Results: Twelve studies (n=847 hearing procedures) with a mean MINORS score of 12.67 (10-16) met inclusion criteria. BAHA implantation was associated with two times greater odds of obtaining a successful hearing outcome than canaloplasty (OR 2.07, 95% CI, 1.69-2.53). Of the 60 cases with comparable complication outcome data, the median number of complications was 1 for canaloplasty cases (n=17) vs. 0 for BAHA cases (n=43) (p=0.001). In subset analysis, mean hearing gain after BAHA implantation (n=17) was 37.4 dB (95% CI, 32.9- 41.9) vs. 24.9 dB (95% CI, 18.3- 31.5) for canaloplasty cases (n=17) (p=.002). Conclusion: BAHA implantation after microtia reconstruction was associated with superior hearing outcomes and lower complications than canaloplasty in a large retrospective meta-analysis cohort study. Subset analysis also identified superior hearing improvement and overall improved hearing using BAHA

Evaluation of COVID-19 Prone-Induced Facial Pressure Sore Development and Rate of Operative Intervention

Danielle M. Khalilzadeh MS, Garrett V. Brittain MS, Spencer R. Anderson MD, Ron M. Johnson MD

Wright State University Boonshoft School of Medicine

2023-02-10

Presenter: Danielle Khalilzadeh

Affidavit: This material has not been published anywhere or presented previously. The work on this project represents the original work of the resident/medical students with the conceptualization from the Program Director.

Director Name: Dr. R. Michael Johnson

Author Category: Medical Student

Presentation Category: Clinical

Abstract Category: General Reconstruction

Hospitalized COVID-19 patients have a 61% chance of developing acute respiratory distress syndrome (ARDS). Per National Institute of Health, extended prone positioning is advantageous for patients with moderate-to-severe ARDS requiring mechanical ventilation. [1] Despite therapeutic benefit, over 45% of prone positioned COVID-19 patients experience facial pressure ulcers (FPU) as a complication [2,3]. To better understand the incidence and management of FPU in the COVID-19 population our study aims to identify best practices of FPU management, analyze the incidence of COVID-19 patients developing FPU secondary to proning techniques, and determine rate of survival and surgical intervention in managing FPU. As a single-institution retrospective case-controlled study, 28 COVID-19 patients and 29 non-COVID-19 patients were randomly selected from electronic health record data and partitioned into two groups. Data variables such as total time spent prone, turning protocol, incidence of pressure sore development, pressure sore grade, and overall mortality were collected. Exhaustive data analysis to be completed by a biostatistician. At the time of submission, comprehensive data analysis is ongoing. Preliminary outcomes indicate COVID-19 patients on average develop 2.17 FPUs compared to 1.53 FPUs in the non-COVID-19 cohort (p=0.037). Additionally, COVID-19 patients with PTU were more likely to require surgical intervention, heal with deformities, or be complicated by death compared to non-COVID-19 patients with PTU (p=0.0045). We hypothesize COVID-19 patients have both a greater incidence and severity of FPU. Thus patients will require earlier discussion regarding plastic surgery involvement when facilitating a long-term plan of care.

Extracorporeal Shockwave Therapy Improves Outcomes Following Secondary Alveolar Bone Grafting

Demetrius M. Coombs, MD; Viren Patel, MD; Nicholas Kochenour, DMD; Niyant Patel, MD; Ananth S. Murthy, MD

The Cleveland Clinic & Akron Children's Hospital

2023-01-31

Presenter: Demetrius Coombs, MD

Affidavit: I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting.

Director Name: Steven Bernard, MD

Author Category: Resident Plastic Surgery

Presentation Category: Clinical

Abstract Category: Craniomaxillofacial

Background: Recent studies have reported that extracorporeal shock wave therapy (ESWT) enhances bone formation during mandibular distraction osteogenesis. This study seeks to investigate the clinical outcomes in children undergoing ESWT alongside secondary alveolar bone grafting procedures at our institution. Methods: Retrospective review of all children that underwent secondary alveolar cleft bone grafting with adjunctive ESWT between 2019 and 2021. Variables including age, gender, cleft type, cleft width, pre-operative cleft dentition, volume of bone graft placed intraoperatively, ESWT settings, pain medication utilization, length of stay (LOS), follow-up, cone beam computed tomography (CBCT) data, and complications were recorded. Results: Twenty patients met inclusion criteria. Mean age at surgery was 9.9 years (range 8-16). Four (20%) patients were female; 16 (80%) were male. Eight (40%) patients had bilateral alveolar clefts; 12 (60%) had unilateral clefts. All (100%) patients were discharged on the day of surgery. Twelve (60%) patients required an average of 2 oxycodone doses post-operatively (range 0-6.5). All patients received ESWT treatments intra and post-operatively. All patients demonstrated an increase in bone graft volume visualized on CBCT: mean increase of 9.5% (range 1.3-35.7%) between 106.8 days (19.5% of ideal visualized, range 5-42%) and 291.9 days (29% of ideal, range 8-55.7%). Three (15%) patients experienced minor complications. Conclusions: Initial outcomes suggest that ESWT may expedite visualization of bone consolidation and facilitate recovery without increasing complications. ESWT could further represent an opportunity to improve care in craniofacial surgery. Pertinent considerations, the role of standardized assessment protocols, and future directions will be reviewed.

Health and Socioeconomic Predictors of 13,546 Clefts in a Population-Based Analysis

Kiersten C. Woodyard, MPH. Douglas Dembinski MD. Sydni Meunier MD. Kelly Spiller MD. Brian S. Pan MD

University of Cincinnati College of Medicine

2023-02-10

Presenter: Kiersten C. Woodyard

Affidavit: Kiersten is responsible for the conception of this project and it's completion. Kiersten is not a resident in our training program however, she is a medical student.

Director Name: Ann R. Schwentker

Author Category: Medical Student

Presentation Category: Clinical

Abstract Category: Craniomaxillofacial

Background: Cleft lip and palate remain among the most prevalent congenital anomalies. A contemporary analysis of cleft epidemiology was conducted to examine trends in health and socioeconomic indices associated with the birth prevalence of clefts in the United States. Methods: Population-based data was extracted using the CDC Wide-ranging ONline Data for Epidemiologic Research (WONDER) database. 19 million births from 2016-2020 were examined, data collection included parental demographics, health conditions, and congenital anomalies. Data was available for patients with Cleft Palate Only (CPO) and Cleft Lip with/without Cleft Palate (CL±P). Odds Ratio was used to compare patients with CPO and CL±P to patients without either condition. Results: 9078 patients with CL±P and 4468 patients with CPO were born between 2016-2020. Approximately 18.95 million infants were born without a cleft condition. Parental education of Bachelor's Degree or higher demonstrated protection against CL±P and CPO, though lower rates of education were associated only with increased risk for CL±P. WIC recipients and Medicaid recipients had increased risk for both CL±P and CPO. Pre-pregnancy diabetes, pre-pregnancy hypertension, tobacco use, and obesity were associated with increased risk for CL±P and CPO. Maternal Hepatitis C was 4 times more likely in CPO and 1.5 times more likely in CL±P. Conclusions: Analysis of US birth data demonstrated that clefts are increasingly associated with predictors of low socioeconomic status, such as WIC, Medicaid recipient status, and parental education. Further investigation is needed examining the association between clefts, socioeconomic indices, and health conditions prevalent in vulnerable populations.

Novel Application of the Piezoelectric Device with an Intraoral Approach to Lateral Osteotomies in Rhinoplasty, An Anatomical Study

Anthony DeLeonibus MD, Marco Swanson MD, Viren Patel MD, Vikas Kotha MD, Bahar Bassiri Gharb MD PhD, Antonio Rampazzo MD PhD

Cleveland Clinic Foundation

2023-02-10

Presenter: Anthony DeLeonibus, MD

Affidavit: Certify that this work is the author's own and that it has not been published or presented before.

Director Name: Steven Bernard, MD

Author Category: Resident Plastic Surgery

Presentation Category: Clinical

Abstract Category: Aesthetics

Introduction: Lateral osteotomies (LO) are the mainstay modality to close reduced prominent dorsal humps or address widened nasal bones in patients undergoing rhinoplasty. Despite their accepted role in rhinoplasty, there is variation in how surgeons osteotomize the nasal bones, with classic reports describing an intranasal or percutaneous approach. Here, we present the first report of using the piezoelectric device to perform LOs through an intraoral approach in a series of cadavers. Materials and Methods: Open rhinoplasty was performed followed by a 2cm intraoral dissection of the bilateral medial maxillary buttresses intraorally exposing the nasofacial junction. Low to low lateral osteotomies was performed with piezoelectric surgery in all cadavers. The duration of exposure, dissection and osteotomy was recorded along with dimensions of dissection. Video nasal endoscopy was subsequently performed to evaluate for intranasal mucosal injury. Results: All cadavers were Caucasian (5 females and 2 males). Median time to open the nose was 13.77 (IQR 5.05 minutes). The median piezo osteotomy time took 1.70 (IQR 0.53 minutes) and 1.73 (IQR 1.06 minutes) for the right and left side, respectively. Out of the 7 cadavers, (14 total dissections), all sides demonstrated no mucosal lacerations.The external branch of anterior ethmoidal nerve and infraorbital nerve were always preserved. Conclusion: Direct visualization of the dissection and osteotomy allows for a consistent and precise approach at narrowing the nasal bones. This study demonstrates that piezoelectric intraoral lateral osteotomies is a safe, expeditious and reproducible means to narrow the bony vault without the need for extensive nasal dissection.

Pediatric Facial Fractures in Patients with Autism Spectrum Disorder

Anne E. Glenney, BA; Zhazira Irgebay, BA; Meeti Mehta, BS; Janina Kueper, MD; John Smetona, MD; Justin Schreiber, MD; Joseph E. Losee, MD; Jesse A. Goldstein, MD

UPMC

2023-01-31

Presenter: Anne E. Glenney, BA

Affidavit: Vu Nguyen

Director Name: Vu Nguyen

Author Category: Medical Student

Presentation Category: Clinical

Abstract Category: Craniomaxillofacial

Background: Craniofacial fractures are understudied and poorly characterized in patients with Autism Spectrum Disorder (ASD). This study presents demographic, diagnostic, and treatment data on pediatric facial fracture patients with ASD. Methods: A retrospective review was performed of patients with craniofacial fractures under 18 years of age who presented to a pediatric level I trauma center from 2006 to 2021. Data collected included demographics, injury details, associated injuries, management, outcomes, and ASD status. Results: Facial fractures were diagnosed in 3334 patients; 30 had a diagnosis of ASD. Average age was 12.0 ą 4.8 years; most were white (90.0%) and male (93.3%). Eleven patients had a concomitant ADHD diagnosis (36.7%) and 12 (40.0%) had previous neurological disorder diagnoses. The most common mechanisms of injury were violence (n = 9, 30.0%) and activities of daily living (n = 8, 26.7%). Nasal fracture was the most common fracture (n = 24, 77.4%). ASD patients were less likely to present with orbital fractures (9.7% vs 26.2%, p <0.037), but there was no difference in rates of maxillary, nasal, or mandibular fractures. Odds of receiving operative treatment were lower in patients on the autism spectrum (OR: 0.4; CI 95%, 0.2-0.8); however, there was no difference in admission rates between groups (25.8% vs 32.5%, p = 0.431). Conclusions: Pediatric facial fractures in ASD patients are poorly characterized. Our study describes the unique characteristics of this understudied population. Our results demonstrate similar patterns of facial fractures compared to controls; however, ASD patients were less likely to receive operative treatment.

Pediatric Nasoorbitoethmoid Fractures: A Single Institution's Fifteen Year Experience

Anne E. Glenney, BA; Zhazira Irgebay, BA;Lucille G. Cheng, BA; Alexander J. Comerci, BS; Joseph W. Mocharnuk, BA; Madeleine K. Bruce, BA; Erin E. Anstadt, MD; Lucas A. Dvoracek, MD; Joseph E. Losee, MD; Jesse A. Goldstein, MD

University of Pittsburgh Medical Center (UPMC)

2023-01-30

Presenter: Anne E. Glenney

Affidavit: Vu Nguyen

Director Name: Vu Nguyen

Author Category: Medical Student

Presentation Category: Clinical

Abstract Category: Craniomaxillofacial

Background: Nasoorbitoethmoid (NOE) fractures impact growth of the craniofacial skeleton in children, which may necessitate differentiated management from adult injuries. This study describes characteristics, management, and outcomes of pediatric NOE fractures seen at a single institution. Methods: A retrospective review of patients under 18 years who presented to our institution from 2006 to 2021 with facial fractures was conducted; patients with NOE fractures were included. Data collected included demographics, mechanism of injury, management, and outcomes, and NOE fractures were sub-divided in accordance with the Markowitz and Manson classification system. Results: 58 patients met inclusion criteria; 77.6% presented with Type I fractures, 17.2% with Type II, and 5.2% with Type III. The most common cause of injury was motor vehicle accidents (MVAs, 39.7%) and sports (31%). GCS and injury mechanism were not predictive of injury severity in the pediatric population (p=0.353, p=0.493). Orbital fractures were the most common associated fractures (n=55, 94.8%); parietal bone fractures were more likely in Type III fractures (p=0.047). LeFort III fractures were more likely in type II fractures (p=0.011). Soft tissue and neurological injuries were the most common associated injuries regardless of NOE fracture type (81% and 58.6%, respectively). There was no significant difference in type of operative management or in the rates of adverse outcomes between types of NOE fractures. Conclusions: These findings suggest that pediatric NOE fractures, though rare, present differently from adult NOE fractures and that revisiting predictive heuristics and treatment strategies is warranted in this population.

Plastic Surgery Match: Are We Speaking The Same 'Language' Regarding Groups URiM And Increasing Diversity Within The Field?

Nerone K.O. Douglas, BS, MSc Carolyn De La Cruz, MD Francesco Egro, MBChB, MSc, MRCS

University of Pittsburgh

2023-01-31

Presenter: Nerone K.O. Douglas, BS, MSc

Affidavit: Nerone Douglas

Director Name: Vu T. Nguyen

Author Category: Medical Student

Presentation Category: Basic Science Research

Abstract Category: General Reconstruction

Background: Plastic Surgery is one of the fields that lags behind the rest when it comes to surgeons from backgrounds underrepresented in medicine(URiM). The goals of our study quantify how many integrated plastic surgery residency programs have outlined criteria defining diversity goals and/or groups of people they consider to be URiM. Methods: Data collected on integrated plastic surgery programs were primarily obtained from their program-specific websites. Each program site was meticulously reviewed for diversity missions/statements and explicit mentions of racial and ethnic groups considered URiM. Results: From a total of 86 programs reviewed, 8 programs(9%) had clear URiM criteria listed on their websites, 26(30%) relied on institutional/department-wide criteria, 1(1%) listed that they were adhering to AAMC definition of URiM, and 51 programs(60%) had no form of definition for what is considered URiM. When looking at the programs with some form of criteria for URiM(n=35;40%), all programs(100%) considered African American/black, Native American/Alaskan Native, Hispanic/Latinx, and Pacific Islander/Native Hawaiian as groups URiM. Assessing the same subset of programs that have a form of criteria listed(n=35; 40%), 19(58%) had listed other groups, outside of race/ethnicity, considered to be URiM for their program and 14(42%) programs did not. 14 programs(74%) considered LGBTQIA+ as a group that is URiM. Conclusion & Significance: This study serves as a call to action to encourage residency programs to evaluate their mission towards diversity, equity, and inclusion, and to spark discussion towards creating a purposeful selection process for applicants URiM into Plastic Surgery.

Propeller Buccal Myomucosal Flap: anatomical study and preliminary experience in 25 primary cleft palate reconstructions

Anthony DeLeonibus, MD; Vikas S. Kotha, MD; Samantha Maasarani, MD, MPH; Brian Figueroa, MD; Majid Rezaei, DDS, MSc; Nicholas Sinclair, MD; Ying Ku, BS; Lianne Mulvihill, BA; Bahar Bassiri Gharb, MD, PhD; Antonio Rampazzo MD, PhD

Cleveland Clinic Foundation

2023-02-10

Presenter: Anthony DeLeonibus, MD

Affidavit: Certify that this is the author's own work and has not been previously published or presented.

Director Name: Steven Bernard, MD

Author Category: Resident Plastic Surgery

Presentation Category: Clinical

Abstract Category: Craniomaxillofacial

Purpose: Buccal artery myomucosal (BAMM) flap has been well-described for cleft palate (CP) reconstruction. However, anatomic investigation and application of a islanded propeller flap have not been reported in the literature. Methods: Anatomical study was performed using Indocyanine green, red and blue latex injected directly into the buccal pedicle of 22 fresh hemifacial cadavers. Then, clinical analysis of the senior authors' (BBG, AR) experience with 25 consecutive primary cleft palate reconstructions utilizing a propeller islanded BAMM flap was conducted to assess palatal healing and flap outcomes. Results: Mean buccal artery diameter was 0.95±0.29mm. Neurovascular pedicle entered the flap 11.38±2.87mm anterior to the pterygomandibular raphe. Buccal artery advanced inside the flap as much as 66.8%±6.0% of the total flap length. All reconstructions were performed using Furlow palatoplasty. 36 flaps were utilized in 25 patients (mean age 478d). The mean maximum cleft width was 11.7 mm. Mean BAMM flap width was 1.2 cm and 11 cases utilized bilateral flaps. The flap always reached the contralateral pillar and the buccal nerve was always preserved. Mean follow-up was 400 days. There were 2/36 flap loss. In both flap losses, pedicles were aggressively dissected. 4/36 flaps underwent revision surgery for flap debulking. Conclusions: This study shows that the buccal pedicle is the main blood supply to the flap and this modification allows preservation of the sensory innervation. The contralateral pillar could always be reached improving the traditional advancement and inset. Traditional extensive propeller flap dissection should be avoided in these neonates to avoid vascular compromise.

Psychiatric Comorbidities in a Large, Single Institution Database of Pediatric Facial Fractures

Joseph W. Mocharnuk, BA, Anne Glenney, BA, Zhazira Irgebay, BA, Sayna Matinrazm, BA, Jesse A. Goldstein, MD

University of Pittsburgh School of Medicine

2023-02-10

Presenter: Joseph Mocharnuk

Affidavit: This abstract represents the work of the submitting author and his collaborating team.

Director Name: Vu Nguyen, MD

Author Category: Medical Student

Presentation Category: Clinical

Abstract Category: Craniomaxillofacial

Background: In pediatric trauma patients, psychiatric disorders are associated with increased length of stay, higher hospital charges, and a greater risk for mortality. The lack of resources to adequately diagnose and treat psychiatric conditions in trauma centers creates further care gaps for this population. Methods: A retrospective review was performed of 3,334 facial fractures patients <18 years of age evaluated at a pediatric level I trauma center between 2006 and 2021. Patient psychiatric conditions included previously diagnosed ADHD, oppositional defiant disorder (ODD), depression, and bipolar disorder. Using chi-squared and independent sample t-tests, patients with a psychiatric history were compared with the rest of the cohort. Results: One hundred ninety-eight patients (6%) had prior diagnoses of ADHD, 20 had ODD (1%), 36 had depression (1%) and 19 had bipolar disorder (1%). Mean age for patients with each psychiatric condition was greater than the rest of the cohort (p<0.001). Violence was the primary cause of injury in each psychiatric condition (ADHD 30% vs 10%, p<0.001; ODD 30% vs 12%, p=0.191; depression 53% vs 11%, p<0.001; bipolar disorder 31% vs 11%, p=0.069), whereas sports-related injuries were more common in the remainder of the cohort. Patients with a psychiatric condition were consistently more likely to be admitted, yet less likely to be surgically treated. Conclusion: Our results highlight the impact of psychiatric conditions on pediatric facial fracture management and outcomes. This overlooked entity, seen more frequently with older children, is associated with violent and severe injuries that require more hospitalization but less surgical intervention.

Resource utilization and disparity characteristics associated with potentially avoidable transfers of pediatric patients with facial fractures

Lucille G. Cheng, BA, Aniket Dhariwal, BA, Anne E. Glenney, BA, Shirley Xiaosu Liu, BS, Richard A. Saladino, MD, Lucas A. Dvoracek, MD; Jesse A. Goldstein, MD

University of Pittsburgh Medical Center

2023-02-08

Presenter: Lucille Cheng

Affidavit: Certified

Director Name: Vu T. Nguyen

Author Category: Medical Student

Presentation Category: Clinical

Abstract Category: Craniomaxillofacial

"Potentially avoidable" transfers (PAT) of pediatric facial fracture patients place undue burden on families to travel outside their communities while diverting resources from urgent cases. Previous work has focused on characterizing these transfers in specific injury subtypes, but it is critical to examine factors influencing transfer and understand the impact of these transfers, on a larger patient cohort and broader craniofacial fracture spectrum. A retrospective review was performed of patients under 18 years of age who were evaluated for facial fractures at a pediatric level I trauma center between 2006 and 2021. PAT was defined as a patient with a length of stay less than one day, no admission, no surgery, and no emergency procedure performed after transfer. Variables studied included demographics, etiology, medical history, associated injuries, treatments, and outcomes. 3120 pediatric patients were included; nearly half (40.1%) were transferred and 299 (24.1% were categorized as PAT. Key patient characteristics associated with PAT likelihood were Black race (p=0.036), being uninsured (p=0.004), less than 6 years of age (p=0.008), and orbit or mandible fractures (p=0.001 and p=0.007, respectively). Odds ratio analysis demonstrated TAP likelihood was 3 times higher for a Black patient with mandible or orbit fracture (p=0.001 and 0.004, respectively). "Potentially avoidable" transfers are a significant burden to patients and hospital systems. This study describes factors associated with such transfers in pediatric facial fractures using one of the largest pediatric facial fracture databases to date. We recommend further research in causes of racial and socioeconomic transfer disparities and improvement in transfer protocols.

Safety of intubation methods in patients with LeFort pattern facial trauma

Joseph Easton, Kiersten Woodyard, Doug Dembinski, Ryan Gobble

University of Cincinnati Medical Center

2023-01-31

Presenter: Joseph Easton

Affidavit: All work represents the original work of the resident

Director Name: Ann Schwentker

Author Category: Resident Plastic Surgery

Presentation Category: Clinical

Abstract Category: Craniomaxillofacial

Background: Patients with complex facial trauma often require surgical intervention to restore facial height, width, and occlusion. There is some uncertainty regarding safety of nasotracheal intubation in this patient population. This investigation compares complications and surgical outcomes in complex facial trauma patients across prevalent intubation methods. Methods: A retrospective chart review was conducted for patients who were surgically treated for LeFort I-III fractures between 2018-2022 at our institution. Data collection included age, fracture pattern, intubation method (oral airway, nasotracheal, or tracheostomy), surgical service, and complications. Complications specific to intubation method were examined between fracture type and intubation method. Statistical analysis included equivalence testing with one-sided t-tests, F-distribution tests, and Chi-squared analysis. Results: 65 patients were identified who were surgically treated for LeFort I-III from 2018-2022. Intubation-related complications included bleeding from airway site, malocclusion, and need for hardware removal. The pooled complication rate in patients who had tracheostomy and nasotracheal intubation was proven to be statistically similar (p-value=0.019), a trend maintained when examining only patients with LeFort II or III fractures (p-value=0.040). There was no difference between overall complications and surgical service. However, the likelihood of a complication requiring a return to OR was significantly higher in tracheostomy compared to other intubation methods (p=0.043). Conclusion: Nasotracheal intubation had statistically equivalent complication rates to tracheostomy regardless of LeFort fracture pattern, demonstrating safe use in patients with complex facial trauma. Nasotracheal intubation could present an equally safe alternative, with lower morbidity than tracheostomy.

Socioeconomic and Racial Disparities in Pediatric Craniofacial Trauma

Yadira Villalvazo, MD, MS¹ Anne Glenney, BS¹ Joseph Mocharnuk, BS¹ Zhazira Irgebary, BA¹ Lucy Cheng, BA¹ Meeti Mehta, BS¹ Casey Zhang, BA¹ Jesse A. Goldstein, MD¹ Joseph E. Losee, MD¹

¹ Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Department of Plastic Surgery, Pittsburgh, PA

2023-02-09

Presenter: Yadira Villalvazo, MD, MS

Affidavit: The work presented represents only the original work of the fellow.

Director Name: J. Peter Rubin

Author Category: Fellow Plastic Surgery

Presentation Category: Clinical

Abstract Category: Craniomaxillofacial

Purpose: Pediatric facial fractures are a common cause of emergency department visits and hospital admissions. However, little has been published on the social determinants of health for pediatric facial fractures. This study aims to investigate the influence socioeconomic, racial, and household disparities have on the management of pediatric patients who present with facial trauma. Methods: A retrospective review was performed of patients under age 18 who were evaluated for facial fractures at a pediatric level I trauma center between 2006-2021. Variables studied included demographic information, CDC's Social Vulnerability Index (SVI), injury characteristics, management, and outcomes. Results: Facial fractures were diagnosed in 3334 patients; 2691 patients met inclusion criteria. A total of 18.3% were non- white, of whom 14.5% were Black. Black patients were 1.62 times more likely than white patients to present with mandibular fractures (p<0.001). Most fracture subtypes were associated with an increased SVI, unemployment, and a single parent household (p<0.0001). When controlling for fracture type, Black patients were 2.4 times more likely to receive imaging (p<0.0001) than white patients, but 0.52 times as likely to receive surgery (p<0.0001). Furthermore, Black patients were 2.2 times as likely to be uninsured as white patients (p=0.00021) and 1.5 times as likely to be lost to follow-up (p=0.00019). Conclusion: Racial/ethnic minority status, lower socioeconomic status, and household characteristics, were all associated with certain fracture patterns and management pathways. Identifying systemic barriers that impact management and outcomes in vulnerable patients is necessary to overcome healthcare gaps and optimize clinical outcomes.

The Utility and Effectiveness of Non-Invasive Intracranial Pressure Monitoring in Craniosynostosis: A Systematic Review

Quan Lu, BA, Anthony DeLeonibus, MD, Niyant Patel, MD

N/A

2023-02-15

Presenter: Quan Lu

Affidavit: Certify that the following work is original, has not been presented or published prior to this submission.

Director Name: Ananth Murthy, MD

Author Category: Medical Student

Presentation Category: Clinical

Abstract Category: Craniomaxillofacial

Introduction: One of the most significant untoward effects of craniosynostosis is the deleterious sequelae of increased intracranial pressures (ICP). The gold standard for measuring ICP is ventricular catheter. These procedures are invasive, time-consuming, costly, and have risk for morbidity. The objective of this study was to systematically evaluate the literature to report on the utility, success, and failures of non-invasive monitoring (NIM) against direct monitoring in craniosynostosis patients. Methods: A PRISMA guided literature review from all recorded history to present was performed utilizing Pubmed, Cochrane, and Web of Science. Inclusion criteria: (NIM) against a direct/invasive ICP monitoring technique in craniosynostosis patients. Exclusion criteria: non-English, non-human, invasive measurement studies alone. Results: There were 700 results with 50 (7.17%) final full-text reports. The most common NIM included radiographic findings, clinical signs/symptoms, ocular ultrasonography, fundoscopy, visual evoked potentials, optical coherence tomography, telemetric, epicutaneous monitoring, and transcranial doppler ultrasound. Forty-seven studies reported on the use of NIM and 3 studies reported on telemetric monitoring which provides NIM following implantation. NIM sensitivity and specificity for ICP was reported in 12/50 studies. In total, 8/50 reported a lack of correlation and 22/50 reported associated correlation between invasive and NIM. Conclusion: Although direct ICP monitoring is considered the gold standard when evaluating ICP of patients with craniosynostosis, NIM provides medically relevant information pertinent for decision making. The present study concurs that the use of NIM provides valuable information and when used in combination with other methods, allows for detection of elevated ICP with considerably less associated risk.

Transnasal approach with endoscopic assistance in treatment of midline nasal dermoids with intracranial extension

Kiersten C. Woodyard MPH. Douglas Dembinski MD. Jesse Skoch MD. Brian S. Pan MD

University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center.

2023-02-10

Presenter: Kiersten C. Woodyard

Affidavit: Kiersten collected and analyzed data, and performed the writing tasks for this project. Kiersten is not a resident in our training program however, she is a medical student.

Director Name: Ann R. Schwentker

Author Category: Medical Student

Presentation Category: Clinical

Abstract Category: Craniomaxillofacial

Background: Nasal dermoid cysts with intracranial extension in the form of dermal sinus tracts require complete resection to prevent recurrence. Resection techniques necessitate adequate intracranial exposure, but morbidity associated with historical resection approaches has presented unique multidisciplinary challenges for surgeons. Methods: We primarily employed a transnasal approach through a midline nasal incision, utilizing endoscopic or microscopic access through the lateral cartilages for resection of nasal dermoid cysts with intracranial extension. A retrospective review was completed for patients treated for nasal dermoid cysts at our pediatric tertiary referral center from 2016-2022. Data collection included demographics, comorbidities, perioperative data, pre- and post-operative imaging, surgical outcomes, and complications. Results: 16 patients with nasal dermoid sinus cysts with possible or confirmed intracranial extension were surgically treated from 2016-2022. 13 were treated with resection performed via midline transnasal approach with endoscopic assistance, achieving successful total resection while avoiding nasal osteotomy or frontal craniotomy. One patient had slow CSF leak from an operative durotomy, successfully treated with a lumbar drain. No other complications occurred. Incision length and post-operative scar burden were less than approaches that used osteotomies or craniotomies, and demonstrated excellent cosmetic results. No patients have had cyst recurrence and no patients have required reoperation. Conclusions: A transnasal approach via midline incision with endoscopic assistance is an effective approach for resection of nasal dermoid cysts with intracranial extension, but utility may vary with cyst size and complexity. This approach leverages appropriate exposure for resection with decreased morbidity and decreased incision length via avoidance of osteotomies.

Trends in Face Call at a Level One Pediatric Hospital and Two Trauma Centers

Rajib Chowdhury MD¹, Nikhi Paul Singh MD, MBA¹, Melissa Cullom MD¹, William Wooden MD¹

Indiana University

2023-01-31

Presenter: Rajib Chowdhury

Affidavit: William Wooden

Director Name: William Wooden

Author Category: Resident Plastic Surgery

Presentation Category: Clinical

Abstract Category: Craniomaxillofacial

Introduction: Approximately 3 million ED consults for facial trauma occur each year in the US. Injuries can be divided into bony trauma: upper, middle and lower facial fractures. They can also be divided into soft tissue trauma: dog bites, lacerations and abrasions. Plastic surgeons divide facial trauma call with Otolaryngology and Oral Maxillofacial Surgery. This study aims to review the Plastic Surgery Call burden as it relates to face call. Methods: IRB exemption was obtained and call sign outs from July to December 2022 were reviewed. Data included patient demographic information, injuries, procedures performed, and estimated time per call. Chi squared tests determined significance. Results: Of the 116 days reviewed, 73 days contained a face consult for a total of 176 consults. Most patients were male (70.3%) and with an average age of 38. The most common presentation was for facial fractures (101) followed by facial lacerations (57), followed by dog bites (14). In total 59 bedside procedures were performed with the most being laceration repairs (56). Three patients went to the OR overnight. Conclusions:Plastic Surgeons play an integral role in evaluating and managing facial trauma. Plastic surgeons are well equipped to perform repair of not only facial fractures but also complex facial soft tissue injuries. Our training allows us to achieve results that are close to the pre-injury level of both function and aesthetics. At our institution, over a third of facial trauma consults (34%) involve a bedside procedure. The majority of patients are younger and of male gender.

Underdiagnosis of syndrome of trephined in patients undergoing cranioplasty

Taborah Zaramo B.S., Hunter Stecko B.S, Kerry-Ann S. Mitchell MD-PhD

The Ohio State University Department of Plastic and Reconstructive Surgery

2023-02-10

Presenter: Taborah Zaramo

Affidavit: The project is orginal work

Director Name: Gregory D. Pearson, MD

Author Category: Medical Student

Presentation Category: Clinical

Abstract Category: Craniomaxillofacial

Introduction: Syndrome of the trephined (SoT) is the neurologic derangement that develops when a large segment of the skull is removed in decompressive craniectomy for severe brain insults such as traumatic brain injury, strokes, or intracranial infection. These derangements markedly improve or resolve after the defect is repaired with a cranioplasty procedure. Therefore, it critical that patients with skull defects be referred for reconstruction in a timely manner. We aimed to assess the frequency of SoT in patients undergoing cranioplasty and evaluate whether SoT was diagnosed. Methods: Retrospective chart review was performed on 113 patients undergoing 172 cranioplasty between 2014-2021. SoT was defined as ≥2 points of improvement in Activity Measure for Post-Acute Care (AM-PAC) score 3-7 days after cranioplasty. If a patient met criteria for SoT charts were investigated for mention or diagnosis of SoT. Paired sample t-test and Wilcoxon signed ranked test was performed to determine significance. Results:Of the seventy-three patients seen by occupational/physical therapist after cranioplasty. 24 patients met the criteria for SoT with average improvement in AM-PAC score of 4 points (p=0.0125). The most significant improvement in score occurred within 3.6 days (Conclusion:These results suggest underdiagnosis of SoT in patients with large size skull defects. It is important for surgeons recognize and diagnose SoT since earlier cranioplasty may be warranted, with utilization of multidisciplinary approach to improve patient outcomes.