Craniofacial Surgery Research Articles

Intraoperative navigation in craniofacial surgery

Craniofacial surgery requires comprehensive anatomical knowledge of the head and neck to ensure patient safety and surgical precision. Over recent decades, there have been significant advancements in imaging techniques and the development of real-time surgical navigation systems. Intraoperative navigation technology aligns surgical instruments with imaging-derived information on patient anatomy, enabling surgeons to closely follow preoperative plans. This system functions as a radiologic map, improving the accuracy of instrument placement and minimizing surgical complications. The introduction of first-generation navigation systems in the early 1990s revolutionized surgical procedures by enabling real-time tracking of instruments using preoperative imaging. Initially utilized in neurosurgery, intraoperative navigation has since become standard practice in otolaryngology, cranio-maxillofacial surgery, and orthopedics. Since the 2000s, second-generation navigation systems have been developed to meet the growing demand for precision across various surgical specialties. The adoption of these systems in craniofacial surgery has been slower, but their use is increasing, particularly in procedures such as foreign body removal, facial bone fracture reconstruction, tumor resection, and craniofacial reconstruction and implantation. In Korea, insurance coverage for navigation in craniofacial surgery began in 2021, and new medical technologies for orbital wall fracture treatment were approved in August 2022. These technologies have only recently become clinically available, but are expected to play an increasingly important role in craniofacial surgery. Intraoperative navigation enhances operative insight, improves target localization, and increases surgical safety. Although these systems have a steep learning curve and initially prolong surgery, efficiency improves with experience. Calibration issues, registration errors, and soft tissue deformation can introduce inaccuracies. Nonetheless, navigation technology is evolving, and the integration of intraoperative computed tomography data holds promise for further enhancements of surgical accuracy. This paper discusses the various types and applications of navigation employed in craniofacial surgery, highlighting their benefits and limitations.

Outcomes of Hydroxyapatite Bone Cement for Craniofacial Reconstruction in 1983 Patients.

Hydroxyapatite bone cement (HABC) has evolved to have diverse applications in craniofacial reconstruction. This ranges from filling cranial defects to secondary contouring of residual defects after primary surgeries. This study aims to determine patient outcomes after reconstruction with HABCs. A systematic review and meta-analysis were conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. PubMed, Embase, Web of Science, and Cochrane Library databases were queried. The results were limited to English-language literature with extractable data on HABC for craniofacial reconstruction. A total of 1983 patients were included in the final analysis from 35 studies. HABCs were mostly used for large defect cranioplasty (21.5%), retrosigmoid (44.6%) and translabyrinthine cranioplasty (8.9%), and correction of residual craniofacial defects after congenital craniofacial surgeries (25%). The rates of cerebrospinal fluid (CSF) leak and infection/explantation were 0% and 7.5% [95% CI: 2.4-11.8] for large defect cranioplasty and 0.8% [0.03-2.07] and 1.5% [95% CI: 0.92-3.3] for retrosigmoid cranioplasty, respectively. The infection/explantation rate was 6.2% [95% CI: 2.6-18.7] for HABCs in the correction of residual craniofacial defects after congenital craniofacial surgeries. The total reoperation rates were 20.4% % [95% CI: 4.8-11.8] for large defect cranioplasty and 12% [95% CI: 3.3-15.3] for correction of residual defects after congenital craniofacial surgeries. Aesthetic satisfaction rates were 93.1% [95% CI: 90.3-98.8] for large defect cranioplasty, 99.4% [95% CI 97.2-99.9] for retrosigmoid cranioplasty, and 92.6% [95% CI: 83.3-95.8] for HABC use in the correction of residual craniofacial defects after congenital craniofacial surgeries. HABC is versatile and associated with a high level of patient reported aesthetic satisfaction after cranioplasty and may have a comparably lower complication profile than those of most other alloplastic materials.

Orthodontic treatment of patients with cleft lip and palate from birth through maturity

Cleft lip and palate (CLP) is one of the most common congenital anomalies, requiring lifelong care by a team of craniofacial specialists. A key member of that team is the craniofacial orthodontist, who provides treatment for these patients throughout the lifetime. This care actually begins prenatally, when families first meet with a craniofacial team. The family is provided with resources to prepare for their child's arrival and counseled about future treatment. Presurgical infant orthopedics (PSIO) will usually begin within a week of birth and continues for 3–5 months. PSIO helps approximate the lip and alveolar segments and reshapes the nostrils to facilitate primary surgical repairs. This is followed by a phase of monitoring growth and dental development throughout childhood, as patients with CLP are at increased risk for dental anomalies. Once the maxillary canine roots are one-third developed, the patient will be prepared for secondary alveolar bone grafting. This may include expansion, alignment, and/or maxillary protraction via facemask therapy. A short phase of maxillary dental alignment might follow if functional or esthetic concerns arise. Comprehensive orthodontic treatment is then performed at skeletal maturity, and coordinated with orthognathic surgery when indicated. The orthodontist and surgeon will collaborate closely in planning and managing the surgical correction. It is crucial that each stage of orthodontics is followed by an appropriate retention protocol. Finally, surgical and esthetic finishing procedures take place after surgical orthodontics is complete. This may include surgery to address lip, nose, speech, and breathing concerns, as well as definitive dental restorations.

Bridging Gaps in Health Literacy for Cleft Lip and Palate: The Role of Artificial Intelligence and Interactive Educational Materials.

Our goal is to address the health literacy gap concerning cleft lip and palate using artificial intelligence (AI), specifically OpenAI's ChatGPT-4, to enhance the readability of patient educational materials (PEMs). Additionally, we aim to explore the integration of interactive educational materials into these resources. A cross-sectional study. Websites of craniofacial teams approved by the American Cleft Palate-Craniofacial Association (ACPA). PEMs collected from these websites. First, we examined the PEMs for interactive educational content such as videos, photos, case examples, and audio clips. Subsequently, we used the WebFX online readability calculator and Grammarly to evaluate the texts' readability and clarity. After that, we used ChatGPT-4 to simplify the PEM texts to a 6th-grade reading level and re-evaluated their readability and clarity. Readability levels (grade level) and clarity scores of PEMs before and after AI modification, and the presence of interactive educational content. Initial evaluations using the Flesch-Kincaid Grade Level formula showed that the texts were written at a median 9th-grade reading level. Modifications using ChatGPT-4 significantly improved readability, achieving a median 6th-grade level and enhanced clarity. Only 27% of the websites featured interactive educational content, indicating a gap in utilizing educational enhancements. The use of AI improved the readability and clarity of patient educational materials, aligning with recommended standards. However, the underutilization of interactive tools suggests a need for broader integration of these resources to optimize patient education and engagement.

Assessing Use and Familiarity of Enhanced Recovery After Surgery Elements in Pediatric Orthognathic Surgery

Enhanced recovery after surgery (ERAS) protocols have informed perioperative care across multiple surgical specialties, optimizing patient outcomes through surgical stress management and accelerated recovery. This study evaluates the familiarity and adoption of ERAS elements among craniofacial and oral and maxillofacial surgeons in pediatric orthognathic surgery, a field where a formal ERAS protocol has not been established. A closed-ended survey of 102 surgeons was conducted to assess familiarity with and utilization of 14 ERAS elements. The survey garnered a 40.2% response rate, with 41 surgeons participating. The majority of respondents (68.3%) specialized in craniofacial (CF) surgery, and their annual pediatric orthognathic surgery caseload varied widely. Key findings revealed that 7 ERAS elements were widely adopted, including hypothermia prevention, normovolemia maintenance, intraoperative tranexamic acid use, and minimized opioid use for postoperative pain control. However, elements such as liposomal bupivacaine and postoperative goal-directed fluid therapy were less utilized, primarily due to limited availability or knowledge. Surgeons demonstrated high familiarity with elements like jaw immobilization and minimizing opioid use but showed knowledge gaps in areas such as preoperative nutritional screening and goal-directed fluid therapy. These insights underline the need for further education and the development of a standardized ERAS protocol tailored for pediatric orthognathic surgery. The study underscores the importance of multidisciplinary collaboration and comprehensive preoperative education in implementing ERAS protocols. This study serves as a foundation for future research into optimizing perioperative care for pediatric patients undergoing orthognathic surgery.

Three-dimensional imaging in craniofacial surgery: utilization of a novel 3D mobile application to evaluate the surgical outcomes of a skull recontouring procedure for cephalohematoma.

Cranial abnormalities are common birth defects that frequently alter skull shape and appearance. Despite their prevalence, objective quantification of defect severity pre- and posttreatment is limited. The authors evaluated the ability of MirrorMe3D, a novel 3D mobile iPhone application, to measure changes in the contour of the skull for patients undergoing contouring of a calcified cephalohematoma. The heads of two 20-month-old patients with disfiguring right parietal cephalohematomas undergoing a skull recontouring operation were scanned pre- and postsurgery. Four scans of the cranial abnormality were taken throughout the procedure and intraoperative 3D models were generated. Models of the head were overlapped pre- and postsurgery and compared using a depth analyzer built into MirrorMe3D. Depth analysis revealed 6.0-mm and 9.9-mm differences for patients 1 and 2, respectively. Volume analysis revealed 33-cm3 and 85-cm3 differences for patients 1 and 2, respectively. Currently, no standard for quantitative measurement of the surgical outcomes of a skull reconstruction procedure exists. MirrorMe3D provides an efficient method for monitoring patients with simple topographic scans that create accurate models of the head. The authors show the app's ability to capture the severity of a calcified cephalohematoma and quantify the changes in the contour of the skull before and after surgery.

Virtual Reality Surgical Planning of a Complex Two-Jaw Defect

Head and neck reconstruction poses challenges requiring stable coverage and optimal appearance and functionality. In complex cases, and beyond the right choice of flap, Virtual Reality (VR) surgical software and preoperative planning, are needed to optimize outcomes. Our patient is a 16-year-old with a history of rhabdomyosarcoma necessitating maxillary-mandibular defect reconstruction. VR-based preoperative planning facilitated the intervention by creating 3D-VR models of facial anatomy and fibula, simulating resection margins, and creating surgical guides for intraoperative use. Our 2-team surgeons opted for a single-staged reconstruction using a vascularized fibula free flap. This case demonstrates successful single-flap reconstruction of a maxillary-mandibular defect, addressing challenges of recipient vessel scarcity, fibrotic scarring, and poor tissue quality. It also underscores the efficacy of a 2-team approach and VR-based preoperative planning in achieving successful outcomes in complex maxillary-mandibular reconstruction. The use of a single fibula flap minimized possible complications and operative time, and the 2-team approach helped by combining the expertise and training of craniofacial and microsurgical trained surgeons. Acknowledging limitations in imaging quality and real-time adaptability, we advocate for continued exploration of VR technologies in enhancing surgical precision in challenging cases.

Midface Skeletal Sexual Dimorphism: Lessons Learned from Advanced Three-dimensional Imaging in the White Population.

Facial shape is significantly influenced by the underlying facial bony skeleton. Sexual dimorphisms in these structures are crucial for craniofacial, aesthetic, and gender-affirming surgery. Previous studies have examined the orbits and upper face, but less is known about the midface. This study aimed to elucidate the sexual dimorphism in the midface region, focusing on the maxilla and zygomatic bones. A retrospective review was conducted using facial computed tomography scans from 101 White patients aged 20-79 years, using Materialise Mimics and 3-Matics for segmentation and 3D reconstruction. Measurements and statistical shape modeling of the midfacial skeleton were performed. Our results show a distinct sexual dimorphism in the midfacial skeletal structure across all age groups. Women typically had a narrower bizygomatic width by 1.5 mm (P = 0.04), a shallower maxillary depth by 1.6 mm (P < 0.01), and a midfacial vertical height that was 4 mm shorter than that of men (P = 0.018). In contrast, men exhibited a greater distance between the frontozygomatic sutures by 5.4 mm (P < 0.01), a 3-mm greater interorbitale distance (P < 0.01), and a 2.1-mm wider infraorbital foramina distance (P = 0.007). There were no significant differences in the pyriform and maxillary angles (P = 0.15 and P = 0.52, respectively). Our analysis of midfacial skeletal anatomy revealed sexual dimorphism differences. Men exhibited more pronounced facial features than women, with a broader horizontal midfacial skeleton, a longer midfacial vertical height, and greater maxillary depths compared with women.

Usefulness of using the superficial temporal pedicle as the recipient site for microvascular anastomosis in facial reconstruction: A retrospective study of 94 cases

In cranio-cervico-facial reconstructive surgery, it is accepted that the use of free flaps is the treatment of choice. The multiple antecedents can place the surgeon in situations of vascular deserts. The aim of our study is to report and analyse our experience of the use of temporal vessels in primary and secondary reconstructive surgery. A retrospective study was conducted between 01/01/2010 and 31/03/2023. Patients who underwent cranio-cervico-facial reconstruction using free flaps, with use of the superficial temporal pedicle as the recipient site for the vascular anastomosis were included. Early and late complication and failure rates were analysed according to type of reconstruction, location and risk factors for free flap failure. A total of 94 patients underwent craniocervical-facial reconstruction using a free flap anastomosed to the superficial temporal pedicle (in primary or secondary situations). Ten patients underwent reconstruction of the upper third, 58 the middle third and 26 the lower third. With an overall complication rate of 28.7% (21.3% minor complications and 7.4% major complications). Our study proves the reliability of the superficial temporal pedicle, both in the primary situation (with a success rate of 93.9%) and in the secondary situation (with a success rate of 89.3%), as well as its versatility whatever the cranio-cervico-facial level to be reconstructed. This study demonstrates the value of preserving the superficial temporal pedicle in craniofacial reconstruction surgery. This is because it is a preferred recipient site for reconstructions of the upper and middle thirds in the primary situation or in the event of recourse.

A novel technique for skull base reconstruction in craniofacial fibrous dysplasia surgery using three-dimensional printing and a dental alginate mold: illustrative case.

Fibrous dysplasia is a rare and benign skeletal lesion characterized by fibrous tissue proliferation due to an abnormal osteogenesis replacing normal bone. An 18-year-old male with fibrous dysplasia of the left sphenoid, ethmoid, orbit, and frontal bones was managed with excision and skull base reconstruction. After complete removal of the tumor, skull base reconstruction was commenced by making a reverse temporalis flap and placing it over the opened paranasal sinuses for a robust vascularized graft, followed by an abdominal fat graft, and then a pedicled pericranal flap was added to complete the multilayer onlay graft. To recreate the skull base, a mirror image of the contralateral skull base was constructed using three-dimensional (3D) printing, and the 3D-printed model was sterilized prior to the surgery. Intraoperatively, the model was then pressed onto dental alginate gel to make a negative mold. This was used to make the definitive flap using polymethylmethacrylate. Temporoplasty was also performed using polymethylmethacrylate to fill the defect left by the temporalis graft. The patient recovered well following the procedure. Appropriate, personalized skull base reconstruction techniques can be successfully done with 3D printing using alternative low-cost materials and implements, especially following resection of cases like craniofacial fibrous dysplasia. https://thejns.org/doi/10.3171/CASE24262.

Barriers in Accessing Orthodontic Care for Patients with Orofacial Clefts: Insights from a Florida-Based Survey and National Database Analysis.

To assess the barriers to obtaining care for patients with orofacial clefts through a survey of Florida-based orthodontists and families and an analysis of the Pediatric Health Information System (PHIS) database. A cross-sectional study utilizing multiple-choice questionnaires completed by Florida orthodontists and caregivers of patients who attended a Florida-based cleft and craniofacial clinic. Additionally, data from the PHIS database were analyzed to investigate national factors affecting the age of alveolar bone grafting (ABG). Craniofacial team in Florida. The survey included 39 orthodontists (7.1% response rate) and 48 caregivers (41% response rate) The PHIS study included 1182 patients. Barrier to orthodontic care and age of ABG. Orthodontic Survey: Among the surveyed orthodontists, 71% treated cleft/craniofacial patients, 37% accepted Medicaid, and 55% provided pro-bono care. Poor reimbursement was identified as the most common barrier (58%). Caregiver Survey: Most patients were insured by Medicaid (67%), with 55% incurring out-of-pocket expenses. PHIS Database: The average age of ABG was 10.3 years (SD = 3.2). Government funding was associated with a 6.0-month delay in ABG (p = 0.047) and residing in non-Medicaid expanded states was linked to a 6.0-month delay (p = 0.023). Post-Medicaid expansion status was also associated with a delay (p = 0.004). Access to oral care is difficult for patients with OFC. Despite both federal and state mandates, many financial and non-financial barriers still exist in accessing orthodontic care and a majority of patients experience significant out-of-pocket expenses despite statutorily mandated insurance coverage.

A Scopus-Based Bibliometric Analysis of the Journal of Craniofacial Surgery From 1990 to 2023.

This study aims to conduct a Scopus-based bibliometric analysis of the studies published in the Journal of Craniofacial Surgery, which has a very important place in its field. In this bibliometric study, all articles in the Journal of Craniofacial Surgery in the Scopus database on 7 July 2024 were listed. The information of the listed articles was exported in CSV file format. When exporting these articles, the citation information, bibliographic information, abstract and keywords, funding details, and other information options were all selected. These exported CSV data were analyzed with VOSviewer software (version 1.6.18). The bibliometric analysis of the Journal of Craniofacial Surgery from 1990 to 2023 included 15,271 articles listed in the Scopus database. The majority (84.7%) of these articles were original studies. The top 5 countries with the highest number of publications were the United States (4004 articles), Turkey (2124 articles), China (2111 articles), South Korea (1597 articles), and Italy (1109 articles). This comprehensive bibliometric analysis demonstrates the Journal of Craniofacial Surgery's increasing prominence and impact in the field over the years. The diverse international contributions highlight the journal's role in fostering global collaboration and knowledge dissemination in craniofacial and maxillofacial research. While the use of a single database (Scopus) is a limitation, the study provides a detailed overview of the journal's scholarly contributions, influential authors, and publication trends. These findings underscore the journal's pivotal position in advancing craniofacial surgery research and education.

Challenging Dogmas in Plastic Surgery.

In medicine, dogmas are subject to evolution and refinement as new research and technologies emerge. The aim of this study was to search for dogmas which were challenged and potentially revised in the plastic surgery field. A search on PubMed for "dogma and plastic surgery" yielded 80 papers. The queries "surgical dogma and craniofacial surgery" and "surgical dogma and flap" returned 9 and 21 papers, respectively. "Surgical dogma and hand" and "surgical dogma and wound healing" produced 41 and 25 papers, respectively. Removing 35 duplicate papers, 141 abstracts were reviewed. Of these, 78 were excluded, leaving 63 papers for analysis. The dogmas being challenged within the field of plastic surgery were classified into various categories. The distribution of these challenged dogmas was as follows: wound healing: 14.29%, epinephrine use: 9.52%, flap surgery: 7.94%, breast reconstruction: 6.35%, rhinoplasty: 7.94%, hand surgery: 4.76%, pressure sores: 4.76%, chemical peel: 4.76%, and hand injuries: 3.17%. The widespread focus on improving wound healing techniques indicates a need for more effective treatments and faster recovery times. Significant attention has been directed toward the use of epinephrine, particularly in fingers, which may reflect ongoing debates about its safety. Innovations and improvements in flap surgery could lead to better reconstructive outcomes. Challenging existing dogma is a vital process and a driving force in the advancement of clinical science. These challenges and potential revisions reflect the dynamic nature of plastic surgery, where ongoing research, patient outcomes, and evolving societal norms drive continuous improvement and adaptation in practices and principles.

Journal Metrics of the Journal of Craniofacial Surgery: An Analysis Based on the Journal Citation Report 2024.

This study aims the analysis of the journal metrics of Journal of Craniofacial Surgery based on 2024 Journal Citation Reports (JCR) data. In the Journal Citation Reports 2024, shared by Clarivate Analytics on June 20, 2024, the journal metrics of the Journal of Craniofacial Surgery were examined in detail. According to the reports published by Clarivate Analytics in 2024, the journal's impact factor in 2023 was determined as 1.0 and the impact factor excluding self-citations was calculated as 0.8. These values show that the impact factor of the journal has increased in recent years. Also, it is seen that the Journal of Craniofacial Surgery, which has been in the fourth quartile (Q4) among the journals in the "Surgery" category for the last 10 years, has risen to the third quartile (Q3) this year. The increase in the impact factor and ranking of the Journal of Craniofacial Surgery shows that the journal has strengthened its position in the scientific field and is moving toward higher levels. However, it is suggested that other metrics should be taken into consideration in addition to the impact factor.

Content Analysis of the Top 25 Most Cited Articles of the Journal of Craniofacial Surgery With ChatGPT-4o.

Since 1990, the Journal of Craniofacial Surgery has been an important resource for clinicians and basic scientists. The journal addresses clinical practice, surgical innovations, and educational issues. This study aims to evaluate the contribution of these articles to clinical practice innovations and surgical procedures by analyzing the content of the 25 most cited articles published in the journal. It also aims to demonstrate the potential of artificial intelligence tools in academic content analysis. All articles published in the Journal of Craniofacial Surgery on June 13, 2024, were searched using the Web of Science Database, and the 25 most cited articles were identified. The full texts of these articles were saved in PDF format and metadata were saved as plain text files. Content analysis of these 25 articles was performed using ChatGPT-4o. As a result of the analysis, some articles stood out in terms of clinical importance. It also appeared that ChatGPT could be used to compare multiple articles. In this study, the authors analyzed the content of the 25 most cited articles published in the Journal of Craniofacial Surgery using ChatGPT-4o. These articles were evaluated according to the criteria of innovations in clinical practice and compliance with surgical procedures. This study presents interesting findings in terms of the use of artificial intelligence tools in academic content analysis. The authors thought that this study could be a source of inspiration for future studies.

An Assessment of Adverse Events in Patients with 22q11.2 Deletion Syndrome Undergoing Palatoplasty: An Analysis of the NSQIP Pediatric Database.

The National Surgical Quality Improvement Program (NSQIP) Pediatric database has been used to identify factors related to adverse surgical outcomes in pediatric and craniofacial surgical procedures. Focusing on a historically "higher-risk" population, our aim was to assess the impact of demographics, comorbidities, and 22q11.2 deletion syndrome (22QDS) diagnosis on 30-day postoperative complications in patients undergoing primary palatoplasty. We used the 2012-2020 NSQIP Pediatric database to identify patients ≤3 years with and without 22q11.2 deletion syndrome who underwent primary palatoplasty. Demographics, comorbidities, and perioperative characteristics were compared between those with and without 22QDS. Logistic regression was used to determine if children with 22QDS were more likely to experience a 30-day postoperative complication or readmission. There were 10,745 patients ≤3 years old who underwent primary palatoplasty; 83 (0.8%) of whom had 22QDS and 10,662 (99.8%) did not. Children with 22QDS were older when they underwent primary palatoplasty and more likely to have comorbidities. A total of 513 patients (4.8%) experienced a postoperative complication within 30 days and 255 were readmitted (2.4%). Of the 513, 8 (9.6%) had a 22QDS diagnosis and 505 (4.7%) did not. A diagnosis of 22QDS was not a significant independent risk factor for a complication (adjusted odds ratio (aOR) = 1.13; 95% confidence interval (CI): 0.50-2.54) or readmission (aOR = 1.74; 95% CI: 0.74-4.13) within 30 days. This study found that the diagnosis of 22QDS was not an independent predictor of post-palatoplasty complication risk, and in fact 30-day complications are rare for those patients undergoing cleft palate repair, even among those patients with 22QDS.

Impact of Gender-Affirming Surgery on Craniofacial Exposure for Plastic and Reconstructive Surgery Training: A Preliminary, Single-Institution Study

Objective: Current available plastic surgery positions in craniofacial surgery are not commensurate with the growing number of trained plastic surgery residents and fellows interested in the field. Despite this, there is growing demand for surgery in other areas of the craniofacial field, such as facial gender-affirming surgery (GAS), in which academic plastic surgery programs can increase resident and fellow case exposure. The present study sought to characterize the increase in craniofacial surgery exposure with the introduction of a GAS rotation among plastic surgery residents at one academic medical center. Methods: A single-center retrospective review of ten plastic surgery resident case logs between 2013 and 2021 was carried out. Case logs were evaluated for case frequency per year in craniofacial surgery and breast reconstruction surgery, which was used as a control. Case frequency was compared before and after the introduction of the GAS rotation in 2017. Results: Craniofacial surgery exposure increased from an average of 26 to 45 cases per resident per year after the introduction of a GAS rotation and overall increased from 17 to 29 cases per year. The average breast reconstruction caseload remained similar at the same time, from an average of 37 to 36 cases per year per resident. Conclusions: The introduction of a GAS rotation at one institution increased craniofacial surgery exposure for plastic surgery residents. Increasing craniofacial surgery exposure is crucial in the competitive landscape for job opportunities, further increasing resident exposure to the transgender and gender-diverse population, and expanding care for this patient population.

Evaluating the Efficacy of Large Language Models in CPT Coding for Craniofacial Surgery: A Comparative Analysis.

The advent of Large Language Models (LLMs) like ChatGPT has introduced significant advancements in various surgical disciplines. These developments have led to an increased interest in the utilization of LLMs for Current Procedural Terminology (CPT) coding in surgery. With CPT coding being a complex and time-consuming process, often exacerbated by the scarcity of professional coders, there is a pressing need for innovative solutions to enhance coding efficiency and accuracy. This observational study evaluated the effectiveness of 5 publicly available large language models-Perplexity.AI, Bard, BingAI, ChatGPT 3.5, and ChatGPT 4.0-in accurately identifying CPT codes for craniofacial procedures. A consistent query format was employed to test each model, ensuring the inclusion of detailed procedure components where necessary. The responses were classified as correct, partially correct, or incorrect based on their alignment with established CPT coding for the specified procedures. The results indicate that while there is no overall significant association between the type of AI model and the correctness of CPT code identification, there are notable differences in performance for simple and complex CPT codes among the models. Specifically, ChatGPT 4.0 showed higher accuracy for complex codes, whereas Perplexity.AI and Bard were more consistent with simple codes. The use of AI chatbots for CPT coding in craniofacial surgery presents a promising avenue for reducing the administrative burden and associated costs of manual coding. Despite the lower accuracy rates compared with specialized, trained algorithms, the accessibility and minimal training requirements of the AI chatbots make them attractive alternatives. The study also suggests that priming AI models with operative notes may enhance their accuracy, offering a resource-efficient strategy for improving CPT coding in clinical practice. This study highlights the feasibility and potential benefits of integrating LLMs into the CPT coding process for craniofacial surgery. The findings advocate for further refinement and training of AI models to improve their accuracy and practicality, suggesting a future where AI-assisted coding could become a standard component of surgical workflows, aligning with the ongoing digital transformation in health care.

Quality of Life and Psychosocial Outcomes Among Children With Cleft Differences.

Introduction Velopharyngeal insufficiency (VPI) and craniofacial differences can lead to diminished speech and swallowing function resulting in communication and social challenges throughout childhood. To monitor changes in patients' psychosocial health and velopharyngeal function, the Pediatric Symptom Checklist (PSC) and Velopharyngeal Insufficiency Effects on Life Outcomes (VELO) survey tools can be utilized. This study aimed to investigate the relationship between VPI quality-of-life outcomes and psychosocial disturbances through a comparative analysis of PSC and VELO parental surveys among children followed by a craniofacial team. Methods A retrospective chart review was completed using data from asingle, multidisciplinary cleft and craniofacial team. Previously completed parental survey responses between 2010 and 2022 were collated and resultswere analyzed using a Spearman's rank correlation test (rs). Results There were 89 subjects who completed both surveys on the same day (n = 148 survey pairs (s)). Patients aged three to five years old (s = 88) had a mean VELO of 17.9 (0-65) and a mean PSC of 7.9 (0-27), while patients aged six to eight years old (s = 60) had a mean VELO of 16.6 (0-74) and a mean PSC of 12.0 (0-37). The strongest correlation observed for both age groups was between the total PSC and VELO Speech Limitations sub-scores (three to five years old: rs = 0.537, p < 0.001; six to eight years old: rs = 0.330, p = 0.010). Similarly, children in the six- to eight-year-old group with cleft lip and palate showed a correlation between the total PSC and VELO Speech Limitations (rs = 0.583, p < 0.001). Conclusion This study suggests arelationship between PSC and VELO scores among childrenages three to eight years old with cleft differences and demonstrates that specific domains within theVELO questionnaireshould be considered as being associated with a higher riskfor psychosocial impairment. Specifically, higher VELO Speech Limitations sub-scores may portend a greater risk for poor psychosocial outcomes supporting the importance of early interventions in this group.

Craniofacial Surgery for Mental Disorders: Trepanation, Stone of Madness, and Third Eye

Craniofacial Surgery for Mental Disorders: Trepanation, Stone of Madness, and Third Eye