Craniofacial Surgery Research Articles

A Mobile Craniofacial Surgery Unit: Reconstructing Casualties of War in Ukraine.

This paper describes the development and implementation of a mobile craniofacial surgical unit designed to address complex posttraumatic craniofacial deformities in both civilian and military casualties resulting from Russia's invasion of Ukraine. Restricted air space, limited possibilities for transportation of personnel and equipment, frequent interruption of power and water supply, and constant threat of injury to patients and medical personnel from missile and drone strikes, precludes reliable and safe delivery of tertiary care. The Canada Ukraine Surgical Aid Program (CUSAP) addressed these challenges by establishing a mobile craniofacial surgery unit, operating just outside of the war zone. The following report characterizes the civilian and military casualties, highlights the barriers to the provision of adequate tertiary care locally, and provides a detailed description of the measures that were taken to organize the mobile unit. The effectiveness of this program is documented, and specific challenges are illustrated through case examples. We believe this model serves as a template for delivering surgical aid to victims of any global disaster where care cannot be provided locally.

Do Open Access Articles Have a Citation Advantage Over Toll Access Articles? A Comparative Analysis of Articles Published in the Journal of Craniofacial Surgery From 2019 to 2023 Based on Web of Science Data.

This study aimed to compare the citation rates of open access (OA), and toll access (TA) articles published in the Journal of Craniofacial Surgery between 2019 and 2023, and to examine whether OA articles received more citations. Using the Web of Science database, articles published in the Journal of Craniofacial Surgery between 2019 and 2023 were listed, excluding those with corrections or retractions. Articles were divided into 2 groups: OA and TA. The number of articles and citation counts for each group were analyzed by year. Citation rates were compared using the independent sample t test, with a p-value of <0.05 considered statistically significant. A total of 4691 articles were analyzed, of which 7.14% were OA and 92.86% were TA. Published in 2021, 2020, and 2019, OA articles had statistically significantly higher citation counts than TA articles. OA articles were found to be funded at a higher rate than TA articles. This study demonstrated that OA articles received more citations over time and were more likely to be funded. Although it is not definitively clear whether the citation advantage stems from the quality of the articles or their open-access status, the citation advantage of OA articles is striking.

Comparative Analysis of Patient-reported Outcomes After Cranial Vault Remodeling and Strip Craniectomy With the FACE-Q Craniofacial Module.

The debate continues among craniofacial surgeons regarding the effectiveness of strip craniectomy (SC) compared with cranial vault remodeling (CVR) in achieving optimal functional and aesthetic outcomes in patients with single-suture craniosynostosis. This study aimed to compare long-term patient-reported outcomes (PROs) between SC and CVR procedures at a single institution using the validated FACE-Q Craniofacial module. Patients older than or equal to 8 years of age and parents of patients younger than 8 years of age who underwent SC or CVR for single-suture craniosynostosis were eligible. Patients with <2 years of follow-up, lambdoid synostosis, and syndromes were excluded. Primary endpoints were PROs as measured by the FACE-Q, with higher scores indicating increased health-related quality of life. Linear regression was used to control for covariates. Sixty-two participants completed the module (response rate 33.3%). SC was performed in 29 patients (46.8%), and CVR in 33 patients (53.2%). On unadjusted bivariate analysis, SC patients had higher eye (P=0.03) and forehead (P=0.05) scores. On regression analysis, controlling for sex, race, craniosynostosis type, and follow-up, there were no significant differences between operation types in any domain. Metopic and sagittal synostosis were associated with higher Eye (metopic: 17.61, P=0.049; sagittal: 41.44, P<0.001) and Head scores (metopic: 48.12, P=0.001; sagittal: 49.35, P<0.001), and sagittal synostosis was associated with higher Face (38.16, P<0.001), Forehead (55.93, P<0.001), and Nose scores (19.28, P=0.003). From patients' and parents' perspectives at a single institution, SC and CVR were equivalent regarding aesthetics and health-related quality of life.

Plastic Surgery Contributions to the World Wars: Historical Foundations for Modern Craniofacial Techniques.

Plastic surgery played a crucial role during the World Wars. Surgeons dedicated their careers to reconstructing facial injuries and residual deformities incurred during combat. Times of unprecedented trauma led to rapid innovation in plastic surgery, with invaluable impact on practice today. Pioneers such as Harold Gillies are well-known for their work. There are numerous additional contributors who deserve wider recognition. A literature review was performed to identify key surgeons who treated soldiers' craniofacial injuries during World Wars I and II. Biographical information, country of practice, and technical contributions to plastic surgery were compiled. Nineteen plastic surgeons were identified who contributed significantly to craniofacial surgery during the World Wars. These surgeons were: Albéric Pont, Archibald Mcindoe, Arthur Mowlem, Harold Gillies, Hippolyte Morestin, James Barrett Brown, Jaques Joseph, Johannes Esser, John Staige Davis, John Reese, Otto Lanz, Paul Tessier, Robert Ivy, Suzanne Blanche Gros Noël, Thomas Kilner, William Kelsy Fry, Varaztad H. Kazanjian, Vilray P. Blair, and Vladimir Petrovich Filatov. Fourteen were active during WWI. Nine were active during WWII. Notable technical developments were made in maxillofacial fracture fixation, bone grafting, rhinoplasty, dental prosthetics, flap-based coverage, skin grafting, and burn reconstruction. Plastic surgeons played an unheralded role in managing the disfiguring craniofacial injuries of World Wars I and II. By treating tens of thousands of war victims, these surgeons contributed not only to the rehabilitation of soldiers but also to the advancement of craniofacial surgery and the establishment of plastic surgery as a distinct subspecialty.

Cleft Lip and Palate Correction: The Utah Protocol.

Cleft repair remains a contentious issue in craniofacial surgery, especially regarding the optimal timing and techniques. This study aims to present our institutions' current protocol for cleft lip and palate repair, including alveolar bone grafting (ABG). A total of 17 patients (20 clefts) treated with the latest protocol from 2016 to 2023 were evaluated. Demographic and clinical data were obtained from electronic charts. The protocol includes lip repair at 3 months, soft palate repair at 1 year, and hard palate closure with concurrent ABG at 2 years. Mean graft height and thickness scores were 2.3 and 2.2, respectively. Three clefts showed scores marginally below the threshold for thickness, potentially requiring regrafting. Malocclusion was minimal with no significant crossbites or velopharyngeal insufficiency. Our modified protocol, emphasizing early hard palate closure with ABG, yields satisfactory outcomes in terms of graft height and thickness. Although long-term follow-up is warranted, our approach seems safe and efficient, potentially improving outcomes compared with traditional methods.

Investigating mechanical properties for developing a human infant cranial bone surrogate in pediatric craniofacial surgery

Investigating mechanical properties for developing a human infant cranial bone surrogate in pediatric craniofacial surgery

Visual Outcomes of Children With Craniosynostosis.

Craniosynostosis can impact the visual development of a child. Historically, children with craniosynostosis, particularly when associated with a syndrome, had a significant risk of vision loss. The authors aimed to study the incidence of ophthalmic pathology in a modern, multidisciplinary craniosynostosis practice. Children aged 7 to 13 years attending face-to-face ophthalmic craniofacial clinics between February 2020 and June 2021 were included in a retrospective case note review. Visual acuity, ocular alignment, optic nerve function, and retinal nerve fiber layer (RNFL) condition using optical coherence tomography (OCT) were recorded. Forty-three children (30 girls) were assessed at a median age of 10.3 years (7.8-13.1). Eleven children had unicoronal synostosis, 15 had single-suture synostosis not involving the coronal, 14 had multisuture synostosis involving the coronal, and 3 had multisuture synostosis not involving the coronal. Thirty-two out of 43 had craniofacial surgery. Sixty-seven percent required glasses. Forty-nine percent had strabismus, 11/43 (26%) had squint surgery, and 2/43 (5%) had tarsorrhaphy for corneal protection. Four out of 43 (9%) had papilloedema detected; however, at the final review, 15/68 (22%) eyes showed RNFL changes on OCT imaging, none of whom had optic atrophy. Two children did not meet UK driving standards due to refractive amblyopia; no children were registered as sight impaired. In this cohort, optic atrophy and visual loss due to exposure keratopathy were not seen. A high incidence of strabismus, glasses wear, and amblyopia is persistent. Binocular visual impairment was rare in this cohort: 95% met UK driving standards. Visual outcomes appear to be improving coinciding with improved craniofacial care alongside multidisciplinary team working.

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.

Evaluating robotic assistance on the learning curve and efficiency of mandibular angle ostectomy: an animal model study.

This study evaluated the efficacy and learning curve of a maxillofacial surgical robotic system (MSRS) guided by electromagnetic navigation for mandibular angle ostectomy (MAO), compared to traditional surgical methods. The study utilized a controlled experiment involving thirty rabbits, paired divided into experimental and control groups. The experimental group underwent MAO using the MSRS, while the control group was treated with conventional surgical techniques. The surgeons performing the procedures were inexperienced in robotic surgery and MAO to assess the learning curve and the impact of robotic assistance. Key parameters measured included the accuracy of ostectomy, setup time, and ostectomy efficiency, with data analyzed through a paired-t test to compare the performance between the two groups. The study indicated a significant reduction in ostectomy time for the experimental group, with improved accuracy and efficiency in ostectomy. The study found that robotic assistance could decrease the risk of complications and enhance surgical outcomes. It also highlighted the presence of an initial learning curve when adopting new robotic technologies, which could be mitigated through adequate training and simulation practices. Using MSRS for MAO could lead to faster early learning curves and increased ostectomy efficiency compared to traditional surgical methods. It demonstrated the potential benefits of integrating robotic systems into craniofacial surgery, suggesting a promising direction for future surgical practices.

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.

Impact of Cleft and Craniofacial Surgery Experience in Oral and Maxillofacial Surgery Residency Training Programs

The impact of cleft and craniomaxillofacial surgeons (CCMFSs) on oral and maxillofacial surgery (OMS) resident training is not well known. The purpose of this study was to measure the association between resident exposure to OMS faculty with CCMFS training, clinical experience, and scholarly activity. An anonymous survey of OMS residency directors in the United States, distributed electronically by the American Association of Oral and Maxillofacial Surgeons, was used to conduct a cross-sectional study. Survey consisted of 3 following sections: 1) CCMFS faculty and program-related information, 2) CCMFS curriculum in residency programs, and 3) academic productivity related to CCMFS. Primary predictor variable was CCMFS exposure: presence or absence of an OMS faculty with CCMFS fellowship or equivalent. Primary outcome variables were: 1) number of CCMFS cases with OMS resident involvement, 2) number of OMS residents who pursued CCMF surgery fellowship, and 3) CCMFS-related academic productivity of faculty and residents by abstract or publication. Covariates include clinical experience of OMS residents in CCMFS cases and CCMFS-related academic productivity. Descriptive statistics and continuous/ordinal variables were summarized. Fisher exact and Wilcoxon Rank Sum tests were completed. 2-sided P values of <.05 were considered statistically significant. There were 81 completed surveys (91% response rate; excluded military programs). Almost half of OMS training programs have at least one attending surgeon who completed a CCMF surgery fellowship (n=36/81, 44.4%). OMS departments with a CCMFS-trained faculty performed more operations on patients with congenital craniofacial differences (P value <.001) and were more likely to publish at least one manuscript related to CCMF surgery in the last 5years (P value=.029). Nearly half of OMS training programs have at least one attending surgeon who completed a CCMF surgery fellowship or equivalent. CCMF surgery faculty may increase opportunities for OMS resident involvement in caring for patients with congenital craniofacial differences. There is academic productivity in programs with CCMF surgeons. This should improve as the cohort of CCMF trained oral and maxillofacial surgeons increases.

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.