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Kim EN, Moss WD, Rosales MN, Lyon N, Lotz A, Yamashiro DK, Gociman BR, Siddiqi FA, Johns DN. Multidisciplinary Presurgical Education: Clinical Impact on Children With Orofacial Clefts Undergoing Maxillary Distraction via Rigid External Distraction. Cleft Palate Craniofac J 2023; 60:75-81. [PMID: 34730019 DOI: 10.1177/10556656211055411] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Treatment of severe maxillary hypoplasia is commonly addressed via distraction osteogenesis with a rigid external device (RED). While effective, this method can be socially stigmatizing in an already vulnerable patient population. To prepare children and their caregivers for life with a RED and decrease peri-operative anxiety, we instituted a multidisciplinary pre-surgical education session (MPES). This educational team involves our cleft care coordinator, child life specialist, orthodontist and plastic surgeon 2 weeks prior to surgery. We reviewed the impact of this intervention by examining clinical outcomes before and after its implementation. DESIGN From February 2017 to February 2020, a retrospective chart review was performed to include patients with orofacial clefts and maxillary hypoplasia who underwent maxillary distraction osteogenesis with RED at our center before (28 patients) and after (29 patients) the implementation of MPES. RESULTS MPES was associated with a significantly shorter length of stay compared to controls who did not receive MPES (3.6 vs 3.1 days, p < 0.03) and significantly decreased usage of inpatient narcotic pain medication compared to controls (16.8 morphine equivalents vs 31.8 morphine equivalents, p < 0.02). Our intervention also demonstrated a trend towards decrease in minor complications but did not achieve statistical significance p = 0.32). CONCLUSIONS Multidisciplinary presurgical education is a beneficial adjunct in the care of patients with orofacial clefts and maxillary hypoplasia undergoing maxillary advancement with a RED.
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Affiliation(s)
- Erinn N Kim
- University of Utah Division of Plastic Surgery, 114380University of Utah Hospital, Salt Lake City, Utah, USA
| | - Whitney D Moss
- University of Utah Division of Plastic Surgery, 114380University of Utah Hospital, Salt Lake City, Utah, USA
| | - Megan N Rosales
- Biostatistician. University of Utah Study Design and Biostatistics Center, University of Utah, Salt Lake City, Utah, USA
| | - Natalee Lyon
- RN Cleft Care Coordinator, 23188Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Analise Lotz
- Certified Child Life Specialist, 23188Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Duane K Yamashiro
- University of Utah Division of Plastic Surgery, 114380University of Utah Hospital and 23188Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Barbu R Gociman
- University of Utah Division of Plastic Surgery, 114380University of Utah Hospital, Salt Lake City, Utah, USA
| | - Faizi A Siddiqi
- University of Utah Division of Plastic Surgery, 114380University of Utah Hospital, Salt Lake City, Utah, USA
| | - Dana N Johns
- University of Utah Division of Plastic Surgery, 114380University of Utah Hospital, Salt Lake City, Utah, USA
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Zygomatic repositioning and Le Fort II distraction with intraoral devices in Apert syndrome: A case report. J Craniomaxillofac Surg 2022; 50:364-370. [DOI: 10.1016/j.jcms.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 01/16/2022] [Accepted: 02/27/2022] [Indexed: 11/18/2022] Open
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Mittermiller PA, Flores RL, Staffenberg DA. Craniosynostosis: Le Fort III Distraction Osteogenesis. Clin Plast Surg 2021; 48:473-485. [PMID: 34051899 DOI: 10.1016/j.cps.2021.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The Le Fort III advancement was first described in 1950 and has since become a key technique in the armamentarium of craniofacial surgeons. The application of distraction osteogenesis to the craniofacial skeleton has allowed for large movements to be performed safely in young patients. This technique is valuable for correcting exorbitism, airway obstruction owing to midface retrusion, and class III malocclusion. It can be performed with either an external distractor or internal distractors. Although serious complications have been reported, these occur rarely when performed by experienced providers.
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Affiliation(s)
- Paul A Mittermiller
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, 222 East 41st Street, 22nd floor, New York, NY, 10017, USA
| | - Roberto L Flores
- Hansjörg Wyss Department of Plastic Surgery, Cleft and Craniofacial Surgery, NYU Langone Health, 222 East 41st Street, 22nd floor, New York, NY, 10017, USA.
| | - David A Staffenberg
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, 222 East 41st Street, 22nd floor, New York, NY, 10017, USA
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Zhang RS, Lin LO, Hoppe IC, Wes AM, Swanson JW, Bartlett SP, Taylor JA. Evaluation of parental and surgeon stressors and perceptions of distraction osteogenesis in pediatric craniofacial patients: a cross-sectional survey study. Childs Nerv Syst 2018; 34:1735-1743. [PMID: 29748706 DOI: 10.1007/s00381-018-3827-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 05/06/2018] [Indexed: 10/16/2022]
Abstract
PURPOSE There is a paucity of literature on how limitations of distraction osteogenesis (DO) are perceived by physicians and parents of pediatric patients. Specifically understanding which features of DO are most concerning to these two groups may better inform parent education, as well as direct improvements in distraction protocols and devices. METHOD Parents/guardians of patients (between January 2016 and October 2017) being treated with craniofacial distraction were recruited to complete a survey regarding level of stress (1 = not stressful, 9 = maximally stressful) associated with eight features of DO. Craniofacial surgeons completed a survey asking them to report (1) their personal level of stress and (2) their perceptions of parental stress regarding these same eight features of DO. RESULTS Thirty-five parents and 15 craniofacial surgeons completed the survey. The risk of the device getting infected was perceived as most stressful by parents (5.5 ± 2.3) followed by the device sticking through the skin (4.9 ± 2.6) and the second operation for removal (4.7 ± 2.3). These same three features also elicited the highest level of stress among surgeons. Surgeon-perceived parental stress regarding turning of the distractor (5.8 ± 1.5) was significantly higher than parent self-reported stress (4.2 ± 2.8, p = 0.042). CONCLUSIONS Both parents and surgeons perceive risk of device-associated infection, the protrusion of the device through the skin, and the requirement of a second operation for removal as the most stressful drawbacks of distraction. Infection reduction protocols, less obtrusive devices, and devices that do not require removal are potential targets for stress reduction.
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Affiliation(s)
- Rosaline S Zhang
- Division of Plastic Surgery, Children's Hospital of Philadelphia, The University of Pennsylvania, Colket Translational Research Building, 9th Floor, Philadelphia, PA, 19104, USA
| | - Lawrence O Lin
- Division of Plastic Surgery, Children's Hospital of Philadelphia, The University of Pennsylvania, Colket Translational Research Building, 9th Floor, Philadelphia, PA, 19104, USA
| | - Ian C Hoppe
- Division of Plastic Surgery, Children's Hospital of Philadelphia, The University of Pennsylvania, Colket Translational Research Building, 9th Floor, Philadelphia, PA, 19104, USA
| | - Ari M Wes
- Division of Plastic Surgery, Children's Hospital of Philadelphia, The University of Pennsylvania, Colket Translational Research Building, 9th Floor, Philadelphia, PA, 19104, USA
| | - Jordan W Swanson
- Division of Plastic Surgery, Children's Hospital of Philadelphia, The University of Pennsylvania, Colket Translational Research Building, 9th Floor, Philadelphia, PA, 19104, USA
| | - Scott P Bartlett
- Division of Plastic Surgery, Children's Hospital of Philadelphia, The University of Pennsylvania, Colket Translational Research Building, 9th Floor, Philadelphia, PA, 19104, USA
| | - Jesse A Taylor
- Division of Plastic Surgery, Children's Hospital of Philadelphia, The University of Pennsylvania, Colket Translational Research Building, 9th Floor, Philadelphia, PA, 19104, USA.
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Wheeler KJ, Early JO. Using Photovoice to Explore Quality of Life Factors of Adults With Crouzon Syndrome. QUALITATIVE HEALTH RESEARCH 2018; 28:357-370. [PMID: 29224414 DOI: 10.1177/1049732317742624] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In the United States, one in 60,000 adults live with Crouzon Syndrome (CS) and facial malformations. Phenomenological studies about their lived experiences and quality of life are lacking. The purpose of this participatory action research study was to gain a richer understanding of the perceived biopsychosocial and socioecological factors that impact quality of life for adults living with CS using Photovoice. Another aim was to develop a conceptual framework of quality of life for those experiencing CS to enhance tailored health education and services. A purposeful sample of nine adults with CS were recruited from U.S. national surgery centers and support groups. Participants used photography to represent their experiences and participated in individual interviews and focus groups. Data were analyzed with the participants using thematic analysis, and 44 themes emerged which informed the development of a quality of life conceptual framework and action plan described in this article.
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Affiliation(s)
| | - Jody O Early
- 2 University of Washington Bothell, Bothell, Washington, USA
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Bredero-Boelhouwer H, Joosten KFM, van Veen-van der Hoek M, Mathijssen IMJ. Family-centred care during midface advancement with a rigid external device: what do families need? J Plast Reconstr Aesthet Surg 2013; 66:1103-8. [PMID: 23664572 DOI: 10.1016/j.bjps.2013.04.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Revised: 03/27/2013] [Accepted: 04/06/2013] [Indexed: 10/26/2022]
Abstract
Midface advancement with distraction osteogenesis using the rigid external device (RED) is an effective but invasive treatment to correct the hypoplastic midface. This study draws up an inventory of the stressors, needs and coping strategies of families during this treatment, to determine the best conditions for family-centred care. Data were collected by reviewing the patients' files and administering semi-structured interviews. The data were analysed using the software program Atlas.ti and were re-analysed by an independent researcher. Parents and patients were interviewed separately. Fourteen families participated. Four patients had an absolute indication for surgery. All families were eager to have the patient's facial appearance improved. Nevertheless, despite psychological counselling, they experienced stress when confronted with the changed facial appearance. Another stressor was weight loss. Six patients were in a state of acute malnutrition and needed supplementary feeding. We conclude that the best conditions for family-centred care should be aligned to the different phases of treatment. Leading up to surgery it is important to screen families' expectations regarding aesthetic, functional and social outcomes and to assess their capacity to cope with the long treatment and effects of changed facial appearance. Peer contact and psychosocial training to increase self-esteem are tools to enhance co-operation and satisfaction. During the distraction and stabilisation phase, we advise the monitoring of nutritional intake and weight. During all phases of treatment easy accessibility to the team is recommended.
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Affiliation(s)
- H Bredero-Boelhouwer
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Dutch Craniofacial Centre, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands.
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