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Villavisanis DF, Blum JD, Plana NM, Taub PJ, Taylor JA. Choosing a Multidisciplinary Cleft and Craniofacial Team: Medical, Surgical, and Social Considerations. Cleft Palate Craniofac J 2024; 61:518-522. [PMID: 36168208 DOI: 10.1177/10556656221129967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Cleft and craniofacial conditions often present with a variety of functional and esthetic sequelae optimally treated by a multidisciplinary approach. Diagnosis of such conditions pre- or postnatally may evoke parental uncertainty and anxiety, and an important primary consideration is the selection of a cleft and craniofacial team. Identifying an optimal team may be particularly important for developing long-term relationships with clinicians who will ideally work intimately with the family from diagnosis to adulthood. While families, parents, and providers should consider several factors, a dearth of evidence-based suggestions preclude critical appraisal of cleft and craniofacial teams. In this article, the authors summarize medical, surgical, and social considerations for selecting a cleft and craniofacial team to optimize patient outcomes and the family/caregiver experience.
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Affiliation(s)
- Dillan F Villavisanis
- Division of Plastic & Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Division of Plastic & Reconstructive Surgery, Mount Sinai Health System, New York, NY, USA
| | - Jessica D Blum
- Division of Plastic & Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Natalie M Plana
- Division of Plastic & Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Peter J Taub
- Division of Plastic & Reconstructive Surgery, Mount Sinai Health System, New York, NY, USA
| | - Jesse A Taylor
- Division of Plastic & Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Bangun K, Sukasah CL, Dilogo IH, Indrani DJ, Siregar NC, Pandelaki J, Iskandriati D, Kekalih A, Halim J. Bone Growth Capacity of Human Umbilical Cord Mesenchymal Stem Cells and BMP-2 Seeded Into Hydroxyapatite/Chitosan/Gelatin Scaffold in Alveolar Cleft Defects: An Experimental Study in Goat. Cleft Palate Craniofac J 2020; 58:707-717. [PMID: 34047209 DOI: 10.1177/1055665620962360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To evaluate bone regeneration in alveolar defects treated with human umbilical cord-derived mesenchymal stem cells (hUCMSCs), hydroxyapatite/chitosan/gelatin (HA/CS/Gel) scaffold, and bone morphogenic protein-2 (BMP-2) in Capra hircus models. DESIGN Randomized posttest-only control group design. SETTING Animal Hospital at Bogor Agricultural Institute. PARTICIPANTS Healthy and equally treated 24 female Capra hircus/goats. INTERVENTION Animals were randomly assigned to 3 experimental group design (iliac crest alveolar bone graft/ICABG [control], HA/Cs/Gel+BMP-2 [Novosys], and HA/Cs/Gel+BMP-2+UCMSCs). Graft materials were implanted in surgically made alveolar defects. MAIN OUTCOME MEASURES Postoperative functional score and operating time were assessed. New bone growth, bone density, inflammatory cells recruitment, and neoangiogenesis were evaluated based on radiological and histological approach at 2 time points, week 4 and 12. Statistical analysis was done between treatment groups. RESULTS Operating time was 34% faster and functional score 94.5% more superior in HA/Cs/Gel+BMP-2+hUCMSC group. Bone growth capacity in HA/Cs/Gel+BMP-2+UCMSCs mimicked ICABG, but ICABG showed possibility of bone loss between week 4 and 12. The HA/Cs/Gel+BMP-2+UCMSCs showed early bone repopulation and unseen inflammatory cells and angiogenesis on week 12. DISCUSSION AND CONCLUSION The HA/Cs/Gel+BMP-2+hUCMSCs were superior in enhancing new bone growth without donor site morbidity compared to ICABG. The presence of hUCMSCs in tissue-engineered alveolar bone graft (ABG), supported with paracrine activity of the resident stem cells, initiated earlier new bone repopulation, and completed faster bone regeneration. The HA/Cs/Gel scaffold seeded with UCMSCs+BMP-2 is a safe substitute of ICABG to close alveolar bone defects suitable for patients with cleft lip, alveolus, and palate.
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Affiliation(s)
- Kristaninta Bangun
- Department of Plastic and Reconstructive Surgery, Cleft and Craniofacial Center, 364090Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Chaula L Sukasah
- Department of Plastic and Reconstructive Surgery, Cleft and Craniofacial Center, 364090Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.,95338Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Ismail H Dilogo
- Unit Pelayanan Terpadu Teknologi Kedokteran Sel Punca (Stem Cell Research Center), 364090Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Decky J Indrani
- Department of Dental Material Science and Technology, 95338Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia
| | - Nurjati Chairani Siregar
- 95338Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.,Anatomical Pathology Department, 364090Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Jacub Pandelaki
- 95338Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.,Radiology Department of 364090Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Diah Iskandriati
- Primate Research Center of 360976Bogor Agricultural Institute, Bogor, Indonesia
| | - Aria Kekalih
- 95338Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.,Community Medicine Department, 364090Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Jessica Halim
- 95338Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.,364090Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
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Cleft and Craniofacial Clinic Formats in the United States: National and Institutional Survey. J Craniofac Surg 2018; 28:693-695. [PMID: 28468150 DOI: 10.1097/scs.0000000000003485] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Craniofacial teams employ multidisciplinary clinics to optimize patient care. Different clinic formats exist among teams. Formats include providers rotating from room to room as separate specialties, patients rotating from room to room to either separate specialties or as 1 group, as well as providers rotating together as 1 group. Surveys were used to study family preferences between the different formats and to compare them with trends of national practices. METHODS Families of the authors' team clinic patients were surveyed from November 2012 to February 2013, after a clinic format change from patients moving between rooms to see providers, to providers moving between rooms to see patients. This survey focused on patient satisfaction, clinic format preference, and their perception of efficiency. A second, national survey was distributed to 161 American craniofacial teams approved by the American Cleft Palate-Craniofacial Association to survey clinic formats, provider satisfaction, and experience with other formats. Institutional survey data were tabulated as percentages and further analyzed using the Mann-Whitney Test. The national survey data was then tabulated and compared with authors' institutional results. RESULTS Thirty-nine of 54 (72.2%) families responded to the institutional survey. Providers moving between rooms were associated with greater patient satisfaction (mean 4.8 of 5, 5 being most satisfied) (0<0.0001), shorter perceived clinic time (76.9%), and an increased sense of comfort (84.6%). The difference in satisfaction rates was statistically significant (P <0.0001) between the primary clinic formats of providers rotating (mean of 4.8) and patients rotating (mean of 2.4).The national survey had 93 responses of 161 (57.7%). 54.9% of respondents have providers rotating between examination rooms, and 32.3% have patients moving between rooms. Other formats included the entire team moving as a group between rooms (10.8%) and specialties sitting together in 1 room while patients rotate (9.7%). Respondents were satisfied with current formats (mean 4.24 of 5, 5 being most satisfied). 22.2% had tried a different format previously. CONCLUSION The most common American cleft and craniofacial clinic format is providers moving between rooms; however, all formats have high provider satisfaction. At our institution, patients prefer when providers move between rooms. Our study suggests that clinic formats do not need to be standardized, and the clinic format utilized should be tailored to the individual needs of the institution.
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Chang CS, Wallace CG, Hsiao YC, Hsieh YJ, Wang YC, Chen NH, Liao YF, Liou EJW, Chen PKT, Chen JP, Chen YR. Airway Changes after Cleft Orthognathic Surgery Evaluated by Three-Dimensional Computed Tomography and Overnight Polysomnographic Study. Sci Rep 2017; 7:12260. [PMID: 28947808 PMCID: PMC5612929 DOI: 10.1038/s41598-017-12251-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 09/04/2017] [Indexed: 11/12/2022] Open
Abstract
Cleft lip and palate is the most common congenital craniofacial anomaly. Up to 60% of these patients will benefit from cleft orthognathic surgery, which consists primarily of maxillary advancement and mandibular setback to address midface retrusion and relative mandibular protrusion, respectively. It is believed that maxillary advancement can enlarge the airway whilst mandibular setback can reduce the airway, but this has not previously been quantified for cleft patients undergoing orthognathic surgery. This unique longitudinal prospective study of 18 patients was conducted between April 2013 and July 2016. No significant changes occurred by six months postoperatively in body mass index, apnoea-hypopnoea index or lowest oxygen saturation (LSAT). There was a mean increase of 0.73 cm3 in velopharyngeal volume, a mean decrease of 0.79 cm3 in oropharyngeal volume, an improvement in snoring index, and no statistically significant change in hypopharyngeal volume. In conclusion, cleft orthognathic surgery that produced anterior advancement of the maxilla, setback of the mandible and clockwise rotation of the maxillo-mandibular complex resulted in increased velopharyngeal, decreased oropharyngeal and unchanged hypopharyngeal airways, and improved snoring, but did not significantly alter objective sleep-related breathing function.
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Affiliation(s)
- Chun-Shin Chang
- Department of Chemical and Materials Engineering, College of Engineering, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 33302, Taiwan (R.O.C.)
- Craniofacial Research Center, Department of Medical Research, Department of Plastic & Reconstructive Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsin St., Guei-Shan 333, Taoyuan, Taiwan (R.O.C.)
| | - Christopher Glenn Wallace
- Craniofacial Research Center, Department of Medical Research, Department of Plastic & Reconstructive Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsin St., Guei-Shan 333, Taoyuan, Taiwan (R.O.C.)
| | - Yen-Chang Hsiao
- Craniofacial Research Center, Department of Medical Research, Department of Plastic & Reconstructive Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsin St., Guei-Shan 333, Taoyuan, Taiwan (R.O.C.)
| | - Yuh-Jia Hsieh
- Craniofacial Research Center, Department of Medical Research, Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, 5, Fu-Hsin St., Guei-Shan 333, Taoyuan, Taiwan (R.O.C.)
| | - Yi-Chin Wang
- Craniofacial Research Center, Department of Medical Research, Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, 5, Fu-Hsin St., Guei-Shan 333, Taoyuan, Taiwan (R.O.C.)
| | - Ning-Hung Chen
- Sleep Center, Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, 5, Fu-Hsin St., Guei-Shan 333, Taoyuan, Taiwan (R.O.C.)
| | - Yu-Fang Liao
- Craniofacial Research Center, Department of Medical Research, Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, 5, Fu-Hsin St., Guei-Shan 333, Taoyuan, Taiwan (R.O.C.)
| | - Eric Jen-Wein Liou
- Craniofacial Research Center, Department of Medical Research, Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, 5, Fu-Hsin St., Guei-Shan 333, Taoyuan, Taiwan (R.O.C.)
| | - Philip Kuo-Ting Chen
- Craniofacial Research Center, Department of Medical Research, Department of Plastic & Reconstructive Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsin St., Guei-Shan 333, Taoyuan, Taiwan (R.O.C.).
| | - Jyh-Ping Chen
- Department of Chemical and Materials Engineering, College of Engineering, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 33302, Taiwan (R.O.C.)
| | - Yu-Ray Chen
- Craniofacial Research Center, Department of Medical Research, Department of Plastic & Reconstructive Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsin St., Guei-Shan 333, Taoyuan, Taiwan (R.O.C.)
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Gilbert J, Karski M, Smith TD, Burrows AM, Norbutt C, Siegel MI, Costello BJ, Cray JJ, Losee JE, Moursi AM, Cooper GM, Mooney MP. Transforming Growth Factor-β3 Therapy Delays Postoperative Reossification and Improves Craniofacial Growth in Craniosynostotic Rabbits. Cleft Palate Craniofac J 2015; 53:210-21. [PMID: 26090789 DOI: 10.1597/14-298] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Postoperative reossification is a common clinical correlate following surgery. It has been suggested that an underexpression of transforming growth factor-β3 (TGF-β3) may be related to craniosynostosis and postoperative reossification. Adding TGF-β3 may delay reossification and improve postoperative growth. The present study was designed to test this hypothesis. Thirty 10-day-old New Zealand white rabbits with hereditary coronal suture synostosis were divided into three groups: (1) suturectomy controls (n = 14), (2) suturectomy treated with bovine serum albumin (n = 8), and (3) suturectomy treated with TGF-β3 protein (n = 8). At 10 days of age, a 3-mm × 15-mm coronal suturectomy was performed, and serial three-dimensional (3D) computed tomography (CT) scans and cephalographs were taken at 10, 25, 42, and 84 days of age. Calvaria were harvested at 84 days of age for histomorphometric analysis. Mean differences were analyzed using a group by age analysis of variance. Analysis of the 3D CT scan data revealed that sites treated with TGF-β3 had significantly (P < .05) greater defect areas and significantly (P < .05) greater intracranial volumes through 84 days of age compared with controls. Histomorphometry showed that sites treated with TGF-β3 had patent suturectomy sites and significantly (P < .001) less new bone in the suturectomy site compared with controls. Serial radiograph data revealed significant (P < .05) differences in craniofacial growth from 25 to 84 days in TGF-β3-treated rabbits compared with controls. Data show that TGF-β3 administration delayed reossification and improved craniofacial growth in this rabbit model. These findings also suggest that this molecular-based therapy may have potential clinical use.
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