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Ronde EM, Esposito M, Lin Y, van Etten-Jamaludin FS, Bulstrode NW, Breugem CC. Long-term aesthetics, patient-reported outcomes, and auricular sensitivity after microtia reconstruction: A systematic review. J Plast Reconstr Aesthet Surg 2021; 74:3213-3234. [PMID: 34489212 DOI: 10.1016/j.bjps.2021.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 08/12/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Auricular reconstruction for microtia is most frequently performed using autologous costal cartilage (ACC) or porous polyethylene (PPE) implants. Short-term results are generally promising, but long-term results remain unclear. Long-term outcomes were explored in this systematic review, and minimal reporting criteria were suggested for future original data studies. METHODS A systematic literature search was conducted in MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from inception through October 14, 2020. Articles on auricular reconstruction in patients with microtia using ACC or PPE were included if postsurgical follow-up was at least 1 year. Outcome reporting was split into separate publications, and results on complications were reported previously. This publication focused on long-term aesthetic, patient-reported, and sensitivity outcomes. RESULTS Forty-one publications reported on these outcomes. Both materials led to aesthetically pleasing results and high rates of patient satisfaction. ACC frameworks grew similarly to contralateral ears, and the anterior surface of auricles regained sensitivity. Furthermore, postoperative health-related quality of life (HRQoL) outcomes were generally good. Data synthesis was limited due to considerable variability between studies and poor study quality. No conclusions could be drawn on the superiority of either method due to the lack of comparative analyses. CONCLUSION Future studies should minimally report (1) surgical efficacy measured using the tool provided in the UK Care Standards for the Management of Patients with Microtia and Atresia; (2) complications including framework extrusion or exposure, graft loss, framework resorption, wire exposure and scalp/auricular scar complications and (3) HRQoL before and after treatment using the EAR-Q patient-reported outcome measure (PROM).
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Affiliation(s)
- E M Ronde
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - M Esposito
- Department of Plastic and Reconstructive Surgery, La Sapienza, University of Rome, Rome, Italy; Department of Plastic and Maxillofacial Surgery, Cleft and Craniofacial Malformation Center, Bambino Gesù Children's Hospital, Rome, Italy
| | - Y Lin
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Plastic Surgery Hospital, Peking Union Medical College, Beijing, China
| | - F S van Etten-Jamaludin
- Amsterdam UMC, University of Amsterdam, Research Support, Medical Library Academic Medical Center, Amsterdam, the Netherlands
| | - N W Bulstrode
- Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - C C Breugem
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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2
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Ronde EM, Esposito M, Lin Y, van Etten-Jamaludin FS, Bulstrode NW, Breugem CC. Long-term complications of microtia reconstruction: A systematic review. J Plast Reconstr Aesthet Surg 2021; 74:3235-3250. [PMID: 34481742 DOI: 10.1016/j.bjps.2021.08.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 04/29/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Microtia is a rare disorder characterized by malformation or even complete absence of the auricle. Reconstruction is often performed using autologous costal cartilage (ACC) or porous polyethylene implants (PPE). However, the long-term outcomes of both methods are unclear. OBJECTIVE This systematic review aimed to analyze long-term complications and suggest minimal reporting criteria for future original data studies. METHODS A systematic literature search was conducted in MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials from inception through October 14, 2020. Articles on auricular reconstruction in patients with microtia using ACC or PPE were included provided that the follow-up period was at least one year. This publication focused on long-term complications reported in patients with a postoperative follow-up period of at least one year. RESULTS Twenty-nine publications reported on complications during long-term follow-up. Overall long-term complication rates were not reported. The incidence of individual complications during long-term follow-up was less than 10% after ACC reconstruction and less than 15% in PPE reconstruction. Framework resorption and wire exposure were reported even after an extended follow-up of more than five years after ACC reconstruction, while reports on the extended long-term results of PPE reconstruction are limited. Data synthesis was limited due to heterogeneity and poor study quality. CONCLUSIONS Future studies should report on long-term complications including framework exposure or extrusion, graft loss, framework resorption, wire exposure and scalp and auricular scar complications. We recommend a surgical follow-up of at least five years.
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Affiliation(s)
- E M Ronde
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
| | - M Esposito
- Department of Plastic and Reconstructive Surgery, La Sapienza, University of Rome, Rome, Italy; Department of Plastic and Maxillofacial Surgery, Cleft and Craniofacial Malformation Center, Bambino Gesù Children's Hospital, Rome, Italy
| | - Y Lin
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Plastic Surgery Hospital, Peking Union Medical College, Beijing, China
| | - F S van Etten-Jamaludin
- Amsterdam UMC, University of Amsterdam, Research Support, Medical Library Academic Medical Center, Amsterdam, the Netherlands
| | - N W Bulstrode
- Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - C C Breugem
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
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3
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Smarius BJA, Guillaume CHAL, Slegers J, Mink van der Molen AB, Breugem CC. Surgical management in submucous cleft palate patients. Clin Oral Investig 2021; 25:3893-3903. [PMID: 33521885 PMCID: PMC8137618 DOI: 10.1007/s00784-020-03719-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/27/2020] [Indexed: 12/03/2022]
Abstract
OBJECTIVES The submucous cleft palate (SMCP) is considered to be the most subtle type of cleft palate. Early detection is important to allow on time intervention by speech therapy and/or surgical repair before the children already develop compensatory speech mechanisms. The purpose of this study was to investigate at what time children with a SMCP present, to determine when children are operated, and to analyze the postoperative outcomes for in SMCP children. PATIENT AND METHODS Medical records from 766 individuals registered in the cleft registry in the Wilhelmina's Children's' Hospital, Utrecht, were retrospectively reviewed. Inclusion criteria were children diagnosed with SMCP. The following data were collected: age at diagnosis, physical examination, age at surgery, surgical technique, speech therapy pre- and post-surgery, otitis media, secondary cleft surgery, family history, syndromes, and other anomalies. RESULTS In total, 56 SMCP children were identified. The mean age of diagnosis was 44.0 months (range 0-150, SD = 37.0). In 48 children (85.7%), surgical intervention was performed (Furlow plasty, intravelar veloplasty, pharyngoplasty, or Furlow combined with buccal flap). CONCLUSION This retrospective study reconfirms that SMCP often presents late, even in a country with a modern healthcare system and adequate follow-up of all newborns by the so-called youth doctors in "children's healthcare centers" up to the age of 4 years old. Almost 86% of patients ultimately needed palate surgery when SMCP was suspected. CLINICAL RELEVANCE Any child presenting with repeated episodes of otitis media, nasal regurgitation, or speech difficulties should have prompt consideration for SMCP as diagnosis.
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Affiliation(s)
- B. J. A. Smarius
- Department of Pediatric Plastic Surgery, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, 3508 AB Utrecht, The Netherlands
| | - C. H. A. L. Guillaume
- Department of Pediatric Plastic Surgery, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, 3508 AB Utrecht, The Netherlands
- Department of Plastic Surgery, Meander Medical Center, Amersfoort, The Netherlands
- Department of Pediatric Plastic Surgery, Emma Children’s Hospital, University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - J. Slegers
- Department of Pediatric Plastic Surgery, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, 3508 AB Utrecht, The Netherlands
| | - A. B. Mink van der Molen
- Department of Pediatric Plastic Surgery, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, 3508 AB Utrecht, The Netherlands
- Department of Plastic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - C. C. Breugem
- Department of Plastic Surgery, Meander Medical Center, Amersfoort, The Netherlands
- Department of Pediatric Plastic Surgery, Emma Children’s Hospital, University Medical Center Amsterdam, Amsterdam, The Netherlands
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4
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Otto IA, Capendale PE, Garcia JP, de Ruijter M, van Doremalen RFM, Castilho M, Lawson T, Grinstaff MW, Breugem CC, Kon M, Levato R, Malda J. Biofabrication of a shape-stable auricular structure for the reconstruction of ear deformities. Mater Today Bio 2021; 9:100094. [PMID: 33665603 PMCID: PMC7903133 DOI: 10.1016/j.mtbio.2021.100094] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 01/04/2021] [Accepted: 01/08/2021] [Indexed: 11/04/2022] Open
Abstract
Bioengineering of the human auricle remains a significant challenge, where the complex and unique shape, the generation of high-quality neocartilage, and shape preservation are key factors. Future regenerative medicine–based approaches for auricular cartilage reconstruction will benefit from a smart combination of various strategies. Our approach to fabrication of an ear-shaped construct uses hybrid bioprinting techniques, a recently identified progenitor cell population, previously validated biomaterials, and a smart scaffold design. Specifically, we generated a 3D-printed polycaprolactone (PCL) scaffold via fused deposition modeling, photocrosslinked a human auricular cartilage progenitor cell–laden gelatin methacryloyl (gelMA) hydrogel within the scaffold, and cultured the bioengineered structure in vitro in chondrogenic media for 30 days. Our results show that the fabrication process maintains the viability and chondrogenic phenotype of the cells, that the compressive properties of the combined PCL and gelMA hybrid auricular constructs are similar to native auricular cartilage, and that biofabricated hybrid auricular structures exhibit excellent shape fidelity compared with the 3D digital model along with deposition of cartilage-like matrix in both peripheral and central areas of the auricular structure. Our strategy affords an anatomically enhanced auricular structure with appropriate mechanical properties, ensures adequate preservation of the auricular shape during a dynamic in vitro culture period, and enables chondrogenically potent progenitor cells to produce abundant cartilage-like matrix throughout the auricular construct. The combination of smart scaffold design with 3D bioprinting and cartilage progenitor cells holds promise for the development of clinically translatable regenerative medicine strategies for auricular reconstruction. First application of human auricular cartilage progenitor cells for bioprinting. Dual-printing of hybrid ear-shaped constructs with excellent shape fidelity over time. Strategy and design ensured adequate deposition of cartilage-like matrix throughout large auricular constructs.
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Affiliation(s)
- I A Otto
- Department of Orthopaedics, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, the Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.,Regenerative Medicine Center Utrecht, Utrecht, the Netherlands
| | - P E Capendale
- Department of Orthopaedics, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, the Netherlands.,Regenerative Medicine Center Utrecht, Utrecht, the Netherlands
| | - J P Garcia
- Department of Orthopaedics, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, the Netherlands.,Regenerative Medicine Center Utrecht, Utrecht, the Netherlands
| | - M de Ruijter
- Department of Orthopaedics, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, the Netherlands.,Regenerative Medicine Center Utrecht, Utrecht, the Netherlands
| | - R F M van Doremalen
- Robotics and Mechatronics, Faculty of Electrical Engineering, Mathematics & Computer Science, University of Twente, Enschede, the Netherlands.,Bureau Science & Innovation, Deventer Hospital, Deventer, the Netherlands
| | - M Castilho
- Department of Orthopaedics, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, the Netherlands.,Regenerative Medicine Center Utrecht, Utrecht, the Netherlands
| | - T Lawson
- Departments of Chemistry and Biomedical Engineering, Boston University, Boston, USA
| | - M W Grinstaff
- Departments of Chemistry and Biomedical Engineering, Boston University, Boston, USA
| | - C C Breugem
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Emma Children's Hospital, Amsterdam, the Netherlands
| | - M Kon
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - R Levato
- Department of Orthopaedics, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, the Netherlands.,Regenerative Medicine Center Utrecht, Utrecht, the Netherlands
| | - J Malda
- Department of Orthopaedics, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, the Netherlands.,Regenerative Medicine Center Utrecht, Utrecht, the Netherlands.,Department of Clinical Sciences, Faculty of Veterinary Science, Utrecht University, the Netherlands
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5
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Smarius BJA, Breugem CC, Boasson MP, Alikhil S, van Norden J, van der Molen ABM, de Graaff JC. Effect of hyperextension of the neck (rose position) on cerebral blood oxygenation in patients who underwent cleft palate reconstructive surgery: prospective cohort study using near-infrared spectroscopy. Clin Oral Investig 2020; 24:2909-2918. [PMID: 32219565 DOI: 10.1007/s00784-019-03157-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 11/13/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To facilitate the best approach during cleft palate surgery, children are positioned with hyperextension of the neck. Extensive head extension may induce intraoperative cerebral ischemia if collateral flow is insufficient. To evaluate and monitor the effect of cerebral blood flow on cerebral tissue oxygenation, near-infrared spectroscopy has proved to be a valuable method. The aim of this study was to evaluate and quantify whether hyperextension affects the cerebral tissue oxygenation in children during cleft palate surgery. MATERIALS AND METHODS This prospective study included children (ASA 1 and 2) under the age of 3 years old who underwent cleft palate repair at the Wilhelmina Children's Hospital, in The Netherlands. Data were collected for date of birth, cleft type, date of cleft repair, and physiological parameters (MAP, saturation, heart rate, expiratory CO2 and O2, temperature, and cerebral blood oxygenation) during surgery. The cerebral blood oxygenation was measured with NIRS. RESULTS Thirty-four children were included in this study. The majority of the population was male (61.8%, n = 21). The mixed model analyses showed a significant drop at time of Rose position of - 4.25 (69-74 95% CI; p < 0.001) and - 4.39 (69-74 95% CI; p < 0.001). Postoperatively, none of the children displayed any neurological disturbance. CONCLUSION This study suggests that hyperextension of the head during cleft palate surgery leads to a significant decrease in cerebral oxygenation. Severe cerebral desaturation events during surgery were uncommon and do not seem to be of clinical relevance in ASA 1 and 2 children. CLINICAL RELEVANCE There was a significant drop in cerebral oxygenation after positioning however it is not clear whether this drop is truly significant physiologically in ASA 1 and 2 patients.
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Affiliation(s)
- B J A Smarius
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, P.O. 85090, 3508 AB, Utrecht, The Netherlands.
| | - C C Breugem
- Department of Pediatric Plastic Surgery, Emma Children's Hospital, University Medical Center Amsterdam, Amsterdam, The Netherlands.,Department of Plastic Surgery, Meander Medical Center, Amersfoort, The Netherlands
| | - M P Boasson
- Department of Anesthesia, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S Alikhil
- Department of Anesthesia, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J van Norden
- Department of Anesthesia, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A B Mink van der Molen
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, P.O. 85090, 3508 AB, Utrecht, The Netherlands
| | - J C de Graaff
- Department of Anesthesia, University Medical Center Utrecht, Utrecht, The Netherlands. .,Department of Anesthesia, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands.
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van Wijk MP, Wouters RHP, Bredenoord AL, Kon M, Breugem CC. If it ain't broke don't fix it? Ethics of splinting deformed newborn ears. J Plast Reconstr Aesthet Surg 2019; 72:1396-1402. [PMID: 31097358 DOI: 10.1016/j.bjps.2019.03.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 01/13/2019] [Accepted: 03/24/2019] [Indexed: 11/26/2022]
Abstract
Neonatal ear splinting is a proven and safe method to mold deformed ears into a more common shape. Based on our earlier studies, splinting is recommended only before the age of six weeks and preferably within the first week after birth. This can be done by initiating a system in which this intervention is actively proposed to parents. In this paper, we ethically evaluate such a system. By molding perfectly healthy newborn ears, we reach the boundary between treatment and enhancement. A key question is, therefore, whether we could classify neonatal ear splinting as a therapy. On the level of the individual, the advantages outweigh the drawbacks, but on the level of society, it is more complicated. Making ear deformities a part of official national screening programs fails to meet WHO criteria. Moreover, by systematically offering ear molding, professionals may be promoting guilt or fear of missing the opportunity. Additionally, it could affect societal attitudes toward cosmetic deformities. However, if we argue that on the individual level infants may benefit from ear splinting, then active detection of ear deformities allows parents to choose in a timely way from the full range of options, including splinting and a wait-and-see approach. We are inclined to optimally inform parents without setting up a full-blown public health program. The extent to which it is possible to timely offer splints to parents of newborns depends on the infrastructure of health care systems. The key will be for everyone involved, public or commercial, to responsibly educate and facilitate.
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Affiliation(s)
- M P van Wijk
- Department of Plastic Surgery, Isala Zwolle, the Netherlands.
| | - R H P Wouters
- Department of Medical Humanities, Julius Center, University Medical Center Utrecht, the Netherlands
| | - A L Bredenoord
- Department of Medical Humanities, Julius Center, University Medical Center Utrecht, the Netherlands
| | - M Kon
- Department of Plastic Surgery, Wilhelmina Children's hospital, University Medical Center Utrecht, the Netherlands
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van Hövell Tot Westerflier CVA, van Heteren JAA, Breugem CC, Smit AL, Stegeman I. Impact of unilateral congenital aural atresia on academic Performance: A systematic review. Int J Pediatr Otorhinolaryngol 2018; 114:175-179. [PMID: 30262360 DOI: 10.1016/j.ijporl.2018.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 09/05/2018] [Accepted: 09/05/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Little is known about the academic performance of children with unilateral congenital aural atresia (CAA). OBJECTIVE of review: Our objective was to summarize what is known about the academic performance of children with hearing loss by unilateral congenital aural atresia, in order to provide pragmatic recommendations to clinicians who see children with this entity. TYPE OF REVIEW Systematic review. SEARCH STRATEGY We conducted a systematic search in PubMed Medline, EMBASE, and Cochrane Library combining the terms "atresia" and synonyms with "unilateral hearing loss" and synonyms. Date of the most recent search was 16 May 2018. EVALUATION METHOD Two independent authors identified studies, extracted data, and assessed risk of bias. This review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Observational studies on the academic achievements of patients of any age with unilateral conductive hearing loss of any level due to congenital aural atresia were included. We considered grade retention, special education, individualized education plans, and parental report of school performance as outcome measures for academic achievement. RESULTS Two studies reporting on academic performance of patients with unilateral CAA, which both had a significant risk of bias. One study (n = 140) showed a grade retention rate of 3.6% (n = 5) in total. 15.7% (n = 22) needed special education, and 36.4% (n = 51) used an individualized education program. The second study, reporting on 67 patients with unilateral CAA, showed that 29.9% (n = 20) of the patients received school intervention, and 25.4% (n = 17) had learning problems. CONCLUSION Current evidence regarding the effect of unilateral congenital aural atresia on academic performance is sparse, inconclusive and has a significant risk of bias. High quality observational studies assessing the effects of aural atresia on academic performance in these patients should be initiated.
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Affiliation(s)
- C V A van Hövell Tot Westerflier
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan, 6, 3584, EA, Utrecht, The Netherlands.
| | - J A A van Heteren
- Department of Otorhinolaryngology, University Medical Center Utrecht, Heidelberglaan, 100, 3584, CX, Utrecht, The Netherlands.
| | - C C Breugem
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan, 6, 3584, EA, Utrecht, The Netherlands.
| | - A L Smit
- Department of Otorhinolaryngology, University Medical Center Utrecht, Heidelberglaan, 100, 3584, CX, Utrecht, The Netherlands.
| | - I Stegeman
- Department of Otorhinolaryngology, University Medical Center Utrecht, Heidelberglaan, 100, 3584, CX, Utrecht, The Netherlands; Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
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8
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Kolodzynski MN, van Hoorn BT, Kon M, Breugem CC. Abnormal soft palate movements in patients with microtia. J Plast Reconstr Aesthet Surg 2018; 71:1476-1480. [DOI: 10.1016/j.bjps.2018.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 05/19/2018] [Accepted: 06/10/2018] [Indexed: 11/27/2022]
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9
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Werker CL, van den Aardweg MTA, Coenraad S, Mink van der Molen AB, Breugem CC. Internationally adopted children with cleft lip and/or cleft palate: Middle ear findings and hearing during childhood. Int J Pediatr Otorhinolaryngol 2018; 111:47-53. [PMID: 29958613 DOI: 10.1016/j.ijporl.2018.05.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/15/2018] [Accepted: 05/17/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Adopted children with cleft lip and/or cleft palate form a diverse group of patients. Due to increased age at palatal repair, adopted children have a higher risk of velopharyngeal insuffiency and poor speech outcome. Delayed palate repair may also lead to longer lasting Eustachian tube dysfunction. Decreased function of the Eustachian tube causes otitis media with effusion and recurrent acute otitis media, which can lead to other middle ear problems and hearing loss. METHODS One-hundred-and-thirty-two adopted children treated by the Cleft palate team in Wilhelmina Children's Hospital during January 1994 and December 2014 were included. Retrospectively, middle ear findings, the need for ventilation tube insertion and hearing during childhood were assessed. Findings were compared with 132 locally born children with cleft lip and/or cleft palate. RESULTS Adopted children had a mean age of 26.5 months old when they arrived in our country. After the age of two the total number of otitis media with effusion episodes and the need for ventilation tube placement did not significantly differ among adopted and non-adopted children. Adopted children had significantly more tympanic membrane perforations. Hearing threshold levels normalized with increasing age. Although within normal range, adopted children showed significantly higher pure tone averages than locally born children when they were eight to ten years old. CONCLUSION In general, adopted patients with cleft lip and/or cleft palate did not have more middle ear problems or ventilation tubes during childhood. However, theyhave more tympanic membrane perforations.
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Affiliation(s)
- C L Werker
- Department of Plastic Surgery and Department of Otolaryngology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, 3584 EA, Utrecht, The Netherlands.
| | - M T A van den Aardweg
- Department of Plastic Surgery and Department of Otolaryngology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, 3584 EA, Utrecht, The Netherlands
| | - S Coenraad
- Department of Plastic Surgery and Department of Otolaryngology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, 3584 EA, Utrecht, The Netherlands
| | - A B Mink van der Molen
- Department of Plastic Surgery and Department of Otolaryngology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, 3584 EA, Utrecht, The Netherlands
| | - C C Breugem
- Department of Plastic Surgery and Department of Otolaryngology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, 3584 EA, Utrecht, The Netherlands
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10
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Otto IA, Levato R, Webb WR, Khan IM, Breugem CC, Malda J. Progenitor cells in auricular cartilage demonstrate cartilage-forming capacity in 3D hydrogel culture. Eur Cell Mater 2018; 35:132-150. [PMID: 29485180 DOI: 10.22203/ecm.v035a10] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Paramount for the generation of auricular structures of clinically-relevant size is the acquisition of a large number of cells maintaining an elastic cartilage phenotype, which is the key in producing a tissue capable of withstanding forces subjected to the auricle. Current regenerative medicine strategies utilize chondrocytes from various locations or mesenchymal stromal cells (MSCs). However, the quality of neo-tissues resulting from these cell types is inadequate due to inefficient chondrogenic differentiation and endochondral ossification, respectively. Recently, a subpopulation of stem/progenitor cells has been identified within the auricular cartilage tissue, with similarities to MSCs in terms of proliferative capacity and cell surface biomarkers, but their potential for tissue engineering has not yet been explored. This study compared the in vitro cartilage-forming ability of equine auricular cartilage progenitor cells (AuCPCs), bone marrow-derived MSCs and auricular chondrocytes in gelatin methacryloyl (gelMA)-based hydrogels over a period of 56 d, by assessing their ability to undergo chondrogenic differentiation. Neocartilage formation was assessed through gene expression profiling, compression testing, biochemical composition and histology. Similar to MSCs and chondrocytes, AuCPCs displayed a marked ability to generate cartilaginous matrix, although, under the applied culture conditions, MSCs outperformed both cartilage-derived cell types in terms of matrix production and mechanical properties. AuCPCs demonstrated upregulated mRNA expression of elastin, low expression of collagen type X and similar levels of proteoglycan production and mechanical properties as compared to chondrocytes. These results underscored the AuCPCs' tissue-specific differentiation potential, making them an interesting cell source for the next generation of elastic cartilage tissue-engineered constructs.
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Affiliation(s)
| | | | | | | | | | - J Malda
- Department of Orthopedics, University Medical Center, P.O. Box 85500, 3508 GA, Utrecht, the Netherlands.j.malda@ umcutrecht.nl
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Mulder FJ, Mosmuller DGM, de Vet HCW, Mouës CM, Breugem CC, van der Molen ABM, Don Griot JPW. The Cleft Aesthetic Rating Scale for 18-Year-Old Unilateral Cleft Lip and Palate Patients: A Tool for Nasolabial Aesthetics Assessment. Cleft Palate Craniofac J 2018; 55:1006-1012. [PMID: 27996297 DOI: 10.1597/16-123] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To develop a reliable and easy-to-use method to assess the nasolabial appearance of 18-year-old patients with unilateral cleft lip and palate (CLP). DESIGN Retrospective analysis of nasolabial aesthetics using a 5-point ordinal scale and newly developed photographic reference scale: the Cleft Aesthetic Rating Scale (CARS). Three cleft surgeons and 20 medical students scored the nasolabial appearance on standardized frontal photographs. SETTING VU University Medical Center, Amsterdam. PATIENTS Inclusion criteria: 18-year-old patients, unilateral cleft lip and palate, available photograph of the frontal view. EXCLUSION CRITERIA history of facial trauma, congenital syndromes affecting facial appearance. Eighty photographs were available for scoring. MAIN OUTCOME MEASURES The interobserver and intraobserver reliability of the CARS for 18-year-old patients when used by cleft surgeons and medical students. RESULTS The interobserver reliability for the nose and lip together was 0.64 for the cleft surgeons and 0.61 for the medical students. There was an intraobserver reliability of 0.75 and 0.78 from the surgeons and students, respectively, on the nose and lip together. No significant difference was found between the cleft surgeons and medical students in the way they scored the nose ( P = 0.22) and lip ( P = 0.72). CONCLUSIONS The Cleft Aesthetic Rating Scale for 18-year-old patients has a substantial overall estimated reliability when the average score is taken from three or more cleft surgeons or medical students assessing the nasolabial aesthetics of CLP patients.
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Kolodzynski MN, van Hövell Tot Westerflier CVA, Kon M, Breugem CC. Cost analysis of microtia treatment in the Netherlands. J Plast Reconstr Aesthet Surg 2017; 70:1280-1284. [PMID: 28734754 DOI: 10.1016/j.bjps.2017.06.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 06/07/2017] [Accepted: 06/09/2017] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Ear reconstruction for microtia is a challenging procedure. Although analyzing esthetic outcome is crucial, there is a paucity of information with regard to financial aspects of microtia reconstruction. This study was conducted to analyze the costs associated with ear reconstruction with costal cartilage in patients with microtia. METHODS Ten consecutive children with autologous ear reconstruction of a unilateral microtia were included in this analysis. All patients had completed their treatment protocol for ear reconstruction. Direct costs (admission to hospital, diagnostics, and surgery) and indirect cost (travel expenses and absence from work) were obtained retrospectively. RESULTS The overall mean cumulative cost per patient was €14,753. Direct and indirect costs were €13,907 and €846, respectively. Hospital admission and surgery cover 55% and 32% of all the costs, respectively. DISCUSSION This study analyzes the costs for autologous ear reconstruction. Hospital admission and surgery are the most important factors of the total costs. Total costs could be decreased by possibly decreasing admission days and surgical time. These data can be used for choosing and developing future treatment strategies.
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Affiliation(s)
- M N Kolodzynski
- Dutch Center for Ear Reconstruction, University Medical Center Utrecht, Heidelberglaan 100, PO Box 85500, 3508 GA Utrecht, The Netherlands.
| | - C V A van Hövell Tot Westerflier
- Dutch Center for Ear Reconstruction, University Medical Center Utrecht, Heidelberglaan 100, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - M Kon
- Dutch Center for Ear Reconstruction, University Medical Center Utrecht, Heidelberglaan 100, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - C C Breugem
- Dutch Center for Ear Reconstruction, University Medical Center Utrecht, Heidelberglaan 100, PO Box 85500, 3508 GA Utrecht, The Netherlands
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Kappen IFPM, Bittermann GKP, Schouten RM, Bittermann D, Etty E, Koole R, Kon M, Mink van der Molen AB, Breugem CC. Long-term mid-facial growth of patients with a unilateral complete cleft of lip, alveolus and palate treated by two-stage palatoplasty: cephalometric analysis. Clin Oral Investig 2017; 21:1801-1810. [PMID: 27638039 PMCID: PMC5442235 DOI: 10.1007/s00784-016-1949-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 08/30/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The aim of this study is to evaluate long-term facial growth in adults previously treated for an isolated unilateral complete cleft lip, alveolus and palate by two-stage palatoplasty. MATERIALS AND METHODS Unilateral cleft lip and palate (UCLP) patients of 17 years and older treated by two-stage palatoplasty were invited for long-term follow-up. During follow-up, lateral cephalograms were obtained (n = 52). Medical history was acquired from their medical files. Outcome was compared to previously published normal values and the Eurocleft study. RESULTS Soft and hard palate closure were performed at the age of 8 (SD 5.9) months and 3 (SD 2.2) years, respectively. The mean maxillary and mandibular angle (SNA, SNB) were 74.9° (SD 4.2) and 75.8° (SD 3.8). Maxillary and maxillomandibular relationships (SNA, ANB) were comparable to all Eurocleft Centres, except for Centre D. We observed a significantly steeper upper interincisor angle compared to the Eurocleft Centres. CONCLUSIONS This study describes the long-term craniofacial morphology in adults treated for a UCLP with hard palate closure at a mean age of 3 years. The mean maxillary angle SNA and mandibular angle SNPg were comparable to previous studies both applying early and delayed hard palate closure. The observed upper incisor proclination is likely caused by orthodontic overcorrection in response to the unfavourable jaw relationships. No clear growth benefit of this protocol could be demonstrated. CLINICAL RELEVANCE The present study shows the long-term craniofacial morphology of UCLP adults after the Utrecht treatment protocol which includes two-stage palate closure.
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Affiliation(s)
- I F P M Kappen
- Department of Plastic Surgery, Wilhelmina Children's Hospital, Lundlaan 6, PO Box 85090, 3508 AB, Utrecht, The Netherlands.
| | - G K P Bittermann
- Department of Maxillofacial Surgery, University Medical Centre Utrecht, Heidelberglaan 100, PO box 85500, 3508 AB, Utrecht, The Netherlands
| | - R M Schouten
- Department of Methodology and Statistics, University of Utrecht, Padualaan 14, 3584 CH, Utrecht, The Netherlands
| | - D Bittermann
- Department of Maxillofacial Surgery, University Medical Centre Utrecht, Heidelberglaan 100, PO box 85500, 3508 AB, Utrecht, The Netherlands
| | - E Etty
- Department of Maxillofacial Surgery, University Medical Centre Utrecht, Heidelberglaan 100, PO box 85500, 3508 AB, Utrecht, The Netherlands
| | - R Koole
- Department of Maxillofacial Surgery, University Medical Centre Utrecht, Heidelberglaan 100, PO box 85500, 3508 AB, Utrecht, The Netherlands
| | - M Kon
- Department of Plastic Surgery, Wilhelmina Children's Hospital, Lundlaan 6, PO Box 85090, 3508 AB, Utrecht, The Netherlands
| | - A B Mink van der Molen
- Department of Plastic Surgery, Wilhelmina Children's Hospital, Lundlaan 6, PO Box 85090, 3508 AB, Utrecht, The Netherlands
| | - C C Breugem
- Department of Plastic Surgery, Wilhelmina Children's Hospital, Lundlaan 6, PO Box 85090, 3508 AB, Utrecht, The Netherlands
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Breugem CC. Commentary: Treating submucous clefts with a double-opposing Z-plasty. J Plast Reconstr Aesthet Surg 2017; 70:707-708. [PMID: 28222964 DOI: 10.1016/j.bjps.2017.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 02/02/2017] [Indexed: 10/20/2022]
Affiliation(s)
- C C Breugem
- Pediatric Plastic Surgeon, Wilhelmina Children's Hospital, University of Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands.
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Ruitenberg G, Young-Afat DA, de Graaf M, Pasmans SGMA, Breugem CC. Ulcerated infantile haemangiomas: the effect of the selective beta-blocker atenolol on wound healing. Br J Dermatol 2016; 175:1357-1360. [PMID: 27105937 DOI: 10.1111/bjd.14687] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- G Ruitenberg
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre Utrecht, PO Box 85090, 3508, AB Utrecht, the Netherlands
| | - D A Young-Afat
- Department of Clinical Epidemiology, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - M de Graaf
- Department of Pediatric Dermatology and Allergology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, PO Box 85090, 3508, AB Utrecht, the Netherlands
| | - S G M A Pasmans
- Department of Pediatric Dermatology and Allergology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, PO Box 85090, 3508, AB Utrecht, the Netherlands.,Department of Pediatric Dermatology, Erasmus University Medical Centre Rotterdam, Sophia's Children Hospital, Rotterdam, the Netherlands
| | - C C Breugem
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre Utrecht, PO Box 85090, 3508, AB Utrecht, the Netherlands
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16
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Hanny KH, de Vries IAC, Haverkamp SJ, Oomen KPQ, Penris WM, Eijkemans MJC, Kon M, Mink van der Molen AB, Breugem CC. Late detection of cleft palate. Eur J Pediatr 2016; 175:71-80. [PMID: 26231683 PMCID: PMC4709386 DOI: 10.1007/s00431-015-2590-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 06/21/2015] [Accepted: 06/26/2015] [Indexed: 11/23/2022]
Abstract
Cleft palate only (CPO) is a common congenital malformation, and most patients are diagnosed within the first weeks after birth. Late diagnosis of the cleft palate (CP) could initially result in feeding and growth impairment, and subsequently speech and hearing problems later in life. The purpose of this study is to retrospectively investigate (1) at which age CPO is diagnosed and (2) how the presence of syndromes and other factors relate to the age at diagnosis. The mean age of all children at our centre with CPO included between 1997 and 2014 at diagnosis (n = 271) was 1 year and 4 months. In all, 24.8% (n = 67) was older than 12 months when diagnosed, and 37.3% (n = 101) of all children had been diagnosed >30 days. These findings remain valid when a cut-off point of 14 days is used (44.3% late). Moreover, the grade of the cleft was a determining factor for successful diagnosis; submucous clefts were detected much later on average (89.3% > 30 days; p = .000). Similar results were found using Kaplan-Meier survival analyses. CONCLUSION CPO is often diagnosed late. Patients diagnosed ≤30 days after birth more often presented with an associated disorder. Early diagnoses became more frequent as the severity of the cleft increased (grades 1-4). Professionals should perform more thorough intra-oral investigations, including manual palpations and visual inspections of the palate; they should be made more aware of the frequent accompanying symptoms. WHAT IS KNOWN The presence of cleft palate only (CPO) is known to negatively affect feeding, hearing, speech and (social) development. Submucous clefts are often underdiagnosed due to their difficulty to detect. As far as we know the literature shows that symptomatic submucous CPs are often diagnosed at an average age of 4.9 years. WHAT IS NEW 37.3% respectively of all children with CPO were diagnosed relatively late (>30 days after birth), 24.8% was older than 12 months when diagnosed. Mean age of all children with CPO was 1 year and 4 months. We conclude that midwives and pediatricians should perform more through intra-oral investigations of all new-borns, including both a manual palpation, als well a visual inspection of the palate.
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Affiliation(s)
- K H Hanny
- Department of Paediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - I A C de Vries
- Department of Paediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - S J Haverkamp
- Department of Speech and Language Therapy, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, The Netherlands
| | - K P Q Oomen
- Department of Otolaryngology-Head and Neck Surgery, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, The Netherlands
| | - W M Penris
- Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - M J C Eijkemans
- Department of Biostatistics and Research Support, Julius Centre, University Medical Centre, Utrecht, The Netherlands
| | - M Kon
- Department of Paediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - A B Mink van der Molen
- Department of Paediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - C C Breugem
- Department of Paediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508 GA, Utrecht, The Netherlands
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Otto IA, Melchels FPW, Zhao X, Randolph MA, Kon M, Breugem CC, Malda J. Auricular reconstruction using biofabrication-based tissue engineering strategies. Biofabrication 2015. [PMID: 26200941 DOI: 10.1088/1758-5090/7/3/032001] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Auricular malformations, which impose a significant social and psychological burden, are currently treated using ear prostheses, synthetic implants or autologous implants derived from rib cartilage. Advances in the field of regenerative medicine and biofabrication provide the possibility to engineer functional cartilage with intricate architectures and complex shapes using patient-derived or donor cells. However, the development of a successful auricular cartilage implant still faces a number of challenges. These challenges include the generation of a functional biochemical matrix, the fabrication of a customized anatomical shape, and maintenance of that shape. Biofabrication technologies may have the potential to overcome these challenges due to their ability to reproducibly deposit multiple materials in complex geometries in a highly controllable manner. This topical review summarizes this potential of biofabrication technologies for the generation of implants for auricular reconstruction. In particular, it aims to discuss how biofabrication technologies, although still in pre-clinical phase, could overcome the challenges of generating and maintaining the desired auricular shapes. Finally, remaining bottlenecks and future directions are discussed.
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Affiliation(s)
- I A Otto
- Department of Orthopaedics, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands. Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands
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Loozen CS, Maarse W, Manten GTR, Pistorius L, Breugem CC. The accuracy of prenatal ultrasound in determining the type of orofacial cleft. Prenat Diagn 2015; 35:652-5. [DOI: 10.1002/pd.4582] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 02/14/2015] [Accepted: 02/17/2015] [Indexed: 11/12/2022]
Affiliation(s)
- C. S. Loozen
- Division of pediatric plastic surgery; Wilhelmina Children's Hospital; Utrecht The Netherlands
| | - W. Maarse
- Division of pediatric plastic surgery; Wilhelmina Children's Hospital; Utrecht The Netherlands
| | - G. T. R. Manten
- Department of Obstetrics and Gynecology; University Medical Center Utrecht; Utrecht The Netherlands
| | - L. Pistorius
- Department of Obstetrics and Gynecology; University Medical Center Utrecht; Utrecht The Netherlands
| | - C. C. Breugem
- Division of pediatric plastic surgery; Wilhelmina Children's Hospital; Utrecht The Netherlands
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Landheer JA, Breugem CC, van der Molen ABM. Fistula incidence and predictors of fistula occurrence after cleft palate repair: two-stage closure versus one-stage closure. Cleft Palate Craniofac J 2014; 47:623-30. [PMID: 21039279 DOI: 10.1597/09-069] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To review the clinical outcomes of our cleft palate team in terms of fistula rate and to determine whether gender, syndrome, cleft type, age at repair, operating surgeon, type of cleft repair, and cleft width influence the risk of fistula occurrence. Cleft palate repair was done in one- or two-stages. DESIGN A retrospective analysis was performed of medical records of 275 patients who underwent palate repair and who were born between 1988 and 1997. All consecutive cleft (lip and) palate patients (including syndromes) were incorporated. Multivariate analysis was performed to look for predictors of the formation of fistulas. RESULTS One hundred fifty-four and 121 patients underwent two-stage and one-stage repair, respectively. The median duration of follow-up was 9 years. The overall incidence of the formation of a fistula was 21%, with a recurrence rate of 9% after fistula repair. Three independent predictors of fistulization were found: palate repair in two stages, younger age at the second stage of a two-stage repair (≤3.0 years), and greater cleft width (≥13 mm). A fistula occurred in 27% of two-stage repairs versus 14% of one-stage repairs. CONCLUSIONS This study found a relatively high incidence of fistula formation after cleft palate repair. Although the study populations were not randomized, this study suggests that a two-stage closure has a higher rate of fistula formation when compared with a one-stage closure. This study demonstrates that cleft width at the time of cleft palate repair plays a crucial role in the development of fistulas.
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Affiliation(s)
- J A Landheer
- Utrecht Medical Center, Utrecht, The Netherlands
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20
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Breugem CC, Courtemanche DJ. Robin sequence: clearing nosologic confusion. Cleft Palate Craniofac J 2014; 47:197-200. [PMID: 19860499 DOI: 10.1597/08-061_1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2008] [Accepted: 09/29/2009] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To gather evidence surrounding the confusion in the classification of Robin sequence and inform those who have the power to make the changes in defining this symptom complex. METHOD A questionnaire was sent to all participating cleft palate teams (N=204) of the American Cleft Palate-Craniofacial Association. The questionnaire identified the precise, different characteristics for diagnosing Robin sequence and evaluated whether the difference between a retrognathia and micrognathia influenced the diagnosis process. We subsequently also investigated whether the cleft type (i.e., U-shaped versus V-shaped) had any influence in the decision-making process. A PubMed literature review of the 50 most recent manuscripts about Robin sequence was evaluated also. RESULTS Seventy-three questionnaires were received. This 35% response rate revealed 14 different definitions of Robin sequence. A PubMed literature review of 50 consecutive manuscripts revealed 15 different descriptions. CONCLUSION This study confirms that nosologic confusion is widespread with regard to defining Robin sequence. This has implications for evaluating Robin sequence, giving advice about the prognosis and genetic counseling, and refining treatment options.
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Affiliation(s)
- C C Breugem
- Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
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Abstract
OBJECTIVE To gather evidence surrounding the confusion in the classification of Robin sequence and inform those who have the power to make the changes in defining this symptom complex. METHOD A questionnaire was sent to all participating cleft palate teams (N=204) of the American Cleft Palate-Craniofacial Association. The questionnaire identified the precise, different characteristics for diagnosing Robin sequence and evaluated whether the difference between a retrognathia and micrognathia influenced the diagnosis process. We subsequently also investigated whether the cleft type (i.e., U-shaped versus V-shaped) had any influence in the decision-making process. A PubMed literature review of the 50 most recent manuscripts about Robin sequence was evaluated also. RESULTS Seventy-three questionnaires were received. This 35% response rate revealed 14 different definitions of Robin sequence. A PubMed literature review of 50 consecutive manuscripts revealed 15 different descriptions. CONCLUSION This study confirms that nosologic confusion is widespread with regard to defining Robin sequence. This has implications for evaluating Robin sequence, giving advice about the prognosis and genetic counseling, and refining treatment options.
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Affiliation(s)
- C C Breugem
- Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
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de Vries IAC, Breugem CC, van der Heul AMB, Eijkemans MJC, Kon M, Mink van der Molen AB. Prevalence of feeding disorders in children with cleft palate only: a retrospective study. Clin Oral Investig 2013; 18:1507-15. [PMID: 24122307 DOI: 10.1007/s00784-013-1117-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 09/24/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The purpose of this study in children with cleft palate only (CPO) is to (1) explore the prevalence of feeding problems on a retrospective basis, (2) investigate rates of nasogastric (NG) feeding, (3) examine the prevalence of associated disorders and/or syndromes (AssD/S), (4) investigate if there are certain risk factors associated with feeding difficulties, NG feeding, and failure of breastfeeding, and (5) investigate the effect of palatoplasty on feeding difficulties. MATERIALS AND METHODS In total, 90 questionnaires were included in this study. The medical records were reviewed. RESULTS Feeding difficulties were reported in 67% (n = 60) of all cases. NG feeding was given in 32% (n = 28) of all children. Forty-nine children (54%) have associated malformations. There is no significant relation for gender, gestational age, and birth weight as risk factors for feeding difficulties, NG feeding, and failure of breastfeeding. The severity of the cleft is significantly related to the prevalence of AssD/S. After palatoplasty, feeding difficulties improved in 79% of the CPO children. CONCLUSIONS AND CLINICAL RELEVANCE First, our results clearly indicate that children with CPO are at high risk of developing feeding difficulties (67%); NG feeding is often necessary (32%). Second, our results also indicate that the more severe the cleft, the more likely the chance for AssD/S. Third, the severity of the cleft is significantly related to the prevalence of AssD/S. Fourth, there is no significant relation for gender, gestational age, and birth weight as risk factors for feeding difficulties, NG feeding, and failure of breastfeeding. Fifth, improvement of feeding difficulties after surgery supports the importance of the soft palate closure in relation to sucking patterns and feeding skills.
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Affiliation(s)
- I A C de Vries
- Department of Paediatric Plastic Surgery, Wilhelmina Children's Hospital, PO Box 85500, 3508, GA, Utrecht, The Netherlands,
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de Jong-Pleij EAP, Pistorius LR, Ribbert LSM, Breugem CC, Bakker M, Tromp E, Bilardo CM. Premaxillary protrusion assessment by the maxilla-nasion-mandible angle in fetuses with facial clefts. Prenat Diagn 2013; 33:354-9. [PMID: 23362132 DOI: 10.1002/pd.4062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The aim of the study was to measure the degree of premaxillary protrusion in fetuses with orofacial clefts of various severities. METHODS The maxilla-nasion-mandible (MNM) angle was measured retrospectively on by multiplanar corrected volumes. Sixty-two fetuses with orofacial clefts and known outcome volumes of the fetal head were available. RESULTS In 48 of the 62 cases, the MNM angle could be measured [mean gestational age 23 (range, 18-30) weeks]. The mean MNM angle was normal in all nine cases with cleft lip and intact alveolar ridge (15.2°; range, 12.5°- 16.9°). In 24 cases with unilateral cleft lip with or without cleft palate (UCL/P), the mean MNM angle was 20.0° (range, 13.3-26.2°), being above the 95th percentile in 79% (n = 19) and normal in 21% (n = 5). In 14 bilateral cleft lip and palate (BCL/P) cases, the mean MNM angle was 26.5° (range, 19.2°-33.7°) and above the 95th percentile in all cases. There was no difference in MNM angle between isolated clefts and clefts associated with other anomalies. In one case with a Tessier 4 cleft, the MNM angle was above the 95th percentile (25.2°). CONCLUSION The premaxilla tends to protrude in both BCL/P as UCL/P cases. The degree of protrusion varies greatly, especially in the BCL/P group.
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Affiliation(s)
- E A P de Jong-Pleij
- Department of Obstetrics and Gynecology, St. Antonius Hospital, Nieuwegein, The Netherlands
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Maarse W, Pistorius LR, Van Eeten WK, Breugem CC, Kon M, Van den Boogaard MJH, Mink van Der Molen AB. Prenatal ultrasound screening for orofacial clefts. Ultrasound Obstet Gynecol 2011; 38:434-439. [PMID: 21113916 DOI: 10.1002/uog.8895] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/27/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To evaluate the sensitivity and specificity of ultrasound for detecting prenatal facial clefts in low-risk and high-risk populations. METHODS This study prospectively followed up a non-selected population, namely all pregnant women who underwent routine second-trimester prenatal ultrasound screening in the Utrecht region during the 2-year period from January 2007 to December 2008. RESULTS A total of 35 924 low-risk and 2836 high-risk pregnant women underwent ultrasound screening. Orofacial clefts were present in 62 cases, an incidence of 1:624. The distribution of clefts was as follows: 18 (29%) cleft lip, 25 (40%) cleft lip with cleft palate, 17 (27%) cleft palate only, one median cleft and one atypical cleft. Of these, 38 (61%) were unilateral and 23 (37%) were bilateral. Thirty-nine per cent (24/62) had associated anomalies, with most chromosomal defects found in the cleft lip with cleft palate and cleft palate only groups. Cleft lip with or without cleft palate was detected prenatally in 38/43 cases, a sensitivity of 88%. No case of cleft palate only was detected prenatally. There were three false-positive cases, of which two were fetuses with multiple congenital deformities. CONCLUSIONS Ultrasound screening has a high sensitivity for the detection of cleft lip with and without cleft palate in high-risk and low-risk pregnancies in our region, where well-trained sonographers carry out primary screening. The key to a high sensitivity of prenatal ultrasound is likely to be a combination of excellent training of sonographers, referral to specialized centers when a cleft is suspected, routine visualization of the fetal face and advances in ultrasound techniques.
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Affiliation(s)
- W Maarse
- Department of Plastic and Reconstructive Surgery, University Medical Centre Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
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van Wijk MP, Breugem CC, Kon M. A prospective study on non-surgical correction of protruding ears: the importance of early treatment. J Plast Reconstr Aesthet Surg 2011; 65:54-60. [PMID: 21903493 DOI: 10.1016/j.bjps.2011.08.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 08/06/2011] [Accepted: 08/09/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Splinting is an elegant method to correct ear deformities in the newborn. However evidence is lacking on the relation between age and efficacy and duration of the treatment. We prospectively studied these questions on protruding ears in 132 babies. METHODS A splint in the scaphal hollow was used in combination with tape (Earbuddies(®)). Treatment continued until the desired shape persisted. Results were judged from photographs and mastoid-helical distance was measured. RESULTS In 132 babies 209 ears were treated. Twenty-four patients had no follow-up, 27 stopped therapy for skin irritation and fixation problems. In the remaining patients results were good in 28%, fair in 36%, poor in 36%. Efficacy deteriorates with age; with fair or good results in 66.7% if therapy started before the sixth week. Older children needed to be splinted longer. The anti-helical fold was easier corrected than a deep concha (correction in 69.8% versus 26.8%). CONCLUSIONS Considering splinting therapy for protruding ears, a reasonable chance of success can only be offered to parents of children up to six weeks of age. It is favorable if the deformity is mainly due to a flat antihelix.
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Affiliation(s)
- M P van Wijk
- Dutch Center of Ear Reconstruction, Division of Pediatric Plastic Surgery KE.04.140.0, Wilhelmina Children's Hospital University Medical Center Utrecht, P.O. Box 85090, 3508 AB Utrecht, The Netherlands.
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Deelder JD, Breugem CC, de Vries IAC, de Bruin M, Mink van der Molen AB, van der Horst CMAM. Is an isolated cleft lip an isolated anomaly? J Plast Reconstr Aesthet Surg 2010; 64:754-8. [PMID: 21146482 DOI: 10.1016/j.bjps.2010.10.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Revised: 09/23/2010] [Accepted: 10/27/2010] [Indexed: 11/29/2022]
Abstract
INTRODUCTION It is well known that patients with cleft lip/palate or cleft palate can have associated anomalies. However, there is a relative paucity of information about the possible anomalies associated with an isolated cleft lip. A recent study (Vallino et al., 2008) showed that children with cleft lip and/or alveolus often develop cleft palate-related issues. This inspired us to investigate our population. METHODS A questionnaire was sent to the parents of 214 children with cleft lip and/or alveolus; 161 questionnaires were returned (response rate (RR): 75%) and included in our study. The study consisted of 91 boys and 70 girls (0.3-13.1 years: mean 6.8 ± 3.5 years). RESULTS Speech and/or language problems were reported in 34% and ventilation tube insertion in 21% of children with ≥6 years' follow-up. Of the children in that group, 33% reported to have undergone an episode of acute otitis media and 11% reported five episodes or more. Additional congenital anomalies were found in 4% of children with a cleft lip and in 16% of children with a cleft lip/alveolus. CONCLUSION Our results demonstrate that an isolated cleft lip can often be described as an isolated anomaly, although children with cleft lip and/or alveolus develop cleft palate-related issues more often than anticipated. Therefore, we suggest an intensive monitoring and treatment of children with these types of clefts.
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Affiliation(s)
- J D Deelder
- Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Breugem CC, Maas M, Breugem SJM, Schaap GR, van der Horst CMAM. Vascular malformations of the lower limb with osseous involvement. J Bone Joint Surg Br 2003; 85:399-405. [PMID: 12729117 DOI: 10.1302/0301-620x.85b3.13429] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Vascular malformations are rare congenital lesions which often have associated skeletal changes. Over a period of ten years, 90 patients at our clinic had a vascular anomaly of the lower limb, examined by either CT or MRI. Of these, 18 (20%) had bony involvement. A questionnaire was sent to these patients (8 men, 10 women) to evaluate their age of presentation, initial symptoms and current complaints. Radiological imaging revealed 15 low- and three high-flow lesions. The mean age at presentation to a physician was six years of age. Pain was the most common complaint. Disparity in leg length of 2 cm or more was observed in ten patients. Of the 16 patients with muscle infiltration, 13 had four or more muscles involved. Treatment by resection alone would require radical surgery.
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Affiliation(s)
- C C Breugem
- Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Centre, University of Amsterdam, The Netherlands
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Abstract
Vascular malformations are congenital lesions resulting from a defect during embryogenesis. Magnetic resonance imaging (MRI) is a very effective method for demonstrating detailed information regarding involved structures, extent, and flow characteristics of vascular malformations. In previous MRI studies, most of the emphasis is laid on the difference between high- and low-flow lesions, whereas little detailed information is available about the extent of local tissue involvement. These additional characteristics may influence the approach in treating these malformations and improve understanding of the pathogenesis. We retrospectively reviewed MRI scans of 40 patients with vascular malformations of the lower extremity. Thirty-four patients had low-flow lesions, and six had high-flow lesions. Of the low-flow lesions, 23 patients (67.6 percent) had muscle infiltration, with four of the six high-flow lesions having muscle infiltration. Nine of the 11 male patients (81.8 percent) with low-flow lesions had associated muscle infiltration, in comparison with 14 of the 23 female patients (60.9 percent) with low-flow lesions (p = 0.206). Eighty percent of the vascular malformations located on the thigh with muscle involvement had involvement of the anterior muscle group, whereas 86.6 percent of the patients with a vascular malformation located on the leg and with associated muscle involvement had at least the posterior muscle group involved (p = 0.0049). Ten patients (25 percent) of the whole group had bone infiltration. Low-flow lesions often had multifocal lesions (20.6 percent), whereas associated muscle atrophy was visible in 10 low-flow lesions and in two high-flow lesions. In low-flow lesions with muscle infiltration (n = 23), 43 percent (n = 10) had associated surrounding muscle atrophy (p = 0.009). Hypertrophy of the subcutaneous tissue was visible in 11 low-flow patients (32.4 percent). The high amount of muscle and bone involvement in vascular malformations of the lower extremity is emphasized with this study. Of particular interest was the difference in affected muscle groups. The angiosome concept is used to explain this preponderance, and we feel the angiosome concept could also be used when assessing possible intervention. The surrounding muscle atrophy and multifocal nature of these anomalies are further important considerations when assessing the possibility of intervention.
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Affiliation(s)
- C C Breugem
- Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center, University of Amsterdam, The Netherlands.
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Breugem CC, Maas M, Reekers JA, van der Horst CM. Use of magnetic resonance imaging for the evaluation of vascular malformations of the lower extremity. Plast Reconstr Surg 2001; 108:870-7. [PMID: 11547141 DOI: 10.1097/00006534-200109150-00009] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Vascular malformations are anatomically subdivided according to the predominant channel anomaly into either capillary, arterial, venous, lymphatic, or combinations. They can be further subdivided into high- or low-flow malformations. Any lesion that has an arterial component is considered a high-flow malformation. Once the diagnosis of a vascular malformation is made, it is of paramount importance to define not only the flow characteristics but also the full range of extension, because the prognosis and appropriate treatment vary substantially for each type of anomaly. The two most useful noninvasive imaging techniques for assessing vascular malformations are magnetic resonance imaging (MRI) and ultrasonography. The aim of this review is to give surgeons involved in treating patients with vascular malformations an opportunity to gain some background on MRI scans when assessing vascular malformations. Although MRI is a powerful modality for assessing vascular malformations, we will also discuss some of the limitations of MRI. We further suggest a diagnostic flow chart developed on the basis of MRI features designed to help determine the composition of a vascular birthmark when intervention is anticipated.
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Affiliation(s)
- C C Breugem
- Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center, University of Amsterdam, The Netherlands
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Affiliation(s)
- C C Breugem
- Department of Plastic, Academic Medical Center, University of Amsterdam, The Netherlands.
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Abstract
High voltage electrical injury can cause considerable damage to the central nervous system. Delayed spinal cord injury is uncommon, usually incomplete, and comprises predominantly motor fallout. The injury can be progressive, with only a few patients showing partial improvement. We present a case report of a 20-year-old male who had a delayed onset spinal cord injury after a high voltage electrical injury. The symptoms started several days postburn with an ascending paralysis, leading to tetraplegia. Gradual recovery became evident at 3 months after the accident, starting with his arms and later showing partial recovery of his lower limbs. The mechanisms of injury and pathophysiology to the spinal cord are poorly understood. Possible explanations for the delayed onset of neurologic complications are given. The exact reasons for the delayed, ascending paralysis and the mechanism of recovery still need further investigation.
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Affiliation(s)
- C C Breugem
- Department of Plastic, Reconstructive, and Hand Surgery, Red Cross Hospital, Beverwijk, The Netherlands
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Abstract
Since the first operation for premature suture closure in North America in 1888, there have been some fundamental changes in the treatment of these sutures, the latest being the U.S. Food and Drug Administration's 1996 approval of a bioabsorbable fixation device. This retrospective study documents our experience with procedures performed primarily by Bennie J. van R. Zeeman for isolated craniosynostosis over a 10-year period. It was an attempt to evaluate factors affecting outcome and to determine the safety of the techniques used to correct these congenital defects. Diagnoses included plagiocephaly (116) and sagittal (44), metopic (17), and bilateral coronal (12) synostosis. All patients underwent fronto-orbital advancement or calvarial vault remodeling, or both. The average patient age at time of sagittal synostosis surgery was 13.4 months; unilateral coronal synostosis, 12.2 months; deformational plagiocephaly, 9.8 months; metopic synostosis, 8.6 months; and bilateral coronal synostosis, 10.4 months. Perioperative complications were minimal, with one mortality. Postoperative complications included three cases involving infection. The problem of reoperation for the removal of wires and plates remains the greatest postoperative complication. Because of poor patient compliance, no accurate postoperative follow-up has been recorded. On the basis of our experience, we wish to point out some problems inherent in this surgery and also the complications that can occur despite careful coordinated planning and team effort.
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Affiliation(s)
- C C Breugem
- Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Centre, University of Amsterdam, The Netherlands
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