While many studies have examined potential risk factors for nonsyndromic craniosynostosis, there have been no publications to date investigating the role of ethnicity in the United States. The current study was undertaken as the first multi-center investigation to examine the relationship between ethnicity and nonsyndromic craniosynostosis, looking at both overall prevalence as well as potential correlation between ethnicity and pattern of affected suture site. A chart review of patients diagnosed with nonsyndromic craniosynostosis treated at four major children's hospitals was performed to obtain ethnicity data. Analysis was preformed based on ethnic group as well as suture site affected. To account for potential One regional selection bias, the KID database (1997–2012) was utilized to identify all cases of craniosynostosis on a national level. This data was analyzed against birth rates by ethnicity obtained from CDC WONDER natality database. Amongst the 2112 cases of nonsyndromic craniosynostosis at all institutions, Caucasians and African Americans were consistently the predominant ethnic groups. There was a statistically significant difference in the distribution of affected suture type with African Americans more likely to present with unicoronal synostosis and Caucasians more likely to present with metopic synostosis (P = 0.005). The national data revealed that there were more cases of craniosynostosis in Caucasians and fewer in African Americans than expected when compared to population birth rates. Our findings demonstrate that the Caucasian race is associated with increased rates of synostosis.

Subclinical peroneal neuropathy is common in medical inpatients and is associated with a recent history of falling. Preventing or identifying SCPN in hospitalized patients provides an opportunity to modify activity and therapy, potentially reducing risk.

ephalohematoma of infancy is a subperiosteal blood collection of the infant cranium, occurring in up to 2.5 percent of all live births. 1 This ensues after sudden blunt trauma or shear forces tear the delicate blood vessels traversing the pericranium. 2 The most common causes of birth trauma leading to cephalohematoma are vacuum extraction, forceps-assisted delivery, intrauterine scalp electrode use for fetal heart rate monitoring, skull fracture, and fetal calvarial impact against the laboring mother's pelvis. [2][3][4][5][6] Although the majority of cephalohematomas resolve within 1 to 4 weeks of life without intervention, a small proportion will persist and can become calcified through subperiosteal osteogenesis. 2,7-10 Because of the subperiosteal location, calcified cephalohematoma of infancy is a distinct entity from subgaleal hematoma and has the capacity to form a permanent cranial deformity.Although the pathophysiology behind the calcification process is not definitive, we postulate that calcified cephalohematoma growth recapitulates normal development of the inner and outer cranial tables, as described by Melvin

Background NSAIDs are useful alternatives to narcotics for analgesia. However, concerns remain regarding their safety. We evaluated ketorolac use and perioperative complications and hypothesized that there is no association between ketorolac and morbidity following outpatient body contouring procedures. Methods We utilized the Truven Marketscan claims database to evaluate patients undergoing breast and body contouring surgery. We selected patients who received ketorolac and minimum enrollment of 90 days postoperatively. We performed a multivariable logistic regression to calculate the risk of morbidity and associated numbers needed to treat or harm, adjusting for clinical and sociodemographic factors. Results Among the 106,279 patients enrolled, 4,924 patients (4.6%) received postoperative ketorolac. In multivariable regression analysis, ketorolac was not associated with diagnosis of hematoma (OR 1.20; 95% CI 0.99-1.46; P>0.05). There was an increased rate of reoperation within 72 hours (OR 1.22; 95% CI 1.00-1.49; P<0.05; NNH 262). Ketorolac was associated with significantly fewer readmissions (OR 0.76; 95% CI 0.62-0.93; P<0.05; NNT 87) with a reduction in the rate of pain as a diagnosis for admission (0.6% vs 4.3%; P=0.021). Ketorolac was associated with seroma, but this association may not be causal (OR 1.28; 95% CI, 1.05-1.57; P<0.05; NNH 247). Ketorolac provided an average cost savings of over $157 per patient. Conclusions Despite a small increase in odds for reoperation, the benefits of ketorolac likely outweigh the small risks after surgery. Absolute differences in reoperation rates were low and improved rates of hospital readmission impact better cost utilization. Based on these findings, we advocate postoperative ketorolac once the wound is hemostatic.

No abstract

Computer aided technology in the form of virtual surgical planning (VSP) and 3D printed surgical guides can allow for a more accurate reconstruction of complex maxillofacial deformities. While this technology is now routinely used for bony reconstruction, it is rarely utilized for soft tissue. In ballistic injuries there is often disfiguring damage to the soft tissue, with destruction of anatomic landmarks making satisfactory soft tissue reconstruction a unique challenge. In this study, the authors present the application of virtual surgical planning and 3D printed guides, in conjunction with anaplastology, for complex soft tissue reconstruction resulting from a gunshot injury. By combining tangible surgical models and aesthetic judgment in a team setting, it is possible to optimize the efficiency and accuracy of soft tissue reconstruction in the setting of complex facial deformities.

Treatment of bilateral subcondylar fractures is a challenging clinical problem, and optimal management of these fractures remains controversial. Similar to unilateral subcondylar fractures, bilateral injuries present with significant malocclusion due to fracture segment displacement; however, the loss of vertical stops on both sides of the mandible mandate a more concerted approach to surgical management. Closed reduction and maxillomandibular fixation (MMF) alone in bilateral subcondylar fractures carry a higher risk of recurrent anterior open bite postoperatively secondary to the absence of a vertical stop with fracture segment displacement and persistent shortening of the posterior facial height. Therefore, some surgeons consider bilateral subcondylar fractures an indication for open reduction and internal fixation (ORIF). Unfortunately, open approaches involving the proximal subcondylar fracture segment are riddled with potential risks including facial nerve damage, parotid gland injury, and temporomandibular joint (TMJ) damage. Given that neither approach is optimal, investigation of new approaches for the treatment of bilateral subcondylar fractures is warranted. The objective of this paper is to present our novel technique for the treatment of bilateral subcondylar fractures, which utilizes a combination of traditional closed reduction and MMF with a custom “wedge” occlusal splint to overcorrect the traumatic shortening of the posterior mandibular height.

Quickshot PresentationAbstracts healing. Our study indicates that modulating mechanical stress directly affects myeloid cell phenotypes and interactions with other cell types in the complicated, multicellular milieu of wound healing. This principle has been previously unexplored in the context of fibrosis and regeneration, with most previous studies focused on fibroblast heterogeneity and transcriptional profiles. To our knowledge, this is the first study to directly investigate the effects of modulating mechanotransduction on immune cell response at the single cell level utilizing parabiosis and wound healing. Collectively, we demonstrate that mechano-immunomodulation of the "early responders" of healing can trigger a cascade of downstream regenerative healing.