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BackgroundEvaluating outcomes after cleft rhinoplasty can be challenging because of the lack of objective measures that would lead to a more desirable outcome.MethodsThis study is a 10-year retrospective review of 30 consecutive patients who underwent secondary unilateral cleft rhinoplasty performed by a single surgeon. Subjective ratings were made using the Unilateral Cleft Lip Surgical Outcomes Evaluation (UCL SOE), which rates 4 components (nose, cupid's bow, lateral lip, and free vermillion) with a score of 0 to 2. Multiple anthropometric measurements (nostril height ratio, width ratio, medial ¼ height ratio, sill ratio, nostril area ratio, columellar angle, tip projection ratio, and nasolabial angle) were taken using a free National Institutes of Health program, ImageJ. Standardized photographs were compared at T0 (preoperatively), T1 (<6 weeks postoperatively), and T2 (>6 weeks postoperatively).ResultsThere were 30 patients who met our inclusion criteria: 10 males (66.7%) and 20 females (66.7%). Of these patients, 26 (86.7%) had a complete cleft lip and 4 (13.3%) had an incomplete cleft lip. The patients' average age at time of surgery was 16.2 years with a mean follow-up of 17.9 months. Subjective scores in both nasal and overall UCL SOE ratings improved from T0 to T1, 0.7 to 1.2 (P ≤ 0.001) and 3.6 to 4.7 (P ≤ 0.001), respectively. Visual analog scores in nasal and overall UCL SOE ratings improved between T0 and T2, 0.7 to 0.9 (P = 0.023) and 3.6 to 4.8 (P = 0.002), respectively. Of all the objective measures, nasal sill ratio and cleft height to width ratio correlated with improved subjective ratings across multiple time points.ConclusionsOur study shows that objective measures such as nasal sill and nostril shape (cleft height to width ratio) correlate with improved subjective visual analog scale using the UCL SOE. The nasal sill is an often overlooked, yet essential, part of creating an aesthetically pleasing nose during cleft rhinoplasty.

Metabolic syndrome (MetS), characterized by hyperglycemia, obesity, and hyperlipidemia, can increase the risk of developing late‐onset dementia. Recent studies in patients and mouse models suggest a putative link between hyperphosphorylated tau, a component of Alzheimer's disease‐related dementia (ADRD) pathology, and cerebral glucose hypometabolism. Impaired glucose metabolism reduces glucose flux through the hexosamine metabolic pathway triggering attenuated O‐linked N‐acetylglucosamine (O‐GlcNAc) protein modification. The goal of the current study was to investigate the link between cognitive function, tau pathology, and O‐GlcNAc signaling in an aging mouse model of MetS, agouti KKAy+/−. Male and female C57BL/6, non‐agouti KKAy−/−, and agouti KKAy+/− mice were aged 12–18 months on standard chow diet. Body weight, blood glucose, total cholesterol, and triglyceride were measured to confirm the MetS phenotype. Cognition, sensorimotor function, and emotional reactivity were assessed for each genotype followed by plasma and brain tissue collection for biochemical and molecular analyses. Body weight, blood glucose, total cholesterol, and triglyceride levels were significantly elevated in agouti KKAy+/− mice versus C57BL/6 controls and non‐agouti KKAy−/−. Behaviorally, agouti KKAy+/− revealed impairments in sensorimotor and cognitive function versus age‐matched C57BL/6 and non‐agouti KKAy−/− mice. Immunoblotting demonstrated increased phosphorylated tau accompanied with reduced O‐GlcNAc protein expression in hippocampal‐associated dorsal midbrain of female agouti KKAy+/− versus C57BL/6 control mice. Together, these data demonstrate that impaired cognitive function and AD‐related pathology are associated with reduced O‐GlcNAc signaling in aging MetS KKAy+/− mice. Overall, our study suggests that interaction of tau pathology with O‐GlcNAc signaling may contribute to MetS‐induced cognitive dysfunction in aging.

Metabolic syndrome (MetS) refers to a cluster of anomalies including type 2 diabetes, obesity, insulin resistance and dyslipidemia. Patients with MetS are 1.5 times more likely to develop late‐onset Alzheimer’s Disease (AD), with impaired glucose metabolism, defective insulin signaling, increased oxidative stress and inflammation being shared between the comorbid diseases. Notably, risk of AD is profoundly enhanced in the aging MetS population. Recent studies in AD patients and AD mouse models suggest a putative link between hyperphosphorylated tau neurofibrillary tangles, a commonly accepted AD pathology, and cerebral glucose hypometabolism. Impaired glucose metabolism is characterized by reduced glucose flux through the hexosamine metabolic pathway triggering attenuated signaling via O‐linked N‐acetylglucosamine (O‐GlcNAc) transferase (OGT), a major regulator of intracellular protein O‐GlcNAcylation. However, the role of OGT in the etiology of MetS‐induced AD remains incompletely understood. The goal of the present study was to examine the link between cognitive function, AD pathology and OGT signaling in a mouse model of MetS (KKAy+/−) that develops increased body weight, hyperglycemia, elevated total cholesterol and total triglyceride levels. Briefly, male and female obese agouti KKAy+/−, lean non‐agouti KKAy−/− and normal C57BL/6 control mice weaned at 4 wks of age on regular chow diet were subjected to periodic body weight and random blood glucose monitoring followed by a battery of behavioral tests at 12+ months of age. Plasma and brain (frontal cortex and hippocampus) tissues were then harvested from each genotype for biochemical and molecular studies. In an object recognition test of attention and memory, obese KKAy+/− mice showed a more severe impairment in discrimination between a novel and familiar object compared to lean KKAy−/− and normal C57BL/6 mice. Additionally, in a test of spontaneous activity obese KKAy+/− mice made significantly fewer rears vs lean KKAy−/− mice and wild‐type C57BL/6 controls; these results suggest diminished cognitive function in the obese KKAy+/− mice. Furthermore, immunoblotting of brain tissue lysates derived from the agouti KKAy+/− mice revealed increased ptau expression coupled with reduced pERK (signaling mediator of neuronal function) and pGSK (inactive form of tau kinase GSK3β) expression compared to non‐agouti KKAy−/−. Importantly, augmented tau phosphorylation was concomitant to attenuated OGT expression in brain lysates of obese KKAy+/− mice. Together, these data demonstrate a direct association between cognitive dysfunction, AD‐related pathology and reduced OGT expression in aged MetS KKAy+/− mice. Overall, our study implicates a role of OGT in MetS‐induced cognitive decline and AD pathogenesis. Support or Funding Information NEOMED Start‐Up Funds

Background: The United States Food and Drug Administration’s (FDA) Manufacturer and User Facility Device Experience (MAUDE) database provides access to device related adverse event reports. This database mandates national reporting of complications that lead to “death and serious injury” by manufacturers, importers, and device user facilities. This study used MAUDE to conduct post-market surveillance of pediatric mandibular distraction osteogenesis (MDO) hardware. Methods: A MAUDE database search with terms related to mandibular distraction was performed for report dates between October 1st, 2011, and October 1st, 2021. Duplicate reports, reports from literature reviews, and vague reports were removed. Manufacturers were contacted to establish which devices were pediatric-use-only. Adult-use and mixed-use devices were excluded. Each remaining report was manually reviewed/categorized to compile summative data. Results: Seventy pediatric-use-only device reports were identified. The damaged/non-functioning part of the device included the distractor itself (57.14% of reports), footplate(s) (37.14%), or screw(s) (5.71%). Intraoperative and postoperative complications made up 15.71% and 84.29% of reports, respectively. Twenty percent of complications occurred during the activation phase and 1.43% occurred during device removal. The most common report was failure of the device to advance (37.14% of total complications). Some form of operative treatment or explantation was performed for 51.43% and 34.29% of complications, respectively. External distractors and related hardware made up 8.6% of reports and the most common complication in this group was the screw backing out at 33.3% of all reports. Conclusions: The MAUDE database is a useful tool in evaluation of MDO device-related incidents. Most complications occur in the postoperative period, during the distraction phase, and often require device removal. The most common complication in external distractors was screws backing out. Mindful activation of the distractor, careful device/screw handling, technical improvement of the devices, and thorough preoperative planning may minimize these untoward events.

Objective. A retrospective cross-sectional analysis was conducted of the US Food and Drug Administration's MAUDE (Manufacturer and User Facility Device Experience) database, to evaluate the complication profile of cochlear implantation according to manufacturer. Methods. A review of the MAUDE database was conducted from 1 January 2010 to 31 December 2020. Complications, including infection, extrusion, facial nerve stimulation, meningitis and cerebrospinal fluid leak, were identified using key word searches. The categorised data were analysed using a chi-square test to determine a difference in global complication incidence between three major cochlear implant manufacturers: manufacturer A (Cochlear Limited), manufacturer B (Med-El) and manufacturer C (Advanced Bionics). Results. A total of 31 857 adverse events were analysed. Implants of manufacturer C were associated with a statistically higher rate of infection (0.97 per cent), cerebrospinal fluid leak (0.07 per cent), extrusion (0.44 per cent) and facial nerve stimulation (0.11 per cent). Implants of manufacturer B were associated with a statistically higher rate of meningitis (0.07 per cent). Conclusion. Consideration of patient risk factors along with cochlear implant manufacturers can heighten awareness of cochlear implant complications pre-operatively, intra-operatively and post-operatively.

Background: The anterolateral thigh free flap is an option for repairing soft tissue defects of the distal lower extremity. This flap uses the descending branch of the lateral circumflex femoral (LCF) artery as the flap vessel. The recipient vessel in these flaps is often the anterior tibial (AT), posterior tibial (PT), or peroneal (P) arteries. Computational fluid dynamic (CFD) evaluation of anastomoses between these vessels can optimize outcomes. Methods: Thirty-eight CFD models were created to model ETS and ETE anastomoses for lower extremity reconstruction. 7/38 models represented ETS anastomoses between the LCF and AT arteries with varying anastomotic angles. 9/38 models represented 45-degree ETS anastomoses between varying diameters of the LCF and AT, PT, and P arteries. 9/38 models represented stenosis on the flap vessel and recipient vessel, pre- and post-bifurcation. 9/38 models represented ETE anastomoses, rather than ETS, with varying vessel diameters. 4/38 models represented ETE anastomoses with varying regions and levels of stenosis. Results: Stasis of blood flow in ETS models increased as anastomotic angle increased in a logarithmic relationship (R2 = 0.918). Flow was optimized overall as flap and recipient vessel diameters approached one another. In ETS models, flap vessel and post-bifurcation recipient vessel stenosis was found to substantially increase stasis. Conclusions: Selection of flap and recipient vessels with similar diameters can optimize outcomes in microvascular anastomoses. In the context of lower extremity reconstruction with the ALT flap, the PT artery can be recommended as a first-line recipient vessel due to its similar vessel caliber to the LCF and relative ease of surgical access compared to the P artery. Avoidance of areas of stenosis is recommended to ensure laminar flow and reduce operative difficulty associated with performing anastomoses on nonpliable arteries. Striving for increased acuity of anastomotic angles is recommended to optimize flow in ETS microvascular anastomoses.