Evaluating International Diagnostic, Screening, and Monitoring Practices for Craniofacial Microsomia and Microtia: A Survey Study

Ronde, Elsa M.; Nolte, J.W.; Kruisinga, Frea; Maas, Saskia M.; Lapid, Oren; Ebbens, Fenna A.; Becking, A.G.; Breugem, Corstiaan C.

doi:10.1177/10556656221093912

Cited by 6 publications

(5 citation statements)

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“…Our response rate was similar to other survey based research, and all regions were represented. [2][3][4][5] The largest demographic was 61-70 years of age. This demographic will be transitioning out of the workforce in the near future suggesting that a shortage of academic OMFS orthognathic surgeons may occur.…”

Section: Discussionmentioning

confidence: 99%

Current Orthognathic Surgery Practice Patterns Among Academic OMS

Bourne

Kinard

2023

The Cleft Palate Craniofacial Journal

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Objective Currently there is variation in perioperative care of orthognathic surgery patients and limited clinical practice guidelines. The current orthognathic surgery practice patterns among US academic OMFS training centers have not been described. The purpose of this study is to describe the practice patterns among US academic OMFS training centers. Design The study design is cross-sectional. Data was collected through a survey of the sample. Setting OMFS programs in the US. Participants Academic OMFS. 573 surgeons were contacted and 85 responses were received. Main Outcome Measure Descriptive and bivariate statistics were reported. Results Respondents were 87% male and worked in full-time academic (80%), part-time academic (19%), or military settings (1%). Thirty-one percent have practiced for 30 years or more and then 29% with 11–20 years, 18% with 21–30 years, 12% with 6–10 years and 11% with 1–5 years. Twenty-six percent of respondents perform 20–40 orthognathic surgeries a year, 22% perform less than 20 surgeries a year, 21% perform 40–60 surgeries per year, and 19% perform more than 100 surgeries per year. Intraoperatively, 48% of surgeons request a mean arterial pressure of 60–64 mmHg, 25% utilize tranexamic acid (TXA), 85% report a blood loss of less than 400 milliliters, and 93% report a blood transfusion rate of <1%. Conclusion There are variations in orthognathic surgery practice patterns with limited clinical practice guidelines. Only 13 of the 32 survey questions had a single response holding a simple majority. This study demonstrates the need for further research and evidence-based protocols and decision making.

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Section: Discussionmentioning

confidence: 99%

Current Orthognathic Surgery Practice Patterns Among Academic OMS

Bourne

Kinard

2023

The Cleft Palate Craniofacial Journal

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“…1 It can occur with or without apparent asymmetry of the face, a widely accepted feature of craniofacial microsomia, 2 where some even consider microtia a mild form of this condition. 3 Ear reconstruction may be considered due to esthetic, functional or psychosocial reasons 4 and is traditionally performed using an implant shaped from autologous costal cartilage (ACC). 5,6 Alternatively, alloplastic porous polyethylene implants (PPE) and osseointegrated (OIP) or adhesive-retained (ARP) auricular prostheses may provide good esthetic results without rib donor site morbidity.…”

Section: Introductionmentioning

confidence: 99%

“… 1 It can occur with or without apparent asymmetry of the face, a widely accepted feature of craniofacial microsomia, 2 where some even consider microtia a mild form of this condition. 3 …”

Section: Introductionmentioning

confidence: 99%

Stakeholders’ Views on Information Needed in a Patient Decision Aid for Microtia Reconstruction

Ronde

Lücht

Lachkar

et al. 2023

The Cleft Palate Craniofacial Journal

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Objective To assess which information about microtia and the possible reconstructive options health care providers (HCPs), patients and parents believe should be included in a patient decision aid (PtDA). Design A mixed-methods study comprised of an online survey of HCPs and focus group discussions with patients and parents. Participants Survey respondents were members of the International Society for Auricular Reconstruction (ISAR). Focus group participants were patients with microtia and their parents, recruited through the microtia outpatient clinic at Amsterdam UMC, and through a Dutch patient organization for cleft and craniofacial conditions. Methods An online, investigator-made survey was sent to ISAR members in December 2021. Semi-structured focus group discussions were held in February 2022. Quantitative results were summarized, and qualitative results were thematically grouped. Results Thirty-two HCPs responded to the survey (response rate 41%). Most respondents (n = 24) were plastic surgeons, who had a median of 15 years of experience (IQR: 7-23 years). Two focus groups were held with a total of five patients and two parents. HCPs, patients and parents generally agreed on the information needed in a PtDA, emphasizing the importance of realistic expectation management. Patients and parents also considered psychosocial and functional outcomes, patient experiences, as well as patients’ involvement in decision-making important. Conclusions A PtDA for microtia reconstruction should target all patients with microtia, and include information on at least technique-related information, expected esthetic results, possible adverse effects, psychosocial and functional outcomes and patient experiences. Preference eliciting questions should be developed for both pediatric patients and their parents.

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“…Eye, vertebral, and other extracraniofacial anomalies may also be present ( Caron, Pluijmers, Wolvius, et al, 2017 ; Raposo et al, 2022 ; Renkema et al, 2017 , 2018 ; Rooijers et al, 2020 ; Yang et al, 2016 ). Because of the complex presentation of both anatomic and functional findings, multidisciplinary craniofacial care throughout childhood is recommended for children with CFM ( Heike et al, 2013 ; Ronde et al, 2023 ; Vong & Funamura, 2018 ). For the purposes of this review, we consider CFM to include hemifacial microsomia, oculo-auriculo-vertebral spectrum, Goldenhar syndrome, first and second branchial arch syndrome, and microtia not associated with a defined syndrome ( Barisic et al, 2014 ; Keogh et al, 2007 ; Rollnick et al, 1987 ; Tasse et al, 2005 ).…”

mentioning

confidence: 99%

“…These effects include hearing loss in over 50% of individuals ( Rooijers et al, 2022 ), chewing and swallowing disorders in over 25%, and obstructive sleep apnea in up to 18% of children with CFM ( Caron et al, 2018 ; Caron, Pluijmers, Maas, et al, 2017 ). In contrast, information regarding the prevalence, etiology, and severity of speech disorders in CFM is limited ( Ronde et al, 2023 ). This limited evidence likely contributes to the lack of established standards of care for speech evaluation in this population.…”

mentioning

confidence: 99%

Characterizing Speech Phenotype in Individuals With Craniofacial Microsomia: A Scoping Review

Kinter,

Kotlarek,

Meehan

et al. 2024

Am J Speech Lang Pathol

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Introduction: Craniofacial microsomia (CFM) is a complex congenital condition primarily affecting the ear, mandible, facial nerve and muscles, and tongue. Individuals with CFM are at increased risk of hearing loss, obstructive sleep apnea, and feeding/swallowing difficulties. The purpose of this scoping review was to summarize evidence pertaining to speech production in CFM. Method: All articles reporting any characteristic of speech production in CFM were included and screened by two independent reviewers by title, abstract, and full text. Data charting captured details related to study population and design, CFM diagnostic criteria, speech outcome measurement, and key findings. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist guided reporting of results. Our protocol was registered on the Open Science Framework (https://osf.io/npr94/) and published elsewhere. Results: Forty-five articles were included in the detailed review. Most articles originated from the United States, were published in the past decade, and utilized case report/series study design. A speech-language pathologist authored 29%. The prevalence of velopharyngeal insufficiency ranged from 19% to 55% among studies. Oral distortion of alveolar and palatal fricatives and affricates primarily characterized articulation errors. Studies identified increased disordered speech and lower intelligibility in adolescents with CFM compared to unaffected peers. Evidence pertaining to phonatory and respiratory speech findings is limited. Conclusions: Evidence supports that individuals with CFM are at increased risk of both velopharyngeal and articulatory speech differences. Additional information is needed to develop speech screening guidelines for children with CFM. Heterogeneity in study design and outcome measurement precludes comparisons across studies. Supplemental Material: https://doi.org/10.23641/asha.24424555

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Evaluating International Diagnostic, Screening, and Monitoring Practices for Craniofacial Microsomia and Microtia: A Survey Study

Cited by 6 publications

References 56 publications

Current Orthognathic Surgery Practice Patterns Among Academic OMS

Current Orthognathic Surgery Practice Patterns Among Academic OMS

Stakeholders’ Views on Information Needed in a Patient Decision Aid for Microtia Reconstruction

Characterizing Speech Phenotype in Individuals With Craniofacial Microsomia: A Scoping Review

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