ABSTRACT
OBJECTIVE: To systematically review literature on therapeutic options for treating hemifacial microsomia (HFM), in young patients with growth potential, classifying and comparing the different dentofacial treatment methods. STUDY DESIGN: An independent review of databases (Scopus, Embase, Ovid, Cochrane Library and PubMed) following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA), conducted by four evaluators. The protocol of this study was registered in International prospective register of systematic reviews (PROSPERO), under the number CRD42021293076. RESULTS: Between 1970-2021, a total number of 1137 articles were published of which 27 were included in this study according to the selection criteria: one randomized multicentric trial, two case-control studies, three case series and 21 case reports. CONCLUSIONS: The most common orthopedic treatments provide vertical stimulation of the maxillary process in the affected side. Orthodontic approaches are mainly applied for vertical correction and stabilization of the occlusal plane. Other treatment options include orthognathic surgery, osteogenic distraction, temporomandibular reconstruction and grafting. It is recommended that prospective clinical randomized controlled studies be conducted using homogeneous pediatric groups with long-term follow-up, to establish recommended evidence-based methods for treating each set of hemifacial microsomia symptoms.
Subject(s)
Goldenhar Syndrome , Humans , Child , Goldenhar Syndrome/surgery , Facial Asymmetry/surgery , Treatment Outcome , Retrospective Studies , Prospective Studies , Mandible , Randomized Controlled Trials as TopicABSTRACT
This is a case report of a 52-year-old man who presented with an acute myocardial infarction. In the process of performing an angiogram to delineate the anatomy for possible percutaneous transluminal coronary angioplasty, large, diffuse coronary aneurysms were observed. When the vessel was opened, several aneurysms were seen to contain thrombus. The size, location, and diffuseness of the aneurysms are suggestive of Kawasaki disease.
Subject(s)
Angioplasty, Balloon, Coronary , Mucocutaneous Lymph Node Syndrome/diagnosis , Mucocutaneous Lymph Node Syndrome/therapy , Myocardial Infarction/diagnosis , Myocardial Infarction/therapy , Diagnosis, Differential , Electrocardiography , Humans , Magnetic Resonance Angiography , Male , Middle Aged , Mucocutaneous Lymph Node Syndrome/complications , Myocardial Infarction/complicationsABSTRACT
A successful change program must have clearly delineated and honestly defined goals. Change requires conviction, money, and effort and the willingness to invest all three. Change programs fail when any of these requirements are lacking. Many health care executives have the conviction, but are unwilling to spend the money or expend the effort. Some lack conviction, despite having money; the effort is merely spinning wheels with no forward motion. Often all three are lacking, despite an outward appearance to the contrary--the result of management delusions. Employees are quick to see through misleading and insincere schemes. It is much easier to foster trust from the outset than to rebuild it after it has been violated.
