Three-Dimensional Printing in Cleft Care: A Systematic Review.

OBJECTIVE: To determine the current applications of 3-dimensional (3D) printing in the care of patients with cleft lip and palate. We also reviewed 3D printing limitations, financial analysis, and future implications. DESIGN: Retrospective systematic review. METHODS: Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were used by 3 independent reviewers. Articles were identified from Cochrane library, Ovid Medline, and Embase. Search terms included 3D printing, 3 dimensional printing, additive manufacturing, rapid prototyping, cleft lip, and cleft palate. Exclusion criteria included articles not in English, animal studies, reviews without original data, oral presentations, abstracts, opinion pieces, and articles without relevance to 3D printing or cleft lip and palate. MAIN OUTCOME MEASURES: Primary outcome measure was the purpose of 3D printing in the care of patients with cleft lip and palate. Secondary outcome measures were cost analysis and clinical outcomes. RESULTS: Eight-four articles were identified, and 39 met inclusion/exclusion criteria. Eleven studies used 3D printing models for nasoalveolar molding. Patient-specific implants were developed via 3D printing in 6 articles. Surgical planning was conducted via 3D printing in 8 studies. Eight articles utilized 3D printing for anatomic models/educational purposes. 3-Dimensional printed models were used for surgical simulation/training in 6 articles. Bioprinting was utilized in 4 studies. Secondary outcome of cost was addressed in 8 articles. CONCLUSION: 3-Dimensional printing for the care of patients with cleft lip and palate has several applications. Potential advantages of utilizing this technology are demonstrated; however, literature is largely descriptive in nature with few clinical outcome measures. Future direction should be aimed at standardized reporting to include clinical outcomes, cost, material, printing method, and results.

Update on extracranial arteriovenous malformations: A staged multidisciplinary approach.

Arteriovenous malformations (AVMs) are vascular lesions that are thought to arise from congenital errors during development of vessels resulting in abnormal connections between arteries and veins. Though most AVMs develop in the brain or spinal cord, they can occur anywhere in the body. These extracranial or peripheral AVMs have a predilection for the head, neck, and limbs. Since these malformations infiltrate normal soft tissue, management requires selective treatment with preservation of normal surrounding architecture. Therefore, they are best addressed through a staged multimodal and multidisciplinary approach, using a combination of different laser, interstitial, intravascular and surgical techniques to specifically target anomalous vessels. The goal of treatment is overall disease improvement and symptom control with interventions that do not result in outcomes worse than the disease itself. Recently, the discovery of somatic and germline mutations in peripheral AVMs have contributed to a better understanding of the pathophysiology, resulting in promising new pharmacologic treatments. Recent evidence suggests that adjuvant medical therapy can enhance and sustain interventional and/or surgical outcomes. Herein we describe how a new understanding of the etiology and physiology of extracranial AVM provides guidance to current treatment approaches.

Assessment of the Learning Curve for Virtual Surgical Planning in Orbital Fractures.

Virtual surgical planning (VSP) is becoming more widely used in maxillofacial reconstruction and can be surgeon-based or industry-based. Surgeon-based models require software training but allow surgeon autonomy. We evaluate the learning curve for VSP through a prospective cohort study in which planning times and accuracy of 7 otolaryngology residents with no prior VSP experience were compared to that of a proficient user after a single training protocol and 6 planning sessions for orbital fractures. The average planning time for the first session was 21 minutes 41 seconds ± 6 minutes 11 seconds with an average maximum deviation of 2.5 ± 0.8 mm in the lateral orbit and 2.3 ± 0.6 mm in the superior orbit. The average planning time for the last session was 13 minutes 5 seconds ± 10 minutes and 7 seconds with an average maximum deviation of 1.4 ± 0.5 mm in the lateral orbit and 1.3 ± 0.4 mm in the superior orbit. Novice users reduced planning time by 40% and decreased maximum deviation of plans by 44% and 43% in the lateral and superior orbits, respectively, approaching that of the proficient user. Virtual surgical planning has a quick learning curve and may be incorporated into surgical training.

HPV-related oropharyngeal cancer: a review on burden of the disease and opportunities for prevention and early detection.

The incidence of oropharyngeal cancer (OPC) related to infection with human papillomavirus (HPV) is rising, making it now the most common HPV-related malignancy in the United States. These tumors present differently than traditional mucosal head and neck cancers, and those affected often lack classic risk factors such as tobacco and alcohol use. Currently, there are no approved approaches for prevention and early detection of disease, thus leading many patients to present with advanced cancers requiring intense surgical or nonsurgical therapies resulting in significant side effects and cost to the health-care system. In this review, we outline the evolving epidemiology of HPV-related OPC. We also summarize the available evidence corresponding to HPV-related OPC prevention, including efficacy and safety of the HPV vaccine in preventing oral HPV infections. Finally, we describe emerging techniques for identifying and screening those who may be at high risk for developing these tumors.

Epitheloid hemangioma treated with naproxen sodium.

UNLABELLED: Epitheloid hemangioma (EH) is a vascular tumor characterized by an epithelioid endothelial cell. Predominantly affecting the head and neck, fewer than 30 cases involving the scrotum have been published. As this represents an extremely rare entity, a multitude of anecdotal treatment modalities have been utilized including systemic/intralesional steroid therapy, radiotherapy, and chemical therapy. However, surgical excision remains the most widely accepted treatment option.We present a case of EH of the scrotum in a 14-year-old male patient that regressed after treatment with naproxen sodium. To the best of our knowledge, this represents the first reported case of scrotal EH regression following treatment with naproxen sodium. LEVEL OF EVIDENCE: V.

A systematic review comparing Furlow double-opposing Z-plasty and straight-line intravelar veloplasty methods of cleft palate repair.

BACKGROUND: A systematic review was conducted to compare the speech outcomes and fistula rates following repair of the cleft palate with Furlow double-opposing Z-plasty and straight-line intravelar veloplasty techniques. METHODS: A systematic search of the English literature published in the MEDLINE, Ovid, and Embase electronic databases was performed using the following keywords: "cleft palate," "intravelar veloplasty," "velopharyngeal insufficiency," and "speech outcome." The exclusion criteria were as follows: syndromic patients, no description or poor description of the technique used, data not stratified by cleft palate type, two-stage cleft palate repair, average age at repair younger than 9 months or older than 18 months, and age at the last follow-up younger than 4 years. Statistical analysis was used to compare the rate of secondary operations and the incidence of velopharyngeal insufficiency. RESULTS: Twelve studies satisfied the inclusion criteria. In the isolated cleft palate group, the mean failure rates were 9.7 and 16.5 percent for Furlow double-opposing Z-plasty and straight-line intravelar veloplasty closure, respectively. In the unilateral cleft lip-cleft palate group, the mean failure rates were 11.1 and 17.1 percent for Furlow and straight-line intravelar veloplasty closure, respectively. The difference in the odds of requiring secondary surgery in the straight-line intravelar veloplasty repair group versus the Furlow group was statistically significant (p=0.03) in unilateral cleft lip-cleft palate. CONCLUSION: This systematic review indicated an increased incidence of velopharyngeal insufficiency as revealed by higher odds of secondary operations in the straight-line intravelar veloplasty repair of unilateral cleft lip-cleft palate when compared with Furlow Z-plasty.