Delay in Cleft Lip and Palate Surgical Repair: An Institutional Review on Cleft Health Disparities in an Urban Population.

Access to specialized medical care is critical to decrease complications and minimize long-term morbidity, yet racial disparities in cleft surgery persist as time to initial reconstruction remains delayed among minority patients. Research has demonstrated an average 3-week delay in surgery for minority patients nationally. A retrospective chart review of patient demographics, visit timing, and surgical history was performed for patients who underwent primary cleft lip with or without palate (CL + P) reconstruction between 2002 and 2016 at an urban craniofacial center. Of the 89 children who underwent surgery, 87% were ethnic minorities (58% Hispanic, 25% African-American, 4% Asian/Other). Caucasian children were the earliest to receive CL (3.5 months) and CP (13-months) repair. Minority children trended toward a delay in CL repair, with surgery for African-Americans at 5-months (P = 0.06) and Hispanics at 4.8-months (P = 0.07). Time from first visit to CL surgery showed significant delays for minority, non-English speaking, and public insurance patients; however, for CP repair, male children were delayed from first visit to surgery compared to females (P = 0.03). While there was no statistical difference in age at CL or CP surgical repair among our racial/ethnic cohorts, there were significant racial/ethnic differences in timing spent in the preoperative period for CL. However, racial/ethnic differences decreased as the patients spent more time within the healthcare system. Thus, established, interdisciplinary cleft/craniofacial centers well versed in minority patients can minimize the complex social and cultural factors that contribute to delays in cleft care.

Acute Breast Implant Periprosthetic Cerebrospinal Fluid Collection After Ventriculoperitoneal Shunt Migration: A Case Report and Review of Literature.

Ventriculoperitoneal shunt (VPS) placement is a common neurosurgical procedure with a high rate of distal catheter malfunction. Rarely, the catheter may migrate to other tissues in the body including the breast pockets. There are increasing odds that a patient may undergo both breast augmentation and VPS placement, because breast augmentation is the most common aesthetic surgical procedure. Complications are possible with both surgical procedures. Proximal migration of the distal aspect of a VPS into the breast pocket containing an implant is a rare complication. We hereby present a successful management of VPS migration with implant salvage and culture-directed antibiotics using a careful no touch technique by avoiding breast incision and washout, or percutaneous drainage, and using the existing VPS as an in situ drainage access point for CSF fluid aspiration and culture.