EarWell Infant Ear Molding Device: Experience and Parent Survey.

BACKGROUND: EarWell infant ear molding device is a noninvasive, nonsurgical option to treat ear deformities in early infancy. There are no studies involving the parents' perspective to the use of the EarWell. AIM: To investigate our experience with EarWell infant ear molding device and to assess the parents' satisfaction. STUDY DESIGN: A retrospective case series study of infants with congenital ear deformities who were treated with EarWell device from October 2021 to November 2022. Demographic and clinical data were collected. Clinical photographs were obtained before, during, and after treatment. Parents' satisfaction level was assessed through telephone encounters and surveys, and issues associated with device application were identified. Clinical improvement of ear deformity was graded into poor, fair, good, and excellent. RESULTS: A total of 9 patients with congenital ear deformities were identified and included in this study (7 bilateral deformities and 2 unilateral deformities). The mean adjusted age of the initial treatment is 17 weeks (4-23 weeks), and the mean treatment duration is 5.7 weeks. The authors received full 8 responses from the parents' survey, and all parents were satisfied with post-treatment results (4 satisfied, 1 fully satisfied, and 2 very satisfied). Issues associated with device application were 3 superficial skin ulcers and 4 skin irritation. Clinical Improvement grades were: 5 excellent improvement, 2 good improvement, and 2 fair improvement. CONCLUSIONS: On the basis of our experience, the EarWell device has shown a high success rate and a low complication rate. It is well accepted by parents, but it needs close follow-up to detect minor device-related issues. The device is safe for multiple skin types.

Endoscopic-assisted Surgery in the Treatment of Isolated Frontosphenoidal Craniosynostosis.

Isolated frontosphenoidal craniosynostosis is extremely rare, due to which diagnosis can be challenging. All the isolated cases reported have been treated by open surgical technique. We present a unique case report of an infant with an isolated frontosphenoidal synostosis corrected by a novel endoscopic surgical technique. The patient was a 5-month-old boy with worsening abnormal head shape indicating progressive right frontal bossing, left orbital displacement, and right occipital plagiocephaly. Computed tomography scan confirmed the diagnosis of left isolated frontosphenoidal craniosynostosis. Endoscopic-assisted surgical release was done starting with a 2.5-cm incision in the left temple area followed by a 2-cm strip osteotomy to excise the fused frontosphenoidal suture. Custom-made orthotic helmet therapy was started 2-weeks postsurgery, with excellent progress noted in the head shape confirmed by laser scans. The benefits of the endoscopic technique include smaller incision, decreased blood loss and need for blood transfusion, and decreased stay in hospital. This is the first case report showing the application of a novel endoscopic-assisted surgical treatment in an isolated frontosphenoidal craniosynostosis with no complications noted.

An anatomical composite nasal lining subunit technique in primary cleft nose correction.

Current primary cleft nose correction techniques are associated with a significant rate of long term alar collapse. The nasal lining on the cleft side has been observed to be distorted and deficient. Nasal endoscopy was used to map the two dimensional topography of the anterior nasal airway lining in a normal and patient with unilateral cleft lip. The vestibular nasal subunit was noted to have a triple structural overlap (Lateral crus, valve and vestibule units). A nasal lining subunit based surgical strategy was designed, based on the subunit principle. The lateral crural tethering was released and differential repositioning of the cartilage/lining complex performed. The difference in domal height between the cleft and non-cleft sides was translated into a superior and medial advancement of the cartilage/lining composite subunit. The valve sub-unit defect was resurfaced with a vermilion full thickness graft, taken at the time of primary cleft lip repair. Primary septal relocation was performed and no percutaneous cartilage sutures were done. Pre and post-operative anthropometry measurements were obtained, and repeated at follow up. Complete nasal correction was seen in the unilateral cleft lip patient and was noted to be stable at 1 year follow-up. A novel nasal cartilage/lining subunit topographical map is proposed and forms the basis for a surgical strategy addressing comprehensive correction of the unilateral cleft nasal deformity.