Postbiotic lactobacilli induce cutaneous antimicrobial response and restore the barrier to inhibit the intracellular invasion of Staphylococcus aureus in vitro and ex vivo.

Intracellular pathogens including Staphylococcus aureus contribute to the non-healing phenotype of chronic wounds. Lactobacilli, well known as beneficial bacteria, are also reported to modulate the immune system, yet their role in cutaneous immunity remains largely unknown. We explored the therapeutic potential of bacteria-free postbiotics, bioactive lysates of lactobacilli, to reduce intracellular S. aureus colonization and promote healing. Fourteen postbiotics derived from various lactobacilli species were screened, and Latilactobacillus curvatus BGMK2-41 was selected for further analysis based on the most efficient ability to reduce intracellular infection by S. aureus diabetic foot ulcer clinical isolate and S. aureus USA300. Treatment of both infected keratinocytes in vitro and infected human skin ex vivo with BGMK2-41 postbiotic cleared S. aureus. Keratinocytes treated in vitro with BGMK2-41 upregulated expression of antimicrobial response genes, of which DEFB4, ANG, and RNASE7 were also found upregulated in treated ex vivo human skin together with CAMP exclusively upregulated ex vivo. Furthermore, BGMK2-41 postbiotic treatment has a multifaceted impact on the wound healing process. Treatment of keratinocytes stimulated cell migration and the expression of tight junction proteins, while in ex vivo human skin BGMK2-41 increased expression of anti-inflammatory cytokine IL-10, promoted re-epithelialization, and restored the epidermal barrier via upregulation of tight junction proteins. Together, this provides a potential therapeutic approach for persistent intracellular S. aureus infections.

Snowflake Amniotic Membrane in Scalp Reconstruction for Pitbull Bite.

Amniotic membrane, derived from the innermost placenta, is widely employed in surgery to help regenerate soft tissue and promote re-epithelialization. The authors detail a case report of a 59-year-old female who presented with a large, full-thickness scalp avulsion injury (13 × 10 cm) after being attacked by her pet pitbull. Innovative application of "snowflake" or fragmented amniotic membrane to her wound bed was used during both stages of scalp reconstruction: irrigation and debridement with Integra biological membrane placement and later split-thickness skin grafting. The patient had an uncomplicated recovery with a satisfactory cosmetic outcome. The authors believe that the "snowflake" application of amniotic membrane played an important role in forming healthy granulation tissue and optimizing the wound bed for definitive coverage. "Snowflake" amniotic membrane may help maximize its mechanical and biological benefits and holds promise to be an important adjunctive treatment for surgical wound healing.

Odontogenic Cutaneous Fistula: A Zombie Diagnosis.

BACKGROUND: Odontogenic cutaneous fistula (OCF) is a pathologic communication between the cutaneous surface of the face and oral cavity. Majority of oral cutaneous fistulas are reported to arise from chronic dental infection. Delay in treatment may result in chronic tissue injury as well as cosmetic deformities. Lesions are often misdiagnosed, leading to delayed management. Misdiagnosis may be the result of the variability of clinical morphological presentation and location of lesions compounded by the lack of knowledge that these lesions can have dental etiology. It is estimated that half of patients with OCF undergo multiple dermatologic surgical operations, antibiotic regimens, and other excisions and biopsies before a correct diagnosis is made. Herein, we present a systematic review to detail cases of odontogenic cutaneous lesions that had been previously misdiagnosed or managed inappropriately. In addition, we include a case report from our own institution. The aims are to demonstrate various presentations of OCF, increase awareness of plastic surgeons and oral maxillofacial surgeons to this pathological condition, and reinforce the importance of prompt diagnosis and treatment. METHODS: The study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A literature search was conducted in PubMed, Web of Science, and Cochrane databases from January 1, 2013 to July 24, 2023. The following search terms were utilized: "odontogenic cutaneous fistula" OR "odontogenic cutaneous sinus." RESULTS: Twenty-three articles published between 2013 and 2023 were included in this review. In addition, we report a case from our own institution. A total of 28 cases were included in the review. CONCLUSIONS: Diagnosis of OCF is challenging for numerous reasons. Misdiagnosis can lead to multiple trials of antibiotics and surgical procedures as well as reoccurrence of the lesion. Cases summarized highlight the importance of communication between oral maxillofacial surgery, plastic surgery, other medical subspecialists, and dentists in the evaluation of patients with head and neck lesions. Physicians should consider dental etiology in the differential diagnosis of orofacial skin lesions, even if teeth appear normal on oral examination.

Nasopharyngoscopic Evaluation of Velopharyngeal Closure During Speech.

Definitive oronasal separation through closure of the velopharyngeal (VP) sphincter is necessary for the development of normal speech and feeding. Individuals with velopharyngeal incompetence or insufficiency often exhibit hypernasal speech, poor speech intelligibility, and nasal regurgitation. Assessment of VP sphincter function using nasopharyngoscopy is a key element in identifying VP dysfunction. A foundational understanding of normal anatomy and physiology of the velopharyngeal mechanism is paramount to successful diagnosis. This includes recognition of 4 distinct VP sphincter closure patterns: coronal, sagittal, circular, and circular with Passavant's ridge. In this study, the authors showcase 2 patients with velopharyngeal competence who presented to an ear, nose, and throat clinic for nasopharyngoscopic evaluation. This study sought to demonstrate the use of nasopharyngoscopy to recognize velopharyngeal closure patterns and discuss how they may influence the surgical management of VP dysfunction.

The Top 100 Most-Cited Publications in Clinical Craniofacial Research.

INTRODUCTION: Craniosynostosis is a birth defect defined as premature closure of sutures leading to possible neurological deficits and cosmetic deformities. Most of the current literature to date focuses on craniosynostosis etiology by analyzing genetics. This paper is a bibliometric analysis of the most influential works related to the clinical management of craniosynostosis to help guide clinicians in their decision-making. METHODS AND MATERIALS: Clarivate Web of Science database was used to identify the top 100 most-cited articles addressing the clinical management of craniosynostosis. A bibliometric review was performed to analyze publication metrics and track research trends. RESULTS: The 100 most-cited publications pertaining to craniosynostosis management were cited a cumulative 12,779 times. The highest cited article was Shillito and colleagues' "Craniosynostosis: A Review Of 519 Surgical Patients" with 352 citations. The oldest clinical craniosynostosis article dates back to 1948, and the most recent was published in 2016. The year with the most clinical-focused publications was 2011. The most prolific author was Renier, D. The United States produced 56 of the 100 articles. Most articles (n=52) were level 3 evidence. DISCUSSION: This bibliometric evaluation of craniosynostosis provides insight into the most impactful literature on this topic. The highest cited articles retrospectively analyze large sample sizes, outline proper evaluation, discuss intervention timelines, and highlight specific treatment plans for this birth defect. By filtering through existing literature, this analysis can guide clinicians on the management of craniosynostosis to maximize patient outcomes.

Application of 3D Printing in Cleft Lip and Palate Repair.

This manuscript reviews the transformative impact of 3-dimensional (3D) printing technologies in the treatment and management of cleft lip and palate (CLP), highlighting its application across presurgical planning, surgical training, implantable scaffolds, and postoperative care. By integrating patient-specific data through computer-aided design and manufacturing, 3D printing offers tailored solutions that improve surgical outcomes, reduce operation times, and enhance patient care. The review synthesizes current research findings, technical advancements, and clinical applications, illustrating the potential of 3D printing to revolutionize CLP treatment. Further, it discusses the future directions of combining 3D printing with other innovative technologies like artificial intelligence, 4D printing, and in situ bioprinting for more comprehensive care strategies. This paper underscores the necessity for multidisciplinary collaboration and further research to overcome existing challenges and fully utilize the capabilities of 3D printing in CLP repair.

An Evaluation of Autologous Fat Injection as a Treatment for Velopharyngeal Insufficiency: A Review and Integrated Data Analysis.

BACKGROUND: Velopharyngeal insufficiency (VPI) is a condition characterized by incomplete separation of the oral and nasal cavities during speech production, thereby leading to speech abnormalities and audible nasal emissions. Subsequently, this adversely impacts communication and potentially interpersonal social interactions. Autologous fat grafting (AFG) to the velopharynx, a minimally invasive technique, aims to improve oronasal separation by providing bulk and advancing the posterior pharyngeal wall toward the soft palate. Despite its potential, the relative novelty of AFG in treating VPI has resulted in reporting of inconsistent indications, varied surgical techniques, and mixed outcomes across existing literature. METHODS: This systemic review examined the evidence of AFG for VPI treatment over the past decade (2013-2023). A thorough search across five electronic databases yielded 233 studies, with 20 meeting the inclusion criteria (e.g., utilized fat injection as their selected VPI treatment, conducted study in human subjects, did not perform additional surgical procedure at time of fat injection). Selected studies encompassed patient and surgical intervention characteristics, perceptual speech assessment (PSA) scores, gap sizes, nasalance measurements, and complications. RESULTS: The majority of patients had a prior cleft palate diagnosis (78.2%), in which nasoendoscopy was the prevalent method for visualizing the velopharyngeal port defect. Fat harvesting predominantly occurred from the abdomen (64.3%), with an average injection volume of 6.3 mL across studies. PSA and subjective gap size scores were consistently higher preoperatively than postoperatively. PSA score analysis from seven studies revealed significant and sustained improvements postoperatively. Gap size score analysis from four studies demonstrated similar preoperative and postoperative differences. Complications were reported in 17 studies, yielding a 2.7% summative complication rate among 594 cases. CONCLUSIONS: Autologous fat grafting has emerged as a minimally invasive, safe, and effective treatment for mild to moderate VPI. However, challenges remain because of variability in patient selection criteria, diagnostic modalities, and outcome measurements. This review underscores the need for randomized control trials to directly compare AFG with standard-of-care surgical interventions, providing more conclusive evidence of its clinical efficacy.

Management of Maxillofacial Trauma in Pregnant Women.

INTRODUCTION: Trauma during pregnancy deserves special attention as management must be directed towards both the mother and the fetus. Management of maxillofacial fractures in pregnancy can adversely affect the well-being of the fetus by impinging on normal functions such as respiration, mastication, and nutrition. Pregnancy complicates the management of facial injury due to the maintenance of the patent airway, anesthesia considerations, and imaging restraints. The purpose of this study is to use three illustrative from our own institution to further elucidate education on the management of mandible fracture in pregnancy with a focus on multidisciplinary treatment and outcomes. METHODS: A retrospective chart review was performed for all cases of facial fractures admitted to Ryder Trauma Center from 2012 to 2022. During this time, 4,910 patients presented with facial fractures 1319 patients were female. Three of the patients were pregnant at the time of admission. Demographics, mechanism of injury, associated injuries, and management information were collected. RESULTS: Patient 1 was a 20-year-old female presented to Ryder Trauma Center following a motor vehicle collision. She was 17 weeks pregnant at the time of admission and was found to have a left mandibular angle fracture. Patient 2 was a 14-year-old female who presented to Ryder Trauma Center status post gunshot wound to the mandible after she and her brother were unknowingly playing with a loaded gun. She was 18 weeks pregnant at the time of admission, with a past medical history of domestic violence, suicidal ideation, and major depressive disorder. Patient 3 was a 20-year-old female 36 weeks pregnant at the time of admission. She presented with a right paraymphyseal fracture and left mandibular angle fracture as a result of falling on the stairs. Patients all underwent surgical repair of fractures.

Yard Work and Gardening: A Pastime with Potential for Craniofacial Injury.

INTRODUCTION: Yard and garden tools are increasingly used by Americans. Despite the growing popularity of gardening as a leisure activity, the rate of injury associated with these tools remains remarkedly high. Previous research has highlighted the risks associated with improper handling of tools and associated potential long-term consequences. This retrospective study aims to provide a comprehensive analysis of the craniofacial injuries caused by yard and garden equipment. The investigation will emphasize the need for improved safety measures and regulations. METHODS AND MATERIALS: Publicly available data from the National Electronic Injury Surveillance System (NEISS) database were utilized to identify craniofacial injuries related to yard and garden tool handling during a 10-year period (2013-2022). Study population included patients aged 1 to 85+ years who visited emergency departments secondary to these injuries. Data analysis involved queries for specific products and diagnostic codes related to craniofacial injuries. RESULTS: Over the study period, a total of 588,384 craniofacial injuries associated with yard and garden tools were recorded, averaging 58,838 injuries annually. Men accounted for a significantly higher proportion of injuries (69.2%) compared to women (30.8%). Elderly population, particularly those aged 60 to 64 years, experienced the highest incidence of craniofacial injuries. Cranium was the most commonly affected anatomical location, comprising 34% of all injuries. Lacerations and contusions were the most frequent injury diagnoses. Greenhouse or gardening supplies and lawnmowers are the most common causative agents, respectively. DISCUSSION: Our study highlights the persistent incidence of craniofacial injuries associated with yard and garden tool handling emphasizing the need for standardized safety regulations and guidelines. Sociological and demographic factors, such as differences in gardening habits and behavioral patterns between genders, contribute to the observed disparities in injury rates. Understanding the underlying factors contributing to these craniofacial injuries is crucial to promoting safer practices and reducing the overall burden associated with yard and garden tools.

Epidemiology of Craniofacial Injuries from Exercise and Weightlifting: A 10-Year Analysis.

INTRODUCTION: Exercise is the cornerstone of a healthy lifestyle. It is recognized for enhancing cardiovascular health and bolstering mental well-being. While the fitness industry grows, the incidence of exercise-related injuries continues to rise. This study examines craniofacial injuries resulting from exercise and weightlifting over the past decade. The goal is to uncover trends, demographics, diagnoses, and patient dispositions. METHODS AND MATERIALS: A retrospective review was conducted using the National Electronic Injury Surveillance System database. Emergency department visits for craniofacial injuries associated with exercise and weightlifting between 2013 and 2022 were analyzed. One-sample t-tests and the Mann-Kendall test were used to evaluate injury prevalence and significant trends. RESULTS: Over the past decade, 582,972 craniofacial injuries related to exercise and weightlifting were documented. Men accounted for 55.7% of cases. Annual incidence increased by 32.7% between 2013 and 2022. It was statistically significant. Adolescents aged 15 to 19 displayed the highest injury rate. Head injuries were most common (45%), followed by face (26%), neck (21%), mouth (4%), eye (3%), and ear (1%). Diagnoses included internal injury (25.2%), laceration (24.8%), contusions/abrasions (12.9%), and strain/sprain (11.9%). Hospitalization was required for only 8.5% of patients. DISCUSSION: This study elucidates the need for injury prevention strategies. Vulnerable subgroups such as males, adolescents, and the elderly demand targeted prevention efforts. Future research should explore specific mechanisms of injury to identify high-risk exercise. This study promotes the need for safe exercise practices and increases awareness of craniofacial injury risks associated with physical activity.

Meralgia Paresthetica as a Result of Surgery With an Emphasis on Harvesting Iliac Bone Grafts: A Review.

Meralgia paresthetica is a neurological disorder characterized by a symptom complex of numbness, burning, tingling, aching, or stabbing in the anterolateral portion of the upper thigh. Typically, this disorder is seen in patients with diabetes mellitus, obesity, and pregnancy. Also, it may result from a wide array of surgical interventions involving the region of the anterior superior iliac spine. Underlying pathophysiology concentrates on entrapment neuropathy of the lateral femoral cutaneous nerve (LFCN). Due to its location and wide anatomic variation, the LFCN is susceptible to compression, scarring, and injury during surgery. It is important to understand the regional anatomy. In addition, the plastic surgeon must have a working knowledge of the most common variations that can precipitate entrapment and increase susceptibility to injury during surgery. Surgeons lacking a substantial background on the numerous risk factors, origins, and anatomic variations of the LFCN may place patients at an even higher risk of damage to the nerve. An extensive knowledge of the anatomy and careful technique may be utilized by surgeons to prevent iatrogenic neuropathy of the LFCN.

Baseball Injury Prevention Through a Community Outreach Initiative.

Sports-related craniofacial injuries account for 10% to 42% of facial fractures in the US pediatric population, with the incidence of injury peaking at ages 6 to 7 and 12 to 14. The National Survey of Children's Health reported ~5.6 million children between the ages of 6 and 17 participated in baseball in 2021. National Electronic Injury Surveillance System reported 861,456 injuries resulting from baseball and 511,117 injuries resulting from softball in 2021, with ~500,000 of those injuries being to the face/head/neck. While participation in baseball and other youth sports has tremendous physical and mental health benefits, facial and other athletic injuries are concerning beyond the pain and disability caused by the incident itself. Severe injury can result in lost time from school as well as other social activities. Players and their families often experience financial strain as a result of physical trauma as well. The use of protective equipment has decreased the incidence of emergency department visits due to baseball-related trauma, especially mouthguards. However, adherence to using mouthguards is relatively low in baseball, with over 80% of players reporting not being told by a coach to wear mouthpieces. Youth from low-income areas often lack financial means to provide protective equipment and health insurance in the case of injury. The authors, along with the University of Miami Miller School of Medicine Division of Plastic and Reconstructive Surgery and Miami Marlins RBI Program, created an outreach program by which over 400 mouthguards were given to players and caretakers at inner-city baseball and softball programs. Two community outreach events took place in South Florida. One event was held at a University of Miami Men's Baseball Game, and another was held on the opening day of the Miami Marlins RBI Program youth baseball league. In addition to handing out protective equipment and informational pamphlets, a question and answers session was held to discuss injury prevention. In conclusion, our community safety initiative created an interactive dialogue and message to hundreds of youth baseball players about the importance of protective gear to prevent injuries.

Unraveling the Enigma: A Rare Case of Recurrent Idiopathic Gynecomastia in an Adolescent.

Gynecomastia presents as abnormal hypertrophy of mammary tissue in males that is typically asymptomatic and usually does not require intervention. Gynecomastia responds well to medical and surgical treatment, when necessary, with low recurrence rates. The authors report an atypical case of recurrent idiopathic unilateral gynecomastia first presenting in an adolescent male. Physical examination, hormonal, and oncologic evaluations were normal. After subcutaneous mastectomy with liposuction and treatment with Tamoxifen at 19 years old, his unilateral gynecomastia recurred over the course of 3 years, requiring a second surgery. Furthermore, we review the literature for recurrent gynecomastia after surgical management to examine prevalence and risk factors.

Jumping Trends In Trampoline-Related Craniofacial Injuries.

INTRODUCTION: In 1990, the American Academy of Pediatrics recommended the sale of trampolines cease in the United States. The risk of traumatic injury is well-documented, yet trampolines remain a growing source of recreation. Trampoline parks, in particular, are becoming a common entertainment attraction that can result in serious injury. There is currently a paucity of literature characterizing craniofacial injuries from trampoline use and plans to prevent these injuries. METHODS AND MATERIALS: A retrospective review of the National Electronic Injury Surveillance System was conducted to analyze emergency department visits for trampoline-related craniofacial injuries in 1 to 20 year olds between 2013 and 2022. RESULTS: An estimated 206,866 trampoline-related craniofacial injuries occurred. Males suffered injuries 1.67 times more frequently than females. Injured sites included the head (41.0%), face (23.2%), neck (20.4%), mouth (11.9%), eyeball (2.0%), and ear (1.4%). The most common diagnoses were lacerations (28.9%), internal injuries (23.2%), strain/sprains (14.8%), contusions/abrasions (13.0%), and concussions (8.7%). Head internal injuries and facial lacerations significantly increased over the observed time period. DISCUSSION: Trampolines are a rising source of craniofacial trauma for America's youth. Children between 3 and 11 years old were disproportionately affected. Regulation over trampoline safety features remains limited in the United States. Future studies should aim to characterize the mechanisms of these injuries for the development of targeted safety measures.

Lessons Learned From Using Silicone Implants in Clean-Contaminated Regions of the Face.

Augmentation rhinoplasty changes the shape of the nose using implanted material. In the 1980s, nasal implantology began to favor silicone over traditional autologous grafts because the synthetic material presented exciting benefits. However, long-term complications of nasal silicone implants have since emerged. This has necessitated the introduction of safe and effective materials. Despite an overwhelming transition to the use of improved implants, craniofacial surgeons will likely continue to see the consequences of silicone implant use as long-term complications arise in the innumerable patients who have had this procedure worldwide.

Diagnosis and Management of Craniofacial Osteomas.

IMPORTANCE: Osteoid osteomas are benign bony overgrowths that can occur in any region of the body. However, they have a predilection to occur in the craniofacial region. Because of the rarity of this entity, there is a lack of literature detailing the management and prognosis of craniofacial osteoid osteomas. OBSERVATIONS: Craniofacial osteomas have a predilection to involve the paranasal sinuses, but can also be found within the jaw, skull base, and facial bones. Because of their slow-growing nature, craniofacial osteomas are often incidentally discovered on routine imaging or after they compress nearby structures or distort nearby anatomy. Osteoid osteomas of the face can be treated with resection via various approaches. Recent advancements describe minimally invasive endoscopic techniques and adjuvant therapy with radiofrequency ablation guided by cone biopsy computed tomography. Osteoid osteomas have an excellent prognosis with complete resection. They demonstrate a low incidence of recurrence when compared with other osteoblastic lesions of the craniofacial structures. CONCLUSIONS AND RELEVANCE: Craniofacial osteoid osteomas remain a developing topic within the field of craniofacial surgery. Their removal may be trending toward minimally invasive techniques. However, all treatment modalities appear to result in improved cosmetic outcomes and low recurrence rates.

A Characterization of Pediatric Craniofacial Injuries from Children's Toys.

INTRODUCTION: Playing with toys contributes significantly to the cognitive, physical, and social development of children. Certain toys, unfortunately, carry the potential for serious craniofacial injury. There is a gap in the literature regarding the comprehensive assessment of toy-related craniofacial injuries. By studying mechanisms of injury and ensuing trauma, our goal is to encourage innovative design and educate caregivers, health care workers, and the Consumer Product Safety Commission on risk mitigation and prevention. METHODS AND MATERIALS: The National Electronic Injury Surveillance System Database was queried to analyze toy-related craniofacial injuries that occurred in children (ages 0-10) between 2011 and 2020. RESULTS: Approximately 881,000 injuries occurred over a 10-year span. Children ages 1 to 5 sustained most injuries, peaking at age 2 (16.3%). Males were injured 1.95 times more frequently than females. Injured sites included the face (43.7%), head (29.7%), mouth (13.5%), ears (6.9%), and eyes (6.2%). The top diagnoses were lacerations (40.4%), foreign bodies (16.2%), internal injuries (15.8%), and contusions (15.8%). The most common causes were scooters (13%), balls (6.9%), toy vehicles excluding riding toys (6.3%), building sets (4.4%), and tricycles (3%). DISCUSSION: This study identifies toys that most frequently cause craniofacial injuries in children. These results provide new information about types of play that should be supervised, and this data helps anticipate injury profiles seen in emergency settings. Future research should study why the products identified are strongly associated with injuries, so safety features can be optimized and designs appropriately altered.

Chronic wound microenvironment mediates selection of biofilm-forming multi drug resistant Staphylococcus epidermidis with capability to impair healing.

Venous leg ulcers (VLU) are the most common chronic wounds characterized by bacterial biofilms and perturbed microbiome. Staphylococcus epidermidis is primarily known as skin commensal beneficial for the host, however, some strains can form biofilms and cause infections. By employing shotgun metagenomic sequencing we show that genetic signatures of antimicrobial resistance, adhesion and biofilm formation in VLU isolates correlate with in vitro bacterial traits. We demonstrate that the capability of chronic wound isolates to form biofilms and elicit IL-8 and IL-1ß expression in human ex vivo wounds, correlates with the non-healing outcomes in patients with VLU. In contrast, commensal strains were incapable of surviving in the human ex vivo wounds. We show that major fitness traits of S. epidermis from VLU involve genes for resistance to methicillin and mupirocin, while the biofilm formation relied on the minimal number of genetic elements responsible for bacterial binding to fibronectin and fibrinogen. This underscores the importance of the emergence of treatment resistant virulent lineages in patients with non-healing wounds.