Faculty Bibliography

ObjectiveTo evaluate caregiver experiences with presurgical lip, alveolus, and nose approximation (PLANA) therapy, including adherence, burden, support, and perceived effectiveness in infants with cleft lip and/or palate.DesignCross-sectional survey study using an anonymous, voluntary questionnaire administered via Research Electronic Data Capture. Descriptive statistics were used to summarize responses, and qualitative responses were analyzed for common themes.SettingSingle tertiary care academic institution.Patients, ParticipantsCaregivers of infants with cleft lip and/or palate undergoing PLANA therapy were identified through institutional records. Of 48 eligible caregivers, 23 unique responses were included.InterventionsPLANA therapy utilizing the NoseAlign device with concurrent lip taping, applied at home with periodic clinical follow-up.Main Outcome Measure(s)Caregiver-reported adherence, training satisfaction, infant tolerance, caregiver burden, perceived support, and perceived effectiveness.ResultsCaregivers reported high satisfaction with training (73.9% very satisfied) and high adherence, with 87.0% reporting consistent use and 100% reporting daily wear. Most reported no feeding interference (86.4%) and good infant tolerance (73.9% comfortable or very comfortable). Caregiver burden was low, with 60.9% reporting minimal impact on daily routines and 78.3% reporting confidence in application. Perceived support from the medical team was uniformly high (100%). Overall, 90.9% were satisfied with outcomes, and 95.7% would recommend PLANA therapy.ConclusionsPLANA therapy demonstrates high caregiver satisfaction, strong adherence, and favorable perceived outcomes. Its simplified design may reduce caregiver burden while maintaining effectiveness. Further studies are needed to evaluate long-term outcomes and cost-effectiveness.

National efforts promoting high-quality cleft care rely on accreditation by the American Cleft Palate-Craniofacial Association (ACPA), though accreditation does not account for regional disease burden. Using U.S. natality and global health datasets (2014-2021), cleft incidence, prevalence, and disability-adjusted life years (DALYs) were compared with trends in ACPA accreditation. While births and cleft incidence declined nationally, accreditation expanded substantially. Conversely, prevalence and DALYs rose regionally without corresponding increases in accredited centers. Several states demonstrated discordant trends between burden and access. These findings suggest misalignment between accredited cleft care availability and evolving geographic disease burden, underscoring the need for data-driven resource planning.

ObjectiveTo assess the incidence of Robin Sequence in the United States and evaluate predictors of early morbidity and mortality.DesignRetrospective cohort study.SettingEpic Cosmos database.Patients, ParticipantsPatients with Robin Sequence diagnosed within the first year of life from January 2015 to December 2024.InterventionsVariables including prenatal drug exposure (PDE), prematurity, intrauterine growth restriction (IUGR), concomitant airway diagnoses, genetic syndromes, and anomalies of the cardiopulmonary, gastrointestinal, or central nervous system (CNS) were captured.Main Outcome Measure(s)Incidence across a 10-year period and associations with admission to the neonatal intensive care unit (NICU) and length of stay (LOS), 30-day readmission and ED visit, and one-year mortality through a multivariate logistic regression.Results3863 patients were identified, for an incidence of 1 in 3713 live births. NICU admission was significantly associated with PDE, prematurity, IUGR, tracheomalacia, laryngomalacia, cleft palate, and presence of a cardiopulmonary or CNS anomaly. NICU LOS was associated with prematurity, bronchomalacia, and the presence of a gastrointestinal anomaly. 30-day readmission was associated with PDE, prematurity, tracheomalacia, laryngomalacia, cleft palate, cardiopulmonary anomalies, and CNS anomalies. 30-day ED visit was associated with prematurity, tracheomalacia, cleft palate, cardiopulmonary anomalies, and CNS anomalies. One-year mortality was associated with prematurity, IUGR, cardiopulmonary anomalies, and CNS anomalies.ConclusionsSignificant associations were identified between morbidity and mortality and perinatal factors, concomitant airway diagnoses, and the presence of cardiopulmonary and CNS anomalies. These findings underscore the importance of an early comprehensive evaluation for patients with Robin Sequence.

Mandibular distraction osteogenesis (MDO) is a common procedure used to correct upper airway obstruction in patients with Robin sequence. However, analysis of predictors of adverse outcomes after MDO has relied on small single-institution cohorts. This retrospective cohort study leveraged the Epic Cosmos multicenter database to evaluate predictors of morbidity and mortality in patients with Robin sequence undergoing MDO from January 2015 to December 2024. A multivariable logistic regression was used to evaluate associations between perinatal factors, airway anomalies, genetic syndromes, and congenital anomalies affecting the cardiopulmonary, gastrointestinal and central nervous system (CNS), and postoperative outcomes including 1-year mortality, tracheostomy, intensive care unit (ICU) admission within 30 days, 30-day hospital readmission, 30-day emergency department visit, ICU length of stay (LOS), and overall hospital LOS. Across a total of 685 patients, CNS anomalies were statistically significantly associated with 1-year mortality; cardiopulmonary anomalies and bronchomalacia were predictive of tracheostomy; tracheal stenosis was associated with ICU admission; CNS anomalies were associated with 30-day emergency department visit; and no variables were significantly associated with 30-day readmission. Age at surgery was inversely associated with longer ICU LOS and overall LOS, whereas prematurity, prenatal drug exposure, gastroesophageal reflux, and CNS anomalies were associated with longer overall LOS. These results highlight the burden of comorbidities of the airway, cardiopulmonary system, and central nervous system for patients with Robin sequence undergoing MDO and can inform surgeons on the likelihood of adverse events based on the diagnostic characteristics of the patient.

INTRODUCTION/BACKGROUND:Nasoalveolar molding (NAM) is a presurgical technique used to improve nasolabial cleft severity prior to repair. This study ascertains the rates of revision surgery in a large cohort of patients with a cleft who underwent NAM and were followed to facial maturity. METHODS:A single-institution retrospective review of all patients with a cleft who underwent NAM from 1995 to 2005 was performed. Operative reports were queried to record intervnetions to the lip and nose performed through facial maturity. Patients with incomplete medical records prior to reaching skeletal maturity were excluded. Pearson correlation coefficient and two-paired student t-tests were employed for data analysis. RESULTS:A total of 81 patients were studied, 46 male and 35 female, with 52(64%) unilateral and 29(36%) bilateral clefts. Average age at last follow-up was 18.8 years. Revision to the lip was carried out in 36(44%) of patients, and only 3(3.7%) prior to reaching facial maturity. Re-repair was performed in 10(12%) patients. No significant difference of lip revisions rates were seen among patients with a bilateral and unilateral cleft (48% v. 37.9%, p=0.38).Immature cleft rhinoplasty was performed in 3(4%) patients, and more commonly among patients with a unilateral (23%) than bilateral cleft (10%), p=0.18. Mature rhinoplasty was performed in 46(57%) patients, similarly between unilateral (58%) and bilateral clefts (55%). Nasal revision following mature rhinoplasty was performed in 8(10%) patients. CONCLUSIONS:Nasoalveolar molding is an effective adjunct to surgical management in reducing the burden of operative revisions as patients reach facial maturity, namely for bilateral clefts.

Presurgical lip, alveolus, and nose approximation (PLANA) is a novel form of presurgical infant orthopedics (PSIO) involving a prefabricated silicone intranasal device combined with hydrocolloid adhesive lip taping. Early studies have demonstrated favorable nasolabial morphologic outcomes using PLANA and a reduction in the burden of care on infants and their caregivers relative to nasoalveolar molding (NAM). However, the efficacy of PLANA in reducing cleft severity to facilitate surgical repair has not been comprehensively assessed from the perspective of the cleft surgeon. This study, therefore, compared surgeon ratings of PSIO outcomes in infants with unilateral cleft lip treated with PLANA and NAM. Two expert surgeons blindly evaluated PSIO outcomes in 10 patients treated with PLANA and 10 patients treated with NAM using standardized pre- and post-PSIO photographs. Surgeons used a 4-point Likert scale to assess improvement in lip approximation, lateral displacement of the subnasale from the midsagittal plane, nasal deviation, alar base width symmetry, alar base height symmetry, columellar angle, columellar length, nostril width symmetry, nostril height symmetry, and nasal tip projection, as well as overall morphologic improvement. The PLANA cohort received statistically significantly greater scores for alar base width symmetry (3.45 versus 2.35, P<0.001), alar base height symmetry (3.40 versus 2.55, P=0.02), columellar angle (3.70 versus 3.10, P=0.05), nostril width symmetry (3.65 versus 2.20, P<0.001), and overall outcome (3.65 versus 2.90, P=0.02). The 2 cohorts received similar ratings across all other parameters. Surgeons consistently rated PSIO outcomes as equivalent or superior with PLANA relative to NAM.

Despite the increasing prevalence of micromobility vehicles, including bicycles, e-bikes, and e-scooters, the burden of neurocranial trauma sustained by pedestrians struck remains understudied. This retrospective observational cohort study compared injury patterns, management, and outcomes between vehicle riders and pedestrians admitted to a level 1 trauma center from 2020 to 2024 for neurocranial trauma. Presence of traumatic brain injury, intracranial hemorrhage, neurocranial fracture, surgical intervention, intensive care unit admission, intensive care unit length of stay, hospital length of stay, 30-day readmission, mortality, and focal neurological deficits on discharge were assessed. χ2 tests and independent-samples t tests were used for comparison between vehicle riders and pedestrians struck. Of the 250 total patients, 70 were pedestrians struck. Pedestrians exhibited significantly greater rates of moderate or severe traumatic brain injury (71.4% versus 56.7%, P=0.032), subdural hematoma (58.6% versus 37.8%, P=0.003), and frontal bone fracture (24.3% versus 13.9%, P=0.048), and were more likely to undergo burr hole evacuation (4.3% versus 0.6%, P=0.035), intracranial pressure monitor placement (5.7% versus 0.6%, P=0.009), and intensive care unit admission (82.9% versus 59.4%, P<0.001). The overall incidence of micromobility-related neurocranial trauma more than doubled (25 in 2020 and 59 in 2024), whereas pedestrian admissions tripled (6 in 2020 and 18 in 2024) during the study period. Pedestrians struck by micromobility vehicles exhibit a growing, underappreciated, and more severe burden of neurocranial trauma than vehicle riders, underscoring the need for targeted prevention strategies.

LEARNING OBJECTIVES/OBJECTIVE:After studying this article, the participant should be able to (1) understand the nonsurgical and surgical techniques and advancements in the management of pediatric head and neck cancers, (2) describe the common management strategies used in pediatric head and neck cancers, and (3) Understand therapies to target head and neck cancers within pediatric patient populations. SUMMARY/CONCLUSIONS:Pediatric head and neck cancer management is complex and often requires a multidisciplinary approach. Management goals aim to deliver a multimodal treatment approach that integrates surgery with concurrent medical management through adjuvant and/or neoadjuvant chemotherapy and/or radiation therapy. Patients in remission should be monitored closely for recurrence or long-term treatment complications. Harmonizing a multidisciplinary approach between pediatric oncologists, hematologists, radiologists, pathologists, and surgeons is a priority. This review discusses advances in management strategies used for common pediatric head and neck malignancies, with a focus on surgical and medical techniques as well as treatment complications that can arise.