182 results on '"William P. Magee"'
Search Results
2. D37. An Evaluation of Rapid Palatal Expansion on Velopharyngeal Insufficiency and Speech Outcomes
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Marah I. Jolibois, MS, Collean Trotter, BA, MAT, Idean Roohani, BS, Sasha Lasky, BS, Tayla Moshal, BS, Mark M. Urata, MD, DDS, William P. Magee, III, MD, DDS, and Jeffrey A. Hammoudeh, MD, DDS
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Surgery ,RD1-811 - Published
- 2024
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3. D104. Long-term Outcomes Of A Modified Straight-line Palate Repair Technique: Low Fistula and Speech Correcting Surgery Rates with Single Layer Closure at the Hard-soft Junction
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Sasha Lasky, BS, Marah I. Jolibois, MS, Idean Roohani, BS, Tayla Moshal, BS, Priyanka Naidu, MBChB, MSc, Eric S. Nagengast, MD, MPH, Naikhoba C O Munabi, MD, MPH, and William P. Magee, MD, DDS
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Surgery ,RD1-811 - Published
- 2024
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4. D33. A Comparative Analysis of the Use of rhBMP-2 with Iliac Crest Bone Graft for Alveolar Bone Grafting in Patients with Cleft Lip and Palate: A Review of 527 Cases
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Idean Roohani, BS, Marah I. Jolibois, MS, Sasha Lasky, BS, Tayla Moshal, BS, Simon Youn, DDS, Mark M. Urata, MD, DDS, William P. Magee, III, MD, DDS, and Jeffrey A. Hammoudeh, MD, DDS
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Surgery ,RD1-811 - Published
- 2024
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5. D38. An Algorithm Utilizing Premaxillary Osteotomy in the Management of Patients with Bilateral Cleft Lip
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Marah I. Jolibois, MS, Sasha Lasky, BS, Idean Roohani, BS, Tayla Moshal, BS, Lacey Foster, BS, Mark M. Urata, MD, DDS, William P. Magee, III, MD, DDS, and Jeffrey A. Hammoudeh, MD, DDS
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Surgery ,RD1-811 - Published
- 2024
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6. SP07. An Evaluation Of Rapid Palatal Expansion On Velopharyngeal Insufficiency And Speech Outcomes
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Marah I. Jolibois, MS, Collean Trotter, BA, MAT, Idean Roohani, BS, Sasha Lasky, BS, Tayla Moshal, BS, Mark M. Urata, MD, DDS, William P. Magee, III, MD, DDS, and Jeffrey A. Hammoudeh, MD, DDS
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Surgery ,RD1-811 - Published
- 2024
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7. SP51. Long-term Outcomes Of A Modified Straight-line Palate Repair Technique: Low Fistula And Speech Correcting Surgery Rates With Single Layer Closure At The Hard-soft Junction
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Sasha Lasky, BS, Marah I. Jolibois, MS, Idean Roohani, BS, Tayla Moshal, BS, Priyanka Naidu, MBChB, MSc, Eric S Nagengast, MD, MPH, Naikhoba C O Munabi, MD, MPH, and William P. Magee, MD, DDS
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Surgery ,RD1-811 - Published
- 2024
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8. Safety and Sustainability: Optimizing Outcomes and Changing Paradigms in Global Health Endeavors
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Sri Harshini Malapati, BS, Elie P. Ramly, MD, Johanna Riesel, MD, Andrea L. Pusic, MD, Gordon K. Lee, MD, William P. Magee, MD, and Peter M. Nthumba, MD
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Surgery ,RD1-811 - Abstract
Background:. The need to address inequities in global surgical care has garnered increased attention since 2015, after the Lancet Commission on Global Surgery underscored the importance of ensuring safe, accessible, affordable, and timely surgical and anesthetic care. The vast unmet global plastic surgery needs make plastic surgery care essential in reducing the global burden of disease. In the past, many nonprofit organizations undertook humanitarian activities within low- and middle-income countries that were primarily service-provision oriented. The Lancet Commission on Global Surgery report prompted a shift in focus from direct patient care models to sustainable global surgical models. The realization that 33% of deaths worldwide were due to unmet surgical needs led to a global shift of strategy toward the development of local systems, surgical capacity, and a focus on patient safety and quality of care within international global surgery partnerships. Methods:. In this report, the authors explore some of the primary components of sustainable international global surgical partnerships discussed in a recent panel at the American Society of Plastic Surgeons Plastic Surgery The Meeting 2022, titled “Safety and Sustainability Overseas: Optimizing Outcomes and Changing Paradigms in Global Health Endeavors.” A literature review elaborating the topics discussed was performed. Results:. This report focuses on cultural competence and humility, international collaboration, and the use of technology and innovation, all of which are needed to promote sustainability and patient safety, within global surgery efforts. Conclusions:. The adoption of these components into international surgical collaborations will lead to greatly enhancing the development and sustainability of mutually beneficial relationships.
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- 2023
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9. Lessons Learned from a Single Institution’s Eight Years of Experience with Early Cleft Lip Repair
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Idean Roohani, Collean Trotter, Pasha Shakoori, Tayla A. Moshal, Sasha Lasky, Artur Manasyan, Erin M. Wolfe, William P. Magee, and Jeffrey A. Hammoudeh
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cleft lip ,cleft palate ,nasoalveolar molding ,neonate ,cleft lip and palate ,children ,Medicine (General) ,R5-920 - Abstract
Background and Objectives: The traditional approach in managing wide cleft lip deformities involves presurgical nasoalveolar molding (NAM) therapy followed by surgical cleft lip repair between three and six months of age. This institution has implemented an early cleft lip repair (ECLR) protocol where infants undergo primary cleft lip repair between two and five weeks of age without NAM. This study aims to present this institution’s ECLR repair protocol over the past eight years from 188 consecutive patients with unilateral or bilateral CL/P deformity. Materials and Methods: Retrospective review was conducted at Children’s Hospital Los Angeles evaluating patients who underwent ECLR before three months of age and were classified as American Society of Anesthesiologists (ASA) class I or II from 2015–2022. Anthropometric analysis was performed, and pre- and postoperative photographs were evaluated to assess nasal and lip symmetry. Results: The average age at cleft lip repair after correcting for gestational age was 1.0 ± 0.5 months. Mean operative and anesthetic times were 120.3 ± 33.0 min and 189.4 ± 35.4, respectively. Only 2.1% (4/188) of patients had postoperative complications. Lip revision rates were 11.4% (20/175) and 15.4% (2/13) for unilateral and bilateral repairs, respectively, most of which were minor in severity (16/22, 72.7%). Postoperative anthropometric measurements demonstrated significant improvements in nasal and lip symmetry (p < 0.001). Conclusions: This analysis demonstrates the safety and efficacy of ECLR in correcting all unilateral cleft lip and nasal deformities of patients who were ASA classes I or II. At this institution, ECLR has minimized the need for NAM, which is now reserved for patients with bilateral cleft lip, late presentation, or comorbidities that preclude them from early repair. ECLR serves as a valuable option for patients with a wide range of cleft severity while reducing the burden of care.
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- 2023
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10. D50. Assessment and Validation of Preoperative Three-dimensional Volumetric Analysis to Predict Bone Graft Success in Alveolar Cleft Reconstruction
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Pasha Shakoori, MD, DDS, MA, Idean Roohani, BS, Simon Youn, DDS, Sarah Alfeerawi, BS, MS, Collean Trotter, BA, MAT, Dylan G. Choi, BS, Artur Fahradyan, MD, Mark M. Urata, MD, DDS, William P. Magee, III, MD, DDS, and Jeffrey A. Hammoudeh, MD, DDS
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Surgery ,RD1-811 - Published
- 2023
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11. D117. Optimal Timing to Minimize Complications of Alveolar Bone Grafting in Cleft Care
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Sarah Alfeerawi, BS, MS, Idean Roohani, BS, Collean Trotter, BA, MAT, Pasha Shakoori, MD, DDS, MA, Dylan G. Choi, BS, Artur Fahradyan, MD, Mark M. Urata, MD, DDS, Jessica A. Lee, MD, William P. Magee, III, MD, DDS, and Jeffrey A. Hammoudeh, MD, DDS
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Surgery ,RD1-811 - Published
- 2023
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12. D75. A Comparison of Vomer Flap Palatoplasty Techniques on Fistula Repair in Bilateral Cleft Lip and Palate: A Single Center 25-year Experience
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Collean Trotter, MD, Dylan G. Choi, BS, Idean Roohani, BS, Sarah Alfeerawi, BS, MS, Pasha Shakoori, MS, DDS, MA, Artur Fahradyan, MD, Mark M. Urata, MD, DDS, William P. Magee, III, MD, DDS, Jessica A. Lee, MD, and Jeffrey A. Hammoudeh, MD, DDS
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Surgery ,RD1-811 - Published
- 2023
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13. 190. A Comparison Of Revision Rates In Patients Undergoing Traditional Versus Neonatal Cleft Lip Repair
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Sarah Alfeerawi, BS, MS, Idean Roohani, BS, Collean Trotter, BA, MAT, Dylan G. Choi, BS, Pasha Shakoori, MD, DDS, MA, Artur Fahradyan, MD, Mark M. Urata, MD, DDS, William P. Magee, MD, DDS, and Jeffrey A. Hammoudeh, MD
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Surgery ,RD1-811 - Published
- 2023
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14. D21. Failure Rates Based on Alveolar Cleft Size: An Analysis of the Critical Size Defect for rhBMP-2/DBM and Iliac Crest in Alveolar Bone Grafting
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Idean Roohani, BS, Simon Youn, DDS, Sarah Alfeerawi, BS, MS, Pasha Shakoori, MD, DDS, MA, Collean Trotter, BA, MAT, Dylan G. Choi, BS, Artur Fahradyan, MD, Mark M. Urata, MD, DDS, William P. Magee, III, MD, DDS, and Jeffrey A. Hammoudeh, MD, DDS
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Surgery ,RD1-811 - Published
- 2023
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15. D23. Quarter Century Review of Velopharyngeal Insufficiency Rates between Palatoplasty Techniques among Patients with Robin Sequence
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Idean Roohani, BS, Collean Trotter, BA, MAT, Pasha Shakoori, MD, DDS, MA, Dylan G. Choi, BS, Sarah Alfeerawi, BS, MS, Artur Fahradyan, MD, Mark M. Urata, MD, DDS, Jessica A. Lee, MD, Jeffrey A. Hammoudeh, MD, DDS, and William P. Magee, III, MD, DDS
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Surgery ,RD1-811 - Published
- 2023
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16. Cleft Palate Repair: A History of Techniques and Variations
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Priyanka Naidu, MBChB, MSc, Caroline A. Yao, MD, MSc, FACS, David K. Chong, MBBS, FRACS, and William P. Magee, III, MD, DDS, FACS
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Surgery ,RD1-811 - Abstract
Summary:. Orofacial clefting is a common reconstructive surgical condition that often involves the palate. Cleft palate repair has evolved over three centuries from merely achieving anatomical closure to prioritizing speech development and avoiding midface hypoplasia. Despite centuries of advancements, there is still substantial controversy and variable consensus on technique, timing, and sequence of cleft palate repair procedures. Furthermore, evaluating the success of various techniques is hindered by a lack of universal outcome metrics and difficulty maintaining long-term follow-up. This article presents the current controversies of cleft palate repair and details how the history of cleft palate repair has influenced current techniques commonly used worldwide. Our review highlights the need for a global consortium on cleft care to gather expert opinions on current practices and outcomes and to standardize technique classifications. An understanding of global protocols is crucial in an attempt to standardize technique and timing to achieve anatomical closure with optimal velopharyngeal competence, while also minimizing the occurrence of maxillary hypoplasia and palatal fistulae.
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- 2022
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17. The experiences of female surgeons around the world: a scoping review
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Meredith D. Xepoleas, Naikhoba C. O. Munabi, Allyn Auslander, William P. Magee, and Caroline A. Yao
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Female surgeon ,Gender equity ,Women in surgery ,Surgeons ,Female ,Surgical workforce ,Medicine (General) ,R5-920 ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Introduction The Lancet Commission for Global Surgery identified an adequate surgical workforce as one indicator of surgical care accessibility. Many countries where women in surgery are underrepresented struggle to meet the recommended 20 surgeons per 100,000 population. We evaluated female surgeons’ experiences globally to identify strategies to increase surgical capacity through women. Methods Three database searches identified original studies examining female surgeon experiences. Countries were grouped using the World Bank income level and Global Gender Gap Index (GGGI). Results Of 12,914 studies meeting search criteria, 139 studies were included and examined populations from 26 countries. Of the accepted studies, 132 (95%) included populations from high-income countries (HICs) and 125 (90%) exclusively examined populations from the upper 50% of GGGI ranked countries. Country income and GGGI ranking did not independently predict gender equity in surgery. Female surgeons in low GGGI HIC (Japan) were limited by familial support, while those in low income, but high GGGI countries (Rwanda) were constrained by cultural attitudes about female education. Across all populations, lack of mentorship was seen as a career barrier. HIC studies demonstrate that establishing a critical mass of women in surgery encourages female students to enter surgery. In HICs, trainee abilities are reported as equal between genders. Yet, HIC women experience discrimination from male co-workers, strain from pregnancy and childcare commitments, and may suffer more negative health consequences. Female surgeon abilities were seen as inferior in lower income countries, but more child rearing support led to fewer women delaying childbearing during training compared to North Americans and Europeans. Conclusion The relationship between country income and GGGI is complex and neither independently predict gender equity. Cultural norms between geographic regions influence the variability of female surgeons’ experiences. More research is needed in lower income and low GGGI ranked countries to understand female surgeons’ experiences and promote gender equity in increasing the number of surgical providers.
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- 2020
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18. The influence of an all-female healthcare environment on mentorship and empowerment of female healthcare professionals
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Naikhoba C. O. Munabi, Allyn Auslander, Meredith D. Xepoleas, Libby D. Bunker, Kella L. Vangsness, Sara Koualla, Kathy S. Magee, William P. Magee, and Caroline A. Yao
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Public aspects of medicine ,RA1-1270 - Abstract
Low- and middle-income countries (LMICs) have the greatest need for additional healthcare providers, and women outside the workforce help address the need. Women in healthcare need more mentorship and leadership training to advance their careers due to systemic barriers. This study evaluates how women working together on a medical team influences mentorship, leadership and empowerment. A single all-female volunteer team participating in a cleft surgery mission in Oujda, Morocco were surveyed before and after the mission. Statistical analysis with student’s t-test or chi-squared were performed. 95 female volunteers from 23 countries participated on this team and 85% completed surveys. Volunteers from high-income countries (32%) and LMICs (68%) had similar mission roles (p = 0.58). Experience as a mission volunteer (p = 0.47), team leader (p = 0.28), and educator (p = 0.18) were equivalent between cohorts. 73% of women had previously received mentorship but 98% wanted more. 75% had previously mentored others, but 97% wanted to be mentors. 73% of volunteers who had no prior mentorship found their first mentor during the mission. All participants found a long-term peer relationship and felt motivated to mentor women at home. 95% were inspired to pursue leadership positions, advance professionally, and continue working with other women. This population of female healthcare professionals overwhelmingly desired more mentorship than is felt to be available. An all-female healthcare environment appears to provide opportunities for mentorship and create lasting motivation to teach, lead, and advance professionally. Findings raise the potential that increasing visibility of female professionals may effectively empower women in healthcare.
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- 2022
19. The Smile Index: Part 3. A Simple, Prognostic Severity Scale for Unilateral Cleft Palate
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Caroline A. Yao, MD, Emma D. Vartanian, MD, Eric Nagengast, MD, Meghan McCullough, MD, MS, Allyn Auslander, PhD, MPH, and William P. Magee, III, MD, DDS
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Surgery ,RD1-811 - Abstract
Background:. Unilateral cleft palates have a large spectrum of variability. Key morphologic factors such as cleft width and palatal length are not represented in current classification systems. Palate length and velopharyngeal port size are clinically linked to speech outcomes, as the soft palate must close the posterior pharynx for proper phonation. This study investigates the relationship between objective preoperative measures and postoperative velopharyngeal port size, to define a reproducible severity scale. Methods:. Surgical data were prospectively collected from unilateral cleft palate patients in Morocco, Bolivia, Vietnam, and Madagascar. Key measurements were cleft width and palate width at the hard–soft palate junction, alveolar cleft width, vertical alveolar discrepancy, velopharyngeal port size. Cleft width ratio (CWR) was defined as the width of the cleft at the hard–soft junction, divided by the palate width. Results:. Seventy-six patients were evaluated. Thirty-one had complete clefts and average age at surgical repair was 2.9 years. Mean CWR was 0.50 ± 0.12. Palate length was increased by an average of 2.2 mm (11%) after palatoplasty. Multivariate analysis determined greater CWR and larger preoperative velopharyngeal ports were significantly correlated with a smaller percent change in palate length after palatoplasty (P < 0.01). Conclusions:. A wider palatal cleft decreases the surgeon’s ability to decrease velopharyngeal port size through palatoplasty. Given the ease of measurement even in low-resource settings, CWR may be a valuable tool for setting expectations for speech results, modifying surgical technique, and correlating future speech outcomes in evidence-based cleft care.
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- 2021
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20. 127. Reducing the Burden of Care of Cleft Lip Nasal Deformities Using Early Cleft Lip Repair
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Christian Jimenez, BS, Katelyn Kondra, MD, Eloise Stanton, BA, Nicolas Malkoff, BS, Laya Jacob, BS, Erik Wolfswinkel, MD, Mark M. Urata, MD, DDS, William P. Magee, MD, DDS, and Jeffrey Hammoudeh, MD, DDS
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Surgery ,RD1-811 - Published
- 2022
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21. A Novel Protocol in Early Cleft Lip Repair: Demonstrating Efficacy and Safety in the First 100 Patients
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Jordan Wlodarczyk, MD, Erik Matthew Wolfswinkel, MD, Alice Liu, BA;, Artur Fahradyan, MD, Pedram Goel, MD, William P. Magee, III, MD, DDS, Mark M. Urata, MD, and Jeffrey A. Hammoudeh, MD, DDS
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Surgery ,RD1-811 - Published
- 2020
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22. A Neuroprotective Protocol in Neonatal Anesthesia: A Review of 101 Early Cleft Lip Repairs
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Jordan Wlodarczyk, MD, Emma Higuchi, BS, Artur Fahradyan, MD, Alice Liu, BA;, Laya Jacob, BS;, William P. Magee, III, MD, DDS, Mark M. Urata, MD, Marla Matar, MD;, Jennifer Lau, MD;, and Jeffrey A. Hammoudeh, MD, DDS
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Surgery ,RD1-811 - Published
- 2020
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23. Autologous Stem Cell Transplantation Promotes Mechanical Stretch Induced Skin Regeneration: A Randomized Phase I/II Clinical Trial
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Shuang-Bai Zhou, M.D., Ph.D., Guo-You Zhang, M.D., Ph.D., Yun Xie, M.D., Tao Zan, M.D., Ph.D., Yao-Kai Gan, M.D., Ph.D., Caroline A. Yao, M.D., M.S., Cheng-An Chiang, M.D., Jing Wang, M.D., Ph.D., Kai Liu, M.D., Ph.D., Hua Li, M.D., Ph.D., Jia Zhou, M.D., Ph.D., Mei Yang, M.D., Ph.D., Bin Gu, M.D., Feng Xie, M.D., Ph.D., Lee Q. Pu, M.D., Ph.D., William P. Magee III M.D., D.D.S., and Qing-Feng Li, M.D., Ph.D.
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Skin regeneration ,Mechanical stretch ,Skin expansion ,Autologous stem cell ,Bone mononuclear cells ,Medicine ,Medicine (General) ,R5-920 - Abstract
Background: Mechanical stretch, in term of skin expansion, can induce effective but limited in vivo skin regeneration for complex skin defect reconstruction. We propose a strategy to obtain regenerated skin by combining autologous stem cell transplantation with mechanical stretch. Methods: This randomized, blinded placebo-controlled trial enrolled 38 adult patients undergoing skin expansion presenting with signs of exhausted regenerative capacity. Patients randomly received autologous bone marrow mononuclear cell (MNC) or placebo injections intradermally. Follow-up examinations were at 4, 8 weeks and 2 years. The primary endpoint was the volume achieved in relation to the designed size of the expander (expansion index, EI). Secondary endpoints were surface area, thickness and texture of expanded skin. This trial is registered with ClinicalTrial.gov, NCT01209611. Findings: The MNC group had a significantly higher EI at 4 weeks (mean difference 0.59 [95% CI, 0.03–1.16]; p = 0.039) and 8 weeks (1.05 [95% CI, 0.45–1.66]; p = 0.001) versus controls. At 8 weeks, the MNC group had significantly thicker skin (epidermis: p
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- 2016
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24. 12. Pilot Evaluation of the Impact of a Mission-Based Surgical Training Rotation on the Plastic Surgery Skills and Competencies Development of General Surgery Residents in Rwanda
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Naikhoba CO Munabi, MD, MPH, Libby Durnwald, MPH, Eric S. Nagengast, MD, MPH, Allyn Auslander, MPH, Faustin Ntirenganya, MD, MMED, PhD, and William P. Magee, III, MD, DDS
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Surgery ,RD1-811 - Published
- 2021
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25. Abstract 58: Geospatial Analysis of Medical Reach and Barriers to Surgical Cleft Care in Los Angeles
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Naikhoba C.O. Munabi, MD, Madeleine S. Williams, BA, Pedram Goel, BS, Eric S. Nagengast, MD, Jeffrey A. Hammoudeh, MD, DDS, Mark M. Urata, MD, DDS, and William P. Magee, III, MD, DDS
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Surgery ,RD1-811 - Published
- 2019
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26. Abstract QS9: Convolutional Neural Network Models for Automatic Pre-Operative Severity Assessment in Unilateral Cleft Lip
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Meghan McCullough, MD, MS, Steven Ly, PhD, Alex Campbell, MD, MS, Caroline Yao, MD, MS, Mark Urata, MD, DDS, Stefan Scherer, PhD, and William P. Magee, III, MD, DDS
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Surgery ,RD1-811 - Published
- 2019
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27. Abstract: Automated Identification of Severity Level of Unilateral Cleft Lip Using Facial Dysmorphology Novel Analysis
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Meghan McCullough, MD, Caroline Yao, MD, MS, Allyn Auslander, MPH, Jordan Swanson, MD, MS, Thomas Imahiyerobo, MD, Pedro Sanchez, MD, and William P. Magee, MD, DDS
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Surgery ,RD1-811 - Published
- 2017
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28. The personal impact of involvement in international global health outreach: A national survey of former Operation Smile student volunteers
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Jenna R. Stoehr, Narainsai K. Reddy, Shady Mikhail, Priyanka Naidu, Caroline A. Yao, William P. Magee, and Arun K. Gosain
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Pediatrics, Perinatology and Child Health ,Surgery ,General Medicine - Published
- 2023
29. Premaxillary Setback in Bilateral Cleft Lip and Palate Repair
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Eloise Stanton, Katelyn Kondra, Christian Jimenez, Pasha Shakoori, Stephen Yen, Mark M. Urata, Jeffrey A. Hammoudeh, and William P. Magee
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Otorhinolaryngology ,Oral Surgery - Abstract
Objective The aim of this study is to evaluate surgical outcomes and maxillofacial growth in patients undergoing primary lip repair with or without premaxillary setback. Design Retrospective review. Setting Children's Hospital of Los Angeles, California. Patients and Participants Patients with bilateral cleft lip ± palate (BCLP) who underwent lip repair with or without premaxillary setback from January 1975 to September 2021. Interventions No intervention was performed. Main Outcome Measure(s) Patient demographics, comorbidities, and syndromic status were obtained. Indications for premaxillary setback, incidence of midface hypoplasia, orthodontic and/or orthognathic treatments, follow-up, complications, and revisions were recorded and analyzed. Comparisons among long-term outcomes, particularly the development of midface hypoplasia were made between groups. Results Thirty-one patients who underwent BCLP repair with premaxillary setback (BCLP + PS) and 31 matched control patients who underwent BCLP repair without premaxillary setback (BCLP − PS) were included. Among the 2 groups, multiple logistic regression demonstrated that when controlling for comorbidities, syndromic status, timing of lip repair, and timing of palate repair, premaxillary setback was neither significantly associated with the development of midface hypoplasia ( P = .076) nor the timing of midface hypoplasia development ( P = .940) in those that ultimately acquired this facial dysmorphology. Conclusions While a high incidence of midface hypoplasia was seen in both BCLP ± PS and BCLP − PS, our findings demonstrate no difference in midface hypoplasia irrespective of premaxillary setback in the setting of BCLP. Future prospective studies investigating the downstream ramifications of our suggested selection criteria for premaxillary setback are warranted.
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- 2022
30. Early Cleft Lip Repair: Demonstrating Efficacy in the First 100 Patients
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Jordan R. Wlodarczyk, Erik M. Wolfswinkel, Alice Liu, Artur Fahradyan, Emma Higuchi, Pedram Goel, Mark M. Urata, William P. Magee, and Jeffrey A. Hammoudeh
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Cleft Palate ,Treatment Outcome ,Nasoalveolar Molding ,Child, Preschool ,Cleft Lip ,Infant, Newborn ,Maxilla ,Humans ,Infant ,Surgery ,Nose - Abstract
Cleft lip and/or palate affects approximately one in 700 live births. Optimal timing for repair of cleft lip has yet to be objectively validated. Earlier repair takes advantage of a high degree of plasticity within the nasal cartilage and maxilla. The authors present patients enrolled in an early cleft lip repair protocol facilitating effective repair of the cleft lip and nostril.American Society of Anesthesiologists class I to II patients with unilateral cleft lip and/or palate undergoing repair before 3 months of age were enrolled over 5 years. Perioperative data, surgical and anesthetic complications, preoperative and postoperative nostril breadth, nostril width, nasal angle, lip length, frontal nasal breadth, and commissure length measured as ratios between the cleft and noncleft sides were abstracted. Early cleft lip repair and nasoalveolar molding patients were matched for cleft lip severity using the cleft width ratios and compared.The surgical and anesthetic complication rate for 100 early cleft lip repair patients was 2 percent. Operative and anesthetic times were 123 ± 37 minutes and 177 ± 34 minutes, respectively. Hospital length of stay was 1 ± 0 day. Age at repair between early cleft lip repair and nasoalveolar molding was 33 ± 15 days and 118 ± 33 days, respectively. After early cleft lip repair, preoperative to postoperative distance from symmetry for all anthropomorphic measurements improved ( p0.001). Comparing severity-matched early cleft lip repair to nasoalveolar molding patients, similar improvements were observed, suggesting equivalent results ( p0.05).Early cleft lip repair provides an efficacious method for correcting the cleft lip and nasal deformity that simulates nasoalveolar molding.Therapeutic, III.
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- 2022
31. Assessing the Safety of a Novel Neonatal Anesthesia Protocol: A Review of 101 Patients With Early Cleft Lip Repair
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Jordan R. Wlodarczyk, Marcus M. Urata, Marla Matar, William P. Magee, Jeffrey A. Hammoudeh, Erik M. Wolfswinkel, Jennifer Lau, Waleed Gabreel, Emma Higuchi, Alice Liu, and Mark M. Urata
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Protocol (science) ,business.industry ,Anesthesia, Dental ,Cleft Lip ,Patient demographics ,Neonatal anesthesia ,Infant, Newborn ,General Medicine ,Cleft lip repair ,Regimen ,Otorhinolaryngology ,Child, Preschool ,Anesthesia ,Anesthetic ,Humans ,Medicine ,Surgery ,Dosing ,Dexmedetomidine ,business ,Anesthetics ,Retrospective Studies ,medicine.drug - Abstract
Purpose Our study introduces a novel anesthetic protocol for neonates without using volatile agents with the goal to minimize potentially neurotoxic and pro-apoptotic agents. The authors evaluated the short-term safety and efficacy of our anesthetic protocol in patients undergoing early cleft lip repair (ECLR). Methods A retrospective review of ECLR patients who underwent repair before 2.5 months of age within the last 4.3 years was performed. This sample was comprised of 2 groups, those who received either a standard volatile gas-based regimen or a dexmedetomidine-based neonatal anesthetic protocol (DBNAP). Patient demographics, medication dosing, anesthetic time (induction to extubation), major and minor complications, and medication side effects were compared between the 2 cohorts. Results A total of 101 patients underwent ECLR. All patients were American Society of Anesthesiologists class 1 or 2. Mean age at surgery was 31 ± 13 days and mean anesthetic time was 179 ± 36 minutes. DBNAP was used in 65 patients while the standard anesthetic protocol was used in 36 patients. Patient weight was significantly lower in the DBNAP group (4.01 ± 0.61 versus 4.38 ± 0.72 kg, P = 0.007). There were no significant differences between the 2 cohorts when comparing anesthetic time, emergence time, complication rate, or medication side effects. Conclusion For patients undergoing ECLR, DBNAP is perioperatively equivalent to the anesthetic standard of care, demonstrating no major complications and acceptable rates of minor complications and medication side effects.
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- 2021
32. Convolutional Neural Network Models for Automatic Preoperative Severity Assessment in Unilateral Cleft Lip
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Caroline A. Yao, Alex Campbell, Allyn Auslander, Stefan Scherer, Steven Ly, William P. Magee, and Meghan McCullough
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Counseling ,Mean squared error ,Automated Facial Recognition ,Cleft Lip ,Nostril ,Clinical Decision-Making ,Datasets as Topic ,Nose ,030230 surgery ,Residual ,Severity of Illness Index ,Convolutional neural network ,Correlation ,03 medical and health sciences ,symbols.namesake ,Deep Learning ,0302 clinical medicine ,Severity of illness ,Image Processing, Computer-Assisted ,Photography ,medicine ,Humans ,business.industry ,Remote Consultation ,Deep learning ,Pattern recognition ,Rhinoplasty ,Mobile Applications ,Pearson product-moment correlation coefficient ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Preoperative Period ,symbols ,Feasibility Studies ,Surgery ,Artificial intelligence ,Anatomic Landmarks ,business - Abstract
Background Despite the wide range of cleft lip morphology, consistent scales to categorize preoperative severity do not exist. Machine learning has been used to increase accuracy and efficiency in detection and rating of multiple conditions, yet it has not been applied to cleft disease. The authors tested a machine learning approach to automatically detect and measure facial landmarks and assign severity grades using preoperative photographs. Methods Preoperative images were collected from 800 unilateral cleft lip patients, manually annotated for cleft-specific landmarks, and rated using a previously validated severity scale by eight expert reviewers. Five convolutional neural network models were trained for landmark detection and severity grade assignment. Mean squared error loss and Pearson correlation coefficient for cleft width ratio, nostril width ratio, and severity grade assignment were calculated. Results All five models performed well in landmark detection and severity grade assignment, with the largest and most complex model, Residual Network, performing best (mean squared error, 24.41; cleft width ratio correlation, 0.943; nostril width ratio correlation, 0.879; severity correlation, 0.892). The mobile device-compatible network, MobileNet, also showed a high degree of accuracy (mean squared error, 36.66; cleft width ratio correlation, 0.901; nostril width ratio correlation, 0.705; severity correlation, 0.860). Conclusions Machine learning models demonstrate the ability to accurately measure facial features and assign severity grades according to validated scales. Such models hold promise for the creation of a simple, automated approach to classifying cleft lip morphology. Further potential exists for a mobile telephone-based application to provide real-time feedback to improve clinical decision making and patient counseling.
- Published
- 2021
33. The International Family Study of Nonsyndromic Orofacial Clefts: Design and Methods
- Author
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Fouzia J. Mahmoudi, David V. Conti, Thi-Hai-Duc Nguyen, William P. Magee, Stephanie Ly, Albertina McGregor, Pedro A. Sanchez-Lara, Angela Rose Hernandez, Roberta McKean-Cowdin, Anselme Mwepu, Frederick Brindopke, Melissa DiBona, Allyn Auslander, Melissa Giron, Rijuta Kapoor, Kathy Magee, Lili Arakaki, Devin Feigelson, and Sylvia Rakotoarison
- Subjects
0301 basic medicine ,medicine.medical_specialty ,Pediatrics ,business.industry ,Cleft Lip ,Brain ,030206 dentistry ,030105 genetics & heredity ,Cleft Palate ,03 medical and health sciences ,0302 clinical medicine ,Otorhinolaryngology ,Pregnancy ,Case-Control Studies ,Epidemiology ,medicine ,Etiology ,Humans ,Female ,Oral Surgery ,business - Abstract
Background: The majority of research to understand the risk factors of nonsyndromic orofacial clefts (NSOFCs) has been conducted in high-income populations. Although patients with NSOFCs in low- and middle-income countries (LMICs) are at the highest risk of not receiving care, global health infrastructure allows innovative partnerships to explore the etiologic mechanisms of cleft and targets for prevention unique to these populations. Methods: The International Family Study (IFS) is an ongoing case–control study with supplemental parental trio data designed to examine genetic, environmental, lifestyle, and sociodemographic risk factors for NSOFCs in 8 LMICs (through August 2020). Interview and biological samples are collected for each family. The interview includes demographics, family history of cleft, diet and water sources, maternal pregnancy history, and other lifestyle and environmental factors. Results: Seven of 8 countries are currently summarized (2012-2017) for a total of 2955 case and 2774 control families with 11 946 unique biological samples from Vietnam, Philippines, Honduras, Madagascar, Morocco, Democratic Republic of the Congo, and Nicaragua. The phenotype distribution was 1641 (55.5%) cases with cleft lip and palate, 782 (26.5%) with cleft lip (CL), and 432 (14.6%) with cleft palate (CP). Discussion: The International Family Study is the largest case set of NSOFCs with an associated biobank in LMICs currently assembled. The biobank, family, and case–control study now include samples from 8 LMICs where local health care infrastructure cannot address the surgical burden of cleft or investigate causal mechanisms. The International Family Study can be a source of information and may collaborate with local public health institutions regarding education and interventions to potentially prevent NSOFCs.
- Published
- 2021
34. Factors Associated With Delay in Cleft Surgery at a Tertiary Children’s Hospital in a Major US Metropolitan City
- Author
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Lori K. Howell, Pedram Goel, Jeffrey A. Hammoudeh, Allyn Auslander, Jacqueline Stoneburner, William P. Magee, Eric S. Nagengast, Madeleine S. Williams, Mark M. Urata, and Naikhoba C. O. Munabi
- Subjects
medicine.medical_specialty ,business.industry ,Cleft Lip ,Retrospective cohort study ,Cleft surgery ,030206 dentistry ,Hospitals, Pediatric ,Metropolitan area ,Cleft Palate ,Tertiary Care Centers ,03 medical and health sciences ,0302 clinical medicine ,Otorhinolaryngology ,030220 oncology & carcinogenesis ,Family medicine ,Humans ,Medicine ,Female ,Oral Surgery ,Child ,business ,Retrospective Studies - Abstract
Objective: To identify factors associated with late cleft repair at a US tertiary children’s hospital. Design: Retrospective study of children with CL/P using Children’s Hospital Los Angeles (CHLA) records. Setting: US tertiary children’s hospital. Patients/Participants: Patients undergoing primary CL or CP repair at CHLA from 2009 to 2018. Main Outcome Measures: Proportion of children who had delayed primary CL repair or CP repair using CHLA and American Cleft Palate-Craniofacial Association (ACPA) guidelines and factors associated with late surgery. Results: In total, 805 patients—503 (62.5%) who had CL repair, 302 (37.5%) CP repair—were included. Using CHLA protocol, 14.3% of patients seeking CL repair had delayed surgery. Delay was significantly associated with female gender, non-Hispanic ethnicity, Spanish primary language, government insurance, bilateral cleft, cleft lip and palate (CLP), and syndromic diagnosis. Using ACPA guidelines, 5.4% had delayed surgery. Female gender and syndromic diagnosis were significantly associated with delay and remained significant after adjustment for confounders in multivariate models. For CP repair, 60.3% of patients had delayed surgery using CHLA protocol. Cleft lip and palate diagnosis, complete cleft, syndromic diagnosis, and longer travel distance were significantly associated with delay. Using ACPA guidelines, 28.5% had delayed surgery; however, significant association with patient variables was not consistently observed. Conclusions: Delay in cleft surgery occurs most often for patients seeking CP repair and is associated with female gender, non-Hispanic ethnicity, Spanish language, government insurance, and bilateral CL, CLP, or syndromic diagnoses. Initiatives should aim to optimize cleft surgery delivery for these subpopulations.
- Published
- 2021
35. The Local Mission: Improving Access to Surgical Care in Middle-Income Countries
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David K. Chong, Naikhoba C. O. Munabi, Allyn Auslander, Meredith D. Xepoleas, William P. Magee, and Eric S. Nagengast
- Subjects
business.industry ,Surgical care ,media_common.quotation_subject ,Middle income countries ,MEDLINE ,Developing country ,030230 surgery ,Surgical workforce ,Surgery in Low and Middle Income Countries ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Service (economics) ,Income level ,Medicine ,Surgery ,Operations management ,Quality (business) ,business ,media_common - Abstract
Background Billions of people lack access to quality surgical care. Short-term missions are used to supplement the delivery of surgical care in regions with poor access to care. Traditionally known for using international teams, Operation Smile has transitioned to using a local mission model, where surgical service is delivered to areas of need by teams originating within that country. This study investigates the proportion and location of Operation Smile missions that use the local mission model. Methods A retrospective review was performed of the Operation Smile mission database for fiscal years 2014 to 2019. Missions were classified into local or international missions. Countries were also classified by their income levels as well as their specialist surgical workforce (SAO) density. As no individual patient or provider data was recorded, ethics board approval was not warranted. Results Between 2014 and 2019, Operation Smile held an average of 144.8 (range 135–154) surgical missions per year. Local missions accounted for 97 ± 5.6 (67%) of the missions. Of the 34 program countries, 26 (76%) used local missions. Of the countries that had only international missions, six (75%) were low-income countries and the average SAO density was 1.54 (range 0.19–5.88) providers per 100,000 people. Of the countries with local missions, 24 (92%) were middle-income, and the average SAO density was 30.9 (range 3.4–142.4). Conclusion International investments may assist in the creation of local surgical teams. Once teams are established, local missions are a valuable way to provide specialized surgical care within a country’s own borders.
- Published
- 2021
36. Clinical Importance of Concomitant Cleft Lip/Palate in the Surgical Management of Patients With Congenital Heart Disease
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Omar Toubat, Naikhoba C. O. Munabi, Demetrios N. Mallios, S. Ram Kumar, Vaughn A. Starnes, and William P. Magee
- Subjects
Heart Defects, Congenital ,Male ,medicine.medical_specialty ,Heart disease ,Cleft Lip ,Disease ,030204 cardiovascular system & hematology ,Article ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,Abnormalities, Multiple ,cardiovascular diseases ,Cardiac Surgical Procedures ,Retrospective Studies ,Cleft lip palate ,business.industry ,Infant, Newborn ,General Medicine ,Plastic Surgery Procedures ,medicine.disease ,Surgery ,Cleft Palate ,Treatment Outcome ,030228 respiratory system ,Concomitant ,Pediatrics, Perinatology and Child Health ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background: Congenital heart disease (CHD) frequently occurs in conjunction with extracardiac developmental anomalies, including cleft malformations. The clinical impact of concomitant cleft disease on the surgical management of CHD has not been studied. We evaluated cardiac surgical outcomes in patients with concomitant CHD and cleft lip and/or palate (CL/P). Methods: Patients with CHD + CL/P managed at our institution between January 2004 and December 2018 were included. Demographic, operative, and follow-up data were retrospectively collected and analyzed using SAS 9.4. Chi-square tests were used for categorical variables and t test or Wilcoxon rank sum tests for continuous variables. Significance of P < .05 was used. Results: There were 127 patients with CHD + CL/P; 63 (50%) were boys. Compared to the general CHD population, patients with CHD + CL/P demonstrated an enrichment of atrial septal defects (10.5% vs 34%), tetralogy of Fallot/double outlet right ventricle (6.4% vs 15.7%), arch defects (4.5% vs 10.2%), truncus arteriosus (1.2% vs 3.1%), and total anomalous pulmonary venous return (1.0% vs 2.4%). Of 63 patients who underwent CHD repair, 58 (92%) did so prior to CL/P repair at 21.5 (6-114) days of age. Compared to CHD lesion-matched patients undergoing cardiac surgical repair at our institution, patients with CL/P had a 2- to 3.7-fold longer intensive care stay, 1.8- to 2.6-fold longer hospital stay, and 6- to 13.5-fold increase in major morbidity, without a significant difference in mortality. Conclusions: Cardiac outflow tract defects are particularly overrepresented in CL/P patients. The presence of CL/P increases the complexity of postoperative care after CHD surgery, without a significant impact on mortality.
- Published
- 2021
37. The Use of Crowdsourcing Technology to Evaluate Preoperative Severity in Patients With Unilateral Cleft Lip in a Multiethnic Population
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Allyn Auslander, Caroline A. Yao, Meghan McCullough, William P. Magee, Eric S. Nagengast, and Jordan W. Swanson
- Subjects
Technology ,medicine.medical_specialty ,Cleft Lip ,Crowdsourcing ,03 medical and health sciences ,symbols.namesake ,0302 clinical medicine ,Humans ,Medicine ,In patient ,030223 otorhinolaryngology ,Data collection ,business.industry ,030206 dentistry ,General Medicine ,Pearson product-moment correlation coefficient ,Multiethnic population ,Cleft Palate ,Vietnam ,Otorhinolaryngology ,Ranking ,symbols ,Physical therapy ,Surgery ,Pairwise comparison ,business ,Multiethnic cohort - Abstract
Crowd sourcing has been used in multiple disciplines to quickly generate large amounts of diverse data. The objective of this study was to use crowdsourcing to grade preoperative severity of unilateral cleft lip phenotype in a multiethnic cohort with the hypothesis that crowdsourcing could efficiently achieve similar rankings compared to expert surgeons. Deidentified preoperative photos were collected for patients with primary, unilateral cleft lip with or without cleft palate (CL ± P). A platform was developed with C-SATS for pairwise comparisons utilizing Elo rankings by crowdsource workers through Amazon Mechanical Turk. Images were independently ranked by 2 senior surgeons for comparison. Seventy-six patients with varying severity of unilateral (CL ± P) phenotype were chosen from Operation Smile missions in Bolivia, Madagascar, Vietnam, and Morocco. Patients were an average of 1.2 years' old, ranging from 3 months to 3.3 years. Each image was compared with 10 others, for a total of 380 unique pairwise comparisons. A total of 4627 total raters participated with a median of 12 raters per pair. Data collection was completed in
- Published
- 2020
38. Increased Distraction Magnitude Leads to Greater Reduction in the Apnea-Hypopnea Index in Infants With Robin Sequence
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Eloise Stanton, Katelyn Kondra, Christian Jimenez, Naikhoba C.O. Munabi, Allen Huang, Kevin Chen, William P. Magee, Mark M. Urata, and Jeffrey A. Hammoudeh
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Male ,Sleep Apnea, Obstructive ,Pierre Robin Syndrome ,Osteogenesis, Distraction ,Infant ,Mandible ,Carbon Dioxide ,Oxygen ,Sleep Apnea Syndromes ,Treatment Outcome ,Otorhinolaryngology ,Humans ,Surgery ,Female ,Oral Surgery ,Child ,Retrospective Studies - Abstract
Upper airway obstruction seen in Robin Sequence (RS) is commonly treated with mandibular distraction osteogenesis (MDO). The purpose of this study is to evaluate the impact of distraction distance on sleep study outcomes in patients with obstructive sleep apnea (OSA) secondary to RS.A retrospective cohort study was conducted for patients with isolated RS who underwent MDO at Children's Hospital Los Angeles between January 2006-September 2021. The predictor variable was distraction distance (maximal distraction using a 30 mm device vs sub-maximal distraction), and the primary outcome variable was OSA scores. Relationships between covariates, including demographic characteristics, preoperative sleep variables, and postoperative OSA outcomes using polysomnography, were also analyzed. Descriptive statistics and tests of statistical significance were performed using the Statistical Package for Social Sciences (SPSS) (version 28.0), including Student's t-test, proportions testing, multiple linear regression, and correlation analysis.Seventy-one patients met inclusion criteria (39.4% female, 60.6% male). Average age at MDO was 3.0 ± 10.2 months. Fifty-six patients were distracted maximally with a 30 mm distractor, while the remaining 15 patients experienced shorter distraction due to distractor limitations (25 mm distractor), persistent infection or family request. Looking at absolute values of postoperative sleep study variables, there were no significant differences between patients who were maximally and sub-maximally distracted across apnea-hypopnea index (AHI), highest carbon dioxide, lowest oxygen saturation, and oxygen requirement. However, both cohorts demonstrated significant improvements in lowest oxygen saturation, AHI, highest carbon dioxide level, and highest oxygen requirement compared to their pre-distraction levels. Compared with patients distracted30 mm, maximal distraction had a significantly greater improvement in AHI when controlling for preoperative sleep study variables (P = .047).Patients with isolated RS who have more severe OSA experienced greater improvements in AHI, oxygen requirement, and oxygen saturation after MDO. Two-thirds of patients no longer had oxygen requirements after MDO. Our results suggest that MDO is helpful in treating patients with RS regardless of distraction distance. However, our study provides evidence that increasing the distraction distance may further improve AHI, which is particularly beneficial to patients with a significant preoperative AHI.
- Published
- 2022
39. High prevalence of deleterious mutations in concomitant nonsyndromic cleft and outflow tract heart defects
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Naikhoba C. O. Munabi, Shady Mikhail, Omar Toubat, Michelle Webb, Allyn Auslander, Pedro A. Sanchez‐Lara, Zarko Manojlovic, Ryan J. Schmidt, David Craig, William P. Magee, and Subramanyan Ram Kumar
- Subjects
Adenosine Triphosphatases ,Heart Defects, Congenital ,Cleft Lip ,Ubiquitin-Protein Ligases ,DNA Helicases ,Nuclear Proteins ,Pilot Projects ,Multifunctional Enzymes ,Cleft Palate ,Mutation ,Genetics ,Prevalence ,Humans ,Genetics (clinical) ,RNA Helicases ,Transcription Factors - Abstract
Our previous work demonstrating enrichment of outflow tract (OFT) congenital heart disease (CHD) in children with cleft lip and/or palate (CL/P) suggests derangements in common underlying developmental pathways. The current pilot study examines the underlying genetics of concomitant nonsyndromic CL/P and OFT CHD phenotype. Of 575 patients who underwent CL/P surgery at Children's Hospital Los Angeles, seven with OFT CHD, negative chromosomal microarray analysis, and no recognizable syndromic association were recruited with their parents (as available). Whole genome sequencing of blood samples paired with whole-blood-based RNA sequencing for probands was performed. A pathogenic or potentially pathogenic variant was identified in 6/7 (85.7%) probands. A total of seven candidate genes were mutated (CHD7, SMARCA4, MED12, APOB, RNF213, SETX, and JAG1). Gene ontology analysis of variants predicted involvement in binding (100%), regulation of transcription (42.9%), and helicase activity (42.9%). Four patients (57.1%) expressed gene variants (CHD7, SMARCA4, MED12, and RNF213) previously involved in the Wnt signaling pathway. Our pilot analysis of a small cohort of patients with combined CL/P and OFT CHD phenotype suggests a potentially significant prevalence of deleterious mutations. In our cohort, an overrepresentation of mutations in molecules associated with Wnt-signaling was found. These variants may represent an expanded phenotypic heterogeneity within known monogenic disease genes or provide novel evidence of shared developmental pathways. The mechanistic implications of these mutations and subsequent developmental derangements resulting in the CL/P and OFT CHD phenotype require further analysis in a larger cohort of patients.
- Published
- 2022
40. Congenital Heart Disease in Patients With Cleft Lip/Palate and Its Impact on Cleft Management
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Sally L. Davidson Ward, Jordan Swanson, Naikhoba C. O. Munabi, William P. Magee, Pedro A. Sanchez-Lara, S. Ram Kumar, Artur Fahradyan, Allyn Auslander, Nikki Aflatooni, Beina Azadgoli, and Meghan McCullough
- Subjects
Heart Defects, Congenital ,Pediatrics ,medicine.medical_specialty ,Cleft lip palate ,Heart disease ,Genetic syndromes ,business.industry ,Cleft Lip ,030206 dentistry ,030204 cardiovascular system & hematology ,medicine.disease ,Cleft Palate ,03 medical and health sciences ,0302 clinical medicine ,Otorhinolaryngology ,Pregnancy ,medicine ,Humans ,Female ,In patient ,Oral Surgery ,Child ,business ,Retrospective Studies - Abstract
Objective: To evaluate characteristics of congenital heart disease (CHD) in patients with cleft lip and/or palate (CL/P) and assess potential associations with cleft outcomes. Design: Retrospective review of all patients with CL/P who underwent primary cleft treatment from 2009 to 2015. Setting: Children’s Hospital Los Angeles, a tertiary hospital. Patients: Exclusion criteria included microform cleft lip diagnosis, international patients, and patients presenting for secondary repair or revision after primary repair at another institution. Main Outcomes Measured: Patient demographics, prenatal and birth characteristics, CL/P characteristics, syndromic status, postoperative complications, and other outcomes were analyzed relative to CHD diagnoses and management. Patients with CL/P with (+CHD) were compared to those without (−CHD) CHD using χ2 tests and analysis of variance. Results: Among 575 patients with CL/P, 83 (14.4%) had CHD. Congenital heart disease rates were significantly higher in patients with cleft palate (CP) compared to other cleft types (χ2, P = .009). Eighty-one (97.6%) out of 83 +CHD patients were diagnosed prior to initial CL/P surgical assessment. Twenty-three (27.7%) +CHD patients required surgical repair of 10 cardiac anomalies prior to cleft care. Congenital heart disease was associated with delayed CP repair and increased rates of fistula in isolated patients with CP. Conclusions: Congenital heart disease is known to be more prevalent in patients with CL/P. These data suggest the condition is particularly increased in patients with CP. Severe forms of CHD are diagnosed and treated prior to cleft care however postoperative fistula may be more common in patients with CHD. Therefore, careful attention is required for patient optimization and palatal flap dissection in patients with coexisting CHD and CL/P.
- Published
- 2020
41. Long-Term Impact of a Mission-Based Surgical Training Rotation on Plastic Surgery Capacity Building in Rwanda
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William P. Magee, Eric S. Nagengast, Libby Durnwald, Naikhoba C. O. Munabi, and Faustin Ntirenganya
- Subjects
medicine.medical_specialty ,Capacity Building ,Rotation ,Primary level ,Congenital hand ,Education ,03 medical and health sciences ,0302 clinical medicine ,Retrospective survey ,District hospital ,medicine ,Humans ,030212 general & internal medicine ,Surgery, Plastic ,Retrospective Studies ,business.industry ,Rwanda ,Core competency ,Internship and Residency ,Capacity building ,medicine.disease ,Surgical training ,Plastic surgery ,General Surgery ,030220 oncology & carcinogenesis ,Surgery ,Medical emergency ,business - Abstract
Objective Short-term, high-volume surgical training experiences can lead to successful skills transfer and be an effective method of training surgical providers in low-resource settings. However, immediate skills acquisition does not guarantee long-term performance of surgical procedures by trainees. This study aims to determine the long-term impact of a short-term plastic surgery training rotation (STR) on general surgeon contribution to plastic surgery capacity building in Rwanda. Design A retrospective survey study was conducted. Surveys were distributed to credentialed general surgeons who previously participated in the Operation Smile STR in Rwanda. Questions focused on exposure to procedures during the rotation and current practice demographics. The percentage of current practice volumes dedicated to plastic surgery was mapped to demonstrate participant contribution to plastic surgery capacity in the country. Setting Surveys were distributed remotely. Surgeon respondents previously participated in the STR at the Rwinkwavu District Hospital, a primary level hospital in eastern Rwanda. Participants All 8 prior participants of the STR who completed residency and are currently practicing as general surgeons in Rwanda were included. Results Six out of 8 prior participants completed the survey (75.0%). All respondents work as general surgeons in governmental hospitals around the country. Up to 75% of surgeon caseloads are dedicated to plastic surgery procedures. Half of respondents work in regions without a credentialed plastic surgeon. Exposure to cleft and congenital hand surgery during the rotation did not lead to durable performance in practice. All participants felt the rotation improved their performance in multiple core competencies. Conclusion Participation in a short-term plastic surgery training experience in Rwanda was associated with increased long-term surgical capacity in the country through a task-sharing model. A mission-based rotation may provide sufficient exposure for basic plastic surgery procedures, but does not provide enough volume or time to durably teach more complicated surgeries such as cleft repair. Further studies are needed to determine how longer durations of training exposure impacts long-term performance of plastic surgery procedures.
- Published
- 2020
42. Sebaceous Nevus of the Scalp
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Mark M. Urata, Michaela Tsuha, Jeffrey A. Hammoudeh, Erik M. Wolfswinkel, William P. Magee, Pedram Goel, Michelle Hough, Lori K. Howell, and Artur Fahradyan
- Subjects
Male ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Nevus, Sebaceous of Jadassohn ,Surgical Flaps ,Lesion ,03 medical and health sciences ,Scalp reconstruction ,0302 clinical medicine ,Nevus sebaceous ,medicine ,Carcinoma ,Humans ,Nevus ,Child ,030223 otorhinolaryngology ,Retrospective Studies ,Scalp ,business.industry ,Infant ,Soft tissue ,030206 dentistry ,General Medicine ,Plastic Surgery Procedures ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Otorhinolaryngology ,Child, Preschool ,Female ,medicine.symptom ,business ,Tissue expansion - Abstract
Excisions of scalp nevus sebaceous (NS) presents a unique challenge due to limited soft tissue laxity, hair-bearing skin, and convex surfaces which often leave the surgeon and patient underwhelmed with the reconstructive outcome. In this study, the authors conducted an institutional review board-approved retrospective review of patients who underwent excision of pathologically proven scalp primary NS from 2003 to 2017 at our institution to better define the reconstructive outcomes and options for treatment of pediatric scalp NS. 92 patients were included in the study, 54 males (58.7%) and 38 females (41.3%). The average age at surgery was 7.24 years (0.5-16.0; SD 4.7). Local tissue undermining/galeal scoring with primary closure (LTUGS) was used for lesions with average surface area of 3.6 cm, rotational or transposition flaps (RF/TF) for lesions averaging 4.3 cm, completed serial excision for lesions averaging 13.9 cm, and tissue expansion (TE) for lesions averaging 21 cm (P
- Published
- 2020
43. Tympanostomy Tubes: Are They Necessary? A Systematic Review on Implementation in Cleft Care
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Eloise Stanton, Katelyn Kondra, Indraneel Brahme, Sasha Lasky, Naikhoba C.O. Munabi, Christian Jimenez, Laya Jacob, Mark M. Urata, Jeffrey A. Hammoudeh, and William P. Magee
- Subjects
Otorhinolaryngology ,Oral Surgery - Abstract
Objective To understand the indication for and the effects of early ventilation tube insertion (VTI) on hearing and speech for patients with cleft lip and/or palate (CLP). Design We conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA)-guided systematic review of relevant literature. Setting Setting varied by geographical location and level of clinical care across studies. Patients, Participants Patients with CLP who underwent VTI were included. Interventions No interventions were performed. Main Outcome Measure(s) Primary outcome measures were hearing and speech following VTI. Secondary outcome measures were tube-related and middle ear complications. Early VTI occurred before or at time of palatoplasty while late VTI occurred after palatoplasty. Results Twenty-three articles met inclusion criteria. Articles varied among study design, outcome measures, sample size, follow-up, and quality. Few studies demonstrated support for early VTI. Many studies reported no difference in hearing or speech between early and late VTI. Others reported worse outcomes, greater likelihood of complications, or needing repeat VTI following early tympanostomy placement. Several studies had significant limitations, including confounding variables, small sample size, or not reporting on our primary outcome. Conclusions No consistency was found regarding which patients would benefit most from early VTI. Given the aforementioned variability and sub-optimal methodologies, additional studies are warranted to provide stronger evidence regarding VTI timing in cleft care.
- Published
- 2022
44. Midface Growth Potential in Unoperated Clefts: A Systematic Review and Meta-Analysis
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Mark M. Urata, Naikhoba C.O. Munabi, Jordan R. Wlodarczyk, William P. Magee, Eric S. Nagengast, Emma Higuchi, Caroline A. Yao, Jeffrey A. Hammoudeh, Erik M. Wolfswinkel, and Marvee Turk
- Subjects
Orthodontics ,Cephalometric analysis ,business.industry ,Cephalometry ,medicine.medical_treatment ,Cleft Lip ,General Medicine ,Surgical correction ,Midface hypoplasia ,Cleft Palate ,Palatoplasty ,Otorhinolaryngology ,Growth restriction ,Bilateral cleft lip ,Meta-analysis ,Maxilla ,Medicine ,Humans ,Surgery ,business - Abstract
Competing hypotheses for the development of midface hypoplasia in patients with cleft lip and palate include both theories of an intrinsic restricted growth potential of the midface and extrinsic surgical disruption of maxillary growth centers and scar growth restriction secondary to palatoplasty. The following meta-analysis aims to better understand the intrinsic growth potential of the midface in a patient with cleft lip and palate unaffected by surgical correction. A systematic review of studies reporting cephalometric measurements in patients with unoperated and operated unilateral cleft lip and palate (UCLP), bilateral cleft lip and palate (BCLP), and isolated cleft palate (ICP) abstracted SNA and ANB angles, age at cephalometric analysis, syndromic diagnosis, and patient demographics. Age and Region-matched controls without cleft palate were used for comparison. SNA angle for unoperated UCLP (84.5 ± 4.0°), BCLP (85.3 ± 2.8°), and ICP (79.2 ± 4.2°) were statistically different than controls (82.4 ± 3.5°), (all P ≤ 0.001). SNA angles for operated UCLP (76.2 ± 4.2°), BCLP (79.8 ± 3.6°), and ICP (79.0 ± 4.3°) groups were statistically smaller than controls (all P ≤ 0.001). SNA angle in unoperated ICP (n = 143) was equivalent to operated ICP patients (79.2 ± 4.2° versus 79.0 ± 4.3° P = 0.78). No unoperated group mean SNA met criteria for midface hypoplasia (SNA < 80). Unoperated UCLP/BLCP exhibit a more robust growth potential of the maxilla, whereas operated patients demonstrate stunted growth compared to normal phenotype. Unoperated ICP demonstrates restricted growth in both operated and unoperated patients. As such, patients with UCLP/BCLP differ from patients with ICP and the factors affecting midface growth may differ.Level of Evidence: IV.
- Published
- 2021
45. Predictors of Complication Following Cleft Lip and Palate Surgery in a Low-Resource Setting: A Prospective Outcomes Study in Nicaragua
- Author
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Marco Swanson, Allyn Auslander, William P. Magee, Breanna Jedrzejewski, Armando Siu, Jordan W. Swanson, Ruben Ayala, and Tatiana Morales
- Subjects
medicine.medical_specialty ,Low resource ,business.industry ,Fistula ,Cleft Lip ,Postoperative complication ,Infant ,Nicaragua ,Perioperative ,Dehiscence ,Anthropometry ,medicine.disease ,Surgery ,Cleft Palate ,Postoperative Complications ,Otorhinolaryngology ,medicine ,Humans ,Leukocytosis ,Prospective Studies ,Oral Surgery ,medicine.symptom ,Complication ,business ,Retrospective Studies - Abstract
Background Higher rates of postoperative complication following cleft lip or palate repair have been documented in low resource settings, but their causes remain unclear. This study sought to delineate patient, surgeon, and care environment factors in cleft complications in a low-income country. Design Prospective outcomes study. Setting Comprehensive Cleft Care Center. Patients Candidate patients presenting for cleft lip or palate repair or revision. Interventions Patient anthropometric, nutritional, environmental and peri- and post-operative care factors were collected. Post-operative evaluation occurred at standard 1-week and 2-month postoperative intervals. Main Outcome Measures Complication was defined as fistula, dehiscence and/or infection. Results Among 408 patients enrolled, 380 (93%) underwent surgery, of which 208 (55%) underwent lip repair (124) or revision (84), and 178 (47%) underwent palate repair (96) or revision (82). 322 (85%) were evaluated 1 week and 166 (44%) 2 months postoperatively. 50(16%) complications were identified, including: 25(8%) fistulas, 24(7%) dehiscences, 17(5%) infections. Mid-upper arm circumference (MUAC) ≤12.5 cm was associated with dehiscence after primary lip repair (OR = 28, p = 0.02). Leukocytosis ≥11,500 on pre-operative evaluation was associated with dehiscence (OR = 2.51, p = 0.04) or palate revision fistula (OR = 64, p Conclusions Multiple patient, surgeon, and perioperative factors are associated with higher rates of complication in a low-resource setting, and are potentially modifiable to reduce complications following cleft surgery.
- Published
- 2021
46. Predicting Outcomes after Mandibular Distraction Osteogenesis in Patients with Isolated Pierre-Robin Sequence
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Eloise Stanton, Katelyn Kondra, Christian Jimenez, Naikhoba Munabi, Kevin Chen, Mark M Urata, William P Magee, and Jeffrey A Hammoudeh
- Subjects
Surgery - Published
- 2022
47. 57 Understanding the Burden of Burn Injury in Latin America & the Caribbean
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Zachary J Collier, Alexandre J Bourcier, Priyanka Naidu, William P Magee, Tom Potokar, and Justin Gillenwater
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Rehabilitation ,Emergency Medicine ,Surgery - Abstract
Introduction Burn injuries are a global health problem disproportionately affecting low- and middle-income countries, especially in Latin America and Caribbean (LAC) where cooking methods, dangerous work conditions, and minimal housing regulations place people at increased risk of burn injury. Until recently, there was limited global epidemiological data on burn injuries. Following publication of the 2017 Global Burden of Disease (GBD17) database, we obtained objective and comparable data on burn injuries while specifically focusing on LAC countries. Methods Data from all 35 LAC countries were collected from GBD17 for fire, heat, and hot substance-related injuries to calculate burn incidence, deaths, and Disability-Adjusted Life Years (DALYs) with respect to country, age, and gender from 1990 to 2017. Incidence and deaths were reported as rates per 100,000 persons. Mortality rate was reported as a percentage of deaths-to-incidence. DALYs were reported in years per 100,000 persons. Incidence, death, DALY, and mortality rate trends were assessed using age-standardized, age-stratified, and gender-specific cohorts. All statistical analyses were performed using Excel. Results Over 27 years, LAC’s rates for burn incidence (-19%), deaths (-63%), DALYs (-62%), and mortality (-54%) all decreased with the greatest improvements seen in Brazil and Paraguay. All indicators improved around 15% more than the global averages during the same period with LAC’s rates 30-40% below global rates by 2017. The highest burn incidence (227 cases/100,000) was in Southern Latin America (Argentina, Chile, Uruguay). The Caribbean had the worst DALYs (124 years/100,000). In 2017, LAC accounted for 7% of global burns, 5.5% of deaths, and 5.1% of DALYs with Central America contributing the greatest numbers. For 27 years, Chile had the highest burn incidence but Haiti had the greatest death, DALY, and mortality rates of all LAC. Children under 14 years of age and males were disproportionately affected compared to other regional and global cohorts. Conclusions Despite a relatively greater reduction in burn severity and lifelong disability within LAC compared to the world, certain regions and countries exhibited significantly higher rates of burn injury, morbidity, and mortality. Central America (e.g. Costa Rica, Belize, Mexico) and the Caribbean (e.g. Haiti, Cuba) were particularly affected, comprising the majority of cases, deaths, and DALYs. This study provides essential analyses for developing regional and country-specific strategies to reduce the burden of burns through targeted interventions for prevention, workforce, and capacity building efforts.
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- 2022
48. 58 Burn Injuries in Asia: A Global Burden of Disease Study
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Zachary J Collier, Katherine McCool, William P Magee, Tom Potokar, and Justin Gillenwater
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Rehabilitation ,Emergency Medicine ,Surgery - Abstract
Introduction Burn injuries disproportionately affect low- and middle-income countries. Work conditions, rapid industrialization, social conditions, cultural activities, political conflict, and lack of access to safe and affordable surgery are key barriers to effective burn care in Asia. This study aimed to better define the burn burden in Asia, its sub-regions, and related sex and age disparities to elucidate populations where targeted burn care interventions are most needed. Methods The 2019 Global Burden of Disease (GBD19) of the Global Health Data Exchange was used to acquire 151,741 sources of epidemiological data on fire, heat, and hot substance-related injuries for 53 countries in Asia from 1990 to 2019. Measures used to derive summative statistics included incidence, deaths, disability-adjusted life years (DALYs), and mortality ratio (deaths: incidence) by year, sex, age, and location. Spatial mapping was performed to geographically delineate burn indicators. Results From 1990 to 2019, an estimated 117 million burns occurred in Asia. The relative proportion of global burns, deaths, and DALYs from Asia increased during that time. By 2019, 46% of global burn cases, 47% of deaths, and 46% of DALYs were from Asia. The two most burdened regions were South and Southeast Asia, accounting for 30-40% of all global cases, deaths, and DALYs. Compared to global averages, the incidence, death, and DALY rates for Asia were 32%, 22%, and 23% higher. Central Asia had the worst rates, averaging 2.9, 2.3, and 2.6 times the global averages. Throughout Asia, men were 32%, 63%, and 47% more likely to be burned, die, and suffer DALYs than women versus the global disparities of 7%, 26%, and 10%. Only South Asia’s trend was reversed with women suffering 15%, 20%, and 27% more burns, deaths, and DALYs than men. In Asia, those under 5 years were most impacted by DALYs (314 years/100,000 people), 5-14 year olds had the highest burn rate (219 cases/100,000), and 70+ year olds had the highest death rate (8.4 deaths/100,000) and mortality ratio (54%). Conclusions In 2019, Asia had an estimated 3.8 million burns comprising nearly half of all the world’s burn cases, deaths, and DALYs. While Asia’s burn indicators have declined since 1990, global improvements have surpassed Asia’s. South and Southeast Asia accounted for the greatest burden of burn morbidity and mortality, but Central Asia consistently had the highest rates relative to overall population. Men were more affected than women, except in South Asia, and the extremes of age (< 5 and 70+ years) suffered the greatest rates of disability and death.
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- 2022
49. 59 Burns in Low- and Middle-income Countries: A Scientometric Analysis of Peer-reviewed Research
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Zachary J Collier, Ulrick S Kanmounye, Priyanka Naidu, Maria Fernanda Tapia, Atenas Bustamante, Daniel Bradley, Chifundo Msokera, John Dutton, William P Magee, and Justin Gillenwater
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Rehabilitation ,Emergency Medicine ,Surgery - Abstract
Introduction Low- and middle-income countries (LMICs) account for 70% of all global burns. Due to this significantly disproportionate burden, it’s critical we identify barriers to burn care and prevention in LMICs. As a result, this study aimed to elucidate trends in LMIC-related burn research to create focused strategies for burn care training, research, and innovation. Accomplishing meaningful change from the study’s findings will be guided by the first 4 steps of Dr. John Kotter’s “8-Step Process for Leading Change” – 1) create urgency for change, 2) build a guiding team, 3) develop a vision and plan, 4) communicate with key stakeholders to obtain buy-in. Methods Web of Science’s 7 citation databases were searched through March 2, 2021 using synonyms of “burns” and “low- and middle-income countries.” After screening articles, metadata were uploaded to VOSviewer (Leiden, Netherlands) where citation and network metrics were generated. The Kruskal-Wallis test and linear regression were used for bivariable and multivariable analysis of factors influencing publications, citations, and total link strength (TLS) – the strength of association between a given research article, other articles, and additional institutions. Results Bibliometric analysis identified 2,027 articles by 8,602 authors in 692 journals. Two-thirds of journals published a single article (n=453, 65.5%) whereas only 3.6% published ≥10 articles. One-quarter of LMIC burn research was published in ISBI’s Burns (n=417 articles, 20.6%) and ABA’s Journal of Burn Care & Research (n=89 articles, 4.4%). Most authors published < 5 articles (n=8521, 99.1%) but 19 (0.2%) had published ≥10. Authors were affiliated with 2,519 organizations in 132 countries. There was a strong positive correlation between total publications and citations (R=0.87, P< 0.001). In addition, there was a significant difference in the number of publications (P=0.003, 0.07), citations (P=0.005, 0.03), and TLS (P=0.009, 0.008) by geographic and economic categories - North America had the highest while Latin American and the Caribbean had the lowest. The USA (n = 563), India (n = 161), and China (n = 154) published the most articles. Conclusions Given the disproportionate representation of high-income countries and authors in the current LMIC burn research landscape, there must be a sense of urgency to develop pathways for facilitating change. Local and regional candidates for mentors and leaders were identified using bibliometric findings. Assembling teams with these individuals and prolific authors using a well-defined vision for change will facilitate sustainable communication and collaboration within LMIC research.
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- 2022
50. A Neuroprotective Protocol in Neonatal Anesthesia: A Review of 101 Early Cleft Lip Repairs
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E. Higuchi, W. Gibreel, William P. Magee, Mark M. Urata, A. Liu, Artur Fahradyan, L. Jennifer, J. Wlodarczyk, and Jeffrey A. Hammoudeh
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Protocol (science) ,Otorhinolaryngology ,business.industry ,Anesthesia ,Neonatal anesthesia ,Medicine ,Surgery ,Oral Surgery ,business ,Neuroprotection - Published
- 2020
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