Abstract Many treatments have been described for infants with Robin sequence and severe respiratory distress, but there have not been many comparative studies of outcome and cost-effectiveness. The ...aim of this study was to compare the cost and complications of two common interventions – mandibular distraction osteogenesis and tracheostomy. Nine patients with isolated Robin sequence (mandibular distraction osteogenesis, n = 5, and tracheostomy, n = 4) were included in the analyses. Predetermined costs and complications were obtained retrospectively from medical records and by questionnaires to the parents over a 12-month period. Overall direct costs (admission to hospital, diagnostics, surgery, and homecare) were 3 times higher for tracheostomy (€105.523 compared with €33.482, p = 0.02). Overall indirect costs (absence from work) were almost 5 times higher (€2.543 compared with €543, p = 0.02). There was a threefold increase in overall total cost/patient (both direct and indirect) for tracheostomy (€108.057 compared with 34.016, p = 0.02) and 4 times more complications were encountered. This study shows that mandibular distraction osteogenesis in infants diagnosed with Robin sequence costs significantly less and results in fewer complications than tracheostomy, and this contributes to our current knowledge about the ideal approach for infants with Robin sequence and might provide a basis for institutional protocols in the future.
Health‐related quality of life in children with Robin sequence Basart, Hanneke; van Oers, Hedy A.; Paes, Emma C. ...
American journal of medical genetics. Part A,
January 2017, 2017-Jan, 2017-01-00, 20170101, Letnik:
173, Številka:
1
Journal Article
Objectives
Initial approaches to and treatments of infants with Robin sequence (RS) is diverse and inconsistent. The care of these sometimes critically ill infants involves many different medical ...specialties, which can make the decision process complex and difficult. To optimize the care of infants with RS, we present our institution’s approach and a review of the current literature.
Material and methods
A retrospective cohort study was conducted among 75 infants diagnosed with RS and managed at our institution in the 1996–2012 period. Additionally, the conducted treatment regimen in this paper was discussed with recent literature describing the approach of infants with RS.
Results
Forty-four infants (59 %) were found to have been treated conservatively. A significant larger proportion of nonisolated RS infants than isolated RS infants needed surgical intervention (53 vs. 25 %,
p
= .014). A mandibular distraction was conducted in 24 % (
n
= 18) of cases, a tracheotomy in 9 % (
n
= 7), and a tongue–lip adhesion in 8 % (
n
= 6). Seventy-seven percent of all infants had received temporary nasogastric tube feeding. The literature review of 31 studies showed that initial examinations and the indications to perform a surgical intervention varied and were often not clearly described.
Conclusions
RS is a heterogenic group with a wide spectrum of associated anomalies. As a result, the decisional process is challenging, and a multidisciplinary approach to treatment is desirable. Current treatment options in literature vary, and a more uniform approach is recommended.
Clinical Relevance
We provide a comprehensive and pragmatic approach to the analysis and treatment of infants with RS, which could serve as useful guidance in other clinics.
Women tend to develop more and deeper wrinkles in the perioral region than men. Although much is known about the complex mechanisms involved in skin aging, previous studies have described histologic ...differences between men and women with respect to skin aging only incidentally and have not investigated the perioral region.
The purpose of this study was to investigate gender-specific differences in the perioral skin.
To determine wrinkle severity, skin surface replicas of the upper lip region in 10 male and 10 female fresh cadavers were analyzed by using the dermaTOP blue three-dimensional digitizing system (Breuckmann, Meersburg, Germany). In 30 fresh male and female cadavers, three full-thickness lip resections were investigated in a blinded fashion for specific histologic features. All results were statistically analyzed in a linear regression model with SPSS software (version 15.0; SPSS, Chicago, IL).
The female replicas showed more and deeper wrinkles than the male replicas (
P < .01). Histologic analysis revealed that the perioral skin of men displayed a significantly higher number of sebaceous glands (
P = .000; 95% confidence interval CI 23.6–53.2), sweat glands (
P = .002; 95% CI 2.1–8.1), and a higher ratio between vessel area and connective tissue area in the dermis (
P = .009; 95% CI 0.003–0.021). The amount of hair follicles did not significantly differ between men and women, although the average number of sebaceous glands per hair follicle was greater in men (
P = .002; 95% CI 0.33–1.28).
Women exhibit more and deeper wrinkles in the perioral region and their skin contains a significantly smaller number of appendages than men, which could be a feasible explanation for why women are more susceptible to development of perioral wrinkles.
Summary Introduction The vascular pedicle of the internal mammary artery perforator (IMAP) flap and its enhancement by inclusion of the internal mammary vessels up to the level of the first rib have ...not been systematically assessed anatomically, to date. This study assesses these features of this pedicle in light of the flap’s application in head and neck reconstruction. Material and methods The length of the dominant perforator and the enhanced vascular pedicle of the IMAP flap were measured in 27 fresh cadaveric hemi-thoraxes. Results In 18 out of 27 cadaveric cases (0.67) the second perforator was dominant. The mean length of the 27 dominant perforators was 47 mm (range: 30–66 mm). By enhancement up to the level of the first rib, the mean length of the vascular pedicle could be doubled to 92 mm when based on the second perforator (0.67). In the five cases (0.19), where the third perforator was dominant, the mean length of the enhanced pedicle was 104 mm, whereas it was 61 mm in the four cases (0.15) where the first perforator was dominant. Conclusion This is the first study that assessed the enhanced length of the vascular pedicle of the IMAP flap. Our results show that the mean length of the dominant second perforator may be doubled by such enhancement and that the arc of rotation to the head and neck region may, then, be doubled again. Hereby, even high-located defects in the head and neck region can be reached. This provides a better understanding of the feasibility of the pedicled IMAP flap in head and neck reconstruction.
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