The Journal of craniofacial surgery
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Multicenter Study
Pediatric National Surgical Quality Improvement Program: Useful for Quality Improvement in Craniosynostosis Surgery?
The American College of Surgeons and the American Pediatric Surgical Association collaborate to provide pediatric hospitals with multispeciality surgical outcomes data through the Pediatric National Surgical Quality Improvement Program (NSQIP Peds). The authors used this national multicenter database to describe 30-day outcomes from craniosynostosis surgery and identify associations with perioperative events and blood transfusion. Data from NSQIP Peds were used to describe children undergoing craniosynostosis surgery. ⋯ Perioperative adverse event rate was 3.15%. Duration of surgery and duration of anesthesia were significantly associated with blood transfusion. The authors identified opportunities for pediatric NSQIP database improvement.
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Epistaxis is one of the most frequently encountered emergency problems in our country, as it is throughout the world. In epistaxis, the benefits of implementing clinical guidelines are evident in both daily practice and medical education. ⋯ In management of epistaxis, the implementation of the simplest method, minimally affecting the life quality of the patient, may be easier with a stepped approach. The authors consider that the stepped approach that they have implemented and presented in their study may lead to using less invasive methods and may accordingly improve the life quality of the patient.
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To compare the quality of life (QOL), side effects, risks, and complications following mandibular third molar coronectomy compared with conventional third molar extraction. ⋯ Coronectomy of impacted mandibular third molars may be offered instead of total extraction in patients presenting radiological characteristics of root proximity to the inferior alveolar nerve.
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Endovascular management of maxillary arteriovenous malformation (AVMs) can be complex. Transarterial, transvenous, and direct puncture embolization has been described. The authors report the case of a 9-year-old girl with a hemorrhagic maxillary AVM, which has been treated by transvenous embolization after failure of transarterial embolization. ⋯ Onyx filled the pouch and retrogradely reached some arterial feeders, achieving complete occlusion. Bleeding episode ceased and at 6 months follow-up no recurrence was found. Maxillary AVMs can be successfully treated by transvenous Onyx embolization.
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The authors experienced a case of severe epistaxis caused by accidental partial middle turbinectomy during nasotracheal intubation, which the patient had bilateral concha bullosa narrowing the nasal airway. Although anesthesiologist checked nasal airway through subjective symptoms and the size of both nostrils, they tend to overlook common anatomic variation, concha bullosa, and can injure turbinate structures. Therefore, preoperative computed tomography images should be carefully evaluated for the possibility of concha bullosa, which narrows nasal airway and induces the traumatic injury or epistaxis during nasotracheal intubation.