The Journal of craniofacial surgery
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Military pediatric plastic surgery humanitarian missions in the Western Hemisphere have been initiated and developed since the early 1990 s using the Medical Readiness Education and Training Exercise (MEDRETE) concept. Despite its initial training mission status, the MEDRETE has developed into the most common and advanced low level medical mission platform currently in use. The objective of this study is to report cleft- and craniofacial-related patient outcomes after initiation and evolution of a standardized treatment protocol highlighting lessons learned which apply to civilian plastic surgery missions. ⋯ Military pediatric plastic surgery humanitarian missions can be executed with similar home institution results after the initiation and evolution of a standardized approach to humanitarian missions. The incorporation of a dedicated logistics support unit, a dedicated operational specialist (senior noncommissioned officer), a speech language pathologist, remote internet follow up, an liaison officer (host nation liaison physician participation), host nation surgical resident participation, and support from the embassy, Military Advisory Attachment Group, and United States Aid and International Development facilitated patient accurate patient evaluation and posttreatment follow-up. Movement of the mission site from a remote more austere environment to a centralized better equipped facility with host nation support to transport patients to the site facilitated improved patient safety and outcomes despite increasing the complexity of surgery performed.
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To assess the effectiveness of continuous lumbar drainage (LD) for management of postoperative cerebrospinal fluid leaks after endoscopic endonasal transsphenoidal approach for resection of pituitary adenoma. Three hundred eighty-four medical records of patients who were admitted to our institute during a 2.5-year period were retrospectively reviewed, 33 of them experienced low-flow cerebrospinal fluid leak postoperatively. If LD was used, all patients with low-flow cerebrospinal fluid leak were classified into 2 groups, lumbar drained group and conservatively treated group. ⋯ One patient required endoscopic repair of skull base because of persistent cerebrospinal fluid leak in both groups, with the rates of 5.6% and 6.7%, respectively. There was no significant difference noted in each rate in both groups. Placement of LD may not be necessary for the management of low-flow postoperative cerebrospinal fluid leak after using endoscopic endonasal transsphenoidal approach to pituitary adenoma.
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Although much debate remains regarding the ethical obligations of surgeons who conduct mission trips in foreign countries, it seems certain from our experience that medical students who participate on such trips have invaluable educational opportunities. From patient care to resource allocation, medical students gain first-hand experience in relatively short periods. They develop skills of patient management along with an enhanced cultural sensitivity and sense of fiscal responsibility. With appropriate guidance and teaching, medical students gain experience that can positively influence their careers and shape their development into competent physicians.
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Large cranial defects represent reconstructive challenges. Polyetheretherketone (PEEK) implants are preoperatively tailored to the exact size of the defect and exhibit an excellent combination of strength, durability, and environmental resistance. This study presents our experience with patient-specific PEEK implants with computer modeling. ⋯ Use of patient-specific PEEK implants is a good alternative for alloplastic cranioplasty. It is associated with low morbidity as reported in our series, with additional advantages including strength, stiffness, durability, and inertness. It would be beneficial to assess the longer-term outcomes; however, it appears at first glance that PEEK implants show great promise in calvarial reconstruction.
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This study aimed to compare the eyes of beautiful women and femme fatales depicted in Western portraits. A total of 37 samples were collected; 19 beautiful women and 18 femme fatales. Nine aspects were measured in reference to the corneal horizontal diameter. ⋯ It is noteworthy that the beautiful women and femme fatales have the same interpupillary distance (5.00). Also, the ptosis ratio was almost zero in both groups (-0.01 [SD, 0.18] in the beautiful women and 0.06 [SD, 0.01] in the femme fatales). The results of this study might be of some reference in performing eyelid surgeries especially in brow lifts or canthoplasties.