Gharavi, Aidin

Although complications of autologous bone flap cranioplasty are well described, data on long-term bone flap survival and the comorbidities associated with secondary reconstruction are limited. This study aimed to quantify the need for secondary alloplastic cranioplasty within a standardized patient cohort. Patients who underwent delayed cranioplasty following craniectomy with banked, frozen autologous bone between 2012 and 2025 were identified and analyzed using Cox regression, spline analysis, and Kaplan–Meier survival analysis. A total of 367 patients with an average age of 39.2±19.7 years (range: 0.3–84.4 years) at the time of cranioplasty were included. A secondary cranioplasty was required in 13.6% of patients (n=50 of 367), with resorption (52%) and infection (42%) as the most common indications. In adjusted analyses, patients who underwent cranioplasty following a traumatic injury (HR: 2.37; 95% CI: 1.07–5.26; P =0.03) and patients younger than 18 years (HR: 2.99; 95% CI: 1.35–6.62; P =0.01) were more likely to require a secondary cranioplasty due to bone flap resorption. Increasing defect size was also associated with a higher risk of secondary cranioplasty due to bone flap resorption, becoming significant at roughly 95 cm² (HR: 2.54; 95% CI: 1.04–6.20; P =0.04). The estimated cumulative incidence of secondary cranioplasty was 37% at ten years after autologous reconstruction. These results indicate that although autologous bone flap cranioplasty is largely effective, select patients face a substantially higher risk of secondary cranioplasty, and alternative reconstructive options may be warranted.

Biparietal osteodystrophy, also known as bilateral parietal calvarium bone thinning, is a rare calvarial condition characterized by loss of diploic bone within the parietal region. Although historically described in anthropologic and radiologic literature, current understanding of its epidemiology, pathogenesis, clinical relevance, and management remains fragmented. This review synthesizes current evidence and highlights emerging studies on biparietal osteodystrophy. Epidemiologic reports indicate that biparietal osteodystrophy affects a broad age range but appears most frequently in older adults, with several series suggesting a slight female predominance. Prevalence is difficult to estimate due to incidental detection, though modern imaging has increased recognition of the condition. Histologically and anatomically, biparietal osteodystrophy is marked by thinning of the outer table and loss of the diploic space, with little osteoblastic or osteoclastic remodeling. Proposed pathogenic mechanisms include chronic degenerative change, impaired vascular supply to the diploë, and other theories, although no single explanation fully accounts for its complete presentation. Clinically, most patients remain asymptomatic, with complications such as calvarial fractures and traumatic brain injury being rare but highlighting the structural vulnerability associated with severe thinning. Management strategies are not standardized, and the use of anti-osteoporotic drugs and cranioplasty has been reported to offer benefit in select cases, although no treatment has been formally validated for biparietal osteodystrophy. As the understanding of biparietal osteodystrophy continues to evolve, future research is needed to clarify its natural history, identify potential etiologic pathways, and establish evidence-based management guidelines.

Introduction Hypergranulation tissue (excess granulation tissue) is a common complication following penile inversion vaginoplasty (PIV). It often requires repeated treatment with silver nitrate using a speculum to access the neovagina. This study evaluates whether adding betamethasone suppositories to silver nitrate treatment improves the resolution of hypergranulation tissue after PIV. Methods A retrospective chart review was conducted on patients who received supplemental betamethasone suppositories in addition to silver nitrate treatment (betamethasone group) between 01/2023 and 12/2024 and matched to a cohort of patients treated with silver nitrate alone (silver nitrate group). Outcomes, number of treatments, and severity of hypergranulation tissue were compared using t tests for continuous variables and Fisher's exact tests for categorical variables. Results There were 16 patients in each group, with similar average follow-up times: 8.5 ± 5.5 months (silver nitrate group) and 7.8 ± 4.7 months (betamethasone group) ( P = 0.70). At the most recent follow-up, moderate and severe hypergranulation resolved more often in the betamethasone group (86%, 50%) than in the silver nitrate group (60%, 25%). Patients in the betamethasone group with moderate or severe hypergranulation tissue required fewer median treatments for resolution (2 vs 3.5 and 4 vs 5, respectively). After excluding cases that required cauterization under anesthesia, patients in the betamethasone group were significantly more likely to have resolution of their hypergranulation tissue compared to patients in the silver nitrate group ( P = 0.035). Conclusions Betamethasone is an effective addition to silver nitrate for the treatment of hypergranulation tissue, with our results indicating it can improve resolution and lessen treatment burden in patients' post-PIV.

Objective: To characterize pediatric patients experiencing unplanned intraoperative extubation (UIE) during cleft lip (CL) and cleft palate (CP) repair and assess postoperative outcomes. Design: Retrospective cohort study using the 2019–2023 National Surgical Quality Improvement Program–Pediatric database. Setting: Multicenter surgical registry of pediatric operations. Patients: Children undergoing CL repair (<1 year) or CP repair (<3 years). Interventions: Not applicable. Main Outcome Measure(s): Incidence of UIE, demographic and operative characteristics, and 30-day postoperative complications. Results: Among 17 047 cases, UIE occurred in 0.37% of CL repairs and 0.20% of CP repairs. Patients who experienced UIE had similar baseline characteristics to those without UIE but demonstrated significantly longer operative and anesthesia times for both procedures. Despite these intraoperative events, no cases of death, pneumonia, or unplanned reintubation occurred postoperatively, and overall 30-day complication rates remained low. Conclusions: UIE during CL and CP repair is rare and not associated with major postoperative complications.

Cranioplasty is a critical reconstructive procedure, with research focused on many different areas. Despite this variety, there is a lack of research analyzing the most impactful studies on cranioplasty. The authors conducted a comprehensive search of the Web of Science (WoS) Core Collection for studies on cranioplasty and selected the top 100 articles by citation count. Bibliometric data, study design, materials used, and study sample sizes were extracted. Spearman correlation tests and Kruskal-Wallis tests were conducted to analyze citation patterns. The top 100 cranioplasty studies, published between 1979 and 2020, were cited an average of 136.7 ± 65.1 times. The majority of studies (n = 68) were classified as clinical, while 21 were reviews and 11 were basic science. Most clinical studies were single-center (92.6%), while 7.4% were multicenter studies. Excluding case reports (n = 7), the median sample size in clinical studies was 70 patients (IQR: 25–147). Studies with larger sample sizes received more citations per year on average (rho = 0.44, P < 0.001), and more recent studies tended to use larger sample sizes (rho = 0.37, P = 0.002). Over half (52.3%) of clinical studies included patients who had reconstruction with autologous bone, followed by titanium (32.3%), polymethylmethacrylate (PMMA) (29.2%), hydroxyapatite (12.3%), and polyetheretherketone (9.3%). These findings demonstrate that the most impactful studies on cranioplasty are predominantly single-center investigations, most with <100 patients, yet have significantly shaped the field.

Surgical outcomes and perioperative factors associated with pediatric cranioplasty remain incompletely understood. The authors queried the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database to evaluate outcomes and intraoperative/postoperative blood transfusions in patients undergoing cranioplasty between 2019 and 2023. A total of 249 patients (mean age 9.1 ± 5.4 y) were included. Most cranioplasties (70.7%) utilized alloplastic materials compared with autologous. Blood transfusion was required in 24.1% of cases, predominantly on the day of surgery (86.7%). Multivariable analysis identified age (OR: 0.86 per year, 95% CI: 0.80–0.93, P < 0.001) and cranioplasty size >5 cm (versus ≤5 cm) (OR: 2.10, 95% CI: 1.01–4.50, P = 0.049) as predictors of transfusion. The 30-day unplanned readmission rate was 5.3% at a mean of 14.6 ± 7.9 days from surgery, most commonly for a surgical site infection (33.0%). The 30-day unplanned reoperation rate was 2.9%, at a mean of 10.2 ± 5.6 days. Autologous cranioplasty was not associated with higher odds of readmission (OR: 0.79, 95% CI: 0.25–2.13, P = 0.66) or reoperation (OR: 5.04, 95% CI: 0.96–36.99, P = 0.07) compared with alloplastic cranioplasty. Rates of readmission and reoperation following pediatric cranioplasty are comparable to other complex craniofacial procedures. Younger age and larger cranioplasty size are associated with higher rates of blood transfusion. Our results show that autologous reconstruction is not associated with higher short-term complication rates compared with alloplastic reconstruction, although future studies are still needed to further the understanding of the optimal cranioplasty material.

Objective We sought to characterize the frequency of postoperative opioid prescriptions in patients undergoing cleft lip repair (CLR). Design The NSQIP-P 2023 database was queried to identify patients undergoing CLR using CPT codes. Univariable analysis was conducted to identify factors associated with postoperative opioid prescription. Setting A multicenter sample from 157 participating sites. Patients/participants A total of 1497 cases (1215 unilateral CLR and 282 bilateral CLR) were identified. Main outcomes/measures The postoperative outcomes of interest were whether an opioid was prescribed to a patient at discharge and what factors were independently associated with opioid prescribing at discharge. Results A total of 44.6% of patients with a mean age of 5.1 ± 1.9 months were prescribed opioids at discharge, most commonly oxycodone (76.3%). Univariable analysis identified an increase in weight (kg) (OR: 1.09, 95% CI: 1.02-1.17, P = .03), American Society of Anesthesiologists (ASA) classification (ordinal) (OR: 1.25, 95% CI: 1.06-1.47, P = .01), anesthesia time (10 min) (OR: 1.02, 95% CI: 1.01-1.04, P = .03), and age (months) (OR: 1.06, 95% CI: 1.00-1.12, P = .04) as being associated with opioid prescription at discharge. Bilateral versus unilateral CLR ( P = .49) and outpatient versus inpatient operation ( P = .38) were not associated with opioid prescribing. Conclusion Opioid stewardship is important in pediatric care, with our results showing age, weight, anesthesia time, and ASA classifications are predictors of opioid prescription. Further research examining contributors to patient pain following CLR is necessary to optimize opioid prescribing without negatively impacting the patient.

Abstract Firework injuries remain a significant public health concern, with an estimated 9700 injuries reported in 2023. This study examines trends in pediatric facial injuries from fireworks over the past decade using the National Electronic Injury Surveillance System. Pediatric cases from 2014 to 2023 were identified using the fireworks consumer code (1313) and filtered for facial injuries (body part code 76). Data was analyzed using chi-square tests to assess significance and logistic regression to evaluate trends. An estimated 4625 pediatric facial injuries from fireworks presented to emergency departments nationwide from 2014 to 2023. Among cases (n = 177), 68.4% were male and 31.6% were female. Thermal burns (60.5%), lacerations (15.3%), and contusions/abrasions (11.9%) were the most common injuries. Males were more likely to be injured than females (P-value: &lt; .001). Overall, 17.5% of injuries required hospitalization or transfer. Older children were significantly more likely to sustain injuries requiring hospitalization (Odds Ratio [OR]: 1.13, 95% CI, 1.04-1.23, P = .005). Younger children had higher odds of sparkler-related injuries, although the risk rapidly decreased with age (OR: 0.76, 95% CI, 0.68-0.86, P &lt; .001). Our results show fireworks continue to cause significant pediatric facial injuries, with thermal burns being the most common diagnosis, and nearly one in 5 facial injuries from fireworks requiring hospitalization. Efforts to reduce facial injuries from fireworks should focus on minimizing the risk of injury in younger children while ensuring safety protocols are in place to address more significant injuries in older children.