Surgical Management of Velopharyngeal Dysfunction: Major Techniques and Trends for the 21st Century

INTRODUCTION: Surgical management of velopharyngeal dysfunction (VPD) has become increasingly complex over recent decades with advances in diagnosis, evaluation and technique, and research focus in this area is expected to shift accordingly. This study aims to educate readers on updates in management of VPD and explore changes in surgical methods through the 21st century. METHODS: A systematic review was conducted of all literature published on surgical treatment of VPD since the year 2000, following PRISMA reporting guidelines. Adult-acquired VPD, any non-surgical management, implants and prosthetic devices, animal or cadaver models, and case series involving less than 10 subjects were excluded. All relevant studies were surveyed for selection and use of surgical technique as well as study conclusions, which were then analyzed for trends in research focus over time. RESULTS: Our review examined 77 original studies. The average number of publications per year increased over time. Overall, the most frequently discussed technique involved some form of pharyngeal flap (represented in 32% of publications), followed by double opposing Z-plasty (22%). While pharyngeal flaps were consistently popular, more recent studies introduced various modifications, many informed by preoperative patient evaluation. Grafting, injection, and buccal myomucosal flaps were more highly represented over the second half of the study period [Figures 1 and 2]. CONCLUSIONS: Research interest in VPD is increasing. Pharyngeal flaps remain a consistent staple of VPD management, but surgeons are moving toward modified procedures and patient-individualized methods. The last decade shows growing attention to alternative techniques including autologous tissue grafting and injection methods

Factors affecting length and complexity of hospital stay in pediatric dog bite patients

Background Dog bite injuries are a source of significant morbidity and expense in the USA, and rates of hospitalization have been rising. Children are at increased risk of dog bites compared with adults, yet there is a lack of published material on factors affecting hospital course. The objective of this study is to explore factors associated with increased length of stay (LOS), more complex course of care and post-discharge return rates in this population.Methods A retrospective review was conducted of all patients presenting to our urban, academic children’s hospital for dog bite injuries between January 2016 and May 2021. Only those patients admitted for inpatient care were included, as identified through our institution’s trauma registry, and variables were examined prior to, during, and after hospital stay.Results 739 pediatric patients in total were treated for dog bites during the study period, of which 349 were admitted. Analysis revealed two pre-admission predictors of increased LOS: bone fracture (mean LOS=5.3 days vs. 2.5 days, p=0.013) and prior medical comorbidity (4.3 days vs. 2.8 days, p=0.042). After admission, fractures were associated with a higher rate of postoperative complications (16% vs. 5.6%, p=0.014) and return (13% vs. 2.0%, p<0.001), primarily due to wound infection. Although the facial region represented the largest proportion of fractures, long bone fractures of the arm and leg were noted to have comparatively higher LOS and complication rates. Postoperative complications were not associated with any documented infection at admission.Conclusions Our findings suggest that long bone fractures in pediatric dog bites can be an underappreciated source of latent wound infection associated with late-presenting negative outcomes. Increased awareness of these relationships could lead to earlier detection of infection in this vulnerable population.Level of evidence Level III, Prognostic / Epidemiological

Predictive Factors for Length of Hospital Stay in Pediatric Dog Bite Patients

Title: Predictive Factors for Length of Hospital Stay in Pediatric Dog Bite Patients Authors: Alessio-Bilowus D1, Kumar N2, Ridelman E1, Shanti C21Wayne State University, Detroit, MI; 2Children’s Hospital of Michigan, Detroit, MI Introduction: Dog bite injuries are a source of significant morbidity in the United States, with children being at increased risk compared to adults, yet there is a lack of published data on factors affecting hospital length of stay (LOS) in pediatric patients. Methods: A full-text retrospective chart review was conducted of all patients presenting to our urban, academic pediatric surgery unit for dog bite injuries between January 2016 and May 2021. Multiple demographic and clinical variables were examined prior to, during and after hospital stay. All data was analyzed using IBM SPSS Statistics V22.0 to compare the impact of each variable on hospital LOS. Results: 739 pediatric patients were evaluated and treated for dog bite injuries during the study period, of which 349 were admitted for inpatient care. Hospital length of stay ranged from 1 to 34 days, with a mean of 2.9 days and median of 2.0 days. Our analysis revealed two major predictors of increased length of stay: presence of bone fracture (n = 45, mean LOS = 5.3 days, p = 0.00), and prior medical comorbidity, including infection of the wound prior to the encounter (n = 24, mean LOS = 4.3 days, p = 0.04). Demographic and other clinical variables were not associated with statistically significant increases in LOS. Conclusions: Pediatric patients admitted for dog bite injuries have significantly longer inpatient LOS when they present with bone fractures or significant medical comorbidities including prior wound infection