Research and Publications

The Craniofacial Program team is dedicated to their work and constantly striving to provide the best care available. In order to accomplish these goals, the team participates in research to improve their knowledge and share their findings with others in the hope of advancing their field.

3DMD Imaging System

In the fall of 2013, the Plastic Surgery Division began using a 3DMD imaging system to assist in the treatment of both craniosynostosis and cleft lip and palate patients in the Craniofacial Program at Texas Children’s. This sophisticated system uses 5 separate cameras to take an instantaneous image. With these exceptional images, the multidisciplinary team of plastic surgeons, neurosurgeons and orthodontists can reconstruct a 3-dimensional shell or image of the patient’s head and face. With the system’s software, CT scans can be imported and morphed with the photographs to manipulate the images and predict, for example, how procedures to the facial or cranial bones will impact the overall image of the jaw, skull or soft tissue.

This system uses no radiation and only takes a fraction of a second to capture the images. Almost every patient who visits the craniofacial clinic at Texas Children’s will be photographed at each visit. The images and data collected from this system have significant value for all involved. For the surgeons, the images allow them to evaluate the patient’s condition before surgery and even plan surgical procedures more precisely before the patient is in the operating room. Patients and their families can review the images with their team and better understand their condition, treatment plans and outcomes.

Dr. David Kechoyan, plastic surgeon, is a recipient of the 2013 Texas Children’s Department of Surgery Research Seed Grant. Dr. Kechoyan will use the grant funding to study the evaluation of outcomes in craniosynostosis surgery and will use data and images captured by the 3DMD imaging system in his research.

Cleft Lip and Palate Program

To further advance the division of Plastic Surgery and the Craniofacial Programs’ outcomes studies, Dr. Laura Monson, plastic surgeon and 2012-2013 Texas Children’s Hospital Auxiliary Fellowship recipient, will study the short- and long-term outcomes of patients with cleft lip and palate, as well as enhance her expertise in clinical research through formal post-graduate training. The study, funded through the Fellowship, will track clinical and quality-of-life data that will enable Texas Children’s to know how patients are affected by a cleft lip and palate beyond physical measurements.

The outcomes program tracks volume of office visits, post-operative use of pain medicine, fistula and velopharyngeal insufficiency volume, post-operative lengths of stay, and a quality-of-life study. The program study has already produced a change in the type of post-operative pain medicine administered. Tylenol with Codine has been replaced by a combination of hydrocodone and acetaminophen to reduce drowsiness and has improved the ability of post-operative patients to drink fluids. Since September 2013, there has been a slight decrease in the overall length of stay.

67 patients between the ages of 11 and 18 are currently enrolled in the Quality-of-Life outcomes study. This portion of the study begins with two sets of NIH-validated questionnaires that measure anxiety, depression, peer relationships, coping, stigma, and self-image. Depending on the questionnaire results, patients considered “at-risk” are referred to a psychologist and a customized plan of care is created for each patient. All patients will have a follow-up visit in 1 year.

Publications

Monson LA, Kirschner R, Losee JE: CME: Primary Repair of Cleft Lip and Nasal Deformity: Plastic Reconstructive Surgery. 2013;132(6):1040e-1053e
 
Wolfswinkel EM, Weathers WM, Wirthlin JO, Monson LA, Hollier LH Jr, Khechoyan DY. Management of Pediatric Mandible Fractures. Otolaryngologic Clinics of North America. 2013;46(5):791-806
 
Weathers WM, Wolfswinkel EM, Hatef DA, Lee EI, Brown RH, Hollier LH Jr. Frontal Sinus Fractures: A conservative shift. Craniomaxillofacial Trauma and Reconstruction. 2013;06(03):155-160.
 
Harris D, Fong AJ, Buchanan EP, Khechoyan D, Monson L, Lam S. History of Synthetic Materials in Alloplastic Cranioplasty. Scheduled for publication Neurosurgical Focus. 4-2014.
 
Ghali MGZ, Srinivasan VM, Jea A, Lam S. Craniosynostosis surgery – the legacy of Paul Tessier: historical vignette. Scheduled for publication Neurosurgical Focus.
4-2014.
 
Beederman M, Alkureishi L, Lam S, Warnke P, Reid R. Exchange hybrid cranioplasty using particulate bone graft and demineralized bone matrix: the best of both worlds. Accepted for publication Journal of Craniofacial Surgery. 10-2013.
 
Rocque BG, Amancherla K, Lew SM, Lam S. Outcomes of cranioplasty following decompressive craniectomy in the pediatric population: a systematic review of the literature. Journal of Neurosurgery: Pediatrics. 12(2):120-5, 2013.
 
Heller JB, Lazareff J, Gabbay JS, Lam S, Kawamoto HK, Bradley JP. Posterior cranial fossa box expansion leads to resolution of symptomatic cerebellar ptosis following Chiari I malformation repair. Journal of Craniofacial Surgery. 18 (2): 274-80, 2007.