Cain Faber (pilotdraw0)

Gastroschisis feeding practices vary. Standardized neonatal feeding protocols have been demonstrated to improve nutritional outcomes. We report outcomes of infants with gastroschisis that were fed with and without a protocol. A retrospective study of neonates with uncomplicated gastroschisis at 11 children's hospitals from 2013 to 2016 was performed.Outcomes of infants fed via institutional-specific protocols were compared with those fed without a protocol. Subgroup analyses of protocol use with immediate versus delayed closure and with sutured versus sutureless closure were conducted. Among 315 neonates, protocol-based feeding was utilized in 204 (65%) while no feeding protocol was used in 111 (35%). There were less surgical site infections (SSI) in those fed with a protocol (7 vs. 16%, = 0.019). There were no differences in TPN duration, time to initial oral intake, time to goal feeds, ventilator use, peripherally inserted central catheter line deep venous thromboses, or length of stay. Of those fed via protocol, less SSIs occurred in those who underwent sutured closure (9 vs. 19%, = 0.026). Further analyses based on closure timing or closure method did not demonstrate any significant differences. Across this multi-institutional cohort of infants with uncomplicated gastroschisis, there were more SSIs in those fed without an institutional-based feeding protocol but no differences in other outcomes. Across this multi-institutional cohort of infants with uncomplicated gastroschisis, there were more SSIs in those fed without an institutional-based feeding protocol but no differences in other outcomes.Zygoma reduction is indicated in patients where the primary aim of surgery is reduction in the width of cheekbones to achieve smoother and more feminine facial aesthetic lines. Surgeons should evaluate the width of midface (bizygomatic width) and the protrusion of zygoma (volume and position of the zygomatic body) when evaluating patients where such a procedure is indicated. Intraoral high-L osteotomy is the most useful method to successfully treat a wide spectrum of zygomatic protrusions and is widely accepted as the treatment of choice for aesthetic purposes. The amount of ostectomy is determined by evaluating the volume of zygomatic body. The zygomatic body and arch are usually moved posteromedially during surgery; the point of maximal malar projection is evaluated and transposed to a new ideal position. Zygoma reduction can be performed solely or in combination with other facial bone contouring procedures such as mandible reduction, genioplasty, or forehead augmentation. learn more Soft tissue sagging, nonunion, malunion, and paresthesia are the most common complications of this procedure. Undercorrection and asymmetry are the most common aesthetically unfavorable sequelae and should be carefully prevented by proper preoperative planning and meticulous execution of surgical technique.A prominent mandible that gives a squared face in Asians is considered unattractive as it imparts a coarse and masculine image. Mandibular contouring surgery allows slender oval faces. The purpose of conventional mandible reduction is to make the lower face appear slim in frontal view and to have a smooth contour in lateral view. As shaping the lateral contour of the mandible alone may result in minimal improvement in the frontal view, surgical techniques to reduce the width of the lower face through narrowing genioplasty (i.e., the "V-line" surgery) and sagittal resection of the lateral cortex should be combined. Examination of the shape and symmetry, the relationship between the maxilla and the mandible, understanding overlying soft tissue contribution, and understanding the overall balance of the face are mandatory. An important factor influencing ideal facial shape is patient's personal preference, which is often influenced by his/her ethnic and cultural background. Especially whe