Robot-assisted frontofacial correction in very young children with craniofacial dysostosis syndromes: a technical note and early functional outcome

OBJECTIVE In this study, the authors aimed to 1) retrospectively analyze the early functional outcomes in a cohort of very young children with craniofacial dysostoses who underwent robot-assisted frontofacial advancement (RAFFA) or robot-assisted midface distraction (RAMD), and 2) analyze the utility of robotic assistance in improving the accuracy and safety of performing transfacial pin insertion for RAFFA or RAMD. METHODS A retrospective analysis of a cohort of 18 children (age range 1–42 months at presentation), who underwent RAFFA or RAMD from February 2015 to February 2021 in the craniofacial unit at Amrita Institute of Medical Sciences and Research Centre in Kochi, India, was performed. Inclusion criteria were patients who had undergone RAFFA in a single stage or RAMD where the cranial vault had been addressed earlier, had been addressed on follow-up, or had not been addressed and had follow-up of at least 6 months. RESULTS Overall, 18 children with syndromic craniosynostosis underwent LeFort level III midface distraction, with or without RAFFA, from February 2015 to February 2021 at a single center in India. The patients’ ages ranged from 6 to 47 months at the time of the procedure. All patients had significant obstructive sleep apnea (OSA), significant ocular issues, and disturbed sleep as determined by the authors’ preoperative protocol. Clinically significant intracranial pressure issues were present in 17 patients. None of the patients had injury due to the transfacial pin trajectory such as globe injury, damage to the tooth buds, or the loss of purchase during the active distraction phase. The mean distraction achieved was 23 mm (range 18–30 mm) (n = 16/18). Of the 18 patients, 10 (56%) had an excellent outcome and 6 (33%) had a satisfactory outcome. In all cases, the degree of OSA had significantly reduced after surgery. Eye closure improved in all patients, and complete closure was seen in 11 patients. On follow-up, the functional gain remained in 14 of 16 patients at the final follow-up visit. The distraction results were stable during the follow-up period (mean 36 months [range 6–72 months]). CONCLUSIONS The early RAFFA and RAMD protocols investigated in this study gave a significant functional advantage in very young patients with craniofacial dysostoses. The results have demonstrated the accuracy and safety of robotic assistance in performing transfacial pin insertion for RAFFA or RAMD.

Open field stress testing: finally an optimal method in young children? Reference values for mobile cardiopulmonary exercise testing in healthy children aged 4–8 years

Introduction: Cardiopulmonary exercise testing represents the diagnostic tool for determining cardiopulmonary function. Especially in small children, exercise testing is extremely challenging. To address this problem, field testing has been implemented using small mobile devices. This study aims at using this protocol for developing normal values for cardiopulmonary exercise testing in very young children. Material and methods: Healthy children aged 4–8 years were recruited. All children were tested according to an outdoor protocol, in which they were instructed to walk, then run slowly, then a little harder and at last run at full speed. Each step lasted for 2 minutes, except the last step, in which the children were instructed to maintain as long as possible. Results: A total of 104 children (64 female/35 male, mean age 6.6 years) performed outdoor cardiopulmonary exercise testing using a mobile device. Almost all tests were completed successfully (95%). Despite a predominance of female study subjects, anthropometric values did not differ between boys and girls. V̇O2peak/kg, respiratory exchange ratio, VT1, heart rate at VT1, and time of exercise were also comparable between sexes. Generally, a tendency of higher maximal oxygen uptake could be observed in older children. Conclusion: Open field mobile cardiopulmonary exercise testing represents a novel approach in very young children. In this study, we were able to determine normal values of maximal oxygen uptake and OUES/kg for 4–8-year-old children. The method is easy to achieve and safe.

A Toddler with Juvenile Ocular Myasthenia Gravis: Clinical Experience

Background:Myasthenia gravis is an extremely rare autoimmune disorder affecting the neuromuscular junction. The incidence rate is 0.9-2.0 cases per 1 million children per year.Ocular myasthenia gravispresents as ptosis with extraocular motility restriction and is prone to be misdiagnosed as third nerve palsy and is difficult to diagnose in very young children. Case: A girl aged 2 years 6 months with clinical features with bilateral ptosis and was diagnosed as juvenile ocular myastenia gravis based on history, physical examination and other diagnostic proceduressuch as chest X-raywithin normal limit and no thymoma, the ice test showed positive result, electromyography (EMG) showed decrement response >10%,progstigmin test showed positive result, andserum acetylcholine receptor antibody levels was 0.43 nmol/L (reference range : positive as >0.40 nmol/L). Conclusion:Juvenile ocular myastenia gravis diagnostics can be established using simple examinations such as ice tests,prostigmin test to sophisticated examinations as systemic acetylcholinesterase antibodies. Management begins with a first-line drug, pyridostigmine, that is safe and effective. Disease monitoring and looking for etiology are very important for successful treatment.

CHARACTERISTICS OF VIRAL ANTIGENS AND MICROBIAL SPECTRUM OF UPPER AND LOWER RESPIRATORY TRACT IN INFANTS WITH BRONCHITIS

Introduction. The difficulty in diagnosing different clinical forms of bronchitis is due to the fact that their clinical manifestations have a number of similar symptoms, despite the fact that these diseases may be as-sociated with different forms according to the classification. Diagnosis can be often complicated by the pre-disposition of very young children to recurrent respiratory diseases, which often mark the formation of a pro-longed and recurrent course of the disease caused by viral and bacterial contamination of the respiratory tract. The aim of this study is to investigate viral and microbial contamination of the respiratory tract in vari-ous clinical forms of bronchitis of infants and to clarify their etiological significance in parallel with the as-sessment of the intestinal microflora. Materials and methods. 578 children aged from 6 months to 3 years with various clinical forms of bronchitis were monitored. Virological examination was performed by the direct Coons method, which detected viral antigens in the cells of the mucous membrane of the lower nasal si-nuses. Bacteriological examination was performed by bacterial inoculation of nasopharyngeal mucus, spu-tum and feces in a nutrient medium. Results. Clinical and laboratory examination of young infants made it possible to identify the influence of detected viral antigens and pathogenic microflora in the throat, sputum and feces on the formation of various clinical forms of bronchitis and their clinical peculiarities not only in the period of exacerbation, but also in a remission period that indicates the persistence of viruses and bacteria. Conclusion. Detection of viral antigens, dysbiosis and microbial aggression of the upper and lower respira-tory tract gives grounds for substantiating the indications for staged rehabilitation therapy for infants with various clinical forms of bronchitis.

Belonging and Home

In this chapter, the authors discuss artifacts in which children explore belonging and home. The chapter defines the sense of belonging as a core feature of humanity and living together. The feeling of having a home and being at home is both an intimate and a socially shared aspect of belonging. The children expressed belonging to a wide range of spaces in their artifacts. This spatial span extends from macro to micro scale and indicates belonging based on spaces, social relations, and materiality. Even very young children can see and depict their belonging as multiple and including spatial and social dimensions. The analyzed artifacts reveal both concrete and symbolic approaches to belonging and home.