OBJECTIVE: Custom prescription helmets for plagiocephaly may be a significant financial burden for families, especially when not covered by insurance. This study aims to identify factors that influence the success of crowdsourcing campaigns for this therapy.
METHODS: GoFundMe campaigns were collected by searching terms such as \"plagiocephaly\" and \"baby helmet.\" Two reviewers analyzed each campaign for variables, including demographic data, story elements, and photo characteristics. Univariate logistic regression was used to determine each variable\'s impact on success, defined as attaining ≥75% of a campaign goal and significance of p ≤ 0.05.
RESULTS: Campaign data from 2011 to 2022 were analyzed. Initial search yielded 1464 campaigns; among these 413 met final inclusion criteria. On average, campaigns raised $2005 (range: $0-$7799) and requested $3151 (range: $160-$30,000). In total, 228 (54%) achieved success, 167 (40%) met their goal, and 35 (8%) raised no funds. A total of $828,256 was raised from the requested $1,301,317. The average reported age was six months (range: 2-17 m). Significant factors associated with success were military affiliation, providing multiple images, including a quoted cost, providing campaign updates, indicating a sense of urgency, diagnosis of torticollis, and mentioning possible complications without treatment. Raising additional funds for therapy, multiple helmets, and unrelated medical costs negatively impacted success. Racial disparities were observed between campaigns. Additionally, regional differences were noted between campaigns.
CONCLUSIONS: Crowdsourcing can be a successful endeavor for some families experiencing financial hardships from helmet therapy. This study highlights current gaps within healthcare coverage for helmet treatment and identifies various factors influencing crowdfunding campaigns.

OBJECTIVE: X-linked hypophosphatemia (XLH) is a rare genetic disease that disturbs bone and teeth mineralization. It also affects craniofacial growth and patients with XLH often require orthodontic treatment. The aim of this study was to describe changes in the dental health of XLH children during orthodontic treatment compared with those in matched controls undergoing similar orthodontic procedures.
METHODS: For this retrospective case-control study, we included all individuals less than 16 years old diagnosed with XLH, orthodontically treated in our centre from 2016 to 2022 and pair-matched them to patients with no chronic or genetic conditions. Clinical and radiological parameters concerning their malocclusion, craniofacial discrepancy and the characteristics and iatrogenic effects of their orthodontic treatment were analysed.
RESULTS: Fifteen XLH patients (mean age: 11.3 ± 2.1), pair-matched to 15 control patients were included. Orthodontic treatment was successfully conducted in XLH patients with slightly shorter duration and similar iatrogenic effects as in the control group, except for the occurrence of dental abscess during and after orthodontic tooth movement. XLH patients did not show more relapse than the controls.
CONCLUSIONS: Despite the presence of oral manifestations of XLH such as spontaneous abscesses, XLH patients can undergo orthodontic treatment with no obvious additional iatrogenic effects.

OBJECTIVE: To investigate the influence of a single infrapositioned ankylosed tooth or implant supported restoration, in smile attractiveness.
METHODS: A series of 48 digital modified images, simulating a varying degree of infraposition(from 0.25 to 2.0 mm, with a step of 0.25 mm), was created for each one of the maxillary anterior tooth, by altering the full-portrait image of a smiling male adult, in medium and high smile lines. For the model with the high smile line, also a series of 24 digital modified images simulating infraposition of a single anterior tooth with a restored incisal edge was created. Smile attractiveness for each one of the images was evaluated from 160 participants (80 dentists and 80 laypersons), implementing a visual analog scale.
RESULTS: For the images with the high smile line, an infraposition ≥ 0.25mm in central incisor\'s region and ≥ 0.5mm in the region of the lateral incisor or the canine, had a negative effect on the perceived smile attractiveness both for the dentists and the laypersons. Regarding the medium smile line, an infraposition ≥ 0.5mm in central and lateral incisor\'s region, had a negative effect on the perceived smile attractiveness for both groups of observers. In the area of the canine, infraposition ≥ 0.5mm for the dentists and ≥ 0.75mm for the laypersons, had a negative impact on the smile attractiveness.
CONCLUSIONS: Even a minor infraposition of a single maxillary anterior ankylosed tooth or implant supported restoration, can reduce the perceived attractiveness of the face. Infraposition in canine\'s area can be better tolerated in a medium, compared to a high smile line. In patients with a high smile line prosthetic intervention in order to restore the incisal edge of an infrapositioned tooth, without to harmonize the gingival contour, can be beneficial for the lateral incisor, ineffective for the central incisor and unfavorable for the canine.

Otitis media (OM) is among the most common of childhood illnesses. It has long been hypothesized that children under age two are predisposed to OM due to differences in the anatomy of the Eustachian tube (ET), including the angle of the ET. OM in later childhood is less common but does occur, begging the question, are there shape differences in the ET that persist underlying later occurrences of OM? To answer this question, a novel method, which applied geometric and morphometric shape analysis to landmarks obtained from MRI data, was used. MRI scans were performed on 16 children (5 control, 3 cOME, and 8 rAOM) between 2011 and 2015. Sixteen landmarks representing the shape of the ET, cranial base, and palate were analyzed. The results of a Procrustes ANOVA indicate that the shape of the ET varies significantly (p < 0.01) between the OM and control groups. The shape differences between the OM group and the control are a medial and low attachment site of the tensor veli palatini (TVP) muscle, a posterior and high torus tubarius, and an anteriorly projected palate. These results support previous findings that a relatively horizontal ET is associated with a predisposition for OM. This study used a novel approach to examine anatomical differences in children with and without OM. First, the data set is unique in that it includes MRI scans of children with a confirmed OM diagnosis. Second, the use of MRI scans in craniofacial anatomy OM research is novel and allows for the collection of soft tissue landmarks and the visualization of soft tissue structures. Third, geometric morphometric shape analysis is a statistical method that captures shape differences, offering a more universal picture of nuanced changes within the entire set of landmarks, in contrast to more traditional linear and angular measurements used in prior OM studies examining craniofacial anatomy.

This retrospective cross-sectional study reviewed adult patients with unrepaired SMCP, OCP and normal control and performed comprehensive skeletal and soft tissue morphological analyses basing on lateral cephalometric radiographs. One way-ANOVA and rank-sum tests detected potential intergroup differences. 32 subjects with unrepaired SMCP, 42 with unrepaired OCP and 28 noncleft normal controls were enrolled. Both the SMCP and OCP groups were significantly different from the normal controls in sagittal maxillary length, jaw relationship, facial profile angle, nasal base and nasal tip prominence, upper lip position, and lower lip protrusion. S-N-A angle in the control group (82.25 ± 2.74°) was significantly greater than in the SMCP (77.96 ± 4.05°, p<0.001) and OCP (78.55 ± 2.93°, p<0.001) groups. Nasolabial angle in the control group (99.18 ± 8.76°) was significantly greater than in the SMCP (91.75 ± 8.93°, p = 0.002) and OCP (93.69 ± 7.24°, p = 0.020) groups. No significant difference was detected between the SMCP and the OCP group in other measurements except upper facial height. Within the limitations of the study it seems that craniofacial growth is impaired in patients with submucous clefts to the same extent as in patients with a conventional cleft palate.

OBJECTIVE: To evaluate the change in overbite within an untreated cohort from 9 to 18 years of age and to compare age-related changes in overbite depth based on vertical skeletal proportion.
METHODS: Lateral cephalograms were obtained from the American Association of Orthodontists Foundation (AAOF) Craniofacial Growth Legacy Collection Project. All cephalometric outcome measures were assessed at ages 9-11 (T1), 13-15 (T2), and 17-19 (T3) years. Generalized estimating equation (GEE) regression models were fit to examine the effect of MP-SN on overbite adjusted for age and gender.
RESULTS: A total of 130 subjects from the Denver, Bolton Brush, and Oregon Growth Studies were included. Overbite was relatively constant from T1 to T3 irrespective of facial type, with a minor decrease (0.15 mm) being observed overall. There was a transient increase between T1 and T2 (0.31 mm) that was canceled out by changes during later adolescence. Based on the GEE regression model adjusted for time and gender, a minor but statistically significantly greater reduction in overbite arose as MP-SN increased (coefficient = -0.080; 95% confidence interval -0.12, -0.04; P < .01).
CONCLUSIONS: In hyperdivergent subjects, a marginal decrease in overbite was observed from 9 to 18 years of age, with a transient increase from the period spanning 9-11 years to 13-15 years, which was negated in later adolescence. There are limited data to suggest that observation of vertical growth is required in most patients with marginally increased vertical facial proportions in the juvenile and pubertal phases.

Pediatric facial fractures are uncommon, and fortunately, the majority can be managed with conservative measures. Rigid fixation of the pediatric facial skeleton can potentially be associated with delayed hardware issues and growth inhibition. When appropriate, resorbable fixation is most commonly used for this purpose. Titanium plates and screws are advantageous when rigid fixation is a priority because properly placed hardware that respects natural suture lines is not thought to significantly inhibit growth. Furthermore, titanium fixation may be removed following healing.

This case report demonstrates a rare finding of a pediatric patient with Morning Glory anomaly and Moyamoya Disease with a palatal meningeal hamartoma discovered as a mass within a previously repaired incomplete cleft of the alveolus. Oral meningeal hamartomas are exceedingly rare with only two palatal cases described and none within a cleft palate or alveolus. These findings prompt a review of oral hamartomas with meningeal subclassification. Further discussion describes the relationship of the proposed origins of meningeal hamartomas within the setting of cleft palate development.

Pediatric panfacial trauma is a rare occurrence with poorly understood implications for the growing child. Treatment algorithms largely mirror adult panfacial protocols with notable exceptions including augmented healing and remodeling capacities that favor nonoperative management, limited exposure to avoid disruption of osseous suture and synchondroses growth centers, and creative fracture fixation techniques in the setting of an immature craniomaxillofacial skeleton. The following article provides a review of our institutional philosophy in the management of these challenges injuries with important anatomic, epidemiologic, examination, sequencing, and postoperative considerations.

OBJECTIVE: A protruded premaxilla has always been challenging to care for by cleft care professionals. This study aims to fortify the use of a single-stage premaxillary setback, with posterior vomerine ostectomy and primary cheiloplasty to achieve proper care for patients with bilateral cleft lip and palate (BCLP) and protruded premaxilla.
METHODS: Longitudinal retrospective analysis.
METHODS: Twenty-three outreach programs to four countries (Ecuador, Lebanon, Peru, and El-Salvador) between 2016-2022.
METHODS: Sixty-five patients between the ages of 3 months and 6 years and 5 months, with BCLP and severely protruded premaxilla underwent premaxillary setback via posterior vomerine ostectomy and primary cheiloplasty. Patients with diagnosed syndromes and inaccessible vomer bone due to fused palates were excluded from the study.
METHODS: Premaxillary setback with posterior vomerine ostectomy, bilateral gingivoperiosteoplasties (GPP), and primary cheiloplasty.
METHODS: Postoperative complications and aesthetic outcomes.
RESULTS: The mean age at surgery was 13.17 ± 14.1 months, with an average follow-up time of 26 ± 17 months. Patients underwent their procedures in Ecuador (72%), Peru (9%), Lebanon (8%) and El-Salvador (1%). The majority of patients were aged 1 year or less (66.7%) and were males (58.5%). All patients were operated on successfully and had good aesthetic outcomes. Only one patient developed partial necrosis.
CONCLUSIONS: Patients with BCLP and severe premaxillary protrusion have always carried immense social, psychological, and financial burdens, especially in outreach settings. Our described single-stage technique has proven to be safe and effective with good aesthetic results. Further follow-up after primary repair should be done to document and ensure proper facial growth and normal nasolabial maturation.