Gaby Doumit

Case Western Reserve University School of Medicine, Cleveland, Ohio, United States

Are you Gaby Doumit?

Claim your profile

Publications (20)33.57 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Epitheloid hemangioma (EH) is a vascular tumor characterized by an epithelioid endothelial cell. Predominantly affecting the head and neck, fewer than 30 cases involving the scrotum have been published. As this represents an extremely rare entity, a multitude of anecdotal treatment modalities have been utilized including systemic/intralesional steroid therapy, radiotherapy, and chemical therapy. However, surgical excision remains the most widely accepted treatment option.We present a case of EH of the scrotum in a 14-year-old male patient that regressed after treatment with naproxen sodium. To the best of our knowledge, this represents the first reported case of scrotal EH regression following treatment with naproxen sodium.
    The Journal of craniofacial surgery. 11/2014; 25(6):2059-61.
  • [Show abstract] [Hide abstract]
    ABSTRACT: A systematic review was conducted to compare the speech outcomes and fistula rates following repair of the cleft palate with Furlow double-opposing Z-plasty and straight-line intravelar veloplasty techniques.
    Plastic and reconstructive surgery. 11/2014; 134(5):1014-22.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose-Maxillary artery has been traditionally considered the main blood supply of the facial skeleton(1). However, the deep and concealed location of the artery in the infratemporal and pterygopalatine fossae enclosed by the cranial base, mandible and maxilla makes the harvest of facial allografts based on this artery challenging and preference has been given to the facial artery to vascularize the facial allografts(2,3). The purpose of this study was to investigate the vascular territories of the maxillary artery and vein and modify the available craniofacial techniques in order to allow reliable harvest of a facial osteomyocutaneous allograft based on the maxillary vessels. Methods-Eighteen fresh cadaver heads were used in this study. Ten full facial allografts containing mandible, maxilla, zygomatic and nasal bones were harvested through a traditional Le Fort III approach. In 6 cadaver heads, maxillary artery and internal jugular vein were injected with red and blue latex respectively. In two cadaver heads colored lead oxide gel was injected in the maxillary artery (1) or internal jugular vein (1). A modified Le Fort III approach was designed: the orbital floor osteotomy was performed at the posterior-most aspect of the orbit. The zygomatic arch and mandibular condyle were osteotomized and removed. The pterygomaxillary disjunction was performed under direct vision after excising the temporalis and lateral pterygoid muscles. Eight full facial allografts were harvested through the modified approach. Maxillary artery and vein were dissected to assess for damage during the procurement. CT scans were performed of the 2 specimen injected with lead oxide. Results- When the traditional Le Fort III approach was used to harvest the facial allograft, the terminal branches of the maxillary artery (the infraorbital and the sphenopalatine arteries) and the pterygoid plexus were injured constantly. The modified approach preserved these branches and allowed the dissection of the maxillary artery and vein under direct vision. Conclusions- Maxillary artery should be considered as the main blood supply of the facial allograft when a major portion of the facial bones is to be harvested along with limited amount of facial soft tissues. The described modified Le Fort III approach allowed the safe dissection of the maxillary artery and vein, preserving the main blood supply to the facial skeleton.
    Plastic and reconstructive surgery. 10/2014; 134(4S-1 Suppl):10-11.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Craniosynostosis is a pathologic condition which is characterized by the premature fusion of cranial sutures. It may occur alone or in association with other anomalies making up various syndromes. Crouzon syndrome is the most common craniosynostosis syndrome. Bicoronal sutures fusion is most commonly involved in Crouzon syndrome. There have only been a handful of cases of squamosal suture synostosis described in the surgery literature with the few ones described in Crouzon syndrome associated with other types of craniosynostosis. To the best of our knowledge, we are presenting the first case of isolated bilateral squamosal suture synostosis in a patient with Crouzon syndrome in a radiology journal with emphasis on its radiological appearance.
    World journal of radiology. 07/2014; 6(7):507-10.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Vascularized composite allotransplantation (VCA) has experienced a growing acceptance, which has led to a debate centered on extending the indications of the procedure to include pediatric patients. The aim of this article was to discuss such indications based on the evidence in pediatric solid organ transplantation, reconstructive surgery in children, and VCA in adult patients.
    Annals of plastic surgery. 07/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Graves' ophthalmopathy is a chronic, multisystem, autoimmune disorder characterized by increased volume of intraorbital fat and hypertrophic extra-ocular muscles. Clinical findings of proptosis, impaired ocular motility, diplopia, lid retraction, and impaired visual acuity are treated with orbit decompression and fat reduction. We present the addition of skeletal augmentation to further improve periorbital aesthetics. Through a transconjunctival with lateral canthotomy incision, a balanced orbital decompression was executed removing the medial and lateral walls, and medial floor. Intraorbital fat was excised. All patients underwent placement of porous polyethylene infraorbital rim implants and midface soft tissue elevation, increasing inferior orbital rim projection and improving globe-cheek relationship. From 2009-2012, 13 patients (11 females/2 males, 26 eyes) with Graves' ophthalmopathy underwent surgery at two institutions. Outcomes were evaluated, specifically for improvements of proptosis, diplopia, dry eye symptoms, and cosmetic satisfaction. Postoperative follow up ranged from 0.5-3yrs (median 1.5yrs). The mean improvement in Hertel exophthalmometer was 5.4mm. Diplopia resolved in 3/13(23%) cases. No patients had worsening diplopia, and 12/13(92%) discontinued use of eye lubricants. All patients had cosmetic satisfaction. One patient suffered temporary paresthesia to the inferior orbital nerve. There were no infections, hematomas or ocular complications. Skeletal augmentation is a useful adjunct to orbital decompression and fat excision for treating Graves' ophthalmopathy. Balanced orbital decompression with infraorbital rim implants are reliable, effective, and safe, with good, lasting results. Improvements are made towards the resolution of ocular symptoms and in the patient's personal well-being, and social life, with a high benefit-to-low-risk ratio.Level of Evidence: Therapeutic Clinical Question.Level IV=Case series with pre/post-test or only post-test.
    Plastic and Reconstructive Surgery 05/2014; · 3.33 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Since 2009, a synthetic material known as kryptonite has become increasingly utilized during cranioplasty to repair bony defects. It provides bone-like strength and adhesive properties that make it a suitable replacement for bone. However, applications have been observed in the immediate postoperative period that demonstrates an increase in its original volume, giving rise to irregularities in the cranial surface. Ten kryptonite samples were reconstituted and allowed to polymerize according to the manufacturer's directions. The kryptonite samples were molded into a cylindrical shape, and they were immersed in 10 graduated cylinders filled with normal saline. Measurements of the rise in saline relative to baseline were taken at 0, 10, 20, 30, 40, 50, and 60 minutes, and then hourly through 5 hours, with the final measurement recorded at 24 hours. The mean expansion of kryptonite was approximately 49% with an SD of 22%. The bulk of the expansion occurred within the first 2 hours, after which the rate tended to plateau for the remaining 22 hours. Kryptonite has been touted as an excellent alternative for repairing contour abnormalities manifested in cranioplasty. Given the unpredictability of its expansile properties, the surgeon must take this variability into careful consideration when planning the desired surgical outcome.The results of the current study were communicated with the manufacture. Immediately thereafter, the manufacturer withdrew the product from the US market and is no longer Food and Drug Administration approved for cranioplasty.
    The Journal of craniofacial surgery 04/2014; · 0.81 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: We present the complete results of our 2013 survey of the members of the American Society of Maxillofacial Surgery (ASMS). We surveyed all 799 members of the Society from around the world regarding educational themes and modalities they wish to add to future ASMS educational programs. We also asked our members about surgical modalities and care paths in which they have the most expertise.The objective of the survey was to provide data that can be used to improve the education and training of the ASMS members. The results suggest that some widely taught topics perhaps should be taught less, whereas coverage of other topics should be increased.
    The Journal of craniofacial surgery 03/2014; · 0.81 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In the craniofacial surgery literature, there is a wide disparity of opinions regarding the appropriate treatment of nonsyndromic sagittal synostosis. With the lack of level 1 evidence to support a particular regimen, our study aims to elucidate the current state of practice among craniofacial surgeons with the hope of establishing a standard of care. An internet-based survey was sent to 102 craniofacial surgeons in 14 countries on 4 continents. Data were collected regarding the following parameters: primary indication for surgery, preference of timing, and choice of operative intervention for patients presenting with nonsyndromic isolated sagittal synostosis with normative intracranial pressure values. Surgeons were also queried regarding preoperative, intraoperative, and postoperative protocols. After 2 mailings, the response rate was 58% (59/102). For 63% of respondents, skull deformity was the primary indication for treatment of craniosynostosis.Open surgical management of sagittal craniosynostosis was most commonly performed at 6 months (35%) of age. Total cranial vault remodeling was the most commonly performed procedure (37%). Thirty-five percent of craniofacial surgeons chose an endoscopic surgical approach for patients presenting at younger than 4 months. Only 10% of craniofacial surgeons selected spring-assisted strip craniectomy. Seventy-one percent of polled surgeons performed computed tomographic scans of the skull in all cases, irrespective of presentation. Our survey demonstrates that there exists a wide disparity of opinion regarding diagnosis and treatment of nonsyndromic sagittal synostosis. When current practice is compared to findings in the literature, significant discrepancies exist.
    The Journal of craniofacial surgery 01/2014; · 0.81 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Muenke syndrome caused by point mutation (C749G) in the FGFR3 gene affects 1 in 30,000 newborns and accounts for 25% to 30% of genetic causes of craniosynostosis. Anomalies in patients with Muenke syndrome include craniosynostosis, hypertelorism, sensorineural hearing loss, and developmental delay, among others. Most craniosynostoses in patients with Muenke syndrome involve bicoronal suture fusion. This article reports, for the first time, the existence of squamosal craniosynostosis in patients with Muenke syndrome.
    The Journal of craniofacial surgery 01/2014; · 0.81 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Maxillary artery is recognized as the main vascular supply of the facial bones; nonetheless clinical evidence supports a co-dominant role for the facial artery. This study explores the extent of the facial skeleton within a facial allograft that can be harvested based on the facial artery. Twenty-three cadaver heads were used in this study. In 12 heads, the right facial, superficial temporal and maxillary arteries were injected. In 1 head, facial artery angiography was performed. Ten facial allografts containing the mandible, naso-orbito-maxillo-zygomatic complex and tongue were raised. The soft tissues were dissected to show the arterial anastomotic connections and thereafter removed. Radiograms and CT scans were performed. Constant anastomosis between the facial, inferior alveolar and infraorbital arteries at the mental and infraorbital foramina were found. Facial artery vascularized the homolateral mandibular symphysis, body and ramus. The condylar and coronoid processes were vascularized in 67% of the allografts. The homolateral maxilla was contrasted in all allografts with the exception of the alveolar and palatine processes which contained the contrast in 83% of specimens. The maxillary process of the zygomatic bone was perfused in all allografts, followed by the body, frontal (83%) and temporal processes (67%). The nasal lateral wall and septum were vascularized in 83% of the allografts. The medial and lateral orbital walls and the orbital floor were stained in all specimens. The zygomatic process of the temporal bone was the least perfused bone. A composite allograft containing 90-95% of the facial bones can be based on bilateral facial arteries.
    Plastic and Reconstructive Surgery 01/2014; · 3.33 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In health care, it is widely known that evidence-based medicine (EBM) has a significant impact on clinical practice, and opinion leaders can enhance the clinician's application of EBM in various disciplines. In this article, we examine the existence and impact of opinion leaders in craniofacial surgery as well as barriers to evidence-based practice. We compiled the answers of an Internet questionnaire, which was sent to 102 craniofacial surgeons. Our results demonstrate that opinion leaders most definitely can be identified in craniofacial surgery. They are tightly connected to their field's social network and promote EBM. In this survey, 44% of craniofacial surgeons reported that their greatest obstacle to clinical decision making in the management of nonsyndromic synostosis was lack of surgical consensus. In addition, craniofacial surgeons stated that EBM and opinion leaders are the most influential factors that caused them to change their management of craniosynostosis. We expect that the use of opinion leaders can further enhance the uptake of EBM in craniofacial surgery.
    The Journal of craniofacial surgery 01/2014; 25(1):106-10. · 0.81 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: INTRODUCTION Glabellar frown lines may produce a cosmetically unappealing appearance. Botulinum toxin and other injectable dermal fillers may reduce the appearance of these frown lines but their results are temporary.1 Percutaneous selective radiofrequency nerve ablation (RFA) is a minimally invasive method for treating the glabellar area.2 Several small series have reported success using RFA to treat glabellar furrowing, but there is morbidity associated with burns and extraneous damage to non-targeted tissue.3 Tumescence can be used to control temperature, pain, electrical conductivity and ease of needle penetration into different tissue layers. No studies have monitored the target muscles or looked at the histopathologic changes that can occur after muscle and nerve have been targeted with and without tumescent. In an effort to better target facial muscles and determine the histopathologic effects of RFA and tumescence on nerve and muscle tissue, we conducted a pilot study. METHODS Each gastrocnemius muscle (GC) of eight Lewis rats was ablated for either 30 (N=8) or 60 seconds (N=8) at 80°C with a 22-gauge custom made electrode. Sciatic nerves were ablated at the same temperature for 15 (N=8) or 30 seconds (N=8). Two rats were injected with 0.5mL of normal saline tumescent. Five rats were sacrificed at 4 days and three at 4 weeks. All nerves and muscles were stained with hematoxylin and eosin (H&E) and analyzed. RESULTS At longer ablation times the nerves showed inflammation, necrosis and degeneration at 4 days. With tumescent there was less inflammation, no necrosis and milder degeneration compared to the group without. The muscles ablated for 60 seconds without tumescent showed inflammation and necrosis and those ablated with tumescent showed minimal or no inflammation. At 4 weeks, the nerves showed severe constriction and the muscles were severely atrophic in rats without tumescent and with longer ablation times. No ambulation defects were observed. CONCLUSIONS RFA is effective in producing muscle and nerve damage in the Lewis rat GC without causing a noticeable ambulation defect. In this model, the use of directional tumescent lessens the degree of muscle inflammation and nerve necrosis on histopathologic examination. A larger study is needed to determine optimal variables for percutaneous RFA to produce a desired defect and if directional tumescence can be used as an adjunct to reduce morbidity.
    Plastic Surgery: The Meeting 2013; 10/2013
  • [Show abstract] [Hide abstract]
    ABSTRACT: Cutaneous metastasis of esophageal cancer, in particular esophageal adenocarcinoma, is rare and metastasis to the scalp is extremely rare. We describe such a case that was originally diagnosed as an adnexal carcinoma. A 77-year-old male with a history of esophageal adenocarcinoma status after esophagectomy at our institution 4.5 years prior, presented to our plastic surgery clinic with a 2-month history of 2 temporoparietal scalp lesions. He was referred to our clinic by a community dermatologist who had performed a shave biopsy of the lesions. The clinical diagnosis was adnexal cyst. The history of esophageal carcinoma was not provided to the pathologist. The dermatopathology report came back as malignant adnexal neoplasm and considerations included apocrine carcinoma. We reexamined the pathologist's slides from the outside facility, comparing them to the histopathology from his esophagectomy. Histopathologic changes were identical. Thus, our surgical and postoperative approach changed significantly. Clinical suspicion should be high for cutaneous metastases in patients with a history of solid organ cancers. It is important for clinicians to illicit a history of malignancy. A biopsy should be performed on any suspicious lesions, and clinical data along with histopathology of the prior cancer resection(s) should be provided to the pathologist for comparison. Diagnosis of the suspicious lesion should be made before definitive excision, as this may change the approach, with the potential for postoperative chemotherapy and radiation. The definitive operative approach consists of surgical debulking with the evidence of negative margins. On the scalp, we feel that 5-mm margins are appropriate to obtain clear margins. One should appreciate the subdermal extent of metastases and adjust the margins accordingly. We recommend excising the galea with the skin as an en bloc resection. This will both assure clear deep margins of resection and assist in a tension-free closure of the scalp.
    Annals of plastic surgery 02/2013; · 1.29 Impact Factor
  • The American surgeon 06/2011; 77(6):793-5. · 0.92 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Alloplastic implants can be adjunctive to orthognathic surgery by correcting contour irregularities or disharmonies after skeletal movements. Implant augmentation can also simulate the visual effect of osteotomies in patients with skeletal deficiencies whose occlusion is normal or has been corrected. Although sometimes it is an adjunct or an alternative to facial skeletal rearrangements, facial skeleton augmentation is not a substitute for orthognathic surgery. Alloplastic implants designed specifically to augment the infraorbital rim can correct the residual upper midface deficiency remaining after Le Fort I maxillary advancement. When used with paranasal and malar implants, they can simulate the visual effect of the Le Fort III osteotomy with advancement. Paranasal implants can simulate the appearance after Le Fort I advancement. Mandible and extended chin implants can correct skeletal irregularities and deficiencies after sagittal and horizontal osteotomies. They can also simulate the visual effect of these osteotomies. The application of these concepts has been effective, with low morbidity, in 294 patients. No implants extruded or migrated. Eight patients (3 percent) had early postoperative infections. There were no late infections. Ten of 108 patients (9 percent) with midface implants had implant visibility with time. Alloplastic augmentation of the facial skeleton can be a useful adjunct or an alternative to orthognathic surgical procedures in situations when the occlusion is normal or has been corrected.
    Plastic and Reconstructive Surgery 05/2011; 127(5):2021-30. · 3.33 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: ABSTRACT: Opinion leaders represent one way to disseminate new knowledge and influence the practice behaviors of physicians. This study explored the stability of opinion leaders over time, whether opinion leaders were polymorphic (i.e., influencing multiple practice areas) or monomorphic (i.e., influencing one practice area), and reach of opinion leaders in their local network. We surveyed surgeons and pathologists in Ontario to identify opinion leaders for colorectal cancer in 2003 and 2005 and to identify opinion leaders for breast cancer in 2005. We explored whether opinion leaders for colorectal cancer identified in 2003 were re-identified in 2005. We examined whether opinion leaders were considered polymorphic (nominated in 2005 as opinion leaders for both colorectal and breast cancer) or monomorphic (nominated in 2005 for only one condition). Social-network mapping was used to identify the number of local colleagues identifying opinion leaders. Response rates for surgeons were 41% (2003) and 40% (2005); response rates for pathologists were 42% (2003) and 37% (2005). Four (25%) of the surgical opinion leaders identified in 2003 for colorectal cancer were re-identified in 2005. No pathology opinion leaders for colorectal cancer were identified in both 2003 and 2005. Only 29% of surgical opinion leaders and 17% of pathology opinion leaders identified in the 2005 survey were considered influential for both colorectal cancer and breast cancer. Social-network mapping revealed that only a limited number of general surgeons (12%) or pathologists (7%) were connected to the social networks of identified opinion leaders. Opinion leaders identified in this study were not stable over a two-year time period and generally appear to be monomorphic, with clearly demarcated areas of expertise and limited spheres of influence. These findings may limit the practicability of routinely using opinion leaders to influence practice.
    Implementation Science 01/2011; 6:117. · 2.37 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Clinical practice is not always evidence-based and, therefore, may not optimise patient outcomes. Opinion leaders disseminating and implementing 'best evidence' is one method that holds promise as a strategy to bridge evidence-practice gaps. To assess the effectiveness of the use of local opinion leaders in improving professional practice and patient outcomes. We searched Cochrane EPOC Group Trials Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, HMIC, Science Citation Index, Social Science Citation Index, ISI Conference Proceedings and World Cat Dissertations up to 5 May 2009. In addition, we searched reference lists of included articles. Studies eligible for inclusion were randomised controlled trials investigating the effectiveness of using opinion leaders to disseminate evidence-based practice and reporting objective measures of professional performance and/or health outcomes. Two review authors independently extracted data from each study and assessed its risk of bias. For each trial, we calculated the median risk difference (RD) for compliance with desired practice, adjusting for baseline where data were available. We reported the median adjusted RD for each of the main comparisons. We included 18 studies involving more than 296 hospitals and 318 PCPs. Fifteen studies (18 comparisons) contributed to the calculations of the median adjusted RD for the main comparisons. The effects of interventions varied across the 63 outcomes from 15% decrease in compliance to 72% increase in compliance with desired practice. The median adjusted RD for the main comparisons were: i) Opinion leaders compared to no intervention, +0.09; ii) Opinion leaders alone compared to a single intervention, +0.14; iii) Opinion leaders with one or more additional intervention(s) compared to the one or more additional intervention(s), +0.10; iv) Opinion leaders as part of multiple interventions compared to no intervention, +0.10. Overall, across all 18 studies the median adjusted RD was +0.12 representing a 12% absolute increase in compliance in the intervention group. Opinion leaders alone or in combination with other interventions may successfully promote evidence-based practice, but effectiveness varies both within and between studies. These results are based on heterogeneous studies differing in terms of type of intervention, setting, and outcomes measured. In most of the studies the role of the opinion leader was not clearly described, and it is therefore not possible to say what the best way is to optimise the effectiveness of opinion leaders.
    Cochrane database of systematic reviews (Online) 01/2011; · 5.70 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Clinical practice is not always evidence-based and, therefore, may not optimise patient outcomes. Opinion leaders disseminating and implementing 'best evidence' is one innovative method that holds promise as a strategy to bridge evidence-practice gaps. To assess the effectiveness of the use of local opinion leaders in improving the behaviour of health care professionals and patient outcomes. We searched MEDLINE, Health Star, SIGLE and the Cochrane Effective Practice and Organisation of Care Group Trials Register. We did not apply date restrictions to our search strategy. Searches were last updated in February 2005. In addition, we searched reference lists of all potential studies that were identified. Studies eligible for inclusion were randomized controlled trials that used objective measures of performance/provider behaviour and/or patient health outcomes. Two reviewers extracted data from each study and assessed its methodological quality. We calculated the absolute difference in the risk of 'non-compliance' with desired practice, adjusting for baseline levels of non-compliance where these data were available. Twelve studies met our eligibility criteria. The adjusted absolute risk difference of non-compliance with desired practice varied from -6% (favouring control) to +25% (favouring opinion leader intervention). Overall, the median adjusted risk difference (ARD) was 0.10 representing a 10% absolute decrease in non-compliance in the intervention group. The use of local opinion leaders can successfully promote evidence-based practice. However the feasibility of its widespread use remains uncertain.
    Cochrane database of systematic reviews (Online) 02/2007; · 5.70 Impact Factor