Jordan Swanson

• MD, MSc
• Associate Professor at University of Pennsylvania

OBJECTIVE The natural history of cephaloceles is not well understood. The goal of this study was to better understand the natural history of fetal cephaloceles from prenatal diagnosis to the postnatal period. METHODS Between January 2013 and April 2023, all patients evaluated with a cephalocele at the Center for Fetal Diagnosis and Treatment were...

The decision to undertake rhinoplasty maneuvers during cleft lip repair remains controversial. Little data compare long-term outcomes with and without primary rhinoplasty (PR). This study compared nasolabial outcomes in cohorts with unilateral cleft lip (UCL) treated with and without PR at the Children's Hospital of Philadelphia using standardized...

Introduction In an effort to maximize benefit and minimize morbidity when performing fronto-orbital distraction osteogenesis (FODO) for unilateral coronal synostosis (UCS), we have transitioned to an endoscopic-assisted approach (“endo-FODO”). This study compares photogrammetric outcomes of patients who underwent FODO via an endoscopic-assisted ver...

Introduction This study aims to clarify the relationship between orbito-zygomatic and mandibular dysmorphology as well as their associations with the most frequently observed craniofacial anomalies in patients with Treacher Collins syndrome (TCS). Methods The authors retrospectively reviewed patients with TCS who presented between 2000 and 2023. P...

Background The risk/benefit ratio of operating on the cleft nasal deformity in the period of mixed dentition remains debated. This study characterizes our 18-year experience with intermediate cleft rhinoplasties to add data and nuance to the discussion. Methods We performed a retrospective cohort study of patients who underwent intermediate cleft...

Objective In this study, the authors investigate the associations between the mandibular condyle and facial asymmetry in patients with cleft lip and/or palate (CLP). Methods Condylar volume was calculated by measuring the bony volume of the posterior mandible superior to the sigmoid notch in skeletally mature patients with CLP and controls. Relati...

Introduction This study compares the long-term aesthetic outcomes of patients with unicoronal synostosis (UCS) who underwent fronto-orbital distraction osteogenesis (FODO) versus traditional fronto-orbital advancement and remodeling (FOAR). Methods Patients treated for nonsyndromic UCS from 2009 to 2023 were retrospectively reviewed. Perioperative...

Background We examined operative and pathologic findings of a large series of dermoid cysts at a high-volume pediatric hospital over 23 years. Methods A retrospective review was performed of all dermoid cysts excised from 2000 to 2023 at the Children’s Hospital of Philadelphia. Lesions were classified by location. Depth was stratified into Type 1,...

Background The aesthetic goals of midface surgery in Apert syndrome are to correct the multi-planar midface deficiency and normalize facial ratios. This study characterizes the long-term photogrammetric outcomes of midface advancement in Apert syndrome. Methods Patients with Apert syndrome who underwent midface distraction from 2000 to 2023 were r...

Objective To examine the impact of primary rhinoplasty on subsequent rhinoplasties for patients with cleft lip nasal deformity. Design Retrospective cohort study. Setting Tertiary care pediatric hospital. Patients/Participants Individuals who underwent definitive cleft lip repair at our institution from 2000 to 2006 with a current age of 18 or o...

Objective To identify associations between scores on the CLEFT-Q and Columbia-Suicide Severity Rating Scale (C-SSRS) Lifetime Version in patients with cleft lip and/or palate (CLP). Design Prospective. Setting Tertiary care center. Patients, Participants Patients ages six and older administered both the CLEFT-Q questionnaire and C-SSRS survey be...

Introduction Assessment for elevated intracranial pressure (ICP) helps guide interventional decision-making to treat craniosynostosis. However, non-invasive techniques for measuring ICP are limited. This study assesses whether optic nerve sheath diameter (ONSD) on low-dose computed tomography (CT) scans is associated with ICP in patients with crani...

Background Advancements in artificial intelligence and the development of shape models that quantify normal head shape and facial morphology provide frameworks by which the outcomes of craniofacial surgery can be compared. In this work, we will demonstrate the use of the Swap Disentangled Variational Autoencoder (SD-VAE) to objectively assess chang...

Purpose We examined differences in long-term morphometric outcomes of spring-mediated cranioplasty (SMC) for various forms of isolated nonsyndromic sagittal craniosynostosis. Methods A retrospective review was performed of children who underwent SMC from 2011 to 2020 at the Children’s Hospital of Philadelphia. Cephalic indices (CI), Whitaker grade...

Objective While genotype correlates with phenotype in patients with many forms of syndromic craniosynostosis, the relationship between molecular diagnosis and craniofacial surgical history in patients with Saethre-Chotzen syndrome (SCS) is more variable. This manuscript characterizes that relationship and evaluates operative trends in these patient...

Purpose The spheno-occipital synchondrosis (SOS) is an important site of endochondral ossification in the cranial base that closes prematurely in Apert, Crouzon, and Pfeiffer syndromes, which contributes to varying degrees of midface hypoplasia. The facial dysmorphology of Muenke syndrome, in contrast, is less severe with low rates of midface hypop...

Purpose Treatment of subjects with refractory idiopathic intracranial hypertension (IIH) or shunted hydrocephalus with chronic shunt complications is challenging. What is the role for cranial vault expansion, particularly utilizing posterior vault distraction osteogenesis (PVDO), in these cases? This study assesses medium-term efficacy of cranial v...

Background Early surgical management of syndromic craniosynostosis varies widely between centers, with patients typically undergoing multiple intracranial procedures through childhood. This study evaluates the long-term impact of early posterior vault distraction osteogenesis (PVDO) versus conventional treatment paradigms on the number and timing o...

The forehead flap is a timeless and robust reconstructive option for complex facial defects. In accordance with aesthetic subunit principles, it has traditionally been used to resurface defects affecting a single cervicofacial region, most commonly the nose or periorbital unit. In this article, we present three cases of congenital nevi treated with...

Objective Little is known about the response of the ventricular system to cranial vault surgery in patients with craniosynostosis. This study aims to evaluate the changes in the cerebral ventricular system in response to posterior vault distraction osteogenesis (PVDO) in patients with syndromic and nonsyndromic craniosynostosis. Methods A single-i...

Background We examined ophthalmologic outcomes and periorbital management in patients with Treacher Collins syndrome (TCS). Methods A retrospective cohort study was performed of children with TCS treated from 2009 to 2023 at our center. Demographics and medical history were collected. Primary outcomes were periorbital findings, surgical burden, an...

Objective This study aimed to (1) assess layperson preferences for how surgical information is presented; (2) evaluate how the format of visual information relates to layperson comfort with undergoing surgery, perceptions of surgeon character traits, and beliefs about artistic skill impacting plastic surgery practice; and (3) identify sociodemograp...

Objective Metopic craniosynostosis (MCS) can be difficult to differentiate from metopic ridge (MR) or normal frontal morphology. This study assess whether the supraorbital notch-nasion-supraorbital notch (SNS) angle can help identify MCS. Methods Records of 212 patients with preoperative three-dimensional computed tomography scans were examined. T...

Background This study assesses nasal airway volumes in skeletally mature patients with CLP and healthy controls and examines the relationship among nasal volumes, cleft laterality, and facial asymmetry. Methods Computed tomography images from patients with CLP and controls were analyzed using Mimics Version 23.0 (Materialise, Leuven, Belgium). Rel...

Objective Recent investigations focused on health equity have enumerated widespread disparities in cleft and craniofacial care. This review introduces a structured framework to aggregate findings and direct future research. Design Systematic review was performed to identify studies assessing health disparities based on race/ethnicity, payor type,...

Objective Patients with normocephalic pansynostosis, who have a grossly normal head shape, are often overlooked early in life and present late with elevated intracranial pressure (ICP) requiring timely cranial vault expansion. This study evaluates the long-term clinical outcomes of patients with normocephalic pansynostosis. Methods We retrospectiv...

Objective To evaluate the outcomes associated with two techniques of periorbital steroid administration in bilateral fronto-orbital advancement (FOA). Design Multi-institutional retrospective chart review Setting Two high volume, tertiary US craniofacial centers Patients, Participants Patients who underwent FOA between 2012 and 2021 Interventio...

Background This study assesses operative trends over time and outcomes of five osteotomy techniques used to treat the Apert midface. Using clinical and photogrammetric data, we present our institution’s selection rationale for correcting specific dysmorphologies of the Apert midface based on the individual phenotype. Methods We retrospectively rev...

Purpose: Treatment of subjects with refractory idiopathic intracranial hypertension (IIH) or shunted hydrocephalus with chronic shunt complications is challenging. What is the role for cranial vault expansion, particularly utilizing posterior vault distraction osteogenesis (PVDO), in these cases? This study assesses medium-term efficacy of cranial...

Introduction This study describes the development and explores the academic impact of a cleft and craniofacial research fellowship. Materials and Methods Research and career outcomes from 3 cleft and craniofacial surgeons, 14 clinical fellows, and 25 research fellows between 2010 and 2023 were examined. Academic productivity was measured by the nu...

Objective Identify and describe factors associated with retention and attrition of patients during longitudinal follow-up at multidisciplinary cleft clinic. Design Retrospective cohort study. Setting Single, tertiary care center. Patients, Participants Patients born between 1995 and 2007 with a diagnosis of cleft palate with or without cleft lip...

Objective To describe how the psychosocial status of patients with cleft lip and/or palate (CL/P) relates to patient-reported outcomes (PROs). Design Cross-sectional retrospective chart review. Setting Tertiary care pediatric hospital. Patients/Participants Patients aged 8 to 29 years attending cleft team evaluations during a 1-year period. Mai...

Background Fronto-orbital advancement and remodeling (FOAR) is a common surgical approach used for craniosynostosis conferring functional and aesthetic benefit. There are few reports examining predisposing factors for postoperative complications within the first year after surgery. This study aimed to establish complication rates and identify risk...

Background Improving occlusion and aesthetics is the primary objective of orthognathic surgery for patients with cleft lip and palate (CLP). However, these patients often suffer from horizontal, vertical, and rotational asymmetry in addition to maxillary retrusion. This study aims to describe maxillary and mandibular asymmetry in patients with CLP...

Apert syndrome classically presents with craniosynostosis at birth, most commonly of the bilateral coronal sutures, which may lead to cephalocranial disproportion and elevated intracranial pressure, the latter of which is associated with optic atrophy, visual loss, and developmental delays. A small number of patients with syndromic craniosynostosis...

Background Facial areas attracting the most visual attention in Hemifacial Microsomia (HFM) are poorly understood. Further, it is not clear if and how visual attention changes from pre- to post-operatively. This study characterized layperson visual attention to pre- and post-reconstruction hemifacial microsomia (HFM) using eye-tracking technology....

Introduction Exorbitism in patients with syndromic craniosynostosis is often managed by LeFort III (LF3) or Monobloc (MB) distraction osteogenesis (DO). This study compared short- and long-term orbital craniometrics after LF3DO/MBDO and related these findings to symptom relief. Methods Patients undergoing LF3DO or MBDO from 2000-2021 with pre- and...

Background Given the relatively resource-intensive burden of treating orofacial clefting and its functional and aesthetic sequelae, it is perhaps unsurprising that lower socioeconomic status is known to have adverse effects on outcomes in patients with cleft lip and/or palate (CL/P). Although outcomes in patients with CL/P are known to be influence...

Objective To describe long-term outcomes and complications following mandibular distraction osteogenesis (MDO) in a diverse patient cohort Design Cross-sectional study Setting Single tertiary-care pediatric center Patients Forty-eight patients previously undergoing MDO with minimum 4-year follow-up Main Outcome Measures Respiratory outcomes, fe...

Purpose Mandibular distraction osteogenesis (MDO) may improve airway grade in patients with Robin Sequence (RS), but little is known about the response of the oropharyngeal airway to the distraction process in cases of tongue base obstruction (TBAO). This study used drug-induced sleep endoscopy (DISE) to evaluate the impact of MDO on the oropharynx...

Background Fronto-orbital distraction osteogenesis (FODO) is an established surgical technique for patients with unicoronal craniosynostosis. Our institution has employed an endoscopic-assisted “endo-FODO” in recent years to decrease cutaneous scarring and lessen our impact on the functional growth matrix. This study compares perioperative outcomes...

Background: Patients with Treacher Collins syndrome (TCS) and attendant airway dysmorphology may be predisposed to airway complications in the perioperative period. However, limited data correlates severity of mandibular hypoplasia and airway status. This study aims to improve risk stratification for perioperative airway insufficiency in TCS by us...

Musculoskeletal (MSK) injuries are the most common and debilitating work-related injuries among healthcare providers. These injuries often occur due to a lack of awareness and insufficient guidance during the early years of medical training. Recognizing the need to address this issue, the Comprehensive Cleft Care Workshop (CCCW) has taken steps to...

Background Nasomaxillary hypoplasia, or Binder syndrome, is conventionally treated at skeletal maturity (SKM). However, our institution has employed a stratified treatment algorithm, treating severe patients with serial nasal expansion beginning at elementary school age (5-11 years) to expand the soft tissues and improve appearance prior to definit...

Purpose Oxycephaly is a specific phenotype of multi-suture craniosynostosis that is often misrepresented. This study aims to review the relevant literature, clarify the diagnostic criteria, and present an alternate approach to its management. Methods Published literature regarding oxycephaly was reviewed from 1997, when the largest series was publ...

Purpose: The purpose of this study was to characterize a novel type of calvarial thickening and provide objective measurements of skull thickness and calvarial suture morphology in patients with bronchopulmonary dysplasia. Methods: Infants with severe bronchopulmonary dysplasia who also had undergone computed tomography (CT) scans were identifie...

PurposeThe incidence of metabolic bone diseases in pediatric neurosurgical patients is rare. We examined our institutional experience of metabolic bone diseases along with a review of the literature in an effort to understand management for this rare entity.Methods Retrospective review of the electronic medical record database was performed to iden...

Background: Previous studies have evaluated the influence of facial features in determining male and female sex using prototypical renderings or artificially altered faces in relatively small sample sizes. Using a large set of human photographs and raters, this study hypothesized that certain anatomic facial ratios are associated with perceptions...

Objective: Measuring disability as a concept of impaired global function enables beneficiaries of treatment, the impact of treatment, and targets of health system investment to be rigorously assessed. Measures of disability are not well established for cleft lip and palate. This study aims to systematically review disability weight (DW) studies pe...

Implementation of patient reported outcome (PRO) tools has increased internationally in a variety of clinical settings, with emerging evidence suggesting benefits for patient satisfaction, improved patient-provider communication, and management of chronic conditions. However, integrating PROs into clinical workflow remains a barrier to implementati...

Background: Elevated intracranial pressure (ICP) in sagittal craniosynostosis has a wide spectrum of reported incidence, and patterns are not well understood across infancy and childhood. Characterizing the natural history of ICP in this population may clarify risks for neurocognitive delay and inform treatment decisions. Methods: Infants and ch...

Background: Costochondral grafts (CCGs) can be used in mandibular reconstruction of Kaban-Pruzansky IIB/III hemifacial microsomia (HFM). Their growth is variable, occasionally necessitating secondary surgery. This study examined one surgeon's 24-year experience to better quantify long-term outcomes and surgical care required in CCG reconstruction...

The expansion of Medicaid under the Affordable Care Act (ACA) increased access to health care for many low-income children. However, the impact of this expansion on the timing of primary cleft lip and palate repair remains unclear. This study aimed to evaluate whether Medicaid expansion improved access to timely cleft lip and palate repair and whet...

Introduction: Patients with micrognathia undergoing mandibular distraction osteogenesis (MDO) for functional and aesthetic improvement are at significant risk for dental complications. This study investigates association of two osteotomy patterns-oblique and inverted-L-with risk to developing dentition. Methods: Our senior orthodontist performed...

Objective: Sagittal craniosynostosis constricts transverse skull growth, with possible neurocognitive sequelae. While the degree of sagittal suture fusion has been shown to influence the degree of dysmorphology, it is unknown if it impacts functional findings, including elevated intracranial pressure (ICP). The purpose of this study was to determi...

Background: Studies of infants with micrognathia, especially Robin Sequence (RS), are limited by its rarity and both phenotypic and diagnostic variability. Most knowledge of this condition is sourced from small, single-institution samples. Methods: This is a cross-sectional study including infants with micrognathia admitted to 38 Children's Hosp...

Background: Orbital fibrous dysplasia (FD) is a disease of disordered fibro-osseous proliferation secondary to altered osteogenesis, with potential sequelae including compressive neuropathy and irreversible vision loss. The purpose of this study was to evaluate the natural history and longitudinal outcomes of 37 patients with orbital FD who underw...

Objective The CLEFT-Q is a validated instrument designed to elicit patient-reported outcomes among people affected by cleft lip and/or palate. However, it has not been reported how use of CLEFT-Q data alters routine cleft care. This study analyzed the impact of CLEFT-Q data integration on patient care and clinical decision making. Methods Patients...

Background: Facial attractiveness influences our perceptions of others, with beautiful faces reaping societal rewards and anomalous faces encountering penalties. The purpose of this study was to determine associations of visual attention with bias and social dispositions toward people with facial anomalies. Methods: Sixty subjects completed tests e...

Background: Facial attractiveness influences our perceptions of others, with beautiful faces reaping societal rewards and anomalous faces encountering penalties. The purpose of this study was to determine associations of visual attention with bias and social dispositions toward people with facial anomalies. Methods: Sixty subjects completed test...

Conventional methods to reconstruct cortical bone defects introduced by pediatric cranial vault remodeling (CVR) procedures have shortcomings. Use of bone burr shavings as graft material leads to variable ossification, and harvesting split-thickness cortical grafts is time-intensive and often not possible in thin infant calvaria. Since 2013, the au...

Introduction: Objective assessment of craniofacial surgery outcomes in a pediatric population is challenging due to complexity of patient presentations, diversity of procedures performed, and rapid craniofacial growth. There is a paucity of robust methods to quantify anatomic measurements by age and objectively compare craniofacial dysmorphology a...

Purpose Carbonated calcium phosphate (CCP) cement is an alloplastic material which has been increasingly utilized for cranioplasty reconstruction; however, there is a paucity of data investigating its use in patients with syndromic craniosynostosis. The purpose of this study was to characterize our institutional experience with CCP cement for secon...

Objective: Characterize the interventions and assistance employed by a cleft nurse navigator (CNN) which have mediated improvement in care equity at our institution. Design: Retrospective study. Setting: Academic tertiary care center. Patients, participants: Patients presenting with cleft lip and/or cleft palate presenting between August 202...

Objective: Determine interactions between geospatial and socioeconomic factors influencing cleft lip and/or cleft palate (CL/P) management and outcomes. Design: Retrospective review and outcomes analysis (n = 740). Setting: Urban academic tertiary care center. Patients: 740 patients undergoing primary (CL/P) surgery from 2009 to 2019. Main...

Introduction The development of a spinal pseudomeningocele is a complication of dural repair or reconstruction that carries significant morbidity for pediatric patients. In addition to cerebrospinal fluid (CSF) hypotension and positional headaches, CSF leaking into the extradural space increases the risk for incisional breakdown, meningitis, and co...

Purpose Our center adopted posterior vault distraction osteogenesis (PVDO) as a first-line intervention for cranial expansion in syndromic craniosynostosis in 2008, and we have a growing cohort of patients undergoing transcranial midface advancement who have not had prior fronto-orbital advancement (FOA). The purpose of this study was to evaluate w...

Background Fronto-orbital advancement and remodeling (FOAR) is among the most common surgical approaches for unicoronal craniosynostosis (UCS), although some data demonstrate failure to achieve long-term aesthetic normalcy, leading some to seek alternative treatment paradigms such as fronto-orbital distraction osteogenesis (FODO). This study compar...

Background: Crowdsourcing uses online platforms to collect large data from laypersons and has been increasingly utilized over the past five years to answer questions about aesthetic and functional outcomes following plastic and reconstructive surgery. This systematic review evaluates crowdsourcing manuscripts in plastic and reconstructive surgery...

Background: Children born with hemifacial microsomia (HFM) can suffer from airway compromise. There is a paucity of data correlating degree of HFM severity with airway difficulty. This study aims to determine the relationship between degree of micrognathia and airway insufficiency in the HFM population. Methods: Patient demographics, airway func...

Purpose Our center adopted posterior vault distraction osteogenesis (PVDO) as a first-line intervention for cranial expansion in syndromic craniosynostosis in 2008, and we have a growing cohort of patients undergoing transcranial midface advancement who have not had prior fronto-orbital advancement (FOA). The purpose of this study was to evaluate w...

Background: The aim of this study was to compare midchildhood speech outcomes in patients with nonsyndromic Robin sequence with cleft palate (RSCP) treated with mandibular distraction osteogenesis (MDO) to patients with nonsyndromic Veau class I and Veau class II cleft palate (CP). Methods: The authors performed a retrospective review of patient...

Background: This study tested the core tenets of how facial scars are perceived by characterizing layperson response to faces with scars. The authors predicted that scars closer to highly viewed structures of the face (i.e., upper lip and lower lid), scars aligned against resting facial tension lines, and scars in the middle of anatomical subunits...

Background: Facial proportionality and symmetry are positively associated with perceived levels of facial attractiveness.Objective: The aims of this study were to confirm and extend the association of proportionality with perceived levels of attractiveness and character traits and determine differences in attractiveness and character ratings betwee...

Background Variables interacting to predict outcomes following spring-mediated cranioplasty (SMC) for non-syndromic craniosynostosis, including spring parameters and calvarial thickness, are poorly understood. This study assessed interactions between spring parameters and calvarial thickness to predict changes in cephalic index (CI) following SMC.M...

Purpose Carbonated calcium phosphate (CCP) cement is an alloplastic material which has been increasingly utilized for cranioplasty reconstruction, however there is a paucity of data investigating its use in patients with syndromic craniosynostosis. The purpose of this study was to characterize our institutional experience with CCP cement for second...

Background: Nasal airway obstruction is an increasingly recognized phenomenon in patients with cleft lip and/or palate and has the potential to significantly affect quality of life in this patient population. To date, the effect of secondary cleft rhinoplasty on cleft-related nasal airway obstruction has not been studied. Methods: Patients under...

Unlabelled: Computer-aided surgical planning has become popular for planning orthognathic surgery (OS) as it saves surgeons' time and effort. A recent advancement has been the utilization of patient-specific cutting guides and osteosynthesis. The purpose of this study is to report the postoperative bimaxillary position utilizing custom plates for...