Travis T Tollefson

University of California, Davis | UCD · Department of Otolaryngology

The repair of an infant with cleft lip includes treatment of the nasal deformity using surgical repositioning of the nasal cartilages. In some cases, the nose is molded before surgery, termed nasoalveolar molding, and in others, postoperatively with nostril stents for a variable amount of time. This best practice evaluation fails to make a definiti...

Objective To characterize and compare microbiological profiles in tympanostomy tube otorrhea for children with and without cleft palate. Design Retrospective cohort study. Setting Pediatric otolaryngology and multidisciplinary cleft/craniofacial clinic at a single tertiary care center. Patients Children with and without cleft palate <18 years of...

Purpose of review This review aims to examine the indications and anatomical circumstances for when to optimally incorporate buccal myomucosal flaps (BMFs) into palatal surgical reconstruction. Recent findings Studies examining outcomes following primary cleft palate repair with incorporation of BMF have demonstrated excellent speech outcomes and...

Purpose of review As the most common congenital craniofacial defect, patients with cleft lip -palate (CLP) experience morbidity and social stigma, particularly in low-income and middle-income countries (LMICs) such as those of sub-Saharan Africa (SSA). Delays in treatment secondary either to lack of awareness, skills, equipment and consumables; poo...

Background The American Society of Plastic Surgeons commissioned the multidisciplinary Performance Measure Development Work Group on Reconstruction after Skin Cancer Resection to identify and draft quality measures for the care of patients undergoing skin cancer reconstruction. Included stakeholders were the American Academy of Otolaryngology–Head...

Objective: Surgical treatment of velopharyngeal insufficiency (VPI) includes a wide array of procedures. The purpose of this study was to develop a classification for VPI procedures and to describe variations in how they are performed.Design/participants/setting/outcomes: We completed an in-depth review of the literature to develop a preliminary s...

The characteristic cleft nasal deformity presents several challenges for the rhinoplasty surgeon attempting to provide the optimal nasal function and appearance for their patient. One of the difficulties with cleft rhinoplasty is how best to address the malposition alar base. The purpose of this review is to evaluate the various surgical approaches...

Prominauris is a common auricular deformity most often due to underdevelopment of the antihelical fold or overdevelopment of the conchal bowl. Significant psychosocial distress may result from prominent ears, leading to the development of a variety of surgical techniques over the years. A thorough understanding of the anatomy of both the normal and...

Objective To determine the accuracy of the Pediatric Sleep Questionnaire (PSQ) as a screening tool for obstructive sleep apnea in children with craniofacial anomalies. Design Retrospective cohort study. Setting Multidisciplinary cleft and craniofacial clinic at a tertiary care center. Patients Children with craniofacial anomalies 2 to ≤18 years...

Objective: This study aims to develop guidelines for the transfer of patients with isolated craniomaxillofacial (CMF) trauma. Methods: A national, multidisciplinary, expert panel was assembled from leadership in national organizations and contributors to published literature on facial reconstruction. The final panel consisted of five plastic sur...

Background: Development of the craniofacial skeleton and different mechanisms of injury warrant different treatment paradigms for younger children versus those at skeletal maturity. Objective: To characterize the mechanism, fracture patterns, and management of mandible fractures across the pediatric age spectrum. Methods: A 10-year retrospective re...

The primary function of the eyelids is to maintain ocular health and protection. In facial paralysis, neurogenic dysfunction of the orbicularis oculi muscle complex leads to a spectrum of ocular and periocular issues including xerophthalmia, exposure keratopathy, and lower eyelid malposition contributing to epiphora and facial deformity. Conservati...

Eyelid coupling using the modified tarsoconjunctival flap is an effective treatment for paralytic ectropion. Eyelid position and quality of life can be improved in patients with flaccid facial paralysis using these eyelid coupling procedures. The modified tarsoconjunctival flap can obscure the lateral visual field by coupling the eyelids, but witho...

Objective: Advances in 3-dimensional modeling have revolutionized presurgical planning for maxillofacial reconstruction, yet little is known about how this technology may affect patient education. This study was designed to evaluate the efficacy of 2-dimensional computed tomography versus 3-dimensional computed tomography for patient education in...

A multi-disciplinary work group involving stakeholders from various backgrounds and societies was convened to develop guidelines for the management of reconstruction after skin cancer resection. The goal was to identify areas of common ground and provide evidence-based recommendations to improve patient care. Given the heterogeneity of reconstructi...

Purpose of review: In the setting of the COVID-19 global pandemic, the demand for and use of telemedicine has surged in facial plastic and reconstructive surgery. This review aims to objectively review and summarize the existing evidence for the use of telemedicine within facial plastic surgery. Recent findings: Telemedicine has been successfull...

A multi-disciplinary work group involving stakeholders from various backgrounds and societies was convened to develop guidelines for the management of reconstruction after skin cancer resection. The goal was to identify areas of common ground and provide evidence-based recommendations to improve patient care. Given the heterogeneity of reconstructi...

A multi-disciplinary work group involving stakeholders from various backgrounds and societies was convened to develop guidelines for the management of reconstruction after skin cancer resection. The goal was to identify areas of common ground and provide evidence-based recommendations to improve patient care. Given the heterogeneity of reconstructi...

The American Society of Plastic Surgeons (ASPS), American Academy of Otolaryngology-Heand and Neck Surgery (AAO-HNS), and the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) commissioned the multi-disciplinary Rhinoplasty Performance Measure Development Work Group to identify and draft quality measures for the care of patient...

Objectives Adapt the Spanish translation of VPI Effects on Life Outcome (VELO) instrument into Ecuadorian Spanish; test the resulting instrument for reliability and validity. Methods A cross-sectional, prospective design, set at a humanitarian mission within a community hospital. Linguistic validation: native Ecuadorian-Spanish speakers modified t...

The management of patients with bilateral cleft lip and palate requires an understanding of anatomy and a focus on function. Comprehensive care in a collaborative multidisciplinary setting is crucial for the future development of these children. The operative technique begins with meticulous measurement and creation of symmetry to set the foundatio...

Rhinoplasty for cleft lip nasal deformities challenges all cleft surgeons. There is great variability of phenotypical anatomy, but iatrogenic changes and scarring from the previous surgeries add another layer of complexity. Rhinoplasties on a patient with cleft lip–palate are technically and intellectually challenging to master requiring a patient-...

Background The last 5 years have seen a surge of both clinical and scientific interest in empty nose syndrome (ENS). Although ENS is still considered a controversial diagnosis plagued by a lack of standardized diagnostic criteria, ENS is increasingly becoming recognized as a legitimate, physiologic disease entity. As such, it is important for clini...

Purpose of review: Craniomaxillofacial (CMF) trauma is a common cause of global morbidity and mortality. Although in high resource settings the management of CMF trauma has improved substantially over the past several decades with internal rigid fixation technology; these advancements have remained economically unviable and have not yet reached lo...

Background Patients' lack of awareness of available services is a significant barrier to delivering surgical care in resource‐limited settings. Short message service (SMS) text messaging is a potential means to disseminate this information in resource‐limited settings, where rates of mobile phone usage are high. Methods A blast SMS text informing...

Objectives To characterize the duration of Eustachian tube dysfunction in children with cleft palate compared to those without cleft palate by performing time‐to‐event analysis on tympanometric data. To determine predictive characteristics of earlier achievement of normal tympanograms in children with cleft palate. Methods Longitudinal tympanometr...

Purpose of review: Frontal sinus fracture management is evolving. This article will highlight recent literature and provide an evidence-based algorithm in the contemporary management of frontal sinus fractures. Recent findings: The role of transnasal endoscopic treatment of frontal sinus fractures has expanded to include fracture reduction and p...

Purpose of review: To discuss the proposed pathophysiology of empty nose syndrome (ENS), summarize and evaluate the role of validated diagnostic tools in the diagnosis of ENS, and review the medical and surgical treatment strategies for patients with ENS. Recent findings: Historically, ENS has been associated with a reduction in nasal turbinate...

Importance Complications that arise after treatment of mandible fractures can result in significant morbidity. Identifying modifiable risk factors associated with these complications is valuable in guiding clinical practice for improved patient outcomes. Objective To describe the risk factors associated with complications in patients undergoing tr...

Objective: To evaluate the characteristics of children with cleft palate associated with persistent otologic issues in the first 10 years of life. Study design: Case series with chart review. Setting: Single academic center. Subjects and methods: Children born with cleft palate from 2003 to 2007 and treated by the UC Davis Cleft and Craniofa...

Objective: Assess interrater agreement of endoscopic assessment of velopharyngeal (VP) function before and after viewing the video instruction tool (VIT). We hypothesized improvement in interrater agreement using the Golding-Kushner scale (GKS) after viewing the VIT. Study design: Prospective study. Setting: Multi-institutional. Methods: Six...

Sir William Osler once stated that “The practice of medicine is an art, based on science. Medicine is a science of uncertainty and an art of probability.”¹ While Osler’s comment was made in 1893, over a century later it remains true that much variability exists in health care and that this variation in care is thought to contribute to significant w...

Background:. Quality of life (QOL) assessments are useful tools that measure a patient’s health status and monitor patient-reported outcome measures. This study highlights the process of linguistic validation of a QOL assessment to serve Spanish-speaking families and ultimately help decrease language barriers in the treatment of velopharyngeal insu...

Background: Trauma is a significant contributor to global disease, and low-income countries disproportionately shoulder this burden. Education and training are critical components in the effort to address the surgical workforce shortage. Educators can tailor training to a diverse background of health professionals in low-resource settings using co...

Rhinoplasty, as a surgical procedure to improve the appearance of the nose while preserving or improving function, is complicated and difficult to master. Revision cleft rhinoplasty offers another tier of challenge. The symmetry, proportions, and definition of the nose are affected by the native cleft deformity but also previous surgical scars, car...

Purpose of review: Characterize indications, perioperative considerations, clinical outcomes and complications for concurrent endoscopic sinus surgery (ESS) and rhinoplasty. Recent findings: Chronic rhinosinusitis and septal deviation with or without inferior turbinate hypertrophy independently impair patient-reported quality of life. Guidelines...

This article examines 6 questions about facial paralysis answered by 3 experts in their field of facial plastic surgery. The topics covered include routine assessment, neuromuscular training, nonsurgical management, and the future of this field. All the authors answered these questions in a “How I do it” manner to provide the reader with a true und...

Purpose: To present the results of treating combined lower eyelid laxity, retraction and midface descent secondary to facial nerve weakness with a hybrid surgical procedure. Materials and methods: A retrospective analysis of patients from January 2015 to January 2017 who underwent a hybrid surgical technique for the treatment of corneal exposure...

Importance: In the setting of facial paralysis, inadequate eyelid closure and lower eyelid ectropion can lead to corneal exposure and impaired quality of life. Repair of paralytic ectropion is challenging, and an ideal surgical approach for all cases has not been identified. Objective: To assess the patient-reported outcomes and eyelid position...

Patient-reported outcome measures (PROMs) are a powerful method to gather quality-of-life (QOL) data on patients. Validated instruments are available for many symptom- or disease-specific patient problems, which can be used to target treatment, assess treatment success, and better understand priorities for a patient population.

The best-selling 2012 book Wonder¹ by author R. J. Palacio (real name Raquel Jaramillo) tells the fictional story of August Pullman (Auggie), a boy born with severe facial differences—“mandibulofacial dysostosis … complicated by a hemifacial microsomia characteristic of oculo-auriculo-vertebral (OAV) spectrum”—who after 10 years and 27 reconstructi...

Facial fractures and soft tissue injuries around the eyes, nose, and mouth can be difficult to manage in the primary setting, but if untreated, the secondary correction of facial trauma is very challenging. Prevention of soft tissue contraction by restoring the skeletal framework is ideal. Staged, individualized camouflage techniques can be effecti...

A majority (58.2%) of patients with cleft lip and/or cleft palate in Sub-Saharan Africa cite “lack of awareness” as a major barrier to receiving surgical care.¹ Mobile phones are expanding communication possibilities in health care in a burgeoning field referred to as mobile health.² Low- and middle-income countries (LMICs) have demonstrated rapid...

Purpose of review: To review the use of three-dimensional (3D) printing in facial plastic and reconstructive surgery, with a focus on current uses in surgical training, surgical planning, clinical outcomes, and biomedical research. To evaluate the limitations and future implications of 3D printing in facial plastic and reconstructive surgery. Rec...

Nasal deformity associated with typical cleft lip can cause aesthetic and functional issues that are difficult to address. The degree of secondary nasal deformity is based on the extent of the original cleft deformity, growth over time, and any prior surgical correction to the nose or lip. Repair and reconstruction of these deformities require comp...

Objective Rhinoplasty, a surgical procedure that alters the shape or appearance of the nose while preserving or enhancing the nasal airway, ranks among the most commonly performed cosmetic procedures in the United States, with >200,000 procedures reported in 2014. While it is difficult to calculate the exact economic burden incurred by rhinoplasty...

Objective Rhinoplasty, a surgical procedure that alters the shape or appearance of the nose while preserving or enhancing the nasal airway, ranks among the most commonly performed cosmetic procedures in the United States, with >200,000 procedures reported in 2014. While it is difficult to calculate the exact economic burden incurred by rhinoplasty...

Cleft lip and palate are the fourth most common congenital birth defect. Management requires multidisciplinary care owing to the complexity of these clefts on midface growth, dentition, Eustachian tube function, and lip and nasal cosmesis. Repair requires planning, but can be performed systematically to reduce variability of outcomes. The use of pr...

Evidence-based medicine (EBM) encompasses the evaluation and application of best available evidence, incorporation of clinical experience, and emphasis on patient preference and values. Different scales are used to rate levels of evidence. Translating available data for interventions to clinical practice guidelines requires an assessment of both th...

Global surgery is an emerging field within the widely known umbrella term of global health. A lack of data on surgically treatable disease states has been the biggest barrier to the necessary support and investments in global surgery. Most public health priorities address specific diseases (eg, malaria, human immunodeficiency virus, tuberculosis),...

Purpose of review: Abnormal scarring remains a poorly understood but functional and aesthetic consequence of surgical and traumatic wounds. The purpose of this review is to describe the current state of the science behind the prevention and management of these scars. Recent findings: A recent update in the International Clinical Recommendations...

The unilateral cleft lip repair is one of the most rewarding and challenging of plastic surgery procedures. Surgeons have introduced a variety of straight line, geometric, and rotation-advancement designs, while in practice the majority of North American surgeons have been using hybrids of the rotation-advancement techniques. The anatomic subunit a...

Congenital anomalies of the nose range from complete aplasia of the nose to duplications and nasal masses. Nasal development is the result of a complex embryologic patterning and fusion of multiple primordial structures. Loss of signaling proteins or failure of migration or proliferation can result in structural anomalies with significant cosmetic...

There is a lack of consensus regarding preferred implant materials for orbital floor fracture reconstruction, leading to surgeon- and institution-dependent preferences. A variety of implants are used for orbital floor fracture reconstruction, each with their own complication profile. Knowledge of different implant materials is critical to identifyi...

Objective: To develop a clinical consensus statement on septoplasty with or without inferior turbinate reduction. Methods: An expert panel of otolaryngologists with no relevant conflicts of interest was assembled to represent general otolaryngology and relevant subspecialty societies. A working definition of septoplasty with or without inferior...

The purpose of this article is to review and evaluate the surgical options for treating patients with facial paralysis, covering primary neurorrhaphy to facial reanimation, with microvascular free tissue transfer. In recent years, free tissue transfer has been increasingly common for rehabilitating the paralyzed face, providing a more dynamic and a...

Panfacial fractures are often sequenced to repair from stable craniofacial structures to provide a framework. The purpose of this review will be to outline the literature and provide opinion on the current practice related to controversy in the management of midface and panfacial fractures. Three areas of concentration will be the use of intraopera...

According the American Cancer Society’s data, in 2013, an estimated 53,640 people developed head and neck cancers [1], which accounts for about 3% to 5% of all cancers in the United States. Removing head and neck malignant neoplasms is one of the first stages towards patient recovery. However, these types of invasive procedures often lead to disfig...

This study describes development of an iPad-based speech therapy game to improve speech accuracy in children with cleft lip and palate. Children with cleft palate (CP) require multidisciplinary care, including palatoplasty and speech therapy (ST). There is currently an unmet need for ST for children with CP in resource-poor and rural areas owing t...

Velopharyngeal insufficiency in children with cleft palate (and other causes) contributes to difficulty with communication and quality of life. The pharyngeal flap is a workhorse to address hypernasality and nasal air escape. However, there is a paucity of literature on the characteristics of cases that require revision. To measure the revision rat...

Objectives/HypothesisTo evaluate the prevalence and unmet need for cleft lip-cleft palate reconstructive surgery by using incidence. Our hypotheses were that the age of presentation to screening clinics will decrease between 2006 and 2012, and the geospatial distribution of cases will expand to a more rural catchment area. Study DesignLongitudinal...

Purpose To identify which patients and canines are involved in dog bites of the head and neck, and how they impact health systems. Materials and Methods This is a single center, retrospective cohort study conducted from January 2012 to June 2013 from an academic, tertiary care center situated between multiple suburban and urban communities. Patien...

Program Description Concussions and return to play are public health concerns that are gaining coverage as incidence and public awareness increases. Otolaryngologists play an increasing role in the diagnosis of facial trauma and concussions. Not only does the public and health community look to head and neck surgeons for facial trauma treatment, bu...

Objectives/hypothesis: The objective of this study was to determine if there are differences in decannulation rates and duration of cannulation between pediatric patients undergoing tracheotomy for different indications. Study design: Retrospective chart review. Methods: Medical records for pediatric patients (age 0-18 years) undergoing trache...

Most children with cleft are required to undertake speech therapy after undergoing surgery to repair their craniofacial defect. However, the untrained ear of a parent can lead to incorrect practice resulting in the development of compensatory structures. Even worse, the boring nature of the cleft speech therapy often causes children to abandon home...

Traumatic amputation and lacerations of the auricle pose a special challenge to the facial plastic surgeon for several reasons. There is considerable variability in terms of injury location, severity, and etiology, all of which can affect the outcome of the patient’s repair. Second, the complexity and visibility of the external ear anatomy creates...