Cosmetic Techniques; Craniocerebral Trauma; Hemangioma; Quality of Life; Surgery, Plastic; Craniofacial Abnormalities
Dr. Persing’s research interests relate to the analysis and treatment of craniofacial conditions, particularly craniosynostosis, cosmetic procedures, the management of vascular anomalies and resident education. Current topics under review in craniofacial disorders are: analysis of neurodevelopmental consequences of craniosynostosis, as it is affected by timing of surgery, and the type of synostosis and the type of surgery performed; the neurodevelopmental implications of deformational plagiocephaly, and the efficacy of orbital rim advancement procedures. Cosmetic surgery topics of investigation are the techniques, safety, and effectiveness of lipoabdominoplasty procedures; technical refinements in body contouring, brachioplasty, blepharoplasty, and breast surgery. Vascular anomalies research includes techniques for optimal treatment of hemangiomas and vascular malformations.
Specialized Terms: Craniofacial growth and development; Cosmetic surgery/quality of life issues; Combined cerebral and facial trauma; Craniofacial vascular malformations; Hemangiomas
Extensive Research Description
Title A Novel Approach to Measuring the Impact of Surgery in Craniosynostosis using Event-Related Potentials (ERPs) Background Much debate surrounds whether children with non-syndromic craniosynostosis (NSC) sustain neurodevelopmental deficits. This controversy surrounding surgery in patients with NSC has initiated many studies involving neuropsychological measurements attempting to characterize the impact of surgical intervention on mental function. However, early studies employing developmental quotients to test infants fail to adequately predict the impact of surgery on neurodevelopment. Unlike these primitive measures, studies utilizing event-related potentials (ERPs), based on cerebral electrical activity, in infants have been shown to be predictive of future outcomes. Objectives This study addresses previous shortcomings by using more sensitive neuropsychological measures in patients with NSC undergoing surgical correction. Furthermore, the study allows us to identify which infants with NSC are at risk of future abnormal language development and neurocognitive deficits. Moreover, ERPs can potentially serve as a standardized measure to assess surgical intervention. Methods Infants with NSC were identified at the Yale Craniofacial clinic prior to surgery. These patients underwent pre-operative testing using ERPs and will be tested post-operatively using the same technique. Their results will be compared to age and gender matched controls. Results Thus far, fifteen patients have subjected to the above protocol. Once their post-operative testing is complete, they will be compared to control groups. Conclusions If the results show that there is a significant difference between the way infants with craniosynostosis process speech sounds as compared to controls, this will provide evidence that surgical intervention is not merely a cosmetic procedure, but rather one necessary to prevent the impairment of neurodevelopment. Also, comparing outcomes between infants subjected to surgery at different ages will elucidate the best timing for surgical intervention. This approach is being supplemented by fMR analysis and long-term neurocognitive studies. References 1. Kapp-Simon, K. A. Mental development in infants with nonsyndromic craniosynostosis with and without cranial release and reconstruction. Plast Reconstr Surg 94: 408-410, 1994. 2. Magge, S. N., Westerveld, M., Pruzinsky, T., et al. Long-term neuropsychological effects of sagittal craniosynostosis on child development. J Craniofac Surg 13: 99-104, 2002. 3. Arnaud, E., Renier, D., Marchac, D. Prognosis for mental function in scaphocephaly. J Neurosurg 83: 476-479, 1995. 4. Renier, D., Marchac, D. Longitudinal assessment of mental development in infants with nonsyndromic craniosynostosis with and without cranial release and reconstruction [discussion]. PlastReconstrSurg 92: 840-841, 1993.
Title: Assessing Neurodevelopment in Positional Plagiocephaly Background: Positional plagiocephaly has been reported to affect as many as 48% of typical healthy infants. Once a rare condition, it has become a prevalent diagnosis since the early 1990s, concurrent with the American Academy of Pediatrics’ recommendation for supine sleep to reduce Sudden Infant Death Syndrome (SIDS). Traditionally, physicians have regarded positional plagiocephaly as a benign condition with no neurodevelopmental sequelae, but recent research has suggested some evidence to the contrary. These studies have relied on the Bayley Scales of Infant Development (BSID) for their assessment. While BSID is the most commonly-employed developmental assessment tool in infancy, it is a poor predictor of long-term intellectual function, and may not be sensitive enough to detect very subtle developmental delays. Unlike BSID, event-related potentials (ERPs, cerebral electrical responses to stimuli) have been shown to be predictive of future cognitive outcomes by other research teams. However, ERPs have never been used to study neurodevelopment in plagiocephaly. Objectives: This study seeks to establish baseline cortical ERPs for infants with positional plagiocephaly and determine if a difference exists between infants with the diagnosis and non-afflicted controls. As a secondary aim, we plan to investigate the effects of skull-molding helmet therapy on auditory ERPs. Methods: Infants with positional plagiocephaly are being identified during consultation at the Yale Craniofacial clinic, and at the Cranial Technologies, Inc. office in Madison, CT. These infants will undergo two ERP sessions: one at baseline, and a second one after 3 months of skull-molding helmet therapy or physical therapy. Results: Pending. Conclusions: Neurodevelopment in positional plagiocephaly remains a debated topic. If the results of this study show a significant difference between infants with the diagnosis and non-affected controls in terms of auditory ERPs, they would provide evidence against the notion that plagiocephaly is an entirely benign condition. We will investigate whether the severity of deformation can be correlated with ERP differences. Additionally, if differences do exist between affected infants and controls, we will investigate whether helmet therapy and/or physical therapy can ameliorate them. References: 1. Molfese, D.L., Predicting dyslexia at 8 years of age using neonatal brain responses. Brain Lang 2000; 72: 238-45. 2. Panchal J, Amirsheybani H, Gurwitch R, et al. Neurodevelopment in children with single-suture craniosynostosis and plagiocephaly without synostosis. Plast Reconstr Surg 2001;108:1492-8; discussion 9-500. 3. Persing J, James H, Swanson J, Kattwinkel J. Prevention and management of positional skull deformities in infants. American Academy of Pediatrics Committee on Practice and Ambulatory Medicine, Section on Plastic Surgery and Section on Neurological Surgery. Pediatrics 2003;112:199-202. 4. Speltz ML, Collett BR, Stott-Miller M, et al. Case-control study of neurodevelopment in deformational plagiocephaly. Pediatrics 2010;125:e537-42. 5. Teichgraeber JF, Ault JK, Baumgartner J, et al. Deformational posterior plagiocephaly: diagnosis and treatment. Cleft Palate Craniofac J 2002;39:582-6.neurodevelopment in craniosynostosis, neurodevelopment in deformational plagiocephaly, cosmetic surgery, efficacy/safety
- Persing J, Jane J Jr, Jane Sr: Neurosurgical Focus – Craniosynostosis. JNSPG Online Section Of August 2011 issue of Neurosurgial Focus http://thejns.org/toc/foc/31/2.
Combined metopic and sagittal craniosynostosis: is it worse than sagittal synostosis alone?
Terner J, Lee SS, Persing: Combined metopic and sagittal craniosynostosis: is it worse than sagittal synostosis alone? JNSPG Online Section of August 2011 issue of Neurosurgical Focus … http://thejns.org/toc/foc/31/2
Improved correction of supraorbital rim deformity in craniosynostosis by the "tilt" procedure.
Patel A, Chang CC, Terner J, Tuggle CT, Persing JA: Improved correction of supraorbital rim deformity in craniosynostosis by the "tilt" procedure. J Craniofac Surg. 2012 Mar;23(2):370-3.
- Patel A, Terner J, Travieso R. Roginiel A, Alderman M, Bridgett D, Losee J, Pollack I, Kanev P, Persing J: The impact of the age of surgery and type of surgical intervention on long term neuropsychological outcomes in sagittal craniosynostosis. Plastic & Reconstructive Surgery 134(4):608e-17e, October 2014
- Forte AJ, daSilva Freitas R, Chang C, Alonso N, Patel A, Persing J: New grading system to assess secondary nasal bone grafting using three-dimensional computed tomography reconstruction. Rev Bars Cir Craniomaxilofac 12(5): 87-91, 2010
Plastic Surgery during natural disasters: lessons from Haiti.
Patel A, Persing JA: Plastic Surgery during natural disasters: lessons from Haiti. Plastic & Reconstructive Surgery 126(2):111e, 2010 August
The intracranial compartmnet volume changes in sagittal craniosynostosis patients: the influence of comprehensive cranioplasty.
Lee SS, duncan CC, Knoll BI, Persing JA: The intracranial compartmnet volume changes in sagittal craniosynostosis patients: the influence of comprehensive cranioplasty. Plastic & Reconstructive Surgery 126(1):187-96, July 2010.
Complication rates of lipoabdominoplasty versus traditional abdominoplasty in high risk patients.
Samra S, Barry O, Persing JA: Complication rates of lipoabdominoplasty versus traditional abdominoplasty in high risk patients. Plastic & Reconstructive Surgery 125(2) 683-90, February 2010.
Full List of PubMed Publications
- Sun AH, Persing JA: Osseous Convexity at the Anterior Fontanelle: A Presentation of Metopic Fusion? J Craniofac Surg. 2017 Dec 7; 2017 Dec 7. PMID: 29227405
- Brooks ED, Beckett JS, Yang J, Timberlake AT, Sun AH, Chuang C, Persing JA: The Etiology of Neuronal Development in Craniosynostosis: A Working Hypothesis. J Craniofac Surg. 2017 Oct 18; 2017 Oct 18. PMID: 29049144
- Timberlake AT, Furey CG, Choi J, Nelson-Williams C, Yale Center for Genome Analysis., Loring E, Galm A, Kahle KT, Steinbacher DM, Larysz D, Persing JA, Lifton RP: De novo mutations in inhibitors of Wnt, BMP, and Ras/ERK signaling pathways in non-syndromic midline craniosynostosis. Proc Natl Acad Sci U S A. 2017 Aug 29; 2017 Aug 14. PMID: 28808027
- Yang JF, Brooks ED, Hashim PW, Reuman HS, Travieso R, Terner J, Mayes LC, Steinbacher DM, Persing JA, McPartland JC: The Severity of Deformity in Metopic Craniosynostosis Is Correlated with the Degree of Neurologic Dysfunction. Plast Reconstr Surg. 2017 Feb. PMID: 28121881
- Timberlake AT, Choi J, Zaidi S, Lu Q, Nelson-Williams C, Brooks ED, Bilguvar K, Tikhonova I, Mane S, Yang JF, Sawh-Martinez R, Persing S, Zellner EG, Loring E, Chuang C, Galm A, Hashim PW, Steinbacher DM, DiLuna ML, Duncan CC, Pelphrey KA, Zhao H, Persing JA, Lifton RP: Two locus inheritance of non-syndromic midline craniosynostosis via rare SMAD6 and common BMP2 alleles. Elife. 2016 Sep 8; 2016 Sep 8. PMID: 27606499
- Persing JA: Discussion: Age at the Time of Surgery and Maintenance of Head Size in Nonsyndromic Sagittal Craniosynostosis. Plast Reconstr Surg. 2016 May. PMID: 27119929
- Brooks ED, Yang J, Beckett JS, Lacadie C, Scheinost D, Persing S, Zellner EG, Oosting D, Keifer C, Friedman HE, Wyk BV, Jou RJ, Sun H, Gary C, Duncan CC, Constable RT, Pelphrey KA, Persing JA: Normalization of brain morphology after surgery in sagittal craniosynostosis. J Neurosurg Pediatr. 2016 Apr; 2015 Dec 18. PMID: 26684766
- Persing JA: In Memory of John Anthony Jane, Sr, MD, PhD: Neurosurgeon, Scholar, and Friend. J Craniofac Surg. 2016 Jan. PMID: 26716551
- Forte AJ, Andrew TW, Colasante C, Persing JA: Perception of Age, Attractiveness, and Tiredness After Isolated and Combined Facial Subunit Aging. Aesthetic Plast Surg. 2015 Dec; 2015 Sep 25. PMID: 26408388
- Forte AJ, Berlin NL, Persing JA, Kwei S: Reply: Cadaveric Study of Breast Measurements during Augmentation with Implants. Plast Reconstr Surg. 2015 Dec. PMID: 26595038
- Forte AJ, Patel A, Moores C, Persing JA: Lateral platysma resection and resetting as an alternative approach to correct aesthetic neck deformity. J Plast Reconstr Aesthet Surg. 2015 Nov; 2015 Jul 26. PMID: 26248492
- Forte AJ, Steinbacher DM, Persing JA, Brooks ED, Andrew TW, Alonso N: Orbital Dysmorphology in Untreated Children with Crouzon and Apert Syndromes. Plast Reconstr Surg. 2015 Nov. PMID: 26505706
- Forte AJ, Tuggle CT, Berlin NL, Fischer JP, Persing JA: Hysterectomy with Concurrent Panniculectomy: A Propensity-Matched Analysis of 30-Day Outcomes. Plast Reconstr Surg. 2015 Sep. PMID: 26313828
- Persing JA, Mayes L, Bridgett D, Hashim P, Patel A, Brooks E, Yang J: Reply: The Effects of Whole-Vault Cranioplasty versus Strip Craniectomy on Long-Term Neuropsychological Outcomes in Sagittal Craniosynostosis. Plast Reconstr Surg. 2015 Jul. PMID: 25811698
- Broer PN, Juran S, Walker ME, Ng R, Weichman K, Tanna N, Liu YJ, Shah A, Patel A, Persing JA, Thomson JG: Aesthetic breast shape preferences among plastic surgeons. Ann Plast Surg. 2015 Jun. PMID: 24691316
- Persing S, Patel A, Clune JE, Steinbacher DM, Persing JA: The Repair of International Clefts in the Current Surgical Landscape. J Craniofac Surg. 2015 Jun. PMID: 26080140
- Ma X, Forte AJ, Berlin NL, Alonso N, Persing JA, Steinbacher DM: Reduced three-dimensional nasal airway volume in treacher collins syndrome and its association with craniofacial morphology. Plast Reconstr Surg. 2015 May. PMID: 25919271
- Persing JA, Brooks E, Hashim P, Patel A, Yang J: Reply: The Effects of Whole-Vault Cranioplasty versus Strip Craniectomy on Long-Term Neuropsychological Outcomes in Sagittal Craniosynostosis. Plast Reconstr Surg. 2015 May. PMID: 25714240
- Persing JA, Hashim P, Bridgett D, Mayes L, Patel A, Brooks E, Yang J, McPartland J, Losee JE: Reply: The effects of whole-vault cranioplasty versus strip craniectomy on long-term neuropsychological outcomes in sagittal craniosynostosis. Plast Reconstr Surg. 2015 Mar. PMID: 25647711
- Ma X, Forte AJ, Persing JA, Alonso N, Berlin NL, Steinbacher DM: Reduced three-dimensional airway volume is a function of skeletal dysmorphology in Treacher Collins syndrome. Plast Reconstr Surg. 2015 Feb. PMID: 25626822
- Hashim PW, Brooks ED, Persing JA, Reuman H, Naples A, Travieso R, Terner J, Steinbacher D, Landi N, Mayes L, McPartland JC: Direct brain recordings reveal impaired neural function in infants with single-suture craniosynostosis: a future modality for guiding management? J Craniofac Surg. 2015 Jan. PMID: 25534054
- Pavri SN, Arnaud E, Renier D, Persing JA: The posterior coronal incision. J Craniofac Surg. 2015 Jan. PMID: 25478982
- Tuggle CT, Patel A, Broer N, Persing JA, Sosa JA, Au AF: Increased hospital volume is associated with improved outcomes following abdominal-based breast reconstruction. J Plast Surg Hand Surg. 2014 Dec; 2014 Mar 31. PMID: 24679114
- Metzler P, Ezaldein HH, Persing JA, Steinbacher DM: Comparing two fronto-orbital advancement strategies to treat trigonocephaly in metopic synostosis. J Craniomaxillofac Surg. 2014 Oct; 2014 Apr 26. PMID: 24997751
- Patel A, Yang JF, Hashim PW, Travieso R, Terner J, Mayes LC, Kanev P, Duncan C, Jane J Jr, Jane J Sr, Pollack I, Losee JE, Bridgett DJ, Persing JA: The impact of age at surgery on long-term neuropsychological outcomes in sagittal craniosynostosis. Plast Reconstr Surg. 2014 Oct. PMID: 25357055
- Hashim PW, Patel A, Yang JF, Travieso R, Terner J, Losee JE, Pollack I, Jane J Sr, Jane J Jr, Kanev P, Mayes L, Duncan C, Bridgett DJ, Persing JA: The effects of whole-vault cranioplasty versus strip craniectomy on long-term neuropsychological outcomes in sagittal craniosynostosis. Plast Reconstr Surg. 2014 Sep. PMID: 24804639
- Forte AJ, Alonso N, Persing JA, Pfaff MJ, Brooks ED, Steinbacher DM: Analysis of midface retrusion in Crouzon and Apert syndromes. Plast Reconstr Surg. 2014 Aug. PMID: 25068327
- Ezaldein HH, Metzler P, Persing JA, Steinbacher DM: Three-dimensional orbital dysmorphology in metopic synostosis. J Plast Reconstr Aesthet Surg. 2014 Jul; 2014 Apr 13. PMID: 24820454
- Hashim PW, Travieso R, Persing JA, Coffman M, Mukerji C, Naples A, Tillman RM, Terner J, Landi N, Patel A, Steinbacher D, Mayes L, McPartland J: Brain electrophysiology reveals intact processing of speech sounds in deformational plagiocephaly. Plast Reconstr Surg. 2014 Jun. PMID: 24867743
- Broer PN, Juran S, Liu YJ, Weichman K, Tanna N, Walker ME, Ng R, Persing JA: The impact of geographic, ethnic, and demographic dynamics on the perception of beauty. J Craniofac Surg. 2014. PMID: 24621757
- Hashim PW, Patel A, Chang CC, Beckett JS, Persing JA: Does an elevated bony ridge along the course of the metopic suture equal metopic synostosis? Implications for management. J Craniofac Surg. 2014 Jan. PMID: 24406558
- Pfaff MJ, Wong K, Persing JA, Steinbacher DM: Zygomatic dysmorphology in unicoronal synostosis. J Plast Reconstr Aesthet Surg. 2013 Aug; 2013 May 2. PMID: 23643777
- Patel A, Sawh-Martinez RF, Sinha I, Watkins JF, Magee WP, Persing JA: Establishing sustainable international burn missions: lessons from India. Ann Plast Surg. 2013 Jul. PMID: 23788123
- Kadlub N, Shin JH, Ross DA, Della Torre T, Ansari E, Persing JA, Ariyan S: Use of the external pectoralis myocutaneous major flap in anterior skull base reconstruction. Int J Oral Maxillofac Surg. 2013 Apr; 2013 Jan 3. PMID: 23290086
- Patel A, Clune JE, Steinbacher DM, Persing JA: Comprehensive cleft center: a paradigm shift in cleft care. Plast Reconstr Surg. 2013 Feb. PMID: 23358049
- Beckett JS, Persing JA, Steinbacher DM: Bilateral orbital dysmorphology in unicoronal synostosis. Plast Reconstr Surg. 2013 Jan. PMID: 22965237
- Broer PN, Buonocore S, Morillas A, Liu J, Tanna N, Walker M, Ng R, Persing JA: Nasal aesthetics: a cross-cultural analysis. Plast Reconstr Surg. 2012 Dec. PMID: 23190836
- Beckett JS, Chadha P, Persing JA, Steinbacher DM: Classification of trigonocephaly in metopic synostosis. Plast Reconstr Surg. 2012 Sep. PMID: 22929268
- Patel A, Chang CC, Terner JS, Tuggle CT, Persing JA: Improved correction of supraorbital rim deformity in craniosynostosis by the "tilt" procedure. J Craniofac Surg. 2012 Mar. PMID: 22421828
- Patel A, Terner J, Travieso R, Clune JE, Steinbacher D, Persing JA: On Bernard Sarnat's 100th birthday: pathology and management of craniosynostosis. J Craniofac Surg. 2012 Jan. PMID: 22337384
- Terner JS, Travieso R, Lee SS, Forte AJ, Patel A, Persing JA: Combined metopic and sagittal craniosynostosis: is it worse than sagittal synostosis alone? Neurosurg Focus. 2011 Aug. PMID: 21806341
- Colebunders B, Matthew MK, Broer N, Persing JA, Dellon AL: Benjamin Alcock and the pudendal canal. J Reconstr Microsurg. 2011 Jul; 2011 May 27. PMID: 21623563
- da Silva Freitas R, de Freitas Azzolini T, Shin JH, Persing JA: Associated (parallel) tomographic findings in patients with single-sutural synostosis. J Craniofac Surg. 2010 Mar. PMID: 20186071
- Samra S, Sawh-Martinez R, Barry O, Persing JA: Complication rates of lipoabdominoplasty versus traditional abdominoplasty in high-risk patients. Plast Reconstr Surg. 2010 Feb. PMID: 20124853
- Patel A, Persing JA: 990 form: a taxing burden for cleft organizations. Plast Reconstr Surg. 2009 Dec. PMID: 19952604
- Patel A, Knoll BI, Persing JA: A congenital cleft of the alar rim. Plast Reconstr Surg. 2009 Feb. PMID: 19182579
- Liu Y, Freitas Rda S, Magriples U, Persing JA, Shin JH: Fetal diagnosis of cleft lip: natural history and outcomes. J Craniofac Surg. 2008 Sep. PMID: 18812841
- Kadlub N, Persing JA, Shin JH: Immediate or delayed nasal reconstruction in infant after subtotal amputation? Nasal reconstruction with forehead flap in a 2-year-old child. Ann Plast Surg. 2008 May. PMID: 18434819
- Kadlub N, Persing JA, da Silva Freitas R, Shin JH: Familial lambdoid craniosynostosis between father and son. J Craniofac Surg. 2008 May. PMID: 18520419
- Knoll BI, Attkiss KJ, Persing JA: The influence of forehead, brow, and periorbital aesthetics on perceived expression in the youthful face. Plast Reconstr Surg. 2008 May. PMID: 18454005
- Persing JA: MOC-PS(SM) CME article: management considerations in the treatment of craniosynostosis. Plast Reconstr Surg. 2008 Apr. PMID: 18379381
- Persing JA, Knoll B, Shin J: The shade procedure: for lower lid deformities. Plast Reconstr Surg. 2008 Apr. PMID: 18349662
- Liu Y, Kadlub N, da Silva Freitas R, Persing JA, Duncan C, Shin JH: The misdiagnosis of craniosynostosis as deformational plagiocephaly. J Craniofac Surg. 2008 Jan. PMID: 18216678
- Heller JB, Heller MM, Knoll B, Gabbay JS, Duncan C, Persing JA: Intracranial volume and cephalic index outcomes for total calvarial reconstruction among nonsyndromic sagittal synostosis patients. Plast Reconstr Surg. 2008 Jan. PMID: 18176220
- Persing JA: Immediate correction of sagittal synostosis. J Neurosurg. 2007 Nov. PMID: 18459910
- Crockett RJ, Pruzinsky T, Persing JA: The influence of plastic surgery "reality TV" on cosmetic surgery patient expectations and decision making. Plast Reconstr Surg. 2007 Jul. PMID: 17572581
- Jae Lee C, Hee Whang J, Lazova R, Ciesielski TE, Thomson JG, McCarthy T, Persing JA: Growth factor expression with different wound treatments after laser resurfacing. Aesthet Surg J. 2007 Jan-Feb. PMID: 19341630
- Levine E, Degutis L, Pruzinsky T, Shin J, Persing JA: Quality of life and facial trauma: psychological and body image effects. Ann Plast Surg. 2005 May. PMID: 15838211
- Knoll BI, Shin J, Persing JA: The bowstring canthal advancement: a new technique to correct the flattened supraorbital rim in unilateral coronal synostosis. J Craniofac Surg. 2005 May. PMID: 15915124
- Bolton MA, Pruzinsky T, Cash TF, Persing JA: Measuring outcomes in plastic surgery: body image and quality of life in abdominoplasty patients. Plast Reconstr Surg. 2003 Aug. PMID: 12900625
- Ta KT, Persing JA, Chauncey H Jr, Bradley BH, Miller SH: Effects of managed care on teaching, research, and clinical practice in academic plastic surgery. Ann Plast Surg. 2002 Apr. PMID: 12068214