Scientific Abstract Presentations: Craniomaxillofacial Session 10 Saturday, October 17 Sat, Oct 17 5:00-6:00 p.m. CDT

Purpose: Velopharyngeal insufficiency (VPI) is characterized by incomplete closure of the velopharyngeal sphincter during speech and swallowing, resulting in hypernasality and nasal air emission. Mild-to-moderate VPI can be treated with posterior pharyngeal wall augmentation using autologous fat grafting. This study presents early clinical experience with this technique in patients with isolated and syndromic cleft palate.

Methods: Patients with mild-to-moderate VPI secondary to cleft palate were included; severe VPI was excluded. Diagnosis and classification were confirmed with videofluoroscopy. All procedures were performed under general anesthesia with endotracheal intubation. Fat was harvested, emulsified, and injected into the posterior pharyngeal wall submucosally using a 19-gauge blunt cannula. Ten patients (6 male, 4 female) underwent fat grafting, with a mean age of 11.9 years (range 8–17). Mean volume injected was 5.2 cc (range 3–7 cc). Mean follow-up was 10.2 months (range 8–14 months). No patient developed obstructive sleep apnea. All patients were discharged after one overnight stay. Postoperative evaluation included speech assessment, videofluoroscopy, and perceptive evaluation of hypernasality at 1, 3, 6, 8, and 12 months. All patients received ongoing speech therapy. Scoring System for Speech Assessment: 1) Borel-Maisonny Scale 2) Pittsburgh Weighted Speech Scale (PWSS)

Results: All patients demonstrated improvements in nasal emission, hypernasality, voice resonance, and overall speech intelligibility. Improvement was greater in patients with isolated cleft palate compared with syndromic cleft palate. The procedure was well tolerated, and no major complications were observed.

Conclusions: Posterior pharyngeal wall fat grafting is a safe and well-tolerated intervention for mild-to-moderate VPI. Preliminary results suggest the procedure effectively improves speech outcomes, particularly in patients with isolated cleft palate. These early findings support further study and broader clinical application.

PURPOSE: The American Cleft Palate-Craniofacial Association (ACPA) accredits multidisciplinary teams to promote standardized cleft care. This study evaluates national, regional, and state-level geotemporal concordance and temporal responsiveness between ACPA-accredited centers and orofacial cleft (OFC) burden from 2014 to 2021.

METHODS: OFC incidence (2014 to 2021) was obtained from National Center for Health Statistics natality files; prevalence and DALYs from the Global Burden of Disease database; and accredited ACPA center counts by state and year from the ACPA directly. Linear regression was used to estimate annual trends in incidence, prevalence, DALYs, and center counts at national, regional (U.S. Census divisions), and state levels. Associations between burden and center availability were assessed using Pearson correlation and multivariable regression. Temporal co-trends were differentiated from independent associations using year-adjusted models. A lagged regression analyses was conducted to evaluate whether burden metrics in the 1 to 3 prior years predicted subsequent changes in accredited center counts, and conversely whether center counts predicted future changes in prevalence or DALYs.

RESULTS: All 50 states and the District of Columbia were included over an 8-year period encompassing 159 to 186 accredited centers and complete national epidemiologic data. National births declined 12 percent and OFC incidence decreased 9.5 percent (p < 0.05), while accredited centers increased 17 percent (159 to 186, p < 0.0001). Concurrently, prevalence rose 23.4 percent (p = 0.003) and DALYs increased 52.3 percent (p = 0.0008).

Regionally, incidence declined in most divisions, yet prevalence and DALYs increased universally. Center growth occurred in most regions independent of regional incidence trends. State-level discordance was also observed where New York state demonstrated stable disease incidence with substantial center expansion, while Texas showed declining incidence with minimal center growth, and Pennsylvania and Illinois experienced rising prevalence and DALYs despite stable or decreasing accredited centers.

After adjusting for year, national correlations were no longer significant, indicating that centers and burden measures increased concurrently over time without evidence that changes in burden independently predicted center expansion. Additionally, lagged analyses demonstrated an inverse association between prior-year burden and subsequent center growth where greater prevalence and DALYs one year prior were associated with modest decreases in accredited center counts in the following year (prevalence slope -0.0165, p = 0.033; DALYs slope -0.2904, p = 0.018). No significant associations were observed at 2 to 3 years. Accredited center counts did not significantly predict subsequent changes in prevalence or DALYs 1 to 3 years later (all p > 0.05).

CONCLUSIONS: Despite declining incidence, ACPA-accredited centers expanded nationally while cumulative burden increased. Lagged analyses suggest that expansion of accredited centers neither followed nor preceded rises in prevalence or DALYs in a consistent or predictive manner. Increased burden did not drive subsequent center growth, and growth in accredited centers did not precede measurable reductions in prevalence or DALYs. These findings indicate that accreditation expansion occurred largely independent of evolving epidemiologic trends. Incorporating longitudinal burden metrics into accreditation planning may improve alignment between multidisciplinary cleft care resources and population needs.

Purpose Mandibular distraction osteogenesis (MDO) has become the intervention of choice for tongue based upper airway obstruction due to Robin sequence (RS). Although postoperative infection is the most frequently reported MDO complication, the definition of infection is often vague. Given that hardware retention is necessary to ensure complete distraction and consolidation, early device removal compromises the intended outcome. The lack of standardized diagnostic criteria for MDO-related infection prompted us to review our institutional cohort to characterize the incidence and microbiology of MDO-associated infections and to evaluate outcomes of infection management strategies with hardware retention.

Methods We reviewed all patients with RS who underwent MDO from 2007 to 2025. Based on previously published expanded criteria for pediatric infections, we used a modified Centers for Disease Control and Prevention-National Healthcare Safety Network (CDC-NHSN) criteria to include at least one of the following: purulent discharge from the pin site or surgical wound, positive cultures, clinical signs of infection (erythema, warmth, swelling, tenderness) from the pin site or surgical wound with or without systemic features. Infections were classified as superficial or deep incisional based on the CDC-NHSN criteria. Cases with concurrent, non-MDO site infections were excluded from analysis. Variables regarding infection timing, location, antibiotic duration, culture results, and procedures performed for temporary source control were analyzed.

Results Fifty-six patients were included in the analysis. Median age at osteotomies/device placement was 85 days (IQR 54.0-226.5). Median follow-up was 17 months (IQR 7.6-39.0). Mandibular lengthening was successful in all patients. Nineteen patients (33.9%) met criteria for postoperative infection at a median of 11.4 postoperative days (IQR 9.9-17.0). Most were isolated pin site infections (PSI) (n=13, 68.4%), with fewer superficial incisional (n=4, 21.1%) and deep incisional (n=2, 10.5%) infections. Systemic signs of infection were documented in 89.5% of cases. Management primarily involved antibiotics, with bedside incision and drainage performed in two cases and operative intervention in one case. Original hardware retention was achieved in all but one case, where device replacement was required during consolidation due to loosening in the setting of active infection. Median antibiotic duration was 4.0 days intravenous (IQR 2.0-14.0) and 15.0 days oral (IQR 4.5-52.0). Fourteen patients received both intravenous and oral antibiotics. Four patients required broadening of antimicrobial coverage and three patients required readmission for infection. The pathogen was identified in 17 of 18 cases in which wound cultures were obtained; 58.8% had polymicrobial growth. Gram-positive cocci were isolated in all culture-positive cases. Gram-negative bacilli were isolated in 52.9% and anaerobes in 5.9% of cases. Blood cultures obtained in 12 cases were all negative. While bone biopsies were not routinely obtained, only one out of four yielded positive growth.

Conclusion The current study provides granular, detailed information regarding MDO-associated infection. This complication occurred in one-third of cases and most often presented as isolated PSI, frequently yielding polymicrobial growth when cultured. Our findings support hardware retention as a safe strategy for achieving adequate lengthening in the setting of active infection.

Background: Autologous fat grafting is widely used in pediatric facial reconstruction, yet its long-term reliability remains debated. Surgeons commonly compensate with overcorrection or staged procedures because adipocyte survival is uncertain during growth, puberty, and weight change is uncertain additionally. No prior series has followed pediatric facial fat grafting patients across adolescence into adulthood to determine whether transplanted adipose tissue is permanent and also behaves proportionally with native facial fat.

Methods: Thirty-two pediatric patients underwent facial reconstruction using a standardized knifeless microcolumn autologous fat injection technique performed by a single surgeon (Sullivan). Eleven patients had extended follow-up exceeding 10 years by the same surgeon (11–22 years; mean 15.1 years). Fat was harvested using low-pressure aspiration and transferred through blunt cannulas in resistance-guided micro-aliquots (0.025–0.05 mL) carefully distributed very systematically in microcolumns across facial subunits without planned overcorrection. Standardized photography, video documentation, and patient/family assessments evaluated contour stability, growth behavior, and complications.

Results: Mean age at surgery was 16.3 years and mean age at final follow-up was 30.8 years. Durable contour restoration was observed in all long-term patients. Ninety-one percent required a single procedure (mean 1.09 treatments). No nodularity, infection, overcorrection, graft removal, or secondary surgical intervention occurred. Across puberty, adult weight change and significant fluctuation, grafted regions expanded and contracted proportionally with adjacent native facial fat. Facial growth appeared normal without distortion to our examinations documented by longitudinal photographs. The longest follow-up (22 years) demonstrated stable contour without additional procedures.

Conclusions: Pediatric microcolumn autologous fat grafts demonstrated long-term persistence and physiologic behavior across growth and adulthood. Rather than acting as a temporary filler, transplanted adipose tissue behaved as integrated living tissue. Reliable correction was achieved without deliberate overcorrection, suggesting technique-dependent survival. These findings support the particular technique described in microcolumn fat grafting as a durable reconstructive option in the growing patient and challenge the assumption that long-term unpredictability is inherent to fat grafting.

References: Sullivan, P. K., Palmer, S. K., & Gomez, D. A. (2025). The Evolution of Knifeless Microcolumn Fat Injection in 1362 Patients: Emphasizing Longevity of Results and Optimal Contour. Plastic and reconstructive surgery. Global open, 13(9), e7118. https://doi.org/10.1097/GOX.0000000000007118

Introduction: Hypotelorism is characteristic in children with metopic synostosis. Fronto-orbital advancement has traditionally been used to address cranio-orbital deformities in these patients. Metopic strip craniectomy offers a minimally invasive surgical alternative in early infancy. Objective assessment of the change in hypotelorism is challenging, as computed tomography carries radiation risk in young patients. Three-dimensional stereophotogrammetry (3DSPG) has been increasingly used in craniofacial surgery as a non-ionising alternative imaging modality. We aimed to assess the improvement of hypotelorism in patients with metopic synostosis who underwent metopic strip craniectomy and helmet therapy. To our knowledge, this is the first prospective study utilising 3DSPG to objectively quantify hypotelorism correction following metopic strip craniectomy.

Methodology: A multi-centre prospective study was conducted from February 2024 to March 2025. Children aged 3–4 months with isolated metopic synostosis who underwent metopic strip craniectomy and 9 months of post-operative helmet therapy were included. Using a 3DSPG 5-pod system (3dMD), pre-operative medial and lateral intercanthal distances were recorded, with repeat measurements at 6 and 12 months post-operative. An intercanthal ratio was calculated by dividing the medial intercanthal distance by the lateral intercanthal distance. The primary outcome was the delta change in ratio from pre-operative to 12 months post-operative. Age matched controls without craniosynostosis, n = 30, underwent identical measurements. Welch's t-test compared delta changes between groups.

Results: 24 patients with a mean age of 3 months and 6 days were included in the metopic synostosis group. All patients were compliant with 9 months of post-operative helmet therapy. The mean delta change in intercanthal ratio from pre-operative to 12 months post-operative was 3.96% (SD 1.12%) in the metopic group compared with 1.03% (SD 0.67%) in the control group. The mean difference in delta between groups was 2.93% (95% CI 2.40% to 3.46%), which was statistically significant (Welch's t test p < 0.001). All patients tolerated 3DSPG imaging without issues.

Conclusion: Metopic strip craniectomy was associated with significant improvement in hypotelorism compared with age-matched normal craniofacial growth. 3DSPG provides a safe and reproducible method of assessing post-operative craniofacial changes. Larger multi-centre studies with longer follow up periods are required to validate durability of surgical correction and to correlate objective improvements of hypotelorism with patient-reported and clinician-rated aesthetic subjective outcomes.

Purpose: Complex full-thickness head and neck defects following skin cancer excision frequently heal by secondary intention and require prolonged wound care. Recombinant human platelet-derived growth factor-BB (rhPDGF-BB) has demonstrated wound healing properties in other clinical settings. This randomized trial evaluates its application in reconstructive head and neck defects.

Methods: Adults undergoing reconstruction of full-thickness scalp, face, or neck defects after skin cancer excision were randomized 1:1 to receive rhPDGF-enhanced wound matrix or saline-saturated wound matrix. Randomization was stratified by anatomic location and defect size. The primary outcome was time to 81–100% wound granulation assessed by blinded review of standardized daily photographs. Secondary outcomes included epithelialization, complete healing, pain, scar quality, and quality of life. Data reflect a predefined blinded data cutoff.

Results: Sixty patients were prescreened; 25 were screened and enrolled, and 24 underwent randomization and completed the procedure. Median age was 68 years (IQR 59–76; range 39–86), and 67% were male. Seventy-one percent had prior cancer history, and 67% of these had previously undergone reconstruction for skin cancer. Clinically significant medical conditions were present in 19%. Most wounds involved the face/neck (92%) rather than scalp (8%). Procedural completion was 100%, and 96% completed at least one follow-up visit. Three participants were terminated (12%), and one screen failure occurred prior to randomization. No study-related adverse events or serious adverse events were observed. Clinical wound progression followed expected patterns for secondary intention healing, with one participant (4.2%) requiring skin graft placement.

Conclusions: This randomized trial demonstrates successful enrollment of an older oncologic population with acceptable retention and reassuring early safety. Biologic augmentation of secondary intention healing represents a promising strategy in reconstructive plastic surgery.

Background

Primary palatoplasty is typically performed between 6 and 14 months of age in high-income countries to optimize speech outcomes while minimizing maxillary growth restriction. However, in low- and middle-income countries (LMICs), delayed access to surgical care results in a substantial number of patients reaching adulthood with unrepaired cleft palate. Furthermore, given that approximately 84% of the global burden of untreated orofacial clefts resides in LMICs, adult primary cleft palate repair remains a clinically significant yet underreported challenge. Cleft palate repair in adult patients often presents with wider clefts, prominent bony spicules, profuse bleeding, and long-standing maladaptive speech patterns, all of which complicate surgical repair and functional rehabilitation. This study analyzes CLAPP Hospital's 10-year institutional experience managing adult patients undergoing primary cleft palate repair, with the aim of evaluating surgical outcomes, identifying predictors of complications, and assessing postoperative speech improvement.

Methods

A retrospective cohort study was conducted at CLAPP Hospital, Lahore, Pakistan, from January 2015 to December 2024. Adult patients (≥18 years) presenting with unrepaired overt cleft palate ± cleft lip were included. Patients with syndromic diagnoses or submucous cleft palate were excluded. Surgical techniques included von Langenbeck palatoplasty, Bardach two-flap palatoplasty, and midline incision-only repair. In patients with inadequate palatal length (Randall Types III/IV), an adjunctive pharyngeal flap was added. Wide clefts (Cleft Palate Index >0.4) were managed with extended lateral incisions to facilitate tension-free nasal layer closure. All soft palates were repaired using Sommerlad's intravelar veloplasty. Outcomes assessed included postoperative fistula formation, palatal dehiscence, and speech outcomes using a modified Ann Kummer Speech Protocol. Logistic regression analysis identified predictors of fistula formation.

Results

A total of 395 consecutive patients met the inclusion criteria. The cohort comprised 220 males (55.6%) and 175 females (44.4%), with a mean age of 21.6 ± 5.68 years. The most common phenotype was bilateral incomplete cleft palate (35.9%), followed by unilateral complete left-sided cleft palate (21.8%). Von Langenbeck repair was performed in 49.4% of cases, and Bardach repair in 42.8%. Overall, postoperative fistula formation and/or palatal dehiscence occurred in 16.96% of patients. The most common fistula location was the hard-soft junction (4.8%). Multivariate analysis demonstrated that increasing age was independently associated with higher fistula risk (aOR 1.05; 95% CI 1.001-1.09; p = 0.04). Surgical technique and cleft laterality were not significant predictors after adjustment. Preoperatively, 97.9% of patients demonstrated severe hypernasality (G3). At 6-month follow-up, 69.6% improved to moderate hypernasality (G2), with mean composite speech scores improving from 14.6 to 12.3, representing a 15.75% improvement. However, no patients achieved normal resonance (G0/G1). Seventy patients (17.7%) required secondary speech-correcting surgery due to persistent severe hypernasality.

Conclusion

Primary cleft palate repair in adults is challenging and associated with higher complication rates compared to pediatric populations. Increasing age independently predicts fistula formation. Nevertheless, meaningful improvement in speech resonance can be achieved in the majority of patients when meticulous surgical technique is combined with structured speech therapy. In LMIC settings, adult primary cleft palate repair should be regarded as a viable intervention capable of enhancing quality of life.

Abstract Background: Cleft lip repair is technically demanding, requiring precise marking, flap mobilisation, and layered closure. Training opportunities remain limited due to reduced operative exposure, variability in case availability, and patient safety concerns. Simulation offers a safe platform to enhance trainee competence. Objective: To validate a novel, low-cost unilateral cleft lip trainer through a multicentre trainee–trainer workshop, assessing its face, content, and construct validity. Methods: A prospective validation study was conducted across three accredited training centres. Sixty-two residents participated in standardised workshops involving lectures, video demonstrations, and supervised practice using the model. Participants completed pre- and post-workshop questionnaires, rating realism (face validity) and comprehensiveness (content validity) on a 5-point Likert scale. Construct validity was assessed by faculty scoring (10-point checklist), repair time, and quality outcomes (suture line integrity, lip height symmetry). Results: Knowledge scores increased from 55% to 87% and confidence in cleft repair rose significantly (p < 0.001). Face validity ratings exceeded 90% across anatomical and procedural domains, with "teaching usefulness" (98%) scoring highest. Content validity was strongly endorsed, with 99% recommending curriculum integration. Construct validity demonstrated clear discrimination: first-, second-, and third-year residents scored 7.1, 8.4, and 9.6 (p < 0.001), with repair times decreasing accordingly. Senior trainees achieved superior repair quality. Conclusion: This multicentre validation confirms that the low-cost cleft lip trainer is realistic, comprehensive, and capable of distinguishing skill levels. Its affordability and reproducibility make it a practical educational tool, particularly valuable for integration into structured plastic surgery training curricula. References: [4 ] Reznick RK, MacRae H. Teaching surgical skills--changes in the wind. N Engl J Med. 2006 Dec 21;355(25):2664-9. doi: 10.1056/NEJMra054785. PMID: 17182991. [5 ] Kneebone R. Simulation in surgical training: educational issues and practical implications. Med Educ. 2003 Mar;37(3):267-77. doi: 10.1046/j.1365-2923.2003.01440.x. PMID: 12603766. [6 ] Barsuk JH, Wilcox JE, Cohen ER, Harap RS, Shanklin KB, Grady KL, Kim JS, Nonog GP, Schulze LE, Jirak AM, Wayne DB, Cameron KA. Simulation-Based Mastery Learning Improves Patient and Caregiver Ventricular Assist Device Self-Care Skills: A Randomized Pilot Trial. Circ Cardiovasc Qual Outcomes. 2019 Oct;12(10):e005794. doi: 10.1161/CIRCOUTCOMES.119.005794. Epub 2019 Oct 11. PMID: 31601111; PMCID: PMC7002015. [7 ] Torkington J, Smith SG, Rees BI, Darzi A. The role of simulation in surgical training. Ann R Coll Surg Engl. 2000 Mar;82(2):88-94. PMID: 10743423; PMCID: PMC2503534. [8 ] Schwab B, Hungness E, Barsness KA, McGaghie WC. The Role of Simulation in Surgical Education. J Laparoendosc Adv Surg Tech A. 2017 May;27(5):450-454. doi: 10.1089/lap.2016.0644. Epub 2017 Jan 24. PMID: 28118085.

Purpose: Septorhinoplasty is a combined surgical procedure that is often associated with significant postoperative pain. Proper pain management is essential to guarantee comfort and facilitate recovery. In this meta-analysis, we evaluated the efficacy of preoperative intravenous acetaminophen as a preemptive analgesia strategy versus placebo in terms of postoperative pain, postoperative opioid consumption, nausea, vomiting, and rescue analgesic use.

Methods: We performed a systematic search of the PubMed, Embase, and Cochrane databases through May 2025 to identify randomized controlled trials (RCTs) comparing preemptive intravenous acetaminophen with placebo in patients undergoing septorhinoplasty. The primary outcome was the incidence of patients requesting rescue analgesics. Secondary outcomes included opioid consumption within the first 24 postoperative hours, postoperative pain scores at 1, 6, 12, and 24 hours assessed using the Visual Analogue Scale (VAS), and the incidence of nausea and vomiting. Statistical analysis was performed using R software version 4.4.1, analyzing mean differences (MD) and relative risks (RR) using a random-effects model.

Results: Four RCTs were included in our analysis, comprising 306 patients, of whom 153 received preemptive acetaminophen. Acetaminophen showed a statistically significant reduction in the incidence of patients requesting rescue analgesics (RR 0.43 [95% CI 0.29; 0.64]; p < 0.01, I² = 41.2%, Figure 1A), in opioid consumption within the first 24 postoperative hours (MD -5.15 mg of intravenous morphine [95% CI -9.54; -0.76]; p = 0.02, I² = 90.8%), and in pain scores at 1 hour (MD -1.99 points [95% CI -3.02; -0.96]; p < 0.01, I² = 94.8%), 6 hours (MD -1.72 points [95% CI -2.94; -0.49]; p < 0.01, I² = 96.1%), 12 hours (MD -1.93 points [95% CI -2.74; -1.11]; p < 0.01, I² = 88.8%), and 24 hours (MD -1.72 points [95% CI -2.44; -1.00]; p < 0.01, I² = 91.4%) compared to placebo. There were no statistically significant differences in the incidence of nausea (RR 0.71 [95% CI 0.45; 1.12]; p = 0.14, I² = 0%) or vomiting (RR 0.63 [95% CI 0.34; 1.18]; p = 0.15, I² = 0%) between groups.

Conclusion: Our results indicate that preemptive intravenous acetaminophen significantly reduces the incidence of patients requesting rescue analgesics, opioid consumption within the first 24 postoperative hours, and pain at 1, 6, 12, and 24 hours in patients undergoing septorhinoplasty compared to placebo. No significant differences were observed in the incidence of nausea and vomiting between the two groups.

Introduction: CranioRate was developed to enable comprehensive, quantitative severity assessment in craniosynostosis patients, supporting preoperative family counseling, research, clinical decision making, and outcomes assessments. The supervised Metopic Severity Score (MSS) and Sagittal Severity Score (SSS) were validated against over 1,380 ratings from 72 craniofacial surgeons, while the unsupervised Cranial Morphology Deviation (CMD) score was developed to quantify overall cranial dysmorphology after being trained on 124 scans. We report the workflow and results of the first year of our international collaborative study utilizing the CranioRate platform.

Methods: After receiving IRB and DUA approvals, participating centers uploaded deidentified CT scans of craniosynostosis patients and respective clinical metadata through XNAT (Neuroinformatics Research Group, Washington University School of Medicine, St. Louis, MO, USA). These scans were automatically processed by the CranioRate pipeline utilizing statistical shape modelling to generate quantitative severity scores, which were returned to participating centers.

Results: Since its launch in January 2025, eleven institutions have been ready to upload and thus far we have data from six of those institutions across the United States and Europe. As of January 2026, 2,304 scans have been uploaded, of which 2,281 have been processed to date. The uploaded scans included 607 metopic, 694 sagittal, 371 unicoronal, and 643 other phenotypes. The sum of diagnosis categories exceeds the total number of scans, as some scans were documented under more than one category. The gap between uploaded and processed scans reflects the need for manual review of challenging cases, including scans from young infants with thin calvaria, postoperative scans with hardware artifact, complex cranial morphologies, and images with motion artifact. Centers across the United States contributed over 2,000 scans, with European centers contributing over 400 scans. Of all scans, 1,309 were identified as preoperative, 229 as non-operative, and 337 as postoperative, as treatment status was not available for all scans. Among preoperative scans, diagnoses included 512 metopic, 389 sagittal, 308 unicoronal, and 102 other phenotypes. The MSS was reported 744 times, the SSS was reported 631 times, and the CMD score was generated 2,281 times. The mean MSS was 2.060 (SD 3.960), the mean SSS was 3.183 (SD 2.167), and the mean CMD was 164.413 (SD 44.080). Upload activity increased sharply in June 2025, stabilized during the summer months, and then rose steadily from August 2025 through January 2026, nearly doubling the total scan count over that period, driven largely by increased turnover across research collaborators implementing CranioRate into their regular workflow and structured training sessions with the primary team.

Conclusion: The first year of CranioRate bulk uploads demonstrates the platform's growing clinical and research utility across a multi-institutional consortium. Active participation from six centers, including an international site, reflects broad applicability of automated craniosynostosis severity scoring. Additional institutions are currently in the process of joining the CranioRate consortium.