Although antibiotic prophylaxis following rhinoplasty is widespread, the evidence on antibiotic prophylaxis effectiveness and the superiority of particular administration regimens is controversial. To date, a meta-analysis on the topic has not been performed. To systematically review the association between use of preventive antibiotics and postoperative complications in patients undergoing rhinoplasty and quantify the review through meta-analysis. MEDLINE, Embase, CINAHL, Central (Cochrane Controlled Register of Trials), Scopus, and Web of Science were searched with prospectively designed search phrases on February 16, 2018. All databases were searched from database inception. Key search terms included rhinoplasty, nasal valve repair, and antibacterial agent. Randomized clinical trials (RCTs) with adults (≥18 years) undergoing rhinoplasty and including systemic antibiotic medications administered in the absence of other reasons for use of an antibiotic (eg, localized or systemic infection), without restrictions on language or the time of publication, were included in the study. Interventions of interest were classified into 3 types: (1) single-dose systemic antibiotic administered within 24 hours before the first incision, (2) multidose systemic antibiotic treatment started within 24 hours before the first incision and continuing after the operation, and (3) systemic antibiotic therapy (single dose or multidose) started within 24 hours after the first incision. The following comparisons were made: for the interventions of type 1, no antibiotic; for the interventions of types 2 or 3, no antibiotic or an intervention of type 1. Data extraction was compliant with PRISMA guidelines and Cochrane Handbook for Systematic Reviews of Interventions. Two independent reviewers assessed the relevance of the remaining records at abstract and full-text stages. Meta-analysis pooled with random-effects model. Difference in infectious complication rate between groups. A total of 262 records were identified; of these, only 5 RCTs fulfilled predetermined population, intervention, comparison, and outcome criteria. The pooled study sample consisted of 589 participants. No significant differences in outcome of preventive antibiotic therapy given either preoperatively or postoperatively were found, with a pooled risk ratio of 0.92 (95% CI, 0.35-2.43; P = .86). This study appears to be the first Cochrane-protocol systematic review and meta-analysis investigating preventive antibiotics in rhinoplasty. This study’s results suggest that pooled evidence from the 5 RCTs does not support the use of preventive antibiotic therapy in rhinoplasty. 1.
JAMA Facial Plastic SurgeryVol. 21, No. 5 Invited CommentaryIs There a Selfie Epidemic?Michael J. Reilly, Keon M. Parsa, and Matthew BielMichael J. ReillyCorresponding Author: Michael J. Reilly, MD, Department of Otolaryngology–Head and Neck Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, 1st Floor Gorman, Washington, DC 20007 E-mail Address: mjr100@gunet.georgetown.eduDepartment of Otolaryngology–Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DCGeorgetown University Medical Center, Washington, DCSearch for more papers by this author, Keon M. ParsaDepartment of Otolaryngology–Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DCSearch for more papers by this author, and Matthew BielGeorgetown University Medical Center, Washington, DCDepartment of Psychiatry, MedStar Georgetown University Hospital, Washington, DCSearch for more papers by this authorPublished Online:19 Sep 2019https://doi.org/10.1001/jamafacial.2019.0419AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Is There a Selfie Epidemic?." JAMA Facial Plastic Surgery, 21(5), pp. 367–368FiguresReferencesRelatedDetailsCited byDifferences in Social Perceptions Between Digital Single Lens Reflex Camera and Cell Phone Selfie Images Cherian K. Kandathil, Priyesh N. Patel, Mikhail Saltychev, and Sam P. Most2 October 2020 | Facial Plastic Surgery & Aesthetic Medicine, Vol. 22, No. 5 Volume 21Issue 5Sep 2019 InformationCopyright 2019 American Medical Association. All Rights Reserved.To cite this article:Michael J. Reilly, Keon M. Parsa, and Matthew Biel.Is There a Selfie Epidemic?.JAMA Facial Plastic Surgery.Sep 2019.367-368.http://doi.org/10.1001/jamafacial.2019.0419Published in Volume: 21 Issue 5: September 19, 2019PDF download
Importance While extracorporeal septoplasty (ECS) and its modifications have been previously studied, to our knowledge, no systematic review of surgical outcomes and complications of this technique has been performed. Objective To evaluate the evidence of surgical outcomes and complications of ECS (including modified techniques) to treat severe L-strut septal deviation defined as deviation within 1.0 cm of the caudal or dorsal septum. Data Sources MEDLINE, Embase, CINAHL, CENTRAL, Scopus, and Web of Science databases and reference lists were searched from inception to April 2018 for clinical and observational studies. Search terms included extracorporeal, septoplasty, and septum. Study Selection Selection criteria were defined according to the population, intervention, comparison, and outcome framework. Relevant studies were selected by 2 independent reviewers based on abstracts and full texts. Data Extraction and Synthesis Data were extracted using standardized lists chosen by the authors according to Cochrane Collaboration guidelines. Data were collected and synthesized with ranges reported, as well as assessment of bias and heterogeneity when applicable. Analysis started in February 2019. Main Outcomes and Measures Outcomes assessed included functional nasal airway improvement by objective measurements and subjective measurements (Nasal Obstruction Symptom Evaluation [NOSE] and visual analog scale scores); complications including bleeding, infection, dorsal irregularities, and other functional or cosmetic deficits; and as revision surgery rates. Results Of 291 records initially obtained, 31 were considered relevant after review according to PRISMA guidelines. All studies except 1 randomized clinical trial (3.2%) were observational in nature, with 21 retrospective studies (67.7%) and 9 prospective studies (29.0%). Conventional ECS was performed in 16 studies (51.6%), and modified ECS was performed in 15 studies (48.4%). The sample size varied from 10 to 567, and the mean age varied from 22.5 to 46 years. Of 31 studies, 14 (45%) were of good methodology. Meta-analysis was performed on 5 studies reporting change in NOSE scores, with pooled effect of -60.0 (95% CI, -67.8 to -52.2) points, but heterogeneity was high, with I2 = 96%. When comparing complications between modified and conventional ECS, the relative risk for infections was 0.95 (95% CI, 0.34-2.7); for bleeding, 0; for nasal dorsal irregularities, 0.29 (95% CI, 0.16-0.53); for other cosmetic complications, 4.3 (95% CI, 0.87-21.1); for other functional complications, 0.47 (95% CI, 0.20-1.1); and for revision operations, 1.4 (95% CI, 0.83-2.3). Conclusions and Relevance Of the 31 studies included in this systematic review, less than half were of good methodology, and a significant level of heterogeneity was found regarding type of outcome measure used and reporting of complications. To improve the level of evidence, better study methodology, standardization of surgical outcomes measures, and reporting of complications are needed.
JAMA Facial Plastic SurgeryVol. 21, No. 1 OpinionFacial Animation Surgery for Long‐standing Facial PalsyOpportunities for Shared Decision MakingKatherine B. Santosa, Alexandra M. Keane, Mary Politi, and Alison K. Snyder‐WarwickKatherine B. SantosaDivision of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri.Search for more papers by this author, Alexandra M. KeaneWashington University School of Medicine, St Louis, Missouri.Search for more papers by this author, Mary PolitiDivision of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri.Search for more papers by this author, and Alison K. Snyder‐WarwickCorresponding Author: Alison K. Snyder‐Warwick, MD, Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8238, St Louis, MO 63110 E-mail Address: snydera@wustl.eduDivision of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri.Search for more papers by this authorPublished Online:17 Jan 2019https://doi.org/10.1001/jamafacial.2018.0930AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Facial Animation Surgery for Long‐standing Facial Palsy." JAMA Facial Plastic Surgery, 21(1), pp. 3–4FiguresReferencesRelatedDetails Volume 21Issue 1Jan 2019 InformationCopyright 2018 American Medical Association. All Rights Reserved.To cite this article:Katherine B. Santosa, Alexandra M. Keane, Mary Politi, and Alison K. Snyder‐Warwick.Facial Animation Surgery for Long‐standing Facial Palsy.JAMA Facial Plastic Surgery.Jan 2019.3-4.http://doi.org/10.1001/jamafacial.2018.0930Published in Volume: 21 Issue 1: January 17, 2019PDF download
JAMA Facial Plastic SurgeryVol. 21, No. 2 JAMA Facial Plastic Surgery Clinical ChallengeNasal Continuous Positive Airway Pressure InjuriesAlisa Timashpolsky and Sydney C. ButtsAlisa TimashpolskySearch for more papers by this author and Sydney C. ButtsCorresponding Author: Sydney C. Butts, MD, Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, State University of New York Downstate Medical Center, 450 Clarkson Ave, PO Box 126, Brooklyn, NY 11203 E-mail Address: sydney.butts@downstate.eduSearch for more papers by this authorPublished Online:21 Mar 2019https://doi.org/10.1001/jamafacial.2018.1643AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Nasal Continuous Positive Airway Pressure Injuries." JAMA Facial Plastic Surgery, 21(2), pp. 165–166"Nasal Continuous Positive Airway Pressure Injuries." JAMA Facial Plastic Surgery, 21(2), pp. 165–166"Nasal Continuous Positive Airway Pressure Injuries." JAMA Facial Plastic Surgery, 21(2), pp. 165–166FiguresReferencesRelatedDetails Volume 21Issue 2Mar 2019 InformationCopyright 2019 American Medical Association. All Rights Reserved.To cite this article:Alisa Timashpolsky and Sydney C. Butts.Nasal Continuous Positive Airway Pressure Injuries.JAMA Facial Plastic Surgery.Mar 2019.165-166.http://doi.org/10.1001/jamafacial.2018.1643Published in Volume: 21 Issue 2: March 21, 2019PDF download
IMPORTANCE:Although antibiotic prophylaxis following rhinoplasty is widespread, the evidence on antibiotic prophylaxis effectiveness and the superiority of particular administration regimens is controversial. To date, a meta-analysis on the topic has not been performed. OBJECTIVE:To systematically review the association between use of preventive antibiotics and postoperative complications in patients undergoing rhinoplasty and quantify the review through meta-analysis. DATA SOURCES:MEDLINE, Embase, CINAHL, Central (Cochrane Controlled Register of Trials), Scopus, and Web of Science were searched with prospectively designed search phrases on February 16, 2018. All databases were searched from database inception. Key search terms included rhinoplasty, nasal valve repair, and antibacterial agent. STUDY SELECTION:Randomized clinical trials (RCTs) with adults (≥18 years) undergoing rhinoplasty and including systemic antibiotic medications administered in the absence of other reasons for use of an antibiotic (eg, localized or systemic infection), without restrictions on language or the time of publication, were included in the study. Interventions of interest were classified into 3 types: (1) single-dose systemic antibiotic administered within 24 hours before the first incision, (2) multidose systemic antibiotic treatment started within 24 hours before the first incision and continuing after the operation, and (3) systemic antibiotic therapy (single dose or multidose) started within 24 hours after the first incision. The following comparisons were made: for the interventions of type 1, no antibiotic; for the interventions of types 2 or 3, no antibiotic or an intervention of type 1. DATA EXTRACTION AND SYNTHESIS:Data extraction was compliant with PRISMA guidelines and Cochrane Handbook for Systematic Reviews of Interventions. Two independent reviewers assessed the relevance of the remaining records at abstract and full-text stages. Meta-analysis pooled with random-effects model. MAIN OUTCOMES AND MEASURES:Difference in infectious complication rate between groups. RESULTS:A total of 262 records were identified; of these, only 5 RCTs fulfilled predetermined population, intervention, comparison, and outcome criteria. The pooled study sample consisted of 589 participants. No significant differences in outcome of preventive antibiotic therapy given either preoperatively or postoperatively were found, with a pooled risk ratio of 0.92 (95% CI, 0.35-2.43; P = .86). CONCLUSIONS AND RELEVANCE:This study appears to be the first Cochrane-protocol systematic review and meta-analysis investigating preventive antibiotics in rhinoplasty. This study's results suggest that pooled evidence from the 5 RCTs does not support the use of preventive antibiotic therapy in rhinoplasty. LEVEL OF EVIDENCE:1.
JAMA Facial Plastic SurgeryVol. 21, No. 3 EditorialJAMA Facial Plastic Surgery—The Year in Review, 2018John S. RheeJohn S. RheeCorresponding Author: John S. Rhee, MD, MPH, Department of Otolaryngology and Communication Services, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226 E-mail Address: jrhee@mcw.eduDepartment of Otolaryngology and Communication Services, Medical College of Wisconsin, MilwaukeeEditor, JAMA Facial Plastic SurgerySearch for more papers by this authorPublished Online:16 May 2019https://doi.org/10.1001/jamafacial.2019.0043AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"JAMA Facial Plastic Surgery—The Year in Review, 2018." JAMA Facial Plastic Surgery, 21(3), pp. 183–184FiguresReferencesRelatedDetails Volume 21Issue 3May 2019 InformationCopyright 2019 American Medical Association. All Rights Reserved.To cite this article:John S. Rhee.JAMA Facial Plastic Surgery—The Year in Review, 2018.JAMA Facial Plastic Surgery.May 2019.183-184.http://doi.org/10.1001/jamafacial.2019.0043Published in Volume: 21 Issue 3: May 16, 2019PDF download
ImportanceAlthough the development of persistent opioid use after surgical procedures has garnered much attention in recent years, large-scale studies characterizing patterns of persistent opioid use among patients undergoing plastic and reconstructive surgery procedures are lacking.ObjectiveTo assess the prevalence of immediate and long-term postoperative opioid use after plastic and reconstructive surgery procedures.Design, Setting, and ParticipantsIn this population-based cohort study, patients who underwent 5 classes of plastic and reconstructive procedures (nasal, eye, breast, abdomen, and soft tissue reconstruction) between January 1, 2007, and December 31, 2015, were identified using IBM MarketScan Commercial and Medicare Supplemental research databases. Patients were excluded if they were younger than 18 years, lacked continuous insurance coverage for 1 year preoperatively and postoperatively, had a second anesthesia event within 1 year postoperatively, and filled an opioid prescription within the year prior to surgery.Main Outcomes and MeasuresAnalgesic prescription patterns in the immediate postoperative period. The primary outcome was rates of persistent opioid use (opioid prescriptions filled 90-180 days postoperatively). The secondary outcome was rates of prolonged opioid use (opioid prescriptions filled 90-180 days postoperatively and again 181-365 days postoperatively). Explanatory variables included patient demographics, procedure type, and relevant comorbidities.ResultsOf the 466 677 patients who met inclusion criteria, 96 397 (45.3%) were men, and the mean (SD) age was 46.8 (17.7) years. Furthermore, 212 387 (54.6%) of the patients filled prescriptions for postoperative analgesics, with 212 387 (91.5%) of analgesic prescriptions filled being for opioids. Persistent opioid use occurred in 30 865 (6.6%) patients (5.1%-13.5% across procedure classes), while prolonged opioid use occurred in 10 487 (2.3%) patients (1.7%-5.6% across procedure classes). Patients who filled prescriptions for opioids in the perioperative period were significantly more likely to exhibit persistent (odds ratio [OR], 2.87; 95% CI, 2.80-2.94) and prolonged (OR, 2.90; 95% CI, 2.77-3.02) opioid use than those who did not fill perioperative opioid prescriptions, with the greatest odds for persistent use found in patients who underwent breast (OR, 4.36; 95% CI, 4.10-4.63) and nasal (OR, 3.51; 95% CI, 3.30-3.73) procedures. On multivariable logistic regression analysis, independent risk factors for persistent and prolonged opioid use included perioperative opioid use, procedure type, and prior-year mental health (depression and anxiety) and substance abuse diagnoses.Conclusions and RelevanceGiven the significant risk of persistent opioid use after plastic and reconstructive procedures, it is imperative to develop best practices guidelines for postoperative opioid prescription practices in this population.Level of EvidenceNA.
Importance Nasal base view is important for rhinoplasty analysis. Although some descriptors of nasal base shape exist, they are largely subjective and qualitative. Objective To evaluate a parametric model of nasal base shape and compare it with categorization by surgeons to create an objective classification system for clinical evaluation and communication. Design, Setting, and Participants Retrospective cohort review of deidentified photographs of 420 patients evaluated for possible facial plastic surgery at a tertiary care academic medical center between January 2013 and June 2017. The nasal bases were classified into 6 shape categories (equilateral, boxy, cloverleaf, flat, round, and narrow) via visual inspection. The contour of each nasal base was traced using MATLAB software (MathWorks Inc). The software then performed a curve fit to the parametric model with output of values for 5 parameters: projection-to-width ratio, the anterior-posterior positioning of the tip bulk, symmetry, degree of lateral recurvature of the nasal base, and size. The differences among shape categories for each parameter were analyzed using 1-way analysis of variance. Pairwise comparisons were then performed to ascertain how the various shapes differed. Finally, a multinomial logistic regression model was used to predict nasal base shape using parameter values. Data were analyzed between April 2017 and January 2018. Main Outcomes and Measures An algorithm that categorized nasal base shapes into 6 categories. Results The 420 nasal base photographs of patients evaluated for possible plastic surgery were categorized into 1 of 6 categories; 305 photographs were readily classified, and the remaining 115 were termed unclassified and were categorized. For both the classified and unclassified nasal base groups, there were statistically significant differences between projection-to-width ratio (classified, F5,299 = 21.51; unclassified, F4,100 = 10.59; P < .001), the anterior-posterior positioning of the tip bulk (classified, F5,299 = 3.76; P = .003; unclassified, F4,110 = 4.54; P = .002), and degree of lateral recurvature of the nasal base (classified, F5,299 = 24.14; unclassified, F4,100 = 7.21; P < .001). A multinomial logistic regression model categorization was concordant with surgeon categorization in 201 of 305 (65.9%) cases of classified nasal bases and 38 of 115 (33.0%) unclassified nasal bases. Conclusions and Relevance The parametric model may provide an objective and numerical approach to analyzing nasal base shape. Level of Evidence NA.
JAMA Facial Plastic SurgeryVol. 21, No. 1 Comment & ResponseSurgical Technique and Other Protocols Used Probably Did Not Induce Polyethylene Glycol Fusion of Rat Facial Nervesis accompanied byFunctional and Anatomical Outcomes of Facial Nerve Injury With Application of Polyethylene Glycol in a Rat ModelGeorge D. Bittner, Cameron L. Ghergherehchi, and Michelle MikeshGeorge D. BittnerCorresponding Author: George D. Bittner, PhD, Department of Neuroscience, The University of Texas at Austin, 2415 Speedway, Patterson Laboratories, Rm 321, Austin, TX 78712 E-mail Address: bittner@austin.utexas.eduDepartment of Neuroscience, The University of Texas at Austin, AustinSearch for more papers by this author, Cameron L. GhergherehchiDepartment of Neuroscience, The University of Texas at Austin, AustinSearch for more papers by this author, and Michelle MikeshDepartment of Neuroscience, The University of Texas at Austin, AustinSearch for more papers by this authorPublished Online:17 Jan 2019https://doi.org/10.1001/jamafacial.2018.1126AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Surgical Technique and Other Protocols Used Probably Did Not Induce Polyethylene Glycol Fusion of Rat Facial Nerves." JAMA Facial Plastic Surgery, 21(1), p. 81FiguresReferencesRelatedDetailsRelated articlesFunctional and Anatomical Outcomes of Facial Nerve Injury With Application of Polyethylene Glycol in a Rat Model17 Jan 2019JAMA Facial Plastic Surgery Volume 21Issue 1Jan 2019 InformationCopyright 2018 American Medical Association. All Rights Reserved.To cite this article:George D. Bittner, Cameron L. Ghergherehchi, and Michelle Mikesh.Surgical Technique and Other Protocols Used Probably Did Not Induce Polyethylene Glycol Fusion of Rat Facial Nerves.JAMA Facial Plastic Surgery.Jan 2019.81-81.http://doi.org/10.1001/jamafacial.2018.1126Published in Volume: 21 Issue 1: January 17, 2019PDF download
IMPORTANCE:The "other-race effect" describes the phenomenon in which individuals demonstrate greatest recognition ability among faces of their own race. Thus, in our multicultural world, it follows that race influences social interactions. However, the association of race with perception of plastic surgery outcomes has not been studied. OBJECTIVE:To objectively measure how the other-race effect influences perception of white and Latin American patients undergoing rhinoplasty by using eye-tracking technology and survey methodology. DESIGN, SETTING, AND PARTICIPANTS:In the first part of the study, 134 participants viewed 32 paired facial images of white and Latin American patients, either prerhinoplasty or postrhinoplasty, on an eye-tracking system that recorded observer scan paths. In the second part of this study, the same patient images were individually graded by a separate group of 134 participants for degree of racial identification and perceived attractiveness. MAIN OUTCOMES AND MEASURES:The primary outcome was to measure the influence of patient and observer race on perception of rhinoplasty outcomes. For the eye-tracking part, planned hypothesis testing was conducted using an analysis of variance to compare patient race, rhinoplasty status, and attractiveness with respect to visual fixation time. RESULTS:Of the 134 eye-tracking participants, 68 (51%) were women and the mean (SD) age was 26.4 (7.7) years; of the 134 graders, 64 (48%) were women and the mean (SD) age was 25.0 (6.9) years. Rhinoplasty did not affect racial identity scores among either same-race or other-race evaluators. Visual fixation times for white faces were significantly increased compared with Latin American faces among all casual observer groups (white observers mean change, -20.14 milliseconds; 95% CI, -29.65 to -10.62 milliseconds; P < .001; Asian observers mean change, -39.04 milliseconds; 95% CI, -48.95 to -29.15 milliseconds; P < .001; and African American observers mean change, -20.73 milliseconds; 95% CI, -37.78 to -3.69 milliseconds; P < .02), with the exception of Latin American observers (mean change, -7.8 milliseconds; 95% CI, -29.15 to 14.39 milliseconds; P < .51). With respect to attractiveness, white graders reported a significant postrhinoplasty increase across both races (white patients mean change, 8.07 points; 95% CI, 5.01-11.12 points; P < .001; and Latin American patients mean change, 3.69 points; 95% CI, 0.87-6.49 points; P = .01), whereas Latin American graders only observed a significant attractiveness increase in their own race (Latin American patients mean change, 10.50 points; 95% CI, 1.70-19.32 points; P = .02). Neither perceived attractiveness nor rhinoplasty status influenced fixation times. CONCLUSIONS AND RELEVANCE:Both patient and observer race influence visual attention and perception of attractiveness before and after rhinoplasty. These findings underscore the importance of counseling patients that the influence of rhinoplasty, as perceived by the casual observer, may vary by race or ethnicity of the observer group. LEVEL OF EVIDENCE:NA.
Importance Quantitative assessment of facial function is difficult, and historic grading scales such as House-Brackmann have well-recognized limitations. The electronic, clinician-graded facial function scale (eFACE) allows rapid regional analysis of static, dynamic, and synkinetic facial function in patients with unilateral facial palsy within the course of a clinical encounter, but it relies on clinician assessment. A newly developed, machine-learning algorithm (Emotrics) provides automated, objective facial measurements but lacks clinical input (ie, recognizing laterality of facial palsy or synkinesis). Objectives To compare the sensitivity of a clinician-based tool (eFACE) to a well-established intervention for facial palsy (eyelid weight placement) with an automated facial-measurement algorithm (Emotrics). Design, Setting, and Participants A retrospective review was conducted of the most recent 53 patients with unilateral facial palsy who received an eyelid weight at the Massachusetts Eye and Ear Infirmary Facial Nerve Center from 2014 to 2017. Preoperative and postoperative photographs were deidentified and randomized. The entire cohort was analyzed by 3 clinicians, as well as by the Emotrics program. Main Outcomes and Measures eFACE scores of the palpebral fissure at rest (0, wide; 100, balanced; 200, narrow), with gentle eyelid closure (0, incomplete; 100, complete), and with forceful eyelid closure (0, incomplete; 100, complete) before and after eyelid weight placement were compared with palpebral fissure measurements by Emotrics. Results Of the 53 participants, 33 were women, and mean (SD) age was 44.7 (18) years. The mean (SD) eFACE scores and Emotrics measurements (in millimeters) before vs after eyelid weight placement of the palpebral fissure at rest (eFACE, 84.3 [15.9] vs 109.7 [21.4]; Emotrics, 10.3 [2.2] vs 9.1 [1.8]), with gentle eyelid closure (eFACE, 65.9 [28.0] vs 92.1 [15.4]; Emotrics, 4.4 [2.7] vs 1.3 [2.0]), and with forceful eyelid closure (eFACE, 75.1 [28.6] vs 97.0 [10.7]; Emotrics, 3.0 [3.1] vs 0.5 [1.3]) all significantly improved. Subgroup analysis of patients with expected recovery (eg, Bell palsy) (n = 40) demonstrated significant development of ocular synkinesis on eFACE (83.9 [22.7] vs 98.9 [4.4]) after weight placement, which could also explain the improvement in eyelid function. The scores of patients with no expected recovery (n = 13) improved in both eFACE and Emotrics analysis following eyelid weight placement, though results did not reach significance, likely limited by the small subgroup size. Conclusions and Relevance The eFACE tool agrees well with automated, objective facial measurements using a machine-learning based algorithm such as Emotrics. The eFACE tool is sensitive to spontaneous recovery and surgical intervention, and may be used for rapid regional facial function assessment from a clinician's perspective following recovery and/or surgical intervention. Level of Evidence 4.
Background: Surgical repair of septal perforations has been historically cumbersome. Recently described techniques utilizing interposition grafting with polydioxanone (PDS) plates wrapped in a temporoparietal fascia (TPF) graft have reported successful closure in 90% to 100% of cases. Our objective is to expand the investigation into the use of interposition grafts of polydioxanone plates combined with a temporoparietal fascia graft for nasal septal perforation repair. Methods: Retrospective review of the medical record was performed for all septal perforation repairs using the TPF-PDS plate interposition graft technique from August 1, 2017 to March 1, 2021 at the University of Iowa. Minimum post-operative follow-up was 1 month. Results: Our series included 31 patients with symptomatic nasal septal perforations. Thirteen patients underwent open while 18 patients underwent endonasal graft placement. The mean perforation size was 1.49 cm(2). The mean post-operative follow-up was 11.5 months. Conclusions: Repair of symptomatic nasal septal perforations using an interposition graft of polydioxanone plate wrapped in temporoparietal fascia demonstrated an overall success rate of 90%.
ImportanceStandardization of outcome measurement using a patient-centered approach in pediatric facial palsy may help aid the advancement of clinical care in this population.ObjectiveTo develop a standardized outcome measurement set for pediatric patients with facial palsy through an international multidisciplinary group of health care professionals, researchers, and patients and patient representatives.Design, Setting, and ParticipantsA working group of health care experts and patient representatives (n = 21), along with external reviewers, participated in the study. Seven teleconferences were conducted over a 9-month period between December 3, 2016, and September 23, 2017, under the guidance of the International Consortium for Health Outcomes Measurement, each followed with a 2-round Delphi process to develop consensus. This process defined the scope, outcome domains, measurement tools, time points for measurements, and case-mix variables deemed essential to a standardized outcome measurement set. Each teleconference was informed by a comprehensive review of literature and through communication with patient advisory groups. Literature review of PubMed was conducted for research published between January 1, 1981, and November 30, 2016.Main Outcomes and MeasuresThe study aim was to develop the outcomes and measures relevant to children with facial palsy as opposed to studying the effect of a particular intervention.ResultsThe 21 members of the working group included pediatric facial palsy experts from 9 countries. The literature review identified 1628 papers, of which 395 (24.3%) were screened and 83 (5.1%) were included for qualitative evaluation. A standard set of outcome measurements was designed by the working group to allow the recording of outcomes after all forms of surgical and nonsurgical facial palsy treatments among pediatric patients of all ages. Unilateral or bilateral, congenital or acquired, permanent or temporary, and single-territory or multiterritory facial palsy can be evaluated using this standard set. Functional, appearance, psychosocial, and administrative outcomes were selected for inclusion. Clinimetric and psychometric outcome measurement tools (clinician-, patient-, and patient proxy-reported) and time points for measuring patient outcomes were established. Eighty-six independent reviews of the standard set were completed, and 34 (85%) of the 40 patients and patient representatives and 44 (96%) of the 46 health care professionals who participated in the reviews agreed that the standard set would capture the outcomes that matter most to children with facial palsy.Conclusions and RelevanceThis international collaborative study produced a free standardized set of outcome measures for evaluating the quality of care provided to pediatric patients with facial palsy, allowing benchmarking of clinicians, comparison of treatment pathways, and introduction of value-based reimbursement strategies in the field of pediatric facial palsy.Level of EvidenceNA.
IMPORTANCE Facial cosmetic surgery has previously focused on improvements in perceived physical attractiveness and youthfulness. However, human beings are judged throughout life based on many other characteristics and personal qualities that are conveyed by their faces. OBJECTIVE To examine the association of facial cosmetic surgery in men with perceptions of attractiveness, masculinity, and personality traits. DESIGN, SETTING, AND PARTICIPANTS Cohort study with retrospective evaluation by blinded raters of preoperative and postoperative photographs of 24 male patients who underwent facial cosmetic surgery between January 1, 2009, and January 31, 2016. A total of 6 surveys were constructed with 8 sets of photographs each (4 preoperative and 4 postoperative). Each of these surveys was then sent to at least 36 lay people via the web-based survey tool Survey Monkey. Additional invites were sent for individual surveys until a minimum of 24 responses were received for each survey. Preoperative and postoperative photographs of the same patient were not placed in the same survey to avoid recall bias. Anonymous raters used a 7-point Likert scale to rate their perception of each patient's personality traits (aggressiveness, extroversion, likeability, risk seeking, sociability, and trustworthiness), attractiveness, and masculinity based on photographs in their assigned survey. Raters were blinded to study intent. Data analysis was performed between August 2018 and March 2019. MAIN OUTCOMES AND MEASURES Ratings of personality, attractiveness, and masculinity. RESULTS This survey study included photographs of 24 men who underwent facial cosmetic surgery; the mean (SD) age of the patients was 49.3 (16.4) years. A total of 145 participants completed the survey; the majority of respondents were men (n = 81; 56%) between the ages of 25 and 34 years (n = 116; 80%). Score increases were significant for perceived attractiveness (0.29; 95% CI, 0.13-0.46), likeability (0.41; 95% CI, 0.24-0.57), social skills (0.25; 95% CI, 0.08-0.40), and trustworthiness (0.27, 95% CI, 0.11-0.44) when evaluating all facial cosmetic procedures together (upper blepharoplasty, lower blepharoplasty, face-lift, brow-lift, neck-lift, rhinoplasty, and/or chin implant). Upper blepharoplasty was associated with positive changes in perceived likeability (0.72; 95% CI, 0.06-1.50) and trustworthiness (0.74; 95% CI, 0.22-1.25). Lower blepharoplasty was associated with decreased perception of risk seeking (-0.78; 95% CI, -1.45 to -0.10). Face-lift was associated with increased perception of likeability (0.69; 95% CI, 0.08-1.30) and trustworthiness (0.66; 95% CI, 0.05-1.27). Neck-lift was associated with increased perception of extroversion (0.60; 95% CI, 0.10-1.09) and masculinity (0.70; 95% CI, 0.21-1.19). Patients who underwent rhinoplasty had improvements in perceived attractiveness (0.51; 95% CI, 0.03-1.00) and likeability (0.40; 95% CI, 0.03-1.00). Chin augmentation did not show any significant improvements. CONCLUSIONS AND RELEVANCE The results of this study suggest that men undergoing facial cosmetic surgery may experience changes in perceived attractiveness, masculinity, and a variety of personality traits. These findings complement those from a previous study on female patients, which together broaden the understanding of the association of cosmetic surgery with societal perceptions of persona.
ImportanceThis study characterizes and compares common surgical manipulations' effects on septal cartilage to understand their implications for rhinoplasty outcomes based on cell viability and cartilage health.ObjectiveTo illustrate distinct differences in the impact of various surgical manipulations on septal cartilage in an in vitro septal cartilage model. A secondary objective is to better understand the chondrocyte's response to injury as well as how alterations in the extracellular matrix correspond to chondrocyte viability.Design, Setting, and ParticipantsIn this bench-top in vitro porcine model using juvenile bovine septal cartilage from bovine snouts, easily obtainable septal cartilage was used to generate large numbers of homogenous cartilage specimens. Quantitative outcomes at early and late time points were cell viability, cell stress, matrix loss, and qualitative assessment through histologic examination. The study was performed at a single academic tertiary care research hospital.InterventionsFour common surgical manipulations were contrasted with a control group: crushed cartilage, scored cartilage, diced cartilage, and shaved cartilage.Main Outcomes and MeasuresFollowing the manipulation of the cartilage, the quantitative outcomes were glycosaminoglycan release to the media, lactate dehydrogenase release to the media, and cell death analysis through apoptosis staining. The qualitative outcomes were histologic staining of the manipulated cartilage with safranin-O/fast green stain to identify proteoglycan loss.ResultsThe crushing followed by shaving manipulations were the most damaging as indicated by increased levels of lactate dehydrogenase release, glycosaminoglycans loss, and cell death. Matrix loss did not increase until after 48 hours postinjury. Furthermore, chondrocyte death was seen early after injury and accelerated to the late time point, day 9, in all manipulations. Conversely, cell stress was found to be greater at 48 hours postinjury, which then declined to the late time point, day 9.Conclusions and RelevanceThe crushing manipulation followed by shaving and then dicing were the most destructive methods of cartilage manipulation relative to control specimens. Collectively, these outcomes demonstrate the range of injury which occurs with all septal cartilage manipulations and can inform rhinoplasty practice to use the least damaging effective surgical manipulation to obtain the desired outcome.Level of EvidenceNA.
The aging neck is one of the most common motivations for patients to seek aesthetic rejuvenation. Increasingly, patients are desiring less invasive aesthetic treatments with less morbidity and downtime. Percutaneous radiofrequency technologies have been recently introduced for cervical rejuvenation. These technologies safely and effectively apply energy directly into the subdermal space, targeting the upper dermal collagen network, the deeper fascial layer, and the fibrofatty septum that anchors the dermis to the deep fascia. Significant skin tightening and fat reduction have been reported with these technologies, beyond that which is currently achievable with other minimally invasive energy-based technologies.
JAMA Facial Plastic SurgeryVol. 21, No. 1 Invited CommentaryIs e-Cigarette Vaping a New Clinical Challenge to Wound Healing?Shaun C. DesaiShaun C. DesaiCorresponding Author: Shaun C. Desai, MD, Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, 6420 Rockledge Ave, Ste 4950, Bethesda, MD 20817 E-mail Address: sdesai27@jhmi.eduDivision of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MarylandSearch for more papers by this authorPublished Online:17 Jan 2019https://doi.org/10.1001/jamafacial.2018.1280AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Is e-Cigarette Vaping a New Clinical Challenge to Wound Healing?." JAMA Facial Plastic Surgery, 21(1), pp. 10–11FiguresReferencesRelatedDetails Volume 21Issue 1Jan 2019 InformationCopyright 2018 American Medical Association. All Rights Reserved.To cite this article:Shaun C. Desai.Is e-Cigarette Vaping a New Clinical Challenge to Wound Healing?.JAMA Facial Plastic Surgery.Jan 2019.10-11.http://doi.org/10.1001/jamafacial.2018.1280Published in Volume: 21 Issue 1: January 17, 2019PDF download
IMPORTANCE Smoking is a known risk to wound healing, but whether electronic cigarettes present the same risk remains unknown. OBJECTIVE To evaluate the rate of flap necrosis in the e-cigarette vapor-exposed group and the unexposed control and to detect a difference in the rate of flap necrosis between the traditional cigarette smoke-exposed group and the unexposed control. DESIGN, SETTING, AND PARTICIPANTS From March 10, 2018, to May 4, 2018, a cohort study was conducted on 45 male Sprague-Dawley rats at Boston University School of Medicine. Each rat weighed approximately 100 g at the beginning of the study and was randomized to 1 of 3 groups: negative control (n = 15), experimental (exposed to e-cigarette vapor; n = 15), and positive control (exposed to traditional cigarette smoke; n = 15). Rats in the experimental and positive control groups were exposed to electronic cigarette vapor and traditional cigarette smoke in a smoking chamber for 30 minutes twice a day for 30 consecutive days. Levels of serum cotinine were monitored and maintained between 150 ng/mL and 200 ng/mL. After 30 days, random pattern dorsal skin flaps were raised. MAIN OUTCOMES AND MEASURES Percentage of flap necrosis for each group. RESULTS All 45 rats survived the surgical procedure and postoperative recovery, and all rats thrived and gained weight over the course of the study. The highest rate of flap necrosis was found in the positive control cohort, with a mean (SD) of 68.7% (8.6%), followed by the experimental cohort, with a mean (SD) of 65.9% (11.8%); the negative control cohort had the least amount of flap necrosis, with a mean (SD) of 50.8% (9.4%). The percentage of flap necrosis in the negative control rats (95% CI, 46.0-55.6; P < .001) was substantially lower than that for both the positive control rats (95% CI, 64.3-73.0; P < .001) and the experimental rats (95% CI, 59.9-71.8; P < .001). No statistically significant difference in flap necrosis was noted between the rats in the experimental cohort and the rats in the positive control cohort (95% CI, 59.9-71.8 vs 95% CI, 64.3-73.0; P = .46). CONCLUSIONS AND RELEVANCE Smoking and vaping appear to be equally detrimental to wound healing and to be associated with a statistically significant increase in flap necrosis compared with the unexposed group. The results suggest that vaping should not be seen as a better alternative to cigarette smoking in the context of wound healing.
