BACKGROUND Robin Sequence (RS) is a congenital condition marked by micrognathia, glossoptosis, and airway obstruction. Patients with RS exhibit anatomical differences in the hyoid bone, a key mediator of swallowing and respiration. Severe RS is treated with mandibular distraction osteogenesis (MDO) to lengthen the mandible and increase oropharyngeal space, the latter thought to be caused by changes in hyoid position. Here, we test this hypothesis by quantitatively evaluating 3D hyoid position and morphology in patients with RS and comparing them to pediatric controls. METHODS Computed tomography (CT) scans were obtained for 38 patients with RS pre- and post-MDO and 15 control patients. Hyoid position relative to craniomandibular landmarks and hyoid morphology were compared between pre- and post-MDO RS patients and controls. RESULTS Pre-MDO patients have shorter relative hyoid-menton distances than post-MDOs and controls (p<0.01). Relative hyoid-basion and hyoid-vertebral column distances are comparable between groups. Controls have smaller relative hyoid-temporomandibular joint distances than RS patients (p<0.05). RS patients have a higher prevalence of abnormal hyoid ossification (control: 13.3%; pre-MDO: 36.8%) and demonstrate dimensional differences in hyoid width and angle related to both RS and MDO. CONCLUSIONS MDO does not enlarge the oropharyngeal space by moving the hyoid anteriorly. Instead, we hypothesize MDO improves airway patency by 1) changing tongue shape and the geometry of the anterior pharyngeal wall, and 2) increasing suprahyoid muscle passive tension. Our results provide new insights into the mechanisms of mandibular distraction and highlight importance of the hyoid and its attachments in the pathologic presentation of RS.
INTRODUCTION Postoperative pain after abdominoplasty can reduce patient satisfaction, delay mobility, and increase complications like deep vein thrombosis (DVT). Multimodal analgesia, including transversus abdominis plane (TAP) blocks, improves pain control, reduces opioid use, improving recovery, minimizing DVT risks, and promoting early ambulation and recovery. OBJECTIVE This article examines the safety, effectiveness, and practical aspects of abdominoplasty under sedation and TAP block as an alternative to general anesthesia, detailing the anesthetic protocol and patient outcomes. MATERIALS AND METHODS This prospective, single-center case series encompassed all consecutive lipoabdominoplasty patients from December 2020 to June 2025. Epidemiology, procedures, medications, patient-reported outcomes, satisfaction, and complications were collected via standardized questionnaires, including BodyQ, Patient and Observer Scar Assessment Scale (POSAS) and International Pain Outcome (IPO) questionnaire. RESULTS Forty patients (mean age 37 ± 11) underwent lipoabdominoplasty under conscious sedation and TAP-block; 45% also underwent breast surgery. During the first 24 postoperative hours, 31% of patients experienced at least one episode of severe pain, lasting a cumulative average of 2.4 hours. 90% reported minimal/no nausea. No antiemetics were required; 25% received one opioid dose. Analgesia satisfaction was 90%. Median discharge time was 2:42 h (interquartile range [IQR] 2:00-3:16). Appearance satisfaction was 100% (IQR 81-100%). CONCLUSION Lipoabdominoplasty with sedation, TAP block, and tumescent anesthesia can be safely performed in the outpatient setting, with minimal to no nausea, low to moderate pain, and great patient satisfaction. The evidence supports revisiting postoperative care pathways to ensure prudent utilization of hospital assets, like minimizing unnecessary inpatient observation, without compromising outcomes.Level of Evidence: IV.
INTRODUCTION Transgender and gender diverse (TGD) individuals may undergo feminizing body contouring (FBC), liposuction with or without fat grafting to the buttocks and hips, to fulfill embodiment goals. There is currently little literature describing FBC outcomes. METHODS A retrospective review of patients who were ≥18 years old with ≥1 postoperative appointment who underwent FBC from 1/2019-10/2024 by four surgeons was performed. Demographic data, medical history, perioperative details, and complications were reviewed. RESULTS A total of 168 primary procedures were completed. Most patients (n=161, 96.4%) used hormones for an average of 8.5 years. Average age was 37.1 years old and average BMI was 29.3 kg/m2. Average fat transferred was 2.2 L, most commonly from the abdomen (98.8%), back (94.6%), and medial thighs (59.5%). A third of patients (33.3%) attended at least one hyperbaric oxygen chamber therapy session with an average of 12.7 sessions. At average follow-up of 318.5 days, 19.6% of patients experienced any complication, 4.2% with contour deformity, 3.0% with fat necrosis, 2.4% with cellulitis, 2.4% having seroma, and 2.4% being readmitted. Revision rate for fat loss or deformity was 20.2%. Increased age was associated with fat necrosis (p=0.05) and increased HBOT sessions was associated with decreased odds of any complication (p=0.03). While BMI did not correlate with complication rates, increasing fat grafting volume trended toward statistical significance for association with any complication (p = 0.07). CONCLUSION FBC appears to be a safe and customizable procedure for transfeminine patients, with relatively low rates of major complications. Clinical counseling should emphasize potential need for revision due to fat loss or contour deformity.
BACKGROUND Obesity is associated with increased complications following reduction mammoplasty (RM). Preoperative weight loss is commonly recommended to reduce surgical risk, although it remains unclear whether obese patients who have recently lost weight experience outcomes comparable to their weight-stable obese counterparts. This study evaluated the impact of recent preoperative weight loss on postoperative outcomes following RM. METHODS Epic COSMOS was used to identify obese patients undergoing RM. Patients who lost ≥5% body weight within two years before surgery were compared with weight-stable controls. Postoperative complications were assessed. Propensity score matching and multivariable regression were used to adjust for covariates. RESULTS After matching, 7,874 patients were included in each cohort. Patients with substantial (>10% body weight) weight loss demonstrated highest risk of surgical site infection [SSI] (aOR 1.26; 95% CI 1.04 - 1.52) and more than double the risk of hospital readmission (aOR 2.09, 95% CI 1.31 - 3.25). Independent of weight loss, severe morbid obesity (BMI 40-50) was associated with increased risk of SSI (aOR 1.77, 95% CI 1.48 - 2.1), wound dehiscence (aOR 2.24, 95% CI 1.81 - 2.77), fat necrosis (aOR 1.51; 95% CI 1.11-2.01), and ED revisit (aOR 1.49, 95% CI 1.21 - 1.82). CONCLUSION In obese patients, preoperative weight loss exceeding 10% of body weight was associated with higher odds of SSI and hospital readmission following RM compared with weight-stable obese counterparts. Given the observational design and unmeasured factors including nutritional status and frailty, no broader inference regarding the effect of preoperative weight loss on surgical risk is drawn.
