Background: The rates and risk factors for wound complications following staged reconstruction after facial lentigo maligna (LM) resection have not been well described. Objectives: (1) To identify the rate and types of wound complications, including infection, graft necrosis, distal flap necrosis, hematoma, superficial epidermolysis, and seroma among patients undergoing staged reconstruction after resection of LM as documented in the surgeon's clinical notes within 30 days of the procedure. (2) To determine a threshold defect size that may predict the development of wound complications. Design and Outcomes: Retrospective review at an academic medical center of patients who underwent staged reconstruction after facial LM resection over a 5-year period. Results: Ninety-eight patients were identified with a mean age of 69.2 +/- 13.6 years; 37% of patients were female. The most common defect sites were the cheek (n = 41; 42%) and nose (n = 22; 22%). Twenty-five of 98 patients (26%) demonstrated complications, with the most common being wound infection (36%) and graft necrosis (24%). Those receiving perioperative antibiotics had lower rates of complication (odds ratio [OR]: 0.36; 95% confidence interval [CI]: 0.13,0.96; p = 0.041). Defects greater than 2.7 cm in maximal diameter had the highest sensitivity for predicting complications. Conclusions: Patients undergoing staged reconstruction after facial LM resection have a high rate of wound complication (26%) and defect size > 2.7 cm may be an important risk factor.

OBJECTIVE:Endoscopy is routinely used to diagnose obstructive airway diseases. Currently, endoscopy is only a visualization technique and does not allow quantification of airspace cross-sectional areas (CSAs). This pilot study tested the hypothesis that CSAs can be accurately estimated from depth maps created from virtual endoscopy videos. STUDY DESIGN:Cross-sectional. SETTING:Academic tertiary medical center. METHODS:Virtual endoscopy and depth map videos of the nasal cavity were digitally created based on anatomically accurate three-dimensional (3D) models built from computed tomography scans of 30 subjects. A software tool was developed to outline the airway perimeter and estimate the airspace CSA from the depth maps. Two otolaryngologists used the software tool to estimate the nasopharynx CSA and the nasal valve minimal CSA (mCSA) in the left and right nasal cavities. Model validation statistics were performed. RESULTS:Nasopharynx CSA had a median percent error of 3.7% to 4.6% when compared to the true values measured in the 3D models. Nasal valve mCSA had a median percent error of 22.7% to 33.6% relative to the true values. Raters successfully used the software tool to identify subjects with nasal valve stenosis (ie, mCSA < 0.20 cm2) with a sensitivity of 83.3%, specificity ≥ 90.7%, and classification accuracy ≥ 90.0%. Interrater and intrarater agreements were high. CONCLUSION:This study demonstrates that airway CSAs in 3D models can be accurately estimated from depth maps. The development of artificial intelligence algorithms to compute depth maps may soon allow the quantification of airspace CSAs from clinical endoscopies.

OBJECTIVE:Mucosal decongestion with nasal sprays is a common treatment for nasal airway obstruction. However, the impact of mucosal decongestion on nasal aerodynamics and the physiological mechanism of nasal airflow sensation are incompletely understood. The objective of this study is to compare nasal airflow patterns in nasal airway obstruction (NAO) patients with and without mucosal decongestion and nondecongested healthy subjects. STUDY DESIGN:Cross-sectional study of a convenience sample. SETTING:Academic tertiary medical center. METHODS:Forty-five subjects were studied (15 nondecongested healthy subjects, 15 nondecongested NAO patients, and 15 decongested NAO patients). Three-dimensional models of the nasal anatomy were created from computed tomography scans. Steady-state simulations of airflow and heat transfer were conducted at 15 L/min inhalation rate using computational fluid dynamics. RESULTS:In the narrow side of the nose, unilateral nasal resistance was similar in decongested NAO patients and nondecongested healthy subjects, but substantially higher in nondecongested NAO patients. The vertical airflow distribution within the nasal cavity (inferior vs middle vs superior) was also similar in decongested NAO patients and nondecongested healthy subjects, but nondecongested NAO patients had substantially less middle airflow. Mucosal cooling, quantified by the surface area where heat flux exceeds 50 W/m2, was significantly higher in decongested NAO patients than in nondecongested NAO patients. CONCLUSION:This pilot study suggests that mucosal decongestion improves objective measures of nasal airflow, which is consistent with improved subjective sensation of nasal patency after decongestion.

Nasal airway obstruction (NAO) is a condition where nasal passages are blocked, preventing normal airflow through the nose. NAO is one of the most common conditions treated by otolaryngologists using surgical procedures. However, surgical procedures have a high failure rate and surgery planning has the potential to improve surgical outcomes. However, current surgical planning systems are challenging to use, are not interactive, and don't consider physiological parameters. This paper reports the development of nSurgSim, an integrated virtual surgical planning application that incorporates model generation, computational fluid dynamics feedback, and patient-outcome analysis. We conducted a usability study with twenty-one board-certified ENT surgeons to evaluate the ease of use, perceived usefulness, and potential for clinical adoption. Overall, the study result shows nSurgSim will be a valuable tool in the ENT surgeon's arsenal for complex cases and a powerful tool for a general understanding of procedures and improvement in procedure outcomes.

Abstract Introduction Structural interventions for obstructive sleep apnea (OSA) have unpredictable success rates. Anatomically accurate computer simulations of airflow and soft tissue dynamics may be used in future virtual intervention planning tools to identify the optimal patient interventions. The objective of this study is to review the existing literature on the correlation between computer-derived biomechanical variables and clinical measures of OSA severity. Methods Scientific papers written in English that correlated the apnea-hypopnea index (AHI) with computer-derived biomechanical variables were identified by searching on the PubMed and SCOPUS databases the search phrase “sleep apnea” AND “computational fluid dynamics” OR "finite element” OR “fluid structure interaction”. Results A total of 19 articles were identified that reported correlations between computer-derived biomechanical variables and AHI, which was the metric of OSA severity reported in most studies. These studies demonstrated that several anatomic and physiologic variables correlate with OSA severity, including airspace cross-sectional areas, airspace volumes, and airflow resistance. No studies were found that correlated computer-derived dynamic measures of upper airway mechanical stability, such as tissue compliance, to OSA severity. Conclusion Computer-derived anatomic and physiologic variables may serve as useful predictors of surgical outcome or mandibular device treatment response in OSA patients. Further research is needed to test the hypothesis that virtual surgery planning based on computer-derived measures of upper airway stability can improve outcomes of OSA interventions. Support (If Any) This project was funded in part by the Advancing a Healthier Wisconsin Endowment.

Upper airway (UA) collapsibility is one of the key factors that determine the severity of obstructive sleep apnea (OSA). Interventions for OSA are aimed at reducing UA collapsibility, but selecting the optimal alternative intervention for patients who fail CPAP is challenging because currently no validated method predicts how anatomical changes affect UA collapsibility. The gold standard objective measure of UA collapsibility is the pharyngeal critical pressure (Pcrit). A systematic literature review and meta-analysis were performed to identify the anatomical factors with the strongest correlation with Pcrit. A search using the PRISMA methodology was performed on PubMed for English language scientific papers that correlated Pcrit to anatomic variables and OSA severity as measured by the apnea-hypopnea index (AHI). A total of 29 papers that matched eligibility criteria were included in the quantitative synthesis. The meta-analysis suggested that AHI has only a moderate correlation with Pcrit (estimated Pearson correlation coefficient r = 0.46). The meta-analysis identified four key anatomical variables associated with UA collapsibility, namely hyoid position (r = 0.53), tongue volume (r = 0.51), pharyngeal length (r = 0.50), and waist circumference (r = 0.49). In the future, biomechanical models that quantify the relative importance of these anatomical factors in determining UA collapsibility may help identify the optimal intervention for each patient. Many anatomical and structural factors such as airspace cross-sectional areas, epiglottic collapse, and palatal prolapse have inadequate data and require further research.

Surgery for nasal airway obstruction (NAO) has a high failure rate, with up to 50% of patients reporting persistent symptoms postoperatively. Virtual surgery planning has the potential to improve surgical outcomes, but current manual methods are too labor-intensive to be adopted on a large scale. This manuscript introduces an automatic atlas-based approach for performing virtual septoplasties. A cohort of 47 healthy subjects and 26 NAO patients was investigated. An atlas of healthy nasal geometry was constructed. The automatic virtual septoplasty method consists of a multi-stage registration approach to fit the atlas to a target NAO patient, automatically segment the patient’s septum and airway, and deform the patient image to have a non-deviated septum. Our automatic virtual septoplasty method straightened the septum successfully in 18 out of 26 NAO patients (69% of cases). In these cases, the ratio of the higher to the lower airspace cross-sectional areas in the left and right nasal cavities improved from 1.47 ± 0.45 to 1.16 ± 0.33 in the region surrounding the septal deviation, showing that the nasal airway became more symmetric after virtual septoplasty. This automated virtual septoplasty technique has the potential to greatly reduce the effort required to perform computational fluid dynamics (CFD) analysis of nasal airflow for NAO surgical planning. Future studies are needed to investigate if virtual surgery planning using this method is predictive of subjective symptoms in NAO patients after septoplasty.

BACKGROUND:The higher incidence of obstructive sleep apnea (OSA) in men than in women has been attributed to the upper airway being longer in men. The Starling resistor is the paradigm biomechanical model of upper airway collapse in OSA where a collapsible tube (representing the pharynx) is located between two rigid tubes (representing the nasal cavity and trachea). While the Starling resistor has been extensively studied due to its relevance to many physiological phenomena, the effect of tube length on tube collapsibility has not been quantified yet. METHODS:Finite element analysis of a 3-dimensional collapsible tube subjected to a transmural pressure was performed in ANSYS Workbench. The numerical methods were validated with in vitro experiments in a silicone tube whose modulus of elasticity (361 ± 28 kPa) and dimensions (length = 100 mm, diameter = 22.2 mm, and wall thickness = 1.59 mm) were selected so that tube compliance was similar to pharyngeal compliance in humans during sleep. The buckling pressure (transmural pressure at which the tube collapses) was quantified in tubes of three different diameters (10 mm, 16 mm, and 22.2 mm) and ten length-to-diameter ratios (L/D = 4 to 13), while keeping the wall-thickness-to-radius ratio constant at 0.143. RESULTS:The absolute value of the buckling pressure decreased from 4.7 to 3.3 cmH2O (461-324 Pa) when L/D increased from 4 to 13. The buckling pressure was nearly independent from tube length for L/D >10. CONCLUSIONS:Our finding that longer tubes are more collapsible than shorter tubes is consistent with the higher incidence of obstructive sleep apnea in males than females.

Background: Predicting symptomatic relief after septoplasty has been difficult. Minimal cross-sectional area (mCSA) measured by acoustic rhinometry and airflow resistance (R) measured by rhinomanometry have been used to select surgical candidates with mixed success. An important assumption is that mCSA and resistance are tightly coupled, but studies have reported weak or no correlation. Recently, we proposed the Bernoulli Obstruction Theory as an explanation, where tight coupling between mCSA and R is only predicted below a critical mCSA (A(crit)). Methods: The nasal airway and septum of 10 healthy subjects were reconstructed from computed tomography scans. Simulated anterior septal deviations of increasing severity were created. Computational fluid dynamics simulations were performed to quantify mCSA, resistance, and flow in the healthy septum model and four simulated septal deviation models for each subject (total of 50 models). Results: A tighter coupling between mCSA and resistance was found below A(crit), estimated to be 0.20 cm(2) (a very severe deviation). Above A(crit), enlarging the mCSA had a smaller effect in patients with narrower cross-sectional area in the postvalve region (CSA(PV)). Conclusions: Two patterns of flow increase are expected with septoplasty. Below A(crit), enlarging mCSA predictably increases flow. Above A(crit), the effect size of increasing mCSA depends on CSA(PV). Unrecognized small CSA(PV) may explain persistent sensation of nasal obstruction after septoplasty. Our data suggest that inferior turbinate reduction ipsilateral to a septal deviation may amplify airflow benefits after septoplasty in patients with a narrow CSA(PV).

Facial Plastic Surgery & Aesthetic MedicineVol. 22, No. 1 EditorialFree AccessIntroducing Facial Plastic Surgery & Aesthetic Medicine: The Best of Both WorldsJohn S. Rhee Editor-in-ChiefJohn S. Rhee Editor-in-ChiefJohn S. Rhee, MD, MPH, John C. Koss Professor and Chairman, Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226Search for more papers by this authorPublished Online:10 Feb 2020https://doi.org/10.1089/fpsam.2019.29004.rheAboutSectionsView articleView PDFView PDF Plus ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View articleJohn S. Rhee, MD, MPHIt is a distinct honor and privilege to announce two exciting changes to our journal. First, we have a new title: Facial Plastic Surgery & Aesthetic Medicine. This inclusive and contemporary new journal name is intentional in uniting the traditional strengths of the discipline of facial plastic surgery (e.g., rhinoplasty, facial reanimation surgery, reconstruction, and surgical rejuvenation) and the burgeoning field of aesthetics (e.g., injectables, topicals, and concepts of beauty and well-being). Our beautiful front cover with the artistic connectedness between the letters “F&A” showcases the thematic dualities of the specialty—surgery and medicine, reconstructive and cosmetic, form and function. Second, the journal is now being published by Mary Ann Liebert, Inc., on behalf of The American Academy of Facial Plastic & Reconstructive Surgery (AAFPRS). I would like to thank both organizations for forging this relationship that will allow us to showcase the science and the art of our discipline in a new and exciting way.This revitalized journal rises from a proud and pedigreed background: a 21-year history of a wonderful relationship between the AAFPRS and the JAMA Network. In Dr. Wayne Larrabee's outgoing editorial in 2014,1 as he passed the torch to me as the succeeding editor, he quoted the phrase, “The path is made by walking.” Indeed, we have walked a long way, and in doing so have created a golden path of success, cherished memories, and academic enrichment. During my time as editor of JAMA Facial Plastic Surgery, these past 5 years have been filled with so much change—not only in the journal itself, but in the overall world of publishing and our discipline. Over this period, the journal enjoyed close to 50% growth in the number of overall submissions (especially large increases in international and interdisciplinary specialties) and an impact factor that grew from 1.41 to 3.06—a proud accomplishment that will carry forward to this newly titled journal. Beyond the increased quality of the science, other metrics of influence such as article downloads and Altmetric scores (which gauge public and social media interest) continued to reach new heights year after year. We shall be forever grateful to the entire editorial and publishing team at the JAMA Network for the wonderful partnership over the past two decades.However, change is rapid and constant, with strategic imperatives shifting due to external stakeholders and factors. This fresh start allows us to pivot more boldly with a new publishing partner. Mary Ann Liebert, Inc., is a nimble publisher and able to shape and present content that better reflects the discipline and the audience of our field. We are positioned to build to new heights as we have gained wisdom, friends, and influence on our journey in the medical publishing sector. Over the ensuing issues, I will be introducing some of the new article types and initiatives in the coming months and early years. Some of these forthcoming initiatives include roundtable discussions with thought leaders on hot topics, theme-based special issues, and industry partnerships to showcase the newest technologies and products. The journal will also launch a separate companion title in the coming months that will be solely dedicated to video and surgical techniques.This first issue under the new title showcases a blockbuster article from my dear friend and one of the world's leading rhinoplasty surgeons, Dean Toriumi, MD. This nasal tip contouring paper2 is truly a state-of-the-art treatise and exemplifies our deepest and strongest roots in the realm of rhinoplasty. Also in this inaugural issue is an artistic piece from my other dear friend and Editor Emeritus, Wayne F. Larrabee, Jr., MD.3 Having both special people contribute to this inaugural issue means so much to me personally and is symbolic of our ability to unite the realms of surgical technical brilliance with the appreciation for beauty and artistry. Finally, I would like to dedicate this first issue to my late mother who passed away from her battle with pancreatic cancer during this journal transition period. My mother was a strong woman with a sense of purpose and unwavering mission—the same qualities that embody the essence of the leader of our new publisher, Mary Ann Liebert herself. She is a remarkable woman, and it is only befitting that our journal has found its new home with her company and the wonderful team she has assembled. I am so grateful and excited about this partnership and the places we will go together!References1. Larrabee WF. The path is made by walking. JAMA Facial Plast Surg. 2014;16(6):393–394. DOI: 10.1001/jamafacial.2014.1287. Link, Google Scholar2. Toriumi DM. Nasal tip contouring: anatomic basis for management. Facial Plast Surg Aesthet Med. 2020;22(1);10–24. Link, Google Scholar3. Faigin G, Larrabee WFJr. The Art of the Smile. Facial Plast Surg Aesthet Med. 2020;22(1);3–5. Link, Google ScholarJohn S. Rhee, MD, MPH, John C. Koss Professor and Chairman, Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226FiguresReferencesRelatedDetails Volume 22Issue 1Feb 2020 InformationCopyright 2020, American Academy of Facial Plastic and Reconstructive Surgery, Inc.To cite this article:John S. Rhee Editor-in-Chief.Facial Plastic Surgery & Aesthetic Medicine.Feb 2020.1-2.http://doi.org/10.1089/fpsam.2019.29004.rhePublished in Volume: 22 Issue 1: February 10, 2020

Facial Plastic Surgery & Aesthetic MedicineVol. 22, No. 5 EditorialsThe Essential Role of the Editor: Seeking, Admiring, and Showcasing GreatnessJohn S. RheeJohn S. RheeJohn S. Rhee, MD, MPH, John C. Koss Professor and Chairman, Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA Department of Otolaryngology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.Search for more papers by this authorPublished Online:2 Oct 2020https://doi.org/10.1089/fpsam.2020.0420AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"The Essential Role of the Editor: Seeking, Admiring, and Showcasing Greatness." Facial Plastic Surgery & Aesthetic Medicine, 22(5), pp. 315–316FiguresReferencesRelatedDetails Volume 22Issue 5Oct 2020 InformationCopyright 2020, American Academy of Facial Plastic and Reconstructive Surgery, Inc.To cite this article:John S. Rhee.The Essential Role of the Editor: Seeking, Admiring, and Showcasing Greatness.Facial Plastic Surgery & Aesthetic Medicine.Oct 2020.315-316.http://doi.org/10.1089/fpsam.2020.0420Published in Volume: 22 Issue 5: October 2, 2020PDF download

Facial Plastic Surgery & Aesthetic MedicineVol. 22, No. 4 Book ReviewStructure Rhinoplasty: Lessons Learned in 30 Years—A Book ReviewJohn S. RheeJohn S. Rhee*Address correspondence to: John S. Rhee, MD, MPH, Department of Otolaryngology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226-0509, USA, E-mail Address: jrhee@mcw.eduSearch for more papers by this authorPublished Online:2 Jul 2020https://doi.org/10.1089/fpsam.2020.0166AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Structure Rhinoplasty: Lessons Learned in 30 Years—A Book Review." Facial Plastic Surgery & Aesthetic Medicine, 22(4), p. 312FiguresReferencesRelatedDetails Volume 22Issue 4Aug 2020 InformationCopyright 2020, American Academy of Facial Plastic and Reconstructive Surgery, Inc.To cite this article:John S. Rhee.Structure Rhinoplasty: Lessons Learned in 30 Years—A Book Review.Facial Plastic Surgery & Aesthetic Medicine.Aug 2020.312-312.http://doi.org/10.1089/fpsam.2020.0166Published in Volume: 22 Issue 4: July 2, 2020PDF download

A deviated nasal septum is the most common etiology for nasal airway obstruction (NAO), and septoplasty is the most common surgical procedure performed by ear–nose–throat surgeons in adults. However, quantitative criteria are rarely adopted to select patients for surgery, which may explain why up to 50% of patients report persistent or recurrent symptoms of nasal obstruction postoperatively. This study reports a systematic virtual surgery method to identify patients who may benefit from septoplasty. One patient with symptoms of NAO due to a septal deviation was selected to illustrate the virtual surgery concept. Virtual septoplasty was implemented in three steps: (1) determining if septal geometry is abnormal preoperatively, (2) virtually correcting the deviation while preserving the anatomical shape of the septum, and (3) estimating the post-surgical improvement in airflow using computational fluid dynamics. Anatomical and functional changes predicted by the virtual surgery method were compared to a standard septoplasty performed independently from the computational analysis. A benchmark healthy nasal septum geometry was obtained by averaging the septum dimensions of 47 healthy individuals. A comparison of the nasal septum geometry in the NAO patient with the benchmark geometry identified the precise locations where septal deviation and thickness exceeded the healthy range. Good agreement was found between the virtual surgery predictions and the actual surgical outcomes for both airspace minimal cross-sectional area (0.05 cm2 pre-surgery, 0.54 cm2 virtual surgery, 0.50 cm2 actual surgery) and nasal resistance (0.91 Pa.s/ml pre-surgery, 0.08 Pa.s/ml virtual surgery, 0.08 Pa.s/ml actual surgery). Previous virtual surgery methods for NAO were based on manual edits and subjective criteria. The virtual septoplasty method proposed in this study is objective and has the potential to be fully automated. Future implementation of this method in virtual surgery planning software has the potential to improve septoplasty outcomes.

This article seeks to inform facial plastic surgeons about the evolving issues that affect contemporary medical literature and the publishing landscape. We hope to shed light on the key metrics that influence a journal’s decision to accept a particular submission and how these metrics are predicated on a rapidly changing landscape within the academic and public community. The key metrics are: citations, number of views, and social media or public attention. These metrics produce what we call “high impact” articles. This article introduces bibliometric terms and further defines the metrics that are most important to a journal.

Facial Plastic Surgery & Aesthetic MedicineVol. 22, No. 1 InterviewEvolution of a Rhinoplasty Master: An Interview with Dean Toriumi, MDInterview by John S. Rhee Editor-in-ChiefInterview by John S. Rhee Editor-in-ChiefSearch for more papers by this authorPublished Online:10 Feb 2020https://doi.org/10.1089/fpsam.2019.29009.intAboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View articleFiguresReferencesRelatedDetailsCited byThe Effect of Acceptance of Cosmetic Surgery, Body Appreciation, and Nasal Obstruction on Patient Satisfaction After Rhinoplasty Serhat İnan and Fatih Yığman28 September 2022 | Facial Plastic Surgery & Aesthetic Medicine, Vol. 0, No. 0 Volume 22Issue 1Feb 2020 InformationCopyright 2020, American Academy of Facial Plastic and Reconstructive Surgery, Inc.To cite this article:Interview by John S. Rhee Editor-in-Chief.Evolution of a Rhinoplasty Master: An Interview with Dean Toriumi, MD.Facial Plastic Surgery & Aesthetic Medicine.Feb 2020.6-9.http://doi.org/10.1089/fpsam.2019.29009.intPublished in Volume: 22 Issue 1: February 10, 2020PDF download

Purpose Virtual surgery planning based on computational fluid dynamics (CFD) simulations of nasal airflow has the potential to improve surgical outcomes for patients with nasal airway obstruction (NAO). Virtual surgery planning requires normative ranges of airflow variables, but few studies to date have quantified inter-individual variability of nasal airflow among healthy subjects. This study reports CFD simulations of nasal airflow in 47 healthy adults. Methods Anatomically accurate three-dimensional nasal models were reconstructed from cone beam computed tomography scans and used for steady-state inspiratory airflow simulations with a bilateral flowrate of 250 ml/s. Normal subjective sensation of nasal patency was confirmed using the nasal obstruction symptom evaluation and visual analog scale. Healthy ranges for several CFD variables known to correlate with subjective nasal patency were computed, including unilateral airflow, nasal resistance, airspace minimal cross-sectional area (mCSA), heat flux (HF), and surface area stimulated by mucosal cooling (defined as the area where HF > 50 W/m(2)). The normative ranges were targeted to contain 95% of the healthy population and computed using a nonparametric method based on order statistics. Results A wide range of inter-individual variability in nasal airflow was observed among healthy subjects. Unilateral airflow varied from 60 to 191 ml/s, airflow partitioning ranged from 23.8 to 76.2%, and unilateral mCSA varied from 0.24 to 1.21 cm(2). These ranges are in good agreement with rhinomanometry and acoustic rhinometry data from the literature. A key innovation of this study are the normative ranges of flow variables associated with mucosal cooling, which recent research suggests is the primary physiological mechanism of nasal airflow sensation. Unilateral HF ranged from 94 to 281 W/m(2), while the surface area stimulated by cooling ranged from 27.4 to 64.3 cm(2). Conclusions These normative ranges may serve as targets in future virtual surgery planning for patients with NAO.

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

ObjectivesAdenotonsillectomy (AT) is commonly used to treat upper airway obstruction in children, but selection of patients who will benefit most from AT is challenging. The need for diagnostic evaluation tools without sedation, radiation, or high costs has motivated the development of long‐range optical coherence tomography (LR‐OCT), providing real‐time cross‐sectional airway imaging during endoscopy. Since the endoscope channel location is not tracked in conventional LR‐OCT, airway curvature must be estimated and may affect predicted airway resistance. The study objective was to assess effects of three realistic airway curvatures on predicted airway resistance using computational fluid dynamics (CFD) in LR‐OCT reconstructions of the upper airways of pediatric patients, before and after AT.MethodsEight subjects (five males, three females, aged 4–9 years) were imaged using LR‐OCT before and after AT during sedated endoscopy. Three‐dimensional (3D) airway reconstructions included three airway curvatures. Steady‐state, inspiratory airflow simulations were conducted under laminar conditions, along with turbulent simulations for one subject using the k‐ω turbulence model. Airway resistance (pressure drop/flow) was compared using two‐tailed Wilcoxon signed rank tests.ResultsRegardless of the airway curvatures, CFD findings corroborate a surgical end‐goal with computed post‐operative airway resistance significantly less than pre‐operative (P < 0.01). The individual resistances did not vary significantly for different airway curvatures (P > 0.25). Resistances computed using turbulent simulations differed from laminar results by less than ∼5%.ConclusionsThe results suggest that reconstruction of the upper airways from LR‐OCT imaging data may not need to account for airway curvature to be predictive of surgical effects on airway resistance. Lasers Surg. Med. 51:150–160, 2019. © 2018 Wiley Periodicals, Inc.

JAMA Facial Plastic SurgeryVol. 20, No. 3 EditorialJAMA Facial Plastic Surgery—The Year in Review, 2017John S. RheeJohn S. RheeCorresponding Author: John S. Rhee, MD, MPH, Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226 E-mail Address: jrhee@mcw.eduEditor, JAMA Facial Plastic SurgeryDepartment of Otolaryngology and Communication Sciences, Medical College of Wisconsin, MilwaukeeSearch for more papers by this authorPublished Online:17 May 2018https://doi.org/10.1001/jamafacial.2017.2264AboutSectionsView 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, 2017." JAMA Facial Plastic Surgery, 20(3), p. 187FiguresReferencesRelatedDetails Volume 20Issue 3May 2018 InformationCopyright 2018 American Medical Association. All Rights Reserved.To cite this article:John S. Rhee.JAMA Facial Plastic Surgery—The Year in Review, 2017.JAMA Facial Plastic Surgery.May 2018.187-187.http://doi.org/10.1001/jamafacial.2017.2264Published in Volume: 20 Issue 3: May 17, 2018PDF download