Complete release of the retaining ligaments during deep plane face and neck lift is essential for durable rejuvenation. This step demands particular caution to avoid nerve injury, however, as branches of the facial nerve course in close proximity to the retaining ligaments. During ligament release, surgeons currently rely on uncodified visual and tactile clues or separate neuromonitoring equipment which introduces an instrument change between identification and division. We describe a three-sign sequential identification framework in which the LigaSure vessel sealing system (Medtronic, Minneapolis, MN) serves as both the diagnostic probe and the division instrument, eliminating the need for an instrument change during ligament release in deep plane facelift. First, the Visual Assessment Test evaluates fiber direction and tissue character. Second, the LigaSure Tweak Test distinguishes excitable nerve from nonresponsive ligamentous tissue. Third, the Skin Tethering Test applies gentle traction to confirm a ligament's dermal insertion through visible skin dimpling. A structure is divided only when all three signs align with a ligamentous identity. This framework synthesizes individually described anatomic identification clues into a structured, reproducible, and teachable approach for what is described as the most challenging step of deep plane facelift.

Nonsurgical facial esthetic procedures have revolutionized cosmetic enhancement, offering minimally invasive options for facial rejuvenation. This comprehensive overview covers a wide range of techniques, including wrinkle relaxation with botulinum toxin, skin volumization using dermal fillers and biostimulators, hair restoration, and various skin tightening and texture improvement methods. The article details the mechanisms, applications, and potential risks of each procedure, highlighting recent advancements and trends in the field. It classifies these treatments into clinically-oriented categories based on patients' desired changes.

Background Neck dissections (ND) are a routine procedure in head and neck oncology. Given the postoperative functional impact that some patients experience, it is imperative to identify and track quality of life (QoL) symptomatology to tailor each patient’s therapeutic needs. To date, there is no validated French-Canadian questionnaire for this patient-population. We therefore sought to translate and validate the Neck Dissection Impairment Index (NDII) in Canadian French. Methods A 3-phased approach was used. Phase 1: The NDII was translated from English to Canadian French using a “forward and backward” translational technique following international guidelines. Phase 2: A cognitive debriefing session was held with 10 Canadian French-speaking otolaryngology patients to evaluate understandability and acceptability. Phase 3: The final version was administered prospectively to 30 patients with prior history of ND and 30 control patients. These patients were asked to complete the questionnaire 2 weeks after their first response. Test-retest reliability was calculated with Spearman’s correlation. Internal consistency was elicited using Cronbach’s alpha. Results NDII was successfully translated and validated to Canadian French. Cronbach’s alpha revealed high internal consistency (0.92, lower 95% confidence limit 0.89). The correlation for test-retest validity were strong or very strong (0.61-0.91). Conclusion NDII is an internationally recognized QoL tool for the identification of ND-related impairments. This validated Canadian French version will allow clinicians to adequately assess the surgery-related QoL effect of neck surgery in the French-speaking population, while allowing French institutions to conduct and/or participate in multisite clinical trials requiring the NDII as an outcome measure.

The dorsal hump is the most common complaint in patients presenting for cosmetic rhinoplasty. Component hump reduction is the technique where a dorsal hump is removed in an incremental top-down fashion. In this chapter you will find the indications, precise technique, and an illustrated case example of incremental hump reduction, with particular attention to midvault reconstruction to preserve the nasal valve area.

We present the first-ever description of a myoepithelial carcinoma arising in the temporal muscle. A 54-year-old fireman presented with a 3-month history of a lump in the right temporal region. Imaging reported a 3 cm lesion in the temporal muscle, eroding the cranial vault. The patient underwent en bloc resection of the lesion, along with overlying skin, dura mater resection, and craniectomy. Duraplasty, cranium reconstruction with mesh, and an anterolateral thigh fasciocutaneous free flap were performed for reconstruction. Adjuvant radiation therapy was administered. An anatomopathological analysis reported a myoepithelial carcinoma of the temporal muscle with dura mater invasion.

Nasal airway obstruction is a very common phenomenon that can significantly decrease patients' quality of life. This review article summarizes in an evidence-based fashion the diagnosis and treatment of nasal airway obstruction. The nasal airway may be obstructed at the level of the nasal valve, septum, nasal turbinates, sinonasal mucosa, or nasopharynx. Nasal valve obstruction and septal deviations are usually treated surgically depending on the level of valve obstruction. Isolated turbinate hypertrophy is usually managed medically as part of the treatment of rhinitis, with surgery reserved for cases refractory to medical care. Sinonasal and nasopharyngeal conditions are treated according to the diagnosis.

Dorsal preservation techniques as a means of addressing the dorsal hump have been popularized recently to avoid midvault disruption or dorsal resection. The pitfall of these techniques is the higher rate of dorsal hump recurrence of up to 15%. We present the use of the upper lateral cartilages (ULCs) as a turn-in flap and as a cutting guide during classic dorsal hump takedown. The cutting guide provides the perfect dorsal angulation and dictates the amount of resection needed. This translates to aesthetically pleasing dorsal lines, avoidance of dorsal irregularities, and decreased risk of hump recurrence.

Facial Plastic Surgery & Aesthetic MedicineVol. 24, No. 1 Research LettersFrench Canadian Translation, Cultural Adaptation, and Validation of Facial Clinimetric Evaluation Scale and Facial Disability Index Questionnaires for Patients with Peripheral Facial ParalysisLaurence Gascon, Sarah Martineau, Mikhail Saltychev, Akram Rahal, and Sami-Pierre MoubayedLaurence GasconDivision of Otolaryngology—Head and Neck Surgery, Hôpital du Sacré-Coeur de Montréal, Montréal, Canada.Search for more papers by this author, Sarah MartineauÉcole d'orthophonie et d'audiologie, Université de Montréal, Montréal, Canada.Search for more papers by this author, Mikhail SaltychevDepartment of Physical and Rehabilitation Medicine, Turku University Hospital and University of Turku, Turku, Finland.Search for more papers by this author, Akram RahalDivision of Otolaryngology—Head and Neck Surgery, Hôpital Maisonneuve-Rosemont, Montréal, Canada.Search for more papers by this author, and Sami-Pierre Moubayed*Address correspondence to: Sami-Pierre Moubayed, MD, FRCSC, Division of Otolaryngology—Head and Neck Surgery, Hôpital du Sacré-Coeur de Montréal, 5400 Boulevard Gouin West, Montreal, Quebec H4J 1C5, Canada, E-mail Address: sp.moubayed@gmail.comDivision of Otolaryngology—Head and Neck Surgery, Hôpital du Sacré-Coeur de Montréal, Montréal, Canada.Search for more papers by this authorPublished Online:3 Jan 2022https://doi.org/10.1089/fpsam.2020.0608AboutSectionsView articleView Full TextSupplemental MaterialPDF/EPUBView Supplemental Data Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View articleFiguresReferencesRelatedDetailsCited byPublic and patients' perceptions of facial reanimation using lengthening temporalis myoplastyJournal of Plastic, Reconstructive & Aesthetic Surgery, Vol. 75, No. 10The "Mirror Effect Plus Protocol" for acute Bell's palsy: A randomized controlled trial with 1-year follow-up19 June 2022 | Clinical Rehabilitation, Vol. 36, No. 10 Volume 24Issue 1Feb 2022 InformationCopyright 2022, American Academy of Facial Plastic and Reconstructive Surgery, Inc.To cite this article:Laurence Gascon, Sarah Martineau, Mikhail Saltychev, Akram Rahal, and Sami-Pierre Moubayed.French Canadian Translation, Cultural Adaptation, and Validation of Facial Clinimetric Evaluation Scale and Facial Disability Index Questionnaires for Patients with Peripheral Facial Paralysis.Facial Plastic Surgery & Aesthetic Medicine.Feb 2022.63-65.http://doi.org/10.1089/fpsam.2020.0608Published in Volume: 24 Issue 1: January 3, 2022Online Ahead of Print:April 13, 2021PDF download

Background: Muscular exercises of the lateral nasal wall have been described as a potential treatment of nasal valve obstruction. The objective of this study was to compare whether nasal exercises improve nasal obstruction, using a randomized controlled model.Methods: Participants were randomized into groups performing exercises targeting nasal (group A) or facial (group B) muscles. Nasal obstruction was measured using a validated standardized patient-reported outcome measure (PROM) questionnaire (Standardized Cosmesis and Health Nasal Outcomes Survey [SCHNOS]) at enrolment and at the end of the 8 weeks program.Results: Fifty-six patients completed the study. Upon completion of the programs, a three-point SCHNOC-C score improvement (95% [confidence interval, CI] = [-9 to 2]) was seen in Group A, whereas an eight-point score improvement (95% [CI] = [-15 to -0.4]) was observed in Group B. A seven-point SCHNOS-O score difference (95% [CI] = [-13 to -1]) was observed in Group A, whereas a difference of 15 points was seen in Group B (95% [CI] = [-22 to -8]). No significant difference was found between group A and B (p = 0.373 and p = 0.065, respectively).Conclusion: This randomized controlled trial suggested that nasal muscle exercises show no improvement on nasal obstruction.

BACKGROUND:Devascularization of the parathyroid glands is generally accepted as the most common mechanism for iatrogenic hypocalcemia, a frequently seen complication of both total and completion thyroidectomy procedures. Much has been written about iatrogenic hypoparathyroidism, but few papers have precisely delineated the arterial supply of the parathyroid glands and the common anatomical variations that may impact parathyroid preservation during thyroid surgery.METHODS:We offer an illustrated review and discussion of the only two anatomic studies published in the medical literature focusing on parathyroid vasculature. In addition, we examine current techniques of parathyroid identification, preservation, and classification.FINDINGS:A surgical technique that preserves the parathyroid arteries is vital to preserving the viability of the parathyroid gland(s) during thyroid surgery. In 1907, Halsted and Evans described a technique of ligating the distal branches of the thyroid arteries beyond the origin of the parathyroid arteries, a technique termed ultra-ligation. In 1982, Flament et al.. reported three distinct anatomical variations of the parathyroid arteries which place the parathyroid blood supply at risk for devascularization during thyroid surgery. Our review also highlights novel techniques that aid surgeons in identification and assessment of the parathyroid glands.CONCLUSIONS:Recognition of the variations of parathyroid anatomy and their potential to lead to devascularization aids thyroid surgeons in their pursuit of parathyroid preservation. An awareness of the variety of novel parathyroid identification and preservation techniques can assist surgeons to achieve this goal.

Objective To study the effects of the “Mirror Effect Plus Protocol” (MEPP) on global facial function in acute and severe Bell's Palsy. Design Single blind and randomized controlled trial to compare the effects of basic counseling (control group) versus MEPP (experimental group) over one year. Setting Outpatient clinic following referrals from Emergency or Otorhinolaryngology Departments. Subjects 40 patients (n = 20 per group) with moderately severe to total palsy who received standard medication were recruited within 14 days of onset. Baseline characteristics were comparable between the groups. Interventions The experimental group received the MEPP program (motor imagery + manipulations + facial mirror therapy) while the control group received basic counseling. Both groups met the clinician monthly until 6 months and at one-year post-onset for assessments. Outcome measures Facial symmetry, synkinesis, and quality of life were measured using standardized scales. Perceived speech intelligibility was rated before and after therapy by naïve judges. Results Descriptive statistics demonstrated improvements in favor of the MEPP for each measured variable. Significant differences were found for one facial symmetry score (House-Brackmann 2.0 mean (SD) = 7.40 (3.15) for controls versus 5.1 (1.44) for MEPP), for synkinesis measures (p = 0.008) and for quality-of-life ratings (mean (SD) score = 83.17% (17.383) for controls versus 98.36% (3.608) for MEPP (p = 0.002)). No group difference was found for perceived speech intelligibility. Conclusion The MEPP demonstrates promising long-term results when started during the acute phase of moderately severe to total Bell's Palsy.

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Objectives Many experts feel that in the absence of well-defined goals for success, they have an easier time identifying failure. As success ought to not be defined only by absence of failure, we aimed to define optimal outcomes for endoscopic sinus surgery (ESS) in chronic rhinosinusitis (CRS) by obtaining expert surgeon perspectives. Methods A total of 12 surgeons participated in this targeted consultation. Face to face semi-structured interviews were performed with expert surgeons in the field of CRS and ESS. General impressions and personal definitions of acceptable operative success and optimal operative outcomes were compiled and summarized. Results According to an expert survey, patients’ main objectives are an improvement in their chief complain, a general improvement in quality of life (QoL), and a better overall symptomatic control. The most important aspects of endoscopy for defining a successful intervention were an adequate mucus circulation, a healthy mucosa, minimal edema, and patency of all explored cavities or ostia. In the assessment of surgical outcomes, it was determined that both objective and patient reported data must be carefully examined, with more attention given to subjective outcomes. Conclusions According to data gathered from a Canadian expert consultation, a definition of success must be based on both subjective data and nasal endoscopy. We propose to define an acceptable outcome as either a subjective improvement of at least the minimal clinically improvement difference of a validated patient reported outcome questionnaire, along with a satisfactory endoscopic result (1) or a complete subjective resolution with a sub-optimal endoscopy (2). Graphical abstract

Through shared decision-making, physicians and patients can elect endoscopic sinus surgery (ESS) when maximal medical therapy fails in patients with chronic rhinosinusitis (CRS). In this study, we aim to explore the most important themes with regards to patients’ perspectives on ESS. Our objective was to define the patient experience and ensure that we have congruent physician and patient goals for obtaining success. Semi-structured face-to-face interviews were conducted with 22 patients at a tertiary-care institution in Montreal. Three themes were established a priori: living with CRS, objectives and expectations and criteria for success. This thematic approach allowed the identification, analysis and reporting of patterns found across the data set. A phenomenological methodological orientation was used. Interviews were audio-recorded and transcribed verbatim for continuous analysis. These were coded by hand by a single coder who read the transcripts multiple times and relistened to the recordings. Exploration of themes on patients’ perspectives on ESS for CRS yielded multiple anecdotal findings, and some recurring patterns. There is a tendency for patients to focus on one principal symptom that drives their decrease in QoL. Headaches and nasal congestion seemed to impact patients’ QoL the most amongst rhinologic symptoms. Hyposmia was rarely spontaneously by patients but was often a significant source of distress when prompted during interviews. Objectives and expectations seemed to be inversely proportional to number of previous surgeries and severity of symptoms preoperatively. There was a clear association between preoperative expectations and postoperative satisfaction. There was no clear pattern in the improvement magnitude or time improved postoperatively for patients to consider the surgery a success. Patients’ level of satisfaction postoperatively and with their care in general is multifactorial. We believe the topic of goals and expectations regarding ESS should be discussed preoperatively for every patient with CRS. This includes patients with seemingly minor disease and patients naive to surgery, as can sometimes have exceedingly high expectations. Preoperative counselling must also include an assessment of what symptom is the most cumbersome to that particular patient, as patients tend to focus a lot on one or two symptoms. Postoperatively, we encourage clinicians to be attentive to the change in each patient’s principal complaints within the context of a personalized approach and to refer back to patients’ preoperative goals in their assessment of operative success.

Facial Plastic Surgery & Aesthetic MedicineVol. 22, No. 2 Research LettersValidation of the Portuguese Language Version of the Standardized Cosmesis and Health Nasal Outcomes SurveyRoberto S. Tunes, Lucas G. Patrocinio, Mikhail Saltychev, Sami P. Moubayed, and Sam P. MostRoberto S. Tunes*Address correspondence to: Roberto S. Tunes, MD, PhD, Department of Otolaryngology, Clinical Hospital, Federal University of Uberlândia (HC-UFU), Av. Pará, Umuarama 1720, Brazil, E-mail Address: robertotunes@icloud.comDivision of Facial Plastic, Department of Otolaryngology, Medical School, Federal University of Uberlândia, Brazil.Search for more papers by this author, Lucas G. PatrocinioDivision of Facial Plastic, Department of Otolaryngology, Medical School, Federal University of Uberlândia, Brazil.Search for more papers by this author, Mikhail SaltychevDepartment of Physical and Rehabilitation Medicine, Turku University Hospital, Turku, Finland.Search for more papers by this author, Sami P. MoubayedDivision of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of Montreal, Montreal, Quebec, Canada.Search for more papers by this author, and Sam P. MostDepartment of Otolaryngology–Head and Neck Surgery, Division of Facial Plastic & Reconstructive Surgery, Stanford University School of Medicine, Stanford, California.Search for more papers by this authorPublished Online:3 Mar 2020https://doi.org/10.1089/fpsam.2019.29015.tunAboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View articleFiguresReferencesRelatedDetailsCited byValidation of the European Portuguese Language Version of the Standardized Cosmesis and Health Nasal Outcomes Survey7 February 2023 | Facial Plastic Surgery, Vol. 156Comparison of the Distribution of Standardized Cosmesis and Health Nasal Outcomes Survey Scores Between Symptomatic and Asymptomatic Patients Priyesh N. Patel, Harsh Wadhwa, Tyler Okland, Cherian K. Kandathil, and Sam P. Most29 July 2022 | Facial Plastic Surgery & Aesthetic Medicine, Vol. 24, No. 4The Safety and Efficacy of Spreader Grafts and Autospreaders in Rhinoplasty: A Systematic Review and Meta-analysis14 January 2022 | Aesthetic Plastic Surgery, Vol. 46, No. 4Updates in RhinoplastyAdvances in Cosmetic Surgery, Vol. 5, No. 1Examining Preoperative Expectations and Postoperative Satisfaction in Rhinoplasty Patients: A Single-Center Study Cherian K. Kandathil, Priyesh N. Patel, Emily A. Spataro, and Sam P. Most3 September 2021 | Facial Plastic Surgery & Aesthetic Medicine, Vol. 23, No. 5Invited Discussion on: Body Dysmorphic Disorder in Rhinoplasty Candidates—Prevalence and Functional Correlations24 September 2020 | Aesthetic Plastic Surgery, Vol. 45, No. 2 Volume 22Issue 2Apr 2020 InformationCopyright 2020, American Academy of Facial Plastic and Reconstructive Surgery, Inc.To cite this article:Roberto S. Tunes, Lucas G. Patrocinio, Mikhail Saltychev, Sami P. Moubayed, and Sam P. Most.Validation of the Portuguese Language Version of the Standardized Cosmesis and Health Nasal Outcomes Survey.Facial Plastic Surgery & Aesthetic Medicine.Apr 2020.114-116.http://doi.org/10.1089/fpsam.2019.29015.tunPublished in Volume: 22 Issue 2: March 3, 2020Online Ahead of Print:February 18, 2020PDF download

The novel Coronavirus (COVID-19) has created a worldwide deadly pandemic that has become a major public health challenge. All semi-urgent and elective medical care has come to a halt to conserve capacity to care for patients during this pandemic. As the numbers of COVID-19 cases decrease across Canada, our healthcare system also began to reopen various facilities and medical offices. The aim for this document is to compile the current evidence and provide expert consensus on the safe return to clinic practice in Otolaryngology – Head & Neck Surgery. These recommendations will also summarize general precaution principles and practical tips for office across Canada to optimize patient and provider safety. Risk assessment and patient selection are crucial to minimizing exposure to COVID-19. Controversial topics such as COVID-19 mode of transmission, duration of exposure, personal protective equipment, and aerosol-generating procedures will be analyzed and discussed. Practical solutions of pre-visit office preparation, front office and examination room set-up, and check out procedures are explored. Specific considerations for audiology, pediatric population, and high risk AGMPs are also addressed. Given that the literature surrounding COVID-19 is rapidly evolving, these guidelines will serve to start our specialty back into practice over the next weeks to months and they may change as we learn more about this disease.

ABSTRACT: Synkinesis is a distressing sequela of peripheral facial palsy (PFP). This study aimed to translate and validate the Synkinesis Assessment Questionnaire (SAQ), a reliable patient-reported outcome evaluation tool for synkinesis, in French. The SAQ was translated following a standard forward–backward translation procedure. After a cognitive debriefing with 10 PFP patients, the SAQ-F was assessed amongst 50 patients for internal consistency, known-group validity, construct validity, criterion validity, and test–retest reliability. Results demonstrated that the SAQ-F was valid, reliable, and had a unidimensional structure. The SAQ-F should be accompanied by clinician-based scales, to provide valuable additional information on the severity of synkinesis.

Utilizing historical clinical datasets to guide future treatment choices is beneficial for patients and physicians. Machine learning and feature selection algorithms (namely, Fisher’s discriminant ratio, Kruskal-Wallis’ analysis, and Relief-F) have been combined in this research to analyse a SEER database containing clinical features from de-identified thyroid cancer patients. The data covered 34 unique clinical variables such as patients’ age at diagnosis or information regarding lymph nodes, which were employed to build various novel classifiers to distinguish patients that lived for over 10 years since diagnosis, from those who did not survive at least five years. By properly optimizing supervised neural networks, specifically multilayer perceptrons, using data from large groups of thyroid cancer patients (between 6,756 and 20,344 for different models), we demonstrate that unspecialized and existing medical recording can be reliably turned into power of prediction to help doctors make informed and optimized treatment decisions, as distinguishing patients in terms of prognosis has been achieved with 94.5% accuracy. We also envisage the potential of applying our machine learning strategy to other diseases and purposes such as in designing clinical trials for unmasking the maximum benefits and minimizing risks associated with new drug candidates on given populations.