Facial Plastic Surgery Research Articles

Fresh Frozen Rib Cartilage Grafts in Revision Rhinoplasty: A 9-Year Experience.

Revision rhinoplasty is undoubtedly one of the most challenging procedures in facial plastic surgery. The complexity is compounded when there is a paucity of native septal cartilage to perform the required framework reconstruction. Harvest of autologous costal cartilage can result in increased operative times and possible secondary-site complications such as contour irregularity, poor scarring, and even pneumothorax. A retrospective review was conducted of the senior author's (R.J.R.) patients from 2011 to 2020 who underwent primary or revision rhinoplasty. Inclusion criteria consisted of patients with fresh frozen off-the-shelf cartilage used in revision rhinoplasty only with a minimum of 6 months' follow-up. Outcomes for evaluation were warping, resorption, displacement, and infection. The authors identified 226 patients who underwent open rhinoplasty with the use of fresh frozen rib cartilage grafts and met inclusion criteria. The mean follow-up period was 12.18 months (range, 6 months to 8 years). The majority of patients had undergone one prior rhinoplasty procedure (54 percent); however, 4 percent of patients had undergone four or more prior procedures on their nose. The overall infection rate was 2.7 percent ( n = 6), with the majority successfully managed with antibiotics alone (2.3 percent). The results in revision rhinoplasty are significantly enhanced with the creation of a stable nasal framework using off-the-shelf, easily accessible, specifically tailored fresh frozen cadaveric rib grafts. The long-term outcomes and complication rate in this 9-year retrospective study demonstrates the safety of fresh frozen rib graft in comparison to autologous or irradiated rib graft. Therapeutic, IV.

Pandemics and facial plastics and reconstructive surgery

The purpose of this article is to review the impact of COVID-19 on the specialty of Facial Plastic and Reconstructive Surgery. Initially, COVID-19 caused significant disruption to facial plastic surgeon practices and patient care with cancellation of surgery and clinical practice. As medical practices resumed, facial plastic surgeons were resilient and adaptive. Reliance on technology helped to meet the needs of patients. There was a surge of facial plastic surgery interest and procedures as the pandemic wore on with recovery of many physician practices. COVID-19 created numerous challenges for facial plastic and reconstructive surgeons but also many opportunities. The facial plastic surgery community and the American Academy of Facial Plastic and Reconstructive Surgery worked together to achieve best outcomes.

Facial Esthetic Analysis of Nepalese Subjects

Background: Facial beauty is a prime concern in facial esthetic treatments and facial plastic surgery. The cephalometric can be used in the diagnosis, treatment planning, assessing the growth pattern in the craniofacial complex and skeletal disproportion with the relationships of the teeth to their supporting bone. Objective: The objective of this research was to analyze the face, evaluate the variability between males and females, and determine the cephalometric norms of Nepalese subjects based on Ricketts analysis. Materials and Methods: Craniofacial analysis of 106 Nepalese Brahmins subjects (60 females and 46 males) was done using the lateral cephalogram. The samples were criteria selected who met the criteria; well-balanced face, class I canine relation, and class I molar relation with normal occlusion. Ten parameters of Ricketts analysis were measured and analyzed using SPSS 20. The results were compared among males and females using Independent T-test with P value = 0.05. Results: The mean values of the facial axis, mandibular plane angle, mandibular arc, convexity at A were higher among the Brahmin females compared to Brahmin males. While the mean values of lower facial height, lower incisor to A Pog distance, lower incisor to A Pog angle, upper molar to PTV, and distance from lower lip to E plane were higher among the Brahmin males compared to Brahmin females. Female had smaller craniofacial variables compared to males. The mean values of upper molar position are higher for both males and females compared to the standard value of 12 ±3 mm; however, the mean values are significantly higher among males compared to females (P = 0.001). It showed that the facial axis, chin position, lower facial height, and facial depth were no significant differences between Nepalese males and females. Conclusion: There was sexual dimorphism in craniofacial features in Nepalese Brahmins. Female had smaller craniofacial variables compared to males. This research provided an overview of craniofacial features and they can be a norm for Nepalese Brahmins in orthodontic diagnosis and treatment planning.

Patterns and Trends of Facial Fractures at a Tertiary Care Trauma Center in India - A 13 years Retrospective Study.

Retrospective study. The purpose of this study was to retrospectively analyze the prevalence, pattern, diagnosis, and treatment of the facial fractures falling under ambit of facial plastic surgery in a multi-specialty hospital at India from the year 2006-2019. This retrospective study analyzed 1508 patients, having orbital fractures (from 2006 to 2019) for demographic data, cause of trauma, type of fracture, and the treatment given. The data were compiled in excel and analyzed by using SPSS version 21.0. Out of these 1508 patient (1127 (74.73%)-males and 381 (25.27%)-females), the etiology of injuries was Road traffic accident (RTA) (49.20%), assault (26.52%), and sports injuries (11.47%). The most common fracture pattern was Isolated Orbit and/or Orbital Floor fracture in 451 patients (32.08%), followed by Mid-facial fractures (21.93%). Also, 105 patients (6.96%) experienced ocular/retinal trauma along with other fractures. Orbit, peri-ocular, and mid-face trauma comprised a large position of this study. It requires a great deal of expertise to treat such complex trauma, which is not covered in one specialty alone. Hence, a holistic approach of craniofacial fracture management, rather than limiting these skills to water-tight craniofacial compartments becomes necessary. The study highlights the critical need of multidisciplinary approach for predictable and successful management of such complex cases.

Commentary on: "Visual Attention to Facial Defects Predicts Willingness to Pay for Reconstructive Surgery" by Ryan et al.

Facial Plastic Surgery & Aesthetic MedicineVol. 24, No. 6 Invited CommentaryCommentary on: “Visual Attention to Facial Defects Predicts Willingness to Pay for Reconstructive Surgery” by Ryan et alJeffrey S. MoyerJeffrey S. Moyer*Address correspondence to: Jeffrey S. Moyer, MD, MS, FACS, Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, 1500 E Medical Center Dr. TC1904, Ann Arbor, MI, USA, E-mail Address: jmoyer@med.umich.eduhttps://orcid.org/0000-0002-0435-9200Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, University of Michigan Medical School, Ann Arbor, MI, USA.Search for more papers by this authorPublished Online:8 Nov 2022https://doi.org/10.1089/fpsam.2022.0057AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Commentary on: “Visual Attention to Facial Defects Predicts Willingness to Pay for Reconstructive Surgery” by Ryan et al." Facial Plastic Surgery & Aesthetic Medicine, 24(6), pp. 443–444FiguresReferencesRelatedDetails Volume 24Issue 6Dec 2022 InformationCopyright 2022, American Academy of Facial Plastic and Reconstructive Surgery, Inc.To cite this article:Jeffrey S. Moyer.Commentary on: “Visual Attention to Facial Defects Predicts Willingness to Pay for Reconstructive Surgery” by Ryan et al.Facial Plastic Surgery & Aesthetic Medicine.Dec 2022.443-444.http://doi.org/10.1089/fpsam.2022.0057Published in Volume: 24 Issue 6: November 8, 2022Online Ahead of Print:April 11, 2022PDF download

The impact of COVID-19 on otolaryngology research: a cross-sectional analysis of discontinued trials.

The COVID-19 pandemic has reduced the capacity to conduct medical research due to recruitment difficulties, supply chain shortages, and funding deficits. The clinical practice of otolaryngology was especially impacted due to a reduction in elective procedures, such as facial plastic surgeries and vocal fold injections. The primary objective was to examine the extent of clinical trial (CTs) disruption secondary to the COVID-19 pandemic in the field of otolaryngology. On August 1, 2021, we conducted a systematic search utilizing ClinicalTrials.gov for CTs related to common otolaryngology disorders. We utilized the date range January 1, 2020 through August 1, 2021 to identify all trials potentially affected by the COVID-19 pandemic. Investigators performed screening and data extraction in a duplicate, masked fashion. Trials resulting from the search were extracted for trial status, condition treated, enrollment number, funding, study type, study design, last update posted date, and trial location. Trials that explicitly mentioned COVID-19 as a reason for discontinuation or suspension were coded as such. For trials that did not explicitly mention COVID-19, we coded the reason provided from ClinicalTrials.gov. The Oklahoma State University Center for Health Science Institutional Review Board determined that this project did not qualify as human subject research. A total of 1,777 CTs met the inclusion criteria, and 223 CTs were discontinued between January 1, 2020 and August 1, 2021. Thirty-three (14.8%) of the 223 CTs reported discontinuation explicitly due to the COVID-19 pandemic. The 33 studies had 1,715 participants enrolled in total. Among the primary interventions, 11 (33.3%) were devices, 10 (30.3%) were drugs, 5 (15.2%) were behavioral, 4 (12.1%) were diagnostic tests, 1 (3.0%) was dietary, and 2 (6.1%) were labeled as "other." Regarding the CT location, 20 (60.6%) were conducted in the United States, and 13 (39.4%) were conducted internationally. Of the 33 CTs, 19 (57.6%) were suspended, 9 (27.3%) were terminated, and 5 (15.2%) were withdrawn. The overall most common reason for trial disruption was recruitment difficulties (24.2%). Median enrollment for discontinued trials due to COVID-19 was 37 (interquartile range [IQR], 19-71) and for other reasons was 6 (IQR, 0-27), for which the Mann-Whitney test showed a statistically significant difference between the two (z=-3.913, p<0.001). There were no significant associations between trial location, funding source, randomization, or whether a study involved masked vs unmasked participants. The COVID-19 pandemic has incited an impact on clinical research in the field of otolaryngology. To preserve trial continuation amid future threats to participant interaction and communication, we recommend further exploration of remote monitoring practices and virtual procedures-those that will maintain the effectiveness and accuracy needed to establish novel therapeutics. We encourage future trials to gauge which remote assessments show the greatest validity, with the long-term goal of establishing innovative study designs resilient to future pandemics.

Practicing functional nasal surgery in the non-urban setting: experience from a single center

Nasal airway obstruction is a prevalent chief complaint in the contemporary facial plastic surgery practice. Studies report an asymmetric distribution of plastic surgeons across the United States with a disproportionately high concentration of surgeons practicing in urban areas. The lack of elective specialist care creates unique challenges for these patients who may need to travel and dedicate time to reach a nasal surgery expert. We conducted a retrospective chart review to report our experience from practicing functional nasal surgery in such a non-urban setting in the United States. A total of 103 patients underwent functional nasal surgery (FNS) between May 2015 and August 2021 including septoplasty, inferior turbinate reduction, septorhinoplasty and nasal valve procedures. We present the epidemiological characteristics, surgical techniques used and postoperative complications and illuminate the unique characteristics of practicing FNS in the non-urban setting.

COMPARISON BETWEEN COLUMELLAR STRUT AND TONGUE-IN-GROOVE TECHNIQUE, AS TO THE ROTATION AND PROJECTION EFFECTS OF THE NASAL TIP: A RETROSPECTIVE STUDY

Rhinoplasty is one of the most challenging facial plastic surgeries. Some authors claim that this surgery should include stabilization of the base of the nose by means of some technique — for example, grafts (columellar strut, septal extensor) or sutures (tongue-in-groove). To try to elucidate which technique is ideal, this study evaluated the effects on nasal tip rotation and projection, comparing columellar strut to the tongue-in-roove technique. A retrospective study was conducted, which consisted of a preoperative and postoperative photographic analysis of patients who underwent rhinoplasty, in 2017 and 2018, at the Instituto Paranaense de Otorrinolaringologia (Curitiba/PR, Brazil) The Rhinobase® program was used to obtain measurements. After data analysis, it was observed no statistically significant difference between the groups, which was also observed by some authors who carried out similar studies in other countries. It can be concluded that both strut and tongue-in-groove are similar techniques for maintaining nasal tip projection and rotation in the postoperative period of rhinoplasty

Traditional rhinoseptoplasty vs Preserving rhinoplasty – Literature Review

The nasal pyramid is an essential structure in the physiognomy of the individual, and the external appearance of the nose is very important in the modern society in which we find ourselves. That is why the anatomical diversity of the nasal pyramids has led to the development of various surgical technique for reshaping the nasal structures. Rhinoseptoplasty has changed considerably in recent decades, from a standardized reduction procedure to a procedure focused on very differentiated problems, reductions, relocations and augmentations of frequently combined tissues Most surgeons around the world have agreed on a new concept of surgery, that of preserving different structures of the nose given the fact that the principle of preservation is better than that of resection, with a more natural result. Material and method. Review of the two surgical concept of rhinoplasty regarding the main advantages and disadvantages of each type of rhinoseptoplasty surgery. Results and conclusions. Proper patient selection is important for good results. Before surgery, nasal analysis should be performed clinically and photographically to determine the necessary corrections. Rhinoplasty is still one of the most challenging procedures in facial plastic surgery. With the right surgical experience and proper surgical techniques the results are most often good and the patients are satisfied.

Allergic reactions to bioimplants

Bioimplants are used in avariety of ways in otorhinolaryngology, most commonly in facial reconstructive surgery, cochlear implants (CI), bone-anchored hearing aids, and partial/total ossicular replacement prostheses (PORP/TORP), but also for tympanic drainage, laryngeal cannula, voice prostheses after laryngectomy, etc., and in otorhinolaryngology-related procedures as dental implants in dentistry. Aliterature search was performed to analyze the immunology of allergic reactions to bioimplants and to determine the available evidence by searching Medline, PubMed, and national and international study and guideline registries and the Cochrane Library. Human studies published in the period up to and including 12/2021 were considered. Based on the international literature and previous experience, areview of allergies to bioimplants in otolaryngology is presented. Otorhinolaryngologists should always consider the possibility of allergic reactions when inserting allogeneic materials, particularly, but not only, when using bioimplants.

Emerging Technologies in Face and Body Contouring

Emerging Technologies in Face and Body Contouring is a 500-page, 25-chapter text available in both hardcopy and e-book formats published by Thieme (New York, NY, USA). This text provides a comprehensive tour of the latest aesthetic techniques and technology, providing the modern aesthetic surgeon with both theoretical and practical guidelines to these various treatments. Technologic advances over the past decade have transformed the aesthetic landscape. From patient analysis to treatment and postoperative care, the manner in which aesthetic treatment is provided today is vastly different from our predecessors. This has been driven by technologic advancements that aim to meet the increasing demand of patients, who seek more minimally invasive approaches with less recovery and downtime. This book considers that many of today’s aesthetic providers are increasingly coming from more diverse training backgrounds (ie, plastic surgery, oral and maxillofacial surgery, facial plastic surgery, etc), often with a paucity of training in aesthetic techniques and technology. The editors have successfully curated chapters from an international list of expert aesthetic surgeons, including contributors from the United States, Colombia, Italy, and Greece.

Commentary on: "A Minimally Invasive Nasal Endoscopic Approach to Distraction Osteogenesis Maxillary Expansion to Restore Nasal Breathing for Adults with Narrow Maxilla" by Liu et al.

Facial Plastic Surgery & Aesthetic MedicineVol. 24, No. 6 Invited CommentaryCommentary on: “A Minimally Invasive Nasal Endoscopic Approach to Distraction Osteogenesis Maxillary Expansion to Restore Nasal Breathing for Adults with Narrow Maxilla” by Liu et alLucas G. PatrocinioLucas G. Patrocinio*Address correspondence to: Lucas G. Patrocinio, MD, PhD, Otolaryngology, Medical School, Federal University of Uberlandia, Rua Arthur Bernardes, 555, Uberlandia 38400-368, Brazil, E-mail Address: lucaspatrocinio@clinicaotoface.com.brhttps://orcid.org/0000-0002-3148-9633Otolaryngology, Medical School, Federal University of Uberlandia, Uberlandia, Brazil.Search for more papers by this authorPublished Online:8 Nov 2022https://doi.org/10.1089/fpsam.2022.0011AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Commentary on: “A Minimally Invasive Nasal Endoscopic Approach to Distraction Osteogenesis Maxillary Expansion to Restore Nasal Breathing for Adults with Narrow Maxilla” by Liu et al." Facial Plastic Surgery & Aesthetic Medicine, 24(6), pp. 422–423FiguresReferencesRelatedDetails Volume 24Issue 6Dec 2022 InformationCopyright 2022, American Academy of Facial Plastic and Reconstructive Surgery, Inc.To cite this article:Lucas G. Patrocinio.Commentary on: “A Minimally Invasive Nasal Endoscopic Approach to Distraction Osteogenesis Maxillary Expansion to Restore Nasal Breathing for Adults with Narrow Maxilla” by Liu et al.Facial Plastic Surgery & Aesthetic Medicine.Dec 2022.422-423.http://doi.org/10.1089/fpsam.2022.0011Published in Volume: 24 Issue 6: November 8, 2022Online Ahead of Print:February 17, 2022PDF download

Size and Perception of Facial Features with Selfie Photographs, and Their Implication in Rhinoplasty and Facial Plastic Surgery.

Patients increasingly use photographs taken with a front-facing smartphone camera-"selfies"-to discuss their goals with a plastic surgeon. The purpose of this study was to quantify changes in size and perception of facial features when taking a selfie compared to the gold standard of clinical photography. Thirty volunteers took three series of photographs. A 12-inch and 18-inch series were taken with a front-facing smartphone camera, and the 5-foot clinical photography series was taken with a digital single-lens reflex camera. Afterward, subjects filled out the FACE-Q inventory, once when viewing their 12-inch selfies and once when viewing their clinical photographs. Measurements were taken of the nose, lip, chin, and facial width. Nasal length was, on average, 6.4 percent longer in 12-inch selfies compared to clinical photography, and 4.3 percent longer in 18-inch selfies compared to clinical photography. The alar base width did not change significantly in either set of selfies compared to clinical photography. The alar base to facial width ratio represents the size of the nose in relation to the face. This ratio decreased 10.8 percent when comparing 12-inch selfies to clinical photography (p < 0.0001) and decreased 7.8 percent when comparing 18-inch selfies to clinical photography (p < 0.0001). This study quantifies the change in facial feature size/perception seen in previous camera-to-subject distance studies. With the increasing popularity of front-facing smartphone photographs, these data allow for a more precise conversation between the surgeon and the patient. In addition, the authors' findings provide data for manufacturers to improve the societal impact of smartphone cameras. Diagnostic, III.

An Innovative Skin Simulation Model to Augment Competency-based Training in Facial Plastic Surgery.

Introduction Competency-based medical education (CBME) approach in the medical curriculum has been introduced globally with the goal of providing flexibility, accountability, and learner-centeredness among medical learners. Traditional surgical skill training in most places has relied on “see one, do one, teach one model,” while simulation model-based training has been shown to improve competencies in surgical trainees. We wanted to assess the usefulness of a hydrophilic barrier adhesive foam wound dressing as a novel skin simulation model for learning biomechanics and practice of cutaneous flaps among plastic surgical resident trainees at our institute. Materials and Methods An absorbent, soft polyurethane foam pad located centrally upon a larger polyurethane membrane, coated with a hydrocolloid adhesive, forming an island dressing, was used as a simulation model for this study. It was obtained from the hospital store either after or nearing their expiry dates of clinical use. Plastic surgery residents in different years of training were invited to participate in a simulation workshop, using this novel model, and give their feedback. Results Seventeen residents in different plastic surgery training levels participated in the workshop and gave their feedback on the skin flap simulation model. The simulation model received extremely high (100%) scores on two parameters, namely, utility for flap and suture practice and high scores (88%–94%) for texture, ability to mark, and improving confidence among trainees. Conclusions Adhesive bilayer polyurethane foam can be used as a novel cutaneous skin flap simulation model for understanding the biomechanics of skin flaps and cutaneous flap practice.

Editorial introductions.

Editorial introductions.

Operating Room Noise and Team Communication during Facial Plastic and Reconstructive Surgery: A Multicenter Study.

Operating room (OR) noise contributes to team miscommunication. In facial plastic and reconstructive surgery (FPRS), many cases are completed under sedation. This creates a unique environment wherein patients are aware of OR noise. The objectives of this study were to quantify noise and evaluate team members' perspectives on communication inside of FPRS ORs. This study was completed across three surgical institutions. Objective noise measurements were recorded with SoundMeter X. A communication questionnaire was delivered to OR team members following each case. Four hundred and twenty-three noise measurements were recorded during facelift/neck, eye/brow, rhinoplasty, and fat transfer/lip surgeries. The mean and maximum noise levels were 66.1 dB (dB) and 87.6 dB, respectively. Measurements during cases with general anesthetic (221/423, 52.2%) had higher noise measurements (70.3 dB) compared with those with sedation (202/423, 47.8%) (69.7 dB) (p = 0.04). The OR was louder with suction on (72.3 dB) versus off (69.3 dB) (p <0.00). Suction (34.5%) and music (22.4%) were the largest noise contributors according to questionnaire replies. Intraoperative noise, awake patients, and suctions/music may negatively impact FPRS OR communication. Innovation to improve FPRS intraoperative communication should be considered for effective patient care.

Commentary on “Augmented Skin Grafting: A New Rung in the Reconstructive Ladder” by Landeen et al: Less Invasive Options for Patients with Significant Comorbidities

Facial Plastic Surgery & Aesthetic MedicineVol. 24, No. 2 Invited CommentaryCommentary on “Augmented Skin Grafting: A New Rung in the Reconstructive Ladder” by Landeen et al: Less Invasive Options for Patients with Significant ComorbiditiesMegan V. Morisada and Travis T. TollefsonMegan V. MorisadaFacial Plastic and Reconstructive Surgery, Department of Otolaryngology—Head and Neck Surgery, University of California Davis Health, Sacramento, California, USA.Search for more papers by this author and Travis T. Tollefson*Address correspondence to: Travis T. Tollefson, MD, MPH, Facial Plastic and Reconstructive Surgery, Department of Otolaryngology—Head and Neck Surgery, University of California Davis Health, 2521 Stockton Boulevard, Suite 7200, Sacramento, CA 95817, USA, E-mail Address: tttollefson@ucdavis.eduhttps://orcid.org/0000-0002-8658-8647Facial Plastic and Reconstructive Surgery, Department of Otolaryngology—Head and Neck Surgery, University of California Davis Health, Sacramento, California, USA.Search for more papers by this authorPublished Online:15 Mar 2022https://doi.org/10.1089/fpsam.2021.0382AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Commentary on “Augmented Skin Grafting: A New Rung in the Reconstructive Ladder” by Landeen et al: Less Invasive Options for Patients with Significant Comorbidities." Facial Plastic Surgery & Aesthetic Medicine, 24(2), pp. 130–131FiguresReferencesRelatedDetails Volume 24Issue 2Apr 2022 InformationCopyright 2022, American Academy of Facial Plastic and Reconstructive Surgery, Inc.To cite this article:Megan V. Morisada and Travis T. Tollefson.Commentary on “Augmented Skin Grafting: A New Rung in the Reconstructive Ladder” by Landeen et al: Less Invasive Options for Patients with Significant Comorbidities.Facial Plastic Surgery & Aesthetic Medicine.Apr 2022.130-131.http://doi.org/10.1089/fpsam.2021.0382Published in Volume: 24 Issue 2: March 15, 2022Online Ahead of Print:January 21, 2022PDF download

Facial Nerve Revascularization Strategies in Facial Restoration.

Background:Facial transplants represent the current exemplar in the reconstruction of severely damaged faces, whereas conventional free flap reconstruction has its limitations in restoring both function and surface cover.Methods:In a retrospective study over 6 years (2014–2020), 5 cases (n = 5) of vascularized nerve flaps (VNFs) were performed by our team. These involved three acute and two late reconstructions. The mean age was 41 years with a maximum of 6-year follow-up. To objectify the different permutations and combinations, we categorized composite, chimeric, and hybrid VNFs into types I, IIa-c, and III, each with a unique characteristic. Postoperative function was evaluated using the validated Sunnybrook and Terzis scores for facial nerve palsy; masticatory function was assessed using dental impression studies.Results:There was a 100% flap survival rate, with no instances of flap necrosis and only one complication: hematoma at 24 hours postoperative. Sunnybrook and Terzis scores showed a statistically significant improvement postoperatively, indicating both improved repose and facial expressions (paired student t test, P < 0.05). Given that each VNF was specifically customized for a particular patient, each type of VNF in this cohort was unique, thereby illustrating each type succinctly.Conclusions:VNFs are separate entities from standard free flaps, as they require extensive preoperative planning to allow the deconstructing of composite blocks of tissue into separate vascularized entities and amalgamating them into a new conglomerate. This allows VNFs to fill a niche area in facial reconstructive surgery between face transplants and conventional free tissue transfers, with enormous potential.

Rural Otolaryngology Care Disparities: A Scoping Review.

To broadly synthesize the literature regarding rural health disparities in otolaryngology, categorize findings, and identify research gaps to stimulate future work. Scoping review. A comprehensive literature search was performed in the following databases: PubMed/MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, Google Scholar, and CINAHL. The methods were developed in concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. Peer-reviewed, English-language, US-based studies examining a rural disparity in otolaryngology-related disease incidence, prevalence, diagnosis, treatment, or outcome were included. Descriptive studies, commentaries, reviews, and letters to the editor were excluded. Studies published prior to 1980 were excluded. The literature search resulted in 1536 unique abstracts and yielded 79 studies that met final criteria for inclusion. Seventy-five percent were published after 2010. The distribution of literature was as follows: otology (34.2%), head and neck cancer (20.3%), endocrine surgery (13.9%), rhinology and allergy (8.9%), trauma (5.1%), laryngology (3.8%), other pediatrics (2.5%), and adult sleep (1.3%). Studies on otolaryngology health care systems also accounted for 10.1%. The most common topics studied were practice patterns (41%) and epidemiology (27%), while the Southeast (47%) was the most common US region represented, and database study (42%) was the most common study design. Overall, there was low-quality evidence with large gaps in the literature in all subspecialties, most notably facial plastic surgery, laryngology, adult sleep, and pediatrics. Importantly, there were few studies on intervention and zero studies on resident exposure to rural populations, which will be critical to making rural otolaryngology care more equitable in the future.

Complication Rates From Otoplasty at a Tertiary Facial Plastic Surgery Center: A Retrospective Analysis.

:Prominent ears are considered the most common congenital external ear deformity among Caucasians. Affecting approximately 5% of the population, it runs in families and exhibits equal sex incidence. This study aimed to determine the complication rate from otoplasty in a tertiary facial plastic surgery center. This retrospective cross-sectional study included all patients with prominent ears deformities who underwent otoplasty at King Abdul-Aziz University Hospital between January 2019 and June 2021. The records of 116 patients who underwent otoplasty during the study period were examined and only 44 matched the inclusion and exclusion criteria. The total of 85 operated ears from 44 patients were included. Of these, 17 were pediatric patients and 25 were male patients. Forty-one patients underwent bilateral otoplasty and 3 underwent unilateral otoplasty. Complications occurred in 17/85 (20%) patients and the complications included recurrence 4 (4.70%), hypertrophic scar 3 (3.52%), keloid 2 (2.35), granuloma 2 (2.35%), infection 2 (2.35%), discomfort 1 (1.17%), wound dehiscence 1 (1.17%), hematoma 1 (1.17%), and retracted ear 1 (1.17%). The overall patient satisfaction was 38/44 (86.36%). Our study is first study conducted in middle east about otoplasty complications. It showed that the complications from otoplasty surgery varied from severe to mild, with acceptable overall satisfactory results. The most common complication was recurrence. Fortunately, serious complications, such as wound dehiscence and hematoma, were rare. However, our study’s small sample size remains a major limitation.