Facial Plastic Surgery & Aesthetic Medicine最新文献

Background: Computer-aided design and manufacturing can enhance microvascular mandible reconstruction, particularly in cases with preexisting segmental defects or exophytic tumors where precise in situ plate bending is difficult. However, its high cost may limit its use in high-volume academic centers. Objective: To compare the costs of industry-performed patient-specific milled locking mandibular reconstruction plates (LMRPs) and surgeon-performed plate bending using 3D-printed (3DP) models as measured by billing data. Methods: A retrospective study of patients who underwent mandibular reconstruction with either industry-performed milled plates or with surgeon-bent plates based on a 3DP model. Costs of patient-specific and stock plates were obtained from the hospital's financial database, along with surgical outcomes associated with each protocol. Results: The study included 25 patients (14 males and11 females) undergoing fibula free flap reconstruction for mandibular defects, averaging 6.4 cm in size. Groups were comparable in age, sex, defect size, number of osteosyntheses, and incidence of osseous union. The average cost of milled plates was $7,709, while 3DP models and standard reconstruction plates cost $1,453, a difference of $6,256. The 3D printer's initial investment was $18,998, but readily with models produced for about $10 per model. Conclusion: Surgeon-performed 3D printing for plate bending is less expensive than computer-aided, patient-specific plates for mandibular reconstruction.

Background: Melasma is a chronic skin pigmentation disorder, and intradermal injection of tranexamic acid (TXA) is an effective treatment option for melasma with limited comparative efficacy studies. Objectives: To compare the effectiveness of TXA injections with other treatment modalities for patients with melasma, as measured by Melasma Area and Severity Index (MASI). Methods: A total of 17 eligible randomized controlled trials were included in the meta-analysis. The MASI and the modified MASI served as the primary outcome measures of treatment effectiveness. Patient satisfaction was also evaluated. Results: Among the various administration routes for TXA, intradermal injection and microneedling demonstrated superior effectiveness, followed by oral administration and topical application. As for patient satisfaction, oral administration outperformed the injection method, whereas topical administration significantly underperformed injection. Furthermore, TXA injections were more effective than the majority of non-TXA standard treatments for melasma. Conclusions: This meta-analysis and systematic review suggested that intradermal TXA injection is an effective alternative for melasma treatment, with potential advantages over other administration routes.

Background: Tranexamic acid (TXA) has the ability to reduce intraoperative bleeding and facilitate hemostasis in addition to its anti-inflammatory properties that can potentially aid in recovery among patients who underwent rhytidectomy. Objective: To compare postoperative ecchymosis in patients who underwent rhytidectomy with TXA added to the tumescent anesthetic. Methods: A multi-institutional, single-blind study was performed on patients who underwent rhytidectomy. The sidedness of the face was randomized to receive either local anesthetic with TXA or without, prior to incision for rhytidectomy. The primary outcome was postoperative ecchymosis that was graded by the surgeons at the 1 week postoperative time frame in standard photograph review. Results: A total of 70 patients, mean age 62.1, were enrolled in the study. The surface area of postoperative ecchymosis at 1 week was shown to be significantly less on the side of the face that received local anesthetic infiltration prior to incision with TXA than the side that had local anesthetic without TXA (p < 0.001). These results were consistent with subjective measurements of postoperative ecchymosis graded at 1 week with two blinded investigators to the sidedness of the face that received TXA (p < 0.001). Conclusions: TXA may potentially facilitate a reduction in postoperative ecchymosis in patients undergoing rhytidectomy.

Introduction: Most patients with acute facial palsy initially present to emergency departments (EDs), where clinical practice guidelines (CPGs) recommend steroids, eye care, and follow-up with facial nerve specialists. Objective: To evaluate adherence to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) Bell's palsy (BP) CPGs within EDs at a single academic institution. Method: We conducted a retrospective review of all patients diagnosed with acute facial palsy in the EDs of an academic tertiary care center between June 1, 2021, and June 1, 2022. Results: A total of 270 patients met inclusion criteria; most were male (n = 150, 55.9%), diagnosed with BP (n = 243, 90.0%), and presented to community-based emergency rooms (n = 170, 62.96). Although most patients received steroid treatment (n = 243, 90.0%), only 61.5% (n = 166) received the AAO-HNS-recommended course. Older patients and those who received steroids were more likely to receive imaging (p < 0.001, p = 0.03). Treatment with the AAO-HNS-recommended steroid regimen was associated with a higher likelihood of receiving laboratory evaluation (p = 0.02). Providers often advised follow-up; however, only 12.2% of patients were discharged with an electronic referral order. Conclusion: There are opportunities to standardize the treatment of patients in the ED presenting with acute facial palsy according to AAO-HNS CPGs.

Background: For auricular reconstruction surgery using autologous costal cartilage, younger patients typically have a limited amount of costal cartilage available. Objective: We introduce a cartilage-saving technique for fabricating the tragus and antitragus, and evaluate its effectiveness based on aesthetic score and complications. Methods: For tragus fabrication, the residual part of the seventh costal cartilage was reoriented by 90° to increase its height and carved into a seagull-shaped structure. The antitragus was constructed by bending the antihelix and stabilizing it on the broadened base frame. Postoperative aesthetic outcomes and complications were documented and analyzed. Results: This study included a total of 658 patients with lobule-type microtia, of whom 356 (54.1%) were male and 302 (45.9%) were female. The average age was 6.5 ± 0.7 years, and the average follow-up period was 13.6 ± 3.5 months. The average aesthetic outcome score was 9.0 ± 0.7. Wound dehiscence at the tragus was seen in four patients, while circulation disturbance at the incisura intertragica area was noted in six patients. Conclusions: This cartilage-sparing technique demonstrated effectiveness in shaping aesthetic tragus and antitragus.

Background: The ability to smile is impaired in patients with facial palsy, and objective parameters assessing smile symmetry to guide treatment are not well elucidated. Objective: This study seeks to identify objective facial measurements that relate smile recognition, perception of smile asymmetry, and perceived emotions from photographs of individuals with asymmetrical smiles compared with control photographs of individuals without smile asymmetry as measured by a photograph analysis application. Methods: Fifty-six photographs of smiles were categorized using objective perioral morphometric measurements (Emotrics). A photographic survey of these smiles was disseminated with queries regarding smile symmetry, smile recognition, and emotion perception. Generalized linear mixed modeling (GLMM) was performed to assess the effect of facial measurements on survey responses. Results: From 756 survey responses, smile symmetry predicted for smile recognition (F = 1084, p < 0.001) and emotion perception (F = 422, p < 0.001). Correlation analysis and GLMM identified three parameters (lower lip height, commissure position, and commissure height) that predicted smile recognition (F = 1040, p < 0.001), emotion perception (F = 976, p < 0.001), and symmetry (F = 1248, p < 0.001). Lower lip height (β = -57.84, p < 0.001) and commissure position (β = -29.41, p < 0.001) were the most significant drivers. Conclusions: Correcting lower lip height and commissure position represents efficacious clinical benchmarks for improving smile recognition by reducing smile asymmetry and conveying negative emotions.