Facial Plastic Surgery & Aesthetic Medicine最新文献

Traditional rhinoplasty techniques primarily address the osseocartilaginous framework; however, the final aesthetic outcome also depends on the skin-soft tissue envelope (SSTE) and its ability to redrape. In patients undergoing reduction of a high radix, early postoperative edema or hematoma related to dead-space formation can promote fibrosis and skin thickening, contributing to secondary increases in radix height and width. This represents a significant aesthetic concern that remains insufficiently addressed. We describe a novel transosseous radix fixation suture designed to prevent postoperative radix height increase following dorsal hump reduction with radix lowering. The technique involves the creation of a transverse transosseous tunnel at the radix. An absorbable suture is passed through the tunnel and sequentially externalized through four discrete cutaneous puncture sites, enabling reapproximation of the SSTE to the underlying periosteal and deep soft-tissue planes and dead-space reduction. The technique was applied in 30 patients and compared with a control cohort. At the 12-month follow-up, the change in nasofrontal angle (NFA) was significantly smaller in the radix-suture group than in controls (ΔNFA: 4.0 ± 3.8° vs. 6.2 ± 3.3°; p = 0.02). Patient-reported satisfaction, measured by the Rhinoplasty Outcomes Evaluation, was higher in the radix-suture group (94 ± 3% vs. 90 ± 4%).

Objective: To determine the cost-effectiveness of single-stage free tissue transfer techniques as compared to no intervention for the treatment of chronic facial paralysis.

Methods: The health utility values specific to unilateral facial paralysis and post-facial reanimation, as well as the cost and success rate of free tissue transfer, were derived from the published literature. Decision tree modeling with Monte Carlo simulation was used to calculate cost-effectiveness. A sensitivity analysis tested the validity of the conclusions by modeling variations in cost and utility values.

Results: The surgical pathway is $141,277 more costly and 2.49 quality-adjusted life years (QALY) more effective than no intervention. The incremental cost-effectiveness ratio between the two pathways is $56,737.80/QALY. At a willingness to pay (WTP) threshold of $100,000 and $150,000, the surgery is cost-effective across all parameters tested (maximum cost end-point being $180,000).

Conclusion: Despite the imperfect success rate and risks involved, free tissue transfer surgery is a cost-effective treatment for facial paralysis as compared to no intervention.

Background: Facial paralysis can negatively impact quality of life (QoL), but its impact compared to other groups is unknown.

Objectives: To compare QoL domain scores of facial paralysis patients with the general population, patients with burns, and patients referred for medical-psychological counselling; evaluate associations with demographic and disease-related factors.

Methods: Medical data of facial paralysis patients were extracted from electronic health records. Participants completed the RAND-36. Mean domain scores between samples were compared using t-tests with Bonferroni correction. Associations with demographic and disease-related variables were assessed using t-tests and Pearson correlations.

Results: Among 177 participants (mean age 58.1 years, 63% female), QoL scores were >5 points (all p < 0.05) lower than the general population across all QoL domains except "Physical function" and "Pain." Scores were comparable to patients with burns and better than individuals referred to medical psychology (difference >5 points, all p < 0.05). Younger age was associated with lower mental health (r = 0.16, p = 0.032) and vitality (r = 0.17, p = 0.026). Females had significantly worse mental health (ES = -0.32), vitality (ES = -0.32), and general health (ES = -0.38).

Conclusions: Facial paralysis is associated with reduced QoL on physical, psychological, and social domains. Clinicians should acknowledge this impact and refer patients to specialists in coping with facial disfigurement when appropriate.