Facial Plastic Surgery & Aesthetic Medicine最新文献

Introduction: Nasal analysis is a challenging skill that otolaryngology trainees must demonstrate competency in on-board examinations.

Study objective: To compare where experts and trainees focus their gaze when completing nasal analysis of a patient, as measured by eye tracking software.

Methods: Participants of various training levels (n = 27) were shown photographs of six faces from all standard angles for photographic nasal analysis. Eye-tracking data were collected. Heat and gaze maps, the time to first fixation on areas of interest, duration, and number of fixations were extracted. These metrics were compared between experts and trainees using t-tests and one-way ANOVA.

Results: Qualitative comparisons of gaze patterns reveal a more comprehensive and organized approach among experts than trainees. However, quantitative measures of eye-tracking metrics, including the time to first fixations, duration, and number of fixations made by experts and trainees, were similar.

Conclusions: Gaze tracking reveals more thorough and efficient eye movements among experts than trainees during nasal analysis. Further study may be useful in the development of learning tools to guide effective nasal analyses.

Introduction: Cross-facial nerve graft with free functional muscle transfer (FFMT) is a mainstay approach for facial reanimation. However, the effect of delay between cross-facial nerve graft and FFMT procedures is unknown. Objective: To measure the effect of delay between cross-facial nerve graft and FFMT among patients with facial nerve paralysis, as measured by clinician-graded assessments longitudinally. Methods: Patients who underwent both cross-facial nerve graft and gracilis FFMT, which was performed from 2016 to 2023, were retrospectively reviewed. Primary outcomes were time to first facial movement and time to spontaneous smile. Results: This study included 31 patients with cross-facial nerve graft and FFMT. Time between procedures did not adversely impact reinnervation. Between single and dual innervation patients, there was no difference in time to first facial movement (198, interquartile [IQR: 152.5-290 days] vs. [146, IQR: 116-196 days] [p = 0.089]) and time to spontaneous smile ([297.5, IQR: 200.25-409 days] vs. [282, IQR: 202-464 days] [p = 0.779]). Conclusion: Delays between cross-facial nerve graft and FFMT do not adversely impact time to first facial movement or spontaneous smile. Mature grafts may potentially remain viable for prolonged periods of time and thereby create opportunities for patients.

Background: Patients undergoing nasal reconstruction with the paramedian forehead flap (PMFF) can lead to scalp hair transfer and brow distortion. To minimize this, we have adopted the low median forehead flap (LMFF). Objectives: To compare the hypothetical flap reach of the LMFF with the PMFF and measure flap viability and hair transfer amongst patients undergoing nasal reconstruction. Materials and Methods: A multi-institutional retrospective chart review of patients undergoing the LMFF collected demographics, flap viability, brow distortion, and hair transfer. Photograph measurements compared the hypothetic flap reach between an LMFF or PMFF design. Results: Eighty patients (mean age 65 ± 13 [SD] years, 56.3% female) met inclusion after LMFF for nasal defects, mostly from skin cancer resection (93.8%) involving the tip (67.1%) and ala (73.4%); with ≥3 involved subunits (63.8%). Transferred scalp hair (n = 1, 1.3%), and no flap compromise occurred. In photograph analysis, the LMFF showed an 11.6% increase in flap reach as compared to the PMFF (p < 0.0001). Intra-rater and inter-rater variances were nonsignificant. Conclusions: The LMFF is a viable modification to the PMFF for nasal reconstruction, especially in patients with short hairline and/or distal nasal tip/alar defects where increased flap reach and minimal hair transfer are desired.

Background: Oral-ocular synkinesis is a frequent sequela of idiopathic facial paralysis (IFP), yet objective, dynamic methods to quantify associated palpebral fissure changes remain limited. Objective: To objectively measure palpebral changes in IFP using automated facial tracking. Design Type: Case-control. Methods: A novel, video-based facial tracking software assessed facial expressions in 12 controls and 30 IFP cases with synkinesis at least 12 months from onset of IFP. Palpebral fissure dimensions were measured at rest and during smile, laugh, and pucker. Bilateral differences across expressions were analyzed using Wilcoxon signed-rank, Kruskal-Wallis, and linear regression. Results: Puckering showed the greatest asymmetry (p < 0.001), with a 30.0% reduction in palpebral fissure size on the paralyzed side versus 21.6% on the non-paralyzed side, compared to a 1.7% reduction in controls. No significant differences were observed between paralyzed and non-paralyzed sides during rest-to-smile or rest-to-laugh expressions. Dynamic modeling found that puckering elicited the fastest and largest decline in palpebral fissure symmetry (slope = -0.196; standard error: 0.011; p < 0.001). Paralysis duration following 12 months had no significant effect on palpebral fissure changes. Conclusion: Dynamic facial tracking effectively quantifies expression-specific disruptions in oral-ocular coordination in IFP, particularly during puckering, offering objective data to support treatment planning and patient counseling.