Facial Plastic Surgery & Aesthetic Medicine最新文献

Purpose: Pediatric neoplastic facial paralysis presents challenges in planning surgical reanimation.

Methods: A review of pediatric patients with facial paralysis secondary to malignant tumors was conducted. Oncological data, functional status, chronology, and degree of paralysis were recorded. Surgical indications and techniques were documented. Postoperative outcomes included facial nerve function and survival.

Results: A total of 14 patients were analyzed. The most common tumor location was the posterior fossa (n = 12). Most patients showed stability of the tumoral disease (n = 11). Facial paralysis occurred mainly after tumor surgery (n = 12). The House-Brackmann (HB) grade at diagnosis was IV (n = 2), V (n = 3), and VI (n = 7). Two patients had bilateral paralysis, with HB grade V (n = 1) and VI (n = 1) respectively. Facial reanimation was performed on 10 patients, with a median paralysis-to-surgery interval of 15 months (2-21). Surgical techniques included interposition nerve grafts, cross-facial nerve grafts, or regional nerve transfers. At 12 months, 9 patients improved to HB grades III-IV, the Sunnybrook score improving from 7.5 (5-55) to 44 (34-67). The deaths of 3 patients were documented. The remaining patients maintained stable facial function.

Conclusion: Our experience with facial reanimation surgery in oncological patients is positive, most patients remaining with stable oncological status and good functional outcomes.

Background: Transcutaneous lower blepharoplasty has been associated with scleral show and lid malposition.

Objective: To evaluate postoperative eyelid position (marginal reflex distance, canthal tilt), complication rates, and patient satisfaction, as measured by standardized photographic analysis and patient-reported outcomes.

Methods: A retrospective review of 78 patients undergoing transcutaneous lower eyelid blepharoplasty with orbicularis suspension between 2022 and 2024 was conducted. Minimum follow-up was 12 months. Clinical photographs were assessed using PicPick software (version 7.2.8), and follow-up data were analyzed for aesthetic outcomes, complications, and satisfaction.

Results: Of 78 patients (62% female, mean age = 47.5 years), the mean follow-up was 14.2 months (range = 12-25). Comorbidities included hypertension (18%) and diabetes (9%). Postoperative eyelid malposition (29.5%) and scleral show (28.2%) were unchanged from preoperative values. No cases of frank ectropion occurred, and one revision surgery (1.3%) was required. Negative preoperative canthal tilt was significantly associated with scleral show (p < 0.001). Overall, 98.7% of patients reported satisfaction.

Conclusions: Transcutaneous lower blepharoplasty with orbicularis suspension maintains eyelid position and contour, with low complication rates and high patient satisfaction.

Introduction: Outcomes for chemodenervation treatment of facial synkinesis are well described, and evidence for surgical interventions such as selective neurectomy and myectomy is growing. There is minimal comparative data on outcomes between selective neurectomy and/or myectomy versus chemodenervation.

Objectives: To compare facial synkinesis treatment with chemodenervation compared with surgery as measured by standardized outcome measures.

Methods: A systematic review of three databases was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Included studies used validated facial nerve outcome measurements (patient-graded, physician-graded, or semiautomatic) for chemodenervation or surgical treatment for patients with facial synkinesis. Studies were excluded if free muscle transfer was performed. Meta-analysis was performed on studies using the same outcome measure, and risk of bias assessment was performed using Cochrane Review systems.

Results: In total, 36 studies (1171 total patients) were included in the review. Chemodenervation and surgery both demonstrated benefit as measured by the Facial Clinimetric Evaluation Scale and Sunnybrook scale, without a difference between treatment types (p = 0.76 and p = 0.061, respectively). Synkinesis Assessment Questionnaire scores improved more with chemodenervation than with surgical treatment (mean 15.45 vs. 5.90 improvement, p < 0.0001). For semiautomated objective measurements using Emotrics software, myectomy produced more improvement in dental show compared to neurectomy (13.28 mm vs. -4.89 mm, p < 0.0001) and more oral commissure excursion than neurectomy or chemodenervation (3.79 mm vs. 1.60 mm vs. 1.00 mm, respectively, p < 0.0001).

Conclusions: Although most commonly used together, comparative analysis suggests that selective neurectomy and/or myectomy produce similar improvements in facial synkinesis compared to chemodenervation when assessed with patient surveys or clinician-graded tools. However, high interstudy heterogeneity and confounding covariates limit definitive conclusions, and more data from surgical treatments are needed.

Background: Artificial intelligence (AI) and machine-learning technology are on the rise, including ChatGPT and Google's Gemini, previously known as Bard. While recent studies have begun to explore the role of AI in medicine, there are no studies to date on the application of large language models to facial feminization surgery.

Objective: Establish the reliability of ChatGPT and Google AI (Bard) in providing patient education and describing surgical techniques specific to facial feminization surgery.

Methods: This was a prospective observational study. Both ChatGPT and Bard were queried with 9 questions. The same series of questions was asked 3 months later. Five expert reviewers were asked to rate responses in a blinded fashion using the modified AI-DISCERN criteria. One-way ANOVA and Tukey's HSD were used for analysis.

Results: ChatGPT outperformed Google Bard in areas of harmlessness, truthfulness, relevance, bias, sources, and aims at baseline. However, Bard was often able to resolve this discrepancy in 3 months.

Conclusions: While large language models show promise in disseminating patient education and general information on facial feminization, caution must be exercised reviewing outputs as inaccurate medical content may be encountered. However, repeated exposure seems to improve the quality of responses over time.