Facial Plastic Surgery & Aesthetic Medicine最新文献

Background: Functional rhinoplasty often relies on repurposed cartilage for nasal framework grafting. Objective: To compare complications in functional rhinoplasty associated with use of autologous versus fresh frozen cadaveric rib cartilage (FFCR). Methods: This retrospective cohort study included patients who underwent functional rhinoplasty from 2017 to 2022 with 6 months of documented follow-up. The primary outcome measure was need for revision rhinoplasty. Secondary outcomes were infection and persistent nasal obstruction without revision surgery. Chi-squared and Fisher's exact tests were used for univariate analysis, and multivariable logistic regression was used to evaluate the relationship between revision surgery and covariates. Results: 259 patients (average age: 43.1 ± 16.2, 185/259 female [71.4%]) underwent functional rhinoplasty with an average of 12.3 months (range: 6-54 months) of documented follow-up. A total of 58 (22.4%) cases utilized FFCR for grafting. Overall, 15 (5.8%) patients required revision rhinoplasty (8/201 [4.0%] autologous versus 7/58 [12.1%] FFCR), while 17 (6.6%) had persistent postoperative nasal obstruction without further surgery and 12 (4.6%) had an infection requiring prescribed oral antibiotics or drainage. Compared to autologous cartilage, there was a significant association between the use of FFCR with revision rhinoplasty on logistic regression (p = 0.024, odds ratio: 4.0 [95% confidence interval: 0.17-2.61]) but not with postoperative infection (p = 0.101) or persistent nasal obstruction (p = 0.187). Conclusion: These findings suggest increased rates of revision surgery associated with the use of FFCR in functional rhinoplasty. In the setting of insufficient autologous cartilage, tailored discussions should take place regarding the risks and benefits of potential supplemental graft material.

Experts in our field have previously issued guidelines to optimize the safety of filler injections. Despite the risks, a growing online trend of at-home self-injection of fillers in the face is putting patients in danger. This article reviews the acute clinical presentation and treatment protocol provided to a 49-year-old female who presented to the emergency department with acute vascular injury, just 3 h after injecting herself in the lips. This case highlights the importance of rapid detection of early signs of vascular injury and impending tissue necrosis. Based on the most recent literature, we share our protocol and its efficacy for this specific case. The fast-growing popularity of fillers in the beauty industry and the availability of online content and videos on how to perform self-injections likely give a false sense of safety to patients. Physician awareness is essential to prevent serious complications in our patient population. A strong knowledge of facial anatomy, the use of FDA approved products, and having the procedure performed by a trained medical professional are key elements to successful and safe filler injection.

Background: Treatment of head and neck cancer with radiation can cause osteoradionecrosis of the mandible (MORN), requiring removal of nonviable bone and free flap reconstruction. Objective: To compare surgical outcomes in patients with MORN treated with free tissue transfer who received hyperbaric oxygen therapy (HBO) to those who did not, measured by flap failure, nonunion, plate exposure, and postoperative infections. Methods: This retrospective cohort study evaluated 311 patients with advanced MORN treated at a single tertiary care academic center with segmental mandibulectomy and free flap reconstruction. One group received HBO preoperatively and postoperatively; the other group did not. Postoperative complications were compared using chi-square test or Fisher's exact test. Results: This study included 311 patients, 131 HBO group (74% male, 26% female, mean age 75.6 years), 180 in the non-HBO group (73% male, 27% female, mean age 76.3 years). Postoperative metrics included; complete flap failure (HBO = 4, non-HBO = 2), partial flap failure (HBO = 2, non-HBO = 3), nonunion (HBO = 10, non-HBO = 14) exposed plate (HBO-7, non-HBO = 8), wound infections treated surgically (HBO = 2, non-HBO = 7), wound infections treated with antibiotics alone (HBO = 5, non-HBO = 12). No differences were identified between groups. Conclusion: We found no difference in rates of postoperative complications between the HBO group and the non-HBO group.