Facial Plastic Surgery & Aesthetic Medicine最新文献

Background: A systematic comparison between the preservation rhinoplasty (PR) and the conventional structural rhinoplasty (SR) technique for hump nose correction is still lacking. Objective: To compare among patients undergoing rhinoplasty for dorsal hump correction using structural versus preservation techniques, as measured by functional and cosmetic patient-reported outcomes. Methods: Comprehensive literature search was conducted across PubMed, Medline, Embase, and Cochrane databases using medical subject heading terms. Among patients undergoing dorsal hump reduction, we analyzed randomized controlled trials (RCTs) comparing PR and SR to assess functional and cosmetic satisfaction using the Standardized Cosmesis and Health Nasal Outcomes Survey, and the visual analogue scale. Results: Among the 38 studies initially screened, four RCTs with 419 patients met the inclusion criteria. PR showed significant superiority over SR in both functional (standardized mean difference or SMD -0.317 [95% confidence interval or CI -0.509 to -0.124]) and cosmetic (SMD -0.460 [95% CI -0.851 to -0.069]) outcomes. Functional outcomes exhibited low heterogeneity (I² = 0%), while cosmetic outcomes showed moderate heterogeneity (I² = 67%). Conclusion: In this review, the data suggest that PR might provide both functional and cosmetic satisfactions in dorsal hump reduction compared with SR.

Importance: Bell's palsy (BP) is reported as the most common cause of facial paralysis, yet literature lacks a standardized definition of BP. Objective: To identify and categorize how the term "Bell's palsy" is defined and applied in published medical literature. Evidence Review: Randomized controlled trials, clinical trials, systematic reviews, meta-analyses, and reviews containing "Bell's palsy" were identified in MEDLINE, Embase, and CENTRAL databases from inception until April 2, 2024. Articles were indexed by their definition of BP: (1) acute (≤72-h onset) idiopathic facial paralysis with no known etiologies, (2) acute "idiopathic" facial paralysis despite providing etiologies, (3) acute non-idiopathic facial paralysis, (4) non-acute but "idiopathic" facial paralysis with or without providing etiologies, (5) synonymous with facial paralysis, and (6) no definition. Ascribed etiologies were recorded. Original articles' exclusion criteria for patients with BP were also categorized. Findings: Of 4,395 articles obtained, 924 met the criteria. Based on the aforementioned categories, incongruent definitions of BP exist in the literature: (1) 12.88%, (2) 14.72%, (3) 4.00% (4) 15.26%, (5) 8.12%, and (6) 45.02%. Ascribed etiologies and exclusion criteria for BP also varied. Conclusions and Relevance: BP is a common condition seen by providers of many specialties, and as such patient diagnosis, management, and research rely on consistency and a shared language. This systematic review found inconsistent definitions and applications of the term "Bell's palsy" in the literature.

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.