Facial Plastic Surgery & Aesthetic Medicine最新文献

Introduction: Bell's palsy, an idiopathic peripheral facial palsy, often resolves naturally but can benefit from electric stimulation therapy. However, efficacy and safety during the acute stage remain controversial and understudied. Objective: To measure the effectiveness of electrical stimulation therapy as an add-on treatment for patients in the acute stage of Bell's palsy, as measured by incomplete recovery rates. Methods: We searched nine databases for randomized controlled trials comparing add-on electric stimulation therapy with usual care or placebo in patients within 7 days of Bell's palsy onset. The primary outcome was incomplete recovery. Risk of bias was assessed using Cochrane RoB 2 tool, with results synthesized via random-effects meta-analysis and evidence certainty evaluated using GRADE. Results: Fourteen studies encompassing 1,311 participants were included. Electric stimulation therapy plus usual care reduced incomplete recovery rates compared with usual care alone (risk ratio 0.65, 95% CI: 0.48-0.88; 13 trials, n = 1,191; moderate certainty). The effect persisted after excluding six studies with a high risk of bias. Conclusion: Add-on electric stimulation therapy during acute Bell's palsy may reduce incomplete recovery risk. However, results had moderate certainty with limitations including risk of bias and short follow-up durations.

Introduction: Facial paralysis secondary to skull base recurrences or facial nerve tumors presents a significant challenge, as tumor resection usually worsens facial function. Objective: The aim of this study is to show an alternative approach, ensuring facial reanimation irrespective of the evolution of the tumor, the so-called "take the facial nerve out of the picture." Methods: Retrospective study of patients with a skull base recurrence or a facial nerve tumor who underwent facial reanimation prior to tumor management. Facial function was assessed using the House-Brackmann and Sunnybrook Facial Grading Scale. Results: Four patients with skull base recurrences and eight with facial nerve tumors underwent facial reanimation with nerve transfers (n = 11) and a microvascular flap (n = 1) before tumor treatment. In all cases, facial function improved to House-Brackmann grades III or IV, with improvement of average Sunnybrook Facial Grading Scale scores from 25.25 (standard deviation [SD] 20.45) to 57.67 (SD 10.3) (p = 0.004). Three patients with skull base recurrence underwent tumor resection uneventfully, while the eight patients with facial nerve tumor remain observed. Conclusions: Early facial reanimation can preserve long-term facial function, facilitate tumor resection, and provide flexibility in managing complex skull base recurrences and facial nerve tumors.

Women surgeons face disproportionately high rates of burnout, depression, and suicide, with a shortened life expectancy compared with those outside of medicine. These outcomes are driven by systemic inequities rather than individual shortcomings. Despite equal representation in medical school, women remain underrepresented in leadership, overburdened by domestic responsibilities, victims of sexual harassment and biases, and inadequately supported by our institutions. These challenges lead to decreased career satisfaction and higher attrition rates. The overuse of terms such as "burnout" without meaningful action has left many of us feeling acknowledged but unsupported. To improve both career and health longevity, we must focus on system-level reform utilizing evidence-based interventions, including paid parental leave, access to childcare and lactation policies, harassment protections, flexible work structures, mentorship, and leadership development. Addressing these barriers is not only essential for gender equity but also pivotal to outstanding patient care.

Background: There is a paucity of validated, patient-reported outcome measures for quality-of-life (QOL) in craniomaxillofacial (CMF) trauma. Objective: To determine whether the Integrated Modular Patient-Reported Outcome Assessment for Craniomaxillofacial Trauma (IMPACT) independently measures QOL in patients presenting for routine follow-up within 3 months of injury by comparing with the 15-Dimension QOL survey (15D). Methods: A mixed-methods, pilot validation was performed via literature review, expert opinion, patient interviews, and prospective survey collection. Criterion validity was determined by multivariable adjusted correlation coefficients (B) between IMPACT and 15D scores. Reliability was assessed by Cronbach's alpha (A). Results: General (IMPACT-G), Nasal (IMPACT-N), Orbit (IMPACT-O), and Jaw (IMPACT-J) modules were developed. Domains include overall satisfaction, facial function, facial appearance, psychosocial function, general symptoms, and pain. Validation was performed in 53 patients with CMF trauma who had mandible (n = 27, 50.1%), nasal (n = 10, 18.9%), zygomaticomaxillary complex (n = 7, 13.2%), Le Fort (n = 6, 11.3%), and/or other fracture patterns. IMPACT scores independently predicted QOL (B > |0.4|; p < 0.05) and reliability was high (A >0.8; p < 0.05). Conclusions: The IMPACT was developed to measure QOL in patients suffering CMF trauma, and results from this initial validation study warrant expansion to a larger, diversified cohort.