The Use of Validated Visual Scales in Plastic Surgery: Where Are We Now?

Background: The assessment of the human body, whether for aesthetic or reconstructive purposes, is an inherently visual endeavor. Ideally, reproducible, prompt, and cost-effective systems of visual evaluation would exist that can provide validated assessments of the aesthetic endpoints of treatment. One method to accomplish a standardization of the appreciation of visual endpoints is the use of visual scales.

Validation of Ideal Breast Characteristics With Breast Augmentation Patients.

Background: Breast augmentation procedures are one of the most commonly performed aesthetic procedures in the United States. Little work has focused on the general public's overall perception of the ideal breast or has validated them with patient photographs.

Objectives: To validate crowdsourced perceptions of breasts with their alignment to the aesthetics of breast augmentation patients.

Public Perception of Ideal Breast Shape.

Background: In the past decade, there has been a dramatic increase in trends related to body-shaping procedures. According to the American Society of Plastic Surgeons, nearly 300,000 breast augmentation procedures were conducted in 2019. Learning the ideal shape of a breast and which esthetics lead to public perception of the most attractive breast is beneficial to properly performing these procedures.

Three-Dimensional Printing for Craniofacial Surgery: A Single Institution's 5-Year Experience.

Background: As 3-dimensional (3D) printers and models become more widely available and increasingly affordable, surgeons may consider investing in a printer for their own cleft or craniofacial center. To inform surgeons considering adoption of this evolving technology, this study describes one multi-surgeon center's 5-year experience using a 3D printer.

Methods: This study included 3D models printed between October 2012 and October 2017.

Surgical Treatment of Nonsyndromic Unicoronal Craniosynostosis.

Purpose: Unicoronal synostosis (UCS) remains one of the most difficult craniofacial conditions to treat. This review attempts to consolidate all existing literature from the past 25 years that has investigated surgical treatment of nonsyndromic UCS. Additional attention is paid to specific areas of controversy regarding surgical management and evaluation of UCS: outcomes of fronto-orbital advancement (FOA) versus endoscopic strip craniectomy (ESC), emergence of spring-associated cranioplasty for craniosynostosis, and morphologic assessment metrics.

Subcranial and orthognathic surgery for obstructive sleep apnea in achondroplasia.

Purpose: Obstructive sleep apnea (OSA) is a common problem in patients with achondroplasia. The purpose of this study was to assess changes in airway volumes following various degrees of facial skeletal advancement.

Methods: This was a retrospective evaluation of patients with achondroplasia who underwent facial skeletal advancement for obstructive sleep apnea.

A Three-Dimensional Study of Midfacial Changes Following Le Fort II Distraction With Zygomatic Repositioning in Syndromic Patients.

Le Fort II distraction with zygomatic repositioning introduced the ability to restore central midfacial height and convexity independent of changes in orbital morphology. This study analyzes midfacial and orbital morphology before and after Le Fort II distraction with zygomatic repositioning.All patients who underwent Le Fort II Distraction with zygomatic repositioning between 2013 and 2015 were included.

Three-dimensional changes in head shape after extended sagittal strip craniectomy with wedge ostectomies and helmet therapy.

OBJECTIVE Outcome studies for sagittal strip craniectomy have largely relied on the 2D measure of the cephalic index (CI) as the primary indicator of head shape. The goal of this study was to measure the 2D and 3D changes in head shape that occur after sagittal strip craniectomy and postoperative helmet therapy. METHODS The authors performed a retrospective review of patients treated with sagittal strip craniectomy at their institution between January 2012 and October 2015.

Adopted children with cleft lip and/or palate: a unique and growing population.

Background: Standard clinical pathways are well established for children with cleft lip and/or palate. Treatment of internationally adopted children differs because of the late age at presentation, a newly evolving child-family relationship, and variable extent and quality of previous treatment.

Methods: The authors characterized the presentation and treatment patterns of all internationally adopted children with clefts at their institution between 1997 and 2011.

Cleft palate repair and velopharyngeal dysfunction.

Learning Objectives: After studying this article, the participant should be able to: (1) Describe the technical details common to all cleft palate repairs that optimize outcomes and minimize complications. (2) Explain the subjective and objective evaluation of speech in children with cleft palate. (3) Practice with an increased awareness of the management of complications associated with cleft palate repair.

Robotic Approaches to Palatoplasty and the Treatment of Velopharyngeal Dysfunction.

The operative techniques used to address palatoplasty and velopharyngeal dysfunction rely on traditional methods of surgical exposure and tissue handling. As the role of robotic surgical systems has expanded, emphasis has shifted from extirpative to reconstructive applications. We discuss the possible role of surgical telemanipulation systems in the treatment of these diagnoses.

The effect of fast-food restaurants on childhood obesity: a school level analysis.

We analyze, using an instrumental variable approach, the effect of the number of fast-food restaurants on school level obesity rates in Arkansas. Using distance to the nearest major highway as an instrument, our results suggest that exposure to fast-food restaurants can impact weight outcomes. Specifically, we find that the number of fast-food restaurants within a mile from the school can significantly affect school level obesity rates.

Interrater reliability of a phenotypic assessment tool for the ear morphology in microtia.

The Elements of Morphology Standard Terminology working group published standardized definitions for external ear morphology. The primary objective of our study was to use these descriptions to evaluate the interrater reliability for specific features associated with microtia. We invited six raters from three different subspecialities to rate 100 ear photographs on 32 features.

An assessment of the risks and benefits of immediate autologous breast reconstruction in patients undergoing postmastectomy radiation therapy.

Background: The utility of immediate autologous breast reconstruction in patients likely to undergo radiation therapy remains controversial. The purpose of this study was to perform a quantitative outcomes assessment of patients undergoing immediate free-flap breast reconstruction and postmastectomy radiation therapy (PMRT).

Methods: A retrospective chart review was performed of patients undergoing free-flap breast reconstruction by the senior authors (L.

Does conventional posterior vault remodeling alter endocranial morphology in patients with true lambdoid synostosis?

Background: True lambdoid synostosis (TLS) produces a consistent morphology that includes occipital flattening, an ipsilateral occipitomastoid prominence, and a mild contralateral hemifacial deficiency that minimally improves with surgery. Prior studies have demonstrated that dysmorphic middle and posterior cranial fossae contribute to the craniofacial scoliosis characteristic of TLS. We hypothesize that these endocranial features remain after surgery, causing the persistent hemifacial deficiency seen in these patients.

Application of a robotic telemanipulator to perform posterior pharyngeal flap surgery: a feasibility study.

Background: The instrumentation used during surgery to address velopharyngeal dysfunction has changed little over the past century. Recent advances in the use of robotic surgical systems in transoral surgery have expanded the use of these instruments beyond their traditional laparoscopic applications. The purpose of this study was to evaluate the feasibility of performing superiorly based, "Hogan"-style posterior pharyngeal flaps using a robotic surgical telemanipulator system.

Extended trimethoprim/sulfamethoxazole prophylaxis for implant reconstruction in the previously irradiated chest wall.

Background: Patients who have undergone prior chest wall irradiation can present as challenging candidates for implant reconstruction because of troublesome rates of infectious complications. The issue of antibiotic prophylaxis remains controversial, and evidence-based postoperative strategies to reduce implant infections have not been well described in the literature. The purpose of this study was to determine the efficacy of extended trimethoprim/sulfamethoxazole therapy in preventing implant infections in the irradiated chest wall.

Does previous chest wall irradiation increase vascular complications in free autologous breast reconstruction?

Background: Prior radiation therapy to the chest, in theory, has a detrimental impact on the recipient vessels in breast reconstruction and may impact microvascular success. The purpose of this study was to determine whether prereconstruction radiation therapy affects the rate of vascular complications in free flap breast reconstruction.

Methods: This was a retrospective review of free flap breast reconstruction performed between 2005 and 2009 by the senior authors.

Analysis of differences in the cranial base and facial skeleton of patients with lambdoid synostosis and deformational plagiocephaly.

Background: Earlier investigations suggest that the morphologic features of patients with lambdoid synostosis include ipsilateral occipital flattening, an ipsilateral mastoid prominence, downward cant of the posterior skull base to the affected side, and contralateral hemifacial deficiency. These features are absent in patients with deformational plagiocephaly. The authors hypothesize that significant differences in craniofacial morphology exist between patients with lambdoid synostosis and those with deformational plagiocephaly.

The modified V-Y dorsal metacarpal flap for repair of syndactyly without skin graft.

Background: Syndactyly repairs that use full-thickness skin grafts risk graft-related complications. The dorsal V-Y advancement flap offers a method of syndactyly release that can eliminate the need for full-thickness skin grafts in some cases of simple syndactyly.

Methods: A retrospective case series of all patients undergoing syndactyly release without skin grafting performed by the senior author (B.

500 Consecutive patients with free TRAM flap breast reconstruction: a single surgeon's experience.

Background: This study reports on the longitudinal experience and outcomes of one surgeon performing free transverse rectus abdominis musculocutaneous (TRAM) flaps on 500 consecutive patients between 1992 and 2003.

Methods: A retrospective review of hospital and outpatient records was performed. Specific risk factors for successful reconstruction were reviewed, including American Society of Anesthesiologists class, obesity, smoking, medical comorbidities, and irradiation and chemotherapy history.

Nitric oxide stimulates proliferation and differentiation of fetal calvarial osteoblasts and dural cells.

Background: Infant dura mater plays a critical role in calvarial development. This investigation examines the expression of nitric oxide synthase isoforms in the craniofacial skeleton and the influence of nitric oxide signaling on the growth and differentiation of fetal dural and calvarial bone cells.

Methods: Sections of fetal and adult calvaria were evaluated for endothelial and inducible nitric oxide synthase expression by immunohistochemistry.