Objective: Mandibular osteoradionecrosis (MORN) is a morbid complication of head and neck radiation therapy. Recent advances in surgical and medical therapies underscore the need for a shift in traditional treatment paradigms and a disease grading system that can guide appropriate management.
Data Sources: Pubmed/MEDLINE.
JAMA Otolaryngol Head Neck Surg
August 2024
Facial Plast Surg Aesthet Med
November 2024
Treatment of Bell's palsy ranges from medical management with high-dose corticosteroids to complex facial reanimation procedures. To characterize the number of static, dynamic, and combined facial reanimation procedures for the management of Bell's palsy using a national database over time. This retrospective cohort study included patients in the 2013-2020 National Surgical Quality Improvement Project database with a postoperative diagnosis of Bell's palsy.
View Article and Find Full Text PDFObjectives: To characterize the effect of facial reanimation using masseteric nerve transfer on the masseter muscle itself, examining whether there is any demonstrable atrophy postoperatively.
Methods: Electronic medical records of adult patients who underwent facial reanimation using masseteric nerve transfer at our institution over a 15-year period were reviewed. To account for the impact of postoperative radiation, randomly selected patients who underwent radical parotidectomy without nerve transfer and received postoperative radiation served as controls in a 1:1 fashion against those who underwent masseteric nerve transfer with postoperative radiation.
Facial Plast Surg Clin North Am
May 2024
A successful nasal reconstruction relies heavily on a stable internal lining. Larger defects pose unique challenges for internal lining reconstruction as obtaining tissue of adequate size while maintaining airway patency is difficult. The prelamination technique uses a staged skin graft to the paramedian forehead flap prior to transfer.
View Article and Find Full Text PDFObjective: To estimate and adjust for rater effects in operating room surgical skills assessment performed using a structured rating scale for nasal septoplasty.
Methods: We analyzed survey responses from attending surgeons (raters) who supervised residents and fellows (trainees) performing nasal septoplasty in a prospective cohort study. We fit a structural equation model with the rubric item scores regressed on a latent component of skill and then fit a second model including the rating surgeon as a random effect to model a rater-effects-adjusted latent surgical skill.
Pediatric facial palsy is rare but severely debilitating and results in profound functional, developmental, psychosocial, and esthetic consequences. Identifying the specific cause of the palsy is important in directing the treatment course. The most common etiologies of pediatric facial palsy are distinct from those of adults.
View Article and Find Full Text PDFJ Plast Reconstr Aesthet Surg
December 2023
The purpose of this review was to study the evaluation, diagnosis, and management of ophthalmic complications associated with facial nerve palsy and to discuss the current and future interventions. The ophthalmic complications of facial paralysis include lagophthalmos, ectropion, exposure keratopathy, ocular synkinesis, and crocodile tears. Evaluation by an ophthalmologist skilled in recognizing and managing complications of facial paralysis shortly after its initial diagnosis can help identify and prevent long-term complications.
View Article and Find Full Text PDFJ Plast Reconstr Aesthet Surg
December 2023
This review aims to summarize recent studies regarding the specific modalities of physical therapy as a form of treatment for patients with facial paralysis, analyze the different components of physical therapy, and provide healthcare providers with guidance for their best practice in treating patients with facial paralysis. This paper will discuss the mechanism, indications, and impact factors for facial retraining, evaluate the standards for facial retraining, the creation of a treatment plan, and analyze the combined use of facial retraining with botulinum toxin injections and the application of facial retraining in post facial reanimation patients. Other modes of physical therapy, including electrical stimulation, dry needling, and acupuncture, will be addressed.
View Article and Find Full Text PDFOtolaryngol Head Neck Surg
November 2023
Objective: Little is known about pricing for reconstructive procedures of the head and neck. As of January 2021, the Centers for Medicare and Medicaid Services requires hospitals to disclose payer-negotiated prices for services, offering new insight into prices for privately insured patients.
Study Design: Cross-sectional analysis.
J Plast Reconstr Aesthet Surg
August 2023
Facial nerve function is essential for a multitude of processes in the face, including facial movement; expression; and functions, such as eating, smiling, and blinking. When facial nerve function is disrupted, facial paralysis may occur and various complications for the patient may result. Much research has been conducted on the physical diagnosis, management, and treatment of facial paralysis.
View Article and Find Full Text PDFUnderstanding the purpose and process of obtaining intellectual property rights (IPR) is fundamental to health care innovation. Facial plastic and reconstructive surgeons are natural innovators; however, knowledge deficit in this space may hinder the ability to move ideas from the "bench to bedside." Here we provide an overview of IPR, outlining the steps necessary to obtain intellectual property protection in an academic setting while highlighting recent U.
View Article and Find Full Text PDFImportance: The management of vestibular schwannoma may include observation, microsurgical resection, or radiation of a tumor near the facial nerve. Injury to the facial nerve can result in facial paralysis with major functional, social, and psychological sequelae, and the experiences of patients after paralysis are not well studied.
Objective: To (1) identify patient preparedness for developing facial paralysis and how well their care is coordinated following its development and (2) present in their own words outcomes of facial paralysis in terms of physical health, emotional health, self-perception, and social interactions.
Objective: In 2013, the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) published guidelines for Bell's palsy (BP), including recommendations for workup, management, and specialist referral. Patients with BP often present to primary care; however, adherence to guidelines may vary by setting. This study sought to evaluate the management of patients with BP presenting to primary care, emergency department (ED), and urgent care settings.
View Article and Find Full Text PDFTraditional techniques of facial reanimation using gracilis free tissue transfer do not address the lower eyelid or provide contraction at the site of orbicularis oculi, which is necessary to create a natural appearing Duchenne smile. In this report, we describe a novel technique to achieve this element of a true mimetic smile using a tri-vector gracilis muscle flap. To describe a novel gracilis free flap technique for facial reanimation to provide contraction of the inferior and lateral orbicularis oculi and achieve a Duchenne smile.
View Article and Find Full Text PDFFacial Plast Surg Aesthet Med
November 2022
The relationship between the value of reconstructive surgery and the visual attention drawn by facial deformity has not been studied. We hypothesized that willingness to pay (WTP) for reconstructive surgery would increase as visual attention to deformity increased in a Mohs defect eye-tracking model. We conducted a randomized observational study.
View Article and Find Full Text PDFFacial Plast Surg Aesthet Med
November 2022
Surgeons must select cases whose complexity aligns with their skill set. To determine how accurately trainees report involvement in procedures, judge case complexity, and assess their own skills. We recruited attendings and trainees from two otolaryngology departments.
View Article and Find Full Text PDFBackground: Hypertension has been shown to be both a protective factor and a risk factor for complications in head and neck reconstructive surgery.
Methods: Retrospective analysis of microvascular free tissue transfer patients using the National Surgical Quality Improvement Program database.
Results: Hypertensive patients (n = 1598; 46.
Facial Plast Surg Clin North Am
August 2021
Temporalis tendon transfer (T3) and gracilis free muscle transfer (GFMT) are popular techniques in lower facial rehabilitation when reinnervation techniques are unavailable. T3 involves a single-stage outpatient procedure resulting in immediate improvement in resting symmetry and a volitional smile. GFMT allows a spontaneous smile, customized vectors, and increased excursion but requires longer surgical time, a delay before movement, and specialized equipment.
View Article and Find Full Text PDFDrug repurposing has the advantage of identifying potential treatments on a shortened timescale. In response to the pandemic spread of SARS-CoV-2, we took advantage of a high-content screen of 3,713 compounds at different stages of clinical development to identify FDA-approved compounds that reduce mucin-1 (MUC1) protein abundance. Elevated MUC1 levels predict the development of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) and correlate with poor clinical outcomes.
View Article and Find Full Text PDFFacial paralysis is a clinical condition associated with significant functional and psychosocial morbidity (Facial Plast Surg FPS. 2011;27(4):346-57). The management paradigm for this condition continues to evolve with the use of both surgical and nonsurgical strategies (Facial Plast Surg FPS.
View Article and Find Full Text PDFFacial Plast Surg Aesthet Med
August 2021
The free functional gracilis flap (FFGF) is a versatile procedure in reanimating the paralyzed face, yet its application in seniors is limited by perceptions of morbidity and inefficacy. The study objective was to compare the morbidity and effectiveness of FFGF reanimation among senior and younger patients. A retrospective chart review was performed on 20 consecutive patients aged 60 years and above (seniors) and 35 patients aged 40 years and below (juniors) who underwent FFGF for facial reanimation.
View Article and Find Full Text PDFObjectives: Free tissue reconstruction of the head and neck must be initially overcorrected due to expected postoperative free flap volume loss, which can be accelerated by adjuvant radiation therapy. In this study, we aim to identify patient and treatment-specific factors that may significantly contribute to this phenomenon and translate these characteristics into a predictive model for expected percent free flap volume loss in a given patient.
Methods: Patients with a history of oral cavity and/or oropharyngeal cancer who underwent nonosseous free flap reconstruction were reviewed between January 2009 and November 2018 at a tertiary care center.
There is considerable variation in the surgical management of patients with large facial defects after excision of skin malignancy. The surrounding facial subunits as well as local, regional, and distant soft-tissue flaps can be considered in more complicated facial defects. We place an emphasis on the versatility of adjacent tissue advancement and transposition flaps in the treatment of these defects.
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