Double-exposure duplication of preoperative and postoperative 2 X 2 transparencies.

Before and after photographs in plastic surgery are an essential part of the patient's record. They also provide visual data to supplement both primary and continuing education lectures. When successive photographs are used in lectures, a sharp visual memory is required to compare effectively the preoperative and postoperative photograph. The method presented in this article uses a specially constructed frame used as an accessory for one of the common commercial slide copiers. This device makes it possible to copy, duplicate, and frame preoperative and postoperative 2 X 2 transparencies onto a single 2 X 2 transparency without any additional work on the original, such as framing, cutting, and remounting. This technique leaves the original preoperative and postoperative 2 X 2 transparency slides intact for possible use elsewhere in the same lecture or subsequent lectures on the same subject.     

A computer-based method of filing photographs and procedures

Careful preoperative and postoperative photographs are an essential part of facial plastic surgery for medical and legal documentation, publication, patient education, and lectures. Computers play an increasing role in many aspects of the medical practice. A method of filing photographs and procedures and a related data base system allows rapid access by multiple factors, including name, procedure, age, surgeon, assistants, anesthetic, complications, dates of all photographs, multiple procedure subheadings, and so on. Additional variables can be added as a date base for analysis of operation results and postoperative recall of patients. This system is based on a personal computer (IBM-PC Computer) and readily available software. The system allow simple entry and retrieval of photographs on any of the multiple variables. We found it to be a superb adjunct to photography in facial plastic and reconstructive surgery.     

Profile analysis in facial plastic surgery

We devised a simple and reliable method of profile analysis for facial plastic surgery. Profile photographs are taken with the natural head position technique. Key cephalometric landmarks are then identified and digitalized from either photographs or slides, using a digitalizer with a resolution of 0.001 in. The digitalizing pad is connected to a microcomputer. The menu-driven software allows selection of multiple functions from different cephalometric systems. Data can be stored on disk for future analysis. The method is useful in preoperative planning and postoperative evaluation of facial plastic surgery procedures.     

Extensive intratemporal cholesteatoma: surgical strategy

OBJECTIVE: To evaluate the decisional elements in the surgical strategy for extensive intratemporal cholesteatomas. STUDY DESIGN: A retrospective review of cases followed up between 1985 and 1996. SETTING: Tertiary referral center. PATIENTS: Nineteen patients with temporal bone cholesteatoma extending beyond the middle ear limits and surgically treated were included. Preoperative imaging distinguished apical (8), infralabyrinthine (3), supralabyrinthine (3), retrolabyrinthine (1), and translabyrinthine (4) cholesteatomas. INTERVENTION: Apical and supralabyrinthine lesions were treated through a middle fossa approach. Infralabyrinthine and translabyrinthine locations were exposed through a subtotal petrosectomy or a transotic route, depending on the preoperative audiovestibular status and labyrinthine destruction on computed tomography. The retrolabyrinthine lesion was approached through a retrolabyrinthine route. MAIN OUTCOME MEASURES: Patients were assessed for postoperative audiologic and facial functions and for recurrence of tumor. RESULTS: The facial nerve was neither rerouted nor interrupted during surgery. Among the 12 patients with preoperative facial palsy (FP), 5 cases of improvement (42%), 6 cases of stable function (50%), and 1 case of mild deterioration (8%) were observed postoperatively. In patients without preoperative FP, facial function remained unchanged postoperatively. The labyrinth could be preserved in three patients (16%), with postoperative stable hearing function in two (11%), and a 40-dB mean auditory deterioration in one (5%). Complete macroscopic resection was obtained in all patients. Two cases (11%) of postoperative recurrence were observed. CONCLUSION: The surgical strategy, principally based on cholesteatoma location and preoperative auditory function, yielded a high rate of local disease control and facial function preservation.     

Acoustic neuroma: postoperative quality of life.

OBJECTIVE: Evaluating patients who have had surgical management of acoustic neuroma has relied heavily on the surgeon's viewpoint for determining success. However, the perspective of the surgeon may be different from that of the patient. Thus, a recent increased interest in terms of quality of life has been documented by the literature on this specific topic essentially through the use of a questionnaire. The objective of this paper was to review this topic in our series of patients operated on for acoustic neuroma to ascertain the personal and social impact that surgery has had on their lifestyle. DESIGN: This retrospective study was devoted to increasing statistics to provide more detailed and valid information during the counselling phase. METHODS: This study was carried out on 82 patients who underwent surgery for acoustic neuroma between 1988 and 1997. Each patient was recalled and assessed for his/her postoperative quality of life. Detailed information was requested on the initial postoperative facial, vestibular, and hearing functions; their evolution; and their social consequence. Finally, at the end of the interview, each patient was invited to give a final comment on his/her opinion regarding the outcomes of surgery and preoperative information. RESULTS: Facial function showed a grade I-III in 85.4% of cases, with postoperative neurovegetative dysfunction (taste and lacrimation) in 43%. Audiologic abnormalities (worsening hearing and tinnitus) were complained of in 90% and 57% of the cases, respectively. Twenty-three percent of the patients had various degrees of gait instability; 6% reported postoperative headache at 1-year follow-up. Social consequence (reduced work ability, vocational change, new education, state pension, etc.) was not influenced by surgery in 80%. CONCLUSIONS: Our experience is in general agreement with previously reported statistics. It is interesting to note that our patients exhibited more disturbances linked to the sensory component of facial nerve. In contrast, dysequilibrium had a less negative influence. These outcomes suggest the importance of thorough preoperative counselling in candidates for surgery for acoustic neuroma in order to motivate them and, at the same time, to reduce their psychological discomfort.     

Intracanalicular meningioma: clinical features, radiologic findings, and surgical management.

OBJECTIVE: Intracanalicular meningiomas are extremely rare, and only 36 cases have been reported to date. The aim of this study is to describe the clinical, radiologic, and histopathologic features of 13 intracanalicular meningiomas highlighting important aspects of tumor diagnosis and treatment. STUDY DESIGN: Retrospective study. SETTING: Quaternary referral otology and cranial base private center. PATIENTS: Thirteen consecutive patients with pathologically confirmed intracanalicular meningioma surgically treated between December 1988 and July 2006. The follow-up of the series ranged from 13 to 60 months. INTERVENTIONS: Nine patients with unserviceable hearing were operated on through the translabyrinthine approach. Four patients underwent enlarged middle cranial fossa approach with the intention of preserving their hearing. RESULTS: Total tumor removal was achieved in all cases. The postoperative facial nerve function was either excellent or good (House-Brackmann Grade I or II) in 10 cases (77%) and acceptable (Grade III) in one case. Two patients with preoperative facial paresis showed no improvement in their facial nerve function. In patients who underwent surgery via the enlarged middle cranial fossa, hearing was preserved at the preoperative level in two cases, but serviceable hearing was lost in the remaining two. CONCLUSION: Primary meningiomas of the internal auditory canal are extremely rare. On account of a lack of specific symptoms and the limited diagnostic findings, preoperative diagnosis of intracanalicular meningioma still represents a diagnostic challenge. Intraoperative findings may help in differentiating meningiomas from other intracanalicular lesions.     

Total skeletal reconstruction of the nasal dorsum

OBJECTIVE: To review the outcomes of rhinoplasty in patients who underwent full-length dorsal reconstruction. DESIGN: Retrospective review. SETTING: Private-practice facial plastic surgery clinic. Patients Thirty-seven patients in a consecutive series of 1273 rhinoplasty cases. INTERVENTIONS: In all patients, a single high-density porous polyethylene implant was used to span the full length of the nasal bridge as part of their rhinoplasty reconstruction. MAIN OUTCOME MEASURES: Retrospective review of medical charts and preoperative and postoperative photographs to identify any complications, including infection, extrusion, movement, or displacement, and examination of the aesthetic outcome. A telephone survey was performed to assess patient satisfaction regarding the appearance and sensation of the nose. RESULTS: In all cases, the full-length dorsal implant provided a smooth bridge contour without leaving an inverted V deformity or focal irregularities. There were no cases of infection or extrusion. In 2 cases, revision surgery was required to enhance cosmetic outcome. CONCLUSIONS: The high rate of patient acceptance, safety, and success of full-length dorsal reconstruction in providing a natural frontal contour challenges the minimal indications for using this type of reconstruction as opposed to using smaller grafts. As with all alloplasts, long-term follow-up is required.     

HIV-associated facial lipoatrophy: establishment of a validated grading scale

OBJECTIVE: HIV-associated lipodystrophy is considered a sequela of highly active antiretroviral treatment. We describe the characteristics, possible etiology, and pathophysiology of HIV-associated lipodystrophy and facial lipoatrophy and establish a validated grading scale for HIV-associated facial lipoatrophy using evidence-based techniques. DESIGN/METHODS: A grading scale was designed based on the severity of each patient's facial lipoatrophy. Preoperative photographs of HIV-infected patients seeking treatment for facial lipoatrophy and control subjects were reviewed by physicians qualified in facial plastic surgery. With use of the devised grading scale, each patient was assigned a severity score. These scores were then compared for interrater variability, and the distribution of scores was analyzed. RESULTS: Preoperative photographs of 39 HIV-infected individuals with facial lipoatrophy and 6 normal subjects were obtained and reviewed. All patients were males. A Cohen kappa of 0.73 was calculated, and there was a fairly equal distribution of all severity grades throughout the 39 patients. CONCLUSION: HIV-associated facial lipoatrophy is a major stigma for HIV patients that can have dramatic effects on their self-esteem, social habits, and medication compliance. This current study introduces a validated evidence-based grading scale that can be implemented to categorize disease severity. Using this scale will hopefully generate improved treatment plans directed to each patient, which should produce enhanced postoperative results.     

The role of computer imaging in facial plastic surgery consultation: a clinical study

The influence of using computerized visual communication on preoperative communication between the surgeon and the patient was analysed. This was a retrospective study based on a questionnaire completed by 50 patients who had undergone various facial plastic surgical procedures. Prediction tracings and postoperative slides were compared by the surgeon. The role of computer imaging in communication between doctor and patient, as well as the patient–doctor relationship and trust in the judgement of the doctor was considered to be positive by most of the patients. The vast majority of patients thought computer imaging should be a routine part of preoperative evaluation. Both the surgeon and the patients agreed that the representative value of prediction tracing was about 80%. In view of the possible positive influences on communication and relationship in the preoperative phase, computer imaging may help to provide a clear and realistic preoperative informed consent.     

影像导航下视神经减压术治疗外伤性视神经病

目的探讨影像导航下视神经减压术治疗外伤性视神经病（TON）的临床特点和预后影响因素。方法回顾性分析自2015年1月—2018年12月山西医科大学第二医院收治的20例TON患者的临床资料。通过单因素分析和非条件Logisitic回归分析评估不同因素对TON治疗效果的影响。结果术后随访3个月至1年,总有效率为60.0％（12/20）,其中术前有光感及以上者有效率为100.0％（6/6）,无光感者有效率为42.9％（6/14）。受伤1周内手术者,有效率75.0％（9/12）。术前CT显示视神经管骨折者,有效率为22.2％（2/9）。单因素与多因素结果均显示：术前视力、CT显示视神经管骨折是患者手术预后的影响因素。结论鼻内镜下视神经减压术是治疗TON的有效手段。术前有光感及以上是视力改善的保护性因素,术前CT显示视神经管骨折是视力无改善的危险性因素。对于伴有复杂颅面部外伤的患者,影像导航的应用可以达到精准定位,有效减压的目的,从而提高手术疗效,值得推广。     

飞秒激光小切口基质透镜取出术后早期视力恢复的相关因素分析

目的 探讨飞秒激光小切口角膜基质透镜取出术(SMILE)术后早期视力恢复的相关因素,以期为SMILE手术方案提供临床依据。 方法 回顾性分析2016年1月至2016年8月行SMILE手术的64例近视及近视散光患者共128只眼的临床资料,记录术后1 d、术后1周的裸眼视力(UCVA)。术后视力与年龄、性别、术前预矫等效球镜度(SE)、K值、中央角膜厚度(CCT)、术后残余基质床厚度(RST)、切削比(AD/CT)之间进行相关分析。 结果 术后1 d 30.4%眼裸眼视力达到0.8以上,10.2%眼裸眼视力达到1.0以上,约5.5%的眼裸眼视力达到术前最佳矫正视力(BCVA);术后1周90.6%裸眼视力达到0.8以上,64.1%达到1.0以上,约33.6%的眼裸眼视力达到术前BCVA。术后第1天、第7天视力与年龄、性别、K值、CCT、屈光度、RST、AD/CT之间均无明显相关性。 结论 SMILE术后早期视力恢复可能与术后早期角膜的炎性及创伤愈合反应及术后角膜微结构的变化有关。     

A meta-analysis of pre- and postoperative corticosteroids for reducing the complications following facial reconstructive and aesthetic surgery

IntroductionEdema and ecchymosis after facial plastic surgery are a troublesome concern for both patients and surgeons. Corticosteroid administration is thought to shorten the recovery period and reduce these sequelae. Data regarding the efficacy of corticosteroid administration remains controversial among surgeons.ObjectiveWe conducted this systematic review and meta-analysis to determine the effect of pre- and postoperative corticosteroids on postoperative complications in patients undergoing facial reconstructive surgery supported with different subgroup analysis.MethodsA comprehensive literature search of articles was conducted in PubMed, Cochrane Central, SCOPUS, and EBSCO through October 2019. We included all clinical trials in which patients underwent any type of facial plastic surgery to study the effect of corticosteroids on postoperative complications. We performed subgroup analysis according to the types and doses of corticosteroid preparation, in addition to a subgroup analysis of pre- or postoperative corticosteroid usage. All statistical analysis was performed using the RevMan software.ResultsNineteen studies were included in this systematic review, but only 10 of them were eligible for meta-analysis. The periorbital edema and ecchymosis scores were significantly reduced in the corticosteroids group compared to placebo ?0.82, 95% CI (?1.37, ?0.26), and -0.95, 95% CI (?1.32, ?0.57), respectively. However, these significant differences were not maintained at day 3 and 7. Smaller doses of corticosteroid (8 mg and 10 mg) were associated with smaller differences in the mean score of upper and lower eyelid edema and ecchymosis, while the higher doses were associated with greater differences. Furthermore, preoperative corticosteroid usage significantly reduced the intraoperative bleeding when compared to placebo for higher doses > 50 mg per day (p < 0.0001), but not for 8 mg corticosteroid (p = 0.06). Adding postoperative steroid dose to the preoperative one was associated with less edema and ecchymosis than preoperative administration alone.ConclusionThis comprehensive meta-analysis confirms a statistically significant benefit of preoperative corticosteroids. Furthermore, continuing the steroids postoperatively is associated with long-term reduction of complications. Higher doses of corticosteroids are associated with a more significant reduction in edema and ecchymosis, but further studies are recommended to determine the postoperative side effects, including surgical site infection and delayed healing.     

Nasal deformity and interpersonal problems

Several studies in facial plastic surgery have suggested that changes in body image that initiate a positive psychological cycle play an important role in a successful outcome. The change in the patient's self-perception leads to a sense of well-being, rather than there being a direct impact from the changed features. One area in which this change in self-perception may be manifest is in the development and maintenance of interpersonal relationships. Due to the impact of negative body image preoperatively, we hypothesized that patients with nasal deformity may have problems with their interpersonal relationships. This theory was tested using the IIP-32: a short version of the inventory of interpersonal problems. A prospective trial was undertaken of 27 rhinoplasty patients with nasal deformity and 16 septoplasty patients without nasal deformity, the latter group used as a control. The results show that the null hypothesis that the two groups are from the same population on all dimensions of the IIP-32 cannot be rejected (total mean score 0.753). From this data, it seems that patients with nasal deformity have no more difficulties in their interpersonal relationships and, as such, this particular issue cannot be used in support of rhinoplasty surgery.     

The importance of vocal affect to bimodal processing of emotion: implications for individuals with traumatic brain injury

Persons with traumatic brain injury (TBI) often have difficulty recognizing emotion in others. This is likely due to difficulties in interpreting non-verbal cues of affect. Although deficits in interpreting facial cues of affect are being widely explored, interpretation of vocal cues of affect has received much less attention. Accurate interpretation of vocal affect cues is important, particularly when facial cues are absent or ambiguous. These cues also contribute to more accurate identification of emotion. The neural substrates of facial and vocal affect recognition appear to be shared, further contributing to improved bimodal processing. This article discusses the importance of vocal affect cues in interpreting emotion. Expression of vocal affect in persons with TBI is also briefly discussed since difficulty in controlling and manipulating vocal cues of emotion when speaking may also contribute to poor social outcomes. A review of the literature in acoustic parameters that contribute to identification and expression of emotions is followed by a discussion on the integration of visual and auditory cues in bimodal processing and the relationship between facial and vocal affect in persons with TBI. Learning Outcomes: Readers will be able to: 1) Identify the parameters primarily used to describe the acoustic characteristics of vocal affect; 2) Describe the acoustic parameters typically associated with Anger, Fear, Happiness and Sadness; 3) Describe the difficulties experienced by persons with TBI in the perception and integration of facial and vocal cues of affect.     

Paranasal sinus mucoceles with visual disturbance

Objective

Paranasal sinus mucoceles may cause visual disturbance in patients because of their close proximity to the orbit. We aimed to investigate visual prognosis to determine whether it is influenced by the interval before surgery and the severity of visual disturbance, and to heighten the physician's awareness of the occurrence of this disease.

Methods

We retrospectively reviewed eight surgically treated patients with paranasal sinus mucoceles accompanied by visual disturbances between March 2005 and January 2009, and examined the visual acuity outcome of the patients.

Results

Four patients with a mild visual acuity loss showed improvement after surgical drainage within 1 month after onset. Two patients with visual disturbances persisting for more than 1 year did not show postoperative improvements. Although two patient's preoperative visual acuity loss was worse than the ability to count fingers, they showed a remarkable improvement after surgery.

Conclusions

These results show the importance of diagnosing and treating paranasal sinus mucoceles with visual disturbance as soon as possible. In addition, the improvement of visual acuity can be expected if surgery is performed within 1 month after onset, and the patient's preoperative visual acuity loss is mild. However, if patients with severe visual acuity loss consult otolaryngologists at a later date, surgery may still be considered worthwhile.     

Early complications and symptoms of cerebellopontine angle tumor surgery: a prospective analysis

Our objective is to prospectively report very early complications and outcomes of cerebellopontine angle (CPA) surgery. Between January and August 2007, 72 patients were operated on by different transpetrosal approaches in a tertiary referral center. During preoperative assessment, facial nerve function (House-Brackmann grading system), the presence of vertigo or tinnitus and caloric test results were recorded and correlated with complications and symptoms occurring daily from day (D) 1 to D 8. The overall number of complications did not differ from those of former retrospective studies; nevertheless, the prospective feature of this study prompts several comments. Even slight (grade II) preoperative facial impairments increased the risk of severe postoperative facial dysfunction. Keratitis was frequent (42%) even in patients with normal facial function. Thrombo-embolic complications only occurred after long air-travel (≥5 h). Preoperative caloric test status was predictive of postoperative vestibular disturbance occurrence. With respect to the activity recovery; younger patients (<40 years old) displayed faster central compensations than the older (>60 years old) patients. This study highlights several features that may be used for preoperative patient counseling and complication management. In particular, the practitioner has to pay attention to even minor preoperative clinical signs of facial dysfunction to properly inform the patient of facial outcome. Routine ophthalmologic evaluation should be practiced, even when facial function is normal or subnormal. Level of evidence: 1b.     

Postoperative nasal symptoms associated with an endoscopic endonasal transsphenoidal approach

Recent studies have indicated the usefulness of endoscopic endonasal transsphenoidal approach (EETSA). A few studies have reported on the postoperative nasal symptoms of patients who have undergone EETSA. Therefore, we adopted a rhinologic perspective to compare preoperative and postoperative nasal symptoms after performing a binostril, four-hand EETSA. Patients who were scheduled to undergo binostril, four-hand EETSA underwent preoperative nasal evaluation using the Nasal Obstruction Symptom Evaluation (NOSE), Sino-Nasal Outcome Test-20 (SNOT-20), and a visual analogue scale (VAS) to assess several nasal symptoms. Repeat testing was performed 6 months postoperatively. Paired Student’s t tests were used to compare preoperative and postoperative scores. A total of 142 patients who underwent a binostril, four-hand EETSA were included in this study. We found no statistically significant differences between preoperative and postoperative NOSE, total SNOT-20 scores, or scores on the VAS for nasal obstruction, sneezing, rhinorrhea, snoring, or facial pain. However, VAS of olfactory change increased significantly after EETSA (p < 0.05). The binostril, four-hand EETSA would be a useful method because it permits operative manipulability and a wide visual field for skull base lesions. However, rhinologists must consider postoperative nasal symptoms and perform a proper preoperative examination, especially with regard to the olfactory function, and inform patients scheduled for EETSA of potential postoperative changes.     

Prognosis of the facial profile line using the finite element method]

AIM: The aim of the present study was to verify how realistic the prediction of the clinical appearance of the patient's profile is by using the finite element method to simulate orthodontic and surgical intervention. MATERIAL AND METHOD: This single-case study explains step by step interdisciplinary treatment planning in a case with angle class III. Orthodontic and surgical procedures can be simulated and visualized using the lateral cephalogram and the Onyx Ceph software. The facial profile line is calculated over the skeletal surface using the finite element method. The morphing feature of the Onyx Ceph software is used to create an image of the predicted appearance of the patient's profile using a preoperative lateral photograph. RESULTS: The comparison of the simulated profile and the clinical result after bimaxillary surgery showed high concordance. CONCLUSION: The finite element method represents a useful tool for the prediction of the postoperative appearance in patients undergoing fixed orthodontic appliance and orthognathic surgery.     

Orbital decompression for thyroid orbitopathy

Thyroid orbitopathy may result in significant proptosis that causes visual lost. Besides pharmacologic and radiotherapeutic procedures surgically decompression of the orbital skeleton occasionally is managed. We present series of 3 patients (5 procedures) who underwent orbital decompressions. The preoperative proptosis ranged from 22 to 31mm. Decompression was performed by an external Walsh-Ogura approach in 3 orbits and in 2 by an endoscopic approach. The reduction in proptosis was 4-6mm in external approach cases and 4-5mm in endoscopic procedures. Diplopia was noted in 2 patients preoperatively, and no one had new postoperative diplopia. Surgical orbital decompression is occasionally necessary procedure or visual lost rescue in thyroid orbitopathy and in cases of diplopia can not improve muscular function. Endoscopic surgery is a safe and effective management in moderate proptosis. Autoimmunologic inflammatory changes in nasal mucosa do not increase postoperative complication risk.