Orbital fractures account for a significant portion of traumatic facial injuries. Although plasti... more Orbital fractures account for a significant portion of traumatic facial injuries. Although plastic surgery literature is helpful, additional pearls and insights are provided in this article from the experience of an oculoplastic surgeon. The fundamentals remain the same, but the perceptions differ and provide a healthy perspective on a long-standing issue. The most important thing to remember is that the optimal management plan is often variable, and the proper choice regarding which plan to choose rests upon the clinical scenario and the surgeon having an honest perception of his or her level of expertise and comfort level.
The introduction of computed tomography (CT) in 1972 revolutionized the radiographic evaluation o... more The introduction of computed tomography (CT) in 1972 revolutionized the radiographic evaluation of patients who have experienced trauma. However, panoramic tomography (PT) continued to be superior in sensitivity to CT in the identification of mandible fractures and has been considered the gold standard for the past 3 decades. In 1989, a faster, higher-resolution spiral or helical CT (HCT) became widely available, and its efficacy in multiplanar evaluation and diagnosis of fractures of the upper two thirds of the face has been well established. The sensitivity of this new-generation HCT in comparison to PT in the detection of mandible fractures has not been determined. The purpose of this study was to compare the sensitivity, physician interpretation error, and interphysician agreement of HCT and PT in the identification of mandible fractures. The number and anatomical location of mandible fractures identified by HCT and PT was not significantly different. However, the number and location of 96% of fractures identified by HCT was agreed on by neuroradiologists compared with only 91% of fractures identified by PT. Furthermore, the interphysician agreement when no fracture was identified was 96% by HCT versus only 81% by PT. In conclusion, HCT has enhanced imaging quality, equivalent sensitivity in identification of fractures, decreased interpretation error, and greater interphysician agreement in the identification of mandible fractures. HCT has surpassed PT as the current gold standard for the radiographic evaluation and diagnosis of mandible fractures.
Orbital fractures account for a significant portion of traumatic facial injuries. Although plasti... more Orbital fractures account for a significant portion of traumatic facial injuries. Although plastic surgery literature is helpful, additional pearls and insights are provided in this article from the experience of an oculoplastic surgeon. The fundamentals remain the same, but the perceptions differ and provide a healthy perspective on a long-standing issue. The most important thing to remember is that the optimal management plan is often variable, and the proper choice regarding which plan to choose rests upon the clinical scenario and the surgeon having an honest perception of his or her level of expertise and comfort level.
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2012
A 29 year old Hispanic woman with a history of breast augmentation and a pregnancy complicated by... more A 29 year old Hispanic woman with a history of breast augmentation and a pregnancy complicated by placental abruption presented to the plastic surgery service for evaluation of a swollen right breast. The patient was examined and several tests were performed to rule out infection, galactocele, and malignancy. The swelling was attributed to fluid adjacent to her implant which was aspirated and found to contain red blood cells and foam cells but no infectious agent or malignant cells. One month after aspiration and continued drainage, the patient returned with recurrent swelling and pain. Repeat imaging showed recurrent fluid collection in the right breast. Excision and capsulectomy were performed and the patient was found to have a double capsule with a seroma. This article presents the first known case of pregnancy-associated late implant seroma formation, as well as a brief review of the literature regarding this rare finding in prosthetic breast augmentation.
The introduction of computed tomography (CT) in 1972 revolutionized the radiographic evaluation o... more The introduction of computed tomography (CT) in 1972 revolutionized the radiographic evaluation of patients who have experienced trauma. However, panoramic tomography (PT) continued to be superior in sensitivity to CT in the identification of mandible fractures and has been considered the gold standard for the past 3 decades. In 1989, a faster, higher-resolution spiral or helical CT (HCT) became widely available, and its efficacy in multiplanar evaluation and diagnosis of fractures of the upper two thirds of the face has been well established. The sensitivity of this new-generation HCT in comparison to PT in the detection of mandible fractures has not been determined. The purpose of this study was to compare the sensitivity, physician interpretation error, and interphysician agreement of HCT and PT in the identification of mandible fractures. The number and anatomical location of mandible fractures identified by HCT and PT was not significantly different. However, the number and location of 96% of fractures identified by HCT was agreed on by neuroradiologists compared with only 91% of fractures identified by PT. Furthermore, the interphysician agreement when no fracture was identified was 96% by HCT versus only 81% by PT. In conclusion, HCT has enhanced imaging quality, equivalent sensitivity in identification of fractures, decreased interpretation error, and greater interphysician agreement in the identification of mandible fractures. HCT has surpassed PT as the current gold standard for the radiographic evaluation and diagnosis of mandible fractures.
Plastic surgeons routinely submit breast capsulectomy surgical specimens for pathologic evaluatio... more Plastic surgeons routinely submit breast capsulectomy surgical specimens for pathologic evaluation. However, clinically significant findings are rarely identified. In an effort to reduce health care costs and the unnecessary use of hospital resources, this study reviews the efficacy of submitting breast capsulectomy specimens for pathologic examination.
A 3-month-old infant was administered high-dose systemic prednisolone for management of a hemangi... more A 3-month-old infant was administered high-dose systemic prednisolone for management of a hemangioma of the nasal sidewall. After 10 weeks of therapy, medical evaluation of weight loss disclosed hypertrophic obstructive cardiomyopathy. After discontinuation of the steroid, the cardiomyopathy resolved.
Orbital fractures account for a significant portion of traumatic facial injuries. Although plasti... more Orbital fractures account for a significant portion of traumatic facial injuries. Although plastic surgery literature is helpful, additional pearls and insights are provided in this article from the experience of an oculoplastic surgeon. The fundamentals remain the same, but the perceptions differ and provide a healthy perspective on a long-standing issue. The most important thing to remember is that the optimal management plan is often variable, and the proper choice regarding which plan to choose rests upon the clinical scenario and the surgeon having an honest perception of his or her level of expertise and comfort level.
The introduction of computed tomography (CT) in 1972 revolutionized the radiographic evaluation o... more The introduction of computed tomography (CT) in 1972 revolutionized the radiographic evaluation of patients who have experienced trauma. However, panoramic tomography (PT) continued to be superior in sensitivity to CT in the identification of mandible fractures and has been considered the gold standard for the past 3 decades. In 1989, a faster, higher-resolution spiral or helical CT (HCT) became widely available, and its efficacy in multiplanar evaluation and diagnosis of fractures of the upper two thirds of the face has been well established. The sensitivity of this new-generation HCT in comparison to PT in the detection of mandible fractures has not been determined. The purpose of this study was to compare the sensitivity, physician interpretation error, and interphysician agreement of HCT and PT in the identification of mandible fractures. The number and anatomical location of mandible fractures identified by HCT and PT was not significantly different. However, the number and location of 96% of fractures identified by HCT was agreed on by neuroradiologists compared with only 91% of fractures identified by PT. Furthermore, the interphysician agreement when no fracture was identified was 96% by HCT versus only 81% by PT. In conclusion, HCT has enhanced imaging quality, equivalent sensitivity in identification of fractures, decreased interpretation error, and greater interphysician agreement in the identification of mandible fractures. HCT has surpassed PT as the current gold standard for the radiographic evaluation and diagnosis of mandible fractures.
Orbital fractures account for a significant portion of traumatic facial injuries. Although plasti... more Orbital fractures account for a significant portion of traumatic facial injuries. Although plastic surgery literature is helpful, additional pearls and insights are provided in this article from the experience of an oculoplastic surgeon. The fundamentals remain the same, but the perceptions differ and provide a healthy perspective on a long-standing issue. The most important thing to remember is that the optimal management plan is often variable, and the proper choice regarding which plan to choose rests upon the clinical scenario and the surgeon having an honest perception of his or her level of expertise and comfort level.
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2012
A 29 year old Hispanic woman with a history of breast augmentation and a pregnancy complicated by... more A 29 year old Hispanic woman with a history of breast augmentation and a pregnancy complicated by placental abruption presented to the plastic surgery service for evaluation of a swollen right breast. The patient was examined and several tests were performed to rule out infection, galactocele, and malignancy. The swelling was attributed to fluid adjacent to her implant which was aspirated and found to contain red blood cells and foam cells but no infectious agent or malignant cells. One month after aspiration and continued drainage, the patient returned with recurrent swelling and pain. Repeat imaging showed recurrent fluid collection in the right breast. Excision and capsulectomy were performed and the patient was found to have a double capsule with a seroma. This article presents the first known case of pregnancy-associated late implant seroma formation, as well as a brief review of the literature regarding this rare finding in prosthetic breast augmentation.
The introduction of computed tomography (CT) in 1972 revolutionized the radiographic evaluation o... more The introduction of computed tomography (CT) in 1972 revolutionized the radiographic evaluation of patients who have experienced trauma. However, panoramic tomography (PT) continued to be superior in sensitivity to CT in the identification of mandible fractures and has been considered the gold standard for the past 3 decades. In 1989, a faster, higher-resolution spiral or helical CT (HCT) became widely available, and its efficacy in multiplanar evaluation and diagnosis of fractures of the upper two thirds of the face has been well established. The sensitivity of this new-generation HCT in comparison to PT in the detection of mandible fractures has not been determined. The purpose of this study was to compare the sensitivity, physician interpretation error, and interphysician agreement of HCT and PT in the identification of mandible fractures. The number and anatomical location of mandible fractures identified by HCT and PT was not significantly different. However, the number and location of 96% of fractures identified by HCT was agreed on by neuroradiologists compared with only 91% of fractures identified by PT. Furthermore, the interphysician agreement when no fracture was identified was 96% by HCT versus only 81% by PT. In conclusion, HCT has enhanced imaging quality, equivalent sensitivity in identification of fractures, decreased interpretation error, and greater interphysician agreement in the identification of mandible fractures. HCT has surpassed PT as the current gold standard for the radiographic evaluation and diagnosis of mandible fractures.
Plastic surgeons routinely submit breast capsulectomy surgical specimens for pathologic evaluatio... more Plastic surgeons routinely submit breast capsulectomy surgical specimens for pathologic evaluation. However, clinically significant findings are rarely identified. In an effort to reduce health care costs and the unnecessary use of hospital resources, this study reviews the efficacy of submitting breast capsulectomy specimens for pathologic examination.
A 3-month-old infant was administered high-dose systemic prednisolone for management of a hemangi... more A 3-month-old infant was administered high-dose systemic prednisolone for management of a hemangioma of the nasal sidewall. After 10 weeks of therapy, medical evaluation of weight loss disclosed hypertrophic obstructive cardiomyopathy. After discontinuation of the steroid, the cardiomyopathy resolved.
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