This Basic Techniques, Surgical Anatomy, and Histology chapter is designed as a concise review fo... more This Basic Techniques, Surgical Anatomy, and Histology chapter is designed as a concise review for facial plastic surgeons, fellows, or residents in training. It includes review of wound healing (phases, cellular components, strengths); evaluation and management of traumatic wounds; wound classification guidelines; surgical suture characteristics; normal and abnormal histology; facial embryology; and facial anatomy (surface landmarks, proportions, skeletal structure, muscles of facial expression, orbital anatomy, facial nerve course, arterial supply). Sources are landmark articles and texts and topics that are focused on surgically pertinent details and relationships.
Facial Plastic Surgery & Aesthetic Medicine, 2020
Importance: Orbital floor fracture repair is complex and postoperative complications are common. ... more Importance: Orbital floor fracture repair is complex and postoperative complications are common. A variety of applicable surgical techniques and technologies are available to surgeons, so data about which of these may decrease postoperative complication rates can help better guide clinical decision making. Objectives: To characterize the patient demographics and surgical techniques utilized in orbital floor fracture repairs at San Antonio Military Medical Center and their relationship with rates of postoperative complications. Design, Setting, and Participants: Retrospective chart review of patients who underwent orbital floor fracture repairs from March 2014 to March 2019 with a mean follow-up time of 1.86 months at a tertiary care academic military hospital and level 1 trauma center. Main Outcomes and Measures: Demographic data, indication for surgical repair, fracture severity, orbital floor approach, implant material, and use of intraoperative computed tomography (CT) scan were recorded. Chi-square analysis was performed to determine the relationship between these factors and postoperative diplopia, hypoglobus, enophthalmos, and infection. Results: A total of 124 procedures were performed during the study period: 71.8% of patients were male and 74% were civilian. Mean age was 39 years (range 19-81). Thirty-one patients were lost to follow-up. The most common approach was transconjunctival (83%), which was most frequently used exclusively (68.5%), but was also combined with cantholysis, transcaruncular, or transantral approach. Postoperative diplopia at follow-up was common (53.8%), resolved after an average of 36.3 days, and was significantly associated with surgical indication of entrapment or revision (p = 0.01) and nonutilization of intraoperative CT (p = 0.04). From 2014 to 2016, intraoperative CT was utilized in 21% of cases and revision rate was 10.5%. From 2017 to 2019, 50% of cases utilized intraoperative CT and revision rate was 2% (p = 0.15). Three cases were revisions performed for abnormal plate position noted on postoperative CT scan. Conclusions and Relevance: A statistically significant association was found between postoperative diplopia, surgical indication of entrapment or revision, and nonutilization of intraoperative CT. Revision rates decreased when use of intraoperative CT increased. Three revision cases may have been prevented by use of an intraoperative CT scan. Patients with entrapment should be counseled regarding the increased risk of postoperative diplopia.
Annals of Otology, Rhinology & Laryngology, 2019
Background: Dynamic rehabilitation of longstanding facial palsy with damaged, atrophied, or absen... more Background: Dynamic rehabilitation of longstanding facial palsy with damaged, atrophied, or absent facial muscles requires replacement of neural and muscular components. The ideal reconstruction would include a fast-twitch muscle that is small, a reliable donor vessel and nerve, and the potential to provide a natural, synchronous, dentate smile with minimal donor site morbidity. Many flaps have been successfully used historically, but none has produced ideal rehabilitation. Objective: To evaluate the novel sterno-omohyoid, dual-vector flap in rehabilitation of chronic facial paralysis. Results: We performed sterno-omohyoid free tissue transfer for smile reanimation in a 39-year-old male with a history of longstanding right facial palsy following resection of a skull base tumor several years previously. We transferred both muscles with the superior thyroid artery, middle thyroid vein, and ansa cervicalis. The patient developed a dynamic smile by 6 months postoperatively, and he had i...
The purpose of the current article is to provide an overview of the functional and aesthetic unfa... more The purpose of the current article is to provide an overview of the functional and aesthetic unfavorable results of head and neck reconstruction, and provide suggestions on how to address these issues. Understanding the consequences of an unsuccessful reconstruction provides the foundation for proper planning and personalized approach to reconstruction of lost structures.
ObjectivesReports of patient injuries associated with videolaryngoscopy are increasing in the lit... more ObjectivesReports of patient injuries associated with videolaryngoscopy are increasing in the literature. There are a wide variety of opinions regarding both safe use of the device and patient care following aerodigestive tract injury.We have seen an increase in videolaryngoscopy‐associated injuries in recent years at our institution. Because of this, we wanted to determine if video‐assisted laryngoscopy presents a greater risk of injury compared with direct laryngoscopy. Furthermore, we wanted to determine if there were patient and/or surgical factors that could contribute to patient injuries following videolaryngoscopy.Data SourcesMAMC anesthesia records, PubMed, Ovid.Review MethodsWe compared rates of injury between videolaryngoscopy to direct laryngoscopy at our institution by searching anesthesia records to identify laryngoscopy procedures that resulted in injury to the soft palate or oropharynx. We also identified 19 published cases in the literature, in addition to our cases,...
This Basic Techniques, Surgical Anatomy, and Histology chapter is designed as a concise review fo... more This Basic Techniques, Surgical Anatomy, and Histology chapter is designed as a concise review for facial plastic surgeons, fellows, or residents in training. It includes review of wound healing (phases, cellular components, strengths); evaluation and management of traumatic wounds; wound classification guidelines; surgical suture characteristics; normal and abnormal histology; facial embryology; and facial anatomy (surface landmarks, proportions, skeletal structure, muscles of facial expression, orbital anatomy, facial nerve course, arterial supply). Sources are landmark articles and texts and topics that are focused on surgically pertinent details and relationships.
Juvenile nasopharyngeal angiofibromas remain rare tumors representing approximately 0.05% of head... more Juvenile nasopharyngeal angiofibromas remain rare tumors representing approximately 0.05% of head and neck tumors. The typical presentation is a male teenager with recurrent epistaxis and nasal obstruction. These tumors were traditionally approached via external and/or intraoral incisions, but many are amenable to endoscopic removal. Preoperative embolization of major feeding vessels to these tumors by interventional radiology has resulted in significantly less blood loss and facilitated endoscopic resection. The following chapter discusses endoscopic resection of juvenile nasopharyngeal angiofibromas and outlines pertinent anatomy while covering important surgical techniques. Appropriate patient selection, anesthesia considerations, surgical preparation and techniques, and postoperative care are discussed. A case presentation is included with preoperative imaging and an accompanying video to demonstrate these surgical techniques.
This Basic Techniques, Surgical Anatomy, and Histology chapter is designed as a concise review fo... more This Basic Techniques, Surgical Anatomy, and Histology chapter is designed as a concise review for facial plastic surgeons, fellows, or residents in training. It includes review of wound healing (phases, cellular components, strengths); evaluation and management of traumatic wounds; wound classification guidelines; surgical suture characteristics; normal and abnormal histology; facial embryology; and facial anatomy (surface landmarks, proportions, skeletal structure, muscles of facial expression, orbital anatomy, facial nerve course, arterial supply). Sources are landmark articles and texts and topics that are focused on surgically pertinent details and relationships.
Facial Plastic Surgery & Aesthetic Medicine, 2020
Importance: Orbital floor fracture repair is complex and postoperative complications are common. ... more Importance: Orbital floor fracture repair is complex and postoperative complications are common. A variety of applicable surgical techniques and technologies are available to surgeons, so data about which of these may decrease postoperative complication rates can help better guide clinical decision making. Objectives: To characterize the patient demographics and surgical techniques utilized in orbital floor fracture repairs at San Antonio Military Medical Center and their relationship with rates of postoperative complications. Design, Setting, and Participants: Retrospective chart review of patients who underwent orbital floor fracture repairs from March 2014 to March 2019 with a mean follow-up time of 1.86 months at a tertiary care academic military hospital and level 1 trauma center. Main Outcomes and Measures: Demographic data, indication for surgical repair, fracture severity, orbital floor approach, implant material, and use of intraoperative computed tomography (CT) scan were recorded. Chi-square analysis was performed to determine the relationship between these factors and postoperative diplopia, hypoglobus, enophthalmos, and infection. Results: A total of 124 procedures were performed during the study period: 71.8% of patients were male and 74% were civilian. Mean age was 39 years (range 19-81). Thirty-one patients were lost to follow-up. The most common approach was transconjunctival (83%), which was most frequently used exclusively (68.5%), but was also combined with cantholysis, transcaruncular, or transantral approach. Postoperative diplopia at follow-up was common (53.8%), resolved after an average of 36.3 days, and was significantly associated with surgical indication of entrapment or revision (p = 0.01) and nonutilization of intraoperative CT (p = 0.04). From 2014 to 2016, intraoperative CT was utilized in 21% of cases and revision rate was 10.5%. From 2017 to 2019, 50% of cases utilized intraoperative CT and revision rate was 2% (p = 0.15). Three cases were revisions performed for abnormal plate position noted on postoperative CT scan. Conclusions and Relevance: A statistically significant association was found between postoperative diplopia, surgical indication of entrapment or revision, and nonutilization of intraoperative CT. Revision rates decreased when use of intraoperative CT increased. Three revision cases may have been prevented by use of an intraoperative CT scan. Patients with entrapment should be counseled regarding the increased risk of postoperative diplopia.
Annals of Otology, Rhinology & Laryngology, 2019
Background: Dynamic rehabilitation of longstanding facial palsy with damaged, atrophied, or absen... more Background: Dynamic rehabilitation of longstanding facial palsy with damaged, atrophied, or absent facial muscles requires replacement of neural and muscular components. The ideal reconstruction would include a fast-twitch muscle that is small, a reliable donor vessel and nerve, and the potential to provide a natural, synchronous, dentate smile with minimal donor site morbidity. Many flaps have been successfully used historically, but none has produced ideal rehabilitation. Objective: To evaluate the novel sterno-omohyoid, dual-vector flap in rehabilitation of chronic facial paralysis. Results: We performed sterno-omohyoid free tissue transfer for smile reanimation in a 39-year-old male with a history of longstanding right facial palsy following resection of a skull base tumor several years previously. We transferred both muscles with the superior thyroid artery, middle thyroid vein, and ansa cervicalis. The patient developed a dynamic smile by 6 months postoperatively, and he had i...
The purpose of the current article is to provide an overview of the functional and aesthetic unfa... more The purpose of the current article is to provide an overview of the functional and aesthetic unfavorable results of head and neck reconstruction, and provide suggestions on how to address these issues. Understanding the consequences of an unsuccessful reconstruction provides the foundation for proper planning and personalized approach to reconstruction of lost structures.
ObjectivesReports of patient injuries associated with videolaryngoscopy are increasing in the lit... more ObjectivesReports of patient injuries associated with videolaryngoscopy are increasing in the literature. There are a wide variety of opinions regarding both safe use of the device and patient care following aerodigestive tract injury.We have seen an increase in videolaryngoscopy‐associated injuries in recent years at our institution. Because of this, we wanted to determine if video‐assisted laryngoscopy presents a greater risk of injury compared with direct laryngoscopy. Furthermore, we wanted to determine if there were patient and/or surgical factors that could contribute to patient injuries following videolaryngoscopy.Data SourcesMAMC anesthesia records, PubMed, Ovid.Review MethodsWe compared rates of injury between videolaryngoscopy to direct laryngoscopy at our institution by searching anesthesia records to identify laryngoscopy procedures that resulted in injury to the soft palate or oropharynx. We also identified 19 published cases in the literature, in addition to our cases,...
This Basic Techniques, Surgical Anatomy, and Histology chapter is designed as a concise review fo... more This Basic Techniques, Surgical Anatomy, and Histology chapter is designed as a concise review for facial plastic surgeons, fellows, or residents in training. It includes review of wound healing (phases, cellular components, strengths); evaluation and management of traumatic wounds; wound classification guidelines; surgical suture characteristics; normal and abnormal histology; facial embryology; and facial anatomy (surface landmarks, proportions, skeletal structure, muscles of facial expression, orbital anatomy, facial nerve course, arterial supply). Sources are landmark articles and texts and topics that are focused on surgically pertinent details and relationships.
Juvenile nasopharyngeal angiofibromas remain rare tumors representing approximately 0.05% of head... more Juvenile nasopharyngeal angiofibromas remain rare tumors representing approximately 0.05% of head and neck tumors. The typical presentation is a male teenager with recurrent epistaxis and nasal obstruction. These tumors were traditionally approached via external and/or intraoral incisions, but many are amenable to endoscopic removal. Preoperative embolization of major feeding vessels to these tumors by interventional radiology has resulted in significantly less blood loss and facilitated endoscopic resection. The following chapter discusses endoscopic resection of juvenile nasopharyngeal angiofibromas and outlines pertinent anatomy while covering important surgical techniques. Appropriate patient selection, anesthesia considerations, surgical preparation and techniques, and postoperative care are discussed. A case presentation is included with preoperative imaging and an accompanying video to demonstrate these surgical techniques.
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