The utilization of three-dimensional imaging and three-dimensional-printed model in autologous microtia reconstruction.

Background: The use of three-dimensional (3D) technology helps surgeons in performing autologous microtia reconstruction due to more accurate measurements and a better precision template model. However, the technical aspects of using a 3D imaging and 3D-printed model and the difference in outcomes postoperatively remain poorly reviewed. Purpose: This systematic review aimed to provide the current evidence of the benefit and technical aspects of using 3D technology in autologous microtia reconstruction. Method: A systematic literature search was conducted across multiple databases: Medline, Embase, Google Scholar, and Central until June 2022. Studies that evaluated the use of 3D imaging or 3D-printed models for autogenous microtia reconstruction were selected. The quality of the included studies was also assessed with respect to the study design. Result: A systematic literature search yielded 17 articles with a combination of observational and case report studies. Overall, 3D imaging showed a precise measurement for preoperative costal cartilage assessment. Compared to the 2D template, the utilization of a 3D-printed template provided a higher similarity rate relative to the unaffected ear, higher patient and surgeon satisfaction, and lower surgical time. Most 3D templates were fabricated using polylactic acid material on fused deposition modelling printers. The template costs were ranging from $1 to $4.5 depending on the material used. Conclusion: 3D imaging and 3D-printed templates could improve the outcome of autologous microtia reconstruction. However, the quality of the existing evidence remains low due to the heterogeneity of the reported outcomes. Further studies with more adequate comparability and defined outcomes are still required.

Correlation of Grading and Number of Ear Subunits With Auditory Brainstem Response Findings in Children With Microtia.

PURPOSE: The association between microtia severity and hearing function has been thoroughly investigated. This study examined the relationship between microtia grade, number of ear subunits (i.e., helix, antihelix, scapha, triangularis fossa, concha, lobule, tragus, and antitragus) with auditory brainstem response (ABR) findings in children with microtia. STUDY DESIGN: A retrospective chart review was employed in this study. METHOD: We analyzed the ABR test results and photographs of 22 children with 30 microtia ears at Dr. Cipto Mangunkusumo National Hospital, Jakarta. The ABR test results were acquired using click (air conduction only) and 500-Hz tone burst stimuli (air- and bone-conduction). Ear photographs were overlaid with a template of a normal ear to determine the number of ear subunits present and the subsequent microtia grade. Number of ear subunits and ABR results were analyzed using the chi-square, Mann-Whitney U, and Spearman's correlation tests. RESULTS: ABR thresholds for click and 500-Hz tone bursts air-conduction were significantly poorer for ears with a subunit < 5 compared to ears with a subunit ≥ 5. No significant difference was observed in 500 Hz bone-conduction ABR thresholds between these groups. Correlation analysis showed a significant negative correlation between increased ear subunits and click ABR thresholds. No significant correlation was found between ear subunits and 500-Hz air- and bone-conduction ABR thresholds. CONCLUSIONS: A higher number of ear subunits are associated with a lower hearing threshold, as assessed using ABR with click stimuli. Therefore, the number of ear subunits and microtia grades can be used to examine the hearing level thresholds in infants and children with microtia. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25669440.

Functional and Esthetic Outcomes of L-Shaped Augmentation Rhinoplasty in Indonesian Noses.

OBJECTIVES: We investigated the satisfaction and nasal airway function of patients who underwent L-shaped augmentation rhinoplasty using rhinoplasty outcomes evaluation (ROE). Nasal obstruction was evaluated using the nasal obstruction symptom evaluation (NOSE) and peak nasal inspiratory flowmeter (PNIF) score. We explored the correlation between tip projection, ROE, NOSE, and PNIF scores. METHODS: We conducted a pre-and post-experimental study of 16 adult Indonesian patients who underwent L-shaped augmentation rhinoplasty. We used the neurotic scale to rule out patients with body dysmorphic disorder (BDD), and patients with low-to-moderate neurotic scores were included as participants. RESULTS: For all patients who underwent augmentation rhinoplasty, the median score of the NOSE questionnaire decreased from 12.5 to 5 after surgery (P = .005). The ROE median satisfaction scores also increased from 7.00 to 14.00 postoperatively (P = .001). The median PNIF preoperative score increased from 92 (70-130) to 115 (105-155) postoperatively. There was an increase in tip projection from 1.5 (1.1-2) preoperative to 2.05 (1.8-2.5) postoperative. There was a significant correlation between ∆ tip projection and ∆ NOSE (P = .048), with a moderate correlation (r = .502). However, there was no significant correlation between ∆ tip projection and ∆ PNIF (P = .080) and ∆ ROE (P = .302). CONCLUSION: The increase in ROE and PNIF, and the decrease in NOSE score after surgery revealed that the augmented L-shaped rhinoplasty technique has high satisfaction rates in both the nasal esthetics and functions of patients. The tip projection increment was proven to elevate nasal function subjectively in a certain range of tip height difference evaluated by the NOSE score.

The effect of plastic tape seal to reduce face seal leak in respirator N-95 type 1860.

The risk of face seal leak while using N-95 respirators is experienced by health workers and thus failing fit test are quite common. Finding solutions to overcome face seal leaks is crucial; one of which is by sealing the N-95 respirator. The seal used in this research was Tegaderm® a transparent film dressing or a plastic tape which is known to have the advantages of strong adhesion, high level of pore density and standardized medical grade. This study tries to determine the effectiveness of plastic tape adhesive on the N-95 type 1860 respirator in overcoming face seal leak qualitative fit test using Bitrex immediately after being worn and after 4 h of using it. The study used a quantitative approach with an incidence study design conducted pre and post experimental without comparison to see the effectiveness of plastic tape sealing. The subjects for the research were 81 health workers in the CMH environment who were at risk of being exposed to COVID-19. The study found a significant difference in the Bitrex fit test immediately after sealing the N-95 type 1860 respirator with plastic tape; 100% passed the fit test immediately after sealing, and 64.2% passed the fit test after 4 h of working. The effectiveness of sealing using plastic tape is considered to be quite good to overcome face seal leak on the N-95 type 1860 respirator. Health care workers need to be more vigilance to ensure better face seal.

Satisfaction and health-related quality of life of patients with microtia following reconstructive surgery using the Nagata technique.

OBJECTIVE: This study aimed to investigate the functional outcomes, satisfaction, and quality of life of patients with microtia following reconstructive surgery. METHODS: This cross-sectional study was conducted using retrospective data of patients with microtia following reconstructive surgery using the Nagata technique. Data were obtained from the medical records of patients who underwent reconstructive surgery at the Division of Facial Plastic and Reconstructive Surgery, Department of Otorhinolaryngology, Head and Neck Surgery, Dr. Cipto Mangunkusumo Hospital between 2014 and 2018. All eligible patients were referred to participate in this study between November 2018 and March 2019. The hearing function was assessed by a professional audiologist after surgery. Patient satisfaction was evaluated by interview using a previously developed questionnaire, while quality of life was assessed using the EuroQol-5D-Young questionnaire. RESULTS: Thirty-one eligible subjects were included in the study. Pain and discomfort were the most commonly reported factors related to the quality of life following surgery. Approximately 67.7% of the patients were satisfied; 19.4% were very satisfied, and 12.9% reported acceptance of their surgical outcomes. The most common complication was infection (n = 8). Most patients did not experience any problems in their lives after microtia surgery. CONCLUSIONS: The highest rate of satisfactory outcomes was observed for the lobule subunit, which was assumed to be associated with the use of the Z-plasty technique. The most common complication was infection, as environmental hygiene was the most important factor. Thus, further concern for maintaining good hygiene is necessary to improve the quality of reconstructive surgery. The level of satisfaction with microtia reconstructive surgery was adequate. Most patients had a good health-related quality of life without experiencing any problems.

Clinical Trial for Cartilage Conduction Hearing Aid in Indonesia.

Hearing improvement represents one of the may valuable outcomes in microtia and aural atresia reconstruction surgery. Most patients with poor development in their hearing function have had a severe microtia. Conventional methods to improve hearing function are bone conduction and bone anchored hearing aids. Cartilage conduction hearing aids (CCHA) represents a new amplification method. This study assessed the outcomes and evaluated the impact and its safety in the patients with microtia and aural atresia whose hearing dysfunction did not improve after surgery for ear reconstruction in our hospital. Hearing functions were evaluated with pure tone audiometry or sound field testing by behavioral audiometry and speech audiometry before and after CCHA fitting. As a result, there was a significant difference between unaided and aided thresholds (p < 0.001). Speech recognition threshold and speech discrimination level also significantly improved with CCHA. The average functional gains of 14 ears were 26.9 ± 2.3 dB. Almost all parents of the patients reported satisfaction with the performance of CCHA, and daily communication in children with hearing loss also became better than usual.

Evaluation of 3 and 2-point internal fixation in the management of zygomaticomaxillary complex fractures: Case report.

INTRODUCTION: The ZMC has a prominent shape compared to other parts in the midfacial region, thus small injuries will generate fractures in the ZMC. The management of ZMC fracture depends on the fracture deformity and the surgeon's considerations. Various studies have revealed the success of ZMC reconstruction with one fixation point to 4 fixation points fitting to the tetrapod shape. CASE REPORT: We report two cases of ZMC fractures which comparing the efficacy of 3- and 2-point internal fixations for improving clinical outcomes The first patient underwent ORIF which placed at 2 fixation points, the first point in the left ZF suture and the second point in the left ZMB. The second patient underwent ORIF reconstruction at 3 fixation points, the first point in the right inferior orbital rim, the second point in the right ZF suture, and the third point in the right ZMB. DISCUSSION: The most common surgical approach for ZMC fractures is through a gingivobuccal groin incision. This approach is for body exposure of the ZMB, which is the main buttress. The 3-point internal fixation improved the postoperative clinical outcome of fracture fragment stability compared to two-point fixation, but the mean malar height projection, vertical dystopia, and enophthalmos were not different between the two fixation methods. CONCLUSION: Three-point internal fixation can improve the clinical outcome of fracture fragment stability compared to 2-point fixation; however, it has a mean operative duration 22.2 minutes longer than 2-point fixation, so its application must be considered during the COVID-19 pandemic.

Comparison between PRP and PRFM on FTSG healing profile: Macroscopic, microscopic and ELISA evaluation.

BACKGROUND: Studies had shown the benefit of PRFM and PRP in wound healing but their use in skin graft healing was rarely studied. This study aims to compare the use of PRP and PRFM in accelerating wound healing process of skin full-thickness skin graft (FTSG). MATERIALS AND METHODS: Five pigs were used to look at the wound healing effect of PRP and PRFM usage prior to FTSG implantation. Subsequent punch biopsies were then conducted on the 1st, 3rd, 7th, 14th, and 30th day to obtain samples for macroscopic (skin color), extracellular matrix (collagen), microscopic (PMN, macrophage, and fibroblast), and ELISA (TGFß1 and PDGF) analysis to determine the level of wound healing activity. ImageJ software was used to photograph for macroscopic and extracellular matrix analysis. RESULTS: Macroscopic, extracellular matrix, and ELISA evaluation show no significant difference in FTSG survival rates for all treatment groups. Microscopic examination showed an increase in PMN, macrophage, and fibroblast levels with PRFM application showing higher increases in all observed microscopic variables compared to PRP and control. CONCLUSION: This study observed that both PRFM and PRP as autologous platelet preparation accelerate wound healing in FTSG, with PRFM being superior due to the higher number of PMN, macrophage, and fibroblast.

Comparison of Eustachian tube ventilation function between cleft palate and normal patients using sonotubometry.

OBJECTIVE: To compare Eustachian tube ventilation function between cleft palate subjects and normal subjects using sonotubometry. METHOD: A comparative cross-sectional study was conducted at the Department Otolaryngology-Head and Neck Surgery of Ciptomangunkusumo National Hospital, Universitas Indonesia, Jakarta, from June 2013 to January 2014.There were 31 subjects with cleft palate and 62 healthy subjects aged ≤18 years, and both groups were matched according to age. Each subject underwent ear, nose, and throat examination with Veau classification and sonotubometry, a new assembly test in Indonesia. The results of the sonotubogram (the number of Eustachian tube openings, amplitude enhancement in dB, and the duration of Eustachian tube opening in ms) were then analyzed with SPSS using chi-square and Mann-Whitney tests. RESULTS: Subjects with cleft palate had lower Eustachian tube function than healthy subjects using three sonotubometry parameters (p < 0.001). The proportion of Eustachian tube dysfunction based on the Veau classification was significant (p < 0.001). In multivariate analysis, several determinant factors of Eustachian tube dysfunction were found, such as adenoid hypertrophy (risk factor6.46), the number of Eustachian tube openings (risk factor 36.21), and higher Veau classification (risk factor 10.41). CONCLUSION: Sonotubometry could be used to assess parameters of Eustachian tube function. Subjects with cleft palate have a higher risk of having Eustachian tube dysfunction, as do subjects with adenoid hypertrophy.