The third generation barbed lifting threads: Added value of hyaluronic acid.

INTRODUCTION: Facial thread lifting is a highly demanded procedure in esthetic clinics worldwide. The aim of this retrospective study is to evaluate the clinical effectiveness and overall patients' satisfaction of a new generation of barbed threads, in which a hyaluronic acid (HA) coat was added to the PLLA/PCL threads and compare the results with PLLA/PCL threads without HA. MATERIALS AND METHODS: Twenty patients treated with the PLLA/PCL threads with or without hyaluronic acid (HA) were compared for FaceQ scales: Age appraisal, psychological function, skin satisfaction, satisfaction with facial appearance, appraisal lines of nasolabial folds, satisfaction of lower face, and jaw were compared at baseline, 4 and 12 months post-treatment. Early impact on life and the skin adverse effects were assessed 1 week post-treatment. Finally, patients and two physicians provided the GAIS score at 4 and 12 months and a comparison was made between the two groups. RESULTS: There was a statistically significant improvement in all scales of FaceQ for all included patients at baseline and at 4 and 12 months post-treatment. Importantly, there were less skin-related adverse effects such as skin redness, uneven tone, irregular surface, burning, and itching sensation at a recovery period (1 week post-treatment) in the group receiving HA-containing threads. CONCLUSION: A notably higher long-term improvement in aging appearance, satisfaction with face appearance, lower jaw and face as well as GAIS was seen in the group treated with HA-containing threads compared to the other treatment arm.

Ethnicity and Nonsurgical Rhinoplasty.

Background: Nonsurgical rhinoplasty is a procedure that is gaining popularity in aesthetic clinics particularly because of its minimally invasive nature compared with surgery. It is recognized that there are ethnic variations in nose injection techniques and planned aesthetic outcomes. Objectives: The objective of this study was to explore experts' views about the ethnic differences in the anatomical features of the nose and procedure-related considerations in nonsurgical rhinoplasty. Methods: Using a priori set topics and questions, 4 expert aesthetic physicians, from 4 different ethnic backgrounds and working in 4 different regions, were asked to describe the essential elements to be considered when planning a nonsurgical rhinoplasty, including product choice, injection technique, safety measures, and any practical hints to facilitate achieving the desired outcome. Results: All invited experts responded to the full set of questions. There were similarities between the treating physicians in some of the technical steps. Nevertheless, there were several differences identified regarding baseline anatomy and patient expectations that could be attributed to ethnicity. Patients' and physicians' expectations regarding a successful nonsurgical rhinoplasty can vary depending on their ethnic backgrounds. Therefore, with the current global ethnic and cultural diversities, in addition to the knowledge of the nasal anatomy and safe injection techniques, it is imperative that aesthetic practitioners have full awareness and a good understanding of these ethnic variations. Conclusions: Nonsurgical rhinoplasty is a highly demanded aesthetic procedure. Patients' ethnic differences need to be carefully taken into consideration when discussing, planning, and performing nasal fillers injection.

Patient Satisfaction with Absorbable Anchoring Facial Threads.

This study aimed to evaluate satisfaction in terms of facial appearance, quality of life, and adverse effects in patients undergoing the facial thread lifting procedure using the absorbable facial threads anchored on the superficial and deep temporal fascias. The charts of patients for whom facial anchored thread lifting was performed using absorbable threads between February 2017 and September 2019 were reviewed. Demographic data including age and gender as well as data from the Face-Q scales were collected. Descriptive analysis was made for the adverse effects 1 week after the procedure. The mean value of adverse effects scales was compared 1 and 2 weeks after the procedure and also the mean values of facial appearance and quality-of-life scales were compared at baseline, 6 months, and 12 months after the procedure. All recruited subjects were females with a mean age of 43.42 years. There was a statistically significant decrease in the rate of adverse effects following the procedure between the first and second week. The mean difference in patients' perceived age 6 and 12 months after the procedure was statistically significant when compared with baseline. The psychological distress significantly decreased and the psychological function improved 6 and 12 months after the procedure. The overall satisfaction with facial appearance increased significantly after 6 months with a mean of 20.08. This was maintained at 12 months. The satisfaction in skin appearance, cheeks, nasolabial folds, marionettes, lower face, and jawline appearances improved significantly 6 months after the procedure. This was also maintained at 12 months. Face lifting using the polycaprolactone threads anchored on the temporalis fascia showed a significant improvement in the quality of life and facial appearance. The adverse effects are tolerable starting 2 weeks after the procedure.

Emulsified fat and nanofat for the treatment of dark circles.

This article is a short literature review on the possible etiologies and treatment options for dark circles. A detailed description about the use of autologous fat as a tool for treating dark circles is elaborated. The preparation and use of microfat, emulsified fat, nanofat, and nanofat gel is listed in details.

Hyperpigmentation after nonsurgical blepharoplasty using plasma technology.

Nitrogen plasma is considered nowadays one of the efficient treatment options for nonsurgical blepharoplasty. Although it is an overall safe treatment, it has some side effects. This short paper addresses the risk of hyperpigmentation following the use of plasma and list few suggestions on how to prevent it.

HPV-related oropharyngeal cancer prevalence in a middle eastern population using E6/E7 PCR.

BACKGROUND: Given the paucity of data and widely variable rates that have been reported, the main objective of this study was to examine the prevalence of HPV-positivity in oropharyngeal squamous cell carcinoma (OPSCC) in Middle Eastern patients presenting to one of the region's largest tertiary care centers using polymerase chain reaction (PCR) amplification of the HPV E6/E7 oncogenes, a highly sensitive and specific method of detection. METHODS: Medical charts and archived pathological specimens were obtained for patients diagnosed with biopsy proven oropharyngeal cancer who presented to the American University of Beirut Medical Center between 1972 and 2017. DNA was extracted from paraffin-embedded specimens and tested for 30 high-risk and low-risk papilloma viruses using the PCR-based EUROarray HPV kit (EuroImmun). RESULTS: A total of 57 patients with oropharyngeal cancer were initially identified; only 34 met inclusion/exclusion criteria and were included in the present study. Most patients were males (73.5%) from Lebanon (79.4%). The most common primary tumor site was in the base of tongue (50%), followed by the tonsil (41.2%). The majority of patients (85.3%) tested positive for HPV DNA. CONCLUSION: The prevalence of HPV-positivity amongst Middle Eastern OPSCC patients, specifically those from Lebanon, may be far greater than previously thought. The Lebanese population and other neighboring Middle Eastern countries may require a more vigilant approach towards HPV detection and awareness. On an international level, further research is required to better elucidate non-classical mechanisms of HPV exposure and transmission.

Sexual Dimorphism in Laryngeal Volumetric Measurements Using Magnetic Resonance Imaging.

The objective of this study is to investigate the dimensional and volumetric measurements in the thyroarytenoid (TA) muscle in men and women using magnetic resonance imaging (MRI). The hypothesis is that there is a gender-related difference in these measurements. A retrospective chart review of 76 patients who underwent MRI of the neck at the American University of Beirut Medical Center was conducted. The dimension and volume of the right and left TA muscle were measured on axial and coronal planes short tau inversion recovery images. Male and female groups were compared with respect to demographic data and MRI findings using parametric and nonparametric tests. The mean length of the thyro-arytenoid muscle in males was larger than that in females on the right (males 2.44 [0.29] cm vs females 1.70 [0.22] cm) and on the left (males 2.50 [0.28] cm vs females 1.72 [0.24] cm) reaching statistical significance (P < .001). The mean width of the thyro-arytenoid muscle in males was larger than that in females on the right (males 0.68 [0.13] cm vs females 0.59 [0.11] cm) and on the left (males 0.68 [0.12] cm vs females 0.57 [0.12] cm) reaching statistical significance (P < .001). The mean height of the thyro-arytenoid muscle in males was larger than that in females on the right (males 1.05 [0.21] cm vs females 0.95 [0.12] cm) and on the left (males 1.05 [0.21] cm vs females 0.95 [0.12] cm) reaching statistical significance (P < .01 on the right and P < .05 on the left). The volume of the thyroarytenoid muscle in males was larger than that in females on the right (males 0.86 [0.25] mL vs females 0.48 [0.15] mL) and on the left (males 0.89 [0.27] mL vs females 0.48 [0.17] mL) reaching statistical significance (P < .001). The results of this investigation clearly indicate a significant difference in these measurements between men and women.

Age-related changes affecting the cricoarytenoid joint seen on computed tomography.

We conducted a retrospective chart review to compare four characteristics-cricoarytenoid joint ankylosis, narrowing, erosion, and density increases-in patients younger and older than 65 years. Our study population was made up of 100 patients, who were divided into two groups on the basis of age. The younger group (<65 yr) comprised 49 patients (27 men and 22 women), and the older group (≥65 yr) was made up of 51 patients (25 men and 26 women). Findings on computed tomography (CT) of the neck were used to determine whether each of the four characteristics was present or absent. Overall, we found only one statistically significant difference between the two groups: ankylosis was significantly more common in the older group (p = 0.036). When we looked further at the side of these anatomic changes, we found that the older group had significantly more right-sided and left-sided ankylosis than did the younger group (p = 0.026 for both), as well as significantly more left-sided narrowing (p = 0.028) (some patients had bilateral involvement). When we analyzed age as a continuous variable, older age was again associated with significantly more ankylosis (p = 0.047) and narrowing (p = 0.011). We conclude that CT can be useful for assessing radiologic changes in the cricoarytenoid joint in elderly patients during the workup of dysphonia and abnormal movement of the vocal folds.

Voice outcome measures after flexible endoscopic injection laryngoplasty.

OBJECTIVE: To report voice outcome measures after injection laryngoplasty using the transnasal or transoral flexible endoscopic technique. METHODS: A retrospective review of all patients who underwent flexible endoscopic injection laryngoplasty between June 2010 and August 2016 was carried out. Only those patients who had pre- and post-injection voice outcome measures recorded were included. Voice outcome measures recorded included perceptual voice evaluation using GRBAS, Voice Handicap Index-10 (VHI-10), maximum phonation time (MPT) and closed quotient (CQ) before and after treatment. RESULTS: Forty-six patients were identified, of which 32 had pre- and post-injection voice outcome measures recorded. There were 19 males and 13 females. The mean age was 56.97 years (range 20-86 years) and the most common indication was unilateral vocal fold paralysis. Thirteen patients had a transnasal flexible endoscopic injection), while 19 patients were injected transorally. Following injection laryngoplasty, there was significant improvement in the mean grade of dysphonia (2.81 vs. 1.22, P < 0.01, roughness (2.44 vs. 1.34, P < 0.01), breathiness (2.72 vs. 1.13, P < 0.01), asthenia (2.78 vs. 1.06, P < 0.01), and strain (2.44 vs. 1.19, P < 0.01), MPT (3.85 s vs. 9.85 s, P < 0.01) and mean CQ (0.19 vs. 0.46, P < 0.01). There was also a decrease in the mean VHI-10 score (33.31 vs. 7.94, P < 0.01). CONCLUSION: s: Patients achieved significant improvement in both subjective and objective voice measures after flexible endoscopic injection laryngoplasty via the nasal or transoral route. Voice outcomes were comparable to those reported for other approaches. This technique provides an alternative approach for the management of patients with vocal fold paralysis or glottal insufficiency.

Prevalence of MTD among Patients with Functional Dysphagia.

OBJECTIVE: To assess the prevalence of laryngeal muscle tension patterns among patients with functional dysphagia. STUDY DESIGN: Retrospective study. SETTING: The study took place at a university medical center. MATERIAL AND METHODS: The medical charts and laryngeal video recordings were reviewed for all patients who presented with dysphagia and who were referred for barium swallow between 2012 and 2017. A total of 170 cases were identified. Only those with normal findings on barium swallow and the absence of vocal fold pathology (exudative lesions, masses or tumors, paresis, and paralysis), referred to as functional dysphagia, were included in this study. Information retrieved included swallowing and phonatory symptoms in addition to patterns of laryngeal muscle tension. RESULTS: The mean ± SD age of the total group was 41.90 ± 15.10 years with a male:female ratio of 4:1. Seventy-five percent had evidence of at least 1 type of laryngeal muscle tension pattern. The most common pattern was type III, characterized by supraglottic anteroposterior compression (13 of 20), followed by type II, characterized by medial compression of the false vocal folds (5 of 20); only 1 patient had muscle tension pattern type IV, characterized as sphincter-like closure of supraglottic structures. The most common laryngopharyngeal symptom was throat discomfort when swallowing (35%), followed by throat clearing and choking/coughing when eating and drinking (25%). CONCLUSION: The high prevalence of laryngeal muscle tension pattern among patients with functional dysphagia supports the notion that laryngeal tension may be one of the underlying causes of dysphagia.

Changes in abnormal muscle tension pattern after fiberoptic injection laryngoplasty.

We performed a retrospective chart review to compare the presence and types of abnormal muscle tension patterns (MTPs) in patients who had been diagnosed with glottal insufficiency before and after fiberoptic injection laryngoplasty. The main cause of glottal insufficiency had been unilateral vocal fold paralysis. Our review included an analysis of the medical records and laryngeal videostroboscopic recordings of 16 patients-9 men and 7 women, aged 25 to 87 years (mean: 59). Stroboscopic frames were analyzed for the presence of one or more types of abnormal MTP. Statistical analysis was performed to determine the significance of the change in scores for type II and type III MTP before injection and 1 month after injection. Before injection laryngoplasty, 15 of the 16 patients exhibited evidence of an abnormal MTP; 10 patients had MTP II only, 2 had MTP III only, and 3 patients had both. The mean percentage of frames showing MTP (i.e., MTP score) in patients with MTP II was 66.2% before the injection and 28.9% 1 month after; the decrease was statistically significant (p = 0.001). For MTP III, the corresponding figures were 71.6 and 37.7% (p = 0.043). We conclude that injection laryngoplasty has a positive effect on reducing muscle tension in patients with glottal insufficiency.

Clinical application of nasometry in patients with nasal obstruction.

The purpose of this case-control study is to report on the clinical application of nasometry as a diagnostic tool in patients with the symptom of nasal obstruction compared with subjects with no history of nasal obstruction. Thirty-eight adult patients (mean age: 28.1 years) complaining of nasal obstruction were enrolled in the study, and another group of 38 adults (mean age: 25.9 years) with no history of nasal obstruction served as controls. Demographic data, including age and sex, were collected. Patients were asked to read three passages; the Zoo passage, the Rainbow passage, and nasal sentences. Nasalance scores were reported on all subjects using a Nasometer II instrument. The control and patient groups each included 22 men and 16 women. No statistically significant difference in nasalance score was found between the study group and the control group in any of the Zoo passage, Rainbow passage and nasal sentences. We conclude that nasometry has limited value in the objective assessment of nasal obstruction as a symptom, which we attribute to nasal obstruction's not always reflecting the volume and pressure in the nasal cavity.

Vocal Symptoms and Acoustic Findings in Menopausal Women in Comparison to Pre-menopause Women with Body Mass Index as a Confounding Variable.

OBJECTIVES: To compare the prevalence of phonatory symptoms in menopausal women compared to pre-menopause women with body mass index (BMI) as a confounding variable. METHODS: A total of 69 women, 34 menopausal and 35 pre-menopausal were invited to participate in this study. Demographic variables included age, smoking, and BMI. All subjects were asked about the presence hoarseness, loss of high or low frequencies, pitch breaks, throat clearing, dryness in the throat and vocal fatigue. Acoustic analysis was performed and the Voice Handicap Index (VHI)-10 was filled by all the subjects. RESULTS: There was a significantly higher prevalence of throat clearing and dryness in the menopausal group compared to the pre-menopause group with a P value of 0.035 and 0.032 respectively. When BMI was taken into account, there was no statistically significant difference in the prevalence of any of the phonatory symptoms in menopausal women with high BMI and pre-menopause. There was no statistically significant difference in the means of any of the acoustic parameters between the menopausal group and pre-menopausal group. There was no significant difference in the mean VHI-10 between the menopause group and the pre-menopause (P = 0.652). CONCLUSIONS: The results of this investigation substantiate the importance of fat as an alternative source of estrogen which can mask some of the phonatory symptoms.

Effect of Vitamin D Deficiency on Voice.

PURPOSE: The purpose of this article was to investigate the relationship between low level of vitamin D, phonatory symptoms, and acoustic findings. METHOD: A total of 38 subjects presenting to the endocrinology clinic were enrolled in 2 groups: 19 with vitamin D deficiency who were not on treatment, and 19 with normal vitamin D level who were on treatment. Demographic data included age, gender, and history of smoking. All patients were asked about the presence or absence of dysphonia, degree of phonatory effort, and vocal fatigue. Acoustic analysis and perceptual evaluation using the grade, roughness, breathiness, asthenia, and strain scale were performed on all subjects. RESULTS: The mean age of the total group was 47.29 ± 13.52 years. The difference in the mean and frequency of phonatory effort, vocal fatigue, and dysphonia, and in the mean of the acoustic variables, perceptual parameters, and the score of the Voice Handicap Index-10 was not statistically significant between patients with low vitamin D levels compared with controls. CONCLUSION: The results of this study revealed no significant difference in the prevalence of phonatory symptoms in patients with vitamin D deficiency compared with patients with no vitamin D deficiency. A larger study is needed to substantiate the difference in the prevalence of phonatory systems between the 2 groups.

Phonatory Symptoms and Acoustic Findings in Patients with Asthma: A Cross-Sectional Controlled Study.

To investigate the prevalence of phonatory symptoms, perceptual, acoustic and aerodynamic findings in patients with asthma compared to a control group. This study is a cross-sectional study. A total of 50 subjects, 31 asthmatic and 19 control subjects matched according to age and gender were enrolled in this study. All subjects were asked about the presence or absence of dysphonia, vocal fatigue, phonatory effort, cough, dyspnea, and respiratory failure. Perceptual evaluation, acoustic analysis and aerodynamic measurements were also performed. Patient's self assessment using the Voice Handicap Index 10 was reported. The mean age of patients was 43.5 years with a female to male ratio of 2:1. There was a statistically significant difference in the prevalence of dysphonia between the two groups (32.3 vs. 5.3%, p value 0.025) with a non-significant higher prevalence of vocal fatigue and phonatory effort. The overall grade of dysphonia was significantly higher in asthmatics compared to controls (p value 0.002). Patients with asthma had also significantly higher degree of asthenia and straining (p value of 0.04 and 0.008, respectively) with borderline significant difference with respect to roughness. There was no significant difference in the means of any of the acoustic parameters between patients and controls except for Shimmer, which was higher in the asthmatic group (p value of 0.037). There was also no significant difference in the Maximum phonation time between the two groups. Dysphonia is significantly more prevalent in patients with asthma compared to controls.

Association Between Facial Length and Width and Fundamental Frequency.

OBJECTIVE: This study aimed to evaluate the association between facial width and length and fundamental frequency (F0) and habitual frequency. STUDY DESIGN: Prospective cross-sectional study. SUBJECTS: A total of 50 subjects (35 females;15 males) were included in this study. METHODS: Lateral and posteroanterior cephalometric measurements included: facial height (N-Me); widths of the maxilla (J-J), mandible (AG-AG), and face (Zyg-Zyg); ratios J-J to AG-AG, N-Me to Zyg-Zyg, and lower face to total face heights. All subjects underwent acoustic analysis using Visi-Pitch IV. Sample was stratified according to age and gender. RESULTS: In the total group (mean age: 14.19±6.49 years; range 6-35 years), a significantly moderate negative correlation existed between Zyg-Zyg, J-J, and AG-AG, and F0 and habitual pitch. Similarly, N-Me moderately correlated with habitual pitch. In males, there was a significant moderate negative correlation between Zyg-Zyg and J-J, and habitual pitch, and between J-J and F0 (-0.571;p=0.026). In females, a significant moderate correlation existed between Zyg-Zyg and AG-AG, and habitual pitch, and between AG-AG and F0 (-0.347;p=0.041). In the prepubertal group (n=25), a negative moderate correlation occurred between J-J and AG-AG, N-Me and habitual frequency, and between J-J and F0 (-0.407;p=0.043). In the postpubertal group, there was a significant moderate correlation only between AG-AG and F0 (-0.403;p=0.046). CONCLUSION: Facial length correlates significantly with habitual frequency, and facial width correlates significantly with both F0 and habitual pitch. A larger sample of adult subjects is needed to substantiate this conclusion.

Structural and Anatomic Laryngeal Measurements in Geriatric Population Using MRI.

OBJECTIVE: The study aims to evaluate the changes in volume and dimensions of the thyroarytenoid (TA) muscle in the elderly using magnetic resonance imaging (MRI). STUDY DESIGN: This is a retrospective study. METHODS: The neck MRIs of 40 adult patients aged less than 65 years old and 40 patients aged 65 years old and above were compared. Demographic data included age and gender. The length, width, and height of the TA muscle as well as its volume were measured on each side, right and left, in both groups. RESULTS: The differences in the mean length, width, and height of TA muscle were not statistically significant between the two groups on either right or left side. Similarly, there was no statistically significant difference in the mean volume of the TA muscles between the two groups on either side as well. The mean volume of the right and left TA muscles in those aged less than 65 years was 0.65 ± 0.26 mL and 0.69 ± 0.30 mL, respectively. The mean volume of the right and left TA muscles in the elderly group was 0.72 ± 0.31 mL and 0.72 ± 0.32 mL, respectively. CONCLUSION: Using MRI, there are no dimensional or volumetric changes in TA muscles with aging.

Effect of Religiosity on Voice.

The aim of this study was to examine the relationship between religiosity and phonatory behavior. A total of 186 participants participated in a survey that included four sections: demographic data, extent of religiosity, history of dysphonia, phonatory behavior and laryngeal manipulation, in addition to the Voice Handicap Index (VHI-10). There was no significant association between the prevalence of phonatory symptoms and any of the religiosity questions. There was no significant association between phonatory behavior, history of laryngeal manipulation and any of the religiosity questions. There was also no significant association between the score of the Voice Handicap Index and any of the five religiosity questions. There is no association between religiosity and prevalence of phonatory disturbances, phonotraumatic behavior and/or history of laryngeal manipulation.

Thyroarytenoid muscle uptake and attenuation in PET/CT in elderly.

The objective of this study is to compare uptake and attenuation on positron emission tomography/computed tomography (PET/CT) imaging modality at the thyroarytenoid muscle between subjects aged less and older than 65 years old. The study design is retrospective chart review. The setting is academic medical center. PET/CT images of 60 patients aged less than 65 years old and 60 patients aged more than 65 years old were selected. Demographic data were collected. Both the groups were compared with respect to the maximum standardized uptake value (SUV max) and CT attenuation of bilateral thyroarytenoid muscles. The mean SUV max of the right thyroarytenoid muscle was 2.09 ± 0.8 in the group of patients aged less than 65 years old compared to 1.9 ± 0.6 in the group of patients aged more than 65 years old. For the left thyroarytenoid muscle, the mean SUV max in the first and second groups was, respectively, 2 ± 0.6 and 1.9 ± 0.6. The differences were not statistically significant. As for the CT attenuation, the mean value at the right thyroarytenoid muscle in the first and second groups was, respectively, 31.2 ± 0.8 HU and 20.8 ± 14.4 HU (p < 0.05). At the left thyroarytenoid muscle, the mean value was, respectively, 29.6 ± 9.9 and 22.8 ± 15 (p < 0.05). This study suggests that CT attenuation measurements can be used for objectively assessing the change in the density of aging thyroarytenoid muscle.

Effect of Rapid Maxillary Expansion on Voice.

OBJECTIVE: The purpose of this investigation is to evaluate the effect of rapid maxillary expansion (RME) on the fundamental frequency (F0) and formant frequencies F1-F4. STUDY DESIGN: Cross-sectional study. MATERIALS AND METHODS: A total of 14 consecutive patients between the ages of 9.6 years and 15 years with a constricted maxilla undergoing RME were included in this study. Measurements were made before (T1) and after treatment (T2). These included maxillary arch length, depth, width, and perimeter in addition to F0, habitual pitch, and formants F1, F2, F3, and F4 for the vowels /ɑ/, /i/, /o/, and /u/. RESULTS: There was a significant difference in the mean of F1/ɑ/ and F2/ɑ/ before and after treatment (P value of 0.04 and 0.013, respectively). It is worth noting that F1/ɑ/ decreased in 11 and F2/ɑ/ decreased in 10 of the 14 subjects. CONCLUSION: The application of RME in the treatment of maxillary constriction leads to a significant lowering of the first and second formants for the vowel /ɑ/ in most subjects. Subjects undergoing rapid maxillary application should be aware of the potential change in voice quality especially in case of professional voice users.