The psychosocial needs of head and neck cancer patients: a multicenter study.

INTRODUCTION: Cancer is among the most frequent pathologies and a major cause of death and disability. Scientific research and surgeons focus mainly on aspects relating to etiopathogenesis, diagnosis, and treatment, but often neglect the psychological needs of patients and related social factors. The aim of this study is to investigate the psychological and social needs of patients affected by head and neck cancer to improve patient management and achieve more empathetic care. MATERIALS AND METHODS: The Need Evaluation Questionnaire (NEQ) was administered to adult patients who had to undergo surgery in 4 Italian tertiary head and neck cancer centers the day before the operation. RESULTS: 188 patients affected by stage I-IV head and neck tumors were enrolled. The main needs expressed by patients fall under the categories of either "information and dialogue", (64.3% more information about future conditions, 50% more information about treatments, 45% more information about the diagnosis, 44% more reassurance) or "spiritual support" (50% need to talk to someone who had the same experience as them). CONCLUSIONS: Common methods of explaining diagnosis, treatment, and prognosis have proven unsatisfactory to patients and most also require more psychosocial support. This highlights the need to implement interventions and activities that are increasingly geared toward supporting the psychological and relational aspects of the care journey.

Technical refinements of the scapular tip-free flap for mandibular reconstruction.

BACKGROUND: The use of scapular tip chimeric free flaps (STFFs) for reconstructing mandibular defects has recently become popular, but its utility relative to other bone-containing free flaps remains debatable. The aim of the report is to describe how technical modification of STFF impacted in its use for mandibular reconstruction also commenting results obtained in a unicentric series of patients. PATIENTS AND METHODS: Patients undergoing mandibular reconstruction using an STFF from January 1, 2014 to June 1, 2022 were retrospectively enrolled in this report. We collected data on chimeric flap type, bone management, vascular pedicles, and the final outcomes. In total, 31 patients (13 men and 18 women) with a mean age of 68 years were enrolled. According to the classification system of Urken, 15 patients had body defects, while 7 had ramus defects, another 7 had symphysis defects, and 2 had both ramus and bodily defects. STFF was always harvested working in two equips simultaneously, in supine position. Dissection included preparation of chimeric components of the flap as latissimus dorsi, serratus and scapular tip. After pedicle dissection scapular bone was cut basing on reconstructive needing with a rectangular (stick) shape including the border of the scapula. In cases of longer bone harvesting, circumflex pedicle was also included to perfuse the upper portion of the scapular border. In five cases, the STFF was harvested with only the scapular angle component, and was thus a composite osteomuscular flap; for the remaining 26 cases, a chimeric STFF was used. Circumflex pedicle was included for eight patients. Six of the seven patients with symphyseal defects underwent a single osteotomy. RESULTS: The average length of the harvested was 69.92 mm (maximum length = 104 mm). The average height of transplanted bone was 26.78 mm (maximum height = 44.2 mm). Mouth-opening was normal in 25 patients, limited in 6 patients, and severely impaired in no patients. The cosmetic results were rated as excellent by 20 patients, good by 8 patients, and poor by 3 patients. CONCLUSION: The STFF is an excellent option for mandibular reconstruction when other flaps are not available and for patients in poor general condition. Technical innovations here presented made possible to harvest long bone segments with accurate shape thanks to osteotomies if needed and with adequate soft tissues components of the chimeric flap, ensuring satisfactory functional and cosmetic results.

The ability of the eighth edition of the TNM staging system plus minor invasion criteria to predict the biological behaviour of oral cavity carcinomas.

BACKGROUND: Oral squamous cell carcinoma (OSCC) treatment is based largely on the TNM stage. The eighth edition includes important new prognostic parameters (extranodal extension and depth of invasion), while it does not consider tumour molecular characteristics or minor invasion criteria (perineural and lymphovascular invasion, grading and resection margins). This study evaluated how well the TNM eighth edition predicts the biological behaviour of OSCC, considering survival and risk of locoregional recurrence. MATERIALS AND METHODS: Data from 217 patients treated for OSCC were analysed, including epidemiologic characteristics, histological features and treatment. RESULTS: No significant correlations with overall survival or tumour recurrence were found for pT stages and the type of treatment, while different pN stages had significant differences in recurrence, but not in overall survival. We found significant correlations between overall survival and tumour grade and lymphovascular and perineural invasion and a significant correlation between tumour resection margins and the risk of recurrence. CONCLUSIONS: The current TNM staging system is a necessary but not sufficient tool for predicting the overall survival and risk of recurrence of OSCC. It could be improved by considering other factors, such as minor invasion criteria and biological markers.

Modified Preauricular Transparotid Approach for Treating Mandibular Condylar Fractures.

AIM OF THE STUDY: We introduce a technical variant of the standard preauricular approach to treat intracapsular and condylar neck fractures: the modified preauricular transparotid approach (MPTA). The main modification, when compared with the conventional submandibular approach, is that the incision of the superficial musculoaponeurotic system is performed directly above the parotid gland, and the buccal branch of the facial nerve is dissected in a retrograde way within the parotid gland. CASE SERIES: Between January 2019 and December 2020 at the Maxillofacial Departments of "Ospedale Maggiore" of Parma and "Policlinico San Martino" of Genoa 6 patients affected by intracapsular and condylar neck fractures underwent open reduction and internal with MPTA. Surgery was uneventful in all patients; no infections occurred in any of the cases; the mean procedure duration was 85 minutes, ranging from 75 to 115 minutes. At the 1-year follow-up, all patients had stable occlusion with a natural, well-balanced morphology of the face and adequate dynamic excursion of the mandible. CONCLUSION: MPTA is particularly suited for intracapsular and condylar neck fractures. Morbidity is negligible in terms of damage to the facial nerve, vascular injuries, and esthetic deformity.

Double Arterialized Scapular Tip Free Flap for Mandibular Reconstruction.

INTRODUCTION: Scapular tip free flap (STFF) has become today one of the workhorse flaps for maxillary reconstruction; recently, the possibility of extending the vascular supply by adding to the angular branch of the circumflex pedicle up to its periosteal entrance in the lateral border of the scapula has been proposed as a reliable technique to improve the length of perfused bone when STFF is used for mandibular reconstruction. The purpose of this study was to evaluate the patients who had received microvascular reconstruction of the mandible with STFF vascularized by both the circumflex scapular artery via the periosteal branch and the thoracodorsal artery via the angular artery. METHODS: A retrospective chart review was conducted for all patients who underwent reconstruction with an STFF for mandibular defect between January 2016 and December 2020 at the University Hospital of Parma. The outcome was evaluated by assessing dietary intake (unrestricted, soft, liquid, and tube feed) and speech (normal, intelligible, partially intelligible, and unintelligible). RESULTS: The final study sample included 9 patients (5 men and 4 women). The average patient age was 68.9 years (range, 59.9-74.8 y) at the time of surgery. There was no flap loss. A 1-year postoperative computed tomography scan revealed full osteointegration of the flap. CONCLUSIONS: Our results show that the STFF is a valuable reconstructive option, especially in patients with complex head and neck defects requiring soft and hard tissues.

Supercharged massetric-facial cross-graft for gracilis reinnervation in unilateral facial palsy treatment.

BACKGROUND: The choice of neurotization source for gracilis neuromuscular transplant is a key point in the treatment of unilateral long-standing paralysis. To combine the advantages of different donor nerves and overcome their disadvantages, mixed neurotization sources have been described with encouraging results. The authors present a preliminary report of a novel technique, the "supercharged" cross-graft, a two-step technique consisting of a double powered cross nerve graft provided by a zygomatic branch of the healthy facial nerve and the masseter nerve of the healthy side. PATIENTS AND METHODS: From January 2015 to December 2019 eight patients, aged between 19 and 61 years old (mean age at surgery 33.62) suffering unilateral established paralysis (congenital or acquired, >24 months) underwent gracilis reinnervation with the supercharged cross grafting technique. Subjects underwent a two-step surgical rehabilitation: in the first operation sural nerve was harvested and used as cross-graft cooptated by healthy side facial nerve branch and masseteric nerve. During second procedure gracilis neuromuscular transplant was performed reinnervarting the muscle with the cross-graft. Patients were evaluated using Emotrics software, which allowed for automated facial measurements on post-operative pictures taken at the last follow-up. The results of the different poses were compared to assess the contribution to smile excursion by the masseter and facial nerve, together and separately. Finally, we analyzed spontaneous smile to assess whether masseteric contribution is used in daily life. RESULTS: No major or minor complications occurred. Follow-up time ranged from 12 to 41 months, with a mean of 22.75 months. A good commissure excursion (mean 33.84 mm) was obtained during smile with no teeth clenching (without masseter activation), as well as during teeth clenching without smiling (activation of gracilis only - mean 32.55). When smiling and biting simultaneously the excursion was greater than the single two components (mean 35.91). In spontaneous smile, commissure excursion was higher (mean 34.23) than that provided by only the facial nerve (smile only) in most patients. CONCLUSIONS: This novel technique of mixed neurotization for gracilis transplant shows consistent results with powerful contraction and good smile coordination. It also allows us to extend the indications for mixed neurotization techniques.

Prognostic role of pre-treatment magnetic resonance imaging (MRI)-based radiomic analysis in effectively cured head and neck squamous cell carcinoma (HNSCC) patients.

OBJECTIVES: To identify and validate baseline magnetic resonance imaging (b-MRI) radiomic features (RFs) as predictors of disease outcomes in effectively cured head and neck squamous cell carcinoma (HNSCC) patients. MATERIALS AND METHODS: Training set (TS) and validation set (VS) were retrieved from preexisting datasets (HETeCo and BD2Decide trials, respectively). Only patients with both pre- and post-contrast enhancement T1 and T2-weighted b-MRI and at least 2 years of follow-up (FUP) were selected. The combination of the best extracted RFs was used to classify low risk (LR) vs. high risk (HR) of disease recurrence. Sensitivity, specificity, and area under the curve (AUC) of the radiomic model were computed on both TS and VS. Overall survival (OS) and 5-year disease-free survival (DFS) Kaplan-Meier (KM) curves were compared for LR vs. HR. The radiomic-based risk class was used in a multivariate Cox model, including well-established clinical prognostic factors (TNM, sub-site, human papillomavirus [HPV]). RESULTS: In total, 57 patients of TS and 137 of VS were included. Three RFs were selected for the signature. Sensitivity of recurrence risk classifier was 0.82 and 0.77, specificity 0.78 and 0.81, AUC 0.83 and 0.78 for TS and VS, respectively. VS KM curves for LR vs. HR groups significantly differed both for 5-year DFS (p<.0001) and OS (p=.0004). A combined model of RFs plus TNM improved prognostic performance as compared to TNM alone, both for VS 5-year DFS (C-index: 0.76 vs. 0.60) and OS (C-index: 0.74 vs. 0.64). CONCLUSIONS: Radiomics of b-MRI can help to predict recurrence and survival outcomes in HNSCC.

A New Neurorehabilitative Postsurgery Intervention for Facial Palsy Based on Smile Observation and Hand-Mouth Motor Synergies.

Objective: To perform a preliminary test of a new rehabilitation treatment (FIT-SAT), based on mirror mechanisms, for gracile muscles after smile surgery. Method: A pre- and postsurgery longitudinal design was adopted to study the efficacy of FIT-SAT. Four patients with bilateral facial nerve paralysis (Moebius syndrome) were included. They underwent two surgeries with free muscle transfers, one year apart from each other. The side of the face first operated on was rehabilitated with the traditional treatment, while the second side was rehabilitated with FIT-SAT. The FIT-SAT treatment includes video clips of an actor performing a unilateral or a bilateral smile to be imitated (FIT condition). In addition to this, while smiling, the participants close their hand in order to exploit the overlapped cortical motor representation of the hand and the mouth, which may facilitate the synergistic activity of the two effectors during the early phases of recruitment of the transplanted muscles (SAT). The treatment was also aimed at avoiding undesired movements such as teeth grinding. Discussion. Results support FIT-SAT as a viable alternative for smile rehabilitation after free muscle transfer. We propose that the treatment potentiates the effect of smile observation by activating the same neural structures responsible for the execution of the smile and therefore by facilitating its production. Closing of the hand induces cortical recruitment of hand motor neurons, recruiting the transplanted muscles, and reducing the risk of associating other unwanted movements such as teeth clenching to the smile movements.

Maxillary reconstruction with scapular tip chimeric free flap.

PURPOSE: Purpose of the article is to discuss the use of the scapular tip free flap (STFF) for the reconstruction of maxillary defects. METHODS: A retrospective evaluation of patients who underwent maxillary reconstruction with STFF is presented. Patients were evaluated with respect to complications, function, and cosmesis. RESULTS: Study population consisted of 53 patients. All flaps survived and partial bone resorption only occurred in a young patient. Minor complications included two instances of partial muscular necrosis. The donor site was primarily closed in all patients. Mouth opening was assessed as good (>3 cm) in 41 patients, partially limited (2-3 cm) in 9 patients, and limited (<2 cm) in 3 patients. Dental rehabilitation was achieved in 35 patients; esthetic results were assessed by patient as excellent in 19 patients, good in 28 patients, and poor in 6 patients. CONCLUSIONS: The scapular tip chimeric free flap represents an indispensable tool for reconstructive head and neck microsurgery. The main advantages of this technique are very low donor site morbidity and a long pedicle, as well as the potential for harvesting multiple flaps in a chimeric design; STFF represents the first choice for treatment of small postero-lateral defects of the maxilla, and of wide and complex through-and-through defects involving all components of the midface.

Perioperative pain management after fibular free flap harvesting for head-and-neck reconstruction using mini-catheters to inject local anesthetic: A pilot study.

BACKGROUND: Fibular donor site pain management in the early postoperative period can help minimize complications, patient discomfort, and agitation. Traditional management of postoperative pain consists of systemic administration of opioids and NSAIDS. The use of local anesthetics in addition to systemic analgesics has the potential to improve pain control. Purpose of the study is to evaluate the efficacy of mini-catheters used to inject local anesthetic into the fibular donor site after flap harvesting for reconstruction of the head-and-neck area. METHODS: Prospective study on 31 patients (mean age 52 years) treated for head and neck reconstruction with fibula free flap using minicatheter for local anesthetic injection in the early postoperative time. A bolus of chirochaine (0.125% w/v; 20 mL) was injected through the catheter before the patient regained consciousness. Postoperatively, three consecutive injections (20 mL each) were administered 8, 16, and 24 h after surgery. Pain evaluation before and after local anesthetic injection is used to assess efficacy and overall pain control. RESULTS: No major or minor complication occurred. Mean pain value was 1.69. At 8 h, the pain scores before injection ranged from 0 to 10 (mean 4.13 ± 3.06). After injection, the pain scores ranged from 0 to 5 (mean 1 ± 1.34). Similarly, at 16 h, the pain scores ranged from 0 to 8 (mean 2.77 ± 2.42) before injection and from 0 to 6 (mean 0.42 ± 1.2) thereafter. At 24 h, the initial pain score ranged from 0 to 6 (mean 1.71 ± 1.74) and from 0 to 1 (mean 0.1 ± 0.3) after drug administration. Pre and postinjection pain scores differences were statistically significant after all three injections (P < .001). CONCLUSIONS: Minicatheter seems to be easy, safe, and efficient when used to control pain after fibular free-flap harvesting.

Bilateral Harvesting of a Fibula Free Flap: Assessment of Morbidity.

PURPOSE: To investigate morbidity related to harversting of bilateral fibula free flap for head and neck reconstruction using subjective and functional tests. METHODS: Patients were retrospectively evaluated using point evaluation system (PES) and balance evaluation systems test (BESTest) questionnaires to assess morbidity related to surgery. RESULTS: Five patients were enrolled in the study. Mean PES scores was 22.2 over 24. Mean overall function assessed with BESTest was 77.6%, and the results were poorest for section I. Sections V and VI had scores of 88% and 83%, respectively, indicating that the sensory balance and gait stability of the patients were compromised only minimally. CONCLUSION: Bilateral harvesting of the fibula free flap is not associated with an increase in long-term morbidity and does not lead to significant functional impairments. Therefore, this procedure should be considered safe, and can be performed without concern regarding morbidity, when bone reconstruction with a fibula free flap is indicated.

Microsurgical Decompression of Inferior Alveolar Nerve After Endodontic Treatment Complications.

Iatrogenic injury in oral surgery is the most frequent cause of sensory disturbance in the distribution of the inferior alveolar nerve (IAN) and mental nerve.Inferior alveolar nerve damage can occur during third molar extraction, implant location, orthognathic surgery, preprosthetic surgery, salivary gland surgery, local anesthetic injections or during the resection of benign or malignant tumors.Injuries to the IAN can be caused also by endodontic treatment of mandibular molars and premolars when filling material is forced into the tooth and mandibular canal.The sensory disturbances that could follow a damage of the IAN could be hypoesthesia, dysesthesia, hyperesthesia, anesthesia, and sometimes a painful anesthesia that strike ipsilateral lower lip, chin, and teeth. These can undermine life quality by affecting speech, chewing, and social interaction.Treatment of these complications is sometimes difficult and could consist in observation or in surgical decompression of the involved nerve to relieve the patient's symptoms and improve sensory recovery. The most debated points are the timing of intervention and the effective role of decompression in clinical outcome-improvement.The purpose of this article is to show authors' experience with 2 patients treated with microsurgical nerve decompression to remove endodontic material from the mandibular canal and providing also a comprehensive review of the literature.

Inflammatory Pseudotumor of the Infraorbital Nerve: A Rare Diagnosis to Be Aware of.

Inflammatory pseudotumor (IPT) is a rare benign mass-forming disease that can arise anywhere throughout the body, mimicking a wide spectrum of other conditions. Its diagnosis can be challenging, especially when it involves uncommon sites. The authors report a patient of an atypical localization of IPT, occurred as an enlarging bulk in the infraorbital nerve channel in a patient who presented with facial numbness. Clinical and radiological aspects similar to schwannoma led to misdiagnosis and over-treatment. The differential diagnosis of an infraorbital mass should include IPT and the least invasive treatment should be preferred, as steroid therapy being the first-line treatment for IPT.

Head and neck reconstruction using the superiorly based reversed-flow facial artery myomucosal flap.

PURPOSE: The use of myomucosal buccinator flaps in the reconstruction of oral cavity defects is well established in the international literature; however, their use for the reconstruction of defects not in the oral cavity has been largely underestimated. The purpose of this report was to describe and review the applications of the superiorly based facial artery myomucosal (FAMM) flap in head and neck reconstruction. MATERIALS AND METHODS: This study was a retrospective evaluation of 12 patients who underwent reconstruction of the palate, lip, nasal septum, and conjunctiva with reversed-flow FAMM flaps. Mouth opening, speech, reconstruction effectiveness, and esthetic outcomes were analyzed. RESULTS: The patient cohort consisted of 7 men and 5 women 33 to 80 years old (mean, 56.2 yr old). No major complication occurred. Cosmetic results were excellent in most patients. Functionally, the best reconstruction results were obtained in the palate, lip, and conjunctiva. Nasal reconstruction led to mild airway obstruction in 2 cases and severe obstruction in 1 case. CONCLUSION: The superiorly based FAMM flap plays an important role in the reconstruction of particular defects involving the oral cavity and other distant sites of the head and neck area. The reliability, low morbidity, and optimal results that can be achieved using this technique make this flap a good option for such reconstructions.

Donor site morbidity after scapular tip free flaps in head-and-neck reconstruction.

BACKGROUND: Recently, the scapular tip free flap has been popularized as a valuable option for bone reconstruction of the head and neck area. Analyses of perioperative and long-time morbidity are crucial to enable complete comprehension of this technique and will be presented in this paper. METHODS: Perioperative and long-term morbidity of scapular tip flaps harvesting were analyzed in a cohort of 19 patients. Local complications and ambulation-time were used to assess perioperative results, while Constant-Murley and DASH scores were used to evaluate long-term morbidity on shoulder functions. RESULTS: Local perioperative complications were minimal (three cases of seroma and two wound dehiscence). Ambulation time ranged between 2 and 4 days (mean 2.7 days). Constant-Murley scores ranged between 66 and 100 (mean 92.2). The DASH score ranged between 39 and 85 (mean 48.6). CONCLUSION: Harvesting a scapular tip free flap resulted in very low shoulder morbidity, without interfering the patient's daily activities. © 2015 Wiley Periodicals, Inc. Microsurgery 35:447-450, 2015.

Reconstruction of mandibular defects using the scapular tip free flap.

PURPOSE: Purpose of the article is to present the use of the scapular tip free flap (STFF) for the reconstruction of oromandibular defects. PATIENTS: Eleven patients who underwent oromandibular reconstruction with STFF were retrospectively evaluated with regards to form and function assessing mouth opening, dietary intake, and cosmetic outcome. Donor site morbidity was evaluated using the Constant-Murley test for the shoulder unit. RESULTS: Follow-up ranged from 6 to 35 months (mean 20.6 months). Good or excellent results in mouth opening and cosmesis were achieved in eight patients, speech was assessed as intelligible or normal in all but one patient and mean ambulation time after surgery was 2.5 days. Results of Constant score ranged from 45 to 70 (mean 60.6), and the main limitation encountered was elevation of the arm above the head, which was seen in all but one patient confirming the low impact of the technique on the shoulder system. CONCLUSION: Low morbidity, early ambulation time, possibility of simultaneous harvesting with the tumor resection, large musculocutaneous paddles in the chimeric version of the flap are advantages of the STFF and makes it a good choice in elderly patients, when other bone containing free flaps are not indicated because of the related morbidity, when other flaps are not available or when wide composite defects are approached.

Ancillary procedures in facial animation surgery.

PURPOSE: Facial animation surgery with neuromuscular transplants has become a standard procedure for the treatment of facial palsies. However, the forehead, periocular complex, nasal base area, and inferior lip are secondary sites that also need to be considered in the complete rehabilitation of a flaccid facial palsy. MATERIALS AND METHODS: A total of 136 ancillary procedures were performed in 49 patients between 2003 and 2013 and consisted of eyebrow suspensions (11), upper eyelid loading with a platinum chain (39), inferior palpebral suspension with fascia lata (22), nasal base suspension with fascia lata (26), and botulinum toxin injection (38). RESULTS: Cosmetic results were good and excellent in 30.7% and 63.2% of the procedures, respectively. Functionally, periocular complex rehabilitation and nasal base suspension led to excellent improvements in function in 87.2% and 73.1% of the patients, respectively. CONCLUSIONS: The use of ancillary procedures can improve the functional and esthetic results of facial animation surgery.

The Evolution of Foreign Bodies Management in a Case of Near-fatal Penetrating Neck Injury.

Penetrating wounds of the neck with foreign bodies retention are frequent and often life-threatening events, and their management has changed in recent years from an open approach to a conservative approach thanks to the possibility of performing minimally invasive radiologically guided surgery. We present a case of penetrating glass injury to zone III of the neck in which the foreign body go through the parotid region passing near, but without injuring, the facial nerve and the external and internal carotid arteries.

Central Bouquet Hemorrhages in Pathologic Myopia: Clinical Characteristics and Prognostic Relevance.

PURPOSE: To compare the clinical implications of central bouquet hemorrhages (CBHs) to primarily subretinal hemorrhages, both occurring in the setting of pathologic myopia with lacquer crack formation. DESIGN: Multicenter retrospective cohort study. PARTICIPANTS: Twenty-five eyes (11 primarily subretinal hemorrhages and 14 CBH) were monitored over a median of 35 (interquartile range [IQR], 9.50-54) months. MAIN OUTCOMES MEASURES: Comprehensive ophthalmic examinations and OCT were reviewed. The study employed linear mixed-effects models to compare the impact of CBH versus primarily subretinal hemorrhages on baseline visual acuity (VA), rate of VA improvement, and final VA, adjusting for the follow-up period. Times of hemorrhages reabsorbtion and rate of ellipsoid zone (EZ) layer disruption on OCT were recorded. RESULTS: Eyes with CBH exhibited significantly worse baseline VA (0.93 ± 0.45 logarithm of the minimum angle of resolution [logMAR]; 20/160 Snellen vs. 0.36 ± 0.26 logMAR [20/50 Snellen], P < 0.001), a slower rate of VA improvement (P = 0.04), and a trend toward worse final VA (0.48 ± 0.47 logMAR [20/60 Snellen] vs. 0.16 ± 0.16 logMAR [20/30 Snellen], P = 0.06) compared with eyes with primarily subretinal hemorrhages. The CBH group experienced longer median reabsorption times (10 [IQR, 4.6-23.3] months vs. 2.3 [IQR, 2-3.2] months), and a higher prevalence of EZ layer disruption (86% vs. 0%), than the group with primarily subretinal hemorrhages. Central bouquet hemorrhage reabsorption was followed by the appearance of vertical hyperreflective lines in the central fovea in 67% of eyes, persisting for up to 6 years of follow-up. CONCLUSIONS: Central bouquet hemorrhage signifies a distinct condition in pathologic myopia, characterized by worse visual outcomes, prolonged structural impact, and possible irreversible damage, compared with primarily subretinal hemorrhages. Central bouquet hemorrhage regression should be taken into account in the differential diagnosis of vertical hyperreflective lesions in the central fovea on OCT in eyes with pathologic myopia. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.