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OBJECTIVES: Patients with Bell's palsy, the sudden onset of facial paralysis, have variable recovery. Frailty has been recognized as an important factor in predicting recovery. This study investigated the relationship between frailty and facial nerve recovery in Bell's palsy patients. METHODS: A retrospective review was conducted on 95 Bell's palsy patients at a single institution's Department of Otolaryngology from 2014 to 2023. A clinically relevant facial nerve recovery was defined as a House-Brackmann (HB) score decrease>1 between the initial and most recent visit. Patients without follow-up visits or initial HB scores <3 were excluded. Frailty was measured by modified frailty index-5 (mFI-5) at the time of Bell's palsy diagnosis. Elderly patients were those over 65 years at presentation (n = 29). Frail patients had mFI-5 > 1 (n = 8). Chi-squared analyses, Fisher's exact tests, and logistic regression models were conducted in SPSS. RESULTS: The analytic sample included 95 patients (median age = 56.8 years, IQR = 24.1) presenting with an initial HB score > 2. 36 % of patients' HB scores decreased by ≥2 within the follow-up period. Frailty (unadjusted Odds Ratio (OR) = 6.3, 95 % CI = [1.2, 33.1], p = .023) was associated with facial nerve recovery while age was not (unadjusted OR = 1.07, 95 % CI = [0.44, 2.59], p = .889). The mFI-5 adjusted OR was 8.43 (95 % CI = [1.38, 51.4], p = .021) when adjusting for age, gender, treatment modality, access to care, and follow-up duration in a logistic regression. CONCLUSIONS: Frailty correlated with enhanced facial nerve recovery after Bell's palsy in this cohort; age was not significantly associated. Further investigation into factors associated with frailty, including increased surveillance and treatment frequency, is warranted.
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Paralisia de Bell , Nervo Facial , Fragilidade , Recuperação de Função Fisiológica , Humanos , Paralisia de Bell/fisiopatologia , Masculino , Feminino , Pessoa de Meia-Idade , Nervo Facial/fisiopatologia , Estudos Retrospectivos , Fragilidade/complicações , Idoso , AdultoRESUMO
Although scar outcomes in rhytidectomy are crucial to patients and surgeons alike, there is a lack of consensus on incision techniques for optimizing rhytidectomy scars. A comprehensive scoping review of the literature was performed on rhytidectomy incision techniques and associated scar outcomes. PRISMA protocol was utilized to conduct a scoping review of the literature through MEDLINE, EMBASE, and Science Citation Index databases to identify articles discussing rhytidectomy incision techniques and scar outcomes. 49 studies were included in this scoping review. 4 themes were identified related to rhytidectomy scars within these studies: temporal incision placement, tragal incision placement, lobule management, and postauricular incision design. Techniques within each theme were described and reported scar outcomes summarized. There are many approaches to rhytidectomy incisions described in the literature, with reportedly low rates of scar complications for each of the techniques described. It cannot be elucidated which techniques are superior due to the heterogeneity of outcomes reported in the literature with significant variability in outcome measures, study design and follow up time. Future studies should focus on utilizing a standardized rating system to aid in objective determination of the superiority of one technique versus another.
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The objective of this study is to characterize surgical pain after facial feminization surgery (FFS) and delineate postoperative opioid usage. It is a retrospective cohort study. It was performed in a multicenter integrated health care system. Electronic medical records were reviewed for patient demographic characteristics, medical history, pain medication prescriptions, and responses to a postoperative pain survey. Student's t-test and the Mann-Whitney U-test were used for bivariate analysis. Fisher's exact tests were used for categorical data. Seventy-four patients who underwent FFS were included. The mean (standard deviation) reported "average" postoperative pain score was 4.3 (2.3) out of 10. A total of 58% of patients reported pain lasting 5 or fewer days after surgery. The severity and duration of postoperative pain was similar between patients who underwent partial-FFS or full-FFS. A total of 68% of patients required fewer than 15 opioid tablets. There were no significant differences in the quantity of opioids prescribed or used between patients who underwent partial-FFS or full-FFS. Older age and premorbid mood disorder did not correlate with greater severity/duration of pain or number of opioids used after surgery. Most patients required fewer than 15 opioid tablets after surgery and experienced less than a week of postoperative pain. Patients undergoing full-FFS did not appear to experience significantly greater pain than those undergoing fewer procedures. Older age and premorbid mood disorder were not predictors of worse pain outcomes or greater opioid utilization.
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Analgésicos Opioides , Transtornos Relacionados ao Uso de Opioides , Analgésicos Opioides/efeitos adversos , Feminização/tratamento farmacológico , Humanos , Masculino , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/etiologia , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Padrões de Prática Médica , Estudos RetrospectivosRESUMO
Ectopic mineralization of renal tissues in nephrocalcinosis is a complex, multifactorial process. The purpose of this study was to examine the role of genetic modulation and the role of diet in nephrocalcinosis using two established mouse models of ectopic mineralization, Abcc6(tm1Jfk) and Enpp1(asj) mice, which serve as models for pseudoxanthoma elasticum and generalized arterial calcification of infancy, two heritable disorders, respectively. These mutant mice, when on standard rodent diet, develop nephrocalcinosis only at a very late age. In contrast, when placed on an 'acceleration diet' composed of increased phosphate and reduced magnesium content, they showed extensive mineralization of the kidneys affecting primarily the medullary tubules as well as arcuate and renal arteries, as examined by histopathology and quantitated by chemical assay for calcium. Mineralization could also be detected noninvasively by micro computed tomography. Whereas the heterozygous mice did not develop nephrocalcinosis, compound heterozygous mice carrying both mutant alleles, Abcc6(tm1Jfk/+) and Enpp1(+/asj), developed ectopic mineralization similar to that noted in homozygous mice for either gene, indicating that deletion of one Abcc6 allele along with Enpp1 haploinsufficiency resulted in renal mineralization. Thus, synergistic genetic defects in the complex mineralization/antimineralization network can profoundly modulate the degree of ectopic mineralization in nephrocalcinosis.
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Transportadores de Cassetes de Ligação de ATP/genética , Calcinose/genética , Nefrocalcinose/genética , Diester Fosfórico Hidrolases/genética , Pirofosfatases/genética , Animais , Cálcio/sangue , Durapatita/análise , Durapatita/química , Feminino , Rim/química , Rim/patologia , Masculino , Camundongos , Camundongos Transgênicos , Proteínas Associadas à Resistência a Múltiplos Medicamentos , Fósforo/sangue , Microtomografia por Raio-XRESUMO
Pseudoxanthoma elasticum (PXE) is a multisystem ectopic mineralization disorder caused by mutations in the ABCC6 gene. Warfarin, a commonly used anticoagulant, is associated with increased mineralization of the arterial blood vessels and cardiac valves. We hypothesized that warfarin may accelerate ectopic tissue mineralization in PXE, with clinical consequences. To test this hypothesis, we developed a model in which Abcc6(-/-) mice, which recapitulate features of PXE, were fed a diet supplemented with warfarin and vitamin K1. Warfarin action was confirmed by significantly increased serum levels of oxidized vitamin K. For mice placed on a warfarin-containing diet, quantitative chemical and morphometric analyses revealed massive accumulation of mineral deposits in a number of tissues. Mice fed a warfarin-containing diet were also shown to have abundant uncarboxylated form of matrix Gla protein, which allowed progressive tissue mineralization to ensue. To explore the clinical relevance of these findings, 1747 patients with PXE from the approximately 4000 patients in the PXE International database were surveyed about the use of warfarin. Of the 539 respondents, 2.6% reported past or present use of warfarin. Based on the prevalence of PXE (approximately 1:50,000), thousands of patients with PXE worldwide may be at risk for worsening of PXE as a result of warfarin therapy.
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Transportadores de Cassetes de Ligação de ATP/deficiência , Calcificação Fisiológica/efeitos dos fármacos , Pseudoxantoma Elástico/patologia , Varfarina/efeitos adversos , Transportadores de Cassetes de Ligação de ATP/metabolismo , Animais , Cálcio/sangue , Proteínas de Ligação ao Cálcio/metabolismo , Derme/diagnóstico por imagem , Derme/efeitos dos fármacos , Derme/patologia , Dieta , Suplementos Nutricionais , Modelos Animais de Doenças , Proteínas da Matriz Extracelular/metabolismo , Humanos , Magnésio/metabolismo , Camundongos , Minerais/metabolismo , Proteínas Associadas à Resistência a Múltiplos Medicamentos , Especificidade de Órgãos/efeitos dos fármacos , Fosfatos/metabolismo , Fósforo/sangue , Pseudoxantoma Elástico/sangue , Pseudoxantoma Elástico/diagnóstico por imagem , Vitamina K/sangue , Varfarina/sangue , Microtomografia por Raio-X , Proteína de Matriz GlaRESUMO
OBJECTIVE: Characterize academic facial plastic surgeons by demographics, time in practice, academic productivity, and faculty position. STUDY TYPE: Cross-sectional study. METHODS: Facial plastic surgery faculty in US otolaryngology residencies with a title of assistant professor, associate professor, or professor were identified. Demographics and academic data were obtained from public profiles and Scopus. RESULTS: One hundred sixty-eight surgeons were identified. Females comprised 25.6%. Most surgeons were White (69.6%), followed by Asian (25%), Hispanic (3.6%), and Black (1.8%). Mean h-index was similar between sexes when controlling for years in practice (1.13 vs. 1.14, p = 0.575). Female representation was greater among early-career surgeons (41%) than among mid- or late-career surgeons (24% and 13%, respectively) (p = 0.006). The correlation of years in practice with academic title was similar between sexes. There was no difference in h-index (p = 0.384) or distribution of academic positions (p = 0.658) between White and non-White surgeons. There was no statistical difference in full professorship (p = 1.0) or research productivity (p = 0.974) between late-career White and non-White academic facial plastic surgeons. There was no statistical difference in promotion from assistant professorship (p = 0.506) or research productivity (p = 0.857) between White and non-White surgeons in practice for over 5 years. CONCLUSION: Female representation in academic facial plastic surgery is low, though greater gender parity among younger surgeons suggests an improving trend. Hispanic and Black surgeons remain significantly underrepresented in the field. Although increased diversity is needed in academic facial plastic surgery, established minority surgeons have experienced similar research productivity and advancement through academic ranks as their majority counterparts. LEVEL OF EVIDENCE: N/A Laryngoscope, 133:1869-1874, 2023.
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Cirurgiões , Cirurgia Plástica , Humanos , Feminino , Estados Unidos , Masculino , Estudos Transversais , Docentes de Medicina , Grupos MinoritáriosRESUMO
OBJECTIVES: Augmented reality (AR) and virtual reality (VR) are emerging technologies with wide potential applications in health care. We performed a scoping review of the current literature on the application of augmented and VR in the field of facial plastic and reconstructive surgery (FPRS). DATA SOURCES: PubMed and Web of Science. REVIEW METHODS: According to PRISMA guidelines, PubMed and Web of Science were used to perform a scoping review of literature regarding the utilization of AR and/or VR relevant to FPRS. RESULTS: Fifty-eight articles spanning 1997-2023 met the criteria for review. Five overarching categories of AR and/or VR applications were identified across the articles: preoperative, intraoperative, training/education, feasibility, and technical. The following clinical areas were identified: burn, craniomaxillofacial surgery (CMF), face transplant, face lift, facial analysis, facial palsy, free flaps, head and neck surgery, injectables, locoregional flaps, mandible reconstruction, mandibuloplasty, microtia, skin cancer, oculoplastic surgery, rhinology, rhinoplasty, and trauma. CONCLUSION: AR and VR have broad applications in FPRS. AR for surgical navigation may have the most emerging potential in CMF surgery and free flap harvest. VR is useful as distraction analgesia for patients and as an immersive training tool for surgeons. More data on these technologies' direct impact on objective clinical outcomes are still needed. LEVEL OF EVIDENCE: N/A Laryngoscope, 2023.
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Objective: Functional endoscopic sinus surgery is a commonly performed otolaryngologic procedure that often uses the microdebrider device for tissue removal. Given the ubiquitous nature of the instrument, we sought to better define the patterns of device failure using the postmarket surveillance openFDA database. Methods: The openFDA database was queried for all microdebrider-related adverse events from January 1, 2000 to November 1, 2020. Descriptive information on the nature of device failure and any associated patient injury was compiled. Reports not directly related to device failure were excluded from the analysis. Results: A total of 641 events were included in the analysis. The most common device failure was overheating (n = 348, 54.3%), followed by material separation (n = 173, 27%), and inconsistent device activation (n = 52, 8.1%). Of the reported events, the vast majority did not result in patient harm (n = 579, 90.3%). On review of the remaining cases, only 24 events (3.7%) resulted in true harm to the patient, defined as a temporary or permanent injury or >30 min of additional anesthesia time. Of these cases, the need to reschedule surgical cases (n = 5, 0.8%), retained foreign body (n = 5, 0.8%), and thermal tissue injury (n = 3,0.5%) were the most common. Five patients suffered an injury due to surgeon error unrelated to device malfunction (n = 5, 0.8%). Conclusions: Microdebrider device failures are extremely rare. When they do occur, less than 10% result in patient harm. In cases of patient harm related to microdebrider failure, preoperative testing of the device before use could prevent many of the reported malfunctions.
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Nasal septal mucoceles are a rare occurance, and reports in the current literature are limited. We describe the case of a 73-year-old woman who developed a nasal septal mucocele several days after an episode of angioedema. The lesion was treated with 2 rounds of needle aspiration with antibiotics and the application of silastic splints. There was no recurrence after 1 month, though the patient developed a saddle nose deformity. She ultimately underwent reconstruction with a diced-cartilage dorsal augmentation graft with fibrin glue. We review the learning points of this case and summarize existing literature on this disease.
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Mucocele , Deformidades Adquiridas Nasais , Rinoplastia , Idoso , Feminino , Humanos , Mucocele/complicações , Mucocele/cirurgia , Septo Nasal/cirurgia , Deformidades Adquiridas Nasais/etiologia , Deformidades Adquiridas Nasais/cirurgia , Rinoplastia/efeitos adversosRESUMO
Objective: Report a large single-institution cohort of quality of life (QOL) data before and after facial feminization surgery (FFS). Study Design: Case series. Methods: Patients who underwent FFS at our institution between 2017 and 2019 and completed a pre- and postoperative QOL survey were included in this study. Responses were scored on a 5-point scale with 1 corresponding to least agreement and 5 corresponding to most agreement. Paired t-test was used to compare pre- and postoperative mean scores for each response. Two-tailed t-test was used to compare the mean postoperative delta for each response by demographics. Results: One hundred seven of 341 patients completed a pre- and postoperative survey. The average age was 36 years (range 18-67). The mean time to postoperative survey completion was 96 days (interquartile range 43). Significant improvements in all aspects of QOL assessed on the survey were noted after surgery, including self-perceived facial femininity (2.1-3.8, p < 0.001) and publicly perceived facial femininity (2.0-3.6, p < 0.001). Patients also felt less limited in social activities (3.2-2.0, p < 0.001) and professional activities (2.7-1.7, p < 0.001). Conclusion: FFS improves self-perceived and externally perceived facial femininity and reduces limitations in social and professional activities.
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Feminização , Qualidade de Vida , Adolescente , Adulto , Idoso , Face/cirurgia , Feminino , Feminização/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Adulto JovemRESUMO
OBJECTIVES: The popularity of mountain biking (MTB) in the United States has risen in recent years. We sought to identify the prevalence and distribution of MTB associated head and neck injuries presenting to emergency departments across the U.S. and identify risk factors for hospital admission in this patient population. METHODS: The National Electronic Injury Surveillance System (NEISS) was queried for MTB related injuries of the head and neck from 2009 to 2018, with analysis for incidence, age, gender, anatomic site, and diagnoses. RESULTS: A total of 486 cases were identified, corresponding to an estimated 18 952 head and neck MTB related ED visits. Patients were predominantly male (80.7%) and white (69.8%) with a median age of 35 years (interquartile range, 21-46 years). A majority (88.4%) of patients were released from the ED, but a significant proportion of patients were admitted (9.2%) or transferred (1.2%). The most common facial fractures were facial/not specified (35%), nasal bone (29%), mandible (15%), orbit (12%), and zygomaxillary complex (9%). The greatest predictors of hospital admission/transfer were injury to the mouth or neck and avulsion-type injury (P < .001). CONCLUSIONS: MTB results in a significant number of traumatic head and neck injuries nationwide. Patients are primarily adult, white males. The majority of injuries result in discharge from the ED, however a small amount of these patients experience significant morbidity necessitating hospital admission. Understanding the distribution of MTB head and neck injuries may aid in the clinical evaluation of these patients. LEVEL OF EVIDENCE: 4.
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Ciclismo/lesões , Traumatismos Craniocerebrais/epidemiologia , Lesões do Pescoço/epidemiologia , Adulto , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Estados Unidos/epidemiologia , Adulto JovemRESUMO
OBJECTIVE: We describe the incidence and characteristics of patients with head and neck injuries from rock climbing who present to United States emergency departments and evaluate predictors of hospitalization. METHODS: The National Electronic Injury Surveillance System (NEISS) database was queried for rock climbing injuries to the head, face, mouth, neck, and ear under product code "mountain climbing" from the years 2009 to 2018. Demographics, injury characteristics, and disposition data were reviewed. Data were evaluated using chi-square analysis with Cochran-Mantel-Haenszal odds ratios (ORs). RESULTS: An estimated 5067 patients (from 129 raw NEISS case numbers) suffered head and neck injuries from rock climbing nationally from 2009 to 2018. Concussion/closed head injury was the most common injury (44%), followed by laceration (23%), soft tissue injury (15%), neck strain/sprain (6%), skull fracture (3%), facial fracture (3%), intracranial hemorrhage (3%), cervical spine fracture (2%), unspecified facial trauma (1%), and dental trauma (0.3%). Males more frequently suffered lacerations (OR 1.6), soft tissue injuries (OR 23.3), cervical spine fractures (OR 336.7), intracranial hemorrhage (OR 582.0), and skull fractures (OR 6.2) than females. Compared to shorter falls, falls over 20 ft were more commonly associated with laceration (OR 2.0), soft tissue injury (OR 3.5), facial fracture (OR 7.5), dental trauma (OR 6.6), intracranial hemorrhage (OR 951.8), skull fracture (OR 81.2), and hospitalization (OR 3.8). Injuries associated with hospitalization included facial fracture (OR 23.7), cervical spine fracture (OR 24.6), intracranial hemorrhage (OR 2210.2), and skull fracture (OR 9.8). CONCLUSIONS: Concussions and facial lacerations are the most common head and neck injuries from rock climbing. Males more commonly suffer severe injuries. Falls over 20 ft are associated with more severe injuries and an increased likelihood of hospitalization.
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Traumatismos Craniocerebrais/epidemiologia , Traumatismos Faciais/epidemiologia , Montanhismo/lesões , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Bases de Dados Factuais , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , Fraturas Cranianas/epidemiologia , Fraturas da Coluna Vertebral/epidemiologia , Estados Unidos/epidemiologia , Adulto JovemRESUMO
OBJECTIVE: To determine changes in the residency experience early in the COVID-19 pandemic and evaluate wellness measures among otolaryngology residents. METHODS: A web-based survey was administered to U.S. otolaryngology residents. Responses to the Shirom-Melamed Burnout Measure (SMBM) and the Generalized Anxiety Disorder-7 scale were recorded along with data on burnout, demographics, wellness, sleep, training, and education. RESULTS: 119 U.S. otolaryngology residents representing 27 of 42 states with otolaryngology residency programs responded to the survey. 24.4% (95% CI 17.0-31.8%) self-reported some level of burnout, while 10.9% met SMBM criteria for "clinically relevant" burnout. 51.3% experienced more stress, and 58.8% reported more anxiety during the COVID-19 pandemic. Compared to males, females had a higher prevalence of burnout (38.9% vs 12.3%, P = .001) and anxiety (75.9% vs 43.8%, P < .001). PGY-2s had a greater mean SMBM index (3.64) and higher rates of self-reported burnout (54.2%) than their counterparts at other levels of training. Residents reported less time spent in the hospital, lower surgical volume, and less procedural independence. Educational didactics, primarily via videoconference, were more frequent for 63.9% of respondents. CONCLUSION: While burnout among otolaryngology residents was low early in the COVID-19 pandemic, likely due to separation from the workplace environment, trainees had higher levels of anxiety and stress. The surgical experience was negatively impacted by the pandemic, but remote didactics and educational opportunities increased. These findings may inform otolaryngology residency programs on the need to promote resident wellness and aid in devising strategies to improve the educational experience during this unique global health crisis as well as in the long term.
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Ansiedade/epidemiologia , Esgotamento Profissional/epidemiologia , COVID-19/epidemiologia , Educação a Distância/estatística & dados numéricos , Internato e Residência , Otolaringologia/educação , Procedimentos Cirúrgicos Otorrinolaringológicos/educação , Estresse Psicológico/epidemiologia , Feminino , Humanos , Masculino , Procedimentos Cirúrgicos Otorrinolaringológicos/estatística & dados numéricos , Questionário de Saúde do Paciente , Prevalência , SARS-CoV-2 , Distribuição por Sexo , Estados Unidos/epidemiologia , Comunicação por VideoconferênciaRESUMO
BACKGROUND: The COVID-19 pandemic has disproportionately impacted mental health among the lesbian, gay, bisexual, transgender, queer community, with the delay of medical services as a factor. The pandemic's psychological effect on the transfeminine community pursuing facial feminization surgery remains unstudied. METHODS: Patients at our institution whose facial feminization surgeries were delayed due to the COVID-19 pandemic were included. A chart review collected validated, self-reported depression and psychological distress measures, as well as perceived facial femininity and desire for feminizing facial surgery prior to the pandemic. The data were compared to repeat measures during the pandemic (March-April 2020). RESULTS: Thirty patients were included in the study, 11 of whom had repeat data. Respondents during the pandemic (compared to prepandemic) felt their face was more feminine (p = 0.026) and more likely to be perceived as feminine by others (p = 0.026). They indicated a lower desire to alter their appearance with surgery (p = 0.041). Depression and distress indices were greater during the pandemic (p = 0.0018 and p = 0.026, respectively). CONCLUSION: This study is consistent with increasing depression and psychological distress among transfeminine individuals pursuing facial feminization surgery during the pandemic. The study revealed greater perceived facial femininity and a lower desire for surgery during the pandemic.
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COVID-19 , Pessoas Transgênero , Face/cirurgia , Feminino , Feminização , Humanos , Masculino , Pandemias , Pessoas Transgênero/psicologiaRESUMO
Objectives/Hypothesis: The face is a major communicator of gender identity. Transfeminine individuals report debilitating quality-of-life deficits as a result of their gender dysphoria, which may be addressed with feminizing therapies. We aimed to quantify the potential impact of facial gender dysphoria experienced by transfeminine patients, as well as associated treatments, including feminizing facial gender surgery, through validated health state utility measures. Methods: A transfeminine patient volunteer who underwent head and neck gender-affirming treatments was consented for research use of perioperative photographs. These media aided in the description of two transfeminine health states, pre- and postfacial feminization facial gender dysphoria. Monocular blindness and binocular blindness were two health state controls. General population adults rated these four health states through visual analog scale (VAS), standard gamble (SG), and time trade-off (TTO), which were used to calculate the quality-adjusted life years (QALYs). Results: Survey respondents totaled 206 with a mean (standard deviation [SD]) age of 35.8 (11.9) years. Mean (SD) health utility measures included 0.75 (0.22) QALYs for VAS, 0.82 (0.19) QALYS for SG, 0.79 (0.21) QALYS for TTO for pretreatment facial gender dysphoria, and 0.81 (0.21), 0.86 (0.19), 0.83 (0.20) QALYS for postgender-affirming treatments for facial gender dysphoria. The health utility scores for the postgender-affirming treatments for facial gender dysphoria (+0.06 VAS, p = 0.005) were significantly improved compared with the pretreatment state. Conclusions: To our knowledge, this study is the first to examine how the general population perceives the health burden of facial gender dysphoria experienced by transfeminine patients. Facial gender dysphoria is perceived to have a negative impact on health states, not dissimilar to monocular blindness in our sample. Feminizing facial gender surgery appears to significantly increase health utility measures.
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Face/anatomia & histologia , Face/cirurgia , Feminização , Disforia de Gênero/psicologia , Opinião Pública , Adulto , Feminino , Identidade de Gênero , Humanos , Masculino , Anos de Vida Ajustados por Qualidade de VidaRESUMO
Due to concerns surrounding travel during the COVID-19 pandemic, the 2020-2021 otolaryngology residency application cycle will be conducted virtually for the first time. Residency programs should consider the logistics of video interviews, drawing on experiences of other programs that have successfully performed virtual interviews in the past. The lack of in-person interviews will create challenges in assessing applicants, and we recommend that programs develop structured and targeted questions and even consider having candidates answer standardized questions prior to the virtual interview day. From an applicant perspective, gauging the intangibles of individual residency programs, such as resident camaraderie, program culture, and program location, will be difficult. To address this, programs should consider hosting informal virtual gatherings, create videos that highlight the resident experience, and ensure that program websites are up-to-date. Ultimately, adaptability, resilience, and innovation will allow residency programs to achieve a successful 2021 otolaryngology match.
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COVID-19/epidemiologia , Internato e Residência , Otolaringologia/educação , Seleção de Pessoal/métodos , Educação de Pós-Graduação em Medicina , Humanos , Pandemias , Distanciamento Físico , Estados UnidosRESUMO
INTRODUCTION: Cocaine is known to cause necrosis of the soft tissues secondary to its vasoconstrictive effects, which has negative functional and cosmetic outcomes of the midface and adjacent structures. To our knowledge, cleft lip caused by cocaine use has not been described in the literature. CASE PRESENTATION: A 52-year-old man presented with a deformity of the lip and nasal sill, septal perforation, and hard palate fistula secondary to long-term cocaine use. The patient underwent lip reconstruction using a modified Millard technique and had a lasting favorable cosmetic outcome more than 5 years after surgery. DISCUSSION: We report a case of cocaine abuse causing cleft lip, and successful reconstruction with a modified Millard technique.
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Fenda Labial , Fissura Palatina , Cocaína , Procedimentos de Cirurgia Plástica , Fenda Labial/induzido quimicamente , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Cocaína/efeitos adversos , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Aspirin-exacerbated respiratory disease (AERD) refers to the combination of asthma, chronic rhinosinusitis with nasal polyposis (CRSwNP), and acute respiratory tract reactions to ingestion of aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs). There have been no in the literature investigating diagnostic delay in AERD. We aimed to investigate whether delay of diagnosis of AERD is associated with poorer clinical outcomes as well as to characterize the role of specialty evaluation in diagnosis. METHODS: We conducted a retrospective observational study of 254 subjects with incident AERD diagnoses between 2009 and 2016 among Kaiser Permanente Northern California (KPNC) members. Descriptive and bivariate statistics were employed to analyze clinical characteristics and outcomes of AERD subjects with and without delay in diagnosis (defined as 1 year or greater from symptom onset to diagnosis). RESULTS: Of the 254 patients in the AERD cohort, 24.4% had a delayed diagnosis. Patients with allergies were significantly less likely to have a delay in diagnosis (p < 0.01). Patients with a delay in diagnosis were more likely to have 2 or more courses of systemic steroids (p = 0.04). Allergists, otolaryngologists, and primary care physicians diagnosed 56%, 36%, and 8% of patients, respectively. There was no association between provider specialty at time of diagnosis and delay in diagnosis (p = 0.22). CONCLUSION: A substantial proportion of AERD patients have a diagnostic delay. Patients with allergies have a lower risk for this delay. This study is the first to describe diagnostic delay in AERD patients.
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Asma Induzida por Aspirina , Pólipos Nasais , Sinusite , Anti-Inflamatórios não Esteroides , Aspirina/efeitos adversos , Asma Induzida por Aspirina/diagnóstico , Asma Induzida por Aspirina/epidemiologia , Diagnóstico Tardio , Humanos , Pólipos Nasais/diagnóstico , Pólipos Nasais/epidemiologia , Sinusite/diagnóstico , Sinusite/epidemiologiaRESUMO
OBJECTIVE: There are few large studies on facial feminization surgery (FFS). We provide the largest comprehensive report to date of an FFS cohort regarding the safety of multilevel surgery, patient-specific considerations with FFS procedures, and complications of surgery. STUDY DESIGN: Retrospective cohort study. SETTING: Multicenter integrated health care system. SUBJECTS AND METHODS: We examined all patients undergoing FFS within our institution from April 2016 to October 2018. Patients over the age of 18 with a diagnosis of gender dysphoria underwent any combination of scalp advancement, cranioplasty, brow lift, rhinoplasty, upper lip lift, mandibuloplasty, chondrolaryngoplasty, and/or additional cosmetic procedures. Medical records were reviewed for preoperative characteristics, FFS procedures undergone, and postoperative complications. RESULTS: In total, 121 patients underwent a total of 594 FFS procedures. Seventy-five percent of patients had only 1 or no comorbidities, and 90% of patients underwent cranioplasty, scalp advancement, and brow lift. African American patients (n = 5) less commonly underwent cranioplasty compared to those of other ethnicities (white, P < .001; Asian, P = .022; Hispanic, P = .014; multiracial, P = .006). Asian patients less commonly underwent rhinoplasty than white patients (38% vs 73%, P = .023). Only 8 (6.6%) patients experienced a significant complication after surgery. CONCLUSIONS: The population undergoing FFS is generally healthy, the upper third of the face is most commonly addressed, there are age and ethnic considerations in FFS, and major complications after multilevel surgery are uncommon.