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Free functional muscle transfer is is an option for reanimating the face in chronic facial nerve paralysis. The optimal outcome in these patients is the ability to restore a spontaneous smile in response to emotion. We discuss the role of free functional muscle transfer in facial paralysis treatment, the choices of nerve used in reconstruction surgery, and the application of different types of muscle flaps in facial reanimation. In this paper, we review the relevant and up-to-date academic literature regarding the outcomes of free functional muscle flap transfer in facial paralysis patients.
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Parálisis Facial , Colgajos Tisulares Libres , Procedimientos de Cirugía Plástica , Humanos , Parálisis Facial/cirugía , Colgajos Tisulares Libres/trasplante , Procedimientos de Cirugía Plástica/métodos , Transferencia de Nervios/métodos , Sonrisa/fisiología , Músculos Faciales/inervación , Músculos Faciales/cirugía , Nervio Facial/cirugía , Resultado del TratamientoRESUMEN
This article aims to provide insights into emerging concepts in ophthalmic manifestations in patients with facial palsy and discusses considerations used to develop patient-specific management plans in acute management.
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Facial palsy describes the denervation of the facial nerve leading to difficulty in facial animation and expression. Facial synkinesis is the result of complex pathological nerve regeneration following damage to the facial nerve axons. Synkinesis in facial palsy can be managed using facial neuromuscular rehabilitation, botulinum toxin neuromodulators, and surgical treatment options. Botulinum toxin A can be used as an adjunct to other treatment options to manage synkinesis. This article will explore the role of botulinum toxin A in the management of synkinesis in facial palsy including the clinical assessment, injection location (muscles targeted), dosages, treatment interval, and long-term results. It will also include surgical management options.
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This article discusses the psychological effects of facial palsy (FP) in adults. FP is the abnormal functioning of facial muscles resulting from temporary or permanent damage of the facial nerves. Following facial paralysis, patients can develop motor and psychosocial functioning issues impacting quality of life. In addition, real or perceived judgment in social settings of those with FP increases the risk of low self-esteem, anxiety, and depression. Currently, most available research focuses on surgical patients and suggests a lack of psychological support throughout the affliction. A multidisciplinary approach when treating patients with FP can help improve the patient's quality of life.
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Parálisis Facial , Calidad de Vida , Humanos , Parálisis Facial/psicología , Autoimagen , Depresión/etiología , Depresión/psicología , Ansiedad/etiología , Ansiedad/psicologíaRESUMEN
Web-based health information plays an increasingly vital role in spreading health information. Many patients interested in aesthetic surgery study the procedure on the Internet. This study aims to evaluate the quality of online health information on injectable fillers using the modified "Ensuring Quality Information for Patients" (EQIP) tool. Nine different search terms, including "fillers," "fuller cheeks," "wrinkle removal," and "antiwrinkle treatment" were identified and queried on Google. Unique links from the first three pages of each search term were identified and evaluated if the contents were in English language and were for general non-medical public use. A total of 172 websites were analyzed, with a median EQIP score of 20. In total 129 websites belonged to aesthetic practitioners, of which 81 were operated by medical doctors. Eighty-three percent of websites disclosed some forms of postoperative complications, most commonly edema (74%) and bruising (73%). Blindness and tissue necrosis were only mentioned by 12 and 10% of the websites, respectively. The current health information available on injectable fillers is of poor quality. While many do provide some information on risks, the majority of websites fail to disclose severe complications and quantifying risks. This poses a barrier against informed decision-making and may lead to unrealistic expectations. Patient satisfaction and expectations may be improved by developing better online education resources on fillers.
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Información de Salud al Consumidor , Estética Dental , Humanos , InternetRESUMEN
There is a large demand for online patient information for patients considering rhinoplasty. While there are many resources available, the quality and content of the information provided are unknown. This study aimed to assess the quality of the most popular information available online, using the "Ensuring Quality Information for Patients" (EQIP) tool to evaluate the content, structure, and readability of patient information on websites. Search terms including nose operation, nose job, nose reshaping, nose tip surgery, rhinoplasty, septorhinoplasty, were identified using Google AdWords and Trends. Unique links from the first 10 pages for each term were identified and evaluated with websites written in English and for general non-medical public use were included. 295 websites met the eligibility criteria with a median overall EQIP score of 17. Only 33% contained balanced information on the risks and benefits. Bleeding and infection risk was only mentioned in 29% and 27% of websites, respectively. Two percent described complication rates of the procedures and only 20% of articles explained further surgery may be required to achieve patient cosmetic or functional satisfaction. Information regarding rhinoplasty available online is currently of poor quality. The lack of effective risk counselling, possible outcome management, and complications may likely lead to unrealistic expectations of rhinoplasty. It is crucial the risks of surgery are communicated to the patient to ensure they can make an informed decision. Improved education through online resources would likely help to promote more realistic patient expectations.
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Información de Salud al Consumidor , Rinoplastia , Humanos , Nariz , Comprensión , InternetRESUMEN
PURPOSE: Competent otoscopy is a key otolaryngology skill for a broad range of medical careers, yet undergraduate's confidence to perform otoscopy is reported as low. Smartphone otoscopes have been suggested to improve undergraduates learning of normal eardrum anatomy because unlike the traditional otoscope, the learner and educator share the same image. This study aimed to evaluate whether a smartphone otoscope could enhance medical undergraduates recognition of common ear pathology. METHODS: 52 medical students were randomised into a standard group that used a traditional otoscope and an intervention group that used a smartphone otoscope. Both groups received a short didactic presentation on the recognition of common ear pathologies and were asked to diagnose four simulated pathologies. Both groups received feedback and guidance on how to better visualise the tympanic membrane. Force response items and 5-point Likert scales loaded on an electronic platform recorded their diagnosis and their perceptions towards the otoscope. RESULTS: The smartphone-group (n = 20) had higher overall rates of correct diagnosis compared to control (n = 22) (84% vs. 39%, p = < 0.001). Only the grommet station did not show a significant improvement between the two groups (100% vs. 91%, p = 0.49). 90% (n = 20) of participants felt the smartphone otoscope was preferential for their learning. The same number expressed that they want to use it in future learning. The remainder were indifferent. CONCLUSIONS: The smartphone otoscope enabled learners to better observe and recognise middle ear pathology. This popular learning tool has the potential to accelerate the learning curve of otoscopy and therefore improve the proficiency of future doctors at recognising middle ear diseases.
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Otolaringología , Otoscopios , Humanos , Otoscopía , Teléfono Inteligente , Membrana TimpánicaRESUMEN
Advances in blepharoplasty have resulted in an improved understanding of preoperative risk factors, intraoperative hemostasis, and wound closure. This has reduced the risk of severe adverse events. The aim of this review is to determine the current evidence base for routine postblepharoplasty management. A literature review was performed using MEDLINE, PUBMED, and EMBASE databases. Expanded search criterion "bleph*" was combined with individual terms assessing postoperative management. Articles were assessed and qualified as per Oxford Centre of Evidence-Based Medicine levels 1 to 5 (1 = highest level of evidence). A total of 47 unique articles matched our search strategy. Most articles were a description of individual expert opinion, surveys of practice, or case series (level 4-5 evidence). Few randomized controlled trials were performed (level 2). Many articles describe the clinical experience of senior facial plastic surgeons. Our review found some evidence for postoperative cooling and preincision antisepsis to be effective. This review highlights the need for higher-quality studies to improve the evidence base for routine postoperative management.
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Blefaroplastia , Práctica Clínica Basada en la Evidencia , Humanos , Periodo PosoperatorioRESUMEN
Nasal septal perforation is a prevalent pathology, and its successful treatment remains a significant challenge. Surgical closure is complex, and there are a plethora of accounts of various surgical techniques within the existing literature. Much less has been written about perioperative considerations, which are arguably just as important. This article therefore focuses predominantly on the pre and postoperative management of patients with septal perforation. By drawing both on the existing literature and a series of 64 cases managed over several years by our department, this review aims to consolidate guidance on patient selection, timing of surgical intervention, postoperative splinting, use of antibiotics, and patient advice. It is clear that the size of the perforation (relative to the size of the septum), health of surrounding mucosa, and the systemic health and age of the patient remain essential considerations in patient selection and operative timing. Internal and external splints are widely used to good effect, but the role of nasal packing is less clear-cut. This article suggests packing, but with an increasing preference for NasoPore over BIPP (bismuth iodoform paraffin paste). Use of prophylactic antibiotics remains controversial. The complete closure rate for the series presented here was 81.3%, with an average perforation diameter of 15.1 mm (range: of 6-32 mm), and that for perforations with a diameter below 22 mm was 97.9%.
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Perforación del Tabique Nasal , Fascia , Humanos , Perforación del Tabique Nasal/cirugía , Tabique Nasal/cirugía , Periodo Posoperatorio , Férulas (Fijadores)RESUMEN
OBJECTIVES: Intracapsular tonsillectomy (ICT) is increasingly adopted by paediatric centres worldwide due to its association with reduced pain, fast recovery and low risks of post-operative complications. Questions still surround its role in patients with recurrent tonsillitis, as well as tonsillar regrowth requiring revision surgery. DESIGN: Prospective consecutive case series from March 2013 to April 2020. SETTING: Tertiary paediatric ENT referral centre. PARTICIPANTS: Paediatric patients undergoing Coblation ICT, with or without adenoidectomy, for obstructive and/or infective indications. MAIN OUTCOME MEASURES: Health-Related Quality of Life (HRQL), analgesia requirement, post-operative haemorrhage rates, time to return to normal diet and activity or school/nursery, and parental satisfaction. We report revision surgery rates and identify predictive factors for revision surgery. RESULTS: A total of 1257 patients (median age 4.2 years) underwent Coblation ICT, with a median direct and implied follow-up of 101.5 and 1419 days, respectively. We noted significantly improved HRQL scores across all domains. Median analgesia requirement was six days, and no patients required a return to theatre for post-operative haemorrhage. The majority of patients were eating a normal diet within 24 hours and returned to normal activity/school within a week post-operatively. Revision surgery was required in 2.6% of cases, mainly due to recurrent obstructive symptoms from tonsillar regrowth. Being under two years old at initial surgery (OR 5.10), having severe OSA (OR 4.43) or severe comorbidities (OR 2.98) increased the risk of needing revision surgery. CONCLUSIONS: Long-term data demonstrate the efficacy and safety of Coblation ICT in paediatric patients across a range of indications.
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Dolor Postoperatorio/tratamiento farmacológico , Complicaciones Posoperatorias/etiología , Calidad de Vida , Tonsilectomía/métodos , Tonsilitis/cirugía , Adolescente , Analgesia , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Lactante , Masculino , Complicaciones Posoperatorias/terapia , Estudios Prospectivos , ReoperaciónRESUMEN
PURPOSE: Recurrent respiratory papillomatosis is a disease caused by the human papilloma virus (HPV). HPV is frequently localised in the larynx. The disease tends to recur and frequent intervention is usually required. Management modules include surgical intervention using microdebriders or laser ablation as well as adjuvant treatments which aim mainly at maintaining an adequate airway and secondly to manage dysphonia caused by the growth on the vocal folds. In this pilot study, another surgical modality is trialled using plasma-mediated radio-frequency ablation (coblation). METHODS: Retrospective study examining management of 15 adult patients diagnosed with recurrent laryngeal papillomatosis and surgically treated using coblation. One patient required multiple procedures. Pre-operative assessment in voice clinic evaluating voice quality and its impact on patients' life-quality using voice parameters and self-assessment questionnaires. Follow-up post-operatively using the same parameters from 4 to 6 weeks after surgery until up to 2 years later to check recurrence rate. No other adjuvant treatment was used and all patients received post-operative voice therapy. RESULTS: 78.6% of patients did not show evidence of recurrence during the study period. Improvement in voice handicap following first intervention is reported and recurrence rate in the rest of the sample reported. CONCLUSIONS: The results of this small sample seem to support the previous small studies' findings that coblation is a good excisional technique to use for removal of laryngeal papillomatosis. Recurrence rates seem to be slightly lower than rates reported in the literature for the other surgical modalities. LEVEL OF EVIDENCE: IV.
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Ablación por Catéter/métodos , Neoplasias Laríngeas/cirugía , Recurrencia Local de Neoplasia/cirugía , Papiloma/cirugía , Adulto , Femenino , Humanos , Laringe , Terapia por Láser , Masculino , Persona de Mediana Edad , Papillomaviridae , Proyectos Piloto , Estudios RetrospectivosRESUMEN
BACKGROUND: There are a variety of surgical techniques which can be used to treat structural nasal obstruction. Airwayplasty is a procedure, combining septoplasty, turbinate surgery, and nasal wall lateralization. The article reports the long-term result of this novel approach. METHODOLOGY: Patients who have evidence of structural nasal obstruction were offered the option to have airwayplasty under the senior surgeon. Patients were asked to quantify the severity and the impact of their nasal obstruction using the Visual Analogue Scale (VAS) and the validated Sino-Nasal Outcome Test (SNOT-22) pre-operatively and post-operatively. RESULTS: The mean total SNOT-22 score and VAS score showed a reduction of more than 50% with significant p value at 6 and 12 months post-operatively. CONCLUSIONS: This novel approach to nasal obstruction can provide good long-term functional results for patients suffering from nasal obstruction.
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Obstrucción Nasal/cirugía , Tabique Nasal/cirugía , Rinoplastia/métodos , Cornetes Nasales/cirugía , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Obstrucción Nasal/diagnóstico , Obstrucción Nasal/etiología , Estudios Prospectivos , Resultado del TratamientoRESUMEN
Breast cancer heterogeneity demands that prognostic models must be biologically driven and recent clinical evidence indicates that future prognostic signatures need evaluation in the context of early compared with late metastatic risk prediction. In pre-clinical studies, we and others have shown that various protein-protein interactions, pertaining to the actin microfilament-associated proteins, ezrin and cofilin, mediate breast cancer cell migration, a prerequisite for cancer metastasis. Moreover, as a direct substrate for protein kinase Cα, ezrin has been shown to be a determinant of cancer metastasis for a variety of tumour types, besides breast cancer; and has been described as a pivotal regulator of metastasis by linking the plasma membrane to the actin cytoskeleton. In the present article, we demonstrate that our tissue imaging-derived parameters that pertain to or are a consequence of the PKC-ezrin interaction can be used for breast cancer prognostication, with inter-cohort reproducibility. The application of fluorescence lifetime imaging microscopy (FLIM) in formalin-fixed paraffin-embedded patient samples to probe protein proximity within the typically <10 nm range to address the oncological challenge of tumour heterogeneity, is discussed.
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Neoplasias de la Mama/patología , Proteína Quinasa C-alfa/metabolismo , Factores Despolimerizantes de la Actina/metabolismo , Neoplasias de la Mama/enzimología , Neoplasias de la Mama/metabolismo , Proteínas del Citoesqueleto/metabolismo , Femenino , Transferencia Resonante de Energía de Fluorescencia , Humanos , Metástasis de la Neoplasia , Fosforilación , Fracciones Subcelulares/metabolismo , Especificidad por Sustrato , Resultado del TratamientoRESUMEN
Concurrent chronic rhinosinusitis with nasal polyps (CRSwNP) in the upper airway, and asthma in the lower airway, often have a shared underlying pathophysiology, namely type 2 inflammation; hence, the term "unified airway disease." The combination of CRSwNP and asthma is associated with uncontrolled disease. The range of treatment of CRSwNP includes intranasal corticosteroids, nasal saline irrigation, oral corticosteroids, antibiotics, and biologics. A combined clinical algorithm for the management of the upper and lower airways in type 2 inflammation will be beneficial, especially for patients with uncontrolled disease who may benefit from biologics.
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Asma , Productos Biológicos , Pólipos Nasales , Rinitis , Sinusitis , Humanos , Rinitis/tratamiento farmacológico , Pólipos Nasales/terapia , Pólipos Nasales/complicaciones , Sinusitis/complicaciones , Asma/terapia , Corticoesteroides/uso terapéutico , Inflamación/complicaciones , Enfermedad Crónica , Productos Biológicos/uso terapéuticoRESUMEN
BACKGROUND: An increasing number of minimally invasive oesophagogastrectomies (MIOG) are being performed. However, the complexity of the surgical skills required and the steep learning curve have thus far confined the minimally invasive approach to selected tertiary centres. The oesophagogastric and the oesophagojejunal anastomosis can be challenging and often time-consuming. The recently developed transorally inserted anvil (OrVil(™)) is a technique aimed to simplify the anastomotic procedure. The aim of the study was to evaluate the safety, feasibility, and efficacy of OrVil(™)-assisted anastomosis during laparoscopic surgery in a tertiary upper-GI cancer centre. METHODS: From July 2008 to July 2010, 53 consecutive patients underwent MIOG for cancer performed by one surgeon at our institution. Thirty patients underwent laparoscopic Ivor-Lewis oesophagectomy (ILO) and 23 patients underwent laparoscopic gastrectomy. Of the latter group, 13 had a total gastrectomy (TG) and 10 had a subtotal gastrectomy (SG). The gastrointestinal anastomosis was checked with intraoperative endoscopy in all cases. RESULTS: There were three in-hospital deaths. Median hospital stay was 14 days for oesophagectomies and 11 days for gastrectomies. There were three anastomotic leaks (5.6%), all in the oesophageal group, successfully treated conservatively. Two patients needed conversion to open surgery (3.7%), 3 patients (5.6%) required re-exploration (for bleeding, infected haematoma, and diaphragmatic hernia), and 18 patients (34%) had respiratory complications (pneumonia, pleural effusions, respiratory failure). Four patients developed anastomotic stricture requiring endoscopic balloon dilatation. The average number of lymph nodes harvested was 22 (range = 11-39) and 26 (range = 5-78) for oesophagectomies and gastrectomies, respectively. CONCLUSIONS: The principles of a good anastomosis are good vascular supply, must be tension-free, and the use of a high-quality surgical technique. The use of the OrVil(™) in laparoscopic upper-gastrointestinal surgery is safe and does not have an increased complication rate. It is quicker and easier compared to the traditional purse-string technique and it may help to expand the adoption of MIOG surgery.
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Adenocarcinoma/cirugía , Carcinoma de Células Escamosas/cirugía , Neoplasias Esofágicas/cirugía , Gastrectomía/métodos , Laparoscopía/métodos , Neoplasias Gástricas/cirugía , Adulto , Anciano , Anastomosis Quirúrgica/métodos , Esófago/cirugía , Estudios de Factibilidad , Femenino , Humanos , Yeyuno/cirugía , Tiempo de Internación , Escisión del Ganglio Linfático/métodos , Metástasis Linfática , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Estómago/cirugía , Resultado del TratamientoRESUMEN
Sclerosing mucoepidermoid carcinoma with eosinophilia of the thyroid in a 46-year-old woman.