Quality-Based Evaluation of Patient-Facing Online Education Materials Regarding Facial Filler Procedures.

Injectable facial fillers have become tremendously more popular in recent years, and the Internet offers a proportional amount of consumer-facing educational material. This study sought to explore the quality of these online materials. The top 20 Web sites offering educational materials about facial filler were identified via Google search and sorted by source: Medical Professional Boards, Hospitals and Providers, Medical News and Reference, and Fashion. The materials were assessed for overall quality with the validated DISCERN instrument. The authors also assessed understandability and actionability (Patient Education Material Assessment Tool - PEMAT), accuracy, comprehensiveness, and readability (Flesch-Kincaid Grade Level and Flesch Reading Ease). The mean DISCERN score was 46.9 ± 7.6, which is considered "fair" quality educational material; above "poor," but below "good" and "excellent." Understandability and actionability scores were low, particularly with respect to visual aids. The materials were generally accurate (76-99%), but scored poorly in comprehensiveness, as 15% failed to mention any risks/adverse effects and only 35% mentioned cost. On average, readability was at an 11th grade level, far more complex than ideal (< 6th grade level). Information disseminated from seemingly reputable sources such as professional boards and hospitals/providers were not of higher quality or superior in any of the above studied domains. In conclusion, online educational materials related to injectable facial fillers are of subpar quality, including those from academic and professional organizations. Visual aids were particularly weak. The facial rejuvenation community should make a concerted effort to set a higher standard for disseminating such information.

Hypoglossal and Masseteric Nerve Transfer for Facial Reanimation: A Systematic Review and Meta-Analysis.

Background: Hypoglossal and masseteric nerve transfer are currently the most popular cranial nerve transfer techniques for patients with facial paralysis. The authors performed a systematic review and meta-analysis to compare functional outcomes and adverse effects of these procedures. Methods: A review of online databases was performed to include studies with four or more patients undergoing hypoglossal or masseter nerve transfer without muscle transfer or other cranial nerve transposition. Facial nerve outcomes, time to reinnervation, and adverse events were pooled and studied. Results: A total of 71 studies were included: 15 studies included 220 masseteric-facial transfers, and 60 studies included 1312 hypoglossal-facial transfers. Oral commissure symmetry at rest was better for hypoglossal transfer (2.22 ± 1.6 mm vs. 3.62 ± 2.7 mm, p = 0.047). The composite Sunnybrook Facial Nerve Grading Scale was better for masseteric transfer (47.7 ± 7.4 vs. 33.0 ± 6.4, p < 0.001). Time to first movement (in months) was significantly faster in masseteric transfer (4.6 ± 2.6 vs. 6.3 ± 1.3, p < 0.001). Adverse effects were rare (<5%) for both procedures. Conclusions: Both nerve transfer techniques are effective for facial reanimation, and the surgeon should consider the nuanced differences in selecting the correct procedure for each patient.

Use of Allografts in Orthopaedic Surgery: Safety, Procurement, Storage, and Outcomes.

The use of allografts has become a vital option for orthopaedic surgeons in the treatment of a variety of musculoskeletal lesions, ranging from osteochondral defects in the glenohumeral joint to meniscal deficiency in the young athlete. Nevertheless, barriers to treating a patient with an allograft-based procedure may arise from concerns over disease transmission, the navigation of tissue banks that supply allografts, the process of obtaining insurance approval, or optimal storage methods. This review serves to support orthopaedic surgeons in the incorporation of allografts into their practice by quelling these potential concerns. Fresh osteochondral allografts, fresh-frozen meniscal allografts, soft tissue allografts, and off-the-shelf cartilage products are the focus of this review amid broad overviews of allograft safety and tissue bank practices in the United States.

Cartilage Restoration: Microfracture and Osteochondral Autograft Transplantation.

The treatment of patellofemoral cartilage defects presents several distinct challenges when compared with cartilage restoration techniques used for other compartments of the knee due to the unique anatomy and distribution of forces. The etiologies of patellofemoral articular cartilage lesions include acute traumatic instability injuries, such as dislocation and subluxation, osteochondritis dissecans, and chronic degenerative changes. Regardless of the etiology, untreated patellofemoral cartilage lesions can contribute to activity-limiting anterior knee pain. The goal of patellofemoral cartilage restoration procedures is to impart symptomatic relief and improve quality of life by repairing the articular cartilage surface and any comorbid malalignment or maltracking.Microfracture and osteochondral autograft transplantation (OAT) are two cartilage restoration procedures to consider when treating full-thickness patellofemoral chondral defects. Considered by some experts to be the gold standard therapy, microfracture is one of the most common procedures used for cartilage restoration. The technique involves the perforation of the subchondral bone plate for the release of marrow elements, filling the defect with a fibrocartilage clot repair. Though less commonly used, OAT allows defect replacement with native hyaline cartilage via autologous transplantation from a non-weight bearing area. The purpose of this article is to discuss the indication, technical considerations, and outcomes of microfracture and OAT when used for treating chondral lesions of the patellofemoral joint.