Nasal Reconstruction: Defects that Cross Anatomical Subunits.

The nose plays a crucial role in the human experience, both aesthetically and functionally. The biomechanics of covering flaps, the importance of a firm framework, and the anatomical basis for aesthetic subunits are imperative concepts as one proceeds through the algorithm of reparative options. The subunits consist of three paired units-the ala, soft tissue facets (also known as soft tissue triangles), and sidewall, as well as three unpaired units-the dorsum, tip, and columella. Because many defects cross aesthetic subunits, it is critical to understand when to adapt the subunit principle and how or when to use a combination of techniques. It can be more challenging to apply the subunit principle to small grafts and local flaps of the nose. Convex subunits, such as the nasal tip and alar lobule, more frequently follow the subunit principle. In our practice, we adhere to a teaching of producing "straight lines and sharp corners." This applies to local flaps and grafts and focuses on keeping scar lines inconspicuous. In this article, we discuss approaches we follow for various defects along with technical pearls for performing these reconstructions. The subunit principle is more of a practice of thinking of resultant scars within a background of existing lines, reflections, and contour inflections.

Posttraumatic Nasal Deformities: Correcting the Crooked and Saddle Nose.

The nose is frequently traumatized in facial injuries and this often results from motor vehicle accidents, sports-related injuries, and altercations. Subsequently, posttraumatic nasal deformity is one of the most common reasons that patients seek consultation in the doctor's office. Depending on the type of nasal deformities, this can result in functional impairment and aesthetic problems. Two challenging problems to be addressed in the posttraumatic nose include the crooked nose deformity and the saddle nose deformity. The numerous publications on these two topics attest to the exacting surgical expertise required in its treatment. The key features in management of these conditions are discussed further.

A quantitative analysis of Twitter ("X") trends in the discussion of rhinoplasty.

Introduction: Rhinoplasty is one of the most common cosmetic surgical procedures performed globally. Twitter, also known as "X," is used by both patients and physicians and has been studied as a useful tool for analyzing trends in healthcare. The public social media discourse of rhinoplasty has not been previously reported in the field of otolaryngology. The goal of this study was to characterize the most common user type, sentiment, and temporal trends in the discussion of rhinoplasty on Twitter to guide facial plastic surgeons in their clinical and social media practices. Methods: A total of 1,427,015 tweets published from 2015 to 2020 containing the keywords "rhinoplasty" or "nose job" were extracted using Twitter Academic API. Tweets were standardized and filtered for spam and duplication. Natural language processing (NLP) algorithms and data visualization techniques were applied to characterize tweets. Results: Significantly more "nose job" tweets (80.8%) were published compared with "rhinoplasty" (19.2%). Annual tweet frequency increased over the 5 years, with "rhinoplasty" tweets peaking in January and "nose job" tweets peaking in the summer and winter months. Most "rhinoplasty" tweets were linked to a surgeon or medical practice source, while most "nose job" tweets were from isolated laypersons. While discussion was positive in sentiment overall (M = +0.08), "nose job" tweets had lower average sentiment scores (P < .001) and over twice the proportion of negative tweets. The top 20 most prolific accounts contributed to 14,758 (10.6%) of total "rhinoplasty" tweets. Exactly 90% (18/20) of those accounts linked to non-academic surgeons compared with 10% (2/20) linked to academic surgeons. Conclusions: Rhinoplasty-related posts on Twitter were cumulatively positive in sentiment and tweet volume is steadily increasing over time, especially during popular holiday months. The search term "nose job" yields significantly more results than "rhinoplasty," and is the preferred term of non-healthcare users. We found a large digital contribution from surgeons and medical practices, particularly in the non-academic and private practice sector, utilizing Twitter for promotional purposes.

Nuances in Forehead Flap Reconstruction for Large Nasal Defects.

The forehead flap is a time-tested and robust resurfacing flap used for nasal reconstruction. Owing to its excellent color and texture match, acceptable donor site morbidity, and robust and independent blood supply that can support both structural and internal lining grafts, this flap remains the workhorse flap for resurfacing large nasal defects. Various nuances of this technique relating to defect and template preparation, flap design, flap elevation, flap inset, donor site closure, and pedicle division are discussed in this article. These nuances are the guiding principles for improved outcomes using a forehead flap for the reconstruction of large nasal defects.

Revision of the functionally devastated nasal airway.

Functional rhinoplasty can be especially challenging in a patient who has had previous surgery, trauma, anatomic abnormalities, or systemic disease affecting the nasal mucosa. A thorough analysis of the type and location of the obstruction is critical, and only after identifying the precise anatomic cause of the problem can surgical planning begin. Scarring, altered anatomy, and disrupted tissue planes all complicate this process. Structural support and nasal mucosa often require augmentation with autogenous grafts from the ear, rib, or other portions of the nasal cavity. Attention to nasal support mechanisms, the internal and external nasal valves, and internal lining during primary surgery may help to avoid future complications. Through careful analysis and planning, proper function may be restored to a functionally devastated nasal airway.

Structural support and dynamics at the tip.

Controlled surgical alteration of the nasal tip remains one of the most difficult aspects of rhinoplasty. The appearance of the nasal tip depends on the underlying anatomy, and the long-term resultant anatomy depends on the structural dynamics and healing process. Many methods have been devised for altering the nasal tip and all do so via their ultimate effect on nasal tip structure and dynamics. This article summarizes the history of nasal tip structural and dynamic theories, reviews the fundamental effects of standard maneuvers on tip position and form, and finally discusses state of the art theories that synthesize classical thought and modern aesthetic goals.

Special Considerations in Facial Reconstruction in the Non-White Patient.

The principles of facial reconstruction are well established and some unique modifications apply to the non-White population. Anatomic and physiologic distinctions to this group give rise to alterations in design and surgical planning. Different ethnic groups have different skin anatomy and physiology and that should be taken into consideration. Healing differs among the different ethnic groups, affecting the final result regardless of method chosen. Variations in aesthetic units can lead to different flap selection and design. These should be considered for this population to maximize aesthetic outcomes and patient satisfaction.

Do Postoperative Antibiotics Affect Outcomes in Mohs Reconstructive Surgery?

OBJECTIVES/HYPOTHESIS: The prescribing of postoperative antibiotics for patients undergoing Mohs reconstructive surgery has increased in the last decade, while antibiotic resistance has been increasing. We hypothesized that routine prescribing of postoperative antibiotics after Mohs reconstruction does not decrease the risk of surgical site infection. STUDY DESIGN: Retrospective, single-institution cohort study. METHODS: This study assessed patients who underwent Mohs reconstructive surgery from January 1, 2012, to January 29, 2019. The main outcomes assessed included postoperative surgical site infections, partial or full flap/graft necrosis, hematoma, and dehiscence. RESULTS: A total of 900 defects in 800 patients (mean age [range] = 65.3 [21-96], 54.60% female) were identified over the 7-year period. Patient-specific variables reviewed included comorbidities, age, and smoking status. Surgery-specific variables analyzed included defect characteristics, time interval between Mohs micrographic surgery and reconstruction, reconstructive modalities, and use of postoperative antibiotics. All patients received peri-incisional antibiotics. On regression analysis, use of cartilage grafts (odds ratio [OR]: 6.53; 95% CI: 2.1-20.6; P = .001), current smoking status (OR: 6.67; 95% CI: 2.09-21.30; P = .001), full-thickness defects (OR: 1.2; 95% CI: 1.0-3.4; P = .045), and interpolated flap reconstruction (OR: 3.4; 95% CI: 1.0-11.5; P = .049) were associated with an increased risk of postoperative infections. Smoking and cartilage grafting remained significant on bivariable regression modeling. Use of perioperative antibiotics was not associated with a decreased risk of infection (OR: 1.82; 95% CI: 0.23-14.21; P = .568). CONCLUSIONS: We found no association between postoperative infections after Mohs reconstructive surgery and the use of postoperative antibiotics. These data support a more targeted approach to antibiotic prescribing in Mohs reconstructive surgery. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E434-E439, 2021.

Comparison of Outcomes of Early vs Delayed Graft Reconstruction of Mohs Micrographic Surgery Defects.

IMPORTANCE: Reconstructing Mohs defects often requires grafting in the form of full-thickness skin grafts (FTSGs) and composite grafts. These grafts can be complicated by a variable and often indeterminable survival rate. Other researchers have found that delaying FTSG reconstruction improves graft outcomes, but the optimal interval between excision and reconstruction remains unclear, and no study has examined the association between delaying composite graft reconstruction and graft survival. OBJECTIVE: To review the outcomes of Mohs micrographic surgery defect reconstruction using FTSG and composite grafts with respect to patient- and surgery-specific variables, particularly early vs delayed reconstruction. DESIGN, SETTING, AND PARTICIPANTS: This retrospective, single-institution cohort study assessed patients who underwent Mohs reconstructive surgery from January 1, 2012, to January 1, 2018. No patients had to be excluded for inadequate follow-up or incomplete medical records. Delayed reconstruction was defined as greater than 6 days after Mohs excision, the third quartile of the interval to reconstruction among our cohort. MAIN OUTCOMES AND MEASURES: Primary outcome was postoperative complications, including hematoma, infection, dehiscence, epidermolysis, and partial or full graft loss. RESULTS: A total of 320 defects were reconstructed with FTSG or composite grafts in 310 patients (median [range] age, 68 [21-96] years; 167 female [53.9%]) during the 6-year study period. The mean interval between the ablative and reconstructive operations was 4.73 days (range, 0-35 days). Univariate logistic regression was used to determine the significant indicators among patient and defect characteristics analyzed. A multivariate logistic regression model found delayed reconstruction to have a protective association (odds ratio, 0.52; 95% CI, 0.27-0.97; P = .046) and male sex to have a harmful association (odds ratio, 2.51; 95% CI, 1.52-4.20; P < .001) with postoperative complications. CONCLUSIONS AND RELEVANCE: This study found that delaying reconstruction in FTSGs and composite grafts was associated with decreased rates of postoperative complications, and male sex was associated with an increased risk of postoperative complications. The findings suggest that this strategy can be considered in patients at increased risk for developing postoperative complications, such as current smokers, patients with large defects, and patients who require use of composite grafts. LEVEL OF EVIDENCE: 3.

Assessment of Hedgehog Signaling Pathway Activation for Craniofacial Bone Regeneration in a Critical-Sized Rat Mandibular Defect.

IMPORTANCE: Osseous craniofacial defects are currently reconstructed with bone grafting, rigid fixation, free tissue transfer, and/or recombinant human bone morphogenetic protein 2. Although these treatment options often have good outcomes, they are associated with substantial morbidity, and many patients are not candidates for free tissue transfer. OBJECTIVE: To assess whether polysaccharide-based scaffold (PS) constructs that are cross-linked with smoothened agonist (SAG), vascular endothelial growth factor (VEGF), and bone morphogenetic protein 6 (BMP-6) would substantially increase bone regeneration. DESIGN, SETTING, AND PARTICIPANTS: This animal model study was conducted at the University of Virginia School of Medicine Cui Laboratory from March 1, 2017, to June 30, 2017. Thirty-three 10-week-old female Lewis rats were acquired for the study. Bilateral nonsegmental critical-sized defects were created in the angle of rat mandibles. The defects were either left untreated or filled with 1 of the 9 PSs. The rats were killed after 8 weeks, and bone regeneration was evaluated using microcomputed tomographic imaging and mechanical testing. Analysis of variance testing was used to compare the treatment groups. MAIN OUTCOMES AND MEASURES: Blinded analysis and computer analysis of the microcomputed tomographic images were used to assess bone regeneration. RESULTS: In the 33 female Lewis rats, minimal healing was observed in the untreated mandibles. Addition of SAG was associated with increases in bone regeneration and bone density in all treatment groups, and maximum bone healing was seen in the group with BMP-6, VEGF, and SAG cross-linked to PS. For each of the 5 no scaffold group vs BMP-6, VEGF, and SAG cross-linked to PS group comparisons, mean defect bone regeneration was 4.14% (95% CI, 0.94%-7.33%) vs 66.19% (95% CI, 54.47%-77.90%); mean bone volume, 14.52 mm3 (95% CI, 13.07-15.97 mm3) vs 20.87 mm3 (95% CI, 14.73- 27.01 mm3); mean bone surface, 68.97 mm2 (95% CI, 60.08-77.85 mm2) vs 96.77 mm2 (95% CI, 76.11-117.43 mm2); mean ratio of bone volume to total volume, 0.11 (95% CI, 0.10-0.11) vs 0.15 (95% CI, 0.10-0.19); and mean connectivity density 0.03 (95% CI, 0.02-0.05) vs 0.32 (95% CI, 0.25-0.38). On mechanical testing, mandibles with untreated defects broke with less force than control mandibles in which no defect was made, although this force did not reach statistical significance. No significant difference in force to fracture was observed among the treatment groups. CONCLUSIONS AND RELEVANCE: In this rat model study, activation of the hedgehog signaling pathway using smoothened agonist was associated with increased craniofacial bone regeneration compared with growth factors alone, including US Food and Drug Administration-approved recombinant human bone morphogenetic protein 2. Pharmaceuticals that target this pathway may offer a new reconstructive option for bony craniofacial defects as well as nonunion and delayed healing fractures. LEVEL OF EVIDENCE: NA.

Association of Mohs Reconstructive Surgery Timing With Postoperative Complications.

IMPORTANCE: Same-day Mohs reconstructive surgery is not always possible; moreover, a delay can offer benefits such as improved surgical planning and increased blood supply to the cauterized wound bed. However, recent work found that delaying reconstruction by more than 2 days increases the postoperative complication rate. OBJECTIVE: To review the outcomes of Mohs micrographic surgery (MMS) reconstruction with respect to patient- and surgery-specific variables, especially timing of repair. DESIGN, SETTING, AND PARTICIPANTS: Retrospective, single-institution cohort study of patients who underwent Mohs reconstructive surgery by 1 of the 2 senior authors from January 2012 to March 2017 for cutaneous squamous cell carcinoma or basal cell carcinoma. No patients had to be excluded for inadequate follow-up or incomplete medical records. MAIN OUTCOMES AND MEASURES: Postoperative complications including hematoma, infection, dehiscence, and partial or full graft or flap loss. RESULTS: A total of 633 defects in 591 patients (median [range] age, 65 [21-96] years; 333 [56.3%] female) were identified over the 5-year period. Reconstructions occurred from less than 24 hours to 32 days after MMS, with 229 (36.2%) delayed longer than 48 hours. Patient-specific variables reviewed included comorbidities, age, smoking status, and use of anticoagulant or antiplatelet medications. Surgery-specific variables analyzed included location and size of defect, time interval between MMS and reconstruction, and reconstructive modalities. Single-variable analysis was performed to determine whether each variable was associated with postoperative complications. On multivariable binary logistic regression, smoking status (odds ratio [OR], 2.46; 95% CI, 1.29-4.71; P = .007), defect size (OR exp(B), 1.04; 95% CI, 1.01-1.06; P = .006), full-thickness defects (OR, 1.56; 95% CI, 1.08-2.25; P = .02), interpolated flaps with cartilage grafting (OR, 8.09; 95% CI, 2.65-24.73; P < .001), and composite grafts (OR, 6.35; 95% CI, 2.25-17.92; P < .001) were associated with an increased risk of postoperative complications. CONCLUSIONS AND RELEVANCE: We found no association between timing of Mohs reconstructive surgery and complications, indicating that a delayed repair did not increase the risk of infection or flap failure. Variables associated with an increased risk of postoperative complications include smoking status, size of the defect, full-thickness defects, interpolated flaps with cartilage grafting, and the use of composite grafts. LEVEL OF EVIDENCE: 3.

Injectable tissue-engineered cartilage using a fibrin sealant.

OBJECTIVE: To investigate a commercially available fibrin sealant as a vehicle for developing injectable tissue-engineered cartilage. METHODS: Fibrin glue was mixed with autogenous chondrocytes from rabbits (n = 15). This isolate was injected along their nasal dorsa using 1 of 3 different fibrin glue concentrations. The samples were harvested at 8 weeks and compared with elastin and hyaline cartilage controls. RESULTS: Neocartilage was created along a linear injection tract on the dorsa of the nasal bones in 5 of 15 rabbits. Higher thrombin concentrations proved to be directly correlated with successful creation of injectable cartilage. Histologically, the staining patterns of both hematoxylin-eosin and safranin O stains were identical to that of normal auricular control cartilage. The presence of elastin fibers was observed following Verhoeff staining. No foreign body reaction was observed from the host. CONCLUSIONS: This study demonstrated a successful method for percutaneous injection of tissue-engineered cartilage as a mixture of chondrocytes suspended in fibrin glue. The thrombin concentration, along with the concentration of fibrinogen and chondrocytes, must be optimized to succeed consistently in cartilage growth.

Lip reconstruction.

The lip presents a unique challenge to the facial plastic surgeon because of its prominent location, elegant form, and important functions. The anatomy and pathology relevant to the lip are considered, along with general concepts to guide lip surgery. The more common approaches to reconstructing lip defects are outlined, illustrated, and discussed.

Evidence-Based Medicine in Facial Trauma.

This article provides the reader with a comprehensive review of high-level evidence-based medicine in facial trauma and highlights areas devoid of high-level evidence. The article is organized in the order one might approach a clinical problem: starting with the workup, followed by treatment considerations, operative decisions, and postoperative treatments. Individual injuries are discussed within each section, with an overview of the available high-level clinical evidence. This article not only provides a quick reference for the facial traumatologist, but also allows the reader to identify areas that lack high-level evidence, perhaps motivating future endeavors.

A Facial Trauma Simulation Course for Evaluation and Treatment of Facial Fractures.

IMPORTANCE: Traditional facial trauma laboratories are used for teaching basic concepts of fracture reduction and hardware manipulation. Facial trauma simulation laboratories allow training physicians the opportunity to develop unique treatment plans as they would in real patient encounters. OBJECTIVE: To assess the value of a novel facial trauma simulation course requiring residents to practice advanced decision making. DESIGN, SETTING, AND PARTICIPANTS: Data were prospectively collected July 23 and August 23 and 24, 2016, in a survey study during a resident physician trauma simulation course. Fresh frozen cadaver heads were fractured using an impactor that applied a measurable amount of force. Each head was scanned with high-resolution computed tomography. Residents were paired and tasked with evaluating their specimen's imaging findings and developing a treatment plan. MAIN OUTCOMES AND MEASURES: Before the course, residents were asked their postgraduate year level, number of facial fractures treated as a resident surgeon, and their comfort level based on the Otolaryngology Milestone for Facial Trauma (OMFT; ratings range from 0-5, with 5 indicating equivalent to fellow-level experience). After the course, residents were asked to assess the course's value relative to a theoretical number of actual operative cases, and a posttraining OMFT assessment was obtained. RESULTS: Thirty resident physicians completed the course at 2 institutions. Residents represented an equivalent distribution of postgraduate year levels. The residents stated that the course was worth a mean (SD) of 6.4 (2.8) operative cases of facial trauma in terms of surgical learning. The mean change in self-reported OMFT rating after the course was 0.87 (95% CI, 0.67-1.07; P < .001, paired t test). On the basis of this change in self-perceived OMFT rating, the course was deemed to be worth 1.5 years of residency training in the management of facial fractures. CONCLUSION AND RELEVANCE: Conducting a facial trauma simulation course increases resident experience with advanced surgical decision making. LEVEL OF EVIDENCE: NA.

Classifying and Standardizing Panfacial Trauma With a New Bony Facial Trauma Score.

IMPORTANCE: The practice of facial trauma surgery would benefit from a useful quantitative scale that measures the extent of injury. OBJECTIVE: To develop a facial trauma scale that incorporates only reducible fractures and is able to be reliably communicated to health care professionals. DESIGN AND SETTING: A cadaveric tissue study was conducted from October 1 to 3, 2014. Ten cadaveric heads were subjected to various degrees of facial trauma by dropping a fixed mass onto each head. The heads were then imaged with fine-cut computed tomography. A Bony Facial Trauma Scale (BFTS) for grading facial trauma was developed based only on clinically relevant (reducible) fractures. The traumatized cadaveric heads were then scored using this scale as well as 3 existing scoring systems. Regression analysis was used to determine correlation between degree of incursion of the fixed mass on the cadaveric heads and trauma severity as rated by the scoring systems. Statistical analysis was performed to determine correlation of the scores obtained using the BFTS with those of the 3 existing scoring systems. Scores obtained using the BFTS were not correlated with dentition (95% CI, -0.087 to 1.053; P = .08; measured as absolute number of teeth) or age of the cadaveric donor (95% CI, -0.068 to 0.944; P = .08). MAIN OUTCOME MEASURES: Facial trauma scores. RESULTS: Among all 10 cadaveric specimens (9 male donors and 1 female donor; age range, 41-87 years; mean age, 57.2 years), the facial trauma scores obtained using the BFTS correlated with depth of penetration of the mass into the face (odds ratio, 4.071; 95% CI, 1.676-6.448) P = .007) when controlling for presence of dentition and age. The BFTS scores also correlated with scores obtained using 3 existing facial trauma models (Facial Fracture Severity Scale, rs = 0.920; Craniofacial Disruption Score, rs = 0.945; and ZS Score, rs = 0.902; P < .001 for all 3 models). In addition, the BFTS was found to have excellent interrater reliability (0.908; P = .001), which was similar to the interrater reliability of the other 3 tested trauma scales. Scores obtained using the BFTS were not correlated with dentition (odds ratio, .482; 95% CI, -0.087 to 1.053; P = .08; measured as absolute number of teeth) or age of the cadaveric donor (odds ratio, .436; 95% CI, -0.068 to 0.944; P = .08). CONCLUSIONS AND RELEVANCE: Facial trauma severity as measured by the BFTS correlated with depth of penetration of the fixed mass into the face. In this study, the BFTS was clinically relevant, had high fidelity in communicating the fractures sustained in facial trauma, and correlated well with previously validated models. LEVEL OF EVIDENCE: NA.

Transplanted tissue-engineered cartilage.

OBJECTIVE: To evaluate the feasibility of transplanting sculpted autogenous tissue-engineered cartilage (TEC) with the hope that it will retain precise 3-dimensional morphologic features after transplantation. Transplanted TEC is described in terms of the gross morphologic and histologic characteristics in contrast to pretransplanted TEC. METHODS: Synthetic scaffolds of a polyglycolic acid and poly-l-lactic acid polymer, coated with chondrocytes derived from rabbit auricular cartilage in concentrations ranging from 2.7 x 10(6)/mL to 6 x 10(7)/mL, were incubated in vivo on the dorsum of a rabbit for 8 weeks and then retrieved. The resultant TEC specimens were then sculpted into defined shapes and transplanted into a different location in the same rabbit, where they were allowed to incubate for another 8 weeks. The specimens were then retrieved and compared with the TEC before transplantation according to size, weight, and histomorphometric analysis. RESULTS: Thirteen chondrocyte-laden templates were successfully engineered to develop TEC. In each case, they were sculpted and transplanted to a different site in the same rabbit. Eight weeks after transplantation, all sculpted TEC specimens lost their original 3-dimensional morphologic features and experienced a significant decrease in mass. Histologically, the staining intensity of both hemotoxylin-eosin and safranin O was dramatically reduced following transplantation. In addition, there was a reduction in chondrocyte viability. Two consistent histologic findings were a foreign-body reaction to the synthetic polymer and ongoing cellular activity directed toward the formation of bone. CONCLUSIONS: Transplanting autogenous TEC does not allow the preservation of precise morphologic features that are needed for clinical implantation. The osteogenic progression and foreign-body reaction must also be controlled.

Surgical Treatment of the Middle Nasal Vault.

The middle nasal vault is a sensitive region of the nose from both an esthetic and a functional perspective. It is critical for the rhinoplasty surgeon to properly evaluate and identify abnormalities of the middle vault when considering patients for primary or secondary surgery. This article addresses the surgical management of the cosmetic deformities and functional deficits of the middle vault and provides guidance for avoiding complications in this structurally critical region of the nose.

An innovative photographic database for cutaneous facial defects.

OBJECTIVES/HYPOTHESIS: To construct an easy-to-use server-based database that stores photographs of patients undergoing reconstructive surgery for cutaneous facial defects and organizes them in a manner best suited for rapid search and education. STUDY DESIGN: An institutional review board-approved user-modifiable database was designed using OnBase software (Hyland Software Inc., Westlake, OH) to store both the photographs of patients undergoing reconstructive surgery and the pertinent clinical data. METHODS: We designed a database using the OnBase software system (Hyland Software Inc.) to catalog patient data and photographs (pre-, intra-, and postoperative) and allow searches based on key data points. The database operates on three different frames: an upload frame, retrieval frame, and patient document frame. Data entry was based on patients undergoing facial reconstruction of Mohs defects, and upload is in the form of 25 keywords for which data values are entered via dropdown menus. Keyword entry describes defect description, flap nomenclature, flap design, outcomes, and complications. RESULTS: The database allows easy and rapid searches of case examples based on a number of criteria. It allows the user to view multiple examples of different patients with a given defect as defined by location, depth, and size. CONCLUSION: Server-based database systems such as OnBase (Hyland Software Inc.) provide platforms that can be used to create user-friendly photograph and data collection systems. Our database provides a way to educate medical students and surgeons-in-training, review personal outcomes, and exercise continued practice-based learning. Implementation of similar databases could potentially be utilized around the globe to facilitate education and self-assessment because OnBase (Hyland Software Inc.) and other similar software platforms are widely available within healthcare systems. Laryngoscope, 2016 Laryngoscope, 126:2451-2455, 2016.

Regenerative Medicine in Facial Plastic and Reconstructive Surgery: A Review.

The field of regenerative medicine aims at enhancing tissue healing and regeneration through the exogenous addition of therapeutic growth factors and cells, often in combination with tissue-compatible scaffolds. Perhaps the biggest advances in facial plastic and reconstructive surgery (FPRS) in the coming years will be the result of regenerative medicine techniques. While many articles on regenerative medicine have been published in the FPRS literature, to our knowledge there are no reviews that describe both soft-tissue and bony regeneration strategies, including scaffolds, stem cells, growth factors, and platelet-rich plasma. In reviewing the literature, we found that these strategies have produced very promising results and that regenerative medicine has the potential to augment conventional treatment options in the FPRS subspecialty. In the near future, these novel approaches may begin to replace autologous grafting and free tissue transfer in FPRS, the current standards of care. In this review we look at where our subspecialty is today with regard to regenerative medicine and suggest ways for future study and growth.