Rejuvenation of the ageing upper lip and nose with suspension lifting.

There are growing number of patients attending aesthetic consultations and requesting the rejuvenation of ageing upper lips. Often these patients also have nasal tip ptosis. There are a number of direct and indirect upper lip lifting procedures. We describe a novel technique, which combines upper lip and nasal tip rejuvenation through hidden incisions and the use of suspension micro-screws.

A systematic review of soft-to-hard tissue ratios in orthognathic surgery. Part III: Double jaw surgery procedures.

OBJECTIVE: The aim was to determine the soft-to-hard tissue ratios in profile view in bimaxillary orthognathic surgical corrections. MATERIAL AND METHODS: A systematic review of studies published in different languages was performed by searching the Medline, Embase, Cochrane Library, Lilacs, Scopus, and Science Direct databases up to August 2015. Additional studies were identified by reference analyses. The methodological quality was evaluated using the instrument developed by the Effective Public Health Practice Project and the Level of Evidence using the Level of Evidence scale from the Oxford Centre for Evidence-based Medicine. RESULTS: The search identified 16 articles; one of which was included from the manual reference search. The analysis of bias revealed weak methodological quality for all the studies included (LOE IV). The studies were retrospective and presented widely varying ratios. In sagittal movements Sn:ANS showed consistency in the evaluations with 60%-90% ratios in five articles. Pn:A presented 66%-90% when V-Y suturing is executed and Ls:U1 ratio was 60%-100% in 6 articles. In vertical direction, poor data are available, considering Sn:A between 54% and 91% in 3 articles and Ls:U1 between 66% and 97% in 3 articles. The Mla-to-point B ratio in sagittal movements was 100% in six articles and Pg-to-sPg demonstrated a relationship between 90% and 100% in 8 articles. CONCLUSION: Soft-to-hard tissue ratios varied greatly in literature. The results for the mentolabial angle and soft Pogonion changes were apparently more uniform. The low LOE of the studies prevented a more in-depth analysis.

Do you mind if I vape? Immediate effects of electronic cigarettes on perfusion in buccal mucosal tissue--a pilot study.

The association between smoking and postoperative complications is compounded in patients who have oral and maxillofacial operations by an additional local effect, and patients often continue to smoke after operation despite advice to stop. Recent studies have suggested that nicotine may reduce inflammation and improve angiogenesis, so topical application may be beneficial for smokers. The electronic cigarette is increasing in popularity and more patients ask whether they can vape after operation. We investigated the effect of electronic cigarettes (of which half contained nicotine and half did not) on blood flow in the buccal mucosa in 10 volunteers immediately after vaping. Smokers were excluded as this was considered an additional variable in a small pilot study and our Trust has a no-smoking policy. After vaping for 5 minutes, capillary blood flow was measured in the buccal mucosa at 5-minute intervals using a laser Doppler probe, and the results were expressed as arbitrary perfusion units. There was a wide variation in results and a small but significant rise (p=0.008) as a result of nicotine vaping, but these fell to the same levels as before within 30 minutes. Electronic cigarettes may have an effect on blood flow to the oral mucosa, although further studies are needed to show whether they improve healing time after operation. Additional work is also needed to compare them with cigarettes.

Contemporary use of imaging modalities in neck mass evaluation.

The effective and efficient management of a patient with a neck mass in a 1-stop clinic requires a collaborative and harmonious partnership among surgeon, radiologist, and pathologist. In this article, theoretic and practical issues are addressed to optimize patient care when prescribing, planning, performing, and interpreting imaging for neck disease.

Management of early stage cutaneous Merkel cell carcinoma of the head and neck.

Merkel cell carcinoma (MCC) is a rare but aggressive skin cancer of neuroendocrine origin. As a result, few large studies have been published, and we know of even fewer on disease of the head and neck alone. The most appropriate way to manage patients with early local disease and no sign of metastases neck is controversial. We reviewed management of early cutaneous MCC of the head and neck in 8 hospitals in the United Kingdom over 12 years between 1999 and 2011 (the largest head and neck series in Europe to date), and identified 39 patients (19 men and 20 women) with early disease according to a well recognised classification. A total of 24 patients had stage Ia disease, 11 had stage Ib disease, and 4 were unclassified. Five of those with stage Ia disease developed regional metastases and 7 with stage Ib disease developed regional recurrence. The 2-year overall survival for stage Ia and Ib disease was 62% and 27%, respectively. Our study shows that prognosis is poor after conservative surgical management of stage I disease. Management of the neck is still controversial, and a meta-analysis of all the published data is needed to establish best practice statistically.