Education on the Business of Plastic Surgery During Training: A Survey of Plastic Surgery Residents.

BACKGROUND: Entrepreneurial skills are important for physicians, especially plastic surgeons. Nevertheless, these skills are not typically emphasized during residency training. OBJECTIVE: Evaluate the extent of business training at plastic surgery residency programs as well as means of enhancing business training. METHODS: A 6-question online survey was sent to plastic surgery program directors for distribution to plastic surgery residents. Responses from residents at the PGY2 level and above were included for analysis. Tables were prepared to present survey results. RESULTS: Hundred and sixty-six residents including 147 PGY2 and above residents responded to our survey. Only 43.5% reported inclusion of business training in their plastic surgery residency. A majority of residents reported they do not expect on graduation to be prepared for the business aspects of plastic surgery. Additionally, a majority of residents feel establishment of a formal lecture series on the business of plastic surgery would be beneficial. CONCLUSIONS: Results from our survey indicate limited training at plastic surgery programs in necessary business skills. Plastic surgery residency programs should consider incorporating or enhancing elements of business training in their curriculum. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Liposuction and lipofilling for treatment of symptomatic silicone toxicosis of the gluteal region.

BACKGROUND: Silicone injection can cause numerous posttreatment complications-including debilitating pain, cellulitis, abscesses, overlying skin compromise, and siliconomas distorting overlying tissues-that can be difficult to manage. OBJECTIVES: The authors evaluate liposuction as a treatment for patients experiencing complications from silicone injections to the gluteal region, to both preserve aesthetic appearance and minimize further risk of complication from these procedures. METHODS: Eight patients (7 women and 1 man) who presented consecutively to us between 2010 and 2013 with complications from silicone injections to their gluteal region were enrolled in this study. Each patient was evaluated by computed tomography scan and a 0 to 6 visual analog scale for pain. Emergency room (ER) visits, previous hospital admissions, and cellulitis requiring antibiotics in the 12 months prior to treatment were recorded. Patients were treated with ultrasonic and standard liposuction followed by lipotransfer into the gluteal musculature. A Student t test was used for statistical comparison of pre- and postoperative values. RESULTS: Average patient age was 36 years (range, 25-43 years). All patients initially presented with intense pain as assessed by a visual analog scale; by the 12th week postoperatively, the entire cohort experienced remission in pain. At 1 year postoperatively, no patients had infections (vs 75% preoperatively; P = .028), visited the ER (vs 50% preoperatively; P = .058), or were hospitalized (vs an average of 1.5 hospitalizations per patient preoperatively; P = .066). CONCLUSIONS: Liposuction with immediate intramuscular fat transfer for buttock augmentation appears to be a safe surgical option that preserves aesthetic appearance for patients with gluteal silicone toxicosis.

Audiologic findings in Pfeiffer syndrome.

Hearing loss has been described in patients with certain craniosynostotic syndromes but is poorly defined in Pfeiffer syndrome (PS). Our objective was to characterize the otologic and audiologic findings in PS. The records of PS patients evaluated at our craniofacial center over a 30-year period were culled. Only patients with a confirmed diagnosis and formal audiologic examination were included. Diagnostic criteria were characteristic mutations in fibroblast growth factor receptor 1 or 2 (FGFR1, FGFR2) or, in the absence of genetic testing, typical clinical findings of PS as determined by a clinical geneticist or the most senior author. Twenty patients met the inclusion criteria, and all had hearing loss. Twenty patients had traditional audiologic testing: 14 (70%) had pure conductive loss (minor to severe), and 3 (15%) had a mixed conductive/sensorineural loss (minor to severe). Two additional patients had hearing loss by Behavioral Observational Audiometry (sound fields method). One patient with early conductive hearing loss was subsequently determined to have a pure sensorineural deficit. Nine patients (45%) had permanent hearing loss significant enough to require audiologic amplification. All patients with PS demonstrated hearing loss, although the severity and the anatomic basis (ie., neural vs conductive) were variable. Conductive hearing loss, possibly caused by structural abnormalities, was most common. Sensorineural hearing loss was less common and may be related to the effect of FGFR mutations on cranial nerve and/or inner-ear development.

Sensorineural hearing loss in patients with inflammatory bowel disease.

OBJECTIVE: The study aimed to discuss the association between sensorineural hearing loss (SNHL) and inflammatory bowel disease (IBD). METHODS: We reviewed cases of patients with known IBD seen in an otolaryngology practice with documentation of all otologic data including age of onset, family history of otologic problems, exposure to noise, audiometric findings, and so on. RESULTS: Of 38 patients with a history of IBD, 22 had documented SNHL. Nineteen of these had no other identifiable etiology for their inner ear dysfunction. Fourteen of these patients had a diagnosis of ulcerative colitis and 5 had Crohn disease. Sixteen patients had bilateral SNHL, and 3 patients had unilateral SNHL. Only one patient had a lasting response of SNHL to medical treatment. CONCLUSION: This review suggests that SNHL is an extraintestinal association of IBD. As IBD is considered to be a local or systemic immunopathy, the associated SNHL might also be an expression of systemic immune dysfunction.

Cleft palate in Pfeiffer syndrome.

The frequency of associated cleft palate is known to be high in some fibroblast growth factor receptor 2 (FGFR2)-mediated craniosynostosis syndromes, such as Apert syndrome. However, there is little information on the frequency of palatal clefts in the FGFR2-mediated disorder, that is, Pfeiffer syndrome. The purpose of this study was to determine the frequency of palatal clefts in patients with Pfeiffer syndrome. The records of patients with Pfeiffer syndrome managed in our craniofacial unit were reviewed. Only patients with a confirmed diagnosis of Pfeiffer syndrome were included. Diagnostic criteria were as follows: characteristic mutations in FGFR1 or FGFR2 or, in the absence of genetic testing, clinical findings consistent with Pfeiffer syndrome as determined by a clinical geneticist or our most experienced surgeon (J.B.M.). Only 2 clefts were noted in 25 patients (8%), including 1 with a submucous cleft and 1 with an overt palatal cleft. Many patients (87%) were described as having a high-arched and narrow palate, and 1 had a low, broad palate. Nine patients were noted to have choanal atresia or stenosis. Clefting of the palate does occur in Pfeiffer syndrome but at a low frequency.

Early laryngeal inhalation injury and its correlation with late sequelae.

OBJECTIVE: Inhalation injury can permanently alter normal laryngeal function. The aim of this study was to examine the early changes in voice, swallowing, and breathing in laryngeal inhalation injuries. STUDY DESIGN: This was a prospective analysis of nine patients with inhalation injuries at a tertiary care institution. METHODS: Laryngeal function of patients admitted for inhalation injury requiring intubation was documented using videostroboscopy and swallowing evaluation by the speech pathology service. Bronchoscopy was used to classify the degree of inhalation injury. Association among total body surface area, facial burns, severity of laryngotracheal injuries, and loss of function was attempted. RESULTS: All three patients with severe tracheal inhalation injury presented persistent hoarseness at 1-year follow up with abnormal videostroboscopy findings. No association was found between inhalation injury and total body surface area burned. None of the patients in this series presented permanent swallowing dysfunction. CONCLUSION: The otolaryngologist plays an important role in the initial and long-term management of inhalation injuries. Inhalation injuries should be managed in a multidisciplinary fashion. There may be a correlation between the degree of tracheal injury and laryngeal injury and hoarseness.

Recurrent fetal rhabdomyoma of the head and neck.

We present a case of a congenital fetal rhabdomyoma which recurred after surgical excision. A review of the patient's chart, imaging studies, operative reports and histologic findings were conducted. A congenital fetal rhabdomyoma involving the head and neck region diagnosed prenatally by ultrasound and MRI was surgically excised without complications. The patient presented with recurrence of the tumor fourteen months after the initial surgery. This case report is supplemented with a review of the relevant literature on congenital fetal rhabdomyoma. This is the fifth documented case of recurrence of a fetal rhabdomyoma. Extracardiac rhabdomyomas are extremely rare benign tumors. Complete excision of these lesions is curative with only a handful of recurrences documented in the literature. Close follow up and a complete workup to rule out rhabdomyosarcoma is warranted in all cases of recurrence.

Silent sinus syndrome: a case presentation and comprehensive review of all 84 reported cases.

OBJECTIVES: The term silent sinus syndrome has been used to describe the constellation of progressive enophthalmos and hypoglobus due to gradual collapse of the orbital floor with opacification of the maxillary sinus, in the presence of subclinical chronic maxillary sinusitis. Currently, it is believed to occur as a result of the sequence of events following maxillary sinus hypoventilation due to the obstruction of the ostiomeatal complex. METHODS: In this study, we present a case of true silent sinus syndrome. In addition, we highlight the previously published cases of silent sinus syndrome, as well as provide a review of the etiology, pathophysiology, radiologic diagnosis, surgical treatment, and pitfalls to avoid in the management of patients with silent sinus syndrome. RESULTS: Eighty-three previously published cases of silent sinus syndrome were reported in the literature and are summarized in this review. CONCLUSIONS: A well-defined set of criteria is needed to classify a patient under the diagnosis of silent sinus syndrome, which include enophthalmos and/or hypoglobus in the absence of clinically evident sinonasal inflammatory disease.