A Consistent, Reliable Landmark to Assist in Placement of Orbital Floor Reconstruction Plates After Blowout Fractures.

OBJECTIVE: To define a reliable and consistent landmark, the superior posterior wall of the maxillary sinus, and to describe how this landmark can be used when repairing orbital floor fractures. METHODS: Retrospective chart review. Patients >18 years old diagnosed with unilateral orbital floor and/or zygomaticomaxillary complex fractures. MAIN OUTCOMES: The distance from the inferior orbital rim to the superior posterior wall of the maxillary sinus (landmark distance), and the distance from the landmark to the entrance of the optic canal were reported. RESULTS: Eighty patients were included in the study. Each had unilateral isolated orbital floor fractures (n = 46) or unilateral zygomaticomaxillary complex fractures with an orbital floor component (n = 34). The contralateral eye in all patients was uninjured, and was used as an internal control. In orbital floor fractures, the mean landmark distance was 38.8 ±â€Š1.4 mm, with a mean distance on the normal side of 38.8 ±â€Š1.6 mm (P = 0.49). Distance to the optic canal on the injured side in isolated orbital floor fracture patients was 9.0 ±â€Š0.8 mm with the same measurement on the normal side being 8.8 ±â€Š0.7 (P = 0.21). In the setting of zygomaticomaxillary complex fracture, the orbital floor length was 38.2 ±â€Š1.3 mm with a mean normal floor length of 37.8 ±â€Š1.1 mm (P = 0.18). The mean distance from the superior posterior wall to optic canal in zygomaticomaxillary complex fractured orbits was 9.2 ±â€Š1.1 mm with a normal side mean length of 9.5 ±â€Š1.0 mm (P = 0.23). No significant difference was found between the measured distances in the fractured orbit and its normal counterpart for both fracture groups. CONCLUSIONS AND RELEVANCE: The superior posterior wall of the maxillary sinus is a reliable landmark that can be used to assist in placement of an orbital floor reconstructive plate. The landmark is unchanged despite the presence of an orbital floor or zygomaticomaxillary sinus fracture.

Ear Scaffold Reconstruction Using Ultrasonic Aspirator for Cauliflower Ear.

Untreated auricular hematomas from ear trauma can result in an ear deformation known as cauliflower ear, secondary to fibrosis and new cartilage overgrowth. Cauliflower ear reconstruction has traditionally utilized tools such as a drill or a scalpel in order to improve auricular cosmesis. We present a case report utilizing an ultrasonic aspirator to recontour the fibrosed cartilage of a cauliflower ear. The ultrasonic aspirator has advantages over traditional tools in its ability to provide finely controlled bone removal without damage to surrounding soft tissue. The patient in this case report underwent multistage reconstruction using the ultrasonic aspirator with excellent cosmetic result and patient satisfaction.

Sonic rhinoplasty: innovative applications.

Sonic rhinoplasty involves the use of the Sonopet ultrasonic bone aspirator (Stryker, Inc., Kalamazoo, MI, USA) to precisely sculpt the nasal bones without damage to the surrounding nasal cartilage, soft tissue, and mucosa. By employing ultrasonic waves to emulsify and remove bone under concurrent irrigation and suction, sonic rhinoplasty improves upon the conventional osteotome, drill, rasp, and powered rasp techniques that may be associated with decreased visualization, heat generation, mechanical chatter, and a lack of surgical precision with attendant soft tissue injury. We have applied this technology to bony dorsal hump and nasal spine removal, deepening of the glabellar angle and reshaping of irregular nasal contours, septoplasty, turbinate reduction, and the correction of bony asymmetries.

Management of auricular hematoma and the cauliflower ear.

Acute auricular hematoma is common after blunt trauma to the side of the head. A network of vessels provides a rich blood supply to the ear, and the ear cartilage receives its nutrients from the overlying perichondrium. Prompt management of hematoma includes drainage and prevention of reaccumulation. If left untreated, an auricular hematoma can result in complications such as perichondritis, infection, and necrosis. Cauliflower ear may result from long-standing loss of blood supply to the ear cartilage and formation of neocartilage from disrupted perichondrium. Management of cauliflower ear involves excision of deformed cartilage and reshaping of the auricle.

Management of traumatic facial nerve injuries.

Management of facial nerve injuries requires knowledge and skills that should be in every facial plastic surgeon's armamentarium. This article will briefly review the anatomy of the facial nerve, discuss the assessment of facial nerve injury, and describe the management of facial nerve injury after soft tissue trauma.

Midface Fracture Simulation and Repair: A Computer-Based Algorithm.

We introduce a novel computer-based method to digitally fixate midfacial fractures to facilitate more efficient intraoperative fixation. This article aims to describe a novel computer-based algorithm that can be utilized to model midface fracture reduction and fixation and to evaluate the algorithm's ability to produce images similar to true postoperative images. This is a retrospective review combined with cross-sectional survey from January 1, 2010, to December 31, 2015. This study was performed at a single tertiary care, level-I trauma center. Ten patients presenting with acute midfacial traumatic fractures were evaluated. Thirty-five physicians were surveyed regarding the accuracy of the images obtained using the algorithm. A computer algorithm utilizing AquariusNet (TeraRecon, Inc., Foster City, CA) and Adobe Photoshop (Adobe Systems Inc., San Jose, CA) was developed to model midface fracture repair. Preoperative three-dimensional computed tomographic (CT) images were processed using the algorithm. Fractures were virtually reduced and fixated to generate a virtual postoperative image. A survey comparing the virtual postoperative and the actual postoperative images was produced. A Likert-type scale rating system of 0 to 10 (0 being completely different and 10 being identical) was utilized. Survey participants evaluated the similarity of fracture reduction and fixation plate appearance. The algorithm's capacity for future clinical utility was also assessed. Survey response results from 35 physicians were collected and analyzed to determine the accuracy of the algorithm. Ten patients were evaluated. Fracture types included zygomaticomaxillary complex, LeFort, and naso-orbito-ethmoidal complex. Thirty-four images were assessed by a group of 35 physicians from the fields of otolaryngology, oral and maxillofacial surgery, and radiology. Mean response for fracture reduction similarity was 7.8 ± 2.5 and fixation plate similarity was 8.3 ± 1.9. All respondents reported interest in the tool for clinical use. This computer-based algorithm is able to produce virtual images that resemble actual postoperative images. It has the ability to model midface fracture repair and hardware placement.

Assessment of a Novel Computer Algorithm for Printing a 3-Dimensional Nasal Prosthetic.

Importance: The introduction and evaluation of a novel technique to create nasal prostheses with 3-dimensional (3-D) imaging software may circumvent the need for an anaplastologist. Objectives: To describe a novel computer algorithm for the creation of a 3-D model of a nose and to evaluate the similarity of appearance of the nasal prosthesis with that of the individual's nose. Design, Setting, and Participants: A prospective pilot study with a cross-sectional survey was conducted from August 1 to October 31, 2016, at a tertiary care academic center. Five volunteers were used for creation of the nasal prostheses, and 36 survey respondents with a medical background were involved in evaluating the nasal prostheses. Exposures: A computer algorithm using a 3-D animation software (Blender; Blender Foundation) and Adobe Photoshop CS6 (Adobe Systems) were used to create a 3-D model of a nose. Photographs of 5 volunteers were processed with the computer algorithm. The model was then printed using a desktop 3-D printer. Attending physicians, residents, and medical students completed a survey and were asked to rate the similarity between the individuals' photographs and their 3-D printed nose on a Likert-type scale. Main Outcomes and Measures: The similarity between 3-D printed nasal models and photographs of the volunteers' noses based on survey data. Results: Thirty-six survey respondents evaluated 4 views for each of the 5 modeled noses (from 4 women and 1 man; mean [SD] age, 26.6 [5.7] years). The mean (SD) score for the overall similarity between the photographs and the 3-D models was 8.42 (1.34). The mean scores for each nasal comparison ranged from 7.97 to 8.62. According to the survey, respondents were able to match the correct 3-D nose to the corresponding volunteers' photographs in 171 of 175 photographs (97.7%). All surveyed clinicians indicated that they would consider using this tool to create a temporary prosthesis instead of referring to a prosthodontist. Conclusions and Relevance: This algorithm can be used to model and print a 3-D prosthesis of a human nose. The printed models closely depicted the photographs of each volunteer's nose and can potentially be used to create a temporary prosthesis to fill external nasal defects. The appropriate clinical application of this technique is yet to be determined.

A novel computer algorithm for modeling and treating mandibular fractures: A pilot study.

OBJECTIVES/HYPOTHESIS: To describe a novel computer algorithm that can model mandibular fracture repair. To evaluate the algorithm as a tool to model mandibular fracture reduction and hardware selection. STUDY DESIGN: Retrospective pilot study combined with cross-sectional survey. METHODS: A computer algorithm utilizing Aquarius Net (TeraRecon, Inc, Foster City, CA) and Adobe Photoshop CS6 (Adobe Systems, Inc, San Jose, CA) was developed to model mandibular fracture repair. Ten different fracture patterns were selected from nine patients who had already undergone mandibular fracture repair. The preoperative computed tomography (CT) images were processed with the computer algorithm to create virtual images that matched the actual postoperative three-dimensional CT images. A survey comparing the true postoperative image with the virtual postoperative images was created and administered to otolaryngology resident and attending physicians. They were asked to rate on a scale from 0 to 10 (0 = completely different; 10 = identical) the similarity between the two images in terms of the fracture reduction and fixation hardware. RESULTS: Ten mandible fracture cases were analyzed and processed. There were 15 survey respondents. The mean score for overall similarity between the images was 8.41 ± 0.91; the mean score for similarity of fracture reduction was 8.61 ± 0.98; and the mean score for hardware appearance was 8.27 ± 0.97. There were no significant differences between attending and resident responses. There were no significant differences based on fracture location. CONCLUSION: This computer algorithm can accurately model mandibular fracture repair. Images created by the algorithm are highly similar to true postoperative images. The algorithm can potentially assist a surgeon planning mandibular fracture repair. LEVEL OF EVIDENCE: 4. Laryngoscope, 2016 127:331-336, 2017.

A preliminary report of percutaneous craniofacial osteoplasty in a rat calvarium.

OBJECTIVES/HYPOTHESIS: To evaluate the potential for injectable, permanent bone augmentation by assessing the biocompatability and bioactivity of subperiosteal hydroxylapatite (Radiesse) deposition in a rat model. STUDY DESIGN: Randomized controlled animal model. METHODS: Fourteen adult Sprague Dawley rats were injected in the parietal skull with 0.2 ml of hydroxylapatite (10 animals) or 0.2 ml of a carrier gel control (4 animals), using a subperiosteal injection technique on the right and a subcutaneous injection technique on the left. At 1, 3, and 6 months, three rats (1 negative control, 2 variables) were sacrificed and the calvaria were harvested. At 12 months, the remaining five rats were sacrificed. After each harvest, the specimens were processed and then examined under both light and polarized microscopy for new bone growth at the injection sites. RESULTS: The inflammatory response was limited with both hydroxylapatite and carrier injections. Injectables were still present 12 months after the injection. New bone formation was only observed when the injection was located deep to a disrupted periosteum The odds of new bone formation was 48.949 times higher (95% confidence intervals CI [2.637, 3759.961]; P=0.002) with subperiosteal hydroxylapatite injections compared to all other combinations of injection plane and injectable. CONCLUSIONS: This preliminary report of subperiosteal hydroxylapatite (Radiesse) injection in a rat model has verified the biocompatibility of injectable hydroxylapatite at the bony interface and suggests the potential for new bone formation. LEVEL OF EVIDENCE: N/A.

Sonic rhinoplasty: histologic correlates and technical refinements using the ultrasonic bone aspirator.

OBJECTIVE: To demonstrate histologic correlates and describe refinements in cosmetic rhinoplasty using the ultrasonic bone aspirator. METHODS: This retrospective review of 103 consecutive patients undergoing cosmetic rhinoplasty at a tertiary care academic facial plastic surgery practice extends the applications for the ultrasonic bone aspirator to include reducing the nasal spine, glabellar deepening, sculpting of mobile bone fragments after osteotomy, smoothing of bony edges after medial osteotomy, and reducing the convexity of nasal bones. We performed histologic analysis of cartilage samples, and the patient and surgeon subjectively evaluated the aesthetic outcome of the procedure. RESULTS: All patients obtained satisfactory outcomes. Seven patients experienced minor complications. One patient had a visible dorsal irregularity, 2 had palpable but not visible dorsal irregularities, 2 had asymmetry of the dorsum, and 2 had underresection of the dorsum. No patients experienced skin or soft-tissue injury. CONCLUSIONS: The ultrasonic bone aspirator can be a useful adjunct for the cosmetic rhinoplasty surgeon. The ultrasonic bone aspirator permits precise, graded removal of bone without damage to surrounding soft tissue or mucosa. With multiple applications in nasal surgery, the ultrasonic bone aspirator permits refinement of subtle irregularities and asymmetry of the nasal bones. Complications associated with the device are rare.

Ultrasonic bone aspirator turbinoplasty: a novel approach for management of inferior turbinate hypertrophy.

OBJECTIVE: Turbinate reduction via microdebrider assisted turbinoplasty (MAIT) or radiofrequency assisted (RFA) turbinoplasty fails to address nasal obstruction caused by bony deformities of the inferior turbinate. Procedures such as Mabry's turbinoplasty, although effective, are challenging to perform. Other procedures such as partial or total turbinectomies may result in prolonged crusting and atrophic rhinitis. We demonstrate the safety and efficacy of inferior turbinate bone removal with an ultrasonic bone aspirator. STUDY DESIGN: Retrospective Review and Prospective Case Series with Patient Questionnaire. METHODS: The SONOPET ultrasonic bone aspirator (MIWATEC Co., Ltd.) utilize sultrasonic waves to emulsify bone while concurrent irrigation and microsuction of the bone particles produces a clean surgical field. This enables precise, graded removal of the inferior turbinate bone under direct visualization without thermal or mechanical injury to the surrounding soft tissue or mucosa. We describe the first application of this technology to turbinate bone reduction. RESULTS: No individuals experienced delayed healing, infection, scarring or other complications. Improvements in nasal obstruction varied depending upon the procedures being concurrently performed such as septoplasty, functional endoscopic sinus surgery, nasal valve repair and rhinoplasty. CONCLUSIONS: Ultrasonic bone aspiration turbinoplasty is a safe and effective addition to the techniques employed for inferior turbinate reduction. Moreover, this technique addresses actual deformities in the turbinate bone which cannot be effectively treated through microdebrider or radiofrequency-assisted turbinoplasty. The technique is simpler than conventional turbinoplasty and avoids the complications associated with turbinate resection.

Sonic rhinoplasty: sculpting the nasal dorsum with the ultrasonic bone aspirator.

OBJECTIVES/HYPOTHESIS: Rhinoplasty often requires precise, graded bone removal without damage to surrounding nasal soft tissue and mucosa. Unfortunately, current techniques are associated with decreased visualization, heat generation, mechanical chatter, and lack of surgical precision with resultant soft tissue injury. We introduce a novel technique to sculpt the nasal dorsum in a precise fashion with the ultrasonic bone aspirator and delineate its advantages over conventional techniques. STUDY DESIGN: Retrospective chart review. METHODS: The SONOPET ultrasonic bone aspirator (Mutoh Co., Ltd., Tokyo, Japan) utilizes ultrasonic waves to emulsify bone with concurrent irrigation and suction, enabling precise, graded bone removal under direct visualization without thermal or mechanical injury to the surrounding soft tissue or mucosa. We describe the application of this technology to dorsal hump reduction with early follow-up to 9 months. Successful reduction was determined by the senior author at postoperative follow-up appointments. RESULTS: Sixty patients underwent open rhinoplasty requiring dorsal reduction with the ultrasonic bone aspirator. No individuals experienced delayed healing, infection, scarring, or major complications. Five of 60 patients had minor post surgical irregularities, which included visible nasal dorsum deformity, palpable nasal deformity, under-resection of the dorsum, and asymmetry of the nasal dorsum. No postoperative open sky deformities, inverted "V" deformities, over-resected dorsums, or skin injuries were observed. CONCLUSIONS: Ultrasonic bone aspiration permits safe, precise, graded bone removal without damaging surrounding nasal soft tissue and mucosa. We introduce novel applications of the ultrasonic bone aspirator in dorsal reduction that provide significant advantages over conventional techniques.

Closure times measured by the platelet function analyzer PFA-100 are longer in neonatal blood compared to cord blood samples.

BACKGROUND: Although neonatal platelets have been shown to be hyporesponsive to most agonists in vitro, several groups have reported shorter closure times (CT) in term cord blood samples than in children and adults. It is unknown whether this is also true for preterm neonates, or for neonates of any gestational age (GA) during the 1st week of life, since limited studies have evaluated neonatal blood samples. OBJECTIVES: We designed this study to determine the effects of GA and postconceptional age on platelet function using the platelet function analyzer PFA-100. METHODS: We measured CTs in cord blood samples and in neonatal blood samples of varying GAs on days of life 1-2, and > or = 7. RESULTS: CTs were determined in 51 cord blood samples, 34 neonatal blood samples obtained on day of life 1-2, 16 neonatal blood samples from preterm neonates > or = 7 days old, and 10 adults. We found a significant inverse relationship between ADP CTs and GA in both cord blood and neonatal blood day of life 1-2 samples (p = 0.02 and p = 0.01, respectively). When cord blood samples were compared with neonatal and adult blood, epinephrine and ADP CTs were significantly longer in adult blood as well as in neonatal samples obtained at either of the two time points (p < or = 0.01 for all). CONCLUSIONS: Platelet function in response to ADP appears to improve with advancing GA. The differences between cord blood and neonatal blood CTs indicate that substantial changes in primary hemostasis occur shortly after birth. The reasons underlying these changes are unknown.

Readability analysis of patient information on the American Academy of Otolaryngology-Head and Neck Surgery website.

OBJECTIVE: To evaluate the readability of patient-oriented online health information (OHI) presented on the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) website. STUDY DESIGN: Review of the Flesch-Kincaid (FK) grade level for 104 articles on the AAO-HNS website. METHODS: The FK grade level for 104 articles was determined using the readability calculator available within Microsoft Office Word 2003. The interobserver reliability for the FK grade level was determined by calculating the intraclass correlation coefficient (ICC) for 52 entries. RESULTS: The average FK grade reading level of the articles was 10.8 (range 6.3-16.7; 95% CI, 10.4-11.2). Eighty-one percent of the articles were written at a ninth grade level or higher. The intraclass correlation was good (r = 0.83) for the 52 articles that were independently reviewed. CONCLUSIONS: This analysis has shown that the average reading level for each article on the AAO-HNS site was higher than the recommended sixth grade reading level. Although the AAO-HNS site is written at a higher level than that suggested for the general public, it is important to realize that readability is just one consideration in the evaluation of OHI comprehension. Physicians need to be cognizant of their patients' ability to read and comprehend written information and tailor their educational material appropriately.