Filler injections in the pre-auricular space: Be aware of the parotid gland.

BACKGROUD: In recent years the pre-auricular area is increasingly used for filler injections. AIMS: Assessment of depth of the subcutaneous fat and the process of realtime filler injection. MATERIALS & METHODS: Ultrasonographic data of two cases and a video are studied. RESULTS: These show how filler injections may very easily be delivered inside the parotid gland. This may go unnoticed by injector and client. DISCUSSION: This study and data from literature prove that filler injections in the pre-auricular area may end up inside or in the vicinity of the parotid gland, and this can lead to an inflammatory response. CONCLUSION: It is recommended to be careful with filler injections in this area. Prior sonographic assessment of the subcutaneous depth in this area is advised.

Biatrial Versus Bicaval Orthotopic Heart Transplantation: A Systematic Review and Meta-Analysis.

BACKGROUND: Orthotopic heart transplantation (OHT) is the gold standard treatment in end-stage heart disease. Controversy remains whether bicaval OHT is superior to biatrial OHT in both early and late outcomes. This study aimed to provide an overview of the early and late outcomes in patients who underwent a bicaval or biatrial OHT. METHODS: A systematic literature search was performed for articles published before December 2017. Studies comparing adult patients undergoing biatrial OHT and bicaval OHT were included. Early outcomes were pooled in odds ratios and late outcomes were pooled in rate ratios. Late survival was visualized by a pooled Kaplan-Meier curve. RESULTS: A total of 36 publications were included in the meta-analysis, counting 3555 patients undergoing biatrial OHT and 3208 patients undergoing bicaval OHT. Early outcomes in mortality, tricuspid regurgitation, mitral regurgitation, and permanent pacemaker implantation differed significantly in favor of the bicaval OHT patients. Long-term survival was significantly better in patients undergoing bicaval vs biatrial OHT (hazard ratio, 1.32; 95% confidence interval, 1.1-1.6; P = .008). Also, late tricuspid regurgitation was less frequently seen in the bicaval OHT patients (rate ratio, 2.14; 95% CI, 1.17-3.94; P = .014). CONCLUSIONS: This systematic review with meta-analysis shows that bicaval OHT results in more favorable early and late outcomes for patients undergoing a bicaval OHT compared with a biatrial OHT. Therefore, bicaval OHT should be considered as preferable technique for OHT.