Influence of Subclinical Anxiety and Depression on Quality of Life and Perception of Facial Paralysis.

Introduction: Patients with facial paralysis have increased psychosocial distress, which affects overall quality of life (QOL). Objective: To evaluate the relationship between QOL and paralysis severity among patients with subclinical anxiety and/or depression. Methods: Patients with facial paralysis were screened for anxiety and depression using the Generalized Anxiety Disorder-2 and Patient Health Questionnaire-2 surveys. QOL scores (Facial Clinimetric Evaluation) and paralysis severity scores (House-Brackmann [HB] and Sunnybrook [SB]) were collected. Patients with a mental health diagnosis or treatment were excluded. Univariate and multivariate analyses and Pearson's correlations were performed after stratifying by anxiety and/or depression screenings. Results: Positive anxiety and depression screening rates were 25.78% and 22.66%, respectively. Patients screening positive had significantly worse QOL scores despite no difference in paralysis severity. QOL scores did not correlate with SB scores among patients who screened positive for depression. Conclusion: Patients screening positive for anxiety and/or depression demonstrated worse QOL, which did not correlate with paralysis severity suggesting that health care professionals should remain alert to mental health symptoms when QOL impairment is out of proportion with the severity of paralysis.

Patient and Observer Graded Rhinoplasty Scar Outcomes: A Randomized Controlled Trial of Fast Absorbing Versus Permanent Columellar Suture Closure.

Background: When performing an open rhinoplasty, surgeons commonly use nonabsorbable skin sutures to close the columellar incision. These are believed to minimize scarring. However, removal can be associated with patient discomfort and outcomes may not be superior to using absorbable sutures. Objective: To compare difference in scar appearance for columellar closure after rhinoplasty with absorbable and nonabsorbable sutures. Methods: We performed a prospective randomized control trial with 61 patients. Forty-one patients completed follow-up and were included in final analysis: 23 whose columellar incision was closed with absorbable sutures and 18 with nonabsorbable sutures. A blinded surgeon performed Stony Brook Evaluation Scale (SBES) and a patient performed Patient Scar Assessment Questionnaire (PSAQ) was completed for each suture type. Results: Our results did not reject the null hypothesis that there is no difference in SBES or PSAQ scores between absorbable and nonabsorbable suture types. Conclusions: No difference was detected in scar outcomes between absorbable and nonabsorbable sutures for closure of the columellar incision created during an open rhinoplasty as rated by both patients and blinded clinicians.

The utility of intraoperative nerve monitoring in secondary and tertiary Hyperparathyroid surgery.

OBJECTIVES: Recurrent laryngeal nerve (RLN) injury is a well-known complication of parathyroid surgery. Despite ample data, there is still uncertainty about the role of intraoperative monitoring (IONM) in mitigating RLN damage. STUDY DESIGN: A retrospective review. METHODS: We included all patients presenting for total, subtotal, or completion parathyroidectomy at a tertiary referral hospital from 2013 to 2018. Information about demographics, previous neck surgery, perioperative data, pathology, and possible RLN injury was collected. Two groups were formed for analysis: IONM vs. nonmonitored (NM). RESULTS: 105 patients underwent 107 surgeries with IONM utilized in 71 cases. The groups were similar in demographics, but significantly differed (all P < 0.05) in preincision parathyroid hormone level (IONM = 2091.44 vs NM = 1334.87), surgery type (IONM = 62.9% vs NM = 27.8% subtotal), and surgery length in minutes (IONM = 155.21 vs NM = 182.22). We observed six cases (6/71 = 8.45%) of persistent RLN complaints (three or more weeks postoperatively) and four cases (4/71 = 5.63%) of temporary complaints with the use of IONM compared with only one temporary complaint (1/36 = 2.78%) in unmonitored procedures (P = 0.129). CONCLUSIONS: These results suggest that the use of IONM does not provide a protective effect on the RLN in patients with secondary or tertiary hyperparathyroidism undergoing total, subtotal, or completion parathyroidectomy. Prospective, randomized studies with pre- and postoperative flexible laryngoscopy are needed to explore the use of IONM in this patient population further.

Impact of body mass index on the short-term outcomes of resected gastrointestinal stromal tumors.

BACKGROUND: Potentially curative treatment for gastrointestinal stromal tumors (GIST) involves resection with selective utilization of tyrosine kinase inhibitors. A potential association between obesity and GIST has been postulated as GIST is among the most common incidental findings during gastric resection for bariatric procedures. The purpose of this study is to investigate the relationship and impact of obesity on the pathologic and short-term outcomes in patients with GIST. METHODS: We performed a retrospective review of patients with resected GIST. The impact of obesity, defined as body mass index (BMI) ≥30 kg/m2, on pathologic results and short-term outcomes was evaluated. RESULTS: Sixty-one patients underwent resection with a median follow-up of 26 mo (1-129 mo). Disease involved the stomach (74%), small intestine (18%), or colon/rectum (5%). Median tumor size was 6 cm, and 13 patients (21%) underwent multivisceral resection. Median BMI for the cohort was 27.2 kg/m2, and 24 patients (39%) were classified as obese based on BMI. Nonobese patients were noted to have larger primary tumors (median: 7 cm versus 5 cm, P = 0.02) and undergo multivisceral resection more frequently (32.4% versus 4.2%, P < 0.01). Short-term outcomes were similar between the groups, with a slight trend toward more postoperative complications among the obese patients. CONCLUSIONS: In this study, obese patients tended to have more favorable pathologic features. GISTs may represent another example of the "obesity paradox" in which obesity seemingly provides a protective effect. Larger studies are warranted to verify the impact of obesity on outcomes and to elucidate any underlying clinicopathologic/biologic factors.