Traumatic Brain Injury in Patients With Frontal Sinus Fractures.

Traumatic brain injury (TBI) is an insult to the brain from an external mechanical force that may lead to short or long-term impairment. Traumatic brain injury has been reported in up to 83% of craniofacial fractures involving the frontal sinus. However, the risk factors for TBI at presentation and persistent neurological sequelae in patients with frontal sinus fractures remain largely unstudied. The authors aim to evaluate the prevalence and risk factors associated with TBI on presentation and neurological sequelae in these patients. The authors retrospectively reviewed patients who presented with traumatic frontal sinus fractures in 2019. The authors' primary outcome was the prevalence of concomitant TBI on presentation, which authors defined as any patient with neurological symptoms/signs on presentation and/or patients with a Glasgow Coma Scale <15 with no acute drug or alcohol intoxication or history of dementia or other neurocognitive disorder. The authors' secondary outcome was the incidence of neurological sequelae after 1 month of injury. Bivariate analysis and multivariate logistic regression were performed. A total of 56 patients with frontal sinus fractures were included. Their median (interquartile range) age was 47 (31-59) years, and the median (interquartile range) follow-up was 7.3 (1.3-76.5) weeks. The majority were males [n = 48 (85.7%)] and non-Hispanic whites [n = 35 (62.5%)]. Fall was the most common mechanism of injury [n = 15 (26.8%)]. Of the 56 patients, 46 (82.1%) had concomitant TBI on presentation. All patients who had combined anterior and posterior table frontal sinus fractures [n = 37 (66.1%)] had TBI on presentation. These patients had 13 times the odds of concomitant TBI on presentation [adjusted odds ratio (95% CI): 12.7 (2.3-69.0)] as compared with patients with isolated anterior or posterior table fractures. Of 34 patients who were followed up more than 1 month after injury, 24 patients (70.6%) had persistent neurological sequelae, most commonly headache [n = 16 (28.6%)]. Patients who had concomitant orbital roof fractures had 32 times the odds of neurological sequelae after 1 month of injury [adjusted odds ratio (95% CI): 32 (2.4->100)]. Emergency physicians and referring providers should maintain a high degree of suspicion of TBI in patients with frontal sinus fractures. Head computed tomography at presentation and close neurological follow-up are recommended for patients with frontal sinus fracture with combined anterior and posterior table fractures, as well as those with concomitant orbital roof fractures.

Disease and toxicity outcomes for a modern cohort of patients with squamous cell carcinoma of cutaneous origin involving the parotid gland: Comparison of volumetric modulated arc therapy and pencil beam scanning proton therapy.

OBJECTIVES: We sought to describe outcomes for locally advanced cutaneous squamous cell carcinoma (SCC) involving the parotid treated with volumetric modulated arc therapy (VMAT) versus pencil beam scanning proton beam therapy (PBT). MATERIALS AND METHODS: Patients were gathered from 2016 to 2022 from 5 sites of a large academic RT department; included patients were treated with RT and had parotid involvement by: direct extension of a cutaneous primary, parotid regional spread from a previously or contemporaneously resected but geographically separate cutaneous primary, or else primary parotid SCC (with a cutaneous primary ostensibly occult). Acute toxicities were provider-reported (CTCAE v5.0) and graded at each on treatment visit. Statistical analyses were conducted. RESULTS: Median follow-up was 12.9 months (1.3 - 72.8); 67 patients were included. Positive margins/extranodal extension were present in 34 cases; gross disease in 17. RT types: 39 (58.2 %) VMAT and 28 (41.8 %) PBT. Concurrent systemic therapy was delivered in 10 (14.9 %) patients. There were 17 treatment failures (25.4 %), median time of 168 days. Pathologically positive neck nodes were associated with locoregional recurrence (p = 0.015). Oral cavity, pharyngeal constrictor, and contralateral parotid doses were all significantly lower for PBT. Median weight change was -3.8 kg (-14.1 - 5.1) for VMAT and -3 kg (-16.8 - 3) for PBT (p = 0.013). Lower rates of ≥ grade 1 xerostomia (p = 0.002) and ≥ grade 1 dysguesia (p < 0.001) were demonstrated with PBT. CONCLUSIONS: Cutaneous SCC involving the parotid can be an aggressive clinical entity despite modern multimodal therapy. PBT offers significantly lower dose to organs at risk compared to VMAT, which seemingly yields diminished acute toxicities.

Management of Frontal Sinus Fractures at a Level 1 Trauma Center: Retrospective Study and Review of the Literature.

Study Design: Case series. Objective: This retrospective review of frontal sinus fractures aims to describe our current experience managing these fractures at an urban level I trauma center. Methods: An institutional database of 2081 patients who presented with maxillofacial fractures on computed tomography face/sinus in 2019 was queried for all patients with traumatic frontal sinus fractures. Demographics, trauma-related history, management approach, and follow-up data were collected and analyzed. Results: Sixty-three (7.3%) patients had at least one fracture involving the frontal sinus. The most common etiologies were assaults, falls, and motor vehicle accidents. Surgical repair was performed in 26.8% of patients with frontal sinus fractures, and the other 73.2% were observed. Fractures that were displaced, comminuted, obstructive of the frontal sinus outflow tract, or associated with a dural tear or cerebrospinal fluid leak were more likely to be operative. Conclusions: The majority of frontal sinus fractures in this study were treated with observation. Despite advances in transnasal endoscopic approaches, many surgeons still rely on open approaches to repair frontal sinus fractures.

Current Management of Subcondylar Fractures: A Systematic Review.

OBJECTIVE: The aim of this study is to review the current literature on treatment of subcondylar fractures using traditional open reduction internal fixation (ORIF), closed reduction with maxillomandibular fixation (MMF), and endoscopic open approaches. DATA SOURCES: PubMed, Embase, Cochrane CENTRAL, Clinicaltrials.gov, and WHO ICTRP. REVIEW METHODS: A comprehensive database search was performed in accordance with PRISMA guidelines. All English-only texts published in the last 20 years with ≥10 patients were included. Studies that included patients <16 years old were excluded. RESULTS: Thirty-two studies met the final inclusion criteria. Nine studies compared ORIF with closed reduction using MMF, 12 studies evaluated ORIF via different approaches, and 10 studies evaluated outcomes after endoscopic approaches. Five studies reported significant improvement in mouth opening with ORIF compared to closed reduction. In 1 study that recorded patient-reported outcomes measure (FACE-Q scale), quality of life scores and patient satisfaction were significantly higher in the ORIF group. Among the 10 studies that used the endoscopic approach, transient facial nerve injury ranged from 0% to 10%. CONCLUSION: Several studies report better mouth opening, dental occlusion, and functional outcomes after ORIF compared to closed reduction, while some found no significant difference. Endoscopic approaches provide ease of access to the condyle with a low incidence of facial nerve injury. However, limitations include special equipment, longer operative times, and a steep learning curve using an endoscope. This review provides surgeons with an overview of the current literature on subcondylar fractures to allow for an individualized management approach for each patient.

Facial Trauma Management During the Coronavirus Disease 2019 Pandemic.

IMPORTANCE: Facial trauma is managed with open or closed treatment modalities; however, the impact of the coronavirus disease 2019 (COVID-19) pandemic on facial trauma management remains unclear. OBJECTIVE: To determine whether the management of facial trauma varied during the COVID-19 pandemic. DESIGN SETTING, PARTICIPANTS: A retrospective review of 127 adults at The R Adams Cowley Shock Trauma Center at the University of Maryland between March 2019 and March 2021. Adults were stratified into pre-COVID (before March 2020) and post-COVID groups. MAIN OUTCOMES AND MEASURES: Open reduction internal fixation alone, maxillomandibular fixation (MMF) alone, Open reduction internal fixation and MMF, and closed reduction. RESULTS: Of the 127 patients, 66 were treated pre-COVID (52%) and 61 post-COVID (48%). While the prevalence of mandible fractures did not differ (pre-COVID, n = 39, 59%; post-COVID, n = 42, 69%; P = 0.33), the use of MMF alone decreased (pre-COVID, n = 9, 23%; post-COVID, n = 1, 2%; P = 0.005). In contrast, while the prevalence of displaced nasal bone fractures decreased (pre-COVID, n = 21, 32%; post-COVID, n = 4, 7%; P = 0.0007), management with closed reduction did not differ (pre-COVID, n = 23, 96%; post-COVID, n = 11, 85%; P = 0.27). CONCLUSIONS AND RELEVANCE: Although the clinical characteristics of patients with facial fractures did not differ during the COVID-19 pandemic, the use of MMF for mandible fractures changed significantly. LEVEL OF EVIDENCE: Level IV.

Selective Neurectomy for Treatment of Post-Facial Paralysis Synkinesis: A Systematic Review.

BACKGROUND: Synkinesis is commonly encountered after flaccid facial paralysis and can have a detrimental impact on a patient's life. First-line treatment of synkinesis is chemodenervation with botulinum toxin (Botox) and neuromuscular retraining. Surgical options include selective myectomy, selective neurectomy (SN), cross-facial nerve grafting, nerve substitution, and free gracilis muscle transfer. Data on surgical management of synkinesis using SN is limited. EVIDENCE REVIEW: PubMed, Embase, Cochrane CENTRAL, Cochrane Neuromuscular Register, Clinicaltrials.gov, and World Health Organization International Clinical Trials Registry Platform were searched using a comprehensive keyword strategy in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All English-only texts published in the past 20 years were included. Two independent investigators reviewed 906 abstracts and 7 studies met inclusion criteria. Demographics, etiology of paralysis, time to surgery, and primary outcomes studied were collected. FINDINGS: A total of 250 patients were included across 7 studies. In 6 out of 7 studies, Botox was used prior to surgical intervention. Two studies showed significant reduction in Botox dosage postoperatively, while one study showed no difference. Other primary outcomes included the House-Brackmann Score, palpebral fissure width, electronic clinician-graded facial function scale (eFACE) score, Facial Clinimetric Evaluation (FaCE) scale, and Synkinesis Assessment Questionnaire (SAQ). Three studies showed significant improvement in the eFACE score, two studies showed significant improvement in the FaCE scale, while one study showed improvement in quality of life measured by the SAQ. CONCLUSION: SN can be considered as an adjunct to other management options including neuromuscular retraining, Botox, selective myectomy, and reanimation procedures. While there is great heterogeneity of study design in the studies included, many cohorts showed improvement in facial symmetry, facial function, and quality of life. There remains a great gap in knowledge in this subject matter and a need for large well-designed prospective studies comparing this technique to other management options.

Closure of a Large Scalp Defect Using External Tissue Expansion.

The limited laxity of the scalp and hair-bearing nature makes it difficult to optimally repair. Primary closure is limited to small defects, while healing by secondary intention requires underlying periosteum. Furthermore, the use of free flaps and skin grafting can lead to unfavorable cosmetic outcomes. This report describes a patient with a large parietal scalp dermatofibrosarcoma protuberans. Multiple resections resulted in a large scalp defect with exposed calvarium. Integra was placed over the exposed calvarium after each debridement and Negative Pressure Wound Therapy (NPWT) was applied. After granulation tissue formed, 2 DermaClose continuous external tissue expansion systems were installed. Following the application and tightening of the external tissue expanders, the wound was reduced in size, facilitating primary closure of the opposing edges. This process allowed for a large area to be covered with hair-bearing scalp with good cosmetic results.

Advances in oral tongue reconstruction: a reconstructive paradigm and review of functional outcomes.

PURPOSE OF REVIEW: Glossectomy remains a common treatment of oral tongue malignancies, which has a range of functional impacts depending on the extent of resection. This review aims to categorize and provide context for the approach to reconstructing these defects using recent evidence. RECENT FINDINGS: The reconstruction method of choice should be tailored to the size and location of the glossectomy defect with special consideration to replace tongue volume and preserve mobility. There has been an increasing focus on patient-reported outcomes in oral tongue reconstruction. For defects beyond one-third of the tongue, free tissue reconstruction, and more recently, the submental artery island flap yield excellent results. Advances in reconstruction of larger defects have included preoperative soft tissue planning and assessment of outcomes in total glossectomy patients with laryngeal preservation. SUMMARY: Depending on the defect, the appropriate reconstruction may range from healing by secondary intention to large volume free tissue transfer. In general, functional outcomes diminish with increasing size and complexity of the defect regardless of the reconstructive technique.

A Novel Approach to Virtual Surgical Planning for Mandibular and Midfacial Reconstruction With a Fibula Free Flap.

BACKGROUND: The fibula free flap is a major workhorse in facial reconstruction. To decrease operative times, virtual surgical planning (VSP) has been implemented. Traditional VSP is costly and may delay operative planning. in this study, the authors present a novel algorithm using readily accessible software packages to perform VSP in a manner that is quick and cost-effective. METHODS: A 6-part survey was administered to physicians with prior training in facial reconstruction. Fourteen physicians participated regarding outcomes on 10 patients who underwent mandibular or midfacial fibula free flap reconstruction. Participants were asked to match the true postoperative and VSP models and rate the similarity of the models using the Likert scale (0-10). The goal was to determine whether the VSP models accurately depicted the actual reconstruction, and whether they would use VSP in future clinical practice. RESULTS: The physicians surveyed were able to match the models correctly 93.6% of the time. The mean score for the similarity between virtual and actual models ranged between 7.60 and 8.80. Most participants (90.9%) who answered stated they would use our VSP algorithm if they were trained in the protocol. CONCLUSIONS AND RELEVANCE: Virtual surgical planning models were created utilizing our novel algorithm. Participants matched the preoperative VSP plan with the postoperative model most of the time and rated the similarity well. Participants in our study are interested in learning more about physician performed VSP. The authors believe this model may be financially and clinically relevant and serve as an excellent educational tool.

Surgical Free Flaps and Grafts in Head and Neck Reconstruction: Principles and Postoperative Imaging.

This review article discusses the basic principles behind the use of flaps and grafts for reconstructive surgery in the head and neck, with a special emphasis on the types of commonly used free flaps, their imaging appearance as well as some frequently encountered postoperative complications. Given the ubiquity and complexity of these reconstructive techniques, it is essential that head and neck radiologists be familiar in distinguishing between the expected evolving findings, complications, and tumor recurrence.

Predictors of Postoperative Complications After Paramedian Forehead Flaps.

Importance: The predictors of postoperative complications after paramedian forehead flaps (PMFF) are unknown. Objective: To determine whether preoperative factors can predict post-PMFF complications. Design, Setting, Participants: A retrospective review of 1438 adults from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database who underwent PMFF between 2010 and 2018. Main Outcomes and Measures: Surgical complications, medical complications, and all-cause mortality. Results: Of the 1438 patients, 75 experienced postoperative complications (5.2%). Of these, 36 developed isolated surgical complications (2.5%), 29 developed isolated medical complications (2.0%), and 8 developed concurrent surgical and medical complications (0.5%). Of the three mortalities (0.2%), one patient developed concurrent surgical and medical complications. A dirty or infected wound classification was the strongest predictor of postoperative complications (odds ratio [OR] 13.5; confidence interval [95% CI] 3.4-49.5). In contrast, the likelihood of postoperative complications decreased significantly with outpatient procedures (OR 0.4; 95% CI 0.2-0.8). Conclusions and Relevance: A dirty or infected wound classification is the strongest predictor of postoperative complications after PMFF.

Fibula Free Flap Salvage From 10-hour Prolonged Arterial Insufficiency and Venous Thrombosis.

ABSTRACT: Fibula free flaps are standard in facial reconstructions after head and neck cancer resection and typically have short flap ischemia times, often under 2 hours. Methods for short-term flap ischemia are characterized, but methods for extremely prolonged flap ischemia have not been well-described. We describe a 72-year-old patient who underwent composite floor of mouth and mandible resection with fibula free flap reconstruction. Patient intraoperative instability forced flap ischemia of over 10 hours with arterial insufficiency and venous thrombosis. Despite complicated and extremely prolonged ischemia, aggressive local and systemic anticoagulants with intraoperative leach therapy were still effective in flap salvage. The flap ultimately survived without necrosis. This case describes a method to guide surgeons faced with situations of forced, prolonged flap ischemia. Traditionally indicated in short-term ischemia, anticoagulation and leach methods can be effective for intraoperative treatment of extremely prolonged flap ischemia, arterial insufficiency, and venous thrombosis.

The Utility of Postoperative Computed Tomography Imaging Following Isolated Orbital Blowout Fracture Repair.

PURPOSE: To determine the clinical utility of computed tomography (CT) imaging following isolated orbital blowout fracture (OBF) repair. METHODS: Single-center retrospective review of adult patients undergoing surgical repair of isolated OBFs between November 2008 and August 2016 who received postoperative CT scans. Preoperative and postoperative examination data, postoperative imaging reads, postoperative courses, and any reoperation documentation were collected from electronic medical records. Postoperative imaging findings were categorized as major, indeterminate, or minor by predicted impact on clinical management. Major findings indicated a need for reoperation, indeterminate a potential reoperation, and minor no reoperation. RESULTS: Fifty-two cases met inclusion criteria: 94.2% (n = 49) of postoperative scans included minor findings, 34.6% (n = 18) indeterminate findings, and 19.2% (n = 10) major findings. Three patients returned to the operating room (OR) for surgical revision. All 3 had a significant and concerning change on postoperative examination. Only 1 also had a major finding on postoperative imaging. The remaining 49 patients had benign postoperative examinations, despite 9 (17.3%) with major imaging findings who did not undergo reoperation. CONCLUSIONS: In the majority of OBF repairs, postoperative CT scan findings were not predictive of a need to return to the OR for revision. Reoperation was instead largely prompted by concerning changes in the postoperative clinical examination. Our findings suggest that postoperative imaging in the absence of clinical concern should not be included in the surgical management of isolated OBFs. Instead, targeted imaging will help reduce radiation exposure and health-care costs without sacrificing patient care.

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.

Outpatient Surgical Management of Orbital Blowout Fractures.

There is ample investigation into the optimal timing and approach to orbital blowout fracture (OBF) repair; however, less attention has been directed toward postoperative care. This is a multicenter IRB-approved retrospective review of patients with OBF presenting to our study sites between November 2008 and August 2016. Those with isolated OBF, over 18 years of age, and who had not suffered additional facial injuries or globe trauma were included. A total of 126 surgical cases of isolated OBF repair were identified that met our inclusion and exclusion criteria; 42.1% were outpatient repairs while the remaining 57.9% were admitted for overnight monitoring. Time elapsed prior to repair differed between the two groups at a mean of 8.4 days versus 5.2 days for the outpatient and inpatient cohorts, respectively ( p = 0.001). A majority of inpatient cases underwent immediate repair, while a majority of outpatient cases were delayed. There were two cases of RBH in the outpatient cohort resulting in an overall incidence of 1.6%. In both instances, a significant change in clinical exam including decreased visual acuity, diplopia, and eye pain prompted repeat evaluation and immediate intervention for hematoma evacuation. Estimated hospital charges to the patient's insurance for key components of an inpatient versus outpatient isolated OBF repair amounted to a total cost of $9,598.22 for inpatient management and $7,265.02 for outpatient management without reflexive postoperative imaging. Reflexive postoperative CT scans were obtained in 76.7% of inpatient cases and only two led to a reoperation. No outpatient repairs included reflexive postoperative imaging. Outpatient OBF repair is an attractive alternative to inpatient management. The potential cost savings of outpatient management of OBF, which do not detract from quality or safety of patient care, should not be ignored. Our results will hopefully contribute to updated shared practice patterns for all subspecialties that participate in the surgical management of OBF.

The evolving roles of computer-based technology and smartphone applications in facial plastic surgery.

PURPOSE OF REVIEW: This article aims to provide a comprehensive review of the established and emerging applications of various computer-based technologies and smartphone applications in the field of facial plastic surgery. RECENT FINDINGS: Computer-based technologies and smartphone applications have widespread utility across various domains of facial plastic surgery; these include preoperative consultation, surgical planning, intraoperative navigation, custom implant creation, postoperative assessment, physician productivity, communication, and education. Smartphone applications are being utilized for assessment of patients such as those with facial paralysis. Three-dimensional (3D) imaging and 3D printing has influenced preoperative counseling, surgical planning, and execution. The incorporation of intraoperative navigation has the potential to improve the accuracy and precision of facial reconstruction. SUMMARY: Current advances in computer-based technology have made a significant impact on the practice of facial plastic and reconstructive surgery. These technological advances have influenced how we counsel patients, perform procedures, assess outcomes, and learn new techniques.

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.

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.