[Lacertus syndrome, an unknown and underestimated diagnosis]. / Het lacertussyndroom.

BACKGROUND: Carpal tunnel syndrome (CTS) is well-known. Less familiar are proximal median nerve entrapments such as the lacertus syndrome. Lacertus syndrome symptoms are very similar to CTS, but often unknowledged. CASE DESCRIPTION: A 37 year old male with persistent tingling of the median nerve area after 3 CTS releases on both wrists. The diagnosis CTS was confirmed with EMG and ultrasound. In our outpatient clinic we saw weakness of the tip pinch (FPL, FDP2). Loss of sensibility in the proximal thenar and digits 1-3 and a positive scratch collapse test. We suspected the patient has lacertus syndrome and performed a lacertus release. All symptoms dissolved afterwards. CONCLUSION: If symptoms do not resolve after CTS-release proximal median nerve compressions should be considered. Tip pinch strength and sensibility of the thenar can differentiate between the various locations of median nerve entrapment. Redo CTS-release lead to unnecessary treatment and costs, because of the wrong diagnosis.

Factors Associated with Treatment Outcome Satisfaction Six Months after Upper Blepharoplasty: A Large Cohort Study.

Background: Upper blepharoplasty is the most popular facial cosmetic surgery. Although there are a variety of reasons to undergo this procedure, all patients expect an optimal cosmetic result. However, little is known about the factors that influence satisfaction with treatment outcome. Objectives: We assessed to what extent patient characteristics, clinician-rated and postsurgical outcome measures, and patient-reported satisfaction with facial appearance and quality-of-life are associated with patient-reported satisfaction with treatment outcome after a primary upper blepharoplasty. Methods: This study was performed in 583 patients with an upper blepharoplasty between 2016 and 2021. The primary outcome was satisfaction with treatment outcome 6 months postoperatively using the FACE-Q. Determinants were baseline patient characteristics (demographics), preoperative and postoperative clinician-rated and surgical outcome measures, and preoperative and postoperative FACE-Q appearance and quality-of-life scales. Hierarchical linear regression analysis was used to determine how much of the variance in satisfaction with outcome could be explained by these groups of determinants. Results: A total of 63% of the variance could be explained by the five groups of determinants of which 8% was explained by the baseline patient characteristics and clinician-rated and patient-reported outcomes together, another 8% by the postoperative clinician-rated outcomes, and the remaining 47% by the postoperative patient-reported outcomes. Conclusions: Patient characteristics, clinician-rated outcome measures, and baseline FACE-Q appearance and quality-of-life scores were of limited value in explaining satisfaction with treatment outcome. However, the postoperative FACE-Q appearance scale and the decision to undergo a blepharoplasty were strongly associated with satisfaction with treatment outcome.

Assessment of Patient Satisfaction With Appearance, Psychological Well-being, and Aging Appraisal After Upper Blepharoplasty: A Multicenter Prospective Cohort Study.

BACKGROUND: To determine the success of an upper blepharoplasty, a popular cosmetic procedure, it is essential to measure outcomes from the patient perspective because these often outweigh objective outcomes. OBJECTIVES: This study aimed to assess patient-reported satisfaction with facial appearance, psychological well-being, and aging appraisal after upper blepharoplasty with validated questionnaires. METHODS: This prospective cohort study included upper blepharoplasty patients from 8 outpatient clinics. Patient-reported satisfaction was assessed with the FACE-Q at intake, and 6 and 12 months postoperatively. RESULTS: In total, 2134 patients were included. High satisfaction with outcome and decision to undergo treatment were measured 6 months postoperatively. Large improvements in FACE-Q scores (range, 0-100) between intake and 6 months postoperatively were seen for satisfaction with appearance (mean, effect size: eyes +48, 2.6; upper eyelids +48, 3.1; facial appearance overall +26, 1.4), psychological well-being (+11, 0.56), and aging appraisal (+22, 1.0). Patients reported they appeared a mean [standard deviation] 3.3 [5.2] years younger postblepharoplasty. No clinically relevant changes were seen between 6 and 12 months. Additionally, improvements in appearance were not dependent on their intake scores, whereas improvements in psychological well-being and aging appraisal were smaller in patients with higher intake scores. Satisfaction with treatment outcome was strongly correlated with appearance satisfaction but not with aging appraisal. CONCLUSIONS: Significant improvements in patient satisfaction regarding appearance, psychological well-being, and aging appraisal can be seen 6 months after blepharoplasty, and outcomes remain stable up to 12 months postoperatively. These data may be used to inform patients and clinicians and improve the overall quality of care.