Ethnic Rhinoplasty: A Middle East-Centered Patient Satisfaction Survey Using the FACE-Q Questionnaire.

Background Rhinoplasty is a common and complex plastic surgery procedure. The evaluation of surgical success in rhinoplasty is primarily based on patient satisfaction. The purpose of the study is to assess the characteristics of patients who underwent rhinoplasty and their satisfaction using the FACE-Q questionnaire. Methodology This was a retrospective, cross-sectional study of patients who underwent primary rhinoplasty, septorhinoplasty, or a revision rhinoplasty from 2010 to 2020 at a single center. Patients were asked to complete the FACE-Q nose score pre and postoperatively. Patients also provided information on their sociodemographic characteristics, smoking status, alcohol consumption, number of rhinoplasty procedures, cause of revision, and respiratory symptoms before rhinoplasty. Results This study included 183 patients who underwent rhinoplasty between 2010 and 2020. The mean (SD) age of patients at surgery was 25.92 (8.69) years. There were 156 female respondents (85.2%) and 27 male respondents (14.8%). FACE-Q nose satisfaction scores increased significantly after surgery with a mean of 67.21 ± 22.3 (p = 0.000). The most common reason for revision surgery was tip dissatisfaction. Conclusions The findings of this study show that ethnic rhinoplasty, although a complex procedure, can lead to aesthetically pleasing outcomes in a complex population such as the Middle Eastern population.

A Rare Presentation of Donkey Bites Involving the Cheek and Ear: A Case Report and Literature Review.

Although animal bites account for a fair number of emergency department visits, donkey bites account for a very limited proportion. A 12-year-old boy presented to our department with a severe donkey bite involving his face. The injury included his left cheek with a laceration of the left ear cartilage. The examination revealed no serious morbidity (no vascular or nerve involvement). The patient received prophylactic antibiotics and anti-rabies/anti-tetanus vaccination. The wound was cleaned thoroughly with copious irrigation. Afterward, the patient underwent surgery to correct the defect in the cheek using a rotational advancement cervicofacial flap, while the penetrated ear cartilage was repaired and the skin margins were approximated and sutured. During the follow-up period, no complications were observed and the functional and cosmetic outcomes were satisfactory. Donkey bites are rarely encountered and they can result in different presentations and morbidities/outcomes. It is suggested that the timing from the bite injury to presentation, the stage/extent of the bite, the use of anti-tetanus and anti-rabies vaccines, and the prophylactic use of antibiotics may play a role in determining the outcomes and/or complications of donkey bites.

Management of Burn Scars: A Five-Year Retrospective Study.

Introduction Despite the heightened interest in the management and prevention of burn scars, only a few articles have been published that assess the risk factors for the development of burn scars. The relationship between admission to the burn unit and the need for reconstructive surgery, the effect of the burn area on the number of further surgeries needed, and the adverse event of the technique used in the reconstructive surgery is not widely explored in the literature. These unmet challenges are crucial for a standardized consensus about burn scar management. Methods A retrospective study of patients admitted for burn reconstructive surgeries was conducted. A total of 100 patients (mean age: 29 years old) were included in this study. Data were retrospectively collected by reviewing the patients' charts. Data were analyzed using the SPSS software, version 25.00 (SPSS Inc., Chicago, IL). Results The most common surgery performed was a release contracture with skin grafting (n = 93.93%). No significant difference was reported between the patient's age and the total number of surgeries. A significant difference was noted between the different techniques used and the total number of surgeries. Patients with release contracture surgery had higher scores of satisfaction and better functional outcome. Conclusion The most common surgery performed for scar treatment was contracture release coupled with skin grafting. The most common cause of burn in Lebanon was flame, and the most commonly affected anatomical area was the upper limb. Further studies recruiting patients from all over Lebanon and assessing their characteristics are now warranted.

A Case Report of Rapidly Necrotizing Fasciitis Post-Falling Down Treated Reconstructively.

Necrotizing fasciitis (NF) is a necrotizing soft tissue infection that can result in fast tissue loss, necrosis, and potentially fatal acute sepsis. Diabetes, cancer, alcohol abuse, and chronic liver and renal disease are all risk factors for NF. In this case report, a 19-year-old man with a negative past medical and surgical history was diagnosed with aggressive rapidly progressive necrotizing fasciitis of the left lower extremity after a recent history of falling down from a skateboard. A successful treatment with long-term debridement surgeries followed by reconstructive surgery with skin grafting was made. Although the severity of this condition, the patient was able to resume a normal range of motion of the concerned extremity. NF has been described in the literature, but early diagnosis, which is crucial for successful management, rests a challenge.

Rhinocerebral Mucormycosis: An Emerging Threat in the Era of COVID-19.

Mucormycosis is a rare but aggressive and fatal infection that is prevalent in immunocompromised patients. The variation in its clinical presentation and the lack of specificity are misleading and lead to a delay in the diagnosis and management. However, the era of coronavirus disease 2019 (COVID-19) is marked by the increasing emergence of Mucor infections, now identified as coronavirus-associated mucormycosis (CAM). Although many clinical forms exist, the most encountered in CAM is rhino-orbito-cerebral, as already reported in India. We present a case of a 56-year-old male patient with uncontrolled diabetes mellitus and a history of recent SARS-CoV-2 infection treated with IV steroids, presenting for maxillary teeth pain and instability on day 16 of COVID-19 infection. Early diagnosis of CAM is crucial and will help decrease mortality in COVID-19 patients, especially those with comorbidities such as diabetes mellitus. Increasing cases of CAM should prompt clinicians to have a high index of suspicion for rhinocerebral mucormycosis, especially in patients with risk factors receiving steroid therapy. In such patients, baseline glycosylated hemoglobin level and strict glycemic control by frequently measuring blood glucose levels and strictly adhering to insulin protocols would be rational but its efficacy in limiting the numbers of CAM in developing countries still needs to be confirmed.

Our experience with lipofilling in secondary rhinoplasty, into a new era.

Rhinoplasty is a commonly performed cosmetic surgery. Clinicians are facing an increased demand on non-surgical procedures, therefore liquid rhinoplasty is gaining popularity. Given the characteristic of lipofilling to rejuvenate and improve skin texture, fat grafting can be used to reshape the nose in secondary rhinoplasty. Fat was injected in 27 patients with a mean age of 42 years. Volume of fat ranged from 1.5 to 4.5 cc with a mean of 2.2 cc. Patients were seen at 1 week, 3 months, 6 months, and 1 year. Patient satisfaction was measured using the Rhinoplasty Outcome Evaluation questionnaire and plastic surgeons' evaluation. After 1 year follow up, 20 patients were satisfied with the results at 1 year. The aesthetic outcome was noted as very good in 11 patients, good in 9 patients, and poor in 3 patients. Most of the patients had an improvement in skin texture with trophic effect on the skin. No complications were seen in our series According to this study, nasal lipofilling is a safe and efficacious filler in secondary rhinoplasty. However, more studies are needed to assess the indications and limitations of nose lipofilling.

Pinna high grade trichoblastic carcinoma, a report.

Trichoblastic carcinoma is a rare malignant hair follicle tumor. It resembles basal cell carcinoma clinically, but different studies emphasize on the importance of differentiating between these two cancers since they have different clinical course which may affect treatment options and follow up. Regardless of its aggressive behavior, no consensus is present for the treatment of trichoblastic carcinoma. We presented the third case of pinna trichoblastic carcinoma, which was surgically excised and followed up for two years post-surgery.

Rhinoplasty and External Nasal Splinting: Is It Really a Must?

Rhinoplasty is a common and challenging procedure. Lateral osteotomy is routinely performed in most cases. Most of the surgeons have the habit of applying external nasal splints to stabilize the nasal tissues and bone in their new position postrhinoplasty. These splints are widely used despite the absence of any evidence supporting this practice. Moreover, these splints have a lot of disadvantages, so we conducted this study to evaluate the cosmetic result in their absence. PATIENTS AND METHODS: A retrospective cross-sectional study was performed. Medical records of 211 patients operated on for rhinoplasty by the same surgeon from 2015 to 2017 were reviewed. All patients were operated using open technique. After surgery, a Steri-Strips dressing with an overlying layer of surgical tape was applied to the nose without the use of an external nasal splint. Most of the patients were followed up for 18 months. Complication rates, revision rates, and nasal bone widths were recorded. RESULTS: Complication rates and revision rates were as follows: skin infection 0.99%, skin necrosis 0.99%, and secondary revision 3.48%. Finally 79.60% of patients had a decrease in their nasal bone width postsurgery. CONCLUSION: Based on the present study, external nasal splinting postrhinoplasty should not be routinely used. Satisfactory cosmetic results can be obtained while avoiding the complications, cost, and bulky dressings associated with external splints.