3D doppler ultrasound imaging of cerebral blood flow for assessment of neonatal hypoxic-ischemic brain injury in mice.

Cerebral blood flow (CBF) acutely reduces in neonatal hypoxic-ischemic encephalopathy (HIE). Clinic studies have reported that severe CBF impairment can predict HIE outcomes in neonates. Herein, the present study uses a non-invasive 3D ultrasound imaging approach to evaluate the changes of CBF after HI insult, and explores the correlation between CBF alterations and HI-induced brain infarct in mouse pups. The neonatal HI brain injury was induced in postnatal day 7 mouse pups using the Rice-Vannucci model. Non-invasive 3D ultrasound imaging was conducted to image CBF changes with multiple frequencies on mouse pups before common carotid artery (CCA) ligation, immediately after ligation, and 0 or 24 hours after HI. Vascularity ratio of the ipsilateral hemisphere was acutely reduced after unilateral ligation of the CCA alone or in combination with hypoxia, and partially restored at 24 hours after HI. Moreover, regression analysis showed that the vascularity ratio of ipsilateral hemisphere was moderately correlated with brain infarct size 24 hours after HI, indicating that CBF reduction contributes to of HI brain injury. To further verify the association between CBF and HI-induced brain injury, a neuropeptide C-type natriuretic peptide (CNP) or PBS was intranasally administrated to the brain of mouse pups one hour after HI insult. Brain infarction, CBF imaging and long-term neurobehavioral tests were conducted. The result showed that intranasal administration of CNP preserved ipsilateral CBF, reduced the infarct size, and improved neurological function after HI brain injury. Our findings suggest that CBF alteration is an indicator for neonatal HI brain injury, and 3D ultrasound imaging is a useful non-invasive approach for assessment of HI brain injury in mouse model.

Arcade Sutures to Minimize Ear Displacement in Rhytidectomy.

Ear deformities after rhytidectomy are not uncommon and have a significant impact on cosmetic success. We postulate the use of horizontal mattress suspension sutures in the anterior face anchored to the deep temporalis fascia (DTF) during rhytidectomy allows for a vertical lift while minimizing the risk to the frontal branch of the facial nerve and decreasing forward rotation of the ear. To compare auricular displacement during rhytidectomy using an arcade of horizontal mattress suspension sutures anchored to the DTF instead of the preauricular pre-parotid fascia, and evaluate outcomes with this modification at 1 year. This was a proof of concept prospective cohort study of 20 patients (40 sides) undergoing rhytidectomy by a single plastic surgeon (level of evidence 4). Intraoperative measurements were taken to determine the amount of auricular displacement with suspension sutures placed in the preauricular fascia compared with the DTF. To confirm longevity, we compared ear position preoperatively and at 1 year after rhytidectomy with our technique. There was significantly less auricular displacement when superficial musculoaponeurotic system (SMAS) suspension sutures were placed in the DTF 0.75 ± 0.69 mm compared with the preauricular fascia 9.71 ± 2.57 mm (p < 0.00001). With our technique at an average follow-up of 370.3 days, there was no significant change in auricular rotation compared with preoperative photos (p = 0.125).Our simple rhytidectomy modification allows for vertical resuspension of the SMAS in the anterior face in a safe manner while minimizing displacement of the auricle.

Point-of-care ultrasound for evaluation of vaginal bleeding or abdominal pain in early pregnancy: Use by family physicians following focused training and certification.

OBJECTIVE: To evaluate the use of point-of-care ultrasound (POCUS) for the assessment of patients experiencing first-trimester bleeding or abdominal pain by family physicians working in family medicine clinics following first-trimester POCUS training and certification. DESIGN: Multisite, retrospective chart review. SETTING: Two hospital-affiliated academic family medicine clinics in Toronto, Ont. PARTICIPANTS: Twelve family physicians who completed a first-trimester POCUS training and certification course. MAIN OUTCOME MEASURES: The primary outcome was the proportion of family physicians using POCUS during their evaluations of patients in the first trimester of pregnancy in the 6 months following the FPs' successful completion of the Family Medicine Obstetrical Ultrasound (FaMOUS) course. Secondary outcomes included indications for POCUS use, diagnostic accuracy of POCUS compared with radiologist-interpreted ultrasound, pregnancy outcomes, and emergency department visits within 10 days of the index family medicine clinic visit. RESULTS: Of the 12 certified family physicians, 7 (58.3%) used POCUS during their assessments of first-trimester patients during the study period. The FPs used POCUS with 56 patients for the following indications: 11 (19.6%) had only vaginal bleeding, 5 (8.9%) had only abdominal pain, and 8 (14.3%) had both vaginal bleeding and abdominal pain; the indication for 32 patients (57.1%) was unclear. Forty-six patients (82.1%) underwent a subsequent radiologist-interpreted ultrasound within 10 days of the index POCUS test. Compared with radiologist-interpreted ultrasound, POCUS had a sensitivity of 91.3% (95% CI 79.2% to 97.6%) for documenting intrauterine pregnancy and a sensitivity of 81.4% (95% CI 66.6% to 91.6%) for documenting the presence of fetal cardiac activity. CONCLUSION: Following a first-trimester POCUS certification course, family physicians used POCUS for the assessment of first-trimester patients with varying frequency and for indications other than vaginal bleeding or abdominal pain. Further study is needed to assess the clinical impact of office-based POCUS, unforeseen barriers and facilitators to its use, and patient and provider preferences.

Preservation of Infraorbital Nerve in Orbital Floor and Maxillary Defect Reconstruction With Patient-Specific Three-Dimensional Implant: A Case Report.

Reconstruction of orbitomaxillary defects poses many operative challenges because it requires consideration of cosmetic as well as functional elements: reestablishing facial symmetry while constituting the orbital volume and preserving involved neurovascular structures. The development of patient-specific polyetheretherketone implants have revolutionized complex craniofacial reconstruction due to its adaptability to anatomic constraints and accommodation of vital structures. Herein, we described 2 cases of orbitomaxillary reconstruction using PEEK implant with novel modifications to preserve the infraorbital nerve with optimal cosmetic outcomes and minimal postoperative morbidity.

The Extended Superficial Musculoaponeurotic System Deep Plane Facelift.

Over the past four decades, the senior author has evolved and perfected his preferred method for face and neck lifting, the extended superficial musculoaponeurotic system deep plane rhytidectomy, and submentoplasty. With this procedure, the superficial musculoaponeurotic system layer is addressed both in the face and neck, repositioning the tissues in a superior and posterior vector and creating a sling in the cervicomental area. Outcomes have proven to be both successful and long lasting. In this article, a detailed update and discussion of the specific techniques utilized are provided.

Adverse Events of Nonablative Lasers and Energy-Based Therapies in Subjects with Fitzpatrick Skin Phototypes IV to VI: A Systematic Review and Meta-Analysis.

BACKGROUND: Although there is an abundance of literature on nonablative laser and energy-based therapies for the management of skin conditions, adverse events are inconsistently addressed and range widely across studies. Fitzpatrick skin phototypes (SPTs) IV to VI are believed to be at higher risk. OBJECTIVES: The aim of this study was to determine the types and rates of adverse events in nonablative laser and energy-based therapies among patients with SPTs IV to VI. METHODS: Articles addressing nonablative laser and energy-based therapies for skin rejuvenation and acne scarring in patients with SPTs IV to VI that provided data on adverse events were included. The pooled prevalence of each adverse event was calculated. To determine whether age, treatment indication, SPT, and device type influenced incidence, subgroup and meta-regression analyses were performed. Heterogeneity was evaluated with the I2 statistic. RESULTS: Forty-three studies were included in the meta-analysis. The sample size was 1654, and the median age of subjects was 39.4 years. The most common adverse events were postinflammatory hyperpigmentation (PIH) (rate, 8.1%) and prolonged erythema (rate, 0.6%). The rate of PIH was significantly higher for diode and erbium-doped lasers compared with intense pulsed light and radiofrequency. PIH correlated positively with SPT, laser density, and total energy delivered. CONCLUSIONS: Although the overall rate of adverse events in nonablative laser and energy-based therapies for SPTs IV to VI is low, the incidence of PIH is not insignificant. Certain lasers, such as diode, Q-switched Nd:YAG, and erbium-doped lasers, tend to have higher rates of PIH, whereas intense pulsed light and radiofrequency have minimal risk. Higher SPTs and higher energy deliverance correlate positively with the incidence of PIH.

Endoscopic Versus Microscopic Stapedotomy: A Single-Blinded Randomized Control Trial.

OBJECTIVE: To demonstrate non-inferiority of endoscopic stapedotomy to microscopic stapedotomy for the treatment of otosclerosis. STUDY DESIGN: Single-blinded randomized control trial. SETTING: Tertiary, academic otology-neurotology practice. PATIENTS: Adult subjects with a diagnosis of otosclerosis and a preoperative air-bone gap (ABG) more than or equal to 20 dB undergoing primary stapedotomy. INTERVENTION: Endoscopic or microscopic stapedotomy. MAIN OUTCOME MEASURES: Primary audiometric outcome was postoperative ABG. Secondary audiometric outcomes included speech reception threshold (SRT), word recognition score (WRS), bone- and air-conduction pure tone averages (PTA), change in ABG, and ABG closure rates to less than or equal to 10 dB and less than or equal to 20 dB. RESULTS: Twenty-two patients were recruited. Eleven patients underwent endoscopic stapedotomy and 11 underwent microscopic stapedotomy. The endoscopic group was non-inferior to the microscopic group in terms of postoperative audiometric outcomes (endoscope versus microscope, p-value): ABG (8.1 dB versus 8.1 dB, <0.001), SRT (27.7 dB versus 25.9 dB, <0.001), WRS (92% at 65 dB versus 98% at 62 dB, <0.001), air-conduction PTA (33.5 dB versus 30.8 dB, <0.01), and change in ABG (23.0 dB versus 20.7 dB, <0.0001). ABG closure rates to less than or equal to 10 dB (72.7% versus 81.2%, p = 1.0) and less than or equal to 20 dB (90.9% versus 100%, p = 1.0) were not significantly different. There was no significant difference in operative time, necessity of scutum curettage, or postoperative dysgeusia. No patients required chorda tympani sacrifice. Preoperative tinnitus resolved in three patients in each group postoperatively. CONCLUSIONS: This study is the first randomized control trial to demonstrate non-inferiority of endoscopic to microscopic stapedotomy.

C-Type Natriuretic Peptide Ameliorates Vascular Injury and Improves Neurological Outcomes in Neonatal Hypoxic-Ischemic Brain Injury in Mice.

C-type natriuretic peptide (CNP) is an important vascular regulator that is present in the brain. Our previous study demonstrated the innate neuroprotectant role of CNP in the neonatal brain after hypoxic-ischemic (HI) insults. In this study, we further explored the role of CNP in cerebrovascular pathology using both in vivo and in vitro models. In a neonatal mouse HI brain injury model, we found that intracerebroventricular administration of recombinant CNP dose-dependently reduces brain infarct size. CNP significantly decreases brain edema and immunoglobulin G (IgG) extravasation into the brain tissue, suggesting a vasculoprotective effect of CNP. Moreover, in primary brain microvascular endothelial cells (BMECs), CNP dose-dependently protects BMEC survival and monolayer integrity against oxygen-glucose deprivation (OGD). The vasculoprotective effect of CNP is mediated by its innate receptors NPR2 and NPR3, in that inhibition of either NPR2 or NPR3 counteracts the protective effect of CNP on IgG leakage after HI insult and BMEC survival under OGD. Of importance, CNP significantly ameliorates brain atrophy and improves neurological deficits after HI insults. Altogether, the present study indicates that recombinant CNP exerts vascular protection in neonatal HI brain injury via its innate receptors, suggesting a potential therapeutic target for the treatment of neonatal HI brain injury.

Further evidence supporting a potential role for ADH1B in obesity.

Insulin is an essential hormone that regulates glucose homeostasis and metabolism. Insulin resistance (IR) arises when tissues fail to respond to insulin, and it leads to serious health problems including Type 2 Diabetes (T2D). Obesity is a major contributor to the development of IR and T2D. We previously showed that gene expression of alcohol dehydrogenase 1B (ADH1B) was inversely correlated with obesity and IR in subcutaneous adipose tissue of Mexican Americans. In the current study, a meta-analysis of the relationship between ADH1B expression and BMI in Mexican Americans, African Americans, Europeans, and Pima Indians verified that BMI was increased with decreased ADH1B expression. Using established human subcutaneous pre-adipocyte cell lines derived from lean (BMI < 30 kg m-2) or obese (BMI ≥ 30 kg m-2) donors, we found that ADH1B protein expression increased substantially during differentiation, and overexpression of ADH1B inhibited fatty acid binding protein expression. Mature adipocytes from lean donors expressed ADH1B at higher levels than obese donors. Insulin further induced ADH1B protein expression as well as enzyme activity. Knockdown of ADH1B expression decreased insulin-stimulated glucose uptake. Our findings suggest that ADH1B is involved in the proper development and metabolic activity of adipose tissues and this function is suppressed by obesity.

Effect of Wendler Glottoplasty on Acoustic Measures of Voice.

OBJECTIVES: Voice therapy has been the primary treatment for voice feminization in transfemale patients due to concerns that surgery worsens voice quality. We aim to determine the impact of Wendler glottoplasty on acoustic measures of voice. STUDY DESIGN: Retrospective case series. METHODS: Transgender female patients treated for vocal feminization with Wendler glottoplasty at a single tertiary care center were identified. Pre- and postoperative measures were taken with the Kay Elemetrics Real-Time Pitch, Analysis of Dysphonia in Speech and Voice, and Multidimensional Voice Program. RESULTS: Twenty-eight patients were included in this study. There were no statistically significant changes in fundamental frequency variation, peak amplitude variation, soft phonation index, noise-to-harmonics ratio, cepstral peak prominence, or cepstral spectral index of dysphonia at a significance level of P < .05. Average speaking fundamental frequency (SF0) increased from 143 Hz after voice therapy to 163 Hz after surgery (P = .0009). Lower range decreased in 61% and increased in 26% of patients. Upper range decreased in 52% and increased in 48% of patients. CONCLUSIONS: Wendler glottoplasty does not worsen voice quality based on acoustic measures. Although most patients experience an increase in average SF0, effects on vocal range are variable with approximately half of patients experiencing a reduction and half experiencing an increase in upper pitch limit. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:583-586, 2021.

Addition of Wendler Glottoplasty to Voice Therapy Improves Trans Female Voice Outcomes.

OBJECTIVES/HYPOTHESIS: VT is often considered the preferred treatment for vocal feminization in transgender patients. However, Wendler glottoplasty offers a surgical option for increasing fundamental frequency and perception of vocal femininity. We aimed to determine whether the addition of glottoplasty to VT results in greater fundamental frequency elevation and improvement in quality-of-life measures. STUDY DESIGN: Retrospective case series. METHODS: Forty-eight trans female patients were treated for vocal feminization. Twenty-seven patients underwent VT, and 21 patients underwent VT with additional glottoplasty (VTWG). Pre- and posttreatment acoustic measures, Trans Woman Voice Questionnaire (TWVQ), and Voice Handicap Index-10 (VHI-10) data were compared. RESULTS: Glottoplasty in combination with VT elevated average speaking fundamental frequency (SF0) to a greater extent than VT alone (P < .0001). The VTWG group achieved a 42-Hz increase in SF0, whereas the VT group achieved a 15-Hz increase in SF0. In both the VT and VTWG groups, the lower bound of physiologic range increased by 18 Hz (P = .0008 and P = .016, respectively). The addition of glottoplasty also resulted in greater improvement in voice-related quality of life. Improvement in TWVQ and VHI-10 was significantly greater in the VTWG group than the VT group (P = .007 and P = .029, respectively). TWVQ showed statistically significant improvement in the VTWG group only. CONCLUSIONS: VT results in SF0 elevation and improvement in VHI-10. The addition of glottoplasty to VT results in further improvements in SF0 and VHI-10 and statistically significant improvement in TWVQ. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:1588-1593, 2021.

Residual Epiphora After Successful Periocular Surgery for Facial Paralysis: Pathophysiology and Management.

The prevalence of residual epiphora following successful periocular surgery for facial nerve paralysis can be as high as 30% or more. The pathophysiology of residual epiphora is complex, but identification of the etiology is paramount because the therapeutic approach varies accordingly. Treatments range from medical management of systemic disease to botulinum toxin injections for conditions that arise from aberrant reinnervation to surgical procedures that bypass the lacrimal drainage system completely. We describe a case report and review the pathophysiology and management of residual epiphora to provide a treatment algorithm for clinical use by facial plastic and oculoplastic surgeons. Laryngoscope, 131:E420-E422, 2021.

The Effect of Platelet-Rich Fibrin Matrix on Skin Rejuvenation: A Split-Face Comparison.

BACKGROUND: Despite the increasingly popular use of platelet-rich fibrin matrix (PRFM) for facial rejuvenation, no studies have evaluated its effects on skin. OBJECTIVES: The aim of this study was to determine the effect of PRFM on skin quality as measured by the Canfield VISIA Complexion Analysis System. METHODS: This was a 12-week randomized, placebo-controlled trial conducted at a single center comparing 2 groups. Thirty patients received a PRFM injection in the mid-cheek region and nasolabial fold on one side of the face and saline on the contralateral side. The primary outcome measure was the difference between pre- and posttreatment total VISIA skin scores for each group at 6 and 12 weeks. The change in subscores for each skin parameter was also calculated. RESULTS: There were 30 participants, with a mean [standard deviation] age of 49.9 [13.9] years. At 6 weeks, the median change in total VISIA score (interquartile range) was -1.77 (2.36) in the PRFM group and -0.73 (2.09) in the saline group (P = 0.003). The only skin parameter that had a significantly different change in score between the groups was texture (P = 0.004). At 12 weeks, the change in median score was -1.31 (3.26) in the PRFM cohort and -0.76 (2.21) in the saline cohort (P = 0.34). There was no statistical significance in the change in score for any of the individual skin parameters. CONCLUSIONS: PRFM can objectively improve skin quality compared with placebo. Texture was the only skin parameter that significantly improved, which is consistent with PRFM's role as a filler agent. The results appear to persist for at least 6 weeks.

Antenatal Hypoxia Accelerates the Onset of Alzheimer's Disease Pathology in 5xFAD Mouse Model.

Alzheimer's disease (AD) is a chronic neurodegenerative disorder associated with cognitive impairment and later dementia among the elderly. Mounting evidence shows that adverse maternal environments during the fetal development increase the risk of diseases later in life including neurological disorders, and suggests an early origin in the development of AD-related dementia (ADRD) in utero. In the present study, we investigated the impact of antenatal hypoxia and fetal stress on the initiation of AD-related pathology in offspring of 5xFAD mice. We showed that fetal hypoxia significantly reduced brain and body weight in the fetal and the early postnatal period, which recovered in young adult mice. Using spontaneous Y-maze, novel object recognition (NOR), and open field (OF) tasks, we found that antenatal hypoxia exacerbated cognitive decline in offspring of 5xFAD compared with normoxia control. Of interest, fetal hypoxia did not alter intraneuronal soluble amyloid-ß (Aß) oligomer accumulation in the cortex and hippocampus in 5xFAD mouse offspring, indicating that antenatal hypoxia increased the vulnerability of the brain to synaptotoxic Aß in the disease onset later in life. Consistent with the early occurrence of cognitive decline, we found synapse loss but not neuronal death in the cerebral cortex in 5xFAD but not wild-type (WT) offspring exposed to antenatal hypoxia. Furthermore, we also demonstrated that antenatal hypoxia significantly increased microglial number and activation, and reactive astrogliosis in the cerebral cortex in WT offspring. Moreover, antenatal hypoxia resulted in an exacerbated increase of microgliosis and astrogliosis in the early stage of AD in 5xFAD offspring. Together, our study reveals a causative link between fetal stress and the accelerated onset of AD-related pathology, and provides mechanistic insights into the developmental origin of aging-related neurodegenerative disorders.

Masseteric-zygomatic nerve transfer for the management of eye closure-smile excursion synkinesis.

OBJECTIVE: The purpose of this study is to illustrate the efficacy of masseteric-to-zygomatic nerve transfer to address eye closure-smile excursion synkinesis after facial nerve paralysis. BACKGROUND: Synkinesis after facial nerve paralysis represents a wide range of facial movement disability. One manifestation is involuntary smiling with eye closure and a concomitant reduction of oral commissure movement with attempted smile ("frozen smile") - arising as a result of aberrant fibers populating the zygomatic branch-muscle complex. This is a particularly difficult area to treat with conservative management. We propose a single-stage procedure to sever the dysfunctional zygomatic nerve and perform a masseteric-zygomatic nerve coaptation to recover a voluntary smile. METHODS: We present a case series of eight patients with eye closure/smile excursion synkinesis who underwent single-stage masseteric-zygomatic nerve transfer by a single surgeon. The surgical technique and indications for surgery were reviewed. Patients underwent facial movement analysis using Emotrics. RESULTS: We analyzed the pre- and post- surgical photographic images of 8 patients with synkinesis (7 female, 1 male). Masseteric-facial nerve transfer was performed from 18 months to 22 years after the initial facial paralysis. Eyelid and brow positioning were more symmetric after surgery, with discrepancy between affected and unaffected side decreasing from 2.1 to 1.0 mm (p < .05) and 1.74 to 1.29 mm (p < .05), respectively. Symmetry of smile excursion postoperatively was also improved with commissure excursion discrepancy decreasing from 8.8 to 3.78 mm (p < .05). Discrepancy in the smile angle when comparing affected to unaffected side improved postoperatively from 10.3 to 5.2 degrees (p < .05). Improvement in oral commissure height was noted, but not statistically significant. CONCLUSIONS: The masseteric-zygomatic nerve transfer is a useful technique for the treatment of eye closure/smile excursion synkinesis after failure of chemodenervation and/or physical therapy.

Revision Surgery of the Cleft Palate.

Cleft palate repairs often require secondary surgeries and/or revisions for a variety of reasons. The most common causes are symptomatic oronasal fistulas and velopharyngeal insufficiency. Complications from primary surgery, such as wound dehiscence, infection, and hematomas, contribute to the relatively high rate of revision surgery. Prevention of postoperative complications that may lead to fistula or velopharyngeal insufficiency is key, and many techniques have been described that have reportedly decreased the incidence of secondary surgery. Management varies depending on the nature of the fistulous defect and the type of velopharyngeal insufficiency. Numerous surgical options exist to fix this deficiency.

Open Versus Closing Wedge Osteotomy and Application to Mandibular Reconstruction.

PURPOSE: To review the specific techniques of closing wedge osteotomy and open osteotomy, compare their clinical and radiographic outcomes, and apply these findings to mandibular reconstruction. METHODS: A thorough review of the otolaryngology, facial plastic and reconstructive surgery, oral and maxillofacial surgery, and orthopedic surgery literature was conducted in the Ovid MEDLINE, EMBASE, and Google Scholar databases using the terms 'osteotomy' and 'mandibular reconstruction.' RESULTS: Traditionally, open osteotomies were thought to result in greater rates of malunion. However, multiple meta-analyses within the orthopedic literature have refuted this. Closing wedge osteotomies, on the other hand, may increase the chance of damaging a perforator. Again, no studies have evaluated the relationship between type of osteotomy and flap survival or wound healing. The particular type of osteotomy performed often depends on the type of osseous flap being utilized. CONCLUSIONS: Open osteotomies are a viable and even preferred alternative, particularly in flaps without consistent perforators, such as scapular free flaps.

Submental island flap vs free tissue transfer in oral cavity reconstruction: Systematic review and meta-analysis.

BACKGROUND: The submental island flap (SMIF) is frequently utilized as an alternative to free tissue transfer (FTT) in oral cavity reconstruction. METHODS: Studies directly comparing SMIF and FTT for oral cavity defects were included. Data were pooled with random-effects meta-analysis to calculate standardized mean differences and risk differences. Heterogeneity was evaluated with the I2 statistic. RESULTS: Five studies were included in the analysis. The aggregate sample sizes for SMIF and FTT cohorts were 122 and 127, respectively. SMIF was correlated with both reduced operative time and hospitalization by a large effect size. The rate of total flap loss was comparable. SMIF was associated with lower donor site morbidity. There was no difference in the rate of disease recurrence between the two procedures. CONCLUSIONS: SMIF is associated with less operative time, shorter hospitalization, fewer perioperative complications, and potentially similar disease recurrence rates compared to FTT for the reconstruction of oral cavity defects.

Canadian national survey of family medicine residents on point-of-care ultrasound training.

OBJECTIVE: To assess the quality of point-of-care ultrasound (POCUS) training in family medicine residency programs and to obtain the opinions of current family medicine residents on the role of ultrasound in primary care. DESIGN: A 23-question online survey conducted using SurveyMonkey between March 15 and June 30, 2017. SETTING: Canada. PARTICIPANTS: All family medicine residents of the 17 Canadian family medicine residency programs were included in the study but all enhanced skills residents were excluded. MAIN OUTCOME MEASURES: The quality and relevance of POCUS to primary care as perceived by residents and reported in the survey. RESULTS: A total of 854 Canadian family medicine residents responded, for a national response rate of 32.3%. Most respondents (94.3%) believe that POCUS training should be included in family medicine residency programs; however, only 18.4% of respondents currently receive formal training within their residency. Among those without POCUS training, 91.7% are interested in receiving formal training and 29.7% resorted to taking external POCUS courses. Most (77.5%) would consider using ultrasound in their future practice if they were competent in POCUS. The most useful applications for family medicine were considered to be the FAST (Focused Assessment with Sonography in Trauma) examination for free fluid and ascites (95.1%), procedural guidance (92.4%), and identifying an intrauterine pregnancy (88.6%). CONCLUSION: This is the largest survey identifying the perceived needs of family medicine residents for POCUS. Very few Canadian family medicine residents currently receive POCUS training. Consistent with our recent family medicine program director survey, there is overwhelming interest by family medicine residents to begin incorporating POCUS training into the family medicine curriculum.

Surgical Orbital Anatomy.

In this article, the anatomy of the orbit is reviewed, with a specific emphasis on surgical anatomy. A brief discussion of the ocular globe is also included. The orbits are pyramidal structures separating the upper and middle facial skeletons. The walls, apex, and base harbor several foramina and fissures as well as bony irregularities where various ligaments, muscles, and capsules attach. There are a variety of surgical approaches to the orbit, including the traditional transcutaneous and neurosurgical techniques and, more recently, minimally invasive, endoscopic approaches.