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.

The First Documented Ibuprofen-Induced Toxic Epidermal Necrolysis in the Middle East and North Africa Region: A Case Report, Complications, and Management.

INTRODUCTION: Stevens-Johnson syndrome (SJS), Stevens-Johnson/toxic epidermal necrolysis overlap syndrome (SJS/TEN) and toxic epidermal necrolysis (TEN) are rare, acute, potentially lethal conditions, considered to be part of the severe cutaneous adverse reactions (SCARs) spectrum, with TEN being the most life-threatening. The distinction between these three entities is based on the extent of total skin surface involvement, with SJS involving < 10%, SJS/TEN involving 10-30% and TEN involving > 30% of total body surface area. These mucocutaneous reactions are most commonly caused by a hypersensitivity reaction to a drug, with infections and vaccines being possible, less common etiologies. CASE PRESENTATION: In the following case report, we summarize a rare case of a 43-year-old, previously healthy male patient who presented with TEN after taking ibuprofen, a non-steroidal anti-inflammatory drug. According to PubMed literature, this is the first documented case of ibuprofen-induced TEN in the Middle East and North Africa (MENA) region. DISCUSSION: TEN is an autoimmune bullous disorder that results in the death of keratinocytes, leading to complete dermo-epidermal separation. In the case of our patient, the desquamation was extensive, involving 70% of the total body surface area, and was complicated by a triple bacterial infection with Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa. The patient was treated with colistin and meropenem, in addition to supportive management, hydration and nutritional support. CONCLUSION: In the case of TEN, early diagnosis and hospitalization in a burn centre are crucial to allow rapid healing, and improve the quality of life of the affected patients. Immediate cessation of the causative mediation is critical. Supportive management, hydration, nutritional support, and maintenance of aseptic conditions are highly encouraged to reduce the mortality and morbidity associated with TEN.

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.

Predictors of generic and burn-specific quality of life among adult burn patients admitted to a Lebanese burn care center: a cross-sectional single-center study.

Burn injuries carry significant implications on short- and long-term quality of health. The present study undertook the first attempt to characterize generic and burn-specific quality of life and their predictors among adult burn patients admitted to a Lebanese burn care center. 130 adult patients admitted to the Lebanese Geitaoui Hospital burn center between 2013 and 2019 willingly answered Arabic versions of RAND's 36-Item Short Form Survey (SF-36), and the Burn-Specific Health Scale-Brief (BSHS-B). Results showed that burn patients continue to exhibit impairments on various generic and burn-specific quality of life subdomains. Education, pain and total body surface area (TBSA) burned were consistently and significantly correlated with both BSHS-B and SF-36 component scores, while inhalation injury exhibited an association with total BSHS-B score. Education and pain emerged as independent predictors of SF-36 components as well as total BSHS-B score. The latter was additionally associated with BMI and burn degree, while TBSA burned negatively correlated with SF-36 physical component scores. Correlates of impaired quality of life among Lebanese adult burn patients should therefore be taken into account and existing burn management practices and rehabilitation programs should be revised accordingly in order to ensure optimal long-term patient outcomes.

Bacterial infection profile and predictors among patients admitted to a burn care center: A retrospective study.

BACKGROUND: Infection is the main cause of mortality and complications in burn patients. The present study was the first to examine the local profile and antecedents of bacterial infections among patients admitted to a Lebanese burn care center. METHODS: The present study was a retrospective analysis of the occurrence and recurrence of infection, its characteristics as well as antimicrobial susceptibility among 475 patients admitted to the Burn Centre at the Lebanese Geitaoui Hospital between January 2014 and December 2018. RESULTS: 55% of patients contracted at least one infection during their hospitalization. Length of stay (LOS), sepsis, wound dressing under anesthesia, blood transfusion and female sex independently and positively predicted infection in burn patients. Infection was predominately caused by Staphylococcus aureus (48.7%), followed by Pseudomonas aeruginosa (22.6%) and Acinetobacter baumannii (15.7%). Bacterial isolates were predominately multi-drug or extensively drug resistant and showed variable antimicrobial susceptibility patterns. Recurrent infections occurred in 44.1% of infected burn patients, and were independently predicted by LOS (p = 0.004), sepsis (p = 0.001), surgery (p = 0.003), burn excision and skin grafting (p = 0.019), and central line insertion (p = 0.004). CONCLUSION: Existing burn management and infection control measures must be revised in order to reduce the incidence and improve the treatment of infections in burn patients.

Mandibular neurofibroma: Case report of a rare tumor.

Neural tumors localized in jaw bone are relatively rare. This article presents a case of intraosseous neurofibroma of the mandible in a 37-year-old female patient. A review of clinical, radiographic, histological features and surgical management of the patient are discussed along with a review of the literature.

Mandibular reconstruction using the titanium functionally dynamic bridging plate system: A retrospective study of 34 cases.

PURPOSE: We sought to examine the use of the Titanium Functionally Dynamic Bridging Plate System (Howmedica Leibinger, Freiburg, Germany) for mandibular reconstruction after oncologic resection in 34 patients. PATIENTS AND METHODS: A retrospective study of 34 patients who had mandibular reconstruction using the titanium dynamic bridging plate system for mandibular reconstruction after oncologic resection were evaluated. The indications and postoperative outcomes were studied. Our evaluation focuses on the tolerance and aesthetic and functional results of this system. RESULTS: The follow-up ranged from 1 to 4 years. At the end of the study, 18 of the 34 patients (53%) still had the plate in place. One plate fracture and 1 plate exposure requiring surgical management were found. Surgical results were satisfying, particularly when looking at healing delay or long-term tolerance. Aesthetic (79% rated the results as good or acceptable) and functional results of this reconstruction material were satisfying. CONCLUSION: This reconstruction system provides a solution for a safe and rapid mandibular reconstruction for patients with a poor prognosis or poor general condition. This method also preserves the possibility of secondary reconstruction.

The temporal fasciocutaneous island flap for oncologic oral and facial reconstruction.

PURPOSE: This study reports the anatomy, operative technique, and postoperative results of the temporal fasciocutaneous island flap (TFCIF), as used for facial and intraoral reconstruction. MATERIALS AND METHODS: Retrospective study of 15 patients who underwent TFCIF reconstruction. The anatomic basis and surgical technique are described. The flap was used for mucosal reconstruction after cheek or maxillary resection. It was used for facial tissue loss in 2 cases: orbital osteoradionecrosis and exposure of a mandibular reconstruction plate. RESULTS: This technique provides a safe and rapid solution for intraoral reconstruction; however, it cannot be used for the anterior floor of the mouth. The best indication that we have found is the reconstruction of hemimaxillectomy, allowing closure of buccosinusonasal communication and prosthetic rehabilitation. The main disavantage is that hair regrowth limits its use to patients who need postoperative radiotherapy. Donor site morbidity is minimal. Only a partial failure was observed. CONCLUSION: The TFCIF is a rapid, safe, and useful flap for oral and facial reconstruction after oncologic resection. Its arc of rotation limits, however, its use to the posterior part of the oral cavity.