Artificial intelligence in maxillofacial and facial plastic and reconstructive surgery.

PURPOSE OF REVIEW: To provide a current review of artificial intelligence and its subtypes in maxillofacial and facial plastic surgery including a discussion of implications and ethical concerns. RECENT FINDINGS: Artificial intelligence has gained popularity in recent years due to technological advancements. The current literature has begun to explore the use of artificial intelligence in various medical fields, but there is limited contribution to maxillofacial and facial plastic surgery due to the wide variance in anatomical facial features as well as subjective influences. In this review article, we found artificial intelligence's roles, so far, are to automatically update patient records, produce 3D models for preoperative planning, perform cephalometric analyses, and provide diagnostic evaluation of oropharyngeal malignancies. SUMMARY: Artificial intelligence has solidified a role in maxillofacial and facial plastic surgery within the past few years. As high-quality databases expand with more patients, the role for artificial intelligence to assist in more complicated and unique cases becomes apparent. Despite its potential, ethical questions have been raised that should be noted as artificial intelligence continues to thrive. These questions include concerns such as compromise of the physician-patient relationship and healthcare justice.

Intraoral Microscopic Versus Robot-Assisted Sialolithotomy and Sialendoscopy for Submandibular Stones.

OBJECTIVE: Sialendoscopy has remained the standard of treatment for sialolithiasis; however, large stones impacted in the submandibular gland hilum often require an intra-oral combined approach. METHODS: Patients treated for submandibular hilar sialolithiasis from 2015 to 2021 at two tertiary centers were stratified into two groups based on the surgical technique: Intraoral Microscopic-Assisted Sialolithotomy (IMAS) versus Robot-Assisted Sialolithotomy and Sialendoscopy (RASS). We compared the characteristics of retrieved stones, surgical success rate, operative time, and post-operative complications in both techniques. True surgical success was defined as successful stone extraction without reoccurrence within 12 months. RESULTS: The RASS technique was attempted in 60 patients and successful in 56 (93.3%) cases whereas the IMAS technique was performed in 52 patients and successful in 48 (92.3%) cases. The longest dimension of the predominant retrieved calculi was 9.6 ± 3.1 mm (range, 5-18 mm) for the robotic technique and 10 ± 4.8 mm (range, 5-30 mm) for the microscopic technique. The operative time for the robotic technique excluding robot setup time was 70.6 ± 24.8 min compared to 61.9 ± 42.4 min for microscopic technique (p = 0.018). No major adverse outcomes were reported; however, temporary lingual paresthesia was found in ten robotic (16.7%) and five microscopic (9.6%) cases. CONCLUSION: The two techniques were comparable in terms of efficacy and safety for large stones. The robot has the advantage of intraoral high dynamic maneuverability and improved surgeon posture while the microscopic technique has the advantage of intraoral tactile feedback. The procedure was significantly shorter in duration with the microscope. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:2170-2176, 2024.

What Do Patients Look for When Scheduling Their Initial Elective Aesthetic Plastic Surgery Consultation?

BACKGROUND: Multiple factors influence patients when deciding on where to seek plastic surgery consultations. Our objective was to determine the most important factors when booking the initial consultation. METHODS: A 23 question survey was distributed online via Amazon Mechanical Turk targeting participants who had prior plastic surgery consultations or were planning to have one in the future. Participant demographic data were collected, and participants were asked to rank the importance of factors related to cost, surgeon reputation, social media, technology, amenities, accessibility, and appointment details on a 1-5 Likert scale. Rankings were reported by mean and standard deviation. RESULTS: A total of 593 responses were gathered. 48.1% of participants were 25-34 years of age, 54.6% were female, 66.3% identified as White, 78.4% were located in the U.S, and 54.5% had a bachelor's degree. Participants rated the importance of a surgeon's online reviews (mean 4.15, SD 0.81), surgeon presence at follow-up visits (mean 4.01, SD 0.91), and availability of pricing prior to appointment (mean 4.01, SD 0.91) the highest. The least important factors were waiting room amenities and social media advertising. Individuals younger than 45 were more likely to rate a surgeon's social media presence higher than those 45 years and older (OR 2.02; 95%CI [1.37-2.96]; p < 0.001). CONCLUSIONS: Patients considered surgeon's online reviews, presence at follow-up visits, and the availability of pricing information the most important when booking a plastic surgery consultation. These findings may assist physicians in structuring plastic surgery consultations based on factors important to patients. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Determinants of extinction in a streamed trial procedure.

The strength of an association between a cue and its outcome is influenced by both the probability of the outcome given the cue and the probability of the outcome in the absence of the cue. Once an association has been formed, extinction is the procedure for reducing responding indicative of the association by repeated presentation of the cue without the outcome. The present experiments tested whether cumulative frequency and/or cumulative duration of these events affects associative extinction in a streamed trial extinction procedure with human participants. Experiment 1 assessed the effects of parametric manipulations of the frequency and duration of either the cue by itself or cue-outcome co-absence. In Experiment 1, participants proved relatively insensitive to manipulation of the event's duration. In contrast, judgements of the association by participants decreased when the frequency of cue-alone events was increased, even when the durations of those events were decreased so that cumulative exposure to the cue was equated. No effect of either the duration or the frequency of cue-outcome co-absence was observed. Experiment 2 demonstrated that the effect of cue-alone (i.e., extinction trial) frequency generalises across a wide range of parameters for initial acquisition achieved by cue-outcome pairings. Experiment 3 tested for an interaction between event duration during initial learning and event duration during extinction. Collectively, these results indicate that the cumulative frequency, and not the cumulative duration, of extinction trials as well as the duration of the cue-outcome co-absences between extinction trials control the effectiveness of an extinction procedure.

An Analysis of Biologic Therapies in Patients With Asthma and Chronic Rhinosinusitis.

Background Asthma, Allergic rhinitis (AR), Chronic Obstructive Pulmonary Disease (COPD), Eczema, and Chronic Rhinosinusitis with Sinonasal Polyposis (CRSwNP) are illnesses often characterized by type 2 (T2) inflammation, wherein T helper (Th) cells release pro-inflammatory cytokines such as IL (interleukin)-4, IL-5, IL-9, and IL-13. This response may also promote the production of IgE and an increase in/activation of serum eosinophils. In the aforementioned type 2 inflammatory diseases, this immune response can cause excess mucous production, inflammation of the airways, other atopic responses when patients are exposed to certain environmental allergic triggers. Relatively new biologic monoclonal antibody therapies such as dupilumab (blocks IL-4 and IL-13), benralizumab (blocks IL-5), mepolizumab (blocks IL-5), and omalizumab (blocks IgE Fc/fragment of crystallization region) offer novel therapeutic targets that more specifically and directly block type 2 inflammatory responses. Methods To examine the effect of monoclonal antibody biologic therapies on patient indicators of type 2 inflammation, a retrospective analysis of 193 patients on biologic therapy was conducted, and these patients were compared to 48 control patients with type 2 inflammatory diseases who did not initiate biologic therapy. Total Lund-MacKay radiographic score, FEV1 (forced expiratory volume in the first second), FEF25-75 (forced expiratory flow from 25-75% of the forced vital capacity curve), annualized pulmonary exacerbations, oral corticosteroid dose, and serum eosinophils were recorded at baseline (zero months), and at three, six, nine, and twelve months after initiation of biologic therapy. Least squares mean data and the percent change from the baseline of least squares mean for the biologic and control groups were compared. Results Omalizumab was the most common biologic therapy prescribed. Control patients were younger than patients who initiated biologic therapy. Patients on biologic therapy had statistically significant reductions in Lund-MacKay score, improvements in FEV1 and FEF25-75, reductions in serum IgE levels, and reductions in serum Eosinophils. Patients on biologic therapy also had statistically significant reductions in annualized pulmonary exacerbations and oral corticosteroid dose compared to controls. Conclusions Patients with a variety of type 2 inflammatory conditions appear to have significant improvements in lung function, radiographic sinusitis, and serum markers of type 2 inflammation after initiation of biologic therapy versus controls. These therapeutic medications appear to significantly improve type 2 inflammatory disease course in patients who can tolerate these medications.

Benefiting from trial spacing without the cost of prolonged training: Frequency, not duration, of trials with absent stimuli enhances perceived contingency.

The statistical relation between two events influences the perception of how one event relates to the presence or absence of another. Interestingly, the simultaneous absence of both events, just like their mutual occurrence, is relevant for describing their contingency. In three experiments, we explored the relevance of coabsent events by varying the duration and frequency of trials without stimuli. We used a rapid trial streaming procedure and found that the perceived association between events is enhanced with increasing frequency of coabsent events, unlike the duration of coabsent events, which had little effect. These findings suggest ways in which the benefits of trial spacing, during which both events are absent, could be obtained without increasing total training time. Centrally, this can be done by frequent repeating of shortened coabsent events, each marked by a trial contextual cue. We discuss four potential accounts of how coabsent experience might be processed contributing to this effect: (a) contingency sensitivity, (b) testing effect, (c) reduced associative interference by the context, and (d) reduced encoding interference. (PsycInfo Database Record (c) 2022 APA, all rights reserved).