Flexor Tenosynovitis Caused by Neisseria gonorrhea Infection: Case Series, Literature Review, and Treatment Recommendations.

Neisseria gonorrhoeae is the most common sexually transmitted disease in the world and is known to cause disseminated disease, most commonly tenosynovitis. Classically, gonorrhea-associated tenosynovitis presents with concomitant dermatitis and arthralgias, though this is not always the case. N. gonorrhoeae -related tenosynovitis has become more commonly seen by hand surgeons. To aid in management, we present three cases of gonorrhea-induced tenosynovitis spanning a range of presentations with variable treatments to demonstrate the variety of patients with this disease. Only one of our patients had a positive gonococcal screening test and no patient had purulent urethritis, the most common gonorrhea-related symptom. A separate patient had the classic triad of tenosynovitis, dermatitis, and arthralgias. Two patients underwent operative irrigation and debridement, and one was managed with anti-gonococcal antibiotics alone. Though gonorrhea is a rare cause of flexor tenosynovitis, it must always be on the differential for hand surgeons when they encounter this diagnosis. Taking an appropriate sexual history and performing routine screening tests can assist in the diagnosis, the prescription of appropriate antibiotics, and potentially avoiding an unnecessary operation.

Gluteal Shape Framework for Augmentation Surgery: A Systematic Review of the Literature and Proposed Classification System.

BACKGROUND: Gluteal augmentation is used to improve the size and shape of the buttocks. Unlike other anatomical areas, such as the breasts, where there are classification systems for size and projection, no standardized methods for classifying gluteal size and shape exist. Patients seeking augmentation rely on photographs to communicate their desired result to surgeons. The authors' study objectively reviews this topic and proposes a novel classification system for the buttocks that can provide an organized framework for patients and providers. METHODS: A systematic of the literature was conducted on March 17, 2021, using various combinations of the following terms: "gluteal augmentation," "classification," "size," "gluteoplasty," and "Brazilian butt lift." All eligible articles were included for analysis. RESULTS: The PubMed/MEDLINE searches yielded 49 articles and abstracts. After review, eight publications were chosen for analysis. All publications were found in plastic surgery journals, with the most common journals as follows: Aesthetic Surgery Journal ( n = 4), Clinics in Plastic Surgery ( n = 2), Annals of Plastic Surgery ( n = 1), and Plastic and Reconstructive Surgery ( n = 1). There are no articles in the plastic surgery literature that provide a standardized classification system for gluteal size determination. CONCLUSIONS: The authors' study revealed the need for a standardized classification system for gluteal size and shape. Although the publications analyzed discussed various techniques for related procedures and provided ways to improve aesthetic outcomes, none presented a system for reproducibly classifying size and shape. By introducing a classification system, we hope to enable plastic surgeons to more accurately and efficiently discuss their patient's goals.

Effect of Throat Pack Placement on the Incidence of Sore Throat and Postoperative Nausea and Vomiting in Septorhinoplasty Patients: A Randomized Controlled Trial.

BACKGROUND: Advances in surgical and anesthetic techniques have led to a growing interest in performing procedures at ambulatory surgery centers. However, procedures involving the oropharyngeal or nasopharyngeal region may lead to the ingestion of blood, which can lead to postoperative nausea and vomiting (PONV). To date, limited studies have largely failed to demonstrate the benefits of oropharyngeal throat packing. OBJECTIVES: The authors aimed to investigate whether throat packing during elective septorhinoplasty increases the incidence of postoperative throat pain and assess its effects on PONV. METHODS: A randomized, prospective, single-blinded study was performed on 101 patients undergoing elective septorhinoplasty who received oropharyngeal throat packing vs no packing to compare the incidence of PONV and throat pain in the immediate postoperative period in addition to postoperative day (POD) 1 and 2. RESULTS: The incidence and severity of postoperative throat pain were significantly greater in patients receiving throat packs in the immediate postoperative period and on POD 1. Significant differences in throat pain and incidence between the 2 groups diminished by POD 2. Patients having received throat packs also demonstrated a higher utilization of opioids in postanesthesia care unit. The incidence of PONV did not significantly differ between the 2 cohorts at any point of observations. CONCLUSIONS: The results of this study largely agree with previous data that throat packs may contribute to postoperative throat pain while not significantly altering the incidence of PONV. Considering these data, we do not recommend routine utilization of throat packing during elective septorhinoplasty.

The COVID-19 Pandemic and Plastic Surgery: Literature Review, Ethical Analysis, and Proposed Guidelines.

BACKGROUND: Coronavirus disease 2019 (COVID-19), known as the "coronavirus," has spread to over 170 countries. In response, many organizations have spoken out and called for cancellation of all elective surgical procedures. This study aimed to provide clear recommendations for plastic surgeons to follow by addressing the following issues: (1) What defines elective surgery, and where does one draw the line between essential versus nonessential services? (2) How does this differ in the hospital versus private practice setting? (3) If called on to operate on a patient with COVID-19, how do plastic surgeons protect themselves and still provide excellent medical care? METHODS: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review of the literature on plastic surgery in the setting of a pandemic was performed on March 19, 2020. An ethical analysis was conducted using the four principles of medical ethics. RESULTS: The initial search yielded 118 articles. Eighteen articles were relevant and included for analysis. Only one editorial article was published in a plastic surgery journal. Accordingly, no peer-reviewed published COVID-19 guidelines exist for plastic surgery. Given that this pandemic may place health care systems under undue stress with an unpredictable trajectory, it is the responsibility of the plastic surgeon to assess and postpone cases whenever possible to properly contribute to adequate resource allocation and patient safety measures. CONCLUSIONS: This article fills an important gap in the literature by addressing COVID-19 and providing guidelines for upholding ethics and responsible resource allocation. By upholding these standards, plastic surgeons can do their part to help minimize the spread of this virus.

Making the Subjective Objective: Machine Learning and Rhinoplasty.

BACKGROUND: Machine learning represents a new frontier in surgical innovation. The ranking Convolutional Neural Network (CNN) is a novel machine learning algorithm that helps elucidate patterns and features of aging that are not always appreciable with the human eye. OBJECTIVES: The authors sought to determine the impact of aesthetic rhinoplasty on facial aging employing a multidimensional facial recognition and comparison software. METHODS: A retrospective chart review and subsequent analysis was carried out on all female patients who underwent open rhinoplasty with the senior author from 2014 through 2018 and had postoperative photos at 12 or more weeks follow-up. All photos were analyzed with Microsoft Azure Face API (Redmond, WA), which estimates patients' age by cropping the face from a photograph and then extracting a CNN-based prediction through multiple deep neural networks. RESULTS: A total of 100 patients ultimately met full inclusion criteria. The average post-surgical follow up for this cohort was 29 weeks (median, 14 weeks; range, 12-64 weeks). Patients ranged from 16 to 72 years old (mean, 32.75 years; median, 28.00 years; standard deviation, 12.79 years). The ranking CNN algorithm on average estimated patients preoperatively to be 0.03 years older than their actual age. The correlation coefficient between actual age and predicted preoperative age was r = 0.91. On average, patients were found to look younger post-open rhinoplasty (-3.10 vs 0.03 years, P < 0.0001). CONCLUSIONS: The ranking CNN algorithm is both accurate and precise in estimating human age before and after cosmetic rhinoplasty. Given the resulting data, the effects of open rhinoplasty on reversing signs of facial aging should be revisited.

The Plastic Surgery Social Media Influencer: Ethical Considerations and a Literature Review.

BACKGROUND: Social media use has become a relevant tool in plastic surgery. These platforms are utilized for many reasons, such as business promotion. Although beneficial, social media can cause ethical dilemmas if used incorrectly. OBJECTIVES: A review of the literature revealed what is understood about the implications of social media in regards to sponsorship/promotion. This paper aimed to create the foundation surrounding this topic and help facilitate future discussions on this new ethical dilemma. METHODS: A MEDLINE search with a custom publication date range and a review of the literature was conducted on June 15, 2019. RESULTS: The search yielded 139 articles and abstracts. After review, 26 publications were chosen for analysis. Articles were taken from the following journals: Plastic and Reconstructive Surgery (n = 12), Aesthetic Surgery Journal (n = 8), PRS Global Open (n = 2), Annals of Plastic Surgery (n = 1), BMJ (n = 1), AMA Journal of Ethics (n = 1), and Facial Plastic Surgery (n = 1). The 4 principles of medical ethics were analyzed in respect to promotion and sponsorship in plastic surgery. CONCLUSIONS: Social media is a novel platform that is becoming increasingly utilized in plastic surgery. Although its impact can be beneficial, it is not well understood in the context of social media sponsorship and promotion. To date, no peer-reviewed articles specifically discuss these limitations. It is critical that all plastic surgeons be cognizant of both the positive and negative aspects of social media before integrating it into their professional lives.

An Updated Review of Plastic Surgery-Related Hashtag Utilization on Instagram: Implications for Education and Marketing.

BACKGROUND: The popularity of social media continues to have a significant impact in the plastic surgery industry. Understanding the influence of such platforms and recognizing trends, specifically on Instagram, can reveal significant implications for education and marketing. OBJECTIVES: This study aims to gather updated information on 3 main questions: (1) what plastic surgery-related content is being posted to Instagram; (2) who is posting this content; and (3) what specific hashtags are they using? METHODS: This study analyzed 22 plastic surgery-related hashtags on Instagram. Content analysis was then used to qualitatively evaluate each of the 9 "top" posts associated with each hashtag (198). Any duplicates or posts not relevant to plastic surgery were excluded. RESULTS: A total of 11,516,969 posts utilized the 22 hashtags sampled. Of the top 198 posts, only 168 met final inclusion criteria (after duplicates and posts irrelevant to plastic surgery were excluded). Plastic surgeons eligible for membership in The Aesthetic Society accounted for only 4.17% of top posts (7 posts), whereas non-eligible physicians accounted for 20.8% (35 posts). Twenty-eight surgeons accounted for the top posts (excluding foreign surgeons); however, only 6 were board certified by either the American Board of Plastic Surgeons or The Royal College of Physicians and Surgeons of Canada. CONCLUSIONS: The Aesthetic Society eligible board-certified plastic surgeons are a minority amongst physicians posting top plastic surgery-related content on Instagram.

Understanding Why Lateral Osteotomy During Rhinoplasty Can Be Performed Safely.

Background: Lateral osteotomy is a mainstay of rhinoplasty surgery and involves fracture of the nasal and maxillary bones to narrow or widen the nasal dorsal bridge and base. To avoid nasal midvault collapse following rhinoplasty, the accepted "high-low-high" lateral osteotomy technique advocates for the preservation of a triangular strut of maxillary bone when initiating the osteotomy. Objective: We evaluated the risk of starting a lateral osteotomy in the "high" position to leave the aforementioned triangular maxillary strut without risk of falling into the nasomaxillary suture line, which can result in an aberrant and uncontrolled fracture. Methods: We utilized high-definition computed tomographic scans to reconstruct layered 3-dimensional images of 20 patient skulls and measured the distance from the rhinion (most inferior point of the central nasal bone junction) to the nasomaxillary suture line and from the rhinion to the maxillary groove. Results: We found that the nasomaxillary suture line was reliably only halfway down the bony nasal pyramid and not in proximity to the maxillary groove. Conclusions: Our findings provide reassurance that a generous triangular strut can be preserved along the maxillary component of the piriform aperture without concern of falling into the nasomaxillary suture line. Thus, controlled lateral osteotomies can be performed safely to achieve aesthetic gains without fear of compromising midvault stability.

Upper Vault Septal Anatomy and Short Nasal Bone Syndrome: Implications for Rhinoplasty.

Introduction: This is a diagnostic study that investigates the clinical significance between patients with short and long nasal bones and the variation in upper septal composition that would delineate propensity for middle vault collapse. Methods: Computed tomographic scans of 16 female patients undergoing evaluation with sinus films were analyzed. Two measurements were taken from each scout image: nasal bone length and total nasal length. Patient scans were separated into 2 groups; patients whose nasal bone length was less than one-half their total nasal length were defined as patients with "short nasal bone" (n = 8), and those with nasal bones longer than one-half the length of their noses were defined as patients with "long nasal bone" (n = 8). Results: Key differences were identified between patients with short and long nasal bones. Total septal area in the upper vault was decreased in the short nasal bone group relative to that of the long nasal bone group (5.7 ± 0.6 cm2 vs 8.1 ± 1.0 cm2, P = .002). This was mainly the result of the decreased ethmoid bone component in the short nasal bone group when compared with the long nasal bone group (1.6 ± 0.6 cm2 vs 3.2 ± 0.8 cm2, P = .007).

Treatment Outcomes following Traumatic Optic Neuropathy.

BACKGROUND: Traumatic optic neuropathy is characterized by sudden loss of vision following facial trauma leading to variable visual deficits. The purpose of this study was to evaluate recent institutional trends in the treatment of traumatic optic neuropathy, evaluate the outcomes of different treatment strategies, and identify factors associated with improved vision. METHODS: Institutional review board approval was obtained to retrospectively review patients diagnosed with traumatic optic neuropathy at a high-volume trauma center from 2004 to 2012. Pretreatment and posttreatment visual acuity was compared using quantitative analysis of standard ophthalmologic conversion. RESULTS: A total of 109 patients met inclusion criteria (74.3 percent male patients), with a mean age of 38.0 ± 17.5 years (range, 8 to 82 years). Management of traumatic optic neuropathy involved intravenous corticosteroids alone in 8.3 percent of patients (n = 9), 56.9 percent (n = 62) underwent observation, 28.4 percent (n = 31) had surgical intervention, and 6.4 percent (n = 7) underwent surgery and corticosteroid administration. Only 19.3 percent of patients returned for follow-up. Vision improved in 47.6 percent of patients, with a mean follow-up of 12.9 weeks. Patients younger than 50 years had a trend toward higher rates of visual improvement, 60 percent versus 16.7 percent (p = 0.15). CONCLUSIONS: The majority of traumatic optic neuropathy patients are unlikely to return for a follow-up examination. Optic nerve decompression has fallen out of favor in the authors' institution, and observation is the most common management strategy. Outcomes following corticosteroid administration and observation are comparable. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.