The effect of various muscle transfer procedures on eye closure and blinking in longstanding facial palsy patients.

BACKGROUND: Facial palsy causes paralytic lagophthalmos, which remarkably deteriorates a patient's quality of life. In cases where denervation time is over 18-24 months (longstanding facial palsy), a free or pedicled muscle transfer is needed to replace the denervated orbicularis oculi muscle. PURPOSE: The purpose of this systematic review is to investigate the effect of various eye sphincter substitution procedures (free or pedicled muscle transfers) in longstanding facial palsy patients on eye closure and blink. METHODS: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we performed a systematic review of the Embase, Medline, Web of Science and Cochrane Library databases and Google Scholar. Our literature search yielded 4322 articles. Following a full-text review, 4 retrospective cohort studies and 21 case series were selected for this review. Meta-analyses using R package meta (version 6.5-0) were conducted. MAIN FINDINGS: All free and pedicled muscle transfers in this review showed an improvement in the scores and measurements on eye closure and blink. The pedicled temporalis muscle transfer was the procedure most commonly performed as eye reanimation surgery and showed consistent good results. Using the random effects model, the pooled effect of mean difference in lagophthalmos after gentle eye closure post-operatively versus pre-operatively (mm) in patients who received a pedicled (temporalis) muscle transfer was -6.19 (I2 = 85%, 95% CI: -7.89; -4.49) whereas it was -4.11 (I2 = 85%, 95% CI: -7.26; -0.95) for free (gracilis or platysma) muscle transfers. The pooled proportion of patients with complete eye closure after surgery was 0.69 (I2 = 49%, 95% CI: 0.54; 0.82) in patients who received a pedicled (temporalis) muscle transfer and 0.40 (I2 = 74%, 95% CI: 0.13; 0.74) in patients who received a free (platysma) muscle transfer. CONCLUSIONS: Unlike smile reanimation, dynamic eye closure and blink restoration are rather neglected topics in facial reanimation. The pedicled temporalis muscle transfer is often recommended as the first treatment of choice for eye reanimation in longstanding facial palsy patients since it is a reliable, straightforward procedure, that does not require complex microsurgery. However, with the advancements in the field of microsurgery, free muscle transfers are promising therapies, which may regenerate voluntary and spontaneous blinking.

Visualization of the Facial Nerve with Ultra-high-Frequency Ultrasound.

Background: Profound variations in facial nerve branching, combined with the severe impact of facial palsy on the patient's quality of life, make surgery in this region challenging. Recent advancements in ultrasound (US) technology, including the improved visualization of small structures, have led to a sharp increase in its medical indications in various medical disciplines. We aimed to prove the feasibility of using ultra-high-frequency (UHF) US to visualize the facial nerve and to guide surgeons during surgery on and around the facial nerve. Methods: A cadaveric study was performed on one hemi-face with a UHF US imaging system and state-of-the-art transducers. Firstly, a transcutaneous US was performed, and the facial nerve branches of interest (zygomatic, buccal, and marginal mandibular branches) were marked using US-guided color-injections of filler mixed with methylene blue. Skin and subcutaneous fat were then removed to simulate the intraoperative field. Secondly, an "intraoperative" US examination was performed, and the same branches were marked by US-guided color-injections of filler mixed with indocyanine green. Anterograde facial nerve dissection was performed, and the distance between the nerve branches and the injected filler was measured. Results: All color-injections (mixed with both methylene blue and indocyanine green) were positioned right next to the nerve branches (<1 mm). The image quality of the US below the skin was observed to be far superior to that of the transcutaneous US. Conclusion: UHF US can be used to visualize the facial nerve with high precision both transcutaneously and intraoperatively (after elevation of the skin flap).

Neurectomy of the Masseteric Nerve Using an Extra-Oral Approach to Treat Masseter Hypertrophy: Case Report and Literature Review.

Masticatory muscle hypertrophy is a benign clinical anomaly which leads to facial asymmetry or a squared face appearance. We report a case of masticatory muscle hypertrophy, particularly on the right side, that was successfully treated by neurectomy of the right masseteric nerve through an extra-oral approach. Clinical examination showed significant aesthetic improvement of the facial symmetry with complete paralysis and atrophy of the right masseter muscle. The impaired postoperative function of the frontal branch of the right facial nerve was fully restored 10 weeks postoperatively. The patient no longer experiences headaches or discomfort with eating or sleeping on her right side.

Five years clinical outcome of maxillary mini dental implant overdenture treatment: A prospective multicenter clinical cohort study.

BACKGROUND: The long-term clinical outcome of mini dental implants (MDIs) to support an overdenture is underreported especially in severely atrophic maxillae and when installed flaplessly. PURPOSE: The current report is a 5-years follow-up of the previously published 2- and 3-years clinical outcome of MDIs supporting a maxillary overdenture in narrow alveolar ridges. MDI survival, marginal bone level, peri-implant health, technical complications, and oral health related quality of life (OHIP) and respective changes over time are reported. MATERIALS AND METHODS: Subjects aged 50 years or older, in need of improvement of maxillary denture retention, were included. The MDIs were 2.4 mm diameter one-piece tapered implants, Class 4 pure Titanium, and lengths 10 or 11.5 mm. Under local anesthesia, 5-6 MDIs were placed in atrophic maxillae with a free-handed flapless approach. One week postoperative the denture was adapted with a retentive soft reliner. The final prosthetic connection was established after 6 months with a metal-reinforced horse-shoe denture. Clinical outcome after 5 years was assessed with probing pocket depts (PPD), bleeding on probing (BoP), and additional cone beam computed tomography (CBCT) MDI bone level measurements were performed. Oral Health-Related Quality of Life (OHRQoL) investigated with OHIP-14 was assessed preoperative, during provisional loading, and after final prosthetic connection up to 5 years. RESULTS: Initially, 31 patients (14 females and 17 males) with mean age 62.30 underwent treatment. In the provisional loading interval, 16 patients encountered 32/185 MDIs failures, resulting in a failure of 17.3%; 170 MDIs were functionally loaded in 29 patients. Additionally, 14 implants were lost in three patients, all of whom had had already previous failures. Reimplantation of 17 MDIs were performed during the provisional loading and 2 MDI after functional loading. After 5 years, the absolute implant failure rate was 46/204 (22.5%), corresponding to a cumulative failure rate of 23.2%. Prosthetic failure was observed in four patients due to implant loss and in two patients related to excessive one-piece implant ball attachment wear, making the 5-years prosthetic success 80.0%. The mean PPD and absence/presence of BoP for 149 implants at 5 years was 4.3 and 0.2 mm, respectively. Average mesial-distal-vestibular-palatal bone loss in the interval 2-5 years was 0.08 mm. No statistically significant difference in marginal MDI bone loss between male or female (p = 0.835), smoking and nonsmoking (p = 0.666) was observed. The five-years total measured CBCT interdental bone level (mesial and distal) correlates with the 5-years PPD (Pearson 0.434; p = 0.01). After 5 years, OHRQoL with the treatment procedure was assessed in 27/31 participants. Decreasing mean total OHIP-14 scores with improved OHRQoL, was observed in 27/31 participants, with values of 21.3 at baseline to 15.6 at the time of provisional loading which significantly (p = 0.006) decrease to 7.3 at the final prosthetic connection. The next 3-5 years further decrease was observed with 6.5 and 4.96, respectively. CONCLUSIONS: Maxillary MDIs for overdentures are an accessible and acceptable treatment option. Although after 5 years between one fifth and one fourth of the MDIs were lost, prosthetic success remains 80.0% and high OHRQoL could be achieved.

Facial Allograft Donation: An Interpretative Phenomenological Analysis of the Experiences of Family Members.

Facial allograft transplantation can be regarded as a particular and complex type of donation because of its perceptibility and the importance of the face as an identity characteristic. As research on this topic is currently lacking, the objective of this study is to explore the experiences of the family members of the donor in facial allograft donation. In-depth, semi-structured interviews were conducted separately with the donor's family members and analyzed using interpretative phenomenological analysis. Six themes were identified: (1) Contrasting facial donation to that of more commonly donated organs; (2) Consenting to facial donation; (3) Expectations towards the recipient of the facial graft; (4) Expectations and consequences of restoration of the donor's face; (5) Relationship with the medical team during the process; and (6) Media attention. The findings of our study help to better support donor families through the facial donation process and to improve facial transplantation procedures.

The Therapeutic Landscape of Salivary Gland Malignancies-Where Are We Now?

Salivary gland malignancies (SGMs) account for less than 5% of new diagnoses in head and neck tumors. If feasible, surgery is the preferred treatment modality. Nevertheless, some malignancies have a tendency of recurrence, with possible distant metastasis. Alternative treatment strategies, such as primary radiation or chemotherapeutics, often present low response rates. As a result, there is an unmet need for novel therapeutic approaches. Nowadays, target-based therapies (e.g., small inhibitors and immunotherapy) are used by the medical oncologist for possible treatment of advanced SGMs. Based on recent published trials, some novel treatments may provide additional disease control for some patients. However, sample sizes are small, the general findings are unsatisfactory, and a lot of uncertainties remain to be elucidated. Nevertheless, research shows that patients do not benefit from blind administration of systemic treatments and therefore a more personalized approach is highly needed. The aim of this review paper is to summarize the most recent advances in the biological understanding and molecular pathways of salivary gland cancers, the association of these pathways with the current treatments used and their implications for more personalized targeted-based therapies.

Better speech outcomes after very early palatal repair?-A longitudinal case-control study in Ugandan children with cleft palate.

INTRODUCTION: Children born with cleft palate with or without cleft lip (CP±L) tend to use less oral pressure consonants and more glottal sounds in their babbling. The purpose of very early palatal repair (i.e., one-stage palatal closure prior to 6 months of age) is to make the palate functional before the onset of speech acquisition to reduce the anchoring of wrong patterns in the child's developing phonological system. As a result, less compensatory articulation errors are expected to be present. Currently, no detailed longitudinal speech outcomes after very early palatal closure are available. This study aimed to provide longitudinal speech outcomes in Ugandan children with CP±L who received palatal closure prior to the age of 6 months. METHODS: Ten children with CP±L were assessed at a mean age of 5 and 10 years old. Speech understandability, speech acceptability, resonance, nasal airflow and articulation were perceptually rated by two experienced speech-language pathologists. Velopharyngeal function was estimated using the velopharyngeal composite score (VPC-sum). Information regarding speech therapy, fistula rate, and secondary (speech) surgery was collected. The outcomes were compared with the longitudinal outcomes of an age- and gender-matched control group of 10 Ugandan children without CP±L. RESULTS: Speech understandability and acceptability improved significantly over time in the group with CP±L (all p's ≤ 0.05, all Z's > -2.43). At both test dates, significantly worse judgments were found for the group with CP±L compared to the control group for these variables and variables related to passive speech errors (all p's ≤ 0.05, all Z's > 2.49). A statistically significant difference with the control group was found for the presence of compensatory articulation errors at the age of 5 years but not at the age of 10 years, indicating a catch up by the children with CP±L. CONCLUSION: Whether a one-stage palatal closure prior to the age of 6 months is more favorable for speech outcomes compared to one-stage palatal closure at 12 months is still not clear. Speech of the children with CP±L improved over time, but significantly differed from the control group at the age of 5 and 10 years old. Limited access to health care facilities and possible influence of malnutrition on wound healing need to be considered when interpreting the results. Whether palatal closure prior to the age of 6 months is transferable to other countries is subject for further research, including both longitudinal and prospective designs with larger samples.

Sociodemographics and Quality of Life in Dutch-Speaking Adolescents and Adults With and Without a Cleft Lip and/or Palate.

OBJECTIVE: To investigate the impact of living with a cleft lip and/or cleft palate (CL/P) on sociodemographic variables, quality of life, aesthetics, life satisfaction, and social distress in Dutch-speaking adolescents and adults. DESIGN: Cross-sectional study. PARTICIPANTS: Thirty Dutch-speaking participants with a CL/P with a mean age of 26.93 years (SD = 11.69) and an age- and gender-matched control group of 30 participants (19 men and 11 women) without a CL/P with a mean age of 26.87 years (SD = 11.73). MAIN OUTCOME MEASURES: Self-reported outcomes of sociodemographics, quality of life, aesthetics, life satisfaction, social distress, and impact of cleft on well-being and functioning. RESULTS: No significant differences in educational level, employment, monthly net income, marital status, and having children were found between participants with and without a CL/P. In addition, quality of life, overall aesthetics, life satisfaction, and social distress did not differ between the 2 groups. Among participants with CL/P, there were no gender differences in the influence of their CL/P on daily functioning, well-being, social contacts, family life, applying for a job, work, education, or leisure time. CONCLUSION: The findings revealed no differences between participants with and without a CL/P with regard to sociodemographics, quality of life, aesthetics, life satisfaction, or social distress. There were no gender differences in the influence of cleft on well-being and functioning. Longitudinal research can help determine possible fluctuations in the impact of living with a CL/P across the life span.

A Tissue Section-Based Near-Infrared Spectroscopical Analysis of Salivary Gland Tumors.

SGTs vary in histological behavior. Mucins, a major component in salivary glands, consist of a glycosylated and sialylated protein core. Rapid evolutions in glycobiology have demonstrated the important role of glycoproteins in cancer development. NIR spectroscopy is a method for the biochemical analysis of substrates. NIR spectra can be analyzed using specific chemometrics. Our aim was to explore the diagnostic possibilities of NIR spectroscopy in SGTs. 238 Hematoxylin and Eosine stained (H&E) SGT tissue sections were examined using NIR spectroscopy. 45 deparaffinized tissue sections were treated with neuraminidase to identify wavelengths in the NIR spectrum related to sialylation. NIR spectra were analyzed with chemometrics. NIR spectra could distinguish malignant SGTs from controls and benign SGTs. Prediction models based on the entire spectral range resulted in a 73.1% accurate classification of malignant SGTs and controls, while, based on neuraminidase experimental spectral peak differences (1436 nm; 1713 nm; 1783 nm; 1924 nm; 2032 nm; 2064 nm; 2178 nm; 2216 nm), an improved overall correct classification rate of 91.9% was obtained between healthy subjects and malignant tumors. H&E tissue section-based NIR spectroscopy can identify malignant SGTs from controls, promising an alternative method in the diagnosis of SGTs.

Long-term voice quality outcome after thyroidectomy without laryngeal nerve injury: a prospective 10 year follow up study.

PURPOSE: This study investigates the long-term voice outcome of thyroidectomy up to 10 years after the surgery using a longitudinal prospective study design. METHODS: Eighteen participants (6 men and 12 women, mean age: 54 years) who underwent a thyroidectomy between September 2006 and May 2007 were included in this study. A voice assessment protocol consisting of subjective (videolaryngostroboscopic evaluation, auditory- perceptual evaluation, patients' self-report) and objective voice assessments (maximum performance task, acoustic analysis, voice range profile and Dysphonia Severity Index) was used to evaluate the participants' pre- and postoperative voice. Voice measurements were compared before and one week, six weeks, three months and 10 years after the surgery. RESULTS: No significant differences over time in auditory-perceptual and objective voice parameters were found, except for shimmer. Only in the first postoperative condition, significantly more patients reported vocal complaints. A progressive amelioration of the vocal folds' movement patterns was observed in the postoperative conditions. CONCLUSION: The findings of this small longitudinal prospective study suggest that thyroidectomy without laryngeal nerve injury does not cause a permanent deterioration of the laryngeal aspect or function, vocal fold behavior and the self-perceived, perceptual and objective vocal quality. The increase of the shimmer 10 years post-thyroidectomy may be related to vocal aging.

Risk factors for postoperative morbidity after thyroid surgery in a PROSPECTIVE cohort of 1500 patients.

BACKGROUND: Postoperative hypocalcaemia, recurrent laryngeal nerve palsy and postoperative bleeding are the most frequent postoperative complications after thyroid surgery, and therefore often used as quality indicators of thyroid surgery. We aimed to assess postoperative morbidity in a high-volume endocrine surgery unit, and to detect which factors are associated with higher risks. METHODS: Prospective surgical cohort in a high-volume tertiary referral centre for endocrine surgery in xxx. The first 1500 patients operated with hemi or total thyroidectomy during 2010-2019 were included. Postoperative hypocalcaemia, recurrent laryngeal nerve palsy and postoperative bleeding were assessed in relation to pre- and peri-operative characteristics using multivariable logistic regression analyses, expressed as odds ratios and 95% confidence intervals. RESULTS: Overall, 1043 patients (69.5%) received a total thyroidectomy and 457 (30.5%) a hemithyroidectomy. Permanent hypocalcaemia occurred in 3.1%, permanent recurrent laryngeal nerve palsy in 1.8% and surgical reintervention for bleeding in 2.6%. Younger age, female sex and cancer were risk factors for permanent hypocalcaemia. No clear risk factors could be identified for permanent nerve palsy. Female sex, high body mass index and heavier thyroids were protective against postoperative bleeding after total thyroidectomy. CONCLUSIONS: Surgical experience in endocrine surgery seems beneficial for clinical outcomes and contributes to organizational efficiency. A low complication risk can be obtained by trained high-volume endocrine surgeons, yet the risk is not negligible.

Intra-operative recovery of preoperative vocal cord paralysis during hemithyroidectomy for benign thyroid disease: case report and review of the literature.

INTRODUCTION: Multinodular goiter associated with preoperative vocal cord palsy is usually indicative of invasive thyroid malignancy. However, benign thyroid disease may also lead to vocal cord paralysis. CASE REPORT: We present a case of a 63-year old woman with a two-month history of hoarseness, loss of vocal pitch, difficulties with swallowing and shortness of breath. Preoperative flexible fiberoptic laryngoscopy showed a left vocal cord paralysis. Left hemithyroidectomy with isthmectomy under intraoperative neuromonitoring for multinodular goiter was performed. Intra-operatively, both ipsilateral recurrent laryngeal nerve (RLN) and vagal nerve (VN) were identified and preserved. Follow-up laryngoscopy 5 weeks postoperatively showed complete recovery of the left vocal cord movement. DISCUSSION: Intuitively, surgeons may assume that preservation of a palsied RLN in patients with preexisting vocal cord paralysis is not meaningful. However, patients with RLN palsy associated with benign thyroid disease can experience full recovery after surgery. CONCLUSION: Multinodular goiter associated with preoperative vocal cord paralysis should be managed with extreme caution and use of intra-operative neuromonitoring. The existing probability of intra-operative recovery of a preoperative RLN palsy underlines the importance of preserving the affected RLN during surgery for benign thyroid disease.

Feasibility of Autofluorescence for Parathyroid Glands During Thyroid Surgery and the Risk of Hypocalcemia: First Results in Belgium and Review of the Literature.

Background. Post-operative hypocalcemia remains the most frequent complication after total thyroidectomy. Recently, autofluorescence imaging was introduced to detect parathyroid glands early during dissection. Aim. We aimed to check the feasibility of autofluorescence regarding the number of parathyroid glands visualised and the risk of post-operative hypocalcemia. Methods. In a prospectively gathered cohort of patients undergoing thyroid surgery, we describe the risk of hypocalcemia in relation to the number of parathyroid glands visualised during surgery (and the risk reported in the scientific literature) and the feasibility to obtain an autofluorescence of the parathyroid glands. Results. From 2010 to 2019, 1083 patients were referred for total thyroidectomy in our tertiary referral centre for endocrine surgery, of which, 40 consecutive cases were operated using autofluorescence. Among the autofluorescence group, 14 (35.0%) had all 4 parathyroid glands visualised, compared to 147 (14.1%) in the other patients, without differences in the number of parathyroid glands reimplanted. No permanent hypocalcemia occurred in the autofluorescence group and 17.5% temporary hypoparathyroidism, compared to 3.1% and 31.9% among the other patients, and 4% (95% confidence interval [CI] 3-5%) and 19% (95% CI 15-24%) in the literature. Conclusion. Autofluorescence imaging provides reliable real-time visualisation at any point during thyroid surgery and helps to identify the parathyroid glands before detection with the naked eye. To date, it cannot be used as a standard technique and does not replace meticulous dissection. To become a useful adjunct in peroperative parathyroid management, large multicentre studies need to establish a potential clinical benefit of this novel technique.

Perceptual Speech Outcomes After Early Primary Palatal Repair in Ugandan Patients With Cleft Palate.

OBJECTIVE: To provide speech outcomes of English-speaking Ugandan patients with a cleft palate with or without cleft lip (CP±L). DESIGN: Prospective case-control study. SETTING: Referral hospital for patients with cleft lip and palate in Uganda. PARTICIPANTS: Twenty-four English-speaking Ugandan children with a CP±L (15 boys, 9 girls, mean 8.4 years) who received palatal closure prior to 6 months of age and an age- and gender-matched control group of Ugandan children without cleft palate. INTERVENTIONS: Comparison of speech outcomes of the patient and control group. MAIN OUTCOME MEASURES: Perceptual speech outcomes including articulation, resonance, speech understandability and acceptability, and velopharyngeal composite score (VPC-sum). Information regarding speech therapy, fistula rate, and secondary surgery. RESULTS: Normal speech understandability was observed in 42% of the patients, and 38% were judged with normal speech acceptability. Only 16% showed compensatory articulation. Acceptable resonance was found in 71%, and 75% of the patients were judged perceptually to present with competent velopharyngeal function based on the VPC-sum. Additional speech intervention was recommended in 25% of the patients. Statistically significant differences for all these variables were still observed with the control children (P < .05). CONCLUSIONS: Overall, acceptable speech outcomes were found after early primary palatal closure. Comparable or even better results were found in comparison with international benchmarks, especially regarding the presence of compensatory articulation. Whether this approach is transferable to Western countries is the subject for further research.

A synchronous papillary and follicular thyroid carcinoma presenting as a large toxic nodule in a female adolescent.

CASE PRESENTATION: We report for the first time a synchronous papillary and follicular thyroid carcinoma in a 12-year-old girl presenting with a large (5 cm diameter) left thyroid nodule, an increased left and right upper pole technetium tracer uptake at scintigraphy and hyperthyroidism. The uptake at the right lobe was explained by the crossing of the left nodule to the right site of the neck at Computed Tomography (CT) scanning. BACKGROUND: Although thyroid nodules are less common in children than in adults, there is more vigilance required in children because of the higher risk of malignancy. According to literature, about 5% of the thyroid nodules in adults are malignant versus 20-26% in children. The characteristics of 9 other pediatric cases with a differentiated thyroid carcinoma presenting with a toxic nodule, which have been reported during the last 20 years, are summarized. A nodular size of more than 3.5 cm and female predominance was a common finding. CONCLUSIONS: The presence of hyperthyroidism in association with a hyperfunctioning thyroid nodule does not rule out thyroid cancer and warrants careful evaluation, even in the absence of cervical lymph node invasion.

Three-dimensional characterisation of the globe position in the orbit.

PURPOSE: Current methods to analyse the globe position, including Hertel exophthalmometry and computed tomography (CT), are limited to the axial plane and require the lateral orbital rim and cornea as landmarks. This pilot study aimed to design a method to measure the position of the globe in the axial, coronal and sagittal plane and independent from orbital bony and corneal references. METHODS: With the aid of three-dimensional CT reconstruction technology, we determined the globe position in the orbit based on the centre of the globe. Method validation was performed using data of consecutive orbital CT scans from the control group and from the patients with Graves' orbitopathy who underwent orbital decompression surgery with removal of the lateral orbital margin. RESULTS: The inter- and intra-observer reliability was excellent with a high intraclass correlation coefficient (> 0.99, 95% CI [0.97; 1.00]). In the decompressed orbits, there was a statistically significant globe position shift along the anterior-posterior axis (P = 0.0005, 95% CI [0.63; 3.66]), but not along the medial-lateral and superior-inferior axis. CONCLUSION: The 3D CT method can accurately and reliably characterise the globe position shift in the three dimensions without using orbital and corneal anatomical landmarks. The method can be useful to determine the globe shift in proptosis, enophthalmos, hypoglobus and hyperglobus, even in the presence of strabismus and orbital bone defects.

New Technologies in Rhinoplasty: A Comprehensive Workflow for Computer-assisted Planning and Execution.

Rhinoplasty in facial cleft patients is among the most challenging types of reconstructive facial surgery due to its variability. Advances in 3-dimensional imaging enable improved preoperative assessment in rhinoplasty. In complex cases with bony support irregularities and asymmetry, it is rational to initiate planning with reconstruction of the aberrant substructure (ie, "bottom-up" planning) rather than starting the surgical design with soft-tissue morphing. We present a new comprehensive workflow in which novel advanced technologies are implemented to perform "bottom-up" computer-assisted planning and execution in complex rhinoplasty cases. This workflow enables meticulous planning, use of grafting templates, and 3-dimensional-guided osteotomies with integration of piezotome and intraoperative navigation. Previous reports separately discuss some of these innovations. However, greater benefit lies in the combination of these techniques, with emphasis on preoperative computer analysis, virtual planning, and transfer to the operation theater. Surgeons are seeking new ways to enhance minimally invasive approaches and to obtain predictable and favorable clinical results. The presently introduced workflow allows clinicians to plan complex cases in a simple, effective, and safe manner, with the combination of different techniques to produce consistent results.

Patient perspectives on electronic health record accessibility and patient participation: a questionnaire survey.

Objectives To explore patient perceptions on personal comfort with participation in their own care process and on support of this patient participation through electronic health record (EHR) accessibility. Methods Explorative quantitative questionnaire study in ambulatory patients visiting the departments of General Internal Medicine or Head, Neck and Maxillo-Facial Surgery of a Belgian tertiary referral center. Results Patients were recruited by convenience sampling of 438 out of the total of 1270 patients visiting either one of these departments within a time period of two weeks. Overall response rate was 97.3% (n = 426; 45.3% male; mean age 42.5 ± 15.4 years). Most patients (89.7%) indicated a desire to make healthcare decisions in partnership with their physician. They were in need of transparent and comprehensible health information. The EHR was perceived as a suitable and effective means to inform patients about their health and to increase involvement in care and treatment (77.6%). Furthermore, access to the EHR was perceived to result in a more effective communication transfer between physician and patient (65.5%), increased patient compliance (64.3%), and satisfaction (57.4%). Conclusion Patients indicate a desire for proactive participation in their individual care process. They felt that medical record accessibility could support decision-making and assist in managing and coordinating individual and personalized care choices.

Facing a New Face: An Interpretative Phenomenological Analysis of the Experiences of a Blind Face Transplant Patient and His Partner.

Increasing evidence points to good functional, aesthetic, and psychosocial outcomes after face transplantation. However, research investigating how patients and their families subjectively experience the transplantation process is lacking thus far. This study aims to investigate the personal experiences of a blind face transplant patient and his partner. In-depth interviews exploring different experiences were conducted with both partners separately 20 months after face transplantation. The interviews were analyzed using interpretative phenomenological analysis. Seven themes were identified in both interviews: coping with the facial trauma, motivation for the face transplantation, outcomes of the face transplantation, acceptance of the new face, gratitude toward the donor family, relation to the medical team, and dealing with the media. Two further themes were only mentioned by the patient (coping with complications and coping with blindness) and one theme only by the partner (loss of choices). The results of this study increase our understanding of the transplantation process as experienced by a face transplant recipient and his partner. They may help to better inform professionals to optimize transplantation procedures or supportive interventions.

Delayed primary palatal closure in resource-poor countries: Speech results in Ugandan older children and young adults with cleft (lip and) palate.

AIMS: Unrepaired clefts still regularly occur in resource-poor countries as a result of limited health-care access. The purpose of the present study was to report resonance, airflow and articulation characteristics following delayed (≥8years) primary palatal closure. METHODS: Fifteen Ugandan participants with cleft (lip and) palate (CP±L) were included as well as 15 age- and gender-matched Ugandan subjects without clefts. Palatal closure was performed at a mean age of 15;10 years using the Sommerlad technique. Speech evaluations were carried out on a single occasion postoperatively (mean age: 18;10 years). Resonance and nasal airflow were perceptually evaluated and detailed phonetic and phonological assessments were carried out. Additionally, nasalance values were determined. RESULTS: Nasal emission occurred postoperatively in only 27% (4/15) of the patients, whereas resonance disorders and articulation errors were prevalent in 87% (13/15) of the patient group. Compared with the control group, a significantly higher prevalence of hypernasality and significantly higher nasalance values for all oral and oronasal speech samples were obtained in the CP±L group. Moreover, significantly smaller consonant inventories and significantly more phonetic and phonological disorders were observed. CONCLUSIONS: Delayed palatal repair (≥8years) seems to be insufficient to eliminate nasal airflow errors, resonance abnormalities, and articulation disorders. In order to prevent patients' late presentation at specialized centers, the availability of high quality surgical cleft palate treatment should increase as well as people's awareness of the possibility and importance of early surgical intervention. Moreover, speech therapy following delayed palatal closure would be beneficial. Furthermore, a standardized and validated protocol for speech assessment in future studies is advocated.