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Dermody SM, Kahng PW, Rao VM, Casper KA, Malloy KM, Rosko AJ, Stucken CL, Chinn SB, Spector ME, Feng AL. Color Match following Free Flap Surgery in Head and Neck Reconstruction: A Colorimetric and Aesthetic Analysis. Plast Reconstr Surg 2024; 153:1142-1150. [PMID: 37285194 DOI: 10.1097/prs.0000000000010807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Many options for free tissue transfer have been described for head and neck reconstruction. Although functional outcomes remain paramount, aesthetic considerations such as color match can be equally consequential for patient quality of life. It is important to understand differences in color match based on flap donor site for head and neck reconstruction. METHODS A retrospective review was performed of patients who underwent head and neck reconstruction with free tissue transfer at a tertiary care academic medical center between November of 2012 and November of 2020. Patients with documented photographs of their reconstruction and external skin paddles were considered. Patient demographics and surgery-specific factors were recorded. Objective differences in color match were obtained by calculating the International Commission on Illumination Delta E 2000 (dE2000) score. Standard univariate descriptive statistics and multivariable statistical analyses were performed. RESULTS Lateral arm, parascapular, and medial sural artery perforator free tissue transfer performed favorably compared with other donor sites, whereas anterolateral thigh flaps had the highest average dE2000 scores. Differences in dE2000 scores were mitigated by postoperative irradiation of the flap site and with increasing time beyond 6 months postoperatively. CONCLUSIONS The authors provide an objective assessment of external skin color match in patients undergoing free tissue transfer for head and neck cancer by donor site. Medial sural artery perforator, lateral arm, and parascapular free flaps performed well compared with traditional donor sites. These differences are more significant at the face and mandible when compared with the neck, but they diminish 6 months after surgery and with postoperative irradiation of the free flap skin paddle. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Sarah M Dermody
- From the Department of Otolaryngology-Head and Neck Surgery, University of Michigan
| | - Peter W Kahng
- From the Department of Otolaryngology-Head and Neck Surgery, University of Michigan
| | - Vishwanatha M Rao
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear
| | - Keith A Casper
- From the Department of Otolaryngology-Head and Neck Surgery, University of Michigan
| | - Kelly M Malloy
- From the Department of Otolaryngology-Head and Neck Surgery, University of Michigan
| | - Andrew J Rosko
- From the Department of Otolaryngology-Head and Neck Surgery, University of Michigan
| | - Chaz L Stucken
- From the Department of Otolaryngology-Head and Neck Surgery, University of Michigan
| | - Steven B Chinn
- From the Department of Otolaryngology-Head and Neck Surgery, University of Michigan
| | - Matthew E Spector
- From the Department of Otolaryngology-Head and Neck Surgery, University of Michigan
| | - Allen L Feng
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School
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Owen S. Commentary on: "Buccal Fat Advancement Transposition Flap for Reconstruction of Midface Volume Defects" by Seth J. Davis et al. Facial Plast Surg Aesthet Med 2024. [PMID: 38597715 DOI: 10.1089/fpsam.2024.0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Affiliation(s)
- Scott Owen
- Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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3
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Shukla A, Loy K, Lu GN. Total lower lip reconstruction: a review of recent advances. Curr Opin Otolaryngol Head Neck Surg 2023; 31:441-451. [PMID: 37831498 DOI: 10.1097/moo.0000000000000926] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
PURPOSE OF REVIEW This review describes the fundamental principles and recent advances in the reconstruction of total lower lip defects to restore peri-oral aesthetic and function. RECENT FINDINGS Modifications to the Abbe flap and visor flap have recently been described. Recent advances to free flap techniques have focused on dynamic restoration of lower lip sling function after reconstruction. This involves the transfer of innervated or noninnervated muscle tissue to reconstruct the lower lip to restore the sphincter function of the lips. SUMMARY The reconstructive goals for a full thickness lower lip defect are to restore a functional oral sphincter, replace mucosal and external skin, and maintain a functional size of the oral aperture. Local flap reconstruction of sub-total lower lip defects is possible, but use of local flaps for total lip reconstruction often leads to microstomia. Several static and dynamic free tissue transfer options exist for lower lip reconstruction and have been summarized in this review.
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Affiliation(s)
- Aishwarya Shukla
- Department of Otolaryngology Head and Neck Surgery, University of Washington, WA, US
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Rasset P, Mange J, Montalan B, Stutterheim SE. Towards a better understanding of the social stigma of facial difference. Body Image 2022; 43:450-462. [PMID: 36345083 DOI: 10.1016/j.bodyim.2022.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 10/10/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
Facial difference (FD) is not only an individual experience; it is inherently social, reflecting interactions between social norms and individual attitudes. Often FD is stigmatized. In this paper, we employ a widely used stigma framework, namely the social stigma framework put forth by Pryor and Reeder (2011), to unpack the stigma of FD. This framework posits that there are four forms of stigma: public stigma, self-stigma, stigma by association, and structural stigma. We first discuss the social and psychological literature on FD as it pertains to these various forms of stigma. We then describe coping approaches for FD stigma. Lastly, we delineate evidence-based methods for addressing the various forms of FD stigma, such that future efforts can more effectively tackle the stigma of facial difference.
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Affiliation(s)
- Pauline Rasset
- Laboratoire de Psychologie de Caen Normandie (LPCN EA 7452), Université de Caen Normandie, France.
| | - Jessica Mange
- Laboratoire de Psychologie de Caen Normandie (LPCN EA 7452), Université de Caen Normandie, France
| | - Benoît Montalan
- Centre de Recherche sur les Fonctionnements et Dysfonctionnements Psychologiques (CRFDP EA 7475), Université de Rouen Normandie, France
| | - Sarah E Stutterheim
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
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5
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Timing and Rationale of Treatment. Dermatol Clin 2022; 40:379-382. [DOI: 10.1016/j.det.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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6
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Bridging a Century-Old Problem: The Pathophysiology and Molecular Mechanisms of HA Filler-Induced Vascular Occlusion (FIVO)—Implications for Therapeutic Interventions. Molecules 2022; 27:molecules27175398. [PMID: 36080164 PMCID: PMC9458226 DOI: 10.3390/molecules27175398] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 01/10/2023] Open
Abstract
Biocompatible hyaluronic acid (HA, hyaluronan) gel implants have altered the therapeutic landscape of surgery and medicine, fostering an array of innovative products that include viscosurgical aids, synovial supplements, and drug-eluting nanomaterials. However, it is perhaps the explosive growth in the cosmetic applications of injectable dermal fillers that has captured the brightest spotlight, emerging as the dominant modality in plastic surgery and aesthetic medicine. The popularity surge with which injectable HA fillers have risen to in vogue status has also brought a concomitant increase in the incidence of once-rare iatrogenic vaso-occlusive injuries ranging from disfiguring facial skin necrosis to disabling neuro-ophthalmological sequelae. As our understanding of the pathophysiology of these injuries has evolved, supplemented by more than a century of astute observations, the formulation of novel therapeutic and preventative strategies has permitted the amelioration of this burdensome complication. In this special issue article, we review the relevant mechanisms underlying HA filler-induced vascular occlusion (FIVO), with particular emphasis on the rheo-mechanical aspects of vascular blockade; the thromboembolic potential of HA mixtures; and the tissue-specific ischemic susceptibility of microvascular networks, which leads to underperfusion, hypoxia, and ultimate injury. In addition, recent therapeutic advances and novel considerations on the prevention and management of muco-cutaneous and neuro-ophthalmological complications are examined.
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Ayyagari R, Goldschmidt D, Mu F, Caroff SN, Carroll B. An Experimental Study to Assess the Professional and Social Consequences of Tardive Dyskinesia. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2022; 20:154-166. [PMID: 35078958 PMCID: PMC8813323 DOI: 10.9758/cpn.2022.20.1.154] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/12/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Antipsychotic medications may cause tardive dyskinesia (TD), an often-irreversible movement disorder characterized by involuntary movements that are typically stereotypic, choreiform, or dystonic and may impair quality of life. This study evaluated others' perceptions of abnormal TD movements in professional and social situations. METHODS This was an experimental, randomized, blinded, digital survey in a general population sample. Participants were randomized 1:1 into a test or control group to view a video of a professional actor simulating TD movements or no TD movements prior to completing surveys on employment, dating, and friendship domains. Assessments for mild-to-moderate and moderate-to-severe TD movements were conducted separately. Authenticity of abnormal movements and Abnormal Involuntary Movement Scale (AIMS) scores were evaluated by physician experts. RESULTS Surveys were completed by 2,400 participants each for mild-to-moderate and moderate-to-severe TD. In all domains, participants responded significantly less favorably to persons with TD movements (both mild-to-moderate and moderate-to-severe) than those without TD movements. Fewer participants in the test versus control group for mild-to-moderate and moderate-to-severe TD, respectively, considered the candidate as a potential employee (29.2% and 22.7% fewer), found him/her attractive (20.5% and 18.7% fewer), and were interested in becoming friends with him/her (12.3% and 16.5% fewer). CONCLUSION Professional actors simulating TD movements were perceived more negatively than those without TD movements in employment, dating, and friendship domains. To our knowledge, this is the first randomized study to quantify professional and social stigma associated with TD movements that may reduce opportunities for gainful employment, marital status, and an effective support system.
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Affiliation(s)
| | | | - Fan Mu
- Analysis Group, Inc., Boston, MA, USA
| | - Stanley N. Caroff
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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8
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Depani M, Ferry AM, Grush AE, Moreno TA, Jones LM, Thornton JF. Use of Biologic Agents for Lip and Cheek Reconstruction. Semin Plast Surg 2022. [DOI: 10.1055/s-0042-1742747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AbstractThe unique requirements of reconstructing cheek defects, often with its proximity to the mobile elements of the face including the lip and the eyelid, have been met very handily with the directed and thoughtful use of biologic wound healing agents. One of the key advantages of these agents is their ability to provide coverage for the mobile elements of the cheek and the lip in patients with multiple co-morbidities. These agents are successfully used where the standard cheek closure techniques including cervicofacial advancement flap are contraindicated due to its anesthetic requirement. Additionally, lip reconstruction involves examining the lip's three anatomic layers: mucosa, muscle, and skin. The defects must be planned for reconstruction based on the involvement of these layers. This paper serves to introduce the use of biologic wound healing agents depending on the involvement of these layers. The authors provide specific illustrations of these agents based on defect location, tissue involvement, and severity of the defect to help with procedural planning to reconstruct a very aesthetically involved part of the face.
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Affiliation(s)
- Monal Depani
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Andrew M. Ferry
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Andrew E. Grush
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Tanir A. Moreno
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Lloyd M. Jones
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - James F. Thornton
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
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9
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Pouwels S, Sanfilippo S, Owen E, Ingels KJAO, De Jongh FW, Blondeel P, Monstrey SJ. Measuring outcomes in facial palsy treatment: adding extra dimensions to a complex matter. EUROPEAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.1007/s00238-021-01937-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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10
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Depani M, Ferry AM, Grush AE, Moreno TA, Jones LM, Thornton JF. Use of Biologic Agents for Lip and Cheek Reconstruction. Semin Plast Surg 2021; 36:26-32. [PMID: 35706563 PMCID: PMC9192158 DOI: 10.1055/s-0041-1741399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The unique requirements of reconstructing cheek defects, often with its proximity to the mobile elements of the face including the lip and the eyelid, have been met very handily with the directed and thoughtful use of biologic wound healing agents. One of the key advantages of these agents is their ability to provide coverage for the mobile elements of the cheek and the lip in patients with multiple co-morbidities. These agents are successfully used where the standard cheek closure techniques including cervicofacial advancement flap are contraindicated due to its anesthetic requirement. Additionally, lip reconstruction involves examining the lip's three anatomic layers: mucosa, muscle, and skin. The defects must be planned for reconstruction based on the involvement of these layers. This paper serves to introduce the use of biologic wound healing agents depending on the involvement of these layers. The authors provide specific illustrations of these agents based on defect location, tissue involvement, and severity of the defect to help with procedural planning to reconstruct a very aesthetically involved part of the face.
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Affiliation(s)
- Monal Depani
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Andrew M. Ferry
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Andrew E. Grush
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Tanir A. Moreno
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Lloyd M. Jones
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - James F. Thornton
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas,Address for correspondence James F. Thornton, MD Department of Plastic Surgery, University of Texas Southwestern Medical Center1801 Inwood Road, Dallas, TX 75390-9132
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11
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Knott PD, Alemi SA, Han M, Seth R, Park AM, Heaton CM, Grekin RC, Arron ST, Neuhaus I, Yu SS, Saylor DK, Zhu BZ. Skin Color Match in Head and Neck Reconstructive Surgery. Laryngoscope 2021; 132:1753-1759. [PMID: 34904721 DOI: 10.1002/lary.29959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/03/2021] [Accepted: 11/03/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To quantify the degree of color match achieved during microvascular facial reconstruction, and to describe a novel technique for improving reconstructive skin color match. We hypothesize that split-thickness skin grafts (STSG) placed atop de-epithelialized free tissue produces better facial skin color match than free tissue with intact epithelium. STUDY DESIGN Cross sectional photographic study of reconstructed facial skin color match. METHODS Sixty-eight adults, who underwent head and neck reconstructive surgery, were divided into six categories based on cutaneous reconstructive technique: cervicofacial flap, radial forearm free flap (RFFF), fibula free flap, anterolateral thigh free flap (ALT), STSG over adiopofascial flap (STAFF), and STSG over myogenous flap (STMF). Averaged color samplings of the reconstructed defect and adjacent normal skin were taken from digital photographs. The color difference was calculated using the delta-E calculation. Blinded expert observers also rated the degree of color match. Nonparametric cohort contrast and correlation statistical analyses were performed. RESULTS The mean delta-E's and 10-point Likert ratings for the ALT, fibula, RFFF, STAFF, STMF, and cervicofacial flaps were 11.6, 10.0, 7.7, 6.3, 8.8, and 4.7, and 5.1, 6.4, 2.4, 3.2, 2.7, and 1.1, respectively. Likert scale inter-rater correlation was strong, with coefficient = 0.80. CONCLUSIONS On average, STSG over de-epithelialized myogenous and adipofascial free tissue transfers produced a better color match than the skin paddles of donor sites, with the exception of the radial forearm donor site. Delta-E values obtained from photos correlated well with expert ratings of color match. This reliable technique for quantifying color match may be used in future studies. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Philip Daniel Knott
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, U.S.A
| | - Sean A Alemi
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, U.S.A
| | - Mary Han
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, U.S.A
| | - Rahul Seth
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, U.S.A
| | - Andrea M Park
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, U.S.A
| | - Chase M Heaton
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, U.S.A
| | - Roy C Grekin
- Department of Dermatology, University of California, San Francisco, California, U.S.A
| | - Sarah T Arron
- Department of Dermatology, University of California, San Francisco, California, U.S.A
| | - Isaac Neuhaus
- Department of Dermatology, University of California, San Francisco, California, U.S.A
| | - Siegrid S Yu
- Department of Dermatology, University of California, San Francisco, California, U.S.A
| | - Drew K Saylor
- Department of Dermatology, University of California, San Francisco, California, U.S.A
| | - Bovey Z Zhu
- Department of Otolaryngology-Head and Neck Surgery, Tripler Army Medical Center, Honolulu, Hawaii, U.S.A
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Jonas RH, Patel KG, Rist TM, Walker ER, Oyer SL. Patient and Observer Graded Rhinoplasty Scar Outcomes: A Randomized Controlled Trial of Fast Absorbing Versus Permanent Columellar Suture Closure. Facial Plast Surg Aesthet Med 2021; 24:196-201. [PMID: 34495754 DOI: 10.1089/fpsam.2021.0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: When performing an open rhinoplasty, surgeons commonly use nonabsorbable skin sutures to close the columellar incision. These are believed to minimize scarring. However, removal can be associated with patient discomfort and outcomes may not be superior to using absorbable sutures. Objective: To compare difference in scar appearance for columellar closure after rhinoplasty with absorbable and nonabsorbable sutures. Methods: We performed a prospective randomized control trial with 61 patients. Forty-one patients completed follow-up and were included in final analysis: 23 whose columellar incision was closed with absorbable sutures and 18 with nonabsorbable sutures. A blinded surgeon performed Stony Brook Evaluation Scale (SBES) and a patient performed Patient Scar Assessment Questionnaire (PSAQ) was completed for each suture type. Results: Our results did not reject the null hypothesis that there is no difference in SBES or PSAQ scores between absorbable and nonabsorbable suture types. Conclusions: No difference was detected in scar outcomes between absorbable and nonabsorbable sutures for closure of the columellar incision created during an open rhinoplasty as rated by both patients and blinded clinicians.
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Affiliation(s)
- Rachel H Jonas
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Krishna G Patel
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Tyler M Rist
- Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Elizabeth R Walker
- Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Samuel L Oyer
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, University of Virginia, Charlottesville, Virginia, USA
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13
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Zebolsky AL, Patel N, Heaton CM, Park AM, Seth R, Knott PD. Patient-Reported Aesthetic and Psychosocial Outcomes After Microvascular Reconstruction for Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2021; 147:1035-1044. [PMID: 34292310 DOI: 10.1001/jamaoto.2021.1563] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Aesthetic outcomes are key determinants of psychosocial functioning among surgically treated patients with head and neck cancer (HNC); however, long-term aesthetic outcomes after microvascular free tissue transfer (MFTT) are not well described. Objective To examine risk factors for impaired long-term aesthetic satisfaction and appearance-related psychosocial functioning after HNC ablation with MFTT. Design, Setting, and Participants A cross-sectional, web-based survey was conducted at an academic tertiary care center. A total of 228 individuals who underwent MFTT between January 1, 2015, and December 31, 2019, for treatment of HNC were included. The study was conducted from November 1, 2020, through January 15, 2021. Exposures Head and neck cancer ablation with MFTT. Main Outcomes and Measures Patient-reported outcomes were assessed via Aesthetic FACE-Q scales. The primary objective was aesthetic satisfaction determined by the Satisfaction With Facial Appearance scale. Secondarily, the Appearance-Related Psychosocial Distress, Psychological Function, and Social Function scales were used to assess appearance-related psychosocial functioning. Patients were stratified by demographic, disease, surgical, and postoperative characteristics. Survey scores on a 100-point scale were compared and subjected to univariable and multivariable linear regression. Results A total of 124 of 228 patients (54.4%) completed surveys a median of 34.4 months after MFTT (interquartile range, 22.6-48.8). Most responders (79 [63.7%]) were men with advanced cancer of the oral cavity or skin, reconstructed with anterolateral thigh or osteocutaneous fibula free flaps. Nonresponders had no significant differences in baseline characteristics. The Satisfaction With Facial Appearance score was independently lower among patients who received osteocutaneous flaps (regression coefficient, -10.6 points, 95% CI, -20.4 to -0.8 points) and/or adjuvant (chemo)radiotherapy (regression coefficient, -6.9 points; 95% CI, -13.8 to -0.1 points). Impaired appearance-related psychosocial functioning was independently associated with female sex, a history of anxiety or depression, osteocutaneous flaps, prolonged tube feeding requirements, and any recurrent or persistent disease. After adjustment for covariates, each 1-point increase in the Satisfaction With Facial Appearance score independently estimated improved appearance-related psychosocial functioning as determined by the Appearance-Related Psychosocial Distress scale (regression coefficient, -0.5 points; 95% CI, -0.7 to -0.4 points), Psychological Function scale (regression coefficient, 0.4 points; 95% CI, 0.3 to 0.5 points), and Social Function scale (regression coefficient, 0.4 points; 95% CI, 0.3 to 0.6 points). Conclusions and Relevance The findings of this cross-sectional, web-based survey study suggest that osteocutaneous reconstruction and adjuvant therapy independently increase the risk of poor patient-reported long-term aesthetic satisfaction, which correlated with impaired appearance-related psychosocial functioning. Aesthetic outcomes appear to be a priority to address in patients with HNC undergoing MFTT.
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Affiliation(s)
- Aaron L Zebolsky
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
| | - Neil Patel
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of California, San Francisco
| | - Chase M Heaton
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
| | - Andrea M Park
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
| | - Rahul Seth
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
| | - P Daniel Knott
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
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14
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Abstract
This article provides a review of soft tissue reconstructive options for the parotidectomy defect, including skin incision, primary closure, acellular dermis, autologous fat transfer, local and regional flaps, and free tissue transfer. The authors discuss considerations for volume enhancement, skin coverage, prevention of Frey syndrome, tumor surveillance, and potential complications.
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Affiliation(s)
- Jennifer Moy
- Department of Otolaryngology/Head and Neck Surgery at Oregon Health & Science University, 3181 SW Sam Jackson Park Road, PV01, Portland, OR 97239, USA
| | - Mark K Wax
- Department of Otolaryngology/Head and Neck Surgery at Oregon Health & Science University, 3181 SW Sam Jackson Park Road, PV01, Portland, OR 97239, USA
| | - Myriam Loyo
- Department of Otolaryngology/Head and Neck Surgery at Oregon Health & Science University, 3181 SW Sam Jackson Park Road, PV01, Portland, OR 97239, USA.
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15
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Patient Expectations Influence Postoperative Facial Satisfaction Measured by the FACE-Q Skin Cancer Module: A Pilot Study. Dermatol Surg 2021; 46:1113-1115. [PMID: 31306272 DOI: 10.1097/dss.0000000000002014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Anderies BJ, Dey JK, Gruszczynski NR, Price DL, Moore EJ, Janus JR. Dermal Fat Grafting to Reconstruct the Parotidectomy Defect Normalizes Facial Attention. Laryngoscope 2020; 131:E124-E131. [PMID: 32658339 DOI: 10.1002/lary.28890] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/18/2020] [Accepted: 06/03/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Use validated eye-tracking technology to objectively measure 1) the attentional distraction of facial contour defects after superficial and total parotidectomy and 2) changes in attentional distraction with abdominal dermal fat graft reconstruction. METHODS Standardized frontal and oblique facial images of 16 patients who had undergone superficial or total parotidectomy with or without fat graft reconstruction; four normal controls were obtained. One hundred casual observers were recruited to view these images, and gaze data were collected using a Tobii Pro eye-tracking system. Gaze durations for predefined facial areas of interest were analyzed using mixed-effects linear regression to test study hypotheses. RESULTS For frontal images, total parotidectomy increased gaze to the operated parotid area compared to the contralateral nonoperated parotid area (92 milliseconds, 95% confidence interval [CI]: 48-138 milliseconds, P < .001). Fat grafting normalized the attentional distraction, with no difference in gaze time on the operated parotid region compared to normal control faces (P = .414). For oblique images, total parotidectomy increased gaze to the operated parotid area compared to the contralateral nonoperated parotid area (658 milliseconds, 95% CI: 463-854 milliseconds, P < .001). Fat grafting normalized this attentional distraction, with no difference in gaze time on the operated parotid region compared to normal control faces (P = .504). In both views, superficial parotidectomy demonstrated no significant attentional distractions, with or without fat grafting. CONCLUSIONS This eye-tracking study objectively demonstrates that total parotidectomy results in a facial contour deformity that is distracting to observers, whereas superficial parotidectomy does not. For total parotidectomy, this attentional distraction can be normalized with dermal fat graft reconstruction. LEVEL OF EVIDENCE 3b Laryngoscope, 131:E124-E131, 2021.
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Affiliation(s)
- Barrett J Anderies
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jacob K Dey
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Nelson R Gruszczynski
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeffrey R Janus
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Jacksonville, Florida, USA
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Strohl MP, Junn JC, House AE, Heaton CM, Seth R, Park AM, Knott PD. Long-Term Stability of Vascularized Adipofascial Flaps in Facial Reconstruction. Facial Plast Surg Aesthet Med 2020; 22:262-267. [PMID: 32250652 DOI: 10.1089/fpsam.2019.0015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Objectives: To determine the quantitative volume change over time of vascularized adipofascial anterolateral thigh (AFALT) free flaps in facial reconstruction, and to evaluate patient factors that are associated with changes in volume. Methods: A retrospective review was performed on patients who underwent AFALT reconstruction for large volume parotid and midface defects after head and neck cancer surgery at a single tertiary care hospital from 2011 to 2018. Flap volume was measured at different time points using 3D Slicer, a free open source software for medical image computing. Trends in volume change over time were evaluated. A multiple linear regression model was used to analyze patient factors associated with mean final volume change. Results: Twenty-one patients were included. The median follow-up period from surgery was 17 months (interquartile range [IQR] = 9-25 months). The first imaging study was obtained a median of 3 months after surgery (IQR = 1-4 months). The majority of patients underwent postoperative radiation (20/21, 95%). Mean final total volume percentage change over time was 96.6% (standard deviation = 21.7%). After controlling for age, smoking history, recurrence, and length of follow-up, a reduction in body mass index (BMI) ≥1.5 U from baseline had the greatest association with mean final volume percentage change (β -31, 95% confidence interval: -52 to -11, p = 0.005). Conclusions: Free tissue transfer using AFALT flaps in the head and neck provided relatively stable volume maintenance over time, even after postoperative radiation. The volume of transplanted fat can change depending on patient factors, such as BMI.
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Affiliation(s)
- Madeleine P Strohl
- Section of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California
| | - Jaqueline C Junn
- Division of Neuroradiology, Department of Radiology, University of California, San Francisco, San Francisco, California
| | - Adrian E House
- Section of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California
| | - Chase M Heaton
- Section of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California
| | - Rahul Seth
- Section of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California
| | - Andrea M Park
- Section of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California
| | - P Daniel Knott
- Section of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California
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Dey JK, Ishii LE, Boahene KDO, Byrne PJ, Ishii M. Measuring Outcomes of Mohs Defect Reconstruction Using Eye-Tracking Technology. JAMA FACIAL PLAST SU 2020; 21:518-525. [PMID: 31670742 DOI: 10.1001/jamafacial.2019.1072] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Objectively measuring how Mohs defect reconstruction changes casual observer attention has important implications for patients and facial plastic surgeons. Objective To use eye-tracking technology to objectively measure the ability of Mohs facial defect reconstruction to normalize facial attention. Design, Setting, and Participants This observational outcomes study was conducted at an academic tertiary referral center from January to June 2016. An eye-tracking system was used to record how 82 casual observers directed attention to photographs of 32 patients with Mohs facial defects of varying sizes and locations before and after reconstruction as well as 16 control faces with no facial defects. Statistical analysis was performed from November 2018 to January 2019. Main Outcomes and Measures First, the attentional distraction caused by facial defects was quantified in milliseconds of gaze time using eye tracking. Second, the eye-tracking data were analyzed using mixed-effects linear regression to assess the association of facial defect reconstruction with normalized facial attention. Results The 82 casual observers (63 women and 19 men; mean [SD] age, 34 [12] years) viewed control faces in a similar and consistent fashion, with most attention (65%; 95% CI, 62%-69%) directed at the central triangle, which includes the eyes, nose, and mouth. The eyes were the most visually important feature, capturing a mean of 60% (95% CI, 57%-64%) of fixation time within the central triangle and 39% (95% CI, 36%-43%) of total observer attention. The presence of Mohs defects was associated with statistically significant alterations in this pattern of normal facial attention. The larger the defect and the more centrally a defect was located, the more attentional distraction was observed, as measured by increased attention on the defect and decreased attention on the eyes, ranging from 729 (95% CI, 526-931) milliseconds for small peripheral defects to 3693 (95% CI, 3490-3896) milliseconds for large central defects. Reconstructive surgery was associated with improved gaze deviations for all faces and with normalized attention directed to the eyes for all faces except for those with large central defects. Conclusions and Relevance Mohs defects are associated with altered facial perception, diverting attention from valuable features such as the eyes. Reconstructive surgery was associated with normalized attentional distraction for many patients with cutaneous Mohs defects. These data are important to patients who want to know how reconstructive surgery could change the way people look at their face. The data also point to the possibility of outcomes prediction based on facial defect size and location before reconstruction. Eye tracking is a valuable research tool for outcomes assessment that lays the foundation for understanding how reconstructive surgery may change perception and normalize facial deformity.
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Affiliation(s)
- Jacob K Dey
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Lisa E Ishii
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Kofi D O Boahene
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Patrick J Byrne
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Masaru Ishii
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
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Bunnell AM. The Facial Skin Defect: Preop to Postop. Atlas Oral Maxillofac Surg Clin North Am 2020; 28:1-5. [PMID: 32008703 DOI: 10.1016/j.cxom.2019.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Anthony M Bunnell
- Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine-Jacksonville, 653-1 West 8th Street, Jacksonville, FL 32209, USA.
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Faris C, Heiser A, Quatela O, Jackson M, Tessler O, Jowett N, Lee LN. Health utility of rhinectomy, surgical nasal reconstruction, and prosthetic rehabilitation. Laryngoscope 2019; 130:1674-1679. [PMID: 31846094 DOI: 10.1002/lary.28480] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 09/04/2019] [Accepted: 11/20/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Advanced nasal malignancies may require rhinectomy, which can have profound psychosocial impacts. Rhinectomy defects can be rehabilitated through surgery or prosthetics. We seek to understand the health utility of the rhinectomy defect, surgical, and prosthetic reconstruction, which have not been previously studied. STUDY DESIGN Prospective clinical study METHODS: Adult naïve observers (n = 273) ranked the utility of five randomized health states (monocular blindness, binocular blindness, post-rhinectomy nasal defect, postsurgical reconstruction, and post-prosthetic rehabilitation). Health utilities were measured using visual analogue scale (VAS), standard gamble (SG), and time trade-off (TTO). One-way analysis of variance (ANOVA) with post hoc Scheffe's test and the independent samples T-test for a priori comparisons were performed. Multiple linear regression was performed using participant demographics as independent predictors of utility scores. RESULTS Health utilities (VAS, SG, TTO) were reported as follows (mean ± SD): monocular blindness (0.71 ± 0.21, 0.84 ± 0.20, 0.85 ± 0.19), binocular blindness (0.48 ± 0.25, 0.68 ± 0.28, 0.63 ± 0.28), post-rhinectomy nasal defect (0.59 ± 0.24, 0.74 ± 0.24, 0.74 ± 0.24), postsurgical reconstruction (0.88 ± 0.16, 0.90 ± 0.18, 0.89 ± 0.13), and post-prosthetic rehabilitation (0.67 ± 0.22, 0.80 ± 0.23, 0.82 ± 0.20). Both surgical reconstruction (P < .001) and prosthetic rehabilitation (P < .001) significantly improved health utility. SG and TTO utility scores were inversely associated with observer age (P < .001) and participants who identified themselves as non-Caucasians (P < .05) in post-rhinectomy nasal defect, post-nasal surgical reconstruction, and post-nasal prosthetic rehabilitation health states, while higher levels of education were directly associated with SG scores (P < .05), respectively. CONCLUSION This is the first study to demonstrate the significant negative impact of the rhinectomy nasal defect on health utility. Rehabilitation by surgical or prosthetic techniques significantly increases health utility as rated by naïve observers. Laryngoscope, 130:1674-1679, 2020.
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Affiliation(s)
- Callum Faris
- Department of Otolaryngology, University of Antwerp Medical Center, Antwerp, Belgium, U.S.A
| | - Alyssa Heiser
- Division of Facial Plastic and Reconstructive Surgery Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Olivia Quatela
- Division of Facial Plastic and Reconstructive Surgery Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Matthew Jackson
- Department of Otolaryngology Head & Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | | | - Nate Jowett
- Department of Otolaryngology, University of Antwerp Medical Center, Antwerp, Belgium, U.S.A
| | - Linda N Lee
- Division of Facial Plastic and Reconstructive Surgery Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
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Lew VH, See AAQ, Goh JJ, Wong TH, King NKK. Survey on Willingness to Pay for Life-Saving Treatment, Functional Recovery, and Cosmesis in a Neuroscience Outpatient Clinic Setting in Singapore. Value Health Reg Issues 2019; 21:45-52. [PMID: 31648146 DOI: 10.1016/j.vhri.2019.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 05/31/2019] [Accepted: 07/23/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Neurologic disorders impose a heavy burden on healthcare in Singapore. To date, no data on the willingness to pay (WTP) for neurologic treatments has been reported in the local population. OBJECTIVES We aimed to quantify the value of various health domains to neuroscience patients and their caregivers by comparing their WTP for different types of treatments. METHODS A questionnaire using a mixed open-ended and closed-ended contingent valuation method was developed to elicit WTP and self-administered by 112 visitors to a neuroscience outpatient clinic. The WTP for treatments in 3 health domains (advanced restoration of function, life extension, and cosmesis) was evaluated and compared. Subgroup regression analysis was performed to investigate the impact of demographic and socioeconomic factors. RESULTS Treatment that improved cosmesis had the highest median WTP of Singapore dollar (SGD) 35 000, followed by treatment that provided 1 year of life extension (SGD 20 000) and 1 year of advanced restored function (SGD 10 000; P < .001). Respondents with a university education were willing to pay as much as 2 to 3 times of those without across all health domains. CONCLUSION This is the first study to provide data on how different health domains are valued by neuroscience patients and caregivers in our population. Respondents valued treatment that restored or improved their physical appearances the most. These findings could contribute to future policies on the improvement of neuroscience care.
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Affiliation(s)
- Voon Hao Lew
- Department of Neurosurgery, National Neuroscience Institute, Singapore
| | - Angela An Qi See
- Department of Neurosurgery, National Neuroscience Institute, Singapore; Department of Neurosurgery, Singapore General Hospital, Singapore
| | - Jia Jun Goh
- Department of Neurosurgery, National Neuroscience Institute, Singapore
| | - Ting Hway Wong
- Department of General Surgery, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore
| | - Nicolas Kon Kam King
- Department of Neurosurgery, National Neuroscience Institute, Singapore; Department of Neurosurgery, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore.
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22
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Vanison C, Beckmann N, Smith A. Recent advances in lip reconstruction. Curr Opin Otolaryngol Head Neck Surg 2019; 27:219-226. [DOI: 10.1097/moo.0000000000000531] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Juarez MC, Ishii L, Nellis JC, Bater K, Huynh PP, Fung N, Darrach H, Russell JO, Ishii M. Objectively measuring social attention of thyroid neck scars and transoral surgery using eye tracking. Laryngoscope 2019; 129:2789-2794. [DOI: 10.1002/lary.27933] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 02/17/2019] [Accepted: 02/25/2019] [Indexed: 12/31/2022]
Affiliation(s)
| | - Lisa Ishii
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck SurgeryJohns Hopkins University School of Medicine Baltimore Maryland U.S.A
- Department of Otolaryngology–Head and Neck SurgeryJohns Hopkins University School of Medicine Baltimore Maryland U.S.A
| | - Jason C. Nellis
- Department of Otolaryngology–Head and Neck SurgeryJohns Hopkins University School of Medicine Baltimore Maryland U.S.A
| | - Kristin Bater
- Johns Hopkins School of Medicine Baltimore Maryland U.S.A
| | | | - Nicholas Fung
- Johns Hopkins School of Medicine Baltimore Maryland U.S.A
| | - Halley Darrach
- Johns Hopkins School of Medicine Baltimore Maryland U.S.A
| | - Jonathon O. Russell
- Department of Otolaryngology–Head and Neck SurgeryJohns Hopkins University School of Medicine Baltimore Maryland U.S.A
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology–Head and Neck SurgeryJohns Hopkins University School of Medicine Baltimore Maryland U.S.A
| | - Masaru Ishii
- Department of Otolaryngology–Head and Neck SurgeryJohns Hopkins University School of Medicine Baltimore Maryland U.S.A
- Division of Rhinology, Department of Otolaryngology–Head and Neck SurgeryJohns Hopkins University School of Medicine Baltimore Maryland U.S.A
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Liao D, Ishii M, Darrach HM, Bater KL, Smith J, Joseph AW, Douglas RS, Joseph SS, Ishii LE. Objectively Measuring Observer Attention in Severe Thyroid-Associated Orbitopathy: A 3D Study. Laryngoscope 2018; 129:1250-1254. [PMID: 30151919 DOI: 10.1002/lary.27447] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 04/23/2018] [Accepted: 06/20/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Measure the attentional distraction of facial deformity related to severe thyroid-associated orbitopathy using three-dimensional (3D) images and eye-tracking technology. METHODS Observers recruited at an academic tertiary referral center viewed 3D facial images of patients with severe thyroid-associated orbitopathy (TAO) and controls without TAO. An infrared eye-tracking monitor recorded their eye movements and fixations in real time. Multivariate Hotelling's analysis, followed by planned posthypothesis testing, was used to compare fixation durations for predefined regions of interest, including the eyes, nose, mouth, central triangle, and remaining face without the central triangle between severe TAO patients and controls. RESULTS One hundred sixteen observers (mean age 26.4 years, 51% female) successfully completed the eye-tracking experiment. The majority of their attention was directed toward the central triangle (eyes, nose, mouth). On multivariate analysis, there were significant differences in the distribution of attention between control and severe TAO faces (T2 = 49.37; F(5,922) = 9.8314, P < 0.0001). On planned posthypothesis testing, observers attended significantly more to the eyes (0.77 seconds, P < 0.0001, 95% confidence interval [CI], 0.51, 1.03 seconds) and less to the nose (-0.42 seconds, P < 0.0001, 95% CI, -0.23, -0.62 seconds) in severe TAO patients. There was no significant difference in time spent on the mouth, the total time spent on the central triangle, or time spent in the remaining face between the two groups. CONCLUSION Severe TAO distracted observer attention toward the eyes compared to control patients. These data lend insight into how TAO may alter observers' perceptions of these patients. Future studies should investigate how these changes in observer gaze patterns may reflect the social perception of TAO patients. LEVEL OF EVIDENCE NA Laryngoscope, 129:1250-1254, 2019.
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Affiliation(s)
- David Liao
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Masaru Ishii
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Halley M Darrach
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kristin L Bater
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jane Smith
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, U.S.A
| | - Andrew W Joseph
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Raymond S Douglas
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, U.S.A
| | - Shannon S Joseph
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, U.S.A
| | - Lisa E Ishii
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Hochman M. The Role of Surgery in the Management of Infantile Hemangiomas: What is the Best Timing? Otolaryngol Clin North Am 2018; 51:119-123. [PMID: 29217056 DOI: 10.1016/j.otc.2017.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Surgery for the management of infantile hemangiomas has become commonplace. Surgical technique articles are plentiful; however, little has been written about the timing of surgery. Knowledge of the biology of the tumors, data from developmental psychology, and the utility of facial reconstruction provide guidelines for timing of surgical intervention.
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Affiliation(s)
- Marcelo Hochman
- The Hemangioma and Malformation Treatment Center, Charleston, SC, USA.
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Dey JK, Ishii LE, Nellis JC, Boahene KDO, Byrne PJ, Ishii M. Comparing Patient, Casual Observer, and Expert Perception of Permanent Unilateral Facial Paralysis. JAMA FACIAL PLAST SU 2017; 19:476-483. [PMID: 28056121 DOI: 10.1001/jamafacial.2016.1630] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Importance Differences in perception of facial paralysis among patients, casual observers, and experts may have implications for outcomes research and patient care. Objective To compare multiple domains of casual observer and expert perception with the actual experience of patients with permanent unilateral facial paralysis. Design, Setting, and Participants This investigation was a prospective cohort study conducted at an academic tertiary referral center. Patients with permanent unilateral facial paralysis (House-Brackmann grades IV to VI) were randomly selected from The Johns Hopkins University Division of Facial Plastic and Reconstructive Surgery clinic. A diverse group of casual observers and experts were recruited to rate their perception of each patient with facial paralysis. The study dates were July 2014 to July 2015. Main Outcomes and Measures Patients rated their paralysis severity, attractiveness, quality of life, and affect using established metrics. Casual observers and experts viewed standardized facial videos of each patient and then used the same metrics to rate each patient's paralysis severity, attractiveness, quality of life, and affect. Results The analysis yielded 40 patient observations, 6400 casual observer observations, and 200 expert observations for each outcome metric in the study. Compared with the patients' self-perception, casual observers and experts rated patients with facial paralysis more negatively in all measured domains. A multivariable mixed-effects regression showed that observers perceived patients as having greater paralysis severity (8.49 [95% CI, -0.65 to 17.64] of 100 points; SE, 4.67), being less attractive (-7.71 [95% CI, -14.92 to -0.50] of 100 points; SE, 3.68), and having a worse quality of life (-7.76 [95% CI, -14.18 to -1.34] of 100 points; SE, 3.28) compared with the patients' perceptions. Logistic regression demonstrated that observers were less likely to rate patients' affect as positive (odds ratio, 0.28 [95% CI, 0.14-0.58]; SE, 0.10) compared with the patients' self-rating. The raw data and regression analyses also showed that patients, casual observers, and experts perceived faces with higher House-Brackmann grades more negatively in all measured domains of facial perception. Conclusions and Relevance This study found that casual observers and experts generally perceive patients with facial paralysis more negatively than patients perceive themselves. These findings have implications for patients and facial plastic surgeons alike. They also emphasize the importance of assessing outcomes from all 3 perspectives. This pilot study lays the groundwork for developing new tools to assess the social perception of facial deformity that could lead to advancement in facial paralysis outcomes research and improved care for patients with facial paralysis. Level of Evidence NA.
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Affiliation(s)
- Jacob K Dey
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lisa E Ishii
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jason C Nellis
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kofi D O Boahene
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Patrick J Byrne
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Masaru Ishii
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Kossintseva I, Zloty D. Determinants and Timeline of Perioperative Anxiety in Mohs Surgery. Dermatol Surg 2017; 43:1029-1035. [DOI: 10.1097/dss.0000000000001152] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Dey JK, Ishii LE, Joseph AW, Goines J, Byrne PJ, Boahene KDO, Ishii M. The Cost of Facial Deformity: A Health Utility and Valuation Study. JAMA FACIAL PLAST SU 2017; 18:241-9. [PMID: 27010626 DOI: 10.1001/jamafacial.2015.2365] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE The impact of facial defects on quality of life as perceived by society and the value society places on facial reconstruction are important outcomes measures. OBJECTIVE To measure the health state utility and dollar value of surgically reconstructing facial defects as perceived by society. DESIGN, SETTING, AND PARTICIPANTS A randomized observational study conducted in an academic tertiary referral center using a socioeconomically diverse group of 200 casual observers. MAIN OUTCOMES AND MEASURES Observers viewed images of faces with defects of varying sizes and locations before and after surgical reconstruction. Observers imagined if the defect in each image were on their own face and rated (1) their health state utility with the defect and (2) how much they would be willing to pay to have the defect surgically repaired to normal (perfect repair). Established health state utility and contingent valuation metrics were used. RESULTS Data from 200 observers were analyzed. Facial defects significantly decreased perceived health state utility with the greatest penalty attributed to large and centrally located defects. Surgical reconstruction of the facial defects increased health state utility to near-normal ranges for all groups except large central defects. Participants were willing to pay an average of $1170 (95% CI, $767-$1572) to repair a de novo small peripheral defect; they were willing to pay $4274 more than the average (95% CI, $3296-$5251) to repair a large defect and $2372 more (95% CI, $1379-$3366) to repair a central defect. Using these valuation and health utility data, we calculated willingness to pay per quality-adjusted life-year (WTP/QALY), a value-related metric. Mean WTP/QALY ratios ranged from $639/QALY for repairing small peripheral defects to $2838/QALY for repairing large central defects, well below all cost-effectiveness thresholds. CONCLUSIONS AND RELEVANCE Casual observers perceived that facial defects significantly decrease quality of life, an effect improved by reconstructive surgery. Measuring WTP and calculating WTP/QALY provides novel data to assess the social importance and value of facial reconstructive surgery. To our knowledge, these are the first data demonstrating that surgical reconstruction of facial defects is a high-value intervention as perceived by society. These findings have implications for a broad range of stakeholders, including patients, surgeons, health policy makers, and payers. LEVEL OF EVIDENCE NA.
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Affiliation(s)
- Jacob K Dey
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Lisa E Ishii
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Andrew W Joseph
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | - Patrick J Byrne
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Kofi D O Boahene
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Masaru Ishii
- Division of Rhinology, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
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Shockley WW. Facial Reconstruction-Judging Our Results. JAMA FACIAL PLAST SU 2016; 18:473-474. [PMID: 27466759 DOI: 10.1001/jamafacial.2016.0824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- William W Shockley
- Division of Facial Plastic and Reconstructive Surgery, University of North Carolina at Chapel Hill, Chapel Hill
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Phillis M, Ishii M, Dey J, Goines J, Byrne PJ, Boahene KDO, Ishii LE. Measurement of the Quality of Facial Lesion Reconstruction With Observer-Graded Affect Display. JAMA FACIAL PLAST SU 2016; 18:467-473. [DOI: 10.1001/jamafacial.2016.0817] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Maria Phillis
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology–Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Masaru Ishii
- Division of Rhinology, Department of Otolaryngology–Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jacob Dey
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology–Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | - Patrick J. Byrne
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology–Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Kofi D. O. Boahene
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology–Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Lisa E. Ishii
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology–Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
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Goines JB, Ishii LE, Dey JK, Phillis M, Byrne PJ, Boahene KDO, Ishii M. Association of Facial Paralysis–Related Disability With Patient- and Observer-Perceived Quality of Life. JAMA FACIAL PLAST SU 2016; 18:363-9. [DOI: 10.1001/jamafacial.2016.0483] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Lisa E. Ishii
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jacob K. Dey
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Maria Phillis
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Patrick J. Byrne
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Kofi D. O. Boahene
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Masaru Ishii
- Division of Rhinology, Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
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Affiliation(s)
- Michael J. Brenner
- Division of Facial Plastic & Reconstructive Surgery; Department of Otolaryngology–Head & Neck Surgery, University of Michigan School of Medicine, Ann Arbor
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34
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Fritz MA, Rolfes BN. Microvascular Reconstruction of the Parotidectomy Defect. Otolaryngol Clin North Am 2016; 49:447-57. [DOI: 10.1016/j.otc.2015.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Affiliation(s)
- Tessa Hadlock
- Division of Facial Plastic and Reconstructive Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
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36
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Dayan SH, Ashourian N. Considerations for Achieving a Natural Face in Cosmetic Procedures. JAMA FACIAL PLAST SU 2015; 17:395. [DOI: 10.1001/jamafacial.2015.1004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Steven H. Dayan
- Chicago Center for Facial Plastic Surgery, Chicago, Illinois
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, University of Illinois Medical Center, Chicago
| | - Nazanin Ashourian
- Chicago Center for Facial Plastic Surgery, Chicago, Illinois
- DeNova Research, Chicago, Illinois
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37
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Ishii LE, Tollefson TT. Evidence-Based Procedures in Facial Plastic and Reconstructive Surgery. Facial Plast Surg Clin North Am 2015. [DOI: 10.1016/j.fsc.2015.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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