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Beaudoin PL, Carles G. Template for Diced Cartilage with Platelet-Rich Fibrin (PRF) in Rhinoplasty: An Easy Solution for Millimetric Camouflage of the Full Dorsal Esthetic Unit. Facial Plast Surg 2023; 39:707-713. [PMID: 36696918 DOI: 10.1055/a-2019-5433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Dorsal irregularities are one of the most common issues in modern rhinoplasty. Rhinoplasty surgeons propose placing interface grafts lining the hole dorsum to ensure a natural unoperated look. Diced cartilage embedded in Choukroun's platelet-rich fibrin (PRF) scaffold being one of the most recent innovations in the field. However, no method has been described to help with the creation of thin, malleable, and reproductive graft with millimetric precision using that technique. The senior author details his protocol and his experience with a newly developed template for the creation of reproductive grafts with standard size and thickness, using diced cartilage, injectable PRF (iPRF), and advanced PRF (aPRF), for full dorsal camouflage and lining in rhinoplasty. This retrospective case series was conducted to evaluate the results looking at the dorsal esthetic unit at a minimum of 6 months for patients who beneficiated from a millimetric dorsal augmentation from 1 to 2mm using diced cartilage with iPRF and aPRF. The author reports his experience with 54 cases operated from April 2018 to May 2022 using his newly developed template.The template is an innovative technique to allow faster and more reliable fabrication of soft grafts using diced cartilage with both iPRF and aPRF. This novel approach allows for millimetric dorsal augmentation from 1 to 2mm with great precision and high reproductivity with good esthetic outcome.
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Affiliation(s)
- Pier-Luc Beaudoin
- Division of Otolaryngology-Head and Neck Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, Quebec, Canada
| | - Guillaume Carles
- Institut de Chirurgie Esthétique de Montpellier, Montpellier, France
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Labarthe P, Beaudoin PL, Wong E, Garrel R, de Boutray M, Damecourt A. Combined genioplasty, chondrolaryngoplasty, and glottoplasty: A novel scarless procedure in facial feminization surgery. J Stomatol Oral Maxillofac Surg 2023; 124:101575. [PMID: 37516199 DOI: 10.1016/j.jormas.2023.101575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/17/2023] [Accepted: 07/27/2023] [Indexed: 07/31/2023]
Abstract
Facial feminization is a long process with multiple surgical steps that is known to improve quality of life in transgender patients. Visible scars are a frequent complaint by this community as it adds to the stigmatization in this population. Combined procedures have been shown to be effective, by reducing the number of hospitalizations and the total length of recovery periods. In this context, we propose a novel scarless procedure combining a chondrolaryngoplasty, a glottoplasty, and a genioplasty using solely a transoral approach. First, we perform a glottoplasty according to the technique described by Wendler et al. and then a contraction genioplasty. Finally, the thyroid cartilage is approached by a subplatysmal dissection, between the mandibular osteotomy fragments. For now, 15 patients have benefited from this procedure in our department. Preliminary results demonstrate that this is an easy and safe procedure with good esthetic results and good patient satisfaction.
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Affiliation(s)
- Pierre Labarthe
- Hôpital Gui de Chauliac, Department of Maxillofacial Surgery, Université de Montpellier, 80 Avenue Augustin Fliche, Montpellier 34295, France
| | - Pier-Luc Beaudoin
- Hôpital Maisonneuve-Rosemont, Division of Otolaryngology-Head and Neck Surgery, Université de Montréal, Quebec, Canada
| | - Eugene Wong
- Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Renaud Garrel
- Hôpital Gui de Chauliac, Departement of Otolaryngology-Head and Neck Surgery, Université de Montpellier, Montpellier, France
| | - Marie de Boutray
- Hôpital Gui de Chauliac, Department of Maxillofacial Surgery, Université de Montpellier, 80 Avenue Augustin Fliche, Montpellier 34295, France
| | - Arnaud Damecourt
- Hôpital Gui de Chauliac, Department of Maxillofacial Surgery, Université de Montpellier, 80 Avenue Augustin Fliche, Montpellier 34295, France.
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Beaudoin PL, Munden J, Faye M, Ndiaye IC, Sewitch M, Ayad T, Poenaru D. Identifying Barriers in Access to Care for Head and Neck Cancer Patients: A Field Study in Dakar. Laryngoscope 2021; 132:1219-1223. [PMID: 34825710 DOI: 10.1002/lary.29963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/24/2021] [Accepted: 11/10/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES/HYPOTHESIS To identify barriers in access to care for head and neck cancer (H&NC) patients in low- and middle-income countries (LMICs), specifically within Dakar, Senegal, using both quantitative and qualitative data. STUDY DESIGN Descriptive observational study. METHODS Patients with H&NC were selected from two independent university hospitals in Dakar, Senegal. A mixed-methods descriptive study was performed using a specifically tailored questionnaire and a focused ethnographic qualitative approach to identify factors that delay patient presentation, referral, and treatment. Quantitative data were analyzed using descriptive statistics and qualitative using a deductive approach based on a systematic review of the literature. RESULTS Thirty-three patients with a mean age of 57.8 years were included. Presentation delay was 5.7 months, mainly attributed to cost of consultation (39%), waiting time at doctor's office (15%), and distance to healthcare facility (12%). Referral delay greater than 3 months was observed in 60% of participants, secondary to misdiagnosis and lack of appropriate referral. Treatment delay was associated with limited local treatment capacity and securing cost of treatment. Cost of transportation impacted all delays. CONCLUSIONS This work used an evidence-based approach to identify barriers in access to care for H&NC patients in sub-Saharan Africa. It suggests the feasibility and transferability of this methodology which combined a quantitative approach based on the literature with a qualitative analysis. Insight provided by this study will be used to guide development of implementation strategies for early detection of H&NC in LMICs. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Pier-Luc Beaudoin
- Department of Surgery, McGill University, Montreal, Québec, Canada.,Otolaryngology-Head and Neck Surgery, Université de Montréal, Montreal, Québec, Canada
| | - Julia Munden
- Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Mamadou Faye
- Otolaryngology and Head and Neck Surgery Department, Hôpital Principal de Dakar, Dakar, Senegal
| | - Issa C Ndiaye
- Otolaryngology and Head and Neck Surgery Department, Hôpital de Fann, Dakar, Senegal
| | - Maida Sewitch
- Division of Clinical Epidemiology and Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Tareck Ayad
- Otolaryngology and Head and Neck Surgery Department, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Dan Poenaru
- Department of Pediatric Surgery, McGill University Health Centre, Montreal, Québec, Canada
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Beaudoin PL, Anchouche S, Gaffar R, Guadagno E, Ayad T, Poenaru D. Barriers in Access to Care for Patients With Head and Neck Cancer in Resource-Limited Settings: A Systematic Review. JAMA Otolaryngol Head Neck Surg 2021; 146:291-297. [PMID: 31944228 DOI: 10.1001/jamaoto.2019.4311] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Importance The identification of the barriers to care for patients with head and neck cancer in low-income and lower-middle-income countries is a crucial first step toward the identification of targets for developing and implementing cost-effective programs to increase awareness, prevention, and treatment of head and neck cancer in this setting. Objective To identify the barriers to care for patients presenting with head and neck cancer in low-income and lower-middle-income countries. Evidence Review Nine databases were searched from their inception to December 21, 2017: Africa-Wide Information, the Cochrane Library, Embase, Global Health, LILACS, MEDLINE, BIOSIS Previews, and Web of Science. Search terms referred to head and neck cancer, barriers to care, and low- and lower-middle-income countries, and no temporal and linguistic restrictions were imposed. Articles were reviewed by 2 independent investigators, and differences in inclusion were resolved by discussion. Bibliographies of all included articles were screened, and all relevant articles were reviewed using the same procedure. Quantitative articles were assessed using the Methodological Index for Non-Randomized Studies tool, and articles with qualitative data used the Critical Appraisal Skills Programme qualitative checklist. This systematic review was registered in PROSPERO (registration No. CRD42018092448) and followed the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Findings Of the 44 articles selected for review, 18 (41%) met the selection criteria. All articles reported quantitative results, and 3 (17%) added some qualitative material to the study design. Most (11 [61%]) of the studies originated from India. A total of 41 different barriers to care were identified, with low level of education (cited in 8 articles [44%]), low socioeconomic status (in 4 articles [22%]), and lack of knowledge about head and neck cancer (in 3 articles [17%]) being statistically associated with a delayed presentation. Misunderstanding of signs and symptoms, use of alternative medicine, and inability to access health care were other barriers discussed in the qualitative articles. Conclusions and Relevance This systematic review highlighted the lack of both qualitative and quantitative information for patients with head and neck cancer in low-income and lower-middle-income countries. The findings suggest that integrating the barriers to care with information from patient lives may identify the clinical and social relevance of these barriers and guide future research.
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Affiliation(s)
- Pier-Luc Beaudoin
- Department of Surgery, McGill University, Montreal, Québec, Canada.,PGY-4 Otolaryngology-Head and Neck Surgery, Université de Montréal, Montreal, Québec, Canada
| | - Sonia Anchouche
- Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Rouan Gaffar
- Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Elena Guadagno
- Pediatric General and Thoracic Surgery, McGill University Health Centre, Montreal, Québec, Canada
| | - Tareck Ayad
- Otolaryngology and Head and Neck Surgery Department, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada.,Otolaryngology and Head and Neck Surgery, Université de Montréal, Montreal, Québec, Canada
| | - Dan Poenaru
- Department of Pediatric Surgery, McGill University Health Centre, Montreal, Québec, Canada
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Yang N, Beaudoin PL, Nguyen M, Maillé H, Maniakas A, Saliba I. Subannular ventilation tubes in the pediatric population: Clinical outcomes of over 1000 insertions. Int J Pediatr Otorhinolaryngol 2020; 131:109859. [PMID: 31918244 DOI: 10.1016/j.ijporl.2020.109859] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 12/31/2019] [Accepted: 01/01/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Long-term transtympanic tube insertions for chronic middle ear disease are associated with high rates of complications. The objective of this study was to examine the clinical outcomes achieved with an alternate technique, the subannular tube insertion, by determining mean tube lifespan, cumulative incidence of post-operative events and complications, audiometric changes and risk factors associated with earlier tube extrusion in the pediatric population. METHODS A retrospective chart review of all patients operated for subannular tube insertion between January 2007 and 2013 was conducted in a single pediatric tertiary care center. Exploratory Cox regression analysis was performed to identify potential risk factors. RESULTS A total of 1014 tubes from 459 patients were included in the study. Mean subannular tube lifespan was 41.3 months with median time of 35.0 months. Cumulative incidence of post-operative events in decreasing frequency were otorrhea (21.7%), tube blockage (16.0%), tympanic membrane retraction (12.5%), otitis media with effusion (10.0%), acute otitis media (6.4%), perforation (4.6%) and cholesteatoma formation (1.1%). For patients with available pre- and post-operative audiograms, mean air-bone gap improved from 19.5 dB to 7.0 dB after subannular tube insertion (p < 0.01). Increasing age and previous subannular tube insertion carried hazard ratios of 1.029 (p < 0.01) and 1.749 (p < 0.01) for tube extrusion respectively, while craniofacial anomalies and concomitant tympanoplasty at the time of tube insertion had hazard ratios of 0.795 (p < 0.01) and 0.680 (p = 0.03). CONCLUSIONS Subannular tube insertion appears to be a safe and effective alternate technique for middle ear ventilation in cases of intractable disease.
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Affiliation(s)
- Nathan Yang
- Division of Otorhinolaryngology, Head & Neck Surgery, University of Montreal, Otology and Neurotology, Sainte-Justine University Hospital Center (CHUSJ), Canada; University of Montreal, Faculty of Medicine, Canada
| | - Pier-Luc Beaudoin
- Division of Otorhinolaryngology, Head & Neck Surgery, University of Montreal, Otology and Neurotology, Sainte-Justine University Hospital Center (CHUSJ), Canada; University of Montreal, Faculty of Medicine, Canada
| | | | - Hélène Maillé
- Division of Otorhinolaryngology, Head & Neck Surgery, University of Montreal, Otology and Neurotology, Sainte-Justine University Hospital Center (CHUSJ), Canada; University of Montreal, Faculty of Medicine, Canada
| | - Anastasios Maniakas
- Division of Otorhinolaryngology, Head & Neck Surgery, University of Montreal, Otology and Neurotology, Sainte-Justine University Hospital Center (CHUSJ), Canada; University of Montreal, Faculty of Medicine, Canada
| | - Issam Saliba
- Division of Otorhinolaryngology, Head & Neck Surgery, University of Montreal, Otology and Neurotology, Sainte-Justine University Hospital Center (CHUSJ), Canada; University of Montreal, Faculty of Medicine, Canada; University of Montreal Hospital Centre Research Centre (CRCHUM), Montreal, QC, Canada.
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Beaudoin PL, Labbé M, Fanous A, Young M, Rappaport J, Park YS, Manoukian J, Nguyen LHP. Teaching communication skills to OTL-HNS residents: multisource feedback and simulated scenarios. J Otolaryngol Head Neck Surg 2019; 48:8. [PMID: 30691537 PMCID: PMC6350291 DOI: 10.1186/s40463-019-0329-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 01/08/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Effective communication has been linked to a reduction in adverse events and improved patient compliance. Currently in Otolaryngology - Head and Neck Surgery (OTL-HNS) residency programs, there is limited explicit teaching of communication skills. Our objective was to implement an educational program on communication skills for residents using multisource assessment in several simulation-based contexts throughout residency. METHODS For three consecutive years, OTL-HNS residents were recruited to participate in a total of nine simulation-based clinical scenarios in which communication skills could be honed. This educational program was designed to provide instruction and practice of challenging ethics scenarios, with communication efficacy as a secondary goal. To facilitate this goal, a multisource assessment was paired with a debriefing process that involved attending staff, observing and participating residents, standardized patients, and invited content experts. RESULTS Seventeen residents completed the curriculum for at least two consecutive years from 2009 to 2011. The internal-consistency reliability of the scenarios ranged from 0.88 to 0.96. The intraclass correlation was 0.19, as expected in this context. There was no statistical difference in the mean ratings of performance across post-graduate year (PGY) level (p = 0.201). Results from the random-intercept regression indicated that, on average, a learner's mean rating at baseline was 3.6/5 and increased significantly by 0.25 points per year (p < 0.05) as assessed by OTL-HNS staff members and peers. No significant improvement across time was found for ratings by non-medical assessors. CONCLUSION Implementing an educational program focused on communication skills using a multisource assessment in various contexts has shown to be potentially effective at our institution, and resulted for yearly improvement and consolidation of performance of OTL-HNS residents as judged by faculty and residents. The inclusion of a multisource assessment in the simulation curriculum is key to allow for the representation of different perspectives on communication skills, for both the assessment and the debriefing process. Future studies are needed to explore the possibility of fully integrating this educational program into residence training in order to support deliberate communication skills teaching.
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Affiliation(s)
| | - Mathilde Labbé
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Amanda Fanous
- Department of Otolaryngology-Head and Neck Surgery, Montreal Children's Hospital, McGill University, 1001 boul. Decarie, A02.3015, Montreal, Quebec, H4A 3J1, Canada
| | - Meredith Young
- Center for Medical Education, McGill University, Montreal, Quebec, Canada.,Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Jamie Rappaport
- Department of Otolaryngology-Head and Neck Surgery, Montreal Children's Hospital, McGill University, 1001 boul. Decarie, A02.3015, Montreal, Quebec, H4A 3J1, Canada
| | - Yoon Soo Park
- Department of Medical Education, University of Illinois, Chicago, Illinois, USA
| | - John Manoukian
- Department of Otolaryngology-Head and Neck Surgery, Montreal Children's Hospital, McGill University, 1001 boul. Decarie, A02.3015, Montreal, Quebec, H4A 3J1, Canada
| | - Lily H P Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Montreal Children's Hospital, McGill University, 1001 boul. Decarie, A02.3015, Montreal, Quebec, H4A 3J1, Canada. .,Center for Medical Education, McGill University, Montreal, Quebec, Canada.
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