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Harthoorn FS, Ingels KJAO, Damen GWJA, Scheffer ART, van Heerbeek N. Long-term effects of the titanium butterfly implant on quality of life: a prospective cohort study. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08703-z. [PMID: 38702434 DOI: 10.1007/s00405-024-08703-z] [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: 02/12/2024] [Accepted: 04/23/2024] [Indexed: 05/06/2024]
Abstract
PURPOSE Nasal valve insufficiency is known to have a negative impact on both nasal patency and quality of life. The titanium butterfly implant is a surgical treatment proven to have a positive effect on these aspects up to 6 months postoperative. This study aimed to determine the long-term effects of the titanium butterfly implant on nasal obstruction symptoms and quality of life in adult patients with nasal valve insufficiency up to 5 years after procedure. METHODS A prospective single cohort study was performed including 29 patients that underwent the titanium butterfly implant in one tertiary medical center. Data was obtained before and at least 5 years after surgery using three questionnaires: the Nasal Obstruction and Septoplasty Effectiveness questionnaire, the Sino-Nasal Outcome Test 22 and the Glasgow Benefit Inventory questionnaire. RESULTS A significant decrease in total NOSE score was seen compared to baseline measurements. The SNOT-22 scores also showed a significant decrease, whereas the GBI scores showed no significant changes at the late follow-up. CONCLUSION Seven years after placement the titanium butterfly implant still has a statistically significant improvement on otorhinologic-related quality of life compared to preoperative measurements.
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Affiliation(s)
- F S Harthoorn
- Faculty of Medical Sciences, Radboud University, Nijmegen, the Netherlands
- Department of Otorhinolaryngology, Radboud University Medical Center, Head and Neck (Number 383), Postbus 9109, 6500 HB, Nijmegen, the Netherlands
| | - K J A O Ingels
- Department of Otorhinolaryngology, Radboud University Medical Center, Head and Neck (Number 383), Postbus 9109, 6500 HB, Nijmegen, the Netherlands
| | - G W J A Damen
- Department of Otorhinolaryngology, Radboud University Medical Center, Head and Neck (Number 383), Postbus 9109, 6500 HB, Nijmegen, the Netherlands
| | - A R T Scheffer
- Department of Otorhinolaryngology, Radboud University Medical Center, Head and Neck (Number 383), Postbus 9109, 6500 HB, Nijmegen, the Netherlands
| | - N van Heerbeek
- Department of Otorhinolaryngology, Radboud University Medical Center, Head and Neck (Number 383), Postbus 9109, 6500 HB, Nijmegen, the Netherlands.
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Wong ZY, de Jongh FW, Wolf O, Ingels KJAO, van Heerbeek N, Pouwels S. Investigating temporalis muscle-based facial reanimation surgery: A need for standardisation of outcomes? J Plast Reconstr Aesthet Surg 2024; 88:324-325. [PMID: 38061254 DOI: 10.1016/j.bjps.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 01/02/2024]
Affiliation(s)
- Zhen Yu Wong
- Department of General Surgery, Nottingham City Hospital, Nottingham, United Kingdom
| | - Frank W de Jongh
- Department of Otorhinolaryngology and Head & Neck Surgery, Radboudumc, Nijmegen, the Netherlands
| | - Olga Wolf
- Department of Plastic, Reconstructive and Aesthetic Surgery, Florence Nightingale Hospital Düsseldorf, Düsseldorf, Germany
| | - Koen J A O Ingels
- Department of Otorhinolaryngology and Head & Neck Surgery, Radboudumc, Nijmegen, the Netherlands
| | - Niels van Heerbeek
- Department of Otorhinolaryngology and Head & Neck Surgery, Radboudumc, Nijmegen, the Netherlands
| | - Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital Tilburg, Tilburg, the Netherlands; Department of General, Abdominal Surgery and Coloproktology, Helios St. Elisabeth Klinik, Oberhausen, Germany; Faculty of Health, Witten/Herdecke University, Witten, Germany.
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Rasing NB, van de Geest-Buit WA, Chan OYA, Mul K, Lanser A, van Engelen BGM, Erasmus CE, Fischer AH, Ingels KJAO, Post B, Siemann I, Groothuis JT, Voermans NC. Treatment Approaches for Altered Facial Expression: A Systematic Review in Facioscapulohumeral Muscular Dystrophy and Other Neurological Diseases. J Neuromuscul Dis 2024; 11:535-565. [PMID: 38517799 DOI: 10.3233/jnd-230213] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
Background Facial weakness is a key feature of facioscapulohumeral muscular dystrophy (FSHD) and may lead to altered facial expression and subsequent psychosocial impairment. There is no cure and supportive treatments focus on optimizing physical fitness and compensation of functional disabilities. Objective We hypothesize that symptomatic treatment options and psychosocial interventions for other neurological diseases with altered facial expression could be applicable to FSHD. Therefore, the aim of this review is to collect symptomatic treatment approaches that target facial muscle function and psychosocial interventions in various neurological diseases with altered facial expression in order to discuss the applicability to FSHD. Methods A systematic search was performed. Selected studies had to include FSHD, Bell's palsy, Moebius syndrome, myotonic dystrophy type 1, or Parkinson's disease and treatment options which target altered facial expression. Data was extracted for study and patients' characteristics, outcome assessment tools, treatment, outcome of facial expression and or psychosocial functioning. Results Forty studies met the inclusion criteria, of which only three studies included FSHD patients exclusively. Most, twenty-one, studies were performed in patients with Bell's palsy. Studies included twelve different therapy categories and results were assessed with different outcomes measures. Conclusions Five therapy categories were considered applicable to FSHD: training of (non-verbal) communication compensation strategies, speech training, physical therapy, conference attendance, and smile restoration surgery. Further research is needed to establish the effect of these therapies in FSHD. We recommend to include outcome measures in these studies that cover at least cosmetic, functional, communication, and quality of life domains.
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Affiliation(s)
- Nathaniël B Rasing
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Willianne A van de Geest-Buit
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - On Ying A Chan
- Information Specialist, Medical Library, Radboud University, Nijmegen, The Netherlands
| | - Karlien Mul
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anke Lanser
- Patient Representative and Chairman FSHD Advocacy Group, Patient Organization for Muscular Disease Spierziekten Nederland, Baarn, The Netherlands
| | - Baziel G M van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Corrie E Erasmus
- Department of Paediatric Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Agneta H Fischer
- Department of Psychology, Social Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Koen J A O Ingels
- Department of Otorhinolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bart Post
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ietske Siemann
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan T Groothuis
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicol C Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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de Jongh FW, Wolf O, Wong ZY, Ingels KJAO, Pouwels S. Botulinum toxin treatment of the buccinator muscle facial synkinesis: A systematic review. J Plast Reconstr Aesthet Surg 2023; 86:88-93. [PMID: 37716254 DOI: 10.1016/j.bjps.2023.08.006] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/13/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND The purpose of this review is to provide an overview of the available literature assessing the treatment of botulinum toxin injections for the treatment of synkinesis of the buccinator muscle in patients with peripheral facial palsy (PFP). MATERIALS AND METHODS A multi database search was performed, including the following databases: Pubmed, Medline, Embase, and the Cochrane Library. Each database was searched from its earliest date until 8 June 2023. The following outcome measures were extracted from the articles when available: subjective, somatic, and psychological effects on the patients and objective outcomes such as the House-Brackmann, Sunnybrook and Sydney scores. The methodological quality of the included studies was rated using the Newcastle-Ottawa scale for nonrandomised trials. RESULTS The primary literature search generated 37 articles. After removing duplicates, 25 articles remained for abstract appraisal, of which 20 underwent full-text appraisal, resulting in 3 studies for analysis. All of these studies showed (significant) improvement in synkinesis either measured using the Synkinesis Assessment Questionnaire or subjectively measured by asking treated patients. CONCLUSION The available literature supports the finding that botulinum toxin treatment of the buccinator muscle could be a welcome addition to facial synkinesis treatment and could significantly improve patient outcomes. In future studies, the efficacy of EMG-guided buccinator injections, optimal dose, and a validated measuring method could be beneficial in optimising treatment for patients with a PFP and synkinesis.
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Affiliation(s)
- Frank W de Jongh
- Department of Otorhinolaryngology and Head & Neck Surgery, Radboudumc, Nijmegen, the Netherlands
| | - Olga Wolf
- Department of Plastic, Reconstructive and Aesthetic Surgery, Florence Nightingale Hospital, Düsseldorf, Germany
| | - Zhen Yu Wong
- Department of General Surgery, Nottingham City Hospital, Nottingham, United Kingdom
| | - Koen J A O Ingels
- Department of Otorhinolaryngology and Head & Neck Surgery, Radboudumc, Nijmegen, the Netherlands
| | - Sjaak Pouwels
- Department of General, Abdominal Surgery and Coloproctology, Helios St. Elisabeth Klinik, Oberhausen, NRW, Germany; Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands; Faculty of Health, Witten/Herdecke University, Witten, Germany.
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Pouwels S, Sanches EE, de Jongh FW, van Heerbeek N, Ingels KJAO. The surgical anatomy of the deep temporal nerve: A cadaveric study. J Plast Reconstr Aesthet Surg 2023; 85:473-478. [PMID: 37597484 DOI: 10.1016/j.bjps.2023.07.033] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 07/13/2023] [Accepted: 07/16/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND The aims of this study were to investigate the surgical anatomy of the deep temporal nerve (DTN) and find (fixed/static) anatomical landmarks that could be used during surgery to localise the DTN branches. METHODS Ten hemifaces of Dutch cadavers were dissected at the Department of Anatomy of the Radboudumc. Landmarks and measurements of interest were number of branches of the DTN, distance from the tragus to the DTN, and distance from the cranial and caudal parts of the posterior root of the zygomatic bone until the DTN. RESULTS In this cadaveric study, 10 hemifaces were dissected (male, n = 6 [60%]; female, n = 4 [40%]) with an equal left/right side division. The number of deep temporal branches varied from 2 (30%) to 3 (70%) per side. The mean distance to the tragus varied from 40 to 53 mm, with a mean distance of 44.3 ± 4.4 mm. The mean distance from the cranial part of the posterior root of the zygomatic bone to the DTN varied from 29 to 35 mm, with a mean distance of 31.3 ± 2.1 mm. The distance from the caudal part of the posterior root of the zygomatic bone to the DTN varied from 8 to 17 mm, with a mean distance of 13.4 ± 3.4 mm. CONCLUSION This study investigated the surgical anatomy and landmarks used for identification of the DTN and its branches. It suggested using firm landmarks for nerve identification, such as the posterior root of the cranial and/or the caudal zygomatic bone.
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Affiliation(s)
- Sjaak Pouwels
- Department of Surgery, Agaplesion Bethanien Krankenhaus, Frankfurt am Main, Hesse, Germany; Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands.
| | - Elijah E Sanches
- Department of Otorhinolaryngology, Head & Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Frank W de Jongh
- Department of Otorhinolaryngology, Head & Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Niels van Heerbeek
- Department of Otorhinolaryngology, Head & Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Koen J A O Ingels
- Department of Otorhinolaryngology, Head & Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
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Rasing NB, van de Geest-Buit W, Chan OYA, Mul K, Lanser A, Erasmus CE, Groothuis JT, Holler J, Ingels KJAO, Post B, Siemann I, Voermans NC. Psychosocial functioning in patients with altered facial expression: a scoping review in five neurological diseases. Disabil Rehabil 2023:1-20. [PMID: 37752723 DOI: 10.1080/09638288.2023.2259310] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
PURPOSE To perform a scoping review to investigate the psychosocial impact of having an altered facial expression in five neurological diseases. METHODS A systematic literature search was performed. Studies were on Bell's palsy, facioscapulohumeral muscular dystrophy (FSHD), Moebius syndrome, myotonic dystrophy type 1, or Parkinson's disease patients; had a focus on altered facial expression; and had any form of psychosocial outcome measure. Data extraction focused on psychosocial outcomes. RESULTS Bell's palsy, myotonic dystrophy type 1, and Parkinson's disease patients more often experienced some degree of psychosocial distress than healthy controls. In FSHD, facial weakness negatively influenced communication and was experienced as a burden. The psychosocial distress applied especially to women (Bell's palsy and Parkinson's disease), and patients with more severely altered facial expression (Bell's palsy), but not for Moebius syndrome patients. Furthermore, Parkinson's disease patients with more pronounced hypomimia were perceived more negatively by observers. Various strategies were reported to compensate for altered facial expression. CONCLUSIONS This review showed that patients with altered facial expression in four of five included neurological diseases had reduced psychosocial functioning. Future research recommendations include studies on observers' judgements of patients during social interactions and on the effectiveness of compensation strategies in enhancing psychosocial functioning.
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Affiliation(s)
- Nathaniël B Rasing
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Willianne van de Geest-Buit
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - On Ying A Chan
- Medical Library, Radboud University, Nijmegen, The Netherlands
| | - Karlien Mul
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anke Lanser
- Patient Representative and Chairman FSHD Advocacy Group, Patient Organization for Muscular Disease Spierziekten Nederland, Baarn, The Netherlands
| | - Corrie E Erasmus
- Department of Pediatric Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan T Groothuis
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Judith Holler
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, and Max Planck Institute for Psycholinguistics, Nijmegen, The Netherlands
| | - Koen J A O Ingels
- Department of Otorhinolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bart Post
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ietske Siemann
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicol C Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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Ten Harkel TC, de Jong G, Marres HAM, Ingels KJAO, Speksnijder CM, Maal TJJ. Automatic grading of patients with a unilateral facial paralysis based on the Sunnybrook Facial Grading System - A deep learning study based on a convolutional neural network. Am J Otolaryngol 2023; 44:103810. [PMID: 36871420 DOI: 10.1016/j.amjoto.2023.103810] [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: 12/01/2022] [Revised: 01/19/2023] [Accepted: 02/19/2023] [Indexed: 02/26/2023]
Abstract
PURPOSE In order to assess the severity and the progression of a unilateral peripheral facial palsy the Sunnybrook Facial Grading System (SFGS) is a well-established grading system due to its clinical relevance, sensitivity, and robust measuring method. However, training is required in order to achieve a high inter-rater reliability. This study investigated the automated grading of facial palsy patients based on the SFGS using a convolutional neural network. METHODS A total of 116 patients with a unilateral peripheral facial palsy and 9 healthy subjects were recorded performing the Sunnybrook poses. A separate model was trained for each of the 13 elements of the SFGS and then used to calculate the Sunnybrook subscores and composite score. The performance of the automated grading system was compared to three clinicians experienced in the grading of a facial palsy. RESULTS The inter-rater reliability of the convolutional neural network was within the range of human observers, with an average intra-class correlation coefficient of 0.87 for the composite Sunnybrook score, 0.45 for the resting symmetry subscore, 0.89 for the symmetry of voluntary movement subscore, and 0.77 for the synkinesis subscore. CONCLUSIONS This study showed the potential of the automated SFGS to be implemented in a clinical setting. The automated grading system adhered to the original SFGS, which makes the implementation and interpretation of the automated grading more straightforward. The automated system can be implemented in numerous settings such as online consults in an e-Health environment, since the model used 2D images captured from a video recording.
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Affiliation(s)
- Timen C Ten Harkel
- Radboud University Medical Centre, 3D Lab Radboudumc, Nijmegen 6500 HB, the Netherlands; Radboud University Medical Centre, Department of Otorhinolaryngology and Head and Neck Surgery, Nijmegen 6500 HB, the Netherlands.
| | - Guido de Jong
- Radboud University Medical Centre, 3D Lab Radboudumc, Nijmegen 6500 HB, the Netherlands
| | - Henri A M Marres
- Radboud University Medical Centre, Department of Otorhinolaryngology and Head and Neck Surgery, Nijmegen 6500 HB, the Netherlands
| | - Koen J A O Ingels
- Radboud University Medical Centre, Department of Otorhinolaryngology and Head and Neck Surgery, Nijmegen 6500 HB, the Netherlands
| | - Caroline M Speksnijder
- Radboud University Medical Centre, Department of Oral and Maxillofacial Surgery, Nijmegen 6500 HB, the Netherlands; University Medical Center Utrecht, Utrecht University, Department of Oral and Maxillofacial Surgery, Utrecht 3508 GA, the Netherlands
| | - Thomas J J Maal
- Radboud University Medical Centre, 3D Lab Radboudumc, Nijmegen 6500 HB, the Netherlands; Radboud University Medical Centre, Department of Oral and Maxillofacial Surgery, Nijmegen 6500 HB, the Netherlands
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Wong ZY, Ramasamy P, Ingels KJAO, Parmar C, Yang W, Pouwels S. Changes of Facial Features After Bariatric Surgery: a Systematic Review. Obes Surg 2023; 33:332-338. [PMID: 36434358 DOI: 10.1007/s11695-022-06363-8] [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: 08/25/2022] [Revised: 10/29/2022] [Accepted: 11/18/2022] [Indexed: 11/26/2022]
Abstract
This study aims to provide an overview of the facial features and structure after bariatric surgery in the existing literature. A systematic literature search was performed in electronic databases until 15th February 2022. Four cohort studies including 129 patients from 3 countries were included between time period 2011 and 2020. Overall, bariatric surgery would promote massive weight loss associated with positive effects on facial aging. Analysis revealed a proportional relationship between body mass index (BMI) and faster facial aging and more attractive. Undergoing bariatric surgery would result in facial skin sagging and a favorable effect on the upper airway. Bariatric surgery was found to have a significant impact on changes in facial features but the current evidence remains inconclusive and further studies are required to illustrate facial changes post-bariatric surgery.
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Affiliation(s)
- Zhen Yu Wong
- Department of General Surgery, Nottingham City Hospital, Nottingham, UK
| | - Pavitra Ramasamy
- Department of General Surgery, Hospital Selayang, Kuala Lumpur, Malaysia
| | - Koen J A O Ingels
- Department of Otorhinolaryngology, Head & Neck Surgery, Radboudumc, Nijmegen, The Netherlands
| | - Chetan Parmar
- Department of Surgery, Whittington Hospital, London, UK
| | - Wah Yang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Hilvarenbeekseweg 60, P.O. Box 90151, 5000 LC, Tilburg, The Netherlands. .,Department of General, Abdominal and Minimally Invasive Surgery, Helios Klinikum, Krefeld, NRW, Germany.
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de Jongh FW, Sanches EE, Pouwels S, Kooiman LBR, Wehrens KME, van Heerbeek N, Monstrey SJ, Tan LT, Ingels KJAO. An overview of surgical techniques and non-surgical treatments in lifting the eyebrow including current treatments available. Eur J Plast Surg 2022. [DOI: 10.1007/s00238-021-01911-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
AbstractThe eyebrow is a complex structure of the human face, which has both functional (communication) and aesthetic aspects and contributes to a persons’ individual appearance. Ptosis of the eyebrow is a common condition, especially among the elderly and smokers. Facial appearance is disrupted by eyebrow ptosis, and in many cases, correction and treatment are needed. No specific type of browlift has been shown to be superior to another, and since there is a wide variation in treatment preference between patients, it requires an individual approach to each specific patient. This review provides an overview of the history of the browlift, non-surgical treatment and current surgical techniques available.Level of evidence: Not ratable.
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Verhoeff R, Bruins TE, Ingels KJAO, Werker PMN, van Veen MM. A cross-sectional analysis of facial palsy-related quality of life in 125 patients: Comparing linear, quadratic and cubic regression analyses. Clin Otolaryngol 2022; 47:541-545. [PMID: 35373461 DOI: 10.1111/coa.13934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 02/15/2022] [Accepted: 03/05/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Rucháma Verhoeff
- Department of Plastic Surgery, University Medical Center Groningen and University of Groningen, Groningen, Netherlands
| | - Tessa E Bruins
- Department of Plastic Surgery, University Medical Center Groningen and University of Groningen, Groningen, Netherlands
| | - Koen J A O Ingels
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Paul M N Werker
- Department of Plastic Surgery, University Medical Center Groningen and University of Groningen, Groningen, Netherlands
| | - Martinus M van Veen
- Department of Plastic Surgery, University Medical Center Groningen and University of Groningen, Groningen, Netherlands
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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. Eur J Plast Surg 2022. [DOI: 10.1007/s00238-021-01937-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Siemann I, Sanches EE, de Jongh FW, Luijmes R, Ingels KJAO, Beurskens CHG, Monstrey SJ, Ramnarain D, Marres HAM, Pouwels S. Psychological counselling in patients with a peripheral facial palsy: initial experience from an expert centre. J Plast Reconstr Aesthet Surg 2021; 75:1639-1643. [PMID: 34975004 DOI: 10.1016/j.bjps.2021.11.079] [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: 09/08/2020] [Revised: 07/13/2021] [Accepted: 11/12/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The aims of this pilot study were to evaluate the psychologist's role on the multidisciplinary team during peripheral facial palsy (PFP) patient care and to identify the potential predictors of anxiety and depressive symptoms/disorders in PFP patients. METHODS Using the prospective non-controlled study design, PFP patients aged 18-75 years who presented to the Radboud Facial Palsy Expert Centre, the Netherlands, were enrolled during a 1-year interval. The main outcome variables were 1) anxiety and depression in relation to PFP using the Hospital Anxiety and Depression Scale (HADS) and 2) the outcome of psychological counselling in patients with a HADS score ≥ 8. RESULTS A sample comprised 25 patients (68% females, 56% right-side PFP, 16% House-Brackmann scale I-II) with a mean age of 50 ± 14 years were referred to a psychologist. The proportion of patients with a HADS score ≥8, were 16 (64%) and 13 (52%), respectively. Especially, coping (in general or coping with the disease, 48%) and/or help with the choice of possible surgery (8.0%) were important reasons for counselling. In one case, a patient had chronic fatigue syndrome and was therefore referred to a psychological specialist centre. One patient was treated with acceptance and commitment therapy (ACT) with good results. CONCLUSIONS Despite a small sample size and limited statistical analyses, the results of this study suggest that one-eighth of the PFP patients require psychological evaluation and treatments. This pilot study emphasises the important role of psychological screening and counselling in PFP patient care.
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Affiliation(s)
- Ietske Siemann
- Department of Medical Psychology, Radboudumc, Nijmegen, The Netherlands
| | - Elijah E Sanches
- Department of Surgery, Haaglanden Medical Center, The Hague, The Netherlands
| | - Frank W de Jongh
- Department of Plastic Surgery, Haaglanden Medical Center, The Hague, The Netherlands
| | - Robin Luijmes
- Department of Interventions, Arbo Unie, Rotterdam Europoort, Rotterdam, The Netherlands
| | - Koen J A O Ingels
- Department of Otorhinolaryngology and Head & Neck Surgery, Radboudumc, Nijmegen, The Netherlands
| | - Carien H G Beurskens
- Department of Orthopedics, section Physical Therapy, Radboudumc, Nijmegen, The Netherlands
| | - Stan J Monstrey
- Department of Plastic Surgery, University Hospital Gent, Gent, Belgium
| | - Dharmanand Ramnarain
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Henri A M Marres
- Department of Otorhinolaryngology and Head & Neck Surgery, Radboudumc, Nijmegen, The Netherlands
| | - Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.
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13
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Kofler B, Ingels KJAO. [Dynamic procedures for facial nerve reconstruction]. Laryngorhinootologie 2021; 100:738-750. [PMID: 34461655 DOI: 10.1055/a-1376-2199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In this article the indications and surgical treatment options for patients with facial nerve palsy are discussed. A distinction is made between static and dynamic surgical procedures. Static reconstructions for example are used to restore the eyelid closure function. For smile reconstruction, which is important for the psychosocial life of the patient, dynamic procedures are used. Depending on the duration of the facial nerve paralysis, there are several possibilities to restore the smile. In this work the masseteric branch transposition to the buccal branch, the hypoglossal-facial nerve anastomosis, the Labbé procedure and the gracilis flap as a free muscle transplant are discussed. The surgical procedures are compared and the advantages and disadvantages of the intervention are presented. A spontaneous smile is aimed, this cannot always be achieved. With the masseteric branch transposition to the buccal branch and the Labbé procedure the smile is initially triggered by chewing. A spontaneous smile is possible through cortical adaptation. With the gracilis flap, however, a nerve anastomosis with the contralateral 'healthy' facial nerve is possible, either directly or via a so-called cross facial nerve grafting, whereby a spontaneous smile can be achieved.
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14
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Bruins TE, van Veen MM, Kleiss IJ, Broekstra DC, Dijkstra PU, Ingels KJAO, Werker PMN. Interpreting Quality-of-Life Questionnaires in Patients with Long-Standing Facial Palsy. Facial Plast Surg Aesthet Med 2021; 24:75-80. [PMID: 34197220 DOI: 10.1089/fpsam.2020.0604] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective(s): To interpret change in quality-of-life scores in facial palsy patients by calculating the smallest detectable change (SDC) and minimal important change (MIC) for the Facial Disability Index (FDI), Facial Clinimetric Evaluation (FaCE) scale, and Synkinesis Assessment Questionnaire (SAQ). Materials and Methods: The SDC, for individuals and groups, was calculated using previously collected test-retest data (2-week interval). The MIC (predictive modeling method) was calculated in a second similar facial palsy population using two measurements (1-1.5-year interval) and an anchor question assessing perceived change. Results: SDCindividual of FaCE was 17.6 and SAQ was 28.2. SDCgroup of FaCE was 2.9 and SAQ was 4.6 (n = 62). Baseline FaCE and SAQ scores were 43.3 (interquartile range [IQR]: 35.8;55.0) and 51.1 (IQR: 32.2;60.0), respectively. MIC for important improvement of FDI physical/social function, FaCE total, and SAQ total were 4.4, 0.4, 0.7, and 2.8, respectively (n = 88). MIC for deterioration was 8.2, -1.8, -8.5, and 0.6, respectively. Baseline scores were 70.0 (IQR: 60.0;80.0), 76.0 (68.0;88.0), 55.0 (IQR: 40.0;61.7), and 26.7 (IQR: 22.2;35.6), respectively. Number of participants reporting important change for the different questionnaires ranged from 3 to 23 per subscale. Conclusion: Interpreting change scores of the FDI, FaCE, and SAQ is appropriate for groups, but for individual patients it is limited by a substantial SDC.
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Affiliation(s)
- Tessa E Bruins
- Department of Plastic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Martinus M van Veen
- Department of Plastic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ingrid J Kleiss
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Otorhinolaryngology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Dieuwke C Broekstra
- Department of Plastic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Pieter U Dijkstra
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Koen J A O Ingels
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Paul M N Werker
- Department of Plastic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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15
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de Jongh FW, Sanches EE, Luijmes R, Pouwels S, Ramnarain D, Beurskens CHG, Monstrey SJ, Marres HAM, Ingels KJAO. Cosmetic appreciation and emotional processing in patients with a peripheral facial palsy: A systematic review. Neuropsychologia 2021; 158:107894. [PMID: 34022186 DOI: 10.1016/j.neuropsychologia.2021.107894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 05/14/2021] [Accepted: 05/14/2021] [Indexed: 11/19/2022]
Abstract
Background; The goal of this review is 1) to summarize the studies assessing PFP by casual observers, patients themselves and the cosmetic appreciation of the PFP and 2) to summarize the studies assessing whether there is a difference in emotional recognition/processing of facial emotions and/or cognitive tasks in patients with a PFP. Materials and Methods; A multi-database systematic literature search was performed using the following databases: Pubmed, Embase, Medline, and The Cochrane Library from the earliest date of each database up to December 2019. Population of interest consisted of patients with a PFP and studies that investigated cosmetic appreciation and/or emotional recognition and/or emotional processing in these patients. Two authors rated the methodological quality of the included studies independently using the 'Newcastle - Ottawa Quality Assessment Scale' for nonrandomised studies' (NOS). Two authors extracted the outcome data regarding cosmetic appreciation and/or emotional recognition/processing from the included studies. Results; Twelve hundred and thirty-two studies were found of which eleven studies met the inclusion criteria. Most studies were assessed to be of 'fair' to 'good' methodological quality. The Cohen's kappa (between author RL and SP) was 0.68. Two studies investigated emotional processing and/or emotional recognition. Nine studies investigated cosmetic appreciation in both patients and casual observers. Important findings of this systematic review are that there is a correlation between the perceived severity of the PFP of the patients and the ratings by casual observers. Secondly there seems to be a laterality difference in cosmetic appreciation and thirdly there might to be a decreased emotional recognition and processing in patients with a PFP. Conclusion; Emotional recognition and cosmetic appreciation in patients with a PFP is an under investigated area, in which further studies are needed to substantiate the findings in current literature.
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Affiliation(s)
- Frank W de Jongh
- Department of Plastic Surgery, Haaglanden Medical Center, The Hague, the Netherlands
| | - Elijah E Sanches
- Department of Surgery, Haaglanden Medical Center, The Hague, the Netherlands
| | - Robin Luijmes
- Department of Interventions, Arbo Unie, Rotterdam Europoort, Rotterdam, the Netherlands
| | - Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands.
| | - Dharmanand Ramnarain
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands
| | - Carien H G Beurskens
- Department of Orthopedics, Section Physical Therapy, Radboudumc, Nijmegen, the Netherlands
| | - Stan J Monstrey
- Department of Plastic Surgery, University Hospital Gent, Gent, Belgium
| | - Henri A M Marres
- Department of Otorhinolaryngology and Head & Neck Surgery, Radboudumc, Nijmegen, the Netherlands
| | - Koen J A O Ingels
- Department of Otorhinolaryngology and Head & Neck Surgery, Radboudumc, Nijmegen, the Netherlands
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16
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Pouwels S, Sanches EE, Chaiet SR, de Jongh FW, Beurskens CHG, Monstrey SJ, Luijmes RE, Siemann I, Ramnarain D, Marres HAM, Ingels KJAO. Association between duration of peripheral facial palsy, severity, and age of the patient, and psychological distress. J Plast Reconstr Aesthet Surg 2021; 74:3048-3054. [PMID: 34020901 DOI: 10.1016/j.bjps.2021.03.092] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 09/08/2020] [Revised: 12/31/2020] [Accepted: 03/13/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Peripheral facial palsy (PFP) (paralysis) can be a devastating condition that has been shown to have associations with increased depression and worse quality of life. The aim of the present study is to better understand the complex association of psychological distress with the duration, severity, and age of patients with PFP. We hypothesize that a shorter duration of PFP is associated with higher levels of psychological distress. METHODS Fifty-nine patients with PFP that existed longer than 3 months were included in this study. The Hospital Anxiety and Depression Scale (HADS) was used to assess the presence and severity of anxiety and depressions. Spearman's correlation analysis was used to determine correlation between psychological distress, duration, severity of the PFP, and age. RESULTS Fifty-nine patients were included in this study, of whom 22 were male and 37 were female. The mean age was 55.6 ± 14.6 years and mean duration of PFP from onset ranged from 3 months to 35 years (with a mean duration of 5.39 ± 6.06 years). Twenty-eight patients had left-sided PFP, 30 patients had right-sided PFP, and one patient had bilateral PFP. The majority were caused by Bell's palsy (50.8%). In the group with a duration less than 5 years, there were five (12.8%) patients having a score between 11 and 15 (on HADS) compared to two (10%) patients in the group with a duration of 5 years or more(p = 0.04). CONCLUSION There seems to be an association between moderate depression and duration of the PFP. Further studies need to substantiate our findings.
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Affiliation(s)
- Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.
| | - Elijah E Sanches
- Department of Surgery, Haaglanden Medical Center, The Hague, The Netherlands
| | - Scott R Chaiet
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine & Public Health, Madison, WI, United States
| | - Frank W de Jongh
- Department of Plastic Surgery, Haaglanden Medical Center, The Hague, The Netherlands
| | - Carien H G Beurskens
- Department of Orthopedics, section Physical Therapy, Radboudumc, Nijmegen, The Netherlands
| | - Stan J Monstrey
- Department of Plastic Surgery, University Hospital Gent, Gent, Belgium
| | - Robin E Luijmes
- Department of Interventions, Arbo Unie, Rotterdam Europoort, Rotterdam, The Netherlands
| | - Ietske Siemann
- Department of Medical Psychology, Radboudumc, Nijmegen, The Netherlands
| | - Dharmanand Ramnarain
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Henri A M Marres
- Department of Otorhinolaryngology and Head & Neck Surgery, Radboudumc, Nijmegen, The Netherlands
| | - Koen J A O Ingels
- Department of Otorhinolaryngology and Head & Neck Surgery, Radboudumc, Nijmegen, The Netherlands
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17
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Harkel TCT, Vinayahalingam S, Ingels KJAO, Berge SJ, Maal TJJ, Speksnijder CM. Reliability and Agreement of 3D Anthropometric Measurements in Facial Palsy Patients Using a Low-Cost 4D Imaging System. IEEE Trans Neural Syst Rehabil Eng 2020; 28:1817-1824. [PMID: 32746313 DOI: 10.1109/tnsre.2020.3007532] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The reliability (precision) and agreement (accuracy) of anthropometric measurements based on manually placed 3D landmarks using the RealSense D415 were investigated in this paper. Thirty facial palsy patients, with their face in neutral (resting) position, were recorded simultaneously with the RealSense and a professional 3dMD imaging system. First the RealSense depth accuracy was determined. Subsequently, two observers placed 14 facial landmarks on the 3dMD and RealSense image, assessing the distance between landmark placement. The respective intra- and inter-rater Euclidean distance between the landmark placements was 0.84 mm (±0.58) and 1.00 mm (±0.70) for the 3dMD landmarks and 1.32 mm (±1.27) and 1.62 mm (±1.42) for the RealSense landmarks. From these landmarks 14 anthropometric measurements were derived. The intra- and inter-rater measurements had an overall reliability of 0.95 (0.87 - 0.98) and 0.93 (0.85 - 0.97) for the 3dMD measurements, and 0.83 (0.70 - 0.91) and 0.80 (0.64 - 0.89) for the RealSense measurements, respectively, expressed as the intra-class correlation coefficient. Determined by the Bland-Altman analysis, the agreement between the RealSense measurements and 3dMD measurements was on average -0.90 mm (-4.04 - 2.24) and -0.89 mm (-4.65 - 2.86) for intra- and inter-rater agreement, respectively. Based on the reported reliability and agreement of the RealSense measurements, the RealSense D415 can be considered as a viable option to perform objective 3D anthropomorphic measurements on the face in a neutral position, where a low-cost and portable camera is required.
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18
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Dings JPJ, Vijverberg MA, Hol MKS, Ulrich DJO, de Haan AFJ, Verhage-Damen GW, de Clonie Maclennan-Naphausen MTP, Kruyt IJ, Ghaeminia H, Bruekers-Schipper GB, Ingels KJAO, Dicker GJ, Meijer GJ, Merkx MAW. Autologous versus prosthetic nasal and auricular reconstruction - patient, professional and layperson perceptions. Int J Oral Maxillofac Surg 2020; 49:1271-1278. [PMID: 32173245 DOI: 10.1016/j.ijom.2020.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/19/2019] [Revised: 12/27/2019] [Accepted: 02/26/2020] [Indexed: 10/24/2022]
Abstract
The aim of this study was to retrospectively evaluate the perceptions of aesthetic outcome following the autologous and prosthetic reconstruction of nasal and auricular defects among patients, professionals (oral and maxillofacial surgeons and ear, nose and throat surgeons) and people unfamiliar with reconstructive surgery. The influence of anatomical subunits on the overall perception of nasal and auricular reconstructions was also determined. A total of 119 patients treated for nasal and auricular defects between 1997 and 2016, with a minimum follow-up period of 6 months, were selected, and photographs of 77 of these patients (65%) were presented in a digital survey and reviewed using a standardized questionnaire. No clinically relevant correlations were found between the age or gender of patients (as well as those of the respondents) and their scores. Prosthetic reconstructions of nasal and auricular defects were considered advantageous over autologous reconstructions in terms of the subjective aesthetic outcome in the view of the professionals, in particular oral and maxillofacial surgeons; however, the patients judged both techniques to be equally effective in terms of aesthetics. No anatomical subunits were found to have a significant impact on the overall match of a nasal or auricular reconstruction with the patient's face.
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Affiliation(s)
- J P J Dings
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - M A Vijverberg
- Department of Otorhinolaryngology, Donders Center for Neurosciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M K S Hol
- Department of Otorhinolaryngology, Donders Center for Neurosciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - D J O Ulrich
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A F J de Haan
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - G W Verhage-Damen
- Department of Otorhinolaryngology, Donders Center for Neurosciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - I J Kruyt
- Department of Otorhinolaryngology, Donders Center for Neurosciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - H Ghaeminia
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - K J A O Ingels
- Department of Otorhinolaryngology, Donders Center for Neurosciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - G J Dicker
- Department of Oral and Maxillofacial Surgery, Elkerliek Hospital, Helmond, The Netherlands
| | - G J Meijer
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M A W Merkx
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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Nelissen RC, Honings J, Meijer FJA, Kunst HPM, Ingels KJAO. [Consider the diagnosis 'Bell's palsy' carefully]. Ned Tijdschr Geneeskd 2019; 163:D2594. [PMID: 30698366] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Patients with facial palsy present with both cosmetic and functional symptoms. When a facial palsy develops quickly (within 72 hours) with no other symptoms, and no cause can be identified, it is probably an idiopathic facial palsy or 'Bell's palsy'. The diagnosis Bell's palsy is, thus, to a certain extent a diagnosis 'per exclusionem'. We present three cases with an incorrectly diagnosed Bell's palsy or inadequate diagnostics or treatment: a 5-year-old male with recurrent facial palsy caused by acute otitis media; a 46-year-old male with facial palsy caused by a malignant parotid tumour; and a 75-year-old female with facial palsy caused by a facial nerve schwannoma in the mastoid segment of the facial nerve. We, therefore, emphasize the importance of thorough history-taking and adequate diagnostics and imaging when patients present with facial palsy.
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Affiliation(s)
- Rik C Nelissen
- Radboudumc, afd. Keel-Neus-Oorheelkunde en Heelkunde van het Hoofd-Halsgebied, Nijmegen
- Contact: R.C. Nelissen
| | - Jimmie Honings
- Radboudumc, afd. Keel-Neus-Oorheelkunde en Heelkunde van het Hoofd-Halsgebied, Nijmegen
| | | | - H P M Kunst
- Radboudumc, afd. Keel-Neus-Oorheelkunde en Heelkunde van het Hoofd-Halsgebied, Nijmegen
| | - Koen J A O Ingels
- Radboudumc, afd. Keel-Neus-Oorheelkunde en Heelkunde van het Hoofd-Halsgebied, Nijmegen
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20
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Luijmes RE, Pouwels S, Monstrey SJ, Ingels KJAO, Beurkens CHG. The forgotten aspects of the quality of life of significant others of patients with a peripheral facial palsy. J Plast Reconstr Aesthet Surg 2018; 71:1094-1095. [PMID: 29625904 DOI: 10.1016/j.bjps.2018.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 03/10/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Robin E Luijmes
- Department of Interventions, Arbo Unie, Rotterdam Europoort, Rotterdam, The Netherlands
| | - Sjaak Pouwels
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam/Schiedam, The Netherlands.
| | - Stan J Monstrey
- Department of Plastic Surgery, University Hospital Gent, Gent, Belgium
| | - Koen J A O Ingels
- Department of Otorhinolaryngology and Head & Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carien H G Beurkens
- Department of Orthopedics, Section Physical Therapy, Radboud University Medical Center, Nijmegen, The Netherlands
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21
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Luijmes RE, Pouwels S, Beurskens CHG, Kleiss IJ, Siemann I, Ingels KJAO. Quality of life before and after different treatment modalities in peripheral facial palsy: A systematic review. Laryngoscope 2016; 127:1044-1051. [DOI: 10.1002/lary.26356] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Robin E. Luijmes
- Department of Medical PsychologyCatharina HospitalEindhoven the Netherlands
| | - Sjaak Pouwels
- Department of SurgeryCatharina HospitalEindhoven the Netherlands
| | - Carien H. G. Beurskens
- Department of Orthopedics, Section of Physical TherapyRadboud University Medical CenterNijmegen the Netherlands
| | - Ingrid J. Kleiss
- Department of Otorhinolaryngology and Head and Neck SurgeryRadboud University Medical CenterNijmegen the Netherlands
| | - Ietske Siemann
- Department of Medical PsychologyRadboud University Medical CenterNijmegen the Netherlands
| | - Koen J. A. O. Ingels
- Department of Otorhinolaryngology and Head and Neck SurgeryRadboud University Medical CenterNijmegen the Netherlands
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22
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Kleiss IJ, Beurskens CHG, Stalmeier PFM, Ingels KJAO, Marres HAM. Quality of life assessment in facial palsy: validation of the Dutch Facial Clinimetric Evaluation Scale. Eur Arch Otorhinolaryngol 2015; 272:2055-61. [PMID: 25628237 PMCID: PMC4473030 DOI: 10.1007/s00405-015-3508-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 01/08/2015] [Indexed: 01/22/2023]
Abstract
This study aimed at validating an existing health-related quality of life questionnaire for patients with facial palsy for implementation in the Dutch language and culture. The Facial Clinimetric Evaluation Scale was translated into the Dutch language using a forward–backward translation method. A pilot test with the translated questionnaire was performed in 10 patients with facial palsy and 10 normal subjects. Finally, cross-cultural adaption was accomplished at our outpatient clinic for facial palsy. Analyses for internal consistency, test–retest reliability, construct validity and responsiveness were performed. Ninety-three patients completed the Dutch Facial Clinimetric Evaluation Scale, the Dutch Facial Disability Index, and the Dutch Short Form (36) Health Survey. Cronbach’s α, representing internal consistency, was 0.800. Test–retest reliability was shown by an intraclass correlation coefficient of 0.737. Correlations with the House–Brackmann score, Sunnybrook score, Facial Disability Index physical function, and social/well-being function were −0.292, 0.570, 0.713, and 0.575, respectively. The SF-36 domains correlate best with the FaCE social function domain, with the strongest correlation between the both social function domains (r = 0.576). The FaCE score did statistically significantly increase in 35 patients receiving botulinum toxin type A (P = 0.042, Student t test). The domains ‘facial comfort’ and ‘social function’ improved statistically significantly as well (P = 0.022 and P = 0.046, respectively, Student t-test). The Dutch Facial Clinimetric Evaluation Scale shows good psychometric values and can be implemented in the management of Dutch-speaking patients with facial palsy in the Netherlands. Translation of the instrument into other languages may lead to widespread use, making evaluation and comparison possible among different providers.
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Affiliation(s)
- Ingrid J Kleiss
- Department of Otolaryngology and Head & Neck Surgery, Radboud university medical center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands,
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van Schijndel O, van Heerbeek N, Ingels KJAO. Current treatment of nasal vestibular stenosis with CO2-laser surgery: prolonged vestibular stenting versus intraoperative mitomycin application. A case series of 3 patients. Int J Pediatr Otorhinolaryngol 2014; 78:2308-11. [PMID: 25282303 DOI: 10.1016/j.ijporl.2014.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 07/11/2014] [Revised: 09/09/2014] [Accepted: 09/10/2014] [Indexed: 11/16/2022]
Abstract
These case studies describe three cases of unilateral nasal vestibular stenoses caused by chemical cauterization. Each case was treated with CO2-laser surgery together with intraoperative topic application of mitomycin or prolonged vestibular stenting for prevention of restenosis. Two patients received intraoperative mitomycin application and one patient received prolonged vestibular stenting. Results were documented using high-resolution photographs. The follow up period ranged from 1 year and 3 months to 4 years and 9 months. All patients improved after CO2-laser surgery. No complications were reported. We consider CO2-laser surgery for relief of nasal vestibular stenosis as a feasible surgical technique for relieve of nasal vestibular stenosis. Prolonged vestibular stenting seems to be an important factor for the prevention of restenosis in which the value of intraoperative mitomycin application without prolonged vestibular stenting remains uncertain.
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Affiliation(s)
- Olaf van Schijndel
- Department of Otorhinolaryngology, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Niels van Heerbeek
- Department of Otorhinolaryngology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Koen J A O Ingels
- Department of Otorhinolaryngology, Radboud University Medical Centre, Nijmegen, The Netherlands
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24
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van Loon B, van Heerbeek N, Bierenbroodspot F, Verhamme L, Xi T, de Koning MJJ, Ingels KJAO, Bergé SJ, Maal TJJ. Three-dimensional changes in nose and upper lip volume after orthognathic surgery. Int J Oral Maxillofac Surg 2014; 44:83-9. [PMID: 25218802 DOI: 10.1016/j.ijom.2014.08.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [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: 07/19/2013] [Revised: 04/09/2014] [Accepted: 08/12/2014] [Indexed: 10/24/2022]
Abstract
Orthognathic surgery aims to improve both the function and facial appearance of the patient. Translation of the maxillomandibular complex for correction of malocclusion is always followed by changes to the covering soft tissues, especially the nose and lips. The purpose of this study was to evaluate the changes in the nasal region and upper lip due to orthognathic surgery using combined cone beam computed tomography (CBCT) and three-dimensional (3D) stereophotogrammetry datasets. Patients who underwent a Le Fort I osteotomy, with or without a bilateral sagittal split osteotomy, were included in this study. Pre- and postoperative documentation consisted of 3D stereophotogrammetry and CBCT scans. 3D measurements were performed on the combined datasets and analyzed. Anterior translation and clockwise pitching of the maxilla led to a significant volume increase in the lip. Cranial translation of the maxilla led to an increase in the alar width. The combination of CBCT DICOM data and 3D stereophotogrammetry proved to be useful in the 3D analysis of the maxillary hard tissue changes, as well as changes in the soft tissues. Measurements could be acquired and compared to investigate the influence of maxillary movement on the soft tissues of the nose and the upper lip.
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Affiliation(s)
- B van Loon
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands; 3D Facial Imaging Research Group Nijmegen-Bruges, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - N van Heerbeek
- Department of Otorhinolaryngology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - F Bierenbroodspot
- Department of Oral and Maxillofacial Surgery, Isala Klinieken, Zwolle, Netherlands
| | - L Verhamme
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands; 3D Facial Imaging Research Group Nijmegen-Bruges, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - T Xi
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands; 3D Facial Imaging Research Group Nijmegen-Bruges, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - M J J de Koning
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands; 3D Facial Imaging Research Group Nijmegen-Bruges, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - K J A O Ingels
- Department of Otorhinolaryngology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - S J Bergé
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands; 3D Facial Imaging Research Group Nijmegen-Bruges, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - T J J Maal
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands; 3D Facial Imaging Research Group Nijmegen-Bruges, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands.
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van Loon B, Reddy SG, van Heerbeek N, Ingels KJAO, Maal TJJ, Borstlap WA, Reddy RR, Kuijpers-Jagtman AM, Bergé SJ. 3D stereophotogrammetric analysis of lip and nasal symmetry after primary cheiloseptoplasty in complete unilateral cleft lip repair. Rhinology 2012. [PMID: 22125785 DOI: 10.4193/rhino11.092] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to evaluate symmetry of the lip and nose in patients with CUCLP after primary cheiloseptoplasty (Afroze technique), in comparison to non-cleft controls. METHODOLOGY In this prospective study, forty-four patients with operated non-syndromic CUCLP were included. The control group consisted of 44 volunteers without cleft defects of approximately the same age and sex. Primary septoplasty was performed in conjunction with the cleft lip (CL) repair using the Afroze incision. 3D facial images were acquired using 3D stereophotogrammetry. After a 3D cephalometric analysis of the lip and nose was performed in both groups, linear and volumetric data were acquired. Lip and nose symmetry were calculated and compared using Student`s t-tests as well as the Chi square test. RESULTS For all measurements, the control group was up to 36% closer to perfect symmetry compared to the CUCLP group after primary surgery. This difference was statistically significant. CONCLUSIONS After primary cheiloseptoplasty according to the Afroze technique in patients with CUCLP, asymmetry in the nose and lip area still exists as compared to non-cleft controls. Although non-cleft individuals also show some degree of asymmetry, the results of this study stress the difficulty in obtaining near normal symmetrical relations.
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Affiliation(s)
- Bram van Loon
- Department of Oral and Maxillofacial Surgery, Radbound University Nijmegen Medical Center, Nijmegen, The Netherlands
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van Loon B, Reddy SG, van Heerbeek N, Ingels KJAO, Maal TJJ, Borstlap WA, Reddy RR, Kuijpers-Jagtman AM, Bergé SJ. 3D stereophotogrammetric analysis of lip and nasal symmetry after primary cheiloseptoplasty in complete unilateral cleft lip repair. Rhinology 2011; 49:546-53. [PMID: 22125785 DOI: 10.4193/rhino.11.092] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to evaluate symmetry of the lip and nose in patients with CUCLP after primary cheiloseptoplasty (Afroze technique), in comparison to non-cleft controls. METHODOLOGY In this prospective study, forty-four patients with operated non-syndromic CUCLP were included. The control group consisted of 44 volunteers without cleft defects of approximately the same age and sex. Primary septoplasty was performed in conjunction with the cleft lip (CL) repair using the Afroze incision. 3D facial images were acquired using 3D stereophotogrammetry. After a 3D cephalometric analysis of the lip and nose was performed in both groups, linear and volumetric data were acquired. Lip and nose symmetry were calculated and compared using Student`s t-tests as well as the Chi square test. RESULTS For all measurements, the control group was up to 36% closer to perfect symmetry compared to the CUCLP group after primary surgery. This difference was statistically significant. CONCLUSIONS After primary cheiloseptoplasty according to the Afroze technique in patients with CUCLP, asymmetry in the nose and lip area still exists as compared to non-cleft controls. Although non-cleft individuals also show some degree of asymmetry, the results of this study stress the difficulty in obtaining near normal symmetrical relations.
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Affiliation(s)
- Bram van Loon
- Department of Oral and Maxillofacial Surgery, Radbound University Nijmegen Medical Center, Nijmegen, The Netherlands
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van Loon B, van Heerbeek N, Maal TJJ, Borstlap WA, Ingels KJAO, Schols JGJH, Bergé SJ. Postoperative volume increase of facial soft tissue after percutaneous versus endonasal osteotomy technique in rhinoplasty using 3D stereophotogrammetry. Rhinology 2011; 49:121-6. [PMID: 21468387 DOI: 10.4193/rhino10.056] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND When lateral osteotomies are performed as part of a rhinoplasty, the nose and paranasal region invariably change in three dimensions. The PURPOSE of this study is to compare the effect of the percutaneous perforating and endonasal continuous osteotomy techniques concerning the degree of postoperative swelling using three dimensional (3D) stereophotogrammetry. METHODOLOGY A prospective follow-up study was conducted. Patients requiring bilateral osteotomies were included and randomly underwent a percutaneous osteotomy on one side and an endonasal osteotomy on the other side. Pre- and postoperative 3D photos were acquired using 3D stereophotogrammetry. Volumetric measurement data were acquired from the paranasal region using 3D software. Measurements were compared using Student`s t-test and Wilcoxon signed rank test statistics. RESULTS Twenty patients were included. A percutaneous osteotomy was performed on the right side in nine patients and on the left side in 11 patients. The total volume, the volume of the right paranasal and left paranasal region were significantly larger postoperative. No difference was found between the sides. CONCLUSIONS No difference concerning swelling is found between the percutaneous and endonasal osteotomy technique sides. With 3D stereophotogrammetry volumetric data can be acquired and compared to evaluate soft-tissue changes.
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Affiliation(s)
- Bram van Loon
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
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van Heerbeek N, Ingels KJAO, van Loon B, Plooij JM, Bergé SJ. Three dimensional measurement of rhinoplasty results. Rhinology 2009; 47:121-125. [PMID: 19593965] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Pre- and postoperative imaging is important and essential for evaluation of the results of rhinoplasty surgery. Two-dimensional photographs are used routinely for this purpose, but have several disadvantages as opposed to three-dimensional imaging techniques, such as stereophotogrammetry. This study is the first to describe the measurement of rhinoplasty results using stereophotogrammetry. The aim of this study was to evaluate the ability of 3D imaging to measure and objectify rhinoplasty results. METHODS During a 6-month period all consecutive hump reduction patients were included in this prospective study. Pre- and postoperative 3D photographs were taken and compared. RESULTS Twelve patients were studied. In ten of these twelve patients a significant volume reduction in the area of the nasal dorsum was found with stereophotogrammetry. The maximum decrease (i.e. lowering) of the nasal dorsum ranged from 0.8 to 4.4 mm. In two patients no reduction of the nasal dorsum was found. In both patients this was due to additional changes made to the nose during surgery. These changes, increased tip rotation and dorsal augmentation respectively, were also documented with stereophotogrammetry. CONCLUSIONS Both pronounced as well as subtle postoperative changes of rhinoplasty surgery can be objectified and measured with stereophotogrammetry. This tool can be used to study whether surgical techniques have the desired effect on the nose, and to compare different techniques with each other.
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Affiliation(s)
- Niels van Heerbeek
- Department of Otorhinolaryngology, Head & Neck Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
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de Heer AR, Bouman H, Gerritsen MJP, Ingels KJAO, Kaanders JHAM, Takes RP. [Regional metastases of head and neck cutaneous squamous cell carcinoma]. Ned Tijdschr Geneeskd 2008; 152:2645-2649. [PMID: 19137960] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Two patients, a woman aged 54 years and a man aged 76 years, developed regional metastases of head and neck cutaneous squamous cell carcinoma (HNCSCC). In general, cutaneous SCC has a low metastatic potential. However these patients illustrate that this tumour may behave aggressively, metastasising to the regional lymph nodes in the neck or parotid gland. Certain clinical and histological features of the primary tumour are associated with a higher risk for nodal metastases. In patients at risk, a more rigorous investigation for nodal metastasis is warranted at diagnosis of SCC as well as during follow-up. The extent of treatment of lymph nodes in the neck region should be directed by the location of the primary tumour, which is an indicator of the most probable lymph drainage pattern. In the case of metastatic parotid involvement, elective treatment of the neck should be considered, even when there are no clinical signs of metastasis. Treatment consists of surgery and/or ipsilateral radiotherapy.
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Affiliation(s)
- A R de Heer
- Afd. Keel-, Neus- en Oorheelkunde, Universitair Medisch Centrum St Radboud, Postbus 9101, 6500 HB Nijmegen
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Ingels KJAO, Orhan KS, van Heerbeek N. The effect of spreader grafts on nasal dorsal width in patients with nasal valve insufficiency. ACTA ACUST UNITED AC 2008; 10:354-6. [PMID: 18794416 DOI: 10.1001/archfaci.10.5.354] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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van Spronsen E, Ingels KJAO, Jansen AH, Graamans K, Fokkens WJ. Evidence-based recommendations regarding the differential diagnosis and assessment of nasal congestion: using the new GRADE system. Allergy 2008; 63:820-33. [PMID: 18588547 DOI: 10.1111/j.1398-9995.2008.01729.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [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: 12/19/2022]
Abstract
Nasal congestion is an important symptom in nasal pathology and can be defined as an objective restriction of nasal cavity airflow because of mucosal pathology and/or increased mucus secretion (excluding anatomical variants). Using the new Grading Recommendations Assessment, Development and Evaluation system, evidence-based recommendations are made that will encompass different clinical questions regarding diagnostic modalities of nasal congestion: (i) their usefulness in assessment of presence and severity of congestion; (ii) their usefulness in assessment of etiological pathology responsible for congestion; and (iii) their usefulness in follow up and treatment effectiveness evaluation of nasal congestion.
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Affiliation(s)
- E van Spronsen
- Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, the Netherlands
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van Heerbeek N, Straetemans M, Wiertsema SP, Ingels KJAO, Rijkers GT, Schilder AGM, Sanders EAM, Zielhuis GA. Effect of combined pneumococcal conjugate and polysaccharide vaccination on recurrent otitis media with effusion. Pediatrics 2006; 117:603-8. [PMID: 16510637 DOI: 10.1542/peds.2005-0940] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Otitis media with effusion (OME) is very common during childhood. Because Streptococcus pneumoniae is one of the most common bacterial pathogens involved in OME, pneumococcal vaccines may have a role in the prevention of recurrent OME. OBJECTIVE We sought to assess the effect of combined pneumococcal conjugate and polysaccharide vaccinations on the recurrence of OME. METHODS A randomized, controlled trial was performed with 161 children, 2 to 8 years of age, with documented persistent bilateral OME. All subjects were treated with tympanostomy tubes (TTs). One half of the subjects were assigned randomly to additional vaccination with a 7-valent pneumococcal conjugate vaccine 3 to 4 weeks before and a 23-valent pneumococcal polysaccharide vaccine 3 months after tube insertion. Blood samples were drawn at the first vaccination, at the time of TT placement, and 1 and 3 months after the second vaccination. Levels of IgA and IgG serum antibody against the 7-valent pneumococcal conjugate vaccine serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F were measured with enzyme-linked immunosorbent assays. All children were monitored for recurrence of OME for 6 months after spontaneous extrusion of the TTs. RESULTS The overall recurrence rate of bilateral OME was 50%. Pneumococcal vaccinations induced significant 4.6- to 24.4-fold increases in the geometric means of all conjugate vaccine serotype antibody titers but did not affect recurrence of OME. CONCLUSIONS Combined pneumococcal conjugate and polysaccharide vaccination does not prevent recurrence of OME among children 2 to 8 years of age previously known to have persistent OME. Therefore, pneumococcal vaccines are not indicated for the treatment of children suffering from recurrent OME.
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Affiliation(s)
- Niels van Heerbeek
- Department of Otorhinolaryngology, Radboud University Nijmegen Medical Centre, PO Box 9101, Nijmegen 6500 HB, The Netherlands.
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Ingels KJAO. [3D-navigation in nasal sinus surgery]. Ned Tijdschr Geneeskd 2005; 149:1675-81. [PMID: 16104113] [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] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Mechanical, infra-red and electrofrequency 3D-navigation equipment enables the visualisation of a probe in a patient in the three dimensions ofa CT-scan. Such a system guarantees better orientation in difficult anatomical areas. 3D navigation is particularly suitable for nasal-sinus surgery as the bony structures are reproduced in precise detail on a CT-scan and bone parameters do not change during operation. These technical developments mean that not only the indications for operation but also the surgical approach have greatly altered. In functional nasal-sinus surgery the aim is to open up the sinus by removing all those structures which may hinder drainage. The mucous membrane with its mucociliary transport is spared and goes on to heal. - Prior to operation the patient's anatomical landmarks are tracked and spatially linked to the corresponding points on the CT-scan. The coordinates of these points are registered on a computer. A probe is moved around within the spaces, its coordinates are calculated and their position shown on a CT-scan. The patient's head is fixed in a frame that is able to move with the head. The advantage of the 3D-navigation system is its surgical and anatomical orientation. Disadvantages are its cost and, to a lesser extent, time requirements and the size of the equipment.
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Affiliation(s)
- K J A O Ingels
- Universitair Medisch Centrum St Radboud, afd. Keel-, Neus-en Oorheelkunde, Postbus 9101, 6500 HB, Nijmegen.
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van Pinxteren SAT, Lohuis PJFM, Ingels KJAO, Nolst Trenité GJ. Interest in Facial Plastic and Reconstructive Surgery Among Otorhinolaryngologists. ACTA ACUST UNITED AC 2005; 7:138-42. [PMID: 15781727 DOI: 10.1001/archfaci.7.2.138] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [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: 11/14/2022]
Abstract
OBJECTIVE To assess the interest of Dutch otorhinolaryngologists in facial plastic and reconstructive surgery (FPRS). METHODS We conducted a 22-question survey among otorhinolaryngology physicians and residents concerning their experience with and interest in FPRS. The response rate was 71% (335/475; 275 physicians and 60 residents). RESULTS Most respondents associated FPRS with rhinoplasty, otoplasty, and the reconstruction of skin cancer defects. Of the physicians, 81% said that 1% to 33% of their practice involves FPRS; 62% were satisfied with this percentage, whereas 36% would like it to be higher. Approximately 70% of physicians regarded their training in FPRS as insufficient, although most (70%) had taken supplementary courses. Moreover, 73% of the otorhinolaryngology physicians and 72% of all respondents said that FPRS should be taught during and after residency, with a preference for hands-on courses. Finally, 84% of all respondents thought that FPRS should be part of the field of otorhinolaryngology, whereas 48% thought that it should become a subspecialty. CONCLUSION There is interest in integrating FPRS training into the Dutch otorhinolaryngology residency program, as it is in the United States.
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Affiliation(s)
- Sors A T van Pinxteren
- Department of Otorhinolaryngology/Head and Neck Surgery, Central Military Hospital, Utrecht, The Netherlands
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van Heerbeek N, Akkerman AE, Ingels KJAO, Engel JAM, Zielhuis GA. Left-right differences in Eustachian tube function in children with ventilation tubes. Int J Pediatr Otorhinolaryngol 2003; 67:861-6. [PMID: 12880665 DOI: 10.1016/s0165-5876(03)00128-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To study the intraindividual variation in Eustachian tube (ET) function in children with ventilation tubes. METHODS The forced response test, the pressure equilibration test and the sniff test were performed on both ears of 148 children. The results of both ears were compared. RESULTS No systematic differences were found between the left and the right ears. However, the intraindividual variation was very pronounced. The variation in passive ET function within children was of similar magnitude as the variation in passive ET function between children. Twenty-eight percent of the children had different active ET function in both ears and 15% had an opposite result in each ear with respect to the sniff test. CONCLUSIONS This study shows that ET function is much more a characteristic of the individual ear than of the individual child. These findings also question the validity of trials on ET function or middle ear disease that use the opposite ear as a control (split level design).
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Affiliation(s)
- Niels van Heerbeek
- Department of Otorhinolaryngology, University Medical Center Nijmegen, Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, Netherlands.
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Abstract
OBJECTIVES/HYPOTHESIS The observation that during otitis media many different types of micro-organisms have been cultured from effusions indicate that, once present in the middle ear cavity, most types of micro-organisms are able to trigger an inflammatory reaction leading to otitis media. The present study was designed to determine the middle ear response after injection of different substances into the middle ear cavity. STUDY DESIGN To determine whether and to what extent an inflammatory response of the middle ear depends on the entering agent, the response in the tympanic cavity was studied by otomicroscopy and histological examination after inoculation of various substances. METHODS Lewis rats were inoculated in transtympanic fashion either with live or heat-killed bacteria (pathogenic and nonpathogenic), Keyhole limpet hemocyanin, active charcoal, or saline. The mucosal response of the challenged middle ears was studied histologically. RESULTS Irrespective of the inoculated substance, no essential differences in the mucosal response were found. The intensity of the inflammatory response was greater when live bacteria were inoculated. CONCLUSIONS The present study demonstrates that any substance reaching the middle ear cavity is likely to induce otitis media. These observations emphasize the role of the eustachian tube as "porte d'entrée" in the pathogenesis of this disorder. Determination of specific aspects of the eustachian tube involved in protection or in facilitating bacterial translocation will be important for the understanding of the pathogenesis of otitis media and the subsequent development of new therapeutic strategies. In addition, elucidation of bacterial factors involved in the process of colonization and translocation will be of equal importance.
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Affiliation(s)
- Edith L G M Tonnaer
- Department of Otorhinolaryngology, University Medical Center St. Radboud, Nijmegen, The Netherlands.
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van Heerbeek N, Tonnaer ELGM, Ingels KJAO, Curfs JHAJ, Cremers CWRJ. Effect of exogenous surfactant on ventilatory and clearance function of the rat's eustachian tube. Otol Neurotol 2003; 24:6-10. [PMID: 12544020 DOI: 10.1097/00129492-200301000-00003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [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: 11/26/2022]
Abstract
HYPOTHESIS AND BACKGROUND The Eustachian tube has three important functions with respect to the middle ear: ventilation, clearance, and protection. Surfactants are assumed to be important to maintain these functions. The administration of exogenous surfactant may therefore be effective to improve the function of the Eustachian tube. This randomized, double-blind, placebo-controlled study was designed to investigate the effect of exogenous surfactant on the function of the Eustachian tube in rats. MATERIALS AND METHODS Exogenous surfactant was administered into the middle ear of 10 otologically healthy rats, and 10 other rats received placebo. The effect on the opening and closing pressure (passive ventilatory function) and the dye clearance time (clearance function) of the rat's Eustachian tube was measured. RESULTS A significant decrease in the opening pressure was seen after the administration of surfactant. Both surfactant and placebo caused an increase in the closing pressure. A serious disturbance of the dye clearance time was induced in 13 rats, and the test failed in 1 rat. In the remaining 6 rats, no significant differences in the dye clearance time were observed between the two groups. CONCLUSIONS Exogenous surfactant decreased the closing forces of the Eustachian tube even in otologically healthy rats. No significant effect on the mucociliary clearance was observed, but this may have resulted from the small number of rats. Additional randomized, double-blind, placebo-controlled trials should be conducted to determine the clinical relevance of these changes and to further assess the effect of surfactant on the function of the Eustachian tube.
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Affiliation(s)
- Niels van Heerbeek
- Departmentof Otorhinolaryngology, University Medical Center Nijmegen, The Netherlands.
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Abstract
OBJECTIVE The aim of the study was to assess the effect of a topical decongestant on eustachian tube function in children with ventilation tubes because of persistent otitis media with effusion. STUDY DESIGN A randomized, double-blinded, placebo-controlled study. METHODS At the outpatient departments of a secondary referral hospital and a tertiary referral hospital, eustachian tube function was measured before and after intranasal administration of five drops of 0.05% xylometazoline hydrochloride or placebo in 80 randomly selected children with ventilation tubes because of otitis media with effusion. RESULTS Xylometazoline nose drops had no effect on the ventilatory or the protective function of the eustachian tube. CONCLUSIONS Topical decongestants do not have a positive effect on eustachian tube function in children. Therefore, the use of topical decongestants to prevent or treat otitis media with effusion in children is not justified and should be discouraged.
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Affiliation(s)
- Niels van Heerbeek
- Department of Otorhinolaryngology, University Medical Center Nijmegen, The Netherlands.
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Abstract
An impaired Eustachian tube is assumed to be an important factor in the pathogenesis of different middle ear diseases. Therefore, several investigators have studied different treatment strategies to improve Eustachian tube function. The aim of this review is to provide a comprehensive summary of the results of these studies on improvement of tubal function. The English language literature was searched systematically to identify all articles that described the effect of different interventions on Eustachian tube function. Although the results were not uniform throughout the different studies and despite several restrictions of the reviewed studies, the results of this review indicate that the function may be improved by medical intervention. However, it seems premature to recommend any of the interventions reviewed in this paper to improve function in humans. More studies, preferably randomized, placebo-controlled trials, should be conducted to assess the efficacy of different interventions.
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Affiliation(s)
- Niels van Heerbeek
- Department of Otorhinolaryngology, University Medical Centre St. Radboud, Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
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