Editorial introductions
2015-08-01 08:00:00 AM
No abstract available
Update of patient-specific maxillofacial implant
Owusu, James A.; Boahene, Kofi, 2015-08-01 08:00:00 AM
Purpose of review: Patient-specific implant (PSI) is a personalized approach to reconstructive and esthetic surgery. This is particularly useful in maxillofacial surgery in which restoring the complex three-dimensional (3D) contour can be quite challenging. In certain situations, the best results can only be achieved with implants custom-made to fit a particular need. Significant progress has been made over the past decade in the design and manufacture of maxillofacial PSIs. Recent findings: Computer-aided design (CAD)/computer-aided manufacturing (CAM) technology is rapidly advancing and has provided new options for fabrication of PSIs with better precision. Maxillofacial PSIs can now be designed using preoperative imaging data as input into CAD software. The designed implant is then fabricated using a CAM technique such as 3D printing. This approach increases precision and decreases or completely eliminates the need for intraoperative modification of implants. The use of CAD/CAM-produced PSIs for maxillofacial reconstruction and augmentation can significantly improve contour outcomes and decrease operating time. Summary: CAD/CAM technology allows timely and precise fabrication of maxillofacial PSIs. This approach is gaining increasing popularity in maxillofacial reconstructive surgery. Continued advances in CAD technology and 3D printing are bound to improve the cost-effectiveness and decrease the production time of maxillofacial PSIs.
Update on the evidence for functional rhinoplasty techniques
Chan, David; Shipchandler, Taha Z., 2015-08-01 08:00:00 AM
Purpose of review: Functional rhinoplasty is a term that is commonly used to describe any technique used to address nasal obstruction in the nasal valve region. The cause of nasal valve collapse differs based on the site. Internal valve collapse may be idiopathic or associated with previous rhinoplasty, trauma, or weakened cartilage in older patients. External valve collapse is usually idiopathic and less likely to be associated with previous surgery. Various techniques have been developed over time, and the data in support of functional rhinoplasty continue to increase. Recent findings: This article discusses popular techniques currently in use, as well as newer techniques that have been described over the past several years. In addition, there is a trend toward utilizing objective testing and validated assessment scales to assess postoperative changes. Summary: Functional rhinoplasty utilizes a multitude of techniques to address nasal valve collapse. Although high-level data are lacking, the current literature is in support of nasal valve correction to improve nasal breathing. Most importantly, the technique employed is unique for each patient.
Botulinum toxin in the management of facial paralysis
Cabin, Jonathan A.; Massry, Guy G.; Azizzadeh, Babak, 2015-08-01 08:00:00 AM
Purpose of review: Complete flaccid facial paralysis, as well as the synkinetic and hyperkinetic sequelae of partial recovery, has significant impact on quality of life. Patients suffer from functional deficiencies, cosmetic deformity, discomfort and social consequences leading to emotional distress. Despite an extensive and sophisticated array of available interventions for facial reanimation, most patients have persistent issues that require consistent follow-up. In long-term management, botulinum toxin (BT) injection remains a critical tool in the treatment of the facial paralysis patient, particularly in the case of synkinesis, hyperkinesis and imbalance. We review the recent scientific literature and highlight key principles and developments in the use of BT in the management of facial paralysis, including less common applications for acute facial paralysis, hyperlacrimation and pseudoptosis. Recent findings: We reviewed the literature for the latest advances in the use of BT in facial paralysis, including applications and technique, as well as measurement tools and adjunct exercises. We also share our experience in treating our own patient population. Summary: BT continues to be a well tolerated and effective tool in the long-term management of facial paralysis, specifically in treating synkinesis, imbalance and hyperkinesis, as well as hyperlacrimation and pseudoptosis. Consistent measurement tools and adjunct neuromuscular retraining are crucial in the successful deployment of BT. Controversy exists as to whether BT should be used to manage facial paralysis during the acute phase, and whether BT application to the nonparalyzed face can improve long-term recovery in the paralyzed side.
Update in disease-specific quality-of-life studies in facial plastic surgery
Allak, Amir; Christophel, J. Jared, 2015-08-01 08:00:00 AM
Purpose of review: Improvements in the quality of life (QOL) of patients undergoing facial plastic and reconstructive surgery are readily apparent to any practitioner performing these procedures and interacting with these patients. However, proving these benefits objectively has become ever more important in the current practice environment and there has been a body of literature reported to address this need. Recent findings: As techniques for facial reanimation, revision cleft surgery and other procedures are further developed and the tailored treatments of these ailments are honed, the body of literature for QOL improvements is growing. A better understanding of the nature of these disorders and the elements that are more impactful to patients has led to procedures that more specifically address these objectives and improve functional and psychological outcomes. Summary: Interest in QOL data to support the interventions performed by facial plastic and reconstructive surgeons has and will continue to expand. The addition of QOL surveys to everyday practice, reporting of objective data in the literature and most importantly the focus of the practitioner on improving the patient's overall health and welfare are testaments to the tailoring of practice to not only address the functional and cosmetic goals but also the overall wellbeing.
Current trends in medical management of infantile hemangioma
Ames, Julie A.; Sykes, Jonathan M., 2015-08-01 08:00:00 AM
Purpose of review: Infantile hemangiomas are the most common benign, soft-tissue tumors of infancy, affecting between 5 and 10% of newborns, and up to 30% of premature infants. Morbidity may include disfigurement and scarring, difficulty in feeding, ulceration, vision loss, airway compromise, congestive heart failure, and death. Advances in understanding the pathogenesis of infantile hemangiomas have given rise to a number of promising treatments. This article reviews the current options for medical management of infantile hemangiomas. Recent findings: In the proliferative phase of infantile hemangiomas, vascular endothelial growth factor and basic fibroblast growth factor have shown increased expression, and vascular endothelial growth factor expression has been up-regulated by adrenergic stimulation. Moreover, the role of the renin–angiotensin system in the pathogenesis of infantile hemangiomas has been demonstrated. Numerous medical options have been under investigation. Since 2008, propanolol has become the first-line therapy, whereas other medical treatments are used less frequently or when propanolol is unsuccessful. Summary: Propranolol has been recently adopted as the first-line medical treatment for complicated infantile hemangiomas. Although emerging treatment options and modalities have shown promising results, there need to be high-quality multicenter randomized trials to support these preliminary data.
Near-misses are an opportunity to improve patient safety: adapting strategies of high reliability organizations to healthcare
Van Spall, Harriette; Kassam, Alisha; Tollefson, Travis T., 2015-08-01 08:00:00 AM
Purpose of review: Near-miss investigations in high reliability organizations (HROs) aim to mitigate risk and improve system safety. Healthcare settings have a higher rate of near-misses and subsequent adverse events than most high-risk industries, but near-misses are not systematically reported or analyzed. In this review, we will describe the strategies for near-miss analysis that have facilitated a culture of safety and continuous quality improvement in HROs. Recent findings: Near-miss analysis is routine and systematic in HROs such as aviation. Strategies implemented in aviation include the Commercial Aviation Safety Team, which undertakes systematic analyses of near-misses, so that findings can be incorporated into Standard Operating Procedures (SOPs). Other strategies resulting from incident analyses include Crew Resource Management (CRM) for enhanced communication, situational awareness training, adoption of checklists during operations, and built-in redundancy within systems. Summary: Health care organizations should consider near-misses as opportunities for quality improvement. The systematic reporting and analysis of near-misses, commonplace in HROs, can be adapted to health care settings to prevent adverse events and improve clinical outcomes.
Recent advances in head and neck free tissue transfer
Markey, Jeffrey; Knott, P. Daniel; Fritz, Michael A.; Seth, Rahul, 2015-08-01 08:00:00 AM
Purpose of review: Free tissue transfer is a versatile and valuable method for reconstructing select head and neck defects following trauma or oncologic resection. Microvascular reconstructive cases are among the longest, most technically challenging, and most labor-intensive operations performed by departments of otolaryngology/head and neck surgery. However, technical advances, increased experience, and robust training programs have permitted realization of microvascular success rates in excess of 97% at most high-volume centers. Given this unprecedented degree of success, research emphasis has shifted to advancing techniques, expanding indications, and increasing efficiencies. Recent findings: Although numerous topics are important for discussion, this update focuses on recent notable advances in reconstruction. These include expanding utility of the anterolateral thigh free flap in soft tissue reconstruction, prefabricated plating for fibula free flap mandibular reconstruction, use of venous couplers, and postoperative free tissue monitoring techniques. Summary: Improvements in technique, technology, and monitoring continue to improve success rates, reduce operative time and associated morbidity, improve overall functional outcomes, and improve patient-specific quality of life. These highlighted recent advances, amongst others, promote further advancement and simplification of reconstructive capabilities.
Current surgical management of macroglossia
Klosterman, Tristan; Tatum, Sherard A., 2015-08-01 08:00:00 AM
Purpose of review: To discuss the current surgical management of macroglossia. Recent findings: Traditional surgical management of severe macroglossia has been with anterior wedge or keyhole resection. Long-term follow-up has been limited, and only recently have assessments been done regarding functional and aesthetic outcomes. New methods including double stellate and combination approaches have shown promise, though with limited case size reports. Addressing macroglossia in three dimensions may be the most effective way of achieving positive positional, speech and aesthetic outcomes, but comparative studies are lacking. Other causes of macroglossia, such as vascular malformations, can be managed with less aggressive measures such as laser and radio-frequency ablation. Summary: The aggressiveness of the management should match the severity of the symptoms. The anterior wedge resection and modified keyhole incisions are the most well studied operative strategies. Short and long-term outcome data are limited, and neither method is definitively superior. Less aggressive measures are options for less severe macroglossia. Surgical management of macroglossia should be tailored to each individual patient and in accordance to surgeon experience and expertise.
Management of orbital tumours
Bewley, Arnaud F.; Farwell, D. Gregory, 2015-08-01 08:00:00 AM
Purpose of review: The management of orbital tumours has evolved significantly over the last two decades, as the body of knowledge about these tumours grows and new techniques are introduced that reduce surgical morbidity. The purpose of this review is to highlight and evaluate the most recent advancements in the management of these tumours. Recent findings: Several recent retrospective series emphasize the broad range of pathologic processes that can arise within the orbit. In addition, there have been a number of recent studies describing advances in endonasal endoscopic techniques for resection of orbital tumours. Summary: This articles summarizes the current opinion regarding the management of orbital tumours. Recent studies reviewing the range of diseases that affect the orbit and technical advances are summarized.
Dentoalveolar reconstruction: modern approaches
Fretwurst, Tobias; Gad, Lames Magdy; Nelson, Katja; Schmelzeisen, Rainer, 2015-08-01 08:00:00 AM
Purpose of review: A variety of bone grafting materials is available to facilitate the augmentation of defective alveolar ridges. This review evaluates current literature regarding bone grafting materials with emphasis on autologous and allogeneic bone block augmentation. Recent findings: Autogenous bone is a reliable grafting material providing predictable long-term results with high implant survival/success rates and low morbidity rates. The resorption properties of the iliac crest are well known and are compared with calvarial grafts more prominent. Recent studies demonstrated surgical techniques to prevent graft resorption after iliac crest grafting. Allogeneic block graft and implant survival rates appear promising in short-term clinical studies. Summary: At this stage, iliac crest remains the gold standard in large alveolar bone defects. Autogenous material is not a panacea; however, none of the available materials can currently surpass it. Rather, each material has its specific advantage for certain indications. Evident long-term studies of allogeneic bone grafting are lacking. Detected cells in allogeneic bone substitute material are positive for major histocompatibility complex classes I and II. Despite the promising clinical results achieved with allogeneic bone grafts, the current literature lacks sufficient data on antigenicity.
Office management of obstructive sleep apnoea: appliances
Johnson, Matthew D., 2015-08-01 08:00:00 AM
Purpose of review: Oral appliances are becoming increasingly common in the treatment of obstructive sleep apnoea (OSA). They work by advancing the mandible and opening the pharynx. There are several types of devices available for use. Many patients intolerant to continuous positive airway pressure (CPAP) are using oral appliances for OSA. Recent findings: Oral appliances have been shown to improve polysomnography, quality of life and health measures associated with OSA. There is current work to better identify patients who are ideal candidates. Development of titratable devices and monitoring are optimizing usage. They have been compared with CPAP, with both showing improvement in OSA; however, CPAP remains superior overall. Summary: Oral appliances are becoming first-line therapy for mild and moderate OSA. They provide a meaningful alternative in severe OSA for patients unable to use CPAP. Device titration and usage monitoring are beginning to hone oral appliances as a therapeutic option.
Παρασκευή 14 Αυγούστου 2015
Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue
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