Effect of Perineural Dexamethasone on the Duration of Single Injection Saphenous Nerve Block for Analgesia After Major Ankle Surgery: A Randomized, Controlled Study.

Background and Objectives: Patients undergoing major elective ankle surgery often experience pain from the saphenous nerve territory persisting beyond the duration of a single-injection saphenous nerve block. We hypothesized that perineural dexamethasone as an adjuvant for the saphenous nerve block prolongs the duration of analgesia and postpones as well as reduces opioid-requiring pain. Methods: Forty patients were included in this prospective, randomized, controlled study. All patients received a continuous sciatic catheter and were randomized to receive a single-injection saphenous nerve block with 10 mL of 0.5% bupivacaine with 1:200,000 epinephrine with addition of 1 mL of saline or 1 mL of 0.4% (ie, 4 mg) dexamethasone. The primary outcome was duration of saphenous nerve block estimated as the time until the first opioid request. Secondary outcomes were opioid consumption and pain. Results: The mean (SD) duration of the saphenous nerve block until first opioid request was 29.4 (8.4) hours in the dexamethasone group and 23.2 (10.3) hours in the control group (P = 0.048). The median opioid consumption [interquartile range] during the first 24 hours was 0 mg [0-0] versus 1.5 mg [0-14.2] in the dexamethasone and control groups, respectively. Nonparametric comparison of opioid consumption from 0 to 24 hours was statistically significant. The opioid consumption was similar in the two groups in the time interval 24 to 48 postoperative hours. Conclusion: Perineural dexamethasone as an adjuvant for the single-injection subsartorial saphenous nerve block can prolong analgesia and reduce opioid-requiring pain after major ankle surgery. Copyright (C) 2016 by American Society of Regional Anesthesia and Pain Medicine.

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Is there a role of food additives in recurrent aphthous stomatitis? a prospective study with patch testing

Abstract

Background

Recurrent aphthous stomatitis (RAS) is a common disease of the oral mucosa with an unknown etiology. This study aimed to determine if food additives play a role in the etiology of RAS as well as to determine if patch testing can be used to detect which allergens cause RAS.

Methods

This prospective study included 24 patients with RAS and 22 healthy controls. All the participants underwent patch testing for 23 food additives.

Results

In total, 21 (87.5%) RAS patients and 3 (13.6%) controls had positive patch test reactions to ≥1 allergens; the difference in the patch test positivity rate between groups was significant (P < 0.05). The most common allergen that elicited positive patch test results in the patient group was cochineal red (n = 15 [62.5%]), followed by azorubine (n = 11 [45.8%]) and amaranth (n = 6 [25%]).

Conclusions

The present findings show that food additives might play a role in the etiology of RAS and that patch testing could be a method for determining the etiology of RAS.

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A Tribute to Tony Bull—Surgeon, Teacher, Leader, Gentleman (1934–2016)

Facial plast Surg 2016; 32: 579-584
DOI: 10.1055/s-0036-1594257

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Worldwide Perspectives in Facial Plastic Surgery

Facial plast Surg 2016; 32: 585-586
DOI: 10.1055/s-0036-1597957

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Optimizing the Soft Tissue Triangle, Alar Margin Furrow, and Alar Ridge Aesthetics: Analysis and Use of the Articulate Alar Rim Graft

Facial plast Surg 2016; 32: 646-655
DOI: 10.1055/s-0036-1596049

The alar lobule, alar margin, and soft triangle facet are receiving more attention in the literature as critical elements to address both preoperatively and during rhinoplasty. We have found that the use of the articulated alar rim graft (AARG) corrects deficiencies in these areas as well as provides mechanical stability to the external valve. In this article, we describe indications for AARG, describe in detail the procedure for AARG placement, and highlight the transformation AARGs can achieve in two illustrated case studies.
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Aesthetic Rhinoplasty as a Surface-Contour Operation: From Analysis to Surgery—Personal Concepts

Facial plast Surg 2016; 32: 587-598
DOI: 10.1055/s-0036-1597146

Numerous beautiful rhinoplasty results have been created by closed rhinoplasty techniques over the past 100 years. This operation was mainly a "reduction" surgery. Overaggressive reduction rhinoplasty is not a hallmark of the closed approach per se, but represents the result of inappropriate aesthetic appraisal, inadequate technical execution, or lack of sound anatomical understanding. Clearly, an operation based primarily on reduction intrinsically exposes the surgeon to the possibility of excessive diminution of support structures and consequently undesirable side effects. The advent of the external approach in the 1970s marked a paradigm shift. In the early 1990s, the external approach witnessed further development with the introduction of "structural rhinoplasty," a deconstruction procedure followed by structural reconstruction. Opponents of the external approach felt that opening every nose can result in an overkill, specifically because the vast majority of patients presenting for cosmetic rhinoplasty neither desire nor require major reconstruction of the nose. In the last decade, the poorly named "closed" approach, once the pariah of rhinoplasty, has been rethought especially in the light of the undesirable long-term side effects, reappraised, and found a new lease of life as "endonasal rhinoplasty." The personal surgical evolution of the senior author (P. P.) has created the concept of "hybrid endonasal rhinoplasty" (HER), where the term "hybrid" implies the incorporation of anatomical concepts and sophisticated suturing–grafting techniques developed by "openers" into the theoretical and technical corpus of HER. The senior author (P. P.) pondered over heterogenous concepts such as filling-reshaping, derived from the so-called medical rhinoplasty, and embodied these concepts into a purely surgical endonasal perspective. Consequently, aesthetic rhinoplasty can be considered a "surface-contour" operation. Nasal analysis, preoperative work-up, surgical logic, and operative techniques have been rethought. The patient is only interested in nasal appearance, not in its anatomy, so deconstructing the nose to change the subtle and demanding interplay of light and shadow is in many cases an overkill. Our emphasis should be on those structures that can be tackled and result in the ultimate aim of altering the aesthetic aspects of surface anatomy. Surface HER can deliver on all these counts.
[...]

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Optimizing Outcomes with Clinical Data Registries

Facial plast Surg 2016; 32: 636-637
DOI: 10.1055/s-0036-1596047

Clinical data registries are platforms to extract, store, analyze, and disseminate large amounts of clinical data. The type of data contained in clinical data registries varies by the registry, and may include patient demographics, clinical examination findings, imaging and laboratory results, procedures performed, and patient-reported outcomes. When large numbers of participants submit data to a clinical data registry the data can then be analyzed in aggregate to answer new clinical questions. Analyses on the data may be performed to show outcomes over time, compare procedures, evaluate care patterns, among others. With the launch of an otolaryngology-specific clinical data registry, Regent, facial plastic and reconstructive surgeons have the opportunity to participate in a clinical data registry for the first time. Through broad participation in the registry, the specialty has a chance to optimize patient outcomes in a manner never before possible.
[...]

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