Intracranial malignant peripheral nerve sheath tumor: A case report and comprehensive literature review.

Background: Malignant peripheral nerve sheath tumors (MPNSTs) are rare malignant soft-tissue sarcomas arising from peripheral nerves. Little data exist regarding MPNST originating intracranially. Here, we present a 7th/8th nerve complex MPNST, discuss the treatment strategy and patient outcome, and provide a comprehensive review of existing literature. Methods: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, PubMed and crossed references were queried, yielding 37 publications from 1952 to the present. Fifty-three cases of primary intracranial and extra-axial MPNST were identified. Results: We additionally report a 40-year-old female presented with acute onset dizziness and subsequent hearing loss with associated right-sided facial numbness. Magnetic resonance imaging revealed a 0.5 cm × 1.7 cm enhancing lesion within the right internal auditory canal extending into the cerebellopontine angle. The patient was initially treated with retro sigmoid craniotomy for tumor resection followed by a trans labyrinth approach for residual tumor resection. She completed adjuvant fractionated radiation therapy and underwent facial nerve transfer to restore complete hemifacial paralysis. The most common cranial nerves involved were V and VIII (43.4% each), with 66% of patients male and 34% female. The average age was 43.4 ± 17.4 years. The mean survival time for reported non-survivors after tissue diagnosis was 15 ± 4 months. Two-year survival for patients receiving gross total resection was 33.3% versus 22.8% with subtotal resection. Conclusion: MPNSTs comprise a group of highly aggressive neoplasms that rarely arise intracranially. Gross total surgical resection should be pursued when feasible.

Evaluation of Mobile and Digital Single-Lens Reflex Photography for Facial Surgical Analysis.

OBJECTIVES: High-quality perioperative photography is imperative to good surgical planning in facial reconstructive and aesthetic surgery. We explore the utility of an add-on smartphone telephoto lens to avoid the distortions noted in prior studies using smartphone cameras. METHODS: Standard perioperative photographs of the same subject were taken with three distinct cameras using a dual-ring light setup. The three camera setups iPhone 11 alone, iPhone 11 with the 58 Moment telephoto lens attachment, and a D3300 Nikon DSLR APS-C sensor camera with a 60 mm NIKKOR F2.8G ED macro lens were compared using a 47-question online survey consisting of demographic and image-specific questions sent to plastic surgeons. RESULTS: Forty-nine facial plastic surgeons completed the survey. The iPhone 11 alone was identified as having the lowest quality for central/peripheral distortion (83%), columella/caudal septum/alar anatomy (58.3%), and skin quality (38.3%). With the addition of the telephoto lens, the ability to assess all categories was significantly improved. 53.1% (n = 26) of respondents found the iPhone 11 + 58 mm telephoto lens setup to be the most useful for perioperative surgical planning. CONCLUSIONS: Smartphone photography with the addition of a telephoto lens can offer a comparable option to the DSLR with regard to photo quality and detail. SUMMARY: A telephoto add-on lens is an effective solution to overcome the central distortion seen in images taken by the iPhone for perioperative photography. This photo quality was found to be comparable to that of traditional DSLR cameras in our survey study. LEVEL OF EVIDENCE: 3 Laryngoscope, 133:2590-2596, 2023.

Perceptions of Attractiveness in Dorsal Aesthetic Lines of the Nose: A Crowd Sourcing Analysis.

Background: Some surgeons have recently advocated for a fusiform pattern with a flare around the keystone area over the more traditional straight/curvilinear shape for the ideal shape of the nasal dorsal aesthetic lines (DALs). Objective: To compare the lay persons judgment of what constitutes an ideal nasal dorsum outline. Methods: An observational crowdsourcing survey-based study was designed and conducted by the authors to determine how the public viewed these two nasal dorsum aesthetic configurations. In total, 1034 surveys comparing various altered images with these variants were analyzed. Results: Our crowd-based cohort preferences for DALs favored as more attractive, the traditional concept of paired straight or curvilinear lines sweeping gently from the glabella to the nasal tip. The fusiform nose was seen as more natural. Conclusion: Our study suggests that individuals may view a straight/curvilinear nasal dorsum as a more attractive result, whereas a fusiform nasal dorsum may be viewed as a more natural result.

Non-Surgical Devices for Nasal Obstruction.

Nasal obstruction is a common presenting complaint in most otolaryngology practices. A reduction of nasal airflow can contribute to exercise intolerance, snoring, obstructive sleep apnea (OSA), and an overall decreased quality of life. When medical management for non-anatomical issues fails to resolve the obstruction, surgeries targeting nasal obstruction-namely septorhinoplasty and/or inferior turbinate reduction are often considered. A frequently overlooked alternative for these patients is the wide array of non-surgical and minimally invasive appliances available to address nasal obstruction. This article attempts to provide a basic overview of these devices, benefits, and limitations, and the evidence supporting their efficacy in alleviating nasal obstruction.

Utilization of Rhinoplasty Worksheets among Practicing Facial Plastic Surgeons.

Rhinoplasty is the most commonly performed procedure by facial plastic surgeons, yet many consider it the most complex and variable surgery performed. Yet no standardized surgical worksheet has been established to document the maneuvers and anatomical changes made despite the known high rate of revision surgery. This study aimed to assess the utility and utilization of rhinoplasty surgical worksheets amongst facial plastic surgeons, as well as the perceptions and attitudes toward standardization of a common rhinoplasty surgical worksheet. METHOD: We distributed an online survey to all active members of the American Academy of Facial Plastic and Reconstructive Surgery, in order to assess trends in utilization of surgical worksheets and the willingness of physicians to adhere to a standardized worksheet to be included in patient's medical records. RESULTS: When surveyed, 84 of the 130 respondents reported using a surgical worksheet, with 63 of 84 mentioned using a variation of their own custom worksheets. Of the 84 surgeons, 45 used these worksheets "often" or "always" during follow-up appointments. However, 111 of the 130 reported "never" or "rarely" receiving a surgical worksheet from another provider for revision rhinoplasties. In total, 96 of the 130 respondents were "strongly in favor" or "in favor" of sharing worksheets with other providers and 87/130 were in favor of establishing a standardized rhinoplasty worksheet for all rhinoplasty patients. CONCLUSIONS: A majority of respondents reported using surgical worksheets for rhinoplasties with very few reporting ever receiving other surgeons' worksheets prior to revision rhinoplasties. Roughly three fourths of respondents were in favor of sharing worksheets along with a majority in favor of a standardized worksheet. This would represent a significant change in practice along with potentially increased collaboration between surgeons and subsequent advancement of patient care.