Low-Cost and Simple Frontal Sinus Surgical Cutting Guide Modeling for Anterior Cranioplasty in Facial Feminization Surgery: How To Do It.

BACKGROUND: This study demonstrates a novel and simple design to create a low cost frontal sinus surgical cutting guide, using patient's frontal sinus cavities as references, to perform an anterior cranioplasty in facial feminization surgery. A clinical series demonstrates its clinical use and safety. MATERIAL AND METHODS: Authors used a 4 open-source software protocol for the virtual surgical modeling (VSP). Retrospectively, pre- and post-operative complications were reviewed, and a FACE-Q questionnaires were used to evaluate patient's postoperative "Satisfaction with forehead and eyebrows." Recordings of the VSP and surgical technic are presented. RESULTS: Sixteen patients were operated between November 2018 and November 2020 using in-house surgical guides. All were performed by authors in 5 to 10 minutes using Blender open-source Software. No complications were reported and authors always found an optimal retention of the surgical guide on the convex bony surface of the forehead and frontonasal area. FACE-Q questionnaire reported a very high satisfaction for all patients (mean score: 22/24). DISCUSSION: This simplify organic design can be performed efficiently by any surgeon even without previous training in home staging VSP. Patient satisfaction was very high, along with an absence of postoperative complications.

Temporalis muscle vasculature directly derived of the middle meningeal artery: a case report and review.

Pedicled temporalis muscular flap is a common procedure nowadays in reconstructive head and neck surgery, especially for oral or orbital cavity defects. We present a case of temporalis muscle and skull base dissection of a seventy-year-old fresh female cadaver with single temporal muscle vessels directly derived of the middle meningeal artery throughout the calvaria, therefore jeopardizing the harvest of the flap, which has never been described to our knowledge. Such a variation must be known of the reconstructive surgeon to plan the ideal reconstruction procedure.

Three-Dimensional Custom-Made Surgical Guides in Facial Feminization Surgery: Prospective Study on Safety and Accuracy.

BACKGROUND: Facial feminization surgery (FFS) includes several osseous modifications of the forehead, mandible, and chin, procedures that require precision to provide the patient with a satisfactory result. Mispositioned osteotomies can lead to serious complications and poor aesthetic outcomes. Surgical cutting guides are commonly employed in plastic and maxillofacial surgery to improve safety and accuracy. Yet, to our knowledge, there is no report in the literature on the clinical application of cutting guides in FFS. OBJECTIVES: The authors sought to assess the safety and accuracy of custom surgical cutting guides in FFS procedures. METHODS: A prospective follow-up of 45 patients regarding FFS with preoperative virtual planning and 3-dimensional custom-made surgical guides for anterior frontal sinus wall setback, mandibular angle reduction, and/or osseous genioplasty was conducted. Accuracy (superimposing preoperative data on postoperative data by global registration with a 1-mm margin of error), safety (intradural intrusion for the forehead procedures and injury of the infra alveolar nerve for chin and mandibular angles), and patient satisfaction were assessed. RESULTS: A total 133 procedures were documented. There was no cerebrospinal fluid leak on the forehead procedures or any infra alveolar nerve or tooth root injury on both chin and mandibular angle operations (safety, 100%). Accuracy was 90.80% on the forehead (n = 25), 85.72% on the mandibular angles (n = 44), and 96.20% on the chin (n = 26). Overall satisfaction was 94.40%. CONCLUSIONS: Custom-made surgical cutting guides could be a safe and accurate tool for forehead, mandibular angles, and chin procedures for FFS.

Thin submental artery perforator flap for upper lip reconstruction: A case report.

Reconstruction of upper lip defects can be challenging even for experienced surgeons. In order to restore both function and morphology, the use of quality soft tissue is essential. To this effect, the most common solution is the use of local flaps, or, in extreme situations, a free flap. However, a thin cutaneous upper lip defect may require a different approach. Perforator flaps are versatile and may allow an efficient reconstruction of soft tissue defects using adjacent similar tissues, providing the benefit of "like with like" coverage. We present the case of a 41-year-old female with a 1 × 1.5 cm basal cell carcinoma of the right-side upper lip, initially treated with a full thickness skin graft. Due to poor aesthetic and functional result, a thin submental artery perforator (SMAP) flap reconstruction was performed. Flaps' dimensions were 6 cm long and 4 cm wide and it was based on a perforator arising from the submental artery. Dissection was conducted above the platysma muscle, and the SMAP flap was transferred into the defect through a subcutaneous tunnel created below the mandible and posterior to the anterior belly of digastric muscle. The pedicle length of 6.5 cm was adequate for a tension free inset of the flap. Postoperative course was uneventful and the patient was discharged after 2 days. The 4-month follow-up showed a satisfying functional and aesthetic outcome with a concealed donor site scar. This report points out the coverage potential of the thin SMAP flap, which can be successfully used for a harmonious reconstruction in both color and texture of the upper lip.

Revisiting the temporal artery posterior auricular skin flap with an anatomical basis stepwise pedicle dissection for use in targeted facial subunit reconstruction.

BACKGROUND: This study demonstrates the anatomy of the pedicled temporal artery posterior auricular skin (TAPAS) flap, its variable arc of rotation based on stepwise dissection, and case reports demonstrating clinical use. This flap provides excellent color match and ultrathin tissue for targeted reconstruction of small- to medium-sized facial subunit defects. METHODS: Twenty-six cadaver dissections were performed. The authors measured the reach and rotation limits of the flap in a pedicled fashion depending on a stepwise approach for vascular pedicle dissection. Two clinical cases demonstrating maximum arc of rotation are seen. RESULTS: The pedicled TAPAS flap maximal rotation limits allow for reconstruction of facial subunits encompassing nearly the entire ipsilateral face. No venous congestion, wound complications, or partial/total flap loss were encountered with extreme clinical applications. CONCLUSION: The pedicled TAPAS flap has extensive versatility for reconstruction of a variety of facial subunit defects. The flap also has, in theory, multiple applications for intraoral reconstruction.

Thyroid surgery outcomes analysis in an oral and maxillofacial surgery department.

The purpose of this study was to identify complication rates of thyroidectomies performed within the Department of Oral and Maxillofacial Surgery, University of Florida Health - Jacksonville, and to compare these with quantified data regarding complications of thyroidectomies performed by other specialties. A retrospective cohort analysis was implemented to determine complication rates amongst patients treated in the department between January 2012 and December 2017. Data variables included demographics, ASA status, social history, and preoperative signs and symptoms. The primary outcome variables were length of hospital length, secondary procedures in the same admission, and postoperative complications including hypocalcemia, hematoma, and voice changes. A total of 402 patients were identified, of whom six were excluded for insufficient data. The mean age of the 396 patients included was 47.9 years and 84.6% were female. Of the patients included, 338 experienced no complications; 86 patients spent more than one postoperative day in the hospital. A statistically significant (P=0.033) correlation was found between higher ASA status (III, IV, V) and increased length of stay. The results indicated safe and efficient thyroid surgery within a department of oral and maxillofacial surgery by current prevailing standards.

Oncological and aesthetic outcome following surgical management of orbito-palpebral skin cancers: A retrospective study of 132 patients.

BACKGROUND: The incidence of facial skin cancers continues to rise, with major studies on their impacts still lacking in the literature. This study reports on the oncological and aesthetic results following surgical management of an orbito-palpebral skin cancer. METHODS: This retrospective, monocentric study included patients treated for a non-melanoma skin cancer of the eyelid and orbit. Risk factors, location, histological type, invaded or insufficient margins, healing time, surgical management by excision and direct closure, skin graft or local flaps, self-evaluated aesthetics, and quality of life results were all compared. RESULTS: The study included 132 patients operated for basal cell carcinoma (71.9%), squamous cell carcinoma (22.9%), or for another type (5.2%) between November 2011 and January 2017. Average tumor size was 9.6 ± 6.3 mm. Surgical management resulted in excision and open healing (9.1%), excision and direct closure (3.9%), skin graft (31.1%), local flap (21.9%), or another type of reconstruction (3.0%). Significant links between invaded or insufficient margins and basal cell type (OR = 3.37, p = 0.014), tumor size over 7 mm (OR = 2.7, p = 0.011), double location (OR = 8.44, p = 0.04), flap-based reconstruction (OR = 0.290, p = 0.02), and female gender (OR = 0.418, p = 0.034) were reported throughout our multivariate analysis. CONCLUSIONS: This study brings out consequential information on factors linked with invaded or insufficient excision margins. Larger cohorts should evaluate the aesthetic outcomes in such a population.

Modified GoPro Hero 6 and 7 for Intraoperative Surgical Recording-Transformation Into a Surgeon-Perspective Professional Quality Recording System.

Recent innovations in wearable action cameras with high-definition video recording enable surgeons to use cameras for their surgical procedures. In this study, the GoPro HERO 6 (and 7) Black edition camera was modified step by step to allow for a completely wireless surgeon-perspective recording with a battery life and memory capacity never previously obtained with such a high level of digital video quality. With this system, a surgeon can record for more than 14 hours 26 minutes in 1,080 pixels at 60 frames per second without breaking scrub and capture the operating surgeon's direct view of the field. By modifying the newest generation of devices, the authors successfully eliminated all shortcomings of the prior generation of GoPro cameras for surgical recording. The modified GoPro HERO6 camera produced professional recording quality for a total cost lower than US$850. This is critically important, because video-based surgical training will continue to be a primary area of development in the future and represents a novel and effective way for young generations of surgeons to attain technical excellence and knowledge in surgery.

Oral Cavity Cancer.

Management of oral cavity squamous cell carcinoma has become increasingly driven by emerging evidence as a result of the improved quality of clinical research associating clinicopathologic risk factors with oncologic and survival outcomes. Multiple significant recent changes to treatment guidelines and staging algorithms for oral cavity squamous cell carcinoma reflect evolving understanding of tumor biology and the need for adequately extensive treatment of aggressive disease. This article provides clinicians with a synopsis of the most contemporary management strategies for oral cavity squamous cell carcinoma, framed within the context of historical treatment philosophies.