The effect of "single" vs "double" eyelids on the perceived attractiveness of Chinese women.

BACKGROUND: A well-defined supratarsal crease has often been considered attractive, representing a significant component in a beautiful upper eyelid. Approximately 50% of East and Southeast Asian women are born with either a minimal or absent supratarsal eyelid crease. Among people of Chinese descent, the creation of a supratarsal crease ("double" eyelid blepharoplasty) is the most common cosmetic surgical procedure, but no comparative study has assessed the height by which an upper eyelid crease is deemed most attractive and depending on cultural background. OBJECTIVES: The authors assess how attractiveness is interpreted by different cultural groups to determine whether double-eyelid blepharoplasty enhances attractiveness according to both Chinese and non-Chinese observers. METHODS: Facial photographs were taken of 19 women of Chinese descent. The photographs were enhanced with computer imaging software to generate 3 additional pictures, depicting low, medium, and high upper eyelid creases on each model. Via an Internet-based survey tool, Chinese and non-Chinese observers were asked to rate the attractiveness of the faces with each potential eyelid position. (Surveys are available online at www.aestheticsurgeryjournal.com, as Appendix 1 and Appendix 2.) RESULTS: Both Chinese and non-Chinese observers considered the medium-height upper eyelid crease most attractive (P < .00001). An absent upper eyelid crease was deemed the least attractive (P < .00001). CONCLUSIONS: These preference data for eyelid height can be used to better counsel patients on perceived attractiveness and expectations for surgical results, since these results further elucidate which facial features are universally considered attractive.

Efficacy of preoperative neck ultrasound in the detection of cervical lymph node metastasis from thyroid cancer.

OBJECTIVES/HYPOTHESIS: This study was performed to assess the diagnostic accuracy of surgeon-performed preoperative neck ultrasound (US) in the detection of both central and lateral cervical lymph node metastases from thyroid cancer. STUDY DESIGN: Prospective cohort study. METHODS: Data for all patients with thyroid cancers and follicular thyroid lesions who were evaluated by means of preoperative neck US were reviewed. The cervical lymph nodes were assessed for suspicion of metastasis based on US characteristics. The diagnostic accuracy of US was determined according to whether histologically confirmed cancer was present in surgical cervical lymph node specimens. RESULTS: The sensitivity and specificity of US in predicting papillary thyroid carcinoma (PTC) metastasis in the central neck were 30.0% and 86.8%, respectively. The sensitivity and specificity of US in predicting metastasis in the lateral neck were 93.8% and 80.0%, respectively. A subset of patients underwent US followed by revision neck dissection for PTC, and the sensitivity and specificity of US in predicting metastasis in the lateral neck were 100% and 100%, respectively. CONCLUSIONS: Preoperative neck US is a valuable tool in assessing patients with thyroid cancers. The highly sensitive and specific nature of US in predicting cervical lymph node metastasis in the lateral neck, especially in the setting of recurrent disease, can provide reliable information to assist in surgical management. Although US for central compartment lymphadenopathy in the presence of the thyroid gland is less sensitive and specific than US for the lateral neck, it still provides useful information that can be obtained at the same time the primary thyroid pathology is assessed.

Traumatic rhinoplasty in the non-Caucasian nose.

Traumatic injury resulting in nasal deformity poses unique challenges to the surgeon. Optimal management requires careful preoperative analysis and thoughtful surgical planning. The goals of rhinoplasty are to correct both cosmetic and functional problems that may not have otherwise been an issue prior to the injury. Although it is overly simplistic to group all individuals from one ethnicity as having one type of nose, the rhinoplasty surgeon must understand the common variations of nasal anatomy seen in various races of individuals. This article discusses ethnic anatomic differences in the non-Caucasian nose in the context of posttraumatic nasal deformity. The various rhinoplasty techniques and strategies to address these issues are reviewed.

Comparison of positron emission tomography/computed tomography imaging and ultrasound in staging and surveillance of head and neck and thyroid cancer.

OBJECTIVES/HYPOTHESIS: Positron emission tomography (PET) combined with cross-sectional computed tomography (CT) is increasingly used for staging and surveillance of cancers in the head and neck region. Ultrasonography (US) is an alternative imaging technique that provides diagnostic information while enabling simultaneous image-guided biopsies. A comparison of these diagnostic modalities in cancer detection is warranted. METHODS: All patients with malignant neoplasms in the head and neck region who were evaluated by both PET/CT and US were reviewed. Diagnostic accuracy rates of PET/CT and US were determined according to whether cytologically or histologically confirmed cancer was present in US-guided fine-needle biopsy or surgical specimens. RESULTS: From October 2004 to December 2007, 42 patients with an ultimately confirmed tissue diagnosis of a head and neck malignancy underwent both neck US and PET/CT. The sensitivity and specificity of US in predicting malignancy in the head and neck was 96.8% and 93.3%, respectively, in those 42 individuals. The positive predictive value (PPV) was 96% and the negative predictive value (NPV) was 93%. In comparison, PET/CT in this group demonstrated a sensitivity of 90.3%, specificity 20%, PPV 70%, and NPV 50%. CONCLUSIONS: PET/CT and US, especially when combined with US-guided fine-needle biopsy, are complementary tools in the detection of cancers of the head and neck. The highly sensitive and specific nature of US, combined with its low cost, low morbidity, availability as an in-office examination, and ability to guide biopsies, warrant consideration of its routine use in the management of head and neck and thyroid cancer patients.

Expansile bone cyst and cholesteatoma of the temporal bone.

OBJECTIVE: To identify primary bony cysts of the temporal bone. PATIENT: A single case of a woman presenting with unilateral bulging of the temporoparietal cranium, progressive stenosis of the external auditory canal, and maximal conductive hearing loss. INTERVENTION(S): Plain x-rays, magnetic resonance imaging, contrast-enhanced computed tomography, audiogram, and modified radical mastoidectomy. MAIN OUTCOME MEASURE(S): Radiologic and histopathologic diagnosis of a primary bone cyst of the temporal bone obstructing the external auditory canal with a retained cholesteatoma of the middle ear. RESULTS: Identification of an inflammatory bony cyst of the temporal bone with a retained cholesteatoma of the middle ear resulting in stenosis of the external auditory canal and maximal conductive hearing loss. CONCLUSION: Primary bone cyst of the temporal bone can lead to external auditory canal stenosis, middle ear cholesteatoma, and conductive hearing loss.