Persistent improvement in lower eyelid-cheek contour after a transtemporal midface lift.

BACKGROUND: This study aimed to assess quantitative changes in lower-eyelid aesthetics after a transtemporal midface lift concomitant with transconjunctival blepharoplasty and lower-eyelid skin pinch. METHODS: The study enrolled 55 consecutive patients who underwent a transtemporal midface lift and concurrent transconjunctival blepharoplasty with lower-eyelid skin pinch. All the surgeries were performed over a 2-year period by the senior author (A.A.J.). Patient demographics and surgical details were recorded. Standardized digital photographs were taken at baseline and then 12 months postoperatively. These were analyzed to assess changes in the vertical height of the lower eyelid and compared using within-subject analysis. RESULTS: The study cohort consisted of 50 women with a mean age of 54 years (range, 28-76 years). Five patients were lost to follow-up evaluation. The mean vertical height of the lower eyelid was 11.8 mm preoperatively and 9.3 mm postoperatively, giving an average difference of 2.5 mm at the 12-month follow-up assessment. The changes in lower-eyelid height were statistically significant (p = 0.0002), and the lower eyelid-cheek contour was improved in all cases. No major complications occurred during the study period, and no revision surgery was performed. Lower-eyelid height changes did not vary significantly with patient age. CONCLUSIONS: Age-related changes to the midface are marked by increased vertical height of the lower eyelid and a concomitant appearance of infraorbital hollowing. Separation of the lower eyelid-cheek complex causes the typical double-contour deformity. To the authors' knowledge, no study to date has reported the long-term effect of a midface lift on lower-eyelid aesthetics. The transtemporal midface lift not only repositions the malar fat pad but importantly also provides significant shortening of the lower eyelid at 12 months. This results in an improved midface contour. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Vocal outcome measures after bilateral posterior cricoarytenoid muscle botulinum toxin injections for abductor spasmodic dysphonia.

OBJECTIVE: To review vocal outcome measures, using the Voice Related Quality of Life (VRQOL) index, after simultaneous bilateral posterior cricoarytenoid muscle botulinum toxin injections. STUDY DESIGN: Case series. SETTING: Tertiary care academic clinic. SUBJECTS AND METHODS: Fourteen subjects with abductor spasmodic dysphonia received 37 simultaneous bilateral posterior cricoarytenoid muscle botulinum toxin injections for isolated abductor spasmodic dysphonia (ABSD) over a 16-month period. MAIN OUTCOME MEASURES: VRQOL index. RESULTS: Of the 37 injections, 33 of 37 (89%) resulted in improvement. Three injections resulted in no improvement, and one injection resulted in a worse VRQOL. The overall VRQOL mean improvement was 19.8 (range 5-53), with an average pre/postinjection VRQOL interval of 36 days (range 21-45 days). CONCLUSIONS: Simultaneous bilateral posterior cricoarytenoid muscle botulinum injections result in a statistically significant improvement in VRQOL index scores for a high percentage of ABSD patients, thus improving patient quality of life.

A novel mechanism for connexin 26 mutation linked deafness: cell death caused by leaky gap junction hemichannels.

OBJECTIVES: Mutations in connexin (Cx) 26 are the most common cause of nonsyndromic hereditary hearing impairments. Our goal is to investigate molecular mechanisms responsible for hearing impairment caused by various types of Cx26 mutations. STUDY DESIGN: Mutant Cxs linked to deafness were expressed in HEK293 cells. The permeability of reconstituted gap junctions (GJs) and hemichannels were studies. METHODS: HEK293 cells were used to reconstitute GJs and hemichannels in vitro. Ionic as well as biochemical permeabilities of reconstituted GJs were evaluated. RESULTS: We found two-point substitution mutations located in the first extracellular loop of Cx26, E47K, and G45E affected the GJ functions in dramatically different manners. E47K mutant Cx26 formed nonfunctional GJs that lacked GJ- and hemichannel-mediated biochemical and ionic coupling. In contrast, G45E mutation resulted in apoptosis and cell death within 24 hours of transfection. Increasing concentration of extracellular calcium ([Ca2+]0) rescued the cells in a dose-dependent manner. The rescued cells formed functional G45E GJs permeable to both ions and fluorescent tracer molecules. CONCLUSIONS: The primary effect of G45E Cx26 mutation is to cause leaky GJ hemichannels when cells are bathed in normal [Ca2+]0. Our data showed that abnormally open hemichannels with resultant cell death, in addition to GJ and hemichannel uncoupling, is a novel molecular mechanism by which Cx26 mutations may result in hearing impairment. One plausible therapeutic strategy for this type of Cx mutation, therefore, is to manipulate [Ca2+]0 and/or the Ca-binding affinity of GJ hemichannels.

Pediatric parotitis: a 5-year review at a tertiary care pediatric institution.

BACKGROUND: Parotitis is a well recognized entity in the adult population, however there are very few studies concerning the clinical presentation and management of this condition in children. OBJECTIVES: To characterize pediatric parotitis in a tertiary care setting, with the goal of clarifying management recommendations and outcomes. METHODS: The charts of all pediatric patients with a diagnosis of parotitis treated at a tertiary care academic institution from 1999 to 2004 were reviewed. The management of inpatients and outpatients were characterized to define differences in presentation and care. RESULTS: Twenty-one children (6 months-15 years) with a diagnosis of parotitis were identified. Thirteen (62%) children were treated as inpatients, of which seven (54%), had significant medical co-morbidities. The most common clinical presentations of the inpatient group included dehydration (46%), fever (38%) and leukocytosis (46%). Two inpatients (15%) required surgical drainage due to abscess formation. Eight children (38%) were treated as outpatients, none with associated co-morbidity, fever, leukocytosis, or complication due to infection. All outpatients were treated with oral antibiotics or conservative therapy with eventual resolution. CONCLUSIONS: Parotitis in the pediatric population is uncommon. The presence of a significant co-morbidity, fever, or leukocytosis may require inpatient therapy and imaging if patients fail to improve with medical therapy. Other than abscess drainage, surgery for parotitis in children is not routinely recommended.

Safety of simultaneous bilateral botulinum toxin injections for abductor spasmodic dysphonia.

OBJECTIVE: To review the safety of simultaneous bilateral posterior cricoarytenoid muscle botulinum toxin injections. DESIGN: Retrospective case series review. SETTING: Tertiary care academic clinic. PATIENTS: Twenty-one patients with abductor spasmodic dysphonia. INTERVENTIONS: Patients received 100 simultaneous bilateral posterior cricoarytenoid muscle botulinum toxin injections for isolated abductor spasmodic dysphonia over a 6-year period. MAIN OUTCOME MEASURES: Major and minor complications, injection dosing, and demographics. RESULTS: The total bilateral botulinum toxin injection dose per session ranged from 2.50 to 7.50 U, and the average total bilateral dose per patient was 4.70 U. There were no major complications, and minor complications were self-limited. There was a 5% incidence of significant dyspnea and a 2% incidence of dysphagia, and all patients were treated conservatively. The average doses at which dyspnea and dysphagia occurred were 4.97 and 5.56 U, respectively. CONCLUSIONS: This case series demonstrates that simultaneous bilateral posterior cricoarytenoid muscle botulinum toxin injection is safe up to the highest doses reported. Complications with this approach are consistent with those previously reported using other methods. Prospective studies on vocal outcome measures are needed for simultaneous bilateral posterior cricoarytenoid muscle botulinum toxin injections to evaluate the efficacy of this technique.