Quality of Life Outcomes After Facial Feminization Surgery.

Objective: Report a large single-institution cohort of quality of life (QOL) data before and after facial feminization surgery (FFS). Study Design: Case series. Methods: Patients who underwent FFS at our institution between 2017 and 2019 and completed a pre- and postoperative QOL survey were included in this study. Responses were scored on a 5-point scale with 1 corresponding to least agreement and 5 corresponding to most agreement. Paired t-test was used to compare pre- and postoperative mean scores for each response. Two-tailed t-test was used to compare the mean postoperative delta for each response by demographics. Results: One hundred seven of 341 patients completed a pre- and postoperative survey. The average age was 36 years (range 18-67). The mean time to postoperative survey completion was 96 days (interquartile range 43). Significant improvements in all aspects of QOL assessed on the survey were noted after surgery, including self-perceived facial femininity (2.1-3.8, p < 0.001) and publicly perceived facial femininity (2.0-3.6, p < 0.001). Patients also felt less limited in social activities (3.2-2.0, p < 0.001) and professional activities (2.7-1.7, p < 0.001). Conclusion: FFS improves self-perceived and externally perceived facial femininity and reduces limitations in social and professional activities.

Simulating a Vertical Evacuation of a NICU and PICU to Examine the Relationship Between Training and Preparedness.

OBJECTIVE: The aim of this study was to implement pediatric vertical evacuation disaster training and evaluate its effectiveness by using a full-scale exercise to compare outcomes in trained and untrained participants. METHODS: Various clinical and nonclinical staff in a tertiary care university hospital received pediatric vertical evacuation training sessions over a 6-wk period. The training consisted of disaster and evacuation didactics, hands-on training in use of evacuation equipment, and implementation of an evacuation toolkit. An unannounced full-scale simulated vertical evacuation of neonatal intensive care unit (NICU) and pediatric intensive care unit (PICU) patients was used to evaluate the effectiveness of the training. Drill participants completed a validated evaluation tool. Pearson chi-squared testing was used to analyze the data. RESULTS: Eighty-four evaluations were received from drill participants. Forty-three (51%) of the drill participants received training and 41 (49%) did not. Staff who received pediatric evacuation training were more likely to feel prepared compared with staff who did not (odds ratio, 4.05; confidence interval: 1.05-15.62). CONCLUSIONS: There was a statistically significant increase in perceived preparedness among those who received training. Recently trained pediatric practitioners were able to achieve exercise objectives on par with the regularly trained emergency department staff. Pediatric disaster preparedness training may mitigate the risks associated with caring for children during disasters.

Initial Facial Feminization Surgery Experience in a Multicenter Integrated Health Care System.

OBJECTIVE: There are few large studies on facial feminization surgery (FFS). We provide the largest comprehensive report to date of an FFS cohort regarding the safety of multilevel surgery, patient-specific considerations with FFS procedures, and complications of surgery. STUDY DESIGN: Retrospective cohort study. SETTING: Multicenter integrated health care system. SUBJECTS AND METHODS: We examined all patients undergoing FFS within our institution from April 2016 to October 2018. Patients over the age of 18 with a diagnosis of gender dysphoria underwent any combination of scalp advancement, cranioplasty, brow lift, rhinoplasty, upper lip lift, mandibuloplasty, chondrolaryngoplasty, and/or additional cosmetic procedures. Medical records were reviewed for preoperative characteristics, FFS procedures undergone, and postoperative complications. RESULTS: In total, 121 patients underwent a total of 594 FFS procedures. Seventy-five percent of patients had only 1 or no comorbidities, and 90% of patients underwent cranioplasty, scalp advancement, and brow lift. African American patients (n = 5) less commonly underwent cranioplasty compared to those of other ethnicities (white, P < .001; Asian, P = .022; Hispanic, P = .014; multiracial, P = .006). Asian patients less commonly underwent rhinoplasty than white patients (38% vs 73%, P = .023). Only 8 (6.6%) patients experienced a significant complication after surgery. CONCLUSIONS: The population undergoing FFS is generally healthy, the upper third of the face is most commonly addressed, there are age and ethnic considerations in FFS, and major complications after multilevel surgery are uncommon.

Evolving Treatment of Frontal Sinus Cholesteatoma: A Case Report.

INTRODUCTION: Cholesteatomas are lined by squamous epithelium, contain keratin debris, and can cause bony erosion. Although commonly found in the middle ear space and mastoid, cholesteatomas may develop in adjacent structures including the paranasal sinuses. Frontal sinus cholesteatoma (FSC) is a rare condition with fewer than 30 reported cases. The aims of this study are to describe the clinical presentation, diagnostic imaging, and endoscopic treatment of FSC and to review the literature focusing on the pathogenesis, diagnosis, and historical and contemporary treatments of FSC. CASE PRESENTATION: A 45-year-old man presented with a 1-week history of right eyelid and forehead swelling. Results of computed tomography scans and magnetic resonance images revealed a right frontal sinus lesion of soft-tissue density with bony dehiscence along the superior orbit and posterior table. He underwent right-sided endoscopic sinus surgery at a tertiary care center in January 2017. Intraoperatively, the frontal sinus contained keratin debris suggestive of FSC. This suspicion was confirmed postoperatively by pathologic analysis after subtotal resection. DISCUSSION: The pathogenesis of frontal sinus cholesteatoma varies based on its cause (congenital vs acquired). Clinical diagnosis remains challenging but is aided by nasal endoscopy, computed tomography, and magnetic resonance imaging. Historically, FSC has been managed by total extirpation through open approaches, which can entail substantial morbidity. With sophisticated endoscopic sinus instrumentation and image guidance, FSC can be successfully treated via an endoscopic approach. Serial débridements and washouts in an outpatient setting may adequately manage the residual disease in the postoperative period.