A Safe Technique for Excising the Perpendicular Plate of the Ethmoid Bone in Patients with Crooked Nose: A Finite Element Analysis.

BACKGROUND: Correction of the crooked nose, especially the perpendicular plate of the ethmoid bone, has the potential to cause skull base injury. At present, the safe and effective method for perpendicular plate resection has not been clearly defined through biomechanics. METHOD: CT scan data of 48 patients with crooked nose and deviated nasal septum were divided into C-type, angular deformity-type, and S-type based on the morphology of the 3D model. Different types of finite element models of the nasal bony septum and skull base were established. The osteotomy depth, angle, and force mode of the PPE resection were simulated by assembling different working conditions for the models. The von Mises stress of the anterior cranial fossa was observed. RESULTS: When the osteotomy line length was 0.5 cm, the angle was at 30° to the Frankfurt plane, and 50 N·mm torque was applied, the von Mises stress of the skull base was minimal in the four models, showing 0.049 MPa (C-type), 0.082 MPa (S-type), 0.128 MPa (angular deformity-type), and 0.021 MPa (control model). The maximum von Mises stress values were found at the skull base when the osteotomy line was 1.5 cm, the angle was 50°, and the force was 10 N along the X-axis, showing 0.349 MPa (C-type), 0.698 MPa (S-type), 0.451 MPa (angular deformity-type), and 0.149 MPa (control model). CONCLUSION: The use of smaller resection angle with the Frankfurt plane, conservative resection depth, and torsion force can better reduce the stress value at the skull base and reduce the risk of basicranial fracture. It is a safe and effective technique for perpendicular plate resection of the ethmoid bone in the correction of crooked nose. LEVEL OF EVIDENCE IV: 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 .

Exploration of surgical approach to reconstruct smile-like lip shape in East-Asian women.

BACKGROUND: To investigate the clinical effects of surgical treatment to improve the lip morphology for a smile-like appearance (joy and happiness) in East-Asian women. METHODS: From October 2016 to April 2020, 63 patients who had received surgery to lift the commissure of the mouth and adjust the shape of the upper red lip to form a smile-like shape were analyzed and evaluated. RESULTS: The lip shape of enrolled patients was improved to a certain extent after surgery without any obvious scar hyperplasia, and the satisfaction rate of people after the surgery was 85.71%. CONCLUSION: For East-Asian women with thin and flat lips, surgical approach can be used to improve the shape of lip, such that the appearance of the lip is in a smile-like shape, which can enhance affinity and also exhibit the aesthetic characteristics of East-Asian women. This treatment can be used for clinical reference. LEVEL OF EVIDENCE: Level IV.

Risk factors associated with loss to follow-up of breast cancer patients: A retrospective analysis.

BACKGROUND: Loss to follow-up (LTFU) during post-operative surveillance of breast cancer patients is detrimental. The pattern of LTFU and its risk factors in Chinese breast cancer patients remains unknown. METHOD: Eligible non-metastatic breast cancer patients who underwent surgery at our institution between 2009 and 2012 were included. The clinicopathological features, as well as the LTFU status, were retrieved from the REDCap database. LTFU was defined as the absence of patients for at least 12 months since her last contact. 5-year LTFU was defined as the LTFU status of each patients at 5 years after surgery. The incidence and potential risk factors of LTFU were analyzed. A LTFU-risk score was developed to quantify the risk of LTFU. RESULTS: A total of 1536 patients with breast cancer were included, and 411(26.8%) patients were 5-year LTFU. 198 patients were LTFU in the first year. Univariate and multivariate analysis revealed that age (younger and older), a lack of medical insurance, longer distance from residence to the hospital, pathology (DCIS/Paget's/Phyllodes), lymph node metastasis, the absence of endocrine therapy and fewer than five contact numbers were significantly and independently associated with the risk of LTFU. A LTFU-risk score was developed and was predictive of LTFU. CONCLUSIONS: A series of risk factors were significantly associated with post-operative LTFU of breast cancer patients. Patients with different risks of LTFU could possibly be identified, and surveillance plans could be individualized for different patients, so as to effectively reduce the overall LTFU rate, and optimize the allocation of medical resources.

Morphological Classification of the Zygomatic Regions in Young Chinese Han Males and Females Based on a Simulated Moiré Pattern.

The complex curved contours of the zygomatic regions are difficult to analyze. Therefore, a better evaluation medium must be developed. We aimed to examine and summarize the morphological characteristics of the zygomatic region by using a moiré pattern map and computer algorithm. In this cross-sectional study, we collected three-dimensional images of the facial contours of 251 Han Chinese youth and established a morphological moiré map database. Clustering analysis using a computer algorithm was applied to obtain the zygomatic morphologies for classification. Aesthetic evaluation was performed to summarize the characteristics of the zygomatic types and provide reference for the preoperative morphological design of the midface. Zygomatic regions were morphologically classified into five types. Each type had its typical feature in the moiré pattern map. The moiré stripes in the left zygomatic region formed an "Ω" shape outward and downward in type 1, and they tended to be diagonal like "\\\" in type 2, smoothly curved like ")))" in type 3, vertical like "|||" in type 4, and diagonal like "///" in type 5. The aesthetic evaluation outcome indicated that the integrally flat zygoma (type 4) was more aesthetically pleasing among males, and the integrally prominent zygoma (type 3) was more aesthetically pleasing among females. Five morphological contour types of the zygoma were classified among the Chinese Han males and females based on the simulated moiré pattern. This morphological classification would aid in preparing a guide for clinical diagnosis and surgical planning.

A combined method of oral commissure lifting for perioral rejuvenation in Asians.

BACKGROUND: A drooping oral commissure shows an appearance of ageing and sadness. To improve it with less complications has become a rising aesthetic concern for Asians. OBJECTIVES: To share our method for oral commissure lifting by a combined technique including skin resection, oral commissure suspension, and dissection of the depressor anguli oris muscle (DAO), and to present the follow-up outcomes. METHODS: This was a retrospective study of patients who underwent oral commissure lifting between 10/2012 and 03/2019 at the Department of Plastic Surgery, Peking University Third Hospital. The patients were routinely followed at 1 week, 1 month, and over 6 months. After operation, cases with the cheilions (oral commissure points) located above the ipsilateral lateral thickening points were considered to be effective, with the points at the same level were considered to be mildly effective, and with the cheilions below the ipsilateral lateral thickening points were considered to be ineffective treatment. RESULTS: Surgery took around an hour. Swelling subsided within 9.2±3.4 days. The red color of the scar disappeared within 3.7±1.5 months and the natural facial expression was restored within 7.9±2.6 weeks. Among the 159 cases, 125 (78.6%) were obviously effective, 21 (13.2%) were mildly effective, and 13 (8.2%) were ineffective. After the first operation, 112 patients (70.4%) were satisfied, 39 patients (24.5%) were basically satisfied, and eight patients (5.0%) were unsatisfied. CONCLUSIONS: The combined technique for the oral commissure lifting displayed a significant effect with little complication in Asian patients.

Lip Morphology and Aesthetics: Study Review and Prospects in Plastic Surgery.

The lip profile plays an important role in the perception of facial aesthetics; lip morphology and aesthetics research is receiving increasing attention. The advancement of research tools such as three-dimensional imaging technology has led to the clarification of lip morphologic and aesthetic characteristics. After studies of lip characteristics according to gender, ethnicity and age provided basic data, studies on lip aesthetics have been conducted by scholars worldwide. These studies could provide a basic theory to support diagnosis and treatment options, as well as the basis for evaluative criteria for precise treatment and technical improvements. According to the conclusions of the above studies, new ideas for cosmetic surgery design, including lip, perioral and labial-facial relationships, have been discovered.Level of Evidence V 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 .