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1.
Artigo em Inglês | MEDLINE | ID: mdl-37780674

RESUMO

Objective: The aim of this review article is to discuss the currently available facial fillers, their differences and indications, relevant anatomy, injection techniques, and avoidance and management of complications. Data Sources: Clinical experience and scientific papers. Conclusions: Reversal of facial aging via filler injection has been around since the late 1800s with the initial use of detrimental products. Today, many safe and effective products exist and can be tailored to the individual patient's desired effect. With the evolution of both products and injection techniques, the rate of complications with facial filler use is low. Nonetheless, providers offering facial filler injections should have detailed knowledge of facial anatomy, including facial planes and soft tissue compartments. Multiple injection techniques exist. Different techniques should be used, depending on the anatomic target. Providers should also know how to avoid and manage complications.

2.
Otolaryngol Clin North Am ; 56(6): 1003-1012, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37328319

RESUMO

The facial trauma surgeon will see a variety of facial injuries. Recognition of emergency cases and proper intervention is and this article aims to highlight those cases and the respective proper interventions.


Assuntos
Traumatismos Faciais , Lesões dos Tecidos Moles , Humanos , Traumatismos Faciais/diagnóstico , Traumatismos Faciais/cirurgia , Lesões dos Tecidos Moles/diagnóstico , Lesões dos Tecidos Moles/cirurgia
3.
Am J Otolaryngol ; 44(3): 103822, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36934594

RESUMO

This review article provides an updated discussion on evidence-based practices related to the evaluation and management of facial paralysis. Ultimately, the goals of facial reanimation include obtaining facial symmetry at rest, providing corneal protection, restoring smile symmetry and facial movement for functional and aesthetic purposes. The treatment of facial nerve injury is highly individualized, especially given the wide heterogeneity regarding the degree of initial neuronal insult and eventual functional outcome. Recent advancements in facial reanimation techniques have better equipped clinicians to approach challenging patient scenarios with reliable, effective strategies. We discuss how technology such as machine learning software has revolutionized pre- and post-intervention assessments and provide an overview of current controversies including timing of intervention, choice of donor nerve, and management of nonflaccid facial palsy with synkinesis. We highlight novel considerations to mainstay conservative management strategies and examine innovations in modern surgical techniques with a focus on gracilis free muscle transfer. Innervation sources, procedural staging, coaptation patterns, and multi-vector and multi-muscle paddle design are modifications that have significantly evolved over the past decade.


Assuntos
Paralisia Facial , Transferência de Nervo , Procedimentos de Cirurgia Plástica , Humanos , Sorriso , Expressão Facial , Paralisia Facial/cirurgia , Transferência de Nervo/métodos , Músculos Faciais/cirurgia , Nervo Facial/cirurgia
5.
Laryngoscope ; 129(4): 841-846, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30575041

RESUMO

OBJECTIVES/HYPOTHESIS: The time interval at which Nasal Obstruction Symptom Evaluation (NOSE) scores stabilize after functional septorhinoplasty has not been determined. Our goal was to characterize longitudinal trends of patient-reported outcomes of nasal obstruction using the NOSE survey instrument following functional septorhinoplasty. STUDY DESIGN: Prospective longitudinal cohort study. METHODS: Adult patients (≥18 years) with nasal obstruction who underwent functional septorhinoplasty by three different surgeons at a single academic, tertiary referral center were identified. NOSE scores were obtained preoperatively and prospectively during three postoperative intervals defined as early (1-3 months), middle (4-6 months), and late (≥10 months.) Longitudinal analysis included repeated measures analysis of variance and adjustments for multiple comparisons. RESULTS: A total of 49 patients met inclusion criteria. For the total cohort, mean NOSE scores significantly improved between preoperative and early postoperative evaluations (71.4, standard deviation [SD] ± 17.0 vs. 24.2, SD ± 19.5; P < .001) but did not significantly change between early and middle (20.6, SD ± 19.1; P = .543) or middle and late (23.1, SD ± 24.9; P > .999) time intervals. CONCLUSIONS: Patients with nasal obstruction who undergo functional septorhinoplasty can be expected to have significant improvement in self -reported nasal obstruction as early as 1 to 3 months postoperatively with a continued, durable, long-standing benefit lasting at least 10 months after surgery. Future studies can consider the 3-month time frame as a proxy for 1 year outcomes to help reduce survey burden. LEVEL OF EVIDENCE: 2c Laryngoscope, 129:841-846, 2019.


Assuntos
Obstrução Nasal/cirurgia , Septo Nasal/cirurgia , Medidas de Resultados Relatados pelo Paciente , Rinoplastia/estatística & dados numéricos , Índice de Gravidade de Doença , Adulto , Idoso , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos , Rinoplastia/métodos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
6.
Facial Plast Surg ; 33(2): 125-132, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28388791

RESUMO

Dorsal hump reduction is a central component of western aesthetic rhinoplasty. Surgical success begins with knowledge of aesthetic ideals and accurate preoperative analysis. Knowledge of the patient's distortion from aesthetic ideals informs approach, technique, and instrument selection. Both endonasal and external approaches are suitable for dorsal hump reduction, though the latter affords more versatility when other surgical modifications are necessary. The main techniques consist of en bloc, Skoog, and component resection. Each has their distinct advantage, though a surgeon's comfort level with each should impact technique selection. Completion of the dorsal reduction often leaves a defect that must be reconstructed. Failure to anticipate the potential long-term sequelae and appropriately manage the dorsal defect can lead to a poor result and patient dissatisfaction.


Assuntos
Estética , Deformidades Adquiridas Nasais/prevenção & controle , Nariz/anatomia & histologia , Rinoplastia/métodos , Humanos , Deformidades Adquiridas Nasais/etiologia , Osteotomia/efeitos adversos , Osteotomia/métodos , Planejamento de Assistência ao Paciente , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Período Pré-Operatório , Rinoplastia/efeitos adversos
7.
Facial Plast Surg Clin North Am ; 24(3): 219-34, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27400837

RESUMO

The nasal valve is an important consideration in patients presenting with nasal obstruction. Controversy exists regarding the anatomy, terminology, evaluation, and management of the nasal valve. Innumerable techniques with variable effects have been described in the literature. The evidence qualifying these techniques has been plentiful, though often lacking in quality. This article reviews the controversial aspects of nasal valve management applying the best available evidence to help clarify potential areas of confusion. Future research using standardized definitions, consistent methodologies, and validated outcome measures are necessary to improve the quality of evidence and impact surgical decision-making.


Assuntos
Obstrução Nasal/cirurgia , Nariz/cirurgia , Rinoplastia/métodos , Humanos , Cartilagens Nasais/transplante , Obstrução Nasal/diagnóstico , Obstrução Nasal/patologia , Obstrução Nasal/fisiopatologia , Nariz/anatomia & histologia , Nariz/fisiopatologia , Avaliação de Resultados em Cuidados de Saúde/métodos , Técnicas de Sutura
8.
Facial Plast Surg Clin North Am ; 24(3): 357-66, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27400849

RESUMO

The primary purpose of the facelift is to restore the shape, volume, and contours of the youthful face. Facelift surgery has evolved over the years into multiple techniques to accomplish the same results. This article discusses the common controversies in facelift surgery and evaluates the best available evidence to guide surgical decision-making. In regard to the salient question of whether there is a "best" technique, the literature suggests that the options are generally equal in efficacy. This highlights the need for high-quality research with standardized preoperative assessment and evaluation of postoperative results to better assess outcomes.


Assuntos
Ritidoplastia/métodos , Contraindicações , Humanos , Próteses e Implantes , Ritidoplastia/instrumentação , Abandono do Hábito de Fumar , Gordura Subcutânea/transplante
10.
Artigo em Inglês | MEDLINE | ID: mdl-29204547

RESUMO

Since the advent of facelift surgery, there has been a progressive evolution in technique. Methods of dissection trended towards progressively aggressive surgery with deeper dissection for repositioning of ptotic facial tissues. In recent decades, the pendulum has swung towards more minimally invasive options. Likewise, there has been a shift in focus from repositioning alone to the addition of volumization for facial rejuvenation. The techniques in this article are reviewed in a chronologic fashion with a focus on historical development as well as brief discussion on efficacy in relation to the other existing options. There is currently no gold standard technique with a plethora of options with comparable efficacy. There is controversy over which approach is optimal and future research is needed to better delineate optimal treatment options, which may vary based on the patient.

11.
Neuroimaging Clin N Am ; 24(3): 531-52, viii-ix, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25086810

RESUMO

Knowledge of relevant anatomy and underlying mechanisms of traumatic injury is essential for understanding the radiologic findings in craniofacial trauma and their clinical importance. Craniofacial anatomy is diverse, and as a result of this anatomic diversity, physicians from numerous different specialties scrutinize similar imaging sets, looking for different pathologic abnormalities within the same anatomic regions. Radiologists familiar with the chief concerns of this anatomically diverse region can help expedite the decision-making process by keeping those concerns in mind when they report their findings. This review provides an overview of situations wherein surgical management may be indicated.


Assuntos
Traumatismos Craniocerebrais/cirurgia , Encéfalo/anatomia & histologia , Encéfalo/cirurgia , Lesões Encefálicas/cirurgia , Traumatismos Craniocerebrais/diagnóstico por imagem , Traumatismos Craniocerebrais/patologia , Face/anatomia & histologia , Face/cirurgia , Humanos , Imageamento por Ressonância Magnética/métodos , Crânio/anatomia & histologia , Crânio/cirurgia , Tomografia Computadorizada por Raios X/métodos
12.
Front Pharmacol ; 2: 88, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-22291645

RESUMO

Tolerance that develops after chronic morphine exposure has been proposed to be an adaptive response that develops and decays over a defined time course. The present study examined the development of tolerance to the acute hypothermic and analgesic effects of morphine and correlated the time course for the desensitization in vivo with the reduced responsiveness to DAMGO and 2-CADO and increased responsiveness to nicotine of the longitudinal muscle/myenteric plexus (LM/MP) preparation in vitro. Assessment was performed at various times after morphine or placebo pellet implantation. Morphine produced a modest hypothermic response to which no tolerance developed. However, the development of tolerance to the analgesic effect of morphine, the inhibitory effect of DAMGO and CADO on neurogenic twitches of the LM/MP and hypersensitivity to the contractile response to nicotine was observed to occur in a time-dependent manner. The alterations in sensitivity to DAMGO, nicotine, and responsiveness to morphine analgesia occurred between days 4 and 10 and returned to normal by day 14 post-implantation. In contrast, sensitivity of LM/MP preparations to 2-CADO displayed a similar time-dependent onset but the tolerance persisted beyond 14 days after implantation. These data suggest that the heterologous tolerance that develops after chronic morphine treatment is time-dependent and persistent but, ultimately returns to normal in the absence of any intervention. Furthermore, the data suggest that the basis of the adaptive phenomenon may involve multiple cellular mechanisms including the modulation of cell excitability and normal physiology but the consequences of the adaptation extend to all effects of the agonist.

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