Shekhar K. Gadkaree, D. Shaye, J. Occhiogrosso, Linda N Lee
{"title":"Association Between Pain and Patient Satisfaction After Rhinoplasty.","authors":"Shekhar K. Gadkaree, D. Shaye, J. Occhiogrosso, Linda N Lee","doi":"10.1001/jamafacial.2019.0808","DOIUrl":"https://doi.org/10.1001/jamafacial.2019.0808","url":null,"abstract":"Importance\u0000In light of the current opioid crisis, there exists a demonstrated need to balance adequate postrhinoplasty pain control with measured use of narcotics. If pain is inadequately controlled, patients may be unsatisfied with their elective surgical experience.\u0000\u0000\u0000Objectives\u0000To characterize the association between patient-reported pain outcomes, objective opioid use, and perception of surgical success.\u0000\u0000\u0000Design, Setting, and Participants\u0000A case series survey study was conducted from July 2018 to January 2019. Consecutive patients who underwent cosmetic and/or functional rhinoplasty by 2 facial plastic surgeons (D.A.S. and L.N.L.) at an academic medical center were surveyed 1 month after surgery.\u0000\u0000\u0000Main Outcomes and Measures\u0000The number of oxycodone tablets taken, patient-reported pain outcomes, number of narcotic prescription refills, and patient-reported functional and cosmetic outcomes were recorded. Perception of pain, surgical outcome, and oxycodone intake were also evaluated by sex. Demographic information and perception of surgical results were recorded. Statistical analysis was performed using STATA statistical software (version 12.0, STATA Corp). Spearman rank order correlation was used for ordinal, monotonic variables with P < .05 being considered statistically significant.\u0000\u0000\u0000Results\u0000Overall, 104 patients were surveyed; 6 were lost to follow-up. Of the participants included, 50 were women with a mean (SD) age of 38 (16.0) years and 48 were men with a mean (SD) age of 38 (16.7) years. Although patients were prescribed a range of 10 to 40 tablets of oxycodone, patients took a mean (SD) of 5.2 tablets (range, 0-23). There were no significant sex differences in perception of pain, perception of outcome, or narcotic use. Among patients undergoing purely functional rhinoplasty, a statistically significant negative association between perception of pain and perception of functional outcome (breathing improvement) was evident. Patients who experienced less pain than they expected had a greater perception of functional improvement (rs = -0.62, P = .001). In contrast, among patients who underwent rhinoplasty with cosmetic improvement, no association was found between pain and perception of surgical outcome (rs = 0.05, P = .64).\u0000\u0000\u0000Conclusions and Relevance\u0000To our knowledge, this is the first study to prospectively evaluate the association between opioid use, patient-reported pain, and perceived surgical success. These data may help guide preoperative counseling because patients who are interested purely in breathing improvement (without cosmetic change) may warrant additional pain-specific counseling to optimize patient satisfaction.\u0000\u0000\u0000Level of Evidence\u00003.","PeriodicalId":14538,"journal":{"name":"JAMA facial plastic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1001/jamafacial.2019.0808","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43073343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jason Gilde, Charles W. Shih, Andrew J. Kleinberger
{"title":"Frontal Sinus Transillumination in Cranioplasty for Facial Feminization Surgery.","authors":"Jason Gilde, Charles W. Shih, Andrew J. Kleinberger","doi":"10.1001/jamafacial.2019.0606","DOIUrl":"https://doi.org/10.1001/jamafacial.2019.0606","url":null,"abstract":"","PeriodicalId":14538,"journal":{"name":"JAMA facial plastic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1001/jamafacial.2019.0606","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49047806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Changes in Opioid Prescribing Habits for Patients Undergoing Rhinoplasty and Septoplasty.","authors":"R. Aulet, V. Trieu, G. Landrigan, D. Millay","doi":"10.1001/jamafacial.2019.0937","DOIUrl":"https://doi.org/10.1001/jamafacial.2019.0937","url":null,"abstract":"Importance\u0000Opioid prescriptions have increased substantially over the last 2 decades, contributing to the opioid epidemic. Physician practices and legislative changes play a key role in decreasing prescription opioid use.\u0000\u0000\u0000Objective\u0000To evaluate changes in opioid prescribing habits for patients undergoing rhinoplasty and/or septoplasty before and after the adoption of new opioid legislation.\u0000\u0000\u0000Design, Setting, and Participants\u0000This single-institution case-control study examined opioid prescribing habits for 80 patients who were undergoing rhinoplasty and septoplasty with or without turbinate reduction at the University of Vermont between March 2016 and May 2018. Patients were excluded if they underwent concomitant endoscopic sinus surgery or were younger than 14 years. Patients were divided by surgery date before or after legislative changes on July 1, 2017.\u0000\u0000\u0000Exposures\u0000Rhinoplasty and septoplasty with or without turbinate reduction.\u0000\u0000\u0000Main Outcomes and Measures\u0000Patient demographics and opioid prescriptions were recorded. Patients were evaluated if they reported pain during follow-up, called the office, or received a second prescription. The Vermont Prescription Monitoring System was queried to determine if opioid prescriptions were filled within 30 days of the procedure. The 2 groups were compared to test the hypothesis that opioid prescriptions had decreased after legislative changes.\u0000\u0000\u0000Results\u0000Of a total of 80 participants, the mean (SD) age in the before (15 women [37.5%]) and after (16 women [40.0%]) groups were 41.4 years and 40.6 years, respectively. There was a statistically significant decrease in the number of pills prescribed to the after group (17.5 to 9.7; P < .001) as well as a decrease in the morphine milligram equivalents that were prescribed (130.9 to 73.2; P < .001). There was no statistical difference in the number of postoperative telephone calls for pain, second prescriptions, or increased complaints of pain at the postoperative visit.\u0000\u0000\u0000Conclusions and Relevance\u0000Recent laws in Vermont regarding opioid prescribing were implemented in 2017 to curb the ongoing opioid epidemic. Our observations of patients undergoing septoplasties and rhinoplasties found a significant reduction in opioid prescriptions. This was not associated with an increase in patient complaints about postoperative pain or the need for a second prescription after surgery. This shows that we may safely be able to decrease the number of narcotic medications that we prescribe.\u0000\u0000\u0000Level of Evidence\u00003.","PeriodicalId":14538,"journal":{"name":"JAMA facial plastic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1001/jamafacial.2019.0937","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44170369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hollin E Calloway, Cameron Heilbronn, J. Gu, Tiffany T. Pham, Christian H. Barnes, B. Wong
{"title":"Functional Outcomes, Quantitative Morphometry, and Aesthetic Analysis of Articulated Alar Rim Grafts in Septorhinoplasty.","authors":"Hollin E Calloway, Cameron Heilbronn, J. Gu, Tiffany T. Pham, Christian H. Barnes, B. Wong","doi":"10.1001/jamafacial.2019.1130","DOIUrl":"https://doi.org/10.1001/jamafacial.2019.1130","url":null,"abstract":"Importance\u0000The design, use, and indications for the articulated alar rim graft (AARG) and the functional and aesthetic improvements that can be achieved have not been fully characterized.\u0000\u0000\u0000Objective\u0000To analyze the functional and aesthetic outcomes of AARG placement on nasal airway function, nasal base shape change, and appearance.\u0000\u0000\u0000Design, Setting, and Participants\u0000A case series study of patients who underwent septorhinoplasty with placement of AARG at University of California, Irvine Medical Center, from 2015 to 2018 was carried out. Surgical data recorded included stage of rhinoplasty (primary vs revision), use of spreader grafts, rim grafts (and dimensions), caudal septal extension graft (CSEG), lateral crural tensioning (LCT), and turbinate reductions.\u0000\u0000\u0000Main Outcomes and Measures\u0000Preoperative and postoperative Nasal Obstruction Symptom Evaluation Survey (NOSE) surveys were analyzed and correlated with AARG geometry, use of CSEG, and the LCT maneuver. Preoperative and postoperative alar base views were evaluated by fitting base shape to a parametric numerical model to categorize each to 1 of 6 shape categories. Blinded reviewers rated alar furrow severity and the alar ridge presence using a Likert scale for both preoperative and postoperative images to subjectively gauge aesthetic outcomes.\u0000\u0000\u0000Results\u0000Overall, 90 patients with both preoperative and postoperative NOSE scores who underwent septorhinoplasty and placement of an AARG were included. Of the 90 patients, 60 were women (mean age, 38.2 years). Patient NOSE scores (70.4 preoperatively to 25.1 postoperatively) significantly improved from preoperation to postoperation (P < .001), regardless of AARG size, CSEG, or LCT. Alar base shape parametric analysis showed preoperative to postoperative improvements were significant for anterior-to-posterior ratio mass distribution (95% CI, -0.16 to 0.02; P = .05) and vertical projection-to-horizontal base width ratio (95% CI, 0.01-0.32; P = .02) in flat noses and cloverleafing for narrow noses (95% CI, -0.05 to -0.01; P = .001); enhancement approached significance for reduction in lateral scalloping in cloverleaf noses (P = .06). Aesthetic analysis showed that there was a statistically significant improvement for the alar furrow (95% CI, -0.68 to -0.29 for rater 1; -0.54 to -0.27 for rater 2; and -0.59 to -0.27 for rater 3; P < .001) for all raters and for the alar ridge (95% CI, 0.16-0.48; P < .001) for 1 rater.\u0000\u0000\u0000Conclusions and Relevance\u0000To our knowledge, this is the first study to demonstrate that AARG use is associated with statistically significant improvement in NOSE scores. Placement of AARGs may improve posterior mass ratios in flat noses and lateral cloverleafing in narrow noses as suggested by quantitative shape change parameter analysis. The placement of AARGs was associated with aesthetic and functional enhancement in the cloverleaf deformity, which is associated with a prominent alar furrow, and often external nasal valve collapse. Pati","PeriodicalId":14538,"journal":{"name":"JAMA facial plastic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1001/jamafacial.2019.1130","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45698935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jacob K. Dey, L. Ishii, K. Boahene, P. Byrne, M. Ishii
{"title":"Measuring Outcomes of Mohs Defect Reconstruction Using Eye-Tracking Technology.","authors":"Jacob K. Dey, L. Ishii, K. Boahene, P. Byrne, M. Ishii","doi":"10.1001/jamafacial.2019.1072","DOIUrl":"https://doi.org/10.1001/jamafacial.2019.1072","url":null,"abstract":"Importance\u0000Objectively measuring how Mohs defect reconstruction changes casual observer attention has important implications for patients and facial plastic surgeons.\u0000\u0000\u0000Objective\u0000To use eye-tracking technology to objectively measure the ability of Mohs facial defect reconstruction to normalize facial attention.\u0000\u0000\u0000Design, Setting, and Participants\u0000This observational outcomes study was conducted at an academic tertiary referral center from January to June 2016. An eye-tracking system was used to record how 82 casual observers directed attention to photographs of 32 patients with Mohs facial defects of varying sizes and locations before and after reconstruction as well as 16 control faces with no facial defects. Statistical analysis was performed from November 2018 to January 2019.\u0000\u0000\u0000Main Outcomes and Measures\u0000First, the attentional distraction caused by facial defects was quantified in milliseconds of gaze time using eye tracking. Second, the eye-tracking data were analyzed using mixed-effects linear regression to assess the association of facial defect reconstruction with normalized facial attention.\u0000\u0000\u0000Results\u0000The 82 casual observers (63 women and 19 men; mean [SD] age, 34 [12] years) viewed control faces in a similar and consistent fashion, with most attention (65%; 95% CI, 62%-69%) directed at the central triangle, which includes the eyes, nose, and mouth. The eyes were the most visually important feature, capturing a mean of 60% (95% CI, 57%-64%) of fixation time within the central triangle and 39% (95% CI, 36%-43%) of total observer attention. The presence of Mohs defects was associated with statistically significant alterations in this pattern of normal facial attention. The larger the defect and the more centrally a defect was located, the more attentional distraction was observed, as measured by increased attention on the defect and decreased attention on the eyes, ranging from 729 (95% CI, 526-931) milliseconds for small peripheral defects to 3693 (95% CI, 3490-3896) milliseconds for large central defects. Reconstructive surgery was associated with improved gaze deviations for all faces and with normalized attention directed to the eyes for all faces except for those with large central defects.\u0000\u0000\u0000Conclusions and Relevance\u0000Mohs defects are associated with altered facial perception, diverting attention from valuable features such as the eyes. Reconstructive surgery was associated with normalized attentional distraction for many patients with cutaneous Mohs defects. These data are important to patients who want to know how reconstructive surgery could change the way people look at their face. The data also point to the possibility of outcomes prediction based on facial defect size and location before reconstruction. Eye tracking is a valuable research tool for outcomes assessment that lays the foundation for understanding how reconstructive surgery may change perception and normalize facial deformity.","PeriodicalId":14538,"journal":{"name":"JAMA facial plastic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1001/jamafacial.2019.1072","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44053882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Julie P. Shtraks, C. Fundakowski, Daohai Yu, M. Hartstein, David Sarcu, Xiaoning Lu, A. Wulc
{"title":"Investigation of the Longevity of the Endoscopic Midface Lift.","authors":"Julie P. Shtraks, C. Fundakowski, Daohai Yu, M. Hartstein, David Sarcu, Xiaoning Lu, A. Wulc","doi":"10.1001/jamafacial.2019.1015","DOIUrl":"https://doi.org/10.1001/jamafacial.2019.1015","url":null,"abstract":"Importance\u0000To our knowledge, until now, the efficacy and durability of the transtemporal endoscopic preperiosteal midface lift has not been reported in the literature.\u0000\u0000\u0000Objective\u0000To determine the efficacy and longevity of the endoscopic preperiosteal midface lift using objective measurements and validated aesthetic scales.\u0000\u0000\u0000Design, Setting, and Participants\u0000This retrospective review included patients 18 years or older who were treated for aging midface by endoscopic midface lift by the senior author (A.E.W.) between June 2000 and August 2016. Patients were categorized based on length of follow-up into 3 groups: (1) short-term (1-3 years), (2) intermediate-term (3-5 years), and (3) long-term (>5 years).\u0000\u0000\u0000Interventions or Exposures\u0000Endoscopic preperiosteal midface lift.\u0000\u0000\u0000Main Outcomes and Measures\u0000(1) Objective measurements of midfacial height (the width of the interzygomatic distance of the midface to the medial canthus [WIZDOM-MC]), (2) validated regional aesthetic scales, and (3) global aesthetic scoring systems measured preoperatively, 3 to 6 months postoperatively, and at the most recent follow-up visit.\u0000\u0000\u0000Results\u0000Adult patients 18 years or older (median [range] age, 59 [31-79] years) who were treated for aging midface by undergoing an endoscopic midface lift were included in this study. The medical records of 143 patients were reviewed (135 women and 8 men). The endoscopic midface lift resulted in objective improvement in midfacial height. The median WIZDOM-MC decreased by 3.4 mm after the endoscopic midface lift (interquartile range [IQR], 2.3-4.4 mm; P < .001), thus shortening the elongated lower eyelid. At 5 to 15 years after surgery, there was a sustained decrease in median WIZDOM-MC of 2.1 mm (IQR, 0.8-3.1 mm; P < .001). Improvement in the infraorbital hollow was also sustained in patients at more than 5 years' follow-up (IQR, 0-1.0; P < .001). Improvements in upper cheek fullness and lower cheek fullness were maintained at 3 to 5 years and tended to be at baseline at more than 5 years. Global aesthetic improvement scores remained significantly improved at 5 to 15 years' follow-up.\u0000\u0000\u0000Conclusions and Relevance\u0000There is a significant, objective improvement in midfacial height after the endoscopic midface lift that persists for up to 15 years. Validated midfacial scales and global aesthetic scoring systems demonstrate sustained improvement in midface appearance over time. Surgery that minimally disrupts the zygomatic and orbicularis retaining ligaments can provide long-lasting aesthetic improvements.\u0000\u0000\u0000Level of Evidence\u00004.","PeriodicalId":14538,"journal":{"name":"JAMA facial plastic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1001/jamafacial.2019.1015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44089302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Clarification of a Suspension Technique for Unstable Nasal Bones-Reply.","authors":"B. G. Hunter, A. Tasman","doi":"10.1001/jamafacial.2019.1145","DOIUrl":"https://doi.org/10.1001/jamafacial.2019.1145","url":null,"abstract":"","PeriodicalId":14538,"journal":{"name":"JAMA facial plastic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1001/jamafacial.2019.1145","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47168400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jacob K. Dey, Chelsey A Recker, M. D. Olson, A. Bowen, A. Panda, Petro M. Kostandy, J. Lane, G. Hamilton
{"title":"Assessing Nasal Soft-Tissue Envelope Thickness for Rhinoplasty: Normative Data and a Predictive Algorithm.","authors":"Jacob K. Dey, Chelsey A Recker, M. D. Olson, A. Bowen, A. Panda, Petro M. Kostandy, J. Lane, G. Hamilton","doi":"10.1001/jamafacial.2019.0715","DOIUrl":"https://doi.org/10.1001/jamafacial.2019.0715","url":null,"abstract":"Importance\u0000Preoperative assessment of nasal soft-tissue envelope (STE) thickness is an important component of rhinoplasty that presently lacks validated tools.\u0000\u0000\u0000Objective\u0000To measure and assess the distribution of nasal STE thickness in a large patient population and to determine if facial plastic surgery clinicians can predict nasal STE thickness based on visual examination of the nose.\u0000\u0000\u0000Design, Setting, and Participants\u0000This retrospective review and prospective assessment of 190 adult patients by 4 expert raters was conducted at an academic tertiary referral center. The patients had high-resolution maxillofacial computed tomography (CT) scans and standardized facial photographs on file and did not have a history of nasal fracture, septal perforation, rhinoplasty, or other surgery or medical conditions altering nasal form. Data were analyzed in March 2019.\u0000\u0000\u0000Main Outcomes and Measures\u0000Measure nasal STE thickness at defined anatomic subsites using high-resolution CT scans. Measure expert-predicted nasal STE thickness based on visual examination of the nose using a scale from 0 (thinnest) to 100 (thickest).\u0000\u0000\u0000Results\u0000Of the 190 patients, 78 were women and the mean (SD) age was 45 (17) years. The nasal STE was thickest at the sellion (mean [SD]) (6.7 [1.7] mm), thinnest at the rhinion (2.1 [0.7] mm), thickened over the supratip (4.8 [1.0] mm) and nasal tip (3.1 [0.6] mm), and thinned over the columella (2.6 [0.4] mm). In the study population, nasal STE thickness followed a nearly normal distribution for each measured subsite, with the majority of patients in a medium thickness range. Comparison of predicted and actual nasal STE thickness showed that experts could accurately predict nasal STE thickness, with the highest accuracy at the nasal tip (r, 0.73; prediction accuracy, 91%); . A strong positive correlation was noted among the experts' STE estimates (r, 0.83-0.89), suggesting a high level of agreement between individual raters.\u0000\u0000\u0000Conclusions and Relevance\u0000There is variable thickness of the nasal STE, which influences the external nasal contour and rhinoplasty outcomes. With visual analysis of the nose, experts can agree on and predict nasal STE thickness, with the highest accuracy at the nasal tip. These data can aid in preoperative planning for rhinoplasty, allowing implementation of preoperative, intraoperative, and postoperative strategies to optimize the nasal STE, which may ultimately improve patient outcomes and satisfaction.\u0000\u0000\u0000Level of Evidence\u0000N/A.","PeriodicalId":14538,"journal":{"name":"JAMA facial plastic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1001/jamafacial.2019.0715","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46463392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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