Objective:As the population ages,facial plastic providers must remain aware of the treatments to prevent and reverse the external signs of aging.In the mandibular region,skin laxity and soft tissue sagging in the jawl...Objective:As the population ages,facial plastic providers must remain aware of the treatments to prevent and reverse the external signs of aging.In the mandibular region,skin laxity and soft tissue sagging in the jawline may lead to jowling and chin ptosis along with reduced chin projection.While surgical procedures,including chin implantation,may be performed,nonsurgical procedures are becoming increasingly popular due to their temporary,noninvasive,yet effective methods.This review covers the use of hyaluronic acid,calcium hydroxylapatite,poly-L-lactic acid,and polymethyl methacrylate in the jawline.Methods:PubMed was searched for data on the mechanism of action,pertinent anatomy,indications,contraindications,technique,and evidence supporting the safety and efficacy of the fillers.Results:There are a wide variety of fillers available for use in the lower face with unique characteristics and application methods.While the advantages of injectable fillers include relatively affordable cost,minimal patient discomfort,and limited recovery times,taking measures to prevent short-and long-term complications is necessary for optimal results.Conclusions:Understanding the benefits and limitations of injectable fillers in the jawline can help providers appropriately counsel and treat patients.展开更多
Objective:Management of postoperative pain after head and neck cancer surgery is a complex issue,requiring a careful balance of analgesic properties and side effects.The objective of this review is to discuss the effi...Objective:Management of postoperative pain after head and neck cancer surgery is a complex issue,requiring a careful balance of analgesic properties and side effects.The objective of this review is to discuss the efficacy and safety of multimodal analgesia(MMA)for these patients.Methods:Pubmed,Cochrane,Embase,Scopus,and clinicaltrials.gov were systematically searched for all comparative studies of patients receiving MMA(nonsteroidal anti-inflammatory drugs(NSAIDs),acetaminophen,anticonvulsants,local anesthetics,and corticosteroids)for head and neck cancer surgeries.The primary outcome was additional postoperative opioid usage,and secondary outcomes included subjective pain scores,complications,adverse effects,and 30-day outcomes.Results:A total of five studies representing 592 patients(MMA,n=275;non-MMA,n=317)met inclusion criteria.The most commonly used agents were gabapentin,NSAIDs,and acetaminophen(n=221),NSAIDs(n=221),followed by corticosteroids(n=35),dextromethorphan(n=40),and local nerve block(n=19).Four studies described a significant decrease in overall postoperative narcotic usage with two studies reporting a significant decrease in hospital time.Subjective pain scores widely varied with two studies reporting reduced pain at postoperative day 3.There were no differences in surgical outcomes,medical complications,adverse effects,or 30-day mortality and readmission rates.Conclusion:MMA is an increasingly popular strategy that may reduce dependence on opioids for the treatment of postoperative pain.A variety of regimens and protocols are available for providers to utilize in the appropriate head and neck cancer patient.展开更多
Purpose:This study aimed to determine the impact of uttering the word"quiet"on clinical workload during the overnight otolaryngology call shift and understand the factors contributing to resident busyness.Ma...Purpose:This study aimed to determine the impact of uttering the word"quiet"on clinical workload during the overnight otolaryngology call shift and understand the factors contributing to resident busyness.Materials and Methods:A multicenter,single-blind,randomized-controlled trial was conducted.A total of 80 overnight call shifts covered by a pool of 10 residents were randomized to the quiet or to the control group.At the start of shift,residents were asked to state aloud,"Today will be a quiet night"(quiet group)or"Today will be a good night"(control group).Clinical workload,as measured by number of consults,was the primary outcome.Secondary measures included number of sign-out tasks,unplanned inpatient and operating room visits,number of phone calls and hours of sleep,and self-perceived busyness.Results:There was no difference in the number of total(P=0.23),nonurgent(P=0.18),and urgent(P=0.18)consults.Tasks at signout,total phone calls,unplanned inpatient visits,and unplanned operating room visits did not differ between the control and quiet groups.While there were more unplanned operating room visits in the quiet group(29,80.6%)compared to the control group(34,94.4%),this was not found to be significant(P=0.07).The majority of residents reported feeling"not busy"during control nights(18,50.0%)compared to feeling"somewhat busy"during quiet nights(17,47.2%;P=0.42).Conclusion:Contrary to popular belief,there is no clear evidence that uttering the word"quiet"significantly increases clinical workload.展开更多
Treatment aimed at preventing and reversing the facial aging process has grown in popularity.The aging midface is defined by classic deepening of the nasolabial folds,formation of marionette lines around the mouth,and...Treatment aimed at preventing and reversing the facial aging process has grown in popularity.The aging midface is defined by classic deepening of the nasolabial folds,formation of marionette lines around the mouth,and significant atrophy of deep facial fat.While surgical options have been investigated with satisfactory and long-lasting results,nonsurgical alternatives such as soft tissue fillers are a safe and effective strategy for facial rejuvenation.This review focuses on a variety of injectable fillers available for the treatment of the aging midface,including hyaluronic acid,calcium hydroxylapatite,poly-L-lactic acid,and polymethyl methacrylate.Mechanism of action,relevant anatomy,indications/contraindications,technique,and any evidence of efficacy and safety are described.The benefits of injectable fillers include reduced patient discomfort and shorter recovery times.Understanding the advantages and limitations of injectable fillers for midface augmentation can allow providers to counsel and treat patients seeking care appropriately.展开更多
Empty nose syndrome(ENS)is an iatrogenic condition that results from traumatic injury,often overresection,of the turbinates during sinonasal surgery.The underlying etiology is not entirely understood but is thought to...Empty nose syndrome(ENS)is an iatrogenic condition that results from traumatic injury,often overresection,of the turbinates during sinonasal surgery.The underlying etiology is not entirely understood but is thought to have multifactorial contributions including alterations in the native nasal airway anatomy,abnormal mucosal and neural healing,and decreased trigeminal sensitivity,among other possibilities and contributors.Patients typically present with an intense fixation on their sensations of nasal obstruction and congestion despite an anatomically patent airway on examination.Because many patients with ENS have been shown to have significant psychiatric comorbidities,multidisciplinary specialist care including psychiatry and pain services is essential.Diagnosis is often difficult due to the variability of presentation and severity of symptoms,but standard assessments exist including the empty nose syndrome 6-item questionnaire(ENS6Q)and cotton test.Patients can be initially managed with conservative measures through humidification,moisturization,and psychiatric testing/referral.Procedural approaches to improve the nasal airway include submucosal implantation of temporary,semi-permanent,and permanent materials.A realistic and empathetic approach to patient communication is necessary in order to help manage patients with ENS,and all plastic surgeons performing septorhinoplasty should be aware of the risk and treatment options of the disease.展开更多
文摘Objective:As the population ages,facial plastic providers must remain aware of the treatments to prevent and reverse the external signs of aging.In the mandibular region,skin laxity and soft tissue sagging in the jawline may lead to jowling and chin ptosis along with reduced chin projection.While surgical procedures,including chin implantation,may be performed,nonsurgical procedures are becoming increasingly popular due to their temporary,noninvasive,yet effective methods.This review covers the use of hyaluronic acid,calcium hydroxylapatite,poly-L-lactic acid,and polymethyl methacrylate in the jawline.Methods:PubMed was searched for data on the mechanism of action,pertinent anatomy,indications,contraindications,technique,and evidence supporting the safety and efficacy of the fillers.Results:There are a wide variety of fillers available for use in the lower face with unique characteristics and application methods.While the advantages of injectable fillers include relatively affordable cost,minimal patient discomfort,and limited recovery times,taking measures to prevent short-and long-term complications is necessary for optimal results.Conclusions:Understanding the benefits and limitations of injectable fillers in the jawline can help providers appropriately counsel and treat patients.
文摘Objective:Management of postoperative pain after head and neck cancer surgery is a complex issue,requiring a careful balance of analgesic properties and side effects.The objective of this review is to discuss the efficacy and safety of multimodal analgesia(MMA)for these patients.Methods:Pubmed,Cochrane,Embase,Scopus,and clinicaltrials.gov were systematically searched for all comparative studies of patients receiving MMA(nonsteroidal anti-inflammatory drugs(NSAIDs),acetaminophen,anticonvulsants,local anesthetics,and corticosteroids)for head and neck cancer surgeries.The primary outcome was additional postoperative opioid usage,and secondary outcomes included subjective pain scores,complications,adverse effects,and 30-day outcomes.Results:A total of five studies representing 592 patients(MMA,n=275;non-MMA,n=317)met inclusion criteria.The most commonly used agents were gabapentin,NSAIDs,and acetaminophen(n=221),NSAIDs(n=221),followed by corticosteroids(n=35),dextromethorphan(n=40),and local nerve block(n=19).Four studies described a significant decrease in overall postoperative narcotic usage with two studies reporting a significant decrease in hospital time.Subjective pain scores widely varied with two studies reporting reduced pain at postoperative day 3.There were no differences in surgical outcomes,medical complications,adverse effects,or 30-day mortality and readmission rates.Conclusion:MMA is an increasingly popular strategy that may reduce dependence on opioids for the treatment of postoperative pain.A variety of regimens and protocols are available for providers to utilize in the appropriate head and neck cancer patient.
文摘Purpose:This study aimed to determine the impact of uttering the word"quiet"on clinical workload during the overnight otolaryngology call shift and understand the factors contributing to resident busyness.Materials and Methods:A multicenter,single-blind,randomized-controlled trial was conducted.A total of 80 overnight call shifts covered by a pool of 10 residents were randomized to the quiet or to the control group.At the start of shift,residents were asked to state aloud,"Today will be a quiet night"(quiet group)or"Today will be a good night"(control group).Clinical workload,as measured by number of consults,was the primary outcome.Secondary measures included number of sign-out tasks,unplanned inpatient and operating room visits,number of phone calls and hours of sleep,and self-perceived busyness.Results:There was no difference in the number of total(P=0.23),nonurgent(P=0.18),and urgent(P=0.18)consults.Tasks at signout,total phone calls,unplanned inpatient visits,and unplanned operating room visits did not differ between the control and quiet groups.While there were more unplanned operating room visits in the quiet group(29,80.6%)compared to the control group(34,94.4%),this was not found to be significant(P=0.07).The majority of residents reported feeling"not busy"during control nights(18,50.0%)compared to feeling"somewhat busy"during quiet nights(17,47.2%;P=0.42).Conclusion:Contrary to popular belief,there is no clear evidence that uttering the word"quiet"significantly increases clinical workload.
文摘Treatment aimed at preventing and reversing the facial aging process has grown in popularity.The aging midface is defined by classic deepening of the nasolabial folds,formation of marionette lines around the mouth,and significant atrophy of deep facial fat.While surgical options have been investigated with satisfactory and long-lasting results,nonsurgical alternatives such as soft tissue fillers are a safe and effective strategy for facial rejuvenation.This review focuses on a variety of injectable fillers available for the treatment of the aging midface,including hyaluronic acid,calcium hydroxylapatite,poly-L-lactic acid,and polymethyl methacrylate.Mechanism of action,relevant anatomy,indications/contraindications,technique,and any evidence of efficacy and safety are described.The benefits of injectable fillers include reduced patient discomfort and shorter recovery times.Understanding the advantages and limitations of injectable fillers for midface augmentation can allow providers to counsel and treat patients seeking care appropriately.
文摘Empty nose syndrome(ENS)is an iatrogenic condition that results from traumatic injury,often overresection,of the turbinates during sinonasal surgery.The underlying etiology is not entirely understood but is thought to have multifactorial contributions including alterations in the native nasal airway anatomy,abnormal mucosal and neural healing,and decreased trigeminal sensitivity,among other possibilities and contributors.Patients typically present with an intense fixation on their sensations of nasal obstruction and congestion despite an anatomically patent airway on examination.Because many patients with ENS have been shown to have significant psychiatric comorbidities,multidisciplinary specialist care including psychiatry and pain services is essential.Diagnosis is often difficult due to the variability of presentation and severity of symptoms,but standard assessments exist including the empty nose syndrome 6-item questionnaire(ENS6Q)and cotton test.Patients can be initially managed with conservative measures through humidification,moisturization,and psychiatric testing/referral.Procedural approaches to improve the nasal airway include submucosal implantation of temporary,semi-permanent,and permanent materials.A realistic and empathetic approach to patient communication is necessary in order to help manage patients with ENS,and all plastic surgeons performing septorhinoplasty should be aware of the risk and treatment options of the disease.
