BACKGROUND: The evolution of artificial intelligence has introduced new ways to disseminate health information, including natural language processing models like ChatGPT. However, the quality and readability of such digi...BACKGROUND: The evolution of artificial intelligence has introduced new ways to disseminate health information, including natural language processing models like ChatGPT. However, the quality and readability of such digitally generated information remains understudied. This study is the first to compare the quality and readability of digitally generated health information against leaflets produced by professionals. METHODOLOGY: Patient information leaflets from five ENT UK leaflets and their corresponding ChatGPT responses were extracted from the Internet. Assessors with various degrees of medical knowledge evaluated the content using the Ensuring Quality Information for Patients (EQIP) tool and readability tools including the Flesch-Kincaid Grade Level (FKGL). Statistical analysis was performed to identify differences between leaflets, assessors, and sources of information. RESULTS: ENT UK leaflets were of moderate quality, scoring a median EQIP of 23. Statistically significant differences in overall EQIP score were identified between ENT UK leaflets, but ChatGPT responses were of uniform quality. Nonspecialist doctors rated the highest EQIP scores, while medical students scored the lowest. The mean readability of ENT UK leaflets was higher than ChatGPT responses. The information metrics of ENT UK leaflets were moderate and varied between topics. Equivalent ChatGPT information provided comparable content quality, but with reduced readability. CONCLUSION: ChatGPT patient information and professionally produced leaflets had comparable content, but large language model content required a higher reading age. With the increasing use of online health resources, this study highlights the need for a balanced approach that considers both the quality and readability of patient education materials.
Current concepts in orthognathic surgery focus on not just rectifying dentoskeletal irregularities but also improving facial aesthetic and function. In this respect, nasal reshaping holds extraordinary significance in de...Current concepts in orthognathic surgery focus on not just rectifying dentoskeletal irregularities but also improving facial aesthetic and function. In this respect, nasal reshaping holds extraordinary significance in determining surgery effectiveness and patient satisfaction. Facial preoperative evaluations emphasize the paramount functional and aesthetic impacts of caudal septum in tip reshaping. Deviations in this anatomical subunit could lead to significant nasal obstructions and aesthetic changes as twisted nasal tip, affecting projection, rotation, and columellar-alar relationship. These considerations are essential in orthofacial surgery, as maxillary movements might exacerbate or worsen preexisting nasal tip deformity. In this paper, we aim to describe a novel and innovative minimally invasive approach presenting a detailed account of a rhinoseptoplasty in which the entire nasal tip reshaping procedure was performed intraorally during orthognathic surgery. The technique focused on achieving optimal nasal tip projection and rotation, centering, and stabilization through strategic maneuvers such as incremental dissection of maxillary spine chondroperiosteal junction, superoposterior strut preservation, vertical and caudal septum resection, and anterior nasal spine tip support. Techniques including subnasal drilling and septal stabilization suture are detailed. Specific attention is given to addressing deficiencies in posterior septal angle and labiocolumellar relationship. Postoperative care is described and subjective evaluations were performed to assess patient and surgeon satisfaction with facial symmetry and overall aesthetic improvements. In our experience, the described approach offers valuable surgical finesse to orthognathic surgery, effectively targeting caudal septum deviations and nasal tip droopy. Its unique perspective enhances both functional and aesthetic results, particularly in the context of profiloplasty. No external nasal incision was performed and the totality of nasal tip reshaping was scarless and performed through an intraoral approach. Surgical precision in execution of this novel and tailored surgical approach has been shown to have a profound impact for enhancing outcomes of orthofacial surgery procedure.
The nasal radix holds significant importance in facial aesthetics, sometimes requiring augmentation to create balanced facial profiles. A flat nasal radix can cause inadequate projection and the appearance of a pseudo-hu...The nasal radix holds significant importance in facial aesthetics, sometimes requiring augmentation to create balanced facial profiles. A flat nasal radix can cause inadequate projection and the appearance of a pseudo-hump. In these cases, rhinoplasty surgeons should avoid working on the pseudo-hump and focus on elevating the radix to achieve the desired aesthetic outcome. Here, we introduce a novel approach and "how we do" the dorsal superficial musculoaponeurotic system (SMAS) periosteal flap for nasal radix augmentation. Using an external septorhinoplasty approach, the initial dissection is performed over the nasal bones in the supra-SMAS plane. Then, an SMAS flap is designed with two lateral and one caudal incision extending to the osseocartilaginous junction and dissected subperiosteally. Next, the flap is rotated to fill the space between the nasal bones and skin, augmenting the nasal radix. Compared to traditional methods, this approach always utilizes the patient's own tissue, minimizes rejection, and ensures seamless integration, providing lasting results. It ensures structural stability and avoids the use of cartilage, eliminating the risk of resorption. The dorsal SMAS periosteal flap presents a tailored, durable solution that consistently yields excellent outcomes while overcoming the risk of instability associated with cartilage grafts.
Pediatric facial nerve paralysis can present significant challenges based on its various etiologies, unique approach to treatment options, and overall outcomes. It can impact both the child and parent when regarding func...Pediatric facial nerve paralysis can present significant challenges based on its various etiologies, unique approach to treatment options, and overall outcomes. It can impact both the child and parent when regarding function, appearance, and psychosocial implications. The etiology of facial nerve palsy can include congenital, traumatic, iatrogenic, and idiopathic causes. In some, the paralysis is transient while others have permanent loss of function. A thorough evaluation and differential diagnosis are essential to guide treatment planning. The purpose of this paper is to review facial paralysis in children with a focus on surgical management.
Although scar outcomes in rhytidectomy are crucial to patients and surgeons alike, there is a lack of consensus on incision techniques for optimizing rhytidectomy scars. A comprehensive scoping review of the literature w...Although scar outcomes in rhytidectomy are crucial to patients and surgeons alike, there is a lack of consensus on incision techniques for optimizing rhytidectomy scars. A comprehensive scoping review of the literature was performed on rhytidectomy incision techniques and associated scar outcomes.The PRISMA protocol was utilized to conduct a scoping review of the literature through MEDLINE, EMBASE, and Science Citation Index databases to identify articles discussing rhytidectomy incision techniques and scar outcomes.A total of 49 studies were included in this scoping review. Four themes were identified related to rhytidectomy scars within these studies: temporal incision placement, tragal incision placement, lobule management, and postauricular incision design. Techniques within each theme were described and reported scar outcomes summarized.There are many approaches to rhytidectomy incisions described in the literature, with reportedly low rates of scar complications for each of the techniques described. It cannot be elucidated which techniques are superior due to the heterogeneity of outcomes reported in the literature with significant variability in outcome measures, study design, and follow-up time. Future studies should focus on utilizing a standardized rating system to aid in objective determination of the superiority of one technique versus another. LEVEL OF EVIDENCE:: Level I.
Nasal reconstruction presents the facial plastic surgeon with a complex problem given its functional and aesthetic importance. The dorsal nasal flap is a composite rotational flap of the glabella and nasal dorsum that ca...Nasal reconstruction presents the facial plastic surgeon with a complex problem given its functional and aesthetic importance. The dorsal nasal flap is a composite rotational flap of the glabella and nasal dorsum that can be used for nasal dorsum and tip defects of medium to large sizes. Given its composite nature, this flap can be split into its constituent parts-the epidermis and dermis and the subcutaneous tissue and superficial musculoaponeurotic system-without flap loss. This case series describes this technique and various potential applications within nasal reconstruction.
Facial asymmetries can significantly affect patient satisfaction post-surgery. Social media can impact a patient's perception of their asymmetries. To gather insights into the practices, perceptions, and approaches conce...Facial asymmetries can significantly affect patient satisfaction post-surgery. Social media can impact a patient's perception of their asymmetries. To gather insights into the practices, perceptions, and approaches concerning facial asymmetry among facial plastic surgeons. The aim of this study was to understand the impact of social media on perceptions of facial asymmetry. This is an American Academy of Facial Plastic and Reconstructive Surgeons (AAFPRS) survey consisting of 46 questions that sought to understand facial plastic surgeons' perceptions of facial asymmetry, their consultation process, their patients' perspectives on their own facial asymmetries, and patient satisfaction. The survey was distributed to 1,269 members of AAFPRS across community hospitals, private practices, and academic hospitals. Sixty-seven members completed the survey. The survey revealed that 31% (21) of surgeons face challenges in managing patient expectations regarding facial asymmetry. In addition, 12% (8) of surgeons felt that patients did not initially recognize their own asymmetries. Eighty-seven percent (58) of surgeons emphasize the natural occurrence of asymmetry during consultations to set realistic expectations. This study emphasizes the need for thorough patient education during initial consultations to align expectations with achievable outcomes. Surgeons should explain the natural occurrence of asymmetry clearly and use digital imaging to show patients realistic previews of surgical results.
This article discusses the process of patient selection for rhinoplasties and the many different psychological aspects that come into play. It is important to identify the warning signs and apply a multidisciplinary appr...This article discusses the process of patient selection for rhinoplasties and the many different psychological aspects that come into play. It is important to identify the warning signs and apply a multidisciplinary approach to the surgeons practice, in collaboration with specialist rhinoplasty psychologists. Patients' motivations and surgeon factors are also discussed, as this can lead to unhappy and unsatisfactory postoperative outcomes. Potential reasons for adverse outcomes throughout the pre- and postoperative periods are also described. Finally, a brief guide is provided to reduce the risks of an unhappy patient.
The Dieffenbach flap is often used for post-Mohs reconstruction of auricle defects, effectively restoring the auricle rim. However, its impact on auricle projection and length after division and inset is not well-documen...The Dieffenbach flap is often used for post-Mohs reconstruction of auricle defects, effectively restoring the auricle rim. However, its impact on auricle projection and length after division and inset is not well-documented. This study evaluates auricle projection and length following defect repair with the Dieffenbach flap, comparing results to the nonoperative ear. We conducted a retrospective review of patients who underwent a Dieffenbach flap repair surgery at a single institution from 2016 to 2023. Auricle projection and length of the reconstructed ear were measured within the first month following division and inset of the flap and compared with the contralateral ear. A subset of patients had additional measurements > 1 month following division and inset, and these measurements were compared with the contralateral ear. Our study included 23 patients with an average age 67.4 years and 78.3% male. Within 1 month following division and inset, the Dieffenbach flap resulted in a significant decrease in auricle projection (16.5 vs. 18.6 mm, < 0.05) and length (67.0 vs. 69.7 mm, < 0.05) compared with the contralateral ear. Subsequent follow-up showed no significant differences in projection (18.5 vs. 18.5 mm, = 0.98) or length (68.0 vs. 68.7 mm, = 0.54). Following division and inset of the Dieffenbach flap, auricle projection and length experience initial reduction but subsequently self-correct to match the contralateral ear.
This study aimed to investigate the impact of three-dimensional (3D) technology on preoperative evaluation for rhinoplasty.A systematic search was conducted on Embase, MEDLINE, and Web of Science. Studies that utilized 3...This study aimed to investigate the impact of three-dimensional (3D) technology on preoperative evaluation for rhinoplasty.A systematic search was conducted on Embase, MEDLINE, and Web of Science. Studies that utilized 3D technology in preoperative assessment for rhinoplasty were included. The primary outcome was surgeon and patient satisfaction. The secondary outcomes included nasal function, cost-efficiency, reoperation rate, precision, and surgical time.Twelve studies (595 patients) were included. Surgeons reported higher satisfaction with 3D approaches based on precision and postoperative results. Patients expressed satisfaction with the 3D approaches due to a better understanding of the procedure and the ability to discuss with the surgeons planning the procedure and participating in postoperative design. The 3D approaches demonstrated higher surgeon satisfaction (mean difference -0.13, 95% confidence interval [CI] -0.20 to -0.06, = 0.0002), particularly in revision cases, and provided higher precision compared with the two-dimensional (2D) approaches. However, 3D technology was more expensive and not cost-efficient. There were no significant differences in reoperation rate (odds ratio 0.16, 95% CI 0.02-1.36, = 0.09) and surgical time. Postoperative nasal function showed inconsistent results.3D technology offered higher surgeon satisfaction and increased precision compared with 2D imaging. However, 3D imaging was expensive and not cost-efficient. Reoperation rate and surgical time were comparable, while postoperative nasal function outcomes showed inconsistent results.
Facial palsy describes the denervation of the facial nerve leading to difficulty in facial animation and expression. Facial synkinesis is the result of complex pathological nerve regeneration following damage to the faci...Facial palsy describes the denervation of the facial nerve leading to difficulty in facial animation and expression. Facial synkinesis is the result of complex pathological nerve regeneration following damage to the facial nerve axons. Synkinesis in facial palsy can be managed using facial neuromuscular rehabilitation, botulinum toxin neuromodulators, and surgical treatment options. Botulinum toxin A can be used as an adjunct to other treatment options to manage synkinesis. This article will explore the role of botulinum toxin A in the management of synkinesis in facial palsy including the clinical assessment, injection location (muscles targeted), dosages, treatment interval, and long-term results. It will also include surgical management options.
Careful evaluation of the neck and its relationship to the lower third of the face is fundamental to provide appropriate recommendations for procedures. The authors propose a modified Baker "clinical" classification as a...Careful evaluation of the neck and its relationship to the lower third of the face is fundamental to provide appropriate recommendations for procedures. The authors propose a modified Baker "clinical" classification as a more reliable and reproducible evaluative basis for the treatment of the aging neck. A total of 450 patients underwent procedures for cervical rejuvenation between December 2012 and December 2022 by the senior author. These included 9 cases of neck liposuction, 6 isolated neck lifts, 15 minimal access cranial suspension face lifts, 94 face lifts with open neck lifts, and 326 extended R-face and neck lifts. The male-to-female ratio was 1:20. The mean patient age was 59.1 years and the mean follow-up was 14 months (range 11.5-20 months). From the data, a modified Baker clinical classification for the aging neck was formulated along with recommendations for possible solutions. Ninety-four percent of the patients expressed high satisfaction on the Owsley Facelift Satisfaction Survey at 1-year follow-up. The complication rate was 1.78% (8 patients), including 1 hematoma, 1 skin edge necrosis (1 cm), 1 slow healing site (postauricular), 3 limited postauricular/earlobe scar revisions, and 2 mild contour irregularities. Cervical rejuvenation can be achieved by a spectrum of interventions and approaches. A comprehensive preoperative assessment and a clinical neck lift classification are the keys to selecting the correct surgical technique for achieving reliable and consistent results. The authors propose a pragmatic approach for both isolated and integrated neck lift procedures with excellent aesthetic outcomes and minimal complications.
With the high demand of rhinoplasty surgery, careful selection and management of aspirants, as well as proper assessment of outcomes after surgery, are imperative for achieving successful outcomes and learning from it. T...With the high demand of rhinoplasty surgery, careful selection and management of aspirants, as well as proper assessment of outcomes after surgery, are imperative for achieving successful outcomes and learning from it. The aim of this study was to answer two important questions: (1) What is the success rate in cosmetic rhinoplasty? (2) How can we best identify candidates who would achieve good outcomes in cosmetic rhinoplasty? In this study cohort, we excluded patients with any functional concerns and confounding factors that could in any way influence patient satisfaction with a cosmetic surgery. This study is a part of the trilogy of articles on "psychology of rhinoplasty" submitted to this volume of , using mandatory psychiatric evaluation (MPE) to optimize candidacy. In total, 184 patients (144 females and 40 males) aged 16 to 63 years ( = 31.09) met the inclusion criteria and were included in this study (follow-up: 3-122 months; = 70.18 months), and outcome satisfaction was assessed using the visual analog scale (VAS) score and a 5-point Likert scale. The mean improvement between preoperative ( = 4.26) and postoperative VAS scores ( = 8.47) was 4.23. Most patients were happy or very happy (95.1%) about the surgical outcome. Patients who were very happy generally scored between 8 and 10 on the VAS (77.2%) and those who were happy generally scored between 6 and 7.9 (21.2%). Some patients, however, were neutral (3.3%) or unhappy (1.6%) about their surgical outcome, and generally scored around ≤7 on the VAS. Although the successful outcome in 95.1% patients reflects a carefully designed protocol for rhinoplasty candidacy, 4.9% patients reported poor satisfaction despite these efforts. An ever-present proportion of unhappy outcomes is a reality of this popular surgery.
This article aims to provide insights into emerging concepts in ophthalmic manifestations in patients with facial palsy and discusses considerations used to develop patient-specific management plans in acute management.This article aims to provide insights into emerging concepts in ophthalmic manifestations in patients with facial palsy and discusses considerations used to develop patient-specific management plans in acute management.
Facial palsy is a condition that affects the facial nerve, the seventh of the 12 cranial nerves. Its main function is to control the muscles of facial expression. This involves the ability to express emotion through cont...Facial palsy is a condition that affects the facial nerve, the seventh of the 12 cranial nerves. Its main function is to control the muscles of facial expression. This involves the ability to express emotion through controlling the position of the mouth, the eyebrow, nostrils, and eye closure. The facial nerve also plays a key role in maintaining the posture of the mouth and as such, people with facial paralysis often have problems with drooling, speech, and dental hygiene.Due to the devastating effects on the quality of life of individuals with facial palsy, there are a multitude of various treatment options for the paralyzed face. This article reviews current management strategies and points towards promising future directions for research in the field of facial reanimation.
Generally, revision rhinoplasty cases require the use of stiff grafts to restore the lost support. However, the majority of patients indicated for revision surgery present with a lack of a bony cartilaginous framework of...Generally, revision rhinoplasty cases require the use of stiff grafts to restore the lost support. However, the majority of patients indicated for revision surgery present with a lack of a bony cartilaginous framework of the septum, especially after previous septoplasty. Thus, surgeons are compelled to harvest costal cartilage. At the same time, rib graft harvesting is associated with additional trauma and a risk of serious complications. Being ENT surgeons, we often resect a part of the lateral wall of the inferior nasal meatus during the extended endoscopic approach to the maxillary sinus. We supposed that this bone plate could be used as a donor site for rhinoplasty graft harvesting. The aim of our study was a radiological assessment of the feasibility and limits of using the inferior meatus lateral wall (IMLW) as a donor site for rhinoplasty bone graft.A retrospective evaluation of 100 CT scans of sinuses was conducted. Further measurements of the IMLW were performed: average length and width (28.06 ± 4.03 mm and 19.73 ± 3.08 mm, respectively), thickness (0.62 ± 0.21 mm), and average deviation from the sagittal plane (17.7 ± 9.53 degrees). According to the obtained measurements, the described donor site is appropriate for harvesting nice straight bony fragments.The IMLW bone graft was used in four revision rhinoplasty cases. There were no postoperative complications. During the long-term follow-up, patients reported significant improvement in aesthetics, function, and social aspects according to Rhinoplasty Outcome Evaluation. Thus, the described technique is an easy and safe method for bone harvesting for revision rhinoplasty. Our first experience demonstrated the convenience and stability of IMLW grafts for revision rhinoplasty during the follow-up period of up to 2 years.
This study was conducted to compare the outcomes of the tongue-in-groove (TIG) technique with and without septal extension graft (SEG) on smile and lip position in rhinoplasty. Fifty-eight rhinoplasty patients, treated a...This study was conducted to compare the outcomes of the tongue-in-groove (TIG) technique with and without septal extension graft (SEG) on smile and lip position in rhinoplasty. Fifty-eight rhinoplasty patients, treated at a tertiary referral center between 2020 and 2022, underwent preoperative and 12-month postoperative evaluations, using the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) and the visual analog scale (VAS). The preoperative and 12-month postoperative photographs were analyzed using Adobe Photoshop to assess changes in lip and smile positions. The study included 38 patients in the TIG with SEG group and 20 patients in the TIG without SEG group. The participants, with an average age of 32.12 ± 7.97 years, comprised 81% females. In terms of surgical outcomes, postoperative evaluations revealed significant improvements in the VAS aesthetic score, SCHNOS-O score, and SCHNOS-C score compared with preoperative scores ( < 0.001) for both groups. Notably, both groups demonstrated significant improvements in the upper lip length, nasolabial angle (NLA), columellar inclination (CI) angle, and smile NLA. Patients in the SEG group exhibited markedly superior SCHNOS-O results, as well as distinctions in smile NLA and smile CI, compared with the group without SEG. The impact of rhinoplasty techniques on lip and smile remains complex requiring further evaluation. Both of the TIG techniques, with and without SEG, resulted in positive outcomes in terms of improving lip and smile positions, with the use of SEG demonstrating greater stability during a smile.
A key component of a well-performed rhinoplasty is to obtain the proper, aesthetic shape of the nasal tip. Various surgical techniques have been developed to achieve this effect. In this work, the author wanted to focus...A key component of a well-performed rhinoplasty is to obtain the proper, aesthetic shape of the nasal tip. Various surgical techniques have been developed to achieve this effect. In this work, the author wanted to focus not only on the satisfactory shape of the nose, but above all on its main role-functionality. In this article, the asymmetrical lateral crus steal (ALCS) technique is proposed, which in its assumption will enable narrowing, better defining and rotating of the nasal tip, and at the same time enhancing nasal patency. We present a retrospective analysis within the group of 267 patients who underwent primary open-approach rhinoplasty that included the ALCS technique. The mean follow-up time was 12 months. A total of 232 patients achieved very good postoperative results without observation of any serious complications related to breathing difficulties or asymmetry of the nasal tip shape. ALCS is a relatively simple surgical technique to perform. The use of the ALCS suture creates the possibility of proper profiling of the nasal tip while improving the respiratory functions of the nose.