Publications by authors named "Aurora G Vincent"

19 Publications

  • Page 1 of 1

Maxillofacial Bony Considerations in Facial Transplantation.

Facial Plast Surg 2021 Apr 20. Epub 2021 Apr 20.

Department of Oral and Maxillofacial Surgery, Texas A&M Health Science Center, Dallas, Texas.

Alloplastic facial transplantation has become a new rung on the proverbial reconstructive ladder for severe facial wounds in the past couple of decades. Since the first transfer including bony components in 2006, numerous facial allotransplantations across many countries have been successfully performed, many incorporating multiple bony elements of the face. There are many unique considerations to facial transplantation of bone, however, beyond the considerations of simple soft tissue transfer. Herein, we review the current literature and considerations specific to bony facial transplantation focusing on the pertinent surgical anatomy, preoperative planning needs, intraoperative harvest and inset considerations, and postoperative protocols.
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http://dx.doi.org/10.1055/s-0041-1726443DOI Listing
April 2021

Reconstruction of the Mandibular Condyle.

Facial Plast Surg 2021 Apr 20. Epub 2021 Apr 20.

Facial Plastic Surgery Associates, Fort Worth, Texas.

The mandibular condyle is an integral structure in the temporomandibular joint (TMJ) serving not only as the hinge point for mandibular opening, but also facilitating mandibular growth and contributing to facial aesthetics. Significant compromise of the TMJ can be debilitating functionally, psychologically, and aesthetically. Reconstruction of the mandibular condyle is rarely straightforward. Multiple considerations must be accounted for when preparing for condylar reconstruction such as ensuring eradication of all chronically diseased or infected bone, proving clear oncologic margins following tumor resection, or achieving stability of the surrounding architecture in the setting of a traumatic injury. Today, there is not one single gold-standard reconstructive method or material; ongoing investigation and innovation continue to improve and transform condylar reconstruction. Herein, we review methods of condylar reconstruction focusing on autologous and alloplastic materials, surgical techniques, and recent technological advances.
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http://dx.doi.org/10.1055/s-0041-1726444DOI Listing
April 2021

Determining the Prognosis of Bell's Palsy Based on Severity at Presentation and Electroneuronography.

Otolaryngol Head Neck Surg 2021 Mar 30:1945998211004169. Epub 2021 Mar 30.

Otolaryngology-Head and Neck Surgery, Madigan Army Medical Center, Tacoma, Washington, USA.

Objective: To examine the demographics of Bell's palsy and determine how House-Brackmann (HB) grade at nadir and electroneuronography (ENoG) results correlate with HB grade after recovery and development of synkinesis.

Study Design: Retrospective cohort study.

Setting: Tertiary care military medical center.

Methods: Patients with acute Bell's palsy and adequate follow-up, defined as 6 months or return to HB grade I function, were included. Demographic information, HB scores at nadir and recovery, and ENoG results were collected.

Results: A total of 112 patient records were analyzed. Ages ranged from 8 to 87 years with peaks at 21 to 25 and 61 to 65 years. Among patients, 16.3% reached a nadir at HB II, 41.9% at HB III, 5.4% at HB IV, 16.3% at HB V, and 20.1% at HB VI. The overall recovery rate was 73.2% to HB I function, 17.0% to HB II, and 9.8% to HB III. The chance of recovery to HB I decreased as the severity of paralysis increased ( = -1.0, < .0001). Mean time to recovery to HB I was 6 weeks. Greater degeneration on ENoG suggested worse recovery ( = 0.62, = .01). Patients with HB V and VI were most likely to develop synkinesis.

Conclusion: More severe paralysis increased the chance of recovery to HB II or III function. The granularity of this study provides prognostic insights that may inform the counseling of patients with Bell's palsy with respect to prognosis and recovery timeline.
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http://dx.doi.org/10.1177/01945998211004169DOI Listing
March 2021

Pilot Study of External Beam Radiotherapy for Recurrent Unremitting Tracheal Stenosis.

Ann Otol Rhinol Laryngol 2021 Feb 25:3489421995064. Epub 2021 Feb 25.

Facial Plastic and Reconstructive Surgery, Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, TX, USA.

Objective: Tracheal stenosis can have a variety of presentations, severities, causes, and be a difficult condition to treat. Some patients demonstrate recurrent stenosis after multiple endoscopic treatments and are either poor candidates for open procedures or do not desire open surgery. We sought to evaluate low-dose postoperative external beam radiotherapy (EBRT) as a novel therapy for patients with recurrent tracheal stenosis refractory to endoscopic therapies.

Method: We performed a retrospective review of patients with recurrent tracheal stenosis who underwent EBRT in addition to endoscopic dilation. We compared the number of endoscopic procedures required in the 6 months before EBRT to the number required in the 6 months after EBRT.

Results: Six patients met criteria for inclusion in our study. The cause of stenosis was variable among the study population. In the 6 months leading up to EBRT, patients underwent an average 6.2 endoscopic procedures. This dropped to an average 1.9 procedures in the 6 months following EBRT ( < .001).

Conclusion: Herein, we show that low-dose postoperative external beam radiotherapy (EBRT), a novel therapy for patients with recurrent tracheal stenosis refractory to endoscopic therapies, is effective in decreasing the frequency of endoscopic dilations.

Level Of Evidence: 4.
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http://dx.doi.org/10.1177/0003489421995064DOI Listing
February 2021

Considerations in Free Flap Reconstruction of the Midface.

Facial Plast Surg 2021 Feb 15. Epub 2021 Feb 15.

Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas.

Midface reconstruction has been a consistent challenge for reconstructive surgeons even with the significant advances in technology and technique achieved over the recent years. A meticulous preoperative assessment of the patient is required to properly assess the defect or anticipated defect, determine proper reconstructive surgical plan, and discuss expected functional and aesthetic outcomes with the patient. For years we have employed local flaps, regional flaps, obturators, alloplastic implants, free flaps, or a combination of the previously mentioned techniques to address complex midface reconstruction. Free flap reconstruction in the midface requires special considerations for the pedicle, flap selection, and flap design to ensure an optimal outcome. The introduction of virtual surgical planning for reconstruction has enhanced patient outcomes to include advances in immediate dental rehabilitation at the time of free flap surgery. Postoperative considerations including quality of life, functional and aesthetic outcomes, and management of complications will also be discussed.
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http://dx.doi.org/10.1055/s-0041-1722981DOI Listing
February 2021

Flap Failure and Salvage in Head and Neck Reconstruction.

Semin Plast Surg 2020 Nov 24;34(4):314-320. Epub 2020 Dec 24.

Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas.

With advanced head and neck ablative surgery comes the challenge to find an ideal reconstructive option that will optimize functional and aesthetic outcomes. Contemporary microvascular reconstructive surgery with free tissue transfer has become the standard for complex head and neck reconstruction. With continued refinements in surgical techniques, larger surgical volumes, and technological advancements, free flap success rates have exceeded 95%. Despite these high success rates, postoperative flap loss is a feared complication requiring the surgeon to be aware of potential options for successful salvage. The purpose of this article is to review free flap failure and ways to optimize surgical salvage in the scenario of flap compromise.
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http://dx.doi.org/10.1055/s-0040-1721766DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7759432PMC
November 2020

Regional Salvage Flap Options in Head and Neck Reconstruction.

Semin Plast Surg 2020 Nov 24;34(4):293-298. Epub 2020 Dec 24.

Otolaryngology and Facial Plastic Associates, Fort Worth, Texas.

Microvascular free tissue transfer is the standard in the complex head and neck reconstruction with success rates greater than 95%. Free tissue transfer allows for more versatility in reconstructing complex defects with better tissue match. Failures, however, do occur and subsequent free tissue transfer might not be an option due to either the patients' health or in a vessel depleted neck. In these challenging salvage scenarios, the head and neck reconstructive surgeon must turn to regional flaps for reconstruction. Here, we review multiple regional flap options for salvage head and neck reconstruction.
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http://dx.doi.org/10.1055/s-0040-1721767DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7759422PMC
November 2020

Radiation Necrosis of the Lateral Skull Base and Temporal Bone.

Semin Plast Surg 2020 Nov 24;34(4):265-271. Epub 2020 Dec 24.

Neurotology, Head and Neck Surgery, Fort Worth, Texas.

Radiation therapy plays a critical role in the treatment of malignancies involving the head and neck. Although the therapeutic effects of ionizing radiation are achieved, normal tissues are also susceptible to injury and significant long-term sequelae. Osteoradionecrosis of the temporal bone (ORNTB) is among the many complications that can arise after therapy. ORNTB is a debilitating and potentially lethal condition that continues to challenge patients and treating physicians. Herein, we review the pathophysiology, presentation, work-up, and management of ORNTB.
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http://dx.doi.org/10.1055/s-0040-1721763DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7759429PMC
November 2020

Avoiding Complications in Functional and Aesthetic Rhinoplasty.

Semin Plast Surg 2020 Nov 24;34(4):260-264. Epub 2020 Dec 24.

Dallas Rhinoplasty, Dallas, Texas.

Historically, nasoseptal surgery favoring functional considerations has compromised aesthetic ones, and vice versa, but modern techniques have evolved that allow symbiotic achievement of both goals. Nasoseptal surgery is among the most commonly performed plastic surgical procedures in the United States, and while it is generally well tolerated, there are a few surgical and aesthetic complications of which to be aware. Herein, we review surgical techniques that improve the nasal airway and nasal aesthetics in a top-down approach with a discussion of possible ensuing complications.
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http://dx.doi.org/10.1055/s-0040-1721762DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7759433PMC
November 2020

Non-vascularized Fibular Cortex Grafts with Osteocutaneous Free Fibula Transfer: A Novel Technique in Midface Reconstruction.

Ann Otol Rhinol Laryngol 2020 Nov 23:3489420972734. Epub 2020 Nov 23.

Department of Otolaryngology - Head and Neck Surgery, Madigan Army Medical Center, Tacoma, WA, USA.

Objectives: To present a method to reconstruct the midface using the fibula as both a microvascular free flap and as a free cortex graft.

Methods: 22-year-old male presented with bilateral maxillary odonotogenic myxoma. Bilateral total maxillectomy defects were reconstructed using an osteocutaneous fibula free flap. The nasomaxillary buttresses were augmented using free cortex grafts to provide additional soft tissue projection and lateral nasal support.

Results: The patient received dental implants at 10 months postoperatively and resumed a normal diet. His midface height, nasal and maxillary projection were adequate. At 36 months post-treatment he has no evidence of disease recurrence or resorption of the free bone grafts.

Conclusion: The fibula free flap can be used to provide additional support to a patient's reconstruction by means of free cortex grafts. The patient has had successful restoration of pyriform aperture, nasal projection, mastication, and dental restoration using a single donor site.
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http://dx.doi.org/10.1177/0003489420972734DOI Listing
November 2020

Treatment of Oligometastatic Disease in Squamous Cell Carcinoma of the Head and Neck.

Laryngoscope 2021 05 12;131(5):E1476-E1480. Epub 2020 Oct 12.

Facial Plastic Surgery Associates, Fort Worth, Texas, U.S.A.

Objective: No surgical or radiotherapeutic treatment guidelines exist for oligometastatic head and neck squamous cell carcinoma (oHNSCC), and only recently have interventions with curative intent been studied. Herein, we sought to elucidate survival rates among patients with oHNSCC to determine if treatment with curative intent is warranted in this population.

Study Design: Retrospective chart review.

Methods: We retrospectively reviewed cases of oHNSCC treated between March 1998 and March 2018. Fisher's exact test was used to compare patients treated with radiotherapy (RT) to those who underwent surgical excision and to compare outcomes of patients with oligometastases at the time of initial presentation to those that developed oligometastatic disease after primary treatment.

Results: Eighty one patients with metastases to the lungs, ribs, pelvis, vertebral column, liver, clavicle, and sternum were included. Overall, 32 patients (40%) were alive 5 years post-treatment. The site of metastasis, the modality of treatment, and the time of development of oligometastatic disease did not significantly affect 5-year survival.

Conclusion: Herein, we demonstrate that multi-modality treatment of oHNSCC is warranted for some patients with an estimated 40% 5-year survival. Aggressive treatment of the primary and regional sites is necessary in addition to treatment of the metastatic site and incurs a survival benefit compared to patients with metastatic HNSCC treated with systemic therapy alone. oHNSCC should be approached separately from polymetastatic disease. Patients should be counseled about the possibility for long-term survival, and aggressive initial treatment with the intention for cure should be considered in this population.

Level Of Evidence: 4 Laryngoscope, 131:E1476-E1480, 2021.
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http://dx.doi.org/10.1002/lary.29115DOI Listing
May 2021

Reconstructive Options During Nonfunctional Laryngectomy.

Laryngoscope 2021 05 10;131(5):E1510-E1513. Epub 2020 Oct 10.

Facial Plastic Surgery Associates, Fort Worth, Texas, U.S.A.

Objective: A paucity of data exists regarding surgical outcomes for patients undergoing total laryngectomy for a dysfunctional larynx. Herein, we present the largest study evaluating the method of closure on postoperative fistula rate and swallowing ability.

Method: We performed a retrospective review of patients undergoing total laryngectomy for a dysfunctional larynx after primary radiation or chemoradiation therapy for laryngeal carcinoma from 1998 to 2020. Demographic information, operative details, length of hospitalization, fistula formation, method of fistula treatment, and need for enteral feeding 6 months after surgery were analyzed.

Results: A total of 268 patients were included. Flaps were performed in 140 (52.2%) patients, including radial forearm free flaps (RFFF), pectoralis flaps, and supraclavicular flaps. Sixty-four (23.9%) patients developed postoperative fistulas. There was no significant difference in the fistula rate between flap and primary closure methods (P = .06). However, among patients who had a flap, RFFF had a significantly lower fistula rate (P = .02). Significantly more patients who had initial closure with a pectoralis flap required an additional flap for fistula repair than those who underwent RFFF or primary closure (P < .05). Last, whereas 87 patients (32.5%) required an enteral feeding tube 6 months after surgery, significantly fewer patients who underwent RFFF were feeding tube-dependent (P = < .0001).

Conclusion: Herein, we present the largest study of outcomes after total laryngectomy for dysfunctional larynx. Postoperative fistula rates are high, 23%; however, the majority of patients, 67%, will not require long-term enteral support. The RFFF is an excellent option demonstrating the lowest rates of postoperative fistula and enteral feeding tube dependence.

Level Of Evidence: 4 Laryngoscope, 131:E1510-E1513, 2021.
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http://dx.doi.org/10.1002/lary.29154DOI Listing
May 2021

Nasoseptal Surgery Outcomes in Smokers and Nonsmokers.

Facial Plast Surg Aesthet Med 2020 Aug 26. Epub 2020 Aug 26.

Otolaryngology-Head and Neck Surgery, Madigan Army Medical Center, Tacoma, Washington, USA.

Many surgeons refuse to perform elective nasal surgery in active smokers, but little literature exists that addresses the risks of doing so; we sought to quantify the differences in outcomes after nasal surgery among smokers, previous smokers, and nonsmokers by measuring complication rates, revision rates, and improvement in Nasal Obstruction Symptom Evaluation (NOSE) scores. We performed a single institution retrospective review of patients undergoing nasoseptal surgery. Specifically, we noted demographic characteristics, smoking status, surgery type, and pre- and postoperative NOSE scores. We compared NOSE scores, complication rates, and revision rates among current smokers, previous smokers, and never smokers. Five hundred thirty patients were included for complication and revision rate analysis; there was no difference in complication or revision rates among patients of different smoking categories. Two hundred ninety-one patients completed pre- and postoperative NOSE scores. Scores for all surgeries and in all smoking categories improved postoperatively ( < 0.001). There was a difference in NOSE score change among surgical groups, with rhinoplasty resulting in the greatest improvement ( = 0.044). There was no difference in NOSE score improvement across smoking categories. Active smokers benefit from surgical intervention and can expect a similar improvement in nasal breathing to their nonsmoking counterparts if they meet indications for and undergo nasal surgery.
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http://dx.doi.org/10.1089/fpsam.2020.0349DOI Listing
August 2020

Management of Facial Scars.

Facial Plast Surg 2019 Dec 29;35(6):666-671. Epub 2019 Nov 29.

Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas.

Scarring is a natural process of healing after damage to the skin that extends to the reticular dermis. While some scars may be socially acceptable, even admirable, scars of the face can be viewed as disfiguring or ugly. Minimizing the appearance of facial scars and optimizing their cosmetic outcome ideally begin before surgery or, in the cause of trauma, at the initial reconstruction. Even when there has been poor initial healing, a scar's appearance can be improved. Herein, we review conservative, medical, and surgical therapies to improve the appearance of facial scars.
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http://dx.doi.org/10.1055/s-0039-3401642DOI Listing
December 2019

Fractures of the Mandibular Condyle.

Facial Plast Surg 2019 Dec 29;35(6):623-626. Epub 2019 Nov 29.

Department of Otolaryngology, Head and Neck Surgery, SUNY Upstate Medical University, Syracuse, New York.

There exists no consensus "gold standard" treatment for condylar fractures, and there is continued debate on whether condylar fractures should undergo surgical or conservative management. Herein, we review various techniques of conservative, closed, and open surgical treatments of condylar fractures. Also, we review complications associated with each treatment modality and compare and contrast closed and open management. Standardization of fracture classification schemes and treatment modalities is needed to elucidate the best course of action for each patient and each fracture.
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http://dx.doi.org/10.1055/s-0039-1700888DOI Listing
December 2019

Sterno-omohyoid Free Flap for Dual-Vector Dynamic Facial Reanimation.

Ann Otol Rhinol Laryngol 2020 Feb 3;129(2):195-200. Epub 2019 Oct 3.

Otolaryngology-Head and Neck Surgery, Madigan Army Medical Center, Tacoma, WA, USA.

Background: Dynamic rehabilitation of longstanding facial palsy with damaged, atrophied, or absent facial muscles requires replacement of neural and muscular components. The ideal reconstruction would include a fast-twitch muscle that is small, a reliable donor vessel and nerve, and the potential to provide a natural, synchronous, dentate smile with minimal donor site morbidity. Many flaps have been successfully used historically, but none has produced ideal rehabilitation.

Objective: To evaluate the novel sterno-omohyoid, dual-vector flap in rehabilitation of chronic facial paralysis.

Results: We performed sterno-omohyoid free tissue transfer for smile reanimation in a 39-year-old male with a history of longstanding right facial palsy following resection of a skull base tumor several years previously. We transferred both muscles with the superior thyroid artery, middle thyroid vein, and ansa cervicalis. The patient developed a dynamic smile by 6 months postoperatively, and he had improved objective facial symmetry.

Conclusion: Herein, we demonstrate the first use of the sterno-omohyoid flap for successful facial reanimation. Overall, it is a novel flap in facial reanimation with many advantages over traditional flaps, including the potential to produce a more synchronous, dynamic smile while adding minimal bulk to the face. Future series will better elucidate the potential of the sterno-omohyoid flap.
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http://dx.doi.org/10.1177/0003489419875473DOI Listing
February 2020

Masseteric-to-Facial Nerve Transfer and Selective Neurectomy for Rehabilitation of the Synkinetic Smile.

JAMA Facial Plast Surg 2019 Dec;21(6):504-510

Division of Otolaryngology-Head and Neck Surgery, Madigan Army Medical Center, Tacoma, Washington.

Importance: Synkinesis is the involuntary movement of 1 area of the face accompanying volitional movement of another; it is commonly encountered in patients affected by facial palsy. Current treatments for synkinesis include biofeedback for muscular retraining and chemodenervation via the injection of botulinum toxin. Chemodenervation is effective in reducing unwanted muscle movement, but it requires a commitment to long-term maintenance injections and may lose effectiveness over time. A permanent solution for synkinesis remains elusive.

Objective: To evaluate masseteric-to-facial nerve transfer with selective neurectomy in rehabilitation of the synkinetic smile.

Design, Setting, And Participants: In this case series, 7 patients at a tertiary care teaching hospital underwent masseteric-to-facial nerve transfer with selective neurectomy for synkinesis between September 14, 2015, and April 19, 2018. The medical records of these patients were retrospectively reviewed and demographic characteristics, facial palsy causes, other interventions used, and changes in eFACE scores were identified.

Intervention: Masseteric-to-facial nerve transfer.

Main Outcomes And Measures: Changes in eFACE scores (calculated via numeric scoring of many sections of the face, including flaccidity, normal tone, and hypertonicity; higher scores indicate better function and lower scores indicate poorer function) and House-Brackmann Facial Nerve Grading System scores (range, 1-6; a score of 1 indicates normal facial function on the affected side, and a score of 6 indicates absence of any facial function [complete flaccid palsy] on the affected side).

Results: Among the 7 patients in the study (6 women and 1 man; median age, 49 years [range, 41-63 years]), there were no postoperative complications; patients were followed up for a mean of 12.8 months after surgery (range, 11.0-24.5 months). Patients experienced a significant improvement in mean (SD) eFACE scores in multiple domains, including smile (preoperative, 65.00 [8.64]; postoperative, 76.43 [7.79]; P = .01), dynamic function (preoperative, 62.57 [15.37]; and postoperative, 75.71 [8.48]; P = .03), synkinesis (preoperative, 52.70 [4.96]; and postoperative, 82.00 [6.93]; P < .001), midface and smile function (preoperative, 60.71 [13.52]; and postoperative, 78.86 [14.70]; P = .02), and lower face and neck function (preoperative, 51.14 [16.39]; and postoperative, 66.43 [20.82]; P = .046). Preoperative House-Brackmann Facial Nerve Grading System scores ranged from 3 to 4, and postoperative scores ranged from 2 to 3; this change was not significant.

Conclusion And Relevance: This study describes the application of masseteric-to-facial nerve transfer with selective neurectomy for smile rehabilitation in patients with synkinesis, with statistically significant improvement in smile symmetry and lower facial synkinesis as measured with the eFACE tool. This technique may allow for long-term improvement of synkinesis and smile. This study is only preliminary, and a larger cohort will permit more accurate assessment of this therapeutic modality.

Level Of Evidence: 4.
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http://dx.doi.org/10.1001/jamafacial.2019.0689DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6902154PMC
December 2019

Modiolar rotational cheiloplasty: Addressing the central oval in facial paralysis.

Laryngoscope 2019 10 28;129(10):2262-2268. Epub 2018 Dec 28.

Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A.

Objectives/hypothesis: Current static reanimation of the midface fails to provide adequate functional and aesthetic improvement; there is a need for more effective static correction of the ptotic midface. Our objective herein was to describe a novel method of static midface suspension that produces improved functional and aesthetic outcomes compared to previous techniques. Specifically, our goal was to describe the technique of alar and oral commissure repositioning via modiolar rotational cheiloplasty with alar base transposition, and gingivobuccal sulcoplasty.

Study Design: Retrospective case series.

Methods: We retrospectively reviewed the results of a series of adult patients desiring surgical intervention for paralysis of the central oval of the face at a tertiary care referral center. We present our technique of modiolar rotational cheiloplasty first with an example case, including subjective outcomes reported by the patient and objective improvements in facial appearance using Massachusetts Eye and Ear Infirmary Facial Assessment by Computer Evaluation Program (MEEI FACE-Gram) software, then demonstrate long-term outcomes from the series.

Results: Clinically, patients noted subjective improvement in drooling, buccal stasis of food, dysarthria, nasal obstruction, and overall appearance. Patients with significant atrophy and lateral displacement of the lower lip underwent concomitant wedge resection, which further improved the symmetry and position of the lips. The MEEI FACE-Gram software demonstrated objective improvement in symmetry of smile and position of the philtrum and nasal base in an example case.

Conclusions: Modiolar rotational cheiloplasty with alar base transposition is an effective and efficient static procedure for midface palsy that improves both function and appearance.

Level Of Evidence: 4 Laryngoscope, 129:2262-2268, 2019.
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http://dx.doi.org/10.1002/lary.27700DOI Listing
October 2019

Higher Complication Rates in Self-Inflicted Gunshot Wounds After Microvascular Free Tissue Transfer.

Laryngoscope 2019 04 24;129(4):837-840. Epub 2018 Sep 24.

Department of Facial Plastic and Reconstructive Surgery, Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas, U.S.A.

Objectives/hypothesis: Microvascular free tissue transfer is often employed to reconstruct significant facial defects from ballistic injuries. Herein, we present our comparison of complications between self-inflicted and non-self-inflicted gunshot wounds after microvascular free tissue transfer.

Study Design: Retrospective case review.

Methods: Approval was obtained from the JPS institutional review board. We performed a retrospective review of cases of ballistic facial injuries between October 1997 and September 2017 that underwent vascularized free tissue transfer for reconstruction. Comparisons were made between self-inflicted and non-self-inflicted gunshot wounds after microvascular free tissue transfer. The χ test was used for all comparisons. P value and 95% confidence interval (CI) were reported.

Results: There were 73 patients requiring free flap reconstruction after gunshot wounds to the face during the study period. There was a statistically significant difference in the rates of nonunion between self-inflicted and non-self-inflicted wounds (P = .02, 95% CI: 0.9 to 35.8) There were also no significant differences in flap failure (P = .10, 95% CI: -2.8 to 24.2), plate exposure (P = .28, 95% CI: -6.7 to 33.0), wound infection (P = .40, 95% CI: -8.9 to 31.2), scar contracture (P = .60, 95% CI: -8.1 to 25.1), and fistula formation (P = .13, 95% CI: -2.8 to 28.8) between patients with self-inflicted and those with non-self-inflicted wounds. Overall, complication rates were significantly higher in the self-inflicted group compared to the non-self-inflicted group (P < .0001, 95% CI: 32.6 to 68.6).

Conclusions: Patients with self-inflicted injuries had more complications postoperatively than those with non-self-inflicted injuries. This is likely helpful in surgical planning and patient counseling.

Level Of Evidence: 4 Laryngoscope, 129:837-840, 2019.
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http://dx.doi.org/10.1002/lary.27391DOI Listing
April 2019