Publications by authors named "David A Shaye"

42 Publications

Opioid Prescribing Patterns Among Facial Plastic and Reconstructive Surgeons in the Medicare Population.

Facial Plast Surg Aesthet Med 2021 Feb 25. Epub 2021 Feb 25.

Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.

To evaluate opioid prescribing patterns among American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) members in the Medicare population. Retrospective cohort study of AAFPRS members in the Medicare Part D Prescriber dataset. From 2014 to 2016, there was a significant decrease in the number of days of opioids supplied per beneficiary (5.9 vs. 4.9 days,  < 0.005), as well as the opioid prescription cost per beneficiary ($14.52 vs. $11.79,  = 0.005). The highest prescription rate was found in the Midwest (20.5%) and lowest in the Northeast (14.0%), however, the difference between geographic regions was not significant ( = 0.11). There was a significant decrease in the number of total opioid days supplied per beneficiary in the South ( = 0.001), Midwest ( = 0.05), and West regions ( < 0.001). There was no significant difference in opioid prescription rate ( = 0.89) or total opioid days supplied per beneficiary ( = 0.26) when states were stratified by age-adjusted opioid-specific death rate. This study demonstrates a national trend toward fewer opioid days supplied and less opioid cost per Medicare beneficiary among AAFPRS members between 2014 and 2016.
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http://dx.doi.org/10.1089/fpsam.2020.0551DOI Listing
February 2021

Lip and Perioral Trauma: Principles of Aesthetic and Functional Reconstruction.

Facial Plast Surg 2021 Feb 22. Epub 2021 Feb 22.

Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan.

Successful management of lip and perioral trauma requires a nuanced understanding of anatomy and surgical techniques. Surgical correction is particularly challenging in instances of tissue loss, due to a narrow tolerance for aesthetic deformity and highly specialized functions of the perioral region, including facial expression, communication, and oral competence. Restoring continuity of the orbicularis oris musculature is critical for dynamic sphincter function of the upper and lower lips. Lip and perioral tissue symmetry are also critical for aesthetic balance, and failure to restore a natural appearance can adversely affect personal identity, with attendant psychological trauma. This discussion of lip and perioral trauma management encompasses lip and perioral anatomy, evaluation of injuries, reconstructive techniques, and prevention and management of complications. Perioral injuries are classified by size, depth, and extent of injury, and the corresponding reconstructive approaches are a function of complexity. These approaches proceed sequentially up rungs of the reconstructive ladder including primary repair, local flaps, grafting, regional flaps, as well as microvascular free tissue transfers. Procedures may be single stage or require multiple stages or subsequent refinement. Regardless of the defect size or location, the guiding principle of repair in the perioral region is restoring natural function and aesthetic appearance. This still-evolving area of facial plastic and reconstructive surgery lends itself to artistry and technical precision, offering opportunities for further innovation to improve the outcomes of patients with lip and perioral trauma.
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http://dx.doi.org/10.1055/s-0041-1725110DOI Listing
February 2021

Noma and Necrotizing Fasciitis of the Face and Neck.

Facial Plast Surg 2021 Jan 31. Epub 2021 Jan 31.

Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.

Necrotizing fasciitis (NF) is part of the class of necrotizing soft tissue infections characterized by rapid fascial spread and necrosis of the skin, subcutaneous tissue, and superficial fascia. If left untreated, NF can rapidly deteriorate into multiorgan shock and systemic failure. NF most commonly infects the trunk and lower extremities, although it can sometimes present in the head and neck region. This review provides an overview of NF as it relates specifically to the head and neck region, including its associated clinical features and options for treatment. Noma, a related but relatively unknown disease, is then described along with its relationship with severe poverty.
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http://dx.doi.org/10.1055/s-0041-1722894DOI Listing
January 2021

Commentary on "Comparison of Two Surgical Epilation Procedures Based on the Nagata Method in All Degrees of Low Hairline Microtia" by Wang et al.

Facial Plast Surg Aesthet Med 2020 Dec 1. Epub 2020 Dec 1.

Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.

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http://dx.doi.org/10.1089/fpsam.2020.0543DOI Listing
December 2020

Asystole During Reduction of a Zygomaticomaxillary Complex Fracture.

Facial Plast Surg Aesthet Med 2021 Mar-Apr;23(2):148-150. Epub 2020 Sep 29.

Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA.

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http://dx.doi.org/10.1089/fpsam.2020.0417DOI Listing
September 2020

National Variation of Insurance Coverage for Gender-Affirming Facial Feminization Surgery.

Facial Plast Surg Aesthet Med 2020 Aug 29. Epub 2020 Aug 29.

Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.

Gender-affirming surgery may be pursued by individuals experiencing gender dysphoria. Although genital and chest procedures are classified as medically necessary, facial feminization surgeries (FFSs) are often considered cosmetic. Insurance companies may limit coverage of these procedures, especially in states less supportive of transgender individuals. To determine insurance coverage and ease of finding policy information for FFSs, and to analyze differences based on state advocacy. Insurance policies for the top three commercial health plans per state were reviewed. Coverage status was determined by web-based search and telephone interviews. Ease of gathering policy information was assessed using a post-task questionnaire graded on a 7-point Likert scale, with higher numbers (e.g., 7) representing relative ease. State advocacy was determined by the number of state laws and policies affecting the transgender community. Of the 150 insurance policies, only 27 (18%) held favorable policies for FFS. Most favorable companies covered chondrolaryngoplasty, with 78% ( = 21) offering preauthorization. Mean ease of use was rated 6, with 12 companies requiring a telephone interview. Insurance policies in states with laws driving transgender equity covered more FFS procedures ( = 0.043), whereas those in restrictive states offered less overall coverage ( = 0.023). FFS is rarely covered by commercial insurance companies, especially in states with less legal support for transgender individuals. Policy information remains difficult to obtain, with variable coverage by employer and no standardized medical necessity criteria. Limited coverage, lack of easily accessible information, and absence of universal criteria may act as barriers to FFS.
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http://dx.doi.org/10.1089/fpsam.2020.0226DOI Listing
August 2020

Coverage for Gender-Affirming Voice Surgery and Therapy for Transgender Individuals.

Laryngoscope 2021 03 10;131(3):E896-E902. Epub 2020 Aug 10.

Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A.

Objectives/hypothesis: To determine insurance coverage for gender-affirming surgery and voice therapy for individuals who seek to align their voice with their gender identity, and to analyze differences based on state-by-state transgender equality.

Study Design: Cross-sectional study.

Methods: Policies from the top three commercial insurers per state in 2019 were reviewed. Coverage status was determined by web-based search, telephone interviews, and email inquiries. A state-by-state equality score was calculated based on the number of laws and policies relating to the transgender community. Correlation between number of preauthorized procedures and state equality scores was assessed.

Results: Of the 150 insurance companies reviewed, only four (2.7%) held favorable policies, whereas 113 (75.8%) provided no coverage. Endoscopic surgery, open surgery, individual voice therapy, and group voice therapy interventions were equally excluded (n = 93, 62.4%). Coverage was not correlated with laws driving transgender equality (P = .782).

Conclusions: Gender-affirming voice interventions are seldom covered by commercial insurance companies. Despite established medical necessity and years of experience in practice, gender-affirming interventions for voice have not yet been fully considered by third-party payors. Further investigation regarding cost-effectiveness and treatment efficacy is warranted to improve insurance coverage of voice-related gender-affirming care.

Level Of Evidence: NA Laryngoscope, 131:E896-E902, 2021.
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http://dx.doi.org/10.1002/lary.28986DOI Listing
March 2021

Self-compounded Doxycycline Sclerotherapy for the Treatment of Lymphatic Malformations in Low-Resource Settings.

World J Surg 2020 Nov 8;44(11):3616-3619. Epub 2020 Jul 8.

Department of Otolaryngology, Central University Teaching Hospital, Kigali, Rwanda.

Background: Congenital anomalies are one component of the overwhelming surgical disease burden in low- and middle-income countries (LMICs). Lymphatic malformations (LMs) are a common congenital deformity of the head and neck in which the utilization of sclerotherapy may avoid surgery and yield superior outcomes. To be useful in LMICs, sclerosing agents must be widely available, inexpensive, and effective.

Methods: A retrospective review of 10 pediatric patients with macrocystic or mixed LMs who were treated with self-compounded doxycycline sclerotherapy at Rwanda's Central University Teaching Hospital of Kigali was performed. Doxycycline oral tablets were crushed by hand, mixed with normal saline at a concentration of doxycycline 10 mg/mL, and injected directly into LMs of the head and neck.

Results: Ten pediatric patients underwent 21 sclerotherapy sessions with a mean of 2.1 sessions per patient (SD 1.3, range 1-5). Of the 8 patients that were seen in follow-up, all achieved at least 80% resolution, 6 of 8 achieved 100% resolution, and none required surgery. One patient developed an infection at the injection site which resolved with antibiotics.

Conclusions: Self-compounded doxycycline sclerotherapy is a safe, effective, and widely available treatment option for sclerotherapy of LMs in LMICs.
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http://dx.doi.org/10.1007/s00268-020-05667-zDOI Listing
November 2020

Quantifying Aerosolization of Facial Plastic Surgery Procedures in the COVID-19 Era: Safety and Particle Generation in Craniomaxillofacial Trauma and Rhinoplasty.

Facial Plast Surg Aesthet Med 2020 Jul 2. Epub 2020 Jul 2.

Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA.

COVID-19 poses a potentially significant infectious risk during procedures of the head and neck due to high viral loads in the nasal cavity and nasopharynx. Facial plastic surgery has significant exposure to these areas during craniomaxillofacial trauma procedures and rhinoplasty. Airborne particulate generation in the 1-10 μm range was quantified with an optical particle sizer in real time during cadaveric-simulated rhinoplasty and facial trauma conditions. Procedures tested included mandibular plate screw drilling, calvarial drilling, nasal bone osteotomy, nasal dorsal rasping, and piezoelectric saw use. Particulate generation was measured both adjacent to the surgical site and at surgeon mouth level (SML). Mandibular plate screw drilling without irrigation generated significant particulate both adjacent to the surgical site and at SML ( < 0.01). Irrigation mitigated particulate generation at SML to nonsignificant levels. Calvarial drilling additionally produced substantial particulate above baseline adjacent to the surgical site ( < 0.01). Standard nasal osteotomies and dorsal rasping did not generate detectable airborne particulate, whereas piezoelectric saw use was associated with significant particulate generation both adjacent to the surgical site ( < 0.001) and at SML ( < 0.01). At SML, smaller particulate represented a significantly higher proportion of total particulate detected. The majority of craniomaxillofacial trauma procedures involve particle generation that may be limited in spread by the use of local irrigation. Most bony work involved in rhinoplasty can be safely performed without a high degree of particle formation. The use of piezoelectric instruments in rhinoplasty should be avoided when concerned for particulate generation.
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http://dx.doi.org/10.1089/fpsam.2020.0322DOI Listing
July 2020

Considerations for the otolaryngologist in the era of COVID-19: a review of the literature.

Curr Opin Otolaryngol Head Neck Surg 2020 Aug;28(4):228-234

Department of Otolaryngology - Head and Neck Surgery.

Purpose Of Review: The SARS-CoV-2 coronavirus pandemic, referred to as COVID-19, has spread throughout the globe since its first case in China in December 2019, leaving a significant number of people infected and clinically ill. The purpose of this review is to provide the current known clinical characteristics of and management for COVID-19 as it relates to otolaryngology.

Recent Findings: COVID-19 is a highly transmissible respiratory disease with common presenting symptoms of fever, cough, and fatigue. In the absence of available vaccines or antiviral therapies, symptomatic and respiratory support is the current standard of therapy. Measures to prevent further transmission have been enacted globally including social distancing and cancellation of public events. Given elevated viral load in the upper aerodigestive tract, extra precautions in patients with otolaryngology needs have been recommended for protection of both healthcare workers and patients.

Summary: Otolaryngologists face unique risk from COVID-19. Maintaining appropriate preventive health measures and remaining updated on institutional clinical guidelines is paramount for both caretaker safety and patient care.
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http://dx.doi.org/10.1097/MOO.0000000000000632DOI Listing
August 2020

The science of art: Leonardo Da Vinci and facial plastic surgery.

Authors:
David A Shaye

Curr Opin Otolaryngol Head Neck Surg 2020 Aug;28(4):195-200

Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.

Purpose Of Review: Leonardo Da Vinci possessed one of humanity's greatest minds, known for exploring the boundaries of art and science. The discipline of facial plastic surgery also relies on art and science for its advancement. This review focuses on key elements of Leonardo Da Vinci's work, and how they relate to concepts within facial plastic surgery.

Recent Findings: Leonardo Da Vinci was a self-taught creative genius. Common themes that permeated his art were those of proportion, perspective, light and shadow, anatomy, and science. These principles are reflected in key aspects of facial plastic surgery, such as facial analysis, human gaze, facial subunits, surgery of the craniofacial skeleton, and evidence-based medicine.

Summary: Leonardo Da Vinci's approach to scientific inquiry and artistic beauty strikes a balance from which facial plastic surgeons have much to learn. In depth study of how Leonardo Da Vinci viewed the world furthers the analytical and creative sides of a facial plastic surgeon as well as informs their personal development.
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http://dx.doi.org/10.1097/MOO.0000000000000643DOI Listing
August 2020

Optimizing speech outcomes for cleft palate.

Curr Opin Otolaryngol Head Neck Surg 2020 Aug;28(4):206-211

Department of Otolaryngology, Massachusetts Eye & Ear, Harvard Medical School, Boston, Massachusetts, USA.

Purpose Of Review: Cleft lip with or without palate is one of the most common pediatric birth anomalies. Patients with cleft palate often have speech difficulties from underlying anatomical defects that can persist after surgery. This significantly impacts child development. There is a lack of evidence exploring, which surgical techniques optimize speech outcomes. The purpose of this update is to report on recent literature investigating how to optimize speech outcomes for cleft palate.

Recent Findings: The two-flap palatoplasty with intravelar veloplasty (IVVP) and Furlow double-opposing Z-plasty has the strongest evidence for optimizing speech. One-stage palatal repair is favored at 10-14 months of age, while delays are associated with significant speech deficits. For postoperative speech deficits, there is no significant difference between the pharyngeal flap, sphincter pharyngoplasty, and posterior pharyngeal wall augmentation. Surgical management should be guided by closure pattern and velopharyngeal gap but few studies stratify by these characteristics.

Summary: According to recent evidence, the two-flap palatoplasty with IVVP and Furlow palatoplasty result in the best speech. The pharyngeal flap, sphincter pharyngoplasty, and posterior pharyngeal wall augmentation are all viable techniques to correct residual velopharyngeal insufficiency. Future research should focus on incorporating standardized measures and more robust study designs.
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http://dx.doi.org/10.1097/MOO.0000000000000635DOI Listing
August 2020

A task-shifted speech therapy program for cleft palate patients in rural Nepal: Evaluating impact and associated healthcare barriers.

Int J Pediatr Otorhinolaryngol 2020 Jul 27;134:110026. Epub 2020 Mar 27.

Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, USA. Electronic address:

Introduction: Though access to surgical care for cleft lip/palate has expanded in low- and middle-income countries (LMICs), post-palatoplasty speech therapy is often lacking due to limited healthcare infrastructure and personnel. This mixed-methods study seeks to: 1) evaluate the impact of task-shifted speech therapy on a standardized speech score; 2) describe the experiences of families with post-operative cleft care and associated barriers; and 3) understand how to optimize cleft care by exploring the experiences of children who had nominal improvements after task-shifted speech therapy.

Methods: A convergent parallel mixed-methods study was conducted in Nepal. Standardized speech scores were compared by a blinded speech-language pathologist before and after the speech intervention. Semi-structured interviews (SSIs) and focus groups with families evaluated cleft care experiences and barriers. Qualitative and quantitative data were merged and analyzed.

Results: Thirty-nine post-palatoplasty children with speech deficits (ages 3-18) underwent task-shifted speech therapy, and demonstrated significant improvements in composite speech scores targeted by exercises (p<0.0001) and weakness (p=0.0002), with improvements in misarticulation (p=0.07) and glottal stop (p=0.05) that trended towards significance. Forty-seven SSIs demonstrated that the greatest barriers to follow-up were family responsibilities (62%), travel/distance (53%), and work (34%). In five focus groups, families expressed a desire to improve their child's speech and seek formal speech therapy. The speech intervention was found to be beneficial because of the compassionate staff, free lodging/food, and ability to socialize with other cleft patients and families. After merging quantitative and qualitative data, we noted that younger children between 3 and 5 years old and families who traveled greater distances for healthcare access benefited less from the speech therapy intervention.

Conclusions: Task-shifted speech therapy has the potential to improve cleft lip/palate speech in LMICs. Multiple biosocial issues limit access to appropriate post-operative care.
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http://dx.doi.org/10.1016/j.ijporl.2020.110026DOI Listing
July 2020

Proboscis Lateralis: A Unique Window into Nasal Embryology.

Facial Plast Surg Aesthet Med 2020 Jul/Aug;22(4):307-308. Epub 2020 Apr 8.

Department of Otolaryngology, University Teaching Hospital of Kigali, University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda.

Proboscis lateralis is a rare congenital nasal deformity often associated with other nasal or ocular deformities. This anomaly offers a unique window into nasal embryology.
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http://dx.doi.org/10.1089/fpsam.2020.0107DOI Listing
November 2020

Prospective Qualitative Multidimensional Assessment of the Postoperative Rhinoplasty Experience.

Facial Plast Surg Aesthet Med 2020 May/Jun;22(3):213-218. Epub 2020 Mar 30.

Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA.

Understanding the multidimensional postoperative patient experience after rhinoplasty is critical for preoperative counseling and postoperative management. A prospective clinical study was conducted from June to December 2019 for 60 patients undergoing cosmetic and/or functional rhinoplasty by two facial plastic surgeons. All patients were administered the brief pain inventory, a clinically validated pain instrument, including multiple quality of life (QOL) domains, survey at postoperative days (PODs) 1, 2, 3, and 8. Nasal Obstruction Symptom Evaluation (NOSE) scores were used to predict patients having greatest QOL disturbance. Primary outcomes were postoperative QOL domains, pain scores, and oxycodone usage. Statistical analysis was performed using STATA 14.0 (STATA Corp., College Station, TX). Preoperative NOSE and postoperative Euro Quality of Life 5-Dimension scores were also recorded. Patients showed greatest disruption to QOL in the first 3 PODs and essentially returned to normal levels by POD8, which mirrored trends in pain and opioid usage. All tested QOL domains (general activity, sleep, work, mood, enjoyment, and relationships) were strongly correlated with overall pain. NOSE scores were not significantly associated with pain or QOL impairment. This is the first study to prospectively evaluate the rhinoplasty patient's postoperative experience using a pain instrument, including multiple QOL domains. Utilizing a validated clinical instrument allows for standardized comparison of postrhinoplasty pain and QOL disruption with other surgical procedures and disease processes. These data may help guide preoperative counseling and set accurate patient expectations for the postoperative period.
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http://dx.doi.org/10.1089/fpsam.2020.0047DOI Listing
November 2020

Variation in the Geographic Distribution of the Otolaryngology Workforce: A National Geospatial Analysis.

Otolaryngol Head Neck Surg 2020 May 3;162(5):649-657. Epub 2020 Mar 3.

Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

Objective: To examine the current geographic distribution of otolaryngologists in the United States and the disparities in socioeconomic demographics at the county and hospital referral region (HRR) level.

Study Design: Cross-sectional study.

Setting: National cohort analysis including all otolaryngologists in the United States.

Subjects And Methods: All otolaryngologists board certified by the American Board of Otolaryngology-Head and Neck Surgery in the United States in 2018 were compared with overlaid demographic data from the 2010 United States Census Bureau by county and HRR. Associations between the density of otolaryngologists per population and socioeconomic characteristics were assessed and stratified by region.

Results: The average number of otolaryngologists was 3.6 (SD 9.6) per 100,000. On multivariable regression analysis, the density of otolaryngologists was positively associated with counties with the highest quartile of college education (1.8 providers per 100,000 [95% confidence interval [CI] 0.89, 2.90], < .001) and income (2.1 providers per 100,000 [95% CI 1.03, 3.07], = .01). Significant regional variation existed in access to otolaryngology care.

Conclusion: There are significant areas with disparate densities of otolaryngologists in the United States. Lower socioeconomic status, more severe poverty, and a lower number of college graduates in a county correlated with reduced density of otolaryngologists.
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http://dx.doi.org/10.1177/0194599820908860DOI Listing
May 2020

What Is the Optimal Timing for Dividing a Forehead Flap?

Laryngoscope 2020 10 25;130(10):2303-2304. Epub 2020 Feb 25.

Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California, U.S.A.

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http://dx.doi.org/10.1002/lary.28588DOI Listing
October 2020

Nepali Linguistic Validation of the Velopharyngeal Insufficiency Effects on Life Outcomes Instrument: VELO-Nepali.

Cleft Palate Craniofac J 2020 08 13;57(8):967-974. Epub 2020 Feb 13.

Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA, USA.

Objective: To translate and validate the velopharyngeal insufficiency (VPI) effects on life outcomes (VELO) instrument into Nepali, and test its internal consistency and validity.

Design: Quality-of-life instrument translation and validation.

Setting: Community served by Nepal's craniofacial referral hospital.

Participants: Twenty-three postpalatoplasty children with VPI, 19 family guardians of VPI cases, and 29 non-VPI controls.

Interventions: The VELO instrument was translated to Nepali by 2 independent bilingual translators, reconciled, backward-translated, compared, and modified using patient cognitive interviews. All VPI children, guardians, and controls completed the VELO-Nepali.

Main Outcome Measure(s): The VELO internal consistency was evaluated using Cronbach α coefficient. Concurrent validity and discriminant validity were assessed using 2-sample test: assuming unequal variances.

Results: The VELO was translated and optimized using cognitive interviews. The VELO-Nepali demonstrated excellent internal consistency, with Cronbach α coefficients of 0.93, 0.94, and 0.90 for VPI cases, guardians of VPI cases, and non-VPI controls, respectively. The VELO-Nepali exhibited strong discriminant validity between VPI cases ( = 45.4, standard deviation [SD] = 22.1) and non-VPI controls ( = 84.9, SD = 12.3), ( < .001). The VELO-Nepali showed strong concurrent validity with similarities in VPI case scores ( = 45.4, SD = 22.1), and guardian scores ( = 52.9, s = 22.8; = .473).

Conclusion: The translated VELO-Nepali demonstrates strong internal consistency, discriminant validity, and concurrent validity, and can assess quality of life for Nepali VPI patients. This instrument represents the first VPI quality of life assessment validated in Nepali, and supports the feasibility of its implementation in other low- and low-middle-income countries.
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http://dx.doi.org/10.1177/1055665620905173DOI Listing
August 2020

Associations between national financial trends and facial plastic surgery procedural volume.

Laryngoscope 2020 03 11;130(3):632-636. Epub 2019 Oct 11.

Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts.

Objective(s): To characterize procedural trends in facial plastic and reconstructive surgery procedures in relation to the United States economy.

Methods: Retrospective cohort study examining annual procedure rates were determined from the American Society of Plastic Surgeons (ASPS) National Clearinghouse of Plastic Surgery Procedural Statistics from January 1 2007 to December 30, 2017. Procedures were compared to economic activity of the United States as measured by gross domestic product (GDP) were compared using Kolmogorov-Smirnov goodness of fit testing and piecewise multivariate regression modeling.

Results: Annual trends in procedural rates showed an overall decrease in the rates of rhinoplasty (284,960 to 218,924), blepharoplasty (240,660 to 209,571), and otoplasty (28,571 to 23,433) from 2007 to 2017. Total cosmetic surgery remained fairly stable, while minimally invasive cosmetic surgery increased in frequency over the study period. On piecewise regression analysis, rhinoplasty (P = .02), rhytidectomy (P = .007), invasive cosmetic surgery (P < .001) were significantly associated with GDP, whereas otoplasty (P = .98) and reconstructive surgery (P = .11) were not associated with GDP.

Conclusion: Cosmetic plastic surgery procedures show a greater correlation to GDP than reconstructive procedures. Trends in plastic surgery cases over the last decade show a decreasing number of rhinoplasty, otoplasty, and blepharoplasty, with stabilization in the last few years. An increasing number of reconstructive cases are found.

Level Of Evidence: 4 Laryngoscope, 130:632-636, 2020.
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http://dx.doi.org/10.1002/lary.28311DOI Listing
March 2020

Association Between Pain and Patient Satisfaction After Rhinoplasty.

JAMA Facial Plast Surg 2019 Dec;21(6):475-479

Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts.

Importance: In 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.

Objectives: To characterize the association between patient-reported pain outcomes, objective opioid use, and perception of surgical success.

Design, Setting, And Participants: A 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.

Main Outcomes And Measures: The 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.

Results: Overall, 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).

Conclusions And Relevance: To 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.

Level Of Evidence: 3.
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http://dx.doi.org/10.1001/jamafacial.2019.0808DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6753502PMC
December 2019

Role of mobile health on patient enrollment for cleft lip-palate surgery: A comparative study using SMS blast text messaging in zimbabwe.

Laryngoscope Investig Otolaryngol 2019 Aug 28;4(4):383-386. Epub 2019 Jun 28.

Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Harvard Medical School Boston Massachusetts U.S.A.

Background: Patients' lack of awareness of available services is a significant barrier to delivering surgical care in resource-limited settings. Short message service (SMS) text messaging is a potential means to disseminate this information in resource-limited settings, where rates of mobile phone usage are high.

Methods: A blast SMS text informing local populations of upcoming cleft lip-palate (CLP) surgical services was distributed to 25% of the subscriber base 1 week prior to arrival of a (CLP) surgical team in Zimbabwe. A retrospective cohort analysis comparing characteristics of patients presenting to the CLP clinic in the year prior to (2016) and 2 years following (2017-2018) the implementation of the blast SMS text messaging system is performed to assess its impact.

Results: Patients presenting to a single Zimbabwean CLP surgical program in the years with SMS messaging notifications were significantly more likely (52 [64%] vs. 5 [17%],  < .001) to have been informed of surgical services through their mobile phones. The average distance traveled per patient was not significantly different prior to implementation of mass text messaging (180.4 km [SD114.8] vs. 167.4 km [SD105.9], = .580). The average patient age was significantly higher following the implementation of mass text messaging (7.4 [SD8.7] vs. 3.0 [SD2.8] years, = .010).

Conclusions: SMS messaging is an effective method of informing patients of CLP surgical services in resource-limited settings. After implementation of SMS text notifications, surgical patients were of increased age, but showed no difference in distance traveled.

Level Of Evidence: IV.
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http://dx.doi.org/10.1002/lio2.287DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6703104PMC
August 2019

Update on the management of craniomaxillofacial trauma in low-resource settings.

Curr Opin Otolaryngol Head Neck Surg 2019 Aug;27(4):274-279

Department of Otolaryngology-Head & Neck Surgery, Facial Plastic and Reconstructive Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.

Purpose Of Review: Craniomaxillofacial (CMF) trauma is a common cause of global morbidity and mortality. Although in high resource settings the management of CMF trauma has improved substantially over the past several decades with internal rigid fixation technology; these advancements have remained economically unviable and have not yet reached low and middle-income countries (LMICs) en masse. The purpose of this review is to discuss the current management of CMF injuries in low-resource settings.

Recent Findings: Trauma injuries remain a global epidemic with head and neck injuries among the most common. CMF trauma injuries largely occur in LMICs, with motor vehicle trauma being a common cause. Patients present in a delayed fashion which increases complications. Diagnostic methods are often limited to plain radiographs as computed tomography is not always available. In low-resource settings, CMF trauma continues to be treated primarily by closed reduction, maxillomandibular fixation, and transosseous wiring, yielding acceptable results through affordable methods. With the advent of less expensive plating systems, internal fixation with plates and screws are gradually finding their place in the management of facial trauma in low-resource settings. A shortage of CMF surgeons in LMICs is a recognized problem and is being addressed by targeted curricula.

Summary: CMF trauma is a major cause of morbidity and mortality globally that remains poorly addressed. Currently, conventional methods of treating CMF trauma in low-resource settings have evolved to meet resource constraints. The education of CMF surgeons remains a key leverage point in improving CMF trauma care globally.
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http://dx.doi.org/10.1097/MOO.0000000000000545DOI Listing
August 2019

Medical Students and Global Surgery Efforts at Academic Medical Centers-Reply.

Authors:
David A Shaye

JAMA Otolaryngol Head Neck Surg 2019 07;145(7):691

Facial Plastic & Reconstructive Surgery, Department of Otolaryngology, Massachusetts Eye & Ear, Harvard Medical School, Boston, Massachusetts.

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http://dx.doi.org/10.1001/jamaoto.2019.0919DOI Listing
July 2019

Isolated Orbital Floor Fracture Management: A Survey and Comparison of American Oculofacial and Facial Plastic Surgeon Preferences.

Craniomaxillofac Trauma Reconstr 2019 Jun 9;12(2):112-121. Epub 2018 Apr 9.

Ophthalmic Plastic Surgery, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Massachusetts.

This article aimed to characterize, compare, and contrast the management of isolated orbital floor fractures among oculofacial and facial plastic surgeons in the United States. An anonymous 17-question multiple-choice web-based survey was distributed to all 590 members of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) and all 1,300 members of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) using each society's email database from November 2016 to January 2017. Two-hundred twenty-five oculofacial and 135 facial plastic surgeons completed the survey. The most important indications for surgery among both oculofacial and facial plastic surgeons were motility restriction, enophthalmos, and diplopia at 2 weeks. The most common preferred time to surgical intervention was 8 to 14 days; however, facial plastic surgeons were more likely to operate after 4 to 7 days (  < 0.001). The most common choices of orbital implant material were porous polyethylene and porous polyethylene plus titanium for both oculofacial and facial plastic surgeons, nylon for oculofacial surgeons, and titanium for facial plastic surgeons. The majority rarely/never used intraoperative computed tomography imaging or navigation. Facial plastic surgeons were more likely to perform postoperative imaging (  < 0.001). We report results of the first survey of isolated orbital floor fracture management among oculofacial and facial plastic surgeons in the United States. This survey characterizes practice patterns and areas of similarities/differences among oculofacial and facial plastic surgeons in the management of isolated orbital floor fractures, which may help define the current standard of care.
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http://dx.doi.org/10.1055/s-0038-1639350DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6506259PMC
June 2019

Opioid Prescription Patterns After Rhinoplasty-Reply.

JAMA Facial Plast Surg 2019 05;21(3):264

Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.

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http://dx.doi.org/10.1001/jamafacial.2018.1747DOI Listing
May 2019

United States-based global otolaryngology surgery: A call to more horizontal sustainable efforts.

Am J Otolaryngol 2019 May - Jun;40(3):404-408. Epub 2019 Feb 19.

Massachusetts Eye and Ear, Department of Otolaryngology, Boston, MA 02114, USA; Harvard Medical School, Boston, MA 02115, USA; Rwanda Central Teaching Hospital, Department of Otolaryngology, Kigali, Rwanda. Electronic address:

Objective: To examine global surgery involvement among general members of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) and characterize international otolaryngology surgical interventions.

Methods: Data on global surgery involvement were derived from responses provided by voluntary online survey respondent members of the AAO-HNS, obtained in October 2017. These data were compared against World Bank metrics of national health expenditure and surgical specialists per capita as benchmarks for need.

Results: There were 362 responses (response rate of 3.7%). A large proportion of respondents reported being involved in global surgery (61.3%). Locations where respondents worked included: South America (13.3%), Central America (17.7%), Caribbean (10.2%), Europe (4.1%), Africa (16.3%), Asia (16.6%), the Middle East (4.1%), and Oceania (3.6%). A greater proportion of respondents reported traveling to locations that have lower health care expenditure per capita and lower mean number of surgical specialists per 100,000 people, according to data from the World Bank. The primary purpose of trips was most commonly surgical mission (60.3%), followed by education (37.8%), and research (1.9%).

Conclusion: Members of the AAO-HNS are active in global surgery efforts around the world. Collaboration among members of the AAO-HNS may serve to improve long-term sustainability of these efforts.
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http://dx.doi.org/10.1016/j.amjoto.2019.02.012DOI Listing
October 2019

A Career in Global Surgery.

Authors:
David A Shaye

JAMA Otolaryngol Head Neck Surg 2019 Mar;145(3):206-207

Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston.

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http://dx.doi.org/10.1001/jamaoto.2018.3556DOI Listing
March 2019

Noma surgery.

Laryngoscope 2019 01 8;129(1):96-99. Epub 2018 Sep 8.

Doctors Without Borders, Amsterdam, Holland. Noma Project, Sokoto, Nigeria.

Objective: Noma is a devastating and destructive disease of the face for which there is a dearth of information regarding surgical options. Herein, we describe the facial deformities and patient characteristics in a patient population affected by noma and the surgical approaches used in treatment.

Methods: Retrospective case series of a Doctors Without Borders (Médecins Sans Frontières) intervention at Sokoto Children's Noma Hospital in northern Nigeria, the highest-volume noma hospital in the world.

Results: Twenty-two procedures were performed on 18 patients with noma, 44% of whom were children. The majority of patients (n = 10, 55.5%) were made aware of surgical care through a Doctors Without Borders outreach program. Patients' reasons for seeking care included functional (61.1%, n = 11), appearance (61.1%, n = 11), and social stigma (66.7%, n = 12). The majority (83.3%, n = 15) had lip involvement. Four patients (22.2%) underwent staged flap procedures including prelamination, flap delay, or pedicle division. The mean duration of surgical procedure was 87 minutes (range 5-306 minutes). The minor complication rate was 16%. There were no major complications or deaths.

Conclusion: Noma is a mutilating disease of the face that occurs in settings of extreme malnutrition. A total of 55.5% of noma patients were made aware of surgical care through outreach programs. The majority of noma patients seek care to improve function (61.1%) and appearance (61.1%), and to address social stigma (66.7%). A total of 83.3% of noma patients had lip involvement. Facial reconstructive surgeons must rely on principles of congenital, traumatic, and oncologic deformity repair while focusing on safe, reliable procedures for low-resource settings.

Level Of Evidence: 4 Laryngoscope, 129:96-99, 2019.
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http://dx.doi.org/10.1002/lary.27230DOI Listing
January 2019

Opioid Prescription Patterns After Rhinoplasty.

JAMA Facial Plast Surg 2019 Jan;21(1):76-77

Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.

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http://dx.doi.org/10.1001/jamafacial.2018.0999DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6439729PMC
January 2019

Banana fruit: An "appealing" alternative for practicing suture techniques in resource-limited settings.

Am J Otolaryngol 2018 Sep - Oct;39(5):582-584. Epub 2018 Jun 30.

University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda; Division of Facial Plastic and Reconstructive Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA. Electronic address:

Purpose: Suturing is an important core surgical competency that requires continued practice. The purpose of this study was to evaluate bananas as a medium for practicing suture techniques in resource-limited settings.

Materials And Methods: Using a crossover design, 20 University of Rwanda medical students practiced suturing on banana peels and commercial foam boards. Students were randomized into 2 groups: group A practiced on foam boards first and then bananas, and group B practiced on banana peels first and then foam boards. A post-workshop survey was then administered to students to gauge their attitude towards banana peels as a suturing practice material. Suture performance for each student was graded by three fellowship-trained facial plastic surgeons based on consistent spacing, knot location, appropriate knot, absence of air knots, and adequate bite size.

Results: Suture performance graded by facial plastic surgeons demonstrated that suturing outcomes with bananas were equal or superior to foam in 56.7% of instances. Twenty students participated in the workshop; 16 students responded to the survey (response rate = 80%). Students were comfortable practicing suturing with banana peels (Mdn = 4, IQR = 1) and strongly agreed that suturing banana peels was a useful activity (Mdn = 5, IQR = 1). Students thought banana peels and foam were comparable learning platforms (Mdn = 3.5, IQR = 1) and felt their suturing abilities improved with practice on banana peels (Mdn = 4, IQR = 1.3).

Conclusions: Banana peels are a low cost, equally viable alternative to synthetic suture media.
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http://dx.doi.org/10.1016/j.amjoto.2018.06.021DOI Listing
January 2019