Publications by authors named "Jason E Cohn"

72 Publications

Special Considerations in Face Transplantation: A Systematic Review.

J Craniofac Surg 2022 Jun 27. Epub 2022 Jun 27.

Division of Neuroplastic and Reconstructive Surgery, Departments of Plastic Surgery and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD.

Abstract: Vascularized composite allotransplantation of the face is an exceedingly complex procedure, requiring extensive planning and surgical precision in order to successfully manage patients with facial disfigurements. This review aims to present an overview of the salient anatomic considerations in facial transplantation, as well as give attention to unique patient populations and special considerations.A literature review was performed in search of articles pertaining to considerations in facial transplantation using the databases PubMed, Web of Science, and Cochrane. Articles selected for further review included full-text articles with an emphasis on specific anatomic defects and how they were addressed in the transplant process, as well as management of special patient populations undergoing facial transplantation. In total, 19 articles were deemed appropriate for inclusion.The use of computer-assisted technologies for the planning portion of the procedure, as well as intraoperative efficiency, has yielded favorable results and can be considered as part of the operative plan. The ultimate outcome is dependent upon the synchronization of subunits of the allograft and the desired functional outcomes, including osseous, ocular, oral, and otologic considerations. Management of specific pathology and subgroups of patients are critical aspects. Although pediatric face transplantation has not yet been performed, it is a likely a future step in the evolution of this procedure.When performing a face transplantation, many components must be considered pre-, intra-, and post-operatively. This systematic review presents specific anatomic considerations, as well as information about special patient populations within this crosssection of multidisciplinary microsurgery, psychiatry, and transplant immunology.
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http://dx.doi.org/10.1097/SCS.0000000000008484DOI Listing
June 2022

Slippery Slopes: Skiing-Related Facial Trauma in Adults.

Craniomaxillofac Trauma Reconstr 2022 Jun 1;15(2):122-127. Epub 2021 Jun 1.

Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic Reconstructive Surgery, LSU Health Sciences Center, Shreveport, LA, USA.

Study Design: Retrospective, observational, cross-sectional study.

Objective: To determine the incidence of skiing-related facial trauma and to identify their patterns in terms of potential risk factors, mechanism of injury, anatomical location, and degree of severity.

Methods: Data was collected using the National Electronic Injury Surveillance System and included snow skiing-related incidents during the years 2009 to 2018. Specifically, injuries limited to the facial region including the head, face, eye(s), mouth, neck or ear(s) were reported. Patients with fractures were further classified by the study variables. Descriptive statistics were used to classify continuous variables while chi-square analysis was used to compare categorical variables.

Results: A total of 514 (n = 514) patients met the inclusion criteria within the study period. The majority of injuries were due to concussions (59%), followed by lacerations (18%), fractures (11%), contusions (11%) and dental injuries (1%). Of the fractures seen, the majority were nasal (30%) and cervical spine (30%), followed by midface (27%), mandible (9%) and skull (4%). In our population, head injuries were more common in females (80%) than in males (60%), whereas, mouth injuries were more common in males (8%) than females (1%) [χ = 30.2, p < 0.001].

Conclusions: Skiing-related craniofacial trauma remains a significant mechanism of injury. Our data illustrates a need to correlate these injuries to the use of personal protective equipment. Furthermore, this data calls for the strict implementation of such equipment and the development of safety protocols to further prevent deleterious injury.
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http://dx.doi.org/10.1177/19433875211020933DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9133525PMC
June 2022

Open Rhinoplasty: A Personal Evolution of Technique.

Plast Reconstr Surg 2022 Feb;149(2):351e-352e

Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic Reconstructive Surgery, Ochsner Louisiana State University of Health, Shreveport, La.

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http://dx.doi.org/10.1097/PRS.0000000000008771DOI Listing
February 2022

Destructive Frontonasal Mucocele Following Facial Trauma and Surgery.

J Craniofac Surg 2022 May 13;33(3):e267-e269. Epub 2021 Aug 13.

Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic Reconstructive Surgery, Ochsner LSU Health, Shreveport, LA.

Abstract: Mucoceles are fluid filled cysts with numerous etiologies that can erode bone and if left untreated, can lead to infraorbital and intracranial complications. With limited cases published in the medical literature, our patient with a frontonasal mucocele expanding from the frontal sinus to the nasal dorsum with erosion of the nasal bones and upper lateral cartilages, provides an opportunity for evidence-based diagnosis and treatment. We present a 24-year-old female with a nasal mass destroying numerous nasal structures. Three surgical approaches were considered: open rhinoplasty, bicoronal approach, and Lynch excision; the latter executed with subsequent total nasal reconstruction. Bone, septal cartilage, and temporalis fascia were utilized to provide structural support and a posterior nasal septal flap was incorporated to maintain a blood supply. integrity of nasal structure and cosmesis as well as recurrence of disease were monitored during postoperative visits.
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http://dx.doi.org/10.1097/SCS.0000000000008090DOI Listing
May 2022

Hereditary angioedema.

Int J Emerg Med 2021 Jul 29;14(1):43. Epub 2021 Jul 29.

Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic Reconstructive Surgery, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA, 71103, USA.

A 14-year-old African American female presented to the emergency department with spontaneous, sudden-onset lip swelling for 1 h. On examination, there was significant water-bag edema of the upper lip extending to the philtrum and premaxilla. Nasopharyngeal laryngoscopy revealed a patent airway without edema. She was initiated on intravenous dexamethasone, famotidine, and diphenhydramine, after which her edema improved but did not resolve. She was subsequently transferred to a local pediatric hospital and upon further testing she was found to have a C1 esterase inhibitor de novo gene mutation. Angioedema causes localized, non-pitting edema of the dermis, subcutaneous and submucosal tissue, and often manifests in the lips, face, mouth, and throat. Signs of laryngeal involvement include change in voice, stridor, dysphagia, and dyspnea. When laryngeal edema is present, it may necessitate definitive airway management and patients should be monitored in the intensive care unit.
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http://dx.doi.org/10.1186/s12245-021-00364-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8323326PMC
July 2021

Otitis Media and Hearing Loss in Patients With Nonsyndromic Craniosynostosis: A Multicenter Study.

Cleft Palate Craniofac J 2022 05 18;59(5):652-658. Epub 2021 May 18.

Department of Otolaryngology and Communication Sciences, 12302SUNY Upstate Medical University, Syracuse, NY, USA.

Objectives: The objectives of this study were to: (1) determine the prevalence of otitis media with effusion in patients with nonsyndromic craniosynostosis; (2) determine the prevalence of hearing loss in patients with nonsyndromic craniosynostosis; and (3) identify potential patterns and outcomes in patients with nonsyndromic craniosynostosis.

Methods: A retrospective chart review was conducted at 2 academic institutions, St Christopher's Hospital for Children and SUNY Upstate Medical University, from January 2015 through August 2018, to identify patients having nonsyndromic craniosynostosis with a concurrent diagnosis of otitis media and/or hearing loss. The demographic data and categorical variables were analyzed using descriptive statistics and chi-square testing, respectively.

Results: In the entire cohort of patients (N = 113, age range 0-123 months), 36% had otitis media with effusion on either history, physical examination, tympanometry, and/or imaging. Half (50%) of patients with coronal synostosis had otitis media with effusion compared to sagittal (40.7%), metopic (26.3%), multiple (25%), and lambdoid (0%). However, these differences were not statistically significant ( = .190). Most patients had normal hearing (91%), while a minority had either conductive (7%) or sensorineural (2%) hearing loss.

Conclusion: The presence of otitis media in our cohort of patients with nonsyndromic craniosynostosis appears to be at the upper limit of normal when compared to historical rates in normocephalic children. Synostosis subtype did not appear to predict the presence of otitis media. Only 9% of patients with nonsyndromic craniosynostosis were found to have a hearing loss.
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http://dx.doi.org/10.1177/10556656211017795DOI Listing
May 2022

Evaluation of stapes mobilization in the 21st century for conductive hearing loss in the otosclerotic ear.

Am J Otolaryngol 2021 Sep-Oct;42(5):103059. Epub 2021 Apr 16.

Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, 219 N. Broad Street, 10th Floor, Philadelphia, PA 19107, United States of America; Lankenau Institute for Medical Research, Philadelphia, PA 19107, United States of America. Electronic address:

Purpose: Compare outcomes of stapes mobilization and stapedectomy performed by a single surgeon for the otosclerosis.

Materials And Methods: A retrospective chart review of adult patients who underwent stapes mobilization or stapedectomy for otosclerosis was performed. Operative notes reviewed; patients included if diagnosed with otosclerosis without another otologic disease that could contribute to their hearing loss and all required data were available. Pre-and post-operative audiograms at 1, 6, and 12-months were evaluated to compare the air-bone gaps between the mobilization and stapedectomy procedures. The rates of sensorineural hearing loss also were compared. Student t-tests and multiple regression models were used to ascertain the association between improvement in post-operative air-bone gaps, sensorineural hearing loss, and the procedure undertaken.

Results: Sixty-seven (n = 67) patients with 108 procedures were included for analysis. No substantial difference between the surgical subgroups was found when comparing stapes mobilization to stapedectomy, and there was no evidence to suggest that either surgical procedure was superior to the other based on the data obtained and analyzed. Improvements in air-bone gap averaged 15.79 dB for stapes mobilization and 19.23 dB for stapedectomy. The results of the study showed no evidence of post-operative sensorineural hearing loss or change in air-bone gaps when comparing virgin to "revision" stapedectomy largely in patients who had failed previous mobilization.

Conclusion: Stapes mobilization provides a conservative approach to otosclerosis patients suffering from conductive hearing loss. Stapedectomy can be used to correct failed mobilization.
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http://dx.doi.org/10.1016/j.amjoto.2021.103059DOI Listing
December 2021

Erratum: Surgical Techniques to Improve the Soft Tissue Triangle in Rhinoplasty: A Systematic Review.

Facial Plast Surg 2021 Jan 11. Epub 2021 Jan 11.

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

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http://dx.doi.org/10.1055/s-0040-1718516DOI Listing
January 2021

Rugby-related adult maxillofacial trauma injuries: a NEISS database study.

Oral Maxillofac Surg 2021 Sep 7;25(3):389-393. Epub 2021 Jan 7.

Department of Otolaryngology-Head and Neck Surgery, University of Arizona College of Medicine, 1501 N. Campbell Avenue, Tucson, AZ, 85724, USA.

Purpose: The primary objective of this study is to delineate the data on maxillofacial trauma in rugby utilizing the National Electronic Injury Surveillance System (NEISS) database. Specifically, we want to establish the prevalence of facial rugby injuries in terms of age, mechanism of injury, and degree of injury in order to develop ways to limit facial trauma in the future.

Methods: The NEISS database was accessed in February 2020 in order to identify adult patients (> 19 years of age) presenting to the emergence department (ED) for rugby-related head and facial injuries from the previous 10 years (2009-2018). Descriptive statistics were organized and presented. Chi-squared testing (χ) was performed to compare categorical variables, and ANOVA was performed to compare continuous variables.

Results: A total of 507 patients (national estimate = 18,952) from 2009 to 2018 were identified as appropriate for study inclusion. The most common injuries were those to the facial region including the eyelid, eye area, and nose (59.4%). The most frequently encountered facial fracture while playing rugby was the nasal bone (58.6%). Overall, 98.4% of patients who presented to the ED with rugby injuries were treated and released, 1.2% were admitted or observed, and 0.4% left against medical advice.

Conclusions: When evaluating a patient with a rugby-related injury, one should expect injuries to the eyelid, eye area, or nose. The most common fracture pattern will most likely be nasal bone. Despite these injuries, the vast majority of patients will be treated and released.
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http://dx.doi.org/10.1007/s10006-020-00925-9DOI Listing
September 2021

Adult Maxillofacial Trauma Patterns in American Football.

J Craniofac Surg 2021 Jun;32(4):1567-1570

Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic Reconstructive Surgery, Ochsner LSU Health, 1501 Kings Highway, Shreveport, LA.

Introduction: The authors aimed to identify and categorize adult maxillofacial trauma patterns in the setting of American football.

Methods: The National Electronic Injury Surveillance System was accessed to identify adult patients presenting with football-related head and facial injuries from 2009 to 2018. Data surrounding each event were collected including age, injury type, injury location, and disposition of the patient. Chi-squared testing was performed to compare categorical variables, with a Bonferroni correction applied.

Results: During the study period, 1784 total patients (national estimate = 65,052) were identified. The average age for this cohort was 27.26 (SD ± 8.49), with young adults (86.1%) and males (87.9%) sustaining the majority of injuries. Lacerations were the most common injury type (43.1%). Maxillofacial fractures comprised 15.8% of the sample, with nasal bone (52.8%) being the most common subtype. Female patients were significantly more likely to present with head injuries than men (46.8% versus 29.0%, P < 0.001). Young and middle-aged adults combined were more likely to be discharged from the emergency department, whereas the elderly were significantly less likely (P = 0.002). Patients with fractures were significantly more likely to be admitted to the hospital compared to all other types of injuries (P < 0.001).

Conclusions: An understanding of maxillofacial injuries while participating in American football is important in developing safety initiatives. To address these, it is crucial that providers understand the patterns of craniofacial injuries as they relate to American football trauma.
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http://dx.doi.org/10.1097/SCS.0000000000007399DOI Listing
June 2021

Leech Therapy for Complex Facial Lacerations.

J Craniofac Surg 2021 Jun;32(4):e335-e337

Department of Otolaryngology-Head and Neck Surgery, Einstein Medical Center, Philadelphia, PA.

Abstract: Facial trauma can pose challenging reconstructive obstacles in both maintaining tissue viability and restoring aesthetic appearance. Medicinal leech therapy can help to promote vascular decompression in the setting of venous congestion. A retrospective chart review was conducted to identify patients who underwent medicinal leech therapy following venous stasis secondary to repair of a complex facial laceration. Three patients were identified; 2 suffered auricular avulsion, while 1 suffered a lip avulsion. All patients suffered from venous congestion and underwent medicinal leech therapy for 48 to 72 hours with reduction of edema and stasis. Decompression was successfully achieved with no further sequelae on last follow-up. Medicinal leech therapy is an adequate treatment for venous congestion following traumatic soft-tissue repair of the face. The authors advocate for the utilization of medicinal leeches to combat venous congestion after repair, particularly when arterial inflow remains intact.
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http://dx.doi.org/10.1097/SCS.0000000000007111DOI Listing
June 2021

Perichondritis: inspect the lobule.

Int J Emerg Med 2020 Oct 28;13(1):51. Epub 2020 Oct 28.

Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic Reconstructive Surgery, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA, 71103, USA.

Case Presentation: This is a brief report of a 57-year-old Caucasian female presented with a 4-day history of worsening left ear pain. Her symptoms began with left otalgia and otorrhea which progressed to helical erythema, prompting a visit to the emergency department. She was noted to have erythema of the left auricle and swelling of the left auditory meatus. Our otolaryngology service observed erythema of the auricle with sparing of the lobule.

Diagnosis: The diagnosis to be otitis externa with perichondritis was established, and we recommended otic ciprofloxacin-hydrocortisone, IV vancomycin, and ciprofloxacin. The patient had marked improvement and was discharged on an oral and otic fluoroquinolone. In this case, the diagnosis of perichondritis was made by a classic physical examination finding: erythema and edema with sparing of the fatty lobule. This key finding helps to distinguish perichondritis from otitis externa.
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http://dx.doi.org/10.1186/s12245-020-00310-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7594288PMC
October 2020

Golf-Related Craniofacial Injuries in Adults: A NEISS Database Study.

J Craniofac Surg 2021 Jun;32(4):1561-1564

Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic Reconstructive Surgery, Ochsner LSU Health, 1501 Kings Highway, Shreveport, LA.

Introduction: Despite its popularity, there have been no reports outlining adult craniofacial trauma in the setting of golf injuries. Our main objective was to identify and describe trends in head and neck injuries incurred while participating in golf including injury type, anatomic location, and patient disposition.

Methods: A retrospective cohort analysis of the National Electronic Injury Surveillance System (NEISS) was conducted from 2009-2018. Population characteristics of golf-related injuries were recorded, including, age, sex, and race distributions. Distribution of injury anatomic location, injury type, distribution of fracture location, patient disposition was further analyzed. A one way ANOVA was utilized to obtain the mean ages for all injuries and compare them for any statistical difference. To identify statistical significance, a Fisher exact test with a Monte Carlo simulation was performed.

Results: A total of 509 golf-related injuries (national estimate 24,425 cases) were recorded over the study period. Lacerations were the most common injury overall (54.2%), while contusions and abrasions were the next most common injuries (27.3%). The most common fracture subtype observed was midface (40.43%), followed by nasal bone (27.66%), mandible (12.77%), skull (12.77%), and cervical spine (6.38%). The highest proportion of patients admitted for further treatment were individuals >70 years of age. Fractures had the highest rate of admission (29.8%).

Conclusions: A better understanding of golf injuries can allow for rapid detection and appropriate treatment when encountered. This knowledge can also help to develop safety precautions by potentially reforming rules and regulations as well as protective equipment.
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http://dx.doi.org/10.1097/SCS.0000000000007136DOI Listing
June 2021

Sublabial Approach to Tip Rhinoplasty: A Cadaver Model.

J Invest Surg 2022 Jan 22;35(1):61-69. Epub 2020 Sep 22.

Eastern Cosmetic Surgery Institute, Bala Cynwyd, Pennsylvania, USA.

Objectives: The main objective of this study was to investigate the utility of the sublabial approach in gaining proper exposure for tip rhinoplasty maneuvers in a cadaver model. Additional objectives included identifying types of grafts that can be placed sublabially and whether these methods can be translated successfully to human subjects.

Methods: Ten (N = 10) fresh-preserved cadavers were dissected at our academic institution from August 18, 2019 through February 5, 2020. Photographs of the cadavers were taken with permission from the anatomy laboratory manager using an iPhone 10 (Apple Inc., Cupertino, CA). Standard rhinoplasty views were taken of all ten cadavers.

Results: Grafts were harvested and designed from septal (80%), auricular (50%) and rib cartilage (40%). The division of depressor septi muscle was accomplished in all ten (100%) cadavers to address tip ptosis. Placement of the columellar strut and shield grafts resulted primarily in the improvement of nasal projection as well as rotation in all (100%) cadavers. Premaxillary augmentation was not always indicated but helped to improve an acute, retrodisplaced nasolabial angle in three (30%) cadavers. Lateral osteotomies via this approach addressed the nasal bony pyramid in all ten (100%) cadavers. The swinging door technique enabled correction of the caudal septum in six (60%) cadavers.

Conclusions: Several rhinoplasty techniques can be successfully performed on cadavers via the sublabial approach and we hope this work can be translated to human subjects.
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http://dx.doi.org/10.1080/08941939.2020.1824042DOI Listing
January 2022

Volleyball-related Adult Maxillofacial Trauma Injuries: A NEISS Database Study.

J Craniofac Surg 2021 Jun;32(4):1564-1567

Department of Otolaryngology-Head and Neck Surgery, University of Arizona College of Medicine, Tucson, AZ.

Introduction: Craniofacial trauma among athletes of various sports has been well detailed and described. Despite this research, there is a dearth of literature describing the nature of facial trauma secondary to volleyball, despite its global popularity.

Methods: A cross-sectional analysis of volleyball-related facial trauma was conducted using the National Electronic Injury Surveillance System (NEISS) database from 2009 to 2018. Patient demographics (age, sex, and race), medical injury information (injury type and location), and disposition (observed and discharged, admitted, deceased) were collected and analyzed. χ2 testing was performed to compare categorical variables.

Results: A total of 235 volleyball-related facial traumas were recorded with an estimated 10,424 visits occurring nationally. The majority of injuries were among young adults aged 20 to 29 years (52.3%) and was evenly distributed for men and women. Lacerations were the most frequent injury type (37.9%), whereas the face was the most common site of injury (41.7%). The majority of fractures involved the nose (71.4%) and among individuals aged 20 through 49 (90.5%). Males had significantly more lacerations than females (75.3% vs 24.7%), whereas females had significantly more contusions/abrasions (64.5% vs 35.5%) and concussions (72.9% vs 27.1%).

Conclusions: Volleyball-related craniofacial injuries can vary depending on patient demographics. This information can help with the development of safety and preventative measures for individuals participating in the sport.
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http://dx.doi.org/10.1097/SCS.0000000000006984DOI Listing
June 2021

An Update on Maxillary Fractures: A Heterogenous Group.

J Craniofac Surg 2020 Oct;31(7):1920-1924

Department of Otolaryngology-Head and Neck Surgery, Einstein Medical Center, Philadelphia, PA.

Background: The purpose of this study was to review the different types of maxillary fractures and highlight their diagnostic and therapeutic differences.

Methods: A retrospective chart review of patients who sustained maxillary fractures was conducted through the Einstein Healthcare Network during the years 2016-2017. Descriptive statistics and chi-square analysis were used to categorize continuous and categorical variables, respectively.

Results: The cohort of patients (n = 141) were predominately African American (62%) and male (75%) with a mean age 45.3 years. The most common maxillary fracture was maxillary sinus (29%), followed by zygomaticomaxillary complex (ZMC) (26%), frontal process (20%), dentoalveolar (16%), and LeFort (9%). Dentoalveolar fractures were mostly evaluated by the oral maxillofacial surgery service (74%), while ZMC and LeFort fractures were more commonly referred to an otolaryngologist (56% and 67%, respectively). Patients with dentoalveolar fractures were more likely to undergo wire splinting (61%). All patients with frontal process and maxillary sinus fractures were managed non-operatively. Most patients with ZMC fractures were managed non-operatively (78%) while the remainder underwent open reduction internal fixation (ORIF) (22%). Patients with LeFort fractures more commonly underwent maxillomandibular fixation (MMF)/ORIF (83%). Dentoalveolar fractures were the most likely to be operated on the same day (93%) while ZMC and LeFort fractures were repaired within 1 week (88% and 100%, respectively).

Conclusion: Maxillary trauma is very heterogenous in comparison to other maxillofacial trauma patterns. Each fracture type is treated uniquely and can involve one or more provider teams depending on the extent and severity of the injury, as well as hospital resources.
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http://dx.doi.org/10.1097/SCS.0000000000006675DOI Listing
October 2020

Reply to: Comment on "Investigation of topical intranasal cocaine for sinonasal procedures: a randomized, phase III clinical trial".

Int Forum Allergy Rhinol 2021 01 18;11(1):85-86. Epub 2020 Aug 18.

Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic Reconstructive Surgery, Ochsner LSU Health, Shreveport, LA.

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http://dx.doi.org/10.1002/alr.22675DOI Listing
January 2021

The Impact of Dermal Fillers on Perceived Personality Traits and Attractiveness.

Aesthetic Plast Surg 2021 02 21;45(1):273-280. Epub 2020 Jul 21.

Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA.

Background: Dermal fillers are increasingly popular for facial rejuvenation and enhancement, including effacement of nasolabial folds (NLFs) and marionette lines and lip augmentation. This study aimed to evaluate casual observer perception of physical and interpersonal traits of subjects who receive filler treatment.

Methods: An anonymous survey of 8 before/after treatment photographical sets was administered in Likert scale format (1-7) using online crowdsourcing. Three sets of photographs were before/after NLF/ marionette line treatment, three of lip augmentation, and two internal controls. Respondents were surveyed on personal demographics, as well as perceptions of subject photographs across nine domains (facial symmetry, confidence, likeability, youthfulness, trustworthiness, attractiveness, intelligence, approachability, happiness).

Results: In total, 260 respondents completed the survey. The majority were male (63.1%), Caucasian (58.1%), 18-34 years old (58.1%), and college graduates (66.2%). Respondents rated photographs with line filler treatment and lip filler treatment as significantly improved compared to the pre-treatment photographs across all nine trait domains [p < 0.001, for all]. No differences were found between the control photosets [p > 0.05, for all]. Middle-aged respondents (35-55 years) were more likely to perceive treated filler photographs as more youthful than younger respondents (18-34 years) [p < 0.006] Additionally, respondents with lower educational attainment (high-school graduate or less) were more likely to perceive treated patients as less intelligent compared to higher-educated respondents (college/postgraduates) [p < 0.05, for both].

Conclusion: The use of dermal fillers for treatment of NLF/marionette lines and lip augmentation have significant associations with the perception of improved attractiveness and several personality traits. Additionally, casual observer demographic subgroups may influence perceptions.

Level Of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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http://dx.doi.org/10.1007/s00266-020-01888-8DOI Listing
February 2021

Comparison of Maxillofacial Trauma Patterns in the Urban Versus Suburban Environment: A Pilot Study.

Craniomaxillofac Trauma Reconstr 2020 Jun 25;13(2):115-121. Epub 2020 Mar 25.

Department of Otolaryngology-Head and Neck Surgery, Einstein Medical Center, Philadelphia, PA, USA.

Introduction: Assault appears to be the most frequent cause of facial fractures in certain urban trauma centers, possibly due to the ease of acquiring weapons and increasingly aggressive behavior. The objectives of this study were to identify specific demographic, socioeconomic, maxillofacial fracture, and assault patterns in urban versus suburban communities.

Methods: A retrospective chart review of patients who sustained maxillofacial fractures from August 2014 through August 2016 at one urban campus, Einstein Medical Center, Philadelphia, and two suburban campuses, Einstein Medical Center Montgomery and Elkins Park. The χ testing was used to compare the categorical variables between the 2 groups.

Results: A total of 259 maxillofacial trauma patients were identified, with 204 (79%) in the urban and 55 (21%) in the suburban environment. Patients in the urban population were more likely to be African American (70% vs 33%) and Hispanic (15% vs 6%) but less likely to be Caucasian (12% vs 55%, < .0001). Urban patients were more likely to be single (70% vs 47%, < .01), unemployed (64% vs 44%, < .001), and receive Medicaid coverage (58% vs 26%, < .001). Urban patients were more likely to be victims of assault (63% vs 44%), whereas suburban patients were more likely to sustain accidental injuries (16% vs 2%, < .0001). Urban victims were more likely to be assaulted with an object (30% vs 12%) or gun (7% vs 0%, = .05).

Conclusion: Maxillofacial trauma patterns were shown to be significantly different in the urban versus suburban environment.
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http://dx.doi.org/10.1177/1943387520910338DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7311833PMC
June 2020

Management of Isolated Zygomatic Arch Fractures and a Review of External Fixation Techniques.

Craniomaxillofac Trauma Reconstr 2020 Mar 17;13(1):38-44. Epub 2020 Mar 17.

Department of Otolaryngology-Head and Neck Surgery, Einstein Medical Center, Philadelphia, PA, USA.

Introduction: Fractures of the zygomatic bone can present with complicated aesthetic and neurological pathology. Specifically, management of isolated zygomatic fracture has been sparsely discussed in the literature, and most studies are based upon older techniques. Here, we compare the results of 2 critical operative techniques as well as review the available literature in the setting of isolated zygomatic fractures.

Methods: A retrospective chart review was performed at our institution from 2010 to 2018 examining for patients who had sustained an isolated zygomatic fracture confirmed by computed tomography scan. Patients were excluded if they sustained additional maxillofacial fractures. Demographical information, symptoms on presentation, fracture management modality, and postoperative course were all collected and examined.

Results: A total of 218 patients were identified for inclusion. The average age of this cohort was 45.5 ± 18 years, with 77.5% being male. Assault (55%) was most the frequent cause of injury with accidents being the least common (17.9%). Most patients (78.8%) underwent nonoperative management. Patients who underwent operation more often presented with zygomatic deformity (97.7% vs 18.4%), paresthesia (29.5% vs 2.9%), and trismus (29.5% vs 6.9%) when compared to their nonoperatively managed counterparts. In all, 44 operatively managed patients underwent open reduction with or without eternal fixation (Gillies Approach vs Keen Approach). There were no significant differences in the presence of zygomatic deformity, paresthesia, and trismus between the 2 operative techniques.

Conclusions: Isolated zygomatic arch fractures can present with discerning symptoms. Unfortunately, the literature on appropriate management is not well described. We find external fixation to provide reestablishment of both form and function with minimal required exposure, although the outcomes may be similar without the use of external fixation.
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http://dx.doi.org/10.1177/1943387520905164DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7311848PMC
March 2020

Dangers beyond drowning: craniomaxillofacial trauma in adult water activities.

Oral Maxillofac Surg 2020 Dec 29;24(4):441-446. Epub 2020 Jun 29.

Otolaryngology and Facial Plastic Surgery Associates, 923 Pennsylvania Ave, Fort Worth, TX, 76104, USA.

Purpose: Water recreation is one of the most popular activities for both fitness and leisure. The dangers of water activities have mostly been examined in the context of drowning and general bodily injuries. Despite the existing research, little is known about adult maxillofacial injuries in these settings.

Methods: We accessed the National Electronic Injury Surveillance System in order to identify adult patients presenting to emergency departments with traumatic maxillofacial injuries secondary to a water-based sport or activity over the most recent 10-year period (2009-2018). Data collected included demographical information, anatomical location, mechanism of injury, and visit circumstances, as well as visit disposition.

Results: A total of 1350 total patients were identified as appropriate for study inclusion. Young, Caucasian male adults were the most common age group to present with maxillofacial injuries secondary to water sport activities. Surfing and water skiing were associated with lacerations, while diving board incidents posed a higher fracture risk. Patients participating in all water activities were more likely to be treated and released rather than admitted.

Conclusion: There appears to be a distinct pattern profile for individuals who sustain maxillofacial trauma while participating in water sports: young, Caucasian males in particular. Additionally, specific activities may be associated with varying injury types. The results of this study may increase interest in legislature and patient counseling when seeking such activities.
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http://dx.doi.org/10.1007/s10006-020-00869-0DOI Listing
December 2020

"I'm Going to Scope You"-The Balance between Examiner Visualization and Patient Comfort.

J Invest Surg 2021 Nov 22;34(11):1270-1271. Epub 2020 Jun 22.

Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic Reconstructive Surgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA.

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http://dx.doi.org/10.1080/08941939.2020.1782544DOI Listing
November 2021

Nasal Bone Fractures: Differences Amongst Sub-Specialty Consultants.

Ann Otol Rhinol Laryngol 2020 Nov 6;129(11):1120-1128. Epub 2020 Jun 6.

Department of Otolaryngology-Head and Neck Surgery, Einstein Medical Center, Philadelphia, PA, USA.

Background: Nasal fractures constitute the largest proportion of facial trauma each year, however, there is no consensus management. In this study, we investingated the role of the consultant and the functional and aesthetic outcomes of procedures performed to address nasal bone fractures.

Methods: A retrospective chart review of patients who sustained nasal bone fractures was conducted from 8/1/14 through 1/23/18. Categorical variables were analyzed using chi-squared testing and Fisher's exact test, where appropriate, while continuous variables were compared using Mann-Whitney U testing.

Results: During the study period, 136 patients met inclusion criteria for full analysis. The mean age of this cohort was 47.6 ± 20.2 years with the majority identifying as African-American (53.7%) and male (67.2%). Otolaryngologists were significantly more likely to assess pre-operative nasal obstruction (100%) compared to plastic surgeons (24.1%) ( < .001). Otolaryngology elected operative management (53.3%) at a significantly higher rate than plastic surgery (24.1%) ( = .005). Additionally, otolaryngology was significantly more likely to manage patients in an outpatient setting (91.2%), whereas plastic surgery more commonly performed inpatient management (57.1%) ( = .006). Plastic surgery averaged a significantly shorter amount of time from presentation to operative management (7.3 ± 10.7 days) compared to otolaryngology (20 ± 27.7) ( = .019). Consulting service was not associated with a need for revision surgery.

Conclusions: Consultants across subspecialties differ in the management of nasal bone trauma. A more standardized approach is warranted by all individuals involved in the care of maxillofacial trauma patients.
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http://dx.doi.org/10.1177/0003489420931562DOI Listing
November 2020

"Not Above, Not Below: Right in the Middle!"-Novel Filler Technique for Temporal Augmentation and Rejuvenation.

Facial Plast Surg 2020 Oct 22;36(5):623-627. Epub 2020 May 22.

Division of Facial Plastic Surgery, Department of Otorhinolaryngology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.

The temporal region is challenging to treat due to its thin skin, which has the propensity toward showing irregularities. The literature on temporal hollowing augmentation suggests placing the filler either into the subcutaneous space or within the temporalis muscle. However, these techniques have been based upon opinion rather than supporting anatomical and clinical data. We introduce a novel injection technique to avoid complications and achieve lasting results. This novel technique was confirmed with a cadaver model, in vivo model, and application to a human subject. The anatomical layers of the temporal region were highlighted: the skin, subcutaneous tissue, temporoparietal fascia (superficial temporal fascia), deep temporal fascia, superficial temporal fat pad, and temporalis muscle. Particular emphasis was placed on identifying the frontal branch of the superficial temporal artery to avoid vascular complications. We believe the potential space between the temporoparietal fascia and the deep temporalis fascia is the safest, most efficacious plane to inject the temporal region with a 27-gauge cannula. Our future goal is to recruit and present a larger series of patients receiving this injection.
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http://dx.doi.org/10.1055/s-0040-1709710DOI Listing
October 2020

Tennis-related adult maxillofacial trauma injuries.

Phys Sportsmed 2021 02 18;49(1):64-67. Epub 2020 May 18.

Department of Otolaryngology-Head and Neck Surgery, University of Arizona College of Medicine , Tucson, AZ, USA.

Tennis participation continues to increase amongst adults across the United States. The purpose of this study was to analyze trends in adult tennis-related facial injury epidemiology, demographics, diagnoses, and locations of injury. : The National Electronic Injury Surveillance System was evaluated for tennis-related facial injuries in adults from 2009 through 2018. Number of injuries were extrapolated, and data were analyzed for age, sex, specific injury diagnoses, locations, and discharge disposition. Descriptive statistics were used to present and describe variables of interest. Chi-squared testing (χ2) was performed to compare categorical variables. : During the study period, 342 tennis-related facial trauma ED visits were analyzed. Lacerations were the most common injury (45%), followed by contusions or abrasions (33.3%), concussions (11.7%), and fractures (8.5%). The most common sites of injury were the face (47.4%) and head (27.2%) regions. Males accounted for 62.0% of injuries, while females accounted for the remaining 38.0%. Patients between 34-65 years-old accounted for 47.7% of all injuries, and athletes over 65 years-old had the highest rate of fractures (10.1%). : Facial trauma incurred secondary to tennis may follow patient-specific patterns. The incidence of tennis-related facial trauma is smaller compared to other sports, but the severity of such injuries remain a danger. Facial protection and enforcement in tennis is virtually absent, and these findings strengthen the need to educate athletes, families, and physicians on injury awareness and prevention.
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http://dx.doi.org/10.1080/00913847.2020.1768451DOI Listing
February 2021

Osteoradionecrosis of the Maxilla: Conservative Management and Reconstructive Considerations.

Semin Plast Surg 2020 May 6;34(2):106-113. Epub 2020 May 6.

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

The implementation of radiotherapy in the multimodal treatment of advanced head and neck cancer has greatly improved survival rates. In some patients, however, this benefit comes at the potential expense of the tissue surrounding the primary site of malignancy. Osteoradionecrosis (ORN) of the facial bones, in particular the maxilla, is a debilitating complication of radiation therapy. Exposure to ionizing radiation results in devitalization of underlying bone with necrosis of adjacent soft tissue. Controversy surrounding appropriate early intervention in ORN persists and no consensus for clinical treatment has been established. In the present article, we review the pathophysiology of maxillary ORN and discuss the role of both conservative medical therapy and reconstruction.
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http://dx.doi.org/10.1055/s-0040-1709144DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202910PMC
May 2020

Premaxillary Deficiency: Techniques in Augmentation and Reconstruction.

Semin Plast Surg 2020 May 6;34(2):92-98. Epub 2020 May 6.

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

Progressive premaxillary retrusion is a common sequela of the facial aging process. In most cases, this manifests with central maxillary recession. Central maxillary insufficiency is also commonly encountered within certain ethnic communities, or in cleft lip nasal deformity, and may represent a challenge for the plastic and reconstructive surgeon attempting correction in the setting of facial contouring, rhinoplasty, or reconstruction following oncologic resection or trauma. Aesthetically, premaxillary retrusion may be coincident with an acute nasolabial angle and ptotic nasal tip. Minor deformities may be addressed with use of either alloplastic implants, autogenous tissue, lipotransfer, or injectable filler. Larger composite defects may require reconstruction with implementation of free tissue transfer. Herein, we describe techniques that aim to augment, or reconstruct, the premaxillary region in the context of nasal deformity, osseous resorption, or composite maxillofacial defects.
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http://dx.doi.org/10.1055/s-0040-1709175DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202913PMC
May 2020

Investigation of topical intranasal cocaine for sinonasal procedures: a randomized, phase III clinical trial.

Int Forum Allergy Rhinol 2020 08 8;10(8):981-990. Epub 2020 May 8.

Department of Otolaryngology-Head and Neck Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA.

Background: The objective of this trial was to demonstrate the clinical efficacy and safety of topical cocaine as part of the effort to gain regulatory approval from the United States Food and Drug Administration.

Methods: This phase III, randomized, prospective, double-blind, multicenter, single-dose, placebo- and dose-controlled, parallel-group study aimed to evaluate the safety and efficacy of topical intranasal cocaine (RX0041-002). A total of 925 subjects were screened and a total of 648 subjects were randomized: 95 to placebo; 275 to 4% RX0041-002; and 278 to 8% RX0041-002. Efficacy was assessed with subjective pain intensity scores using the visual numeric rating scale and objectively using the von Frey filament test. Adverse events (AEs), vital signs, Holter monitoring, nasal irritation on visual examination, and smell assessment were recorded. The placebo and experimental groups were compared using a two-tailed Fisher's exact test.

Results: Topical 4% and 8% cocaine achieved significant subject analgesia, the primary efficacy endpoint. Both doses were safe and well-tolerated, with a safety profile similar to placebo. In the 4% and 8% groups, headache (1.5% and 2.5%, respectively), epistaxis (0.7% and 1.1%), and anxiety (0.7% and 0%) were the only AEs reported by >1 subject. No cardiovascular AEs, serious AEs, or deaths occurred. A higher percentage of subjects in the 4% and 8% groups compared with the placebo group had a modest increase in either systolic or diastolic blood pressure.

Conclusion: Topical 4% and 8% cocaine is an effective anesthetic that can be safely administered for nasal procedures.
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http://dx.doi.org/10.1002/alr.22561DOI Listing
August 2020

Advanced Techniques for the Use of Neurotoxins in Non-Surgical Facial Rejuvenation.

Aesthetic Plast Surg 2020 10 1;44(5):1788-1799. Epub 2020 Apr 1.

Center of Excellence in Facial Cosmetic Surgery, 2 Bala Plaza, PL-15, Bala Cynwyd, PA, 19004, USA.

Background: Neurotoxins initially were used to treat hyperfunctional rhytids of the face, but now have been expanded to improve facial shaping, correct facial asymmetry and even improve skin texture and tone.

Methods: The clinical approach to non-surgical facial rejuvenation is approached into four anatomical regions: the upper face, midface, lower face and neck.

Results: The key muscles of the upper face include frontalis, orbicularis oculi, corrugator supercilii, procerus, depressor supercilii and temporalis. The muscles in the midface to be discussed include the levator labii superioris, levator labii superioris alaeque nasi, depressor anguli oris, depressor septi nasi and nasalis. Treatment of the lower face focuses on the orbicularis oris, mentalis, depressor anguli oris and masseter muscles. Finally, treatment of the neck region will be reviewed with emphasis on platysmal bands and necklace lines as well as the Nefertiti lift.

Conclusions: Non-surgical facial rejuvenation using neurotoxins should be performed safely and effectively in order to avoid and treat complications.

Level Of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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http://dx.doi.org/10.1007/s00266-020-01691-5DOI Listing
October 2020
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