Publications by authors named "Mofiyinfolu Sokoya"

47 Publications

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 Jan 7. 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
January 2021

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

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

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

Facial Plast Surg 2020 Feb 24;36(1):120-128. Epub 2020 Feb 24.

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

In this systematic review we aim to (1) describe the anatomy and function of the soft tissue triangle, (2) identify the existing rhinoplasty literature that discusses the role of the soft tissue triangle, (3) provide a summary of the outcome measures for soft tissue triangle techniques in rhinoplasty, and (4) demonstrate the need for further research reviewing soft tissue triangle techniques in rhinoplasty. A systematic literature review was conducted from 2002 to 2019 utilizing MEDLINE/PubMed, Embase, Ovid, and Cochrane databases with the keywords, "rhinoplasty" and "soft tissue triangle" or "facet" to identify articles that describe the anatomical significance, clinical applicability, and rhinoplasty outcomes involving the soft tissue triangle. A total of 26 studies were identified as appropriate for inclusion. The vast majority describe the relationship of structure and function of the soft tissue triangle with particular focus on notching and retraction. The soft tissue triangle is an important area of the nose often neglected in rhinoplasty. This area is a common source of patient dissatisfaction and the need for revision rhinoplasty. Due to this fact, a formal evaluation of the role of the soft tissue triangle in nasal airway patency is needed. Specific validated outcome measures such as the NOSE (Nasal Obstruction and Septoplasty Effectiveness) score or the SCHNOS (Standardized Cosmesis and Health Nasal Outcomes Survey) should be employed in the evaluation of surgical intervention to the soft tissue triangle.
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http://dx.doi.org/10.1055/s-0040-1701520DOI Listing
February 2020

Single-Point Fixation for Noncomminuted Zygomaticomaxillary Complex Fractures-A 20-Year Experience.

J Oral Maxillofac Surg 2020 May 7;78(5):778-781. Epub 2020 Jan 7.

Attending Physician, Department of Facial Plastic and Reconstructive Surgery, Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, TX.

Purpose: Zygomaticomaxillary complex (ZMC) fractures occur often. However, no clinical consensus has been reached regarding the number of fixation points required when performing open reduction and internal fixation (ORIF). The objective of the present study was to explore the utility of single-point fixation in the management of noncomminuted ZMC fractures.

Patients And Methods: We analyzed the data from a retrospective case series of 211 patients treated during a 20-year period.

Results: The mean length of follow-up was 3.4 months. Of the 211 patients, 162 with noncomminuted ZMC fractures had been treated with single-point fixation of the zygomaticomaxillary buttress. During the follow-up period, 1 patient experienced tooth loss because of a root present in the fracture line, 7 experienced intraoral plate exposure, with 2 subsequently undergoing plate exchange, and 8 developed a wound infection. No patients required orthognathic surgery or cheek implants for malar asymmetry. No patient developed hypoglobus or enophthalmos, and none required revision ORIF of their ZMC fracture.

Conclusions: To the best of our knowledge, the present study represents the largest series in the literature reporting the surgical results and outcomes of patients with noncomminuted ZMC fractures treated with single-point fixation. In experienced hands, we believe this is a viable surgical option if appropriate surgical considerations are made.
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http://dx.doi.org/10.1016/j.joms.2019.12.030DOI Listing
May 2020

Management of Skull Fractures and Calvarial Defects.

Facial Plast Surg 2019 Dec 29;35(6):651-656. Epub 2019 Nov 29.

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

Scalp and calvarial defects can result from a myriad of causes including but not limited to trauma, infection, congenital malformations, neoplasm, and surgical management of tumors or other pathologies. While some small, nondisplaced fractures with minimal overlying skin injury can be managed conservatively, more extensive wounds will need surgical repair and closure. There are many autologous and alloplastic materials to aid in dural and calvarial reconstruction, but no ideal reconstructive method has yet emerged. Different reconstructive materials and methods are associated with different advantages, disadvantages, and complications that reconstructive surgeons should be aware of. Herein, we discuss different methods and materials for the surgical reconstruction of calvarial defects.
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http://dx.doi.org/10.1055/s-0039-3399522DOI Listing
December 2019

Management of Orbital Floor Fractures.

Facial Plast Surg 2019 Dec 29;35(6):633-639. Epub 2019 Nov 29.

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

Fractures of the orbital floor represent a common yet difficult to manage sequelae of craniomaxillofacial trauma. Repair of these injuries should be carried out with the goal of restoring normal orbital volume, facial contour, and ocular motility. Precise surgical repair is imperative to reduce the risk of long-term debilitating morbidity. This article aims to review concepts on the management of orbital floor fractures in the hope of further elucidating perioperative evaluation and decision-making regarding operative intervention.
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http://dx.doi.org/10.1055/s-0039-1700852DOI Listing
December 2019

Secondary Management of Mandible Fractures.

Facial Plast Surg 2019 Dec 29;35(6):627-632. Epub 2019 Nov 29.

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

Mandibular fractures are the most common facial fractures that need surgical intervention. If untreated, these fractures affect a patient's occlusion, degree of mouth opening, and facial symmetry, and could cause infection with significant pain. The goal of any surgical intervention is to restore the preinjury occlusion, even if the preinjury occlusion is abnormal. Initial therapies, whether surgical or conservative, are not always successful, however, and revision or delayed surgical intervention can be challenging. Herein, we review common causes of failure of primary surgical management of mandibular fractures and provide tips to successful secondary intervention.
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http://dx.doi.org/10.1055/s-0039-1700887DOI Listing
December 2019

The Role of External Fixation in Trauma and Reconstruction of the Mandible in the Age of Rigid Fixation.

Facial Plast Surg 2019 Dec 29;35(6):614-622. Epub 2019 Nov 29.

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

Internal rigid fixation is the gold-standard treatment for facial fractures, but there are some specific cases that are more amenable to external fixation (ex-fix) application. Herein, we discuss advantages and disadvantages to ex-fix in the modern treatment of comminuted mandible fractures, infected mandible fractures, fractures of the condylar region, oncologic mandibular resection, pediatric mandible fractures, and fractures in the edentulous patient.
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http://dx.doi.org/10.1055/s-0039-1700799DOI Listing
December 2019

Dental Injuries and Management.

Facial Plast Surg 2019 Dec 29;35(6):607-613. Epub 2019 Nov 29.

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

Traumatic dental injuries affect 1 to 3% of the population, and disproportionately affect children and adolescents. The management of these injuries incorporates the age of patients, as children between 6 and 13 years of age have a mixed dentition. This helps to preserve the vitality of teeth that may be salvaged after a traumatic event. The clinical examination of these cases involves a thorough examination of the maxilla and mandible for associated fractures and any lodged debris and dislodged teeth or tooth fragments. The objective is to rule out any accidental aspiration or displacement into the nose, sinuses, or soft tissue. After ruling out any complications, the focus is on determining the type of injury to the tooth or teeth involved. These include clinical examination for any color change in the teeth, mobility testing, and testing for pulp vitality. Radiographic evaluation using periapical, occlusal, panoramic radiographs, and cone beam computed tomography is performed to view the effect of trauma on the tooth, root, periodontal ligament, and adjoining bone. The most commonly used classification system for dental trauma is Andreasen's classification and is applied to both deciduous and permanent teeth. Managing dental trauma is based on the type of injury, such as hard tissue and pulp injuries, injuries to periodontal tissue, injuries of the supporting bone, and injuries of the gingiva and oral mucosa. Hard-tissue injuries without the involvement of the pulp typically require restoration only. Any pulp involvement may require endodontic treatment. Fractures involving the alveolar bone or luxation of the tooth require stabilization which is typically achieved with flexible splints. The most common procedures employed in managing dental injuries include root canal/endodontics, surgical tooth repositioning, and flexible splinting. Recognition and treatment of these injuries are necessary to facilitate proper healing and salvage of a patient's natural dentition, reducing future complications to patients.
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http://dx.doi.org/10.1055/s-0039-1700877DOI Listing
December 2019

Management of Complex Mandible Fractures.

Facial Plast Surg 2019 Dec 29;35(6):602-606. Epub 2019 Nov 29.

Department of Otolaryngology, University of Colorado, Denver, Colorado.

Mandible fractures represent a common sequela of craniomaxillofacial trauma encountered by reconstructive surgeons. Management of complex mandibular fractures, and reestablishment of the occlusal relationship, represents a challenging reconstructive endeavor for even the most skilled surgeon. In this article, the authors review the treatment options for particularly complex presentations of this injury pattern.
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http://dx.doi.org/10.1055/s-0039-1700878DOI Listing
December 2019

Management of Complex Mandible Fractures.

Facial Plast Surg 2019 Dec 29;35(6):602-606. Epub 2019 Nov 29.

Department of Otolaryngology, University of Colorado, Denver, Colorado.

Mandible fractures represent a common sequela of craniomaxillofacial trauma encountered by reconstructive surgeons. Management of complex mandibular fractures, and reestablishment of the occlusal relationship, represents a challenging reconstructive endeavor for even the most skilled surgeon. In this article, the authors review the treatment options for particularly complex presentations of this injury pattern.
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http://dx.doi.org/10.1055/s-0039-1700878DOI Listing
December 2019

Surgical Management of Panfacial Fractures.

Facial Plast Surg 2019 Dec 29;35(6):565-577. Epub 2019 Nov 29.

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

The evaluation and management of a patient with panfacial fractures are multifaceted. Herein, we describe basic facial skeletal anatomy, considerations for airway securing, and common concurrent injuries. Finally, we discuss primary and secondary reconstructions of facial trauma including sequencing of repair, available landmarks, and the utility of intraoperative computed tomography imaging and virtual surgical planning with custom implants.
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http://dx.doi.org/10.1055/s-0039-1700800DOI Listing
December 2019

Orbitocranial Approaches to the Skull Base.

Semin Plast Surg 2019 May 26;33(2):114-119. Epub 2019 Apr 26.

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

There are a myriad of approaches and surgical options for removal and treatment of skull base diseases. While, historically, large open approaches have been preferred, several endoscopic and minimally invasive techniques are now available that preserve intraoperative visualization and surgical success while minimizing morbidity and recovery times. Herein, the authors review common open, minimally invasive, and endoscopic approaches to the anterior skull base.
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http://dx.doi.org/10.1055/s-0039-1685478DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6486386PMC
May 2019

Considerations in Orbital Exenteration.

Semin Plast Surg 2019 May 26;33(2):103-105. Epub 2019 Apr 26.

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

Orbital exenteration (OE) is a radical operation associated with significant psychosocial disability and functional impairment. Indications for OE include primary tumors of the eye, oral cavity, paranasal sinuses, skin, and brain. Careful consideration regarding the likelihood of local control and cure is needed before proceeding with this operation. Multidisciplinary work-up should be performed before proceeding with surgery. The method of reconstruction after OE should be tailored to the defect and the postoperative needs of the patient. Appropriate follow-up and rehabilitation should be arranged for the patient.
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http://dx.doi.org/10.1055/s-0039-1685209DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6486380PMC
May 2019

Pharyngeal Reconstruction with Microvascular Free Tissue Transfer.

Semin Plast Surg 2019 Feb 8;33(1):78-80. Epub 2019 Mar 8.

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

Reconstruction of pharyngoesophageal defects after total laryngectomies and extirpation of hypopharyngeal and upper esophageal carcinomas presents a challenging task. Goals of reconstruction include adequate voice rehabilitation and restoration of normal swallowing. The reconstructive armamentarium contains many options for reconstruction and creation of a new upper digestive tract. This review article focuses on the most commonly used free tissue transfer options for the reconstruction of these defects, with an assessment of their advantages and disadvantages.
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http://dx.doi.org/10.1055/s-0039-1677877DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6408241PMC
February 2019

Free-Flap Reconstruction of Skull Base and Orbital Defects.

Semin Plast Surg 2019 Feb 8;33(1):72-77. Epub 2019 Mar 8.

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

Orbital and anterior skull base defects present a significant challenge for reconstruction due to the complexity of the anatomy and the need for separation of intracranial and extracranial contents in this area. While endoscopic techniques have revolutionized the treatment of many anterior skull base defects, microvascular free tissue transfer is a viable option for large volume defects not suitable for traditional open approaches or for cases where endoscopic techniques have failed. The various free tissue transfer techniques for anterior skull base and orbit, as well as the advantages and disadvantages, are reviewed.
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http://dx.doi.org/10.1055/s-0039-1677881DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6408239PMC
February 2019

Free Tissue Reconstruction of the Scalp.

Semin Plast Surg 2019 Feb 8;33(1):67-71. Epub 2019 Mar 8.

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

Reconstruction of scalp defects can be accomplished by many methods, but larger defects, especially those in which the periosteum is absent or calvarial defects are present, require free tissue transfer. Various methods of scalp reconstruction, as guided by the defect components and size, are presented herein, with a focus on free tissue transfer. Different free flaps for scalp reconstructed are described with a comparison of their advantages and disadvantages. Overall, free tissue transfer for scalp defects provides a reliable, durable, and cosmetically adequate reconstructive option.
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http://dx.doi.org/10.1055/s-0039-1678470DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6408242PMC
February 2019

Free-Flap Reconstruction of the Mandible.

Semin Plast Surg 2019 Feb 8;33(1):46-53. Epub 2019 Mar 8.

Division of Maxillofacial Oncologic and Reconstructive Surgery, Department of Oral and Maxillofacial Surgery, John Peter Smith Health Network, Fort Worth, Texas.

Mandible reconstruction has evolved over the years with advances in surgical options and three-dimensional technology. Although nonvascularized bone grafting is still used, vascularized flaps show advantages with immediate reconstruction, the possibility of immediate dental implants, and the ability to reconstruct composite defects of both soft tissue and bone. This article discusses current vascularized techniques for mandible reconstruction. While each reconstructive method has advantages and disadvantages, a defect-based reconstruction focused on full rehabilitation allows surgeons to plan and counsel the patient for the best available reconstruction.
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http://dx.doi.org/10.1055/s-0039-1677791DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6408245PMC
February 2019

Free Tissue Transfer Penile Reconstruction.

Semin Plast Surg 2019 Feb 8;33(1):24-29. Epub 2019 Mar 8.

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

Phalloplasty can be a challenging plastic surgery procedure associated with complications and unsatisfactory results. Phalloplasty has become an important procedure in the setting of trauma, partial or complete excision of the penis, and gender affirmation. Advances in microsurgery has expanded penile reconstruction through free tissue transfer techniques which include the radial forearm free flap, fibular osteocutaneous flap, anterolateral thigh flap, latissimus dorsi flap, scapular flap, and abdominal flaps. Each procedure has advantages and disadvantages; most of the procedures achieve adequate cosmetic results with high patient satisfaction. Most of the surgical complications are related to the reconstruction of the urethra or creating rigidity for intercourse. The main goals of reconstruction are to create a cosmetically appealing phallus with satisfactory sexual function.
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http://dx.doi.org/10.1055/s-0039-1677879DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6408249PMC
February 2019

Alopecia and techniques in hair restoration: an overview for the cosmetic surgeon.

Oral Maxillofac Surg 2019 Jun 21;23(2):123-131. Epub 2019 Feb 21.

Department of Orthopedics and Plastic Surgery, Wright State University, Dayton, OH, USA.

Purpose: Alopecia is a debilitating disorder affecting millions of individuals worldwide. Although challenging to treat, advances in hair restoration technologies have led to multiple viable options with excellent clinical results. This paper seeks to provide an overview of hair loss and the currently utilized techniques in hair transplantation in order to serve as a reference source for the facial plastic surgeon.

Methods: A comprehensive review of recent literature regarding the evaluation of, and management modalities for, alopecia was performed.

Results: The follicular unit extraction technique and the strip harvest technique are both widely used for patients desiring transplantation. While both techniques can lead to successful outcomes, each has pros and cons that are important to understand prior to engaging in the procedure.

Conclusion: Advancements in hair restoration technologies implementing robotics, manual, or motorized follicular unit extraction have facilitated optimization of outcomes. Adjuvant treatment modalities including robotics and platelet-rich plasma injections have shown utility in augmenting transplantation.
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http://dx.doi.org/10.1007/s10006-019-00750-9DOI Listing
June 2019

Comparison of radial forearm free flap and gastric pull-up in pharyngo-oesophageal reconstruction.

Clin Otolaryngol 2019 05 22;44(3):405-407. Epub 2019 Feb 22.

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

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http://dx.doi.org/10.1111/coa.13279DOI Listing
May 2019

Pseudoaneurysm Following Endoscopic-Assisted Repair of Subcondylar Fracture.

Craniomaxillofac Trauma Reconstr 2018 Dec 27;11(4):302-304. Epub 2017 Oct 27.

Department of Otolaryngology, Denver Health and Hospital Authority, Denver, Colorado.

Pseudoaneurysms are a known complication following facial trauma and orthognathic surgery. Few reports exist of this clinical entity following traditional open techniques of repair, and none have been associated with endoscopic-assisted open reduction and internal fixation (ORIF) of a subcondylar fracture. We present a case of a 33-year-old man who developed pseudoaneurysm after endoscopic-assisted ORIF as well as a review of the literature on this topic. While uncommon, this is a potential complication that should be recognized with the use of endoscopic-assisted repair of mandibular fractures.
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http://dx.doi.org/10.1055/s-0037-1607064DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6224284PMC
December 2018

In Response to combination of panendoscopy and positron emission tomography/computed tomography increases detection of unknown primary head and neck carcinoma.

Laryngoscope 2019 04 14;129(4):E121. Epub 2018 Dec 14.

Department of Otolaryngology, University of Colorado School of Medicine Aurora, Colorado.

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http://dx.doi.org/10.1002/lary.27691DOI Listing
April 2019

The Paramedian Forehead Flap for Nasal Reconstruction: From Antiquity to Present.

J Craniofac Surg 2019 Mar/Apr;30(2):330-333

Columbia Presbyterian Medical Center, New York City, NY.

Nasal reconstruction is considered the historic foundation of facial plastic surgery, and the forehead flap remains the workhorse of repair. To recreate both the aesthetic contour and function of the nose, all anatomic layers must be addressed-covering, lining, and structural support. This article reviews the noteworthy history underlying the development of the paramedian forehead flap as the primary tool in reconstruction of large nasal defects while highlighting its implications on modern nasal repair. Current developments in the use of 2-staged paramedian forehead flap reconstruction are examined and a modern technique is presented.
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http://dx.doi.org/10.1097/SCS.0000000000004976DOI Listing
August 2019

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

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

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

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

Study Design: Retrospective case review.

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

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

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

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

Combination of panendoscopy and positron emission tomography/computed tomography increases detection of unknown primary head and neck carcinoma.

Laryngoscope 2018 11 8;128(11):2573-2575. Epub 2018 Sep 8.

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

Objectives/hypothesis: With positron emission tomography/computed tomography (PET/CT) now commonplace as a diagnostic tool, new questions have arisen regarding the utility and cost-effectiveness of panendoscopy. In this retrospective review of a large cohort of head and neck squamous cell carcinoma of unknown primary (HNSCC-UP), we describe the enduring utility of panendoscopy in the detection of the primary site of mucosal disease even when PET/CT is negative.

Study Design: Retrospective cohort study.

Methods: A retrospective analysis of patients presenting to the senior author (y.d.) from July 1 1997 to July 1 2017 with fine-needle aspiration-proven metastatic squamous cell carcinoma to the neck. All patients underwent formal panendoscopy (direct laryngoscopy, bronchoscopy, and rigid esophagoscopy). Presence of squamous cell carcinoma on final pathology was examined.

Results: A total of 190 patients had HNSCC-UP, with 87 positive and 103 negative on PET/CT. Of the PET/CT-negative patients, 71 patients retained the HNSCC-UP designation after panendoscopy. Eighteen patients (56% of cases) were found to have primary tonsillar squamous cell carcinoma. Eight of 32 primary sites were found in the base of tongue (25%), with HPV positivity in two of these patients. The sensitivity and negative predictive value of PET/CT in detecting the primary site in unknown primary head and neck squamous cell carcinoma in the total study population were 73.1% and 68.9%, respectively.

Conclusions: Surgical panendoscopy has an important role in the workup of patients with unknown primary head and neck squamous cell carcinoma. There is a high rate of cancer diagnosis, even in PET/CT negative patients.

Level Of Evidence: 4 Laryngoscope, 2573-2575, 2018.
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http://dx.doi.org/10.1002/lary.27268DOI Listing
November 2018

The radial forearm free flap for scalp and forehead reconstruction: A 20-year experience.

Clin Otolaryngol 2018 12 1;43(6):1611-1613. Epub 2018 Aug 1.

Department of Facial Plastic and Reconstructive Surgery, Otolaryngology and Facial Plastic Surgery Associates, Ottawa, Canada.

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http://dx.doi.org/10.1111/coa.13189DOI Listing
December 2018

Preoperative radiation and complication rates after double free flap reconstruction of head and neck cancer.

Am J Otolaryngol 2018 Sep - Oct;39(5):558-560. Epub 2018 Jun 18.

Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, TX, USA. Electronic address:

Introduction: In this study, we explore whether preoperative external beam radiation affects complication rates in patients that have undergone double simultaneous free tissue transfer for head and neck defects.

Study Design, Setting, Subjects And Methods: Approval was obtained from the JPS Institutional Review Board. We performed a retrospective analysis of patients who underwent double free flap reconstruction of head and neck defects between August 1997 and April 2017. Minimum follow up was 6 months. Patients were grouped according to preoperative radiation status (XRT vs non-XRT). The chi-squared test was used for all comparisons. P-values and 95% confidence intervals (CI) were reported as (P, 95% CI).

Results: 90 flaps were performed on 45 patients. The most common flap combination utilized was fibula plus radial forearm free flap (RFF) in 17 out of 45 patients. There were no statistically significant differences in frequency of flap failure (0.35, -15.9-20.1), wound infection (0.75, -22.1-19.3), hematoma (0.16, -5.3-36.7), or fistula formation (0.69, -22.5-24.6). There were also no statistically significant differences in cardiac complications (0.57, -10.3-28.2) and DVT (0.22, -12.4-25.3).

Conclusion: Our findings suggest that double free flap patients who had preoperative radiation are not more likely to have complications compared to non- radiated patients. Simultaneous double free flaps should be reserved for the most complex cases. Extensive discussion should be had with the patient about possible morbidity and mortality.
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http://dx.doi.org/10.1016/j.amjoto.2018.06.015DOI Listing
January 2019
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