Publications by authors named "Tsung-Yen Hsieh"

25 Publications

  • Page 1 of 1

Three-Dimensional Printing in Cleft Care: A Systematic Review.

Cleft Palate Craniofac J 2021 May 7:10556656211013175. Epub 2021 May 7.

Department of Otolaryngology-Head and Neck Surgery, University of California Davis Medical Center, Sacramento, CA, USA.

Objective: To determine the current applications of 3-dimensional (3D) printing in the care of patients with cleft lip and palate. We also reviewed 3D printing limitations, financial analysis, and future implications.

Design: Retrospective systematic review.

Methods: Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were used by 3 independent reviewers. Articles were identified from Cochrane library, Ovid Medline, and Embase. Search terms included 3D printing, 3 dimensional printing, additive manufacturing, rapid prototyping, cleft lip, and cleft palate. Exclusion criteria included articles not in English, animal studies, reviews without original data, oral presentations, abstracts, opinion pieces, and articles without relevance to 3D printing or cleft lip and palate.

Main Outcome Measures: Primary outcome measure was the purpose of 3D printing in the care of patients with cleft lip and palate. Secondary outcome measures were cost analysis and clinical outcomes.

Results: Eight-four articles were identified, and 39 met inclusion/exclusion criteria. Eleven studies used 3D printing models for nasoalveolar molding. Patient-specific implants were developed via 3D printing in 6 articles. Surgical planning was conducted via 3D printing in 8 studies. Eight articles utilized 3D printing for anatomic models/educational purposes. 3-Dimensional printed models were used for surgical simulation/training in 6 articles. Bioprinting was utilized in 4 studies. Secondary outcome of cost was addressed in 8 articles.

Conclusion: 3-Dimensional printing for the care of patients with cleft lip and palate has several applications. Potential advantages of utilizing this technology are demonstrated; however, literature is largely descriptive in nature with few clinical outcome measures. Future direction should be aimed at standardized reporting to include clinical outcomes, cost, material, printing method, and results.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/10556656211013175DOI Listing
May 2021

Alloplastic Facial Implants.

Facial Plast Surg 2021 Mar 16. Epub 2021 Mar 16.

Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota.

As the face ages, there is thinning of the epidermis, volume loss and rearrangement of the soft tissues, and malabsorption of the skeletal framework. It is essential to have a thorough understanding of the aging process for successful facial augmentation and rejuvenation. Alloplastic implants can be used to provide a long-lasting solution for augmentation of skeletal deficiencies, restoration of facial irregularities, and rejuvenation of the face. In this study, we describe the ideal implant characteristics along with the advantages and disadvantages of various implant materials. We also present techniques in nasal and premaxillary augmentation, midface augmentation, mandibular augmentation, and lip augmentation. Additionally, computer-aided design and manufacturing as well as bioprinting are emerging technologies with growing applications in facial plastic and reconstructive surgery. We discuss their role in the creation of patient-specific custom implants. The overall goal of facial rejuvenation is to address multiple aspects of the facial aging process including deficiencies in the skin, soft tissues, and skeletal framework. The use of alloplastic implants alone or synergistically with additional surgical procedures can restore a wide range of anatomical deficits that occur with age.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0041-1725088DOI Listing
March 2021

Rapid, Effective Cannulation for Salivary Duct Access: Use of Hydro-Dilation With Viscous Lidocaine.

Laryngoscope 2021 08 15;131(8):E2432-E2435. Epub 2021 Mar 15.

Division of Otolaryngology-Head and Neck Surgery, The George Washington University, Washington, DC, U.S.A.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/lary.29456DOI Listing
August 2021

Assessment of the Learning Curve for Virtual Surgical Planning in Orbital Fractures.

Craniomaxillofac Trauma Reconstr 2020 Sep 5;13(3):186-191. Epub 2020 May 5.

Department of Otolaryngology-Head and Neck Surgery, University of California Davis Medical Center, Sacramento, CA, USA.

Virtual surgical planning (VSP) is becoming more widely used in maxillofacial reconstruction and can be or . Surgeon-based models require software training but allow surgeon autonomy. We evaluate the learning curve for VSP through a prospective cohort study in which planning times and accuracy of 7 otolaryngology residents with no prior VSP experience were compared to that of a proficient user after a single training protocol and 6 planning sessions for orbital fractures. The average planning time for the first session was 21 minutes 41 seconds ± 6 minutes 11 seconds with an average maximum deviation of 2.5 ± 0.8 mm in the lateral orbit and 2.3 ± 0.6 mm in the superior orbit. The average planning time for the last session was 13 minutes 5 seconds ± 10 minutes and 7 seconds with an average maximum deviation of 1.4 ± 0.5 mm in the lateral orbit and 1.3 ± 0.4 mm in the superior orbit. Novice users reduced planning time by 40% and decreased maximum deviation of plans by 44% and 43% in the lateral and superior orbits, respectively, approaching that of the proficient user. Virtual surgical planning has a quick learning curve and may be incorporated into surgical training.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1943387520923940DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7797975PMC
September 2020

Predicting complications of pediatric temporal bone fractures.

Int J Pediatr Otorhinolaryngol 2020 Nov 1;138:110358. Epub 2020 Sep 1.

Department of Otolaryngology - Head and Neck Surgery, UC Davis Health, Sacramento, CA, USA. Electronic address:

Objective: Our aim is to characterize complications of pediatric temporal bone fractures and identify predictive risk factors associated with fracture complications.

Methods: A retrospective review was conducted of all temporal bone fractures diagnosed in children (age less than or equal to 18 years) from a single academic institution between 2003 and 2017. Demographics, mechanism of injury, fracture characteristics, computed tomography evaluation and follow-up duration were recorded on each patient. Outcomes measured include facial nerve injury (FNI), cerebrospinal fluid (CSF) leak, sensorineural hearing loss (SNHL), and conductive hearing loss (CHL).

Results: One-hundred-seventeen patients with 129 temporal bone fractures were included in the study. Most fractures were otic capsule sparing (OCS) (96%, n = 124) and longitudinal (71%, n = 91). Otic capsule violating (OCV) fractures were associated with higher CSF leak rates (20% versus 2%, p = 0.14) and FNI rates (60% versus 5%, p = 0.002) compared to OCS fractures. Audiograms were available in 37 patients (34%). Patients with Glasgow coma scale (GCS) consistent with a mild traumatic brain injury (TBI) (GCS > 13) had significantly fewer complications (FNI and CSF leaks) compared to the group with moderate and severe TBI (GCS < 13), 5% versus 23% (p = 0.03).

Conclusions: Higher complication rates are seen with OCV fractures and transverse fractures. Moderate and severe TBI as measured by GCS is predictive of FNI and CSF complications in pediatric temporal bone fractures.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijporl.2020.110358DOI Listing
November 2020

Response to Elmaraghi et al. re: "A Guide to Facial Trauma Triage and Precautions in the COVID-19 Pandemic".

Facial Plast Surg Aesthet Med 2020 Jul/Aug;22(4):314. Epub 2020 Jun 11.

Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/fpsam.2020.0302DOI Listing
July 2020

A Guide to Facial Trauma Triage and Precautions in the COVID-19 Pandemic.

Facial Plast Surg Aesthet Med 2020 May/Jun;22(3):164-169. Epub 2020 Apr 16.

Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA.

COVID-19 is an emerging viral illness that has rapidly transmitted throughout the world. Its impact on society and the health care system has compelled hospitals to quickly adapt and innovate as new information about the disease is uncovered. During this pandemic, essential medical and surgical services must be carried out while minimizing the risk of disease transmission to health care workers. There is an elevated risk of COVID-19 viral transmission to health care workers during surgical procedures of the head and neck due to potential aerosolization of viral particles from the oral cavity/naso-oropharynx mucosa. Thus, patients with facial fractures pose unique challenges to the variety of injuries and special considerations, including triaging injuries and protective measures against infection. The proximity to the oral cavity/naso-oropharyngeal mucosa, and potential for aerosolization of secretions containing viral particles during surgical procedures make most patients undergoing operative interventions for facial fractures high risk for COVID-19 transmission. Our proposed algorithm aims to balance patient care with patient/medical personnel protection as well as judicious health care utilization. It stratifies facial trauma procedures by urgency and assigns a recommended level of personal protective equipment, extreme or enhanced, incorporating current best practices and existing data on viral transmission. As this pandemic continues to evolve and more information is obtained, the protocol can be further refined and individualized to each institution.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/fpsam.2020.0185DOI Listing
May 2020

Multi-Institutional Regional Otolaryngology Bootcamp.

Ann Otol Rhinol Laryngol 2020 Jun 29;129(6):605-610. Epub 2020 Jan 29.

Department of Otolaryngology, Division of Head and Neck Surgery, University of California, Davis, Sacramento, CA, USA.

Introduction: In order to increase junior resident physician proficiency and improve patient safety, simulation-based procedural training courses, or bootcamps, have been become an emerging educational tool.

Objectives: To compare pre- and post-course confidence levels and to assess station efficacy after completion of our single day bootcamp.

Methods: We developed the University of California (UC) Davis otolaryngology bootcamp, a single day course including six cadaveric task trainer stations and four simulations. The six task trainer stations included (1) Epistaxis, (2) Cricothyrotomy/tracheostomy, (3) Peritonsillar abscess/auricular hematoma, (4) Nasal bone reduction/zygoma reduction/lateral canthotomy/canalicular trauma and probing, (5) Local nerve blocks, and (6) Soft tissue reconstruction. The simulations comprised of airway fire during tracheostomy, pediatric respiratory code during airway evaluation, dislodged pediatric tracheostomy tube in the ICU, and angioedema in the emergency department with inability to intubate or ventilate. Junior residents from multiple locoregional institutions were recruited to participate. Pre- and post-course Likert surveys assessing participant confidence and station efficacy were collected and analyzed.

Results: There was a statistically significant increase in resident confidence levels for all task trainer stations. All stations had a station efficacy Likert score average of 4 "very effective" or 5 "most effective."

Conclusion: A multi-institutional, locoregional, simulation-based bootcamp can be a valuable adjunct to junior resident training. It can promote camaraderie, pool limited resources, and may be cost-effective.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0003489420903067DOI Listing
June 2020

Assessment of Tracheostomy and Laryngectomy Knowledge among Non-Otolaryngology Physicians.

Ann Otol Rhinol Laryngol 2020 Feb 16;129(2):115-121. Epub 2019 Sep 16.

Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Medical Center, Sacramento, CA, USA.

Objective: Identify knowledge deficits about alternate airways (AAs) (tracheostomy and laryngectomy) among physicians across multiple specialties a tertiary institution and to assess the impact of an educational lecture on improving deficits.

Methods: : Cross-sectional assessment. : Academic medical center. : An anonymous 10-item, multiple choice assessment was given to physicians at a tertiary care center in the departments of Otolaryngology, Emergency Medicine, Family Medicine, General Surgery, Internal Medicine, and Pediatrics. An educational lecture on AAs was presented. Scores between a pre-lecture and a 3-month post-lecture assessment were compared. Data was analyzed using ANOVA and chi-squared analysis.

Results: Otolaryngology physicians scored an average of 97.8%, while non-otolaryngology physicians scored 58.3% ( < .05). Non-otolaryngology surgical physicians scored 68.4% while non-surgical physicians were lower at 55.1% ( < .0001). Comparing pre-lecture to post-lecture scores, all non-otolaryngology physicians improved their scores significantly from 58.3% to 86.5% ( < .005). Non-surgical physicians had significant improvement after the instructional lecture, closing the score gap with surgical physicians for the post-lecture assessment.

Discussion: The care of patients with AAs requires an understanding of their basic principles. Our findings identify significant knowledge deficits among non-otolaryngologists. Through an instructional lecture, we demonstrated improvement in knowledge among non-otolaryngology physicians and durability of the knowledge after 3 months.

Conclusions: Through an instructional lecture, we found tracheostomy and laryngectomy knowledge deficits can be identified and improved upon. Periodic reinforcement of basic principles for non-otolaryngology physicians may be a promising strategy to ensure the proper care of patients with AAs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0003489419877198DOI Listing
February 2020

Use of multiple free flaps in head and neck reconstruction.

Curr Opin Otolaryngol Head Neck Surg 2019 Oct;27(5):392-400

Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA.

Purpose Of Review: To review the recent literature on the use of multiple flaps in head and neck reconstruction with attention to form, function, outcomes, and complications.

Recent Findings: Multiple free flap reconstructions are technically feasible with high flap survival rates, tolerable complication rates, and overall adequate functional and aesthetic outcomes, given the large extent of the defects and the high surgical complexity of these cases.

Summary: Multiple free flap reconstructions should be considered in cases of large defects involving multiple functional regions and tissue types, which most often arises following resection of advanced malignancies. As there is mortality benefit with clear surgical margins and eradication of malignant lymph nodes, larger resections should be pursued if necessary, followed by a multiple flap reconstruction.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MOO.0000000000000574DOI Listing
October 2019

Perceived Preparedness of Facial Plastic Surgery Fellows Over Time: A Survey of AAFPRS Fellowship Directors.

Ann Otol Rhinol Laryngol 2019 Oct 12;128(10):915-920. Epub 2019 May 12.

1 Department of Otolaryngology Head and Neck Surgery, University of California Davis, Sacramento, CA, USA.

Objective: Assess the effects of American Council for Graduate Medical Education (ACGME) resident work hour restrictions on the preparedness of incoming facial plastic surgery fellows as assessed by American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) fellowship directors.

Methods: Observational survey study evaluating the perception of ACGME resident duty hour change on resident surgical and clinical skills from fellowship directors of AAFPRS fellowship programs in the US. A cross-sectional survey was sent to 47 fellowship directors of AAFPRS fellowship programs. Perceived change in resident clinical and surgical skills were measured using a 5-point Likert scale (1 = significantly improved, 2 = improved, 3 = neither improved nor worsened, 4 = worsened, 5 = significantly worsened) to evaluate 15 benchmarks.

Results: Responses received from 36 fellowship directors. The results indicate no statistically significant perceived trend of ACGME duty hour reform on fellows for AAFPRS fellowships among fellowship directors. However, cohort analysis demonstrated that fellowship directors with more than 10 years of service perceived a more negative impact in 2 clinical benchmarks (assessment/planning and basic exposure) over time.

Conclusions: The study results appear to show no significant perceived trend over time on the effect of duty hour reform on fellows for AAFPRS fellowships among fellowship directors. However, there are some apparent opinion differences between fellowship directors separated by years of service, with more negative perceptions noted in 2 clinical areas by those with more than 10 years of service. This study is in line with the more recent literature that suggests a trend toward a less negative perception of the duty hour change. This may suggest resident education is adapting to the ACGME duty hour regulations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0003489419849611DOI Listing
October 2019

Risk Factors Associated With Complications After Treatment of Mandible Fractures.

JAMA Facial Plast Surg 2019 May;21(3):213-220

Department of Otolaryngology-Head & Neck Surgery, University of California, Davis, Sacramento.

Importance: Complications that arise after treatment of mandible fractures can result in significant morbidity. Identifying modifiable risk factors associated with these complications is valuable in guiding clinical practice for improved patient outcomes.

Objective: To describe the risk factors associated with complications in patients undergoing treatment for mandible fracture.

Design, Setting, And Participants: A retrospective review was conducted of 137 patients presenting to a tertiary care, level 1 trauma center with mandible fractures between January 1, 2014, and January 1, 2017. Outcomes and demographic characteristics for patients with at least 3 weeks of follow-up were compared using multivariate logistic regression analysis.

Results: Of the 137 patients meeting inclusion criteria, there were 113 males (82.5%) and 24 females (17.5%), with a mean (SD) age at presentation of 32.3 (15.7) years. Median follow-up was 71 days (range, 22-1189 days). Postoperative complications were identified in 29 patients (21.2%); complications included wound dehiscence or surgical site infection (n = 17), bony nonunion (n = 5), and hardware exposure (n = 13). Complications were managed surgically in 19 patients and nonsurgically in 10 patients. On univariate analysis, the initial surgery was completed later (mean [SD], 5.9 [6.6] days after injury) in patients who developed complications than in those who did not (mean [SD], 3.8 [4.0] days). On multivariate analysis, complications were associated with increased time from injury to treatment (odds ratio [OR], 1.60; 95% CI, 1.02-2.53; P = .04), tobacco use (OR, 8.10; 95% CI, 1.26-52.00; P = .03), and dental extraction (OR, 93.00; 95% CI, 1.19 to >999.00; P = .04). Residence in the same city as the medical center was associated with fewer complications (OR, 0.08; 95% CI, 0.01-0.69; P = .02).

Conclusions And Relevance: In a 3-year review of mandible fractures managed at a single academic center, complications were associated with an increased time to treatment, tobacco use, dental extraction, and living farther from the treatment facility. On a systems level, the results of this study suggest that expediting intervention for mandible fractures may improve outcomes.

Level Of Evidence: 3.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamafacial.2018.1836DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6537826PMC
May 2019

Posterior Maxillary Sinus Wall: A Landmark for Identifying the Sphenoid Sinus Ostium.

Ann Otol Rhinol Laryngol 2019 Mar 3;128(3):215-219. Epub 2018 Dec 3.

Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, CA, USA.

Importance: Safe entry into sphenoid sinus is critical in endoscopic sinus and skull base surgery. A number of surgical landmarks have been used to identify the sphenoid sinus ostium during endoscopic endonasal surgery with variable reliability and intraoperative feasibility.

Objective: To determine if the posterior wall of the maxillary sinus is a reliable landmark to determine the depth of the sphenoid sinus ostium during anterior to posterior dissection.

Design, Setting, And Participants: Prospective study of adult patients undergoing endoscopic sinus surgery between August 2016 and September 2017. Measurements were made intraoperatively between the depth of the posterior maxillary sinus wall and sphenoid sinus ostium.

Main Outcomes And Measures: The primary measurement is the distance between the depth of the posterior maxillary sinus wall and sphenoid sinus ostium. Additional data points included age, gender, surgical indication, and primary versus revision endoscopic sinus surgery.

Results: Forty-five patients (38% male, 62% female) with an average age of 56 were enrolled, resulting in 88 operated sides. The average distance between the depth of the posterior wall of the maxillary sinus and the sphenoid ostium was 1.5 mm ± 1.4 mm. The most common position of the sphenoid sinus ostium was posterior to the level of the posterior maxillary sinus wall (54%), followed by same level (23%) and anterior (23%). There was no significant difference between different disease states ( = .75) and between primary and revision cases ( = .13).

Conclusions And Relevance: The posterior wall of the maxillary sinus serves as an adjunctive intraoperative landmark to determine the depth of the sphenoid sinus ostium. While the posterior wall of the maxillary sinus approximates the depth of the sphenoid sinus ostium, the relative position is variable and can be anterior or posterior.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0003489418816725DOI Listing
March 2019

Validation of Haptic Properties of Materials for Endoscopic Sinus and Skull Base Surgery Simulation-Reply.

JAMA Otolaryngol Head Neck Surg 2018 12;144(12):1185-1186

Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Medical Center, Sacramento.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamaoto.2018.1811DOI Listing
December 2018

Cleft Rhinoplasty: Strategies for the Multiply Operated Nose.

Facial Plast Surg 2018 Jun 1;34(3):290-297. Epub 2018 Jun 1.

Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, UC Davis Medical Center, Sacramento, California.

Rhinoplasty, as a surgical procedure to improve the appearance of the nose while preserving or improving function, is complicated and difficult to master. Revision cleft rhinoplasty offers another tier of challenge. The symmetry, proportions, and definition of the nose are affected by the native cleft deformity but also previous surgical scars, cartilage grafts, and skin excisions. Our preferred approach is to use structural cartilage grafting to establish septal and lower lateral cartilage resiliency. Internal lining deficiency is addressed with skin or lining transfer, while excess nasal tip thickness is contoured to improve definition. Of the utmost importance, the cleft nasal deformity cannot be considered in isolation, but rather a combined amalgamation of the lip muscle and scar, dentofacial occlusion, and skeletal maxillary deficiency.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0038-1653986DOI Listing
June 2018

Assessment of a Patient-Specific, 3-Dimensionally Printed Endoscopic Sinus and Skull Base Surgical Model.

JAMA Otolaryngol Head Neck Surg 2018 07;144(7):574-579

Department of Otolaryngology-Head and Neck Surgery, University of California, Davis Medical Center, Sacramento.

Importance: Three-dimensional (3D) printing is an emerging tool in the creation of anatomical models for simulation and preoperative planning. Its use in sinus and skull base surgery has been limited because of difficulty in replicating the details of sinus anatomy.

Objective: To describe the development of 3D-printed sinus and skull base models for use in endoscopic skull base surgery.

Design, Setting, And Participants: In this single-center study performed from April 1, 2017, through June 1, 2017, a total of 7 otolaryngology residents and 2 attending physicians at a tertiary academic center were recruited to evaluate the procedural anatomical accuracy and haptic feedback of the printed model.

Interventions: A 3D model of sinus and skull base anatomy with high-resolution, 3D printed material (VeroWhite) was printed using a 3D printer. Anatomical accuracy was assessed by comparing a computed tomogram of the original patient with that of the 3D model across set anatomical landmarks (eg, depth of cribriform plate). Image-guided navigation was also used to evaluate accuracy of 13 surgical landmarks. Likert scale questionnaires (1 indicating strongly disagree; 2, disagree; 3, neutral; 4, agree; and 5, strongly agree) were administered to 9 study participants who each performed sinus and skull base dissections on the 3D-printed model to evaluate anatomical accuracy and haptic feedback.

Main Outcomes And Measures: Main outcomes of the study include objective anatomical accuracy through imaging and navigation and haptic evaluation by the study participants.

Results: Seven otolaryngology residents (3 postgraduate year [PGY]-5 residents, 2 PGY-4 residents, 1 PGY-3 resident, and 1 PGY-2 resident) and 2 attending physicians evaluated the haptic feedback of the 3D model. Computed tomographic comparison demonstrated a less than 5% difference between patient and 3D model measurements. Image-guided navigation confirmed accuracy of 13 landmarks to within 1 mm. Likert scores were a mean (SD) of 4.00 (0.71) for overall procedural anatomical accuracy and 4.67 (0.5) for haptic feedback.

Conclusions And Relevance: This study shows that high-resolution, 3D-printed sinus and skull base models can be generated with anatomical and haptic accuracy. This technology has the potential to be useful in surgical training and preoperative planning and as a supplemental or alternative simulation or training platform to cadaveric dissection.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamaoto.2018.0473DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6145784PMC
July 2018

Optimization of 3D Print Material for the Recreation of Patient-Specific Temporal Bone Models.

Ann Otol Rhinol Laryngol 2018 May;127(5):338-343

2 Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Medical Center, Sacramento, California, USA.

Objective: Identify the 3D printed material that most accurately recreates the visual, tactile, and kinesthetic properties of human temporal bone Subjects and Methods: Fifteen study participants with an average of 3.6 years of postgraduate training and 56.5 temporal bone (TB) procedures participated. Each participant performed a mastoidectomy on human cadaveric TB and five 3D printed TBs of different materials. After drilling each unique material, participants completed surveys to assess each model's appearance and physical likeness on a Likert scale from 0 to 10 (0 = poorly representative, 10 = completely life-like). The 3D models were acquired by computed tomography (CT) imaging and segmented using 3D Slicer software.

Results: Polyethylene terephthalate (PETG) had the highest average survey response for haptic feedback (HF) and appearance, scoring 8.3 (SD = 1.7) and 7.6 (SD = 1.5), respectively. The remaining plastics scored as follows for HF and appearance: polylactic acid (PLA) averaged 7.4 and 7.6, acrylonitrile butadiene styrene (ABS) 7.1 and 7.2, polycarbonate (PC) 7.4 and 3.9, and nylon 5.6 and 6.7.

Conclusion: A PETG 3D printed temporal bone models performed the best for realistic appearance and HF as compared with PLA, ABS, PC, and nylon. The PLA and ABS were reliable alternatives that also performed well with both measures.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0003489418764987DOI Listing
May 2018

Outcomes From Lateral Eyelid Coupling for Facial Paralysis Using the Modified Tarsoconjunctival Flap.

JAMA Facial Plast Surg 2018 Sep;20(5):381-386

Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento.

Importance: In the setting of facial paralysis, inadequate eyelid closure and lower eyelid ectropion can lead to corneal exposure and impaired quality of life. Repair of paralytic ectropion is challenging, and an ideal surgical approach for all cases has not been identified.

Objective: To assess the patient-reported outcomes and eyelid position improvement in patients with flaccid facial paralysis undergoing lateral eyelid coupling with a tarsal strip canthoplasty and modified tarsoconjunctival flap to correct eyelid malposition.

Design, Setting, And Participants: Review of medical records of adults with flaccid facial paralysis who underwent a single-stage tarsal strip canthoplasty and modified tarsoconjunctival flap at a tertiary academic center. Inclusion criteria included a minimum of 3 months of follow-up.

Intervention: The lateral upper and lower eyelid are coupled with the hybrid tarsoconjunctival flap.

Main Outcomes And Measures: Patient-reported outcome measures and objective photograph analysis. Preoperative and postoperative Facial Clinimetric Evaluation (FaCE) scores and Moe Ectropion Grading Scale scores were compared. The relationship between radiation therapy (RT) and outcomes was analyzed.

Results: Sixteen patients (8 [50%] female; mean [SD] age at surgery, 71.5 [9.6] years) were identified between January 2014 and August 2017. Twelve (75%) had paralysis from facial nerve sacrifice during cancer ablation. The mean time between paralysis and referral for surgical repair of ectropion was 23 months (range, 0-151 months) and mean follow-up after surgery was 9.8 months (range, 3-39 months). The most common symptom was epiphora, which was significantly reduced after surgery (75% vs 25%; P = .01). Median Moe Ectropion Grading Scale score improved from 3 (interquartile range, 2-3) to 0 (interquartile range, 0-1; P < .001). Quality of life measured using the FaCE scale demonstrated a significant improvement in mean eye comfort (from 18.8 [95% CI, 2.3-35.2] to 47.9 [95% CI, 31.9-63.9]; P = .01) and lacrimal control scores (from 12.5 [95% CI, 0-29.2] to 45.8 [95% CI, 29.3-62.3]; P = .03) in the 6 patients in the RT group, but no difference in the 4 patients in the non-RT group.

Conclusions And Relevance: Ocular symptoms, eyelid appearance, and quality of life were improved after lateral eyelid coupling among patients with flaccid facial paralysis and paralytic ectropion. The tarsoconjunctival flap does limit peripheral vision, but is reversible if dynamic eyelid closure is returned with nerve grafting.

Level Of Evidence: 4.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamafacial.2018.0070DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6233623PMC
September 2018

3D Printing: current use in facial plastic and reconstructive surgery.

Curr Opin Otolaryngol Head Neck Surg 2017 Aug;25(4):291-299

Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, CA, USA.

Purpose Of Review: To review the use of three-dimensional (3D) printing in facial plastic and reconstructive surgery, with a focus on current uses in surgical training, surgical planning, clinical outcomes, and biomedical research. To evaluate the limitations and future implications of 3D printing in facial plastic and reconstructive surgery.

Recent Findings: Studies reviewed demonstrated 3D printing applications in surgical planning including accurate anatomic biomodels, surgical cutting guides in reconstruction, and patient-specific implants fabrication. 3D printing technology also offers access to well tolerated, reproducible, and high-fidelity/patient-specific models for surgical training. Emerging research in 3D biomaterial printing have led to the development of biocompatible scaffolds with potential for tissue regeneration in reconstruction cases involving significant tissue absence or loss. Major limitations of utilizing 3D printing technology include time and cost, which may be offset by decreased operating times and collaboration between departments to diffuse in-house printing costs SUMMARY: The current state of the literature shows promising results, but has not yet been validated by large studies or randomized controlled trials. Ultimately, further research and advancements in 3D printing technology should be supported as there is potential to improve resident training, patient care, and surgical outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MOO.0000000000000373DOI Listing
August 2017

Cleft Septorhinoplasty: Form and Function.

Facial Plast Surg Clin North Am 2017 May;25(2):223-238

Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, UC Davis Medical Center, 2521 Stockton Boulevard, Suite 7200, Sacramento, CA 95817, USA. Electronic address:

Nasal deformity associated with typical cleft lip can cause aesthetic and functional issues that are difficult to address. The degree of secondary nasal deformity is based on the extent of the original cleft deformity, growth over time, and any prior surgical correction to the nose or lip. Repair and reconstruction of these deformities require comprehensive understanding of embryologic growth, the cleft anatomy, as well as meticulous surgical technique and using a spectrum of structural grafting. This article reviews cleft lip nasal deformity, presurgical care, primary cleft rhinoplasty, and definitive cleft septorhinoplasty with a focus on aesthetics and function.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.fsc.2016.12.011DOI Listing
May 2017

Evidence-based Medicine in Facial Plastic Surgery: Current State and Future Directions.

Facial Plast Surg Clin North Am 2016 Aug;24(3):265-74

Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA. Electronic address:

Evidence-based medicine (EBM) encompasses the evaluation and application of best available evidence, incorporation of clinical experience, and emphasis on patient preference and values. Different scales are used to rate levels of evidence. Translating available data for interventions to clinical practice guidelines requires an assessment of both the quality of evidence and the strength of recommendation. Essential to the practice of EBM is evaluating the effectiveness of an intervention through outcome measures. This article discusses principles essential to EBM, resources commonly used in EBM practice, and the strengths and limitations of EBM in facial plastic and reconstructive surgery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.fsc.2016.03.005DOI Listing
August 2016

Orbital reconstruction.

Curr Opin Otolaryngol Head Neck Surg 2015 Oct;23(5):388-92

Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA.

Purpose Of Review: Post-traumatic orbital reconstruction is a complex issue that involves both the soft tissue and bony injury. The current literature focuses primarily on bony reconstruction, with fewer investigators evaluating soft-tissue injuries. This article will review recent advances in orbital reconstruction, including presurgical planning software, intra-operative navigation, patient-specific implants, and intra-operative imaging.

Recent Findings: Traditional techniques for diagnosis and orbital injuries continue to be refined; however, advances in computer-aided surgery are allowing surgeons to significantly improve the anatomic accuracy of orbital reconstruction.

Summary: While not all surgeons currently have access to computer-aided applications for orbital reconstruction, these techniques will continue to be refined, resulting in lower cost and greater access.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MOO.0000000000000190DOI Listing
October 2015

Developing a Novel Speech Intervention iPad Game for Children With Cleft Palate: A Pilot Study.

JAMA Facial Plast Surg 2015 Jul-Aug;17(4):309-11

Department of Otolaryngology-Head and Neck Surgery, University of California Davis Medical Center, Sacramento.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamafacial.2015.0164DOI Listing
March 2016

Organelle membrane proteomics reveals differential influence of mycobacterial lipoglycans on macrophage phagosome maturation and autophagosome accumulation.

J Proteome Res 2011 Jan 16;10(1):339-48. Epub 2010 Dec 16.

College of Life Sciences, Nankai University, Tianjin 300071, China.

The mycobacterial cell wall component lipoarabinomannan (LAM) has been described as one of the key virulence factors of Mycobacterium tuberculosis. Modification of the terminal arabinan residues of this lipoglycan with mannose caps in M. tuberculosis or with phosphoinositol caps in Mycobacterium smegmatis results in distinct host immune responses. Given that M. tuberculosis typically persists in the phagosomal vacuole after being phagocytosed by macrophages, we performed a proteomic analysis of that organelle after treatment of macrophages with LAMs purified from the two mycobacterial species. The quantitative changes in phagosomal proteins suggested a distinct role for mannose-capped LAM in modulating protein trafficking pathways that contribute to the arrest of phagosome maturation. Enlightened by our proteomic data, we performed further experiments to show that only the LAM from M. tuberculosis inhibits accumulation of autophagic vacuoles in the macrophage, suggesting a new function for this virulence-associated lipid.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1021/pr100688hDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3018347PMC
January 2011

Membrane proteomics of phagosomes suggests a connection to autophagy.

Proc Natl Acad Sci U S A 2008 Nov 29;105(44):16952-7. Epub 2008 Oct 29.

Department of Chemistry, Howard Hughes Medical Institute, University of California, Berkeley, CA 94720, USA.

Phagocytosis is the central process by which macrophage cells internalize and eliminate infectious microbes as well as apoptotic cells. During maturation, phagosomes containing engulfed particles fuse with various endosomal compartments through the action of regulatory molecules on the phagosomal membrane. In this study, we performed a proteomic analysis of the membrane fraction from latex bead-containing (LBC) phagosomes isolated from macrophages. The profile, which comprised 546 proteins, suggests diverse functions of the phagosome and potential connections to secretory processes, toll-like receptor signaling, and autophagy. Many identified proteins were not previously known to reside in the phagosome. We characterized several proteins in LBC phagosomes that change in abundance on induction of autophagy, a process that has been previously implicated in the host defense against microbial pathogens. These observations suggest crosstalk between autophagy and phagocytosis that may be relevant to the innate immune response of macrophages.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1073/pnas.0809218105DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2579359PMC
November 2008