RESUMEN
BACKGROUND: The aim of this study was to investigate the use of the terms "plastic surgeon" or "cosmetic surgeon" in British newspapers. METHODS: Based on readership volume, the top eight British newspapers were searched for articles written between 09/2016-09/2021 for their use of keywords "plastic surgeon" OR "cosmetic surgeon". The names of the doctors referenced were searched in the GMC register to determine their speciality registration. RESULTS: A total of 2326 articles were read. 2107 (91%) articles were excluded as they did not refer to a specifically named doctor. Of the 219 articles remaining, 136 referenced "plastic surgeons". 22 (16%) doctors referred to as "plastic surgeons" were not on the GMC speciality register for plastic surgery. 83 articles made reference to "cosmetic surgeons". 39 (47%) were on the plastic surgery register but 11 (13%) were on other higher surgical registers [ENT (2) and ophthalmology (9)]. 18 (22%) cosmetic surgeons were registered as GPs and 15 (18%) were not on any speciality register. DISCUSSION: There is mis-representation of individuals performing cosmetic procedures as plastic surgeons regardless of their speciality or training. This prevents public awareness of the true scope of plastic and reconstructive surgery as a speciality in its own right.
Asunto(s)
Procedimientos de Cirugía Plástica , Cirujanos , Cirugía Plástica , HumanosRESUMEN
Three-dimensional surgical planning is used widely in orthognathic surgery. Although numerous computer programs exist, the accuracy of soft tissue prediction remains uncertain. The purpose of this study was to compare the prediction accuracy of Dolphin, ProPlan CMF, and a probabilistic finite element method (PFEM). Seven patients (mean age 18years; five female) who had undergone Le Fort I osteotomy with preoperative and 1-year postoperative cone beam computed tomography (CBCT) were included. The three programs were used for soft tissue prediction using planned and postoperative maxillary position, and these were compared to postoperative CBCT. Accurate predictions were obtained with each program, indicated by root mean square distances: RMSDolphin=1.8±0.8mm, RMSProPlan=1.2±0.4mm, and RMSPFEM=1.3±0.4mm. Dolphin utilizes a landmark-based algorithm allowing for patient-specific bone-to-soft tissue ratios, which works well for cephalometric radiographs but has limited three-dimensional accuracy, whilst ProPlan and PFEM provide better three-dimensional predictions with continuous displacements. Patient or population-specific material properties can be defined in PFEM, while no soft tissue parameters are adjustable in ProPlan. Important clinical considerations are the topological differences between predictions due to the three algorithms, the non-negligible influence of the mismatch between planned and postoperative maxillary position, and the learning curve associated with sophisticated programs like PFEM.
Asunto(s)
Delfines , Cirugía Ortognática , Procedimientos Quirúrgicos Ortognáticos , Adolescente , Animales , Cefalometría , Tomografía Computarizada de Haz Cónico , Cara , Femenino , Análisis de Elementos Finitos , Humanos , Imagenología Tridimensional , Osteotomía Le FortRESUMEN
INTRODUCTION: Head and neck sarcomas are rare and difficult to manage surgically. Factors that influence the prognosis include the type and grade of tumour, resection margins, the anatomical site and patient-specific parameters. We review our experience as plastic surgeons working in a bone and soft-tissue tumour multidisciplinary team (MDT) in managing these tumours surgically. METHODS: Data on all patients with sarcoma of the head or neck managed surgically from 2004 to 2015 was reviewed. Demographics, surgical details and outcomes were analysed. RESULTS: Forty-nine patients underwent surgery for sarcoma of the head or neck. The mean age at presentation was 53.1 years (range 0.5-92). Histological diagnosis was varied. Leiomyosarcoma (n = 6), angiosarcoma (n = 9), synovial sarcoma (n = 4), sarcoma of no specific type (n = 5) and rhabdomyosarcoma (n = 5) were the most frequently seen tumours. All sarcomas were treated by wide excision. Excision margins were histologically complete in the vast majority (n = 43). Reconstruction was undertaken as follows: direct closure (n = 12), local flap ± skin graft (n = 12), free tissue transfer (n = 21), pedicled flap ± skin graft (n = 3) and skin graft (n = 1). Twelve patients received adjuvant chemotherapy and fifteen patients received adjuvant radiotherapy. Eleven patients developed local recurrence and 10 patients developed metastasis. Twelve patients died of their disease: mean survival period was 17 months (range 8-28 months). The mean duration of follow-up was 78 months (range 18-137 months). Estimated 5-year disease-specific survival for this cohort was 72% and overall estimated survival was 61% (Kaplan-Meier equation). CONCLUSION: Head and neck sarcomas are rare and challenging to manage. Successful outcomes can be achieved by early, aggressive resection and appropriate reconstruction within the specialist MDT setting.
Asunto(s)
Neoplasias de Cabeza y Cuello/cirugía , Sarcoma/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Neoplasias de Cabeza y Cuello/mortalidad , Neoplasias de Cabeza y Cuello/patología , Humanos , Lactante , Masculino , Persona de Mediana Edad , Procedimientos de Cirugía Plástica , Estudios Retrospectivos , Sarcoma/mortalidad , Sarcoma/patología , Colgajos Quirúrgicos , Tasa de Supervivencia , Resultado del Tratamiento , Reino Unido , Adulto JovenRESUMEN
This report discusses a case of spontaneous pneumomediastinum in a 25-year-old medical student. The patient presented with chest pain and a tonal change in voice. Symptoms occurred after an episode of stretching and were exacerbated by coughing. There was no history of underlying respiratory disease and he was a non-smoker. Management was conservative. At the four-week follow-up appointment, bronchoscopy and computed tomography of the thorax demonstrated complete resolution. Spontaneous pneumomediastinum is uncommon, with rhinolalia being a rare presenting feature. It should be considered as a differential diagnosis in patients with chest pain associated with a change in voice. A detailed history may reveal preceding activities associated with raised intrathoracic pressure.