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PURPOSE: Release of the orbicularis retaining ligament (ORL) has been advocated as a technique to address tear trough deformities. This study sought to compare the effectiveness and morbidity of lower blepharoplasty with and without ORL release. METHODS: Retrospective chart review of 53 lower blepharoplasty patients. Twenty-six patients had ORL release and 27 patients did not. Three independent masked experienced cosmetic surgeons reviewed preoperative and postoperative photographs to assess degree of swelling, ecchymosis, change in steatoblepharon and tear trough deformity, and overall aesthetic result. RESULTS: There were no significant differences in overall aesthetic result, change in steatoblepharon or tear trough deformity, and postoperative ecchymosis in patients who had ORL release compared with those who did not. Patients who had ORL release had postoperative swelling and chemosis of significantly longer duration and a higher likelihood of developing postoperative ectropion. CONCLUSIONS: Orbicularis retaining ligament release does not appear to result in additional aesthetic benefit in lower blepharoplasty patients and may increase morbidity in the form of ectropion and prolonged swelling and chemosis.
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Blefaroplastia/métodos , Párpados/cirugía , Ligamentos/cirugía , Adulto , Anciano , Ectropión/etiología , Estética , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Estudios RetrospectivosRESUMEN
OBJECTIVE: To elucidate the progression of angioedema of the head and neck with routine management and to assess the utility of serial physical exams and fiberoptic laryngoscopy in its management. METHODS: This study was a prospective observational research. From 2013 to 2014, a prospective observational study was conducted at a tertiary referral center. Forty patient were approached, 7 refused, 33 (18-90 years old) were enrolled. Patients presented with angioedema involving the head and neck over a 12 month period were asked to participate in the study. Physical examination and fiberoptic laryngoscopy were performed at presentation and then repeated at least 1 h later. RESULTS: Thirty-three patients with head and neck angioedema from any cause were enrolled (mean age 58, range 23-89 years). The upper lip was the most commonly involved site (58%). On reevaluation, 82% of patients reported subjective improvement in symptoms. The association between subjective improvement and the physical exam, including fiberoptic laryngoscopy findings, was statistically significant (P < 0.001). CONCLUSION: In stable patients with angioedema of any head and neck subsite, self-reported symptoms are associated with clinical stability or improvement as assessed by physical signs and fiberoptic laryngoscopy. Patients' symptoms may be an appropriate surrogate to monitor clinical status without the need for routine serial physical examinations or fiberoptic laryngoscopy, though further study is needed.
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OBJECTIVE: This study aimed to determine the duration of use, presentation, and management of angiotensin converting enzyme (ACE) inhibitor-related angioedema patients at an urban academic medical center. METHODS: Retrospective chart review. RESULTS: Eighty-eight patients who presented with ACE inhibitor-related angioedema between January 1, 2012, and December 31, 2012, were identified. They presented anywhere from 1 day to 20 years after starting an ACE inhibitor. About half the patients (50.7%) presented after taking an ACE inhibitor for at least 1 year. Fifty-five patients were female (62.5%). Twenty-eight patients (31.8%) had an airway intervention with 27 intubated and 1 requiring cricothyroidotomy. Six patients were intubated after more than 1 flexible laryngoscopy. The percentage of patients with involvement of the face, lips, tongue, floor of mouth, soft palate/uvula, and larynx were 12.5%, 60.2%, 39.7%, 6.8%, 17.0%, and 29.5%, respectively. Sixty-eight percent of patients with laryngeal edema were intubated. The majority of patients were treated with a corticosteroid and H1 and H2 receptor antagonists. CONCLUSION: Angioedema can occur at any time after starting ACE inhibitor use, with nearly half occurring after 1 year of use. Laryngeal involvement occurred in a minority of patients, but most of these patients were felt to require airway protection.
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Angioedema , Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Antialérgicos/administración & dosificación , Edema Laríngeo , Laringoscopía/métodos , Procedimientos Quirúrgicos Otorrinolaringológicos/métodos , Centros Médicos Académicos/estadística & datos numéricos , Manejo de la Vía Aérea/métodos , Angioedema/inducido químicamente , Angioedema/complicaciones , Angioedema/diagnóstico , Angioedema/fisiopatología , Angioedema/terapia , Inhibidores de la Enzima Convertidora de Angiotensina/administración & dosificación , Inhibidores de la Enzima Convertidora de Angiotensina/clasificación , Femenino , Hospitales Urbanos/estadística & datos numéricos , Humanos , Intubación Intratraqueal/métodos , Edema Laríngeo/diagnóstico , Edema Laríngeo/etiología , Edema Laríngeo/fisiopatología , Edema Laríngeo/cirugía , Masculino , Persona de Mediana Edad , Pennsylvania , Estudios Retrospectivos , Factores de Riesgo , Factores de TiempoRESUMEN
BACKGROUND: Vibration anesthesia is an effective pain-reduction technique for facial cosmetic injections. The analgesic effect of this method was tested in this study during facial dermal filler injections. The study aimed to evaluate the safety and efficacy of vibration anesthesia for these facial injections. METHODS: This prospective study analyzed 41 patients who received dermal filler injections to the nasolabial folds, tear troughs, cheeks, and other facial sites. The injections were administered in a randomly assigned split-face design. One side of the patient's face received vibration together with dermal filler injections, whereas the other side received dermal filler injections alone. The patients completed a posttreatment questionnaire pertaining to injection pain, adverse effects, and preference for vibration with future dermal filler injections. RESULTS: The patients experienced both clinically and statistically significant pain reduction when a vibration stimulus was co-administered with the dermal filler injections. No adverse events were reported. The majority of the patients (95 %) reported a preference for vibration anesthesia with subsequent dermal filler injections. CONCLUSIONS: Vibration is a safe and effective method of achieving anesthesia during facial dermal filler injections. 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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Anestesia/métodos , Técnicas Cosméticas , Ácido Hialurónico/farmacología , Dolor/prevención & control , Rejuvenecimiento/fisiología , Vibración/uso terapéutico , Adulto , Anciano , Análisis de Varianza , Femenino , Estudios de Seguimiento , Humanos , Inyecciones Subcutáneas , Surco Nasolabial , Dimensión del Dolor , Estudios Prospectivos , Medición de Riesgo , Envejecimiento de la Piel/efectos de los fármacos , Estadísticas no Paramétricas , Resultado del TratamientoRESUMEN
Purpose The sphenoid sinus is a complex structure with key variations that are important for endoscopic parasellar approaches. In this study, high-resolution computed tomography (HRCT) scans were analyzed for the frequency of these variations. Methods A retrospective radiographic analysis was conducted on patients undergoing HRCT between July 2008 and September 2010. Results Sphenoid sinus pneumatization was defined as conchal, presellar, sellar, and postsellar based on pneumatization relative to the anterior and posterior face of the sella. The distribution ranged from 1.8%, 7.3%, 47.6%, and 43.3%, respectively. We found a greater preponderance of sellar and postsellar variation than previously reported. No differences were found in regard to age, gender, and ethnicity (African American, Caucasian, Asian, and Hispanic) (p > 0.05). The prevalence of optic nerve, maxillary nerve, and internal carotid artery protrusion was 26.1%, 25.9%, and 28.2%, respectively, and dehiscence was 2.1%, 7.4%, and 2.9%, respectively. Accessory septae were present in 43.5% of cases. A lateral recess was identified in 72.4% and clinoid pneumatization in 20% of patients. Conclusion This study demonstrates a greater prevalence of sphenoid sinus pneumatization and variations than previously reported. This has important implications in terms of preparation and anticipation of possible variations to avoid complications.
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OBJECTIVES/HYPOTHESIS: Onodi cells are the posterior-most ethmoid air cells that lie superior to the sphenoid sinus. Identification of these cells is essential prior to endoscopic sinus and skull base surgery due to their intricate relationship with the optic nerves and carotid arteries, which may lead to deleterious complications. In this study, high-resolution computed tomography (HRCT) scans from 170 adult-patients were analyzed by two independent observers for the presence of Onodi cells. STUDY DESIGN: Radiographic analysis at a tertiary care medical center. METHODS: A retrospective analysis was performed on patients undergoing HRCT between July 2008 and September 2010. Incidence of Onodi cells and demographic data were collected. RESULTS: The overall prevalence of Onodi cells in this cohort was 65.3%. Subgroup analysis based on ethnicity showed a rate of Onodi cells of 83.3% in Asians, 73.1% in whites, 57.0% in African Americans, and 62.7% in Hispanics. The prevalence of Onodi cells was not significantly different among the different ethnicities (P > .05). However, this was limited by a small sample size in some ethnic groups. Onodi cell prevalence was equivalent among males and females: 62.2% and 63.5% respectively (P > .05). Overall, our results show a greater prevalence of Onodi cells than previously reported. CONCLUSIONS: We found a higher prevalence of Onodi cells in our cohort than previously reported in the literature. Therefore, it is important for surgeons to anticipate the presence of these cells during endoscopic sinus and skull base procedures to prevent potential complications.
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Senos Etmoidales/citología , Senos Etmoidales/diagnóstico por imagen , Seno Esfenoidal/citología , Seno Esfenoidal/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenRESUMEN
Quantification of two types of nucleic acids [double-stranded (ds-) and single-stranded (ss-) DNA] was performed to understand the distribution of DNA within the epidermal strata and to examine the effects of DNA structure on gene expression, viz., apoptosis and terminal differentiation. In addition, we examined the precise starting point of cell death within the epidermis (suprabasal layer); examined how DNA structure affects gene expression of melanocytes; and characterized the "transitional cells" located between the stratum granulosum and stratum corneum, viz., epidermal phase transition zone (EPTZ). Ultrasensitive anti-DNA antibody probes (ds-DNA, ss-DNA), the Feulgen reaction, histological stains (morphological characterization) and the terminal deoxyribonucleotidyl transferase (TUNEL) assay (apoptosis) were used to characterize cell death in normal human epidermis. This study characterized, for the first time, the deterioration of right-handed ds-B-DNA and the increase in denatured ss-DNA during epidermal maturation. For the first time, this approach also allowed for the quantitative and qualitative characterization of DNA content and structure in all epidermal strata, using anti-ds-B-DNA and anti-ss-DNA antibodies. In order to improve the retention and quality of DNA, a novel histotechnological processing procedure was used. The results indicate that the largest decline in DNA occurred within the stratum granulosum, followed by the EPTZ, and the stratum spinosum. Not all epidermal nuclei lost DNA, indicating two differentiating keratinocyte pathways, viz., apoptotic and non-apoptotic. Both pathways united in the stratum granulosum. These results suggest that keratinocyte terminal differentiation and apoptosis are distinct cellular events, cell death begins earlier than expected, and molecular epidermal events take place in a gradual and orderly manner within keratinocytes. During maturation, ds-B-DNA decreases as ss-DNA increases. Therefore, during differentiation of keratinocytes, both DNA content and DNA structure are altered.
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Apoptosis , ADN de Cadena Simple/metabolismo , Epidermis/fisiología , Adulto , Diferenciación Celular , Núcleo Celular/metabolismo , ADN de Cadena Simple/análisis , Células Epidérmicas , Epidermis/química , Humanos , Queratinocitos/citología , Queratinocitos/fisiología , Desnaturalización de Ácido NucleicoRESUMEN
Histotechnological processing of DNA can cause damage to and loss of DNA and can change its structure. DNA probes have severe tissue-staining limitations. New DNA probes and improved histotechnology are needed to enhance the characterization of fixed tissue-bound DNA. Our team developed a novel DNA staining technique and histotechnological processing procedure that improves tissue-bound DNA retention and the qualification and quantification of intact double-stranded (ds)-B-DNA. We used the ultrasensitive PicoGreen ds-DNA probe for the histochemical characterization of ds-DNA. Fifteen fixatives were examined to determine which were best for preventing DNA denaturation and retaining original DNA content and structures. Our use of a microwave-vacuum oven reduced heating temperatures, shortened heating and processing times, and enhanced fixation. We achieved better qualitative and quantitative results by using superior tissue-acquisition techniques (e.g., reduced prefixation times) and improved histotechnology. We also compared our novel approach with archival tissues, delayed fixation, less sophisticated and conventional histological processing techniques, and by experimenting with preservation of tissue-bound ds-Z-DNA. Results demonstrate that our histotechnological procedure and nucleic acid staining method significantly improve the retention of intact, undamaged ds-DNA which, in turn, allows the investigator to more precisely quantify the content and structures of unaltered and undamaged tissue-bound ds-B-DNA.