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Aesthetic Plastic Surgery Aug 2022Temporoparietal fascia is important for auricular reconstruction or repair after auricular reconstruction. Thus, the course of the superficial temporal artery (STA) is...
OBJECTIVE
Temporoparietal fascia is important for auricular reconstruction or repair after auricular reconstruction. Thus, the course of the superficial temporal artery (STA) is of vital importance to prevent destruction of the artery. The purpose of this study was to evaluate the course of the superficial temporal artery in patients with congenital microtia and its relationship with remnants.
METHODS
This was a prospective study. Patients with microtia who underwent auricular reconstruction in our hospital from January 2021 to July 2021 underwent ultrasound examination of the STA. Under the guidance of ultrasound, the superficial temporal artery and its branches were located and marked on the body surface before the operation, ranging from the zygomatic arch plane to the temporal parietal artery. In addition, the hemodynamics of the STAs were recorded.
RESULTS
A total of 108 patients with microtia were collected, including 106 patients with unilateral microtia and 2 patients with bilateral microtia. There were 82 cases of lobule type, 21 cases of small concha type, and 7 cases of large concha type. The superficial temporal artery in 103 ears was divided into two branches: the parietal branch and the frontal branch, but there was only one branch in 7 ears. The parietal branch was absent in 5 cases, and the frontal branch was absent in 2 cases. In most of the ears, the bifurcation was located above the zygomatic arch plane. Only in 2 ears was the bifurcation located below the zygomatic arch, and the most common bifurcation position was the eyebrow arch level (43.7%). Regarding the shortest distances between the STA and the remnant, they were less than 0.5 cm in 47 ears, more than 1 cm in 30 ears, and 0.5 cm to 1 cm in 33 ears.
CONCLUSION
The course of STA varied greatly and there were occasional single branches. The distances between the STA and remnant were often near 0.5 cm by ultrasonography. Therefore, when removing the remnant and separating the pocket, care should be taken to avoid arterial injury.
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 .
Topics: Congenital Microtia; Ear Auricle; Humans; Prospective Studies; Plastic Surgery Procedures; Temporal Arteries; Zygoma
PubMed: 35386006
DOI: 10.1007/s00266-022-02802-0 -
BMC Cardiovascular Disorders Nov 2023The impact of sex hormones on right and left auricular contractile apparatus function is largely unknown. We evaluated the impact of sex hormones on left and right heart...
BACKGROUND
The impact of sex hormones on right and left auricular contractile apparatus function is largely unknown. We evaluated the impact of sex hormones on left and right heart contractility at the level of myocardial filaments harvested from left and right auricles during elective coronary artery bypass surgery.
METHODS
150 patients (132 male; 18 female) were enrolled. Preoperative testosterone and estradiol levels were measured with Immunoassay. Calcium induced force measurements were performed with left- and right auricular myofilaments in a skinned fiber model. Correlation analysis was used for comparison of force values and levels of sex hormones and their ratio.
RESULTS
Low testosterone was associated with higher top force values in right-sided myofilaments but not in left-sided myofilaments for both sexes (p = 0.000 in males, p = 0.001 in females). Low estradiol levels were associated with higher top force values in right-sided myofilaments (p 0.000) in females and only borderline significantly associated with higher top force values in males (p 0.056). In females, low estradiol levels correlated with higher top force values in left sided myofilaments (p 0.000). In males, higher Estradiol/Testosterone ratio (E/T ratio) was only associated with higher top force values from right auricular myofilaments (p 0.04) In contrast, in females higher E/T ratio was associated with lower right auricular myofilament top force values (p 0.03) and higher top force values in left-sided myofilaments (p 0.000).
CONCLUSIONS
This study shows that patients' comorbidities influence left and right sided contractility and may blur results concerning influence of sex hormones if not eliminated. A sex hormone dependent influence is obvious with different effects on the left and right ventricle. The E/T ratio and its impact on myofilament top force showed divergent results between genders, and may partially explain gender differences in patients with cardiovascular disease.
Topics: Humans; Male; Female; Myofibrils; Testosterone; Estradiol; Coronary Artery Bypass; Gonadal Steroid Hormones
PubMed: 37925416
DOI: 10.1186/s12872-023-03582-4 -
Medicine Apr 2022With the advantages of miniature damage and optimal effectiveness, percutaneous coronary intervention (PCI) has been performed in a large number of coronary artery...
BACKGROUND
With the advantages of miniature damage and optimal effectiveness, percutaneous coronary intervention (PCI) has been performed in a large number of coronary artery disease patients. However, recent studies have indicated a higher incidence of depression on post-PCI patients. Acupuncture therapy is effective for depression. As a form of acupuncture, the auricular acupuncture has been used to relieve symptoms in patients with post-PCI depression, but its effectiveness and safety have not yet reached a definitive conclusion. Therefore, this systematic review and meta-analysis protocol is planned to evaluate the efficacy and safety of auricular acupuncture for depression in post-PCI patients.
METHODS
Six English databases (PubMed, Web of Science, MEDLINE, EMBASE, Springer Cochrane Library, and WHO International Clinical Trials Registry Platform) and 4 Chinese databases (Wan Fang Database, Chinese Scientific Journal Database, China National Knowledge Infrastructure Database, and Chinese Biomedical Literature Database) will be searched normatively according to the rule of each database from the inception to February 1, 2022. Two reviewers will independently conduct article selection, data collection, and risk of bias evaluation. Any disagreement will be resolved by discussion with the third reviewer. Either the fixed-effects or random-effects model will be used for data synthesis based on the heterogeneity test. The change in the scores on the Hamilton Depression Scale and the Self-rating Depression Scale will be used as the main outcome measure. All-cause mortality, cardiac mortality, major adverse cardiovascular events, rehospitalisation rate, and Quality of Life Scale as the secondary outcome. Treatment Emergent Symptom Scale, general physical examination (temperature, pulse, respiration, blood pressure), routine examination of blood, urine and stool, electrocardiogram, liver and kidney function examination as the security indexes. RevMan 5.3.5 will be used for meta-analysis.
RESULTS
This study will provide high-quality evidence to assess the efficacy and safety of auricular acupuncture for depression in post-PCI patients.
CONCLUSION
This systematic review will explore whether auricular acupuncture is an effective and safe intervention for depression in post-PCI patients.
INPLASY REGISTRATION NUMBER
INPLASY202230003.
Topics: Acupuncture, Ear; Depression; Humans; Meta-Analysis as Topic; Percutaneous Coronary Intervention; Quality of Life; Systematic Reviews as Topic
PubMed: 35475802
DOI: 10.1097/MD.0000000000029173 -
Annals of Plastic Surgery Sep 2021Various local techniques have been successfully used for the reconstruction of auricular defects. However, most local techniques are not suitable for extensive auricular...
BACKGROUND
Various local techniques have been successfully used for the reconstruction of auricular defects. However, most local techniques are not suitable for extensive auricular defects. The aim of this study is to investigate the utility of a retroauricular artery perforator-based propeller flap for the reconstruction of extensive auricular defects by evaluating aesthetic outcomes using objective and quantitative parameters.
METHODS
Twenty-one patients with extensive full-thickness and partial-thickness defects were treated with retroauricular artery perforator-based propeller flaps harvested from the mastoid and neck regions. The surgical procedures were performed using single-stage reconstruction in postauricular partial-thickness defects and 2-stage reconstruction in full-thickness auricular defects. Levels of final satisfaction and tissue matching as well as donor scar perception were evaluated by the patients and objective observers.
RESULTS
The original sizes and projections of the auricles were achieved. The color, texture, and thickness of the flaps matched well with the adjacent auricles. The vast majority of the patients and observers were very satisfied with the surgical outcome.
CONCLUSIONS
Retroauricular artery perforator-based propeller flaps may preserve the size and projection in both partial- and full-thickness extensive defects of the auricle. With this procedure, there was also excellent matching of the color, texture, and thickness of the flap with the adjacent tissue, as well as acceptable levels of donor scarring, thereby achieving satisfactory aesthetic outcomes.
Topics: Arteries; Ear Auricle; Ear, External; Humans; Perforator Flap; Plastic Surgery Procedures; Treatment Outcome
PubMed: 33625022
DOI: 10.1097/SAP.0000000000002753 -
Aesthetic Plastic Surgery Feb 2024Ophthalmic artery occlusion caused by facial hyaluronic acid filler injection has always been a rare but devastating complication. With the pursuit of beauty, people...
Ophthalmic artery occlusion caused by facial hyaluronic acid filler injection has always been a rare but devastating complication. With the pursuit of beauty, people have become more interested in ears and hyaluronic acid fillers. Herein, we report the case of a more serious rare complication of ophthalmic artery occlusion caused by ear filler injection. A 45-year-old woman developed vision loss on the left side immediately after receiving cosmetic hyaluronic acid injection in the ear, with only the visual field at the inferior temporal side remaining. She was diagnosed with central retinal artery occlusion in the left eye. After treatment with hyaluronidase injection, dexamethasone, hyperbaric oxygen, and oral alprostadil, blood flow was partially restored in the left ophthalmic artery, and her vision improved. Vascular complications after ear injections are rare. However, as the demand for ear filler injections increases, the probability of serious vascular complications is predicted to increase. The potential mechanism by which occlusion occurred involved the filler reaching the superficial temporal artery system through the superior auricular artery, thus occluding the ophthalmic artery. Having an understanding of anatomy is an important measure to avoid complications.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 .
PubMed: 38388798
DOI: 10.1007/s00266-024-03903-8 -
The Journal of Craniofacial Surgery Jun 2021Facial trauma can pose challenging reconstructive obstacles in both maintaining tissue viability and restoring aesthetic appearance. Medicinal leech therapy can help to...
Facial trauma can pose challenging reconstructive obstacles in both maintaining tissue viability and restoring aesthetic appearance. Medicinal leech therapy can help to promote vascular decompression in the setting of venous congestion. A retrospective chart review was conducted to identify patients who underwent medicinal leech therapy following venous stasis secondary to repair of a complex facial laceration. Three patients were identified; 2 suffered auricular avulsion, while 1 suffered a lip avulsion. All patients suffered from venous congestion and underwent medicinal leech therapy for 48 to 72 hours with reduction of edema and stasis. Decompression was successfully achieved with no further sequelae on last follow-up. Medicinal leech therapy is an adequate treatment for venous congestion following traumatic soft-tissue repair of the face. The authors advocate for the utilization of medicinal leeches to combat venous congestion after repair, particularly when arterial inflow remains intact.
Topics: Animals; Humans; Lacerations; Leeches; Leeching; Retrospective Studies; Soft Tissue Injuries
PubMed: 33170826
DOI: 10.1097/SCS.0000000000007111 -
The Journal of Craniofacial SurgeryGlossopharyngeal neuralgia (GPN) is an uncommon facial pain syndrome and is characterized by paroxysms of excruciating pain in the distributions of the auricular and...
Glossopharyngeal neuralgia (GPN) is an uncommon facial pain syndrome and is characterized by paroxysms of excruciating pain in the distributions of the auricular and pharyngeal branches of cranial nerves IX and X. Glossopharyngeal neuralgia characterized by otalgia alone is rare. Herein, the authors analyzed 2 patients with GPN with otalgia as the main clinical manifestation. The clinical features and prognosis of this rare group of patients with GPN were discussed. They both presented with paroxysmal pain in the external auditory meatus and preoperative magnetic resonance imaging suggested the vertebral artery were closely related to the glossopharyngeal nerves. In both patients, compression of the glossopharyngeal nerve was confirmed during microvascular decompression, and the symptoms were relieved immediately after surgery. At 11 to 15 months follow-up, there was no recurrence of pain. A variety of reasons can cause otalgia. The possibility of GPN is a clinical concern in patients with otalgia as the main complaint. The authors think the involvement of the glossopharyngeal nerve fibers in the tympanic plexus via Jacobson nerve may provide an important anatomic basis for GPN with predominant otalgia. Surface anesthesia test of the pharynx and preoperative magnetic resonance imaging is helpful for diagnosis. Microvascular decompression is effective in the treatment of GPN with predominant otalgia.
Topics: Humans; Retrospective Studies; Earache; Glossopharyngeal Nerve Diseases; Glossopharyngeal Nerve; Pain; Microvascular Decompression Surgery
PubMed: 37418618
DOI: 10.1097/SCS.0000000000009521 -
Journal of Materials Chemistry. B Feb 2023It is challenging to stop bleeding effectively in patients treated with heparin which leads to enhanced risk of uncontrolled bleeding during operation. Herein, we report...
It is challenging to stop bleeding effectively in patients treated with heparin which leads to enhanced risk of uncontrolled bleeding during operation. Herein, we report an easy-to-use and heparin-tolerant hemostatic agent based on a thrombin-like cysteine enzyme (papain), which catalyzes the hydrolysis of fibrinogen and cross-linking of fibrin clots. A papain-based hemostat with increased procoagulant activity is developed through immobilizing papain on the cellulose carrier, which displays short clotting time in both normal and heparinized plasmas. The excellent hemostatic performance of the papain-based hemostat is further confirmed with reduced hemostatic time and limited blood loss in a mouse tail amputation model, rabbit auricular artery injury model and rat liver injury model, in which a natural coagulation system fails to function on account of heparin. This bio-hemostat has great potential to reverse the effect of heparin and stop topical hemorrhage rapidly in surgical procedures.
Topics: Mice; Rats; Animals; Rabbits; Heparin; Cysteine; Papain; Hemostatics; Blood Coagulation; Hemorrhage; Disease Models, Animal
PubMed: 36625414
DOI: 10.1039/d2tb02220f -
American Journal of Otolaryngology 2022The study was designed with the purpose of showing the potential advantages of the VITOM-3D assisted paramedian forehead flap for nasal reconstruction.
BACKGROUND
The study was designed with the purpose of showing the potential advantages of the VITOM-3D assisted paramedian forehead flap for nasal reconstruction.
METHODS
A 72 years-old female patient presented to our department with a wide left nasal defect. On her clinical history she referred a basal cell carcinoma of the left nasal skin treated with multiple excision in another center without reconstruction. On clinical examination, we observed the absence of the left nasal tip, columella, upper lateral and lower lateral cartilage. In our experience the paramedian forehead flap based on supratrochlear artery is a feasible reconstruction (Shokri, T., et al). The first surgeon (Dr. Placentino) along with the head and neck team decided to reconstruct the nasal defect assisted by the 3D 4 K exoscope (VITOM®; Karl Storz, Tuttlingen, Germany).
RESULTS
The goal of reconstruction is to carefully evaluate the nasal defects and rebuild the nose as close as possible to its original shape with the multilayer technique, creating the internal lining, the intermediate bony-cartilage structure and external skin. (Kim, I.A., et al). The exoscope allowed us to reconstruct the inner layer with the mucoperiostal septal flap, middle layer with auricular cartilage and the external skin through the elevation of the paramedian forehead flap. The flap is elevated from cranio-caudal direction including skin, subcutaneous tissue, frontalis muscle and associated fascia or periosteum. Donor site was primarily closed with the exception of a small defect. Post-operative period was uneventful, and after a period of 4 weeks when vascularization was complete, the patient underwent pedicle excision. At the recent 6 months follow-up, the flap had healed completely with the shape of nose restored with good symmetry.
CONCLUSION
High-definition (4 K), three-dimensional (3D) exoscope are being used to perform a growing number of head and neck surgeries (Bartkowiak, E., et al). However, the use of the 3D exoscope in the nasal reconstruction has not been previously described. In our opinion the potential advantages of this technique are, firstly, to achieve a better magnification and to improve the vision of anatomical structure that leads to a better functional and aesthetic result, secondly, to reduce surgical times. High-definition allowed us to highlight the scar tissue and preserve as much healthy tissue as possible. In addition, we underline the use of the exoscope for a better remodeling of cartilage.
Topics: Aged; Carcinoma, Basal Cell; Ear Cartilage; Female; Forehead; Humans; Nasal Septum; Nose; Nose Neoplasms; Rhinoplasty; Skin Neoplasms
PubMed: 35715292
DOI: 10.1016/j.amjoto.2022.103493 -
Acta Otorrinolaringologica Espanola 2023Unstable cavities are defined as cavities with cerumen accumulation that need frequent cavity cleaning in the out-patient clinic, cavities that are intolerant to water...
OBJECTIVE
Unstable cavities are defined as cavities with cerumen accumulation that need frequent cavity cleaning in the out-patient clinic, cavities that are intolerant to water due to risk of infection or that are subject to frequent infection and otorrhoea. The objective of this study is to address the problem of troublesome mastoid cavities, with the performance of secondary mastoid obliteration and canal wall reconstruction, using a novel posterior auricular artery (PAA) fascia-periosteum flap.
MATERIALS AND METHODS
A prospective study was designed, only secondary obliterations were included. Unstable mastoid cavities were defined as Merchant grade 2 or 3 and were included for surgery.
RESULTS
At 12 months of follow up, a complete external auditory canal (EAC) and a self-cleaning ear were achieved in all 23 patients. Completely dry ears were achieved in 21 patients (91.3%). An air-bone gap improvement of 5dB was achieved.
CONCLUSION
Mastoid obliteration and EAC reconstruction are effective procedures to treat troublesome post canal wall down mastoid cavities. They improve quality of life and enable patients to overcome ear discharge. A standard EAC size enables the utilization of conventional hearing aids, it also reduces the need for constant mastoid cleaning and decreases healthcare expenses. The PAA flap seems to be an effective procedure to achieve all these features, as it is used to obliterate the mastoid and becomes a structural component of the neo-EAC.
Topics: Humans; Periosteum; Mastoid; Prospective Studies; Quality of Life; Arteries; Fascia
PubMed: 36858782
DOI: 10.1016/j.otoeng.2021.07.006