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Botulinum Toxin in the Treatment of Facial Paralysis

Mehdizadeh, Omid B; Diels, Jacqueline; White, William Matthew
This article reviews the current literature supporting the use of botulinum toxin in producing symmetric facial features and reducing unwanted, involuntary movements. Methods, protocols, and adverse events are discussed. Additionally, the authors suggest that using botulinum toxin A therapy in postparalytic facial synkinesis can provide long-term results when used in conjunction with other treatment modalities.
PMID: 26611697
ISSN: 1558-1926
CID: 1857102

Current Concepts in the Use of PLLA: Clinical Synergy Noted with Combined Use of Microfocused Ultrasound and Poly-L-Lactic Acid on the Face, Neck, and Decolletage

Hart, Donna R; Fabi, Sabrina G; White, W Matthew; Fitzgerald, Rebecca; Goldman, Mitchel P
BACKGROUND: Aging of the face, neck, and decolletage is a multifactorial process involving epidermal photodamage and loss of soft tissue and bony volume. Multilevel rejuvenation of these areas can be obtained by enhancing volume restoration, neocollagenesis, and tissue contraction with combined efficacy of poly-L-lactic acid (PLLA) and microfocused ultrasound (MFU, Ultherapy) treatments. METHODS: The authors reviewed the use of PLLA and MFUs as collaborative modalities to improve the appearance of the face, neck, and decolletage. RESULTS: Experienced cosmetic dermatology centers deliver PLLA and MFU in a single session to target multiple tissue planes. CONCLUSIONS: Concurrent treatment with PLLA and MFUs can be performed efficiently and safely; however, additional research is needed to explore the synergistic effects of these treatments. Patients may also benefit from decreased overall downtime and necessary office visits.
PMID: 26441097
ISSN: 1529-4242
CID: 1793092

Nasal and Sinus Trauma

Chapter by: Immerman, Sara; Alexander, Ashlin; White, W Matthew
in: Encyclopedia of Otolaryngology, Head and Neck Surgery by Kountakis, Stilianos E [Eds]
Berlin, Heidelberg : Springer Berlin Heidelberg, 2013
pp. 1729-1742
ISBN: 3642234992
CID: 1808132

Reformatted computed tomography to assess the internal nasal valve and association with physical examination

Bloom, Jason D; Sridharan, Shaum; Hagiwara, Mari; Babb, James S; White, W Matthew; Constantinides, Minas
OBJECTIVES To assess the cross-sectional area and angle of the internal nasal valve more accurately by reformatting computed tomography (CT) scans of the nasal airway according to a more appropriate orientation than scans traditionally sectioned in the coronal plane and then to compare the results with clinical data on the nasal valve obtained from physical examination. METHODS We performed a retrospective review of the medical records of 24 rhinoplasty patients treated at a private practice facial plastic surgery office affiliated with a tertiary care university hospital. The patients had fine-cut (0.75-mm section) CT scans ordered for nasal airway obstruction or nasal valve compromise at the same institution. These patients were evaluated from January 1, 2000, through December 31, 2010. The previously acquired CT scans were reformatted to obtain sections through the internal nasal valve at a more appropriate orientation. The internal nasal valve cross-sectional area and valve angle were measured through a standardized section (1 cut immediately anterior to the head of the inferior turbinate) from the reformatted scans. The cross-sectional area was also measured through the same point on the traditionally oriented CT scan, and the values were compared. The results from each patient's scan were compared with data from the patient's medical record and analyzed against the patient's preoperative modified Cottle examination findings. RESULTS The CT scans oriented in the reformatted plane through the internal nasal valve provided a narrower valve angle than the traditionally oriented CT scans and more closely approximated the hypothesized true value of the internal nasal valve of 10 degrees to 15 degrees (P < .001). In a comparison of the same-side internal nasal valve angle and cross-sectional nasal valve area between the 2 different CT scan orientations, a statistically significant difference in the internal nasal valve angles between the 2 scan orientations was discovered, but this finding did not reach significance when distinguishing the nasal valve cross-sectional area. Finally, no correlation was found with regard to the preoperative modified Cottle maneuver scores for the internal nasal valve angle and cross-sectional valve area values in either scan orientation. CONCLUSIONS Precise preoperative evaluation of the internal nasal valve is critical to the workup for reconstruction or repair of problems that involve this area. Although tools such as acoustic rhinometry exist to evaluate the cross-sectional area of the nasal valve, many rhinoplasty surgeons do not have access to this expensive equipment. A CT scan with reformatting in the proper plane of the internal nasal valve can provide the surgeon with improved anatomical information to assess that region. With this in mind, however, the surgeon should always perform a thorough preoperative physical examination and treat the patient and his or her symptoms, not the imaging studies, when considering a candidate for a surgical intervention.
PMID: 22986939
ISSN: 1521-2491
CID: 180207

The angry face syndrome

Pastorek, Norman J; White, W Matthew
PMID: 21422448
ISSN: 1538-3660
CID: 134146

Cartilage grafting in nasal reconstruction

Immerman, Sara; White, W Matthew; Constantinides, Minas
Nasal reconstruction after resection for cutaneous malignancies poses a unique challenge to facial plastic surgeons. The nose, a unique 3-D structure, not only must remain functional but also be aesthetically pleasing to patients. A complete understanding of all the layers of the nose and knowledge of available cartilage grafting material is necessary. Autogenous material, namely septal, auricular, and costal cartilage, is the most favored material in a free cartilage graft or a composite cartilage graft. All types of material have advantages and disadvantages that should guide the most appropriate selection to maximize the functional and cosmetic outcomes for patients
PMID: 21112519
ISSN: 1558-1926
CID: 114853

Nasal soft tissue trauma and management

Immerman, Sara; Constantinides, Minas; Pribitkin, Edmund A; White, W Matthew
The nose is the most prominent of all facial structures and is susceptible to many types of trauma. All soft tissue injuries of the nose have the potential to distort its appearance and adversely affect the patient's self-image and self-esteem. Once life-threatening injuries are stabilized, a careful history and physical exam should be completed and treatment individualized. The ultimate objective of treatment is to achieve both functional and cosmetic restoration with timely diagnosis and repair. Immediate nasal reconstruction is ideal when medically possible because this decreases long-term sequelae
PMID: 21086240
ISSN: 1098-8793
CID: 114596

Oculocardiac reflex associated with a large orbital floor fracture [Case Report]

Joseph, Jeffrey M; Rosenberg, Caroline; Zoumalan, Christopher I; Zoumalan, Richard A; White, W Matthew; Lisman, Richard D
A 40-year-old man presented with bradycardia, left eye pain, and intermittent nausea 1 day after blunt trauma to the left orbit. Imaging revealed a large orbital floor fracture with significant herniation of orbital contents but no obvious extraocualar muscle entrapment. Oculocardiac reflex was suspected, and the fracture was repaired surgically within 24 hours of presentation. His bradycardia resolved immediately postoperatively. This case is a unique presentation of the oculocardiac reflex in a large orbital floor fracture with significant herniation of orbital contents but without extraocualar muscle entrapment
PMID: 19935262
ISSN: 1537-2677
CID: 105515

Surgical and nonsurgical treatments of the nasal valves

Lee, Judy; White, W Matthew; Constantinides, Minas
Nasal obstruction is known to be associated with a major decrease in disease-specific quality of life, and nasal valve dysfunction can play a considerable role in nasal airflow obstruction. Diagnosis and treatment of nasal valve dysfunction requires a thorough understanding of normal anatomy and function as well as pathophysiology of common abnormalities to properly treat the exact source of dysfunction. As the pathophysiology of the nasal valves has become better understood, surgery designed to treat its dysfunction has evolved. Here, we explore the progress we have made in treating the nasal valves, and the deficiencies we still face
PMID: 19486744
ISSN: 0030-6665
CID: 99244

Recurrent laryngeal nerve monitoring during thyroidectomy and related cervical procedures in the pediatric population [Case Report]

White, W Matthew; Randolph, Gregory W; Hartnick, Christopher J; Cunningham, Michael J
OBJECTIVES: To gather data on, and assess the applicability of, intraoperative recurrent laryngeal nerve (RLN) monitoring during thyroidectomy and related cervical procedures in children and adolescents. Recurrent laryngeal nerve trauma is one of the most serious complications of surgery in the anterior neck compartment. Numerous studies have demonstrated the utility of intraoperative monitoring of the RLN in adult thyroid surgery to prevent such injury. Although the risk of RLN injury is reportedly higher in the pediatric population, little data exist regarding the use of intraoperative RLN monitoring in children and adolescents. DESIGN: Retrospective case series review. SETTING: A pediatric otolaryngology practice in a tertiary care hospital. PATIENTS: Five patients undergoing surgical excision of thyroid neoplasms or branchial pouch anomalies. INTERVENTIONS: During surgical excision, intraoperative RLN monitoring was performed with use of the Xomed NIM II monitor and Xomed RLN monitoring endotracheal tube, which allow for both passive and stimulation-evoked electromyographic monitoring of the thyroarytenoid muscle. MAIN OUTCOME MEASURES: True vocal fold mobility as assessed by postoperative flexible laryngoscopy. RESULTS: Intraoperative RLN monitoring was performed successfully for up to 4 hours. Such monitoring facilitated the identification of the RLN and was predictive of the subsequent presence or absence of postoperative RLN paresis. CONCLUSIONS: Intraoperative RLN monitoring can be a useful tool during cervical procedures that place the RLN at risk in children and adolescents. As has been demonstrated in adults, it is a safe and reliable technique that can be predictive of and may lessen the risk of RLN morbidity in this younger patient population
PMID: 19153313
ISSN: 1538-361x
CID: 106263