Faculty Bibliography

PURPOSE/OBJECTIVE:The purpose of the present study was to compare the severity of craniomaxillofacial injuries between accidents involving motorized and nonmotorized standup scooters. MATERIALS AND METHODS/METHODS:We performed a 20-year cross-sectional study of the National Electronic Injury Surveillance System. Injuries from powered and unpowered standup scooters were included in the present study if they had involved the head, face, eyeball, mouth, or ear. Study predictors were obtained from both patient and injury characteristics. The study outcome was the probability of hospital admission from the emergency department. A multiple logistic regression model was created to model the probability of admission using all significant univariate predictors. RESULTS:A total of 11,916 records were included in the present study, of which 9.5% had involved motorized scooters. The proportion of motorized injuries more than tripled from 2014 (5.8%) to 2018 (22.1%). Motorized injuries had occurred more often in older individuals (24.0 vs 8.5 years; P < .01). A greater proportion of motorized injuries involved the head (55.0 vs 36.9%; P < .01) and had resulted in concussion (11.5 vs 5.6%; P < .01), fractures (6.7 vs 2.0%; P < .01), and other nonspecified internal organ injuries (31.1 vs 19.6%; P < .01). Motorized scooters had resulted in more than triple the admission rate compared with nonmotorized scooters (13.9 vs 3.7%; P < .01). After controlling for potential confounders, injuries from motorized scooters still had double odds of hospital admission (odds ratio, 2.03; P < .01). CONCLUSIONS:Motorized standup scooters appear to cause more severe injuries than conventional nonmotorized scooters. The recent growth of rentable electric scooters could pose a future public health concern. Ride-sharing companies should ensure that customers are capable of safely and responsibly operating these vehicles.

Changes made to the forehead and periorbital region can have dramatic effects in gender-affirmation surgery. Removal of frontal bossing and alteration of orbital shape can result in significant facial feminization. This elective surgical intervention must be safe, reliable, and aesthetically effective. The described technique of frontal and periorbital bone contouring allows for a safe and consistent surgical outcome in properly selected patients. Nuances in specific technical maneuvers in this operation can have profound effects on safety and aesthetic outcomes. In this article, specific points are detailed in text and video describing the senior author's (E.D.R) surgical approach.

Background/UNASSIGNED:Choosing the optimal mastectomy incision must account for oncologic, reconstructive, and aesthetic considerations, including nipple preservation, mastectomy skin margins and potential for skin involvement, mastectomy skin perfusion and viability, mastectomy skin excess, previous breast scars, the reconstructive plan, and inconspicuous new scar placement. In the present study, we aimed to assess breast reconstruction aesthetics, as they are influenced by mastectomy incision design. Methods/UNASSIGNED:Nine commonly utilized mastectomy incision patterns were grouped into 3 categories: hidden scar, vertical scar, and transverse scar. Twenty plastic surgeons were asked to blindly grade before and after photographs of reconstructed breasts with regard to scar visibility and position and according to their influence on breast aesthetics. Results/UNASSIGNED:Statistically significant differences were observed between the study groups. Mastectomies and reconstructions performed through hidden incisions yield the most aesthetic results. Vertical scars are favorable to transverse scars. In the case of bilateral reconstructions, symmetric scar placement is paramount to optimizing aesthetic outcomes. Conclusions/UNASSIGNED:The mastectomy incision pattern significantly affects the aesthetic outcomes in breast reconstruction. Patterns borrowed from cosmetic breast surgery consistently yield highly aesthetic outcomes. Surgeons must consider oncologic factors and patient characteristics in choosing an ideal incision for each patient.

Background/UNASSIGNED:A major challenge in face transplantation (FT) is the limited donor allograft pool. This study aimed to investigate the feasibility of cross-sex FT (CSFT) for donor pool expansion by: (1) comparing craniomaxillofacial metrics following CSFT versus same-sex FT (SSFT); and (2) evaluating the public and medical professionals' perception of CSFT. Methods/UNASSIGNED:Seven cadaveric FTs were performed, resulting in both CSFT and SSFT. Precision of bony and soft tissue inset was evaluated by comparing pre- versus post-operative cephalometric and anthropometric measurements. Fidelity of the FT compared to the virtual plan was assessed by imaging overlay techniques. Surveys were administered to medical professionals, medical students, and general population to evaluate opinions regarding CSFT. Results/UNASSIGNED:< 0.001). On non-blinded and blinded assessments, 62.9% and 79% of responses rated the CSFT superior or equal to SSFT, respectively. Conclusions/UNASSIGNED:Our study demonstrates similar anthropometric and cephalometric outcomes for CSFT and SSFT. Participants were more reticent to undergo CSFT, with increased willingness if supported by research. CSFT may represent a viable option for expansion of the donor pool in future patients prepared to undergo transplantation.

Large head and neck arteriovenous malformations are notoriously difficult to manage given their location and propensity for extreme hemorrhage. We propose a unique approach utilizing a Hyperform balloon and percutaneous Surgiflo sclerotherapy to provide intraoperative hemostatic stability during the excision of a left-sided scalp arteriovenous malformation. In a hybrid operating room a microcatheter balloon was fed into the left external carotid artery for occlusion of the malformation's main blood supply, and subsequently followed with digital subtraction angiography guided sclerotherapy of selective vessels. A split thickness graft was used to reconstruct the site of excision. This method offered optimal hemostatic control with a blood loss less than 120 cc. Our approach may offer safety advantages over traditional modalities and allow resection of head and neck lesions previously thought to be inoperable.

We present a case report of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) that was mistaken as disseminated silicosis after multiple percutaneous biopsies. The correct diagnosis of BIA-ALCL was confirmed only after a pathologic examination of the capsulectomy specimens. A review of the literature of percutaneous biopsies of ALCL showed a diagnostic yield of only 63%. Although percutaneous biopsies may be facile to obtain and may be diagnostic, in our case, biopsies were not sufficient to exclude the diagnosis of BIA-ALCL.

OBJECTIVE:To synthesize a zirconia toughened alumina (ZTA) composite with 70% alumina reinforced by 30% zirconia for dental applications and to characterize its microstructure and optical properties for comparison with the isolated counterpart materials and a first-generation 3Y-TZP. METHODS:Disc-shaped specimens were divided in four groups (n = 70/material): (1) 3YSB-E (first generation 3Y-TZP), (2) Zpex (second generation 3Y-TZP), (3) alumina, and (4) ZTA-Zpex 70/30. After synthesis, ceramic powders were pressed, and green-body samples sintered following a predetermined protocol. Specimens were polished to obtain a mirror surface finish. Apparent density was measured by Archimedes principle. X-ray diffraction (XRD) and scanning electron microscope (SEM) were used to characterize the crystalline content and microstructure. Reflectance tests were performed to determine the contrast-ratio (CR) and translucency-parameter (TP). Mechanical properties were assessed by biaxial flexural strength (BFS) test. All analyses were conducted before and after artificial aging (20 h, 134 °C, 2.2 bar). Optical parameters were evaluated through repeated-measures analysis of variance and Tukey tests (p < 0.05). BFS data were analyzed using Weibull statistics (95% CI). RESULTS:High density values (95-99%) were found for all ceramic materials and SEM images exhibited a dense microstructure. While XRD patterns revealed the preservation of crystalline content in the ZTA composite, an increase in the monoclinic peak was observed for pure zirconias after aging. Significantly higher CR and lower TP values were observed for the ZTA composite, followed by alumina, 3YSB-E, and Zpex. The highest characteristic stress was recorded for 3YSB-E, followed by intermediate values between ZTA and Zpex, and the lowest for alumina. Aging affected the optical and mechanical properties of both zirconias, while remained stable for ZTA composite and alumina. SIGNIFICANCE/CONCLUSIONS:The synthesis of experimental 70-30% ZTA composite was successful and its relevance for dental applications relies on its higher masking ability, aging resistance, and strength similar to zirconia.