Adam Honeybrook

Correlation between sinus and lung cultures in lung transplant patients with cystic fibrosis: Sinus and Lung Cultures in CF Transplant

Lung transplantation has revolutionized the treatment of end‐stage pulmonary disease due to cystic fibrosis. However, infection of the transplanted lungs can lead to serious complications, including graft failure and death. Although many of these patients have concurrent sinusitis, it is unclear whether bacteria from the sinuses can infect the allograft.

Radiographic characterization of the retroantral ethmoid cell

The retroantral ethmoid cell (RAEC) is defined as a posterior ethmoid cell that pneumatizes inferolaterally behind the posterior wall of the maxillary sinus. The RAEC can present a challenge to otolaryngologists during endoscopic ethmoidectomy due to its concealed location. It is also encountered during the endoscopic transpterygoid approach to the skull base, which requires dissection behind the posterior wall of the maxillary sinus. Because the RAEC is not described in the literature, this study aims to better characterize this anatomic variant.

Radiodensity of the Ostiomeatal Complex in Recurrent Acute Rhinosinusitis

Objective Recurrent acute rhinosinusitis (RARS) can be an elusive diagnosis due to the lack of clinical and radiographic findings in between acute episodes. This study aims to identify objective computed tomography (CT) characteristics in RARS. Study Design Case series with chart review. Setting Tertiary academic medical center. Subjects and Methods Patients meeting diagnostic criteria for RARS were identified retrospectively from the senior author’s practice. Patients were diagnosed with RARS if they experienced 3 or more episodes of acute sinusitis within the past year with complete resolution of symptoms in between episodes. At least 1 episode was confirmed via CT or endoscopy. CT scans showing prior surgery were excluded. The scans for these patients were compared with those from a normal control group. Bone radiodensity of the entire ostiomeatal complex (OMC), including the ethmoid bulla, middle turbinate, and uncinate, was measured in Hounsfield units. Maximum radiodensity was noted for each side. Results A total of 16 patients meeting inclusion criteria for RARS were compared with 16 healthy patients. The mean Lund-MacKay score was 1.6 in the RARS group and 1.3 in the control group. The maximum radiodensity of the OMC was significantly higher in the RARS group (556) compared with that of the control group (327) (P < .0001). Conclusion Patients with RARS had significantly greater radiodensity of the OMC compared with those in the control group despite minimal differences in mucosal disease. Radiodensity measurement of the OMC using Hounsfield units may help to identify patients with this elusive diagnosis.

Sinusitis in patients on tumor necrosis factor alpha inhibitors

Tumor necrosis factor alpha (TNF‐α) inhibitors have revolutionized treatment of many inflammatory diseases. Sinusitis after initiation of TNF‐α inhibitors has been observed, but has not been well described in the literature. We aim to characterize the clinical features of sinusitis in patients on anti‐TNF‐α therapy.

Free dermal fat graft reconstruction of the head and neck: An alternate reconstructive option

OBJECTIVES Ablative procedures of the head and neck often result in significant facial and cervical irregularities and cosmetic asymmetry. The deformity resulting from ablative procedures of the head and neck is a significant source of cosmetic morbidity and postoperative dissatisfaction. Reconstruction of post-ablative defects in the head and neck can employ a broad range of techniques, ranging from primary closure to free tissue transfer. The free dermal fat graft (FDFG) is one such option and has been used to repair volume defects of varying sizes after common head and neck procedures such as parotidectomy. However, its use is largely undocumented in the literature. We seek to further illustrate the FDFG as an alternate method of reconstruction of head and neck defects. STUDY DESIGN Non-randomized retrospective analysis. METHODS The medical records of all patients who underwent primary autologous abdominal FDFG reconstruction of head and neck defects by a single surgeon at Vanderbilt University Medical Center from January 1997 to August 2010 were reviewed. All patients were called in order to assess their post-operative cosmetic satisfaction. RESULTS Sixty-two patients were analyzed. Only three patients were found to have post-operative complications directly related to the FDFG. No complications were found at the donor site. Based on a telephone survey, the majority of patients were satisfied post-operatively with their cosmetic outcomes in the primary site and donor site. CONCLUSIONS From our experience the FDFG is a cosmetically and functionally advantageous option for reconstruction of ablative procedures of the head and neck.

The Evolution and Future of Rhytidectomy Literature: A Bibliographic Study

Since Eugene Holländer performed the first rhytidectomy in 1901, face-lift surgery has dramatically transformed over 100+ years. Our objective was to assess conceptual themes and content evolution in the published rhytidectomy literature. A bibliometric rhytidectomy analysis was performed on English-language literature between the period of 1951 and 2017. Analyses included most productive authors, countries, journals, most-cited articles, and keywords. K-means clustering was used to discern trends in topics. A total of 1927 rhytidectomy abstracts were mined from the Scopus® bibliographic database over the period of 1951-2017. These abstracts originated from 500 different source publications and 3744 different authors. The annual growth rate of rhytidectomy literature is 6.87 articles/year. The most productive countries were the United States (856 publications), France (107 publications), and Brazil (67 publications). Between-country collaborations were rare. From 1995-2015, the recent literature centered on younger adults, surgical approaches, and complications. Older literature investigated surgical techniques, facial skin, aging, and lipectomy. Two distinct concept clusters were discovered: (1) surgical outcomes and techniques/approaches, and (2) study design. Bibliometric analyses are useful in understanding intellectual structure, gaps, and opportunities for knowledge advancement. The recent rhytidectomy literature is focused on new techniques/approaches, complications, and younger adults and is dominated by US-based clinicians.

Botulinum Toxin-A and Scar Reduction: A Review

Pathologic scars remain a therapeutic enigma. Several therapeutic modalities have been described for the prevention and treatment of hypertrophic and keloid scars, but the optimal management approach has not yet been defined. This article reviews the newly emerging, off-label treatment, botulinum toxin-A (BTXA) for scar reduction. Eight in vitro, 9 in vivo animal, and 23 human clinical studies were deemed relevant to this review. Studies were conducted between 2000 and 2018. Clinical studies were of various methodologic qualities and comprised of 8 blinded randomized control trials, 7 cohort studies, and 7 case series/reports. Across all 23 human clinical studies, 521 patients were recruited, 20 studies were in favor of BTXA to reduce scars, 2 studies had equivocal results, and 1 study showed no benefit. The efficacy of BTXA to reduce scars appears promising and the clinical literature currently favors its use over placebo controls as a safe scar reduction alternative. The efficacy of this modality in comparison with other more widely accepted scar reduction methods is less clear. Further understanding of the molecular mechanism of action of BTXA upon scars and treatment modality cost-effectiveness comparisons remain to be explored. Large-scale randomized control trials of high methodologic quality, using objective measurement scales, must be produced to truly determine the efficacy of this innovative treatment.

Three-Dimensional Photography for Measuring Volumetric Changes After Submental Cryolipolysis

High-resolution 3-dimensional photography offers unparalleled advantages in objective and detailed skin contour characterization, quantification, volumetric and surface area analysis. This study aims to illustrate the benefits of 3-dimensional photography through analysis of noninvasive reduction of submental fat using cryolipolysis. A nonrandomized prospective analysis was performed of 14 selected patients who underwent treatment with cryolipolysis (CoolSculpting System; Zeltiq) between February and June 2016. The benefits of 3-dimensional photography (Vectra; Canfield Scientific) are presented. High-quality 3-dimensional images are presented to illustrate the utility of 3-dimensional photography as a means to quantitatively evaluate changes in submental volume, fat thickness, and surface area reduction, thereby exemplifying the broad applicability of this imaging technique. Three-dimensional photography technology provides clinicians with enhanced options that extend beyond simple 2-dimensional photography. Our study illustrates the benefits of the technology for accurately measuring volumetric changes after submental cryolipolysis treatment.

A Novel External Nasal Splint

Every year, hundreds of thousands of individuals suffer from nasal bone fractures, and in 2016, more than 780 000 rhinoplasty surgeries were performed globally. As part of the comprehensive care for these patients, external nasal splints are routinely used during the healing process. Nasal splints stabilize the bony and cartilaginous nasal framework and provide compression to the nose, thereby reducing nasal edema and hastening recovery. In this article, we present a novel external nasal splint that addresses some of the shortcomings of other commercially available nasal splints.

Long-term outcome of a patient with paradoxical hypertrichosis after laser epilation

ABSTRACT One underreported, rare side effect of laser hair removal is paradoxical hypertrichosis. It is largely unknown what the long-term outcomes are of patients who develop this complication. We report a 21-year-old, Fitzpatrick II, male patient, who had patchy areas of dark hair affecting various body areas. An Alexandrite 755 nm laser was used to address the desired areas at energies between 20 and 22 J/cm2 at 10–12-week intervals over a course of seven treatments. After three treatments, the patient noted a significant increase in the density and length of hairs involving the back, shoulders, neck, and upper arms. The patient was followed on a biannual basis, without further epilatory intervention. After 10 years, the areas of paradoxical hair growth were sparser compared to immediate post-treatment but remained denser compared to pre-treatment. This case illustrates improvement in the condition over time without intervention. Further studies are needed to determine the etiopathogenesis of this phenomenon.