Ramsey Alsarraf

Outcomes Research in Facial Plastic Surgery: A Review and New Directions

Abstract. Outcomes research is a fast-growing field of study that focuses on patient-related aspects of medical or surgical outcomes such as satisfaction and quality of life. In the realm of facial plastic surgery, many outcomes are subjective evaluations based on the patient and physicians judgment as to the surgical result, but little has been done to quantify these qualitative results in an objective manner. This paper discusses the basis for outcomes research and suggests its application to the field of facial plastic surgery. Four new facial plastic outcomes instruments have been developed and are provided for the potential use in measuring the quality of life results of rhytidectomy, rhinoplasty, blepharoplasty, and skin rejuvenation procedures.

Quality of life in head and neck cancer

Because treatments for patients with cancer of the head and neck can have major impact on physical, social, and psychological function, the collection of quality of life (QOL) data in this group of patients is critical for our specialty. The University of Washington Quality of Life data have been collected and analyzed on three subsets of cancer patients. Information learned from these patients is summarized and strategies for future projects are outlined.

Otitis media health status evaluation : A pilot study for the investigation of cost-effective outcomes of recurrent acute otitis media treatment

There are no reliable and valid instruments that measure otitis media clinical or functional health status in children ages 1 to 3 years. This study develops and tests three new instruments of clinical and functional otitis health status: the Otitis Media Clinical Severity Index (OM-CSI), the Otitis Media Functional Status Questionnaire (OM-FSQ), and the Otitis Media Diary (OMD). The OM-CSI was found to be a reliable measure of clinical acute otitis media (AOM) severity, with high internal consistency (Cronbachs α) scores, as well as an accurate indicator of AOM severity. The OM-FSQ and OMD were demonstrated to be reliable and valid measures of otitis-specific functional health status, with reproducible scores over time, high internal consistency α scores, and high correlation with measures of AOM clinical severity and other functional health status instruments. These three new instruments were also sensitive and specific indicators of AOM episodes.

Quality-of-Life Outcomes after Osteoplastic Frontal Sinus Obliteration

Frontal sinusitis and its treatment remain controversial. Although several authors have evaluated the results of traditional endoscopic sinus surgery, few have assessed patient outcomes and quality of life after osteoplastic frontal sinus obliteration. This retrospective study evaluates these outcomes in a postoperative review and questionnaire of 39 patients treated at the University of Washington from 1991 to 1994. Most patients were satisfied with the results of this procedure, had significant improvements in their Chronic Sinusitis Survey scores, and reported decreased clinic visits and antibiotic use. However, approximately half thought nonsurgical treatments were more effective and continued to require other medical therapy; 30% required additional surgical intervention. Such outcomes may reflect the ineffectiveness of frontal sinus obliteration to treat the chronic symptoms of patients affected by the refractory underlying disease process of chronic sinusitis; however, despite these mixed results, we found a significant decrease in annual days of lost work or activity in this study group after osteoplastic obliteration.

Symptomatic presentation of an enlarged, ossified triticeal cartilage

(Editorial Comment: The reporters describe an unusual source of cervical pain; removal of the source resulted in symptomatic relief.) There are many reported cases of symptomatic stylohyoid ligament calcification or stylohyoid process elongation in the medical literature: however, similar reports that involve symptomatic enlargement or ossification of other infrahyoid musculature, ligaments, or cartilages are limited.’ Case reports of stylohyoid calcification include patients who present with symptoms of dysphagia, cervical and craniofacial pain, otalgia, ossification that mimics submandibular sialadenopathy, difficult intubation, and radiologically misdiagnosed foreign bodies. 2-5 Several researchers have investigated this process, and although symptomatic stylohyoid ossification is quite rare, asymptomatic ossification or elongation has been reported to be present in up to 40% of children and 84% of adults.“17 Eagle’s syndrome is a well-described condition of a post-traumatic, elongated, ossified styloid process or calcified stylohyoid ligament that results in dull cervical and facial pain secondary to a presumed compression of trigeminal or glossopharyngeal cranial nerves.6 This pain is often temporarily relieved by the injection of local anesthetic into the tonsillar fossa, and permanent relief may be obtained by resection of the involved calcified segments. Kehrl and Hartwein2 describe a series of syndromic patients with dysphagia and craniofacial or cervical pain who underwent either transoral or external resection of their