A retrospective study of patient outcomes and satisfaction following pinnaplasty

Introduction: Up to 5% of all children have prominent ears. Psychological distress and bullying adversely affect these children and can cause significant social exclusion. In times of austerity, cosmetic procedures such as surgical correction of prominent ears are felt to be an unnecessary cost to the health service. Materials and methods: A retrospective case note review of all patients undergoing pinnaplasty was undertaken. Postoperative outcomes were compared against the Royal College of Surgeons of England standards. The Glasgow Benefit Inventory, a validated post-intervention questionnaire, was then posted out to all patients. Results: A total of 72 patients were identified. Average age at procedure was 13 years. Eleven patients were above the age of 19 years. Twenty-eight patients were male and forty-four female. Sixty-two cases underwent bilateral pinnaplasty. No patients developed hematoma, and there were no readmissions within 30 days of surgery. Twenty-nine patients responded to the questionnaire (40%), of whom 27 reported a positive impact on their psychosocial well-being with a mean score of 36. Conclusion: Pinnaplasty offers patients an opportunity to alleviate the psychological distress of bullying and harassment secondary to the appearance of prominent ears

Ear, nose and throat injuries at Bugando Medical Centre in northwestern Tanzania: a five-year prospective review of 456 cases.

Injuries to the ear, nose and throat (ENT) regions are not uncommon in clinical practice and constitute a significant cause of morbidity and mortality in our setting. There is dearth of literature on this subject in our environment. This study was conducted to describe the causes, injury pattern and outcome of these injuries in our setting and proffer possible preventive measures. This was a descriptive prospective study of patients with ear, nose and throat injuries managed at Bugando Medical Centre between May 2007 and April 2012. Ethical approval to conduct the study was sought from relevant authorities. Statistical data analysis was performed using SPSS computer software version 17.0. A total of 456 patients were studied. The median age of patients at presentation was 18 years (range 1 to 72 years). The male to female ratio was 2:1. The commonest cause of injury was foreign bodies (61.8%) followed by road traffic accidents (22.4%). The ear was the most common body region injured accounting for 59.0% of cases. The majority of patients (324, 71.1%) were treated as an outpatient and only 132(28.9%) patients required admission to the ENT wards after definitive treatment. Foreign body removal and surgical wound debridement were the most common treatment modalities performed in 61.9% and 16.2% of cases respectively. Complication rate was 14.9%. Suppurative otitis media (30.9%) was the commonest complication in the ear while traumatic epistaxis (26.5%) and hoarseness of voice (11.8%) in the aero-digestive tract were commonest in the nose and throat. The overall median length of hospital stay for in-patients was 8 days (range 1 to 22 days). Patients who developed complications and those who had associated injuries stayed longer in the hospital (P < 0.001).Mortality rate related to isolated ENT injuries was 1.3% (6 deaths). The majority of patients (96.9%) were treated successfully and only 3.1% of cases were discharged with permanent disabilities. Injuries to the ENT regions are not uncommon in our environment and foreign bodies constitute a significant cause of injury. Majority of these injuries can be prevented through public enlightenment campaigns

Axial propeller flaps : a proposal for update of the 'Tokyo consensus on propeller flaps'

LETTER TO EDITO

Objective analysis of anthropometric parameters of the auricle in health and disease

Background: The auricle is a prominent anatomical feature of the face, and its distinct shape and symmetry make auricular deformities, such as microtia, highly noticeable. Microtia not only affects patients’ auditory function and facial aesthetics but can also have a profound impact on the psychological well-being of affected children. Due to the complex morphology of the auricle, our understanding of the underlying mechanisms of auricular malformations remains limited, and there is a lack of standardized methods for evaluating auricular shape, which hinders the objective assessment of treatment outcomes. Therefore, it is crucial to investigate the pathogenesis of auricular anomalies and to develop objective tools for quantifying auricular morphology to improve the diagnosis and management of these onditions. Methods: In Part I, we explored the molecular mechanisms underlying MPA (mycophenolic acid)-induced microtia using bioinformatics analysis and human genetic databases. Part II involved a systematic review of classification systems and measurement methods for auricular deformities, summarizing objective measurement techniques used in microtia, auricular reconstruction, and prominent ear correction. In Part III, we developed a novel automated 3D surface-based auricle measurement algorithm, compared it with traditional manual methods, and validated its performance using a larger database of normal individuals to assess bilateral auricular differences. Results: Our research revealed that MPA may induce auricular malformations by inhibiting MDM2, thereby increasing p53 activity, which leads to neural crest cell (NCC) apoptosis and subsequent ear development defects. The systematic review identified that current objective assessment techniques primarily focus on parameters such as auricular length, width, auriculocephalic angle, protrusion, and bilateral symmetry. These metrics play a critical role in the classification and evaluation of auricular deformities. Our developed automated measurement software demonstrated significantly higher precision than traditional manual methods, with improvements ranging from 5x to 54x across various parameters. Additionally, our automated measurement algorithm provided objective quantification of bilateral asymmetry and maintained high accuracy under both high- and low-radiation CT settings, revealing subtle asymmetries undetectable by manual measurements. Conclusion: This study advances our understanding of the pathogenesis of auricular anomalies and introduces an innovative, high-precision automated auricular measurement algorithm for the objective assessment of auricular shape. Our findings underscore the urgent need for standardized classification systems and objective evaluation tools for treatment outcomes of auricular anomalies. The software developed in this study enables clinicians to assess auricular morphology with greater precision, providing a robust basis for clinical decision-making. Future research should focus on validating the software using 3D optical scanners to eliminate radiation exposure and achieve consistent measurement precision across different imaging modalities, ultimately establishing a new standard for the diagnosis and evaluation of auricular deformities

Objective analysis of anthropometric parameters of the auricle in health and disease

Background: The auricle is a prominent anatomical feature of the face, and its distinct shape and symmetry make auricular deformities, such as microtia, highly noticeable. Microtia not only affects patients’ auditory function and facial aesthetics but can also have a profound impact on the psychological well-being of affected children. Due to the complex morphology of the auricle, our understanding of the underlying mechanisms of auricular malformations remains limited, and there is a lack of standardized methods for evaluating auricular shape, which hinders the objective assessment of treatment outcomes. Therefore, it is crucial to investigate the pathogenesis of auricular anomalies and to develop objective tools for quantifying auricular morphology to improve the diagnosis and management of these onditions. Methods: In Part I, we explored the molecular mechanisms underlying MPA (mycophenolic acid)-induced microtia using bioinformatics analysis and human genetic databases. Part II involved a systematic review of classification systems and measurement methods for auricular deformities, summarizing objective measurement techniques used in microtia, auricular reconstruction, and prominent ear correction. In Part III, we developed a novel automated 3D surface-based auricle measurement algorithm, compared it with traditional manual methods, and validated its performance using a larger database of normal individuals to assess bilateral auricular differences. Results: Our research revealed that MPA may induce auricular malformations by inhibiting MDM2, thereby increasing p53 activity, which leads to neural crest cell (NCC) apoptosis and subsequent ear development defects. The systematic review identified that current objective assessment techniques primarily focus on parameters such as auricular length, width, auriculocephalic angle, protrusion, and bilateral symmetry. These metrics play a critical role in the classification and evaluation of auricular deformities. Our developed automated measurement software demonstrated significantly higher precision than traditional manual methods, with improvements ranging from 5x to 54x across various parameters. Additionally, our automated measurement algorithm provided objective quantification of bilateral asymmetry and maintained high accuracy under both high- and low-radiation CT settings, revealing subtle asymmetries undetectable by manual measurements. Conclusion: This study advances our understanding of the pathogenesis of auricular anomalies and introduces an innovative, high-precision automated auricular measurement algorithm for the objective assessment of auricular shape. Our findings underscore the urgent need for standardized classification systems and objective evaluation tools for treatment outcomes of auricular anomalies. The software developed in this study enables clinicians to assess auricular morphology with greater precision, providing a robust basis for clinical decision-making. Future research should focus on validating the software using 3D optical scanners to eliminate radiation exposure and achieve consistent measurement precision across different imaging modalities, ultimately establishing a new standard for the diagnosis and evaluation of auricular deformities

Estimating the risk of adverse birth outcomes in pregnant women undergoing non-obstetric surgery using routinely collected NHS data: an observational study

Background: Previous research suggests that non-obstetric surgery is carried out in 1 – 2% of all pregnancies. However, there is limited evidence quantifying the associated risks. Furthermore, of the evidence available, none relates directly to outcomes in the UK, and there are no current NHS guidelines regarding non-obstetric surgery in pregnant women. Objectives: To estimate the risk of adverse birth outcomes of pregnancies in which non-obstetric surgery was or was not carried out. To further analyse common procedure groups. Data Source: Hospital Episode Statistics (HES) maternity data collected between 2002 – 3 and 2011 – 12. Main outcomes: Spontaneous abortion, preterm delivery, maternal death, caesarean delivery, long inpatient stay, stillbirth and low birthweight. Methods: We utilised HES, an administrative database that includes records of all patient admissions and day cases in all English NHS hospitals. We analysed HES maternity data collected between 2002 – 3 and 2011 – 12, and identified pregnancies in which non-obstetric surgery was carried out. We used logistic regression models to determine the adjusted relative risk and attributable risk of non-obstetric surgical procedures for adverse birth outcomes and the number needed to harm. Results: We identified 6,486,280 pregnancies, in 47,628 of which non-obstetric surgery was carried out. In comparison with pregnancies in which surgery was not carried out, we found that non-obstetric surgery was associated with a higher risk of adverse birth outcomes, although the attributable risk was generally low. We estimated that for every 287 pregnancies in which a surgical operation was carried out there was one additional stillbirth; for every 31 operations there was one additional preterm delivery; for every 25 operations there was one additional caesarean section; for every 50 operations there was one additional long inpatient stay; and for every 39 operations there was one additional low-birthweight baby. Limitations: We have no means of disentangling the effect of the surgery from the effect of the underlying condition itself. Many spontaneous abortions will not be associated with a hospital admission and, therefore, will not be included in our analysis. A spontaneous abortion may be more likely to be reported if it occurs during the same hospital admission as the procedure, and this could account for the associated increased risk with surgery during pregnancy. There are missing values of key data items to determine parity, gestational age, birthweight and stillbirth. Conclusions: This is the first study to report the risk of adverse birth outcomes following non-obstetric surgery during pregnancy across NHS hospitals in England. We have no means of disentangling the effect of the surgery from the effect of the underlying condition itself. Our observational study can never attribute a causal relationship between surgery and adverse birth outcomes, and we were unable to determine the risk of not undergoing surgery where surgery was clinically indicated. We have some reservations over associations of risk factors with spontaneous abortion because of potential ascertainment bias. However, we believe that our findings and, in particular, the numbers needed to harm improve on previous research, utilise a more recent and larger data set based on UK practices, and are useful reference points for any discussion of risk with prospective patients. The risk of adverse birth outcomes in pregnant women undergoing non-obstetric surgery is relatively low, confirming that surgical procedures during pregnancy are generally safe. Future work: Further evaluation of the association of non-obstetric surgery and spontaneous abortion. Evaluation of the impact of non-obstetric surgery on the newborn (e.g. neonatal intensive care unit admission, prolonged length of neonatal stay, neonatal death). Funding: The National Institute for Health Research Health Services and Delivery Research programme

Pattern of presentation of ear , nose, throat, head and neck injury in a developing country

Objective: Ear, nose, throat, head and neck injuries are a common otorhinolaryngology disorder worldwide. This study aimed at determining the prevalence, sociodemographic features, aetiology , clinical presentation management and outcome of injuries to the ear, nose, throat, head and neck region. Methods: This was a prospective study of patients with otorhinolaryngolology , head and neck injuries that presented at our tertiary health institution. Consented patients were studied between October 2015 and September 2017. Analysis of obtained data was done with SPSS version 16.0. Results: The prevalence of ear, nose, throat, head and neck injury was 9.4%. There were 63.5% males 36.5% females with male to female ratio of 1.5:1. Foreign bodies' impaction was the commonest cause of injury in 32.3% followed by road traffic accidents in 19.8%. Commonest anatomical region were ear and nose in 49.7% and 28.5% respectively . Common clinical features among the patients were pain in 46.5%, bleeding in 37.8% and foreign bodies' impaction in 32.3%. Presentations for otorhinolaryngology care among the patients were common in 95.1% acute injury than 4.9% chronic injury (≥13 weeks). Commonest associated complications of the injuries were otitis media in 18.8% others were 14.9% otitis externa, 9.4% perforated tympanic membrane and 6.3% epistaxis. Pre-hospital treatment in the patients was 67.4%. Major treatment offered to the patients was conservative/medical therapy in 28.8%. Conclusion: Ear , nose, throat, head and neck injuries are common in the otorhinolaryngology practice. Commonest causes are self inflicting foreign bodies' impaction and road traffic accident. Pre-hospital treatment among the patients was very high

Effectiveness of Ear Splint Therapy for Ear Deformities

OBJECTIVE: To present our experience with ear splint therapy for babies with ear deformities, and thereby demonstrate that this therapy is an effective and safe intervention without significant complications. METHODS: This was a retrospective study of 54 babies (35 boys and 19 girls: 80 ears: age </=3 months) with ear deformities who had received ear splint therapy at the Center for Torticollis, Department of Physical Medicine and Rehabilitation, Ajou University Hospital between December 2014 and February 2016. Before the initiation of ear splint therapy, ear deformities were classified with reference to the standard terminology. We compared the severity of ear deformity before and after ear splint therapy by using the physician's ratings. We also compared the physician's ratings and the caregiver's ratings on completion of ear splint therapy. RESULTS: Among these 54 babies, 41 children (58 ears, 72.5%) completed the ear splint therapy. The mean age at initiation of therapy was 52.91+/-18.26 days and the treatment duration was 44.27+/-32.06 days. Satyr ear, forward-facing ear lobe, Darwinian notch, overfolded ear, and cupped ear were the five most common ear deformities. At the completion of therapy, the final physician's ratings of ear deformities were significantly improved compared to the initial ratings (8.28+/-1.44 vs. 2.51+/-0.92: p<0.001). There was no significant difference between the physician's ratings and the caregiver's ratings at the completion of ear splint therapy (8.28+/-1.44 vs. 8.0+/-1.61: p=0.297). CONCLUSION: We demonstrated that ear splint therapy significantly improved ear deformities in babies, as measured by quantitative rating scales. Ear splint therapy is an effective and safe intervention for babies with ear deformities

Psychological characteristics and motivation of women seeking labiaplasty

Background Labiaplasty is an increasingly popular surgical intervention but little is known about the characteristics and motivation of women who seek the procedure or the psychosexual outcome.Method A total of 55 women seeking labiaplasty were compared with 70 women who did not desire labiaplasty. Various general measures of psychopathology as well as specific measures (Genital Appearance Satisfaction; Cosmetic Procedure Screening for labiaplasty) were used. Labia measurements of the women seeking labiaplasty were also obtained.Results Women seeking labiaplasty did not differ from controls on measures of depression or anxiety. They did, however, express increased dissatisfaction towards the appearance of their genitalia, with lower overall sexual satisfaction and a poorer quality of life in terms of body image. Women seeking labiaplasty reported a significantly greater frequency of avoidance behaviours on all the domains assessed, and greater frequency of safety-seeking behaviours for most of the domains. Key motivations reported for labiaplasty were categorized as cosmetic, functional or sexual. Of the 55 women seeking labiaplasty, 10 met diagnostic criteria for body dysmorphic disorder.Conclusions This is the first controlled study to describe some of the characteristics and motivations of women seeking labiaplasty. We identified a wide range of avoidance and safety-seeking behaviours, which occurred more frequently in the labiaplasty group than the control group. These could be used clinically as part of a psychological intervention for women seeking labiaplasty.</p