An Unusual Case of Bony Styloid Processes That Extend to the Hyoid Bone

The embryological origin of the hyoid bone is a point of uncertainty, with controversy surrounding the relative contribution of the second pharyngeal arch to hyoid development. We encountered a 52-year-old male with bilateral bony styloid extension to the lesser cornu of the hyoid bone during the workup of a patient with laryngeal cancer. This embryological malformation clearly supports the hypothesis that the second pharyngeal arch gives rise to the lesser cornu and demonstrates an unusual clinical finding that may be encountered by otolaryngologists. We demonstrate the imaging findings and surgical management of this unusual anatomical variant and review the embryological basis for this rare malformation

Does Sensory Function Decline Independently or Concomitantly with Age? Data from the Baltimore Longitudinal Study of Aging

Objectives. To investigate whether sensory function declines independently or in parallel with age within a single individual. Methods. Cross-sectional analysis of Baltimore Longitudinal Study of Aging (BLSA) participants who underwent vision (visual acuity threshold), proprioception (ankle joint proprioceptive threshold), vestibular function (cervical vestibular-evoked myogenic potential), hearing (pure-tone average audiometric threshold), and Health ABC physical performance battery testing. Results. A total of 276 participants (mean age 70 years, range 26–93) underwent all four sensory tests. The function of all four systems declined with age. After age adjustment, there were no significant associations between sensory systems. Among 70–79-year-olds, dual or triple sensory impairment was associated with poorer physical performance. Discussion. Our findings suggest that beyond the common mechanism of aging, other distinct (nonshared) etiologic mechanisms may contribute to decline in each sensory system. Multiple sensory impairments influence physical performance among individuals in middle old-age (age 70–79)

Ergonomics in facial plastic and reconstructive surgery

Understanding effective ergonomic interventions is crucial for enhancing occupational health and career longevity. There is a paucity of clear ergonomics guidelines in facial plastic and reconstructive surgery (FPRS), placing practitioners at high risk of work-related musculoskeletal disorders (WMSDs) and their consequences. There is mounting evidence that FPRS specialists are at increased risk of WMSDs as compared with the public and other surgical specialties. Numerous studies have demonstrated that implementation of ergonomics principles in surgery decreases WMSDs. Furthermore, WMSDs are reported as early as the first year of surgical residency, marking the importance of early intervention. Fatigue and physical injuries among surgeons occur more often than expected, particularly during complex, extended procedures that necessitate maintaining a constant posture. FPRS procedure often place surgeons into procrustean positions. Thus, integrating ergonomic practices into the practice of FPRS is essential for reducing WMSDs

Defining Typical Acetaminophen and Narcotic Usage in the Postoperative Rhinoplasty Patient

Objective To characterize the acetaminophen and narcotic use pattern of the postoperative rhinoplasty patient. To describe a pain level and pain medication usage pattern of the typical post-rhinoplasty patient and identify demographic considerations. Study design Prospective cohort study at a tertiary care center. Methods Rhinoplasty patients were given standardized perioperative pain instructions and narcotic medication (18 tabs oxycodone) along with a pain medication use survey. Postoperatively, survey and tracking information was collected regarding narcotic and acetaminophen use at their first postoperative appointment. Patients were asked about non-steroidal anti-inflammatory drug, aspirin, and chronic opioid use. Narcotic and acetaminophen use along pain levels (1-10) at time of use were recorded by patients at 4-hour increments postoperatively until their first postoperative visit. Results Pain medication usage (oxycodone and acetaminophen) peaked on (postoperative day 1) POD1. Pain was significantly higher in younger patients (30 years old or younger), female patients, and primary rhinoplasty patients. Pain was correlated with acetaminophen and oxycodone use for women, and acetaminophen used for men. Autologous rib grafting was not correlated with higher narcotic use. Conclusion Describing a pain medication usage pattern for the typical post-rhinoplasty patient provides both patients and clinicians important knowledge of postoperative pain expectations and has the potential to reduce both the amount of narcotic prescribed by providers and the amount of narcotic used by patients. Level of evidence 4 (Case Series) Laryngoscope, 131:48-53, 2021

The Impact of Upper Lateral Cartilage Release on Patient-Perceived Nasal Appearance and Obstruction

Objectives/hypothesis Although upper lateral cartilages are commonly released from the dorsum of the septum during spreader graft placement in septorhinoplasty (SRP), there has been a focus on maintaining integrity of connections in the middle vault. Avoiding release of upper lateral cartilages in certain patient groups may represent an early step in this paradigm shift. We aim to assess satisfaction with nasal appearance and correction of nasal obstruction in patients who underwent SRP with spreader graft placement without upper lateral cartilage release and compared it to the traditional upper lateral cartilage release cohort. Study design Prospective cohort study. Methods A total of 559 patients who underwent SRP with spreader graft placement with upper lateral cartilage release and 30 patients who underwent SRP with spreader graft placement without release between 2012 and 2020 were administered the Nasal Obstruction Symptom Evaluation (NOSE), FACE-Q Satisfaction with Nose, and FACE-Q Social Functioning scales pre- and postoperatively. Pre- and postoperative NOSE FACE-Q, and negative inspiratory force (NIF) scores and changes were compared between groups. Results Results demonstrated clinically and statistically significant improvement at follow-up for both groups. There was no significant difference between groups in mean improvement of NOSE, FACE-Q, and NIF scores at time of last follow-up. Conclusion SRP with spreader graft placement with and without upper lateral cartilage release provide clinically and statistically significant improvement, and no significant difference in functional outcome. This suggests that upper lateral cartilages do not need to be released to achieve functional improvement and that surgeons should consider whether release is necessary to achieve goals of surgery. Level of evidence 3 Laryngoscope, 2021

Association Between Pain and Patient Satisfaction After Rhinoplasty

ImportanceIn light of the current opioid crisis, there exists a demonstrated need to balance adequate postrhinoplasty pain control with measured use of narcotics. If pain is inadequately controlled..