Embryologically Based Classification Specifies Gender Differences in the Prevalence of Orofacial Cleft Subphenotypes

Background: A recently published validated classification system divides all orofacial cleft (OFC) subphenotypes into groups based on underlying developmental mechanisms, that is, fusion and differentiation, and their timing, that is, early and late periods, in embryogenesis of the primary and secondary palates. Aims: The aim of our study was to define gender differences in prevalence for all subphenotypes in newborns with OFC in the Netherlands. Methods: This was a retrospective cross-sectional study on children with OFC born from 2006 to 2016. Clefts were classified in early (E-), late (L-), and early/late (EL-) embryonic periods, in primary (P-), secondary (S-), and primary/secondary (PS-) palates, and further divided into fusion (F-), differentiation (D-), and fusion/differentiation (FD-) defects, respectively. Results: A total of 2089 OFC children were analyzed (1311 males and 778 females). Orofacial cleft subphenotypes in females occurred significantly more frequent in the L-period compared to males (66% vs 55%, P = .000), whereas clefts in males occurred significantly more in the EL-periods (40% vs 27%, P = .000). Females had significantly more S-palatal clefts (42% vs 23%, P = .000), while males had significantly more PS-palatal clefts (44% vs 30%, P = .000). Furthermore, the clefts in females were significantly more frequent the result of an F-defect (60% vs 52%, P = .000). Conclusions: Orofacial cleft in females mainly occur in the L-period are mostly S-palatal clefts, and are usually the result of an F-defect. Orofacial cleft in males more commonly occur in the EL-periods, are therefore more often combined PS-palatal clefts, and are more frequent D- and FD-defects

Asymmetry in upper blepharoplasty:A retrospective evaluation study of 365 bilateral upper blepharoplasties conducted between January 2004 and December 2013

Background: This study was undertaken to evaluate dermatochalasis, eyebrow position, and (a) symmetry in both sides in patients before and after bipolar coagulation-assisted orbital (BICO) septo-blepharoplasty, so as to carry out further investigation if these aforementioned aspects improve, persist, or even worsen after this procedure. Methods: The preoperative and postoperative photographs of 365 patients were evaluated for the (asymmetry in) degree of skin surplus, eyebrow height, and eyelid fissure height (EFH). The degree of skin surplus was scored using a five-point grading scale (0 = no, 1 = minimal, 2 = moderate, 3 = evident, and 4 = severe skin surplus). For eyebrow height and EFH, respectively, the distance was measured between the lower bound of the eyebrow and the center of the pupil and between the upper and lower lash line. Results: On both the right and left upper eyelids, the skin surplus was significantly lesser postoperatively than preoperatively (p = 0.000). Furthermore, the asymmetry in skin surplus between the right and left upper eyelid was significantly lesser postoperatively (p = 0.000). The eyebrow height was significantly lower on both the right and left sides postoperatively than preoperatively (p = 0.000). EFH was significantly higher postoperatively than preoperatively in both the right and left eyes (p = 0.000). Therefore, the asymmetry in EFH between the right and left eyes was significantly lesser postoperatively (p = 0.000). Conclusions: A significant decrease in skin surplus and eyebrow height and a significant increase in EFH were observed in patients after BICO septo-blepharoplasty. However, a significant reduction in (the prevalence of) asymmetry in skin surplus and EFH was observed after the procedure. (C) 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved

Silicone breast prostheses:A cohort study of complaints, complications, and explantations between 2003 and 2015

Background: Complications after silicone implantation, with silicone extravasation being the most severe, remain a safety issue in breast implantation surgery. The purpose of our study was to determine the incidence of medium- and long-term postoperative complaints and complications and indications for explantation in patients with a silicone breast implant. Methods: This is a retrospective cohort study consisting of patients who received silicone breast implants of the fourth or fifth generation between 2003 and 2015. Long-term outcomes (> 3 months after initial placement) were derived from medical records. The association with indication of breast surgery, method of placement, and type of reconstruction was determined. Results: In total, 448 patients (n=738 silicone breast implants) met the inclusion criteria with a median follow-up of 330 days. Overall, 18% of the implants resulted in postoperative complaints, with discomfort or pain being the most common complaint (12%), significantly more frequent in reconstructive cases and significantly associated with subglandular placement in cosmetically augmented breasts. Physical examination revealed in 14% one or more postoperative complications, with capsular contracture being the most common complication. A total of 12% of the implants were eventually explanted within a median time of 568 days. Predominant reasons were cosmetic dissatisfaction, capsular contracture, and pain (in 37%, 21%, and 15%, respectively). Macroscopic leakage was demonstrated in 3% of the explanted prostheses. Conclusions: Explantation of breast implants occurred in 12%, within a median time of 1.6 years, wherein macroscopic leakage was rarely seen. Cosmetic dissatisfaction, capsular contracture, and pain were the most common indications. (C) 2018 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved

A randomised double-blinded crossover study comparing pain during anaesthetising the eyelids in upper blepharoplasty:First versus second eyelid and lidocaine versus prilocaine

Aim: The aim of this study was to investigate whether infiltration of the upper eyelid skin is less painful with prilocaine than with lidocaine. Methods: In 40 consecutive patients scheduled for bilateral upper blepharoplasty, one upper eyelid was anaesthetised with lidocaine with epinephrine and the other with prilocaine with felypressin. After injection of each upper eyelid, the patient scored the pain experienced on infiltration using a visual analogue scale (0-10). In addition, the surgeon scored the need for reinjection during the operation; differences in perioperative bleeding; and degree of oedema, erythema and haematoma before discharge on a four-point rating scale (no, minimal, moderate or severe). Results: Pain scores were significantly lower in upper eyelids injected with lidocaine than in those injected with prilocaine (p = 0.036). In addition, scores for oedema, erythema and haematoma were significantly lower in upper eyelids anaesthetised with lidocaine than in those anaesthetised with prilocaine (respectively, p = 0.001, p = 0.004 and p = 0.000). Conclusions: Compared with prilocaine with felypressin, lidocaine with epinephrine is significantly less painful in anaesthetising the upper eyelids; gives significantly less postoperative oedema, erythema and haematoma; and provides better haemostasis during upper blepharoplasty. (C) 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved

Improved Upper Blepharoplasty Outcome Using an Internal Intradermal Suture Technique: A Prospective Randomized Study

OBJECTIVETo assess whether a suture technique in upper blepharoplasty may be the cause of differences in the occurrence of suture abscess formation and focal inflammation.MATERIALS AND METHODSA Level I, randomized controlled trial. The upper blepharoplasty wound was closed with a running intradermal suture. External intradermal suturing implied that this suture was started by initially passing it through the intact skin adjacent to the wound. In contrast, internal intradermal suturing meant the intradermal suture was not started in the adjacent skin but simply within the wound itself. One week and 6 weeks after surgery, the presence of suture abscesses and focal inflammation was assessed at the entrance and exit of the sutures.RESULTSAfter 1 week, 12 abscesses (40.0%) were found at the medial side of the externally sutured upper eyelids and 4 abscesses (13.3%) in the internally sutured upper eyelids (p = .02). The presence of erythema and edema after 1 week was also significantly lower in internally sutured upper eyelids (p = .02).CONCLUSIONIn this series, the method of starting the suture (internal vs external) at the medial side of an upper blepharoplasty wound was associated with a statistically significant reduction in the incidence of medial wound inflammation and suture abscess formation at a 1-week follow-up

The Effect of Eyelid Cooling on Pain, Edema, Erythema, and Hematoma after Upper Blepharoplasty:A Randomized, Controlled, Observer-Blinded Evaluation Study

Background: The purpose of this study was to investigate the efficacy of eyelid cooling to reduce postoperative pain, edema, erythema, and hematoma after upper blepharoplasty. Methods: After bilateral upper blepharoplasty in 38 consecutive patients, one eyelid per patient was randomized for cooling with an ice pack, and the other eyelid was left uncooled. Pain was scored by the patients using a visual analogue scale (0 to 10) 1 hour and 1 day after surgery. Degree of edema, erythema, and hematoma were scored by the patients on a four-point rating scale (no, minimal, moderate, or severe) 1 hour, 1 day, 1 week, and 2 months after surgery. Light photography was obtained 1 week after surgery for scoring the degree of bruising on a four-point rating scale by a blinded observer. Results: Pain did not differ between cooled and uncooled eyelids on the day of surgery. However, pain in cooled eyelids was significantly lower 1 day after surgery (p = 0.046), yet absolute pain scores were low (median, 0 and 0.5, on a scale of 10). Edema, erythema, or hematoma did not differ between cooled and uncooled eyelids on any of the time points studied. Conclusions: Cooling of eyelids after upper blepharoplasty does not reduce edema, erythema, or hematoma of the eyelids, but reduces pain 1 day after surgery. However, because the degree of pain seems clinically irrelevant and because the majority of patients indicate that they have no preference for cooling over noncooling, eyelid cooling after upper blepharoplasty as a rule of thumb can be abandoned