bluuebunny/crossref_metadata_2025_split huggingface dataset:
Conversion of Breast Implants into Natural Breast Reconstruction: Evaluating Lipofilled Mini Dorsi Flap
Authors: Piat Jean-Marc , Giovinazzo Vincenzo , Talha Aurore , Dinnebier Tomazzoni Gabriela , Maiato Anna Paula , Roskamp Budel Lucas , Ho Quoc Christophe 
Published: July 2022

Background:
Autologous reconstruction techniques can provide a long-lasting natural breast reconstruction for patients. This study aimed to further investigate outcomes in the conversion of breast implant reconstruction into a lipofilled mini dorsi flap, focusing on reviewing its techniques, efficiency, and final results.

Methods:
Over 3 years, we performed a number of breast implant replacements via the lipofilled mini dorsi flap technique. The artificial implants were replaced to a deepithelized flap. The efficiency and tolerance of the technique were evaluated by the whole surgical team, and the achieved results were also analyzed by the patients in terms of postoperative pain, functional impact, and the softness of the reconstructed breast by comparing their prior condition to the lipofilled mini dorsi flap condition at least 9 months after operation.

Results:
Forty-seven consecutive operations were prospectively studied. The mean ± standard deviation volume of the removed implants was 348.66 ± 86.54 mL. The mean volume of fat injected was 284.13 ± 62.94 mL. The procedure’s average duration was 108.93 ± 17.65 minutes. The surgical team evaluated the results as very satisfactory in 32 cases (68.1%), satisfactory in 15 cases (31.9%), and moderately satisfactory or unsatisfactory in zero cases (0.0%). Eighteen patients (38.3%) evaluated their reconstruction as very good, while 20 patients (42.6%) considered their reconstruction as good, four (8.5%) as average, and zero (0.0%) as insufficient.

Conclusion:
According to our experience, the lipofilled mini dorsi flap is a simple, less invasive, and quick procedure to convert breast implants into natural breast reconstruction.
Harnessing the Power of Artificial Intelligence to Teach Cleft Lip Surgery
Authors: Sayadi Lohrasb Ross , Hamdan Usama S. , Zhangli Qilong , Vyas Raj M. 
Published: July 2022

Background:
Artificial intelligence (AI) leverages today’s exceptional computational powers and algorithmic abilities to learn from large data sets and solve complex problems. The aim of this study was to construct an AI model that can intelligently and reliably recognize the anatomy of cleft lip and nasal deformity and automate placement of nasolabial markings that can guide surgical design.

Methods:
We adopted the high-resolution net architecture, a recent family of convolutional neural networks–based deep learning architecture specialized in computer-vision tasks to train an AI model, which can detect and place the 21 cleft anthropometric points on cleft lip photographs and videos. The model was tested by calculating the Euclidean distance between hand-marked anthropometric points placed by an expert cleft surgeon to ones generated by our cleft AI model. A normalized mean error (NME) was calculated for each point.

Results:
All NME values were between 0.029 and 0.055. The largest NME was for cleft-side cphi. The smallest NME value was for cleft-side alare. These errors were well within standard AI benchmarks.

Conclusions:
We successfully developed an AI algorithm that can identify the 21 surgically important anatomic landmarks of the unilateral cleft lip. This model can be used alone or integrated with surface projection to guide various cleft lip/nose repairs. Having demonstrated the feasibility of creating such a model on the complex three-dimensional surface of the lip and nose, it is easy to envision expanding the use of AI models to understand all of human surface anatomy—the full territory and playground of plastic surgeons.
Residual Cholesteatoma After Endoscopic-Assisted Canal Wall-Up Tympanomastoidectomy: A Randomized Controlled Trial
Authors: Noschang Lopes da Silva Maurício , Selaimen da Costa Sady , André Selaimen Fábio , da Costa Huve Felipe , Lang Silva Alice , Dias Toshiaki Koga Fernanda , Martins-Costa Luciana Lima , Bernard Rosa Nery Marcel , Zanardini Marcos , Sperling Neil 
Published: July 2022

Objective
This study aimed to determine the effectiveness of using endoscopes in reducing recidivism secondary to residual cholesteatoma after canal wall-up tympanomastoidectomy.

Study Design
Randomized clinical trial.

Setting
Tertiary referral center.

Patients
Patients with cholesteatoma, aged 7 to 70 years.

Interventions
Subjects were randomly allocated into two groups: endoscopic-assisted canal wall-up (EACWU; group 1) and conventional canal wall-up (CWU; group 2) techniques. Pars flaccida and pars tensa subgroups were analyzed according to the anatomic location of cholesteatoma origin.

Main Outcome Measures
Presence or absence of residual cholesteatoma, based on second look surgery, diffusion-weighted magnetic resonance imaging, or video-otoscopy at 12 and 18 months after surgery.

Results
In total, 57 ears were analyzed: 29 in group 1 and 28 in group 2. Group 1 revealed residual disease in 17.2% of ears, whereas group 2 had residual disease in 35.7% (p > 0.05) of the ears. In the pars tensa cholesteatoma subgroup, the incidence of residual disease was 13.3% for EACWU and 47.1% for the CWU technique (p < 0.05). A tendency of reduced incidence was observed for cholesteatoma due to residual disease using EACWU. In addition, a statistically significant reduction in the residual disease was observed in the subgroup of pars tensa cholesteatomas. In this subgroup, the relative risk was 0.28, and the number needed to treat was 4.6.

Conclusion
The use of the endoscope reduces the incidence of recidivism secondary to residual disease in pars tensa cholesteatomas. Endoscopic-assisted surgery may be useful in cases with an indication for canal wall-up tympanomastoidectomy.

Level of Evidence
1b.
Benefits of High-Dose Corticosteroid and Antiviral Agent Combination Therapy in the Treatment of House-Brackman Grade VI Ramsay Hunt Syndrome
Authors: Furukawa Takatoshi , Abe Yasuhiro , Ito Tsukasa , Kubota Toshinori , Hull Melinda , Goto Takanari , Sugiyama Motoyasu , Kakehata Seiji 
Published: July 2022

Objective
Few large-scale investigations have been conducted on treatment of House-Brackmann grade VI (HB grade VI) Ramsay Hunt syndrome (RHS) patients. We compared recovery rates among patients receiving a normal-dose corticosteroid (prednisolone [PSL] 60 mg/d) or high-dose corticosteroid (PSL 200 mg/d), both with or without an antiviral agents. Recovery rates were also examined based on the order of presentation of herpetic vesicles versus facial palsy.

Study Design
Retrospective case review.

Setting
Tertiary referral center.

Patients
A total of 128 patients with HB grade VI RHS were treated in our department between 1995 and 2017. These patients were divided into four treatment groups based on corticosteroid dosage and use of an antiviral agent.

Methods
We assessed treatment outcomes for HB grade VI patients together with logistic regression analysis to investigate factors that can impact treatment outcomes, that is, sex, age, days to start of treatment, PSL dosage, and antiviral agent administration.

Results
Recovery rates were best in the high-dose corticosteroid group with an antiviral agent (71.1%) in comparison with the normal-dose corticosteroid group with an antiviral agent (60.0%) or high-dose corticosteroid alone (57.1%). Significant factors for treatment outcomes were high-dose corticosteroid administration and early initiation of treatment. A better recovery rate was also found when the herpetic vesicles appeared before facial palsy.

Conclusion
We showed that a combination of a high-dose corticosteroid and antiviral agent produced the best outcomes for patients with HB grade VI RHS. However, our results were not statistically significant because of small sample size.
Expansion of the Foramen Ovale in Patients With Cerebrospinal Fluid Leak or Encephalocele
Authors: Curry Steven D. , Granger Kleve W. , Richman Evan H. , Liu Collin , Moore Gary F. , Barnes Christie A. , Surdell Daniel L. , Hatch Jonathan L. 
Published: July 2022

Objective
Spontaneous cerebrospinal fluid (CSF) leaks are associated with elevated intracranial pressure and idiopathic intracranial hypertension (IIH). Skull base erosion and widening of the foramen ovale have been reported in patients with IIH. This study sought to investigate changes in the size of the foramen ovale and foramen spinosum in patients with IIH, spontaneous CSF leak, and encephalocele.

Study Design
Retrospective cohort study.

Setting
Tertiary care academic medical center.

Patients
Adult patients treated from 2014 to 2018 with computed tomographic imaging of the head and who were diagnosed with IIH, encephalocele, or CSF leak.

Intervention
Two blinded observers measured the long and short axes of the foramen ovale and foramen spinosum on axial computed tomographic images. Measurements were used to calculate the approximate elliptical cross-sectional area of the foramina.

Main Outcome Measures
Length, width, and area of the foramen ovale and foramen spinosum.

Results
A total of 264 patients were identified meeting the inclusion criteria and were placed into three groups. There were 170 patients with IIH, 48 with spontaneous CSF leak or encephalocele (CSF/E group), and 46 with traumatic or iatrogenic CSF leak (control group). Mean foramen ovale short axis (4.85 ± 1.00 mm) and cross-sectional area (30.17 ± 9.25 mm2) in the CSF/E group were significantly increased compared with measurements in patients with IIH or the control groups. Foramen ovale size was positively correlated with age in the CSF/E group. No significant difference in foramen spinosum size was found.

Conclusion
Skull base defect resulting in spontaneous CSF leak or encephalocele is associated with enlargement of the foramen ovale on axial computed tomography.
Vestibular Migraine Confounds Management of Superior Canal Dehiscence Syndrome
Authors: Smetak Miriam R. , Cass Nathan D. , Manzoor Nauman F. , Hatton Kelsey , Perkins Elizabeth L. , Rivas Alejandro , O'Malley Matthew R. , Bennett Marc L. , Haynes David S. 
Published: July 2022

Objective
To investigate the prevalence of vestibular migraine (VM) in a cohort of patients with radiologic confirmation of superior canal dehiscence (SCD) and to compare management of superior canal dehiscence syndrome (SCDS) in patients with and without comorbid VM.

Study Design
Retrospective review of a SCD database.

Setting
University-based tertiary medical center.

Patients
Ninety-one patients identified with SCD from 2009 to 2017.

Interventions
None.

Main Outcome Measures
Coincidence of VM and SCD, and resolution of symptoms.

Results
Ninety-one patients with SCD met the inclusion and exclusion criteria. VM was diagnosed in 36 (39.6%) patients. Of those receiving medical therapy for VM alone, five (45.5%) reported symptom resolution, five (45.5%) reported partial improvement, one (9.1%) had no change, and none worsened. Fifteen patients (41.7%) were treated with both surgery (for SCD) and medical therapy (for VM). Seven (46.7%) reported symptom resolution, seven (46.7%) reported partial improvement, and one (6.7%) worsened. There was no statistically significant difference in symptom resolution between SCD + VM patients who were treated medically compared with those treated with medical therapy and surgery (p = 0.951). There was no significant difference in symptom resolution after surgery between SCD + VM and SCD-only cohorts (p = 0.286).

Conclusions
This is the first study describing the incidence of VM in a cohort of patients with SCDS. The symptoms of VM confound those of SCDS and unrecognized or undertreated VM may contribute to surgical failure in SCDS. Therefore, we recommend a high index of suspicion for VM in patients with SCDS and a trial of medical therapy in the setting of suspected VM.
Stapedotomy Versus Hearing Aids in the Management of Conductive Hearing Loss Caused by Otosclerosis: A Prospective Comparative Study
Authors: Molinier Charles-Edouard , Gallois Yohan , Deguine Olivier , Iversenc Gaetan , Vales Olivier , Taoui Soumia , Lepage Benoit , Fraysse Bernard , Marx Mathieu 
Published: July 2022

Objective
To compare the outcomes of patients with unilateral otosclerosis treated consecutively by a hearing aid then stapedotomy.

Study Design
Monocentric, nonrandomized, prospective, longitudinal, cohort study.

Setting
Tertiary university hospital.

Patients
Adult patients with a unilateral conductive hearing loss of at least 30 dB caused by otosclerosis.

Interventions
Consecutive treatment by an external hearing aid followed by stapedotomy.

Main Outcome Measures
Differences between hearing aids and stapedotomy in quality of life, pure-tone audiometry, binaural hearing, tinnitus severity, and patient satisfaction.

Results
Twenty-two patients were included, of which 20 (91%) underwent stapedotomy. Stapedotomy demonstrated increased quality of life according to Glasgow Health Status Inventory scores versus hearing aids (+10.4 ± 9.4 [p = 0.0001]). Stapedotomy versus hearing aids showed improved pure-tone averages (−11.1 ± 11.0 dB [p = 0.002]) and air-bone gaps (−11.8 ± 10.7 dB [p = 0.0006]). Stapedotomy was superior to hearing aids for speech-in-noise recognition in the reverse dichotic condition (−8.4 ± 26.9 dB [p = 0.004]) and showed improved sound localization accuracy in root mean square error (−14.5 ± 24.5 degrees [p = 0.02]). Stapedotomy, but not hearing aids, showed improved patient self-evaluated tinnitus after baseline adjustment according to the Tinnitus Handicap Inventory (−8.0 ± 13.4 [p = 0.02]) and visual analog scale for tinnitus intensity (−28.7 ± 34.1 [p = 0.006]). Overall, patients were more satisfied with surgery versus hearing aids.

Conclusions
Stapedotomy remains more effective compared with hearing aids with greater improvements in quality of life, patient satisfaction, hearing outcomes, and self-evaluated tinnitus.
Dural Venous Sinus Arachnoid Granulations in Patients with Pulsatile Tinnitus
Authors: Bauschard Michael J. , Reichl Kaitlyn , Socolovsky Leandro D. , Sismanis Aristides A. , Coelho Daniel H. 
Published: July 2022

Objective
To determine the relationship, if any, between dural venous sinus arachnoid granulations (AGs) and pulsatile tinnitus.

Study Design
Retrospective case-control study.

Methods
Between October 1999 and March 2020, magnetic resonance imaging of patients with tinnitus (pulsatile [PT] and nonpulsatile [NPT]) were assessed for the presence of dural venous sinuses AG. During the same interval, patients with AGs found incidentally on all magnetic resonance imagings ordered without an indication of tinnitus were reviewed. Demographic variables recorded included patient age, sex, race, body mass index, and a history of idiopathic intracranial hypertension (IIH) or obstructive sleep apnea. Location of AGs, when present, were recorded.

Results
A total of 651 (PT 250, NPT 401) were found to have AGs. AGs had a higher prevalence in PT patients (10.4% [n = 26]) versus NPT patients (0.3% [n = 1]; odds ratio, 31.0; confidence interval 4.1–234; p < 0.001). Of the 77,607 patients who had an indication for imaging other than tinnitus, 230 patients (0.30%) were found to have incidental AGs, suggesting that the NPT cohort was an adequate control. Patients with PT were more likely to have a higher body mass index, be female, be non-White, and have an existing diagnosis of IIH. For all patients with AGs, AGs were more likely to be found in the lateral sinuses (i.e., sigmoid, transverse) in the PT group (odds ratio, 8.1; confidence interval, 1.1–61.1; p = 0.0218).

Conclusions
This study evaluates the association between AG and PT, finding higher rates of AG in patients with PT than in NPT. However, despite the increased prevalence of AG in patients with IIH, these data combined with existing literature would suggest that AGs are not necessarily the missing link to explain PT pathophysiology in IIH.
Normative Cochlear Implant Quality of Life (CIQOL)-35 Profile and CIQOL-10 Global Scores for Experienced Cochlear Implant Users from a Multi-Institutional Study
Authors: McRackan Theodore R. , Hand Brittany N. , Chidarala Shreya , Velozo Craig A. , Dubno Judy R. 
Published: July 2022

Objective
Although adult cochlear implant (CI) outcomes have primarily focused on speech recognition scores, the rigorous development of a CI-specific patient-reported outcome measure provides an opportunity for a more comprehensive and ecologically valid approach to measure the real-world functional abilities of adult CI users. Here, we report for the first time normative Cochlear Implant Quality of Life (CIQOL)-35 Profile and global scores and variance for a large, multi-institutional sample of adult CI users.

Study Design
Cross-sectional study design.

Setting
CI centers in the United States.

Patients
Seven hundred five adults with bilateral moderate to profound hearing loss with at least 1 year of CI use.

Intervention(s)
Cochlear implantation.

Main Outcome Measure(s)
CIQOL-35 Profile and CIQOL-10 Global scores.

Results
During the development of the CIQOL instruments, 1,000 CI users from all regions of the United States were invited to participate in studies. Of these, 705 (70.5%) completed all portions of the study, and their data are reported here. Mean CIQOL domain scores were highest (indicating better function) for the emotional and social domains and lowest for listening effort. The entertainment and social domains demonstrated the widest distribution of scores and largest standard deviations, indicating greatest variability in function. Overall, there were minimal ceiling and floor effects for all domains.

Conclusion
Normative scores from a large sample of experienced adult CI users are consistent with clinical observations, showing large differences in functional abilities and large variability. Normative CIQOL data for adult CI users have the potential to enhance preoperative discussions with CI candidates, improve post-CI activation monitoring, and establish standards for CI centers.
HiRes Ultra Series Recall: Failure Rates and Revision Speech Recognition Outcomes
Authors: Lindquist Nathan R. , Cass Nathan D. , Patro Ankita , Perkins Elizabeth L. , Gifford René H. , Haynes David S. , Holder Jourdan T. 
Published: July 2022

Objective
To report Advanced Bionics (AB) Ultra (V1) and Ultra 3D (V1) cochlear implant (CI) electrode failures and revision speech recognition outcomes for patients at a large CI program.

Study Design
Retrospective case series.

Setting
Tertiary referral center.

Patients
Patients receiving Ultra (V1) or Ultra 3D (V1) devices as of September 21, 2021.

Main Outcome Measures
Failure rate, revision surgery, speech recognition scores.

Results
To data, 65 (21.1%) of the 308 implanted devices are known failures, with 63 (20.5%) associated with the recent voluntary field corrective action (FCA). Average time to failure was 2.2 ± 1.1 years. Fifty-two patients (82.5%) elected for revision surgery. Among adults, immediate prerevision scores demonstrated a significant decrease from best-achieved scores with the faulty implant, with mean difference of −15.2% (p = 0.0115) for consonant-nucleus-consonant (CNC) and −27.3% (p < 0.0001) for AzBio in quiet. By 3 months postactivation of the revised device, CNC (p = 0.9766) and AzBio in quiet (p = 0.9501) scores were not significantly different than best prerevision scores. Overall, 15 of 19 patients regained or improved their best prerevision CNC score. The current trajectory for FCA device failures is approximately 6% per year.

Conclusion
Compared to manufacturer reporting, a high number of patients experienced hard failures of the Ultra (V1) and Ultra 3D (V1) devices. Early identification of failures is possibly because of the diligent use of electrical field imaging testing. Most patients affected by the FCA regain or exceed their prefailure speech recognition score as soon as 3 months after revision surgery.
Personal Evolution in Rhinoplasty Tip Shaping: Beyond the Tri-pod Concept
Authors: Rohrich Rod J. , Bellamy Justin L. , Chamata Edward S. , Alleyne Brendan 
Published: July 2022

Summary:
Introduced over fifty years ago, the “tripod concept” has long been the foundation of our understanding of tip dynamics in rhinoplasty. Modern approaches to rhinoplasty have built upon these principles and seen the evolution of several operative techniques to address tip aesthetics. The following manuscript and accompanying case video details our algorithmic approach to tip shaping, based upon the utilization of complete lower lateral cartilage reshaping & tensioning; clarified use of medial crural transection & overlap; with stabilization on a fixed-floating septal extension graft and deliberate management of the soft-tissue envelope. The intra-operative sequencing, key technical considerations, relevant classification schemes, and global decision-making processes are reviewed.
Zones for Fat Grafting in Hybrid Breast Augmentation Revisited: Standardization for Intraoperative Planning of Fat Grafting Based on Breast Cleavage Units
Authors: Munhoz Alexandre Mendonça , Maximiliano João , Neto Ary de Azevedo Marques , Duarte Daniele Walter , de Oliveira Antonio Carlos Pinto , Portinho Ciro Paz , Zanin Eduardo , Collares Marcos Vinicius Martins 
Published: July 2022

Background:
Autologous fat grafting (AFG) is a procedure indicated for breast augmentation (BA) to improve coverage of silicone implants and redesign breast shape. Different techniques are based on parameters such as intermammary distance and implant volume/projection, none of which have been systematically standardized according to the main areas for AFG placement. This study presents a method utilizing breast zone standardization based on breast anatomy and implant location to promote natural superior/medial breast poles and achieve an anatomical composite breast.

Material/Methods:
The authors performed this zone standardization in 76 breasts (38 patients) undergoing primary/secondary hybrid BA. An upper/medial pole area between the implant and the clavicle region and parasternal area was marked to receive subsequent AFG and divided into three zones. A mathematical formula (VAFG= (π. r2.p)/4.8) was used to estimate the volume of fat grafts according to implant volume in the respective zones.

Results:
Implant volumes ranged from 205 to 375 cc (mean: 265 cc), and patients received an average AFG volume of 105.3 cc per breast (range: 36–135 cc); the average fat graft volume in zones I-II and III was 78.28 (range: 0–100 cc) and 27.03 (15–60 cc), respectively. Three cases of minor complications were observed in 2 patients (5.2%) during a mean follow-up of 12.8 months (6–19 months). A high correlation was observed between the AFG performed in the cohort and predictions obtained from the formula (p<0.001).

Conclusion:
Recognizing risky cleavage breast zones between the implant pocket and upper and medial quadrants remains essential to attain satisfactory outcomes and minimize adverse results. Although experience and proper judgment are still important in the AFG technique, the data presented here offer plastic surgeons an additional standardized framework to help deliver predictable HBA.