McFarland Joyce (bettywarm47)

Importance Sleep-disordered breathing (SDB) represents a spectrum of sleep-related disorders associated with significant medical comorbidities. Nasal airway surgery has been shown to improve SDB but no large-scale studies exist that describe the long-term impact of surgery on patient perception of snoring and nasal obstruction. Objective To characterize longitudinal snoring symptoms and nasal obstruction after functional nasal surgery for patients with SDB, stratified by history of snoring or obstructive sleep apnea (OSA). Design, Setting, and Participants In this prospective cohort study, patients undergoing nasal surgery between 2013 and 2017 at a tertiary academic center were surveyed using Snoring Outcome Survey (SOS) and Nasal Obstruction Symptom Evaluation (NOSE) questionnaires through 24 months postoperatively. Patient demographics, history of snoring, diagnosis of OSA, and prior nasal surgeries were analyzed. A total of 625 patients were recruited with 325 females (52.0%) and mean age of 36.3 years (Selated QOL outcomes after nasal airway surgery. Future studies using objective measures of snoring are needed to quantify the physiologic change in snoring after treatment of nasal obstruction. Level of Evidence 2c.Importance Quantitative assessment of facial function is challenging, and subjective grading scales such as House-Brackmann, Sunnybrook, and eFACE have well-recognized limitations. Machine learning (ML) approaches to facial landmark localization carry great clinical potential as they enable high-throughput automated quantification of relevant facial metrics from photographs and videos. However, the translation from research settings to clinical application still requires important improvements. Objective To develop a novel ML algorithm for fast and accurate localization of facial landmarks in photographs of facial palsy patients and utilize this technology as part of an automated computer-aided diagnosis system. Design, Setting, and Participants Portrait photographs of 8 expressions obtained from 200 facial palsy patients and 10 healthy participants were manually annotated by localizing 68 facial landmarks in each photograph and by 3 trained clinicians using a custom graphical user interface. A novel ML modelions and Relevance Retraining a computer vision facial landmark detection model with fewer than 1600 annotated images of patients significantly improved landmark detection performance in frontal view photographs of this population. The new annotated database and facial landmark localization model represent the first steps toward an automatic system for computer-aided assessment in facial palsy. Level of Evidence 4.Importance There are no surgical techniques described to treat synkinesis and concurrent facial asymmetry. We describe our innovative and effective approach and technique. Objective To improve the spontaneous smile mechanism as well as facial symmetry in patients with synkinesis not only during the smile mechanism but also at rest. Design Surgical pearls-surgical technique description. Setting Private practice. Participants Patients who underwent the operation.Pedicled buccal fat flaps have demonstrated great utility for oral reconstructions. We present a retrospective case description detailing the utility of the buccal fat pad (BFP) as an anterior maxillary flap for midfacial and lower eyelid volumization and reconstruction. A 64-year-old healthy female had undergone bilateral lower blepharoplasty with silicone tear tough implantation, complicated by infection of the right tear trough implant. Delayed implant removal resulted in chronic infection and inflammation producing significant right lower eyelid retraction, and full-thickness scarring to the orbital rim. Reconstruction was performed, featuring the creation of a midfacial subperiosteal pocket and to access the BFP, which was mobilized and secured to the inferior orbital rim. Long-term follow-up confirms ongoing viability of the surgical