Citations

Background Malpositioned orbital implants are an underappreciated source of significant postoperative morbidity, often necessitating revision surgery. Decision-making regarding practical frameworks to guide revision remains challenging and is not well standardized or characterized. Objective To analyze clinical presentations, radiographic failure patterns, multidisciplinary surgical strategies, and outcomes of patients undergoing revision surgery for malpositioned orbital implants. Methods A single-center retrospective consecutive case series was conducted of patients who underwent removal or replacement of malpositioned orbital implants. Patient demographics, presenting symptoms, radiographic findings, surgical approaches, implant management strategies, and postoperative outcomes were reviewed. Most cases were co-managed by plastic/reconstructive and oculoplastic surgeons. Descriptive statistics were used to summarize findings. Results Five of seven patients (71.4%) were female, with a median age of 60 years (range 29–78). Diplopia was the most common presenting symptom (5/7, 71.4%) along with pain or swelling (5/7, 71.4%) followed by globe malposition (3/7, 42.9%). CT demonstrated implant protrusion into orbital soft tissue in 4/7 patients (57.1%) and peri-implant inflammatory collections in 3/7 (42.9%). Out of our 7 revision cases, four patients (57.1%) underwent explantation alone, and three (42.9%) underwent secondary reconstruction with custom or semi-custom implants. At follow-up, diplopia improved or resolved in 4/5 affected patients (80%), and pain, swelling, and globe position improved in all symptomatic patients. Conclusion Malpositioned orbital implants demonstrate heterogeneous failure mechanisms that require individualized surgical management. A multidisciplinary approach can guide decision-making regarding implant removal versus revision of reconstruction, enabling safe revision surgery and favorable clinical outcomes. Additionally, virtual surgical planning and intraoperative navigation are enablers of safe and precise revision orbital surgery.

Summary: Anatomy is a critical component of surgical training; however, traditional resources—such as Netter’s Surgical Anatomy , Gray’s Anatomy , and anatomy applications—often fall short in delivering surgically relevant, 3-dimensional (3D) perspectives of facial anatomy. Although cadaveric dissection remains a valuable teaching tool, its accessibility is limited by cost, ethical concerns, and the lack of structured curricula, making it less feasible for ongoing surgical education. To address these limitations, this article introduced a novel educational approach that integrates 3D photogrammetry and virtual reality technology into the surgical anatomy curriculum for craniofacial and aesthetic surgery. Six fresh cadaveric specimens were meticulously dissected by a plastic surgeon to illustrate the intricate layered anatomy of the face and neck. At each stage of the dissection, a photogrammetry technique was used to capture 360-degree images using 5 digital single-lens reflex cameras alongside a 3D handheld camera. This approach not only ensured high-quality imaging but also facilitated the creation of detailed, lifelike virtual 3D models, enhancing the understanding of facial and neck anatomy within a surgical context. Additionally, we present some technical refinements of the 3D volume renderings to capture precise anatomical details during our dissections. Preliminary results from the use of this technology in anatomy courses and workshops indicated trainee engagement, a clearer grasp of the spatial anatomical relationships, and greater confidence in applying this knowledge to hands-on surgical procedures.

Background: Despite increased adoption of virtual surgical planning (VSP) in various craniofacial indications, the incorporation of VSP/3DP into facial trauma care remains limited. Therefore, Expedited Preoperative Point of Care for Fracture Reduction to Normalized Anatomy and 3DP to Improve Surgical Outcomes (EPPOCRATIS) was introduced in 2021. This study evaluates our experience with EPPORATIS in craniomaxillofacial trauma over 10 years. Methods: A retrospective review of patients who underwent facial trauma repair between September 2014 and September 2024 was conducted. For each VSP/3DP case, a patient with similar facial trauma patterns, who was treated without VSP, was selected. Evaluation metrics included operative time, blood loss, length of stay, complication rates, and fracture reduction accuracy through 3D heatmap analyses. Operative metrics were normalized by implant (i.e., fracture plates and screws) count to account for fracture complexity. A value of p < 0.05 was deemed statistically significant. Results: The VSP group presented with more complex injuries and higher involvement of various surgical specialties (p < 0.5) and demonstrated longer operative times (p < 0.03). Although the difference was not statistically significant (p = 0.4), when adjusted for implant count, the VSP group had shorter operative times (median: 15.4 vs. 19.3 min/implant) and reduced blood loss compared to non-VSP cases (median: 3.4 mL/implant vs. 4.2 mL/implant). Complications, revision rates, and length of stay showed no significant differences. Conclusions: The use of VSP/3DP (EPPOCRATIS) in craniomaxillofacial trauma reconstruction demonstrated operative efficiency and accurate fracture reduction in complex cases. Further studies are needed to examine the feasibility and cost-effectiveness of point-of-care VSP/3DP in trauma centers.

Background: Development of ectropion is a frequently reported complication after reconstruction of infraorbital Mohs defects. This study aimed to characterize preoperative and surgical factors contributing to ectropion development in patients undergoing reconstruction after Mohs micrographic surgery. Methods: We conducted a retrospective single-center case-control study on patients undergoing reconstruction of Mohs micrographic surgery defects involving the nonmarginal lower eyelid and upper cheek from 2011 to 2023. Pre- and postoperative photographs were reviewed to confirm defect location and postreconstructive eyelid malposition. Ectropion risk factors were determined with uni- and multivariate odds ratio analyses. Results: A total of 202 patients were included, 45 cases in the ectropion group and 157 in the control group. Negative orbital vector (P = 0.02), recurrent disease (P = 0.01), and greater defects size (P = 0.007) were associated with postreconstructive ectropion. Ectropion was more likely after multidisciplinary reconstruction (13.3% versus 1.4%, P < 0.001) and reconstruction with cervicofacial flaps (28.9% versus 4.2%, P < 0.0005); and less likely after primary closure (8.9% versus 28.5%, P < 0.001). Multivariate assessment (odds ratio [95% confidence interval], P value) revealed that combined cheek and eyelid defect involvement (4.32 [1.36–13.6], P = 0.01), larger size (1.07 [1.03–1.13], P < 0.001), and negative orbital vector (12.11 [2.65–65.42], P = 0.002) were independent risk factors for ectropion development. Conclusions: Combined cheek/lower eyelid defects and negative orbital vector increase the risk of postreconstructive ectropion. These findings can be used to optimize surgical technique and counsel patients on increased likelihood of this complication with possible need for revision surgery.

Background: Postoperative fluid-related complications, such as hematoma and seroma formation, are common concerns in breast surgery, adversely affecting surgical outcomes and patient recovery. Topical tranexamic acid (TXA) has emerged as a promising intervention to minimize bleeding while reducing systemic adverse effects linked to intravenous administration. However, evidence on the efficacy of topical TXA in breast surgery remains sparse. Methods: This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. English-language databases were searched through April 2024 to identify randomized controlled trials and cohort studies assessing the effects of topical TXA on postoperative outcomes in breast surgery, including hematoma, seroma, infection rates, and drain output/duration. Results: Six studies, encompassing 823 patients and 1477 breasts, were included. Subgroup meta-analysis demonstrated a statistically significant reduction in hematoma rates in patients who underwent mastectomy (risk ratio [RR] = 0.14; 95% confidence interval [CI], 0.03–0.78; P = 0.02), but not in patients who underwent breast reduction (RR = 0.76; 95% CI, 0.08–7.08; P = 0.24). No significant differences were found in overall hematoma rates (RR = 0.32; 95% CI, 0.08–1.195; P = 0.09), seroma formation (RR = 1.22; 95% CI, 0.99–1.51; P = 0.07), or infection rates (RR = 0.85; 95% CI, 0.46–1.56; P = 0.59). Conclusions: Topical TXA significantly reduced hematoma rates in patients who underwent mastectomy but showed no significant effect on other outcomes. Larger studies with standardized methodologies are required to fully establish the role of topical TXA in optimizing breast surgery outcomes.

Background: Venous thromboembolism (VTE) poses a major risk after abdominal contouring surgery, impacting morbidity and mortality. Despite various preventative strategies, surgeons are cautious about using enoxaparin for extended postoperative periods. This study aims to determine if a 7-day postoperative course of enoxaparin increases bleeding risks compared with a single dose of intraoperative unfractionated heparin in patients undergoing abdominal contouring surgery. Methods: A retrospective cohort analysis was performed on patients who underwent abdominoplasty or panniculectomy from August 2017 to October 2023. Patients were split into 2 groups: Group 1 received 5000 units of intraoperative unfractionated heparin in addition to 7 days of postoperative enoxaparin (40 mg daily); group 2 received only the intraoperative heparin dose. Primary outcomes included bleeding events and VTE incidence. Secondary outcomes were seroma, infection, surgical site dehiscence, necrosis, drain duration, and reoperation rates. Results: The study included 121 patients (111 women, 10 men), with 61 patients in group 1 and 60 in group 2. The average age was 49 ± 12 years, and the average body mass index was 29.8 ± 5 kg/m². No cases of VTE were reported. Postoperative bleeding occurred in 3 patients (4.9%) in group I and 2 patients (3.3%) in group 2, showing no statistically significant difference (P = 0.66). Secondary outcomes also showed no significant differences between the groups. Conclusions: Our study of 121 patients undergoing either abdominoplasty or panniculectomy demonstrated that administering enoxaparin for 7 days postoperatively is safe and does not increase the risk of bleeding.

Background: Facial shape is significantly influenced by the underlying facial bony skeleton. Sexual dimorphisms in these structures are crucial for craniofacial, aesthetic, and gender-affirming surgery. Previous studies have examined the orbits and upper face, but less is known about the midface. This study aimed to elucidate the sexual dimorphism in the midface region, focusing on the maxilla and zygomatic bones. Methods: A retrospective review was conducted using facial computed tomography scans from 101 White patients aged 20–79 years, using Materialise Mimics and 3-Matics for segmentation and 3D reconstruction. Measurements and statistical shape modeling of the midfacial skeleton were performed. Results: Our results show a distinct sexual dimorphism in the midfacial skeletal structure across all age groups. Women typically had a narrower bizygomatic width by 1.5 mm (P = 0.04), a shallower maxillary depth by 1.6 mm (P < 0.01), and a midfacial vertical height that was 4 mm shorter than that of men (P = 0.018). In contrast, men exhibited a greater distance between the frontozygomatic sutures by 5.4 mm (P < 0.01), a 3-mm greater interorbitale distance (P < 0.01), and a 2.1-mm wider infraorbital foramina distance (P = 0.007). There were no significant differences in the pyriform and maxillary angles (P = 0.15 and P = 0.52, respectively). Conclusions: Our analysis of midfacial skeletal anatomy revealed sexual dimorphism differences. Men exhibited more pronounced facial features than women, with a broader horizontal midfacial skeleton, a longer midfacial vertical height, and greater maxillary depths compared with women.