Importance: Informed consent in rhinoplasty is a challenging process due to the technically demanding surgery with a wide array of potential complications. Objective: To underscore the significance of informed consent in rhinoplasty, its complications, and identify gaps in the consent process. Design, Setting, and Participants: Dual search and comparison. First a review of the literature for rhinoplasty articles was carried out between January 2000 and November 2017 with at least 100 patients to identify complications and their incidences. Then a comprehensive online search for rhinoplasty consent forms was carried out to identify consent form topics and their incidences. Main Outcomes and Measures: Consent form topics and complication rates from the literature review were reported and directly compared. Results: A total of 117 articles were included, with 36 different complications reported. Twenty-four consent forms were evaluated, yielding 80 different topics. Common complications within the literature included skin problems such as acne (18.3%), numbness (16.7%), hospital revisit (6.5%), primary source revision rate (5.3%), and dissatisfaction (5.0%). The most commonly covered consent topics included infection (100%), bleeding (95.8%), and scarring (95.8%). Unsatisfactory results and need for revision were only covered in 83.3% and 75.0% of consent forms, respectively, despite both being in the top 5 complications cited in the literature. Conclusions and Relevance: Rhinoplasty consent forms generally cover a wide range of topics, with varying incidences of complications cited within the literature. Certain complications such as dissatisfaction and revision surgery should be included in every consent process. These data help provide a contextual framework as well as valuable information in preoperative counseling for patients and physicians regarding rhinoplasty and its potential complications Level of Evidence: NA

Objective: Idiopathic subglottic stenosis (iSGS) is a rare disease with few local resources for individuals to use. With the explosive growth of online social networking, platforms such as Facebook possess compelling potential to facilitate user-driven sharing of health information and peer support. This study was performed to better understand the content shared in a busy online community for individuals with iSGS. Methods: The largest online community (OC) for individuals with iSGS, Living With Idiopathic Subglottic Stenosis (LwiSGS), was examined. A thematic content analysis of the communications shared in February of 2018 was performed. A conventional qualitative analysis model was employed to analyze aggregated data. The data were then codified. Results: Analysis demonstrated that communications primarily encompassed three major thematic elements: (1) information sharing; (2) emotional support, expression, and experience sharing; and (3) community building. Positively toned posts grossly overshadowed negatively toned posts by almost a factor of 3. A significant portion of group members requested information from their peers, suggesting a high level of trust toward the resources provided in this group, even those involving a surgical procedure or medication. Conclusion: LwiSGS is a forum for patients with a rare chronic condition to share informational resources, personal experiences, and emotional support, as well as a community with their peers. These data suggest that LwiSGS could be a powerful resource for individuals with iSGS to share information, personal experiences, or emotional support.

HNBs significantly impact healthcare delivery, as over 200,000 visits reportedly presented to EDs over the 5-year period studied. Consumer products facilitating visits and associated patient demographics described may guide history, clinical examination, and identification of secondary injuries. In particular, age-specific patterns detailed may be included in consumer education and patient counseling to facilitate injury prevention, as office visits provide an opportunity to counsel patients.

IMPORTANCEThe design, use, and indications for the articulated alar rim graft (AARG) and the functional and aesthetic improvements that can be achieved have not been fully characterized.OBJECTIVE To analyze the functional and aesthetic outcomes of AARG placement on nasal airway function, nasal base shape change, and appearance. DESIGN, SETTING, AND PARTICIPANTSA case series study of patients who underwent septorhinoplasty with placement of AARG at University of California, Irvine Medical Center, from 2015 to 2018 was carried out. Surgical data recorded included stage of rhinoplasty (primary vs revision), use of spreader grafts, rim grafts (and dimensions), caudal septal extension graft (CSEG), lateral crural tensioning (LCT), and turbinate reductions. MAIN OUTCOMES AND MEASURES Preoperative and postoperative Nasal ObstructionSymptom Evaluation Survey (NOSE) surveys were analyzed and correlated with AARG geometry, use of CSEG, and the LCT maneuver. Preoperative and postoperative alar base views were evaluated by fitting base shape to a parametric numerical model to categorize each to 1 of 6 shape categories. Blinded reviewers rated alar furrow severity and the alar ridge presence using a Likert scale for both preoperative and postoperative images to subjectively gauge aesthetic outcomes. RESULTSOverall, 90 patients with both preoperative and postoperative NOSE scores who underwent septorhinoplasty and placement of an AARG were included. Of the 90 patients, 60 were women (mean age, 38.2 years). Patient NOSE scores (70.4 preoperatively to 25.1 postoperatively) significantly improved from preoperation to postoperation (P < .001), regardless of AARG size, CSEG, or LCT. Alar base shape parametric analysis showed preoperative to postoperative improvements were significant for anterior-to-posterior ratio mass distribution (95% CI, −0.16 to 0.02; P = .05) and vertical projection-to-horizontal base width ratio (95% CI, 0.01-0.32; P = .02) in flat noses and cloverleafing for narrow noses (95% CI, −0.05 to −0.01; P = .001); enhancement approached significance for reduction in lateral scalloping in cloverleaf noses (P = .06). Aesthetic analysis showed that there was a statistically significant improvement for the alar furrow (95% CI, −0.68 to −0.29 for rater 1; −0.54 to −0.27 for rater 2; and −0.59 to −0.27 for rater 3; P < .001) for all raters and for the alar ridge (95% CI, 0.16-0.48; P < .001) for 1 rater. CONCLUSIONS AND RELEVANCETo our knowledge, this is the first study to demonstrate that AARG use is associated with statistically significant improvement in NOSE scores. Placement of AARGs may improve posterior mass ratios in flat noses and lateral cloverleafing in narrow noses as suggested by quantitative shape change parameter analysis. The placement of AARGs was associated with aesthetic and functional enhancement in the cloverleaf deformity, which is associated with a prominent alar furrow, and often external nasal valve collapse. Patient selection is key when placing AARGs.LEVEL OF EVIDENCE NA.

Objectives Determine rates and reasons for unplanned revisits after ambulatory otologic surgery. Methods Cross‐sectional analysis of State Ambulatory Surgery Databases of California, Florida, Iowa, and New York was performed for years 2010 and 2011. Ambulatory adult otology surgical procedures were linked to ambulatory, emergency, and inpatient databases for revisit encounters occurring within 30 days. The numbers of revisits and associated diagnoses were analyzed. Results A total of 16,709 ambulatory otologic cases were extracted (mean age, 50.3 years; 54.2% female). The most common primary procedures performed were tympanoplasty (n = 7,919), stapedectomy (n = 2504), cochlear implantation (n = 1444), tympanomastoidectomy (n = 713), and mastoidectomy (n = 697). The 30‐day revisit rate was 5.2% (n = 875; 95% confidence interval [CI] 4.9%–5.6%). Urinary retention/urinary tract infection (UTI) (n = 93, 10.6%; CI 8.8%–12.9%) was the most common diagnosis at revisit, followed by otalgia (n = 85, 9.7% of revisits; CI: 7.9%–11.9%) and dizziness (n = 80, 9.1%; CI 7.4%–11.2%). Revisits most frequently occurred within the first 10 days postoperatively (47.2% of revisits), and a second revisit occurred 134 times (0.8% of cases). Fewer than 10 cases of facial nerve palsy were diagnosed (CI 0.03%–0.11%). Conclusion With a relatively low unplanned revisit rate, ambulatory otologic surgery demonstrates a favorable safety profile. Common reasons for revisit included pain, urinary retention, and dizziness. Quality improvement measures should be directed at addressing these postoperative issues to minimize rates of complications and unplanned revisits. Level of Evidence NA Laryngoscope, 130:1788–1791, 2020