Management of the skin-soft tissue envelope (SSTE) in rhinoplasty is challenging and critical for the overall outcome. The preoperative identification of patients with thick or thin skin and with preexisting skin conditions may contribute significantly to the postsurgical result. Most publications and textbooks focus on the management of the osseocartilaginous framework, but the SSTE management is often not addressed in detail. However, nonsurgical treatments, such as skin preconditioning, topical steroid-injections, oral isotretinoin, and topical vitamin A derivatives, may provide strong benefits. In this article, we reviewed the literature to present a comprehensive review on the available surgical and nonsurgical approaches pre-, intra-, and postoperatively dealing with SSTE in rhinoplasty.

Objective To determine the distribution of female physicians throughout the rank from resident to leadership positions in German Otolaryngology‐Head and Neck Surgery (OHNS) departments. Methods This cross‐sectional study collected data about the physician workforce in the German OHNS. The primary outcome was the proportion of female physicians. Data were collected from 165 departments from January 2022 to February 2022. The physician workforce was stratified based on gender and leadership. Results We included 2089 physicians from 165 departments of OHNS in German hospitals. Female residents and specialists outnumbered male peers (484/872 [55.5%] vs. 388/872 [44.5%] and 224/363 [61.71%] vs. 139/363 [38.29%], respectively). However, the women proportion decreased gradually with elevated hierarchical rank starting at the attending physician level to reaching its lowest extreme (14/165 [7.23%]) at the head of the department level. Holding a leadership position was associated with being male ( n = 282 [85.2%] vs. n = 49 [14.8%], p < .0001). This persisted even after controlling the academic rank in a multivariable regression model (OR: 5.027, 95% CI: 3.536–7.146). The gap between the two genders in favor of men regarding leadership persisted in all kinds of hospitals. However, this disparity was lowest in university hospitals, (male: n = 83 [78.3%] vs. female: n = 23, [21.7%], p < .0001). Conclusions Even though women outnumbered men in resident and specialist positions, they are still underrepresented in leadership positions in OHNS. Continuous surveillance is needed to watch the dynamic changes in the gap between the two genders and address it with more sex equality‐supporting policies. Level of Evidence IV.

Leiomyosarcoma (LMS) in the sinonasal tract (SNT) is a rarity that has been firstly described in 1958. Since then, there have been only a few articles about this entity. Most of the data available about LMS in the SNT is derived from case reports. We believe that our case will support the data set and help guiding the management of this rare condition. A 84-year-old female presented with nasal airway obstruction on the left side. She experienced several episodes of epistaxis from her left nostril, what made her to seek medical care. A rhinoscopy revealed an obstructing mass in the left nasal cavity. Computed tomography (CT) scan of the paranasal sinuses revealed a homogenous mass occupying the left nasal cavity, bone destruction of the left middle, and inferior nasal turbinates. An infiltration of the left nasolacrimal duct was also present. The patient refused to undergo open surgery and the mass was removed during an endoscopic approach. The histopathological analysis combined with immunohistochemistry was consistent with LMS. The resection margins were positive for tumor cells. A staging with CT-neck-thorax, abdomen ultrasound, and MRI of the head ruled out metastases. She underwent a second endoscopic tumor resection surgery with positive resection margins and obtained adjuvant radiotherapy. On 9 months of follow-up, there was no recurrence or metastases.

Rhinoplasty is considered a very challenging surgery since minimal changes of this central area of the face may significantly impact a person's appearance and self‐awareness. This is even more challenging in thick‐skinned patients because results are less predictable, and changes to the osseocartilaginous framework (OCF) may not be sufficiently visible due to the blanket effect of the thick skin. Furthermore, pre‐existing skin conditions may exacerbate following surgery. Therefore, managing patients with extremely thick skin or patients who suffer from pre‐existing dermatological conditions such as rosacea or acne requires a synergy of surgeons and dermatologists to achieve optimal results. In this article, we review the most significant pre‐ and post‐surgical regimens that surgeons and dermatologists should apply in selected patients to achieve optimal results after rhinoplasty.

Introduction Breast cancer represents a traumatic experience with a psychological burden. The prevalence of psychological distress (which include depression and anxiety) among breast cancer patients is estimated to be 15 to 54%, but studies have shown that applying some psychological treatments has contributed to decreasing depression and anxiety. So, it is crucial to diagnose and treat patients with the appropriate means. After reviewing the literature, no studies discussed depression and anxiety among Syrian breast cancer patients. Methods A cross-sectional study in Al-Bairouni hospital in Damascus, Syria carried out using face-to-face interviews based on a structured questionnaire. All breast cancer patients were included, except who refused to participate, and responses with missing data were excluded. The questionnaire consisted of 2 sections: the first included Socio-demographic characteristics, and the other evaluated patients' depression using PHQ-2 and GAD-2 scales. Data were gathered using the Kobo toolbox app and then entered into an Excel sheet. Results Five hundred patients were interviewed. 35.6% of the patients had a GAD-2 score greater than or equal to 3.00, while 35% had a PHQ-2 score greater than or equal to 3.00. There is a significant negative relationship between the age of the patient and the GAD-2 score and PHQ-2 score, which means the older the patient is, the lower the GAD-2 and PHQ-2 scores are. A multivariable regression model showed that younger (age ≤ 45 years) and being widowed were associated with being positive for further evaluation for generalized anxiety disorder. Similarly, patients younger than 45 are significantly associated with the need for further evaluation for major depressive disorder (MDD). Social status had a stronger association with the need for further assessment for MDD, with divorced women showing the strongest association, followed by widowed and married women compared to single women. Conclusion This study showed high anxiety and depression among breast cancer patients. The patient’s age and social status were significant factors in determining the need for further psychological assessment. In General, Younger patients showed higher levels of depression and anxiety, the size of the tumor did not show significant association with psychological distress.

Deep learning (DL) is a subset of machine learning that is rapidly gaining traction in surgical fields. Its tremendous capacity for powerful data-driven problem-solving has generated computational breakthroughs in many realms, with the fields of medicine and surgery becoming increasingly prominent avenues. Through its multi-layer architecture of interconnected neural networks, DL enables feature extraction and pattern recognition of highly complex and large-volume data. Across various surgical specialties, DL is being applied to optimize both preoperative planning and intraoperative performance in new and innovative ways. Surgeons are now able to integrate deep learning tools into their practice to improve patient safety and outcomes. Through this review, we explore the applications of deep learning in surgery and related subspecialties with an aim to shed light on the practical utilization of this technology in the present and near future.

Background: Rhinoplasty is one of the most popular procedures in facial plastic surgery. It is a technically demanding surgery with a long learning curve. The outcome may be very beneficial to the function of the nasal breathing as well as the patient’s social life but harbors many pitfalls and sequelae from minor to devastating. This grants a high demand on the knowledge of the nose’s anatomy and the implication of each conducted maneuver or grafting during the surgery both short and long term. Methods and Results: In the presented case report, we demonstrate the sequelae of a secondary rhinoplasty case, analyze the outcomes, present the revision surgery in detail, and show the follow-ups. Most negative outcomes of primary rhinoplasty may be led back to the particular techniques applied. Leading causes of revision surgery include loss of tip projection, inverted-V-deformity, axis deviation, dorsal irregularities, internal and external nasal valve collapse, damage to the soft tissue envelope, and many more. Conclusions: We believe that through such an illustrative case discussion, we may enhance the skills and critical appraisal of young surgeons in decision-making.

ImportanceVenous thromboembolism (VTE) is a severe complication after free tissue transfer to the head and neck (H&amp;amp;N). Enoxaparin 30 mg twice daily (BID) is a common regimen for chemoprophylaxis. However, differences in enoxaparin metabolism based on body weight may influence its efficacy and safety profile.ObjectiveTo assess the association between BMI and postoperative VTE and hematoma rates in patients treated with prophylactic enoxaparin 30 mg BID.Design, Setting, and ParticipantsThis was a retrospective review of a prospectively collected cohort from 2012 to 2022. Postoperative VTE, hematoma, and free flap pedicle thrombosis were recorded within 30 days of index surgery. The setting was a tertiary academic referral center. Participants included patients undergoing H&amp;amp;N reconstruction with free flaps that received fixed-dose subcutaneous enoxaparin 30 mg BID postoperatively. Statistical analysis was conducted from April to May 2022.Main Outcomes and MeasuresOutcomes include incidence of VTE, hematoma, and flap pedicle thrombosis events within 30 days of the surgery. Univariate and multivariable regression models were used to evaluate associations between BMI and other patient factors with these outcomes.ResultsAmong the 765 patients included, 262 (34.24%) were female; mean (SD) age was 60.85 (12.64) years; and mean (SD) BMI was 26.36 (6.29). The rates of VTE and hematoma in the cohort were 3.92% (30 patients) and 5.09% (39 patients), respectively. After adjusting for patient factors, BMI was the only factor associated with VTE (OR, 1.07; 95% CI, 1.015-1.129). Obesity (BMI &amp;gt;30) was associated with increased odds of VTE (OR, 2.782; 95% CI, 1.197-6.564). Hematoma was not associated with BMI (OR, 0.988; 95% CI, 0.937-1.041). Caprini score of at least 9 was not associated with VTE (OR, 1.259; 95% CI, 0.428-3.701).Conclusions and RelevanceThis cohort study found that obesity was associated with an increased risk of VTE in patients after microvascular H&amp;amp;N reconstruction and while on standard postoperative chemoprophylaxis regimens. This association may suggest insufficient VTE prophylaxis in this group and a potential indication for weight-based dosing.