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In This Issue of JAMA Facial Plastic Surgery
Jan/Feb 2015


JAMA Facial Plast Surg. 2015;17(1):3. doi:10.1001/jamafacial.2014.934

Yoo and colleagues performed a retrospective medical record review of 363 consecutive adult patients who underwent preoperative nasal swab testing and rhinoplasty or septorhinoplasty in a single private practice. Directed nasal swab cultures were taken by the surgeon from the nasal vestibule 4 to 14 days prior to surgery using a culture swab. Of 363 patients, 284 (78.2%) showed normal nasal flora on preoperative cultures. Thirty-nine patients (10.7%) had Staphylococcus aureus, and only 1 (0.28%) had methicillin-resistant S aureus (MRSA). There were 27 patients (7.4%) whose cultures grew out of one of the fecal coliform species. Age, sex, smoking, the use of oral contraceptives, or the presence of seasonal allergies did not significantly change the nasal flora or the postoperative infection rate. The overall infection rate was 3.0%, with 4.0% seen in primary septorhinoplasties and 2.1% seen in revision cases. Coliforms accounted for 5 cases (45.5%) of postoperative infections, while S aureus was responsible for 4 cases (36.4%), including 1 case of MRSA. The results of this study suggest that risk factors alone may not reliably predict the subset of patients for whom antibiotic prophylaxis is indicated.

Barrett and colleagues conducted a review of the University of Virginia clinical data repository of 100 patients with recent mandible fractures to estimate the cost associated with running an operating suite for mandibular fracture repair. They developed a decision tree model that accounted for cost of imaging modalities, adequacy of reduction, complication rate, cost of initial operating room time, and, if applicable, operative charges for revision surgery in the event of a complication. Analysis showed that the utility of postreduction imaging from the standpoint of cost analysis depends on the complication rate of the facial traumatologist and institutional charge data. Based on this model, the facial traumatologist should obtain postreduction Panorex imaging for patients with mandible fractures until complication rates drop below 17.7%.

Chen and colleagues performed a prospective study assessing changes in midfacial volume in 15 women aged between 40 and 60 years using a 3-dimensional imaging system at 12, 24, 36, and 48 weeks after 3 treatments with poly-L-lactic acid. Using this objective measuring tool, they demonstrated that the volumizing effect of poly-L-lactic acid becomes apparent as early as 12 weeks following the last injection and is maintained at the 48-week follow-up (>1 year after initial treatment). In addition, they found that the maximal volume gain from poly-L-lactic acid is noted within 12 to 24 weeks following the last treatment in most participants.

Wee and colleagues performed a systematic review and a meta-analysis of the available literature to evaluate complications regarding autologous rib cartilage in rhinoplasty. Ten studies involving a total of 491 patients were identified. The mean follow up across all studies was 33.3 months. The overall long-term complications and donor-site morbidity rates associated with autologous rib cartilage use in rhinoplasty were low. Cartilage warping and hypertrophic chest scarring showed relatively higher rates.