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In This Issue of JAMA Facial Plastic Surgery
May/Jun 2016


JAMA Facial Plast Surg. 2016;18(3):153. doi:10.1001/jamafacial.2015.1224

Ozucer and coauthors conducted a randomized clinical trial to evaluate the effect of postrhinoplasty taping (PRT) on nasal edema and nasal draping. Of the 57 total patients, 17 were in the 2-week PRT group; 20, the 4-week PRT group; and 20, the control group. As a whole, compared with the control group, 4-week PRT had a significant effect on the supratip region. Subset analysis revealed that PRT had no effect in thin-skinned patients but significantly improved edema in thick-skinned patients.

Invited Commentary

Teti and colleagues sought to provide a model for the comparative analysis of medical vs surgical treatment for nasal obstruction to explore the cost-effectiveness of corticosteroid nasal spray in patients with severe to extreme nasal airway obstruction. Comparative treatment groups were medical therapy with corticosteroid nasal spray vs surgical therapy for nasal airway obstruction. Among 179 patients evaluated, surgical repair of severe nasal airway obstruction cost $6537 and produced a total of 1.15 quality-adjusted life-years (QALYs) at 1 year. Medical treatment involved a trial of corticosteroid nasal sprays, which cost $520 and produced a total of 1.03 QALYs. The surgical approach was markedly more effective but at greater short-term cost. If the evaluation is extended to 5 years, surgical treatment cost $8984 per QALY compared with $52 571 per QALY for medical treatment. Owing to the improved effectiveness outcomes, greater cost savings were demonstrated with surgery in patients with extreme nasal obstruction.

Radabaugh and coauthors conducted a retrospective cohort study at a tertiary care facility to assess factors affecting timing of repair and barriers that may exist in the management of maxillofacial trauma. Demographic information, presence and severity of concomitant injuries, and fracture-specific data including fracture type(s), mechanism of injury, and documented complications were recorded. Identifiable delays for medical, logistical, or other reasons were also documented. Multivariate regression modeling was used to determine factors associated with increased time to repair. A comparative analysis was used to identify association between complications and time to operative repair. Of the 780 patients evaluated, mean time to repair was 6.5 days with no significant association between known operative delay and development of complications. The authors concluded that management of maxillofacial trauma seems to occur in a timely manner, with patient injury severity appearing to have the greatest effect on timing of repair.

Jackson and colleagues conducted a retrospective review of all patients undergoing both fibula free tissue reconstruction of mandibular defects and endosseous dental implantation at a single institution. Forty-six patients underwent dental implantation to the fibula graft. A total of 227 implants were placed (mean, 5 implants per patient). Of these, 44 were placed into native mandible and 183 into fibula flap. There was a 93% overall implant survival rate (n = 212) and 98% overall implant-supported prosthesis success rate (n = 45) at a mean follow-up of 22 months. There was no difference in implant survival between primary (94%) (n = 90) and secondary (93%) (n = 122) implantation. Neither a history of preimplant or postimplant radiation exposure nor the diagnosis of osteoradionecrosis affected implant survival.