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In This Issue of JAMA Facial Plastic Surgery |

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JAMA Facial Plast Surg. 2016;18(1):3. doi:10.1001/jamafacial.2015.1212.
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Sobin and colleagues point out a potentially glaring health care delivery gap of clinicians underdiagnosing concussions that accompany mandible fractures. They report that up to 75% of their patients meet the criteria for being at high risk for concussions while their review of the Nationwide Inpatient Sample database revealed that only 5.6% of mandible fractures had a concurrent diagnosis of concussion. In the accompanying Invited Commentary, Chun poses the question of whether we are missing the opportunity to ask a simple but needed question: “Do you have a headache?”

Rhinoplasty is a common surgical procedure, but widely used and validated outcome measures, objective or patient-reported, are uncommon. The patient-reported instrument described by Klassen and coauthors has the potential to serve as an important new tool for the rhinoplasty surgeon. This rigorously validated tool captures the voice of the patient in the health care episode by providing information that can only come from the patient, including symptoms (frequency, severity) and effect of a condition or treatment on the patient’s disability or quality of life.

Jacono and colleagues present some intriguing insight on the topic of self-esteem and face-lift surgery. They report that the overall difference between the mean preoperative and postoperative self-esteem scores is not statistically significant, although the patients believed that they appeared to be a mean of 8.9 years younger after their face-lift surgery. A subset analysis revealed that patients with low preoperative self-esteem had an increase in self-esteem after surgery, while those with average preoperative self-esteem experienced no change, and finally, those with high preoperative self-esteem experienced a decrease in self-esteem after surgery. These findings illustrate that patients exhibit a wide spectrum of psychological reactions after face-lift surgery.

Albathi and colleagues present a paradigm shift in the treatment of resultant facial paralysis in patients who undergo cerebellopontine angle tumor surgery. They present compelling evidence to suggest that there does not seem to be any benefit in “watchful waiting” beyond 6 to 8 months after onset of paralysis as opposed to the 12-month timeline that has been traditionally followed. In addition, the use of the masseteric nerve substitution procedure can greatly speed the clinical recovery. In the accompanying Invited Commentary, Knott poses the question of whether more than 11 months may be reduced from the ultimate wait for recovery by following the strategies proposed by this study.





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