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Background Craniosynostosis, a malformation caused by premature closure of one or more cranial sutures, is a rare congenital disability usually of unknown cause; however, it is often associated with assisted reproductive technology. Given the increasing prevalence of craniosynostosis and the use of the in vitro fertilization (IVF) method, the authors evaluated the association between IVF and the prevalence of craniosynostosis. Methods This retrospective study reviewed records of patients with nonsyndromic craniosynostosis who underwent surgery in Mofid Hospital, a tertiary children's hospital affiliated to Shahid Beheshti University of Medical Sciences, between 2010 and 2019. Results A total of 200 patients aged one month to 7 years old, were evaluated. Out of 200 patients, 43% were plagiocephalic, 39% trigonocephalic, 8.5% scaphocephalic, 8% brachiocephalic, and 1.5% were mixed. Nine (4.5%) patients had received clomiphene citrate. Eight (4%) mothers had become pregnant under IVF, and they all had used clomiphene citrate for ovulation stimulation. No use of artificial insemination was reported. Of the eight patients whose mother had become pregnant through IVF, three were trigonocephalic, and five were plagiocephalic. Conclusions Without a control group, we are not able report the statistical results confirming or denying a link between craniosynostosis and infertility treatment. However, 4% prevalence of IVF use among craniosynostosis patients is significant. Further studies with a broader statistical community are suggested in this regard.

Single suture craniosynostosis (SSC) is a disorder, affecting brain growth. Reviewing literature reveals controversialists of papers in this field.This prospective study was conducted from 2014 to 2016. All the individuals, aged 2 to 16 years, whose medical records files were complete, with SSC from 1999 to 2013 were included. All patients had undergone cranial vault remodeling at Mofid Hospital, Tehran, Iran. Wechsler questionnaires, WPPSI-III and WISC-IV, were completed for each child based on his/her age.Seventy children were included, with the mean age of 6.7 (±2.9) years. Forty-six (65.7%) children were boys while 24 (34.3%) were girls. Mean FSIQ for all of children was 95.5 (±13.2). Mean verbal IQ, performance IQ, verbal comprehension, perceptual reasoning, processing speed, and working memory are 93.4 (±14.1), 96.1 (±13.3), 97.5 (±13.9), 102.2 (±12.5), 94.5 (±9.8), and 97.5 (±12.9), respectively. There was statistically significant difference between FSIQ of children with SSC and that of unaffected children (P-value0.05). There was significant difference between verbal IQ of children with SSC and that of unaffected ones (P-value0.007). There was significant difference between in processing speed between affected children and unaffected children (P-value0.012).Children, aged 2 to 6 years, with SSC had a significantly lower Verbal IQ, and children, aged 6 to 16 years, with SSC had a significantly lower processing speed than their healthy counterparts. Though FSIQ of children with SSC falls within normal range, it is a little lower than healthy peers.

Background This study investigated the prevalence of lip and palate clefts, need for reoperation and primary surgery in unrepaired patients younger than 18 years old in Zanjan province, northwest of Iran. Methods All urban and rural healthcare centers and the education department of Zanjan province were informed about this project. After identifying all patients with cleft lip and palate, they were sent to the plastic surgery clinic of our hospital. Their data were gathered, including sex, age, clinical classification, surgical modality, complications, surgery satisfaction and un-repaired patients. Results A total of 87,356 people were examined by social workers. Among them 120 children and adolescents had cleft lip and palate (1.37 per 1000). 59 (49.1%) patients had cleft lip and palate, 35 (29.1%) patients had only cleft lip and 26 (21.6%) patients had only cleft palate. 25 patients (20.8%) had not done surgery (detection rate was 2.86 per 10,000). Secondary surgery was done in 39 patients (41.05%). In spite of a referral health system in Iran, 25 children with cleft lip had not been operated. Conclusion Although most of the identified patients had been operated before, almost half of them had to undergo surgery again. Given the lack of studies on this topic in Iran, our findings can form the basis for further studies to precisely identify the roots of cleft lip and palate and properly plan to decrease its risk factors. Further studies are needed to identify reasons of missed detections and why primary surgeries are not satisfying.

BACKGROUND The demand for facial plastic surgery has dramatically been increased in recent years. Over the last decade, numerous methods have been improved for facelift surgery. Despite these modifications, skin excision technique has not changed significantly. In this study, authors have tried to introduce a new technique regarding skin excision at the initial step of facelift surgery. METHODS A prospective study from 2012 to 2017 on 52 patients was carried out to apply a new technique for facelift ''Prefabricated skin excision method'' for all eligible patients undergoing facelift surgery. The skin calling for excision was marked by the surgeon, and then, an analgesic drug was administered. Then, excision of the marked part of the skin was performed and afterward the dissection of the superficial musculoaponeurotic system (SMAS) was performed with the direct exposure. RESULTS All patients were female, and 50 (96.1%) cases were primary face lift and 2 (3.9%) cases were secondary. There were no complications among the patients. CONCLUSION Facilitating the manipulation of deep layer, using this technique led to the further exposure of the surgical site, and more preferable hemostasis was achieved as well.

Background On March 11, 2020, the World Health Organization (WHO) announced the COVID-19 outbreak as a new pandemic. In the meantime, plastic surgeons postponed their appointments due to the fair and rational allocation of medical supplies. These limitations made all junior and senior residents perform operations only on traumatic patients rather than those needing reconstructive procedures. This study aims to determine the effects of the COVID-19 pandemic on plastic surgery training programs in Iran. Also, the number of canceled surgeries will be determined to see the effects of the pandemic on the patients. Methods This retrospective case study considers a six-month timeframe in two consecutive years before and after the COVID-19 pandemic. For this purpose, the researchers evaluated the number of surgeries, types of procedures, age distribution, and gender distribution. The training program data of plastic surgery residents were collected from their logbooks and then analyzed in IBM SPSS Statistics 26. Differences were considered significant if p

Sociodemographic characteristics of cosmetic surgery patients are less studied in developing countries. Examining sociodemographic characteristics of cosmetic surgery patients in clinical settings can help surgeons identify their potential patients and highlights marketing opportunities for medical institutions. We conducted this study to determine the sociodemographic details of a large clinical sample from Tehran, Iran. The aim of this study was to present the demographic characteristics of Iranian patients undergoing cosmetic procedures. Tehran was selected from Iran as its most populated city and center of most medical facilities. The present study aimed to examine the sociodemographic characteristics of a large clinical sample (N = 744 patients; 900 cosmetic procedures) who underwent cosmetic surgery in Tehran, Iran. These surgeries were performed by 3 well-known plastic surgeons in Tehran. Sociodemographic details were gathered using patient’s cases and phone interview. A previously published questionnaire with modification was used. Findings suggest that most of the patients (90.7%) are women. Rhinoplasty (61.3%), facial fat injection (6.7%), blepharoplasty (6.3%), facelift (4.0%), and breast augmentation (3.8%) were the top 5 cosmetic procedures in the present sample. Approximately half of the sample (49.6%) was single, and most of married patients (80%) had children. A large number of patients (37.2%) were between 30 and 39 years old. In addition, a considerable proportion of the sample reported university education and being currently employed. This is the first study to document sociodemographic details in a large clinical sample from Iran as an understudied setting. We used insights from evolutionary psychology to explain the large sex differences in the number of cosmetic surgeries. In addition, we compared the findings with existing evidence from the United States and Saudi Arabia. Limitations and future directions are also discussed.

Background This study aimed to identify the impact of cosmetic surgery on married women's marital satisfaction and self-concept in Tehran. Methods This study was causal-comparative research. The study population consisted of all women having or applying for cosmetic surgery in Tehran over the second half of 2015. Convenient random sampling was used to select the participants. Enriching and Nurturing Relationship Issues Communication and Happiness (ENRICH) marital satisfaction questionnaire and Rogers' Self-concept Inventory were used to collect data. Results The study sample included 44 individuals having facial cosmetic procedures, 51 individuals applying for cosmetic surgery and 55 non-applicants (ordinary people). There were significant differences in terms of marital satisfaction and its components between the cosmetic surgery applicants and surgery group and control group. The cosmetic surgery applicants revealed higher levels of satisfaction in comparison with the surgery and control groups regarding the components' personality, conflict and leisure. Considering the component marital relationship, the applicant group had higher satisfaction than control group. With regard to the components financial management and relatives and friends, the applicant group had higher satisfaction, in comparison to the control group. The control group had better self-concept than the surgery and applicant groups. Conclusion Expectation for postoperative positive outcome is an important factor affecting high level of marital satisfaction in surgery applicants. Furthermore, the component self-concept is also a significant predictor of having or applying for cosmetic surgery.

Anterior plagiocephaly is a type of non-syndromic craniosynostosis requiring surgery. In this study, the authors have presented 15 neglected patients with anterior plagiocephaly. Two of patients had moderate plagiocephaly whereas others had mild plagiocephaly. A total of 38 procedures (fat injections) were performed on these patients. Following procedures, 2 of patients were under corrected, 2 of who were over corrected, and others were adequate corrected. One of the patients developed fat necrosis. None of them showed persistent over correction. Authors believe that autologous fat transplantation is a safe and effective method, in patients with anterior plagiocephaly who have not been operated, to improve patients' appearance and, subsequently, their self-esteem as well as their social function.

Background Craniofacial clefts are one of the rarest congenital malformations. When it comes to genetic inheritance patterns of craniofacial clefts, there are few studies on this subject due to the rarity and sporadic nature. In this study an extended family whose members have multiple craniofacial clefts has been introduced. Methods The authors haphazardly found a family whose members have craniofacial clefts, either Tessier no. 0 or both Tessier nos. 0 and 14, and, consequently, they were categorized into 3 groups based on the severity of clefts. Results Forty-two craniofacial clefts were noticed within the family. Twenty-two (52.3%) of patients were females and 20 (47.6%) were males. Twenty-three (54.8%) members had isolated Tessier no. 0 cleft, whereas 19 (45.2%) members had both Tessier nos. 0 and 14. Of all 42 patients, 18 (42.8%), 3 (7.1%), and 21 (50%) patients had severe, intermediate, and mild clefts, respectively. Conclusion The present study reveals that in some patients genetic background is likely to be the cause of clefts.

Background Craniofacial clefts are extremely rare congenital malformations that have adverse functional, psychosocial, and aesthetic effects on patients' life. Although the exact incidence is unclear, it is estimated between 1.4 and 4.9 per 100,000 live births. Prevalence of the rare craniofacial clefts is imprecise due to the paucity of literature as well as their etiologies. Methods All the patients with rare craniofacial clefts during 10 years in a plastic surgery tertiary referral hospital were included, and Tessier craniofacial clefting classification was used for classifying the clefts. Results Of 964 patients with craniofacial clefts, 80 (8.29%) patients were identified with rare craniofacial clefts. There were 39 (48.7%) males and 41 (51.3%) females. Family history was determined positive in 30 (37.5%) patients. Tessier number 0 (58.7%) was the most common cleft in the authors' study. Tessier numbers 8, 13, and 30 were the rarest clefts. There was no patient with Clefts numbers 5, 6, or 9. Maternal smoking during pregnancy was observed in 1 (1.3%) of the women and 3 of the women had used drugs, 1 of them used the dexamethasone tablets and 2 of them could not remember name of the used drug. Conclusions Tessier number 0 was the most common cleft and Tessier numbers 8, 13, and 30 were the rarest types. The precise etiology of rare craniofacial clefts remained undetermined in this study. Women should be educated about the risk factors and subsequent ways of preventing from these risk factors.

Background Craniosynostosis has an incidence of 1 in 2000 to 2500 live births, and is categorized into syndromic and nonsyndromic types. Nonsyndromic ones can be familial in which more than one of the family members are involved. Methods This is a prospective study which is carried out from April 2015 to January 2018 in 2 academic hospitals. Those patients who had nonsyndromic craniosynostosis and completed medical follow-up were included in the study as well as their 1st degree relatives. Age of patients, gender, existing consanguineous marriage, type of deliveries, type of pregnancy (assisted reproductive technologies [ART] versus sexual intercourse), severity and type of craniosynostosis were gathered. Results Ninety-four (46.0%), 58 (28.4%), 28 (13.7%), 16 (7.8%), and 8 (3.9%) of patients had trigonocephaly, scaphocephaly, anterior plagiocephaly, complex, and brachycephaly, respectively. A total number of 204 patients were included in the study. Of all 204 families which were included, 30 (14.7%) families had positive familial history. Familial patients were determined in 10, 15, 8, 1, and 5 patients with scaphocephaly, trigonocephaly, anterior plagiocephaly, rachycephaly, and mixed type. Male to female ratio was 2:1, 1.9:1, 1.3:1, 1:1, and 1:1 for scaphocephaly, trigonocephaly, anterior plagiocephaly, brachycephaly, and mixed craniosynostosis. Twelve (5.9%) women had applied ART. Conclusion Present study reveals that metopic suture is the most frequent craniosynostosis within nonsyndromic types. All the types of nonsyndromic craniosynostosis had male prevalence but for complex one which was equal in both gender. Nonsyndromic craniosynostosis in about 14.7% of patients was familial.

Background Examining psychological aspects of cosmetic surgery has gained considerable attention in the research literature, particularly among women. The present study aimed to examine the role of three self-worth variables including self-esteem, narcissism, and self-perceived attractiveness on interest in cosmetic surgery among Iranian women.

Facial duplication, in whole or in part, is a very rare malformation. It may be symmetrical or asymmetric. Those cases that have been reported in the literature constitute a spectrum extending from simple nasal duplication to complete separation of 2 faces. Up to now there are some reports of eye, nose, mandible, or maxilla duplication separately. But there is no report of oral orifice or lips duplication. The present article reports a case of a newborn girl who presented with 2 mouths and also duplication of zygoma and maxilla. Then, we describe her stages of treatment from birth through now that she has 20 years.

In rhinoplasty, one of the most popular aesthetic surgical procedures worldwide, several different techniques are utilized when performing a rhinoplasty procedure. Many complications can arise postoperatively depending on the surgical approach and technique utilized. A method to reduce immediate postoperative complications has been identified. The use of different colored nasal splints for various surgical procedures could assist in identifying high-risk patients to the postsurgical recovery team and the clinical staff. In this prospective 10-year study, patients were divided into 2 groups. In Group I, the green-colored splint was applied to all patients, whereas in Group II, patients were divided into 3 subgroups. Patients undergoing rhinoplasty and septoplasty, rhinoplasty, and minimally invasive rhinoplasty were placed in Subgroup I, Subgroup II, and Subgroup III, respectively. Different survey questionnaires were designed for patients, the surgical team, the postsurgical recovery team, the follow-up care team, and the clinical staff. A total of 2,680 (88%) patients were females, whereas 332 (12%) patients were males. There was no significant difference in surgeon's responses between 2 groups (p > .05). Between the 2 groups, there was a significant difference in the postsurgical recovery team and the follow-up care staff (p < .001). Patients in Group II were significantly more aware of their conditions and possible complications (p < .001). The current study reveals that patients undergoing rhinoplasty should be identified through colored splints, particularly patients whose surgery accompanies a high possibility of complications. In such patients, colored splint is a red flag for surgical and postsurgical nurses and staff who are providing health care to patients.

BACKGROUND Although referrals for nonsyndromic frontal plagiocephaly have been increased during the past several years, successful surgical repair of unicoronal synostosis (UCS) remains a challenge for craniofacial surgeons. Most surgical techniques followed to correct supraorbital rim elevation and temporal constrictions are being noticed less and often require a secondary revision. But this new technique consists of correcting the affected ipsilateral frontal, temporal, and superior orbital rim areas in the first operation. METHODS From 1995 to 2016, a total of 154 cases of UCS were operated by first author. A total of 91 patients were operated with standard technique, whereas the new technique was applied on 63. Whitaker scoring system was used for evaluation of patients after surgery. RESULTS Data analysis shows a significant difference between 2 operation techniques results (P = 0.007). None of the patients from the new technique group required revision surgery. CONLUSIONS We believe that our new technique have less invasive osteotomy on the frontal bone and no manipulation of the orbital bone, so provide sufficient bone graft and is applicable even for younger patients (

Trigonocephaly is one of the most common types of craniosynostosis leading to triangular-shaped head and neurodevelopmental complications. Several surgical techniques have been suggested for its correction, but the newly suggested technique seems to have optimal outcomes compared with the traditional methods. Thus, the authors retrospectively evaluated the outcomes of the simplified horse-shoe technique with previous procedures performed on 169 children severe trigonocephaly during 1996 to 2015 at Mofid Hospital, Tehran, Iran. Demographic data of the patients and the surgical outcomes and complications and the need for reoperation were recorded and scored using the Whitaker system. The male-to-female ratio was 2.75:1. The mean ± standard deviation age of all the patients at the time of surgery was 7.09 ± 7.5, 9.95 ± 7.71, 10.53 ± 6.57, and 10.59 ± 7.96 months for the traditional, horse-shoe, and simplified horse-shoe techniques, respectively. The total reoperation rate was 6.5% (4.7% in the traditional technique, 1.2% in the horse-shoe, and 0.6% in the simplified horse-shoe technique) (P

BACKGROUND Craniosynostosis results from premature closure of one or more cranial sutures, leading to deformed calvaria and craniofacial skeleton at birth. Postoperative complications and outcome in intensive care unit (ICU) is related to surgical method and perioperative management. This study determined the perioperative risk factors, which affect outcome of patients after craniosynostosis surgery. METHODS In a retrospective study, 178 patients with craniosynostosis who underwent primary cranial reconstruction were included. Postoperative complications following neurosurgical procedures including fever in ICU, level of consciousness, re-intubation, and blood, urine, and other cultures were also performed and their association with the main outcomes (length of ICU stay) were analyzed. RESULTS Factors independently associated with a longer pediatric ICU stay were fever (OR=1.59, 95% CI=1.25-4.32; p=0.001), perioperative bleeding (OR=2.25, 95% CI=1.65-3.65; p=0.01), age (having surgery after the first 5 years) (OR=1.59, 95% CI=1.33-3.54, p=0.016) and infection (OR=2.17, 95% CI=1.83-7.46; p=0.002). Mean blood loss during surgery was significantly higher in patients whose duration of ICU was longer than 4 days compare to less than 4 day (p=0.026). Amount of bleeding significantly was correlated to duration of surgery (r=0.70, p=0.001) and patient’s age (r=0.23, p=0.44). CONCLUSION perioperative management particularly blood loss could deteriorate patients outcome and length of stay in ICU and hospital. Infections in ICU could deteriorate outcomes.

Migraine headaches are fairly common among people throughout the world with many treatment modalities. The cornerstone of treatment has been traditionally medical treatment which is mostly symptomatic and needs to be repeated. A few surgical procedures have been proposed which eliminate the inciting factor, and septorhinoplasty is one of them. Between October 2001 and August 2004, 24 patients suffering from migraine headaches, underwent septorhinoplasty at 15th Khordad Hospital, Tehran, Iran. Our inclusion criteria were refractory migraine, contact points demonstrated by computed tomography scan, and significant headache improvement after topical anesthesia to the contact area. Reduced severity and frequency of migraine headaches were documented which is statistically significant (p < 0.05). Septorhinoplasty in selected patients with contact points could reduce frequency, severity, and duration of migraine attacks.

Arteriovenous malformations (AVMs) are uncommon errors of vascular morphogenesis. Hemodynamically, they are high- flow lesions. Approximately 50% of AVMs are located in the cra- niofacial region. The successful treatment of vascular anomalies depends on the profound knowledge of the biologic behavior of vascular lesions and their correct classification. Vascular malfor- mations that persist lifelong require treatment in most cases, espe- cially when clinical symptoms occur. On the basis of individual parameters such as the diameter, location, or growth behavior, dif- ferent therapeutic options such as cryotherapy, corticosteroids, laser therapy, sclerotherapy, surgical intervention, and/or embolization can be performed successfully. Subtotal excision or proximal liga- tion of the feeding vessel frequently results in rapid progression of the AVMs. Hence, the correct treatment consists of highly selective embolization (superselective) followed by complete resection 24 to 48 hours later. Reconstructive procedures in the head and neck re- gion use a wide range of flaps for defect closure. The methods range from local, mostly fasciocutaneous flaps and skin grafts, to free microsurgical flaps. To ensure a satisfactory functional and aesthetic result, good texture and color of the flap are always es- sential. Moreover, the donor-site defect needs to be reduced, with no resulting functional or aesthetic impairment. The supraclavicular flap has been used successfully for difficult facial reconstruction cases, providing acceptable results without using microsurgical techniques. We treated 2 patients with facial AVM by this method. Both of the lesions were located within the cheek and lip. There were no procedure-related complications, and the cosmetic results were excellent.

Metopic synostosis is characterized by keel-shaped forehead (trigonocephaly), prominent midline ridge of the forehead, bitemporal narrowing, bilateral retrusion of supraorbits, egg-shaped orbits, low nasal dorsum, and reduced volume of the anterior cranial fossa. The mainstay treatment is early surgical intervention before the age of 12 months, which usually consists of bifrontal craniotomy with bilateral recontouring, lateral advancement, and lateral displacement of the superior orbital rims. Here, we have developed a new simplified technique for surgical treatment of trigonocephaly. A total of 60 cases of trigonocephaly were operated on between January 1995 and January 2010 by the first author. Surgical outcomes were evaluated 6 months after surgery using postoperative photographs and clinical examination notes, and scaling was made using the Whitaker classification. The evaluation showed that 85% of them were in class I, 11.6% were in class II, and 3.3% were in class III. No case was in class IV. Only the last 10 cases received the new surgical technique, and all were in class I. Complication rate was 38.3% for all cases and was only 20% for the last 10 cases, that is, the new technique group. Revision rate for trigonocephaly surgery was 13.3%, and the most common reason was hardware removal. None of the patients from the new technique group underwent revision surgery. We believe that our new technique is fast and easy, can provide sufficient bone graft, and is more useful for older patients (>1 y). Early postoperative results have been promising.

Reconstructive procedures in the head and neck region use a wide range of flaps for defect closure. The methods range from local, mostly myocutaneous flaps and skin grafts to free microsur- gical flaps. To ensure a satisfactory functional and aesthetic result, good texture and color of the flap are always essential. Moreover, the donor-site defect needs to be reduced, with no resulting functional or aesthetic impairment. The supraclavicular island flap has been used successfully for difficult facial reconstruction cases, providing ac- ceptable results without using microsurgical techniques. As a com- plementary study to the publication by Heitland and Pallua (Plast Reconstr Surg 2005;115:1591), we report our preliminary clinical experience with bilateral tunneled supraclavicular island flaps for simultaneous reconstruction of massive facial defect and intraoral lining in massively progressed invasive squamous cell carcinoma of the lower lip with severe intraoral extension. This thin flap is easy and quick to harvest, has a reliable pedicle, and has minimal donor-site morbidity. It is now the authors' flap of choice for many common head and neck reconstructive problems.

Preoperative planning and postoperative outcome assessment in rhinoplasty are important. For preoperative planning, some standard relationships are defined and evaluated primarily with standard photographs, but photographs do not necessarily reflect reality. Outcome assessment, on the other hand, is mostly subjective, and again, even photographic analyses may not address real changes after rhinoplasty."Rhinometry" is introduced as a clinical method for preoperative evaluations and postoperative judgments, and rhinometric parameters are defined. Measurements of these parameters were performed for 300 patients before rhinoplasty and in the follow-up visits 3 months postoperatively.Preoperatively, the nasal length and tip projection for most patients were more than ideal. There was moderate reduction in nasal length (mean, 9.21 mm) and a decrease in tip projection (mean, 3.34 mm) for the majority of the patients after rhinoplasty. Reductions in nasal length, tip projection, bony base width, alar base width, and alar base width during a smile were statistically significant. Patients who underwent surgery using the closed approach had significantly more reduction in nasal length and less reduction in tip projection. All the patients were satisfied with these pre- and postoperative data. Rhinometry changed the ideas of the authors about some changes that their operative approaches produce.Rhinometry can change the ideas of plastic surgeons about the changes their operative approaches accomplish and can be a very useful guide for patients. It is recommended as a part of the pre- and postoperative physical examination of patients undergoing rhinoplasty.

Background Basal cell carcinoma (BCC) is the most common human malignant neoplasm. Some patients with scalp BCC have had a history of childhood scalp radiation for the treatment of tinea capitis. It is not clear whether BCC in these cases has a more aggressive nature and requires a more aggressive resection. We performed a retrospective study to compare BCC tumor specification and treatment results between irradiated and nonirradiated patients. Materials and methods From 1995 to 2005, a total of 74 patients were diagnosed with scalp BCC. Thirty-eight patients (group A) had a history of childhood radiation to the scalp for the treatment of tinea capitis, and the other 36 (group B) did not. We compared these 2 groups in 16 different parameters, which included general information (age, sex), disease history (time interval from onset of lesion to the first office visit, number of admissions, total length of hospital stay), tumor specifications (number of primary lesions, invasion depth, histologic subtypes, location), surgical history (number of operations in our center and other hospitals, type of surgical treatment, margins of resection), recurrences, new lesions, and metastasis. Statistical analysis was performed using SPSS 13.0 software. Results No significant difference in gender and age was observed between the 2 groups (P = 0.06 and P = 0.35, respectively). Patients in group A had a longer history of scalp lesions (P = 0.001). They also had more hospital admissions (P = 0.008) and operations (P = 0.01) in our center, with a longer period of hospitalization (P = 0.01). Mean number of primary lesions, the location of tumor, and the depth of invasion did not differ significantly between the 2 groups (P = 0.34, P = 0.78, and P = 0.73, respectively). There was no meaningful difference in safe resection margin for the first lesion between the 2 groups (P = 0.27); however, the number of recurrent lesions was significantly higher in group A (P = 0.003). Also, need for more aggressive resection and more complicated reconstruction was more in group A patients (P = 0.01 and P = 0.015, respectively). Only in group A new lesions and metastasis were found. Conclusion BCC in irradiated scalp has a more aggressive behavior and may need a more aggressive surgical resection. Also, these patients should be under close observation because there is a higher chance for tumor recurrence and also new lesions occurring elsewhere in the scalp.

Background The depressor septi nasi muscle is responsible for smiling deformity. Its manipulation is beneficial in patients with muscle hypertrophy. In addition, it enhances the smile and tip-lip relationship. In this study, depressor septi nasi muscle excision through a transfixion incision is compared with its transposition through an upper labial sulcus incision. Methods Two techniques of depressor septi nasi muscle treatment were performed randomly for rhinoplasty cases. Smile analysis in rhinoplasty, consisting of measurements of nasal length, nasal diagonal, tip projection, and upper lip height, and noting transverse upper labial crease in repose and full smile, was performed on preoperative and postoperative photographs. Results One hundred patients were studied in two equal groups. Preoperatively, tip projection and upper lip height were decreased significantly with smiling. Generally, the effect of smiling on all five parameters was decreased significantly following rhinoplasty. The two different techniques were not significantly different in decreasing the effects of smiling on nasal length, nasal diagonal, tip projection, upper lip height, or transverse crease. Conclusions The two different techniques were the same in decreasing the effects of smiling. The authors recommend smile analysis in rhinoplasty, consisting of measurement of nasal length, nasal diagonal, tip projection, and upper lip height, and noting transverse upper labial crease in repose and during smiling, before rhinoplasty for preoperative evaluation and after the operation for outcome assessment. Depressor septi nasi muscle treatment should be considered if a decrease in tip projection or upper lip height with smiling or a transverse upper labial crease during smiling is extraordinary or unsightly. Clinical question/level of evidence Therapeutic, II.

Summary Introduction Osteoradionecrosis of the mandible is a serious complication following radiotherapy for head and neck cancer. Reconstructive procedures in the head and neck region use a wide range of flaps for defect closure. The methods range from local, mostly myocutaneous flaps and skin grafts to free microsurgical flaps to ensure a satisfactory functional and aesthetic result. Moreover, the donor site defect needs to be closed, with as little as possible functional or aesthetic impairment. Patient and method A 60-year-old male is presented with a history of squamous cell carcinoma of the left lower lip and chin area in whom the tumour was resected and treated by adjuvant radiotherapy. The follow-up was complicated by chronic inflammation of the left mandibular body as a sequel of radiotherapy; it resulted with partial bone destruction, and soft tissue dehiscence. He was admitted for repair and treatment of the infected mandibular osteoradionecrosis. A supraclavicular artery island flap was used to close the mandibular soft tissue defect. Conclusion The shoulder provides a relatively good skin texture and match to provide cover and lining for defects in the lower part of the face, in combination with minor donor site morbidity.

Although the exact time of performing plastic surgery is not addressed in the medical and historical literature, it can be supposed that these surgical procedures have a long and fascinating history. Recent excavations provided many documents regarding the application of medical instruments, surgical and even reconstructive procedures during the pre-historic and ancient periods. Actually, there is no historical definite time-zone separating general and cosmetic operations in the pre-modern time; however, historically there have been many surgeons who tried to perform reconstructive procedures during their usual medical practice. This article presents a brief look at the history of plastic surgery form the ancient to the contemporary era, with a special focus on Iran.

Preoperative planning and postoperative outcome assessment in rhinoplasty are important. For preoperative planning, some standard relationships are defined and evaluated primarily with standard photographs, but photographs do not necessarily reflect reality. Outcome assessment, on the other hand, is mostly subjective, and again, even photographic analyses may not address real changes after rhinoplasty. “Rhinometry” is introduced as a clinical method for preoperative evaluations and postoperative judgments, and rhinometric parameters are defined. It can change the ideas of plastic surgeons about the changes their operative approaches accomplish and can be a very useful guide for patients. It is recommended as a part of the pre- and postoperative physical examination of patients undergoing rhinoplasty.

Wound healing is a multipart process involving different cell types and growth factors. Third-degree burns are usually treated by early excision and skin grafting. Tissue engineering has been developed in this field in response to limitations associated with autografts. Allogeneic fibroblasts on meshed split thickness skin grafts (STSGs) are known to have useful properties in wound healing and can be used to construct a new model of living skin substitute. Fourteen patients were chosen from June 2009 until December 2010 as the sample for this study. After debridement and wound excision, meshed STSG was used to cover the entire wound. Alloskin (allofibroblasts cultured on a combination of silicone and glycosaminoglycan) was applied on one side and petroleum jelly-impregnated gauze (Iran Polymer and Petrochemical Institute) was applied on the other. The healing time, scar formation, and pigmentation score were assessed for the patients. All analyses were undertaken with SPSS 17 software. Alloskin demonstrated good properties compared to petroleum jelly-impregnated gauze. The average healing time and hypertrophic scar formation were significantly different between the two groups. In addition, the skin pigmentation score in the alloskin group was closer to normal. Alloskin grafting, including fibroblasts on meshed STSG, may be a useful method to reduce healing time and scar size and may require less autologous STSG in extensive burns where a high percentage of skin is burned and there is a lack of available donor sites.

In the modern medical era, facial paralysis is linked with the name of Charles Bell. This disease, which is usually unilateral and is a peripheral facial palsy, causes facial muscle weakness in the affected side. Bell gave a complete description of the disease; but historically other physicians had described it several hundred years prior although it had been ignored for different reasons, such as the difficulty of the original text language. The first and the most famous of these physicians who described this disease was Mohammad Ibn Zakaryya Razi (Rhazes). In this article, we discuss his opinion.

The peripheral primitive neuroectodermal tumor (pPNET) is a rare and highly malignant soft tissue neoplasm in children and young adults. Fewer than 10 reported cases of pPNET of maxilla are available in the English literature. A 28-year-old woman was presented with the pPNET of the maxilla and metastasis. Two years after diagnosis, she experienced diplopia, and then magnetic resonance imaging was done, which showed a mass in the optic chiasma and parasellar region. The typical appearance resembled large noncalcified soft tissue masses in the magnetic resonance image and computed tomographic scan of the maxilla. Diagnosis was established by immunohistochemical features. She was treated with surgery, chemotherapy, radiation therapy, and gamma knife. She was under close observation since then (approximately 8 mo), and there has been no recurrence of tumor up to now.

Background We aim to provide evidence that despite not administering epinephrine, (1) the amount of hemorrhaging during surgery will not change, (2) surgery time will not increase and may even be shorter, and (3) there would be fewer cardiovascular-related consequences. Methods One hundred thirteen patients were enrolled and randomized into the control (n = 74) and intervention groups (n = 39). During the primary open or closed rhinoplasty operation, anesthesia was managed by continual infusion of remifentanil (14–20 μg/h) and propofol (4–6 mg/kg/h) with an infusion pump, in addition to N2O–O2 (50%). Atracurium was repeated (5 mg every 20 min). Patients in the control group received an epinephrine (1/100,000) injection to the nose, and patients in the intervention group did not. All patients received dexamethasone (8 mg IV) and metoclopramide (10 mg IV). At the end of the operation and before extubation, the muscle relaxants were reversed with prostigmine (0.35 mg/kg) and atropine (0.175 mg/kg). Results We found (1) no statistically significant association between epinephrine injection and hemorrhage during or after surgery (P = 0.949), (2) a statistically significant association between epinephrine injection and complications, and (3) the group that did not receive the injection had fewer complications (P = 0.01). With respect to the duration of surgery, we did not detect any statistically significant associations between the groups. Conclusion Elimination of epinephrine during rhinoplasty as an alternative procedure may lead to the same surgery outcomes if not a better one. Studies with a larger sample size are needed to further substantiate these findings.

The authors describe their experience with the retroauricular temporal flap in facial reconstruction.Twenty-two (20 females, 2 males) patients with composite tissue defect of various areas of the face have been esthetically reconstructed with a modified Washio flap. This flap is a good choice for facial reconstruction, due to its color match, reliability, feasibility, and potential for modification including elements such as skin, hair, and cartilage. The donor site is inconspicuous.The 22 patients in this report underwent reconstruction without flap loss.The Washio flap, with different modifications, is a useful technique for reconstruction of facial defects which may include hairy and non-hair bearing skin, preferably not larger than 7x5 cm in size, and particularly in young patients.

To determine the concentration of epinephrine that causes end artery necrosis and ischemia.An experimental study.Animal Laboratory of Khordad Hospital, Tehran, Iran, from September 2007 to June 2008.This study was done on 54 ear flaps from 9 rabbits [9 (rabbits) x2 (ears) x3 (splits) =54] divided into three groups of 18 ear flaps each. Nine of the ear flaps were randomized as control and nine of them were randomized as study group. The different concentrations of epinephrine and lidocaine 1% were injected in study groups but only 1% lidocaine was injected in control groups. Study group 1 received 1/200000, group 2 received 1/100000 and group 3 received 1/500000 concentration of epinephrine respectively.There was no evidence of necrosis in the control and study groups 1 and 2. However, 4 out of 9 of the ear flaps showed clear evidence of tissue necrosis in group 3.Injecting epinephrine in 1/200000 and 1/100000 concentrations had no side effect for the end artery of the rabbit ear flaps, but 1/50000 concentration is shown that it can cause tissue necrosis. Further studies need to be done in order to find out the effects of epinephrine with the same concentrations on the human end artery.

The development of antisepsis in the late nineteenth and early twentieth centuries revolutionized health care. The time-honored technique of skin preparation is to scrub the entire operative area of the patient for 5 to 7 minutes with a germicidal detergent solution and then paint the region with an antimicrobial solution of either tincture of povidone-iodine (Betadine) or chlorhexidine. Although antiseptics result in lower colony counts on the skin, they have side effects and higher cost in relation to normal saline. The authors have prepared patients by showering the surgical site with soap and water and rinsing it with normal saline, in 905 cases of outpatient, clean-wound plastic surgery. In another 905 cases that served as the control group, the traditional method of preoperative shower and scrub with chlorhexidine or Betadine was used. In both groups, there was no incidence of wound infection.

Satisfactory reconstruction of the columella area is always challenging. An 8-year-old girl underwent columellar reconstruction 7 years after bilateral cleft lip surgery using a temporo-parieto-auricular flap. This method was found to be useful for columellar reconstruction with good colour and aesthetic result.

Speech recognition system (SR) is a tool to create comprehensive, accurate and legible information in the patient's medical records. The present study is a part of a project to create a specialty text database for SR software in the field of reconstructive hand surgery. This project is considered a fundamental work for practical application of the system to enter the healthcare field in Iran. An interventional, quasi-experimental study and fundamental work to create surgical text database in the existing Persian software of "Nevisa". 1863 reconstructive hand surgical descriptions during a 3-month period (March 20, 2012 through June 20, 2012) in 15-Khordad Subspecialty Hospital were used to create database. The statistical population of the study consisted of all patients admitted with hand disorders within this time interval. About 108 dictated voices of physicians were collected after surgery. After the type and required analysis, the reconstructive hand surgery text database was created and tested in a real operating room. In this paper, a reconstructive hand surgery text database was created for Persian SR software. The database contains capital vocabulary and more than1200 words for use in the hand surgical unit in specialty hospitals and clinics. The record of findings and results of surgery in the patients’ medical records is very important. The lack of computerized data recording is one of the reasons for failure and illegibility of medical records in health centers. To solve these problems, software was used for data entry in the medical records and creating comprehensive electronic records. The designed software was tested in the operating room. The obtained accuracy demonstrated the potential for practical applicability of the developed software in Iran.