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Nonflaccid facial palsy is a debilitating entity characterized by hypertonicity, synkinesis, and hypomobility. Patients with nonflaccid facial palsy often have smile asymmetry and restriction because of disruption of normal vector forces on the modiolus. Excision of the depressor anguli oris can lead to improved oral commissure excursion, smile angle, dental show, and symmetry.All depressor anguli oris resection cases between January 8, 2018, and December 26, 2019, were reviewed. Patients with postoperative photographs were included in this cohort study. Preoperative and postoperative photographs were analyzed using the Emotrics software program, and changes in oral commissure excursion, smile angle, and dental show were tracked. Clinician-graded facial palsy assessments and patient-reported outcome measures were compared preoperatively and postoperatively using the Electronic Facial Paralysis Assessment and Facial Clinimetric Evaluation Scale, respectively.Forty-three patients were included in this study; 79 percent of patients underwent isolated depressor anguli oris resection. Depressor anguli oris resection led to a statistically significant increase in oral commissure median excursion, smile angle, and dental show [3.02 mm (p = 0.015), 1.70 degrees (p = 0.002), and 2.36 mm (p0.001), respectively]. Median Electronic Facial Paralysis Assessment and Facial Clinimetric Evaluation Scale instrument scores also improved [6.0 (p = 0.001) and 7.5 (p = 0.013), respectively]. Depressor anguli oris resection also led to more symmetric smiles. No correlation was seen between duration of follow-up and change in metrics.Depressor anguli oris resection is a minimal-risk procedure that frequently results in improved smile dynamics, smile symmetry, and quality of life in patients with nonflaccid facial palsy.Therapeutic, IV.

Rhinoplasty is uniquely suited to capitalize on different aspects of three-dimensional (3D) modeling technology. Currently, 3D surface imaging of preoperative and postoperative nasal structure provides a platform for better surgical planning and patient counselling as well as objective postoperative measurements. Physical nasal models using 3D printing technology can improve rhinoplasty performance intraoperatively, postoperative outcomes, together with nasal prosthetic manufacture, by tailoring to specific patient anatomy. Advances in tissue engineering using 3D-printed biocompatible scaffolds have shown excellent nasal cartilage mimicry and hold promise for increasingly versatile directed tissue regeneration in rhinoplasty and nasal reconstructive surgery. As health care innovations are expected to become increasingly common in standard rhinoplasty practices in the future, we give an account of how 3D technologies can create new opportunities to optimize surgical planning and improve overall the patient experience.

OBJECTIVES/HYPOTHESIS Studies across multiple specialties of medical students, residents, and attending physicians demonstrate increased retention, breadth of knowledge, and literature awareness when podcasts are used as an adjunctive educational tool. This Contemporary Review aims to 1) quantify podcast availability and episode frequency for medical learners across a broad range of specialties, and 2) compare these metrics between otolaryngology-specific podcasts with those of other specialties. DATA SOURCES Top five podcast platforms: Spotify (Stockholm, Sweden 2006), Apple Podcasts (Cupertino, CA 2012), Google Podcasts (Mountain View, CA 2018), Stitcher (San Francisco, CA 2008), and TuneIn (San Francisco, CA 2002). METHODS The selected podcast platforms were queried with a comprehensive set of keywords and manually searched for medically-relevant podcasts. Specialty, content, and number of episodes annually for the last 10 years were recorded for each podcast. RESULTS Otolaryngology has a comparable number of podcasts and breakdown of podcast category compared to other specialties, but reduced total episodes and episode frequency compared to other specialties. This may limit otolaryngologists' ability to engage in this validated form of medical education. CONCLUSIONS Podcast-based education provides a valuable resource for medical professionals to reinforce learning, broaden general knowledge base, and stay updated on current literature, particularly in light of increased demand for mobile and on-demand learning options. There is room for an increased number of podcasts and, particularly, increased episode frequency within the field of otolaryngology to extend these benefits to otolaryngologists and otolaryngologists in training. Laryngoscope, 131:E2131-E2138, 2021.

Aberrant depressor anguli oris (DAO) activity may arise after recovery from acute facial paralysis and restrict movement of the oral commissure.To quantify the degree to which DAO inhibition affects smile dynamics and perceived emotional state.In this prospective, pretest-posttest study performed at an academic tertiary referral hospital, patients with unilateral postparalysis facial palsy were studied from January 16 through April 30, 2016.Local anesthetic injection into the ipsilateral DAO.Healthy- and paretic-side commissure displacements from the midline lower vermillion border referenced to the horizontal plane were calculated from random-ordered photographs of full-effort smile before and after injection, and random-ordered hemifacial photographs of the paretic side were assessed as expressing positive, negative, or indiscernible emotion.Twenty patients were identified as having unilateral postparalysis facial palsy with marked synkinesis of the ipsilateral DAO. Patient mean age was 46 years (range, 24-67 years), with a male to female ratio of 1:3. Mean paretic-side commissure displacement increased from 27.45 mm at 21.65° above the horizontal plane to 29.35 mm at 23.58° after DAO weakening (mean difference, 1.90 mm; 95% CI, 1.26-2.54 mm; and 1.93°; 95% CI, 0.34°-3.51°; P .001 and P = .20, respectively). Symmetry of excursion between sides improved by 2.00 mm (95% CI, 1.16-2.83 mm; P .001) and 2.71° (95% CI, 1.38°-4.03°; P .001). At baseline, observers assessed 7 of 20 paretic hemifaces (35%) as expressing positive emotion; this proportion increased to 13 of 20 (65%) after DAO weakening (P = .03).Ipsilateral DAO weakening results in significant improvements in smile dynamics and perceived expression of positive emotion on the paretic hemiface in postparalysis facial palsy. A trial of DAO weakening should be offered to patients with this disfiguring complication of Bell palsy and similar facial nerve insults.3.

Flapping wings are important in many biological and bioinspired systems. Here, we investigate the fluid mechanics of flapping wings that possess a single flexible hinge allowing passive wing pitch rotation under load. We perform experiments on an insect-scale (${\approx}1$ cm wing span) robotic flapper and compare the results with a quasi-steady dynamical model and a coupled fluid–structure computational fluid dynamics model. In experiments we measure the time varying kinematics, lift force and two-dimensional velocity fields of the induced flow from particle image velocimetry. We find that increasing hinge stiffness leads to advanced wing pitching, which is beneficial towards lift force production. The classical quasi-steady model gives an accurate prediction of passive wing pitching if the relative phase difference between the wing stroke and the pitch kinematics,${\it\delta}$, is small. However, the quasi-steady model cannot account for the effect of${\it\delta}$on leading edge vortex (LEV) growth and lift generation. We further explore the relationships between LEV, lift force, drag force and wing kinematics through experiments and numerical simulations. We show that the wing kinematics and flapping efficiency depend on the stiffness of a passive compliant hinge. Our dual approach of running at-scale experiments and numerical simulations gives useful guidelines for choosing wing hinge stiffnesses that lead to efficient flapping.

The research sought to examine parents and teachers attitudes to parental involvement and find whether there are differences between parents and teachers regarding the issue, and if there are such differences, what are they? The research also sought an optimal way to develop parents involvement in schools. The research tools are a validated, previously used closed-ended questionnaire (Friedman Fisher, 2003) which was previously used to evaluate parents and teachers attitudes and in-depth semi-structured interviews with a small sample of 10 teachers and parents with the aim of reinforcing the findings obtained from analysis of the questionnaire. It was found that according to the questionnaire, there are no significant differences between teachers and parents, which was quite surprising. According to the interviews, it appears that both parents and teachers regard parental involvement in the same way. According to both groups, parental involvement is a must, important for the school and its progress and for the children of the involved parents. Parental involvement can be an empowering process for each of the participants. Nevertheless, it appears that the relationship is delicate, fragile and may be emotionally complex. That is why it is important to find an optimal way for building a partnership, which offers an overview of the concepts and views proposed by parents alongside those raised by teachers, and in between them the optimal way of creating the partnership

Chronic Obstructive Pulmonary Disease (COPD) is the fourth leading cause of morbidity in aging populations worldwide. In very severe cases of COPD arising from het- erogenous emphysema, portions of diseased lung are unable to expel air normally and over time hyperinflate, restricting the function of healthier portions of the lung, diaphragm, and heart. Lung volume reduction surgery (LVRS) has shown promising results in alleviating symptoms of lobar hyperinflation, but is associated with unacceptably high morbidity and mortality rates. Because of this, non-surgical methods of reducing the volume of hyperinflated lungs are the focus of much investiga- tion, especially Bronchoscopic Lung Volume Reduction (BLVR), consisting of one-way valves inserted bronchoscopically that slowly drain the diseased lobe of it's accumulated air. Presented here is a novel redesign of current BLVR devices using pop- up microelectromechanical systems (MEMS) manufacturing to create microscale check valves. These operate more reliably than current polymer valves and allow tuneable airflow to accommodate widely varying patient physiologies. Analysis and ex vivo testing of the redesigned valve predicted the valve should outlast current valves with a lifetime of well over eight years, and showed airflow controllability within desired physiological ranges of up to 1.2 SLM. The valve resists backflow twice as well as the current standard valves while permitting comparable forward flow.

Background Disease processes causing increased neural compartment pressure may induce transient or permanent neural dysfunction. Surgical decompression can prevent and reverse such nerve damage. Owing to insufficient evidence from controlled studies, the efficacy and optimal timing of decompression surgery remains poorly characterized for several entrapment syndromes. New method We describe the design, manufacture, and validation of a device for study of entrapment neuropathy in a small animal model. This device applies graded extrinsic pressure to a peripheral nerve and wirelessly transmits applied pressure levels in real-time. We implanted the device in rats applying low (under 100 mmHg), intermediate (200–300 mmHg) and high (above 300 mmHg) pressures to induce entrapment neuropathy of the facial nerve to mimic Bell’s palsy. Facial nerve function was quantitatively assessed by tracking whisker displacements before, during, and after compression. Results At low pressure, no functional loss was observed. At intermediate pressure, partial functional loss developed with return of normal function several days after decompression. High pressure demonstrated complete functional loss with incomplete recovery following decompression. Histology demonstrated uninjured, Sunderland grade III, and Sunderland grade V injury in nerves exposed to low, medium, and high pressure, respectively. Comparison with existing methods Existing animal models of entrapment neuropathy are limited by inability to measure and titrate applied pressure over time. Conclusions Described is a miniaturized, wireless, fully implantable device for study of entrapment neuropathy in a murine model, which may be broadly employed to induce various degrees of neural dysfunction and functional recovery in live animal models.