HEAD & NECK SURGERY - Stanford University School of Medicine

EVIDENCE-BASED MEDICINE IN
FACIAL PLASTIC SURGERY
Sam P. Most, MD
The primary goal of this research program
is to develop a higher standard of
care for facial plastic surgery patients.
The approach to this goal is two-fold. The
first involves development of prospective
studies that examine the efficacy of
new or existing surgical techniques in
facial plastic surgery. One clinical problem
we have already begun to examine
is nasal obstruction. Functional rhinoplasty
techniques have been a mainstay
of otolaryngology, and facial plastic surgery
in particular, for decades. While
many have attempted, with mixed success,
to examine nasal function using
quantitative measures, few prospective
studies of quality of life have been performed.
To this end, we have begun to
examine prospectively various functional
rhinoplasty techniques.
The second approach to development of
a higher standard of care for our patients
is the testing of various over-the-counter
‘cosmeceutical’ products. Generally, products
that are touted as effective by industry
have little or no clinical evidence
to back up said claims. Two of these
studies have been completed and have
resulted in remarkable response from
industry as well as the media. More
importantly, these types of studies provide
valuable information about product
efficacy to physicians and patients alike.
Facial Nerve Recovery after Injury –
Facial nerve injury after trauma or extirpative
surgery can be devastating to
patients. The Division seeks to develop a
clinical and basic research program
studying facial nerve recovery after such
injuries. The basic research program
within the Division will use a previously
developed animal (mouse) model for
facial nerve injury to examine the agedependence
of motor neuron survival in
the facial nucleus and its correlation to
facial nerve recovery. Furthermore, the
role of apoptotic cell death in the facial
nerve nucleus will be studied, with the
hope that anti-apoptotic processes may
aid in facial nerve recovery. The clinical
research program will study quality of
life issues in facial nerve injury patients.
Anterior septal reconstruction, a modified extracorporeal
septoplasty technique.
A) Murine facial nerve nucleus (outlined with arrowheads);
B) Facial motor neurons stained with anti-bcl2
antibody (arrows).
Fall 2006
CLINICAL RESEARCH IN
LARYNGOLOGY
Edward Damrose, MD and Yuling Yan, PHD
The Division of Laryngology is currently
performing research in several fields.
Since the arrival of Dr. Yuling Yan, PhD,
we have begun investigations into vocal
fold vibration using high-speed digital
imaging. High-speed digital imaging can
capture motion at a rate of more than
2000 frames per second, allowing the
resolution of a single vibration of the
vocal folds. Because pathological voicing
represents the generation of an aperiodic
signal, traditional laryngostroboscopy
has been somewhat limited in allowing
extensive analysis of the factors that
cause abnormal voicing. Coupled with
algorithms developed by Dr. Yan, highspeed
imaging techniques can resolve
the vibratory properties of an individual
vocal cord through individual cycles,
affording us insight into the mechanism
of voice production that has never been
possible before (Figure 1).
Figure 1 – A single cycle of vocal fold vibration as seen
by high-speed digital imaging.
When multiple vibratory cycles are analyzed
in regards to symmetry and regularity,
a visual graphic of periodicity
can be generated, called a Nyquist plot
(Figure 2).
With the incorporation of these new analytical
tools into the armamentarium of
the Stanford Voice Center, it is hoped
that new insight may be provided into
the causes and treatments of a variety of
voice disorders.
Our division is also partnering with the
Departments of Electrical Engineering
and Radiology to apply an experimental
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