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High-Resolution Ultrasound for Diagnosis and Treatment of Filler-Related Septal Necrosis.

ABSTRACT: Nonsurgical rhinoplasty using filler injections is a popular procedure; however, it carries risks of significant complications, including vascular occlusion, skin necrosis, blindness, and cerebral ischemia. We present a case of septal necrosis after nonsurgical rhinoplasty and describe management using ultrasound guidance. Awareness of this complication and high clinical index of suspicion are necessary for early diagnosis and treatment, crucial to minimizing permanent sequelae. We show that high-definition ultrasound can help to guide the management and improve the treatment outcomes.

SUBMITTER: Desyatnikova S

PROVIDER: S-EPMC10898670 | biostudies-literature | 2024 Feb

REPOSITORIES: biostudies-literature

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High-Resolution Ultrasound for Diagnosis and Treatment of Filler-Related Septal Necrosis.

Desyatnikova Stella S Barrera Patricia P

Plastic and reconstructive surgery. Global open 20240227 2

Nonsurgical rhinoplasty using filler injections is a popular procedure; however, it carries risks of significant complications, including vascular occlusion, skin necrosis, blindness, and cerebral ischemia. We present a case of septal necrosis after nonsurgical rhinoplasty and describe management using ultrasound guidance. Awareness of this complication and high clinical index of suspicion are necessary for early diagnosis and treatment, crucial to minimizing permanent sequelae. We show that hig ...[more]

PMID: 38415104

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Project description:BackgroundThe styloid process (SP), stylohyoid ligament and lesser horn of hyoid bone together form the stylohyoid chain. Differences in the ossification degree and the connection sites of each segment of the stylohyoid chain on both sides lead to variations in the length, orientation, thickness, and straightness of SP. The incidence of elongation of the SP, known as styloid process syndrome (SPS), is around 4%, with only 4% of patients showing elongation show symptoms. Computed tomography (CT) remains the first-choice auxiliary examination for diagnosing SPS, but its performance can be affected by a variety of factors. Ultrasound can reveal the parapharyngeal space and adjacent structures, which offer high consistency with CT findings. Here, we investigated the ultrasonographic features of the SP and its adjacent structures in normal adults and assessed the clinical utility of ultrasound assessment for SP-related diseases.MethodsWith the ramus of mandible, mastoid process, SP, and salivary gland as the anatomical landmarks, ultrasonography was conducted on the parapharyngeal space in 78 healthy adults. The scans were performed along the oblique coronal section of the ramus and the cross-sectional plane between the mastoid process and ramus to visualize the SP and its adjacent structures. The SP length, the shortest distance from the SP tip to the outer edge of tonsil (SP-tonsil distance), and the distance from SP to the internal carotid artery (SP-ICA distance) were measured.ResultsSP and its adjacent structures were successfully visualized on ultrasonography in all 78 subjects. The measured SP length was 2.65±0.48 cm. The SP-tonsil distance was 1.95±0.50 cm. The SP-ICA distance was 0.509±0.231 cm. The SP length and SP-tonsil distance measured by ultrasound were not significantly different from those measured by CT (P=0.071, P=0.053). Furthermore, the SP length and SP-tonsil distance measured by ultrasound were positively correlated with CT measurements (r=0.917, P=0.071; r=0.978, P=0.053, respectively). SP-tonsil distance was negatively correlated with SP length and SP inward deflection angle.ConclusionsUltrasound can accurately reveal the shape and size of SP and its adjacent structures and thus will be helpful for the diagnosis of SP-related diseases.

Project description:The success of any minimally invasive treatment procedure can be enhanced significantly if combined with a robust noninvasive imaging modality that can monitor therapy in real time. Quantitative ultrasound (QUS) imaging has been widely investigated for monitoring various treatment responses such as chemotherapy, radiation, and thermal therapy. Previously, we demonstrated the feasibility of using spectral-based QUS parameters to monitor high-intensity focused ultrasound (HIFU) treatment of in situ tumors in euthanized rats [Ultrasonic Imaging 36(4), 239-255, 2014]. In the present study, we examined the use of spectral-based QUS parameters to monitor HIFU treatment of in vivo rat mammary adenocarcinoma tumors (MAT) where significant tissue motion was present. HIFU was applied to tumors in rats using a single-element transducer. During the off part of the HIFU duty cycle, ultrasound backscatter was recorded from the tumors using a linear array co-aligned with the HIFU focus. A total of 10 rats were treated with HIFU in this study with an additional sham-treated rat. Spectral parameters from the backscatter coefficient, i.e., effective scatterer diameter (ESD) and effective acoustic concentration (EAC), were estimated. The changes of each parameter during treatment were compared with a temperature profile recorded by a fine-needle thermocouple inserted into the tumor a few millimeters behind the focus of the HIFU transducer. The mean ESD changed from 121 ±6 to [Formula: see text], and the EAC changed from 33 ±2 to [Formula: see text] during HIFU exposure as the temperature increased on average from 38.7 ±1.0 (°)C to 64.2 ±2.7 (°)C. The changes in ESD and EAC were linearly correlated with the changes in tissue temperature during the treatment. When HIFU was turned off, the ESD increased from 81 ±8 to [Formula: see text] and the EAC dropped from 46 ±3 to 36±2 dB/cm(3) as the temperature decreased from 64.2 ±2.7 (°)C to 45 ±2.7 (°)C. QUS was demonstrated in vivo to track temperature elevations caused by HIFU exposure.

Dataset Information

High-Resolution Ultrasound for Diagnosis and Treatment of Filler-Related Septal Necrosis.

Publications

High-Resolution Ultrasound for Diagnosis and Treatment of Filler-Related Septal Necrosis.

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