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3.Acheivements(Publications,research,et.al.) : |
1- A Retrospective Comparison between the Role of Alar Spanning Sutures and Tongue in Groove Technique in Rhinoplasty IRB-28067
Tip management is among the most challenging parts in nasal reconstructive surgery.
A successful treatment plan depends on an understanding of the anatomic variations of the soft tissues and cartilaginous framework of the tip, factors that influence tip support and their interrelation, and the effect of each surgical modification on the final surgical results.
There are many techniques to restore tip rotation and projection and the choice is dependent on the surgeon’s armamentarium. One of the most popular is tongue in groove technique, which can be placed to increase tip projection using open approach.
However, surprisingly, the effects tongue in groove technique on maintaining tip rotation and projection as a routine technique during rhinoplasty still is questionable.
Also, the other famous techniques like spanning suture have their proponents. Here, we tried to compare the results of two techniques on tip projection and rotation in two groups of unselected cases comparing the preoperative simulation picture.
We want to understand the best method for correcting and restoring tip rotation, which enable patients to better breathing.
There has not been a similar study in medical literature, and we hope to present the most effective technique to other specialists.
The study protocol was approved by Stanford IRB with above mentioned number and I was the primary investigator of this project.
2- Examination of Septum Anatomy in Patients Undergoing Septoplasty IRB-23939
Nasal deviation or deviated nasal septum (DNS) is a common physical disorder of the nose, involving a displacement of the nasal septum. It is most frequently caused by impact trauma, such as by a blow to the face. It can also be a congenital disorder, caused by compression of the nose during childbirth. Deviated septum is associated with genetic connective tissue disorders such as Marfan syndrome.
The nasal septum is the bone and cartilage in the nose that separates the nasal cavity into the two nostrils. The cartilage is called the quadrangular cartilage and the bones comprising the septum include the maxillary crest, vomer and the perpendicular plate of the ethmoid. Normally, the septum lies centrally, and thus the nasal passages are symmetrical. A deviated septum is an abnormal condition in which the top of the cartilaginous ridge leans to the left or the right, causing obstruction of the affected nasal passage. The condition can result in poor drainage of the sinuses. Patients can also complain of difficulty breathing, headaches, bloody noses, or of sleeping disorders such as snoring or sleep apnea.
It is common for nasal septa to depart from the exact centerline; the septum is only considered deviated if the shift is substantial or is adversely affecting the patient. Many people with a deviation are unaware they have it until some pain is produced. By itself, a deviated septum can go undetected for years and thus be without any need for correction.
One of important part of septal deviation is its lower part called the septal spur, but the anatomy of this part was not fully evaluated. We want to have a better understanding about the characteristics of septal spur, which can enable surgeon to design better technique to correct septal deformity and I was the primary investigator of this project.
3- The functional and aesthetic effect of modified extracorporeal septoplasty by using of radiated rip cartilage IRB-28498
Nasal deviation, termed as “deviated nose†in medical literature, is a complex deformity involving almost all structures within the nose. Deviated nose or crooked nose can be defined by drawing a line virtually drawn from mid-glabella to pogonion (glabella-to-pogonion line), passes through nasal bridge, nasal tip, and cupids’ bow and finally incisive teeth; nasal deviation from this line to either side, would be defined as “deviated noseâ€. Occasionally, nasal deviation is accompanied by other facial deformities, too. The bony and the cartilage components of the nose, together, form the functional nasal structure; and they are both subject to deviation, especially nasal septum. Nasal septum has a major role in forming the “nasal valve†with caudal portions of lateral nasal cartilages; even a slight change to its shape or length may affect nasal physiologic function through altering the nasal valve diameter; this ends up to a variety of diseases such as: nasal obstruction, sinus disease, structural disorders and nasal cosmetic appearance. According to this, septal and nasal valve correction is the basic principle in treatment of a deviated nose.
The real incidence of deviated nose is unclear, but probably like septal deviation different among countries and ethnicity.
Whatever the cause of deviated nose is, this deformity precipitates in structural asymmetry leading to a variety of problems to either or both nasal aesthetic and function .This fact ascertains the need for surgical intervention. Surgeons might be so obsessive about the cosmetic outcome, because this is maybe the only thing that satisfies their patients best; but sometimes patients favor a better functional outcome than the aesthetic; the truth is that both aesthetic and function have their own values, one gives a better self-image and one gives a better quality of life, so the effort should be put on the selection of a surgical method which best fulfills the ideals for both aesthetic and function. Certainly, they are not easily achievable, and keeping both at their optimums is the art of a good surgeon. Thus, septorhinoplasty in patients with deviated nose, more as a therapeutic operation than a cosmetic, should pay attention to nasal function as much as nasal aesthetic.
There are a variety of surgical techniques for septorhinoplasty, and no unique method is applicable to all patients; it’s on the surgeon to choose the best that ends up to a better possible outcome.
We want to evaluate the outcome of extra corporeal septoplasty by usage of the radiated rib cartilage in deviated nose as a novel treatment for this problem.
The protocol of this study was approved in Stanford IRB with above mentioned number and I was the primary investigator of this project.
4- The effect of RF turbinoplasty versus two other methods in management of polypoid change of middle turbinates: A clinical randomized trial NCT01906697
Sinusitis or rhinosinusitis is inflammation of the paranasal sinuses. It can be due to infection, allergy, or autoimmune issues. Most cases are due to a viral infection and resolve over the course of 10 days. It is a common condition, with over 24 million cases annually in the U.S. One of the severest forms of sinusitis is nasal polyposis. Nasal polyps are polypoid masses arising mainly from the mucous membranes of the nose and paranasal sinuses. They are overgrowths of the mucosa that frequently accompany allergic rhinitis. They are freely movable and non tender.
The management of middle turbinate in treatment of nasal polyposis is still an interesting debatable topic. The surgical access and its possible role in pathophysiology of sinusitis are two important points about its treatment. On the one hand, middle turbinate resection can improve surgical access and possibly reduce the nasal polyposis recurrence. On the other hand, there are some reports of anosmia, empty nose syndrome, synechia, and difficulties in revision surgery. Also, synechia, lateralization, and possibly recurrence can be the possible outcome after middle turbinate preservation.
Among different modalities, radiofrequency (RF) gradually increase its popularity as surgical tools, which can treat mucosal hypertrophy without any tissue removal. Inferior turbinate is a famous place for its usage, especially for decreasing of the nasal obstruction. Also, some authors have showed its effect on refractory allergic rhinitis, which is not only related to reducing nasal obstruction, but also it is related to changing of the allergic mediators. Comparing to other treatments for turbinates is sparing its overlaid mucosa, which can reduce the possible future morbidities.
Probably considering the above mention points, RF has a possible impact on the polypoid changes of middle turbinates and possibly does not have the same deleterious effect of the resection on cilia of mucosal layer. Therefore, we performed a randomized clinical trial to compare its outcome with two famous methods of the middle turbinate management: partial resection and medialization.
The protocol of this study was approved and published in FDA clinical trial.gov with above mentioned number and I was the primary investigator on this project. This study has been done as a combined project between Stanford University and Tehran University of Medical sciences.
5- Comparing the aesthetic results of two common incisions in external rhinoplasty: A randomized trial NCT01907256
Approaches to nasal reconstruction surgery can be separated into two broad categories: external and endonasal, with each of them their own supporter. Although, the external approach provides better exposure, critics of this technique complain about cosmetic deformity regarding the incision. Hence, over the recent years surgeons have modified the trans-columellar incision into two big categories: gull wing and stair steps. While each of them has its own proponents, there is no randomized trial, comparing their cosmetic results.
Previous studies have sought to characterize the outcome of external nasal incision, and some specifically with regard to columellar scar. However, none of above mentioned articles compared two popular external incisions with each other.
Actually, the previous surgery did not use a validate scar analysis method and also transverse incision in not a common incision in external approach.
Herein, we use both self-rating by patients, independent physician observers Visual Analogue Scale (VAS) and also a validated scar analysis to compare inverted V and stair step incisions.
This study is the first randomized control trial whose protocol was approved and published in FDA clinical trial.gov with above mentioned number. This study has been done as a combined project between Stanford University and Tehran University of Medical sciences and I was the primary investigator of this project.
6-The role of spreader flaps in preventing of nasal obstruction in primary rhinoplasty: A randomized-controlled trial. NCT01907243
Nasal reconstructive surgery is a common facial reconstructive surgery procedure, one complication of which is nasal vault narrowing and consequent nasal obstruction. Recently, researchers have paid much attention to nasal valve area and especially to the role of upper lateral cartilage (ULC) in preserving of nasal patency, since a possible consequence of destructive techniques was permanent functional problems for patients. In addition to functional problems, it can cause some aesthetic problems such as the inverted-V deformity. Accordingly, reconstruction of the midvault after dorsal reduction has been advocated and widely adopted.
The gold standard for midvault reconstruction after dorsal reduction has been the spreader graft, first advocated by Sheen. Subsequently, its usage has been widened to include repair of the valve in the unoperated nose, and its efficacy well-documented. However, it can be a time-consuming procedure that requires the harvest of septal cartilage. Therefore, some authors proposed the spreader flap as an alternative technique. While the results of the above mentioned articles proposed the efficacy of spreader flaps, none of them was a randomized trial and subjective methods were used for measurement of nasal breathing after rhinoplasty.
Nasal obstruction can be evaluated in different methods, both quantitative and subjective, the validity of each debated. For example, while the numeric form of Visual Analogue Scale (VAS) is commonly used, it is ultimately related to patients’ subjective perception. Alternatively, objective evaluation of nasal patency is also of common interest to many researchers, and various methods for objective measurement exist. Among these different methods, acoustic rhinomanometry is an effective tool. However, some researchers debate the reliability of these results. Herein we examine the efficacy of the spreader flap in preventing of nasal valve collapse after dorsal reduction using a randomized trial, with both objective and subjective measures.
This research as a combined project between Stanford University and Tehran university of Medical sciences was the first randomized trial in this topic. I was the primary investigator of this project
This article was accepted for publication in the most prestigious journal in rhinology field “American Journal of Rhinology & Allergyâ€
Considering the high impact factor of this journal (2.3) and its acceptance/rejection rate which is 33% / 65% can show the importance of this article.
7--The effect of septorhinoplasty on allergic nasal symptoms in normal patients
Allergic rhinitis, as a presentation of systemic atopia, is a mucosal inflammation of intranasal airways due hyper-responsiveness to certain allergens through an IgE-mediated immunologic interaction. The process starts when airborne allergens are first exposed to the immune system at the nasal mucosa. Thereafter, through a sensitization process, some allergen-specific IgE are generated which circulate in the peripheral blood and attach to the surface basophiles and mast cells. From the second exposure on, the allergens activate local immune cells and subsequently lead to the “allergic response†at the site of exposure. This, in the nose, is expressed as acute nasal symptoms and dominantly as nasal obstruction.
When the diagnosis is established, the treatment includes avoidance of allergens, pharmacotherapy, immunotherapy, and in those with persistent symptoms failing to respond to medical treatment, surgery to the hypertrophied inferior turbinate may be necessary.
As one of the treatments of allergic rhinitis, the surgery of hypertrophied inferior turbinate is effective in relieving nasal obstruction symptoms. However, given the high incidence of allergic rhinitis in the general population, a large subset of patients with either cosmetic nasal deformities or structural nasal obstruction requiring surgical intervention may be at risk for allergic rhinitis. The effect of nasal surgery on allergic rhinitis in this group of patients has not been examined. The majority of studies have focused on the effect of active allergic rhinitis on surgical outcomes, which reported poorer outcomes of nasal surgery in patients with concomitant allergic rhinitis. These studies provide evidence that the outcomes of nasal surgical interventions are poorer in patients with allergic nasal disease, or more specifically, that patients with allergic rhinitis do not necessarily get better results from their surgeries than normal patients.
This study was a combined project between Stanford University and Tehran University of Medical Sciences and I was the primary investigator of this project. This project was finished and its manuscript was submitted in American Journal of Otolaryngology.
8-Sleep Disorders in ESRD Patients Undergoing Hemodialysis
Kidney malfunction affects different aspects of normal life, among different manifestations of sleep problems can be considered as a common complaint of ESRD (End Stage Renal Disease) patients. Logically, this condition is also quite frequent in end-stage renal disease (ESRD) patients with no functional kidneys, even while regularly undergoing maintenance dialysis. In ESRD patients sleep disorders usually present as insomnia, restless leg syndrome (RLS), obstructive sleep apnea syndrome (OSAS) or sleep apnea-hypopnea syndrome (SAHS), excessive daytime sleepiness (EDS), narcolepsy, sleepwalking, nighttime waking, nightmares, rapid eye movement behavioral disorder (RBD), periodic limb movements (PLM) in sleep, and poor concentration, which sometimes are ascribed to the uremic state itself ,while improvements to the uremic state, either by dialysis or renal transplant, could not necessarily ameliorate the sleep disorders. This implicates more complicated processes causing sleep disorders in ESRD patients, which are not fully understood yet.
Whatever the causes of sleep disorders are, the shortage of sleep and its low quality in ESRD patients make the nighttime rest insufficient for their physiologic needs, and subsequently keep them sleepy, exhausted and with low level of concentration during daily activity.
So, the vast problems coming from sleep disorders in ESRD patients raise the need for studies in more detail for the scope of the neuromuscular impairments to be fully figured out, and for new treatments to be discovered. In this study, we conducted a cross-sectional investigation where the presence and the severity of sleep disorders in ESRD patients were determined and analyzed with multiple variables including the patients’ and dialysis characteristics, clinical and laboratory findings and specific medications and stimulants they may have been using.
This is a combined project between Stanford University and Tehran University of Medical Sciences and I was the primary investigator of this project.
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4.Assessment of Value of Sabbatical leave(benefits,faculty development,future professional activities,...) : |
Spending of enough time in a prestigious university completely affect your future career as an Academic faculty. You can learn new techniques, can see a well organised educational system, and also can take part in high rank research.
In the areas of medicine and surgery, from the perspective of both the patient and the physician, it influences the way we operate. Medical students and residents display an increasing tendency to focus on particular areas of the curriculum, and patients search for the doctor with the special knowledge, training, and experience to care for their individual problems.
Patients, in fact, search not just for specialists, but for subspecialists, as medical knowledge deepens and physicians of necessity restrict their practices to ever narrower subspecialty interests.
By the early 1980s, more than twenty years ago, facial plastic surgery had established itself as the number one subspecialty interest among otolaryngology–head and neck surgeons. Many practitioners belonged to the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS), which then had 2,500 members and sponsored more than twenty facial plastic surgery fellowships across North America. With AAFPRS support, substantial, identifiable training in facial plastic surgery became a required component of accredited otolaryngology–head and neck residency programs, and residents had to demonstrate a solid grasp of this area to attain certification by the American Board of Otolaryngology (ABOto).
The growth of subspecialization within otolaryngology mirrored what was occurring on a grander scale in the American Board of Medical Specialties (ABMS) community—and all of these ABMS subspecialists wanted additional recognition so that patients could readily identify the physicians with the expertise they sought. Physicians with ABMS certificates in internal medicine wanted subspecialty certificates in pulmonary disease, cardiovascular disease, gastroenterology, and more. General surgeons wanted subspecialty certificates in pediatric surgery, which is separate from the seventeen subspecialty certificates issued by the pediatric board itself.
Today, there are twenty-four ABMS specialties that offer ninety-one subspecialty certificates—though none in facial plastic surgery. On paper, there is a conjoint certificate in something called “plastic surgery within the head and neck†offered by the ABOto and the American Board of Plastic Surgery (ABPS), but “facial plastic surgery†per se is nowhere to be seen under the ABMS umbrella.
What has happened since the 1980s, when facial plastic surgery was fully recognized within otolaryngology as its largest subspecialty, and today, when it remains a central component of otolaryngology training but certification in facial plastic surgery can be achieved only outside the ABMS? The answer to that question is the story of the American Board of Facial Plastic and Reconstructive Surgery (ABFPRS).
It is the story of how a competing medical specialty (plastic surgery) fought in hospital credentials committees, the media, state medical boards and legislatures, the ABMS, the American Medical Association, and even the U.S. Congress to prevent otolaryngologists from disclosing their expertise in facial plastic surgery to the public.
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Today, the ABFPRS is recognized as equivalent to primary boards of the ABMS in every state that has set standards for such equivalence. This did not just happen one day when random circumstances serendipitously aligned. A group of people worked hard for two decades to attain this stature for the ABFPRS, and their actions make an interesting story not only for facial plastic surgeons but also, I believe, for physicians in other emerging medical specialties and perhaps even for anyone who enjoys a tale about what people can achieve when they put their minds to a task.
Drawing from archival records and illustrated with pictures of the people who played major roles, this book details the external battles that forged a steely collective will among facial plastic surgeons to create a certifying board that could withstand the sharpest scrutiny of regulators and competitors and deliver to the public the names of surgeons who meet the highest standards of practice. It further chronicles the internal work required to create a national medical specialty certifying board, from the establishment of an independent entity to the hiring of staff and legal counsel uniquely qualified to advise the new board and the creation of mechanisms to attract the unstinting efforts of young surgeons while retaining the sage counsel of senior people whose practices have exemplified the kind of surgeon envisioned in the ABFPRS standards for certification. All of these elements have been factors that enabled this board to meet its challenges, grow, and ultimately gain the recognition it enjoys today.
Yes, things have changed in the past twenty years. The emphasis on comprehensive and collaborative patient care has eased tensions and fostered cooperation, at times, between previously distanced competitors. The real winner is the patient. The ABFPRS, after all, was founded to set standards for the practice of facial plastic surgery and to assess which surgeons meet those standards so that patients and the public can more readily identify physicians with the expertise they seek.
Now more than ever is the time for each one of us with an interest in facial plastic surgery to help maintain and even further raise the bar, settling for nothing less than the highest level of personal training, performance, and integrity. Embracing the contributions and knowledge of respected colleagues and friends, we will continue to provide the highest level of care for our patients and in so doing, preserve, protect, and honor the existence of our specialty., |