Bio


Dr Abdelwahab is currently a Clinical Instructor in the Sleep Surgery Division, Department of Otolaryngology - Head and Neck Surgery at Stanford. His previous academic work in the department has focused on nasal and facial skeletal surgery in the division of Facial Plastic and Reconstructive Surgery. His previous clinical training included dual training in maxillofacial surgery and rhinology.

Academic Appointments


  • Clinical Instructor, Otolaryngology - Head & Neck Surgery Divisions

All Publications


  • Combined Functional and Preservation Rhinoplasty. Facial plastic surgery clinics of North America Patel, P. N., Abdelwahab, M., Most, S. P. 2021; 29 (1): 113–21

    Abstract

    Dorsal preservation rhinoplasty has aesthetic advantages over conventional hump takedown rhinoplasty. In dorsal preservation surgery, the nasal vault is treated en bloc. The internal nasal valve angle is not disrupted and there is no need for midvault reconstruction. Two techniques for management of the bony vault exist in dorsal preservation surgery: the let-down and the push-down techniques. There are a variety of techniques used for management of the septum in dorsal preservation. Available patient-reported outcomes of suggest positive results in nasal breathing. More robust data are needed to clarify the functional results of dorsal preservation and compare breathing outcomes.

    View details for DOI 10.1016/j.fsc.2020.09.005

    View details for PubMedID 33220836

  • Dorsal Preservation Rhinoplasty: Method and Outcomes of the Modified Subdorsal Strip Method. Facial plastic surgery clinics of North America Patel, P. N., Abdelwahab, M., Most, S. P. 2021; 29 (1): 29–37

    Abstract

    There has been particular recent interest in dorsal preservation rhinoplasty techniques because of claims of superior functional and aesthetic results relative to conventional hump reductions. The septum in dorsal preservation rhinoplasty is managed in a variety of ways with differences largely based on the location of septal excision (subdorsal resection, midseptal resection, and inferior septal resection). The technical considerations of a modified subdorsal strip method using a structural preservation technique are described. This technique maintains a subdorsal and caudal strut of cartilage. Patient-reported measures demonstrate significantly improved functional and aesthetic outcomes postoperatively with this procedure.

    View details for DOI 10.1016/j.fsc.2020.08.004

    View details for PubMedID 33220841

  • Effect of Lateral Crural Procedures on Nasal Wall Stability and Tip Aesthetics in Rhinoplasty. The Laryngoscope Abdelwahab, M., Patel, P., Kandathil, C. K., Wadhwa, H., Most, S. P. 2021

    Abstract

    OBJECTIVES/HYPOTHESIS: To evaluate the lateral nasal wall stability, nasal function, and cosmesis when creating an aesthetically pleasing nasal tip subunit utilizing lateral crus (LC) altering procedures.STUDY DESIGN: Retrospective cohort.METHODS: In this retrospective cohort study, cosmetic rhinoplasty patients undergoing LC procedures with available lateral wall insufficiency (LWI) scores were included. An LWI grading system was used to evaluate internal (zone 1) and external (zone 2) nasal valves objectively. Secondarily, Nasal Obstruction Symptom Evaluation (NOSE) Score, Visual Analog Scale (VAS) and Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) results were evaluated. Based on the LC intervention, the cohort was divided into six groups: lateral cural strut graft (LCSG), mini-LCSG, lateral crural overlay (LCO) with and without additional support, cephalic trimming, and cephalic turn-in flaps.RESULTS: Subjects undergoing LCO with and without support, LCSG, and mini-LCSG showed significant improvement in zone 1 LWI (P =.042, P =.041, P <.001, and P <.001, respectively), while cephalic trimming and turn-in/hinged flaps had no effect. Subjects undergoing LCO with support and LCSG showed significant improvement in zone 2 LWI (P =.022, P =.004), while LCO without support, mini-LCSG, cephalic trimming, and turn-in flaps showed no effect on LWI. The SCHNOS-C and VAS-C showed significant improvement in all subgroups (P <.05) when comparing pre- to postoperative values. Alar-spanning sutures did not significantly change zone 1 scores but did conceal zone 2 improvements in LCSG and LCO with support groups.CONCLUSIONS: Selected LC procedures are robust techniques for improving tip cosmesis independently without compromising nasal lateral wall stability. Some LC procedures can improve nasal valves patency in tip surgery. Laryngoscope, 2021.

    View details for DOI 10.1002/lary.29389

    View details for PubMedID 33459395

  • Effect of Midvault Reconstruction Versus Preservation on Lateral Nasal Wall Stability. Facial plastic surgery & aesthetic medicine Abdelwahab, M. n., Patel, P. N., Kandathil, C. K., Most, S. P. 2021

    View details for DOI 10.1089/fpsam.2020.0494

    View details for PubMedID 33555984

  • The Use of Indocyanine Green Angiography for Cosmetic and Reconstructive Assessment in the Head and Neck. Facial plastic surgery : FPS Abdelwahab, M., Patel, P. N., Most, S. P. 2020; 36 (6): 727–36

    Abstract

    Reconstructive procedures in the head and neck can be a surgical challenge owing to the complex anatomical and physiological structure. Different locoregional and microvascular flaps are used for various defects to improve both function and cosmesis. Subjective clinical findings have been the mainstay for perfusion monitoring; however, areas of borderline perfusion are much more difficult to assess clinically. Multiple technologies that offer objective perfusion assessment have been developed to improve surgical outcomes. Indocyanine green (ICG) angiography has gained popularity owing to its minimal invasiveness and increased sensitivity and specificity in assessing flap perfusion particularly in the head and neck. It has been extensively used in free flaps, pedicled flaps (including nasal reconstruction), facelift procedures, random flaps, skull base reconstruction, and pharyngocutaneous fistula prediction. Its perioperative use has provided valuable qualitative and quantitative data that aid our understanding of flap hemodynamics. Clinically, this impacted decision-making in flap design, harvest, inset, and precocious salvage interventions. Though increased cost and intraoperative time could be limitations, cost-effectiveness studies have supported its use, particularly in high-risk individuals. Limitations include the lack of standardized dosing and consistent methodology agreement for data analysis. Future studies should involve larger cohorts and multi-institute studies to overcome such limitations.

    View details for DOI 10.1055/s-0040-1721113

    View details for PubMedID 33368129

  • A Review and Modification of Dorsal Preservation Rhinoplasty Techniques. Facial plastic surgery & aesthetic medicine Patel, P. N., Abdelwahab, M. n., Most, S. P. ; 22 (2): 71–79

    Abstract

    Importance: Although conventional hump resections are a hallmark of rhinoplasty, there has been a rekindled interest in dorsal preservation (DP) techniques as a means for addressing the dorsal hump, with claims of superior functional and aesthetic results. As such, an understanding of DP, including technical considerations and outcomes, is imperative. Observations: DP allows for mobilization of the osseocartilaginous nasal vault as a single unit and thereby prevents disruption of the natural keystone area. The osseous nasal vault is managed with a transverse osteotomy and either a bilateral single lateral osteotomy (pushdown procedure) or bilateral bony wedge resections (letdown procedure) to allow for descent of the nasal dorsum. A variety of approaches to the septum exist, each differentiated by the location of cartilage resection: subdorsal, high-septal, midseptal, or inferior septum. These techniques result in pleasing dorsal aesthetic lines but may be limited by a higher rate of dorsal hump recurrence. Patency of the internal nasal valve (INV) is theoretically improved with DP. Robust series with patient-reported outcomes are lacking, although several reports and early experience at our center with a newly described high-septal resection technique do suggest positive functional and cosmetic outcomes with DP. Conclusions and Relevance: With the recent revitalized interest in DP, an understanding of the potential benefits, techniques, and challenges associated with this surgery is helpful. Maintenance of the dorsum as a single unit has implications for maintaining structural integrity at the nasal keystone, pleasing dorsal aesthetic lines, and the patency of the INV. As surgeons continue to develop and employ these techniques, critical assessment of patient-reported outcomes and objective nasal measurements, with an emphasis on comparison with standard hump takedown techniques, will be valuable.

    View details for DOI 10.1089/fpsam.2020.0017

    View details for PubMedID 32130066

  • Impact of rapid palatal expansion on the internal nasal valve and obstructive nasal symptoms in children SLEEP AND BREATHING Yoon, A., Abdelwahab, M., Liu, S., Oh, J., Suh, H., Trieu, M., Kang, K., Silva, D. 2020

    Abstract

    The aim of this study is to evaluate the impact of rapid palatal expansion (RPE) on the nasal airway subjectively by utilizing patient-reported outcome measures (PROM) and objectively by evaluating validated internal nasal valve (INV) measurements obtained from cone beam computed tomography (CBCT) in pediatrics.In this retrospective cohort study, subjects who underwent RPE from March to December 2018 with cone beam CT and Nasal Obstruction Symptom Evaluation (NOSE) scores were included. Exclusion criteria included craniofacial deformity, allergies, asthma, recent nasal trauma, or surgery. INV measurements (angle and cross-sectional area), diastema, midpalatal suture opening, and NOSE scores were evaluated.Fifty-one subjects met the inclusion criteria with a mean age of 10.1 ± 2.6. Pre-expansion mean NOSE score was 32.55 (moderate) while post-expansion was 13.92 (mild). Mean NOSE score improved significantly by an average of 18.63 following post-expansion (P < 0.0001). The patients' right and left INV angles increased significantly by a mean of 2.42° and 2.65° respectively (P < 0.0001). Right and left INV cross-sectional areas increased significantly by an average of 14.35 mm2 (P < 0.0001) and 14.17 mm2 (P < 0.0001) respectively. An average expansion of the diastema and the suture was 1.60 mm and 3.05 mm respectively (P < 0.0001), with an average of 6.29 mm of expansion. We found the amount of diastema expansion to correlate with change in NOSE score (R = - 0.32, P = 0.022). Age and diastema showed a negative correlation (R = - 0.44, P = 0.0019), while INV angle and diastema showed a statistically significant positive correlation (R = 0.28, P = 0.048).RPE showed improvement in both NOSE scores and objective measures of the INV. This may show the possibility of considering RPE in managing resistant pediatric nasal airways. Future studies should include collaboration with pediatric otolaryngologists, with the inclusion of pediatric patients with persistent nasal obstruction.

    View details for DOI 10.1007/s11325-020-02140-y

    View details for Web of Science ID 000546893500002

    View details for PubMedID 32648185

  • Paramedian forehead flap pedicle division after 7 days using laser-assisted indocyanine green angiography. Journal of plastic, reconstructive & aesthetic surgery : JPRAS Rudy, S. F., Abdelwahab, M., Kandathil, C. K., Most, S. P. 2020

    Abstract

    The paramedian forehead flap is a major workhorse for reconstruction of medium- to large-sized nasal defects. The tissue bridge that results from the vascular pedicle results in significant cosmetic deformity, with associated social and occupational costs to the patient. This prospective cross-sectional study sought to assess efficacy and safety of takedown of the flap pedicle at 1week using indocyanine green (ICG) angiography to assist in determining neovascularization of the flap. This study was performed at a tertiary care center from April 13, 2018 to March 22, 2019. Patients eligible for enrollment included those with defects appropriate for reconstruction with a paramedian forehead flap, partial-thickness defect, vascularized tissue in more than 50% of the recipient bed, and lack of nicotine use. Ten patients were included, and all underwent reconstructive surgery by a single surgeon. Laser-assisted ICG angiography was used during the first stage as well as at the second stage both immediately before and after flap division. Perfusion was in both time-independent and time-dependent analyses relative to a cheek reference point. Herein, we found successful 7-day flap takedown with no flap-related complications in all patients. There was an average of approximately 44% flap-to-cheek vascularity across all patients, and pre-division flap perfusion correlated well with post-division perfusion. In conclusion, in carefully selected patients with amenable defects, division of the pedicle at 1week after initial flap transfer is safe and has the potential to limit the morbidity associated with the procedure.

    View details for DOI 10.1016/j.bjps.2020.05.079

    View details for PubMedID 32565139

  • Impact of Dorsal Preservation Rhinoplasty Versus Dorsal Hump Resection on the Internal Nasal Valve: a Quantitative Radiological Study. Aesthetic plastic surgery Abdelwahab, M. A., Neves, C. A., Patel, P. N., Most, S. P. 2020

    Abstract

    This study evaluates the impact of different hump takedown techniques, namely the conventional hump resection with midvault reconstruction, the push-down (PD) and the let-down (LD) procedures, on the INV dimensions.In this cadaveric study, six heads were divided randomly into either the conventional hump resection technique (Group A; n = 6 sides) or DPR techniques (n = 6 sides). This latter group was subdivided such that initially a PD procedure was performed (Group B; n = 6 sides), followed by a LD procedure on the same heads (Group C; n = 6 sides). A validated radiological method was used to measure the INV angle and cross-sectional area (CSA) in a modified coronal plane both pre- and post-procedurally.Group A did not show significant reduction in the INV angle nor in CSA (p = 0.068 and p = 0.156, respectively). In the push-down group (B), we observed a mean change of 2.05° in the angles and 0.3 cm2 in the CSA (p = 0.0163 and p < 0.001, respectively). The LD group (C) did not show significant reduction in the INV angle nor in CSA (p = 0.437 and p = 0.331, respectively).Neither the conventional hump resection nor the LD DPR technique reduced the INV dimensions. However, the PD preservation technique significantly reduced the INV dimensions.This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

    View details for DOI 10.1007/s00266-020-01627-z

    View details for PubMedID 32016500

  • Functional Outcomes of Septal Extension Grafting in Aesthetic Rhinoplasty: A Cohort Analysis. Facial plastic surgery & aesthetic medicine Patel, P. N., Abdelwahab, M. n., Shukla, N. D., Wadwha, H. n., Grimm, D. R., Kandathil, C. K., Most, S. P. 2020

    Abstract

    Background: Septal extension grafts (SEGs) are used widely in rhinoplasty as a means of controlling tip position. Grafts positioned in a side-to-side configuration may cause nasal airway obstruction. Methods: Retrospective cohort analysis of patients undergoing cosmetic rhinoplasty. Patients undergoing SEG placement were grouped according to completion of the Nasal Obstruction Symptom Evaluation (NOSE) or Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS). The latter has a cosmetic (C) and functional (O) domain. Each group was matched to a cohort that did not undergo SEG placement using criteria: preoperative NOSE or SCHNOS-O score, age, and gender. Patient demographics and outcomes, including NOSE, SCHNOS, and visual analog scale (VAS) scores, were compared between SEG and no-SEG groups using univariate and multivariate analyses. If patients underwent placement of an SEG and complained of obstruction, the laterality of the graft in relation to the complaint was examined. Results: SEGs were placed in 79 patients, of whom 77 completed the NOSE survey and 37 completed the SCHNOS-O both pre- and postoperatively. These patients were matched to patients without SEGs. For both the SCHNOS and NOSE-matched cohorts, functional outcomes (NOSE, SCHNOS-O, and VAS-F) did not significantly differ between SEG and no-SEG groups. These findings were also observed when patients were stratified by cosmetic surgery alone versus combined functional and cosmetic surgery. On multivariate linear regression analysis, when accounting for intraoperative techniques, there was no difference in postoperative NOSE or SCHNOS-O outcomes between the SEG and no-SEG cohorts. Side of postoperative nasal obstruction did not correlate with side of SEG placement. Conclusion: SEGs, when used in a unilateral side-to-side configuration, yield excellent aesthetic results without compromising functional outcomes.

    View details for DOI 10.1089/fpsam.2020.0304

    View details for PubMedID 32716730

  • Facial Paralysis and Communicative Participation: The Importance of Facial Symmetry at Rest. The Annals of otology, rhinology, and laryngology Ayoub, N. F., Abdelwahab, M. n., Zhang, M. n., Ma, Y. n., Stranberg, S. n., Okland, T. S., Pepper, J. P. 2020: 3489420912446

    Abstract

    There is a paucity of research devoted to understanding the communication restrictions encountered by facial paralysis patients. We aim to explore the relationship between patient-reported restrictions in communicative participation and objective facial paralysis severity using validated scales of facial movement.We performed a pilot retrospective study using a consecutive series of adult patients with a diagnosis of unilateral facial paralysis. In addition to baseline demographics, subjects were evaluated using the Communicative Item Participation Bank Short Form (CPIB), Electronic Facial Assessment by Computer Evaluation (eFACE), and Sunnybrook Facial Grading System (SFGS).Twenty patients were included, 10 (50%) of whom were female with a mean age of 61 ± 13 years and mean duration of facial paralysis of 53 ± 82 months. The mean CPIB score was 14.6 ± 10.0 (range 0-29) and was comparable to scores of patients with conditions known to cause significant communicative disability. The mean eFACE scores were 67.4 ± 29.2, 44.2 ± 30.1, and 73.8 ± 30.0 for the static, dynamic, and synkinesis domains, respectively, with a composite smile score of 58.5 ± 16.9. After adjusting for age, gender, and duration of facial paralysis, significant moderate correlations were observed between the CPIB and the static eFACE domain (r = -0.51, P = .03) and smile composite score (r = 0.48, P = 0.0049), in addition to between the CPIB and SFGS synkinesis domain (r = 0.48, P = 0.04).Patients with unilateral facial paralysis experience significant limitations in communicative participation. These restrictions demonstrate moderate to strong correlations with objective assessments of facial paralysis and quality of life measures. Communicative participation may be a helpful means of tracking response to treatment.IV.

    View details for DOI 10.1177/0003489420912446

    View details for PubMedID 32192355

  • The miniature lateral crural strut graft: Efficacy of a novel technique in tip plasty. The Laryngoscope Abdelwahab, M. n., Most, S. P. 2020

    Abstract

    To describe a novel technique for tip plasty and determine its efficacy using validated patient-reported outcome measures and objective measures.Retrospective cohort study.This study was carried out at a tertiary center. Patients undergoing tip plasty using the miniature lateral crural strut grafts (mini-LCSG) in cosmetic/combined rhinoplasty between January 2016 and August 2019 with available outcome measures were included. We used the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS), Nasal Obstruction Symptom Evaluation (NOSE) scores, visual analog scale: functional and cosmetic, and lateral wall insufficiency (LWI) grades.Among 52 patients, 33 were included; 26 had cosmetic whereas seven had combined functional and cosmetic rhinoplasty, with a follow-up up to 3 years. Both cosmetic and combined subjects showed significant improvement in SCHNOS-Cosmesis (C) scores (-57.31 ± 1.79, P < .001 and - 53.57 ± 8.39, P < .001, respectively) and zone 1 LWI (P < .05, both sides). SCHNOS-Obstruction (O) and NOSE scores showed significant decrease among subjects undergoing combined rhinoplasty only (-55.36 ± 18.58, P < .004, and - 53.93 ± 15.99, P < .003, respectively). With specific regard to tip cosmesis, the mean SCHNOS-6 (item 6 of the SCHNOS questionnaire for tip cosmesis) showed significant improvement (-2.61, P < .001).The mini-LCSG is a novel modification for tip plasty that improves tip cosmesis and symmetry, both subjectively and objectively without compromising nasal function.4 Laryngoscope, 2020.

    View details for DOI 10.1002/lary.28530

    View details for PubMedID 32031694

  • Biportal transparotid dissection in the retromandibular approach for condylar fracture osteosynthesis: Efficacy of a novel technique. Journal of plastic, reconstructive & aesthetic surgery : JPRAS Abdelwahab, M. A., Spataro, E. A., Elkholy, N. A., El-Degwi, A., Most, S. P. 2019

    Abstract

    OBJECTIVE: Facial nerve injury is a primary complication of open surgical management of condylar fractures. A new modification of the retromandibular transparotid approach, the "biportal transparotid dissection" (BTD), was developed to reduce these injuries in accidental nerve exposure.DESIGN: Prospective cohort study.SETTING: Tertiary referral center.METHODS: Patients managed by retromandibular transparotid approach for condylar fractures at Department of Otolaryngology - Head and Neck Surgery, Mansoura University were included between November 2015 and August 2019 with exclusion of cases managed endoscopically or by a closed approach. Three groups were identified: Group A included patients undergoing the BTD technique, which entails transparotid dissection above and below exposed nerve branches and minimal nerve retraction; Group B included patients undergoing traditional dissection and nerve retraction away from the surgical field; and Group C included patients with unidentified facial nerve branches. The function of facial nerve branches was documented postoperatively.RESULTS: Fifty-seven fractures were included in the study. Facial nerve branches' injury occurred in 13 cases (22.8%): two (of ten) in Group A (20%), seven (of ten) in Group B (70%) and four (of 37) in Group C (10.81%). Compared to patients with non-exposed branches, Groups A and B were found to have 2.06 (p = 0.447) and 19.25 (p = 0.001) greater odds of nerve injury, respectively. The results showed significant faster nerve recovery in the BTD group compared to traditional dissection (mean 5 versus 9 weeks) (p = 0.015).CONCLUSION AND RELEVANCE: Although avoiding facial nerve exposure minimizes injury the most, BTD approach reduces exposed nerve injury compared to the traditional method.

    View details for DOI 10.1016/j.bjps.2019.11.044

    View details for PubMedID 31959498

  • Minimal Clinically Important Difference of the Standardized Cosmesis and Health Nasal Outcomes Survey AESTHETIC SURGERY JOURNAL Kandathil, C. K., Saltychev, M., Abdelwahab, M., Spataro, E. A., Moubayed, S. P., Most, S. P. 2019; 39 (8): 837–40

    View details for DOI 10.1093/asj/sjz070

    View details for Web of Science ID 000475855200018

  • Nasopharyngeal Angiofibroma Staging with a Novel Nominal Basis: An 18-Year Study in a Tertiary Center OTOLARYNGOLOGY-HEAD AND NECK SURGERY Abdelwahab, M., Overdevest, J. B., Elmokadem, A., El-Sisi, H., El-Kholy, N., Zaki, H., Kamal, E., Khafagy, Y., Tawfik, A., Eldawoody, H., Hwang, P., Rakha, A. 2019; 161 (2): 352–61
  • Impact of Distraction Osteogenesis Maxillary Expansion on the Internal Nasal Valve in Obstructive Sleep Apnea OTOLARYNGOLOGY-HEAD AND NECK SURGERY Abdelwahab, M., Yoon, A., Okland, T., Poomkonsarn, S., Gouveia, C., Liu, S. 2019; 161 (2): 362–67
  • Impact of Distraction Osteogenesis Maxillary Expansion on the Internal Nasal Valve in Obstructive Sleep Apnea. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Abdelwahab, M., Yoon, A., Okland, T., Poomkonsarn, S., Gouveia, C., Liu, S. Y. 2019: 194599819842808

    Abstract

    OBJECTIVE: To assess the effect of distraction osteogenesis maxillary expansion (DOME) on objective parameters of the internal nasal valve and correlate findings with subjective outcomes.STUDY DESIGN: Retrospective cohort study.SETTING: Tertiary referral center.SUBJECTS AND METHODS: After Institutional Review Board approval, included subjects were those with obstructive sleep apnea, had undergone DOME from September 2014 to April 2018, and had cone beam computed tomography scans available before and after expansion. Measurement of the internal nasal valve parameters was performed with Invivo6 Software (version 6.0.3). Interrater reliability of all pre- and postexpansion parameters was measured. Patient-reported outcome measures included the Nasal Obstruction and Septoplasty Effectiveness Scale (NOSE) and Epworth Sleepiness Scale scores, and correlation between objective and subjective outcomes were evaluated by Spearman correlation analysis.RESULTS: Thirty-two subjects met inclusion criteria. All showed significant improvement in their subjective outcomes as well as an increase in their internal valve parameters. Significant correlation was observed between increased angles and improvement in postexpansion NOSE score (right angle, P = .024; left angle, P = .029).CONCLUSION: DOME widens the internal nasal valve objectively (dimensions), which correlates significantly with subjective improvement (NOSE scores).

    View details for PubMedID 31084256

  • Neovascularization Perfusion of Melolabial Flaps Using Intraoperative Indocyanine Green Angiography JAMA FACIAL PLASTIC SURGERY Abdelwahab, M., Spataro, E. A., Kandathil, C. K., Most, S. P. 2019; 21 (3): 230–36
  • Association of Periosteal Sweeping vs Periosteal Preservation With Early Periorbital Sequelae Among Patients Undergoing External Perforating Osteotomy During Rhinoplasty JAMA FACIAL PLASTIC SURGERY El-Sisi, H., Abdelwahab, M., Most, S. P. 2019; 21 (3): 185–90
  • Utility of Indocyanine Green Angiography to Identify Clinical Factors Associated With Perfusion of Paramedian Forehead Flaps During Nasal Reconstruction Surgery JAMA FACIAL PLASTIC SURGERY Abdelwahab, M., Kandathil, C. K., Most, S. P., Spataro, E. A. 2019; 21 (3): 206–12
  • Nasopharyngeal Angiofibroma Staging with a Novel Nominal Basis: An 18-Year Study in a Tertiary Center. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Abdelwahab, M., Overdevest, J. B., Elmokadem, A., El-Sisi, H., El-Kholy, N. A., Zaki, H., Kamal, E., Khafagy, Y., Tawfik, A., Eldawoody, H., Hwang, P., Rakha, A. 2019: 194599819842155

    Abstract

    OBJECTIVE: To develop a systematic method for anatomic mapping of juvenile nasopharyngeal angiofibroma (JNA) tumors to standardize communication, facilitate surgical planning, and convey prognosis.STUDY DESIGN: Retrospective cohort.SETTING: Tertiary referral center.SUBJECTS AND METHODS: Following Institutional Review Board approval, we performed a retrospective review of radiologic and angiographic data of patients with JNA presenting to the Department of Otolaryngology-Head and Neck Surgery, Mansoura University, from 2001 to 2017. All patients underwent angiography with embolization and had >1-year follow-up. Based on frequently involved anatomic sites and factors predictive of prognosis, the NSF-COR staging system (nose/nasopharynx, sinus, fossa-cranium, orbit, residual internal carotid artery supply) was developed to explicitly convey anatomic site of involvement and presence of residual vascularity. We validated the NSF-COR staging system against other systems with Pearson chi-square test based on risk factors and clinical outcomes of blood transfusion volume, recurrence, and JNA resectability.RESULTS: Fifty-four patients met inclusion criteria, where all primary cases (100%) demonstrated nose/nasopharynx involvement, followed by sinus (85.2%), natural fossae (85.2%), intracranial (26%), and orbital involvement (16.7%). These sites, with assessment of residual internal carotid artery vascular supply, were used to develop the NSF-COR anatomically based staging system. The components COR showed significant association with clinical outcomes of blood transfusion and recurrence. Contingency coefficients between the NSF-COR staging system and available staging systems showed significant correlations ( P < .05) for prognosis.CONCLUSION: The NSF-COR staging system conveys a communicable anatomic map of JNA tumors that integrates residual vascularity of the tumor and demonstrates strong concordance with current staging systems to assess clinical outcomes.

    View details for PubMedID 31012381

  • Minimal Clinically Important Difference of the Standardized Cosmesis and Health Nasal Outcomes Survey. Aesthetic surgery journal Kandathil, C. K., Saltychev, M., Abdelwahab, M., Spataro, E. A., Moubayed, S. P., Most, S. P. 2019

    Abstract

    BACKGROUND: The minimal clinically important difference (MCID) for the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) has not been determined.OBJECTIVE: To define the MCID for both domains of the SCHNOS questionnaire.METHODS: This prospective cohort study included patients who underwent functional, cosmetic, or combined rhinoplasty operation from June 2017-June 2018 at a tertiary referral center. The average preoperative, postoperative, and change in scores were calculated for NOSE and SCHNOS. Anchor-based MCIDs were estimated for both SCHNOS subscales to define change in obstruction and cosmesis perceived after the rhinoplasty.RESULTS: Eighty-seven patients (69% women, 31% males) with mean age (SD) of 38 years (14.7) at the time of surgery. The mean postoperative follow up period (SD) was 145 days (117). The mean preoperative score (SD) for NOSE was 52 (32), SCHNOS-O score 55 (33), and SCHNOS-C score was 50 (26) points. Postoperatively, the NOSE score was 23 (22), SCHNOS-O score 24 (23), and SCHNOS-C score was 13 (18) points. The mean change in scores (SD) for NOSE, SCHNOS-O and SCHNOS-C were -29 (37), -31 (38), and -37 (28), respectively. The calculated MCID for SCHNOS-O was 26 (16) and for SCHNOS-C was 22 (15) points. The MCID for NOSE was 24 (13) points. A sensitivity test for the patients with follow-up ≥3 months showed only slightly different MCID estimates: 28 (17) for SCHNOS-O, 18 (13) for SCHNOS-C, and 24 (15) points for NOSE.CONCLUSION: For the obstruction domain SCHNOS-O, the MCID was 28 points. For the cosmetic domain SCHNOS-C, the MCID was 18 points.

    View details for PubMedID 30873533

  • Arabic Validation of the Standardized Cosmesis and Health Nasal Outcome Survey for Arabic-Speaking Rhinoplasty Patients PLASTIC AND RECONSTRUCTIVE SURGERY Abdelwahab, M., Saltychev, M., Elkholy, N. A., Elsisi, H., Moubayed, S. P., Most, S. P. 2019; 143 (3): 673E–675E
  • Association of Periosteal Sweeping vs Periosteal Preservation With Early Periorbital Sequelae Among Patients Undergoing External Perforating Osteotomy During Rhinoplasty. JAMA facial plastic surgery El-Sisi, H., Abdelwahab, M., Most, S. P. 2019

    Abstract

    Importance: Periorbital sequelae are a significant source of early postoperative morbidity after rhinoplasty, particularly after an osteotomy is performed.Objective: To compare postoperative periorbital sequelae after external perforating lateral osteotomy in rhinoplasty using a periosteal sweeping vs a periosteal preserving approach.Design, Setting, and Participants: This prospective cohort study conducted at a tertiary referral center located in Mansoura, Egypt, included 28 patients who underwent external perforating lateral osteotomy in open rhinoplasty between January and May 2017.Exposures: Periosteal sweeping was performed on one side of the nose and periosteal preservation was performed on the other side during external perforating lateral osteotomy.Main Outcomes and Measures: Periorbital sequelae, including eyelid edema, periorbital ecchymosis, and subconjunctival hemorrhage, were assessed on both sides of the face on postoperative days 1, 7, and 21 by 2 independent surgeons using the scale first proposed by Kara and Gokalan in 1999. The scales for eyelid edema ranged from 0 to 4, for ecchymosis from 0 to 4, and for subconjunctival hemorrhage from 0 to 2, with higher values indicating greater edema, ecchymosis, and hemorrhage, respectively. Differences in the 3 time points and differences between the 2 osteotomy methods were analyzed.Results: In total, 19 men and 9 women with a mean (SD) age of 23.7 (3.9) years were enrolled. All patients showed significant decreases in eyelid edema on postoperative days 7 and 21 compared with day 1 (1.71 and 1.39 vs 2.89 for the swept side, and 1.86 and 1.46 vs 2.68 for the preserved side; both P<.05) and in periorbital ecchymosis (2.02 and 1.13 vs 2.86 for swept side, and 2.05 and 1.13 vs 2.82 for the preserved side; both P<.05). A significant decrease in subconjunctival hemorrhage was observed on day 21 compared with days 1 and 7 (1.79 vs 2.11 and 2.11 for the swept side, and 1.71 vs 2.14 and 2.14 for the preserved side; both P<.05). The mean rank score for eyelid edema on day 1 for the swept side was significantly higher than that for the preserved side (33.18 vs 23.82, P=.02), and the mean rank score for periorbital ecchymosis on the swept side was significantly higher than that for the preserved side (33.59 vs 23.41, P=.01). Although both eyelid edema and periorbital ecchymosis appeared to remain greater on the swept side on postoperative days 7 and 21, the differences no longer reached statistical significance. Periosteal preservation was not associated with minimizing subconjunctival hemorrhage postoperatively.Conclusions and Relevance: This study suggests that lateral nasal osteotomy is associated with varying degrees of eyelid edema, periorbital ecchymosis, and subconjunctival hemorrhage. Compared with sweeping the periosteum, preserving the periosteum in an external perforating lateral osteotomy was associated with less eyelid edema and periorbital ecchymosis in the early postoperative period.Level of Evidence: 2.

    View details for PubMedID 30789649

  • Neovascularization Perfusion of Melolabial Flaps Using Intraoperative Indocyanine Green Angiography. JAMA facial plastic surgery Abdelwahab, M., Spataro, E. A., Kandathil, C. K., Most, S. P. 2019

    Abstract

    Importance: Assessment of melolabial flap perfusion using indocyanine green (ICG) angiography for nasal reconstruction has not been previously described.Objective: To assess melolabial flap relative perfusion using ICG angiography in nasal reconstruction and highlight its clinical relevance.Design, Setting, and Participants: In this retrospective case series at a tertiary referral center, 10 patients undergoing melolabial flap reconstruction of nasal defects between January 2015 to April 2018 with flap perfusion were assessed by ICG angiography.Exposures: Indocyanine green angiography was performed to assess melolabial flap perfusion at second stage surgery after temporary clamping of the pedicle and after pedicle division and flap inset.Main Outcomes and Measures: Flap perfusion in relation to a reference point on the cheek was calculated after both pedicle clamping and division by 2 methods: (1) ingress (arterial inflow) and egress (venous outflow) flap-to-cheek ratio; (2) flap-to-cheek perfusion (fluorescence) ratio at 3 time points (midpoint of ICG flap inflow, maximum [peak] fluorescence, and midpoint of ICG outflow), and their calculated mean. Correlations of perfusion with time between stages, and patient factors were performed; perfusion parameters after temporary pedicle clamping and after division and flap inset were compared.Results: Ten patients (mean [SD] age, 66 [7.5] years) were enrolled with a mean (SD) interval of 23 (4) days between first and second surgery. No correlation existed between perfusion parameters and time interval between first and second stage, or any other patient factors. Of the different perfusion parameters, a statistically significant difference was observed when comparing temporary clamping and postdivision mean (SD) flap-to-cheek perfusion ratio (0.89 [0.22] and 0.80 [0.19]; 95% CI, 4.1-12.6; P=.001), as well as mean (SD) peak perfusion ratio (0.81 [0.2] and 0.77 [0.2]; 95% CI, 0.005-0.080; P=.02) only. No partial or complete flap necrosis was reported after pedicle division.Conclusions and Relevance: Indocyanine green angiography is an effective method to determine neovascularization perfusion of melolabial flaps, with a mean perfusion of 89% after pedicle clamping. Future applications of this technology include use in patients at high risk for flap necrosis, or those who may benefit from early flap division to ensure adequate perfusion and minimize the time interval between staged procedures.Level of Evidence: NA.

    View details for PubMedID 30730539

  • Confirmatory Factor Analysis of the Standardized Cosmesis and Health Nasal Outcomes Survey. Plastic and reconstructive surgery Saltychev, M., Kandathil, C. K., Abdelwahab, M., Spataro, E. A., Moubayed, S. P., Most, S. P. 2019; 143 (2): 454e–456e

    View details for PubMedID 30689612

  • Confirmatory Factor Analysis of the Standardized Cosmesis and Health Nasal Outcomes Survey PLASTIC AND RECONSTRUCTIVE SURGERY Saltychev, M., Kandathil, C. K., Abdelwahab, M., Spataro, E. A., Moubayed, S. P., Most, S. P. 2019; 143 (2): 454E–456E
  • Utility of Indocyanine Green Angiography to Identify Clinical Factors Associated With Perfusion of Paramedian Forehead Flaps During Nasal Reconstruction Surgery. JAMA facial plastic surgery Abdelwahab, M., Kandathil, C. K., Most, S. P., Spataro, E. A. 2019

    Abstract

    Importance: Identifying factors affecting forehead flap neovascularization during nasal reconstruction surgical procedures using quantitative dynamics of fluorescence from indocyanine green angiography may be associated with reduced vascular complications.Objectives: To identify quantifiable forehead flap perfusion measures using indocyanine green angiography during nasal reconstruction procedures and to evaluate clinical factors associated with neovascularization.Design, Setting, and Participants: Retrospective cohort study of 71 patients at a tertiary referral center of Stanford University, Stanford, California, between January 1, 2010, and March 31, 2018, undergoing forehead flap nasal reconstruction surgery with flap perfusion assessed by indocyanine green angiography.Exposures: Indocyanine green angiography was performed intraoperatively to record forehead flap neovascularization during the second stage of nasal reconstruction surgery after temporary clamping of the pedicle.Main Outcomes and Measures: With use of quantifiable data of fluorescence dynamics, flap perfusion in association with a reference point in the cheek after pedicle clamping was assessed by 2 methods: (1) ingress (arterial inflow) and egress (venous outflow) flap-to-cheek ratio and (2) flap-to-cheek perfusion (fluorescence) ratio at 3 time points (midpoint of indocyanine green flap inflow, maximum fluorescence [peak], and midpoint of indocyanine green flap outflow) and their calculated mean. Association of the perfusion measures with patient and procedural factors was performed using linear regression models.Results: Of the 71 patients included in the study, 43 (61%) were men; the mean (SD) age was 71.1 (11.0) years. The mean (SD) flap-to-cheek inflow ratio was 0.48 (0.40), peak fluorescence ratio was 0.59 (0.34), and outflow ratio was 0.88 (0.42). The calculated mean (SD) flap-to-cheek perfusion ratio of these measures was 0.65 (0.35). The mean (SD) flap-to-cheek ingress ratio was 0.54 (0.36) and egress ratio was 0.65 (0.98). With use of a multivariable regression model, the time between stages was positively associated with flap-to-cheek ingress ratio (beta, 0.015; 95% CI, 0.001 to 0.030), and cartilage grafting was negatively associated with flap-to-cheek outflow ratio (beta, -0.240; 95% CI, -0.472 to -0.008).Conclusions and Relevance: The findings suggest that indocyanine green angiography is an effective method to quantify relative neovascularization perfusion of forehead flaps. Future applications may include the use of this technology to aid in early flap division and ensure adequate perfusion among high-risk patients.Level of Evidence: NA.

    View details for PubMedID 30703191

  • Arabic Validation of the Standardized Cosmesis and Health Nasal Outcome Survey (SCHNOS) for Arabic-speaking Rhinoplasty Patients. Plastic and reconstructive surgery Abdelwahab, M., Saltychev, M., Elkholy, N. A., Elsisi, H., Moubayed, S. P., Most, S. P. 2018

    View details for PubMedID 30601313

  • Psychometric Properties of the Standardized Cosmesis and Health Nasal Outcomes Survey: Item Response Theory Analysis JAMA FACIAL PLASTIC SURGERY Saltychev, M., Kandathil, C. K., Abdelwahab, M., Spataro, E. A., Moubayed, S. P., Most, S. P. 2018; 20 (6): 519–21

    View details for PubMedID 30027293