Background: Chin implantation is a commonly performed facial plastic surgery procedure. There are 2 approaches to this procedure: submental and transoral. There is no consensus as to which is the best and safest approach. Objective: The objective of this review is to ascertain the risks and benefits of using an intraoral versus submental approach for chin implantation. Methods: A systematic review of all articles published in MEDLINE, Embase, Cochrane Library, and Google Scholar was performed from 1966 to 2020. Results: A total of 1410 articles were reviewed and 38 were chosen for the review based on predetermined selection criteria. Total complication rates in the transoral group ranged from 0% to 14.7%, whereas total complication rates in the submental group ranged from 0% to 15%. No clear difference in the rates of any specific complication was found between the 2 groups. Conclusion: There is no demonstrated difference in complication rates between the 2 approaches to chin implantation. Individual patient assessment and surgeon preference remain the most important determinants of surgical approach.

ObjectiveTo systematically review the evidence to evaluate oncologic outcomes for patients with early stage buccal squamous cell carcinoma treated with surgery versus surgery and adjuvant radiation therapy.Data sourcesOvid MedLine, EMBASE, Google Scholar, PubMed.Review methodsThe primary purpose was to perform a systematic review to determine the published literature comparing oncologic outcomes of patients with early stage (Stages I&II) buccal mucosal squamous cell carcinoma, treated with surgical resection alone versus surgery plus adjuvant radiation therapy. Oncologic outcomes of interest were overall survival, locoregional recurrence, and disease specific survival. The secondary aim was to perform a meta-analysis to quantitively compare and summarize the data on oncologic outcomes between treatments.ResultsA total of 1457 studies were screened and five retrospective cohort studies (n = 733 patients) were eligible for quantitative analysis. Overall study quality was moderate to high. Pooled relative risk ratios using a fixed effects model did not reveal any statistically significant difference in overall survival (p = 0.70) or locoregional recurrence rates (p = 0.72) in Stage I and II disease.ConclusionsThese results demonstrate there is sparse evidence comparing oncologic outcomes for early stage buccal squamous cell carcinoma treated with surgery alone versus surgery and adjuvant radiation therapy. Our findings based on a limited body of evidence suggest no obvious benefit in the addition of adjuvant radiation therapy, however robust randomized trials are warranted to reach firm conclusions.

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Introduction Kussmaul's sign, the absence of a drop in jugular venous pressure or a paradoxical increase in jugular venous pressure on inspiration, can be evaluated as an indicator of right ventricular myocardial infarction. Right ventricular myocardial infarction complicates 30-50% of inferior myocardial infarctions and is associated with increased mortality when compared to inferior myocardial infarction without right ventricular involvement. Early recognition allows maintenance of preload. We reviewed the diagnostic test accuracy studies for Kussmaul's sign for diagnosis of right ventricular myocardial infarction. Methods We conducted a librarian-assisted search using PubMed, Medline, Embase, and the Cochrane database from 1965 to October 2019. Only English language restriction was imposed. We identified studies that assessed patients presenting to a hospital with a suspected myocardial infarction who underwent an assessment for Kussmaul's sign and a diagnostic test for right ventricular myocardial infarction. Four independent reviewers extracted data from relevant studies. Study quality was assessed using the QUADAS-2 tool. A bivariate random effects meta-analysis was performed. Results We identified 122 studies; ten were selected for full review. Eight studies had comparable populations with a total of 469 consecutive patients admitted with acute inferior myocardial infarction and were included in the analysis. Prevalence of right ventricular myocardial infarction was 36% (confidence interval [CI] 95% 31.8-40.5). All reference standards were combined. Kussmaul's sign had a sensitivity of 62.5% (44.6, 77.5), specificity 90% (73.0, 96.8), negative likelihood ratio (LR) 0.2 (0.1-0.8) and positive LR 5.8 (2.5, 13.3). ConclusionIn the presence of acute myocardial infarction, Kussmaul's sign is specific for acute right ventricular myocardial infarction and may serve as an important clinical sign of right ventricular dysfunction requiring preload preserving management.

Introduction: Kussmaul's sign, the absence of a drop in JVP or a paradoxical increase in JVP on inspiration, can be elicited clinically as an indicator of right ventricular myocardial infarction (RVMI). RVMI poses unique diagnostic and management challenges. It complicates 30-50% of inferior MI and is associated with increased mortality when compared to inferior MI without RV involvement. Early recognition allows maintenance of preload by avoiding use of nitroglycerin, diuretic and narcotic medication, and treatment with fluids and vasopressors. We reviewed the evidence for Kussmaul's sign for diagnosis of RVMI. Methods: We conducted a librarian assisted search using PubMed, Medline, Embase, the Cochrane database, relevant conference abstracts from 1965 to October 2019. No restrictions for language or study type were imposed. All studies with patients presenting with acute myocardial infarction were reviewed. Two independent reviewers extracted data from relevant studies. Studies were combined when similar study populations were present. Study quality was assessed using the QUADAS-2 tool. Random effects meta-analysis was performed using metaprop in Stata for the 3 reference standards combined. Subset analysis for each of the 3 reference standards was completed. Results: We identified 122 studies: 10 were selected for full text review. Eight studies had comparable populations with a total of 469 consecutive patients admitted to the coronary care unit with acute inferior myocardial infarction and were included in the analysis. Prevalence of RVMI was 36% (CI 95% 31.8–40.5). References standards for the diagnosis of RVMI included echocardiography, 16 lead ECG and haemodynamic studies. A gold standard for diagnosis of RVMI is lacking and thus the reference standards were combined. Kussmaul's sign had a sensitivity of 69.3% (CI 95% 46.3 - 85.5, I2- 86.7%), specificity of 95.1% (CI 95% 75.6 - 99.2, I2- 89.3%) and LR + 14.1 (CI 95% 2.6-73.2). Subset analysis of echocardiography, ECG and haemodynamic studies revealed sensitivity of 45%, 77% and 82% (I2- 62%, N/A, 70%) respectively and specificity of 92%, 84% and 92% (I2- 86%, N/A, 86%). Conclusion: Kussmaul's sign is specific for acute right ventricular myocardial infarction and may serve as an important clinical sign of right ventricular dysfunction requiring preload preserving management.