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Background: Hirsch-index (or h-index ) is a bibliometric measure calculated for researchers based on number of publications and their citations. This study examined the h-index of board-certified plastic surgeons in Saudi Arabia and the different factors that may influence it. Method: In this cross-sectional study, an electronic questionnaire was sent to 156 board-certified plastic surgeons practicing in Saudi Arabia. Using their names, we conducted an online search on Scopus, Semantic scholar, and Google scholar to calculate their h-index . Bivariate and multiple regression analyses were conducted to determine the relationship of those factors with the index. Results: A total of 84 surgeons participated in this study, of whom 83.3% were men. Our sample scored a mean index of 1.7 and published a mean of 5 articles. More publications and a higher academic rank predicted a higher h-index , ( β = 0.79, P < 0.001) and ( β = 0.14, P 0.017), respectively. On the other end of the spectrum, the country of residency training ( P 0.33), the year of training completion ( P 0.95), attaining fellowship training ( P 0.95), the number of fellowships ( P 0.20), interest in research ( P 0.74), working in an academic hospital ( P 0.44), or attaining a higher degree ( P 0.61) were not significant independent predictors of the index. Conclusions: More publications and a higher rank predicted increased academic productivity among the plastic surgeons in Saudi Arabia. Despite its limitations, h-index is a useful measure that can be considered in promotions and applications to prestigious plastic surgery centers in adjunct to other factors.

Objective: To demonstrate anatomic relationships pertinent to the endoscopic multiport approach to the infratemporal fossa (ITF). Discuss advantages and limitations of each individual approach.Study Design: Cadaveric study.Methods: Endoscopic and endoscopic-assisted endonasal transpterygoid, sublabial transmaxillary, endoscopic transorbital, and endoscopic transoral approaches to accessing the ITF were completed in five silicone-injected fresh cadaveric specimens (10 sides) with the assistance of 0, 30, and 45 0 rods-lens endoscopes. Image guidance was used to confirm and document the anatomical relationships encountered in each approach.Results: The endonasal endoscopic transpterygoid approach provides better visualization and more direct exposure to median structures. Endoscopic-assisted sublabial transmaxillary approach enhances the field of exposure, angle of attack, and ease of instrumentation to the lateral part of the ITF. Endoscopic-assisted transorbital approach via the inferior orbital fissure provided cephalic and anterior access. Endoscopic-assisted transoral approach complements the access to lesions extending inferior to the hard palate or far lateral to the mandibular condyle.Conclusions: A combination of minimal access infratemporal approaches can provide adequate exposure of the entire ITF while avoiding some of the morbidity associated with open approaches.

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BACKGROUND AND IMPORTANCEUnilateral inferior hypophyseal artery (IHA) sacrifice is routinely performed during endoscopic endonasal transcavernous interdural posterior clinoidectomy. However, unilateral IHA sacrifice presents the risk of temporary postoperative diabetes insipidus. We present a case demonstrating the feasibility of endoscopic endonasal transcavernous posterior clinoidectomy without IHA sacrifice.CLINICAL PRESENTATION:A 62-year-old man presented with progressive weakness of his left oculomotor and abducens nerves. MRI of the brain revealed a small lesion suspicious for hemangioma in the posterior compartment of the left cavernous sinus. Following an endoscopic endonasal transcavernous approach using the interdural peeling technique, an IHA-sparing posterior clinoidectomy was performed to provide access to the tumor in the posterior cavernous sinus. After complete resection, the patient's symptoms improved and a diagnosis of cavernous sinus hemangioma was confirmed by histopathology.CONCLUSIONUnilateral IHA preservation may be performed safely when performing a transcavernous interdural posterior clinoidectomy. IHA preservation can be readily achieved if the artery is redundant, the lesion is small and located in the posterior cavernous sinus, and there is a short posterior clinoid, ultimately avoiding the risk of transient postoperative diabetes insipidus.