Brian Nuyen

All Publications

• The Social Perception of Microtia and Auricular Reconstruction. The Laryngoscope Nuyen, B. A., Kandathil, C. K., Saltychev, M., Firmin, F., Most, S. P., Truong, M. T. 2020

  Abstract

  To examine the social perception of microtia and quantify the effect of reconstruction on socially perceived attributes.Parental consent was obtained for peri-reconstruction photographs in a patient with unilateral grade 3 microtia without an underlying craniofacial syndrome. With computer simulation, the normal, preoperative microtia, and postoperative reconstruction ear were isolated and blended into the oblique and lateral views of that volunteer's face to isolate ear morphology as a variable against a constant facial baseline. These photographs were embedded into Web-based surveys with visual analogue scales to capture social perception data and then were sourced to general population adults.Survey respondents totaled 631. On average, the face with the microtia ear was perceived to be less friendly (P = .015), less healthy (P = .022), and less successful (P = .005) than the same face with the "normal" ear. There were no statistically significant differences in socially perceived attributes between the face with the normal ear and the face with the reconstructed ear.This is the first study to examine the social perception consequences of microtia and microtia reconstruction in children. These findings may explain the significant psychosocial distress experienced by these patients by exploring the social perception of specific attributes perceived. Lastly, this study may better inform microtia patients and their physicians on the impact of auricular reconstruction on third party's perception of social attributes.N/A Laryngoscope, 2020.

  View details for DOI 10.1002/lary.28619

  View details for PubMedID 32275329

• Social Perception of the Nasal Dorsal Contour in Male Rhinoplasty. JAMA facial plastic surgery Nuyen, B., Kandathil, C. K., Saltychev, M., Most, S. P. 2019

  Abstract

  Importance: The social perception of nasal dorsal modification for male rhinoplasty is poorly understood.Objective: To investigate the association of modifying the male nasal dorsum with the perception of such social attributes as youth, approachability, healthiness, masculinity/femininity, intelligence, successfulness, and leadership.Design, Setting, and Participants: Using computer simulation software, 12 images with varied combinations of the nasal dorsal shape, nasofrontal angle (NFA), and nasolabial angle (NLA) were generated from a photograph of a male volunteer's face in profile. These photographs were then sent to participants at a university clinic who were English-speaking adult internet users who were masked to the purpose of the study, which asked them to value different social attributes regarding the face in the photograph in a 16-question survey. The study was conducted in September 2018 and the data were analyzed thereafter until March 2019.Exposures: Twelve photographs embedded in a 16-question survey.Main Outcomes and Measures: Population proportions of responses and chi2 test and graphical analysis based on 95% confidence intervals.Results: Of 503 respondents (survey provision rate, 100%), 412 (81.9%) were women, 386 (76.7%) were white, 32 (6.4%) were Hispanic or Latinx, 63 (12.5%) were black/African American, 10 (2.0%) were Asian/Pacific Islander, and the median age was 46 years (interquartile range, 32-61 years). The man with ski slope-shaped nose with an NFA of 130° and NLA of 97° was often associated with frequently perceived positive characteristics; specifically, he was judged to be the most attractive (95% CI, 18%-26%; P<.001). Participants also often associated superlative youth (95% CI, 15%-24%; P<.001), approachability (95% CI, 13%-20%; P=.002), and femininity (95% CI, 14%-22%; P<.001) with dorsal contours that did not feature a dorsal hump. The man with a dorsal hump-shaped nose with an NFA of 140° and NLA of 105° was associated by the highest proportion of participants with being the oldest (95% CI, 35%-44%; P<.001), least approachable (95% CI, 27%-35%; P<.001), least attractive (95% CI, 37%-42%; P<.001), and least healthy (95% CI, 26%-34%; P<.001). Subset analyses also revealed statistically significant dorsal contour preferences by observers' age, gender, and race/ethnicity.Conclusions and Relevance: A reduced dorsal slope combined with more acute NFAs and NLAs was associated with positively perceived social attributes. The results may be of interest to rhinoplasty surgeons and their male patients when planning changes to the nasal dorsal contour.Level of Evidence: NA.

  View details for DOI 10.1001/jamafacial.2019.0321

  View details for PubMedID 31219525

• Relationship of Sociodemographic Factors and Outcomes in Functional Rhinoplasty FACIAL PLASTIC SURGERY Nuyen, B., Spataro, E. A., Olds, C., Kandathil, C. K., Most, S. P. 2019; 35 (1): 85?89

  View details for DOI 10.1055/s-0039-1677708

  View details for Web of Science ID 000459145800014

• Comparison of Primary and Secondary Anterior Septal Reconstruction: A Cohort Study FACIAL PLASTIC SURGERY Spataro, E., Olds, C., Nuyen, B., Kandathil, C. K., Most, S. P. 2019; 35 (1): 65?67

  View details for DOI 10.1055/s-0038-1667154

  View details for Web of Science ID 000459145800010

• Relationship of Sociodemographic Factors and Outcomes in Functional Rhinoplasty. Facial plastic surgery : FPS Nuyen, B., Spataro, E. A., Olds, C., Kandathil, C. K., Most, S. P. 2019

  Abstract

  The objective of this article was to compare the effect of such sociodemographic factors as gender, age, marital status, employment status, race, and income on short- and long-term rhinoplasty outcomes using a validated disease-specific instrument-Nasal Obstruction Symptom Evaluation (NOSE) scale, as well as complication and revision rates. Patients who underwent a functional (+/- cosmetic) rhinoplasty with the senior author between January, 1 2012, and September 9, 2017, and had both a preoperative and at least one postoperative NOSE score, were included in the study. Sociodemographic variables of binary gender, age, marital status, employment status, race, and income based on zip code were collected. The primary outcomes were the differences between the preoperative and postoperative NOSE scores with short-term (less than 3 months) and longer-term (greater than 3 months) follow-up. Secondary outcomes were general complications and specifically revision surgery. Standard descriptive statistics, as well as univariable linear and logistic regressions, were conducted with each outcome measure. A total of 341 patients were included in this study. No individual patient-level variables were found to significantly affect the short- or longer-term average change in NOSE scores, although older age trended toward significance in longer-term average change in NOSE scores (p=0.07). No factors significantly affected the rate of complications or revision surgery in this cohort. The authors found improvement in NOSE scores after rhinoplasty was not related to factors of age, gender, race, employment status, income, and marital status. This cohort also did not demonstrate differential rates in complications or revision surgery based on sociodemographic variables.

  View details for PubMedID 30654390

• Evaluation of Antibiotic Prophylaxis in Rhinoplasty A Systematic Review and Meta-analysis JAMA FACIAL PLASTIC SURGERY Nuyen, B., Kandathil, C. K., Laimi, K., Rudy, S. F., Most, S. P., Saltychev, M. 2019; 21 (1): 12?17

  View details for DOI 10.1001/jamafacial.2018.1187

  View details for Web of Science ID 000456152200004

• Comparison of Primary and Secondary Anterior Septal Reconstruction: A Cohort Study. Facial plastic surgery : FPS Spataro, E., Olds, C., Nuyen, B., Kandathil, C. K., Most, S. P. 2018

  Abstract

  This article compares outcomes in patients presenting for either primary or secondary (revision) anterior septal reconstruction (ASR) to treat caudal septal deviation. Patients undergoing ASR by senior author (S. P. M.) between January 1, 2012 and September 1, 2017, with both preoperative and postoperative Nasal Obstruction Symptom Evaluation (NOSE) scores documented in the chart were included. Data were compared between patients undergoing primary and secondary ASR by univariable and multivariable logistic regression. A total of 199 patients were included in this study; 128 (64%) underwent primary ASR and 71 (36%) underwent secondary ASR. After multivariable analysis, a greater ratio of females and autologous rib graft harvest in the secondary compared with primary ASR, and decreased odds of inferior turbinate reduction in the secondary group was found. There was no significant difference in NOSE scores between the primary and secondary group, and there were very few complications or revision surgeries. While outcomes are similar between primary and secondary (revision) ASR to treat caudal septal deviation, there was a significantly higher rate of autologous rib harvest, highlighting the importance of addressing deviations of the caudal septum at the primary procedure to reduce morbidity related to rib graft harvest and revision surgery.

  View details for PubMedID 30566990

• Outcomes in Head and Neck Resections That Require Multiple-Flap Reconstructions A Systematic Review JAMA OTOLARYNGOLOGY-HEAD & NECK SURGERY Gao, R. W., Nuyen, B. A., Divi, V., Sirjani, D., Rosenthal, E. L. 2018; 144 (8): 746?52

  View details for DOI 10.1001/jamaoto.2018.0835

  View details for Web of Science ID 000441939900018

• Dysphagia and Pharyngeal Obstruction in a Nonsmoker JAMA OTOLARYNGOLOGY-HEAD & NECK SURGERY Nuyen, B. A., Berry, G., Megwalu, U. 2018; 144 (2): 171?72

  View details for PubMedID 29222562

• Outcomes in Head and Neck Resections That Require Multiple-Flap Reconstructions: A Systematic Review. JAMA otolaryngology-- head & neck surgery Gao, R. W., Nuyen, B. A., Divi, V., Sirjani, D., Rosenthal, E. L. 2018

  Abstract

  Complex head and neck cancer defects that require multiflap reconstructions are technically feasible, but the morbidity and patient outcomes of such large-scale head and neck operations have yet to be systematically reviewed.To systematically review existing literature to characterize the outcomes of large-scale head and neck resections that require multiple-flap reconstructions (defined as defects that require >1 flap [free, pedicled, or combinations thereof]).Two authors independently searched PubMed, Embase, and the Cochrane Review databases for English-only texts published on any date. Included studies examined patients who underwent complex head and neck surgical resections that required multiple simultaneous flaps for reconstruction. Included studies reported results on at least one of the following outcomes: functional and aesthetic, patient survival, or cost (estimated by operating room time, length of stay, and/or complications). Methodological Index for Non-Randomized Studies (MINORS) criteria for bias and modified Oxford Centre for Evidence-Based Medicine recommendations were used to assess study quality.Twenty-four studies published from November 1, 1992, through September 1, 2016, met the final inclusion criteria, with a total of 487 patients (370 male [79.4%]; mean [SD] weighted age, 55.1 [4.1] years). Sixty-two of 250 patients (24.8%) were partially or fully dependent on feeding tubes at follow-up. Twenty-two of 75 patients (29.3%) had poor postoperative oral competence, causing moderate to severe drooling. Nineteen of 108 patients (17.6%) had unintelligible speech. Nine of 64 patients (14.1%) were unsatisfied with their aesthetic outcome. The mean (SD) reported survival was 2.36?(1.39) years. The mean (SD) length of stay was 24.5 (12.2) days in 219 patients. Eighty-eight minor complications (eg, partial flap necrosis, donor site complications) and 185 major complications (eg, surgical reexplorations, flap loss, or cardiopulmonary complications) were reported in 380 patients. Mean (SD) MINORS scores were 16.0 (3.2) for comparison studies and 11.4 (1.8) for noncomparison studies.Because of limited patient life expectancies, modest functional and aesthetic outcomes, and significant associated costs, surgeons should weigh the curative potential and palliative benefits for individual patients with a comprehensive view of the overall outcomes of extensive head and neck resections and reconstructions. Realistic expectations should be emphasized during preoperative discussions with patients.

  View details for PubMedID 29978196

• Evaluation of Antibiotic Prophylaxis in Rhinoplasty: A Systematic Review and Meta-analysis. JAMA facial plastic surgery Nuyen, B., Kandathil, C. K., Laimi, K., Rudy, S. F., Most, S. P., Saltychev, M. 2018

  Abstract

  Although antibiotic prophylaxis following rhinoplasty is widespread, the evidence on antibiotic prophylaxis effectiveness and the superiority of particular administration regimens is controversial. To date, a meta-analysis on the topic has not been performed.To systematically review the association between use of preventive antibiotics and postoperative complications in patients undergoing rhinoplasty and quantify the review through meta-analysis.MEDLINE, Embase, CINAHL, Central (Cochrane Controlled Register of Trials), Scopus, and Web of Science were searched with prospectively designed search phrases on February 16, 2018. All databases were searched from database inception. Key search terms included rhinoplasty, nasal valve repair, and antibacterial agent.Randomized clinical trials (RCTs) with adults (?18 years) undergoing rhinoplasty and including systemic antibiotic medications administered in the absence of other reasons for use of an antibiotic (eg, localized or systemic infection), without restrictions on language or the time of publication, were included in the study. Interventions of interest were classified into 3 types: (1) single-dose systemic antibiotic administered within 24 hours before the first incision, (2) multidose systemic antibiotic treatment started within 24 hours before the first incision and continuing after the operation, and (3) systemic antibiotic therapy (single dose or multidose) started within 24 hours after the first incision. The following comparisons were made: for the interventions of type 1, no antibiotic; for the interventions of types 2 or 3, no antibiotic or an intervention of type 1.Data extraction was compliant with PRISMA guidelines and Cochrane Handbook for Systematic Reviews of Interventions. Two independent reviewers assessed the relevance of the remaining records at abstract and full-text stages. Meta-analysis pooled with random-effects model.Difference in infectious complication rate between groups.A total of 262 records were identified; of these, only 5 RCTs fulfilled predetermined population, intervention, comparison, and outcome criteria. The pooled study sample consisted of 589 participants. No significant differences in outcome of preventive antibiotic therapy given either preoperatively or postoperatively were found, with a pooled risk ratio of 0.92 (95% CI, 0.35-2.43; P?=?.86).This study appears to be the first Cochrane-protocol systematic review and meta-analysis investigating preventive antibiotics in rhinoplasty. This study's results suggest that pooled evidence from the 5 RCTs does not support the use of preventive antibiotic therapy in rhinoplasty.1.

  View details for PubMedID 30489601

• Survival Outcomes in Oropharyngeal Small-Cell Carcinoma Compared With Squamous Cell Carcinoma: A Population-based Study. JAMA otolaryngology-- head & neck surgery Megwalu, U. C., Nuyen, B. A. 2017

  View details for DOI 10.1001/jamaoto.2017.0025

  View details for PubMedID 28301632