Anthony P. Sclafani

Determining when to perform combined eyelid and brow surgery for functional deficits remains subjective, despite measurable visual field (VF) impairment in affected patients. We sought to identify VF patterns associated with selection for combined eyelid–brow surgery. Retrospective cohort study. Patients with preoperative Humphrey Visual Field testing undergoing isolated eyelid surgery or combined eyelid–brow surgery for VF deficits were matched 1:2 by demographic and surgical characteristics. VF patterns were analyzed using generalized estimating equations. Among 171 patients, the mid-temporal VF zone was the only independent predictor of combined-repair selection on multivariable analysis (OR = 1.38 per dot missed, 95% CI: 1.06–1.81, p = 0.018). Combined repair was also independently associated with lower odds of need for revision surgery (OR = 0.31, 95% CI: 0.10–0.97, p = 0.044). The mid-temporal VF may serve as a marker of brow-related visual obstruction, helping guide selection for combined eyelid–brow surgery in functional blepharoptosis.

Objectives: Facial retaining ligaments (RLs) are well‐characterized for their role in soft‐tissue support and in rhytidectomy. This study investigates whether RLs also act as anatomical barriers that influence the spread of basal cell carcinoma (BCC). We hypothesized that the dermal insertion of RLs impedes the dermal spread pattern of BCCs, specifically causing them to grow along the RL. Methods: We conducted a retrospective cohort study of 163 patients who underwent Mohs micrographic surgery (MMS) for BCC. Post‐MMS defects were used as a proxy for the BCC size and shape. The defects were categorized as “near,” “far,” or “crossing” based on their proximity to the RL. Defect symmetry was quantified using the perpendicular‐to‐parallel ratio of the defect relative to the RL. A relative proximity ratio (RPR) was used for continuous linear regression analysis. Results: Analysis revealed significant defect asymmetry in lesions near RLs. The “near” group demonstrated a growth pattern parallel to the RL (ratio of 0.73) compared to the “far” group (ratio of 0.98, p < 0.0001). Linear regression confirmed that RPR was a predictor of tumor growth parallel to the RL ( B = 0.099, p < 0.0001). Only 5.5% of lesions breached the RL. Conclusion: RLs correlate with an eccentric, oblong BCC growth pattern parallel to the direction of the ligament. Recognizing lesions within these zones may improve preoperative counseling and reconstructive planning. Level of Evidence: III.

Objective: To evaluate the feasibility, process adherence, and clinical outcomes associated with department‐wide implementation of simplified venous thromboembolism (VTE) risk assessment models (RAM) for inpatient and ambulatory otolaryngology surgical patients. Methods: A mixed prospective and retrospective quality improvement initiative was conducted across two tertiary academic medical centers, including all scheduled adult otolaryngology surgical procedures from January 3, 2025, to November 20, 2025. Inpatient admissions were risk stratified using the COBRA score and ambulatory procedures using the Pannucci‐NSQIP score; inpatient risk stratifications were shared with surgeons. High VTE risk was defined as COBRA ≥ 4 for inpatients and Pannucci‐NSQIP ≥ 4 for ambulatory cases. Pharmacologic prophylaxis beginning on postoperative Day 1 was recommended for high‐risk inpatients. Process measures included adherence to prophylaxis guidance and documented rationales for deviation. Outcome measures included 30‐day VTE and hemorrhage events. Results: A total of 3854 consecutive adult procedures were included (608 inpatient, 3246 ambulatory). 65% of inpatients and 14% of ambulatory cases were classified as high risk. Among high‐risk inpatients with length of stay ≥ 2 days, VTE occurred in 2.5% of patients receiving chemoprophylaxis on POD1 compared with 4.7% of those not receiving POD1 prophylaxis. No VTE events occurred in low‐risk inpatients, high‐risk inpatients discharged on POD1, or high‐risk ambulatory patients. Hemorrhage rates were similar across prophylaxis groups (3.2%–4.1%). Overall VTE rates were 1.8% for inpatients and 0.1% for ambulatory procedures. Conclusion: The simplified COBRA and Pannucci‐NSQIP RAMs provide a feasible and potentially scalable framework for integrating VTE risk stratification into routine otolaryngology practice. Level of Evidence: 3.