Multimodal optical and ultrasound imaging (USI) provides complementary diagnostic insights. However, because conventional USI uses opaque ultrasound (US) transducers, integrating these two modalities results in a bulky and complicated handheld probe in which neither modality performs efficiently. Although transparent ultrasound transducers (TUTs) solve these issues by acting as optical windows, enabling the seamless combination of light and US beams, single-element TUTs are not common in clinical environments. Here, we demonstrate a clinical triple-modal US, photoacoustic, and fluorescence imaging system, seamlessly integrated via a linear TUT-array. This system, with 64 channels and a 7-MHz center frequency achieves 72.7% optical transparency in the near infrared region. The system’s handheld opto-US probe coaxially integrates the TUT-array with a miniaturized camera and an optical fiber in a small form factor. The triple-modal imaging system effectively visualizes tissue structures, vasculatures, and lymphatics in real time in live animals, healthy volunteers, and lymphedema patients. By accurately mapping superficial tissues, blood vessels, and lymphatic vessels, we use the prototype system to successfully guide lymphovenous anastomosis microsurgery. These preclinical demonstrations illustrate the potential use of our system in various clinical procedures requiring microsurgical guidance, paving the way for future advances in multimodal imaging.

Background: Deepening of the nasolabial fold with reduced malar highlight caused by sagging of the midface is one of the most important characteristics of facial aging. This report describes the use of 18-G polydioxanone (PDO) cog threads to improve midface soft tissue sagging and achieve satisfactory results through a minimally invasive procedure. Methods: In total, 64 patients (all women; age, 33–60 years) underwent a midface thread lift from January 2017 to January 2018. After a stab incision was made through an 18-G needle over the lateral orbital rim, three 18-G precannulated PDO cog threads were inserted, targeting the deep medial fat pad and inner layer of the superficial muscular aponeurotic system. The threads were anchored to the periosteum of the lateral orbit, suspending the soft tissue to a more superior direction. Surgical results were evaluated subjectively (patient satisfaction ratings) and objectively (blinded physician ratings based on changes in the vertical position of the malar highlight). Results: No major complications (postoperative hematoma, infection, or temporary sensory/motor decreases) were observed. The mean procedural time was 15 minutes, and all patients underwent local anesthesia. Patient satisfaction was the highest at 1 month postoperatively (mean, 4.7/5.0), decreasing at 1 year postoperatively (2.8/5.0). The scores on the objective assessment followed the same trend (4.5/5.0 at 1 month; 3.1/5.0 at 1 year). Conclusion: Using PDO cog threads for midface lifting is simpler, quicker, and less invasive than using conventional surgical methods, and this method simultaneously achieves satisfactory results for at least 6 months.

Background: Facial trauma, including panfacial fractures caused by high-impact trauma, is increasingly frequent in elderly patients. The purpose of this study was to investigate the effects of the particularly serious and challenging panfacial fractures on elderly adults. Methods: The authors retrospectively reviewed the files of all patients who were operated for panfacial fractures at our institution from December 2006 to December 2018. The definition of a panfacial fracture was a concurrent fracture in 2 or more locations, including nasoethmoid, frontozygomaticomaxillary, Le Fort I and II, and mandibular fractures. The authors reviewed in-hospital medical records to collect data on the medical history, cause of injury, fracture location, accompanying surgery, postoperative complications, duration of hospital stay, laboratory results, radiographic studies, and computed tomography scans. Results: A total of 454 patients were enrolled. Among them, 57 (13%) were 60 years old. Compared with younger patients, those aged older than 60 years were more likely to have underlying diseases including diabetes, hypertension, and antiplatelet, and showed a significantly higher proportion of brain hemorrhage, internal organ contusion, surgical site infection, and hematoma after surgery. Conclusion: The authors have analyzed the largest number of panfacial fractures in an elderly population so far. The pattern of injury and sequelae of severe facial trauma in elderly patients may be more serious, and the postoperative course more prone to complications than in younger patients. Therefore, more delicate treatment and a high degree of suspicion are needed.