Myxoma arising from the parotid gland

Myxomas can be divided into two groups: those derived from the facial skeleton, and those derived from external skeletal soft tissue. Soft tissue myxomas of the head and neck are uncommon, with fewer than 50 cases reported. In any form and location, myxoma of parotid gland is rare. We report a case of myxoma arising from the left superficial lobe of the parotid gland with good long-term follow-up after superficial parotidectomy with tumor excision. A 49-year-old man was referred to our department of plastic and reconstructive surgery with a painless palpable mass that had persisted in the left mandible angle region for 2 years. Excision of the facial mass and superficial parotidectomy with facial nerve preservation were performed. The biopsy result was myxoma. Long-term follow-up for 22 months showed favorable results without evidence of recurrence but with temporary facial nerve weakness right after the surgery. Myxoma should be considered as a differential diagnosis when benign tumor of the parotid gland is being considered.

A useful additional medial subbrow approach for the treatment of medial orbital wall fracture with subciliary technique

BACKGROUND: To date, a variety of surgical approaches have been used to reconstruct the medial orbital wall fracture. Still however, there is still a controversy as to their applicability because of postoperative scars, injury of anatomical structures and limited visual fields. The purpose of this study was to introduce a useful additional medial subbrow approach for better reduction and securement more accurate implant pocket of medial orbital wall fracture with the subciliary technique. METHODS: We had performed our technique for a total of 14 patients with medial orbital wall fracture at our medical institution between January 2016 and July 2017. All fractures were operated through subciliary technique combined with the additional medial subbrow approach. They underwent subciliary approach accompanied by medial wall dissection using a Louisville elevator through the slit incision of the medial subbrow procedure. This facilitated visualization of the medial wall fracture site and helped to ensure a more accurate pocket for implant insertion. RESULTS: Postoperative outcomes showed sufficient coverage without displacement. Twelve cases of preoperative diplopia improved to two cases of postoperative diplopia. More than 2 mm enophthalmos was 14 cases preoperatively, improving to 0 case postoperatively. Without damage such as major vessels or extraocular muscles, enophthalmos was corrected and there was no restriction of eyeball motion. CONCLUSION: Our ancillary procedure was useful in dissecting the medial wall, and it was a safe method as to cause no significant complications in our clinical series. Also, there is an only nonvisible postoperative scar. Therefore, it is a recommendable surgical modality for medial orbital wall fracture.

Adverse Hemodynamic Effects of Nefopam in Patients Undergoing Plastic and Aesthetic Surgery: A Single-Center Retrospective Study

BACKGROUND: Nefopam is used to improve postoperative hypothermia in the field of plastic and aesthetic surgery. However, there is a paucity of data about its adverse hemodynamic effects and safety. We therefore assessed its adverse hemodynamic effects in patients undergoing plastic and aesthetic surgery. METHODS: We conducted a single-center retrospective study of 148 patients, in whom we measured hemodynamic parameters using sphygmomanometry (systolic blood pressure [SBP], diastolic blood pressure [DBP], arterial blood pressure [ABP], and heart rate [HR]). Moreover, we also assessed myocardial oxygen demand using the rate pressure product (RPP). RESULTS: The patients included 96 men and 52 women, with a mean age of 34.7±8.5 years. There were no significant differences in SBP, DBP, ABP, HR, or RPP before and after nefopam administration (P>0.05). However, a significant difference was found in the number of the patients with an HR of >100 beats per minute or with an RPP of >12 U before and after nefopam administration (P=0.001). CONCLUSIONS: Surgeons should consider the possibility of tachycardia and increased blood pressure in the management of postoperative hypothermia in patients with cardiac arrhythmia, ischemic heart disease, or essential hypertension. Nonetheless, further prospective, large-scale, multi-center, randomized, controlled studies are warranted to confirm our results.

Factors Associated with a Prolonged Length of Hospital Stay in Patients with Diabetic Foot: A Single-Center Retrospective Study

BACKGROUND: We conducted this study to identify factors that may prolong the length of the hospital stay (LHS) in patients with diabetic foot (DF) in a single-institution setting. METHODS: In this single-center retrospective study, we evaluated a total of 164 patients with DF, and conducted an intergroup comparison of their baseline demographic and clinical characteristics, including sex, age, duration of diabetes, smoking status, body mass index, underlying comorbidities (e.g., hypertension or diabetic nephropathy), wound characteristics, type of surgery, the total medical cost, white blood cell (WBC) count, C-reactive protein (CRP) levels, erythrocyte sedimentation rate, and albumin, protein, glycated hemoglobin, and 7-day mean blood glucose (BG) levels. RESULTS: Pearson correlation analysis showed that an LHS of >5 weeks had a significant positive correlation with the severity of the wound (r=0.647), WBC count (r=0.571), CRP levels (r=0.390), DN (r=0.020), and 7-day mean BG levels (r=0.120) (P 5 weeks had a significant positive correlation with the severity of the wound (odds ratio [OR]=3.297; 95% confidence interval [CI], 1.324–10.483; P=0.020), WBC count (OR=1.423; 95% CI, 0.046–0.356; P=0.000), CRP levels (OR=1.079; 95% CI, 1.015–1.147; P=0.014), albumin levels (OR=0.263; 95% CI, 0.113–3.673; P=0.007), and 7-day mean BG levels (OR=1.018; 95% CI, 1.001–1.035; P=0.020). CONCLUSIONS: Surgeons should consider the factors associated with a prolonged LHS in the early management of patients with DF. Moreover, this should also be accompanied by a multidisciplinary approach to reducing the LHS.

Fibroareolar Tissue Wrap-Around Flap for Tip Plasty in Rhinoplasty in Asians

BACKGROUND: Asians tend to have bulbous, wide, and thick-skinned noses, leading to limitations in tip augmentation. Therefore, following various tip plasty procedures, the use of a dermal graft or a fat graft may be considered for additional augmentation. For definition of the Asian nasal tip, thick fibroareolar and subcutaneous tissues are resected. However, these previously discarded tissues may be a useful material for tip augmentation. Hence, we would like to propose the fibroareolar tissue wrap-around flap as an adjuvant augmentation procedure. METHODS: Tip plasty procedures, including various suture techniques and cartilage grafts, were performed. Near the scroll area, the fibroareolar tissues above both lower lateral cartilages were dissected in the supraperichondrial plane. Caudally based fibroareolar tissue flaps were elevated around the nasal tip. The tip portion of the alar cartilage framework was covered with the flaps. The flaps were fixed to the middle or medial crura of the lower lateral cartilages. RESULTS: A total of 13 patients underwent the fibroareolar tissue wrap-around flap procedure for nasal tip plasty. No complaints were reported at follow-up by 12 patients. No cases of major infection, hematoma, or vascular compromise occurred. CONCLUSIONS: The fibroareolar tissue wrap-around flap offers several advantages for tip plasty in Asians, including additional tip projection, soft tissue volume reduction, redraping, and a naturally soft nasal tip, and likely aids in preserving the volume of other cartilage grafts. Therefore, this fibroareolar tissue wrap-around flap is worth considering as a useful adjuvant option for tip plasty in rhinoplasty in Asian patients.

Nipple Reconstruction Using a Scar-Based Modified C-V Flap

BACKGROUND: Numerous techniques have emerged for nipple-areolar complex (NAC) over the years. Scar-based modified C-V flap technique is a new method for creating NAC, surgeons can accomplish nipple reconstruction and scar revision simultaneously. This article described the modified C-V flap technique for nipple reconstruction. This modified method is simple and reliable with good outcome. METHODS: To evaluate the effectiveness of our technique, we reviewed 21 patients who underwent nipple reconstruction using the scar-based modified C-V flap technique. For scar-based modified C-V flap, a C flap was designed to match the contralateral nipple in width while a V flap including scar after mastectomy was designed. The flap pedicle was centrally located. The V flap was then fixed surrounding the central part with a proper shape and volume considering the distal part of the flap that had poor vascularization. RESULTS: The average age of the 21 patients was 48.4 years. The average length of follow up was 7.4 months. Complication rate was 19.0% including projection loss in 2 cases, tip necrosis in 1 case, postoperative infection in 1 case, and wound dehiscence in 1 case. Re-operations were performed for 2 cases of projection loss, 1 case of partial flap necrosis, and 1 case of wound dehiscence. CONCLUSIONS: The scar-based modified C-V flap technique is a simple and reliable method for nipple reconstruction with aesthetic outcome. Patients who have undergone this surgical technique tend to have great satisfaction with the results.

The Efficacy of Bioabsorbable Mesh in Craniofacial Trauma Surgery

BACKGROUND: The ultimate goal of craniofacial reconstructive surgery is to achieve the most complete restoration of facial functions. A bioabsorbable fixation system which does not need secondary operation for implant removal has been developed in the last decade. The purpose of this study is to share the experience of authors and to demonstrate the efficacy of bioabsorbable mesh in a variety of craniofacial trauma operations. METHODS: Between October 2008 and February 2015, bioabsorbable meshes were used to reconstruct various types of craniofacial bone fractures in 611 patients. Any displaced bone fragments were detached from the fracture site and fixed to the mesh. The resulting bone-mesh complex was designed and molded into an appropriate shape by the immersion in warm saline. The mesh was molded once again under simultaneous warm saline irrigation and suction. RESULTS: In all patients, contour deformities were restored completely, and bone segments were fixed properly. The authors found that the bioabsorbable mesh provided rigid fixation without any evidence of integrity loss on postoperative computed tomography scans. CONCLUSION: Because bioabsorbable meshes are more flexible than bioabsorbable plates, they can be molded and could easily reconstruct the facial bone in three dimensions. Additionally, it is easy to attach bone fragments to the mesh. Bioabsorbable mesh and screws is effective and can be easily applied for fixation in various craniofacial trauma reconstructive scenarios.

Characteristics of Inpatients with Distal Phalangeal Injuries: Predictors of Long Term Hospitalization

PURPOSE: Distal phalangeal injury is one of the most common hand injuries. Distal phalanx is very small area, but in the patients who injure in this area, hospiltalization is often necessary. Some of the patients need the long hospital stay for three or more weeks. Assessment of trends of the injuries may help in enhancing patient education and designing the management plan. We analyzed the characteristics of inpatients with distal phalangeal injuries and the predictors of long-term hospitalization. METHODS: A retrospective review of inpatients with distal phalangeal injuries was performed consecutively from June 2008 to July 2015. Patient demographics and outcomes were compared with chi-squared analysis and Student's t-test. Using multivariate regression analysis, predictors of long-term hospitalization were identified. RESULTS: Five hundred and twelve patients were investigated. The rate of long-term hospitalization was 21.9%. Multivariate logistic regression model revealed that diabetes mellitus, operation time of three or more hours, amputation injury, injury sustained at an industrial place, complication, distant flaps, and replantation were significant risk factors of long-term hospitalization. CONCLUSION: This analysis will help evaluate the possibility of long-term hospitalization and manage patients with distal phalangeal injuries.

Compound Type Odontoma at Maxilla

No abstract available.

Delayed Methicillin-Resistant Staphylococcus aureus Infection on a Mandibular Angle Fracture with Absorbable Plates

No abstract available.

A Huge Neurofibroma of the Lower Back Invading the Spinal Cavity

No abstract available.

The Cheapest and Easiest Way to Make Platelet-rich Plasma Preparation

BACKGROUND: Platelet-rich plasma (PRP) has been advocated as a way to introduce increased concentrations of growth factors and other bioactive molecules to injured tissues in an attempt to optimize the local healing environment. Many methods for PRP preparation have been introduced. Despite variations in the volume of whole blood taken and the efficacy of the platelet concentration, the main objective of PRP preparation is to obtain sufficient platelet concentration in the finally processed autologous plasma. We have been making our own internal primitive PRP preparation, which is safe and aseptic, using simple tubes and a centrifugal separator at the outpatient department base. METHODS: Twenty cc of whole blood was collected and 10 cc of blood was added to each of two bottles, followed by addition of 1.5 cc adenosine-citrate-dextrose-acid solution to each bottle. Then, centrifugal separation was performed at 4,000 RPM for 15 minutes. Then, the buffy coat layer was aspirated using a 10 cc syringe equipped with a spinal needle. Platelet activation was initiated by addition of CaCl2 and botropase. RESULTS: We were successful in attaining PRP, which was three folds and six folds concentrated compared with the initial platelet count of whole blood. CONCLUSIONS: Our protocol is economical and only requires a few simple procedures for preparation of PRP. We expect the protocol to be applied to clinical trials without significant cost of time and money.

Bone and Soft Tissue Changes after Two-Jaw Surgery in Cleft Patients

BACKGROUND: Orthognathic surgery is required in 25% to 35% of patients with a cleft lip and palate, for whom functional recovery and aesthetic improvement after surgery are important. The aim of this study was to examine maxillary and mandibular changes, along with concomitant soft tissue changes, in cleft patients who underwent LeFort I osteotomy and sagittal split ramus osteotomy (two-jaw surgery). METHODS: Twenty-eight cleft patients who underwent two-jaw surgery between August 2008 and November 2013 were included. Cephalometric analysis was conducted before and after surgery. Preoperative and postoperative measurements of the bone and soft tissue were compared. RESULTS: The mean horizontal advancement of the maxilla (point A) was 6.12 mm, while that of the mandible (point B) was -5.19 mm. The mean point A-nasion-point B angle was -4.1degrees before surgery, and increased to 2.5degrees after surgery. The mean nasolabial angle was 72.7degrees before surgery, and increased to 88.7degrees after surgery. The mean minimal distance between Rickett's E-line and the upper lip was 6.52 mm before surgery and 1.81 mm after surgery. The ratio of soft tissue change to bone change was 0.55 between point A and point A' and 0.93 between point B and point B'. CONCLUSIONS: Patients with cleft lip and palate who underwent two-jaw surgery showed optimal soft tissue changes. The position of the soft tissue (point A') was shifted by a distance equal to 55% of the change in the maxillary bone. Therefore, bone surgery without soft tissue correction can achieve good aesthetic results.

Columella Lengthening with a Full-Thickness Skin Graft for Secondary Bilateral Cleft Lip and Nose Repair

BACKGROUND: Various techniques for lengthening short columellae have been used for bilateral cleft nose repair. However, previous methods have not yielded satisfactory results. We performed a full-thickness skin graft to lengthen short columellae during secondary cleft nose repair in adult patients. METHODS: Ten bilateral cleft lip and nose patients underwent secondary cheiloplasty with open rhinoplasty between July 2008 and August 2014. The patients underwent a full-thickness skin graft on the medial crura to elongate the columella. The average age of the patients at the time of surgery was 22.2 years. Nasal profiles were evaluated before and after the operation using the photogrammetric method. RESULTS: The nasal profiles were improved in all patients, and all skin grafts were well taken, with the exception of one patient. Columellar height, nostril height, and columella-lip angle increased, and nasal width decreased significantly. The ratios of columellar height to nasal height, columellar height to nasal width, and nasal height to nasal width increased to a statistically significant extent. CONCLUSIONS: Columella lengthening with a full-thickness skin graft is a simple and effective method for the repair of severely short columellae in bilateral cleft nose patients. We had satisfactory outcomes, with good color matching and aesthetically pleasing contours.

Salvage of a Free Flap Using Postoperative Percutaneous Angioplasty in Patients with Diabetic Foot Ulcers

No abstract available.

Efficacy of Lateral Canthoplasty Combined with Transconjuctival Lower Blepharoplasty in Young Asian Patients

BACKGROUND: The lower eyelid bag associated with an old and tired appearance is not a rare aesthetic problem in young Asian people who have short palpebral fissures and an up-slanting appearance. Many patients want to make their eyes larger, brighter and more youthful at the same time. The purpose of the current study was to determine the feasibility of lateral canthoplasty combined with transconjunctival lower blepharoplasty in minimizing complications and maximizing aesthetic results. METHODS: From June 2011 to May 2014, 59 patients underwent inferior orbital fat removal and orbital septal resets through transconjunctival approaches and lateral canthoplasty. Simple inferolateral canthotomy incisions were used to provide a sufficient operative field for manipulation of the orbital septum, to lengthen the horizontal palpebral fissures and to lower the lateral canthal angle. Patients were evaluated to identify the presence of postoperative complications and to assess the need for additional operations. RESULTS: Most of the patients were satisfied with the aesthetic results during the 2-12-month postoperative follow-up period. There were no recurrences of lower eyelid bulging, postoperative asymmetry, or wound-related complications. Three cases of entropion and two cases of roundness of the lateral canthal angle occurred following the primary operation. However, there were no further complications after secondary operations to correct the tarsal-periosteal fixation position. CONCLUSIONS: Lateral canthoplasty combined with transconjunctival lower blepharoplasty using simple lateral canthotomy is a safe and effective method for maximizing aesthetic results in young Asian patients.

Subbrow Approach as a Minimally Invasive Reduction Technique in the Management of Frontal Sinus Fractures

BACKGROUND: Frontal sinus fractures, particularly anterior sinus fractures, are relatively common facial fractures. Many agree on the general principles of frontal fracture management; however, the optimal methods of reduction are still controversial. In this article, we suggest a simple reduction method using a subbrow incision as a treatment for isolated anterior sinus fractures. METHODS: Between March 2011 and March 2014, 13 patients with isolated frontal sinus fractures were treated by open reduction and internal fixation through a subbrow incision. The subbrow incision line was designed to be precisely at the lower margin of the brow in order to obtain an inconspicuous scar. A periosteal incision was made at 3 mm above the superior orbital rim. The fracture site of the frontal bone was reduced, and bone fixation was performed using an absorbable plate and screws. RESULTS: Contour deformities were completely restored in all patients, and all patients were satisfied with the results. Scars were barely visible in the long-term follow-up. No complications related to the procedure, such as infection, uncontrolled sinus bleeding, hematoma, paresthesia, mucocele, or posterior wall and brain injury were observed. CONCLUSIONS: The subbrow approach allowed for an accurate reduction and internal fixation of the fractures in the anterior table of the frontal sinus by providing a direct visualization of the fracture. Considering the surgical success of the reduction and the rigid fixation, patient satisfaction, and aesthetic problems, this transcutaneous approach through a subbrow incision is concluded to be superior to the other reduction techniques used in the case of an anterior table frontal sinus fracture.

Open Reduction of Proximal Interphalangeal Fracture-Dislocation through a Midlateral Incision Using Absorbable Suture Materials

BACKGROUND: Fracture-dislocation of the proximal interphalangeal (PIP) joint is a relatively common injury. Various treatments for fracture-dislocation of the PIP joint have been reported. In the present study, we performed open reduction through a midlateral incision using absorbable sutures to reduce the small bone fragments and performed volar plate repair. METHODS: We treated nine patients with fracture-dislocation of the PIP joint with small fractured bone fragments too small for pinning or screw fixation. Patients with volar plate injury were treated with open reduction and volar plate repair at the periosteum of the middle phalangeal bone base by the modified Kessler method using absorbable sutures. All patients were placed in a dorsal aluminum extension block splint, which maintained the PIP joint in approximately 30 degrees of flexion to avoid excessive tension on the sutured volar plate. RESULTS: At a mean final follow-up of postoperative 9 months, all patients were evaluated radiographically and had adequate alignment of the PIP joint and reduction of the displaced bone fragments. Range of motion was improved and there were no complications. CONCLUSIONS: This technique is an excellent alternative to the current method of treating patients with fracture-dislocations that include small fragments that are too small for pinning or screw fixation. It is a less invasive surgical method and enables stable reduction and early exercise without noticeable complications.

Nostril Base Augmentation Effect of Alveolar Bone Graft

BACKGROUND: The aims of alveolar bone grafting are closure of the fistula, stabilization of the maxillary arch, support for the roots of the teeth adjacent to the cleft on each side. We observed nostril base augmentation in patients with alveolar clefts after alveolar bone grafting. The purpose of this study was to evaluate the nostril base augmentation effect of secondary alveolar bone grafting in patients with unilateral alveolar cleft. METHODS: Records of 15 children with alveolar clefts who underwent secondary alveolar bone grafting with autogenous iliac cancellous bone between March of 2011 and May of 2012 were reviewed. Preoperative and postoperative worm's-eye view photographs and reconstructed three-dimensional computed tomography (CT) scans were used for photogrammetry. The depression of the nostril base and thickness of the philtrum on the cleft side were measured in comparison to the normal side. The depression of the cleft side pyriform aperture was measured in comparison to the normal side on reconstructed three-dimensional CT. RESULTS: Significant changes were seen in the nostril base (P=0.005), the philtrum length (P=0.013), and the angle (P=0.006). The CT measurements showed significant changes in the pyriform aperture (P<0.001) and the angle (P<0.001). CONCLUSIONS: An alveolar bone graft not only fills the gap in the alveolar process but also augments the nostril base after surgery. In this study, only an alveolar bone graft was performed to prevent bias from other procedures. Nostril base augmentation can be achieved by performing alveolar bone grafts in children, in whom invasive methods are not advised.

Anthropometric Analysis of Mid-face; Senile Changes of Nasal Dimensions

The objective of this study is anthropometric analysis of nose and mid-face in Korean. This study was based on extensive sample size and variable measurement points. Total 3,000 healthy volunteers (18 to 79 years of age) were took two standardized photographs (frontal and lateral view). And 21 items were measured per person. Age groups were classified into three as young, middle-aged, and elderly. Average nasal length was around 4 cm and height was 5 cm. Female was 5~6% smaller than male. Facial width was 3.5 times larger than nasal length. Nasal length reduced by 5% as get older. Nasofrontal angle was 141degrees and nasolabial angle was 92degrees. Nasal width was 39mm and intercanthal distance was 35 mm. The significant age-related changes were eyeball depth (se-pu) and intercanthal distance. The characteristic senile change of male mid-face was downward deflection of soft tissue but female was soft tissue atrophy. The goal of augmentation rhinoplasty is not filling up sellion point depression but superior shifting of that point. Similarity between nasal length and width was another interesting finding of Korean nose. The results of this study will represent typical values of Korean nose and facilitate exact prediction of surgical results.