A case of extremely early cervical adenocarcinoma diagnosed only by endocervical curettage with macroscopic pelvic lymph node metastases

Microinvasive adenocarcinoma is not as well studied as microinvasive squamous cell carcinoma because diagnosis of adenocarcinoma cannot be ascertained for early invasive lesions. However, most clinicians consider a depth of invasion of 3 mm without lympho-vascular space invasion as the maximum limit for conservative management. Microinvasive cervical adenocarcinoma is characterized by a rare incidence of lymph node metastasis and very good prognosis. We describe a 62-year-old patient with an extremely early cervical adenocarcinoma which was detected only by endocervical curettage. However, she had multiple macroscopic pelvic node metastases. Clinicians should consider the probability of lymph node metastasis, although management of stage IA1 cervical adenocarcinoma may still be conservative.

Treatment of 5th Metacarpal Neck Fracture Using Percutaneous Transverse Fixation with K-Wires

PURPOSE: To evaluate the radiologic and clinical results of percutaneous transverse fixation with K-wires for 5th metacarpal neck fracture. MATERIALS AND METHODS: Between January 2007 and September 2010, 18 patients with a 5th metacarpal neck fracture, who underwent operative treatment, were included in this study. The surgical method was percutaneous transverse fixation using K-wires. We evaluated fracture angulation in oblique radiographs preoperatively, postoperatively, and at final follow-up, and used SPSS to perform statistical analysis. We also performed clinical evaluation using the Disabilities of the Arm, Shoulder and Hand (DASH) score. RESULTS: All of the 18 cases were completely united, and in the oblique radiographs, the angulation was corrected from 50.69degrees to 11.68degrees. The average difference between postoperative and final follow-up angulations was 0.14degrees, which was statistically insignificant. Clinically, the DASH score was 1.030 and no complications were observed. CONCLUSION: Percutaneous transverse fixation using K-wires could be one of the best ways to treat a 5th metacarpal neck fracture because of its simple method and low rate of complications.

Sub-brow Resection via Relocation of Retro-orbicularis Oculi Fat and Preseptal Fat Unit

PURPOSE: Retro-orbicularis oculi fat (ROOF) and preseptal fat pad (PSF) are deep fat structures of frontal and supraorbital area, that encounter galeal fat pad (GFP). If galeal wall is weakened by aging process, GFP loses its anchoring structure, moved downward pushing ROOF and PSF. This especially occur in lateral brow area. As a result of drooping, eyebrow affects the eyelid covering PSF as a sac descended to a lateral hooding and ptotic eyelid simultaneously. Consequently, in the case of lateral hooding and brow ptosis, besides the skin, deep fat structures (ROOF and PSF) should be corrected as well. METHODS: ROOF-PSF repositioning technique in subbrow resection were performed. 21 cases of patients from April, 2007 to January, 2008. Before surgery, all patients were examined carefully to evaluate the degrees of dermatochalasia, drooping of the eyebrow, marginal reflex distance 1 (MRD1), eyelid crease height. Surgery was performed under local anesthesia, then excised the drooped eyelid skin by lateral subbrow resection, removed proper amount of ROOF, repositioned ROOF-PSF at the supraorbital rim, and fix it on periosteum. During follow up periods, the patients were surveyed of the satisfaction of surgery, and postoperative MRD1 was evaluated. RESULTS: One patient had a hematoma on left eyebrow, and another one patient had a numbness on left forehead for two months. Except for these two patients, all patients had good results without any significant complications. The mean follow up period was about 5 months, and the position of lateral eyebrow maintained above the supraorbital rim in all cases. Postoperatively, MRD1 increased by 0.8 mm in 5-months mean follow up period. CONCLUSION: In patient with lateral brow ptosis and lateral hooding, the ROOF-PSF repositioning technique in sub-brow resection could be a good operative option.

Serial Reconstruction Considerating the Aesthetic Unit on Congenital Giant Nevus in Periorbital Area

PURPOSE: Soft tissue deformity and skin defect after tumor resection in the periorbital area can cause trouble in the function of eyelid as well as in the aspect of external appearance. Therefore, as cosidering reconstruction in periorbital area, detailed assessment of both functional and aesthetic property are required. thus, the purpose of this study is to examine an appropriate reconstruction through clinical cases. METHODS: A 14-year-old girl with congenital giant hairy nevus on right periorbital area was selected. Her first visit to our plastic surgery outpatient clinic was on July 2006. Since then, she has undergone staged removal of lesions and reconstruction by various flap technique such as pedicled island flap, forehead galeal flap, paramedian forehead flap, cheek rotation & advancement flap. RESULTS: In the case of this girl, most lesions were removed and replaced by normal skins. Although there was the difference of skin color after skin graft, such difference was not noticeable and section scar by skin flaps was slight. There was no obvious dysfunction in the eyelids and the girl and her parents were satisfied with results after the surgery. CONCLUSION: In the reconstruction of soft tissue defect or soft tissue deformity and contracture, it is required to choose appropriate reconstruction method, considering aesthetic and functional aspects depending on aesthetic unit sufficiently.

A Surgical Correction of Pneumosinus Dilatans of Maxillary Sinus by Segmental Zygoma Ostectomy and Maxilloplasty

Pneumosinus dilatans is defined as an abnormal enlargement of paranasal sinuses containing only air. The frontal sinus is most commonly affected, but the maxillary sinus is rare. The surgical aims of pneumosinus dilatans are to re-establish a permanent pressure equilibrium in the involved sinus and to correct possible facial deformity. Generally, pneumosinus dilatans of maxillay sinus is corrected by ostectomy of anterior wall of maxillary sinus and repositioning of removed bony fragment. Despite correction of anterior facial contour asymmetry, asymmetry of facial width remains to be a problem. Therefore, the authors present a technique for correction of pneumosinus dilatans of maxillary sinus by segmental zygoma ostectomy and maxilloplasty. A 16-year-old girl with a slowly enlarging mass in the right side of the face was referred to our department. No history of sinusitis, nasal obstruction or facial trauma were noted. CT scan presented an abnormal enlargement of right maxillary sinus. Surgery was delayed for 2 years until maturation of facial bone. Surgical correction was accomplished through circumferential osteotomy with repositioning of maxillary segment and segmental zygoma ostectomy. Postoperatively, the patient's facial contour was improved with equal malar height and width and no significant complication was noted.

A Case Report of Giant Cell Tumor of the Occipital Bone

PURPOSE: Giant cell tumors of the bone are rare, locally aggressive lesions that primarily affect the epiphysis of the long bones in young adults. These tumors occur very rarely on the skull, principally in the sphenoid and temporal bones. The occipital bone is an unusual site. We report a rare case of a giant cell tumor of the occipital bone with a review of the relevant literature. METHODS: A 7-year-old boy presented with a mass of the right occipital area, which was accompanied by localized tenderness and mild swelling. The mass was first recognized approximately 1 year earlier and grew slowly. There was no significant history of trauma. The physical examination revealed a non-mobile and non-tender bony swelling on the occipital region. The neurological evaluation was normal. The serial skull radiography and CT scan showed focal osteolytic bone destruction with a bulged soft tissue mass in the right occipital bone. The patient underwent a suboccipital craniectomy and a complete resection of the epidural mass. The lesion was firm and cystic. The mass adhered firmly to the dura mater. RESULTS: The postoperative clinical course was uneventful, and the patient was discharged 5 days later. The histopathology report revealed scattered multinucleated giant cells and mononuclear stromal cells at the tumor section, and the giant cells were distributed evenly in the specimen, indicating a giant cell tumor. CONCLUSION: Giant cell tumors are generally benign, locally aggressive lesions. In our case, the lesion was resected completely but a persistent long term follow up will be needed because of the high recurrence rate and the possible transformation to a malignancy.

A Case Report of Chondroid Syringoma of Philtrum

PURPOSE: Chondroid syringoma is a rare mixed tumor of the skin that was first described by Hirsch and Helwig (1961). Characteristically, it is composed of the proliferation of epithelial cells in a myxoid and chondroid matrix. Most lesions occur on the head and neck region, and their size may range from 0.5~3 cm. Since a chondroid syringoma presents similar characteristics to other masses on the head and neck region, it is significantly important to distinguish with other masses by a surgical biopsy. METHODS: A 51-year old woman presented with a painless nodular mass (0.5 x 0.5 x 0.5 cm) on the philtrum, which appeared during the previous year. The mass was treated with a laser without a surgical biopsy. However, the size of the mass showed no changes. Surgical excision under local anesthesia was performed and sent for histopathology. RESULTS: Gross examination showed a mass surrounded by a well developed capsule within the dermal layer. After complete excision without injury to the orbicularis oris muscle, the wound was covered with a local flap. The histology examination revealed numerous cuboid epithelial cells with tuboalveolar structures and keratinous cysts within a chondroid stroma. No recurrence or metastasis was observed at the follow-up visits. CONCLUSION: Chondroid syringoma is a rare mass on the face. An accurate diagnosis is essential for optimal treatment. This paper reports a case of a chondroid syringoma on the philtrum with a brief review of the relevant literature.

The Suture Method Using Ribbon Shaped Knot in Pediatric Facial Lacerations

PURPOSE: Stitching out in facial simple laceration on children, we use No.11 blade. But the procedure is technically demanding to take care of the uncooperative pediatric patient. When we suture a laceration on the pediatric patients, we apply this method using ribbon shaped knot. On stitching out, We pull on the edge of a stitching fiber easily without injury about normal tissue. METHODS: From May 2006 to December 2007 we studied 54 pediatric patients under six years of age, who had facial lacerations in Plastic Surgery department Emergency room. Among them 35 were male, 19 were female and the average age was 3.9. RESULTS: For following up dressing, ribbon shaped knots were not loosened. After stitching out in facial laceration on children, Major complications of infection, hematoma, dehiscence were not found. CONCLUSION: The advantage of this operation method using ribbon shaped knot when stitching out the fiber on the uncooperative pediatric patients, is easy to perform and to reduce the stitching time, without sedation.

A Comparison of Standard Laparoscopic Surgery and Hand-Assisted Laparoscopic Surgery in Patients with Diverticular Diseases of the Large and the Small Bowel

PURPOSE: In complicated diverticular disease, hand-assisted laparoscopic surgery (HALS) has been considered as a useful alternative treatment to standard laparoscopic surgery (SLS) and open surgery. As compared with standard laparoscopic surgery, HALS offers advantages such as tactile sense, better exposure, and shorter learning curve. Minimally invasive surgery is another advantage of HALS. The aim of this study was to compare SLS to HALS in patients with diverticular diseases of the small bowel and the colon. METHODS: We retrospectively reviewed the records of 32 patients who had undergone SLS and HALS for diverticular disease between February 2002 and March 2009. RESULTS: Of the 32 patients, 20 patients (62.5%) were in the SLS group, and 12 patients (37.5%) were in the HALS group. The mean maximal incision length was longer in the HALS group (SLS group vs. HALS group, 4.5 vs. 7.4 cm, P<0.001). However, the mean operating time, the time to flatus, the time to diet, the mean duration of narcotic analgesia, the length of hospital stay, and the postoperative complications were similar. There was no mortality in either group. CONCLUSION: The longest incision length for the HALS group was longer than that for the SLS group, but HALS could reduce the conversion rate and has the many advantages of minimally invasive surgery. For complicated diverticular disease, HALS may be considered as a useful alternative treatment.

Abnormal Wound Healing of Patient with Cushing Syndrome Found after Aesthetic Surgery

Cushing syndrome has several adverse effect such as infection and delayed wound healing. However, it can't be easily detected by routine screening test. Our department reports a case of abnormal wound healing of Cushing syndrome that was found after face lift and abdominoplasty. A 55-year-old woman presented with aging face and abdominal obesity. Pre-operative screening test was normal except thin and dry skin. MACS(minimal access cranial suspension) lift and high tension abdominoplasty were done. After surgery, preauricular and abdominal flaps were deepithelialized and necrotized despite of stitch out and conservative dressing. To find the reason of abnormal wound healing, we conducted additional studies including hormone and CT. A 30mm sized adrenal cortical tumor was found on CT scan, and she was diagnosed as Cushing syndrome. After removal of the tumor, wound was stabilized. Therefore, full thickness skin graft and local flap were done. Wound healing became normal, and major complications such as dehiscence and infection did not occur. Abnormal wound healing process caused by Cushing syndrome can be normalized after resection of adrenal tumor.

A Case Report of Osteochondroma Occuring on the Right Zygoma Body

PURPOSE: An osteochondroma, also known as osteocartilaginous exostosis, is a common bone tumor, but rarely occurs in the facial bone, especially in the zygoma body. Because most of the craniofacial bones develop from intramembranous ossification, osteochondromas are relatively infrequent in mesenchymal bones of the head and neck. The osteochondroma of the facial bone is a slow growing, painless mass, and causes facial asymmetry. In spine and other extremities, it rarely changes malignant, but until now, there is no evidence of malignant change in facial bone. We herein describe a rare case of osteochondroma occurring on zygoma body with review of the literature. METHODS: A 50-year-old male has painless, slowly growing mass on a right cheek for several years. For a diagnosis, CT and whole body bone scan were done and a diagnosis, osteochondroma was made. The tumor was removed with osteotome under general anesthesia. RESULTS: Radiography showed a well-defined calcified mass attached to the anterior aspect of the right zygoma body. And pathologic exam showed degenerative chondocyte and cancellous bone. As a result, this appearance is that of an osteochondroma. CONCLUSION: An osteochondroma is a common bone tumor, but rarely occurs in the facial bone. To the authors knowldege, this is the first case of osteochondroma occuring on zygoma in korea, body. For this case, we reviewed literature related to this topic.

Antibiotic Prophylaxis' Effect on Enophthalmos in Orbital Floor Fracture with Chronic Maxillary Sinusitis

PURPOSE: Orbital floor fracture has open wound to maxillary sinus and if the patient has chronic maxillary sinusitis, it may be have more risk of infection, complications. The purpose of this comparative study is to be the effectiveness of prophylactic antibiotics in orbital floor fracture with chronic maxillary sinusitis. METHODS: We studied 20 patients who diagnosed as orbital floor fracture with chronic maxillary sinusitis from march, 2005 to may, 2006. Among them 16 were male, 4 were female and age was ranged from 15 to 68, average was 42. A day before operation, Prophylactic antibiotics were used to 10 patients. Prophylactic antibiotics were not used to 10 patients. We defined control group as prophylactic antibiotics injection group a day before operation. After surgery, we confined use of same antibiotic for 7 days in both group. After 6 month from surgery, we compare the degree of enophthalmos from healthy side to legion side with hertel exopthalmometry(Inami, Japan) in control group and non-prophylactic antibiotics injection group. RESULTS: In control group, comparison of discrepancy between enophthalmic eyeball and normal eyeball with Hertel exophthalmometer was 1.1mm and non-prophylactic antibiotics injection group was 2.1mm. In independent sample t-test, control group was showed statistically significant difference with non-prophylactic antibiotics injection group(p=0.007). CONCLUSIONS: In orbital floor fracture with chronic maxillary sinusitis, bacteria in maxillary sinus can increase post-operative complication by infecting infraorbital soft tissue, and it is thought to be antibiotic prophylaxis is play a role in decrease in degree of enophthalmos. We feel the need to further study of prophylactic antibiotics in orbital floor fracture with chronic maxillary sinusitis.

New Method for Removing Involuted Bony Fragment in Reduction Angleplasty of Mandible

Oriental women, in general, have prominent mandibular angles and short chins that are thought to be unattractive, square and muscular appearance. Therefore, mandibular ostectomy is one of the most common aesthetic facial bone contouring surgery in oriental and intraoral approach has been used commonly. After the angle ostectomy via intraoral approach, it is not easy for unexperienced surgeons to remove the involuted bony fragment due to the limited view and operation access. This report describes a new method for removal of involuted bony fragment in reduction mandibular angleplasty Thirty eights Case of reduction mandibular angleplasty has been operated from February 2003 to June 2005. We have experienced the involuted bony segment in 12 cases after angle ostectomy. We have adopted periosteal cottle elevator and 18 gauze spinal needle as new methods of extracting the involuted bony fragment. The institutes were used to push the involuted bone segment. We could easily extract the bony fragment with new methods involuted 12 patients mandibular angle within 5 minutes. No major complications were occurred.

The Changes of Bone and Soft Tissue after Maxillary Anterior Segmental Osteotomy and Advancement Genioplasty

PURPOSE: Mid and lower facial convexity is more common in Oriental people than in Caucasian. Bimaxillary dentoalveolar protrusion is characterized by procumbent teeth, protruding lips, acute nasolabial angle, gummy smile, receding chin, facial convexity. Especially, pure maxillary dentoalveolar protrusion is less frequent than bimaxillary dentoalveolar protrusion. Therefore, it is important to make an accurate decision for the operation throughout the history taking, cephalogram, dental cast to arrive at accurate diagnosis and surgical plan. METHODS: From December 2002 to June 2004, ten patients with maxillary dentoalveolar protrusion and microgenia were corrected by maxillary anterior segmental osteotomy and advancement genioplasty. 10 patients were analyzed by preoperative and postoperative clinical photography, posteroanterior and lateral cephalograms. RESULTS: No major complications were occurred throughout the follow-up period except one of the over- recessed, otherwise most of the patients were satisfied with the result. CONCLUSION: We could correct the occulusal relationship with teeth and improve lower facial profile, asthetically and functionally, by maxillary anterior segmental osteotomy and advancement genioplasty.

Mid-face Lift with Preauricular Pre-excision Technique

PURPOSE: Facial nerve injury is a rare but feared complication of face lift. Uncertainty as to the depth and vulnerability of the facial nerve in face lift dissection causes some surgeon, particularly novices, to dissect slowly. Excessively thin flaps can be made because of fear of nerve injury, contributing to skin slough. METHODS: From September 1998 to February 2003, the authors operated on 34 aging face patients using classical face-lift. We had analysed about quantity of skin removal and degree of elevated flap. The authors have found quantity of skin removal was 1.5-2.0cm, degree of elevated flap was 40-45 degree on average. RESULTS: The authors performed preauricular pre-excision face-lift technique on 12 aging face patients from July 2003 to Feburary 2005 based on experienced surgery. This technique reduced fear of dissecting skin flap necrosis and facial nerve injury because of firmly attached pre-auricular skin removed in advance. CONCLUSIONS: We easily dissected SMAS without visual field disturbance, nerve damage and reduced operation time and bleeding loss compared to classical face-lift.

Large Orbital Cavernous Hemangioma: A Case Report

Hemangioma is one of the most common congenital tumors in the region of the face and neck. Although histologically benign, these facial masses are clinically malignant for their deforming and inexorable growth, especially in so-called 'cavernous hemangioma'. Carvenous hemangioma is the most common primary tumor occurring in the adult orbit. This tumor has symptoms that characteristically develop over several years with slowly progressive proptosis, eyeball deviation, hyperopia, diplopia and optic nerve compression. Today, hemangiomas are being treated by various methods; steroids, electrocoagulation, injection of sclerosing agent, cryotherapy, radiation therapy, laser therapy, and surgical treatment, etc. In principle, surgical approaches to the orbit must provide maximum safety and optimal visualization. We have experienced a case of large cavernous hemangioma in the orbit inferolaterally. The surgical treatment of tumor was achieved by the bicoronal approach combined with inferomedial and inferolateral orbitotomy. This surgical approach allows better visualization of the tumor and greater protection of essential anatomic structures. We obtained satisfactory results in terms of aesthetic and functional consideration. We present our case with a brief review of the literature related to orbital cavernous hemangioma.

A Clinical Experience of Frontal Periosteal Osteoma: 20 Cases

Osteoma is benign tumor composed of mature compact or cancellous bone. Generally it is classified as periosteal(or peripheral) osteoma and endosteal(or central) osteoma by its origin. Clinically, periosteal osteoma on forehead is usually asymptomatic. From March 2002 to February 2005, We experienced 20 patients(23 cases) of histologically confirmed frontal osteoma. 20 patients are classified as sex, age, the number of osteoma, size, location and shape. Out of 20 patients, 16 were female and 4 were male in sex and mean age was 46. 18 patients have only one lesion but one patient has two lesions and another patient has three lesions. The size of osteoma varied from 7 x 5 x 3 mm to 16 x 14 x 6 mm and mean size is 12 x 10 x 5 mm. All osteomas were located at midline of forehead and shape of attachment was all sessile type. Surgical excision was superficial ostectomy through direct cutaneous incision or endoscopic approach. we obtained satisfactory result without specific complication.

Clinical Experience of Lacrimal Canalicular Injury with Using Mini Monoka Tube

Reconstruction of lacrimal canalicular laceration has the difficulty to plastic surgeon due to the golden time. Many treatment methods have been developed, but they often ended up with treatment failure because of the difficulty in isolation of proximal segment of laceration canaliculi and the post-operative development of scar adhesion. Recently, silicone tube is the most widely used material in the canalicular reconstruction. Generally silicone tube is used with pigtail probe or stainless steel probe. However sometimes it affects normal punctum and the normal eyelid soft tissue. So, We have tried to reduce such problem by using mini monoka. Mini monoka is easily controlled, has no aesthetic problem, as well as easily removed, and has less foreign body sensation. We were treated with 10 case of canalicular laceration alternative silicone tube (Mini monoka). In conclusion, this method was easier to control than any other silicone tube intubation methods and also saved some time, no corneal irritation sign, any other complications. Mini monoka tube was superior to result of other silicone tube intubation methods.

The Correction of Lower Palpebral Bulge & Tear trough Groove by Repositioning of Orbicularis Oculi Muscle, Orbital Septum & Orbital Fat

Bulging of the lower eyelid & tear trough groove is regarded as a sign of aging. In the past, the surgical excision of the fat pad has been the mainstray of the management of lower palpebral bag in cosmetic blepharoplasty, Recently, fat pad sliding method has been introduced to make more attractive lower eyelids. We used the fat pad for covering the hollowness of the lower eye lid. And we use redundant fat pad for filling & augmentation of the lower eye lid by reflexion. Redraping of the orbicularis arc, with its accompanying midfacial fat repositioning, anatomically restores the cheek and lower lid to make more youthful contour. By redraping and fixing the orbicularis arc on the medial surface of the orbital rim, it becomes a more attractive midface and may prevent of ectropion. From August, 2002 to July, 2004 in correction of lower palpebral bulge & tear trough groove, these two technique were performed in 42 consecutive individuals (84 lower eyelid) for two-year period. Follow up ranged from 3 to 15 months. (an average of 9 months) Palpebral bulge & tear trough groove were corrected and obtained a youthful midface. Complication was rare. The advantages of these techniques are that: prevent in of secondary palpebral bulge and irregularity of lower eyelid by using of reflexed fat fad; prevent in of ectropion. Thus an attractive midface is obtained by redraping of orbicularis arc.

The Usefulness of Mandible CT Scanning in the Diagnosis and Treatment of Mandible Fracture

Mandible fractures, among facial injuries, cause severe pain and difficulties in masticating movement, moreover, it can also bring problems to social life. Accurate diagnosis and proper treatment for mandible fractures is needed to preserve mandibular function and to prevent malformation and complications. A history taking, a physical examination, a simple radiograph, and a conventional facial computed tommography are usually used to diagnose mandible fractures. However, these methods are not enough to understand the three dimensional structured mandible, the fractures-types, the relationship between inferior alveolar nerve and fractures. In the course of planning mandible operation, conventional facial computed tommography has wider section than mandible computed tommography, and horizontal & vertical mid-line division. Resultly, only poor information about inferior alveolar nerve could be achieved and no vertical imaging of mandible. Oppositely, mandible CT could get vertical imaging, and enough information, cause of getting 1mm-gap slice. In this study, we have compared image- information from mandible CT with from conventional facial CT about 28 patients(28/64 1 year-visit patients). Vertical images of mandible could not only help our pre- surgery diagnosis, but also result better post-surgery effect. Mandible enlarged fine-gap CT has used to examine mandible fractures in our hospital, and could be reported that makes operation plan and operation approach easier than conventional facial CT.