Simple Method for Prevention of Bleeding in Mandible Angle Reduction Ostectomy Using Intravenous Tube Rubber

A prominent mandibular angle is considered to be unattractive in the Orient. With recent increase of angle reduction via intraoral approach, it also has risks of injuries on the surrounding structures, especially vessels and nerve. We herein describe a simple method using intravenous tube rubber for prevention of bleeding in mandible angle ostectomy. After elevation of the periosteum, an intravenous tube rubber sutured with 2-0 nylon on one or both side was positioned deeply along the inferior border of mandible, and planned ostectomy was performed. The rubber was removed easily by pulling out the string. We experienced 21 cases of the mandible angle ostectomy using intravenous tube rubber from November 2008 to June 2009 and found no major complications. Intravenous tube rubber can cheaply and easily be obtained in the hospital. During ostectomy, the rubber protects the facial vessels and nerve from saw blade, and provides better visual field. Therefore, intravenous tube protection of facial vessel is a simple method to prevent massive bleeding or nerve injury in mandibular angle ostectomy.

Forehead and Temporal Augmentation with Medium Porosity and High Density ePTFE

In augmentation surgery, one of the important considerations is the selection of artificial implants. Recently, medium-porosity and high-density expanded polytetrafluoroethylene(ePTFE), which has high biocompatibility without gradual loss of volume, has been used as an implant, however, there are not many cases and reports on the post-operative complications and patient satisfactions. Between 2006 and 2009, a total of 23 patients with a flat or depressed forehead/temple underwent augmentation with medium-porosity and high-density ePTFE at our hospital. During follow up periods, 15 patients visited the clinic to fill out a survey and receive a physical examination for any complications, whereas 8 patients underwent a survey on the phone. The patients were asked questions to score their satisfaction rates on a scale of 1 to 10 points. There were no post-operative complications, and, the average score of satisfaction rates on the survey was 8.3 points. Since there were no complications and high rates of satisfaction during follow up periods, this medium-porosity and high- density ePTFE could be considered as a durable implant.

Correction of Out-fold to In-fold

Many Asian people want to have bigger eyes. It is one of the reasons of why high out-fold upper eyelids are made. We corrected out fold to in-fold or neutral-fold. The purpose of this study is to introduce operation procedures. The authors corrected out folds of 32 patients with medial orbital fat slide down anchoring method, 15 patients with fat graft and 13 patients who had ptosis with the levator advancement-Muller tucking method, and removed epicanthic folds of 11 patients. Follow-up ranged from 3 months to 4 years. The authors used medial orbital fat slide down anchoring method to correct out folds of 32 patients and all patients were satisfied with the results. Eleven of 15 patients who had fat graft were satisfied with the results. All patients who had ptosis were satisfied with the results. Generally, out fold can be corrected by the medial orbital fat slide down anchoring method. If orbital fat is not sufficient, fat graft will be a method for correction. Levator advancement - Muller tucking is a good method for ptosis, and epicanthoplasty is helpful for those who have epicanthic folds to make their eyes bigger.

Experiences in Excessive Fat Survival after Fat Graft in Upper Eyelid

Soft tissue augmentation with autologous fat graft is a popular procedure in plastic surgery. Some surgeons usually graft more than necessary amount of fat, because of possible absorption of grafted fat. In case of upper eyelid, however, the volume of grafted fat can increase with weight gain or survive for a long time. The purpose of this report is to introduce our experiences in excessive fat survival in upper eyelid and how to manage it. From March 1999 to September 2006, we grafted autologous fat to fifteen of thirty six patients during secondary blepharoplasty. The fat graft was harvested from axilla. Follow-up ranged from 3 months to 4 years. Some of them had excessive fat survival in the upper eyelid after fat graft, therefore, a part of the fat was removed for natural appearance. In case of upper eyelid, the volume of grafted fat can increase with weight gain or survive for a long period of time, therefore, surgeons have to graft a minimum amount of fat without overcorrection and correct excessive fat by removing part of it or by liposuction after injection of hyaluronidase.

Experiences in Reduction of Height of Double Eyelid Fold

Most Koreans who do not have supratarsal fold are anatomically quite different from Caucasians, and double eyelid operation is one of the most common operations in Korea. However, it might cause various complications, and high fold might occur as a complication. The purpose of this study is to introduce an appropriate operation procedures to correct the high fold. From March 1999 to April 2008, 45 patients experienced secondary blepharoplasty due to high fold after double eyelid operation. We divided patients into four groups to correct the high fold. We operated the first group with lower flap dissection method because of mild high fold and bulky lower flap eyelid. We operated the second group them with upper orbital fat slide down anchoring method due to sufficient orbital fat. We operated the third group with the free fat graft method due to insufficient orbital fat. We operated the fourth group with ptosis correction method. The lower flap dissection method was applied to most of the forth cases because of thick lower flap. The upper orbital fat slide down anchoring method is to drag orbital septum-fat down to prevent readhesion and showed the best result without any complication. The case of insufficient fat could be corrected through the free fat graft to prevent readhesion. The case of ptosis which was corrected by the levator advancement-Muller Tucking method showed good result. The operation to correct the high fold could be very difficult and in order to get good result, one needs to exactly know anatomical structure of upper eyelid, and accurate understanding of how much orbital fat should be left by pushing eyelid skin and eyeball down. It is suggested that the best method to use is the upper orbital fat slide down anchoring method. It would be better to use the free fat graft for patients who suffer from insufficient fat. In cases of ptosis, the use of the levator advancement- Muller tucking method is recommended.

Modified Narrowing Corrective Rhinoplasty & Augmention Rhinoplasty in Patient with Wide Nasal Bone

The human nose is located in the center of the face and it's cosmetic importance is high. The contour of the nasal dorsum and side walls play a major role in the shaping of the nose, and even a slight distortion may results in significant variance of the human facies. However, in the case of patients with wide nasal bone, augmention rhinoplasty can make nasal planes look wide, resulting in bulbous appearing noses or lateral borders of the nasal implant may be visible after the surgery making the final cosmetic results unsatisfactory. To solve such problems, from march, 1999 to march, 2004, the authors have performed augmention rhinoplasty in 36 patients. The cause of operations were as follows: flat nose 20, hump nose 5, deviated nose 4, secondary rhinoplasty 7. Paramedian osteotomy was performed at a distance that was the same as the width of the implant from the midline(5 mm+5 mm). To prevent it from connecting to the roof at the lateral osteotomy line, intentional green stick fracture of the roof was performed. Agumentation rhinoplasty was done with either Silicone or Gortex and ear cartilage as a supplement. The follow up period was 2 weeks to 13 months with an average of 5.5 months. There were no infections and postoperative bleeding. As a result, the nose was augmented higher and narrower than before which we and the patient both found highly satisfactory.

Technique for Open Reduction of Subcondylar Fractures Using Bended Iron Stick Scale

The methods of management for condylar fractures have been investigated and improved. The methods which have been used up to date are classified broadly into conservative and surgical treatment. Conservative treatment is chosen usually in the cases of children's or growing adolescent's fracture and non-displaced high leveled condylar fracture. But in the cases of displaced fracture, surgical reduction is to fit. The aim of surgical treatment is restore preexisting anatomical relationships by means of functionally stable rigid fixation. And rigid fixation will avoid uncomfortable IMF. Most miniplate fixations are accomplished through extraoral approaches. Extraoral approaches have the advantage of accurate reduction and fixation under a good visual field, but they have several disadvantages of facial nerve injury, facial scarring, and the possibility of necrotic bone change of fragment. Thus trocar assisted intraoral approach was introduced. But this method have disadvantage of uncertain fixation, because of visual field limitation and unaccurate reduction. To overcome this, we design a bended iron stick scale. The iron stick scale has 2 holes, 5 mm and 7 mm. apart from bending point for drilling. This hole was used for accuracy drilling. We treated 16 cases of displaced subcondylar fracture, using this method.