Le Fort I osteotomy as treatment for traumatic class III malocclusion caused by Le Fort III fracture: A case report

Trauma in the modern society is characterized by multiple injuries, and the several comorbidities are often accompanied by facial bone fracture. The types of multiple facial bone fractures vary from Le Fort to panfacial fracture. Le Fort fracture, which can cause problems, such as facial disfigurement, functional impairment of mastication, malocclusion and speech abnormalities, is a challenging case for plastic surgeons. The purpose of treatment for patients with malocclusion due to Le Fort fracture is to maintain and restore both function and aesthetics. The author reports a case of Le Fort I osteotomy as a surgical correction of traumatic class III malocclusion due to Le Fort III fracture.

Reconstruction of temporal hollowing using two alloplastic materials simultaneously with titanium mesh and a silicone implant

Temporal hollowing is a contour deformity that results in a concavity or hollowing of the temporal region, causing significant cosmetic problems that affect patients both physically and psychologically. For these patients, cranioplasty is needed for protective coverage of the brain and to restore a pleasing aesthetic contour to the cranium. We report a case in which titanium mesh was used as a customized craniofacial implant for a bony defect and a silicone implant was used for soft tissue augmentation of muscle and to address temporal fat pad atrophy. The procedure resulted in high patient satisfaction from an aesthetic standpoint and, importantly, restored a functional barrier resistant to trauma.

Staged lower lip reconstruction following gangrenous stomatitis in an immunosuppressed patient

A 70-year-old male with a history of diabetes mellitus, hypertension, and coronary stent insertion visited our hospital 7 days after biting his lower lip. Swelling and inflammation had worsened despite debridement and antibiotic treatment. On the 8th hospital day, fungal infection with Candida albicans and superimposed bacterial infection with Klebsiella pneumoniae were found on tissue culture. Extensive necrosis resulted in a defect of approximately 3/4 of the entire lower lip and a full-layer skin defect from the vermilion to the gingivobuccal sulcus at the right corner of the mouth. To correct drooling, incomplete lip sealing, and trismus, staged reconstruction was performed with consideration of cosmetic and functional features. The treatment process using staged reconstruction and antifungal treatment for an extensive lower lip defect caused by fungal stomatitis is described.

Irritated Subtype of Seborrheic Keratosis in the External Auditory Canal

No abstract available.

Reconstruction of a Traumatic Cleft Earlobe Using a Combination of the Inverted V-Shaped Excision Technique and Vertical Mattress Suture Method

Traumatic cleft earlobes are a common problem encountered by plastic and reconstructive surgeons. Various techniques have been reported for the repair of traumatic cleft earlobes. Usually, the techniques of split earlobe repair are divided into two categories, namely straight- and broken-line repairs. Straight-line repair is simple and easy, but scar contracture frequently results in notching of the inferior border of the lobule. It can be avoided by the broken-line repair such as Z-plasty, L-plasty, or a V-shaped flap. Between April 2016 and February 2017, six patients who presented with traumatic cleft earlobe underwent surgical correction using a combination of the inverted V-shaped excision technique and vertical mattress suture method. All the patients were female and had a unilateral complete cleft earlobe. No postoperative notching of the inferior border the lobule occurred during 6–16 months of follow-up. Without the use of a broken-line repair, both the patients and the operators attained aesthetically satisfactory results. Therefore, the combination of the inverted V-shaped excision technique and vertical mattress suture method is considered useful in the treatment of traumatic cleft earlobes.

Reconstruction of a Traumatic Cleft Earlobe Using a Combination of the Inverted V-Shaped Excision Technique and Vertical Mattress Suture Method

Traumatic cleft earlobes are a common problem encountered by plastic and reconstructive surgeons. Various techniques have been reported for the repair of traumatic cleft earlobes. Usually, the techniques of split earlobe repair are divided into two categories, namely straight- and broken-line repairs. Straight-line repair is simple and easy, but scar contracture frequently results in notching of the inferior border of the lobule. It can be avoided by the broken-line repair such as Z-plasty, L-plasty, or a V-shaped flap. Between April 2016 and February 2017, six patients who presented with traumatic cleft earlobe underwent surgical correction using a combination of the inverted V-shaped excision technique and vertical mattress suture method. All the patients were female and had a unilateral complete cleft earlobe. No postoperative notching of the inferior border the lobule occurred during 6–16 months of follow-up. Without the use of a broken-line repair, both the patients and the operators attained aesthetically satisfactory results. Therefore, the combination of the inverted V-shaped excision technique and vertical mattress suture method is considered useful in the treatment of traumatic cleft earlobes.

Comparison of Cultured Keratinocyte Allograft versus Alloplastic Material in Management of Burn Injury

PURPOSE: In the past days, the majority of 2nd degree burns were treated conservatively, and deep 2nd degree burns were usually covered by skin grafts. However, conservative treatment spends a long time in complete healing and accompanies severe pain and discomfort. Additionally, covering the wound with skin graft causes recipient site scarring and donor site morbidity. Since keratinocyte graft was introduced, nowadays it is widely used in burn wound. These treatment methods are proved to be clinically successful by many clinical and experimental studies. However, there are several disadvantages such as inconvenient using methods and limited usage in several cases. For that reason, at 2004, alloplastic material was first introduced to come over these problems of keratinocyte graft. There had been no precious reports comparing theses two methods, so we planned to focus on differences of two methods in our institute. METHODS: From March 2013 to september 2014, among the 47 patients with burn wound (2nd degree - partial 3rd degree) underwent biologic dressing with cultured keratinocyte allograft (Kaloderm(R) (Tegoscience, Korea)) alloplastic material (Suprathel(R) (Polymedics Innovations GmbH, Germany). The outcomes were assessed using time for epithelization, TBSA (%), Vancouver Scar Scale and complication. RESULTS: All burn wounds were completely epithelized without any complication. The average time for epithelization was 13.4/13.4 days. CONCLUSION: The result of this study suggests that Kaloderm(R) and Suprathel(R) did not show significant difference. Therefore, Suprathel(R) may be considered as an alternative choice for treating 2nd and 3rd degree burns in some clinical settings.

Effect of Heparin on Expression of mRNA of MMP 1,2,9 in Adult Rat Wound

PURPOSE: This study was to investigate how the heparin, which has been known to induce neovascularization by MMP in the infarcted tissue of the myocardium, had influence on the expression of mRNA of MMP 1,2,9 of the skin wound of rat. METHODS: Full depth skin wounds were created on the dorsum of Sprague-Dawley 60 rats. The experimental rats were divided into two groups according to the concentration of heparin(100microgram/ml in 20, 300microgram/ml in 20). Heparin soaked gelatin sponges in different concentration were inserted into the pocket of experimental rats and the wounds were closed. Normal saline soaked gelatin sponges were used in control rats. Wounds were harvested at 48 and 72 hours after closure. We performed histologic study in H-E stain. RNA was isolated from the harvested tissue and then real time polymerase chain reaction was performed to determine the gene expression of MMP-1,2,9. RESULTS: We observed that inflammatory cell decreased in heparin soaked group and heparin increased the expression of MMP-1,9 mRNA of dorsal wound of rat at 72 hours (p<0.05). CONCLUSION: This result suggest that heparin may be used inducing another factor inducing scarless wound healing by increasing MMP.

Comparative Study of Acticoat(R) & Allevyn(R) on Infected Full-thickness Wound of the Rat Skin

PURPOSE: Allevyn(R)(Smith & Nephew, England) is a type of polyurethane foam material with good wound discharge absorption. Acticoat(R)(Smith & Nephew, England) is a silver coated dressing material which is effective in infected wound. The purpose of this study is to compare the effects of dry gauze, Acticoat(R) and Allevyn(R) on infected full-thickness wound healing in rat. METHODS: One hundred and twenty rats were divided into 3 groups: group I(dressing with dry gauze, n=40), group II(dressing with Allevyn(R), n=40), group III(dressing with Acticoat(R), n=40). A 15x15mm square full-thickness wound was made on the dorsum and left open for 24 hours. The size of wound defects were measured each dressing changes. The histological evaluation was performed on the 3rd day, 7th day, 14th day, 21th day. RESULTS: After the wound was left open for 24 hours, typical findings of bacterial infection was observed. After the 7th day, group III showed larger area of epithelialization, smaller defect size compared to those of two other groups. Complete replacement by fibrotic scar tissue was observed in group III with no signs of inflammation on the 14th day. By day 21, the average defect size in group III was decreased from initial 100% to 3.63%. while in group I and II, it was decreased to 62.66% and 53.62%, respectively. CONCLUSION: Acticoat(R) is an effective tool in the treatment of infected wound.

Reconstruction of Soft Tissue Defect, Exposing Achilles Tendon by Using Gracilis Muscle Free Flap and Skin Graft

PURPOSE: Reconstruction of the soft tissue defect exposing Achilles tendon is a formidable challenge because of the paucity of soft tissue and relatively poor blood supply. This article describes the reconstruction of soft tissue defect exposing Achilles tendon using gracilis muscle free flap and split-thickness skin graft. METHODS: From 2000 to 2005, four patients with soft tissue defect exposing Achilles tendon and infection were operated using gracilis muscle free flap and split-thickness skin graft. The defect size ranged from 3.5 to 5cm wide and 6.5 to 8cm long. The mean postoperative follow-up was twenty months. RESULTS: All the flaps were survived without necrosis and infection. We obtained the satisfactory results with good functional and aesthetical outcomes. All cases showed good results with the characteristics of a relatively thin flap without additional debulking procedure. CONCLUSION: Gracilis muscle free flap with split thickness skin graft could be a good option for reconstruction of soft tissue defect of posterior ankle, exposing Achilles tendon with minimal morbidity of the donor site.

A Photogrammetic Study of the Eyes in Korean Youths

PURPOSE: Photogrammetry has been introduced as an alternative to direct measurement to obtain facial distances for a variety of anthropometric applications. The aim of this study is to establish morphological and functional value of an eye in Korean youths using specially designed computer software with digital photographic images. METHODS: Authors measured anthropometry of an eye in Korean youths 1,449 individuals(622 males, 827 females) and analyzed stastically them. RESULTS: The mean measurements are as follows. The diameter of cornea was 11.6+/-0.9mm in males and 11.3+/-0.9mm in females. The vertical dimension of palpebral fissure was 7.4+/-1.7mm in males and 8.2+/-1.6mm in females. The intercanthal width was 35.8+/-3.2mm in males and 34.4+/-2.9mm in females. The biocular width was 90.4+/-5.7mm in males and 87.4+/-5.3mm in females. The endocantion-superior margin of palpebral fissure distance was 12.7+/-1.4mm in males and 11.6+/-1.4mm in females. The horizontal dimension of palpebral fissure was 28.5+/-2.2mm in males and 27.4+/-1.9mm in females. The slant of palpebral fissure was 10.7+/-2.6degrees in males and 11.3+/-3.0degrees in females. The height of upper eyelid was 10.6+/-2.3mm in males and 10.7+/-2.3mm in females. The width of double fold was 2.0+/-0.7mm in males and 1.9+/-0.6 mm in females. A double fold was seen in 21.9% of males and 44.9% of females. The most frequent shape of the double fold was type IV. The most common type of epicanthal fold was type III in both males and females. CONCLUSION: Photogrammetic measurement of large population using specially designed software could offer reliable data and these data could be useful reference for preoperative consultation, surgical planning and anthropometic study of eye.

A Photogrammetic Study of the Eyes in Korean Youths

PURPOSE: Photogrammetry has been introduced as an alternative to direct measurement to obtain facial distances for a variety of anthropometric applications. The aim of this study is to establish morphological and functional value of an eye in Korean youths using specially designed computer software with digital photographic images. METHODS: Authors measured anthropometry of an eye in Korean youths 1,449 individuals(622 males, 827 females) and analyzed stastically them. RESULTS: The mean measurements are as follows. The diameter of cornea was 11.6+/-0.9mm in males and 11.3+/-0.9mm in females. The vertical dimension of palpebral fissure was 7.4+/-1.7mm in males and 8.2+/-1.6mm in females. The intercanthal width was 35.8+/-3.2mm in males and 34.4+/-2.9mm in females. The biocular width was 90.4+/-5.7mm in males and 87.4+/-5.3mm in females. The endocantion-superior margin of palpebral fissure distance was 12.7+/-1.4mm in males and 11.6+/-1.4mm in females. The horizontal dimension of palpebral fissure was 28.5+/-2.2mm in males and 27.4+/-1.9mm in females. The slant of palpebral fissure was 10.7+/-2.6degrees in males and 11.3+/-3.0degrees in females. The height of upper eyelid was 10.6+/-2.3mm in males and 10.7+/-2.3mm in females. The width of double fold was 2.0+/-0.7mm in males and 1.9+/-0.6 mm in females. A double fold was seen in 21.9% of males and 44.9% of females. The most frequent shape of the double fold was type IV. The most common type of epicanthal fold was type III in both males and females. CONCLUSION: Photogrammetic measurement of large population using specially designed software could offer reliable data and these data could be useful reference for preoperative consultation, surgical planning and anthropometic study of eye.

Superficial Non-incisional Double Fold Operation

Non incisional blepharoplasty, so called buried double fold operation in Asia, although a common procedure, has a some complications such as inclusion cyst or granuloma or loss of crease. To obviate this problem, we tried to modify existing suture method. Three sutures(medial, middle, lateral) were located on the skin crease site as superficial as possible to anchor the dermis for secure fixation, and we've located suture knot on the orbicularis oculi muscle as deep as possible. Between January 2001 and February 2004, 162 patients were operated with these procedure by one surgeon, we could trace 63 patients for postoperative follow-up, there were no postoperative findings of inclusion cyst or granuloma or loss of fold crease except 1 case of short crease. This simple suture operation could be one of useful non-incisional methods for Asian blepharoplasty.

Photogrammetric Study of Lip in Young Population in Korean

The aim of this study is to establish anatomical dimension of the lip in young population in Korean, using specially designed soft ware with photographic image. We measure 13 anatomical dimensions of lips in 2,229 young people. (917 male, 1312 female, Aged from 18-33 years. Average age 19.7). Statistical analysis of these measurements of large population could offer useful information in facial plastic surgery. The mean measurements are as follows 1. Lengths (male/female) Widths of philtrum: 1.11+/-0.19cm/1.02+/-0.21cm Heights of philtrum: 1.6+/-0.24cm/1.47+/-0.21cm Heights of cupid bow: 0.88+/-0.16cm/0.83+/-0.16cm Height of upper vermilion: 0.74+/-0.16cm/0.70+/-0.15cm Height of lower vermilion: 1.08+/-0.17cm/1.02+/-0.15cm Height of upper lip(Rt.): 1.24+/-0.2cm/1.23+/-0.2cm Height of upper lip(Lt.): 1.24+/-0.2cm/1.17+/-0.19cm Half horizontal length of lip: 2.2+/-0.26cm/2.11+/-0.2cm Horizontal length of lip: 4.41+/-0.4cm/4.25+/-0.36cm Height of lower face: 7.1+/-0.58cm/6.52+/-0.6cm 2. Angles Nasolabial angle: 97.77+/-11.97degrees/95.5+/-11.34 degrees Mentolabial angle: 133.88+/-14.65 degrees/129.27+/-13.67 degrees Angle of Cupid's bow: 111.65+/-13.99degrees/116.75+/-16.2 degrees Previous reported photogrammetric measurements was difficult to implement to surgical practice. Because these were printed photographies of the same size. Therefore, in this study, we can measure a lot of objects and items more conveniently and correctly by using proportional program on computer after taking a digital photograph. Consequently, proportional measurements with photogrammetry of lip could be useful and corrective substitute for anthropometrical measuring. These data could be useful reference for preoperative consultation, surgical planning and learning anatomical measurement of lips and adjacent structures.

The Effect of Prostaglandin E1 on Apoptosis Induced by Ischemia Reperfusion Injury in Rat Intestinal Mucosa

Apoptosis is a physiologic or programmed cell death process which is controlled by genes. It is essential for the function and the appropriate development of multicellular organism. It is also thought to be one of the main mechanisms of cell death in ischemic tissues. The effect of prostaglandin E1(PGE1) is proven to be useful in the recovery of ischemic changes by inducing vasodilation of peripheral vessels and platelet disaggregation. PGE1 is also known to suppress apoptosis in human liver sinusoidal endothelial cell from ischemia-reperfusion injury. The purpose of this study is to evaluate the effects of PGE1 on the apoptosis in the ischemia reperfusion injury of rat intestine. Thirty Sprague-Dawley rats were used. In control group(N=15), superior mesenteric artery was occluded for 60 minutes and after removing the vessel clamp, it was reperfused for 60 minutes and harvested. In experimental group(N=15), a jejunal flap was also made as in the control group except for the intraarterial administration of the PGE1 right after clamping the artery and removing the clamp. H&E, TUNEL and immunohistochemical stains for p53, bax, and bcl-2 were performed. There were ischemic changes in gross and microscopic findings in both groups. The apoptotic index was significantly lower in the experimental group(1.29+/-0.82(p=0.003)) than in the control group (2.33+/-0.95). The rat intestinal ischemia apoptosis by ischemia-reperfusion was partly related to the modulating of bcl-2, bax, and p53 expression. Our results indicate that PGE1 suppresses the apoptosis in the ischemic jejunal flap and this effect is probably the result of a increase in expression of bcl-2.

Correction of Lowerlid Entropion by Using Skin-tarsal Fixation Method

For its lowerlid entropion correction, nonsurgical eyelid suture or surgical eyelid suture can be employed. Different types of surgical eyelid suture such as the Hotz method and the Callahan method, are generally performed, but were not sufficient for correcting of entropion. In our hospital we performed modified skin-tarsal fixation on 15 patients, 5 male and 10 female from January 20, 1999 to December 16, 2002. We corrected lower eyelid entropion with the excision of the skin and orbicularis oculi muscle and buried suture of tarsal plate and dermis which is a variant of the Callahan method. All the patients were satisfied with the operation results, and there was no case of recurrence of the lower eyelid pricking the cornea. During the 6 months period after the operation, the lower eyelids slightly turned inward but there was no further progression. The correction was performed excessively, therefore there was no case of recurrence after the operation and the results were satisfactory. There developed a dimple at the suture margin caused by skin contraction but it usually disappeared within 2 months after the operation. To avoid recurrence and to achieve satisfactory results, the orbicularis oculi muscle must be totally resected at the ciliary margin. We resected ciliary as well as pretarsal portion of orbicularis oculi muscle. Also, since most of the recurrences are originated from the medial side, the medial portion of skin flap must be tightly fixed to avoid recurrence and the upper part of the dermis should be fixed tightly to the lower border of the tarsal plate.

Safety and Efficacy of Ethylene Oxide Gas Sterilized Acellular Allogenic Dermis

The human acelluar allogenic dermis has been used for soft tissue augmentation of sunken areas. Because of high price, extra-acelluar allogenic dermis is resterilized after being used. The purpose of this experiment is to evaluate the safety and efficacy of ethylene oxide (E.O) gas sterilized acellular allogenic dermal graft(Sure Derm(R)). Twenty-four white rats, weighing about 200 grams and of 5 weeks of age were divided into 3 groups. The prepared SureDerm(R) sheets(10x10mm sized , each 1 mm in thickness) were implanted into the pockets of back area. Biopsy specimens were taken after 4, 8 and 12 weeks and examined histologically for inflammatory reaction, neocollagen synthesis. The initial volume of the graft was measured by immersing it in a 2cc of normal saline and the volume of fluid displaced was checked. The changes in graft volume were measured by the same method. There was a tiny decrease in the volume of the E.O. gas sterilized graft. However, there was no significant difference in the survival rate among the groups(p<0.05). Histological analysis demonstrated progressive monocytes and fibroblast infiltration, sparce collagen bundle organization with time in E.O. gas sterilized grafts. Our experimental study suggests that E.O. gas re- sterilized SureDerm(R) might not be a safe material to use as an implant.

A Suture Fixation Method to Avoid Deviation & Extrusion of Silicone in Closed Augmentation Rhinoplasty

The augmentation rhinoplasty using silicone implant is one of the most popular cosmetic procedure in Asians. But complications such as deviation and extrusion are often noted. For prevention of these problems, we discussed and assessed the effectiveness of augmentation rhinoplasty through unilateral infracartilaginous incision and fixation of the silicone to the septal cartilage. Among 121 patients who underwent closed rhinoplasty using anchoring suture in silicone fixation and covering the silicone tip with medial border of lateral crus in both alar cartilage by intercrural suture, we analyzed 47 patients. No other procedures were used. The average follow-up period was 11 months. This technique showed good results without deviation or extrusion of silicone implants. In addition, this procedure yields good nasal tip projections. Herein, this treatment will be a future promising treatment modality for reducing complications with high level of patient satisfaction

Expression of Fas, Fas Ligand, bcl-2 in Fetal Wound Healing of Rats

Cutaneous wound healing in adult humans and higher vertebrate animals results in scar formation. In contrast, both human and animal fetuses at early gestational ages exhibit skin wound healing without scarring. A recent study has suggested that apoptosis occurs and plays an important role in achieving a decrease in cellularity during skin wound healing. The purpose of this study is to reveal the hypothesis the apoptosis may decreases the inflammatory infiltrates in fetal skin wound healing and may affect the fetal scarless wound healing. Open full-thickness incisional skin wounds were created on fetal rats at gestational ages 16 days(term= 21days). Wound were harvested at 24 hour(n=15), 72 hour(n=15), 120 hour(n=15). Adult skin wound was harvested at 24 hour(n=15), 72 hour(n=15), 120 hour(n =15). The wounds were fixed and stained with hematoxylin and eosin, TUNEL stain, immunohistochemical stain for Fas, Fas ligand, bcl-2. Fetal wounds was healed without scar formation and with regeneration of normal dermal and epidermal appendage architecture. Immunohistochemical staining for Fas, Fas ligand shows sparse positive cells in squamous epithelium of the both adult and fetus, there are no difference of expression between two groups. Immunohistochemical stainings for bcl-2 shows no positive cells in both adult and fetus. The apoptotic index of adult is 0.65+/-0.32 and fetus is 0.56 +/-0.37(p=0.464), there is no significant difference stastically between two groups. These data indicate that apoptosis is not likely to be related to decreased infiltration of inflammatory cells that is main factor of scarless fetal wound healing.

Histologic Study of Injected Dermal Fillers (Artecoll(R), Restylane(R), Sheba(R)) in Mouse

Many attempts have been made to fill the space the dermis with biological or artificial implants. The ideal injectable material should be biocompatible, nonantigenic, nonpyrogenic, noninflammatory, nontoxic, easy to use, stable for injection, non-migratory, long-lasting, and not too expensive. This study was designed in order to select the ideal injectable filler material among PMMA microspheres suspended in collagen solution(Artecoll(R)), micronized allderm(Sheba(R)), and hyaluronic acid (Restylane(R)). We divided into 3 groups according to the injected material (Group I; Artecoll(R) , Group II; Restylane(R) , Group III; Sheba(R)). 0.2 ml of Artecoll(R) was injected into back skin of group I mice in subdermal plane. 0.2 ml of Restylane(R) & Sheba(R)were injected intradermally group II & III in each. The biopsy specimens were taken from each group at 3 day, 1 week, 4 weeks, 12 weeks, 24 weeks after injection and examined grossly as well as histologically. Three matrials showed mild inflammatory response until 4 weeks and disappeared until 12 weeks. Foreign body giant cell has not been shown in any section. In Artecoll(R) and Sheba(R) group, the volume of injected materials was reduced significantly at 24 weeks, but that of Restylane(R) group maintained at 24 weeks. In conclusion, Restylane(R) might be more ideal as an injectable filler than Artecoll(R) and Sheba(R) in this study.