Use of resorbable mesh and fibrin glue for restoration in comminuted fracture of anterior maxillary wall

BACKGROUND: The facial bone has a complex structure compared to other bones, and various types of fractures can occur due to its characteristics. Among them, in comminuted fractures of anterior maxillary wall, multiple depressed and impacted bony segments cannot be reduced easily when performing internal fixation using plates and screws or wires, and inadequate restoration leads to a range of complications. This paper introduces an alternative technique using a resorbable mesh with fibrin glue to restore comminuted fractures of anterior maxillary wall. METHODS: Thirteen patients were diagnosed with comminuted fractures of anterior maxillary wall between March 2017 and February 2018 in the authors’ hospital. All patients with comminuted fractures of anterior maxillary wall underwent restoration using resorbable mesh with fibrin glue. The patients’ demographics, causes of facial trauma, mean operation time, length of hospital stay, follow-up period, and complications were recorded. RESULTS: No major complications and only one hypoesthesia of the skin area was noted. Three months after surgery, the hypoesthesia recovered completely. After surgery (mean, 3.9 months; range, 2–12 months), computed tomography showed that the bone fragments in all patients were fixed successfully in their anatomical places. CONCLUSION: In comminuted fractures of anterior maxillary wall, the use of a resorbable mesh with fibrin glue can be an advantageous and effective method for a successful restoration without complications.

Concurrent Two Types of Burn with Airbag in an Upper Extremity: Case Report

Automobile airbags have been shown to reduce morbidity and mortality in the event of a vehicle crash; however, new problems have been identified. Among these problems, direct injury from the airbag itself has become a serious concern. This suggests that an airbag itself may not be safe. Burn injury from airbags accounts for about 7.8% of all injuries caused by vehicle crashes. There are three types of burn injuries from airbags: Thermal, chemical, and frictional. Moreover, there are three subtypes within the category of thermal airbag burn, as identified by Tsunetuki in 2003. Herein, we review a case of an airbag burn and report a unique burn case on ‘an upper extremity’, including both thermal and frictional burns.

Malignant Hyperthermia under General Anesthetic Operation: A Case Report

Malignant hyperthermia is an inherited disorder of skeletal muscle, characterized by temperature elevation, muscle destruction, muscle rigidity and high oxygen consumption. It is triggered by anesthetic agents, usually potent inhalation anesthetics and succinylcholine. It is fatal in the majority of cases unless early diagnosis and treatment are performed. We experienced one case of malignant hyperthermia incidentally. She had post burn scar contracture on anterior chest and abdomen and local flap was prepared for releasing scar contracture under general anesthesia. Approximately 3 hours after induction, tachycardia developed followed by severe arrhythmia with unstable blood pressure, temperature elevation and cyanosis. Anesthesia was stopped immediately and aggressive emergency management was performed with Dantrolene. About 4 hours after induction, the patient was recovered to normal state with intensive care.

Role of Bioabsorbable Plates and Screws in Genioplasty

The use of bioabsorbable fixation system for the craniomaxillofacial surgeon has become available for prevention of intracranial migration, growth restriction by metal implants in pediatric patients as well as palpability in patients of all of ages. Recently, the field of bioabsorbable fixation system was expanded and the bioabsorbable screws were used successfully in endoscopic brow lift surgery. We reviewed 6 cases in which bioabsorbable plates and screws were used in aesthetic genioplasty: one male and 5 female patients between 17 and 38 years of age. The fixation of repositioned bone segment in genioplasty was obtained by using plates composed of a copolymer, polyglycolic acid and polylactic acid(LactoSorb, Walter Lorenz Surgical, Jacksonville, Fla.). The fixation devices were evaluated with regard to satisfactorily rigid fixation at the time of procedure. The postoperative follow-up procedure evaluated clinical wound healing, infection, palpability of plates through the skin and its visibility on imaging technique. Our experience with bioabsorbable fixation system in aesthetic surgery has been very favorable and reliable, although prospective studies with a longer follow-up of a larger number of patients are desirable to confirm these findings.

Clinical Experience in Reconstruction of the Posterior Lingual Mandibular Bony Defect

Posterior lingual mandibular bony defect is rare disease entity. Diagnosis of this entity is almost incidental because it has neither symptoms nor signs. However, it has characteritic features in radiologic images that radiolucent defect located near the mandibular angle. Many of this defects are filled with sublingual salivary gland tissues and some includes fat tissue. Various terms such as aberrant salivary gland defect, mandibular embryonic defect, developmental submandibular bone defect, are available for this disease entity bacause cause of this entity is controversal. Operation for reconstruction of the defect is not necessary except this entity has symptoms or diagnosis of this is unclear. Authors experienced one case of this entity incidentally, and operated for defect reconstruction by osteotomy and filled the defect with hydroxyapatite. The result is satisfactory without any complications.

Reconstruction of Pharyngocutaneous Fistula with Radial Forearm Free Flap: A Case Report

Pharyngocutaneous fistula formation is a serious complication after total laryngectomy and its incidence varies from 7.6% to 50%. It leads to a prolonged hospitalization and complicated rehabilitation. Although many reconstruction methods have been introduced, each has its own merit and demerit and there is no single perfect answer. In our study, the fistula was reconstructed with inner lining using hinge method and radial forearm free flap. The operation was performed in 5 patients who underwent pharyngocuatneous fistula after total laryngectormy. We obtained a satisfactory reconstruction of the fistula and natural neck contouring using this method in all cases. Only 1 patient had complication of wound infection. However, the patient was healed with conservative antibiotics therapy. We believe the radial forearm free flap with hinge flap is the optimal method for circumferential reconstruction of pharyngocutaneous fistula. In comparison with other reconstructive techniques, the radial forearm free flap offers the best combination of flap reliability and low donor site morbidity. This method also allows patients to shorten the hospitalization and meet their cosmetic needs.

Surgical Treatment of Moyanoya Disease

Moyamoya disease is an unusual cerebrovascular disease that is characterized by progressive occlusion of major cerebral arteries and abnormal collateralization of intracranial blood flow. The etiology of this disorder remains unknown. The diagnosis of moyamoya disease is made on the basis of angiographic findings: In its early stage there is stenosis of the supraclinoid portion of the internal carotid artery, frequently bilaterally. Later, there is enlargement of extracranial transdural collateral circulation. Surgical treatment of moyamoya disease consists of either direct anastomosis surgery (STA-MCA anastomosis) or indirect anastomosis, includingencephaloduroarteriosynangiosis (EDAS), encephalomyosynangiosis (EMS), encephalomy- oarteriosynangiosis (EMAS), encephaloduroarterio-myosy- nangiosis (EDAMS), and omentum transplantation. Direct anastomosis is the immediately effective procedure, and it is effective in case of the acute occlusive case. But its disadvantage is high incidence of the neurological deficits due to temporary stasis of blood in the cortical arteries. The double or triple anastomosis is recommended for the multiple occlusive lesion. Additionally, in a young child it may be technically difficult because of the small caliber of the STA. Therefore, indirect anastomosis is a more popular procedure than direct anastomosis except actue infarct case. We have performed the surgical treatment for 15 cases with moyamoya disease. Improvement of clinical symtoms was obtained and postoperatively good collateral circulation was confirmed on the angiogram and brain SPECT. In conclusion, among various methods of indirect anastomosis, EDAS is a safe and effective revascularization procedure for most cases of moyamoya disease.

Histopathologic Changes after Injection of Botulinum Toxin A in the Rat

Recently, Botulinum toxin A has been used effectively in nonsurgical treatment of facial wrinkles. This toxin produce predictable and reversible paralysis in facial mimetic muscles. To investigate the histological changes in skeletal muscle following botulinum toxin injection, 27 female rats (200 - 250 gm) were injected with single dose of 50 of 0.1/ml botulinum toxin A (Botox, manufactured by Allergan Inc.) in right gastrocnemius muscle. Three months after the first toxin injection, second injection was given at the same area. The muscle biopsy was made in the 1st, 2nd, 3rd week, and the 1st, 2nd, 3rd month after the first injection and in the 1st, 2nd, 3rd week, and the 1st, 2nd month after the second injection. The pathologic findings showed atrophy of myofibers, cell proliferation in intermyofibers, and internalization of sarcolemmal nuclei. The incidence and severity of these changes increased gradually by 4 weeks and then recovery of paralysis occurred slowly. The pathologic findings of the second injection showed slightly severer than the first injection, but the progress of pathologic changes were the same as the first injection. In conclusion, the present study demonstrates that extensive myopathic changes develop following botulinum toxin injection. But, botulinum toxin A produces no persistent histologic change in muscle fiber. Its therapeutic effect is reversible and transient.

4 Cases of Treatment of Growing Skull Fracture

A fracture of the skull occurred during the infancy and childhood ordinarily heals without difficulty. Rarely, however, such a fracture enlarges progressively to form a permanent cranial defect with pulsating mass. Patients usually have a history of head trauma and skull fracture and show pulsating soft mass with underlying bony defect. Pulsation of the brain is transmitted through the cysts to the inner table of the skull, and erosion of the bone ordinarily occurs in a localized area overlying the cysts. Enlargement of skull fractures has been reported at least 4 months after the accident. The existence of a dura defect in this syndrome has been amply verified by operative and autopsy observation, and appears to be a requisite for enlargement of the fracture. Ideal is early diagnosis and preventive treatment before it develops into a growing skull fractrue. Repeated simple radiology and color doppler sonography are very useful for evaluation of growing skull fracture. Also an early and aggressive operation is strongly recommended in young children. We experienced 4 cases of the growing skull fracture, which were reconstructed with cranioplasty and duraplasty. Clinical findings and management of the growing skull fracture are discussed, a review of the relevant literature is presented.

Long Term Follow up of complications in 43 Cases after Skull Base Approach

Skull base surgery has developed through the evolution of imaging, anatomic research, surgical approach and reconstructive techiques. The basic disciplines of approaching skull base lesions are to provide direct vision, minimize brain retraction, allow excellent exposure and minimal blood loss. Although many advantages listed above are reported, objective long-term follow up results about post-operative complications of this procedures were not introduced. This study was designed to review the complications of skull base approach that we experienced 43 cases by a team approach with neurosurgery-supraorbital rim osteotomy, orbitozygomatic osteotomy, orbitozygom aticoglen-oidotomy, orbitozygomaticoglenoidocondylotomy, and transfrontonasomaxillary osteotomy-through objective evalutation criteria. The result of this study demonstrated that the type of complications were consisted with perioperative infection (5 cases), subdural empyema (1 case), CSF leakage(1 case), hematoma (1 case), meningitis (3 cases), ophthalmic nerve injury (1 case),facial nerve injury (2 cases), T-M joint problem ( 2 cases), & enophthalmos ( 2cases). In conclusion, after performing the different skull base approaches, we analyzed several complications of the above procedures. We analyzed with the purpose of preventing complications in the next skull base approach.

The reconstruction of soft tissue defects of cranioface using modified lower trapezius musculocutaneous flap

Reconstruction of extensive soft tissue defect of the head and neck after or resection or injury has improved with advances in surgical techniques. Traditional local flap techniques are not easy to reconstruct the extensive soft tissue defects and irradiated or contaminated recipient beds. Then musculocutaneous flaps such as pectoralis major flap, trapezius flap, latissimus dorsi flap and sternocleidomastoid flap have been performed. These musculocutaneous flaps are effective in resurfacing the neck and lower face, for example, mandibular area but difficult to reconstruct the upper face and scalp and the result is poor. Other alternative flap used to cover this area is free flap, but this flap has many limitation too and therefore reconstructive surgeons have attempted to develop new flaps. There are three distinct musculocutaneous flaps, the superior, the lateral island, and the lower island flaps, that can be harvested from the trapezius muscle that are used in head and neck reconstruction. The lower trapezius musculocutaneous flap provides a long paddle of thin, pliable skin and muscle and offers the long are of rotation and thus the greater versatility of the three types of trapezius flaps. But this lower trapezius musculocutaneous flap has may problems to reconstruct the upper part of face and scalp by traditional method and has used mainly to resurface the neck and lower face. Thus, authors modified the procedure of lower trapezius flap and tried to reconstruct the upper part of face and scalp. The modification is that during the dissection, the trapezius muscle must be totally mobilized and the dorsal scapular artery must be preserved. By this procedure, blood flow can circulate effectively to the distal portion of flap and then modified flap has greater are of rotation and reliably reach higher portion of face and scalp. The operative results me that among the eight cases performed by modified lower trapezius musculocutaneouas flap, seven were reconstructed successfully, and remaining one presented partial flap necrosis and secondary procedure was needed. The functional defecits of donor site were minimal in all cases.

THE APPROACH OF SKULL BASE LESIONS IN THE VIEW POINT OF PLASTIC SURGERY

Skull base surgery has developed through the evolution of imaging, anatomic research, surgical approach and reconstructive techniques. The basic disciplines of approaching skull base lesions are provide direct vision, minimizing brain retraction, excellent exposure and minimal blood loss. The focus of this report is to review the advantages of skull base approach in our cases and suggest some indications. We experienced 20 cases of skull base surgery by a team approach consisting of a neurosurgeon and plastic surgeon. The surgical approach were supraorbital osteotomy(5 case), orbitozygomatic osteotomy(8 case), orbitozygomaticoglenoid osteotomy (5 case ) and orbitozygomaticoglenoidocondylar osteotomy (2 case). In our experience, these approaches provided excellent exposure of the lesion, direct access to lesions and minimal brain retraction thereby better outcome.

A CLINICAL REVIEW OF EXPOSED FRONTAL SINUS

No abstract available.

Effect of rat peripheral nerve regeneration through artery-including silicone tubing

No abstract available.