Exercise rehabilitation for recurrent extraocular muscle movement limitation after pediatric blowout fracture surgery: a case report

White-eyed blowout fractures with extraocular muscle (EOM) entrapment necessitate emergency surgical intervention. However, even after surgery, diplopia or EOM motion limitations may persist due to the incomplete reduction of soft tissue herniation caused by inadequate dissection or unresolved muscle strangulation. In this report, we present a case of postoperative EOM movement limitation in a 5-year-old girl who experienced recurrent restriction in the upward gaze of her right eye 14 days after surgery. Instead of revision surgery, the patient was treated with targeted EOM exercises focusing on the inferior rectus muscle and inferior oblique muscle. The patient was instructed to slowly move her pupils from the central point to the upper and outer sides, then in a straight line from the central point to the lower and inner sides before returning to the center point. On the 28th postoperative day, 2 weeks after initiating the exercises, the patient’s EOM motion fully recovered. This case highlights the effectiveness of EOM exercises as a non-surgical treatment approach for improving recurrent EOM movement limitations in the absence of soft tissue herniation following surgical management of blowout fractures in children.

A wide depressed scar deformity treated with cutting wire and autologous fat graft: a case report

Scars are still a challenging problem in medical practice, despite advancements in treatment modalities. Numerous treatment modalities, ranging from simple revision, Z-plasty, and W-plasty to laser treatments, have been used to treat scar deformities. However, for wide depressed scars, additional methods are needed to completely restore the contour of the depression caused by tissue adhesion. We report on the case of a 34-year-old woman with a wide depressed scar deformity on the left upper buttock and the encouraging results of an autologous fat graft injection technique that utilized a cutting wire to form a pocket for the fat graft site, while simultaneously resolving the adhesion caused by the tissue. This method is safe and easily reproducible, making it a useful addition to the surgeon’s toolkit when dealing with such lesions.

Immunogenicity of botulinum toxin

Botulinum toxin treatment is the most common non-surgical cosmetic treatment. Although there are many available treatments using botulinum toxin, their effects are temporary and repeated injections are required. These frequent injections can trigger an immunological response. In addition, botulinum toxin acts as an antigen in the body; thus, its effect disappears progressively due to this immunological reaction, which may cause treatment failure. Active botulinum toxin consists of a core neurotoxin and complexing proteins, the exact effects of which remain unclear. However, the complexing proteins are closely related to the immune response and the formation of neutralizing antibodies. Since neutralizing antibodies can lead to treatment failure, their formation should be prevented. Furthermore, various methods of detecting neutralizing antibodies have been used to predict treatment failure.

A comparative discussion of incisional methods in total capsulectomy of the breast

Background@#Capsular contracture is a frequent complication of breast augmentation that constitutes one of the most common reasons for secondary operations. Capsular contracture is treated surgically, often with total capsulectomy. Therefore, in this study, we aimed to study correlations among intraoperative observations, physical examination findings, and characteristics of the previous operation in patients with capsular contracture who underwent total capsulectomy. @*Methods@#A retrospective chart review was conducted for patients treated from May 2017 to April 2019, analyzing 24 breasts in 12 female patients. The patients were classified in terms of the Baker grade, incision type, implant type, and implant plane. During the operation, we evaluated the ease of dissection based on intraoperative features such as anterior and posterior wall dissection, bleeding tendency, and scar length. Statistical analysis was performed to identify association between variables @*Results@#The implant was changed in eight patients, while only explantation was performed in the remaining four patients. The ease of capsule dissection had a proportional correlation with the Baker grade (P=0.005). Intraoperative dissection was significantly easier in the inframammary fold (IMF) group than in the periareolar group (P=0.035). @*Conclusions@#An IMF incision is preferable for planning en bloc capsulectomy. However, for aesthetic concerns, a periareolar incision would be preferable. In addition, a lower Baker grade (grade I or II) was associated with easier dissection. Therefore, surgeons should choose the incision type depending on the necessity of performing en bloc capsulectomy, Baker grade, and scar length.

Delayed-type retrobulbar hematoma caused by low temperature after reconstruction of inferior blow-out fracture

Retrobulbar hemorrhage is a disastrous condition that can lead to permanent blindness. As such, rapid diagnosis and treatment are critical. Here, we report a patient who presented with retrobulbar hemorrhage following an orbital floor fracture. Restoration of inferior orbital wall with porous polyethylene implant was underwent. Four days after the orbital floor reconstruction, the patient smoked a cigarette outdoors in –3˚C weather. Cold temperature and smoking caused an increase in his systemic blood pressure. The elevated blood pressure increased intraorbital pressure to the extent of causing central retinal artery occlusion and exacerbated oozing. During exploratory surgery, 3 mL of hematoma and diffuse oozing without arterial bleeding were observed. Prompt diagnosis and treatment prevented vision impairment. Few studies have reported on the risk factors for retrobulbar hemorrhage. This case showed that daily activities, such as exposure to cold weather or tobacco smoking, could be risk factors for retrobulbar hemorrhage.

Augmentation mastopexy using a double skin incision: the inframammary fold approach with periareolar de-epithelialization

Background@#For the correction of small breasts with grade I ptosis, it is very challenging for plastic surgeons to obtain excellent aesthetic results by performing simultaneous breast augmentation and nipple-areolar complex (NAC) lifting. Previous research has introduced one-stage augmentation mastopexy, but most studies described using the periareolar approach. The current study proposes a technique for augmentation mastopexy using the inframammary fold approach for augmentation and the periareolar approach for mastopexy. @*Methods@#Twenty patients were enrolled, and surgery was performed on 40 breasts. A pocket was made with the inframammary fold approach and the dual-plane method; subsequently, a tear-drop shape implant was inserted using a funnel. We performed NAC lifting using the de-epithelialization and interlocking purse-string suture method through the periareolar approach. @*Results@#The mean distance from the mid-clavicular line to the nipple was 23.4 cm preoperatively, 19.6 cm at 7 days of follow-up, and 20.3 cm at 12 months of follow-up. Complications such as hematoma, infection, NAC necrosis, capsular contracture, and wound dehiscence were not reported. @*Conclusions@#We performed successful breast augmentation and mild ptosis correction. No specific complications were observed during 1 year of postoperative follow-up. Our method is a simple and fast method that enables surgeons to perform augmentation and mastopexy in one stage for breasts with grade I ptosis.

Delayed-type retrobulbar hematoma caused by low temperature after reconstruction of inferior blow-out fracture

Retrobulbar hemorrhage is a disastrous condition that can lead to permanent blindness. As such, rapid diagnosis and treatment are critical. Here, we report a patient who presented with retrobulbar hemorrhage following an orbital floor fracture. Restoration of inferior orbital wall with porous polyethylene implant was underwent. Four days after the orbital floor reconstruction, the patient smoked a cigarette outdoors in –3˚C weather. Cold temperature and smoking caused an increase in his systemic blood pressure. The elevated blood pressure increased intraorbital pressure to the extent of causing central retinal artery occlusion and exacerbated oozing. During exploratory surgery, 3 mL of hematoma and diffuse oozing without arterial bleeding were observed. Prompt diagnosis and treatment prevented vision impairment. Few studies have reported on the risk factors for retrobulbar hemorrhage. This case showed that daily activities, such as exposure to cold weather or tobacco smoking, could be risk factors for retrobulbar hemorrhage.

Augmentation mastopexy using a double skin incision: the inframammary fold approach with periareolar de-epithelialization

Background@#For the correction of small breasts with grade I ptosis, it is very challenging for plastic surgeons to obtain excellent aesthetic results by performing simultaneous breast augmentation and nipple-areolar complex (NAC) lifting. Previous research has introduced one-stage augmentation mastopexy, but most studies described using the periareolar approach. The current study proposes a technique for augmentation mastopexy using the inframammary fold approach for augmentation and the periareolar approach for mastopexy. @*Methods@#Twenty patients were enrolled, and surgery was performed on 40 breasts. A pocket was made with the inframammary fold approach and the dual-plane method; subsequently, a tear-drop shape implant was inserted using a funnel. We performed NAC lifting using the de-epithelialization and interlocking purse-string suture method through the periareolar approach. @*Results@#The mean distance from the mid-clavicular line to the nipple was 23.4 cm preoperatively, 19.6 cm at 7 days of follow-up, and 20.3 cm at 12 months of follow-up. Complications such as hematoma, infection, NAC necrosis, capsular contracture, and wound dehiscence were not reported. @*Conclusions@#We performed successful breast augmentation and mild ptosis correction. No specific complications were observed during 1 year of postoperative follow-up. Our method is a simple and fast method that enables surgeons to perform augmentation and mastopexy in one stage for breasts with grade I ptosis.

Embolization for treating posttraumatic pseudoaneurysm of the sphenopalatine artery

Posttraumatic pseudoaneurysms of the sphenopalatine artery are rare. Only a few cases have been reported. We report two cases of hemorrhage due to pseudoaneurysm of the sphenopalatine artery. The hemorrhage was uncontrollable. It required embolization. Two patients visited our hospital for treatment of zygomaticomaxillary complex fracture. At the emergency room, patients presented with massive nasal bleeding which ceased shortly. After reduction of the fracture, patients presented persistent nasopharyngeal bleeding. Under suspicion of intracranial vessel injury, we performed angiography. Angiograms revealed pseudoaneurysms of the sphenopalatine artery. Endovascular embolization was performed, leading to successful hemostasis in both patients. Due to close proximity to pterygoid plates, zygomaticomaxillary complex fracture involving pterygoid plates may cause injury of the sphenopalatine artery. The only presentation of sphenopalatine artery injury is nasopharyngeal bleeding which is common. Based on our clinical experience, although pseudoaneurysm of maxillary artery branch after maxillofacial trauma has a low incidence, suspicion of injury involving deeply located arteries and early imaging via angiogram are recommended to manage recurrent bleeding after facial trauma or surgery.

Oroantral fistula after a zygomaticomaxillary complex fracture

Zygomaticomaxillary complex (ZMC) fractures account for a substantial proportion of trauma cases. The most frequent complications of maxillofacial fracture treatment are infections and soft tissue flap dehiscence. Postoperative infections nearly always resolve in response to oral antibiotics and local wound care. However, a significant infection can cause a permanent fistula. A 52-year-old man visited our clinic to treat an oroantral fistula (OAF), which was a late complication of a ZMC fracture. Postoperatively, the oral suture site dehisced, exposing the absorbable plate. However, he did not seek treatment. After 5 years, an OAF formed with a 2.0× 2.0 cm bony defect on the left maxilla. We completely excised the OAF, harvested a piece of corticocancellous bone from the iliac crest, inserted the harvested bone into the defect, and covered the soft tissue defect with a buccal mucosal transposition flap. Although it is necessary to excise OAFs, the failure rate is higher for large OAFs (> 5 mm in diameter) because of the extensive defect in the underlying bone that supports the overlying flap. Inappropriate management of postoperative wounds after a ZMC fracture can lead to disastrous outcomes, as in this case. Therefore, proper postoperative treatment and follow-up are essential.

A better facial contour accomplished by parotid duct preserving superficial parotidectomy

Depression of facial contour after parotidectomy is still challenging to many of surgeons. A 68-year-old man presented with a 4-month history of a painless swelling in both parotid area. The mass was multiple and fixed at the parotid region. We conducted a parotid duct preserving bilateral superficial parotidectomy by one-stage operation to remove the multiple tumors. A lazy S incision was made in both preauricular area and the peripheral branches of the facial nerve were identified using surgical landmark. After dissecting the branches of the facial nerve and parotid duct, main parotid duct was preserved but only small fine ductules from the superficial lobe were ligated. Parotid gland was excised from its anterior aspect with about 1 cm of normal parotid tissue margin. The patient was followed up for 6 years to evaluate postoperative parotid gland function and the computed tomography (CT) was taken. Patient was satisfied with no significant complication such as sunken changes in facial contour, facial nerve function. As far as we know, it is the first study to compare long-term soft tissue contours of soft tissue of duct preserving superficial parotidectomy with duct sacrificing superficial parotidectomy by means of CT findings.

The Characteristics and Safety of Previous Fillers in Secondary Rhinoplasty

BACKGROUND: Filler injection into the soft tissue of the nose is a useful technique for rhinoplasty. The individual characteristics of fillers determine which is best suited for a patient's specific circumstances. The objective of this study was to identify the characteristics of various fillers and to determine which fillers should be used for primary rhinoplasty in order to yield optimal long-term results. METHODS: Excluding patients treated with hyaluronic acid fillers, we reviewed 17 patients who underwent surgical rhinoplasty due to dissatisfaction with an injection using a different filler. After removing the previously injected filler, rhinoplasty was performed as part of the same procedure using a silicone or Surgiform® prosthesis. RESULTS: Various previous fillers were used in the cohort. During the process of filler removal, skin perforation occurred in 2 cases and infection was observed in 1 case. In the other cases, rhinoplasty using a prosthesis was performed at the time of filler removal and no complications were observed. CONCLUSIONS: We found that if surrounding tissue had been maintained stably, a simultaneous secondary operation using implants produced ideal results in most cases without any complications, despite the presence of residual remnant filler material.

Alar Rim Composite Graft: A Safe and Simple Way to Correct Alar Retraction

BACKGROUND: The alar rim is a complex structure that ensures the competence of the external valves and the patency of inlets to the nasal airways. Retraction of the alar rim is caused by congenital malpositioning, hypoplasia, or surgical weakening of the lateral crura, with the potential for both functional and aesthetic ramifications. Most previously introduced procedures involved a relatively long operation time and relatively high risks of surgical complications. The purpose of this study is to introduce a novel surgical technique for alar rim connection and to present its results. METHODS: After marking the extent of the correction, the recipient alar bed was created by making an incision through the vestibular skin 2-mm cephalad to the rim. Then, the composite graft was harvested from the cymba concha by removing the cartilage with its adherent anterior skin. According to the degree of retraction, the harvested composite graft was divided into 2 pieces considering the symmetry of both alar rims. The composite grafts were inserted into the defects and primary closure was done at the donor site. RESULTS: Our surgical technique was used to correct 12 retracted alar rims in 6 patients. Caudal advancement of the alar rims was observed and the contour of the ala was corrected in all 6 patients. The mean length of follow-up was 1-year, and there were no postoperative complications, such as graft loss or disruption. CONCLUSIONS: The alar rim composite graft is a safe and simple technique for correction of short nostril and caudal transposition of the retracted alar rim.

Four Limb Shaped Auricular Chondrocutaneous Composite Graft for the Alar and the Columellar Defects

BACKGROUND: Composite grafts have advantages for small nasal defect coverage. However, if the the outer skin defect and the inner skin defect have a different location, conventional composite grafts encounter considerable limitations. Therefore, we devised a 4-limbed graft to overcome this limitation by use of soft tissue transposition. METHODS: Over the course of 5 years, this auricular composite graft was used in 10 cases of reconstruction. We harvested skin and cartilage from the helix. The composite graft had 2 limbs of soft tissue to cover the nasal defect and another 2 limbs of cartilage to support nasal framework. The cartilage limbs extended 3 to 5 mm beyond the margin of the skin. The direction of each limb was modified according to defect position. RESULTS: All 10 composite grafts survived completely. All composite grafts shrank by a small percentage of their bulk. Nonetheless, the nasal framework was maintained to an acceptable extent because of the cartilage limbs. CONCLUSIONS: This technique was capable not only of covering defects in the alar and columellar area, but also of maintaining a satisfactory external appearance, because the 2 limbs of cartilage included in the graft strengthened the nasal framework and provided modest support to the nostril margin. The 2 limbs of soft tissue covered the defect area. Our 4-limbed auricular chondrocutaneous composite graft is reliable option for the reconstruction of alar and columellar defects in a single-stage procedure.

A Novel Lactiferous Duct Preserving Method for Inverted Nipples: An Inlay Wrap-Around Flaps Supporting the Nipple Column

BACKGROUND: Inverted nipples can pose aesthetic and functional problems, especially for young women. The objectives of inverted nipple correction are both sufficient aesthetic projection of the nipple and postoperative functional preservation of the lactiferous ducts. Recurrence of nipple inversion is still an unsolved problem in many cases. We present a new nipple suspension technique using nipple- and areola-based dermal flaps for correcting inverted nipples and preserving the lactiferous duct to minimize the risk of recurrence. METHODS: We corrected six inverted nipples in three patients, which were classified as grade II using the Han and Hong classification of nipple inversion. The anteroposterior and lateral medical-quality photographs of the respective patients were identified for nipple protrusion and recurrence during a 6-month follow-up period to evaluate aesthetical goal and assess the sensitivity of the nipple to confirm preservation of the main lactiferous ducts. Surgical details are described within the main text. RESULTS: Preoperative and postoperative photography revealed good nipple protrusion during the 6-month follow-up period without any complications such as skin necrosis and recurrence. We were unable to directly identify breast-feeding function because all three patients were young and unmarried women. However, we assumed preservation of the main lactiferous duct since no nipple sensory change was identified in the postoperative examination when compared with the preoperative examination. CONCLUSIONS: With this method, we were able to confirm the hardness of the column and minimize the injury of the main lactiferous duct.

Combined Subbrow Excision with Upper Blepharoplasty Using a Tadpole Shaped Excision for Blepharochalasis

BACKGROUND: In efforts to solve blepharochalasis, induced by aging process, various surgical methods have been developed over the years. Among them, classical upper blepharoplasty has a problem that severe lateral hooding may be restricted in making correction, cause of difference in thickness between the pretarsal skin and subbrow skin. And also subbrow excision (SE) blepharoplasty cannot be easily corrected in severe drooping of the medial skin. In an effort to make up for the disadvantages of these methods, we attempted SE-tadpole shaped excision blepharoplasty (TSEB). METHODS: Fifteen patients underwent SE-TSEB from January 2013 to November 2014. SE-TSEB was performed the following cases: 1) patients who showed moderate to severe blepharochasis with severe lateral wrinkles; 2) patients with a history of pre-existent SE blepharoplasty; 3) patients with a tattoo on the eyebrows, who want to make revision; and 4) patients with eyelid skins that are thick or have overly protuberant fat pads of the retro-orbicularis oculi fat (ROOF), and have a plan to extirpate them. RESULTS: During the follow-up observation period, most patients showed amicable correction of visibility difficulty and were aesthetically satisfied with the postoperative results with respect to correction of the lateral wrinkles. Scars formed in the subbrow incision line were within the scope of management. CONCLUSIONS: SE-TSEB is a treatment modality that overcomes the disadvantages and limitations of classical upper blepharoplasty and SE blepharoplasty. Furthermore, maximizing the advantage of each surgical approach is another innovative approach for correction of changes in the upper eyelid, induced by aging.

A Case of Multiple Piloleiomyoma on the Shoulder, which is Mistaken for Keloid

A 30-year-old male presented with multiple tender erythematous nodules, varying in size from 0.5 cm to 2 cm on the right shoulder of the body. He gave a history of pain associated with these lesions, especially on exposure to cold and touch. These lesions showed multi-segmental distribution; each began as a papule, which gradually increased both in size and number to form a nodule. The lesions, which were misdiagnosed as keloids at another hospital, were managed with numerous intralesional steroid injections. This treatment did not improve the symptoms. Based on the history and cutaneous findings during the physical examination, we considered a diagnosis of a benign tumor. Among the lesions, some of the larger ones were completely excised, followed by excision biopsy. We then made a diagnosis of cutaneous leiomyoma, more specifically, piloleiomyoma. The excisional lesions were covered by skin grafts and closed by primary repair.

The Effects of Botulinum Toxin (BTXA(R)) Dermal Injections on Facial Wrinkle Lines

Facial rejuvenation using Botulinum toxin A is one of the most popular aesthetic procedures. Many cosmetic applications of Botulinum toxin A are under evaluation. Intradermal injection of Botulinum toxin A is a variation of the intramuscular injection technique and remains relatively new technique. This evaluates the effects of intradermal injection of Botulinum Toxin A on facial wrinkle lines. Thirty patients were included to undergo intradermal injections of Botulinum toxin A on forehead, cheek and periorbital area. Three sessions of injection were performed for 10 days. Clinical photograpahs were taken for 24 weeks, and evaluated patient's satisfaction and objective improvement of facial wrinkle lines. Improvement in patient's satisfaction and facial wrinkle line was noted in the post-treatment photographs. This effect was lasted for about 12 weeks. The intradermal injection of Botulinum toxin A is effective method for facial rejuvenation without obvious side effects.

Peptococcus Infection after Breast Augmentation Using Autologous Fat Injection

No abstract available.

Treatment of Nasal Bone Fracture with Reverse U-Shaped Silicone Sheet

PURPOSE: The majority of nasal bone fractures have been managed by routine procedure of closed reduction and intranasal packing. However, nasal packing can cause nasal injury, hypoxia and patients' discomfort. And, synechiae formation frequently occurs after the nasal surgery. Various methods are used to reduce the incidence of synechiae formation. The purpose of this study is to compare routine procedure and nasal packing with reverse "U" shaped silicone sheet with respect to postoperative nasal synechiae formation and final outcome. METHODS: We analyzed the medical records of 100 patients with nasal bone fracture who were operated by closed reduction in the last one year. The silicone sheet was designed in reverse "U" fan-shape and inserted between the middle turbinate and the septal wall. Nasal packing was removed at two days after the operation, and silicone sheet was removed on 10 to 14 days. RESULTS: Synechiae in the middle meatus developed in 2 of 75 patients. Although synechiae between the middle meatus and nasal septum occurred in patients, the patients did not complaint of any olfactory disturbance or nasal obstruction. CONCLUSION: The reverse "U" fan-shape silicone sheet caused less pain for patients and no significant differences in outcome were found. The results of this study suggest that insertion of silicone sheet between the middle meatus and septum can be a useful method in the prevention of intranasal synechiae formation. The reverse "U" silicone sheet is a good alternative for routine packing methods.