Correction of Closed Outer Table Fracture of Frontal Sinus using Upper Eyelid Incision and Autogenous Bone Graft

PURPOSE: The bicoronal incision, traditional procedure to correct the frontal sinus fracture, could remain a long scar, alopecia etc. Hence, the authors introduce the procedure to fix the outer table fracture of the frontal sinus through the upper eyelid incision as a concealed scar. MATERIAL & METHODS: From November, 2007 to December, 2010, five patients who suffered from outer table fracture of frontal sinus fracture underwent operation to correct the depressed contour of forehead. Instead of the reduction of depressed outer wall, autogenous bone was grafted trough the upper eyelid incision. The result of operation was evaluated with VAS score system(score arrange 0 to 5). VAS score was taken from patients as well as 4 plastic surgeons. RESULTS: Both patients and surgeons were satisfied about result of operation. The overall average score from plastic surgeon was 4.2. Especially to the scar of upper eyelid incision, the score was 4.7. Average score from the patients was 4.1. And there were no other complications as follow-up periods. CONCLUSION: This technique could be one of good options to correct the depression after the outer table fracture of the frontal sinus. And this technique has some benefits to overcome the disadvantage of previous introduced methods.

Prevalence of Midfacial Creases according to Aging of the Korean

The tear trough deformity and the palpebromalar groove are characteristic appearances in midface aging. The aim of this study is to suggest the direction of aging process in midface by sampling survey in the Koreans. Sampling survey was conducted to 480 subjects who had preoperative pictures of the midface in Koreans. The excluding criteria of the subjects were with prior oculoplastic surgery, facial bone fracture, facial palsy, previous rejuvenation procedure, Grave's oculopathy and some medical history affecting eyelid position. Prevalence of tear trough deformity and palpebromalar groove in each subject, and age-related change in prevalence were analyzed. Prevalence of the tear trough deformity and the palpebromalar groove was 57.92% and 44.58%, respectively. Prevalence of tear trough deformity was higher than that of palpebromalar groove in both males and females(Chi-Square test, p<0.05). The tear trough deformity and the palpebromalar groove showed a strong positive correlation with age. All the subjects with the palpebromalar grooves had the tear trough deformities. From the results of survey, it suggested that the aging process of midface of the Korean, from medial to lateral direction, differed from that in westerns.

Change on Vertical Height of Palpebral Fissure between Sitting and Lying Position

We tried to check the vertical palpebral height when the patient sit up as well as when one lie down respectively. Measurements of the vertical palpebral height and corneal diameter were taken in pictures of both eyes of 96 Koreans. They consisted of 59 males and 37 females of average age 25.3. The picture was taken in the position of primary eyeball, and the measured values were adjusted by the known photometrical average value of corneal diameter. During adjustment, the ruler tool in the software Adobe(R) Photoshop(R) was used. They were divided into 4 groups: females with same or larger(group 1, n=20) and with smaller(group 2, n=17) than 11.3mm, and males with same or larger (group 3, n=28) and with smaller(group 4, n=31) than 11.6mm during sitting position. There was no statistical difference in the rate of respective postural effect on vertical height according to sex and the covering amount of cornea. However, the changing amount was meaningful statistically(p=0.000) through two samples t-test. The average ratio of vertical palpebral height was 1:0.929(sitting:lying). We introduce the objective way to compare postural change of vertical dimension of palpebral fissure through the photometrical method.

Simultaneous Non-transcolumellar Incisioned Rhinoplasty in Nasal Bone Fracture : Analysis of 121 Cases

The traditional treatment of nasal bone fracture is closed manual reduction. Disadvantage of the method arises from frequent recurrence and inaccurate correction because open method is nonused in anatomical result. In addition, since the interest about cosmetic problems rapidly rises, people who want aesthetic correction during reduction surgery are increasing. From June 2007 to June 2009, This study includes 121 patients who had been performed by correction of nasal bone fracture in our center. 98 out of 121 patients, were undergone with nasal tip plasty, septoplasty was done in 51 patients. Cartilage graft for augmentation rhinoplasty was performed in 36 patients. Average period of follow-up was 6 months and existence of complications such as nasal deviation, nasal obstruction, infection and etc were investigated. Reoperation was done in one patient who showed nasal obstruction, and patients who complained about other complications, such as nasal deviation, were observed. There is the need of more accurate reduction method than traditional non-invasive reduction maneuver, in order to reduce the occurrence of secondary deformation after nasal bone fracture. Hence the authors operated precise reduction by extended endonasal approach without columellar scar, and aesthetic correction rather than anatomical correction was done with variable cartilage if needed.

Correction of Problems after Eyelid Surgery using Various Techniques

Many techniques for prevention and correction of complication after blepharoplasty have been developed, however, satisfactory method has not yet been documented. The purpose of this article is to review common unfavorable complications after Asian cosmetic eyelid surgery, and to propose several methods of treatment for effective correction. From 1988 to 2008, authors reviewed 364 cases(480 eyes) of complications after cosmetic eyelid surgery. Follow-up period ranged from 6 months to 16 years. The results of treatments were classified into excellent, good, fair and unsatisfactory by operating surgeons, other surgeons, and by patients. About 40% of complications requiring revisional surgeries were treated early within 2 weeks after first operation. Other 60% of complications were treated by late reoperations, at least 6 months after first surgery. Majority of patients were satisfied with the results. However, a few patients reported unsatisfactory outcomes which required additional revisional procedures. The correction of complications following cosmetic eyelid surgery remains a difficult task. The strategies for successful Asian upper blepharoplasty include not only careful preoperative evaluation and delicate operative technique, but also, proper postoperative interventions such as early secondary blepharoplasty.