A Case Report of Chondroid Syringoma of Philtrum

PURPOSE: Chondroid syringoma is a rare mixed tumor of the skin that was first described by Hirsch and Helwig (1961). Characteristically, it is composed of the proliferation of epithelial cells in a myxoid and chondroid matrix. Most lesions occur on the head and neck region, and their size may range from 0.5~3 cm. Since a chondroid syringoma presents similar characteristics to other masses on the head and neck region, it is significantly important to distinguish with other masses by a surgical biopsy. METHODS: A 51-year old woman presented with a painless nodular mass (0.5 x 0.5 x 0.5 cm) on the philtrum, which appeared during the previous year. The mass was treated with a laser without a surgical biopsy. However, the size of the mass showed no changes. Surgical excision under local anesthesia was performed and sent for histopathology. RESULTS: Gross examination showed a mass surrounded by a well developed capsule within the dermal layer. After complete excision without injury to the orbicularis oris muscle, the wound was covered with a local flap. The histology examination revealed numerous cuboid epithelial cells with tuboalveolar structures and keratinous cysts within a chondroid stroma. No recurrence or metastasis was observed at the follow-up visits. CONCLUSION: Chondroid syringoma is a rare mass on the face. An accurate diagnosis is essential for optimal treatment. This paper reports a case of a chondroid syringoma on the philtrum with a brief review of the relevant literature.

Treatment of a Carotid-Cavernous Sinus Fistula via the Superior Ophthalmic Vein Approach: A Case Report

PURPOSE: Arteriovenous fistulas that involve the cavernous sinus often produce ophthalmologic symptoms and signs. Transvenous endovascular access is the method of choice for a carotid-cavernous sinus fistula. The superior ophthalmic vein is a safe and reasonable alternative route for the transvenous embolization of carotid-cavernous sinus fistula. We report a case of the embolization of a carotid-cavernous sinus fistula using the superior ophthalmic vein approach. METHODS: A 58 year old female had conjunctival congestion, periocular pain and diplopia with a 2 month duration. Diagnostic orbital CT, brain MRI and cerebral angiography revealed a carotid-cavernous sinus fistula. The fistula occlusion was treated by coil embolization using the superior ophthalmic vein approach. RESULTS: The initial presenting symptoms, conjunctival congestion, periocular pain and diplopia, decreased after surgery. Coil embolization via the superior ophthalmic vein approach was difficult because of the venous tortuosity and friability. During the follow up period, the patient was in a good condition without complications. CONCLUSION: Surgical exposure of the superior ophthalmic vein provides direct venous access to the cavernous sinus as well as an effective and safe treatment approach. The cooperation of the plastic surgeon and interventionist is a factor in successful treatment.

The Suture Method Using Ribbon Shaped Knot in Pediatric Facial Lacerations

PURPOSE: Stitching out in facial simple laceration on children, we use No.11 blade. But the procedure is technically demanding to take care of the uncooperative pediatric patient. When we suture a laceration on the pediatric patients, we apply this method using ribbon shaped knot. On stitching out, We pull on the edge of a stitching fiber easily without injury about normal tissue. METHODS: From May 2006 to December 2007 we studied 54 pediatric patients under six years of age, who had facial lacerations in Plastic Surgery department Emergency room. Among them 35 were male, 19 were female and the average age was 3.9. RESULTS: For following up dressing, ribbon shaped knots were not loosened. After stitching out in facial laceration on children, Major complications of infection, hematoma, dehiscence were not found. CONCLUSION: The advantage of this operation method using ribbon shaped knot when stitching out the fiber on the uncooperative pediatric patients, is easy to perform and to reduce the stitching time, without sedation.

Antibiotic Prophylaxis' Effect on Enophthalmos in Orbital Floor Fracture with Chronic Maxillary Sinusitis

PURPOSE: Orbital floor fracture has open wound to maxillary sinus and if the patient has chronic maxillary sinusitis, it may be have more risk of infection, complications. The purpose of this comparative study is to be the effectiveness of prophylactic antibiotics in orbital floor fracture with chronic maxillary sinusitis. METHODS: We studied 20 patients who diagnosed as orbital floor fracture with chronic maxillary sinusitis from march, 2005 to may, 2006. Among them 16 were male, 4 were female and age was ranged from 15 to 68, average was 42. A day before operation, Prophylactic antibiotics were used to 10 patients. Prophylactic antibiotics were not used to 10 patients. We defined control group as prophylactic antibiotics injection group a day before operation. After surgery, we confined use of same antibiotic for 7 days in both group. After 6 month from surgery, we compare the degree of enophthalmos from healthy side to legion side with hertel exopthalmometry(Inami, Japan) in control group and non-prophylactic antibiotics injection group. RESULTS: In control group, comparison of discrepancy between enophthalmic eyeball and normal eyeball with Hertel exophthalmometer was 1.1mm and non-prophylactic antibiotics injection group was 2.1mm. In independent sample t-test, control group was showed statistically significant difference with non-prophylactic antibiotics injection group(p=0.007). CONCLUSIONS: In orbital floor fracture with chronic maxillary sinusitis, bacteria in maxillary sinus can increase post-operative complication by infecting infraorbital soft tissue, and it is thought to be antibiotic prophylaxis is play a role in decrease in degree of enophthalmos. We feel the need to further study of prophylactic antibiotics in orbital floor fracture with chronic maxillary sinusitis.

New Method for Removing Involuted Bony Fragment in Reduction Angleplasty of Mandible

Oriental women, in general, have prominent mandibular angles and short chins that are thought to be unattractive, square and muscular appearance. Therefore, mandibular ostectomy is one of the most common aesthetic facial bone contouring surgery in oriental and intraoral approach has been used commonly. After the angle ostectomy via intraoral approach, it is not easy for unexperienced surgeons to remove the involuted bony fragment due to the limited view and operation access. This report describes a new method for removal of involuted bony fragment in reduction mandibular angleplasty Thirty eights Case of reduction mandibular angleplasty has been operated from February 2003 to June 2005. We have experienced the involuted bony segment in 12 cases after angle ostectomy. We have adopted periosteal cottle elevator and 18 gauze spinal needle as new methods of extracting the involuted bony fragment. The institutes were used to push the involuted bone segment. We could easily extract the bony fragment with new methods involuted 12 patients mandibular angle within 5 minutes. No major complications were occurred.

The Changes of Bone and Soft Tissue after Maxillary Anterior Segmental Osteotomy and Advancement Genioplasty

PURPOSE: Mid and lower facial convexity is more common in Oriental people than in Caucasian. Bimaxillary dentoalveolar protrusion is characterized by procumbent teeth, protruding lips, acute nasolabial angle, gummy smile, receding chin, facial convexity. Especially, pure maxillary dentoalveolar protrusion is less frequent than bimaxillary dentoalveolar protrusion. Therefore, it is important to make an accurate decision for the operation throughout the history taking, cephalogram, dental cast to arrive at accurate diagnosis and surgical plan. METHODS: From December 2002 to June 2004, ten patients with maxillary dentoalveolar protrusion and microgenia were corrected by maxillary anterior segmental osteotomy and advancement genioplasty. 10 patients were analyzed by preoperative and postoperative clinical photography, posteroanterior and lateral cephalograms. RESULTS: No major complications were occurred throughout the follow-up period except one of the over- recessed, otherwise most of the patients were satisfied with the result. CONCLUSION: We could correct the occulusal relationship with teeth and improve lower facial profile, asthetically and functionally, by maxillary anterior segmental osteotomy and advancement genioplasty.

The Usefulness of Mandible CT Scanning in the Diagnosis and Treatment of Mandible Fracture

Mandible fractures, among facial injuries, cause severe pain and difficulties in masticating movement, moreover, it can also bring problems to social life. Accurate diagnosis and proper treatment for mandible fractures is needed to preserve mandibular function and to prevent malformation and complications. A history taking, a physical examination, a simple radiograph, and a conventional facial computed tommography are usually used to diagnose mandible fractures. However, these methods are not enough to understand the three dimensional structured mandible, the fractures-types, the relationship between inferior alveolar nerve and fractures. In the course of planning mandible operation, conventional facial computed tommography has wider section than mandible computed tommography, and horizontal & vertical mid-line division. Resultly, only poor information about inferior alveolar nerve could be achieved and no vertical imaging of mandible. Oppositely, mandible CT could get vertical imaging, and enough information, cause of getting 1mm-gap slice. In this study, we have compared image- information from mandible CT with from conventional facial CT about 28 patients(28/64 1 year-visit patients). Vertical images of mandible could not only help our pre- surgery diagnosis, but also result better post-surgery effect. Mandible enlarged fine-gap CT has used to examine mandible fractures in our hospital, and could be reported that makes operation plan and operation approach easier than conventional facial CT.

Correction of Pixie Ear Using Non-incisional Method

There is a long tradition to decorate the ear lobules, so the ear lobules have some special meaning compare to other accessory organs of a face. Among many deformities of ear lobule the pixie ear is a long lopped ear which does not have a narrow part between the ear lobule and the cheek. Especially, it is considered unfortunate because of the oriental tradition that the thick and round ear lobule brings good luck. Nakamura and others defined the pixie ear by the angle of the vertical line and the bottom line of the ear lobule, and when the angle is between 30 to 69 degrees, it can be said the pixie ear. There are many reports about correction of the pixie ear which occurs after face lifting, but there is not a manual method and several surgeons use various methods. We have performed operations by the nonincisional method for the last 1 year. A simplified technique for correction of the pixie earlobe deformity is presented. Three stab incisions are made at the base of the ear lobule, at a 9 o'clock, 6 o'clock, and 3 o'clock postauricular position in three women without rhytidectomy. A subdermal triangular 4-0 prolene suture is passed inferiorly down through the 9 o'clock incision, exited the 6 o'clock incision, passed posteriorly up and out through the 3 o'clock postauricular incision. Once again, the suture is returned. Compared to the existing methods, this method is simple, does not take much time and make the better shape, because the quantity of ear lobule can be maintained thanks to the unnecessity of skin incision. In this article, we reported about this method on the basis of literature review and clinical experience.