ABSTRACT
Naso-orbito-ethmoidal (NOE) fractures are complicated fractures of the mid-face. The treatment of NOE fractures is challenging and a comprehensive treatment strategy is required. We introduce a case of NOE fracture treated with open reduction and suspension sutures. A 28-year-old woman presented with a unilateral NOE fracture. To reduce the frontal process of the maxilla, a suspension suture was made by pulling the fragment using a double arm suture via a transcaruncular incision. The suture thread was placed in the horizontal plane. Another suspension suture on the inferior orbital rim assisted reduction procedure, and they passed through the overlying skin. The reduction alignment could be finely adjusted by tightening the transcutaneous suture threads while checking the degree of bone alignment through the subciliary incision. The two suture threads were suspended using a thermoplastic nasal splint. An additional skin incision on the medial canthal area, which would have resulted in a scar, could be avoided. Four months postoperatively, computed tomography showed an accurate and stable reduction. The patient was satisfied with her aesthetic appearance, and functional deficits were not present.
ABSTRACT
Forehead flaps are widely used to reconstruct nasal defects. The authors report a case wherein a folded forehead flap was used to reconstruct a large nasal defect after wide excision of squamous cell carcinoma. A 65-year-old man was diagnosed with squamous cell carcinoma by a punch biopsy conducted at the dermatology department, and the mass was located in the left nasal vestibule. A forehead flap was planned to cover the full-thickness defect that occurred after wide excision. A flap with an extended transverse skin paddle was designed; thereafter, the distant part of the flap was folded up to the nasal lining inside the nose. The interpolation flap was properly maintained for 3 weeks, and flap division was performed. The reconstructed nose exhibited symmetry during a 5-month observation period. A folded forehead flap is a surgical option when considerable nasal restoration, including soft tissue and the internal lining, is necessary.
ABSTRACT
The scalp is the thickest skin in the body and protects the intracranial structures. The coverage of a large scalp defect is a difficult surgical procedure, the full details of which must be considered prior to the procedure, such as defect size and depth, and various factors related to the patient’s general condition. Although a free flap is the recommended surgical procedure to cover large scalp defects, it is a high-risk operation that is not appropriate for all patients. As such, other surgical options must be explored. We present the case of a patient with an ulcer on the scalp after wide excision and split-thickness skin graft for squamous cell cancer. We successfully performed a reverse temporalis muscle flap for this patient.
ABSTRACT
Intraosseous hemangioma is a rare, benign vascular tumor of endothelial origin. It accounts for fewer than 1% of all hemangiomas, and very rarely occurs in the face. Intraosseous hemangioma usually presents as an asymptomatic lesion, but symptoms can occur due to the mass effect. The authors describe a case of intraosseous hemangioma of the zygoma with a review of the relevant literature. A 44-year-old man presented with a chief complaint of painless swelling on the left zygomatic region that had been slowly growing for the past year. On physical examination, a hard, non-movable mass in a deep layer was palpated. On computed tomography performed to evaluate its layers and extent, trabeculation was found inside the mass, but the lack of destruction of the surrounding bone suggested that the mass was benign. Complete surgical excision was performed under local anesthesia. After complete excision of the mass, slight erosions remained on the cortical bone of the zygoma, but because it was small enough not to cause a facial deformity such as depression or asymmetry, no additional reconstructive procedure was performed. There were no symptoms or recurrence during a 8-month follow-up period.
ABSTRACT
Primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder is a rare disease characterized by a single mass on the face or upper part of the trunk. It usually presents an asymptomatic and favorable progression, and its histopathologic findings include small and medium-sized lymphoid cells. The authors report a case of primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder on the forehead. A 51-year-old man presented with a protruding mass on his forehead that the patient had noted 1 month previously. Surgical excision and a permanent biopsy were performed under local anesthesia. Based on the biopsy results, the mass was diagnosed as a primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder. There was no evidence of recurrence at a 15-month follow-up visit.
ABSTRACT
Intraosseous hemangioma is a rare, benign vascular tumor of endothelial origin. It accounts for fewer than 1% of all hemangiomas, and very rarely occurs in the face. Intraosseous hemangioma usually presents as an asymptomatic lesion, but symptoms can occur due to the mass effect. The authors describe a case of intraosseous hemangioma of the zygoma with a review of the relevant literature. A 44-year-old man presented with a chief complaint of painless swelling on the left zygomatic region that had been slowly growing for the past year. On physical examination, a hard, non-movable mass in a deep layer was palpated. On computed tomography performed to evaluate its layers and extent, trabeculation was found inside the mass, but the lack of destruction of the surrounding bone suggested that the mass was benign. Complete surgical excision was performed under local anesthesia. After complete excision of the mass, slight erosions remained on the cortical bone of the zygoma, but because it was small enough not to cause a facial deformity such as depression or asymmetry, no additional reconstructive procedure was performed. There were no symptoms or recurrence during a 8-month follow-up period.
ABSTRACT
Background@#Hand fractures can be treated using various operative or nonoperative methods. When an operative technique utilizing fixation is performed, early postoperative mobilization has been advocated. We implemented a protocol involving controlled active exercise in the early postoperative period and analyzed the outcomes. @*Methods@#Patients who were diagnosed with proximal phalangeal or metacarpal fractures of the second to fifth digits were included (n=37). Minimally invasive open reduction and internal fixation procedures were performed. At 3 weeks postoperatively, controlled active exercise was initiated, with stress applied against the direction of axial loading. The exercise involved pain-free active traction in three positions (supination, neutral, and pronation) between 3 and 5 weeks postoperatively. Postoperative radiographs and range of motion (ROM) in the interphalangeal and metacarpophalangeal joints were analyzed. @*Results@#Significant improvements in ROM were found between 6 and 12 weeks for both proximal phalangeal and metacarpal fractures (P<0.05). At 12 weeks, 26 patients achieved a total ROM of more than 230° in the affected finger. Postoperative radiographic images demonstrated union of the affected proximal phalangeal and metacarpal bones at a 20-week postoperative follow-up. @*Conclusions@#Minimally invasive open reduction and internal fixation minimized periosteal and peritendinous dissection in hand fractures. Controlled active exercise utilizing pain-free active traction in three different positions resulted in early functional exercise with an acceptable ROM.
ABSTRACT
Primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder is a rare disease characterized by a single mass on the face or upper part of the trunk. It usually presents an asymptomatic and favorable progression, and its histopathologic findings include small and medium-sized lymphoid cells. The authors report a case of primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder on the forehead. A 51-year-old man presented with a protruding mass on his forehead that the patient had noted 1 month previously. Surgical excision and a permanent biopsy were performed under local anesthesia. Based on the biopsy results, the mass was diagnosed as a primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder. There was no evidence of recurrence at a 15-month follow-up visit.
ABSTRACT
Juvenile psammomatoid ossifying fibroma (JPOF) is a rare, benign, fibro-osseous variant of ossifying fibroma. It exhibits short-term rapid growth and has a high recurrence rate. Herein we describe a case of JPOF of the maxilla that was treated via complete excision utilizing an intraoral approach with immediate reconstruction using an iliac bone graft, in conjunction with a comprehensive review of the literature. A 20-year-old man presented with a mass on his right cheek that he reported had been growing over the last 10 months. In that cheek he had noticed fullness and experienced pressure, tenderness, and fluffiness, with no other ophthalmic or dental symptoms. After clinical, radiological, and histological examinations, the diagnosis was confirmed as JPOF. Surgical excision was performed, followed by immediate reconstruction with an autologous iliac cortical and cancellous bone graft harvested from the right iliac crest under general anesthesia. Good cicatrization of the intraoral surgical wounds and right iliac crest were evident. He was monitored for 6 months after the surgery and exhibited appropriate midfacial contour. There were no signs of recurrence or complications.
ABSTRACT
Cutaneous horn is the clinical entity, which is circumscribed, conical, markedly hyperkeratotic lesion in which the height of the keratotic mass amounts to at least half of its largest diameter. It may be associated with many different pathological lesions. It is a relatively rare and a kind of epidermal tumor that generally appears as a conical projection. Here, we report rare case of congenital cutaneous horn. A 39-month-old female Korean patient presented at our clinic with a mass at the tip of her nose present since birth. Under general anesthesia, cutaneous horn of nasal tip was completely excised without any complications. The operation site was small enough to perform a primary closure, without any nasal deformity. Histopathologically, it was reported as a fibroepithelial polyps. After operation, there is no evidence of recurrence at 16 months of follow-up.
ABSTRACT
Xeroderma pigmentosum is a rare autosomal recessive disease, related to defects in DNA repair mechanism. It presents skin lesions on sun-exposed areas, leading to various skin cancer. Skin lesions can be treated with cryotherapy, skin resurfacing, 5-FU, Imiquimod, topical T4 endonuclease V, radiotherapy and genetic therapy, but invasive skin cancer should be treated by a surgery. We report a 12-year-old female xeroderma pigmentosum patient with recurrent basal cell carcinoma successfully treated by skin grafting. In that there is no cure for this disease, prevention and patient education is most important.
ABSTRACT
Cutaneous horn is the clinical entity, which is circumscribed, conical, markedly hyperkeratotic lesion in which the height of the keratotic mass amounts to at least half of its largest diameter. It may be associated with many different pathological lesions. It is a relatively rare and a kind of epidermal tumor that generally appears as a conical projection. Here, we report rare case of congenital cutaneous horn. A 39-month-old female Korean patient presented at our clinic with a mass at the tip of her nose present since birth. Under general anesthesia, cutaneous horn of nasal tip was completely excised without any complications. The operation site was small enough to perform a primary closure, without any nasal deformity. Histopathologically, it was reported as a fibroepithelial polyps. After operation, there is no evidence of recurrence at 16 months of follow-up.
ABSTRACT
Xeroderma pigmentosum is a rare autosomal recessive disease, related to defects in DNA repair mechanism. It presents skin lesions on sun-exposed areas, leading to various skin cancer. Skin lesions can be treated with cryotherapy, skin resurfacing, 5-FU, Imiquimod, topical T4 endonuclease V, radiotherapy and genetic therapy, but invasive skin cancer should be treated by a surgery. We report a 12-year-old female xeroderma pigmentosum patient with recurrent basal cell carcinoma successfully treated by skin grafting. In that there is no cure for this disease, prevention and patient education is most important.
ABSTRACT
BACKGROUND: Brown adipocytes have thermogenic characteristics in neonates and elicit anti-inflammatory responses. We postulated that thermogenic brown adipocytes produce distinctive intercellular effects in a hypobaric state. The purpose of this study is to analyze the correlation between brown adipocyte and regulatory T cell (T(reg)) expression under intermittent hypobaric conditions. METHODS: Brown and white adipocytes were harvested from the interscapular and flank areas of C57BL6 mice, respectively. Adipocytes were cultured with syngeneic splenocytes after isolation and differentiation. Intermittent hypobaric conditions were generated using cyclic negative pressure application for 48 h in both groups of adipocytes. Expression levels of T(regs) (CD4 + CD25 + Foxp3 + T cells), cytokines [tumor necrosis factor-α (TNF-α) and interleukin-10 (IL-10), and the programmed death-ligand 1 (PD-L1)] co-inhibitory ligand were examined. RESULTS: Splenocytes, cultured with brown and white adipocytes, exhibited comparable T(reg) expression in a normobaric state. Under hypobaric conditions, brown adipocytes maintained a subset of T(regs). However, a decrease in T(regs) was found in the white adipocyte group. TNF-α levels increased in both groups under hypobaric conditions. In the brown adipocyte group, anti-inflammatory IL-10 expression increased significantly; meanwhile, IL-10 expression decreased in the white adipocyte group. PD-L1 levels increased more significantly in brown adipocytes than in white adipocytes under hypobaric conditions. CONCLUSION: Both brown and white adipocytes support T(reg) expression when they are cultured with splenocytes. Of note, brown adipocytes maintained T(reg) expression in intermittent hypobaric conditions. Anti-inflammatory cytokines and co-inhibitory ligands mediate the immunomodulatory effects of brown adipocytes under altered atmospheric conditions. Brown adipocytes showed the feasibility as a source of adjustment in physical stresses.
Subject(s)
Animals , Humans , Infant, Newborn , Mice , Adipocytes , Adipocytes, Brown , Adipocytes, White , Coculture Techniques , Cytokines , Interleukin-10 , Ligands , NecrosisABSTRACT
BACKGROUND: This study was conducted to determine the relationship between third molar (M3) and mandibular fracture.METHODS: Patients with unilateral mandibular angle or condyle fractures between 2008 and 2018 were evaluated retrospectively. Medical records were reviewed regarding the location of fractures, and panoramic radiographs were reviewed to discern the presence and position of ipsilateral mandibular third molars (M3). We measured the bony area of the mandibular angle (area A) and the bony area occupied by the M3 (area B) to calculate the true mandibular angle bony area ratio (area A–B/area A× 100).RESULTS: The study consisted of 129 patients, of which 60 (46.5%) had angle fractures and 69 (53.5%) had condyle fractures. The risk of angle fracture was higher in the presence of M3 (odds ratio [OR], 2.2; p< 0.05) and the risk of condyle fracture was lower in the presence of M3 (OR, 0.45; p< 0.05), than in the absence of M3. The risk of angle fracture was higher in the presence of an impacted M3 (OR, 0.3; p< 0.001) and the risk of condyle fracture was lower in the presence of an impacted M3 (OR, 3.32; p< 0.001), than in the presence of a fully erupted M3. True mandibular angle bony area ratio was significantly lower in the angle fractures than in the condyle fractures (p= 0.003).CONCLUSION: Angle fractures had significantly lower true mandibular angle bony area ratios than condyle fractures. True mandibular angle bony area ratio, a simple and inexpensive method, could be an option to predict the mandibular fracture patterns.
Subject(s)
Humans , Mandible , Mandibular Fractures , Medical Records , Methods , Molar, Third , Retrospective Studies , Tooth, ImpactedABSTRACT
BACKGROUND: Temporal hollowing is inevitable after decompressive craniectomy. This complication affects self-perception and quality of life, and various techniques and materials have therefore been used to restore patients’ confidence. Autologous fat grafting in postoperative scar tissue has been considered challenging because of the hostile tissue environment. However, in this study, we demonstrate that autologous fat grafting can be a simple and safe treatment of choice, even for postoperative depressed temporal scar tissue. METHODS: Autologous fat grafting was performed in 13 patients from 2011 to 2016. Fat was harvested according to Coleman’s strategy, using a tumescent technique. Patient-reported outcomes were collected preoperatively and at 1-month and 1-year follow-ups. Photographs were taken at each visit. RESULTS: The thighs were the donor site in all cases for the first procedure. The median final volume of harvested fat was 29.4 mL (interquartile range [IQR], 24.0–32.8 mL). The median final volume of fat transferred into the temporal area was 4.9 mL on the right side (IQR, 2.5–7.1 mL) and 4.6 mL on the left side (IQR, 3.7–5.9 mL). There were no major complications. The patient-reported outcomes showed significantly improved self-perceptions at 1 month and at 1 year. CONCLUSIONS: Despite concerns about the survival of grafted fat in scar tissue, we advise autologous fat grafting for patients with temporal hollowing resulting from a previous craniectomy.
Subject(s)
Humans , Adipose Tissue , Cicatrix , Decompressive Craniectomy , Follow-Up Studies , Lipectomy , Quality of Life , Self Concept , Thigh , Tissue Donors , Transplantation , Transplantation, Autologous , TransplantsABSTRACT
BACKGROUND: This study was conducted to determine the effect of the distributional relationship between dental roots and the mandibular bone on single mandibular bone fractures, which are common craniofacial fractures. METHODS: This was a retrospective, single-center study in Seoul, Korea. Patients with single mandibular fractures in the symphysis, parasymphysis, body, and angle area, with tooth structure involvement were included. The control group included patients with simple, bone-level lacerations without fractures. In total, 94 patients (72 males and 22 females) were included in the treatment group, and 125 (71 males and 54 females) were included in the control group. The height of the mandibular bone and the dental root were measured with panoramic radiography. The central incisor represented the symphysis area, the canine represented the parasymphysis area, the first molar represented the body area, and the second molar represented the angle area. RESULTS: In the treatment group, symphysis fractures occurred in 16 patients (17%), parasymphysis fractures in 36 patients (38%), body fractures in 17 patients (18%), and angle fractures in 25 patients (27%). The ratios of the dental roots to the total height of the mandibular bone in the treatment group were 30.35%, 39.75%, 39.53%, and 36.27% for symphysis, parasymphysis, body, and angle areas, respectively, whereas in the control group, they were 27.73%, 39.70%, 36.76%, and 35.48%. The ratios of the treatment group were significantly higher than those of the control group. CONCLUSION: The results show that the higher ratio of the dental root to the height of the mandibular bone increases the fracture risk.
Subject(s)
Humans , Male , Fractures, Bone , Incisor , Korea , Lacerations , Mandible , Mandibular Fractures , Molar , Radiography, Panoramic , Retrospective Studies , Seoul , Tooth , Tooth RootABSTRACT
Frontal sinus fractures, particularly anterior sinus fractures, are relatively common facial fractures. Many agree on the general principles of frontal fracture management; however, the optimal methods of reduction are controversial. The subbrow approach enables accurate reduction and internal fixation of the fractures in the anterior table of the frontal sinus by allowing direct visualization of the fracture. Given the surgical success in reduction and rigid fixation, patient satisfaction, and aesthetic benefits, the transcutaneous approach through a subbrow incision is superior to other reduction techniques used in the management of an anterior table frontal sinus fracture.