Treatment of Glabellar frown Lines Using Selective Nerve Block with Radiofrequency Ablation

PURPOSE: Corrugator supercilii muscle pulls eyebrow to inferomedial direction and produces the vertical component of the glabellar line formation. Current techniques for eliminating of glabellar frown include direct resection of corrugators and botulinum toxin injection. Muscle resection in endoscopic face lift procedure is relatively complex and has many disadvantages such as possible nerve injury, postoperative edema, pain and a long recovery period. The Botox treatment on the other hand is much more simple in technique but has a short duration of action. The authors have attempted new ways of finding improved treatment of the glabellar frown by selectively blocking of motor nerves innervating the corrugator supercili muscle by using radiofrequency ablation technique. METHODS: A total of 80 patients were recruited in our study during the period from Feb. 2007 to June 2008. A probe was introduced from the supraorbital ridge and advanced to the corrugator supercilii muscle. Nerve stimulator was then used to locate the nerve innervating the corrugator and radiofrequency ablation of the nerve was done. RESULTS: In all patients, there were marked improvement in glabellar frown after treatment. There were no reported cases of any relapses during the follow up period. No complication was noted such as facial nerve injury. No patient complained of any adverse symptoms other than slight discomfort due to swelling of the operation site. CONCLUSION: The treatment of glabellar frown lines using selective nerve block with radiofrequency ablation was not only less invasive but also excellent in surgical outcomes.

Clinical Experiences of Acrylic Splint on Pediatric Mandile Fracture

The goal of open reduction in mandibular fracture is to restore the underlying bony architecture to its pre-injury position in a stable fashion, with a minimal of aesthetic and functional impairment. Many cases of mandibular fracture are treated by intermaxillary fixation using arch bars after open reduction. In this study, after open reduction of fracture, 23 patients were grouped according to acrylic splint appliction. All patients was younger than 15 years old. Open reduction was performed by miniplate or interosseous wire fixation. After open reduction, 8 patients were applied with acrylic splint and 15 patients were applied with arch bar for intermaxillary fixation. Physical examination and postoperative panoramic x-ray were reviewed for the evaluation of occlusion. In the group where acrylic splint was used, 75% of the patients showed excellent subjective satisfaction and 25% showed good satisfaction. In the group where the acrylic splint was not used, 33% showed excellent and good satisfaction, 27% fair satisfaction and 1 patient showed poor satisfaction. On long-term follow- up, the group where acrylic splint was applied showed better occlusion compared to the group where acrylic splint was not applied.

Split Level Lid Resection for the Correction of Moderate Congenital Ptosis

Split-lid excision with or without levator hitching has been experienced in the correction of mild to moderate blepharoptosis in 18 lids in 15 patients. 12 patients were unilateral and 3 patients were bilateral. Split level resection was performed in cases of levator function of more than 7mm, whereas 5-6mm of levator function was addressed with additional levator hitching as described by Mustarde. In patients with a moderate degree of ptosis, the authors split the lid vertically into two layers and resected a horizontal block of full-thickness upper eyelid at two different levels. Most of the tarsal plate with its overlying conjunctiva was removed from one layer and, at a higher site, a corresponding amount of skin and orbicularis from the other. In patients with more severe degree of ptosis, the authors achieved levator complex shortening by folding some of the levator complex upward on itself after split-lid excision procedure. Undercorrection was seen in 4 lids, and lid lag on downward gaze was observed in 6 lids. In contrast, overcorrection or significant lagophthalmos at primary gaze could not be seen. Except for lid edema which abated during the ensuing several months, troublesome complication was not observed. It can be safely said from this that split-lid excision technique with or without levator hitching is a reasonable option in the correction of mild to moderate forms of blepharoptosis.

Treatment of Romberg`s Disease Using Superior Gluteal Perforator-based Flap

Romberg's disease manifests as progressive hemifacial atrophy of skin, soft tissue, and bone. Treatment involves three-dimensional reconstruction of all soft- tissue and skeletal disturbances. Soft-tissue reconstruction is directed at augmentation of deficient soft-tissue volume and there are many therapeutic modalities available, such as autologous tissue grafts and inorganic implants. The arrival of microsurgical techniques has improved the outlook for facial contour restoration. The tissues used for microsurgical tissue transfer include groin, scapular, and omentum. This article introduces our experience with the superior gluteal perforator-based flap for the restoration of facial contour defects in the patient of Romberg`s disease. Superior gluteal perforator flap has some advantages; It doesn`t need to transect or sacrifice of the gluteus maximus muscle, Flap elevation time is short, Blood flow of the perforator is reliable, There is no post-operative hindrance to walking in patient. The disadvantages of this perforator-based flaps are the anatomical variation in the location of perforators and the need for tedious dissection.