Correction of Retracted Ala Using Spacer Graft in Secondary Cleft Lip and Nose Deformity

PURPOSE: In patients with unilateral cleft lip and nose deformity, alar retraction is commonly seen on the non-cleft side after cleft side is corrected. Spacer graft was used to drag down the inferior border of the alar cartilage of the non-cleft side so as to match the cleft side. By performing spacer graft and septal extension graft together, symmetry and cosmetic improvements were achieved. METHODS: Seven unilateral cleft lip and nose deformity patients underwent surgery for alar retraction correction. The median age was 24 years (ranged from 15 to 34 years), and the median follow-up period was 7.4 months (ranged from 6 to 12 months). The perpendicular length from the longitudinal axis of the nostril to the alar rim, the nasolabial angle and the ala-labial angle were measured in the lateral view photo. The longest perpendicular length from the cephalic border of the alar rim to the parallel line of the alar base was measured in the frontal view photo. RESULTS: Improvement in alar retraction was seen after the surgery. There were no specific complications during the follow-up and the symmetry of both nostrils was satisfactory. No increase in the nasolabial angle or exposure of the nostrils was seen after the tip projection via tip plasty. CONCLUSION: The fundamental factor in correcting alar retraction with secondary cleft lip and nose deformity is repositioning the alar rim with spacer graft, which seems to be more physiologic than other methods. The method combining spacer graft with septal extension graft will bring symmetry as well as more cosmetic improvement in correction of alar retraction with secondary cleft lip and nose deformity.

The Evaluation of Topical Anesthetic Effects of a Liposome Encapsulated Mixture of Local Anesthetics (Lipo-MLA) / 대한마취과학회지

BACKGROUND: This study investigated the effect of topical analgesic effects of a liposome encapsulated mixture of local anesthetics (lipo-MLA) compared with EMLA. METHODS: 3% lipo-MLA (0.5% tetracaine base, 2.5% lidocaine base) and 5% lipo-MLA (1% tetracaine base, 4% lidocaine base) were encapsulated into liposomal vesicles made with egg yolk phosphatidylcholine, cholesterol and phosphatidyldioleoyl. 3% lipo-MLA and EMLA were applied to volunteers' forearms bilaterally with and without an occlusive dressing. The topical anesthetic effects of the lipo-MLA and EMLA as a control were evaluated by the pinprick test in 28 adult volunteers after 60 minutes of application. The analgesic influence of the concentration of local anesthetics was also compared with 3% and 5% lipo-MLA under a non-occlusive dressing. RESULTS: Analgesic effects of the 3% lipo-MLA were similar with EMLA under an occlusive dressing for 60 minutes. In addition, analgesic effects of the 3% lipo-MLA under a non-occlusive dressing were more potent than EMLA. Lipo-MLA under a non-occlusive dressing showed more potent analgesic effect than lipo-MLA under an occlusive dressing. 5% lipo-MLA was more potent than 3% lipo-MLA under a non-occlusive dressing. CONCLUSIONS: Lipo-MLA has more potent analgesic effects than EMLA without an occlusive dressing and 5% lipo-MLA is more potent than 3% lipo-MLA. Therefore, lipo-MLA appeared to be an improved topical analgesic formulation which provides a more potent and convenient topical application.

Anesthetic Management during Interventional Neuroradiologic Embolization of a Vein of Galen Malformation: A case report / 대한마취과학회지

The vein of Galen malformation is a midline intracranial arteriovenous fistula with aneurysmal dilatation of the vein of Galen. This abnormality, though rare, is associated with a bleak prognosis and significant mortality. However, significant advancements have been made in understanding the pathophysiology of this abnormality, and improvements in both interventional neuroradiologic embolization and microneurosurgical techniques have contributed to a better outcome. In neuroradiologic embolization, children are likely to become agitated and confused and thereby jeopardize the entire procedure. For this reason, this procedure is performed with the children under general anesthesia. We experienced a case of neuroradiologic embolization under general anesthesia with propofol. The patient was a 9- year-old boy who weighed 29 kg. He was healthy and had no other abnormalities in our preoperative evaluation. Throughout the entire procedure, especially before and after closure of the fistula, hemodynamic changes and unexpected events did not appear.