ABSTRACT
BACKGROUND: The most common surgical treatment for paralytic lagophthalmos is the placement of a weight implant in the upper eyelid; however, this technique confers the risks of implant visibility, implant extrusion, and entropion. In this study, we present a new technique of placing platinum weight implants between the levator aponeurosis and inner septum to decrease such complications. METHODS: A total of 37 patients with paralytic lagophthalmos were treated between March 2014 and January 2017 with platinum weight placement (mean follow-up, 520.1 days). After dissecting through the orbicularis oculi muscle, the tarsal plate and levator aponeurosis were exposed. The platinum weights (1.0–1.4 g) were fixed to the upper margin of the tarsal plate and placed underneath the orbital septum. RESULTS: Five patients could partially close their eye after surgery. The average distance between the upper eyelid and the lower eyelid when the eyes were closed was 1.12 mm. The rest of the patients were able to close their eye completely. Three patients patient developed allergic conjunctivitis after platinum weight insertion, which was managed with medication. None of the patients complained of discomfort in the upper eyelid after surgery. Visibility or extrusion of the implant were observed in three patients. CONCLUSIONS: Postseptal weight placement is a safe and reproducible method in both primary and secondary upper eyelid surgery for patients with paralytic lagophthalmos. It is a feasible method for preventing implant visibility, implant exposure, and entropion. Moreover, platinum is a better implant material than gold because of its smaller size and greater thinness.
Subject(s)
Humans , Conjunctivitis, Allergic , Entropion , Eyelid Diseases , Eyelids , Facial Paralysis , Follow-Up Studies , Methods , Orbit , Platinum , Prostheses and Implants , Thinness , Weights and MeasuresABSTRACT
BACKGROUND: Velopharyngeal insufficiency (VPI) may persist after primary repair of the cleft palate, and surgical correction is necessary in many cases. The purpose of this study is to evaluate the effect of double opposing Z-plasty (DOZ) in cleft palate patients suffering from VPI after primary two-flap palatoplasty. METHODS: Between March 1999 and August 2005, we identified 82 patients who underwent two-flap palatoplasty for cleft palate repair. After excluding the patients with congenital syndrome and mental retardation, 13 patients were included in the final study group. The average age of the patients who underwent DOZ at was 5 years and 1 month. Resonance, nasal emission, and articulation were evaluated by a speech pathologist. The velopharyngeal gaps were measured before and after surgery. RESULTS: Six patients attained normal speech capabilities after DOZ. The hypernasality grade was significantly improved after surgery in all of the patients (P=0.0015). Whereas nasal emission disappeared in 8 patients (61.5%), it was diminished but still persisted in the remaining 5 patients. Articulation was improved in all of the cases. In two cases, the velopharyngeal gap was measured using a ruler. The gap decreased from 11.5 to 7 mm in one case, and from 12.5 to 8 mm in the second case. CONCLUSIONS: The use of DOZ as a surgical option to correct VPI has many advantages compared with other procedures. These include short surgery time, few troublesome complications, and no harmful effects on the dynamic physiological functioning of the pharynx. This study shows that DOZ can be another option for surgical treatment of patients with VPI after two-flap palatoplasty.
Subject(s)
Humans , Cleft Palate , Intellectual Disability , Palate , Pharynx , Stress, Psychological , Velopharyngeal InsufficiencyABSTRACT
In cleft lip and/or palate patients with the complex congenital heart diseases, surgical repair of the cleft lip and/or palate has been postponed after the open heart surgery because the heart problem of the patient might cause more complications associated with anesthesia and surgery. There has been little report about experiences in the surgical management of these patients and optimal time of surgical intervention. Authors are introducing the experiences of performing corrective surgery of cleft lip and/or palate in the patients with congenital heart diseases before and after the open heart surgery. We managed five patients from May 1992 to March 2004. Two patients were male and the rest were female. One of them had cleft lip alone and others had cleft lip and palate. Two of them underwent delayed cleft lip and/or palate surgery after open heart surgery, and the rest had immediate intervention for cleft lip and/or palate. There was no complication during the operation and postoperative period. There would be no need to delay the corrective surgery of the cleft lip and/or palate after the open heart surgery, if solid medical team approach was available with the pediatric cardiologist and the anesthesiologist.
Subject(s)
Female , Humans , Male , Anesthesia , Cleft Lip , Cleft Palate , Heart , Heart Defects, Congenital , Heart Diseases , Palate , Postoperative Period , Thoracic SurgeryABSTRACT
Sagittal split ramus osteotomy(SSRO) has become one of the most popular procedure for correction of mandibular prognathism. Rigid fixation is favored for its stability and patient comfort. But there were few data presented about skeletal stability and factors contributing to relapse for sagittal split ramus osteotomy with rigid fixation. From August 1997 to August 2002, eleven patients, who underwent sagittal split osteotomy with rigid fixation, were studied. Patients with genioplasty or any other orthognatic surgical procedures were excluded from sample. Lateral cephalograms were analyzed before surgery, 1 month after surgery, and 12 months after surgery. The mean amount of surgical setback was 6.29 mm at pogonion and the mean amount of skeletal relapse was 1.29 mm at pogonion. The mean postoperative horizontal change of soft tissue pogonion was 5.66 mm posteriorly, vertical change of menton was 1.83 mm superiorly, and angular change of ramus inclination was 5.88 degree increased. The mean amount of postoperative movement was 1.9 mm anteriorly at soft tissue pogonion, 2.13 mm superiorly at menton, 0.8 degree was decreases at ramus inclination. The amount of skeletal relapse is related to the amount of setback. The results of this study present that the bilateral sagittal split osteotomy with rigid fixation has many advantages and stable procedure for the correction of mandibular prognathism.
Subject(s)
Humans , Genioplasty , Osteotomy , Osteotomy, Sagittal Split Ramus , Prognathism , RecurrenceABSTRACT
This study is to compare a tissue adhesive, 2-octylcyanoacrylate(Dermabond(R)), with conventional wound closure techniques for pediatric facial lacerations. Twenty children presenting to Asan Medical Center Emergency Department with facial lacerations in July 2001 were enrolled into this prospective clinical trial study. These patients were randomly assigned to treatment with either 2-octylcyanoacrylate or 6-0 monofilament sutures. The two groups were similar in both clinical and demographic characteristics. Photography taken at three months after treatment were rated by two plastic surgeons blinded to the method of closure. There was no difference between the two groups for appearance scores based on a visual analog scale(60.4mm for 2-octylcyanoacrylate versus 62.9mm for 6-0 monofilament sutures). The length of time for laceration repair was decreased in the 2-octylcyanoacrylate group(3.1 minutes for 2-octylcyanoacrylate versus 9.3 minutes for 6-0 monofilament sutures, p<0.001). The parents' assessment of the pain felt by their children in the 2-octylcyanoacrylate group was less. Moreover, the use of 2-octylcyanoacrylate obviates the need for suture removal. In conclusion, the use of 2-octylcyanoacrylate for pediatric facial laceration repair in Korean is an acceptable alternative which includes many advantages to conventional suturing with a comparable cosmetic outcome.
Subject(s)
Child , Humans , Emergency Service, Hospital , Lacerations , Photography , Prospective Studies , Sutures , Tissue Adhesives , Wound Closure TechniquesABSTRACT
No abstract available.