Outcomes of a superiorly-based pharyngeal flap for the correction of velopharyngeal dysfunction

Background@#This study investigated the outcomes of pharyngeal flap surgery in Asian patients with velopharyngeal dysfunction (VPD), with a focus on postoperative improvements in speech articulation and complications. Additionally, this study explored whether the cause of VPD and the timing of surgery affected outcomes in terms of speech improvement. @*Methods@#A retrospective review was conducted of the medical records of 72 Asian VPD patients who underwent pharyngeal flap surgery performed by a single surgeon from 1996 to 2014. Operative complications were analyzed for all 72 patients, and preoperative and postoperative speech articulation tests were compared for the subset of 43 patients in whom such testing was possible. The relationships of age at surgery and the cause of VPD with the extent of improvement in speech articulation were also investigated. @*Results@#Nine of the 72 patients (13%) experienced wound-related complications. Furthermore, 34 patients (47%) reported persistent snoring lasting for over 3 months, and 16 (22%) reported snoring for over 1 year. Three patients (4%) underwent reoperation. Speech articulation scores significantly improved postoperatively across all groups. Younger age at surgery was associated with greater improvements in speech outcomes, but no significant relationship was found between the cause of VPD and the extent of the postoperative improvement in speech outcomes. @*Conclusion@#Speech outcomes improved after pharyngeal surgery in Asian patients with VPD. Early surgery was associated with favorable speech outcomes, but no association was found between the cause of VPD and postoperative speech outcomes.

Evaluation of the donor site after the median forehead flap

BACKGROUND: Forehead flaps are useful for facial reconstruction. Studies of these flaps have mostly focused on the results of the reconstruction. However, due to the scarring and changes on the forehead caused by the median forehead flap (MFF), surgeons may be reluctant to perform this flap. Research into the donor site is needed for practical purposes. METHODS: We examined 42 patients who underwent an MFF at Pusan National University Hospital from 1996 to 2016. Based on a retrospective chart review, we examined the occurrence of complications. We also evaluated scars on the forehead using the Vancouver Scar Scale (VSS) and assessed changes in the eyebrow position of 22 patients. RESULTS: No complications occurred in the 42 patients. The mean VSS score of the 22 patients was 2.8±0.79. The ratio of the height of the eyebrow on each side to the distance between the medial canthi increased postoperatively, meaning that both the left and right brows were elevated slightly (P=0.026 and P=0.014). However, the symmetry between the left and right sides did not change (P=0.979). The ratio of the interbrow distance to the distance between the medial canthi decreased slightly, meaning that the interbrow distance narrowed mildly (P < 0.001). Moreover, there were no noticeable changes in the brow position as seen in a photo overlay. CONCLUSIONS: There were no notable complications in the forehead. Forehead scarring was acceptable. No change in brow symmetry was observed via photographic measurements and a photo overlay. Therefore, we propose that the MFF is a useful choice for minimizing scarring or deformation of the donor site.

Characteristics and Treatment of Cutaneous Melanoma of the Foot

BACKGROUND: In East Asia, the foot is the most common site of cutaneous melanoma. The purpose of this study was to investigate the differences between cutaneous melanoma of the foot and melanomas of other sites. METHODS: We studied 52 patients who underwent surgical treatment for cutaneous melanoma of the foot from September 2000 to January 2015. Through a retrospective review of their medical records, we collected data relating to their sex, age, histopathological subtype, Clark level, tumor thickness, lymph node involvement, stage, and survival rate, and we compared these parameters to those of 61 patients treated for melanoma of other sites. Moreover, we analyzed the surgical procedures, complications, and mortality rates associated with cutaneous melanoma on various parts of the foot. RESULTS: Melanoma of the foot differed from other melanomas only in the histopathological subtype. Other clinical features, including survival rate, did not differ significantly between the two groups heel was the most common site of melanoma of the foot (22 cases, 42.3%). The method of reconstruction varied depending on the region involved. CONCLUSIONS: A comparison of melanoma of the foot to other melanomas showed that melanoma of the foot was associated with a significantly different distribution of histological subtypes. Consistent with previous findings, we found that the acral lentiginous subtype was the most common among melanomas of the foot. Furthermore, in contrast with previous studies, we did not find a worse prognosis or lower survival rate for melanoma of the foot in comparison with other melanomas.

A Case of Synovial Sarcoma Involved in the Infratemporal Fossa Resected with Subtemporal-Infratemporal Fossa Approach with Hearing Preservation / 대한이비인후과학회지

Synovial sarcoma is a rare mesenchymal tumor that usually occurs in the extremities of young adults. Only 10% originates from the head and neck region, where the hypopharynx and retropharynx are the most common involved. Fewer than 100 cases of synovial sarcoma have been reported in this area. The infratemporal region, by virtue of its relatively concealed location, is a difficult site to access. It is considered a mainstay to design an appropriate technique to provide maximum exposure with minimal morbidity and preserve hearing ability, which may be achieved by the subtemporal-infratemporal fossa approach. We experienced a 50-year-old female patient who was suffering from right infratemporal fossa mass. We report this rare case that was successfully removed via this approach with a literature review.

Reconstruction of the Partial Soft Tissue Defect of the Nose

Reconstruction of total nasal defect is limited in methods, but in cases of partial nasal defect, various methods can be adapted according to the size, shape and location. The authors tried to summarize the relationship between the etiology, location, size of partial nasal defect and reconstructive methods. The authors experienced 27 patients of partial nasal defect for the recent 3 years, male patients were 13 and female patients were 14 among them. The age of the patients ranged from 27 to 78. Malignant skin tumor was the most common among the causes of the defect: 16 cases of basal cell carcinoma, 4 cases of squamous cell carcinoma. The locations of the defect can be summarized as 8 cases of nasal alar area, 8 cases of nasal tip area, 6 cases of nasal side wall and 5 cases of nasal dorsum. As reconstructive methods, the authors used median forehead flap in 7 cases, dorsal nasal flap in 6 cases, full thickness skin graft in 5 cases, bilobed local flap in 3 cases, nasolabial flap in 3 cases, and other local flap in 3 cases. Skin graft is an easy method for the shallow defect, but its major disadvantage is color mismatch with adjacent skin. In cases of flap surgery, though it often causes deformity in contour, appropriate reconstruction was possible with through preoperative evaluation. According to our survey, local flap such as bilobed flap was enough for the defect of small size, and in cases moderate to large sized defect, nasolabial flap was appropriate for defect in nasal tip area, dorsal nasal flap was good for the defect in nasal dorsum and median forehead flap was useful for the defect in nasal side wall. The authors presents our comparative results of the 27 cases of partial nasal defect for the recent 3 years with the hope of being contributed in choosing the reconsfructive methods in the future.

CLINICAL EXPERIENCES OF RESTYLANE(R) IMPLANTATIONS

The search for the ideal augmentation material of facial soft tissues has been an ongoing effort for many years. Injectable soft tissue substitutes provide an affordable, non-surgical alternative for correcting contour defects in facial skin. A safe and effective material for this purpose should respect certain characteristics that it should be biocompatible, non-antigenic, nonpyrogenic, noninflammatory, noninflammatoy, nontoxic, easy to use, stable after injection, non-migratory, long-lasting but reabsorbable, natural looking and not too expensive. Although many biomaterials are currently on the market, none meets all the above criteria. The recent development of hyaluronic acid gels(Restylane ) for dermal implantation is therefore particularly interesting in treating the aging face. Restylane is produced in cultures of Equine streptococci by fermentation in presence of sugar, the hyaluronic acid chains are then chemically stabilized through permanent epoxidic cross-links that the manufacturer reports to alter only about 1% of the hyaluronan molecular network. The resulting viscoelastic transparnet gel, suitable for intradermal infection, has a concentration of 20 mg/ml, is delivered in disposable syringes (0.7 ml) ready for use, using a 30 gauge needles. The twenty-one patients in thirty area were treated with facial intradermal implantation of hyaluronic acid gel for augmentation therapy of wrinkles and folds for recoutouring. The results were evaluated in all patients by subjective judgment by the physician and the patients. This study provides a clinical evaluation of safety and efficacy of a cross-linked stabilized non-animal hyaluronic acid gel to determine its characteristics, advantages, disadvantages, and side-effects in Korean. We concluded that Restylane implantation was soft, easy to use and long lasting effective materials in augmentation therapy of soft tissue of face.

THE COMPARATIVE HISTOPATHOLOGIC STUDY BETWEEN THE FRONTAL PROGRESSIVE BALDNESS AREA AND THE OCCIPITAL NON-BALDNESS AREA IN KOREAN MALE PATTERN BALDNESS

Hair takes a great role in featuring man's appearance and absence of hair can causes troubles in physical and psychological aspects. Many efforts have been made to treat male pattern baldness, including medical therapy and surgical correction, but there is not a definite and eternal method of treatment. Even though the diagnosis of male pattern baldness can be made with its characteristic clinical manifestations, histopathological study must be done for definite diagnosis. Author obtained biopsy material from the frontal progressive baldness area and the occipital non-baldness area with punch biopsy in 20 patients who were diagnosed to be Type II and III male pattern baldness according to the Norwood classification. A comparative study was done in the basis of histopathology using serial vertical section of the biopsy materia with the aid of light microscope and the results are as follows : 1. The average number of total hair in the frontal area was on third than that of occipital area and the number of anagen hair was less in the frontal area. The number of telogen hair in the frontal area was seven times more than that of occipital area. 2. The thickness of epidermis and dermis in the frontal area was thinner than that of occipital area. 3. The infiltration of inflammatory cells in the periadnexal field like blood vessels, hair follicles, sebaceous glands, eccrine glands was more prominent in the frontal area than in the occipatal area. 4. Perifollicular fibrosis and hypertrophy of arrector pilli muscle were more remarkable in the frontal area compared with that of occipital area. 5. There was no difference between the frontal and occipiral area in the number of lobules of sebaceous glands.

Comparative Study of Corretive Operationof Unilateral Secondary Cleft Lip Nose Deformity According to the Shape of Nostril

Many methods of correcting secondary cleft lip nose deformity have been introduced, but a single best method that can be uniformly adjusted for all cases does not exist. Since it is difficult to make the nostril of the cleft side symmetric with that of normal side, the authors tried to formulate the basis for correction of unilateral secondary cleft lip nose deformity according to the varying amounts of deformed nostril. We then adopted 4 different methods of correcting the soft tissue and nostril deformity in 63 patients from 1996 to 1998 and surveyed the results. Our principles were as follows: 1) Alar rim incision was done in cases of different-shaped cleft-side nostrils with nearly the same measured area in comparison to the normal side. 2) When deformity of the alar-columellar web was severe, we performed modified Z-plasty. 3) When the nostril of the cleft-side nostril was smaller than the normal side with slight asymmetry, reverse W-plasty was done. 4) We adopted a reverse-U incision when there was a discrepancy in height with moderate asymmetry compared with the normal nostril. After dissection, repositioning of alar cartilage was done by same method in each case. A nasal stent was kept in position for at least 6 months postoperatively in almost all cases. After follow-up of 6 to 24 months, we concluded that our choice was correct in selecting the optimal operative method, considering the characteristics of deformity of the cleft side nostril in an effort to make it symmetric with that of the normal side.