Cosmetic Lateral Canthoplasty: Lateral Canthoplasty to Lengthen the Lateral Canthal Angle and Correct the Outer Tail of the Eye

There are many women who want larger and brighter eyes that will give a favorable impression. Surgical methods that make the eye larger and brighter include double eyelidplasty, epicanthoplasty, as well as lateral canthoplasty. Double eyelidplasty produces changes in the vertical dimension of the eyes, whereas epicanthoplasty and lateral canthoplasty create changes in the horizontal dimension of the eyes. Epicanthoplasty, a surgical procedure which enlarges the eye horizontally, is performed at the inner corner of the eye, whereas lateral canthoplasty enlarges the outer edge of the eye. In particular, if the slant of the palpebral fissure is raised and the horizontal dimension of the palpebral fissure is short, adjusting the slant of the palpebral fissure through lateral canthoplasty can achieve an enlargement of eye width and smoother features. Depending on the patient's condition, even better results can be achieved if this procedure is performed in conjunction with other procedures, such as double eyelidplasty, epicanthoplasty, eye roll formation surgery, fat graft, and facial bone contouring surgery. In this paper, the authors will introduce in detail their surgical method for a cosmetic lateral canthoplasty that lengthens the lateral canthal angle and corrects the outer tail of the eyes, in order to ease the unfavorable impression.

Comparison of Two-Flap Palatoplasty and Pushback Palatoplasty: Complication Rates

The objectives of palatoplasty are to close the palatal defect completely and create and adequately functioning velopharyngeal mechanism for normal speech production. The goal is to minimize adverse effects on maxillofacial growth. The are various surgical techniques in cleft palate repair procedure. According to the report of Bardach and Salyer, two-flap palatoplasty allows closure of the palatal cleft with minimal or no exposure of the bare bone by downward rotation of the mucoperiosteal flap instead of posterior transposition. Thus, two-flap palatoplasty is totally different from the concepts and techniques of other palatoplasties and it results in minimal or no adverse effects on maxillofacial growth. But, there have been no reports about two-flap palatoplasty in Korea. We retrospectively reviewed postoperative complications of 172 consecutive nonsyndromic patients with cleft palate repaired by single operator(two-flap palatoplasty 120 cases, pushback palatoplasty 52 cases). Submucous cleft palate patients were excluded from the study group. Age at cleft repair was from 3 months to 51 years and mean follow-up period was 29 months. Cleft palate fistulas occurred in 20 of 172 patients(11.6%), and fistula rate was similar in patients with two-flap palatoplasty (10.8%) and in patients with pushback palatoplasty (13.5%). Type of palatoplasty, extent of clefting, and age at palate repair did not significantly affect the fistula formation. Of the 52 cleft palates repaired with pushback palatoplasty, there has been one postoperative bleeding that resulted in reoperation. But, of the 120 cleft palates repaired with two-flap palatoplasty, there has been no incidence of postoperative bleeding. Two-flap palatoplasty is considered to be another choice of operative method of palatoplasty. However, more in-depth study is needed to clarify the relationship between two-flap palatoplasty and speech pattern, maxillofacial growth.

Microvascular Free Tissue Transfers for Reconstruction of Irradiated Lesions in the Head and Neck

Radiation therapy is an effective cancer treatment modality as a primary treatment in early cancer and as an adjuvant treatment in advanced cancer, especially in head and neck lesions, but it also causes irreversible chronic damages to overlying normal tissues that may lead to wound complications. As well, at the microscopic level, radiation injury causes both stasis and occlusion of small vessels. Therefore, surgical reconstruction of previously-irradiated lesions in the head and neck poses a great problem. Fifth-six patients with head and neck lesions underwent 57 microsurgical reconstructions between 1990-1998. Thirteen patients were irradiated before surgery. The previous radiation dose was 30-75.6 Gy. The free tissue transfer was successful in 52 of the 57 microsurgical reconstructions(91.2%). The success rate was 92.3%(12/13) in previously-irradiated patients and 90.9%(40/44) in nonirradiated patients. Postoperative complications, such as flap loss, fistula, and infection, developed in 4 irradiated patients and 8 nonirradiated patients. Overall complication rate was 30.8%(4/13) in previously-irradiated patients and 18.2%(8/44) in nonirradiated patients. Although the failure rate of previously-irradiated patients was higher than that of nonirradiated patients, there was no statistically significant difference between them. Thus, free tissue transfers in patients with previously-irradiated head and neck lesions are suitable for one-stage reconstruction.