Temple and Postauricular Dissection in Face and Neck Lift Surgery

Periauricular paresthesia may afflict patients for a significant amount of time after facelift surgery. When performing face and neck lift surgery, temple and posterior auricular flap dissection is undertaken directly over the auriculotemporal, great auricular, and lesser occipital nerve territory, leading to potential damage to the nerve. The auriculotemporal nerve remains under the thin outer superficial fascia just below the subfollicular level in the prehelical area. To prevent damage to the auriculotemporal nerve and to protect the temporal hair follicle, the dissection plane should be kept just above the thin fascia covering the auriculotemporal nerve. Around the McKinney point, the adipose tissue covering the deep fascia is apt to be elevated from the deep fascia due to its denser fascial relationship with the skin, which leaves the great auricular nerve open to exposure. In order to prevent damage to the posterior branches of the great auricular nerve, the skin flap at the posterior auricular sulcus should be elevated above the auricularis posterior muscle. Fixating the superficial muscular aponeurotic system flap deeper and higher to the tympano-parotid fascia is recommended in order to avoid compromising the lobular branch of the great auricular nerve. The lesser occipital nerve (C2, C3) travels superficially at a proximal and variable level that makes it vulnerable to compromise in the mastoid dissection. Leaving the adipose tissue at the level of the deep fascia puts the branches of the great auricular nerve and lesser occipital nerve at less risk, and has been confirmed not to compromise either tissue perfusion or hair follicles.

Individualized Considerations Regarding Sub-Superficial Musculoaponeurotic System Facelift Techniques

Based on a thorough understanding of facial structure around the superficial musculoaponeurotic system (SMAS), some types of sub-SMAS techniques have emerged to allow more harmonious rejuvenation procedures in the lower face and midface. These techniques are the Hamra composite facelift, the Stuzin extended SMAS technique, the Barton high SMAS technique, and the Ramirez subperiosteal facelift, each of which involves a specific dissection plane and is informed by distinct rationales with reasonable support. Each patient presents a unique facial structure and undergoes an individual rate of aging. The facial structures of East Asian faces, in particular, differ from those of Western faces. While emphasizing that the theory of structural mid-cheek anatomy is an essential part of facial rejuvenation, we would like to discuss the advantages and disadvantages of various sub-SMAS facelift techniques and to propose the most suitable techniques for a variety of individual faces.

Various Applications of Deep Temporal Fascia in Rhinoplasty

PURPOSE: In Asians, nasal dorsal and tip augmentation procedures are usually performed at the same time, and most dorsal augmentations use implants. In this study, dorsal augmentation was given by various types of grafts using deep temporal fascia (DTF) for primary rhinoplasty cases using only autologous tissues to improve the curve of hump noses and depressions. For secondary rhinoplasty cases, DTF was used to improve implant demarcation and transparency. Such effectiveness and utility of DTF is discussed. MATERIALS AND METHODS: Between May 2009 and May 2012, we performed rhinoplasty using DTF in 175 patients, which included 78 secondary surgery patients and 128 female patients. The mean age of the patients was 31.4. DTF was utilized with various types of grafts without implants to improve the curve in dorsal augmentation of hump noses and cases that required curve betterment. DTF was used to improve implant demarcation and transparency for secondary cases. RESULTS: The mean follow-up duration was 1.5 years. Of the 175 patients, 81% were satisfied with the natural correction achieved, whereas 19% complained of undercorrection, which was resolved with additional surgery. No specific complications such as nasal inflammation or contractures were observed. CONCLUSION: DTF can be used with various graft methods for correction of radix, dorsal, and tip irregularities. It can also be used to correct implant contour transparency in secondary rhinoplasty and thus may be considered as a useful supplementary graft material in rhinoplasty for Asians.

10th Rib Cartilage: Another Option of the Costal Cartilage Graft for Rhinoplasty

BACKGROUND: The costal cartilage allows for versatile and stable cartilage supply for rhi-noplasty but disadvantages remain; to minimize these, the 10th costal cartilage was used. We present our experience with the use of the 10th costal cartilage as autologous graft material for rhinoplasty. METHODS: Sixty-four patients whose 10th costal cartilage had been used for correction of severe caudal nasal deviation, secondary cleft lip nasal deformity, and secondary rhi-noplasty with difficulty using the septal and auricular cartilages were enrolled in this study from November 2008 to December 2012. To evaluate the efficacy and safety of this method in rhinoplasty, donor-site morbidity, scarring, and postoperative results, including availability of graft material and complications, were assessed. RESULTS: The mean time for cartilage harvesting was 18 minutes, and the mean length of the harvested cartilage was 2.4 cm. The harvested cartilage was used for columellar struts and tip onlay grafts. The natural curvature of the 10th costal cartilage was used, depending on the purpose of the strut. It could be applied without carving in 38 cases (59%). Although revision was performed in three patients, there were no graft-related complications. CONCLUSIONS: The 10th costal cartilage can be harvested safely and quickly, and its han-dling procedure is simple. As such, it is a good option as an autologous graft for rhinoplasty.

Effective Septal Extension Graft for Asian Rhinoplasty

BACKGROUND: This study aimed at overcoming the disadvantages of septal extension grafts and keeping the nasal tip as natural as possible by using different forms of the graft and additional supporting methods depending on the case. METHODS: Among 458 patients who received a septal extension graft from March 2008 to September 2011, 107 patients were selected who underwent at least a 6-month follow-up. Patients were categorized according to the primary objective of the operation; an upturned tip correction or tip lengthening, tip lengthening with tip projection, or retracted columella correction. Each group of patients received a different type of septal extension graft out of 3 different types of grafts based on the purpose of the operation. The evaluation of the results was made from by comparing preoperative and postoperative photographs of the tip angle, projection, and nasolabial angle. RESULTS: The average tip angle for the patients in the upturned tip correction group was reduced to 98.3 from 124.9 degrees. For the patients in the tip lengthening with tip projection group, the average tip angle was reduced to 96.8 from 122.4 degrees and the average tip projection was increased to 27.5 from 23.2 mm. The average nasolabial angle for the patients in the retracted columella correction group was increased to 94.6 from 74.8 degrees. CONCLUSIONS: Sufficient nasal tip lengthening and projection could be achieved by applying a septal extension graft using the graft best suited for the group of patients categorized by surgical objective.

Various Surgical Procedures in the Scale of Upturned Nose

We should better not confuse "short nose" with "the nose that the tip of it turned upward regardless of its length". If we simply diagnose "the nose that the tip of it turned upward" as "short nose", we might have the risk of focusing on lengthening the whole nose instead of correcting the angle of the tip of the nose. We, therefore, started to call "the nose that the tip of it turned upward" differently from "short nose" in the cases of Asian patients who have relatively short and small noses. We then decided to classify "the nose that the tip of it turned upward" as "upturned nose". And, in revision cases, we have to be careful about changes of anatomical structures, and the usage of the amount of shared cartilages, we have to be fully aware of various operation procedures to correct upturned nose. Furthermore, we have to consider many other different ways of corrections that possibly need various types of grafts and suture techniques combined or modified from the usual procedures. We achieved satisfactory results by using this new paradigm of "upturned nose" and concepts of procedures to have the better result of reforming the "short nose".

Application of Korean Mechanical 3D Bone Model to the MADYMO(R) / 대한법의학회지

MADYMO(R) (Mathematical Dynamic Models) is a computer software with a multibody dynamics solver, which can be employed to reconstruct and interpret dynamic motions of the human body in impacts. The human model of the software is composed of many ellipsoidal structures, which makes it possible to interpret dynamic whole-body motions and calculate applied forces to human body parts. However, this model has some disadvantage to interpret injuries of the smaller body parts such as ribs, vertebral bodies or intervertebral discs. After achieving the finite element bone model produced by CT and software BIONIX BODYBUILDER(R) (finite element modeller), we tried to import this model into the MADYMO(R) and parts of the human bone model were successfully imported to it. Importing of the whole bone model was, however, impossible because of the numerous elements. The coming experiments need to reduce the number of elements in the whole human bone model and incorporate ligaments, tendons and muscles into each separated part of bone models.

Correction of Craniosynostosis using Distraction Osteogenesis via Endoscopic Approach

Craniosynostosis is the term that designates premature fusion of one or more structures in either crania1 vault or cranial base. Various surgical methods including frontal bone advancement and crania1 vault remodeling have been developed in order to correct craniosynostosis. Nowadays, distraction osteogenesis technique has been successfully used by many plastic surgeons. We have experienced several patients with craniosynostosis who had surgical correction using distraction device. All patients obtained satisfactory results and no relapses were observed during the follow-up period. However, previous approaches have required bicoronal incisions and extensive scalp mobilization for adequate exposure. The specific technique of using the endoscope in assisting and perfoming osteotomies and inserting distraction devices made less blood loss, less blood transfused, less operative time, shorter length of stay, overall less expenses, and less visible scars. In conclusion, the endoscopic technique for early correction of craniosynostosis is safe and can be used for correction of other various deformities of craniosynostosis. Because of the minimal invasive technique, the patients with craniosynostosis can be treated at a very early age.

An Experimental Study of Fibroblast Suppression in Collagen Lattice

Fibroblasts are known as the key cells for wound contraction. In the plastic surgical field, wound contraction is one of the main concerns. Many drugs and treatment modalities have been tried to reduce the action of fibroblasts. To investigate the effects of minoxidil and griseofulvin on fibroblasts, fetal human fibroblasts were isolated from the anterior chest of normal fetus. Minoxidil, in addition to its effect on hypertension and hair growth and griseofulvin which has been used as antifungal agent were added on cultured fibroblasts. The morphological changes and numerical changes of the fibroblasts were observed by phase contrast microscopy. In low concentration, minoxidil does not inhibit the proliferation of fibroblasts but in high concentration, it inhibits the proliferation of fibroblasts and prevents the formation of proliferative cytoplasmic buds of fibroblasts. Griseofulvin inhibits the action of fibroblasts but not so significant as minoxidil. Also, they prevent the contraction of collagen lattice in high concentration. The importance of these findings is possible usage of these drugs to treat clinical fibrosis and hypertrophic scars. Further studies will be planned to learn more about a possible role of minoxidil and griseofulvin in prevention of wound contraction.

Lymphatic, Vessel, and Neural Invasions in Gastric Cancer and Its Significance in Prognosis

PURPOSE: This study was undertaken to investigate the prognostic significance of lymphatic invasion (LI), vessel invasion (VI), and neural invasion (NI) in gastric cancer and their correlations with other standard prognostic variables, such as the TNM stage. METHODS: The case histories of 100 gastric adenocarcinoma patients who had undergone a curative resection from 1992 to 1996 at Taegu Hyosung- Catholic University Hospital, Taegu, Korea were analyzed retrospectively. The Chi-Square test was used to determine the statistical significance of differences, and the Kaplan-Meier method was used to calculate survival rates. Significant differences in the survival rate were assessed using the log-rank test. The cox regression method was used for evaluation of independent prognostic significance. RESULTS: The 2-year survival rate was significantly lower (p<0.05) in LI (+) and NI (+) cases. The correlation between the T stage and LI, VI, and NI was statistically significant. Also, the correlation between the N stage and LI, VI, and NI was statistically significant. In the lymph node (+) group (n=43), the 2-year cumulative survival rate was higher in LI (-), VI (-), and NI (-) cases, but this result was not statistically significant. In the lymph node (-) group (n=57), the 2-year cumulative survival rate was higher in LI (-), VI (-), and NI (-) cases, but only the result for the NI (-) group was significant. Multivariate analysis demonstrated that LI, VI, and NI were not significant factors influencing the prognosis, although they were significant in the univariate analysis. CONCLUSION: This study identifies LI, VI, and NI as possible prognostic factor in gastric adenocarcinoma cases, but more careful research is needed.

Effect of the Mixture of Thrombin Powder and Gelfoam Powder on Control of Exposed Cancellous Bone Bleeding

No abstract available.