Swing Door Reduction Malar Plasty Without the Need for Fixation

The zygomatic bone is one of the most important bone in forming the facial contours. Asians, especially Northeast asians, including Koreans have a very wide and protruding zygomatic bone making, they have a very rough and manly look. Most of the malar osteotomy reductions including triangular osteotomy need a fixation of the bone fragment to prevent the nonunion or malunion of the zygomatic bone or the lower margin of the bone fragment after the surgery. 76 cases were reviewed between October 2004 and August 2006 which were operated in Korean hospitals and Shanghai hospital in China. 74 of the 76 cases were done for women, and the average age was 27.5(21-38). The first osteotomy was done where the frontal process and temporal process meet with a safety zone between the orbital margin towards the oral angle. The electronic saw maintains a 45 degrees to the zygomatico-maxillary buttress with preservation of the 5mm of the outer table of the zygomatic bone. However the inner table has a greater preservation of the bone and periosteum from the osteotomy. The second osteotomy line was towards the downward-laterally at a almost 90 degree angle with a 5mm interval between the first cut starting at the zygomatic body inferior laterally. To prevent the mobility and the loss of the bone when using the electronic saw for the preauricular incision or post sideburn incision, osteotome was used. In the 76 cases followed by 2 weeks, no dropping of the buccal area was found nor unwanted anterior dropping of the buccal fat was found. The authors used triangular osteotomy method and the method of creating artificial depression through 3 partial osteotomy prior to this method. There was no inferior displacement of the bone fragment after the surgery. There was essentially no loss of the bone of the osteotomy surface due to the incomplete fracture of the osteotomy-fracture of the swing zygomatic body using the osteotome. Comparing to other operations, operating time was shorter and recovery was faster. It was economical because fixation equipments did not use. Also, it was easy to do asymmetry correction since broken bone and spicule were easily moved as an operator's intention.

Effect of Maternal Thyroxine Treatment on the Postnatal Development of Brain-derived Neurotrophic Factor-containing Neuron in the Brain of Pups of Alcohol Abused Mother / 대한해부학회지

Maternal alcohol abuse is thought to be the common cause of mental retardation. Especially, continuous alcohol consumption during critical period of brain development induce fetal alcohol effects. In this study, the authors investigated the effects of maternal alcohol drinking on the postnatal changes of BDNF contents and patterns of BDNF-containing neuron in neonatal rat brain, and, the influence of maternal thyroxine treatment on the brain of pups of alcohol abused mother. Pregnant rats were divided into three groups. Alcohol-fed group (n=4) received 35 calories of liquid alcohol diet daily from gestation day 6; control pair-fed group (n=4) was fed a liquid diet in dextrin replaced alcohol isocalorically; alcohol+T4 group (n=4) received 35 calories liquid alcohol diet and exogenous thyroxine (5 microgram/kg/day) subcutaneously. The amount of BDNF was significantly higher in the alcohol+T4 group as compared to the alcohol group at P7, P14 and P21, especially, alcohol+T4-exposed pups showed a significant increase of BDNF at P7. The decrease in BDNF was found in alcohol group compared to control pair-fed group at all ages. In alcohol+T4 group, BDNF-containing Purkinje cells exhibited mature pattern and monolayer arrangement at P14. Alcohol+T4 group showed mature pattern and numerical increase of BDNF-containing cells in cerebral cortex, hypothalamus and hippocampus at P7. The BDNF immunoreactivity of hippocampus continued to show prominent configuration in alcohol+T4 group at P28. These results indicate that the increase of the BDNF-containing neurons and BDNF amount in pups of thyroxinesupplemented alcohol-exposed dams as compared to control pair-fed and alcohol-exposed pups at P7, presumably suggest the early postnatal growth stimulatory effect of the exogenously supplemented thyroxine. Therefore, the increase of BDNF synthesis caused by maternal administration of exogenous thyroxine may ameliorate fetal alcohol effects, one of the ill effects as a result of the dysthyroid state following maternal alcohol abuse.

Effect of Maternal Thyroxine Treatment on the Postnatal Development of Brain-derived Neurotrophic Factor-containing Purkinje Cell in Fetal Alcohol Effects in the Rat Cerebellum / 체질인류학회지

Maternal alcohol abuse is thought to be the common cause of mental retardation. Even moderate maternal alcohol consumption may produce fetal alcohol effects with behavioral and learning difficulties, if the drinking is associated with malnutrition. Especially, continuous alcohol consumption during critical period of brain development is very likely to produce fetal alcohol effects. The aims of this study are to investigate whether exogenous thyroxine treatment to alcohol -fed dams may ameliorate the detrimental effects of alcohol on the postnatal development of BDNF -containing Purkinje cell of the cerebellar cortex of the offspring. The morphological features of the growth and maturation were observed at 0, 7, 14, 21, 28 postnatal days via immunohistochemistry. In addition, electron microscopic finding of BDNF -containing Purkinje cell at P14 was also examined. Time -pregnant rats were divided into three groups. Alcohol -fed group received 35 calories of liquid alcohol diet daily from gestation day 6; control pair -fed group was fed a liquid diet in which dextrin replaced alcohol isocalorically; alcohol +/-T4 group received 35 calories liquid alcohol diet and exogenous thyroxine subcutaneously. As a result, a similar developmental pattern of BDNF -immunoreactive Purkinje cells was observed in control pair - fed and alcohol+/-T4 group on and after P14. These cells of alcohol -fed group showed immature features. Single -layer arrangement of these cells in alcohol -fed group was not completely achieved throughout postnatal life. Electron microscopic observations of BDNF -immunoreactive Purkinje cells at P14 revealed large nucleus, small cytoplasm, small amount of ribosomal collection and rudimentary cytoplasmic organelles in alcohol -fed group. The morphology of BDNF -immunoreactive Purkinje cell in alcohol +/-T4 group was similar to that in control pair -fed group. It was characterized by numerous short segments of rough endoplasmic reticulum, many of which showed a tendency of parallel alignment that suggested an attempt at Nissl body configuration. The cytology of Golgi complexes was also found within the cytoplasm in perinuclear location. Those observed differences of postnatal maturation patterns between alcohol -fed and alcohol +/-T4 group may indicate the beneficial effects on the postnatal development of BDNF -containing Purkinje cells in cerebellar cortex in the pups of thyroxine -treated alcohol -exposed dams. These results suggest that the increase of BDNF synthesis during early postnatal life caused by maternal administration of exogenous thyroxine may ameliorate fetal alcohol effects as a result of the dysthyroid state following maternal alcohol abuse.

The Rectus Abdominis Flap for Reconstruction of Pressure Sores in Quadriplegia Patient

A pressure sore, such as quadriplegia, is developed in patients who have been idle in bed for a long time, particularly in the spinal cord. The treatment is particularly difficult in cases of multiple recurrent sores, osteomyelitis with pathologic fractures, other underlying conditions such as diabetes mellitus, immuno-suppression, or radiotherapy. Over the last 20 years, the development and popularization of rectus abdominis flap have significantly increased for reconstruction of a wide variety of difficult clinical problems. From March 2000 to Dec 2001, 6 neurologically impaired patients underwent reconstruction of chronic pressure sores utilizing an inferiorly based rectus abdominis musculocutaneous flap. Postoperative follow-up ranged from 6 to 15 months. The average thickness of rectus abdominis muscle in quadriplegic patient is less than half of that in healthy patient. In most cases, mild venous congestions are developed, but these were resolved by medical treatment. All wounds have healed without any significant complications such as flap loss, infection, hernia, and sepsis. In conclusion, rectus abdominis muscle for these reconstructions provides a simple, reliable solution to often difficult reconstructive problem. We recommended this highly viable, versatile and reliable flap as one to be considered in planning the reconstruction of the quadriplegia patient with pressure sores when other local and regional flaps are unavailable.

Surgical Correction of Macrostomia

Congenital macrostomia is a result of defective union between the mandibular and maxillary processes and it is a rare deformity seen in every 100 to 300 facial clefts. Ohnizuka1`classified macrostomia into two groups as congenital and posttraumatic. We experienced two cases of acquired macrostomia due to NOMA sequelae(58/F:Lt & 51/F:Rt) and one case of congenital macrostomia (3 months/M:Rt). Many plastic surgeons have developed surgical procedures for repair of this congenital macrostomia. Among them, McCarthy6,11 described the classic commissuroplasty. We could repaired 1 case of congenital macrostomia and two cases of acquired macrostomia due to NOMA sequelae using modified technique of McCarthy,s classic commissuroplasty. McCarthy described new oral commissure 2-3mm laterally for prevention of postoperative contraction, orbicularis oris muscle transposition to restore labial function and a z- plasty cutaneous closure. But some author raise an objection to new oral commissure 2-3mm laterally, and they made new oral commissure at same distance of opposite side normal commissure. And so, we designed the new oral commissure moved 1mm laterally comparing to original commissuroplasty in a congenital case for the prevention of displacement. In cases of acquired macrostomia due to NOMA sequelae, we reconstructed new oral commissure like congenital case, moved 1mm laterally. Orbicularis oris muscle transposition could not be possible because of destruction of muscle, adhesion and atrophy. And so we dissected muscle and just sutured side by side. Acquired macrostomia following NOMA sequelae manifsted facial deformity variably, and reconstruction of the facial deformity is difficult by using simple approach. Other variable reconstructive procedures were needed with commissuroplasty as like Washio flap, rotation advancement flap, bone graft and free radial forarm flap, etc. Postoperative results were relatively good. We propose that macrostomia due to NOMA sequelae must add to Ohnizuka classification of acquired macrostomia.

Bioabsorbable Skeletal Fixation System Devices in Reduction for Facial Bone Fracture

The rigid metal fixation devices are currently the most widely used in maxillofacial surgery. The use of metal plate and screw fixation, however, is not free of some postoperative complication. Once the fractures have healed, metal devices no longer serve any tissue purpose other than the potential for adverse reaction, including loosening, palpability, corrosion, and artifacts in CT and MRI, and they restrict growth of the neurocranium. To overcome these drawbacks, there had been a continuous research on the development of a bioabsorbable skeletal fixation system using polymers of polylactic and polyglycolic acid. There is an increasing acceptance of there use as an alternative fixation device in craniomaxillofacial surgery. We have used the BiosorbFX(R) system(Bionix Implants Ltd) in 48 patients of facial bone fractures. Age varied from 3 to 70(mean 34) and follow up period varied form 1 months to 10 months(mean 5 months). A total of 860 bioabsorbable devices(151 plates and 709 screws) was used. We encountered no significant intraoperative difficulties in obtaining placement of the devices. No patients has experienced any implant-related complications including infection, fracture instability or relapse, or radiographic evidence of osteolysis. The use of nonmetallic materials as a fixation devices that will be resorbed after facial bone fracture healing, therefore, would have advantages. The good results indicate that the use of bioabsorbable implants can be considered for the fixation of facial bone fractures.

Comparison of Transforming Growth Factor-alpha and Epidermal Growth Factor Expression in Melanocytic Nevi: An Immunohistochemical Study / 대한해부학회지

Transforming growth Factor-alpha(TGF-alpha) and epidermal growth factor (EGF) are polypeptides which interact with the epidermal growth factor receptor (EGFR) to produce its biological effects. In normal human tissues, its immunocytochemical presence and biological effects have been demonstrated. The aim of the present investigation was to elucidate the immunolocalization of TGF-alpha and EGF in melanocytic nevi. The data presented in this paper focus attention on comparison of TGF-alpha and EGF in intradermal nevus. The expression of TGF-alpha was stronger than EGF in epidermis of melanocytic nevi. In intradermal nevus, TGF-alpha immunoreactivities were present in most of layers of epidermis and a group of nevus cells in dermis were uniformly immunoreactive with minimal cytoplasm. The expression of EGF was found in part of cytoplasm of keratinocytes in the stratum spinosum and stratum granulosum of epidermis. However, keratinocytes in the stratum basale and nevus cells did not demonstrate immunoreactivity for EGF. In epidermal appendages, the staining intensity of EGF was generally weaker than for TGF-alpha except cells in the external root sheath of hair follicle. In conclusion, some regional variations in the intensity of the immunostaining between TGF-alpha and EGF were present in melanocytic nevi. Our results indicate that TGF-alpha may play a role in growth and proliferation of nevus cells.

Clinical Comparison of the Scar Revision According to Two Different Intradermal and Skin Suture Technique

No abstract available.

Half V-Y-S Plasty for the Reconstruction of Circular Defects Around the Nasolabial Fold Area

When soft tissue circular or elliptical pathologic lesions are located around the nasolabial fold, the most appropriate method is to make the excision parallel with the scar or along a natural wrinkle-crease. For this purpose, simple elliptical excision following primary closure is recommended. But when its long axis of elliptical defects is located vertically to the nasolabial fold, these will bring a bad aesthetic result after elliptical excision following primary closure due to long vertical straight scar to nasolabial fold. If soft tissue defect is larger, we should depend on the wide dissection for the closure of elliptical excised area. As a result, it is inevitable to make postoperative deformity due to tension around the eyelids, oral commissures, canthal fold, and alar nose. V-Y-S plasty was introduced by Algamaso in 1974 for closure of a round defect. It adopted some aspects of the double rotation flaps(or S-plasty) and some of the V-Y advancements. The authors applied from March 1998 to December 2000 to use single rotation flaps(or half-S plasty) and V-Y advancement for closure of a round defect, around nasolabial folds in 12 patients, named it half V-Y-S plasty, by modifying of Argamaso's V-Y-S plasty. We could obtain sufficient coverage of round defects and placement postoperative scar on the nasolabial fold and alar crease area using single V-Y-S plasty. Even in case of hypertrophic scars, we could obtain the same result and symmetric postoperative supralabium contour. The average soft tissue defect diameter was 1.9 cm (biggest one: 3.2 cm), and advanced gain of V-S advancement was 1.34 cm. As a result, we could obtain the final result more aesthetic and functional than that of straight line closure or other type of local flap. We described the experience of half V-Y-S plasty with a review of literature.

A Clinical Experience of Malignant Nodular Hidradenoma in Face

Sweat gland carcinoma is the uncommon neoplasm, with few cases reported in the literatures. In a review of literatures, the most commonly used term is malignant nodular hidradenoma; however, similar cases also have been known as a malignant clear cell hidradenoma, malignant clear cell myoepithelioma, clear cell eccrine carcinoma and malignant clear cell acrospiroma. It is difficult to differentiate clinically between sweat gland carcinomas and other skin lesion, such as keloids, sebaceous cyst, dermatofibroma, lymphoma, and squamous cell carcinoma. Thus, a preoperative diagnosis of sweat gland carcinoma is rarely made and histologic examination is the only means of diagnosis. Most sweat gland carcinomas are found on the scalp, face, upper extremities, and axilla. The lesions are typically small, very slow growing, painless nodules. However, it is aggressive, infiltrative, and has highly recurrent rate. Lymph node metastases are frequent and overall survival is poor. So, that must be treated with wide local excision of the lesion and primary regional node dissection is recommended.We have experienced of a case of malignant nodular hidradenoma in cheek area. It was widely excised by total parotidectomy and covered by scapula fasciocutaneous free flap. We report this case with the review of the literature.

A Clinical Experience of Malignant Nodular Hidradenoma in Face

Sweat gland carcinoma is the uncommon neoplasm, with few cases reported in the literatures. In a review of literatures, the most commonly used term is malignant nodular hidradenoma; however, similar cases also have been known as a malignant clear cell hidradenoma, malignant clear cell myoepithelioma, clear cell eccrine carcinoma and malignant clear cell acrospiroma. It is difficult to differentiate clinically between sweat gland carcinomas and other skin lesion, such as keloids, sebaceous cyst, dermatofibroma, lymphoma, and squamous cell carcinoma. Thus, a preoperative diagnosis of sweat gland carcinoma is rarely made and histologic examination is the only means of diagnosis. Most sweat gland carcinomas are found on the scalp, face, upper extremities, and axilla. The lesions are typically small, very slow growing, painless nodules. However, it is aggressive, infiltrative, and has highly recurrent rate. Lymph node metastases are frequent and overall survival is poor. So, that must be treated with wide local excision of the lesion and primary regional node dissection is recommended.We have experienced of a case of malignant nodular hidradenoma in cheek area. It was widely excised by total parotidectomy and covered by scapula fasciocutaneous free flap. We report this case with the review of the literature.

A Case Report of Van der Woude Syndrome

Van der Woude syndrome is a rare developmental malformation characterized by pits in the lower lip, usually bilateral and located on either side of the midline. Van der Woude syndrome is accompanied with cleft lip with or without cleft palate, bifid uvula and hypodontia or missing incisors and premolars. It was first described by Van der Woude in 1954. It is inherited as an autosomal dominant syndrome with an estimated prevalence of 1 in 100,000~200,000 live births. The syndrome affects both sexes with variable expressivity and estimated penetrance close to 100%. The treatment of choice, but only for esthetic purposes is surgical excision. We experienced a case of newborn baby who had two pits in the lower lip of the midline and left side, with complete cleft lip and palate on the Rt. side. The midline sinus showed papilla like protrusion. The orifice was situated to the lip pit on the midline and the tract was about 4 mm in length. The lip pits were excised under general anesthesia with Millard II rotation advancement flap for cleft lip and primary rhinoplasty at 5 months. Histologic finding from excised lip pits showed multiple mucin-producing minor salivary glands with epithelial hyperplasia. And so we could diagnose Van der Woude syndrome. There was no reccurrence or developmental abnormality postoperatively after 1 year follow-up.

Correction of the Aging Upper Third of the Face Using by Transpalpebral Approach

Aging changes on the upper third of the face include brow ptosis, glabellar furrowing and forehead transverse wrinkle caused by an imbalance of the forehead muscles. Surgical methods to correct these phenomena include forehead lift with a coronal incision, endoscopic access, and direct forehead skin excision. In response to a common need for cosmetic improvement in the brow-upper eyelid and a desire for minimal incisions for forehead rejuvenation, an approach through blepharoplasty incision had been developed. This approach has many advantages, such as fewer skin incision, less tissue mobilization and direct excision of the hyperactive depressor muscles. However, this approach is not suitable for those who have significant forehead wrinkle and ptosis. We used a combined subperiosteal approach for forehead lift and transection of the hyperactive corrugator and procerus muscles through blepharoplasty incision. This combined surgical technique is simple and effective to correct aging of the upper third of the face without the usual complication. We performed 10 cases of the transpalpebral approach for the correction of the upper third of the face from January 1997 to September 1998, following them up for from 3 to 6 months and obtained satisfactory results. We report our experiences with a review of the literature.

Neurovascular Free Toe Pulp Flap Using Dorsal Digital Artery In Finger Reconstruction

Free neurovascular flap transfers have been widely used for restoration of discriminative sensibility and contour of the finger. The free neurovascular flaps from first web space of the foot is a good treatment option to achieve above two conditions. Fingertip reconstruction with a free toe pulp neurovascular flap, since it was described first in 1979, have been reported a lot. But in most cases. toe pulp flap used first dorsal metatarsal artery as a vascular pedicle. The authors, therefore, carried out four dissections on the cadavers to study first web space neurovascular anatomy for using the dorsal digital artery of the foot as a vascular pedicle. On the basis of the results of this cadaver dissection, we reconstructed posttraumatic soft tissue defect of the fingers with first and second toe pulp free flaps in nine patients from February 1999 to April 2000, and obtained adequate functional recovery as well as satisfactory aesthetic appearance. In our case, maximal flap was 2.5 x 2 cm in size, and the dorsal digital artery of the foot, subcutaneous vein and branch of the dorsal deep peroneal nerve were used as a neurovascular pedicle of the flap. All patients gradually recovered a discriminative sensibility, with static two-point discrimination test between 7 and 16mm and a moving two-point discrimination test between 6 and 13mm. The advantages of this free flap from toe(mainly second toe) are minimal donor site morbidity including arterial system, one-stage operation and shorter rehabilitation period. We consider that the free toe pulp flap using dorsal digital artery of the foot is a useful method for reconstruction of small finger soft tissue defect.

Transnasal Edoscopic Reduction Of Medial Orbital Blowout Fracture

As the use computed tomographic (CT) scanning spread, the diagnosis of blowout fractures of the medial orbital wall increased. Now, the diagnosis of blowout fracture in the medial wall are not uncommon. Conventionally, the surgery of blowout fractures in medial orbital wall was performed by the various approach with external incision. The conventional method had seveal possible disadvantages, including an external scar, incomplete reduction, increased mobidity rate and general anesthesia. Recently, endoscopic reconstruction of the medial orbital wall has provided good functional and cosmetic results. We performed endoscopic transnasal reduction surgery without external incision in 12 cases of medial blowout fracture under local anesthesia. The fractured bony fragments were removed after the intranasal ethmoidectomy and the entrapped medial rectus was released. And then a sheet of silicone late or uncinate process were placed on the fracture site. For the maintain of the position of fractured wall, Merocel packing or urinary ballon catheter were used in orbital fracture site for 1-3 weeks. There were no specific complications related to this procedure. Result of the surgery in all cases were satisfactory. In this article, we discussed the surgical procedure, the benifit of the transnasal endoscopic approach, the indications for surgery, and possible comlications.

Reconstruction of Soft Tissue Defect of Feet and Legs Using Alloderm

Variable methods have been using for reconstruction of soft tissue defect of feet and legs. Skin graft, local flap, and free flap have been using for this purpose. But, skin graft produced secondary contracture of recipient site and increased in donor site scarring. Local flap was limited its donor site and remained severe deformities of recipient site. Free flap was required prolonged operation time and secondary operation. Acelluar human dermal allograft, AlloDerm, was removed cellular elements of the epidermis and dermis. It was relatively immunologically inert. From August 1997 to April 1998, we have grafted acellular human dermal allograft with thin split-thickness skin graft on soft tissue defect of feet and legs in 7 cases. We concluded that cryopreserved acelluar human dermal allograft has been proposed as the solution to problems of skin graft, local flap, and free flap.

Treatment of the Earlobe Keloid with Preservation of the Piercing for an Earring

In the East, Probably one of the most commonly performed esthetic operation is the piercing of the earlobes for earring. the complication of this procedure includes infection, the formation of the hypertrophic scar or keloid, and tearing. Keloid formation is one of the disaterous common complications of the ear piercing. the patients regard the keloid as a cosmetic blemish and they complain that they cannot wear earrings. We have experienced 5 patients of earlobe keloid complicated from piercing of the earlobes. We used intralestional steroid njection, in conjunction with surgical excision and pressure therapy for treatment of the keloid. Among various techniques for reconstructing a piercing, we chose modified Pardue's method for artificial earlobe cleft after wide excision of the keloid. the result was good and satisfactory without any complication after 4 to 24 months of follow-up. the purpose of this paper is to present a simple method of treatment of the earlobe keloid with preservation of the perforation for an earring.

Clinical study for skin graft donor site after regional thigh blockade

In general, split thickness skin graft was done under general anesthesia. However, there was a difficulty to do general anesthesia in some cases due to poor general condition. The lateral cutaneous nerve block of the thigh(LCNBT) anesthesia the usual donor site of split-thickness skin graft in the thigh. Using 10 ml of 0.5% bupivacaine, LCNBT was used thigh for harvesting split-thickness skin in 42 patients. Patients age ranged from 18 to 62 years with mean 49 years. The onset of full anesthesia took between 12 and 21 minutes. The area anesthetised ranged from 200 cm2to 940 cm2with mean 551 cm2. The duration of full anesthesia was from 6 to 16 hours. In 6 patients, LCNBT was compared with previous lidocaine local anesthesia and all patients preferred to do LCNBT. In our experience, LCNBT is a safe, and simple method for harvesting split-thickness from the thigh and LCNBT provided good postoperative analgesia.

A Case of Virus Associated Hemophagocytic Syndrome

No abstract available.