Treatment of Mandibular Prognathism with Bilateral Sagittal Split Ramus Osteotomy and Paranasal Augmentation: Mandible-to- Paranasal Bone Transfer without Additional Bone Graft Donor-Site

The patients with mandibular prognathism frequently have a retrusion of the lower nasal base and around the piriform aperture. In such cases, paranasal depression or flattening gives a person a gloomy, tired, depressive and old appearance by accentuating the nasolabial folds. In this case, mandibular set back is not enough to achieve the maximum aesthetic results and facial harmony. Although severe retrusion of maxilla needs large graft for paranasal augmentation or Lefort osteotomies, mild retrusion around the piriform aperture can be restored by simple autogenous onlay bone graft. In order to correct the mild paranasal retrusion combined with mandibular prognathism, we performed sagittal split osteotomy of ramus and retropositioned the distal segment of mandible for mandibular set back. Thereafter, we harvested autogenous bone from the distal portion of a mandibular proximal segment. The harvested bone was about 1 X 2.5cm sized and sculptured in a semilunar shape to fit the paranasal region. Through two separate 1-cm upper buccal incision, the bone grafts were placed around the piriform aperture for contour restoration and fixed with screw. Our operative technique is simple and easy, moreover has no need for another donor site for paranasal augmentation. Using this method, we treated paranasal depression as well as mandibular prognathism at the same time and so, improved facial profile and contour in 5 cases. At the time of follow-up at 1 year, there has been no infection, extrusion or relapse with this technique and patients were satisfied with their aesthetic results.

Ear Elevation using the Superficial Temporal Fascia Harvested Through Minimal Incision

The superficial temporal fascia is a thin, pliable, well- vascularized flap that is useful in elevation of the reconstructed ear of the microtia. However, the elevation of the superficial temporal fascial flap by conventional T or zigzag incisions in temporal region frequently leaves a conspicuous scar, hair thinning and alopecia. To overcome these problems, we harvested the superficial temporal fascia as a random pattern flap using only a retroauricular skin incision line for the ear elevation. Thereafter, the cartilage framework was elevated including superficial temporal fascia and superficial mastoid fascia underneath: dissection plane was continuous with the superficial temporal fascial flap harvest and dissection was performed just beneath the superficial mastoid fascia under the framework. A carved costal cartilage block was grafted at the posterior wall of the concha and covered with the harvested superficial temporal fascial flap, followed by a full-thickness skin graft. From June 2001 to December 2001, 9 patients (male 8 and female 1), who ranged from 9 to 26 years in age, underwent ear elevation using this method. The skin grafts was successful and the appropriate auriculocephalic angle was preserved in all cases. We did not find any complications such as infection, graft loss or cartilage extrusion in the 3 to 9 months follow-up period and the patients were satisfied with their cosmetic results. This method was easy to perform and did not leave any other scar in the temporal hear-bearing area and the results have been favorable.

Psychological Characteristics and Changes after the Tattoo Removal

Tattooing has been practised since pre-Christian times, as an object of both fascination and revulsion. In the Present day, body tattoo has been a flourishing and contemporary teen issue. Adolescents have discovered tattoos as a means of self-expression. Due to the external characteristics of the tattoo however, a lot of researchers have shown their interest and done various researches. The examination of the psychological characteristics of the tattooed people revealed that a lot of people have psychological problems, the tattoos revealing the person's deviated image. As a result, several attempts have been made to try and correlate tattoos with the psychiatric diagnoses such as schizophrenia or personality disorder, or with adverse social circumstances such as poverty. The subject of tattoo removal is as old as the history of tattooing itself. Plastic surgeons have witnessed numerous tragic instances where a tattoo has caused hardship, including diminished employment prospects, even loss of love and affection from family and friends and, very commonly, loss of self-esteem. For this reason, the bearers of tattoo often consider the inevitable scarring left by tattoo removal as a preferable alternative. Past techniques of removing tattoos, using corrosive agents or skin graft, have been universally unsuccessful, or certainly less than satisfactory. But, currently laser therapy has been introduced into the market to remove tattoos. As a result, a lot of people have visited hospitals to get tattoos removed. In addition, many of those who had tried to hide the fact that they had tattoos, have been given the opportunity to express their feelings, and rate their psychological statements. This research enables to find the best approach to the person's psychiatric point of view, by objectively observing the person's psychological characteristics and psychological changes after the tattoo removal.