Rhinoplasty in combination with the total septal reconstruction of the severe septal & external deformities / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Caudal and/or dorsal septal deformities cause blockage of nasal passages and result in the external deformities of the nose. As these septal deformities can not be corrected by submucosal resection or septoplasty, the surgical correction of these nasal deformities is a difficult challenge. Functional and aesthetic results of total septal reconstruction provide the validity of total septal reconstruction. Material and Methods : This retrospective study reviewed the patients' records in case of "total septal cartilage reconstruction" for severely twisted scoliotic nose. Fifteen cases were detected as "total septal reconstruction" between January, 1998 and December, 1999. All cases were approached externally, and we followed up the patients from three months to one year by analyses with photography, rhinologic examination, and patients' survey. RESULTS: All patients noted marked improvement of nasal obstruction. Aesthetic improvement of the nose was mostly obtained in fourteen cases. No infection, hematoma, graft extrusion, saddle nose deformity, or distortion occurred in this series. CONCLUSION: Total septal reconstruction through external rhinoplasty approach is a suitable technique to obtain satisfactory aesthetic and functional results in severely deformed noses with caudal and/or dorsal septal deformities

Biologic changes of implants and grafts in rhinoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: An array of materials have been used for rhinoplasty, however, the fate of these materials after rhinoplasty is not all clear. This study was performed to find post-operative gross and microscopic changes of the implants and grafts (cartilage, Gore-Tex , and Alloderm), and to guide selection of implants and graft. MATERIALS AND METHODS: We took the implants and grafts out from nine patients who underwent revision rhinoplasty for cosmetic problems, and studied gross and microscopic charaterizations. RESULTS: Autologous cartilages showed minor volume reduction and remodeling in gross examination, and mild degeneration, peripheral fibrosis, and fibroblast in-growth without inflammation under microscopic examination. Gore-Tex , which was a little difficulty to remove, had good volume preservation with focal in-growth of fibroblasts and inflammatory cells. A gross examination of Alloderm showed preserved volume, but thin, soft and weak appearance. A microscopic examination of Alloderm showed well preserved collagen materials without inflammation. CONCLUSIONS: Cartilages have good biocompatibility and stabilization, but it is necessary to study absorption and remodeling. We found that Gore-Tex is a good volume filler for dorsal augmentation, whereas Alloderm is a good material for camouflage.

Psychoanalysis of the Aesthetic Nasal Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although there are many different reasons for rhinoplasty, there has not been any been systematic research conducted about different motivations patients have. The motivation for the surgery, the preferred shape of nose, the concerns about surgery, the terms needed to make the decision were different and greatly depended on the circumstances. MATERIALS AND METHODS: Two hundred and seventeen persons who have been operated in the Inha Hospital from 1996 to 2000 have been consulted. The survey paper is constituted by fifty-one multiple-choice questions. RESULTS: For the question asking the main reason for wanting rhinoplasty, the majority answered it was to restore their injured nose. The next popular answer was the desire to have a better-shaped nose. For male patients, their deviated nose was caused by injury or accident, and thus desired to have the normal or the original shape of nose by operation. The survey revealed a different result for the opposite sex. The main reason for female patients' wanting rhinoplasty was to have a good-looking nose, and for that purpose they expressed their desire to heighten their nose. Interestingly, the concern about the side effects after the surgery was the greatest reason for avoiding rhinoplasty. CONCLUSION: Every surgery should be well-prepared with the exact analysis of the patient's nasal history and his special request.

Iridocorneal Endothelial Syndrome: iris nevus syndrome

Iridocorneal endothelial syndrome (ICE syndrome) embraces a group of rare diseases with similar characteristics in the anterior segment, namely Essential iris atrophy, Chandler`s syndrome, and Iris nevus syndrom (Cogan Reese syndrome). The origin and pathogenesis of ICE syndrome remain unkown, but it appears that it is an abnormality of the corneal endothelial cells that is fundamental to all three conditions and leads to characteristic changes in the cornea, iris, and angle. Finding by specular microscopy of abnormal cells on the posterior corneal surface has led to the speculation of possible pathogenensis of this condition. We have experienced two patients with Iris nevus syndrome. Both cases presented with glaucoma as the chief clinical problem, and they illustrated difficult challenges in the glaucoma managemant in this disorder.

Topographic Central Island after Excimer Photorefractive Keratectomy

We analyzed the topographic findings of central islands following excimer photorefractive keratectomies(VISX Twenty/Twenty, Inc, Santa Clara, CA) for myopia to evaluate whether the size of the central island was significantly different betwaen 1 week and 6months postoperatively and whether central island at postoperative 6months affected the decrease of corrected visual acuity from preoperative level. There were statistically significant differences in the indices related to the size of central island(peak, height, area) between 1 week(40 patients, 41 eyes) and 6 months(55 patients, 64 eyes) follow-up groups. In 64 eyes of 6months follow-up group, we could not find any statistically significant effect of the indices related to the size of central island on the decrease of corrected visual acuity, except SAI.

A Case of Ghost Cell Glaucoma in Phakic Eye

A 52-year-old male was visited our clinic complaining of severe right ocular pain, redness. He had highly elevated intraocular pressure, corneal edema, ciliary injection, cells and flare in the anterior chamber, and vitreous opacities. Then We performed anterior chamber paracentesis and aspiration cytology and this showed typical RBC ghosts with Heinz body so we confirmed the diagnosis of ghost cell glaucoma and treated him with standard medical treatment for glaucoma and anterior chamber irrigation. Since there has been no previous reports of cases like this, we present this case for the first time in Korea.

Refractive Errors in Strabismic Patients: Fixing Eye Becomes Myopicl

We examined 59 intermittent strabismic patients who were not alternate fixaters. Fixing eyes of these patients were found to be more myopic that the fellow eyes in 80% of the cases, and it was statistically significant(p<0.01). When both eyes were myopic and corrected with glasses, the more myopic of the two eyes was still used to fixate at distant objects(87%). Although neither the duration of strabismus nor the degree of anisometropia was found to be significantly related(r=0.336), we do suspect that myopia of the fixating eyes is causatively related to greaterer use rather than clearer image of certain distant objects without accommodation.

2 Case of Epikeratopkakia in the Adult Aphakia

One of the indications for epikeratophakia is monocular aphakia intolerant of spectacles and contact lens correction and unsuited for intraocular lens implantation for whatever reason. The procedure involves suturing a lamellar corneal stromal tissue of a human donor eye prelathed for corrective power onto the recipient cornea whose epithellum has just been removed. We performed the epikeratophakia procedure on two patients who were included in the above indication on May 26, 1988. Through the first 6 months of postoperative period, both the graft and recipient tissues remained clear with excellent optical quality, with corrected visual acuity of 0.4 at 1 month, 0.6 at 3 month and 0.8 at 6 month postoperative period respectively. The average increase of corneal curvature was 10.5 diopters and induced refractive error was within 1.5 spherical equivalent diopters after the 6 month period. No significant postoperative compications have been encountered.