Reccurent Foreign body Granuloma after Gore-tex(R) Removal in Rhinoplasty

PURPOSE: Infection, foreign body reaction and decreased volume of implant are common complications after augmentation rhinoplasty with Gore-tex(R) implant. The author experienced two cases of recurrent foreign body granuloma in the patients who underwent Gore-tex(R) removal because of infection after augmentation rhinoplasty. and treated them with complete removal of Gore-tex(R). METHODS: Case 1: A 49 year-old female visited our clinic for recurrent foreign body reaction on nasal dorsum and tip area. The patient underwent augmentation rhinoplasty with Gore-tex(R) 3 years ago and implant was removed due to infection 9 months ago. Excision of the granuloma was performed and a piece of foreign body suspicious to be a Gore-tex(R) implant debris was detected under the subcutaneous pocket. The implant fragments were removed and nasalis muscle rotation flap was performed to cover the lesion. The specimen was proved to be Gore-tex(R) in histological study. Case 2: A 31 year-old-male with recurrent foreign body granuloma on the nasal tip area visited our clinic. 10 years ago, the patient had augmentation rhinoplasty with silicone implant and then, he underwent revisional rhinoplasty five times including nasal implant removal, which was performed 9 months ago. The authors excised the granuloma and found a small sized foreign body suspicious to be a Gore-tex(R) implant debris under the granuloma. The foreign body was excised and identified to be Gore-tex(R) in histological study. RESULTS: In both cases, the lesions were healed without any complications and there were no evidences of recurrence up to 6 months of follow-up. CONCLUSION: The Gore-tex(R) is known to be weak against mechanical force. These properties of Gore-tex(R) make it difficult to remove the implant completely. In the patient who have infection after augmentation rhinoplasty with Gore-tex(R), the operator should take care to perform the complete removal without remaining fragment of the implant.

The Classification of Aging Lower Eyelid and Selection of the Operation Options in Asians

PURPOSE: It is generally accepted that anatomical structures of the soft tissue in Asian faces are quite different from those in Caucasian. It is presumed that these differences are due to collagen rich thick dermis and durable superficial musculo-apponeurotic system (SMAS) in Asian. We classified the aging lower eyelids and reviewed the operative procedures according to the types of aging lower eyelids in Asian. METHODS: We compared preoperative and postoperative photos of 117 patients over 30 years of age, who underwent lower blepharoplasty at the Kyunghee Medical Center from January 2001 to April 2006. We classified the patients based on the degree of skin laxity, presence of nasojugal groove and malar bag, the extent of aging process. We also reviewed the operative procedures according to each type of classification. RESULTS: We classified our patients into four types as following. Type I patients showed minimal skin-muscle excess confined to lower eyelids regardless of the facial line. For these patients, we performed only transcutaneous or transconjunctival blepharoplasty. In type II patients, nasojugal grooves were shown and skin- muscle laxity was limited to the medial side of imaginary vertical line at lateral margin of pupil. In these cases, we performed free fat graft or fat repositioning on nasojugal groove or fat removal and septal duplication confined to medial side. Type III patients displayed more advanced medial bulging and remarkable laxity over the lateral side, the same operation methods as those of type II were applied at the lateral side of the line. Type IV patients demonstrated extensive midfacial aging changes including malar bags and underwent superficial subciliary cheek lift. CONCLUSION: The lower eyelid aging of Asian is different from those of Caucasian. We think that our classification is useful in selection of appropriate operative procedure to address specific problems for Asian patients.

A Case Report of the Chemical Burns Due to Sodium Hypochlorite(NaOCl)

PURPOSE: Chemical burn accounts for a small proportion of burns in burn patient population. However, chemical injuries own importance to their deep tissue destruction which continues long after the initial exposure. YUHANROX(R) is a domestic bleach which has been widely used in Korea. Chemical burn by the domestic bleach is an unusual case. METHODS: A 70 yrs old female soiled with stool, her husband wiped the mess with YUHANROX(R). Skin edema, erythematous lesion was developed the second day, and she was admitted to our hospital via emergency department. RESULTS: Complete epithelization was done after 3 times STSG but, severe scar was formed. CONCLUSION: We report this case to warn about the dangers of domestic bleaches chemical substances and to emphasize that they should be used with caution. Public relation of the primary care of the chemical burn injury is needed.

Superficial Subciliary Cheek Lift for Rejuvenating Infraorbital Region and Orbitomalar Groove

PURPOSE: Aging changes of midface include drooping of lower lid, wrinkles of malar area, orbitomalar groove and deepening of nasolabial fold from drooping of malar fat pad. Improvement of lower lid can be achieved through lower blepharoplasty, but improvement of cheek can not be gained. Superficial subciliary cheek lift(by Moelleken, 1996) is a method that lifts malar fat pad through extended subciliary incision. We obtained simultaneous improvement of lower lid, malar wrinkles and orbitomalar groove with modification of this technique. METHODS: From December 2003 to January 2006, we performed this method on 21 patients among volunteers for lower blepharoplasty who wanted to correct orbitomalar groove and malar wrinkles. Under local anesthesia, lateral extension of subciliary incision is done 1cm from the lateral orbital rim. Skin-muscle flap is elevated, and dealing of orbital fat and septum is the same as with ordinary lower blepharoplasty. After downward subcutaneous dissection through extended incision, exposing the upper 1/3 level of malar fat pad, superolateral fixation is done to superior deep temporal fascia. Excision of the upper part of fat pad is performed, if needed. After excision of overlapped skin-muscle flap, skin closure is done. RESULTS: We obtained satisfactory results with this simple method for improvement of orbitomalar groove and malar wrinkles among patients for lower blepharoplasty. During a follow-up period of 5 months on the average, no revision was performed. CONCLUSION: Under local anesthesia, lower blepharoplasty and improvement of orbitomalar groove and malar wrinkles can be achieved at the same time. It is good for patients who do not want conventional midface- lifting. But surgeons should select patients and perform cautiously for it may leave a scar of the extended incision that require over 2 months for maturation and it is insufficient for improvement of nasolabial fold compared to conventional mid face-lifts.

Correction of the Tear Trough Using Orbital Fat Graft from the Lower Lid

Lower palpebral bags and tear trough grooves are the common signs of aging. Weakness of the orbital septum, atrophy of the orbicularis oculi muscle, slackness and laxity of the lower lid skin are the main causes of these aging changes. Tear trough groove with skeletonization of the lower orbital rim can not be corrected easily by the conventional lower blepharoplasty, but the augmentation of the volume, can be an effective method. Lower lids provide a well vascularized recipient site, which is vital for proper grafting of fat to occur. We treated tear trough groove with free fat graft of surgically removed orbital fat. Surgical excision of the fat pad and septal reinforcement with free fat graft below the levator labii superioris alaeque nasi muscle were performed to correct tear trough groove. This technique was performed in 29 consecutive individuals from October, 2001 to January, 2005. Palpebral bags and tear trough groove were corrected concomitantly and obtained a youthful attractive midface with no secondary hollowness of lower lid and irregularity. The overall results obtained were satisfactory without any complications. Recurrence of tear trough deformity due to grafted fat absorption was not noted during the 7 months of the follow-up period. The authors conclude that the procedure is safe and effective in selected patients.

The Effectiveness of Fibrin Glue Using in Dermal Shaving at Osmidrosis

Axillary osmidrosis is caused by excessive secretion of apocrine gland, which causes an acidic spicy odor and social embarrassment. Recently, many kinds of treatment for osmidrosis are introduced, but one of the conventional surgical method, dermal shaving is still the most effective method for osmidrosis. But it is often accompanied by complications like seroma, hematoma, necrosis, large scar, and long immobilization period. So, to reduce these disadvantages, we used fibrin glue which has the effect of reducing hematoma, encouraging capillary ingrowth by reinforcement of the flap fixation. Then, we compared the dermal shaving with fibrin glue spraying group with only dermal shaving group by retrospective study for clinical effect. From January 2001 to January 2005, a total of 56 patients were underwent dermal shaving operation for treatment of osmidrosis. Fibrin glue using group, the study group was 11 patients, 22 cases and dermal shaving only group without using fibrin glue, the control group was 45 patients, 90 cases. During operation, fibrin glue was sprayed after dermal shaving, just before completing skin closure. We compared the data from the view point of complications, the time for graft take(pressure dressing) and total occlusive dressing period(immobilzation period). Complication rate was lower in study group. There was 1 case of hematoma in the study group (4.5%), and 10 cases of hematoma, 1 case of seroma and 1 case of partial necrosis in the control group(13.3%). In both group, hematoma was the most common complication. The time for graft take were shorter in the study group than the control group(11.6 vs 13.6 days) and total dressing period was shorter in study group, too(14.3 vs 17.7 days). Statistically, significant difference was found in both the time for graft take and total dressing period. Using fibrin glue in dermal shaving was effective for lowering complication rate, reducing the time for graft take and total dressing period.

Analysis of Results in Rehabilitation Surgery of Down Syndrome Children

Down syndrome patients possess multiple facial stigmata; hypotonic macroglossia with small oral cavity, saddle nose, epicanthal fold, telecanthus, and high palpebral fissure inclination, etc. Surgical mitigation for some of these conditions may benefit both patient and family, and may influence the patient's acceptance by general public. We reported the basic study of craniofacial complex and anthropometric study of face in Korean children with Down syndrome. With the benefit of these study, 210 Down syndrome children underwent orthomorphic surgery including augmentation rhinoplasty, epicanthoplasty, lateral canthoplasty, and partial glossectomy and for the relief of respiratory distress tonsilar adenoidectomy were performed in selected cases of Down syndrome children. We evaluated the postoperative change in 105 Down syndrome children through questionnaires about the parent's satisfaction, the change of oral function and sleep pattern. We analysed postoperative change of speech with multi-speech model 3700 program. After these rehabilitation operation, we found out some facts. The parents were happy with the result of partial glossectomy(85.1%) and augmentation rhinoplasty(82.3%). And we found general improvement in oral function and sleep pattern. The results of speech analysis showed improvement in voice quality, patch, resonance and articulation.

Experience of Recurrent Periprosthetic Infection After Augmentation Mammaplasty

Infection following insertion of a breast implant is relatively uncommon, with an overall incidence of less than 4 percent, but can be devastating. Although its management options may be antibiotic therapy along with active surgical regimen like drainage, mechanical irrigation, debridement and implant removal, the efficacy of aforementioned therapeutic regimen is unclear in some cases, thus can be challenging. In particular cases of being chronic and refractory to therapy, spreading of infection which was originally localized in the periprosthetic space-over adjacent tissues by an aggressive curettage at the early stage appears to play a major role. Months elapse before a complete resolution of the infection, and it can also cause serious physical and mental issues in patients. Based on clinical and operative findings in four cases of a chronic, refractory and recurrent periprosthetic infection following an aggressive initial debridement and curettage, we suggest that surgeon should be watchful against debridement and curettage at the early stage of infection and pay special attention to make an accurate and limited curettage using endoscopy.