Postoperative Speech Improvement in the Patients of Velopharyngeal Dysfunction without Definite Cleft Palate

The velopharyngeal dysfunction usually occurs in patients with previous operation of the cleft palate or with submucosal cleft palate. In case of velopharyngeal dysfunction without cleft palate, no study has been made when it comes to operative method and postoperative results. Here, we would like to present the operative methods and the postoperative results with the cases we've experienced. This study is based on seven cases of velopharyngeal dysfunction without cleft palate from 1999 to 2004. Analysis of age, sex, etiology, operative methods, satisfaction rate and speech evaluation was done. The patients were 3 males and 4 females, with an age ranged from 10 to 28 at the time of surgery. The follow-up period was more than six months. One case had bifid uvula, another had atypical anomaly in palate, and five cases had no anatomical abnormality. The palatal lengthening was done on one patient, the levator muscle repositioning on another patient and to the rest of them, the superiorly based posterior pharyngeal flap was done. It was difficult to determine the etiology of the velopharyngeal dysfunction without cleft palate. The speech improvement and the satisfaction rate of the patients and parents were diverse. Although the authors had a problem with statistical analysis between the operative age and the speech improvement, it was reasonable to perform a surgical operation because post operative speech improvement was observed in most cases regardless of age. There is little statistical correlation, but significantly higher outcomes were observed in palatal lengthening and levator muscle repositioning than in pharyngeal flap.

A Study for the Mechanism of Abnormal Proliferation in Vascular Endothelial Cells using Inhibitors to the Signal Transduction Pathway

Protein tyrosine kinase(PTK), protein kinase C(PKC), oxidase, as a mediator, take a significant role in signal transduction pathway of angiogenesis. The authors utilized the inhibitors, targeting the formation of three co-enzyme in signal transduction pathway in order to quantify the suppression of abnormal vascular endothelial cell proliferation induced by DMH, to compare the level suppression in each up-regulated growth factors, CTGF, CYR61, ITGbeta1, FHL2, and to identify the relationship between abnormal cell proliferation and signal transduction pathway. Five groups were established; Control group, Group of DMH, Group of DMH-mixed Herbimycin, inhibitor of protein tyrosine kinase, Group of DMH-mixed Calphostin C, inhibitor of protein kinase C, Group Of Dmh-Mixed 10U Catalase, Inhibitor Of oxidase. The rise of vascular endothelial cell was compared by MTT assay, and four growth factors were analysed with RT-PCR method, at pre-administration, 4, 8, 12, and 24 hours after administration. In comparison of abnormal proliferation of vascular endothelial cell induced by DMH, suppression was noticed in Herbimycin and Calphostin C group, and Calphostin C group revealed higher suppression effect. Nevertheless, Catalase group did not have any suppression. In manifestation of four growth factors, Herbimycin and Calphostin C group presented similar manifestation with control group, except in ITGbeta. Catalse group had similar manifestation with DMH group in all four growth factors. Abnormal proliferation of vascular endothelial cell induced by DMH have a direct relationship with PTK and PKC, more specifically to PKC. Oxidase was confirmed not to have any relevance.

Speech Improvement of the Patients Performed Primary Palatal Repair over 4 Years Old

Time to time, we face patients who missed the proper time for primary palatal repair. Although we do not have enough available documents, it is important to establish efficacy of palatal repair in patients more than 4 years old. From May 1995 to March 2005, we selected 14 patients who underwent palatal repair in more than 4 years old patients and they are able to tolerate speech articulation tests. Out of 14 patients 5 males an 9 females in sex, aged form 4 to 50 years old. 6 patients with incomplete cleft palate and 8 patients with submucous cleft palate. Double reversing Z-plasty(n=5), pushback palatoplasty(n=4), two flap palatoplasty(n=2), von Langenbeck palatoplasty(n=2), and intravelar veloplasty(n=1) were performed. Preoperative and postoperative speech articulation test, "Simple method of speech evaluation in Korean patients with cleft palate", were conducted. Satisfaction rate was sorted into 5 levels. There is no significant statistical correlation in the speech improvement, satisfaction rate, patients sex, cleft type and operative method. But there is significant statistical correlation between the speech improvement and patienet's age. There were better result in younger patient group than aged patients group.

Simultaneous Reduction Mammoplasty with Excision of Benign Tumor

The purpose of study was to retrospectively assess the possibility of simultaneous breast reduction and tumor excision in women with benign tumor and mammary hyperplasia. Performance status of the patient, appropriate operation technique and postoperative results were analyzed. Evaluation was made regarding four patients who underwent simultaneous breast reduction and tumor excision with more than 6 months follow up. The types and locations of the tumor, corresponding operation technique, postoperative complication such as flap necrosis, subjective alteration in sensorium around the nipple-areolar complex and esthetic satisfaction were assessed. Preoperative radiologic examinations, histologic findings of the fine needle aspiration, and postoperative biopsy were equivalent. The histologic types revealed were tubular adenoma, leiomyoma and lipoma(2 cases). The tumor was each located in lower lateral quadrant, subpectoral, inframammary fold, and upper lateral quadrant of breast, respectively. Regarding the location of tumor and status of mammary hyperplasia, each breast reduction was done with superior, inferior and medial pedicle(2 cases). There were no postoperative complications and esthetic satisfaction rate was high in all patients. When accurate diagnosis based on preoperative radiologic and histologic evaluation and appropriate selection of operative technique were done, simultaneous breast reduction with excision of benign tumor showed satisfying outcome without postoperative complication even along with esthetic satisfaction.

RT-PCR of Up-Regulated Factors in Abnormally Proliferated Vascular Endothelial Cells by 1,2- Dimethylhydrazine

Many studies for verifying angiogenesis have been in progress, especially in the field of abnormal vascular proliferation to explain the pathogenesis and to develop a treatment of several diseases. In our previous experiments, endothelial cell proliferations were induced by DMH stimulation in vitro, and the 177 factors(142 up- regulated and 35 down-regulated factors) were identified. Among the up-regulated factors, 9 substances (EFEMP1, CTGF, CYR61, ITGbeta1, FHL2, SERPINE1, MYC, PTTG1 and MSH6) were selected, which were related to cell proliferation and showed high signal intensities. The RNA was isolated from HUVECs at the time of 0, 6, 12, 24 hours after the DMH treatment, and RNA of control group HUVECs was also isolated. Genetic information of selected molecules was used to make primer for each, and RT-PCR was performed to analyze both groups. In control and treatment groups, each substance presented variety of manifestation degree according to time differences. EFEMP1, CTGF, CYR61, ITGbeta1, FHL2 and MYC were related to abnormal vascular proliferation steadily and SERPINE1, PTTG1 and MSH6 were related secondarily. CTGF was related to both normal and abnormal proliferation, but it played a more significant role in abnormal proliferation from earlier stage. EFEMP1, CYR61, ITGbeta1, FHL2 and MYC were similar to CTGF, although the relation appeared lately. Further study should be performed to analyze the expressions and the interactions of growth factors, which could be utilized in the new therapeutic development.

Columellar Lengthening Using V-Y Advancement Flap or Central Lip Flap in Secondary Correction of Bilateral Cleft Lip Nose Deformity

Even though it is generalized to perform synchronous lip and nasal correction, there are some cases in need of secondary correction of cleft lip nose deformity. In these procedures, the lengthening of columella plays an important role. We performed eighteen cases of the secondary cleft lip nose deformity correction using two different methods from 1997 to 2003. The central lip flap was used in eight patients and V-Y advancement flap in ten patients. Additional procedures including reverse U-incision, interdomal fixation sutures and suspension sutures were used for correction of combined deformity. Silastic nasal retainers were kept in all patients for 6 months. Both of central lip flap and V-Y advancement flap seems to be a good technique for lengthening columellar soft tissue. But new columella after V-Y advancement flap appeared to be too narrow and a bit unnatural looking and central lip flap left additional scar on the upper lip although it was conspicuous. We think that central lip flap is a better technique in a case with wide philtrum and narrow columella and V-Y advancement flap can be another choice in a columella with sufficient width.

Gene Expression Profiling of 1,2-Dimethylhydrazine-Stimulated Human Umbilical Vein Endothelial Cells

The purposes of this study are to establish standard model in which endothelial cell proliferations are induced by DMH stimulation in vitro, and to analyze the gene expressions of proliferative HUVECs using DNA chip technique which could evaluate the mechanisms of angiogenesis, and the development of vascular tumors. To perform the MTT assay in 96-well microplates, 104 cells were seeded in each well which were cultured in medium. On the third day, the cells were treated with 5 different concentrations of diluted DMH from 10 to 10-3 ng/ml. Five DMH-treated groups were compared with the control group which was not treated with DMH. The optical densities in each group were measured at the time of 0, 6, 12, 24, 36, 48, and 72 hours after DMH treatment. The same experiment was repeated 9 times. Statistically significant cell proliferations were observed in 1 and 10-1ng/ml group. The RNAs were isolated from HUVECs of control group and 1ng/ml DMH-treated group, and they were used to analyze the gene expressions using DNA chip technique. One hundred and seventy-seven genes(142 of up-retulated genes and 35 down-regulated genes) were identified, and several genes were associated with VEGF and FGF production. Also DMH could affect expression of genes that involve oncogenesis. Further study should be performed to evaluate the processes of angiogenesis and morphogenesis of vascular tumors, which could be utilized in the development of new therapeutic approaches.

Effectiveness of Vascular Network Including Angular Artery in Inner Canthal Region for Mid-facial Reconstruction

Angular artery as a terminal branch of facial artery ends at inner canthal region and anastomoses with adjacent arteries to form the vascular network in this region. Flaps using this network have been widely used to reconstruct the mid-facial defects. This study was designed to investigate the anatomical basis of theses arteries, especially angular artery which is known to have variable courses, and to demonstrate safety and effectiveness of flaps using this network. The authors reviewed several textbooks of anatomy and reported literatures through MEDLINE search about anatomy of angular artery and its anastomosis. To document clinical application, the authors also analyzed clinical experiences of 19 patients for recent 6 years who were undergone the reconstructive flap surgeries for mid-facial defects using forehead, dorsal nasal and retroangular flaps based on anastomosed vascular network in inner canthal region. As a result of review, the authors could not get an exact conclusion, although there were numerous opinions about anatomical variations of facial and angular artery. However, robust network composed of anastomotic arteries in inner canthal region seems to give high viability to flaps due to rich blood supply regardless of variation. Clinical experiences also showed excellent flap viability without any complication and satisfactory results functionally and cosmetically. In conclusion, flaps using vascular network in inner canthal region should be suggested as safe and effective methods for mid-facial reconstruction.

Three Dimensional Analysis of Normal Smiles in Korean

Smile reconstruction through restorating the movement of the upper and lower lips and the nasolabial fold for facial paralysis, is the one of the most important fields of plastic and reconstructive surgery. It is necessary to understand and analyze the normal smile in planning the surgery for facial paralysis. Fifty volunteers(25 men and 25 women) have been measured using 6-mm digital video camera with various computer programs to get the most spontaneous smile. Stop frames from the cycle of smile were captured in frontal, both lateral, and inferior views and the differences between resting and maximum smiling states were compared. Each subject had ten points marked on the lips and nasolabial creases. The distance and angle between each point of two states were measured and converted into x, y and z components in three dimensional space. Averages of each component were calculated. Average movement, average angle on coronal plane, and average posterior angle were 13.7 mm, 52.2 degrees, and 48.9 degrees at commissure, 10.5 mm, 56.3 degrees, and 31.4 degrees at nasolabial fold, 7.3 mm, 88.1 degrees, and 33.3 degrees at center of upper lip, 10.1 mm, 57.2 degrees, and 30.9 degrees at mid-lateral upper lip, 5.9 mm, -87.5 degrees, and 66.9 degrees at the center of lower lip, and 6.7 mm, -12.7 degrees, and 61.5 degrees at mid-lateral lower lip respectively. This study was tried to define the basis of smile in reconstruction of facial paralysis and to suggest the objective method of assessing preoperative state and postoperative result. Further studies should be followed to establish the standardized useful data for smile reconstruction.