Nanoparticle-Based Chimeric Antigen Receptor Therapy for Cancer Immunotherapy

Adoptive cell therapy with chimeric antigen receptor (CAR)-engineered T cells (CAR-Ts) has emerged as an innovative immunotherapy for hematological cancer treatment. However, the limited effect on solid tumors, complex processes, and excessive manufacturing costs remain as limitations of CAR-T therapy. Nanotechnology provides an alternative to the conventional CAR-T therapy. Owing to their unique physicochemical properties, nanoparticles can not only serve as a delivery platform for drugs but also target specific cells. Nanoparticle-based CAR therapy can be applied not only to T cells but also to CAR-natural killer and CAR-macrophage, compensating for some of their limitations. This review focuses on the introduction of nanoparticle-based advanced CAR immune cell therapy and future perspectives on immune cell reprogramming.

Traumatic hematoma-based pseudoaneurysm of the superficial temporal artery in a 7-year-old boy: a case report

The superficial temporal artery (STA), the terminal branch of the external carotid artery, is divided into the frontal (anterior) and parietal (posterior) branches. The frontal branch of the STA is located superficially on the anterior region of the scalp, making it especially susceptible to trauma. Here, we report a traumatic pseudoaneurysm of the STA in a 7-year-old boy who was injured in a minor car accident. A physical examination showed only a small bruise on the patient’s forehead, and all vital signs were stable at the emergency room of our medical center. A facial computed tomography scan showed no significant findings. However, the boy later re-visited the hospital with slight swelling on the right forehead, and an ultrasonography scan revealed a hematoma near the right temporal artery. The resected hematoma (approximately 2 cm) was diagnosed as a traumatic pseudoaneurysm. Awareness of the possibility of a traumatic pseudoaneurysm in the STA may prevent a circumspect diagnosis in the future.

Anthropometric analysis of the eyeball exposure area in Koreans

Background@#Eyelids vary in morphology and structure depending on age, sex, and race. Usually, one-dimensional measurements are used to evaluate blepharoplasty outcomes. However, in recent years, three- or four- directional enlargements of the eyelid have been used for blepharoplasty in Asian patients, and the outcomes of techniques such as lateral canthoplasty or canthotomy and medial epicanthoplasty with increased scleral area cannot be analyzed using marginal reflex distance 1 or the area of corneal exposure. Therefore, we describe the use of a measurement method based on the eyeball exposure area (EEA). @*Methods@#To obtain normal EEA values by age and sex, 320 individuals were recruited. The participants were divided into eight age groups (n=40 in each group: female subjects, n=20; male subjects, n=20): 10–19, 20–29, 30–39, 40–49, 50–59, 60–69, 70–79, and 80–89 years. The EEA value was obtained by dividing the exposed area by the total eyeball area. The normal EEA values and differences in EEA according to age and sex were calculated. @*Results@#The mean EEA values for male and female subjects were 66.86% ±9.20% and 71.48%±10.48%, respectively. In each age group, the EEA values of females were higher than those of males. EEA decreased significantly with age in both male and female subjects (P<0.05). @*Conclusions@#We determined normal EEA values according to age and sex. EEA can be used as an indicator of the outcome of blepharoplasty.

Comparison of outcomes between simultaneous fat grafting and filler injection with transconjunctival fat removal for improvement of the lower eyelid contour

Background@#Mid-facial aging is associated with various changes, particularly around the lower eyelid, where these changes manifest as herniation of orbital fat, sagging of soft tissue around the zygoma, and the tear trough deformity. We improved the lower eyelid contour via transconjunctival orbital fat removal and the use of either an autologous fat graft or filler injection. @*Methods@#Between June 2016 and July 2018, 100 patients aged 23–48 years underwent autologous fat grafts (group A: 50 patients, 100 eyes) or filler injections (group B: 50 patients, 100 eyes). The mean follow-up period was approximately 3 months. The results of surgery were evaluated using a visual analog scale (VAS) to assess patient satisfaction and with preoperative and postoperative scores determined by three plastic surgeons according to the grading system for lower eyelid contour deformity devised by Barton et al. @*Results@#The mean VAS score was 8.48 in group A and 8.92 in group B, but the difference was not statistically significant. The percentage of postoperative improvement from preoperative grade I deformity to grade 0 was 97.7% in group A and 100% in group B. The percentage of improvement from preoperative grade II deformity to grade 0 was 96.0% in group A and 96.1% in group B, and the percentage of improvement from grade III deformity to grade 0 in was 66.7% in group A and 75% in group B. @*Conclusions@#Filler injection can be an alternative to fat grafting for improvement of the lower eyelid contour after transconjunctival orbital fat removal.

Analysis of long-term outcomes after surgery in patients with severe blepharoptosis

BACKGROUND: Blepharoptosis is the drooping of the margin of the upper eyelid, which narrows the palpebral fissure and makes it difficult to open the eye. Various surgical methods are used to correct blepharoptosis and have been investigated in different studies. After surgery, blepharoptosis can relapse over time, which affects a patient’s satisfaction with the operation. However, few studies have investigated the long-term outcomes of patients after blepharoptosis surgery. METHODS: From 1991 to 2013, 325 patients (480 eyelids) underwent frontalis muscle transfer or Müller-aponeurosis composite flap advancement in our clinic. We analyzed 12 patients (13 eyelids) with severe ptosis who had been followed-up for more than 5 years. Six patients underwent frontalis muscle transfer for the correction of seven eyelids, while Müller-aponeurosis composite flap advancement was performed on six patients (six eyelids). The marginal reflex distance (MRD1), area of corneal exposure (ACE), and height of the eyebrow were used to analyze the objective outcomes, and the Glasgow Benefit Inventory questionnaire was used for the analysis of subjective patient satisfaction. RESULTS: There were no significant differences in the MRD1, ACE, and eyebrow height between the two methods used to correct ptosis. However, over the long-term (>5 years), the MRD1, ACE, and eyebrow height were better maintained in patients who underwent Müller-aponeurosis composite flap advancement than in patients who received frontalis muscle transfer. CONCLUSIONS: Both surgeries were effective for blepharoptosis correction. However, Müller-aponeurosis composite flap advancement was better for long-term maintenance after surgery than frontalis muscle transfer.

Frontalis Transfer and Closed Silicone Rod Frontalis Suspension

BACKGROUND: Improvements in the degree of marginal reflex distance 1 (MRD1) were compared before and after use of the frontalis transfer (FT) method and closed silicone rod frontalis suspension surgery (SS) for severe blepharoptosis under general or local anesthesia with or without minimal sedation. METHODS: We reviewed the medical records and photographs of 76 patients who had visited our institute between 2006 and 2013 because of severe blepharoptosis with poor levator function and treated by the same senior doctor. RESULTS: In total, 104 eyes (63 patients) were included after applying exclusion criteria; 71 eyes (44 patients) were corrected using FT, and 33 eyes (19 patients) were corrected using the frontalis sling method with a silicone rod. Among the general FT, local FT, general SS, and local SS groups, the mean preoperative MRD1 was not significantly different. Postoperative MRD1 was highest in the local FT group. CONCLUSIONS: Both FT and SS positively increased MRD1, regardless of the anesthesia used; however, the change in MRD1 of the general SS group was the lowest (1.11+/-0.848 mm). Further, general FT, local FT, and local SS groups had an approximate 2 mm or greater increase in the differences between postoperative and preoperative MRD1. Specifically, the local FT group had a definite positive correlation with postoperative MRD1.

Comparison of Saccharina japonica–Undaria pinnatifida Mixture and Minoxidil on Hair Growth Promoting Effect in Mice

BACKGROUND: Algae have traditionally been used for promotion of hair growth. Use of hair regrowth drugs, such as minoxidil, is limited due to side effects. The aim of this study was to examine a mixture of Saccharina japonica and Undaria pinnatifida (L-U mixture) on hair growth and to compare the promoting effect of hair growth by a 3% minoxidil and a L-U mixture. METHODS: To evaluate the hair growth-promoting activity, saline, 50% ethanol, 3% minoxidil, and the L-U mixture were applied 2 times a day for a total of 14 days on the dorsal skin of C57BL/6 mice after depilation. Analysis was determined by using a high-resolution hair analysis system, real-time polymerase chain reaction, and H&E staining. RESULTS: On day 14, the hair growth effect of the L-U mixture was the same as that of the 3% minoxidil treatment. The L-U mixture significantly (P<0.05) stimulated hair growth-promoting genes, as vascular endothelial growth factor (VEGF) and insulin-like growth factor -1. Increase of VEGF was observed in the L-U mixture group compared with minoxidil and the negative control. In contrast, the L-U mixture suppressed the expression of transforming growth factor-β1, which is the hair loss-related gene. In histological examination in the L-U mixture and minoxidil groups, the induction of an anagen stage of hair follicles was faster than that of control groups. CONCLUSIONS: This study provides evidence that the L-U mixture can promote hair growth in mice, similar to the effect from minoxidil, and suggests that there is potential application for hair loss treatments.

Ten Years of Results of Modified Frontalis Muscle Transfer for the Correction of Blepharoptosis

BACKGROUND: Conventional frontalis transfer may cause a range of complications. In order to overcome complications, we made modifications to the surgical technique, and compared the outcomes of patients who underwent conventional frontalis transfer with those of patients who underwent modified frontalis transfer. METHODS: We conducted a retrospective study of 48 patients (78 eyes) who underwent conventional frontalis transfer between 1991 and 2003 (group A) and 67 patients (107 eyes) who underwent modified frontalis transfer between 2004 and 2014 (group B). The frontalis transfer procedures were modified conform to the following principles. The tip of the frontalis muscle flap included soft tissue that was as thick as possible and the soft tissue on the tarsal plate was removed to the greatest extent possible. A double fold was created in cases of unilateral ptosis. In order to evaluate the objective effects of modification, preoperative and postoperative values of the marginal distance reflex 1 (MRD1), the corneal exposure area, and the decrease in eyebrow height were compared between the two groups. RESULTS: In group A, patients showed an improvement of 1.19 mm in the MRD1, a 6.31% improvement in the corneal exposure area, and a 7.82 mm decrease in eyebrow height. In group B, patients showed an improvement of 2.17 mm in the MRD1, an 8.39% improvement in the corneal exposure area, and an 11.54 mm decrease in eyebrow height. The improvements in group B were significantly greater than those in group A. CONCLUSIONS: Modified frontalis transfer showed better results than the conventional procedure and provided satisfactory outcomes.

The Effect of Virtual Reality and Tetra-Ataxiometric Posturography Programs on Stroke Patients With Impaired Standing Balance

OBJECTIVE: To investigate the effect of virtual reality (VR) and a tetra-ataxiometric posturography (Tetrax) program on stroke patients with impaired standing balance. METHODS: Thirty acute stroke patients with impaired standing balance were recruited and randomly assigned to a VR, Tetrax, or control group. All patients received conventional balance training as a baseline; and VR and Tetrax patients received VR or Tetrax treatment, in addition. The primary outcome measures to evaluate the overall standing balance were the Berg Balance Scale (BBS) and the falling index (FI). The secondary outcome measures were the stability index (SI) and the weight distribution index (WDI), which were used to evaluate the balance status according to specific body positions. The FI, SI, and WDI were measured using the Tetrax instrument. RESULTS: The BBS and FI scores were improved in all groups, with no significant differences between groups. In open-eyed positions, the VR group showed significantly greater improvement in SI and WDI scores than the control group (p<0.017). In closed-eyed positions, the Tetrax group showed significantly greater improvement in SI and WDI scores than the control group (p<0.017). CONCLUSION: The inclusion of VR and Tetrax programs did not lead to an overall benefit in balance. VR and Tetrax did, however, demonstrate a benefit in specific positions. A Tetrax program may benefit patients with abnormal proprioceptive function, whereas a VR program may benefit patients with normal sensory function.

The Effect of Virtual Reality and Tetra-Ataxiometric Posturography Programs on Stroke Patients With Impaired Standing Balance

OBJECTIVE: To investigate the effect of virtual reality (VR) and a tetra-ataxiometric posturography (Tetrax) program on stroke patients with impaired standing balance. METHODS: Thirty acute stroke patients with impaired standing balance were recruited and randomly assigned to a VR, Tetrax, or control group. All patients received conventional balance training as a baseline; and VR and Tetrax patients received VR or Tetrax treatment, in addition. The primary outcome measures to evaluate the overall standing balance were the Berg Balance Scale (BBS) and the falling index (FI). The secondary outcome measures were the stability index (SI) and the weight distribution index (WDI), which were used to evaluate the balance status according to specific body positions. The FI, SI, and WDI were measured using the Tetrax instrument. RESULTS: The BBS and FI scores were improved in all groups, with no significant differences between groups. In open-eyed positions, the VR group showed significantly greater improvement in SI and WDI scores than the control group (p<0.017). In closed-eyed positions, the Tetrax group showed significantly greater improvement in SI and WDI scores than the control group (p<0.017). CONCLUSION: The inclusion of VR and Tetrax programs did not lead to an overall benefit in balance. VR and Tetrax did, however, demonstrate a benefit in specific positions. A Tetrax program may benefit patients with abnormal proprioceptive function, whereas a VR program may benefit patients with normal sensory function.

Assessment of Peripheral Neuropathy in Patients With Rheumatoid Arthritis Who Complain of Neurologic Symptoms

OBJECTIVE: To assess the prevalence of peripheral neuropathy in patients with rheumatoid arthritis (RA) having neuropathic symptoms, and to investigate the relationship between electrophysiological findings of peripheral neuropathy and clinical findings of RA. METHODS: Patients with a clinical diagnosis of RA and who had tingling or burning sensation in any extremity were electrophysiologically examined for evidence of peripheral neuropathy. Study parameters, including age, gender, laboratory parameters, duration of RA, and medication, were recorded. The symptoms and signs of neuropathy were quantified with the neuropathy symptom score, and the functional statuses of these patients were assessed. RESULTS: Out of a total of 30 RA patients, 10 (33%) had peripheral neuropathy: 2 had bilateral carpal tunnel syndrome (CTS), 5 had unilateral CTS, 1 had sensory polyneuropathy, and 2 had motor-sensory polyneuropathy. The mean ages of the patients with and without peripheral neuropathy were 69.4 and 56.5 years, respectively (p<0.05). A significant relationship was found between peripheral neuropathy and anti-cyclic citrullinated peptide (anti-CCP) antibody. However, no relationship was found between peripheral neuropathy and the type of medication, RA duration, the patients' functional status, neuropathic symptoms, erythrocyte sedimentation rate, and C-reactive protein values. CONCLUSION: Neuropathic symptoms are common in RA patients, and it is difficult to distinguish peripheral neuropathy symptoms from those of arthritis. Patients with RA, particularly elderly patients and anti-CCP antibody positive patients who complain of neuropathic symptoms should undergo electrophysiological examination.

Assessment of Peripheral Neuropathy in Patients With Rheumatoid Arthritis Who Complain of Neurologic Symptoms

OBJECTIVE: To assess the prevalence of peripheral neuropathy in patients with rheumatoid arthritis (RA) having neuropathic symptoms, and to investigate the relationship between electrophysiological findings of peripheral neuropathy and clinical findings of RA. METHODS: Patients with a clinical diagnosis of RA and who had tingling or burning sensation in any extremity were electrophysiologically examined for evidence of peripheral neuropathy. Study parameters, including age, gender, laboratory parameters, duration of RA, and medication, were recorded. The symptoms and signs of neuropathy were quantified with the neuropathy symptom score, and the functional statuses of these patients were assessed. RESULTS: Out of a total of 30 RA patients, 10 (33%) had peripheral neuropathy: 2 had bilateral carpal tunnel syndrome (CTS), 5 had unilateral CTS, 1 had sensory polyneuropathy, and 2 had motor-sensory polyneuropathy. The mean ages of the patients with and without peripheral neuropathy were 69.4 and 56.5 years, respectively (p<0.05). A significant relationship was found between peripheral neuropathy and anti-cyclic citrullinated peptide (anti-CCP) antibody. However, no relationship was found between peripheral neuropathy and the type of medication, RA duration, the patients' functional status, neuropathic symptoms, erythrocyte sedimentation rate, and C-reactive protein values. CONCLUSION: Neuropathic symptoms are common in RA patients, and it is difficult to distinguish peripheral neuropathy symptoms from those of arthritis. Patients with RA, particularly elderly patients and anti-CCP antibody positive patients who complain of neuropathic symptoms should undergo electrophysiological examination.

The Change of Eyebrow Height after Blepharoptosis Correction

Blepharoptosis patients use frontalis muscle unconsciously to widen eye, and it results in several aesthetic problems-such as forehead wrinkling and elevated eyebrow. So forehead wrinkling and elevated eyebrow can be resolved with correction of blepharoptosis. We evaluated the change of eyebrow height in 30 patients who were corrected blepharoptosis through photogrammetry. The mean age of the patients was 36.8 years old and the mean follow up periods were 6 months. Horizontal line passing medial and lateral canthal corner in both eyes was drawn in Photopshop. From the horizontal line, 3 vertical lines perpendicular to this line were drawn passing medial and lateral canthal corner and the vertically oriented center of the pupil. Eyebrow height was measured through these 3 vertical lines. The average length of decreased value of the eyebrow height were 3.64 mm in H1, 3.31 mm in H2, 2.79 mm in H3. In unilateral cases, 2.42 mm in H1, 2.86 mm in H2, 2.78 mm in H3, and in bilateral cases, the decreased values were 4.25 mm in H1, 3.53 mm in H2, 2.79 mm in H3. From this study, the author would like to introduce the method to calculate the changes of eyebrow height after blepharoptosis correction and the values objectively.

Clinical Application and Evaluation of Preoperative Bleeding Tendency using Platelet Function Analyzer (PFA(R))-100

Routine preoperative tests such as BT/CT, PT/PTT and CBC, could not test abnormal hemostasis that take drugs and health functional food. We used platelet function analyzer (PFA(R))-100, to evaluate preoperative bleeding tendencies. From November 2008 to February 2010, 306 surgical patients were tested preoperative PFA in our hospital. There are 2 tests in PFA(R)-100. The Pre Operative EPI (collagen/epinephrine) assay tests extrinsic platelet function, whereas the Pre Operative ADP (collagen/adenosine diphosphate) assay tests intrinsic platelet function. We divided normal and abnormal groups by the PFA(R)-100 assay tests. If either of results were abnormal in the two tests, the patient was divided to the abnormal group. 306 surgical patients were observed with hemorrhagic complications. All of the patients were divided normal and abnormal groups by the PFA(R)-100 test result. The normal group was made up of 286 (93.5%) patients, the abnormal group was made up of 20 (6.5%) patients. We observed each group hemorrhage complication including sever echymosis and hematoma, and analyzed each group complication rate. There were 9 (3.1%) cases of complication in the normal group. There were 3 (15.0%) cases of complication in the abnormal group. To evaluate preoperative bleeding tendency, PFA(R)-100 can be complementary examination with previous routine blood coagulation tests.

Effect of Seaweed Extract on Hair Growth Promotion in Experimental Study of C57BL/6 Mice

BACKGROUND: Recently, substances from seaweeds have been widely used in hair growth solutions, and have been proven to be effective. Seaweeds have been documented to possess hair growth activity; however, no report on the effect of seaweed on hair regeneration has been issued to date. In this study, we investigated which exact substance of hair tonic made by JW-bio and our institute shows effects on hair growth by studying the mechanisms of candidate substances. METHODS: The study was conducted to investigate the hair restoring effect of domestic natural substances; we categorized the candidate substances as seaweed, cereal, and herbal medicine. Five experimental groups were included in the study as follows: a saline group, a 50% ethanol group, seaweed group, a cereal group, and a herbal medicine group. RESULTS: Three extracts (seaweed, cereal, and herbal medicine) were administered to C57BL/6 mice for two weeks after depilation. Depilated areas were found to be completely covered with fully grown hair, and the hair re-growth score was highest in the seaweed group. Using a hair analysis system, hair characteristics were measured in all groups on days 10 and 14 after depilation. The width and length of hair follicles were largest in the seaweed group. Groups treated with seaweed showed significantly increased gene expression of insulin-like growth factor-1. Groups treated with all the three extracts showed decreased expression of transforming growth factor-beta1. CONCLUSION: Findings from our study suggest that seaweeds possess hair-growth effects and may be useful for the treatment of alopecia in the future.

Postoperative Contralateral Blepharoptosis in Patients with Unilateral Blepharoptosis and Negative Hering's Law Dependence Test

BACKGROUND: Correction of unilateral blepharoptosis is unexpectedly difficult because healthy eye is often affected by Hering's law. METHODS: We measured changes of marginal reflex distance (MRD1) on the unaffected eyelids between preoperative and 3-month postoperative photographs after ptosis correction. This study analyzed 134 unilateral blepharoptosis patients with ptosis correction from February 2002 to February 2011. Fifty patients among them were negative in Hering's law dependence test. From the preoperative and postoperative photographs the MRD1 of unaffected upper eyelids were measured and adjusted with the average pupil diameter of Koreans. Mean age was 34.4 and male was 30 and female was 20. Average follow-up periods were 14 months. RESULTS: Thirteenth unaffected eyes (26%) showed decreased MRD1, and 3 patients (6%) showed decreased MRD1 value over 1.0 mm. Then 3 patients needed additional operations for correction of preoperatively unaffected but ptotic eyelids. CONCLUSION: There were no meaningful data statistically in the value of MRD1 in every unaffected eye of the patients and in the difference between preoperative and postoperative MRD1 of groups divided according to severity, causes, and types of operation.

Clinical Consideration of 137 Cases of Basal Cell Carcinoma in Face

BACKGROUND: Basal cell carcinoma (BCC) is the most common skin cancer. About 74% cases of basal cell cancer occur on the head and neck. Basal cell carcinoma on the face may have a higher degree of subclinical spread than tumors arising elsewhere. And incompletely excised BCCs become more aggressive when they recur. So the surgical removal and reconstruction of BCC located on the face are important to make perfect curing and cosmetic results. METHODS: A retrospective study was done with 128 patients (137 cancers) who were treated with BCC on the face since 1987 to 2011. General data of these cases such as the primary site of cancer, age and sex of the patients, operative methods, and recurrence rate were reviewed. RESULTS: The ratio of men to women was 1:1.4. And 86.9% of the patients with BCC were older than the age of 50 years with the mean age of 65.8 years. The distribution of facial basal cell carcinoma was on the nose, eyelids, cheek, and nasolabial fold. Surgical methods for treatment were local flap, full thickness skin graft, primary closure, and split thickness skin graft. Specifically, local flap consists of V-Y advancement flap, cheek advancement flap, limberg flap, forehead flap, nasolabial flap, rotation flap, transposition flap, bilobed flap, and island flap. Six cases recurred and all of them were treated with reoperation. CONCLUSION: The authors reviewed facial basal cell carcinoma cases in our hospital. This study might be helpful to choose appropriate operation method to manage BCC on face in Korea.

Comparison of Swallowing Functions Between Brain Tumor and Stroke Patients

OBJECTIVE: To compare the swallowing functions according to the lesion locations between brain tumor and stroke patients. METHODS: Forty brain tumor patients and the same number of age-, lesion-, and functional status-matching stroke patients were enrolled in this study. Before beginning the swallowing therapy, swallowing function was evaluated in all subjects by videofluoroscopic swallowing study. Brain lesions were classified as either supratentorial or in-fratentorial. We evaluated the following: the American Speech-Language-Hearing Association (ASHA) National Outcome Measurement System (NOMS) swallowing scale, clinical dysphagia scale, functional dysphagia scale (FDS), penetration-aspiration scale (PAS), oral transit time, pharyngeal transit time, the presence of vallecular pouch residue, pyriform sinus residue, laryngopharyngeal incoordination, premature spillage, a decreased swal-lowing reflex, pneumonia, and the feeding method at discharge. RESULTS: The incidence of dysphagia was similar in brain tumor and stroke patients. There were no differences in the results of the various swallowing scales and other parameters between the two groups. When compared brain tumor patients with supratentorial lesions, brain tumor patients with infratentorial lesions showed higher propor-tion of dysphagia (p=0.01), residue (p<0.01), FDS (p<0.01), PAS (p<0.01), and lower ASHA NOMS (p=0.02) at initial evaluation. However, there was no significant difference for the swallowing functions between benign and malig-nant brain tumor patients. CONCLUSION: Swallowing function of brain tumor patients was not different from that of stroke patients according to matching age, location of lesion, and functional status. Similar to the stroke patients, brain tumor patients with infratentorial lesions present poor swallowing functions. However, the type of brain tumor as malignancy does not influence swallowing functions.

The Accuracy Rate in Comprehension of Aspects of Nasal Bone Fracture Based on Simple X-ray and 2D CT Compared with 3D Image

PURPOSE: The nasal bone fracture is known as the most common facial fracture, with the postoperative results and the patient's satisfaction known to be lower than other facial fractures. The patient's satisfaction is firstly related to the accurate comprehension of the spatial relationship in the fractured nasal bone and secondly to the accurate reduction based on accurate comprehension. The aim of this study is to evaluate the objective usefulness of the three-dimensional (3D) imaging. METHODS: The survey was conducted on 10 randomly selected cases of nasal bone fractures among the 46 cases with 3D computed tomography (CT) during the past one year. It was requested upon 4 plastic residents and 4 plastic surgeons to draw 3D aspect of fractured nasal bone directly on the printed photos of cadaver nasal bone, based on simple X-ray and twodimensional (2D) CT. They were compared with the real fractured nasal bone aspects based on the 3D image and marked the difference in the 10-point scale of 0 to 10. RESULTS: The average score of the 4 residents was 1.62 and that of the 4 surgeons was 4.47 out of 10 by simple X-ray. The average score of the 4 residents was 5.67 and that of the 4 surgeons was 7.25 out of 10 by 2D CT. CONCLUSION: It was surmised that the precise analysis and accurate comprehension of the spatial relationship of the fractured nasal bone using the 3D image, as based on the 2D CT images, can produce more favorable satisfaction levels in the patients.

Acquired Simulated Brown Syndrome Combined with Blepharoptosis after Upper Blepharoplasty

PURPOSE: Brown syndrome is motility disorder of the eyeball which shows limited elevation in adduction and occurs very rarely after eye surgery. The authors have experienced a case of strabismus-like Brown syndrome combined with blepharoptosis and report this case with the review of literatures. METHODS: A 28-year-old female suffered from hypotropia in the primary gaze and severe blepharoptosis with diplopia of the right eye after upper blepharoplasty. Rotation showed an inability to elevate the adducted right eye. She underwent extraocular muscle surgery about the 7 mm tucking of the right superior rectus muscle and 6 mm recession of right inferior rectus muscle. Intraoperatively, injury of the superior rectus muscle and foreign body were observed. Seven months after the extraocular surgery, the patient underwent frontalis muscle transfer on the right upper eyelid for the correction of blepharoptosis. RESULTS: Postoperatively, the patient was orthophoric in the primary gaze, and she had improvements in the correction of blepharoptosis and eyeball movement. CONCLUSION: Repeated eyelid surgeries increase the risk of ocular motility disorder. Careful approach is essential for the proper treatment and successful outcome in secondary surgeries.