Dynamic Evaluation of Skin Displacement by the Frontalis Muscle Contraction Using Three-Dimensional Skin Displacement Vector Analysis

Purpose@#Understanding the muscle actions and resultant skin movement can enable more safe and effective botulinum toxin injection for the treatment of forehead wrinkles. We aimed to investigate skin displacement patterns of the forehead and adjacent skin due to frontalis muscle contraction using three-dimensional skin vector displacement analysis. @*Materials and Methods@#Thirty healthy individuals were enrolled. Photographs of the face were taken at rest and during maximal contraction of the frontalis muscle. Each expression image was aligned to its respective static image to compute the differences in the skin position. @*Results@#When frontalis muscle contracts, forehead skin displacement vectors were mostly vertical (63.4%), followed by lateral oblique (33.3%) and medial oblique (3.3%). In 53.3%, only the lower part of the forehead moved upward, while 40.0% showed bidirectional skin movement with transition line at a mean distance of 59.4 mm above the pupil. Moreover, 86.7% showed asymmetric skin displacement, and 83.3% showed both glabellar and eyebrow skin displacement. Frontalis muscle contraction also induced medial 2/3 (50.0%) or entire (33.3%) skin movement of the temple. @*Conclusion@#Botulinum toxin injection into the forehead can be individualized by considering the vector and asymmetry of skin displacement. Vertical or medial vector requires more centrally located injections, while laterial vector requires more laterally located injections. The presence and location of the vertical transition line are important for preventing ptosis when treating forehead lines with botulinum toxin. Glabellar movement during frontalis contraction suggests the need for a concomitant injection into the glabella to prevent glabella wrinkle accentuation.

Short-term safety of facial rejuvenation using an absorbable polydioxanone monofilament thread in patients with mild-to-moderate facial skin sagging

Background@#Facial rejuvenation techniques using thread lifts are performed by passing sutures under the facial skin to treat sagging and facial flaccidity, and their advantages include a relatively short recovery time and relatively small incisions. In this study, we describe the short-term safety of a facial rejuvenation technique involving an absorbable polydioxanone monofilament thread (Mint Lift) in patients with mild-to-moderate facial skin sagging. @*Methods@#The current multicenter, retrospective, case-series study was conducted in a total of 196 patients who visited the Grace Plastic Surgery Clinic or the Songdo IB Clinic between 2016 and 2018. The patients underwent insertion of the Mint Lift 43 and 17 in the deep temporal fascia and the deep subcutaneous layer, respectively. Of these patients, 179 met the eligibility criteria and their medical records were retrospectively reviewed. @*Results@#The patients comprised six men (3.4%) and 173 women (96.6%), with a mean age of 44.4±14.4 years. In our series, postoperative complications included ecchymosis (1.7%), infection (0.4%), thread extrusion (1.1%), and skin dimpling (1.5%). No cases of iatrogenic nerve injury were observed, and all postoperative complications spontaneously resolved. @*Conclusions@#The Mint Lift 43 and 17 may be safe for thread lifting in patients with mildto-moderate facial skin sagging. However, further long-term follow-up studies are warranted.

Histological Evaluation of Gore-Tex(R) used in Nasal Augmentation of Human / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although Gore-Tex is popularly used in nasal augmentation in human, studies about the histological changes have been carried out only in animal models. The purpose of this study is to investigate histological changes of Gore-Tex used in nasal augmentation in human. SUBJECTS AND METHODS: Gore-Tex of 24 patients who underwent nasal augmentation using Gore-Tex (non-reinforced sheets) 2-36 months ago and had re-operated for the sole cosmetic problems was obtained. Histologic examination was performed from specimens including Gore-Tex and the surrounding soft tissue with light microscope and electromicroscope. RESULTS: Histologically, connective tissue ingrowth was observed in all specimen. But the degree of foreign body reaction and collagen deposit varied from specimen to specimen and had no relationship with the duration. Neovascularization was observed from specimen whose duration was longer than 12 months and degenerative calcification was observed from 36 month old specimen. CONCLUSION: Unlike the findings of previous reports, individual differences and partial degenerative lesions in Gore-Tex were observed. Additional studies are required to confirm the stability of Gore-Tex as an implant to be used in human.

Multicenter Evaluation on the Safety of Gore-Tex as an Implant in Rhinoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study was done to evaluate the safety of Gore-Tex as a nasal implant. Materials and METHOD: A retrospective multicenter study was carried out on 15 surgeons from 11 general hospitals and 4 private practice clinics regarding the safety of the Gore-Tex as a nasal implant. The study involved 853 patients, of whom 656 received primary surgery and 197 revision surgery. Gore-Tex was mainly used as a dorsal implant in a form of sheet or as a reinforced nasal implant. RESULTS: The overall complication rate associated with Gore-Tex was 2.5% (21 cases). Infection was the most common complication (18 cases ; 2.1%) followed by 2 cases of seroma and 1 case of persistent nasal swelling. In 19 out of 21 complication cases, the graft needed removal to control the infection or seroma (91% removal rate). Nine cases of infection developed in both primary cases (1.37%) and in revision cases (4.57%), which suggests a higher association rate between infection and revision cases (p=0.0062). Infection developed within 1 month in 5 cases while 9 cases developed infection after 6 months of operation. Other complications such as aesthetic problems (malpositioning of the implant or dorsal irregularities) were found in 15 cases (1.8%) and hematoma in 1 case. CONCLUSION: The infection rate of Gore-Tex used in rhinoplasty was about 2% and it rose significantly in the revision cases. If infected, almost all of the implanted Gore-Tex needs removal; therefore, we suggest judicious use of Gore-Tex in rhinoplasty.

Analysis of the Complication of Expanded-Polytetrafluoroethylene(e-PTFE) as Augmentation Material in Oriental / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although the complication of using e-PTFE as augmentation material in rhinoplasty for occidental patients have been reported, but only a little information is available for oriental patients. The aim of the present study is to analyze complications of e-PTFE for nasal augmentation in rhinoplasty for oriental patients. MATERIALS AND METHOD: The subjects consisted of 1376 patients who had been performed augmentation rhinoplasty with e-PTFE between January 1994 and October 2002. The subjects were classified according to experience of rhinoplasty. The first group included primary cases and second group revision cases. The revision group was divided into two groups according to the different techniques performed, one being the minor group that had been performed the simple technique, and the other group that had been performed the complicated technique. We reviewed postoperative complications of augmentation rhinoplasty with artificial implants including displacement, surface irregularity, infection, dorsal line and height problem, soft tissue reaction, extrusion and resorption. RESULTS: Side effects occurred in 127 (9.2%) of the 1376 patients: 38 (29.9%) was displacement, 29 (22.8%) dorsal height problem, 23 (18.1%) surface irregularity, 18 (14.2%) dorsal line and 18 (14.2%) infection and others. CONCLUSION: Compared with other autogenous and artificial materials, the study found e-PTFE as a good material for augmentation rhinoplasty for the orientals.

Surgical Anatomy of the Anterior Ethmoidal Canal in Ethmoid Roof: Anatomical and Computed Tomographic Analysis / 대한이비인후과학회지

BACKGROUNDS AND OBJECTIVES: This study was undertaken to examine three main relationships. First, the distance and angle from the anterior ethmoid canal to the limen nasi and the sill were measured. Second, The location of the anterior ethmoid canal was examined in relation to the lamellas and the skull base. Third, the existence of bony defects in the canal and the course through the anterior cranial fossa were studied. MATERIALS AND METHODS: This study employed both sagittal computed tomography and cadaver dissection. Seventy sagittally divided heads from randomly chosen Korean adult cadavers were used. Sagittal computed tomography was performed on all specimens. Then they were meticulously dissected under a surgical microscope. RESULTS: The mean distance and angle between the limen nasi and the anterior ethmoid canal was 49.0 mm and 54.5, respectively. The anterior ethmoid canal was located between the 2nd and 3rd lamella in 61 of 70 cases. In 60 of 70 cases, it was attached to the base of the skull, and in the remaining 10 cases, it ran 2 to 3 mm below the skull base. When viewed from the superior side, the course of the anterior ethmoid canal formed a diagonal line from the lateral to the medial side. Partial bony defects of the anterior ethmoid canal were observed in eight cases and complete bony defects in none. CONCLUSION: This study provides surgeons with a better understanding of the anatomy of the anterior ethmoid canal.

Saddle Nose & Septal Perforation Associated with Chemotherapy in Patients with Acute Leukemia / 대한이비인후과학회지

To date, no cases of nasal septal perforation during or after chemotherapy in patients with acute leukemia have been reported. In this study, we report three acute leukemia patients that had septal perforation and saddle nose deformity after chemotherapy and the results of our attempts to determine the causes of this phenomenon. We investigated retrospectively the types of chemotherapeutic agents involved and the duration of chemotherapy until the development of the nasal septal perforation. In addition, we also studied whether there were any remaining malignant cells by biopsy from the septal perforation margin. We found that Ara-C was the only drug that was used in all 3 patients. Nasal septal perforation and saddle nose developed approximately 4~7 weeks after the chemotherapy. A biopsy revealed inflammatory cells but no malignant cell infiltration. In cases of saddle nose associated with septal perforation after the chemotherapy for acute leukemia, one may consider the possibility of side effects of Ara-C. Furthermore, more active diagnosis and treatment are required when patients with acute leukemia complain of epistaxis or nasal obstruction during or after chemotherapy.

The Change of Nasal Blood Flow after a Total Laryngectomy Determined by Laser Doppler Blood Flowmetry / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The effects of airflow cessation on the human nasal mucosa can be conveniently studied in laryngectomees and the blood flow to nasal mucosa is an important factor in maintaining normal nasal function. Therefore, we investigated the changes in nasal mucosa blood flow after a total laryngectomy with Laser Doppler flowmetry. MATERIALS AND METHOD: Twenty-four laryngectomees were studied and compared with 35 normal volunteers. Among 24 total laryngectomees, 9 were esophageal speakers. The Laser Doppler flowmetry was performed using a Periflux 4001 (Perimed, Jrtlla, Sweden) and Perfusion unit (PU), Velocity unit (VU), and Concentration Unit (CU) were measured. The laser Doppler flowmetry data in the laryngectomees were compared with those of the normal subjects, and between the esophageal and non-esophageal speakers. RESULTS: The difference between laryngectomees and normal subjects was statistically significant with the exception of the CU (p<0.05). Furthermore, no correlations were found between blood flow and age, and between blood flow and postoperative duration. The difference between esophageal speakers and non-esophageal speakers was statistically significant with the exception of the level of concentration (p<0.05). CONCLUSION: The nasal blood flow decreased after a total laryngectomy. When airflow improved, an increase in the level of blood flow was recorded. And the change of the nasal blood flow most likely occured within the first year after a total laryngectomy.

Changes of the Secretion and Morphology on Normal Human Nasal Epithelial Cells by Interleukin-1beta / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES:Interleukin (IL)-lbeta is one of proinflammatory cytokines with an active role in acute nd chronic inflammation of airway mucosa. The present study was undertaken to find out the changes in the amount of released mucin and lysozyme by immunoblot assay which are the main constituents of airway secretion, to see if there were any changes in the mRNA expression of mucin and lysozyme genes by reverse transcription-polymerase chain reaction, and also to observe the morphologic changes of IL-1beta treated the normal human nasal epithelial (NHNE) cells by scanning and transmission electron microscopy. MATERIALS AND METHODS: NHNE cells were cultured using air-liquid interface technique and on the plating day 12, IL-lbeta 10 ng/ml was added and the cells were cultured for 24 hours. Afterwards the media and cells in the insert were harvested. RESULTS:The secretion of mucin and lysozyme didn't change significantly after the stimulation with IL-1beta and there was no significant difference between the control group and IL-1beta treated group in mRNA expression of MUC2, 5AC, 5B and lysozyme genes whereas MUC8 mRNA was significantly increased by IL-1beta stimulation. Electron microscopic findings revealed no significant differences between these two groups. CONCLUSION:The stimulation with IL-1beta alone in the differentiation stage couldn't induce changes in the secretory function and morphology of NHNE cells, but could enhance the expression of MUC8 mRNA. Therefore, the further study on the pathologic changes of NHNE cells by the combined actions of various inflammatory mediators should be followed.

Morphologic Changes in Cultured Normal Human Nasal Epithelial Cells Following Treatment with Histamine

The aims of this study are to observe morphologic changes in normal human nasal epithelial (NHNE) cells caused by varying concentrations of histamine, to evaluate the changes in relation to the degree of epithelial differentiation, and to examine whether these changes are caused by the proper action of histamine or are general inflammatory processes represented by lipopolysaccharide (LPS). Cultured NHNE cells were treated with histamine diphosphate and LPS 0111 : B4 at different concentrations : 20 ng/ml, 200 ng/ml, 2 microgram/ml and 20 microgram/ml. The timing of the treatment was conducted in one of two ways : a duration of 48 hours on floating day 12 or a duration of seven days on floating day seven. On floating day 14, all specimens were collected, and hematoxylin & eosin staining and scanning electron microscopy (SEM) were conducted. The areas of ciliated and secretory cell were calculated with the Optimas program. In SEM of specimens that were given 48-hour treatments of histamine and LPS at 20 microgram/ml dosages, coverage by secretory cells had increased and damaged cilia were noted. In SEM of specimens given the seven-day treatment, enlargement of the secretory cell area and damaged cilia were observed after a treatment of 20 microgram/ml LPS, but in specimens treated with histamine, findings were normal. Morphologic changes caused by histamine treatment may be a nonspecific finding observed in inflammation, and the changes can vary according to the differentiation of the epithelium.

Epidemiological Study for Allergic Disease of School Aged Children and Adolescence in Rural Area of Korea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Basic epidemiologic investigations are important given the need for prevention and proper treatment of the patient with allergic disease. However, basic epidemiologic data of allergic disease in Korea are rarely found. Especially, data about school children in the rural areas of Korea are not found in the review of literature. We attempted to obtain epidemiological data of allergic diseases, such as prevalence rate, skin test results and family history, in school children living in the rural area of Korea. MATERIALS AND METHODS: We performed statistical analysis of 13,160 students who responded to the questionnaire concerning several allergic symptoms and family history. Of these 13,160 students, 171 students were given skin tests, and their results were also statistically analyzed. RESULTS AND SUMMARY: The percentage of students who had ever suffered from allergic diseases were as follows: atopic dermatitis (11.2%), urticaria (31.3%), asthma (11.1%), and allergic rhinitis (28.5%). The prevalence rate of allergic disease at the point of study performed were as follows: atopic dermatitis (1.5%), urticaria (4.7%), asthma (2.2%), and allergic rhinitis (5.3%). Students with allergic symptoms showed positive skin test results (64.7%). The most common allergen causing the allergic symptoms were Dermatophagoides pteronyssinus and Dermatophagoides farinae. Seasonal predominance was prominent in the winter (33.8%) for students who have allergic rhinitis.

Effect of Botulinum Toxin Injection in Patients with Adductor Spasmodic Dysphonia / 대한이비인후과학회지

In the treatment of spasmodic dysphonia, local injection of botulinum toxin A has been reported to be successful. The treatment of adductor type spasmodic dysphonia using botulinum toxin type A was conducted in 31 patients. These patients were given toxins in the vocal fold(s), unilaterally or bilaterally, under telelaryngoscopic guidance with 23 gauge scalp needle attached by laryngeal forceps. Before the above procedure, laryngeal anesthesia was done with 2% pontocain instillation. Among the 31 patients, 30 patients were given the toxin successfully. Telephone interview were made at 2 weeks and then at 4 weeks post injection. Among the above 30 patients, 90% reported that the injection was of significant benefit. The functional status of the patient's disorder was classified into four grades. The mean pre-injection grade for the patients in this study was 2.10 and it was significantly lowered to 1.13 after the injection(p<0.01). As a self assessment method, the patients were asked to rate their voice on a scale of 100. In this study, the mean pre-injection score was 40 and it was significantly improved to 69.8 after the injection(p<0.01). In conclusion, botulinum toxin injection using telelaryngoscope is a safe and effective method for the treatment of adductor type spasmodic dysphonia.