One-Stage Reconstruction with Pericraniosubgaleal Flap after Removal of Skin Involved Severe Paraffinoma

Paraffinoma on nose from injection of paraffin by the quack doctor for the purpose of augmentation rhinoplasty has so many problem, especially when invaded overlying nasal skin. 6 cases of skin involved severe paraffinoma were treated by one step reconstruction with pericraniosubgaleal flap and follow up periods was 2 to 17 months. All patients were successfully treated without any complications and had satisfactory results. In cases of three telangiectasis among six patients, the severity of telangiectasis was improved, but not completely. We believe that the advantages of this method are one step reconstruction and good vascularity, which prevent infection and enable easy to make variable shape. When the overlying skin loss was developed, the flap became tolerable graft bed. The authors conclude that the pericraniosubgaleal flap is one of the reliable surgical options for treatment of the skin involved severe nasal paraffinoma.

Optic Nerve Injury Associated with Facial Trauma

The traumatic optic neuropathy occurs in 0.5 to 5% of closed head trauma cases. Because it may cause permanent blindness, the early diagnosis and proper treatment are very important. We have treated 6 traumatic optic neuropathy patients among 433 head trauma cases from Sep, 1997 to Aug, 1998. Four patients showed visual recovery with steroid therapy. The diagnosis can be made clinically when the patient suffers from acutely decreased vision, Marcus-Gunn pupil, with its relatively normal fundoscopic finding, is considered as the most sensitive indicator and the first herald of visual tract injury, even though visual acuity is normal at the initial stage. The megadose steroid therapy must be diagnosed for the recovery of incompletely injured axons rather than regeneration. The optic canal decompression surgery must be spared for the delayed onset optic neuropathy patients who do not respond to the steroid therapy. In a case of indirect optic neuropathy, the associated orbital fracture reduction should not be undertaken until the optic neuropathy has stabilized. But severely displaced blow-in fracture of the orbit that decreases orbital volume should repaired early for orbital decompression.

A Case Report of Pseudoxama Elasticum of the Neck: Surgical Excision and The Effect of Laserbrasion

Pseudoxanthoma elasticum (PXE) is an uncommon heritable disorder of elastin characterized by cutaneous, ocular and vascular abnormalities. Typical skin lesion shows yellowish papules and redundant skin folds on the neck, axilla and groin due to degeneration and calcification of elastic fibers in deep dermis. As in all heritable disorders of connective tissue, no curative therapy is presently know. Redundant and unsightly skin folds about the neck can be improved by surgery, but irregular papular lesion on skin does not improved by surgery. A-44-year-old female who had a skin lesion and angioid streak was treated as follows: Skin folds on the neck were excised successfully without any significant problem such as intraoperative bleeding, wound dehiscence or hypertrophic scar formation. To evaluate whether we could smooth the irregular skin surface due to multiple papules, laserbrasion with a SLT contack Nd:YAG laser system was performed experimentally on a limited area which was located on the right supracla-vicular area about 2 x 3cm in size. An acceptable aesthetic appearance was achieved with surgical excision 12 months after the operation. Biopsy of the laserbrasion site revealed disappearance of the calcium deposit. This study emphasizes the possibility of using laserbrasion in solving troblesome skin lesion of the PXE.