Outcome Analysis of Extended, Long, Curved Ostectomy with Outer Cortex Grinding for Prominent Mandibular Angle and Broad Chin to Achieve V-line Contouring

BACKGROUND: In Asian countries, patients with a square-shaped lower face want a narrow chin as well as improvements in the mandibular angle contour, which is called a "V-line shape." Currently, various surgical techniques have been developed for mandibuloplasty. METHODS: We have developed an extended, long, curved ostectomy, which starts from the inferior mandibular margin below the lateral incisor to the angle, using reciprocating and oscillating saws. We also used a small round bur to grind the outer cortex of the chin and ramus. A total of 243 patients were included in this study from 2012 to 2014. RESULTS: To analyze aesthetic outcomes, we compared mandibular angles and gonial-gonial (G-G) distances on preoperative three-dimensional computed tomography scans with postoperative images. Mandibular measurements demonstrated significant increments in angle degrees on the right (115.2degrees+/-11.1 vs 129.3degrees+/-11.5, P<0.05) and left sides (112.2degrees+/-10.2 vs 130.4degrees+/-11.3, P<0.05). The G-G distance was reduced postoperatively from 123.7 mm+/-7.9 to 110.0 mm+/-3.5 (P<0.05). CONCLUSIONS: In this study, we demonstrate the effectiveness of our technique and assume that we can improve frontal shape and lateral contour with its use.

The Effects of Botulinum Toxin A on Collagen Synthesis, Expression of MMP (matrix metalloproteinases)-1,2,9 and TIMP (tissue inhibitors of metalloproteinase)-1 in the Keloid Fibroblasts

Keloids are characterized by excessive extracelluar matrix (ECM) deposition such as collagen, fibronectin, elastin, and proteoglycans in the dermis. Recently, the use of botulinum toxin A (BTXA) in the treatment of keloids have had good results. To investigate the therapeutic effect of BTXA on the keloids, we evaluated the mRNA expression of collagen type I, type III, MMP (matrix metalloproteinases)-1, and TIMP (tissue inhibitor of metalloproteinases)-1 on keloid fibroblasts (KFs, n=5) after administration of BTXA. We also evaluated the enzymatic activity of MMP-2 and 9 by using zymography with BTXA. The same process was repeated after administration of TGF-beta in addition to BTXA. Type III collagen mRNA expression was decreased significantly when BTXA was administrated on KFs regardless of the presence or absence of TGF-beta. MMP-1 mRNA expression in KFs was increased according to the BTXA concentration increment, however, not increased with TGF-beta. Moreover, MMP-2 enzymatic activity in KFs was increased when BTXA administrated regardless of the presence or absence of TGF-beta. These results suggest that the down regulation of collagen III expression, the up regulation of MMP-1, and increased MMP-2 enzymatic activity on KFs after BTXA administration are able to decrease the excess collagen deposition in keloids.

Outcome Analysis of Cranial Molding Therapy in Nonsynostotic Plagiocephaly

BACKGROUND: It is known that nonsynostotic plagiocephaly does not spontaneously improve, and the craniofacial deformities that result from it. This study was conducted to analyze the effectiveness of helmet therapy for the nonsynostotic plagiocephaly patient, and to suggest a new treatment strategy based on this analysis. METHODS: A total of 108 pediatric patients who had undergone helmet therapy after being diagnosed with nonsynostotic plagiocephaly were included in this study. The patients were classified according to the initiation age of the helmet therapy, severity, and helmet wearing time. The treatment effect was compared using cranial vault asymmetry (CVA) and the cranial vault asymmetry index (CVAI), which were obtained from diagonal measurements before and after therapy. RESULTS: The discrepancy of CVA and CVAI of all the patients significantly decreased after helmet therapy. According to the initiation time of helmet therapy, the treatment effect was best at 5 months old or less. The helmet wearing time per day was proportional to the treatment effect up to 20 hours. In addition, the rate of the successful treatment (final CVA < or =5 mm) significantly decreased when the initiation age was 9.1 months or older and the treatment period was less than 7.83 months. CONCLUSIONS: This study showed the effectiveness of the helmet therapy for nonsynostotic plagiocephaly patients. Based on analysis of this study, helmet therapy should be started at the age of 9 months or younger for 7.83 months or more, and the helmet wearing time should be more than 20 hours a day.