Clinical Experience of External Carotid A-V Fistula after Reduction Mandibuloplasty

Reduction mandibuloplasty was first operated as an intraoral approach by Converse in 1951. Since then, it bacame the most widely-operated facial contouring surgeries on the patients who has squared appearance with prominent mandibular angle. Lateral cortical ostectomy, two step angle ostectomy and sagittal angle osteotomy are the popular methods of reduction mandibuloplasty. In addition, resection of masseter muscle during surgery and botox injection before or after surgery have been used widely. Recent advancement of the medical appliances and the surgical procedures have slashed the rate of complication such as facial asymmetry, undercorrection, secondary angle formation, surgical hematoma, inferior alveolar nerve injury, subcondylar fracture, transient facial nerve palsy and infection, etc. Acquired facial arteriovenous fistulas except congenital cases rarely develop after stab injuries or panfacial bone fracture or basal skull fracture. Especially, external carotid arteriovenous fistulas have been seldom reported. We experienced a case of external carotid arteriovenous fistula after reduction mandibuloplasty.

A Case of Primary Antiphospholipid Syndrome Presenting as Digital Gangrene / 대한류마티스학회지

Antiphospholipid syndrome (APS) is characterized by a combination of arterial/venous thrombosis or obstetric morbidity and antiphospholipid antibodies such as anticardiolipin antibody or lupus anticoagulant. Digital gangrene is an uncommon manifestation of primary APS. A 61 year-old woman was admitted because of acrocyanosis and progressive digital gangrene in both hands for 1 month. Serologically, lupus anticoagulant was positive. Angiography showed obstruction of digital arteries with collaterals, but there was no evidence of atheromatous plaque or vasculitis. Cardiac echogram did not reveal intracardiac thrombosis or valvular vegetations. She had no evidence of other thrombotic disorders, connective tissue disease, infections or malignancy. Treatment of intravenous heparin and prostaglandin E1 led to stabilization of the symptom, and the necrotic digits were surgically removed. Pathological examination of the amputed digital stump showed arterial and arteriolar thrombotic occlusion, proliferation of capillaries, and ischemic necrosis. After oral anticoagulation therapy, she has been followed without recurrence.We describe the first case of primary APS presenting as digital gangrene in Korea and review the literatures.