Inferomedially impacted zygomatic fracture reduction by reverse vector using an intraoral approach with Kirschner wire

Background@#In inferomedially rotated zygomatic fractures sticking in the maxillary sinus, it is often difficult to achieve complete reduction only by conventional intraoral reduction. We present a new intraoral reduction technique using a Kirschner wire and its clinical outcome. @*Methods@#Among 39 inferomedially impacted zygomatic fractures incompletely reduced by a simple intraoral reduction trial with a bone elevator, a Kirschner wire (1.5 mm) was vertically inserted from the zygomatic body to the lateral orbital rim in 17 inferior-dominant rotation fractures and horizontally inserted to the zygomatic arch in nine medial-dominant and 13 bidirectional rotation fractures. A Kirschner wire was held with a wire holder and lifted in the superolateral or anterolateral direction for reduction. Following reduction of the zygomaticomaxillary fracture, internal fixation was performed. @*Results@#Fractures were completely reduced using only an intraoral approach with Kirschner wire reduction in 33 cases and through an additional lower lid or transconjunctival incision in six cases. There were no surgical complications except in one patient with undercorrection. Postoperative 6-month computed tomography scans showed complete bone union and excellent bone alignment. Four patients experienced difficulty with upper lip elevation; however, these problems spontaneously resolved after manual tissue lump massage and intralesional steroid (Triamcinolone) injection. @*Conclusions@#We completely reduced infraorbital rim fractures, zygomaticomaxillary buttresses, and zygomaticofrontal suture fractures in 84% of patients through an intraoral approach alone. Intraoral Kirschner wire reduction may be a useful option by which to obtain effective and powerful reduction motion of an inferomedially rotated zygomatic body.

Evaluation and management of facial granuloma caused by various injection materials

Background@#Various substances are currently being used for cosmetic or postsurgical reconstruction reasons. Injecting of various materials into the face may provoke inflammatory or granulomatous reactions, infection and tissue necrosis. Among these reactions are foreign body granulomas. This study aims to describe the clinical characteristics of and therapeutic approaches used in patients with facial foreign body granulomas caused by the injection of various substances. @*Methods@#From 2007 to 2020, a total of 64 patients visited our hospital due to inflammatory signs, palpable masses or surface irregularities. We reviewed patient characteristics, type of injected material, medical history and treatment outcomes. The treatment results were scored with patient satisfaction and statistical analysis of the treatment period was performed. @*Results@#Most patients underwent conservative treatment followed by surgical treatment because of persistent symptoms; one patient did not require surgery. All patients reported good treatment results and satisfaction. The earlier the surgical treatment was performed, the shorter the treatment period and the higher patient satisfaction scoring. @*Conclusion@#Granulomatous changes to the face are an emerging concern in various cosmetic procedures and surgeries, including fillers, silicone implants and autologous fat injections. Our findings strongly suggest that patient symptoms require accurate diagnosis and surgical treatment.

Soft tissue sarcoma in neurofibromatosis type 1: A rare case of malignant peripheral nerve sheath tumor of the skin

Malignant peripheral nerve sheath tumor (MPNST) is a rare and often aggressive soft tissue sarcoma originating from the sheaths of peripheral nerves. Approximately 50% of MPNSTs occur in patients with neurofibromatosis (NF). These tumors often present as deep soft tissue lesions, arising from the nerve plexuses of the extremities or from the nerves extending from the trunk. They rarely occur in the skin, especially in patients with NF. Herein, we report our experience with an MPNST of the skin in a patient with NF.

Relationship between First-Episode Schizophrenic Psychopathology and 99m-Tc-ECD SPECT Regional Cerebral Blood Flow and Plasma Homovanillic Acid / 대한정신약물학회지

OBJECTIVE: The purpose of this study was to examine the relative blood flow differences of brain regions between first-episode schizophrenic patients and normal controls and the relationships between these regions and the changes of psychopathology scores, the treatment response, after serotonin dopamine antagonist (SDA) risperidone treatment. Another purpose of this study was to investigate SPECT relative blood flow index as the treatment response predictor of SDA treatment under control of the influences of homovanillic acid (HVA). We hypothesize that there is differences in the brain blood flows examined by SPECT between first-episode schizophrenic patients and normal controls. Relative blood flow index examined by SPECT will be the response predictors of SDA treatment of schizophrenia under control of influences of metabolites. METHODS: The relative blood flows of seventeen first-episode schizophrenic patients and ten normal controls were examined by 99m-Tc ECD SPECT before drug treatment. The patients group was treated for 6 weeks with SDA. The psychopathology was assessed at baseline just before SDA trial and then at 2 weeks and 6 weeks after SDA treatment. At the same time plasma HVA was evaluated by HPLC (high performance liquid chromatography). RESULTS: The cerebral blood flow of first-episode schizophrenic patients was decreased in thalamus and left basal ganglia and the relative blood flow index of schizophrenic patient's left thalamus was significant therapeutic predictor of SDA treatment of positive symptoms under control of the HVA influnences. CONCLUSION: These results suggest that the relative blood flow examined by SPECT will be a therapeutic index of SDA treatment in schizophrenia.

Clinical Analysis of Reoperation for Prosthetic Valve Replacement: Report of 12 cases / 대한흉부외과학회지

Between May 1986 and May 1996, 269 patients underwent prosthetic valve replacement. A bioprosthetic valve was replaced in 70 cases and mechanical valve was replaced in 232. Of this 12 patients performed reoperations for replacement, and the mean interval between primary valve operation and reoperation was 87.6 months for mitral valve and 87.7 months for aortic valve. There were 10 women and 2 men, agcd from 22 to 68 years(mean 45). A bioprosthetic valve was implanted in 8 cases and a mechanical valve was implanted in 4 cases for initial operation. llidications for reoperation were structural deterioration in 5 cases(42%), valve thrombus in 5 cases(42%) and endocarditis in 2 cases(17%). Operations performed included 3 aortic valve replacements(25%), 9 mitral valve replacements(75%). Wc used mechanical valve in llcases(92%) and tissue valve in 1 case(8%) for reoperation. There were 2 early operative deaths because of valve detachment and of acute respiratory failure. Among ten survivor's, there were no late deaths with follow up of 35.8 months.

Clinical Analysis of Traumatic Diaphragmatic injuries: Report of 28 cases / 대한흉부외과학회지

The records of 28 patients with traumatic diaphragmatic injuries seen at Masan Samsung Hospital from march 1986 o March 1995 were reviewed. We treated 21 male and 7 female patients ranging in ages from 5 to 68 years. Thc diaphragimatic injuries were due to blunt trauma in'20 cases(Trawc accident 18, compression injury 1, Human trauma 1) and penetrating injuries 8 cases (all stab wound). Most common symptoms were dyspnea 27 (96%), chest pain 26 (93%), abdomianl pain 8 (29%), comatose mentality 36 (11 %). Chest X-ray were elevated diaphragm in 20 cases(71%) find hemothorax in 18 cases (64%) and 25 cascs (89%) were diagnosed or suspected as diaphragmatic inju,rims prcopcrativcly. The repair of 28 cases were performed with thoracic approach in 20 cases, abdominal approach 7, thoracoabdominal approach in 1 cases. There were 5 death (18%) and all death related to the severity of associated injury. (hypovolcmic shock 3, combined head injury 1, renal failure 1).

A Clinical Study of the Medistinal Tumors and Cysts: 27 cases analysis / 대한흉부외과학회지

We have experienced 27 cases of primary medistinal tumors and cyst from April, 1986 to April 1996. At Masan Samsung General Hospital. The results of the anslysed were as follows. 1. Of 27 medistinal tumors and c,pests, 9 patients were male and 18 patients were female(m : f = 1 : 2). 2. The most common chief complaint was chest discomfort or pain(8 cases 30 %) and 17 patients(63%) were asymptomatic. 3. The most common primary medistinal tumor was Neurogenic tumor in 9 cases(33 %) followed by Thymoma in 7 cases(26 %), teratoma in 6 cases(22 %). 4. The incidence of malignancy of all case was 3 cases(11 %), all cases were symptomatic and the most common malignancy was malig. thymoma(3 cases,43 %). 5. The anterior mediastinum was the most common tumor location with 15 cases(56 %) followed by posterior 11(41 %) and middle mediastinum 1(4 %). Anterior mediastinum tumors were predominantly thymomas and teratoma and posterior mediastinal tumors were neurogenic tumors. 6. Complete removal of tumor was achieved in 26 cases(96 %) and open biopsy was done on 1 case. 7. Postoperative complications were continued lumbar shunt drainage in 1 case and wound infection in 1 case. 8. There was no case of postoperative mortality and good clinical course in surgically completely resected cases.

A Case of Pseudotumor Cerebri Complicated by Acute Frontal Sinusitis

Pseudotumor cerebri is a condition of obscure etiology characterized by headache, papilledema and raised intracranial pressure in the absence of a space-occupying lesion. We have experienced a case of pseudotumor cerebral complicated by acute frontal sinusitis associated with mild intracranial meningeal inflammation. We have checked the intracranial pressure through serial lumbar puncture before and after medication and conservative management. Symptom were resolved gradually upon lowering the intracranial pressure by serial lumbar puncture and conservative management. So we report a case with brief review of the literature.