Delayed Foreign Body Reaction Caused by Bioabsorbable Plates Used for Maxillofacial Fractures

BACKGROUND: Bioabsorbable plates and screws are commonly used to reduce maxillofacial bones, particularly in pediatric patients because they degrade completely without complications after bone healing. In this study, we encountered eight cases of a delayed foreign body reaction after surgical fixation with bioabsorbable plates and screws. METHODS: A total of 234 patients with a maxillofacial fracture underwent surgical treatment from March 2006 to October 2013, in which rigid fixation was achieved with the Inion CPS (Inion, Tampere, Finland) plating system in 173 patients and Rapidsorb (Synthes, West Chester, PA, USA) in 61 patients. Their mean age was 35.2 years (range, 15-84 years). Most patients were stabilized with two- or three-point fixation at the frontozygomatic suture, infraorbital rim, and anterior wall of the maxilla. RESULTS: Complications occurred in eight (3.4%) of 234 patients, including palpable, fixed masses in six patients and focal swelling in two patients. The period from surgical fixation to the onset of symptoms was 9-23 months. Six patients with a mass underwent secondary surgery for mass removal. The masses contained fibrous tissue with a yellow, grainy, cloudy fluid and remnants of an incompletely degraded bioabsorbable plate and screws. Their histological findings demonstrated a foreign body reaction. CONCLUSIONS: Inadequate degradation of bioabsorbable plates caused a delayed inflammatory foreign body reaction requiring secondary surgery. Therefore, it is prudent to consider the possibility of delayed complications when using bioabsorbable plates and surgeons must conduct longer and closer follow-up observations.

Orbital Wall Restoring Surgery in Pure Blowout Fractures

BACKGROUND: Restoring orbital volume in large blowout fractures is still a technically challenge to the orbital surgeon. In this study, we restored the orbital wall using the combination of transorbital and transnasal approach with additional supports from the paranasal sinuses, and we compared the surgical outcome to that of a conventional transorbital method. METHODS: A retrospective review of all patients with pure unilateral blowout fractures between March 2007 and March 2013 was conducted. 150 patients were classified into two groups according to the surgical method: conventional transorbital method (group A, 75 patients, control group), and the combination of transorbital and transnasal approach with additional supports from the paranasal sinuses (group B, 75 patients, experimental group). Each group was subdivided depending on fracture location: group I (inferior wall), group IM (inferomedial wall), and group M (medial wall). The surgical results were assessed by the Hertel scale and a comparison of preoperative and postoperative orbital volume ratio (OVR) values. RESULTS: In the volumetric analysis, the OVR decreased more by the experimental groups than each corresponding control groups (P0.05). CONCLUSIONS: Our surgical results suggest that orbital volume was more effectively restored by the combination of transorbital and transnasal approach with additional supports from the paranasal sinuses than the conventional method, regardless of the type of fracture.

Orthodromic Transfer of the Temporalis Muscle in Incomplete Facial Nerve Palsy

BACKGROUND: Temporalis muscle transfer produces prompt surgical results with a one-stage operation in facial palsy patients. The orthodromic method is surgically simple, and the vector of muscle action is similar to the temporalis muscle action direction. This article describes transferring temporalis muscle insertion to reconstruct incomplete facial nerve palsy patients. METHODS: Between August 2009 and November 2011, 6 unilateral incomplete facial nerve palsy patients underwent surgery for orthodromic temporalis muscle transfer. A preauricular incision was performed to expose the mandibular coronoid process. Using a saw, the coronoid process was transected. Three strips of the fascia lata were anchored to the muscle of the nasolabial fold through subcutaneous tunneling. The tension of the strips was adjusted by observing the shape of the nasolabial fold. When optimal tension was achieved, the temporalis muscle was sutured to the strips. The surgical results were assessed by comparing pre- and postoperative photographs. Three independent observers evaluated the photographs. RESULTS: The symmetry of the mouth corner was improved in the resting state, and movement of the oral commissure was enhanced in facial animation after surgery. CONCLUSIONS: The orthodromic transfer of temporalis muscle technique can produce prompt results by applying the natural temporalis muscle vector. This technique preserves residual facial nerve function in incomplete facial nerve palsy patients and produces satisfying cosmetic outcomes without malar muscle bulging, which often occurs in the turn-over technique.

Retiform Hemangioendothelioma on the Finger

No abstract available.

Anatomical Reconstruction of the Medial Orbital Wall Fracture

PURPOSE: In surgical treatment of the medial orbital wall fractures, restoring the original position of the orbital wall is difficult in some cases. Under such condition, the orbital wall is often reconstructed with synthetic material, without bony reduction, which is considered to be the conventional reconstruction. The purpose of this study is to compare the outcomes of anatomical reconstruction, which restores the bony wall to the anatomical position, from that of the conventional reduction in the isolated medial orbital wall fractures. METHODS: Thirty patients, who underwent reconstruction surgery for the isolated medial orbital wall fractures from March 2007 to August 2011, were reviewed retrospectively. The surgical outcomes of two groups, the conventional reconstruction group (15 patients) and the anatomical reconstruction group (15 patients), were studied in 2 measurements, a one day before and 6 months after the surgery. The changes of orbital volume were calculated by the images from a computed tomography scan and enophthalmos was measured by a Hertel exophthalmometer. RESULTS: The orbital volume ratio was decreased by an average of 1.05% in the conventional reconstruction group, while in the anatomical reconstruction group, the ratio decreased by 5.90% (p0.05). CONCLUSION: In conclusion, the anatomical reconstruction technique of the isolated medial orbital wall fracture results in a better outcome than that of the conventional reconstruction, in terms of restoring of the original orbital volume and anatomic position. Thus, it can be considered as a useful method for the isolated medial orbital wall fractures.

Anatomical Reconstruction of the Medial Orbital Wall Fracture

PURPOSE: In surgical treatment of the medial orbital wall fractures, restoring the original position of the orbital wall is difficult in some cases. Under such condition, the orbital wall is often reconstructed with synthetic material, without bony reduction, which is considered to be the conventional reconstruction. The purpose of this study is to compare the outcomes of anatomical reconstruction, which restores the bony wall to the anatomical position, from that of the conventional reduction in the isolated medial orbital wall fractures. METHODS: Thirty patients, who underwent reconstruction surgery for the isolated medial orbital wall fractures from March 2007 to August 2011, were reviewed retrospectively. The surgical outcomes of two groups, the conventional reconstruction group (15 patients) and the anatomical reconstruction group (15 patients), were studied in 2 measurements, a one day before and 6 months after the surgery. The changes of orbital volume were calculated by the images from a computed tomography scan and enophthalmos was measured by a Hertel exophthalmometer. RESULTS: The orbital volume ratio was decreased by an average of 1.05% in the conventional reconstruction group, while in the anatomical reconstruction group, the ratio decreased by 5.90% (p0.05). CONCLUSION: In conclusion, the anatomical reconstruction technique of the isolated medial orbital wall fracture results in a better outcome than that of the conventional reconstruction, in terms of restoring of the original orbital volume and anatomic position. Thus, it can be considered as a useful method for the isolated medial orbital wall fractures.

Shoulder Augmentation

As the breast of woman is considered as a symbol of femininity, the shoulder of man is regarded as a symbol of masculinity. Narrow shoulders disallow proper fitting of male clothing and result disproportionately large and unbalanced facial look in men. The purpose of this article was to evaluate the aesthetic outcomes of shoulder augmentation using soft silicone in patients with narrow shoulders. From April 2009 to July 2010, 21 male patients received shoulder augmentation by using silicone implants in the subfascial space of the deltoid muscle. The silicone implant was prefabricated according to the shape of the lateral portion of the deltoid muscle, and placed in subfascial pocket. After the operation, the shoulder width was increased by 6.6cm on average and patients were satisfied with their augmented shoulders, giving them more sharp figure when wearing their clothes. The firmness of the soft silicone is similar that of the deltoid muscle, and the curvature of the implant looks like a natural deltoid muscle. The subfascial position of the implant does not limit the range of motion of the shoulder joint. The authors expect that shoulder augmentation will take part in a new entity of body contouring surgery.

Ophthalmomyiasis Caused by a Phormia sp. (Diptera: Calliphoridae) Larva in an Enucleated Patient

Ophthalmomyiasis rarely occurs worldwide, and has not been reported in Korea. We present here a case of ophthalmomyiasis caused by Phormia sp. fly larva in an enucleated eye of a patient. In June 2010, a 50-year-old man was admitted to Dankook University Hospital for surgical excision of a malignant melanoma located in the right auricular area. He had a clinical history of enucleation of his right eye due to squamous cell carcinoma 5 years ago. During hospitalization, foreign body sensation developed in his right eye, and close examination revealed a fly larva inside the eye, which was evacuated. The larva was proved to be Phormia sp. based on the morphology of the posterior spiracle. Subsequently, no larva was found, and the postoperative course was uneventful without any complaints of further myiasis. This is the first case of ophthalmomyiasis among the literature in Korea, and also the first myiasis case caused by Phormia sp. in Korea.

A Study of Potential Application of Rubus coreanus Miquel Extract for Seborrheic Dermatitis Treatment / 대한의진균학회지

BACKGROUND: Seborrheic dermatitis is chronic relapsing inflammatory skin disorder. Bokbunja (Rubus coreanus Miquel) is a wild berry to Rosaceae genus and also known to have an anti-inflammation effect. OBJECTIVE: We were to determine the effect of Rubus coreanus Miquel extract for seborrheic dermatitis in vivo and in vitro. METHODS: Seven patients with mild seborrheic dermatitis were enrolled in this study. PCR and culture were performed to identify subtypes of six Malassezia species (M. restricta, M. globosa, M. furfur, M. slooffiae, M. sympodialis, M. obtusa). Topical application of Rubus coreanus Miquel Extract was applied twice daily for 2 weeks. Clinical improvement and safety assessment were performed initially and 2 weeks later. Minimum inhibitory concentration (MIC) was evaluated on Malassezia globosa comparing with ketoconazole and itraconazole. Sebum production was also checked prior the experiment and 2 weeks later. RESULTS: Five of seven patients showed improvement. No significant adverse effects were found during the clinical trial. Mild dryness was reported in 2 patients but they resolved spontaneously without any treatment. Rubus coreanus Miquel Extract didn't show antimicrobial effect to Malassezia globosa. However, Rubus coreanus Miquel Extract showed anti-inflammatory effect. CONCLUSION: In this study, we were verified that Rubus coreanus Miquel Extract can be applied for seborrheic dermatitis treatment. And this action mechanism is not related with antimicrobial effect.

Discovery of Maritrema jebuensis n. sp. (Digenea: Microphallidae) from the Asian Shore Crab, Hemigrapsus sanguineus, in Korea

Maritrema spp. (Digenea: Microphallidae) are parasites of birds, but have not been found in the Republic of Korea. In this study, metacercariae of Maritrema sp. were discovered in the Asian shore crab, Hemigrapsus sanguineus, caught in the mud-flats of Jebu-do, Hwasung-gun, Gyeonggi-do, and the adult flukes were confirmed by experimental infection into mice. Based on the symmetric ribbon-like vitellarium, adult flukes of Maritrema sp. were identified, but did not belong to previously described species in terms of the following morphologic characteristics: ceca reaching to the lateral wall at the anterior border of the ovary; ventral sucker larger than oral sucker; a prominent metraterm; and vitellarium forming a complete ring. Hence, we named this microphallid M. jebuensis n. sp. after the island where the second intermediate hosts were collected. From this study, it has been shown that Maritrema sp. is distributed in Korea and transmitted by the Asian shore crab, H. sanguineus.

Augmentation Mammaplasty in Women with Simple Sunken Chest

PURPOSE: The sunken chest deformity without breast asymmetry is not a rare condition encountered in augmentation mammaplasty. Therefore, failure to recognize the deformity and improper surgical plan will lead to a suboptimal result. The authors review the experience of breast augmentation in simple sunken chest patient based on retrospectively collected data. METHODS: From January, 2008 to January, 2009, patients with simple sunken chest underwent endoscopic submuscular augmentation mammaplasty through axilla, using silicone implants. Patient demographics were queried and outcomes were assessed. RESULTS: Eleven patients (22 breasts) were followed up for 8.2 months after surgery. Sunken chests were augmented with implant size of approximately 248.9 cc (range: 213~286 cc) and contralateral chest with 211.4 cc (range: 180~235 cc). Simultaneous camouflaging the chest wall depression with breast augmentation resulted in good aesthetic outcome. All of the patients were satisfied with the surgery. There were no complications among all patients. CONCLUSION: We have demonstrated proper surgical planning with precise implant selection to optimize results in patients with small breast and simple sunken chest. Even though asymmetry still remains after the operation, it is still considered as acceptable.

CO2 Laser Resurfacing in Skin Tumor Surgery

PURPOSE: The prevalence of skin cancers and cutaneous premalignant lesions are increasing recently. It is necessary to treat cutaneous premalignant lesions, because these can progress to invasive skin cancers. We conducted a retrospective study to evaluate the usefulness of CO2 laser resurfacing in skin tumor surgery. METHODS: From 2005 to 2008, 14 patients with skin cancers, photodamaged skin and cutaneous premalignant lesions were treated with skin cancer excision, immediate reconstruction, and CO2 facial laser resurfacing. Mean average follow-up period was 15.6 months(5 months-36 months). Biopsy and clinical photograph were taken preoperatively, intraoperatively and through follow-up period to assess the effectiveness of laser resurfacing. Recurrence and side effects were evaluated through follow-up period. RESULTS: Histologic examination shows the abolition of actinic atypia, regeneration of epidermis and normalization of cellular differentiation after laser resurfacing. Clinical photographs shows elimination of keratoses and spots, and the homogeneous, smoothening change of skin surface, indicating healthy and younger faces. All patients had remained free of skin cancers and premalignant lesions in laser-treated field through follow-up period. CONCLUSION: CO2 laser resurfacing in skin tumor surgery can treat not only premalignant lesions but also subclinical lesions of photodamaged skin. Moreover it may be helpful in prophylaxis against skin cancers and premalignant lesions, providing rejuvenation and cosmetic improvement.

Reattachment of Amputated Auricle using Postauricular Subcutaneous Pocket

PURPOSE: There are several modalities to reattach the amputated auricle. Although microvascular replantation can achieve the best outcome, it is technically difficult. Conventional composite graft is technically easy, but uniformly unsuccessful. Our successful experience of reattachment using postauricular subcutaneous pocket is presented. METHODS: The amputated tissue was placed in its anatomical position with buried sutures. The amputated part is dermabraded to remove the epidermis and outer layer of dermis(Fig. 1, Center, left). Postauricular skin flap was then raised and the reattached dermabraded ear was buried beneath the flap(Fig. 1, Center, right). Two weeks after the original surgery, the buried ear was removed from its pocket(Fig. 1, Below, left). RESULTS: The ear was reepithelialized spontaneously in 7 days. In 3 months, the reattached ear shows satisfactory appearance without contour deformity(Fig. 1, Below, right). CONCLUSION: This technique provides increase in contact surface between the amputated segment and the surrounding tissues which supply blood, serum, oxygen and nutrients, maximizing the probability of "take". Minimally injured dermis can be healed from spontaneous reepithelialization and provides minimal contour deformity. We have used this non-microsurgical technique with very satisfying outcome.

Cosmetic Lengthening and Repositioning of the Lateral Canthal Angle with Skin-Muscle Redraping Method

The size and shape of palpebral fissures are the most important features to determine the eye shape. There have been many methods reported for the lateral canthal lengthening. The authors performed lengthening of lateral canthal angle using skin-muscle redraping method to lengthen the palpebral fissure and lower the upturned lateral canthus. From December 2008 to Aug 2009, 27 patients underwent lengthening of lateral canthal angle using skin-muscle redraping. Twelve cases had lateral canthal lengthening with double eyelid operation or blepharoplasty. and combination with rhinoplasty, epicanthoplasty, and the other 9 cases was performed. There were 2 males and 25 females with ages ranging from 19 to 45 years. The procedure was composed of inferolateral canthotomy, tarsal-periosteal canthopexy, subciliary incision, skin-muscle flap elevation that connecting with canthotomy space and skin-conjunctival repair. After operation, the length and tilt of the palpebral fissures were improved remarkably, and most patients were satisfied. There were 3 patients who presented with complication; 2 cases of chemosis and 1 case of overcorrection. However, no major complication was noted. This method can be effective in lengthening the palpebral fissure and lowering upturned lateral canthal angle without significant recurrence and scar.

Minimal-incision Tenorrhaphy in Flexor Tendon Injury

PURPOSE: To retrieve the retracted flexor tendon, additional incision and wide dissection are conventionally required. We introduce minimal-incision tenorrhaphy using 1cm-long incision and minimal dissection. METHODS: Transverse incision about 1cm in length is made over the level of retracted tendon. Nelaton's catheter is advanced into tendon sheath from distal primary laceration wound to emerge proximally through the incisional wound. A catheter is sutured to proximal tendon in end-to- end fashion. By gently pulling the catheter, retracted tendon is delivered to distal wound. Tenorrhaphy with core suture and epitendinous suture is then carried out. RESULTS: This retrieving technique provides minimal incision, minimal dissection, minimal bleeding, minimal injury to tendon end, and shorter operation time with preservation of vincula tendinum and pulley system. CONCLUSION: In case of flexor tendon rupture with retraction, this operative method is believed to allow reliable and effective tenorrhaphy and excellent postoperative outcomes.

DuoDERM EXTRA THIN(TM) Dressing Modified by Multiple Incisions

In reconstruction of the skin defect, partial thickness skin graft (STSG) is common procedure in plastic and reconstructive surgery. Even if the graft is taken successfully, the texture of the donor site can be an aesthetic problem to the patient and the surgeon. Nowadays, occlusive dressings have been recommended for better results and accelerated healing of the donor site. Although hydrocolloid dressing is one of the popular occlusive dressings, its application is limited to the wounds that have mild to moderate discharge because of its absorption capacity. We modified the DuoDERM EXTRA THIN(TM) with multiple incisions to drain the massive discharge in acute stage in STSG donor dressing from January 2003 to May 2003. During the surgery, the half of the donor site was covered with the modified DuoDERM and the other half with original one as a control study. Dressing was changed after the 2nd day of operation. As bloody exudates were drained through the incisions areas, blood clot was less attached on experimental groups than control. Epithelialization was faster in modified dressing and skin surface was more even than the control. We are reporting the advantage of making multiple incisions on DuoDERM EXTRA THIN(TM) for dressing of the partial thickness skin graft donor site.

Comparison of Titanium Micro Mesh(R) with Titanium Mesh Screen 1.3(R) in the Reconstruction of Medial Orbital wall Fracture

The aim of the surgical reconstruction of medial orbital wall fracture is to restore the three-dimensional shape and size of the orbital cavity. Many different autologous and alloplastic implants have been used for the reconstruction of medial orbital wall fracture. Recently, titanium mesh has been reported of its advantage over other various implants. As the advantage of the Titanium Mesh Screen(R) in orbital reconstruction was reported in our previous report1, this study is focused on the comparison of the two different types of titanium mesh screen through our experiences. From March 1998 to February 2003, 18 cases of medial orbital wall fracture were surgically repaired. Nine cases were repaired with Titanium Micro Mesh(R)(Stryker Leibinger, USA) and 9 cases with Titanium Mesh screen 1.3(R)(Marthys, USA). Through our experiences, shaping of the Titanium Micro Mesh(R) was as easy as Titanium Mesh Screen 1.3(R). the Titanium Micro Mesh(R) has some advantages over Titanium Mesh Screen 1.3(R); (1) Titanium Micro Mesh(R) was more easily inserted than the Titanium Mesh Screen 1.3(R). (2) The insertion failure by crumbling was less frequent in Titanium Micro Mesh(R) than in Titanium Mesh Screen 1.3(R). (3) Fixation of Titanium Micro Mesh(R) was more secure than that of Titanium Mesh Screen(R). So we are reporting the superiority of the Titanium Micro Mesh(R) to Titanium Mesh Screen 1.3(R) in the reconstruction of medial orbital wall fracture.