Effectiveness of Botulinum Toxin A in Treatment of Frey's Syndrome

PURPOSE: Several therapeutic approaches have been introduced and tried to treat Frey syndrome following parotidectomy. However they were not proved as an effective treatment. A new therapeutic modality using botulinum toxin injections was presented previously by several study groups. But, the duration of the demonstrated positive effect was essentially unknown so far. The purpose of this clinical investigation is to demonstrate the effectiveness of Botulinum toxin type A(BTXA) in patients with Frey syndrome. METHODS: For this study, 12 patients were treated, They were assessed with the Minor's iodine-starch test and interviewed before and after treatment. Botulinum toxin is injected with 1.0cm2 apart into the skin where symptoms of Frey's syndrome has manifestated. The patients were classified according to the concentration of botulinum toxin and dosage of botulinum toxin. RESULTS: The outcome measures were the time of reappearance of gustatory sweating(subjective study), and the results of an Minor's iodine-starch test(objective study) of 3 weeks, 3 months, 6 months, 9 months, 12 months after treatment. This treatment was effective in all groups of patients. The concentrations and the amount of dosages did not affect the treatment. But high concentration produced faster effectiveness in subjective. CONCLUSION: Botulinum toxin type A(BTXA) for Frey syndrome is easy, convenient and effective withouts severe complication. And the patients has no difficulty and limitation in their life.

Effectiveness of Botulinum Toxin A in Treatment of Frey's Syndrome

PURPOSE: Several therapeutic approaches have been introduced and tried to treat Frey syndrome following parotidectomy. However they were not proved as an effective treatment. A new therapeutic modality using botulinum toxin injections was presented previously by several study groups. But, the duration of the demonstrated positive effect was essentially unknown so far. The purpose of this clinical investigation is to demonstrate the effectiveness of Botulinum toxin type A(BTXA) in patients with Frey syndrome. METHODS: For this study, 12 patients were treated, They were assessed with the Minor's iodine-starch test and interviewed before and after treatment. Botulinum toxin is injected with 1.0cm2 apart into the skin where symptoms of Frey's syndrome has manifestated. The patients were classified according to the concentration of botulinum toxin and dosage of botulinum toxin. RESULTS: The outcome measures were the time of reappearance of gustatory sweating(subjective study), and the results of an Minor's iodine-starch test(objective study) of 3 weeks, 3 months, 6 months, 9 months, 12 months after treatment. This treatment was effective in all groups of patients. The concentrations and the amount of dosages did not affect the treatment. But high concentration produced faster effectiveness in subjective. CONCLUSION: Botulinum toxin type A(BTXA) for Frey syndrome is easy, convenient and effective withouts severe complication. And the patients has no difficulty and limitation in their life.

The Clinical Experiences of Congenital Preauricular Fistulectomy including Cartilage Excision

The preauricular fistula is a congenital malformation of the ear with a small opening in the preauricular area. In general, this malformation should be treated by excision after its infection is brought under control with antibiotics. For cosmetic consideration, we performed a elliptic incision around opening, and then we dissected along the fistula tract to the cyst without sacrificing too much soft tissues. From March 2001 to March 2005, 90 patients with 102 cases of fistulas were excised including a small portion of auricular perichondrium and cartilage, where they adhered closely. Then, histologic findings of preauricular fistula were studied. The histologic findings reveal that the fistular tract is very close to auricular cartilage, and the thickness of fistular epithelium and perichondrium are about the same. There was no specific complications related to this procedure. The recurrence rate for the excision with cartilage was 2 out of 102(2%). Results of surgery in all cases were satisfactory. It is important, in preauricular fistular excision, perichondrium and auricular cartilage should be excised to prevent recurrence.

Nonspecific Traumatic Carotid-Cavernous Fistula Presented as Naso-Orbital Mass

Traumatic carotid-cavernous fistulae(TCCF) are rare but can cause potentially lethal complications such as visual loss and subarachnoid hemorrhage after craniomaxillofacial trauma. This represents aberrant vascular communication in skull base between the carotid artery system and the venous channels within the cavernous sinuses of a sphenoid bone. The symptoms are mostly related with ophthalmic problems such as pulsatile proptosis, chemosis, and diplopia. The standard diagnostic method is cerebral angiography. CT and MRI can be also useful. The main current treatment is endovascular detachable balloon occlusion. The clinicians who treat patients with craniofacial injuries should have complete understandings of this pathological entity, so that early diagnosis and urgent intervention can be done to avoid serious complications and to get successful results. We report the experience of treating a 25-year-old female with nonspecific traumatic carotid-cavernous fistula presented as naso-orbital mass using intravascular detachable balloon catheter embolization.

The Treatment of Penile Paraffinoma Using Various Scrotal Flap

Paraffin injection for augmentation of penis is usually attempted by untrained persons. Complications such as penile deformity, skin necrosis, erectile dysfunction, and foreign body sensation usually follow. Definite treatment for the patients with those complications includes complete removal of skin and subcutaneous tissue infiltrated by the paraffin and resurfacing with skin graft and local flap. It may not be possible to remove paraffinoma completely due to infiltrated corpus cavernosum and spongiosum. The remnant paraffinoma does not permit skin graft coverage. For the patients who had these problems, we tried techniques comprised of various scrotal flaps to produce reliable and stable coverage. The scrotal skin, which has high elasticity and good texture, seems to be a good material for denuded penis coverage, despite its hairy nature. Since March 1998, 21 patients with penile paraffinoma have been treated using the various scrotal flaps. All flaps survived and the reconstructed penis had immediate postoperative tactile sensibility. The results were successful with no other major complications.

The Endoscopic Treatment of Blow-out Fracture

Blow-out fracture is frequently encountered in facial bone trauma. It used to be reduced through sucilliary or transconjunctival incisions. But the field of orbital surgery is difficult due to lack of visualization of fracture site, blind dissection of orbital floor, susceptibility of injury of orbital structures. Recently, endoscopic reduction of orbital wall was provided good functional and cosmetic results. In order to address this shortcoming we have explored the use of endoscopic transantral approach in orbital floor dissection to allow direct visualization of orbital content and whole fracture components. We performed endoscopic transantral approach with or without subcilliary incision in 10 cases of blow-out fracture under general anesthesia. To accomplish this technique, a rigid 4mm, 0 or 30 degree angled endoscopy was inserted into the maxillary sinus. The operative field in maxillary sinus was kept visually clear by saline irrigation and fine suction. For the maintain of the position of fractured site, urinary balloon foley catheter were used in fracture site for 2 weeks. There was no specific complications related to this procedure. Result of surgery in all cases were satisfactory. We discussed the surgical procedure, the advantages of the transantral endoscopic approach.

Huge chondrosarcoma on the anterior chest wall / 대한흉부외과학회지

Huge chondrosarcoma is a rare form of primary malignant tumor of the chest wall. We operated on a 60 year old female patient who had a huge anterior chest wall mass with local invasion into the pericardium and satellite tumors on the visceral pericardium of the heart. En-bloc resection of the huge tumor including both upper 3 ribs, both clavicles, manubrium of the sternum, pleura, and pericarium, was followed by complex chest wall reconstruction using a Gore-tex soft tissue patch and latissimus dorsi musculocutaneous free flap.

An Experimental Study of Bone Distraction in Rabbit Skull

The epiopathogenesis of craniosynostosis remains obscure. According to the studies involved, the conditions observed at birth are very different. In case that a deformity is obvious or the risk of brain compression is possible, strip craniectomy, frontal bone advancement and cranial vault remodeling methods are used. These direct reshaping or remodeling methods are time consuming and require greater use of physical resources and still are not uniformly successful in making skull shape to normal. Distraction of the cranial bone has been studied to solve this problem. This study subsequently included 30 white rabbits aged about 25 weeks. The rabbits were divided in three groups. In group I, a 0.25mm distraction was done every other day after 3 day latency period. In group II, there was a 7 day latency period with the same rate of distraction as in group I. There was a 3 day latency period with a 0.5mm distraction every other day in group III. The contralateral side underwent a sham operation as a control group. During distraction and after consolidation periods, histologic and ultrastructural studies were carried out. And a serial radiologic study was done. As a result, group I and group II showed successful distraction osteogenesis, and we demonstrated the biological and mechanical factor associated with distraction osteogenesis. In group I, despite the short latency period, there was successful bone regeneration. Group III, it also showed successful ossification. During the distraction period, there was a remarkable increase of TGF-beta1 in both groups, especially in periosteum osteoid and newly developed connective tissue. In conclusion, we have demonstrated a useful model of distraction osteogenesis in rabbit skulls, and attempted to evaluate associated biological and mechanical factors.

Comparrison of End - to - side Loop Neurorrhaphy with Epineurium Versus without Epineurium

The high incidence of pain recurrence in traumatic neuromas continues to be a major problem in about 10% of patients. There are more than 100 techniques that have been proposed, but no single reliable method prevents painful neuroma formation. The end-to-side neurorrhaphy published by Viterbo1, and demonstrated encouraging results in prevention of neuroma with end-to-side loop neurorrhaphy. The aim of this study is to compare with the result that end-to-side loop neurorrhaphy with intact epineurium versus resected epineurium. Thirty Spraque-Dawley rats were divide in two group; control and experirnental group. In control group (n = 20), both sciatic nerve are transected and the ends were left unrepaired. In experimental group A (n = 20), the left sciatic nerve are transected and repaired with end-to-side loop neurorrhaphy with intact epineurium. In experimental group B (n = 20), the right sciatic nerve are transected and repaired after removal of epineurium. After 6 weeks, the cantrol and experimental group are sacrificed and examed grossly and histopathologically. In the control group, there were typical neuromas with irregular disorderly growth of axons, spreading out into the surrounding connective tissue. In experimental group A, there was no gross evidence of neuroma formation. In histology, there was some minirnal pattern of disorganized growth of the axons in the end-to-side surface, in only 1 case, but limited to the sutured area without typical spread out growth pattern. In experimental group B, the aspect were similar to the experimental group A. The end-to-side loop neurorrhaphy prevents disorganized axonal spouting seen in typical neuroma. And the interposing epineural sheath has no specific role in prevention of neuroma.

Reconstruction of the Leg with a Vertically-Based Deep Fascia Turnover Flap

The reconstruction of soft tissue defects on the leg remains a difficult challenge for plastic surgeons. If the defect is large and complicated by bone or joint defects, and excellent result can be obtained with free tissue transfer. In cases with no bony problem, no severe osteomyelitis and small medium-sized defects local flap is more acceptable than free tissue transfer because of its simple onestage and reliable operation. Fasciocutaneous turnover flaps revolve around the lack of criteria for safely designing these random pattern flaps as well as the risk of donorsite problems. Vertically-based deep fascia turnover flaps nourished by the subfascial plexus within deep fascia were used successfully for reconstruction of the leg in 5 patients. A vertically-based deep fascia turnover flap consists of deep fascia of the leg and its subfascial and epifascial plexus. As musculofascial, septofascial and periosteofascial branches these contribute to a richly anastomosing vascular network within deep fascia. Unlike adipofascial turnover flaps, the transversely-oriented deep fascia turnover flap keeps its subcutaneous layer with its intact vascular plexus so that the overlying skin is adequately perfused, even in patients with sizable flaps or extremely thin skin. Between March 1998 and February 1999, five cases underwent this procedure to reconstruct soft tissue defect on the leg. The advantages of this method are fast, safelyelevated preservation of the superficial vascular plexus, thus preserving the shape of the leg minimizing donor site scar and hypertrophy.

Surgical Correction for Minimal Cleft Lip

Minimal cleft lip has been defined as a cleft which does not extend over the vermilion. Minimal cleft lip has no specific classification and few methods for its correction. Based on our operative experience with secondary cleft lipnose deformities, we have developed principles of operation for minimal cleft lip: minimal incision, nostril and alar reconstruction, philtrum reconstruction. alignment of cupid's bow, and vermilial notching correction. Nine patients of minimal cleft lip were operated on from March 1992 to June 1998 in our department. Each partients was evaluated for lip and nose deformities presurgically: the nasal tip, columella, ala, scar, cupid's bow, lip pout and lip length. Every patients required a different technique for repair. Satisfactory results were obtained by treating the cleft following the principles.

Clinical Consideration of Complications of Free Flap Donor Sites

Various remedies have been developed for broad damage to soft tissue in limbs by traffic accidents and mechanical mishaps that have greatly increased in modern society. If the damaged part is trivial, it may be generally treated with local flap or skin graft. However, this has been limited by the ability to choose the flap available depending on the condition of the wounded part, so that, if it is rather large or severly inflamed, or if it occurred with a bone-fracture, it is inevitable to practice the free flap. In the past, the focus was on whether the free flap would survive or not. However, the function of donor the and recipient, as well as the problem of aesthetic appearance, gas become a matter of increqsing interest and concern as the survival rate of the flap has greatly improved due to the development of precise operations. In thes study, therefore, some complications were analyzed which may develop in a donor by a variety of free flaps. Preoperative plans, as well as intraoperative and postoperati-ve treatment were also studied to minimize the cause of complications. To investigate these questions, we undertook a clinical analysis of 91 followed patients from 1990 to 1997. There were 68 male and 23 female patients ranging in age from 6 to 67 years, with an average of 34.7 years. The length of follow-up ranged from 8 months to 6 years. The results of this study were as follows: Sufficient plans must be made on the donor before operation, single textures like muscle or fascia should be used if possible, and incision should be arranged along Langer`s line. Some measures to reduce wound tension should be pursued, and plans must be made to immobilize the site for an ample period after the operation. Some precautious should also be considered during the operation, such as avoiding traction surrounding nerves and vessels, preserving paratenon, practicing osteotomy with great care and properly stopping any bleeding. In addition, formation of a hematoma or seroma should be preventcd and the donor must be sutur-ed as soon as possible to reduce infection. With the application of the basic operational principles on the treatment of donors, the complications which might be caused by each free flap can be reduced, and furthermore, be protected against.

Dacryocystorhinostomy with two mucosal flap

The obstruction of nasolacrimal conduit system which produces epiphora can be caused by congenital anomalies, chronic dacryocystitis, after trauma and facial paralysis. Dacryocystorhinostomy is a popular procedure for adult nasolacrimal duct obstruction. But various methods are used for flap formation and plugging. We performed 23 cases of the dacryocystorhinostomy with two mucosal flap of "U" shape from August 1993 to August 1996. Anterior flap was formed of nasal mucosa, and posterior flap was formed of lacrimal sac. The posterior flap was retracted through the nasal cavity by 6-0 black silk instead of suturing. Vaseline gauze was used as a plugging agent. Epiphora disappeared in 21 (91.3%) of 23 cases.

Clinical Analysis of the Removed Nasal Implants

No abstract available.

A CASE OF MALIGNANT LYMPHOMA OF THE PAROTID GLAND

Malignant lymphoma is a neoplastic proliferation of cells in the lymphoreticular system and deviled largely as Hodgkin's disease and non-Hodgkin's lymphoma. Non-Hodgkin's lymphoma occurs primarily in lymph nodes and is rare found in extralymphatic organs. The most frequently affected extranodal sites area head and neck, gastrointestinal tract, followed by bladder, skin, brain, eye and bone. Primary lymphomas arising in salivary glands are very uncommon. Lymphomas in salivary glands represented 1.7 ~ 5% of all reported salivary neoplasms. Recently authors experienced one case of primary malignant lymphoma in carotid gland and report that with a brief review of literature.

PREVENTION OF FREY`S SYNDROME BY USING TEMPOROPARTIETAL FASCIAL FLAP

Frey's syndrome is a fairly common sequelae of surgery, trauma and inflammation of the parotid gland. Some patients with Frey's syndrome may be socially compromised by their gustatory sweating and flushing. In the past three decades, a variety of surgical and pharmacological methods have been unsuccessful in alleviating these symptoms. And since misdirection of auriculotemporal secretomotor nerve fibers has been found to play an important role in the development of the syndrome, a study was initiated to attempt mechnical interference with regenerating nerve fibers. Therefore, the recent trend in management of Frey's syndrome has been the use of prophylactic procedures performed at the time of parotidectomy to prevent its symptoms postoperatively. An additional benefit of this approach is prevention of the typical cheek contour deformity after parotidectomy We reviewed our experience with interposition of a vascularized temporoparietal fascial flap between the parotid bed and overlying skin immediately after complete superficial parotidectomies to prevent Frey's syndrome and hollow contour defects. The result of seven consecutive attempts revealed it to be an effective technique, achieving both goals in all patients with minimal morbidity.