Incomplete Ear Amputation.

Ear amputations are common in emergency departments as the auricle's protrusion from the lateral aspect of the head makes it particularly susceptible to trauma. Of the numerous approaches for auricle injuries, the classic methods include microsurgical replantation, primary reattachment, composite graft, retroauricular pocket principle, secondary reconstruction with rib cartilage, and methods using postauricular flap. The success of the operation depends largely on choosing the appropriate surgical procedure since many factors can influence surgical outcome. There is no 1 gold standard technique to treat the variety of auricle injuries. Inappropriate choice of surgical approach can be detrimental to subsequent reconstructive surgery. Therefore, the initial choice of optimal surgical approach is particularly important. In this article, a rare report of left subtotal ear laceration with inferior lobule pedicle by nonmicrosurgical primary reattachment was presented. The operation obtained an ideal cosmetic effect.

Application of the 3D digital ostectomy template (DOT) in mandibular angle ostectomy (MAO).

BACKGROUND: Mandibular angle ostectomy (MAO) is a standard approach in reconstruction of facial contour that is commonly used in East Asian patients with prominent mandibular angles (PMA). MAO is commonly performed via an intraoral approach to reduce scar visibility and risk of facial nerve injury. Since this intraoral approach for MAO has limited visual guidance during the procedure, plastic surgeons often perform the operation based on personal clinical experience. Therefore, we designed a 3D digital ostectomy template (DOT) for guidance during surgery to improve the accuracy and safety of MAO. METHODS: 10 female patients (average age 25.3 years) with PMA were enrolled in this study from August 2014 to October 2015. The DOTs were designed and printed preoperatively and utilized in the operation to guide the osteotomy. The excised mandibular angle bone and the DOTs were measured respective to each other. The data were analyzed to verify the feasibility and safety of the DOT. RESULTS: All of the patients were satisfied with the surgical results, and no complications such as fracture, hemorrhage and infection occurred. The distance from gonion (Go) along inferior margin of mandible forward to the distal end of the excised bone is "a". The distance from Go along posterior margin of ramus upward to the distal end of the excised bone is "b". The widest distance from Go to the ostectomy line is denoted by "c". Similarly, the corresponding distance in the DOT is denoted by "a'", "b'", "c'". The statistical results showed that left a vs a', b vs b', c vs c' was 63.27 ± 6.39 mm vs 62.97 ± 6.30 mm (p > 0.05), 23.98 ± 2.25 mm vs 21.83 ± 2.27 mm (p < 0.05), 13.58 ± 2.24 mm vs 13.37 ± 2.14 mm (p > 0.05), respectively. The right a vs a', b vs b', c vs c' was 62.92 ± 5.00 mm vs 62.72 ± 4.99 mm (p > 0.05), 24.03 ± 1.88 mm vs 21.80 ± 1.91 mm (p < 0.05), 13.36 ± 1.70 mm vs 13.22 ± 1.72 mm (p > 0.05), respectively. The results indicate a significant difference between b and b' both on the right and left sides. CONCLUSION: Through the application of DOT in MAO, the accuracy and safety of the operation were improved significantly. Unfortunately, the osteotomy could not be guided well in the posterior rim of the ramus. Further improvements in the surgical template are needed for application in PMA associated with oversized chin deformity or in PMA associated with large mandibular angle and severe involution.

A Novel Hypothesis of Visual Loss Secondary to Cosmetic Facial Filler Injection.

With the current tendency of increasing minimally invasive cosmetic surgeries, some rare but disastrous complications of facial filler injections come into sight, such as visual loss. The study aims to investigate the possible route that the injected droplet accesses the ophthalmic artery to explain and prevent such devastating complications. We searched the National Library of Medicine's PubMed database for cases of visual loss secondary to cosmetic facial filler injection, and reviewed relevant case reports/surveys, as well as accompanying references. Data obtained were analyzed, with special interest in injected sites and filler material, and clinical features of visual loss. Based on the anatomy of facial vessels, we inferred the possible route of injected droplet migrating from injection sites to ophthalmic artery. Most physicians propose a retrograde embolic mechanism, but the culprit artery when injecting different sites is not determined. We consider accidentally breaking into supraorbital artery or supratrochlear artery may cause occlusion of ophthalmic artery when injecting into glabella or forehead region. Speaking of the nasolabial fold and nasal dorsum region, any injections in the anastomosis of the dorsal nasal artery, angular artery, and lateral nasal artery can lead to retrograde embolism. Similarly, in the temporal region, we believe there is abnormal anastomosis between frontal branch of superficial temporal artery from external carotid artery and supraorbital artery from ophthalmic artery. In our hypothesis, we can explain the accompanying brain infarction after iatrogenic visual loss. If the injecting pressure is forceful enough, it may push the embolic materials into middle cerebral artery. Although iatrogenic ophthalmic artery occlusion is a rare complication after the facial filler injection surgery, it is usually devastating. Both the patient and the surgeon should be aware of the risk of irreversible blindness. Ideally, the injection sites should avoid the small vessels nearby, the injecting force and velocity should be as gentle and slow as possible.

Iatrogenic mandibular fracture associated with third molar removal after mandibular angle osteotectomy.

The extraction of mandibular third molars is a common dental procedure. The complications include hemorrhage, pain, dental fracture, the displacement of teeth or fragments, iatrogenic damage or luxation of the second molar, neurologic injuries, soft tissue damage, subcutaneous emphysema, trismus, swelling, infection, and iatrogenic mandibular fracture. Fracture of the angle of the mandible associated with third molar removal is a rare but severe complication. This article describes a case of mandibular angle fracture associated with third molar extraction after mandibular angle osteotectomy, including a brief review of the literature. The removal of the mandibular angle and the outer cortex of the mandible, especially the external oblique ridge, may contribute to the bone fracture. We conclude that the extraction of the lower third molar must be before the removal of the mandibular angle, and a soft diet for at least 4 weeks postoperatively is essential to prevent late mandible fracture.

Single stage surgery for contouring the prominent mandibular angle with a broad chin deformity: en-bloc Mandibular Angle-Body-Chin Curved Ostectomy (MABCCO) and Outer Cortex Grinding (OCG).

BACKGROUND: Various surgical options are reported to address the Asian 'squared face', characterized by a prominent mandibular angle (PMA) associated with an oversized chin deformity; but shortcomings lie in the requirement of multi-stage procedures with the risk of further revision surgery. We have developed a single-stage "Mandibular Angle-Body-Chin Curved Ostectomy (MABCCO) and Outer Cortex Grinding (OCG)" surgical technique to shorten the period of the surgical treatment and minimize the inherent surgical risks in the multi-staged procedures. METHODS: A retrospective study involving patients (n = 36) presented with prominent mandibular angle and an oversized chin who underwent the operation described from 2010 to 2012 with at least 12 months of follow-up. The surgical and aesthetic outcomes were evaluated through clinical assessment, photography, imaging analysis including preoperative and post-operative patient satisfaction rates. RESULTS: All the patients were satisfied with the improvement in their appearance following surgery; specifically the 'smoothness' of the mandibular inferior border with no 'second mandibular angle'. The width of the mandible was reduced with G-G distance reduced from 119.9 mm ± 3.9-109.7 mm ± 3.5 (p < 0.05). A significant preoperative and post-operative gonial angle (G-A) was found at the left (110.7° ± 9.6 vs 139.9° ± 11.5, p < 0.05) and right side of mandible (111.3° ± 10.7 vs 140.7° ± 11.8, p < 0.05). There was no iatrogenic inferior alveolar nerve or mental nerve injury and a stable aesthetic outcome beyond the first year. CONCLUSION: We demonstrated favourable surgical and aesthetic outcomes with our single-stage en-bloc curved osteotomy surgical technique to reshape the prominent mandibular angle with a broad chin deformity with no increased in surgical risks but a high satisfaction rate and stable outcomes.

Surgical treatment of craniomaxillofacial fibrous dysplasia: functionally or aesthetically?

BACKGROUND: Fibrous dysplasia (FD) is a tumor-like growth that consists of replacement of the medullary bone with fibrous tissue, causing the expansion and weakening of the areas of bone involved. The most commonly affected bones are facial bones, causing a number of facial cosmetic and functional problems. METHODS: From December 2008 to July 2012, 10 patients with craniomaxillofacial fibrous dysplasia were treated by conservative resection and local recontouring. The patients were followed up yearly, with an average of 3 years; the longest follow-up period was 5 years. RESULTS: All the 10 patients received appropriate treatment and histopathological examinations were performed to confirm the diagnosis of FD. Four patients with zygoma involved had received partial zygoma osteoectomy and 2 patients received mandibular partial osteoectomy. Average time of follow-up was 3 years, with a range from 1 to 5 years, and all patients obtained satisfactory aesthetic and functional results. CONCLUSION: In most patients, a conservative surgery will achieve good functional and aesthetic results. For patients with mild symptoms, the aesthetic effect should be given priority while for the heavier patients the restoration of function and aesthetic effects should all be taken into account.

Epicanthoplasty with double eyelidplasty incorporating modified Z-plasty for Chinese patients.

BACKGROUND: Blepharoplasty, without correction of the epicanthal folds, weakens the aesthetic appearance of the results. Hence, a modified Z-plasty procedure with double eyelidplasty was carried out for different degrees of epicanthus. METHODS: From 2005 to 2010, the authors performed epicanthoplasties using the modified Z-plasty and double eyelidplasty for 322 Chinese patients. The conventional double eyelidplasty incisions were made with conterminous modified 'Z' formation on the medial canthus as well as cutting off the malpositioned superficial head of preseptal musculus orbicularis oculi. RESULTS: Epicanthoplasty, using this technique, showed good results in most cases. There were no recurrences of the epicanthal fold and the scars were inconspicuous. CONCLUSION: The modified 'Z' plasty is indicated for all types and degrees of medial epicanthi, except epicanthus inversus. The easy design and operation, and the excellent and reproducible results satisfy both the plastic surgeons and the Chinese patients.

[Application of free anterolateral thigh adipofascial flap in the correction of facial depression].

OBJECTIVE: To investigate the operative technique and therapeutic effect of free anterolateral thigh adipofascial flap in the correction of facial depression. METHODS: From Oct. 1996 to Jan. 2007, 32 patients with facial depression deformities were treated with free anterolateral thigh adipofascial flaps. The bone defects in 8 cases were corrected with Medpor implants at the same stage. RESULTS: 33 free anterolateral thigh adipofascial flaps were used in 32 patients. 2 flaps were used bilaterally in one patient. The size of the flaps ranged from 12 cm x 8 cm to 20 cm x 11 cm (average, 16.5 cm x 10.5 cm). 30 flaps survived completely. Flap edge resorption happened in 3 flaps within half a year postoperatively. Satisfactory results were achieved in 23 patients after one-stage treatment. Another 9 patients underwent secondary operation 6 months postoperatively. Among them, 6 patients underwent flap liposuction because of fatty appearance, 3 patients underwent fat transplantation because of flap edge resorption. The patients were followed up for 6 months to 2.5 years. All the deformities were improved greatly, and the faces were almost symmetrical. The wounds at the donor sites were primarily healed with no functional morbidity. CONCLUSIONS: Free anterolateral thigh adipofascial flap is a large size flap. The flap thickness can be adjusted for three-dimensional reconstruction. The vascular anatomy is relatively stable. The bone defects can also be corrected at the same stage.

[Expression of the P450arom mRNA in the glandular tissue of the pubertal mammary hypertrophy].

OBJECTIVE: To investigate the expression status of the P450arom mRNA in breast tissue of pubertal mammary hypertrophy and then explore the possible etiology of pubertal mammary hypertrophy. METHODS: 15 patients were selected for pubertal mammary hypertrophy group. Breast hypertrophy tissue specimens were collected from the gland excised during reduction mammaplasty. 15 patients with pathologically simple fibroadenoma were used as another control group. Patient approval of participation in this study was obtained preoperatively. The expression of P450arom mRNA was detected by RT-PCR in all the cases above. RESULTS: There was no significant difference between the pubertal mammary hypertrophy groups and normal groups on the expression rates of P450arom mRNA. But among the positive cases, the expression of P450arom mRNA within breast tissue were 0.202 +/- 0.048 in pubertal mammary hypertrophy group; and 0.159 +/- 0.068 in normal group. There was significant difference between the pubertal mammary hypertrophy and normal groups (P < 0.05). CONCLUSION: The expression of P450arom mRNA in pubertal mammary hypertrophy are significantly higher than in normal mammary glandular tissue. The pubertal mammary hypertrophy may be related to the expression status of P450arom mRNA within breast tissue.

Porous polyethylene implants in orbital blow-out fractures and enophthalmos reconstruction.

OBJECTIVE: To evaluate the efficacy of porous polyethylene sheet implants in reconstruction of orbital blow-out fractures. METHODS: Sixty-eight patients with orbital blow-out fractures were admitted in our center from December 1996 to June 2005. Porous polyethylene sheet implants were used to repair the defects of orbital wall and to correct the enophthalmos. The clinical results of extrinsic eye movement, enophthalmos, hypoglobus (vertical dystopia), visual acuity, and infraorbital nerve anesthesia were analyzed preoperatively and postoperatively. RESULT: Patients stayed in the hospital between 4 and 10 days. The enophthalmos and hypoglobus of all 68 patients was corrected except for one. The patient needs another surgery 6 months after operation to remove a piece of Medpor because the hypoglobus was overcorrected. Diplopia was resolved in 36 of 45 patients postoperatively. Persistent diplopia was found in 9 cases that were complicated orbitozygomaticomaxillary fractures. Visual acuity was improved in 13 of 45 patients, whereas no change was observed in the others. Infraorbital nerve hypoesthesia was resolved in 32 of 43 cases 6 months after operation. Only 1 patient developed postoperative ectropion, for which local suspending was required. No infections and Medpor outcrop were seen after operation. CONCLUSION: Porous polyethylene sheet implant is a very reliable material for reconstruction of the orbital blow-out fractures and restoration of the orbital volume. Overcorrection of 1 to 2 mm is necessary during operation to neutralize the tissue swelling or atrophy.

[Repairing traumatic partial helical defect with postauricular tube flap].

OBJECTIVE: To investigate the effect of postauricular tube flap for repairing traumatic partial helical defect. METHODS: The tube flaps were designed according to the site and size of helical defects. The length of tube flaps was 1.2 - 1.5 times as the length of the defects. The length-to-width ratio of tube flap was 3 - 4:1. The procedures required three stages for completion: (1) fabrication of tube flap; (2) 2 - 3 weeks later, division of one pedicle and insetting the flap; (3) 2 - 3 weeks later, complete division of pedicle and repairing the defects. RESULTS: From January 1998 to June 2006, 47 cases of traumatic partial helical defects were treated with postauricular tube flaps. All the tube flaps survived completely with no vascular disturbance, infection or necrosis. The patients were followed up for 2 months to five years with satisfactory results. CONCLUSIONS: Postauricular tube flap is a reliable and simple procedure for traumatic partial helical defects with good cosmetic result and less donor site morbidity.

[Seasonal and semi-lunar changes in fish community structure in low salinity intertidal area of Yangtze estuary].

Based on the survey of the fishes in low salinity intertidal area of the Yangtze estuary from spring (May) 2006 to winter (February) 2007, the seasonal and semi-lunar changes of fish species and abundances were analyzed. A total of 53 fish species were collected, most of which belonged to Cyprinidae, followed by Gobiidae, and few of other families. The fish species and average abundance were higher in spring, summer, and autumn than in winter and lower in low tides than in high tides in four seasons. Shannon-Weaver (H') value had a greater fluctuation in a tidal cycle, and was appreciably lower in low tides than in high tides. The fish species and abundance were clustered into two groups, i. e., that of winter, and of the other seasons. As for the whole year, the abundance had the highest positive correlation with water temperature, then with tide height, and lowest with water salinity.

[Reduction mammaplasty with the superomedial glandular pedicle].

OBJECTIVE: To explore a new technique that keep function and good aesthetic shape after reduction mammaplasty. METHODS: The superomedial glandular pedicle technique was applied with differing patterns of skin incision according to the degree of the mammary hypertrophy. The extra glandular tissue was removed from the lateral and inferior segment of the breast. The remaining superomedial glandular tissue was remodeled a conical shape. The skin incision was sutured after excision of excess skin. RESULTS: 36 cases (72 breasts) were treated with this technique. The results were satisfactory and there were no complications. The breasts maintained a lasting and aesthetically pleasing shape and the nipple-areola preserved good sensation. CONCLUSIONS: The superomedial glandular pedicle is a safe and effective technique that can provide long-lasting outcome. The design of the procedure can be adapted to a variety of skin incision patterns and breast morphologies.

[Succession character of salt marsh vegetations in Chongming Dongtan wetland].

This paper studied the ecological character, importance value, aboveground biomass and its N content of salt marsh vegetations in Chongming Dongtan wetland in the process of succession. The results indicated that with the increase of altitude, the importance value of Scirpus mariqueter, a representative species at early succession stage, decreased gradually, while those of Spartina alterniflora and Phragmites australis increased. The biodiversity of the vegetations increased with succession. During growth period (from March to October), the aboveground biomass of the three species varied in single hump curve, with the peak in July and August. The N content had a decreasing trend, while the N capacity showed a single-peak curve. The estimated annual N accumulation in aboveground biomass was 383.4 t for P. australis, 50.5 t for S. mariqueter, and 39. 3 t for S. alterniflora.

Correction of inverted nipple: an alternative method using continuous elastic outside distraction.

Inverted nipple, which is defined as a nipple located on a plane lower than the areola, presents both functional and cosmetic problems. It is a source of repeated irritation and inflammation and interferes with nursing. In addition, its abnormal appearance may cause psychologic distress. With consideration of its underlying pathophysiologic components and severity, a number of techniques have been introduced for correction of this anomaly. Most of these techniques involve extensive skin incision around the nipple that may jeopardize the blood and nerve supply to the nipple or create much scar tissue that is esthetically objectionable. For correcting the inverted nipple, the authors introduce an alternative, simple method using continuous elastic outside distraction. Compared with other methods using outside distraction, the authors used an adjustable elastic instrument made of steel wire, spring, and plastic syringe; continuous distraction of the inverted nipples; and sustaining 3 to 6 months. From August 2002 to December 2003, 14 patients (26 nipples) were treated. 12 patients had bilateral inverted nipples. Patient age at operation ranged from 14 to 40 years (mean age, 24 years). All nipples were congenital, and they had no previous operation. Six nipples were grade I, 9 nipples were grade II, and 11 nipples were grade III according to the classification of inverted nipple by Han and Hong. The mean follow-up period was 7.3 months (range, 3-12 months). Follow-up examinations revealed no evidence of recurrence of inversion. There was no complication associated with surgery, such as infection, hematoma, permanent sensory disturbance, or nipple necrosis. All patients were satisfied with their results. The authors conclude that their procedure is reliable, a simple, safe, and effective method for correction inverted nipple. But a long-term follow-up is needed. This technique can be applied to any type of inverted nipple as a primary surgical procedure.

[Cox regression analysis on influencing factors of coronary heart disease among people over 40 years of age].

OBJECTIVE: To explore the affecting factors on coronary heart disease among people over 40 years of age in Guangxi area, China. METHODS: Baseline data was gathered through the Third National Blood Pressure Survey in 1991 in China. A total number of 11 818 adults over 40 years old had been studied in Guangxi province. Data of morbidity and mortality of coronary heart disease was obtained. RESULTS: Cardiovascular events were related to systolic blood pressure, diastolic blood pressure, pulse pressure, smoking, BMI regardless of their myocardial infarct (MI) history. Cox regression analysis showed that the relative risk for cardiovascular events increased by 21 [95% confidence interval (CI): 9.06-48.44] times for those people having MI history. When pulse pressure, systolic blood pressure, diastolic blood pressure increased by every 10 mm Hg, the relative risk for cardiovascular events increased by 1.29 (95% CI: 1.11-1.49), 1.18 (95% CI: 1.02-1.22), 1.13 (95% CI: 1.05-1.28) respectively. There was 1.23 (95% Cl: 1.05-1.45) times higher in smoker than non-smoker on relative risk for cardiovascular events. When BMI increasing 1, the relative risk for cardiovascular events would increase 1.03 (95% CI: 1.01-1 .05) times. CONCLUSION: Hypertension, smoking, increase of BMI were the risk factors of coronary heart disease among people who were over 40 years of age.