Reconstruction of Orbital Wall Fractures with a Combination of Resorbable Plates and Antibiotic-Impregnated Collagen Sheets.

(1) Background: Orbital wall fractures are common in maxillofacial trauma, and artificial implants are often used for reconstruction. However, there has always been concern about infection because implants are directly exposed to the airway. This study was conducted to determine the effectiveness of a combination of resorbable plates and antibiotic-impregnated collagen sheets in reconstructions of orbital fractures and to determine whether it had an effect in reducing postoperative antibiotic use. (2) Methods: The retrospective study was conducted on 195 patients who underwent orbital wall reconstruction from March 2019 to August 2022. The 176 patients in the control group underwent reconstruction using only resorbable plates and were administered postoperative antibiotics for 5 to 7 days. On the other hand, the 19 patients in the experimental group underwent reconstruction using a combination of resorbable plates and antibiotic-impregnated collagen sheets and only received antibiotics once before surgery. The occurrence of ocular complications, the length of hospitalization, the infection incidence rate, and the adverse effects of antibiotics were investigated. (3) Results: significant ocular complications were observed in the experimental group during a follow-up period of more than 1 year. Regarding postoperative infections, there were two cases of infection in the control group (infection rate: 1.14%), while no infection was found in the experimental group. The hospitalization period of the experimental group was significantly shorter than that of the control group (p < 0.01), and the incidence of total adverse effects of antibiotics, especially nausea, was lower in the experimental group (p = 0.02). (4) Conclusions: The combined use of resorbable plates and antibiotic-impregnated collagen sheets allows effective orbital wall reconstruction without infection, with a shorter hospital stay, and with fewer antibiotic adverse effects.

Anterior-First Approach for Latissimus Dorsi Myocutaneous Flap Breast Reconstruction: A Refined Elevation Method with Detailed Video Instructions.

Background: The latissimus dorsi myocutaneous (LDMC) flap is a preferred flap in breast reconstruction for its wide surface area and volume. Since the flap is situated in the midback area, a lateral decubitus approach is a conventional method. However, proper visualization and access to the thoracodorsal vascular pedicle or muscle insertion is difficult from the lateral approach, causing inefficiency and surgeon fatigue. We propose the 'anterior-first' approach in LDMC flap reconstruction, where the landmark structures are first approached from the supine-anterior position through the mastectomy incision. Methods: From January 2014 to December 2020, 48 patients who received immediate breast reconstruction with LDMC flap were included in the study. Patients received reconstruction with the conventional approach (n = 20), or anterior-first approach (n = 28). Demographic factors and the operative outcomes were retrospectively analyzed and compared between the two groups. Results: Compared to the conventional approach group, the anterior-first approach group showed improved efficiency in the duration of total reconstruction (228 versus 330 min, p < 0.001), and flap elevation (139 versus 200 min, p < 0.001). No difference in complication rate and time to drain removal was observed (p = 0.14 and >0.9, respectively). Conclusion: The anterior-first approach for breast reconstruction with LDMC flap provides surgeons with an enhanced surgical exposure and superior ergonomics, leading to a safer and more efficient flap elevation.

Delayed contralateral traumatic carotid cavernous fistula after craniomaxillofacial fractures.

A carotid-cavernous sinus fistula is a rare condition in which an abnormal communication exists between the internal or external carotid artery and the cavernous sinus. It typically occurs within a few weeks after craniomaxillofacial trauma. In most cases, the carotid-cavernous sinus fistula occurs on the same side as the craniomaxillofacial fracture. We report a case of delayed carotidcavernous sinus fistula that developed symptoms 7 months after the craniomaxillofacial fracture. The fistula developed on the side opposite to that of the craniomaxillofacial fracture. Based on our experience with this case, we recommend a long follow-up period of 7-8 months after the occurrence of a craniomaxillofacial fracture. We also recommend that the follow-up should include consideration of the side contralateral to the injury.

Trichoepithelioma Misdiagnosed as Basal Cell Carcinoma.

Trichoepithelioma is a benign tumor which can be easily confused with basal cell carcinoma. Since both tumors are histologically similar, it is important to distinguish them correctly as the courses for treatment are very different. Basal cell carcinoma is malignant; therefore, it requires total surgical excision, including a wide healthy margin. In contrast, trichoepithelioma requires only simple excision. A study involving a 69-year-old woman with a simple mass on the nasal tip was described in this study. On examination, a single skin-colored, round protruding mass (approximately 0.5 × 0.5 cm) was observed. Simple excision was performed and basal cell carcinoma was diagnosed at the initial biopsy. However, clinically, we considered it to be a benign tumor; therefore, we sought a histologic reconfirmation. Consequently, trichoepithelioma was diagnosed on histopathologic examination. When a small, round protruding simple mass is histologically diagnosed to be a basal cell carcinoma, it is important to suspect trichoepithelioma and seek histologic reconfirmation.

Skeletal cavernous hemangiomas of the frontal bone with orbital roof and rim involvement.

Skeletal cavernous hemangiomas are rare, benign tumors that may involve the supraorbital rim and orbital roof. However, such involvement is extremely rare. We report a case of skeletal cavernous hemangioma of the frontal bone involving the orbital roof and rim. En bloc excision and reconstruction, using a calvarial bone graft for the orbital roof and rim defect, was performed. It is important not only to perform total excision of skeletal cavernous hemangiomas, but to properly reconstruct the defects after the total excision since several complications can arise from an orbital roof and rim defect.

Pediatric follicular lymphoma of the parotid gland.

Primary malignant lymphoma rarely presents as a mass in the salivary gland. It accounts for about 1% of salivary gland tumors. The lymphomas of the parotid gland are mainly non-Hodgkin's lymphoma of B-cell follicular type. It usually occurs in male adults and is very rare in children. In contrast to the intractable disease course of adult parotid follicular lymphoma, when occurred in children or adolescent, its prognosis is very good when it is first treated with surgical excision. Thus, a solitary follicular lymphoma in an extranodal site that has occurred in children is termed separately as pediatric follicular lymphoma (PFL). We share our treatment experience of a 16-year-old PFL patient through surgical removal combined with superficial parotidectomy. In line with the few previous case reports of PFL, we suggest that active surgical removal should be undertaken for solitary, extranodal follicular lymphoma of the pediatric and adolescent population.

Comparison of dissection with harmonic scalpel and conventional bipolar electrocautery in deep inferior epigastric perforator flap surgery: A consecutive cohort study.

Reduced tissue damage is a theoretical advantage of using an ultrasonic harmonic scalpel. We hypothesized that the harmonic scalpel would outperform electrocautery in deep inferior epigastric perforator flap surgery, possibly resulting in a shorter operative time and reduced postoperative drainage and pain. Between January and August 2015, 24 consecutive patients were assigned to immediate deep inferior epigastric perforator flap elevation (12 for bipolar electrocautery and 12 for harmonic scalpel). The main outcome variables were total operative time, flap elevation time (starting from the fascia incision), and drainage volume. We compared the number of perforators isolated and the Moon and Taylor classification of the pedicle. Data were tested for normality using the Kolmogorov-Smirnov test before analysis. Continuous variables were compared by Wilcoxon rank-sum test. Data were analyzed using the statistical software SAS, version 9.3 (SAS Institute, Cary, NC, USA). Both groups were comparable with respect to clinical characteristics (mean age, body mass index, and flap weights). There was a statistically significant difference in the operative time between dissection with the harmonic scalpel and electrocautery (305.2 vs. 380.3 min, respectively, p = 0.002). The flap elevation time was reduced, particularly when using the harmonic scalpel where its usage seems crucial for dissecting deep inferior epigastric perforators (59.8 vs. 145.9 min, respectively, p < 0.0001). No statistical difference was observed in the drainage volume and length of hospital stay between the groups. We conclude that the harmonic scalpel may be more reliable and efficient as an alternative to electrocautery.

Simultaneous Double Eyelid Blepharoplasty and Ptosis Correction with a Single-Knot, Continuous, Nonincisional Technique: A Five-Year Review.

BACKGROUND: Double eyelid blepharoplasty is one of the most popular facial cosmetic surgeries performed in patients with Asian eyelids. Although most patients choose to undergo blepharoplasty for cosmetic purposes, rather than functional reasons, these patients frequently present with concomitant mild-to-moderate blepharoptosis. OBJECTIVES: Performing nonincisional double eyelid surgery without correcting the ptosis tends to lead to unsatisfactory results. The authors introduce our new method for simultaneous correction of blepharoptosis during double eyelid blepharoplasty. METHODS: For 5 years, the authors have performed a single-knot continuous nonincisional technique for simultaneous correction of blepharoptosis during double eyelid blepharoplasty. The medical charts of 127 patients (254 eyelids) were retrospectively reviewed. Müller muscle tagging suture was utilized to achieve the accurate amount of Müller tucking during the surgery. RESULTS: There was a statistically significant difference between pretreatment MRD1 (1.62 ± 0.57 mm), and postoperative MRD1 (3.97 ± 0.81 mm; P < .001, Wilcoxon signed rank test, nonparametric paired comparison). The mean duration of surgery for both eyelids was 14.8 minutes (range, 14.1-19.7 minutes), and the mean extent of Müller muscle tucking was 7.8 mm (range, 6.0-10.0 mm). The majority of patients showed favorable results during long-term follow-up, with minimal complications. CONCLUSIONS: There are no previously published articles documenting simultaneous double eyelid blepharoplasty and ptosis correction, using a single-knot continuous nonincisional technique. The authors suggest our simple and effective method is a good option for double eyelid blepharoplasty in cases with mild-to-moderate blepharoptosis.' LEVEL OF EVIDENCE 4: Therapeutic.

Endotine Midface for Soft Tissue Suspension in Zygoma Fracture.

Treatment of zygomatic fractures necessitates dissection beneath the soft tissues of the cheek. Inadequate resuspension may lead to deformities, including cheek ptosis, lower lid ectropion, and lateral canthal dystopia. The authors present their experience using a biodegradable suspension device for cheek flap resuspension. Patients who received open reduction for unilateral zygomatic fracture between January, 2006 and December, 2013 at a single center were included in the study. Patients could choose whether or not to have Endotine midface inserted. Patients rated satisfaction on facial symmetry. Computed tomography (CT) at 15 months was assessed for soft tissue thickness at the level of the midpoint of the nasolabial fold on each side. Photographs at 15 months were viewed by 3 blinded plastic surgeons and rated for cheek drooping. The results for all 3 parameters were compared between the Endotine group and the control group. A total of 83 patients were included (43 in the Endotine group and 39 in the control group). Patient satisfaction scores were statistically higher (P = 0.03) in the Endotine group (3.70 ±â€Š0.76) than the control group (2.85 ±â€Š0.96). Computed tomography soft tissue thickness score ratio between affected and unaffected side was significantly lower (P < 0.001) in the Endotine group than the ratio in the control group. Photography evaluation score difference between affected and unaffected side for the Endotine group (0.70 ±â€Š0.77) was significantly (P = 0.041) smaller than the control group (1.92 ±â€Š1.24). Endotine midface is easy to apply and effective in repositioning the elevated cheek flap in zygomatic fracture patients.

Identifying preoperative factors associated with the postoperative nasal synechia in patients undergoing closed reduction of the nasal bone fracture.

We conducted this study to identify preoperative factors that are associated with the postoperative nasal synechiae in patients with nasal bone fracture who underwent closed reduction.In the current single-center, retrospective study, we evaluated the fracture type, septal deviation angle (SDA), synechia scores (SSs) and visual analog scale (VAS) scores through a retrospective review of the medical records and computed tomography scans of 42 patients (n = 42) who had undergone closed reduction for nasal bone fracture at our medical institution during a period ranging from April to August 2013.The mean SS was significantly lower in the plane I group (n = 25) as compared with the plane II group (n = 17) (1.28 ± 1.77 vs 2.76 ± 1.89, P = 0.013). There was a significant positive correlation between the SDA and the SS with a formula of SS = 0.216SDA - 0.322 (r(2) = 0.532, P < 0.001) and between the SS and the VAS with a formula of VAS = 1.280SS + 0.612 (r(2) = 0.648, P < 0.001). Both the SS and VAS were significantly higher on the convex side as compared with the concave side of the nasal cavity.Our results indicate that patients with higher SDA or combined septal fractures might be at increased risks of developing the postoperative synechiae. Further large-scale, prospective studies are warranted to establish our results.

Bioabsorbable plates and screws fixation in mandible fractures: clinical retrospective research during a 10-year period.

We present the basic guidelines for the safe fixation of a mandible fracture using a bioabsorbable system with less strength than the metallic system based on our 10 years of experience.We conducted a retrospective review of 75 patients who had undergone fixation using a bioabsorbable system for a mandible fracture. We analyzed the method of fixation and the size and thickness of the plates and screws that were selected depending on the mandible's fracture site.Minor complications including intraoral wound disruptions and infections occurred in 12 (16%) patients, and 2 (2.7%) patients among 10 patients who presented with infections had nonunion; therefore, they underwent replacement of the absorbable system with the titanium system. Bone resorption that was caused by the absorbable plate occurred in 12 (16%) patients.The bioabsorbable system also may be able to replace the metallic system in the fixation of comminuted mandible fractures if further research on the development of the system is supported.

Surgical Treatment of Polyotia.

Polyotia is an extremely rare type of the auricular malformation that is characterized by a large accessory ear. A 3-year-old girl presented to us with bilateral auricular abnormalities and underwent two-stage corrective operation for polyotia. In this report, we present the surgical details and postoperative outcomes of polyotia correction in the patient. Relevant literature is reviewed.

Lipofibromatous hamartoma of a cranial nerve.

Lipofibromatous hamartomas (LFHs) are rare benign tumors that typically present as slow-growing firm masses in the subcutaneous soft tissue of the extremities. These often develop in young adults on the volar aspects of the hands, wrists, and forearms along major nerves and their branches. Only a single case of LFH growth along a cranial nerve has been reported. A 41-year-old man presented with a subcutaneous soft mass of the cheek. Histologically, the mass consisted of a proliferating fibrofatty tissue that surrounded and infiltrated the nerve structure and it was confirmed to be an LFH. After surgical excision, the patient experienced mild facial numbness and motor disturbance on the side ipsilateral to the resection. Because complete excision of the mass can cause sensory or motor disturbances, an accurate diagnosis and proper subsequent treatment, such as partial decompression, are necessary.

Orbital dystopia due to orbital roof defect.

We performed a retrospective review of patients who presented with delayed dystopia as a consequence of an orbital roof defect due to fractures and nontraumatic causes to search for a correlation between orbital roof defect size and surgical indications for the treatment thereof. Retrospective analyses were performed in 7 patients, all of whom presented with delayed dystopia due to orbital roof defects, between January 2001 and June 2011. The causes of orbital roof defects were displaced orbital roof fractures (5 cases), tumor (1 case), and congenital sphenoid dysplasia (1 case). All 7 patients had initially been treated conservatively and later presented with significant dystopia. The sizes of the defects were calculated on computed tomographic scans. Among the 7 patients, aspiration of cerebrospinal fluid, which caused ocular symptoms, in 1 patient with minimal displaced orbital roof and reconstruction with calvarial bone, titanium micromesh, or Medpor in 6 other patients were performed. The minimal size of the orbital roof in patients who underwent orbital roof reconstruction was 1.2 cm (defect height) x 1.0 cm (defect length), 0.94 cm(2). For all patients with orbital dystopia, displacement of the globe was corrected without any complications, regardless of whether the patient was evaluated grossly or by radiology. In this retrospective study, continuous monitoring of clinical signs and active surgical management should be considered for cases in which an orbital roof defect is detected, even if no definite symptoms are noted, to prevent delayed sequelae.

An analysis of pure blowout fractures and associated ocular symptoms.

Blowout fractures are one of the commonly occurring facial bone fractures and clinically important, as they may cause serious complications such as diplopia, extraocular movement limitation, and enophthalmos. The purpose of this study was to evaluate the current patient demographics and surgical outcomes of 952 pure blowout fractures from 2 hospitals of the Catholic University of Korea, from 2003 to 2011. The medical records were reviewed according to the cause, fracture site, ocular symptoms, time of operation, and sequela. Male patients outnumbered female patients, and blowout fractures were most often seen in 21- to 30-year-old men. The most common cause was violent assault (40.7%). The medial orbital wall (45.8%) was the most common site, followed by floor (29.4%) and inferomedial wall (24.6%). The most common ocular injury was hyphema. Diplopia was presented in 27.6%; extraocular movement limitation was detected in 12.8% patients, and enophthalmos was encountered in 3.4% patients. Diplopia, extraocular movement limitation, and enophthalmos were significantly improved by surgical repair (P < 0.05). Postoperative complications were persistent diplopia (1.6%) and enophthalmos (0.4%). We surveyed a large series of blowout fracture in the Republic of Korea and recommend this study to serve as an important guideline in treating pure blowout fractures.

Posttraumatic delayed cranio-orbital cerebrospinal fluid leakage: case report.

A 56-year-old man sustained subarachnoid haemorrhage, skull base fracture and multiple facial fractures in a traffic accident. Two weeks later, the patient developed a subperiosteal fluid collection into the orbit of the right side presenting with a progressive proptosis and an increased intraocular pressure. We performed drainage of the fluid on the superior part of the right orbit, followed by a surgical reduction of the facial fractures. The patient had no exophthalmos any longer, whose intraocular pressure was normalised. In conclusion, our case indicates that careful monitoring of clinical signs and a follow-up radiography would be mandatory for patients with craniocerebral trauma despite a lack of the definite symptoms. Clinicians should consider the possibility that the cerebrospinal fluid (CSF) leakage into the orbit might occur in these patients.

Treatment of sagittal synostosis: subtotal cranial vault remodelling with right-angled Z-osteotomies.

INTRODUCTIONS: Sagittal synostosis is the most common type of non-syndromic craniosynostosis with fusion of the sagittal suture. Various techniques have been introduced for the treatment of this irregular calvarial deformity. However, since these methods were not suitable for patients who were aged over 1 year when they were diagnosed with sagittal synostosis, a new approach should be undertaken. PATIENTS AND METHODS: Between 2001 and 2005, five patients who were diagnosed with sagittal synostosis, after the age of 1 year, were treated with subtotal cranial vault remodelling. The procedure consisted of right-angled Z-osteotomies in the frontal and parieto-occipital bones, a shortening of the sagittal strut, and barrel-stave osteotomies in the temporal bone. They were undertaken to expand bitemporal diameter and to shorten anteroposterior diameter. RESULTS: Cranial index increased from 68.2 to 77.8 immediately after surgery and to 78.4 post-surgery 36 months. Cranial morphologies were satisfactory during follow-up. The main advantage of the procedure is the easy control of fixation angle according to the surgeon's preference. There were no major complications including infections or relapses. CONCLUSIONS: The treatment goal of sagittal synostosis is to eliminate factors that may impede brain development by assuring an adequate cranial cavity and to maintain an aesthetically acceptable cranial morphology. We obtained functionally and aesthetically favourable results by right-angled Z-osteotomies. Further, our one-staged procedure is safe, especially in patients over the age of 1 year.

Anterior two-thirds calvarial remodelling: operative technique for the correction of metopic synostosis in toddlers.

BACKGROUND: Premature closure of the metopic suture results in deformation of the anterior calvarium. Trigonocephaly is expressed in various forms--from a simple midline ridge of the forehead to a severe keel-shaped deformity--often requiring specific surgical correction for aesthetic improvement and cognitive and linguistic function advancement. This article presents a surgical technique used over 5 years to treat trigonocephalic toddlers in Korea. METHODS: Retrospective analyses were performed on eight patients with metopic synostosis treated at St. Mary's Hospital (Seoul) during 2002-2006. The study included reviews of preoperative and postoperative computed tomography scans, operative techniques, clinical outcomes and complications. Operative techniques included fronto-orbital bandeau tilting after expansion with a midline wedge-bone graft, detriangulation of foreheads with an inward bending at lateral orbital wall, multiple zigzag osteotomy of frontal bone, barrel-stave osteotomy of parietal bone and the occasional application of calcium phosphate cement (BoneSource, Leibinger Inc., Michigan, USA) to refine the forehead shape. RESULTS: The average age of the patients at time of surgery--due to late referral to medical care--was 25.1 months. Two patients had concomitant bicoronal synostosis requiring coronal suture resection with anterior two-thirds calvarial reconstruction. The central angle measurements improved from a preoperative average of 118 degrees to 134 degrees ; interorbital distances widened from 18.8mm to 20.9 mm. Mean follow-up was 2.6 years, and no neurological sequelae or other significant complications were encountered. CONCLUSIONS: Moderate-to-severe trigonocephaly requires surgical correction involving anterior two-thirds calvarial remodelling with fronto-orbital advancement and frontal-bone remodelling. The described operative approach, especially in toddlers, minimises bone defects by adopting multiple zigzag osteotomy of the frontal bone. This modality results in significant improvements in skull form and high patient/parent satisfaction.