A Clinical Experience of Direct Extension to Parotid Gland of Cutaneous Squamous Cell Carcinoma

Cutaneous squamous cell carcinoma has a high incidence. However, regional metastasis occurs infrequently because skin cancer is usually recognized and treated early. We report the case of squamous cell carcinoma around the earlobe in a 74-year-old male patient. The cutaneous squamous cell carcinoma invaded ipsilateral parotid gland directly without lymphatic spreading. Wide excision was made with 1.5 cm margin and immediate reconstruction was performed with radial forearm fasciocutaneous free flap. During operation facial nerve was preserved. No recurrence was noted for 5 years and the patient was satisfied with good aesthetic result. Cutaneous squamous cell carcinoma spreads to the parotid gland usually through lymph nodes and there are few reports of invasive organ damage by direct invasion. We experienced a case of direct invasion to parotid gland without lymph node involvement of cutaneous squamous cell carcinoma and treated the cancer adequately with wide excision and free flap coverage.

Growth Pattern and Normal Anthropometric Values of Skull Base in Korean Child

While studying skull base in craniosynostosis, it became apparent that there is a lack of reference studies quantifying the changes of the normal skull base throughout childhood. There is a considerable amount of work published already, obtained from skull radiographs with orthognathic deformities. While this has established some growth trends during childhood, it cannot easily be used for correlative studies, due to the known reliability and reproducibility errors that apply to all studies based on plain skull radiographs. This study presents simple measurement of brain CT and analysis of 2D growth of the skull base throughout childhood, which can be used as reference for further studies of condition that affect skull base growth, such as craniofacial deformities, in oriental childhood. The landmarks of skull base were identified on brain CT scan of 120 normal korean infants and children, aged 0 month to 24 months and several distances between the various landmarks were measured in an attempt to quantify the growth of skull fossa. The results of the measurements showed that at the age of 24 months, the distances reach 90% of adult values except for the anterior cranial fossa. This fossa only reaches 78% of the adult value which means that much potential remains at this age for further growth. There are two periods of time where total growth(total cephalic length) is the fastest: 0-9 months and 16-24 months. In regards to the anterior cranial fossa, 0-12 months is the period of fastest growth. The middle fossa grows fastest between 18-24 months. The posterior fossa follows a linear pattern with a constant rate of growth. or our measurements.

Statistical Analysis of the Polydactyly and Syndactyly by National Health Insurance Corporation Data

The feature of congenitial hand anomalies is multiple and complex. Polydactyly and syndactyly is one of the most common congenital anomalies of the upper limb. The statistical analysis of these anomaly is the basic study of congenital hand anomalies. However, the number of reports is small. The purpose of this study is to compare and analyze objective data and make a nation-wide statistical report on polydactyly and syndactyly. We used data from the National Health Insurance Corporation for reviewing polydactyly and syndactyly. We reviewed 3 years of data from 1998 to 2000 focusing on age, the number of operations, male to female ratio, the duration of hospital care and cost. The number of operations for polydactyly was 694 cases and for syndactyly was 574 cases. Therefore we may assume that polydactyly occurs 1:910 births and syndactyly occurs 1:1101 births. The duration of hospital care for polydactyly was 12 days and for syndactyly was 17 days. The full cost for the correction of polydactyly was 770,000 won and syndactyly was 1,220,000 won. The ratio of polydcatyly and syndactyly was 1.12:1. The operation for polydactyly and syndactyly was performed between the age of 1 and 2 in most cases. Male to female ratio of polydactyly was 1.14 :1 and syndactyly was 1.39:1. This study will be helpful to find appropriate treatment for congenital hand anomalies.

The Regional Anatomy of the Corrugator Supercilii Muscle and Facial Nerve

Glabellar frown lines develop as a result of contraction of the corrugator supercilii muscles. These lines make look angry or aging. The neurotomy of facial nerve supplying corrugator supercilii muscle will prevent complications of the surgical technique and the reversibility of the nonsurgical technique. The regional anatomy of corrugator supercilii muscle is necessary for developing new technique. However, there is little information regarding the motor innervation of this muscle. The purpose of this study is to identify the regional anatomy of corrugator supercilii muscle and facial nerve and help to develop new technique of the neurotomy. We have dissected 6 Korean adult cadavers(12 sides). The motor innervation of this muscle was the temporal branch of facial nerve. The entry point of facial nerve into this muscle was found to be the inferolateral part. It was directly beneath the hair of lateral side of mid one-third of the eyebrow. The average distance between median plane and the entry point was 35.8mm. The measurement was not significantly different between right and left side. This study will be helpful for developing new technique of the neurotomy of motor nerve that supplies to corrugator supercilii muscle.

Tissue-Engineered Human Neocartilage Formation Using Human Adult Auricular Cell Line

The purpose of these studies was an establishment of human auricular chondrocyte cell line using retrovirus mediated v-myc transfer, characterizing the human auricular chondrocyte cell line by type II collagen mRNA expression and transplantation of human auricular cell line into immunological incompetent nude mice to establish neocartilage formation. Also, I evaluated the growth rate of chondrocyte cell line to measure the cellular proliferative potency. I have established the human auricular chondrocyte cell line integrated v-myc and confirmed by v-myc transduced Myc protein expression by immunohistochemistry and immunoblotting study. And, growth rate of established human auricular chondrocyte cell line increased 4 folds times faster than primarily cultured human auricular chondrocyte. The established human auricular chondrocyte had type II collagen mRNA upto 8 months in monolayer culture. And we observed formation of neocartilage on the back of nude mice using chondrocyte cell line/fibrin glue polymer at 12 weeks transplantation.

The Reduction and Fixation in Periorbital Bone Fracture via the Supratarsal Fold Incision

For the approach to the supraorbital rim and frontozygomatic suture line, surgeons have used the bicoronal incision or lateral eyebrow incision. However it may leave the scar or alopecia. For the successful surgical repair of the frontal sinus fracture and frontozygomaticomaxillary complex fracture, we reviewed the use of the supratarsal fold incision, and selected cases of the open reduction and fixation of frontal sinus fracture and frontozygomatic suture line fractures. We investigated six cases, two were frontal sinus anterior wall fracture and four were frontozygomaticomaxillary complex fracture. The patients underwent bony reduction via supratarsal fold incision to expose the frontal sinus and frontozygomatic suture line. In all six cases, the supratarsal fold incision provided very satisfactory exposure of lateral orbital wall, frontozygomatic suture line, frontal sinus and supraorbital rim. No patients had post-operative alopecia, scar, ptosis, lagophthalmus and hematoma. The supratarsal fold incision provides excellent approaches to the frontozygomatic suture line and frontal sinus and there was not any post-operative complicaitons. So it may be the option for the approach to the superolateral orbital rim or supraorbital rim for frontal sinus simple fracture and non-comminuted fractures at frontozygomatic suture area.

Correction of Macrocephaly using Sagittal Hinge Flap

Macrocephaly commonly occurs in children with untreated or neglected hydrocephalus, and in most cases this is accompanied with discrepancy between the volume of the brain and the cranial cavity. Macrocephaly usually interferes with head control, seating, locomotion, and social acceptance. So the goals of the reduction cranioplasty lie in reconstruction of the head shape, control of intracranial pressure, obstruction of the growth of the head, which enables to ambulate. However, reports about surgery of macrocephaly are scanty. A 24-month-old girl suffered from hydrocephalus with macrocephaly. Her head circumference was 71cm and couldn't control her head or lie in lateral position. The surgical technique we used was a one-stage operation, using a sagittal hinge flap. This technique includes infracturing with wedge resection of the marginal skull and pushing it inward. The dura mater in the frontal region was plicated, while care was taken to maintain attachment of the superior sagittal sinus, the fixation was done with microplates, screws and wirings. After the operation, she had no air embolism, venous infarction, infection, neurologic deficit and had satisfactory cosmetic results. History of the operation of macrocephaly, tactical considerations and possible risks are discussed with our surgical experience in this publication.

The Use of Mesh Microplates in Management of Comminuted Nasal Bone Fracture

The majority of nasal fractures have been managed by using closed reduction, intranasal packing and external splinting. However, in comminuted nasal bone fractures, the conventional closed reduction may be inadequate to reduce the fracture segments accurately, and insufficient to prevent secondary nasal deformity. In these cases, open reduction and interfragment wire fixation was recommended for accurate reduction, and has been mainstay of treatment modality. Furthermore, in nasoethmoid orbital fractures, anatomic reduction of fractured nasal bone, medial and inferior orbital rim segments to reconstruct nasofrontal buttress and transnasal wiring to prevent telecanthus were essential. But, the interfragment wire fixation is difficult and time-consuming procedure. The care must be taken to fix small fracture segments. It is also difficult to obtain bony support due to extensive dissection of periosteum, and to achieve rigid fixation on three- dimensional space, causing depression of bony contour. From April 1998 to August 1999, we used malleable mesh microplates for treatment of 3 comminuted nasal bone fractures and 3 nasoethmoid orbital fractures. During the follow up period of 8 months to 24 months, all of six patients had successful cosmetic result without complications. There was no recurrent depression of bony contour, no secondary nasal deformity, no displacement of microplates and no palpable, externally shown hardwares. The use of mesh microplates is reliable and useful method for the treatment of comminuted nasal fractures because it is relatively simple procedure and achieves rigid fixation on three-dimensional space without postoperative temporary nasal packing which may cause patient's discomfort. Furthermore, in nasoethmoid orbital fractures, correction of telecanthus can be done without application of transnasal wiring.

Reduction of Zygomatic Arch Fractures Via Postauricular Approach

Zygomatic arch fracture is one of the most commonly seen facial bone fractures and there have been many methods of reduction designed so far. However, for a simple fracture, the Gillies temporal approach is most commonly used because of the easy reducibility, and also because the depressed fracture can be approached without a facial incision. The Gillies temporal approach starts in the temporal area, between the temporalis muscle and deep temporal fascia. We have developed a new route which starts in the postauricular hair margin area and then reaches to the periosteum of the temporal bone. An elevator is then inserted to penetrate the periosteum and subperiosteal dissection is performed toward the zygomatic process of the temporal bone. At the origin of the zygomatic process, the route of dissection changes to the posterior aspect of the zygomatic arch using a curved palate elevator or the authors' modified Langenbeck elevator. This method of approach has been used in 6 cases of zygomatic arch fracture with good results and we report this method along with written reports.

Use of microplate on flxation of orbital rim fracture

The orbitozygomatic area occupies a key anatomic position in midface, is prone to injury, and plays a prominent role in facial aesthetics. So the facial appearance including orbital shape can be altered by complications of orbitozygomatic fractures. Most possible initial complications include blindness, hyphema, retinal detatchment, and paralysis or entrapment of extraocular muscles. Long term sequelaes include infraorbital nerve dysfunction, loss of malar projection, enophthalmos, and dystopia. Accurate anatomic reduction and rigid fixation is essential for management of orbitozygomatic fractures to minimize those late sequelaes. Conventional fixation devices to fix displaced fracture of facial bone are interosseous wire and miniplate. But interosseous wirings are unstable for primary bone healing and time consuming. Miniplates have great deal in rigid fixation but their high profile and palpability are the main complaints in many patients, especially in orbital rim area. In this article, we reviewed the 30 cases of zygomamaxilla complex fractures with orbital rim fracture fixed with microplates, and discussed the stability of microplate and superiorities in final aesthetics result. The use of microplates in these area permits enough stability of fracture segment with ease of procedures and superiorities in final results without any palpability.