Revisiting bilateral bony orbital volumes comparison using 3D reconstruction in Korean adults: a reference study for orbital wall reconstruction, 3D printing, and navigation by mirroring.

BACKGROUND: Orbital wall fractures can result in changes to the bony orbital volume and soft tissue. Restoring the bony orbital and intraconal fat volumes is crucial to prevent posttraumatic enophthalmos and hypoglobus. We aimed to establish an evidence-based medical reference point for "mirroring" in orbital wall reconstruction, which incorporates three-dimensional (3D)-printing and navigation-assisted surgery, by comparing bilateral bony orbital volumes. METHODS: We retrospectively analyzed the data obtained from 100 Korean adults who did not have orbital wall fractures, categorized by age groups. The AVIEW Research software (Coreline Soft Inc., Seoul, South Korea) was used to generate 3D reformations of the bony orbital cavity, and bony orbital volumes were automatically calculated after selecting the region of interest on consecutive computed tomography slices. RESULTS: The mean left and right orbital volume of males in their 20 s was 24.67 ± 2.58 mL and 24.70 ± 2.59 mL, respectively, with no significant difference in size (p = 0.98) and Pearson's correlation coefficient of 0.977 (p < 0.001). No significant differences were found in orbital volumes in other age groups without fractures or in patients with nasal bone fractures (p = 0.84, Pearson's correlation coefficient 0.970, p < 0.001). The interclass correlation coefficients (2,1) for inter- and intrarater reliability were 0.97 (p < 0.001) and 0.99 (p < 0.001), respectively. CONCLUSIONS: No significant differences were found in the bilateral bony orbital volumes among males of any age. Thus, the uninjured orbit can be used as a volumetric reference point for the contralateral injured orbit during orbital wall reconstruction.

Mastectomy Skin Flap Stability Prediction Using Indocyanine Green Angiography: A Randomized Prospective Trial.

BACKGROUND: The first step in successful breast reconstruction is obtaining a stable skin flap. Indocyanine green (ICG) angiography has recently been studied for its value and usefulness in predicting the stability of skin flaps; however, relevant prospective studies of its clinical efficacy are limited. OBJECTIVES: The aim of this study was to prospectively investigate the clinical impact on breast reconstruction outcomes of the intraoperative use of ICG angiography. METHODS: Between March and December 2021, 64 patients who underwent immediate breast reconstruction at the authors' institution were prospectively enrolled. They were classified into an experimental group (n = 39; undergoing ICG angiography) and a control group (n = 25; undergoing gross inspection alone). In the absence of viable skin, debridement was performed at the surgeon's discretion. Skin complications were categorized as skin necrosis (the transition of the skin flap to full-thickness necrosis) or skin erosion (a skin flap that did not deteriorate or become necrotic but lacked intactness). RESULTS: The 2 groups were matched in terms of basic demographic characteristics and incision line necrosis ratio (P = .354). However, intraoperative debridement was significantly more frequent in the experimental group (51.3% vs 48.0%, P = .006). The authors additionally classified skin flap necrosis into partial- and full-thickness necrosis, with a higher predominance of partial-thickness necrosis in the experimental vs control group (82.8% vs 55.6%; P = .043). CONCLUSIONS: Intraoperative ICG angiography does not directly minimize skin erosion or necrosis. However, compared to gross examination alone, it enables surgeons to perform a more active debridement during surgery, thereby contributing to a lower incidence of advanced skin necrosis. In breast reconstruction, ICG angiography may be useful for assessing the viability of the postmastectomy skin flap and could contribute to successful reconstruction. LEVEL OF EVIDENCE: 4.

A multicenter, randomized, double-blind, comparative study of a multiphasic hyaluronic acid filler and existing hyaluronic acid fillers for temporary restoration of the midface volume of Asian individuals.

BACKGROUND: Giselleligne is the world's first multiphasic gel product that evenly surrounds particles. In the current study, Giselleligne was compared with other existing fillers to evaluate their clinical use, safety, and ability to improve midface volume deficits of Asian individuals. METHODS: A comparative experiment was conducted to gain an understanding of the physical properties of Giselleligne, which is a multilayered hyaluronic acid filler, and to compare its properties with those of existing hyaluronic acid fillers. The primary outcome of this study was a Midface Volume Deficit Scale (MFVDS) score improvement at 24 weeks after the procedure. The secondary outcomes were as follows: MFVDS score improvement after the procedure; MFVDS score changes after the procedure; Global Esthetic Improvement Scale (GAIS) scores as evaluated by the operator after the procedure; the operator's satisfaction with the product; evaluation of the GAIS scores by the patient after the procedure; and pain level of the patient on the day of the procedure. RESULTS: Giselleligne exhibited properties that are expected to result in significantly superior clinical outcomes compared to existing products. Giselleligne was superior not only to the existing products but also in terms of global esthetic improvement, effect duration, and operator satisfaction. Furthermore, Giselleligne was found significantly safer than the existing products. CONCLUSION: Giselleligne is a safer, more user-friendly, and more effective alternative to existing products for improving the midfacial volume.

Efficacy of split-thickness skin graft combined with novel sheet-type reprocessed micronized acellular dermal matrix.

BACKGROUND: Autologous split-thickness skin grafts (STSGs) remain the mainstay for treatment of large skin defects. Despite its many advantages, there exist critical disadvantages such as unfavorable scar and graft contracture. In addition, it cannot be used when structures such as tendons and bones are exposed. To overcome these limitations, acellular dermal matrix (ADM) is widely used with STSG. CGDerm Matrix®, which was recently developed, is a novel reprocessed micronized ADM (RMADM). In this study, outcomes of the combined application of RMADM and STSG on full-thickness wounds were analyzed. METHODS: Forty-one patients with full-thickness skin defects due to trauma, scar contracture release, and diabetic foot ulcers, who underwent STSGs, from January 2021 to July 2021, were retrospectively reviewed. The primary outcome of interest was skin loss rate, which was measured 14 days after surgery. RESULTS: The most common cause of skin defect was trauma (36 patients), diabetic foot (2 patients), scar contracture release (2 patients), and malignancy (1 patient). The average defect size was 109.6 cm2 (range, 8-450 cm2). The average skin loss rate was 9.1%, showing a graft take rate of > 90%. CONCLUSION: The use of combined RMADM and STSG in full-thickness wound reconstruction provides stable and acceptable outcomes. The newly developed ADM can be a promising option in wound reconstruction.

Current strategies for aesthetic soft tissue refinement in nasal reconstruction.

The challenges of successful nasal reconstruction, which are related to the anatomical complexity of the region, have been extensively studied. Revisional operations are often required to achieve proper nasal reconstruction, with results resembling the premorbid nasal status. This is necessary to ensure the quality of life of skin cancer patients. Fundamental nasal reconstruction requires both proper soft tissue coverage and proper function. However, earlier studies in the field primarily focused on the functional aspect of nose reconstruction, although the cosmetic aspect is also an important factor to consider. In response to this need, many recent studies on nose reconstruction have proposed various refinement strategies to improve aesthetic satisfaction. Most plastic surgeons accept the nasal aesthetic subunit principle as a standard for nasal reconstruction. This review outlines the commonly used surgical refinement options and management strategies for postoperative complications based on the subunit principle. In patients with nasal defects, a proper technical strategy might help minimize revision operations and optimize the long-term results.

Impact of establishing a level-1 trauma center for lower extremity trauma: a 4-year experience.

PURPOSE: A multidisciplinary approach is essential for trauma patients' treatment, particularly for cases with open lower extremity fractures, which are considered major traumas requiring a comprehensive approach. Recently, the social demand for severe-trauma centers has increased. This study analyzed the clinical impact of establishing a trauma center for the treatment of open lower extremity fractures. METHODS: A retrospective chart review was conducted for trauma patients admitted to our hospital. Patients were classified into two groups: before (January 2014-December 2015, 178 patients) and after establishment of a Level-1 trauma center (January 2017-December 2018, 125 patients). We included patients with open fracture below the knee level and Gustilo type II/III, but excluded those with life-threatening trauma that affected the treatment choice. RESULTS: Total 273 patient were included in this study, initial infection was significantly more common and external fixator application significantly less in post-center establishment group. The time to emergency operation decreased significantly from 13.89 ± 17.48 to 11.65 ± 19.33 h post-center setup. By multivariate analysis, the decreased primary amputation and increased limb salvage was attributed to establishment of the trauma center. CONCLUSION: With the establishment of the Level-1 trauma center, limbs of patients with open lower extremity fractures could be salvaged, and the need for primary amputation was decreased. Early control of initial open wound infection and minimizing external fixator use allowed early soft tissue reconstruction. The existence of the center ensured a shorter interval to emergency operation and facilitated interdepartmental cooperation, which promoted active limb salvage and contributed to patients' quality of life.

Paraspinal Necrotizing Fasciitis Associated with Pressure Injury: An Unusual Case Report.

ABSTRACT: Necrotizing fasciitis is a type of soft tissue infection that destroys subcutaneous tissue. It is particularly dangerous for patients with chronic diseases and those who are bedridden while recuperating. Although necrotizing fasciitis is often caused by trauma or postoperative infection, in rare cases, it can be attributed to pressure injury (PI). The disease progression is very aggressive and can be lethal for patients who are bedridden or immunocompromised.This case report describes a 47-year-old man with a history of diabetes and hypertension who became bedridden after a sudden status decline caused by nephrotic syndrome. He gradually developed an infection and rare deterioration of a PI on his upper back. After radiologic evaluation with magnetic resonance imaging and computed tomography, surgical intervention was performed and necrotizing fasciitis was confirmed. In this case of necrotizing fasciitis derived from a PI on the upper back, the infected area spread to the periphery at a rapid rate. The infection spread over his back and across the T1-T9 levels.In this report, the authors describe the integrated system of the thoracolumbar fascia and the very aggressive spread of necrotizing fasciitis. Because of the anatomic structure of the back and the characteristics of this infection, only aggressive surgical debridement could prevent the spread of infection and reduce the systemic effects of the infection. Physicians should be aware of the possibility of PIs in bedridden patients and, in cases of exacerbation of the wound, consider rapid surgical intervention after prompt examination and diagnosis to reduce mortality.

Early management of parotid gland injury with oral nortriptyline and closed drain.

Parotid gland plays the most critical role in saliva secretion in the oral cavity. Parotid gland injuries due to facial trauma can cause various complications such as formation of a fistula or sialocele. Thus, such saliva-related complications can interfere with wound healing and increase the risk of infection. Several previous studies have discussed the treatment of fistula or sialocele. Nonetheless, prevention of such complications is of utmost importance. We present a case of parotid gland injury due to trauma to the cheeks that was surgically treated, with early postoperative management involving oral administration of nortriptyline and closed drainage, without complications.

Skin malignancy initially misdiagnosed as a benign epidermal cyst.

Skin cancer, which often occurs as a result of skin exposure to ultraviolet light radiation, usually presents with characteristic abnormal features, such as ulcerative lesions, irregular morphology, bleeding, and excessive growth. Therefore, skin cancer rarely resembles a benign tumor on visual inspection. Nonetheless, squamous cell carcinoma and basal cell carcinoma with nodular or polypoid features can have a similar appearance to that of benign tumors, meaning that they are sometimes misdiagnosed as benign. As benign and malignant tumors have some overlapping features, clinicians sometimes use additional imaging techniques such as ultrasonography to improve the accuracy of the diagnosis because even a malignant tumor that externally resembles a benign tumor generally has internal morphological features characteristic of malignancy, such as invasion and irregular borders. However, these imaging tools also have limitations, and punch or excisional biopsy can be needed if malignancy cannot be completely ruled out. Herein, we report a case of skin malignancy initially misdiagnosed as a benign epidermal cyst based on external visual inspection and ultrasonography.

Increased risk of gallstones after appendectomy: A longitudinal follow-up study using a national sample cohort.

To evaluate the association between appendectomy and the occurrence of gallstones using a national sample cohort from Korea.The Korean National Health Insurance Service-National Sample Cohort was collected from 2002 to 2013. We extracted data for patients who had undergone appendectomy (n = 14,955) and a 1:4 matched control group (n = 59,820) and then analyzed the occurrence of gallstones. The patients were matched according to age, sex, income, region of residence, hypertension, diabetes mellitus, and history of dyslipidemia. Appendectomies were identified using operation codes (Q2860-Q2863) for appendicitis alone (International Classification of Disease-10: K35). Gallstones were diagnosed if the corresponding International Classification of Disease-10 code (K80) was reported ≥2 times. Crude (simple) and adjusted hazard ratios (HRs) were analyzed using stratified Cox proportional hazard models, and 95% confidence intervals were calculated. Subgroup analyses were performed based on age, sex, and time period after appendectomy.The adjusted HR for gallstones was 1.78 (95% confidence interval = 1.51-2.09, P < .001) in the appendectomy group. Consistent HRs were found in the analyses of all the subgroups determined using age and sex, with the exception of men ≥60 years of age. The risk of gallstones was increased during the first year after appendectomy.The occurrence of gallstones was increased in the patients who had undergone appendectomy.

Early cicatricial lagophthalmos release with pentagonal wedge resection of the scar, fat redistribution, and full-thickness skin grafting.

The specialized structure of the upper eyelid ensures complete closure of the eye and eyeball sealing. An upper eyelid injury can cause various symptoms associated with eyeball trauma, not just scar formation or eyelid deformity. In this report, we describe a case of lagophthalmos observed after wound repair in a patient with a crushing injury caused by a grinder. Several surgical techniques are used to treat lagophthalmos or scar contracture. In most cases, a releasing procedure is performed after 6 months of initial repair. However, if the patient has severe symptoms that are not relieved by conservative care, early revision is inevitable. We describe a case of early lagophthalmos successfully resolved with pentagonal wedge resection, fat redistribution, and full-thickness skin grafting. After the revisional surgery, we observed that the patient regained the ability to completely close the injured eyelid, with restoration of function and favorable cosmetic outcomes. Pentagonal wedge resection to release a retracted structure, fat redistribution to prevent readhesion, and full-thickness skin grafting for enough amount of skin to regain upper eyelid function is useful for scar release and lagophthalmos following crushing injuries of the upper eyelid.

Smoking and Alcohol Consumption Are Associated With the Increased Risk of Peritonsillar Abscess.

OBJECTIVES/HYPOTHESIS: The purpose of this study was to evaluate the relationship among smoking, alcohol consumption, and peritonsillar abscess in a Korean population. STUDY DESIGN: Individuals ≥40 years old from the Korean National Health Insurance Service-Health Screening Cohort were assessed from 2002 to 2013. METHODS: In total, 1,285 peritonsillar abscess participants were matched with 5,140 controls at a ratio of 1:4 with respect to age group, sex, income group, region of residence, hypertension, diabetes, and dyslipidemia. We analyzed the participants' previous histories of smoking (current smokers vs. nonsmokers or past smokers) and alcohol consumption (drinkers vs. nondrinkers) in the peritonsillar abscess and control groups. Peritonsillar abscess was defined using the International Classification of Disease-10 code J36 combined with claim codes for incision and drainage or aspiration. Crude and adjusted odds ratios (ORs) were analyzed using unconditional logistic regression analyses, and 95% confidence intervals (CI) were calculated. RESULTS: The rates of smoking and consuming alcohol were higher in the peritonsillar abscess group than in the control group. The adjusted OR of smoking for peritonsillar abscess was 1.23 (95% CI = 1.06-1.44, P = .009), and that of alcohol consumption was 1.18 (95% CI = 1.02-1.36, P = .024). CONCLUSION: The odds of smoking and alcohol consumption were increased in peritonsillar abscess patients compared to those in the control group. LEVEL OF EVIDENCE: NA Laryngoscope, 2020.

Increased risk of migraine in patients with psoriasis: A longitudinal follow up study using a national sample cohort.

Both psoriasis and migraine are associated with inflammatory diseases. However, few studies have been conducted the increased risk of migraine in psoriasis patients. The aim of this study was to identify whether the psoriasis increases the risk of migraine. This study used the national cohort study data collected by the Korean Health Insurance Review and Assessment from 2002 to 2013. Patients with psoriasis (n = 11,071) and control participants (n = 44,284) were selected and matched 1:4 by age, sex, income, region of residence, and past medical history of hypertension, diabetes, and dyslipidemia. This study used Cox-proportional hazard model for calculating hazard ratio (HR) with crude and adjusted model. Stratification by age and sex was analyzed. Migraines occurred significantly more frequently in psoriasis patients than in control participants (adjusted HR = 1.16, 95% confidence interval (CI) = 1.04-1.31, P <.05). In the stratification analysis, migraines occurred significantly more frequently in psoriasis patients than in control participants only in the group of middle-aged males (adjusted HR = 1.62 95% CI = 1.22-2.13, P = .001). In conclusion, psoriasis might increase the risk of migraine.

Three-Dimensional Computed Tomography Analysis of Stability Following Two- and Three-Point Fixation With Biodegradable Plates Among Patients With Zygomatic Fracture.

BACKGROUND: Open reduction followed by internal fixation has been regarded as the most effective technique for the surgical repair of zygomatic fractures. However, the ideal number and locations of internal fixation points to maintain stable reduction remain controversial. Using 3-dimensional computed tomography, we aimed to compare the stability of 2-point and 3-point fixation among patients who had undergone surgical repair of zygomatic bone fractures. METHODS: The study included 22 patients (17 men, 5 women) with unilateral zygomatic bone fractures who had undergone open reduction with 2-point or three-point fixation using biodegradable materials (11 patients in each group). The authors measured the lateral projection and height of the zygoma at 2 landmark points (zygomaticofacial foramen and frontozygomatic suture). In each group, bony displacement was analyzed between the preoperative and immediate postoperative phases, and between the preoperative and follow-up phases. Differences in stability between the 2 groups were analyzed by comparing values between the immediate postoperative and follow-up phases. RESULTS: The 2-point group exhibited a lower rate of complex fractures at the frontozygomatic suture than the 3-point group (18.2%, 63.6%, respectively). In both groups, the authors observed significant differences in the lateral projection of the zygomaticofacial foramen between the preoperative and immediate postoperative phases, and between the preoperative and follow-up phases. No significant differences in stability were observed between the groups. CONCLUSION: Our findings demonstrated that 2-point fixation of the zygoma with biodegradable materials is as stable as 3-point fixation. It could be initially considered when open reduction of frontozygomatic suture was not essential.

A retrospective computed tomography analysis of maxillary fractures and the clinical outcomes of their unreduced parts.

BACKGROUND: Some parts of a maxillary fracture-for example, the medial and posterior walls-may remain unreduced because they are unapproachable or hard to deal with. This study aimed to investigate the self-healing process of unreduced maxillary membranous parts of fractures through a longitudinal computed tomography (CT) analysis of cases of unilateral facial bone injuries involving the maxillary sinus walls. METHODS: Thirty-two patients who had undergone unilateral facial bone reduction surgery involving the maxillary sinus walls without reduction of the medial and posterior walls were analyzed in this retrospective chart review. Preoperative, immediate postoperative, and 3-month postoperative CT scans were analyzed. The maxillary sinus volume was calculated and improvements in bone continuity and alignment were evaluated. RESULTS: The volume of the traumatized maxillary sinuses increased after surgery, and expanded significantly by 3 months postoperatively (p< 0.05). The significant preoperative volume difference between the normal and traumatized sides (p= 0.024) resolved after surgery (p> 0.05), and this resolution was maintained at 3 months postoperatively (p > 0.05). The unreduced parts of the maxillary bone showed improved alignment and continuity (in 75.0% and 90.6% of cases, respectively), and improvements in bone alignment and bone continuity were found to be correlated using the Pearson chi-square test (p= 0.002). CONCLUSION: Maxillary wall remodeling through self-healing occurred concomitantly with an increase in sinus volume and simultaneous improvements in bone alignment and continuity. Midfacial surgeons should be aware of the natural course of unreduced fractured medial and posterior maxillary walls in complex maxillary fractures.

Association between BMI for Obesity and Distress about Appearance in Korean Adolescents.

BACKGROUND: Previous research has related obesity to body dissatisfaction and low self-esteem. This study aimed to evaluate this relation between obesity and distress about appearance. METHODS: We performed a cross-sectional study using data from the Korea Youth Risk Behavior Web-based Survey for 288,390 participants assessed from 2009 to 2012. The participants were categorized according to body mass index; obese, overweight, healthy weight, and underweight. The relation between obesity and distress was analyzed using simple and multiple logistic regression with complex sampling adjusted for age, sex, region of residence, economic level, parental education level, alcohol consumption, and smoking habits as confounders. RESULTS: The adjusted odds ratio (AOR) was higher for participants with obesity (AOR for healthy weight = 1.15 [95% confidence interval {CI}, 1.08-1.22]; AOR for overweight = 1.85 [95% CI, 1.72-1.98]; AOR for obese = 2.45 [95% CI, 2.27-2.64]; reference = underweight, P < 0.001). In males, healthy weight was associated with an AOR below 1 (AOR for healthy weight = 0.92 [95% CI, 0.85-0.99]; AOR for overweight = 1.26 [95% CI, 1.14-1.38]; AOR for obese = 1.66 [95% CI, 1.50-1.84], P < 0.001). In females, higher AORs were associated with obesity (AOR for healthy weight = 1.44 [95% CI, 1.33-1.57]; AOR for overweight = 2.71 [95% CI, 2.45-2.99]; AOR for obese = 3.71 [95% CI, 3.32-4.14], P < 0.001). CONCLUSION: Obesity is related to distress about appearance, and the relation is stronger in girls than in boys.

Retained large glass fragments for over 40 years in the maxillofacial region.

Foreign body (FB) impaction in the maxillofacial area could be caused by knives, glass fragments, and vegetative materials. We present the rare case of a 62-year-old man with a large glass FB in the left cheek retained for over 40 years. He had traffic accident over 40 years ago and glass fragments impacted on his left cheek. Glass fragments were retained around the zygomatic arch with dimpled scar and unclear serous discharge, but other facial motor or sensory dysfunction was not observed. We confirmed three glass fragments with radiologic examination including plain radiograph and computed tomographic image. Under general anesthesia, impacted glass fragments were removed through the direct incision on the dimpled scar and the additional incision on the left lateral canthal area. Remnant FBs were not seen on an intraoperative C-arm radiograph. After 2 days of irrigation for inflammation control, the dimpled wound was sutured. The wound was healed without major complication and the original dimpled scar was much improved.

Postoperative Changes in Isolated Medial Orbital Wall Fractures Based on Computed Tomography.

The treatment has been improved on the accurate reduction of blow-out fracture for many decades. But still, it has been limited to reduce completely when surgeons are approaching by conventional technique. The authors analyzed the postoperative results using computed tomography (CT) scans after conventional open reduction of isolated medial wall fracture. Thirty-seven patients with isolated medial wall fracture were reviewed. All patients underwent preoperative, immediate, and postoperative CT scans. Two surgeons have performed the surgery by conventional open reduction with transcaruncular approach and absorbable mesh insertion. The authors evaluated changing orbital volume and distance, comparing the immediate and 6 months postoperative outcomes with preoperative outcome. The differences between immediate postoperative and 6 months postoperatively data were statistically evaluated. The authors used the distant value to minimize bias of CT view selection. Significant differences from the 2 kinds of data were observed (P < 0.05 for volume, P < 0.01 for distance, Paired t test). Bone remodeling process after conventional open reduction of orbital wall has not been fully understood. Most popular technique is conventional open reduction and mesh insertion but it is not easy for surgeons to reduce fractured bones completely. The authors analyzed the bone remodeling after incomplete reduction. These results suggest that the decreased measurements might be caused from the scar contracture with fibrosis. This research is very limited to explain the change while bone remodeling is progressed. Further research should be continued to discover the understanding of the process.

Postoperative Changes After Closed Reduction of Nasal Fracture.

Nasal bone fracture is the most common facial fracture; however, surgery does not guarantee reduction and complications, such as undercorrection, overcorrection, and deviation, may occur. By analyzing findings of computed tomography (CT) immediately and at 3 months postoperatively, we evaluated the accuracy of reduction and long-term changes to the nasal bone.Patients with pure nasal bone fracture were evaluated from January 1, 2010 to December 31, 2011. First, we categorized fracture types according to the Stranc-Robertson classification system, using preoperative CT findings (ie, F1, F2, L1, and L2). We categorized each result of reduction by immediate postoperative CT scan findings as "Excellent," "Good," "Fair," and "Poor," with "Excellent" and "Good" ratings being considered a "Success." We evaluated changes to the nasal bone at 3 months after reduction, using the same grade.A total of 128 patients were analyzed. The results of patients in the F1 group were better than those of other patients immediately postoperatively, whereas those of the L2 group were worse. The overall success rate was 49.2% (58/118). At 3 months postoperatively, 33 cases exhibited an improvement to a higher grade, whereas 25 cases improved from an unacceptable outcome to a successful outcome, with the overall success rate being 70.3% (83/118).Immediately postoperative CT scans can be helpful for surgeons in determining whether a secondary adjustment is necessary. Incompletely reduced nasal bone showed spontaneous improvement in bony arrangement according to our study, so simple observation could be a choice.

Sinus Tract Formation with Chronic Inflammatory Cystic Mass after Beta Tricalcium Phosphate Insertion.

Beta tricalcium phosphate (ß-TCP) is one of allogenic bone substitute which is known to have interconnected pores that draws cell and nutrients for bone generation. It has been resulted in good outcomes for bone defect coverage or augmentation. However, several studies have also reported negative outcomes and associated complications including unexpected formation of cystic mass, continuous pain and secretion. We present the case of a 36-year-old man with a right cheek cystic mass who had a history of right zygomaticomaxillary (ZM) complex fracture and surgical correction with ß-TCP powder insertion to ZM bone defect. Excisional biopsy under local anesthesia revealed calcified mass in a sinus tract which was found to be connected to the ZM bone defect site in postoperative computed tomography image. Further excision under general anesthesia was performed to remove the sinus tract and fine granules which filled the original defect site. Pathologic report revealed bony spicules and calcification materials with chronic foreign body reaction. Postoperative complications and recurrence were not reported.