• Archives of Craniofacial Surgery
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• v.14 no.1
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• pp.16-23
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• 2013

Background: Even though degrees of deformation of microform cleft lip are not high, it has to be corrected with various procedures upon conditions and areas since it has various expressions. Many studies have focused on the classifications and procedures, but there are only a few studies on how much these procedures are performed in the actual field. This study aims to analyze the utilization of various procedures upon major correction points. Methods: A total of 52 patients who had been corrected by one surgeon from 1995 to 2011 were enrolled as subjects. Based on the medical records, it was checked whether the incision was made or not along with the correction procedures for alar base and philtral column, Cupid's bow, and vermillion free margin. Results: In case of an incision, full incision (42 times) was conducted most frequently. For alar base and philtral column, muscle re-approximation (25 times) was performed most frequently. However, recently, it was shown that excision on only the affected area and correction with dermis were more likely to be used. For Cupid's bow and vermilion free margin, elliptical excision on the only affected area followed by re-approximation was performed most frequently for 46 times (Cupid's bow) and 44 times (vermilion free margin), respectively. Conclusion: For the correction of microform cleft lip, less invasive procedures are preferred. However, in the actual field, if needed, aggressive procedures consisting of incisions have been conducted to correction. These trends are somewhat changed to utilization of a simple procedure, such as excision on the modified area, followed by a re-approximation rather than complicated procedures using the muscle.

• Archives of Craniofacial Surgery
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• v.14 no.1
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• pp.41-45
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• 2013

Background: Merkel cell carcinoma (MCC) is a rare locally aggressive cutaneous neuroendocrine carcinoma with a high incidence of local recurrence, regional lymph node metastasis, followed by distant metastasis. Because of shortage of the retrospective study, standard treatment has not been established. The purpose of this study was to present the surgical treatment and outcome of 8 patients with MCC. Methods: We report our experiences with 8 patients who underwent treatment for MCC at our institution from 2000 through 2012. Two men and 6 women received treatment for MCC. The mean age was 76.4 years (range, 53 to 93 years). Results: The follow-up period ranged from 7 to 26 months (mean, 22.9). During the follow-up period, three of 8 patients had a relapse (mean time before recurrence, 10 months; 1 month, 7 months, and 22 months). After primary surgery, 3 patients underwent radiotherapy, and 1 patient received chemotherapy. Conclusion: MCC is an aggressive skin cancer with a high rate of local recurrence. Complete surgical excision is the mainstay of local treatment, but adjuvant radiotherapy should be considered for better local control.

• Archives of Craniofacial Surgery
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• v.14 no.1
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• pp.30-35
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• 2013

Background: For reconstruction of the mild to moderate medial orbital wall fractures, various surgical approaches have been used. Prior existing W-shaped incision was a direct local approach through a 3 cm incision on the superior medial orbital area with a titanium mesh implant. In this study, the authors modified W-shaped incision and reconstructed the defect with silastic sheet to improve the result and the postoperative scar. Methods: This study included 20 patients who had mild to moderate size of medial wall defect and therefore relatively suitable for reconstruction with silastic sheets from July, 2009 to December, 2011. A modified W-shaped skin incision approximately 1.2 to 1.5 cm in length was made along the superior medial orbital rim from approximately 1 cm medial to the medial canthus to the lower border of the medial eyebrow. The angles of the limbs of the W ranged from 150 to 160 degrees. Results: By using soft flexible silastic sheet, the authors reduced the incision from 3 to 1.5 cm, and by widening the angle of the W limbs, scars were more effectively hided in the relaxed skin tension line. Scar assessment was done with modified patient and observer scar assessment scale and mean score from patients was 2.08 and mean score from observers was 2.12. Conclusion: Although this method will not be suitable for every case, it can be a consistent method to obtain the surgical goal in treatment of mild to moderate blowout fractures of the medial orbital wall.

• Archives of Craniofacial Surgery
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• v.14 no.1
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• pp.36-40
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• 2013

Background: Correction of unilateral blepharoptosis is unexpectedly difficult because healthy eye is often affected by Hering's law. Methods: We measured changes of marginal reflex distance (MRD1) on the unaffected eyelids between preoperative and 3-month postoperative photographs after ptosis correction. This study analyzed 134 unilateral blepharoptosis patients with ptosis correction from February 2002 to February 2011. Fifty patients among them were negative in Hering's law dependence test. From the preoperative and postoperative photographs the MRD1 of unaffected upper eyelids were measured and adjusted with the average pupil diameter of Koreans. Mean age was 34.4 and male was 30 and female was 20. Average follow-up periods were 14 months. Results: Thirteenth unaffected eyes (26%) showed decreased MRD1, and 3 patients (6%) showed decreased MRD1 value over 1.0 mm. Then 3 patients needed additional operations for correction of preoperatively unaffected but ptotic eyelids. Conclusion: There were no meaningful data statistically in the value of MRD1 in every unaffected eye of the patients and in the difference between preoperative and postoperative MRD1 of groups divided according to severity, causes, and types of operation.

• Journal of Yeungnam Medical Science
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• v.7 no.1
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• pp.173-179
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• 1990

We report 2 cases of midface defect reconstructed with latissimus dorsi myocutaneous free flap. In these cases, the main points to cover the defects were as follows ; 1. For the contour of zygoma and maxilla, it was well preserved without bone graft which was not used for second stage reconstruction. In first case, for application of artificial eye and in second case, for, operation after full development. 2. For the drainage of paranasal sinuses, we made the nostril with skin graft, and it was well preserved without any complications during follow up. 3. It was sufficient to cover the defect with latissimus dorsi muscle well designed before surgery and thick enough to fill the defect. 4. In second case, the remained defect of palate and maxilla was not covered for the appropriate reconstructions after full development. In conclusions, we experienced two cases of midface defect reconstructed with latissimus dorsi myocutaneous free flap without any complication and with good results.

• Archives of Craniofacial Surgery
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• v.20 no.5
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• pp.297-303
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• 2019

Background: Absorbable plates are widely used in open reduction and internal fixation surgeries for facial bone fractures. Absorbable plates are made of polyglycolic acid (PGA), polylactic acid (PLA), polydioxane (PDS), or various combinations of these polymers. The degradation patterns of absorbable plates made from different polymers and clinical courses of patients treated with such plates have not been fully identified. This study aimed to confirm the clinical courses of facial bone fracture patients using absorbable plates and compare the degradation patterns of the plates. Methods: A retrospective chart review was conducted for 47 cases in 46 patients who underwent open reduction and internal fixation surgery using absorbable plates to repair facial bone fractures. All surgeries used either PLA/PGA composite-based or poly-L-lactic acid (PLLA)/hydroxyapatite (HA) composite-based absorbable plates and screws. Clinical courses were confirmed and comparisons were conducted based on direct observation. Results: There were no naturally occurring foreign body reactions. Post-traumatic inflammatory responses occurred in eight patients (nine cases), in which six recovered naturally with conservative treatment. The absorbable plates were removed from two patients. PLA/PGA compositebased absorbable plates degraded into fragments with non-uniform, sharp surfaces whereas PLLA/HA composite-based absorbable plates degraded into a soft powder. Conclusion: PLA/PGA composite-based and PLLA/HA composite-based absorbable plates showed no naturally occurring foreign body reactions and showed different degradation patterns. The absorbable plate used for facial bone fracture surgery needs to be selected in consideration of its degradation patterns.

• Archives of Craniofacial Surgery
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• v.20 no.5
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• pp.284-288
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• 2019

Background: Closed reduction of nasal fracture with various instrument is performed to treat nasal fracture. Depending on the type of nasal fracture and the situation in which it is being operated, the surgeon will determine the surgical tool. The objective of this study was to investigate whether a periosteal elevator (PE) was a proper device to perform closed reduction for patients with simple nasal fractures. Methods: From March 2018 to December 2018, 50 cases of simple nasal bone fracture underwent closed reduction performed by a single surgeon. These patients were divided into two groups randomly: nasal bone reduction was performed using only PE (freer) and nasal bone reduction was performed using Walsham, Asch forcep, and Boies elevator (non-freer, non-PE). Results: The paranasal sinus computed tomography was performed on patients before and after operation to carry out an accurate measurement of reduction distance at the same level. According to the results, the interaction between instruments and fracture types had a significant influence on reduction distance (p = 0.021). To be specific, reduction distance was significantly (p= 0.004) increased by 2.157 mm when PE was used to treat patients with partial displacement compared to that when non-PEs were used. Conclusion: Closed reduction using PE and other elevator is generally an effective treatment for nasal fracture. In partial-displacement type of simple nasal fracture, closed reduction using PE can have considerable success in comparison with using classic instruments.

• Archives of Craniofacial Surgery
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• v.20 no.5
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• pp.304-309
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• 2019

Background: Treatment for venous malformations of the head and neck includes sclerotherapy, surgical resection, or a combination of both. Surgical resection can remove or reduce the volume of vascular lesions; however, surgery can cause postoperative scarring and potential surgical complications. This study sought to determine the effectiveness of surgery for the treatment of venous malformations of the head and neck. Methods: A retrospective review of the medical records of patients who received surgeries for venous malformations of the head and neck from January 2011 to July 2019 was performed. Using clinical photographs, preoperative and postoperative Doppler ultrasonography, outpatient clinic records, and operation records, the postoperative result and complications were evaluated for each case. Results: Among patients who visited our vascular anomalies clinic, 43 patients (ratio of male to female= 24:19) received surgeries for venous malformations of the head and neck. Twenty-nine patients had undergone surgery only, five patients received sclerotherapy after surgery, and nine patients received surgery after preoperative sclerotherapy. In postoperative evaluations, the result was excellent in 24 patients, good in 18 patients, and poor in one patient. Four patients experienced a recurrence of lesions with lagophthalmos, drooping of the corner of the mouth, partial wound necrosis, and scar widening found in one patient each. Conclusion: Because the head and neck region is the most exposed area in the body, more active implementation of surgical treatments with or without sclerotherapy is essential to reduce the functional and cosmetic impairments associated with venous malformations.

• Archives of Craniofacial Surgery
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• v.22 no.5
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• pp.268-275
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• 2021

Background: The study aimed to evaluate nasal reconstruction techniques customized for Asians. The currently available nasal reconstruction guidelines are based on Caucasian patients, and their applicability is limited in Asian patients due to differences in anatomical and structural features. Methods: A retrospective analysis was performed of the medical records of 76 patients who underwent nasal reconstruction at a single center between January 2010 and June 2020. A comprehensive evaluation was conducted of patients' baseline demographics and clinical characteristics, including age, sex, medical history, defect size and location, reconstructive procedure, pathological diagnosis, postoperative complications, and recurrence. Results: In 59 cases (77%), nasal defects resulted from tumor ablation, and the remaining 17 cases involved post-traumatic (20%) and infection-induced (3%) tissue damage. The most common defect location was the alae, followed by the sidewalls, tip, and dorsum. Forehead flaps were the most commonly used reconstructive technique, followed by nasolabial advancement flaps, rotation flaps, and skin grafts. Each procedure was applied considering aspects of structural anatomy and healing physiology specific to Asians. Complications included nasal deformity, hypertrophic scarring, secondary infection, and partial flap necrosis, but no cases required additional surgical procedures. Tumors recurred in two cases, but tumor recurrence did not significantly affect flap integrity. Conclusion: Nasal reconstruction techniques applied considering Asians' facial features resulted in fewer postoperative complications and higher patient satisfaction than the approaches that are currently in widespread use. Therefore, this study is expected to serve as an essential reference for establishing treatment guidelines for nasal reconstruction in Asians.

• Archives of Craniofacial Surgery
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• v.22 no.5
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• pp.239-246
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• 2021

Background: Bone grafts can provide an optimal environment for permanent tooth to erupt and enhance the stability of the alveolar maxilla. Although autologous bone is an optimal source for osteogenesis, its inevitable donor site morbidity has led to active research on bone substitutes. This study was designed to evaluate the safety and feasibility of using biphasic calcium phosphate (BCP; Osteon) as a bone substitute in dogs. Methods: Bilateral third and fourth premolars of four 15-week-old mongrel dogs were used. All teeth were extracted except the third premolar of the right mandible, which was used as a control. After extraction of the premolars, each dog was administered BCP (Osteon), demineralized bone matrix (DBM; DBX), and no graft in the hollow sockets of the right fourth premolar, left fourth premolar, and left third premolar, respectively. Radiographs were taken at 2-week intervals to check for tooth eruption. After 8 weeks, each dog was sacrificed, and tooth and bone biopsies were performed to check for the presence of tooth and bone substitute particle remnants. Results: Four weeks after the operation, permanent tooth eruptions had started at all the extraction sites in each dog. Eight weeks after the operation, all teeth had normally erupted, and histological examination revealed BCP particles at the right fourth premolar. Conclusion: In all four dogs, no delay in the eruption of the teeth or shape disfigurement of permanent teeth was observed on gross inspection and radiologic evaluation. On histological examination, most of the BCP and DBM were replaced by new bone. Bone substitutes can be used as graft materials in patients with alveolar clefts.