Usefulness of a Transconjunctival Approach in the Reconstruction of the Medial Blow-Out Wall Fracture

이치안,선훅,윤지영 대한두개안면성형외과학회 2017 Archives of Craniofacial Surgery Vol.18 No.2

Background: A transcaruncular approach is typically used for reconstructions of medial wall fractures. However, others reported that a transconjunctival approach was conducive for securing an adequate surgical field of view. In this study, we aimed to examine the extent of repair of medial wall fracture via a transconjunctival approach. Methods: We retrospectively reviewed the medical records of 50 patients diagnosed as having medial wall fracture via preoperative computed tomography and who underwent surgery between March 2011 and February 2014. The fracture location was defined by dividing each of the anterior-posterior and superior-inferior distances into three compartments. Results: A transcaruncular approach was used in 7 patients, while the transconjunctival approach was performed in the remaining 43 patients. The transconjunctival approach enabled a relatively broad range of repair that partially included the front and back of the medial wall, and was successful in 86% of the entire study population. Conclusion: It is known that more than 50% of total cases of the medial wall fracture occur mainly in the middle-middle portion, a majority of which can be reconstructed via a transconjunctival approach. We used a transconjunctival approach in identifying the location of the fracture on image scans except for cases including the fracture of the superior portion in patients with medial wall fracture. If it is possible to identify the location of the fracture, a transconjunctival approach would be an useful method for the reconstruction in that it causes no damages to the lacrimal system and is useful in confirming the overall status of the floor.

Peripheral Osteoma in the Mandibular Angle

정의한,선훅,양영일,윤성호,전민경 대한성형외과학회 2015 Archives of Plastic Surgery Vol.42 No.6

Simple Aesthetic Correction for Patients with Acute Auriculocephalic Angle

이병미,강석주,선훅 대한두개안면성형외과학회 2015 Archives of Craniofacial Surgery Vol.16 No.1

Background: Acute auriculocephalic angle refers to an ear with helix that is spacedclosely to the cranium. An increasing number of patients with acute auriculocephalicangle wish to undergo corrective operation for aesthetic purposes. However, there is apaucity of data regarding acute auriculocephalic angle. This paper proposes a treatmentprotocol for patients with acute auriculocephalic angle. Methods: We performed a retrospective analysis of patients undergoing acute auriculocephalicangle (4 patients, 6 ears). Patient records were reviewed for demographic dataas well as auricular measurements at preoperative, immediate postoperative and finalfollow-up evaluations. Results: All of the patients were men with a mean age of 36.5 years (range, 23–52years). The mean follow-up period was 47.5 months (range, 28–60 months). Postoperativeauriculocephalic angle was close to the normal auriculocephalic angle (25˚–30˚)without notable scars. Moreover, the patients had minimal contractions of the skin flapswithout any hematoma or relapse. Conclusion: We propose the following three treatment protocols for patients with acuteauriculocephalic angle: the posterior auricular muscle should be sufficiently released,the mastoid area should be augmented using implants, the skin should be repositionedwith a superior auricular flap.

Superficial Subcutaneous Leiomyosarcoma on the Face of a Pediatric Patient

이병미,강석주,정승빈,선훅,김보미 대한성형외과학회 2015 Archives of Plastic Surgery Vol.42 No.6

Simultaneous Development of Three Different Neoplasms of Trichilemmoma, Desmoplastic Trichilemmoma and Basal Cell Carcinoma Arising from Nevus Sebaceus

이치안,강석주,전성빈,선훅,강미선 대한두개안면성형외과학회 2017 Archives of Craniofacial Surgery Vol.18 No.1

Nevus sebaceus is a hamartoma of the sebaceous gland that occurs congenitally, from which various secondary tumors can arise with a prevalence of 5%–6%. Benign neoplasms commonly arise from nevus sebaceous, but they have a very low malignant potential. Two neoplasms may occasionally arise within the same lesion, but it is rare for three or more neoplasms to occur in a nevus sebaceus simultaneously. A 61-year-old male patient was admitted to our hospital for a 4 cm×2.5 cm growing tumor in a verrucous form arising within a periauricular nevus sebaceus in the post auricle of the left ear that had developed 30 years earlier. The nodule was diagnosed as 3 different types of tumors: trichilemmoma, desmoplastic trichilemmoma, and basal cell carcinoma. To our knowledge, this is the first report of the coexistence of three different tumors arising from nevus sebaceous. It contain malignant neoplasm also. Surgeons should be aware of the need for close monitoring and early complete surgical excision of sebaceous nevus in order to improve patient outcomes.

Clinical Analysis of Lobular Keloid after Ear Piercing

김형도,주성철,황소민,선훅,황민규,김민욱,이종서 대한두개안면성형외과학회 2016 Archives of Craniofacial Surgery Vol.17 No.1

Background: Lobular keloid appears to be a consequence of hypertrophic inflammation secondary to ear piercings performed under unsterile conditions. We wish to understand the pathogenesis of lobular keloids and report operative outcomes with a literature review. Methods: A retrospective review identified 40 cases of lobular keloids between January, 2005 and December, 2010. Patient records were reviewed for preclinical factors such as presence of inflammation after ear piercing prior to keloid development, surgical management, and histopathologic correlation to recurrence. Results: The operation had been performed by surgical core extirpation or simple excision, postoperative lobular compression, and scar ointments. Perivascular infiltration was noted in intra- and extra-keloid tissue in 70% of patients. The postoperative recurrence rate was 10%, and most of the patients satisfied with treatment outcomes. Conclusion: Histological perivascular inflammation is a prominent feature of lobular keloids. Proper surgical treatment, adjuvant treatments, and persistent follow-up observation were sufficient in maintaining a relatively low rates of recurrence.

Transient Anisocoria during Medial Blowout Fracture Surgery

이재일,강석주,전성빈,선훅 대한두개안면성형외과학회 2016 Archives of Craniofacial Surgery Vol.17 No.3

Transient anisocoria is rare during blowout fracture reconstruction. We report a case of transient anisocoria occurring during medial blowout fracture reconstruction and review the relevant literature. A 54-year-old woman was struck in the face and was admitted for a medial blowout fracture of the left eye. During the operation, persistent bleeding occurred. To control this bleeding, a 1% lidocaine solution with 1:200,000 epinephrine was applied to the orbital wall with cotton pledgets. In total, 40 mL of local anesthetic was used for the duration of the operation. After approximately three hours of the surgery, the ipsilateral pupil was observed to be dilated, with sluggish response to light. By 3 hours after the operation, the mydriasis had resolved with normal light reflex. In conclusion, neurological and ophthalmologic evaluation must be performed prior to blowout fracture surgery. Preoperative ophthalmic evaluation is simple and essential in ruling out any preexisting neurologic condition. Moreover, surgeons must be aware of the fact that excessive injection of lidocaine with epinephrine for hemostasis during orbital wall surgery can result in intraoperative anisocoria. Anisocoria-related situations must be addressed in a proficient manner through sufficient understanding of the mechanism controlling the pupillary response to various stimuli.

Stafne Bone Cavity of the Mandible

이재일,강석주,전성빈,선훅 대한두개안면성형외과학회 2016 Archives of Craniofacial Surgery Vol.17 No.3

Stafne bone cavity is a rare mandibular defect that was first reported by Edward C. Stafne in 1942. It commonly presents with a well-demarcated, asymptomatic, unilateral radiolucency that indicates lingual invagination of the cortical bone. A 52-year-old female patient who with nasal bone fracture, visited the hospital. During facial bone computed tomography (CT) for facial area evaluation, a well-shaped cystic lesion was accidentally detected on the right side of the mandible. Compared to the left side, no swelling or deformity was observed in the right side of the oral lesion, and no signs of deformity caused by mucosal inflammation. 3D CT scans, and mandible series x-rays were performed, which showed a well-ossified radiolucent oval lesion. Axial CT image revealed a cortical defect containing soft tissue lesion, which has similar density as the submandibular gland on the lingual surface of the mandible. The fact that Stafne cavity is completely surrounded by the bone is the evidence to support the hypothesis that embryonic salivary gland is entrapped by the bone. In most cases, Stafne bone cavity does not require surgical treatment. We believe that the mechanical pressure from the salivary gland could have caused the defect.