Venous malformations of the head and neck: A retrospective review of 82 cases

Hannara Park,김진수,Hyochun Park,김지윤,허승,이종민,Sang Yub Lee,이석종,이준석,이정우,정호윤 대한성형외과학회 2019 Archives of Plastic Surgery Vol.46 No.1

Background Venous malformations (VMs) are a common type of vascular malformation. However, their causes and management remain unclear, and few studies specific to VMs of the head and neck have been reported. This study describes our experiences with VMs of the head and neck. Methods This retrospective study included 82 patients who underwent treatment for head and neck VMs, among 222 who visited our vascular anomalies center. Medical records between 2003 and 2016 were reviewed to identify common features in the diagnosis and treatment. The diagnosis of suspected head and neck VMs was based on the results of imaging studies or biopsies, and the VMs were analyzed based on magnetic resonance imaging, computed tomography, and Doppler sonography findings. Results VMs were slightly more common in female patients (59.8%), and 45.1% of patients developed initial symptoms at the age of 10 or younger. Lesions were slightly more common on the right side (47.3%). The main sites involved were the cheek (27.7%) and lip area (25.5%). The muscle layer was commonly involved, in 98.7% of cases. Small lesions less than 5 cm in diameter accounted for 60.8% of cases, and well-defined types were slightly more prevalent at 55.4%. Improvement was observed in 77.1% of treated patients. Conclusions Early and accurate diagnosis and appropriate treatment according to individual symptoms are important for successful treatment of VMs. If treatment is delayed, the lesions can worsen, or recurrence becomes more likely. Therefore, VMs require a multidisciplinary approach for early and accurate diagnosis.

Standardized surgical strategy for the treatment of preauricular sinus to reduce recurrence

Hannara Park,Jaemin Seong,Hyouchun Park,Hyeonjung Yeo 대한두개안면성형외과학회 2023 Archives of Craniofacial Surgery Vol.24 No.5

Background: Preauricular sinus (PAS) is a common congenital anomaly, and complete excision is recommended to prevent recurrence. However, PAS has a high recurrence rate as a result of incomplete removal due to the high variability of the sinus ramifications, making its treatment challenging. In this study, we standardized the surgical procedure to reduce the complications and recurrence rate and compared the postoperative results between the non-standardized and the standardized groups. Methods: This retrospective study included 97 patients (120 ears) who had undergone PAS excision by a single surgeon between October 2014 and September 2022 and underwent at least 6 months of follow-up. After October 2018, all patients were treated using the standardized method, which comprised the use of magnifying glasses, exploration with a lacrimal probe, the use of methylene blue staining, and excision of a piece of surrounding normal tissue and related cartilage in continuity with the specimen. There were 38 patients (45 ears) in the non-standardized group and 59 patients (75 ears) in the standardized group. Results: Recurrence was observed in six of 120 ears, indicating an overall recurrence rate of 5.0%. Recurrence occurred in five ears (11.1%) in the non-standardized group and one ear (1.3%) in the standardized group. The standardized group had a significantly lower recurrence rate (p= 0.027) than the non-standardized group. Conclusion: We defined a standardized sinectomy protocol and used it for the surgical treatment of PAS. With this standardized method, we were able to reduce the rates of complications and recurrence without the use of a long incision.

Surgical refinement of the purse-string suture for skin and soft tissue defects of the head and neck

Park, Hyochun,Lee, Yunjae,Yeo, Hyeonjung,Park, Hannara Korean Cleft Palate-Craniofacial Association 2021 Archives of Craniofacial Surgery Vol.22 No.4

Background: The purse-string suture (PSS) is a simple and rapid wound closure method that results in minimal scarring. It has been used to treat circular or oval skin defects caused by tumor excision or trauma. However, due to obscurity, it is not widely used, especially for the head and neck. This study aimed to modify the PSS to obtain predictable and acceptable results. Methods: A total of 45 sites in 39 patients with various types of skin and soft tissue defects in the head and neck were treated with PSS. We used PDS II (2-0 to 5-0), which is an absorbable suture. Minimal dissection of the subcutaneous layer was performed. The suture knot was hidden by placing it in the dissection layer. Depending on the characteristics of the skin and soft tissue defects, additional surgical interventions such as side-to-side advancement sutures, double PSS, or split-thickness skin graft were applied. Results: All wounds healed completely without any serious complications. Large defects up to 45 mm in diameter were successfully reconstructed using only PSS. Postoperative radiating folds were almost flattened after approximately 1-2 months. Conclusion: PSS is simple, rapid, and relatively free from surgical design. Owing to the circumferential advancement of the surrounding tissue, PSS always results in a smaller scar than the initial lesion and less distortion of the body structures around the wound in the completely healed defect. If the operator can predict the process of healing and immediate radiating folds, PSS could be a favorable option for round skin defects in the head and neck.

Venous malformations of the head and neck: A retrospective review of 82 cases

Park, Hannara,Kim, Jin Soo,Park, Hyochun,Kim, Ji Yoon,Huh, Seung,Lee, Jong Min,Lee, Sang Yub,Lee, Seok Jong,Lee, Joon Seok,Lee, Jeong Woo,Chung, Ho Yun Korean Society of Plastic and Reconstructive Surge 2019 Archives of Plastic Surgery Vol.46 No.1

Background Venous malformations (VMs) are a common type of vascular malformation. However, their causes and management remain unclear, and few studies specific to VMs of the head and neck have been reported. This study describes our experiences with VMs of the head and neck. Methods This retrospective study included 82 patients who underwent treatment for head and neck VMs, among 222 who visited our vascular anomalies center. Medical records between 2003 and 2016 were reviewed to identify common features in the diagnosis and treatment. The diagnosis of suspected head and neck VMs was based on the results of imaging studies or biopsies, and the VMs were analyzed based on magnetic resonance imaging, computed tomography, and Doppler sonography findings. Results VMs were slightly more common in female patients (59.8%), and 45.1% of patients developed initial symptoms at the age of 10 or younger. Lesions were slightly more common on the right side (47.3%). The main sites involved were the cheek (27.7%) and lip area (25.5%). The muscle layer was commonly involved, in 98.7% of cases. Small lesions less than 5 cm in diameter accounted for 60.8% of cases, and well-defined types were slightly more prevalent at 55.4%. Improvement was observed in 77.1% of treated patients. Conclusions Early and accurate diagnosis and appropriate treatment according to individual symptoms are important for successful treatment of VMs. If treatment is delayed, the lesions can worsen, or recurrence becomes more likely. Therefore, VMs require a multidisciplinary approach for early and accurate diagnosis.

Three-Dimensional Computed Tomography Follow-Up on Spontaneous Bone Healing after Excision of Periorbital Dermoid Cyst: A Case Report

Park Hannara,Seong Jaemin,Park Hyochun,Yeo Hyeonjung 대한창상학회 2021 Journal of Wound Management and Research Vol.17 No.3

Dermoid cysts are among the most common periorbital and orbital tumors presenting in childhood. Several studies have shown that dermoid cysts may deform adjacent bones; however, few studies have followed the course of bone regeneration after the excision of a cyst. We report a case of a 29-month-old female infant who presented with a palpable mass over her right lateral eyebrow. Ultrasonography findings suggested a dermoid cyst, and computed tomography revealed a 2.1-cm round bony defect in the right zygoma. After surgical excision of the dermoid cyst, we successfully applied fibrin sealant to eliminate the dead space. Pathological findings showed nodular lesions with flat cystic walls containing lamellated keratin and sebaceous glands, supporting the diagnosis of dermoid cyst. At 6 months postoperatively, a follow-up computed tomography scan confirmed complete recovery of the bone defect in the right zygoma.

Bilateral Rectangular Musculocutaneous Advancement Flap: A Viable Alternative for Reconstruction of Large-Sized Forehead Defects with Exposed Bone

Park Hannara,Seong Jaemin,Park Hyouchun,Yeo Hyeonjung 대한창상학회 2020 Journal of Wound Management and Research Vol.16 No.3

Reconstruction of large-sized forehead defects with exposed bone is challenging, as the forehead is an esthetically important area and the complex courses of the sensory nerves make them prone to damage during reconstruction. The purpose of this study was to achieve forehead reconstruction by predicting the pathways of the forehead sensory nerves and applying an operative technique that minimizes sensory nerve injury. We classified forehead sensory nerves that traverse the flap into five types according to their course, defined the frontalis muscle piercing line that allows for intuitive prediction of a nerve course, and devised a surgical technique for each nerve type. Next, we applied the techniques to a bilateral rectangular musculocutaneous advancement flap to reconstruct a large defect on the forehead caused by squamous cell carcinoma. No complications were observed except partial skin necrosis of the flap that healed spontaneously. Although tension and restricted early movement of the forehead was observed, it resolved within 2 weeks. After 5 months of treatment, the transverse scars were camouflaged by the skin creases and the sensory nerves of the forehead were intact.

Comparative Analysis of the Extracellular Matrix Composition in Proliferating and Involuted Infantile Hemangiomas

Park, Hyochun,Park, Hannara,Chung, Ho Yun,Teresa, MO,Waner, Milton Korean Society of Plastic and Reconstructive Surge 2015 Archives of Plastic Surgery Vol.42 No.5

Background Changes in the composition of the extracellular matrix (ECM) occur between the proliferating and involuted phases of infantile hemangiomas (IH), and are associated with angiogenic growth. We examined the composition of the ECM in proliferating and involuted IHs and assessed correlations between the composition of the ECM and whether the IH was in the proliferating or the involuted phase. Methods We evaluated IH samples from a cohort of patients who had five proliferating IHs and five involuted IHs. The following ECM molecules were analyzed using enzyme-linked immunosorbent assays and immunohistochemistry: laminin, fibronectin, collagen type I, collagen type II, and collagen type III. Results The involuted IHs had higher levels of deposition of collagen type III than the proliferating IHs. The median values (interquartile ranges) were 1.135 (0.946-1.486) and 1.008 (0.780- 1.166) (P=0.019), respectively. The level of laminin was higher in involuted IHs than in proliferating IHs, with median values (interquartile ranges) of 3.191 (2.945-3.191) and 2.479 (1.699- 3.284) (P=0.047), respectively. Abundant collagen type III staining was found in involuted IHs. Laminin ${\alpha}4$ chain staining was clearly present within the basement membrane adjacent to the blood vessels, and was significantly more intense in involuted IHs than in proliferative IHs. Conclusions Involuted hemangiomas showed extensive deposition of collagen III and laminin, suggesting that differences in the composition of the ECM reflect stages of the development of IHs. This pattern may be due to the rapid senescence of IHs.

경부 피부에서 발생한 저등급 근섬유모세포 육종 증례 보고

박한나라(Hannara Park),임준현(Junhyun Lim),박효천(Hyochun Park),여현정(Hyeonjung Yeo) 대한두경부종양학회 2022 대한두경부 종양학회지 Vol.38 No.2

Myofibroblastic sarcoma can be classified as low-, intermediate-, and high-grade. Low-grade myofibroblastic sarcoma (LGMS) is uncommon and rarely appears on the skin. LGMS is diagnosed based on histopathological and immunohistochemical findings. Additionally, LGMS metastases are rare as well. Herein, the authors describe a case of cutaneous LGMS in the neck. To the best of our knowledge, there are no cases regarding cutaneous LGMS in the neck present in the existing literature. Surgical resection is considered as the most important treatment for LGMS. Therefore, a complete tumor resection was performed in this case. However, another mass in the uterus was identified on abdominal computed tomography performed post-surgery.

Extended Estlander flap for repairing a large upper lip defect involving the oral commissure

김진수,이상훈,Hannara Park,Hyeonjung Yeo,Hyochun Park 대한미용성형외과학회 2020 Archives of Aesthetic Plastic Surgery Vol.26 No.3

Various methods for reconstructing partial upper lip defects have been reported, some of which, such as the Abbe and Estlander flaps, involve using the lower lip. However, determining the appropriate reconstruction method for large upper lip and oral commissure defects is particularly difficult because of the need to preserve the function and sensory ability of the lips and oral sphincter while achieving a satisfactory appearance. We describe our successful experience of using an extended Estlander flap to reconstruct a large defect caused by the excision of basal cell carcinoma on the upper lip and oral commissure.

Surgical Technique Applying Mosquito Forceps to Galeotomies for Scalp Reconstruction

Yeo Hyeonjung,Seong Jaemin,Park Hyouchun,Park Hannara 대한창상학회 2023 Journal of Wound Management and Research Vol.19 No.2

Reconstruction of scalp defects can be difficult due to the stiffness and inelasticity of the scalp, posing challenges for surgeons. Galeotomies can be applied to allow for this inelastic tissue to stretch, increasing local tissue movement and reducing tension on wound margins, but they generally require large incisions and dissections. Here, we completely repaired scalp defects by applying a surgical technique for galeotomies that only required small incisions of the scalp using simple mosquito forceps. This study included nine patients who underwent scalp reconstruction for defects due to mass excision; all surgeries were performed by the same surgeon. All surgical wounds completely recovered with a satisfactory aesthetic outcome, with no notable complications during a mean follow-up period of 21 months. Taken together, our results showed that galeotomies can be successfully performed even in a confined space using mosquito forceps, offering an effective modality for reconstruction of medium-sized scalp defects with minimal complexity.