다발성 낭종을 동반한 면포 모반

김유진,홍창일,이종록 대한두개안면성형외과학회 2009 Archives of Craniofacial Surgery Vol.10 No.2

Purpose: Nevus comedonicus is a rare disease involving abnormal development of the pilosebaceous unit, clinically appearing confluent clusters of open comedones. It is characterized by follicular epidermic invaginations filled with keratin, with atrophic pilose or sebaceous structures which are open to the lower pole of the invagination. We report a child with inflammatory pustules and cysts correlated to the nevus comedonicus. Methods: A 15-month-old girl was referred for treatment of a nevus comedonicus that has been developed since birth. There were periodic episodes of erythema and swelling of the plaque. The patient had treated previously with retinoid cream for 2 weeks without obvious benefit at dermatology clinic. We excised the nevus comedonicus with Y-shape leaving some lesions. Results: When we incised skin, we could see multiple large whitish cysts beneath the nevus comedonicus. Histopathologic findings showed deep invagination of epidermis filled with keratin plugs, keratinous cyst in the dermis, rudimentary hair follicle. Conclusion: We treated rare nevus comedonicus with multiple large cysts as surgical excision.

다양한 피판술을 이용한 두안면부 피지선암의 치료

김다앎,유용아,강낙헌,오상하 대한두개안면성형외과학회 2010 Archives of Craniofacial Surgery Vol.11 No.1

Purpose: Sebaceous carcinoma is a rare malignant tumor that occurs mostly in head and neck regions. Early diagnosis and treatment are necessary because it tends to be locally aggressive and goes through distal metastasis with fast progression. This study presents reliable surgical methods for sebaceous carcinoma in head and neck regions. Methods: Three patients were included in this study. First, a 61-year-old woman visited the hospital with a yellow-colored, slowly growing mass on the left ala. A 54-year-old woman had a brown-colored mass on her right preauricle. Last case was a 62-year-old man who had a yellow-colored mass on his scalp. CT scan and punch biopsy were done. All cases were diagnosed as sebaceous carcinoma. The lesions were resected with 10 mm safety margin and various regional flaps were used for reconstruction. Results: Histological examination revealed sebaceous differentiation and local invasions. Postoperatively, all patients did not suffer from complication and no recurrence was found. Conclusion: We recommend early wide excision with an enough safety margin, and a regional flap as a treatment of sebaceous carcinoma. (J Korean Cleft Palate Craniofac Assoc 11: 58, 2010)

이마피판에서 피판 노출면의 인조 콜라겐막을 이용한 관리

김다앎,오상하,서영준,양호직,정승원,Kim, Da-Arm,Oh, Sang-Ha,Seo, Young Joon,Yang, Ho Jik,Jung, Sung Won 대한두개안면성형외과학회 2012 Archives of Craniofacial Surgery Vol.13 No.1

Purpose: The forehead flap is the workhorse in nasal reconstruction, which provides a similar skin color, texture, structure, and reliability. There are some disadvantages, including donor site morbidities, 2- or 3-stage operations, and postoperative management after initial flap transfer. Furthermore, there has been little attention to the exposed raw surface wound, after the first stage of an operation. This article describes the authors' modification to overcome this problem, using artificial collagen membrane. Methods: An Artificial collagen membrane is composed of an outer silicone membrane and an inner collagen layer. After a forehead flap elevation, the expected raw surface was covered by an artificial collagen membrane with 5-0 nylon suture. A simple dressing, which had been applied to the site, was changed every 2 or 3 days in an outpatient unit. At 3 weeks postprocedure, a second stage operation was performed. Results: With biosynthetic protection of the raw surface, there were no wound problems, such as infection or flap loss. Thus, the patient was satisfied due to an effortless management of the wound and a reduction in pain. Conclusion: The application of an artificial collagen membrane to the raw under-surface of the flap could be a comfortable and a protective choice for this procedure.

Chondroid Syringoma on Face

민경희,변진환,임정수,이혜경,이원미,주종은 대한두개안면성형외과학회 2016 Archives of Craniofacial Surgery Vol.17 No.3

Chondroid syringoma is a rare mixed tumor of the skin which is composed of both mesenchymal and epithelial cells. Its incidence at less than 0.1% and is frequently located on the head and neck. Chondroid syringoma is easily confused with epidermal cysts. Since malignant forms of chondroid syringoma have been reported, accurate and timely diagnosis is important for proper management. We report clinical and histological features of chondroid syringoma in 5 patients treated at our institution. In most of the cases, chondroid syringoma presented as a round, firm, nodular or cystic lesion that had well marginated heterogeneity in sonography. Clinically, all of the lesions were removed by simple excision. Microscopically, all five tumors were well circumscribed and consisted of epithelial, myoepithelial, and stromal components. The epithelial component formed tubules lined by one or more rows of eosinophilic epithelial cells. The outer layer of tubules appeared to be flattened myoepithelial cells. The stroma is myxoid and contained spindle shaped myoepithelial cells. We expect that the clinical, sonographic, and histological data from our report may help clinicians who are confronted with various kinds of analogous facial lesions to decide the most proper management for their patients.

Effectiveness of Dual-Maneuver Using K-Wire and Dingman Elevator for the Reduction of Unstable Zygomatic Arch Fracture

윤형우,김지예,정세움,정윤규 대한두개안면성형외과학회 2014 Archives of Craniofacial Surgery Vol.15 No.2

Background: The zygoma is the most prominent portion of the face. Almost all simplezygomatic arch fractures are treated in a closed fashion with a Dingman elevator. However,the open approach should be considered for unstable zygomatic arch fractures. The coronal approach for a zygomatic arch fracture has complications. In this study,we introduce our method to reduce a special type of unstable zygomatic fracture. Methods: We retrospectively reviewed zygomatic arch view and facial bone computedtomography scans of 424 patients who visited the Wonju Severance Christian Hospitalfrom 2007 to 2010 with zygomaticomaxillary fractures, among whom 15 patients metthe inclusion criteria. Results: We used a Dingman elevator and K-wire simultaneously to manage this typeof zygomatic arch fracture. Simple medial rotation force usually collapses the posteriorfractured segment, and the fracture becomes unstable. Thus, the posterior fracturesegment must be concurrently elevated with a Dingman elevator through Keen’s approachwith rotation force applied through the K-wire. All fractures were reduced withoutany instability using this method. Conclusion: We were able to reduce unstable and difficult zygomatic arch fractureswithout an open incision or any external fixation device.

Reduction of Nasal Bone Fracture using Ultrasound Imaging during Surgery

황소민,Hao-Ching Pan,김홍일,김형도,황민규,김민욱,이종서 대한두개안면성형외과학회 2016 Archives of Craniofacial Surgery Vol.17 No.1

Background: Most nasal bone fractures are corrected using non-invasive methods. Often, patients are dissatisfied with surgical outcomes following such closed approach. In this study, we compare surgical outcomes following blind closed reduction to that of ultrasound-guided reduction. Methods: A single-institutional prospective study was performed for all nasal fracture patients (n=28) presenting between May 2013 and November 2013. Upon research consent, patients were randomly assigned to either the control group (n=14, blind reduction) or the experimental group (n=14, ultrasound-guided reduction). Surgical outcomes were evaluated using preoperative and 3-month postoperative X-ray images by two independent surgeons. Patient satisfaction was evaluated using a questionnaire survey. Results: The experimental group consisted of 4 patients with Plane I fracture and 10 patients with Plane II fracture. The control group consisted of 3 patients with Plane I fracture and 11 patients with Plane II fracture. The mean surgical outcomes score and the mean patient dissatisfaction score were found not to differ between the experimental and the control group in Plane I fracture (p=0.755, 0.578, respectively). In a subgroup analysis consisting of Plane II fractures only, surgeons graded outcomes for ultrasoundguided reduction higher than that for the control group (p=0.007). Likewise, among the Plane II fracture patients, those who underwent ultrasound-guided reduction were less dissatisfied than those who underwent blind reduction (p=0.043). Conclusion: Our study result suggests that ultrasound-guided closed reduction is superior to blind closed reduction in those patients with Plane II nasal fractures.

Comparison of intermaxillary fixation techniques for mandibular fractures with focus on patient experience

Young Geun Kim,Sung Ho Yoon,Jae Wook Oh,Dae-Hwan Kim,이근철 대한두개안면성형외과학회 2022 Archives of Craniofacial Surgery Vol.23 No.1

Background: Intermaxillary fixation (IMF) is a technique that allows for the reduction and stabilization of mandibular fractures. Severalmethods of IMF, such as self-tapping screws or arch bars, have been developed. This study aimed to validate the usefulness of IMF with aself-tapping screw compared to IMF with arch bars with focus on the patients’ perspective. Methods: We retrospectively reviewed the medical records of all patients who were treated for mandibular fractures at our hospital between August 2014 and February 2021. A total of 57 patients were enrolled in this study. Thirteen patients were excluded from the analysis: three patients were lost to follow-up, and 10 patients did not undergo IMF. Finally, 44 patients were analyzed, of which 31 belonged tothe arch bar group, and 13 belonged to the screw group. Patient discomfort and pain during IMF application and removal were analyzed using a patient self-assessment questionnaire. The surgeon also assessed oral hygiene, IMF stability, and occlusion. Results: We applied IMF to 34 men (77%) and 10 women (23%). The mean age of the patients was 37.3 years. The most common fracturesite was the angle (30%), followed by the parasymphysis (25%), the body (23%), the condyle (11%), and the ramus (11%). Patient discomfort and oral hygiene were statistically favorable in the screw group. The IMF application time was statistically shorter in the screw group(p< 0.001). IMF stability was not statistically different between the two groups. The pain score during IMF removal was lower in the screwgroup (p< 0.001). Conclusion: Compared to arch bars, IMF screws provide more comfort during the IMF period, help maintain favorable oral hygiene, andhave a shorter application time. From the patient’s perspective, IMF screws are an excellent alternative to conventional arch bars when applicable.

Direct Open Venous Drainage: An Alternative Choice for Flap Congestion Salvage

박수한,최우영,손경민,천지선,양정열 대한두개안면성형외과학회 2015 Archives of Craniofacial Surgery Vol.16 No.3

In this report, we present a scalp defect reconstruction with lateral arm free flap. We highlight the difficulty in obtaining a recipient vein and the venous drainage managed through an open end of the donor vein. A 52-year-old woman presented with a pressure sore on the left scalp. A lateral arm free flap was transferred to cover this 8×6 cm defect. The arterial anastomosis was successful, but no recipient vein could be identified within the wound bed. Instead, we used a donor venous end for the direct open venous drainage. In order to keep this exposed venous end patent, we applied heparin-soaked gauze dressing to the wound. Also, the vein end was mechanically dilated and irrigated with heparin solution at two hour intervals. Along with fluid management and blood transfusion, this management was continued for the five days after the operation. The flap survived well without any complication. Through this case, we were able to demonstrate that venous congestion can be avoided by drainage of the venous blood through an open vessel without the use of leeches.

Forehead Osteoma Excision by Anterior Hairline Incision with Subcutaneous Dissection

김준식,이정환,김남균,이경석 대한두개안면성형외과학회 2016 Archives of Craniofacial Surgery Vol.17 No.1

Forehead osteomas are benign but can pose aesthetic and functional problems. These osteomas are resected via bicoronal or endoscopic approach. However, large osteomas cannot be removed via endoscopic approach, and bicoronal approach can result in damage to the supraorbital nerve with resultant numbness in the forehead. We present a new approach to resection of forehead osteomas, with access provided by an anterior hairline incision and subcutaneous dissection. Three patients underwent resection of the forehead osteoma through an anterior hairline incision. The dissection was carried in the subcutaneous plane, and the frontalis muscle and periosteum were divided parallel to the course of supraorbital nerve. The resulting bony defect was re-contoured using Medpor ®. All three patients recovered without any postoperative infection or complication and symptoms. Scalp sensory was preserved. Aesthetic outcomes were satisfactory. Patients remain free of recurrence for 12 months of follow up. The anterior hair line approach with subcutaneous dissection is an effective method for removal of forehead osteoma, since it offers broad visualization and hides the scar in the hairline. In addition, the dissection in the subcutaneous plane avoids inadvertent injury to the deep nerve branches and helps to maintains scalp sensation.

안면이식에 대한 최근 동향: 한국에서의 안면이식은 어떤 단계에 있는가?

홍종원,김영석,윤인식,이동원,이원재,노태석,유대현,김용욱,나동균,탁관철,박병윤,Hong, Jong Won,Kim, Young Seok,Yun, In Sik,Lee, Dong Won,Lee, Won Jai,Roh, Tai Suk,Lew, Dae Hyun,Kim, Yong Oock,Rah, Dong Kyun,Tark, Kwan Chul,Yun Park, Be- 대한두개안면성형외과학회 2012 Archives of Craniofacial Surgery Vol.13 No.2

The world's first face transplantation was performed in France, in 2005. Since then, 21 cases of face transplantation have been performed. Face transplantation is one of the most prominent part of composite tissue allotransplantation (CTA) along with hand transplantation. Since these fields are not deal with life-saving organs, there are many arguments about immunosuppression therapy. Recent paradigm of face transplantation shows that surgical ranges are expanded from partial face transplantation to full face transplantation. Most immunosuppression protocols are triple therapy, which consists of tacrolimus (FK-506), mycophenolate mofetil and prednisolone. Anatomical researches, immunosuppression, and immunotolerance take great parts in the researches of CTA. The medical fields directly related to face transplantation are microsurgery, immunology, and transplantation. Nowadays, each field is performed widely. Therefore people, even medical teams think face transplantation could be easily realized, sooner or later. But there are lots of things that should be prepared for not only practice and immunosuppression therapy but also for the cooperation with relevant fields. That's the reason why only 21 cases of face transplantation have been done, while more than 70 cases of hand transplantation have been done in the past years. Especially in Korea, brain death patients are not enough even for organ transplantation and furthermore there are some troubles in taking part in the society of transplantation. Face transplantation has lots of problems concerning variable medical fields, administration, society, ethics, and laws. Therefore, for the realization of face transplantation in Korea, not only medical skills but also political powers are needed.