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The purpose of this experiment was to study the effect of chitosan on the osteogenesis in the distracted zones of mandibles. Eight dogs were used for this study. Mandibular distraction was started 5 days after the mandibular osteotomy at a rate of 2mm per day for a total of 10mm distraction for 5 days. The experimental group was divided into control group(n=4) and chitosan group(n=4) depending on the type of the injected material into the distracted area. On the day of completion of distraction, a 1ml volume of hyaluronic acid solution was injected in the distracted area of control group and 1ml of injectable solution of chitosan mixed with hyaluronic acid was done in chitosan group. After injection of the materials, the distraction device was left in place for 3 or 6 weeks to allow for bony consolidation. Two dogs in each group, a total of four dogs, were sacrificed at 3 weeks, and another four dogs at 6 weeks after completion of distraction, and bone specimens of the distracted mandibles were taken after radiographs for histologic examination. In the radiographs of the distracted areas of the mandibles, the control group had shown a mostly radiolucent zone but the chitosan group had shown the bilateral radiodense zones and central radiolucent zone. Bilateral radiodense zones were more extended into the center of the distracted area following passage of time and vertical thickness of the radiodense zone was about two times wider in 6 weeks than in 3 weeks after finishing bone distraction. In the histological findings, the control group showed whole fibrous tissue but the chitosan group showed bilateral new woven bones and central narrow fibrous interzone. In conclusion, there was more new bone formation in the distracted area of the mandible in case of injection of chitosan. These findings suggested that injectable chitosan appears to be effective in early bony consolidation in distraction osteogenesis.
Purpose: It is accepted universally that correction of the cleft lip nasal deformity requires multiple stages of surgery. Following primary lip repair in infancy or early childhood, secondary surgery to improve the deformity of the lip and nose is frequently necessary. A suitable surgical procedure to correct the accompanying deformity, such as cleft palate and alveolus, must be carried out at an appropriate age. In developing countries, it is common for patients with cleft lip nasal deformity to present severe secondary deformities in adolescence, because of poor follow-up and inappropriate surgery. Methods: The first patient was a 12 year old Mongolian boy. He presented prominent lip scar, short lip, wide columella, asymmetric nostril, palatal fistula, cleft alveolus, and velopharyngeal incompetence. He underwent cheilorhinoplasty, transpositional flap, alveoloplasty by iliac bone graft, and sphincter pharyngoplasty. On follow-up, a bilateral maxillary hypoplasia and a class III malocclusion developed. He underwent LeFort I osteotomy and maxillary advancement at the age of 16 years. The second patient was an 18 year old Eastern Russian girl. She presented with a deviated nose, right alar base depression, short lip, protrusion on vermilion, large palatal fistula, and severe VPI due to short palate. She underwent the combined procedure of cheilorhinoplasty, corrective rhinoplasty, tongue flap for palatal fistula, and superiorly based pharyngeal flap. And the tongue flap was detached at postoperative 3 weeks. Results: The overall results have been extremely pleasing and satisfactory to patients. There were no postoperative complications. Conclusion: We discovered the one stage operation for radical correction was sufficient procedure to provide excellent clinical outcomes in patients with severe cleft lip nose deformity. (J Korean Cleft Palate Craniofac Assoc 12: 102, 2011)
Purpose: Lipomas of the skin are one of the most frequently encountered tumors in plastic surgical practice. Huge lipomas of all areas of the body have been described. Large lipomas of the face, however, are not so common. We report on the treatment of a huge lipoma of the forehead causing distortion of the eyebrows. Methods: A 55 year old man was referred to our department by the neurosurgeons. He was primarily admitted for removal of a meningioma of the left frontal lobe of his brain. More striking was a huge protruding mass of 75x60x30mm covering almost the whole left half of his face's upper third and displacing his left eyebrow downward by almost 1cm. MRI showed a large lipoma, which caused 3cm anterior protrusion of the overlying skin. A meningioma of the left frontal lobe was also seen. The lipoma was removed via an external approach. Before closure of the skin a 3.5 cm wide strip of muscle and skin was resected. The multilobulated specimen was covered by a thin capsule and weighed 95g. The pathologist diagnosed it as benign lipoma. Results: The postoperative course was uneventful. At 11 months after the operation the resulting scar was inconspicuous, the position of the eyebrows was almost symmetric and a symmetric brow elevation was observed. Conclusion: We describe the largest facial lipoma reported in the recent literature. By using an open approach, skin excision and redraping, we achieved an aesthetically satisfactory outcome.
Clinical Analysis of the Nasal Bone Fracture Kwang-Ryeol Lim, M.D., Hong-Il Kim, M.D., Sung-Min Ahn, M.D., So-Min Hwang, M.D.,Yong Hui Jung, M.D., Jennifer K. Song, M.D. Aesthetic, Plastic and Reconstructive Surgery Center, Good Moonhwa Hospital, Busan, Korea Purpose: Nasal bone fracture is the most common facial fracture. Although nasal bone fractures are considered to be minor injuries, the incidence of post-traumatic nasal deformity remains high. This study is designed to support management and patient satisfaction by classifying the simple nasal bone fracture, and survey the care method and result, which is compared with other studies. Methods: From May 2008 to April 2010, 334 patients with simple nasal bone fractures visited our hospital. The incidence, cause, types of nasal bone fracture, treatment, and complications are analyzed according to clinical examination, patient's record and radiographic images. Results: The mean age of patients was 30 years old, with 74% of the patients having been male, and 26% were female. The highest incidence of this fracture was between late teens to late twenties. The causes of nasal bone fracture were the following: having slipped or fallen down(39%), violence(16%), sports accident(14%), traffic accident(11%), industrial accident(6%), and others(16%). Patient's radiographic images were analyzed by Stranc and Robertson classification, frontal impact plane I was 38%, plane II was 16%, plane III was 1%, lateral impact plane I was 21%, plane II was 21%, and plane III was 3%. On average, surgical treatment was performed 7.2 days after trauma under general anesthesia. Closed reduction of nasal bone fracture was performed in 99% of patients. In patients with septal injuries, septal management was performed in 76.7% of cases. Aesthetic surgery was done on same time in 24% of patients. There were some complications, such as residual nasal deformity(7.2%), nasal obstruction(0.9%) and hyposmia(0.3%). Conclusion: According to this study, nasal bone fractures occurred commonly in physically active age groups(age 15~29 years), as a result of having slipped or fallen down, at afternoon and at night time. And it could be treated successfully by closed reduction and septoplasty by 7 days after trauma. (J Korean Cleft Palate Craniofac Assoc 12: 81, 2011)
Purpose: It is difficult to objectively evaluate the outcomes of plastic surgical procedures. The combination of aesthetic and medical factors makes outcome quantification difficult. In this study, fracture reduction accuracy was objectively evaluated in patients with zygomatic complex fractures. Patients satisfaction with the accuracy was also examined. In addition, the patients' overall satisfaction and discomfort due to complications were analyzed. Methods: Eighty-five patients who had surgeries via bicoronal incision for zygomatic complex fracture from March 2006 to December 2009 were included in this study. Two plastic surgeons evaluated the accuracy of the fracture reduction with postoperative computed tomography. A survey questionnaire was administered to evaluate the patients' overall satisfaction and the impact of symptoms associated with the procedure on the patients' daily lives. Results: The overall patient satisfaction rate was 82.1 ± 10.9% (range, 45~100%). The level of deformation was 6.7 ± 10.9%, the levels of discomfort in daily life due to pain, paresthesia, scar, and facial palsy were 8.5 ± 13.2%, 5.8 ± 8.9%, 4.4 ± 9.9%, and 1.9 ± 9.2%, respectively. According to the visual analogue scale, paresthesia was found to be the most frequent symptom (43.5%), and pain was the most troublesome symptom. Conclusion: The use of bicoronal incision for treating zygomatic complex fractures can cause various complications due to wide incision and dissection. However, this technique can provide optimized reduction and rigid fixation. Most of these postoperative complications can cause significant discomfort in the patient. It is thought that the use of correct surgical technique and the accurate knowledge of craniofacial anatomy will result in a reduction of complications and significantly increase patient satisfaction. (J Korean Cleft Palate Craniofac Assoc 12: 17, 2011)
A New Facial Composite Flap Model(Panorama Facial Flap) with Sensory and Motor Nerve from Cadaver Study for Facial Transplantation Peter Chan Woo Kim, M.D.1, Eon Rok Do, M.D.1, Hong-Tae Kim, M.D.21Department of Plastic and Reconstructive Surgery, Daegu Catholic University Medical Center,2Department of Anatomy, School of Medicine, Daegu Catholic University, Daegu, Korea Purpose: The purpose of this study was to investigate the possibility that a dynamic facial composite flap with sensory and motor nerves could be made available from donor facial composite tissue. Methods: The faces of 3 human cadavers were dissected. The authors studied the donor faces to assess which facial composite model would be most practicable. A "panorama facial flap" was excised from each facial skeleton with circumferential incision of the oral mucosa, lower conjunctiva and endonasal mucosa. In addition, the authors measured the available length of the arterial and venous pedicles, and the sensory nerves. In the recipient, the authors evaluated the time required to anastomose the vessels and nerve coaptations, anchor stitches for donor flaps, and skin stitches for closure. Results: In the panorama facial flap, the available anastomosing vessels were the facial artery and vein. The sensory nerves that required anastomoses were the infraorbital nerve and inferior alveolar nerve. The motor nerve requiring anstomoses was the facial nerve. The vascular pedicle of the panorama facial flap is the facial artery and vein. The longest length was 78mm and 48mm respectively. Sensation of the donor facial composite is supplied by the infraorbital nerve and inferior alveolar nerve. Motion of the facial composite is supplied by the facial nerve. Some branches of the facial nerve can be anastomosed, if necessary. Conclusion: The most practical facial composite flap would be a mid and lower face flap, and we proposed a panorama facial flap that is designed to incorporate the mid and lower facial skin with and the unique tissue of the lip. The panorama facial composite flap could be considered as one of the practicable basic models for facial allotransplantation. (J Korean Cleft Palate Craniofac Assoc 12: 86, 2011)
Background: If patients have a better understanding about their problem and treatment, compliance and satisfaction with treatment will increase. For this purpose, simple repeated explanations regarding a patients' problem and treatment are essential. Critical pathway (CP) has a very wide range in medicine with the exception of the plastic surgery field. The authors developed a CP for facial bone fractures and implemented it clinically. The aim of this study was to evaluate the effectiveness of the CP on the degree of recognition of the problem along with patient satisfaction with the treatment process. Methods: From May 2011 to October 2011, a total of 82 patients suffering from facial bone fractures were studied. The CP for facial bone fractures was developed by plastic surgeons, residents and nurses. Subsequently, the authors investigated the degree of recognition of the disease and patient satisfaction with the treatment through the use of a questionnaire. The authors compared the score of the questionnaires before and after implementation of the clinical pathway. Results: The degree of the recognition of the problem changed from 3.1 to 4.2 (p<0.001). Further, the degree of satisfaction with the treatment process changed from 3.6 to 4.3 (p<0.05). Overall, there was a two point increase in improvement. Conclusion: Implementation of the CP for facial bone fractures was effective in improving the degree of recognition and satisfaction. The authors expect that hereafter, the CP for facial bone fractures will be implemented actively in the plastic surgery field.
Purpose: Lambdoid synostosis can be found unilaterally, bilaterally or in combination with other forms of craniosynostosis. Based on concept of frontoorbital advancement, we used the technique of occipital advancement in order to correct lambdoid synostosis Material & Method: From 2002 to 2006, standardized occipital bandeau advancement with barrel stave osteotomy was performed in two children who had multiple synostosis. The surgery was carried out for patients 12 & 18 months of age. Results: Aesthetically satisfactory skull shape and normalization of the intracranial pressure could be achieved. A major complication in the form of life-threatening intraoperative hemorrhage and other complications such as infection have not occurred. Conclusion: Standardized occipital Bandeau advancement with barrel stave osteotomy allows precise, reproducible and predictable positioning of the segments. Artificial sutures are created as a result of the osteotomy. Remodeling leads to a well-proportioned skull shape and posterior advancement leads to an increase in intracranial volume.
Purpose: Deformities after bilateral cleft lip repair usually involve the philtrum and the central upper lip, which presents as wide philtrum, wide Cupid's bow, whistling deformity and prominent prolabium. The object of this study is to introduce a simple method to correct such deformities of bilateral cleft lip, that is the redo-operation following the modified Millard's method. Methods: We present 2 patients with secondary deformities of the philtrum and central upper lip after bilateral cleft lip repair. A simple design was used to excise the excessive skin and mucosa of the central upper lip, and the philtrum and Cupid's bow were restored to the standard average width of Korean population. Results: The wide central upper lip and philtrum were successfully restored to the appropriate width(10-12mm) and shape. Also the border of the red vermilion was aligned properly resulting in a good contour of the upper lip. Both patients were satisfied with the results. Conclusion: In patients with wide philtral deformities, our simple method can be utilized for a satisfying result.