Forehead Lift for Asians.

Asians have anatomic and clinical characteristics to be considered before forehead lift. Because of the anatomic characteristics of Asians, for the better outcomes of blepharoplasty or augmentation rhinoplasty, forehead lift as a combined surgery must be considered beforehand. Forehead lift is frequently indicated in young Asian patients. Endoscopic browlift without visible scar is favored for patients, and it can be done in a modified multiplane fashion for better outcomes in patients with thick and redundant skin. There are rare but severe complications of endoscopic forehead lift, such as motor nerve paresis and diplopia, although they are temporary in most cases.

Augmentation Rhinoplasty Using Silicone Implants.

Augmentation rhinoplasty is one of the most common aesthetic procedures in Asian countries with silicone implant being the most widely used material for augmentation rhinoplasty. Despite potential advantages, use of alloplastic materials in rhinoplasty is often discouraged in Western countries because of concern for possible risk of infection and extrusion of the implant. The collective experience of long-term favorable outcomes in Asia makes the silicone augmentation rhinoplasty a common procedure. Complication rates for silicone implants vary significantly, depending on surgeon experience, surgical technique, and implant design. Silicone implants can be safely used for nasal dorsal augmentation if precautions are taken.

Epidemiological survey on the infection of intestinal flukes in residents of Muan-gun, Jeollanam-do, the Republic of Korea.

Infection status of intestinal flukes was investigated in residents of Muan-gun, Jeollanam-do, the Republic of Korea. Total 1,257 fecal samples of residents were examined by formalin-ether sedimentation technique and Kato-Katz thick smear method. Helminth eggs were detected from 95 (7.6%) residents, and eggs of heterophyid flukes and Clonorchis sinensis were found from 62 (4.9%) and 40 (3.2%) cases, respectively. The larger heterophyid eggs, somewhat dark-brown in color and 37.7 x 21.5 microm in average size, and found in 32 (2.6%) out of 62 egg positive cases of heterophyid flukes. To confirm the adult flukes, we performed worm recovery from 12 cases after praziquantel treatment and purgation with MgSO(4). A total of 1,281 adult flukes, assigned to 7 species, were recovered from 9 cooperative cases. Heterophyes nocens (total 981 specimens) was collected from 9 cases, Stictodora fuscata (80) from 7, Gymnophalloides seoi (75) from 5, Pygidiopsis summa (140) from 3, Stellantchasmus falcatus (3) from 2, and Stictodora lari and Acanthotrema felis (each 1 worm) from 1 case each. The intrauterine eggs of S. fuscata collected from the recovered worm were identical with the larger heterophyid eggs detected in the stool examination. By the present study, it was confirmed that A. felis is a new intestinal fluke infecting humans, and residents in Muan-gun, Jeollanam-do are infected with variable species of intestinal trematodes.

An anatomic study on the overlap patterns of structural components in the keystone area in noses of koreans.

OBJECTIVES: The keystone area has critical importance in maintaining the stability of the nasal dorsum. However, overlap patterns between structural components in the keystone area have rarely been studied, especially in the noses of Koreans. METHODS: Dissections were performed on 18 cadaveric noses. The length and width of the structural components in the keystone area were measured. The shape of the caudal margin of the nasal bone and the overlap patterns between the upper lateral cartilage and the nasal bone were classified. RESULTS: THE SHAPE OF THE CAUDAL MARGIN OF THE NASAL BONE WERE CLASSIFIED AS FOLLOWS: type A, curvilinear margin; type B, paramedian retractions or "M" shape; type C, elongated midline; and type D, retracted midline. The overlap area between the upper lateral cartilage and the nasal bone was classified as follows: type Ao, crescent shape; type Bo, short midline extension; and type Co, long midline extension. The cephalocaudal length of the overlap area between the upper lateral cartilage and the nasal bone was 4-10 mm (mean, 7 mm) in the midline, and 0-7 mm (mean, 3.1 mm) in the paramedian area. The overlap width of the upper lateral cartilage with the nasal bone was 8-14 mm (mean, 9.7 mm). CONCLUSION: The overlap pattern of the structural components in the keystone area is variable. Therefore, a thorough understanding and a cautious evaluation of the relationships of these components before and during surgery is important in performing safe and effective nasal procedures.

Analysis of the Development of the Nasal Septum according to Age and Gender Using MRI.

OBJECTIVES: This study was designed to evaluate the normal development of the nasal septum in Koreans using sagittal MRI for the valuable clinical information on septal procedures. METHODS: Two hundred eighty patients who had their whole nasal septum visualized in the midline sagittal view were selected among the 3,904 patients with brain MRI from January, 2004 to December, 2006 at Dankook University Hospital. The patients who had a history of nasal septal surgery or nasal trauma were excluded. Following parameters are calculated and analyzed: lengths of bony and cartilage dorsum and septal cartilage-nasal bone overlap, total septal area, septal cartilage area and, the proportion of the cartilage area to septal area and the maximal harvestable cartilage for grafting were calculated using the PAC program. RESULTS: All the parameters were increased until adolescence. Thereafter, bony dorsal length, cartilage dorsal length, total dorsal length, total septal area and maximal harvestable cartilage for grafting have not changed significantly with age, while SC-NB overlap length, septal cartilage area, and proportion of the cartilage area to the total septal area were significantly decreased with age. The SC-NB overlap length was positively correlated with the septal cartilage area and the proportion of the cartilage area to the total septal area. CONCLUSION: The small septal cartilage area and its proportion to the total septal area were significantly correlated with a short overlap length of the septal cartilage under the nasal bone. Septal procedures should be carefully performed in the elderly due to the risk of incurring saddle nose.

Effects of purinergic stimulation on ciliary beat frequency and chloride secretion in sinusitis.

OBJECTIVES: We aimed to identify the functional abnormality of sinusitis-affected mucosa by observing the responsiveness of the mucosa to purinergic stimulation after the onset of sinusitis and during the recovery period. We also aimed to identify possible beneficial effects of purinergic agonists on sinusitis. METHODS: A rabbit sinusitis model was developed by blocking maxillary ostia. Sinus mucosae were harvested immediately and 1 and 4 weeks after reopening the ostia. We measured chloride secretion and ciliary beat frequencies responding to purinergic stimulation. RESULTS: The increases of ciliary beat frequency by adenosine triphosphate (100 micromol/L) were 3.2%+/-8.5%, 7.9%+/-2.3%, and 12.2%+/-1.9% immediately after establishment of sinusitis and 1 week and 4 weeks after reopening of ostia, respectively. Chloride secretion stimulated by adenosine triphosphate also showed gradual increase during the recovery period. Grossly, the mucosae appeared to have normalized in 80% (4 of 5) after 4 weeks; however, functional and microscopic improvements were still incomplete. CONCLUSIONS: Mucosal functions, assessed by increase of ciliary activity and ion secretion by purinergic stimulation, and microscopic findings showed gradual but incomplete recovery after 4 weeks of recovery, in contrast to the gross normalization. Purinergic agonists may have beneficial effects on sinusitis by stimulating decreased ciliary motility and chloride secretion in sinusitis.

Comparison of ciliary wave disorders measured by image analysis and electron microscopy.

CONCLUSION: We have developed a simple, reliable method for the simultaneous determination of the ciliary wave disorder (CWD) and ciliary beat frequency (CBF) of actively beating cilia. OBJECTIVE: The CBF and the directions of beating cilia are two important components of mucociliary transport. Although lots of studies have been performed on the measurement of the CBF, there have been few studies on the direction of cilia, with the exception of those using electron microscopy (EM). EM takes too long to determine the directions of cilia, and it cannot determine the direction of actively beating cilia. The aim of this study was to develop an image analysis (IA) system to conveniently determine the wave directions of multiple actively beating cilia as well as the CBF. MATERIAL AND METHODS: Sphenoid sinus mucosae obtained from 10 patients undergoing pituitary tumor removal via a trans-septal trans-sphenoidal approach were divided into two 4 x 4 mm2-sized pieces. One piece was studied using IA, the other with EM. Using IA, ciliary wave directions were determined from 5 20 x 20 microm2 regions of interest and the mean of 5 consecutive values was regarded as the CWD of each sample. The CBF was also measured. CWD was also measured using EM. RESULTS: The average number of cilia analyzed by EM was 102.50 (range 48-136). The mean CWDs determined using IA and EM were 28.25+/-4.84 degrees and 23.59+/-8.16 degrees, respectively. There was a significant correlation between the CWDs determined using these two methods (Spearman's correlation coefficient =0.648; p =0.043). The mean CBF of sphenoid mucosa was 10.50+/-2.20 Hz.