Le Fort I osteotomy as treatment for traumatic class III malocclusion caused by Le Fort III fracture: A case report

Trauma in the modern society is characterized by multiple injuries, and the several comorbidities are often accompanied by facial bone fracture. The types of multiple facial bone fractures vary from Le Fort to panfacial fracture. Le Fort fracture, which can cause problems, such as facial disfigurement, functional impairment of mastication, malocclusion and speech abnormalities, is a challenging case for plastic surgeons. The purpose of treatment for patients with malocclusion due to Le Fort fracture is to maintain and restore both function and aesthetics. The author reports a case of Le Fort I osteotomy as a surgical correction of traumatic class III malocclusion due to Le Fort III fracture.

Reconstruction of temporal hollowing using two alloplastic materials simultaneously with titanium mesh and a silicone implant

Temporal hollowing is a contour deformity that results in a concavity or hollowing of the temporal region, causing significant cosmetic problems that affect patients both physically and psychologically. For these patients, cranioplasty is needed for protective coverage of the brain and to restore a pleasing aesthetic contour to the cranium. We report a case in which titanium mesh was used as a customized craniofacial implant for a bony defect and a silicone implant was used for soft tissue augmentation of muscle and to address temporal fat pad atrophy. The procedure resulted in high patient satisfaction from an aesthetic standpoint and, importantly, restored a functional barrier resistant to trauma.

Staged lower lip reconstruction following gangrenous stomatitis in an immunosuppressed patient

A 70-year-old male with a history of diabetes mellitus, hypertension, and coronary stent insertion visited our hospital 7 days after biting his lower lip. Swelling and inflammation had worsened despite debridement and antibiotic treatment. On the 8th hospital day, fungal infection with Candida albicans and superimposed bacterial infection with Klebsiella pneumoniae were found on tissue culture. Extensive necrosis resulted in a defect of approximately 3/4 of the entire lower lip and a full-layer skin defect from the vermilion to the gingivobuccal sulcus at the right corner of the mouth. To correct drooling, incomplete lip sealing, and trismus, staged reconstruction was performed with consideration of cosmetic and functional features. The treatment process using staged reconstruction and antifungal treatment for an extensive lower lip defect caused by fungal stomatitis is described.

A Retrospective Study of Invasive Bacterial Infections in Children with Asplenia

PURPOSE: Because children with asplenia have an increased risk of fulminant infection associated with a high fatality, chemoprophylaxis, and vaccinations against encapsulated bacteria are recommended. However, there have been few reports of the burden of severe bacterial infection and the current status of chemoprophylaxis and immunization among children with asplenia in Korea. METHODS: We conducted a retrospective study including children with asplenia who were treated at our institute between January 1997 and December 2016. RESULTS: From a total of 213 children with asplenia, 114 (53.5%) had congenital asplenia and 58 (27.2%) had functional asplenia. The remaining 41 (19.3%) had acquired asplenia with the median age at splenectomy being 12.2 years (range, 5.0 to 16.9 years); the most common cause of splenectomy was hereditary spherocytosis (39.0%). The chemoprophylaxis rate was 16.4%. The immunization rates were 44.1% for pneumococcus, 53.0% for Haemophilus influenzae type B, and 10.7% for meningococcus. The incidence of invasive bacterial infection among children with asplenia was 0.28/100 person-year; a total of six episodes (2.8%) were observed in five patients with congenital asplenia and one patient with functional asplenia. The median age for these infections was 15 months (range, 4 to 68 months). Five of the six episodes were bacteremia, and the other was meningitis. The most common pathogen was Streptococcus pneumoniae (n=3), followed by H.influenzae (n=1). Three of the six patients (50.0%) died, all of whom had pneumococcal bacteremia. None of the six had chemoprophylaxis or proper vaccinations. CONCLUSIONS: Although there is an increased risk of a severe infection proper vaccinations and chemoprophylaxis are still lacking. Physicians should be encouraged to implement appropriate chemoprophylaxis and immunizations for patients with asplenia.

A Retrospective Study of Invasive Bacterial Infections in Children with Asplenia

PURPOSE: Because children with asplenia have an increased risk of fulminant infection associated with a high fatality, chemoprophylaxis, and vaccinations against encapsulated bacteria are recommended. However, there have been few reports of the burden of severe bacterial infection and the current status of chemoprophylaxis and immunization among children with asplenia in Korea. METHODS: We conducted a retrospective study including children with asplenia who were treated at our institute between January 1997 and December 2016. RESULTS: From a total of 213 children with asplenia, 114 (53.5%) had congenital asplenia and 58 (27.2%) had functional asplenia. The remaining 41 (19.3%) had acquired asplenia with the median age at splenectomy being 12.2 years (range, 5.0 to 16.9 years); the most common cause of splenectomy was hereditary spherocytosis (39.0%). The chemoprophylaxis rate was 16.4%. The immunization rates were 44.1% for pneumococcus, 53.0% for Haemophilus influenzae type B, and 10.7% for meningococcus. The incidence of invasive bacterial infection among children with asplenia was 0.28/100 person-year; a total of six episodes (2.8%) were observed in five patients with congenital asplenia and one patient with functional asplenia. The median age for these infections was 15 months (range, 4 to 68 months). Five of the six episodes were bacteremia, and the other was meningitis. The most common pathogen was Streptococcus pneumoniae (n=3), followed by H.influenzae (n=1). Three of the six patients (50.0%) died, all of whom had pneumococcal bacteremia. None of the six had chemoprophylaxis or proper vaccinations. CONCLUSIONS: Although there is an increased risk of a severe infection proper vaccinations and chemoprophylaxis are still lacking. Physicians should be encouraged to implement appropriate chemoprophylaxis and immunizations for patients with asplenia.

Sebaceous Carcinoma Arising from the Nevus Sebaceous

No abstract available.

A Case Report of Sweet's Syndrome with Parotitis

Sweet's syndrome is characterized by clinical symptoms, physical features, and pathologic findings which include fever, neutrophilia, tender erythematous skin lesions, and a diffuse infiltrate of mature neutrophils. This is a report of our experience of Sweet's syndrome with parotitis. A 57-year-old man initially presented with tender swelling on the right cheek similar to parotitis. His symptoms relapsed despite the use of an oral antibiotic agent for 3 weeks. He additionally presented with erythematous papules and plaques on the periocular area and dorsum of both hands. Histiopathologic findings on punch biopsy of the right dorsum of the hand showed superficial perivenular histiocytic infiltration without vasculitis. We confirmed this as histiocytoid Sweet's syndrome and used systemic corticosteroid. After initiation of treatment with systemic corticosteroids, there was a prompt recovery from both the dermatosis-releated symptoms and skin lesions. Sweet's syndrome should be considered in patients with therapy-refractory parotitis and unclear infiltrated nodules. We present a confusing case who initially appeared to have parotitis but turned out to have histiocytoid Sweet's syndrome.

The Correction of Mild Mandibular Prognathism Using Mandibular Anterior Segmental Osteotomy

PURPOSE: For a minor degree of mandibular prognathism, mandibular anterior segmental osteotomy (ASO), usually extracting the bilateral premolars, has been performed frequently to correct malocclusion of the anterior teeth. Preoperative planning using cephalometry and a dental model is very important for such a orthognathic surgery. Depending on the specific preoperative mock surgery with the dental model, ASO, with ipsilateral unitooth extraction, is defined to be feasible and performed for ten patients. The comparisons of its preoperative and postoperative analysis of clinical photographs, dental casts, and lateral cephalograms, for soft tissue profiles, skeletal and dental relationships are described in the following, and its clinical applications are noted. METHODS: From March 1, 2004, to March 31, 2006, We performed 10 mandibular ASO by extraction of ipsilateral unitooth to improve their lower facial profiles and the lip relationships. Patient age ranged from 19 to 33 years, with a mean age of 25.6 years. Two were males and eight were females. RESULTS: All patients were satisfied with aesthetic and occlusal changes postoperatively. Significant and persistent decrease in the SNB and interincisal angle were observed in the postoperative cephalometries. The soft tissue profiles also were improved and near Ricketts's esthetic line. Other combined procedures include nine genioplasties, two rhinoplasties, and one blepharoplasty. One patient complained of transient unilateral inferior mental nerve paresthesia. There were no other significant complications or relapses throughout the follow-up period(6-20 months). CONCLUSION: Mandibular ASO, extracting the ipsilateral unitooth, was performed for ten patients to correct mild mandibular prognathism. The amount of setback of the mandibular anterior portion was 2 to 3mm, and satisfactory results were obtained combined with genioplasties.

The Effect of Silk Fibroin-Alginic Acid Sponge Treatment as an Artificial Skin on Wound

PURPOSE: This study was designed to compare the wound healing effect of silk fibroin, alginate and fibroin/ alginate blend sponge with clinically used Nu gauze in a rat skin defect model. METHODS: Two full thickness excisions were made on the back of Sprague-Dawley rat. The excised wound was covered with either of the silk fibroin(SF), alginate (SA), or fibroin/alginate blend sponge(SF/SA). On the postoperative days of 3, 7, 10 and 14, the wound area was calculated by image analysis software. At the same time, a skin wound tissue was biopsied. RESULTS: Healing time 50% (HT(50)) of SF/SA sponge treated group was dramatically reduced as compared with that of control treatment. We also found that the HT50 of SF/SA sponge was significantly decreased as compared with either those of SF or SA treatment. Furthermore, SF/SA treatment significantly increased the size of epithelialization and collagen deposition as well as the number of PCNA positive cells on epidermal basement membrane as comapred with those of control treatment. CONCLUSION: Our results suggest that the wound healing effect of SF/SA blend sponge is the best among other treatments including SF and SA during the whole wound healing period.

Clinical Analysis of Pediatric Facial Bone Fracture; 10-years Experiences in 201 Cases

The proper management of the pediatric facial bone fracture is critical in the facial bone development. This study characterizes the surgically treated patient population suffering from facial bone fractures by the use of current data from a large series consisting of 201 cases. The data was gathered through a retrospective chart review of patients surgically treated for facial bone fractures at the department of plastic and reconstructive surgery, Sanggye Paik hospital, Inje university medical center, collected over 10-years period from January, 1993 to December, 2002. Data regarding patient demographics(age, sex), seasonal distribution, location of fractures, and the causes of injury with admission periods, were collected. In total, there were 201cases of pediatric facial bone fractures. Male patients outnumbered female patients by a 5.48: 1 ratio and were found to engage in a wider range of behaviors that resulted in facial bone fractures. Physical violence was the leading cause of pediatric facial bone fractures(27.9%), followed by sports-related mechanisms (22.9%) and falling down(17.9%). The most prevalent age group was 11-15 years-old(71.1%) and there was a 14.3% prevalence in March. Among the location of fractures, the nasal bone was the most prevalent, accounting for 82.3% of injuries, followed by the orbit(9.95%), and the mandible fractures(7.5%). Most patients(59.7%) were treated within 6-9 days after trauma and the mean hospitalization period was 8-11 days. We should follow up the surgically treated patients, and they will be further evaluated about postoperative sequele and effect on the facial bone development. These studies demonstrate differences in the demographics and clinical presentation that, if applied to patients, will enable a more accurate diagnosis and proper management.

Partial Incision Double Fold Operation Using Debulking Method

Double fold operation is one of the most common cosmetic operations performed on young adults in Korean. These days, as many women are working outside home, growing number of women who want to have a natural-looking double eyelid choose the method with not only a short recovery time and less discomfort but also definite long lasting double fold. Double fold operation can be classified as incision technique and non incision technique. Although there are various non-incision techniques yielding good result, these techniques still have some problems, such as loosening of double fold with time, cyst formation, conjunctivitis and so on. Incision techniques also have problems such as long recovery time, irreversibility and visible scar. Our technique uses two or three 4-5mm of partial incision and removes the subcutaneous fat, pretarsal muscle, and small part of orbital septum through small incisions. And then we suture the wound skin to skin through levator aponeurosis and upper part of tarsal plate. These procedures prevent the possible problem of loosening of the folds of non-incision method by creating scar- adhesion between wider portion of the dermis and the tarsal plate and allows the application on puffy eyelid without any difficulty and is expectable of short recovery time. A retrospective review of data for 154 patients who underwent the partial-incision blepharoplasty using debulking method from November 2000 through april 2003 is presented. Most results were successful except 3 cases. Two patients complained of weak fold and one patient complained of short fold line. Satisfactory results in most patients prompt us to report this method, and we hope this debulking method complement the existing incision and non-incision method.

Dressing with a Splint in Osmidrosis

For the surgical treatment of osmidrosis with subdermal excision in adolescent patients, immobilization of the axilla after the surgery is very important to prevent hematoma. Skin necrosis may occur when hematoma develops in the axilla after subdermal shaving. However, in case of young patients, they cannot maintain immobilization of the axilla after surgery for a long time, so they are relatively vulnerable to skin necrosis of the axilla due to hematoma after surgery. We used Yogips(R) splint for the dressing in 21 patients from January, 2002 to December, 2002 in our institute to prevent hematoma. The control group was composed of 46 patients only with tie-over dressing after subdermal excision for the dressing. We compared the incidence of hematoma 5 days after the surgery with that of the control group. There was no evident hematoma observed in the patients with Yogips(R)splint, but in case of the control group, hematoma developed in 16 patients of total 46 patients(33%). In this 16 patients with hematoma, 12 patients(75%) were adolescents. In conclusion, the dressing with a Yogips(R)splint seems to be a good method for immobilization of axilla and preventing hematoma after subdermal excision in young patients with osmidrosis.

Efficacy of Tie-over Dressing Using Silicone Gel Sheet in Skin Graft on Flat Surface

Success of skin grafts depends on sufficient immobilization and early intervention for hematoma, seroma, or infection. To stabilize and cover skin grafts with a tie-over technique was used with translucent silicone gel sheet on flat surface. Skin defect was resurfaced with skin grafts. A sterile silicone gel sheet was placed over the skin graft. Gel was fixed to the wound edges with skin sutures. Skin graft healed without any complications. Using silicone gel sheet in skin graft on flat surface is an effective method for stabilization, which also allows direct visualization of the graft designed to inspect hematoma-like complications.

The Technique for Correction of Male Nipple Hypertrophy: The Sinusoidal Wave Form Excision and Purse-String Suture Method

Nipple hypertrophy is not a common condition in male but it can cause psychological and social disturbances to young male patients and hinder them from participating in various recreational activities. The main goal of nipple reduction is cosmesis in male, but functional goals are more important in females. Several methods1-5 of reduction have been described. However very few 6-8 adress the problem of male nipple hypertrophy. In our report, we have described the technique for nipple hypertrophy in male using sinusoidal wave form excision and purse-string suture method. We have used this technique for a male nipple hypertrophy patient and had good aesthetic result without any postoperative complications.

A Clinical Study of the Nasal Bone Fracture: 1488 Cases Review

Nose is the most prominent of part of the face and prone to traumas. Therefore posttraumatic deformities are easily seen and play a major effect on the personal impression. Result of clinical analysis of nasal bone fracture that gives general understands and advices of diagnosis and treatment of nasal bone fracture is presented with reports discussed. The author has performed radiologic evaluation, clinical study and statistical analysis in 1488 cases of nasal bone fracture treated in Department of Plastic and Reconstructive Surgery, Inje University Sanggye Paik hospital, from March, 1992 to February, 2002 Most of operation were performed on 5th-10th posttraumatic days(80.7%), and 1040 cases were treated with closed reduction using C-arm. We could obtain satisfactory results using C-arm. In satisfaction rate, 1296 cases(87%) had satisfactory results. The rate of dissatisfaction was high in the patients performed operation after 11th posttraumatic days and who had septal fracture. The author used C-arm during closed reduction of nasal bone fracture and verified the outcomes intraoperatively and were able to get more accurate reduction. With this method, we could obtain satisfactory results cosmetically and functionally. We should follow-up for longer time and we think that further research will be needed in treatment of nasal bone fracture

A Comparison of Wound Repair by Tissue Adhesive(2-Octylcyanoacrylate, Dermabond(R) and Standard Wound Closure Techniques in Rats

The ideal method of wound closure should be simple, rapid, inexpensive, painless, and bactericidal, and should achieve optimal cosmetic results. Tissue adhesives offer many of these characteristics. Until recently, the only commercially available tissue adhesive was 2-butylcyanoacrylate. A new tissue adhesive, 2-octylcyanoacrylate (Dermabond(R)), offers several advantages over 2-butylcyanoacrylate. It is more pliable and less brittle. To compare a new tissue adhesive, 2-octylcyanoacrylate, with standard wound closure techniques for the repair of open wound, two groups of each 20 rats were studied. Two groups were similar for demographic and clinical characteristics. Photographs taken at three months were rated by seven plastic surgeons blinded to the method of closure. There was no difference between two groups for appearance or complication. In conclusion, wound treated with Dermabond(R) and standard wound closure techniques have similar cosmetic results 3 months later, and Dermabond(R) is a faster method of wound repair that has cosmetic results similar to the use of sutures.

Palatoplasty with AlloDerm(R) Graft

Recently, Furlow's palatoplasty, intravelar veloplasty and other procedures have become popular for cleft palate. However, the push-back method holds an important position among the various palatoplasties because it is safe and reliable. Previous reports have shown that normal or nearly normal speech is attained in between 70 and 90 percent of the patients of push-back method. Early palatoplasty might influence maxillary growth more than late palatoplasty. There are some problems after operation of push-back method. The raw surface causes bleeding, pain, poor oral intake, growth interference for scar contracture and tension on central suture line. This lateral defect can be closed directly but tension on central suture area is increased, and the risk of wound dehiscence is increased. We used AlloDerm(R) graft for covering of this bony exposed raw surface on both lateral palatal area. Thus exposed surface was protected by AlloDerm(R) graft and then patient suffered from pain less than conventional method. The bony surface was compressed by AlloDerm(R) and bleeding was not found after AlloDerm(R) graft. Patient was not irritable and intake of patient was good after operation. The recovery was faster than conventional push-back method.

The Bilobed Flap for Nasal Reconstruction

Various methods of nasal reconstruction were performed over time. The physiology and anatomy of nose were clarified and its aesthetic subunits were employed, more improvement and modification were performed. The bilobed flap is particularly suitable for reconstruction of small or medium sized nasal defect up to 1.5 cm in diameter. Authors performed 6 cases of the bilobed flap for the defect of nasal dorsum (4 cases: basal cell carcinoma, 2 cases: compound nevus) from March 2000 to February 2001. The bilobed flap was medially based and second lobe was positioned on the nasal alar groove. This flap results in little or no distortion around tissue, by which scars of nasal dorsum and dog-ear deformity are reduced. Moreover we could achieve better cosmetic results for the scar, primary repair site of the second lobe, which is concealed by nasal alar groove.

Double Eyelid Operation using Subconjunctival Buried Suture Method

Double eyelid operation is one of the most common aesthetic surgical procedure performed in Korea. In correlation with the cultural background and social changes, most patients prefer a nonincision method rather than an incision method at the present. Forty-two consecutive patients were operated on for creation of double eyelids, with the subconjunctival buried suture method through conjunctival approach, from June of 1999 to September of 2000. The choice of procedure was based on the age of the patient and the amount of subcutaneous fat and redundant skin. This method was especially advisable if the young patient wants not to leave any visible scar and rapid recovery. The follow-up period ranged from two months to one year. Of forty-two patients undergoing this procedure, three patients(7.1%) required reoperation because of asymmetry, disappearance of fold, and irrtation respectively. This method is similar to various ordinary nonincisional methods previously described except for subconjunctival buried suture. But authors could obtain better cosmetic result with the advantage of shorter operation time, less morbidity, no scarring, and natural look earlier in the appropriate candidates.

Clinical Application of Single Hair Graft Using Choi Hair Transplanter

The transplantation of a large number of hair graft has become an important method in hair restoration surgery and reconstruction of pubic hair and eyebrows. Between September 1996 and December 1998, single hair graft using Choi hair transplanter was performed for 22 patients with male pattern baldness, 8 patients with alopecia of pubis, 6 patients with alopecia of eyebrows ranging from 20 to 59 years of age. Usually between 1000 and 1500 single hair grafts per session are performed on male pattern baldness, between 350 and 500 grafts on alopecia of pubis, between 150 and 250 grafts on alopecia of eyebrows. All procedures were done under intravenous sedation and local anesthesia. A donor horizontal ellipse of scalp is harvested from the occipital area. Questionaires regarding cosmetic satisfaction, side effects and general efficacy of hair transplantation were recorded by patients themselves one year after surgery. The procedure has been proved to be safe and patients can expect aesthetically satisfactory results. No serious complications were reported The complications including facial edema, temporary sensory change on the donor site, and folliculitis were observed and resolved spontaneously. The use of single hair graft using Choi hair transplanter for the correction of male pattern baldness, alopecia of pubis and alopecia of eyebrows has been proven as one of the safe and effective method in obtaining excellent results.