Correction of Dark Coloration of the Lower Eyelid Skin with Nanofat Grafting

BACKGROUND: A number of factors can cause dark circles around the eyes including excessive pigmentation, thin and translucent lower eyelid skin overlying the orbicularis oculi muscle, and shadowing due to skin laxity and tear trough. Autologous fat graft is an effective method for the treatment of lower lid dark circles, but irregularities caused by leaving visible lumps of the fat can occur. Tonnard et al. suggested 'nanofat' grafting and introduced its characteristics and clinical applications. The authors used their nanofat grafting to correct lower eyelid dark circles. METHODS: Nanofat grafting was performed in 19 patients for dark lower eyelids. The grafts were injected into subdermal layer using blunt cannula. Microfat grafting with nasojugal fold was performed to all the patients. Among them, 18 patients received transconjunctival fat removal at the same time. RESULTS: All the patients showed much improvement from preoperative dark coloration. There were no visible lumps of fat, contour irregularities, or fat necrosis. Postoperative edema and ecchymosis were minimal. CONCLUSIONS: Nanofat grafting methods provide a good alternative for correcting dark circles by augmenting thin skin with lower complications. This simple, cost effective procedure is suitable for correction of dark circles and various skin rejuvenation purposes.

A Case of Recurrent Cerebral Infarction due to Carotid Compression by a Neurogenic Tumor in the Neck / 대한뇌졸중학회지

A 62-year-old man with a neurogenic tumor in the neck was admitted to our hospital for recurrent ischemic stroke due to carotid occlusion. The magnetic resonance (MR) angiograms revealed the occlusion of the right internal carotid artery (ICA). Arterial compression by the tumor could be considered as the cause of ICA occlusion. Since neurogenic tumors of the neck have significant surgical risks, the patient underwent extracranial-intracranial arterial bypass (EC-IC bypass) surgery. We report a case with recurrent ischemic stroke due to carotid compression by a neurogenic tumor of the neck.

Analysis of Posterior Circulation Vascularity in Vestibular Neuritis

BACKGROUND: Vestibular neuritis (VN) is one of the most common causes of acute vertigo. Viral infection is regarded to be the most common etiology of VN, but other various causes including labyrinthine ischemia have not yet been fully elucidated. We assumed that labyrinthine ischemia can develop from various disorders in the posterior circulation including vertebral artery hypoplasia and vertebrobasilar dolichoectasia. METHODS: Fifty-six patients with acute VN and 56 healthy controls were enrolled. Two neurologists independently used magnetic resonance angiography (MRA) to retrospectively investigate the posterior circulation in VN patients. The relation between the presence of VN and abnormalities of posterior circulation vascularity was analyzed. RESULTS: MRA findings of vertebral artery hypoplasia and vertebrobasilar dolichoectasia were present in 15 (27%) and 14 (25%) of the VN patients. However, the frequencies of these findings did not differ significantly from those in the healthy controls (p=0.16). CONCLUSIONS: The frequencies of vertebral artery hypoplasia and vertebrobasilar dolichoectasia did not differ significantly between VN patients and healthy subjects. We suggest that brain MRI and MRA are not essential in acute VN patients without central signs. Large prospective studies are needed to characterize the vascular etiology of vestibular neuritis.

Management of Malignant Melanoma Using Sentinel Lymph Node Biopsy: A Case Report

The single most powerful prognostic factor in malignant melanoma is the status of the regional lymph node metastases. The surgical excision of involved node is the most effective treatment for local disease control. Surgical management of malignant melanoma has been the therapeutic value of elective lymph node dissection in the clinically node-negative individual. However, more recent prospective randomized trials have failed to demonstrate an overall survival benefit for patients undergoing prophylactic elective lymph node dissection. The histologic status of the sentinel lymph node reflects the status of the total nodal basin. Therefore the status of the regional lymph node metastases was confirmed by the sentinel lymph node biopsy in malignant melanoma without lymphedema and nerve injury in the patients undergoing elective lymph node dissection. In this case, we performed sentinel lymph node biopsy using lymphoscintigram and radioactive materials and confirmed no evidence of regional lymph node metastases. After wide excision of the primary tumor, the soft tissue defect with bone exposure on the heel was reconstructed with skin-grafted muscle free flap. There is no evidence of recurrence or distant metastases in this patient 1 year after excision.

Accessory Earlobe Malformation

A rare auricular malformation with an accessory earlobe is presented, and its method of correction is described. After review of literature, there has not been any previous report of such malformation. Relevant embryologic correlations are discussed. A 13-years-old girl is presented with a bilateral ear deformity that was present since birth. Two bulging masses below both ears and mild indentation of upper lobules were noticed. Bulging masses were removed and indented upper lobules were augmented by composite graft using these soft tissue. The pixie earlobes were also corrected using superiorly based flap of the lobe border. The external ear of the human develops from a fusion of six small hillocks at the region of the first and second branchial arches of the embryo. Although the case is limited to one, it is reasonable to presume that the mild depression of the upper lobule might have been caused by a deficiency of the divided hillock 1.