The relationship between lymphedema severity and awareness of lymphedema surgery.

BACKGROUND: During the early stages of lymphedema, active physiologic surgical treatment can be applied. However, lymphedema patients often have limited knowledge and misconceptions regarding lymphedema and surgical treatment. We analyzed the correlations between lymphedema severity and surgical technique according to patients' awareness of surgical treatment for secondary upper extremity lymphedema (UEL). METHODS: Patients with UEL diagnosed between December 2017 and December 2019 were retrospectively evaluated. At the time of their presentation to our hospital for the treatment of lymphedema, they were administered a questionnaire about lymphedema and lymphedema surgery. Based on the results, patients were classified as being aware or unaware of surgical treatment. Lymphedema severity was classified according to the arm dermal backflow (ADB) stage and the MD Anderson Cancer Center (MDACC) stage based on indocyanine green lymphography conducted at presentation. Surgical techniques were compared between the two groups. RESULTS: Patients who were aware of surgical treatment had significantly lower initial ADB and MDACC stages (P<0.05) and more frequently underwent physiologic procedures than excisional procedures (P=0.003). CONCLUSIONS: If patients are actively educated regarding surgical treatment of lymphedema, physiologic procedures may be performed during the early stages of UEL.

Primary Palatoplasty With Intravelar Veloplasty Using Acellular Dermal Matrix Interpositional Graft.

ABSTRACT: The aim of this study was to analyze the effect of acellular dermal matrix (ADM) on fistula formation after primary palatoplasty using intravelar veloplasty for levator veli palatini muscle repair.This single-center retrospective study included patients who underwent primary palatoplasty with intravelar veloplasty for reorientation of the levator veli palatini muscles between April 2014 and March 2018. In the control group (group A) conventional intravelar veloplasty was performed, while in the ADM group (group B) intravelar veloplasty using ADM was performed. The study sample was composed of 162 patients, 81 in each of the 2 groups (A and B). In group B, securely dissected muscles were overlapped, and a pentagon-shaped ADM (AlloDerm, LifeCell Corp., Branchburg, NJ) of 1.6 mm mean thickness, 11.3 mm mean width, and 14.4 mm mean length was designed, and placed under the repaired levator muscle sling. The outcome variable was the occurrence of oronasal fistula within the first 6 months after surgery.Postoperative fistula formation was reported in 6 patients in group A (7.4%) and in 5 patients in group B (6.2%). There was no statistically significant difference between the 2 groups (P = 0.755). There were 7 cases of ADM exposure and 2 cases of wound dehiscence in group B.The results of this study demonstrated that ADM use did not have any disadvantage with respect to oronasal fistula complications after intravelar veloplasty for levator veli palatini muscle repair.

Quantitative analysis of the impact of radiotherapy on facial nerve repair with sural nerve grafting after parotid gland surgery.

In this study, we aimed to reveal the long-term impact of radiotherapy on recovery of facial animation function after facial nerve repair using sural nerve grafting in patients undergoing parotid gland surgery. We reviewed the medical records of patients who did or did not undergo radiotherapy following sural nerve graft repair after parotid gland surgery. Facial function metrics, such as House-Brackmann (HB) scale scores and FACEgram measurements, were used to compare facial muscle function between groups. Postoperative radiotherapy was performed in 14 of 21 patients. There was no significant difference regarding successful repair (HB I-III), which was achieved in three of 14 irradiated patients and two of seven non-irradiated patients (p = 0.181). On FACEgram analysis, there was no significant difference in mean smile excursion length between the radiotherapy group (9.16 ± 8.48 mm) and the control group (6.15 ± 4.24 mm) (p = 0.392). There was no significant difference in the mean angle of excursion between the irradiated group (3.59 ± 3.73°) and the non-irradiated group (1.06 ± 5.24°) (p = 0.216). In this study, postoperative radiotherapy did not appear to prevent successful recovery of facial function after sural nerve grafting in parotid gland surgery.

Analysis of Speech and Functional Outcomes in Tongue Reconstruction after Hemiglossectomy.

BACKGROUND: Reconstruction in tongue cancer to restore the shape and function of the tongue without airway obstruction in the narrow oral cavity is challenging for reconstructive surgeons. Herein, the authors retrospectively analyzed flaps to reveal the factors that affect the functional outcome of tongue reconstruction. METHODS: Herein, we retrospectively reviewed 30 patients (men, 16; women, 14; mean age, 50.3 years) who underwent the hemi-tongue reconstruction followed by speech therapy between 2009 and 2017. Data about postoperative chemotherapy and radiotherapy were collected. The dimensions (width and length) of the flaps were measured. Speech outcomes were assessed under the conditions of varying distances of the tongue tip from lower incisors when it was protruded, retracted, and elevated. Lateralization was evaluated based on the count of teeth reached by the tip of the tongue from the midline. RESULTS: Preoperative chemotherapy and radiotherapy significantly influenced tongue retraction, tongue articulation, and intelligibility (p = 0.006, 0.002, 0.048, respectively). Postoperative chemotherapy did not statistically significantly influence any outcome measure. Contralateralization of the tongue was significantly decreased in the postoperative radiotherapy group (p = 0.029). The length of the flap showed highly negative correlation with articulation and intelligibility (p = 0.009, p< 0.001, respectively). The width of the flap was not correlated with the outcomes. CONCLUSION: We proved that unlike chemotherapy, postoperative radiotherapy influences the functional outcome of tongue reconstruction. The dimensions, particularly the length of the flap, were also important for restoring the reconstructed tongue function.

Analysis of the Intrinsic Predictors of Oronasal Fistula in Primary Cleft Palate Repair Using Intravelar Veloplasty.

INTRODUCTION: The purpose of the present study was to investigate various factors of cleft palate and to analyze their effect on fistula occurrence following palatal muscle repair using intravelar veloplasty. METHODS: A retrospective review of patients who underwent palatoplasty was performed. Primary palatoplasty was performed by a single surgeon in a single center. A total of 165 patients who underwent palatoplasty were enrolled. Primary palatoplasty with levator veli palatini muscle repair using intravelar veloplasty was performed. Three extrinsic factors (age, gender, and body weight) and 6 intrinsic factors (cleft width, ratio of cleft width to intermaxillary tuberosity distance, cleft anterior margin shape, uvula position, cleft lip, and radical intravelar veloplasty) were analyzed. RESULTS: Palatal fistula occurred in 11 (6.67%) patients. The occurrence of fistula was significantly correlated with a specific Veau classification, that is, type II (P = .041). Fistula tended to occur more frequently with a wide cleft palate (P = .063), and the high-risk cutoff value of the width was 7.75 mm. CONCLUSIONS: A larger cleft width tended to increase the occurrence of fistula. Close observation and information about the higher risk of fistula formation should be given to patients with a large cleft width who underwent intravelar veloplasty.

Comparison of Facial Proportions Between Eastern and Western Attractive Young Women.

The characteristics of what is considered a beautiful face differ between Eastern and Western countries.The authors of this study analyzed beauty pageant contestants using a three-dimensional (3D) photogrammetric analysis tool. All of the 3D photographs were taken between October and November 2016 in Seoul, Korea. The participants were 43 Miss Korea contestants (Group I) and 22 Miss Paraguay contestants (Group II).In absolute length, those in Group I had longer upper and middle faces. In the proportions of volume and length, Group I had larger upper and middle faces than Group II. Widths of the lower face and entire face were also wider in Group I. The lower facial index was larger in Group I. Group I had longer noses and wider intercanthal distance, not only in absolute length but also in proportion to the face. Group II showed thicker lips, longer chins, and wider noses relative to the face. Group II had wide eyes, in the absolute measurement and in proportion to the face. Group I participants appeared to have an increased height of eyes and had wider angles in their faces as well as wider nasofrontal, labiomental, and nasomental angles.The authors objectively established reference data for faces that are considered attractive in the East and the West. The data are expected to contribute to the clinical practice of plastic surgeons.

Study for Cephalometrics of Facial Bone by Computerized Tomography Images.

Authors tried to investigate the maxillomandibular morphology of Korean nationality with computerized tomography images and establish a series of cephalometric values which should be considered in orthognathic plastic surgery in Korea.The computerized tomography images of 200 patients were retrospectively reviewed with the computer workstation in Sanggye Paik Hospital, Inje University College of Medicine from 2016 to 2017.The mean distance between nasion to point A (NA) line and the maxillary central incisor was 5.07 cm. The mean distance from nasion to point B (NB) line to the mandibular central incisor was 7.11 cm. The mean angle between NA line and the long axis of the maxillary central incisor was 20.58 degree. The mean angle between NB line and the long axis of the mandibular central incisor was 26.47 degree. The mean angle between SN (sella to nasion) line and NA line was 83.18 degree. The mean angle between SN line and NB line was 78.83 degree. The mean angle between NA line and NB line was 4.35 degree. There were no any statistically significant differences between age groups. But there were statistically significant difference in the mean of angle between NB line and the long axis of the mandibular central incisor (P = 0.025, between sex groups) and in the mean of angle between NA line and the long axis of the maxillary central incisor between sex groups in the 51 to 60 age group (P = 0.045).The maxillomandibular profile of Korean adults was established which can be applied for orthognathic surgery of Korean patients.

A Study on the Effective Ratio of Fat to Stromal Vascular Fraction for Cell-Assisted Lipotransfer.

BACKGROUND: Fat grafting, used for soft tissue augmentation during aesthetic or reconstructive plastic surgery, has disadvantages of low efficiency and unpredictable resorption rate. As an alternative, cell-assisted lipotransfer (CAL) is widely used because of its simplicity and low fat resorption rate. However, relevant studies on optimal CAL parameters are still lacking. Here, we aimed to identify the most effective ratio of fat to stromal vascular fraction (SVF) for CAL. METHODS: We designed two experimental paradigms. The first involved four groups of mice, each group injected with varying ratios of fat and SVF purified from different amounts of fat from a fixed amount of harvested fat. The second experiment involved four groups of mice, each injected with varying amounts of SVF mixed with a fixed amount of fat tissue. The amount of surviving fat in both experiments was compared 8 weeks after fat transplantation. RESULTS: In the first experiment, the group injected with only fat, without consuming any of the harvested fat for SVF purification, showed the greatest mean volume and weight. In the second experiment, groups with 1:1 or more ratio of fat to SVF showed greater volume and weight than the group without SVF. Notably, a ratio of 1:1 did not give significantly different results than higher ratios. CONCLUSIONS: Thus, when a limited amount of fat tissue is available, using all of it for grafting is the most effective. However, if an adequate amount is available, using a fat-to-SVF ratio of 1:1 is the most efficient. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Three-Dimension-Printed Surgical Guide for Accurate and Safe Mandibuloplasty in Patients With Prominent Mandibular Angles.

Performance of mandibuloplasty is highly dependent on each surgeon's experience, and reproducing the results of simulation surgery is often difficult. In order to obtain successful clinical outcomes, a fast and efficient surgery technique that minimizes operation time and risk to patients is needed. The authors designed a 3D-printed mandible fit surgical guide for use as a bridge between simulation and actual surgery.The authors enrolled 7 patients with prominent mandibular angle who visited the outpatient clinic of the Department of Plastic and Reconstructive Surgery at Asan Medical Center in Seoul, Korea between December 2013 and May 2017.The surgical guides were made with a 3D printer and simulated based on individual facial bone CT scans. The surgical guides were designed to fit the lower border of the mandible and to cover the portion planned for removal.The resulting personalized 3D-printed surgical guides were applied on both mandibular angles to the body and along the lower border of the mandible. Osteotomy of the mandibular angle and body were performed along the surgical guide. All patients recovered without any immediate postoperative complications. The use of 3D-printed surgical guide was effective in simplifying the process of mandibuloplasty.Our results demonstrate the value of 3D printing technology in mandibuloplasty.

Comparison study of the use of absorbable and nonabsorbable materials as internal splints after closed reduction for nasal bone fracture.

BACKGROUND: The authors sought to compare the use of the nonabsorbable polyvinyl alcohol sponge (PVA, Merocel) and absorbable synthetic polyurethane foam (SPF, Nasopore Forte plus) as intranasal splints after closed reduction of fractured nasal bones during the hospitalization period. METHODS: The medical records of 111 patients who underwent closed reduction for nasal bone fracture at Sanggye Paik Hospital, Inje University College of Medicine, from 2012 to 2013 were reviewed retrospectively. PVA (group A) or SPF (group B) was packed as an internal splint after closed reduction. The efficacy of the materials was compared and statistically analyzed. RESULTS: PVA was used in 82 patients, and SPF was used in 29 patients. The patients in group B complained significantly more of nasal pain on the first day after operation than the patients in group A. Headaches on the operation day were significantly more painful in group B than in group A. Bleeding on the fourth postoperative day was significantly reduced in group B as compared to group A. The patients in group B exhibited significantly more intensive nasal obstruction on the operation day and the following day than the patients in group A. However, on the third and fourth postoperative days, the nasal obstruction in group B was less than that in group A. The pain and bleeding related to the packing material was significantly reduced in group B as compared to group A. CONCLUSIONS: The use of SPF as an absorbable packing material is a reasonable substitute for the traditional nonabsorbable material.