Surgical Fixation With Only Fibrin Glue in the Isolated Anterior Wall of the Maxillary Sinus Fracture.

ABSTRACT: When isolated anterior wall fractures of the maxilla occur, there is a high possibility that a comminuted fracture also exists. Because of thin and small fracture fragments and the associated damage to the mucosa, treating these fractures using conventional methods is difficult. The authors considered a surgical method that utilizes only fibrin glue after reduction. This method was also compared with the use of absorbable mesh. in total, 30 patients were diagnosed with an isolated anterior wall fracture of the maxilla between January 2013 and December 2018 in a single hospital. From these, 19 patients underwent fractured fragment reconstruction using only fibrin glue after reduction. The remaining patients underwent reconstruction using an absorbable mesh. Patient demographics, trauma vector, length of hospital stay, follow-up period, and acute/chronic complication rates of the two groups were investigated and statistically analyzed. The group using only fibrin glue showed better results with regard to the length of hospital stay and acute complication rates. Therefore, the surgical method using only fibrin glue after reduction can be recommended as a viable treatment method for these fractures.

Optimal treatment for penile verrucous carcinoma: a systematic literature review.

BACKGROUND: Verrucous carcinoma, a rare low-grade well-differentiated squamous cell carcinoma, is known for its favorable biological behavior and lack of metastatic potential. However, aggressive resection is problematic in terms of compromised function and aesthetics. Hence, more conservative treatments are needed. METHODS: To identify the up-to-date general biological behavior, diagnosis, and treatment trends, we searched PubMed using the keyword "penile verrucous carcinoma" without restrictions on publication date. RESULTS: Current treatments for penile verrucous carcinoma include wide surgical excision, seldom preventive lymphadenectomy, and conservative chemotherapy without surgery or local excision with safe margins. Despite the advent of partial penectomy to minimally impact function and aesthetics, affected patients experience psychosexual problems. Local excision can be used to save the penile shaft and glans penis without preventive lymphadenectomy or adjuvant therapy and can achieve good clinical prognosis with rare recurrence. CONCLUSIONS: To preserve the functional and cosmetic aspects, we recommend local excision, especially for tumors measuring < 3 cm and classified as stage T1 according to the 2016 tumor node metastasis clinical and pathological classification for penile cancer.

Simultaneous Use of Bioabsorbable and Nonbioabsorbable Packing Materials During Closed Reduction of a Nasal Bone Fractures.

ABSTRACT: The nasal packing material after closed reduction of nasal bone fracture may be bioabsorbable or nonbioabsorbable. To investigate the usefulness of the packing method using bioabsorbable and nonbioabsorbable materials simultaneously, a chart review was retrospectively performed involving 255 patients. Group A (n = 119), Nasopore (bioabsorbable) was cut appropriately and packed, and subsequently, supportive packing with Merocel (nonbioabsorbable) was performed. Group B (n = 78), nasal packing was performed with Vaseline roll gauze. Group C (n = 49), packed only Merocel. Pain and rhinorrhea were significantly lower in Merocel + Nasopore group (P < 0.05). It is thought that rhinorrhea is reduced by less mucosal irritation and maximizing the discharge absorption capacity by using Merocel and Nasopore simultaneously. By packing Nasopore first, pain is thought to be reduced by reducing the contact surface between Merocel and the injured mucosa and preventing a direct force to the fracture site. Therefore, our packing method, which uses Merocel and Nasopore simultaneously, can be recommended because it can provide sufficient support for the reduced fracture site, cause less pain, and maximize discharge absorption.

Superolateral Dislocation of Bilateral Mandibular Condyles With a Mandibular Body and Condyle Fracture.

ABSTRACT: An 82-year-old man fell from a motorcycle and was admitted with superolateral dislocation of the bilateral mandibular condyles. The displaced condyles on the right and left were hooked in the posterior root of the zygomatic arch and in the temporal fossa beyond the zygomatic arch, respectively. There was a sagittal split fracture on the medial side of the right mandibular condyle and a right mandibular body fracture. Under general anesthesia, manual reduction of the dislocation was successfully performed the day after the injury. Bilateral superolateral dislocations hooked to the temporal fossa or zygomatic arch are very rare, as they may require multiple strong impacts to occur. Open reduction and closed reduction are possible treatment modalities, and the period from trauma to treatment is relevant for the choice of treatment.

Alcohol Intoxication-Related Soft Tissue Injuries in Patients With Orbital Wall Fractures.

BACKGROUND: To date, involvement of alcohol intoxication (AI) in the occurrence of traumatic bone injuries has been well described in the literature. Still, however, there is a paucity of data regarding its involvement with soft tissue injuries in the oral and maxillofacial region. Considering that it is one of the significant predisposing factors that are involved in facial bone fractures in assault victims, we have speculated that they are also vulnerable to soft tissue injuries. We therefore examined the incidence, type and, pattern of soft tissue injuries in patients with trauma owing to the AI in a single-institution setting. MATERIALS AND METHODS: A total of 488 patients underwent reconstructive surgery for orbital wall fracture at our medical institution between 2012 and 2017. Of these, 162 eligible patients were enrolled in the present study; they were divided into 2 groups (the AI group and the control group) based on a history of the AI. Then, we compared baseline and clinical characteristics, including the incidence, type, and pattern of soft tissue injury, between the 2 groups. RESULTS: In our series, assault was the most common cause of traumatic injuries. We found that the patients with AI were at increased risks of preoperatively developing subconjunctival hemorrhage and diplopia and postoperatively developing infraorbital nerve (ION) hypesthesia. CONCLUSIONS: In conclusion, our results indicate that the AI is closely associated with the preoperative risks of subconjunctival hemorrhage and diplopia and the postoperative risks of ION hypesthesia. But further large-scale, multicenter studies are warranted to establish our results.

Topographic relationships between the transverse facial artery, branches of the facial nerve, and the parotid duct in the lateral midface in a Korean population.

BACKGROUND: The aims of the present study were to clarify the topographic relationships between various structures in the lateral midface and to provide important anatomical information pertinent to face lifting or treatment of damage to the midface structure. METHODS: Thirty-two fixed cadavers were dissected (23 males and 9 females; mean age, 66.8 years) and 55 sides of midface were used. The transverse facial artery (TFA), zygomatic branch (Zb) and buccal branch (Bb) of the facial nerve, and the parotid duct (PD) were identified. The structures of the lateral midface were measured relative to the zygion and tragion. The vertical average distances from the zygion to each structure increased in the following order: ZB of the facial nerve, TFA, first Bb of the facial nerve, and PD. The horizontal average distance from the tragion to the point of emergence from anterior border of the parotid gland was also measured. RESULTS: The TFA was the closest and the third Bb of the facial nerve was the farthest away. The angles between the horizontal line and ZB of the facial nerve, TFA, PD, and first Bb of the facial nerve were +10.4, -2.3, -18.5, and -27.1 degrees, respectively. CONCLUSIONS: These results may be used to establish the precise locations and the courses of the important midface structures, and represent valuable data that may help to prevent complications during surgery for face lifting and reconstruction of the facial nerve and PD.

Anatomical characteristics of the nasal cartilages for successful rhinoplasty in Koreans.

BACKGROUNDS: The aims of the present study were to determine the exact level of separation of the upper lateral cartilage from the septal cartilage, and to classify the patterns of connection between the upper lateral cartilage and the lower lateral cartilage. METHODS: We dissected and photographed 60 sides of noses; 18 specimens were sectioned and stained with Masson's trichrome. RESULTS: The mean length of the connection between the upper lateral cartilage and septal cartilage was 16.1 mm. The mean level for separation of the upper lateral cartilage was 7.5 mm from the nasal bone. The pattern of connection between the upper lateral cartilage and lower lateral cartilage could be classified into five types: disconnection, end-to-end, overlap, scroll, and reverse scroll. CONCLUSIONS: The results of the present study will be helpful for surgical procedures such as nasal hump reduction and nasal cartilage work and also provide information for the anthropometric study of the nose.

Centralization or decentralization of facial structures in Korean young adults.

It is well known that facial beauty is dictated by facial type, and harmony between the eyes, nose, and mouth. Furthermore, facial impression is judged according to the overall facial contour and the relationship between the facial structures. The aims of the present study were to determine the optimal criteria for the assessment of gathering or separation of the facial structures and to define standardized ratios for centralization or decentralization of the facial structures.Four different lengths were measured, and 2 indexes were calculated from standardized photographs of 551 volunteers. Centralization and decentralization were assessed using the width index (interpupillary distance / facial width) and height index (eyes-mouth distance / facial height). The mean ranges of the width index and height index were 42.0 to 45.0 and 36.0 to 39.0, respectively. The width index did not differ with sex, but males had more decentralized faces, and females had more centralized faces, vertically. The incidence rate of decentralized faces among the men was 30.3%, and that of centralized faces among the women was 25.2%.The mean ranges in width and height indexes have been determined in a Korean population. Faces with width and height index scores under and over the median ranges are determined to be "centralized" and "decentralized," respectively.

Coverage of skin defects without skin grafts using adipose-derived stem cells.

A satisfying result is difficult to achieve in the repair of a full-thickness skin defect in the facial area, including the subunits of the nose. A full-thickness skin graft, nasolabial flap, or forehead flap as a major treatment still is used despite its relative potential for secondary contracture, unmatched skin color, hypertrophic scars, and donor-site morbidity. Another option, with good wound-healing power and soft tissue regeneration without skin grafts would be helpful for initiating treatment. Adult stem cells are a useful material in tissue engineering. Adipose-derived stem cells (ADSCs), an abundant population of pluripotent cells found in the stroma of adipose tissues, have been shown to differentiate in vitro into various cell lineages. As a robust source of bioactive growth factors, ADSCs contribute to recovery from ischemic damage, and they can promote the wound-healing process as well as soft tissue regeneration. The authors have experienced several cases of facial skin defect repair using ADSCs without skin grafts. In these cases, they observed rapid coverage of the wound with the patient's own regenerated tissue. During the treatment period, ADSC treatment showed an excellent wound-healing process in terms of quantity and quality.

Anatomical verification and designation of the superficial layer of the temporalis muscle.

The temporalis muscle, which is one of the masticatory muscles, enables elevation and retraction of the mandible. Direct injury to the temporalis muscle, facial nerve, or temporal fat pad during cranial-base surgery can cause temporal hollowing. The temporalis muscle is currently described in almost all atlases and textbooks as comprising a single layer. In this study, a superficial layer of the temporalis muscle is described, clarifying the anatomy of this muscle. Twenty heads of adult cadavers were dissected. The gross anatomy of the temporalis muscle was examined after removing the skin, subcutaneous tissue, superficial temporal fascia, and deep temporal fascia. The superficial layer of the temporalis muscle was clearly distinguishable from the deep layer. The superficial layer originated from the same region as the deep layer, and the muscle fibers of the two layers were intermingled in the superior part of the muscle. The deep layer of the temporalis muscle, which is referred to in textbooks and atlases simply as the temporalis muscle, was exposed after removing the superficial layer. The existence of this superficial layer was confirmed herein both histologically and by magnetic resonance imaging. Henceforth, the superficial layer of the temporalis muscle must be included in descriptions of the temporalis muscle in anatomy textbooks and atlases. The findings of this study are important not only from the perspective of simply acquiring correct anatomical knowledge, but also from the surgical perspective in preventing temporal hollowing during related surgical procedures.

New proposal for skin grafts on tendon-exposed wounds.

Performing a skin graft is not feasible for tendon-exposed defect reconstruction because tendons are fibrous connective tissues with relatively poor blood supply. This study proposes a method to effectively perform skin graft surgery in tendon-exposed wounds. A 48-year-old male patient with diabetes mellitus had a very large left dorsal foot defect (8×8 cm). The wound bed had healthy granular tissue, with tendon exposure. The tendons were turned over so that the posterior side would behave as the anterior side. The edge of the paratenon was then fixed together to the surrounding granulation tissue or dense remnant fascia using absorbable sutures, and the close granulation tissue was approximated and buried. A split-thickness skin graft was performed after 1 week. The graft site was stably taken on postoperative day 3. A small disruption was then observed at the graft site within 1 week postoperatively, but conservative treatment was continued for 1 month, after which the defect site was completely restored. This technique can increase the success rate of skin grafts for defects with tendon exposure.

Analysis of the midface, focusing on the nose: an anthropometric study in young Koreans.

Improvements in both living standards and incomes have meant that many more people are now able to undergo elective plastic surgery for facial improvement. The nose and midface are the most frequent surgical target in Korea. However, the lack of reliable and precise anthropological data is a hindrance for effective surgical applications in this area. In the current study, 21 different lengths and angles of the midface and nose were measured in 2065 volunteers. The data were analyzed to establish sex and racial differences. Most of the measurements obtained from male volunteers were 5% to 10% greater than for the females, exceptions being the nasofrontal, nasolabial, and nasal tip angles. The biggest sex difference was found for depth of pupil, and the smallest difference was for intercanthal distance. For each measurement, the ratio of proportional differences was similar to that for whites. Many Koreans exhibited a columella protrusion of 4 to 5 mm; that parameter measures 2 to 3 mm in whites. The prevention of a hanging columella is important in nasal tip surgery. The intercanthal distance was also relatively large compared with the facial width. In females, the intercanthal distance was similar to the length of the nasal dorsum and the width of the nose. Surgeons may find this analysis useful for surgical planning. The present study provides basic clues for planning and practice in reconstructive and aesthetic facial surgery.

Staged excision of basal cell carcinoma arising from a tattooed eyebrow.

Side effects of tattoos can occur due to unexpected body responses. Concerns about the side effects of tattoos are growing concomitantly with the increasing number of tattooed individuals. We report a rare case of basal cell carcinoma (BCC) on a tattooed eyebrow. A 48-year-old woman with no family history or occupational risk of skin cancer had her eyebrows tattooed 6 years prior, and she noticed a black mass on her right eyebrow 1 year before presentation. Staged excision was planned due to the patient's reluctance regarding the possibility of a wide scar. After the first surgical procedure, a histopathological examination confirmed BCC. Wide excision and primary closure were performed for remnant BCC, and no recurrence was observed. The mechanism of skin neoplasms involving tattoos has not been clearly identified. Unapproved tattoo inks contain carcinogenic substances, and previous case reports indicate that skin neoplasms may differ depending on the tattoo color. Therefore, the carcinogenic effects of these unknown components of tattoo ink might cause skin neoplasms. Accurate component analysis and systematic management of tattoo ink is necessary, and medical practitioners must also pay attention to this possibility because it is easy to overlook tattoos as a causal factor contributing to cancer.

Multiple nonmelanocytic skin cancers in multiple regions.

The most common forms of nonmelanocytic skin cancer (NMSC) are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). The growing incidence of skin cancer in the Republic of Korea has sparked increasing scientific interest in these types of tumors. In the case described herein, multiple NMSCs occurred asynchronously in various areas of the body in a single patient. A 67-year-old man presented with an ulcerative lesion on the right retro-auricle and multiple keratinized masses on the back and face. The right retro-auricular lesion was diagnosed as BCC, and the keratinized masses on the patient's back and face were diagnosed as SCC. He subsequently presented with numerous pigmented skin lesions on the forehead, temple, pre-auricle, neck, right forearm, right hand, and both thighs. One lesion on the neck was diagnosed as BCC, and five lesions on the right hand and forearm were diagnosed as SCC. The patient was also diagnosed with supraglottic SCC and external auditory canal SCC. An otolaryngologist performed radical excision of the primary SCC. Suspected skin cancer lesions observed on the face and both ears were diagnosed as SCC. Patients with multiple NMSCs are at an elevated risk for additional skin cancers, making periodic follow-up important; furthermore, all suspicious lesions should be biopsied.

Location of the split line of the deep temporal fascia when reducing a zygomatic arch fracture.

BACKGROUND: The deep temporal fascia (DTF) is known to separate into two layers that descend to attach to the zygomatic arch. When surgeons reduce an isolated fracture of the zygomatic arch through a temporal approach, the temporal incision site needs to be superior to the split line of the DTF. MATERIALS AND METHODS: Sixty-seven hemifacial cadavers were investigated after removing the skin, subcutaneous tissue, and superficial temporal fascia. The superficial layer of the DTF was exposed. We cut the superficial layer along the line along, which it adhered to the deep layer inseparably. The heights of the split line of the DTF from the superior border of the zygomatic arch and from the top of the helix were measured at three points: at the jugale, zygion, and 3 cm from the tragus. RESULTS: In all cases there were thick identifiable deep layers of the DTF. The mean heights of the split line of the DTF from the superior border of the zygomatic arch were 49.8, 46.7, and 42.6 mm at the jugale, zygion, and 3 cm from the tragus, respectively; the corresponding mean heights of the split line from the top of the helix were 19.1, 15.6, and 11.4 mm. CONCLUSIONS: Knowledge of the mean height of the split line of the DTF will be helpful for surgeons to determine the temporal incision site for ensuring the safe reduction of a zygomatic arch fracture.

Female-to-male proportions of the head and face in Koreans.

It is well known that the head and face are smaller in female subjects than in male subjects. However, almost all previous studies have quantified the size difference between female and male subjects as simple numerical values, which might not clarify the difference. The present study evaluated the female-to-male proportions of the head and face so as to clarify the sex-related differences. A total of 1939 female subjects and 1398 male subjects were divided into 3 age groups: young (20-39 y), middle-aged (40-59 y), and elderly (60-79 y). The dimensions were classified into 3 categories: 5 cephalic, 3 frontal facial, and 6 lateral facial. The female-to-male proportions of individual dimensions were compared in the 3 age groups using the following formula: female measurement value x 100/(mean of male measurement value). The female-to-male proportions of the cephalic dimension increased with age, with the female cephalic dimensions overall being about 96% of the male cephalic dimensions. The female-to-male proportions of the frontal facial dimension were constant across the age groups, with the female frontal facial dimensions overall being 95% of the male frontal facial dimensions. The female lateral facial dimension increased markedly from the young to middle-aged group and was constant or decreased slightly from the middle-aged to the elderly group. Overall, the female lateral facial dimensions were approximately 97% of the male lateral facial dimensions. The present study will suggest a new approach to elucidate those sex-related dimensional differences that are characteristic of female and male subjects.

Association between sphingosine-1-phosphate-induced signal transduction via mitogen-activated protein kinase pathways and keloid formation.

We conducted this experimental study to analyze the relationship between sphingosine-1-phosphate (S1P)-induced mitogen-activated protein (MAP) kinase pathways and keloid formation. We collected samples of the normal tissue and the keloid tissue from 10 normal healthy individuals and 12 patients with keloid scars, respectively. Then, we compared the level of sphingosine-1-phosphate receptor (S1PR1/S1PR2) mRNA/protein expression between the normal tissue and the keloid tissue. Moreover, we also compared the level of S1PR protein expression, that of S1P-induced COL1A1 (collagen Type I, α-1 chain) expression, that of S1P-induced JNK/ERK phosphorylation, that of S1P-induced COL1A1 expression following the treatment with 30 µM PD98059 (ERK inhibitor) or 30 µM SP600125 (JNK inhibitor) and that of S1P-induced COL1A1 expression following the treatment with W146 (S1PR1 inhibitor) or JTE013 (S1PR2 inhibitor) between the normal fibroblasts and the keloid fibroblasts. We found that the level of S1PR1/S1PR2 mRNA/protein expression was significantly higher in the keloid tissue as compared with the normal tissue. Our results also showed that the level of S1P-induced COL1A1 expression and that of S1P-induced JNK/ERK phosphorylation were significantly higher in the keloid fibroblasts as compared with the normal ones (P < 0.05). Furthermore, there were significant decreases in the level of S1P-induced COL1A1 expression when the keloid fibroblasts were treated with 30 µM SP600125 or 30 µM PD98059 and that of S1P-induced COL1A1 expression when the treated with 100 nM W146 or 100 nM JTE013 (P < 0.05). Our results indicate that S1P-induced signal transduction is associated with increased collagen synthesis via S1PR-mediated signaling pathways in the keloid tissue.

Myxoma arising from the parotid gland.

Myxomas can be divided into two groups: those derived from the facial skeleton, and those derived from external skeletal soft tissue. Soft tissue myxomas of the head and neck are uncommon, with fewer than 50 cases reported. In any form and location, myxoma of parotid gland is rare. We report a case of myxoma arising from the left superficial lobe of the parotid gland with good longterm follow-up after superficial parotidectomy with tumor excision. A 49-year-old man was referred to our department of plastic and reconstructive surgery with a painless palpable mass that had persisted in the left mandible angle region for 2 years. Excision of the facial mass and superficial parotidectomy with facial nerve preservation were performed. The biopsy result was myxoma. Long-term follow-up for 22 months showed favorable results without evidence of recurrence but with temporary facial nerve weakness right after the surgery. Myxoma should be considered as a differential diagnosis when benign tumor of the parotid gland is being considered.

A useful additional medial subbrow approach for the treatment of medial orbital wall fracture with subciliary technique.

BACKGROUND: To date, a variety of surgical approaches have been used to reconstruct the medial orbital wall fracture. Still however, there is still a controversy as to their applicability because of postoperative scars, injury of anatomical structures and limited visual fields. The purpose of this study was to introduce a useful additional medial subbrow approach for better reduction and securement more accurate implant pocket of medial orbital wall fracture with the subciliary technique. METHODS: We had performed our technique for a total of 14 patients with medial orbital wall fracture at our medical institution between January 2016 and July 2017. All fractures were operated through subciliary technique combined with the additional medial subbrow approach. They underwent subciliary approach accompanied by medial wall dissection using a Louisville elevator through the slit incision of the medial subbrow procedure. This facilitated visualization of the medial wall fracture site and helped to ensure a more accurate pocket for implant insertion. RESULTS: Postoperative outcomes showed sufficient coverage without displacement. Twelve cases of preoperative diplopia improved to two cases of postoperative diplopia. More than 2 mm enophthalmos was 14 cases preoperatively, improving to 0 case postoperatively. Without damage such as major vessels or extraocular muscles, enophthalmos was corrected and there was no restriction of eyeball motion. CONCLUSION: Our ancillary procedure was useful in dissecting the medial wall, and it was a safe method as to cause no significant complications in our clinical series. Also, there is an only nonvisible postoperative scar. Therefore, it is a recommendable surgical modality for medial orbital wall fracture.

Anisakiasis Involving the Oral Mucosa.

Anisakis is a parasite with life cycles involving fish and marine mammals. Human infection, anisakiasis, occurs with the ingestion of raw infected seafood and usually presents with acute or chronic gastrointestinal symptoms from esophageal or gastric invasion. We report a rare caseinvolving the oral cavity. A 39-year-old male presented with oral and sub-sternal pain of one day duration after eating raw cuttlefish. Physical examination revealed areas of erythema and edema with a central white foreign particle on the labial and buccal mucosa. With microscopic field we could remove the foreign material from the lesions. The foreign material was confirmed to be Anisakis. Anisakis was also removed from the esophagus by esophagogastroduodenoscopy. The patient was discharged the following day without complication. Anisakiasis is frequently reported in Korea and Japan, countries where raw seafood ingestion is popular. The symptoms of acute anisakiasis include pain, nausea, and vomiting and usually begin 2-12 hours after ingestion. The differential diagnosis includes food poisoning, acute gastritis, and acute pancreatitis. A history of raw seafood ingestion is important to the diagnosis of anisakiasis. Treatment is complete removal of the Anisakis to relieve acute symptoms and prevent chronic granulomatous inflammation.