Congenital macrostomia is a result of defective union between the mandibular and maxillary processes and it is a rare deformity seen in every 100 to 300 facial clefts. Ohnizuka1`classified macrostomia into two groups as congenital and posttraumatic. We experienced two cases of acquired macrostomia due to NOMA sequelae(58/F:Lt & 51/F:Rt) and one case of congenital macrostomia (3 months/M:Rt). Many plastic surgeons have developed surgical procedures for repair of this congenital macrostomia. Among them, McCarthy6,11 described the classic commissuroplasty. We could repaired 1 case of congenital macrostomia and two cases of acquired macrostomia due to NOMA sequelae using modified technique of McCarthy,s classic commissuroplasty. McCarthy described new oral commissure 2-3mm laterally for prevention of postoperative contraction, orbicularis oris muscle transposition to restore labial function and a z- plasty cutaneous closure. But some author raise an objection to new oral commissure 2-3mm laterally, and they made new oral commissure at same distance of opposite side normal commissure. And so, we designed the new oral commissure moved 1mm laterally comparing to original commissuroplasty in a congenital case for the prevention of displacement. In cases of acquired macrostomia due to NOMA sequelae, we reconstructed new oral commissure like congenital case, moved 1mm laterally. Orbicularis oris muscle transposition could not be possible because of destruction of muscle, adhesion and atrophy. And so we dissected muscle and just sutured side by side. Acquired macrostomia following NOMA sequelae manifsted facial deformity variably, and reconstruction of the facial deformity is difficult by using simple approach. Other variable reconstructive procedures were needed with commissuroplasty as like Washio flap, rotation advancement flap, bone graft and free radial forarm flap, etc. Postoperative results were relatively good. We propose that macrostomia due to NOMA sequelae must add to Ohnizuka classification of acquired macrostomia.
Atrophy ; Classification ; Congenital Abnormalities ; Macrostomia* ; Noma ; Transplants

The aim of aesthetic rhinoplasty is to produce harmonious contour of the nasal tip as well as to provide dorsal augmentation. The nasal tip should look definite but not too pointed or artificial. Natural contour is most desirable. Among the patients(n = 140) who had augmentation rhinoplasty between 1995 to 1999, 107 patients were classified to have blunt tips. The cases who have other types of tip deformities were excluded. In this study, we present our tip plasty technique for the correction of blunt tips. The blunt tip deformities were divided into bulbous tip(n = 82) and broad tip(n = 25). As for the operation, different tip thinning procedures were done according to this classification. Then dorsal augmentation with silastic implant was performed. Authors used "Contour Tip Graft" technique to produce aesthetic oriental nasal tip. This technique made use of the graft of stacked autogenous cartilages with small pieces of diced cartilage around it. The stacked cartilages were for tip projection and surrounding pieces for natural contour. This method can yield more natural appearance of the tip and lobule. Our tip plasty technique combined with dorsal augmentation is very useful and effective procedure in the correction of blunt tip.
Cartilage* ; Classification ; Congenital Abnormalities ; Humans ; Rhinoplasty ; Transplants

PURPOSE: To prevent excessive sliding and subsequent fixation failures in unstable intertrochanteric fractures with posteromedial comminution, extramedullary reduction through overlapping of the anteromedial cortices of both proximal and distal fragments as a buttress has been introduced. The purpose of this study was to compare the biomechanical properties between two reduction methods-intramedullary reduction and extramedullary reduction-in treating unstable intertrochanteric fractures with posteromedial comminution (AO/OTA classification 31-A2.2). MATERIALS AND METHODS: Eight pairs of frozen human cadaveric femora were used. The femora of each pair were randomly assigned to one of two groups: the intramedullary reduction group or the extramedullary reduction group. A single axial load-destruction test was conducted after cephalomedullary nailing. Axial stiffness, maximum load to failure, and energy absorbed to failure were compared between the two groups. Moreover, the pattern of mechanical failure was identified. RESULTS: The mean axial stiffness in the extramedullary reduction group was 27.3% higher than that in the intramedullary reduction group (422.7 N/mm vs. 332.0 N/mm, p=0.017). Additionally, compared with the intramedullary reduction group, the mean maximum load to failure and mean energy absorbed to failure in the extramedullary group were 44.9% and 89.6% higher, respectively (2,848.7 N vs. 1,966.5 N, p=0.012 and 27,969.9 N·mm vs. 14,751.0 N·mm, p=0.012, respectively). In the intramedullary reduction group, the mechanical failure patterns were all sliding and varus deformities. In the extramedullary reduction group, sliding and varus deformities after external rotation were noted in 3 specimens, sliding and varus deformities after internal rotation were noted in 3 specimens, and medial slippage was noted in 2 specimens. CONCLUSION: In unstable intertrochanteric fractures with posteromedial comminution, the biomechanical properties of extramedullary reduction are superior to those of intramedullary reduction. Anteromedial cortex could be the proper buttress, despite a comminuted posteromedial cortex. It could help enhance the stability of the bone-nail construct.
Cadaver ; Classification ; Congenital Abnormalities ; Hip Fractures ; Humans

The classification of thoracolumbar spinal injuries has been based on morphological criteria, mechanism or both. Recently Denis and Macfee insisted no the middle column of the spine but their classification is useful as a morphologic description. Especially, the classification and decision of treatment are difficult in the burst fracture. So we have applied the new classification described by Gertzbein that considers the morphologic patterns and mechanism of injury and compared with another classifications. We studied 28 cases of the thoracolumbar burst fracture who were treated and followed up at Wonkwang university hospital from May, 1988 to March, 1992. We classified burst fracture according to the three kind of classifications and CT finding. 1. The burst fracture associated with flexion-distraction injury was revealed 5 cases(about 18%). 2. In the treatment, Type A injuries requires the use of distractive and type B requires compressive forces in the correcting the deformity.
Classification ; Congenital Abnormalities ; Spinal Injuries ; Spine

The purposes of operative treatment in unstable thoracolumbar and lumbar spine fractures are anatomical reduction and stabilization of the fractures and thus promote neurological recovery and early rehabilitation. To achieve these goals, complete preoperative assessment and recognition of the fracture pattern is necessary in addition to good surgical technique. The authors analyzed 47 cases of thoracolumbar and lumbar spine fractures operated from Jan. 1989 to Dec. 1991 at the Department of Orthopaedic Surgery, National Medical Center. All cases were classified according to Denis classification and in deciding the appropriate surgical approach, fracture type, stability, neurologic status and degree of deformity were all considered. Anterior approaches were performed in 23 cases of burst fracture and 3 cases of fracture-dislocation, and posterior approaches were performed in 1 case of compression fracture, 7 cases of burst fracture, 4 cases of seat-belt type injury and 5 cases of fracture-dislocation, In 3 cases of burst fracture and 1 case of fracture-dislocation, both anterior and posterior approaches were combined. With the analysis of postoperative changes in sagittal and coronal angle, translation and degree of rotation, we evaluated the results of operative reduction in terms of restoring normal anatomical configuration of injured spinal segments. So we tried to find the attributing factors in the operative reduction of the thoracolumbar and lumbar spine fractures and suggest the proper surgical approach that provides better reduction and stabilization.
Classification ; Congenital Abnormalities ; Fractures, Compression ; Rehabilitation ; Spine

BACKGROUNDUterus didelphys and blind hemivagina associated with ipsilateral renal agenesis are collectively known as Herlyn-Werner-Wunderlich syndrome (HWWS). In the literature, the syndrome often appears as a single case report or as a small series. In our study, we reviewed the characteristics of all HWWS patients at Peking Union Medical College Hospital (PUMCH) and suggested a new classification for this syndrome because the clinical characteristics differed significantly between the completely and incompletely obstructed vaginal septum. This new classification allows for earlier diagnosis and treatment.

METHODSFrom January 1986 to March 2013, all diagnosed cases of HWWS at PUMCH were reviewed. A retrospective long-term follow-up study of the clinical presentation, surgical prognosis, and pregnancy outcomes was performed. Statistical analyses were performed using SPSS, version 15.0 (IBM, Armonk, NY, USA). Between-group comparisons were performed using the χ2 test, Fisher's exact test, and the t-test. The significance level for all analyses was set at P < 0.05.

RESULTSThe clinical data from 79 patients with HWWS were analyzed until March 31, 2013. According to our newly identified characteristics, we recommend that the syndrome be classified by the complete or incomplete obstruction of the hemivagina as follows: Classification 1, a completely obstructed hemivagina and Classification 2, an incompletely obstructed hemivagina. The clinical details associated with these two types are distinctly different.

CONCLUSIONSHWWS patients should be differentiated according to these two classifications. The two classifications could be generalized by gynecologists world-wide.

Adolescent ; Child ; Congenital Abnormalities ; classification ; diagnosis ; Female ; Humans ; Male ; Retrospective Studies ; Urogenital Abnormalities ; classification ; diagnosis ; Uterus ; abnormalities ; Vagina ; abnormalities

Microform cleft lip is a mild expression of cleft lip. Downward depression of the nostril rim, skin striae of the upper lip, notching of the Cupid`s bow, and deformity of the vermilion border are characteristic findings. The definition is very important to aid in selection of the operative methods. Based on our operative experiences of cleft lip, we classified microform cleft lip according to our new definition.. According to author`s classification, class I(1 case) has cleft lip nose deformity without lip deformity or with slight short lip of cleft side, class IIa(5 cases) has minimal lip deformity with blurring of cupid`s bow, vermilion notching, and skin striae with intact of orbicularis oris muscle, class IIb(12 cases) has discontinuity of the orbicularis oris muscle, class III(5 cases) has mild lip nose deformity with discontinuity of orbicularis oris muscle including Cupid`s bow deviation. In class IIb and class III, reconstruction of orbicularis oris muscle is important and we repaired it with radical operation by rotation-advancement method. A total of 23 microform cleft lip result was reviewed. We treated the clefts following the above principles according to the classification and obtained satisfactory results.
Classification* ; Cleft Lip* ; Congenital Abnormalities ; Depression ; Lip ; Microfilming* ; Nose ; Skin

PURPOSE: Subcutaneous mastectomy has been accepted as a standard for the treatment of gynecomastia. Surgical managements including ultrasound-assisted liposuction(UAL) have had limited success and several combined approaches were tried to find the most effective method. We designed a modified subcutaneous mastectomy, which we call "pan-cake method". The purpose of this study is to evaluate the results of our method for the treatment of gynecomastia. METHODS: 16 patients from 16 to 31 years of age having gynecomastia were operated using the pan-cake method. 11 patients were in grade I, and 5 patients were in grade II, no patient were in grade III or IV, according to Rod's classification. The pan-cake method started with modified periareolar incision. We executed subcutaneous dissection first and suprafascial dissection next. After dividing the breast into four equal quadrants, we removed breast tissue from each quadrant as necessary. The operation time for the resection was recorded and the weight of removed parenchyme tissues was measured. RESULTS: All the operations were successful. There were no asymmetries, contour deformities, or irregularities. Only 6 cases needed the combined therapy with ultrasound-assisted liposuction(UAL) because of the step deformities. The average operation time was 24.1 minutes and the average weight of removed breast tissue was 98.1g. All the patients were satisfied with the aesthetic results. CONCLUSION: We concluded that the pan-cake method is an alternative option for the surgical treatment of gynecomastia, giving good aesthetic results and relatively short operation time.
Breast ; Classification ; Congenital Abnormalities ; Gynecomastia* ; Humans ; Male ; Mastectomy, Subcutaneous

PURPOSE: Blowout fracture can lead to functional impairments and esthetic deformities such as impairment of ocular movement, diplopia, visual loss and enophthalmos. The object of this study is to present a classification and its analysis according to the computed tomographic scan in blowout fractures. We classified blow out fractures into three types according to the anatomical location of fracture, the size of the bone defect and the degree of periosteal injury by using the computed tomography scan. Each progress and complications were analyzed more than mean 1 year. METHODS: Among the 155 cases during 4 years, there were 11 cases of medial orbital wall fracture, 97 cases of inferior orbital wall fracture, 47 cases of combined type. The mean age of patients was 31.2 years, ranged from 8 to 84 years. RESULTS: According to our classification, surgical treatments through the nasoendoscopic approach, the subciliary approach, the transconjunctival approach or their combinations were performed in 116 patients, and conservative treatments were done in 46 patients. Presurgical clinical findings of diplopia, impairment of ocular movement, enophthalmos of more than 2 mm were present in 62 patients. After surgical treatment, clinical findings were remained in 7 patients. CONCLUSION: We think that our classification according to computed tomographic scan is helpful for the indication and it may decrease the complications such as impairment of ocular movement, diplopia, visual loss and enophthalmos.
Classification* ; Congenital Abnormalities ; Diplopia ; Enophthalmos ; Humans ; Orbit ; Orbital Fractures

The constricted ear was suggested by Tanzer for the purpose of obviating the confusion involving lop ear, cup ear and prominent ear as defect whose helix turns down, and scapha and fossa triangularis are narrowed. The constricted ear has a spectrum of severity and therefore, requires a graded surgical approach. Tanzer has described the degree of deformities of the constricted ear as falling into three groups. For the correction of constricted ear, there are numerous techniques but we have had difficulties in adopting these techniques in various type. We also describe the various constricted ear as the Tanzer's classification and adopted three methods to each type, banner flap(group I), concha cartilage graft (group II) and rib cartilage graft(group III) for reducing postoperative deformity and confusion in correcting the ear deformities. Constricted ear repairs must be individualized to accomodate each specific deformity. We corrected 22 cases of constricted ear in 20 patients using each optimal method described above according to the degree of deformities. Mild deformities need only reshaping and adjusting of existing tissues, moderate deformities need additional skin and severe deformities require a cartilage graft. For correction of constricted ear, accurate identification of the severity of deformity is essential. The results were satisfactory and we report our experience with relative literatures.
Cartilage ; Classification ; Congenital Abnormalities ; Ear* ; Humans ; Ribs ; Skin ; Transplants