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

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

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

Minimal cleft lip has been defined as a cleft which does not extend over the vermilion. Minimal cleft lip has no specific classification and few methods for its correction. Based on our operative experience with secondary cleft lipnose deformities, we have developed principles of operation for minimal cleft lip: minimal incision, nostril and alar reconstruction, philtrum reconstruction. alignment of cupid's bow, and vermilial notching correction. Nine patients of minimal cleft lip were operated on from March 1992 to June 1998 in our department. Each partients was evaluated for lip and nose deformities presurgically: the nasal tip, columella, ala, scar, cupid's bow, lip pout and lip length. Every patients required a different technique for repair. Satisfactory results were obtained by treating the cleft following the principles.
Cicatrix ; Classification ; Cleft Lip* ; Congenital Abnormalities ; Humans ; Lip ; Nose

STUDY DESIGN: A review of the literature. OBJECTIVES: To discuss how to evaluate, interpret, and utilize measurements of spino-pelvic alignment before and after spinal surgery in patients with lumbar degenerative disease. SUMMARY OF LITERATURE REVIEW: Various spino-pelvic parameters are currently utilized in the evaluation of spinal patients; however, interpretation of these parameters is not easy. MATERIALS AND METHODS: Each spino-pelvic parameter and factors affecting its value, and how to interpret and utilize the spino-pelvic parameters before and after spinal surgery were discussed for patients with lumbar degenerative disease with and without sagittal spinal deformity. RESULTS: Sagittal modifiers in the SRS-Schwab classification including pelvic incidence minus lumbar lordosis (PI-LL), sagittal vertical axis (SVA), and pelvic tilt (PT) are widely accepted in the evaluation of lumbar degenerative disease with sagittal deformity. Surgery for sagittal realignment is meant to restore both the SVA and PT by restoring the LL in reference to the PI. However, patients with an extremely high SVA and PT or those with a high SVA and low PT can end up with postoperative residual malalignment. In patients without deformity, PI-LL mismatch (> 10°) should be highlighted and should be actively corrected by restoring the lordosis of the pathologic segment. CONCLUSIONS: Sagittal modifiers are beneficial for their simplicity and comprehensibility; however, they are insufficient for evaluating sub-regional spinal deformity. Spino-pelvic parameters can be useful for evaluating spinal patients in a clinical setting, but the measurements are greatly affected by confounding factors such as poor patient posture, unqualified testers, and manual measurement techniques.
Animals ; Classification ; Congenital Abnormalities ; Humans ; Incidence ; Lordosis ; Posture

Polydactyly is a most common congenital anomaly of the foot. As is in the hand, it's classification systems and operative methods are various and complicated, but not much attention is given. We reviewed 129 foot polydactylies of 96 patients since the last 10 years(1993- 2003). Cases were classified morphologically and radiologically by previous classification systems(Wassel's classification, Hirase's classification) and then operative methods, complications, residual deformities were reviewed. Cases from the complications related to surgery including residual deformities were the major concern and 20 cases of unfavorable results were mainly due to varus deformity and metatarsal bone status. Based on our study, cases were reclassified by metatarsal bone status and varus deformity, and in conclusion we found that the new classification system is more helpful in deciding surgical method, predicting complications and residual deformities. Therefore, we suggested a new simple classification system based on the status of metatarsal bone and varus deformity, which is a more suitable system to planning operative method and predicting complication and residual deformity than the previous classification system.
Classification* ; Congenital Abnormalities* ; Foot* ; Hand ; Humans ; Metatarsal Bones* ; Polydactyly*

There have been several reports that nasal bone fractures are inadequately managed. They are probably due to poor understanding of the pathophysiology of nasal bone fracture and absence of the accurate diagnostic method. And there has been little adequate comprehensive classification of nasal bone fracture and nasal septal fracture. We examed 132 patients sustaining nasal bone fracture using computerized tomography. Fracture line, deviation, depression, associated skeletal deformities and the nasal septum were clearly identified. We compared our results with Murray & Maran's classification of nasal bone fracture. We found that they revealed almost same results and computerized tomography was good method for diagnosis of nasal septal fracture. The computerized tomography will be helpful for accurate diagnosis and preperative planning of the correction of nasal bone and septal fracture.
Classification ; Congenital Abnormalities ; Depression ; Diagnosis ; Humans ; Nasal Bone* ; Nasal Septum