Craniosynostosis is a congenital anomaly in which cranial sutures close prematurely and restrict skull growth. In this paper, the case of two siblings, a male and a female, who were both diagnosed as craniosynostosis is reported. They underwent corrective osteotomy for cranial vault remodeling. A 22-month-old female infant who was brought to the department of plastic and reconstructive surgery of the authors' hospital was diagnosed with plagiocephaly. At the same time, her 7-month-old brother was diagnosed with brachycephaly. In the case of the female infant, corrective coronal osteotomy and supraorbital bar advancement were performed. Her brother underwent frontal advancement osteotomy using Tessier's tongue in the groove procedure. After the correction of the craniosynostosis, the two patients recovered in several days later, and the results were good in both cases cosmetically and functionally. They showed normal head circumference increasing curves and no symptom of functional disorder in their last follow-up. Isolated or nonsyndromic craniosynostosis is sporadic but mostly autosomal dominant. This paper presents a case of craniosynostosis with a genetic tendency; and although it occurred between siblings, the affected lesions differed. Thus, appropriate diagnosis and management in patients are needed.
Cranial Sutures ; Craniosynostoses* ; Female ; Follow-Up Studies ; Head ; Humans ; Infant ; Male ; Osteotomy ; Plagiocephaly ; Siblings* ; Skull ; Tongue

The anterior maxillary sinus walls are the most frequently injured sites in midfacial fractures. The maxillary sinus is a difficult surgical site for reduction and fixation due to its narrow surgical field, and has a chance of developing sinusitis when sufficient treatment is not given. In this study, the methods developed by the authors for managing such are introduced. Two small openings were made on both sides of the fracture line, then a suture knot was tied instead of wiring for reduction and fixation. Then an absorbable mesh was applied on top of the fracture site, with a suture knot for additional fixation. This method was applied on an actual patient, and it was a convenient method despite the narrow surgical field that was provided. The authors believe that using suture knots to fixate fractured segments and absorbable mesh is relatively convenient and economically efficient when it comes to the reduction and fixation of the maxillary sinus wall fracture with several fragments.
Humans ; Maxillary Sinus* ; Sinusitis ; Sutures*

BACKGROUND: Basal cell carcinoma (BCC) is the most common skin cancer. About 74% cases of basal cell cancer occur on the head and neck. Basal cell carcinoma on the face may have a higher degree of subclinical spread than tumors arising elsewhere. And incompletely excised BCCs become more aggressive when they recur. So the surgical removal and reconstruction of BCC located on the face are important to make perfect curing and cosmetic results. METHODS: A retrospective study was done with 128 patients (137 cancers) who were treated with BCC on the face since 1987 to 2011. General data of these cases such as the primary site of cancer, age and sex of the patients, operative methods, and recurrence rate were reviewed. RESULTS: The ratio of men to women was 1:1.4. And 86.9% of the patients with BCC were older than the age of 50 years with the mean age of 65.8 years. The distribution of facial basal cell carcinoma was on the nose, eyelids, cheek, and nasolabial fold. Surgical methods for treatment were local flap, full thickness skin graft, primary closure, and split thickness skin graft. Specifically, local flap consists of V-Y advancement flap, cheek advancement flap, limberg flap, forehead flap, nasolabial flap, rotation flap, transposition flap, bilobed flap, and island flap. Six cases recurred and all of them were treated with reoperation. CONCLUSION: The authors reviewed facial basal cell carcinoma cases in our hospital. This study might be helpful to choose appropriate operation method to manage BCC on face in Korea.
Carcinoma, Basal Cell* ; Cheek ; Eyelids ; Female ; Forehead ; Head ; Humans ; Korea ; Male ; Nasolabial Fold ; Neck ; Neoplasms, Basal Cell ; Nose ; Recurrence ; Retrospective Studies ; Skin ; Skin Neoplasms ; Transplants

BACKGROUND: When using the anterior approach for performing superficial parotidectomy, the first thing to do is to find the buccal branch of the facial nerve and the parotid duct. The buccal branch usually runs transversely with the parotid duct from the anterior border of the parotid gland. We wanted to check the relationship between the two structures during the operation and to get clinically helpful information. METHODS: Twelve patients with parotid mass were treated with superficial parotidectomy between May 2012 and August 2012. The outline of superficial and deep lobes of the parotid gland, parotid duct, and the buccal branch of the facial nerve were drawn on the transparent film by tracing the structures intraoperatively. RESULTS: In 7 (58.3%) of 12 cases, the buccal branch of the facial nerve was located more caudally than the parotid duct at the anterior border of the superficial lobe of the parotid gland. In 3 cases (25%), the buccal branch was located more cephalically than the parotid duct. The mean distance between two structures were 2.54+/-1.48 mm. In 11 cases, the parotid duct was located deeper than the buccal branch. CONCLUSION: The buccal branch of the facial nerve tends to be located more caudally than parotid duct and runs more superficially than parotid duct in all cases. We identified the relationship between the parotid duct and the buccal branch of the facial nerve during the operations on living subjects, not from the cadavers, so it would be a clinically helpful study which supplied more accurate anatomical information.
Cadaver ; Facial Nerve* ; Humans ; Parotid Gland ; Salivary Ducts*

BACKGROUND: Among facial fractures, nasal bone fracture, zygomatic arch fracture and mandibular subcondyle fracture take a large portion. Among surgical operations for nasal bone fracture, zygomatic arch fracture and mandibular subcondyle fracture, closed reduction has been generally used but, unlike open reduction, there is a problem in evaluating its accuracy of reduction. METHODS: An assessment was made from October 2011 until April 2013 prospectively on 37 patients. For all the operations, closed reductions were executed in a conventional way and simultaneously using C-Arm to verify the reduction of fractures. Two images of plain radiography, one taken before operation and another one taken one day after the operation, were compared. After obtaining images of plain radiography using C-Arm immediately after the correction upon operation, they were compared with the images of plain radiography taken one day after the operation. RESULTS: The fracture reductions of 26 patients among 27 nasal fracture patients were satisfactory but one patient showed a marginal overcorrection of less than 1 mm. The fracture reductions of 7 patients among 8 zygomatic arch fracture patients were satisfactory but one patient showed a marginal undercorrection of less than 2 mm. All of two mandibular subcondyle fracture patients showed less than 2 mm undercorrection. CONCLUSION: Closed reduction guided by C-Arm for nasal bone fracture, zygomatic arch fracture and mandibular subcondyle fracture was clinically useful because it could make a real-time assessment on fractured areas and add immediate corrections during the operation.
Facial Bones* ; Fluoroscopy* ; Fractures, Closed ; Humans ; Mandible ; Nasal Bone ; Prospective Studies ; Zygoma ; Zygomatic Fractures

BACKGROUND: If patients have a better understanding about their problem and treatment, compliance and satisfaction with treatment will increase. For this purpose, simple repeated explanations regarding a patients' problem and treatment are essential. Critical pathway (CP) has a very wide range in medicine with the exception of the plastic surgery field. The authors developed a CP for facial bone fractures and implemented it clinically. The aim of this study was to evaluate the effectiveness of the CP on the degree of recognition of the problem along with patient satisfaction with the treatment process. METHODS: From May 2011 to October 2011, a total of 82 patients suffering from facial bone fractures were studied. The CP for facial bone fractures was developed by plastic surgeons, residents and nurses. Subsequently, the authors investigated the degree of recognition of the disease and patient satisfaction with the treatment through the use of a questionnaire. The authors compared the score of the questionnaires before and after implementation of the clinical pathway. RESULTS: The degree of the recognition of the problem changed from 3.1 to 4.2 (p<0.001). Further, the degree of satisfaction with the treatment process changed from 3.6 to 4.3 (p<0.05). Overall, there was a two point increase in improvement. CONCLUSION: Implementation of the CP for facial bone fractures was effective in improving the degree of recognition and satisfaction. The authors expect that hereafter, the CP for facial bone fractures will be implemented actively in the plastic surgery field.
Compliance ; Critical Pathways* ; Facial Bones* ; Humans ; Patient Satisfaction ; Surgery, Plastic ; Surveys and Questionnaires

BACKGROUND: To suggest the need of more aggressive reduction techniques than closed reduction (CR) technique in nasal fracture treatment, we identified the usefulness of algorithm oriented treatment of nasal fracture that includes indirect open reduction (IOR) and external fixation (EF) as well as the CR. METHODS: We compared the clinical course of the group A (n=128) where only the CR was performed regardless of the pattern of the nasal fracture and the group B (n=127) where algorithm oriented treatment including IOR and EF as well as CR was performed depending on the pattern of nasal fracture. And the degree of postoperative pain after CR and IOR technique was compared through the dose of analgesics and pain scores. RESULTS: More than 80% of patients were satisfied the result of reduction in both group A and B. Good contour of nasal bone after reduction was showed 71% of group A and 81% of group B without significant difference. Minor (p>0.05) and major (p<0.05) deformity after reduction were less occurred in the group B than group A. Postoperatively, the dose of analgesics was significantly lower after IOR technique than CR technique (53 mg vs. 142 mg) (p<0.05). CONCLUSION: Algorithm oriented treatment of nasal fracture including IOR and EF as well as CR reduce major deformity after reduction than treatment of CR alone. It is useful to perform the more aggressive reduction techniques such as IOR and EF according to the pattern of fracture in treatment of nasal fracture.
Analgesics ; Congenital Abnormalities ; Humans ; Nasal Bone ; Pain, Postoperative

It is important to distinguish deformational plagiocephaly from craniosynostosis, the two conditions are different with respect to clinical progression and treatment options. Deformational plagiocephaly is diagnosed based on the patient's medical history and physical examination. Until recently, there has been no standardized method of evaluation. Visual assessment, anthropometric assessment, digital scanning, and radiologic evaluation are mostly commonly used modalities for diagnosis and assessment. Treatment of deformational plagiocephaly requires an understanding of natural progression of the disease. Deformational plagiocephaly should be classified according to its severity before the proper method and time for treatment are determined. Treatment includes repositioning, physiotherapy and remodeling with the use of orthotic devices. In general, repositioning is preferred for patients younger than six months old while treatment with the use of orthotic devices such as helmet is preferred for patients over six months old. Moreover, treatment with the use of orthotic devices is also favored for severe plagiocephaly. There is continuing research on the relation between deformational plagiocephaly and developmental delay.
Craniosynostoses ; Head Protective Devices ; Humans ; Orthotic Devices ; Physical Examination ; Plagiocephaly ; Plagiocephaly, Nonsynostotic*

Retrobulbar hemorrhage is a rare but serious complication after blepharoplasty, mid-face injury, and treatment of facial bone fractures. The incidence of postoperative retrobulbar hemorrhage is 0.055% with an incidence of associated permanent blindness of 0.005%. A 69-year-old male came to the emergency room with pain on both orbital areas and uncontrolled bleeding after cosmetic lower blepharoplasty performed at a private clinic. He had not been evaluated preoperatively by the private clinic, but we found that he had undergone percutaneous transluminal coronary angioplasty and taken anticoagulants for 10 years. We performed an emergency operation to evacuate the hematoma. However, after surgery, he persistently complained of orbital pain, pressure and diminished visual acuity. Intraocular pressure was increased, and computed tomography demonstrated a retrobulbar hemorrhage with globe displacement. Emergent lateral canthotomy and cantholysis were performed. Intraocular pressure was decreased to 48/30 mm Hg immediately after the operation, falling within the normal range the next day. We recommend three points to minimize loss of vision by retrobulbar hematoma. Firstly, careful preoperative evaluation must be conducted including current medications, underlying diseases and previous history of surgeries. Secondly, cautious postoperative observation is important for the early diagnosis of retrobulbar hematoma. Lastly, immediate treatment is crucial to prevent permanent blindness.
Aged ; Angioplasty, Balloon, Coronary ; Anticoagulants ; Blepharoplasty* ; Blindness ; Early Diagnosis ; Emergencies ; Facial Bones ; Hematoma ; Hemorrhage ; Humans ; Incidence ; Intraocular Pressure ; Male ; Orbit ; Reference Values ; Retrobulbar Hemorrhage* ; Vision, Ocular ; Visual Acuity

Cutaneous squamous cell carcinoma is the second-most common skin cancer and represents 20% of all skin cancers. Cutaneous squamous cell carcinoma often spreads to the parotid gland through lymph nodes, but, direct invasion of an adjacent organ may also occur. We present the case of 78-year-old man with ulcerated mass on the right infra-auricular area. The histopathologic finding was squamous cell carcinoma. There was no evidence of distant metastasis, but the mass was found to invade the superficial lobe of the right parotid gland. The mass was widely excised and superficial parotidectomy was performed while preserving the facial nerve. The defect was covered by primary closure. Postoperative radiotherapy was performed. At 20 months after surgery, our patient had no facial palsy, local recurrence, or metastasis. Cutaneous squamous cell carcinoma involving the parotid gland is an aggressive, rapidly advancing lesion, which if not recognized and treated early will result in high morbidity and mortality. Squamous cell carcinoma of the parotid gland has shown that patients who receive adjuvant radiotherapy have a lower recurrence rate and a higher survival rate than patients treated with surgery alone. The role of elective neck dissection remains controversial.
Aged ; Carcinoma, Squamous Cell* ; Facial Nerve ; Facial Paralysis ; Humans ; Lymph Nodes ; Neck Dissection ; Neoplasm Metastasis ; Parotid Gland* ; Radiotherapy, Adjuvant ; Recurrence ; Skin Neoplasms ; Survival Rate ; Ulcer