No abstract available.
Cleft Lip* ; Congenital Abnormalities* ; Nose* ; Transplants*

No abstract available.
Ankylosis* ; Facial Asymmetry* ; Temporomandibular Joint*

In the practice of modern craniomaxillofacial surgery, there is a general agreement in favor of obtaining solid bony union through the use of titanium and vitallium rigid fixation. These metallic osteosynthesis are not free from inherent drawbacks and limitation. They are liable to have an adverse effect on the growth of the craniofacial skeleton, be a cause of secondary bony resorption, increase risk of infection, result in palpability or exposure and cause artifact in radiologic imaging. These can lead to undue secondary operations necessitating their removal. To overcome there shortcomings, there had been a continuous research on the development of a bioabsorbable skeletal fixation system using polymer of polylactic and polyglycolic acid. Recently, with introduction and commercial availability of a product(Lactosorb, Walter Lorenz) with a minimized resorption period and foreign body reaction, there is an increasing acceptance of its use as an alternative fixation device in craniomaxillofacial surgery. In effort to extend its use in facial bone fractures, Tatum and Eppley were the first report in its successful application in a clinical setting. We report on the clinical experience of such bioabsorbable rigid fixation in patients with maxillofacial trauma. In included one adult and three children in their growth period, underwent open reduction of facial bone fractures. They were followed up in terms of clinical and radiologic outcome for six months. Stalbe and adequate longterm fixation was obtained and no recurrences were noted.
Adult ; Artifacts ; Child ; Facial Bones* ; Foreign-Body Reaction ; Fracture Fixation* ; Humans ; Polyglycolic Acid ; Polymers ; Recurrence ; Skeleton ; Titanium ; Vitallium

No abstract available.
Cleft Lip* ; Congenital Abnormalities* ; Lip* ; Nose*

PURPOSE: To evaluate the usefulness of ultrasound guided confirm this change; the symbol has been corrupted in my version placement of tunneled hemodialysis catheters via internal jugular vein (IJV). METHOD: The outcomes of 52 hemodialysis catheters placed from January 2000 through December 2002 were retrospectively analyzed. Of 50 patients, 2 received two catheters. Initially, the patency of the IJV was evaluated with ultrasonography, after which the IJV puncturehe was performed under the guidance of ultrasonography. Under fluoroscopy, a 12.5 F double lumen hemodialysis catheter was placed at the caval atrial junction through a subcutaneous tunnel in the neck. To prevent initial failure we performed a flow test using a 50 cc syringe through the catheters in 47 patients. RESULT: Catheter placements were successful in all patients. Early complication was poorly functioning catheters immediately after placement (initial failure) in two cases (4%). However, no patients developed initial failure after we performed flow test using the 50 cc syringe through the catheters. There were no instances of pneumothorax or hemothorax. Nevertheless, late complications included injured catheters in two cases (4%), bacteremia in five (9.5%), and tunnel infection in 2 (4%). Mean duration of catheter use before removal was 86 days (3~55 days). The blood flow rate at first hemodialysis after catheter placement was 230+/-35.5 ml/min and after 1 month was 248+/-18.6 ml/min. Catheters were removed because of matured arteriovenous fistula in 36 cases (69%), bacteremia in five (9.5%), patient death in 7 (13.5%), injured catheters in two (4%) and tunnel infection in 2 (4%). Symptomatic central venous stenosis was not developed during the study period. CONCLUSION: Ultrasound guided placement of tunneled hemodialysis catheters via IJV is a safe method, and is useful for patients requiring long-term hemodialysis.
Arteriovenous Fistula ; Bacteremia ; Catheters* ; Constriction, Pathologic ; Fluoroscopy ; Hemothorax ; Humans ; Jugular Veins ; Neck ; Pneumothorax ; Renal Dialysis* ; Retrospective Studies ; Syringes ; Ultrasonography*

The goal of open reduction in mandibular fracture is to restore the underlying bony architecture to its pre-injury position in a stable fashion, with a minimal of aesthetic and functional impairment. Many cases of mandibular fracture are treated by intermaxillary fixation using arch bars after open reduction. In this study, after open reduction of fracture, 23 patients were grouped according to acrylic splint appliction. All patients was younger than 15 years old. Open reduction was performed by miniplate or interosseous wire fixation. After open reduction, 8 patients were applied with acrylic splint and 15 patients were applied with arch bar for intermaxillary fixation. Physical examination and postoperative panoramic x-ray were reviewed for the evaluation of occlusion. In the group where acrylic splint was used, 75% of the patients showed excellent subjective satisfaction and 25% showed good satisfaction. In the group where the acrylic splint was not used, 33% showed excellent and good satisfaction, 27% fair satisfaction and 1 patient showed poor satisfaction. On long-term follow- up, the group where acrylic splint was applied showed better occlusion compared to the group where acrylic splint was not applied.
Adolescent ; Humans ; Mandibular Fractures ; Physical Examination ; Splints*

The measurement and visualization of the roundness of the cranial circumference has not been attempted by the simple measurement device. That's why there has been a tendency that the morphologic cranial deformity can be diagnosed with accuracy only by the experienced physician. The accurate understanding of the roundness of the cranial circumference, however, is essential for the diagnosis and the decision of the treatment principle in cranofacial morphological deformity. Current methods, such as simple physical examination and/or the photography, are not enough to accurately express the roundness of the cranial circumference. In order to develop the new method of measurement, authors selected 16 points from the axial cutting plane of the cranium. These points can be selected under the same principle even though the axial plane changes. After measuring the distance of 16 points, the values are put into computer program. In conclusion, authors can retrieve the x, y coordinates of the 16 points and can show the intuitive roundness of the circumference of the selected axial plane of the cranium. This measurement tool will be helpful not only for the identification of the severity of the morphologic cranial deformity, but for the classification and the assessment of the result of the surgery.
Classification ; Congenital Abnormalities ; Diagnosis ; Photography ; Physical Examination ; Skull

PURPOSE: Rigid external distraction(RED) is a highly effective technique for correction of maxillary hypoplasia in patients with cleft or syndromic craniosynostosis. Despite many advantages of RED, it also has the problem of relapse as the conventional advancement surgery. Bicoronal approach, that is the common approach to gain access to the craniofacial skeleton, had some morbidity, such as hair loss, sensory loss, wide scar and temporal hollowing. We present our clinical experience of RED distraction with minimal invasive approach and early rigid fixation to overcome these disadvantages. METHODS: A 27-year-old female patient with Crouzon's disease underwent Le Fort III osteotomy and RED device application through the minimal invasive direct skin incisions. After the latent period of 5 days, distraction was undertaken until proper convexity and advancement were obtained. During the rigid retention period, inflammation occurred on the right cheek, and proper conservative managements were done including continuous irrigation. To maintain the stability of distraction, early rigid fixation was undertaken on the osteotomy sites through another skin incisions. Preoperative and postoperative orthodontic treatments were performed. Serial photographs and cephalometric radiographs were obtained preoperatively, after distraction and 6 months after distraction. RESULTS: The cephalometric analysis demonstrated postoperatively significant advancement of the maxilla and improvement of facial convexity. After 6-month follow-up period, the maxilla was stable in the sagittal plane and no relapse was found. Facial scars were not noticeable and other deformity and morbidity did not occur. CONCLUSION: This effective and stable technique will be a good alternative for the patients who need large amount of distraction and for adult patients with severe maxillary hypoplasia or syndromic craniosynostosis.
Adult ; Cheek ; Cicatrix ; Congenital Abnormalities ; Craniofacial Dysostosis* ; Craniosynostoses ; Female ; Follow-Up Studies ; Hair ; Humans ; Inflammation ; Maxilla ; Osteogenesis, Distraction* ; Osteotomy* ; Recurrence ; Skeleton ; Skin

PURPOSE: Rigid external distraction(RED) is a highly effective technique for correction of maxillary hypoplasia in patients with cleft or syndromic craniosynostosis. Despite many advantages of RED, it also has the problem of relapse as the conventional advancement surgery. Bicoronal approach, that is the common approach to gain access to the craniofacial skeleton, had some morbidity, such as hair loss, sensory loss, wide scar and temporal hollowing. We present our clinical experience of RED distraction with minimal invasive approach and early rigid fixation to overcome these disadvantages. METHODS: A 27-year-old female patient with Crouzon's disease underwent Le Fort III osteotomy and RED device application through the minimal invasive direct skin incisions. After the latent period of 5 days, distraction was undertaken until proper convexity and advancement were obtained. During the rigid retention period, inflammation occurred on the right cheek, and proper conservative managements were done including continuous irrigation. To maintain the stability of distraction, early rigid fixation was undertaken on the osteotomy sites through another skin incisions. Preoperative and postoperative orthodontic treatments were performed. Serial photographs and cephalometric radiographs were obtained preoperatively, after distraction and 6 months after distraction. RESULTS: The cephalometric analysis demonstrated postoperatively significant advancement of the maxilla and improvement of facial convexity. After 6-month follow-up period, the maxilla was stable in the sagittal plane and no relapse was found. Facial scars were not noticeable and other deformity and morbidity did not occur. CONCLUSION: This effective and stable technique will be a good alternative for the patients who need large amount of distraction and for adult patients with severe maxillary hypoplasia or syndromic craniosynostosis.
Adult ; Cheek ; Cicatrix ; Congenital Abnormalities ; Craniofacial Dysostosis* ; Craniosynostoses ; Female ; Follow-Up Studies ; Hair ; Humans ; Inflammation ; Maxilla ; Osteogenesis, Distraction* ; Osteotomy* ; Recurrence ; Skeleton ; Skin

Patients with secondary cleft lip nose deformity usually complain not only aesthetic problems but also functional problems such as nasal obstruction. However, there have been few studies on nasal airway problem in secondary cleft lip nose deformity patients and no reports for the correlation between degree of the deformity and nasal airway obstruction. The authors selected 34 patients with secondary cleft lip nose deformity and measured the degree of morphological deformity by photo analysis and the degree of nasal airway obstruction by VAS score and acoustic rhinometry. Almost all patients complained of more obstructive symptom on the affected side. Functional anatomic structure and volume of the nasal airway examined by acoustic rhinometry showed that narrowest point was located above the nostril and pathological obstruction was more significant in patient group in both side and the area of the narrowest point and the total nasal volume was smaller in patient group. The result that alar contour difference has correlation with total nasal volume but not with objective symptom shows that there may be other factors affecting the nasal obstruction. Therefore the authors conclude that not only the correction of the external morphologic deformity but also the consideration of nasal airway obstruction is essential when performing operation on the secondary cleft lip nose deformity patients.
Acoustics* ; Airway Obstruction* ; Cleft Lip* ; Congenital Abnormalities* ; Humans ; Nasal Obstruction ; Nose* ; Rhinometry, Acoustic