From 1989 to 1996, push back palatoplasty, 2-flap palatoplasty and Furlow's palatoplasty were the main procedures of cleft palate repair in our institute. To compare the maxillary growth state of patients in each palatoplasty group, evaluation of dental occlusion and cephalometric analysis were performed in total 50 patients. The results were as follows: 1. Normal control group was composed of 17 children who didn't have cleft lip or cleft palate. Mean values of cephalometric data in the normal control group were 6.19 cm in SN length, 1.17cm in ONA length, 7.29cm in effective maxillary length 53.88degree in SNO angle, and 82.41 degree in SNA angle. 2. Fourteen patients who underwent push-back palatoplasty showed anterior crossbite in all cases. SNO angle and SNA angle were significantly decreased compared to the normal control group, which indicated significant impairment of maxillary growth. 3. In seventeen patients who underwent 2-flap palatoplasty, 7 patients showed anterior crossbite. Cephalometric parameters showed no significant difference compared to the normal control group. 4. Nineteen patients underwent Furlow's palatoplasty. In this group, 3 patients had anterior crossbite. Cephalometric parameters showed no significant difference compared to the normal control group. Although this report was based on data acquired from patients before the age of complete maxillary growth, our results suggested that each palatoplasty would have a different influence on maxillary growth.
Child ; Cleft Lip ; Cleft Palate ; Dental Occlusion ; Facial Bones* ; Humans ; Malocclusion

No abstract available.
Follow-Up Studies* ; Lung Neoplasms* ; Lung*

Infections of the face, especially of the medial third or "the danger triangle", are the most frequent primary foci associated with thrombosis of cavernous sinus. Microorganisms entering the facial vein and pterygoid plexus from these sites are easily carried to the sinus through the ophthalmic vein. When the septic thrombosis involves various structures in the sinus, multiple clinical manifestations develop and if appropriate anti-infective therapy is not instituted timely, grave consequences with high mortality is possible. Recently, we experienced such a case. A five-year-old boy had high fever, proptosis, periorbital edema, chemosis and limitation of eye movements. Three days before admission, he had suffered from erythematous swelling spreading over the periorbital area, where simple steroid ointment containing no antibiotics had been applied after a furuncle on the nose had been squeezed. On admission, brain MRI revealed meningeal enhancement, high-signal densities in enlarged right cavernous sinus and narrowing of internal carotid artery. Analysis of cerebrospinal fluid showed bacterial meningitis and the cultures of blood and eye discharge proved to be Staphylococcus aureus. On massive antibiotic therapy, he recovered swiftly without any adverse sequelae. The authors report this case with a warning against wide-spread misuse of steroids and inadequate treatment of the mostly neglected, but once-dreaded minor infections on the face.
Anti-Bacterial Agents ; Brain ; Carotid Artery, Internal ; Cavernous Sinus Thrombosis* ; Cavernous Sinus* ; Cerebrospinal Fluid ; Edema ; Exophthalmos ; Eye Movements ; Fever ; Furunculosis* ; Humans ; Magnetic Resonance Imaging ; Male ; Meningitis, Bacterial ; Mortality ; Nose ; Staphylococcus aureus ; Steroids ; Thrombosis ; Veins

Malignant transformation develops in a little less than 2% of mature cystic teratomas. A wide variety of malignant tumors may arise within benign mature cystic teratomas, and the most common of these is squamous cell carcinoma, which account for 75~85%. In general, the tumors are in an advanced stage and the prognosis is poor as most patients die within a year. However, when the tumor is confined to the ovary, they have a good prognosis and the 5-year survival rate is 63~83%. We experienced three cases of squamous cell carcinoma arising in mature cystic teratoma. Two of the carcinomas occurred in postmenopausal women: 58-(case 1) and 66-(case 2) year-old, and were confined to the ovaries. They were alive 37 months and 18 months after the operation, respectively. The third case was a 45-year-old premenopausal woman who had an extraovarian extension of the tumor and early recurrence within two months. Histologically, cases 1 and 3 were conventional well to moderately differentiated squamous cell carcinomas and case 2 showed a well-differentiated squamous cell carcinoma with exuberant proliferating trichilemmal tumor-like areas.
Carcinoma, Squamous Cell* ; Female ; Humans ; Middle Aged ; Ovary* ; Prognosis ; Recurrence ; Survival Rate ; Teratoma*

PURPOSE: Tracheal transplantation is necessary in patients with extensive tracheal stenosis caused by trauma, congenital disease, benign or malignant tumor. Results with the cryopreserved vascular homograft have prompted us to evaluate cryopreserved trachea. When trachea is cryopreserved, it maintains viability of the cartilage and allogenicity decreased because epithelium of trachea whitch has major allogenicity (MHC class II Antigen) is exfoliated after some periods of cryopreservation. We assessed the proper duration of cryopreservation and probability of trachea allotransplantation. METHODS: The trachea were harvested from Mongrel dogs and frozen to 80degrees C for different length preservation (group 1: 1~10 week, group 2: 1 month, 2 months, 3 months, 6 months, 2 months). Ggoup 1 was thawed and tested epithelial viability, Group 2 was perfomed trachea transplantation with cryopreserved trachea allograft, after one months We checked gross appearance, viability of cartilage and grade of monocyte infiltration (rejection). RESULTS: In group 1, Exfoliation of epithelium was begun after four weeks cryopreservation, in group 2, when allograft was extracted, trachea of 4 dogs was stenosed, and six months preserved trachea was not seen due to total necrosis. Cartilage viability of 4 case of transplantation, three of 4 case were mild infiltration of monocyte. CONCLUSION: We conclude that more than 1 month cryopreservation for prevention of rejection and additional procedure (omentopexy) for graft vascular supply are needed for trachea transplatation. Although cryopreservation was performed, all case of transplantation happened some degree graft rejection. if trachea transplantation will be applied, immune suppress will be needed.
Allografts* ; Animals ; Cartilage ; Cryopreservation ; Dogs* ; Epithelium ; Graft Rejection ; Humans ; Monocytes ; Necrosis ; Trachea* ; Tracheal Stenosis ; Transplants

A wide variety of free muscle or composite flaps have been used clinically for the reconstruction of soft tissue or compound tissue defects since introduction of the microsurgical technique but there were still difficulties in their application due to donor site morbidity and flap bulkiness. Free serratus anterior muscle flap and free composite flap, including serratus anterior muscle have been applied to 17 patients with small or medium sized tissue defects or large sized compound tissue defects from June 1995 to July 1997. There were 11 male cases and 6 female. Average age was 27 years. Defect sites were the anterior tibial area in 6 cases, the dorsum of foot in 6, the medial malleolar area in 1, the heel area in 1, the foot in 2, and the thumb and 1st web space in 1. There were 12 free muscle flaps, 2 free serratus anterior and rib composite flaps, 2 free serratus anterior and latissimus dorsi combined muscle flap and 1 free serratus anterior and latissimus doris and rib composite flap. The average follow up period was 14 month. The survival rate was 100% in 16 cases, 80% in 1 case. There was no remarkable donor site morbidity and operative results were satisfactory in all cases. The advantages of this flap are consistent and reliable flap with minimal donor site morbidity, long constant large caliber pedicle, taking a thin flap, excellent malleability allowed a broad of range of inserting technique, and additional possibility of a composite flap.
Female ; Follow-Up Studies ; Foot ; Heel ; Humans ; Male ; Ribs ; Superficial Back Muscles ; Survival Rate ; Thumb ; Tissue Donors

The major step toward successful tracheal transplantation is revascularization of the grafted trachea. There are many reports that although omentopexy is an effective method to facilitate neo-vascularization in tracheal transplantations, the procedure has not been accepted universally in the transplantation field. It remains unclear whether an omentopexy can successfully revascularize tracheal graft regardless of the length of graft. This study was undertaken to assess the usefulness of omentopexy for long-segment(more than 4 cm) tracheal allotransplantation. We have performed six tracheal transplantations with omentopexy (group A) and four tracheal transplantations without omentopexy (group B) in mongrel dogs from July 1993 to February 1995. Five mid-portion tracheal rings were removed from ten donor dogs and ten corresponding tracheal rings were removed from the ten recipient dogs. The excised tracheal rings from the donors were transplanted to the recipient tracheal-excised sites. All the recipients were given cyclosporine, azathioprine, and prednisolone for immunosuppression in the post-operative period. The histologic results of all the surviving members of group B were better than those of the group A. These findings indicate that omentopexy has a limitation, it is not a major method for graft revascularization. Therefore the length of the tracheal graft was greater than 4.0 cm, for its viability, a longer tracheal graft requires some other blood supply aside from the omentopexy.
Animal ; Dogs ; Omentum/*surgery ; Support, Non-U.S. Gov't ; Trachea/*transplantation ; Transplantation, Homologous

Acute pulmonary infarction by tumoral thromboemboli is an extremely rare fatal complication as the first clinical manifestation of hepatocellular carcinoma (HCC) patient with tumoral thrombi in the inferior vena cava. The treatment method has not been established and shown to very poor prognosis despite of trying various modalities such as anticoagulation, radiotherapy and thromboembolectomy. Here, we describe a 74-year-old man who was diagnosed with HCC that presented as pulmonary thromboembolism and subsequent pulmonary infarction as the first manifestation.
Aged ; Carcinoma, Hepatocellular* ; Humans ; Infarction ; Methods ; Prognosis ; Pulmonary Embolism ; Pulmonary Infarction* ; Radiotherapy ; Thromboembolism* ; Vena Cava, Inferior

Osteomas of the paranasal sinuses rarely lead to intracranial manifestations. The authors report an unusual case of a frontal sinus osteoma leading to subdural emyema formation. A 19-year-old man presented with headache and fever one month after minor facial trauma. Neuroradiological studies revealed subdural empyema in left frontal lobe with moderate cerebral edema and a osteoma in the left frontal sinus with sinusitis of maxillary sinus. The patient was surgically treated in one stage operation of decompressive craniectomy, removal of subdural empyema with frontal sinus osteoma, and endoscopic sinus surgery via cranial and nasal route. The patient recovered very well after surgery and postoperative antibiotic therapy. The etiology of intracranial infection and the treatment strategy are to be discussed.
Brain Edema ; Decompressive Craniectomy ; Empyema, Subdural* ; Fever ; Frontal Lobe ; Frontal Sinus* ; Headache ; Humans ; Maxillary Sinus ; Osteoma* ; Paranasal Sinuses ; Sinusitis ; Young Adult

PURPOSE: Venous malformation(VM) which often causes pain and discomfort is the most common type of vascular malformations. Although it is presented with disfigured appearance and associated soft tissue or skeletal hypertrophy, the molecular bases of VMs are poorly understood. Differentially expressed genes(DEGs) of VMs were investigated to illuminate the molecular mechanism of the disease entity. METHODS: Gene expressions of VM patients' subcutaneous tissue were studied in comparison with normal persons' by GeneFishing(TM) technique using the annealing control primers (ACPs) to identify DEGs. Candidate genes were sequenced and screened by basic local alignment search tool (BLAST) afterwards. RESULTS: Among seventy DEGs identified, forty DEGs which had shown significantly different expression pattern were sequenced. Twenty eight out of 40 were up- regulated while 12 were down-regulated. BLAST searches revealed that 37 were known genes and 3 were unknown genes. Many genes were involved in the differentiation and remodeling of smooth muscle cells, opposed to the previous hypothesis that a lot of angiogenetic genes would be involved. Furthermore, several transcription factors and related genes, as well as cell signaling and metabolism regulators, were up regulated. CONCLUSION: It suggests that analysis of DEGs in VMs provide basic knowledge about its pathophysiology. and new therapeutic approaches.
Gene Expression* ; Genes, vif ; Hypertrophy ; Metabolism ; Myocytes, Smooth Muscle ; Subcutaneous Tissue ; Transcription Factors ; Vascular Malformations