Numerous surgical procedures have been advocated to correct the facial deformity in patients with hemifacial microsomia, including chondrocostal grafts, mandibular osteotomies combined with bone grafts, and maxillary osteotomies done at an early age after permanent dentition is completed. The standard treatment of these malformations consists of the application of bone grafts which can lead to unpredictable growth. Furthermore, these procedures often require intermaxillary fixation, blood transfusions and sometimes tracheostomies. Lengthening of the mandible by gradual distraction, according to the method of Ilizarov, opens new perspectives for interceptive therapy. Laboratory and clinical studies have shown that mandibular distraction is an effective and powerful reconstructive surgical technique. Lengthening of the mandible by gradual distraction was performed on five patients of hemifacial microsomia and one patient of Goldenhar syndrome using unidirectional or bidirectional extraoral device and intraoral device. In two patinets, simultaneous mandibular and maxillary distraction was performed with incomplete Le Fort I osteotomy. The amount of mandibular bone lengthening ranged from 8 to 21 mm, the patinets were maintained in fixation for an average of 12 weeks to allow ossification. There was no severe perioperative complication and the length of clinical follow-up ranged from 3 to 17 months. The skeletal change resulting from directional bone lengthening could be seen best by comparing the pre-and postoperative 3-D CT scans. There was also the potential for improvement in neuromuscular function (functional matrix), attendant growth and development of the affected jaw. Mandibular distraction is a simple procedure with minimal morbity and complications, so the results to date indicated that the technique can be applied to the correction of hemifacial microsomia. The development of new devices should permit multidirectional mandibular distraction and craniofacial distraction to allow early reconstruction of cranio-maxillofacial malformations. Distraction osteogenesis for reconstruction of the mandible in this subest of young patients was a safe and effective technique for improving the craniofacial skeletal form and appearance, with minimal associated morbidity.
Blood Transfusion ; Bone Lengthening ; Congenital Abnormalities ; Dentition, Permanent ; Follow-Up Studies ; Goldenhar Syndrome* ; Growth and Development ; Humans ; Jaw ; Mandible ; Mandibular Osteotomy ; Maxillary Osteotomy ; Osteogenesis, Distraction ; Osteotomy ; Tomography, X-Ray Computed ; Tracheostomy ; Transplants

Autogenous costal cartilage graft has been commonly used for reconstruction of auricular deformity. However, the risk of complication and discomfort at the donor site, as well as distortion of the graft due to morphological change in the cartilage have been serious drawbacks to this procedure. Previous studies examining the chondrogenic potential of perichondrium have suggested that perichondrium may be used as graft for cartilage reconstruction. When a perichondrial flap or a free perichondrium was used as graft, new cartilage formed appositional to the grafted perichondrium. However, the neocartilage was often irregular in shape and varied considerably in quantity. In this study, the feasibility of controlling the shape and the mass of neocartilage was investigated using coral, a porous biomaterial, as a template. A coral a template was wrapped with perichondrial flap from the ears of New Zealand white rabbits and placed into a subcutaneous pocket in the rabbits and placed into a subcutaneous pocket in the rabbit's back by incision. A total of 12 animals were used. Formation of new cartilage was later evaluated by gross and histological examination of the perichondrial flap and the coral template. New cartilage was formed in 11 animals. Immature chondrocytes were visible by 3 weeks after the surgery, and by 8 weeks the immature chondrocytes had formed a cartilage. New cartilage was formed only on the surface of the coral template. These results indicated that the shape and the mass of new cartilage may be controlled by using coral template. Therefore, the desired shape of cartilage may be achieved using a coral template of corresponding shape, and this may help in correcting subtle auricular contour defect and in correcting other structural defects that also require new cartilage formation.
Animals ; Anthozoa* ; Cartilage ; Chondrocytes ; Congenital Abnormalities ; Ear ; Humans ; Rabbits ; Tissue Donors ; Transplants

Macrostomia is a relatively rare malformation. There have been many surgical methods for the correction of macrostomia. The old method, a simple straight line closure , did not include reconstruction of the orbicularis oris muscle. Postoperatively, a depressed scar and severe contraction on the cheek were found, especially with animation. As a result, many authors have known that reconstruction of the orbicularis oris muscle was very important to avoid a depressed scar for the correction of macrostomia. The tendency toward lateral displacement of the reconstructed commissure has been attributed to linear scar contraction, and Z-plasty is advocated to prevent this deformity. However, we found that the Z-plasty scar may be conspicuous when the patient smiles. So we performed reconstruction of the orbicularis oris muscle to avoid a depressed scar, and straight line closure to avoid a conspicuous scar. In order to prevent linear scar contracture due to straight line closure, we overcorrected the new commissure. We treated 6 cases of macrostomia form May 1, 1996 to April 30, 1999 using straight line closure and reconstruction of the orbicularis oris muscle. Periods of follow-up were from 12 months to 35 months, with an average of 20,2 months. Every patient was analyzed clinically by ordinary scale method and anthropometrically by the ratio of abnormal distances to normal distances between cheilion and crista philtri. In 3 clinical assessments : symmetry of the commissure was excellent: degree of the scar at rest was good: and degree of depression with animation was excellent. The anthropometrical ratio was 1:1.05. Despite the fact that the linear scars were perpendicular to the minimal skin tension lines, the scars were inconspicuous. The muscle repair provided reconstruction to the modiolus and gave a natural appearance to the commissure, however it did not seem to provide sufficient bulkiness around the commissure. The straight line skin closure and repair of the orbicularis oris muscle provide effective functional and aesthetic reconstruction.
Cheek ; Cicatrix ; Congenital Abnormalities ; Contracture ; Depression ; Follow-Up Studies ; Humans ; Macrostomia* ; Skin

PURPOSE: In the correction of cleft lip, there have been various methods to minimize recurrence of the nasal deformity after primary nasal surgery. After cheiloplasty and primary nasal surgery, we tried to elongate the columella of the cleft side, to stretch the vestibular lining of cleft side, and to elevate the alar cartilage of the cleft side with a molding prong. METHODS: We had fifteen cleft lip patients; 12 unilateral cases(6.3-8.2 months), and 3 bilateral cases(3 -7.5 months). Immediately after primary repair of the cleft lip, the toboggan shaped molding prong was located to deep inside of vestibular web of the cleft side. It was persistently suspended by a silicone tube which was connected to the prong and the frontal scalp. The results were analyzed with Photoshop(R) photogrammetrically for 6-48 months with on average of 20.6 months. We measured the proportion index of columellar length-interalar distance for three times(preoperation, immediate postoperation, and postoperation) on the nasal base views. RESULTS: In unilateral, the index had a significant increase statistically between preoperation(10.73) and immediate postoperation(23.96). It is supposed that columellar length was reconstructed to 105.80% of normal side. But, it was decreased to maintain 87.7% of normal side in postoperation(20.54). The results were similar in bilateral. The linear scars by suture penetrating nose skin were not discernable. CONCLUSION: In summary, placement of the molding prong could elongate the reconstructed columella with some relapse postoperatively.
Cartilage ; Cicatrix ; Cleft Lip* ; Congenital Abnormalities ; Fungi* ; Humans ; Nasal Surgical Procedures ; Nose ; Recurrence ; Scalp ; Silicones ; Skin ; Sutures

Damage of temporomandibular joints in infancy may result in ankylosis and alteration of the mandibular growth. In case of unilateral ankylosis occurring in early childhood, a mandibular hypoplasia of the affected side usually follows. The patients have limitation of mouth opening, poor oral hygiene, facial and mandibular growth disturbances, and rarely, upper airway obstruction in the form of either night snoring or obstruction sleep apnea. The objective of this study is to show the use of distraction osteogenesis in mandibular hypoplasia associated with ankylosis and to present our technique for the treatment of mandibular hypoplasia with unilateral ankylosis in infancy consisting of simultaneous arthroplasty which treats the ankylosis and mandibular distraction and enables to correct the facial asymmetry in the same procedure. Between November 1999 and May 2000, three girl patients (42, 44, and 48 months old) who had mandibular hypoplasia associated with ankylosis were treated with simulatneous arthroplasty and distraction osteogenesis. Two kinds of arthroplasties, consisting of gap arthroplasty for one patient and interpositional arthroplasty using a temporal fascia turn-over flap for the other two patients, were executed and mandibular distraction in all three patients. Mouth-opening exercises began on the first day following the operation. Mandibular distraction began on the fifth day after the operation at a rate of 1 mm per day (0.5 mm twice a day) and continued to achieve a slight overcorrection of deviated chin. From the first day after the operation, an increase in the mouth opening was achieved. The average duration of distraction was 20 days. Average duration of consolidation was 6 weeks. Oral opening increased from 2 to 20 mm in case of the first patient, from 4 to 28 mm in the second patient, and from 5 to 24 mm in the third patient. The follow-up period was from 5 to 12 months (mean 8 months). At the time of final evaluation, oral opening and a more normal facial contour persist. It is believed that mandibular distraction combined with arthroplasty offers a new therapeutic option for the treatment of mandibular hypoplasia associated ankylosis, with minimal morbidity and complications.
Airway Obstruction ; Ankylosis* ; Arthroplasty* ; Chin ; Exercise ; Facial Asymmetry ; Fascia ; Female ; Follow-Up Studies ; Humans ; Mouth ; Oral Hygiene ; Osteogenesis, Distraction ; Sleep Apnea Syndromes ; Snoring ; Temporomandibular Joint*

Adequate first web space is essential for web space expansion, thumb abduction, and a wide range of thumb mobility and hand function activities. First web space contracture is caused by burns, trauma, infection, arthritis, ischemia, paralysis, spastic conditions, improper splinting, Dupuytren's contracture, or congenital anomaly. We have treated 18 cases of first web space contracture from Nov. 1, 1996 to Apr. 30, 2000 using 23 various flaps. Four measurements such as maximal abduction angle, maximal abduction distance, radial abduction angle, and palmar abduction angle were examined preoperatively and postoperatively. We have classified first web space contracture as mild, moderate, or severe depending upon the magnitude of contracture and scarring of the first web contents (skin, fascia, muscle and joint capsule). We have performed hree Z-plasty, three double opposing Z-plasty, and two 4 flap Z-plasty in 6 mild contracture. We have performed two Z-plasty and F.T.S.G, two dorsal rectangular flap and F.T.S.G, two F.T.S.G, and two S.T.S.G in 5 moderate contracture. We have performed two distant flaps and five free flaps in 7 severe contracture. Periods of follow-up were from 12 months to 35 months with an average of 15 months. Every patient was analyzed by the ratio of postoperative measurements to preoperative measurements. The mean ratios of mild, moderate, and severe contracture were 1.33, 1.28, and 1.38 respectively. Although first web space contracture was severe, its ratio was more improved than that of mild or moderate contracture because of complete release and abundant soft tissue coverage such as first web space free flap. The proper methods of first web space contracture release in accordance with the classification allowed to achieve excellent results.
Arthritis ; Burns ; Cicatrix ; Classification* ; Contracture* ; Dupuytren Contracture ; Fascia ; Follow-Up Studies ; Free Tissue Flaps ; Hand ; Humans ; Ischemia ; Joints ; Muscle Spasticity ; Paralysis ; Splints ; Thumb

Leiomyomas of the appendix are rare and most are encountered incidentally during exploration of the abdomen for some other disease, during postmortem examination, or in the course of routine pathologic examinations of surgical specimens. We report here the findings of ultrasonography, CT and surgery of a case of leiomyoma that arose from the appendix; this lesion was pathologically confirmed.
Abdomen ; Appendix* ; Autopsy ; Leiomyoma* ; Ultrasonography

Medial canthoplasty is required to correct congenital anomaly and acquired deformity after trauma, especially nasoethmoid orbital fracture and to correct epicanthal fold. Several medial canthal surgical procedures have been used, but the postoperative results have not always been estimated. Between January 1, 1986 and April 30, 2000, 55 medial canthoplasties were performed in 32 patients. We report the experiences with 55 medial canthoplasties and analyze and compare each methods. The patients who underwent medial canthoplasty were analyzed anthropometrically by the ratio of left to right palpebral fissure dimension, the ratio of postoperative to preoperative palpebral fissure dimension and the ratio of postoperative to preoperative intercanthal distance. And every patient was analyzed clinically by ordinary scale method. Of several singly performed medial canthoplasties, del Campo technique was excellent because the ratio was much improved anthropometrically and the clinical assessments were 'excellent'. Of several singly performed medial canthopexies, transnasal wiring was excellent anthropometrically and clinically. Of simultaneously performed medial canthoplasties, del Campo technique with transnasal wiring were excellent because the ratio was much improved anthropometrically and the clinical assessments were 'excellent'. And the results of simultaneously performed medial canthoplasties group was better than that of singly performed medial canthoplasties group. And so, we concluded that del Campo technique with transnasal wiring for severe cases were recommendable for medial canthoplasty.
Anthropometry ; Congenital Abnormalities ; Humans ; Orbital Fractures

The mandible with the lower maxilla comprises the lower third of the face. A correction of the mandible in facial asymmetry would be helpful in improving aesthetic appearance. In general, surgical techniques for improving the contour of lower jaw deformities include correcting the deficient mandible by osteotomies, distraction osteogenesis and the augmentation of the mandible with alloplastic or autogenous materials. In a patient with satisfactory occlusal relationships and mild hypoplasia, alloplastic material for augmentation of the mandible on the affected side is more practical than autogenous augmentation. The porous high density polyethylene (PHDPE) implant is a widely available alloplast which is an attractive alternative to other alloplasts and autogenous tissues. Thirteen patients (8 men, 5 women), ages ranging from 17 to 47 years old, have types IA (n = 6) and IB (n = 5) hemifacial microsomia(Munro and Lauritzen, 1985), Klippel-Feil syndrome (n = 1), Romberg's disease (n = 1) were corrected with prefabricated porous high density polyethylene over a 4 year period (1996- 1999). The average follow-up period was 12 months, however the range has been between 6 and 36 months. Preoperative planning was done based on an aesthetic assessment of thickness of the soft tissue, the use of life size photographs, cephalometric and panorex x-rays and three dimensional computed tomography. The surgical technique consists of an intraoral approach incision, the an implant was placed subperiostealy, appropriately sculptured and fixed to posterior and inferior border of the mandible at the gonial angle. In four patients the implant had to be removed due to complications which included three cases of infection and one case of extrusion by iatrogenic trauma. One of the above four patients' implant was replaced with a smaller one, approximately 3 months after its removal. With the others nine patients there was no infection or permanent morbidity. Postoperative appearance was considered very satisfactory, the mandible was well outlined, and the facial proportions were improved. Porous high density polyethylene implant is recommended for hypoplastic mandible augmentation when proper indication are strictly observed and surgical steps are accurately followed.
Congenital Abnormalities ; Facial Asymmetry ; Facial Hemiatrophy ; Follow-Up Studies ; Humans ; Jaw ; Klippel-Feil Syndrome ; Male ; Mandible* ; Maxilla ; Middle Aged ; Osteogenesis, Distraction ; Osteotomy ; Polyethylene*

Loss of heterozygosity (LOH) has been established as an important genetic mechanism giving rise to malignant neoplasia. The mechanism of LOH has been shown to cause basal cell carcinoma and malignant melanoma as well as other types of skin cancer. A few studies on LOH in sporadic keratoacanthomas have been reported. The purpose of this study was to investigate the significance of LOH in the pathogenesis of sporadic keratoacanthomas developed in 10 Korean patients. The presents of LOH at 7 microsatellite markers (D2S286, D3S1317, D5S346, D9S160, D9S171, D10S185, and D17S261) were evaluated in sporadic keratoacanthomas. LOH was found in only 1 of 10 cases at D10S185. The low frequency of LOH detected in this study suggests that LOH may not be significant in the induction of sporadic keratoacanthomas.
Adult ; Aged ; Female ; Humans ; Keratoacanthoma/*genetics ; *Loss of Heterozygosity ; Male ; Middle Aged ; Research Support, Non-U.S. Gov't