The nasal tip occupies important position in Asian rhinoplasty because Asian has a nasal tip featuring of round or bulbous shape, lower height and wider base compared with that of Caucasian. The hardness of the nasal tip may be increased during the course of a routine rhinoplasty by maneuvers such as incision or excision of the lower lateral cartilage, suturing, and grafting of the cartilages. Changes of the hardness may be a component of postoperative dissatisfaction. However there is no device to measure the hardness of the nasal tip. We developed a "nasal tip durometer" using Teclock Durometer GS series 701 G. The spring rate of Teclock Durometer was converted from 0.223 kgf/mm to 0.036 kgf/mm to apply to the human body. After the remote air switch was fixed to apply with the same speed in a patient's nose, we manufactured the frame attachable to the surgical operation table. The reliability, validity, and responsiveness to clinical change of our durometer were evaluated in a clinical study of 20 patients. Our durometer was highly reliable (Spearman correlation coefficient, r=0.95), valid (Spearman correlation coefficient, r= 0.85), and responsible (effect size=11.37). We concluded that nasal tip durometer was useful to measure the hardness of the nasal tip objectively.
Asian Continental Ancestry Group ; Cartilage ; Hardness* ; Human Body ; Humans ; Nose ; Operating Tables ; Rhinoplasty ; Transplants

Although there has not yet been a clear determination of the structures responsible for nasal tip support, it is generally agreed that for Caucasians the components of nasal tip support include the attachment between the upper and lower lateral cartilage, the attachment between the lateral crus and the pyriform aperture, the attachment between the paired domes of the lower lateral cartilages, and the medial crural attachments of the caudal septum. To our knowledge, there has been no anatomical study of the nasal tip supporting structures for Asian patients. The purpose of this study is to determine these structures and how they differ from those of Caucasian patients. Ten noses of fresh cadavers were investigated. Dissection was performed and the above-mentioned nasal tip supporting structures were observed and excised. Histological examination was done with hematoxylin and eosin stains and Van Gieson elastin stains. Based on our results, we propose that the structures between upper and lower lateral cartilages, between lateral crus and pyriform aperture, between the paired domes of lower lateral cartilages should referred to as an intercartilaginous ligament, sesamoid fibromuscular tissure, and interdomal loose connective tissue, respectively. There is no identified specific tissue between medial crus and caudal septum. We consider that the loose connection between the domes of the middle crura and the lack of a specific structure between the medial crus and caudal septum might be the reasons why the nasal tips of Asian patients tend to be broad and unprojected with a wide base.
Asian Continental Ancestry Group ; Cadaver ; Cartilage ; Coloring Agents ; Connective Tissue ; Elastin ; Eosine Yellowish-(YS) ; Hematoxylin ; Humans ; Ligaments ; Nose

No abstract available.
Neurofibromatoses ; Peripheral Nerves

We present a case of a 57-year-old male patient who presented with squamous cell carcinoma on his mouth floor with cervical and mandibular metastases. Wide glossectomy with intergonial mandibular ostectomy, and sequential reconstruction using fibular osteomyocutaneous free flap were planned. When the anastomosis between the peroneal artery of the fibular free flap and the right lingual artery was performed, no venous flow was observed at the vena comitans. Then re-anastomosis followed by topical application of papaverine and lidocaine was attempted. However, the blood supply was not recovered. Warm saline irrigation over 30 minutes was also useless. Microvascular thromboses of donor vessels were clinically suspected, so a solution of 100,000 units of urokinase was infused once through a 26-gauge angiocatheter inserted into the recipient artery just at the arterial anastomotic site, until the solution gushed out through the flap vena comitans. Immediately after the application of urokinase, arterial flow and venous return were restored. There were no complications during the follow-up period of 11 months. We believe that vibrating injuries from the reciprocating saw during osteotomies and flap insetting might be the cause of microvascular thromboses. The use of urokinase may provide a viable option for the treatment of suspicious intraoperative arterial thrombosis.
Arteries ; Carcinoma, Squamous Cell ; Follow-Up Studies ; Free Tissue Flaps ; Glossectomy ; Humans ; Lidocaine ; Male ; Mouth Floor ; Neoplasm Metastasis ; Osteotomy ; Papaverine ; Salvage Therapy ; Thrombosis ; Tissue Donors ; Tissue Plasminogen Activator ; Urokinase-Type Plasminogen Activator

Objectives: . Fibro-osseous lesions of the paranasal sinuses can present various clinical manifestations. This study aimed to report the long-term clinical course of benign fibro-osseous lesions (BFOLs) in the paranasal sinuses, including clinical and radiologic features. Methods: . Radiologically confirmed BFOLs between 1994 and 2016, with the exclusion of osteoma cases, were retrospectively reviewed. We compared demographic characteristics between the surgery and observation groups. The reasons for the imaging study, radiographic features, histopathology, and clinical course based on serial image scans were analyzed. Results: . In total, 183 subjects were selected from a thorough review of head and neck radiologic tests (n=606,068) at a tertiary referral hospital over 22 years. Patients’ mean age was 28.6±18.1 years, and 56.3% were males. A diagnostic imaging workup was performed in 55.7% of patients due to facial asymmetry, headache, skull mass, or other symptoms related to BFOLs. In other patients (37.7%), BFOLs were found incidentally on computed tomography or magnetic resonance imaging. The most common diagnosis was fibrous dysplasia, followed by ossifying fibroma, based on both radiologic exams and histopathologic results. In total, 42.6% of the patients underwent surgery because of subjective symptoms or esthetic concerns. The patients who underwent surgery were younger (P<0.001) and had a longer follow-up duration (P<0.001) than those who underwent observation. Patients who experienced lesion growth (11.5%) were younger (P<0.001) and had more lesion sites (P=0.018) than those who did not, regardless of surgical treatment. Five patients underwent optic nerve decompression, and one patient experienced malignant transformation. Conclusion . BFOL in the paranasal sinuses is a rare disease, and most cases were observed without specific treatment. Surgical treatment should be considered in symptomatic patients with aggressive clinical features. Regular observation and management are needed, particularly in younger patients in their teens.

BACKGROUND: Scar revision is a fundamental technique in the field of plastic and reconstructive surgery. Methods using local flaps, such as a Z-plasty, W-plasty, or geometric broken-line closure, have been used for scar revision. Widening of scars is a frustrating event that most plastic surgeons have encountered. Several therapeutic modalities have been proposed, but frequently, the result is disappointing. We describe our experience with the use of a dermal splinting technique for scar revision. METHODS: We propose a technique by which tension on the wound is applied by tough scar tissue instead of the suture line, thereby reducing the incidence of postoperative widening. This technique was used to treat 21 nonburn scars that had widened:5 scars were facial (3 patients), 8 were on the extremities (6 patients), and 8 were on the torso (5 patients). All scars were at least 4 months old. The operations were performed between January 2003 and December 2012; follow-up was 9 to 24 months. RESULTS: Only one scar widened during the follow-up period. Overall, satisfaction with scar appearance and surgery was assessed with a visual analog scale (VAS). Mean patient satisfaction was 8.1 +/- 0.5. CONCLUSIONS: We recommend this technique in dealing with widened scars in highly tensile areas during revision surgery.
Cicatrix* ; Cosmetic Techniques ; Extremities ; Follow-Up Studies ; Incidence ; Patient Satisfaction ; Splints* ; Sutures ; Torso ; Visual Analog Scale ; Wounds and Injuries

BACKGROUND: In 2004, we reported on 110 consecutive Asian rhinoplasty patients who were treated with the addition of a footplate incision to obtain a greater aesthetic satisfaction. We continue to perform the reported technique with several modifications, and we still think that this method contributes to Asian rhinoplasty. METHODS: A footplate incision was made along the caudal border of the footplate of the medial crura onto the floor of the nasal vestibule. This incision can be made alone or in combination with either endonasal or open rhinoplasty. It enables surgeons to achieve a further tip projection since the pressure of the skin flap is reduced on the tip. In this study, we emphasize a couple of recent changes that we made to our procedure after publication of the prior article. First, we excised the dog-ear that appeared at the caudal end of the extended footplate incision. After making the new tip, a dog ear can be seen at the posterior end of the footplate incision. Second, an inferior columellar dissection was also extended to achieve an additional tip projection and to improve the columello-labial angle. RESULTS: This study included 85 consecutive patients who underwent an aesthetic rhinoplasty using footplate incision techniques between August of 2010 and May of 2013. A total of 43 patients had an adequate follow-up time of over 12 months. The majority of the patients (40/43 cases) were satisfied with the results. CONCLUSIONS: The authors believe that a footplate incision in aesthetic rhinoplasty is safe and can reliably achieve better results for Asian patients.
Animals ; Asian Continental Ancestry Group ; Dogs ; Ear ; Follow-Up Studies ; Humans ; Publications ; Rhinoplasty* ; Skin

We evaluated the morphologic changes that follow division of transverse carpal ligament in patients with carpal tunnel syndrome using high resolution sonography. Twenty hands of 10 patients underwent high- resolution ultrasonographic studies before the operation and 8 months after the operation. They were all diagnosed as bilateral idiopathic CTS. We evaluated the configuration of the median nerve and carpal tunnel at different three levels of the wrist; the distal radiocarpal joint level, the pisiform level, and the hook of hamate level. The median nerve remarkably gained its thickness at distal two levels after the operation. The morphology of carpal tunnel has also changed at distal levels. Increase in the anteroposterior diameter at distal two levels was obvious, but the cross sectional area of the carpal tunnel was increased significantly only at the hook of hamate level. The transverse diameters of the carpal tunnel were not significantly changed. As above, we found that the median nerve gained its volume significantly at distal part of carpal tunnel postoperatively, and the volumetric increase of carpal tunnel would have resulted from an anterior displacement of newly formed transverse carpal ligament and not from a widening of the bony carpal arch.
Carpal Tunnel Syndrome* ; Hand ; Humans ; Joints ; Ligaments ; Median Nerve ; Ultrasonography* ; Wrist

BACKGROUND: Among the various signs and symptoms of orbital fractures, certain clinical findings warrant immediate surgical exploration, including gaze restriction, computed tomographic (CT) evidence of entrapment, and prolonged oculocardiac reflex. Despite proper surgical reconstruction, prolonged complications such as diplopia and gaze restriction can occur. This article evaluated the prognostic factors associated with prolonged complications of orbital fractures with muscle incarceration. METHODS: The medical records of 37 patients (37 orbits) with an orbital fracture with muscle incarceration from January 2001 to January 2015 were reviewed. The presence of Incarcerated muscle was confirmed via CT, as well as by intraoperative findings. Various factors potentially contributing to complications lasting for over 1 year after the injury were categorized and analyzed, including age, cause of injury, injury-to-operation time, operative time, fracture type, nausea, vomiting and other concomitant symptoms and injuries. RESULTS: All patients who presented with extraocular muscle limitations, positive CT findings, and/or a positive forced duction test underwent surgery. Of the 37 patients, 9 (24%) exhibited lasting complications, such as diplopia and gaze restriction. The mean follow-up period was 18.4 months (range, 1–108 months), while that of patients who experienced prolonged complications was 30.1 months (range, 13–36 months). Two factors were significantly associated with prolonged complications: injury-to-operation time and nausea/vomiting. Loss of vision, worsening of motility, and implant complication did not occur. CONCLUSIONS: Patients who present with gaze limitations, with or without other signs of a blow-out fracture, require a thorough evaluation and emergent surgery. A better prognosis is expected with a shorter injury-to-operation time and lack of nausea and vomiting at the initial presentation.
Diplopia ; Follow-Up Studies ; Humans ; Medical Records ; Nausea ; Operative Time ; Orbit* ; Orbital Fractures* ; Prognosis ; Reflex, Oculocardiac ; Vomiting

BACKGROUND: Among the various signs and symptoms of orbital fractures, certain clinical findings warrant immediate surgical exploration, including gaze restriction, computed tomographic (CT) evidence of entrapment, and prolonged oculocardiac reflex. Despite proper surgical reconstruction, prolonged complications such as diplopia and gaze restriction can occur. This article evaluated the prognostic factors associated with prolonged complications of orbital fractures with muscle incarceration. METHODS: The medical records of 37 patients (37 orbits) with an orbital fracture with muscle incarceration from January 2001 to January 2015 were reviewed. The presence of Incarcerated muscle was confirmed via CT, as well as by intraoperative findings. Various factors potentially contributing to complications lasting for over 1 year after the injury were categorized and analyzed, including age, cause of injury, injury-to-operation time, operative time, fracture type, nausea, vomiting and other concomitant symptoms and injuries. RESULTS: All patients who presented with extraocular muscle limitations, positive CT findings, and/or a positive forced duction test underwent surgery. Of the 37 patients, 9 (24%) exhibited lasting complications, such as diplopia and gaze restriction. The mean follow-up period was 18.4 months (range, 1–108 months), while that of patients who experienced prolonged complications was 30.1 months (range, 13–36 months). Two factors were significantly associated with prolonged complications: injury-to-operation time and nausea/vomiting. Loss of vision, worsening of motility, and implant complication did not occur. CONCLUSIONS: Patients who present with gaze limitations, with or without other signs of a blow-out fracture, require a thorough evaluation and emergent surgery. A better prognosis is expected with a shorter injury-to-operation time and lack of nausea and vomiting at the initial presentation.
Diplopia ; Follow-Up Studies ; Humans ; Medical Records ; Nausea ; Operative Time ; Orbit* ; Orbital Fractures* ; Prognosis ; Reflex, Oculocardiac ; Vomiting