The chest wall and breast asymmetry varies from severe pectus deformities to an isolated breast hypoplasia. In addition to the chest abnormality, a natural-looking breast is the aesthetic challenge in women. Considering that the most common indication of operations is an aesthetic one, any procedures leaving much scars and deformities at the donor site aren't preferred by patients. A 31-year-old female had a 4 x 10 x 2.5 cm sized pectus-excavatum deformity on her right chest, and a slightly hypoplastic breast compared with the left one. The nipple of her right breast was located supero-medially and pectoralis muscles were preserved to some degree at the right side. Through a bilateral submammary and subxiphoid incision, the deformed cartilage was resected from 3th to 7th rib bilaterally and chondrotomy was done at the sternum partially. After this modified Ravitch's technique, two-metal pins were fixated between right 4th~5th ribs and left 4th rib, and the depressed sternum was elevated over the metal pins. The deficient volume of her right breast was corrected by inserting a siliconegel breast implant (120 cc) submuscularly to restore a adequately projected breast. The results of twelve months' follow-up demonstrated a symmetric and well- projected breast. There were no significant chest wall depression or capsular contracture. Restoring a fundamental bony structure would decrease the amount of augmentation needed in the soft tissues. And a silicone-gel breast implant may be used as an the alternative material for whose axillary fold is preserved to some degree.
Adult ; Breast Implants ; Breast* ; Cartilage ; Cicatrix ; Congenital Abnormalities* ; Contracture ; Depression ; Female ; Follow-Up Studies ; Humans ; Nipples ; Pectoralis Muscles ; Ribs ; Sternum ; Thoracic Wall* ; Thorax* ; Tissue Donors

Septorhinoplasty in Asians is very challenging in terms of shortage of septal cartilage. Many cases in correction of dorsal and caudal septal deformities requires septal surgery including cartilaginous graft. Septoplasty is a well-known procedure which preserves majority of quadrangular cartilage, however, it is hardly adopted in Asians. The preoperative evaluation is accomplished using nasal endoscopy. The posterior and inferior chondrotomy for septal swinging-door procedure can be performed under endoscopic view. Also, the precise amount of bony spur and excessive cartilage can be excised. Endoscopy is also indispensable to precise hemostasis and turbinoplasty. Asian septoplasty is usually performed with maximal central submucous resection leaving critical L-strut, because surgeons need as much cartilages as possible for proper graft. In caudal septum, posterior septal angle loses its integrity after swinging-door procedure, and also loses the tip projection. This should be reinforced. Furthermore, in patients who have weak septal cartilage, key stone area needs to be reinforced by unilateral or bilateral spreader graft at the same time. Proper bilateral strut at the posterior septal angle continuous with spreader graft at rhinion may confirm the newly made solid L-strut. This solid caudal septum will be the new nasal base for the next tip plasty.
Asian Continental Ancestry Group ; Cartilage ; Congenital Abnormalities ; Endoscopy ; Hemostasis ; Humans ; Nasal Cartilages ; Nasal Septum ; Reinforcement (Psychology) ; Rhinoplasty ; Transplants

PURPOSE: The epicanthus is a specific feature in Asian. Many techniques have been described to eliminate the epicanthal fold: resection of glabellar skin, resection of medial canthal skin, V-Y advancement, V-W technique, modified Z-plasty, multiple Z-plasties, and others. The authors observed postoperative epiphora after correction of epicanthal fold by periciliary skin flap without damaging lacrimal duct. METHODS: A 19-year-old woman underwent non-incisional blepharoplasty, septorhinoplasty, and periciliary epicanthoplasty. On her history, she didn't have any symptom of epiphora preoperatively. And there was no specific complaint of epiphora during the postoperative two weeks. However epiphora got worse from one month after the surgery. She was out of this country, so the patient re-visited the clinic on the postoperative six months for this on-going symptom. On an ophthalmologic examination, patient's lacrimal duct and sac was intact but both lacrimal puncta of the patient were covered with a thin membrane. This membrane was punctuated by a 25 gauge needle and dilated with a standard dilator. RESULTS: After ophthalmologic treatment, no recurrence was observed during five weeks of follow-up periods. CONCLUSION: Both lacrimal puncta of the patient were only covered with membranes. And we could not confirm the direct relationship between periciliary epicanthoplasty and postoperative epiphora. The probable factors will be a predisposing narrowed punctum, post operative peri-punctal edema and decrease in muscular function of orbicularis oculi.
Asian Continental Ancestry Group ; Blepharoplasty ; Edema ; Female ; Follow-Up Studies ; Humans ; Lacrimal Apparatus Diseases ; Membranes ; Needles ; Recurrence ; Skin ; Young Adult

BACKGROUND: Nasal tip support is an essential consideration for rhinoplasty in East Asians. There are many techniques to improve tip projection, and among them, the columellar strut is the most popular technique. However, the conventional design is less supportive for rotating the tip. The amount of harvestable septal cartilage is relatively small in East Asians. For an optimal outcome, we propose an L-shaped design for applying the columellar strut. METHODS: To evaluate the anthropometric outcomes, the change in nasal tip projection and the columella-labial angle were analyzed by comparing preoperative and postoperative photographs. The anthropometric study group consisted of 25 patients who underwent the same operative technique of an L-shaped strut graft using septal cartilage and were followed up for more than 9 months. RESULTS: There were statistically significant differences between the preoperative and postoperative values in the nasal tip projection ratio and columella-labial angle. We did not observe any complications directly related to the L-shaped columellar strut in the anthropometric study group. CONCLUSIONS: The L-shaped columellar strut has advantages not only in the controlling of tip projection and rotation, but in that it needs a smaller amount of cartilage compared to the conventional septal extension graft. It can therefore be an alternative technique for nasal tip plasty when there is an insufficient amount of harvestable septal cartilage.
Asian Continental Ancestry Group ; Cartilage ; Humans ; Nasal Septum ; Rhinoplasty ; Transplants ; Treatment Outcome

PURPOSE: A common side effect of the scalp reduction is a creation of a 'slot' with the hair growing in the opposite directions away from the scar. Overcoming the unnatural appearance of the slot has been a vexing problem in the scalp reduction surgery. None of the conventional corrective surgical techniques provides a complete and satisfactory aesthetic result. The Frechet flap is a triple transposition flap used for the correction of the slot defect secondary to scalp reduction surgery, seldom needing further scar revision. The Frechet technique provides a solution to the problem of the central slot concealment that is unattainable by other means, such as; Z-plasty and mini-graft. METHODS: Authors applied the Frechet technique to Asian patients who had undergone scalp reduction and operated on 4 patients from March, 2000 to January, 2001. Average follow-up period was 13 months. Patients with long scars passing through the temporoparietoccipital zone were excluded. All the undermining was performed in the subgaleal plane, reaching the upper auricular sulcus and stopping just above the nuchal ridge. RESULTS: None of the patients experienced infection, hematoma, nor any permanent hair loss. Transient telogen effluvium at the distal end of flap 2 and 3 was noticeable in one case. CONCLUSION: In conclusion, the results are aesthetically satisfactory without any significant complications.
Asian Continental Ancestry Group ; Cicatrix ; Follow-Up Studies ; Hair* ; Hematoma ; Humans ; Scalp

Several imaging methods are helpful in the diagnosis of carpal tunnel syndrome and they are, for example, traditional X-ray, CT and MRI, etc. CT and MRI have their advantage in direct visualization of structural abnormality of the carpal tunnel and median nerve, but these two modalities are expensive and take much time. Recently, high resolution ultrasonography has been reported to be effective in the study of musculoskeletal system. We designed a case control study to assess the diagnostic value of high resolution ultrasonography. Ninety-six hands of 48 patients, who were confirmed of diagnosis by self-administered questionnaires and electrodiagnostic test, underwent high resolution ultrasonographic studies. We compared sonographic findings with EMG data and patients' severity scores of self-questionnaires. Proximal swelling of median nerve at the entrance of the carpal tunnel correlated with the nerve conduction data. And compression of the median nerve under the transverse carpal ligament correlated with the subjective symptoms. Although ultrasonography is not an ideal method in diagnosis of carpal tunnel syndrome, it may be helpful for estimating the symptom severity and nerve conduction deficit.
Carpal Tunnel Syndrome ; Case-Control Studies ; Diagnosis ; Hand ; Humans ; Ligaments ; Magnetic Resonance Imaging ; Median Nerve ; Musculoskeletal System ; Neural Conduction ; Surveys and Questionnaires ; Ultrasonography

PURPOSE: The goals of a blow-out fracture reconstruction are to restore the osseous continuity, provide support for the orbital contents and prevent functional and anatomic defects. Over the past several years, a range of autogenous and synthetic implants have been used extensively in orbital reconstructions. None of these implants have any absolute indications or contraindications in certain clinical settings. However, in extensive blow-out fractures, it is difficult to restore support of the orbital contents, which can cause more complications, such as enophthalmos. This study examined the clinical outcomes of extensive or comminuted blow-out fractures that were reconstructed by the simultaneous use of a titanium mesh plate and Medpor(R). METHODS: Eighty six patients with extensive orbital fractures, who were admitted between March 1999 and February 2007, were reviewed retrospectively. The patients' chart and CT were inspected for review. Twenty three patients were operated on with both a titanium mesh plate (Matrix MIDFACE pre-formed orbital plate, Synthes, USA) and Medpor(R) (Porex, GA, USA). The patients underwent pre-operative CT scans to evaluate the fracture site and measure the area of the fracture. A transconjunctival approach was used, and titanium mesh plates were inserted subperiosteally with screw fixation. Medpor(R) was inserted above the titanium mesh plate. The patients were evaluated post-operatively for enophthalmos, diplopia, sensory disturbances and eyeball movement for a period of at least 6 months. RESULTS: No implant-related complications were encountered during the follow-up period. Enophthalmos occurred in 1 patient, 1 patient had permanent sensory disturbance, and 3 patients complained of ocular pain and fatigue, which recovered without treatment. Although there were no significance differences between groups, the use of 2 implants had fewer complications. Therefore, it can be an alternative method for treating blow out fractures. CONCLUSION: The use of both a titanium mesh plate and Medpor(R) simultaneously may be a safe and acceptable technique in the reconstruction of extensive blow-out fractures.
Diplopia ; Enophthalmos ; Fatigue ; Follow-Up Studies ; Humans ; Orbit ; Orbital Fractures ; Polyethylene ; Retrospective Studies ; Titanium

Complete division of transverse carpal ligament (TCL) is accepted as a standard procedure for carpal tunnel syndrome (CTS). In some cases however, after complete release of TCL, the loss of grip and pinch power occurs frequently. Previous study revealed that normal intracanal pressure is 25-30mmHg, therefore There were the possibility that complete division of TCL is an over-correction for CTS. The purpose of this experiment was to measure the carpal tunnel pressure during the incremental division of TCL. Twenty patients who were confirmed as CTS were selected from September 2002 to February 2003. By step-wise division of TCL, the pressure was obtained for 3 times serially. Comparative pressure changes between the pre-division and post-division were analyzed by SRM (standard responsiveness mean) and ES (effect size). In Carpal tunnel syndrome, the mean intracanal pressure was 215.5mmHg. After partial release of the portion which was revealed as most severely compressed area on inching test, the carpal pressure decreased to 70.6 mmHg. Releasing the remaining portion of TCL resulted in another 30% decompression. Effect size of partial release was 2.86, and after release of the remaining portion of TCL the effect size was 1.19. Comparing the effect size, as much effect as 70% of the total release (4.15) can be obtained by partial release.
Carpal Tunnel Syndrome ; Decompression ; Hand Strength ; Humans ; Ligaments

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