Facial clefts are uncommon congenital deformities in comparison to the clefts of the lip and palate. the clinical expression of the craniofacial clefts is highly variable. the face can be marred by a faint expression of the cleft or be disfigured by a full representation of the defect. the extent of the soft tissue and skeletal components is also variable, and they are seldom affected to an equal degree. Generally, discription of the clefts are based on the bony malformation, since the skeletal landmarks tend to be more constant. I report six cases of rare craniofacial clefts that I recently experienced. the soft tissue repair was accomplished with local flaps from cheek, eyelid and nose. Additional vertical length was obtained from the lower Z-plasty flaps in the sutures. the coloboma was corrected with local flaps and a cartilage graft, the depression of cheek with a dermofat graft, and the macrostomia with the repositioning of orbicularls oris muscle and a Z-plasty. the results were cosmetically acceptable.
Cartilage ; Cheek ; Coloboma ; Congenital Abnormalities ; Depression ; Eyelids ; Lip ; Macrostomia ; Nose ; Palate ; Sutures ; Transplants

The cleft lip is the most common congenital craniofacial anomaly, the anatomical difference in operated patient and normal person by several authors. Authors deserved the ultrastructural changes in secondary cleft lip patients treated with primary cheiloplasty. We obtained eighteen muscle specimens from the upper lip of 18 patients during the time of secondary lip revision. It was stained with Hematoxylin Eosin, Epon-toluidine blue and histochemical method, and examined by light microscope. Also it was examined by electron microscope with various stain and several steps. We found the extensive collagenous fibrosis with various atrophy of muscles by light microscope, and the myofibroblast with rER, mitochondria, and abundant intermediate filaments by electron microscope in 14 cases. We also found muscular atrophy characterized with variable size of muscle fibers by light microscope, and marked variation of muscle fiber size with sarcoplasmic vacuoles, myocytolysis and internal migration of nuclei by electron microscope in 4 cases. In conclusion, in the most cases the major part of the tissues were surrounded by progressive fibrosis, the mild muscular atrophy was seen at some cases.
Atrophy ; Cleft Lip* ; Collagen ; Eosine Yellowish-(YS) ; Fibrosis ; Hematoxylin ; Humans ; Intermediate Filaments ; Lip ; Mitochondria ; Muscles ; Muscular Atrophy ; Myofibroblasts ; Vacuoles

We experienced a case of Takayasus arteritis with eclampsia in a 43-year-old woman. The patient had angiographically definite Takayasus arteritis with the involvement of right common and internal carotid arteries. On MR images performed at clinical manifestations of eclampsia, unilateral involvement of T2 high signal intensities were demonstrated in right cerebral hemisphere. We report this case with a literature review.
Adult ; Carotid Artery, Internal ; Cerebrum ; Eclampsia* ; Female ; Humans ; Magnetic Resonance Imaging ; Pregnancy* ; Takayasu Arteritis*

BACKGROUND: Combining blepharoptosis correction with double eyelid blepharoplasty is common in East Asian countries where larger eyes are viewed as attractive. This trend has made understanding the relationship between brow position and height of the palpebral fissure all the more important in understanding post-operative results. In this study, authors attempt to quantify this relationship in order to assess whether the expected postoperative brow descent should be taken into consideration when determining the amount of ptosis to correct. METHODS: Photographs of ten healthy female study participants were taken with brow at rest, with light elevation and with forceful elevation. These photographs were then viewed at 2 x magnification on a computer monitor and caliper was used to measure the amount of pull on the eyebrow in relation to the actual increase in vertical fissure of the eye. RESULTS: There was a positive, linear correlation between amount of eyebrow elevation and height of the palpebral fissure, which was statistically significant. Brow elevation increased vertical fissure, and thereby aperture of the eye, by 18%. CONCLUSIONS: Although the eye-opening strength as well as height of the palpebral fissure is improved with ptosis repair, the true effectiveness of ptosis surgery is diminished by the associated descent of the brow from relief of the involuntary frontalis muscle action and this should be taken into account prior to surgical intervention. Regardless, the combination of frontalis muscle relaxation and the increased eye-opening strength from ptosis repair gives the eye and the periorbital region a more natural look.
Asian Continental Ancestry Group ; Blepharoplasty ; Blepharoptosis* ; Eyebrows* ; Eyelids ; Female ; Humans ; Muscle Relaxation ; Muscles

BACKGROUND: There has been increasing interest in facial contouring procedures throughout Asian countries. As such, botulinum toxin A injections for masseteric hypertrophy have become a common procedure provided to patients who desire non-surgical correction of a square-angled mandible. We published a retrospective review of our initial results and our technique and treatment protocol in 2005. We also completed a long-term follow-up of the results (average follow-up period of 4.28 years) and the efficacy of repeated injections in 2010. The purpose of the current study is to systematically evaluate the changes to the masseter muscle at weekly intervals to determine the physiologic effects of botulinum toxin A injection. METHODS: Eight patients were prospectively followed on a weekly basis after botulinum toxin A injection for masseteric hypertrophy. Eight patients were followed for 15 weeks and four patients were followed for 25 weeks. Changes in the thickness of the muscle were recorded and analyzed. RESULTS: A reduction in the muscle thickness was found during the clenching phase of the muscle in the first week followed by a reduction in thickness during the resting phase in the second week. The reduction in muscle thickness continued until the eleventh week after which there was a gradual, but incomplete, return of muscle thickness over the study period. CONCLUSIONS: There is a predictable, phasic reduction in muscle thickness after botulinum toxin A injection for masseteric hypertrophy. This reduction first occurs during the clenching phase followed by a concomitant reduction during the resting phase. Maximal size reduction occurs at 11 weeks followed by gradual muscle size recovery.
Asian Continental Ancestry Group ; Botulinum Toxins* ; Botulinum Toxins, Type A* ; Clinical Protocols ; Follow-Up Studies ; G0 Phase ; Humans ; Hypertrophy* ; Mandible ; Masseter Muscle* ; Nerve Block ; Prospective Studies ; Retrospective Studies

BACKGROUND: As society changes, patients have high expectations of plastic surgery and rapid recovery after surgery. A thread-based facelift meets these requirements and is growing in popularity. METHODS: Former thread lifts were either floating or fixed types. The authors used both types. Using a vertical line from the lateral orbital rim as the center, the anterior face was lifted with floating-type threads and the lateral face was lifted with fixed-type threads. The Blue RoseTM thread was used for the combined-type facelift, as it is stronger than other threads. Improvements were measured using the Global Aesthetic Improvement Scale (GAIS). RESULTS: Eighteen patients out of 28 were followed over 3 months. Five patients (28%) reported a GAIS score of 2, 10 patients (55%) had a GAIS score of 3, 2 patients (11%) had a GAIS score of 4, and one patient was unsatisfied with the surgical results. Results showed improvements in 83% of the patients. CONCLUSIONS: The combined, minimally invasive, thread-based facelift has some benefits. First, the functional anatomy of the face is considered. Second, the pulling force of the threads is stronger than formerly used threads. Third, especially in Asian patients, the postoperative broadening of the malar area can be minimized. Thus, a combined thread lift using Blue Rose threads can provide a natural-looking and strong facelift.
Asian Continental Ancestry Group ; Humans ; Orbit ; Rejuvenation ; Rhytidoplasty* ; Surgery, Plastic ; Surgical Procedures, Minimally Invasive

BACKGROUND: Progressing stroke (PS) variably develops from initially the same size and severity, and is most frequently observed in lacunar infarctions. We investigated fractional anisotrophy (FA), mean diffusivity (MD) and infarct volume by using diffusion tensor imaging during the acute phase of ischemic stroke to determine whether these parameters are useful in characterizing and predicting PS. METHODS: In this study, 55 consecutive patients admitted within 24 hours of the onset of their first ischemic stroke were included. NIH stroke scale (NIHSS) and Canadian Neurological scale (CNS) were performed upon admission, twice a day, and at discharge. Modified Rankin scale and Barthel index were also evaluated. PS was defined as a 2-point drop in NIHSS and a 1-point drop in CNS from admission to day 3. A correlation analysis was performed between clinical scale scores and imaging parameters, and the distribution of those values was compared between the two groups with and without PS. RESULTS: Significant correlations were observed between clinical scale scores and infarct volumes. The FA ratio in 14 patients with PS was lower than the patients without PS (p=0.004). Other characteristics including infarct volume and MD ratio were not different. The FA ratio remained as an independent predictor of PS (OR, 1.055; p=0.011). CONCLUSIONS: In acute ischemic stroke within the first 24 hours, only infarct volume was correlated with clinical status. However, patients with PS showed lower FA values, which accounts for rapid and severe vasogenic edema involving the disruption of the cell membrane and axonal fibers. Moreover, FA may be a predictor of PS.
Anisotropy* ; Axons ; Cell Membrane ; Diffusion Tensor Imaging* ; Diffusion* ; Edema ; Humans ; Stroke* ; Stroke, Lacunar