Access to the craniofacial skeleton and skull base requires osteotomies. An adequate exposure of neoplasms occupying the skull base and the oral cavity and oropharynx, especially retromolar trigone, is very important for precise tumor ablation. The demonstration by Tessier of the capacity for large segments of bone to survive removal and replacement has enabled skull base tumor surgery to grow into a subspeciality. Through the refined craniofacial exposure osteotomies, the surgery is safer, the operation shorter, and the result better both oncologically and reconstructively. We experienced 24 cases of exposure osteotomies consisting of 12 cases transzygomatic approaches, 1 case tranglabellar osteotomy, 1 case lateral transmaxillary approach, 1 case Le Fort II & midline splitting, and 9 cases mandibulotomy. There was no significant complication except a local wound infection in transzygomatic approach and one case of minimal malocclusion after parasymphyseal mandibulotomy. The orthotopic bone graft and the rigid fixation enables the postoperative morbidity to decrease. It seems that the previously inaccessible craniofacial tumors can be treated through the various exposure osteotomies.
Malocclusion ; Mouth ; Oropharynx ; Osteotomy* ; Skeleton ; Skull Base ; Transplants ; Wound Infection

BACKGROUND: Hemoptysis is a common clinical symptom, responsible for 11% of admission to the hospital chest service. Correct diagnosis, accurate localization of the bleeding source and proper management are imperative to reduce the risk of massive hemoptysis. We performed the study to define the optimal time of fiberoptic bronchoscopy in 63 patients with hemoptysis admitted to Kyung Hee University Hospital between Aug 1989 and Aug1992. METHODS: Retrospective analysis of medical records concerning the cause, amount, duration of hemoptysis and the timing of fiberoptic bronchoscopy in 63(M:F=36:27) patients. RESULTS: 1) The main causes of hemoptysis were pulmonary tuberculosis(52.4%) bronchiectasis(27.0%) and lung cancer(11.1%). 2) The bleeding sites were localized in 26 Patients(41.3%). 3) The rates of localization of bleeding site were not related to the amount and duration of hemoptysis. 4) The rates of localization of bleeding site were 61.8%(21/34) during hemoptysis,18.2%(122) within 24hr after resolution of hemoptysis, 14.3%(1/7) thereafter. CONCLUSION: Early bronchoscopy, especially during hemoptysis may show higher rates of successful localization than delayed bronchoscopy.
Bronchoscopy* ; Diagnosis ; Hemoptysis* ; Hemorrhage* ; Humans ; Lung ; Medical Records ; Retrospective Studies ; Thorax

PURPOSE: Several methods of the nipple reduction have been reported. However, the methods described previously are difficult or have some demerits. This study proposes a simple technique for reduction of the nipple height as well as diameter. METHODS: The purposed nipple height is marked. A pentahedral design of excision was marked around thenipple. Local anesthetic solution was infiltrated and a 4- 0 Nylon traction suture was applied at the nipple apex. Excision of the nipple inside both two triangles and a rectangle was made. Remaining two flaps were approximated using 5-0 Nylon simple interrupted sutures. However, a part of wound closure was not done in the central area of the nipple. RESULTS: Eighty-three patients (166 nipples) underwent this procedure from December 1999 to December 2008. Follow-up period ranged from 6 months to 2 years with a mean of 10 months. Seventy-eight patients were female and 5 patients were male. No major complications occurred and remaining scars were very inconspicuous. CONCLUSION: This simple technique has the advantage of nipple reduction in both height and diameter, and provides good aesthetic outcomes.
Cicatrix ; Female ; Follow-Up Studies ; Humans ; Imidazoles ; Male ; Nipples ; Nitro Compounds ; Nylons ; Sutures ; Traction

PURPOSE: The transaxillary approach for breast augmentation has been advocated for patients and surgeons for several decades. However, this blind technique had many disadvantages including, traumatic dissection, difficult hemostasis, displacement of implants, and ill-defined asymmetrical location of inframammary crease. In the present study, the precise endoscopic electrocautery dissection was applied to eliminate the limits of blunt dissection throughout the procedures. METHODS: From December 2006 to December 2007, a total of 103 patients with an average age of 29.5 years underwent endoscopic assisted transaxillary dual plane augmentation mammoplasty. The mean implant size was 243 cc with the range between 150 and 350cc. Through a 4cm axillary incision, electrocautery dissection for submuscular pockets was carried out under the endoscopic control. The costal origin of pectoralis muscle was completely divided to expose subcutaneous tissue and to make type I dual plane. RESULTS: Using the endoscopic dissection, we achieved good aesthetic results including a short recovery period, less morbidity, and symmetrical well-defined inframammary crease. Type I dual plane procedure could support the consistent inframammary fold shape and be applied to most patients without breast ptosis. Minor complications did not occur, however, four major complications of capsular contracture occurred. CONCLUSION: In contrast to the era of the blind techniques, endoscopic assisted transaxillary dual plane breast augmentation can now be performed effectively and reproducibly. With Its advantage, the axillary application of endoscopy for augmentation mammaplasty is useful to achieve the optimal cosmetic outcomes.
Breast ; Contracture ; Cosmetics ; Displacement (Psychology) ; Electrocoagulation ; Endoscopy ; Female ; Hemostasis ; Humans ; Imidazoles ; Mammaplasty ; Nitro Compounds ; Pectoralis Muscles ; Subcutaneous Tissue

PURPOSE: Reduction mammaplasty is a procedure with a relatively high patient satisfaction rate, however, associated scarring around the areola can be a serious problem. This study proposes a new modification of the breast reduction procedure by means of an inframammary incision alone. METHODS: The breast is marked out preoperatively with standing position. Under the general anesthesia, an inframammary incision of approximately 7-8cm is done. The subcutaneous plane is made in the lower pole of the breast, then the subglandular plane is entered and a sharp dissection is made up to 2cm below the areola. The breast is mobilized from the chest wall and a cone-shaped parenchyme is removed in en-block except from the retroareolar central part. The remaining both pillars are gathered together with absorbable sutures and the base of the gland is narrowed to project the breast forward. The wound is closed in a layered fashion and taping of the breast mound is applied to redistribute the breast skin. RESULTS: 21 patients(36 breasts) underwent this procedure from December 2004 to December 2009. Average follow up was 9 months(ranged from 6 months to 12 months). No major complication occurred. Most patients were pleased with the breast size, shape, and scars. However, 2 patients complained their hypertrophic scars which were corrected by revision. CONCLUSION: This technique is a simple approach to mild to moderate breast reduction through an inframammary incision alone. And, this technique provides an option with minimal complications and invisible scarring, which is especially important in the young patient group.
Anesthesia, General ; Breast ; Cicatrix ; Cicatrix, Hypertrophic ; Female ; Follow-Up Studies ; Humans ; Mammaplasty ; Patient Satisfaction ; Skin ; Sutures ; Thoracic Wall

The pathophysiology of the inverted nipple is characterized by less connective tissue beneath the nipple, dense fibrous tissue at nipple-areola junction and shortened fewer functional lactiferous ducts. For grade I and II nipple inversion, the dissection of dense fibrous tissue at nipple-areola junction is sometimes not enough to completely bring out the nipple and also the recurrence rate is high. These findings suggest that the shortened hypoplastic ducts might play a considerable role in grade I and II nipple inversion. The purpose of this study was to prove the effectiveness of partial ductal division and V-Y advancement of glandular tissue to correct the inverted nipple. Through a 3mm slit incision around the nipple base, partial division of lactiferous ducts was performed and V-Y advancement of parenchyma was followed. The extent of ductal division was limited only to the central portion until the nipple protrusion persisted without any support. A deep purse-string with a 4-0 permanent suture reinforced the advancement of glandular tissue to add bulk beneath the nipple, and a superficial purse-string was applied at the subcutaneous layer to avoid instability of the nipple. 168 female patients(309 nipples) underwent this procedure from April 2000 to June 2008. 37 nipples were grade I and 272 nipples were grade II. No major complication occurred. Overall recurrence rate was 4.2%(13/309). Among 17 women who had breast-fed after correction of inverted nipples, 2 women failed to breast- feed. This safe and simple technique can correct almost all pathologic factors of nipple inversion, and it can also be easily applied to reoperation cases.
Female ; Humans

Various approaches for gynecomastia correction have been described to remove glandular tissue. In recent years, standard and ultrasound-assisted liposuction became popular methods. However, these methods cannot meet all their needs in some patients who do not want to have scars on their breast's esthetic units and are known to have a tendency to form keloid. The purpose of this study is to introduce the usefulness of endoscope-assisted transaxillary removal of breast tissue in selected patients. Through a stab incision in the axilla, the entire surgical area was infiltrated using the tumescent technique. Ultrasoundassisted liposuction(UAL) was initially performed, followed by power-assisted liposuction(PAL). Then, the endoscope was introduced through a 3 cm axillary incision, and endoscopic electrocautery dissection of glandular tissue was performed under direct vision throughout the procedures. Adjuvant subcutaneous dissection around areola was done via 1 cm subareolar incision. Twelve male patients(22 breasts), whose age ranged from 19 to 38 years, underwent this technique from April 2007 to July 2008. Follow-up ranged from 2 to 16 months with a mean of 9 months. Average volume of aspirate was 290 mL, and mean amount of glandular tissue removed was 35g. No major complications occurred. The resulting scar in the axilla was inconspicuous, and patients were satisfied with postoperative breast contour. These results show that the combined use of an endoscope with the subareolar technique enables an effective treatment of gynecomastia and provides a smooth masculine breast contour without stigma of breast surgery.
Axilla ; Breast ; Cicatrix ; Electrocoagulation ; Endoscopes ; Follow-Up Studies ; Gynecomastia ; Humans ; Keloid ; Lipectomy ; Male ; Vision, Ocular

Bilateral breast cancer is not a common clinical problem, and its occurance is not suprising in this paired organ. Bilateral breast cancer is categorized as synchronous or metachronous. We propose to evaluate clinical and biological characteristics in bilateral breast cancer. Previous cancer in one breast is the strongest known risk factor for cancer to develop in the second breast, and a young age at dignosis of a breast cancer and lobular type of tumor are additional risk factors related to bilaterality. Seventeen cases of bilateral breast cancer have been admitted to the department of General surgery, Samsung Cheil general Hospital from 1980 till 1995. We report the analysis of these cases with the references. The incidence of bilateral breast cancer among all case of total breast cancer was 2.1%(17/827). Synchronous breast cancer was 3 cases(0.4%) and metachronous breast cancer was 14cases (1.7%). The median age was 41 years. The mean age at diagnosis of the primary tumor in the metachronous group was 40 years. Among metachronous cases, the mean interval between the treatment of the primary cancer and the detection of secondary cancer was 37months. The clinical stage was 0-I in 12%, II in 50%, III in 32%, and IV in 6% of tumors. The majority of patients (88%) were clinically node positive. Out of a total of 34 tumors, the clinical tumor size Tis-T1 in 8 tumors, T2 in 21 tumors, and T3 in 5 tumors. Histopathologic type of the pimary tumor was the same with the second in 70%(12/17). The location of secondary breast cancer was in the upper outer quadrant in 9 cases, and in the upper medial quadrant of breast in 2 cases. The premenopausal primary cancer was in 50% of the patients, and postmenopausal primary cancer was in 50% of patients for whom this information was available. Median survival period was 57 months, and 5 year survival rate was 80%. Bilateral breast cancers have similar biological features to unilateral breast cancer more freqently than would be predicted by chance alone. The similarity in clinical aspects of unilateral and bilateral breast cancers should be considered in clinical management of patients with breast cancer. Further investigation is required to know these similaritics and differences between unilateral and bilateral breast cancer.
Breast Neoplasms* ; Breast* ; Diagnosis ; Hospitals, General ; Humans ; Incidence ; Population Characteristics ; Risk Factors ; Survival Rate

Millard presented the concept of rotation advancement for unilateral cleft lip repair, and today this method of cleft lip closure is acknowledged by most as optimal in principle. However, it has been noted that this procedure occasionally can produce a scar that is symmetrical on the lower two-thirds of philtral column. The scar crosses the upper one third of the philtrum obliquely. The purpose of our study is to determine the configuration of the philtrum. 200 newborn infants were examined from June 1998 to September 1998. Mean gestational ages were 39 weeks and 5 days. Mean birth weight was 3226 gm. Multiple parameters such as philtral shape, nostril sill shape, vermilion shape, curvature of Cupid's bow, mean philtral length, mean white roll length, mean Cupid's bow length, and mean distance between both commissures were applied. An arbitrary classification of the philtrum was established to divide these infants into five groups. As a result, the parallel philtral column from nostril base to vermilion border(Type lla) was found to be the most popular type. Most common vermilion shape was protrusion type. Normal curve of Cupid's was most common. Mean values of philtral length, white roll length, Cupid's length, and distance between commissures were 8.3+/-1.1 mm, 13.9+/-1.3 mm, 5.7+/-1.0 mm, 24.7+/-2.3 mm, respectively. We believe this classification system will be useful for newborn infants evaluation and analysis, systemic planning and application of proper cleft lip repair procedure.
Birth Weight ; Cicatrix ; Classification ; Cleft Lip ; Gestational Age ; Humans ; Infant ; Infant, Newborn* ; Lip*

We measured the anterior chamber depth and chamber angle to understand the biological structure of anterior segment and find a possible relation between cataract and angle closure glaucoma on 235 eyes over 40 years old divided into two groups: 111 cataract eyes and 124 normal control eyes using the Scheimpflug Camera(EAS-1000, Nidek, Japan) and image analysis technique. The values of the anterior chamber depth and angle of the eye of the young person were greater than those of older person, and the values in the male were deeper(p<0.01) and larger(p<0.05) than those in female in both groups. In cata ract eyes, the mean anterior chamber depth was 2.77mm and mean anterior chamber angle was 30.36 degrees. The mean anterior chamber depth and angle of normal control eye were 2.67mm and 29.10 degrees. The anterior chamber depth and angle in cataract group was deeper(p<0.05) and larger(p<0.05) than in normal control group.
Adult ; Anterior Chamber* ; Cataract* ; Female ; Glaucoma, Angle-Closure ; Humans ; Male