Although orthognathic surgery has been performed at the maxilla and the mandibular ramus to obtain a normal functional occulsion and aesthetic improvement of the face, deformities of the chin and disproportion of the soft tissue have been left. Mandibular set-back or advancement usually leaves soft tissue redundancy or deficiency along with its displacement. We have combined genioplasty with orthognathic surgery after intermaxillary fixation through a separate incision to get aesthetic improvement in the chin area in 28 patients. The authors obtained the aesthetic profile of the chin and lower lip according to various soft tissue analysis as follows: 1) The depth of the mentolabial fold 2) The distance from the E-line to labrale inferius (LI) 3) N-ANS/ANS-Me The soft tissue disproportion and residual deformities which were not usually corrected by the orthognathic surgery alone could be improved by combining it with genioplasty.
Chin ; Congenital Abnormalities ; Genioplasty* ; Humans ; Lip ; Maxilla ; Orthognathic Surgery

The autogenous fascia graft has been used for various surgical purposes because it has good durability, a gliding capacity, elasticity and a high survival rate. However, few studies have reported histological changes of the graft in various situations. This study attempted to determine histomorphologic changes after autogenous fascia graft in various surgical conditions. The results revealed were as follows: 1. The tension applied to grafts plays the key role in the survival rate of autogenous fascia grafts. 2. Rolling the fascia reduced the volume and weight after autogenous graft due to fibrosis and central fatty degeneration. 3. Autogenous fascia graft covering silicone blocks showed its fascial structure and reduction of the formation of fibrous capsule around the silicone.
Elasticity ; Fascia ; Fibrosis ; Silicones ; Survival Rate ; Transplants*

Soft tissue expansion technique has been a very useful method for the reconstruction of scalp defects and alopecia since the scalp is an unyielding tissue allowing minimal distension in traditional local flap surgery. As a result, there has been wide use of the tissue expansion method in the reconstruction of scalp defect and treatment of alopecia in the plastic surgery. There have been many concerns about histomorphologic changes of the overlying skin and the underlying structure resulting from tissue expansion. We also know that progressive tissue expansion induces increased mitotic activity of the epidermis and thining of the dermis in the overlying skin, as well as significant gross, histologic bony erosion in the underlying structure. However, little informations have been reported about the changes of the hair and pilocebaceus units in scalp expansion. We compared the horizontal sections of the expanded scalp and its longterm histologic changes with a normal unexpanded scalp specimen as a control. The terminal hair proportions to the vellus hair both increased. There was a 32% decrease in follicular units, a 24% decrease in terminal hair, and a 23% decrease in total hairs 8 week after scalp expansion compared to the normal unexpanded scalp. The perifollicular inflammatory changes and fibrosis observed in the full expanded scalp specimen disappeared within 12 weeks after removal of the expander and the flap transposition. In our observation, tissue expansion at the hair-bearing scalp did not precipitate any adverse changes on the hair follicles. On the contrary, we observed that secondary scalp expasion could be safetly performed 3 months after the first scalp expansion.
Alopecia ; Dermis ; Epidermis ; Fibrosis ; Hair Follicle* ; Hair* ; Humans* ; Scalp* ; Skin ; Surgery, Plastic ; Tissue Expansion*

OBJECTIVE: Internal carotid artery (ICA) trunk aneurysms are rare constituting about 0.9 to 6.5% of all ICA aneurysms. They may arise from medial, lateral, ventral (posterior) or dorsal (anterior) walls of ICA. The most frequent site of origin is dorsomedial, followed by dorsal, dorsolateral and ventromedial wall. ICA dorsal wall aneurysms can be divided into the saccular type and blister type, which have different shapes, wall histological features and surgical tactics. The authors report an analysis of 27 cases of ICA trunk aneurysms treated with surgical clipping or GDC embolization. METHODS: Of 145 cases of ICA aneurysms from May 1998 to December 2005, we found 27 cases (17.5%) of such unusual aneurysms located at nonbranching sites of the intradural ICA. Features of neuroimagings and medical records were analyzed. RESULTS: Out of 27 aneurysms, 10 were located at ICA dorsal wall, 8 aneurysms were developed at ICA medialwall. Seven aneurysms originated from ICA ventral wall. Seven cases presented with subarachnoid hemorrhage and 20 cases were found unruptured. Two patients had blister-like aneurysm, and the others had saccular aneurysms. All patients were treated successfully with microsurgical clippings or GDC embolization. Microsurgical clipping were performed in 14 cases and among them, removal of anterior clinoid process was done in 12 cases. Eleven aneurysms were occluded with detachabel coil. Two patients underwent balloon occlusion of ICA. Blister aneurysm was clipped including a portion of the normal ICA wall. Good outcomes were obtained in 25 patients, and two patients were dead. CONCLUSION: ICA trunk aneurysms are developed at any site of ICA circumference. Therefore we consider a variety of treatment strategies. On clipping of aneurysms at proximal ICA trunk, removal of anterior clinoid process is important. Endovascular treatment may be good an alternative. However, surgical treatment is essential for blister like aneurysms.
Aneurysm* ; Balloon Occlusion ; Blister ; Carotid Artery, Internal* ; Humans ; Intracranial Aneurysm ; Medical Records ; Subarachnoid Hemorrhage ; Surgical Instruments

Botulium toxin A has been used therapeutically in humans for over 20 years for a variety of medical indications. Some wrinkle and unsightly facial expressions are due to hyperkinetic muscle. For the past year, the author has injected it for variant purpose, so we describe the our experience with the variant extended use of the toxin including correction for just dynamic wrinkle, used with subperiosteal face lifting or peeling, post-traumatic twitching, and facial paralysis and relevant anatomy are discussed. Also we have another concept about muscle anatomy which have superficial and deep portion. The superficial portion is for harmonious action with SMAS during facial expression, which is also related to fine wrinkle, and the deep portion play role gross movement. Botulium toxin is safe and effective in varient field without complication. Its use is associated with a high degree of patient and physician satisfaction.
Exotoxins* ; Facial Expression ; Facial Paralysis ; Humans ; Rhytidoplasty

No abstract available.
Temporomandibular Joint*

No abstract available.
Temporomandibular Joint*

Coronary artery fistula is an unusual anomaly in elderly patients that consists of a communication bet- ween one of the coronary arteries and other cardiac chambers or veins. It causes many cardiac compli- cations due to hemodynamic changes, and thus has recognized its clinical significance. It occurs usually in congenital origin, but also occurs secondarily in traumatic or neoplastic or artherosclerotic coronary diseases. Congenital coronary artery fistula is a very rare congenital anomaly that results in multiple hemodynamic complications. It has reported rarely in elderly patients, that induces myocardial ischemia due to coronary steal syndrome and heart failure that caused by diastolic volume overload via a left to left shunt. We observed a 68-year-old male patient with exertional chest pain and dyspnea, in whom selective coronary angiography revealed abnormal reticular communication between left anterior descending artery and left circumflex artery and drained to left ventricle through multiple microfistulous channels. We report this patient case who complicated by myocardial ischemia and left ventricular failure those caused by hemodynamic complication due to multiple coronary artery-left ventricular fistulae.
Aged ; Arteries ; Cations ; Chest Pain ; Coronary Angiography ; Coronary Disease ; Coronary Vessels ; Dyspnea ; Fistula ; Heart Failure* ; Heart Ventricles ; Heart* ; Hemodynamics ; Humans ; Male ; Myocardial Ischemia ; Veins

Coronary artery fistula is an unusual anomaly in elderly patients that consists of a communication bet- ween one of the coronary arteries and other cardiac chambers or veins. It causes many cardiac compli- cations due to hemodynamic changes, and thus has recognized its clinical significance. It occurs usually in congenital origin, but also occurs secondarily in traumatic or neoplastic or artherosclerotic coronary diseases. Congenital coronary artery fistula is a very rare congenital anomaly that results in multiple hemodynamic complications. It has reported rarely in elderly patients, that induces myocardial ischemia due to coronary steal syndrome and heart failure that caused by diastolic volume overload via a left to left shunt. We observed a 68-year-old male patient with exertional chest pain and dyspnea, in whom selective coronary angiography revealed abnormal reticular communication between left anterior descending artery and left circumflex artery and drained to left ventricle through multiple microfistulous channels. We report this patient case who complicated by myocardial ischemia and left ventricular failure those caused by hemodynamic complication due to multiple coronary artery-left ventricular fistulae.
Aged ; Arteries ; Cations ; Chest Pain ; Coronary Angiography ; Coronary Disease ; Coronary Vessels ; Dyspnea ; Fistula ; Heart Failure* ; Heart Ventricles ; Heart* ; Hemodynamics ; Humans ; Male ; Myocardial Ischemia ; Veins

We report a case of giant cell tumor of the tendon sheath involving the foot, in a 21-year-old female patient, who presented with an asymptomatic tumor on the dorsum of her right foot. Histopathologically the tumor is surrounded by thin fibrous connective tissue. The characteristic findings of the excised specimen revealed a typical mixture of abundunt round or polygonal histocyte-like cells with varying portions of spindle-shaped fibroblast-like cells and multinucleated giant cells. Variable amounts of hyalinized fibrous stromal tissue were also present. After excision, local recurrence has not been observed for 3 months.
Connective Tissue ; Female ; Foot* ; Giant Cell Tumors* ; Giant Cells* ; Humans ; Hyalin ; Recurrence ; Tendons* ; Young Adult