Bilateral mandibular hypoplasia is found in Treacher Collins syndrome, Pierre Robin sequence, and bilateral craniofacial microsomia. It causes many aesthetic and functional problems such as facial deformities with malocclusion and airway problems. We have corrected bilateral hypoplastic mandible with distraction osteogenesis, which is a highlighted method in mandibular lengthening. For last 3 years 8 months, We applied this method to four bilateral cases, where were Treacher Collins syndrome patients and bilateral craniofacial microsomia patient in rapid multidirectional fashion. A complete ostectomy was made at angle of the mandible and the mandible was fixed 5 days after lengthening was started serially 1mm every 12 hours. After consolidation period for one to three month, the device was removed. We have distracted the mandibles in vertical plane, left.18.8mm, right. 13.4mm, in horizontal plane, left 13.9mm, right 13.7mm on the average. We could achieve good aesthetic results, and their airway problems were improved without any complications.
Congenital Abnormalities ; Goldenhar Syndrome ; Humans ; Malocclusion ; Mandible* ; Mandibulofacial Dysostosis ; Osteogenesis, Distraction ; Pierre Robin Syndrome

The aim of this study is to identify the branches of the facial nerve to the corrugator supercilii muscle(CSM), upper orbicularis oculi muscle(OOM) and procerus muscle(PM), and to elucidate the relation between the course of facial nerve and the superficial landmark of face. Furthermore, this study is also aimed to present anatomical information which is attributed to the treatment of the glabellar frowning wrinkles using selective neurectomy. Cadaver dissection was done on 19 hemifaces to investigate the distribution of the temporal branch of the facial nerve and its entering into the CSM. Twenty hemifaces of cadavers were dissected to investigate the pattern of the temporal branch of the facial nerve to the upper OOM, and the course of facial nerve into the OOM at three different sagittal/vertical planes through the lateral canthus, midpalpebral fissure, and medial canthus, respectively. Twenty-three hemifaces of cadavers were dissected for the investigation of nerve innervation to PM, and identification of the main trunk of the facial nerve and the buccal branches to the nasal bridge. A crossing point between buccal branch and the intercanthal line, and the entering point of the buccal branch into the PM were measured. 1. The temporal branch of the facial nerve contained 2 to 4 smaller branches on the zygomatic arch, and they were furtherly divided into 4 to 7 thin rami at the position 2.8 to 25 mm above the point 10mm lateral to the supraorbital notch. A plexus mainly from the inferior ramus, partially from the middle ramus entered into the CSM in the supraorbital area. 2. The ramifying point of the temporal branch was continued to the circular hazardous zone with a 10mm diameter, and its center was 7.5cm away from the lateral canthus at angle of minus 15 degrees. The highest level of the those rami that entered OOM on the X-axis and Y-axis from lateral canthus was +2.51+/-0.23cm, +2.70+/-0.35cm, and the lowest was +2.68+/-0.32cm, 0cm, respectively. The uppermost ramus on the Y-axis from lateral canthus, midpalpebral fissure, and medial canthus was +3.47 +/-0.27cm, +3.49+/-0.45cm, and +2.97+/-0.35cm, and the lowest ramus was +1.62+/-0.12cm, +1.82+/-0.17cm, and +1.63+/-0.22 cm, respectively. 3.The PM was innervated by the buccal branch of the facial nerve, which coursed infraorbitally. The buccal branch crossed the intercanthal line(nasion to the medial canthus) at approximately lateral one third. The nerve entrance was within a circle with a diameter of 5mm and the location of its center was 9.1mm lateral and 10.4mm superior from nasion. The present study shows the identification of nerve innervation to CSM, OOM and PM, and the relation between the course of facial nerve and the superficial landmark of face. We elucidated especially the course and entering point of buccal branch of the facial nerve to procerus muscle for the first time. We confirm that selective cutting of buccal branch of the facial nerve is essential to the treatment of the glabellar frowning lines. Furthermore, the anatomic knowledge from this study might be contributive to improve the efficacy of selective neurectomy and minimize the injury of facial nerve during surgical procedure of the face.
Cadaver ; Facial Muscles ; Facial Nerve* ; Muscles* ; Zygoma

Epithelioid Hemangioendothelioma(EH) is a rare vascular tumor, originating from endothelial cells. The principal locations are lung, soft tissue, bone and liver. This tumor is of borderline malignancy, relatively benign course. In the lung, the tumor is often multifocal, bilateral and frequently lead to the mistaken diagnosis of metastatic carcinoma. Although EH of the lung is relatively slow growing tumor, extensive pulmonary involvement, systemic metastasis, mainly to the liver have been documented. A 26-year-old man with EH involving the lung and liver was reported. Chest X-ray and chest CT showed multiple nodules in both lung fields and Abdominal CT multiple round low densities in liver. Transbronchial lung biopsy was performed. The patient diagnosed as EH by light microscopic finding and immunohistochemical study for Factor VIII-related antigen.
Adult ; Biopsy ; Bone and Bones ; Diagnosis ; Endothelial Cells ; Hemangioendothelioma, Epithelioid* ; Humans ; Liver* ; Lung* ; Neoplasm Metastasis ; Thorax ; Tomography, X-Ray Computed ; von Willebrand Factor

Background/Aims: Treatment decisions for locally advanced head and neck squamous cell carcinoma (LA-HNSCC) are complicated, and multi-modal treatments are usually indicated. However, it is challenging for older patients to complete treatments. Thus, we investigated disease characteristics, real-world treatment, and outcomes in older LA-HNSCC patients. Methods: Older patients (aged ≥ 70 years) were selected from a large nationwide cohort that included 445 patients with stage III–IVB LA-HNSCC from January 2005 to December 2015. Their data were retrospectively analyzed and compared with those of younger patients. Results: Older patients accounted for 18.7% (83/445) of all patients with median age was 73 years (range, 70 to 89). Proportions of primary tumors in the hypopharynx and larynx were higher in older patients and older patients had a more advanced T stage and worse performance status. Regarding treatment strategies of older patients, 44.5% of patients received concurrent chemoradiotherapy (CCRT), 41.0% underwent surgery, and 14.5% did not complete the planned treatment. Induction chemotherapy (IC) was administered to 27.7% (23/83) of older patients; the preferred regimen for IC was fluorouracil and cisplatin (47.9%). For CCRT, weekly cisplatin was prescribed 3.3 times more often than 3-weekly cisplatin (62.2% vs. 18.9%). Older patients had a 60% higher risk of death than younger patients (hazard ratio, 1.6; p = 0.035). Oral cavity cancer patients had the worst survival probability. Conclusions Older LA-HNSCC patients had aggressive tumor characteristics and received less intensive treatment, resulting in poor survival. Further research focusing on the older population is necessary.

Purpose: Certain patient subgroups who do not respond to induction chemotherapy (IC) show inherent chemoresistance in locally advanced head and neck squamous cell carcinoma (LA-HNSCC). This study aimed to assess the prognostic value of IC, and role of IC in guiding the selection of a definitive locoregional therapy. Materials and Methods: Out of the 445 patients in multi-institutional LA-HNSCC cohort, 158 (36%) receiving IC were enrolled. The study outcome was to assess overall survival (OS) through IC responsiveness and its role to select subsequent treatments. Results: Among 135 patients who completed subsequent treatment following IC, 74% responded to IC (complete response in 17% and partial response in 58%). IC-non-responders showed 4.5 times higher risk of mortality than IC-responders (hazard ratio, 4.52; 95% confidence interval, 2.32 to 8.81; p < 0.001). Among IC-responders, 84% subsequently received definitive concurrent chemoradiotherapy (CCRT) and OS was not differed by surgery or CCRT (p=0.960). Regarding IC-non-responders, 54% received CCRT and 46% underwent surgery, and OS was poor in CCRT (24-month survival rate of 38%) or surgery (24-month survival rate of 63%). Conclusion Response to IC is a favorable prognostic factor. For IC-responders, either surgery or CCRT achieved similar survival probabilities. For IC-non-responder, multidisciplinary approach was warranted reflecting patients’ preference, morbidity, and prognosis.

Purpose: This subgroup analysis of the Korean subset of patients in the phase 3 LASER301 trial evaluated the efficacy and safety of lazertinib versus gefitinib as first-line therapy for epidermal growth factor receptor mutated (EGFRm) non–small cell lung cancer (NSCLC). Materials and Methods: Patients with locally advanced or metastatic EGFRm NSCLC were randomized 1:1 to lazertinib (240 mg/day) or gefitinib (250 mg/day). The primary endpoint was investigator-assessed progression-free survival (PFS). Results: In total, 172 Korean patients were enrolled (lazertinib, n=87; gefitinib, n=85). Baseline characteristics were balanced between the treatment groups. One-third of patients had brain metastases (BM) at baseline. Median PFS was 20.8 months (95% confidence interval [CI], 16.7 to 26.1) for lazertinib and 9.6 months (95% CI, 8.2 to 12.3) for gefitinib (hazard ratio [HR], 0.41; 95% CI, 0.28 to 0.60). This was supported by PFS analysis based on blinded independent central review. Significant PFS benefit with lazertinib was consistently observed across predefined subgroups, including patients with BM (HR, 0.28; 95% CI, 0.15 to 0.53) and those with L858R mutations (HR, 0.36; 95% CI, 0.20 to 0.63). Lazertinib safety data were consistent with its previously reported safety profile. Common adverse events (AEs) in both groups included rash, pruritus, and diarrhoea. Numerically fewer severe AEs and severe treatment–related AEs occurred with lazertinib than gefitinib. Conclusion Consistent with results for the overall LASER301 population, this analysis showed significant PFS benefit with lazertinib versus gefitinib with comparable safety in Korean patients with untreated EGFRm NSCLC, supporting lazertinib as a new potential treatment option for this patient population.