No abstract available.
Centric Relation ; Head ; Osteotomy

No abstract available.

Port-wine stains (PWSs) are benign congenital vascular malformations that most commonly occur as isolated lesions on the face, neck and trunk. The major indication for therapy in most patient, regardless of age, is psychological burden imposed by the PWSs. A Candela SPTL-1 flashlamp-pumped pulsed dy laser (Candela Corp. Wayland, Mass.) using the principle of selective photothermolysis was used. Selective cutaneous vascular damages are influenced by the wavelength. pulse duration and energy density of the laser. To evaluate histopathological changes according to energy densities are essential to treat cutaneous benign vascular lesion by the iaser. 5 patients with PWSs were treated with the Candela SPTL-1 laser. Lesions were biopsied and analized immediately after laser exposure. 2 days and 7 days after laser exposure. The results were as follows : 1. Depth of penetration The penetration depth was increased from .2mm to 1.9mm with energies ranging from 6J/cm(2) to 10J/cm(2) respectively. 2. Nonvascular damages of epidermis & dermis Focal epidermal vacuolization has been observed in biopsy specimens immediately after laser exposure with energy density 6J/cm(2). As energy densities increased from 6J/cm(2) to 10J/cm(2), histopathological changes got worsened with appearance of vesicles. subepi dermal seperations and epidermal necrosis. 2. Vascular damages of dermis Multiple foci of agglutinated RBC, fibrin and platelet thrombi within the dermal blood vessels have been observed in biopsy specimens immediately after laser exposure. There was a pattern of "acute vasculitis" in the upper dermis and a prominent perivascular neutrophilic responses in the mid-dermis 2 days after laser exposure. Dermal vessels with smaller lumen and granulation tissue have been observed in biopy specimens 7 days after laser exposure. In summary, penetration depth of laser beam and nonvascular epidermal and dermal damages were directly proportional ot the energy density of the laser. But 7 days after laser exposure, epidermis and dermis showed normal appearance without detectable scarring. This study suggested that Candela SPTL-1 laser is safe and has no scar formation on the treatment of PWSs.
Biopsy ; Blood Platelets ; Blood Vessels ; Cicatrix ; Dermis ; Epidermis ; Fibrin ; Granulation Tissue ; Humans ; Neck ; Necrosis ; Neutrophils ; Port-Wine Stain* ; Vascular Malformations

No abstract available.
Choledochal Cyst* ; Cholestasis*

For many years, healing membranous bone fractures have been known to show a persistent lucency at the fracture interface. Radiographic follow-up has proven to be of little value as a guideline for healing of mandibular fractures. Recently, a fracture has been treated by rigid internal fixation by metallic plate and screws rather than closed reduction and wire fixation, we expected that some difference in the radiographic features of fracture healing. To investigate these questions we undertook a retrospective radiographic and clinical analysis of 33 followed patients with fractures of the body and angle of the mandible from 1993 to 1997. There were 26 male and 7 female patients ranging in age between 5 and 74 years, with an average of 29.7 years. All patients were managed by open reduction with metallic plates and screws. The length of follow-up ranged from 9 to 187 weeks. Total 81 radiographic follow-up films were obtained and divided into 3 grades according to the degree of radiolucency of fracture lines; grade 0 radiolucent fracture line and no evidence of fracture interface calcification, grade 1 decreased radiolucent area and evidence of fracture interface calcification, and grade 2 disappearance of fracture line.Until follow-up of 8 weeks, all of the radiographs showed grade 0. From 8 weeks to 16 weeks, 62.5 percent showed grade 0 and 37.5 percent showed grade 1. From 16 weeks to 48 weeks, 38.5 percent showed grade 1 and 61.5 percent showed grade 2. After follow-up of 48 weeks, all showed grade 2.In this study we have shown that the radiographic disappearance of mandibular fracture lines was usually accomplished by 48 weeks. We feel that radiographic union of the mandible is lagging well behind clinical union, but disapperance of the fracture line in rigidly fixated mandibular fracture was occurred earlier than healed by fibrous union. We propose that radiographic union of the mandible by approximately 1 year can be a guideline for the normal mandibular bone healing.
Female ; Follow-Up Studies* ; Fracture Healing ; Fractures, Bone ; Humans ; Male ; Mandible ; Mandibular Fractures* ; Retrospective Studies

Despite continually improving results of total hip arthroplasty, infection remains the major debilitating complication. The treatments of infected total hip arthroplasty were variable. but initially we removed infected implants and inserted antibiotic containing cemented spacer so called PRSTALAC to prevent scar contracture and disuse osteoporosis. After 6 weeks later, control of infection was clinically and radiologically determined, we inserted new prosthesis with cement. Three weeks postoperatively, patient began touch down standing exercise. We observed infected total hip patient in whom hip had been salvaged successfuily with twostage implantation using so called "" PROSTALAC "" which was made with Moore stem.
Arthroplasty, Replacement, Hip* ; Cicatrix ; Contracture ; Hip ; Humans ; Osteoporosis ; Prostheses and Implants ; Replantation*

Restoration of anteroposterior projection of the zygomatic body and facial width are key elements in treatment of complex zygomatic fractures. Traditionally, it has been understood that for most fractures of the zygoma, three-point fixation of the zygomaticofrontal suture, inferior orbital rim, and zygomaticomaxillary buttress generally produces exact structural restoration. Recently, the importance of accurate reduction of the zygomatic arch through coronal incision has been favored in complex zygomatic fractures. Though coronal incision has the advantages of accurate reduction and fixation as a result of extensive exposure of the fractured area, this procedure also has many disadvantages including injury to the facial nerve, paresthesia, alopecia, scar formation, longer operating time, protracted hospitalization, etc. As well, there have been no objective data to prove the fact that four-point fixation through coronal incision is superior to traditional three-point fixation. From May, 1994 to December, 1998, the authors treated 45 patients by traditional three-point (n=20) and coronal four-point fixation (n=25) with random sampling. To assess the difference between the two methods the authors measured the axial angle of the zygoma, the axial angle of the zygomatic arch, and the degree of zygomatic arch inclination on submentovertex X-ray, and then analyzed the measurements by the paired T-test(p < 0.05). As a result, the axial angle of the zygoma and zygomatic arch assessed by anteroposterior projection, as well as the facial width showed no statistical difference between the two groups, respectively(p = 0.26, p = 0.18). Mean while, the degree of zygomatic arch inclination representing the local contour of the fractured zygomatic arch was statistically significant between the two groups(p < 0.05). Thus, the traditional three-point fixation method may be widely acceptable in treatment of complex zygomatic fractures with anterior three-point or zygomatic arch comminution.
Alopecia ; Cicatrix ; Facial Nerve ; Hospitalization ; Humans ; Orbit ; Paresthesia ; Sutures ; Zygoma ; Zygomatic Fractures

Adhesion formed between tendon and its sheath after repair often impairs functional recovery. There have been many attempts to reduce adhesion around a repaired tendon, but most results have been unsatisfactory or impractical in clinical application. Moreover, most attempts were focused on extrinsic tendon healing. whereas studies on the intrinsic tendon healing are sacrce in the literature. We have previously reported that fibrotic tendon adhesion after repair was decreased by decorin, a natural inhibitor of TGF-beta. Accordingly, the serial tensile strength was measured after complete tensection and repair of the tendon severance in order to confirm the effect of decorin inhibition of intrinsic healing capability. Forty White Leghorn chickens were subject to complete transection and repair of the third toe flexor digitorum profundus tendon in Zone II. In the experimental group, 0.5ml of diluted decorin(50microgram/ml) was injected around the repaired site, and the same volume of saline solution in the control group. Tendons were harvested at 1, 3, 5 and 7 weeks. The disrupting force of the repair site was analyzed using tensiometry(LLOYD LR 30K, U.K). The tensile strength of repaired tendon was similar in both groups for all postoperative periods. This indicates that intrinsic healing proceeds normally within the decorin group in spite of the blockade of TGF-betaactivity. Decorin, a natural inhibitor of TGF-beta, showed a significant inhibitory effect on reducing post-repair tendon adhesions, without disruption of intrinsic healing in the chicken flexor tendon injury model. Therefore, decorin is expected to be a useful agent for preventnion on tendon adhesion after the repair in clinical usage.
Chickens ; Decorin* ; Postoperative Period ; Sodium Chloride ; Tendon Injuries ; Tendons* ; Tensile Strength* ; Toes ; Transforming Growth Factor beta

Frontometaphyseal dysplasia is an uncommon genetic syndrome affecting bone and connective tissue. This condition is characterized by the prominence of supraorbital ridges, hyperostosis of the skull, mandibular hypoplasia and malocclusion with antegonial notching, underdeveloped paranasal flaring of the long bone, and a widened iliac wing. Frontometaphyseal dysplasia has an X-linked dominant trait. Clinical manifestations are more severe in males and have extreme variability in females. We present an 11-year-old boy who had frontometaphyseal dysplasia with disfigured face due to bilaterally urinary tract malformation and chronic urinary tract infection. To improve facial appearance, his prominent supraorbital ridges were contoured by ostectomy and burring through bicoronal incision. Urologic operation was performed simultaneously. Histologically, resected bony specimen revealed bony tissue with normal trabecular pattern suggesting exostotic bone. The patient healed without any postoperative complications and he and his parents were satisfied with his final facial morphology.
Child ; Connective Tissue ; Female ; Humans ; Hyperostosis ; Male ; Malocclusion ; Parents ; Postoperative Complications ; Skull ; Urinary Tract ; Urinary Tract Infections

Major concerns in cleft palate repair are improved speech results and adequate maxillary growth. In these respects, Furlow's double reversing Z-plasty which requires minimal hard palatal dissection and redirects palatal muscles to produce an overlapping muscle sling is theoretically optimal method to close the cleft palate. However, it often requires backcut around the maxillary tubercle even dissection around the pedicle on oral mucosal Z-plasty flap. Raw surface heals secondarily but leads to scarring within the soft palate. In the current study, IIpatients all had incomplete cleft palate and were operated double reversing Z-palatoplasty using intraoperative rapid mucosal expansion (IRME), from November, 1996 till July, 1997. With the IRME, we reduced the incidence of backcut or dissection on the oral mucosal flap. Only three patients need small backcut incision and two of these were closed primarily with V-Y fashion. To examine the histologic changes and expansion rate with the IRME, same procedures were performed to palatal mucosa of three cats. Expanded mucosal size was increased to 33.3% and histologically, change of mucosal architecture was not found except capillary dilatation. As a result, intraoperative mucosal expansion offers sufficient mucosal size, reduce incidence of backcut, therefore minimizes palatal scar formation. Balanced maxillofacial growth and normal occlusion are expected with this procedure.
Animals ; Capillaries ; Cats ; Cicatrix ; Cleft Palate ; Dilatation ; Humans ; Incidence ; Mucous Membrane ; Palatal Muscles ; Palate, Soft