The blow-out fracture can be reconstructed by various autogeneous and alloplastic material. Particulate, nonresorbable hydroxyapatite is currently one of the choice of implant material available for reconstruction of blow-out fracture. Hydroxyapatite is radiopaque ceramic, physically and chemically similar to enamel and cortical bone. It is a biomaterial derived from natural corals to use as a bone graft substitute. And we looked into the clinical usefulness of 2 type of hydroxyapatite with their advantages and disadvantages in reconstruction of blow-out fracture. 183 patients with blow-out fracture who underwent surgical reconstruction with two types of hydroxyapatite from March 1933 to July 1977 have been analyzed the results of surgical reconstructions, and have been followed up for more than a year. And the condition of formerly inserted hydroxyapatite was observed in the patients who needed 2nd surgical reconstruction due to the enophthalmos. The disadvantages of hydroxyapatite are fragility, size and contour limitations. In spite of these demerits, hydroxyapatite can be one of the prospective materials to reconstruct orbital floor. Through the clinical experiences for 5 years, we have not found any of complications of exposure, infection, and foreign body reaction. Low rates of diplopia, limitation of ocular movement, and enophtalmos was observed. Hydroxyapatite was well adherent to adjacent orbital bone in most patients who needed secondary reconstruction for enopthalmos. In conclusion, our study shows that the availability of hydroxyapattite in reconstruction of blow-out fracture is recommendable, with low complication rates. Hydroxyapatite important appears to be well tolerated, and provides useful alloplastic prosthesis with few problems in reconstruction of blow-out fracture.
Anthozoa ; Ceramics ; Dental Enamel ; Diplopia ; Durapatite* ; Enophthalmos ; Foreign-Body Reaction ; Humans ; Orbit* ; Orbital Fractures* ; Prostheses and Implants ; Transplants

Primary pulmonary hypertension is a rar, incurable, and progressive clinical entity. When associated with pregnancy, the prognosis of primary pulmonary hypertension is worsened with maternal mortality rates of at least 50%. The patient was a 29-year-old mother in her 2nd pregnancy, with previous uncomplicated gestation, 5 years ago. She had been well until the 28th week of present gestation when she was admitted because of increasing dyspnea on exertion. She was a housewife with no remarkable family and past histories. We have experienced a patient with primary pulmonary hypertension in pregnancy. She was treated with an oral calcium-channel blocker and low-molecular-weight heparin and was delivered vaginally with good maternal and fetal outcome. So we report a case of primary pulmonary hypertension associated with pregnancy and review literature.
Adult ; Dyspnea ; Heparin, Low-Molecular-Weight ; Humans ; Hypertension, Pulmonary* ; Maternal Mortality ; Mothers ; Pregnancy* ; Prognosis

No abstract available.
Enophthalmos* ; Orbit*

Mucormycosis is an opportunistic fungal infection caused by the mucorales, which consist of the Rhizophus, Absidia, Mortierella, and Mucor. The diverse clinical forms of mucormycosis can be categorized as rhinocerebral, pulmonary, disseminated, gastrointestinal, cutaneous and miscellaneous. Although it can cause disease in healthy people, it most commonly affects patients who are diabetic or immunosup-pressed. Rarely, mucormycosis develops confined to the subcutaneous tissue. We experienced a case of cutaneous mucormycosis developed in a well-controlled diabetic patient who had previously injected foreign material on her face for an aesthetic purpose at the behest of an unlicensed physician. The patient had tissue necrosis and purulent discharge on her left cheek. Following histologic examination, we diagnosed the condition as cutaneous mucormycosis and treated it by wide excision combined with amphotericin B therapy. The disease was cured without any significant sequelae within 6 months of follow up. Cutaneous mucormycosis is rarely reported but it can cause facial deformity due to tissue necrosis, so that early diagnosis and appropriate treatment are important. Currently, foreign material injection for aesthetic purposes is still performed by unlicensed physicians. We present a case report concluding that one should consider the possibility of fungal infection in skin lesion in diabetic or other immunosup-pressed patients. We also emphasize the seriousness of illegal injection of foreign material.
Absidia ; Amphotericin B ; Cheek ; Congenital Abnormalities ; Early Diagnosis ; Follow-Up Studies ; Humans ; Mortierella ; Mucor ; Mucorales ; Mucormycosis* ; Necrosis ; Paraffin* ; Skin ; Subcutaneous Tissue

In analyzing the postoperative results or evaluating the velopharyngeal incompetence after palatoplasty, speech evaluation is the inevitable factor. However, a standardized method for evaluating the speech problem in Korean cleft palate patients has not been available until now. So, the authors tried to establish a method of speech evaluation which is simple, economic and applicable to young patients, and to make a scoring method of the speech results in cleft palate patients based on the 'hypernasality diagnosing tool for cleft palate patient (OK Ran Jung)' which is commonly used by domestic speech therapists. The authors adopted the 'hypernasality diagnosing tool for cleft palate patients (OK Ran Jung)' male and female of children and adults, each consisting of 10 patients and make them speak according to the items about hypernasality and misarticulation evaluation, and record the results. We also calcuted the degree of the formants of the vowels (/a/, /o/, /u/)using sound spectrography. We examined the interjudge and intrajudge reliance of speech evaluation among the 10 inverstigators, revised the evaluation tool, devised the scoring method according to the above results, and compared the scoring results with those of sound spectrography to prove the reliance of our speech evaluation tool. With the scoring method, the authors could estimate the degree of hypemasality and misarticulation in cleft palate patients with evidence of reliability based on point-to-point agreement in two items. In comparing the results of our scoring method with the formant of vowels using sound spectrography, staistical significance existed except /u/F2 and that meant that our scoring method was reliable. We suggest that this simple, economic and reliable method of speech evaluation in cleft palate patients can create the basis for speech evaluation in patients of cleft palate and velopharyngeal incompetence under circumstances in which the results of various speech treatments are evaluated in comparison to various methods of speech evaluation.
Adult ; Articulation Disorders ; Child ; Cleft Palate* ; Female ; Humans ; Male ; Research Design ; Sound Spectrography ; Velopharyngeal Insufficiency

Many methods of correcting secondary cleft lip nose deformity have been introduced, but a single best method that can be uniformly adjusted for all cases does not exist. Since it is difficult to make the nostril of the cleft side symmetric with that of normal side, the authors tried to formulate the basis for correction of unilateral secondary cleft lip nose deformity according to the varying amounts of deformed nostril. We then adopted 4 different methods of correcting the soft tissue and nostril deformity in 63 patients from 1996 to 1998 and surveyed the results. Our principles were as follows: 1) Alar rim incision was done in cases of different-shaped cleft-side nostrils with nearly the same measured area in comparison to the normal side. 2) When deformity of the alar-columellar web was severe, we performed modified Z-plasty. 3) When the nostril of the cleft-side nostril was smaller than the normal side with slight asymmetry, reverse W-plasty was done. 4) We adopted a reverse-U incision when there was a discrepancy in height with moderate asymmetry compared with the normal nostril. After dissection, repositioning of alar cartilage was done by same method in each case. A nasal stent was kept in position for at least 6 months postoperatively in almost all cases. After follow-up of 6 to 24 months, we concluded that our choice was correct in selecting the optimal operative method, considering the characteristics of deformity of the cleft side nostril in an effort to make it symmetric with that of the normal side.
Cartilage ; Cleft Lip* ; Congenital Abnormalities* ; Follow-Up Studies ; Humans ; Nose* ; Stents

The search for the ideal augmentation material of facial soft tissues has been an ongoing effort for many years. Injectable soft tissue substitutes provide an affordable, non-surgical alternative for correcting contour defects in facial skin. A safe and effective material for this purpose should respect certain characteristics that it should be biocompatible, non-antigenic, nonpyrogenic, noninflammatory, noninflammatoy, nontoxic, easy to use, stable after injection, non-migratory, long-lasting but reabsorbable, natural looking and not too expensive. Although many biomaterials are currently on the market, none meets all the above criteria. The recent development of hyaluronic acid gels(Restylane ) for dermal implantation is therefore particularly interesting in treating the aging face. Restylane is produced in cultures of Equine streptococci by fermentation in presence of sugar, the hyaluronic acid chains are then chemically stabilized through permanent epoxidic cross-links that the manufacturer reports to alter only about 1% of the hyaluronan molecular network. The resulting viscoelastic transparnet gel, suitable for intradermal infection, has a concentration of 20 mg/ml, is delivered in disposable syringes (0.7 ml) ready for use, using a 30 gauge needles. The twenty-one patients in thirty area were treated with facial intradermal implantation of hyaluronic acid gel for augmentation therapy of wrinkles and folds for recoutouring. The results were evaluated in all patients by subjective judgment by the physician and the patients. This study provides a clinical evaluation of safety and efficacy of a cross-linked stabilized non-animal hyaluronic acid gel to determine its characteristics, advantages, disadvantages, and side-effects in Korean. We concluded that Restylane implantation was soft, easy to use and long lasting effective materials in augmentation therapy of soft tissue of face.
Aging ; Biocompatible Materials ; Fermentation ; Humans ; Hyaluronic Acid ; Judgment ; Needles ; Skin ; Syringes

Augmentation mammoplasty can be done in various manners according to the way of approach. the type of implant or implatation site depending on the status and demand of the patients or the operator's preferrence. In reviewing the many published reports about augmentation mammoplasty, they compare their surgical outcomes with mixed factors, so it is difficult to compare the results of mammoplasty simply with one factor under the same conditions. We think that analyzing the surgical results with one consistent method enables to compare and decide the influencing effect of one factor within it in augmentation mammoplasty. We could find the fact that the Korean women who wanted augmentation mammoplasty had same physical characteristics and demands, so developed the standardized method of augmentation mammoplasty among those debatable data for the purpose of increasing the patients' satisfaction, decreasing the complications, and shortening the operation time. The method we adopted was placing the implant through transaxillary subpectoral approach and using the endoscope auxiliarily in additional dissection and hemostasis. We employed saline-filled implants of round, textured type with the size ranging fro 125cc to 175cc and overinflated them by 10 to 30% beyond its original volume. After irrigation of the dissected pocket, we placed the suction drainage system into the subpectoral pocket. We educated the patients to massage their breasts right after removal of the drain. During the period of follow-up (from 6 months to 24 months), most of the patients were satisfied with their operative results. Though we experienced one case of capsular contracture, one case of malposition of the implant, and three cases of scar contracture on axillar incision site, as a whole, we could minimize the complications associated with augmentation mammoplasty. We present our postoperative results with the conclusion that our standardized method of augmentation mammoplasty can bring results of high satisfaction rate, minimal complication, predictability of postoperative results, shortening of operation time when applied consistently to the Korean patients whose physical characteristics are similar. We also hope that stanadardized method can be used to compare the influencing effect of many factors in the case of changing one factor within the standardized in the future follow up period.
Breast ; Cicatrix ; Contracture ; Endoscopes ; Female ; Follow-Up Studies ; Hemostasis ; Hope ; Humans ; Mammaplasty* ; Massage ; Suction

Hair takes a great role in featuring man's appearance and absence of hair can causes troubles in physical and psychological aspects. Many efforts have been made to treat male pattern baldness, including medical therapy and surgical correction, but there is not a definite and eternal method of treatment. Even though the diagnosis of male pattern baldness can be made with its characteristic clinical manifestations, histopathological study must be done for definite diagnosis. Author obtained biopsy material from the frontal progressive baldness area and the occipital non-baldness area with punch biopsy in 20 patients who were diagnosed to be Type II and III male pattern baldness according to the Norwood classification. A comparative study was done in the basis of histopathology using serial vertical section of the biopsy materia with the aid of light microscope and the results are as follows : 1. The average number of total hair in the frontal area was on third than that of occipital area and the number of anagen hair was less in the frontal area. The number of telogen hair in the frontal area was seven times more than that of occipital area. 2. The thickness of epidermis and dermis in the frontal area was thinner than that of occipital area. 3. The infiltration of inflammatory cells in the periadnexal field like blood vessels, hair follicles, sebaceous glands, eccrine glands was more prominent in the frontal area than in the occipatal area. 4. Perifollicular fibrosis and hypertrophy of arrector pilli muscle were more remarkable in the frontal area compared with that of occipital area. 5. There was no difference between the frontal and occipiral area in the number of lobules of sebaceous glands.
Alopecia* ; Biopsy ; Blood Vessels ; Classification ; Dermis ; Diagnosis ; Eccrine Glands ; Epidermis ; Fibrosis ; Hair ; Hair Follicle ; Humans ; Hypertrophy ; Male* ; Sebaceous Glands

Skin grafting is often required for diabetic ulcerative foot lesions. In skin grafting, effective regional or local anesthesia into the donor and recipient areas plays a significant role in continuous control of pain. We report on a technique of ultrasound-guided nerve block on the femoral, sciatic, and lateral femoral cutaneous nerves in large split-thickness skin grafting for ulcer of the foot and leg.
Anesthesia, Local ; Femoral Nerve ; Foot* ; Humans ; Leg* ; Nerve Block* ; Sciatic Nerve ; Skin Transplantation* ; Tissue Donors ; Ulcer*