Tanzer reported microtia reconstruction using autogenous costal cartilage, thereafter so many plastic surgeons have tried various modification to get further refinement of reconstructed auricle. But the multiple stages of ear reconstruction required prolonged hospitalization and cost. In order to decrease the number of surgical stages and for the maximal convolution, we have employed a surgical procedure with three layered costal cartilage graft for the high profile auricle, concha formation and lobule transposition at the same time. However, it has still been difficult to reconstruct the tragus in cases of microtia that lack such component. We reconstructed the tragus using part of the microtic ear in addition to our above procedure simultaneously. This procedure is started with transposition of the lower two-thirds of the microtic ear to make lobule and then the upper third of the microtic ear is elevated as a chondrocutanenous flap which is then transposed 120-180degree C downwards to reposition at the area anterior to the conchal cavity. Using this technique, we have reconstructed 28 microtic ears. Adequate positioning of the auricle and tragus have been achieved and a more natural auricle obtained.
Cartilage ; Ear ; Hospitalization ; Transplants

The prominent mandibular angle is one of the disfiguring features in the Oriental, commonly seen and considered to be unattractive. Because it gives a square and muscular facial appearance, its surgical correction is dine frequently as a modality of facial contouring surgery in the Oriental. The reduction mandibular angleplasty is not a simple surgical technique for the unexperienced surgeon. We adopted C-arm fluoroscopy as a method of identifying the osteotomy line for the beginners. The reduction mandibular angleplasties assisted by C-arm fluoroscopy were performed in 9 patients, providing symmetric and satisfactory results. Now we are sure that the reduction mandibular angleplasty assisted by C-arm fluoroscopy can be an accurate and safe method for the unexperienced surgeon, especially the patient with deep-seated prominent mandibular angle.
Fluoroscopy* ; Humans ; Osteotomy

No abstract available.
Zygoma*

There are numerous noninvasive buried suture methods available to make a double eyelid, such as, fixation with skin and pretarsal tissue, fixation with skin and conjunctiva through the tarsal plate and the sling technique, which goes between the levator and Muller muscle and subdermal tissue. But these methods have some shortcomings and many operators are concerned for preventing the double fold to lower and to fade away in puffy eyelid. Because, in puffy eyelid, the excessive orbital fat may migrate to the area of fixation and it jeopardizes the effect of suturing. So, We tried to change the thick and puffy eyelid to the slim eyelid by selectively removing soft tissue(pretarsal fat, muscle, orbital fat) through the three tiny incisions. Ninety-five patients underwent operation for creation of a double fold between January of 1996 and February of 1999. All were female. The patients' age ranged from 16 to 31 years, with the mean of 22 years. Most of our patients were satisfied except 5 cases with minor complication(mild asymmetry: 4 cases, foreign body granulation: 1 case). Our method is very similar to various nonincisional methods, however, we removed a portion of pretarsal tissue, muscle, and/or orbital fat around three small incision sites to facilitate tissue adhesion. A continued modification in nonincisional method and improvement in results for double eyelid operation can be expected.
Conjunctiva ; Eyelids* ; Female ; Foreign Bodies ; Humans ; Orbit ; Skin ; Sutures ; Tissue Adhesions

The constricted ear was suggested by Tanzer for the purpose of obviating the confusion involving lop ear, cup ear and prominent ear as defect whose helix turns down, and scapha and fossa triangularis are narrowed. The constricted ear has a spectrum of severity and therefore, requires a graded surgical approach. Tanzer has described the degree of deformities of the constricted ear as falling into three groups. For the correction of constricted ear, there are numerous techniques but we have had difficulties in adopting these techniques in various type. We also describe the various constricted ear as the Tanzer's classification and adopted three methods to each type, banner flap(group I), concha cartilage graft (group II) and rib cartilage graft(group III) for reducing postoperative deformity and confusion in correcting the ear deformities. Constricted ear repairs must be individualized to accomodate each specific deformity. We corrected 22 cases of constricted ear in 20 patients using each optimal method described above according to the degree of deformities. Mild deformities need only reshaping and adjusting of existing tissues, moderate deformities need additional skin and severe deformities require a cartilage graft. For correction of constricted ear, accurate identification of the severity of deformity is essential. The results were satisfactory and we report our experience with relative literatures.
Cartilage ; Classification ; Congenital Abnormalities ; Ear* ; Humans ; Ribs ; Skin ; Transplants

This case report involves tracheal intubation using i-gel(R) in combination with a lightwand in a patient with a difficult airway, classified as Cormack-Lehane grade 3. I-gel(R) was used during anesthesia induction to properly maintain ventilation. The authors have previously reported successful tracheal intubation on a patient with a difficult airway through the use of i-gel(R) and a fiberoptic bronchoscope. However, if the use of a fiberoptic bronchoscope is not immediately available in a patient with a difficult airway, tracheal intubation may be performed by using i-gel(R) and a lightwand in a patient with difficult airway, allowing the safe induction of anesthesia.
Airway Management ; Anesthesia ; Bronchoscopes ; Humans ; Intubation ; Intubation, Intratracheal* ; Laryngeal Masks ; Transillumination ; Ventilation

Spontaneous intracranial hypotension (SIH) is an uncommon disease that's caused by cerebrospinal fluid (CSF) leakage and this disease is considered to be an important cause of persistent headache. It is characterized by a postural headache in patients who are without any history of dural puncture or trauma. Conservative management, including bed rest analgesics and intravenous fluid administration, are the first-line treatment of SIH, and an autologous epidural blood patch (EBP) is generally indicated for those who fail the conservative management. We report here on a case of SIH with confirmed CSF leakage at the cervical, thoracic and lumbar levels, and this was successfully managed with a single autologous EBP at the lumbar level. We believe that an EBP at the leakage site with the highest pressure level should be considered as a primary treatment for SIH with multiple sites of leakage.
Analgesics ; Bed Rest ; Blood Patch, Epidural ; Headache ; Humans ; Intracranial Hypotension ; Punctures

BACKGROUND: Dexmedetomidine extends the duration of nerve block when administered perineurally together with local anesthetics by central and/or peripheral action. In this study, we compared the duration of nerve block between dexmedetomidine and epinephrine as an adjuvant to 1% mepivacaine in infraclavicular brachial plexus block. METHODS: Thirty patients, scheduled for upper limb surgery were assigned randomly to 3 groups of 10 patients each. We performed brachial plexus block using a nerve stimulator. In the control group (group C), patients received 40 ml of 1% mepivacaine. In group E, patients received 40 ml of 1% mepivacaine containing 200 microg of epinephrine as an adjuvant. In group D, patients received 40 ml of 1% mepivacaine containing 1 microg/kg of dexmedetomidine as an adjuvant. Sensory block duration, motor block duration, time to sense pain, and onset time were assessed. We also monitored blood pressure, heart rate, oxygen saturation and bispectral index. RESULTS: In group D and group E, sensory block duration, motor block duration and time to sense first pain were prolonged significantly compared to group C. However, there was no significant difference between group D and group E. CONCLUSIONS: Perineural 1 microg/kg of dexmedetomidine similarly prolonged nerve block duration compared to 200 microg of epinephrine, but slowed heart rate. Thus, dexmedetomidine is expected to be a good alternative as an adjuvant to local anesthesia in patients who are cautioned against epinephrine.
Anesthesia, Local ; Anesthetics, Local ; Blood Pressure ; Brachial Plexus* ; Dexmedetomidine* ; Epinephrine* ; Heart Rate ; Humans ; Mepivacaine* ; Nerve Block ; Oxygen ; Upper Extremity

BACKGROUND: Dexmedemomidine, a highly selective alpha-2 adrenoreceptor agonist has an analgesic and sedative effect without causing respiratory depression. In this study, we compared the duration of brachial plexus block (BPB), the time at which the patient first feels pain after performing BPB, the need for use of analgesics, and the occurrence rate of complications while continuous infusion with dexmedetomidine was used for sedation in patients undergoing BPB, to a control group, who were only infused with normal saline. METHODS: BPB was performed in 48 patients scheduled for upper limb surgery. Infraclavicular approach was provided with 40 ml of 1.5% mepivacaine and 200 microg of epinephrine using nerve stimulator. After verification of successful block, dexmedetomidine group received dexmedetomidine (loading dose 0.1 microg/kg/min for the first 10 minutes followed by a maintenance dose of 0.005 microg/kg/min as required to maintain bispectral index 60-80). In the control group, normal saline was infused at a rate of 10 ml/hr. The duration of BPB, the time at which the patient first feels pain after performing BPB, frequency of complication, and the use of analgesics of the both groups were checked. RESULTS: The motor and sensory block duration, and the time at which the patient first feels pain after BPB were longer in the dexmedetomidine group compared to the control group. And the need for analgesics were less in the dexmedetomidine group. CONCLUSIONS: Intravenous administration of dexmedetomidine prolongs the duration of BPB.
Administration, Intravenous ; Analgesics ; Brachial Plexus ; Dexmedetomidine ; Epinephrine ; Humans ; Hypnotics and Sedatives ; Mepivacaine ; Respiratory Insufficiency ; Upper Extremity

Seborrheic dermatitis is a chronic recurrent inflammatory disorder presumed to be caused by increased sebaceous gland secretion, metabolic changes in the cutaneous microflora, and changes in the host immune function. Stellate ganglion block (SGB) is known to increase the blood flow rate without altering the blood pressure, heart rate, or cardiac output, to stabilize hypertonic conditions of the sympathetic nerves, and to affect the endocrine and immune systems. It is used in the differential diagnosis and treatment of autonomic nervous system disorders of the head, neck, and upper limbs. The authors report the first case of successful treatment of a patient with seborrheic dermatitis through repeated SGB trials.
Autonomic Nervous System Diseases ; Blood Pressure ; Cardiac Output ; Dermatitis, Seborrheic* ; Diagnosis, Differential ; Head ; Heart Rate ; Humans ; Immune System ; Neck ; Nerve Block ; Sebaceous Glands ; Stellate Ganglion* ; Upper Extremity