PURPOSE: The purpose of this report is to present a case of persistent parotid fistula treated successfully with preoperative botulinum toxin type A injection into the parotid parenchyma, followed by fistulectomy. METHODS: A 72-year-old female patient presented to the hospital with a 5-month history of clear, watery discharge from a tiny opening on the left cheek, which increased during food intake. A chemistry test of the fluid revealed an high amylase level. An ultrasonography of left parotid gland showed a 1.13x0.6cm sized fistula. After demarcating the left parotid gland with assistance of ultrasonography, a total 40 units of botulinum toxin type A(Botox, Allergan, Irvine, CA) was injected into 4 subdivisions of the left parotid gland. The clear serous discharge ceased completely on the 5th day after botulinum toxin injection. On the 7th day, a fistulectomy was performed under the local anesthesia. RESULTS: The parotid fistula healed completely without complications. During the 6-month follow up period, there was no discharge from the cheek. CONCLUSION: On the basis of our experience with type A botulinum toxin as a local anticholinergic agent in treating parotid fistula, preoperative botulinum toxin A injection seems to be very useful to prevent recurrence after fistulectomy.
Aged ; Amylases ; Botulinum Toxins ; Botulinum Toxins, Type A ; Cheek ; Eating ; Female ; Fistula ; Follow-Up Studies ; Humans ; Parotid Gland ; Recurrence

PURPOSE: Asymmetric crying facies is caused by agenesis or hypoplasia of the depressor anguli oris muscle and is often associated various anomalies. Several static and dynamic surgical interventions have been reported, but their effects are unreliable. We report on the successful use of botulinum toxin A in an asymmetric crying facies patient. METHODS: A 4-year-old girl presented with a facial asymmetry on crying or smiling. Physical examination revealed that her face had no asymmetry at rest. However, the patient showed characteristic asymmetry when smiling, crying, and with other normal facial movements. Asymmetric crying facies was clinically suspected and the weakness of left depressor anguli oris was present on electrophysiology study. Fifteen units of botulinum toxin type A were injected to the right depressor anguli oris muscle. RESULTS: The patient showed the prominent improvement in the facial symmetry without significant complication and the effect persisted until 3 months post injection. CONCLUSION: Asymmetric crying facies was treated successfully with botulinum toxin A and this method was easy and noninvasive.
Botulinum Toxins ; Botulinum Toxins, Type A ; Crying ; Electrophysiology ; Facial Asymmetry ; Facial Paralysis ; Facies ; Humans ; Muscles ; Physical Examination ; Preschool Child ; Smiling

PURPOSE: The congenital epulis is a rare, benign tumor. It can protrude out of the newborn's mouth to prevent normal closure of the mouth and it can interfere with respiration or feeding. METHODS: An 11-day old female neonate presented with a 1.5x1.5x2.3cm sized mass in the gingival and anterior alveolar ridge of the mandible. We performed a simple excision. RESULTS: In our case, histologically, there was no pseudoepitheliomatous hyperplasia. The staining for S-100 protein, and actin was negative. After 8 months, the patient had normal teeth eruption and no recurrence of the tumor. CONCLUSION: With early detection and appropriate treatment, we were able to help the baby avoid developing any dyspnea. Nursing was possible after the mass had been removed.
Actins ; Alveolar Process ; Dyspnea ; Female ; Gingival Neoplasms ; Humans ; Hyperplasia ; Infant, Newborn ; Mandible ; Mouth ; Recurrence ; Respiration ; S100 Proteins ; Tooth

PURPOSE: Scalp avulsion is a life-threatening injury that may cause trauma to the forehead, eyebrows, and periauricular tissue. It is difficult to treat scalp avulsion as it may lead to severe bleeding. Therefore, emergency scalp replantation surgery is necessary, and we must consider the function, aesthetics, and psychology of the patients. A case of scalp avulsion leading to massive bleeding was encountered by these authors, which led to a failure to achieve the proper operation conditions in an adequate time period. METHODS: A 49-year-old female was hospitalized due to having had her head caught in a rotatory machine, causing complete scalp avulsion which included the dorsum of the nose, both eyebrows, and ears. Emergent microsurgical replantation was performed, where a superficial temporal artery and a vein were anastomosed, but the patient's vital signs were too unstable for further operation due to excessive blood loss. Three days after the microanastomosis, venous congestion developed at the replanted scalp, and a medicinal leech was used. Leech therapy resolved the venous congestion. A demarcation then developed between the vitalized scalp tissue and the necrotized area. Debridement was performed 2 times on the necrotized scalp area. Finally, split-thickness skin graft with a dermal acellular matrix(Matriderm(R)) was performed on the defective areas, which included the left temporal area, the occipital area, and both eyebrows. RESULTS: The forehead, vertex, right temporal area, and half of the occipital area were successfully replanted, and the hair at the replanted scalp was preserved. As stated above, two-thirds of the scalp survived; the patient could cover the skin graft area with her hair, and could wear a wig. CONCLUSION: Complete scalp avulsion needs emergent replantation with microsurgical revascularization, but it often leads to serious vital conditions. We report a case with acceptable results, although the microanastomosed vessel was minimal due to the patient's unstable vital signs.
Debridement ; Ear ; Emergencies ; Esthetics ; Eyebrows ; Female ; Forehead ; Glycosaminoglycans ; Hair ; Head ; Hemorrhage ; Humans ; Hyperemia ; Leeching ; Middle Aged ; Nose ; Replantation ; Scalp ; Skin ; Temporal Arteries ; Transplants ; Veins ; Vital Signs

The bicoronal incision, popularized by Tessier, provides wide access to the orbits, nose, and zygomas as well as the cranium. But blood loss is unavoidable. We attempt to reduce the blood loss and the transfusion with tumescent technique. Athors had performed 17 cases of bicoronal incision between June, 2002 and march, 2003. 8 cases of them underwent the procedure with tumescent solution(Group A). 9 cases was done by usual manner(Group B). We analyzed 23 cases undergiong bicoronal incision for the blood loss and the transfusion amount. Intraoperative blood loss, postoperative transfusion was reduced at Group A. And the dissecting was easy. We think that tumescent technique contributes to reduce the bleeding, additionally reduce the postoperative transfusion.
Hemorrhage ; Nose ; Orbit ; Postoperative Hemorrhage ; Skull ; Zygoma

The two important factors of the ear reconstruction are the contour of the cartilage framework and the projection of the auricle. A lot of techniques of the ear reconstruction were developed but recently, two staged method is widely used that is composed of the 1st stage operation of grafting 3-D costal cartilage framework and the 2nd stage operation of the auricular elevation using superficial temporal fascia and skin graft. But, as time goes by after the auricular elevation, the obliteration of the auriculocephalic angle is often produced by the scar formation, the contracture of the skin graft, and the tissue fibrosis. To maintain the projection of the auricle, we used the cartilage block and the resorbable plate composed of polylactic acid copolymer. The polylactic acid copolymer keeps the strength more than 1 year and is absorbed as slowly as 4 years. If the scar contracture and the tissue fibrosis would be made within the time that the resorbable plate is keeping the strength, the deformities from the scar contracture could be minimal. We used the resorbable plates in the surgery of the auricular elevation in eight cases of microtia from December, 2002 to June, 2003. The average duration of follow-up is about 6 months. The contour and the projection were kept well and the aesthetic results were excellent.
Cartilage ; Cicatrix ; Congenital Abnormalities ; Contracture ; Ear ; Fascia ; Fibrosis ; Follow-Up Studies ; Skin ; Transplants

Contrast agents are now commonly used for both diagnostic and therapeutic purposes. Complications of these agents include allergic reactions and damage to specific organs such as the kidney. But in rare cases, a temporary visual loss have been reported as our case. The 20-year-old male patient with 3cm sized cheek mass was transferred to our hospital. Initial CT findings showed a hemangioma. During follow-up survey, the mass enlarged and the pulsation was palpable. Indicating a vascular malformation, the carotid angiography checked and it was diagnosed as the A-V malformation. At 3 hours after angiography, he complained a progressive visual loss. 2 hours after onset of the visual loss, he lost his visual acuity completely. High dose steroid therapy started and he restored a complete visual acuity by 15 hours. The transient cortical blindness associated with angiography is not always due to the contrast agent. Clinical features of the cerebral embolism are identical to those of the neurotoxic effect of the contrast agent. So physicians should examine the patient carefully and other causes such as embolism, vasospasm and thrombotic event need consideration in the differential diagnosis. We experienced a case of the transient cortical blindness after the carotid angiography and review the literatures on this complication.
Angiography* ; Blindness, Cortical* ; Cheek ; Contrast Media ; Diagnosis, Differential ; Embolism ; Follow-Up Studies ; Hemangioma ; Humans ; Hypersensitivity ; Intracranial Embolism ; Kidney ; Male ; Vascular Malformations ; Visual Acuity ; Young Adult

Orbital mass is about 17% of orbital disease and only 7-8% of mass is lymphoma. Lymphoma involved extraocular muscles are unusual. Lymphoma occurred in lateral rectus muscle, rarely. The authors experienced a case of malignant lymphoma occurred in the lateral rectus muscle in 17-year-old male. His main symptom was exopthalmos and diplopia. The patient was treated with excision via bicoronal approach and radiation. We report the unusual case of malignant lymphoma occurred in lateral rectus muscle.
Adolescent ; Diplopia ; Humans ; Lymphoma* ; Male ; Muscles ; Orbit ; Orbital Diseases

Congenital earlobe deformity and the presence of the cleft at a site of the earlobe seems to be rare. It is important to well-formed, symmetrically positioned ears as a sign of esthetically pleasing, harmonious facial features. So the patients with cleft earlobe require operative repairs. The surgical techniques for congenital earlobe clefts employed vary from simple closure, Z-plasty, L-plasty, two flap method, triangular flap method, and so on. Among them, Passow-Claus described the classic L-plasty method. We designed the modified method that the L-flap direction faced laterally opposed to that of classic L-plasty and propose to term this method `reverse L-plasty`. Kitayama classified the congenital earlobe cleft into four groups according to the shape of cleft, as longitudinal, transverse, triplelobe or mixed, and defective type. We experienced four cases of congenital earlobe cleft. One patient was a defective type and the others were triplelobe types. There`s no complication in patients. We could obtain the advantages of smooth contour of free border, lack of groove or notching due to scar contracture, and possible in moderate defective type without additional method after long term follow-up. This technique breaks the vertical component of scar contracture, resulting in a smooth lobular border. So we believe that this reverse L-plasty technique offers a better cosmetic result in the repair of the cleft earlobe.
Cicatrix ; Congenital Abnormalities ; Contracture ; Ear ; Follow-Up Studies ; Humans

Exenteraion in early infancy by a tumor and radiotherapy caused the contracted eye socket and Orbital hypoplasia. This result is because of the abscence of the conjunctival fornix and in severe contraction of orbital fat and developmental bone abnormalities. The authors corrected a contracted eye socket and orbital hypoplasia simultaneously, secondary to previous surgery and radiotherapy. A one-stage surgical reconstruction was undertaken using a radial osteocutaneous flap, which were transfered for eye socket reconstruction and orbital hypoplasia. Adipofascia and fragment of radius inserted as an hypoplastic orbit rim susbtitute to enlarge the orbital region. We report that we have experienced a case of eye socket reconstruction with a radial forearm osteocutaneous free flap.
Forearm* ; Free Tissue Flaps* ; Orbit* ; Radiotherapy ; Radius