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

PURPOSE: Reconstruction of a full thickness defect of the nose is a difficult task for plastic surgeons because the anatomical characteristic, shape, and function of the nose all need to be taken into consideration. Most often, a local flap or a composite graft is used, but for a large defect, reconstruction using free flaps is the most ideal method. In free flap reconstruction, the chondrocutaneous preauricular area can be a suitable donor site. We performed a chondrocutaneous preauricular free flap with an interpositional vascular graft for reconstruction of a nasal ala. METHODS: A 46 year-old male presented to the hospital with a right alar deformity induced by a dog bite. During the surgery, the existing scar tissue was removed and thereby a newly formed full thickness defect was reconstructed using the chondrocutaneous preauricular free flap with an interpositional vascular graft harvested from the descending branch of the lateral femoral circumflex vessel between the facial and superficial temporal vessels of the free flap. RESULTS: The flap survived without flap loss and showed symmetry in its overall shape, contour, texture, and color. The patient was satisfied with the results and the surgery yielded no additional scars at the nasolabial fold area. CONCLUSION: The chondrocutaneous preauricular free flap is a valuable method in reconstruction of full thickness defects of the nose, and using the descending branch of the lateral femoral circumflex vessel as the interpositional vascular graft at the anastomotic site produces reliable results.
Animals ; Bites and Stings ; Cicatrix ; Congenital Abnormalities ; Dogs ; Free Tissue Flaps ; Glycosaminoglycans ; Humans ; Male ; Nasolabial Fold ; Nose ; Nose Deformities, Acquired ; Succinates ; Tissue Donors ; Transplants ; Vascular Grafting

PURPOSE: There have been few case reports regarding treatment plans for long-term, neglected scalp defects and calvarial defects with subdural abscess. The purpose of this case report is to present our experience with a free latissimus dorsi musculocutaneous flap for scalp and calvarial defects and to discuss flap options in comparison with a literature review. METHODS: A 60-year-old man who fell down from a four-story-height that resulted in a craniotomy in 1979; he visited our outpatient clinic for a chronic, purulent scalp and calvarial defects with unidentified artificial bone. The artificial bone was removed by a neurosurgeon and reconstructed with a free latissimus dorsi musculocutaneous flap. The deep temporal artery was used as a recipient artery. The postoperative flap status was excellent until the 6th day post-operation when the patient experienced a seizure, and an arterial insufficiency occurred at the flap probably due to an arterial spasm. Emergency exploration with arterial re-anastomosis was performed and the flap status was stabilized. RESULTS: Complete wound healing was achieved after 3 weeks without infectious and systemic postoperative complications. During the 6 month follow-up period, there were no complications. CONCLUSION: We suggest the latissimus dorsi myocutaneous free flap as a good treatment option for a chronic, purulent, complicated scalp with calvarial defect, as a well as treatment for an acute traumatic defect.
Abscess ; Ambulatory Care Facilities ; Arteries ; Craniotomy ; Emergencies ; Follow-Up Studies ; Free Tissue Flaps ; Humans ; Middle Aged ; Postoperative Complications ; Scalp ; Seizures ; Spasm ; Temporal Arteries ; Wound Healing

PURPOSE: It is accepted universally that correction of the cleft lip nasal deformity requires multiple stages of surgery. Following primary lip repair in infancy or early childhood, secondary surgery to improve the deformity of the lip and nose is frequently necessary. A suitable surgical procedure to correct the accompanying deformity, such as cleft palate and alveolus, must be carried out at an appropriate age. In developing countries, it is common for patients with cleft lip nasal deformity to present severe secondary deformities in adolescence, because of poor follow-up and inappropriate surgery. METHODS: The first patient was a 12 year old Mongolian boy. He presented prominent lip scar, short lip, wide columella, asymmetric nostril, palatal fistula, cleft alveolus, and velopharyngeal incompetence. He underwent cheilorhinoplasty, transpositional flap, alveoloplasty by iliac bone graft, and sphincter pharyngoplasty. On follow-up, a bilateral maxillary hypoplasia and a class III malocclusion developed. He underwent LeFort I osteotomy and maxillary advancement at the age of 16 years. The second patient was an 18 year old Eastern Russian girl. She presented with a deviated nose, right alar base depression, short lip, protrusion on vermilion, large palatal fistula, and severe VPI due to short palate. She underwent the combined procedure of cheilorhinoplasty, corrective rhinoplasty, tongue flap for palatal fistula, and superiorly based pharyngeal flap. And the tongue flap was detached at postoperative 3 weeks. RESULTS: The overall results have been extremely pleasing and satisfactory to patients. There were no postoperative complications. CONCLUSION: We discovered the one stage operation for radical correction was sufficient procedure to provide excellent clinical outcomes in patients with severe cleft lip nose deformity.
Adolescent ; Alveoloplasty ; Cicatrix ; Cleft Lip ; Cleft Palate ; Congenital Abnormalities ; Depression ; Developing Countries ; Emigrants and Immigrants ; Fistula ; Follow-Up Studies ; Humans ; Lip ; Malocclusion ; Nose ; Osteotomy ; Palate ; Rhinoplasty ; Succinates ; Tongue ; Transplants ; Velopharyngeal Insufficiency

PURPOSE: Nasal bone fracture is the most common type of facial bone fracture. The standard 6-view photography was not adequate to support the evaluation of nasal deformity and the results of closed reduction. The authors have standardized a bird's eye view photography to more effectively evaluate this nasal deformity. METHODS: We reviewed the medical records and radiologic studies of 63 nasal bone fracture patients. We had taken clinical photography including bird's eye view that was standardized as nasal tip was aligned to Cupid's bow of upper lip and light was focused on the nasion of all 63 patients. RESULTS: Nasal deviations and reductions were more noticeable on the newly standardized bird's eye view. This clinical photography was very useful to explain the results of reduction. CONCLUSION: It was concluded that this photography can be more reliable for evaluation of severity of nasal deformity and the result of closed reduction.
Congenital Abnormalities ; Eye ; Facial Bones ; Humans ; Light ; Lip ; Medical Records ; Nasal Bone ; Photography

PURPOSE: In most cases of nasal bone fracture, closed reduction with internal or external splint fixation approach is selected. However, because of indiscriminate insertion of the internal splint without considering of anatomical difference or deformity, insufficient fixation happens frequently that need additional fixation. Therefore, we suggest a new method for providing adequate support in reduced nasal bone by carving Merocel(R) that is fixed for the anatomical structure. METHODS: Closed reduction and internal fixation with carved Merocel(R) was performed in 15 nasal bone fracture patients from March, 2010 to July, 2010. Each patient was evaluated by physical examination, facial photographic check, simple X-ray, and computerized tomography. On the first day post-operation, location of packing and amount of reduction were checked by follow up X-ray and computerized tomography. In addition, patients' symptoms were evaluated. During the 3-month post-op follow up at out-patient clinic, operator, 2 doctors in training and one assistant performed the objective evaluations by physical examination on nasal dorsal hump, nasal deviation, nasal depression, nasal breath difficulty, and nasal airway obstruction. A survey of subjective patients' satisfaction in 4-stages was also performed. RESULTS: The results of follow-up computerized tomography of the 15 patients revealed that 11 patients had good reduced state. Three patients with combined maxillary frontal process fracture had over reductions. A survey performed on the first day post-operation showed that 14 of 15 patients answered that their current symptoms were more than tolerable. At the 3-month follow-up physical exam, one case had a dorsal hump. However, there were no nasal deviations, nasal depressions, nasal breath difficulties, or nasal airway obstructions. Twelve of the 15 patients answered more than moderate on the 3-month survey. CONCLUSION: Intranasal packing after carving the Merocel(R) considering anatomical structure is a new effective method to promote proper-reduction, maintain stability, and minimize patients' symptoms by addition of a simple procedure.
Airway Obstruction ; Congenital Abnormalities ; Depression ; Follow-Up Studies ; Fractures, Closed ; Humans ; Nasal Bone ; Nasal Obstruction ; Outpatients ; Physical Examination ; Splints

PURPOSE: The purpose of this study was to investigate the possibility that a dynamic facial composite flap with sensory and motor nerves could be made available from donor facial composite tissue. METHODS: The faces of 3 human cadavers were dissected. The authors studied the donor faces to assess which facial composite model would be most practicable. A "panorama facial flap" was excised from each facial skeleton with circumferential incision of the oral mucosa, lower conjunctiva and endonasal mucosa. In addition, the authors measured the available length of the arterial and venous pedicles, and the sensory nerves. In the recipient, the authors evaluated the time required to anastomose the vessels and nerve coaptations, anchor stitches for donor flaps, and skin stitches for closure. RESULTS: In the panorama facial flap, the available anastomosing vessels were the facial artery and vein. The sensory nerves that required anastomoses were the infraorbital nerve and inferior alveolar nerve. The motor nerve requiring anstomoses was the facial nerve. The vascular pedicle of the panorama facial flap is the facial artery and vein. The longest length was 78mm and 48mm respectively. Sensation of the donor facial composite is supplied by the infraorbital nerve and inferior alveolar nerve. Motion of the facial composite is supplied by the facial nerve. Some branches of the facial nerve can be anastomosed, if necessary. CONCLUSION: The most practical facial composite flap would be a mid and lower face flap, and we proposed a panorama facial flap that is designed to incorporate the mid and lower facial skin with and the unique tissue of the lip. The panorama facial composite flap could be considered as one of the practicable basic models for facial allotransplantation.
Arteries ; Cadaver ; Conjunctiva ; Facial Nerve ; Facial Transplantation ; Humans ; Lip ; Mandibular Nerve ; Mouth Mucosa ; Mucous Membrane ; Sensation ; Skeleton ; Skin ; Tissue Donors ; Veins