From March 1997 to August 2001, Titanium mesh screen 1.0 (SYNTHES(R)) were applied to the repair of 29 medial orbital fractures; 18 patients with orbital inferior wall fracture, 16 patients with nasal bone fracture and 6 patients with pure medial wall fracture. Clinically, the periorbital ecchymosis and subconjunctival hemorrage were sensitive indications of orbital wall fracture. Even though there are no sign of diplopia or enophthalmos, in cases of simple nasal bone fracture with periorbital ecchymosis and subconjunctival hemorage, the evaluations of medial orbital wall fracture were strongly recommended because the medial orbital wall fractures occurred frequently combined with simple nasal bone fractures. Titanium mesh screen 1.0 was used as onlay implant to fit the anatomical shape on the fracture portion needed to be reconstructed and 1.3mm microscrews (SYNTHES(R)) were used to fix titanium mesh screen. The patients were followed up for 18 months with no significant enophthalmos or diplopia.
Diplopia ; Ecchymosis ; Enophthalmos ; Humans ; Inlays ; Nasal Bone ; Orbit* ; Orbital Fractures ; Titanium

The reconstruction of the cheek area is a complex problem because the cheek is the most broad area of the face and is close to the aesthetically important region such as eyelids, nose, and mouth. The ultimate purpose of the cheek reconstruction is the restoration of the original shape and function, and establishment of the harmony with the adjacent structure in terms of color, nature and thickness. Various procedures such as skin graft, local flap, free flap, and local flap using skin expansion have been performed for cheek reconstruction. However, no golden principal or indication has been clarified to be imperative. Analyzing our clinical experiences of the cheek reconstruction, we intend to present a general guide of the cheek reconstruction and to assess the advantages and/or disadvantages of the operative methods. Between march of 1989 and August of 1999, we have experienced 154 cases of the cheek reconstruction. There were 52 males and 73 females, and their ages ranged from 3 to 89 years (mean 28.1 years). Preoperative diagnosis were post-burn deformity(n=74), Romberg disease (n=9), post-traumatic deformity(n=7), hemangioma(n=7), nevus(n=7), neurofibroma(n=5), hemifacial microsomia (n=3), lymphangioma(n=3), cancer(n=6), post-hemimandibulectomy(n=1), radical maxillectomy(n=1). The procedures were one stage cervicofacial flap(49 cases), cervicofacial flap following skin expansion(42 cases), local cheek flap (14 cases), deltocervicopectoral flap(2 cases), skin graft(29 cases), free flap(18 cases). Follow up period ranged from 3 to 72 months(mean 11.8 months). Advantages and disadvantages of each procedures were explained. The satisfaction rate was higher in one stage cervicofacial flap and free flap when assessed by both patients and surgeon. There were 3 cases of the ectropion of lower eylids, 4 cases of partial flap necrosis, and 1 case of exposure of tissue expander. The local flap is always the preferred method for the cheek reconstruction and the free flap is the treatment of choice for the cheek contour reconstruction. Selection of the most suitable flap is mandatory depending on the location and size of the defects.
Cheek* ; Diagnosis ; Ectropion ; Eyelids ; Facial Hemiatrophy ; Female ; Follow-Up Studies ; Free Tissue Flaps ; Goldenhar Syndrome ; Humans ; Male ; Mouth ; Necrosis ; Nose ; Skin ; Tissue Expansion Devices ; Transplants

A great number of operative techniques has been described about the correction of the prominent ears. The most primary deformity of the prominent ears comes from an underdeveloped or unfolded antihelix, which results in widening of the conchoscaphal angle and/or flattening of the superior crus, and which, in severe forms, involves antihelical body and inferior crus. Most authors manage the prominent ear deformity by excising, suturing, scoring, or sculpturing the auricular cartilage. We carried out a modified quilting suture technique in order to produce an antihelix. This technique provides several advantages; 1) it prevents the bowstring of the suture material during the formation of the helix; 2) the procedure is easy and time-saving; 3) the reconstructed ear shows reliable results in firmness and stability against external force or trauma; 4) the recurrence rate is not more than that of the conventional methods.
Congenital Abnormalities ; Ear Cartilage ; Ear* ; Recurrence ; Suture Techniques* ; Sutures*

Anatomy of oral cavity in Down syndrome is characterized by hypotonic macroglossia, small oral cavity, narrow palate with high-arch shape and hypertrophy of tonsil and adenoid. Because of such a anatomic characteristics, they show difficulty in respiration, mastication, swallowing and articulation. So far we operated on 135 children with Down syndrome for partial glossectomy in average volume of 4.6cc. This study is histopathologic finding of partially resected tongue in 4 cases, analyzed by histochemical stain and electron microscopy. The results of histochemical study showed predominant of Type 2 myofiber and interstitial edema, fibrosis and chronic nonspecific inflammation. In the study of electron microscope, the size and number of mitochondria were increased, but structural abnormality was not showed.
Adenoids ; Child* ; Deglutition ; Down Syndrome* ; Edema ; Fibrosis ; Glossectomy ; Humans ; Hypertrophy ; Inflammation ; Macroglossia ; Mastication ; Microscopy, Electron ; Mitochondria ; Mouth ; Palate ; Palatine Tonsil ; Respiration ; Tongue*

Cranioplasty is a method of the correction of defects and deformities of the bony walls protecting the brain. If defects and deformities are located in the frontal region, the correction is often necessary for cosmetic reasons. Rib, iliac bone and calvarium may be used for frontal cranioplasty. Rib bone and iliac bone have the donor morbidity and may result in cosmetically unacceptable contour. Calvarium is superior to the ilium and rib for it causes less donor site morbidity, it's consistency is harder than others and postoperative bone resorption is less. But it is difficult to mold and shape at the operative table, because the contour of parietal bone is different from that of frontal bone. For the last recent two years, we have performed frontal cranioplasty in five patients with frontal defect or deformity, by using calvarial bone graft that is molded with multiple osteotomy and microplate. Follow-up period ranged from 6 to 18 months with a mean of 12 months. There were no complications. This technique was simple and we could get aesthetically good contour on the frontal area.
Bone Resorption ; Brain ; Congenital Abnormalities ; Follow-Up Studies ; Frontal Bone ; Fungi ; Humans ; Ilium ; Osteotomy* ; Parietal Bone ; Ribs ; Skull ; Tissue Donors ; Transplants

With the introduction of smaller metallic plating systems, many surgeons have adopted their use for craniofacial procedures in infants and small children. However, this metallic plating system had problems associated with the use of plates and screw in infants and children. These problems include intracranial migration of material, cranial growth restriction, foreign body reaction and infection. Absorbable plating system has been used as solution of these problems. In this study, absorbable plates (BioSorbFX, BIONX IMPLANTS inc.) composed of a copolymer of polylactic and polyglycolic acid were used in the reconstruction of pediatric craniofacial deformities. In 4 patients who were diagnosed with craniosynostosis between 10 and 36 months of age, absorbable plates were implanted. Follow-up periods were from 6 months to 18 months. Postoperatively, circumferential length of head was increased and cranial bone growth was symmetric. No complications were seen with this use, including infection, overlying soft tissue reaction, reconstructive instability, or underlying osteolysis around the screws. In secondary reconstructive surgery of patient with Crouzon's disease, we found out that no residual traces of polymer were evident visually and all osteotomy sites were healed completely without underlying osteolysis. These results demonstrate the safety and effectiveness of this copolymeric material for pediatric craniofacial applications.
Bone Development ; Child ; Congenital Abnormalities ; Craniofacial Dysostosis ; Craniosynostoses* ; Follow-Up Studies ; Foreign-Body Reaction ; Head ; Humans ; Infant ; Osteolysis ; Osteotomy ; Polyglycolic Acid ; Polymers

Correction of the severe cleft lip nasal deformity is challenging and we used the composite graft to correct the cleft lip nasal deformity with severe tissue deficiency or severe nostril asymmetry. A total of 19 patients, who were born with complete cleft type, was operated between 1995 and 1999. Among them, 10 patients were men and nine were women. Age distribution was seven to 35 years old. In nine patients with unilateral cleft lip nasal deformity and six patients with bilateral cleft lip nasal deformity, columella lengthening was performed using composite graft taken from the helix in 14 cases and contralateral alar rim in one case. In four patients with severe asymmetric nostrils due to a short alar rim in unilateral cleft lip nasal deformity, the ear helix was used in two cases. while in the other two cases the alar rim of the unaffected side was transferred to the affected side to make symmetric nostril by reducing the length of the alar on the affected side. Follow up periods ranged from one to three years, and results were as follows: 1. Four days after the graft, the composite tissue exhibited a pinkish color. Complete survival was confirmed after seven days. The absorption rate observed was about 10 percent and color mismatch became minimal with time. 2. Composite tissue taken from the ear was found to be useful for a full layer reconstruction of the alar and columella due to its stiffness, thin nature, and similarity. Composite tissue from the alar rim of the contralateral side was also determined as good material for a full layer reconstruction of the deficient alar.
Absorption ; Adult ; Age Distribution ; Cleft Lip* ; Congenital Abnormalities* ; Ear ; Female ; Follow-Up Studies ; Humans ; Male ; Transplants*

The epiopathogenesis of craniosynostosis remains obscure. According to the studies involved, the conditions observed at birth are very different. In case that a deformity is obvious or the risk of brain compression is possible, strip craniectomy, frontal bone advancement and cranial vault remodeling methods are used. These direct reshaping or remodeling methods are time consuming and require greater use of physical resources and still are not uniformly successful in making skull shape to normal. Distraction of the cranial bone has been studied to solve this problem. This study subsequently included 30 white rabbits aged about 25 weeks. The rabbits were divided in three groups. In group I, a 0.25mm distraction was done every other day after 3 day latency period. In group II, there was a 7 day latency period with the same rate of distraction as in group I. There was a 3 day latency period with a 0.5mm distraction every other day in group III. The contralateral side underwent a sham operation as a control group. During distraction and after consolidation periods, histologic and ultrastructural studies were carried out. And a serial radiologic study was done. As a result, group I and group II showed successful distraction osteogenesis, and we demonstrated the biological and mechanical factor associated with distraction osteogenesis. In group I, despite the short latency period, there was successful bone regeneration. Group III, it also showed successful ossification. During the distraction period, there was a remarkable increase of TGF-beta1 in both groups, especially in periosteum osteoid and newly developed connective tissue. In conclusion, we have demonstrated a useful model of distraction osteogenesis in rabbit skulls, and attempted to evaluate associated biological and mechanical factors.
Bone Regeneration ; Brain ; Congenital Abnormalities ; Connective Tissue ; Craniosynostoses ; Frontal Bone ; Latency Period (Psychology) ; Osteogenesis, Distraction ; Parturition ; Periosteum ; Rabbits ; Skull* ; Transforming Growth Factor beta1

In the maxillofacial surgery, close care is mandatory during operation and anesthesia. The surgical field is limited since most procedure is done through the mouth. In this situation, airway management and blood pressure controls are keystone. So, the induced hypotensive anesthesia is essential to the maxillofacial surgery for bleeding control and accurate operation. One hundred and ninety-eight cases of maxillofacial surgery was carried out under induced hypotensive anesthesia from 1991 to 1999. Authors divided them into 4 groups based on the anesthetic protocol. In group 1(n = 43) inhalation anesthetics(enflurane, halothane) and sodium nitroprussde(SNP) were used; in group 2(n = 99) inhalation anesthetics(enflurane), SNP and labetalol were used; In group 3(n = 27) inhalation anesthetics(enflurane) and labetalol were used; In group 4(n = 29) total intravenous anesthesia(propofol, fentanyl, midazolam) was applied with SNP, and esmolol(or labetalol). The patient records were retrospectively studied during the operation and anesthesia, including degree of fluctuation in the mean arterial blood pressure, amounts of the blood loss and transfusion during the operation, complications, and the period of hospitalization. Mean operation time of 4 groups decreased in order. The blood pressure was controllable without reflex tachycardia in beta-blocker using groups. Amount and incidence of transfusion was smaller in total intravenous anesthesia group. However there were no significant differences in total admission days and ICU stay periods between 4 groups.
Airway Management ; Anesthesia ; Anesthesia, Intravenous ; Arterial Pressure ; Blood Pressure ; Fentanyl ; Hemorrhage ; Hospitalization ; Humans ; Incidence ; Inhalation ; Labetalol ; Mouth ; Reflex ; Retrospective Studies ; Sodium ; Surgery, Oral ; Tachycardia

Along with aural atresia, abnormalities of the middle ear and external ear canal can impede the audition of the developing infant. In cases of bilateral atresia when bone-conduction aids fail to adequately restore impaired hearing, unilateral canal reconstruction may be required at a very early age to enable proper speech and language development. We are often confronted by cases in which canaloplasty has previously been performed by ENT surgeons, leaving auricular canals of various locations and sizes in addition to scars. In such cases, it can be difficult to prepare a skin flap sufficient in size to cover the cartilagenous framework for auricular reconstruction. Scar tissues with relatively poor vascularity induced by a prior incision and elevation of the soft tissue may compromise the ultimate result of auricular reconstruction. To obtain the sufficient, thin, pliable and well vascularized skin, we used tissue expansion at the first stage of the auricle reconstruction in microtia patients who previously received canaloplaty. From December, 1988 to February, 1999, we attempted tissue expansion using volume 35cc, cresent- type inflatable silicone expanders(SebbinR) in 12 patients who previously received canaloplasty. Ear frameworks were prepared using autologous rib cartilage. The expanded skin provided sufficient, thin, pliable, and well vascularized skin for easy draping and better contouring. The reconstructed auricle was satisfactory in both color and texture and had nearly normal sensation. No resorption of the inserted rib cartilage has been observed from 7 months to 9 years and 9 months after the operation.
Cartilage* ; Cicatrix ; Ear ; Ear Canal ; Ear, Middle ; Hearing ; Humans ; Infant ; Language Development ; Ribs* ; Sensation ; Silicones ; Skin ; Tissue Expansion ; Tissue Expansion Devices* ; Transplants*