Vascular transformation of lymph node sinuses is a rare condition and only isolated cases have been reported in the literature. Most lymph nodes with vascular transformation of sinuses are found in abdomen, and head and neck involvement is rare. It is characterized by the intrasinusoidal proliferation of endothelial cells forming a system of anastomosed channels filled with blood, and by an intrasinusoidal fibrous reaction. It is important to recognize that they may be a marker for the presence of any undetected malignant tumor. In this article, we report a rare case of vascular transformation of cervical lymph node sinuses with some reviews of the literature.
Abdomen ; Endothelial Cells ; Head ; Lymph Nodes* ; Neck

Hemangioma is one of the most common tumor in the region of the head and neck. There are many methods were tried for the treatment of hemangioma, however no single satisfactory method was introduced. The hemangioma which arised from the external ear are rare. Authors report three cases of the hemangioma which involved the external ear. The hemangioma was aesthetically treated with surgical reduction and ligation
Ear, External* ; Head ; Hemangioma* ; Ligation* ; Neck

The purpose of this article is to review the method using the mucosal island flap for the reconstruction of upper and lower lip defect and introduce its versatile applications and advantages. This flap is based on the inferior labial artery as the axial pedicle and is composed of musosa only, excluding muscle to give a sufficient rotation arc of the flap. Mucosal island flap is effective for the reconstruction of vermilion, because the mucosa of the flap is similar to the lip, with its color and texture matched well. Four patients with various large defects of vermilion underwent the reconstruction with mucosal island flaps. Two patients were presented with venous malformations and others were admitted with lip deformities caused by traffic accident or operation for basal cell carcinoma. Elevation of flap is simple and safe in maintenance with the interdental wire fixation to prevent the pedicle from being stretched and, primary closure is available in donor site under local anesthesia. Therefore, mucosal island flap can be recommended as an effective and reliable method for the reconstruction of over one-third defect of vermilion.
Accidents, Traffic ; Anesthesia, Local ; Arteries ; Carcinoma, Basal Cell ; Congenital Abnormalities ; Humans ; Lip ; Mucous Membrane ; Surgical Flaps ; Tissue Donors

Fibrous dysplasia is a benign pathologic condition of bone and causes facial deformity as well as functional problems. The monostotic form of the disease is much more common(70-80 percent) than the polyostotic variety (20-30 percent). In craniofacial fibrous dysplasia, craniofacial involvement occurs in 10-30 percent of monostotic and 50 percent of polyostotic patients. Frontal, sphenoid, ethmoid, and maxilla bones are frequently involved. Jaw involvement may involve a solitary lesion, but nonetheless in more common in the maxilla than in the mandible. We report a case of mandible reconstruction of pan-craniofacial polyostotic fibrous dysplasia that do not involve maxilla. In operation, extensive hemimandibulectomy was done and fibular bone free flap was done for mandible reconstruction. Postoperative 6 months later, focal osteomyelitis was seen in mandible angle. We removed mini-plate and screw and illiac cancellous bone graft was performed. 3 months after second operation, wound healing was uneventful and we have a functionally and cosmetically good outcome.
Congenital Abnormalities ; Fibrous Dysplasia, Polyostotic ; Free Tissue Flaps ; Humans ; Jaw ; Mandible* ; Mandibular Osteotomy ; Maxilla* ; Osteomyelitis ; Transplants ; Wound Healing

Condylar and subcondylar fractures constitute 26-49% of all mandible fractures. There are two principal treatments in these fractures: closed and open reduction. Closed reduction is adopted most frequently. However, there are many reports about the sequelae of closed reduction such as occlusal disruption, varying degree of nonunion and arthritic change, etc. There have been many papers describing advantages of the surgical treatments. In 1989, Ellis et al. reported a new technique for subcondylar fracture. In severe anteromedial fracture dislocations where the condylar head is not retrievable, they recommended a submandibular incision and a vertical ramus osteotomy followed by removal of osteotomized segment. After rigid fixation between the ramus and condylar head, the union was returned as a free bone graft, and the osteotomy site was plated. During their original procedure, however, there are possibility of injury to the inferior alverolar nerve because the distance from posterior cortex of ramus to the canal for nerve has been reported 12.1mm. In this study we modified the Ellis' method to avoid injury to the nearby inferior alveolar nerve. Our method, slight oblique vertical osteotomy of ramus from the sigmoid notch to 1 cm above from the gonion and short horizontal osteotomy, was applied to treat most cases where there are indications for open reduction, contrary to the original indication. Six patients were treated using our method. After 3 months follow-up, the maximal mouth opening showed 39.3cm, protrusion 5.6, lateral deviation 14.3(homolateral side), and 12.2(contralateral side). The occlusal states became good without openbite and crossbite. In this study, we could have satisfactory results from our modified procedure applying to most cases where closed reduction cannot be used or cannot guarantee restoration of TMJ integrity.
Colon, Sigmoid ; Dislocations ; Follow-Up Studies ; Head ; Humans ; Malocclusion ; Mandible ; Mandibular Condyle* ; Mandibular Nerve ; Mouth ; Open Bite ; Osteotomy ; Temporomandibular Joint ; Transplants

Rigid fixation with metallic plates & screws have been widely used in craniofacial surgery. But the metallic plating system had some problems including intracranial migration, growth restriction, foreign body reaction, infection and artifacts in radiologic evaluation. To overcome these drawbacks, there had been a continuous research on the development of a bioabsorbable skeletal fixation system using polymers of polylactic and polyglycolic acid. There is an increasing acceptance of its application as an alternative fixation device in craniofacial surgery. The resorbable fixation devices have been used in our department between January 2001 and June 2004 in craniofacial surgery. The aim of this retrospective study is to review the complications experienced during this period. We have used the SR-PLDLA(Self reinforecd poly- L/DL-lactide polymer, BioSorbFX(R)) in 131 patients of craniofacial bone fractures. Age varied from 3 to 72 and follow up period varied from 4 months to 40 months. We encountered 4 cases of foreign body reaction, 3 cases of infection and 1 cases of device exposure. In patient showing foreign body reaction, we treated with antibiotics. In case of uncontrolled infection, we removed implants. We think that the resorbable plating system on the rise as alternative method in craniofacial surgery. But more research is needed about its complications.
Anti-Bacterial Agents ; Artifacts ; Follow-Up Studies ; Foreign-Body Reaction ; Fracture Fixation ; Fractures, Bone* ; Humans ; Polyglycolic Acid ; Polymers ; Retrospective Studies

There is a tendency that facial traumas are increasing constantly due to the growing traffic accidents and criminal violences with the industrialization of the society. Among these traumas, the frequency of the mandible fracture is the second highest next to that of the nasal bone fracture. The mandible is an evitable part which makes the temporomandibular joint movement and occlusion. The reduction of these fractures is considered important in view of the aesthetic and functional aspects of human beings. This retrospective study comprised 587 patients with mandibular fracture who had been treated in the Department of Plastic and Reconstructive Surgery from March, 1, 1997 to February, 28, 2004. The studied items are age and sex distribution, prevalent time, causes of the fracture, fracture sites, accompanied soft tissue and bone injuries, treatment methods, time interval between the accident and operation, and the complications. The following results were obtained. 1. The male and female ratio of mandibular fractures was 4.1:1. The mandibular fractures of the young men in twenties were the highest(32.7%). 2. The monthly incidence was the highest on June and the greatest numbers of incidence occurred between 9 p.m and 3 a.m.(51.2%). 3. The most common cause of mandibular fracture was the traffic accident(35%). 4. The most common fracture site was symphysis (36.6%), followed by angle(28.9%), condyle(24.2%). 5. The mandibular fractures were usually accompanied with zygoma, maxilla, orbit and nasal fractures. 6. We have done 518 operative treatments out of 587 cases. We can get perfect reduction and shorten the treating period, performing operative treatment, which is open reduction with the plate and screw. In case of subcondyle level, we utilize the external fixation. 7. The most common time interval between onset and surgical intervention was less than 10 days(66.8%). 8. The long term follow up longer than 6 months was possible in 286 patients. Malocclusion(14 cases, 4.9%), sensory disturbance of lower lip(11 cases, 3.8%), malunion or nonunion(8cases, 2.8%), and infection(8cases, 2.8%) were the complications found in these patients.
Accidents, Traffic ; Criminals ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Mandible* ; Mandibular Fractures ; Maxilla ; Nasal Bone ; Orbit ; Plastics ; Retrospective Studies ; Sex Distribution ; Temporomandibular Joint ; Zygoma

Mandible fractures, among facial injuries, cause severe pain and difficulties in masticating movement, moreover, it can also bring problems to social life. Accurate diagnosis and proper treatment for mandible fractures is needed to preserve mandibular function and to prevent malformation and complications. A history taking, a physical examination, a simple radiograph, and a conventional facial computed tommography are usually used to diagnose mandible fractures. However, these methods are not enough to understand the three dimensional structured mandible, the fractures-types, the relationship between inferior alveolar nerve and fractures. In the course of planning mandible operation, conventional facial computed tommography has wider section than mandible computed tommography, and horizontal & vertical mid-line division. Resultly, only poor information about inferior alveolar nerve could be achieved and no vertical imaging of mandible. Oppositely, mandible CT could get vertical imaging, and enough information, cause of getting 1mm-gap slice. In this study, we have compared image- information from mandible CT with from conventional facial CT about 28 patients(28/64 1 year-visit patients). Vertical images of mandible could not only help our pre- surgery diagnosis, but also result better post-surgery effect. Mandible enlarged fine-gap CT has used to examine mandible fractures in our hospital, and could be reported that makes operation plan and operation approach easier than conventional facial CT.
Diagnosis* ; Facial Injuries ; Mandible* ; Mandibular Nerve ; Physical Examination ; Tomography, X-Ray Computed*

It is well known that crow's feet are caused by hyperkinetic facial muscles. Recently, rejuvenation in this area has been improved enormously by radical approach and various combined adjuvant surgery. And many articles regarding with the various applicable treatment modalities are published every year. Actually, there are various types of crow's feet, but treatment method of crow's feet doesn't have to be different according to their types. Therefore, we tried to analyze the pattern of crow's feet among Korean people and classified them by age and sex. Total of 256 volunteer people were inspected and photographed. We took pictures of oblique view of periorbital area showing primary gaze and smiling feature. Pictures which show poor quality or any disagreement of opinions from three plastic surgeons were excluded. Finally, 160 pictures were collected and classified. The crow's feet lines were classified as four patterns; i.e., central upper, central, central lower and combined pattern. The "central upper pattern" is shown among those with wrinkle lines only in the upper eyelid skin down to the lateral canthus. The "central pattern" is categorized in those who exibit wrinkles only in the lateral canthal area, and the "central-lower pattern" is recognized to have wrinkling on the lower lid and upper cheek area. The "combined pattern" is defined as patients exhibiting crinkling of their lateral canthal skin from the lower lateral brow across the upper eyelid, through the lateral canthus, and across the lower eyelid, upper cheek junction with horizontal and perpendicular wrinkles crossing over. In this study, the most common pattern of the wrinkle pattern was the combined type. In thirties and fourties, central- lower pattern was more common in men. In women, the type of central and central-upper pattern showed nearly equal frequency. However, over the age of 50-year's, combined pattern was common in both sex. For maintenance of a long-lasting and natural outcome we should recognize the diversity of facial expression among indivisuals and render the treatment accordingly. This observations could also be applied to the injection technique of botulinum toxin for the facial rejuvenation.
Botulinum Toxins ; Cheek ; Crossing Over, Genetic ; Eyelids ; Facial Expression ; Facial Muscles ; Female ; Foot* ; Humans ; Male ; Rejuvenation ; Skin ; Smiling ; Volunteers

The materials used in rhinoplasty can be divided into autogenous and alloplastic one. The advantages of autogenous materials such as bone, cartilage, dermofat are no postoperative rejection and good adaptation. They are also economical. But they are often limited in harvesting which entails additional morbidity. Many synthetic materials have been introduced in rhinoplasty. Silicone is popular material for augumentation, but that has disadvantage, such as infection, protrusion, foreign body reaction and showing. Porous high density polyethylene implant (Medpor(R)) present an alternative to autogenous material as they allow of fibrovascular ingrowth, leading to stability of the implant and decreased rates of infection. We reviewed the data from 10 consecutive patients with foreign body injection on the nose who were operated in Dong-A University Hospital from May 2001 to July 2003. Our application is that the necessity of enough rigidity to provide structural support and enough volume to provide augumentation. Patient follow-up ranged from 1 month to 2 years. We can achieve 7 good satisfaction patients and 3 fair satisfaction patients. No complications were reported, such as infection, secondary deformity and exposure of implants. Medpor(R) is useful in corrective rhinoplasty, especially in the cases with foreign body injection, because it can provide structural support and augumentation with enough rigidity.
Cartilage ; Coinfection ; Congenital Abnormalities ; Follow-Up Studies ; Foreign Bodies* ; Foreign-Body Reaction ; Humans ; Nose ; Polyethylene* ; Rhinoplasty* ; Silicones